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Issues on Health impacts

Issues on Health impacts. Hannu Kiviranta. Topics. Issues of risk assessment (RA) and communication (RC) Description and analysis of the risk Risk perception Credibility / Level of trust What more do we need in RA and RC Examples of risk communication challenges

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Issues on Health impacts

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  1. Issues onHealth impacts Hannu Kiviranta Contemporary topics on product liability / Hannu Kiviranta

  2. Topics Issuesof riskassessment (RA) and communication (RC) • Description and analysis of the risk • Risk perception • Credibility / Level of trust • What more do we need in RA and RC Examples of riskcommunicationchallenges • POPs in breastmilk • POPs in fish Contemporary topics on product liability / Hannu Kiviranta

  3. In RC – notice the audience • Scientists, colleagues, experts • Users, authorities, administration • Media, journalists • NGOs, pressuregroups • Individualcitizens Itprobably is dangerous to try to usesimilartechiques to thesedifferentgroups (attitude, level of details, language and terminology). Think to whomyoutalk! But: behonest with all Contemporary topics on product liability / Hannu Kiviranta

  4. State of knowledge ? • ”Cleantable” situation, the audience open to information (is thisdangerous?) • The audiencealready ”knows” the truthor the direction of the truth and is onlyinterested in implementation and details It is important to thinkevenbefore the firstwordswhich of thesesituationsmightbetrue Thismayapply to allgroups, butit is especiallytrue of NGOs and media Contemporary topics on product liability / Hannu Kiviranta

  5. Risk communication problematicThis is true with most audiences (also professional) • Difficult and complicatedissues • Administrativeattitudesveryrigid – almostimpossible to changeduringonegeneration (e.g. the linearcancerextrapolationbased on thinking of 1970s, zero-risktarget) • Non-governmentalorganisationsattack and claim the approachindustry-friendly • Public and the media mightbesuspicious • Some business is making money of publicfears Contemporary topics on product liability / Hannu Kiviranta

  6. Approaching the risk • Description and analysis of the risk • Cognitive and intellectual level • Risk perception • Insight and digestion • Credibility • Level of trust • What more in risk assessment or communication Contemporary topics on product liability / Hannu Kiviranta

  7. The first difficulty is to differentiate between hazard and riskHazard in the two pictures is the same, risk is notHazard is the property of a substance or other factorRisk also includes the likelihood of the hazard to become true and therefore the same hazard may cause totally different risk in different conditions Figs: Wikipedia Contemporary topics on product liability / Hannu Kiviranta

  8. Chances of dying from selected causes (USA statistics) Chapman and Morrison, Nature 1994:367:39 Contemporary topics on product liability / Hannu Kiviranta

  9. Difference between measured and extrapolated risks • Measured risk: we have direct knowledge in real conditions on incidence in human populations • Death statistics (e.g. traffic accidents) • Epidemiological studies (e.g. cancer rate in smokers vs. non-smokers) • Clinical experience (mushroom poisonings) • Extrapolated risk: we extrapolate from other species or from high exposure levels • Safety margins (e.g. 100x from animal data) • Modeling of cancer incidence from accidents or occupational setting (model crucial: linear, threshold) Contemporary topics on product liability / Hannu Kiviranta

  10. Problems from different sources of information • Extrapolatedrisk is difficult to communicate to people • The public and evensomeauthoritiesthinkthatif a limitvalue is exceeded, there is a realrisk • There is usuallyamplesafetymargin • Evenif the risk is real, it is oftenstatisticallyunlikely (e.g. cancerriskusuallyunmeasurablebyepidemiologicalmethods, i.e. lessthan 1 %, butpeoplethinkalmosteverybodywillcontractcancer) • A veryrealmeasuredrisk is notthought as ”my risk”, ifpleasure is involved (alcohol, speeding in traffic): willingness to accept ”selftakenrisks” Contemporary topics on product liability / Hannu Kiviranta

  11. Multitude of limitvalues • as lowas reasonablyachievable (ALARA) • Based on measuredamounts / concentrations, usually a compromise • Eg. Aim to cut the mostcontaminated products from the market • NOT healtheffectbased • healthbasedvalues • Drawupbyeg. WHO, OECD, EPA, institutes • Based on riskassessment (oftenextrapolated RA) • Include a safetymargin • Jungle of acronymes: TDI, TWI, ADI, RfD, BMD, NOAEL, LOAEL, EC… Limit values are risk management tools for authorities, not meant for assessment of one’s risk! Contemporary topics on product liability / Hannu Kiviranta

