Module 3: Communicating Environmental and Health Risks

Hi, I'm Laurel. Welcome to Module 3, Communicating Environmental and Health Risks. Communicating Environmental and Health Risks is Step 3 of our five-step land reuse model. We'll start with an overview that includes module objectives, risk communication definitions, and the seven cardinal rules of risk communication. There are four main objectives for today. One, identify at least two of the seven cardinal rules of risk communication. These rules help us ensure we are speaking clearly, plainly, and in a manner appropriate to our audience. Two, describe message mapping and key messages. Clear messages are very important in communicating risks. Three, explain how to create message maps from a template. Four, explain the role, responsibilities, and scope of practice of a development community team member. As an environmental health professional, you are part of the team. Let's discuss how we define risk communication. Risk communication within the public health context is the process of sharing information or recommendations with the public so they can make informed decisions about how to manage risks to their health and safety. Risk communication works best as two-way communication between experts and the audience. I'm going to turn it over to Huda, who will talk about important factors for effective risk communication. Hi, I'm Huda. There are a couple important factors to consider when providing risk communication. First, it is important to enhance understanding and knowledge. As risk communicators, our main focus is to provide clear, simple messages about the risk of environmental contamination at a site. We also suggest steps people can take to protect themselves and their families from exposure to site contaminants until the site can be cleaned up. It's important to work with partners such as local and state health departments as well as environmental professionals to help you understand the community and their concerns. We also want to build trust and credibility with the community. Before going to a community, learn as much about the community as you can to develop a basic understanding about them. For example, you can look at demographic information to understand the culture and educational level in communities so that your messages are appropriate for the community and to the level that people can understand. If income level is lower, people may have limited access to services such as a wide range of healthy foods or access to medical care. Age is a factor. For example, older people may prefer fact sheets. Younger people may prefer receiving messages via social media or their phones. It's also important to understand the languages that people speak or read. You may need a translator from the community at public meetings. Religious beliefs may be important. We often partner with faith-based organizations. For example, one of our health educators hosted lead-free Sundays at a church. The local ministers partnered with us to tell their congregations how important it was to test their children under three years old for lead. Because we partnered with trusted ministers, there was a large increase in the number of children tested for lead. In addition, try to learn about cultural background norms and values. For example, one community with many different ethnicities was located within the boundaries of a hazardous site with contaminated soil. Each ethnic group wanted to receive their health messages in different ways. We needed to understand each group to come up with appropriate ways to provide information to that group. Other points to consider when providing risk communication to communities is to consider your audience and where they're from. Geographic location is important. Reaching a community in a small town in southern Arkansas would be very different than reaching out to a community in Chicago. Ask the community how much they know about environmental contamination and how close they live to a site. One of our former health educators worked on a site contaminated with ethylene oxide. We learned that community members felt they were being affected by ethylene oxide even though they lived 10 miles away. We were able to explain that at this particular site, ethylene oxide can travel about one and a half miles away from the plant where it's generated. If you're further away than that from the site, you likely won't have negative effects from ethylene oxide. Are people concerned about brownfields and other potentially hazardous sites? Ask them. Now I'm going to turn this over to Laurel to talk about the seven cardinal rules of risk communication. Let's discuss the seven cardinal rules of risk communication. Dr. Vincent T. Covello developed these rules for the U.S. Environmental Protection Agency or EPA. Over time, Covello and EPA adapted the rules for current applicability. The first rule is to accept and involve the public as a legitimate partner. This can be challenging. Sometimes you may get involved in a site after something has already happened. The community may already have had some negative experiences with other regulatory or health partners. In order to involve the public as a legitimate partner, you need to do your best to involve them early and recognize that people hold you accountable. You also need to recognize the rights of people and communities to participate in decisions that affect their lives, their property, and the things that they value. It is important to put yourself in their shoes and consider the demographics of the community. Are there parents with young kids? Are they taking care of elderly parents who may be at additional risk? What kind of stresses do people have and what