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Commentary
A Sectio n 508–conformant H TML version of this arti cle
is available at http://dx.doi.org/10.1289/ehp.1409337.
Defining the Scope and
Purpose of Environmental
Health Literacy (EHL)
Fundamentally, environmental health literacy
(EHL) begins with an understanding of
the link between environmental exposures
and health. EHL has recently coalesced as a
new subdiscipline combining key principles
and procedural elements from the fields of
health literacy, risk communication, envi-
ronmental health sciences (EHS), commu-
nications research, and safety culture (Biocca
2004; Chinn 2011; Edwards et al. 2013;
Fitzpatrick-Lewis et al. 2010; Nicholson
2000). Each of these disciplines has contrib-
uted unique frameworks and perspectives
to the development of EHL as a distinct
subfield and is likely to continue to inform
the evolution of EHL.
e purpose of this article is to propose
a definition of and a conceptual framework
for EHL, to understand EHL in its social
and historical contexts, and to identify the
complementary fields and domains where
EHL is being defined and implemented.
This commentary acknowledges the
value of current academic efforts to delin-
eate the progressive nature of EHL that
begins with an individual’s understanding
and proceeds to the ability to create new
information because similar to health literacy,
EHL is not a static achievement, but an
evolutionary process.
Another purpose of this article is to high-
light the role that the National Institute of
Environmental Health Sciences (NIEHS) has
played in advancing the concept of EHL and
to outline a research agenda that will move
forward and stimulate the development of
research on this topic. Similar to the vali-
dated benefits health literacy can provide in
biomedical settings (Benjamin 2010; Lin
et al. 2004), we propose that EHL can poten-
tially benefit the conduct and outcomes of
community-engaged and health disparities
environmental health sciences (EHS) research
as well as efforts to promote environmental
justice. We also propose that EHL can ensure
that the translation of research findings
leads to a greater understanding of specific
risks, reduction of exposures, and improve-
ment of health outcomes for individuals
and communities.
Our extensive literature searches of
PubMed (http://www.ncbi.nlm.nih.gov/
pubmed) and Web of Science (http://apps.
webofknowledge.com) confirm that the
field is evolving rapidly, as are definitions of
the scope of inquiry and purpose of EHL.
Academic endeavors to date have focused
primarily on elucidating the attributes of
EHL and on the stages of becoming literate
about environmental health concepts and
issues (Kaphingst et al. 2012; Sørensen et al.
2012). These academic efforts have built
upon conceptual frameworks from the fields
of health literacy and risk communication to
define the progression of understanding from
basic knowledge to comprehension and appli-
cation (Colucci-Gray et al. 2006; Guidotti
2013; Nutbeam 2008). Addressing gaps
in education and promoting EHL among
health care professionals via curricula and
educational module development is another
major theme that emerged from the literature
review (Barnes et al. 2010; Gehle et al. 2011).
A review of the existing literature related
to EHL makes it clear, however, that raising
EHL is more than simply the stages of
an educational process. It also represents a
philosophical perspective, a public health
policy to improve literacy and health literacy
in the general public, and a set of strategies
to empower individuals and communi-
ties to exert control over the environmental
exposures that may lead to adverse health
outcomes (Estacio 2013; Minkler et al. 2008;
Mogford et al. 2011; Zoller 2012).
Environmental health literacy integrates
concepts from both environmental literacy
and health literacy to develop the wide range
of skills and competencies that people need in
order to seek out, comprehend, evaluate, and
use environmental health information to make
informed choices, reduce health risks, improve
quality of life and protect the environment.
(Society for Public Health Education; http://
www.sophe.org/environmentalhealth/key_ehl.asp)
Address correspondence to L. O’Fallon, Program
Analyst, Division of Extramural Research and
Training, National Institute of Environmental
Health Sciences, National Institutes of Health, U.S.
Department of Health and Human Services, P.O.
Box 12233 (MD K3-13), Research Triangle Park,
NC 27709. Telephone: (919) 541-7733. E-mail:
ofallon@niehs.nih.gov.
e authors declare they have no actual or potential
competing financial interests.
Received: 10 October 2014; Accepted: 25 June
2015; Advance Publication: 30 June 2015; Final
Publication: 31 March 2017.
