Background: UK Public Health departments are charged with assessing the health needs of their resident population. Dealing with environmental health issues generally takes a low priority in their day-to-day working. Here I discuss my experience in the role of director of public health following the discovery of incinerator ash on allotment footpaths across Newcastle upon Tyne. I set up a steering group, which comprised representatives from local communities, members of local campaign groups and representatives of statutory agencies, which oversaw the research work carried out by the academic department of epidemiology and public health at the local university. The aims of this presentation are to examine (with the benefit of hindsight): a) the expectations from others of both the director of public health and health authority with regards to expertise and independence; b) the risk communication techniques used and their relative merit and; c) lessons learned for the structure and function of public health in risk communication.
Methods: I report on experiences between August 1999 and April 2001. During this time 118 items of direct correspondence were either received or produced by the health authority. The steering group met 11 times, proceedings of which were recorded in detailed minutes. I was speaker at four public meetings attended by several hundred residents and the local campaign group, and attended numerous interviews with local and national media. I also met on several occasions with individuals and small groups and spoke in person to allotment gardeners, local residents and campaigners.
Results: Based on previous experience in dealing with controversial issues around clinical governance I approached this issue recognizing the benefit of openness to all parties I perceived a surprising lack of expertise in National agencies which were approached for their advice My wider role required an ongoing dialogue with the local authority There was conflict between campaigners' perceptions of the independence of my role and my perception of my duty to protect the public's health Within the health authority views differed as to whether the issue was so high profile that it should be left alone or be handled proactively (my view) The amount of resource in time and effort outstripped the capacity of a health authority We failed to adjust our risk communication strategy for different segments of the public (allotment gardeners, local residents, campaigners) It was difficult to communicate the potential for a small risk Lessons from other public health issues such as MMR were not as useful as expected Personal attacks made the handling of the steering group challenging at times The crisis around the ash led to good working relationships between statutory agencies in the city and the region.
Conclusion: Controversial environmental health issues are rare at local level. Local public health organisations are unlikely to have sufficient expertise or capacity to handle these without better regional and national support. The role of the director of public health as an 'independent' public health advocate is a conflicted role in current NHS structure. Figure 1:
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