Health Risk Science - Health Interventions

• Regulatory
• Economic
• Advisory
• Community Action
• Technological

Multiple interventions, including multi-level and multi-strategy interventions that are often multi-sectoral (Edwards et al. 2004), can be employed with this integrated framework.  In selecting a strategy, its effectiveness and suitability for the population or sub-population must be considered. Following implementation of the selected strategies, an evaluation of the impact of the actions taken to reduce risk is conducted, ideally through the use of appropriate indicators of population health improvement.

Government agencies responsible for managing risks to health often rely on regulatory action to eliminate or reduce health risks.  In Canada, there are currently more than a dozen federal statutes relating to population health risk management, including the Canadian Environmental Protection Act, the Food and Drugs Act, the Pest Control Products Act, the Hazardous Products Act, Radiation Emitting Devices Act and the Tobacco Products Control Act (Tyshenko et al. 2007). Whereas regulatory solutions to health risk management problems have been widely employed in the past, governments are increasingly exploring non-regulatory strategies for risk management that may be more efficient and possibly more effective (Krewski et al. 2006b).  A comprehensive and systematic approach to assessing the broad range of health risks will be of great value in strengthening the manner in which governments manage population health risks.

Economic approaches to risk mitigation employ economic incentives or disincentives to limit the introduction of, or population exposure to, health risks (Baram 1982).  In general, economic incentives may be used as a means of altering decisions regarding investments, at both the organizational and individual level, as well as making it more advantageous to reduce harm or protect health.  Economic approaches may include insurance and other related schemes to compensate risk consumers without placing excessive financial burdens on individual risk producers; levies and other cost structures to increase the cost of risk producing activities, thereby providing an incentive for risk reduction; fiscal support may also be offered by government to facilitate the development and installation of new technology or procedures designed to reduce risk (Kunreuther 2001).
Although important in all components of the integrated framework, effective risk communication is critical as population health risk management strategies are put into action (National Research Council 1989; Bennett and Calman 1999).  Interested and affected parties need to be provided with timely information about health risks and how they can avoid them (advisory approaches) as well as information which explains the scientific and political basis for policy decisions related to health.  Studies of risk perception can inform the design of appropriate risk communication messages and strategies (Krewski et al. 1995a,b; 2006a).  Finally, the public must be made aware of new health policy initiatives, their underlying rational, and the method and time frame for their implementation.  The management of a risk issue once it captures media attention has recently been discussed by Leiss (2001).

Community action is a term used to describe the involvement of community members in setting priorities, making decisions, planning and implementing health-related initiatives (Boutilier et al. 2000).  Engaging community members in this process involves a process of empowering communities, and building their sense of ownership and control over decisions and programs which affect their lives and their communities (Fawcett et al. 1995; Rifkin 2003).  Community action involves mobilizing existing community resources, increasing meaningful public participation, sharing and increasing access to information, and building skills (Hawe et al. 1997; White et al. 2001).  Strengthening community action increases a sense of common purpose and identity, strengthens partnerships and social networks, builds commitment to group action and in the longer term commitment to strategic action (Roussos and Fawcett 2000; Best et al. 2003).  With respect to risk management, community action has provided the basis for influencing public opinion and changing social norms (such as drinking and driving), changing policies (such as second hand smoke in public places),  making healthy choices easier choices (heart healthy menus in restaurants, exercise programs in workplaces, providing hand sanitizers at the entrance and exits of clinics and hospitals), and garnering the support of diverse interest groups for a common cause (voluntary standards for product safety, changes in building codes to reduce stair hazards, public support for the Kyoto protocol on climate change).

The development or introduction of new technologies may also serve to reduce risk without necessarily invoking any of the preceding options for risk management.  Technological approaches to risk management rely on technological solutions to reduce risk; the availability of different technologies affords flexibility in decision-making and compliance­.  A variety of technological approaches have been developed for example to address mobility of the elderly or road traffic accidents (Nelson et al. 2004; World Health Organization 2004).  Emerging technologies such as genomics (National Research Council 2005b) and nanotechnology (U.S. Environmental Protection Agency 2005) hold great promise for population health risk management in the future (Eng 2004).  In addition to encouraging new technological developments, technological solutions may involve transfer of information about existing technology in conjunction with the use of financial and other incentives to promote its adoption.   

