The Art

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The Art Science of Evidence-based
Decision-making

• Epidemiology Can Help!!

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Purpose of this Presentation

• Explain how the use of epidemiology can
• enhance evidence-based decisions in public
• health.
• Emphasize the importance of training in
• epidemiological methods.

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Early quests to

• Find the causes of disease
• Control epidemics

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Epidemiology is

• The study of the distribution and determinants
  of health-related states or events in specified
  populations, and the application of this study to
  the control of health problems.
• (J. Last)

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Its elementary my dear Watson!

• or is it?

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Scenario 1A - Report from a Public Health
Laboratory

• 75 increase in HIV-positive cases
• Recommendation expand HIV/AIDS program(funds
  moved from the Tobacco Control Program)

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Scenario 1B - Report from a Public Health
Laboratory

• increase number of new cases 75
• 1999 2000 new HIV-positive cases 4 7
• Population 25,200 43,700
• Rate/100,000 16 16 increase in rates
  0Recommendation maintain current level of
  effort

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Scenario 2A - Do We Need Organized Cervical
Cancer Screening Programs?

• Conclusion No

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Scenario 2B - Do We Need Organized Cervical
Cancer Screening Programs?

• Results of Further Analysis
• Could eliminate cervical cancer as a cause of
  death
• Pap test is effective, acceptable and
  cost-efficient
• Subgroups less likely to get Pap smears
• Incidence in Aboriginal women is 10 times higher
• Educational outreach works
• Better information systems provide timely
  information
• Organized screening and effective management of
  early stage cases can prevent 90 of invasive
  cervical cancer.
• Recommendation Organized community and
  provincial screening programs

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Scenario 3A - Adolescent Suicide Prevention

• Three adolescent suicides in the last three
  months
• Suicide rates increasing in the 15 to 19-year-old
  age group
• Should we use a specific high school curriculum
  suicide prevention program?
• Recommendation Begin the program in six weeks

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Scenario 3B - Adolescent Suicide Prevention

• Further analysis
• Limitations and details of suicide data
• Systematic review and evaluation of curriculum
  programs
• Recommendation Develop a comprehensive
  multi-strategy suicide prevention initiative

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Scenario 4A - Physical Activity and Obesity

• Is it worthwhile to promote physical activity
  specifically among men and women who are
  overweight?Review of large study in Texas
• Recommendation Not enough evidence to recommend
  resources at this time

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Scenario 4B - Physical Activity and Obesity

• Using Epidemiology to Assess Cause and Effect
• Strength of association
• Dose response
• Biological plausibility
• Coherence
• Effectiveness of interventions
• Recommendation Allocate more funds to promote
  physical activity tailored for overweight people

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What Competencies in Epidemiology Do We Need?

• Core competencies among all public health
  professionals
• Specialized skills (e.g., epidemiologists, health
  analysts, advisors)

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Core Competencies for All Public Health
Practitioners

• Understand basic research methods and
  surveillance
• Access data and scientific evidence
• Carry out program evaluations
• Critically appraise the literature
• Assess population health status and the
  determinants of health and illness
• Present health information
• Attach meaning to data

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Local Capacity Requirements

• Train in core competencies for all professional
  staff (and decision-makers)
• Access to specialists
• Other support as required

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What Support Do We Need to Increase Our Use of
the Epidemiological Approach?

• Management support
• Technology support

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Management Support for an Epidemiological
Approach

• Provide support to increase use of epidemiology
• Upgrade and strengthen staff skills
• Include epidemiological capacity in accreditation
  standards and job descriptions
• Collaborate with universities and colleges
• Support professional networking
• Recruit and retain staff with expertise
• Recruit content facilitators

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Technological Support for an Epidemiological
Approach

• Computer and internet access
• Easy access to appropriate software
• Commitment to high quality data collection and
  timely reporting

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Data Sources

• Existing data (e.g., census, registries,
  treatment statistics)
• New data (e.g., focus groups, population health
  surveys, mapping)
• Weigh the pros and cons of different measures

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Missing the Obvious
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The Final Challenge

• Partnerships for Informed Decision-Making
• Epidemiology specialists, program managers,
  decision-makers and public health staff
• Public health practitioners and the community.

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The Skills Enhancement for Health Surveillance
Program

• An initiative within the Public Health Agency of
  Canadas Centre for Surveillance Coordination
• Internet based training for public health
  practitioners across Canada
• Self-paced modules in both official languages
• Relevant, practical content
• Modules available
• Basic Epidemiological Concepts
• Measurement of Health Status
• Descriptive Epidemiological Methods
• Orientation to online learning

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Acknowledgements

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Thank You!

• For more information
• health_surveillance_at_phac-aspc.gc.ca
• www.healthsurv.net/skills

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Population Health

• Address determinants of health
• Base decisions on evidence
• Invest in root causes
• Apply multiple strategies
• Is collaborative
• Engage the public
• Health outcomes
• Source HEALTH CANADA