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The Emergence of Environmental Health Literacy—From Its Roots to
ItsFuture Potential
Symma Finn and Liam O’Fallon
Division of Extramural Research and Training, National Institute of Environmental Health Sciences, National Institutes of Health,
Department of Health and Human Resources, Research Triangle Park, North Carolina, USA
Background: Environmental health literacy (EHL) is coalescing into a new subdiscipline that
combines key principles and procedural elements from the fields of risk communication, health
literacy, environmental health sciences (EHS), communications research, and safety culture. ese
disciplines have contributed unique expertise and perspectives to the development of EHL. Since
1992, the National Institute of Environmental Health Sciences (NIEHS) has contributed to the
evolution of EHL and now seeks to stimulate its scientific advancement and rigor.
oBjectives: e principal objective of this article is to stimulate a conversation on, and advance
research in, EHL.
discussion: In this article, we propose a definition of and conceptual framework for EHL, describe
EHL in its social and historical context, identify the complementary fields and domains where EHL
is being defined and implemented, and outline a research agenda. Extensive reviews of web and
literature searches indicate that the concept of EHL is evolving rapidly, as are the definitions of its
scope and inquiry. Although several authors have outlined different frameworks, we believe that a
more nuanced model based on Bloom’s taxonomy is better suited to EHL and to future research
in this area.
conclusions: We posit that EHL can potentially benefit the conduct and outcomes of community-
engaged and health disparities EHS research and can ensure that the translation of research findings
will lead to greater understanding of specific risks, reduction of exposures, and improvement of
health outcomes for individuals and communities. We provide four recommendations to advance
work in EHL.
citation: Finn S, O’Fallon L. 2017. The emergence of environmental health literacy—
from its roots to its future potential. Environ Health Perspect 125:495–501; http://dx.doi.
org/10.1289/ehp.1409337
Finn and O’Fallon
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Existing definitions of EHL, such as
the one that the Society for Public Health
Education (SOPHE) first outlined in 2008,
often include language connoting the evolu-
tionary nature and stages of EHL (Hatfield
1994; Nutbeam 2009); however, we propose a
baseline definition that emphasizes the under-
lying issue: an understanding of the connection
between environmental exposures and human
health. As we discuss later, this understanding
is only the first stage of a hierarchy of increasing
literacy. We believe that this baseline definition
enables EHL to be described through related
disciplinary perspectives such as health literacy,
risk communication, EHS, communications,
public health, and the social sciences. As EHL
evolves, it will be measured and applied in
many ways depending on the disciplinary lens,
the aim, and the audience.
The Historical Roots of
Environmental Health Literacy
ere are a number of different sources of the
emergence of environmental health literacy
(Figure 1). Risk communication, one of
EHL’s roots, has deep historical origins and
can be traced to the display of symbols in
ancient cultures to connote tribal and state
affiliations on the battlefield. More recent
historical examples of risk communication
also utilized symbols to connote danger: the
well-known skull and crossbones symbol used
initially by pirates and then later as the symbol
for poison, and the color red that is widely
used to indicate “stop” or “danger” (Hancock
et al. 2004). World War II expanded the
symbolic vocabulary for dangerous and toxic
situations, and the postwar era adopted much
of this military iconography in high-risk and
dangerous settings related to toxic chemicals,
imminent danger, poison, and, increasingly
in the 1950s, as symbols for nuclear energy’s
threat (Matthews et al. 2014; Young 1998).
Symbolic representations are recognized as an
effective and appropriate method of commu-
nicating hazards; however, cultural differences
in risk perception and in the interpretation of
specific colors or icons has led to the consid-
eration of universal symbols and to research
evaluating the optimal formats for commu-
nicating environmental risks (Chan and Ng
2012; Lesch et al. 2009).
More recent impetus for the development
of EHL began in the late 20th century with
the recognition that risks to human health
came from a number of different environ-
mental sources and had varying levels of
immediate toxicity that could not be suffi-
ciently communicated via an icon or symbol
(Hancock et al. 2004). is understanding of
complex risk was encapsulated in the 1960s
with the publication of Silent Spring (Carson
et al. 1962) and was further elucidated by
Rachel Carson’s testimony to Congress on
pesticides in 1963. Although much of the data
that she presented was known to the scientific
community, Carson was the first to explain
to policy makers and the general public the
far-reaching consequences of the introduction
of chemicals into the environment in such
compelling and convincing terms. Through
her vision of a compromised environment,
“Carson, the citizen–scientist, spawned a revo-
lution” (Griswold 2012) that led to the rise of
organized environmental activism.
