Transcript Slide 1

International Residential Radon Project
Radiation and Environmental Health Programme
Department of Protection of the Human Environment
World Health Organization HQ - Geneva, Switzerland
Radiation & Environmental Health Program in WHO
Director General Office
(DGO)
Communicable
Diseases
(CDS)
General Management
(GM)
Family and
Community Health
(FCH)
Evidence and
Information for Policy
(EIP)
Health Action in
Crises
(HAC)
WHO HQ
Structure
Sustainable Development &
Healthy Environments
(SDE)
Health Technology &
Pharmaceuticals
(HTP)
Non-communicable
Diseases & Mental Health
(NMH)
External Relations and
Governing Bodies
(EGB)
HIV, Tuberculosis,
Malaria
(HTM)
Links to Regional and
Country Offices
(RO, CO)
WHO Radiation and Environmental Health Programme
RAD
Unit
RAD Mandate
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Develop and promote evidence-based policy for Member States
that reduce risks and protect health from exposure to radiation
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Provide medical support and public health advice in case of
major radiation accidents or terrorist events
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Build capacity and provide information to support national
programs
WHO Radiation and Environmental Health Programme
Ionizing Radiation Risk Factors by Origin
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Natural background radiation
• Radon in homes
• Elevated background radiation areas (e.g. India, Iran, Brazil, etc)
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Medical applications
• Diagnostic X-rays
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Radioactive pollution
• Chernobyl and other accidents
• Nuclear fallout and waste disposal
• Depleted uranium
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Occupational exposure
• Nuclear workers
• Cosmic radiation (Air crews)
WHO Radiation and Environmental Health Programme
WHO/RAD: Ionizing Radiation Projects
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Radiation Emergency Response (2 UN Conventions)
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Environmental Radiation
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Co-ordination of research on exposed populations (Chernobyl, Urals, Semipalatinsk)
International Research Reviews (Chernobyl….)
Global Burden of Disease (GBD) assessment
Occupational Radiation Health Evaluation
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Radon in homes
Depleted Uranium
High Natural Background Radiation Areas (Iran, India, Brazil, China)
Research agenda (With UNSCEAR, IAEA, etc)
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REMPAN for emergency medical and public health response
Education and Training
Telemedicine
Nuclear workers
Cosmic Radiation
Health Aspects of Diagnostic Imaging (X-rays, CT, PET, MRI, Ultrasound)
WHO Radiation and Environmental Health Programme
Radon
Scientific literature is now suggesting that 10% of lung
cancers are due to exposure to indoor radon.
People and politicians are not taking enough notice of
this problem.
Mitigation is easily
There is a need for an international focus to raise
awareness
WHO Radiation and Environmental Health Programme
International Radon Project
First Meeting of the Expert Group
Geneva, Switzerland - January 17-18, 2005
Scope: Establish a global project (3-year), with all key international and
national partners participating, to identify and promote programs that
reduce the health impact of exposure to residential radon
Objectives:
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Estimate the global health impact of exposure to residential radon
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Create a global database of residential radon exposure
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Identify effective measures to reduce radon's health impact
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Promote sound policy options and mitigation programs to Member States
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Raise public and political awareness about the consequences of exposure to
radon
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Monitor and periodically review mitigation measures to ensure effectiveness
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Provide annual reports
WHO Radiation and Environmental Health Programme
Global Burden of Disease
GBD is the quantification of health impacts
(mortality and morbidity) caused by risk
factors at population level, using a comparable
and internally consistent framework,
definitions and outcome measures.
 A national burden of disease for radon has
already been completed in Canada: protocol
could used for a full GBD
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WHO Radiation and Environmental Health Programme
Why Assess GBD?
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Provides a global picture of health impacts from
risks associated with radon
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Identifies problem areas to focus resources more
effectively
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Provides tools for identifying intervention
measures and monitoring progress
WHO Radiation and Environmental Health Programme
Mitigation programs
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Provide policy options for national authorities that
lead to a reduction in exposure to radon
Draft international limits on radon concentrations
in collaboration with appropriate international
and national agencies
Provide elements of model legislation
Others?
