Managing environmental risks: the benefits of a place-based approach.

CONTEXT: Effective management of environmental risks such as food and water contamination requires both high quality scientific information and effective, informed social policy. Not only must health practitioners and policy-makers recognize the complexities of human health as a social phenomenon, they must also negotiate the vagaries of uncertainty, precaution, and ethics in their implementation of public health guidelines and advisories. For example, some health practitioners in Alaska have argued against implementation of US Environmental Protection Agency and World Health Organization's standardized consumption advisories for methylmercury (MeHg) in fish, in favor of place-based approaches to evaluating and communicating risk. They stress the importance of traditional subsistence foods and lifestyles, along with other local environmental, economic, and cultural drivers and determinants of environmental health. Such place-based approaches have been successful in improving health outcomes in Alaska and elsewhere.

ISSUE: Nevertheless, debate continues regarding the validity and ethics of place-based approaches to developing and communicating standards and advice for managing environmental risks. Recent critiques suggest that place-based approaches to environmental health represent an undesirable kind of regional 'exceptionalism': the implication of which is that precaution, in respect to acting on the best available objective science, is undermined by attention to subjective local values. In this article we comment on this debate, a debate rooted in concerns regarding the delineation between science-based and policy-based decision-making.

LESSONS LEARNED: Our experience with the social and ecological dimensions of MeHg contamination of fish and game in Alaska and elsewhere offers three considerations regarding the potential benefits available through place-based approaches: (1) they can contribute to the accuracy and systematic characterization of risks and their relationship to multiple direct and indirect health outcomes; (2) they are more likely to inform actual changes in behavior; and (3) they afford greater transparency to the risk management process and therefore facilitate environmental justice. We stress that standardized risk assessments and advisories remain important for providing a precautionary baseline that can inform the management and enforcement of industrial and other polluting activities at the state level. However, the management of environmental health at the regional and local level requires an approach that is cognizant of local circumstances and needs, and addresses health in a systemic and integrative fashion capable of incorporating qualitative social, cultural, and economic drivers and determinants. Thus, we recommend a two-tiered approach that blends state-based and place-based environmental risk management.