Concurrent with this new societal aware-
ness of environmental risks, the NIEHS and
the U.S. Environmental Protection Agency
Figure1. The cultural context: streams leading to the coalescence of environmental health literacy.
Emergence of environmental health literacy
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(EPA) were established (1966 and 1970,
respectively), and early efforts to explore envi-
ronmental sciences expanded into consider-
ation of the effects of pollutants and other
environmental exposures on human health.
Since 1970, EHL has been coalescing as
a distinct field in direct proportion to the
federal commitment to provide information to
the public, including EHS research findings,
and to the increased public awareness of
environmental risks.
Articles describing the historical basis
for the emergence of EHL often point to its
roots in the health literacy movement in the
United States. However, EHL is more than
an extension of health literacy, it is the logical
and inevitable outcome of the validation of
health literacy to improve health outcomes
and treatment adherence (Benjamin 2010;
Paasche-Orlow et al. 2005) and the extrapola-
tion of that value to the prevention of envi-
ronmentally induced disease. e coalescence
of EHL as a distinct subfield may also be
attributed to the recognition of the public
health implications of environmental health
research with affected communities (Brown
et al. 2012; Perez et al. 2012) and the need for
research to identify and address environmental
risks. Recent reports show that health literacy
efforts have evolved, and these reports indicate
recognition of the need to move beyond the
health care setting and system [Institute of
Medicine of the National Academies (IOM)
2004, 2011]. EHL acknowledges this need
and addresses the health context of the indi-
vidual and the community. e goals of EHL
are consistently focused on preventing illness
by raising awareness of risks from environ-
mental factors and by providing approaches
that individuals and communities can take to
avoid, mitigate, or reduce such exposures.
The cultural shift in the value of scien-
tific literacy among the general public also
stimulated the evolution of the concept of
EHL. Analogous to the rise of bioethics in
the context of genetics research, EHL arose
in response to growing public interest in the
environment as well as to scientific and tech-
nological advancements that were increas-
ingly available to the public. Furthermore,
the emergence of the Environmental Justice
movement drew political attention to ineq-
uitable and disproportionate environmental
exposures faced by low-income, minority,
and indigenous populations (Stokes et al.
2010). ese and other concerns about envi-
ronmental pollutants in air, food, and water
also led to the emergence of citizen science
and the necessity for health risk communi-
cations related to environmental exposures
(Bonney et al. 2014; Conrad and Hilchey
2011; Minkler et al. 2010).
Scientific and technological develop-
ments also contributed to the evolution of
communication modalities related to envi-
ronmental risk that are not dependent on
reading ability. In this context, the emergence
of EHL can be considered the next stage in
risk assessment and a reflection of advances in
the fields of exposure assessment and exposure
biology. In the 1980s and 1990s, technologies
were developed to measure environmental
toxicants, standards and regulations were
established for chemical exposure and “levels
of concern,” and there was an increase in the
availability of computer-based visual represen-
tations of risk. With the widespread adoption
of computers in the 1990s and the develop-
ment of geographic information system (GIS)
mapping software, computer-based visual
representations of risk and the ability to link
relative risk to geographic locations emerged
as an accessible and cost-effective commu-
nication modality for the public (Lahr and
Kooistra 2010; Severtson 2013). e field of
risk communication was an early adopter of
visual representations of risk. Such commu-
nications represented the most rapid means
of translating evidence into risk messages
and offered a modality that was both under-
standable and meaningful for individuals
with varying levels of basic and scientific
literacy (Hermer and Hunt 1996; LePrevost
et al. 2013).
The roots of EHL can also be traced to
widespread public awareness of human-made
technological disasters that caused large-scale
environmental pollution (Brennan 2009).
Since the 1980s, media attention to such
accidents has been so extensive that one need
only mention the Bhopal chemical spill, Love
Canal, the ree Mile Island, Chernobyl, or
Fukushima nuclear accidents, or the Exxon
Valdez or Deepwater Horizon oil spills to elicit
images of severe and pervasive contamination.
