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The Use Of Epidemiologic Evidence For Public Health Is Doomed To Fail Without Champions According To Tobacco Control Expert

Keynote Speaker Shares Important Lessons That Apply To All Public Health Issues

 

It’s a paradox. Smoking and lung cancer are the perfect example of the power of epidemiologic evidence to bring about important social change, and the perfect example of the inadequacy of data to bring about important social change, according to Matthew Myers, President of the Campaign for Tobacco Free Kids. Speaking to The Epidemiology Monitor following his keynote address to a special meeting of the Young Epidemiology Scholars (YES) program in Washington in early June, Myers noted that “The effort to reduce tobacco use and the death and disease caused by it is often seen as one of the great public health victories, but while the progress that has been made is impressive, the battle is far from over. There are extraordinarily important lessons that apply to all public health issues.”

Disease Burden

In a talk entitled “Putting the Power of Science to Work—It Takes Leadership As Shown by Both The Failure and the Success in US and Global Tobacco Control”, Myers laid out the challenge facing scientists and others committed to tobacco control.

There were 100 million deaths from tobacco in the 20th century and an estimated 1 billion people will die from tobacco in the 21st century if current trends continue. According to Myers, tobacco is the leading preventable cause of death killing more than 400,000 annually which is a larger number than those dying from AIDS, alcohol, car accidents, murders, suicides, and fires combined. Nearly 90% of lung cancer cases, one third of the total cancer deaths, and twenty percent of the deaths from heart disease are tobacco related. Tobacco results in 96.7 billion in annual health care costs.

Hurdles To Policy Action

In his presentation, Myers sought to explain some of the reasons behind the slower than warranted progress in tobacco control. He noted that the tobacco industry was the first to recognize the power of politics and of political action and the importance of framing the debate. Thus, the industry developed political friends in high places, according to Myers, used the media to frame the issue as one of an individual’s right to choose or tobacco as a legal product or tobacco control as government intrusion, and it created scientific create doubt about the science.

He reiterated that in epidemiology and public health it is rarely enough to produce science and assume that change will happen. Change requires leaders, leadership, dedication, and sustained commitment, said Myers.

Three Hurdles

Like other public health issues, tobacco is a health issue, but its solution is a political AND social issue according to Myers. “All policy change faces three hurdles,” said Myers, including 1) “uninformed policy makers and the public, 2) inertia, and 3) active opposition—often from powerful forces that creates a lack of political will.”

To address these hurdles, Myers claimed a solid scientific base is a prerequisite. Stated most simply, “we must have the facts and serve as the information resource,” according to Myers.

More About Hurdles

Myers elaborated on overcoming the hurdles by saying that facts must be followed by achieving a public recognition of the problem. This he argued for in the form of media campaigns to keep the issue visible and framed as a serious problem with a sense of urgency if not public outrage.

Next he highlighted the importance of gaining support from organizations and individuals to join in the fight because “when priorities collide, political leaders do what they believe the people who are active care about.” He urged non-governmental groups to relate to government by helping where appropriate but pushing where necessary. He made a distinction between coalition building and advocacy stating that direct advocacy for public policies that make a difference is crucial and that advocates need to know who counts to make change take place. He cautioned that change does not occur overnight ---“it is a marathon not a sprint.”

Formula for Success

He told the audience “it is our responsibility to address all three hurdles.” His formula for success in bringing about change is: Science + Communications + Advocacy + Coalition Building = Policy Action, Environmental and Behavior Change. Individual leaders are required to make these elements happen, he said, and the roles of the engaged persons can vary depending on the circumstances, but all of the elements must be addressed.

Staying Objective

When asked about potential loss of objectivity for scientists engaged in the process of making change, Myers said engaging in the process of social change does not require a loss of objectivity. In fact, he said, “we expect nothing less from scientists” and being engaged is the best guarantee that the evidence produced by epidemiologists or other scientists is not ignored or misused. When scientists fail to engage, Myers said they fail to assure the proper use and impact of the evidence. Furthermore, it is important for scientists to be engaged with those interested in addressing public health and social problems because non-scientists can identify gaps in data which must be filled for the scientific work to be of real benefit

Constructing The Story

As part of his formula for success, Myers told the audience that scientists and public health professionals must be able to tell a compelling story and tell it simply. “We need individual leaders to be engaged, to reach out to the public, to make the case,” he told the Epi Monitor. “It does not happen naturally.” Using tobacco as an example, he said it is a story that can be and must be told in just four sentences or concepts:

1. We must act. We face a genuine tragedy if we don’t act, act now, and act decisively.

2. Tobacco caused deaths are preventable. We already know how to reduce tobacco use. And we can afford it.

3. The action we propose translated into lives saved, costs saved, and longer healthier living. This is about real people.

4. This is the time to act.

Champions

Myers anchored his talk in expanding on these four concepts concluding that people make a difference and that behind every public health victory is a champion or a group of champions providing the essential leadership element. Unless individuals and scientists feel strongly enough about the need to translate evidence into action or policy, then it won’t happen, said Myers. 

Even when the science is right, he added, well meaning decision makers have lots of problems to address. Which one gets tackled depends on which one has people behind it demanding change.

Perseverance

He reiterated that meaningful change takes time and perseverance. “What is radical and impossible today becomes tomorrow’s norm,” he said, “and success is rarely a straight line. But with the right effort, the arc of progress leans the right way. There is nothing more fulfilling,” he stated at the end of his presentation.

Audience Reaction

Kevin Xu, one of the young participants in the YES event in Washington, told the Epi Monitor that Myers’ presentation was remarkable and very different from other keynote speeches. Why? Because Myers’ talk was very down to earth and candid about the challenges facing those who would translate evidence into action, he said. He added, there is a “schism” between policymakers in the outside world and researchers in the ivory tower with the latter not really aware of what it takes to get people to listen or to take action. Myers’ talk was “very constructive”, he said.

 

 
 
 
      ©  2011 The Epidemiology Monitor

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