Principles for transforming health evidence to recommendations and decisions

Systematically, transparently, and reliably translating the vast body of high-quality medical scientific evidence into recommendations that can guide clinical practice and health policy is a core challenge faced by the global medical community and a central component of evidence-based medicine. This article introduces the fundamental principles for translating health evidence into recommendations and decisions. Centering on the principles for moving from science evidence into recommendations and decisions (Core GRADE 7) released by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group in June 2025, this article systematically elaborates on the key principles, decision-making frameworks, and critical considerations throughout the entire process from health evidence evaluation to the formulation of recommendations. By interpreting the core contents of Core GRADE 7, this article clarifies how Core GRADE 7 employs a structured Evidence-to-Decision (EtD) framework to systematically weigh the benefits and harms of interventions, assess the certainty of evidence, and integrate multidimensional factors-including patient values and preferences, health resource availability, acceptability, and equity-to ultimately form recommendations with clear directions and strengths. By doing so, this paper aims to provide a reference for developers of health practice guidelines, public health practitioners, health policymakers, researchers, and other stakeholders in China.