Risk Management &
Population Health
Case Study of Canada
Prepared By:- Mohammad Abu Mahfouze
Master Security of Information System
AABFS
Supervised By;- Dr. Lo’ai Tawalbeh
Introduction
 Health policy development has focused on individuals and the
role of medical care in preventing and treating disease and
injury .
 Recent attention to health inequities and social determinants
of health has raised the profile of population health and
evidence-based strategies for improving the health of whole
populations
 This presentation reviews a historical developments in the
fields of risk management and population, health and
proposes a joint population health risk management
framework that integrates the key elements of both fields
Introduction
 Risk science has started at the 1970s, and since that time it has
been developed into powerful tool for managing technological
change.
 Modern risk analysis took shape with the application of
probabilistic risk assessment methods in the evaluation of reactor
safety.
 As a result of the air pollution in urban areas in Canada
associated with motor vehicle and industrial emissions has been
linked to adverse health effects, which raised the important of
the policy questions about pollution management .We still know
little about the potential risks from genetically modified
organisms, including foods, therapeutic products, and best
control products.
Introduction
 The evolution in thinking about how to manage health and
environmental risks associated with modern technology and
technological change. In 1983, the U.S. National Research
Council (NRC) issued a pioneering report on Risk
Assessment in the Federal Government: Managing the
Process
 This work proposed a comprehensive framework for
assessing and managing health and environmental risks that
has influenced the development of risk management policy.
This and subsequent frameworks provide guidance both on
scientific approaches to characterize risks, and on policy
options for managing them.
Introduction
 The concept of population health has also emerged over the
past 30 years, during which it became accepted that changes
in lifestyle or social and physical environments may have a
greater impact on population health than the health system.
 Although risk management and population health evolved
largely independently, both approaches offer firm bases for
guiding evidence-based health policy
An Integrated Framework for Risk Management and Population
Health (1983)
Figure 1. U.S. National Research Council framework for risk assessment(1983).
EVOLUTION OF RISK MANAGEMENT
 The NRC (1983) report, commonly referred to as the “Red
Book,” gave the first structured description of the health risk
assessment and management process, and has been widely
endorsed throughout the world. The framework consists of three
components: Research, Risk assessment, and Risk
management (Figure 1).
 Risk assessment : is defined as characterization of the potential
adverse health effects of human exposures to environmental
hazards.
Risk assessment involves four steps
1. Hazard identification : is the process of determining
whether exposure to an agent can increase the incidence of
a health condition
2. Dose-response assessment: is the process of characterizing
the relation between the dose of an agent administered or
received and the incidence of an adverse health effect in
exposed populations; it expresses incidence as a function of
exposure to the agent.
Risk assessment involves four steps
3.
Exposure assessment : is the process of measuring or
estimating the intensity, frequency, and duration of human
exposures to an existing agent or of estimating
hypothetical exposures that might arise from the release of
new chemicals into the environment .
4.
Risk characterization: is the process of estimating the
incidence of a health effect under the various conditions of
human exposure described in the exposure assessment
Risk Management
 Risk management: refers to the process of evaluating
alternative regulatory options and selecting among them.
The results of risk characterization are used to identify
potential options that are then evaluated in terms of
expected public health, economic, social, and political
consequences.
 The responsible agency then makes a decision and
implements the selected option.
Risk Determination Diagram
 The limitations of the NRC framework are that it is better
suited to dealing with environmental agents than other
health hazards; it only considers regulatory options; it
contains no provision for monitoring, evaluating, or
revising the risk management strategy; nor is stakeholder
involvement explicitly addressed .
 So it was not the best framework .
Health and Welfare Canada 1990 Framework
 In 1990, Health Canada developed a risk management
framework that defined and described the general process
used to assess and deal with health risks, then it was
updated at 1993(Health and Welfare Canada 1993).
 The Risk Determination Framework consists of two major
components: Risk assessment and Risk management .
Health and Welfare Canada 1990-1993 Framework
Figure 2. Health Canada health risk determination framework (1990, 1993).
A- Risk assessment consists of four steps:
1.
Hazard Identification: is the process of determining
whether exposure to an agent can increase the incidence of
a health condition .
2.
Risk Estimation :is the process of characterizing the
relation between the dose of an agent administered or
received and the incidence of an adverse health effect in
exposed populations; it expresses incidence as a function
of exposure to the agent.
Risk assessment consists of four steps:
3.
Exposure Assessment: is the process of measuring or
estimating the intensity, frequency, and duration of human
exposures to an existing agent or of estimating
hypothetical exposures that might arise from the release of
new chemicals into the environment
4.
Risk Characterization : is the process of estimating the
incidence of a health effect under the various conditions of
human exposure described in the exposure assessment.
B- Risk management
 Risk management : Refers to the process of evaluating
alternative regulatory options and selecting among them. The
results of risk characterization are used to identify potential
options that are then evaluated in terms of expected public
health, economic, social, and political consequences. The
responsible agency then makes a decision and implements the
selected option.
Risk Management consist of four steps
1.
Decision: Is the process of choosing between the options .
2.
Implementation : Is the process of creating the option that
we had choose .
3.
Monitoring and Evaluation : Is the process of controlling
the option to be sure that we achieved our aim .
4.
Review : Is the process of choosing other option in case we
didn’t have the best results.
Canadian Public Health Association (CPHA)
 In 1989, a National Advisory Panel on the Risk/Benefit
Management of Drugs was appointed by the Canadian
Public Health Association (CPHA), to review risk/benefit
methodology applied to the field of prescription drug use
and to develop a framework for use in risk management.
The panel built on the 1993 Health Canada Risk
Determination Framework as a starting point to develop its
Benefit/Risk/Cost Determination Framework (CPHA 1993).
