Risk communication

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Epidemiology may contribute to a rational public and political awareness of the risks of daily life. Descriptive epidemiological studies may help health authorities to see the state of public health and its relationship with environmental problems in true perspective. With relatively simple statistical parameters of the health impact of serious diseases, one can inform the public and policy makers on the importance of certain risk factors. This may be useful in setting priorities for the funding of research, prevention, and control programs. For instance, one may rank diseases in terms of potential years of life lost and then conclude that cancer is by far the most serious threat to public health, followed by coronary heart disease, and traffic accidents (see Figure 20.1, based on Canadian health statistics). The diagram in Figure 20.2 shows the lost life expectancy for an individual, caused by several risk factors.

all cancer coronary heart disease car accidents suicide lung cancer breast cancer stroke cancer of large intestine birth defects of circulation cirrhosis emphisema lymphoid cancer leukemia brain cancer homicide

100 200 300 400 500

potential years of life lost (x1000 years)

Figure 20.1 Health problems ranked by potential number of years of life lost.

A recent review of worldwide trends in age-related cancer mortality showed rapid increases in the prevalance of various types of cancer (e.g., of the brain, the central nervous system, breast, kidney). These could not be explained by increased accessibility of health care records, changes in disease registration, improvements of diagnostic technology or by life-style trends. The investigators suggested that these trends reflect an increase in environmental or occupational exposures to carcinogenic factors. Such descriptive studies may stress the need for more research and preventive measures to reduce exposure to carcinogenic agents. However, public health is a complicated subject that may be looked upon from many different angles. To find the right method to measure health impact is not easy. During the last decades public health science and management have focused on the

100 200 300 400 500

potential years of life lost (x1000 years)

male female male female lost life expectancy (thousands of days)

lost life expectancy (day) x 20

lost life expectancy (day) x 1000

* = average over US population

Figure 20.2 Comparison of risks. Asterisk designates average risk spread over the total US population: others refer to risks of those exposed or participating. The ordinate scale is shown at the left. The heights of the bars are multiplied by 20 in the center section and by 1000 in the right section. The first bar in each of these reproduces the last bar in the previous section, showing the effect of scale change. (Source: Cohen, 1991.)

prevention of (early) death. Nowadays many have recognized the fact that there is more to life than dying, as the saying goes. The area of special attention for public health policy is shifting from prevention of fatal disease to improvement of quality of life by reducing the period of dependence and disability in elderly life. Prevention should aim at chronic morbidity as in the cases of rheumatoid arthritis, chronic obstructive pulmonary disease, diseases of the eyes and ears, diabetes, dementia, and other multi-factorial diseases of old age which cause severe disability. The diagram in Figure 20.3 shows the principles of reduction of morbidity.

The great challenge for public health care is to make the disease-curve move faster to the right than the death-curve in order to reduce the black area in the diagram that represents severe disability. It is the concept of the ideal car that disintegrates completely after exactly ten years of loyal service without any prior mechanical problems. Some authors argue that for the purpose of health risk assessment, attention should be focused on risk factors associated with chronic morbidity rather than on pursuing every carcinogen that shows itself in animal experiments or occupational epidemiology.

It should be noted that there is no scientific consensus yet on how one should measure public health. The above examples were given to show that public health is more than just counting bodies, or the sum of years of life lost.

The public's perception of the threats of daily life may sometimes be seriously biased. Often the public opinion is fixed on the effects of popular risk factors such as percent alive

percent alive

100 age good health illness of short duration chronic illness

100 age good health illness of short duration chronic illness

Figure 20.3 The burden of disease.

asbestos, TCDD, benzene, and radiation. However, the risks from these factors are, if verifiable, in fact often trivial compared to the dramatic health effects of factors such as traffic, smoking, dietary habits, occupational exposures, and poverty (wealthier is healthier).

Epidemiological data may give a good notion of the real risks of daily life by transfering information on health risk from the expert sphere to the public sphere in a way that appeals to lay-people. This can be achieved, for instance, by comparing the effects of different risk factors on public health. Although an oversimplification, the risk yardstick in Figure 20.4 might be a first step.

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The Complete Compendium Of Everything Related To Health And Wellness

The Complete Compendium Of Everything Related To Health And Wellness

A lot of us run through the day with so many responsibilities that we don't have even an instant to treat ourselves. Coping with deadlines at work, attending to the kids, replying to that demanding client we respond and react to the needs of other people. It's time to do a few merciful things to reward yourself and get your health in order.

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