Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services (2006) / Chapter Skim
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5 Evaluating the Department of Health and Human Services Dissemination and Communication Efforts
5 Evaluating the Department of Health and Human Services Dissemination and Communication Efforts
Pages 130-199
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From page 130... ...
However, the committee judged that to truly evaluate public understanding of health effects, as described in the MOU, it also had to look closely at the communication efforts of HHS agencies. Communication implies a two-way process -- an interchange of knowledge, thoughts, and opinions or -- as one dictionary puts it -- communication is a backand-forth process (Webster's Third New International Dictionary 2003)
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From page 131... ...
COMMUNICATING ABOUT RADIATION RISKS Communicating effectively about risks such as radiation health effects at DOE facilities to workers and concerned citizens is difficult for a number of reasons. First is the level of public fear about radiation from these sites.
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From page 132... ...
. Again, the events leading to having three HHS agencies replace DOE as the performer of research on health effects and becoming the lead agencies in conducting research and communicating research findings and operations at DOE facilities were attempts to restore public confidence and trust in the operations of the federal government.
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From page 133... ...
. More immediately germane to the challenges confronted by HHS agencies and DOE in organizing communication programs is that members of a community can have varying preferences about how they want such programs to be conducted and different criteria for determining the effectiveness or success of such programs.
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From page 134... ...
The effectiveness of the risk communication effort may rest, in part, on meeting social preferences for how the process of planning and decision-making is designed." General Risk Communication Guidelines As described above, each site and different stakeholders involved at that site have their own ideas, preferences, needs, and problems regarding the risks present or anticipated. Developing an environmental or health risk communication program to meet all of these needs is a complex process that requires considerable levels of commitment, time, money, and personnel on the part of government agencies.
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From page 135... ...
Finally, for a risk communication effort to succeed, the developers of the communication program must ensure that their messages are being understood as intended. Failing to evaluate whether risk messages have been understood or whether a risk program has been effective is a major problem because everyone involved in the process could be miscommunicating or talking past each other and yet no one knows it.
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From page 136... ...
report also bears directly on the committee's review of HHS's communications activities: "Risk communication is successful only to the extent that it raises the level of understanding of relevant issues or actions and satisfies those involved that they are adequately informed within the limits of available knowledge." All of the guidelines mentioned for effective risk communication in this introduction, taking into consideration the considerable challenges involved, were used to evaluate HHS dissemination and communication efforts to workers and citizens. COMMITTEE'S APPROACH TO EVALUATING THE HHS EFFORTS To evaluate HHS's dissemination and communication efforts under the MOU, the committee reviewed information provided by HHS agencies to the affected communities in terms of relevance, accuracy, accessibility, timeliness, comprehensibility, and credibility.
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From page 137... ...
, undertook considerable public communication efforts. Of the three HHS agencies, the ATSDR is the most heavily involved in conducting communication, outreach, and education efforts for the general public in the communities surrounding DOE facilities.
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From page 138... ...
. NIOSH Brief Reports of Findings NIOSH places significant emphasis on the use of short reports of study findings to communicate about research and activities to workers and the general public.
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From page 139... ...
NIOSH frequently provided the same information to various DOE facilities with these reports, using different "editions," such as the Hanford or Oak Ridge edition. This was particularly true if the study was one that involved multiple sites.
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From page 140... ...
Date of conference call/visit with site labor and management Memo from DOE headquarters sent to all site POC's announcing study communication timeline Sections of the One-Page Report of Study Findings 1. Names of principal investigators HERB study team develops a draft 2.
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From page 141... ...
PDF document sent to DOE · Site IRB representatives headquarters · 1-800 NIOSH Satellite Broadcast Organize and complete site and/or Site Visit visit to or Satellite Broadcast NO Place the Following in the Branch Files: Study Close Out · Copy of all site-specific one-page study announcements · Copy of all site-specific one-page study results · Copy of the communication timeline · Copy of the DOE memo announcment of the study · Presentation overheads used by the principal investigator and/or study team Communication of Study · Videotape copy of the satellite broadcast Results Complete or trip report of the site visit(s) FIGURE 5-2 Phase II: NIOSH's Communication of Study Findings with DOE and Site Labor and Management.
