Transcript PowerPoint-presentatie

Living with risk and
uncertainty
Wim Passchier
Health Risk Analysis and Toxicology,
Maastricht University
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
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Mid-air aircraft crash
An accident
that cannot
happen
The aircraft
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An accident that cannot happen
July 1, 2002
23:35
Überlingen
Germany
Tupolev 154
collides in
mid-air with
Boeing 757
 71 fatalities
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More pictures
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It cannot happen
General
Before flight
In flight
Training
Construction
Maintenance
Flight plan
Weather
Checklist
Traffic control
Detection
systems
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Network model aircraft crashes
Alertness
Environment
Instrument
failures
Time of the
year
Procedure
flaws
Pilot error
Reduced
visibility
Training
Procedure
flaws
Training
Reduced
Weather
visibility
Topography
Unstable air
Ice
Proximity to
airport
Skill
Type/stage
of crash
Human error
Exposure Factors
Skill
Maintenance
quality
Flight
density
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Population
density
Impact zone
Injuries
Crash angle
Aircraft
failure
Fuel loading
Foreign
object
injection
Fuel loading
Age
Alertness
Aircraft
ownership
Death
Target
characteristic
Instrument
failures
ATC errors
Population
density
Effects
Type
Property
damage
Aircraft size
Public Policy - Risk & Uncertainty
Aircraft Failure
Fire/
explosion
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Look behind the obvious
 Hardware
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Poor state or unavailability of equipment and tools
 Design
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Poor design of a whole plant as well as individual equipment
 Housekeeping
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Poor housekeeping
 Defences
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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
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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
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Poor way safety and internal welfare are defended against a
variety of other goals like time pressure and a limited budget
 Communication
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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
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Assessing the Überlingen crash
Alertness
Environment
Instrument
failures
Time of the
year
Procedure
flaws
Pilot error
Reduced
visibility
Training
Procedure
flaws
Training
Reduced
Weather
visibility
Topography
Unstable air
Ice
Proximity to
airport
Skill
Type/stage
of crash
Human error
Exposure Factors
Skill
Maintenance
quality
Flight
density
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Population
density
Impact zone
Injuries
Crash angle
Aircraft
failure
Fuel loading
Foreign
object
injection
Fuel loading
Age
Alertness
Aircraft
ownership
Death
Target
characteristic
Instrument
failures
ATC errors
Population
density
Effects
Type
Property
damage
Aircraft size
Public Policy - Risk & Uncertainty
Aircraft Failure
Fire/
explosion
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Behind the obvious: Überlingen
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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)
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The accident’s risk tail
One and a half year
after the
aircraft catastrophe
at Lake Constance
Swiss
air traffic controller
stabbed
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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
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Risk
Attribute of human activities
Risk
Economic
subsystem
Economic
subsystem
Social
subsystem
Ecological
subsystem
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Risk:
(serious) harm
might occur
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Risk governance framework
Focus on management:
Decision on and
implementation of actions
Focus on assessment:
Generation of knowledge
Structure
Communicate
Manage
Decide
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Assess
Characterise
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Risk governance framework
Focus on management:
Decision on and
implementation of actions
Focus on assessment:
Generation of knowledge
Structure
•Problem framing
•Identification of stakeholders
•Selection of assessment framework
•Scientific conventions
•Design of assessment and
management process
Communicate
Manage
Decide
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Assess
Characterise
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Risk governance framework
Focus on management:
Decision on and
implementation of actions
Focus on assessment:
Generation of knowledge
Structure
Communicate
Manage
Assess
Scenario analysis
•Comb. Options and measures
•Societal developments
Option 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 risks
Concern analysis (per option)
•Risk perceptions
•Societal concerns
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Decide
Characterise
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Risk governance framework
Focus on management:
Decision on and
implementation of actions
Focus on assessment:
Generation of knowledge
Structure
Communicate
Manage
Decide
Assess
Characterise
Risk characterisation (per scenario)
•Risk profile
•Assessing scope and severity
•Ranking options for risk mitigation
Costs and benefits (per scenario)
•Balancing benefits and costs
•Opportunity costs
Value of information analysis
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Risk governance framework
Focus on management:
Decision on and
implementation of actions
Focus on assessment:
Generation of knowledge
Structure
Communicate
Manage
Decide
Assess
Characterise
Evaluation (per scenario)
•Acceptability, tolerability
•Additional mitigation measures
Decision process
•Selection of options
•Determine review period
•Implementation plan
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Risk governance framework
Focus on management:
Decision on and
implementation of actions
Focus on assessment:
Generation of knowledge
Structure
Communicate
Manage
Assess
Implementation
•Implementing options
•Monitoring and adjustment
•Feedback experiences
•Review
Decide
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Characterise
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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
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Environmental health
The top of the iceberg
Environment and health
Determinants:
Physical
environment
Social
environment
Life style
Processing
by the
