Public health messaging helps public understand environmental health: Toolkit available ======================================================================================= * Kim Krisberg When Megan Weil Latshaw describes herself as an environmental health practitioner, many people assume she spends her days in the forest tracking endangered species. Most of the time, they have no idea that the efforts of Latshaw and her fellow environmental health professionals impact nearly every aspect of their daily lives. “Their first default is that I’m a tree-hugger or I’m trying to save the polar bears,” said Latshaw, PhD, MS, chair-elect of APHA’s Environment Section and director of environmental health programs at the Association of Public Health Laboratories. “Then the idea of ‘health’ evokes the idea of personal decisions, like not smoking and exercising. But environmental health is so much more than those two things put together…these (practitioners) work every day to keep us healthy, and people don’t even know who they are or what they do.” Despite the field’s central role in protecting the basic fundamentals of health — such as safe water, food and air — environmental health work remains a mystery to the average American. To address this knowledge gap, APHA partnered with the FrameWorks Institute in 2011 to uncover new ways to communicate about environmental health that resonate with the public and engage people in productive policy discussions. This year, the two organizations released “Framing Environmental Health,” a collection of research, sample communications and messaging recommendations that offers environmental health practitioners new strategies for talking about their work and its connection to healthy communities. “Research reveals that environmental health is largely invisible to people,” said Susan Nall Bales, MS, founder and president of FrameWorks Institute. “And what we know is that when people have a hole in their understanding, they default to things they do know — in this case, the environment becomes all about critters, not people, and health becomes about individual acts and choices, instead of acting collectively.” In their research, Bales and her colleagues found that while most people are unfamiliar with the terms “environmental health” and “environmental public health,” people do think about environmental health issues, though such thinking largely revolves around environmental contaminants such as chemicals, heavy metals and artificial hormones. The problem is that the dominance of what the institute described as the “contaminant model of environmental health” impedes a broader understanding of environmental health work — for instance, the field’s work on the impact of community design on healthy behaviors. Perhaps not surprisingly, the institute’s research is not the first to document a lack of public knowledge about environmental public health. For example, a study published in 2005 in the *Journal of Environmental Health* tested a handful of environmental health messages on practitioners, policymakers and the general public, finding a significant perceptual gap between all three groups. To redirect the public away from its default thinking about environmental health, FrameWorks Institute researchers analyzed hundreds of media reports and scholarly articles, surveyed 4,400 registered voters and interviewed dozens of experts and nearly 175 members of the general public. The research culminated in three main tools for reframing public dialogue about environmental health work: values, explanatory metaphors and solutions. Among the many values that researchers tested, the idea of “fairness across places” — that all Americans, regardless of where they live, deserve the opportunity to live in healthy communities — had broad appeal. In turn, using the value of fairness can be an effective way to begin a dialogue about environmental health and frame conversations about the work of practitioners, Bales said. When it came to testing metaphors, Bales and her colleagues found that comparing environmental health workers to an airport ground crew was particularly effective. For example, just as an airport ground crew ensures all goes smoothly on the runway and in the air, an environmental health ground crew ensures the healthy environmental conditions in which people live and work. Another useful metaphor is the idea of upstream environments and downstream health, which researchers said is a promising way to shift understanding from individual health choices to collective action. ![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/45/8/1.2/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/45/8/1.2/F1) Patrick Warner samples water in Grand Isle, Louisiana, in June 2010 following the Deepwater Horizon oil spill. Testing and monitoring are common duties for environmental health workers. Photo by Eric Vance, courtesy EPA “A big takeaway is that environmental health experts really need to take their role as communicators seriously,” Bales told *The Nation’s Health*. “If we can pull back and show (people) the trajectory of how environmental health happens and is built over time, you can begin to talk about prevention…It allows people to really feel and be more in charge of the situation.” APHA member David Dyjack, DrPH, CIH, executive director of the National Environmental Health Association, argues that environmental health workers struggle with communicating their role because they were never trained to do so in the first place. As a former university professor for nearly two decades, Dyjack said the curriculum focuses almost entirely on the “science of environmental health at the expense of the public in public health.” Dyjack, who was involved in the APHA-FrameWorks Institute process, believes that it is more important for the field of environmental health to resonate with society’s values and beliefs than for people to understand exactly what an environmental health professional does on a daily basis. When people ask Dyjack about his profession, he talks about environmental health as a “profoundly personal issue” that touches the most intimate aspects of daily life, from the safe water and food that people put in their bodies to the breastmilk mothers feed their babies. “We have to start with individual people and once they can personalize what we do, then we can mature the conversation to a systems approach,” he told *The Nation’s Health.* “For example, if a restaurant has an ‘A’ (food safety inspection) grade in the window, that has a personal meaning to you and then you may think about the policies and systems that created that rating.” Beyond better understanding of environmental public health work, which could translate into heightened public support for related funding as well, Latshaw noted that enhanced awareness of the field could also lead to new community partnerships. For example, as more people join the “citizen science realm,” collecting their own environmental samples and testing for contaminants, many may not even realize there is an entire workforce silently working behind the scenes on the very same issues. However, she said it might take some convincing to get environmental health practitioners on board with a new communications agenda. “The people who work in environmental health inherently see the value in what we do,” said Latshaw, who was also involved in the APHA-FrameWorks Institute project. “To us, it’s plain and easy to see. But a lot of times when we talk about our field, we can trigger negative frames about government intruding in what people do…we need to better understand when we communicate, exactly what frames we’re engaging.” For Pat Breysse, PhD, director of the National Center for Environmental Health and Agency for Toxic Substances and Disease Registry at the Centers for Disease Control and Prevention, the profession has no time to lose when it comes to educating the public about environmental health work. “When we can communicate what we do in a way the general public understands, we’re benefiting the profession and public health at the same time,” Breysse told *The Nation’s Health.* “We need to make sure the field gets the resources it needs and can attract new people into the profession…The whole world is a better place when we do a better job at communicating what we do.” APHA will host a free toolkit workshop in Chicago on Saturday, Oct. 31, in conjunction with APHA’s 143rd Annual Meeting and Exposition. To register for the workshop and view archived webinars related to the toolkit, visit [www.apha.org/understanding-environmental-health](http://www.apha.org/understanding-environmental-health). For more information on the workshop, email surili.patel{at}apha.org To access the toolkit, visit [www.frameworksinstitute.org/toolkits/environmentalhealth](http://www.frameworksinstitute.org/toolkits/environmentalhealth). * Copyright The Nation’s Health, American Public Health Association