Document J3QrqxBYKggxQMmXmaQeM4Ka6

Thomas G. Grumbles <%1AJ-''* ^ *< To a\|u74^\ (Y^ er\ Va\ Cc?ozoifKxkoas Do,e 4" '2,?. P\'W cVvGo i -b u-.M'tw ^tsl< a^v cA*^ CU?nr,flft.^A\Ca-{:iu/\ - ~ \\ e. \cx^ \ <4_ a r\ C^OP oV . 1>S";Z'2- & ' ^ CL C_ \Y\ \W OjL'IA o'U <Qs> VVV 000009626 Risk is Normal to Life Itself* GERALDINE: V. COX, Ph.D.. Vice President-Technical Director and GORDON D. STRICKLAND. M PH, Deput\ 1 cchnical Director Chemical Manufacturers Association. 25Ul M St., N.W.. Washington. DC 20037 Health and safety professionals face an enormous challenge. We must communicate about safety in the context of all risks that society faces. The health and safety professional must be scientifically accurate while working in an atmosphere that is frequently emotionally charged. As professionals, we face decisions that force us to balance voluntary risks and externally imposed risks. How do we set "safety levels" in this context? Even more important, are we allowing rational risk decisions to be relegated to computerized risk analyses that have so many compounded errors that common sense tells us the estimates are clearly wrong? Absurd conclusions, of course, lead to loss of credibility in the entire field of risk assessment. In an emotionally-charged environment, perceptions are reality. Perceptions are frequently far from scientific reality, but perceptions are so strongly held that scientific reality alone cannot change opinion. Until risk communicators learn to address perceptions concurrently with scientific reality, we will find little improvement in the general understanding of relative risk and. hence, little acceptance of slight risks. No one has the correct answer to effective risk communication yet, but we must continue the search for optimum communication techniques. Background: Our Lives Are Surrounded by Risks A fetus faces risk from the moment of conception. If the baby has the misfortune to "select" the wrong parents, it can inherit such genetic diseases as hemophilia, diabetes, sickle cell anemia. Down's syndrome, retinitis pigmentosa. Alzheimer's disease, spina bifida, hydrocephalus, or many others that are still being identified. The baby could inherit a predisposition for conditions such as heart disease, cancer, allergies, obe sity. alcoholism and many others. While in the womb, babies are exposed to involuntary i isks based on their mother's lifestyle. If mother smokes five or more cigarettes a day. the baby might have a lower birth weight or even a risk of childhood leukemia or Whilm's syndrome. If mother drinks alcohol while pregnant, baby runs the risk of mental retardation. If mother takes certain drugs, birth defects--such as those induced by thalidomide--are possible. If mother has certain diseases such as AIDS, measles, or other viral infections that can be transmitted through the placenta, then serious risks ofdelormityare very real. Moth ers who use "recreational drugs" can turn their newborns into infant "junkies." and many newborns do not survive drug withdrawal after birth. In fact, recreational drugs such as marijuana reduce sperm counts and motility. Therefore, potential fathers who smoke pot may not be able to fertilize an egg. This is the child's only possibility of having "zero risk." 1 haven't even reached the point of birth where mother's blood type might be incompatible with the baby's, resulting in Rh problems and a high infant death rate if not treated immediately. Maternal venereal disease can lead to infant blindness or AIDS. The birthing process itself can lead to brain damage or other complications. The inlant years arc fraught with dangers ol accidents and childhood illnesses. With all of these risks, it seems hard to believe that so many of us grow up to be adults. Yet. we are `Presented at the American Industrial Hygiene Conference in Montreal. Quebec, Canada, May 31-June 5, 1987. nm. ina Hyg Jssoc. J. (49) Aynl. 1988 generally living longer and healthier lives world-wide than ever before in history (with the exception of the Soviet Union where life expectancy is decreasing and in a few coun tries where the rate is essentially constant). 1 give these examples to put things into perspective. We expect to see these risks reduced. In fact, through technology and human efforts, risksare being reduced. Whenevera case of botulism is identified, for instance, it makes national headlines. Botulism and related food infections were com mon causes of death before refrigeration and modern food processing techniques and were unworthy of news coverage just two generations ago. We live longer now because we have a cleaner environ ment. medicines, vaccines, preservation ol foods, ireezers and refrigerators, vaccination, proper nutrition and because of other factors common to our higher standard ot living. Today life expectancy in the United States is higher than at any other time in history, and each year life expectancy increases. We live in a society that expects technology to provide a risk-free utopia. As w'c all know, utopias do not exist, and energies spent trying to reach an unrealistic goal are spent in vain. As practitioners in risk reduction, we should strive to reduce risk to a level that reaches toward zero, but any attempt to actually try to reach absolute zero will mean misspent resources. VVV 000009627 Approaches to Risk Communication Perception is reality. 