Risk as number
Risk = Probability x consequences
• Deaths per million people
• Loss of life expectancy
The fundamental dilemma of
risk communication
The risks that kill people and the risks that alarm peopleare completely different
Covello & Sandman, 2001.
Norwegian University of Life SciencesTittel på presentasjon 5
What influences people’s
perceptions of different risks?
Characteristics of the hazard that
have an influence on Risk Perception
Fischhoff, et al., 1981
Acceptable Risks:
Voluntary
Under your control
Clearly beneficial
Fairly distributed
Natural
Statistical
From a reliable source
Familiar
Those that affect adults
Unacceptable risks:
Involuntary
Controlled by others
Of little or no benefit
Unfairly distributed
Man-made
Catastrophic
From unknown sources
Unfamiliar, exotic
Those that affect children
People are not irrational
Characteristics of the hazard that
have an influence on Risk Perception
Fischhoff, et al., 1981
Unacceptable risks:
Involuntary
Controlled by others
Of little or no benefit
Unfairly distributed
Man-made
Catastrophic
From unknown sources
Unfamiliar, exotic
Those that affect children
Additional factors -
Fukushima
• Nontransparent attitudes towards public from responsible
organizations and nuclear industry
• Lack of trust in government and experts
• Lack of communication
• Attention of media
• Uncertainty
Fukushima Challenges and Radiation Risk
Perception and Communication
• Tens of thousands died in the Fukushima earthquake, nearly half a
million were made homeless, yet since the accident most of the
focus has been on nuclear incident
• Reports of iodine tablets selling out in Europe
• More than 25 embassies closed or relocated from Tokyo
• Bans on import of foods from Japan
Fukushima Challenges
• 100,000 people haven’t returned home
• Increased stress
• Other effects like obesity
10
How do we deal with this?
Traditional media: Why?
Norwegian University of Life Sciences 11
• Media – main bridge for risk information from experts to
public
• Numerical information can be confusing
• Comparisons are more effective: but are they used and
how?
• Ongoing debate on how to present health risks
• Visual represention of risks
How should one communicate risk information to them?
Traditional media: How?
Norwegian University of Life Sciences 12
• Media content analysis
(N=1340)
• Articles related to the
Fukushima nuclear
accident
• In Belgium, Italy, Norway,
Russia, Slovenia, Spain.
• Published between the
11th of March - 11th of
May, 2011.
Analyzed:
• Radiation measurement unitsmSv (milli sievert)
mSv/h (millisievert per hour)
μSv/h (microsievert per hour)
nSV/h (nanosievert per hour)
Sv (Sievert)
Sv/h (Sievert per hour)
Bq/kg (Bequerel per kilogram)
Bq/g (Bequerel per gram)
Bq/l (Bequerel per litre)
kBq/kg (kilo Bequerel per kilogram)
MBq/kg (mega Bequerel per kilogram)
Bq/m2 (Bequerel per square meter)
Bq/cm2 (Bequerel per square centimetre)
kBq/cm2 (kilo Bequerel per square centimetre)
MBq/m2 (mega Bequerel per square metre)
MBq/km2 (mega Bequerel per square kilometre)
TBq/km2 (terra Bequerel per square kilometre)
no measurement units related to radioactivity in
the article
other units related to radiation
• Risk comparisons
no comparisons
with risks from medical purposes (e.g. x-ray)
with risks from flying
with natural radiation background
with workers' exposure to radiation at nuclear
inst.
with something else (open variable! )
with (legal,..) limits, norms
with a historic nuclear accident
• Visuals
Measurement units
Norwegian University of Life Sciences 14
32%
24%
15%
0%4% 2%
9% 8%
1% 0% 0%
37%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Perc
en
tag
e o
f art
icle
s
Type of unit
Percentage of unit type (all countries)
Total articles with units/all
articles
N = 211/1340
Comparisons
Available data
No explanation on
what they mean
Available data
Perceived
differently
Recommended
but not used
Health effects of radiation
Norwegian University of Life Sciences 16
“The radiation dose of 500,000
microsievert can cause dizziness
and fatigue after some hours. A dose
of 750,000 microsievert will cause
hair loss within to - three weeks
and a dose of one million will result
in bleedings. The deadly dose is 4
million microsieverts”
“… level which rose from 370 to
1,000 Becquerel per kilogram,
significantly increases the risk of
diseases such as cancer.”
“Since the beginning of the
crisis in the nuclear plant, 17
workers have been exposed to
more than 100 millisievert,
the level at which the risk of
getting cancer exists.”