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From page 142... ...
and adjustments were continuously made to accommodate this feedback, to make the process and information more useful to the target audience." All formal communications to worker representatives, including the Brief Reports, were reviewed and edited by the NIOSH public information office, whose personnel also provided feedback to OERP on ways to better involve workers and the public in its activities (NIOSH 2006c)
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From page 143... ...
Of the 13 individuals who were contacted as a part of the Hanford case study, only a few indicated that they were generally familiar enough with the activities of all three HHS agencies to offer any observations on their comparative effectiveness. However, these few judged NIOSH to be the most effective in its dissemination activities.
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From page 144... ...
Other newspaper or wire articles that appeared about NIOSH studies included the following: · Epidemiological Evaluation of Childhood Leukemia and Paternal Exposure to Ionizing Radiation, September 1998.3 This was a very brief article by Associated Press that represented information in the NIOSH report (Associated Press 1998)
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From page 145... ...
These efforts extended the reach of NIOSH information from some of the Brief Reports of Findings. DOE Communications In the 1990s, DOE provided information to workers about studies, including some by NIOSH, in several different ways.
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From page 146... ...
It also published a paper called "Description of CDC [Centers for Disease Control and Prevention] Studies," which summarized various NIOSH studies of the health of workers at individual DOE facilities and mentioned other NIOSH studies, including community studies near DOE facilities by NCEH and a study at multiple sites of maternal and paternal pre-conception exposure to ionizing radiation and childhood leukemia.
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From page 147... ...
The HEDR was initiated to estimate the amount and type of radiation releases to which individuals living at or near the Hanford site may have been exposed during the production of nuclear materials. The purpose of the study was to "address community health concerns by estimating the amount and types of radioactive materials that were released to the environment (via air and river pathways)
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From page 148... ...
The TSP used the following tools to support its public information program (Niles 1996) : · A quarterly newsletter; · Fact sheets written by TSP members on a variety of topics -- the TSP produced 18 fact sheets and distributed about 100,000 copies of them; · Two informational videos explaining how and when radiation releases occurred at Hanford, among other things -- more than 300 copies of each were distributed to libraries, hospitals, schools, and community groups throughout the Northwest; · A poster for use in libraries and meeting places to introduce people to HEDR; · Public meetings in conjunction with each TSP meeting; · A question-and-answer brochure; · A speakers' bureau whose members spoke to civic groups, the medical community, scientific groups, schools, and others; · Quarterly and annual reports to keep interested parties updated on TSP work: the Communications Subcommittee provided quarterly reports to ensure that the TSP and the public were aware of ongoing public information activities; according to the TSP, public reaction to this approach was good; · Newspaper advertising for TSP and community meetings to encourage public attendance;
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From page 149... ...
Months of careful planning went into preparing for each announcement at well-attended public meetings in a number of cities in Oregon and Washington, according to the TSP. The Hanford Thyroid Disease Study Project The second major NCEH project at Hanford was the HTDS.
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From page 150... ...
. Of the three HHS agencies, ATSDR is the most heavily involved in conducting communication, outreach, and education efforts for the communities surrounding DOE facilities.
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From page 151... ...
that may be experienced by individuals in the vicinity of the DOE sites. · Engaging in health education and promotion activities by developing and implementing strategies to promote health and reduce potential exposures and disease.
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From page 152... ...
. Perhaps due to the low response rate to its flyers or other unknown factors, the discussions of community health concerns in the Hanford PHAs appear to be formulaic.
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From page 153... ...
ATSDR used three other survey tools in FY 2004 to obtain public feedback including the following: "3,612 community health concerns surveys mailed out to communities resulted in an 11% return; distribution of 298 community meeting surveys at the meetings resulted in a return rate of 46%; and 11See http://www.atsdr.cdc.gov/toxpro2.html. Last accessed August 2006.
