Strengthening Risk Prevention Policies tor the development of surprises and controversies and assess the effects of interventions, manage the development of new knowledge and access to it, and evaluate human behav- lour as a con ributor to hazards. Agencies that monitor and manage food safety or disposa of toxic waste are examples It is not necessarily the case that prioritization requires making the choice between managing known risks and focusing on uncertain risks. The two activities are complemen tary to a considerable extent. Improved capabilities in managing known risks will be resource to draw upon when dealing with new risks, and capabilities at detecting risk pos sibilities, assessing uncertainty, and learning from experience will inform and improve the management of familiar risks. Furthermore, avoiding or reducing some uncertain risks, such as global climate change or toxic chemicals, can be achieved erventions such as energy efficiency or use of alternative chemicals which may provide other economic benefits Risk management is by now an international task. Many risks cross boundaries, so that tions in one country or region have an impact in another. In the case of management of uncertain risks, an important aspect of strengthening capabilities will be partnerships between specialists-experts in dealing with particular hazards- from different countries ut the overall build-up of risk management capability will be fragmented unless there is active coordination involving generalists in the country and associated with intemational agence ETHICAL CONSIDERATIONS IN RISK PREVENTION Medical ethics is a well-developed subject but it is mainly concerned with individual atient-doctor relationships and there has been little application of its principles to public health and even less to risks to health(15, 16). However, there is a wide range of ethical issues concerning risk exposures and risk outcomes, mainly to do, firstly, with balancing the rights, freedoms and responsibilities of individuals against achieving greater risk prevention using population-wide approaches and, secondly, protecting those individuals at high-risk exposures. In addition, strong regulatory and legal mechanisms may be required, which can affect both individuals as consumers as well as those in high-risk groups. There are four fundamental ethical principles that are widely used throughout the worl nedical practice, commonly called autonomy, non-maleficence, (17). Each is a complex ethical principle, but when applied to public health and risk factors they might each be paraphrased respectively as protecting the rights of the individual and informed choice, do no harm orinjury, produce benefits that far outweigh risks, and achieve a more equitable and fair distribution of risks and benefits. The application of these principles requires that whole populations and exposed or affected individuals, together with a wide range of other concerned stakeholders, have free and open access to all the information. Freedom should exist for full representation and transparent decision-making. These are all frequently problematic issues in risk management When conflict exists between these principles in particular risk situations, one principle or example distributive justice-may have to override another one. When this is necessary, which one is given priority should be declared and made explicit. If this is not done, the result can be even greater public and professional controversy and a loss of trust in political decision-makers. These principles are ethical guidelines and considerable judgement and negotiation is required for their use in many risk prevention situations. As there is little previous experience of applying these principles to risks to health, especially in developingStrengthening Risk Prevention Policies 153 tor the development of surprises and controversies and assess the effects of interventions, manage the development of new knowledge and access to it, and evaluate human behav￾iour as a contributor to hazards. Agencies that monitor and manage food safety or disposal of toxic waste are examples. It is not necessarily the case that prioritization requires making the choice between managing known risks and focusing on uncertain risks. The two activities are complemen￾tary to a considerable extent. Improved capabilities in managing known risks will be a resource to draw upon when dealing with new risks, and capabilities at detecting risk pos￾sibilities, assessing uncertainty, and learning from experience will inform and improve the management of familiar risks. Furthermore, avoiding or reducing some uncertain risks, such as global climate change or toxic chemicals, can be achieved with interventions such as energy efficiency or use of alternative chemicals which may provide other economic benefits. Risk management is by now an international task. Many risks cross boundaries, so that actions in one country or region have an impact in another. In the case of management of uncertain risks, an important aspect of strengthening capabilities will be partnerships between specialists – experts in dealing with particular hazards – from different countries. But the overall build-up of risk management capability will be fragmented unless there is active coordination involving generalists in the country and associated with international agencies. ETHICAL CONSIDERATIONS IN RISK PREVENTION Medical ethics is a well-developed subject but it is mainly concerned with individual patient–doctor relationships and there has been little application of its principles to public health and even less to risks to health (15, 16). However, there is a wide range of ethical issues concerning risk exposures and risk outcomes, mainly to do, firstly, with balancing the rights, freedoms and responsibilities of individuals against achieving greater risk prevention using population-wide approaches and, secondly, protecting those individuals at high-risk exposures. In addition, strong regulatory and legal mechanisms may be required, which can affect both individuals as consumers as well as those in high-risk groups. There are four fundamental ethical principles that are widely used throughout the world in medical practice, commonly called autonomy, non-maleficence, beneficence and justice (17). Each is a complex ethical principle, but when applied to public health and risk factors they might each be paraphrased respectively as protecting the rights of the individual and informed choice, do no harm or injury, produce benefits that far outweigh risks, and achieve a more equitable and fair distribution of risks and benefits. The application of these principles requires that whole populations and exposed or affected individuals, together with a wide range of other concerned stakeholders, have free and open access to all the information. Freedom should exist for full representation and transparent decision-making. These are all frequently problematic issues in risk management. When conflict exists between these principles in particular risk situations, one principle – for example distributive justice – may have to override another one. When this is necessary, which one is given priority should be declared and made explicit. If this is not done, the result can be even greater public and professional controversy and a loss of trust in political decision-makers. These principles are ethical guidelines and considerable judgement and negotiation is required for their use in many risk prevention situations. As there is little previous experience of applying these principles to risks to health, especially in developing