<b>Bijsluiter</b>. De hyperlink naar het originele document werkt niet meer. Daarom laat Woogle de tekst zien die in dat document stond. Deze tekst kan vreemde foutieve woorden of zinnen bevatten en de opmaak kan verdwenen of veranderd zijn. Dit komt door het zwartlakken van vertrouwelijke informatie of doordat de tekst niet digitaal beschikbaar was en dus ingescand en vervolgens via OCR weer ingelezen is. Voor het originele document, neem contact op met de Woo-contactpersoon van het bestuursorgaan.<br><br>====================================================================== Pagina 1 ======================================================================

<pre>Science advice on public health
at national and European level
Discussion paper
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<pre></pre>

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<pre>Science advice on public health
at national and European level
Discussion paper
Invitational meeting
Health Council of the Netherlands
No. A05/06E, The Hague, September 29, 2005 (Revised version, May 16, 2006)
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<pre>The Health Council of the Netherlands, established in 1902, is an independent
scientific advisory body. Its remit is “to advise the government and Parliament on
the current level of knowledge with respect to public health issues...” (Section
21, Health Act).
     The Health Council receives most requests for advice from the Ministers of
Health, Welfare & Sport, Housing, Spatial Planning & the Environment, Social
Affairs & Employment, and Agriculture, Nature & Food Quality. The Council
can publish advisory reports on its own initiative. It usually does this in order to
ask attention for developments or trends that are thought to be relevant to gov-
ernment policy.
     Most Health Council reports are prepared by multidisciplinary committees of
Dutch or, sometimes, foreign experts, appointed in a personal capacity. The
reports are available to the public.
This meeting is supported by the department of International Affairs of the Dutch
Ministry of Health, Welfare and Sport.
This report can be downloaded from www.healthcouncil.nl.
Preferred citation:
Health Council of the Netherlands. Science advice on public health at national
and European level. The Hague: Health Council of the Netherlands, 2005. Publi-
cation no. A05/06E
all rights reserved
ISBN-10: 90-5549-597-2
ISBN-13: 978-90-5549-597-9
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<pre>  Contents
1 Introduction 7
2 Current developments and challenges for science advice on public health in the future 9
3 Science advice in a European context 13
4 European expertise network for science advice on public health 21
5 Issues for discussion 25
  References 27
  Annex 29
A Responsibility 31
  Contents                                                                                5
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<pre>6 Science advice on public health at national and European level</pre>

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<pre>Hoofdstuk 1
          Introduction
          The Health Council of the Netherlands will host an invitational meeting entitled
          ‘Science advice on public health at national and European level’ in The Hague
          on 29 September 2005. This meeting will address the following issues:
          • What is the role of science advice in the field of public health and health care,
               considering current developments in this field?
          • What are the challenges for science advice on public health and health care in
               the future?
          • Would national and European health policies profit from the strengthening of
               science advice in a European context?
          Background
          The European Commission stated in its 2001 white paper on European gover-
          nance that scientific expertise plays an increasingly significant role in preparing
          and monitoring decisions1. Director-General for Health and Consumer Protection
          Robert Madelin referred to this viewpoint in his speech at the inaugural joint
          meeting of the members of the non-food scientific committees in 20042. ‘The
          Commission in general and DG Sanco in particular attach high importance to
          the use of sound science to underpin its work and strive therefore to ensure that
          its scientific advice is of the highest quality’. In 2002 the European Commission
          Introduction                                                                        7
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<pre>  published a document in which the principles and guidelines on the collection
  and use of expertise by the Commission3 were laid down.
