Context. Individuals make decisions every day that reflect how they value health and mortality risks, such as driving an automobile, smoking a cigarette, and eating a medium-rare hamburger. There are no cost-free or risk-free decisions; each choice involves trade-offs and judgment of the risk-reward balance. Many choices involve market-based economics, such as using a hazardous product or working on a risky job. Because increases in health risks are undesirable, there must be some other aspect of the activity that makes it attractive. Context becomes more complex as risk management raises issues about “whose risk” and risk appetite as well as the insurability of transferred risk. Residual risk. Residual risk gets at the core of risk decision making and management. The conundrum in risk decision making reveals itself when we recognize that zero risk is impossible to achieve. At best, we manage to achieve a residual risk that is not unacceptable and thus defined as safe. Even when residual risk is low (for example, 1 in 10-3) or extremely low (1 in 10-53), risk for the population cannot be zero, and humans will judge a risk according to its consequence, not its probability. If an undesirable consequence occurs—and there are undesirable consequences associated with every hazard and risk—then surely someone must be to blame for “allowing” it to happen. From a government perspective, all policy choices ultimately involve balancing additional risk reduction and incremental costs as well as society’s willingness to pay for the benefits. Based on implicit tradeoffs between risk and money, economists have developed estimates of the “value of statistical life” (VSL), which provide a reference point for assessing the costs and benefits of risk reduction efforts and government risk policies ranging from the draining of swamps near ancient Rome to suppress malaria to the limits on air pollution in developed countries over the past 30 years.  Perception vs. science. Perhaps the most vexing aspect of risk is the tension between risk perception and science. People judge the consequences and outcomes of risk according to their emotions and perceptions, yet the calculation of risk is cognitive and scientific. Emotions are essential to decision making because positive emotions are often the desired ends of our decisions, but we can only choose what course to take if we know what will make us happy. Industrial hygienists who recognize this paradox can communicate more effectively while engaging workers, management, and the public, being leaders in innovative thinking, and exploring the soundness of risk management considerations. Emotional response. As much as we might like to think humans are rational creatures, we are driven by beliefs and emotions. Kahneman and Tversky showed that humans systematically make choices that defy clear logic. We simply don’t have the time or capacity to calculate the statistical probabilities and potential risks that come with every choice. Most truly important decisions rely at least in part on subjective preferences. Some may call these preferences “instincts”; in fact, they are not instincts but heuristics—learned mental shortcuts that allow our subconscious to focus on one key factor to make a decision, rather than taking into account every tiny detail. RISK MANAGEMENT SYSTEMS AND WORKER HEALTH  The International Organization for Standardization recently published ISO 45001, the first global standard for occupational health and safety management systems. According to ISO, the standard

provides a framework to improve employee safety, reduce workplace risks and create better, safer working conditions, all over the world.… [ISO 45001 was] developed by a committee of occupational health and safety experts, and follows other generic management system approaches such as ISO 14001 and ISO 9001. It will take into account other International Standards in this area such as OHSAS 18001, the International Labour Organization’s ILO-OSH Guidelines, various national standards and the ILO’s international labour standards and conventions.

