living with risk and uncertainty wim passchier health risk analysis and toxicology, maastricht...
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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
6 November 2006 Public Policy - Risk & Uncertainty 4
The aircraft
6 November 2006 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
6 November 2006 Public Policy - Risk & Uncertainty 6
More pictures
6 November 2006 Public Policy - Risk & Uncertainty 7
It cannot happen
Before flight In flightGeneral
Flight planWeatherChecklist
Traffic controlDetectionsystems
TrainingConstructionMaintenance
6 November 2006 Public Policy - Risk & Uncertainty 8
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
6 November 2006 Public Policy - Risk & Uncertainty 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
6 November 2006 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
6 November 2006 Public Policy - Risk & Uncertainty 11
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
6 November 2006 Public Policy - Risk & Uncertainty 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)
6 November 2006 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
6 November 2006 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
Risk
Attribute of human activities
6 November 2006 Public Policy - Risk & Uncertainty 16
Risk
Socialsubsystem
Economic subsystem
Ecological subsystem
Economic subsystem
Ecological subsystem
Social
subsystem
Risk:(serious) harm
might occur
6 November 2006 Public Policy - Risk & Uncertainty 17
Risk governance framework
Structure
Focus on management:Decision on and implementation of actions
Focus on assessment:Generation of knowledge
CharacteriseDecide
AssessManage Communicate
6 November 2006 Public Policy - Risk & Uncertainty 18
Risk governance frameworkFocus on management:Decision on and implementation of actions
Focus on assessment:Generation of knowledge
CharacteriseDecide
AssessManage Communicate
Structure
•Problem framing•Identification of stakeholders•Selection of assessment framework•Scientific conventions•Design of assessment andmanagement process
6 November 2006 Public Policy - Risk & Uncertainty 19
Assess
Risk governance framework
Structure
Focus on management:Decision on and implementation of actions
Focus on assessment:Generation of knowledge
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
6 November 2006 Public Policy - Risk & Uncertainty 20
Risk governance framework
Structure
Focus on management:Decision on and implementation of actions
Focus on assessment:Generation of knowledge
CharacteriseDecide
AssessManage Communicate
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
6 November 2006 Public Policy - Risk & Uncertainty 21
Risk governance framework
Structure
Focus on management:Decision on and implementation of actions
Focus on assessment:Generation of knowledge
CharacteriseDecide
AssessManage Communicate
Evaluation (per scenario)•Acceptability, tolerability•Additional mitigation measuresDecision process•Selection of options•Determine review period•Implementation plan
6 November 2006 Public Policy - Risk & Uncertainty 22
Risk governance framework
Structure
Focus on management:Decision on and implementation of actions
Focus on assessment:Generation of knowledge
CharacteriseDecide
AssessCommunicateManageImplementation•Implementing options•Monitoring and adjustment•Feedback experiences•Review
6 November 2006 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
Environmental health
The top of the iceberg
6 November 2006 Public Policy - Risk & Uncertainty 25
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
6 November 2006 Public Policy - Risk & Uncertainty 26
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
6 November 2006 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
Expert assessments
Ivory tower or political arena
6 November 2006 Public Policy - Risk & Uncertainty 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
6 November 2006 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'
6 November 2006 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
6 November 2006 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?
Health impacts of large airports
‘Integration’ and ‘international’
6 November 2006 Public Policy - Risk & Uncertainty 34
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
6 November 2006 Public Policy - Risk & Uncertainty 35
Health effects of large airports International Committee Integrative assessment Risk characterisation
Per factor Evidence Severity Number affected
6 November 2006 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.
Lead in drinking water
Old problem in new form
6 November 2006 Public Policy - Risk & Uncertainty 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
6 November 2006 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.
6 November 2006 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.
O
O
X
X
X
X
X
X
X
X
Dioxins
Negotiating standards
6 November 2006 Public Policy - Risk & Uncertainty 42
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
6 November 2006 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
6 November 2006 Public Policy - Risk & Uncertainty 44
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
6 November 2006 Public Policy - Risk & Uncertainty 46
6 November 2006 Public Policy - Risk & Uncertainty 47
Typology of environmental risk Modest benefits Mechanism unknown Low subjective
probability Potential
catastrophic
Irreversibility Latency External costs Collective risk Internal benefits
6 November 2006 Public Policy - Risk & Uncertainty 48
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
6 November 2006 Public Policy - Risk & Uncertainty 49
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
6 November 2006 Public Policy - Risk & Uncertainty 50
‘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’)
6 November 2006 Public Policy - Risk & Uncertainty 51
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
6 November 2006 Public Policy - Risk & Uncertainty 52
Precaution and seriousnessExtent
Severity
Many
Specialgroups
Few
Small,
can be abso
rbed
Reversible,
repairable
Very serio
us,
many generations
Considerapplying
precautionary principle
6 November 2006 Public Policy - Risk & Uncertainty 53
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
6 November 2006 Public Policy - Risk & Uncertainty 54
Wireless communication
6 November 2006 Public Policy - Risk & Uncertainty 55
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
6 November 2006 Public Policy - Risk & Uncertainty 56
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’
6 November 2006 Public Policy - Risk & Uncertainty 57
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
6 November 2006 Public Policy - Risk & Uncertainty 58
Summary (2) Risk governance framework
Structure Assess Characterise Decide Manage
6 November 2006 Public Policy - Risk & Uncertainty 59
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
6 November 2006 Public Policy - Risk & Uncertainty 60
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)