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 when you look at the health that is public have urged their colleagues to offer voice to its health implications. Previous studies have 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 – can 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, see the essay and were asked to highlight in green or pink any portions regarding 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 all the 18 sentences when you look at the essay; and respondents’ general reactions into the essay that have been coded for valence (positive, neutral, or negative). We tested the hypothesis that five regarding the six audience segments would respond positively into the essay on both measures that are dependent.

Results

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

Conclusions

Presentations about climate change that encourage visitors to consider its health that is human relevance likely to provide many Americans with a helpful and engaging new frame of reference. Information on the health that is potential of specific mitigation-related policy actions is apparently particularly compelling. We genuinely believe that the health that is public has an essential perspective to share about climate change, a perspective that produces the difficulty 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 when you look at the United States [1] and other nations worldwide [2]. Unless greenhouse gas emissions worldwide are sharply curtailed – and actions that are significant to greatly help communities conform to alterations in their climate which can be unavoidable – the human toll of climate change probably will become dramatically worse throughout 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 connected with extreme poverty which can be being exacerbated because of the climate that is changing. As previously mentioned 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 cut back 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 regarding the gases beneath the Clean Air Act, citing its authority to guard health that is public welfare through the impacts of global warming [5]. The agency unearthed that global warming poses health that is public – including increased morbidity and mortality – as a result of 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 somewhat small group of public medical researchers will work rapidly to raised comprehend and quantify the type and magnitude among these 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 for instance the New York Times [unpublished data]. It is really not surprising therefore that the general public also has yet to totally 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. Approximately half of American survey respondents, as an example, selected “don’t know” (as opposed to “none,” “hundreds,” “thousands,” or “millions”) when asked the number that is estimated of 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 into the 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 within their country [8].

Cognitive research within the last decades that are several shown that how people “frame” a concern – for example., how they mentally organize and discuss with other people the matter’s central ideas – greatly influences the way they comprehend the nature regarding the problem, who or whatever they see to be in charge of the difficulty, and whatever they feel ought to be done to handle the difficulty [11, 12]. The polling data cited above [7–9] suggests that the dominant mental frame employed by most people in the general public to prepare 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 individuals through the issue and plays a part in too little serious and sustained public engagement required to develop solutions. This focus can be at risk of a dominant counter frame that the solution that is best is to keep to cultivate the economy – investing in adaptive measures in the future when, theoretically, society should be wealthier and better in a position to afford them – as opposed to concentrate on the root factors that cause the environmental problem [13]. This frame that is economic leaves the public ambivalent about policy action and actively works to the main advantage of industries which can be reluctant to cut back their carbon intensity. Indeed, it really is exactly the lack of a countervailing movement that is populist climate change who has made policy solutions so very hard to enact [13, 14].

Significant efforts were made within the last many years by public health organizations to increase knowing of the health that is public of climate change and prepare the general public health workforce to respond, although as noted above, it is really not clear the extent to which public medical researchers, journalists, or first and foremost, the general 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 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,” in addition to World Health Organization has continued to develop a climate change and health work plan, the objective that is first of 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 health that is urging to offer voice into the health implications of climate change.

An assumption that is important these calls to action is the fact 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 basis that is theoretical this assumption, into the best of your knowledge there isn’t yet empirical evidence to aid the validity regarding the assumption [22].

The goal 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 could be regarded as useful and personally relevant by readers, apart from people in one small segment of Americans who dismiss the idea that human-induced climate change is occurring. We used two dependent measures in this hypothesis: a score that is composite on respondent reactions to every sentence when you look at 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% regarding the population that is adult, the Concerned (33%), the Cautious (19%), the Disengaged (12%), the Doubtful (11%), https://shmoop.pro in addition to Dismissive (7%) – fall along a continuum from those who find themselves engaged from the issue and seeking for ways to take appropriate actions (the Alarmed) to those that actively deny its reality and tend to be searching for ways to oppose societal action (the Dismissive; see Figure 1). The four segments in the exact middle of the continuum will likely benefit most from a reframing of climate change as a health that is human because, to a higher or lesser degree, they may not be yet certain that they completely understand the matter and tend to be 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 audience that is unique predicated 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 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 built to yield completed interviews with a demographically and group that is geographically diverse of least 10 individuals from all the previously identified “Six Americas” [7]. Four respondents were dropped with this study as a result of data that are incomplete leaving an example measurements of 70. Audience segment status (i.e., which one of several “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 obtain diversity that is demographic the sample, we recruited an approximately balanced wide range of both women and men, and an approximately balanced wide range 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 backgrounds that are racial/ethnic.

