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

Living with risk and uncertainty

Wim PasschierHealth Risk Analysis and Toxicology, Maastricht University

6 November 2006 Public Policy - Risk & Uncertainty 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

Mid-air aircraft crash

An accident that cannot happen


The aircraft


An accident that cannot happen July 1, 2002 23:35 Überlingen Germany Tupolev 154

collides in mid-air with Boeing 757

71 fatalities


More pictures


It cannot happen

Before flight In flightGeneral

Flight planWeatherChecklist

Traffic controlDetectionsystems

TrainingConstructionMaintenance


Network model aircraft crashes

Human error

Exposure Factors EffectsEnvironment

Aircraft Failure

Type/stage of crash

Fuel loadingForeign object

injection

Maintenance quality

Aircraft ownership

Aircraft failure

Age

Type Aircraft size

Reduced visibility

Pilot error

Instrument failures

Procedure flaws

Alertness

SkillTraining

Instrument failuresProcedure

flaws ATC errors

AlertnessFlight

density

SkillTraining

Population density

Time of the year

Weather Topography

Reduced visibility

Unstable air Ice

Proximity to airport

Target character-

istic

Crash angle

Fuel loadingFire/

explosion

Impact zone

Population density

Property damage

Injuries

Death


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


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


Assessing the Überlingen crash

Human error

Exposure Factors EffectsEnvironment

Aircraft Failure

Type/stage of crash

Fuel loadingForeign object

injection

Maintenance quality

Aircraft ownership

Aircraft failure

Age

Type Aircraft size

Reduced visibility

Pilot error

Instrument failures

Procedure flaws

Alertness

SkillTraining

Instrument failuresProcedure

flaws ATC errors

AlertnessFlight

density

SkillTraining

Population density

Time of the year

Weather Topography

Reduced visibility

Unstable air Ice

Proximity to airport

Target character-

istic

Crash angle

Fuel loadingFire/

explosion

Impact zone

Population density

Property damage

Injuries

Death


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)


The accident’s risk tail

One and a half year after the

aircraft catastrophe at Lake Constance

Swissair traffic controller

stabbed




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

Risk

Attribute of human activities


Risk

Socialsubsystem

Economic subsystem

Ecological subsystem

Economic subsystem

Ecological subsystem

Social

subsystem

Risk:(serious) harm

might occur


Risk governance framework

Structure

Focus on management:Decision on and implementation of actions

Focus on assessment:Generation of knowledge

CharacteriseDecide

AssessManage Communicate


Risk governance frameworkFocus on management:Decision on and implementation of actions


CharacteriseDecide


Structure

•Problem framing•Identification of stakeholders•Selection of assessment framework•Scientific conventions•Design of assessment andmanagement process


Assess


Structure



CharacteriseDecide

Manage Communicate

Scenario analysis•Comb. Options and measures•Societal developmentsOption 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 risksConcern analysis (per option)•Risk perceptions•Societal concerns



Structure



CharacteriseDecide


Risk characterisation (per scenario)•Risk profile•Assessing scope and severity•Ranking options for risk mitigationCosts and benefits (per scenario)•Balancing benefits and costs•Opportunity costsValue of information analysis



Structure



CharacteriseDecide


Evaluation (per scenario)•Acceptability, tolerability•Additional mitigation measuresDecision process•Selection of options•Determine review period•Implementation plan



Structure



CharacteriseDecide

AssessCommunicateManageImplementation•Implementing options•Monitoring and adjustment•Feedback experiences•Review

Environmental health

The top of the iceberg


Environment and health

Dynamic demographic, social, cultural, economical and technological environment

Processing by the

organism

Genetic and acquired

characteristics

Determinants:Physical

environmentSocial

environmentLife style

Effects on health and

quality of life

Health care and prevention


Environment and HealthMortalit

yMorbidity

Adverse health effects (impairments)

Functional or structural changes

Body burdenExposure

(Aggravation of) disease,medical consumption absenteeism

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

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)

Persistent organic chemicals, cadmium, lead,

infection, DNA-adducts, stress-hormones

Chemical, physical, biological,

psychological factors

Manifest phenomena

Phenomena observable in specific surveys or investigations

Expert assessments

Ivory tower or political arena


Independent expert committees Independence

Selection process Diversity

Advantages scientific rigour transparent process

Disadvantages no scientist is independent from any

stakeholder scientific knowledge and values


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'


Complex problems and precaution

Health impacts of large airports Lead in drinking water Dioxins Precautionary principle Wireless communication

Any preference?