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From page 154... ...
Generally, ATSDR appears to have fulfilled its requirements to disseminate information to citizens living near DOE facilities. Its web site has many items and links, conveying and explaining information to interested readers about health issues at these sites.
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: 1. How effective are the subcommittees in providing relevant and timely advice to the agencies on site-specific public health activities and research?
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From page 156... ...
These included broad public participation in public health activities and research, representation of diverse viewpoints on the subcommittee, communication of the findings of public health activities and research, and identification and communication to the federal government of the community's concerns. The report noted that at the time, confusion existed among some agencies about the appropriateness of subcommittee outreach activities.
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From page 157... ...
. Committee Evaluations of Site-Specific Communication Efforts In addition to reviewing the overall agency dissemination and communication activities, the committee reviewed these activities in detail at three DOE sites: Hanford, Oak Ridge, and Los Alamos.
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From page 158... ...
The loss of the Hanford Health Information Network (HHIN) was a blow to many in the Hanford community who felt that this central information network was a considerable asset for informing individuals of happenings related to cleanup and remediation at the site as well as public health issues and may have detracted from the community's trust in the agency.
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From page 159... ...
They were actively engaged in relating Hanford information to readers in both Washington and Oregon. To conclude, Hanford was rich in dissemination and communication opportunities for the HHS agencies, particularly going beyond conventional programs and developing ones that serviced an anxious worker and citizen population.
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From page 160... ...
The large number of publications from both ATSDR and DOE regarding health and environmental issues in the Oak Ridge community are available publicly through the DOE Oak Ridge Office Information Center. However, as stated throughout this chapter, it is clear that most of these publications were not designed particularly well for understandability by the average person in the community and therefore were interpreted by many as government "propaganda." The Oak Ridge Reservation HES itself appeared to be controversial, according to a review of its meeting minutes as well as press reports about it.
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From page 161... ...
For all of these reasons, developing an environmental or health risk communication program to meet all of these 13Los Alamos Historic Document Retrieval and Assessment Project.
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From page 162... ...
Finally, believing as many others do that an effective risk communication program must have a minimum of two-way communication interactions, the committee looked at methods used by HHS agencies for the public and workers to provide opinions, recommendations, and other inputs as well as have an influence on decision making. Although bringing the public into a participatory process is important and has been included by both DOE and HHS in their site-specific Citizen Advisory Boards and HESs, respectively, two important priorities for the sponsoring government agency should be present for successful public and stakeholder participation outcomes and increasing public trust.
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From page 163... ...
Information dissemination activities to citizens and workers at DOE sites by the HHS agencies were extensive, often tailored to the needs of specific audiences, and sometimes accompanied by useful public meetings, small group discussions, and other face-to-face exchanges. These activities benefited citizens and workers by providing them with needed information about health risk concerns.
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From page 164... ...
In addition, the agency's discussion about using the most conservative measures in PHAs for evaluating public health concerns could be construed as misleading by concerned citizens since the ATSDR definition of what is considered scientifically "conservative" does not agree with the linear extrapolation of health effects to very low doses used by
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From page 165... ...
Better external evaluation of these efforts beyond just numbers of individuals reached or stories placed in newspapers would have given this committee, and more importantly ATSDR, a more accurate measure of this plan's success. The two other HHS agencies also have web sites.
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From page 166... ...
. The COSMOS evaluation found that the Hanford HES provided consensus advice and recommendations to HHS agencies about a variety of issues, including communication, and that agencies often responded to the recommendations in writing and orally at the meetings (COSMOS 2001a, 2001b)
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From page 167... ...
Also of great concern to this committee was that the efforts made by the three HHS agencies over the years to communicate with workers and citizens about radiation risk issues are being curtailed. The need for HHS, working under the terms of the MOU, to develop more effective two-way communication programs containing relevant, accessible, and comprehensible information about the safety and health effects of the operations of DOE facilities is a central theme of this report.
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From page 168... ...
