The March 2024 issue of the Journal of Environmental Health (Volume 86, Number 7), published by the National Environmental Health Association.
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JOURNAL OF Environmental Health Dedicated to the advancement of the environmental health professional Volume 86, No. 7 March 2024
ADVANCEMENT OF THE SCIENCE Exploring Perceptions on Climate Change Through the American Climate Metrics Survey, 2016–2019 ......................................................................................................... 8 Parental Knowledge, Attitudes, E cacy, and Protective Behaviors About Thirdhand Smoke and Children Ages 0–17 .............................................................................. 18 ADVANCEMENT OF THE PRACTICE Special Report: Measuring the Eectiveness of Environmental Health Practice: An Exploratory Analysis ............................................................................................................. 26 Direct From AEHAP: Artificial Intelligence in Environmental Health: Education and Practice ............................................................................................................... 34 Programs Accredited by the National Environmental Health Science and Protection Accreditation Council.............................................................................................. 37 Direct From CDC/Environmental Health Services: Resources for Healthy Cruising .................. 38 Direct From ecoAmerica: Women, Climate Change, and Health: A Call for Action ..................... 40 Spotlight on Our NEPHIP Interns: Unraveling Environmental Health Laws: A NEPHIP Intern’s Journey in Shelby County, Tennessee .............................................................. 42 ADVANCEMENT OF THE PRACTITIONER JEH Quiz #5............................................................................................................................... 17 Environmental Health Calendar ...............................................................................................44 Resource Corner........................................................................................................................ 45 YOUR ASSOCIATION President’s Message: The Scope of Work for Environmental Public Health Should Evolve ....................... 6 Special Listing ........................................................................................................................... 46 NEHA Second Vice-Presidential Candidate Profile ................................................................... 48 NEHA Regional Vice-Presidential Candidate Profiles ............................................................... 50 NEHA News .............................................................................................................................. 52 NEHA Member Spotlight .......................................................................................................... 56 NEHA 2024 AEC....................................................................................................................... 58
ABOUT THE COVER
This month’s cover article examined parental knowl- edge, attitudes, e - cacy, and protective behaviors about thirdhand smoke and the toxic mix- ture of chemicals left in indoor
environments after smoking stops. Parents with children 0–12 years had significantly higher knowledge, attitudes, e cacy, and protective behaviors than did parents with children 0–17 years. In addition, statistical modeling signifi- cantly accounted for thirdhand smoke-related parent behaviors with the strongest independent associations being attitudes, smoking status, reaction to the smell of tobacco smoke, home ownership, and age. Overall, families with ado- lescents require education to protect all children from exposure to thirdhand smoke. See page 18. Cover images © iStockphoto: weerapatkiatdumrong, Rouzes
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AAS Davis Calvin Wagner Award........................... 5 CDP, Inc................................................................ 33 Environmental Health and Land Reuse Certificate Program .............................................. 33 Hedgerow Software, US, Inc. .................................. 2 HS GovTech.......................................................... 60 JEH Advertising ....................................................49 NEHA Credentials ................................................ 43 NEHA Endowment Foundation Donors .............. 57 NEHA Membership ................................................ 4 NEHA REHS/RS Credential.................................. 37 NEHA REHS/RS Study Guide............................... 49 NEHA/AAS Scholarship Fund Donors ................. 32 NEHA/NSF Walter F. Snyder Award ....................... 5
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March 2024 • Journal of Environmental Health
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don’tmiss in the next Journal of Environmental Health A Census of Federal and State Food Codes for Language Involving Reuse and Multiuse Containers Decoding Training Needs: Exploring Demographic Data to Understand Retail Food Regulatory Workforce Composition and Inform Capacity Building Estimating Natural Attenuation of Nitrate and Phosphorus From On- site Wastewater Treatment Systems Erratum In the January/February 2024 Journal of Environmen- tal Health (volume 86, number 6), the author listing for M.A. Kalis and S. Daly were incorrectly listed in the article, “Rebuilding Caribbean Environmental Health Post-Crisis Programs: A Preliminary Study for Virtual Mentorship,” by R. DeVito, E. Landeen, D. Dyjack, R. Labbo, G. Gill, J. Gerding, M.A. Kalis, S. Daly, R. Lopez, C. Somaiya, S. Chera, C. Vanover, L. Fahnestock, and M. Randhawa. The correct listings are: Martin A. Kalis, MA, Centers for Disease Control and Prevention, and LCDR Scott Daly, MPH, REHS, Centers for Disease Control and Prevention.
