Provenue Corporation Sdn. Bhd.

Principles of Health Risk

Assessment
Jamal Hisham Hashim, PhD, MCIEH
Director, Provenue Corporation Sdn. Bhd.
Visiting Professor, UN University-
International Institute for Global Health

Short Course on Health Risk and Impact Assessment in Environmental Impact

Assessment (EIA), Universiti Putra Malaysia, 26-28 September 2018
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 • Man continuously introduces new chemical
and physical hazards into his ambient and
work environments.
• 5 to 10 millions chemicals synthesized.
100,000 in common use today.
• USEPA listed more than 85,000 chemicals on its
inventory under the Toxic Substances Control Act
(TSCA)
• USEPA found 1,152 organic chemicals in drinking
water.
• ACGIH has TLVs for about 700 chemicals.

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 • Voluntary risk : e.g. smoking, alcohol-
overconsumption, occupational hazards,
diet-induced diseases.
• Involuntary risk : e.g. environmental
pollution, communicable diseases,
environmental disasters, natural
disasters, war casualty, road accidents,
industrial accidents.
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 Top 15 Major Causes of Deaths in the United States in 2014 (1)

4 Source : National Center for Health Statistics; National Safety Council

 Video : https://youtu.be/qo5P9zvM59A

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 • There is no point in getting into a panic about
the risks of life until you have compared the
risks which worry you with those that don’t,
but perhaps should (Lord Rothschild, The
Wall Street Journal, 1979).
• The 1 in a million risk level used to regulate
some chemicals and other hazards is many
times below risks which people face
everyday.

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 Source : National Safety
Council, 2017

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 Individual Risk of Mortality in Malaysia due to Various Causes in 1998.
Cause of mortality Individual risk
Cardiovascular disease 5.7 x 10-4
Cancers 2.2 x 10-4
Motor vehicle accidents 1.7 x 10-4
Pneumonia 8.7 x 10-5
Kidney disease 4.8 x 10-5
Chronic obstructive pulmonary disease 4.6 x 10-5
Liver disease 3.6 x 10-5
Drowning 2.5 x 10-5
Falls 2.0 x 10-5
Asthma 1.9 x 10-5
Suicide 1.3 x 10-5
DOE’s tolerable risk limit for fatal accident among workers 1.0 x 10-5
Homicide 9.0 x 10-6
Fires and flames 7.1 x 10-6
Accidental poisoning 4.2 x 10-6
Accidents due to firearms and explosive 4.0 x 10-6
Dengue Fever 2.1 x 10-6
Railway accidents 2.1 x 10-6
Natural disasters 1.7 x 10-6
DOE’s tolerable risk limit for fatal accident among public 1.0 x 10-6
Struck by falling objects 8.9 x 10-7
Lifetime acceptable risk level of 10-6 1.4 x 10-8

8 Source : Jamal H.H. and Zailina H. 2004. Environmental Health Focus, 2(2): 11-20. Adapted from Department of
Statistics, Malaysia. 1999. Vital Statistics Malaysia. Estimated mid-year population in 1998 was 21,466,031.
 Equivalent one in a million risk of mortality due to various causes.
Cause of mortality Quantity to reach
one in a million risk
level
Motor vehicle accident 1 2 days
Falling 1 18 days
Drowning 1 15 days
Fire 1 51 days
Electrocution 1 215 days
Air trip (cancer from cosmic radiation) 2 6000 miles by jet
Chest X-ray (cancer from ionizing radiation) 2 1 X-ray
Wine (cirrhosis of the liver) 2 0.5 Liter
Peanut butter (liver cancer from aflatoxin B1) 2 40 tablespoon
Smoking (cancer and heart disease) 2 1.4 cigarettes
Living with a cigarette smoker (cancer and heart disease) 2 2 months

Sources : 1 Jamal H.H. and Zailina H. 2004. Environmental Health Focus, 2(2): 11-20.
2 Wilson R. 1979. Technol. Rev. 81:41-46
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 The characterization of the
probability of potentially adverse
effects from human exposures to
environmental hazards.
(National Academy of Sciences)

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 Risk assessment is a methodological
approach in which the toxicities of a
chemical are identified, characterized,
analyzed for dose-response relationships,
and the data generated are applied to a
mathematical model to produce a numeric
estimate representing a guideline or
decision concerning allowable exposure.
Source : James, R.C. 1985. Risk assessment. In : Williams, P.L. and Burson,
J.L. Industrial Toxicology. New York : Van Nostrand Reinhold.
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 • To assess and characterize the potential risk
posed by an existing or new hazard to a
particular community.
• To formulate and update environmental and
occupational health standards.
• To communicate potential health hazards to
policy makers.
• To provide information for appropriate
management of hazards.
• To minimize future health risks and
costs.
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 • Scientists and researchers.
• Regulatory agencies involved in the
enforcement of standards :
- Environmental agencies (D.O.E.)
- Occupational health agencies
(D.O.S.H.)
- Health agencies (M.O.H.)
• E.I.A. consultants.
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 • When a new chemical is to be marketed for
consumers’ use (e.g. a new pesticide).
• When there is suspicion of a potentially new
health hazard (e.g. emf radiation).
• When there is an increase in the incidences of
certain disease (e.g. breast cancer).
• When an environmental disaster strikes (e.g.
S.E. Asian haze, Chernobyl, Fukushima).
• When there is a need to review existing
environmental and health standards.
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 • Qualitative environmental
health risk asessment.

