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01.05.2012 | Scientific Contribution

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

verfasst von: Federica Russo

Erschienen in: Medicine, Health Care and Philosophy | Ausgabe 2/2012

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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.

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.

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.

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.

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

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

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

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).

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).

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

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.

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.

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

Bechtel, W., and A. Abrahamsen. 2005. Explanation: A mechanist alternative. Studies in the History and Philosophy of the Biological and Biomedical Sciences 36:421–441.CrossRef

Blass, E.M, ed. 2008. Obesity: Causes, mechanisms, prevention, and treatment. Massachusetts: Sinauer.

Bophal, R. 1997. Which book? A comparative review of 25 introductory epidemiology textbooks. Journal of Epidemiology and Community Health 51:612–622.CrossRef

Bophal, R. 1999. Paradigms in epidemiology textbooks: In the footsteps of Thomas Khun. American Journal of Public Health, 89(8):1162–1165.CrossRef

Brownson, R.C., Baker, E.A., Leet, T.L., and K.N. Gillespie. (2003). Evidence-based public health. New York: Oxford University Press.

Brownson, R.C., Gurney, J.G., and G.H. Land. 1999. Evidence-based decision making in public health. Journal of Public Health Management Practice, 5(5):86–97.

Cartwright, N. 2008. Evidence for evidenced-based policy. Talk at a home office seminar on criminology and evidence-based policy.

Cartwright, N. 2009. Causality, invariance, and policy. In The Oxford handbook of philosophy of economics, chapter 15, ed. Kincaid, H., and, D. Ross, 410–421. Oxford: Oxford University Press.CrossRef

Cartwright, N. 2011. Predicting ‘it will work for us’: (way) beyond statistics. In Causality in the sciences, eds. McKay-Illari, P., Russo F., and J. Williamson. Oxford: Oxford University Press.

Constantin, A., Costache, G., Sima, A.V., Glavce, C.S., Vladica, M., and D.L. Popov. 2010. Leptin G-2548A and leptin receptor Q223R gene polymorphisms are not associated with obesity in Romanian subjects. Biochemical and Biophysical Research Communications 391(1):282–286.PubMedCrossRef

Evidence-Based Medicine Working Group. 1992. Evidence based medicine: A new approach to teaching the practice of medicine. Journal of American Medical Association, 268:2420–25.CrossRef

Galea, S., Riddle, M., and G.A. Kaplan. 2010. Causal thinking and complex system approaches in epidemiology. International Journal of Epidemiology 39:97–106.PubMedCrossRef

Gillies, D.A. 2011. The Russo-Williamson thesis and the question of whether smoking causes heart disease. In Causality in the Sciences. eds. McKay Illari, P., Russo, F., and J. Williamson. Oxford: Oxford University Press.

Glasziou, P., Chalmers, I., Rawlins, M., and P. McCulloch. 2007. When are randomised trials unnecessary? Picking signal from noise. British Medical Journal 334:349–351.PubMedCrossRef

Greener, J., Douglas, F., van and E. Teijlingen. 2010. More of the same? Conflicting perspectives of obesity causation and intervention amongst overweight people, health professionals and policy makers. Social Science and Medicine 70: 1042–1049.

Guyatt G., and R. Drummond. 2002. Users guides to the medical literature: A manual for evidence-based practice. Chicago: American Medical Association.

Hill, B. 1965. The environment of disease: Association or causation? Proceedings of the Royal Society of Medicine, 58:295–300.PubMed

Hu, F. 2008. Obesity epidemiology. Oxford: Oxford University Press.CrossRef

Illari, P., and J. Williamson. 2010. Function and organization: comparing the mechanisms of protein synthesis and natural selection. Studies in History and Philosophy of Biological and Biomedical Sciences 41:279–291.PubMedCrossRef

Illari, P.M. 2011. Mechanistic evidence: Disambiguating the Russo-Williamson thesis. International studies in philosophy of science (in press).

Kahn, S.E., Hul, R.L., and K.M. Utzschneider. 2006. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 444:840–846.PubMedCrossRef

Killoran, A., and M.P. Kelly, eds. 2010. Evidence-based public health. Effectiveness and efficiency. New York: Oxford University Press.

Mouchart, M. and F. Russo. 2011. Causal explanation: Recursive decompositions and mechanisms. In Causality in the sciences, eds. McKay-Illari, P., Russo, F., and J. Williamson. Oxford: Oxford University Press.

Perry I.J. 1997. Risk factor epidemiology. The Lancet 350(9086):1256.CrossRef

Philipson, T., and R. Posner. 2008. Is the obesity epidemic a public health problem? A decade of research on the economics of obesity. Technical Report Working paper 14010, The National Bureau of Economic Research.

Porta, M., ed. 2008. A dictionary of epidemiology. Oxford: Oxford University Press, fifth edition.

Power, M. and J. Schulkin. 2009. The evolution of obesity. Baltimore: The John Hopkins University Press.

Reilly, J. 2005. Descriptive epidemiology and health consequences of childhood obesity. Best Practices & Research Clinical Endocrinology & Metabolism 19(3):327–341.CrossRef

Reilly, J.J., Armstrong, J., Dorosty, A.R., Emmett, P.M., Ness, A., Rogers, I., Steer, C., and A. Sheriff. 2005. Early life risk factors for obesity in childhood: Cohort study. British Medical Journal 330:1357.PubMedCrossRef

Russo, F. 2009, Variational causal claims in epidemiology. Perspectives in Biology and Medicine 52(4):540–554.PubMed

Russo, F. 2011. Causal webs in epidemiology. Paradigmi (In Press).

Russo, F. and J. Williamson. 2007. Interpreting causality in the health sciences. International Studies in Philosophy of Science 21(2):157–170.CrossRef

Russo, F. and J. Williamson. 2011. Generic versus single-case causal knowledge. the case of autopsy. European Journal for Philosophy of Science, 1(1):47–69.CrossRef

Rychetnik, L., Hawe, P., Waters, E., Barratt, A., and M. Frommer. 2004. A glossary for evidence based public health. Journal of Epidemiology and Community Health 58:538–545.PubMedCrossRef

Salmon, W. 1984. Scientific explanation and the causal structure of the world. Princeton: Princeton University Press.

Steel, D. 2008. Across the boundaries. Extrapolation in biology and social science. Oxford: Oxford University Press.

Trust for America’s Health. 2008. F as in fat. How obesity policies are failing in America. Technical report. Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

Titel: Public health policy, evidence, and causation: lessons from the studies on obesity
verfasst von: Federica Russo
Publikationsdatum: 01.05.2012
Verlag: Springer Netherlands
Erschienen in: Medicine, Health Care and Philosophy / Ausgabe 2/2012
Print ISSN: 1386-7423
Elektronische ISSN: 1572-8633
DOI: https://doi.org/10.1007/s11019-011-9335-y

Springer Medizin

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