Evidence-based public health--what level of competence is required?

BACKGROUND: Increasing prominence is being given to the use of best current evidence in decision-making, both in clinical practice and health care management and purchasing. Public health is regarded as a specialty in which evidence-based decision-making may be taken for granted, partly because epidemiology is the principal basic science on which public health has developed. To practise evidence-based decision-making requires both organizations that have systems for finding and appraising evidence and professionals who are skilled in searching, appraising, storing and using knowledge.

METHODS: A workshop was organized which posed a challenge for participants based on the assumption that a public health specialist could face hostile examination by a lawyer in court on their abilities to find and appraise best current evidence. The findings from this workshop were tested at a second workshop in London. Participants were principally public health specialists from the United Kingdom.

RESULTS: Participants were able to identify the core skills that were required for public health specialists and the resources that the individual professional needed to practise evidence-based decision-making. It was also obvious that there was a gap between the level of competence required and the level of competence that many public health professionals actually had. There was also a gap between the resources that were needed by public health professionals wishing to find and appraise the best current evidence.

CONCLUSIONS: If public health wishes to continue to claim that it is in the forefront of evidence-based decision-making, both the skills of the professionals and the resources available to them need to be improved.