Improving Health Risk Assessment as a Basis for Public Health Decisions in the 21st Century

A rapid review of best practices in the development of risk registers for public health emergency management

Introduction

Public health organizations (PHO) must prepare to respond to a range of emergencies. This represents an ongoing challenge in an increasingly connected world, where the scope, complexity, and diversity of public health threats (PHT) have expanded, as exemplified by the COVID-19 pandemic. Risk registers (RR) offer a framework for identifying and managing threats, which can be employed by PHOs to better identify and characterize health threats. The aim of this review is to establish best practices (BP) for the development of RRs within Public Health Emergency Management (PHEM).

Methods

In partnership with a librarian from Health Canada (HC), and guided by the Cochrane Rapid Review Guideline, journal articles were retrieved through MEDLINE, and a comprehensive search strategy was applied to obtain grey literature through various databases. Articles were limited to those that met the following criteria: published on or after January 1, 2010, published in the English language and published within an Organisation for Economic Co-operation and Development setting.

Results

57 articles were included for synthesis. 41 papers specifically discussed the design of RRs. The review identified several guidelines to establish RRs in PHEM, including forward-looking, multidisciplinary, transparent, fit-for-purpose, and utilizing a systems approach to analyze and prioritize threats. Expert consultations, literature reviews, and prioritization methods such as multi-criteria-decision-analysis (MCDA) are often used to support the development of RRs. A minimum five-year-outlook is applied to assess PHTs, which are revisited yearly, and iteratively revised as new knowledge arises.

Discussion

Based upon this review, RRs offer a systems approach to PHEM that can be expanded to facilitate the analysis of disparate threats. These approaches should factor in the multidimensionality of threats, need for multi-sectoral inputs, and use of vulnerability analyses that consider inherent drivers. Further research is needed to understand how drivers modify threats. The BPs and recommendations highlighted in our research can be adopted in the practice of PHEM to characterize the public health (PH) risk environment at a given point in time and support PHOs policy and decision-making.

Is Crisis and Emergency Risk Communication as Effective as Vaccination for Preventing Virus Diffusion? Measuring the Impacts of Failure in CERC with MERS-CoV Outbreak in South Korea

This study measured the impacts of failure in Crisis and Emergency Risk Communication (CERC) during the outbreak of a contagious Corona viral disease. The study measured the impacts by the number of individuals and hospitals exposed to the virus. The 2015 Middle East Respiratory Syndrome (MERS) outbreak in South Korea was used to investigate the consequences of CERC failure, where the names of hospitals exposed to MERS-CoV were withheld from the public during the early stage of virus diffusion. Empirical data analyses and simulated model tests were conducted. The findings of analyses and tests show that an early announcement of the hospital names and publicizing the necessary preventive measures could have reduced the rate of infection by approximately 85% and the number of contaminated healthcare facilities by 39% at maximum. This level of reduction is comparable to that of vaccination and of social distancing.

Getting through a COVID-19 winter: Physical coldness increases the perceived risk of coronavirus disease

What factors influence how people perceive the risk of getting COVID-19? Extending beyond features of general health conditions, media coverage, and genetic susceptibility to disease, the present research investigates whether the immediacy of experience with temperature, a subtle yet pervasive environmental factor, can affect people's estimation of contagion probability. According to the attribute substitution model, people may rely on the visceral experience of coldness, a far easier quantity to evaluate, to estimate the contagion probability of the new coronavirus disease. Study 1 found that Chinese university students who perceived the indoor temperature to be lower believed that the coronavirus was more infectious. To provide causal evidence for the effect, Study 2 randomly assigned participants to different conditions. The results showed that participants in the cold condition reported a higher likelihood of contracting the coronavirus than participants in the control condition. Overall, these findings are consistent with the attribute substitution model: people tend to recruit simpler and more accessible information (e.g., local temperature) in place of more diagnostic but less tangible information (e.g., scientific data) in assessing the risk of disease transmission. Theoretical contributions and the significance of this research for policy makers are discussed.

Practical Opportunities to Improve the Impact of Health Risk Assessment on Environmental and Public Health Decisions

Following alerts about the diminishing role of health risk assessment (HRA) in informing public health decisions, this study examines specific HRA topics with the aim of identifying possible solutions for addressing this compelling situation. The study administered a survey among different groups of stakeholders involved in HRA or decision-making, or both. The responses show various understandings of HRA in the decision-making context-including confusion with the health impact assessment (HIA)-and confirm recurring foundational issues within the risk analysis field that contribute to the growth of inconsistency in the HRA praxis. This inconsistency lowers the effectiveness of HRA to perform its primary purpose of informing public health decisions. Opportunities for improving this situation come at the beginning of the assessment process, where greater attention should be given to defining the assessment and decision-making contexts. Both must reflect the concerns and expectations of the stakeholders regarding the needs and purpose of an HRA on one side, and the methodological and procedural topics relevant for the decision case at hand on the other. The HRA process should end with a decision follow-up step with targeted auditing and the participation of stakeholders to measure its success.