The impact of these disasters was commu-
nicated by newspaper photos of oil-soaked
marine birds or workers in HazMat suits, tele-
vised images of billowing clouds of oil gushing
from the wellhead, or YouTube videos of tar
balls on the beach. Public attention to such
extreme polluting events is heightened by the
ever-increasing amounts of information on
the Internet about the negative health impacts
of the multiple exposures we all experience
throughout our lives (Murphy et al. 2010).
The Social Context Underlying
the Development of EHL
Although several authors recognize the
various roots that have come together and
flowered into the emergence of EHL (Baur
2010; Huber et al. 2012), there is little in
the literature that explores the larger cultural
context that underlies how the public under-
stands environmental health risks. As efforts
are made to promote the value of EHL, it
will be important to comprehend and address
public understanding and misunderstanding
of environmental risks and how this knowl-
edge has been informed and defined by
cultural media (i.e., books, films, television)
(Frayling 2005; Kennedy et al. 2011; Moore
2015; Murphy et al. 2010).
Films have historically explored and
exploited public awareness of the negative
aspects of increasing environmental expo-
sures. Film studies of cinematic trends have
consistently recognized the thematic preva-
lence of “nuclear anxiety” in films from the
1950s and the plethora of films that depicted
the horrendous “atomic mutations and mass
devastation” resulting from nuclear exposure
(Newman 2000). Films produced since the
1970s, in contrast, have focused on pollu-
tion more generally and the threats posed by
toxic waste, contamination of the food chain
and water supplies, and the increasing reality
of diminishing resources (Frayling 2005).
Unfortunately, cultural expressions about
the outcomes of environmental pollution, as
depicted in movies and books, have too often
portrayed such scenarios in overly dramatic
or unrealistic terms (Murray and Heumann
2014). Despite a few examples of positive
outcomes (e.g., A Civil Action, Silkwood),
the majority of cultural depictions of dimin-
ishing resources do not reflect optimism
that science can “fix” pollution. Rather, the
postapocalyptic film trend reflects a pervasive
attitude that our current actions will lead to
barbaric societies where diminishing resources
have been completely depleted and clima-
tological changes have spun out of control
(e.g., Mad Max, e Hunger Games, e Day
After Tomorrow).
The scientific community recognizes
that media, and most recently social media,
play a key role in public understanding of
environmental risk (Fitzpatrick-Lewis et al.
2010; McCallum et al. 1991). Publications
and news reports that are evidence based and
reflect an understanding of science represent
positive examples of media representation of
environmental risks. However, the media can
misrepresent environmental risks (and indeed
have done so), tending to focus on the most
dramatic aspects of exposure events and disas-
ters, and presenting news about the outcomes
of environmental health science research as
a means of driving specific political agendas
(Jaspal and Nerlich 2014a, 2014b). These
information challenges must be considered
as efforts are made to build EHL, especially
when attempting to raise public under-
standing of actual versus perceived risks from
environmental exposures.
Ultimately, evidence-based environmental
health risk communications can help to
provide more accurate evidence to counterbal-
ance media and cultural representations of
environmental degradation and its impact on
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Environmental Health Perspectives
human health. Furthermore, raising EHL can
help individuals to navigate the abundance of
information, of varying quality and veracity,
that is available on the Internet (e.g., on-line
blogs, chat rooms, other forms of social
media) and can empower them to decide what
choices are best for their health and that of
their families (Wilcox 2012). More important,
improving knowledge about environmental
health risks can be used to promote a more
optimistic view of the potential that exists to
reduce, mitigate, or eliminate the worst envi-
ronmental exposures and improve the health
of both humans and the environment.
