Risk Communication and Risk Management Decision Making

Risk Communicationand

Risk ManagementDecision Making

Daniel Krewski, PhD, MHA

Professor and DirectorMcLaughlin Centre for

Populaiton Health Risk Assessment

March 12, 2009

McLaughlin Centre for Population Health Risk Assessment

• Evolution of Risk Science

• Risk Communication

• Case Study: Prion Diseases

• Risk Perception

• Web-based Risk Communication

• Conclusions

• Training

Outline


-U.S. National Research Council

-World Health Organization

-Health Protection Branch

-Canadian Standards Association

-Health Protection Branch-CPHA National Advisory Panel on Risk/Benefit Management of Drugs-Codex Alimentarius

-Canadian Standards Association-U.S. Presidential/Congressional Commission on Risk Assessment and Risk Management

19831985

1990

1991

1993

1997

-McLaughlin Centre for Population Health Risk Assessment

2007

Frameworks for Risk Assessment and Risk Management


An Integrated Framework forRisk Assessment and

Risk Management

Health Risk ScienceDeterminants and Interactions

Health Risk Policy AnalysisEvidence Based Policy

Biologyand

Genetics

Biologyand

Genetics

Socialand

Behavioural

Socialand

Behavioural

Biology-social interactions

Environmentand

Occupation

Environmentand

Occupation

Biology-environmentinteractions

Population HealthPopulation Health

Environment-socialinteractions

Multiple Interventions

AdvisoryRegulatory Economic Community Technological


Problem/Context

Risks

Options

Decisions

Actions

EvaluationEngage

Stakeholders

U.S. Presidential/Congressional Commission on Risk Assessment and Risk Management (1997)


Risk Communication


“…risk communication is the act of conveying or transmitting information between interested parties about (a) levels of health or environmental risks; (b) the significance or meaning of health or environmental risks; or (c) decisions, action, or policies aimed at aging or controlling health or environmental risks. Interested parties include government agencies, corporations and industry groups, unions, the media, scientists, professional organization, public interest groups, and individual citizens.”

Covello et al. (1987)

Risk Communication


Risk Communication in Practice

• Determine best ways to present scientific information on important risk issues

• Develop guidelines on expert/public communications


GeneralPublic

PublicInterest Groups

Domain ofPerceived Risk

Domain ofTechnical Risk

PublicSphere

ExpertSphere

GOVERNMENTS

MassMediaIndustry

IndependentResearchers

Risk Communication Flows

Communications Processes Model


ManagingPrion Disease Risks


0

10000

20000

30000

40000

Number of

Cases

1997

1980

1988

Transmission of Mad Cow Disease to Humans


• Canada has been challenged both economically and socially by BSE since the first indigenous Canadian case was confirmed in May 2003 in a 6-year old Albertan beef cow.


• 1997: CFIA banned the use of brains, spinal cords and other parts, known as specified risk materials (SRM), in cattle feed. The feed ban also applied to the remains of sheep, goats, bison, elk and deer.

• 2003: Slaughterhouses were to dispose of all SRMs from the bodies of cattle older than 30 months.

• 2004: New regulations to prevent animal parts linked to BSE from being fed to pets and livestock such as chicken or pigs (not only cows and sheep).

• 2006: Cattle tissues capable of transmitting BSE were banned from all animal feeds, pet foods and fertilizers.

• 2007: CFIA introduces enhanced feed ban.

BSE Risk Management in Canada


• People not eligible to donate blood or plasma if they spent a cumulative total of > 3 months in U.K. or France between 1980 and 1996, or a cumulative total of > 5 years in Western Europe (outside U.K. or France) since 1980.

• People not eligible to donate blood or plasma if have had a blood

transfusion in the U.K., France or Western Europe since 1980.

vCJD Risk Management in Canada


BSE Risk Assessment

& Management (B-RAM) Framework

Identify Issue& Context

Involve Interested &

Affected Parties

Assess Risks& Benefits

Identify & Analyze Options

Select Strategy

ImplementStrategy

Monitor &EvaluateResults

Literature Reviews - TSE agents - Psychosocial impacts - Psychosocial interventions - Risk communication - Policy evaluation

International Expert Consultations: Canada, US, Australia, UK, EU,

Japan

Individual Interviews

Community Focus Groups

National Public Survey(n=1500)

Expert Framework Consultations

Analysis of Risk Assessments

Analysis of Policy Instruments

BSE Risk Assessment

& Management (B-RAM) Framework

Prioritize Components - Risk Modeling - Farm family impacts - Psychosocial impacts - Public perception - Domestic Policy - International Policy context

Risk Communication

Canadian Policy and Expert Framework

Consultation

International Expert Consultations: Canada,

US, Australia, UK, Norway, EU, Japan

Integration of Policy

Integration of Added Inputs

Managing BSE/vCJD

Risks


InterpretationScientificData

Social Issues Economic Issues

Political IssuesTechnological Issues

SciencePolicy

Policy Uptake:Interpreting Science for Decision Makers

Toxicity Testing:Science Informing Risk Management

www.nas.edu


Prion Misfolding as a Toxicity Pathway


Federal35%

Research30%

Provincial9%

International4%

IndustryAssociations

22%

Attendee Demographics

Attendees = 48

Communication with Animal & Health Policy Community


Government (U.S.)42%

Research19%

Government (Canada)10%

Other (PAHO, etc.)

