Evidence-Based Decision Making at Local Health Departments: Q&A with Ross Brownson
The last session of the Keeneland Conference focused on translation and dissemination of public health systems and services research, with the critical goal of more efficient and effective delivery of public health services and improving population health. NewPublicHealth spoke with Ross Brownson, PhD, of the Prevention Research Center at Washington University in St. Louis. Dr. Brownson has received funding from the Robert Wood Johnson Foundation to explore evidence-based decision making at local health departments.
NewPublicHealth: How far back does evidence-based public health go?
Ross Brownson: The formal underpinnings of evidence-based public health were developed in the late 1990s, so at least the formal literature has been around for probably about 15 years. Of course, research on effective interventions has been around for many more decades. The newer field of public health services and systems research is much newer, just within the last five years or so, and these different bodies of research are now converging.
The early research focused a lot on identifying evidence-based interventions. The newer research is more on the process of evidence-based public health—regardless of the intervention, how do you develop and implement an evidence-based health department?
We identified five domains that are really important:
- leadership of the agency;
- ability to develop, formalize and maintain good partnerships within the community;
- workforce training and development;
- focus on organizational climate and culture; and
- effective financial and budgeting processes.
The ultimate goal is to make the population healthier and we know that the way to improve the overall health of the public is largely through state and local governmental public health. To reach that ultimate goal you want to have the most effective health department possible and also make the most efficient use of resources. We’re always in a time of tight resources, but probably now more than ever. That calls on us to be as effective and efficient as we can be in the delivery of public health services.
NPH: How will you disseminate these best practices and this evidence base to state and local public health officials?
Ross Brownson: We’ve done studies with leading public health researchers and we asked them the most effective way to disseminate findings to public health practices and state and local health departments, and 90 to 95 percent of the time what they say is through journal articles. But we’ve also surveyed leaders in local health departments and found that only about a third of them regularly read scientific journals. So, there’s a big mismatch between what researchers think is the best way to reach health department directors and how they get their information. So what we need are some new methods of dissemination and we don’t know what all those are yet. We’re still trying to learn more about those, but I think social media is one—Twitter, Facebook. And we need other, nontraditional ways of getting the word out.
I think taking research and making brief, short summaries that people can read quickly that will link them to the larger article could be useful. And I think having opinion leaders, such as local health department leaders, get the word out is also important.
And for those who want to get the scientific literature, a large barrier is often that they have to pay to get the article, and so we need better ways to offer access to the scientific literature, and one way is Frontiers in PHSSR, the new free, online journal launched by the Coordinating Center for PHSSR last year.
Another strong example is the Annual Review of Public Health, which is published once a year.
They publish state-of-the-art reviews in public health, and we’ve entered into an agreement with Frontiers where we’ll take an Annual Review of Public Health article, create a short synopsis of it and publish it online in Frontiers. Then the readers of the Frontiers article can link to the Annual Review article and get a free copy of the full review paper without having to go to the library, without having to pay anything. So, I think options like these will link practitioners to the broader literature in a really user-friendly way, and that is very important. This will link academics with people working in public health practice in a partnership that I think will further the field.