EHL Methodology and
Approaches
EHL builds on, synthesizes, and encompasses
validated tools and methodologies from existing
fields of research such as health literacy, risk
communication, and education. Although the
development of these approaches is most closely
based on health literacy concepts and practices,
several authors working in this emerging field
conceptualize EHL as a process that individuals
and communities embrace as a means of critical
reflection within their local socio economic
context rather than as a type of health literacy
that incorporates specialized knowledge of
environmental factors (Chinn 2011; Sykes
et al. 2013). is concept of critical reflection
was initially proposed by Nutbeam as one of
three phases of learning and processing that
reflect the evolutionary nature of health literacy
(Nutbeam 2008). Although a number of
articles cite this three-stage conceptual frame-
work for EHL, we propose adapting Bloom’s
taxonomy of educational objectives as a more
nuanced model for the evolutionary nature of
becoming more literate about environmental
health issues (Bloom 1956) (see Figure 2).
Since its publication, more than 5,000
authors have found Bloom’s taxonomy to be
a useful construct (Flinders 1996). Bloom’s
stepwise progression of six distinct educational
stages is a fitting approach for the development
of targeted interventions for the various stages
of EHL. e value of this model for describing
the evolution of learning and understanding
is that it acknowledges an individual’s poten-
tial for environmental health literacy at each
stage. For example, those at the earliest stage,
“Recognition,” know that a specific substance
is toxic and may affect their health without
any other understanding of how this occurs,
what levels are concerning, or how to mitigate
the exposure. This is, nonetheless, an initial
stage of environmental health literacy. As the
model suggests, the goal of EHL is to continue
to promote greater understanding, to improve
an individual’s extrapolation of knowledge to
other potential environmental risks, and to
stimulate actions based on the understanding
of risk. However, the model is not meant to
suggest a single path upward to total literacy
or an equal level of literacy about different
exposures; like the disease-specific nature of
health literacy, an individual’s environmental
health literacy may vary from topic to topic.
For example, someone may have achieved a
high degree of EHL related to asthma because
of ongoing family experiences with this condi-
tion as well as the widespread public infor-
mation linking asthman to air pollution, and
yet possess a very low EHL regarding breast
cancer and its lesser-known connections to
environmental exposures.
e stages in the taxonomy also indicate
the type of action individuals and communities
might take based on their level of EHL. ese
actions can be wide-ranging, from an indi-
vidual decision to avoid certain personal care
products to a union movement to improve
workplace conditions, each of which might
represent a single stage of environmental health
literacy. An example that represents all stages of
this model could be a statewide movement to
address potential health effects from hydraulic
fracturing that builds from the recognition of
the exposure to an extrapolation of a health
risk to the creation of policy to address the
risk. Individuals who are proficient in EHL
are able to recognize their exposures and exert
some manner of control over them rather than
feeling as if “there’s nothing I can do.”
Environmental exposures most commonly
affect communities as a whole; however,
individual health outcomes arising from these
exposures are dependent on an individual’s
socioeconomic, biological, and psychological
susceptibility to these exposures (Lee et al.
2005; Quandt et al. 2004). erefore, efforts
to promote EHL should include ways to
measure literacy at individual and community
levels as well as a range of information that
recognizes the psychosocial and demographic
heterogeneity within communities and the
potential for distinct medical, psychological,
or cultural responses to a common source of
exposure(s). To be truly effective, efforts to
promote EHL should be based on the types
of awareness and knowledge needed, and
they should use validated and culturally sensi-
tive strategies to best promote the uptake of
information by individuals, communities,
public health officials, health care providers,
or in regulatory or policy settings (Arcury et al.
2010; Ramos et al. 2001). An understanding
of environmental health risks could serve as
a needed mediator to improve media repre-
sentations of environmental health science
and in popular cultural representations of the
relationship between the environment and
health (Fitzpatrick-Lewis et al. 2010). More
critically, raising EHL could be an important
goal of science, technology, engineering, and
math (STEM) educational efforts in vulner-
able communities and could provide future
generations with the knowledge, skills, and
evidence to address environmental injustices
that lead to health disparities.
NIEHS Contributions to EHL
NIEHS has played an influential role in the
emergence of EHL since the early 1990s.
Since then, NIEHS programs have focused on
building the capacity of researchers and commu-
nity members to work together to address the
environmental health concerns of community
residents and related concerns about envi-
ronmental justice and environmental health
disparities. Although not specifically stated,
these programs have shared a common goal:
to build and strengthen EHL. To further this
goal, NIEHS included community outreach,
dissemination, translation, and education cores
as required components of key programs (Hursh
et al. 2011). Moreover, the institute transitioned
from communication to the public to commu-
nicating with the public. One-way communi-
cation strategies changed to bidirectional and
multidirectional approaches, including social
media and other Internet-based modalities, to
ensure that all partners could contribute to a
dialogue about environmental health risks
(Sullivan et al. 2003).