is the reality of their lives? The second rule is to listen to the audience. It is important to hear what they know, think about, or want. Don't just assume that you know what their concerns are. If you're coming in a little late to the situation, you can read the news articles to see what kind of concerns people have, but it is important to hear from them directly. You can do this with interviews, small discussion groups, surveys, and toll-free numbers. You could hold a public availability session where you introduce ATSDR and what it's doing at this site. Or if you're a state or local health department, talk about your activities and role at this site. This is a good time to talk with residents about their health concerns from living on or near a hazardous waste site. You may learn information about historical activities at the site that shed light on how people might have been exposed to site-related chemicals either in the past, currently, or in the future. This is a good time to conduct a windshield tour of the area to understand where people live in relation to on-site and off-site contamination. Identify with your audience and find out what are they worried about in the immediate and in the long term. Try to imagine what it would be like to be in their place and walk in their shoes. The third rule is to be honest, frank, and open. State your credentials. Don't ask or expect to be trusted by the public. Tell people your credentials so they know what kind of background and experience you have. To build trust, it will be necessary to have honest conversations and tell people what you know about the situation and their possible exposures. If you don't know the answer to a question, say so. If there are questions that you don't have an answer to, you may say, I don't have that information right now or that's not my area of expertise. Offer to contact another person or obtain that information and then get back to the community or the person asking the question. This helps build trust. Share more information rather than less. This ensures that people don't think you are hiding anything. In the photo image on the right, a community leader is discussing contamination and exposure with community members. This is risk communication. Sometimes we have weekly or monthly check-ins with the community affected by a site, including checking in with this community leader, which we have done for many years. The fourth rule is to coordinate and collaborate with other credible sources. We need to find out who the local trusted partners are. It could be the local health department, local universities, local officials, local community organization members, or citizen advisory groups. You can issue joint communications. At the LCP Chemical site in Brunswick, Georgia, ATSDR worked with the director of the Glynn Environmental Coalition. GEC is a local grassroots environmental organization that monitors cleanup activities at all the hazardous waste sites in The image on the right is of environmental professionals, planners, and a local official coordinating to discuss site concerns. The fifth rule is to meet the needs of the media. Be open and accessible to reporters. Respect their deadlines and stay on topic. Get the information to them as soon as possible. Prepare a limited number of factual key messages and repeat them in your answers. You want to answer the questions that they're asking you, but also take that opportunity to get out the important messages, such as informing people if they need to take a specific action, reduce or prevent their exposures to a contaminant, or do something that could improve their health. Say only what you are willing to have repeated. Remember, everything you say in an interview is on the record. Reporters may overhear you talking to a citizen at a public meeting. Your voices may carry. If the reporter is within earshot, they may quote you as if that was a public statement. You may need to find a place to talk privately. The sixth rule is to speak clearly and with compassion. Use plain, regular, and understandable language with the public and the media. Avoid abbreviations and acronyms. Be sensitive to local norms. You can use images to get your messages across. Personalize risk data through stories, examples, and anecdotes. Your clothing and appearance may have an impact. Wear something that a member of the community might wear, such as a business casual outfit. Or, if you are meeting with a lot of officials, you may need to be respectful and wear a suit. Acknowledge and be empathetic to people's feelings and emotions. You need to let them know that you are aware of their anxiety, their fear, their anger, their outrage, and their helplessness. Tell people what you can and cannot do about this site. Honesty builds trust. If you cannot do something, try to find someone who can meet their needs or refer them to someone who is better suited to answer their question. The seventh rule is to plan carefully and evaluate your performance. Have clear objectives. When going into a meeting, you should be prepared. Know what your objectives are and what information you are intending to share. Provide information and reassurance. Involve partners in joint problem solving. Evaluate your efforts and learn from mistakes. If you're in charge of the meeting, provide an agenda to attendees. Ask them if they want to add anything to the agenda and negotiate where to place that addition to the agenda. When possible, work by consensus. Try not to vote to make decisions, but rather keep talking until you reach a consensus on a topic. Your staff should be trained in communication skills. CDC and ATSDR have searchable community engagement and communication tools and resources. You