Methodology for analysing toxic chemical risks to animal health

As a contribution to community-based disaster management, a methodology was designed for analysing toxic chemical risks to animal health, in line with national and international approaches to these issues. The methodology includes: hazard identification, risk assessment of the animal population according to its degree of vulnerability and other communication and risk management tools. Its validation in thirteen Cuban communities shows that the methodology provides the necessary technical basis for formulating and implementing disaster risk mitigation plans in compliance with current legislation. It also facilitates decision-making for disaster risk control in a community by acting as an early warning mechanism for toxic chemical risks to public health and the environment and by promoting multi-sector action in the field of veterinary public health.     

Health risk assessment of the translocation of wild animals

Potential health risks are always associated with the translocation of wild animals. A formal assessment of these health risks should be conducted in advance of each translocation, and the results of the risk assessment should be incorporated into decisions as to whether or not the translocation should occur or whether changes in the translocation protocol could substantially reduce health risks inherent in the translocation. Credible health risk assessments can be performed by individuals without extensive previous experience, given the necessary background in animal health and wildlife biology and access to sufficient valid information. Assessment of health risks should not be performed or influenced by those who will use the results to make decisions or those with vested interests in a particular outcome. The assessment process itself must be transparent, and the final risk assessment report must clearly present each step taken, all available information and all reasoning. Health risk assessment is a rigorous application of common sense to evaluate whether or not important health-related risks are associated with a proposed activity. The level of health risk inherent in a planned translocation is determined by identifying the full range of possible health hazards that might be associated with that translocation, identifying from among these a subset of potential hazards that require complete assessment, and for each hazard thus selected, evaluating the probability that the hazardous event will occur and the magnitude of negative consequences if it does occur. The combination of probability of occurrence and magnitude of consequences constitutes the risk posed by a potential health hazard, and the combined risk for each assessed health hazard constitutes the overall health risk estimate for the translocation. A valid numerical (quantitative) health risk assessment for wild animals is rarely possible because the available information on which the assessment must be based is too approximate and imprecise. Qualitative health risk assessments for wild animal translocations are usually of equal or greater value than numerical assessments and can be of enormous importance to wildlife conservation, domestic animal health and public health.     

The role of the public in the management of public health risks

OBJECTIVE: To critique current models of public involvement in the management of public health risks. METHODS: Two case studies are used to highlight the challenges of contemporary practice. RESULTS: Current models often result in affected communities having perceptions of risk that conflict with those responsible for risk management. This can lead to ineffective decision making. CONCLUSIONS: Involving the public throughout the risk assessment and risk management process may lessen conflict and result in better decisions. IMPLICATIONS: Those responsible for responding to public health risks should aim for transparent processes that highlight assumptions and uncertainties, and involve the public wherever possible.     

Risking public safety: Experts,the medical profession and ‘acceptable’ drug injury

By locating expertise within an institutional framework, this paper examines the roles of regulators, the pharmaceutical industry and the medical profession in drug risk assessment and in the construction of ‘acceptable’ drug injury in particular. It is suggested that, while public perceptions of risks are important, they may be extremely limited due to relative secrecy surrounding some risk-generating activities, such as pharmaceutical development and regulation. Under these circumstances, a necessary starting point is the investigation of the formation of expert risk assessments. Taking the case of the anaesthetic drug, Althesin, the article explains how drug risks, largely unknown to the public, came to be defined as acceptable by expert and regulatory interpretation for over a decade. The reasons for and drivers of the regulatory route taken, together with alternative regulatory approaches are identified in relation to the salient risk – benefit problems: extrapolation of animal toxicology to humans, construction of therapeutic benefit, comparative risk assessment, unpredictability of risk and risk – benefit evaluation. It is argued that professional closure between expert regulators, the manufacturer and sections of the anaesthesiology profession led to passive decision-making and a regulatory approach towards acceptable drug injury unlikely to have been sustainable if it had been subjected to public accountability. The Althesin experience also suggests that regulators, the medical profession and other stakeholders concerned about drug risks should focus their attention not only on improving the evidence-base of risk assessment, but also on more robust interpretation and informative communication of the evidence already available at any particular time. Finally, the Althesin case demonstrates that, contrary to popular claims, major drug risks have not necessarily only been discovered upon widespread use after marketing approval and that, even after discovery of life-threatening risks, drugs have not necessarily been withdrawn quickly by the UK regulatory authorities despite the availability of safer alternatives.     

