Science for policy, policy for science: bridging the gap
WHO symposium to inform the European environment and health research agenda
Copenhagen and Madrid, 20 October 2008
Is policy a direct result of available evidence? Is there a way of bringing research closer to decision-making process? At what stages in the policy process is research most relevant and what is its place among other guiding factors? How best can policy-related research priorities be determined? What is the role of different stakeholders? How do policy-makers and researchers deal with the need for evidence in uncertain situations?
These key questions mark the relationship between policy-makers and scientists today. They will constitute the core of discussion as policy-makers and researchers from across the WHO European Region gather at the International Public Health Symposium on Environment and Health Research, in Madrid, Spain on 20–22 October 2008. The WHO Regional Office for Europe and the Carlos III Institute of Health of the Spanish Ministry of Science and Innovation are organizing the event, in cooperation with the European Commission (EC) Directorate-General for Research. The Ministry of Health and Consumer Affairs of Spain is the Symposium’s host.
"A history of environmental crises and their effects has taught us that we need to do a better job of using science as an instrument to support policy-making. The health effects of, for example, toxic oil syndrome, BSE [bovine spongiform encephalopathy] and current issues like climate change, are so striking that countries’ leaders need handy results of research to help them identify the most effective measures to reduce risks and address public concerns,” says Dr Marc Danzon, WHO Regional Director for Europe. “That is why we are bringing together experts from the environment and health research communities and key European decision-makers in Madrid.” At the Symposium, scientists and policy-makers will hear reports on current research, debate alternative approaches and try to identify common positions to inform strategic planning in the field of public health research.
“Human health is the ultimate and most important sufferer from environmental disasters”, says Dr Bernat Soria Escoms, Minister of Health and Consumer Affairs, Spain. “Science has provided, over at least two centuries, a rock-solid basis for dramatic gains in public health. Today, faced with phenomenal challenges of global scale, and with unprecedented technological development, we need evidence on health effects more than ever before. As policy-makers, we need timely, realistic and relevant knowledge more than ever before, to inform our choices and continue to protect our people’s health. Is the research community capable of delivering?”
“Mobilization and timely responses are made possible by a continuous dialogue with the scientific community. We must strive to distil the best possible information from research conducted by various disciplines in all parts of the world. Spain supports this research and promotes a closer integration of public health research with environmental sciences. As many emerging questions still do not have exhaustive answers, we need to come together at the international level to pool resources and intellectual capacity and help each other addressing these new challenges. Our policy response should be in line with EU [European Union] treaties stipulating that environmental policies shall be based on the precautionary principle,” says Dr Cristina Garmendia, Minister of Science and Innovation, Spain. “Biomedical research is today a good example of the ‘lights and shadows’ of scientific and technological progress. Most of us feel proud of each dollar spent because it gave us the opportunity to longer and healthier lives. But its social value rests on equal access to health care. It is our social responsibility to reconcile science and society from a different perspective. We have advanced some steps in this direction; science and technology today are key components of the part of the policy agenda that is given over to cooperation and the promotion of the socioeconomic development of less favoured societies.”
The Symposium will provide a major platform for collaboration on public health research with emphasis on environment and health.
“The European Union is a major financial contributor to research and development in Europe. Its 7th framework programme (1) is making available more than 50 billion Euro to research as a whole, for the period 2007–2013. Of this, almost 2 billion Euro is allocated to research in the environmental domain alone,” states Mr José Manuel Silva Rodriguez, Director-General of the EC Directorate-General for Research. “Embedded within the environment theme is a specific environment and health activity, from which research funding for environmental health issues is available. The FP7 level of investment indicates the importance the EC attaches to research in general, and reflects the great expectations of civil society for the scientific community. This is a unique opportunity, as well as a challenge, for scientific institutions to set the pace.”
In addition, the Symposium will identify the most relevant evidence to form the basis for WHO’s fifth ministerial conference on environment and health, the next milestone in the environment and health process for Europe.
The second high-level meeting in preparation for the conference will take place back-to-back with the Symposium (on 22–24 October). Organized by the WHO Regional Office for Europe and the Spanish Ministry of Health and Consumer Affairs, it will continue the call for stronger commitment to protect children’s health from environmental threats, with special emphasis on two of the four regional priorities for action: clean air and chemical-free environments (2). The meeting will also address the main political document of the conference. As evidence shows that well-tested environmental health interventions could save nearly 1.8 million lives a year in the 53 countries in the European Region, the conference will review countries’ implementation of their pledges over the last 5 years to assess progress.
