Social determinants of bioterrorism the concept of risk

Any discussion of bioterrorism, and certainly one that involves mitigation strategies, hinges on the concept of "risk." "Risk" refers to the likelihood that exposure to a hazard will lead to a negative consequence; therefore, it is essential to understand both the threat and the potential range of consequences associated with bioterrorism in order to accurately assess risk in this regard (Ropeik and Gray, 2002). When applied to cause-specific mortality, risk can be viewed in a purely statistical sense: the risk of dying from cardiovascular disease in the US in the year 2000 was approximately 1 in 400, while the risk of succumbing in a lightning strike was approximately 1 in 4.5 million (Table 12.1). In the arenas of human biology and medicine, however, risk assessment is based on the complex interplay of genetics, environmental factors, and chance. Risk as it relates to bioterrorism is difficult to quantify; while the probability of exposure to a biologic attack is statistically low, it is not zero, and the consequences are potentially catastrophic. This, coupled with the fact that the likelihood of actual

Table 12.1 US mortality risk analysis for selected public health concerns

Heart disease

1 in 397

Cancer

1 in 511

Stroke

1 in 1699

Alzheimer's

1 in 5.752

Motor vehicle accident

1 in 6745

Homicide

1 in 15,440

Drowning

1 in 64,031

Fire

1 in 82,977

Bicycle accident

1 in 376,165

Lightning strike

1 in 4,478,159

Bioterrorism (anthrax)

1 in 56,424,800

Source: Artenstein, 2006; Harvard Center for Risk Analysis, http://www.hcra.harvard.edu/ © 2004 CBEP.

Source: Artenstein, 2006; Harvard Center for Risk Analysis, http://www.hcra.harvard.edu/ © 2004 CBEP.

hazard exposure is dependent on the whims of terrorists (and therefore an unpredictable variable), renders accurate risk assessment impossible.

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