Using natural experimental studies to guide public health action: turning the evidence-based medicine paradigm on its head.
Gregg, Edward W
Siegel, Karen R
Journal of epidemiology and community health
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Ogilvie, D., Adams, J., Bauman, A., Gregg, E. W., Panter, J., Siegel, K. R., Wareham, N., & et al. (2020). Using natural experimental studies to guide public health action: turning the evidence-based medicine paradigm on its head.. Journal of epidemiology and community health, 74 (2), 203-208. https://doi.org/10.1136/jech-2019-213085
ABSTRACT Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population- and system-wide approaches that generate and sustain healthier behaviours. Population health interventions are often implemented as natural experiments, which makes their evaluation more complex and unpredictable than a typical randomised controlled trial (RCT). We discuss the growing importance of evaluating natural experiments, and their distinctive contribution to the evidence for public health policy. We contrast the established evidence-based practice pathway, in which RCTs generate ‘definitive’ evidence for particular interventions, with a practice-based evidence pathway in which evaluation can help adjust the compass bearing of existing policy. We propose that intervention studies should focus on reducing critical uncertainties, that non-randomised study designs should be embraced rather than tolerated, and that a more nuanced approach to appraising the utility of diverse types of evidence is required. The complex evidence needed to guide public health action is not necessarily the same as that which is needed to provide an unbiased effect size estimate. The practice-based evidence pathway is neither inferior, nor merely the best available when all else fails. It is often the only way to generate meaningful evidence to address critical questions about investing in population health interventions.
Humans, Health Behavior, Public Health, Cultural Characteristics, Evidence-Based Practice, Public Health Systems Research, Population Health, Population Health Management
DO, JP and NW are supported by the Medical Research Council (Unit Programme numbers MC_UU_12015/6 and MC_UU_12015/1). The paper was initially developed in the course of a visiting appointment as Thought Leader in Residence at the School of Public Health at the University of Sydney, for which the intellectual environment and financial support provided by the Prevention Research Collaboration is gratefully acknowledged. It was further developed under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence at the University of Cambridge, for which funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and the Wellcome Trust, under the auspices of the United Kingdom Clinical Research Collaboration, is gratefully acknowledged
Wellcome Trust (087636/Z/08/Z)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0616-10019)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
External DOI: https://doi.org/10.1136/jech-2019-213085
This record's URL: https://www.repository.cam.ac.uk/handle/1810/298691
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