• Quantitative environmental
health risk assessment.

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 It merely characterizes or compares the
hazard of a chemical relative to others, or
defines the hazard in only qualitative terms,
such as mutagen or carcinogen, which
connote certain risks or safety procedures,
and as such may not necessarily require a
numerical assessment of risk.
Source : James, R.C. 1985. Risk assessment. In : Williams, P.L. and Burson, J.L.
Industrial Toxicology. New York : Van Nostrand Reinhold.
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 It generates a numerical
measure of the risk or safety
of a chemical exposure.

Source : James, R.C. 1985. Risk assessment. In : Williams, P.L. and Burson, J.L.
Industrial Toxicology. New York : Van Nostrand Reinhold.
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 According to the National Academy of Sciences :

• Hazard identification : characterization of innate adverse

toxic effects of agents.
• Dose-response assessment : characterization of the relation
between doses and incidences of adverse effects in exposed
populations.
• Exposure assessment : measurement or estimation of the
intensity, frequency, and duration of human exposures to
agents.
• Risk characterization : estimation of the incidence of health
effects under the various conditions of exposure.

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 Risk Assessment Risk Management

Dose-response
Assessment Technical

Socioeconomic

Hazard Risk Regulatory

Identification Characterization Decision

Political
Exposure Others
Assessment

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 Science Science policy Policy
Facts Judgments Values
RESEARCH NEEDS AND PRIORITIES

Scientific Research
 Epidemiology Risk Assessment Risk Management
 Clinical Studies Dose-Response Economic No Action
Assessment Issues D
 Animal Toxicology Research E Information Programs
Needs Risk
 Cell/Tissue Experiments Hazard Charazterization C Economic Incentives
Identification Legal Issues I
 Computational Methods S Ambient Standards
Social Issues
 Monitoring/Surveillance Exposure I Control Devices
Assessment Political Issues O
Emission Limitations
Engineering Issues
N
S Ban
SCIENTIFIC INFORMATION AND
UNDERSTANDING

Research Risk assessment Risk management

 Develops factual basis  Estimates magnitude, likehood, and uncertainty  Integrates risk assessment with other issues
 Explicitly considers personal and societal uncertainty of risk  Determines acceptability of risk and appropriate
values  Requires scientific judgments and policy responses
choices  Emphasizes values in selection of policy options

Figure 3. An alternative risk assessment paradigm and its relationship to the fact-value
continuum. Adapted from Sexton et al.
Source : Sexton, K. 1995. Science and policy in regulatory decision making : getting the facts right 20
about
hazardous air pollutants. Environ. Health Perspective, 103 (Suppl. 6) : 213-221.
 • Identification of the type of hazards
(biological, chemical and physical).
• Recognition of hazard sources or
reservoirs.
• Understanding the modes of hazard
transmissions.
• Describing the toxicity characteristics of
hazards.

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 • Characterization of the relationship between
increasing dosages of a hazard and its
corresponding adverse effects.
• Dose-response data are mainly derived from
animal toxicity testings.
• Human data are available from epidemiological
data and environmental catastrophe.

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 • Exposure is the contact of a biological,
chemical or physical substance with the
outer boundary of an organism.
• Exposure assessment is the determination
or estimation of the route, magnitude,
frequency, duration of exposure, and
characteristics of the exposed population.

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 Contaminant
Source

Transport and
Transformation

Exposure
Point

Exposure
Route

Receptor

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 • To integrate and summarize the hazard
identification, dose-response assessment,
and exposure assessment procedures, in
order to:
• Develop a numerical risk estimate for the
hazard assessed.
• Present assumptions, uncertainties, and
scientific judgement pertaining to the hazard
assessed.
• Define significance of estimated risk.
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 • One CT scan of the abdomen @ 12 mSv per whole body scan =
6 mSv.
• 2 chest X-rays @ 0.1 mSv per X-ray = 0.2 mSv.
• 720 miles air travel from Kuala Lumpur to Siem Reap = @ 0.01
mSv per 1,000 miles = 0.007 mSv.
• 950 miles air travel from Kuala Lumpur to Yogyakarta = 0.01
mSv.
• 6,067 miles air travel from Kuala Lumpur to Vienna = 0.06 mSv.
• X-ray luggage inspection scanner @ 0.00002 mSv x 9 = 0.0002
mSv.
• My total dose of ionizing radiation this year = 6.28 mSv.
• According to BEIR VII Phase 2 Report (2006) an exposure to
100 mSv is associated with a risk of developing solid cancer or
leukemia of 1 out of 100 exposed individuals.
• Therefore, an exposure of 6.28 mSv is associated
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with a cancer risk of 6.3 x 10-4or 6.3 per 10,000.
 Thank you

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