Strengthening Risk Prevention Policies ASSESSMENT AND MANAGEMENT OF HIGHLY UNCERTAIN RISKS People who work in the public health arena regularly face surprises and controversies While these are at times caused by special interest groups, they often reflect unmet challenges to health management capabilities and a lack of preparedness. In these situations preventie becomes a particularly politicized process, which leads to a need for better communications, trust, dialogue, information sharing and planning to contain panic (11, 12). Planning for high uncertain risks should be an important component of the activities of the major organizations entrusted with public health management. In recent years the public has requested much greater caution in the management of highly uncertain risks, leading to use of the term "precautionary principle". Considerable debate exists on what the precautionary principle actually means and there is no generally accepted definition. The most basic definition of the precautionary principle is that adopted at the United Nations Conference on the Environment and Development in 1992: "Where there are threats of serious or irreversible environmental damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to preven environmental degradation"(13) Although the principle is widely seen as a part of regulatory action, it is not actually embodied in any international legal agreement. If it has to be used to resolve difficult risks, how will it be interpreted by different group interests? A summary of the features of the weak","moderate"and"strong" positions for and against the possible use of the precautionary principle within regulatory frameworks are summarized in Box 6.1 It is important to recognize that, because of a lack of scientific knowledge and scarce esources no public agency can prepare for the infinitely large number of eventualities. The risk assessment, risk management and risk communication tools that have been discussed for dealing with many health hazards that are now familiar can nonetheless be helpful, if appropriately employed, in tackling highly uncertain risks Box 6.1 Contrasting views of the role of the precautionary principle within different world views of regulation No presumption of either market-led or velopment and technological innovation, technologically driven development. but recognition that this can sometimes be erthrown by high levels of societal concern. Regulators intervene only on positive scientific Presumption about interventions as under weak Risk creator has to demonstrate safety of evidence of risk and only use interventions that precaution, but with case by case flexibility to activity. Little acceptance of cost-effectiveness are demonstrably cost-effective shift the need for proof towards the risk creator. arguments Presumption of risk management Underlying presumption of risk management. Presumption of risk avoidance. Banning very rare Banning possible, but only as last resort. Banning very likely resumption of free trade based on objective Underlying presumption of free trade on the No automatic presumption of free trade. scientific criteria basis of scientific criteria Individual preferences and societal concerns Individual preferences and societal concerns Recognition that individual preferences and given no weight. societal concerns do matterStrengthening Risk Prevention Policies 151 ASSESSMENT AND MANAGEMENT OF HIGHLY UNCERTAIN RISKS People who work in the public health arena regularly face surprises and controversies. While these are at times caused by special interest groups, they often reflect unmet challenges to health management capabilities and a lack of preparedness. In these situations prevention becomes a particularly politicized process, which leads to a need for better communications, trust, dialogue, information sharing and planning to contain panic (11, 12). Planning for high uncertain risks should be an important component of the activities of the major organizations entrusted with public health management. In recent years the public has requested much greater caution in the management of highly uncertain risks, leading to use of the term “precautionary principle”. Considerable debate exists on what the precautionary principle actually means and there is no generally accepted definition. The most basic definition of the precautionary principle is that adopted at the United Nations Conference on the Environment and Development in 1992: “Where there are threats of serious or irreversible environmental damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation”(13). Although the principle is widely seen as a part of regulatory action, it is not actually embodied in any international legal agreement. If it has to be used to resolve difficult risks, how will it be interpreted by different group interests? A summary of the features of the “weak”, “moderate” and “strong” positions for and against the possible use of the precautionary principle within regulatory frameworks are summarized in Box 6.1. It is important to recognize that, because of a lack of scientific knowledge and scarce resources no public agency can prepare for the infinitely large number of eventualities. The risk assessment, risk management and risk communication tools that have been discussed for dealing with many health hazards that are now familiar can nonetheless be helpful, if appropriately employed, in tackling highly uncertain risks. Box 6.1 Contrasting views of the role of the precautionary principle within different world views of regulation Weak precaution Presumption of unfettered market-led development and technological innovation. Regulators intervene only on positive scientific evidence of risk and only use interventions that are demonstrably cost-effective. Presumption of risk management. Banning very rare. Presumption of free trade based on objective scientific criteria. Individual preferences and societal concerns given no weight. Strong precaution No presumption of either market-led or technologically driven development. Risk creator has to demonstrate safety of activity. Little acceptance of cost-effectiveness arguments. Presumption of risk avoidance. Banning very likely. No automatic presumption of free trade. Individual preferences and societal concerns are dominant. Moderate precaution Underlying presumption of unfettered market￾led development and technological innovation, but recognition that this can sometimes be overthrown by high levels of societal concern. Presumption about interventions as under ‘weak precaution’, but with case by case flexibility to shift the need for proof towards the risk creator. Underlying presumption of risk management. Banning possible, but only as last resort. Underlying presumption of free trade on the basis of scientific criteria. Recognition that individual preferences and societal concerns do matter. Adapted from: (14)