Precautionary Action Research Articles

Risk management and the record of the precautionary principle in EU case law

The ‘modern’ approach to risk management fails with increasing scientific uncertainty. Risk regulators have responded to this difficulty by invoking the precautionary principle (PP). Under the PP, the bridge from risk assessment to risk management involves scenarios which use retrospective analyses to decide on future actions in order to avoid prospective harm. This new approach is termed ‘post‐modern’ by some observers. In response to such ‘post‐modern’ risks, the EU incorporated the PP into its primary law in 1992 and issued an explanatory Communication on the PP in 2000. The Communication presented five criteria that should govern precautionary actions and these criteria are now reflected in secondary laws in a number of sectors. Critically, the practical application of this body of law is being clarified through the case law of the EU courts. PP case law up to the end of 2008 is critically analysed in the light of the five criteria set out in the Commission’s Communication. It is found that the first criterion (proportionality) is used effectively by the courts but that the fifth criterion (responding to the dynamics of scientific progress) is not. The paper concludes with a discussion regarding the future management of uncertain risks and the PP in the light of this case law.

Hurricane preparedness as anticipatory adaptation: A case study of community businesses

This paper examines adaptation to current storm surge flood risk as one indicator of anticipatory adaptation to climate change impacts. Focusing on community businesses, a web-based survey obtained information on hurricane preparedness and risk perceptions in Sarasota County, Florida. A model of current precautionary action that utilized previously identified business characteristics predictive of business preparedness and post-disaster recovery, a spatial variable indicating storm surge exposure, and items measuring the risk perception and information-seeking behavior of business owners explained a majority of the variance in current levels of preparedness. Use of online risk information sources and the geographic distribution of customers and were the strongest predictors of preparedness. Results indicate that the adaptive capacity of businesses may vary significantly with types of businesses, locations, and socio-cognitive characteristics of business owners. To encourage overall community resilience, risk communication efforts should be targeted based on specific elements that predict business preparedness.

Emotions, Risk Perceptions, and Precautionary Behavior Under the Threat of Terror Attacks: A Field Study Among Israeli College Students

AbstractThe current study uses the unique data from a natural experiment conducted in a college located in southern Israel that was exposed to rocket attacks in 2008. The study examines the relationships between the negative emotions, the perceptions of risk to oneself, the precautionary actions, and the intentions of 290 students who were exposed to terror attacks while on campus. In addition, we compared the emotions, the risk perceptions, and the precautionary behavior between the two groups: those who lived within the range of the rockets and were also exposed to rocket attacks at home and those who lived outside the range of the rockets. The results show that the risk perceptions were affected mainly by the emotion of fear while the students were on campus. In particular, fearful people became more pessimistic about their general and personal risks from terror but not about routine risks. The results also reveal that those who lived outside the rocket area (and had less or no experience with terror attacks) were more likely to take precautionary actions during their stay in the campus and were more pessimistic about continuing their studies in college in the coming year than those living in the area, who had more experience with terror attacks. Copyright © 2011 John Wiley & Sons, Ltd.

Environment and women's reproductive health

There is significant evidence that continuous and prolonged exposure to several endocrine disrupting chemicals (EDC) is a risk factor for reduced fertility and fecundity in women. There is also evidence that ED exposure has trans-generational effects. In this systematic review, we evaluate the evidence for an association between EDC exposure and women's reproductive health. Studies were found by searching the PubMed database for articles published up to 2010. Associations between ED exposure and women's reproductive health reported in the PubMed database are summarized and classified as fertility and fecundity, pregnancy outcomes, transgenerational exposure and effects. Epidemiological studies on EDCs are not always consistent, in part due to limitations imposed by practical constraints. In order to make progress in this field, we recommend taking advantage of biomonitoring and biobanks, including the development of appropriate biomarkers, and taking into greater consideration modulating factors such as genetic polymorphisms and dietary habits. Further human studies are warranted with particular focus on impaired fertility/fecundity associated with currently widespread ED (e.g. bisphenol A, phthalates and polybrominated flame retardants). A detailed appraisal of compounds specifically related to adverse reproductive outcomes is very important for prevention and risk-communication strategies. Besides research needs, the current evidence is sufficient to prompt precautionary actions to protect women's reproductive health.

