What do friends and the media tell us? How different information channels affect women’s risk perceptions of age‐related female infertility

This paper investigates through which channels women receive information about the general risk levels of age‐related female infertility and how the different channels affect women’s perceptions of the risk. We find that the media reaches women of all ages, while only about one woman in four has received information from the health care system. We also find that friends and relatives are an important source of information that affects women’s risk perceptions. However, the information from friends and relatives seems to generally make female recipients more likely to overestimate the risks. We conclude that the information sources have different, sometimes even opposite, impacts on the risk perceptions, possibly making it harder for a woman to be aware of the true general risks of age‐related infertility.     

Risk communication for catastrophic events: results from focus groups

Focus group methods are adapted here to address two important needs for risk communication: (1) to provide approaches to risk communication in very extreme and catastrophic events, and (2) to obtain risk communication content within the specific catastrophe area of chemical and biological attacks. Focus groups were designed and conducted according to well‐established protocols using hypothetical sarin and smallpox attacks resulting in a chemical or biological release in a confined public space in a transit system. These cases were used to identify content for risk communication information and suggest directions for further research in this area. Common procedures for conducting focus groups were used based on an initial review of such procedures. Four focus groups – two for each type of release – each lasted about two hours. Participants were professionals normally involved in emergencies in health, emergency management, and transportation. They were selected using a snowball sampling technique. Examples of findings for approaches to communicating such risks included how information should be organized over time and how space, locations, and places should be defined for releases to anchor perceptions geographically. Examples of findings for risk communication content are based on how professionals reacted to risk communications used during the two hypothetical releases they were presented with and how they suggested using risk communications. These findings have considerable implications for using and structuring focus groups to derive risk communication procedures and types of content to be used in the context of catastrophes.     

The end of risk communication as we know it

According to the US National Research Council, risk communication ought to be viewed as a dialogue among people conducted to help facilitate a more accurate understanding of risks and, related, the decisions they may make to manage them. But, in spite of this widely accepted perspective on risk communication, there is often a disconnect between how it is defined and how it is practiced. Rather than focusing on a true dialogue aimed at improving risk assessments and risk management decisions, risk communication is often viewed as means of simply educating people about existing risk assessments so that, on their own, they might make (or contribute to) better risk management decisions. More worrisome, risk communication is still often seen as a means of ‘correcting’ misconceptions about, or perceptions of, risk; in other words, risk communication is used as a vehicle for attempting to align lay perceptions with their expertly assessed severity. In this paper, I argue that risk communication must become more decision-focused if it is to meet the objectives set forth – in 1989 – by the US National Research Council.     

Examining inequities in children’s environmental health: results of a survey on the risk perceptions and protective actions of new mothers

Young children are more highly exposed and vulnerable to environmental health hazards than adults due to a variety of physiological and behavioural factors. Despite the significant responsibility mothers typically bear in managing their children’s health, little is known about how they perceive and negotiate these risks in their day-to-day lives. To better understand mothers’ environmental health risk perceptions and associated protective actions across socio-economic and geographic contexts, a telephone survey was conducted among new mothers (n = 606) recruited through two Public Health Units in Ontario, Canada. Analyses revealed that approximately half of the respondents were moderately or highly concerned about environmental health risks, ranging in nature from household products to outdoor air contaminants. Factors affecting the likelihood of experiencing concern included lower income and lower levels of perceived control. With regard to protective actions, 43% reported taking three or more actions to reduce environmental health risks to their children, with the likelihood of taking action being negatively affected by factors including low income and first language other than English or French, and positively affected by being a first-time parent (primiparous). This study contributes to our understanding of environmental health risk perceptions and associated protective behaviours among new mothers, and has implications for the development of more context-focused risk management and communication strategies.     