ISO 45001, like all other regulations, consensus standards, and policies, does not purport to eliminate risks or ensure no worker will ever be injured or develop an occupational disease. We return to the reality that zero risk, if that is the objective, is not attainable.  Risk is context-dependent, and judging risk demands upfront agreement on terms, units of measure, and metrics. To what or whom is something a risk—the organization, the worker, the community, the environment, or the biota? Depending upon the context, a risk may be acceptable (or not unacceptable), which we define as “safe.” As risk management concepts have evolved, more attention has been placed on notions such as “responsible party,” “risk owner,” “risk transfer,” and “sustainability.” But the Occupational Safety and Health Act places the responsibility upon the employer to provide a work environment “free from recognized hazards that are causing or are likely to cause death or serious physical harm.” Today, when it can be difficult to identify both the workplace and the employer, the question arises, “who controls the place of work, and thus, who is responsible for health and safety?” STRUCTURED DECISION MAKING Risk analysis and risk management decision making need to be systematic and structured. Structured decision making is a term for organized analysis of problems to reach decisions that are focused on achieving defined objectives. In structured decision making, every decision comprises several primary elements—management objectives, decision options, and predictions of outcomes. Analyzing each of these elements separately and thoughtfully leads to improved decision making. Structured decision making is as useful for minor, personal decisions as it is for complex public-sector issues involving multiple decision makers, scientists, and stakeholders. The steps of structured decision making are: 1. Define the problem. What decision has to be made? What is the spatial and temporal scope of the decision? Will the decision be iterated over time? 2. Define objectives. Management objectives should be measurable. Setting objectives falls in the realm of policy, and should be informed by legal and regulatory mandates, as well as stakeholder viewpoints. 3. Define alternatives. What are the different management actions to choose from? The range of permissible options is often constrained by legal or political considerations, but creative new alternatives may be found. 4. Analyze consequences. What are the consequences of different management actions? How many of the objectives would each alternative achieve? This step may use a model to predict the consequences of the alternative actions. Depending on the information available or the quantification desired, consequences may be modeled, ideally, with computer applications or with careful and transparent personal judgment. 5. Analyze tradeoffs. If there are multiple objectives, how do they trade off with each other? In most complex decisions, the best we can do is choose intelligently between less-than-perfect alternatives. Numerous tools are available to help determine the relative importance of conflicting objectives and to compare alternatives to find the “best” compromise solutions. Clearly, the analysis of consequences and tradeoffs involves judgments of values, preferences, and risk attitudes. 6. Acknowledge uncertainty. Decisions are frequently made in the face of uncertainty, which makes choosing among alternatives more difficult. Confront uncertainty and evaluate the likelihood of different outcomes and their possible consequences. 7. Understand risk tolerance. Identify the greatest uncertainty that clouds decision making and analyze the risk related to that uncertainty. The decision- making process will be more objectives driven, transparent, and defensible if informed by an understanding of the level of risk a decision maker is willing to accept. 8. Sequence linked decisions. Many important decisions are linked over time. The key to dealing effectively with linked decisions is to isolate and resolve the near-term issues while sequencing the collection of information needed for future decisions. For example, when addressing supply-chain questions, initially focus on issues that are causing adverse effects right now before investigating more insidious issues. THE SCIENCE OF CHOICE NIOSH’s Total Worker Health initiative has expanded the domain of the industrial hygienist beyond our traditional focus on exposure and on ensuring that work is safe and that workers are protected from the harms that arise from work itself. According to NIOSH, Total Worker Health “builds on this approach through the recognition that work is a social determinant of health; job-related factors such as wages, hours of work, workload and stress levels, interactions with coworkers and supervisors, access to paid leave, and health-promoting workplaces all can have an important impact on the well-being of workers, their families, and their communities.” Total Worker Health clearly goes beyond any regulation, consensus standard, and policy. Perhaps Total Worker Health is clear demonstration of AIHA’s tagline, “Protecting Worker Health.” If Total Worker Health fulfills our mission to protect worker health in today’s globalized and nebulous place of work, how does our profession meet the challenge? What additional skills do we need to learn? Historically, we’ve focused on workplaces (factories, offices), but today more than 30 percent of the U.S. labor force comprises contingent workers whose places of work may not meet the definition a “workplace” in OHS laws and regulations. How can the science of choice help forward-looking industrial hygienists build healthy places of work? Are the topics of “residual risk” and “safe” the best lens through which we can provide the greatest value to employers, workers, the public, and the environment? These challenges, as well as inherent tensions and paradoxes, can be addressed by mastering structured decision making across the five dimensions of risk science: assessment, characterization, communication, analysis of benefits and costs, and management.    FRED W. BOELTER, CIH, PE, BCEE, FAIHA, is principal at RHP Risk Management Inc. He can be reached via email. CHARLES F. REDINGER, PhD, MPA, CIH, FAIHA, is president of Redinger 360, Inc. in Harvard, Mass. He can be reached via email. Send feedback to The Synergist.