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May 12, 2013

The Challenge of Producing Worthy Evidence

“What do we want? Evidence-based change. When do we want it? After peer review.”   

This sentiment, written on a recent rally placard posted on Facebook, states clearly one of the challenges we face in public health, a challenge highlighted in the Institute of Medicine’s report, For the Public’s Health: Investing in a Healthier Future. The IOM report stresses the need for public health to gather evidence on the effectiveness of population-based interventions and to relate intervention effectiveness and impact to expense. In effect, we in public health need to make comparative effectiveness research and evaluation a routine component of program operations. Building public health system-wide capability to generate such data must be in our near-term future and, I believe, will become an informatics focus soon.
 
Reflecting on how to accomplish the goals, confronts us with the sentiment expressed on the placard. Academic careers are made by publishing. Producing comparative effectiveness results from using valid data in a well constructed and thoughtful analysis. It’s not a simple exercise in reusing data gathered in the course of program operations. Thoughtful research analysis is required. In addition to being a requirement for respected publishing, peer review offers all of us the reassurance that at least a few persons well versed in the topic have given substantial thought to the issue at hand and recommended that the work be published for broader consumption. 
 
As public health faces tighter budgets and is pressed to show evidence of program effectiveness, and possibly even that we are promoting the most cost-effective interventions among those shown to be effective, we must somehow accelerate the evidence production life cycle. Accelerating the life cycle for data capture and analysis is where informatics must step up to the plate. We need to use our information systems to support program work in the most useful ways possible, while also assuring that data needed for comparative research analysis is made available and useful as fast as possible. Future investments in the power of prevention ride on meeting this challenge.
 

David A. Ross, ScD

President/CEO of the Task Force for Global Health, former director of PHII