DDT and Malaria Prevention: Addressing the Paradox

BackgroundThe debate regarding dichlorodiphenyltrichloroethane (DDT) in malaria prevention and human health is polarized and can be classified into three positions: anti-DDT, centrist-DDT, pro-DDT.ObjectiveWe attempted to arrive at a synthesis by matching a series of questions on the use of DDT for indoor residual spraying (IRS) with literature and insights, and to identify options and opportunities.DiscussionOverall, community health is significantly improved through all available malaria control measures, which include IRS with DDT. Is DDT “good”? Yes, because it has saved many lives. Is DDT safe as used in IRS? Recent publications have increasingly raised concerns about the health implications of DDT. Therefore, an unqualified statement that DDT used in IRS is safe is untenable. Are inhabitants and applicators exposed? Yes, and to high levels. Should DDT be used? The fact that DDT is “good” because it saves lives, and “not safe” because it has health and environmental consequences, raises ethical issues. The evidence of adverse human health effects due to DDT is mounting. However, under certain circumstances, malaria control using DDT cannot yet be halted. Therefore, the continued use of DDT poses a paradox recognized by a centrist-DDT position. At the very least, it is now time to invoke precaution. Precautionary actions could include use and exposure reduction.ConclusionsThere are situations where DDT will provide the best achievable health benefit, but maintaining that DDT is safe ignores the cumulative indications of many studies. In such situations, addressing the paradox from a centrist-DDT position and invoking precaution will help design choices for healthier lives.

A National Epidemic of Campylobacteriosis in Iceland, Lessons Learned

Epidemics often result in organizational, policy and technical changes within a country. In 1999, an epidemic of campylobacteriosis was reported in Iceland. The recent availability of fresh poultry products in the marketplace was suggested as the source of infection. This paper reports on the context of the epidemic, reviews interventions implemented to prevent campylobacteriosis, and discusses lessons learned. A retrospective study of interventions implemented in Iceland from June 1995 to December 2007 was conducted by interviewing key informants and reviewing Iceland's literature. Cumulative incidence rates of domestic campylobacteriosis by year and average incidence rates per epidemic period were calculated. Interventions included on-farm surveillance of Campylobacter, producer education, enhanced biosecurity measures, changes in poultry processing, a leak-proof packaging policy, a freezing policy for products from Campylobacter-positive poultry flocks, consumer education, and the creation of a legislated inter-organizational response committee. These interventions appear to have collectively contributed to a decrease in campylobacteriosis' incidence rate near pre-epidemic baseline levels. Expert consultations revealed that the implementation of a Campylobacter surveillance program in poultry and the freezing policy were critical to controlling the disease in the Icelandic population. It was also recognized that new multidisciplinary collaborations among public health, veterinary, and food safety authorities and a sustained co-operation from the poultry industry were integral factors to the mitigation of the epidemic. Iceland's response to the campylobacteriosis epidemic is a lesson learned of inter-disciplinary and inter-organizational precautionary public health action in the face of a complex public health issue.

The uncertainties of precaution: Zero discharges in the Barents Sea

Abstract This paper describes and analyzes the application of the precautionary principle in the regulation of operational discharges from offshore petroleum activities. Norway implemented a zero discharge policy in line with international agreements. However, companies are obliged to follow considerably stricter requirements in the Barents Sea compared to other parts of the Norwegian Continental Shelf. This paper follows the development of the zero discharge measure and analyzes what it implies for activities in the Barents Sea. Several “uncertainties of precaution” are discussed, which relate to technological issues, monitoring, compliance and unintended environmental consequences. Precautionary action should be scrutinized for its proportionality: how do the benefits of the measure relate to the technological, financial and environmental costs? It is concluded that the most (cost-) effective solutions that could lead to the lowest total environmental harm are not always the solutions that are most politically feasible.

