An Integrated Framework for Risk Management and Population Health

ABSTRACT The traditional medical model of health and health policy development has focused on individuals and the role of medical care in preventing and treating disease and injury. Recent attention to health inequities and social determinants of health has raised the profile of population heath and evidence-based strategies for improving the health of whole populations. At the same time, risk science has emerged as an important new discipline for the assessment and management of risks to health. This article reviews historical developments in the fields of risk management and population health and proposes a joint population health risk management framework that integrates the key elements of both fields. Applying this integrated approach to managing population health risks will facilitate the development of evidence-based health policy. It will encourage a more systematic and comprehensive evaluation of population health issues and promote the use of a broader suite of interventions to reduce health risks and enhance population health status.

[1]  Division on Earth.  Acute Exposure Guideline Levels for Selected Airborne Chemicals: Volume 15 , 2009 .

[2]  Derek Jorgenson,et al.  Determinants of Health , 2009 .

[3]  J. Samet,et al.  Colloquium Statement: Strategic Policy Directions for Air Quality Management , 2008, Journal of toxicology and environmental health. Part A.

[4]  Daniel Krewski,et al.  A risk management framework for the regulation of nanomaterials , 2008 .

[5]  J. Adamson.  Social injustice and public health , 2007 .

[6]  C. Portier,et al.  The Forest for the Trees: A Systems Approach to Human Health Research , 2007, Environmental health perspectives.

[7]  Daniel Krewski,et al.  Recent Advances in Research on Radiofrequency Fields and Health: 2001–2003 , 2007, Journal of toxicology and environmental health. Part B, Critical reviews.

[8]  M. Saier,et al.  Climate Change, 2007 , 2007 .

[9]  D. Krewski,et al.  Regulatory and Nonregulatory Strategies for Improving Children's Environmental Health in Canada , 2007, Journal of toxicology and environmental health. Part B, Critical reviews.

[10]  J. Samet,et al.  Strategies for Clean Air and Health , 2007, Journal of toxicology and environmental health. Part A.

[11]  Daniel Krewski,et al.  Health Effects Associated With Exposure to Ambient Air Pollution , 2007, Journal of toxicology and environmental health. Part A.

[12]  D. Kindig,et al.  Understanding Population Health Terminology , 2007, The Milbank quarterly.

[13]  D. Dockery,et al.  Health Effects of Fine Particulate Air Pollution: Lines that Connect , 2006, Journal of the Air & Waste Management Association.

[14]  D. Krewski,et al.  Public Perception of Population Health Risks in Canada: Health Hazards and Sources of Information , 2006 .

[15]  R. Burnett,et al.  Spatial Analysis of Air Pollution and Mortality in Los Angeles , 2005, Epidemiology.

[16]  Francesca Dominici,et al.  Revised Analyses of the National Morbidity, Mortality, and Air Pollution Study: Mortality Among Residents Of 90 Cities , 2005, Journal of toxicology and environmental health. Part A.

[17]  L. Curry.  The Future of the Public's Health in the 21st Century , 2005 .

[18]  N. Skovgaard.  Safety of Genetically Engineered Foods. Approaches to Assessing Unintended Health Effects , 2005 .

[19]  A. Nelson,et al.  Technology to promote safe mobility in the elderly. , 2004, The Nursing clinics of North America.

[20]  M Cameron,et al.  World Report on Road Traffic Injury Prevention. , 2004 .

[21]  T. Eng,et al.  Population health technologies☆ , 2004, American Journal of Preventive Medicine.

[22]  John Lynch,et al.  Is income inequality a determinant of population health? Part 1. A systematic review. , 2004, The Milbank quarterly.

[23]  A. Kothari,et al.  Multiple intervention research programs in community health. , 2004, The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres.

[24]  E. van Doorslaer,et al.  Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations. , 2004, Health economics.

[25]  Margaret M. Peden,et al.  World Report on Road Traffic Injury Prevention , 2004 .

