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Workshop Report Workshop on Guiding Public Health Policy in Areas of Scientific Uncertainty July 11-13, 2005. McLaughlin Centre for Population Health Risk Assessment Institute of Population Health University of Ottawa In partnership with the World Health Organization WORKSHOP REPORT Prepared by Lorraine Craig, M.H.Sc. [email protected] TABLE OF CONTENTS 1.0 Workshop Overview ........................................................................................................... 1 2.0 Introduction to the Framework ........................................................................................... 3 2.1 Overview of the Framework ........................................................................................... 3 2.2 European Perspective on the Protection of Human Health............................................. 5 2.3 Discussion of Framework Elements ............................................................................... 7 2.3.1 Putting Health Issues into Context.......................................................................... 7 2.3.2 Option Generation and Assessment........................................................................ 8 2.3.3 Integrating Public Perception in the Precautionary Principle................................. 9 2.3.4 Scientific Risk Assessment and Uncertainty ........................................................ 10 2.3.5 Action Implementation and Evaluation ................................................................ 10 2.3.6 Legal Aspects of Using Precaution....................................................................... 11 2.3.7 Plenary Discussion of Framework........................................................................ 14 3.0 Case Studies to Test the Framework................................................................................. 15 4.0 Stakeholder Perspectives on Precaution ........................................................................... 23 5.0 Direction for Improvements to the Draft Framework Document ..................................... 42 Appendix A –List of Participants Appendix B –Meeting Agenda & Speaker Biographies Appendix C –June 2005 Draft WHO Document 2 Workshop on Guiding Public Health Policy in Areas of Scientific Uncertainty 1.0 Workshop Overview More than 120 scientists, academics, regulators, and representatives of industry and non-governmental organizations from 17 countries worldwide convened at the University of Ottawa on July 11-13, 2005 to participate in a Workshop on Guiding Public Health Policy in Areas of Scientific Uncertainty (see Appendix A for List of Participants). The Workshop was spearheaded by the World Health Organization (WHO) and organized in collaboration with the McLaughlin Centre for Population Health Risk Assessment to seek stakeholder feedback on a draft WHO framework designed to assist member states in managing issues where scientific evidence of the risks is uncertain. The lack of global scientific consensus on the long term health risks associated with electromagnetic radiation exposures from cellphones has resulted in inconsistent radiation exposure standards around the world. As a result, WHO initiated the development of the framework in parallel with their International EMF project to provide assistance to regulators in member states in formulating policies on the EMF issue and other emerging issues in which technological development has outpaced the scientific assessment of the risks. The objectives of the workshop were to: Discuss the use of precautionary measures in the development of public health policy Review and provide useful inputs on the draft Fretwork Discuss the implications of its implementation with stakeholders Challenge the Framework to a series of relevant case studies to ensure it is useful and practical Critique the Framework so it can withstand reasonable criticism and therefore serve as a “global” Framework To achieve the above objectives, the workshop format was structured according to four main sessions: i) presentation of the framework and discussion of the key framework elements; ii) presentation and discussion of case studies to assess the framework and identify needs for the framework based on past experiences in environmental risk management; iii) presentation of stakeholder perspectives on the framework (presentations and panel discussion); and iv) a concluding plenary discussion of strengths and weaknesses in the draft framework and opportunities to further improve the Framework. The workshop presenters included representatives from WHO, Public Health Agency of Canada, University of Ottawa, University of Toronto, University of Montreal, Pollution Probe, PAHO, National Gird Transco/UK, Decisionalysis Risk Consultants Inc., City of Ottawa Department of Public Health, American Chemistry Council, Shell Canada, Elanco/U.S. office and GSM Association/Ireland (see Appendix B for Meeting Agenda and Speaker Biographies). Jeannette Ward, Director of the Institute for Population Health, provided welcoming remarks, noting the timeliness and importance of WHO's work in developing a robust framework for health professionals and decision-makers at the global level and the McLaughlin Center’s world recognized work in health risk assessment and recent designation as a WHO Collaborating Centre. David Butler-Jones, Chief Public Health Officer of the Public Health Agency of Canada provided an opening address. He commented on the complexity of today’s public health issues and the interconnectedness between social determinants, genetic and environmental influences on population 1 health. He discussed the importance of balancing tradeoffs in decision-making and the need to intervene to accomplish the most with the fewest side effects. He noted the difficulty for the public and the media to understand the complexity of emerging public health issues. The importance of debate and the involvement of a range of disciplines and communities in discussions on questions such as what is the risk, what does it mean and what are the tradeoffs were identified as a key elements in public health decision-making process. Michael Repacholi of World Health Organization set the context for the workshop by presenting an overview of WHO’s activities on the issue of precautionary principle leading to the development of the draft WHO Framework on Guiding Public Health Policy Options in Areas of Scientific Uncertainty. These activities have included participation in various international workshops, conferences and symposia on the precautionary principle (Rome, 2001; Vancouver, 2002; Bologna, 2002) preparation of a WHO/EURO briefing paper on Children’s Environmental Health (June 2004) and activities focused on application of precaution to EMF. He described the International EMF Project, established in 1996 to assess the health and environmental effects of exposure to EMF and WHO's activities related to assessing scientific evidence, policy development and communication. WHO has traditionally provided advice to national authorities to set policy on public health issues for which the scientific knowledge is well established. The growing movement, particularly in Europe and increasingly around the world, to adopt precautionary approaches to decision-making on health risks where there is science is unclear resulted in the need for WHO to look at precaution. The draft WHO Framework was developed in response to the regulatory confusion and public concern resulting from inconsistencies in EMF standards around the world, particularly the adoption of standards considerably more stringent than international standards in some locations as a precautionary response to scientific uncertainty on the potential public health impacts. Dr. Repacholi described the framework as a bottom up approach within WHO to address precaution in EMF policy. Is it envisioned that the WHO framework will be developed first for the EMF issue and then adapted for broader application to other public health issues within WHO. This workshop summary report is one of several products of the workshop. The intent of the report is to provide a record of the workshop presentations and discussion so that the comments and suggestions can be further considered by WHO in their revisions to finalize the Framework document. A summary of the suggestions provided by delegates for improvement to the next version of the Framework is provided in Section 5.0. The June 2005 draft Framework document discussed at the workshop is provided in Appendix C. Readers may also wish to refer to the WHO Workshop website http://www.who.int/peh- emf/meetings/ottawa_june05/en/index1.html for additional information. 2 2.0 Introduction to the Framework A number of issues were raised in plenary discussion following Dr. Repacholi’s introductory presentation. One delegate pointed out the importance of clearly defining three terms: uncertainty, precaution and precautionary principle as these terms are applied differently in North America and Europe and mean different things to different people. Dr. Daniel Krewski, Professor and Director of the R. Samuel McLaughlin Centre for Population Health Risk Assessment at the University of Ottawa referred to a review of risk management frameworks for human health and environmental risks that was undertaken by the Network for Environmental Risk Assessment and Management (www.irr-neram.ca) for the Federal/Provincial/Territorial Committee on Environmental and Occupational Health1. Based on the review, ten guiding principles for risk
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