Professor Mike Kelly, PhD, FFPH. Director, The Centre for Public Health Excellence, NICE
The Health Development Agency’s approach to evidence Professor Mike Kelly.
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Transcript of The Health Development Agency’s approach to evidence Professor Mike Kelly.
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The Health Development Agency’s approach to
evidence
Professor Mike Kelly
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The rise of the evidence based approach in Britain
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Cochrane, A.L.(1972)
• Effectiveness and Efficiency: Random Reflections on Health Services, British Medical Journal/Nuffield Provincial Hospitals Trust, London.
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Archie Cochrane’s Principles
• The best care available to all- universalism
• The need for a means to determine what was best-rationality
• The importance of rooting out harmful or useless practice-compassion
• The necessity of ascertaining costs and benefits-accountability
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The legacy
• The importance of the randomised control trial
• Clinical resistance
• Health economics
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The legacy
• The Cochrane and Campbell Collaborations
• The importance of the systematic review and meta analysis
• NHS Centre for Reviews and Dissemination
• Health Evidence Bulletins Wales• The Health Development Agency
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The inequalities conundrum
• The unintended consequences of health policy and health delivery
• Regressive population health
• Widening inequalities
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HDA Remit to support work on reducing inequalities
• What is effective?
• What is ineffective?
• What is harmful or dangerous?
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Application of similar evidence based principles in public
health
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Key problems
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• Lack of evidence of what works (less than 0.4% of studies)
• Lack of cost effectiveness data
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The evidence about upstream and downstream
interventions
• Bulk of the evidence about downstream interventions
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Biological variation and social variation
• Social differences in the population
• Different dimensions of social difference
• Differential responses to interventions
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When should effectiveness be measured?
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Starting Point for the HDA
• to synthesise review level work in public health priority areas
• to bring in other forms of scientific evidence
• to bring evidence and practice together to target public health priorities and get the evidence into action
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• Teenage pregnancy• HIV/AIDS• STIs• Smoking• Alcohol• Drugs• Obesity• Low birth weight• Breastfeeding• Housing• Qualitative evidence• Definitions of
inequalities
• Social support in pregnancy
• Physical activity• Mental health• Accidental injury• Depression • Health Impact
Assessment• Transport• Child poverty• Health Impact
Assessment• Gradients and gaps
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Evidence Briefings• Strengths and weaknesses of the evidence
• Identification of gaps
• Implications for practice and policy
• Recommendations for future research
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• Comprehensive,systematic up to date map of the evidence
• Passive resource
• Baseline resource from which other products can be developed
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Evidence Reviews
• Broader approach to data and evidence
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Epistemological and related
problems
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Biases
Biases of method (the dominance of the RCT)
Compounding biases (errors repeated)
Content biases (some problems not investigated)
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Practical problems
• Evidence synthesis of qualitative and quantitative information
• Threshold standards
• Academic hostility
• Practitioner hostility
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What the evidence does not tell you
• How to do it
• Process data
• Implementation problems
• Local infrastructures
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Two different aspects of how things work
• Plausibility: a scientific assessment – biologically, organizationally, socially, psychologically.
• Likelihood of success: the nature of local conditions married to tacit knowledge of practitioners
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Thinking beyond the evidence
• The evidence as a framework of plausible possibilities
• The evidence as a starting point for intervention not an imperative or a recipe
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Developing Guidance and Resources: A new form of
synthesis• Involving the practitioners
• Establishment of Evidence and Guidance Collaborating Centres
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Permissions and facilitations
• For practitioners to think creatively beyond the evidence
• For researchers to take responsibility for their evidence
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Muted voices
• Dominant discourses of evidence
• Qualitative methods of data elicitation
• Access to tacit knowledge
• Access to life worlds
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Conclusion
• Embracing a range of evidence and learning
• Evidence from traditional research
• Evidence from practice
• Evidence into practice and policy
• Practice into evidence