DOE should work with the HHS agencies, its own contractors, and citizens' advisory boards to try to gain back trust in communities near its facilities with its own open, two-way communication efforts. · Dissemination and communication efforts should be coordinated among the federal agencies involved as long as such coordination does not affect trust issues for HHS agencies among workers and citizens in and near DOE facilities.
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From page 169... ...
This subcommittee should work with DOE and relevant HHS agencies to provide overview, feedback, and advice on communication activities. To further these goals, site-specific advisory boards, reconstituted HESs, or these risk communication subgroups should add a communication professional as a member, if there is no such person already on the group.
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From page 170... ...
· Such assessments would include not only evaluating the quality of the communication products and the ability to disseminate information effec tively but, more importantly, an assessment of how the information is inter preted, perceived, and accepted by the affected communities and workers. To ensure that these evaluated efforts are adjusted to make them more effec tive, internal evaluations should be done yearly and external evaluations should be done at least every 3 years to ensure that the most current feasible risk communication research and practices are being applied.
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From page 171... ...
Many of the three agencies' general communication activities have already been discussed in this chapter, so the site information here deals with additional programs at each of the sites selected for review by the committee. Agency Communication Efforts NIOSH and NCEH NIOSH has conducted more than 10 studies at the Hanford site and has produced numerous publications resulting from these studies, including the Brief Reports of Findings discussed earlier.
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From page 172... ...
As a result of these plans, ATSDR established a number of health education and promotion activities. Hanford Community Health Project One of the results of this need for an environmental health education program at Hanford is the Hanford Community Health Project (HCHP)
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From page 173... ...
. To assess community needs, the HCHP initially surveyed approximately 500 individuals who were potentially exposed to I-131 at the Hanford site to determine their information and health care service needs.
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From page 174... ...
Partnerships were formed with 24 community organizations that agreed to disseminate information. The public relations strategy used the interpersonal communication influence of family and friends by encouraging downwinders on the HCHP mailing list to send pre-stamped postcards to their friends and family who might be unaware of potential exposure and prompt them to learn more about potential health risks.
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From page 175... ...
ATSDR estimated that 14,000 people who lived in areas surrounding the Hanford facility were potentially exposed to iodine-131 at levels high enough to pose a significant health risk, including thyroid disease and a number of other health issues. ATSDR announced its decision on February 7, 1997, that a medical monitoring program was necessary for people exposed to radiation from the Hanford site (ATSDR 1997c)
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From page 176... ...
. Additional Communication Resources: Hanford Health Information Network In addition to information being supplied by HHS agencies and subcontractors, the Hanford community had a major information source available for 9 years.
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From page 177... ...
Representing a variety of interests, members included tribal nations, affected downwinders, labor organizations, and scientific and medical experts, among others. The HHES provided HHS agencies with guidance on handling public health activities at the Hanford site.
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From page 178... ...
The COSMOS report cited a number of examples where the HHES made notable recommendations including recommending changes in the Hanford PHAs and the infant mortality study and trying to implement the Hanford Medical Monitoring Program. These served as examples of the subcommittees recommending "new research or public health activities that their members would like CDC or ATSDR to conduct" (COSMOS 2001a, 2001b)
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From page 179... ...
Other activities covered by the news media included NIOSH's worker studies; HEDR; ATSDR's studies of infant mortality, heart, and autoimmune disease among people living near the Hanford site; ATSDR's community outreach efforts including the HCHP; the HHIN; and the proposed Medical Monitoring Program. Some examples of the news coverage for each agency are discussed below.
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From page 180... ...
. The issue of medical monitoring at the Hanford site was also covered extensively by the news media.
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From page 181... ...
. One of the country's DOE sites, the ORR at its peak in the mid-1940s "demanded a workforce of 80,000."15 The original goal of the work at Oak Ridge was to separate and produce uranium and plutonium for use in developing nuclear weapons.
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From page 182... ...
Some of these were multisite studies involving other DOE sites, while others were specific to ORR workers. A list of NIOSH studies that involved the Oak Ridge Reservation includes the 20 listed in Annex 2A.
