Summary of Discussion: Science Advisory Board Meeting

This content was archived on June 24, 2013.

June 15-16, 2010

Table of Contents

Day 1

• Preliminary Matters
• Orientation for new members
• Update from the Assistant Deputy Minister, Karen Dodds
• Presentation: Human Health Risk Assessment under the Chemicals Management - A Proposed Path Forward
• Presentation: Strengths and Weaknesses of Community Participatory Research when Working with Indigenous Communities
• Presentation: Medium and Long Term (MLT) Policy Agenda
• S&T Foresight: Strategic Insights for Health System Decision Makers

Day 2

• Update on progress made from advice received from the SAB from the last four meetings
• Deputy Minister's Address and Expectations of the Board
• Health Canada's Sodium Reduction Strategy
• Vitamin D: Review of Dietary Reference Intakes
• The SCAAALAR Project: Surveying Canadians to Assess the Prevalence of Common Food Allergies and Attitudes towards Food Labeling and Risk
• HC Science Plan: Setting Health Canada's Science Priorities
• Closing remarks

Participants

SAB Members

Present

• Renaldo Battista
• Claire Franklin
• Jacques Simard
• John O'Neil
• Renée Lyons
• Susan Kennedy
• Lori Sheremeta
• Lorne Tyrrell
• Annalee Yassi

Regrets

• Stephen Bornstein
• Chris Loomis
• Ahmed El-Sohemy
• Marie-Élise Parent
• Yola Moride
• Jack Gauldie

Ex-Officio Members

Present

• Glenda Yeates
• Paul Glover
• Karen Dodds
• Frank Plummer

Alternates

• David Clapin

Regrets

• Meena Ballantyne
• Janet Storch
• Richard Aucoin
• Anne Lamar
• Kin Choi
• David Butler-Jones    
• Michelle Kovacevic
• Carolina Giliberti
• Germain Tremblay
• Alain Beaudet 
• Anne Marie Robinson

Invited Participants/Presenters

• Hasan Hutchinson - HPFB
• Leah Soroka - SPB
• Roy Kwiatkowski - FNIHB
• Christine Norman - HECSB
• Gordon Taylor Lee - SPB
• Ellen Birnbaum - SPB
• Julie Thorpe - PACCB
• Brandon Northwood - PACCB
• Carol Della Penta - PACCB
• Ann Clark - McGill University
• Lianne Soller - McGill University
• Moshe Ben-Shoshan -
• McGill University
• Samuel Godefroy - HPFB
• Stéphane Lessard - SPB
• Danielle Brulé - HPFB

Observers

• Samir Khan - FNIB
• Ken Mcallister - FNIB
• Louise Poulin - FNIB
• Karen Lloyd - HECSB
• Louise Bouchard - SPB
• Annie Bronsard - SPB
• Joey Rathwell - PACCB

SAB Secretariat

• Pierre Charest
• Laird Roe
• Jean Sharp
• Ashleigh Gledhill

Day 1

Room 0115C, Brooke Claxton, Tunney's Pasture
Tuesday, June 15, 2010

1. Preliminary matters

Opening / welcoming remarks provided by Karen Dodds, Assistant Deputy Minister, Strategic Policy Branch and Renaldo Battista, Chair and introductions of Board Members, Ex-officios, invited guests and the SAB Secretariat.

2. Orientation for new members

Presentation from Pierre Charest, Director General, Science Policy Directorate on Science at Health Canada

Main points -

Our role is to help the people of Canada maintain and improve their health; we have a strong regulatory role, working with First Nations and Inuit peoples, and health care policy and health care service delivery. We have a relatively small research capacity relying heavily on outside science evidence to help us make decisions and fulfill our mandate. A large challenge is to have access to cutting-edge science and be able to incorporate the very best into the Department. We need to strengthen linkages to organizations such as CIHR and universities with academic health centres.

