PCRS/PHAC2024

Schedule

Sessions begin at 1400 Eastern

  • Session 1  Living with Risk 
  • Session 2  Fundamentals of Risk Science 
  • Session 3  Evidence Pipeline 
  • Session 4  Measuring Public and Population Health Risks 
  • Session 5  Evaluating Burden of Disease 
  • Session 6  Mid-term Review
  • Exam  Mid-term Exam 
  • Session 7  Risk Perception
    •  Includes Mid-term Exam debrief
  • Session 8  Risk Communication 
  • Session 9  Risk Management 
  • Session 10  Risk Economics 
  • Session 11  Final Review  
  • Exam  Final Exam  
  • Session 12  Case Studies in Risk Science 7 Jan ’25
    • Includes Final Exam Debrief
  • Exam  Case Study Exam  7 to 14 Jan ’25
  • Session 13: Case Study Exam Debrief 14 Jan ’25

Presentation Slides

PCRS Session 01 – Living with Risk v2.0Download
PCRS Session 02 – Fundamentals of Risk Science v2.0Download
PCRS Session 03 – Sources of Evidence v2.0Download
PCRS Session 04 – Measuring Public and Population Health Risks v2.0Download
PCRS Session 05 – Evaluating Burden of Disease v2.0Download
PCRS Session 06 – Midterm Review v2.0Download
PCRS Session 07 – Risk Perception v2.0Download
PCRS Session 08 – Risk Communication v2.0Download
PCRS Session 09 – Risk Management v2.0Download
PCRS Session 10 – Risk Economics v2.0Download
PCRS Session 11 – Final Review v2.0Download

Video Recordings

The following links will immediately begin the download of the recorded session.

Background Materials

Session 1

An Integrated Framework for Risk Management and Population Health

Krewski et al 2007 HERA Integrated frameworkDownload

The document “An Integrated Framework for Risk Management and Population Health” by Krewski et al. (2007) discusses combining risk management with population health to enhance health policy. It emphasizes how population health identifies determinants like lifestyle, social conditions, and environmental factors, while risk management focuses on minimizing exposures to harmful risks. The framework promotes a holistic approach, integrating interventions from both fields for better decision-making. The authors highlight challenges such as balancing regulatory and non-regulatory actions and stress the need for collaborative efforts among stakeholders. It encourages evidence-based health policies by evaluating risks in a broader context, utilizing diverse interventions, and adopting iterative processes. The integrated model aims to address health inequalities, optimize resource allocation, and enhance population well-being. This approach fosters adaptive strategies that engage communities and consider economic, social, and cultural impacts to improve health outcomes sustainably.

Who and what is population?

KriegerN_Definition of Population_2012Download

The document “Who and What Is a ‘Population’?” by Nancy Krieger examines the concept of “population” in population health sciences, challenging conventional statistical definitions. Krieger traces historical perspectives, highlighting Adolphe Quetelet’s 19th-century idea of the “average man,” which emphasized populations as statistical constructs. She argues for an alternative view, seeing populations as relational beings shaped by intrinsic and extrinsic relationships across social, biological, and ecological contexts. The ecosocial theory, which underpins her argument, emphasizes that individuals embody societal and environmental conditions. Krieger critiques the simplistic division between internal validity and generalizability in research and urges deeper theorizing on population definitions. She presents four key propositions: meaningfulness depends on population definition, structured chance influences health distributions, research participants should not be equated with study populations, and study validity requires context-aware participant selection. This expanded view aims to promote better causal analysis and actions toward health equity.

Science and Decisions: Advancing Risk Assessment

Science and DecisionsDownload

The document Science and Decisions: Advancing Risk Assessment outlines challenges in current risk assessment practices and proposes improvements for the U.S. Environmental Protection Agency (EPA). It highlights inefficiencies in addressing complex risks, such as chemical exposures and environmental hazards, which lead to prolonged decision-making processes. The report emphasizes the need for better technical tools to handle uncertainty and variability in data. It recommends a unified framework for assessing both cancer and non-cancer risks and integrating cumulative risk assessment, including non-chemical stressors. The document calls for engaging stakeholders in all phases of risk assessment to enhance relevance and credibility. Furthermore, it suggests shifting from default assumptions to science-based approaches wherever possible. The proposed improvements aim to align risk assessments with practical decision-making needs, ensuring timeliness, transparency, and accuracy to protect public and environmental health effectively.

Session 2

Development of an Evidence-Based Risk Assessment Framework

2022 Krewski ALTEX Evidence-based RADownload

The document “Development of an Evidence-Based Risk Assessment Framework” outlines advancements in risk science, emphasizing interdisciplinary collaboration and new methodologies like high-throughput screening and computational toxicology. It focuses on building a framework to integrate diverse evidence streams for comprehensive risk evaluation, applicable to both data-rich and data-poor scenarios. The paper highlights the adoption of systematic review methods by institutions like EFSA, U.S. EPA, and Health Canada, promoting transparency and rigor. It discusses challenges in incorporating new approaches such as alternative testing methods and stresses the importance of public engagement. Case studies and prototypes are explored to validate the framework’s practical utility. Key objectives include setting minimum data requirements, supporting evidence-based decisions, and aligning risk assessments with global best practices through modern scientific tools and methodologies.

