Kerstin Maja DRESSEL, Steffen SCHUELE sine-Institut gGmbH, Germany, Federal Republic of

1. A New Concept of Risk Governance in the Field of
Public Health
-The Case of Hantavirus Disease in Germany-
IDRC Conference, Davos, Switzerland
Session: Environmental changes & health implications
28th August 2012
Kerstin Dressel & Steffen Schüle
sine-Institute gGmbH Munich (Germany)

2. EDENext: Biology and control of vector-borne
infections in Europe
•EU-funded project under 7th FP
•46 partners in 22 countries
•Investigate the biological, ecological, epidemiological
and social components of vector-borne infections and
•Consequences triggered by VBD for human and
veterinary Public Health (PH)
 In order to meet the new challenges of PH a re-
conceptualization of PH is suggested:

3. IRGC Framework and Methods
The IRGC Risk Governance Framework: a (new) helpful tool for assessing public health risks
Scientific Risk Assessment
An effective combination for Public Health resarch!
Concern Assessment
International Risk Governance Council, 2008
Pre-assessment: addressing and framing the health risk
Risk Appraisal: combination of scientific risk assessment and concern assessment
Characterisation and evaluation: Is the risk tolerable and /or acceptable?
Management: to take actions
Communication: to establish an interactive two-way communication process

4. Study Framework and Methods
CONCERN ASSESSMENT within the EDENext PH risk governance appraoch
Top-down approaches in public risk communication Methods:
Risk communication strategies:
- Public health authorities
Intra -and
- Stakeholders Inter-communication
Improvement of
risk communication
strategies
? ?
- Risk associations and concerns
- Risk knowledge
- Risk behaviour
- Information behaviour
- Assessment of received information
Bottom-up perspectives of public risk perception & information expectations

5. Development of the Hantavirus in Germany
Age Number of cases
00..00 3
01..01 0
02..02 0
03..03 2
04..04 2
05..09 29
10..14 101
15..19 352
20..24 585
25..29 630
30..39 1627
40..49 2341
50..59 1380
60..69 647
70+ 286
Total 7985
Source: Robert-Koch-Institute, 8/8/2012
• No studies, which analyzed public risk perception of Hantavirus
• Lack of knowledge how risk perception influence risk behaviours and the acceptance
of risk communication strategies

6. Public concern assessment – Endemic areas examined
Distribution of Hantacases (2001-2012)
and places of focus groups
Focus group discussion in the Bavarian Forest
Source: Robert-Koch-Institute, 8/8/2012

7. Results – First Risk Associations
Scientific Risk Assessment Concern Assessment
What are your first associations regarding the Hantavirus
or mice transmitted diseases?
Performed by scientific
risk assessors within
Public Health & research
departments

8. Findings from expert interviews – risk perception
PH authority/gov. level Stakeholder level
• Risk of HV is present in • Risk of HV is recognized
Germany • Risk on a regional scale
• Risk perception is • Only relevant for specific
increasing risk groups
• Risk only in endemic
regions
• Risk of HV is relatively
small
• VBD are considered of
increasing importance

9. Findings risk perception of the general public
PH authority /gov. – evaluation General public
• Public risk perception of • FG attendees reported that
HV is not considered to be they consider the HV to be
very high a moderate risk to Public
• Ignorance of the HV, Health, but:
particularly in non- • Increased risk perception
endemic areas when people know other
people, who were already
• In endemic regions
affected by HV (‚disease
increased awareness of proximity‘)
HV due to risk
• Occupational risk groups
communication
show increased awareness
of the HV risk and are
better informed about the
health risks of HV

10. Findings: Evaluation of risk perception of
general practitioners
PH authority/gov. level General public
• In the first years of HV in • Attendees of the group
Germany GP were discussion reported high
insufficiently aware of trust in local GP
the HV disease • Awareness of the GP has
(unspecific symptoms) clearly increased since
Underreporting HV became a notifiable
• However, situation has disease (2001).
changed, especially in
endemic areas

11. Results – risk communication
Top-down approaches in public risk communication

12. Findings – risk communication
PH authority/gov. level General public – information
– information provided expectations
• Information sheets will be • Information sheets provided
provided by community bulletins
• Behavioural cues are • Local newspaper
included in the sheets • Local radio and TV reports
• Publishing articles in • Black boards at the city hall,
scientific journals etc. in doctors‘ practices and
pharmacies
• Issue press releases (local
• Information material
press!) provided by insurance
• Placing warning signs companies
• Informing local physician, • Special information
stakeholders, etc. campaign for tourists
• Recurring information
campaigns

13. Conclusions (1)
•Meaningful health communication strategies have to be established
on consolidated knowledge of the risk perception, risk knowledge,
coping strategies and information behaviour and expectations of the
public.
• A holistic, interdisciplinary approach towards Public Health is
essential for improvements of risk governance.
•The proposed adapted IRGC risk governance framework could not
only be applied for an integrative risk management of vector-borne
diseases, but should be considered a new and innovative approach
towards Public Health.

14. Conclusions (2)
• Risk communication without (feeling of) personal affectedness is
problematic  local activities in endemic regions
• Risk communication should address scientific uncertainties
•Newspaper articles are perceived more trustful if references to
public health authorities are made

15. Questions?
Dr. Kerstin Dressel, sine-Institut München,
Germany
kerstin.dressel@sine-institut.de
Don‘t worry dear!
I´m going to
get the broom!