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Docteur Jean Pauluis,

Maître de conférences à la Faculté de Médecine de Liège.2 octobre 2010

KwaliteitsdagLa journée de la qualité

05 03 2011

SSMG Domus medica

Gerico, a communication tool for the general practitioners and the

citizens in case of local environmental and health (E&H)

exposure .

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GERICO.Gestion of the Risk and Communication.

www.hector-asbl.be

• The pursued objective is to find multidisciplinary solutions to face environment-health problems between local, medical, scientific and political actors.

• The communication constitutes the keystone of the process of social acceptability of any public decision in risk, particularly in situation of uncertainty.

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Create an expertise and a decision-making support.

• Gerico plans to collect the opinions and the points of view of various experts (doctors, GP’s, sociologists, economists, environmentalists, jurists, ngo’s…) in the optics of the search for a consensus between all these actors.

• In case of disagreement, the positions of some and the others will be clarified and a reflection will be introduced about the process of communication.

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Experts' quarrels and communicationSource: Le Généraliste le 17 février 1999 page 3

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Contribution of the EU: Strategy environment-health,

SCALE in June, 2003

• Collaboration between 3 DG of the Commission• Development of an approach based on science

(Science)• Centred on the children ( Children)• Bringing to awareness raising ( Awareness)• Using the legal instruments (Legal instrument)• Planning a permanent evaluation (Evaluation)

– Implementation of the strategy by successive actions plans

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Option 6: Actions for improved communication and education (1) TWG Biomonitoring of children SCALE 2004

Endorse actions to ensure high-quality information exchange, using E&H IS (information system):

• Communication strategy• Develop tools to increase communication (eg

policymakers, E&H professionals, public) • Develop clear, easy-to-use information, processed at

every step of policy-making process– Pros: increased understanding different stakeholders,

awareness raising; education, balanced and transparentdecision-making; targeted preventive policy, cost-effective

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GEstion du RIsque et COmmunication (GERICO)

1. Demande d’accès à la zone privée

Communication sur les risques Identification

et examen des options

Evaluation des risques

Evaluation du processus

et des interventions

Mise en œuvre des

interventionsChoix

de la stratégie

Définition des problèmes

et des contextes

Groupe opérationnel

Pouvoir régional

Comité scientifique indépendant

Médecins de l’entité Pouvoir communal

Leaders d’opinion Grand public

Zone de consensus

GERICO

Comité de coordination

Communication étendue GERICO www.hector-asbl.be

Court terme : phase de test sur une problématique loco-régionale avec des acteurs intéressés de façon à réaliser un test grandeur nature et finaliser les fonctionnalités de l’outilMoyen terme : mettre l’outil à disposition des autorités loco-régionales moyennant la conclusion d’un protocole d’accord de services entre Hector et ces autoritésLong terme : développer des versions multilingues permettant d’utiliser l’outil au-delà de la francophonie.

L’avenir…

La méthode…

La théorie…

2. Login et mot de passe introduits

3. Choix du thème à discuter

4. Choix de la grille de lecture

5. Lecture des brèves et des résumés

6. Analyse des documents originels

7. Réaction sur les documents ou résumé

8. Participation à un forum de discussion

9. Proposition de documents

ConfidentialitéCharte à signer

Déontologie

Modérateur

10. Dégagement de solutions pluridisciplinaires dans un processus itératif

Convention d’Aarhus

Loi du22 août 2002.Droit du patient Art.7§1.

Convention d’Aarhus

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GEstion du RIsque et COmmunication (GERICO)

Un nouvel outil de communication et de participation au niveau local.

Dr. J. Pauluis, P. Biot, M.C. Lahaye

La théorie…

Communication sur les risques

Identification et examen des options

Evaluation des risques

Evaluation du processus

et des interventions

Mise en œuvre des

interventions

Choix de la stratégie

Définition des problèmes

et des contextes

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GEstion du RIsque et COmmunication (GERICO)

Un nouvel outil de communication et de participation au niveau local.

