Skip to main content Accessibility help
Hostname: page-component-684899dbb8-662rr Total loading time: 0.339 Render date: 2022-05-28T10:34:02.777Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true }

7 - Conclusion

Published online by Cambridge University Press:  05 February 2013

Anne Andermann
McGill University, Montréal
Get access


It is easy enough to propose an algorithm for making evidence-informed decisions to improve health, but the real challenge is putting it into practice. We have already discussed in Chapter 5 the various facilitators and barriers to using evidence in making decisions about health, and Chapter 6 describes the key elements that should be considered as part of the overall decision (i.e. the content), but it is important not to overlook how decisions are made and, in particular, who is involved (i.e. the process). In many ways, the process itself can be just as important as the content. This concluding chapter will therefore look at how to make evidence-informed decisions work in practice, as well as how to ensure that these decisions have the greatest possible impact on improving health.

Making it work in practice

It may appear self-evident, but decisions do not occur in some other realm and then are handed down to us mere mortals to abide by and follow. Rather, everything that structures our lives has been decided by people, and, if we want, these decisions could be changed to create a healthier and more equitable world. Indeed, the recent Rio +20 United Nations (UN) Conference on Sustainable Development asks: What is the Future We Want? Once we define our goals for the future, it is possible to change course and make it a reality. For instance, it was recently announced that “the [Millennium Development Goal (MDG)] drinking water target, which calls for halving the proportion of the population without sustainable access to safe drinking water between 1990 and 2015, was met in 2010, five years ahead of schedule”. Only two decades ago, almost one-quarter of the population on this planet did not have access to clean drinking water – one of the most basic necessities for health and daily life. Yet, with a concerted effort on the part of our global society, in 2010 there were only 11% left who still relied on unimproved sources of water – and that number is continually decreasing. That is not to say that no challenges remain. Nonetheless, it is quite remarkable what can change when the decision is made to make it happen. However, influencing decisions and ensuring that they are implemented requires involving a range of key players from the very outset.

