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date: 20 September 2017

Communication Campaigns that Emphasize Environmental Influences on Health and Risk

Summary and Keywords

The environment influences health and risk outcomes, and communication campaigns often strive to reduce risk and promote positive health outcomes by raising awareness, increasing knowledge, influencing attitudes, and impacting intentions and behavior. Communication campaigns should be based on good formative research and theory, and they should be implemented with fidelity and a clear evaluation plan. Communication campaigns that address environmental influences are typically focused on promoting human, animal, or environmental outcomes despite the fact that all three are interconnected and would benefit from being considered in a larger ecological framework. The One Health approach reconceptualizes environmental influences by focusing not just on the environmental but also connections with human and animal health. One Health can be applied to communication campaigns to support efforts that acknowledge and promote the complexity of these relationships. Campaigns about environmental influences on health and risk range from a longstanding campaign built on individual activities to reduce environmental and personal risk to a sun smart campaign to reduce sun exposure risk to a lead-free campaign and an asthma-control campaign concerned about air quality. Other environmental campaigns focus on tobacco prevention, obesity prevention by addressing environmental influences as part of their strategy, climate control, and ocean species preservation—and that is only a sampling of popular campaign topics. These communication campaigns face similar challenges like lack of formative research and evaluation plans as well as atheoretical approaches to influence outcomes.

Keywords: campaigns, public communication campaigns, environmental campaigns, environmental influences, environmental risks, One Health

Introduction

Public communication campaigns have focused on protecting the public from serious health risks and protecting natural resources for the good of everyone. For example, there are a multitude of health-focused campaigns aimed at influencing individuals to get immunized, increase their physical activity, obtain regular mammograms, quit smoking, and to engage in other prevention or health-promoting activities that improve the overall population’s health with some specific health outcome expected as a result. Environmental campaigns, those strategic communication efforts that include ecological or human-built environment features in their design typically either as context for behavioral responses or as causal mechanisms to explain outcomes, are one type of public communication campaign. For example, campaigns designed to help protect both the environment and human health might include the classic Smokey Bear campaign, global warming and climate control campaigns, and more recently anti-fracking campaigns; all of these campaigns are aimed at keeping the public, the environment, and the resources it provides healthy and safe. Discussing environmental influences on health and risk is a somewhat tricky proposition as much of the information included in public communication campaigns is not only from evidence-based government entities with a public good motivation but also from advocacy groups with varying agendas that either align for or against a potential hazard and provide accompanying recommendations to reduce risk and/or improve health. While so many campaign efforts with relationships to the environment are advocacy driven, this article aims to present information about campaigns rather than to advocate for any specific campaign and its goals.

A perusal through evidence-based, government-sponsored websites like those of the National Institute of Environmental Health Sciences, the Centers for Disease Control and Prevention, and the Environmental Protection Agency, as well as other credible environmental and health websites, reveals a large range of known and potential environmental factors that impact human health and risk. While these websites identify many environmental influences, not all of them have accompanying public communication campaigns with strategic aims to influence the public in a specific way; therefore, those environmental influences are not a focus of this article. Campaigns whose ultimate goal generally is profit motivated rather than pro-social in their orientation are also not discussed in this article. Although the goal of the article is to focus on pro-social campaigns that attempt to address environmental influences on health and risk, this article will not be comprehensive in its coverage of all campaigns that emphasize environmental influences on health and risk. By necessity, the scope of this article will be limited to representative exemplars of campaigns that address known environmental influences.

The article begins by providing definitions for campaign and environment to provide a context for our discussion, followed by a definition and discussion of the One Health concept as it relates to environmental campaigns. A brief overview of selected campaigns will be discussed along with their objectives, campaign strategies, and overall messages, as well as differentiating features that distinguish them as added value to discuss in this article. The article ends with common barriers across the campaigns and lessons learned related to communicating about environmental influences.

Campaigns Defined

Rice and Atkin (2013) define public communication campaigns as efforts to influence the knowledge, attitudes, and behaviors of a specified audience through organized communication and theoretically based mediated messages disseminated through a variety of channels. Key components of this definition are the following words: influence, specific audience, organized communication, messages, and channels. Rice and Atkin understand campaigns as a persuasive enterprise designed to bring about a change in both primary and secondary audiences via messages delivered through multiple channels. To create a successful communication campaign, researchers must first identify the target audience and target behaviors in order to determine the need and barriers associated with the desired campaign. After these first steps, the focus generally moves to the design of campaign messages. Public communication campaigns often take one of two strategic approaches: messages focus on either promoting positive health behaviors or preventing problematic ones. Both prevention and promotion campaigns often feature persuasive messages that emphasize why the audience should adopt or avoid the featured behaviors.