• Health effects were rarely mentioned
• Detrimental health effects of high
doses rather than those relevant for
Japanese population
• Few mentioned cancer risks
Visuals
Norwegian University of Life Sciences 17
Dagsavisen,
17.03.2011
Corriere della Sera,
5.04.2011
Misrepresentations and
mistakes
• References to non-existing norms (e. g. levels in the enviroment)
• Using norms for drinking water as benchmark for seawater
• Mixing up allowed levels for general population and emergency
workers
• Mixing up dose and dose rate
• Presenting permitted levels as what divides
(food) into «safe» and «unsafe»
Norwegian University of Life Sciences 18
Conclusions
• Communication advice didn’t work – Why?
• Clear need of context, especially in the modern dynamic
media world
• Explain information that is hard to find (e.g. health effects)
• Importance of visual content
• Need to build relationships between experts and media in
the peace times
TOMKIV, Y., PERKO, T., OUGHTON, D., PREZELJ, I., CANTONE, M. C. & GALLEGO, E. 2016. How did
media present the radiation risks after the Fukushima accident: a content analysis of newspapers in Europe.
Journal of Radiological Protection, 36, S64.
PERKO, T., TOMKIV, Y., PREZELJ, I., CANTONE, M. C., GALLEGO, E. & OUGHTON, D. H. 2016. Communication with media in
nuclear or radiological emergencies: general and practical recommendations for improvement. Radioprotection, 51, S163-
S169.
Norwegian University of Life SciencesTittel på presentasjon 20
KJM360: Societal and Ethical
Aspects of Risk Assessment
and Management
Deborah Oughton, NMBU
Psychosocial
Consequences
• “The social and psychological
consequences of Chernobyl far
outweigh any direct heath effects
from radiation exposure” (IAEA,
1991, + +)
• “The most important health effect is
on mental and social well-being,
related to the enormous impact of the
earthquake, tsunami and nuclear
accident, and the fear and stigma
related to the perceived risk of
exposure to ionizing radiation”
(UNSCEAR, 2013)
Public perception of risk
• ”Expert I” – the public is
ignorant, misunderstands
risks, is irrational in attitude
towards risks (smoke and
drive but rejects much
smaller risks associated with
GM foods, biotechnology,
nuclear power)
• ”Expert II” – the public’s
perception of risk is complex
(psychological, societal,
ethical, …)
Many factors influencing risk perception have
a strong ethical relevance
Oughton and Howard 2012. The Social and Ethical Challenges of Radiation Risk Management, Ethics, Policy and
Environment, 15:71-76; Oughton, D.H. 2011. Social and Ethical Issues in Environmental Risk Management.
Integrated Environmental Assessment and Management, 7: 404-405
Autonomy, Dignity, Control
• Control over situation
• Consent to risks
• Choice
• Participation in decision-making
Practical implications: self-help,
transparency about policy, stakeholder
engagement, personal dosimeters, local-
monitoring, …
Ethically and psychologically
importantLavrans Skuterud, NRPA
Justice, Fairness and Equity
• Distribution of risks and benefits
• Risks for children
• Differences between medical
(personal benefit) and environmental
exposures
• Practical Implications: Waste
disposal, time and spatial variation
in risk; compensation, cross boarder
issues
Photo: EPA
Oughton and Howard 2012. The Social and Ethical Challenges of Radiation Risk Management, Ethics, Policy and
Environment, 15:71-76; Oughton, D.H. 2011. Social and Ethical Issues in Environmental Risk Management.
Integrated Environmental Assessment and Management, 7: 404-405
Well-being and Community Values
• Societal consequences of accidents
and risk management
• “Doing more good than harm”
• Fears of discrimination and stigma
• Importance of community and social
well-being (e.g. employment,
relationships, infrastructure)
Practical Implications: Remediation and
risk management needs to address more
than dose reduction; infrastructure,
“new-normality”
Oughton and Howard 2012. The Social and Ethical Challenges of Radiation Risk Management, Ethics, Policy and
Environment, 15:71-76; Oughton, D.H. 2011. Social and Ethical Issues in Environmental Risk Management.
Integrated Environmental Assessment and Management, 7: 404-405
Social and Ethical Issues – Deborah Oughton
Other Factors Influencing
Radiation Risk Perception
• Natural vs unnatural sources
• Internal vs external exposure
• Identifiable vs statistical deaths
Harder to ground in ethical relevance
Evolution of the System of Radiological Protection:
Science, Ethical Values, and Experience
• Influence of scientific developments
• Influence of different applications – medical, energy,
accidents, …
• Influence of changes in societal and cultural
attitudes
29
ICRP TG94: The Ethical Foundations of the
ICRP System of Radiological Protection
• Beneficence/Non-maleficence
• Prudence
• Dignity
• Justice
30
Core Ethical Values Underpining the ICRP
System
Tools and proceduresfor the practical
implementation of the system
Radiological protection principles
Core ethical values underpinning the system of radiological protection
ICRP (2016) The Ethical Foundations of the ICRP System of Radiological Protection,
Draft out for consultation on icrp.org
Case Study – Thyroid Screening
• Prefecture wide screening – offered
to all 18 years old and under
• Baseline screening 2011-2104
–300,456 participants (81,7%)
• Full survey 2014-
• 169,455 participants (44,7%)
–113 suspicious or malignant
cases; 34 were operated on
(2015).