  12. EU legislation for food and feedcontamination, Viite: Hallikainen, 2009 Example of ALARA limitvalues Contemporary topics on product liability / Hannu Kiviranta

  13. Health based limit values include Safety margin Human in general Human susceptible Animal in general 100 90 80 70 60 Individual difference Species difference Effect 50 10 10 40 30 TDI NO(A)EL 20 10 0 0.1 1 10 100 1000 Dose Contemporary topics on product liability / Hannu Kiviranta

  14. Approaching the risk • Description and analysis of the risk • Cognitive and intellectual level • Risk perception • Insight and digestion • Credibility • Level of trust • What more in risk assessment or communication Contemporary topics on product liability / Hannu Kiviranta

  15. Risk perception • Dread is notdirectlycorrelated to magnitude of risk • Familiarrisk - unknownrisk (alcohol/genemanipulation) • Magnitude of episode (caraccident vs. accident of jumbo jet) • Voluntary/involuntary (1000x difference?) (mountainclimbing/beingsubject to criminalassault) • Association to psychologicallysensitiveissues (nuclearpower/nuclearweapons, chemicals/natural products) Contemporary topics on product liability / Hannu Kiviranta

  16. Risk perception – unknown, high dreadThe right upper corner illustrates difficult topics – unknown, high dread World Health Report 2002 Contemporary topics on product liability / Hannu Kiviranta

  17. Risk perception • Riskpsychology is notverywellknown, butevenexistingknowledge is poorlyutilized • Donotunderestimate the intellect and understanding of the audience • Donotoverestimate the previousknowledge of the audience • Donotforget the power of attitudes and prejudices Contemporary topics on product liability / Hannu Kiviranta

  18. Approaching the risk • Description and analysis of the risk • Cognitive and intellectual level • Risk perception • Insight and digestion • Credibility • Level of trust • What more in risk assessment or communication Contemporary topics on product liability / Hannu Kiviranta

  19. Problems with credibility • Youhave to earncredibility, itrequirespatience, youcanloseit in minutesbywrongchoise of words • The worstapproach is to suggestsomeone just beingemotional: in the presentsocietyonehasalso to considerdifferentattitudes of males and females • People canbetrulyafraid, neverminimisethat Contemporary topics on product liability / Hannu Kiviranta

  20. Typical differences between professionals and lay people • ”Differencesamongresearchers”, difficult to understandthattheyarepart of scientificdiscussion, tendency to pickupone’sownfavourite (climatechangeskeptics a typical case) • Differentsafetymarginshard to understand: limitvalue is not a linebetweensafety and risk • Familiarrisksarebelittled, especiallyiftheywouldthreatenownpleasures Contemporary topics on product liability / Hannu Kiviranta

  21. Approaching the risk • Description and analysis of the risk • Cognitive and intellectual level • Risk perception • Insight and digestion • Credibility • Level of trust • What more in risk assessment or communication Contemporary topics on product liability / Hannu Kiviranta

  22. The mostimportantchangesneeded in riskanalysis and communication • Lack of risk-benefitanalysis is usually the worstproblem in riskanalysis – and riskcommunication • In theoryriskmanagementconsidersrisks, benefits, costs, alternatives etc., in practicethisdoesnotusuallyhappen • Anotherproblem is thatscientificriskassessmentshouldprobablygive the bestassessment, not the ”worst case” – thismakescommunicationdifficult • Health shouldnotdepend on secretdocuments: riskacceptancewouldbenefitfrompublication of alldocuments on riskassessment (nowmostoftenconfidentialbetweenauthorities and industries) Contemporary topics on product liability / Hannu Kiviranta

  23. Weshoulduseprioritization • This is a must, butveryhard to sell to the public • Familiarexamplesmay help Colin Berry: Risks, costs, choice and rationality Contemporary topics on product liability / Hannu Kiviranta

  24. We should use prioritization The mostimportantenvironmentalrisks: air pollution (PM), UV, passive smoking, radon, ozone, noise,… Contemporary topics on product liability / Hannu Kiviranta