can also have staff take Module 1 on our training landing page. This module is about community engagement. You can pre-test your messages. You can share them with people within your field who are not involved with the particular site so they can provide feedback. Different audiences may need different risk communication strategies. Now I will turn it over to Charette, who will walk you through a series of knowledge checks. Hi, I'm Charette. Here is knowledge check one. A basic tenet of Covello's risk communication rules is that people and communities have a right to participate in decisions that affect their lives, property, and things they value. A, true. B, false. Let's take about five seconds for you to answer. The answer is A, true. We should ensure that community members are given the opportunity to participate and express how living with hazardous waste has affected their lives. Knowledge check two. Which are true? Select all that apply. A, train all staff in communication skills. B, talk only to the subgroup that you feel will listen to the message. C, avoid thinking of your audience as the public or using this term. Understand the concept of different audiences, each with its own interests, needs, concerns, priorities, preferences, and organizations. D, begin with clear, explicit risk communication objectives, such as providing information to your audiences, motivating individuals to act, stimulating response to emergencies, or contributing to the resolution of conflict. E, recruit spokespeople who are very technical so they can get all the minute details correct. F, pre-test messages whenever possible. G, evaluate efforts carefully and learn from mistakes. Let's take about 10 seconds for you to answer. The answer is all but B and E are true. Answer A is true because you should have staff trained in risk communication. Answer B, talking only to the subgroup that will listen to the message, is false. It does not reach the part of the population who may disagree initially but may need more interaction with you to fully develop an opinion. Answer C is correct because it encourages you to think about your audience and their needs. Answer D is correct because your clear communication may motivate individuals to take action. Answer E is incorrect. You do not want to have very technical people as spokespeople unless they have training in risk communication and can speak plainly. Answer F is correct. You should pre-test your message to ensure they are effective. Answer G is also correct. It is important to evaluate your efforts throughout your project. Knowledge check three. Select all that apply. When listening to your audience's concerns, remember to A, let all parties with an interest or stake in the issue be heard. B, let people know that what they say is understood, addressing their concerns as well as yours. C, recognize the hidden agendas, symbolic meanings, and broader economic or political considerations that often underlie and complicate the task of risk communication. D, be honest. If you don't know an answer, say so and offer to find out more information. Let's take about 10 seconds for you to answer. The answer is all of the above are true. Knowledge check four. Select all that apply. What strategies will help build trust and credibility in the community? A, be honest if an answer is unknown or uncertain. B, disclose risk information as soon as possible, emphasizing any reservation about reliability. C, never disclose data uncertainties. D, get back to people with answers. E, emphasize worst-case scenarios just in case. F, never admit mistakes. Let's take about 10 seconds for you to answer. The answer is A, B, and D are correct. A, be honest if you are uncertain about an answer or the answer is unknown. B, disclose as much information as you can. D, get back to people with answer in a timely way. C is incorrect. At the appropriate time, such as when you're presenting your analysis, you should discuss uncertainty in the data or information about a site. E is incorrect. Emphasizing worst-case scenarios without looking at typical scenarios may alarm people and make them think everyone is at risk. F is also incorrect. You should always be willing to admit your mistakes. What's important is what you plan to do now that you've found a mistake. Here's your opportunity to build trust with community members. Many years ago, an ATSDR staff person apologized to a community member for not getting to a promised task. The community member said that it's the first time a government official had ever apologized to them. The two people ended up developing a good working relationship at the site. Knowledge check five. Conflicts or public disagreements with other credible sources have no effect on risk communication. A, true. B, false. Let's take about five seconds for you to answer. The answer is B, false. Conflicts or public disagreements can confuse your audience and impact the way you communicate. Whenever possible, you should work closely with trusted sources identified by the community so you avoid public disagreements. Knowledge check six. Select all that apply. Meet the needs of the media by A, telling them only what they need to know. B, telling them where to find their own background information. C, providing risk information tailored to the each type of media, for example, graphics and other visual aids for television. D, ignoring their deadlines and only worrying about the project deliverables. Let's take about 10 seconds for you to answer. The answer is C, is correct. Provide risk information tailored to each type of media, such as having graphics for television. For A, you do not want to filter what you are telling the media. It breaks any trust