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Public health leadership series: Data as an enabler

katinadonise



It is well accepted that data should form a basis for decision making in public health. Data can identify the root cause of risk or protective factors, can identify when and where new issues emerge and can test interventions for effectiveness. A critical skill for public health leaders is to understand what data to use, when to use data, how to use it and how to generate new data with the purpose of implementing change.


A good example of a strategic approach to using data is best practice research translation. There is a well-known gap between when evidence is generated for change and when change is actually implemented. This research translation gap is often decades long in public health. While this gap can be for political, capacity, or financial reasons, for example, it can also be because there has not been explicit consideration of best practice research translation. This approach considers the decision makers and other key stakeholders. What information might best motivate them, what are their key restraints? Once these are understood, then the available data/evidence can be mapped to understand if there are gaps with regards to what will motivate decision makers, so they can be filled. This might be a missing piece of information from a data perspective, a missing tool, insufficient stakeholder engagement or other barrier that can be overcome with adaptation.


Systematic reviews of the literature to understand what the literature can tell you about an intervention is a fundamental public health leadership skill. This takes a systematic but nuanced approach to the literature, appraising the quality of evidence as well as the relevance to the population you are working with. The most important aspects for public health interventions are that the search is unbiased and systematic, identifying all relevant papers for inclusion and the findings of higher quality studies are given a greater weight than those of lower quality. This avoids the trap of finding and citing papers to support our own world view, rather than understanding what the literature can tell us and considering that alongside other considerations such as feasibility and acceptability in our own communities for the intervention.   


Gaps in the available evidence for public health action are commonplace, and it is rare to have the opportunity of intervention trials with a low risk of bias to guide our work. Given this, public health should look to different techniques to appraise the existing literature. A technique I commonly use is triangulation. When we are using observational data as the basis for a possible intervention, we can form a view as to the strength of that available data through considering different study designs, using different disciplinary knowledges or evidence for effectiveness of the intervention in different populations. If there is consistency in the findings across this multiple lens view of the data, there can be more confidence that the intervention may be effective when applied at the population level. 


Another approach is to consider the theoretical frameworks that underpin public health interventions. The timeless guidance of the Ottawa Charter provides a framework for considering change at the population level. We can have confidence in this approach as it has been successful in important public health interventions such as tobacco control and road injury prevention. This is particularly important with the actions needed for our biggest challenges, for example, to reduce consumption of low nutrition, high caloric density foods. There is a relatively limited literature on effective interventions at the population level to achieve this, however we know there needs to be multi-facetted interventions to shift consumption away from discretionary foods to nutritious whole foods. This would include interventions not limited to advertising, pricing, availability, accessibility, education, and labelling. It is important then to not wait for the best evidence published in a paper to take public health action, when we have sufficient evidence from other public health issues.


Much of this skill requires training in epidemiology, but also a strong understanding of health promotion, key pillars to high quality public health leadership.


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