Pharmaceuticals in the Environment

Pharmaceuticals are chemicals that are used because of their biological activity. They are often excreted unchanged and can reach the environment. Throughout developed countries, the pharmaceutical concentrations in the aquatic environment are in the same range (μg L−1 and below); however, it is not clear whether this holds for less-developed countries too. The health risks of active pharmaceutical ingredients (APIs) remain poorly understood. Although there are no known short-term effects on humans, long-term effects cannot be ruled out until there is more research. The significance of metabolites and transformation products resulting from the parent APIs is not yet known. Awareness of the presence of pharmaceuticals in the environment, coupled with some evidence of effects, suggests that precautionary management action to reduce the release of pharmaceuticals to the environment should be considered. As for effluent treatment, no technology works well for all compounds. Advanced effluent treatment is not sustainable because of energy consumption, efficiency, and efficacy. Therefore, its appropriateness must be assessed on a case-by-case basis. Increased handling and use measures at the source and better biodegradable pharmaceuticals are necessary in the long run for the new paradigm called “sustainable pharmacy.”

Communication, perception and behaviour during a natural disaster involving a 'Do Not Drink' and a subsequent 'Boil Water' notice: a postal questionnaire study

BackgroundDuring times of public health emergencies, effective communication between the emergency response agencies and the affected public is important to ensure that people protect themselves from injury or disease. In order to investigate compliance with public health advice during natural disasters, we examined consumer behaviour during two water notices that were issued as a result of serious flooding. During the summer of 2007, 140,000 homes in Gloucestershire, United Kingdom, that are supplied water from Mythe treatment works, lost their drinking water for up to 17 days. Consumers were issued a 'Do Not Drink' notice when the water was restored, which was subsequently replaced with a 'Boil Water' notice. The rare occurrence of two water notices provided a unique opportunity to compare compliance with public health advice. Information source use and other factors that may affect consumer perception and behaviour were also explored.MethodA postal questionnaire was sent to 1,000 randomly selected households. Chi-square, ANOVA, MANOVA and generalised estimating equation (with and without prior factor analysis) were used for quantitative analysis.ResultsIn terms of information sources, we found high use of and clear preference for the local radio throughout the incident, but family/friends/neighbours also proved crucial at the onset. Local newspapers and the water company were associated with clarity of advice and feeling informed, respectively. Older consumers and those in paid employment were particularly unlikely to read the official information leaflets. We also found a high degree of confusion regarding which notice was in place at which time, with correct recall varying between 23.2%-26.7%, and a great number of consumers believed two notices were in place simultaneously. In terms of behaviour, overall non-compliance levels were significantly higher for the 'Do Not Drink' notice (62.9%) compared to the 'Boil Water' notice (48.3%); consumers in paid employment were not likely to comply with advice. Non-compliance with the general advice to boil bowser water was noticeably lower (27.3%).ConclusionHigher non-compliance during the 'Do Not Drink' notice was traced to the public's limited knowledge of water notices and their folk beliefs about the protection offered from boiling water. We suggest that future information dissemination plans reduce reliance on official leaflets and maximise the potential of local media and personal networks. Current public health education programmes are recommended to attend to insufficient and incorrect public knowledge about precautionary actions.

The role of risk perception and other risk-related judgements in transportation mode use

Aims The core aim of the present study was to examine the role of risk perception in use of private and public modes of transportation. An additional aim was to examine the relative importance of perception of transport risks with risk perception of non-transport factors and also to investigate differences in worry, perceived control of transportation modes, as well as trust in authorities’ risk handling, safety motivation, and attitudes towards transport safety. Sample The results are based on a mailed self-completion questionnaire survey carried out among a representative sample of the Norwegian public aged from 18 to 65 years ( n = 1864). Data collection was carried out during October–December 2008. Results Perceived control related to private modes of transportation, knowledge about safety and trust in authorities were found to be significantly different among respondents who often used private modes of transportation compared to those who most often used public modes. It was no significant difference in severity of consequences due to which transport modes that the respondents used most frequently. Conclusion It may be that conclusions of previous research about the role of consequence judgement for precautionary action and demand for risk reduction are misleading when generalised to decisions about transport mode use.

