The evidence debate

Abstract

T his issue presents an excellent arti-cle from Australia addressing the criteria for evaluating evidence for public health interventions. 1 This article should be read within the context of the evidence debate that occupied the last decade of the 20th century and contin-ues into the present. The origins of this debate are found in a clinical medicine that sought to establish a dialogue on evidence-based medicine. 2 Gradually this debate has been extended to public health, health promotion and community-based public health inter-ventions. The assumption of many in public health is that this is an important, vital debate, that is necessary to demon-strate what constitutes evidence and therefore proof that public health inter-ventions are effective. The application of evidence criteria has taken much public health evaluation down a path implying scientific rigor. Evidence as a topic may be debatable, but arguably most public health practitioners feel a strong need to either justify their actions or demon-strate to others that their field of application is one with tangible benefits to the public. 3 Still, there are many, particularly in health promotion who believe that " evidence " , the very word, is inappropriate in evaluating much of public health practice. What is most useful about the evi-dence debate is how it has served to broaden the discussion on evaluation of community-based public health inter-ventions. Today, perhaps more than ever, public health practitioners are aware of the social and cultural context in which they carry out their work. This aware-ness applies at all levels of society. At the local level we are sensitised to local needs and public understandings of health. At the global level we recognise the incredible diversity of nations in terms of economic development and cultural beliefs. Despite this accepted awareness of the great diversity in populations, some may still hold the belief that the evidence discussion is not affected by the contextual diversity.