Your SlideShare is downloading. ×
Russo Obesity Presentation Paris
Upcoming SlideShare
Loading in...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.

Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Russo Obesity Presentation Paris


Published on

  • Be the first to comment

  • Be the first to like this

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

No notes for slide


  • 1. Public health policy, evidence, and causationLessons from the studies on obesity
    Federica Russo
    Philosophy, Kent
  • 2. Prologue
  • 3. Causality Across the Levels:Biomedical Mechanisms and Public Health Policies
    A British Academy funded project at Kent
    Genuine distinction between generic and single-case
    Yet, poorly understood, crucial questions remain
    Different notions at different levels?
    How to draw inferences from one level to another?
    How socio-economic variables affect health variables (and vice-versa)?

  • 4. Food for thought
    Studies on obesity provide a diversified
    and balanced philosophical diet

  • 5. The fat generation
  • 6. Facts
    In more and more Member States of EU
    More than 20% adult population is obese
    More than 50% adult population is overweight
    Up to 20% of children are overweight
    Check out stats:

  • 7. Causes and effects
    What are the causes of obesity?
    What are the causes of the increased prevalence of obesity?
    Health effects:
    cardiovascular diseases, cancer, diabetes …
    Socio-economic effects:
    standard seat width increased, office furniture, average passengers weight implications for fuel used by airlines, equipment in hospitals ..
  • 8. Something must be done
    Public health actions
    Worksite health promotion programmes
    School-based interventions
    Information on healthy eating

    What should we base public health actions upon?
  • 9. A plea for causally-based public health
  • 10. Overview
    Take-home message
    Public health actions need 3 types of evidence, having each a different role in informing actions
    A 3-step argument
    Public health and epidemiology.
    A population-level perspective on disease causation
    Evidence-based public health.
    Evidence assessment isn’t enough
    Causally-based public health.
    Causal assessment has 3 evidential components: difference-making, levels, mechanisms
  • 11. Public health and epidemiology
  • 12. Public-health is population-level
    PH aims to:
    Preventing disease
    Prolonging life
    Promoting health
    Actions to reach those aims are based on population-level analyses
    Epidemiology is essential for public health
  • 13. Epidemiology and disease causation
    Epidemiology studies how the distributions of disease
    and their biological and socio-economic determinants
    vary within and across different populations.
    Descriptive epidemiology
    Who, what, when, where.
    Focus on risks of exposure.
    Analytic epidemiology
    How and why.
    Focus on measures of associations to identify causes of disease,
    reinforce causal hypotheses with mechanistic explanations
  • 14. Two goals of epidemiology, arguably
    (1) To understand and learn about disease and
    (2) To take action in order to reduce the burden of disease at the population level
    Drawing causal conclusions from evidence
    Questions about what evidence
    for disease causation are upfront
    Difference-Making & Levels
    [See also Russo & Williamson (2007 and 2011)]
  • 15. evidence-based public health
  • 16. (2) Taking action to reduce the burden of disease
    Evidence-based public health is defined as the development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program.
    (Brownson et al., 2003)
    Evidence-based public health is the process involved in providing the best available evidence to influence decisions about the effectiveness of policies and interventions and secure improvements in health and reductions in health inequalities.
    Killoranand Kelly (2010, p. xxii)
  • 17. Evidence galore
    EBPH inherits from epidemiology
    crucial questions about evidence
    Evidence on focus
    Evidence on which one’s practice or policy is based
    Soundness of evidence
    Strength of inference permitted by evidence