  25. Whatshouldweremember in RA and RC ? • Whenyoudonotknow, say it. Mostcatastrophies in communicationstartfrom an attempt to hideignorance • Ifyouneedmoretime, say it. Media arepatient to somedegree, if the reasonsexplained • Be open and honest. The worstthing is giverise to suspicion of cover-up • Becrystalclear Contemporary topics on product liability / Hannu Kiviranta

  26. At leastdonotcauseharm(Hippokratesca. 400 B.C.) • Recentlyanotheraspecthasbeenemphasized: someremediesmaybeworsethan the disease • Dioxins and otherPOPs in fish – avoidingfishconsumptionleads to moreillness, notless • Climatechange – somebiofuelsmaybeworsethanfossilfuels • Chemicals in milk – breastfeedingstillmorefavourable to the newborn Contemporary topics on product liability / Hannu Kiviranta

  27. Examples of risk communication challenges • POPs in breast milk • POPs in fish Contemporary topics on product liability / Hannu Kiviranta

  28. In Finland, no human biomonitoring program National Health and Nutrition Examination Survey (NHANES) • Informationaboutexposure to environmentalchemicalsobtainedfrom • Time trendstudy of POPs in breastmilk • Individualepi-studies Contemporary topics on product liability / Hannu Kiviranta

  29. Time trendstudies in 1987, 1992-4, 2000, 2005, 2011 • Target: to followPCDD/F + PCB + PBDE occurence in Finnishbreastmilk • Aimwas/is to: • Promotebreastfeeding as the bestchoise for a newborn POPs in Finnishbreastmilk Contemporary topics on product liability / Hannu Kiviranta

  30. Concentrations have declined Level of these contaminants in Finland are not exceptionally high 96 75 Contemporary topics on product liability / Hannu Kiviranta

  31. Riskcommunication of POP in breastmilk • Concentrationshavedeclined 80% in 25 years • Finnishconcentrationsnotdifferfromothercountries • Minorrisk of anyhazardoushealtheffectdue to POPs in breastmilk • The nutritional and otherbenefits of breastmilkexceedclearlyanyhazardousrisks => it is good to breastfeed as recommentedby WHO • Has the breastfeedingdurationgrown? NO ! • Therehas to beotherfactorsinvolvingbreastfeedingtime Contemporary topics on product liability / Hannu Kiviranta

  32. Dioxins in Balticherring • Background for the strictdioxinregulations in European Union was the traumaticexperience in the handling of Belgian dioxincatastrope in 1999. Therewas a big need to dosomething • Therewasenoughscientificdioxinexpertise in Finland to beable to challenge the wisdom of verylowdioxinlimitvalues in fish • Emphasizingbenefit-riskapproachratherthanmererisk Contemporary topics on product liability / Hannu Kiviranta

  33. Questionasked: ”Whatif I eatfishexceeding EU maximumlimitvalues”? Toxins ω-3 D-, A-vitam. Ca, P, K, I Contemporary topics on product liability / Hannu Kiviranta

  34. Fishermen study • In Finland main source of PCDD/F and PCBs is fish, • Professional fishermenare the mostexposedsubgroup of Finnish to PCDD/Fs and PCBs • Exposure is 2-5 foldwhencompared to general population • still… Kuva: ProKala Oy Contemporary topics on product liability / Hannu Kiviranta

  35. Fishermenhavelowermortality Viite: Turunen ym., 2008 Contemporary topics on product liability / Hannu Kiviranta

  36. It was calculated that balance is positiveRestricting fish consumption would increase cardiac mortality in Europe, when the preventive effect of omega-3 fatty acids disappearsNumber of reduced cancers dwarfs with this even assuming the worst case If risk managers assume responsibility of total health effect of salmon consumption Cancer Prevented cardiac deaths -206 30900 Present -154 23400 Restrict fish use 0 25000 30000 If risk managers care only for cancer due to pollutants Tuomisto JT et al. 2004 Contemporary topics on product liability / Hannu Kiviranta

  37. Riskcommunication of dioxins in Balticherring • The media/laypopulationaccepted the approachverywell, becauseitwaspossible to explain the issue in layterms • fewcancersavoidedbutmanymorecardiacdeathsdue to decreasedintake of beneficial omega-3 fattyacids of fish • dioxinlevelsalreadydecreased to a fraction of those in 1970s Contemporary topics on product liability / Hannu Kiviranta

  38. KIITOS !Thankyou for listening! Contemporary topics on product liability / Hannu Kiviranta

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