Risk Communication and Risk Management Decision Making

2. Risk CommunicationandRisk ManagementDecision Making Daniel Krewski, PhD, MHA Professor and Director McLaughlin Centre for Populaiton Health Risk Assessment March 12, 2009

3. Outline • Evolution of Risk Science • Risk Communication • Case Study: Prion Diseases • Risk Perception • Web-based Risk Communication • Conclusions • Training

4. Frameworks for Risk Assessment and Risk Management 1983 -U.S. National Research Council 1985 -World Health Organization 1990 -Health Protection Branch -Canadian Standards Association 1991 -Health Protection Branch -CPHA National Advisory Panel on Risk/Benefit Management of Drugs -Codex Alimentarius 1993 1997 -Canadian Standards Association -U.S. Presidential/Congressional Commission on Risk Assessment and Risk Management 2007 -McLaughlin Centre for Population Health Risk Assessment

5. An Integrated Framework for Risk Assessment and Risk Management

6. Environment-social interactions Biology-environment interactions Population Health Regulatory Economic Advisory Community Technological Multiple Interventions Health Risk Policy Analysis Evidence Based Policy Health Risk Science Determinants and Interactions Biology and Genetics Environment and Occupation Social and Behavioural Biology-social interactions

7. U.S. Presidential/Congressional Commission on Risk Assessment and Risk Management (1997) Problem/ Context Evaluation Risks Engage Stakeholders Options Actions Decisions

8. Risk Communication

9. 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)

10. Determine best ways to present scientific information on important risk issues Develop guidelines on expert/public communications Risk Communication in Practice

11. Communications Processes Model Domain of Technical Risk Domain of Perceived Risk Mass Media Industry GOVERNMENTS Public Interest Groups General Public Independent Researchers Expert Sphere Public Sphere Risk Communication Flows

12. Managing Prion Disease Risks

13. Transmission of Mad Cow Disease to Humans Number of Cases 1997 1980 1988

14. 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.

15. 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. BSE Risk Management in Canada

16. 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. vCJD Risk Management in Canada

17. Managing BSE/vCJD Risks

18. ScientificData Interpretation Policy Uptake:Interpreting Science for Decision Makers Social Issues Economic Issues Science Policy Technological Issues Political Issues

19. Toxicity Testing:Science Informing Risk Management www.nas.edu

20. Prion Misfolding as a Toxicity Pathway

21. Communication with Animal & Health Policy Community Attendee Demographics Attendees = 48

22. ‘Prion Disease Risk Management’ Attendee Demographics Attendees = 50 International Communication

23. Risk ManagementPolicy 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)

24. Risk Perception

25. Public decision making Risk Perception Risk Acceptability Risk Behaviours Public Perception of Risk Expert decision making Risk Assessment Risk Guidelines Risk Interventions

26. 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 Perceived High Risk (%)

27. Public Perception of Foodborne Risks

28. 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”

30. Sources of Information on Population Health Risks

31. Confidence in Sources of Health Risk Information

32. Risk Beliefs Getting cancer mostly depends on the environment. Getting cancer mostly depends on lifestyle. Getting cancer mostly depends on genetic makeup. Genetics Environment Social

33. Risk Beliefs I believe that a risk-free environment is an attainable goal in Canada.

34. 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 Why Study Risk Perception?

35. Web-based Risk Communication

36. www.emcom.ca

37. 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). Session 6 – 22/29

38. 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 Potential Population Health Risks

39. Website on Population Health Risks

40. Conclusions

41. Roles of Risk Communication Media and Stakeholder Involvement Risk Management Science - Policy Interface Policy Debate Public - Science Interface Communication

42. Training in Risk Science • Graduate Certificate in Population Health Risk Assessment and Management • MSc in Epidemiology • PhD in Population Health • Postdoctoral Fellows • Visiting Scientists