Risk management: State-of-the-art?Mikko Pohjola, THL

Contents

• Outline of the RM lectures 30.3.-7.4.

• State-of-the-art in environmental health assessment

• State-of-the-art in risk management?

• The reality of risk management?

• Discussion• Introduction to the RM exercise• RM in the swine flu case

Some concepts & abbreviations• SOTA: State-of-the-art

• ~ best common practice• DA:Decision analysis• RM: Risk management• RA: Risk assessment• ORM: Open risk management• OA: Open assessment• DM: Decision making• SH: Stakeholder(s)• EH: Environmental health (environment and health)• EHA: Environmental health assessment• EHRM: Environmental health risk management• BRA: Benefit-risk analysis

Outline of RM lectures• 30.3. State-of-the-art?

• Theory lecture: frameworks vs. reality• Discussion: RM in the swine flu case

• 31.3. A social learning perspective• Theory lecture: participation, openness, collective learning• Discussion: Citizen perspective to the swine flu RM

• 1.4. Facilitation of (open) risk management• Theory lecture: Pragmatic knowledge services• Exercise: discussion and content evaluation in Opasnet

• 7.4. From needs to knowledge, knowledge to action• Theory lecture: TBD• Discussion: TBD

• 8.4. Summary/overview of DA & RM• 11.-12.4. Final seminar

Outline to RM lectures

• Aims to present and discuss:• Conventional views to RM• Open risk management as an alternative view to RM• What is RM?

• What is it perceived to be?• What should it be?• Who does/should it involve?

General RA/RM framework

• Systematic analysis according to societal needs

Assessment Use

Assessmentprocess

Assessmentproduct

Decision making

Knowledgeneed

Productrequirement

Processrequirement

Societal setting for RA/RM

Risk assessment is collection, synthesis and interpretation of scientific information and value judgments for use of the society

Risk management is use and implementation of that information

SOTA in EHA

• BEPRARIBEAN research project• Manuscript: “State-of-the-art in benefit-risk analysis:

Environmental health” to be published soon-ish• One out of a set of six “SOTA in BRA” papers• Others domains considered are: Food and

nutrition,Food microbiology, Economics and marketing-finance, Medicine, Consumer perception

• Available in Heande (link on the course web-page)• Also a “Beyond the SOTA in food and nutrition BRA”

manuscript is in preparation• Combines the lessons learned in above mentioned

studies

SOTA in EHA

• What is the SOTA in EHA?• Underlying: what could food and nutrition BRA learn

from the SOTA in EHA?

SOTA in EHA• 8 approaches to environmental health assessment:

• Red Book risk assessment• Understanding risk• IRGC risk governance framework• Chemical risk assessment: REACH• Environmental impact assessment: YVA• Health impact assessment (HIA)• Integrated environmental health impact assessment (IEHIA)• Open assessment

• Why not:• Life-cycle assessment?• Nuclear safety assessment?• Silver Book?

SOTA in EHA• Analysis framework:

• Purpose: What need(s) does an assessment address?• Problem owner: Who has the intent or responsibility to conduct

the assessment?• Question: What are the questions addressed in the

assessment? Which issues are considered?• Answer: What kind of information is produced to answer the

questions?• Process: What is characteristic to the assessment process?• Use: What are the results used for? Who are the users?• Interaction: What is the primary model of interaction between

assessment and using its products?• Performance: What is the basis for evaluating the goodness of

the assessment and its outcomes?• Establishment: Is the approach well recognized? Is it

influential? Is it broadly applied?

SOTA in EHA• Interaction:

• Trickle-down: Assessor's responsibility ends at publication of results. Good results are assumed to be taken up by users without additional efforts.

• Transfer and translate: One-way transfer and adaptation of results to meet assumed needs and capabilities of assumed users.

• Participation: Individual or small-group level engagement on specific topics or issues. Participants have some power to define assessment problems.

• Integration: Organization-level engagement. Shared agendas, aims and problem definition among assessors and users.

• Negotiation: Strong engagement on different levels, interaction an ongoing process. Assessment information as one of the inputs to guide action.

• Learning: Strong engagement on different levels, interaction an ongoing process. Assessors and users share learning experiences and implement them in their respective contexts. Learning in itself a valued goal.

• A continuum of increasing engagement and power sharing

SOTA in EHA

• Legend for following process diagrams:• Process/work: thin-border box or bulky arrow• Products: thick-border box• Information flow: thin solid arrow

NRC: Red book

Extrapolation

Measurements and population characteristics

Hazard identification

Dose-response assessment

Exposure assessment

Risk characterization

Regulatory options

Evaluation of options

Decisions and actions

Risk assessment Risk management

Observations

NRC 1983. Risk Assessment in the Federal Government: Managing the Progress. The National Research Council. National Academy Press, Washington D.C.

