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

First, I would like to thank H.E. Betty King, U.S. Ambassador to the United Nations for the introduction and the idealism that we all can work together to make the world a better place for our children. World Information Transfer, Inc. founder and chair Dr. Christine Durbak should be commended for her commitment to promoting environmental health.  I am also honored to share the podium with co-chairs Bernard Goldstein and Farouk Mawlawi who endeavor to make our human contribution to this planet admirable.

 The Bangladesh government also should be recognized for their interest in this topic.  While many would say that overcoming food scarcity, poverty and starvation might top the lists of their concerns, forward thinking in highlighting survival for humankind is a magnanimous response in 1998.

 I would like to begin with a quote uttered in the middle of this Century:

"Man in this moment of history has emerged in greater supremacy over the forces of nature than has ever been dreamed of before...There lies before him, if he wishes, a golden age of peace and progress.  All is in his hand.  He has only to conquer his last and worst enemy -- himself."

 In the time since Winston Churchill made this comment in 1950 warning of human success, we have seen the world population triple to six billion people.  We  have also witnessed change at a speed unlike any other time in history.  We have been to the moon, split the atom, and created an international superhighway -- the internet. We are no longer in an industrial or information age; it is now the communication age.

 Computers are no longer used for computation and are communication devices.  They present opportunities for sharing and transferring information like never before.

 Indeed, during the 20th Century, we have set challenging goals in health and have achieved some modest victories –  Smallpox was eradicated from the world in 1977, polio was eliminated from the Americas in 1991, and we are on our way to eliminating measles from this Hemisphere.  Vaccines now protect about 8 out of 10 of the world's children against six killer diseases.

 Despite the discovery of antibiotics,  microbial resistance due to overuse of antibiotics has contributed to the emergence of new diseases and the re-emergence of old ones that were once under control.  The HIV/AIDS virus continues to afflict and kill 1000s each day.  While it is hard to predict which infectious diseases or environmental disaster we have to conquer next, international travel, the movement across borders of goods, foodstuffs, and diseases will require a new level of preparedness.

 Today, I hope to present ideas to address trauma of environmental disasters.  In fact, the title of my address, "Health Risk Communication -- Heeding the Challenge," might be viewed as a 21st century challenge.  Yet, for the first time, we will begin the next century with human numbers and technology that have the power to radically alter the fate of the planet and its inhabitants.  While 20th Century scientific discovery could change the way people live,  environmental consequences are of the greatest magnitude in history.  Last year, it is estimated that 5000 species of plants and animals were "lost," never to return to the planet Earth.

 At the end of this Century we also have greater disasters.  The International Red Cross and Red Crescent Societies states that disasters have tripled in one decade.  For example, in 1991, 311 million people were killed, injured or displaced by disasters.  The number of refugees are the greatest at any time in this century, including the years around World War II.  Furthermore, we now have human made calamities that are unparalleled in any other time in history -- the Bhopal incident, Chernobyl and the Mad Cow Crisis that remind us of our limitations and our vulnerabilities.

 We also have our own form of chronic disaster.  In 1997,  we grew tens of billions of pounds of tobacco worldwide, consumed by over 500 million people.   Tobacco unequivocally causes harm to the human species.  However, this menace is a long-term environmental disaster because it requires tackling financial and biological addiction.  It also has a multi-billion dollar industry establishing a tolerant societal environment that condones cigarette smoking.

 The field of health communication has been of great interest since my commitment to combine science and humanities to be an ethical global citizen. I have been fortunate to study medicine, public administration and communication.  For the past decade my efforts include development of a prototype graduate program in health communication, and also advancing academic inquiry and application in examining ideal ways to communicate health and risk.

 I currently edit the peer-reviewed Journal of Health Communication: International Perspectives.  Recently, as we have a technological tool chest unlike any other time in history to positively impact society, I have joined the Academy for Educational Development to advance health throughout the world with applications of health communication technology and educational innovation.