organism
Genetic and
acquired
characteristics
Effects on
health and
quality of life
Health care and prevention
Dynamic demographic, social, cultural,
economical and technological environment
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Mortality
Environment and Health
Morbidity
(Aggravation of) disease,
medical consumption absenteeism
Manifest
phenomena
Adverse health effects (impairments)
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
Functional or structural changes
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)
Body burden
Persistent organic chemicals,
cadmium, lead, infection, DNAChemical, physical,
adducts, stress-hormones
biological, psychological
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Phenomena
observable in
specific surveys
or investigations
Exposure
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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
6 November 2006
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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
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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'
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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
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Complex problems and precaution
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Health impacts of large airports
Lead in drinking water
Dioxins
Precautionary principle
Wireless communication
 Any preference?
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Health impacts of large airports
‘Integration’ and ‘international’
Aircraft 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
Multi-stakeholder issue
Associated activities:
• Businesses at and near the airport
• Energy supply
• Rail- and road traffic
Freight handling:
• Transport to and from the airport
• Storages, loading and unloading
• Logistics
• Support services
Groups at risk:
Authorities:
• Security
• Local population
• Multinational
• Passengers
• National
• Travellers
• Regional
• Workers at the airport
• Local
• Workers in the vicinity
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Health effects of large airports
 International Committee
 Integrative assessment
 Risk characterisation
 Per factor
 Evidence
 Severity
 Number affected
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Integrated assessment
as 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.
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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
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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.
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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.
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Dioxins
X
X
O
X
X
Negotiating standards
X
X
X
O
X
Environmental quality policy
 Policy development for priority substances
(1980’s, 1990’s):
Peer review
by Health
Council
Integrated
criteria
document
by RIVM
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Government
sets policy
Consultations
of
stakeholders
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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
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picogram per kilogram body
mass per day
Uncertainty factor approach
100
10
1
LOAEL
monkey
LOAEL>NAEL
monkey>human
>sensitive
human
0,1
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Precautionary principle
Dealing with high complexity and
large uncertainty
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Typology of environmental risk
 Modest benefits
 Mechanism unknown
 Low subjective
probability
 Potential
catastrophic
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Irreversibility
Latency
External costs
Collective risk
Internal benefits
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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 X X X ?
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X Occupational accident (hand in machine)
X Occupational exposures (toxics)
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Assessment and management:
decision principles
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Modest benefits
Mechanism
unknown
Low subjective
probability
Potential
catastrophic
Irreversibility
Latency
External costs
Collective risk
Internal benefits
Scope in space
and time
Principles
Social
Absolute
prevention
Ecologic
Precaution
Economic
Utility
(cost-benefit)
Uncertainty
about scope in
space and time
Traditional
practices
Societal importance
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Precautionary principle (‘Rio’)
‘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)
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Precautionary principle (UNJESCO)
UNESCO ethics commission:
When human activities may lead to morally
unacceptable harm that is scientifically
plausible but uncertain, actions shall be taken to
avoid or diminish that harm.(2005)
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
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Precaution and seriousness
Extent
Many
Consider
applying
precautionary principle
Special
groups
Few
Severity
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Precaution and uncertainty
Uncertainty in knowledge
Undetermined,
too complex
Unknown
Consider
applying
precautionary principle
Not studied
Variability
Interpretation
(ambiguity)
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Wireless communication
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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
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Precaution for mobile telephony
Health
protection
Process
measures
Further
research
Safety margin
ICNIRP-limits
Support decision
process
Define research
targets
Precautionary
(lower) limits
Reduce
controversies
Criteria for project
selection
Minimize exposure
Stimulate
participation
Assess ‘state of
knowledge’
Reverse burden of
proof
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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
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Summary (2)
 Risk governance framework
 Structure
 Assess
 Characterise
 Decide
 Manage
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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
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Contact data
 Severij 1, NL 3155 BR MAASLAND
 tel +31 10 599 0247, mobile +31 6 1297 4165
 e-mail [email protected]

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

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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 at
www.gr.nl
(if not, contact me)
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