ADVANCEMENT OF THE PRACTICE
THE PRACTITIONER’S TOOL KIT
James J. Balsamo, Jr., MS, MPH, MHA, RS, CP-FS, CSP, CHMM, DEAAS Nancy Pees Coleman, MPH, PhD, RPS, RPES, DAAS Gary P. Noonan, CAPT (Retired), MPA, RS/REHS, DEAAS
Risk: We Assess It!
Robert W. Powitz, MPH, PhD, RS, CP-FS, DABFET, DLAAS Vincent J. Radke, MPH, RS, CP-FS, CPH, DLAAS Charles D. Treser, MPH, DEAAS
of the growth of Clostridium botulinum , Gerry orders the immediate safe destruction of the jar’s contents and decontamination of the jar. If the bulging lid was caused by the pro- duction of botulinum toxin, then the con- tents of the jar were extremely hazardous. As long as the corn and toxin remain safely in the sealed jar, no one would be exposed and therefore there was no risk at that time. If the jar, however, was opened and people con- sumed the corn and were then exposed to the toxin, the risk is extreme. By destroying the corn and any toxin, Gerry has removed the hazard and thus eliminated the risk. In this example, Gerry has conducted a risk assess- ment, risk communication, and risk manage- ment through the actions taken! At its simplest level, the primary task of any environmental health professional is to assess the risk to the public of being exposed to a hazard present in their work, home, recre- ational, or community environments. Increas- ingly we need to consider the vulnerability of the population potentially aected. That is, some people or populations are more or less susceptible to hazards than are others due to genetics, physiology, lifestyle, socioeconom- ics, etc. Figure 2 shows how all of these factors work together to characterize risk. Risk Assessment Risk assessment is the systematic, scientific evaluation of potential adverse health eects resulting from human exposures to hazard- ous agents or situations. Risk assessment can be qualitative or quantitative depending on the type of information used to evaluate the risk. A set of observations that includes sighting of roaches, hazardous food sitting
Editor’s Note: The National Environmental Health Association (NEHA) strives to provide relevant and useful information for environmental health practitioners. In a recent membership survey, we heard your request for information in the Journal that is more applicable to your daily work. We listened and are pleased to feature this column from a cadre of environmental health luminaries with over 300 years of combined experience in the environmental health field. This group will share their tricks of the trade to help you create a tool kit of resources for your daily work. The conclusions of this column are those of the authors and do not necessarily represent the ocial position of NEHA, nor does it imply endorsement of any products, services, or resources mentioned.
E nvironmental health professionals— including sanitarians, environmen- tal health specialists, environmental health o cers, industrial hygienists, safety professionals, environmental protection specialists, and environmental managers, to name a few—are by their very nature risk assessors and risk communicators. All the actions taken during the conduct of an in- spection or investigation develop the infor- mation used for a risk assessment whether you realize it or not. Depending on your professional position, you could also be con- sidered a risk manager. Just so we are all on the same page, we begin by defining some risk terms. • Hazard is any physical, chemical, biologi- cal, or other agent present in the human environment than could cause human injury, disease, or death. • Exposure is the pathway through which the hazard could come into contact with
the human host, typically through eating, drinking, breathing, or skin absorption. • Risk is the result of the interaction of haz- ard and exposure. If a substance or condi- tion (due to the amount or potency) does not cause injury, disease, or damage, then there is no risk. Likewise, if there is no pos- sible exposure (due to the absence, con- tainment, or treatment of the substance) there is no risk. Figure 1 shows the major factors involved in characterizing the risk or threats to the life, health, and safety of human populations. An example would be an environmen- tal health specialists, we will call them Gerry, who is conducting a routine inspection of a restaurant while working as a food service in- spector. During the inspection, Gerry finds a jar of home-canned corn in the stock room, which is a violation of the code. Gerry also notices that the lid on the jar is bulging. Sus- pecting that this bulging could be the result
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