Health Risk Assessment in Western Australia

Health Impact Assessment - Department of Health

 Health Risk Assessment in Western Australia Page 

Health Risk Assessment in Western Australia Message from the Environmental Health Director
This document has been designed to introduce the reader to the basic concepts of health risk assessment. It provides
an introduction to the topic and an overview of the potential uses and limitations of health risk assessments. An
outline of the process is intended to clarify the core issues of health risk assessment and provide a range of references Development is going on all around us in Western Australia. Yet developments such as land
where more technical and detailed information is available. use developments, industrial activities or clean up of old waste sites can put communities at
risk and possibly cause ill health.
The document focuses on delivering information that can be used to consider the potential health effects of proposed
projects in a logical and objective manner. It highlights the role and benefits of health risk assessments in protecting Health Risk Assessment is the process the Department of Health in Western Australia
the health of ourselves, our community and our environment. requires of developers to use to demonstrate that their proposals will not adversely affect
the health of the surrounding community. It requires proponents to consider each aspect of their proposed
Health risk assessment is about providing us with the information to make informed decisions. We hope that this
development, to determine whether the proposal has any risks associated with it, and to consider what could
document helps you to do just that.
be done to ensure that the community is protected from the risks.

The Australian procedures for Health Risk Assessment have been developed through collaboration of experts
across the country and published by the National Environmental Health Council (enHealth Council) as the:

Environmental Health Risk Assessment: Guidelines for assessing human health risks from
environmental hazards.

We have felt in WA, that a document was needed which clarified what Health Risk Assessment is, why it is
important to assess the risks from development and to provide proponents and the community alike as to
what is required of the process for us to be assured that people are protected.

We hope you find this document meets these needs and assists all involved.

Jim Dodds

Director Environmental Health

Acknowledgements
This document has drawn primarily from the 2004 enHealth document “Environmental Health Risk Assessment:
Guidelines for assessing human health risks from environmental hazards.” The enHealth guidelines are over 200 pages
in length and cover many of the technical and scientific aspects of health risk assessment that are beyond the scope of
this introductory document. For those readers seeking a more detailed understanding of health risk assessment, the
enHealth guidelines are recommended.

The draft document was prepared by Jeffery Spickett, Helen Brown, Martin Matisons and Dianne Katscherian.
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Glossary Contents
Taken from enHealth, Environmental Health Risk Assessment 2004. Section 1 Page
Dose-response assessment - Determination of the relationship between the magnitude of the dose or level of Introduction to Health Risk Assessment
exposure to a chemical and the incidence or severity of the associated adverse effect.

Environmental Health - Those aspects of human health determined by physical, chemical, biological and 1.1 Introduction 4
social factors in the environment. Environmental health practice covers the assessment, correction, control
1.2 Why carry out an HRA 5
and prevention of environmental factors that can adversely affect health, as well as the enhancement of those
aspects of the environment that can improve human health.
1.3 When to carry out an HRA? 7
Hazard - The capacity of an agent to produce a particular type of adverse health or environmental effect.
1.4 Who is involved in an HRA? 8
Health - Health is a state of complete physical, mental and social well being and not merely the absence of
disease or infirmity. (World Health Organisation (WHO), 1946). 1.5 What makes a good HRA? 9
Health Impact Assessment - A systematic process to assess the actual or potential, and direct or indirect, effects
on the health of individuals, groups or communities arising from policies, objectives, programs, plans or activities.

Health Risk Assessment - The process of estimating the potential impact of a chemical, biological, physical or Section 2
social agent on a specified human population system under a specific set of conditions and for a certain time-
The Health Risk Assessment Process
frame.

Risk - The probability that, in a certain timeframe, an adverse outcome will occur in a person, group of people, 2.1 Issue Identification 12
plants, animals and/or the ecology of a specified area that is exposed to a particular dose or concentration of a
hazardous agent. i.e. it depends on both the level of toxicity of the agent and the level of exposure. 2.2 Hazard Assessment 14

Risk Communication - An interactive process involving the exchange among individuals, groups and institutions of 2.3 Risk Characterisation 16
information and expert opinion about the nature, severity, and acceptability of risks and the decisions taken to
combat them. 2.4 Health Risk Assessment Reports 17
Risk Management - The process of evaluating alternative actions, selecting options and implementing them in
response to risk assessments. The decision making will incorporate scientific, technological, social, economic
and political information. The process requires value judgements, e.g. on the tolerability and reasonableness of
Section 3
costs.
A Framework for Health Risk Assessment