      At the national level, science advice for policy decision in the field of public
  health is generally provided by national science advisory bodies such as a health
  council, a research institute or a scientific committee. Cross-border collaboration
  between national science advisory bodies has been modest so far. Consequently,
  science advice on similar health threats can differ between European countries,
  resulting in different national policies. A distinction should be drawn between
  science advice on public health at the national level and that in a broader context,
  for example at EU level. Scientific advice to the European Commission regard-
  ing public health and food safety is now provided by scientific committees. The
  scientific committees of the Directorate-General for Public Health and Consumer
  Protection consist of 13-18 national experts each. For specific questions they can
  call on the assistance of external experts and are even encouraged to do so4. As
  Mr Madelin stated in his above-mentioned address: ‘We actively encourage you
  to make best use of external experts and to benefit from the enormous reservoir
  of expertise in the Community and beyond’.
  The Health Council of the Netherlands and the Health Council of Belgium think
  that there is ample room for intensifying the collaboration between national sci-
  ence advisory bodies beyond the national borders. A recent study performed by
  the Health Council of the Netherlands showed that science advisory bodies in
  European countries are keenly interested in setting up cross-border cooperation.
  The following chapter describes current developments and challenges in the field
  of public health and health care to illustrate the issues requiring independent sci-
  ence advice. Chapter 3 gives an overview of institutions in Europe providing sci-
  ence advice on public health issues. Chapter 4 presents an initiative for
  establishing a European expertise network for science advice on public health,
  aimed at increasing cooperation between science advisory bodies at a European
  level. Chapter 5 presents questions to be discussed during the invitational meet-
  ing hosted by the Health Council of the Netherlands in The Hague on 29 Septem-
  ber 2005.
8 Science advice on public health at national and European level
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<pre>Hoofdstuk 2
          Current developments and challenges
          for science advice on public health in
          the future
          The health and life expectancy of people living in developed countries have
          improved dramatically during the 20th century. Average life expectancy at birth
          in several European countries rose by about 25 years in this period. These
          improvements are largely attributable to public health measures. The Ten Great
          Public Health Achievements identified by the US Centers for Disease Control
          and Prevention (CDC) in 1999 included vaccination programmes, the control of
          infectious diseases, food safety, safety at work, the promotion of mother and
          baby health, motor-vehicle safety, the control of cardiovascular disease and the
          recognition of tobacco use as a health hazard5. In the same year, priorities for
          public health action in the former 15 EU countries were summarised in a study
          financed by the European Commission6. The major public health issues identi-
          fied here were social gradients in health, aging of the population, mental health,
          environmental health, food and nutrition and, of course, the major lifestyle issues
          alcohol, tobacco and drugs. Quality of care was also mentioned.
          Many health problems are related to increasing globalisation. The transmission
          of infectious disease agents has, for example, become a transnational phenome-
          non as a result of increased international travel. Key issues concerning infectious
          diseases in Europe were addressed in recent reports of the Health Council of the
          Netherlands7 and the European Academies’ Science Advisory Council 8. Reports
          of this kind, prepared by an independent entity and based on thorough scientific
          Current developments and challenges for science advice on public health in the future 9
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<pre>   analysis, are helpful in determining the opportunities and challenges for innova-
   tion and health policy.
        The increase in the prevalence of obesity likewise calls for action9. A sub-
   stantial proportion of chronic diseases is now recognised as being linked to
   dietary and related factors, such as lack of physical activity, resulting in over-
   weight and obesity. Although there are large dietary differences throughout the
   European Union and the prevalence of obesity shows a wide variation as well,
   there has been a significant increase in overweight children and adults in a num-
   ber of European countries. In 2005, the Spanish Ministry of Health and Con-
   sumer Affairs launched a strategy for nutrition, physical activity and the
   prevention of obesity. It is to be expected that other countries will initiate similar
   measures if they have not already done so.
        The demand for health care will change dramatically in the coming decades,
   partly as a result of the aging of the population and the increase in the number of
   people with chronic diseases (e.g. COPD, depression, diabetes, musculoskeletal
   disorders, neurodegenerative diseases and heart failure)10-12. This ‘demographic
   pull’ is accompanied by a ‘technology push’ arising from advances in medical
   science and progress in the field of industrial product innovation. These advances
   include information technology, sophisticated imaging, less invasive treatment,
   biotechnology, genetics, screening technologies and further progress in organ
   function support and replacement11-13. Various techniques will also be applied
   more frequently outside the hospital setting in the future. A gradual shift from
   clinical to outpatient, non-residential and home care13 has been observed for
   some time now.