Thiazolidinedione Drugs in the Treatment of Type 2 Diabetes Mellitus: Past, Present, and Future

Davidson-2018-Thiazolidinedione drugs in the tDownload

The review article “Thiazolidinedione Drugs in the Treatment of Type 2 Diabetes Mellitus: Past, Present, and Future” explores the benefits and risks of TZD drugs like pioglitazone and rosiglitazone. These drugs improve insulin sensitivity, glycemic control, and lipid metabolism but have also raised concerns over adverse effects. Their mechanism involves activating PPAR receptors, influencing various metabolic and inflammatory pathways. While initially praised, troglitazone was withdrawn due to hepatotoxicity, and further studies linked TZDs to cardiovascular issues, bone fractures, and bladder cancer. Despite these risks, newer TZD-related therapies are being explored for anti-inflammatory effects, cancer treatment, and neurodegenerative disorders. The article suggests that advancements in TZD formulations could offer safer options, balancing therapeutic benefits with minimized side effects. Research into the long-term safety and novel therapeutic applications continues to evolve, reflecting the complex legacy of TZDs in diabetes care and beyond.

Estimates of Global Mortality Attributable to Particulate Air Pollution Using Satellite Imagery

Evans-2013-Estimates of global mortality due tDownload

The study “Estimates of Global Mortality Attributable to Particulate Air Pollution Using Satellite Imagery” assesses mortality linked to chronic exposure to fine particulate matter (PM2.5) using satellite data. The research leverages MODIS and MISR satellite instruments to provide global coverage, overcoming the limitations of ground-based air quality monitors. Results indicate that long-term PM2.5 exposure contributes to 8% of global cardiopulmonary deaths, 12.8% of lung cancer deaths, and 9.4% of ischemic heart disease deaths. The study highlights the higher mortality rates in regions with severe air pollution, such as parts of the Western Pacific. The findings show that satellite-derived estimates tend to be higher than those from ground monitors but align more closely with chemical transport models. The study underscores the health risks from anthropogenic pollution, emphasizing the need for better global air quality management to mitigate these impacts.

Decision-Making Framework for Identifying, Assessing, and Managing Health Risks

Health-2000-Health Canada Decision-Making FramDownload

The document “Decision-Making Framework for Identifying, Assessing, and Managing Health Risks” by Health Canada outlines a structured approach for addressing health risks. It emphasizes a systematic process for identifying, assessing, and managing risks while ensuring stakeholder engagement and transparency. The framework integrates scientific evidence with social, economic, and ethical considerations to guide health-related decisions. It involves key steps such as problem formulation, risk assessment, evaluation of management options, and monitoring outcomes. The process also encourages iterative feedback to refine actions over time. The framework supports informed decision-making by balancing risks and benefits while accounting for public values and uncertainty. It promotes accountability and consistency in handling diverse health risks across sectors, ensuring that decisions are evidence-based, transparent, and inclusive of public input.

Risk Factors Associated with the Onset and Progression of Alzheimer’s Disease: A Systematic Review

Hersi-2017-Risk factors associated with the o1Download

The document “Risk Factors Associated with the Onset and Progression of Alzheimer’s Disease: A Systematic Review” by Hersi et al. (2017) presents a comprehensive analysis of risk factors linked to Alzheimer’s disease (AD). It highlights factors increasing AD risk, such as head injuries in males, diabetes, smoking, depression, estrogen use, and lower social engagement. Protective factors identified include statin use, moderate alcohol consumption, adherence to the Mediterranean diet, cognitive and physical activities, higher education levels, and the APOE ε2 gene. Conversely, APOE ε4 remains the strongest genetic predictor of AD. The review notes that AD risk increases with age but remains poorly understood due to conflicting evidence and methodological differences in studies. It emphasizes that while many factors are potentially modifiable, additional research is necessary to confirm causal relationships. The study integrates findings from 81 systematic reviews and calls for further exploration to enhance prevention strategies targeting modifiable risks.

Risk Management Frameworks for Human Health and Environmental Risks

Jardine et al 2003 Risk management frameworksDownload

The document “Risk Management Frameworks for Human Health and Environmental Risks” by Jardine et al. (2003) provides an analytical review of various risk assessment, management, and communication frameworks employed by key agencies in Canada and internationally. It highlights differences, commonalities, strengths, and weaknesses among frameworks, covering applications in health, ecological, and occupational risks. Twelve major frameworks are extensively compared to identify elements essential for a comprehensive risk management approach. Key elements include stakeholder involvement, communication, quantitative assessments, and iterative processes for informed and flexible decision-making. The document emphasizes balancing scientific and social considerations and provides guiding ethical principles for risk decisions, such as fairness, transparency, and precaution. The study aims to enhance consistency and effectiveness across frameworks by recommending common principles for risk communication and management practices.