WHO Radiation and Environmental Health Programme
Advocacy and Risk Communication
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Draft scientific reports, fact sheets, press releases
and other documents to raise public and political
awareness of health concerns about radon
exposure
What more would you like WHO to do to assist
national programs?
WHO Radiation and Environmental Health Programme
International Radon Project:
Shaping the Project I
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Four questions (Barnes Johnson):
• What are the benefits of an international action agenda on radon?
• If recommendations were developed to encourage more risk reduction
from radon, what would they say?
• What are some key opportunities for WHO and us to raise visibility for
such recommendations?
• How can we get started to develop and implement a step-by-step
process?
WHO Radiation and Environmental Health Programme
International Radon Project
Shaping the Project II
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Communication issues
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Measurement issues
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Modeling issues
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Cost issues
WHO Radiation and Environmental Health Programme
International Radon Project
Shaping the Project III: Workplan
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Program elements
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Workgroups
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Timelines
WHO Radiation and Environmental Health Programme
International Radon Project
Shaping the Project IV: Conclusion
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Consensus statements
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Next steps
WHO Radiation and Environmental Health Programme
Q1. What are the benefits of an international action agenda on
radon?
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Provide scientific consensus on radon health risks
Promote public awareness of health risks associated with residential radon
Promote action at national level
Increase homeowner compliance with voluntary/advisory radon guidelines
Set minimum criteria for radon risk management (but allow for country
specific needs)
WHO Radiation and Environmental Health Programme
Q2. If recommendations were developed to encourage more
risk reduction from radon, what would they say?
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Better to install mitigation devices at the time of construction, rather than
retrofit
Building codes provide a natural point of intervention for control of
residential radon (radon levels have increased substantially in Norway
because of the use of aerated concrete in foundations; indoor radon levels
are also increasing in Finland)
Radon testing and mitigation might also be required when an existing home
is sold
Control measures should focus on medium exposure levels, which
contribute most to the overall radon lung cancer burden
Since the vast majority of radon related lung cancers occur in smokers,
consideration needs to be given to the role of tobacco smoking in radon risk
reduction programs
Unburned brick and open floors in homes in developing countries can lead
to elevated thoron levels
Since resources will be required to implement radon risk reduction
measures, it is important to demonstrate the cost-effectiveness of such
measures (cost-effectiveness will vary with radon levels)
WHO Radiation and Environmental Health Programme
Q2 (cont’d). If recommendations were developed to encourage more
risk reduction from radon, what would they say?
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Consideration needs to be given to both guidelines (as is the case in homes
in Britain) and enforceable regulations (as is the case in the workplace in
Britain)
Both voluntary and enforceable guidelines may be useful for residential
exposure (as is the case in Switzerland, where homes exceeding 1,000
Bq/m3 must be mitigated)
Should mitigation focus on new homes only, or include existing homes?
Radon affected areas comprised of high radon levels (defined as those areas
in which 1% of homes exceed the action level in Britain) might be
selectively targeted for testing
Government grants might be used to support radon mitigation actions in
cases of need (may require a means test to administer this type of public
support for mitigation)
WHO Radiation and Environmental Health Programme
Q2 (cont’d). If recommendations were developed to encourage more
risk reduction from radon, what would they say?
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Should schools be identified as an environment that require special
consideration with respect to radon mitigation?
Should workers be included within the scope of this project?
Should thermal spas with high radon content in the water be included?
Should new buildings have a more stringent radon reference level than
existing buildings? (some EU countries have two reference levels, with a
lower level for new buildings)
All new homes constructed since 1998 are required to have a radon sump in
Ireland (nonetheless, 10% of new homes still have radon levels above the
action level of 200 Bq/m3)
WHO Radiation and Environmental Health Programme
Q3. What are some key opportunities for WHO and us to
raise visibility for such recommendations?