Questions and case studies for debate at the Symposium
Toxic oil syndrome (TOS) is a unique episode in medical history for at least two reasons:
- its occurrence in Spain in 1981 was unprecedented;
- no similar outbreaks have been reported, with the possible exception of eosinophilia-myalgia syndrome.
The hypothesis that contaminated food oil caused the illness was formulated thanks to the observations of an astute clinician. The decision for public heath intervention, based on limited but sound evidence, is a classic example of public health epidemiology at its finest. Even though about 20 000 people were affected in the first 3 months of the outbreak and more than 300 died within the first 7 months, the national health system demonstrated its ability both to deliver services to the people affected and to develop appropriate research on the origin of the disease.
While results show that patients ingested many interrelated compounds, the exact chemical agent responsible for TOS has not been identified, despite considerable research. This is not only unsatisfying from a scientific point of view but also worrying from a public health perspective, because it means that a similar food-related poisoning is unlikely to be prevented in the future. The establishment of ad hoc collaboration between the Spanish Government and the WHO Regional Office for Europe through the TOS Scientific Committee was crucial to clarifying aspects of the condition. The lessons learnt include the importance of:
- early interventions in public health emergencies, even when full scientific evidence is not available;
- a multidisciplinary scientific approach; and
- the participation of patients in research.
TOS is slated to be a landmark example of interdisciplinary collaboration that can serve as a model for managing food safety and future outbreaks of previously unrecorded diseases and environmental disasters.
The research of recent decades shows that air pollution causes almost 350 000 premature deaths in the EU, reducing life expectancy by almost a year. The policy response to this challenge is difficult, as it requires both the application of new technologies (such as low-emission diesel cars) and the creation of conditions that support individual behavioural changes to reduce air pollution and population exposure. These actions, although less spectacular than those needed in crises, will support healthy development in children and prevent disease in millions of adults. The recently announced EU directive on air quality is an example of such a solution, providing a compromise between health objectives and the feasibility of implementation in countries. Referring to this, the Symposium will debate the extent to which more evidence on the health effects of air pollution could influence regulatory solutions, where health gains are further prioritized.
Many challenges have a global scale. Investment in research to improve understanding of the extent of the risks from climate change and the effectiveness of responses, for example, has already proved to be timely and effective. The findings of the International Panel on Climate Change (IPCC) helped highlight the unprecedented rise in greenhouse-gas emissions and their effects on the climate system and human health, and provided information on which measures could be effective and economically viable. Health security is at serious risk today, and climate change could affect millions of people in future years. Health effects are already observed in the Region: the 70 000 excess deaths following the 2003 heat-wave and changes in the geographical distribution of some vectors are the first alarming examples. Symposium participants will discuss how this evidence has supported decision-making on how the United Nations Framework Convention on Climate Change is reflected in global, regional, national policies.
Finally, the Symposium will examine modern risk governance. To manage environmental risks and crises, governments need not only evidence on the health effects of environmental determinants but also the capacity to handle serious controversy over such evidence. This is particularly urgent when governments must make decisions rapidly and in conditions of uncertainty and/or mounting public alarm. Recent experience with the management of risks involved in activities necessary to society (such as disposing of waste and producing and handling energy and chemicals) has shown how difficult this can be in industrialized countries. There is now a general consensus that policies on the management of environmental risks and crises should be developed and adopted through transparent decision-making and communication processes, with the involvement of the public and the health sector.
For more information, contact:
Ms Cristiana Salvi
Technical Officer, Partnership and Communications
WHO Regional Office for Europe
Via Francesco Crispi 10, I-00187 Rome, Italy
Tel.: +39 06 4877543, mobile: +39 348 0192305
Fax: +39 06 4877599; e-mail: email@example.com
Ms Maite Perea
Head of Press, Ministry of Health and Consumer Affairs,
Paseo del Prado 18–20, E-28071 Madrid, Spain
Tel.: +34 91 596 15 87; fax: +34 91 596 15 86; e-mail: firstname.lastname@example.org
Mr Fernando Torrecilla
Press Office, Ministry of Science and Innovation
Calle de Albacete 5, E-28027 Madrid, Spain
Tel.: +34 91 603 75 09; e-mail: email@example.com
1) The framework programmes of the European Commission are instruments for funding research in various fields, including environment and health. On 1 January 2007, the new legislative package of the EC Seventh Research Framework Programme (FP7) – came into force. FP7 aims to help increase the potential for economic growth and to strengthen European competitiveness by investing in knowledge, innovation and human capital.
2) Children’s Environment and Health Action Plan for Europe (CEHAPE) [web site]. Copenhagen, WHO Regional Office for Europe, 2006.