   The functioning of health care systems should not be overlooked. The accessibil-
   ity, quality and affordability of health care are essential prerequisites of public
   health. Free movement of EU citizens between Member States raises the issue of
   cross-border health care. These aspects require permanent monitoring as health
   care systems come under increasing pressure. Health care systems have an unex-
   ploited potential to improve the prevention as well as the treatment of diseases,
   injuries, and disabilities9. At the same time, however, we need to balance equity,
   cost and quality, bearing in mind that unacceptable socio-economic health dis-
   parities still exist10. These disparities are a growing problem in many countries
   and are undesirable from a social and ethical point of view. There is an urgent
   need to strengthen public health activities aimed at socio-economically vulnera-
   ble groups.
10 Science advice on public health at national and European level
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<pre>The proliferation of health care problems and solutions is clearly paralleled by an
explosion in scientific knowledge generated by academia and industry. Against
this background, science advisory bodies could play an essential role by sharing
information and providing advice on public health matters. Knowledge develop-
ment, technology innovation and public health problems are typically all issues
that tend not to be confined by national boundaries9,10,14.
Current developments and challenges for science advice on public health in the future 11
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<pre>12 Science advice on public health at national and European level</pre>

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<pre>Hoofdstuk 3
          Science advice in a European context
          National and international issues
          Europe has a long-standing tradition of scientific achievement in the fields of
          public health and health care. There has also always been a great ambition to
          incorporate the results of scientific progress in policy and professional practice.
          While such efforts have been considerably successful in the past, current and
          future threats and challenges have led to increasing awareness of the need for
          international cooperation in the development of evidence-based health policy in
          Europe. Such an approach will not only have benefits for public health but will
          also contribute to societal and economic advances by improving the health of the
          population as a whole.
              However, scientific progress cannot be built into policy without appropriate
          synthesis of research results, professional experience and expert judgment, mak-
          ing these available for public-health decision-making and evaluation. Science
          advice is thus a sine qua non for effective policy and professional practice.
          Science advice on public health and health care in Europe is currently heteroge-
          neous, complex and fragmented. Its coverage, efficiency and impact need to be
          improved to enable European countries to deal more effectively with the many
          common challenges at the interface of science and health policy concerning:
          Science advice in a European context                                                13
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<pre>   •    issues that can in principle be handled at a national level but are encountered
        in much the same form in most countries and can thus be more efficiently
        analysed using international top expertise, e.g. blood safety, noise pollution,
        aging, genomics, biotechnology and the cost-effectiveness of various inter-
        ventions;
   •    issues that are transnational in themselves and that require international col-
        laborative analysis and advice for their resolution, e.g. food safety, epidem-
        ics, air quality and ecosystem integrity, but also the provision of top clinical
        care for disorders that are so infrequent or complex, or need such an expen-
        sive infrastructure for treatment, that individual nations may be unable to
        cope with them. Furthermore, the comparison of health-system performance
        and the factors determining such performance is a matter that demands a
        transnational approach.
   Some issues can however be considered most effectively at the national level.
   These include the implementation of local prevention programmes, or topics on
   which scientific knowledge is shared internationally but may be applied in
   widely different ways in different countries, such as soft drug policy, medical
   end-of-life decisions or stem cell research15.
        Creating an appropriate, stronger link between the national and transnational
   levels may be expected to yield greatly enhanced opportunities for more effec-
   tive and efficient science advice for public health policy at both levels. Such an
   approach is particularly promising in the EU context, given the increasing possi-
   bilities for coherent European policy and the similarity of many health problems
   in the various Member States.
