Systematic reviews of effectiveness of Public Health practice

Background. Public Health is the main discipline involved in the prevention of avoidable deaths. To implement interventions aimed at eliminating causes of death, and to take decisions based on evidence of effectiveness, research summaries are needed. Methods. To discuss the critical points for synthesizing the evidence on the effectiveness of public health interventions, the inconsistencies between the results produced by different epidemiological study designs and the methodological issues related to the quality of the summaries. Results. The Randomized Controlled Trial is recognized as the best study design for the assessment of the effectiveness of clinical practices; however, the integration of the results from nonrandomized and randomized interventions has been suggested recently. In particular this involves Public Health, where the randomization of individuals is often impossible, and interventions are administered at different levels (individual, group, population). Conclusions. Systematic reviews are not common in Public Health. Methodological tools to write rigorous summaries of the evidence from public health interventions, taking into account all possible biases, appears to be a priority.