Evidence-Based Public Health: Origins, Assumptions, and Cautions

  • Luis A. Avilés
  • Dani Filc


This chapter presents the origins and assumptions of evidence-based medicine as rooted in the philosophy of science called positivism. The basic principles of the positivist approach to science, empiricism, exclusivity, universality, and autonomy are explained and identified in reproductive and perinatal health outcomes related studies from the systematic reviews of the Cochrane Library, the premier database on evidence-based medicine. A series of articles published in the Evidence-based Public Health Policy and Practice section of the Journal of Epidemiology and Community Health are used to contrast the difference between evidence-based medicine and evidence-based public health. The series of seven articles related to issues of reproductive and perinatal health outcomes demonstrates that evidence-based public health departs from positivism by their incorporation of a diversity of methodological research strategies, by their interest in local and community focus, and by embracing research with clear political implications. As evidence-based public health overcomes the limitations of positivism, researchers should be aware of the limitations of some evidence-based approaches.


Cochrane Library Emergency Contraception Medical Abortion Public Health Researcher Reference Universe 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Afolabi, B. B., Lesi, F. E. A., & Merah, N. A. (2006). Regional versus general anesthesia for caesarean section. Cochrane Database of Systematic Reviews, (4), CD004350. doi:10.1002/14651858.CD004350.pub2.Google Scholar
  2. Anderson, G. L., Limacher, M., Assaf, A. R., Bassford, T., Beresford, S. A., Black, H., et al. (2004). Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women’s Health Initiative randomized controlled trial. JAMA: The Journal of the American Medical Association, 291(14), 1701–1712.Google Scholar
  3. Barrett-Connor, E. (2007). Hormones and heart disease in women: The timing hypothesis. American Journal of Epidemiology, 166(5), 506–510.CrossRefPubMedGoogle Scholar
  4. Bonds, D., Zaccaro, D., Karter, A., Selby, J., Saad, M., & Goff, D. (2003). Ethnic and racial differences in diabetes care: The Insulin Resistance Atherosclerosis Study. Diabetes Care, 26, 1040–1046.CrossRefPubMedGoogle Scholar
  5. Bremberg, S. (2003). Does an increase of low income families affect child health inequalities? A Swedish case study.. Journal of Epidemiology and Community Health, 57, 584–588.CrossRefPubMedGoogle Scholar
  6. Briggs, L. (2002). Reproducing empire: Race, sex, science, and U.S. imperialism in Puerto Rico. Berkeley: University of California Press.Google Scholar
  7. Carter, J., Pugh, J., & Monterrosa, A. (1996). Non-insulin-dependent diabetes mellitus in minorities in the United States. Annals of Internal Medicine, 125(3), 221–232.PubMedGoogle Scholar
  8. Chavkin, W. (2004). Access denied, science denied. American Journal of Public Health, 94(8), 1298–1299.CrossRefPubMedGoogle Scholar
  9. Cheng, L., Gülmezoglu, A. M., Van Oel, C. J., Piaggio, G., Ezcurra, E., & Van Look, P. F. A. (2004). Interventions for emergency contraception. Cochrane Database of Systematic Reviews, (3), CD001324. doi:10.1002/14651858.CD001324.pub2.Google Scholar
  10. Chronbach, L. J., Gleser, G. C., Nanda, H., & Rajaratnam, N. (1972). The dependability of behavioural measurements: Theory of generalizability of score and profiles. New York: Wiley.Google Scholar
  11. Cochrane Library. (2006). About the Cochrane Library. Retrieved December, 2006, from
  12. Collins, J. W. Jr., Wambach, J., David, R. J., & Rankin, K. M. (2009). Women’s lifelong exposure to neighborhood poverty and low birth weight: A population-based study. Maternal and Child Health Journal, 13(3), 326–333.CrossRefPubMedGoogle Scholar
  13. Dalen, J. E., & Bone, R. C. (1996). Is it time to pull the pulmonary artery catheter? JAMA: The Journal of the American Medical Association, 276(11), 916–918.CrossRefGoogle Scholar
  14. Davey-Smith, J., Ebrahim, S., & Frankel, S. (2001). How policy informs evidence: “Evidence based” thinking can lead to debased policy making. British Medical Journal, 322, 184–185.CrossRefPubMedGoogle Scholar
  15. Drozd, M. (2000). Cultural sensitivity in diabetic care. Home Health Care Management and Practice, 12(1), 1–6.CrossRefGoogle Scholar