The SAB is responsible for Health Canada, and the Public Health Agency of Canada (PHAC); (the president of the Canadian Institutes for Health Research (CIHR) is an ex-officio member and is welcome to bring topics to the SAB).

Presentation on Science and Research at the Public Health Agency of Canada, Frank Plummer, Chief Science Advisor, PHAC      

Main points -

Since PHAC was created six years ago as the Federal response to the SARS crisis, the agency has grown to a staff of 1,200 with approximately 200 research scientists.  Science is integral to the work being done with one third of expenditures on science and research activities. Intramural science and research ranges from biomedical research to research on the determinants of health. Main focus: infectious disease, chronic disease and health promotion, H1N1 response, threats from the food supply, One World One Health - linking human, animal and environmental health.

PHAC's Science and Research Strategic Plan will strengthen PHAC's vision for science and research, bring cohesion to its activities and set objectives for the next five years. The agency does many things very well; however it needs to establish a better governance system and be able to gauge success, and needs to position itself to be leading and not trying to catch up.

Research being done in PHAC is in direct response to its regulatory mandate. Possible topic for upcoming SAB: PHAC's role in the genomic revolution: what are the public health implications?

Question/Action:  Frank Plummer to provide the SAB with information/data on PHAC's resources committed to research.

Presentation on Improving the Management of External Advisory Bodies at Health Canada, Carol Della Penta, Acting Director, Public Affairs, Consultation and Communications Branch

Main points -

The Public Affairs, Consultation and Communications Branch is developing a departmental policy for the management of Health Canada's external advisory bodies. The new policy will respect current best practices and applicable government policies, in order to promote the Department's effective management of advisory bodies, the use of external advice and support Health Canada'sopenness, transparency and accountability commitments. The purpose of the presentation to the Science Advisory Board was to discuss these departmental best practices and key areas for integration into the Science Advisory Board's operations and more particularly what these best practices would mean to the Board's members. The discussion also included some new key standards that are a part of a new departmental policy, and that are already in practice in some branches. In addition to formalizing management practices, the policy will be accompanied by tools, templates and implementation support for Advisory Body Secretariats.

The inclusion of the Science Advisory Board in this policy development initiative will strengthen governance practices andimprove processes related to the management of external advice.

Terms of Reference, Laird Roe, Director, Science Policy Directorate, Strategic Policy Branch

Main points -

New Terms of Reference are closely drawn on the old ToRs, with help from PACCB.  The short timeline that we have had to work under means that we have not gone over this document with a fine-toothed comb.

Discussion -

Terms of Reference seem to discourage members from seeking advice on topics from non-SAB colleagues.  The Secretariat noted that, without divulging draft Departmental positions, members are encouraged to seek broader perspectives from their colleagues; it is recognized that agenda items may not be within the expertise of Board members and they may have access to expertise that would benefit the discussions; Board members do not represent an institution, they come to the table as individuals.  It is not the intention for the SAB to become a broad consultation process - there are other mechanisms for sounding out the perspectives of the community.  The Board may invite guests to provide more precise information on any topic.

A commitment to openness in reporting on SAB meetings might discourage both presenters and SAB members from engaging in frank discussion.  The Secretariat confirmed that the new rules required openness but that the proceedings would not report the specifics of sensitive discussions.  While the advice may be made public, the use of the advice in choosing the course of action that the Department takes is not necessarily public knowledge.  SAB members and Departmental representatives will have an opportunity to review the proceedings before they are made public.  SAB members felt that sensitive topics may need to be discussed in in-camera sessions.

It was confirmed that, while the ToRs refer only to the Deputy Minister of Health Canada, the intent is to ensure that the Chief Public Health Officer is equally able to seek the advice of the SAB. The Board should have a role in the renewal of the membership; the Secretariat will revise the ToRs to confirm this role; SAB members are welcome to put forward names of nominees to fill the gaps in the Board's expertise.  This new reality will make the Board's operations more efficient, meaning that the advice will go more quickly to the Branches that need it; the new process does not preclude the SAB offering advice to the Minister, if appropriate.

