A framework for scientific advice on health: EuSANH’s principles and guidelines

Background Society expects politicians to make sound decisions by bringing the best evidence to bear on the health problems in question. Performing this task requires access to independent sources of sound scientific advice. The European Science Advisory Network for Health (EuSANH) is a network of national science advisory bodies in Europe which are active in the field of health and provide independent scientific advice to their authorities. The EuSANH addressed this question in a European project. Methods Guidelines and principles for producing sound advice have been formulated after international comparative evaluations and extensive discussions among participants of the EuSANH-ISA project with input from international experts. Results A framework for scientific advice on health has been produced. Conclusions This framework will ensure a uniform approach and thus opens possibilities for collaboration between science advisory bodies.


Science and policy
In society there is a clear and growing recognition of the role of scientific and technical knowledge in advancing human health. However, individual scientists usually do not speak with one voice, the outcomes of their research often involve uncertainties, or they may address issues which have no direct societal applications or implications. Practical issues of relevance to society are the very points of departure and reference for policy makers. These two approaches do not necessarily link-up. Citizens expect politicians to make sound decisions by bringing the best evidence to bear on the problems in question. Carrying out this task requires access to independent sources of sound scientific advice. But what is 'sound'? The European Science Advisory Network for Health (EuSANH; participating countries can be found at www.eusanh.eu) addressed this question in the three-year project entitled Improving Science Advice for Health in Europe (EuSANH-ISA). During this project a common methodological framework for scientific advice, a first joint scientific advice and a sustainable EuSANH structure have been developed. This paper is an executive summary of the full methodological framework with principles and guidelines for scientific advice and is meant to draw attention to these guidelines.

Bridging the gap
The worlds of science and policy have their own position, language, and dynamics. How can the two meet? When one thinks in terms of distinct and contrasting concepts characterizing each world, such as facts versus values, objectivity versus subjectivity, or truth versus power, scientific advice seems almost a paradox [1]. Studies of scientific advising have shown, however, that it is not possible to draw sharp boundaries between facts and values [1]. For complex policy questions input from different scientific fields is required. Science advisory bodies can combine and translate them into policy recommendations. Discussion among scientists, as well as between scientists and policy makers, is one of the keys to the success of the advisory process. Scientific knowledge and information must always be debated and valued within the context of political problems. This usually involves a process of gradually adjusting divergent or complementary scientific viewpoints. At the same time, however, standards of adequacy for scientific evidence and inference are applied. As long as this is done in a transparent manner, the conclusions and recommendations of Advisory Committees will be viewed as highly credible. Thus, a firm scientific underpinning may be provided for public policy development.
Important though scientific advice may be, measures to be taken always also have political, economic, social or cultural aspects that must be considered. That is where scientific advice ends and policy begins. Weighing these aspects is up to policy makers and politicians, and takes place within the context of political and societal values, beliefs, and objectives. Publishing the report Openness 25 Make the report publicly available 26 Where more active dissemination is required, issue press statements, press releases or press briefings 27 Where more clarification is required, organize meetings with policy makers and target groups Assessing the impact Accountability 28 There should be a follow-up procedure that monitors the policy makers' actions in response to the advisory report 29 The advisory body should regularly perform a (self)assessment, both of the impact of its reports and of its performance More detailed information can be found in the full publication [13].

Sound scientific advice
Building on the general definition of scientific advice [2], scientific advice on health is defined as the solicited or unsolicited analysis of a defined public health, health care or health policy problem, based on updated scientific knowledge, considering also relevant expert judgment, practical experience, and ethical, cultural and societal values and implications, with conclusions and recommendations for health policy. The principles and guidelines contained in this framework address how high-quality science advisory reports should be produced which may be effectively used in policy decision making. They have been formulated after international comparative evaluations and extensive discussions among participants of the EuSANH-ISA project with input from international experts [3]. Also, related frameworks developed by other organizations have been considered in these discussions [2,[4][5][6][7][8][9][10][11][12]. The principles and guidelines are not only relevant as a quality seal to current EuSANH members, however. Because all national and international health authorities face similar problems and are expected to base their decisions and programmes on the best available evidence, this methodological framework may help any advisory body in providing sound scientific advice. A summary of the principles and guidelines is given in Table 1. More detailed information can be found in the full publication, A Framework for Science Advice on Health: Principles and Guidelines [13]. Examples of the framework are the reports on 'determinants of a successful implementation of population-based cancer screening programmes' and 'childhood leukaemia and environmental factors' [14][15][16]. The impact of both reports will become clear in the coming period.

Practical application of the framework
First, it must be emphasized that implementation of the guidelines presented here requires attention to specific circumstances, such as the legal or strategic position of the advisory body and the associated administrative traditions within which it has to operate. Put another way, each organization should examine how the guidelines can be operationalized in its own situation. Operationalizations may also vary depending on the issue under analysis. In fact, the phrasing of various guidelines, for example: "Consider . . ." or "Where appropriate, . . ." already explicitly invites advisory bodies to explore and compare alternative procedures. Second, the framework addresses the core business of advisory bodies, with regards to appointing multidisciplinary committees to advice on request of government agencies. Sometimes other working methods may be considered, such as a working conference or an advisory letter, where experts are consulted outside of a Committee setting. Many guidelines will then still provide valuable assistance. Finally, the framework should be considered from a dynamic perspective. In the coming years, all experiences and lessons learned should lead to regular updating and may lead to fine tuning or modifying the guidelines. In this context, the principles provide the robust architecture and will remain leading.

Conclusions
This methodological framework will ensure a more uniform approach in Europe and thus opens possibilities for collaboration between national science advisory bodies. Since the scientific base of our policy decisions is the same, much of the process of science advice can be shared, even if the recommendations will always be particular to the country.

Abbreviations
EuSANH: European Science Advisory Network for Health.