   The national level
   No comprehensive overview has yet been made of the science advisory bodies in
   the EU Member States, the domains they are active in, their composition, the
   advisory reports they publish (and have published in the past), and their current
   and future working programmes.
        A survey, carried out in 2004/2005 by the Health Councils of the Netherlands
   and Belgium in collaboration with the EU’s Network for Competent Authorities
   in Health Information and Knowledge, showed that at least 200 organisations
   were reported to be active in the 25 EU countries in the domains prevention &
   lifestyle, biomedicine, health care (development), environment and health, occu-
   pational hygiene, food and health, and bioethics. Substantial variation between
14 Science advice on public health at national and European level
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<pre>countries was found in the characteristics, structure and number of organisations
(the last-mentioned variable ranging from just a few organisations to dozens).
The European level
There are various committees, organisations and collaborative structures
involved in the provision of science advice on health policy at the European
level. These bodies mainly address transnational issues. Important European
organisations that provide science advice on public health will be highlighted in
this chapter, but the list is by no means exhaustive.
     Since the mid-1990s, EU institutions have taken steps to improve the use of
the best scientific evidence in decision-making at EU level16. In 1997 the Euro-
pean Commission created eight independent scientific committees charged with
providing scientific advice on matters relating to consumer health and food
safety17. In January 2002, it decided to establish a European Food Safety Author-
ity (EFSA)18.The five scientific committees dealing with food and animal health
were transformed into a single scientific committee with eight supporting scien-
tific panels advising the EFSA. The three remaining non-food scientific commit-
tees were replaced by three new scientific committees on consumer products,
health and environmental risks and emerging and newly identified health risks 17.
These committees were placed under the responsibility of the Directorate-Gen-
eral for Health and Consumer Protection.
     The Directorate-General for Employment and Social Affairs is supported by
the scientific committee on Occupational Exposure Limits. This committee pre-
pares expert advice on the exposure limits of potentially toxic substances. After
review by the Economic and Social Committee and the European Commission
these health-based exposure limits can become part of European legislation.19
     The European Centre for Disease prevention and Control (ECDC) was
recently established. Its core mission is to identify, assess and report on current
and emerging threats to human health from communicable diseases20. One of the
Centre’s objectives is to ‘provide independent scientific opinions, expert advice,
data and information’, for the Commission, Member states and other community
agencies. It will work closely with relevant key organisations and experts in the
Member States, and its Director may set up international scientific panels.
     There are various other fields and EU organisations where scientific opinions
and advisory reports are prepared. For example, in the domain of health ethics,
the European Group on Ethics in Science and New Technologies (EGE) – a mul-
tidisciplinary group of 12 independent experts appointed by and reporting to the
European Commission – advises the Commission on all ethical questions relat-
Science advice in a European context                                                15
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<pre>   ing to sciences and new technologies, either at the request of the Commission or
   on its own initiative. An important task is preparing opinions on the ethical
   aspects of biomedical scientific progress. Another, more recently initiated activ-
   ity addressing bioethics in Europe is the National Ethics Committee (NEC)
   Forum, which is a collaboration of the national ethics committees in Europe, sup-
   ported by the Directorate-General for Research. The Forum gives feedback on
   issues that relate to the Framework Programme, and liaises closely with the EGE.
       The World Health Organization (WHO) is also active in the field of science
   advice, not only globally but also in an European context, addressing issues like
   infectious diseases, chronic illness, mental health, evidence-based health care
   and technology assessment (e.g., as covered by the Health Evidence Network –
   HEN – of WHO Europe), life style problems, inequity and health, toxic sub-
   stances and electromagnetic fields.