A public health context for residual risk assessment and risk management under the clean air act.

The 1990 amendments to the Clean Air Act required the EPA to institute new pollution control technology requirements for industrial sources of air pollution. In part because agreement could not be reached on the best way for the EPA to determine whether any significant risks to human health will remain after the technology controls are in place, the amendments also created a Commission on Risk Assessment and Risk Management and gave the commission a broad mandate to review and make recommendations concerning risk assessment and risk management in federal regulatory programs. In its March 1997 final report to Congress and the administration, the commission recommended a tiered approach to assessing such residual risks. That approach included the idea that when decisions about managing residual risks are made, emissions should be evaluated in the context of other sources of air pollution. Evaluating risks in their larger contexts is consistent with what the commission called a public health approach to environmental risk management. This paper describes the public health approach and how it applies to evaluating residual risks under the Clean Air Act.     

基于两种ICMM风险评估模型研究某蓄电池生产企业职业健康风险

  目的  采用国际采矿与金属委员会（ICMM）职业健康风险评估方法评估某蓄电池企业职业健康风险,探讨该方法的适用性,为企业采取合适的职业卫生管理方法提供科学依据。
  方法  采用ICMM风险评估技术中定性评估矩阵和定量评估模型两种方法,对某蓄电池企业关键岗位工人的职业健康风险进行评估,并比较、分析方法的适用性。
  结果  矩阵法评估结果:极板打磨、分板、极板入壳、铸板、极板焊接等岗位接触铅所致铅中毒的健康风险为中等风险,分板、极板入壳、铸板等岗位接触噪声所致听力损失或噪声聋的健康风险为高风险,其他岗位健康风险水平为低风险或非常低风险。定量评估模型评估结果:和膏、分板打磨、极板打磨、分板、极板入壳、铸板、极板焊接等岗位接触铅所致铅中毒的健康风险为不可容忍风险,涂板、极板打磨、分板、极板入壳、铸板等岗位接触噪声所致听力损失或噪声聋的健康风险为不可容忍风险;其他岗位健康风险水平为可容忍的风险。
  结论  铅和噪声是蓄电池企业健康风险水平最高的危害因素,企业应采取改进生产工艺、调整原有防护设施和加强职业卫生管理等措施来降低职业健康风险。矩阵法和定量法评估结果各有偏倚,矩阵法风险评估结果所得危害等级比定量法的低。在实际应用中应结合现场检测结果和职业健康检查结果来综合考虑岗位健康风险水平。
     

A conceptual framework for the economic analysis of factors influencing decision-making of small-scale farmers in animal health management.

The delivery of veterinary services in most of sub-Saharan Africa has undergone substantial changes, with the private sector gaining increasing recognition as an alternative to state provision. Given this policy shift, the authors argue that a better understanding of the behaviour and decision-making processes of small-scale farmers in animal health management is urgently required, to guide policy decisions regarding the delivery of animal health services. Whether the involvement of the private sector will improve overall efficiency in the delivery of veterinary services will depend greatly on the demand response of livestock producers who must make decisions about the health of livestock. The authors briefly review the decision-making process in small-scale farming systems, the economic nature of animal diseases and disease control and the models that have been used to guide resource allocation for disease control. To gain an improved understanding of the behaviour and decision-making processes of small-scale farmers, the authors propose a conceptual model including variables that relate to characteristics specific to small-scale farmers and farms, economic factors, institutional setting and biophysical factors. Two possible approaches are proposed for the economic analysis. Agricultural household modelling allows the derivation and testing of hypotheses regarding the demand elasticities for veterinary services, while qualitative choice models are better suited to the analysis of determinants behind the choices of farmers. The authors conclude that an urgent need exists for empirical research in this area.     

Veterinary public health in world-wide animal health and production.

The first section of this paper presents a concise analysis of the current world situation in animal health, zoonoses, food production and hygiene and Veterinary Services. The second section discusses future perspectives for healthy animal production in relation to veterinary public health problems. The coming decades will be crucial for the future of Veterinary Services. The protection of human health and the improvement of food production through animal health will continue to be the priorities of these services. Scientific and technological developments and the many associated changes in human living conditions and needs, as well as in animal production, call for a general revision of veterinary philosophy, strategy and programmes. In this context, it is recommended that efforts be made to significantly strengthen activities aimed at protecting human health against diseases of animal origin.     

