Communicating occupational and environmental issues

Effective health risk communication is an important tool that can prevent or modify the inappropriate public reactions that often accompany occupational and environmental health issues and allegations. The public perception of the magnitude or significance of risk is influenced by factors other than scientific data. The goal of risk communication therefore is more than just imparting scientific facts. It is about ensuring that the public fully understand risk and that they are enabled to make informed decisions under conditions of uncertainty. How people perceive risk, and their values and feelings toward occupational and environmental health issues, are as important considerations for risk communication as are numerical or factual scientific data. Occupational and environmental health scares often occur because of complexities such as the multidimensionality of risk, trust or mistrust in sources of information, technological revolution, the reliance of the public on the media for health information and the public desire for information and the truth. If, as health professionals, we are to address effectively both real and perceived occupational and environmental health issues, we need to be aware of the major advances that have been made in the use of risk communication in recent years.     

Models of public perceptions about environmental risk

A survey on public perceptions about environmental risk was carried out in the industrial area of Portoscuso. The aim was to obtain information on how citizens correlate industrial risk exposure to adverse health effects, in order to plan effective risk communication strategies. Perceptions were found to vary among the population: some citizens do not believe any hazards from industrial pollution exist, others consider adverse health effects as an inevitable consequence of industrial pollution, still others believe in the role of individual factors. Effective risk communication strategies should increase the population's knowledge about environmental risks, so as to enable individuals to achieve a balance between normal concern for possible health hazards and excessive alarm, and to encourage public awareness and participation.     

Communicating about emerging infectious disease: The importance of research

Emerging infectious diseases have taken on renewed significance in the public health sector since the 1990s. Worldwide, governments are preparing emergency plans to guide them; their plans acknowledge that communication will be vital in the event of an outbreak. However, much of the emerging infectious disease communication literature deals with one-way transmission of facts to the public by experts. Little attention is paid to how differently various groups conceptualize risk, or to the idea that there is more to communication than the intentional transfer of information. Emerging infectious disease communication is often based in traditional health promotion or emergency/crisis communication literature, where it is assumed that the only ‘enemy’ is the disease, the right course of action is obvious and the expertise (coming from a public health assumed to be value-free) will not be questioned. Research tends to be limited to exploring barriers to understanding or education, to facilitate better message development. Emerging infectious disease communication research should be broadened to include exploration of implicit assumptions about the nature of the problem at hand (and how to deal with it) as well as the concepts of uncertainty, trust, power, values and biases. Recent risk communication theory, whose focus has historically been on more obviously controversial technological/environmental situations, should guide such research, as it would highlight important contextual factors in which to embed emerging infectious disease communication. This article reviews existing emerging infectious disease communications literature, discusses risk communications theories that could broaden emerging infectious disease communication research, and suggests next steps in a research agenda.     

Community network linkages during a health controversy.

The communication of complex scientific and technical health risk information in a community context is little understood and seldom studied. The study reported here examines how information about an environmental health controversy is obtained, exchanged, and used within the community as decision makers and public health officials struggle to protect lake-source drinking water for a community of 55,000. Findings suggest that public health officials may need to broaden their communication strategies to reach less integrated groups with quality scientific and technical health risk information.     

Public meetings about suspected cancer clusters: the impact of voice, interactional justice, and risk perception on attendees' attitudes in six communities

Holding a public meeting is a frequent method of communicating with community residents during official investigations into possible cancer clusters; however, there has been little formal research into the effectiveness of this method of health communication. This article presents research examining the influence of public meetings held during ongoing cancer cluster investigations in six U.S. communities. Drawing on social psychological theories of organizational justice, it examines the degree to which three specific elements of justice, including having a voice in the process, receiving fair interactional treatment, and facing equal risk of loss (i.e., cancer), influenced five outcome variables: meeting satisfaction, community connectedness, willingness to accept meeting outcomes or recommendations, willingness to attend future public meetings, and concern about the potential cancer cluster. The analysis of data collected from meeting attendees who responded to the mailed survey (N = 165) confirms a strong role for justice concerns in public meeting evaluations. In particular, perceptions of voice and interactional treatment had consistently large effects on the outcome variables, suggesting that managing a fair public engagement process can contribute to positive civic outcomes even during periods of heightened community concern about area cancer rates.     