 Today, I will address the theme of the conference with disasters that have been caused by ineffective communication.  The subject of my recent book The Mad Cow Crisis: Health and the Public Good provides the initial backdrop.  Thereafter, I will briefly discuss warnings of ensuing disasters and finally, offer opportunities for all of us to "make a difference" in our quest for a healthy world.

TRAUMA OF ENVIRONMENTAL DISASTERS
 Of course, it would be appropriate to discuss the theme -- trauma of environmental disasters with some definitions. In his book A New Species of Trouble: The Human Experience of Modern Disasters, Kai Erikson, defines trauma as a violent event that injures in one sharp stab.  Trauma can be from a sustained exposure to battle as well as from a moment of shock, from a pattern of abuse, or a sudden flash of fear.  Trauma also, according to Erikson, "can mean not only a loss of confidence in the self but a loss of confidence in the scaffolding of family and the community, in the structures of human government, in the larger logics by which humankind lives, and in the ways of nature itself."
 
While we use the word disaster in everyday conversation to refer to an event that interrupts the flow of everyday life, disasters seem to adhere to Aristotle's rules of drama -- they have a beginning, middle and an end.  They can have differing mechanisms, but their consequences are grim.
 
Of course, we all have an idea of how we define the environment in which we live.  In this respect, we should not view our countries as our environment.  The languages and borders we have created have half-lives far shorter than nuclear wastes.  Our environment also has natural resources.  Unfortunately, inflicted human elements deplete these for "one time usage."

MAD COW ISSUE
 Although we also know of some of the problems in the 20th Century -- two world wars and the largest organized genocide in modern history -- we still have a series of human derived health hazards.  Misunderstanding, mismanagement, and failed policy-making in Europe caused a Mad Cow Crisis.

 The bovine spongiform encephalopathy issue, commonly termed the mad cow crisis,  has cost over $10 Billion worldwide and an immeasurable amount of misdirected energy in Europe and throughout the world.  This saga continues to garner front page headlines and magazine covers since the release of data of the infinitesimal, hypothetical chance of contracting the disease  by eating beef.
 Despite the losses, there has neither been great progress toward a cure or diagnostic test, nor has there been an understanding by the public of what went wrong in the process.

 Here is a short synopsis of what occurred:
In March, 1996 a British government report suggested mad cow disease -- a disease prevalent in British cattle -- could be transmissible to humans.  The ensuing media frenzy crippled the British beef industry and further questioned the safety of the food supply throughout the world.

 Few people challenged the veracity of the claims or the quality of evidence.  While the British government tried to calm such food-related fears, a ban on British beef products was proclaimed by the European Union.  European domestic politics interceded.  The result -- a British blockade of legislation and a threat to leave the European Union.

 The issue escalated while accurate communication and dissemination of  health information was incomplete.  The hypothesis of the cause of the mad cow disaster was the human derived idea of feeding ruminant offal, that is, meat and bone meal from cows and sheep that are not fit for human consumption back to cows.  This high quality protein of animal feed may have harbored the infectious agent responsible for BSE.  It is thought the same mechanism may have been the vector for the 20 human cases of CJD (Creutzfeldt-Jakob Disease).

 However, even today, years since public discussion began on BSE (bovine spongiform encephalopathy), and a microscopically similar disease in humans CJD (Creutzfeldt-Jakob Disease), mis-information continues to dominate the discourse.  The public at large still lacks   literacy on complex health and science issues, shall we say a new health illiteracy.

 Today, following a slaughter of over 200,000 cows,  the same mystery shrouds the unaccountable human deaths.  Europeans are consuming less beef, while the verifiable facts suggest that only cows die of Mad Cow Disease.  There has yet to be a single documented case of CJD - the purported human equivalent  - from ingesting beef, lamb or dairy products.

 The mad cow/bovine spongiform encephalopathy case presented a good example of how a potential problem became of interest to many due to its uniqueness and potential impact on food supply.  However, while our leadership is not focused on effective health communication and disease prevention, health crises ensue.

WARNING SIGNS OF ENSUING DISASTERS
 Although there have been preparations for the next millennium, the warning signals often are overshadowed by immediate concerns.