Campaigns can be implemented on both large and small scales, reaching audiences of various sizes. Campaigns can tailor a very specific, even complex message to their audiences, or the message can be broader in its focus and recommendations. For example, a campaign message might offer specific steps for how to reduce exposures to environmental carcinogens, or it can simply offer a message of “find out more” with the URL for an informative website. Campaign messages generally use multiple channels, including traditional channels like brochures, billboards, and television advertisements and public service announcements; in the last 10 to 15 years, the range of online outlets has expanded significantly as the Internet is the primary go-to for all types of information. For example, online approaches for message exposure can include websites, online advertisements, social media platforms such as Facebook and Twitter, and smart phone applications that bring health information to people’s fingertips. It is arguably much easier to create a campaign than ever before with all of the novel technological tools available to create images and messages and because people can access and harness the Internet to attempt to reach most target audiences.

Effective campaigns generally include several types of evaluation. First, formative evaluation, often gathered via focus group interviews and surveys, provides background information on audience attitudes, channel preferences, and opinions on source and different types of appeals. Throughout the campaign, process evaluation provides a measure of the extent to which the campaign is being implemented in the intended manner and also provides opportunities to identify areas that could be improved. Finally, researchers perform outcome evaluation to determine the campaign’s effectiveness. Evaluation problems are prevalent as many campaigns fail to implement an evaluation plan at one or all stages, making it difficult to determine the effects and effectiveness of campaigns. Identifying campaign effects is further complicated in the context of environmental influences because of the expansive nature of what comprises the environment and its known effects.

As the definitions of environment and health broaden, health and risk communication campaign scholars must consider these changes at every step of campaign design, implementation, and evaluation. In recent years, professionals have come to acknowledge the expansive nature of the environment and its effects, along with the need for collaboration between professionals across fields, to gain a comprehensive understanding of environmental influences and how to address them. Environmental campaigns that take this approach align themselves well with the understanding that humans, animals, and the environment continually interact with and influence one another, operating as one larger system. This system is commonly referred to as One Health.

The Environment as One Health

According to the National Center for Environmental Health (2015), “The environment is everything around us—the air we breathe, the water we drink and use, and the food we consume. It’s also the chemicals, radiation, microbes, and physical forces with which we come into contact.” In other words, environmental factors include anything except genes—and even then, genes interact with the environment to impact health. Health and risk behaviors are influenced by a myriad of environmental factors. Focused on how organisms interact with their environments, social-ecological models of human behavior have a prominent place in the literature on health- and environment-related behaviors (see Stokols, 1996, for a review). Ecological models of health specifically describe a systematic range of factors that influence health-related outcomes, from macro-level factors such as access to services to social-psychological factors that influence action. These models can include specific psychological drivers (e.g., perceptions of the benefits and risks of taking action) to the more general social (e.g., normative barriers) and contextual (e.g., access to an environment that facilitates behavior) factors. By considering ecosystem and animal health in connection with human health, the complex causes of human action can be better understood.

One Health adopts an ecological approach with its conceptualization that the health of humans, other animals, and ecosystems are interdependent and that acknowledgment of the intersection of these factors adds value to scholarly inquiry or practice (Zinsstag, Schelling, Waltner-Toews, & Tanner, 2011). Within this context, health is broadly defined (see Lapinski, Funk, & Moccia, 2014); for instance, human health encompasses not only physical health (e.g., infectious and non-infectious diseases of both acute and chronic duration) but also more broad indicators of the health of people and societies such as psychological, emotional, spiritual, and economic well-being and socio-political stability. The health of animals includes not only physical health but also concepts of animal welfare and ethical considerations of animal use. Ecosystem health does not only involve the mitigation of environmental toxicants but also captures plant health, biodiversity, sustainability, and resilience of ecosystems. By considering ecosystem and animal health in connection with human health, the complex causes of human action can be better understood. Climate change provides a compelling example as it is causing temperature and water availability changes world-wide, influencing the movement of wild animals and the ways in which humans care for domestic animals.