Evidence for Health
From Patient Choice to Global Policy
, pp. 175 - 197
Publisher: Cambridge University Press
Print publication year: 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Rio +20 Conference on Sustainable Development. The Future We Want. New York, NY: United Nations, 2012.Google Scholar
World Health Organization, UNICEF. Progress on Drinking Water and Sanitation: 2012 Update. Geneva and New York: World Health Organization and UNICEF, 2012. Available at: .Google Scholar
Daniels, N, Sabin, J. Setting Limits Fairly: Can We Learn to Share Medical Resources?New York:Oxford University Press, 2002.CrossRefGoogle Scholar
Daniels, N. Fair process in patient selection for antiretroviral treatment in WHO’s goal of 3 by 5. Lancet 2005; 366(9480): 169–71.CrossRefGoogle ScholarPubMed
Kaner, S, Lind, L. Facilitator’s Guide to Participatory Decision-making. Gabriola Island, BC:New Society Publishers, 1996.Google Scholar
Church, J, Saunders, D, Wanke, M et al. Citizen participation in health decision-making: past experience and future prospects. J Public Health Policy 2002; 23(1): 12–32.CrossRefGoogle ScholarPubMed
Arnstein, S. A ladder of Citizen participation. J Am Inst Plann 1969; 35(4): 216–24.CrossRefGoogle Scholar
Verweij, M, Hoven, M. Nudges in public health: paternalism is paramount. Am J Bioeth 2012; 12(2): 16–17.CrossRefGoogle ScholarPubMed
Coulter, A, Parsons, S, Askham, J. Where Are the Patients in Decision-Making about Their Own Care?Geneva: World Health Organization, 2008. Available at: Google Scholar
College of Family Physicians of Canada. Marking Scheme for the SOO Video. Ottawa: College of Family Physicians of Canada, 2012. Available at: Google Scholar
Bourque, D. Concertation et partenariat: Entre levier et piège du développement des communautés. Québec: Presses de l’Université du Québec, 2008.Google Scholar
Dakutis, P. Cancer-prevention diet wins praise on navy destroyer. J Natl Cancer Inst 1992; 84(5): 297–8. Available at: .CrossRefGoogle Scholar
Agence de la santé et des services sociaux de Montréal. Rapport du Directeur de Santé Publique 2011. Les Inégalités Sociales de Sante à Montréal : Le Chemin Parcouru. Montréal : Agence de la santé et des services sociaux de Montréal, 2011. Available at: .Google Scholar
International Union for Health Promotion and Education. The Evidence of Health Promotion Effectiveness: Shaping Public Health in a New Europe (Part 1). Brussels: International Union for Health Promotion and Education, 1999. Available at: .Google Scholar
Task Force on Community Preventive Services; Zaza, S, Briss, P, Harris, K (ed.). The Guide to Community Preventive Services: What Works to Promote Health? Oxford: Oxford University Press, 2005. Available at: .Google Scholar
The Cochrane Collaboration. Cochrane Summaries. Oxford: The Cochrane Collaboration, 2012. Available at: Google Scholar
Commission on Social Determinants of Health (CSDH). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health.Geneva: World Health Organization, 2008. Available at: .Google Scholar
Lavis, J, Oxman, A, Lewin, S, Fretheim, A. SUPPORT Tools for evidence-informed health Policymaking (STP). Health Res Policy Syst 2009; 7(Suppl 1): I1.CrossRefGoogle Scholar
Public Heath Agency of Canada. The Population Health Template Working Tool. Ottawa: Public Heath Agency of Canada, 2001. Available at: .Google Scholar
Felitti, V, Anda, R, Nordenberg, D et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998; 14(4): 245–58.CrossRefGoogle ScholarPubMed
Anda, R, Dong, M, Brown, D et al. The relationship of adverse childhood experiences to a history of premature death of family members. BMC Public Health 2009; 9: 106.CrossRefGoogle ScholarPubMed
US Preventive Services Task Force. Screening for Family and Intimate Partner Violence. Bethesda, MD: US Preventive Services Task Force, 2004. Available at: .Google Scholar
Task Force on Community Preventive Services. Recommendations to reduce violence through early childhood home visitation, therapeutic foster care, and firearms laws. Am J Prev Med 2005; 28(2S1): 6–10.CrossRefGoogle Scholar
Shea, B, Nahwegahbow, A, Andersson, N. Reduction of family violence in aboriginal communities: a systematic review of interventions and approaches. Pimatisiwin 2010; 8(2): 35–60.Google ScholarPubMed
Public Health Agency of Canada. Canadian Best Practices Portal. Ottawa: Public Health Agency of Canada, 2012. Available at: .Google Scholar
