Living with risk and uncertainty

1. Living with risk and uncertainty Wim Passchier Health Risk Analysis and Toxicology, Maastricht University

2. Contents • Mid-air aircraft crash – An accident that cannot happen • Risk – Attribute of human activities • Environmental health - the top of the iceberg • Expert assessments • Complex problems and precaution Public Policy - Risk & Uncertainty

3. Mid-air aircraft crash An accident that cannot happen

4. The aircraft Public Policy - Risk & Uncertainty

5. An accident that cannot happen • July 1, 2002 • 23:35 • Überlingen • Germany • Tupolev 154 collides in mid-air with Boeing 757 • 71 fatalities Public Policy - Risk & Uncertainty

6. More pictures Public Policy - Risk & Uncertainty

7. It cannot happen General Before flight In flight Training Construction Maintenance Flight plan Weather Checklist Traffic control Detection systems Public Policy - Risk & Uncertainty

8. Alertness Instrument failures Time of the year Weather Topography Reduced visibility Pilot error Population density Death Procedure flaws Proximity to airport Reduced visibility Unstable air Ice Population density Training Skill Target character-istic Impact zone Injuries Instrument failures Procedure flaws ATC errors Crash angle Aircraft failure Fuel loading Maintenance quality Foreign object injection Training Skill Fuel loading Fire/ explosion Property damage Age Flight density Alertness Aircraft ownership Type Aircraft size Network model aircraft crashes Environment Exposure Factors Effects Type/stage of crash Human error Public Policy - Risk & Uncertainty Aircraft Failure

9. Look behind the obvious • Hardware • Poor state or unavailability of equipment and tools • Design • Poor design of a whole plant as well as individual equipment • Housekeeping • Poor housekeeping • Defences • Poor quality of the protection against hazardous situations • Maintenance management • Poor quality of the maintenance procedures regarding quality, utility, availability and comprehensiveness • Error enforcing conditions • Poor quality of the working environment, regarding circumstances that increase the probability of mistakes Public Policy - Risk & Uncertainty

10. Look behind the obvious (cont’d) • Employee training • Inadequate training or insufficient experience • Procedures • Poor quality of the operating procedures regarding utility, availability and comprehensiveness • Incompatible goals • Poor way safety and internal welfare are defended against a variety of other goals like time pressure and a limited budget • Communication • Poor quality or absence of lines of communication between the various regions, department or employees • Organisation • The way the project is managed and the company is operated Public Policy - Risk & Uncertainty

11. Alertness Instrument failures Time of the year Weather Topography Reduced visibility Pilot error Population density Death Procedure flaws Proximity to airport Reduced visibility Unstable air Ice Population density Training Skill Target character-istic Impact zone Injuries Instrument failures Procedure flaws ATC errors Crash angle Aircraft failure Fuel loading Maintenance quality Foreign object injection Training Skill Fuel loading Fire/ explosion Property damage Age Flight density Alertness Aircraft ownership Type Aircraft size Assessing the Überlingen crash Environment Exposure Factors Effects Type/stage of crash Human error Public Policy - Risk & Uncertainty Aircraft Failure

12. Behind the obvious: Überlingen • Hardware (ATC) • Design • Housekeeping • Defences • Maintenance management • Error enforcing conditions (ATC, Tupolev) • Employee training (Tupolev) • Procedures (ATC, Tupolev) • Incompatible goals (ATC) • Communication (ATC, Tupolev) • Organisation (ATC) Public Policy - Risk & Uncertainty

13. The accident’s risk tail One and a half year after the aircraft catastrophe at Lake Constance Swissair traffic controller stabbed Public Policy - Risk & Uncertainty

14. Contents • Mid-air aircraft crash – An accident that cannot happen • Risk – Attribute of human activities • Environmental health - the top of the iceberg • Expert assessments • Complex problems and precaution • Mid-air aircraft crash – An accident that cannot happen • Risk – Attribute of human activities • Environmental health - the top of the iceberg • Expert assessments • Complex problems and precaution Public Policy - Risk & Uncertainty

15. Risk Attribute of human activities

16. Economic subsystem Social subsystem Ecological subsystem Economic subsystem Socialsubsystem Ecological subsystem Risk Risk:(serious) harm might occur Public Policy - Risk & Uncertainty

17. Focus on management: Decision on and implementation of actions Focus on assessment: Generation of knowledge Structure Communicate Manage Assess Decide Characterise Risk governance framework Public Policy - Risk & Uncertainty

