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This chapter introduces the social science of health risk. Analysis of references to risk in health-related research papers shows that use of the ‘lens of risk’ has expanded remarkably steadily in the period since World War II. This chapter surveys existing texts, identifies a need for a book which offers accessible critical analysis, and promotes risk literacy. Tendencies to make naïve claims about medical rationality in some health service oriented texts and to use impenetrable jargon in social science writing are illustrated. An important distinction between ‘the study of risks’ and ‘the study of risk’ is drawn. Those who engage with health risks focus on specific clinical issues and tend to take the framework of risk-thinking for granted. The social sciences can direct attention towards the general presuppositions that must be drawn upon whenever a particular risk is considered.

Efficient health care requires informed doctors and patients. The health care system inherited from the 20th century falls short on both counts. Many doctors and most patients do not understand the available medical evidence. Seven “sins” are identified which have contributed to this lack of knowledge: biased funding; biased reporting in medical journals; biased patient pamphlets; biased reporting in the media; conflicts of interest; defensive medicine; and medical curricula that fail to teach doctors how to comprehend health statistics. These flaws have generated a partially inefficient system that wastes taxpayers’ money on unnecessary or even potentially harmful tests and treatments as well as on medical research that is of limited relevance to the patient. Raising taxes or rationing care is often seen as the only viable alternative to exploding health care costs. Yet there is a third option: by promoting health literacy, better care is possible for less money. The 21st century should become the century of the patient. Governments and health institutions need to change course and provide honest and transparent information to enable better doctors, better patients, and, ultimately, better health care.

Studies consistently show that health care practitioners are poor at processing statistical information on risk. Indeed, almost everybody in health care, apart from a few people with advanced training, is poor at processing statistical information. The inability to process statistical information among health care practitioners is one cause of patients failing to receive optimal care. But there are many others, including a flawed and biased information base, unawareness of evidence, unwillingness to accept the evidence, lack of applicability of the evidence, inability to implement treatments, failures to act, unwillingness of patients to accept evidence, and failure to adhere to treatments. Commissioners of health care and those who set policy may be in a much stronger position than practitioners to follow evidence, as they have access to expert advice and are not under the same time pressures as practitioners. The reductionist ideas of evidence-based medicine, however, are not simply applied in commissioning and the making of policy. Improvement is most likely to come with a systems approach, making it easy for practitioners to use interventions based on evidence and more difficult to use those not based on evidence.

Many doctors, patients, journalists, and politicians alike do not understand what health statistics mean, or they draw wrong conclusions without noticing. The causes of statistical illiteracy should not be attributed to cognitive biases alone, but to the emotional nature of the doctor–patient relationship and conflicts of interest in the health care system. As the chapter shows, many sources of medical information intentionally or uninentionally use nontransparent information to persuade individuals, with serious consequences for personal health. Without understanding the numbers involved, the public is susceptible to political and commercial manipulation of their anxieties and hopes, which undermines the goals of informed consent and shared decision making.

A personal account of how the author came to recognize the importance of statistical literacy, particularly in the fields of health care and the law, and went on to teach physicians and judges how to better understand statistics. Thanks to training in statistics and a year in an interdisciplinary research group, he came to challenge the popular view that humans are subject to cognitive illusions and unable to deal with probabilities. Instead, he developed insight into how, through risk literacy, humans can be better equipped to make “illusion-free” decisions. Beyond its importance to professionals in the medical and legal fields, risk literacy is essential for maintaining democratic societies.

People are frequently faced with the task of making a variety of health decisions, from decisions about preventative screening, to taking medications, or deciding whether or not to have a surgical procedure. For many health decisions, there is no single best option, and people need to be informed about their chances of experiencing the benefits and harms of each option. However, risk information is not always easy to find and numbers can be used to mislead, emphasizing benefits or reducing harms. Balanced and transparent presentation of risk information is essential for promoting risk literacy to help people understand and make good decisions about health risks. The Facts Box is a simple decision tool that presents data about the benefits and harms of treatments in a summary table and has been shown to facilitate comprehension and understanding of health information. Facts Boxes can be used by patients and health professionals alike.

A notion of rationality represents a structure that can be used to explain, evaluate, and recommend a certain course of action. Full rationality, independent of context, builds such a structure based on the rules of logic and statistical inference. Ecological rationality, on the other hand, focuses on the interaction between the human mind and the task environment. This chapter argues that ecological rationality can provide an operational framework for evolutionary medicine based on compatible foundational concepts. Risk literacy and numeracy methods developed on the basis of an adaptive toolbox approach constitute effective education tools. An evolutionary approach to medical education facilitates the integration of these accessible and well-retained educational tools for physicians and their patients, and can enrich public health policymaking.

People strive for certainty due to an inherent desire for it. Uncertainty seems to be stressful in the same unconscious manner as anger and fear. We cannot really control this feeling, and we feel relaxed only when we feel certain about what we know or about what we should anticipate. However, our world is filled with uncertainty and so are most aspects of our life. Therefore, instead for looking for certainty where it does not exist, we had better learn to appreciate uncertainty and learn to live and deal with it. Education could play a major role here. But a major shift is necessary from the current educational practice of providing yes or no answers to one that would educate people to understand and deal with risk and uncertainty.