WP2.1: Cross-cutting (policy) consultation on HBM
WP2.2: Science – policy translation (‘phased action plan’)
WP2.3: Risk communication and social inclusion
WP2.1: Cross-cutting (policy) consultation on HBM
In the first year of the new cycle of the Center of Expertise on Environment and Health an open dialogue will be organized across scientific disciplines, policy domains and stakeholders about human biomonitoring and relevant transversal topics for environmental health research and policy. Many environmental health risks are systemic in nature, embedded in wider environmental, social, economic and political systems . This requires integration of different perspectives and balancing of interests, for both the risk assessment and management.
Early involvement of relevant stakeholders and creating openness towards issue framing and research design are important prerequisites to achieve better integrated assessments and understanding [32,33]. We cannot simply assume that consensus exists (or should exist) about the definition and boundaries of the issues under consideration. A well-organized consultation can reveal the (potential) multiple uses and relevance of the HBM-campaigns. Involving stakeholders in an interactive procedure with well delineated discussion topics, avoids that sectoral claims are just aggregated. E.g. discussing which aspects are important or not, to be included in the analysis, or more generally in the policy discussion and communication towards the public.
There is another good reason for opening up to the multitude of perspectives. Environmental health risks are often complex risks, both scientifically and socially (see WP2.2 for more detailed background). They are not always unambiguous and thus not easily translated into a surveillance framework. This urges for a rational dialogue with policy makers and stakeholders in order to co-decide on the aspects that need to be taken into account, how to cope with remaining uncertainties, what to accept and what policy to install. Transparency and open dialogue on these aspects is also increasingly demanded by stakeholders that have the knowledge and skills to challenge governments and scientific expertise 
The call for this project also explicitly emphasises this early and sustained involvement: “It is therefore important that the translation into policy is monitored and assessed from the start of the assignment in cooperation with the government and through consultation/cooperation with relevant policy areas.”
Discuss the proposed research focus, priorities and frames with relevant scientific disciplines, policy domains and stakeholders, generate input for the research plan and framing of environmental health issues (‘get the questions right’; ‘HBM of value for a broad spectrum of actors);
Increase awareness about the potential of human biomonitoring in a wider circle so that opportunities for cooperation and integration are more likely to be detected,
Stimulate the opportunity for networking among the participating scientists, policy makers and stakeholders to interweave environmental health aspects in other policy domains and vice versa. Specific concerns with regard to environmental health from policy fields as physical planning and infrastructure, health, housing, agriculture and social inclusion, can be taken into account and included in the study.
WP2.2: Science – policy translation (‘phased action plan’)
Although HBM-research yields a lot of relevant data on environmental health (body burden of environmental pollution, determinants of exposure, vulnerable subgroups, time trends etc.), the evaluation of the scientific results and it’s translation into policy action is often complicated by both scientific and social complexity. From the scientific point of view, environmental health risks are often faced with large (partly irreducible) uncertainties, limited information and scientific debate [36–38]. E.g. the absence of guidelines for health interpretation (for many chemical substances and early health effects), confounding variables, the fact that measurable exposures and (early) effects do not automatically lead to disease, uncertainty about the impact of multiple exposures and effects, etc. complicate the interpretation of the actual health impact of environmental pollution and nurtures scientific debate. From a societal point of view, environmental health risks are interwoven with our way of life, our perceptions, norms and values, and may have unequal social impacts [39–41], giving rise to social and ethical debate, the need to reconcile (contrasting) interest or lack of support for policy measures.
New approaches have been proposed to deal with these complex, unstructured problems in a more effective way, such as the extended peer community , Mode II knowledge production and transdisciplinarity [42,43] and more recently pragmatic approaches to expand the scope of impact assessments and risk governance [32,44]. Hage et al. (2010) defined some main issues that are at stake within these new approaches : the quest for the production of knowledge that explicitly acknowledges its own frontiers and uncertainties, the quest for more legitimate knowledge, the quality control of this new type of knowledge, the organization of more applicable knowledge and the inclusion of non-scientific expertise. Inspired by these approaches, a structured and participatory procedure (‘phased action plan’) was developed and implemented during the first cycle of the center to facilitate the evaluation and policy uptake of HBM-research results . We could label this as experimenting with a novel knowledge-policy arrangement. The successful application of this procedure made this approach a guiding example for the successive cycles of HBM-research of the center, leading to different action plans .
