Bard D
Institut de Protection et de Sûreté Nucléaire, Département de Protection de la Santé de l'Homme et Dosimétrie, Fontenay-aux-Roses.
Rev Epidemiol Sante Publique. 1995;43(5):423-31.
Assessing environmental health risk is fraught with difficulties: often, the agents under study are weak pathogens, and exposures are poorly characterised. Direct studies in man are frequently inconclusive (or inconsistent) because of the limited sensitivity of epidemiological studies. Experimental studies raise questions about the validity of animal to man extrapolation. However, taking steps to protect public health is needed and impose the use of all available data. Remaining uncertainties lead the health risk assessor to make assumptions. Such a process implies as much transparency as possible, both for ethical reasons and to allow the public to be involved in the debate. A formalized approach has been proposed by various US agencies in charge of public health. One important matter is a strict separation between risk assessment and risk management. The procedure is divided into four portions: hazard assessment, exposure assessment, dose-response assessment which includes the study of risk at low doses--sometimes through the use of mathematical high to low dose extrapolation modelling--and risk characterisation.
通常，所研究的病原体致病性较弱，且暴露情况难以确切描述。由于流行病学研究的敏感性有限，对人体进行的直接研究往往没有定论（或结果不一致）。实验研究引发了关于从动物推断到人类的有效性问题。然而，采取措施保护公众健康是必要的，这需要利用所有可用数据。剩余的不确定性使得健康风险评估者不得不做出假设。出于伦理原因，并为了让公众参与辩论，这样的过程意味着要尽可能保持透明。美国负责公共卫生的各机构已提出一种形式化方法。一个重要问题是严格区分风险评估和风险管理。该程序分为四个部分：危害评估、暴露评估、剂量反应评估（包括低剂量风险研究——有时通过使用数学高剂量到低剂量外推模型）以及风险特征描述。
