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Abstract

The area of risk assessment continues to be challenged by foundational issues that limit its potential to inform public health decisions. This doctoral work improves our understanding of the interaction between science and public and environmental health policy by addressing specific challenges in risk assessment within and for decision-making. The focus is on analyzing current health risk assessment practices and understanding health risk assessment (HRA) and health impact assessment (HIA) in a decision-making context to identify specific opportunities for clarifying and improving the value and impact of HRA on public health decisions.
The research followed two general approaches: policy to science (P2S) and science to policy (S2P). The P2S approach was based on the principle of auditing, which was adapted for the public health domain. In contrast, the S2P approach included decision analysis methods, case studies focusing on risk-informed decision-making processes, reviewing the use of human biomonitoring (HBM) data for HRA and related policy decisions, and a survey focusing on understanding HRA in the context of decision-making.
An audit of the selected Slovenian public health strategy on the health of children and adolescents regarding the environment highlighted the issue of inconsistent or indirect associations between available environmental quality information and assumed exposures contributing to specific health outcomes, which impedes the evaluation of public health policy’s success. In addition, a review of HBM for HRA and within the environmental health paradigm supported the need for consolidating the understanding of the usefulness and limitations of HBM, which is crucial for targeted risk management interventions. From this analysis, several ways of improving the risk-informing potential of HRAs that use HBM data are suggested, including specific and related epidemiological evidence, stakeholder involvement, clarification of the assessment context, and transparent reporting of underlying assumptions and limitations.
A survey of the understanding of HRA revealed widespread inconsistencies in how the issues relating to the evaluation process and the core terms and principles of risk analysis are understood. It was found that opportunities for improving HRA’s impact on decisions occur at the beginning of the HRA process, where the assessment and decision contexts should be clarified for all relevant and participating stakeholders. Such clarifications can be facilitated by using decision analysis tools or methods. The thesis also highlights the necessity of having a decision follow-up step at the end of the process for evaluating decision implementation and identifying the real success and benefits of HRA. As a decision follow-up step, this thesis shows how auditing can help evaluate the implementation, compliance, and adherence to selected public health policy and the accountability and honesty of those involved in policy development and implementation. It can also provide evidence of stakeholder satisfaction in terms of their effective participation and contribution to decisions, which can, in turn, add to the overall credibility of the assessment process, decision making and policy implementation.