Reproduced from:  Krewski D, Hogan V, Turner MC, Zeman P, McDowell I, Edwards N, Losos J. 2007. An Integrated Framework for Risk Management and Population Health. Human and Ecological Risk Assessment, in press.   

References:
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Tyshenko MG, Benidickson J, Turner MC, et al. 2007. Regulatory and nonregulatory strategies for improving children’s environmental health in Canada. J Toxicol Environ Health B 10: 143-156

Krewski D, Benidickson J, Tyshenko MG, et al. 2006b. Health Policy Approaches to Children’s Environmental Health.  Contract report prepared for Health Canada. Institute of Population Health, University of Ottawa, Ottawa, Canada. Available ; from: www.mclaughlincentre.ca (Date accessed June 1, 2007).

Baram M. 1982. Alternatives to Regulation. Lexington Books, Lexington, MA

Kunreuther H. 2001. Incentives for mitigation investment and more effective risk management: the need for public-private partnerships. J Hazard Mater 86:171-85

National Research Council. 1989. Effective Risk Communication. National Academy Press, Washington, D.C.

Bennett P and Calman K. 1999. Risk Communication and Public Health. Oxford University Press, New York

Krewski D, Slovic P, Bartlett S, et al. 1995a. Health risk perception in Canada I: rating hazards, sources of information and responsibility for health protection. Hum Ecol Risk Assess 1:117-32

Krewski D, Slovic P, Bartlett S, et al. 1995b. Health risk perception in Canada II: worldviews, attitudes and opinions. Hum Ecol Risk Assess 1:231-48

Krewski D, Lemyre L, Turner MC, et al. 2006a. Public perception of population health risks in Canada: health hazards and sources of information. Hum Ecol Risk Assess 12:626-44

Leiss W. 2001. In the Chamber of Risk: Understanding Risk Controversies. McGill- Queens University Press, Montreal and Kingston

Boutilier M, Cleverly S, and Labonte R. 2000. Community as a setting for health promotion. In: Poland B, Green LW, and Rootman I (eds), Settings for Health & Promotion: Linking Theory and Practice, pp 250-7. Sage Publications Inc, Thousand Oaks

Fawcett SB, Paine-Andrews A, Francisco VT, et al. 1995. Using empowerment theory in collaborative partnerships for community health and development. Am J Community Psychol 23:677-97

Rifkin SB. 2003. A framework linking community empowerment and health equity: it is a matter of CHOICE. J Health Popul Nutr 21:168-80

Hawe P, Noort M, King L, et al. 1997. Multiplying health gains:  the critical role of capacity-building within health promotion programs. Health Policy 39:29-42

White R, Mitchell T, Gyorfi-Dyke E, et al. 2001. Prince Edward Island heart health dissemination research project:  establishing a sustainable community mobilization initiative. Promot Educ Suppl 1:13-7 

Roussos ST and Fawcett SB. 2000. A review of collaborative partnerships as a strategy   for improving community health. Annu Rev Public Health 21:369-402

Best A, Stokols D, Green LW, et al. 2003. An integrative framework for community partnering to translate theory into effective health promotion strategy. Am J Health Promot 18:168-76

Nelson A, Powell-Cope G, Gavin-Dreschnack D, et al. 2004. Technology to promote safe & mobility in the elderly. Nurs Clin North Am 39: 649-71

World Health Organization. 2004. World report on road traffic injury prevention. World Health Organization, Geneva

National Research Council. 2005b. Toxicity Testing for Assessment of Environmental Agents: Interim Report. National Academy Press, Washington, D.C.

U.S. Environmental Protection Agency Nanotechnology Working Group. 2005.  External Review Draft Nanotechnology White Paper. Science Policy Council, U.S. Environmental Protection Agency, Washington, D.C.

Eng TR. 2004. Population health technologies.  Emerging innovations for the health of   the public.  Am J Prev Med 26:3