Waterborne disease is a major contributor to the disease burden globally, causing substantial morbidity and mortality. Whilst of most of this burden of disease falls on the very young in the poorest countries, outbreaks of waterborne disease continue to affected wealthy nations. The main influencing agency in public health policy globally is the World Health Organization (WHO). Although WHO has no statutory or legislative power with regard to water safety and the prevention of waterborne disease, the guidance documents it publishes has a major impact on national legislation throughout the world with many countries simply transposing WHO guidance directly into law. This presentation considers how scientific advice may influence WHO guidance. Initially, we will consider the nature and strength of medical and public health scientific evidence, particularly focusing on the strengths and weaknesses of expert opinion and systematic review. Systematic reviews are potentially powerful tools for summarising scientific evidence. However, as with all tools they can be misused. Furthermore, even when properly conducted, it is still not always possible to translate such reviews directly into policy. We will then consider the issue of uncertainty in the scientific evidence. Some such uncertainties can be quantified, but others cannot. The precautionary principle is often heralded as the most appropriate approach to take in such issue but this leaves the question of how unlikely a risk or costly an intervention needs to be before this is set aside. One of the key issues regarding the formulation of good policy is the influence of political lobbying. Probably the most dramatic evidence of such lobbying comes for the disclosure concerning the activities of the tobacco industry which systematically abused the scientific evidence to prevent and delay public health interventions. Perhaps a modern day example of this is the political manoeuvring over the Climate Change issue. However, lobbying is not always one- sided and other lobby groups may push for public health interventions that are not warranted. The issues will be illustrated with recourse to two case studies, one centring on Household Water Treatment and the other on the issue of the health benefits of Magnesium in drinking water. A strategic approach to incorporating scientific evidence into public health policy formulation will be set out that will include approaches such as the GRADE scheme to quantify the strength of scientific evidence and cope with uncertainty in the evidence base.


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  • Received: 05 March 2012
  • Accepted: 05 March 2012
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