Floods, evidence based medicine and the welcome return of MedAct

At the start of all my lectures I’m briefing our students to observe closely the media coverage of floods across the UK. None have yet been affected directly, unlike my own family members beside Chesil Beach and the River Avon, but heated discussions develop quickly and the unfolding events are a master-class in the politics of environmental health.

George Monbiot’s recent article ‘Drowning in Money’ (http://www.monbiot.com/2014/01/13/drowning-in-money/) engages with the catchment management evidence, raises important questions about spending on flood defence and goes far beyond the simplistic and loaded language of many of those we elect to represent us. But recent events remind me of an earlier article by Peter Preston from January 2005 entitled ‘Bureaucracy is fine for them, not us’ (http://www.theguardian.com/society/2005/jan/03/internationalaidanddevelopment.politics) where, in the wake of the Indian Ocean tsunami, Preston argues that effective bureaucracy can be “the greatest friend of those in need”. Monbiot raises important questions about this effectiveness at all levels, but the ongoing floods remind me of the utility of local administrators who, far from burdening businesses with red tape, contribute towards the very functioning of our economy and wider society each and every day come rain or shine.

Second, the 25th Jan. edition of the British Medical Journal (Volume 348:1-40 No 7942) includes a wonderful oral history article and video on the origins of evidence based medicine (that informed our own definition of evidence based environmental health) which is available for free via: http://www.bmj.com/content/348/bmj.g371

In her associated editorial, BMJ Editor Fiona Godlee summarises the evidence based debate before commenting that, with apologies to Churchill, it maybe the worst system for clinical decision making, except for all the others, and it’s “only as good as the evidence and the people making the decisions”.

Lastly, November 2013 saw the welcome rebirth of MedAct, a charity for health professionals that campaigns for a safer, fairer and better world. I first came across their work whilst living in South Africa when I attended a launch of the 2nd (highly recommended) Global Health Watch report (available for free via: http://www.ghwatch.org/) which was partly co-authored by MedAct members.

For more information visit http://www.medact.org/ , but the videos from their re-launch (environmental health) conference are excellent and include many leading agitators (e.g. Richard Horton, Allyson Pollock, Andy Haines) for a better global public health (see http://www.medact.org/relaunch-conference/ ). I hope that more environmental health professionals will be willing to get involved in their work, if so I hope to see you there!

With best wishes,



2 thoughts on “Floods, evidence based medicine and the welcome return of MedAct

  1. Important to understand how “evidence basing” emerged from the muddy waters of “Expert” based Medecine. Also important to remember its quality can be impaired if the right parameters are not applied in terms of its collection, interpretation , and proper application in the decision-making process .

  2. I couldn’t agree more with your comment Maurice, but my concerns remain (see our eBook) that the decision making of many EHPs is not very evidence based and, worse still, we in the Universities teaching environmental health (who are mostly not research active ourselves) are sustaining this problem!!! Therefore I think we have much to learn from the journeys of Dave Sackett and others towards more evidence based working!

    With best wishes, Rob

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