The precautionary principle: protecting public health, the environment and the future of our children Edited by: Marco Martuzzi and Joel A. Tickner Keywords RISK ASSESSMENT RISK MANAGEMENT UNIVERSAL PRECAUTIONS CHILD WELFARE ENVIRONMENTAL HEALTH PUBLIC HEALTH SUSTAINABILITY ISBN 92 890 1098 3 Address requests about publications of the WHO Regional Office to: x by e-mail [email protected] (for copies of publications) [email protected] (for permission to reproduce them) [email protected] (for permission to translate them) x by post Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark © World Health Organization 2004 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization. Contents Contributors ............................................................................ i Acknowledgements................................................................. iv Foreword................................................................................. v Executive summary................................................................. 1 1. Introduction – the precautionary principle: protecting public health, the environment and the futureof our children ................................................................................... 7 Marco Martuzzi & Joel Tickner 2. Dealing with uncertainty – how can the precautionary principle help protect the future of our children?.................... 15 WHO 3. The precautionary principle: a legal and policy history...... 31 Andrew Jordan & Timothy O’Riordan 4. Public health and the precautionary principle..................... 49 Neil Pearce 5. Why is a precautionary approach needed?.......................... 63 Ted Schettler & Carolyn Raffensperger 6. The precautionary principle in decision-making: the ethical values..................................................................... 85 Pietro Comba, Marco Martuzzi & Caterina Botti 7. Late lessons from early warnings: improving science and governance under uncertainty and ignorance.......................... 93 David Gee & Andrew Stirling 8. Applying the precautionary principle in environmental risk assessment to children...................................................... 121 Philip J. Landrigan & Leonardo Trasande 9. The precautionary principle in environmental science ....... 145 David Kriebel, Joel A. Tickner, Paul Epstein, John Lemons, Richard Levins, Edward L. Loechler, Margaret Quinn, Ruthann Rudel, Ted Schettler & Michael Stoto 10. The precautionary principle: a central and eastern European perspective .............................................................. 167 Janos Zlinszky 11. Implementing precaution: assessment and application tools for health and environmental decision-making .............. 181 Andrew Stirling & Joel A. Tickner 12. A compass for health: rethinking precaution and its role in science and public health .................................................... 209 Joel A. Tickner, David Kriebel & Sara Wright Contributors Caterina Botti, Department of Philosophy and Social Sciences, University of Siena, Siena, Italy Pietro Comba, National Institute of Health, Rome, Italy Paul Epstein, Center for Health and the Global Environment, Harvard University Medical School, Boston, Massachusetts, USA David Gee, European Environment Agency, Copenhagen, Denmark Andrew Jordan, Centre for Social and Economic Research on the Global Environment (CSERGE), University of East Anglia, Norwich, England, United Kingdom David Kriebel, Lowell Center for Sustainable Production, Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA Philip J. Landrigan, Department of Community and Preventive Medicine, Department of Pediatrics, Mount Sinai School of Medicine, New York, New York, USA John Lemons, Department of Life Sciences, University of New England, Biddeford, Maine, USA Richard Levins, Department of Population and International Health, Harvard University School of Public Health, Boston, Massachusetts, USA Edward L. Loechler, Department of Biology, Boston University, Boston, Massachusetts, USA Marco Martuzzi, WHO European Centre for Environment and Health, Rome Operational Division, WHO Regional Office for Europe, Rome, Italy i Timothy O’Riordan, Centre for Social and Economic Research on the Global Environment (CSERGE), University of East Anglia, Norwich, England, United Kingdom Neil Pearce, Centre for Public Health Research, Massey University Wellington Campus, Wellington, New Zealand Margaret Quinn, Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA Carolyn Raffensperger, Science and Environmental Health Network, Ames, Iowa, USA Ruthann Rudel, Silent Spring Institute, Newton, Massachusetts, USA Ted Schettler, Science and Environmental Health Network, Newburyport, Massachusetts, USA Andrew Stirling, Science and Policy Research Unit, University of Sussex, Sussex, England, United Kingdom Michael Stoto, Department of Biostatistics, George Washington University School of Medicine, Washington, District of Columbia, USA Joel Tickner, Lowell Center for Sustainable Production, Department of Work Environment, University of Massachusetts Lowell, Lowell, USA Leonardo Trasande, Center for Children’s Health and the Environment, Department of Community and Preventive Medicine, Department of Pediatrics, Mount Sinai School of Medicine, New York, New York, USA ii Sara Wright, Lowell Center for Sustainable Production, University of Massachusetts Lowell, Lowell, Massachusetts, USA Janos Zlinsky, Regional Environmental Center for Central and Eastern Europe, Budapest, Hungary iii Acknowledgements This publication was conceived and assembled during the preparation of the Fourth Ministerial Conference on Environment and Health, Budapest, Hungary, 23–25 June 2004. Discussion and negotiation on the theme of the precautionary principle was highly stimulating and provided invaluable intellectual contribution for the development of the monograph. We thank David Breuer for editing the text, Rachel Massey for initially revising the text, Maria Teresa Marchetti for organizing the publication process and design and Francesco Mitis for typesetting. We are grateful to Island Press, the National Institute of Environmental Health Sciences and Oxford University Press for granting permission to reproduce Chapters 7, 9 and 12 respectively. iv Foreword Human society has been developing rapidly. In Europe and elsewhere, industrial, technological and economic development has created wealth and opportunity. Health has largely benefited: many people in Europe, although unfortunately not all, live longer and better than ever before. These positive trends must be sustained and extended to as many people as possible. Technological development has often outpaced scientific knowledge related to the determinants of health. Increasing complexity in societal organization multiplies the pathways by which a variety of agents can affect health, including physical risk factors such as toxic chemicals or radiation, social circumstances such as exclusion and deprivation, limited access to clean natural resources, and the endless combinations of them all. Decisions taken in domains apparently distant from health often have the potential to affect people’s health positively or negatively because of the great number of connections and exchanges in modern life. Health is a function of highly complex systems, which can be unintentionally disrupted in unpredictable ways and result in adverse health consequences that may be serious and irreversible. When solid science is available, health can be protected effectively through preventive action. However, people must humbly acknowledge that science has limitations in dealing with the complexity of the real world and do their utmost to promote the development and progress of science. While people strive for better science, how can health be protected? In particular, how can people ensure that children and future generations will have the opportunity that many people have of reaping the benefits of progress and enjoying good health? This question is difficult. Irreparable