3.1 The Use of Health Risk Assessments in Western Australia Today 17

3.2 A Basic Framework 19

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Section 1 It is important at this stage to clarify our use of the 1.2 Why carry out a health risk assessment? The greater the confidence in the risk assessment
terms risk and hazard, as they are terms that will be The protection of public health lies at the heart process, the greater the confidence we have in
1.1 Introduction used throughout this document and are frequently of health risk assessment. Health risk assessment decisions made to minimise the risk to our health.
confused. In terms of health risk assessment, a risk provides us with a systematic approach for
Most people in Western Australia would agree that Protecting public health requires careful consideration
is the probability that an adverse health outcome characterising the nature and magnitude of the
we enjoy a good quality of life. A range of social, of potential differences in susceptibility or sensitivity
will occur in a given situation in a certain timeframe. risks associated with environmental health hazards
economic and environmental factors, including our to hazards. Not all individuals or groups will
A hazard is the capacity of an agent to produce a (enHealth, 2004).
lifestyle, our unique natural environment, a strong experience the same level of risk from the same
particular type of adverse health effect. If we use an
economy and high standards of health and education hazard. Certain groups such as children, the elderly,
everyday example, the distinction between the two To understand how health risk assessment can minimise
all contribute to our way of life and high standard of indigenous groups or people suffering an illness or
becomes clear. The hazard of a particular prescription the risks to our health, it needs to be considered in
living. Protecting and preserving this for current and certain medical conditions, may be more susceptible
drug may be severe breathing difficulties in the case terms of its relationship with risk communication and
future generations is a common goal of individuals, to particular hazards. Consideration also needs to
of an overdose. An open packet of this drug sitting on risk management (Figure 1). Risk communication is
communities and governments. be given to those individuals or groups that may be
the kitchen bench poses a significant risk to the health a consultative process that considers all stakeholders
and gives each of them the opportunity to exchange exposed to higher levels of a hazard. A health risk
Health is one of the cornerstones of our quality of life of a young child in the household. The same drug, in
information about the risks being assessed and about assessment ensures that these different degrees of
and people place greater value on their health than a locked medicine cabinet, is a negligible risk. The
the decisions taken to combat them. The scope and susceptibility and exposure are taken into account.
most other priorities. Protection of our health needs hazard of the drug in both situations is the same, yet
to be achieved in an environment of technological, the risks of the two situations are very different. By nature of the consultation should reflect the potential Figure 1: Relationship of risk assessment, risk
industrial, economic and social change. Whilst understanding these differences, we can see that the effects on the community and the level of community management and risk communication.
such changes bring many benefits, they may also risk to our health from a hazard can be controlled concern. Ideally, consultation should begin before (Adapted from enHealth 2004)
bring hazards that have the potential to harm the through appropriate measures, to an acceptable level. health risk assessment and continue right through to
environment or the health of our community. the risk management stage. Effective consultation will
Health risk assessment uses a risk based approach RISK COMMUNICATION
provide information that is useful for risk assessment
& COMMUNITY CONSULTATION
The National Environmental Health Strategy (1999) and applies it to risks associated with environmental and risk management.
states that ‘protection of health involves analysing the health hazards. Environmental health refers to
risks involved, evaluating interventions and developing ‘those aspects of human health that are determined Risk management makes decisions based on a range
appropriate management strategies.’ This risk based by physical, chemical, biological and social factors of scientific, technical, economic, environmental,
approach recognises that all situations carry some in the environment. It also refers to the theory and cultural and political information, including health risk
assessments and input from the risk communication RISK RISK
degree of risk and that analysis of these risks can practice of assessing, correcting, controlling, and
ASSESSMENT MANAGEMENT
contribute to decisions aimed at minimising harm to preventing those factors in the environment that can process.
individuals and communities. potentially affect adversely the health of present
One of the crucial differences between the health
and future generations’ (WHO, 1993). Environmental
As individuals we learn to minimise risks to our health risk assessment process and risk communication
health hazards can occur in a wide range of situations
from a very early age. We learn to recognise hazards, and management is that the assessment process
and examples include chemical contaminants in air,
assess them for their likelihood to harm us, make is objective – it provides available and relevant
water, soil and food, biological hazards such as viruses,
judgements about the acceptability of the risks and information about the nature and magnitude of
bacteria or insects and physical hazards such as noise Whilst the main focus of health risk assessment is
take measures to minimise them. Examples range potential risks of a particular situation, it does not
and traffic. the protection of human health, the benefits are not
from simple actions such as looking before we cross however make decisions about the management of
those risks. In contrast, both risk communication restricted to issues of health. If failure to conduct
the road, applying sunscreen and wearing seatbelts, to Health risk assessment provides us with the information
and risk management are subjective – they make a thorough, well managed health risk assessment
major lifestyle factors that affect our health, such as to make informed decisions. It is about acknowledging
value judgements and decisions, such as prioritising ultimately leads to a situation where significant
diet, exercise and smoking. and addressing the potential effects on our health that
issues and actions, based on a wide range of factors, adverse health effects are experienced, the flow-on
many projects have. A health risk assessment will
including the health risk assessment. effects can be significant. If the community believes
collect and evaluate available and relevant information
that the appropriate steps to assess and minimise the
about the potential health effects of environmental
The nature and the quality of the decisions in risk risk to their health have not been properly carried out,