Evaluating lotteries,risks, and risk‐mitigation programs

Two experiments were designed to explore the existence of systematic differences in risk perceptions and risk attitudes between Chinese and US participants. The first experiment involved ranking monetary lotteries using measures of perceived riskiness and willingness to pay (WTP). Several simple heuristics were evaluated to predict perceived riskiness and WTP. Using WTP responses, Cumulative Prospect Theory functions were determined for participants from both countries. The second experiment involved ranking multi‐attribute real‐world risks and associated risk‐mitigation programs using measures of concern and preference, respectively. Compared to their US counterparts, Chinese participants are found to be less risk averse, more concerned about risks with higher catastrophic potential, and more in favor of risk‐mitigation programs with greater scope of benefit. The results also reveal higher within‐group agreement by Chinese participants for all tasks. For both national groups, the within‐group agreement was highest when ranking risk‐mitigation programs, but lowest when ranking lotteries with negative expected value. The implications of cross‐cultural versus cross‐task variation are discussed.     

Risk perceptions and risk attitudes among Chinese consumers: the toxic capsule crisis

The toxic capsule crisis (TCC) shocked China in 2012, and seriously harmed consumer confidence. Based on a firsthand survey in 12 provinces with 850 observations, this paper examines Chinese consumers’ risk perceptions and risk attitudes about drugs after the TCC. The empirical results suggest that Chinese consumers’ risk perceptions (attributed likelihood of a drug safety accident occurrence) and risk attitudes (measured as level of concern about drug labeling) are weakly negatively correlated, but that risk perceptions are positively correlated with consumer concern about drug safety problems in general. Risk perception was higher among male consumers and those from rural areas, reporting a religious faith, of higher education, and with a family member who has experienced problems caused by drug safety problems. Those reporting a higher level of concern about drug safety issues, with a higher level of understanding of TCC, who reported less frequent physical examinations, and who searched for information after the TCC also had a higher level of risk perception. Being or having a family member who engaged in the health industry and being more satisfied with the government response to the TCC decreased risk perception. Regarding risk attitude, older consumers, those with a higher level of education and with a self-reported religious faith, and those less prepared including those who did not purchase health insurance, do not have health exams as frequently, and who do not take measures of protection and isolation when ill are more concerned about drug labeling information.     

Risk management challenges of shared public services: a comparative analysis of Scotland and Finland

This paper analyses the risk management challenges of shared service provision in Scotland and Finland. Policy context and institutional frameworks largely determine the local choice of organizational arrangements and so the risks that arise and the way they are shared. Finnish municipalities have developed joint municipal arrangements for sharing services, whereas Scotland's shared service challenges are related to the historical separation of health and social care services and the search for cost savings while improving service effectiveness.     

The ‘Plateau‐ing’ of the European Better Regulation Agenda: An Analysis of Activities Carried out by the Barroso Commission

In this paper we examine cases commonly characterised as risk‐risk tradeoffs (i.e., creating new risks while solving existing ones), in an attempt to learn lessons that can be valuable for future regulatory decision‐making. A broad range of environmental and health literature was reviewed and numerous cases of proclaimed risk‐risk tradeoffs were analysed in order to determine: 1) why regulatory measures were initially taken, 2) why these measures caused a countervailing risk to emerge, 3) how tradeoffs could have been avoided, and 4) whether the case is a good example of a risk‐risk tradeoff. The analysis reveals that only a small number of these cases can actually be considered risk‐risk tradeoffs. In a large number of cases safer alternatives are and were available at the time decisions were made. In some cases the proclaimed risk‐risk tradeoff simply did not exist or occur, and in some cases countervailing risks were ignored for reasons unknown. In many cases, the countervailing risks could have been anticipated and avoided by proactively seeking safer alternatives, completing a tradeoff and impact assessment, or increasing stakeholder input in the decision‐making process. We conclude that concerns about risk‐risk tradeoffs are not a reasonable argument against future application of the precautionary principle. Indeed, sound decision‐making processes in the face of uncertainty should always consider and attempt to mitigate reasonable risk‐risk tradeoffs.     