Technology assessment in health care: the U.S. perspective.

Formal programs in medical technology assessment in the United States have become increasingly prominent in health care during the last 10 years in large part stimulated by remarkable technologic innovation, expansion in medical knowledge and increasing health care expenditures. The establishment of the Consensus Development Program of the National Institutes of Health initiated a decade of activities in technology assessment in both the public and private sectors and it was intensified by efforts to contain expenditures, particularly the Prospective Payment System. However, in spite of the wide range of evaluation activities, deficiencies remain which will have to be remedied if medical and policy decisions regarding technologies are to be made on sound bases.     

Risk identification,assessment and management in public health practice: a practical approach in one public health department

BACKGROUND: The continuing identification, assessment and management of risks are key themes for clinical governance. These themes are being integrated into both primary and secondary care practice; however, integration into public health practice appears much slower. This paper describes the recent approach that we have taken in Sheffield, and proposes a model for public health departments to identify, assess and manage risks, which complements other risk management processes and is transferable to other settings. It assumes that public health practice is not a risk-free activity and holds that the process of identifying, assessing and managing risks is a key component to raising standards. METHODS: A number of risk 'management' models were reviewed and a primary care approach was applied to public health practice. A list of potential risks was identified using a number of methods including reflective practice, information from complaints and/or critical incidents. Risks were assessed by likelihood and impact, and were captured in a risk framework. RESULTS: By March 2002, 21 risks had been identified and characterized, and progress had been made to manage 11 of these risks. CONCLUSION: This process, and the development of a risk framework, was useful in identifying a prioritized work programme to improve standards of public health practice in this department. This model can also be used not only for planning risk management activities, continual identification and assessment of risks but also to provide inspiration for other clinical governance activities including public health audit.     

Evaluation and use of epidemiological evidence for environmental health risk assessment: WHO guideline document

Environmental health risk assessment is increasingly being used in the development of environmental health policies, public health decision making, the establishment of environmental regulations, and research planning. The credibility of risk assessment depends, to a large extent, on the strength of the scientific evidence on which it is based. It is, therefore, imperative that the processes and methods used to evaluate the evidence and estimate health risks are clear, explicit, and based on valid epidemiological theory and practice. Epidemiological Evidence for Environmental Health Risk Assessment is a World Health Organization (WHO) guideline document. The primary target audiences of the guidelines are expert review groups that WHO (or other organizations) might convene in the future to evaluate epidemiological evidence on the health effects of environmental factors. These guidelines identify a set of processes and general approaches to assess available epidemiological information in a clear, consistent, and explicit manner. The guidelines should also help in the evaluation of epidemiological studies with respect to their ability to support risk assessment and, consequently, risk management. Conducting expert reviews according to such explicit guidelines would make health risk assessment and subsequent risk management and risk communication processes more readily understood and likely to be accepted by policymakers and the public. It would also make the conclusions reached by reviews more readily acceptable as a basis for future WHO guidelines and other recommendations, and would provide a more rational basis for setting priorities for future research.     

Introduction: The provision of animal health services in a changing world

In the future, animal health services in developing countries will need to operate in a continuously changing policy, institutional and commercial environment. Firstly, the changing policies and priorities of national policy-makers regarding public and private sector roles, reinforced in Africa by the donors, have reduced funding and support for the large number of tasks that animal health services have traditionally performed, and there is continuing pressure from policy-makers to focus on what the public sector can do best. Secondly, poverty reduction has become one of the main criteria guiding the allocation of official development assistance, which has major implications for the main target clientele of veterinary services. Thirdly, population growth, increasing income and urbanisation are causing a marked increase in demand for livestock products in the developing world. As a result, the entire livestock commodity chain is undergoing major structural changes, which has significant implications for the definition and control of food safety standards. Fourthly, globalisation, and increasing trade and travel have greatly increased the risk of disease transmission between different countries and continents. Veterinary institutions in the developing world need to adapt to these challenges. They will have to be able to focus on the essential public sector roles. At the same time they must deliver those essential services to the poor, and provide the policy framework to ensure that the inevitable structural changes in the commodity chain take place in an equitable and sustainable fashion, with an acceptable level of health risk for the consumer. According to the weight given to these different objectives, changes in the institutional set-up need to be considered. This issue of the Scientific and Technical Review addresses these challenges. It begins by reviewing the basic economic characteristics underlying the provision of animal health services, and then examines the alternative delivery systems that are emerging in the developing world and their strengths and weaknesses. The implications for food safety and trade are specifically highlighted. Also included are the practical experiences of countries, from all along the development continuum, that have introduced alternative systems. This paper deals with implications for the future, and while the growing importance of veterinary care for companion animals is acknowledged, the focus is on veterinary services for food animals.     