 This added the assessment and management of benefits and
costs within the risk determination paradigm
Canadian Public Health Association (CPHA)
 The intent of this expanded framework was to examine
benefits, risks, and costs in a formal manner, and to use
standard procedures to calculate a net benefit/risk/cost
value for the drug under examination. Changes in
quality-adjusted life expectancy was proposed as a
utility based measure of health benefit associated with
therapeutic intervention; however, this refined measure
of risk has limited the broader applicability of the
framework.
The Framework for Environmental Health Risk
Management
 The Framework for Environmental Health Risk
Management
developed
by
the
U.S.
Presidential/Congressional Commission on Risk
Assessment and Risk Management (1997) is designed to
assist risk managers, such as government officials, private
sector businesses, and individual members of the public in
making good risk management decisions about
environmental health risks (Figure 3). The framework is
sufficiently general to encompass a wide variety of
environmental health risk issues, with the level and effort
invested being scaled to the importance of the problem, the
potential severity and economic impact of the risk, level of
controversy surrounding it,
Figure 3. U.S. Presidential/Congressional Commission Framework for Environmental
Health Risk Management (1997).
The Framework for Environmental Health Risk
Management
 The framework is intended primarily for risk decisions
related to setting standards, controlling pollution, protecting
health, and cleaning up the environment. The framework
consists of Six Steps: Define the problem and put it into
context; Analyze the risks associated with the problem
in context; Examine options for addressing the risks;
Make decisions about which options to implement; Take
actions to implement the decisions; and Conduct an
evaluation of the results of the action
The Framework for Environmental Health Risk
Management
 These steps are implemented in collaboration with
stakeholders. In this framework, risk management is used
both to encompass the process of analyzing, selecting,
implementing, and evaluating actions to reduce risk, and to
describe the entire process. The framework emphasizes the
importance of considering health and environmental
problems in a broad context rather than evaluating
individual risks associated with single agents in specific
environmental media, ensuring stakeholder involvement to
the extent appropriate and feasible during all stages of the
risk management process, and adopting an iterative
approach that affords the flexibility to revisit early stages of
the process as new information becomes available.
The Framework for Environmental Health Risk
Management
 Health Canada has recently revised its approach for dealing
with health risks (Risk Management Framework Project
Team, Health Protection Branch Transition and Health
Canada, 2000). The proposed Decision-Making Framework
consists of a series of inter-connected steps that may be
grouped into three phases: Issue Identification (identify
the issue and put it into context); Risk Assessment (assess
potential risks and benefits—where appropriate); and Risk
Management (identify and analyze regulatory and nonregulatory options; select a strategy; implement the
strategy; and monitor and evaluate the results).
The Framework for Environmental Health Risk
Management
 The framework portrays the involvement of interested and
affected parties throughout the process, including partners,
the public, and other stakeholders. The framework is similar
in structure to that developed by the U.S.
Presidential/Congressional Commission, although many
aspects of the framework have been developed in more
detail.
 The Health Canada framework focuses on examining and
integrating other types of information (social, cultural,
ethical, and economic factors as well as perceived risk) into
the risk assessment process when there is a demonstrated
influence on the level of risk for specific populations.
EVOLUTION OF POPULATION HEALTH
 Public health addresses environmental conditions that exert
widespread effects on the health of populations. The U.S.
Institute of Medicine (IOM 1988, p. 7) has defined public
health as: “fulfilling society’s interest in assuring conditions
in which people can be healthy.” Public health interventions
include sanitation, the protection of drinking water; mass
immunization against vaccine-preventable diseases and the
control of microbiological, radiological, and chemical
hazards. The IOM views the application of scientific
knowledge to disease prevention and health promotion in an
organized community effort as the aim of public health
services.
EVOLUTION OF POPULATION HEALTH
 Health promotion was defined by the World Health
Organization (WHO) as “the process of enabling people
to increase control over, and to improve their health”
(WHO 1986, p. 1). Arising out of the health education
movement, it focused less on physical factors that cause
specific diseases than did public health, and more on
changing broad aspects of lifestyles .
 Population health has been defined as “a conceptual
framework for thinking about why some populations are
healthier than others, as well as the policy development,
research agenda, and resource allocation that flow from it”
(Young 1998,p. 4).
EVOLUTION OF POPULATION HEALTH
 The distinction between population and public health
continues to be a point of discussion ,Whereas public health
focused traditionally on environmental factors that
influence disease, including sanitation and infectious
disease control, population health takes into account all of
the factors affecting the health of populations. The IOM
(2002) foresees closer linkages between the fields of public
and population health, suggesting that public health can be
enriched by the incorporation of population health
principles.
EVOLUTION OF POPULATION HEALTH
 In an article entitled Achieving Health For All: A
Framework for Health Promotion, Epp (1986) proposed a
new approach to health that would meet emerging health
challenges. The report first emphasized the importance of
inequities in health and of reducing inequities in the health
of low versus high income groups. Epp cited the disturbing
evidence that, despite Canada’s equitable health services
delivery system, people’s health remained directly related to
their economic status. Epp’s second health promotion
challenge was to increase prevention efforts by finding new
and more effective ways of preventing injuries, illnesses,
chronic conditions, and disabilities .
Figure 5. Federal, Provincial, and Territorial Advisory Committee on Population
Health Framework for Population Health (1994).
Conclusion
 Although it is now widely recognized that a variety of
determinants can influence our health, the conceptualization
of health and the determination of how health can be
achieved and how health inequalities and inequities can be
reduced remains complex.
 An integrated approach provides a stronger foundation for
evidence-based population health risk management
decision-making by encouraging a more consistent,
systematic and comprehensive evaluation of population
health issues.