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Information programs describing radon as a public health issue
Future (open) meetings to develop WHO International Residential Radon
Project
Education materials are available in a number of countries: these might be
used to develop an “international” radon information kit
WHO Radiation and Environmental Health Programme
Q4. How can we get started to develop and implement a stepby-step process?
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Consensus report from the present meeting
Action plan for WHO residential radon project
Obtain international residential (and outdoor?) radon levels from
UNSCEAR
Reference levels for radon in 20 European countries have been tabulated as
part of ERRICA 2 (advisory levels are largely between 200 and 400
Bq/m3)
WHO Radiation and Environmental Health Programme
Communication Issues
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Information needs to be made available to the public on how to determine
radon levels in their homes, and on ways in which radon in homes can be
reduced
Need to put residential radon lung cancer risk in perspective, perhaps by
comparison with other agents included in the WHO GBD program
Studies have indicated that people may not elect to take voluntary action to
reduce radon in their homes, although this depends on the level of
knowledge that they have on radon health risks
Radon is the largest source of environmental exposure to ionizing radiation
(approx 40% of total exposure in Switzerland)
Radon is the second leading contributor to the global lung cancer burden,
after tobacco smoking
WHO Radiation and Environmental Health Programme
Communication Issues (cont’d)
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Consider tools developed by ERRICCA 2 Project (European Radon
Research and Industry Collaboration Concerted Action): website, public
awareness, protection of new building, mitigation, mapping and
measurement)
WHO Radiation and Environmental Health Programme
1993 WHO Europe Communications Guidelines
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Countries should collect baseline information on existing attitudes and
perceptions about radon before initiating a risk communication programme.
The goal of the radon communications programme should be to provide
accurate scientific information to reduce radon health risks.
Continuous evaluation and improvement of the risk communication
programmes should be undertaken in order to achieve the overall
communications goals.
For special target audiences, appropriate (and possibly different) radon risk
communication messages should be prepared.
Radon risk communication efforts should be linked to key issues, such as
the availability of qualified radon contractors and testing services.
Messages should be repeated and reinforced; a one-time message will not
result in behavioural change.
Countries should be encouraged to share information and discuss new
findings in the area of radon risk communication.
WHO Radiation and Environmental Health Programme
Measurement Issues
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Although homeowners may want quick monitoring results based on shortterm measurements, it is difficult to determine long-term exposure levels on
the basis of short-term measurements
Adjustment for residential radon exposure measurement error results in
increased estimates of the lifetime relative risk – what are the implications
of exposure measurement error for estimating the population attributable
risk?
Spatial patterns in radon concentrations may be related to geographic
characteristics, which may help in identifying “radon affected areas”
Twenty EU countries have carried out radon mapping to some extent under
the ERRICCA 2 Project (by measuring indoor radon gas concentrations, by
soil gas measurements, by geological mapping, and by other radiological
techniques)
Maps can be used to plan radon campaigns, to distribute radon dosimeters,
for radon prevention in new buildings, and to increase public awareness
Mapping studies have designated 1/3 of Ireland as “high radon areas”
(HRAs)
WHO Radiation and Environmental Health Programme
Measurement Issues (cont’d)
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Identification of high radon areas by direct measurement may take some
time (10 years in Switzerland)
Can measurements of less than one year be used to reliably predict annual
residential radon concentrations (possibly using seasonal adjustment
models developed by Pinel et al., 1995, and Krewski et al., 2004)?
