Emerging importance of risk perceptions
By the early 1990s, particularly in North America and Europe, it became apparent that relying mainly on the scientific approaches to risk assessment and management was not always achieving the expected results. It also became clear that risk had different meanings to different groups of people and that all risks had to be understood within the larger social, cultural and economic context (5,7). In addition, people compare health risks with any associated benefits and they are also aware of a wide array of other relevant risks. In fact, it has been argued that concepts of risk are actually embedded within societies and their cultures, which largely determines how individuals perceive risks and the autonomy they may have to control them (8). In addition, it became apparent that public perceptions of risks to health did not necessarily agree with those of the scientists, whose authority was increasingly being questioned by both the general public and politicians. Although there was considerable agreement between the public and scientists on many risk assessments, there were also some, such as nuclear power and pesticides, where there were large differences of opinion (see Box 3.1). These differences of perception often led to intense public controversy.
Box 3.1 Perceptions of risk by scientists and the general public
"Perhaps the most important message from this research is that there is wisdom as well as error in public attitudes and perceptions. Lay people sometimes lack certain information about hazards. However, their basic conceptuali-sation of risk is much richer than that of experts and reflects legitimate concerns that are typically omitted from expert risk assessments. As a result, risk communication and risk management efforts are destined to fail unless they are structured as a two-way process. Each side, expert and public, has something valid to contribute. Each side must respect the insights and intelligence of the other."
At the same time, there was also increasing disillusionment with the "lifestyles" approach to health promotion and education strategies, that relied on improving the health knowledge and beliefs of individuals. These approaches were not achieving sufficient behavioural change for the interventions to be judged cost-effective. For instance, the rapid emergence of HIV/AIDS demonstrated that relying on the health beliefs model for behavioural change was largely ineffective in reducing the high-risk sexual behaviours that increased transmission in the epidemic. In addition, as the general public and special interest groups, particularly those in the environmental movements, became better organized they also began challenging the motives of the large corporate businesses, such as the tobacco industry (10).
By the mid-1990s, improving risk communications was seen as essential for resolving the differences between these various positions, as it became more widely accepted that both the scientific approaches and public perceptions of risk were valid. It was also generally accepted that differences in perceptions of risk had to be understood and resolved. This in turn led to the conclusion that governments and politicians had a major role to play in handling conflicts over risk policies by promoting open and transparent dialogue within society, in order to have high levels of public trust in such dialogue. A very important lesson is that high levels of trust between all parties are essential if reductions in the future global burden of risks to health are to be achieved (11,12).