Members noted that the ToRs do not give enough attention to the SAB's role in looking at the Department's consideration of science policy and the overall health of science within Health Canada.

Action:  The Secretariat will review and revise the Terms of Reference based on the meeting discussions. 

3. Update from the Assistant Deputy Minister, Karen Dodds

Main Points -

In the discussions held on the status of the SAB, the Minister's Office and the Deputy Minister's Office considered the role of the SAB and its future. Our new Deputy Minister, Glenda Yeates, is very supportive of the SAB; however, she needs to see its value for herself. With time and experience she will see the value of the SAB in advising Health Canada and PHAC on matters of science. This new reporting regime will simplify matters and in no way diminish the input of the work of the SAB.

The global fiscal situation has had an impact on the federal government; Health Canada's operating budgets have been frozen for the next three years and we will have to continue our work within those parameters. To maintain a flat line budget means the Department will have less to work with as the years go by; it will need to make sure that those in the political offices understand that the need to have the best science to fulfill the Department's mandate.

The former DM had given Dr. Dodds the title of Science Champion, an informal continuation of one of the roles of the old Chief Scientist position. Her work, along with Pierre Charest's, plays an important role in maintaining strong science in the Department and making sure that the science used in the Department supports its mandate.  Therefore, the primary focus of the research science conducted in Health Canada is to provide scientific evidence that enables appropriate decision-making.  The need to embrace new scientific discoveries as part of this process would benefit greatly from an active collaboration with researchers at universities, the NRC and CIHR.  SAB members can play a significant role in fostering this collaboration.  Karen also noted the importance of the SAB to initiatives such as Medium and Long Term Planning and Foresight.

Dr. Dodds outlined for the SAB, the Department's three business lines:   

1. Regulatory work - health protection, managing health risks - Food and Drugs Act, all of the Health Products and Food Branch's work, for example: the tobacco act, hazardous products, controlled drugs act, pest control products;
2. First Nations and Inuit Health is not directly a regulatory responsibility; it is a policy responsibility to support the health of FNI;
3. Health Care Policy - working with the provinces and territories to identify what needs to be done to support Canadians having publicly financed, universal, cutting-edge, accessible health care.

4. Presentation: Human Health Risk Assessment under the Chemicals Management - A Proposed Path Forward

Christine Norman, Director of the Risk Assessment Bureau, HECSB provided background information on chemical assessment under CEPA, 1999 and the Chemicals Management Plan along with key elements that characterize the remaining priorities. HECSB is seeking advice on their proposed risk-based screening approach in the context of emerging technologies for risk assessment of chemical substances; the lack of human studies data to allow for informed decision-making; and international activities and developing program options when faced with insufficient toxicological information for decision-making.

Discussion -

A key theme was occupational exposures, an area not directly addressed under CEPA; SAB members felt that it was important to try to ensure that the standards of safety imposed by CEPA also protect workers (worker health and safety is a provincial responsibility with the exception of federal workers).  The lack of safety data for many products is a concern; if firms cannot produce evidence that a substance is safe, then the product should not be allowed on the market.  The onus should be on industry to demonstrate evidence that substances are safe, although it is the responsibility of government to regulate the industry.  Canada has provided enormous leadership in this field and that the Draft Screening Framework for Existing Substances is unique.  The members encouraged the Department to ensure the approach results in a true safety net, to use a cautionary approach in general, but to push hard to get as much information as possible when there is an indication of concern.

How well does CEPA and the Chemicals Management Plan deal with nanotechnology?  The Department noted that there are challenges in dealing with nanomaterials because although a material may have the same chemical composition as an approved substance its size makes it a different product.  Working with Environment Canada, Health Canada has requested "Significant New Use" information on a number of materials being used in their nano forms.

A non-traditional route to expanding the risk triage process - there are many graduate students looking for projects that might be interested in putting the results of Health Canada's triage to the test in the context of a thesis topic.

