Randomised controlled trials as a driving force of evidence-based public health on the population level.

Abstract

IntroductionEvidence-based public health offers more useful and thoughtfully developed intervention efforts worldwide. Although the practice remains most utilised in the field of clinical medicine, public health has seen an influx of research based on randomised controlled trials (RCTs) for the purpose of assessing clinical interventions in the last three decades. We propose a paradigm shifttowards an evidencebased public health system buttressed by RCTs in order to equip those who practice and make policies with the knowledge they need to make informed decisions.While RCTs have resulted in substantial gains in public health, particularly in policymaking and determining the validity of interventions, such trials have largely been applied appropriately to the unique challenges of the field.1,2 We seek to show that it is possible to apply a framework for evidence-based public health with carefully crafted trials and analyses, and that RCTs represent an effective method of applying evidencebased public health strategies on a population scale. It is our view that RCTs represent the most effective means of implementing evidence-based public health on a population level. However, only recently have evidence-based strategies even been considered in decision-making regarding complex and crucial global public health issues.3If employed on a larger scale, evidence-based public health can empower policymakers as well as public health practitioners, medical professionals, and private individuals to make informed decisions based on carefully conducted trials and analyses that represent the best of our current collective knowledge and will have resounding positive effects, such as more effective and increased access to care.4Relevance Of Evidence-Based Public HealthThe field of public health has traditionally relied on less scientific methods of information-gathering, which has affected the way recommendations have been made to policymakers. RCTs represent a driving force for evidencebased public health that can be utilised specifically for pharmaceutical and other types of clinical interventions, especially with those diseases that afflict many and are well documented. RCTs represent the most effective means of implementing evidence-based public health on a population level. By building upon existing structures for training public health professionals and by implementing RCTs, the field can reap benefits of an evidence-based public health system.An evidence-based approach to public health offers a method for making policy decisions and recommendations, as well as population-scale interventions that are grounded in the scientific method. This is a departure from the ways public health efforts have traditionally been executed. Traditionally, evidence cited in the field of public health relies on multiple caveats, which is not ideal. This is because public health studies are often observational in nature, at times fail to utilise comparison groups, and are usually not fully experimental.5 Research practices in the field of clinical medicine, which typically relies on RCTs to derive evidence, offer a model for more precise and broadly applicable data collection than what is currently utilised in the field of public health. Due to the complex nature of public health challenges, carefully crafted means of gathering and interpreting evidence for interventions are crucial.Increasing Usefulness of RCTsA sound trial design seeks to minimise bias resulting from selection of information used in the study, offers deliberate control of all variables by researchers, and strives to eliminate the possibility of chance.6 RCTs are considered the best available tool for determining validity of design because such trials are seen as meeting these three objectives. Unfortunately, the kinds of probability results generated by RCTs when applied to large-scale endeavours in the public health field are, in isolation, unable to address many of the questions that arise. …