 In 1980, West German Chancellor Willy Brandt warned in a report of the Independent Commission on International Development Issues:

 "Everywhere, there are people who see their whole planet involved at a breathtaking place in the same problems of energy shortage, urbanization with environmental pollution, and highly sophisticated technology which threatens to ignore human values and which people may not be able to handle inadequately."

 Later that decade, Norwegian Prime Minister Gro Harlem Brundtland reminded in a presentation to the United Nations General Assembly:

"As the century closes, the rate of change outstrips the ability of scientific disciplines and our current capabilities to assess and advise.  This frustrates the attempts of political and economic institutions, which evolved in a different world, to adapt and cope." (World Commission on Environment and Development Report,  1987)

 And, recently, the two foremost honorary societies in the world, the U.S. National Academy of Sciences and the Royal Society of London, offered a sobering alarm:  "If current predictions of population growth prove accurate and patterns of human activity on the planet remain unchanged, science and technology may not be able to prevent either irreversible degradation of the environment or continued poverty for much of the world." (Nature, 1992)

 The global society or interconnectedness also challenges the compartmentalization of the past.   Each month the world's population grows as if we added a New York City to the planet.  Today, we no longer have an environmental crisis, a development crisis or an energy crisis. They are all one.  We can still destroy the world "as we know it"  with acute trauma--with nuclear or biological weapons.  Or, we can end it chronically with the creation of over 70,000 human made chemicals, the annual release of 23 billion tons of carbon dioxide into the air, or with energy and water depletion.

 Last year I participated in a UN seminar in Moscow entitled Chernobyl and Beyond: Humanitarian Assistance to Victims of Technological disasters.  At the meeting, scientists warned of the certainty of the degrading nuclear plants in Eastern Europe.  They identified the issue as such: "We should not phrase the question to respond if  it (another Chernobyl) happens."  Their belief was more certain.  The question they were trying to predict was "how soon it would happen."
 Recent environmental disasters -- Bhopal, the Exxon Valdez and the Mad Cow Issue -- all are obvious disasters of epoch proportion.  We also have a lethal legacy of leadership as the global health "as we know it" is disproportionate to our knowledge and economic might.

WHAT CAN WE DO?
Effective leadership and long-term planning would also suggest we monitor, prevent and control infectious diseases, and establish an effective infrastructure at country, regional and global levels to meet future challenges .  Interdisciplinary collaboration will be necessary to develop a new PR, from Public Relations to a Planned Response.  We must be proactive, have a plan and focus on people. The ethical application of how we communicate health and risk is a great challenge.  Yet, while communication is a major element, policy initiatives and ethical leadership are paramount.

 As we prepare for the next century, we have hope that this new technological advancement can promote health and prevent disease.  The ethical use of this technology will allow the health consumer -- the  individual patient, caregiver, or professional -- to access or transmit health information or to receive guidance on a health-related issue.

 Communicating health is not just about the technologic channel, but rather, the strategic use of communication.  Four predominant areas have emerged within the burgeoning field of health communication.  They each address the overall goal of health communication as the art and technique  for effective delivery of information.  In short, it means getting the right message to the right people, at the right time, with the intended effect.

 The principal areas each have a wide body of literature and application: public relations, advocacy, social marketing, and negotiation/coalition building.  Public relations was coined in the 20th century, and is one of the ways we can change the culture or the environment for individual decision making.  Advocacy targets a change in the regulatory environment, including the workplace, legislative arena,  utilizing media, policy and social mechanisms to elicit change.  Social marketing uses the tools of the commercial marketing world to change target audience behavior.  Negotiation changes the nature of the involvement of people so that they participate in decisions working with community groups, public-private partnerships and other interested parties.

 While the new technologies and science  have unlimited promise and potential, they will not a priori develop a healthier world.  In fact, potential negative effects of the over- reliance on scientific discovery to increase longevity and cure disease as well as a sedentary lifestyle with increased time in front of a computer interface could be an unintended ill effect.  Yet, the opportunity is great for success.

