Public Health Practice

Public health practice is understood broadly as the collection and analysis of identifiable health data by a public health authority for the purpose of protecting the health of a particular community, where the benefits and risks are primarily designed to accrue to the participating community. Public health practice is dominated by the use of standard, accepted, and proven interventions to address known or suspected public health problems.

Per the Revised Common Rule, the following are considered Public Health Surveillance, not "Research" subject to the Common Rule:

  • Public health surveillance activities conducted by a public health authority, limited to those necessary to allow a public health authority to identify, monitor, assess, or investigate potential public health signals, onsets of disease outbreaks, or conditions of public health importance.
    • Including the collection and testing of information or biospecimens, conducted, supported, requested, ordered, required, or authorized by a public health authority.
    • Including trends, signals, risk factors, patterns in diseases, or increases in injuries from using consumer products.
    • Including those associated with providing timely situational awareness and priority setting during the course of an event or crisis that threatens public health (including natural or man-made disasters).

As explained by the CDC:

For many public health practice activities, data are systematically collected and analyzed. Scientific methods are used in both public health research as well as public health practice activities. Knowledge is generated in both cases. Furthermore, the extent to which knowledge is generalizable might not differ greatly in research and nonresearch. Thus, nonresearch and research activities cannot be easily defined by the methods they employ. Three public health activities – surveillance, emergency response, and evaluation – are particularly susceptible to the quandary over whether the activity is research or non research.

The major difference between research and nonresearch lies in the purpose of the activity. The purpose of research is to generate or contribute to generalizable knowledge. The purpose of nonresearch in public health is to prevent or control disease or injury and improve health, or to improve a public health program or service. Knowledge might be gained in any public health endeavor designed to prevent disease or injury or to improve a program or service. In some cases, that knowledge might be generalizable, but the purpose of the endeavor is to benefit clients participating in a public health program or a population by controlling a health problem in the population from which the information is gathered.

To help discern whether your particular project will need IRB review, consider the following criteria which tend to represent one or the other.  Please note, this list is to be used as a guide and is not a definitive determination:

Common Elements
Public Health Practice Research
Involves direct performance or oversight by a governmental public health authority (or its authorized partner) and has public accountability Often conducted by academic centers and institutions which have experience conducting research 
Primary intent is to prevent or control a disease or injury Main aims are to research and draw conclusions about a hypothesis in order to contribute to the field at large
Focused on improving the health of a specific population or group Focused on generating knowledge that can be disseminated and applied broadly
Benefits and risks are primarily designed to accrue to the participating community Benefits are intended to apply beyond the participating community who bear the risks
May legitimately involve persons who did not specifically volunteer to participate (i.e. no informed consent) Involves research subjects who voluntarily consent to participate (or else a specific waiver of such)