Evaluating the communication of environmental permitting decisions in diverse communities

Environmental communication plays a critical role in addressing the public's growing awareness and apprehension about environmental health risks. Although opportunities for public participation in environmental health assessments have greatly increased, environmental communication among key stakeholders is an evolving process. The authors evaluated the communication that occurred among a state environmental agency, six Title V operating facilities, and the public concerning environmental permitting decisions perceived to impact environmental and human health. The authors identify environmental concerns of diverse communities, analyze communication among key stakeholders regarding environmental permitting decisions, and propose recommendations for practitioners to improve environmental communication strategies among these key stakeholders in either urban or rural communities.     

The use of economic evaluation in health care: Australian decision makers' perceptions

Decision making about the alternative uses of health care resources is an issue of critical concern for governments and administrators in all health care systems. While many factors need to be taken into consideration when making these decisions, economic evaluation can help to determine the relative efficiency of different choices. Research in various countries suggests that economic evaluation is not being used by health care decision makers to the extent that health economists think that it should be. Interest in the use of economic evaluation is increasing in Australia but, to date, there has been no Australian research which looks at its use from the point of view of its potential users--the decision makers. This study fills that gap. It was found that there was a high level of awareness of economic evaluation among the group of decision makers interviewed and that some had used it in their decision making. However decisions often have to be made quickly and take into account factors other than efficiency, hence limiting the use of economics. Other problems limiting its use were availability of data and lack of expertise. Those interviewed suggested a number of ways in which the problems they identified could be overcome. In particular, they recommended that researchers doing economic evaluations should be more responsive to the needs of the decision makers using them.     

Strengthening community capacity to participate in making decisions to reduce disproportionate environmental exposures

Environmental exposures impose a disproportionate health burden on low-income populations and communities of color. One contributing factor may be the obstacles such communities face to full participation in making policy decisions about environmental health. This study described and analyzed the characteristics that contributed to communities' capacity to participate in making environmental decisions and suggested steps public agencies could take to achieve more meaningful participation. By strengthening community capacity, advancing authentic participation, and building democratic power, it might be possible to alter current patterns of health inequities. Strengthening participation by working with communities to develop the capacities needed to be effective in such processes is a key role for local, state, and national environmental agencies.     

The influence of economic evaluation studies on decision making. A European survey. The EUROMET group

Despite the growing activity in the field of health economics very little is known about the influence of economic evaluation studies on health care decision making in the EU member states. Several investigations about the impact of health economic studies on decision making have been performed, but most of them did not involve decision makers themselves. In this paper the results of the EUROMET survey are reported and discussed. Different types of decision makers in nine European countries were surveyed by postal questionnaires, semi-structured interviews and focus group discussions. Questions include issues about the extent of knowledge about economic evaluation, the actual and potential use of study results as well as barriers and incentives in the use of studies. It is concluded that despite the general positive attitude knowledge about the formal methodology is rather limited. Accordingly, results of economic evaluation studies are not widely used in decision making. The results show that institutional dimensions, such as difficulties in transferring budgets, are viewed as important barriers. Also, the lack of credibility of studies is assigned a high relevance. Moreover, decision makers wish for a better explanation of the practical relevance of studies and feel that there is a need for more training in health economics. Considering these requirements a number of recommendations for enhancing the value of health economic studies are given.     

Ethical Issues in the Economic Assessment of Health Care Technologies

This paper challenges traditional views which oppose health economics and medical ethics by arguing that economic assessment is a necessary complement to medical ethics and can help to improve public participation and democratic processes in choices about resource allocation for health care technologies. In support of this argument, four points are emphasized: (1) Most current biomedical ethical debates implicitly deal with economic issues of resource allocation. (2) Clinical decisions, which usually respect the Hippocratic code of ethics, are nevertheless influenced by economic incentives and constraints. (3) Economic assessment is concerned with both efficiency and equity and potential trade-offs between the two, which means that ethical judgements are always embedded in welfare economics. (4) The real debate is not between economics on the one side and medical ethics on the other. Rather it is between different ethical conceptions of social justice and the contrasting approaches they entail to reconciling individual interests and preferences with collective goods and welfare. This revised version was published online in August 2006 with corrections to the Cover Date.     