Summary/Advice -

• The Department should push it as hard as it can if there is some surrogate information available that indicates that there is a problem - given the fact that under CEPA, the Department has limited legal authority to force the company to give it information without credible scientific reason, it is worth pushing to identify other credible sources.  Health Canada's path forward is not unreasonable. Using a tiered approach is good, however finding relevant "exposure" information will be complex and challenging. On the toxicity side, Health Canada could do a number of things, including going with the best available scientific prediction.
• The SAB fully supports the path forward proposed by the Department, but suggests that it would be useful to have some more information on the subtext under which the Department works; there might well be a body of knowledge.
• The Board would be open to reviewing and commenting on draft Standard Operating Procedures, if requested.

5. Presentation: Strengths and Weaknesses of Community Participatory Research when Working with Indigenous Communities

Roy Kwiatkowski, Director of the Environmental Health Research Division, FNIHB gave a presentation on the need for a diverse approach to Indigenous environmental health research ranging from traditional western science-based, to participatory, to community based.

Indigenous communities have repeatedly requested inclusive rather then exclusive research on environmental health issues (research on what Aboriginal communities want to know, not research ON Aboriginal communities).  It is important that Health Canada determine what steps could be taken to be more inclusive of the unique Aboriginal perspective to scientific research, in particular with regards to the broader determinants of health, Tradition Knowledge and Western Science integration.  It would also be appropriate for the Department to evaluate whether those steps are solely the responsibility of one Branch or Department-wide. If the Department, then it will be important to find ways to encourage research that is more inclusive of this unique sub-population within Canada and to leverage funds to encourage such research in the scientific community.

Discussion -

Since the Framework for Aboriginal Health was presented to the SAB in 2007 it does not appear that there has been much advancement on the file. In fact the situation has somewhat worsened - at times these groups can no longer be brought together in the same room due to disagreements over ownership of research results. First Nations' communities want OCAP (Ownership, Control, Access and Possession) principles adhered to and researchers want total freedom to publish and present the information.

Research within First Nations' or Inuit communities faces two major hurdles: although there are resources available for research into Aboriginal issues, many scientists are not doing the types of research that would be of interest to Aboriginal communities (things such as the levels of chemical residues in their country foods or herbal remedies, and the social, cultural or economic impacts associated with the fear of consuming traditional foods); and the lack of respect given by many in the scientific community to participatory or community-based research.

The frustrations faced by both sides - Northern communities have very limited means of accessing the data they would need to even think of doing a risk assessment of a health impact assessment (broad determinants of health); and there are few scientists that are willing to go to a reserve to do their work due to stress, travel and accommodation issues. As well, those who do and do not get the same recognition by their peers or by the scientific promotion board as those who go to conferences or publish primary literature papers, even though the work with communities is equally as challenging and scientifically demanding.

Summary/Advice -

• There is growing acceptance of community-based participatory research as rigorous fields of academic study - scholarships are available and discussions are under way to create a journal dedicated to the field. Community-based or participatory research requires the same rigour as bench science activity and it was suggested that those in the scientific community who denigrate this work must stop. The field of global health research has grown in stature and there are many parallel issues with the Aboriginal populations. There are many researchers at universities who see the value in participatory research and would be willing to undertake it if funds were made available.
• Work already underway within CIHR and the Network Environments for Aboriginal Health Research (NEAHR) which are helping to build research capacity centres in Canadian universities of which there are nine. They bring together university-based expertise to build capacity and partnerships between scientists. The CIHR Institute for Aboriginal Peoples' Health (IAPH) is working closely with communities and elders to do this kind of research. Health Canada should be trying to support the infrastructure and build partnerships with other government departments, universities and communities. HC partnership with IAPH on population health is a good example that could blend with the NEAHR initiatives. The US is developing a strategic plan to develop native researchers to look into contaminants in theirs communities. FNIHB should maintain linkages with the Northern Contaminants Program, and push for an expanded scope looking beyond contaminants to information on exposure, risks, benefits of local diet (social and nutritional); while it may not be possible to fully quantify the results, it will be important to try to link to health outcomes - will risk outweigh benefit?
• Action is needed on both political and scientific levels.   Perhaps government would respond with more money for this type of research if First Nations leaders themselves made it one of their top priorities.