The need for research to support the emergence of alternative animal health systems

Animal diseases remain one of the main problems for livestock production in terms of trade development, poverty reduction and public health. Animal health systems are complex because of the diversity of the parties involved and because of various changes in the delivery of veterinary services, such as the redefinition of the roles of the public and private sectors. It is, therefore, often difficult to assess the global performance of animal health systems and sub-systems in terms of their medical, economic and social effectiveness. In addition, the necessary reliability of the health information obtained leads to certification of the status of regions and countries with regard to epizootics, which requires a high degree of standardisation and conformity with international norms. An assessment therefore needs to be made of the advantages of alternative systems compared with conventional systems. An animal health system should be seen as a whole, and when assessing its overall performance several things must be taken into account, e.g. the markets for products and the sometimes contradictory interests of all the different parties involved. There are, therefore, many research needs and avenues to be pursued, including: the methods, data and tools required for assessing the effectiveness of systems, including a definition of what constitutes a reliable indicator; the factors that determine the health of a herd; having a clearer idea of what will affect herd health will make it possible to map risk indicators and animal health care needs; the design and management of realistic and harmonised animal health information systems whose indicators provide reliable measurements of health; the function, organisation and effectiveness of participative surveillance approaches; the definition and effectiveness of animal health contracts, such as health mandates between the State and private veterinarians; the function and role of livestock auxiliaries; the establishment of assessment methods and standards that take into account the specific situation of southern countries that could lead to the certification and accreditation of alternative systems. The efficiency of these systems must then be tested (direct impact, cost-benefit studies) using the above-mentioned indicators, and an implementation 'toolkit' can then be assembled, taking into account the local differences which will affect the suitability of each system for different locations. Research into the assessment of animal health systems is a long-term investment, but it ensures that quality certification is reliable and allows for the safe development of animal product markets.     

Research on risk assessment and risk management: future directions

This paper has been reviewed by the Office of Health and Environmental Assessment, U.S. Environmental Protection Agency, and approved for publication. Approval does not signify that the contents necessarily reflect the views and policies of the Agency, nor does mention of trade names or commercial products constitute endorsement or recommendation for use. The U.S. EPA has increasingly relied upon quantitative health risk assessments as the basis for management decisions about public health protection. Full utilization of risk assessment in management applications, however, is limited by uncertainties in the resultant accuracy of the risk estimates. This paper will discuss a research strategy to address the uncertainties in the risk assessment process and describe parallel issues to address in the risk management area. An attendant need for effective communication of complex scientific concepts is also identified.     

From concept to practice: including the social determinants of health in environmental assessments

The present paper examines the historical evolution of health impact assessments as part of the environmental assessment process. The development of a coherent public health framework must be based on the model of determinants of health, integrating toxic and infectious risks and social impacts of projects. The integration of common concepts, processes and methodologies from the area of public health and social impact assessment challenges the quantitative model approach to risk assessment. The expert-driven risk assessment is transformed into a social learning process where local knowledge and scientific input foster a dialogue among stakeholders. The issue-oriented, iterative and participative assessment process may be applied to the health impact assessment of public policies. Sustainable development with its social objectives of empowerment, participation, equity, poverty alleviation, social cohesion, population stability and institutional development is an appropriate framework for conducting health impact assessments.     