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.     

Creating effective messages about environmental health

The Centers for Disease Control and Prevention supported research coordinated by the Association of Environmental Health Academic Programs (AEHAP) for the purpose of developing effective messages about environmental health. The purpose of these messages would be to increase the visibility of the environmental health profession and improve the public's awareness and understanding of the role played by the profession in protecting the public's health. To accomplish this task, AEHAP first collaborated with a marketing team to develop initial test messages. The core message revolved around five major themes: effects of pollution, susceptible populations, economics and prevention, homeland security, and specific environmental health issues. The draft messages were tested in three focus group settings: 1) policy makers, 2) environmental health professionals, and 3) the general public. This paper reports a finding that there is a perceptual gap among environmental health professionals, policy makers, and the public. This gap is part of why there is a compelling need for the environmental health community to develop and disseminate more effective messages about the profession.     

Economic analysis of nutrition interventions for chronic disease prevention: methods, research, and policy

Increased interest in the potential societal benefit of incorporating health economics as a part of clinical translational science, particularly nutrition interventions, led the Office of Dietary Supplements at the National Institutes of Health to sponsor a conference to address key questions about the economic analysis of nutrition interventions to enhance communication among health economic methodologists, researchers, reimbursement policy makers, and regulators. Issues discussed included the state of the science, such as what health economic methods are currently used to judge the burden of illness, interventions, or healthcare policies, and what new research methodologies are available or needed to address knowledge and methodological gaps or barriers. Research applications included existing evidence-based health economic research activities in nutrition that are ongoing or planned at federal agencies. International and US regulatory, policy, and clinical practice perspectives included a discussion of how research results can help regulators and policy makers within government make nutrition policy decisions, and how economics affects clinical guideline development.     

PROTECTING CONFIDENTIALITY IN SMALL POPULATION HEALTH AND ENVIRONMENTAL STATISTICS

Public policy decisions are fuelled by information. Often, this information is in the form of statistical data. Questions stemming from public health and environmental concerns often arise or are studied within small subgroups of a population. Continuing improvements in the performance and availability of computing resources, including geographic information systems, and the need to better understand environmental exposures and consequent health effects create increasing demand for small population health and environmental data. These demands are at odds with the need to preserve the privacy and data confidentiality of persons, groups or organizations covered by the data. Although confidentiality issues for demographic and economic data are well-studied and are gaining maturity for health data, these issues are only beginning to emerge for environmental data and combined environmental-health data. The aim of this paper is to provide a framework for that examination. Herein we examine confidentiality problems posed by small population health and environmental data, summarize available statistical methods, and propose avenues for the solution of new problems.     

The effects of physical environments in medical wards on medication communication processes affecting patient safety

Physical environments of clinical settings play an important role in health communication processes. Effective medication management requires seamless communication among health professionals of different disciplines. This paper explores how physical environments affect communication processes for managing medications and patient safety in acute care hospital settings. Findings highlighted the impact of environmental interruptions on communication processes about medications. In response to frequent interruptions and limited space within working environments, nurses, doctors and pharmacists developed adaptive practices in the local clinical context. Communication difficulties were associated with the ward physical layout, the controlled drug key and the medication retrieving device. Health professionals should be provided with opportunities to discuss the effects of ward environments on medication communication processes and how this impacts medication safety. Hospital administrators and architects need to consider health professionals' views and experiences when designing hospital spaces.     

Threats to the estimation of benefit: are preference elicitation methods accurate?

Stated preference methods are used to estimate the value that people place on health care. The data that emerges from these studies is used to guide health policy. However, relatively little is known about how individuals make decisions in a preference elicitation task. Two methods (willingness to pay and conjoint analysis) are considered within the context of the literature from psychology (and also environmental economics) regarding how people construct preferences, process information, and make decisions. There is substantial evidence that individuals employ heuristics (cognitive shortcuts) in order to simplify tasks they are presented with. The use of heuristics implies that people ignore much of the information they are presented with and make decisions which would not be considered rational in the economic sense. These stated preference methods assume that individuals trade between the different attributes of a good or service when making decisions - an assumption that other theories predict is wrong. The implications of this are discussed.     

