Evidence-based medicine and public health

Evidence-based medicine (EBM) emphasizes the integration of the “best” evidence in clinical decision making and has become a dominant framework for practice over the past few decades. In that time, EBM thinking has been adopted by other health professions and fields, including public health. That has given rise to evidence-based public health (EBPH). However, application of the principles of EBM, which were established in light of the clinical encounter, in public health may not always be appropriate. In this chapter, we will provide a brief review of EBM and the major criticisms of the movement. This will include an overview of the GRADE framework for developing evidence-based recommendations, a process that has been adopted by several key organizations responsible for providing technical knowledge about responding to health issues, such as the World Health Organization (WHO). We will then discuss the role of EBM thinking in public health. That discussion will include an examination of issues that arise when adopting or adhering to standards of evidence developed for clinical practice by public health decision makers. These issues will be illustrated using a case study of face covering in public as an intervention to mitigate spread of Covid-19.