The U.S. Centers for Disease Control and Prevention (CDCP) lists three factors that have increased the importance of the One Health concept, including the rapid growth and expansion of the human population, changes in climate and agricultural practice, and increased international travel (CDCP, 2013). One Health provides an integrative model that focuses attention on the interconnectedness of our world and the complex relationships that impact it, providing added value over approaches implemented without consideration of this interdependence. It is included in this article as a critical concept that already underlies all environmental campaign efforts but needs to be more explicitly articulated so individuals better recognize how efforts and results from one campaign also impact the efforts of other environmental campaigns. It is important to acknowledge this innovative thinking about health and the environment because the CDCP, World Health Organization, World Bank, Food and Agricultural Organization of the United Nations (FAO), World Organization for Animal Health (OIE), and others have begun to shape policy and practice in this area (CDC, 2013; World Bank, 2012), which has implications for how environmental influences are communicated in the campaign context. In sum, public health interventions and campaigns must address human, animal, and environmental health and employ the cooperation of experts across disciplines to effectively address their impacts and to find actionable solutions. While the campaigns summarized in this article may not have been intentionally created under the One Health framework, several of them exemplify interdisciplinary work that emphasizes the connection between human, animal, and environmental health. These connections will be highlighted in the discussion of those campaigns.

Campaigns and Environmental Influences

A large number of campaigns were considered for inclusion in this article because they address environmental factors and meet the criteria of being a campaign; however, it is beyond the scope of this article to be comprehensive in its coverage of campaigns that address environmental factors on health and risk. This article strives to be representative of a range of campaigns that are reflective of the landscape of prominent environmental factors addressed in public communication campaigns. For example, lead, sun exposure, and air quality are all environmental factors known to negatively impact human health. It was also deemed important to include some environmental campaign examples as they ultimately address some environmental issue but also are reflective of the One Health concept. There is a class of campaigns that have addressed human and wild or domesticated animal interactions associated with health and risk. These include, for example, work on prevention of bear–human conflict, reduction of zoonotic diseases, and species preservation or protection, but these are beyond the scope of this article. Ultimately, this article includes a longstanding campaign built on individual activities to reduce environmental and personal risk, a sun smart campaign to reduce sun exposure risk, a lead-free campaign, an asthma-control campaign concerned about air quality, a tobacco-prevention campaign, obesity-prevention campaigns that address environmental influences as part of their strategy, a climate control campaign, and an ocean species preservation campaign.

Smokey Bear

The Smokey Bear campaign is illustrative of a safety campaign designed to protect forests from human activities that cause wildfires. Since 1944, Smokey Bear has promoted public awareness about the prevention of wildfires caused by humans through recognizable images and slogans, the most recent being “Only you can prevent forest fires.” Currently managed by the U.S. Forest Service, the National Association of State Foresters, and AdCouncil, Smokey Bear not only represents forest fire prevention, he is also the face of the longest running public service campaign in United States history (see https://smokeybear.com/en/smokeys-history). The Smokey Bear Wildfire Prevention campaign has evolved alongside decades of technological and digital advancements that have impacted the prominent channels used for campaign efforts. However, the campaign continues to use traditional channels alongside new media to spread its message.

Throughout the 1940s and 1950s, campaign messages were disseminated through traditional posters and radio messages targeting those who spend significant time in forests. Beginning in 1960, the popularity and availability of television sets provided a new, visually appealing channel for Smokey Bear messages, and in the early 2000s, Smokey Bear moved into the digital age. Currently, the campaign continues to reach its audience through traditional channels but also relies on a heavy digital presence, including an interactive website, social media pages, and an active YouTube account. The campaign is notable because of its duration and ability to stay current with its designs of Smokey Bear. Familiarity with Smokey is one measure of awareness, pledge completions to follow wildfire prevention guidelines indicate intentions to engage in recommended practices, and estimates of acreage saved from wildfires provide some evidence of effectiveness of the campaign. Overall, Smokey Bear is a campaign to save the natural resources by activating individual and collective responsibility, and its efforts help to reduce risks to human health.

Go Sun Smart

Perhaps one of the most obvious environmental influences is exposure to harmful ultraviolet rays from the sun, which can cause sunburn, premature aging, skin cancer, and other skin damage. Campaign efforts to reduce sun exposure and to increase protective skin behaviors abound. Consider the Slip! Slop! Slap! EWG Sun Safety: Practice Smart Sun, Choose Your Cover, and Go with Your Own Glow, campaigns to name a few. Also consider the Go Sun Smart campaign, a collaborative effort between researchers, the National Ski Areas Association (NSAA), and a professional association for instructors. The campaign addressed sun exposure risks through a series of messages disseminated through a variety of channels at the workplace. The collaborative nature of the project granted researchers access to over 100 ski areas in the United States and Canada, allowing for relevant and accurate formative research and exposure to high-risk populations, including primary and secondary audiences. Unlike many environmental campaigns, including sun safety campaigns, the Go Sun Smart campaign used a strong theoretical and research approach to the design and evaluation of the campaign.