Competing perspectives on public involvement: Planning for risk characterization and risk communication about radiological contamination from a national laboratory

Public involvement is increasingly emphasized as part of government agencies' responses to environmental health hazards, including risk characterization and risk communication. For example, there is a growing body of literature on health and risk communication proposing best practices and evaluating processes, yet there has been little attention to the ways that preferences for process features and criteria for evaluating success may vary among stakeholders and between stakeholders and government agency staff. This paper reports on a study into how participants associated with an effort to address public health risks from the distribution of plutonium contaminated sewage sludge in Livermore, California, think about the most appropriate way to conduct a process integrating public involvement. Using Q method this paper identifies five perspectives about what constitutes a good collaborative process in this case. The lessons for organizers and participants of risk characterization and risk communication efforts when people subscribe to different (sometimes competing) perspectives about process are discussed.     

Communication of radiation benefits and risks in decision making: some lessons learned

This paper is focused on summarizing the "lessons learned" from discussions at the 2010 NCRP Annual Meeting on effective communications on the subject of radiation benefits and risks in public exposures. Five main lessons learned are discussed in regard to effective methods of public communication: the use of new social media communication tools such as Facebook and Twitter, emergency situations that require rapid societal and personal messaging, medical radiological procedures where benefits must be described in comparison to long-term health risks of radiation exposures, and information that should be provided to stakeholders in situations such as environmental radionuclide contamination to which members of the public may be exposed. It is concluded that effective communications in which radiation benefits are contrasted with health risks of exposure are an important aspect of making and implementing decisions on employing radiation health protection procedures.     

Food scares and sustainability: A consumer perspective

Health campaigns have focused on lifestyle decisions such as physical inactivity, diet and smoking to minimise health risks. The links between health, environmental sustainability and consumer food choices have less prominence. Reported here are Australian consumer perceptions of environmental health issues related to the food system. Interviews with 26 participants explored the environmental implications of food choices. Concerns included conflicting information, related health risks, and the blaming of individuals for ‘poor’ choices. Participants recognised that focussing on the individual overlooked the structural context of food production. They requested information about food production processes to assist decision-making and identified the need for an influential body to advocate for their interests in food production decisions. The results indicate a need for government, industry and consumer collaboration to develop and implement practical communication strategies about food production for communities.     

L’économie comportementale au service de la santé

The COVID-19 pandemic is bringing about far-reaching structural changes on both the economy and public health, and conventional methodologies have to be fine-tuned to assist public health decision making. In this context, behavioural economics, which is situated at the crossroads between economics and social psychology, is an undeniably innovative field. In contrast with conventional models, the economic models of behavioural economics incorporate psychological and social determinants to produce more accurate predictions of individual behaviour. In the last 20 years, the scientific community has been using this approach’s quantitative tool, experimental economics, in many areas of health, including prevention, promotion, human resources and social signage. Studies have come up with effective solutions that have improved best public health practices and provided sources of inspiration that should not be overlooked in the fight against COVID-19. They have allowed natural human behaviour to take a central role again, helped us to understand how the social and economic environment influences individuals, and enabled us to anticipate human reactions and so make faster adjustments to public policies.     

The new millennium: values, perceptions of risk, and the key roles of science and technology

Radiation protection and management of radioactive waste streams and products are certain to be important areas of public policy, worker education, and technology development in the new millennium. Overriding values of freedom, sustainability, transparency, and public participation in decision making about technology's benefits and risks will shape the public policy agenda. Early engagement of stakeholders in the identification and assessment of risks and in communications about risk management will be beneficial in most cases. Putting specific environmental problems into broader public health and ecologic context will be helpful to all parties and will improve decisions about how best to utilize precious resources and enhance public confidence in the process and the outcomes.     