Acute illnesses associated with exposure to fipronil—surveillance data from 11 states in the United States, 2001–2007

Introduction. Fipronil is a broad-spectrum phenylpyrazole insecticide widely used to control residential pests and is also commonly used for flea and tick treatment on pets. It is a relatively new insecticide and few human toxicity data exist on fipronil. Objective. This paper describes the magnitude and characteristics of acute illnesses associated with fipronil exposure. Methods. Illness cases associated with exposure to fipronil-containing products from 2001 to 2007 were identified from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program and the California Department of Pesticide Regulation. Results. A total of 103 cases were identified in 11 states. Annual case counts increased from 5 in 2001 to 30 in 2007. Of the cases, 55% were female, the median age was 37 years, and 11% were <15 years old. The majority (76%) had exposure in a private residence, 37% involved the use of pet-care products, and 26% had work-related exposures. Most cases (89%) had mild, temporary health effects. Neurological symptoms (50%) such as headache, dizziness, and paresthesia were the most common, followed by ocular (44%), gastrointestinal (28%), respiratory (27%), and dermal (21%) symptoms/signs. Exposures usually occurred from inadvertent spray/splash/spill of products or inadequate ventilation of the treated area before re‐entry. Conclusions. Our findings indicate that exposure to fipronil can pose a risk for mild, temporary health effects in various body systems. Precautionary actions should be reinforced to prevent fipronil exposure to product users.

Paternal Smoking and Childhood Overweight: Evidence From the Hong Kong “Children of 1997”

This study examined, in a non-Western sociohistorical context, whether prenatal or postnatal secondhand smoke (SHS) exposure for children of nonsmoking mothers was associated with higher childhood BMI, and it clarified whether the observed associations were biologically mediated or socioeconomically confounded. A total of 6710 and 6519 children of nonsmoking mothers (N = 7924) with BMI data at approximately 7 and approximately 11 years, respectively, from a population-representative (N = 8327), Hong Kong Chinese birth cohort ("Children of 1997"), born in April or May 1997, were included in the analysis. Compared with no SHS exposure, daily paternal smoking increased mean BMI z scores, but not height, at 7 years (difference: 0.10 [95% confidence interval: 0.02-0.19]) and at 11 years (difference: 0.16 [95% confidence interval: 0.07-0.26]), with adjustment for gender, birth order, socioeconomic position, mother's place of birth, breastfeeding, serious morbidity, and pubertal status. Our findings, although preliminary, suggest that the association of paternal smoking with child overweight might be biologically mediated. Given the known harms of smoking, reducing SHS exposure from conception as a precautionary action for childhood overweight might be warranted.

Judicious management of uncertain risks: II. Simple rules and more intricate models for precautionary decision‐making

Rational decision theory could be more fully exploited for the prudent management of uncertain‐risk situations. After an integrative circumscription of the precautionary principle (PP), 10 key issues are discussed covering assessment, decision and control. In view of this, a variety of decision‐theoretic considerations are explored. ‘Sufficient evidence’ for precautionary action is treated as a diagnostic decision in the framework of signal detection theory. Thus, an assessment about ‘danger’ versus ‘no danger’ should depend on prior probability, evidence strength and the relative seriousness of false‐positive versus false‐negative outcomes. From an illustrated survey of simple and more complex decision rules, it appears that ‘precaution’ may be variously expressed via, for example, maximin utility, minimax regret, maximin expected utility and maximising expected utility‐minus‐regret. Logically, serious uncertain risk (against modest benefits) may provoke a precautionary approach – under the PP. In contrast, however, an uncertain ‘great opportunity’ (against modest costs) may elicit a venturous approach – following the venture principle (VP). Thus, the PP amounts to a basic attitude rather than a normative principle, whose practical application hinges on straightforward albeit uncertain decision variables. Decision postponement, temporal discounting and risk–risk tradeoffs are summarily reviewed. General conclusions are drawn and some suggestions for policy‐making and further research are proposed.

