POPs and Human Health

COMMUNICATING INFORMATION ON HEALTH RISKS OF ENVIRONMENTAL CONTAMINATION: EXPERIENCE OF ROLL PROJECT

In 1995 - 1998, in order to improve environmental management in urban areas, and prevent adverse health impacts of environmental factors, a series of projects were implemented in several cities of the Russian Federation - Volgograd, Novokuznetsk, Perm, Krasnouralsk, Angarsk, Nizhny Tagil, Novgorod, Cherepovets and Zelenograd. The projects were dedicated to assessment of health risks of environmental contamination. The projects were implemented with the aim to obtain evidence of "contributions" of specific pollution sources and particular chemical compounds into excessive mortality or morbidity rates, to assess cost efficiency of different risk-reduction activities, to inform decision-makes in the sphere of environmental policy in urban areas, scientific community and the general public on priority sources of environmental risks and potential risk-reduction options

In 1997 - 2001, within the framework of ROLL project ("Roll-out of Findings and Experience"), 17 projects, dedicated to health risk assessment and environmental policies, have been funded. These projects made their contribution into the process of adjustment of health risk assessment technique (HRAT) to the system of environmental management in Russia and into procedures of decision-making on environment quality management matters in interests of health of local population. The projects have demonstrated opportunities for further adjustment of the technique to Russian conditions. Works of 1997 - 2000 addressed diverse problems in the sphere: assessment of health risks of environmental contamination and assessment of efficiency of risk-reduction actions, dissemination of techniques for justification of managerial decisions, based on risk criteria, dissemination of experience of measuring low levels of lead in children's blood, approval of procedures for co-operation of governmental agencies and non-governmental organisations in the course of risk assessment works, trainings for health and environment specialists, health care professionals, representatives of environmental agencies.

Risk assessment projects are usually implemented by inter-disciplinary teams of experts, representing environmental protection, epidemiology, environment and health, and environmental economics.

Typically, there projects result in development of recommendations for reduction of health risks identified. The recommendations may incorporate different measures - from engineering and technological to administrative, economic and legal ones.

Communicating of risk information is an integral component of health risk assessment techniques, it promotes establishment of relations of trust between authorities and population, socio-economic stability of regional development and follows principles of environmental fairness. Practical experience shows, that programs for communicating information about health risks facilitate involvement of population and stakeholder groups into management of these risks at different levels, including the individual level.

Responses to questionnaires on "risk perception" show, that "voluntary risks" are the most often associated with lifestyle patterns (smoking, daily habits, inadequate nutrition), these risks are also classified as "controlled risks". Respondents associate "forced risks" with overall environmental contamination and food products of poor quality. "Controlled risks" are assumed to incorporate nutrition, daily habits and living conditions. "Risks under control of others" are assumed to incorporate environmental contamination and nutrition. Therefore, even specialists (economists and sanitarians) consider health risks in fairly broad terms, without subdividing them into environmental and social risks. "Natural risks" are assumed to incorporate "poor quality of drinking water", "climate", radioactive contamination", while "chronic risks" are assumed to incorporate "contamination of drinking water and ambient air". "Industrial risks" are characterised as emissions and discharges, but the same risks categories are classified as "forced risks". Respondents suggest that "examinable risks" include environmental contamination, social factors, and, to the equal extent, quality of products, smoking, stresses, carelessness, while "incognisable" ones include space rays, extrasensory impacts, geo-pathogen zones, influences of UFOs. Actually, now specialists cannot make a clear distinction between health risks and environmental risks.

It is necessary to emphasise, that responses of the general public and individuals to all messages (especially to the ones, that call for altering lifestyle patterns) are partly associated with different factors, including risk perception. Inducing people to change their behaviour is a rather complex process. Its complexity is associated with difficulties of identification of reasons, that prevent individuals from participating in risk reduction actions - these reasons might be attributed either to the fact, that people simply do not wish to alter anything, or to lack of understanding of risks involved. People typically tend to underestimate "voluntary risks" and overestimate "forced" ones. Therefore, an insight into public perception of risks allows risk-assessment specialists to estimate thresholds and probabilities of individual and social changes.

It is necessary to remembers that mass media outlets and specialists objectively pursue different aims in communicating information on health risks. Therefore, the roles of environmental awareness and education of all participants of the communication process are extremely important for perception and understanding of health risks of adverse environmental factors.

Practice shows, that depending on a particular audience, the following information communication forms are used: papers, newsletters/publications, ad hoc "hot" issues, methodological manuals, databases, audio-visual materials, news releases, environmental labelling, press-releases.

It is believed, that a message must be communicated several times to induce changes in human behaviour. An individual, who changes his/her behaviour, needs be assessed positively by him/herself and by others. Typically, use of a mix of several communication channels promotes higher message-communicating efficiency, e.g. use of individual communications in parallel with mass media channels. When many people begin to follow a new behaviour pattern (more than 10% of a group), the pattern transforms into a standard for the whole group.. At the level of micro-programs for communicating information on health risks, the following algorithm had been developed and tested in several cities: 1) development of concepts and objectives of a communication program, efficiency assessment criteria; 2) identification of target audiences for communicating information on risks; 3) assessment of interim and final results of risk assessments; 4) development of contents of the information on health risks, depending of a target group/audience selected; 5) selection of forms for communicating information; 6) selection of information communication channels; 7) development of channels to receive a feedback from the target group; 8) assessment of efficiency of the micro-program against selected criteria; 9) communicating information on assessment of the program (to the same target groups and using the same communication channels).

It is necessary to note, that information on risks is communicated at all stages of HRAT - i.e. at stages of risk assessment and risk management. For example, implementation of a micro-program for communicating information on health risks of environmental contamination in Serpukhov (ROLL project - 1998 - 1999) was focused on two major groups; the city population and administration. The city administration received recommendations on risk-reduction at the city level (risks of particulate matter - PM10); while the city residents received recommendations on risk management at the individual level - switch from cultivation of vegetables to cultivation of flowers, reduction of risks of PCB contamination due to reduction of consumption of food products from "Zaborie" district, where levels of PCBs were found to exceed relevant levels of other city areas in 5 times. After completion of the project, the information campaign in mass media outlets continued (health risks and potential health problems, associated with main carcinogens, present in the city environment).

Assessment of the program's efficiency (it was made 6 moths after completion of the project) was made in qualitative terms - "reduction of health risks due to changes in behaviour of the city residents". According to survey data, 15% of residents, who cultivated vegetables in contaminated "Zaborie" district have followed recommendations of the project and the health risk information communication program - they switched from cultivation of vegetables to cultivation of flowers - as a result, supply (and consumption) of contaminated food products decreased. The city administration had approved the program for dust management works as a component of its health risk management system for 2000 (including an adjusted timeframe for cleaning and street-washing works in places of high dust contamination).

Therefore, in order to improve efficiency of risk management decisions at city and individual levels (with involvement of population into management of health risks), it is necessary to ensure comprehensive planning and design of information communicating programs with use of tested foreign experience. Recommendation on improvement of the process in respect to every particular component of information communication procedures - sources of information, contents, communication channels and audiences - are or particular importance for risk management. All components of the procedure, taken together, must form a well-designed mechanism of the overall system of environmental management for protection of human health.