Reuters
Suzuki, 2016. Clinical Ontology; Shibuya et al. 2014, Lancet; Yasumura S, et al. Fukushima
Health Management Survey, 2012;
Background – Screening Results
Suzuki, 2016. Clinical Ontology; Shibuya et al. 2014, Lancet; Yasumura S, et al. Fukushima
Health Management Survey, 2012;
High Media and Academic Interest
Tsuda, et al. 2014: «An
excess of thyroid cancer has
been detected by ultrasound
among children and
adolescents in Fukushima
Prefecture within 4 years of
the release, and is unlikely to
be explained by a screening
surge” Epidemiology
Ethics of Health Screening and
SurveillanceThyroid Screening a text book case
• False positives/false negatives/overdiagnosis –
unnecessary surgery or worry
Carter et al. BMJ 2015;350
FOLKEHELSEVITENSKEP ETIKK –Deborah Oughton
Beneficence/Non-malificence
• Are we doing more good than harm?
• Will the procedure reduce incidence, severity or mortality
related to the disease?
• Overdiagonisis and unnecessary surgery
• Relieving or increasing anxiety?
• Highlights the complexity of balancing benefits and risks
“Health is a state of complete physical,
mental and social well-being and not
merely the absence of disease or infirmity”
(WHO, 1948)
Prudence
“Prudence is the ability to make informed and carefully
considered choices without the full knowledge of the scope
and consequences of actions” ICRP 2017, Ethical
Foundations….
• Links to precautionary approach
• Should not be taken to be synonymous with zero risk or
over conservatism
Thyroid Screening: Careful consideration of the
uncertainties and potential negative consequences of
surveillance and evaluation of measures to reduce negative
consequences
Justice
Distributive Justice - Fairness in the distribution of
advantages and disadvantages among groups of people
Restorative Justice – Fairness in compensation for losses
Procedual Justice – Fairness in the rules and procedures in
the processes of decision making
• Recognises vulnerability of children
• Selection of participants – location, not dose
• Screening for reassurance, epidemiology, research …
• Control groups
• Participation in decision making and screening planning
Dignity
• Survey (in part) responds to requests for screening
from parents – recognises their autonomy
• Free Informed Consent of children
• Stigma and discrimination – both from participation or
non-participation
• Provision of information to participants, pre, during and
post screening
• Privacy and confidentiality issues
Practical Aspects
Accountability:
– Clarification on responsibilities for screening, follow-
up, funding, …
Transparency
– Information to participants (initially by post, now
during consultation)
– Clarity on expectations and purpose of screening
– Communication strategy, including media, public
health officials
Stakeholder Participation
– Critical for success of screening
– Heath professionals, communities, parents, …
Stakeholder involvement
processes
Stakeholder
Anybody who can affect or is
affected by an organisation,
strategy or project
Stakeholder involvement
The process by which an
organisation involves people who
may be affected by the decisions it
it makes or can influence the
implementation of its decisions.
Norwegian University of Life Sciences 41
Norwegian University of Life SciencesTittel på presentasjon 42
From Arnstein, Sherry R., "A Ladder of
Citizen Participation," Journal of the
American Institute of Planners, July
1969,Vol. 35, No. 4, pp. 216-224.
Norwegian University of Life Sciences 43
Stakeholder involvement
metods
Public hearing
Referenda
Consensus conference
Focus groups
Citizen jury
100++
• Representativeness
• Independence
• Early involvement
• Influence
• Transparency
Process: resource accessibility, task definition, structured
decision making and cost-effectiveness.
Norwegian University of Life Sciences 44
Stakeholder involvement
processes - Criteria
(Rowe and Frewer, 2000)
Accepta
nce
Is the evaluation of method
sufficient?
Does it show the quality of the process?
Redeveloping criteria
Norwegian University of Life Sciences 46
Y. Tomkiv, A. Liland, D. Oughton, B. Wynne. Assessing quality of stakeholder
engagement: why methodology is not enough (to be submitted Spring 2017)
Representativeness
Independence
Early involvement
Influence
Transparency
Inclusiveness
Independence+Framing
Continuity and flexibility
Framing
Purpose and benefit
Accountability and learning
Made for policy-making – need adaptation
Too much focus on acceptance – process should be good!
(Rowe and Frewer, 2000)