Evidence-Based Public Health: Origins, Assumptions, and Cautions

This chapter presents the origins and assumptions of evidence-based medicine as rooted in the philosophy of science called positivism. The basic principles of the positivist approach to science, empiricism, exclusivity, universality, and autonomy are explained and identified in reproductive and perinatal health outcomes related studies from the systematic reviews of the Cochrane Library, the premier database on evidence-based medicine. A series of articles published in the Evidence-based Public Health Policy and Practice section of the Journal of Epidemiology and Community Health are used to contrast the difference between evidence-based medicine and evidence-based public health. The series of seven articles related to issues of reproductive and perinatal health outcomes demonstrates that evidence-based public health departs from positivism by their incorporation of a diversity of methodological research strategies, by their interest in local and community focus, and by embracing research with clear political implications. As evidence-based public health overcomes the limitations of positivism, researchers should be aware of the limitations of some evidence-based approaches.