Bulletin of the World Health Organization

Religion-based interventions must be supported by evidence

Article: Fatimah El Awa. 2004;82:894.

Dear Editor—In her response to the article published in the bulletin by Jabbour and Fouad (1), Dr. El Awa argues that we should not wait for the evidence of effectiveness or consensus about the effectiveness of certain tobacco control campaigns in order to use them (2). This may be true, as common sense sometimes precedes evidence in terms of health promotion. However, when public funding of such activities is involved (in this case, it is international WHO funds) we are obliged to abide by evidence rather than anything else.

Dr. El Awa cites an example arguing that the lack of consensus about the use of health education campaigns does not mean that they should stop. Actually, if the evidence against the effectiveness of such campaigns is more compelling (according to our current standards of evaluation of evidence through meta-analysis and peer expert systematic reviews), we should surely stop them, especially if they are funded from public money and if there are other evidence-supported alternatives. Resolutions and plans cited (2) do not justify public health strategies, unless these are based on clear evidence. Not abiding by this basic principle is a departure from a path that combines years of work and research to assess and evaluate what actually works in terms of public health, in order to recommend its wider application. It also opens the door to all sorts of individual/group improvisations of health campaigns that can not only waste public funds, but lead to unwarranted consequences (e.g. youth smoking prevention programs).

I have no doubt about the influence of religious beliefs on human wellbeing, or about religion's potential as a powerful public health tool. But religion-based interventions should not be exempt from the usual mechanisms of evaluation of effectiveness, not by the leading evidence-for-policy promoter worldwide. In any case, evidence of effectiveness should precede wider application of by international organizations.


  • Jabbour S, Fouad MF. Religion-based tobacco control preventions: how should WHO proceed? Bulletin of the World Health Organization 2004;82:923-7.
  • El Awa F. The role of religion in tobacco control interventions. Bulletin of the World Health Organization 2004;82:894.

Wasim Maziak PhD. Director, Syrian Center for Tobacco Studies (email: maziak@net.sy)