Thursday, September 28, 2006

Responsible Risk Management

Originally posted 20 Apr 2006.

Risk of harm is omnipresent. One could address the issue of risk by focusing on obvious issues like the threat of terrorism, crime, global warming, hurricanes, etc. but let me approach the topic from a different angle. I wish to recount two separate stories that were reported in the media awhile back but have remained vivid in my mind whenever I think about the issue of risk management and responsible governance.

The first story is the sad story of a man who was decapitated by a malfunctioning elevator. CNN reported this story a few years back and I kept it on file because I found it interesting. The story is here

The story notes that elevators and escalators kill about 30 and injure about 17,100 people each year in the United States. I'd like to think my interest in such stories is not based on some subconscious morbid interest in human suffering but rather an interest in how pervasive (and sometimes unimaginable) risk of harm is and how complex the challenges of mitigating such risks can be. When one hears a story like the elevator tragedy (or a story about a child abduction, threat of terrorism, etc.) one can't help but feel that more should be done to mitigate the particular risk in question. But the reality is that there are an infinite number of risks that we are susceptible to, and thus we face tough and complex decisions when the reality is we can't eliminate *all* risk of harm. How do we prioritise the efforts to mitigate different kinds of risk? And whose responsibility is it to protect us from different types of risk?

The second story I would like to recount is from 2 years ago. It was a nice summer evening and I was watching the Canadian national news when two stories were reported (independently) one after the other. The first story was about a woman from Ontario who was paralyzed by West Nile virus and was suing the Ontario government for not doing enough to protect citizens. The second story was about protestors in a Western province who were protesting the government's decision to spray fields in an attempt to guard against the dangers of West Nile virus. The irony! The government can't seem to win- your damned if you do and damned if you don't.

These kinds of concerns (and the ones brought more vividly to the fore by 9/11 and hurricane Katrina) show that any humane society must take a responsible approach to the prevention of harm (and risk of harm). I have been led to these concerns by my work on genetics where genetic diseases can vary widely in terms of their risk of harm, prevalence and severity of disadvantage. These considerations ought to impact how stringent we believe the duty to mitigate genetic disadvantage is. But keeping the discussion more general for now, I think the following four considerations are central questions that any responsible approach to risk management must address and consider:

1. How probable is the risk of harm? The greater the probability of harm (all else being equal) the greater the case for intervention.

2. How severe and pervasive is the disadvantage in question? The greater the harm (all else being equal) the greater the case for intervention.

3. What is the likelihood that intervention will have the desirable effect (i.e. prevent or reduce the risk of harm)? The greater the likelihood that intervention will make a difference (all else being equal) the greater the case for intervention.

4. What is the cost of intervention? The cheaper the cost of intervention (all else being equal) the greater the case for intervention.

Thinking about these considerations in the context of environmental policy, the war on terror, healthcare, crime prevention, etc. will help ensure that we take a responsible approach to risk management. These considerations highlight the importance of getting the input of experts with specialised knowledge. But responsible risk management does not prescribe autocratic rule by knowledge elites. Nor does it lead us to embrace a crude or simplistic cost-benefit analysis (CBA). I like the purposeful approach taken by CBA but I think we need to embrace a more nuanced version of it if we are to make it a component of an attractive normative theory. How do we do this? One way would be to incorporate a democratic mechanism in the cost/benefit metric. Rather than simply positing a monetary value to everything we could permit informed citizens to play a role in terms of ranking the importance of various goods (e.g. better education vs. better healthcare vs. greater economic stability vs. safer streets, etc.). So one way of fostering a responsible approach to risk management is to foster democratic accountability and reflective deliberation (in addition to accumulating reliable facts).

At a minimum an informed and reflective citizenry must appreciate how enormous the task of minimizing risk is. Such a citizenry will not demand the government make protection from risk X or Y a top priority simply because they read a story about someone suffering from X, or witness a gripping amateur video showing someone being harmed by Y. An informed and reflective citizenry (and government) should ensure that other considerations (like the 4 points highlighted above) are part of the public debate.

And responsible journalists should ensure that the stories they report to the public are balanced and placed in an appropriate context. So the quality of the media is *vital* to ensuring responsible risk management. The sad reality is that many citizens are more afraid of being harmed by terrorists when the reality is that the greatest threat to their health is often themselves (e.g. their diet, lack of exercise, etc.). Reporting on how we are losing the war against obesity [update: kudos to the Guardian for reporting this] might not make for exciting news reports but it would serve a very useful societal function.

Finally, responsible risk management must also recognise that a division of labour is required. Certain responsibilities fall to the government in terms of enforcing formal regulations (e.g. covering food preparation) and policies/law (e.g. criminal law, etc.), but some responsibility should (and must) fall to us as individuals. As individuals we can do many things to reduce our own health risks- wear seatbelts, quit smoking, limit the intake of alcohol, exercise, eat well, etc. So the next time you feel inclined to slam the government for not doing enough to protect your safety ask yourself if you yourself are doing enough to protect yourself. Would you "re-elect" yourself as your own personal "Health Minister"? If not, put pressure on yourself to be more proactive about promoting your health!