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Preventing Childhood Obesity: Health in the Balance
without making implicit value judgments (NRC, 1978, 1996). The solution to this dilemma ideally lies in the development and application of new approaches for integrating scientific considerations with social and normative considerations in a transparent, fair, and competent manner (Renn et al., 1995; NRC, 1996; Klinke and Renn, 2002).
Although randomized controlled trials (RCTs) are the gold standard for testing interventions in clinical and public health research, it is not always feasible, appropriate, or ethical to use that methodology in conducting population-based research; furthermore, RCTs may not always illuminate the complexity of some population-based prevention strategies (Robinson et al., 1998; Briss et al., 2000).
Therefore, the evidence base regarding public health prevention efforts often involves the integration of a range of research methodologies. Several health promotion and disease prevention initiatives have implemented comprehensive population health programs using a broader integrated approach to the evidence. For example, Table 3-4 illustrates the different approaches required for guiding the design of individual and community-based approaches to CVD prevention (Osaka Declaration, 2001).
TABLE 3-4 Comparison of Individual and Community Approaches for CVD Prevention
Clinical Practice Approaches for Individuals
Community and Population-Based Approaches for Health Promotion
The evidence standards are RCTs
The evidence standards are RCTs and outcome and process evaluations that use both quantitative and qualitative methods
The focus is on individual patients
The focus is on the community
Less than a therapeutic dose is unacceptable
Preventive dose rarely applies
Easier to treat an individual
Difficult to scale up health promotion programs that reach the entire population
Outcomes of interventions are individual change
Outcomes are to change social norms, environments, and the behavior of entire populations
Interventions can focus on most factors relevant to outcomes
Interventions rarely take on social determinants external to the community