       An important development is the increasing collaboration of the national
   academies of sciences through EASAC, the European Academies’ Science Advi-
   sory Council. EASAC’s aim is ‘to support politicians and members of policy-
   making institutions at EU level in accessing the best available scientific knowl-
   edge related to their needs to enable the European institutions to build science
   into policy’21. In the past few years EASAC has initiated and presented reports to
   the European Parliament on key topics such as infectious diseases and genomics
   and crop plant science. EASAC also assists the Scientific and Technological
   Options Assessment Unit of the European
   Parliament in addressing the scientific aspects of policy issues of concern to the
   Parliament, for example by reviewing proposals prepared by the Parliament.
   EASAC’s work is firmly based on two essential characteristics of the Acade-
   mies: input from the key scientific experts in the field, and complete indepen-
   dence from policy-making or executive bodies as regards both the selection and
   appointment of the experts and the working methods followed. In addition, as the
   academies are independent of the executive bodies, that often have a short-term
   focus, they devote considerable attention to long-term threats and perspectives,
   including related potentials of and challenges for science and the scientific com-
   munity.
       Another relevant European collaborative body is the Federation of the Euro-
   pean Academies of Medicine, which focuses in particular on initiating and pro-
   viding advice to the European Commission regarding public health and health
   care issues.
16 Science advice on public health at national and European level
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<pre>Considerations
It has been clearly shown above that science advice on health issues in Europe is
a dynamic field, both at the national and the international level. Appraisal of the
overall picture reveals a number of issues for discussion that can be raised, some
of which have already been mentioned.
    Involvement of many experts is required at both national and international
level to provide the necessary advice. Issues of efficiency and quality then
become important. To maximise efficiency, duplication of effort should be
avoided as much as possible; the available knowledge, evidence, analyses,
reviews and reports should be shared; there should be good communication on
activities and working programmes, with the aim of achieving complementarity;
and the possibility of setting up collaborative (European) advisory committees
should be considered.
    In addition, the European key experts on the relevant fields of interest should
be identified and steps should be taken to ensure that they are available when
needed. One possible means of making the most efficient use of this expertise
might be to create a register, available for consultation throughout the Commu-
nity, of top experts who are available for science advice on policy issues. Listing
their current involvements (after obtaining the consent of the persons concerned)
would add to the utility of such a register. However, the compilation, manage-
ment and updating of an effective register of this kind would be quite a chal-
lenge.
The independence of both individual experts and committees is a key issue and
concerns a number of points, such as the selection of experts (e.g., is this done by
experts or administrators?); ways of dealing with potential conflicts of interest;
the advisory work to be performed and the procedures to be followed; and the
way advisory reports are published, discussed, and used. The independence of
science advice on matters of public health should be considered in the light of
possible confrontations with economic, political or commercial interests and pre-
occupations. In addition, executive pressure leading e.g. to small budgetary mar-
gins or narrowly planned time frames can play a role. Another key aspect of
independence is that experts should be able, or even expected, to present unsolic-
ited and when necessary even unwelcome advice to those responsible for policy.
    A distinction can be drawn between the giving of science advice on policy
issues to the executive levels and directly to the political level. When vital issues
are involved, care must be taken to ensure that the latter route is followed,
Science advice in a European context                                                  17
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<pre>   enabling the independent voice of the scientific community to reach the most
   responsible decision-makers.
   Proportionality and subsidiarity are important principles with a bearing on sci-
   ence advice. What advice can be prepared at a national level? When should inter-
   national collaboration be preferred? When is the European level most
   appropriate? Key criteria are the topic, the type and availability of expertise
   required, the added value of a shared approach (e.g., efficiency, fast distribution
   of knowledge and more effective implementation), and the resources available. It
   should be recognised in this context that the number of important topics any
   national advisory body has to address is generally much larger than can be dealt
   with given its resources. International collaboration could provide a way to
   achieve knowledge-based policy on more topics with the same total budgets for
   each country concerned.
