Reframing climate change as a public health issue: an exploratory study of public reactions

Abstract

Background

Climate change is taking a toll on human health, and some leaders into the public health community have urged their colleagues to offer voice to its health implications. Previous research has shown that Americans are merely dimly alert to the health implications of climate change, yet the literature on issue framing implies that providing a novel frame — such as for example human health — might be potentially useful in enhancing public engagement. We conducted an exploratory study in the United States of people’s reactions to a public health-framed short essay on climate change.

Methods

U.S. adult respondents (n = 70), stratified by six previously identified audience segments, see the essay and were asked to highlight in green or pink any portions of this essay they found «especially clear and helpful» or alternatively «especially confusing or unhelpful.» Two dependent measures were created: a composite sentence-specific score based on reactions to all or any 18 sentences into the essay; and respondents’ general reactions towards the essay that have been coded for valence (positive, neutral, or negative). We tested the hypothesis that five of this six audience segments would respond positively towards the essay on both dependent measures.

Results

There was clearly clear evidence that two of this five segments responded positively towards the public health essay, and mixed evidence that two other responded ina positive manner There was clearly limited evidence that the fifth segment responded ina positive manner Post-hoc analysis showed that five of this six segments responded more positively to information regarding the healthy benefits connected with mitigation-related policy actions than to information regarding the health threats of climate change.

Conclusions

Presentations about climate change that encourage visitors to consider its human health relevance appear very likely to provide many Americans with a helpful and engaging new frame of reference. Information regarding the potential healthy benefits of specific mitigation-related policy actions is apparently particularly compelling. We genuinely believe that the public health community has an essential perspective to generally share about climate change, a perspective that produces the situation more personally relevant, significant, and understandable to members of the public.

Peer Review reports

Background

Climate change is already taking a toll on human health into the United States [1] and other nations worldwide [2]. Unless greenhouse gas emissions worldwide are sharply curtailed — and significant actions taken to greatly help communities conform to changes in their climate which can be unavoidable — the human toll of climate change probably will become dramatically worse within the next several decades and beyond [3]. Globally, the human health impacts of climate change will continue to differentially affect the world’s poorest nations, where populations endemically suffer myriad health burdens connected with extreme poverty which can be being exacerbated by the changing climate. As previously mentioned in a recent British Medical Journal editorial, failure of the world’s nations to successfully curtail emissions will likely lead to a «global health catastrophe» [4]. In developed countries for instance the United States, the segments of this population most at an increased risk will be the poor, the very young, the elderly, those already in poor health, the disabled, individuals living alone, people that have inadequate housing or basic services, and/or individuals who lack usage of affordable health care or who are now living in areas with weak public health systems. These population segments disproportionately include racial, ethnic, and indigenous minorities [5].

While legislation to cut back U.S. greenhouse gas (GHG) emissions has stalled in Congress, in December 2009 the Environmental Protection Agency (EPA) moved toward regulating carbon dioxide and five other of this gases beneath the Clean Air Act, citing its authority to guard public health and welfare from the impacts of global warming [5]. The agency unearthed that global warming poses public health threats — including increased morbidity and mortality — as a result of declining air quality, rising temperatures, increased frequency of extreme weather events, and higher incidences of food- and water-borne pathogens and allergens.

This finding comes as a somewhat small set of public medical researchers are working rapidly to raised comprehend and quantify the type and magnitude of those threats to human health and wellbeing [6]. This new but rapidly advancing public health focus has received minimal news media attention, even at internationally leading news organizations including the New York Times [unpublished data]. It’s not surprising therefore that the public has also yet to totally comprehend the public health implications of climate change. Recent surveys of Americans [7], Canadians [8], and Maltese [9] demonstrate that the human health consequences of climate change are seriously underestimated and/or poorly understood, if grasped at all. Approximately half of American survey respondents, as an example, selected «don’t know» (as opposed to «none,» «hundreds,» «thousands,» or «millions») when asked the estimated number of current and future (for example. 50 years hence) injuries and illnesses, and death due to climate change. A youthful survey of Americans [10] demonstrated that a lot of people see climate change as a geographically and temporally distant threat towards the non-human environment. Notably, not a single survey respondent freely associated climate change as representing a threat to people. Similarly, few Canadians, without prompting, can name any specific human health threat linked to climate change impacts within their country [8].

