The rise of evidence based public health in the European Union.

Evidence-based medicine is most readily adopted when it can be applied to pharmaceutical or other clinical interventions for common diseases found in well-defined populations of patients. Public health policy on the other hand, is frequently formed in contentious, time-constrained circumstances where decisions are reached before the health problem and the population at risk are adequately defined. Policy may also emerge on the basis of an incomplete search for evidence and a limited assessment of the quality of research. Conducting trials of public health interventions is not usually possible in emerging disease situations such as a pandemic, where initially there are very small numbers of cases, speed of policy response appears critical and creating control groups for alternative interventions raises political problems. In respect of a problem such as illicit drug use, legal and ethical issues, populist politics and public opinion create significant barriers for evidence influenced public health policy. The paper examines the promotion of evidence based public health policies by the EU, using pandemic vaccination and responses to illicit drug use as cases.