While multiple theoretical approaches guided the creation of the Go Sun Smart messages, diffusion of innovations theory (DIT) provided the overarching framework for the campaign as a whole. Campaign messages were specifically designed to influence ski resort employees as they moved through the five stages described in DIT. To gain the employees’ attention, messages were placed throughout the workplace in the form of newsletters, meetings, and an employee training program. A variety of theories guided the creation of persuasive messages, including self-perception theory (Bem, 1972), social cognitive theory (Bandura, 1986), and the extended parallel process model (Witte, 1992). The messages were designed to normalize the use of sunscreen in the workplace, highlight the risks associated with sun exposure, and emphasize the ease of employing sun safety behaviors. The same message concepts were altered slightly to target ski resort guests, although employees remained the campaign’s primary audience. Buller, Walkosz, Andersen, Scott, Dignan, and Cutter (2013) and Anderson, Buller, Voeks, Walkosz, Scott, and Cutter (2008) reported the effectiveness of the Go Sun Smart campaign during both the ski and summer seasons. Researchers reported a 14% decrease in sunburns between 2001 and 2002, a significantly larger decline compared to the control ski areas, which observed an 8% decline in the same time period. The Go Sun Smart campaign reflects a theoretically informed, research-based, highly targeted, persuasive campaign that focused on sun safety practices to reduce the environmental influence of sun exposure.

Lead-Free Kids

Reducing lead exposure, particularly among children, has been a large scale public health effort for decades, and the Lead-Free Kids campaign continued efforts beginning in 2010 (Ad Council, 2011). Lead exposure is problematic because it can be poisonous and high exposures can lead to neurological damage, learning problems, headaches, and slowed growth as well as other health impacts. Efforts to reduce lead exposure are a result of partnerships between the Environmental Protection Agency and the CDC. The Lead-Free Kids campaign is a multimedia effort that includes donated support for mass media, billboards, and print public service announcements. Guides for multiple audiences (parents, pregnant women, landlords, etc.) also provide helpful information about lead-safe practices. Individuals and agencies are able to download and use online materials, and the campaign hits high intensity during the annual National Lead Poisoning Prevention Week.

Other localized campaigns to reduce lead exposure also work toward similar goals of Lead-Free Kids. For example, Get the Lead Out, an awareness campaign in Hartford, Connecticut, used children’s art, newspaper ads, educational displays and videos, milk carton messages, posters, and postage stamps to communicate about lead. Evaluation of Get the Lead Out found high recall of campaign components and a large percentage of people reporting taking action to reduce lead exposure in their households. Although there is no known safe blood lead level, national tracking of blood lead level data reveals a decrease in the blood lead levels of children over the last few decades, indicating that prevention efforts have likely had some impact on this health outcome. Both the Lead-Free Kids and the Get the Lead Out campaigns are examples of how research about an environmental risk factor evolved into policies and accompanying recommendations that were ultimately communicated to target audiences through a government-sponsored campaign. This path from research to policy to organized communication efforts is a typical evolution that provides a basis for many environmental communication campaigns.

National Asthma Education and Prevention Program (NAEPP)

Asthma is a growing problem in the United States, and efforts to help asthma sufferers manage their condition are necessary. While everyone benefits from cleaner air, individuals with asthma are at greater risk than others when they are exposed to environmental hazards like car exhaust, factory emissions, tobacco smoke, molds, dander, and household chemicals. The NAEPP has the goal of promoting quality of life for those who suffer from asthma and reducing the morbidity and mortality associated with asthma. Components of the NAEPP campaign include an asthma action plan that helps individuals monitor their asthma, a learning module for adults and caregivers, a Web-based game, a self-management program, a school curriculum, and a downloadable app that allows people to keep up with the air quality across states. The Asthma and Allergy Foundation of America (AAFA), another organization providing education and resources, annually declares May as National Asthma and Allergy Awareness month because May is generally peak season for sufferers. The NAEPP and the AAFA are similar in their goals, but the AAFA is a patient-focused advocacy group that also focuses on allergies along with it research and education goals. The NAEPP attempts to connect local, state, regional, and national organizations so they can pool resources and share best practices; similarly, the AAFA has the aim of connecting communities to improve the quality of life for those with asthma and allergies. Asthma-related campaign efforts are essential to acknowledge because air quality is a fundamental environmental influence on human health as well as the environment.

