Vol. 2, Num 3: Contents | Editorial | Up Front | Abstracts

Editorial: United Nations Address

SCOTT C. RATZAN

In the last 100 years we have witnessed monumental and sweeping change that arguably parallel any such period of time: the tedious process and ethical fervor and debate initiated by splitting the atom, the invention of electricity that has spawned the construction of a new global village -- the internet, and discovery of DNA that subsequently led to mapping the human genome and even cloning animals.

Today, many would agree that success in science and marvels in medicine -- intervening in human life with advancing technology, drugs and vaccinations -- have advanced humankind and heightened expectations equal to our imagination. Our medical breakthroughs, indeed, have increased life span expectations throughout the world. There will be people born this year that have the biological capability to live for over one hundred years, to marvel at life's treasures in the 22nd century.

However, during the last century, we have been at odds with the environment in which we live. In the U.S. alone, in 1993 over 4.23 billion pounds of pesticides (based on active ingredients only) were used in agriculture, wood preservatives, disinfectants, water treatments, and in households and buildings.

While humankind appears to have the upper hand advantage over the environment, some believe certain trends in reproduction signal the beginning of a degrading environment that ultimately will triumph over us -- the human visitors.

For example, studies have shown that:

• There are falling sperm counts in men throughout the industrial world.

• There is an unexplained rise in testicular cancer.

• There is an increased incidence of endometriosis in women decreasing fertility rates.

We have also identified deaths due to polluted air, extinction of species due to the changing climate, an increase in cancer deaths due to ionizing radiation, and disease and death due to poor nutrition, housing, hygiene and environmental toxins. At the same time, millions of people contribute to their own premature death with inhalation of tobacco smoke.

Environmental Degradation and Children’s Health -- is especially important as only the adult age population can truly affect society and policy. . Our children deserve the best from our leaders to overcome myths and misunderstandings advanced through the media.

Of course, any society ought to promulgate the future by protecting our most precious resource -- our environment, and our most precious treasure, our children. Yet, we know our children are vulnerable. They are vulnerable because of the reliance on adults for food, shelter and clothing. If we do not provide a world that is environmentally safe, they will continue to be vulnerable as they enter adulthood.

Let’s consider our benefactors -- children

Children are distinct. They are not small adults. Children have unique biological developments. There are different organs (e.g. thymus), different physiologic and metabolic pathways (e.g. bone growth) and different developmental changes (e.g. puberty). Other differences include:

• increased respiratory rate -- breathing more air per unit weight

• eat more food and drink more water as a percentage of body weight than adults

• more time spent near the floor

• rapid lung growth

• diet and the indiscriminate ingestion of "non-food" items

• high rates of activity

• general growth

• less developed immune systems

Hence, diseases in children, even when they are due to similar agents, could affect their organ systems differently.

We know that children are especially vulnerable to toxic exposures because of their rapid development and distinct physiologic processes. Yet, the differences between children and adults have not received adequate attention in the field of environmental health. Even when the U.S. Environmental Protection Agency has considered toxins more likely to affect children than adults, environmental safety standards including those for pesticides do not always account for differences in the size, respiratory, or metabolic characteristics of a child.

Where are we now?

As we enter the 21st Century, one-fifth of the entire globe uses three quarters of the wealth and physical resources of the planet. Of course, the concentration of population and industrialization in the North account for such a maldistribution amongst the globe. While we all have heard about and are now familiar with global warming and ozone depletion, current warning signs in the environment should inspire everyone to take an active role as a global citizen.

In 1995, the warmest temperatures worldwide were recorded since global temperatures were first kept in 1856. If this current trend from fossil fuel use continues over the next century, average global temperatures by the year 2100 will be 2 to 6 degrees warmer than they are now. This would present the greatest change to the Earth of the past 120,000 years. Such warming may compromise food sources affecting agriculture productivity and marine life and threaten countless numbers of species with extinction.

Additionally, human settlement patterns make us susceptible to some diseases, with nutritional deficiencies, crowded living standards, poor hygiene and water sources allowing pathogens to flourish and lead to death and disease.