Risk of agricultural and property damage associated with the recovery of Japanese monkey populations

The management of human–wildlife conflicts often involves walking the fine line between conservation of the species concerned and damage control. This article documents conflict management with Japanese monkeys ( Macaca fuscata) in northern Japan. Although these monkeys are listed as endangered populations in Japan, local residents consider them serious vertebrate pests. In order to devise a reasonable population recovery plan that also serves to minimize the risk of social damage caused by these monkeys, the authors invent a simplified procedure for broadly assessing damage risk. Two indices are analyzed: species accessibility, estimated via an accessibility analysis that uses ecological-niche factor analysis (ENFA), and regional weakness to damage, calculated by evaluating the geographical placement of human settlements. ENFA shows that in northern Japan, most of the potential monkey habitats are not occupied by the species; therefore, the species distribution is expected to expand. The weakness values demonstrate that the municipalities expected to suffer damage in the near future are more vulnerable to damage than the already-damaged ones. A risk map is generated through a consideration of these results. It indicates that the conflicts will increase if no precautionary actions are taken. This risk mapping approach assists in identifying the municipalities where precautionary actions should be taken to efficiently minimize the overall risk in the reference area.

Factors Motivating Individuals to Take Precautionary Action for an Expected Earthquake in Istanbul

Istanbul is expected to experience an earthquake in the near future, but individuals show limited interest in preparing for it. This study aims to identify the factors associated with taking action to prepare for an earthquake and mitigate its effects at the individual level. A field survey was carried out in 2007 in two districts of Istanbul with different levels of earthquake risk. Within these districts, three socioeconomic levels were considered. A total of 1,123 people were interviewed face to face. Analysis indicated that the educational level of the respondents was the leading factor associated with taking at least three measures, followed by living in a higher earthquake risk area, having participated in rescue and solidarity activities in previous earthquakes, a higher level of knowledge about earthquakes, home ownership, a higher score for action-stimulating attitudes, being younger, and a higher general safety score, in that order. The findings pointed to the role of knowledge about earthquakes and possible mitigation/preparedness measures, and thus the importance of developing effective awareness programs. Such programs should also consider the characteristics of different groups in the population. Motivated individuals, such as those who have participated in rescue and solidarity activities in previous earthquakes, could be involved in reaching other people.

Monitoring of risk perceptions and correlates of precautionary behaviour related to human avian influenza during 2006 - 2007 in the Netherlands: results of seven consecutive surveys.

BackgroundAvian influenza (AI) is a public health challenge because of ongoing spread and pandemic potential. Non-pharmaceutical measures are important to prevent the spread of AI and to contain a pandemic. The effectiveness of such measures is largely dependent on the behaviour of the population. Risk perception is a central element in changing behaviour. This study aimed to investigate perceived vulnerability, severity and precautionary behaviour related to AI in the Netherlands during seven consecutive surveys in 2006 - 2007 as well as possible trends in risk perception and self-reported precautionary behaviours.MethodsSeven web-based surveys were conducted including 3,840 respondents over a one-year period. Time trends were analyzed with linear regression analyses. Multivariate analysis was used to study determinants of precautionary behaviour.ResultsWhile infection with AI was considered a very severe health problem with mean score of 4.57 (scale 1 - 5); perceived vulnerability was much lower, with a mean score of 1.69. While perceived severity remained high, perceived vulnerability decreased slightly during a one-year period covering part of 2006 and 2007. Almost half of the respondents (46%) reported taking one or more preventive measures, with 36% reporting to have stayed away from (wild) birds or poultry. In multivariate logistic regression analysis the following factors were significantly associated with taking preventive measures: time of the survey, higher age, lower level of education, non-Dutch ethnicity, vaccinated against influenza, higher perceived severity, higher perceived vulnerability, higher self efficacy, lower level of knowledge, more information about AI, and thinking more about AI. Self efficacy was a stronger predictor of precautionary behaviour for those who never or seldom think about AI (OR 2.3, 95% CI 1.9 - 2.7), compared to those who think about AI more often (OR 1.5, 95% CI 1.2 - 1.9).ConclusionsThe fact that perceived severity of AI appears to be high and remains so over time offers a good point of departure for more specific risk communications to promote precautionary actions. Such communications should aim at improving knowledge about the disease and preventive actions, and focus on perceived personal vulnerability and self efficacy in taking preventive measures.

