The UK Public Health Practice - Essay Example

CRITICALLY REVIEW AND APPRAISE THE EVIDENCE THAT UNDERPINS UK PUBLIC HEALTH PRACTICE Public health has become increasingly a matterof concern in the new world order. This has been stimulated by the emergence of new health concern issues. These include the wide spread of HIV and AIDS infection; the reemergence of previously eradicated diseases like polio; the increased drought and hunger endemic; the increase in tension among enemy countries thus posing the risk of war using chemical, biological and nuclear weapons. These issues of concern make it extremely vital for everyone to be on their toes (Milner 2008, p114). We all need to be ready and prepared for any issues that threaten our health. We cannot afford to sit back and watch as health matters go astray (Steel 1987, p68). All medical practitioners from the management to the assistants have taken up seriously the matter of evidence research. There are many kinds of research, namely the randomized control trial, qualitative research, the survey and action research (Gomm & Davies 2000, p18). Evidence research is the form of research where the researcher builds his study around or based on an evidence or fact proven by an earlier conducted research. This is the form of research that is taking a toll in the current world. Nations are rooting for its development. It is relatively cheaper and faster. It encourages a chain of continuous discoveries and inventions. Strong promotion of the use of research evidence to underpin public health policy is currently ongoing. It is slowly but surely taking over from the evidence based medicine policy. In the UK, the body charged with the development of this new system of research is the National Institute for Health and Clinical Excellence. Critical evaluation of governments’ use of evidence Evidence shows that the response to a similar public health intervention is very different between separate populations. Likewise, an intervention which generally improves a population’s health has the capability of increasing inequalities in health. In this regard, a government should not focus only on intervention’s average effects for it is likely to miss important differences. It is in fact argued that the approach of public health through evidence based research actually increases inequality bias. This is for instance the case when based on the fact that most people over the age of sixty die of cancer, the government responds by offering free chemotherapy sessions for this population only in its facilities. This creates an inequality bias on the other populations (Orme 2007, p28). It may even intensify the severely of the situation in the other populations. Legislation and decision making on matters that affect public health is such a complex phenomenon. Almost all sectors of the economy affect public health in one way or the other. Research evidence aids in simplifying the depth to which the government has to sink into research in pursuit of the right legislation to employ. It thus simplifies policy making in all fields. These include the transport sector, the agriculture sector, the fishing sector, the town planning agency, the fiscal sector among others. The U.K government makes use of evidence research to come up with a quick solution to a problem of public health concern. There is a very large number of people who are affected by public health policy. Thistremendously increases the necessity for proper decision making. It is a fact well known that in order to come up witheffective public health legislation; its evidence has got to include a very wide range of influence. This is unlike evidence based medicine, where arbitrarily controlled trials as well as systematic reviews form the basis of the matter.Providing evidence in the case of public health policy is relatively speaking much more complex (Bulock 2001, 131).. The policy making process definitely involves an array of steps. Most studies from around the world reveal that research is not the only factor that influences public health decision making. This has affected very many countries around the globe. It is the case in the UK as well. Interviews conducted with UK policy makers, their general practitioners as well as researchers who are charged with the responsibility for commissioning on behalf of the UK government in health revealed undoubtedly that research is actually only one amongthe several other sources of information. Some of these sources were sought out, while the others were actually imposed on them. They were drawn upon in the course of making decision (Dalton 2009, p187). These other factors also influence decisions that are made regarding public health by the managers and the policy makers of the land in the UK includes: the budget involved, the competition in the local scene, the degree of strategic fit, the amount of pressure sustained from the stakeholders and finally the general public opinion. The decision makers in matters related to public health in the UK also make use of an array of sources of evidence, other than the systematic reviews as well asthe primary research studies. These include the evaluations of internal program, as well as the best practices that are employed locally and provincially. These policy makers in matters that regards to public health as also consider the political viability of the policies they attempting to come up with, the degree of each unique community’s support. They also take note of the presence of good evidence, the general intuition, the professional expertise that is available, thepreferences