18. Structure • Problem framing • Identification of stakeholders • Selection of assessment framework • Scientific conventions • Design of assessment andmanagement process Communicate Manage Assess Decide Characterise Risk governance framework Focus on management: Decision on and implementation of actions Focus on assessment: Generation of knowledge Public Policy - Risk & Uncertainty

19. Decide Characterise Risk governance framework Focus on management: Decision on and implementation of actions Focus on assessment: Generation of knowledge Structure Communicate Manage Assess • Scenario analysis • Comb. Options and measures • Societal developments • Option analysis • What are the intended benefits? • Options for obtaining benefits? • Impact of risk mitigation. • Analysis risk attributes (per option) • Assessing threats • Assessing exposure and susceptibility • Assessing risks • Concern analysis (per option) • Risk perceptions • Societal concerns Public Policy - Risk & Uncertainty

20. Risk governance framework Focus on management: Decision on and implementation of actions Focus on assessment: Generation of knowledge Structure Communicate Manage Assess Decide Characterise • Risk characterisation (per scenario) • •Risk profile • •Assessing scope and severity • •Ranking options for risk mitigation • Costs and benefits (per scenario) • Balancing benefits and costs • Opportunity costs • Value of information analysis Public Policy - Risk & Uncertainty

21. Risk governance framework Focus on management: Decision on and implementation of actions Focus on assessment: Generation of knowledge Structure Communicate Manage Assess Decide Characterise • Evaluation (per scenario) • Acceptability, tolerability • Additional mitigation measures • Decision process • Selection of options • Determine review period • Implementation plan Public Policy - Risk & Uncertainty

22. Manage • Implementation • Implementing options • Monitoring and adjustment • Feedback experiences • Review Decide Characterise Risk governance framework Focus on management: Decision on and implementation of actions Focus on assessment: Generation of knowledge Structure Communicate Assess Public Policy - Risk & Uncertainty

23. Contents • Mid-air aircraft crash – An accident that cannot happen • Risk – Attribute of human activities • Environmental health - the top of the iceberg • Expert assessments • Complex problems and precaution • Mid-air aircraft crash – An accident that cannot happen • Risk – Attribute of human activities • Environmental health - the top of the iceberg • Expert assessments • Complex problems and precaution Public Policy - Risk & Uncertainty

24. Environmental health The top of the iceberg

25. Processing by the organism Genetic and acquired characteristics Environment and health Dynamic demographic, social, cultural, economical and technological environment Determinants: Physical environment Social environment Life style Effects on health and quality of life Health care and prevention Public Policy - Risk & Uncertainty

26. Environment and Health Mortality Manifest phenomena Morbidity (Aggravation of) disease,medical consumption absenteeism Adverse health effects (impairments) Retarded development of organ systems (e.g. brain), (progressive) loss of organ function (e.g. lung, kidney, cardiovascular system, liver), chronic disturbance of sleep, concentration and performance, prolonged inflammation, allergy, immuno-suppression Functional or structural changes Reversible loss of organ function, chronic stress, alteration of macromolecules (protein, DNA), enzyme induction, inflammation, immune suppression, physical, biochemical, psychological changes (e.g. in diastolic/systolic blood pressure, in serum lipoproteins, anxiety) Phenomena observable in specific surveys or investigations Body burden Exposure Persistent organic chemicals, cadmium, lead, infection, DNA-adducts, stress-hormones Chemical, physical, biological, psychological factors Public Policy - Risk & Uncertainty

27. Contents • Mid-air aircraft crash – An accident that cannot happen • Risk – Attribute of human activities • Environmental health - the top of the iceberg • Expert assessments • Complex problems and precaution • Mid-air aircraft crash – An accident that cannot happen • Risk – Attribute of human activities • Environmental health - the top of the iceberg • Expert assessments • Complex problems and precaution Public Policy - Risk & Uncertainty

28. Expert assessments Ivory tower or political arena

29. Independent expert committees • Independence • Selection process • Diversity • Advantages • scientific rigour • transparent process • Disadvantages • no scientist is independent from any stakeholder • scientific knowledge and values Public Policy - Risk & Uncertainty

30. Alternatives • Mixed committees • scientists • stakeholders • Knowledge/policy vs. science/policy • Science has no prerogative • Inevitable for complex and uncertain issues • Voting or polling • ‘Everything is perception' Public Policy - Risk & Uncertainty

