by Lloyd F. Novick, MD, MPH

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As DeGroff and colleagues point out in their article “Using Evidence-Based Interventions to Improve Cancer Screening in the National Breast and Cervical Cancer Early Detection Program,” the Affordable Care Act, with its expansion of insurance to 24 million individuals, has removed barriers to cancer screening. This legislation has required many plans to require preventive screening recommended by the US Preventive Services Task Force. This includes breast and cervical cancer screening. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), with a network of greater than 1000 primary care clinics, can increase screening on those newly insured as well as those who are uninsured or underinsured. This article describes the use of evidence-based interventions (EBIs) by this program. The Centers for Disease Control and Prevention (CDC) requests NBCCEDP grantees to use evidence-based interventions (EBIs) recommended in the Guide to Community Preventive Services. This article documents that on average 4.1 EBIs out of a possible 5 EBIs are being implemented per grantee for NBCCEDP clients and providers. This extensive use of EBIs is extending the reach and impact of the overall program.

In an accompanying editorial on evidence-based decision making in public health, Ross Brownson notes the availability of evidence-based interventions for the Guide to Community Preventive Services. He stresses the need to find ways to implement EBIs in the context of a real world environment. He suggests development of “administrative evidence-based practices” that can be associated with performance measures measuring the capacity to carry out EBIs.

Tangka and colleagues, in their article “Cost of Operating Central Cancer Registries and Factors That Affect Cost: Findings From an Economic Evaluation of Centers for Disease Control and Prevention National Program of Cancer Registries,” report that although a key driver of cost per case is low-case volume, registries receiving high quality data also have lower cost per case. They recommend that small-volume registries should consider consolidation and centralization of data collection to reduce the high fixed costs faced by cancer registries. Centralization can decrease the overall cost of reporting a cancer case.

Students of mine sometimes commented, “We look forward to our career as public health practitioners but without the politics.” They missed the point as demonstrated by the commentary in this issue authored by Edward Hunter. “Among professionals in public health, the political system is commonly viewed as a subway’s third rail: avoid touching it, lest you get burned.” He goes on to assert that the politics or third rail is what provides the power for resulting public health action. He gives advice for both public health professionals and politicians on how to work within this charged situation.

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Lloyd F. Novick, MD, MPH is the Founding Editor and Editor-in-Chief of the Journal of Public Health Management and Practice and Professor Emeritus of the Department of Public Health at the Brody School of Medicine, East Carolina University. Follow him on Twitter. [Full Bio]