This paper examines how the concept of the 'evidence-based' approach has transferred from clinical medicine to public health and has been applied to health promotion and policy making. In policy making evidence has always been interpreted broadly to cover all types of reasoned enquiry and after some debate the same is now true for health promotion. Taking communities rather than individuals as the unit of intervention and the importance of context means that frequently randomized controlled trials are not appropriate for study of public health interventions. Further, the notion of a 'best solution' ignores the complexity of the decision making process. Evidence 'enlightens' policy makers shaping how policy problems are framed rather than providing the answer to any particular problem. There are lessons from the way that evidence-based policy is being applied in public health that could usefully be taken back into medicine.
Healthy Public Policy is one of the key health promotion actions. Advancement of Healthy Public Policy requires that the health consequences of policy should be correctly foreseen and that the policy process should be influenced so that those health consequences are considered. Health Impact Assessment is an approach that could assist in meeting both requirements. Policies often produce health impacts by multiple indirect routes, which makes prediction difficult. Prediction in Health Impact Assessment may be based on epidemiological models or on sociological disciplines. Health Impact Assessment must be based on an understanding of, and aim to add value to, the policy-making process. It must therefore conform to policy-making timetables, present information in a form that is policy relevant and fit the administrative structures of policy makers. Health Impact Assessment may be used to inform health advocacy but is distinct from it. There is a danger that Health Impact Assessment could be misunderstood as health imperialism.
In all birth cohorts, male and female, after age 25 years the percentage of current smokers falls with age. In the earliest birth cohort for males (1897-1901) about 85 per cent were ever smokers (i.e. had smoked at some time). After the 1922-1926 cohort this started to fall, to reach the level of about 50 per cent in the 1962-1966 cohort. In females only 25 per cent of the earliest cohort ever smoked but this rose, reaching about 65 per cent in the 1922-1926 cohort before falling back to about 50 per cent in the 1962-1966 cohort. The age at which smokers quit appears to be falling in successive cohorts. Once they have started quitting the rate at which smokers do so is very similar in all cohorts, with about 1 per cent of ever smokers quitting each year. If these trends are continued the UK smoking prevalence targets will not be met.
This paper first reviews the evidence that the pathogenesis of many diseases which present in adult life begin in childhood, and that intervention in childhood may delay their onset. The diseases discussed include ischaemic heart disease, malignancy, cerebrovascular accidents, hypertension and obesity. The factors determining food habits are described and the possibilities of influencing food preferences and eating patterns in childhood are explored.
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