Cognitive research within the last several decades has shown that how people «frame» an issue — for example., how they mentally organize and discuss with others the matter’s central ideas — greatly influences how they understand the nature of this problem, who or what they see as being in charge of the situation, and what they feel should be done to handle the difficulty [11, 12]. The polling data cited above [7–9] suggests that the dominant mental frame employed by most members of the public to prepare their conceptions about climate change is that of «climate change as an environmental problem.» However, when climate change is framed as an environmental problem, this interpretation likely distances many individuals from the issue and plays a part in too little serious and sustained public engagement necessary to develop solutions. This focus can be vunerable to a dominant counter frame that the best solution is to keep to cultivate the economy — investing in adaptive measures as time goes on when, theoretically, society is going to be wealthier and better able to afford them — rather than focus on the root factors behind the environmental problem [13]. This economic frame likely leaves the public ambivalent about policy action and works to the main advantage of industries which can be reluctant to cut back their carbon intensity. Indeed, it is precisely the lack of a countervailing populist movement on climate change that includes made policy solutions so very hard to enact [13, 14].

Significant efforts have been made within the last several years by public health organizations to improve knowing of the public health implications of climate change and prepare the public health workforce to respond, although as noted above, it’s not clear the extent to which public medical researchers, journalists, or most of all, the public and policy makers have taken notice. In america, National Public Health Week 2008 was themed «Climate Change: our health and wellness when you look at the Balance,» the Centers for Disease Control and Prevention created a Climate Change and Public Health program, and lots of professional associations assessed the public health system’s readiness to respond to the emerging threat [15–17]. Globally, World Health Day 2008 was themed «Protecting Health from Climate Change,» as well as the World Health Organization is rolling out a climate change and health work plan, the first objective of which is «raising knowing of the consequences of climate change on health, so that you can prompt action for public health measures» [18]. Several prominent medical journals have released special issues on climate change and health [19–21], and these as well as other medical journals [4] have issued strongly worded editorials urging medical researchers to offer voice towards the health implications of climate change.

An important assumption in these calls to action is that there could be considerable value in introducing a public health frame in to the ongoing public — and policy — dialogue about climate change. Because there is indeed solid theoretical basis for this assumption, towards the best of our knowledge there is not yet empirical evidence to aid the validity of this assumption [22].

The goal of this study therefore was to explore how American adults respond to an essay about climate change framed as a public health issue. Our hypothesis was that a public health-framed explanation of climate change could be perceived as useful and personally relevant by readers, apart from members of one small segment of Americans who dismiss the notion that human-induced climate change is occurring. We used two dependent measures in this hypothesis: a composite score based on respondent reactions to every sentence into the essay, in addition to overall valence of respondents’ general comments made after reading the essay.

Our study builds on previous research that identified six distinct segments of Americans, termed Global Warming’s Six Americas [7]. These six segments of Americans — the Alarmed (18% of this adult population), the Concerned (33%), the Cautious (19%), the Disengaged (12%), the Doubtful (11%), in addition to Dismissive (7%) — fall along a continuum from those who find themselves engaged regarding the issue and looking for how to take appropriate actions (the Alarmed) to those that actively deny its reality and generally are researching to oppose societal action (the Dismissive; see Figure 1). The four segments in the exact middle of the continuum will probably benefit most from a reframing of climate change as a human medical condition because, to a better or lesser degree, they may not be yet sure that they fully understand the matter and generally are still, if motivated to take action, relatively ready to accept learning about new perspectives.

Figure 1

Global Warming’s Six Americas. A nationally representative sample of American adults classified into six unique audience segments centered on their climate change-related beliefs, behaviors and policy preferences.

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Methods

Sample

Between May and August 2009, 74 adults were recruited to be involved in semi-structured in-depth elicitation interviews that lasted an average of 43 minutes (ranging from 16 to 124 minutes) and included the presentation of a public health framed essay on climate change. The recruitment process was built to yield completed interviews with a demographically and geographically diverse set of at least 10 individuals from all the previously identified «Six Americas» [7]. Four respondents were dropped using this study as a result of incomplete data, leaving a sample size of 70. Audience segment status (i.e., which one of many «Six Americas» a person belonged) was assessed with a previously developed 15-item screening questionnaire that identifies segment status with 80% accuracy [unpublished data].

To reach demographic diversity in the sample, we recruited an approximately balanced quantity of gents and ladies, and an approximately balanced quantity of younger (18 to 30), middle-aged (31 to 50), and older (51 and older) adults (see Table 1). We did not set recruitment quotas for racial/ethnic groups, but did try to recruit a variety of individuals from various racial/ethnic backgrounds.

Table 1 Distribution of Respondents by Age, Gender and Segment.
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To reach geographic diversity, we recruited participants in just one of two ways. The majority of participants (n = 56) were recruited — and then interviewed — face-to-face in just one of two locations: out-of-town visitors were interviewed at a central location on the National Mall in Washington, DC (a national park situated involving the U.S. Capitol, the Smithsonian Museum buildings, in addition to Lincoln Memorial); and shoppers were interviewed at an «outlet» mall (i.e., discount branded merchandise shopping mall) right beside an interstate freeway in Hagerstown, MD. The outlet mall is more than an hour driving distance outside of Washington, DC and attracts shoppers from Maryland, Pennsylvania, and West Virginia, in addition to visitors from further away who will be driving the interstate freeway. The remaining study participants were recruited via email from among participants to a nationally representative survey that we conducted in Fall 2008 [7]. These people were interviewed subsequently by telephone, after being mailed a copy of this test «public health essay» — described below — in a sealed envelope marked «do not open until asked to take action by the interviewer.» As a reason to participate, all respondents were given a $50 gift card upon completion of these interview. George Mason University Human Subjects Review Board provided approval for the analysis protocol (reference #6161); all potential respondents received written consent information ahead of participation.