[26]  R. Burnett,et al.  Gaseous air pollutants and asthma hospitalization of children with low household income in Vancouver, British Columbia, Canada. , 2004, American journal of epidemiology.

[27]  J. Stephenson.  World health report. , 2004, Lancet.

[28]  R. Burnett,et al.  Cardiovascular Mortality and Long-Term Exposure to Particulate Air Pollution: Epidemiological Evidence of General Pathophysiological Pathways of Disease , 2003, Circulation.

[29]  Bruce Tonn,et al.  An equity first, risk-based framework for managing global climate change , 2003 .

[30]  Diana B Petitti,et al.  Measuring quality of care and performance from a population health care perspective. , 2003, Annual review of public health.

[31]  D. Stokols,et al.  An Integrative Framework for Community Partnering to Translate Theory into Effective Health Promotion Strategy , 2003, American journal of health promotion : AJHP.

[32]  R. Burnett,et al.  A time-series study of air pollution, socioeconomic status, and mortality in Vancouver, Canada , 2003, Journal of Exposure Analysis and Environmental Epidemiology.

[33]  Daniel Krewski,et al.  Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada. , 2003, Environmental health perspectives.

[34]  B. Sonawane,et al.  Workshop to develop a framework for assessing risks to children from exposure to environmental agents. , 2003, Environmental health perspectives.

[35]  S. Rifkin.  A framework linking community empowerment and health equity: it is a matter of CHOICE. , 2003, Journal of health, population, and nutrition.

[36]  B. Guyer,et al.  Integrated perinatal health framework. A multiple determinants model with a life span approach. , 2003, American journal of preventive medicine.

[37]  R. Burnett,et al.  Overview of the Reanalysis of the Harvard Six Cities Study and American Cancer Society Study of Particulate Air Pollution and Mortality , 2003, Journal of toxicology and environmental health. Part A.

[38]  F. Lipfert,et al.  Commentary on the HEI Reanalysis of the Harvard Six Cities Study and the American Cancer Society Study of Particulate Air Pollution and Mortality , 2003, Journal of toxicology and environmental health. Part A.

[39]  Daniel Krewski,et al.  Risk Management Frameworks for Human Health and Environmental Risks , 2003, Journal of toxicology and environmental health. Part B, Critical reviews.

[40]  Daniel Krewski,et al.  Rejoinder: Reanalysis of the Harvard Six Cities Study and American Cancer Society Study of Particulate Air Pollution and Mortality , 2003 .

[41]  R. Burnett,et al.  The Effect of Concurvity in Generalized Additive Models Linking Mortality to Ambient Particulate Matter , 2003, Epidemiology.

[42]  Wayne R. Munns,et al.  Framework for the Integration of Health and Ecological Risk Assessment , 2003 .

[43]  A. Cohen,et al.  On the relationship between time-series studies, dynamic population studies, and estimating loss of life due to short-term exposure to environmental risks. , 2002, Environmental health perspectives.

[44]  D. Wasylenki,et al.  A population health framework for inner-city mental health , 2002, Journal of Urban Health.

[45]  S. Atkinson.  Political cultures, health systems and health policy. , 2002, Social science & medicine.

[46]  M. Turcotte.  In the Chamber of Risk: Understanding Risk Controversies , 2002 .

[47]  R. Burnett,et al.  Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. , 2002, JAMA.

[48]  Michael Power,et al.  Trends in the Development of Ecological Risk Assessment and Management Frameworks , 2002 .

[49]  D Krewski,et al.  Particulate air pollution standards and morbidity and mortality: case study. , 2001, American journal of epidemiology.

[50]  William Leiss,et al.  In the Chamber of Risks: Understanding Risk Controversies , 2001 .

[51]  H Kunreuther,et al.  Incentives for mitigation investment and more effective risk management: the need for public-private partnerships. , 2001, Journal of hazardous materials.

