From Public Health Science to Prevention Policy: Placing Science in Its Social and Political Contexts

Harvard University, Cambridge, Massachusetts, United States
American Journal of Public Health (Impact Factor: 4.55). 11/1997; 87(10):1603-6. DOI: 10.2105/AJPH.87.10.1603
Source: PubMed

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    • "In step 1 policy makers (legislators) define a public health problem in terms of its relevance to their political ideology and public opinion [15,30-32,53,93]; practitioners define the same public health problem in terms of its relevance to perceived needs and demands of individuals, epidemiological findings, and products agreements [75,80]; and researchers define the same public health problem in terms of its relevance to theory, existing body of knowledge, and interests of the investigator [59,81,87]. The starting points are different as social, practical and scientific relevance do not automatically overlap [4,14,15,30,32,34,92,94,95], but species do not exploit each other and can search for a new equilibrium. Besides, the decision to start the policy cycle is made by a small number of city councillors who together decide to put a subject on the policy agenda [32]. "
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    ABSTRACT: Public health includes policy, practice and research but to sufficiently connect academic research, practice and public health policy appears to be difficult. Collaboration between policy, practice and research is imperative to obtaining more solid evidence in public health. However, the three domains do not easily work together because they emanate from three more or less independent 'niches'.Work cycles of each niche have the same successive steps: problem recognition, approach formulation, implementation, and evaluation, but are differently worked out. So far, the research has focused on agenda-setting which belongs to the first step, as expressed by Kingdon, and on the use of academic knowledge in policy makers' decision-making processes which belongs to the fourth step, as elaborated by Weiss. In addition, there are more steps in the policy-making process where exchange is needed. A qualitative descriptive research was conducted by literature search. We analyzed the four steps of the policy, practice and research work cycles. Next, we interpreted the main conflicting aspects as disconnections for each step. There are some conspicuous differences that strengthen the niche character of each domain and hamper integration and collaboration. Disconnections ranged from formulating priorities in problem statements to power roles, appraisal of evidence, work attitudes, work pace, transparency of goals, evaluation and continuation strategies and public accountability. Creating awareness of these disconnections may result in more compatibility between researchers, policy makers and practitioners. We provide an analysis that can be used by public health services-related researchers, practitioners and policy makers to be aware of the risk for disconnections. A synthesis of the social, practical and scientific relevance of public health problems should be the starting point for a dialogue that seeks to establish a joint approach. To overcome the above mentioned disconnections, face-to-face encounters consistently emerge as the most efficient way to transfer knowledge, achieve higher quality and acknowledge mutual dependence. We recommend practice and policy based research networks to establish strong links between researchers, policy makers and practitioners to improve public health.
    Health Research Policy and Systems 12/2010; 8(1):37. DOI:10.1186/1478-4505-8-37 · 1.86 Impact Factor
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    • "In addition, those researchers concerned with making systematic reviews more relevant to policy makers have proposed even broader approaches to the process of synthesizing evidence (Atwood et al. 1997; Lomas, et al. 2005; Mays et al. 2005; Pawson et al. 2005), highlighting disparities in how researchers and policy makers define and describe evidence. Reducing obesity in children: a synthesis A recently-published synthesis research study, which has moved beyond the traditional approach of systematic reviews, provides a starting point on which to begin making judgments on best practices in population health (Flynn et al. 2006 "
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    ABSTRACT: Childhood obesity has reached a crisis stage and has become a population health issue. The few traditional systematic reviews that have been done to identify best practice provide little direction for action. The concept of evidence-based practice has been adopted in health care, and in medicine in particular, to determine best practice. Evidence-based medicine has its origins in the scientific method and for many researchers this concept means strict adherence to standards determining internal validity in order to justify a practice as evidence based. Practitioners addressing population health face challenges in identifying criteria for determining evidence, in part because of the nature of population health with its goal of shifting the health of whole populations. As well, the type of evidence provided by more traditional critical appraisal schema is limiting. Expanded approaches in finding and defining evidence have been proposed that use: expert panels; broad and inclusive search and selection strategies; appraisal criteria that incorporate context and generalizability. A recent synthesis of 147 programmes addressing childhood overweight and obesity provides a concrete example of using a broader approach to identify evidence for best practice (Flynn et al. 2006). Incorporating evaluation and population health frameworks as criterion components in addition to traditional methodological rigour criteria, this synthesis has identified programmes that provide contextual information that can be used to populate what Swinburn et al. (2005) have described as the 'promise table'. Using this approach a range in 'certainty of effectiveness' and a range in 'potential for population impact' are integrated to identify promising strategies. The exercise can provide direction for agencies and practitioners in taking action to address obesity.
    Proceedings of The Nutrition Society 12/2006; 65(4):403-11. DOI:10.1079/PNS2006520 · 5.27 Impact Factor
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    • "Health educators are frequently implored to contact policy makers (Atwood et al., 1997; Christoffel, 2000; Goodhart, 1999; Johnson, 2001; Ward & Koontz, 1999). "
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    ABSTRACT: Advocacy for the public's health and for the profession are widely recognized as responsibilities of health educators. Increasing emphasis on advocacy by professional organizations has peaked the interest of health educators, yet knowing where to begin as an advocate is, to many, a mystifying process. This article provides basic advocacy terminology, dispels concerns about participating in advocacy activities, and provides a practical and stepped approach to becoming an effective advocate. A tiered approach is used in relation to the advocacy strategies of voting behavior, electioneering, direct lobbying, grassroots lobbying, Internet use, and media advocacy to help individuals in their quest to begin or enhance their engagement in advocacy. A compendium of highly accessible resources is also provided. Finally, this article provides motivation for the beginning advocate.
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