Official Publication
An open access journal published monthly (except bimonthly in January/ February and July/August) by the National Environmental Health Association (NEHA), 720 S. Colorado Blvd., Suite 105A, Denver, CO 80246-1910. Phone: (303) 802-2200; Internet: www.neha.org. E-mail: jeh@neha.org. Volume 86, Number 7. Yearly print subscription rates: $160 (U.S.) and $200 (international). Single print copies: $15, if available. Claims must be filed within 30 days domestic, 90 days foreign, © Copyright 2024, NEHA (no refunds). Opinions and conclusions expressed in articles, columns, and other contributions are those of the authors only and do not reflect the policies or views of NEHA. NEHA and the Journal of Environmental Health are not liable or responsible for the accuracy of, or actions taken on the basis of, any information stated herein. NEHA and the Journal of Environmental Health reserve the right to reject any advertising copy. Advertisers and their agencies will assume liability for the content of all advertisements printed and also assume responsibility for any claims arising therefrom against the publisher. Advertising rates available at www.neha.org/jeh. The Journal of Environmental Health is indexed by Clarivate, EBSCO (Applied Science & Technology Index), Elsevier (Current Awareness in Biological Sciences), Gale Cengage, and ProQuest. The Journal of Environmental Health is archived by JSTOR (www.jstor.org/journal/ jenviheal). Full electronic issues from present to 2015 available at www.neha.org/jeh. All technical manuscripts submitted for publication are subject to peer review. Visit www.neha.org/jeh for submission guidelines and instructions for authors. To submit a manuscript, visit https://jeh.msubmit.net. Direct all questions to jeh@neha.org. Periodicals postage paid at Denver, Colorado, and additional mailing offices. POSTMASTER: Send address changes to Journal of Environmental Health , 720 S. Colorado Blvd., Suite 105A, Denver, CO 80246-1910.
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Volume 86 • Number 7
Honoring a history of advancing environmental health. Walter F. Snyder was a pioneer in our field and was the cofounder and first executive director of NSF. He embodied outstanding accomplishments, notable contributions, demonstrated capacity, and leadership within environmental health. Do you know someone like that? Nominate them for the Walter F. Snyder Award for outstanding contributions to the advancement of environmental health. This award is cosponsored by NSF and NEHA. Nomination Deadline: May 1, 2024 nsf.org/about-nsf/annual-awards/ snyder-award Walter F. Snyder Award
Davis Calvin Wagner Award
Do you know an exceptional diplomate of the American Academy of Sanitarians (AAS) who is a leader who shows professional commitment, outstanding resourcefulness, dedication, and accomplishments in advancing the environmental health profession? Nominate them to be recognized with the AAS Davis Calvin Wagner Sanitarian Award. Nomination deadline: April 15, 2024 www.sanitarians.org/Awards
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March 2024 • Journal of Environmental Health
YOUR ASSOCIATION
Open Access
PRESIDENT’S MESSAGE
The Scope of Work for Environmental Public Health Should Evolve
Tom Butts, MSc, REHS
M aintaining quality regulatory pro- grams while working to build proactive, upstream environmen- tal public health capacity is something that should be considered as foundational regu- latory programs also evolve. Considering the value of various environmental health programs as they relate to the activities that have the potential to change community health outcomes involves a variety of fac- tors in our organizations as we each play a unique role in promoting and protecting en- vironmental public health. As we have learned from the past 5 years, keeping a wary eye on the potential for emerging or reemerging diseases is a must. This vigilance involves maintaining focus on preparing for and responding to infectious diseases and outbreaks, which will continue to be crucial in the wake of global pandemics. As an example, let us contemplate what role environmental health can play—as health departments, nonprofit organizations, and other agencies—to work with com- munity members to address healthy eating and active living activities. This work often focuses on changing policies, the built envi- ronment, and access to address chronic dis- eases through lifestyle changes, focusing on long-term health outcomes. Although we have been working to address impacts on community health from hazardous waste sites for years, a renewed focus (and funding) is supporting a refo- cused interest in addressing environmental justice. These activities work to ensure equi- table distribution of environmental benefits and burdens that impact the health of mar- ginalized communities.
(e.g., regulating water quality). Responses to issues such as emerging diseases can be more reactive and require the ability to adjust more rapidly. All our programs need to be nimble to respond to these issues. • Equity and Accessibility: Addressing health disparities might look dierent in dierent program contexts, but equity and accessibility need to be embraced in each. Both traditional and contemporary envi- ronmental health programs are vital for com- munities to consider, but they operate on dierent levels, address dierent aspects of health, and are often funded very dierently. Traditional programs are crucial for immedi- ate, localized health needs, while contempo- rary focuses address broader, long-term global health challenges. A balanced approach that recognizes the importance of both is essential for comprehensive community health As organizations consider evolving their scope of work, leaders must seek ways to maintain quality regulatory environmen- tal public health programs while working to build proactive programming to address health disparities and climate change. Main- taining or improving the quality of traditional regulatory environmental public health pro- grams while proactively addressing health disparities and climate change is not only possible but also increasingly necessary. This integrated approach can create a more resilient and equitable public health frame- work through: • Understanding the Intersection of Tradi- tional and Proactive Programs: Traditional environmental health programs such as food safety, water quality, and waste management are foundational to public
Maintaining or improving the
quality of traditional environmental public health programs while proactively addressing health disparities and climate change is not only possible but also increasingly necessary.