Client Risk Factors and Audit Resource Allocation Decisions

While contemporary auditing standards such as ISA 315 provide broad categories of client risks, prior research regarding audit resource allocation decisions has been based on individual client risks. This study contributes to the literature by using factor analysis to examine how individual client risks are categorized into broad risk factors and by examining the extent to which such broad risk factors are associated with audit engagement planning decisions. These issues are important because auditing standards direct auditors to consider risk patterns and interrelationships in addition to individual risks. Finally, we consider additional individual client risks that reflect those relevant to contemporaneous audit approaches and have not been examined in prior studies. Based on archival data extracted from the working papers of 228 clients of a Japanese audit firm, we find that individual client risks empirically group together in a way that is similar to categories discussed in recent auditing standards. We also find significant relationships between audit resource allocation decisions and broad risk factors that have not been found in prior studies which use individual risk assessments in their models. Finally, we find that client risks that are emphasized in holistic audit approaches such as aggressiveness of forecasts and industry decline also have a significant impact on audit resource allocations.     

Emotions,attitudes, and appraisal in the management of climate-related risks by fish farmers in Northern Thailand

Many previous studies have documented that farmers are risk-averse, while other studies have shown that farmers analyze and estimate risks. Conventional risk aversion measures and analytical judgment often do not fully explain decision behavior. Thus, it may be necessary to consider emotions. The objective of this study was to enhance understanding of the interactions between attitudes, analysis, and emotions in making risk decisions. The study used a mixture of methods, including: a tablet game, risk aversion scales, in-depth interviews, and focus group discussions with fish cage farmers in Northern Thailand. There was no significant difference in risk aversion with respect to gender, age group, or region. Having sufficient capital made it possible to take more risks. Recently being impacted by floods or droughts, or being very concerned with climate change, was not associated with taking fewer risks. Measures of risk aversion did not predict risk decisions. Feeling worried, concerned, anxious, or stressed were the most common negative emotions referred to in interviews. Fear was a reason for not taking risks. Common positive emotions were joy, excitement, and feeling relaxed or relieved. Men who expressed feeling excited or thrilled chose riskier, higher stocking densities in games than women. A common belief was that men were quicker and more confident when making decisions. Another was that emotions had little impact on decisions, but were a response to success and failure – a claim inconsistent with other findings that imply emotions are also important prior to stocking decisions, and while waiting for the harvest. Fear and anxiety in the period prior to harvest may help motivate risk management practices, such as close monitoring and aeration. In conclusion, emotions may play a more important role in making decisions about climate-related risks than was previously recognized.     

Genetic risk and value

A conceptual truth about risks is that they involve a possible and future adverse effect or a negative value of some kind. The genetic risks that individuals may face in the health care setting differ in some crucial respects to other kind of risks. The aims of this paper are to analyse the notion of value in the context of genetic risk in the setting of health care, and to suggest a conception of the evaluative aspect of genetic risk that is fruitful for genetic risk information. Two influential and relevant approaches to value, preferentialism and the capability approach, are discussed in the light of certain distinctive features of genetic risk and a third, a sensibility theory of value is suggested. According to this view, the concept of risk is a so-called ‘thick’ evaluative concept that has both a world-guiding function as well as an action-guiding or normative function. It is argued that this provides a more promising way to think about genetic risks in the clinical setting.     

Choosing between precautions for nanoparticles in the workplace: complementing the precautionary principle with caring

Workers who develop and use nanoparticles are on the front line of exposure to the purported risks of nanoparticles. Employers have a legal duty to protect their employees against any work-related harm. However, it is difficult to perform the required risk assessment and management when dealing with uncertainty. Risk ethicists have therefore argued for using the precautionary principle to guide such decisions on uncertain risks. In this paper, I argue that if we want to make use of innovative products, such as nanomaterials, but lack the knowledge and shared standards for choosing between protective measures, the precautionary principle is underdetermined. For the use of nanoparticles in working environments, there are several guidelines that suggest different precautionary strategies for dealing with their purported risks, but choosing between these guidelines proves difficult in the absence of a clear, scientific, decision principle. I therefore explore the ethics of care to develop a complementary decision criterion for the precautionary principle. From this perspective, the caring qualities of working relationships are key in comparing precautions with each other. I propose three conditions for assessing risk management strategies based on (1) the existence of a mutual concern for employee health and safety, (2) the connectedness and continuity of the relationships between employer and employee, and (3) the responsiveness of employers to employee needs. Using these criteria will support choosing between precautions, by shifting attention from the acceptability of imposing a risk to creating a social context in which the imposition of the residual risks can be considered acceptable.     