6. Presentation: Medium and Long Term (MLT) Policy Agenda

Stephane Lessard, Executive Director, Strategic Policy Initiatives, Strategic Policy Branch provided the background regarding MLT work to date; a synopsis of conclusions from internal analyses and external consultations; the MLT recommendations made to SMB-Policy on April 6, 2010 and their decisions; and information on the proposed MLT forward path. Advice from the SAB is being sought regarding the orientations, priorities and overall MLT process, as well as any particular roles Members envision for the Board with respect to the MLT work moving forward.

Discussion -

The discussion identified a number of opportunities where the SAB could provide advice in the planning process, such as:  identification of residual risks that might need to be examined if Canada used submission reviews from other countries; providing comment on potential federal directions post-2004 Health Accord; balancing risks and instruments - using the broader levers, not just the acts and regulations; continued consideration of the social determinants of health approach; priority directions for the future; and health promotion and its place in reducing overall health costs.

The MLT Policy Agenda does not intend to capture all the policy priorities of Health Canada.  Rather it seeks to (i) identify priority areas in which Health Canada is not currently, but should be, engaged, in response to relevant S&T and other trends and drivers (domestic and international), and (ii) to guide the policy research and policy development work pertaining to those issues.  The MLT Policy Agenda was developed by and for Health Canada specifically, although this work will also inform possible enhanced cooperation within the Health Portfolio.

Summary/Advice -

• The SAB commended Health Canada for its initiative and, in particular, for the workshops hosted by the Deputy Ministers.  They engaged a cross section of participants and stimulated good idea exchanges. While they were interested in the process and its progress, it was not clear how best they could participate in this sort of planning for the Department.  Health Canada needs to be "bold" - sometimes boldness gets stripped out of these initiatives.  They encouraged the Department to continue this sort of planning for the future and to come back to the SAB on a regular basis.
• The Department should come back to the SAB with requests related to specific issues or to the implementation of the process.

7. S&T Foresight: Strategic Insights for Health System Decision Makers

SAB received a background presentation on the Health Canada foresight agenda including the significance and purpose of foresight in Health Canada, the foresight work plan with a summary of what has been learned and the proposed next steps in the foresight agenda. Key questions related to foresight proposed for discussion and feedback are:

• What do you think about the process we have designed?
• What do you see as the long-term priorities in health?
• Do you see any new signals we should consider?
• Would you like to be part of the foresight process?

Discussion -

Discussion revolved around the role and importance of foresight in departmental planning, such as the sustainability of the health system - there was some disagreement about sustainability and the role of research as both a cost driver and a cost reducer. Around the concept of prevention - can you really predict what it is you are trying to prevent, and how can you measure the value of prevention?

SAB members agreed with the department that building "resilience" into the system is a valuable objective.  The expectations from the system have grown; research infrastructure is "driving force" of increased costs; however "innovation" has given us cost reductions in some diseases, but it means that a larger proportion of the budget is going to curing and treating rather than education and addressing social determinants. Foresight should be a broad and inclusive process that brings together as many perspectives as possible - it must be combined with observational studies; if something is not functioning, look at all the steps that got you to that place.

Summary/Advice -

• The SAB recognizes the important role that foresight can play in developing a system that is resilient.  At the same time foresight should be a complement to shorter-term planning efforts that focus on immediate and emerging issues.  
• Even foresight needs some focus on medium or long term health of the population and an understanding of how it is changing, where it is going. The demographic face of Canada is changing and the department's role in the future will not be so straightforward, people are living longer and we need to address co-morbidities; we need to identify who we are dealing with and we need to get a handle on future health care needs of Canadians.