Public health implications of emerging zoonoses

Many new, emerging and re-emerging diseases of humans are caused by pathogens which originate from animals or products of animal origin. A wide variety of animal species, both domestic and wild, act as reservoirs for these pathogens, which may be viruses, bacteria or parasites. Given the extensive distribution of the animal species affected, the effective surveillance, prevention and control of zoonotic diseases pose a significant challenge. The authors describe the direct and indirect implications for public health of emerging zoonoses. Direct implications are defined as the consequences for human health in terms of morbidity and mortality. Indirect implications are defined as the effect of the influence of emerging zoonotic disease on two groups of people, namely: health professionals and the general public. Professional assessment of the importance of these diseases influences public health practices and structures, the identification of themes for research and allocation of resources at both national and international levels. The perception of the general public regarding the risks involved considerably influences policy-making in the health field. Extensive outbreaks of zoonotic disease are not uncommon, especially as the disease is often not recognised as zoonotic at the outset and may spread undetected for some time. However, in many instances, the direct impact on health of these new, emerging or re-emerging zoonoses has been small compared to that of other infectious diseases affecting humans. To illustrate the tremendous indirect impact of emerging zoonotic diseases on public health policy and structures and on public perception of health risks, the authors provide a number of examples, including that of the Ebola virus, avian influenza, monkeypox and bovine spongiform encephalopathy. Recent epidemics of these diseases have served as a reminder of the existence of infectious diseases and of the capacity of these diseases to occur unexpectedly in new locations and animal species. The need for greater international co-operation, better local, regional and global networks for communicable disease surveillance and pandemic planning is also illustrated by these examples. These diseases have contributed to the definition of new paradigms, especially relating to food safety policies and more generally to the protection of public health. Finally, the examples described emphasise the importance of intersectorial collaboration for disease containment, and of independence of sectorial interests and transparency when managing certain health risks.     

The new millennium: values, perceptions of risk, and the key roles of science and technology

Radiation protection and management of radioactive waste streams and products are certain to be important areas of public policy, worker education, and technology development in the new millennium. Overriding values of freedom, sustainability, transparency, and public participation in decision making about technology's benefits and risks will shape the public policy agenda. Early engagement of stakeholders in the identification and assessment of risks and in communications about risk management will be beneficial in most cases. Putting specific environmental problems into broader public health and ecologic context will be helpful to all parties and will improve decisions about how best to utilize precious resources and enhance public confidence in the process and the outcomes.     

New partnerships between animal health services and public health agencies

As Veterinary Services and animal health organisations attempt to respond to a new era of emerging and re-emerging zoonotic diseases, their ability and skill in forming new strategic partnerships will be paramount. While these new partnerships are likely to include many relationships outside traditional Veterinary Services and animal agriculture, none will become more important than the formation of new animal health and public health partnerships. Episodes of emerging zoonoses are being increasingly recognised around the world and the confluence of people, animals and animal products today is unprecedented. Concurrently, a wide array of complex factors are also converging that will not only ensure the continuous emergence of zoonoses, but are also likely to drive the further increase and expansion of these diseases. This article discusses the need for the creation of more effective and co-operative partnerships in the face of new microbial threats, the complexity of both the formation and expansion of zoonoses, and the collective abilities of both human and animal health services to respond to them. Lessons learned from recent zoonotic epidemics supportthe need for co-ordinated research, interdisciplinary centres, integrated surveillance systems, response systems and infrastructures, and workforce development strategies. While there are some excellent examples of collaborative animal and public health relationships, there is no question that more and stronger partnerships among national and international organisations, both academic and private, will be necessary to meet the future challenges of emerging zoonoses and to manage their profound implications.     

Using economic and social data to improve veterinary vaccine development: Learning lessons from human vaccinology

The drivers of vaccine development are many and varied. They include, for example, recognition of the burden of a vaccine-targeted disease, prioritisation of the multiple problems associated with a disease, consideration of the differing socio-economic situations under which vaccines are used, the influence of advocacy groups, and assessment of the feasibility of large-scale vaccine manufacture and distribution. In the field of human health, data-driven development of vaccines is becoming increasingly common through the availability of reliable information on the Global Burden of Disease (GBD) and stringent evaluations of vaccination programmes utilising empirical data on costing and effectiveness, and standardised cost-effectiveness thresholds. The data generated from such analyses allow policymakers, implementing partners, industries and researchers to make decisions based on the best, and most contextually relevant, available evidence. In this paper, we wish to explore the current use of economic and social data for the development of veterinary vaccines. Through comparison with the development of human vaccines, we will look for opportunities in animal health sciences to better integrate socio-economic data and analyses into the process of veterinary vaccine selection, development, and field implementation. We believe that more robust animal health impact assessments could add value to veterinary vaccine development by improving resource allocation and animal disease management.