We cannot really predict with any precision what all of this might mean for humankind, but what we can predict is a future with enormous dangers for the human species. As the experts in the World’s Fair predicted in 1893 that we would live to 150 years old, the so called experts today cannot predict the future with scientific certainty. However, with advancement in science, we have some successes to counteract our failures -- controlling the release of ozone depleting chemicals, creating pest-resistant crops, and purifying water. Despite minor victories, we still have a long way to go to protect all global citizens -- workers, voters, and more importantly our children.

Today, the true challenge is to create an environment -- a media milieu --that promotes rather than erodes our health. To meet this need, we must work to develop a synergistic relationship of individuals and organizations working together.

We can address some of these vulnerabilities with instantaneous communication technology. If we begin to employ communication strategically, with ingenuity and human will, we can advance the health of future generations. We know the power of communication as we have witnessed its global force in the latter part of this Century as it has swept away coups and the outworn dogmas and borders of the past.

One of the most powerful educators today - the media - now more than ever must act ethically to provide information to the public. Over a century ago, Abraham Lincoln said, "With public sentiment nothing can fail; without it nothing can succeed. Consequently, he who molds public opinion goes deeper than he who enacts statutes or pronounces decisions." The relevance of Lincoln's pronouncement endures today and should empower us to protect the environment by informing various publics through the media to enact change effectively. There are three principal strategies that can assist in this endeavor that are often applied in the field of health communication: Negotiation, Social Marketing and Advocacy.

Negotiation

A proactive negotiation approach has the potential to affect various levels of society contributing to an informed citizenry. Just as we know it is much easier to prevent disease rather than treat it, it is also easier to prevent conflict than to resolve it.

For example, in our response to global warming, policy-makers, industry and scientists can work toward establishing mandatory limitations on CO2 and other greenhouse gases from fossil fuel combustion. More importantly, we should not focus only on the past and existing emissions, but instead work together to reduce all air pollution.

Such bodies like those at the United Nations can foster an environment for negotiation. As the next century will have an increase in future emissions from developing countries, a strategy to control the world’s greenhouse gases is limited. Together, non-governmental organizations along with corporations and governments can work together and invest in our most precious resource to make the world a healthier place for our children. Negotiation ultimately can maximize success with agreed upon agendas consistent with the interests, needs, rules, norms and concerns of all of us as global citizens.

Advocacy

This strategy of advocacy is about influencing an issue’s presentation in the media. It also can help place issues on the political/public agenda, and move the debate about public policy to social causes and solutions. Appropriate advocacy and the judicious use of press conferences and staged events (e.g. community march on the "statehouse" or power plant) can influence the media conduits to the public. Full fledged media advocacy attempts to generate news coverage on environmental issues to reframe such issues so that the chemical industry or other "villain" can be "shamed." Highlighting the negative in news and targeted advertising can mobilize policymakers to decide for the public good over profit. The issue is transformed from a problem of individual responsibility to the best interest of all in society. In may instances, a non-governmental organization with multi-national membership can advocate to be invited for formal observer status, circulate position papers or even make official statements becoming an active negotiator.

In addition, the media advocate can lobby for commercial or governmental regulated television to address the relationship of the environment and health. This would encourage responsible reporting and regular programming in the effort to reach the wider viewing audience. Given that television is the number one source of information for most people, its programming must strive to breakdown statistics to understand the human consequences of what we are currently doing that jeopardizes future generations.

Social Marketing

One important strategy often described within the realm of social marketing is entertainment-education. As such, the ideals go beyond the age-old simple development of public service announcements or purchasing of advertisements. The idea is to use the mass media venues of television, film, and radio to incorporate health messages into characters and dramatic accounts. For example, a radio soap opera in Tanzania incorporates appropriate sexual practice for truck drivers to avoid HIV infection. Street theater plays and talk shows incorporated family planning messages in Peru. Today, there are a variety of opportunities to discuss environmental precursors for cancer and other diseases in the stories throughout the world in popular venues.