NRC: Understanding Risk (Orange book)Role and importance of deliberation

Risk characterization as the link between assessment and management

DecisionProblem formulation

Process design

Selecting options & outcomes

Information gathering

Synthesis

Public officials

Natural and social scientists

Interested and affected parties

ImplementationEvaluation

Learning and feedback

Analysis and deliberation

NRC 1996. Understanding Risk: Informing Decisions in a Democratic Society. The National Research Council. National Academy Press, Washington D.C.

IRGC – Risk governanceAssessment sphere:

Generation of knowledge

Risk managementImplementation▪ Option realization▪ Monitoring & control▪ Feedback from risk management practice

Decision making▪ Option identification & generation▪ Option assessment▪ Option evaluation & selection

Pre assessment▪ Problem framing▪ Early warning▪ Screening▪ Determination of scientific conventions

Communication

Tolerability & acceptability judgement

Risk appraisalRisk assessment ▪ Hazard identification & estimation▪ Exposure & vulnerability assessment▪ Risk estimation

Concern assessment▪ Risk perceptions▪ Social concerns▪ Socio-economic impacts

Risk evaluation▪ Judging tolerability & acceptability▪ Need for risk reduction measures

Risk characterization▪ Risk profile▪ Judgment of the seriousness of risk▪ Conclusions & risk reduction options

Management sphere:Decision & implementation of actions

IRGC 2005. Risk governance – towards an integrative approach. International Risk Governance Council. Geneva.

REACH – EU Chemical safety

Hazard assessment▪ Hazard identification▪ Classification & labeling▪ Derivation of threshold levels ▪ PBT/vPvB assessment

Exposure assessment▪ Exposure scenarios building▪ Exposure estimation

Risk characterisation

Information: available vs. required/needed▪ Substance intrinsic properties▪ Manufacture, use, tonnage, exposure, risk management

Dangerous or PBT/vPvB

Risk controlled

no yes

noyes

Ite

rati

on

Chemical safety report

ECHA 2008. Guidance on Information Requirements and Chemical Safety Assessment. Guidance for the Implementation of REACH.

YVA - regulatory EIA in Finland

Opinions and statements about the program

Statements of the ministry of employment

and economy about the evaluation

Evaluation report

Statements of the ministry of employment

and economy about the

report

Evaluation program

Opinions and statements about the

report

Pa

rticipa

tion

Pa

rtic

ipa

tion

Phase 1 Phase 2

Assessment

Pohjola et al. State of the art in benefit-risk analysis: Environmental health. Manuscript.

Health impact assessment (HIA)

Pohjola et al. State of the art in benefit-risk analysis: Environmental health. Manuscript.

Screening

Scoping

Appraisal

Reporting

Monitoring

Policy and programme development phase for prospective assessments

Policy implementation phase

IDEA framework (IEHIA/INTARESE)

Briggs: A framework for integrated environmental health impact assessment of systemic risks. Environmental Health 2008, 7:61.

Open assessment

Assessment

Participant’s knowledge

Participant’s knowledge

Participant’s knowledge

Participant’s updated knowledge

Updated assessment

Participant’s updated knowledge

Decision

Decision m

aking

Perce

ption

Perception

Contributio

n

Con

trib

utio

n

Pohjola et al. State of the art in benefit-risk analysis: Environmental health. Manuscript.

Main findings

• EHA is a very complex field• Environment?• Health?

• No single SOTA approach exists

• Approaches often either academic or regulatory• Assessment centered vs. management centered?

• Traditional and novel approaches

• Regulatory and traditional tend to be more established

EHA

NOTE: this is an influence diagram (not a process diagram)

Adapted from Briggs: A framework for integrated environmental health impact assessment of systemic risks. Environmental Health 2008, 7:61.

Main findings

• Purpose: All state to aim to support societal decision making

• Question, answer, process: Quite different operationalization of the (stated) aims

• Question, answer: Huge differences in scopes

• Process, interaction: Mostly expert activity in institutional settings

• Performance: Societal outcomes hardly ever considered

Assessment – management interaction

Main findings

• The key issues in benefit-risk analysis in environmental health are not so much related to the technical details of performing the analysis, but rather:

• i) the level of integration (cf. Scope)• ii) the perspective to consider the relationship

between assessment and use of its outcomes in different assessment approaches• “Assessment push” or “needs pull”

• The means of aggregation are basically the same as in other fields

• e.g. DALY, QALY, willingness-to-pay (WTP)

Main findings

• In EHA there are tendencies towards:• a) increased engagement between assessors, decision makers,

and stakeholders• b) more pragmatic problem-oriented framing of assessments• c) integration of multiple benefits and risks from multiple

domains• d) inclusion of values, alongside scientific facts, in explicit

consideration in assessment

• Indicative of the incapability of the common contemporary approaches to address the complexity of EHA?

