**21. Barriers to more extensive use of evidence in decision making**

Several obstacles are present in the decision-making process to better employ data and analytical processes [51, 64, 113] (**Table 5**). Others have explored possible


#### **Table 5.**

*Potential barriers and solutions for use of evidence-based decision making in environmental/public health.*

*'Silent Pandemic': Evidence-Based Environmental and Public Health Practices to Respond… DOI: http://dx.doi.org/10.5772/intechopen.100204*


#### **Table 6.**

*Factors influencing decision making amongst environmental/public health administrators, decision makers, and the general public.*

methods to overcome these obstacles [2, 3, 100]. The necessity for and relevance of evidence-based decision-making is the leadership that environmental and public health professionals need. Such leadership is apparent in training programs, for instance the regional environmental and public health leadership network [107] and continuous efforts to establish and distribute documented evidence-based recommendations for intervention [79].

However, numerous factors affect environmental/public health decisionmaking [114, 115] (see **Table 6**). Some of these variables are under the control of environmental**/**public health practitioners, while others are very difficult to change.

Also, there are quite at least four techniques in which environmental/public health policy or program cannot achieve a specific success goal:


However, part of the reason that environmental/public health-policy officials have struggled in the face of the COVID-19, is that it's very difficult to identify appropriate interventions that might inspire people to change their behaviors given reasons. For instance, do people who will not wear masks think the virus is not risky, since they do not think masks work, or just as their leaders including others aren't wearing them? To make matters worse, surveys or studies often represent only a portion of the population leaving those most at risk underrepresented. "Data can be instructive, but it does not speak for itself, as data access remains one of the primary hurdles to advancing science". "Behind every data point is a person. And with something like the coronavirus, where people are so deeply affected, there is need to think about the ethics of intervening in people's lives."

## **22. Addressing the issue**

While, the 2020 COVID-19 pandemic unlocked our eyes toward the everchanging situations as well as uncertainty that prevail in today world, particularly with regards to environmental and public health practices disruption. Due to the unprecedented novel nature and scale of coronavirus as well as the worldwide public/environmental health crisis nature, which upended several public/environmental research norms almost overnight. Though, the virus is expected with further waves as well as more pandemics increase is anticipated. COVID-19 had demonstrated a global catastrophe that touched everybody, including the scientific community. As we respond and recover rapidly from this pandemic, there is an opportunity to guarantee that the fabric of our society includes sustainability, fairness, and care. However, approaches to environmental health attempt to decrease the populations burden of COVID-19, toward saving patients from becoming ill along with preserving the allocation of clinical resources and public safety standards.

Even though the coronavirus continues to surge globally, the COVID-19 pandemic continues to put the health as well as economic security of millions of Nigerians and the world at large at risk, evidence is building and has accumulated over the course of the COVID-19 pandemic, scientific understanding about the virus has changed. Overall, to improve evidence-based or proven practices, every option must attempt to give practical recommendations on how programs and policies based on evidence in environmental and public health settings may be selected, implemented and evaluated. It also addresses the need for a highly trained environmental/public health workforce and expands available technologies, hence study into the origins of infectious diseases and the creation of vaccinations and medicines that have triggered formerly deadly diseases such as polio, smallpox and now COVID-19. Thus, the successful EBE/PH implementation in the practice of public/environmental health is both scientific as well as art. Science is based on behavioral, epidemiologic, as well as policy research that reflects the size with the magnitude of the public/environmental health issues and which interventions probable are to be of advantage to problem solving. The policy-making art experience usually comprises understanding of what information that is significant toward a specific stakeholder at the appropriate time. Remarkable environmental/public

*'Silent Pandemic': Evidence-Based Environmental and Public Health Practices to Respond… DOI: http://dx.doi.org/10.5772/intechopen.100204*

health decisions should balance science as well as art, because rational, scientificbased policy making that frequently comprises selecting an option amongst set of choices that are rational in nature.