health hazards in a specific situation in a logical and
management, and the confidence we have in them then the level of community mistrust and anger can be
objective manner. This information can then be used
depends on the quality of the information provided by very high. Regaining community trust in such situations
in the risk management process, where decisions about
the health risk assessment. A health risk assessment is extremely difficult. Economic costs can also result
how to best manage risk are made.
that provides the best and most objective scientific and are not necessarily limited to the proponent. Loss
The following information will highlight the role and information available about health risks will enable of productivity and income, clean-up and monitoring
benefits that health risk assessment can provide the best possible discussions and decisions to follow. costs, work required to ensure the situation does
in protecting the health of our community, our If the risk management process is based on flawed not occur again, cost of potential litigation, financial
environment and ourselves. information, then subsequent decisions will be flawed. penalties and medical costs are all possibilities.
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Adverse health effects from environmental health may have specific guidelines, such as the Department locating intensive horticulture Effective risk communication will ensure that the
hazards will possibly be accompanied by adverse of Environment’s Contaminated Sites Guidelines. level and type of consultation adequately reflects
locating new power generation plants
environmental effects that also have a range of Large complex projects or situations will require more the situation. Proper management of communication
associated costs. All of these possibilities demonstrate complex approvals systems and more detailed health locating toxic waste disposal plants between all stakeholders will help to develop a
the overlap between health, environmental, social and risk assessments. They will usually require approval productive and meaningful relationship between all
economic issues. at state government level and may involve a number locating sewage treatment plants groups. Effective community consultation has been
of different agencies that assess proposals and make addressed in a range of publications from the Citizens
Our experience of situations where health has been Past experience plays a crucial role in our evaluation
recommendations to decision making authorities. and Civics Unit, Department of Premier and Cabinet,
adversely affected by environmental health hazards has of situations for potential adverse health effects.
These decision-making authorities consider the including Consulting Citizens: A Resource Guide (2002)
taught us that prevention of these events is more cost The Health Act (1911) classifies a range of noxious
recommendations and make the final decision on and Planning for Success (2003).
effective than treatment. Time, effort and resources industries. Situations with a higher potential
whether the project can proceed and under what
spent on identifying and assessing risks to human health for contamination are identified in ‘Potentially Given the depth and breadth of knowledge required
circumstances. Often the decision is dependent on
are justified when we consider the potential human, contaminating activities, industries and landuses,’ for an extensive health risk assessment, it is usually
the imposition of regulations. Health risk assessment
environmental and economic costs of inaction. (DoE, 2004). Examples include abattoirs, chemical not realistic for any one person to effectively address
carried out for these types of projects will generally be
manufacturing, oil and gas production, mining, landfill all aspects of all issues. The range of medical and
detailed and situation-specific.
sites and airports. health experts that provide information, advice or
1.3 When to carry out a health risk assessment?
Simpler projects may be addressed at a local expertise reflect the complex nature of some health
A major focus of the National Environmental Health
Strategy was the development of the Australian
government level and in some cases potential risks to 1.4 Who is involved in a health risk assessment? risk assessments. For complex assessments, agreement
our health will be addressed in a generic manner, using Each project undergoing a health risk assessment between stakeholders on what experts will be used for
Charter for Environmental Health. One of the guiding
previous experience of similar situations. In these will involve a range of stakeholders. These typically specific aspects of the health risk assessment may be
principles of the Charter is to “protect human health
cases simple and rapid assessments of issues and risks include those proposing the project (the proponent); helpful.
by identifying threats posed by environmental hazards
can be made without the need for a new health risk members of the community or workers potentially
as early as possible and by introducing appropriate Independent peer reviews of health risk assessments
assessment. Local government regularly deals with affected by the project, government representatives
safeguards. Ideally these should be sustainable and for major or potentially controversial projects can
potential risks to our health in a range of situations from all levels of government, other experts and
cost-effective.” The Charter highlights the basic bring added benefits. A review process that supports
without the need for a detailed health risk assessment. consultants, environmental planners and other health
entitlements and responsibilities required to maintain the findings of an assessment and is independent of
An example is assessing the potential health risks of a officials.
and improve the quality of health for all Australians. all stakeholders can potentially increase the level
new restaurant. Poor hygienic practices in restaurants
Those responsibilities and entitlements operate at of confidence in the findings. This strengthened
can potentially endanger public health through Any health risk assessment should consider relevant
the individual, community, business, industry and confidence can extend to all stakeholders – proponents,
contaminated food. This type of environmental health stakeholder concerns. The level of involvement of
government level. community groups and government agencies, and may
hazard is effectively controlled through enforcement each of the stakeholders will depend on the nature
and size of the project and the level of community contribute to the level of acceptance and decision
In terms of activities or projects that can cause harm of a range of environmental health criteria, which have
concern. The appropriate level and extent of making processes surrounding a proposal. Ensuring
through environmental health hazards, it is clearly been derived using risk assessment techniques. In such
consultation should be carefully considered as early as that peer reviewers have an appropriate level of
the responsibility of the proponent to address these cases, there is no need for either a detailed health risk
possible. Each stakeholder may have a range of issues, expertise and independence is critical to the success
