ISSN:0272-4332    

DOI:10.1111/j.1539-6924.1995.tb01332.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We propose three principles and a general framework of reasoning for managing risk in the public interest.Principle 1.Risks shall be managed to maximize the total expected net benefit to society—The principle that the net benefit is to be maximized across society as a whole is argued to be a sufficient and rational guide to assessing the effectiveness of efforts directed at reducing risk and thus improving health and safety. The net benefit of an activity is the excess of the totality of benefits over the totality of detriments.Principle 2.The safety benefit to be promoted is life‐expectancy—The goal is to ensure that risk mitigation efforts maximize the net benefit to society in the specific terms of length of life for all individuals. The effect of an activity on life expectancy is proposed as the proper basic measure of its net safety impact. Life expectancy is a universal measure valid for comparisons both within and among countries and can be adjusted to include health expectancy and other factors such as income levels that affect the quality of life. The impact on life expectancy allows a dispassionate accounting of the good and the bad inherent in any proposal or activity that is in the public interest but has some impact on life and health.Principle 3.Decisions for the public in regard to health and safety must be open and apply across the complete range of hazards to life and health—Systematic efforts to evaluateallthe important consequences, both direct and indirect, are required to improve the basis for risk management in society. Balancing of the detrimentsandthe benefits of any given initiative is the key aspect of the undertaking. Safety may well be an important objective in society, but it is not the only one. Thus, allocation of society's resources devoted to safety must be openly and continually appraised in light of other competing social needs because there is a limit on the resources that can be expended to save lives. Maximization of healthful life for all is judged the proper basis for managing risk in the public interest, and that this is achieved when the net of the contribution to the total saving of life exceeds the loss

ISSN:0272-4332    

DOI:10.1111/j.1539-6924.1995.tb01333.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Modern science and medicine, and increasing prosperity, have brought many benefits to our society, but not without costs. One cost is that some of the technological innovations and new activities bring with them different and perhaps greater risks that threaten our lives. Any problem involving life‐threatening risks is complex, so it is difficult to think through all the implications of the alternatives proposed to address it. This paper presents a number of “facts” to guide constructive thinking about decisions concerning life‐threatening risks. The intent is to help us appraise alternatives, design public policy and laws, and communicate about specific risk p

ISSN:0272-4332    

DOI:10.1111/j.1539-6924.1995.tb01334.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Health management and safety regulation are separate disciplines but share the aim to extend expectancy of life in good health. The need to improve cost‐effectiveness calls for their co‐ordinated management according to a unified rationale. Three guiding principles of accountability, demonstrable net benefit and a uniform measure of performance, have been laid out in Canada by the Joint Committee on Health and Safety. They call for open accounting in terms of (health‐related quality‐adjusted) life expectancy. The principles are utilitarian in format but, it is argued, inequity is naturally diminished in the process of optimizing cost‐effectiveness through maximum marginal returns. Comments are made on practical implementation. The need for public consent in practice calls for two additional principles reflecting fair procedure and sovereignty of the citizens. It is concluded that public health and safety measures should be surveyed, documented for cost‐effectiveness and prioritized for

ISSN:0272-4332    

DOI:10.1111/j.1539-6924.1995.tb01335.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Problems in the theoretical basis for the linear‐no threshold theory of radiation carcinogenesis are reviewed, and it is shown that they very strongly suggest that the theory greatly overestimates the risk of low level radiation. A direct test of the theory, based on the radon—lung cancer relationship is described; it strongly reinforces that conclusion. However, it is shown that even if the linear‐no threshold theory is valid, the public's fear of low level radiation, at least in some contexts, is grossly exagge

ISSN:0272-4332    

DOI:10.1111/j.1539-6924.1995.tb01336.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Cancer prevention is a major component of cancer control, which also comprises screening, treatment, rehabilitation and palliative care. Preventive approaches need to be congruent with those adopted for other chronic diseases, with a major impact in reduction of incidence and mortality of many common cancers to be expected from smoking control and dietary modification. Increasing interest is now being paid to other environmental causes of cancer, and to gene‐environment interactions. However, one of the major research needs remains the evaluation of better ways to convince people to make the necessary changes in their lifestyle that will reduce their risk of cance

ISSN:0272-4332    

DOI:10.1111/j.1539-6924.1995.tb01337.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