Sustainability, Synthetic Chemicals, and Human Exposure

Public concerns regarding exposures to synthetic chemicals are increasing. Globally, there are increasing concentrations of many synthetic chemicals within the environment. The ubiquitous extent of some chemicals makes human exposure unavoidable. Biomonitoring has emerged as the optimal method for assessing exposures. The extent of human exposure and contamination occurs throughout the life cycle and is widespread. Although there is limited information on health risks for the majority of chemicals within our environment, and those identified with biomonitoring, many are known or suspected to cause human harm. Continued global and national unsustainable development regarding synthetic chemicals will increase the extent of environmental and human contamination unless precautionary action is implemented. Precautionary legislation may protect ecological and public health until societal sustainability is achieved.

Evaluation of the regulation changes in medical waste management in Turkey

In this study, a survey containing 28 questions concerning general information about the healthcare services, waste collection, training, waste quantities, storage and general evaluation was applied to 311 healthcare services. The response rate was 82%, which was considered acceptable for the evaluation of the results. The separate collection of medical waste and sharps was completely achieved in all of the healthcare services participating in the survey and 82.6% of the healthcare services used containers for separate collection of medical waste. Only 5% of the containers used for waste collection and temporary storage were inappropriate for collecting medical waste. Almost 33% of healthcare services organized courses monthly, 40% quarterly and 20% at least twice a year. A total of 88% of the hospitals have temporary storage depots for medical waste and all of these depots complied with the Medical Waste Control Regulation. The results of this study showed that the medical waste generation rate was 2.35 kg bed(-1) day(-1). The amount of liquid waste and sharps was determined for the first time in Turkey. The rate of separate collection for recyclables increased to 94%, having been 83% in 2006. The results indicate that in the period 2006-2009, the healthcare services conformed completely to the Medical Waste Control Regulation as it applied. Any deficiencies observed will be satisfied by precautionary actions that will be taken by hospital managers and local administrations.

Macroeconomic policy in light of the credit crunch: the return of counter-cyclical fiscal policy?

This paper begins by arguing that the 2007/8 credit crunch does not require a fundamental reevaluation of monetary policy. The crunch occurred because regulation was too lax, and we need to develop new and more effective tools of regulatory control. To focus on current account imbalances or mistakes in setting interest rates as a prime cause of the credit crunch is unconvincing, and has the danger of diverting attention away from the need to increase financial regulation. The current recession does require a re-evaluation of the role fiscal policy can play when interest rates hit a zero bound. An expansionary fiscal policy is required because monetary policy-makers are reluctant to promise higher future inflation, and the impact of quantitative easing is likely to be small. Although rising debt may place a limit on how much conventional fiscal policy can do, not all expansionary fiscal measures require additional borrowing. There are two important lessons for the future. First, although monetary policy should remain the primary tool to stabilize the business cycle, the combination of fiscal implementation lags and uncertainty means that some precautionary fiscal action may be appropriate during the early phase of some economic downturns. Second, to play this 'backstop' stabilization role effectively, a policy that results in the government debt-to-GDP ratio declining (albeit gradually and erratically) in normal times seems appropriate.

The precautionary principle and environmental persistence: prioritizing the decision-making process

Abstract There is continuing activity among regulatory bodies to assess and prioritize chemicals used in commerce based on their potential to be persistent, bioaccumulative, and toxic (PBT). Reliable data needed to perform a PBT hazard or risk assessment, however, may not always be readily available. Consequently concern may arise regarding the potential for false positives and false negatives to be wrongly classified. In order to more effectively classify substances, adequate time is needed to acquire the necessary data to support the overall PBT assessment. Of particular interest is the question of whether or not restrictions on the use and manufacture of a substance can be delayed to allow time to conduct the necessary field and laboratory studies of a particular substance? To address this question it is demonstrated that chemical partitioning property and environmental persistence information can be effectively combined to provide guidance for regulatory priority setting. Specifically, it is argued that substances that have media specific half-life values that exceed the regulatory threshold value for persistence under the EU chemicals REACH program, for example, are more likely to have a ‘legacy’ associated with their use when the log K OA > 8, and when they are emitted to air or soil. Thus, precautionary actions limiting the use and manufacture of the substance may be warranted. Whereas substances emitted to air with log K OA K AW > −2 are less likely to have a ‘legacy’ associated with their use. Thus precautionary actions in the absence of data may not be warranted.