Public Health and Risk Assessment (2nd of 10 Lectures on Toxicologic Epidemiology)

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Public Healthand Risk Assessment(2nd of 10
Lectures onToxicologic Epidemiology)
? readings

• Michael H. Dong
• MPH, DrPA, PhD

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Taken in the early 90s, when desktop computers
were still a luxury.
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Learning Objectives

• Revisit the mission of public health (PH), and
  learn the impact of social choice on PH.
• Revisit the concept of health risk assessment
  (RA) and learn the various RA activities
  performed in the U.S.A. and worldwide.
• Learn that exposure monitoring and mitigating are
  bridges between PH and RA.

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Performance Objectives

• Integrate social choice with health risk
  assessment (RA) through public health (PH).
• Realize that various RA activities can be
  performed to promote PH.
• Appreciate the concept that exposure monitoring
  and exposure mitigating are guided by RA with the
  goal of promoting and improving PH.

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The mission of public health is to fulfill
societys interest in assuring conditions in
which people can be healthy.
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Social Choice on Public Health

• A process through which collective goals are
  pursued and appropriate methods resolved (by and
  large) systematically.
• Public health activities and mission are a subset
  of this process.

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Administrative Structures of Public Health

• Systems - Canada/U.S. Veterans Administration.
• Partnerships - Sweden/U. K.
• Alliances - United States.

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as a core function of public health . . . .
Assessment and monitoring of the health of
communities and populations at risk to identify
health problems and priorities.

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Health Risk Assessment The process by which the
potential adverse health effects of human
exposure to etiologic agents (usually chemicals)
are characterized.
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Health Risk Assessment Components
Hazard Identification
Risk Characterization
Dose-Response Assessment
Exposure Assessment
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Risk Assessment Activities in U.S. A. and
Worldwide

• United States DHHS EPA CPSC OSHA.
• Worldwide Development Policies and/or Projects
  (DPP).

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Risk Assessments in the U.S. DHHS (I)

• Substance Abuse and Mental Health Services
  Administration (SAMHSA)
• Predecessor agency ADAMHA.
• Substance abuse prevention addict
  treatment mental health services.

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Risk Assessments in the U.S. DHHS (II)

• Centers for Disease Control and Prevention (CDC)
• Established as Communicable Disease Center in
  1946.
• Monitoring disease trends injury control
  outbreak investigation.

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Risk Assessments in the U.S. DHHS (III)

• Agency for Toxic Substances and Disease Registry
  (ATSDR)
• Prevent exposure to hazardous substances from
  waste sites.
• Conduct health risk assessments and health
  studies per EPAs risk prioritization list.

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Risk Assessments in the U.S. DHHS (IV)

• National Institutes of Health (NIH)
• Medical research organization with 18 separate
  health institutes.
• Diseases studied including AIDS cancer
  Alzheimers diabetes eye heart lung
  arthritis blood, etc.

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Risk Assessments in the U.S. DHHS (V)

• Office of the Assistant Secretary for Health
  (OASH)
• Office of Public Health and Science.
• Public Health Service agencies and program
  offices.
• U.S. Surgeon General.

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Risk Assessments in the U.S. DHHS (VI)

• Food and Drug Administration (FDA)
• Assures safety of foods and safety of cosmetics.
• Assures safety and efficacy of drugs, biological
  products, and medical devices.

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Risk Assessments in the U.S. CPSC

• Created in 1972 by the Consumer Product Safety
  Act.
• An independent regulatory agency.
• Saving lives and keeping families safe (from
  household products).

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Risk Assessments in the U.S. EPA

• Established in 1970 active in both research and
  regulation.
• Most important U.S. federal agency for the
  regulation of toxic chemicals and pesticides.
• Important influence over the design and conduct
  of toxicity testing and toxicologic studies.

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Risk Assessments in the U.S. OSHA

• Created by the Occupational Safety and Health Act
  of 1970.
• An administration office of the U.S. Department
  of Labor.
• Mission is to save lives, to prevent injuries,
  and to protect the health of Americas 100
  million plus workers.

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DPP on Health Risk Assessment (I)

• Impact of development policies and projects
  (DPP) more subtle indirect.
• Use environmental impact assessment (EIA) to
  address public concerns about unintended effects.
• EHIA (environmental health impact assessment) is
  now a component of EIA.

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DPP on Health Risk Assessment (II)

• Six common steps for EIA one of the steps
  requires some form of health risk assessment for
  EHIA.
• Courses and study programs on EHIA and EIA
  available worldwide.
• DPP exacerbates poverty and health problems of
  industrialization.

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DPP on Health Risk Assessment (III)

• Unintended effects from DPP five (5) basic
  types.
• Housing and economic growth health utility
  services and nutrition problems.
• Agricultural growth, industrialization, and
  energy exposure to pesticides to toxic wastes
  and to radiation.

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Exposure Monitoring and Mitigation

• Used as health protection, surveillance, and
  regulation tools.
• Mitigation to lower potential or current
  exposure to an acceptable level.
• Monitoring to ensure and maintain a safe
  exposure level.

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Overview of Next Lecture
Toxicology and Risk Assessment

• Impacts of statutes and regulations.
• Toxicity testing procedures and data acquisition
  for health risk assessment.
• Effects of risk and health perception.
• Advances in assessment techniques.