   Focus is important in both science and policy-related problem solving. At the
   same time, multidisciplinarity and overview are also essential. It follows that
   fragmentation of the voice of the scientific community in different domains, at
   various levels and in different periods will be counterproductive, especially in
   relation to broad public health topics such as the influence of demographic
   changes, health system effects, environmental issues and preparedness for out-
   breaks of disease. The best expertise from a wide range of disciplines needs to be
   involved to ensure a comprehensive scientific overview on these topics. Broad,
   stable national and international public health advisory bodies and the academies
   of sciences can play a key role in providing such expertise.
   The need for a combined approach
   The leading motivation for science advice on policy issues in the Member States
   and at the European level is that decision-making should be based on the best sci-
   entific knowledge, which should be shared where appropriate.
       Given the available opportunities and challenges, and taking the consider-
   ations given above into account, it may be concluded that a combined approach
   to science advice in Europe, based on complementarity, is the best way to ensure
   maximal quality, efficiency and impact in the coming years. This approach
   would encompass a network of national bodies and the collaborating academies
   together with the relevant EU agencies. One question to consider in this context
   is whether specific additional effort is required to coordinate the various activi-
   ties, and if so what form this coordination would take.
18 Science advice on public health at national and European level
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<pre>     To facilitate international collaboration between national advisory bodies, the
Health Councils of the Netherlands and Belgium have taken the initial steps
towards the creation of a European expertise network for science advice on pub-
lic health. Details of this network are given in the next chapter. On short term a
meeting with invited bodies for this expertise network will be organized and a
limited number of concrete topics for collaboration will be selected.
     One important question is what steps can be taken to strengthen the indepen-
dent voice of the scientific community at the European level, and to position this
in relation to the various existing EU advisory bodies. In this context it is impor-
tant to consider the potentials of the academies’ European network. As a useful
model, one can think of the Institute of Medicine (IOM) in the USA. This insti-
tute was established in 1970 by the National Academy of Sciences, ‘to secure the
services of eminent members and appropriate professions in the examination of
policy matters pertaining to the health of the public’22. It acts under the responsi-
bility given to the National Academy of Sciences to be an advisor to the federal
government, both on request and on its own initiative. The IOM has a strong
position at the federal level, independent of e.g. the CDC (Centers for Disease
Control and Prevention) and the FDA (Food and Drug Administration). In a
European context, where prestigious national academies of sciences and other
national bodies are already well established, an effectively coordinated network
might be preferable to a new large central institution. Moreover, the qualification
‘Medicine’ would be too narrow for such a network, as public health includes a
much broader field.
Science advice in a European context                                                  19
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<pre>20 Science advice on public health at national and European level</pre>

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<pre>Hoofdstuk 4
          European expertise network for
          science advice on public health
          The Health Council of the Netherlands and the Health Council of Belgium have
          contributed to the strengthening of Europe-wide collaboration between national
          science advisory bodies by taking the first steps towards the establishment of a
          European expertise network for science advice on public health which is aimed
          at complementing existing structures for science advice on public health in
          Europe.
          In August 2005, the Health Council of the Netherlands invited the organisations
          reported to be active in the field of science advice on public health* to register on
          the SINAPSE E-network of the Directorate-General for Research of the Euro-
          pean Commission**. This allows the organisations to be vetted regarding their
          suitability for participation in the European expertise network for science advice
          on public health. In first instance, this network will include institutions with a
          statutory and more or less permanent character within the Member States of the
          European Union and countries that are still candidate for inclusion in the EU.
          These institutions should moreover have a core task in providing science advice
*         These organisations were mentioned in a survey carried out in 2004/2005 by the Health Council of the Nether-
          lands.
**        The SINAPSE (Scientific InformAtion for Policy Support in Europe) E-network was established to promote the
          effective exchange of information between all stakeholders in the use of science in European governance23. Fur-
          ther information can be obtained by visiting http://europa.eu.int/sinapse/sinapse/index.cfm
          European expertise network for science advice on public health                                                21
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<pre>   to governmental authorities at national and/or state level in one or more domains
   of public health.
   The network has three specific goals.