The 70 study participants resided in 29 states. Using U.S. Census Bureau classifications, 14% (n = 10) were from the Northeast region, 21% (n = 15) were from the Midwest, 40% (n = 28) from the South, and 23% (n = 16) were from the West; state and region were unknown for starters participant. In 2006, the geographic distribution of this overall U.S. population was 18%, 22%, 36% and 23% into the Northeast, Midwest, South and West, respectively [23].

Data Collection and Coding

A lot of the interview was specialized in open-ended questions designed to establish the respondent’s emotions, attitudes, beliefs, knowledge and behavior relative to global warming’s causes and consequences. As an example, respective open-ended questions asked alternatively if, how, as well as whom global warming was a challenge; how global warming is caused; if and just how global warming may be stopped or limited; and what, if anything, an individual could do to help limit global warming. Toward the end of the interview, respondents were asked to learn «a brief essay about global warming» (see Appendix 1), that has been designed to frame climate change as a human health issue. Respondents were also given a green and a pink highlighting pen and asked to 123helpme.me «use the green highlighter pen to mark any portions of this essay that you feel are specially clear or helpful, and employ the pink highlighter pen to mark any portions of this essay which can be particularly confusing or unhelpful.»

As shown in Appendix 1, usually the one page essay was organized into four sections: an opening paragraph that introduced the public health frame (5 total sentences); a paragraph that emphasized how human health is going to be harmed if action is certainly not taken up to stop, limit, and/or drive back global warming (i.e., a description of this threat; 7 sentences); a paragraph that discussed several mitigation-focused policy actions and their human health-related benefits if adopted (4 sentences); and a quick concluding paragraph intended to reinforce the public health frame (2 sentences).

When respondents finished the reading, these people were asked to spell it out in an open-ended format their «general reaction to this essay.» (Note: This question was inadvertently not asked of just one respondent, which means sample size for analysis with this data is 69.) For every single percentage of the essay they marked in green, these people were subsequently asked: «What about each one of these sentences was especially clear or helpful for your requirements?» For every single percentage of the essay they marked in pink, these people were also asked: «What about each one of these sentences was especially confusing or unhelpful for your requirements?»

To gauge the respondent’s general reactions towards the essay we reviewed their individual statements (n = 193), thought as discrete thoughts or concepts. Centered on this review, we iteratively developed eight thematic categories that captured the product range of statements created by respondents. Table 2 defines and describe these themes.

Table 2 Thematic Categories Used to Code Respondents’ General Reactions to the Public Health Essay.
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Two graduate student coders were then trained to code each statement into one of many thematic categories. The coders were also instructed to assess the as you like it quick summary overall valence of each and every respondent’s statements — the initial of our dependent measures — rating them as: -1 (entirely negative comments); 0 (mixed, including both positive and negative comments); or 1 (entirely positive comments). Following standard content analysis procedures, we tested inter-coder agreement on approximately 50 statements, making sure that the full variety of possible forms of coding decisions were required of this coders. To assess reliability, we used Krippendorff’s alpha [24, 25], a conservative measure that corrects for chance agreement among coders; a K-alpha of .70 or maybe more is known as sufficient and .80 or maybe more is known as excellent. For 7 of this 8 thematic categories, we achieved a reliability of .80 or higher; «Lack of Evidence or Stylistically Confusing» was the exception, with an inter-coder reliability of .70. After establishing reliability, the two coders then went on to categorize the remainder remaining statements from the sample of respondents.

To code the respondent’s sentence-specific reactions made out of the highlighting pens, sentences marked with only green on at least one word were scored +1 (for example. indicating «especially clear or useful»), sentences marked with only pink on at the very least one word were scored -1 (for example. indicating «especially confusing or unhelpful), and sentences with either no highlighting, or both green and pink, were scored 0. Composite scores were made for all the four chapters of the essay — the opening, the threat section, the power section, in addition to conclusion — by summing the sentence-specific scores into the section and dividing by the quantity of sentences. A composite score for the complete essay — the next of the dependent measures inside our hypothesis — is made by summing the sentence scores across each segment and dividing by the quantity of respondents per segment. Population estimates, that could be taken solely as preliminary indicators given the non-probabilistic nature of our sampling, were estimated by weighting the mean values for every single of this six segments in accordance with its prevalence into the U.S. population (see Figure 1).