Truth

The Truth Campaign is a national tobacco prevention campaign targeted to youth. Tobacco, one of the more avoidable environmental influences, increases risk for dozens of different cancers, stroke, coronary heart disease, osteoporosis, vision problems, blood disorders, as well as autoimmune disorders, reproductive challenges, and a whole host of additional health problems. The Truth Campaign was conceptualized, implemented, and evaluated with funds from the Master Settlement Agreement between the tobacco industry and the majority of states in the United States. The Truth Campaign uses a social marketing approach and social science practices to develop messages that reveal the manipulative strategies that the tobacco industry uses to market tobacco. In addition to a website that provides updates and resources, The Truth Campaign features television commercials, radio spots, and billboards provide facts about smoking, with a focus on how many people tobacco kills. For example, to represent that tobacco kills 1,200 each day, one ad features teenagers unloading 1,200 body bags onto the sidewalk of a tobacco company’s corporate office, while another features 1,200 teenagers marching to a tobacco corporate office and then falling to the ground as if dead. Another ad featured a man in a rat costume emerging from a New York City subway entrance only to fall to the ground choking and gasping for air. People passing by in the ad stare in shock and disgust at the “rat man” as he holds up a cardboard sign that states: “There is cyanide in cigarette smoke—same as in rat poison.” These ads use a fear appeal approach to place the blame for tobacco addiction and the impurities of smoking on the tobacco industry.

The campaign is illustrative of a strong formative research process that found that teens wanted facts about smoking rather than preachy messages. The campaign has resonated with teens, and research has shown that teens are familiar with the campaign and recognize Truth messages. Even more compelling is the fact that teen smoking has consistently declined over the duration of the campaign. While the campaign cannot account for the decline in teen smoking completely, evaluation studies attribute much of the decline to changing social norms about smoking, and a key objective of the campaign has been to change norms around smoking. A new campaign from Truth, Finish It, is designed for the next generation of teens who are less interested in the wrongs of the tobacco industry and more interested in positive collective action to end smoking. Finish It is different from the original Truth Campaign in its tone and approach, again demonstrating the willingness of campaign designers to use formative research to reach their target audience. In sum, the Truth Campaign is an innovative campaign that addresses a preventable environmental risk factor with a social marketing and research intensive approach.

Cans Not Cancer

Cans Not Cancer is a campaign sponsored by the Breast Cancer Fund to promote safe food packaging. The environmental culprit at the root of the campaign is bisphenol A (BPA), a mass-produced chemical used in plastics and the lining of canned foods. The BPA from the packaging of certain plastics and canned foods leaches into products, exposing people to the chemical. The National Toxicology Program reports some concern of the public’s widespread exposure to BPA because animal studies have shown defects in fetuses and newborns at low exposure levels. Thus, BPA is a case where the precautionary principle has been enacted as enough evidence has accumulated for recommendations to reduce exposure to be established, while more research is being conducted to further understand potential risks. The Breast Cancer Fund sponsors the Cans Not Cancer campaign because BPA is an estrogenic chemical linked to increased breast cancer risk. Similar to the previously noted campaigns and all campaign efforts these days, the Cans Not Cancer campaign has a Web presence that explains its goals, calls people to action, and provides resources to help educate and promote action. The primary focus of the campaign is to garner public support to pressure manufacturers to remove BPA from their product packaging.

Companies who do not have BPA in their packaging have capitalized on public concerns about the chemical by adding BPA-free stickers to their products, and this is likely how the majority of the lay public has become aware of BPA as an environmental risk factor. BPA-free have probably had a greater impact on public awareness of BPA than Cans Not Cancer. Another effect of efforts like Cans Not Cancer is to create an opportunity for companies to present their products as safer with BPA-free stickers, creating further demand for more BPA-free products as consumers investigate the chemical. Ultimately, exposure to BPA has been reduced as consumers select BPA-free products and because it puts market pressure on those organizations with BPA in their packaging to eliminate its use. For example, the Breast Cancer Fund counts Johnson & Johnson’s commitment to phase out certain chemicals linked to cancer in their cosmetic and baby products as a success story. And because of their credibility and longstanding advocacy efforts, advocates from the Breast Cancer Fund testify in front of Congress and strive to get legislation passed to keep products safe as a strategy to reduce breast cancer risk.

VERB and Let’s Move!

Social and environmental factors impact levels of physical activity and nutrition, modifiable behaviors that are priorities of many public communication campaigns that strive to reduce obesity and reduce risk of other diseases. Campaigns to increase physical activity and improve nutrition often acknowledge environmental constraints and focus on achievable activities. The VERB (2002–2006) campaign sought to increase the physical activity of American youth between the ages of 9 and 13, or “tweens.” Following extensive formative research, the campaign aimed to make physical activity a regular part of a tween’s day and messages often emphasized the various opportunities to be active. Using the memorable tagline “It’s what you do” to drive the campaign, the CDC promoted healthy, active lifestyles through both paid advertising and cooperation with communities across America. Through community partnerships, the primary message of the campaign was disseminated through parents and influential adults, such as youth leaders, teachers, and health care professionals. The paid advertisements aired on specific channels known to target the intended audience, such as Nickelodeon, Cartoon Network, and Disney. Notably, the campaign’s multicultural approach targeted tweens from various ethnic and racial backgrounds, including African Americans, Asian Americans, Hispanics/Latinos, Native Americans, and Caucasians, through paid advertising that aired on Telemundo, BET, and SinoVision, which target Hispanics/Latinos, African Americans, and Asian Americans, respectively.

