Evidence for Health: From Patient Choice to Global Policy

BOOK REVIEW / CRITIQUE DE LIVRE

Evidence for Health: From Patient Choice to Global Policy

Vanessa Kitchin
Education Liaison / Bachelor of Health Sciences Liaison Librarian
Health Sciences Library, McMaster University
1280 Main Street West
Hamilton ON, L8S 4K1
E-mail: kitchin@mcmaster.ca

JCHLA / JABSC 35: 75–76 (2014) doi: 10.5596/c14-017

Evidence for Health: From Patient Choice to Global Policy. By Anne Andermann. New York: Cambridge University Press, 2013. Softcover: 206 p. ISBN: 978-1107648654. Price: USD$48. Available from: http://www.cambridge.org/ca/academic/subjects/medicine/medicine-general-interest/evidence-health-patient-choice-global-policy.

As a resource for health practitioners and policy makers, Anne Andermann's Evidence for Health offers a comprehensive guide to evidence-informed decision making at both personal and public levels. In their astute 2009 Lancet article, Koplan et al. [1] defined global health as “an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide” (p. 1995). Evidence for Health is a highly accessible and practical guide for knowledge translation as it relates to global health policy creation and interpretation. The content of the book includes factors affecting the ways in which health is conceptualized and on a more micro level, the steps involved in finding valid and relevant information in decision making as it relates to personal health.

Dr. Andermann is an Associate Professor in the department of Family Medicine; an Associate Member in the Department of Epidemiology, Biostatistics, and Occupational Health; and a Research Associate in Public Health and Primary Health Care at St Mary's Research Centre at McGill University, Montreal, Quebec. She has published highly insightful papers on topics such as genetic screening [2] as well as the social causes of poor health and how they relate to medical practice [3]. Her stunning range of research and relevant experience is a clear asset to the complexity of Evidence for Health and the result is a profoundly well written and insightful tool for understanding evidenced-based health policy formation.

Evidence-based medicine (EBM) is a relatively new concept and is credited to Gordon Guyatt and the Evidence-Based Medicine Working Group at McMaster University in Hamilton, Ontario [4]. In our instruction work, health sciences librarians consult many of the seminal texts on evidence-based clinical practice as well as pivotal guidelines such as Users’ Guides to the Medical Literature published by the Journal of the American Medical Association [5]. It is not new to state, especially to an audience of librarians, that evidence-based practice permeates many disciplines beyond medicine and even beyond information science. Dr. Andermann's book adds a highly practical resource for post-graduate reading in evidence-based practice as it relates to global health policy. The book demystifies the notion of evidence for health by strategically identifying terminology and explaining how evidence is produced and retrieved at various levels of the research process.

Over the course of seven chapters, a thorough exploration of the levels of evidence and how they are produced and used in health decision making is explained. What is more, although Evidence for Health is a guideline, it is also a call for change. Dr. Andermann persuasively argues that the health status of individuals, populations, and the global community is determined not only by how choices are informed by personal experience and access to information but also by social and economic inequalities that limit or challenge that access. To further explain the notion of multidimensionality in health decision making, Dr. Andermann devises a framework for describing the determinants of health. Using this framework she outlines disease prevention strategies that can be implemented at the policy-making level. In my liaison work with the Global Health specialization in the Bachelor of Health Sciences at McMaster University, it has been difficult to find resources that objectively synthesize the data required to meet the research needs of evidenced-based public health as applied to a global health context. Evidence for Health provides a necessary and thought-provoking contextualization for the complexities of decision making and said research needs, using both qualitative and quantitative evidence.

Beyond conceptualizing health and all the layers it is comprised of, Dr. Andermann also explores how decisions inform and influence those layers. She identifies cultural factors as key determinants of health and through case studies, explores the “Patient Preferences and Actions” aspect of EBM. Further to this, she uses various models and figures to visually represent how competing interests can influence health-related decisions and identifies the key stakeholders (e.g., United Nations agencies and lobby groups) who have the potential to influence global health decisions. She then ties this part of the book together by stating that if these stakeholders had access to the varied opportunities for intervention and the implications each might have, more effective health status interventions could be implemented as the decision making would be clear and evidence informed.

Of particular use to health sciences librarians, especially those who teach or support evidence-based decision making, is the way Dr. Andermann identifies the notion of using specific types of research studies to build the evidence base for specific types of health policy research questions. She explains how to identify the most appropriate evidence (study type) for research questions related to improving the health of individuals and populations. This is determined by whether the question is attempting to define a health priority, understand a cause, develop an intervention, or evaluate a health outcome. For example, decisions regarding the improvement of health outcomes related to a specific disease will be best informed by a randomized controlled trial, whereas those that aim to assess the most pressing health priorities for a particular population might be best informed by a cross-sectional survey. This is highly relevant for librarians when selecting for study type as a parameter in a searchable research question or when providing guidance to a student conducting a search. What is more, her discussion of how evidence is produced to inform health decisions also reviews ethical considerations in research, another aspect of the text that serves as a beneficial review for librarians who are heavily involved in research support.

The one minor shortcoming of Dr. Andermann's text lies within her coverage of critical appraisal. Although she does describe the threats to internal and external validity within individual studies, this topic is not placed within a global health policy context. Critical appraisal is a key component of EBM and provides a way to assess the applicability of research to specific clinical or policy questions. I would have liked this aspect of the text to be explored further as it is an imperative step in using evidence to inform decisions in a skillful way. I still particularly appreciated how she conveyed knowledge synthesis as not simply a tool used to conduct research but also as a form of research in itself.

Ultimately, Dr. Andermann provides the reader with a sweeping overview of how informed decisions allow for sound policy making. The content is quite accessible and offers a fine balance between theory and practice. The steps involved with the synthesis, dissemination, and utilization of research is contextualized in her proposed research cycle. This cycle informs how research evidence is produced and includes causes, interventions, implementations, and evaluations. Although Evidence for Health can serve as a refresher for health librarians who are involved with supporting research, especially research surrounding the socioeconomic and sociocultural aspects of health, the most beneficial aspect of the text will be its use in global health studies, both at the Masters and undergraduate study levels.

References

1. Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, et al. Towards a common definition of global health. The Lancet. 2009;373(9679):1993–1995. doi: org/10.1016/S0140-6736(09)60332-9.
2. Andermann A, Blancquaert I, Beauchamp S, Costea I. Guiding policy decisions for genetic screening: Developing a systematic and transparent approach. Public Health Genomics. 2011;14(1):9–16. doi: 10.1159/000272898.
3. Andermann A. Addressing the social causes of poor health is integral to practising good medicine. Canadian Medical Association Journal. 2011;183(18):2196–2196. doi: 10.1503/cmaj.111096.
4. Guyatt G. Evidence-based medicine - a new approach to teaching the practice of medicine. Journal of the American Medical Association. 1992;268(17):2420–2425. doi: org/10.1001/jama.1992.03490170092032.
5. Guyatt GH, Rennie D, Meade, MO, Cook DJ. (2008). Users’ guides to the medical literature: A manual for evidence-based clinical practice. (2nd ed.). New York: McGraw-Hill Medical.

Vanessa Kitchin
Education Liaison / Bachelor of Health Sciences Liaison Librarian
Health Sciences Library, McMaster University
1280 Main Street West
Hamilton ON, L8S 4K1
E-mail: kitchin@mcmaster.ca

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