The phased action plan procedure intertwines the knowledge with the policy cycle by combining scientific analysis and deliberation on policy options, based on the analytic-deliberative approach . The phased action plan mobilises knowledge and expertise from different sources (scientific and non-scientific) and evidence-based criteria are complemented by policy- and social considerations to underpin decisions, with the final aim to arrive at policy options that are both scientifically and socially robust.
General principles of the phased action plan:
Structured and iterative process: The phased action plan is structured around several phases, each with its own objective. The conclusions of each phase are used as a starting point for the next phase. Subdividing the decision making process in more manageable, iterative sub-questions leads to better understanding and transparency on final policy decisions and fosters a mutual learning process among the participating actors.
- Pre-phase: pre-selection of relevant research results within a science-policy setting.
- Phase I: prioritization of HBM-results based on scientific, policy and social criteria.
- Phase II: more detailed analysis of the issues with the highest priority and co-production of appropriate policy options.
- Phase III: elaboration and implementation of policy actions.
- Phase IV: evaluation of policy actions.
The pre-phase and phase I and II are organized collaboratively by the center and the contracting government. Elaboration, implementation and evaluation of policy (phase III and IV) remains the responsibility of respective governments (potentially in collaboration with other stakeholders).
- Pragmatism: Absence of full scientific certainty cannot be used as an argument to postpone policy decisions, in some cases in line with the precautionary principle. The phased action plan facilitates decision making in a context of complexity, on the basis of the (appraisal of) best available knowledge and by deliberating on uncertainties, stakes, norms and values.
- Transparency and participation: Involving relevant experts, policymakers and societal stakeholders in the decision making process leads to mutual learning and guarantees that all relevant perspectives are taken into account. Transparency on all aspects of the process is essential to gain trust and cooperation off all parties involved. This approach has been implemented successfully in the past, in different policy contexts (on local and regional level), and will be the basis for future HBM-campaigns. Advantages of this approach include: broadening the knowledge base, increase trust among actors involved, mutual learning, increase support and effectiveness of policy action.
- Transdisciplinary interpretation and prioritisation of HBM-research results, based on three general criteria: scientific evaluation, policy relevance and public concern.
- Translation of research findings (and related public concerns) in a problem solving strategy.
- Co-production of recommendations for integrated solutions, eventually leading to action plan(s) by policymakers and societal stakeholders and to policy integration: interweaving environmental health and other policy goals.
WP2.3: Risk communication and social inclusion
Communication about environmental health risks and human biomonitoring is challenging and requires careful consideration. The ambitions are to raise awareness, trigger behavioural change (to prevent both pollution and exposures), strengthen trust in science and authorities responsible for environmental health protection, empower disadvantaged groups and create support for policy measures. But on the other hand unnecessary anxiety needs to be avoided and scientific uncertainty and knowledge gaps need to be addressed.
One of the main problems in risk communication is negligence of the social context . There is growing recognition that technical approaches with a one-sided transfer of risk information from experts to the lay public should be replaced by a more dialogical approach, with focus on participation and cooperation between scientists, policy-makers and the public . Important in this approach is the fact that different perceptions and knowledge production modes are relevant and should be respected. Overcoming the gap between science and the public is still one of the biggest challenges of risk communication. Mutual understanding is necessary to create trust in order to solve problems that are both scientifically and socially complex. Risk communication is no panacea though, but will result in fewer misunderstandings and ‘better’ (informed) conflicts . From the social scientific perspective moreover, in order to achieve social change, taking perceptions seriously is a prerequisite . Finally an important reason for taking into account perceptions of the affected groups and lay knowledge is simply the fact that science itself suffers from many uncertainties and unknowns. Lay knowledge may contribute to the better understanding of problems. A social scientific perspective on risks thus broadens the horizon and offers other ways of understanding and describing reality and the way people socially construct their own realities .