A COMMON GOAL--The 21st C. Health Communication Approach
 During the 20th Century, we have witnessed monumental change that has enabled science and technology to direct our progress.  If we trust some estimates, the Internet could continue its growth rate tripling in use to 150 million people by 2000.  If we kept the same pace, the number of people on the Internet will exceed the world's  population by 2012.  Nonetheless, projections by Intel suggest that over one billion people will be connected to the internet in the next decade; and over 60% of homes in the U.S. will have PCs.

 This new superhighway offers the technological possibility of reading a tailored newspaper each day dealing with specific areas that interest YOU on health and the environment.  Except this one would be electronic with your (and your family's, communities, etc.) health information and new scientific discovery tailored specifically..  It might be a health minute when you turn on your new telescreen (TV & computer) or blasted on your personal radio or cellular phone on your way home from work.  The *push* would narrowcast salient information to you with the opportunity for interactive responses if you would ask what? why? or how? etc. accessed by a voice command,  pushing a button or clicking a mouse.   These are within reach now.

 Although this might seem exciting, we must not forget that 72% of the world's population has never made a phone call.

 Despite the disparity, we have hope that this new technological advancement can promote health and prevent disease.  The ethical use of this technology will allow the health consumer -- the  individual patient, caregiver, or professional -- to access or transmit health information or to receive guidance on a health-related issue.
 Finally, we must attempt to apply the new technologies to level the playing field for health access.  This can move beyond the international charters for health derived in Ottawa and Jakarta to a 21st Century Charter embodying Health for All.  The new communication technologies, if used correctly could enable us to increase the knowledge of health in the public and increase their ability to negotiate, understand the risks of both individual and community behaviors, and have communications, caring, and coping skills.  Further, we ought to hope that people can access the healthcare and information sector for more information, hopeful that the knowledge transfer will give people promise and posterity over feudalism and fatality.
 If we rise to the task, we should hope that at the end of the next century we are NOT burning fossil fuels at the same rate, NOT depleting finite resources, NOT spewing greenhouse gases, and NOT treating health and science communication the same way as we are today.  Today, we can predict genetic engineering, radiation, as well as biologic and chemical weapons will challenge our ethical fabric of society. Humankind must be prepared to rise to the challenge and truly progress, rather than just follow the fervor of scientific discovery.

 My hope is that this generation will not be possessed by our possessions.  As inhabitants of the planet Earth, we should all recall Chief Seattle's belief "the land does not belong to us, but we belong to the land."  Our generation should remember what the great French writer La Rochefoucauld's suggested are ethical actions.  He said -- to do "without witnesses what one would be capable of doing with the world looking on."  Centuries later, we should now be able to explain what we do today, so that if our witnesses were our great grandchildren, we could be proud of our actions.

 Finally,  I would like to conclude with an apropos quote from the final scene of Hamlet:

  ...let me speak to the yet unknowing world.
   How these things came about:  So you shall hear
   Of carnal, bloody and unnatural acts,
   Of accidental judgments, casual slaughters
   Of deaths put on by cunning and forced cause,
   And, in this upshot, purposes mistook
   fall'n on the inventors' heads...

 World Information Transfer Inc., together with all interested parties, hopefully will continue to advance the dialogue and drive the debate for promoting the ideal for health for all of the earth's inhabitants.  After all, health and the environment are the only common currencies we have had since the beginning of humankind.  We should preserve, respect and secure such currencies for the future.
 _______________________________________________________________________
Note:
This address was given at the  United Nations Headquarters, New York on April 17, 1998.
Scott C. Ratzan MD, MPA is Editor-in-Chief of the Journal of Health Communication.  He also is Executive Director, Health Communication Technology and Educational Innovation at the Academy for Educational Development, Washington, DC and an Assistant Professor of Family Medicine and Community Health at Tufts University School of Medicine.  His edited volume The Mad Cow Crisis: Health and the Public Good  was recently published by University  College London Press and New York University Press.