that you may have built. B is incorrect because you want to provide reliable information as an environmental health expert. D is incorrect. You want to provide information as soon as possible. You want the media to get accurate information to the community. Knowledge check seven. Select all that apply. When communicating risk to the public, it is important to speak clearly and with compassion. Tips to remember include A, avoid distant, abstract, unfeeling language about deaths, injuries, and illnesses. B, never include a discussion of actions that are underway or can be taken. C, use technical language and jargon. D, be sensitive to local norms such as speech and dress. E, use risk comparisons to help put risks in perspective, but avoid comparisons that ignore distinctions that people consider important. F, use vivid concrete images that communicate on a personal level. Let's take about 10 seconds for you to answer. The answer is A, D, E, and F are correct. Answer B is incorrect. You can include an update on what is happening or will happen to keep the community informed and build trust. Answer C is incorrect. You should avoid technical language and jargon so that your communication is clear and easy to understand. Now I will summarize the risk communication points. Include the public early in the process. Ensure the public that you are their partner working in collaboration with them. Listen and ask questions for clarification. Use plain, clear language. Don't promise more than you can deliver. Be honest. It is okay to say, I don't know, but I will try to find an answer for you or refer them to someone who can answer their question. Follow up promptly to maintain trust. As an environmental or health professional, you have a role in risk communication. There is a chance that when you work with a community, you may be the first environmental or health professional they've ever worked with. You need to engage community members to understand their needs. Make sure to address their concerns. They may worry that they have been exposed to a chemical that could harm them. You may need to communicate key messages about any potential hazards or risks. You may be seen as a reliable source for accurate information about contaminants, risks, exposures, and site development techniques. Part of your role may be to explain an environmental cleanup at a site. You can explain the extent of contamination and what cleanup methods were used. You can discuss the status of the site and methods used to make sure that public health was protected while the site was being cleaned up to a level appropriate for its intended use. For example, if demolition occurred, you can explain that the area was enclosed to prevent migration of dust. Or if a site was capped to prevent any migration of contaminants and soil, you can explain how the cap will be monitored in the future. In risk communication, we tell people about the contaminants on the site, how they may be exposed, and whether it may harm their health. Now that we've defined the role of an environmental health professional, let's discuss how we use messaging and how we get the message to our community about environmental risks. Messages can be written, such as fact sheets or information on a website. Messages can be spoken, such as providing key points to community members. Messages can be visual. For example, a picture of a person washing hands with a clock showing 20 seconds. Messages are generally simple one-sentence statements, such as stop or reduce exposure, test children for lead, use bottled water, wash children's hands, follow fish consumption advisories. I am now going to turn it over to Huda, who will talk about how we use message maps in our work. This is an example of a message map. We identify the most common questions and concerns that our partners or audience have. Then we develop message maps, one map per concern. In message mapping, we develop three key messages. We try to use nine words on average. Keep your messages short, succinct, easy to understand, and written in plain language. Under each key message, we can have up to three supporting messages. For example, supporting message 1A, 1B, 1C, etc. You can download a copy of the message map blank template from the course materials using the link at the bottom of the slide. Here are some key points to think about when developing key messages. Key message number one is, what is most important for people to know? Here we plainly address the issue, such as we did find arsenic in the playground soil. Key message number two is, how can this impact people's health? This is usually what most people are concerned about. For example, children, and especially those with soil pica behavior, might experience nausea and vomiting from contact with arsenic in playground soil. Key message number three is, what conclusions can be drawn related to risk and exposure? For example, children were not likely exposed for part of the year because they did not use the playground in winter. Now we will do a message map exercise with a site that is fictitious, but it is based on real events. Its mock location is my daycare in Carved Rock, New Mexico. The daycare building formerly housed a company that made plastic safety nets. While manufacturing the safety netting, they contaminated the soil with arsenic and other chemicals. Most but not all of the contaminated soil was cleaned up. After the factory closed, new owners redeveloped the building as a daycare center. Unfortunately, the soil in what is now the playground area was never sampled for contamination. When local officials and environmental professionals found out that it had never been sampled, they had concerns. They were concerned that the