Cwikel J G
Charlotte & Jack Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Public Health Rev. 1994;22(3-4):375-94.
The underlying purpose of all epidemiological research is ultimately to use inferences in order to prevent disease and promote health and well-being. Effective skills in translating results into appropriate policy, programs, and interventions are inherently tricky, and often politically controversial. Generally they are not taught to epidemiologists formally, even though they are a traditionally part of public health practice. To move from findings to policy change requires that the informed and committed epidemiologist should known how to: (1) organize affected parties to negotiate successfully with government and industry; (2) activate populations at risk to protect their health (3) communicate responsibly with lay persons about their health risks so as to encourage effective activism; (4) collaborate with other professionals to achieve disease prevention and health promotion goals. The paper presents and discusses four case studies to illustrate these strategies: (1) the grass-roots social action that was the response of the community to the environmental contamination at Love Canal, New York; (2) mobilization of recognized leaders within the gay community to disseminate HIV risk reduction techniques; (3) collaboration with an existing voluntary organization interested in community empowerment through health promotion in a Chicago slum by using existing hospital, emergency room admissions, and local motor vehicle accident data; (4) a self-help group, MADD (mothers against drunk driving) which fought to change public policy to limit and decrease drunk driving. In addition, the importance of multidisciplinary collaboration and responsible communication with the public is emphasized. Factors that limit the ability of the epidemiologist to move into public health action are discussed, including who owns the research findings, what is the degree of scientific uncertainty, and the cost-benefit balance of taking affirmative public action. Putting epidemiological knowledge to good use should be an integral part of an epidemiologist's repertoire.
所有流行病学研究的根本目的最终是运用推断来预防疾病、促进健康和福祉。将研究结果转化为恰当的政策、项目和干预措施的有效技能本身就很棘手，而且往往在政治上存在争议。通常，即使这些技能是公共卫生实践的传统组成部分，也不会正式教授给流行病学家。从研究结果转向政策变革要求明智且坚定的流行病学家应该知道如何：（1）组织受影响各方与政府和企业成功谈判；（2）动员高危人群保护自身健康；（3）与非专业人士就其健康风险进行负责任的沟通，以鼓励有效的行动主义；（4）与其他专业人员合作以实现疾病预防和健康促进目标。本文展示并讨论了四个案例研究以说明这些策略：（1）纽约州洛夫运河社区针对环境污染做出的基层社会行动；（2）动员同性恋社区内知名领袖传播降低感染艾滋病毒风险的技巧；（3）与一个现有的志愿组织合作，该组织通过利用现有医院、急诊室入院数据和当地机动车事故数据，在芝加哥一个贫民窟开展以促进健康为目的的社区赋权活动；（4）一个自助组织——反对酒后驾车母亲协会（MADD），该组织努力推动公共政策变革以限制和减少酒后驾车。此外，还强调了多学科合作以及与公众进行负责任沟通的重要性。文中讨论了限制流行病学家采取公共卫生行动能力的因素，包括研究结果的归属、科学不确定性的程度以及采取积极公共行动的成本效益平衡。善用流行病学知识应成为流行病学家全部技能的一个组成部分。