Dr. J. Pauluis, P. Biot, M.C. Lahaye

Groupe opérationnel

Pouvoir régional

Comité scientifique indépendant

Médecins de l’entité Pouvoir communal

Leaders d’opinion Grand public

Zone de consensus

GERICO

Comité de coordination

Communication étendue GERICO www.hector-asbl.be

Convention d’Aarhus

Loi du22 août 2002.Droit du patient Art.7§1.

Convention d’Aarhus

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•

1. Demande d’accès à la zone privée

2. Login et mot de passe introduits

3. Choix du thème à discuter

ConfidentialitéCharte à signer

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4. Choix de la grille de lecture

5. Lecture des brèves et des résumés

6. Analyse des documents originels Déontologie

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7. Réaction sur les documents ou résumé

8. Participation à un forum de discussion

9. Proposition de documents

10. Dégagement de solutions pluridisciplinaires dans un processus itératif

Modérateur

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1- The risk

2- The obligation to communicate

3- The communication

THREE

NOTIONS

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1989 : Les liens entre environnement et santé

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La gestion du risqueIDENTIFICATION D U

DANGER

effe ts, c iné tiques

RELATIONS DOSE-REPONSE

seuils d' ef fets, fac teurs de

sécurité

EXPOSITION

nom bre , durée , espace ,

concentra tions, fonctions de

transformation, diffusion

APPRECIATION

com paraison avec d' autres

r isques, acceptabilité , choix

politiques, ana ly ses

coûts/bénéf ices

ESTIMATION DU DANGER

ESTIMATION DU RISQUE

GESTION DU RISQUE

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1- The risk

2- The obligation to communicate• For legal reasons

• For deontologic reasons

• For ethical reasons

3- The communication

THREE

NOTIONS

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AarhusCommission économique pour l ’Europe.

CONVENTION SUR L'ACCES A L'INFORMATION, LA PARTICIPATION DU PUBLIC AU PROCESSUS DECISIONNEL ET

L'ACCES A LA JUSTICE EN MATIERE D'ENVIRONNEMENT.

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The medical environmental information and its difficulties.

• Can we accept the minimization of the risks by fear " of terrifying the population "?

• Accepting this minimization does it engage the responsibility of the general practitioner?

• For the general practitioner where to find a fast, objective and validated information?

• How long can we wait for the "validation" of the contents?

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The ruling " Hédreul " in February 25th, 1997

1st civil appeal division of a superior court of the Highest Court of Appeal - France

• Reversal of the burden of proof of the information.

• Health-environment = management of the uncertainty

" The general practitioner is held by a particular obligation of information towards his patient and he has to prove that he executed this obligation . "

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Law of August 22nd, 2002 relative to the rights of the patient. Belgium

" Art 7 §1er: the patient is entitled, on behalf of the professional practitioner, to all the information which concern him and can be necessary for him to understand his health and its likely evolution ".

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Information and transparency.(1) Source.Pr G.Sokal - Bureau national de l Ordre des Médecins - Le généraliste - 31 mars 1999.

« Il est du devoir du médecin d’avertir sans ambages et dans une pleine transparence, c’est-à-dire en ne celant aucun renseignement valable et utile, toute personne du risque auquel elle est exposée suite à la pollution de l’environnement. Il est tout autant de son devoir, comme celui de tout citoyen, d’en avertir les autorités responsables. »

" It is of the duty of the doctor to warn frankly and in a full transparency, he can’t hide valid and useful piece of information, to every person of the risk to which he is exposed further to the environmental pollution. It is necessary just as much of its duty, as that of every citizen, to warn the responsible authorities of it. "

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Information and transparency (2) Source.Pr G.Sokal - Bureau national de l Ordre des Médecins - Le généraliste - 31 mars 1999

" We can only recommend the dialogue (concertation) of the

general practitioners of a region or a community when a problem

of pollution arises. "

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Information and transparency (3)Source.Pr G.Sokal - Bureau national de l Ordre des Médecins - Le généraliste - 31 mars 1999

