**5. Triangulating evidence**

Triangulation is the process of combining multiple evidence from various sources toward gaining understanding into a specific topic as well as typically includes both qualitative as well as quantitative data [39]. It often entails the application of several ways of data collection as well as analysis toward determining disagreement or commonality points. Due to the corresponding nature of evidence

from varied sources, triangulation is generally useful. Even though quantitative data offer an outstanding opportunity toward determining by what method, variables are made in the lives of many individuals, these data does not provide much insight into why such associations exist. Qualitative data, on the other hand, can aid in providing information toward explaining quantitative results, or what is known as "illuminating meaning". Many instances of the application of qualitative as well as quantitative data triangulation toward evaluating health programs as well as policies, together with AIDS & HIV prevention programs [54], policies as well as programs on occupational health [35], and programs in community settings toward chronic disease prevention [2, 55].

### **6. Geographic and cultural differences**

The concept of EBPEH was developed largely by a context of Western, European American [56]. The epistemologic grounds of logical positivism, which discovers meaning by a rigorous observation as well as measurement, are revealed in the reality through the conceptual method. This is apparent in a professional preference aimed at randomized controlled trial between clinicians designed for research designs. Additionally, most research in the EBPEH literature are academic research, typically through well-established investigators receiving external financial support. In dissimilarity, even if the problem scope might be huge, the information base aimed at how best toward addressing mutual public/environmental health glitches is generally limited in emerging countries as well as some impoverished areas of affluent countries, Cavill and colleagues [57] likened interventions that are evidencebased across European countries, demonstrating that considerable evidence base is restricted toward experimental observations in various domains. Even in nations that remain developed (such as United States), much of peer-reviewed published information in journals or data made available by websites as well as government agencies might not sufficiently epitomize entirely interested populations. There are (4) four prime user evidence groups in environment and public health, namely: practitioners of environmental and public health as well as their partners, who are likely to recognize the scope as well as quality of evidence in certain strategies (for example, policies, programs)? In actual fact, nevertheless, practitioners of environmental and public health often possess a comparatively narrow selection process option. Funds resulting from local, state and federal sources are usually earmarked for definite purpose [for example, sexually transmitted diseases as well as surveillance treatment [54], establishments of retail food inspection [58–60]. However, there is an opportunity for environmental and public health professionals, including the responsibility, toward cautiously examining the evidence to find alternative methods toward achieving required health goals [3, 15, 35, 61, 62]. Decision-makers at regional, state, local, national, as well as international levels (deciding at the macro level in what way toward allocating public resources aimed at which they have remained nominated stewards [2, 16–18, 20–22, 63] make up the next generation user group. This group is also in charge of extra responsibility for formulating policies for complex and controversial public issues), Stakeholders (This group consist of many development partners i.e., NGOs whose missions' emphasis on or incorporate health improvement, either directly or by improving the social as well as physical milieus that remain significant demographic health determinants for example whether the community water supply should be fluoridated, dumpsite should be sited in a community cemetery or burial ground) and researchers on population health issues (They create as well as apply exploring research hypotheses using evidence. Some remain principally interested in used methodologies toward

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

determining the quality as well as research implications on population-based interventions studies). Both enhance and use the evidence to answer research questions. However, the additional increased benefits of evidence-based environmental/ public health (EBE/PH) have many indirect as well as direct benefits, including access toward a more as well as better quality evidence toward improving public's/ environmental health, an effective and efficient probability of successful policies as well as programs implemented, better workforce productivity, as well as greater efficient usage of private as well as public resources [10, 64]. Therefore, in most areas of environmental, public health as well as clinical practice, decisions about when to intercede as well as what policy or program to execute remain not simple as well as straightforward. These choices are generally based on (3) three essential questions: (1) Should public and environmental health intervention remain taken toward addressing a specific environmental/public health concern (Type 1, etiologic information or evidence of behavioral knowledge)? (2) What measures or action must be taken (Type 2, intervention evidence or proof of intervention)? (3) In what manner can a specific policy or program remain implemented most effectively at the local setting (Type 3, contextual evidence)? **Table 1** presents a range of systematic evidence aimed at public and environmental health practice [2, 38, 64]. Evidence from Type 1 assesses the diseases causes as well as its severity, magnitude, and risk factors preventability as well as diseases. Also, evidence from Type 2 describes the comparative effects of specific interventions that may or may not advance health and evidence from Type 3 comes from the context of the intervention and specifies the five (5) overlapping domains (**Table 2**).

Firstly, there are features of the number of populations for intervention like, for instance education level as well as health history. In addition, interpersonal variables make available an important context. For instance, an individual with cancer family history might be more probable toward undergoing screening of cancer. Thirdly, institutional variables ought to remain considered. For instance, whether an organization is successfully implementing an evidence-based program that may remain influenced through the aforementioned capacity (example, professional workforce, organizational leadership) [1, 2, 7, 64].

Fourth, it is argued that social norms and cultural norms cause and shape a lot of health behaviors. Lastly, more economic as well as political forces tend to affect context. For instance, the occurrence of high rate aimed at certain disease like the recent COVID-19 pandemic, has claimed far too many lives worldwide. Fortunately, as environmental health officers and doctors continue to gained more experience at monitoring, contact tracing, communicating and treating COVID-19 patients, and many people hospitalized eventually recover, this might impact a state's political will toward addressing the problem meaningfully, logically as well as in a systematic method [1–3, 9, 10, 19]. Particularly because of the understudied populations at high-risk, there is a great requirement for more evidence between contextual variables as well as process toward adapting program change as well as policies in context as well as population subgroups. Problem-solving questions are addressed in novel detail known as "realist review," which remains a systematic assessment procedure that explores not only how intervention works, but then again by what method, interventions measures work in a real-world situation [1–3, 53, 65, 66]. Numerous ideas are important in achieving a greater evidence-based method toward the practice of public and environmental health. Essentially, scientific knowledge is required on programs as well as policies that can be effective toward promoting and improving health (i.e., conducting evaluation research toward generating sound evidence) [2, 3, 64, 67]. Second, in order to transform science into scientifically sound practice, there is a necessity toward marrying evidence-based interventions information from peer-reviewed literature through the realities of a

definite real-world milieu [2, 3, 64]. To achieve this, there is prerequisite to properly define decision making procedures that must be evidence-based. Lastly, widespread dissemination of proven effectiveness interventions must arise more constantly at levels of state as well as local [3, 35, 68, 69]. Therefore, the main characteristics of evidence-based features of public and environmental health decision making comprise:


For instance, the injury management program remained properly discontinued after evaluating its effectiveness. This program evaluation demonstrates the usage of both multiple critical quantitative as well as qualitative data toward framing the evaluation model.

vi.Disseminating what is being taught to key stakeholders in decision-makers: If a policy or program is implemented, or if final outcomes is recognized, other public and environmental health such as community medicine, social medicine, community health and preventive medicine (environmental health) can draw on their research findings toward enhancing their own evidence use, while making decision. It can be disseminated or communicated to health practitioners through scientific literature, toward overall public through the media, toward decision-makers through individual meetings, as well as toward training public/environmental health professionals. In many settings, effective interventions remain required**,** comprising worksites, health care settings, schools, as well as wide-ranging community environments etc. Hence, accomplishing these activities in EBE/PH is likely to require a synthesis of scientific skills, enhanced communication, common sense, and political acumen.