WHO Radiation and Environmental Health Programme
Modeling Issues
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Develop updated radon risk projection models based on BEIR
VI (considering recent modifications by US EPA)
Develop updated risk projection models based on combined
analysis of residential studies, including the ongoing
combining of European and North American studies
Consider the use of simple approximations to these models,
which provide insight into different indices of risk are interrelated, and on how to extrapolate results among different
conditions
Characterize sources of uncertainty in radon risk projections
WHO Radiation and Environmental Health Programme
Main Program Elements I:
Science
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Risk models – develop “WHO” model for
projecting radon lung cancer risk (build on BEIR
VI and European and North American combined
analyses, including joint effects of tobacco
smoking)
Radon database – develop global database on
indoor (and outdoor?) radon levels; describe
spatial variation in radon levels using mapping
techniques
Population health impact – estimate global burden
of disease for radon
WHO Radiation and Environmental Health Programme
Main Program Elements II:
Policy
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Exposure guidelines – develop WHO guidelines
for residential radon exposure levels
Cost effectiveness – conduct economic analyses of
alternative mitigation strategies
WHO Radiation and Environmental Health Programme
Main Program Elements III:
Measurement and Mitigation
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Measuring residential radon – recommend
measurement methods for indoor radon
Radon reduction – recommend technologies for
reducing indoor radon levels
WHO Radiation and Environmental Health Programme
Main Program Elements IV:
Communication
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Communications – develop communications
materials to promote program to the public and to
national public health agencies
WHO Radiation and Environmental Health Programme
Main Program Elements V:
Program Evaluation
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Effectiveness monitoring – track reductions in
indoor radon concentrations related to radon
mitigation
Reporting – annual project reports
WHO Radiation and Environmental Health Programme
Work Groups
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Risk assessment (risk modeling , GBD, and
global radon database)
WHO exposure guidelines
Cost effectiveness (framework + analyses)
Measurement and mitigation
Risk communication (including education and
training)
Program coordination and evaluation
[All groups should identify research and
information needs as part of their work]
WHO Radiation and Environmental Health Programme
Timelines: Year 1
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Develop WHO residential radon risk projection model
Preliminary GBD estimates (based on approximate
methods: need average radon concentration, lifetime risk
of dying of lung cancer, prevalence of ever-smokers, lifeexpectancy, geometric standard deviation of indoor radon
levels also useful)
Establish global radon database
Review current residential radon exposure guidelines, and
recommend radon WHO radon guidelines
Review current radon measurement methods
Review current methods of radon reduction
Outline main elements of communications strategy
Develop framework for cost-effectiveness analysis
Consolidate findings into first annual report
WHO Radiation and Environmental Health Programme
Timelines: Year 2
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Conduct GBD analysis for radon
Map global residential radon levels
Conduct cost-effectiveness analysis of alternative
radon mitigation strategies
Complete communications strategy and develop
communications materials, including radon fact
sheets
Second annual report
WHO Radiation and Environmental Health Programme
Timelines: Year 3
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WHO Radon “Handbook” describing radon as a
global population health issue (with input from all
workgroups)
International symposium on WHO Radon
Mitigation Program (showcasing WHO
Handbook)
Program evaluation (impact on national public
health agencies, changes in building codes,
reduction in exposure, other impacts)
Third annual report
WHO Radiation and Environmental Health Programme
Workgroup 1: Risk Assessment
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J. Zielinski
S. Darby
M. Tirmarche
H. Paretzke
D. Chambers
M. Kreuzer
L. Kreienbrock
K. Brand
D. Krewski
M. Zhukovsky
B. Shang
L. Veiga
D. Hill
M. Pavia
E. Wichmann
J. Puskin
S. Akiba
B. Field
WHO Radiation and Environmental Health Programme
Workgroup 2: Exposure Guidelines
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J. McLaughlin
E. Ettenhuber
G. Kendall
D. Fenton (to be confirmed)
A-L Soderman
T. Strand
B. Johnson
H. Yonehara
WHO Radiation and Environmental Health Programme
Workgroup 3: Cost-effectiveness
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A. Gray
K. Brand
T. Strand
B. Johnson
Q. Sun
I. Makelainen
D. Krewski
WHO Radiation and Environmental Health Programme
Workgroup 4: Measurement and Mitigation
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B. Field (measurement M1)