staff and the children in the daycare might be exposed to harmful contaminants. Local officials and environmental professionals worked with the owner and the daycare operator to test the playground soil. They found that the surface and subsurface soil was contaminated with high levels of arsenic. They worked with the new property owner to prevent exposure to the contaminated soil. They had a trained contractor that excavated the soil, added clean soil, and then added a layer of wood chips. The community, including parents and daycare staff, were concerned about the soil contamination. They wondered if their health might be harmed because they had been exposed to arsenic in the soil. They wanted to know how the daycare soil was going to be cleaned up. The local officials and an environmental professional prepared a fact sheet. They held a public meeting to provide information to the community, the parents and staff of the daycare. They answered their questions. Daycare staff and parents were reassured and were satisfied with the remediation. The message to parents was that children from the daycare will not have direct contact with the contaminated soil in the playground. As a result, the children will not be exposed to the arsenic in the soil. This is an overview of the case study. There was arsenic in soil at the daycare center. While much of the site was cleaned up, the playground soil was not sampled. The risk focused on how much might remain in the unsampled playground soil. The outcome was that local officials and an environmental professional helped get the soil tested. The soil was contaminated with arsenic. The local officials and environmental professionals put in a plan to prevent exposure. As a result, local officials and environmental professionals oversaw the remediation of the soil and placement of clean fill and wood chips. Laurel will walk you through the message map. The partner question or concern is, are the children going to be sick from exposure to arsenic in the soil? We have three key messages. We use more than nine words in this example as part of our instruction, but you would use less. We also don't need to have three supporting messages under each key message. That is fine if you can get your point across with fewer sub-messages. Key message number one, what is most important for people to know? In this case, the local officials ensured that the soil was removed and covered with clean soil. Key message number two, how can this impact people's health? Before remediation, children who came into contact with playground soil were likely exposed to arsenic. Key message number three, what conclusions can be drawn related to risk and exposure? Children might have experienced nausea or vomiting before the soil was remediated. For key message one, the supporting messages are, 1A, the cleanup placed additional wood chip layers across the entire playground as extra protection. 1B, the daycare owner will get the soil screened twice a year to reassure parents that the children are safe. For key message two, the supporting messages are, 2A, after remediation children will not have contact with arsenic in soil. 2B, after remediation children can use the playground. For key message three, the supporting messages are, 3A, during winter children were not using the playground which lowered their exposure risk. 3B, a child would need to play directly in the soil to be exposed. We don't have a third supporting message for the three key messages, and that is fine. We made our point in fewer messages and words. This exercise is about an asbestos mine. This is a mock site. The ABC site mock location is in the Wilderness Peninsula of Minnesota, again a fictitious location. It was an active asbestos mine from the early 1900s to 1993. Chrysotile was mined from this site. Chrysotile is a toxic form of asbestos mineral. As a result of mining this material, there were tons of waste rock and mine tailings. Tailings are a waste product of mining and are small particles that typically need to be contained. Runoff from this tailing site began to drain off the site. The contaminated water containing asbestos fibers got into the surface water, the stream, and the sediments at this site. There were also wetlands contaminated with this runoff. People hiked, skied, and camped in these areas. Charette will continue with the discussion about asbestos and exposure factors. So, now we need to think about the material found, which environmental media it is in, and how people are exposed to it. Asbestos in the tailing piles and the nearby wetland areas represented an ongoing source of airborne asbestos. This was a particular concern for people who previously accessed the site and wetlands. The site was known as a great place for recreation, such as hiking. We know that asbestos exposure is not a problem if asbestos is left alone and not disturbed. It is possible that people recreating and moving through this area could have disturbed the site. Asbestos exposure results from breathing in asbestos fibers. Asbestos fibers can be released into air when rocks, soil, or products containing asbestos are disturbed. Fibers breathed into the lungs could remain there for a lifetime. This could result in lung disease or mesothelioma, a form of cancer. It is important to consider exposure factors to determine how one's health may be affected. Exposure to asbestos doesn't mean you will develop health problems. Factors that affect whether your health will be harmed include how long and how frequently a person was exposed. Was it just a one-time occurrence or was the person at the site every weekend? How long it has been since exposure started? How much a person was exposed to? Whether someone