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Public health policy, evidence, and causation: lessons from the studies on obesity

Medicine, Health Care and Philosophy volume 15, pages 141–151 (2012)Cite this article

Abstract

The paper addresses the question of how different types of evidence ought to inform public health policy. By analysing case studies on obesity, the paper draws lessons about the different roles that different types of evidence play in setting up public health policies. More specifically, it is argued that evidence of difference-making supports considerations about ‘what works for whom in what circumstances’, and that evidence of mechanisms provides information about the ‘causal pathways’ to intervene upon.

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Notes

  1. This data refers to statistics published on open access websites and databases of the European Commission (http://www.hopeproject.eu/index.php?nav_id=), the UK National Health Services (http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/obesity/statistics-on-obesity-physical-activity-and-diet-england-2010), and the World Health Organisation (http://www.who.int/mediacentre/factsheets/fs311/en/index.html), all accessed in March 2010.

  2. Information about the programme, the services, the follow-up, related scientific publications, etc. can be found at the sable URL=http://www.mendprogramme.org/hom.

  3. It goes without saying that, when discussing policy, questions about the ethical principles and values that ought to guide interventions inevitably come up. Those are certainly important. However, I want to focus here on a theoretical issue, namely on what constitutes evidence for policy in public health contexts.

  4. Trumble W.R., Stevenson A. (eds), Shorter Oxford English dictionary on historical principles, Oxford:Oxford University Press, 2002.

  5. Information about EFSA, its goals, organisation, documents, campaign and events can be retrieved from its portal, URL=http://www.efsa.europa.eu/.

  6. The document may be accessed at the following stable URL=http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2006:404:0009:0025:EN:PDF

  7. For clarity of exposition I draw a neat distinction between evidence of difference-making and evidence of mechanism. However, in practice this distinction is much more blurred and in fact the two types of evidence are often entangled. For a discussion, see for instance Russo (2011).

  8. I say ‘part of the job’ and ‘by and large’ because this leads us straight into problems of external validity, which are far from being settled. For a novel and thought provoking account of external validity see Steel (2008); for a discussion of the insufficiency of statistics for external validity, see Cartwright (2011).

  9. See for instance the National Childhood Obesity Database 2005–2006 (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_063565).

  10. See for instance http://ec.europa.eu/eahc/projects/database.html?prjno=2003305, or http://ec.europa.eu/eahc/projects/database.html?prjno=2004313. Notice that, although those projects are listed under policy actions, they are in fact highly exploratory, in that they are meant to provide relevant difference-making information for actions such as prevention in children or particular classes of professionals.

  11. See for instance http://ec.europa.eu/research/leaflets/diabetes/index_en.html. Here is a list of projects funded under the 5th and 6th Framework Programme: http://cordis.europa.eu/lifescihealth/major/diabetes-eu-funding.htm.

  12. See for instance http://ec.europa.eu/health/social_determinants/policy/index_en.htm.

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Acknowledgments

I wish to thank Mike Joffe and Paolo Vineis for drawing my attention to obesity as an interesting case study. Rafael Blanc Moya, Lorenzo Casini, Brendan Clarke, Donald Gillies, Phyllis Illari, Jon Williamson, and two anonymous referees have been very helpful in providing stimulating comments, wise suggestions, and bibliographical references. I also wish to thank the participants of the workshop ‘Multi-level causation’ (IHPST, Paris I, 25–26 March 2010) and of the conference CitBaSS (Erasmus University, Rotterdam, 6–8 October 2010) for their feedback.

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  1. Philosophy—SECL, University of Kent, Canterbury, CT2 7NF, UK

    Federica Russo

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  1. Federica Russo
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Correspondence to Federica Russo.

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Russo, F. Public health policy, evidence, and causation: lessons from the studies on obesity. Med Health Care and Philos 15, 141–151 (2012). https://doi.org/10.1007/s11019-011-9335-y

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Keywords

  • Causation
  • Disease causation
  • Evidence
  • Evidence-based public health
  • Obesity
  • Public health policy