1 know this is a difficult thought for a scientifically-trained person, but the more work 1 do in communications, the more 1 have come to believe the adage that perception is reality. If we look at the messages that bombard us daily, we can see that many messages do not lit the facts. Tor example, a government employee union is running an advertisement on Washington TV that savs that water cleanup isn't working A-223 TABLE I Risk Ranking Based on HERP from Ames, et a/.'11 (Human Exposure Dose/Rodent Potency Dose) Oaily Human Exposure Carcinogen Dose per 70-kg Person HERP % Tap water (1 L) Contaminated well water (1 L) (worst well in Silicon Valley) Well water (1 L, Woburn. Mass.) Swimming pool (1 hr) (average child) Conventional heme air (14 hr/day) Mobile home air (id hr/day) PCBs: daily dietary intake DDE/DDT: daily dietary intake EDB: daily dietary intake (from grains and grain products) Bacon, cooked (100 gm) Sake (250 ml) Comfrey herb tea (1 cup) Peanut butter (32 gm: one sandwich) Dried squid, broiled in gas oven (54 c;m) Brown mustard (5 gm) Basil (1 gm dried leaf) Mushroom (Angancus bisporus). one raw (15 gm) Natural root beer (354 mL) (now banned) Beer before 1979 (12 oz) Beer (12 oz) Wine (250 mL) Diet coia (12 oz) Formaldehyde: Workers' daily average intake EDB: Workers' daily intake (high exposure) Chloroform, 83 /ig Trichloroethylene, 2800 ^g Trichloroethylene, 267 jig A. Chloroform, 12 B. Tetrachloroethylene, 21 m9 Chloroform, 250 (average pool) A. Formaldehyde, 593 yg B. Benzene, 155 ^9 Formaldehyde, 2.2 mg PCBs, 0.2 Mg (U.S. average) DDE, 2.2 wg (U.?. average) Ethylene dibromide. 0.42 ng (U.S. average) A. Dimethylnitrosamme 0.3 fig B. Diethylnitrosamine. 0.1 m9 Urethane, 43 pg Symphytine 38 ng, 750 m9 of pyrrolizidine alkaloids Aflatoxin 64 ng (U.S. average 2 ppb) Dimethylnitrosamine 7.9 Ally! isothiocyanate 4.6 mg Estragole. 3.8 mg Mixture of hydrazines, etc. Safrole, 6.6 mg Dimethylnitrosamme, 1 m9 Ethyl alcohol, 18 mg Ethyl alcohol, 30 mg Saccharin, 95 mg Formaldehyde. 6.1 mg Ethylene dibromide, 150 mg 0.001 0.004 0.0004 0.0002 0.0003 0.008 0.6 0.004 2.1 0.0002 0.0003 0.0004 0.003 0.006 0.003 0.03 0.03 0.06 0.07 0.1 0.1 0.2 0.008 2.8 4.7 0.06 5.8 140.0 VVV 000096?a and the government must be forced to do more. The Clean Water Act was just reauthorized for S20 billion, and the water quality in the United States has improved to a point where many previously polluted waters now host swarms of swimmers without fear of polluted water. The advertisement clearly flies in the face of facts, but the image is retained, and people who see the ad will firmly believe that the government isn't doing anything to clean up water. Their perception becomes political reality. Likewise, many risks are ingrained in our minds that do ot tit scientific reality--both positive and negative. People perceive risks they don't understand as far more serious than risks they do understand. Risks with positive benefits will be subconsciously ignored or played down while risks asso A-224 ciated with no benefits will be magnified beyond their real ity. This "risk understanding gap" is best exemplified in Table l where commonly accepted environmental hazards are compared with common materials in our daily lives. Another example is the public tolerance of smoking versus environmental standards. The risk of smoking is far greater than living near most hazardous waste management sites, yet smokers will continue to smoke as they worry about the risks from landfills. Human nature will opt to blame external forces when faced with adversity of its own making or of unknown origin. Phis is especially true when we face risks with chronic and severe outcomes. Am. Ind. Hyg. Assoc J <491 April. 1988 Risk perception is not rational. Risk perception does not iow the normal laws of science and can be based on fear of . unknown, fear of the outcome, fear of the financial ...pact, fear of loss of control of one's fate, or many other ..tors independent of reality, ,\x scientists, we must learn to put risk in perspective and c:p ihc general public understand that perspective. Since x\ is such a scary concept, our first problem as risk comunicators is to put risk in the context of daily life. I'crhaps we. the risk communicators, are to blame for me of the public's misunderstanding. Wc all talk of risk S; ile we control for safety. Perhaps we should talk of safety .ctors rather than risk factors. \ major difficulty with identifying