[52]  R. Levins,et al.  The precautionary principle in environmental science. , 2001, Environmental health perspectives.

[53]  D. Prevention.  Ottawa charter for health promotion. , 1986, Canadian journal of public health = Revue canadienne de sante publique.

[54]  F. Dominici,et al.  Fine particulate air pollution and mortality in 20 U.S. cities, 1987-1994. , 2000, The New England journal of medicine.

[55]  John C. Licciardone,et al.  Risk Communication and Public Health , 2000, BMJ : British Medical Journal.

[56]  Evan Wood,et al.  Population health: Concepts and methods , 2000 .

[57]  A. Jourdain.  Equity of a health system , 2000 .

[58]  J. Dunn,et al.  Toward a Lexicon of Population Health , 1999, Canadian journal of public health = Revue canadienne de sante publique.

[59]  S. Moolgavkar,et al.  Quantitative Estimation and Prediction of Human Cancer Risks , 1999 .

[60]  J. Rose,et al.  Quantitative Microbial Risk Assessment , 1999 .

[61]  J F Gamble,et al.  PM2.5 and mortality in long-term prospective cohort studies: cause-effect or statistical associations? , 1998, Environmental health perspectives.

[62]  T. K. Young.  Population Health: Concepts and Methods , 1998 .

[63]  B. Poland,et al.  Wealth, equity and health care: a critique of a "population health" perspective on the determinants of health. Critical Social Science Group. , 1998, Social science & medicine.

[64]  S. Birch,et al.  Allocating resources in health care: alternative approaches to measuring needs in resource allocation formula in Ontario. , 1998, Health & place.

[65]  B. Brunekreef.  Air pollution and life expectancy: is there a relation? , 1997, Occupational and environmental medicine.

[66]  M. Segré,et al.  [The concept of health]. , 1997, Revista de saude publica.

[67]  M. Morris.  Understanding Risk - Informing Decisions in a Democratic Society , 1997 .

[68]  Sverre Vedal,et al.  Ambient particles and health: lines that divide. , 1997, Journal of the Air & Waste Management Association.

[69]  E. Luebeck,et al.  A critical review of the evidence on particulate air pollution and mortality. , 1996, Epidemiology.

[70]  E G Luebeck,et al.  Particulate air pollution and mortality. , 1996, Epidemiology.

[71]  Rhonda K. Lewis,et al.  Using empowerment theory in collaborative partnerships for community health and development , 1995, American journal of community psychology.

[72]  C. K. Mertz,et al.  Health risk perception in Canada II: Worldviews, attitudes and opinions , 1995 .

[73]  C. K. Mertz,et al.  Health risk perception in Canada I: Rating hazards, sources of information and responsibility for health protection , 1995 .

[74]  A. M. Davis.  Health Promotion in Canada: Provincial, National and International Perspectives , 1995 .

[75]  J. W. Frank,et al.  Why "population health"? , 1995, Canadian journal of public health = Revue canadienne de sante publique.

[76]  D. Dockery,et al.  Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. , 1995, American journal of respiratory and critical care medicine.

[77]  R. McClellan.  A commentary on the NRC report "Science and judgment in risk assessment". , 1994, Regulatory toxicology and pharmacology : RTP.

[78]  Daniel Krewski,et al.  Air pollution effects on hospital admission rates: A random effects modeling approach , 1994 .

[79]  Lori B. Andrews,et al.  Assessing Genetic Risks: Implications for Health and Social Policy , 1994 .

[80]  D. Dockery,et al.  An association between air pollution and mortality in six U.S. cities. , 1993, The New England journal of medicine.

[81]  S. Julius.  The Concept of Health , 1990 .

[82]  J Epp,et al.  Achieving health for all. A framework for health promotion. , 1987, Health promotion.

[83]  Division on Earth.  Risk Assessment in the Federal Government: Managing the Process , 1983 .

[84]  H Labelle,et al.  A new perspective on the health of Canadians. , 1976, AARN news letter.