VERB was evaluated through a nationally representative longitudinal survey of tweens and their parents from 2002 to 2006. A second group of tween–parent dyads was surveyed from 2004 to 2006, with a third group interviewed in 2006 only. Reflections on the process, implementation, and outcomes of the campaign were published in a special issue of the American Journal of Preventive Medicine. Price, Huhman, and Potter (2008) reported that parental awareness of the VERB campaign was associated with positive attitudes about the importance of physical activity and the number of days parents and children were physically active. Despite the reported success of the VERB campaign, concerns surrounding the sedentary lifestyles of American children remain a salient topic in the nation, so much so that in 2010 First Lady Michelle Obama launched her own physical activity and childhood obesity prevention campaign: Let’s Move!

The First Lady’s campaign takes a more social ecological approach with a lot of policy-level efforts by targeting not only children and their parents but also schools, environments that influence children’s health options and choices each day. The campaign originated from President Obama’s Task Force on Childhood Obesity, which generated 70 suggestions to help the nation reduce the childhood obesity rate to 5% by 2030. Let’s Move! has reportedly increased public awareness of childhood obesity and increased access to important health information necessary for parents to make safe and smart choices for their children. However, the campaign’s more prominent accomplishments deal with collaboration with community partners and policy change. For example, the USDA released improved school meal regulations to provide healthier options for students, and popular regional grocers have committed to expand into communities that have limited access to healthy food choices. Adapting environments to facilitate physical activity and to promote healthy eating choices represents a key strategy for reducing the burden of obesity in the United States.

An Inconvenient Truth

Climate change includes changes in the environment like increased and more intense rainfall, more frequent and severe heat, warming of oceans, and melting of ice caps, resulting in the rising of sea levels. Research has determined that this is at least partially due to human actions and thus, world-wide efforts are occurring to help reduce our impacts. For example, 350.org has created a global network to build a global climate movement. They sponsor a range of online campaigns and motivate grassroots organizing in almost 200 countries. Campaigns around climate change abound, and unlike more specifically targeted environmental campaigns, they are motivated by the One Health concept because they understand the interconnectedness between the environment, human, and animal health. Perhaps one of the most persuasive and well-known efforts is An Inconvenient Truth, an Academy Award–winning documentary championed by former Vice President Al Gore that articulates much of the One Health concept in its approach.

An Inconvenient Truth framed global warming and environmental responsibility as a political and moral issue by focusing on the human activities that cause global warming. The film has had global impact on the issues of global warming and climate change at multiple levels, boasting political, community, and individual partnerships with those passionate about environmental causes. Narrating the film, Gore openly shares his personal and political journeys and how they were shaped by both the facts and the myths surrounding global warming. This narrative approach aided in audience understanding of the current and future consequences of global warming, such as major flooding, storm frequency, and other natural disasters. The film launched a movement to bring greater awareness to global warming by including calls to action that invited people to sign up for e-newsletters and follow social media accounts in order to receive the most up-to-date news on global warming and climate change. An Inconvenient Truth also spurred alliances with recognizable organizations, such as the Alliance for Climate Protection, Climate Reality Project, Natural Resources Defense Council, National Wildlife Federation, and Stop Global Warming.

An evaluation of the film’s and accompanying campaign’s effect do not necessarily reflect the true impact of the film. Those associated with the film claim that surveys revealed a 50% increase in public awareness of global warming after the film’s release. However, this cannot be solely attributed to An Inconvenient Truth due to the lack of evaluation measures utilized to gauge the film’s impact. In the years since the film was released, Congress has reviewed more than 15 climate change bills and several government committees have been formed to tackle the issue of global warming. Additionally, several countries, the United States not included, now include An Inconvenient Truth as part of their school curriculum, demonstrating the film’s value in educating the next generation of lawmakers and activists. An Inconvenient Truth, unlike any of the campaigns included in the article, uses a high-quality documentary as the primary persuasive strategy to raise awareness, increase knowledge, and encourage action to address global warming.