National Aboriginal Circle Against Family Violence. Ending Violence in Aboriginal Communities: Best Practices in Aboriginal Shelters and Communities. Ottawa: National Aboriginal Circle Against Family Violence, 2006. Available at: .Google Scholar
World Health Organization. Violence Prevention, The Evidence: Changing Cultural and Social Norms Supportive of Violent Behaviour. Geneva: World Health Organization, 2009. Available at: .Google Scholar
Ross, R. Returning to the Teachings. Toronto, ON: Penguin Canada, 1996.Google Scholar
Archibald, L.Final Report of the Aboriginal Healing Foundation. Volume III: Promising Healing Practices in Aboriginal Communities. Ottawa: Aboriginal Healing Foundation, 2006. Available at: .Google Scholar
Daar, A, Singer, P. The Grandest Challenge: Taking Life Saving Science from Lab to Village. Toronto: Doubleday Canada, 2011.Google Scholar
Grand Challenges Canada. Who we are. Toronto: Grand Challenges Canada, 2012. Available at: .Google Scholar
Oxman, A, Bjørndal, A, Becerra-Posada, F, et al. A framework for mandatory impact evaluation to ensure well informed public policy decisions. Lancet 2010; 375(9712): 427–31.CrossRefGoogle ScholarPubMed
Richmond, J. Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention. Washington, DC: US Department of Health, Education and Welfare, 1979. Available at: .
US Department of Health and Human Services. History and Development of Healthy People. Washington, DC: Office of Disease Prevention and Health Promotion, 2011. Available at: .Google Scholar
Measure DHS. About DHS. Calverton, MD: Measure DHS, 2012. Available at: .Google Scholar
Wharam, J, Daniels, N. Toward evidence-based policy making and standardized assessment of health policy reform. JAMA 2007; 298(6): 676–9.CrossRefGoogle ScholarPubMed
International Conference on Primary Health Care. Declaration of Alma-Ata. Geneva: World Health Organization, 1978. Available at: .Google Scholar
Commission on Social Determinants of Health (CSDH). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization, 2008. Available at: .Google Scholar
Szreter, S. Economic growth, disruption, deperivation, disease and death: on the importance of the politics of public health for development. Popul Dev Rev 1997; 23(4): 693–728.CrossRefGoogle Scholar
Minkler, M (ed.). Community Organizing and Community Building for Health, 2nd edn. New Brunswick, NJ: Rutgers University Press, 2005.
Gofin, J, Gofin, R. Essentials of Global Community Health. Sudbury, MA: Jones and Bartlett Learning, 2011.Google Scholar
Geiger, H. Community-oriented primary care: a path to community development. Am J Public Health. 2002; 92: 1713–16.CrossRefGoogle ScholarPubMed
Mullan, F, Epstein, L. Community-oriented primary care: new relevance in a changing world. Am J Public Health 2002; 92(11): 1748–1755.CrossRefGoogle Scholar
Beaglehole, R, Bonita, R. Strengthening public health for the new era. In: Beaglehole, R, Bonita, R (eds.). Global Public Health: A New Era, 2nd edn. Oxford: Oxford University Press, 2009, pp. 283–98.CrossRefGoogle Scholar
Potvin, L. Intersectoral action for health: more research is needed!Int J Public Health 2012; 57(1): 5–6.CrossRefGoogle ScholarPubMed
Whitehead, M, Dahlgren, G, Gilson, L. Developing the policy response to inequities in Health: a global perspective. In: Evans, T, Whitehead, M, Diderichsen, F, Bhuiya, A, Wirth, M (eds.). Challenging Inequities in Health Care: From Ethics to Action. New York: Oxford University Press, 2001, pp. 308–24.CrossRefGoogle Scholar
Daniels, N, Kennedy, B, Kawachi, I. Health and inequality, or, why justice is good for our health. In: Anand, S, Peter, F, Sen, A (eds.). Public Health, Ethics and Equity. Oxford: Oxford University Press, 2004, pp. 63–92.Google Scholar
Andermann, A. Addressing the social causes of poor health is integral to practicing good medicine. CMAJ 2011; 183(18): 2196.CrossRefGoogle Scholar
Mercer, M. Shall we leave it to the experts? In: Sickness and Wealth: The Corporate Assault on Global Health. Fort, M, Mercer, MA, Gish, O (eds.). Cambridge, MA: South End Press, 2004, pp. 167–83.Google Scholar
Stone, D. Policy Paradox: The Art of Political Decision Making. New York, NY: WW Norton & Company, 2002.Google Scholar
Coulter, A, Collins, A. Making Shared Decision-Making a Reality: No Decision About Me, Without Me. London: The King’s Fund, 2011. Available at: .Google Scholar
