Reframing climate change as a health that is public: an exploratory study of public reactions
Abstract
Background
Climate change is taking a toll on human health, plus some leaders within the health that is public have urged their colleagues to give voice to its health implications. Previous studies have shown that Americans are only dimly aware of the health implications of climate change, yet the literature on issue framing suggests that providing a novel frame – such as human health – could be potentially beneficial in enhancing engagement that is public. We conducted an study that is exploratory the usa 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, read the essay and were asked to highlight in green or pink any portions associated with the essay they found “especially helpful and clear” or alternatively “especially confusing or unhelpful.” Two dependent measures were created: a composite score that is sentence-specific on reactions to any or all 18 sentences within the essay; and respondents’ general reactions to your essay that were coded for valence (positive, neutral, or negative). We tested the hypothesis that five associated with the six audience segments would respond positively to your essay on both measures that are dependent.
Results
There is evidence that is clear two associated with the five segments responded positively to your public health essay, and mixed evidence that two other responded positively. There is evidence that is limited the fifth segment responded positively. Post-hoc analysis indicated that five associated with the six segments responded more positively to details about the ongoing health benefits associated with mitigation-related policy actions rather than details about the health risks of climate change.
Conclusions
Presentations about climate change that encourage people to consider its health that is human relevance expected to provide many Americans with a useful and engaging new frame of reference. Details about the health that is potential of specific mitigation-related policy actions appears to be particularly compelling. We believe that the health that is public has an important perspective to fairly share about climate change, a perspective that makes the issue more personally relevant, significant, and understandable to people in the general public.
Peer Review reports
Background
Climate change has already been taking a toll on human health within the United States [1] and other nations worldwide [2]. Unless greenhouse gas emissions worldwide are sharply curtailed – and actions that are significant to help communities adapt to alterations in their climate that are unavoidable – the human toll of climate change is likely to become dramatically worse on the next several decades and beyond [3]. Globally, the human health impacts of climate change continues to differentially impact the world’s poorest nations, where populations endemically suffer myriad health burdens associated with extreme poverty that are being exacerbated because of the climate that is changing. As stated in a recently available British Medical Journal editorial, failure around the globe’s nations to successfully curtail emissions will probably result in a health that is”global” [4]. The segments of the population most at risk are the poor, the very young, the elderly, those already in poor health, the disabled, individuals living alone, those with inadequate housing or basic services, and/or individuals who lack access to affordable health care or who live in areas with weak public health systems in developed countries such as the United States. These population segments disproportionately include racial, ethnic, and minorities that are indigenous.
While legislation to reduce U.S. greenhouse gas (GHG) emissions has stalled in Congress, in December 2009 environmentally friendly Protection Agency (EPA) moved toward regulating carbon dioxide and five other associated with the gases under the Clean Air Act, citing its authority to protect health that is public welfare through the impacts of global warming [5]. The agency found that global warming poses health that is public – including increased morbidity and mortality – due to declining quality of air, rising temperatures, increased frequency of extreme weather events, and higher incidences of food- and water-borne pathogens and allergens.
This finding comes as a relatively small selection of public health professionals will work rapidly to better comprehend and quantify the nature and magnitude of the threats to health that is human wellbeing [6]. This new but rapidly advancing health that is public has gotten minimal news media attention, even at internationally leading news organizations like the New York Times [unpublished data]. It isn’t surprising therefore that the general public comes with yet to fully comprehend the health that is public of climate change. Recent surveys of Americans [7], Canadians [8], and Maltese [9] demonstrate that the health that is human of climate change are seriously underestimated and/or poorly understood, if grasped after all. About half of American survey respondents, for example, selected “don’t know” (rather than “none,” “hundreds,” “thousands,” or “millions”) when asked the number that is estimated of and future (i.e. 50 years hence) injuries and illnesses, and death due to climate change. An earlier survey of Americans [10] demonstrated that most people see climate change as a geographically and temporally distant threat to your environment that is non-human. Notably, not a survey that is single freely associated climate change as representing a threat to people. Similarly, few Canadians, without prompting, can name any human that is specific threat connected to climate change impacts in their country [8].
