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7 HEALTH MESSAGES AND STRATEGIES FOR DISSEMINATION In the previous chapters, speakers identified the divides that exist between sustainability and environmental protection and health promotion in the United States and the larger international community, and presented potential solutions to bridging these gaps. This chapter focuses on discussing strategies for disseminating these solutions within the environmental health community, as well as broader groups. A summary of this discussion follows, which mainly emphasizes communication strategies for connecting with the general public in the United States. Linda McCauley started this discussion by stating that individuals need to be challenged to think about how to take information and collectively help chart a course for environmental health. McCauley noted the need for the environmental health community to define the messages and identify the audience upfront—which may include U.S. government agencies or the global community—in order to have an impact with its communication strategy. She asked the workshop participants to share their thoughts on the communication messages that should be utilized to move forward the key environmental health and sustainability issues that were discussed during the workshop. Martin Philbert noted that scientists often labor under the misconception that because they can define risks to the fifth or sixth decimal place, this information will influence the person making daily decisions in the supermarket. Philbert stated that the general public does not understand, for instance, the implications that purchasing high- thread-count Egyptian cotton sheets may have on a worker thousands of miles away. Philbert noted there is a disconnect between the scientist, who imagines a world in which sustainability prevails, and the general public, which needs to be convinced that sustainability is the next logical 117

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118 PUBLIC HEALTH LINKAGES WITH SUSTAINABILITY step to a state of improved health for everyone. Philbert agreed with the need to identify who to convince, the steps needed, and the mechanisms available to achieve the goal. Kirk Smith noted the need to focus on problems that actually cause substantial ill health and contribute to the global burden of disease estimates. He added that the public often reacts to stories of more severe chemicals or disease (such as childhood cancer), than to more common hazards that result in greater rates of morbidity and mortality (such as accidents). Lauren Zeise added that we often cannot identify the cumulative effects of low-level environmental exposures in the myriad of things we are exposed to in our daily lives. Zeise agreed with the need to look at the big contributors, but noted that she did not know the extent to which the attributable risk of these low-level chemical exposures can be assessed with the current methodology. Zeise noted that it would be useful to better understand the extent to which some of the underlying environmental chemicals and chemicals present in food and food processing contribute to death and disease. Jamie Bartram noted the need to address both communication that is internal to the environmental health community, as well as commun- ication that is external. With regard to internal communication, he said, two things that have come up in our discussions are the need to talk about (1) metrics and approaches to sustainability and environmental health, and (2) how we can bring the available evidence usefully together to further environmental health and sustainability initiatives. Bartram noted that with external communication, the messaging in many domains of science tends to focus on what does not work and uses that as a basis of how to proceed, rather than looking at what does work. Bartram explained that the communication strategy should be relevant to people in terms of enabling or empowering them to act in ways that they perceive to be relevant to their lives. This form of communication is much better than a very complex risk message, he said, which even if conveyed correctly is not something that can be translated into immediate practical action for people. John Spengler stated that people in the Ministry of Environment in the Netherlands found that imagery was effective in getting the population to support their National Environmental Policy Plan. For instance, he said, the communication strategy included multiple images of what the Netherlands would look like from a population and environmental perspective 25 years into the future without the policy

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HEALTH MESSAGES AND STRATEGIES FOR DISSEMINATION 119 plan, and the public did not want that image. Linking this to the work of the Institute of Medicine, he said, we have to do more to get our messages out to the public, which may include investing in short videos with experts providing effective sound bites and with imagery around the message. Spengler noted that this type of communication would be better than just releasing a hard copy report or summary that remains on the bookshelf in most cases. Additionally, Spengler said, we have to take our messages and disseminate them into PowerPoint slides and lecture materials, so the information is packaged for environmental health courses in graduate schools, undergraduate schools, and community colleges across the country. Wilfried Kreisel introduced the topic of health literacy and noted that for a health message to be effective the audience needs to understand the health message, which often depends on where they are located on the social gradient in society. Kreisel stated that in the United States we would like to reach those at the lower end of the social gradient, but we have not been able to improve the health literacy among the poorer segments of society. He noted that our health messages tend to reach a few and not really those who are crucial to improve population health, which is important in the debate on health equity, health literacy, and health sustainability. Nsedu Witherspoon pointed out that many groups in the United States are certainly working on targeted messages at the local level, including messages on air pollutants and pesticide exposure targeted at mothers and pregnant women. Witherspoon noted that we should appreciate that these localized efforts are under way and perhaps try to uplift these efforts or assist in discussing the action or implementation steps. Robert Goldsmith continued with this topic area and noted the need to find common ground, not just with groups with similar messaging but also with groups on the other side of some of these environmental health and sustainability issues, to build bridges and move things forward in a collaborative way. Goldsmith stated that the best solutions to put forward may be innovations that have both a sustainability impact as well as a return on investment. He noted that efforts could focus on validating potential solutions to these high-level environmental health and sustainability issues, with the pros and cons adequately presented for policy makers to debate the merits. Over the course of the workshop, Goldsmith said, wonderful solutions were presented that could work on the global scale

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120 PUBLIC HEALTH LINKAGES WITH SUSTAINABILITY or on the local scale, and it would be nice to see this group develop innovative messaging to introduce these issues to broader groups. Richard Jackson then noted that the good solutions tend to solve multiple problems or challenges, and this is a positive message that may resonate. Luiz Galvão stated that with the green economy discussions taking place, there is a perfect opportunity to place environmental health at the center of the agenda. Additionally, Galvão said, there are grassroots efforts targeting noncommunicable diseases (NCDs) in developing countries that provide an opportunity to inform discussions with some of the information that was presented here. Galvão emphasized that he sees this as a great opportunity for how environmental health can become a perfect solution for a perfect storm. Galvão added that he is uncertain of the exact processes that should be employed, but noted that we should take advantage of the possibility to collaborate with other experts or advocacy groups who are present at large meetings focusing on the green economy or NCDs, in addition to finding ways to collaborate with outside groups leading up to and during the Rio+20 conference.