The Red Book and the practice of environmental public health: Promise, pitfalls, and progress

This paper examines the impact of the National Research Council's report Risk Assessment in the Federal Government: Managing the Process, known as the "Red Book," on the practice of risk assessment, risk management, and the education of public health and risk professionals. The four-step approach to risk assessment was broadly adopted by the regulatory community and has a profound impact on science, research, public health, and regulatory decision-making. Early limitations and unintended negative consequences of the approach are also examined, including the isolation of public health agencies from regulatory decision-making and the de-emphasis of epidemiology and public health surveillance. Recent progress to address the gap between public health and risk assessment is described and a list of future challenges is presented to assure continued building upon the foundation provided by the first 20 years of the Red book. Among the greatest of these challenges is the continued effort to improve the interface between science and policy in risk decision-making.