With regard to communication of human biomonitoring results to study participants, scientists must weigh participants' right-to-know and the potential benefits of receiving individual information against the possible psychological or financial harm of trying to make sense of data that may not provide a clear picture of potential health implications . Although most human biomonitoring studies follow an approach driven by clinical ethics, and do not disclose individual results , some recent empirical studies from a more participatory approach show that reporting-back individual results has important benefits like increasing trust in science, retention in cohort studies, environmental health literacy, individual and community empowerment and motivation to reduce exposures [54,55]. Studies conducting participants’ evaluation observed on the other hand no excessive fear or anxiety after receiving personal biomonitoring results [56,57].
Important elements in the practices of effective reporting-back are designing protocols and communication plans in partnership with study communities [52,55], understanding the disclosure preferences of the study population and tailoring the mode of reporting-back , and including contextual information about health implications and exposure reduction strategies to help individuals understand the meaning of their results [54,59].
Another point of attention in the participatory approach on risk communication and management is the inclusion of all relevant perspectives and stakeholders, especially those with fewer capacities or agenda-setting power. This implies looking at environmental health risks through a ‘justice’ lens. Literature on environmental health inequalities demonstrate that socially disadvantaged populations are in ‘double jeopardy’ of environmental health risks, since they can be more exposed to environmental pollution and more susceptible to its damaging health effects, while having a smaller contribution to environmental pollution [60,61].
This research is rooted in the environmental justice movement in the US, which showed that hazards in the physical and chemical environment disproportionately affect those individuals, households and neighbourhoods that also face hazards in their social environment . Research and politics outside the US is rather scarce, but in Europe there is a growing interest in environmental health disparities. For instance, the fourth and fifth Ministerial Conferences on Environment and Health organised by the WHO clearly stated that the unequal distribution of environmental health conditions and risks by a range of socio-demographic determinants is a major challenge for public health governance [63,64]. Also the European Environmental Agency stated in a report on environmental health that “the environment-related share of the burden of disease depends strongly on socioeconomic aspects such as income” (2005) .
Paradoxically, while there is consensus on the existence of a close relationship between social inequality and environmental health, exploration of this link is still underdeveloped. One of the main identified knowledge gaps in the empiric evidence for Europe, is the fact that most studies use aggregated data to correlate the distribution of external exposure (emissions, pollution proximity) and indicators of social deprivation. This gives only a partial view of the processes involved in environmental inequalities because it may not reflect the individual experience . There is a lack of individual data on the internal exposure to (a mixture of) chemicals, e.g. from human biomonitoring research, and available evidence shows more nuanced results which do not always support the environmental justice hypothesis [67,68]. For instance, concerning the internal dose of environmental exposure, research reveals that the lowest social classes are not always exposed to higher concentrations. This was also found in the data of the first and the second Flemish Human Biomonitoring program, and was most pronounced within adolescents [13,69].
Unfortunately, most human biomonitoring studies are not designed to detect social gradients. At least three important shortcomings can be distinguished:
Firstly, HBM-studies are easily biased towards higher social classes. Ethnic minorities and socially disadvantaged groups are less represented, and thus less visible in most biomedical studies and preventive monitoring surveys because they experience more participation barriers. This social bias not only undermines the validity of scientific data, it also complicates policy actions to identify and tackle environmental health inequalities.
Secondly, most human biomonitoring studies either do not include social indicators in their questionnaires and analysis or tend to consider SES data only to control for potential confounding. But rather than claiming to have ‘controlled for SES’, researchers should acknowledge the potentially relevant aspects of SES when interpreting findings of environment and health studies [70,71].
Thirdly, the communication vocabulary and reporting back of individual biomarker results is often matched to the preferences of middle and higher social classes. However, to ensure effective communication, there is more need for a flexible system of disseminating results (for instance written versus oral format), tailored to the education level and ethnic background of study participants .
To foster transparency on research design, results and research practice.
Strategy to report-back individual and group results to study participants (for practical implementation see WP3.7)
Taking into account risk perceptions and investing in trust.
Taking into account mechanisms of social exclusion and inequality as a cross-cutting theme, both in the research practice (involving hard-to-reach stakeholders and participants), in the research results (socio-stratifying the biomonitoring results) and in the science-policy discussions.