In the last 2 decades India has seen 2 major exoduses triggered by health catastrophes: the first, after the Bhopal gas leak in 1984; and Surat's plague-scare exodus exactly 10 years later. But were the risks as great as the rumours which induced the panic? Perception of a risk is sometimes subjective. For instance, road accidents kill more than 4 persons every day in Delhi alone, yet, it rarely induces panic. Yet, perceived risks are a not always a figment of imagination. Far from it.
Risk assessment is a newly developing science. It attempts to predict the risk to a population from specific causes. The tool is effective for obtaining decision-support information, and to construct a hierarchy of risks which helps in prioritising abatement measures.
Society's perceptions of health risks, and its response are influenced by public memory and experience, economic status, culture and the ability to control the course of events. A risk which is not seen to be very frightening is accepted with less anxiety. Concern mounts once the perceived risk exceeds a certain acceptable threshold, fixed heuristically by people as a fuzzy line.
The bubonic plague outbreak in Beed district (Maharashtra) last August was seen as a local phenomenon, hence, caused little concern outside the district. But when the pneumonic plague hit Surat in September, it made world headlines and initiated garbage cleanups on a war-footing in most Indian cities. The Risk Homeostasis Theory today accepts human decisions regarding risk to be not very rational.
The need for effective risk assessment, and abatement measures consequent upon it, should be clearly understood. Surat has driven home the lesson that in this era of liberalisation, or Opportunity Management, with expanding business opportunities, neglect of a pro-active public health risk management, despite fetching no immediate financial returns, can cause an expensive backlash, and even undo the progress made by opportunity management. The plague has left behind a trail of tragic and needless loss of life; dislocation, stress and income loss to thousands of Surat residents; the loss of hundreds of crores of rupees; and the loss of face for India in the international community. This could have been avoided had a small risk management cell been operative in the Planning Commission, to advise on remedial action based on the plague alert issued just after the Latur earthquake.
Reducing risks through technology change, legislation, campaigns and a host of other administrative methods does not alter human behaviour unless these go along with programmes specifically geared to modify risk perceptions. There is a gap between a community's risk perceptions, which should be accepted as valid for a risk management programme, and good information, resources and organisation and the wherewithals to sustain such a programme. The government can help provide these by setting up national and state level risk management cells which will initially train risk management teams drawn from non-government organisations.
The first task of each risk management team is to create a hierarchy of perceived health risks based on very simple heuristic risk assessment techniques, such as the 'what if' and 'how can', in consultation with the specific communities that they choose to work with. The range of health risks that can be addressed by these methods are limitless. The next task is to separate risks into 2 groups -- those that can be abated with the community's resources, and those that require external intervention and assistance. The third task is to help the community set up health risk management programmes for the former group of risks.
This approach uses easily understandable, qualitative risk assessment methods, suitably modified for public health application, and places community perceptions and experience at the centre of a grassroots community self-help risk management programme. The practicability of this programme was already tested in this year's Children's Science Congress, in which over 2 lakh children from all over the country assessed environmental quality and made workable plans to clean their neighbourhoods.
Health risks are inextricably linked to the environment. To give a public health risk management programme more teeth, an environmental right-to-know and right-to-act legislation, more comprehensive than the clauses of the 1986 Factories Act amendment, which give workmen and the bystander populations in and around hazardous facilities the right to know what risks they bear, should be enacted. This will go some distance to forestall a third possible environment-related exodus.
Sagar Dhara is an expert on Environmental Impact Assessment and Risk Management