Risk Communication
and
Risk Management
Decision Making
Daniel Krewski, PhD, MHA
Professor and Director
McLaughlin Centre for
Populaiton Health Risk Assessment
March 12, 2009
Outline
• Evolution of Risk Science
• Risk Communication
• Case Study: Prion Diseases
• Risk Perception
• Web-based Risk Communication
• Conclusions
• Training
McLaughlin Centre for Population Health Risk Assessment
Frameworks for Risk Assessment and Risk Management
1983
1985
-U.S. National Research Council
1990
-Health Protection Branch
1991
-Canadian Standards Association
1993
1997
2007
-World Health Organization
-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
-McLaughlin Centre for Population Health Risk
Assessment
McLaughlin Centre for Population Health Risk Assessment
An Integrated Framework for
Risk Assessment and
Risk Management
McLaughlin Centre for Population Health Risk Assessment
Population Health
Regulatory
Economic
Advisory
Community
Multiple Interventions
Health Risk Policy Analysis
Evidence Based Policy
Health Risk Science
Determinants and Interactions
Biology-environment
interactions
Biology
and
Genetics
Environment-social
interactions
Environment
and
Occupation
Biology-social interactions
Social
and
Behavioural
Technological
U.S. Presidential/Congressional Commission on
Risk Assessment and Risk Management (1997)
Problem/
Context
Evaluation
Risks
Engage
Stakeholders
Options
Actions
Decisions
McLaughlin Centre for Population Health Risk Assessment
Risk Communication
McLaughlin Centre for Population Health Risk Assessment
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)
McLaughlin Centre for Population Health Risk Assessment
Risk Communication in Practice
• Determine best ways to
present scientific information
on important risk issues
• Develop guidelines on
expert/public
communications
McLaughlin Centre for Population Health Risk Assessment
Communications Processes Model
Domain of
Technical Risk
Domain of
Perceived Risk
Mass
Media
Industry
GOVERNMENTS
General Public
Public Interest
Groups
Independent
Researchers
Expert
Sphere
Public
Sphere
Risk Communication Flows
McLaughlin Centre for Population Health Risk Assessment
Managing
Prion Disease Risks
McLaughlin Centre for Population Health Risk Assessment
Transmission of Mad Cow Disease to Humans
40000
30000
Number
of
Cases
20000
10000
0
McLaughlin Centre for Population Health Risk Assessment
• 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.
McLaughlin Centre for Population Health Risk Assessment
BSE Risk Management in Canada
• 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.
McLaughlin Centre for Population Health Risk Assessment
vCJD 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.
McLaughlin Centre for Population Health Risk Assessment
Literature Reviews
- TSE agents
- Psychosocial impacts
- Psychosocial interventions
- Risk communication
- Policy evaluation
Managing
BSE/vCJD
Risks
BSE
Risk Assessment
& Management (B-RAM)
Framework
Monitor &
Evaluate
Results
Canadian Policy and
Expert Framework
Consultation
Risk Communication
International Expert
Consultations: Canada,
US, Australia, UK,
Norway, EU, Japan
BSE
Risk Assessment
& Management (B-RAM)
Framework
Community Focus
Groups
National Public Survey
(n=1500)
Analysis of Policy
Instruments
Analysis of Risk
Assessments
Expert Framework
Consultations
Identify Issue
& Context
Integration of
Policy
Individual Interviews
International Expert
Consultations: Canada,
US, Australia, UK, EU,
Japan
Assess Risks
& Benefits
Involve
Interested &
Affected
Parties
Implement
Strategy
Identify &
Analyze
Options
Select
Strategy
Prioritize Components
- Risk Modeling
- Farm family impacts
- Psychosocial impacts
- Public perception
- Domestic Policy
- International Policy context
McLaughlin Centre for Population Health Risk Assessment
Integration of
Added Inputs
Policy Uptake:
Interpreting Science for Decision Makers
Social Issues
Scientific
Data
Economic Issues
Interpretation
Technological Issues
Political Issues
McLaughlin Centre for Population Health Risk Assessment
Science
Policy
Toxicity Testing:
Science Informing Risk Management
www.nas.edu
Prion Misfolding as a Toxicity Pathway
McLaughlin Centre for Population Health Risk Assessment
Communication with
Animal & Health Policy Community
Attendee Demographics
Research
30%
Provincial
9%
Federal
35%
Industry
Associations
22%
International
4%
Attendees = 48
McLaughlin Centre for Population Health Risk Assessment
International Communication
Attendee Demographics
Other
etc.)
(PAHO,
‘Prion
20%
Government (Canada)
Disease
Risk Management’
10%
Industry
Association
8%
Government (U.S.)