C. Scivyer (mitigation M2) (to be confirmed)
Y. Yamada (M1)
G. Kendall (M1)
T. Strand (M1, M2)
E. Ettenhuber (M1)
G. Piller (M1, M2)
D. Steck (M1)
G. Fisher (M1, M2)
J. Jankowski (M1, M2)
L. Quindos (M1, M2)
A-L. Soderman (M1, M2)
J. Tschiersch (M1)
H. Arvela (M2, M1) (mitigation) (to be confirmed)
Q. Guo (M1)
W. Zhuo (M1, M2)
B. Shang (M1, M2)
M. Zhukovsky (M1)
WHO Radiation and Environmental Health Programme
Workgroup 5: Risk Communication
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V. Koukouliou
A-L. Soderman
J. McLaughlin
G. Piller
H.H. Landfermann
L. Quindos
Q. Sun
T. Strand
B. Johnson
H. Walker
D. Fenton
WHO Radiation and Environmental Health Programme
Workgroup 6: Program Monitoring and Evaluation
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Z. Carr
B. Johnson
H. Walker
A. Gray
A. Auvinen
V. Koukouliou
WHO Radiation and Environmental Health Programme
Consensus Statements
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For many people, radon represents the largest source of exposure to ionizing
radiation in humans.
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Radon is a known cause of lung cancer in humans.
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Radon is an important contributor to the human lung cancer burden, after tobacco
smoking.
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Radon is considered to be responsible for some 10% of the human lung cancer
burden in developed countries/worldwide (will differ between developed and
undeveloped countries)
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The BEIR VI Report estimated that there are approximately 22,000 deaths
annually from radon in the United States alone. (Add European results here)
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Radon related lung cancer risk is affected by tobacco smoking, with most radon
related lung cancers occur in smokers; however, radon is one of the leading causes
of lung cancer in nonsmokers.
WHO Radiation and Environmental Health Programme
Consensus Statements (cont’d)
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Radon should be a priority public health issue for national environmental and
radiation safety programs
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There is a need to carefully evaluate the costs and benefits of national and
international radon mitigation programs.
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Based on existing knowledge of geological conditions and building types, and
consideration of the total lung cancer burden, countries should consider
developing cost-effective national or regional policies on testing and
mitigation
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Where appropriate, countries should build capacity within the public and/or
private sectors to provide testing, mitigation, and radon-resistant new
construction
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Where appropriate, countries should issue and widely disseminate statements
which address the importance of radon risk reduction and the steps that can
be taken to reduce such risks
WHO Radiation and Environmental Health Programme
Consensus Statements (cont’d)
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Countries should explore ways to address radon health risks in a cost-effective
manner, considering both the installation of preventive measures in new
buildings and remediation of existing buildings.
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National governments should team with other stakeholders to ensure radon risk
communication messages are delivered from multiple sources
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Governments should strive to include radon health messages and action steps
with other national efforts on green buildings, housing policy, and the built
environment.
WHO Radiation and Environmental Health Programme
Towards the WHO Radon Guideline
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Immediate remedial action at levels exceeding 1000 Bq/m3
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Guideline of maximum of 400 Bq/m3 for existing homes
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Guideline of 200 Bq/m3 for new homes
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Efforts should be made to reduce radon to even lower levels, where
possible, since there is still some risk of lung cancer below the above
guidelines
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Group recommended giving risk at different proposed guideline levels,
for smokers and nonsmokers.
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Explain role of smoking in relation to radon risk?
WHO Radiation and Environmental Health Programme
Next Steps & Related Activities
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Next annual meeting: January 23-26, 2006 in Geneva) [WHO Geneva]
Four page fact sheet on radon (what radon is, characterizes health effects, testing
and mitigation techniques known and easily implemented, cost effectiveness of
exposure reduction, raise awareness, what WHO will do) (May 30, 2005) [WHO
Geneva]
Press conference to launch WHO project (June, 2005) [WHO Geneva]
WHO Radiation and Environmental Health Programme
WHO Radiation and Environmental Health Programme