concerns. If there are health issues, they need to be assessment or widespread community consultation.
some of which will be common to all groups whilst of the process.
identified and a determination made as to whether a
The enHealth guidelines provide a list of situations others may reflect the concerns of specific groups or
health risk assessment will effectively address those
where there is a ‘plausible increased risk of significant individuals. Each concern should be acknowledged 1.5 What makes a good health risk assessment?
concerns.
health consequences for the human population’ and and addressed. Not all issues will necessarily be A good health risk assessment aims to provide the best
A health risk assessment is not the answer for all where health risk assessment may be needed. Whilst part of a health risk assessment – they may already and most objective scientific information about the
situations where there is a risk of adverse health the following list is not exhaustive, it gives some be adequately addressed through other processes or risks of a specific situation. If this is the aim, how do
effects. Projects or activities may have obvious examples to illustrate the point. health risk assessment may not adequately address the we achieve it?
health effects that are well understood and effectively issue. For such issues, the reasons for their omission
changes where impacts on environmental health
controlled by existing standards. In such cases, from a health risk assessment should be clearly stated. The process itself is the first key and follows four main
factors may be permanent and irreversible
protection of public health would be better served by steps, as outlined by enHealth (2002):
putting resources into improved management of the A health risk assessment that is not inclusive of
situations where there is a high level of public
all stakeholders’ concerns may be seen to be less Issue Identification
known risks rather than a health risk assessment that interest in and/or concern about environmental
will not provide any new information. objective than one that has actively considered all
health issues. Hazard Assessment
stakeholders from the very first stages. Failure to
Most activities or projects in our society require situations where vulnerable populations may consider all stakeholder concerns may also result in Exposure Assessment
some type of planning approval. The nature of this be affected by environmental health issues e.g. potential health issues being overlooked. The need for
approval will often dictate the need for and the level Risk Characterisation.
placement of schools effective consultation highlights the importance of risk
of health risk assessment required. Some situations communication and its role in health risk assessment.
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This framework is used in most health risk assessment The quality of the information used in the process Justification for why particular data or methods were In summary, the key points that are important for the
models around the world and provides a uniform needs to be clearly stated. This will include disclosure used in the assessment needs to be clearly stated at development of a good health risk assessment are:
approach to assessing and quantifying risks from of the source of the information, details of the studies each step of the process. If conflicting data exists,
Transparency
environmental health hazards. These steps will be from which data was used and quality assurance why was one set of data chosen over another? Why
covered in detail in Section 2. systems for collection and analysis of data and was one type of study chosen over another? Why was a Objectivity
samples. Different sources of data are considered particular model of exposure used?
In addition to the basic process, there are a number Consideration of all stakeholder concerns
to carry more weight than others. The enHealth
of fundamental principles that should be followed to The health risk assessment process is usually situation-
guidelines categorise sources of toxicological data into
ensure the best possible quality health risk assessment. specific and care should be taken at each step to use Appropriate consultation
3 levels, in order of preference, as indicated in Table 1
information and models that are most relevant to the
Transparency of the process is vital. Clearly detailing and state that ‘all documents, particularly those in the Ensuring quality of the data
situation. Any information used, including toxicological
each step of the process, to those reviewing the second and third categories require rigorous appraisal
data, routes of exposure, exposure assessment and Justification for methodologies
assessment, is essential. A health risk assessment for relevance, validity and accuracy.’
health or population data, should reflect the situation
conducted behind closed doors, without open access to Justification for reference standards and for
The quality of data from samples collected specifically as closely as possible. For example if the most likely
the information upon which its conclusions are based, modelling
for a situation under assessment should also be route of exposure is by inhalation, then data based
cannot be defended and will generally lead to more
adequately addressed. Section 8.7 in the enHealth on inhalation pathways should be used. If this data Relevance of data and models to the situation
questions than answers. In contrast a transparent
guidelines provides a detailed description of is not available, the use of data from other routes
health risk assessment that has used the most reliable Clear indication of assumptions
environmental sampling methods and quality control. of exposure needs to be justified and any additional
and relevant information available and that has
Sampling regimens for specific situations are often assumptions or uncertainties arising from its use,
ensured additional investigation where necessary, Clear indication of limitations and uncertainties
available, for example, the ‘Development of Sampling clearly stated.
will provide the best possible assessment of potential
and Analysis Programs’ (DoE, 2001). Gaps in available
health risks for any project. Any health risk assessment will include assumptions.
knowledge may also occur in health risk assessment
These assumptions may be part of the models used in
and the effect of these gaps on the quality or certainty
the assessment or may be made when there are gaps in
of the data needs to be addressed.
the available knowledge. These assumptions should be
clearly stated and justified.
Table 1: Levels of Sources for Toxicological Data.
Uncertainty may arise because of incomplete
information, the uncertainty inherent in areas such
Level Description Examples
as data collection, sampling and measurement
and uncertainty in the models used in the process.
1 High level of scientific agreement. National Health and Medical Research Council
Uncertainty needs to be clearly addressed at each step
(NHMRC)
of the process. An overall assessment of uncertainties
Acceptable Daily Intake list from the Therapeutic can be useful for planning future studies or monitoring
Goods Administration. that will fill in gaps in the current knowledge and
sensitivity and potentially reduce levels of uncertainty.
National Environment Protection Measure (NEPM)

Australia and New Zealand Environment and These basic principles recognise that health risk
Conservation Council (ANZEEC) assessment is not an exact science. However,
adherence to these principles provides a process in
World Health Organisation documents.
which the potential health risks of any project are
assessed in an open and objective manner. Such an
2 Varying levels of scientific agreement. Use should be Peer-reviewed journals. approach is crucial to the establishment of a process
clearly justified, for example, by lack of Level 1 data that is trusted by the community, the government and
Industry publications.
and appraised for levels of uncertainty. proponents alike
Occupational health and safety sources.

3 Lower level of scientific agreement. Use requires Unpublished information.

justification that other sources are unavailable.
Non-peer reviewed information – magazines,
Should be appraised for levels of uncertainty.
newspapers, and internet.
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Section 2: 2.1 Issue Identification The main aim at this stage should be the development
of a useful health risk assessment – one that will
What are the issues relating to a particular project or provide information that will be helpful in making
2.1 The Health Risk Assessment Process
development for which health risk assessment is useful? decisions about the management of risk associated
The four steps of the health risk assessment process are issue identification, hazard assessment, exposure
A thorough approach to this step is critical to any health with a project. Careful planning and consideration of
assessment and risk characterisation. Whilst these steps can be applied to all hazards, whether they are chemical,
risk assessment. The questions and issues raised here the scope and objectives of a health risk assessment
physical, biological or psychosocial in nature, they have been developed primarily for chemical hazards. Application
will provide the overall working plan for the assessment. are crucial. For complex health risk assessment,
of the process to the different types of hazards will require different methods, models and assumptions and these
Failure to address all issues at this point can result in an effective risk communication is crucial at this stage.
should be clearly stated at all steps.
incomplete and poorly accepted assessment. In terms of potential environmental health issues,
The assessment of social and psychological hazards and their risks to health require different approaches. The
Issue identification comprises several phases: the range is immense and will vary according to the
ongoing development of these is part of the evolving use of more integrated approaches to health, such as health
project. Our experience and knowledge of previous
impact assessment.
identification of environmental health issues and similar situations will help to identify issues. These
determining whether there are hazards amenable to issues will arise from environmental health hazards
risk assessment; that are physical, chemical or biological in nature.
Putting these hazards into their environmental health
Figure 2: Health Risk Assessment Process (from enHealth 2004) relating the hazards to their environmental health
context, as outlined in the enHealth guidelines, will
context (clarification and prioritising of problems
involve a consideration of:
and hazards);
Whether there are single or multiple sources
identification of potential interactions between
of the hazard;
agents; and
RISK ASSESSMENT
Whether the contaminant affects multiple
stating clearly why risk assessment is needed and
environmental media (e.g. lead smelter emissions
the scope and objectives of the risk assessment.
contaminating soil, air, water and food);
Issues are different from hazards and are influenced
How do stakeholders perceive the problem?
EXPOSURE ASSESSMENT by perceptions, economics, science and social factors.
HAZARD Do different groups have different perceptions?
ASSESSMENT
Examples are community concern over emissions from
a power plant, assessment of a new food additive or How do the hazards compare to other
local opposition to the expansion of a landfill facility. environmental hazards affecting the community?
Different stakeholders may have different issues
– this is often because perceptions of risk vary widely. 2.1 Hazard Assessment
Recognising and understanding the different perceptions
Hazard assessment comprises two aspects: hazard
HAZARD DOSE-RESPONSE of risk is a crucial aspect of issue identification.
IDENTIFICATION ASSESSMENT identification and dose-response assessment.
Consideration of all stakeholder issues is the key
point here. The level of consultation required for 2.1.1 Hazard Identification
this consideration generally reflects the level of Does the substance or situation have the potential to
community concern and the potential effects on the cause adverse health effects?
community. Some situations may have well-recognised
REVIEW REVIEW issues that can be easily identified and there will be The previous step of issue identification will have
& REALITY RISK CHARACTERISATION & REALITY
CHECK CHECK no need for direct involvement or consultation with identified those environmental health hazards that
all stakeholders. Other more complex situations, are to be considered by the health risk assessment.
such as a proposal for a major mining project, will Hazards addressed by a health risk assessment can be
have a range of complex issues that require a greater physical (e.g. noise, mechanical hazards, radiation
degree of stakeholder involvement. For example, and vibration), chemical (either naturally occurring
RISK MANAGEMENT local residents may be most concerned about increased or synthetic substances) or biological (e.g. viruses,
traffic and the proximity to local schools, workers bacteria and vermin).
may focus on adequate protection in the workplace
Information about the hazards can be collected from
and toxicologists may be particularly concerned with
a range of sources including human or animal studies
air emissions. In complex situations, all of the issues
and chemical information. The range of information
need to be considered for their suitability for health
available will vary with the situation and the type
risk assessment and to be prioritised.
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of hazard. Animal toxicity data, human data or The route of exposure is another variable. The health influenced by the environmental persistence of a measures of risk for issues where quantification
biochemical activity data may all be available for effects of a substance will often differ depending substance. The longer a substance persists in the is difficult may be justified. For example current
chemical, biological and physical data. on whether they are inhaled ingested or in contact environment, the longer it persists as a potential uncertainty regarding ‘safe’ levels of dust and the
with skin and data used should attempt to reflect the source of exposure. highly subjective nature of odour, makes quantification
The reliability and quality of the studies and other
situation under assessment. The possibility of multiple of these issues difficult.
sources of information used at this stage should be Susceptible groups are not necessarily exposed to
routes of exposure should be addressed.
addressed in the health risk assessment. higher levels of the substance, but for some reason Risk characterisation will often make comparisons
The type of data used should attempt to take all they are more likely to experience adverse health between the exposure assessment and established
2.1.2 Dose-response Assessment of these variables into account with the usual effects than the general population. This susceptible environmental health criteria. It should be ensured
considerations of relevance, quality and uncertainty. group may be different for different hazards and can that these criteria have been endorsed by the
The dose-response assessment examines the
include children, the elderly, women, the sick and appropriate agencies or otherwise appropriately
relationship between the dose of a particular hazard
2.2 Exposure Assessment people with particular medical or genetic conditions. justified. The protection of public health requires
and the adverse health effects in humans. This
The notion of different exposure levels is relevant for the incorporation of safety factors that guard against
relationship is conveyed by the accepted toxicological What exposures are likely to be experienced under
all types of hazards - physical, chemical and biological. uncertainties. Guidelines such as ‘accepted daily
principle of ‘the dose makes the poison.’ An example anticipated conditions?
intakes’ or ‘tolerable intakes’ typically incorporate
is an everyday substance such as Vitamin A, which in Existing projects or situations may use environmental
This step gathers information about how much of a safety factors into their calculation.
small doses is an essential part of our diet, but which samples that have the potential to give the most direct
particular substance different groups will be exposed
can be toxic if consumed in large quantities. measure of exposure levels. Proposed projects usually Whilst strictly speaking, the health risk assessment
to, exactly how that exposure takes place - by
rely on experience from similar projects in existence process stops with the characterisation of risk, there is
Dose-response relationships need to take into account breathing, eating or drinking - and for how long the
and the use of transport and fate models that forecast a natural progression to risk management, which may
a range of potential variables. The relationship exposure will occur. This information is then combined
what happens to a substance after it is released into use information from the health risk assessment to
between dose and the health effects of a substance is with known information such as breathing rates, food
the environment. The data used for these models, the apply management decisions such as the introduction
often very different for different substances. These or water consumption and life expectancy to estimate
choice of model and the uncertainties and limitations of measures to reduce the level of risk.
different relationships are dealt with by using different total exposure.
associated with each, should be clearly stated.
models and by using data analysis and interpretation
In essence, this step puts the previous two steps 2.4 Health Risk Assessment Reports
that are appropriate for the data at hand.
into a meaningful context. If hazard assessment 2.3 Risk Characterisation The findings and details of a health risk assessment
Some people may be more sensitive to a substance or has concluded that a particular substance can cause
What is the estimated incidence of the adverse health need to be reported in a clear and logical manner.
a situation than others. Experience shows that groups breathing difficulties at 150 parts per million (ppm)
effects in a given population? Reports should contain sections on issue identification,
that can be more susceptible to potential hazards in the air, we cannot draw any conclusions until the
hazard assessment, exposure assessment and risk
include children, the elderly and those with existing final part of the equation, the expected exposure, This final step brings together all the information from
characterisation. Standardised formats may be
medical conditions. Children may be more sensitive to is calculated. In this case, an estimated exposure the previous steps to describe the risks to different
required by different agencies.
certain hazards for a range of reasons including higher assessment of 5ppm indicates minimal risk of breathing groups. It will make conclusions by weighing up all
metabolic and breathing rates than adults, an immature difficulties whilst one of 300ppm indicates a significant the information, taking into consideration the quality An in-depth coverage of the key aspects and
immune system and behavioural factors such as a risk. We can see from this how reports about of the data, the amount of evidence and levels of requirements of a health risk assessment report are
greater tendency to ingest soil. Asthmatics and people substances toxicity, if used out of context, can cause uncertainty, to prepare an overall picture of risk. covered in Chapter 10 of the enHealth guidelines.
with heart or respiratory conditions are more sensitive unnecessary alarm. Whilst the scope of the health risk assessment should A checklist for each step in the health risk assessment
to a range of hazards, particularly air pollutants, which be agreed upon early in the process, there may be process is included and the general attributes of a good
It is important that the exposure assessment takes
may trigger asthma, shortness of breath and coughing. instances where new information, new perspectives or report are stated as:
into account different levels of exposure that
Other diseases, which result in a decrease in immune new issues emerge during the process that prove to be
may be experienced by different groups. Exposed the scope and objectives of the report are explicitly
system response, can also result in greater sensitivity to significant in terms of human health. The health risk
populations will include the general population, those stated;
some environmental health hazards. assessment process should have the capacity to feed
most exposed and those most susceptible. The most
back significant issues to earlier steps in the process to the content is laid out impartially, with a balanced
The type of exposure can also influence the dose- exposed will be those who for some reason are likely
gather new and relevant information. treatment of the evidence bearing on the
response relationship – a continuous low dose of a to be exposed to higher levels of the hazard than
conclusions;
substance over a long period will have a different the general population. This may include workers on This is a complex step. Judgements need to be made
dose-response than a series of high intermittent doses. the project, those living near known sources of the about the strengths and weaknesses of evidence inclusion of a description of any review process
If we take the example of Vitamin A again, ingestion hazard and those who may be exposed to other sources at each step of the process. There is no magical that was employed, acknowledging specific review
of a small amount of Vitamin A every day over a of the hazard. The possibility of multiple exposure equation that will calculate an accurate figure for commentary;
lifetime plays an essential role in our vision, growth routes may arise from exposure to a combination of risk. Quantitative estimates for risk, at hazard
and development, yet ingestion of a lifetimes worth of air, water, soil and food sources, from occupational identification, dose-response and exposure assessment the key findings of the report are highlighted in a
Vitamin A in a single dose would be likely to result in sources and even from lifestyle factors such as diet steps, will include confidence intervals that take into concise executive summary;
liver failure and possibly death. and tobacco smoking. The level of exposure is also account the uncertainty of the assessment. Qualitative
Page 16 Health Risk Assessment in Western Australia Health Risk Assessment in Western Australia Page 17

the report explains clearly how and why its findings Health risk assessment needs to work in a changing Section 3: A Framework for Health
differ from other risk assessment reports on the environment. New developments, new science and
Risk Assessment
same topic; and new information will continue to impact on our
health. As health risk assessment responds to these
the report explicitly and fairly conveys scientific 3.1 The Use of Health Risk Assessments in
changes, it too, can contribute to our knowledge
uncertainty, including a discussion of research that Western Australia Today
about the potential effects of existing and emerging
might clarify the degree of uncertainty. These guidelines have been written in a general fashion
environmental health hazards. These improvements
in our knowledge and understanding of such matters to give the reader background knowledge about the
Health risk assessments are not meant to gather dust
can be used to better manage future situations and health risk assessment process. That knowledge can be
on a shelf. They are designed as a working tool for
ultimately contribute to a safer and healthier society. applied to a wide range of situations and activities with
risk management and should be used as such. Health
the potential to affect our health. These situations
risk assessments can contribute to decisions made
It is important to realise that the information provided may include mining, agriculture, all types of industry,
in risk management such as prioritising issues and
by a health risk assessment is one of considerations manufacturing, food-production, waste-disposal,
actions according to risk, setting of specific health
that will be taken into account in making decisions planning and many others. In general, the nature
based criteria for projects and developing plans to
about new projects. Other considerations and sources of the project will dictate what level and areas of
reduce certain risks. If measures to reduce risk are
of information – technical, economic, environmental, government are involved in any health risk assessment.
implemented, health risk assessment can be used as an
cultural and political – can all contribute to the effective
effective tool to re-assess the impact of the reduced or An example of the increasing recognition of the
risk management of any project. This is all part of the
residual risk. As well as providing a revised estimate complex nature of many development projects is
integrated approach to risk management that attempts
of risk this provides stakeholders with information the introduction in 2004, of the Integrated Project
to reflect the complex nature of our world.
regarding the effectiveness of the measures that have Approvals System. This system, specifically for
been implemented. projects within the State Development Portfolio, was
developed to coordinate the approval process for
Health risk assessment should be seen as a process
complex projects, requiring agreement from numerous
that can serve all stakeholders. Whilst health risk
Government agencies. The Department of Health
assessments can address situations where stakeholders
or the Environment Protection Agency, may state
hold a range of conflicting views, each with
the need for a health risk assessment. The Office of
legitimate arguments, it is essential that the process
Development Approvals Coordination, based at the
is independent of these viewpoints and provides an
Department of Premier and Cabinet, will assist in the
objective assessment. Health risk assessments that
coordination of the approvals process.
are accepted as objective by all groups will provide
far greater benefits than an assessment that is
considered subjective. A well accepted, objective
assessment can provide valuable information for
proponents, for communities and for government
departments. Decisions based on such information
will generally be held in greater confidence by
all stakeholders and contribute to more effective
management of the project.
Page 18 Health Risk Assessment in Western Australia

