The international community has come a long way in developing a consensus that the remediation and management of naturally occurring radioactive materials and nuclear legacy sites will benefit from the use of the framework for risk-informed decision-making. Such a framework should ideally integrate risk assessment and decision-making. The framework presented in this paper specifically addresses the needs and expectations in the wider socio-economic and environmental context, as well as a narrower human health context. The framework was demonstrated as part of the International Atomic Energy Agency’s second Modelling and Data for Radiological Impact Assessments Programme. Three case studies, which have used or could use this integrative approach, are used for illustration. The first concerns remediation from uranium mining activities at Beaverlodge Lake in northern Saskatchewan, Canada, engaging stakeholders (also called ‘interested parties’) in the decision-making process on further options. The second case study suggests how decision analysis could support the selection of the best option for waste disposal for uranium ore processing at Žirovski vrh, Slovenia, taking into account a potential landslide and migration of waste throughout the adjacent valley in the event of flooding. The third case study presents the process and results of radiological safety assessment of the Kepkensberg sludge basin in Tessenderlo area, Belgium both before and after the disposal of material from remediation of the nearby Winterbeek River. It illustrates how such assessments could interface with decision analysis for the purpose of supporting the regulatory decisions related to future approval of a waste disposal option. Results show that formal stakeholder engagement in decision analysis provides a strong contribution to objective, robust, and transparent decision-making not only for radiation protection area but also in others where health and environmental impacts are of concern. A number of recommendations for future work have also been made.

Human biomonitoring (HBM) is a rapidly developing field that is emphasized as an important approach for the assessment of health risks. However, its value for health risk assessment (HRA) remains to be clarified. We performed a review of publications concerned with applications of HBM in the assessment of health risks. The selection of publications for this review was limited by the search engines used (only PubMed and Scopus) and a timeframe of the last five years. The review focused on the clarity of 10 HRA elements, which influence the quality of HRA. We show that the usage of HBM data in HRA is limited and unclear. Primarily, the key HRA elements are not consistently applied or followed when using HBM in such assessments, and secondly, there are inconsistencies regarding the understanding of fundamental risk analysis principles and good practices in risk analysis. Our recommendations are as follows: (i) potential usage of HBM data in HRA should not be non-critically overestimated but rather limited and aligned to a specific value for exposure assessment or for the interpretation of health damage; (ii) improvements to HRA approaches, using HBM information or not, are needed and should strictly follow theoretical foundations of risk analysis.

Following alerts about the diminishing role of health risk assessment (HRA) in informing public health decisions, this study examines specific HRA topics with the aim of identifying possible solutions for addressing this compelling situation. The study administered a survey among different groups of stakeholders involved in HRA or decision-making, or both. The responses show various understandings of HRA in the decision-making context—including confusion with the health impact assessment (HIA)—and confirm recurring foundational issues within the risk analysis field that contribute to the growth of inconsistency in the HRA praxis. This inconsistency lowers the effectiveness of HRA to perform its primary purpose of informing public health decisions. Opportunities for improving this situation come at the beginning of the assessment process, where greater attention should be given to defining the assessment and decision-making contexts. Both must reflect the concerns and expectations of the stakeholders regarding the needs and purpose of an HRA on one side, and the methodological and procedural topics relevant for the decision case at hand on the other. The HRA process should end with a decision follow-up step with targeted auditing and the participation of stakeholders to measure its success.