of the patients that are involved and other mechanisms such asthe available precedence (Plymouth &Thatcher 1999). Hence, the process of decision making in the UK inmatters regarding to public health employs a mix of forms of evidence to be able to come up with proper policies The steps undertaken in research evidence are typically: problem delineation followed by option development and lastly followed by implementation. The proof that is required at each and every step is noticeably different. Therefore, public health evidence has got to cover, not only the issue of efficiency of interventions; but it has also got to cover the issues of association, executionas well as the issue of feasibility. The latter are regrettably less frequentlytackled by research evidence. In this view, it is clear that public health evidence is far away from being either perfect, complete or unequivocal. Research results are hardly ever definitive or stout that they completely and undoubtedly rule out all substitute emphases (Ruddolf , Backstubber & Lahm 2007, p95). They at all timesneed some form or extent ofanalysisfor the sake of being able to be implemented efficiently. Recommendedsupplementary sources of evidence comprise of: the opinion of the experts or professionals, the knowledge gathered from case study, the social values and impact of various aspects as well asthe patients or clients’tastes and preferences. In spite of such intricate decision making atmosphere, until very recently, only a few of the primary research studies had cared to take it upon themselves to reveal how the decision making process inpublic health made use of research evidence as they go through their business in their day-to-day routines at work. In order that it becomes simple to synthesis and understand the newly emerging results, researchers havein turntaken it upon themselves to steadily review studies which disclose how research evidence should rightfully be used by thedecision makers in the public health domain. There is enough evidence that warrants the suggestion that planners as well as the policy makers all have anextremely different pointof viewwhen administeringhealth care mechanisms based largely on personal medicine, which is contrary to those where bywidespread coverage is offered on the foundation of obligatory health insurance or even taxations. In this regard, researchers explicitly limittheir systematic assessment. Limitations and implications of research evidence Majority of the researches are conducted using research evidence some of which include qualitative studies (Fraser and Mathews 2008, p77). Researchers come across barriers as well as facilitators in the application of research evidence in the decision making process in public health. They address quite a number of issues in the decision making process. Some of the concrete specific aspects which are addressed in the decision making process include: the impact of epistemologyin production as well as onthe evidence; the influence that research presentation has on the process of decision making; the success of current information transfer processes; the worth of models in the process of improving decision making as well as priority setting. This also includes timescales for the process of decision making. There is a clear cut degree of general consensus that cuts across all research studies. These aredrawn from the various make ups and they include a wide range of types of decision makers. They impact on the most significant factors which limit the use of research evidence during thepolicy making process in public health (Bulock 2001, p69). From the investigation of two typical studies that were conducted in the UK, it is clear thatthere was perceived lack or failure to conduct research evidence among thedecision makers in public health. There are other studies which have found a negative opinion of the existing research facts commonly marred with incompletionin their use. These incorporated: alarge quantity of “policy free” proof; an unwarrantedattention on randomizedprohibited trials;a large amountof scientific doubt; deprived local applicability; a lack of determination on the communal determinants of physical condition; and lack of intricacy to tackle multi-component health mechanism. Another one of the main, limitations to research evidence is lack of the evidence in the first place (Ruddolf, Backstubber & Lahm 2007, p234). A mechanism to limit the amount of traffic in the UK is employed. This is aimed at eventually reducing the amount of carbon emissions. Carbon emissions combine with oxygen in the atmosphere and form carbon dioxide and carbon monoxide. Carbon dioxide reduces the amount of oxygen used by humans for respiration. Carbon monoxide is poisonous to the human body when inhaled into the human body system. The mechanism which is employed to limit the amount of traffic is also aimed at encouraging physical exercises through cycling or walking as pedestrians. It is however not easy to evaluate the effectiveness of this mechanism due to a lack of evidence of the amount of people who actually resort to walking or cycling. It is not easy to measure or conduct an assessment of trends of cycling, walking or driving. The only way out is to try and evaluate the number of people cycling or walking or driving by observing the trend then forming a general pattern which does not boil down to specific figures. The final figures are obtained by sheer speculations out of the general trends. This is a huge set back to the process of research evidence. Some of the studies conducted in the