Health Affairs, 25, no. 4 (2006): 968 doi: 10.1377/hlthaff.25.4.968 © 2006 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

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Evidence & Information

PROLOGUE

Evidence And Information In Public Health

But public health entails a broad universe of social, environmental, biomedical, and economic inputs that are challenging to define and measure. In many instances, the small scale of local decision making makes data mining harder, not easier, because the statistical virtues of large numbers do not apply. As the following discussion by Jonathan Fielding and Peter Briss rightly emphasizes, effective public health leadership requires "integrating science-based interventions with community preferences." Where they occur, the successes of evidence-based policy are compelling. Spurred by research findings and federal incentives, all fifty states have adopted reduced blood-alcohol thresholds in their drunken-driving laws, for example, which are now believed to be saving hundreds of lives every year. In Los Angeles, Fielding and Briss report, local health officials increasingly ground their strategic thinking in consultation with environmental, housing, and education colleagues. But research is not a panacea when preferences and predispositions obtrude. Despite poor showings in well-designed studies, they note, many school systems cling to politically popular drug abuse education programs.

At the nitty-gritty level of the local health department, the challenge for evidence-based policy begins with the elemental task of data gathering, according to a paper by Jeff Luck and colleagues. When the right data are available, they find, dramatic successes have been achieved in local public health initiatives. But many opportunities are lost because of the difficulty of amalgamating information in complex and often contentious local environments. Existing data sources often fail to produce the requisite community-by-community breakdowns. The job of getting local institutions to cooperate in data-gathering enterprises might run afoul of the players’ territorial impulses. Privacy concerns and the underdeveloped state of the U.S. electronic health information infrastructure represent additional obstacles, these authors warn. The Information Age offers a golden opportunity for the public health sector to fulfill its potential for improving life and health, but success is not guaranteed.

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