Assessing Risks to Health: Methodologic Approaches

Risk assessment is a highly important activity of numerous governmental health and regulatory bodies. It is on the accuracy of quantitative and qualitative measurement that the decisions of government policymakers depend. Those decisions, of course, are intended to manage risks. That management frequently involves regulations over a wide range of individual and environmental exposures. Bailar and his colleagues examine the methodological challenges faced by federal agencies involved in risk assessment and the sometimes controversial implications and consequences of methodological considerations. The authors query how, given a choice of methods, one is chosen; the role that method-related issues and problems may have in the acceptance of risk assessment findings; and what impact the controversies regarding methods have on the role of risk assessment in overall risk management.

Ten hazards, as assessed by a range of federal agencies with a variety of assessment methods, give topicality and specificity to the analysis. Among the risks addressed are ethylene dibromide, formaldehyde, passive smoking, and the use of mammography for breast cancer screening. The authors conclude with a setting of priorities for risk assessment because risks to human health clearly outstrip resources available for accurate assessment.

JOHN C. BAILAR is a professor in the Department of Epidemiology and Biostatistics at McGill University. His primary professional interests focus on uncertainty in scientific inference and risk assessment. In 1990 he was awarded a MacArthur fellowship.

JACK NEEDLEMAN is currently a fellow at the Malcolm Wiener Center for Social Policy, John F. Kennedy School of Government, Harvard University, He previously was vice president and co-director of the public policy practice at Lewin and Associates, a Washington, D.C. health policy and consulting firm.

BARBARA L. BERNEY, a Pew health policy fellow, is a project director in the Department of Environmental Health, School of Public Health, Boston University. Her principal professional interests include community strategies for abating environmental health hazards and national health reform.

J. MICHAEL McGINNIS is assistant surgeon general and director of the Office of Disease Prevention and Health Promotion in the U.S. Department of Health and Human Services. He also served as chair of the Departmental Task Force on Health Risk Assessment, which produced the report Determining Risks to Health: Federal Policy and Practice (Auburn House, 1986).