   1   Exchange of scientific expertise
       The network promotes the exchange of scientific expertise in the field of
       public health in Europe among member institutions. This can be achieved by
       sharing scientific knowledge and advisory reports, inviting experts to sit on
       transnational committees, or peer review of advisory reports. Participating
       institutions can then base their national advisory reports on high level scien-
       tific expertise and make optimal use of expertise that is already present
       within other science advisory bodies.
   2   Complementarity of working programmes
       This aim involves harmonising the working programmes of the participating
       institutions and bringing them into line with developments at European (pol-
       icy) level.
   3   Preparation of joint advisory reports
       Issues in the field of public health and issues that go beyond the national bor-
       ders (for example air pollution and its effect on health, or infectious diseases)
       can be addressed in joint advisory reports in which the expertise of several
       member institutions is combined. These joint reports can be presented to
       national governments and to European bodies, thus strengthening the scien-
       tific basis of public health policy in Europe.
   The SINAPSE E-network, established by the Directorate-General for Research
   of the European Commission, will be used as communication tool for the exper-
   tise network. A subgroup for members of the expertise network will be estab-
   lished within SINAPSE, to permit the exchange of expertise and advisory
   reports. SINAPSE will also be used to alert members of the expertise network to
   topics for discussion and early warnings. Other forms of communication, such as
   meetings and workshops, will also be used. The workshops can focus on specific
   topics and/or involve specific areas of expertise.
       A basic requirement of such an expertise network is that all national reports
   should be accessible for an international audience. It would seem reasonable to
   expect the country of origin of a given report to bear the costs of translating the
22 Science advice on public health at national and European level
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<pre>reports into English before the reports are made available to all interested parties
via the SINAPSE website.
The Health Council of the Netherlands and Belgium are prepared to coordinate
the European expertise network for science advice on public health for the first
few years of its life. Sister organizations can take over the task of coordination
later, on a rotary basis.
European expertise network for science advice on public health                       23
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<pre>24 Science advice on public health at national and European level</pre>

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<pre>Hoofdstuk 5
          Issues for discussion
          Scientists have a good record in crossing borders of both knowledge and geogra-
          phy, and they experience an even wider than European network as a daily reality.
          As science is international by its very nature, it can not only provide specific
          knowledge aimed at furthering the public interest and societal progress but can
          also help to overcome an excessively national focus on issues of general concern.
          Moreover, since science has an inherently long-term perspective, it can help pol-
          icy-makers who are often subject to short-term pressures to aim at sustainable
          targets and to work for future generations.
          Answers to the following questions will be helpful in determining the potential
          and the feasibility of more cooperation on science advice in a European context.
          1 Would national and European health policies profit from the strengthening of
              science advice in a European context (considering the main challenges for
              science advice on public health)?
          2 Do you have any comments or suggestions about the further development of
              European cooperation between national science advisory bodies?
          3 What is your view on the relation between (collaborating) national science
              advisory bodies and existing scientific advisory bodies on the European
              level? Do you have suggestions for further development?
          All parties invited to the meeting are kindly requested to prepare answers to the
          above-mentioned questions and to give their views on future steps to be taken.
          Issues for discussion                                                             25
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<pre>26 Science advice on public health at national and European level</pre>

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<pre>  References
1 European Governance. A White Paper. Brussels: Commission of the European Communities; 2001:
  Document COM(2001) 428.
2 Madelin R. The importance of scientific advice in the Community decision making process .
  Brussels: Commission of the European Communities; 2004: Opening address at Inaugural joint
  meeting of the members of the non-food scientific committees, Brussels, 7 September, 2004 .
  Internet: http://europa.eu.int/comm/health/ph_risk/documents/ev_20040907_co01_en.pdf consulted
  22-9-2004.
3 Communication from the Commission on the collection and use of expertise by the commission:
  principles and guidelines 'improving the knowledge base for better policies'. Brussels: Commission
  of the European Communities ; 2002: COM(2002) 713 final. Internet: http://europa.eu.int/comm/
  governance/docs/comm_expertise_en.pdf .
