evidence-based policy on physical activity: the tale of the emperor's new clothes ·...

Evidence-based policy

on physical activity:

the tale of the

Emperor's New

Clothes

Nick Cavill PhD

“Use of robust evidence to inform

public health policy is likely to

ensure the greatest and most

equitable population health gains”

Macintyre S. Evidence based policy making. BMJ 2003;326:5-6.

“Our new approach across public health

services must meet tougher tests of evidence

and evaluation . . . We must only support

effective interventions that deliver proven

benefits.”

Andrew Lansley, Secretary of State for Health.

Speech to the Faculty of Public Health conference in

July 2010

'the integration of experience,

judgement and expertise with the

best available external evidence from

systematic research'

Davies, 1999, Civil Service Policy Hub

Evidence-based policy

Evidence trajectories

Time

Hunch-based

Leve

l o

f a

ctiv

ity

Evidence-based

Absence of evidence?

or

Evidence of absence?

Smith GCS, Pell JP. (2003). Parachute use to prevent

death and major trauma related to gravitational

challenge: systematic review of randomised

controlled trials. BMJ, 327(7429),

no RCT evidence was found to

support the use of parachutes in

preventing death when exiting a

plane at high altitudes

We think that everyone might

benefit if the most radical

protagonists of evidence-based

medicine organised and

participated in a double-blind,

randomised, placebo-controlled,

crossover trial of the parachute.

4

18

16

9

4

0

2

4

6

8

10

12

14

16

18

20

strong

evidence

effective

weak

evidence

effective

absence of

evidence

mixed

evidence

weak

evidence

ineffective

Evidence for statements in public health white paper

No. studies

Srinivasa Vittal Katikireddi, Martin Higgins, Lyndal Bond, Chris Bonell, Sally Macintyre.

How evidence based is English public health policy? BMJ 2011;343:d7310 doi:

10.1136/bmj.d7310 (Published 17 November 2011)

Srinivasa Vittal Katikireddi, Martin Higgins, Lyndal Bond, Chris Bonell, Sally Macintyre.

How evidence based is English public health policy? BMJ 2011;343:d7310 doi:

10.1136/bmj.d7310 (Published 17 November 2011)

Olympic Legacy

• McCartney G, Thomas S, Thomson H, Scott J, Hamilton V, Hanlon P, et al. The health and socioeconomic impacts of major multi-sport events: systematic review (1978-2008). BMJ 2010;340:c2369.

• Weed M, Coren E, Fiore J. A systematic review of the evidence base for developing a physical activity and health legacy from the London 2012 Olympic and Paralympic Games. London: Centre for Sport, Physical Education & Activity Research (SPEAR), Canterbury Christ Church University, 2009

• Murphy NM, Bauman A. Mass sporting and physical activity events--are they "bread and circuses" or public health interventions to increase population levels of physical activity? J Phys Act Health. 2007 Apr;4(2):193-202.

"The participation target was intrinsically flawed from the

outset, not just because it was more convincing as a sales

pitch than a policy objective, but also because engaging any

number of additional people in some unspecified sporting

activity is not the same thing as a serious, targeted work

aimed at transforming the lives of Britain's neediest people."

Exercise on referral

Exercise on referral

• Sport-led

• Refer to facility

• Poor evidence base

• Health-led

• Often counselling

• Strong evidence

Williams NH, Hendry M, France B, Lewis R, Wilkinson C. Effectiveness of

exercise-referral schemes to promote physical activity in adults:

systematic review. British Journal of General Practice 2007;57:979-86.

Pavey TG, Anokye N, Taylor AH, Trueman P, Moxham T, Fox KR, et al. The

Effectiveness and Cost-effectiveness of Exercise Referral Schemes: A

Systematic Review and Economic Evaluation. Exeter: Peninsula College of

Medicine and Dentistry, 2011.

Anokye NK, Trueman P, Green C, Pavey TG, Hillsdon M, Taylor RS. The

cost-effectiveness of exercise referral schemes. BMC Public Health. 2011

Sowden SL, Raine R. Running along parallel lines: how political reality

impedes the evaluation of public health interventions. A case study of

exercise referral schemes in England. J Epidemiol Community Health.

2008 Sep;62(9):835-41.

Exercise Referral

Led walks programmes

Use evidence

Create evidence

“wanton large-scale experimentation is

unethical, and needs to be superseded by a more

rigorous culture of piloting, evaluating and using

the results to inform policy.”

House of Commons Health Select Committee