  16. Fuller, S. (2000). Thomas Kuhn: A philosophical history for our times. Chicago: University of Chicago Press.Google Scholar
  17. Glanz, J. (2004, February 19). Scientists say administration distorts facts. The New York Times.Google Scholar
  18. Godwin, M., & Hodgetts, G. (2003). The Bedford murder: An evidence-based clinical mystery. Philadelphia: Hanley and Belfus.Google Scholar
  19. Grimes, D. A., Gallo, M. F., Halpern, V., Nanda, K., & Schultz, K. F. (2004). Fertility awareness-based methods for contra­ception. Cochrane Database of Systematic Reviews, (4), CD004860. doi:10.1002/14651858.CD004860.pub2.Google Scholar
  20. Halfon, N., & Hockstein, M. (2002). Life course health development: An integrated framework for developing health, policy and research. The Milbank Quarterly, 80(3), 433–479.CrossRefPubMedGoogle Scholar
  21. Haraway, D. J. (1991). Simians, cyborgs, and women: The reinvention of nature. New York: Routledge.Google Scholar
  22. Harding, S. (1991). Whose science? Whose knowledge? Thinking from women’s lives. Ithaca, New York: Cornell University Press.Google Scholar
  23. Harding, S. (2006). Science and social inequality: Feminist and postcolonial issues. Urbana: University of Illinois Press.Google Scholar
  24. Hawe, P., Shiell, A., & Riley, T. (2004). Complex interventions: How ‘out of control’ can a randomized controlled trial be? BMJ (Clinical Research Ed.), 328, 1561–1563.CrossRefGoogle Scholar
  25. Holmes, D., Murray, S. J., Perron, A., & Rail, G. (2006). Deconstructing the evidence-based discourse in health sciences: Truth, power and fascism. International Journal of Evidence-Based Health Care, 4, 180–186.CrossRefGoogle Scholar
  26. ICH harmonised tripartite guideline: E5: Ethnic factors in the acceptability of foreign clinical data E5 [ICH Web site]. Accessed December 16, 2009, from
  27. Jackson, N., & Waters, E. (2005). Criteria for the systematic review of health promotion and public health interventions. Health Promotion International, 20, 367–374.CrossRefPubMedGoogle Scholar
  28. Johnston, R., Gregory, D., Pratt, G., & Watts, M. (2000). The dictionary of human geography. Malden, MA: Blackwell.Google Scholar
  29. Kuhn, T. (1970). The structure of scientific revolutions. Chicago: The University of Chicago Press.Google Scholar
  30. Kulier, R., Fekih, A., Hofmeyr, G. J., & Campana, A. (2001). Surgical methods for first trimester termination of pregnancy. Cochrane Database of Systematic Reviews, (4), CD002900. doi:10.1002/14651858.CD002900.Google Scholar
  31. Kulier, R., Gülmezoglu, A. M., Hofmeyr, G. J., Cheng, L. N., & Campana, A. (2004). Medical methods for first trimester abortion. Cochrane Database of Systematic Reviews, (1), CD002855. doi:10.1002/14651858.CD002855.pub3.Google Scholar
  32. Larhme, A. C., & Pugh, J. A. (2001). Evidence-based guidelines meet the real world: The case of diabetes care. Diabetes Care, 24, 1728–1733.CrossRefGoogle Scholar
  33. Last, J. M. (2001). A dictionary of epidemiology. New York: Oxford University Press.Google Scholar
  34. Lee, L. C., Halpern, C. T., Hertz-Picciotto, I., Martin, S. L., & Suchindran, S. M. (2006). Child care and social support modify the association between maternal depressive symptoms and early childhood behaviour problems: A US national study. Journal of Epidemiology and Community Health, 60, 305–310.CrossRefPubMedGoogle Scholar
  35. Lewontin, R., & Levins, R. (2007). Biology under the influence: Dialectical essays on ecology, agriculture and health. New York: Monthly Review Press.Google Scholar
  36. Lu, M. C., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: A life-course perspective. Maternal and Child Health Journal, 7, 13–30.CrossRefPubMedGoogle Scholar
  37. Macinko, J., Guanais, F. C., & Marinho de Souza, M. F. (2006). Evaluation of the impact of the Family Health Program on infant mortality in Brazil, 1990–2002. Journal of Epidemiology and Community Health, 60, 13–19.CrossRefPubMedGoogle Scholar
  38. Mays, V., Yancey, A. K., Cochran, S. D., Weber, M., & Fielding, J. E. (2002). Heterogeneity of health disparities among African American, Hispanic, and Asian American women: Unrecognized influences of sexual orientation. American Journal of Public Health, 92, 632–639.CrossRefPubMedGoogle Scholar
  39. Nielsen, J. M. (1990). Introduction. In J. Nielsen (Ed.), Feminist research methods: Exemplary readings in the social sciences (pp. 1–37). Boulder, CO: Westview Press.Google Scholar