Cognitive research over the past decades that are several shown that how people “frame” a concern – i.e., how they mentally organize and discuss with other people the issue’s central ideas – greatly influences the way they comprehend the nature associated with the problem, who or whatever they see to be responsible for the issue, and whatever they feel ought to be done to address the problem [11, 12]. The polling data cited above [7–9] suggests that the dominant mental frame used by most people in the general public to organize their conceptions about climate change is the fact that of “climate change as an environmental problem.” However, when climate change is framed as an problem that is environmental this interpretation likely distances many people through the issue and contributes to a lack of serious and sustained public engagement required to develop solutions. This focus is also prone to a dominant counter frame that the solution that is best is to continue to grow the economy – paying for adaptive measures as time goes by when, theoretically, society is supposed to be wealthier and better in a position to afford them – as opposed to concentrate on the root reasons for the environmental problem [13]. This frame that is economic leaves the public ambivalent about policy action and actively works to the advantage of industries that are reluctant to reduce their carbon intensity. Indeed, it really is exactly the lack of a countervailing movement that is populist climate change which has had made policy solutions so difficult to enact [13, 14].
Significant efforts were made over the past many years by public health organizations to boost awareness of the health that is public of climate change and prepare the general public health workforce to respond, although as noted above, it isn’t clear the extent to which public health professionals, journalists, or above all, the general public and policy makers have taken notice. In the United States, National Public Health Week 2008 was themed “Climate Change: Our Health in the Balance,” the Centers for Disease Control and Prevention created a Climate Change and Public Health program, and several professional associations assessed the health that is public’s readiness to react to the emerging threat [15–17]. Globally, World Health Day 2008 was themed “Protecting Health from Climate Change,” plus the World Health Organization is promoting a climate change and health work plan, the objective that is first of is “raising awareness of the effects of climate change on health, in order to prompt action for public health measures” [18]. Several prominent medical journals have released special issues on climate change and health [19–21], and these and other medical journals [4] have issued strongly worded editorials health that is urging to give voice to your health implications of climate change.
An assumption that is important these calls to action is the fact that there may be considerable value in introducing a public health frame into the ongoing public – and policy – dialogue about climate change. While there is indeed solid basis that is theoretical this assumption, to your best of your knowledge there isn’t yet empirical evidence to support the validity associated with the assumption [22].
The purpose of this research therefore would be to explore how American adults react to an essay about climate change framed as a health issue that is public. Our hypothesis was that a public explanation that is health-framed of change would be regarded as useful and personally relevant by readers, with the exception of people in one small segment of Americans who dismiss the idea that human-induced climate change is happening. We used two dependent measures in this hypothesis: a score that is composite on respondent reactions to each sentence within the essay, and the 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% associated with the population that is adult, the Concerned (33%), the Cautious (19%), the Disengaged (12%), the Doubtful (11%), and the Dismissive (7%) – fall along a continuum from those who are engaged in the issue and seeking for techniques to take appropriate actions (the Alarmed) to those who actively deny its reality consequently they are researching ways to oppose societal action (the Dismissive; see Figure 1). The four segments in the middle of the continuum are going to benefit most from a reframing of climate change as a health that is human because, to a larger or lesser degree, they are not yet certain that they completely understand the issue consequently they are still, if motivated to do so, relatively open to learning about new perspectives.
Figure 1
Global Warming’s Six Americas. A nationally representative sample of American adults classified into six audience that is unique according to 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 participate in semi-structured elicitation that is in-depth that lasted on average 43 minutes (which range from 16 to 124 minutes) and included the presentation of a public health framed essay on climate change. The recruitment process was designed to yield completed interviews with a demographically and group that is geographically diverse of least 10 people from each of the previously identified “Six Americas” [7]. Four respondents were dropped out of this study due to data that are incomplete leaving an example measurements of 70. Audience segment status (i.e., which among the “Six Americas” a person belonged) was assessed with a previously developed screening that is 15-item that identifies segment status with 80% accuracy [unpublished data].
To produce diversity that is demographic the sample, we recruited an approximately balanced amount of women and men, and an approximately balanced amount 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 make an effort to recruit a mix of people from various backgrounds that are racial/ethnic.
Table 1 Distribution of Respondents by Age, Gender and Segment.
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To produce diversity that is geographic we recruited participants in one of two ways. Almost all of participants (n = 56) were recruited – after which interviewed – face-to-face in one of two locations: out-of-town visitors were interviewed at a location that is central the National Mall in Washington, DC (a national park situated between your U.S. Capitol, the Smithsonian Museum buildings, and the Lincoln Memorial); and shoppers were interviewed at an “outlet” mall (i.e., discount branded merchandise shopping mall) adjacent to an interstate freeway in Hagerstown, MD. The outlet mall is much more than one hour driving distance away from as you like it short summary in hindi Washington, DC and attracts shoppers from Maryland, Pennsylvania, and West Virginia, as well as visitors from further away who are driving the freeway that is interstate. The study that is remaining were recruited via email from among participants to a nationally representative survey that we conducted in Fall 2008 [7]. These were interviewed subsequently by telephone, after being mailed a duplicate associated with the test health that is”public” – described below – in a sealed envelope marked “do not open until asked to do so because of the interviewer.” As climate change argumentative essays a motivation to participate, all respondents were given a $50 gift card upon completion of their interview. George Mason University Human Subjects Review Board provided approval for the study protocol (reference #6161); all respondents that are potential written consent information prior to participation.