Day 2

Room 0115C, Brooke Claxton, Tunney's Pasture
Wednesday, June 16, 2010

8. Update on progress made from advice received from the SAB from the last four meetings

Pierre Charest provided a comprehensive picture of how the SAB's advice has affected the Branches' work. Presenters from the last four meetings were asked to provide an update and describe how the SAB's advice assisted them in progressing with their files and whether or not the advice was useful. These meetings covered a broad range of issues covering all of the Branches, the Public Health Agency of Canada (PHAC) and the Canadian Institutes of Health Research (CIHR).  The nature of the advice was primarily operational, dealing mainly with science policy questions and a few science issues.

Discussion -

Departmental officials reassured SAB members that there were strong follow-up mechanisms in place to ensure that the SAB's advice was considered by Health Canada.  Officials accepted the offer of the SAB to assist in the development of performance indicators to gauge the impact of the Board. 

There was some discussion of what a "typical" SAB meeting should look like - creating a balance between strategic, operational, information, and update items.  Presenters should come prepared with well defined questions.  A SAB member (preferably with some subject matter expertise) could be assigned as a lead discussant for each item both to lead the discussions and assist in formulating recommendations.  More background material on the items would be useful.  In formulating advice, the use of "in-camera sessions" could be reserved for exceptional circumstances - the discussion should be open and challenged, not necessarily a safe place, but a respectful and non-political place. 

Summary/Advice -

• There needs to be more time allocated for discussion of many of the items - perhaps fewer items on the agenda and it would be beneficial to be able to track issues on a longer term by requesting follow-up/updates on items.
• It would be useful to have some of its members present issues in their areas of expertise to Departmental officials to stimulate discussion. 
• Evaluation forms are very important to let the Secretariat know how to improve the meetings and work of the SAB.
• SAB members discussed the feasibility of holding more than two meetings a year; Departmental officials responded that it was possible but would have budget implications - it was agreed that teleconference could be an option if there were a specific issue that the SAB wished to discuss or on which the Department needed urgent advice. 

9. Deputy Minister's Address and Expectations of the Board

Glenda Yeates, Deputy Minister, Health Canada provided her thoughts on the SAB and its role in providing Health Canada with science advice.

• The DM sees the SAB as complement to the Department - a cross-cutting, second opinion on the science issues that it deals with. She wants the SAB to alert Health Canada to issues that the Department might not see coming, or may assume implications are not significant; there may be great consequences. The SAB might reference new studies the Department might not be aware of and could function as an excellent sounding board.  It could also advise on structure and operations by providing general advice on: how science is done in the Department; how to maintain infrastructure and talent; input into what needs to be done in-house versus relying on international help / partnerships.
• Although the SAB reports to the Deputy Minister, the board also serves PHAC and the CIHR' needs for scientific advice.  A respectful engagement will be built between the SAB and the Department that would create an atmosphere where the Agencies and Branches are comfortable bringing items early to the table.  The federal government tends to be risk adverse but if the respectful atmosphere is maintained, there will be a higher likelihood of issues coming for discussion early in the process. 
• Even if SAB's advice is not taken, don't assume it is not worthwhile or useful - it is considered in the decision-making process.  Many of Health Canada's issues are very complex and the senior cadre is used to dealing with the political context - at times they may not be able to share with the SAB all of those considerations.  The SAB's role is to offer the best possible science advice into this process.
• The DM invited the SAB's assistance in formulating "the questions" that need to be asked from a scientific perspective.
• The Department is evaluating its use of international linkages - does Health Canada need to replicate submission reviews that have been done by the EU and/or the US?  The SAB may have a role in establishing a scientific rationale for a decision one way or the other.

Discussion -

• In the discussion that ensued, the SAB suggested, and received the support of the DM, the possibility of taking on a "major project" - topics suggested included an appropriate balance of research capacity in follow up to the Health Accord, or the question of international linkages. 