Sea Shepherd

Sea Shepherd Conservation Society is an activist organization with the mission of protecting marine wildlife. Sea Shepherd sponsors a range of campaigns focused on a particular marine species, and they use a range of strategies such as videotaping illegal activities, confiscating nets, and recruitment of volunteers to stand round-the-clock vigil at critical sites in their goal to conserve and protect ecosystems and species. Sea Shepherd is quite different from the other campaigns highlighted here because while they certainly provide educational information about harm being done to ocean species, seek media attention, and strive to communicate with the public to activate their support of Sea Shepherd activities, they are well known for their action-oriented strategies to stop illegal and unethical ocean activities. Loss of marine species is a serious issue that has implications for ecosystems and humans. The effectiveness of Sea Shepherd’s advocacy efforts has taken the form of policy changes in some countries, creating more protections for ocean species. Sea Shepherd’s mission is motivated by the One Health concept because the group has a sophisticated understanding of the interconnectedness of ocean species, the larger environment, and human health, and the group is highly motivated to save species to secure that balance. Their activist orientation provides a different flavor to the more traditional campaign efforts covered in this article.

Discussion of Campaign Challenges Common for Communicating Environmental Influences

The campaign examples provided here are representative of a range of efforts that address different environmental factors influencing health and risk, but a wealth of other environmental factors and campaigns are not included here that also have a significant impact on health and risk. Across all of these campaigns are some common challenges and issues that each needs to overcome and address.

Timing

One of the key challenges for public communication campaigns is the readiness of a government entity, agency, or group to invest in a campaign. This is perhaps due to the large body of evidence necessary to make risk estimates about chemical compounds or other potential hazards, the complexity associated with communicating how the environment interacts with human health, and/or a lack of resources to address all issues of concern comprehensively. Advocacy groups generally show great initiative to reach out to the public when there is enough evidence to invoke a precautionary principle that puts the public’s safety and well-being first rather than the need for definitive evidence about the environmental factor. For example, breast cancer advocates have been very active in urging the removal of certain chemicals from products long before they were listed as definitive risk factors for breast cancer by the EPA or other government agencies. While government-sponsored campaigns certainly invoke the precautionary principle, the threshold of evidence to invest resources into a public communication campaign is higher, particularly because of the changing nature of science and the need to communicate the state of the science rather than having specific advocacy goals. The question of “when” to launch a campaign about an environmental influence is one that all campaigns need to determine. Ultimately, prioritization of environmental influences to translate into campaigns is based not simply on the state of the science and known risks but also on available resources and public will as well as readiness to see the environmental factor addressed.

Website Focus

Another common challenge is a tendency to spend resources on populating websites with information about the environmental factor, without the same investment aimed at reaching target audiences directly. While the resources available on websites are necessary, helpful, and generally of high quality, efforts to reach audiences through other channels need to continue on a consistent basis because people are inundated with large amounts of information, including competing environmental, health, and risk messages. In other words, while a website presence is fundamental to all campaign efforts, it is not sufficient in reaching target audiences to create awareness of the prioritized issue. Websites provide an almost infinite amount of space to share information about environmental influence, and they need to be designed for both attractiveness and usability. Many campaigns have the goal of activating communities to engage in their own tailored efforts (Lead-Free Kids, Cans for Cancer, etc.) and provide high-quality online resources to help communities do so. Websites are pivotal to the success of most campaigns because they not only make resources available to others but are relatively inexpensive to maintain, provide opportunities for engagement, facilitate ongoing engagement over time, and help keep a “brand” presence available around the clock so that information is available at all times to information seekers.

Theoretical Framework

Another common challenge is to identify what type of persuasive framework and strategies will be the most effective in influencing others to pay attention to the campaign effort. Creative approaches are necessary, but understanding what theories make sense to help reach a particular audience and to design effective messages is also important. Some campaigns like the Truth and Go Sun Smart campaigns are very research-based and mindful of how theory can inform their campaigns, while other campaigns are less explicit about how theory informed their efforts—and some are not mindful of theory at all. Campaigns are impacted by their reach and specificity, and being able to reach the most people with the most specific message possible is desirable. The broader the reach of a campaign, the less specific the campaign messages generally can be; thus, larger campaign efforts often are limited in the amount of information they can provide, and this is challenging when trying to communicate often complex environmental issues to lay audiences.

Evaluation

Similar to any other communication campaign, evaluation of the effectiveness of campaigns about environmental influences remains a challenge. The effectiveness of campaigns is measured with a variety of metrics specific to the objectives of the campaign. Metrics might include increases in knowledge about the environmental factor, changes in attitude and intentions about risk reduction behaviors, or changes in behavior. Metrics might also include dollars raised, website hits, number of petitions signed, amount of information downloaded, number of animals or acreage saved, and other types of measurable outcomes. However, it is important to note that having enough resources to do an evaluation is a common problem. Resources are spent on creating and implementing campaigns and then not enough are budgeted to demonstrate the effects of the campaign. Advocacy groups are focused on “taking action” with less emphasis on measuring impacts, while government-sponsored efforts require evidence to merit continued funding. Even when evaluation plans are implemented and effects are found, campaigns are often criticized because of the limited nature of the effects. Having an informed and realistic understanding of what effects are feasible is also critical when assessing the effectiveness of environmental campaigns because providing information via campaign messages is likely necessary but not sufficient to affect higher levels of change beyond awareness and knowledge.