risks centers on dis hes that have many causes. Confounding causes of diseases e very difficult to separate, making it very difficult to - xign a single cause to a disease. For example, lung cancer an result from causes unknown, from use of cigarettes, and aim asbestos, silica and other fine-particlc respiratory .usts. Separating the causes of cancer--industrial expo-ures. pollution, and many lifestyle factors--is most difficult and requires sophisticated statistical and epidemiological methods. Many w ho try to link cause and effect w ithout these advanced techniques can easily reach erroneous conclusions. Any effective system of risk communication we develop must be based on the best science available, but I am becotyi ng convinced that purely factual communication is ineffcc:i\e. Factual information must be communicated in the context of comparisons and should show risks relative to other, similar situations. Dr. Bruce Amcsll) demonstrated an excellent way to put carcinogenic risks in perspective. He developed a system called H ERP, human exposure dose/ rodent potency dose. While the rodent is far from the ideal model of human toxicity because its metabolism is often dissimilar, it has the advantage that more data exist for the rat than for other animal models. Table 1 contains excerpts from his paper published in Science.''1* Vet, in its original form. HERP is not as effective a risk communication tool as it might be. I took the liberty of expanding Dr. Ames's table to include comparisons ot var ious daily human exposures with a glass of wine and beer (Table II). 1 feel that we must communicate risk on the basis of something that people accept as sale and something in their daily environment. We all accept risk as a fact of life, either consciously or unconsciously. Other factors intrude into our acceptance of risk. These factors include severity of the outcome. proximity of the outcome. ability to control exposure to the risk. pain and suffering resulting from the adverse conse quence. peer pressure to accept the risk. ability to blame someone else for the adv erse outcome. Am. Ind Hyg Assoc. J. (49) April, 1988 perceived benefits, and degree of uncertainty in the risk (the more uncertain, the greater the fear). Involuntary versus voluntary risk arguments may be a trap. All too often we are sidetracked into exploring these issues, but I think voluntary - involuntary risk is a blind trail. Involuntary risk exposure is not the issue; rather it is an inability io control decisions affecting our personal envi ronment. The public is losing faith in the government's ability to protect us--even if data show that we are living longer and healthier lives than ever before. Risk isn't the issue: loss of freedom is part of the issue. TABLE II Hazard Comparison with Beer and Wine (Based on Data from Ames, et ai.`l') Times Less Hazardous than 1 Glass of Daily Human Exposure Beer Wine Tap water (1 L) Contaminated well water (1 L) (worst well in Silicon Valley) Well water (1 1_, Woburn, Mass.) Swimming pool (1 hr) (average child) Conventional home air (14 hr/day) Mobile home air (14 hr/day) PCBs: daily dietary intake DDE/DDT: daily dietary intake EDB: daily dietary intake (from grains and grain products) Bacon, cooked (100 gm) Sake (250 mL) Comfrey herb tea (1 cup) Peanut butter (32 gm: one sandwich) Dried squid, broiled in gas oven (54 gm) Brown mustard (5 gm) Basil (1 gm dried leaf) Mushroom (Angaricus bisporus). one raw (15 gm) Natural root beer (354 mL) (now banned) Beer before 1979 (12 oz) Beer (12 oz) Wine (250 mL) Diet cola (12 oz) Formaldehyde: Workers' daily average intake DB: Workers' daily intake (high exposure) 28 000 700 7000 A. 14 000 B. 9300 350 A. 4,7 B. 700 1.3 14 000 9300 7000 A. 930 B. 467 930 93 93 47 40 28 28 56 350 1 0.59 47 0.48 0.002 4700 1200 12 000 A. 24 000 B. 16 000 590 7.8 12 000 2.2 24 000 1600 1200 A. 1600 B. 780 1600 160 160 78 67 47 47 24 590 1.7 1 78 0.81 0.03 (Please refer to Table I for additional detail.) vw 000009629 A-225 Risk communicators make a very serious error about their audiences lor the communication message. The communica tors assume that the audience will absorb facts when the reality is that risk communication is received emotionally, not factually. Peter Sandman^' says that the issue is moral and ethical, not factual. The more 1 work with risk communication, the more 1 tend to agree with his observation. We must learn to communicate factual information about safety factors while we communicate within an emotional context. Sometimes we are our own worst enemy. We use an emotionallv-laden vocabulary when we communicate risks. We don't think about our choice of words. We talk of risk, not safety; toxic waste rather than industrial waste: air toxics, not air quality; need-to-know, not right-to-know; etc. Technical folk commit a serious sin of jargon and of convoluted communication. We must learn the old public relations adage. KISS -- Keep it simple stupid! For those of us who worked hard to develop a good vocabulary, it seems sinful not to use it. We must remember our objective is to communicate understanding, which is best done in simple terms. In the early debates about environmental quality, cost; benefit analyses were common arguments. Industry pre dicted dire consequences if it had to meet the burden of strict environmental controls. 