    Whence the importance of evidence-assessment
    to assess the best evidence
  • 18. But what evidence serveswhat purpose?
  • 19. Causally-based public health
  • 20. The underlying intuition
    Arguably, making good decisions and taking good actionsdepend
    on having a good understanding of the phenomenon or situation.
    In public health policy, the better our understanding
    of the disease, the better too the interventions
    to reduce the burden of disease.
    Thus, if we accept the idea that understanding disease causation
    involves making considerations about different types of evidence,
    then those different types of evidence
    will also serve different roles in setting public health policies.
  • 21. A key feature of EBPH:Conceptual plausibility
    “An understanding of causal pathways defining the factors influencing health and the potential for intervention; use of different types of evidence to determine what works for whom in what circumstances.”
    (Killoran & Kelly 2010)
    What evidence gives us such information?
  • 22. What works for whomin what circumstances
  • 23. Difference-making evidence
    Correlations, probabilistic and counterfactual dependencies, etc.
    This is typically provided by descriptive epidemiology
    Informs about who, what, when, where.
  • 24. Evidence about the levels
    ‘Vertical’ level
    Whether interventions have to target
    the whole population, or only subgroups
    or individuals that fall under certain categories;
    ‘Horizontal’ level
    Whether it is most efficient to intervene on
    the social or biological factors of disease
    (or on both simultaneously)
    [See also Russo (2009) and (2010)]
  • 25. For instance
    The work done in local and national cancer registers
    or in obesity databases
    Research conducted in a number of projects
    promoted by the Executive Agency for Health and Consumers
    Nota Bene
    Those projects are listed under policy actions
    but are in fact exploratory:
    inform actions such as prevention in children
    or particular classes of professionals
  • 26. Causal pathways
  • 27. Mechanistic evidence
    Studies to test epidemiological hypotheses coming from descriptive epidemiology
    Analytic epidemiology
    Tests explanatory causal hypotheses
    That is, mechanistic hypotheses
    Answer questions about how and why
  • 28. For instance
    Studies on type 2 diabetes and
    on mechanisms regulating insulineresistance
    endocrine deregulation syndromes
    Studies on changes in dietary habits due to
    changes in socio-economic environments

    descriptive studies that discovered neat correlations
    and identified high risks
  • 29. Mechanisms and Levels
    Mechanistic evidence is concerned
    about the levels of causation too
    Average mechanisms vs single-case mechanisms
    No ‘conceptual’ priority of
    one type of evidence over the other
    True, different types of evidence may have
    unequal weights in assessing
    different hypotheses of disease causation
  • 30. To sum up and conclude
  • 31. Multi-level, Mechanism, Evidence, Action
    Studies on obesity and public health programmes
    What should be base public health actions upon?
    Public health, evidence, and causation
    Public health and epidemiology
    Epidemiology and evidence
    Evidence and causation
    Causally-based public health
  • 32. Selected bibliography
    Brownson, R. C., andT. L. Leet, E. A. B., and Gillespie, K. N. (2003). Evidence-Based Public Health. Oxford University Press, New York.
    Cartwright, N. (2008). Evidence for evidenced-based policy. Talk at a Home Office Seminar on Criminology and Evidence-Based Policy.
    Cartwright, N. (2009). Causality, invariance, and policy. In Kincaid, H. and Ross, D., editors, The Oxford Handbook of Philosophy of Economics, chapter 15, pages 410{421. Oxford University Press.
    Glasziou, P., Chalmers, I., Rawlins, M., and McCulloch, P. (2007). When are randomised trials unnecessary? Picking signal from noise. British Medical Journal, 334:349-351.
    Greener, J., Douglas, F., and van Teijlingen, E. (2010). More of the same? Conflicting perspectives of obesity causation and intervention amongst overweight people, health professionals and policy makers. Social Science & Medicine, 70:1042-1049.
    Guyatt, G. and Drummond, R. (2002). Users Guides to the Medical Literature: A Manual for Evidence-Based Practice. American Medical Association, Chicago.
    Killoran, A. and Kelly, M. P., editors (2010). Evidence-based public health. Effectiveness and efficiency. Oxford University Press, New York.
    Philipson, T. and Posner, R. (2008). Is the obesity epidemic a public health problem? A decade of research on the economics of obesity. Technical Report Working paper 14010, The National Bureau of Economic Research.
    Power, M. and Schulkin, J. (2009). The evolution of obesity. The John Hopkins University Press, Baltimore.
    Riboli, E. and Lambert, R., editors (2002). Nutrition and lifestyle: opportunities for cancer prevention. Number 156. IARC Scientic publications.
    Russo, F. (2009). Variational causal claims in epidemiology. Perspectives in Biology and Medicine, 52(4):540-554.
    Russo, F. (2010). Causal webs in epidemiology. Paradigmi.
    Russo, F. and Williamson, J. (2007). Interpreting causality in the health sciences. International Studies in Philosophy of Science, 21(2):157-170.
    Russo, F. and Williamson, J. (2011). Generic vs. single-case causal knowledge. The case of autopsy. European Journal for Philosophy of Science.
    Rychetnik, L., Hawe, P., Waters, E., Barratt, A., and Frommer, M. (2004). A glossary for evidence based public health. Journal of Epidemiology and Community Health, 58:538-545.