Life Satisfaction and Subsequent Physical,Behavioral, and Psychosocial Health in Older Adults

Policy Points

• Several intergovernmental organizations (Organisation for Economic Co‐operation and Development, World Health Organization, United Nations) are urging countries to use well‐being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions.
• As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well‐being outcomes we might observe from policies aimed at improving life satisfaction.
• The results of this study suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well‐being, health behaviors, and physical health outcomes.

ContextSeveral intergovernmental organizations (Organisation for Economic Co‐operation and Development, World Health Organization, United Nations) are urging countries to use well‐being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions. As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well‐being outcomes we might observe from policies aimed at improving life satisfaction.MethodsWe evaluated whether positive change in life satisfaction (between t₀;2006/2008 and t₁;2010/2012) was associated with better outcomes on 35 indicators of physical, behavioral, and psychosocial health and well‐being (in t₂;2014/2016). Data were from 12,998 participants in the University of Michigan''s Health and Retirement Study—a prospective and nationally representative cohort of US adults over age 50.FindingsParticipants with the highest (versus lowest) life satisfaction had better subsequent outcomes on some physical health indicators (lower risk of pain, physical functioning limitations, and mortality; lower number of chronic conditions; and higher self‐rated health) and health behaviors (lower risk of sleep problems and more frequent physical activity), and nearly all psychosocial indicators (higher positive affect, optimism, purpose in life, mastery, health mastery, financial mastery, and likelihood of living with spouse/partner; and lower depression, depressive symptoms, hopelessness, negative affect, perceived constraints, and loneliness) over the 4‐year follow‐up period. However, life satisfaction was not subsequently associated with many specific health conditions (i.e., diabetes, hypertension, stroke, cancer, heart disease, lung disease, arthritis, overweight/obesity, or cognitive impairment), other health behaviors (i.e., binge drinking or smoking), or frequency of contact with children, family, or friends.ConclusionsThese results suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well‐being, health behaviors, and physical health outcomes.     

The simplicity complex: exploring simplified health messages in a complex world

A challenge in individual and public health at the start of the 21st century is to effectively communicate health and science information about disease and complex emergencies. The low health literacy of millions of adults in the USA has been referred to as a 'silent killer'. A popular approach to improving health communication and health promotion to low health literate consumers has been to simplify the language of health information. The expected result has been that individuals and groups will better understand information and will then make informed decisions about their health and behaviors. This expectation has grown to include the belief that the public will be better prepared to take appropriate action in complex natural and man-made emergencies. Demonstrating the efficacy of this approach remains, in large part, uninvestigated. And it is becoming more evident that health literacy itself is complex and multifaceted. This article applies linguistic and sociolinguistic models in order to better articulate the role of simplification in health communication and health promotion. Focusing on two models from sociolinguistics-pragmatics and text theory-the article discusses their usefulness in rethinking message simplification. The discussion proposes that a richer, more theory-based understanding of text structures and functions, along with other powerful constructs, including cultural appropriateness, relevancy and context, are needed to close the gaps between health messages, health messengers and patients/the public. The article concludes by making recommendations for future study to empirically test the strengths and limitations of these models and constructs.     

Do individuals’ health preferences validate the decentralisation of the public health system in Spain?

The objective of this paper is to estimate individuals’ preferences about public health services in two Spanish regions, the Basque Country (BC) and Canary Islands (CI) and analyse whether they differ. This work was motivated by the actual economic situation, where it is necessary to obtain equilibrium between the needed health services and limited economic resources. With this limitation in mind, politicians have tried to design health policies that maximise individuals’ welfare. Based on the theory of decentralisation, the devolution of public expenditure decisions and management to regional government maximises individuals’ welfare more when individual preferences differ among regions. A discrete choice experiment was implemented with a survey designed to obtain data about individuals’ choices. Using this data and discrete choice models, individual preferences for health services were estimated. Our findings indicate that these preferences differ among regions, so, for reasons of efficiency, decentralising decisions and management of public health policies to regional governments would be recommended. Once health policies are decentralised, our results provide a tool for identifying the health services most valued by the individuals in each region. This information would be useful policymakers designing health policies.