Table 1 Distribution of Respondents by Age, Gender and Segment.
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To obtain diversity that is geographic we recruited participants in just one of two ways. Almost all of participants (n = 56) were recruited – after which interviewed – face-to-face in just 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 amongst 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 much more than one hour driving distance away from Washington, DC and attracts shoppers from Maryland, Pennsylvania, and West Virginia, in addition to visitors from further away who will be 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]. They certainly were interviewed subsequently by telephone, after being mailed a duplicate regarding the test health that is”public” – described below – in a sealed envelope marked “do not open until asked to take action because of the interviewer.” As a bonus 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 respondents that are potential written consent information ahead of 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 example participant. In 2006, the distribution that is geographic of overall U.S. population was 18%, 22%, 36% and 23% when you look at 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 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 read through “a quick essay about global warming” (see Appendix 1), that has been 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 regarding the essay which you feel are specially clear or helpful, and employ the pink highlighter pen to mark any portions regarding the essay which can be particularly confusing or unhelpful.”

As shown in Appendix 1, the only 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 should be harmed if action is certainly not taken up to stop, limit, and/or drive back global warming (in other words., a description regarding 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 quick concluding paragraph meant to reinforce the general public health frame (2 sentences).

When respondents finished the reading, they certainly were asked to spell it out in an open-ended format their reaction that is”general to essay.” (Note: This question was inadvertently not asked of just one respondent, which means sample size for analysis for this information is 69.) For every single percentage of the essay they marked in green, they certainly were subsequently asked: “think about every one of these sentences was especially helpful or clear to you personally?” For every single percentage of the essay they marked in pink, they certainly were also asked: “think about every one of these sentences was especially unhelpful or confusing to you personally?”

To guage the respondent’s general reactions into the essay we reviewed their statements that are individualn = 193), thought as discrete thoughts or concepts. Predicated 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 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 one of several thematic categories. The coders were also instructed to evaluate the valence that is overall of respondent’s statements – the initial 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 the full range of possible forms of coding decisions were required regarding 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 maybe more is regarded as sufficient and .80 or maybe more is regarded as excellent. For 7 regarding 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 fashioned with the pens that are highlighting sentences marked with only green on one or more word were scored +1 (for example. Indicating “especially useful” or clear), 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. scores that are composite 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 when you look at the section and dividing because of the wide range of sentences. A score that is composite the complete essay – the next of this dependent measures inside our hypothesis – is made by summing the sentence scores across each segment and dividing because of the wide range of respondents per segment. Population estimates, that could be taken solely as preliminary indicators because of the nature that is non-probabilistic of sampling, were estimated by weighting the mean values for every single regarding the six segments relating to its prevalence when you look at the U.S. population (see Figure 1).

Data Analysis

To evaluate the between-segment variations in our dependent measures – overall reactions into the essay (for example., valence) and composite sentence-specific reactions into the 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 evaluate our hypothesis that five regarding the six segments (the Dismissive being the only exception) would respond positively into the essay; the hypothesis that is null that the median score for every single regarding the five segments did not change from zero. The Wilcoxon signed rank test is acceptable for small sample sizes and distributions that are non-normal each of that are the scenario 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 into the 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 sheer number of times every one 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 variety 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 made a decision to test for just two possible main effects when you look at 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 as compared to essay’s earlier give attention to public health-related threats, we calculated the essential difference between the re-scaled (by one factor of 10) average reaction to both the power while the threat sections after which used the Wilcoxon signed rank test to evaluate, by segment, perhaps the median among these differences was higher than zero. We then evaluated the general main effectation of the essay – across all segments – using the t-test that is weighted the distinctions with weights corresponding into the frequencies regarding the segments when you look at the population.

Figure 4

Essay evaluations by sentence: Alarmed, Concerned and segments that are cautious. Sentence-specific evaluations regarding 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 wide range of times a sentence was marked as “especially clear or helpful” in addition to wide range 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 = policy that is mitigation-related and their own health benefits (4 sentences); and C = concluding section (2 sentences). The population that is national is made by weighting the values for every single regarding the six segments relating to 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 regarding the public health essay by respondents when you look at the Disengaged, Doubtful and Dismissive segments and also by a population estimate that is national. Note: Scores reflect the essential difference between the true wide range of times within a sentence was marked as “especially clear or helpful” in addition to wide range 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 persuasive writing on 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 is made by weighting the values for every single regarding the six segments relating to their relative proportion of American adults.

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Figure 6

Essay evaluations by section (opening, threat, benefits, closing). Average section-specific evaluations regarding the public health essay by respondents in all the six audience segments and also by a population estimate that is national. Note: Scores reflect the essential difference between the true wide range 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 throughout the wide range 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 = policy that is mitigation-related and their own health benefits (4 sentences); and C = concluding section (2 sentences). The population that is national is made by weighting the mean values for every single regarding the six segments relating to 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 regarding 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 additionally the concluding sections after which used the Wilcoxon signed rank test to evaluate, by segment, perhaps the median among these differences was higher than zero. We then evaluated the general effect that is main across all segments – using the weighted t-test from the differences with weights corresponding into the frequencies regarding the segments when you look at the population.