• Does not necessarily show much (yet) in practice

Implications to RM?

• RM more or less included in the approaches• E.g. YVA & REACH are actually RM approaches that

include assessment• Purpose, use, interaction, … all (somewhat)

acknowledge RM and the broader societal context

Other perspectives to RM

• For example:• The EHRM framework by The

Presidential/Congressional Commission on Risk Assessment and Risk Management

• Risk-based decision making framework, i.e. The NRC Silver Book approach

EHRM framework

The Presidential / Congressional commission on Risk Assessment and Risk Management: Final Report Volume 1, 1997.

NRC: Science and decisions (Silver book)

NRC 2009. Science and Decisions: Advancing Risk Assessment. The National Research Council. National Academy Press, Washington D.C.

How does RM look like according to the frameworks?

• Mostly institutional• Professional/expert-based• Often considered as single-actor activity• Primarily unidirectional (knowledge push)• Rational• Quite straightforward

• Implementation of decisions is not the (big) problem

• Is this a realistic view?

How does RM look like according to the frameworks?• A caricature of traditional risk research

• Risk assessment: Scientific experts deal with scientific facts• Risk management: Professional decision makers make decisions

according to the scientific facts• Risk communication: Commuication experts explain the decisions

and the facts to the ignorant (stakeholders, NGO’s, public, …)• Risk perception: Scientific experts analyze why do not the ignorant

understand the facts

• Also in DA there are two branches• What decision should be taken?• How are decisions actually made?

• Are distinctions necessary? Does it correspond with reality and practical needs? Do these things need to be kept separate?

Reality of EHRM?

• Environment and health relevant to everyone• Multiple relevant decision situations• Multiple relevant questions• Multiple relevant actors• Multiple relevant roles• Multiple relevant sources of knowledge

• Experts and professional (societal) decision makers of course, but also:

• DMs in business and industry• NGO’s• Common citizens

Reality of EHRM?

• Reality is much more complex than the (common) RM frameworks recognize/describe

• Simplicity -> explicitness -> good guidance?• Should it not be possible to expand the scope of

systematic analysis/practice?

• The emerging approaches in EHA more or less aim to merge assessment and management into an intertwined social knowledge process

• Assumes a too rational and straightforward practice of assessment, management, and implementation?

Discussion

Intro to RM exercise

RM in the swine flu case

RM exercise

• Individual work

• Max. score 10 points• Course total max. 45 points

• Reports are written in Opasnet• Pages were created for each student in the

introduction to Opasnet lecture 4.3.

• Presentations of reports in final seminar 11.-12.4.

• If needed, improvements can be made up to the final evaluation in the end of April

RM exercise• Task description:

• Consider yourself in the role of the Ministry of Social and Health affairs• Development of capacity to manage major public health risks

• Evaluate all four DA study plans from the use/r point of view:• What value would each planned analysis bring you?• Make use of the properties of good assessment framework:

• Relevance (is content relevant in relation to purpose?)• Pertinence (is purpose relevant in relation to use?)• Usability (does your understanding increase?)• Availability (is information accessible and/or timely?)• Acceptability (Would results/conclusions be acceptable

to you? Why or why not?)• Give an overall statement: would/could the analysis influence

your practices (in the given imaginary role)? Also explain how

RM exercise

• Task description (continued):• Take (one) another perspective and repeat the

evaluation of the DA study plans• E.g. common citizen, medical superintendent in a

hospital, health researcher, journalist, nurse in public health care, principal of an elementary school, …

• Focus on the differences in comparison to the above evaluation

• Write an (freely formatted) evaluation report and present the main findings in the final seminar

• More detailed instructions (will be) available on the exercise web-page in Opasnet

Properties of good assessment

Reasons for changing exercise part 2

• More explicit task (?)• Clearer linkage between DA & RM• Students can better make use of their earlier efforts

in working on the DA study plans• Might help in improving the study plans too!

• Emphasizes different perspectives to DA & RM• First half of the course mostly expert/assessor point

of view• Activates collaboration and cross-fertilization

between students and groups• Collective learning!

Discussion: RM in the swine flu case

• RM in the swine flu case• What risks exist(ed) in the swine flu case?• What risks are/were addressed? How?• Who are/were in the roles of managing the risks?• Who else are/were involved? What roles do/did they

take?• On what basis do/did different actors take action to

manage (in a way or another) the risks?

Concepts

• Some basic concepts:• Performance = goodness!• Assessment, Management• Model• Process (making/using), Product• Output, Outcome• Assessor, Decision/Policy maker, Stakeholder• Participant, User