When some of these issues must be addressed, it often involves taking a dierent approach than regulatory compliance activi- ties. How should this issue be looked at as we consider the comparative value to the much broader range of community health outcomes? • Direct Versus Indirect Impact: Traditional programs often have a more direct and immediate impact on health (e.g., prevent- ing foodborne illness), while contempo- rary issues may have broader, long-term impacts (e.g., mitigating climate change eects) that are harder to measure. • Scale and Scope: Contemporary issues such as climate change and emerging diseases often operate on a global scale, which impacts a wide range of environ- mental health factors. Traditional pro- grams, however, are more localized but critical in daily life. • Preventative Versus Reactive Approaches: Traditional programs are often preventative
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Volume 86 • Number 7
health. These programs address immediate health risks and ensure basic health stan- dards. Proactive programming focuses on health disparities and climate change and addresses long-term, systemic issues that aect public health outcomes. • Leveraging Data and Technology: Employ- ing data analytics and technology (e.g., using real-time air and water quality moni- toring) can enhance the eciency of tradi- tional programs. Big data can also identify health disparities to inform targeted inter- ventions in underserved communities. •Integrating Climate Change Consider- ations Into Traditional Programs : Climate change impacts every aspect of environ- mental health. For example, warmer tem- peratures can increase foodborne illnesses, requiring more stringent food safety proto- cols. Water quality programs must adapt to the challenges posed by extreme weather events (e.g., floods, drought) that are exac- erbated by climate change. •Collaborative Approaches and Cross- Sector Partnerships: Partnerships between public health departments, environmen- tal agencies, community groups, and the private sector can create synergies. Such collaborations can pool resources and expertise, leading to more eective and comprehensive programs. •Community Engagement and Educa- tion: Engaging communities in the design and implementation of health programs ensures that these programs are more responsive to community needs. Educa- tion campaigns can raise awareness about the importance of environmental health and empower communities to participate in proactive health measures. •Policy Integration and Advocacy: Inte- grating health considerations into all
areas of policymaking—including urban planning, transportation, and housing— can address both environmental health and health disparities. Public health lead- ers can advocate for policies that address the root causes of health disparities and climate change impacts. • Building Resilience in Vulnerable Popu- lations: Proactive programs should focus on building resilience in communities most aected by health disparities and cli- mate change. This work includes ensuring access to healthcare, clean air and water, and safe housing, particularly in histori- cally marginalized communities. •Workforce Development and Training: Training the public health workforce in the latest environmental health practices and in understanding the implications of climate change is essential. Developing skills in community engagement, data analysis, and interdisciplinary collabora- tion prepares the workforce for integrated health approaches. •Sustainable Funding Models: Securing sustainable funding is crucial for both maintaining existing programs and invest- ing in new initiatives. Innovative funding models, such as public–private partner- ships and grant programs focused on cli- mate and health, can support these eorts. • Monitoring, Evaluation, and Continuous Improvement: Regular monitoring and evaluation of both traditional and proac- tive programs ensure that these programs are meeting their objectives and eciently using resources. Continuous improve- ment models can help adapt and refine programs in response to new challenges and emerging data. •Addressing the Social Determinants of Health: Proactive programs must address
the broader social determinants of health— such as poverty, education, and access to green spaces—to eectively tackle health disparities. Integrating these consider- ations into environmental health program- ming ensures a more holistic approach to public health. • Embracing a Health Equity Lens: Apply- ing a health equity lens to all environmen- tal health programs ensures that the needs of the most vulnerable are not only met but also prioritized. This approach acknowl- edges that health disparities are often a result of systemic inequalities and seeks to rectify these disparities and inequities through targeted interventions. • Adaptability and Flexibility: The public health landscape is constantly evolving, especially with the challenges posed by climate change. Programs must be adapt- able and capable of responding to new health threats and changing environmen- tal conditions. Maintaining and enhancing traditional environmental public health programs, while also building proactive programming to address health disparities and climate change, is a multifaceted task. It requires an integrated approach that combines data and technol- ogy, collaborative partnerships, community engagement, policy integration, workforce development, and a strong focus on health equity and resilience. By embracing this holis- tic approach, environmental public health systems can not only respond to immediate health threats but also proactively work toward a healthier, more equitable future in the face of climate change and social inequities.
tbutts@neha.org
Joint inspections, field observations, flowcharts, and forms—these are a few of the practices we are hearing about from jurisdictions from around the country through our Retail Food Safety Regulatory Workforce Standardization Census. Is your jurisdiction using similar practices? Have you found innovative processes for standardization? Tell us about it! Your input will inform the specific, tailored assistance available to you, whether to maintain your existing program or support you with training and standardization. Learn more and take the census at www.neha.org/retail-grants-standardization-survey.
Did You Know?