Moat, K, Lavis, J. Supporting the Use of Cochrane Reviews in Health Policy and Management Decision-Making: Health Systems Evidence [editorial]. The Cochrane Library February 16, 2011. Available at: .Google Scholar
Chalkidou, K, Levine, R, Dillon, A. Helping poorer countries make locally informed health decisions. BMJ 2010; 341: c3651.CrossRefGoogle ScholarPubMed
Braveman, P, Egerter, S, Woolf, S, Marks, J. When do we know enough to recommend action on the social determinants of health?Am J Prev Med 2011; 40(1 Suppl 1): S58–66.CrossRefGoogle ScholarPubMed
Rosenbaum, S, Glenton, C, Wiysonge, C, et al. Evidence summaries tailored to health policy-makers in low- and middle-income countries. Bull World Health Organ 2011; 89(1): 54–61.CrossRefGoogle ScholarPubMed
Directorate-General for Research. Communicating Research for Evidence-Based Policymaking: A Practical Guide for Researchers in Socio-Economic Sciences and Humanities. Brussels: European Commission, 2010. Available at: .Google Scholar
Wilkinson, R, Pickett, K. The Spirit Level: Why Equality is Better for Everyone. London: Penguin Books, 2010.Google Scholar
WHO Secretariat. International Trade and Health: Report by the Secretariat [EB116/4]. Geneva: World Health Organization, 2005. Available at: .Google Scholar
Gostin, L, Heywood, M, Ooms, G, et al. National and global responsibilities for health. Bull World Health Organ 2010; 88(10): 719–719A.CrossRefGoogle Scholar
Fawcett, S, Schultz, J, Watson-Thompson, J, Fox, M, Bremby, R. Building multisectoral partnerships for population health and health equity. Prev Chronic Dis 2010; 7(6): A118.Google ScholarPubMed
Department for International Development. The Politics of Poverty: Elites, Citizens and States. London: Department for International Development, 2010. Available at: .Google Scholar
Ooms, G. Managing mutual dependence will be the biggest challenge of the 21st Century. In: Merritt, G, House, R (eds.); Development Policy Forum. Creating a Global Health Policy Worthy of the Name. Brussels: Friends of Europe, 2010, pp. 20–21. Available at: .Google Scholar
Sen, A. Development as Freedom. New York, NY: Anchor Books, 1999.Google Scholar
The Royal Society Science Policy Centre. People and the Planet. London: The Royal Society, 2012. Available at: .Google Scholar
Randers, J. 2052: A Global Forecast for the Next Forty Years. White River Junction, VT: Chelsea Green Publishing, 2012. Available at: .Google Scholar
Hunter, D. Evidence-based policy and practice: riding for a fall?J R Soc Med 2003; 96: 194–6.CrossRefGoogle ScholarPubMed
Ministers of Foreign Affairs of Brazil, France, Indonesia, Norway, Senegal and Thailand. Why we need a Commission on Global Governance for Health. Lancet 2012; 379(9825): 1470–1.CrossRefGoogle Scholar
Tenbensel, T, Eagle, S, Ashton, T. Comparing health policy agendas across eleven high income countries: islands of difference in a sea of similarity. Health Policy 2012; 106(1): 29–36.CrossRefGoogle Scholar
Gakidou, E, Cowling, K, Lozano, R, Murray, C. Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. Lancet 2010; 376(9745): 959–74.CrossRefGoogle ScholarPubMed
Swanson, D, Bhadwal, S (eds.). Creating Adaptive Policies – A Guide for Policy-making in an Uncertain World. Ottawa: International Development Research Centre, 2009. Available at: .
Black, N. Evidence based policy: proceed with care. BMJ 2001; 323: 275–9.CrossRefGoogle ScholarPubMed
Stern, P, Fineberg, H (eds.). Understanding Risk: Informing Decisions in a Democratic Society. Washington, DC: National Academies Press, 1996.
Pang, T, Tharyan, P. Evaluating the global “Evidence Footprint”: how can evidence better serve the needs of global public health?J Evid Based Med 2009; 2(1): 44–6.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Conclusion
  • Anne Andermann, McGill University, Montréal
  • Book: Evidence for Health
  • Online publication: 05 February 2013
  • Chapter DOI:
Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Conclusion
  • Anne Andermann, McGill University, Montréal
  • Book: Evidence for Health
  • Online publication: 05 February 2013
  • Chapter DOI:
Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Conclusion
  • Anne Andermann, McGill University, Montréal
  • Book: Evidence for Health
  • Online publication: 05 February 2013
  • Chapter DOI:
Available formats