Data Analysis

To evaluate the between-segment differences in our dependent measures — overall reactions towards the essay (i.e., valence) and composite sentence-specific reactions towards the entire essay — we used the nonparametric Kruskal-Wallis test (see Figures 2, 3). To check if the median response to the essay on each dependent measure was higher than zero (i.e., a positive reaction) for our full sample, we used the Wilcoxon signed rank test. Lastly, for both dependent measures, we used the Wilcoxon signed rank test to check our hypothesis that five of this six segments (the Dismissive being usually the one exception) would respond positively towards the essay; the null hypothesis was that the median score for every single of this five segments did not change from zero. The Wilcoxon signed rank test is acceptable for small sample sizes and non-normal distributions, both of which are the truth for at the very least some segments inside our data.

Figure 2

Average valence of respondents’ general essay comments. The mean valence of respondent comments when asked their general reactions towards the public health essay by audience segment and by a national population estimate. Note: 1 = (entirely positive comments); 0 = (mixed, including both positive and negative comments); and -1 = (entirely negative comments).

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Figure 3

Composite essay scores by segment. Scores reflect respondent average values by segment for the difference between how many times every one of 18 sentences were marked «especially clear or helpful» and «especially confusing or unhelpful» with a full variety of possible values between 18 and -18. The scores are adjusted for unequal variety of respondents within each segment by re-weighting values to represent n = 10.

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Post-hoc — after examining the visualized data (see Figures 4, 5 and 6) — we made a decision to test for just two possible main effects into the data. To examine the possibility that the essay’s later focus on the public health benefits of mitigation-related policy actions was seen by respondents as clearer and more useful compared to the essay’s earlier give attention to public health-related threats, we calculated the difference between the re-scaled (by one factor of 10) average response to both the power together with threat sections and then used the Wilcoxon signed rank test to check, by segment, whether or not the median of those differences was higher than zero. We then evaluated the general main effectation of the essay — across all segments — with the weighted t-test on the differences with weights corresponding towards the frequencies of this segments into the population.

Figure 4

Essay evaluations by sentence: Alarmed, Concerned and Cautious segments. Sentence-specific evaluations of this public health essay by respondents in the Alarmed, Concerned and Cautious segments and by a national population estimate. Note: Scores reflect the difference between the quantity of times a sentence was marked as «especially clear or helpful» in addition to quantity of times it absolutely was marked as «especially confusing or unhelpful,» adjusting for unequal variety of respondents within each segment by re-weighting values to represent n = 10. Sentence abbreviations correspond to O = opening section (5 sentences); T = climate change health threat related section (7 sentences); B = mitigation-related policy actions and their health benefits (4 sentences); and C = concluding section (2 sentences). The national population estimate is made by weighting the values for every single of this six segments in accordance with their relative proportion of American adults.

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Figure 5

Essay evaluations by sentence: Disengaged, Doubtful and Dismissive segments. Sentence-specific evaluations of this public health essay by respondents into the Disengaged, Doubtful and Dismissive segments and by a national population estimate. Note: Scores reflect the difference between the quantity of times within a sentence was marked as «especially clear or helpful» in addition to quantity of times it absolutely was marked as «especially confusing or unhelpful,» adjusting for unequal variety of respondents within each segment by re-weighting values to represent n = 10. Sentence abbreviations correspond to O = opening section (5 sentences); T = climate change health threat related section (7 sentences); B = mitigation-related policy actions and their health benefits (4 sentences); and C = concluding section (2 sentences). The national population estimate is made by weighting the values for every single of this six segments in accordance with their relative proportion of American adults.

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Figure 6

Essay evaluations by section (opening, threat, benefits, closing). Average section-specific evaluations of this public health essay by respondents in all the six audience segments and by a national population estimate. Note: Scores reflect the difference between the quantity of sentences within each section marked by a respondent as «especially clear or helpful» and those marked as «especially confusing or unhelpful» with those values averaged throughout the quantity of sentences per section and rescaled by one factor of 10. Section abbreviations correspond to O = opening section (5 sentences); T = climate change health threat related section (7 sentences); B = mitigation-related policy actions and their health benefits (4 sentences); and C = concluding section (2 sentences). The national population estimate is made by weighting the mean values for every single of this six segments in accordance with their relative proportion of American adults.

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Lastly, to examine for the possibility that the concluding framing section of this essay was perceived by respondents as clearer and more useful than the opening framing section, we calculated the difference between the re-scaled average response to both the opening as well as the concluding sections and then used the Wilcoxon signed rank test to check, by segment, whether or not the median of those differences was higher than zero. We then evaluated the general main effect — across all segments — with the weighted t-test regarding the differences with weights corresponding towards the frequencies of this segments into the population.