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Public Health Assessments ATSDR began its public health activities at ORR in 1992. Initially, the agency's effort focused on Superfund cleanup activities at the East Fork Poplar Creek and the Watts Bar reservoir.
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From page 184... ...
According to ATSDR reports, from 2000 to 2005 ATSDR health scientists collected and documented health concerns and issues in the ATSDR Community Health Concerns Database for the ORR. This database allowed ATSDR to record, track, and address community concerns obtained from written correspondence, phone calls, newspapers, concern comment sheets, and comments made at public meetings.
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From page 185... ...
Various "public" activities developed during the period of time that HHS was working with DOE on health activities at the site. It appears that many of the committees began their activities shortly after the signing of the first MOU between DOE and HHS in 1990.
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From page 186... ...
While this board did not have specific health activities as part of its charter, it had a very active community interface. The board continues to meet monthly, and its proceedings are posted on a web site.18 · Oak Ridge Reservation Local Oversight Committee (ORRLOC)
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From page 187... ...
; and federal, state, and local agencies; and (2) to maximize public participation and involvement in CDC and ATSDR public health activities in the communities surrounding the Oak Ridge Reservation" (ATSDR/NCEH 2006)
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From page 188... ...
was rejected and a resolution was passed "to ignore this paper as scientifically inaccurate in its conclusions which they claim could not be arrived at from the data presented in the paper." A more recent, extensive study entitled Assessing the Health Education Needs of Residents in the Area of Oak Ridge Reservation, Tennessee (Parkin et al.
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Senate Appropriations Subcommittee on Energy and Water Appropriations to eliminate ATSDR's budget for activities at DOE facilities for FY 2006 brought forth further debate about the value of these activities in the local press (Rogers 2005d)
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From page 190... ...
Agency Communication Efforts An assessment of HHS communication activities at LANL is provided below. NIOSH As discussed previously, NIOSH produced one-page Brief Reports of Findings to communicate study results to workers and the community.
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From page 191... ...
These documents are summarized in a searchable database, which also will be available in the reading rooms.24 The LAHDRA web site notes that public outreach has been an important part of the project, including ongoing solicitation of public input and active outreach efforts in public education. The goal of the public outreach program is to present a complete and accurate picture of past operations and releases.
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From page 192... ...
To assess community health concerns for the PHA, in 1994, Boston University conducted a survey to identify the public health concerns of the community surrounding LANL under an ATSDR grant. Initially, surveys were mailed to 71 citizens and organizations on an NCEH contact list.
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From page 193... ...
According to its web site, the NNMCAB is "dedicated to increasing public involvement, awareness and education relating to environmental remediation and management activities at LANL." It strives to ensure that decisions about LANL include informed advice from the community, and it openly solicits public participation in all deliberations. The NNMCAB committee's goal is to make it easier for members of the public to make their voices heard by DOE decision makers, emphasizing the continuing need for intensive public information and involvement efforts by LANL and DOE.26 The NNMCAB stresses that such public information and involvement events 26See http://www.nnmcab.org/.
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From page 194... ...
. Although both of these recommendations are for DOE because this body advises that agency, many of its comments also could be applied to efforts reviewed by this committee for HHS agencies at other DOE sites.
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From page 195... ...
NIOSH's Response to the National Academies' Request 12/9/05, Supporting Documents, CD ROM-2. Presentation to the Committee to Review the Worker and Public Health Activities Program Washington, DC, January 25.
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From page 196... ...
The Committee to Review the Worker and Public Health Activities Program, Worker and Public Health Committee's Public Access File.
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. Submitted to the Committee to Review the Worker and Public Health Activities Program, June 24, 2006.
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From page 198... ...
The Committee to Review the Worker and Public Health Activities Program, May 23, 2006, Atlanta, GA. NCEH/ATSDR (National Center for Environmental Health/Agency for Toxic Substances and Dis ease Registry)
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2005. Competing perspectives on public involvement: planning for risk characterization and risk communication about radiological contamination from a na tional laboratory.
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