By using the outlined concepts in EBE/PH above, decision making are ultimately improving environmental/public health practice; this is particularly important in a times when environmental/public health practitioners should be incentivized, not disincentivized, toward providing remote and long-term care and if implemented as well as maintained successfully in the post COVID era, this could benefit from our efforts as well as welcome efficiency consequence and cost savings [3–5, 15, 16]. These efforts can assist toward adapting effective interventions strategies to improve the pandemic response to COVID-19. However, suppression of the COVID-19 pandemic, cannot depend solely on the hope that effective vaccines as well as medical treatment, especially having the new, fast spreading SARS-CoV-2 variants: thus, an effective behavioral, environmental, social and systems interventions (BESSI) known as "Plan B" is needed to cut transmission. Given the pandemic, Covid-19 is probable to remain around to at least first quarter of 2022 (hypothetically followed via seasonal outbreaks), even if an effective treatments or vaccine is established, it is essential to deal with Behavioral, Environmental, Social and Systems Interventions (BESSI) now and establish long-term research priorities and processes for improving evidence on BESSI Interventions toward preventing as well as managing outbreaks of futuristic infectious diseases through fostering research synthesis, systems thinking, incorporating interprofessionalism and team-based care, piloting, prioritization, as well as field trials in partnership with health organizations, communities, policy makers, as well as an array of relevant researchers to BESSI research strategy (see **Figure 6**).

Furthermore, there is need to fund evidence-based projects that will focus on recognizing condition of a health or disease, aimed at which there is need for community support intervention as well as engagement toward addressing the issues, articulate a cultural appropriateness process must be established and recognizing community strengths as well as resiliencies, advancing knowledge must be promoted to address the condition of health or disease by etiologic research, prevention research, building robust frameworks for governance, oversight, and accountability, treatment or research recovery, or dissemination as well as implementation research and accounting for sustainability in test communities

#### **Figure 6.**

*Behavioral environmental social and system intervention (BESSI) (for pandemic preparedness) research strategy. Adapted from [116].*

and for dissemination and scale up to other communities as indicated. Hence, real-world evidence could significantly improve public health (community medicine, preventive medicine, social medicine, as well as community health) decisions throughout the health system, eventually improving environmental health. However, expanding its usage, will need multi-stakeholder engagement on numerous priorities, along with country-specific initiatives. Therefore, the broader public/environmental health community is best positioned toward making progress in addressing individual behaviors, social circumstances, or environmental factors associated with a disorder or disease. Making improvement on such goals will thereby help contribute to the creation of a culture where evidencebased innovation may thrive, while also ensuring that the required, complementary proficiencies occur toward supporting traditional research and development (R&D) operations activities. Likewise, governments at all levels must act expeditiously and aggressively in providing robust support for crucial national public/ environmental health as well as health care programs, the development of medical countermeasures, global readiness and response mechanism programs as well as international collaborations. So as to reduce the virus effects. National as well as international response prompt action are now needed to respond and prevent worst case health as well as economic repercussions. Based on the identified realities of the present COVID-19 pandemic, it seems that government must urgently take additional steps now to prepare domestically and to invest globally and to help make the shift from containment of the virus to mitigation of its effects. This shift will be difficult, and the response will be exceptionally resource intensive. Response as well as readiness toward threats to health security like COVID-19 is as critical to the safety as well as well-being of humanity. Preparedness for emergency situations have been essential for increasing national resilience and capacities to combat health risk emergencies. There is need to build systems to strengthen evidence-based research and expertise must remain sustained as well as boistered. With the intention of reducing death as well as diseases in the current dark times and time to come. The COVID-19 pandemic provides a unique opportunity to discuss critical issues related to defining living reviews and how often they should be conducted. It has significantly accelerated the production of living reviews as a useful tactic toward informing decision makers in a context where evidence is constantly evolving on a regular (sometimes even on a daily basis). Since 'living' reviews are most useful in a context where information is changing relatively frequently on a topic, so hopefully an update is expected to be happening at pace with evolving literature. From this perspective, part of the requirements of a living review should be that there is a positive plan to monitor for new relevant data or evidence, and a plan for managing this evidence when it emerges. Hence, there is needs to be a plan for incorporating new information as it emerges, with the aim that decisions that are made on the basis of the reviews can be relied on or trusted to be informed by the best current evidence. Thus, the framework above provides an important Living Evidence Network criterion from a positive sense (i.e., the question must be an important priority, there is uncertainty in the outcomes, and that new forthcoming evidence can likely improve this certainty). It is important to assess whether or not the review should no longer be updated on a living basis if at least one of these characteristics are no longer true. As we have seen with COVID-19, the frequency of updating may vary depending on the rate at which new research is coming through and its likely impact on the evidence base, but whatever frequency is adopted this needs to be communicated clearly together with the intent to keep the review under active surveillance. While, communicating with users and readers about the currency and comprehensiveness of the evidence.

*'Silent Pandemic': Evidence-Based Environmental and Public Health Practices to Respond… DOI: http://dx.doi.org/10.5772/intechopen.100204*