20%

Industry Association

8%

Government (Mexico & Costa Rica)

1%

Attendee Demographics

Attendees = 50

International Communication

‘Prion Disease Risk Management’


2009 Canada (Regina) North and South America

(Brasilia) Europe (Brussels)

2008 Canada (Ottawa, June 25) North America (Washington, July

10)

2010 Canada (Edmonton) North and South America

(Washington) Asia (Beijing)

2011 Canada (Ottawa)

Risk ManagementPolicy Consultation Workshops


Risk Perception


Public Perception of Risk

RiskAssessment

RiskGuidelines

RiskInterventions

Expert decision making

Public decision making

RiskPerception

RiskAcceptability

RiskBehaviours

0 20 40 60 80

Cigarette SmokingOzone DepletionBreast Implants

Street DrugsStress

Chemical PollutionCrime and Violence

SuntanningAIDS

Motor Vehicle AccidentsNuclear Waste

Alcohol & PregnancyPCBs or Dioxin

Nuclear Power PlantsClimate Change

Non-prescription MedicationAsbestos

Waste IncineratorsMalnutrition

High Volt Power LinesFood Irradiation

Prescription DrugsGenetically Engineered Bacteria

Outdoor Air QualityBacteria in FoodMoulds in Food

Mercury in FillingsTap Water

Medical X-raysIndoor Air Quality

VDTsContraceptives

Heart PacemakersBottled Water

Contact lenses

Perceived High Risk (%)

Public Perception of Risk


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Bottled water M=1,4, SD=1,2Foot and mouth disease M=1,7, SD=1,3

Tap water M=1,7, SD=1,2WILD GAME DISEASE M=1,8, SD=1,2

Food packaging M=1,8, SD=1,2Food irradiation M=2,0, SD=1,2

MAD COW DISEASE M=1,9, SD=1,4Agroterrorism M=2,0, SD=1,4

Bacteria M=2,2, SD=1,1Artificial sweetners M=2,3, SD=1,3

Genetically modified foods M=2,3, SD=1,3Imported food M=2,5, SD=1,0

Improper food labelling M=2,5, SD=1,2Antibiotics in livestock M=2,5, SD=1,2

Food additives M=2,5, SD=1,1Pesticides M=2,5, SD=1,1

Mercury in fish M=2,6, SD=1,1Growth hormones M=2,7, SD=1,1

Public Perception of Foodborne Risks


“Even the ‘better times’ are not really better because you are simply digging yourself out of the hole, recouping your losses”

“As a young person [who was to take over the farm]…I will not go into farming and I want to tell that to the general public and the government…The message needs to get out that farming is no longer viable for families”

Farm Family Focus Groups



0% 20% 40% 60% 80% 100%

Industry

Government

Pub. Interest or Env. Groups

Univ. Scientists / Sci. Journals

Friends and Relatives

Health Brochures / Pamphlets

Internet

Medical Doctors

News Media

A lot Fair Little None Don't Know / No Opinion

Sources of Information on Population Health Risks


0% 20% 40% 60% 80% 100%

Industry

Pub. Interest or Env. Groups

Government

Internet

News Media

Friends and Relatives

Health Brochures / Pamphlets

Univ. Scientists / Sci. Journals

Medical Doctors

A lot Fair Little None Don't Know / No Opinion

Confidence in Sources of Health Risk Information


020

4060

80

100

Disagree Agree Don’tKnow / NoO pinion

Getting cancer mostly depends on the environment.

Getting cancer mostly depends on lifestyle.

020

4060

80

100


Getting cancer mostly depends on genetic

makeup.

0

20

40

60

80

100


Risk Beliefs

Environment Social Genetics


I believe that a risk-free environment is an attainable goal in

Canada.

0

20

40

60

80

100


Risk Beliefs


• Not to correct public misperceptions of risk• Understanding the factors that shape public attitudes and opinions about risk

can lead to more effective risk communication• More effective risk communication can lead to increased public acceptance of

risk management interventions• “When the public worries, it is our responsibility to worry.”

» Dan Beardsley

US Environmental Protection Agency

•

Why Study Risk Perception?


Web-basedRisk Communication


The preferred source of information and commentary on endocrine modulation

EM comwelcome to emcom

bienvenue chez emcomENTER HERE ENTREZ ICI

www.emcom.ca


An exogenous agent that interferes with the synthesis, secretion, transport, binding, action or elimination of natural hormones in the body that are responsible for the maintenance of homeostasis, reproduction, development and/or behavior" (USEPA 1997).

Session 6 – 22/29

Endocrine Toxicants


• breast cancer• endometrial cancers • endometriosis• fecundity and fertility • increased rates of

spontaneous abortion• sex ratios

• testicular cancer• ovarian cancer • prostate cancer• declining semen quality• male reproductive tract

abnormalities • precocious puberty

Potential Population Health Risks


Website on Population Health Risks


Conclusions


Risk ManagementMedia and

Stakeholder

Involvement

Public -

Science

Interface

Science -

Policy

Interface

Policy Debate

Communication

Roles of Risk Communication


• Graduate Certificate in Population Health Risk Assessment and Management

• MSc in Epidemiology

• PhD in Population Health

• Postdoctoral Fellows

• Visiting Scientists

Training in Risk Science

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Risk Communication and Risk Management Decision Making

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