Hess Jeremy J, Eidson Millicent, Tlumak Jennifer E, Raab Kristin K, Luber George
Climate and Health Program, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Environ Health Perspect. 2014 Nov;122(11):1177-86. doi: 10.1289/ehp.1307396. Epub 2014 Jul 8.
Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation.
Our goal was to review the literature on evidence-based public health (EBPH), to determine whether it can be applied to climate change adaptation, and to consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change.
We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders.
A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors currently limit application of the framework, including a lack of higher-level evidence of intervention efficacy and a lack of guidelines for reporting climate change health impact projections. To enhance the evidence base, there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This approach has implications for funders, researchers, journal editors, practitioners, and policy makers.
The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders.
公共卫生致力于循证实践，但对于如何将循证实践框架应用于气候变化适应方面的讨论却很少。
我们的目标是回顾循证公共卫生（EBPH）的文献，确定其是否可应用于气候变化适应，并思考强调循证实践如何影响与公共卫生适应气候变化相关的研究和实践决策。
我们对循证公共卫生进行了实质性回顾，确定了一个共识性的循证公共卫生框架，并对其进行修改以支持采用循证公共卫生方法来适应气候变化。我们将该框架应用于一个实例，并考虑了对利益相关者的影响。
一个经过修改的循证公共卫生框架能够适应与气候变化适应相关的广泛暴露、结果和探究模式，以及开展适应活动的各种环境。目前有几个因素限制了该框架的应用，包括缺乏关于干预效果的更高级别证据以及缺乏报告气候变化对健康影响预测的指南。为了加强证据基础，必须更加关注适应干预措施的设计、评估和报告；标准化健康影响预测报告；以及更多地关注知识转化。这种方法对资助者、研究人员、期刊编辑、从业者和政策制定者都有影响。
当前的循证公共卫生方法经过修改后可以支持气候变化适应活动，但关于干预措施和知识转化的证据很少，并且缺乏健康影响预测指南。要实现循证方法的目标，需要各利益相关者进行系统、协调的努力。