The 70 study participants resided in 29 states. Using U.S. Census Bureau classifications, 14% (n = 10) were through the Northeast region, 21% (n = 15) were through the Midwest, 40% (n = 28) through the South, and 23% (n = 16) were through the West; region and state were unknown for just one participant. In 2006, the distribution that is geographic of overall U.S. population was 18%, 22%, 36% and 23% within the Northeast, Midwest, South and West, respectively [23].
Data Collection and Coding
The majority of the interview was devoted to open-ended questions intended to establish the respondent’s emotions, attitudes, beliefs, knowledge and behavior in accordance with warming that is global causes and consequences. An individual could do to help limit global warming for example, respective open-ended questions asked alternatively if, how, and for whom global warming was a problem; how global warming is caused; if and how global warming can be stopped or limited; and what, if anything. Toward the termination of the interview, respondents were asked to see “a quick essay about global warming” (see Appendix 1), which was designed to frame climate change as a health issue that is human. Respondents were also given an eco-friendly and a pink pen that is highlighting asked to “use the green highlighter pen to mark any portions associated with the essay which you feel are especially clear or helpful, and use the pink highlighter pen to mark any portions associated with the essay that are particularly confusing or unhelpful.”
As shown in Appendix 1, the main one page essay was organized into four sections: an paragraph that is opening introduced the public health frame (5 total sentences); a paragraph that emphasized how human health is supposed to be harmed if action is not taken to stop, limit, and/or protect against global warming (in other words., a description associated with the threat; 7 sentences); a paragraph that discussed several mitigation-focused policy actions and their human health-related benefits if adopted (4 sentences); and a brief concluding paragraph meant to reinforce the general public health frame (2 sentences).
When respondents finished the reading, these were asked to describe in an open-ended format their reaction that is”general to essay.” (Note: This question was inadvertently not asked of one respondent, therefore the sample size for analysis of the information is 69.) For each portion of the essay they marked in green, these were subsequently asked: “think about all these sentences was especially helpful or clear for you?” For each portion of the essay they marked in pink, these were also asked: “think about all these sentences was especially unhelpful or confusing for you?”
To judge the respondent’s general reactions to your essay we reviewed their statements that are individualn = 193), defined as discrete thoughts or concepts. According to this review, we iteratively developed eight thematic categories that captured the range of statements made by respondents. Table 2 defines and describe these themes.
Table 2 Thematic Categories familiar with Code Respondents’ General Reactions to the general public Health Essay.
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Two student that is graduate were then taught to code each statement into among the thematic categories. The coders were also instructed to evaluate the valence that is overall of respondent’s statements – the first of your dependent measures – rating them as: -1 (entirely negative comments); 0 (mixed, including both negative and positive comments); or 1 (entirely positive comments). Following standard analysis that is content, we tested inter-coder agreement on approximately 50 statements, ensuring that a full number of possible types of coding decisions were required associated with the coders. To evaluate reliability, we used Krippendorff’s alpha [24, 25], a measure that is conservative corrects for chance agreement among coders; a K-alpha of .70 or higher is recognized as sufficient and .80 or higher is recognized as excellent. For 7 associated with the 8 thematic categories, we achieved a reliability of .80 or maybe more; “not enough Evidence or Stylistically Confusing” was the exception, with an reliability this is certainly inter-coder of. The two coders then went on to categorize the rest of the remaining statements from the sample of respondents after establishing reliability.
To code the respondent’s sentence-specific reactions created using the pens that are highlighting sentences marked with only green on one or more word were scored +1 (i.e. Indicating “especially useful” or clear), sentences marked with only pink on at least one word were scored -1 (i.e. indicating “especially confusing or unhelpful), and sentences with either no highlighting, or both green and pink, were scored 0. scores that are composite created for each of the four sections of the essay – the opening, the threat section, the benefit section, and the conclusion – by summing the sentence-specific scores within the section and dividing because of the amount of sentences. A score that is composite the entire essay – the second of this dependent measures in our hypothesis – was created by summing the sentence scores across each segment and dividing because of the amount of respondents per segment. Population estimates, which can be taken solely as preliminary indicators because of the nature that is non-probabilistic of sampling, were estimated by weighting the mean values for each associated with the six segments based on its prevalence within the U.S. population (see Figure 1).
