Improving Population Health: The Uses of Systematic Reviews
Melissa Sweet and Ray Moynihan
Milbank Memorial Fund - Produced in collaboration with the
December 2007
Available online as PDF file [84p.] at: http://www.milbank.org/reports/0712populationhealth/0712ImprovingPopulationHealthFinal.pdf
“…..Efforts to improve population health will yield better returns if there is more effective integration of reliable scientific evidence into policymaking. Increasing the use and usefulness of systematic reviews is one powerful mechanism for improving the evidence available to inform population health decision making.
Systematic reviews provide a systematic, transparent means for gathering, synthesizing, and appraising the findings of studies on a particular topic or question. They aim to minimize the bias associated with single studies and nonsystematic reviews. They can include many types of studies from diverse disciplines.
Systematic reviews can help provide information useful to policymakers, practitioners, and researchers, including the extent of a health problem and whether interventions work, at what cost, and for whom. They can help policymakers make the most efficient use of scarce resources and evaluate the relative merits of competing policies or programs—though for the most part current reviews compare an innovative intervention with some sort of “usual care” scenario rather than compare two different interventions or strategies. Systematic reviews can also help policymakers resist pressures from vested or competing interests, and they can help identify gaps in the evidence and priorities for future research. …”
“….. However, scientific evidence is only one of many forces and many types of information that influence policymaking. Systematic reviews face tough competition for policymakers’ attention. They cannot always provide information that is useful or relevant to policymakers’ needs, and policymakers often must make decisions on the basis of incomplete evidence within a very short time frame.
Evidence-based public/population health differs from evidence-based medicine because it bridges complex systems and populations rather than homogenous patient populations. Many methodological issues confront those who produce and use systematic reviews relevant to public/population health, and concerted efforts are under way to improve the quality of systematic reviews in this area.
David MacLean, professor and dean of the faculty of health sciences at
This report includes case studies—ranging from tobacco control to binge drinking among college students to the mental health challenges of the Indian Ocean tsunami—that bear many lessons for those seeking to improve population health. First and foremost they suggest there is significant room to enhance the role of evidence in policymaking. They also reveal the importance of
· taking a systems, environmental, or policy approach to changing human behavior, rather than strategies focused solely on individuals,
· the role of social norms in influencing behavior,
· the power of legislative, regulatory, and financial incentives to encourage the implementation of evidence-based policies,
· and the value of a reliable and relevant evidence base to help set political and public agendas and to shape interventions. ….”
Table of Contents
Introduction: The Potential of Systematic Reviews . . . and the Limitations
Traffic Safety Interventions: Successes and Setbacks—Implementing the Evidence Saves Lives
Tackling Youth Drinking: Collaboration Counts—When the Evidence Engages Communities
Tobacco Control: The Long War—When the Evidence Has to Be Created
Obesity: Dealing with Uncertainty and Complexity—When There Are Gaps in the Evidence
Drug Abuse Resistance Education (DARE): Lessons Learned—When the Evidence Is Lacking
Conclusion and Recommendations of the Authors of This Report
Notes - References - For Further Reading
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