This study is a replication and extension in Canada of a previous study in the United States in which toxicologists and members of the public were surveyed to determine their attitudes, beliefs, and perceptions regarding risks from chemicals. This study of “intuitive vs. scientific toxicology” was motivated by the premise that different assumptions, conceptions, and values underlie much of the discrepancy between expert and lay views of chemical risks. The results showed that Canadian toxicologists had far lower perceptions of risk and more favorable attitudes toward chemicals than did the Canadian public. The public's attitudes were quite negative and showed the same lack of dose‐response sensitivity found in the earlier U.S. study. Both the public and the toxicologists lacked confidence in the value of animal studies for predicting human health risks. However, the public had great confidence in the validity of animal studies that found evidence of carcinogenicity, whereas such evidence was not considered highly predictive of human health risk by many toxicologists. Technical judgments of toxicologists were found to be associated with factors such as affiliation, gender, and worldviews. Implications of these data for risk communication are briefly disc

ISSN:0272-4332    

DOI:10.1111/j.1539-6924.1995.tb01338.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The development of the techniques of risk assessment and management are considered, noting the early emphasis on quantitative approaches. The basic strategies available to governments for risk management—educational, economic, and regulatory—are discussed. Six specific issues are considered with reference to the Canadian experience and the lessons learned. These are: the separation of risk assessment from risk management; the uncertainties of science; the weakness of numerical comparisons; too great a trust in education; the Great White Father Syndrome; and regulatory perils. This examination shows a number of inadequacies in the application of risk management techniques. It is suggested that knowledge of the limitations of quantitative assessment in its application to decision‐making together with the involvement of those affected by the risk in the decision‐making processes will lead to greater

ISSN:0272-4332    

DOI:10.1111/j.1539-6924.1995.tb01339.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Many recent contributions to risk communication research stress the importance of the element of “trust” in the process of successful communication. This paper uses that theme in considering risk communication within the context of seeking consensus on matters of health and environmental risk controversies through stakeholder negotiation. It suggests that there are very good reasons, based on historical experience, for the parties to mistrust each other deeply in such settings. For example there is abundant evidence involving episodes in which risk promoters have concealed or ignored relevant risk data or simply have sought to advance their own interests by selective use of such data. These well‐established practices compound the difficulties other stakeholders face, in all such negotiation, by virtue of the inescapable uncertainties (as well as absence of needed data) inherent in risk assessments. These factors encourage the participants to treat such negotiations as poker games in which bluffing, raising the ante, and calling the perceived bluffs of others are matters of survival. In the end we should recognize the genuine dilemmas that citizens face in trying to figure out who and what to believe in making sensible decisions among the range of risks, benefits, and tradeoffs that confro

ISSN:0272-4332    

DOI:10.1111/j.1539-6924.1995.tb01340.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Health status assessment and disease surveillance are essential to identify and priorize health issues, to evaluate intervention programs and to plan to meet future needs for health services. Canadians currently benefit by having among the highest life expectancies at birth in the world (81 for females, 74 for males). Disability‐free life expectancies for females and males, respectively, were 10.1 and 11.3 years lower for the lowest income quintile compared to the highest. Canada's infant mortality rate in 1990 (7/1000 live births) was one of the lowest in the world but within Canada, the rate in the lowest income quintile (10.5/1000 live births) was almost double that in the highest income quintile (5.8/1000 live births). Fair or poor health was reported by 36% of adult Canadians in the lowest income category in 1990 compared to only 5% in the highest income group. The leading causes of premature death for females in 1991 were breast cancer, coronary heart disease, lung cancer, car crashes, birth defects and suicide; those for males were coronary heart disease, suicide, car crashes, lung cancer, birth defects, and AIDS. Lowest income quintile males had mortality rates at least double those for the highest income quintile for alcohol‐related conditions, violence, injuries and emphysema. Cardiovascular diseases, cancer, musculoskeletal diseases, injuries and respiratory diseases imposed the highest direct and indirect economic costs in Canada in 1986. For all of these conditions, improved prevention is possible. For example, the forecasted tobacco‐related deaths before age 70 among current male smokers age 15 will far exceed those due to car crashes, suicide, murder, AIDS, and drug abuse combined. Population aging will aggravate trends for many chronic conditions especially those with increasing incidence rates; there will be large increases in the numbers of persons with aging‐related cancers, dementias and other conditions. There is an urgent need for Canadian health jurisdictions to ensure that rational priorities, goals/objectives, strategies, and programs are in place to enhance prevention and disease

ISSN:0272-4332    

DOI:10.1111/j.1539-6924.1995.tb01341.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY