Risk perception is capable of turning every threat into an attraction but usually stops short of making death desirable. If parachuting were as safe as a day at ​​the office, would it have the same thrill?

Several speakers challenged attendees to think about how they can effectively communicate risk issues given the general population’s difficulty understanding numbers and concepts such as relative risk. Summaries of a few keynote and plenary sessions are provided here. SUBCONSCIOUS VS. CONSCIOUS THINKING Keynote speaker Professor Paul Dolan of the London School of Economics focused on the role of processes in human behavior. “Context matters,” Dolan said, when examining people’s behaviors, since behaviors are often both unconscious and automatic. He provided several examples where changes in environmental factors affected behavior. In one study he conducted, participants were more truthful when exposed to brighter lights; in another, participants were more truthful on their tax returns if they signed them before filling them out. Since we are poor observers of our own behaviors, Dolan said, past behaviors are much better predictors than what people say they will do. Dolan said that it is difficult if not impossible to change behaviors that are governed by a person’s unconscious. He summarized the groundbreaking work of Nobel Prize recipient Daniel Kahneman, who observed that people think and act according to two different brain systems: the subconscious (system 1) and the conscious (system 2). System 1 makes your life easier: the subconscious makes 10,000 automatic decisions for you each day (though not all of those decisions may be good ones). System 2 is deliberate and requires effort. Dolan asserted that humans do System 2 thinking as infrequently as possible because it takes time and requires attention, and therefore results in inattention to other things, such as your surroundings and the road ahead. For effective workplace interventions, Dolan suggested that it’s important to understand both the subconscious and the conscious systems. While it is difficult to change what people think, it is possible to change what they do by finding evidence consistent with their personal beliefs. Affecting a person’s beliefs requires effective messaging from a familiar or trusted source. He used an example of an effective public health intervention in Zimbabwe where hair dressers conveyed a message to their clients about controlling AIDS. The challenge is to make the message clear and relevant. MICROMORTS AND MICROLIVES Professor Sir David Spiegelhalter, a statistician from the University of Cambridge, demonstrated that people struggle with numbers, an important point regarding risk characterization, especially coming from a statistician. Framing the information is everything: he advised attendees to choose metaphors and analogies carefully and remember that audiences usually do not engage unless the information is something they want to know. And he advised against using relative risk when characterizing risk; it’s better to use whole numbers. Spiegelhalter introduced two innovative metrics for risk communication. To characterize small risks, he suggested the “micromort,” a measure that corresponds to a one-in-1-million chance of death. The average risk for a typical life is 1 micromort per day. A newborn on her first day of life experiences a risk of 15 micromorts—a level of risk she won’t see again until she reaches age 60. The micromort provides a useful perspective on risk. For example, seven-year-old children are generally thought to be a high-risk group, yet at no other age is life safer than at age 7, which carries a risk of just 0.5 micromort. Spiegelhalter also introduced the “microlife.” One microlife corresponds to one of 1 million 30-minute intervals in 57 years. Your first 20 minutes of exercise earn you 2 microlives, while smoking six cigarettes subtracts 2 microlives. Spiegelhalter asserted that risk perception is capable of turning every threat into an attraction but usually stops short of making death desirable. If parachuting were as safe as a day at the office, would it have the same thrill? Danger and thrill are measured not only in the head but also in the bones. Objective measures of harm are not irrelevant to subjective thrills, but if we want to feel safe undertaking something thrilling and even a bit dangerous, we tell ourselves, “I’ll be all right.” For many others, the old saying “risk has its own reward” has to be taken seriously. People choose different levels of risk for different aspects of their lives. Attitudes vary even within individuals; for many people, risk is strangely but carefully compartmentalized. People do not actually judge risk, they judge consequence—but always after the fact, whether the risk was great or infinitesimal. ​ A SCIENTIFIC REVOLUTION Professor Alan Goldberg, a toxicologist from The Johns Hopkins University Bloomberg School of Public Health, used examples from his long and distinguished career in developing alternatives to animal testing to address the question, “how do we use in vitro data to achieve in vivo risk assessment?” He addressed everything from quantitative laboratory work to qualitative public policy challenges, while reminding the audience that throughout history, scientific revolutions “necessitated the community’s rejection of a once time-honored theory in favor of another incompatible with it.” Professionally, Goldberg said, we need to be wary of decades-old extrapolated animal testing data because in vitro testing wi​​th human cells is more specific. We are nevertheless in need of better tools and techniques to map the pathway from hazard, to risk, to safe. In the era of big data, pathway mapping is just as critical as a clear understanding of how to judge risk and safety because we now have the ability to detect a response to any exposure, regardless of whether that exposure is significant or meaningless. Goldberg boldly concluded that human health risk assessment is in the midst of a scientific revolution. BIGGER THAN SAFETY Dr. Alistair Fraser with Royal Dutch Shell delivered a lecture that touched on Shell’s decades of work in developing a “culture of health.” Fraser asserted that if we get health right, we will automatically drive safety. “While safety gets the attention, health is bigger than safety,” Fraser said. Teams need to be resilient to effectively manage risk, and worker engagement is central to generating a culture of health. Shell’s data shows a strong link between engagement and health and safety. Fraser said the key is to trust people to be adults, engage them, and give them tools. He introduced a notion of risk that goes beyond our traditional notion of hazard and severity/exposure. Our profession will have significant opportunities to have impact on risk if we define it as:

There is broad professional and public interest in exposure assessment, risk characterization, risk communication, and risk management. Many other exciting and dynamic initiatives were discussed at the IOHA/BOHS conference, including product stewardship, occupational exposure banding, and modeling. Those topics also intersect with the topic of risk. As a result, there are many opportunities for collaboration to address the varied challenges facing our profession worldwide.