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