The world health report

Chapter 3

Changing perceptions of risk

Given the research on the global burden of risks to health, together with the analysis that underpins the choice of cost-effective interventions, what lessons have been learned about risk perceptions? For high priority risks, how can we implement more effective risk avoidance and reduction policies in the future?

This chapter starts with an overview of how the study of risk analysis has developed since the 1970s. It then draws attention to the need to have a broad perspective on how risks are defined and perceived in society, both by individuals and by different groups. Next, emphasis is given to the importance of improving communications about health risks if successful strategies are to be adopted to control them. However, risk perceptions all over the world are increasingly being influenced by three other trends. First, by the power and influence of special interest groups connected to corporate business interests and the opposition being organized by many advocacy and public health groups. Second, by the increasing influence of the global mass media. And third, by the increase in risk factors within many middle and low income countries as a consequence of the effects of globalization.

Until recently, risks to health were defined largely from the scientific perspective, even though it has been recognized for some time that risks are commonly understood and interpreted very differently by different groups in society, such as scientists, professionals, managers, the general public and politicians. Assessment and management of risks to health is a relatively new area of study that has been expanding steadily since the early 1970s. It began by focusing on developing scientific methods for identifying and describing hazards and for assessing the probability of associated adverse outcome events and their consequences. Particular attention has been given to the type and scale of the adverse consequences, including any likely mortality. In the early years, risk analysis, as it was then called, was seen mainly as a new scientific activity concerned with environmental and other external threats to health, such as chemical exposures, road traffic accidents, and radiation and nuclear power disasters. The early study of risk developed mainly in the USA and Europe (1).

During the early 1980s, risk analysis evolved into the two main phases of risk assessment and risk management, as more attention was given to how hazards or risk factors could be controlled at both the individual level and by society as a whole. The emphasis moved from determining the probability of adverse events for different risk factors to assessing the scale and range of possible consequences. Deaths are commonly seen as one of the most important consequences. Attempts were also made to reduce any uncertainties in making the scientific estimates (2). An important consequence of this change was that individual people were now seen as being mainly responsibility for handling their own risks to health, since many risks were characterized as behavioural in origin and, therefore, largely under individual control. This in turn led to the lifestyles approach in health promotion. For instance, a great deal of attention was paid to combating coronary heart disease through health promotion aimed at high-risk individuals, such as increasing exercise and lowering dietary cholesterol, while policies for combating cigarette smoking also emphasized the importance of individual choice.

The need for stronger government regulatory controls also became more apparent, with two other important developments. First, governments in many industrialized countries saw their role as law enforcers and passed legislation to establish new and powerful public regulatory agencies, such as the Food and Drug Administration (FDA) in the USA and the Health and Safety Executive (HSE) in the United Kingdom. Second, increased attention was given to deriving minimum acceptable exposure levels and the adoption of many new international safety standards, particularly for environmental and chemical risks. This included, for example, risks associated with air pollutants, vehicle emissions, foods and the use of agricultural chemicals.