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March 2024 • Journal of Environmental Health
ADVANCEMENT OF THE SCIENCE
Open Access
Exploring Perceptions on Climate Change Through the American Climate Metrics Survey, 2016–2019
Jesse Bliss, MPH, PhD Roseanne DeVito, MPH Gina Bare, RN Becky Labbo, MA Reem Tariq, MSEH Amy Chang, MS National Environmental Health Association Meighen Speiser ecoAmerica David T. Dyjack, DrPH, CIH National Environmental Health Association
Abstract This article compares perceptions of climate change between the U.S. public and National Environmental Health Association (NEHA) members collected from the annual American Climate Metrics Survey from 2016 to 2019. We analyzed the similarities, di erences, and changes over 4 years regarding climate change beliefs and concerns, harms, benefits and costs of action, and solutions. While both groups had simi- lar climate change concerns, NEHA members were significantly more likely than the public to recognize the harmful impact of climate change on health, prioritize climate action over economic growth, and act on climate solu- tions. NEHA members were also less likely to agree that the costs of acting on climate change are too high. We recommend that NEHA continue supporting the environmental public health workforce through education and training, facilitating cross-sectoral engagement between local partners and community members, and encour- aging participation in programs such as NEHA’s Climate Health and Adap- tation Mitigation Partnership (CHAMP) program and ecoAmerica’s Climate for Health Ambassador Training. Developing resources to help communi- ties understand climate health threats and implement climate solutions is important for NEHA to support due to limited resources available for local environmental public health. Through continued partnerships and collabo- rations—such as our work with ecoAmerica and our engagement with the National Center for Environmental Health within the Centers for Disease Control and Prevention—NEHA will continue to build the capability and capacity of the workforce so they can be leaders in their jurisdiction’s local climate and health conversation. Keywords: climate change, environmental public health workforce, perceptions, NEHA
that aects a variety of sectors and increases risks for individuals, communities, and the economy (Hwong et al., 2022). Climate change disproportionately aects people of color, children, older adults, and low-income individuals. Socioeconomic inequities can make underserved groups more vulnerable, as they often have the highest exposures and the fewest resources to address them (Fiske et al., 2022). Urgent actions are needed to ensure cli- mate health hazards do not overwhelm the ability of our health systems to protect us (Romanello et al., 2023). To eectively address climate change, communities must implement appropriate mitigation and adap- tation eorts. These eorts are strengthened by actions taken by the general public and the environmental public health workforce. Understanding the perception of climate change is important for the National Envi- ronmental Health Association (NEHA) to be able to provide support for the environ- mental public health workforce to address climate health threats in their communities. Climate change directly aects environmen- tal public health sectors such as air qual- ity, water quality, emergency response, and food safety. Environmental public health professionals are viewed as trusted sources of guidance on protocols and systems that protect water quality, ensure food safety, safeguard indoor air quality, and mitigate vectors (National Environmental Health Partnership Council, 2017). The environ- mental public health workforce is well- positioned to collaborate with community partners and members to enact climate miti- gation, adaptation, preparedness, response, and recovery (Shezi et al., 2019). They are
Introduction Climate change is the single most important challenge and threat facing humanity (Watts et al., 2015). Climate change negatively aects human health through air quality, extreme heat, drought, wildfires, extreme storms, floods,
and vectorborne illnesses. There is strong sci- entific evidence to justify anthropogenic cli- mate change and its detrimental impacts on ecological and human health systems (Tam et al., 2021). The impacts of climate change are interrelated, making it a threat-amplifier
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Volume 86 • Number 7
engage in mitigation and adaptation strate- gies. Media attention and communications from thought leaders in the community also influence perceptions of harm. With regard to climate change, however, media coverage aects individuals dierently based on their political views and the trust placed in the source of information (Marlon et al., 2022). The development and adoption of inno- vative solutions for climate change mitiga- tion and adaptation are also aected by the community’s perception of climate change and willingness to act (Marlon et al., 2022). Climate change mitigation and adaptation requires a multisectoral and multidisci- plinary approach that involves individuals, communities, governments, international organizations, and the research community. Despite the development of innovative cli- mate change solutions, adoption has been slow. While these policies have been dicult to enact due to the lack of uniform support across the U.S., bills that incentivize investing in clean energy and mitigating the impact of climate change—such as the Inflation Reduc- tion Act and the Bipartisan Infrastructure Law—have been passed recently (Bertrand, 2022; Carmack et al., 2022). Per its mission to support the environ- mental public health workforce, NEHA has prioritized highlighting climate change miti- gation and adaptation strategies and support- ing state, tribal, local, and territorial (STLT) health departments to develop and imple- ment community climate solutions. NEHA’s membership comprises more than 7,000 environmental public health professionals, many of whom are within STLT agencies. NEHA and ecoAmerica have partnered to build leadership on climate solutions and institutionalize climate action as a health imperative through engaging all leadership, members, and partners within the NEHA community. As part of this partnership, NEHA and ecoAmerica’s Climate for Health program collected data on climate change awareness, attitudes, and behaviors from NEHA mem- bers and the U.S. public as part of the Ameri- can Climate Metrics Survey (ACMS). This survey explores the perceptions of climate change and its eects. This article examines certain trends in the ACMS results over the period of 4 years and provides recommenda- tions on how NEHA can provide support to the environmental public health workforce
to implement climate change mitigation and adaptation in their communities. Methods The annual ACMS, conducted by ecoAmerica in collaboration with Lake Research Partners, was administered to a public sample of U.S. adults and a sample of NEHA members in 2016, 2017, 2018, and 2019. The most recent survey for NEHA members was conducted online by ecoAmerica from September 16 to October 10, 2019. In 2019, NEHA had 6,600 members. A sample of 258 self-selected NEHA members participated in the 2019 survey. In the past, this survey received 277 responses in 2016, 383 responses in 2017, and 124 responses in 2018. The most recent national ACMS was con- ducted online in 2019 from September 16–19 and from October 25–28, receiving a total of 1,000 responses. The sample was drawn from respondents who were screened to verify that they were ≥18 years. Additionally, the sample was weighted slightly by region, age, race, and education. The margin of error for the 2019 U.S. public sample was 3.1%, weighted to represent the U.S. We present a summary and general trend analysis of a selection of the survey results across the 4 years of data to illustrate the progress and changes in NEHA member awareness of climate and health issues, how they compare with the results from the U.S. public, and the relevance of this information on climate action and solutions for NEHA members. For the most recent 2019 survey, the data from the selected questions were recoded into dichotomous responses, and a series of chi-square tests for independence (with Yate’s continuity correction for 2 x 2 tables) were conducted on the data to assess dierences in how, in 2019, the U.S. public answered the survey questions compared with how NEHA members answered.