31. Contents • Mid-air aircraft crash – An accident that cannot happen • Risk – Attribute of human activities • Environmental health - the top of the iceberg • Expert assessments • Complex problems and precaution • Mid-air aircraft crash – An accident that cannot happen • Risk – Attribute of human activities • Environmental health - the top of the iceberg • Expert assessments • Complex problems and precaution Public Policy - Risk & Uncertainty

32. Complex problems and precaution • Health impacts of large airports • Lead in drinking water • Dioxins • Precautionary principle • Wireless communication • Any preference? Public Policy - Risk & Uncertainty

33. Health impacts of large airports ‘Integration’ and ‘international’

34. Multi-stakeholder issue • Passenger operations: • Transport to and from the airport • Ticketing, check-in • Luggage handling • Food services • Support services • Security • Hotel and meeting facilities • Aircraft operations: • Take-off and landing • Fuel services • Maintenance • Air traffic control • Meteo • Ground services • Emergency services • Security • Associated activities: • Businesses at and near the airport • Energy supply • Rail- and road traffic • Freight handling: • Transport to and from the airport • Storages, loading and unloading • Logistics • Support services • Security • Groups at risk: • Local population • Passengers • Travellers • Workers at the airport • Workers in the vicinity • Authorities: • Multinational • National • Regional • Local Public Policy - Risk & Uncertainty

35. Health effects of large airports • International Committee • Integrative assessment • Risk characterisation • Per factor • Evidence • Severity • Number affected Public Policy - Risk & Uncertainty

36. Integrated assessmentas normal practice Published results of comprehensive assessments of the public health impact of large airports […], are lacking. In fact, the health impact assessment study [1999] in progress at Amsterdam Schiphol is an exceptional example of what […] should be normal practice. On the basis of such studies measures to safeguard public health effectively and efficiently can be implemented. The committee strongly recommends that public health impact assessment, to guide the further international development of the civil aviation system, become the norm instead of the exception. Public Policy - Risk & Uncertainty

37. Lead in drinking water Old problem in new form

38. Lead in drinking water • 'Classical problem' • Several Health Council reports from before 1940 dealt with lead in drinking water • Annually 11,000 infants in the Netherlands are at risk (estimate) • Recommendation: replacement of leaden drinking water pipes is warranted Public Policy - Risk & Uncertainty

39. New research underpins earlier risk assessments These four new lines of [neurotoxicological] research comprise compelling evidence that exposures to Pb [lead] have adverse effects on the nervous system, that environmental factors increase nervous system susceptibility to Pb, and that exposures in early life may cause neurodegeneration in later life. Public Policy - Risk & Uncertainty

40. Lead in drinking water (…) On request of the Lower House Minister Pronk of the Environment has extended the end date of the subsidy regulation till 2004. According to the Health Council babies run a health risk if being fed with formula milk prepared with water from a leaden pipe. Public Policy - Risk & Uncertainty

41. X X O X X X X O X X Dioxins Negotiating standards

42. Peer review by Health Council Government sets policy Integrated criteria document by RIVM Consultations of stakeholders Environmental quality policy • Policy development for priority substances (1980’s, 1990’s): Public Policy - Risk & Uncertainty

43. Exposure limits for dioxins • Dioxins criteria document RIVM completed by Health Council • Revised exposure limits recommended • ADI: 1 picogram per kilogram per day • Below 'background' values • Science policy problem: • Limiting the nursing period? • Benefit-risk assessment difficult • Rescued by Dutch epidemiological study • ADI incorporated in new WHO guidelines Public Policy - Risk & Uncertainty

44. Uncertainty factor approach Public Policy - Risk & Uncertainty

45. Precautionary principle Dealing with high complexity and large uncertainty

46. Public Policy - Risk & Uncertainty

47. Modest benefits Mechanism unknown Low subjective probability Potential catastrophic Irreversibility Latency External costs Collective risk Internal benefits Typology of environmental risk Public Policy - Risk & Uncertainty

48. Low subjective probability Potential catastrophic Mechanism unknown Internal benefits Modest benefits External costs Collective risk Irreversibility Latency Examples Public Policy - Risk & Uncertainty

49. Scope in space and time Principles Absolute prevention Social Precaution Ecologic Economic Utility(cost-benefit) Uncertainty about scope in space and time Traditional practices Societal importance Assessment and management: decision principles • Modest benefits • Mechanism unknown • Low subjective probability • Potential catastrophic • Irreversibility • Latency • External costs • Collective risk • Internal benefits Public Policy - Risk & Uncertainty

50. Precautionary principle (‘Rio’) ‘Rio-declaration’: Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation. (1992) Public Policy - Risk & Uncertainty