10. Health Canada's Sodium Reduction Strategy

Hasan Hutchinson, Director General of the Office of Nutrition Policy and Promotion, Health Products and Food Branch provided an update to the SAB on the progress made to date on the issue of sodium and discussed the upcoming release of the Sodium Working Group Strategy.

Discussion -

The SAB noted that this was a well elaborated plan, but that it is important to have good science to ensure there are no unintended consequences, i.e., substituting salt with something even more detrimental to health. There needs to be research, monitoring and evaluation on this issue and it would be prudent if CIHR is supporting research into this.  Hasan noted that while a research agenda is not mentioned in the report (which was produced by an independent group), it is expected that one will be part of the government's strategy moving forward.

SAB members questioned the voluntary approach being proposed - some favoured a more aggressive, mandatory approach.  Hasan noted that industry buy-in to sodium reduction is key and that a quicker response is expected through the voluntary approach. 

Summary/Advice -

• The SAB congratulated the Sodium Working Group for their well developed work and encouraged the government to look at their findings through a diversity lens; for example, Aboriginal peoples' diets are currently very dependent on processed foods leading to concerns of diabetes and they also add a large amount of salt to game hunted for food.  As well it was suggested that the Department closely follow and try to influence what is being done in the US, as a large proportion of the sodium comes from processed foods linked with US markets.  The SAB recommended the use of complexity frameworks in structuring the sodium strategy. The federal government could be a leader in providing low salt products in publically funded institutions (Hasan noted that procurement strategies are included in the strategy and that governments are to take a strong lead).
• The government should start moving on the regulatory approach so that it would be ready if the voluntary approach is not successful.  The plan is for the industry response to be monitored and made public - consumers will have the ultimate say.

11. Vitamin D: Review of Dietary Reference Intakes

Hassan Hutchinson brought this issue to the SAB because there has been external pressure and media attention on new vitamin D studies and Health Canada's current recommendations on vitamin D.  In 2008, Health Canada took action by contracting out a review of the Dietary Reference Intakes for vitamin D and Calcium.

This was an overview of Health Canada's contribution to the Dietary Reference Intakes process and a plan to engage the Canadian Academy of Health Sciences to provide an advisory body that can provide recommendations and guidance on implementation of recommendations considering the Canadian context.  Health Canada was seeking SAB support for the proposed course of action.

Discussion -

SAB members thanked Hasan for his summary of the issue and agreed with the importance of harmonizing with the US on dietary reference intakes and the value in using the data from the US Institute of Medicine as a source.  They also agreed that using a group identified by the Canadian Academy of Health Sciences (CAHS) as an advisory panel was both a good way to bring in Canadian context and a good way to provide the CAHS with much needed funding.

Summary/Advice -

• In the ongoing work on Dietary Reference Intakes, the Department should ensure linkages to experts in toxicology and neurological diseases.

12. The SCAAALAR Project: Surveying Canadians to Assess the Prevalence of Common Food Allergies and Attitudes towards Food Labeling and Risk

Ann Clarke, Professor in the Divisions of Clinical Immunology/Allergy and Clinical Epidemiology in the Department of Medicine at McGill University presented the methodology and results of a McGill/McMaster population-based study on allergen prevalence in Canada. The Food Directorate sought SAB's input on the study, its method of design and outcomes.

Discussion -

This project demonstrated how Health Canada science needs can, in part, be met through accessing academic science. SAB members posed a number of questions about the methodology, including the limited scope (these are the five most prevalent, long-term allergies). The SAB appreciated the opportunity to hear about how Health Canada uses outside research to inform its internal decision making.

Summary/Advice -

• A specific strategy should be developed to assess the nature of non-respondents and better ensure that the sample did not over-report the incidence of allergies through selection bias.  In looking to the proposed new studies that would include First Nations and Inuit communities, careful attention should be paid to the contact strategy and the non-respondent strategy as these populations do not have the same level of access to telephones and/or computers (Dr. Clark noted that they had collaborators with significant expertise in working with these populations).