smokes. Cigarette smoking increases chances of getting lung cancer from asbestos exposure. Was the person exposed to secondhand smoke from a smoker? What was the size and type of asbestos a person was exposed to? Does the individual have other pre-existing lung conditions that can exacerbate or accelerate exposure risk such as chronic obstructive pulmonary disease or emphysema? These are the recommendations that the local health agencies want the public to know. Restrict access to the ABC mine property. Prohibit and discourage recreational use of site to minimize exposure. Ultimately, the site was fenced. Prevent the reuse of tailings beyond the ABC property. Don't use wetlands located downstream for camping or other recreational activities. Again, the site was fenced and all activities were banned. You can download a copy of the message map blank template from the course materials using this link. https://www.atsdr.cdc.gov communications-toolkit-documents-12-message-mapping-tool-final-111015-508.pdf Huda and Laurel will now demonstrate the message map for the asbestos mine. You can fill in your blank template at the same time. Remember to start with the partner question Key message number one is, what is most important for people to know? Key message number two is, how can this impact people's health? Key message number three, what conclusions can be drawn related to risk and exposure? The partner question or concern is, I hiked on the mine tailings and camped there. Will I get sick? Key message number one is, what is most important for people to know? You may have been exposed to asbestos if you hiked and camped on the tailing piles or in the contaminated area downstream. Huda, what is key message two? Remember, people usually want to know how this will harm their or their family's health. So, key message number two is, how can this impact people's health? Being exposed to asbestos does not mean that you will develop health problems. Key message number three is, what conclusions can be drawn related to risk and exposure? Here are things you can do to stop or reduce exposure to asbestos. For key message one, the supporting messages are, 1a. Several factors affect whether you will develop health problems. 1b. Factors include how long, how often, and how much you were exposed to. 1c. The size and type of asbestos fibers you were exposed to is another factor. For key message two, the supporting messages are, 2a. Other pre-existing lung conditions can exacerbate or accelerate exposure risk. 2b. Cigarette smoking with asbestos exposure increases your chances of getting lung cancer. For key message three, the supporting messages are, 3a. Stay off the mine property. 3b. The site and immediate wetland area is fenced to block access. 3c. Do not camp or recreate in wetlands outside the fenced area within one mile of the property. Remember, we don't have to have second or third supporting messages if we have already made our point. The outcomes of the case study of the ABC mine are, the local partners developed an education and awareness campaign. Federal, state, environmental, and health agencies worked together to ensure that their messages were consistent and had the same priorities. The campaign informed residents about asbestos exposures and encouraged residents to minimize exposure by staying off the mine property. Sometimes restricting access is the most important factor in preventing exposure. The site was identified as a hazardous place where recreation can be dangerous to people's health. Nobody was allowed to access the site. I will now turn it over to Charette to discuss resources for risk communication. Let's discuss some resources you can use. These include CDC and Federal Plain Language Guidelines, National Center for Environmental Health ATSDR Clear Writing Hub, Risk Communication Resources, ATSDRs for Health Agencies Risk Communication Module. I will review these resources in more detail over the next few slides. You can use CDC's and Federal Plain Language Guidelines. The Plain Writing Act of 2010 enhances citizen access to government information and services by establishing that government documents issued to the public must be written clearly. The Plain Language Guidelines are available at https://www.plainlanguage.gov. There is also an icon link on this page to download the Plain Language Manual. The National Center for Environmental Health and ATSDR hosts the Clear Writing Hub. There are several resources that can help you communicate clearly with messages tailored to your audiences. These include clear writing training modules and writing tips, a plain language thesaurus, toolkits, and other resources. You can access the Clear Writing Hub at https://www.cdc.gov. ATSDR's communication toolkit is also a useful website at https://www.atsdr.cdc.gov. Some of the resources on the website include the ATSDR Communication Toolkit User's Guide and various tools to assist with community meetings, presentations, partner engagement, message mapping, and more. You can access ATSDR's For Health Agencies page on the Land Reuse website and click on the Risk Communication Module. The page is available at https://www.atsdr.cdc.gov. The reading that supplements this training is Chapter 10 of the free course textbook, Land Reuse and Redevelopment, Creating Healthy Communities. The book is available on the training homepage. To receive continuing education for this course, please access the link on the training landing page for this training module. You will be linked to CDC TRAIN to take a short, open book post-test and to complete an evaluation. That is the end of the presentation for Module 3. Thank you for attending. For more information, email attsdr.landreuse at cdc.gov.