[Evidence-based public health. Prevention and health promotion in the context of science, values and (vested) interests]

Abstract

Background and purpose: Public health aims at prevention and health promotion at the level of populations. Like in medicine, public health interventions should be based on the best available evidence. A coherent model for evidence-based public health (EBPH) is missing so far. This paper aims at developing a conceptual as well as operational model for EBPH.

Methods and results: Based on the concept of evidence-based medicine (EBM) a model of EBPH was developed that takes the specific situation of public health into account: (1) nonmedical aspects, e.g. ethical, sociocultural, or organizational aspects, are often more relevant in EBPH than in EBM. 2) Criteria for decision-making at population level are often different from those employed at the individual level. (3) Values and (vested) interests affect not only the decision itself but the whole process of decision-making, including the generation of the evidence.

Conclusion: A comprehensive model of EBPH that takes the aspects described above into account allows for the analysis of the interplay between decision-making and evidence in the complex reality of public health. This is illustrated using the introduction of the vaccination against human papillomavirus as an example.