13. HC Science Plan: Setting Health Canada's Science Priorities

Pierre Charest presented the Board with an update on progress on the Health Canada Science Plan and sought advice from the SAB with regards to the science needs recently identified and opportunities to meet these needs through linkages with external organizations. 
The specific questions presented were:

1. Do you agree with the prioritization criteria?
2. Do you agree with the seven horizontal needs identified?
3. Do the science needs cover the range of important science/knowledge needs for Health Canada? More specifically:
   1. Are you aware of existing research, networks, and/or centres of excellence with which we could connect to in order to fulfill these needs?
   2. Are there areas that are well covered in academia or outside Health Canada that are less critical for the Department to focus on?
4. What science needs should we focus on?

Discussion -

SAB members were keenly interested in the Department's efforts to identify priorities.  They felt that laying out areas of interest for the Department would facilitate building linkages with academic scientists looking for projects.  They had specific comments about some of the identified science needs (why is HIV included when the science needs and prevalence of Hepatitis B & C are much higher; why isn't there more about nanotechnology?) but much of the discussion was around the process of identifying priorities.

On the criteria:  SAB members felt that it might be necessary to have a "finer" set of criteria in order to set real priorities; the Department clarified that it was intending to identify a set of science needs, not specific project areas.  SAB members felt that Departmental priorities (especially for in-house work) should also factor in existing HC capacity / HC researchers' expertise.

Do the needs identified cover the appropriate spectrum?  SAB members expressed a view that Health Canada should invest more in "intervention research" or "implementation research" - what works, what doesn't, what can be expected if a particular policy or regulatory approach is selected.  They also suggested that HC science priorities should be developed in close collaboration with PHAC and CIHR.  This would allow the Health Portfolio to address its needs in an integrated way.

Summary/Advice -

• SAB members expressed their desire and willingness to continue to be involved in the priorities exercise outside of the SAB meeting schedule.  Health Canada's science plan and science priority setting should be done in collaboration with PHAC and CIHR.  It would be useful if this collaboration included an increased focus on regulatory science on the part of CIHR.  Health Canada science has to include and/or be linked to "implementation science", including socioeconomic and health care research.  With reference to the Science Priorities work, First Nations and Inuit populations should be given separate attention - not just as one of many "vulnerable populations".
• It is also important to maintain an international perspective on science needs - that collaboration with other regulators could and should be a part of realizing the science needs.  Departmental officials noted that the current exercise was to develop a list of priority science needs - deciding how the department filled those needs would be a separate step.

14. Closing remarks

Action Item:  Agenda for next meeting

The Chair invited input on possible agenda items for the next meeting.  This stimulated a broad discussion and a list of potential ideas/topics.  The Secretariat will work with the Chair and the Department to develop the next agenda, keeping in mind the topics of the discussion:

• National leadership in Health Care - lack of action in reform - is Canada is falling behind?; real need for leadership in health care delivery - session just with the Deputy Minister - scientific needs in health policy
• End of the Health Accord 2004 - 1% of provincial health care should go to research - research agendas of hospitals - very little research being done; what will encourage implementation of Health Canada science with universities?
• Health Technology Assessment
• Personalized Medicine
• Updates - drug licensing, biomonitoring - data due in soon
• Nanotechnology/Nano Safety/Parliamentary Hearings - is not a priority for government - what do we think about that - how can we make it a priority?
• Health and global change - implementation/intervention science
• First nation's tripartite experts groups shifts in health services - key policy initiative in the  pillar three - BC experiment to create a FN health authority; First Nations - ways to positively connect with fundable work being done at universities; How to promote scientific rigor in participatory community-based research
• Protecting health workers during a pandemic - occupational & environmental health
• Interaction between Health Canada and PHAC on topics such as climate change's role in the pandemic, and the listeriosis issue. There should also be linkages with Environment Canada and CFIA
• Chronic diseases - to see how that fits with science priorities

Next meeting: November 2-3, 2010