EuSANH

To view the position of science advice within the framework of ‘evidence-for-policy’, the ‘knowledge pyramid’ in figure 1 below has been found to be a useful tool.

In this concept, the bottom layer is provided by the raw ‘data’ arising from primary research and monitoring activities or data collected by statistical agencies. Many scientific findings are published as such without much context. Regular data collection (monitoring) results in reports showing tables and trend lines. Sometimes pre-defined indicators are calculated from the data. In the EU context, examples include the regular production of statistical tables by Eurostat, or the calculation of indicators according to the ECHI (European Community Health Indicators) shortlist of health indicators supported by the EC Directorate General Health and Consumer Protection (DG Sanco).

The second layer from the bottom, ‘information’, results from a basic degree of intelligent combination of data or isolated studies. This may involve comparison of routine data, e.g. on differences between countries, time trends, etc., or simple compilation of research results. Ideally, this level is seen in public health reports, on paper or in electronic form, or in inventories of research papers on a certain subject.

The third layer, called ‘knowledge’, would add the dimension of integrated results and meta-analyses from scientific research and investigations. These investigations are often directed by changing public and policy interests. Advanced public health reports and thematic reports may include elements of ‘knowledge’ on top of ‘information’.

The top of the figure, named ‘wisdom’, would place the knowledge into its broader context, in time, space and complexity. Here the term ‘synthesis’ of information and knowledge takes place. At this layer, aspects of the historical, societal and ethical context of the issue are to be included.

Figure 1. The ‘knowledge pyramid’

Decisions in the field of public health and health care should at least in part be ‘evidence-based’, or even better ‘evidence-informed’. This evidence can be at any level of the pyramid. ‘Routine’ decisions could be based on basic data or indicators. Actions on higher levels would allow more informed decisions to be taken in more complex situations. Getting to the top of the pyramid (knowledge and wisdom) we enter the area of science advice, where the problem definition is much more precise than at the bottom, and the advice itself is ideally based on all available data, information and knowledge related to the specific problem, including the societal context. Building on the general definition for science advice[1], scientific advice for 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. 

At this level, the issue of values is a crucial one. Real world problems may have different but equally answers depending on the values of the decision maker. In these cases there is no ‘correct’ answer defined by science, because the concept of ‘correct’ relates to values, and decisions have to be taken in the political arena. Differences in values may explain the tension between the scientific community and policy makers that occasionally appears. One may need to uncover political and ethical values that sometimes underlie the scientific advice. On the other hand, science advisors can help policy makers in verifying (ex-ante or ex-post) to what extent their values actually play a role, thus clarifying their real position. In fact, ambiguity can be a conscious political position that may play a very important role whenever policy makers are confronted with very different interests on the same topic. A valid option for science advisors is to present different alternative scenarios to the questions of policy makers, leaving them room to choose according to their values, which they then make explicit.[2]

This conceptual framework does not just show the importance of improved methodologies in science advising, but also indicates its role in the entire area of EU activities on health information and knowledge, as it is, for example, present in the DG Sanco Health Programme 2008-2013. In that programme, we have data collection and indicators, as well as public health reports in paper and electronic form (see http://health.europa.eu). In this context, an unified model of science advising would fit as a hitherto lacking part, which is properly addressed by the EuSANH-ISA project. 

 
[1] Government of Canada. A Framework for Science and Technology Advice: Principles and Guidelines for the Effective Use of Science and Technology Advice in Government Decision Making.     http://strategis.ic.gc.ca/pics/te/stadvice_e.pdf, accessed 8.02.08.
[2] Roger A. Pielke. When Scientists Politicize Science. Regulation spring 2006; 28-34. Accessible