Reanalysis of the Harvard Six Cities Study and the American Cancer Society Study of Particulate Air Pollution and Mortality

Krewski-2000-Reanalysis of the Harvard Six CitDownload

The document “Reanalysis of the Harvard Six Cities Study and the American Cancer Society Study of Particulate Air Pollution and Mortality” (Krewski et al., 2000) assesses the original findings that linked long-term exposure to air pollution, specifically PM2.5, with increased mortality. The reanalysis aims to validate the original results by auditing study population data, air quality datasets, and statistical methods. Key findings confirm the association between air pollution and elevated risks of cardiopulmonary and lung cancer mortality. The study highlights meticulous efforts to address errors in data recording and handling, ensuring transparency and accuracy. It evaluates mortality data over 14-16 years for 8,111 subjects across six cities. The audit also examines the performance of data collection methods, including issues related to the dichotomous particle samplers. Despite some discrepancies, the reanalysis supports the conclusions of the original studies, emphasizing the adverse health effects of air pollution and the need for robust air quality management.

A Framework for the Next Generation of Risk Science

Krewski-2014-A framework for the next generatiDownload

The document “A Framework for the Next Generation of Risk Science” by Krewski et al. (2014) introduces the NexGen framework, aimed at advancing risk assessment methodologies to make them faster, more cost-effective, and scientifically robust. It emphasizes three core pillars: toxicity pathway-based approaches, population health perspectives, and the integration of new methodologies such as in vitro and computational tools. The framework is structured into three phases: problem formulation, risk assessment, and risk management, ensuring that risk decisions are informed by scientific evidence and practical considerations. It advocates for cumulative risk assessment, incorporating both chemical and non-chemical stressors, and encourages stakeholder engagement throughout the process. NexGen’s tools and techniques are validated through case studies and emphasize moving from animal-based testing to molecular and cellular data. The framework also aims to enhance transparency, improve resource allocation, and adapt to emerging scientific developments, aligning risk management strategies with population health goals.

Strategies for Population Health

Strategies for Population Health 1994Download

This document from Health Canada outlines a population health approach, emphasizing that health extends beyond medical care. It highlights key health determinants, such as income, education, employment, social support, and environmental factors, advocating for collaborative strategies across government sectors to improve population health. The framework recommends focusing on actions that enhance well-being, prevent diseases, and reduce disparities. It stresses intersectoral cooperation, long-term investment, and public involvement to effectively implement health strategies. The ultimate goal is to create a healthier society through targeted interventions addressing broad social, economic, and environmental determinants of health.

U.S. Presidential/Congressional Commission: Framework for Environmental Health Risk Management (1997)

U.S. Presidential Congressional Commission. Risk Assessment and Risk Management 1997Download

This report presents a six-stage framework for risk management to address environmental and health risks comprehensively. The stages include defining the problem, analyzing risks, exploring options, making decisions, implementing actions, and evaluating outcomes. The framework emphasizes stakeholder engagement, iterative processes, and considering multiple sources of risk to improve public health outcomes. The report encourages the integration of scientific, social, economic, and cultural factors into decision-making. It aims to foster collaboration across sectors, moving beyond traditional regulatory approaches towards more flexible, effective, and inclusive risk management practices.

US NRC Red Book: Risk Assessment in the Federal Government (1984)

US NRC Red Book 1984Download

The Red Book provides guidelines for conducting risk assessments within U.S. federal agencies. It emphasizes the importance of separating risk assessment from risk management to ensure unbiased evaluation. The document outlines four key stages: hazard identification, dose-response assessment, exposure assessment, and risk characterization. It advocates for improving data completeness, transparency, and consistency in regulatory processes. The Red Book also highlights the need for interdisciplinary approaches, stakeholder engagement, and iterative refinement in risk assessments to enhance decision-making processes across various federal agencies.

Association between Aluminum in Drinking Water and Incident Alzheimer’s Disease

Van Dyke-2020-Association between aluminum inDownload

This study examines the relationship between aluminum exposure through drinking water and Alzheimer’s disease (AD) using data from the Canadian Study of Health and Aging. The cohort included 10,263 individuals aged 65 and above, with detailed water quality data linked to their residential histories. Although no statistically significant association was found between aluminum levels and AD, a trend was observed in participants with the APOE ε4 gene variant, suggesting potential sensitivity to aluminum. The study emphasizes the need for further research, particularly in understanding genetic and environmental interactions related to AD risk.