1 ndustry predicted many plant clos ings and lost jobs. When these closings did not happen immediately after tighter environmental controls, these irguments began to ring hollow. In the present economic climate, however, manufacturing industries are losing jobs. For example, the chemical industry employs 100 000 few'er people than it did 7 years ago. Much of that loss may be due to international competitiveness, but some is due to increased regulatory burdens that made industry less competitive in the international market. The real question is. "Are the environmental and health controls necessary in this lorm?" It the answer is technically "yes.'' then the regulation should be there, and industry should comply or go out of that line of business, If the answer is "yes" based on sociopolitical, emotional judgments, then the regulation should not be put into effect. Unfortu nately. far too many regulations fit the latter rather than the former. If we are merely wasting our resources rather than solving a real problem, then we will eventually run our costs so high that we can no longer compete internationally. We live in a different time now. We live in a period where safety controls are set at such low levels that cost truly becomes a major factor. Perhaps we need to revive the old cost/ benefit concept in these eases. If we are trying to con trol a one-in-one-miliion risk, especially lor chronic disease, the model is probably conservative to a point of absurdity. For example, one Environmental Protection Agency (EPA) model estimating risk of children eating contaminated soil .vas 100 million times overly conservative."*1 The cost, in this case, was buying the entire town of Times Beach. At times like this. 1 feel that risk decisions have reached a point of A-22G TABLE III Observations on Risk and Risk Communication On Risk Life cannot exist without risk. Without assuming some risk, societies cannot grow or prosper. Change is healthy in ecosystems and societies- With changes come some risks. Without changes comes death. The absence of something, such as harm, cannot be proved; only the presence of something, such as harm, can be proved. Pisk from injury or illness is lower now than it has ever been in society. Without some risk, one cannot receive benefits. On Emotion Fear is the strongest human emotion. Risk plays to fear. The greater the uncertainty about the risk, the greater the emotional turmoil about the issue. Risk implies uncertainty. People are more comfortable with certainty in their lives. The lower the understanding of the science relating to a specific risk, the lower the willingness to accept risk (assuming benefit and real risk remain constant). Risk should not be considered in isolation. Rather, risk should only be considered within the context of the full spectrum in which the risk is assumed. What is the risk o! raking no action? What is me nsk of the alternatives and the benefit of tne alternative actions? These should be presented as a full analysis rather than a single number. On Society The public feels that injury caused by involuntary risk should be com pensated (either by those directly responsible for the injury or py the greater society). Reasonable risk is a societal judgment that the benefits to the many outweigh the small risks to an unidentifiable individual. General societal benefits do not justify an individual assuming a dis proportionate burden of risk without an individual benetit. In general, older people are less willing to accept risk than younger people. The United States has a rapidly aging population, so we can expect it to be increasingly less willing to accept risk. As the industrial component of our economy shrinks, the public's willing ness to accept risk decreases. On Individuals The degree of freedom an individual has is directly related to the respon sibility the individual assumes for his own actions. A person s ability to handle uncertain risk and responsibility cannot expand if it is taken away from him. People accept less risk when they attain a zone of comfort, certainty, control or trust than when they are struggling for survival. An individual will assume what society would consider an unacceptable risk if he perceives a personal benefit. On Perception Public perception is reality and must be addressed in whatever solution is proposed Most people view risk as negative. Political action responds to perceived crisis. Good technical solutions come from dispassionate