References General Framework for a Health Risk Assessment*

Citizens and Civic Unit (2002) - Consulting Citizens: A Resource Guide. Department of the Premier and Questions to Address Results
Cabinet, Western Australia
(http://www.ccu.dpc.wa.gov.au) Issue Identification What are the issues, why are they an issue and Overall scope and plan of the health risk
what is causing them? assessment.
Citizens and Civic Unit (2003) - Consulting Citizens: Planning for Success. Department of the Premier and
What issues are priorities?
Cabinet, Western Australia
(http://www.ccu.dpc.wa.gov.au) What are the possible adverse health effects
and when are they likely to occur?
Citizens and Civic Unit (2005) - e-Engagement: Guidelines for Community Engagement using Information
and Communications Technology (ICT). Department of the Premier and Cabinet, Western Australia What questions do we need to answer?
(http://www.ccu.dpc.wa.gov.au) What information is needed to answer these
questions and is this information available?
Department of Environment (2001) - Development of Sampling and Analysis Programs. Contaminated
Sites Management Series. Will a health risk assessment answer these
(http://environment.wa.gov.au) questions?

Department of Environment (2004) - Potentially contaminating activities, industries and landuses. What are the boundaries of the assessment
Contaminated Sites Management Series. and what level of effort is justified?
(http://environment.wa.gov.au)
Hazard Identification What are the hazards and their likely health Major conclusions.
Department of Environment (2005) - The Use of Risk Assessment in Contaminated Site Assessment (Draft). effects?
Contaminated Sites Management Series Level of uncertainty
(http://environment.wa.gov.au) How long is the hazard likely to last?
Clear statement of methods.
What data was used?
enHealth 2004 - Environmental Health Risk Assessment: Guidelines for assessing human health risks from Quality of data.
environmental hazards. Department of Health and Ageing and enHealth Council. Major assumptions
Dose-Response Assessment What data was used?
(http://enhealth.nphp.gov.au)
What models were used and why? Relevance of information or data used.
enHealth 1999 - The National Environmental Health Strategy. Department of Health and Ageing.
(http://enhealth.nphp.gov.au) Does the route & level of exposure in the data
used reflect the situation?

If not, how are these differences taken into

account?

Exposure Assessment What are the most significant sources and

pathways?

What populations have been assessed–general,

exposed and susceptible groups?

What monitoring or modelling was used?

How was exposure described and calculated?

Risk Characterisation What are the risks to different groups? Overall picture of risk

Feedback information or questions to previous Major conclusions

steps.
Uncertainty
Summarise major conclusions and strengths of
each of the main steps.

Provide information to risk management team

*This framework gives examples of the type of questions that a health risk assessment may address. It is not intended
to cover every aspect of every situation.
© Department of Health, 2006