the second-largest public health profession, and they intimately know their communi- ties through their work to ensure safe living, working, learning, and recreational spaces through the use of science-based regula- tory methods and practices (National Asso- ciation of County and City Health Ocials [NACCHO], 2019). Despite investments of billions of dollars by federal and state government into clean energy, infrastructure, and protection of the natural environment, limited funding has reached local health departments (Brown, 2022). The environmental public health workforce con- tinues to encounter barriers such as funding, lack of resources, competing priorities, lack of support, and an adversarial political atmo- sphere that often hinders them from taking a more active role in climate mitigation and adaptation (Gould & Rudolph, 2015). Addressing climate change requires the public to collectively perceive climate change as a threat and act in response (Ballew et al., 2019). A majority of people in the U.S. say that they see the eects of climate change and believe that action should be taken to reduce the negative impacts of climate change (Tyson & Kennedy, 2020). Public attitudes toward climate change tend to vary based on fac- tors such as region, age, ideology, and gender (Capstick et al., 2015). Identifying climate change as a major threat to health and well- being has significant potential to motivate individuals to take measures to reduce their health risks from expected negative impacts. Another factor influencing perception is the immediate eect on an individual from climate change. People in regions that have already experienced frequent extreme weather events might be more likely to per- ceive climate change as a threat due to the high personal impact of these events (Zan- occo et al., 2018). This perception was seen in a 2022 poll of U.S. adults, which found that people who had been aected by extreme weather events in the past 5 years were more likely to see climate change as a major issue than were people who have not been aected (77% versus 46%, respectively) (National Public Radio et al., 2022). According to Fownes and Allred (2019), sociodemographic and regional factors, along with existing views and politics, are pro- foundly influential to perceptions of harm due to climate change and motivation to
Results
Survey Results: Beliefs and Concerns The percentage of respondents who believed that climate change is happening, for NEHA members and the U.S. public, has remained consistent over the past 4 years, although the percentage is slightly higher for NEHA members than the U.S. public. In 2019, sig- nificantly more NEHA members (87%) than
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March 2024 • Journal of Environmental Health
ADVANCEMENT OF THE SCIENCE
TABLE 1
Climate Change Beliefs Over Time of National Environmental Health Association (NEHA) Members and the United States Public From the American Climate Metrics Survey
Climate Statement
Survey Respondent Agreement With Statement (%)
2016
2017
2018
2019
NEHA Members
U.S. Public
NEHA Members
U.S. Public
NEHA Members
U.S. Public
NEHA Members
U.S. Public
80
Yes, climate change is happening.
83
83
86
80
83
80
87*
Climate change is due to human activities.
31
26
32
49
35
23
50*
24
Climate change is due to natural causes.
17
13
15
27
10
16
13
14
Climate change is due to a combination of human and natural causes.
45
55
46
17
47
53
33*
52
I am concerned about climate change.
70
76
71
76
77
73
78
76
45
I am VERY concerned about climate change.
47
38
51
44
48
40
62*
I think people around me are concerned about climate change. The effects of climate change have already begun to happen.