42%
Research
19%
Government (Mexico
& Costa Rica)
1%
Attendees = 50
McLaughlin Centre for Population Health Risk Assessment
Risk Management
Policy Consultation Workshops
2008
Canada (Ottawa, June 25)
North America (Washington, July 10)
2009
Canada (Regina)
North and South America (Brasilia)
Europe (Brussels)
2010
Canada (Edmonton)
North and South America (Washington)
Asia (Beijing)
2011
Canada (Ottawa)
McLaughlin Centre for Population Health Risk Assessment
Risk Perception
McLaughlin Centre for Population Health Risk Assessment
Public Perception of Risk
Expert decision making
Risk
Assessment
Risk
Guidelines
Risk
Interventions
Public decision making
Risk
Perception
Risk
Acceptability
McLaughlin Centre for Population Health Risk Assessment
Risk
Behaviours
Public Perception of Risk
Cigarette Smoking
Ozone Depletion
Breast Implants
Street Drugs
Stress
Chemical Pollution
Crime and Violence
Suntanning
AIDS
Motor Vehicle Accidents
Nuclear Waste
Alcohol & Pregnancy
PCBs or Dioxin
Nuclear Power Plants
Climate Change
Non-prescription Medication
Asbestos
Waste Incinerators
Malnutrition
High Volt Power Lines
Food Irradiation
Prescription Drugs
Genetically Engineered Bacteria
Outdoor Air Quality
Bacteria in Food
Moulds in Food
Mercury in Fillings
Tap Water
Medical X-rays
Indoor Air Quality
VDTs
Contraceptives
Heart Pacemakers
Bottled Water
Contact lenses
0
20
40
Perceived High Risk (%)
60
80
Public Perception of Foodborne Risks
Growth hormones M=2,7, SD=1,1
Mercury in fish M=2,6, SD=1,1
Pesticides M=2,5, SD=1,1
Food additives M=2,5, SD=1,1
Antibiotics in livestock M=2,5, SD=1,2
Improper food labelling M=2,5, SD=1,2
Imported food M=2,5, SD=1,0
Genetically modified foods M=2,3, SD=1,3
Artificial sweetners M=2,3, SD=1,3
Bacteria M=2,2, SD=1,1
Agroterrorism M=2,0, SD=1,4
MAD COW DISEASE M=1,9, SD=1,4
Food irradiation M=2,0, SD=1,2
Food packaging M=1,8, SD=1,2
WILD GAME DISEASE M=1,8, SD=1,2
T ap water M=1,7, SD=1,2
Foot and mouth disease M=1,7, SD=1,3
Bottled water M=1,4, SD=1,2
0%
10%
20%
30%
40%
50%
McLaughlin Centre for Population Health Risk Assessment
60%
70%
80%
90% 100%
Farm Family Focus Groups
“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”
McLaughlin Centre for Population Health Risk Assessment
McLaughlin Centre for Population Health Risk Assessment
Sources of Information on Population Health Risks
Ne ws Me dia
Me dical Doctors
Inte rne t
He alth Brochure s / Pamphle ts
Frie nds and Re lative s
Univ. Scie ntists / Sci. Journals
Pub. Inte re st or Env. Groups
Gove rnme nt
Industry
0%
20%
A lot
Fair
40%
Little
60%
None
80%
Don't Know / No Opinion
McLaughlin Centre for Population Health Risk Assessment
100%
Confidence in Sources of Health Risk Information
Me dical Doctors
Univ. Scie ntists / Sci. Journals
He alth Brochure s / Pamphle ts
Frie nds and Re lative s
Ne ws Me dia
Inte rne t
Gove rnme nt
Pub. Inte re st or Env. Groups
Industry
0%
20%
A lot
Fair
40%
Little
60%
None
80%
Don't Know / No Opinion
McLaughlin Centre for Population Health Risk Assessment
100%
Risk Beliefs
Getting cancer mostly
depends on the
environment.
100
80
60
40
20
0
Disagree Agree
Don’t
Know / No
O pinion
Environment
Getting cancer mostly
depends on lifestyle.
Getting cancer mostly
depends on genetic
makeup.
100
80
60
100
80
60
40
20
0
40
20
0
Disagree Agree
Don’t
Know / No
O pinion
Social
McLaughlin Centre for Population Health Risk Assessment
Disagre e
Agre e
Don’t
Know / No
O pinion
Genetics
Risk Beliefs
I believe that a riskfree environment is an
attainable goal in
Canada.
100
80
60
40
20
0
Disagree
McLaughlin Centre for Population Health Risk Assessment
Agree
Don’t
Know / No
O pinion
Why Study Risk Perception?
• 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
McLaughlin Centre for Population Health Risk Assessment
Web-based
Risk Communication
McLaughlin Centre for Population Health Risk Assessment
www.emcom.ca
The preferred source of information and
commentary on endocrine modulation
EM com
ENTER HERE
welcome to emcom
bienvenue chez emcom
McLaughlin Centre for Population Health Risk Assessment
ENTREZ ICI
Endocrine Toxicants
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).
McLaughlin Centre for Population Health Risk Assessment
Session 6 – 22/29
Potential Population Health Risks
•
•
•
•
•
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
McLaughlin Centre for Population Health Risk Assessment
Website on Population Health Risks
McLaughlin Centre for Population Health Risk Assessment
Conclusions
McLaughlin Centre for Population Health Risk Assessment
Roles of Risk Communication
Risk Management
Media and
Stakeholder
Involvement
Policy Debate
Science Policy
Interface
Communication
Public Science
Interface
McLaughlin Centre for Population Health Risk Assessment
Training in Risk Science
• Graduate Certificate in Population
Health Risk Assessment and
Management
• MSc in Epidemiology
• PhD in Population Health
• Postdoctoral Fellows
• Visiting Scientists
McLaughlin Centre for Population Health Risk Assessment