Data Analysis
To test the between-segment variations in our dependent measures – overall reactions to your essay (for example., valence) and composite sentence-specific reactions to your essay that is entire we used the nonparametric Kruskal-Wallis test (see Figures 2, 3). A positive reaction) for our full sample, we used the Wilcoxon signed rank test to test if the median response to the essay on each dependent measure was greater than zero (i.e. Lastly, both for dependent measures, we used the Wilcoxon signed rank test to try our hypothesis that five associated with the six segments (the Dismissive being the main one exception) would respond positively to your essay; the hypothesis that is null that the median score for each associated with the five segments did not differ from zero. The Wilcoxon signed rank test is appropriate for small sample sizes and distributions that are non-normal each of that are the scenario for at least some segments in our data.
Figure 2
Average valence of respondents’ general essay comments. The mean valence of respondent comments when asked their general reactions to your public health essay by audience segment and also by a population estimate that is national. Note: 1 = (entirely positive comments); 0 = (mixed, including both negative and positive comments); and -1 = (entirely negative comments).
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Figure 3
Composite essay scores by segment. Scores reflect respondent average values by segment when it comes to distinction between the amount of times each of 18 sentences were marked “especially clear or helpful” and “especially confusing or unhelpful” with a range that is full of values between 18 and -18. The scores are adjusted for unequal numbers of respondents within each segment by re-weighting values to represent n = 10.
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Post-hoc – after examining the data that are visualizedsee Figures 4, 5 and 6) – we decided to test for two possible main effects within the data. To look at the chance that the essay’s later concentrate on the health that is public of mitigation-related policy actions was seen by respondents as clearer and much more useful compared to essay’s earlier focus on public health-related threats, we calculated the essential difference between the re-scaled (by a factor of 10) average reaction to both the benefit additionally the threat sections after which used the Wilcoxon signed rank test to try, by segment, if the median of the differences was greater than zero. We then evaluated the overall main effect of the essay – across all segments – making use of the t-test that is weighted the distinctions with weights corresponding to your frequencies associated with the segments within the population.
Figure 4
Essay evaluations by sentence: Alarmed, Concerned and segments that are cautious. Sentence-specific evaluations for the public health essay by respondents when you look at the Alarmed, Concerned and Cautious segments and also by a population estimate that is national. Note: Scores reflect the essential difference between the true amount of times a sentence was marked as “especially clear or helpful” and the amount of times it was marked as “especially confusing or unhelpful,” adjusting for unequal numbers 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 = policy that is mitigation-related and their own health benefits (4 sentences); and C = concluding section (2 sentences). The population that is national was created by weighting the values for each associated with the six segments based on their relative proportion of American adults.
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Figure 5
Essay evaluations by sentence: Disengaged, Doubtful and segments that are dismissive. Sentence-specific evaluations for the public health essay by respondents within the Disengaged, Doubtful and Dismissive segments and also by a population estimate that is national. Note: Scores reflect the essential difference between the true amount of times within a sentence was marked as “especially clear or helpful” and the amount of times it was marked as “especially confusing or unhelpful,” adjusting for unequal numbers 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 = policy that is mitigation-related and their own health benefits (4 sentences); and C = concluding section (2 sentences). The population that is national was created by weighting the values for each associated with the six segments based on their relative proportion of American adults.
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Figure 6
Essay evaluations by section (opening, threat, benefits, closing). Average section-specific evaluations associated with the public health essay by respondents in each of the six audience segments and also by a population estimate that is national. Note: Scores reflect the essential difference between the true amount of sentences within each section marked by a respondent as “especially clear or helpful” and the ones marked as “especially confusing or unhelpful” with those values averaged across the amount of sentences per section and rescaled by a factor of 10. Section abbreviations correspond to O = opening section (5 sentences); T = climate change health threat related section (7 sentences); B = policy that is mitigation-related and their own health benefits (4 sentences); and C = concluding section (2 sentences). The population that is national was created by weighting the mean values for each associated with the six segments based on their relative proportion of American adults.
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Lastly, to look at when it comes to possibility that the framing that is concluding associated with the essay was perceived by respondents as clearer and much more useful compared to the opening framing section, we calculated the essential difference between the re-scaled average response to both the opening plus the concluding sections after which used the Wilcoxon signed rank test to try, by segment, if the median of the differences was greater than zero. We then evaluated the overall effect that is main across all segments – making use of the weighted t-test in the differences with weights corresponding to your frequencies associated with the segments within the population.