Commonplaces in Risk Talk: Face Threats and Forms of Interaction

Talk about risk is problematic for interaction; it can involve the speaker or hearer saying things that threaten participants' ‘face’, the ways they want themselves to be seen by others. One way of dealing with these threats to face, and to keep the conversation going, is the use of commonplaces. Commonplaces, generally applicable and generally known arguments, play an important role in interaction, invoking shared, taken‐for‐granted perspectives embedded in familiar roles and everyday practices. They are similar to some of the frames discussed in risk communication, but they focus our attention on rhetoric and interaction rather than cognition. In this paper, I show how commonplaces are used in focus group discussions of public choices involving dangers to life or health. They tend to be used in response to dilemmas, when a speaker is put on the spot, and they tend to lead to other commonplaces. Analysis of commonplaces supports those who argue that studies of public perception of risks and programmes of communication about risks need to be sensitive to the personal interactions, rhetorical strategies, and cultural embeddedness of any risk talk.     

Healthcare professionals’ perceptions of risk in the context of genetic testing for the prediction of chronic disease: a qualitative metasynthesis

Advances in genomic technologies and a growing trend towards stratified and preventive approaches to medicine mean that increasing numbers of individuals may have access to information about their genetic makeup, and their risk of developing diseases. This is likely to impact on healthcare professionals involved in the delivery of genetic tests, or in supporting patients who are affected by a disease with a genetic risk factor. It is therefore important to understand healthcare professionals’ perceptions about providing these services, and how they feel about communicating information about genetic risk to patients. This paper provides a systematic review and metasynthesis of qualitative research exploring healthcare professionals’ perceptions of genetic risk in the context of predictive genetic testing for chronic disease. Healthcare professionals expressed a range of reservations about the utility of predictive testing in this context. Professionals judged patients’ understanding of risk information to be limited and subject to bias and a range of sociocultural influences. Concerns about the psychosocial impact of genetic risk information were frequently cited, both in relation to individual patients and the wider impact on their families and communities. The need for provision of multidisciplinary support was described. The concept of responsibility was also an important theme. Healthcare professionals recognized the responsibility that accompanies risk knowledge, and that ultimately this responsibility lies with the patient, not the provider. Our analysis suggests that professionals’ evaluation of the utility of predictive genetic testing is influenced not only by resource deficits, but may also be interpreted as a response to challenging ethical and social issues associated with genetic risk, that are not well aligned with current medical practice.     

Shifting reactions to risks: a case study

Social science research in the field of risk analysis has emphasised evaluating the magnitude of individuals’ reactions to risks (e.g. strength and salience of concerns, frequency and forcefulness of behaviours that respond to risks). Fewer studies assess the factors that contribute to risk reactions or the types of risks to which reactions are directed (e.g. human health, wildlife health or ecosystem health risks; economic or aesthetic concerns). Theoretical and empirical research on amplification and attenuation of risk (e.g. the Social Amplification of Risk Framework) reveals that the strength of people’s reaction to risks can change markedly over time, as a function of new stimuli. We expand on this foundation to consider here how the types of risks members of the public react to may also shift over the course of their exposure to a hazard, particularly as more information about the hazard becomes available. This case study of risk reactions related to an outbreak of type E botulism in north-western Michigan, USA, demonstrates that the types of risks people react to can change substantially over time. We identify factors that contributed to changes in types of risk reactions, and then consider how these factors potentially distinguish the botulism outbreak from other outbreaks. This case study suggests that, under certain conditions, risk communication can meaningfully alter the types of risks that people react to in response to an environmental hazard. We discuss implications of these findings for risk research, risk communication and environmental conservation.     

Product pricing and solvency capital requirements for long-term care insurance

This paper presents a comprehensive assessment of premiums, reserves and solvency capital requirements (SCRs) for long-term care (LTC) insurance policies using Activities of Daily Living and US data. We compare stand-alone policies, whole life insurance policies with LTC benefit riders (LTC insurance combined with whole life insurance), life care annuities (LTC insurance combined with annuities) and shared LTC insurance in terms of net premium cost and SCRs. Net premiums and best-estimate reserves for base LTC insurance policies are determined using Thiele’s differential equation. Product features such as the elimination period and the maximum benefit period are compared using a simulation-based model. We show how a maximum benefit period can reduce costs and risks for LTC insurance products. SCRs for longevity risk and disability risk are based on the Solvency II standard formula. We quantify the extent to which whole life insurance policies with LTC benefit riders and life care annuities provide lower SCRs than stand-alone LTC insurance policies.     