NA
NA
52
57
58
59
NA
NA
77
60
76*
52
Note. Chi-square analyses were conducted on the 2019 data only. NA = not applicable because the question was not included in the survey that year. *Significant based on chi-square analyses ( p < .05).
public respondents (80%) shared this senti- ment. Asked in 2018 and 2019, three quar- ters (77% and 75%, respectively) of NEHA members also believed that climate change has already had noticeable eects on the planet, compared with slightly more than one half (60% and 52%, respectively) of the U.S. public. In 2019, 52% of public respondents thought there were noticeable eects of cli- mate change, a significant dierence from the 76% of NEHA members who reported having noticed climate change impacts. Year after year, concern about climate change was high among respondents from both the public and NEHA member groups; NEHA members who reported concern over the years ranged from 70% to 78% compared with the U.S. public range of 73% to 76%. In 2019, 78% of NEHA members indicated con- cern about climate change compared with 76% of the public (a nonsignificant dier- ence). But of those 78% of NEHA members, 62% reported being “very concerned” about climate change; this number is compared with 45% of the public, which is a signifi-
cant dierence. The public respondents and NEHA members were comparable in report- ing if they believed that the people around them were concerned. In 2019, slightly more than one half of NEHA members (58%) and the U.S. public (59%) perceived that people around them were also concerned about cli- mate change. NEHA members and the sample from U.S. public generally believed that climate change is due to a combination of human and natural causes rather than human activities or natural causes alone. There was a significant dier- ence in 2019 between the 52% of respondents from the public and the 33% of NEHA mem- bers who attributed climate change to a com- bination of natural and human causes. There was a noticeable increase, however, from 31% of NEHA members in 2016 to 50% in 2019 who attributed climate change to humans. In 2019, the number of NEHA members (50%) who recognized climate change was due to human behavior was double the U.S. public average (24%), which was a significant dier- ence. In 2019, a similar percentage of NEHA
members (13%) and public respondents (14%) linked climate change mainly to natu- ral causes. See Table 1 for more information on the beliefs and concerns of those surveyed across the 4 years. Survey Results: Perception of Harm In 2019, ACMS participants were asked about the harm of climate change on diverse groups, which was a new question added in the 2019 survey. NEHA members were significantly more aware than the public respondents were about how climate change will harm dierent groups of individuals, responding that climate change will harm them a great deal or moderately. More than one half of NEHA members (59%) felt that climate change will personally harm them or their families, compared with approximately one half of the public (52%). Compared with U.S. public respondents, more NEHA mem- bers believed that climate change will harm low-income households, urban communities, rural communities, future generations, and the U.S. Of the U.S. public, only 55% agreed
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Volume 86 • Number 7
FIGURE 1
Climate Change Harms Perceived by National Environmental Health Association (NEHA) Members and the United States Public From the 2019 American Climate Metrics Survey
49
Harms Whites
61
52
Harms Latinos and Hispanics
69
55
Harms African Americans
69
63
Harms people in the U.S.
73
55
Harms people in my community
65
61
Harms rural areas
72
59
Harms urban areas
71
67
Harms future generations
79
62
Harms people in low-income households
74
52
Harms me personally or my family
59
0
10
20
30
40
50
60
70
80
90
% of Respondents U.S. Public NEHA Members
Note. All NEHA percentages are significant based on chi-square analyses ( p < .05).
that climate change will harm people in their community, compared with 65% of NEHA members. Lastly, approximately two thirds of NEHA members (69%) believed that climate change will harm African Americans, Lati- nos, and Hispanics, while on average only approximately one half (54%) of the public respondents believed that there will be harm across these groups (Figure 1). Survey Results: Benefits of Action Versus Costs of Action Respondents were asked if the U.S. took steps to prevent climate change, then to what extent would these actions impact four national issues (Figure 2). NEHA members responded that climate change solutions will improve our health “some extent” or “a lot” (increased from 65% in 2016 to 73% in 2019), the economy (increased from 45% in 2016 to 64% in 2019), and jobs (increased from
47% in 2016 to 59% in 2019). The majority of the public agreed with the three perceived positive impacts, but there was a decrease in agreement across all three areas from 2016 to 2017. For the 2019 data, significantly more NEHA members than the U.S. public believed that if the U.S. took steps to prevent climate change, then these actions would improve health, the economy, and employment. Agreement about if there will be a posi- tive impact on the cost of energy has slightly increased for NEHA members, from 21% in 2017 to 26% in 2019. Fewer NEHA mem- bers felt this way, however, compared with the U.S. public. The public data showed a larger increase in the percentage of respon- dents who thought there would be a positive impact on the cost of energy (increased from 27% in 2017 to 37% in 2019). In 2019, com- pared with the U.S. public, significantly fewer NEHA members perceived a positive impact
on energy costs if the U.S. took steps to pre- vent climate change. Respondents were then asked about the costs of acting on climate change. NEHA members were less likely to agree than their public counterparts about the importance of prioritizing economic growth over acting on climate change (Table 2). From 2017 to 2019, only one quarter (25%) of NEHA members agreed with this statement compared with approximately one half (48%) of the U.S. public. In 2019, significantly fewer NEHA members (26%) agreed with the importance of prioritizing economic growth over acting on climate change, compared with 48% of the U.S. public respondents who agreed with that statement. Similarly, over the years less than one quarter (21%) of NEHA members agreed that the costs and sacrifices are too high to address climate change, compared with approximately 40% of the public respon-
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March 2024 • Journal of Environmental Health
ADVANCEMENT OF THE SCIENCE
FIGURE 2
Impact of Climate Action on National Issues Perceived by National Environmental Health Association (NEHA) Members and the United States Public From the American Climate Metrics Survey
I mprov e th e Economy
I mprov e Health
66
0 10 20 30 40 5 0 60 70
0 10 20 30 40 5 0 60 70 80
64
64*
73*
72
61
68
67
66
66
65
5 6
5 5
5 3
5 4
45
U.S. Public
NEHA Members
U.S. Public
NEHA Members
2016 2017 2018 2019
2016 2017 2018 2019
I ncrease J obs
Decrease Cost of Energy
0 10 20 30 40 5 0 60 70
40
37
61
5 9*
5 6
5 6
5 6
5 2
30
30
47
47
27
26*
21
19
20
10
0
U.S. Public
NEHA Members
U.S. Public
NEHA Members
2016 2017 2018 2019
2017 2018 2019
*Significant based on chi-square analyses ( p < .05).