" The information must be complete including the part of

uncertainty, towards those who are responsible in the front line for

the health: the general practitioners. "

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1- The risk

2- The obligation to communicate

3- The communication

THREE

NOTIONS

Integration of environment and health.TWG Biomonitoring of children SCALE 2004

• Human biomonitoring is an excellent tool to better integratethe two fields, environment and health

• One of its big advantages is that within the

chain it is much closer to health effects than environmental monitoring

Biomarker of susceptibility

Biomarkers of exposure

Internal dose

Biological effective dose

Biomarker of effect

Early response

Altered structure and funcion

Disorder Disease

Exposure EmissionEnvironmental

concentration

• Gerico domain of action

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Objectives for Action Plan 2004-2010 in thefield of environmental and health links.TWG

Biomonitoring of childrens SCALE 2004

• endorse activities to establish standardised E&H Indicatorreporting and assessment

• set up decision-making process to support progressive development of E &H information system (national/regional level)

• Improve access to information, communication andeducation

• Involve all stakeholders in building-process

• Set up mechanisms to Ensure Rapid, Accurate and EfficientIterative Updating of Monitoring Programmes and Policy Measures.

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A more harmonised biomonitoringapproach.

TWG Biomonitoring of childrens SCALE 2004

• Comparability would contribute to the EU Strategy for E & H by:

– Providing data on distribution of exposure and related health impact across Europe

– definition of reference values– detection of spatial differences in exposure (populations/regions at

risk) – detection of temporal differences in exposure

– Providing policy makers with better information on control measures to be taken

– identification of priorities in exposure reduction strategies

– allowing follow up of the efficiency of reduction strategies, – allowing a geographically differentiated E&H policy

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• Carrying out large (or local) surveys that include human biomonitoring presents challenging logistical problems and generally cannot be done without having medical staff available.

Problems.

TWG Biomonitoring of childrens SCALE 2004

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Research needs TWG Biomonitoring of childrens SCALE 2004

• Research on socio-ethical and legal constraints

It is increasingly recognized that medical ethics, originated anddeveloped for clinical situations, may require modification forpublic health or community needs, taking into account the“public interest” of the outcome of biomonitoring surveys.

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ETHICS TWG Biomonitoring of childrens SCALE 2004

• Informed consent: authenticity of consent– Who should ask for consent?– Who should give the information and how, written, video, oral, updates regularly – How to treat “given consent” in long term follow up studies?

• Right to know & right not to know

– Communication of results when link with health risk is not clear – Communication of individual results or aggregated data?

• ....

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The Belgian NEHAP. What role for the general practitioners?

• Establish a functional collaboration between the existing structures in the domains of the environment and the health;

• Develop and manage databases concerning all the aspects environment-health;

• Define the priorities of search(research) on the relations between the environment and the health;

• Develop a prevention policy;• Develop a policy of communication;• Support the development of course and trainings on the

relations between the environment and the health;• Make sensitive and educate in the relations between

environment and health.

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• Diffuser of information.

• Detector of symptoms.

• Social mediator.

* Concern for Europe ’s Tomorrow 1995 - OMS

The communication of the risk (E&H) by the general practitioner

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Conclusion.Develop tools to translate results into a

response system TWG Biomonitoring of childrens

• In order to translate the results of biomonitoring into effective policy measures, effective communication is needed.

• Effective communication needs participation and exchange between the different stakeholders (general

public, study participants, general practitioners, regulators, scientists, public interest NGO’s, industry, others) and will promote public awareness.

• A communication plan is an essential part of a biomonitoring programme and should be a part of the study design.

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The future of GERICO?

• Short term: phase of test on a loco-regional problem with actors interested so as to realize a life-size test and finalize the features of the tool

• Middle term: give tool of the loco-regional authorities for the conclusion of a draft agreement of services between Hector and these authorities

• Long term: develop multilingual versions allowing to use the tool beyond the Francophony.