The effects of risk‐taking tendency on risk choice and pre‐ and post‐decisional information selection

Ideally, people seek and select information about unfamiliar risks with which they are confronted, before they make a risk choice. This study investigated what happens when people do not have this opportunity. The main question was how risk‐taking tendency influences intuitive risk decisions and how this impacts subsequent information search and subsequent choices. In the present study, participants had to make a choice about an unfamiliar risk, either before or after they had had the opportunity to search for (risk‐promoting or risk‐averse) information. In the condition where they could only seek for information after they had made a choice, they had to reconsider their first choice and make a second risk choice. We expected that (1) risk‐taking tendency would impact people's risk choices, but only in the situation where they have little information. On the basis of cognitive dissonance theory, it was furthermore predicted that (2) risk‐taking tendency and (3) initial risk choice would affect risk information selection. Furthermore, we predicted that (4) the first risk choice and (5) the risk information selected would influence the subsequent risk choice. The results suggest that if people make a first, intuitive decision about an unknown risk, risk‐taking tendency has an effect on the choice, but that this does not happen when people can first select information. Risk‐taking tendency did not influence information selection, but initial choice did (although in another way than we expected). Furthermore, both the first risk choice and the risk information selected affected subsequent risk choices. These findings suggest that people often make initial intuitive decisions that are influenced by personality characteristics, and that are subsequently difficult to change.     

Household portfolio choices,health status and health care systems: A cross-country analysis based on SHARE

Health risk is increasingly viewed as an important form of background risk that affects household portfolio decisions. However, its role might be mediated by the presence of a protective full-coverage national health service that could reduce households’ probability of incurring current and future out-of-pocket medical expenditures. We use SHARE data to study the influence of current health status and future health risk on the decision to hold risky assets, across ten European countries with different health systems, each offering a different degree of protection against out-of-pocket medical expenditures. We find robust empirical evidence that perceived health status matters more than objective health status and, consistent with the theory of background risk, health risk affects portfolio choices only in countries with less protective health care systems. Furthermore, portfolio decisions consistent with background risk models are observed only with respect to middle-aged and highly-educated investors.     

A vision for Nicaragua : Health services in the new century

Nicaragua is facing a crisis in health and health care, and a health futures programme has been initiated to focus concern and mobilize key actors. Two national scenario workshops have been held at which participants constructed several scenarios describing alternative health futures for the country, with particular emphasis on the organization of health services. One or these, a scenario of profound change, was selected by the participants as their vision of the preferred future. It involves more emphasis on health promotion, decentralization of health-care services, broader participation in health matters, improved training for health professionals, and a stronger role for universities and other educational and research centres. Implications of the selected scenario regarding health policies and actions have been identified, among them being the adoption and implementation of the Ottawa Charter on Health Promotion, the organization of local health service networks, and the more active involvement of health professionals in the designing of health systems.     

A proposed enterprise risk management model for health organizations

Health care organizations are environments with high management complexity and subject to a constant exposure to risks. Enterprise risk management (ERM) has been studied and applied in different economic environments with the aim of improving organizational performance. However, the health sector still suffers from a lack of attention in this context, in particular with regard to the need for a high degree of financial transparency and for the establishment of process-orientated management, and this provides the motivation for the study described in this paper. An ERM model for health organizations is proposed, based on a systematic literature review and on seven case studies in Brazilian hospitals. An approach to economic risk assessment using indicators such as the cash flow at risk and the variability of costs and receipts from the proposed model is suggested. The health organizations involved in the case studies all interpret ERM as a source of information contributing to corporate governance, and the indicators listed provide constructive data for improvement-driven decision-making. Given the interest expressed by the organizations involved, further application and validation of the proposed model in subsequent studies is suggested.