dents. In 2019, 18% of NEHA members, com- pared with 41% of the U.S. public, agreed that the costs of acting on climate change are too high, which is a significant di erence. Survey Results: Climate Change Solutions NEHA members have demonstrated continu- ous support from year to year for a breadth of proposed climate solutions. Over the years, more than 90% of NEHA members strongly supported modernizing the electric grid and almost 90% of NEHA members supported expanding public transportation, compared with three quarters (77% and 74%, respec- tively) of the U.S. public respondents in 2019. In 2019, NEHA members showed sig- nificantly stronger support for each of the cli- mate solutions than did the public. See Table 3 for more detail on the extent of support for climate change solutions.
In 2019, climate solutions from the Green New Deal were included in the survey. NEHA members were significantly more supportive of most of these solutions than were public respondents (Figure 3). Of NEHA members, 89% supported technologies that remove car- bon pollution from the air compared with 79% of the public; further, 84% of NEHA members supported training for jobs as we transition to a Green New Deal, compared with 74% of public respondents. There was not a significant di erence between the two groups regarding support for speeding up the transition to clean energy sources. Discussion Our findings are consistent with a survey of local public health ocials and U.S. public respondents that showed most public health professionals and the public believe climate change is happening (NACCHO, 2014). In
response to the statement that climate change is noticeably causing harm to people now, however, NEHA members and public health ocials showed more concern than did public respondents (NACCHO, 2014). Furthermore, NEHA members were significantly more likely than public respondents to believe that climate change will cause harm across a broad diver- sity of people. Environmental public health professionals have observed firsthand the impacts of climate change on their communi- ties and its e ects on routine services such as food and water safety, vector control, air qual- ity, and disaster preparedness. Our analysis also revealed that a major- ity of the surveyed NEHA members increas- ingly agreed that climate change solutions will improve national issues such as health, economy, and jobs. This finding was signifi- cantly di erent than that of public respon- dents, whose agreement that climate change
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Volume 86 • Number 7
TABLE 2
Priority and Cost Beliefs of National Environmental Health Association (NEHA) Members and the United States Public From the American Climate Metrics Survey
Climate Statement
Survey Respondent Agreement With Statement (%)
2016
2017
2018
2019
NEHA Members
U.S. Public
NEHA Members
U.S. Public
NEHA Members
U.S. Public
NEHA Members
U.S. Public
I think that it is more important that we prioritize economic growth over taking action on climate change. We could address climate change, but the costs and sacrifices are too high.
48
NA
24
51
24
44
26*
24
34
19
42
20
39
18*
41
Note. Chi-square analyses were conducted on the 2019 data only. NA = not applicable because the question was not included in the survey that year. *Significant based on chi-square analyses ( p < .05).
