The Guide to Community Preventive Services. What works to promote health?

Citation

Speller, V. (2006), "The Guide to Community Preventive Services. What works to promote health?", Health Education, Vol. 106 No. 4, pp. 329-330. https://doi.org/10.1108/09654280610673508

The Guide to Community Preventive Services, or simply the Community Guide as it is known, was produced over eight years of collaborative work by an extensive team of experts in the USA, the Task Force on Community Preventive Services. Since 1996 this Task Force has systematically reviewed the scientific evidence from primary research on interventions to promote health. The review processes used have been based upon traditional methods of evaluating the effectiveness of health care interventions, and while there has been, and continues to be, debate on the merits of using such processes to judge the effectiveness of complex community‐based interventions, it has yielded an impressive suite of recommendations about what is known to be effective in the field. It is undeniable that the arguments for and against such an approach are still relevant, and the number of interventions for which the final conclusion remains “insufficient evidence to determine the effectiveness of the intervention” is substantial. However, it is equally well known that “no evidence of effect” does not mean “evidence of no effect” and the book should be used as an essential reference guide in that light. While the repetition of such statements is frustrating, this is a reflection of both the limitations of the review process, and of the depth and breadth of the research base upon which this is drawn, not of the quality of the exhaustive and systematic reviews and recommendations arising from them. Accepting these limitations the book presents a “snapshot” although given its length and detail this is hardly an appropriate term, of the state of scientific knowledge about effective health promotion at this time.

The Community Guide includes sections on methodology, including the use of economic evidence, and recommendations for how to use the information. This usefully references the web site www.thecommunityguide.org which contains related publications, summaries, full reviews, and importantly information on updates as new research becomes available. Interesting aspects of the methodology are the use of conceptual models to describe the relationships between causes of public health problems, interventions, and intermediate and health outcomes. Logic and analytical frameworks are produced to look at “big‐picture” relationships between determinants and interventions, and to focus in on the complex relationships between preventive interventions and outcomes, used to map the search area for evidence. The full content of the reviews are presented in topic‐focussed chapters in two main sections: Part I on changing risk‐behaviours and addressing environmental challenges, and Part II on reducing disease, injury and impairment. In changing risk behaviour topics include: tobacco, physical activity and the social environment. Chapters are quite broad in their scope, for example, the social environment encompasses early childhood development programmes, housing and culturally competent health care. Part II covers cancer, diabetes, vaccine‐preventable diseases, oral health, motor‐vehicle occupant injury and violence. For the most part selected studies are drawn from research in the USA and other developed countries, and are limited to English language literature only, but the authors point out that this bias will be reduced in future reviews. However, these constraints are similar to most other systematic reviews and do not limit the relevance of the recommendations to other countries. While the purpose of the Task Force was to provide recommendations for the USA, many of these are readily transferable, except for example, in the area of reducing violence from firearms where the legal and cultural context varies considerably, but such limitations are made clear. Finally, the Appendix provides a comprehensive listing of all the findings in a readily accessible format.

The evidence production industry worldwide continues to generate recommendations for effective interventions and areas where more and better research is needed. One of the advantages of a book such as this is having both the detail and a digest of the findings for a range of health promotion issues in one place and in a readily and traditional searchable format i.e. one can look up the index, flip the pages and read it on the train. However, it will always be necessary to keep such information updated and to search for evidence on specific issues on the web when needed. The real challenge of course lies in using the evidence and learning how to implement it in different contexts. This book should be treated as an essential reference and source of information on methodologies, on individual studies and on the current estimation, however limited in approach, on intervention effectiveness. It is authoritative and clearly presented, and should be used, along with other reviews of evidence, to inform debate about primary and secondary research methodology, and most importantly to inform investment in and effective delivery of, improved community‐based public health practice.