While all of these can work independently, to maximize success one must strategically use communication to protect the environment to advance health.

Where do we fit in?

Centuries ago, Machiavelli prescribed that "it is the duty of the prince to solve problems before public emotions make them unsolvable." Earlier this century, Sir Geoffrey Vickers suggested that we need to stimulate the "world of the well" to mobilize private and public bodies, including policymakers, to create living and working conditions and foster public attitudes that are supportive to health and well being. And recently, leading scientific minds at the U.S. Institute of Medicine as well as the U.K. Ministry of Health, proclaim that the origins of health and illness are too complex to leave individuals solely responsible for their own health. Today, the opinion leader and conduit is the ultimate educator for the world on health and environmental issues. Therefore, we should add the media as a target and disseminator in the process.

We need a concerted effort among global citizenship -- including non-governmental organizations, non-profit organizations, government, industry, and academia. Together, we can rise to the task and serve as an ethical compass in helping the public digest pertinent health information, with the use of negotiation, advocacy, and social marketing strategies advanced through the modern media megalopolis.

Today, in a world where perception has become de facto reality, public understanding of the direct environmental links to death and disease are minimal. One of our goals will be to advance the modern-day mantra of scientific progress beyond a sound bite, short story and quick "conclusion" in the public's mind. Systematically approaching health and environmental issues at the local, state, national and global levels to advance accurate understanding of health information and appropriate behavior change could be a hallmark of the next century.

There are some questions we must address in the next century:

• Will the world respond with urgency to the human health risks predicted from the global climate change and draft a treaty to control greenhouse gases?

• Will we protect future generations with a society of scientifically literate citizens?

• Finally, will we use new technologies justly to deliver health to all global citizens?

In conclusion, I would like to add a challenge President Clinton offered in the U.S. on a new wealth: "In earlier history, wealth was measured in land, in gold, in oil, in machines. Today, the principal measure of our wealth is information: Its quality, its quantity and the speed with which we acquire it and adapt to it."

We can only hope that the next millennium will produce true wealth -- an environmentally just society with a common currency for all global citizens -- optimal health.

REFERENCES

1. Environmental Protection Agency. Quantities of pesticides used in the United States, information sheet. 1996. Washington: Author.

2. Auger J. et al. Decline in semen quality among fertile men in Paris during the past 20 years. 1995. New England Journal of Medicine, 332, 5.

3. Raloff, J. Manhood's cancer. 1994. Science News, 145, 138-140.

4. R. Weiss. Estrogen in the environment. 1994. The Washington Post, 25 Jan.

5. Lubin B., & Lewis R. Biomarkers and pediatric environmental health. 1995. Environmental Health Perspectives, 103 (Suppl. 6), 99-104.

6. Farland W.H. The U.S. Environmental Protection Agency's risk assessment guidelines: Current status and future direction. 1992. Toxicology Ind Health 8(3), 205-212.

7. Rogers P. 1993. A jungle full of snakes: Responding to north/south conflict. in J. Tansey & C. Tansey (Eds.), A world divided: militarism and development after the cold war (pp1-25) London: Earthscan.

8. Chivian E., & Epistein P. 1997. Weather Alert. Boston Globe 10 Apr. p. A27

9. Leahigh A.K. 1993. The history of -- quote, unquote -- public relations. Public Relations Quarterly, 38(3), 24-25.

10. Bluden M., & Dando M. 1994. Rethinking public policy-making: Questioning assumptions, challenging beliefs, American Behavioral Scientist 38:1

This editorial was adopted from an address delivered at the United Nations in New York on April 18, 1997 as part of the conference "Environmental Degradation: Its Effect on Children’s Health." Special thanks to Dr. Christine Durbank, Founder and Chair, World Information Transfer, Inc for her efforts to advance dialogue and discourse for children's health.

Professor Scott C. Ratzan, MD, MPA, is also Director of the Center for Ethics in Political and Health Communication, Emerson College Boston.