Not everything you hear about health is true. PH asked public health experts to talk about what they see and hear in the practice of public health that is not right.
Linda M. Niccolai
Assistant Professor at Yale School of Public Health
"Individuals who claim that “condoms don’t work” are taking scientific evidence out of context."
Abstinence-only education proponents, politicians, and young men trying to convince their girlfriends they do not need to use condoms during sex endorse the notion that condoms are not effective in preventing the spread of sexually transmitted infections (STI). Condoms do in fact work, and the debate about condom effectiveness should be put aside. It is true that condoms are not perfect. Their effectiveness may be somewhat lower for STI that have clinical manifestations on anatomical sites not physically covered by condoms, such as human papillomavirus. However, laboratory studies prove that condoms do provide a highly impermeable physical barrier to transmission of particles of similar size to those of the smallest STI pathogens, and positive scientific evidence from population-based epidemiologic studies is growing.
Some criticism of condom effectiveness has spurred from the difficulty of conducting well-designed and methodologically sound epidemiologic studies on condoms. Many studies lacked sufficient numbers of participants to evaluate condom effectiveness with sufficient statistical power. Also, the vast majority of available studies had limited data regarding condom use in relation to exposure to STI. In other words, much condom use in studies is between two uninfected partners, which will always be inconclusive. These methodological problems are not the same as substantive doubt about the effectiveness of condoms. Individuals who claim “condoms don’t work” are taking scientific evidence out of context. Our challenges moving forward include finding the optimal methods for assuring that people who need protection are able and capable of using condoms consistently and correctly.
Paul Bolton
Associate Professor at the Boston University School of Public Health
Stress is a normal reaction to dreadful situations.
The most relevant misconception in the field of post-conflict reconstruction is the belief that, after a disaster, most people are severely mentally damaged in ways that require specialized counseling or treatment services. Although people who have survived war often exhibit severe distress in the short term, this does not usually translate into pathology in the long term. Temporary stress is a normal reaction to dreadful situations but is often mistaken for mental 'trauma' that needs treatment. In fact, most of this short-term trauma will resolve itself spontaneously. Only a small proportion of people require counseling or specific treatment. The rest are best served by interacting with family and friends, rebuilding habits, and returning to work or school.
Richard Garfield
Henrik H. Bendixen Clinical Professor of International Nursing at Columbia University.
It is poor science when we grab the biggest, worst numbers we can think of.
In public health we do two separate things: science and advocacy. Unfortunately, people working in public health too often don’t care to realize the difference. Advocacy involves communication and organizing. It takes time and often shows few splashy results. It is messy and political, and so often we don’t actually do it. As a public health worker you have to engage local officials, your funders, even your neighbors, in a discussion of where we need to go, step by step, in actual action on public health problems.
When we fail to engage as citizen advocates, we often resort to mixing advocacy in with our science. This causes confusion and defeats our special abilities to shed useful light on the problems we deal with. It is poor science when we grab the biggest, worst numbers we can think of to hit people over the head with a problem and draw funding to it. This gets some attention but fails to mobilize useful thinking or action.
To be better than the talking heads and politicians we are often up against, we should be modest and careful in what we report. We should give people a clue about how much we do know, and how solid a basis to sat what we are saying. This is a little harder than waving our arms and screaming about “millions and millions of something”, and it’s harder than whining about the system, but it gets things done.