solutions will improve these national issues decreased over the years of 2016 to 2018. Although agreement between both groups has increased over the survey years, an unex- pected result was that significantly more pub- lic respondents (37%) than NEHA members (26%) agreed that preventing climate change will lower energy costs. Currently, clean energy is cheaper than fossil fuels (International Renewable Energy Agency, 2022). Public health plays a role in monitoring, evaluating, and supporting the transition to healthier and more sustainable energy sources (McMonagle et al., 2021). Based on this finding, one of NEHA’s priorities should be to provide envi- ronmental public health professionals with education and training on transitioning com- munities to clean energy and the benefits of clean energy to health and well-being. Environmental public health profession- als play a crucial role in climate change mitigation and adaptation. As such, their involvement in this work influences their perceptions on climate change solutions, which can be seen in the findings that show NEHA members strongly agree that urgent solutions (e.g., Green New Deal) need to be rapidly implemented. Moreover, NEHA members were approximately twice as likely as public respondents to prioritize climate action over economic growth and disagree with perceived costs and sacrifices associated with climate change actions. A 2022 poll, however, showed that when the U.S. public was presented with co-benefits of taking cli- mate action (e.g., protection against future
weather disasters), their support for climate action increased (National Public Radio et al., 2022). Our analysis demonstrates that environ- mental public health professionals believe cli- mate change is happening, currently poses a threat to human health, and solutions should be a priority. Environmental public health professionals are rooted in their communi- ties and understand the factors that influence the perceptions of local community members regarding climate change and solutions. Given this knowledge and their role as trusted leaders, environmental public health professionals can leverage their position to communicate the health threats of climate change to the public and provide targeted guidance toward solutions that will prepare communities for climate change and mitigate future negative impacts. NEHA should pro- vide support and actively encourage environ- mental public health professionals to imple- ment adaptation and mitigation solutions for climate change through core environmental public health services and programs such as NEHA’s Climate Health and Adaptation Miti- gation Partnership (CHAMP) program and the Climate for Health Ambassador Training (NEHA, 2023a). CHAMP encourages local jurisdictions to progress toward meeting Healthy People 2030 objectives put forth by the U.S. Depart- ment of Health and Human Services. Further, CHAMP promotes health equity by raising awareness of how climate change-associated environmental public health hazards dispro-
portionately aect the health of various com- munities and population groups. CHAMP also helps to promote and expand the use of the Building Resilience Against Climate Eects (BRACE) framework from the Centers for Disease Control and Prevention (CDC). Through continued partnership with ecoAmerica’s Climate for Health Ambassa- dor Training program, NEHA can bolster the capability to build the capacity of the environ- mental public health workforce to be involved in local climate and health conversations. In addition, NEHA should encourage this work- force to facilitate cross-sectoral engagement among community members, the healthcare sector, climate-related policymakers and regu- lators, climate change coalitions, and industry to gain insight and support from these local leaders to mobilize implementation of cli- mate solutions in their communities (NEHA, 2023b). Furthermore, NEHA should share and highlight jurisdictions that have been suc- cessful in these endeavors through webinars and case studies to help other jurisdictions initiate similar eorts. Limitations for our survey include a small sample size that might not be representative of NEHA membership, a decrease in participa- tion in 2018, and potential self-selection bias. While notable events occurred each year— such as a polarizing presidential election campaign, a national election that used cli- mate change as a focal point, and an increase in media coverage of extreme weather events between 2016 and 2019—we cannot deter- mine if these events aected responses.
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March 2024 • Journal of Environmental Health
ADVANCEMENT OF THE SCIENCE
TABLE 3
Climate Solution Beliefs of National Environmental Health Association (NEHA) Members and the United States Public From the American Climate Metrics Survey
Solution Statement
Survey Respondent Agreement With Statement (%)
2016
2017
2018
2019
NEHA Members
U.S. Public
NEHA Members
U.S. Public
NEHA Members
U.S. Public
NEHA Members
U.S. Public
Charge corporate polluters a fee.
71
78
81 81 76 88 82
81 76 72 76 72
84 86 85 91 83
83 81 76 80 79
83* 83* 78* 86* 81*
76 73 68 74 71
Pass laws for more efficient buildings and cars. Provide personal tax credits for electric cars. Expand public transit like buses and trains. Provide corporate tax credits to expand clean energy.
NA NA NA NA
Modernize America’s electric grid.
NA
94
83
97
87
90*
77
Note. Chi-square analyses were conducted on the 2019 data only. NA = not applicable because the solution was not included in the survey that year. *Significant based on chi-square analyses ( p < .05).
Future ACMS eorts should be contin- ued to maintain an understanding of the dynamic needs of environmental public health professionals. Public perception of climate change can shift based on politi- cal and economic situations and overall national discourse. Local environmental public health professionals are knowledge- able about the factors that influence their community’s perception of climate change. Survey results can help them tailor commu- nications and propose solutions. We think it will be useful for future ACMS eorts to include questions about how NEHA mem- bers are integrating climate justice into routine environmental public health ser- vices. This information will help us support environmental public health programs to develop and share leading practices on tar- geted mitigation and adaptation initiatives to communities and people who are most vulnerable to climate change impacts. Conclusion Understanding the perceptions held by NEHA members and by the general public regarding climate change and health and solutions to identified challenges will bet- ter inform how NEHA can support envi- ronmental public health professionals to communicate climate and health threats and to implement mitigation and adapta- tion initiatives. Our analysis revealed that
FIGURE 3
Green New Deal Solutions Perceived by National Environmental Health Association (NEHA) Members and the United States Public From the 2019 American Climate Metrics Survey
Provide training for jobs to transition to a New Green economy* Develop technologies that remove carbon pollution from the air* Preserve nuclear power plants*
74
84
79
89
66
78
Move away from sources that create carbon pollution*
66
78
Speed up the transition to clean sources of energy
77
83
0
20
40
60
80
100
% of Respondents U.S. Public NEHA Members
*Significant based on chi-square analyses ( p < .05).
although most NEHA members and public respondents believe that climate change is happening, more NEHA members recognize the importance of taking urgent action to mitigate and adapt to climate threats. Some specific areas can be targeted, such as pro-
viding education on the benefits of prevent- ing climate change and lowering energy costs and encouraging participation in pro- grams such as CHAMP. With limited funding for local environ- mental public health to address climate
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Volume 86 • Number 7
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