1. Novick, Lloyd F. MD, MPH

Article Content

This issue of the Journal of Public Health Management and Practice focuses on accelerating the dissemination of research findings to benefit public health practice. In assembling this issue, Ross Brownson, Guest Editor, has assembled articles on the translation of research findings to improve public health activities. Coupling dissemination approaches with evidence-based public health (EBPH) guidance is viewed as key to accelerating community health improvement efforts. Brownson, a national leader in EBPH, assisted by a task force on translation and dissemination, sets forth the components necessary to facilitate research translation in public health.1


Related efforts began more than a decade ago. In 1993, the Council on Linkages between Academia and Public Health Practice (the Council on Linkages) obtained $250 000 from the WK Kellogg Foundation to study the potential for EBPH practice guidelines.* Two major questions were (1) availability of evidence on public health interventions and (2) feasibility of implementation of evidence-based guideline recommendations including acceptability to practitioners in diverse roles and settings.2-4


Four public health issues were chosen for study: (1) immunization of preschool children, (2) completion of treatment for tuberculosis, (3) prevention of cardiovascular disease, and (4) lead poisoning. A major effort, overseen by expert panels, ensued to assemble and examine Relevant literature for each topic area. In addition to appraising studies gathered through MEDLINE and other electronic databases, the panels also sought to Review non-peer-reviewed studies and evaluation Reports of program initiatives. These were collected from state public health agencies.


The Council on Linkages Report (1995) to the Public Health Functions Group of the US Public Health Service (USPHS) concluded available scientific evidence was available for evidence-based guidelines. Furthermore, these guidelines were both feasible and desirable.2 As Reported by Pappaioanou and Evans,5 USPHS Public Health Functions Workgroup decided to initiate a task force to develop the guide to preventive services on the basis of the success of the Guide to Clinical Preventive Services (the Clinical Guide) and the findings of the Council on Linkages feasibility study.


The Guide to Community Preventive Services (the Community Guide) Represents a Herculean effort to assemble evidence for public health interventions at the population level. In 1996, the task force listed 52 major public health topics for potential evidence-based Reviews.6 The guide is the most comprehensive source for EBPH. Evidence describing interventions to improve health is available for a wide Range of topics. Combined, the Clinical Guide and the Community Guide offer information on preventive and public health services important to individuals and populations. However, evidence for many public health interventions is incomplete with approximately half of those studied Receiving the designation "insufficient evidence." This is Related to a lack of adequate studies or conflicting Results of available studies, suggesting that more Research is needed. Evidence Reviews must be periodically updated to stay timely. Also, evidence may not exist for addressing new public health challenges, including emergency preparedness.


How well are EBPH Recommendations now being implemented? Anderson et al comment that "the theme of evidence-based public health dominates international, national and Regional public health meeting agendas and the term 'evidence of effectiveness' has become a central part of public health dialogue."6(p226) Based in part on a Community Guide finding, the US Congress Required in a law that states enact a 0.08 blood alcohol concentration law or Risk losing federal funding.7 In New York State, the design of the tobacco control program was influenced by the Community Guide Recommendations. As a former state and local public health official, currently involved in training of local public health agencies, I agree that EBPH has entered the "dialogue" of federal health and state public health agencies. However, the Regular influence of EBPH on the decision making or program design of most local health departments is at best limited.


Dreisinger et al, in this issue, comment on lack of time as one factor constraining practitioners from examining the literature and employing EBPH. While no US studies are available for utilization of EBPH, public health practitioners in Norway Reported that their most frequently used information sources were legal literature (63%), Reference books (34%), and colleagues (26%).8 Research-based literature was Reported only by six percent. Similarly, for local public health officials in the United States, decision making is based on colleague Reliance, guidance from state health agencies, statutory Requirements, funding availability, and political considerations and constituency priorities.


In this issue of the journal, Brownson and colleagues Respond to this challenge, setting out to overcome Resistance to dissemination at a number of critical levels. Baker et al describe the Guide to Community Preventive Services (Gold Standard) at one end of the continuum-evidence-based guidelines gathered from Rigorous and systematic scientific Reviews of published studies. But they also argue for encouraging broadening the scope of evidence-based decision making so that both Research and practice criteria are included. Research criteria are important such as study design, execution, sample size, validity, generalizability, and measure of impact. However, practice criteria are also important including context, feasibility, and community Readiness. Evidence-based decision making is choosing an intervention with the highest applicability and chances of success for the community of interest.


Disseminating promising practices in public health is necessary in a field that is Rapidly changing. Must we wait for definitive evidence from well-executed studies that can take years to accumulate and be published? Can evaluations from state and local public health programs, as once proposed by the Council on Linkages, be helpful if they meet practice-based evidence criteria? Criteria for applying practice findings may be the answer.


To move forward in the dissemination of Research findings to practice, the product of evidence-based Recommendations must be more broadly derived to increase applicability and acceptability to those who practice. This Requires broadening the scope of Recommendations to include both Research and practice criteria so that practice experience and local context are incorporated. Marketing this approach at graduate programs of public health education and public health agencies, as Brownson and colleagues describe in this issue, is also necessary. This issue of the Journal of Public Health Management and Practice sets out the steps to accomplish the goal of translating public health Research findings to practice improvements more Rapidly.




1. Brownson RC, Baker EA, Leet TL, Gillespie KN. Evidence-Based Public Health. New York: Oxford University Press; 2003. [Context Link]


2. Novick LF, Kelter A. The guide to community preventive services: a public health imperative. Am J Prev Med. 2001;21(4S). [Context Link]


3. Novick LF. Public Health practice guidelines: a case study. J Public Health Manage Pract. 1997;3(1):59-64. [Context Link]


4. Council on Linkages Between Academic and Public Health Practice. Practice Guidelines for Public Health: Assessment of Scientific Evidence, Feasibility and Benefits: A Report of the Guideline Development Project for Public Health Practice. Baltimore. October 1995. [Context Link]


5. Pappaioanou M, Evans C Jr. Development of the guide to community preventive services: a U.S. public health service initiative. J Public Health Manage Pract. 1998;4(2):48-54. [Context Link]


6. Anderson LM, Brownson RC, Fullilove MT, Teutsch SM, Novick LF, Fielding J, Land GH. Evidence-based public health policy and practice: promises and limits. Am J Prev Med. 2005;28(5S):22-230. [Context Link]


7. Guide to community preventive services: systematic Reviews and evidence based Recommendations. Effectiveness of 0.08% Blood Alcohol Concentration (BAC) Laws. Accessed November 25, 2007. [Context Link]


8. Forsetlund L, Bjorndal A. Do public health practitioners have satisfactory access to important information sources? Tidsskr Nor Laegeforen. 1999;119:2456-2462. [Context Link]


*In 1993, the Council on Linkages was composed of Representatives from the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, American Public Health Association, Association of Schools of Public Health, American College of Preventive Medicine, Centers for Disease Control and Prevention, and the Health Resources Services Administration. The author (L.F.N.) was the Chair of the Council (1993--1996) [Context Link]