Strengthening Risk Prevention Policies The choices may well be different, however, for different risks, depending to a large extent on how common and how widely distributed is the risk and the availability and costs of effective interventions. Large gains in health can be achieved through inexpensive treatments when primary prevention has failed. Secondary prevention is based on screening exposed populations for the early onset of subclinical illnesses and then treating them. This approach can be very effective if the disease processes are reversible, valid screening tests exist, and effective treatments are available MANAGING THE RISK PREVENTION PROCESS As identifying and preventing risks to health is a political procedure, risk prevention requires its own decision-making processes if determined leaders from ministries of health and the public health community are to be successful (8). Other important factors which determine whether policies are adopted include public perceptions of the risks and benefits involved, perceived levels of dread and scientific uncertainty, how widely the risks are distributed and how inequitable or unfair are the health outcomes(9). Special interest groups nd the media also have major roles in influencing these issues. Finally, there are important lessons for achieving success in risk communications that should be more widely disseminated, including the implications for more transparent govemment and greater openness by the scientific community (10). Successfully tackling risks to health involves many stakeholders from different sections in society, a combination of scientific and political processes, many qualitative and quantitative judgements, a range of intersectoral actions by different agencies and opportunities for open communication and dialogue (11) Success in risk prevention will be largely determined by the strength of the politic leadership from the ministry of health Risk management is by no means a linear process and, although it typically involves an iterative decision-making process, action will be necessary in all four of the main components of assessment, management, communication and surveillance(see Figure 6.2) Figure 6.2 Implementing risk prevention Risk assessment identifying risk factors surveillance of risks and outcomes feedback to risk management probability of adverse events ntion strategy consultations with stakeholders cost-effectiveness of interventions promoting trust and debate political decision makingStrengthening Risk Prevention Policies 149 The choices may well be different, however, for different risks, depending to a large extent on how common and how widely distributed is the risk and the availability and costs of effective interventions. Large gains in health can be achieved through inexpensive treatments when primary prevention has failed. Secondary prevention is based on screening exposed populations for the early onset of subclinical illnesses and then treating them. This approach can be very effective if the disease processes are reversible, valid screening tests exist, and effective treatments are available. MANAGING THE RISK PREVENTION PROCESS As identifying and preventing risks to health is a political procedure, risk prevention requires its own decision-making processes if determined leaders from ministries of health and the public health community are to be successful (8). Other important factors which determine whether policies are adopted include public perceptions of the risks and benefits involved, perceived levels of dread and scientific uncertainty, how widely the risks are distributed and how inequitable or unfair are the health outcomes (9). Special interest groups and the media also have major roles in influencing these issues. Finally, there are important lessons for achieving success in risk communications that should be more widely disseminated, including the implications for more transparent government and greater openness by the scientific community (10). Successfully tackling risks to health involves many stakeholders from different sections in society, a combination of scientific and political processes, many qualitative and quantitative judgements, a range of intersectoral actions by different agencies and opportunities for open communication and dialogue (11). Success in risk prevention will be largely determined by the strength of the political leadership from the ministry of health. Risk management is by no means a linear process and, although it typically involves an iterative decision-making process, action will be necessary in all four of the main components of assessment, management, communication and surveillance (see Figure 6.2). Figure 6.2 Implementing risk prevention Risk surveillance - monitoring interventions - surveillance of risks and outcomes - feedback to risk management Risk communication - communicating prevention strategy - consultations with stakeholders - promoting trust and debate Risk assessment - identifying risk factors - distribution and exposure levels - probability of adverse events Risk management - understanding risk perceptions - cost-effectiveness of interventions - political decision making