Evidence-based public health--what level of competence is required?

BACKGROUND Increasing prominence is being given to the use of best current evidence in decision-making, both in clinical practice and health care management and purchasing. Public health is regarded as a specialty in which evidence-based decision-making may be taken for granted, partly because epidemiology is the principal basic science on which public health has developed. To practise evidence-based decision-making requires both organizations that have systems for finding and appraising evidence and professionals who are skilled in searching, appraising, storing and using knowledge. METHODS A workshop was organized which posed a challenge for participants based on the assumption that a public health specialist could face hostile examination by a lawyer in court on their abilities to find and appraise best current evidence. The findings from this workshop were tested at a second workshop in London. Participants were principally public health specialists from the United Kingdom. RESULTS Participants were able to identify the core skills that were required for public health specialists and the resources that the individual professional needed to practise evidence-based decision-making. It was also obvious that there was a gap between the level of competence required and the level of competence that many public health professionals actually had. There was also a gap between the resources that were needed by public health professionals wishing to find and appraise the best current evidence. CONCLUSIONS If public health wishes to continue to claim that it is in the forefront of evidence-based decision-making, both the skills of the professionals and the resources available to them need to be improved.