  40. Ortiz-Roque, C., & López-Rivera, Y. (2004). Mercury contamination in reproductive age women in a Caribbean island: Vieques. Journal of Epidemiology and Community Health, 58, 756–757.CrossRefPubMedGoogle Scholar
  41. Pilkington, H., Mayombo, J., Aubouy, N., & Deloron, P. (2004). Malaria, from natural to supernatural: A qualitative study of mothers’ reactions to fever (Dienga, Gabon). Journal of Epidemiology and Community Health, 58, 826–830.CrossRefPubMedGoogle Scholar
  42. Popay, J. (2001). What should count as evidence for Social Development Interventions – The case of Regeneration Initiatives. In J. Popay (Ed.), Regeneration and health: A selected review of the literature. London: Kings Fund & Nuffield Institute for Health.Google Scholar
  43. Porter, T. (1995). Trust in numbers: The pursuit of objectivity in science and public life. Princeton: Princeton University Press.Google Scholar
  44. Potvin, L. (2006). Should we worry about the enthusiasm toward evidence-based health promotion practices? Health Promotion and Education, 13, 228–229.Google Scholar
  45. Prasad, A. N. (2006). Disease profile for children in Kabul: The unmet need for health care. Journal of Epidemiology and Community Health, 60, 20–23.CrossRefPubMedGoogle Scholar
  46. Rosenstock, L., & Lee, L. J. (2002). Attacks on science: The risks to evidence-based policy. American Journal of Public Health, 92(1), 14–18.CrossRefPubMedGoogle Scholar
  47. Rossouw, J. E., Anderson, G. L., Prentice, R. L., LaCroix, A. Z., Kooperberg, C., Stefanick, M. L., et al. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial. JAMA: The Journal of the American Medical Association, 288(3), 321–333.Google Scholar
  48. Rychetnik, L., Hawe, P., Waters, E., Barrat, A., & Frommer, M. (2004). A glossary for evidence-based public health. Journal of Epidemiology and Community Health, 58, 538–545.CrossRefPubMedGoogle Scholar
  49. Sackett, D., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312, 71–72.PubMedGoogle Scholar
  50. Say, L., Kulier, R., Gülmezoglu, M., & Campana, A. (2002). Medical versus surgical methods for first trimester termination of pregnancy. Cochrane Database of Systematic Reviews, (4), CD003037. doi:10.1002/14651858.CD003037.pub2.Google Scholar
  51. Spencer, N., & Logan, S. (2004). Sudden unexpected death in infancy and socioeconomic status: A systematic review. Journal of Epidemiology and Community Health, 58, 366–373.CrossRefPubMedGoogle Scholar
  52. Terry, J., & Urla, J. (1995). Deviant bodies: Critical perspectives on difference in science and popular culture. Bloomington: Indiana University Press.Google Scholar
  53. The Economist. (2004, April 7). Cheating nature? The Bush administration has been accused of manipulating science. The Economist. Digital version. Retrieved December 2006.Google Scholar
  54. Victora, C. G., Habicht, J. P., & Bryce, J. (2004). Evidence-based public health: Moving beyond randomized trials. American Journal of Public Health, 94(3), 400–405.CrossRefPubMedGoogle Scholar
  55. Visser, J., Snel, M., & Van Vliet, H. A. A. M. (2006). Hormonal versus non-hormonal contraceptives in women with diabetes mellitus type 1 and 2. Cochrane Database of Systematic Reviews, (4), CD003990. doi:10.1002/14651858.CD003990.pub3.Google Scholar
  56. Watt, H. C., Carson, C., Lawlor, D. A., Patel, R., & Ebrahim, S. (2009). Influence of life course socioeconomic position on older women’s health behaviors: Findings from the British Women’s Heart and Health Study. American Journal of Public Health, 99(2), 320–327.CrossRefPubMedGoogle Scholar
  57. Weber, L. (2006). Reconstructing the landscape of health disparities research: Promoting dialogue and collaboration between feminist intersectional and biomedical paradigms. In A. J. Schulz & L. Mullings (Eds.), Gender, race, class, and health: Intersectional approaches (pp. 21–59). Josey-Bass: San Francisco.Google Scholar
  58. West, S. G., Duan, N., Pequegnat, W., Gaist, P., Des Jarlais, D. C., Holtgrave, D., et al. (2008). Alternatives to the randomized controlled trial. American Journal of Public Health, 98, 1359–1366.CrossRefPubMedGoogle Scholar
  59. White, K. L. (1991). Healing the schism: Epidemiology, medicine and public’s health. New York: Springer.Google Scholar

Copyright information

© Springer US 2011

Authors and Affiliations

  1. 1.Department of Social SciencesUniversity of Puerto RicoMayagüezUSA

Personalised recommendations