In public health, we are trying to make a difference with limited resources. In forming the scientific basis for our work, we have a great body of evidence on what causes diseases, such as the link between smoking and lung cancer, physical inactivity and heart disease, or lack of mammography screening and breast cancer mortality. These kinds of relationships have been studied very well (known as etiologic research). We also have sound data on defining where health problems exist, and where health disparities are present.
We do a less adequate job in knowing which interventions work for the whole population, which interventions make a difference for populations facing inequalities, and how to disseminate and translate those interventions into real world public health practice. In many cases, the public health problems are big enough that we are not going to sit and wait for years for the evidence to accumulate. We are going to do something based on the best evidence we have available. This can be difficult in weighing the choice between action based on imperfect evidence and inaction while waiting for the best possible evidence. When agencies conduct practice-based research they contribute to the body literature on effective interventions that can help inform future generations.
Evidence-practice needs to put more attention on dissemination research—what some call the “black box” that sits between the generation of new knowledge and its widespread use. It is likely that more than 90% of the US national research budget for health is spent on the discovery of new knowledge. But publishing this new knowledge in top-tier journals is not enough to improve practice. We need creative ways to reach various audiences so the evidence to improve public health can be put to better use.
Many of the challenges in moving research to practice relate to the competency of the public health workforce. For example, a public health nurse is likely to have had less training in how to locate the most current evidence and interpret alternatives than an epidemiologist. A recently graduated health educator with an MPH is more likely to have gained an understanding of the importance of evidence-based practice than an environmental health specialist holding a bachelors degree. Probably fewer than half of public health workers have any formal training in a public health discipline such as epidemiology or health education. An even smaller percentage of these professionals have formal graduate training from a school of public health or other public health program. This is where the training modules in EBBP.ORG can be useful. These modules can help one in choosing interventions that are effective and also learning how to evaluate and disseminate those that are not yet proven.