Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.
-
Upload
domenic-marshall -
Category
Documents
-
view
215 -
download
2
Transcript of Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.
![Page 1: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/1.jpg)
Embracing Risk:One IH’s Perspective
Tim Mukoda, MSPH, CIH
July 18, 2013
![Page 2: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/2.jpg)
2
What is Risk*
Risk (noun)exposure to the chance of injury or loss; a hazard or dangerous chance
*Source – Dictionary.com
![Page 3: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/3.jpg)
3
Putting yourself ‘at risk’
Participating voluntarily or involuntarily in an activity or event that could lead to injury, damage, or loss.
![Page 4: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/4.jpg)
4
Voluntary Risk
Exposure to hazards we knowingly accept
Examples of voluntary risk: skydiving driving a car smoking cigarettes living in a floodplain investing in the stock market
![Page 5: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/5.jpg)
5
Involuntary Risk Exposure to hazards that occur
without our prior consent Examples of involuntary risk:
tornado terrorist attack lightning strike cosmic radiation contamination in drinking water
![Page 6: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/6.jpg)
6
Relative Risk Percentage increase in risk associated with one
activity over another Typically it compares the ‘risk of doing something’
to the ‘risk of doing nothing’ Most common type of risk quoted by the media By itself, relative risk is meaningless
A 100% increase in relative risk must have context Is a change from 1 in a million to 2 in a million
significant?
![Page 7: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/7.jpg)
7
“USING PAIN PILLS INCREASES RISK OF HEART ATTACK BY 24%"
Increased risk of heart attack was observed ‘in men over the age of 50 using ibuprofen-like medication at ‘intensive’ doses’
Let’s say the risk of heart attack for all individuals over a lifetime is 10 in 1000, or 1%
A relative increase of 24% would be 1.24% In terms of real increase: ~ 12-13 heart attacks per 1000 people,
or an increase of 2 - 3 per 1000 But…the study only applies to intensive users of the drug Out of 1000 people taking intensive doses of pills, expect 2 – 3
deaths in addition to the ten that would likely happen anyway The relative risk for a 30-something using ‘pain pills’ in
moderation may be negligible
![Page 8: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/8.jpg)
8
Activities w/ Equivalent Relative Risk (each listed activity increases risk of premature death by 1 in a million)*
Smoke 1.4 cigarettes (total in a lifetime)
Live 2 months with a smoker (cancer - secondhand smoke)
Travel 10 miles by bicycle (accident)
Travel 300 miles by car (accident)
Travel 1000 miles by jet airplane (accident)
Travel 6000 miles by jet airplane (cancer from cosmic rays)
Live 5 miles from nuclear plant for 50 years (nuclear accident)
Live 2 months in Denver (cancer - radiation)
Live 2 months in stone/brick building (cancer - radiation)
Live 5 years - boundary of a nuclear power plant (cancer - radiation)
Exposure to 1 chest x-ray (cancer - radiation)
Eat 40 tablespoons of peanut butter (cancer)
Eat 100 charcoal-broiled steaks (cancer)
Drink 30 cans of diet soda made w/ saccharine (cancer)
*Bernard Cohen, University of Pittsburgh (1995)
![Page 9: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/9.jpg)
9
Risk in Perspective
“Life” is a series of activities that affect our well-being
We encounter risk every day All decisions are, to some degree, our
attempt to manage risk Which risks do / should we…
…fret over? …avoid? …accept?
![Page 10: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/10.jpg)
…Ignoring risk completely? …Being totally risk averse?
10
What are the consequences of…
![Page 11: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/11.jpg)
11
If we viewed risk through a different lens, we might find
ourselves embracing it!
…so why don’t we do it?
Acknowledging risk could be the best management strategy…
![Page 12: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/12.jpg)
12
People tend to: Overestimate the danger associated with rare events Underestimate dangers of common events Worry more about dramatic but infrequent events Assume if a situation can be ‘controlled’ it is safer Have different perspectives on voluntary &
involuntary risk
WHAT ARE WE AFRAID OF?
