The Risk Management Approach to Public Health RisksWilliam Leiss, O.C., Ph.D., FRSC“Shifting Landscapes in Environmental Health: Meeting the Challenge” The Canadian Institute of Public Health Inspectors (Ontario) 69th Annual Educational Conference 17 September 2008, MississaugaWilliam Leiss Stating risk management objectives; Specifying the “value at risk” in quantitative and qualitative terms; Estimating probabilities of occurrences which can produce losses; Identifying and costing risk control options; Agreeing on a hierarchy of preferred solutions.7 7Leiss 2008Leiss 2008The Risk Management Approach (1) Name the responsible entity and the roles of all major collaborating parties; State the objective (e.g., ALARA); Specify the decision sequence steps; Identify the decision inputs; Characterize the risk, including uncertainties, confidence levels, and need for precaution;8 8Leiss 2008Leiss 2008The Risk Management Approach (2) Assess the potential consequences (harms); Perform a formal risk estimation R=P x C and assign a risk class (level of severity); List the available risk control options, including feasibility, cost, public perception, other factors; Evaluate options against objectives in the light of the risk estimation; Make a decision, ideally with an explicit rationale.9 9Leiss 2008Leiss 20081010Leiss 2008Leiss 2008A. The Risk Management Approach (3) Risk management is “the attempt to anticipate and prevent or mitigate harms that may be avoidable.” Risk: The chance of loss or harm; “Measurable uncertainty.” Anticipate: Dont wait until after the disaster occurs; Depending on the type of event, sometimes we can forestall the adverse event entirely, at other times we seek to reduce the scope of the future harmful consequences.1111Leiss 2008Leiss 2008The Risk Management RM Approach (4) Anticipate (continued): This is the precautionary principle, which is built into RM, and is not an add-on; Rio Conference, 1992: Where there are threats of irreversible and serious harms, and incomplete knowledge, take cost-effective steps for risk reduction. Prevent: For drinking water, effective risk control measures will stop pathogens from causing harm. Mitigate: Reduce the scope of the potential harm.1212Leiss 2008Leiss 2008The Risk Management RM Approach (5) “Harms that may be avoidable”: We can never forecast just how well prevention or mitigation will work, except for very well described risks, but good estimation can be done. The general theme of this presentation: Build public trust in science-based RM where it is done well; Participate in criticizing instances of poor RM and in correcting those mistakes.1313Leiss 2008Leiss 2008The Challenge: Decision Credibility One of the most significant weaknesses in risk management decision-making to date is that, Whereas the decision inputs are clearly specified, the decision itself is a “black-box” operation; In other words, the “decision algorithm” is neither stated nor defended. Another significant weakness is lack of transparency and disclosure of key information to the public, preventing stakeholders from contributing to informed discussions of good practicesand bad.1414Leiss 2008Leiss 2008Case: Listeria (1)“Im glad we got hold of it early and now well take serious steps working with the feds to put it behind us.” Dalton McGuinty (Aug. 23)“The fact that it actually moved along, got investigated, ended up at CFIA and others finding samples that were positive in the food was actually quite fast in terms of how these things could progress.” Robert Clarke, ADM, PHAC (Aug. 23)“While this situation is tragic, it is important to note that this is an example of where our surveillance system worked.” Tony Clement, Minister of Health (Aug. 24)“Its necessary to reform and revamp our food-and-product- inspection regimes after some years of neglect.” Prime Minister Stephen Harper (Aug. 26)1515Leiss 2008Leiss 2008Case: Listeria (2)“We have an unwavering commitment to keeping your food safe, with standards well beyond regulatory requirements.”Michael H. McCain, President The only reason we know the above is because the FDA was naughty and published Andersons complete letter; Canada terminated its rankings of plants this year, at the behest of The Canadian Meat Council, because the reports were made public, resulting in “negative” media coverage.1717Leiss 2008Leiss 2008Case: Listeria (4)A litany of risk management errors: Inexcusable delays in surveillance regimes; Delayed public notification of risk; Confused explanation by the company of why its own protective procedures failed; Totally confused explanations by the federal government agencies about differences between U.S. and Canadian standards; To date, no explanation by our governments about why their own regulatory standards failed to protect the public. 1818Leiss 2008Leiss 200