Institute for Research in Extramural Medicine vrije Universiteit Amsterdam

2. Risk perception and risk communication in occupational health Tjabe Smid KLM health safety & environment EMGO-Institute Free University Amsterdam Institute for Research in Extramural Medicinevrije Universiteit Amsterdam

3. As occupational and radiation hygienist, As safety advisor, In advising on environmental noise and safety (in a ‘political’ arena), In teaching HSE issues to students, In research on prevention of back pain, As project leader in a study into health complaints among workers involved in salvage and cleanup after an airplane crash. Personal experience

4. I. Why is risk communication increasingly important? II. Risk perception III. Risk communication IV. Lessons (to be?) learned Program

5. Increasing job demands and productivity -> potentially conflicting with safety goals Increasing personal responsibilities through empowerment Perceived risk is more important Less chemical and physical hazards -> stress-related influences are more important I. Why risk communication is important

6. After major disasters, war, etcetera With marginal chemical/physical risk Many health complaints Functional somatic syndromes: General, diffuse, common symptoms Explicit self-diagnoses Comparable to SBS, multiple chemical sensitivity Example:Post …. syndromes

7. Symptoms somatic and psychological Fatigue, weakness, headache, sleep disturbances, musculoskeletal, gastro-intestinal, skin complaints, respiratory problems, fear and anxiety, depression Related to disaster AND AFTERMATH Mechanism: general symptoms attributed to disaster Or stress -> central nervous system effect -> immunologic effects Communication is crucial! Functional somatic syndromes

8. I. Why is risk communication increasingly important? II. Risk perception III. Risk communication IV. Lessons (to be?) learned Program

9. Experts and the public (workers) differ in their perception of risk Experts try to evaluate risk using: Numbers and statistics Relative ranking The public (workers) evaluate and ranks risk intuitively But there are patterns in risk perception II. Risk perception

10. The effect is larger (especially catastrophic) Exposure is not voluntarily Risk/effect is lesser known Sensory perception is difficult There is less personal control Effects are long-term Risk is man-made Previous incidents have happened, (with victim identity) Experts are not consistent There is less confidence in people in control There is more media attention Intuition overestimates risk when:

11. The risk of large scale accidents and catastrophes is overestimated (plane vs. car accidents) And large scale accidents appear to have more psychological impact 1. Larger effects

12. Voluntary risks are underestimated This factor may explain (among others) why workers don’t wear PPD when it is not compulsory 2. Voluntary risks

13. Unfamiliar risk is overestimated I.e. chemical risk is considered more severe than example falling, or back injuries 3. Risk is less known

14. Difficult sensory perception leads to overestimation of risk Because you have to rely on others for information I.e. radiation, or (odourless and invisible) asbestos fibers in air 4. Sensory perception

15. Relates to 2. (voluntary risk) Perceived control leads to a less severe risk perception 80 % of the Dutch consider their driving above average 5. Less personal control

16. Workers are more afraid of long term health effects, than of short term effects 6. Long term effects

17. Man made risks (chemical, nuclear) are perceived more severe than for example lightning, storm, or flooding 7. Man made risk

18. Especially when there is victim identity Victim identity can be brought through media 8. Previous accidents

19. Or not perceived consistent Internet information is also considered expert opinion 9. Experts are not consistent

20. Especially when risk is not familiar, not known, not sensory perceived, people have to rely on others for their information 10 Less confidence in people responsible for control and information

21. Last but not least! 11. Media attention

22. 1999: KLM has transported a package of nuclear medical material. The package leaked small amounts of radioactive radiation. The maximum estimated dose for crew was 1 % of the total allowed annual dose. The shipper reported it two months later, and simultaneously it was published in national newspapers and television. Workers (and passengers) were very upset about this (in terms of radiation) minor incident, and it lead to a total ban on radioactive cargo Vs. the most recent deadly accident in KLM ground staff was around 1985, when a worker fell from a platform in maintenance. Falls occur more often, are are considered a major risk by safety experts Examples

23. The effect is larger (especially catastrophic) - Exposure is not voluntarily ++ Risk/effect is lesser known + Sensory perception is difficult +++ There is less personal control ++ Effects are long-term +++ Risk is man-made +++ Previous incidents have happened, (with victim identity) +/- Experts are not consistent + (internet) There is less confidence in people in control ++ (2 months lag) There is more media attention ++++ Radiation incident

24. The effect is larger (especially catastrophic) + / - - Exposure is not voluntarily - / + Risk/effect is lesser known - - - Sensory perception is difficult - There is less personal control - - - Effects are long-term - - - Risk is man-made -/+ Previous incidents have happened, (with victim identity) + Experts are not consistent - - - There is less confidence in people in control - - There is more media attention - - - Falls in maintenance

25. I. Why is risk communication increasingly important? II. Risk perception III. Risk communication IV. Lessons (to be?) learned Program

26. There is no standard risk communication ! III. Risk communication

27. Know your target group(s) Know your goal Know the expectations Be trustworthy The message should be unequivocal Be timely Be open and transparent Be consistent Keep the initiative Risk communication

28. I.e. Workers involved Victims Others Uninvolved workers Their representatives Their management Third parties (among others media) 1. Know your target group

29. May be different for different target groups Transfer of information is not the goal But is used for for example: Safe behaviour Prevention of stress: reassurance Compliance Prevention of reliability 2. Know your goal

30. Knowledge Skills Attitudes Behaviour Know your goal (2)

31. What, how, when does the target group needs information Consider perception, culture I.e. symptoms are somatic in Functional somatic syndromes Know your role as perceived by the target group 3. Know the expectations

32. Workers know about risk from others The criterion is confidence rather then ratio External factors are your Position Age Gender 4. Be trustworthy

33. Not too many details Emphasize what is known Coordinate different speakers Know that your perception of competence may differ from that of your target group (‘The American professor’) 5. The message should be unequivocal

34. Total transparency and openness Is not a goal but instrumental Example: asbestos in buildings Never keep something ‘under the hat’ that may escape 6/7/8. Be timely, consistent and transparent

35. By keeping the initiative, the agenda can be set Latent disturbances can evolve any moment 9. Keep the initiative

36. I. Why is risk communication increasingly important? II. Risk perception III. Risk communication IV. Lessons (to be?) learned Program

37. Risk perception shows a consistent pattern Recognition of this phenomenon among professionals is marginal But individuals may be very different from each other. Knowing the perspective of the worker is very important (on your role an contents of the message) There is more then an expert role for professionals After incidents: give information on causes and circumstances Take health complaints serious Communicate on group level, but also on individual level IV Lessons (to be) learned

38. Thank you.Any questions?