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Public Health Perspective on Radon Control in Ireland

Public Health Perspective on Radon Control in Ireland. Dr. Ina Kelly Specialist Registrar in Public Health Medicine Health Service Executive Department of Public Health Tullamore. Radon Control in Ireland. Prevention – Building Regulation 1997 (Technical Guidance Document C)

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Public Health Perspective on Radon Control in Ireland

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  1. Public Health Perspectiveon Radon Control in Ireland Dr. Ina Kelly Specialist Registrar in Public Health Medicine Health Service Executive Department of Public Health Tullamore

  2. Radon Control in Ireland • Prevention – Building Regulation 1997 (Technical Guidance Document C) • All new homes fitted with standby radon sump • Homes located in High Radon Areas -install radon barrier as well as a standby radon sump • Mitigation • Homes - RPII has identified and focuses on high radon areas, raising awareness of radon and the benefits of testing • Workplaces - Safety, Health and Welfare at Work Act 2005 - employers to identify all hazards in their workplace, including radon

  3. New Evidence & International Guidance • Gray et al 2009 • Health economic study showed installation of radon barrier in all new builds is cost effective • WHO Radon Handbook • As no threshold for radon risk, recommends reducing overall burden of radon for population • Independent Advisory Group on Ionising Radiation (AGIR) • Recommend criteria for health screening should be applied to radon screening

  4. Why apply criteria for health screening to Control of Radon in Ireland? Radon control strategies differ from country to country • Threshold values and action levels, definition of high radon area • Approach to prevention • Testing and mitigation interventions • Awareness in population • Resource issues Radon exposure is different from country to country • Geology and rock formations • Building practice • Smoking rates (co-factor with radon)

  5. About the screening criteria of the National Cancer Forum, Ireland • Disease screening • - WHO criteria 1968 (Wilson and Jungner) • Criteria to also consider: • Harmful effects of screening • Quality of evidence of effectiveness of screening • Opportunity costs of implementing screening programme

  6. National Cancer Forum Criteria • The condition • The test • The treatment • The screening programme Note – screening may be population based or instead, targeted at higher risk groups

  7. Cancer screening criteria The condition • Important health problem • Epidemiology and natural history understood • Cost-effective primary prevention interventions implemented The test • Simple, safe, precise and validated • Distribution of test values known and cut-off level defined and agreed • Should be acceptable to population • Agreed policy on further diagnostic investigation of individuals with a positive test and on choices available

  8. Cancer screening criteria The treatment • Effective treatment or intervention for those identified through early detection, with evidence of better outcomes for early rather than late treatment • Agreed evidence-based policies covering which individuals should be offered treatment and the appropriate treatment to be offered • Management of the condition and patient outcomes should be maximised prior to starting programme

  9. Cancer screening criteria The screening programme • Screening programme reducing mortality or morbidity • Complete screening programme acceptability to health professionals and to the public • Benefit should outweigh the adverse effects • Opportunity cost • Plan for evaluating programme with agreed QA standards • Adequate resources in place prior to commencement • All other options for managing the condition should have been considered (e.g. improving treatment, providing other services)

  10. Public Health priorities Overall aim: To reduce the number of cases of lung cancer due to radon exposure • Effective radon control strategy • Primary prevention first • Screening programme (secondary prevention) - effectiveness and opportunity cost • Evaluation of outcomes of programme implementation

  11. Public Health recommendations • Time to review current policy on radon control including: • Building regulations • Smoking cessation • Standardisation of prevention, testing and mitigation interventions • On-going monitoring and evaluation of programme effectiveness

  12. References • Gray A, Read S, McGale P, Darby S. Lung cancer deaths from indoor radon and the cost effectiveness and potential of policies to reduce them. BMJ 2009; 338:a3310. doi:10.1136/bmj.a3110 HPA (2009) • WHO. WHO Handbook on Indoor Radon. A public health perspective (2009) • Independent Advisory Group on Ionising Radiation (AGIR) “Radon and Public Health” Available at: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1243838496865

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