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14.3 Health effects to be quantified
The health effects to be considered for a quantitative integration of risks and benefits should be selected by a process of screening. This should start by identifying all adverse and beneficial effects that might potentially occur (including a comprehensive search of relevant literature) and assessing them individually to determine which may be expected to occur in the scenarios under assessment (Tier 1 of the Brafo approach, Hoekstra et al., submitted). Those effects that are expected to occur may then be considered together qualitatively (Tier 2 of the Brafo approach), to evaluate their relative contributions to net health impact. Quantitative assessment of net health impact (Qalibra framework and Tiers 3 and 4 of Brafo) should potentially consider all of the effects assessed at Tier 2. It may not be necessary to quantify all of these effects: if the difference between scenarios after quantifying the larger effects is big enough, it may be possible to conclude by qualitative evaluation that it would not be outweighed by the sum of the smaller effects, without quantifying them. Therefore, it may be efficient to start Tier 3 by quantifying only the effects that appear from Tier 2 to be largest, and then quantify the smaller effects only if this is necessary to reach a conclusion.