Health impacts of large airports

‘Integration’ and ‘international’


Multi-stakeholder issueAircraft operations:• Take-off and landing• Fuel services• Maintenance• Air traffic control• Meteo• Ground services• Emergency services• Security

Passenger operations:• Transport to and from the airport• Ticketing, check-in• Luggage handling• Food services• Support services• Security• Hotel and meeting facilities

Freight handling:• Transport to and from the airport• Storages, loading and unloading• Logistics• Support services• Security

Associated activities:• Businesses at and near the airport• Energy supply• Rail- and road traffic

Groups at risk:• Local population• Passengers• Travellers• Workers at the airport• Workers in the vicinity

Authorities:• Multinational• National• Regional• Local


Health effects of large airports International Committee Integrative assessment Risk characterisation

Per factor Evidence Severity Number affected


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.

Lead in drinking water

Old problem in new form


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


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.


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.

O

O

X

X

X

X

X

X

X

X

Dioxins

Negotiating standards


Environmental quality policy

Policy development for priority substances (1980’s, 1990’s):

Integrated criteria

document by RIVM

Peer review by

Health Council

Consultations of

stakeholders

Government sets policy


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


Uncertainty factor approach

0,1

1

10

100

LOAELmonkey

LOAEL->NAEL

monkey->human

>sensitivehuman

pic

og

ram

per

kilo

gra

m b

od

y

mass p

er

day

Precautionary principle

Dealing with high complexity and large uncertainty


Typology of environmental risk Modest benefits Mechanism unknown Low subjective

probability Potential

catastrophic

Irreversibility Latency External costs Collective risk Internal benefits


Examples

X X X X X X X X X Environmental risk (ozone depletion)

X ? X X X X X X Environmental risk, major benefits (CO2)

X X X X X X ? X X Food additives (red dye)

X X X X X X Occupational accident (hand in machine)

? ? X X X X ? X Occupational exposures (toxics)

Modest benefits

Mechanism

unknown

Low su

bjective probabilit

y

Potential c

atastrophic

Irreversi

bility

Latency

External costs

Collecti

ve risk

Internal benefits


Modest benefits Mechanism

unknown Low subjective

probability Potential

catastrophic Irreversibility Latency External costs Collective risk Internal benefits

Assessment and management: decision principles

Principles

Absolute prevention

Precaution

Utility(cost-benefit)

Traditional practices

Scope in space and time

Ecologic

Social

Economic

Uncertainty about scope in space and time

Societal importance


‘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)

Precautionary principle (‘Rio’)


UNESCO ethics commission: When human activities may lead to morally

unacceptable harm that is scientificallyplausible but uncertain, actions shall be taken to

avoid or diminish that harm.(2005)

Precautionary principle (UNJESCO)

Morally unacceptable harm is threatening to human life or health, or serious and effectively irreversible, or inequitable to present or future generations, or imposed without adequate consideration of the

human rights of those affected


Precaution and seriousnessExtent

Severity

Many

Specialgroups

Few

Small,

can be abso

rbed

Reversible,

repairable

Very serio

us,

many generations

Considerapplying

precautionary principle


Precaution and uncertaintyUncertainty in knowledge

Interpretation(ambiguity)

Undetermined,too complex

Unknown

Variability

Consensu

s

Multiple

interpretations

Dependent

on value judgements

Considerapplying

precautionary principle

Not studied


Wireless communication


Context Old technology, new applications Rapid dissemination Using communication and placing of antennas

disconnected Practically everybody exposed Lack of knowledge on ‘subtle’ effects Strong pressure for generating profits because

of expensive concessions and large investments


Precaution for mobile telephony

Health protection

Safety margin ICNIRP-limits

Precautionary (lower) limits

Minimize exposure

Reverse burden of proof

Process measures

Support decision process

Reduce controversies

Stimulate participation

Further research

Define research targets

Criteria for project selection

Assess ‘state of knowledge’


Summary (1) Risk

Attribute of the evolvement of societal systems

Look for wider context(‘behind the obvious’)

Risk determined by Scope in space and time Societal relevance Uncertainty in space and time


Summary (2) Risk governance framework

Structure Assess Characterise Decide Manage


Summary (3) Precaution

Nine dimensions of ‘environmental risk’ Complexity Uncertainty

Why and how Uncertainty and severity Uncertainty and ambiguity Scientific humility Stakeholder knowledge and concerns


Contact data Severij 1, NL 3155 BR MAASLAND tel +31 10 599 0247, mobile +31 6 1297 4165 e-mail [email protected]

Universiteit Maastricht Dept. of Health Risk Analysis and Toxicology PO Box 616, NL 6200 MD MAASTRICHT tel +31 43 388 1097 (secretariat) e-mail [email protected]

Health Council reports are available atwww.gr.nl(if not, contact me)

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

Documents

Transcript of Living with risk and uncertainty Wim Passchier Health Risk Analysis and Toxicology, Maastricht...