4 The scientific committees on 'consumer products (SCCP)', 'health and environmental risks (SCHER)',
  'emerging and newly identified health risks (SCENIHR) Rules of procedure. Brussels: Commission
  of the European Communities; 2004: SCs/01/04 final.
5 Center for Disease Control and Prevention. Ten great public health achievements -- United States,
  1900-1999. Morbidity and mortality weekly report 2005; 48 (12): 241-243
6 European Commission, DG Employment and Social affairs. Weil O, McKee M, Broding M, Oberlé
  D. Priorities for public health action in the European Union. 1999.
7 Health Council of the Netherlands. Emerging zoonoses. The Hague: Health Council of the
  Netherlands; 2004: No. 2004/18.
8 European Acadamies' Science Advisory Council. Infectious diseases - importance of co-ordinated
  activity in Europe. London: The Royal Society; 2005.
  References                                                                                         27
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<pre>9  Koplan JP, Fleming DW. Current and future public health challenges. JAMA 2000; 284(13): 1696-
   1698
10 Working meeting on public health; a joint initiative of the Health Council of the Netherlands and the
   Ministry of Health, Welfare and Sport. The Hague: 2005.
11 Institute of Medicine. 2020 Vision; Health in the 21st century. Washington DC: National Academy
   Press; 1996.
12 Marinker M, Peckham M. Clinical futures. London: BMJ Books; 1998.
13 Health Council of the Netherlands. Contours of the basic health care benefit package. The Hague:
   Health Council of the Netherlands; 2003: 2003/02E.
14 Beaglehole R, Bonita R, Horton R, Adams O, McKee M. Public health in the new era: improving
   health through collective action. Lancet 2004; 363: 2084-2086
15 Eisenberg JM. Globalize the evidence, localize the decision: evidence-based medicine and
   international diversity. Health Affairs (Milwood) 2002; 21(3): 166-168
16 Ballantine B. Enhancing the role of science in the decision-making of the European Union. Brussels:
   European Policy Centre; 2005: EPC Working paper N° 17.
17 Commission Decision of 23 July 1997 setting up Scientific Committees in the field of consumer
   health and food safety. Brussels: The Commission of the European Communities; 1997: 97/579/EC.
18 Regulation (EC) No 178/2002 of the European Parliament and of the Council of 28 january 2002
   laying down the general principles and requirements of food law, establishing the European Food
   Safety Authority and laying down procedures in matters of food safety. Official Journal of the
   European Communities 2002; L31(1-2-2002)
19 Council Directive 98/24/EC of 7 April 1998 on the protection of the health and safety of workers
   from the risks related to chemical agents at work. Official Journal of the European Communities
   1998; L131(5-5-1998): 11-23
20 European Centre for Disease Prevention and Control. Program of Work 2005-2006. 2005.
21 About EASAC. European Academies' Science Advisory Council. http://www.easac.org/index.htm
   consulted: 24-8-2005.
22 About IOM. Institute of Medicine of the National Academies. http://www.iom.edu/about.asp
   consulted: 24-8-2005.
23 SINAPSE A better use of scientific knowledge in European governance. 2005. Brussels European
   Commission, Directorate-General for Research, Science and Society.
28 Science advice on public health at national and European level
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<pre>A Responsibility
  Annex
                 29
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<pre>Annex A
      Responsibility
      Responsible for this publication are:
      • Professor JA Knottnerus, President
         Health Council of the Netherlands, The Hague
      • Dr GHM ten Velden, scientific staff member
         Health Council of the Netherlands, The Hague
      • Dr CH Langeveld, scientific staff member
         Advisory Council on Health Research, The Hague
      • NM van Kuijeren, scientific staff member
         Health Council of the Netherlands, The Hague
      Lay-out: J van Kan
      Responsibility                                    31
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<pre>32 Science advice on public health at national and European level</pre>

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<br><br>