The nature of evidence in public health decision making

This research into decision making around public health in local authorities demonstrates an interesting parallel to decision making in NHS commissioning processes in CCGs.

Evidence-based medicine meets democracy: the role of evidence-based public health guidelines in local government
M.P. Kelly L. Atkins C. Littleford G. Leng S. Michie
J Public Health (Oxf) 2017, p1-7. DOI:

NICE has published a number of public health guidelines developed using classical evidence based approaches. Researchers interviewed¬†public health local authority (LA) employees in four LAs about their experiences of implementing these guidelines following the move of public health functions in 2013. Participants reported tensions between evidence based and political decision making, differences in views about what constituted “good” evidence, and that organisational life is an important mediator in the¬†way evidence is used.

“Political decision making does not necessarily align with decision making based on the evidence from the international scientific literature, and local knowledge and local evidence are very important in ways that public health decisions are made.”




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