logic. In highly emotional situations the two may not converge. Both political and technical solutions are necessary to solve problems On Communication Risk communication is negative. To communicate acceptable risk, we must change the vocabulary to a positive, e.g., degree of safety. Numerical calculations should not be used to communicate risk. "Parts per. ."communications should be abandoned because the public only hears the large number at the end of the phrase and thinks the value is very large rather than infinitesimally small. The media cannot be counted on (or expected) to do any more than report or deliver the risk message it receives. Thus the messenger must be a skilled communicator who is knowledgeable in me field. The effectiveness of a risk communication should be judged by the effect (response) it creates. Doing the right thing isn't news. Activists will create stories that emphasize risk rather than safety. It's almost impossible for industry to generate stories m the media that emphasize safety. The earlier the stakeholders in an issue talk to each other and try to reach a common definition of tne problem, the faster a solution can be reached, it will be a better solution, too. VVV 000009630 Am Ind. Hyg Assoc. 1 (49i April. 1988 absurdity. No wonder the public places little credibility in scientists. While considering risks, risk perceptionand reality, 1 have collected a series of observations on risk. These thoughts are contained in Table IN. 1 offer them as food for thought to anyone who has to struggle with risk communication. We all face an overwhelming problem in the immediate future. The Superfund Amendments and Reauthorization Act of 1986 (SARA) requires communications with com munities and emergency response personnel. SARA requires material safety data sheets (MSDS) at fire stations if they are requested by fire departmental personnel. The real goal of the law should be access to hazard information that is current and easily accessible. We all agree with the goal, but implementa tion cf the letter of the law is a blueprint for disaster. The over whelming requirements for material safety data sheets will not satisfy the real need of providing information and understand ing. They might represent health hazards from hernias and back strain as fire fighters move large boxes of material safety data sheets, or they could represent fire hazards with all of the paper that must be stored at the fire station. Professional societies should unite with industry, unions, local emergency responders and special interest groups to design a system that works. The chemical industry estab lished the Chemical Referral Center (CRC). a toll-free number for anyone to get product safety information (for nonemergency information). We currently have more than 130 000 MSDSs on chemicals in our system. The informa tion number is 1-800-CM A-8200. The CRC was in operation before the current law' was passed, as a response to the need lor chemical information by the general public. While this may not be the ultimate answer to meeting the public's need to know, we feel that it is a practical option to provide information quickly and with more personal attention than could be possible with an MSDS. Conclusion Risk communicators must be sensitive to the needs of their audiences. Yet all of our training teaches us to be unemo tional and scientifically objective. The mixture of approaches we traditionally use makes us appear uncaring and unap proachable. To communicate safety with proper perspec tive. w-e must become humanists who continue to seek biasfree risk assessment. An unw'ritten contract exists between management and labor in the chemical industry. Management has an obliga tion to provide a safe workplace, necessary safety equipment for the situation, and training for anyone who will be work ing in a potentially hazardous environment. Labor has an obligation to use the protective equipment provided, learn and use safe procedures, and work in such a manner that minimizes risks. Both parties of the contract--management and labor--need to work diligently on their respective sides of the unw-ritten contract to achieve safety. This w orks well in the chemical industry and has resulted in a safety record that other industries envy. We know that no amount of regulation will bring safe work conditions until this .social contract between labor and management is manifest. References 1. Ames, B.N., R. Magaw and L.S. Gold: Ranking Possible Car cinogenic Hazards. Science 236:271-280 (1987). 2. United States Environmental Protection Agency: Explaining Environmental Risk (Report) by P. Sandman. Washington, D.C.: EPA Office of Toxic Substances, 1986. 3. Vollmerhausen, J.M.: "The Uncertainty in Risk Estimation for a Soil Ingestion Model." M.H.S. Thesis. Johns Hopkins School of Public Health. Baltimore, Md., 1987. A/n Ina Hyn Assoc. J (49) April. 19SS yyV 000009631 A-227