![Page 13: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/13.jpg)
13
Activities w/ Equivalent Relative Risk (each listed activity increases risk of premature death by 1 in a million)*
Smoke 1.4 cigarettes - total in a lifetime (cancer)
Live 2 months with a smoker (cancer - secondhand smoke)
Travel 10 miles by bicycle (accident)
Travel 300 miles by car (accident)
Travel 1000 miles by jet airplane (accident)
Travel 6000 miles by jet airplane (cancer from cosmic rays)
Live 5 miles from nuclear plant for 50 years (nuclear accident)
Live 2 months in Denver (cancer - radiation)
Live 2 months in stone/brick building (cancer - radiation)
Live 5 years - boundary of a nuclear power plant (cancer - radiation)
Exposure to 1 chest x-ray (cancer - radiation)
Eat 40 tablespoons of peanut butter (cancer)
Eat 100 charcoal-broiled steaks (cancer)
Drink 30 cans of diet soda made w/ saccharine (cancer)
*Bernard Cohen, University of Pittsburgh (1995)
![Page 14: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/14.jpg)
14
…collect a sample & compare the result to a standard…
The traditional IH perspective…
…health risk assessment.
![Page 15: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/15.jpg)
What exposure (and associated risk) is the IH
trying to assess & manage?
The dose makes the poison…
15
![Page 16: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/16.jpg)
16
Response
Dose
0%
50%
100%
LD50
Dose-Response Curve
Cancer is the typical ‘response of interest’
![Page 17: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/17.jpg)
Occupational Exposure Limit:
Formaldehyde
17
How are exposure limits established?
![Page 18: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/18.jpg)
Formaldehyde
Classified as a Suspected Human Carcinogen – rat nasal carcinoma
Rats are obligate nose breathers Current Standards:
OSHA – 0.75 ppm 8-TWA; 2 ppm STEL ACGIH – Ceiling 0.3 ppm
18
![Page 19: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/19.jpg)
Points to Consider: LC50 – Lethal Concentration 50%
LOAEL – Lowest Observable Adverse Effect Level NOAEL – No Observable Adverse Effect Level Limit of Quantification – LOQ Limit of Detection – LOD Applying exposure data collected on rats to humans? What to consider in setting an exposure limit?
19
Formaldehyde
![Page 20: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/20.jpg)
20
Response
Dose
0%
50%
100%
LC50 = 165 ppm
Notional Dose-Response CurveFormaldehyde
No Effect
NOAEL = 1.6 ppm
LOAEL = 4.8 ppm
LOQ = 0.18 ppm*LOD = 0.06 ppm*
*NIOSH Method 2016 using minimum sampling volume
![Page 21: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/21.jpg)
Formaldehyde In Summary:
LC50 – 165 ppm
LOAEL – 4.8 ppm NOAEL – 1.6 ppm LOQ – 0.18 ppm LOD – 0.06 ppm
Current Standards: OSHA – 0.75 ppm 8-TWA; 2 ppm STEL ACGIH – Ceiling 0.3 ppm
21
![Page 22: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/22.jpg)
What is a reasonable exposure limit based on the data being considered?
What is an appropriate margin of safety – 10x, 100x, 1000x?
What if the difference between controlling exposure at the NOAEL versus the LOQ is $1 million in real cost?
22
Considerations
![Page 23: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/23.jpg)
Do lawmakers rigorously consider the science on which standards are based?
Do regulatory agencies consider all types of risk & associated cost w/ proposed standards?
Who can be ‘most’ objective in establishing a risk-based standard?
23
Points to Consider
![Page 24: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/24.jpg)
Health Risk is one consideration in performing a comprehensive risk assessment…
Operational risk Financial risk Non-compliance risk Political risk
24
![Page 25: Embracing Risk: One IH’s Perspective Tim Mukoda, MSPH, CIH July 18, 2013.](https://reader030.fdocuments.in/reader030/viewer/2022032518/56649cc65503460f94990075/html5/thumbnails/25.jpg)
Understand the processes being employed to make decisions in your organization
Recognize health risk is weighted differently in different situations
EHS professionals may lose credibility by focusing solely on health risk
Understand and be engaged in the EHS regulatory standard setting process
Use ‘teachable moments’ to educate on risk
25
Final Thoughts