UK reported a gap between the decision makers andthe researchers under the study. Thisprohibited the products of research from steaming right into the decision making processes. In some of these researches the customsin which decision makers workdirectto the compilation and assessment of research to be perceived as “non-work” amongst the people who had to look likethey were taking action. Other studies establish that policy makers are not backed (by means of training, the configuration of factsemployed to enlighten decisions, and the prospects of superior managers) to obtain the necessary skills or to make use of research evidence (Bulock 2001, p78). A frequent finding from some of the studies is that opposing influences, which includemanagerial, political and tactical factors; fiscal and supply constraints; individual experience; basic common sense; specialist opinion; shareholder and communal pressure; the public views and local rivalry, limited the utilization of research evidence in the decision making process regarding public health. Practical limitations on the utilization of research evidence in the process of decision making are also frequently reported (Fraser & Mathews 2008, p142). These include: mismatchedtimelines for research as well as for policy making; troubles in disseminating as well asreaching research evidence; and also in its presentation (thisis seen to be meantfor an intellectual audience) and understanding. Proof on how to conquer these limitations to the utilization of research evidence in the decision making process regardingpublic health is less widespread.Some studies report anappeal for enhanced communication and continued dialogue among researchers as well as the end users. In one study, the significance of faith, among researchers as well as the policy makers isstressed. Capacity building is as wellperceived as significant to boost researchers abilities to create and efficientlypropagate evidence of utilization of decision makers, and also to advance policy makers attributes to significantlyevaluate and understand these results. Methodological research isconsidered to be desirable to come up withefficient means of assessing multi-component interceptions (Wright & Crespo 2001, p214). In some studies it isunderstood that altering the customsin which the policy makers labor (in stipulations of organization, rewards and teaching) so that additionalworth is sited on the utilization of research evidence in decisions mayhasten its use. Other studies stipulate precise necessities for research to additionallyenlighten decision making (Ruddolf ,Backstubber & Lahm 2007, p52). Study types which are particularly proposed,requests are varied and replicate the variety of decision makers taking part in the incorporated studies. These include: “fine stories”; family studies; normal policy experiments; past evidence which have a long life inshelf; restrictedassessment of interventions; proof on the outlay of action or in other cases inaction; observational studies whichrecognize a setback; prognosticmodelingas well as cost-effectiveness lessons; and systematic reviews thatsuccessfullysum up evidence and boostself-confidencevia critical appraisal Conclusion Outcomes from the studies conducted within the UK propose that the course of decision making is one that varies extensively among settings; it is regarded in a different way by key participants. A wide assortment of research evidence is obtained (Parker & Milner 2008, p35). Nevertheless, there is no steadfast proof on the scope to which it is utilized. Its force is frequently not direct, and sits in conjunction withnumerous other influences. Inhibitors to the utilization of research evidence are well articulated and comprise: decision makers conceptualization of research evidence; the gapthat is between the researchers and the decision makers; the customs in which decision makerswork; oppositionimpacts on decision making; and realistic constraints. Recommended (although generally untried) ways of outdoing these barriers comprise of: research waged at the requirements of decision makers; study clearly stresses key messages; as well as capacity building. There is slightproof on the role that is played by research in affecting decision making to decrease health liabilities, a primeobjective of public health policy. Research evidence is a newly developed method of conducting research (Brown, Crawford & Hicks 2003, p34). It greatly saves on time and resources. It allows for an increase in the tendency to make discoveries and innovations. The UK government is steadfast in introducing this method to all its stake holders (Steel 1987, p67). It is used to aid in the decision making process in public health. There are many limitations to this method but by and by they can be overcome. The UK government is very steadfast in enhancing the public health of its citizens. It has adopted great practices which are geared towards ensuring that the health of its citizens is held with utmost regards. Studies conducted in the UK confirm the use and steadfast growth of research evidence. References Brown B, Crawford P, Hicks C (2003) Evidence Based Research: Dilemma and debates in health care. London: Taylor & Francis Gomm R and Davies C (EDS (2000) using evidence in Health and Social Care. New York: Springer Keeping C (2008) Practitioner Research. New York: Springer Fraser S and Mathews S (2008) The critical practitioner in Social Work and Health Care. London: Oxford Orme J (2007) Public Health for the 21st Century (2nd Edition). 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