Environmental Literacy

Another challenge experienced by environmental campaigns is disinterested audiences with low scientific and environmental literacy. Most campaigns have a minimal objective of raising awareness about the environmental factor featured in the respective campaign, and others have higher-level goals to save species and to motivate people to think and act differently as they engage with the world and its natural resources. Some of the campaigns overtly acknowledge the relationship between human health, animal health, and the environment. Groups like the National Resource Defense Council (NRDC; an environmental action group that mobilizes professionals, lawyers, and scientists) and the Environmental Defense Fund (EDF; similar to the NRDC but with a major focus on economic solutions to solve problems) as well as Sea Shepherd have an integrated view similar to the One Health concept introduced in this article. These environmental advocacy groups have a holistic view that needs to be communicated in effective ways that help increase the environmental literacy of the lay public. The more the lay public is able to process information from campaigns focused on environmental influences, the more they may benefit individually in reducing risks and preventing disease, and the more the world may benefit through conservation efforts.

A One Health Conclusion

Campaigns that emphasize environmental influences on health and risk are plentiful. This article highlights a selection of campaigns that focus on some of the major environmental influences and it provides a brief overview of key campaign components. It is important to note that each campaign has many more facets than could be addressed in this article. While environment-focused campaigns are specific in their environmental, human, and/or animal health goals, some campaigns have the implicit or explicit goal to demonstrate the connections among the three to illustrate their interdependence. For example, the Smokey Bear campaign strives to maintain the safety of forests, animals, and humans in their efforts, thereby benefiting all entities identified in the One Health concept. An Inconvenient Truth breaks down very clearly how human behavior is impacting our climate and environment. Similarly, Sea Shepherd has a strong understanding of the One Health concept with its recognition of how marine life impacts other ecological systems as well as human health.

Future efforts to communicate about environmental influences should strive to consider the One Health perspective more intentionally in their mission and messages to help raise the environmental and scientific literacy of audiences. One Health is a guiding notion for future campaigns that is necessary to help appropriately educate and motivate lay individuals, industry, and even researchers so they are motivated to take on complex projects that address the vital connections between the environment, human, and animal health. This goal is not a small task, especially as environmental campaign designers need to create campaigns that have the greatest potential to influence the desired campaign outcomes. In other words, environmental campaigns need to be specific in their campaign objectives, theoretically informed, designed creatively for target audiences, implemented with fidelity, and evaluated comprehensively for effects and effectiveness.

Further Reading

Diffey, B. L. & Norridge, Z. (2009). Reported sun exposure, attitudes to sun protection and perceptions of skin cancer risk: A survey of visitors to Cancer Research UK’s SunSmart campaign website. British Journal of Dermatology, 160, 1292–1298.Find this resource:

Farrelly, M. C., Nonnemaker, J., Davis, K. C., & Hussin, A. (2009). The influence of the national truth campaign on smoking initiation. American Journal of Preventive Medicine, 36(5), 379–384.Find this resource:

Hayden, D. & Dills, B. (2015). Smokey the Bear should come to the beach: Using mascot to promote marine conservation. Social Marketing Quarterly, 21(1), 3–13.Find this resource:

Huhman, M., Potter, L. D., Nolin, M. J., & Judkins, D. R. (2009). Evaluation of the VERB campaign: Challenges and solutions. Communication Methods and Measures, 3(1–2), 47–60.Find this resource:

Krieger, J. K., Takaro, T. K., Song, L., & Weaver, M. (2005). The Seattle-King County healthy homes project: A randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. American Journal of Public health, 95, 652–659.Find this resource:

McLaughlin, R. J., Humphries, O., Nguyen, T., Malijanian, R., & McCormack, K. (2004). “Getting the lead out” in Hartford, Connecticut: A multifaceted lead-poisoning awareness campaign. Environmental Health Perspectives, 112, 1–5.Find this resource:

Silk, K. J., Atkin, C., & Salmon, C. (2011). Developing effective media campaigns for health promotion. In T. Thompson, R. L. Parrott, & J. Nussbaum (Eds.), Handbook of health communication (pp. 203–219). Mahwah, NJ: LEA.Find this resource:

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