[85]  Timothy L. Sellnow,et al.  Effective Risk Communication , 2009 .

[86]  R. Bell.  Healthier Societies – From Analysis to Action , 2008 .

[87]  Steven K. Gibb.  Toxicity testing in the 21st century: a vision and a strategy. , 2008, Reproductive toxicology.

[88]  D. Krewski,et al.  Health Policy Approaches to Children's Environmental Health , 2006 .

[89]  J. Lynch,et al.  Income inequality as a determinant of health , 2006 .

[90]  Christine M. Coussens,et al.  Implications of Nanotechnology for Environmental Health Research , 2005 .

[91]  Interpreting Epidemiological Studies of Acute and Long-Term Exposure to Particulate Matter for Policy Development. Proceedings of a conference. , 2005, Journal of toxicology and environmental health. Part A.

[92]  T. Shirakawa,et al.  Genetic Polymorphisms and Environmental Risk of Lung Cancer: A Review , 2004, Reviews on environmental health.

[93]  Ritu Sadana,et al.  Knowledge for better health: a conceptual framework and foundation for health research systems. , 2003, Bulletin of the World Health Organization.

[94]  Terri Damstra,et al.  Global assessment of the state-of-the-science of endocrine disruptors , 2002 .

[95]  B. MacDonald,et al.  Prince Edward Island Heart Health Dissemination Research Project: establishing a sustainable community mobilization initiative. , 2001, Promotion & education.

[96]  D Krewski,et al.  Potential health risks of radiofrequency fields from wireless telecommunication devices. , 2001, Journal of toxicology and environmental health. Part B, Critical reviews.

[97]  C. Brunk,et al.  Elements of precaution: recommendations for the regulation of food biotechnology in Canada. , 2001, Journal of toxicology and environmental health. Part A.

[98]  Daniel Krewski,et al.  Recent advances in research on radiofrequency fields and health. , 2001, Journal of toxicology and environmental health. Part B, Critical reviews.

[99]  E. Oberdörster.  Hormonally Active Agents in the Environment , 2001 .

[100]  G. R. Barrie Webster,et al.  Hormonally Active Agents in the Environment , 2001 .

[101]  L. Green,et al.  Health impact assessment as a tool for health promotion and population health. , 2001, WHO regional publications. European series.

[102]  Li Yue-yu.  Environmental Risk Assessment and Management , 2001 .

[103]  Yuanzhang Li,et al.  Assessment of recent ozone short-term epidemiologic studies. , 2001, Inhalation toxicology.

[104]  K. McDowell,et al.  Pathophysiology of asthma. , 2000, Respiratory care clinics of North America.

[105]  Ronald Labonte,et al.  Community as a Setting for Health Promotion , 2000 .

[106]  S. Fawcett,et al.  A review of collaborative partnerships as a strategy for improving community health. , 2000, Annual review of public health.

[107]  Daniel Krewski,et al.  Reanalysis of the Harvard Six Cities Study and the American Cancer Society Study of Particulate Air , 2000 .

[108]  R. Spasoff.  Epidemiologic methods for health policy , 1999 .

[109]  C. Jordens,et al.  Multiplying health gains: the critical role of capacity-building within health promotion programs. , 1997, Health policy.

[110]  R. Wilkinson.  Unhealthy Societies: The Afflictions of Inequality , 1996 .

[111]  Strategies for population health--investing in the health of Canadians. , 1996, Probe.

[112]  H. Fineberg,et al.  Understanding Risk: Informing Decisions in a Democratic Society , 1996 .

[113]  J. Kemm,et al.  The determinants of health , 1995 .

[114]  G L Stoddart,et al.  Producing health, consuming health care. , 1990, Social science & medicine.

[115]  J. Epp,et al.  Achieving health for all: a framework for health promotion. , 1986, Canadian journal of public health = Revue canadienne de sante publique.

[116]  L. White,et al.  Alternatives to regulation , 1982 .