The World Health Report 2002 the subject of a few international studies, for example comparing perceptions of risks to nuclear power in the USA with those in other industrialized countries (27) FRAMING THE INFORMATION ON RISKS After defining a particular risk problem, determining which people are at risk, measur- to exposure levels and selecting the risk outcomes, all this information has to be presented lecision-makers. How the information is presented usually depends on whether it is meant to influence individuals or national policy-makers. The way the information is pre- sented is often referred to as"framing"(see Box 3.3) Numerous research studies have demonstrated that different but logically equivalent ways of presenting the same risk information can lead to different evaluations and decision A famous example is the study which asked people to imagine that they had lung cancer and had to choose either surgery or radiation therapy(29). The choices were strikingly different, depending on whether the results of treatment were framed as the probability of surviving for varying lengths of time after the treatment or in terms of the probability of dying. When the same results were framed in terms of dying, the choice of radiation therapy over surgery increased from 18%to 44%. The effect was just as strong for physicians as for la All presentations of risk information use frames that can exert a strong influence on decision-makers. However, if all information is equally correct, there are really no"right"or "wrong frames-just different frames. How risk information is framed and communicated to individuals or policy-makers, scientists or the general public can be of crucial importance in achieving maximum influence over public perceptions. It can also be very important in convincing the public health community and high-level policy-makers about the impor tance of risks to health and the value of adopting different interventions SOCIAL AND CULTURAL INTERPRETATIONS OF RISK While the cognitive psychological approach has been very influential, it has also been criticized for concentrating too much on individual perceptions and interpretations of risk. Some psychologists, anthropologists and sociologists have argued that, since individuals are not free agents, risks can best be understood as a social construct within particular within groups and institutions, not only at the individual level (8).These disciplines start from the belief that risks should not be treated independently and separately from the complex social, cultural, economic and political circumstances in Box 3.3 Framing risks to health: choosing presentations Positive or negative framing? Striking changes in preference ca Whole numbers or an analogy? Whole numbers may be less well from framing the risk in either positive or negative terms, such understood than an example or analogy for the size of an adverse event. saved or lives lost, rates of survival or mortality, mproving good health or Small or large numbers? A small number of deaths is more easily ducing risks of disease. understood than a large number, which is often incomprehensible. Relative or absolute risks? Although relative risks are usually better. Short or long periods? A few deaths at one time or over a short period, as nderstood, it can be very important to present absolute changes as well. in a tragic accident, often have more impact than a larger number of Percentages or whole numbers? Probabilities are better understood as deaths occurring discretely over a longer period of time percentage changes than by comparison of whole numbers Source: (28)36 The World Health Report 2002 the subject of a few international studies, for example comparing perceptions of risks to nuclear power in the USA with those in other industrialized countries (27). FRAMING THE INFORMATION ON RISKS After defining a particular risk problem, determining which people are at risk, measur￾ing exposure levels and selecting the risk outcomes, all this information has to be presented to decision-makers. How the information is presented usually depends on whether it is meant to influence individuals or national policy-makers. The way the information is pre￾sented is often referred to as “framing”(see Box 3.3). Numerous research studies have demonstrated that different but logically equivalent ways of presenting the same risk information can lead to different evaluations and decisions. A famous example is the study which asked people to imagine that they had lung cancer and had to choose either surgery or radiation therapy (29). The choices were strikingly different, depending on whether the results of treatment were framed as the probability of surviving for varying lengths of time after the treatment or in terms of the probability of dying. When the same results were framed in terms of dying, the choice of radiation therapy over surgery increased from 18% to 44%. The effect was just as strong for physicians as for lay persons. All presentations of risk information use frames that can exert a strong influence on decision-makers. However, if all information is equally correct, there are really no “right” or “wrong”frames – just different frames. How risk information is framed and communicated to individuals or policy-makers, scientists or the general public can be of crucial importance in achieving maximum influence over public perceptions. It can also be very important in convincing the public health community and high-level policy-makers about the impor￾tance of risks to health and the value of adopting different interventions. SOCIAL AND CULTURAL INTERPRETATIONS OF RISK While the cognitive psychological approach has been very influential, it has also been criticized for concentrating too much on individual perceptions and interpretations of risk. Some psychologists, anthropologists and sociologists have argued that, since individuals are not free agents, risks can best be understood as a social construct within particular historical and cultural contexts and within groups and institutions, not only at the individual level (8). These disciplines start from the belief that risks should not be treated independently and separately from the complex social, cultural, economic and political circumstances in Box 3.3 Framing risks to health: choosing presentations • Positive or negative framing? Striking changes in preference can result from framing the risk in either positive or negative terms, such as lives saved or lives lost, rates of survival or mortality, improving good health or reducing risks of disease. • Relative or absolute risks? Although relative risks are usually better understood, it can be very important to present absolute changes as well. • Percentages or whole numbers? Probabilities are better understood as percentage changes than by comparison of whole numbers. • Whole numbers or an analogy? Whole numbers may be less well understood than an example or analogy for the size of an adverse event. • Small or large numbers? A small number of deaths is more easily understood than a large number, which is often incomprehensible. • Short or long periods? A few deaths at one time or over a short period, as in a tragic accident, often have more impact than a larger number of deaths occurring discretely over a longer period of time. Source: (28)