Public Healthand Risk Assessment

(2nd of 10 Lectures onToxicologic Epidemiology)

Michael H. DongMPH, DrPA, PhD

readings

Taken in the early ’90s, when desktop computers were still a luxury.

Learning Objectives• Revisit the mission of public health (PH),

and learn the impact of social choice on PH.

• Revisit the concept of health risk assessment (RA) and learn the various RA activities performed in the U.S.A. and worldwide.

• Learn that exposure monitoring and mitigating are bridges between PH and RA.

Performance Objectives• Integrate social choice with health risk

assessment (RA) through public health (PH).

• Realize that various RA activities can be performed to promote PH.

• Appreciate the concept that exposure monitoring and exposure mitigating are guided by RA with the goal of promoting and improving PH.

The mission of public health

is to “fulfill society’s interest in assuring conditions in which

people can be healthy.”

Social Choice on Public Health

• A process through which collective goals are pursued and appropriate methods resolved (by and large) systematically.

• Public health activities and mission are a subset of this process.

Administrative Structures of Public Health

• Systems - Canada/U.S. VeteransAdministration.

• Partnerships - Sweden/U. K.

• Alliances - United States.

as a core function of public health . . . .

“Assessment and monitoring of the health of communities

and populations at risk to identify health problems and

priorities.”

Health Risk Assessment:The process by which the

potential adverse health effects of human exposure to etiologic agents (usually chemicals) are

characterized.

Health Risk Assessment Components

Hazard Identification

Dose-Response Assessment

Exposure Assessment

Risk Characterization

Risk Assessment Activities in U.S. A. and

Worldwide•United States: DHHS; EPA; CPSC; OSHA.

•Worldwide: Development Policies and/or Projects (DPP).

Risk Assessments in the U.S. DHHS (I)

Substance Abuse and Mental Health Services Administration (SAMHSA)

•Predecessor agency: ADAMHA.

•Substance abuse prevention; addict treatment; mental health services.

Risk Assessments in the U.S. DHHS (II)

Centers for Disease Control and Prevention (CDC)

•Established as Communicable Disease Center in 1946.

•Monitoring disease trends; injury control; outbreak investigation.

Risk Assessments in the U.S. DHHS (III)

Agency for Toxic Substances and Disease Registry (ATSDR)

•Prevent exposure to hazardous substances from waste sites.

•Conduct health risk assessments and health studies per EPA’s risk prioritization list.

Risk Assessments in the U.S. DHHS (IV)

National Institutes of Health (NIH)

•Medical research organization with 18 separate health institutes.

•Diseases studied including: AIDS; cancer; Alzheimer’s; diabetes; eye; heart; lung; arthritis; blood, etc.

Risk Assessments in the U.S. DHHS (V)

Office of the Assistant Secretary for Health (OASH)

•Office of Public Health and Science.

•Public Health Service agencies and program offices.

•U.S. Surgeon General.

Risk Assessments in the U.S. DHHS (VI)

Food and Drug Administration (FDA)

•Assures safety of foods and safety of cosmetics.

•Assures safety and efficacy of drugs, biological products, and medical devices.

Risk Assessments in the U.S. CPSC

• Created in 1972 by the Consumer Product Safety Act.

• An independent regulatory agency.

• Saving lives and keeping families safe (from household products).

Risk Assessments in the U.S. EPA

• Established in 1970; active in both research and regulation.

• Most important U.S. federal agency for the regulation of toxic chemicals and pesticides.

• Important influence over the design and conduct of toxicity testing and toxicologic studies.

Risk Assessments in the U.S. OSHA

• Created by the Occupational Safety and Health Act of 1970.

• An administration office of the U.S. Department of Labor.

• Mission is to save lives, to prevent injuries, and to protect the health of America’s 100 million plus workers.

DPP on Health Risk Assessment (I)

• Impact of development policies and projects (DPP): more subtle & indirect.

• Use environmental impact assessment (EIA) to address public concerns about unintended effects.

• EHIA (environmental health impact assessment) is now a component of EIA.

DPP on Health Risk Assessment (II)

• Six common steps for EIA; one of the steps requires some form of health risk assessment for EHIA.

• Courses and study programs on EHIA and EIA available worldwide.

• DPP exacerbates poverty and health problems of industrialization.

DPP on Health Risk Assessment (III)

• Unintended effects from DPP: five (5) basic types.

• Housing and economic growth: health; utility services; and nutrition problems.

• Agricultural growth, industrialization, and energy: exposure to pesticides; to toxic wastes; and to radiation.

Exposure Monitoring and Mitigation

• Used as health protection, surveillance, and regulation tools.

• Mitigation: to lower potential or current exposure to an acceptable level.

• Monitoring: to ensure and maintain a safe exposure level.

Overview of Next Lecture:

Toxicology and Risk Assessment

•Impacts of statutes and regulations.

•Toxicity testing procedures and data acquisition for health risk assessment.

•Effects of risk and health perception.

•Advances in assessment techniques.