Methodological problems and the role of statistics in cluster response studies: A framework

More and more citizens urge public health authorities to investigate reports of disease excess in their neighbourhood. These environmental concerns are legitimate and it is part of good public health practice to respond to these complaints. However, the methodological and practical problems are severe and a lot of controversy exists about the usefulness of these investigations. To clarify the possibilities and limitations in this situation, this paper proposes a typology of cluster studies. According to this framework, cluster response is distinguished from two other types of cluster studies: Cluster monitoring, screening proactively for clusters to act as an early warning system, and cluster research, scrutinizing clustering to generate and test aetiological hypotheses. To each of these three types of cluster studies corresponds a different public health context; respectively public health action, public health surveillance and public health research. Probably, part of the controversy mentioned stems from not acknowledging sufficiently the corresponding intrinsic differences in rationality and practical constraints. Cluster response is crisis management and not scientific research. In a relatively short time, an informed decision should be taken by a multidisciplinary team of experts using readily available information and knowledge. In accordance with this point of view, cluster reports should be handled stepwise and the role of statistics is to quantify a cluster exploring different points of view as an input to the decision process.     

Beyond the knowledge deficit: recent research into lay and expert attitudes to food risks

The paper reviews psychological and social scientific research on lay attitudes to food risks. Many experts (scientists, food producers and public health advisors) regard public unease about food risks as excessive. This expert-lay discrepancy is often attributed to a 'knowledge deficit' among lay people. However, much research in psychology and sociology suggests that lay risk assessments are complex, situationally sensitive expressions of personal value systems. The paper is organised around four themes: risk perception, the communication of risk, lay handling of risk, and public trust in institutions and experts. It suggests that an interdisciplinary, contextualised and psychologically sound approach to the study of risk is needed.     

Communicating health risk.

Health risk communication is a two way interactive process that involves the exchange of information among interested parties about the nature, magnitude, significance, or control of a risk. Although it has only recently become a topic for scientific research, much has been learned in relation to the strategies and the techniques that contribute to effective health risk communication. In parallel, there has probably never been a time of greater need for effective training in health risk communication. The media and the general public are now very hazard conscious, subsequent to apparently regular events in the areas of public health, safety and environmental issues. Public concern regarding such issues is sometimes much less than experts feel to be appropriate, whilst at other times concern has outstripped the concern of the experts involved. Health professionals trained in the techniques of health risk communication are a vital resource in ensuring that the workforce or the population is properly informed so as to exercise appropriate decisions and actions in relation to hazard and risk.     

A framework and information needs for the management of the risks from consumption of self-caught fish

Governmental agencies deal with the potential risk from consuming fish contaminated with toxic chemicals by issuing fish consumption advisories. Yet such advisories are often ignored by the general public, who continue to fish and consume self-caught fish that are the subject of advisories and are from contaminated waters. Further, people are often unaware of specific warnings (which species to avoid, who is vulnerable, when they are vulnerable). In this paper we propose a more inclusive framework for examining consumption behavior of self-caught fish and identify information needs for effective communication. We include not only the usual variables that are used for calculating risk from fish consumption (meal frequency, meal size, contaminant levels) but also other aspects of behavior that contribute to risk. These include attitudes (trust, risk aversion, environmental concerns), behavior (sources of information, cultural mores, personal preferences), exposure (physical proximity, ingestion rates, bioavailability, target tissues), contaminant levels, individual host differences, and hazards (levels of contaminants). We suggest that attitudes and behavior shape risk as much as exposure and hazards and that all four of these factors must be considered in risk management. Factors such as gender, age, pregnancy status, and nutrition all influence who is at risk, while other consumption factors affect these at-risk populations, including meals/week, meal size, cooking method, fish species and sizes eaten, and years of fish consumption. Similarly, contaminant levels in fish vary by fish species, fish size and age, part of the fish, and collection location. Elucidating the risk to individual consumers involves integrating this range of factors, and managing the risk likewise involves incorporating these factors. We suggest that development of appropriate advisories and compliance with advisories will occur only if managers, risk assessors, and public policy makers consider this whole range of factors and not just the traditional fish consumption rate (often underestimated) and contaminant levels in fish (often undersampled). Merely informing the public of contaminant levels or the risk from contaminants will not ensure a public that has enough information to make informed decision, or to be in compliance with consumption advisories, or to effect changes in consumption behavior where public health is at risk.     

Investigation of clusters of adverse reproductive outcomes, an overview

Clusters of adverse reproductive outcomes are reported with increasing frequency to public health services, but it is likely that only a minority of clusters are caused by a common environmental teratogen or mutagen. Many guidelines and protocols have been developed for the investigation and the management of chronic disease clusters and can be applied to the study of adverse reproductive outcomes. Cluster investigation normally follows four successive phases: (i) the generation of one or more etiologic hypotheses, (ii) the confirmation of the hypotheses, (iii) an intervention aimed at reducing any dangerous exposure, and (iv) the evaluation of the effect of the intervention. However, each situation is unique and there is no standard recipe for conducting the epidemiologic investigation at each successive phase, for choosing the appropriate statistical technique and for communicating with interested parties. In order to minimize both the risk of pursuing a worthless investigation and the risk of ignoring a real excess of cases caused by an adverse environmental factor, it is imperative to rely on a team of specialists with expertise in epidemiology, statistics, toxicology, embryology, and communication.