Community-engaged research (CEnR)
programs at NIEHS have demonstrated
how raising EHL can also serve as a tool for
empowering individuals to actively participate
in efforts to address environmental exposures
of local or regional concern (Adams et al.
2011; Haynes et al. 2011). An additional
positive consequence for promoting EHL is
raising general scientific literacy and numeracy
among the public.
Figure2. Conceptual model of environmental health literacy adapted from Bloom (1956), representing the
potential for different levels of EHL across various environmental health science topics.
Emergence of environmental health literacy
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Over time, these community-engaged
programs fostered novel partnerships (Shepard
et al. 2002), taught researchers how to
work collaboratively with community resi-
dents (DeLemos et al. 2007), empowered
community groups to be actively involved in
the conduct and dissemination of research
(Minkler et al. 2010), and trained teachers
how to bring environmental health concepts
into the classroom (Moreno and arp 1999).
e NIEHS experience shows that cultivating
equity in community–academic partner-
ships enables projects to develop effective
and culturally appropriate materials for local
communities. Additionally, sustained support
for CEnR, which includes capacity building
of all partners, allows projects to address
environmental health disparities in vulnerable
populations, such as Latino, Native American,
African American, and low-socioeconomic-
status communities. ese programs have all
addressed essential components of an EHL
model that emphasizes the importance of
health literacy for public health and preven-
tion (Freedman et al. 2009; Sørensen et al.
2012). These successes, and the continued
need to raise EHL and public health aware-
ness of risks, have kept multidirectional
communication and engagement as a central
goal in the NIEHS 2012–2017 Strategic Plan
(NIEHS 2012).
EHL as a Research Topic
The trans-National Institutes of Health
(NIH) Health Literacy program exempli-
fies NIH recognition of the need to explore
fundamental issues in HL. For NIEHS,
the focus is on validating effective ways of
communicating about environmental health
risks. Although the term EHL is increas-
ingly used by investigators to denote a type
of communications research, environmental
health risk messaging is understudied, and
relatively little is known about
• whether there are specific stages of EHL
that are amenable to intervention
• whether raising EHL correlates with
improved health outcomes
• the relationship between EHL and resilience,
for example, whether EHL increases the
ability of an individual or a community to
cope in challenging circumstances
• the effectiveness of EHL resources and
educational materials to inform intended
audiences (within the context of their existing
beliefs and attitudes)
• different approaches for meas uring success
• the level of cultural acceptance of environ-
mental risk messages in different ethnic and
socioeconomic settings
• the utilization and sustainability of evidence-
based tools and approaches to raise EHL
• whether risk messaging about environmental
factors leads to behavior change
• whether risk messaging leads to prevention,
reduction or mitigation of environmental
risk factors.
A key focus of EHL research will involve
formal and rigorous assessment and valida-
tion to move from projects that produce new
educational materials to projects that explore
the effectiveness of educational resources.
Additionally, research that explores EHL
and advances the science of environmental
risk messaging will require transdisciplinary
or team science approaches. Environmental
health scientists, individuals with exper-
tise in community-engaged research, risk
communication specialists, health educators,
anthropologists, experts in dissemination and
implementation science, community partners
in research, and “citizen scientists” from
affected communities will be critical to the
success of this research.
Conclusions and
Recommendations
Examine the influence of sociocultural context
on EHL. When research focuses on ways to
improve the EHL of individuals and commu-
nities, it will be important to understand the
larger cultural context for how the public
understands risks and to address mispercep-
tions driven by media and cultural expres-
sions. It is likely that media and films form the
basis of beliefs and perception because they are
widely accessed forms of communication and
are often easier for the public to understand,
rather than the more technical and scientific
communication that investigators have histori-
cally disseminated. Effective efforts to raise
EHL must therefore make risk messaging
more understandable and more relevant to
individuals, and they must provide not only
the results of research but also address existing
misinformation and misperceptions.
Develop conceptual models. As EHL
evolves, measuring its stages will be benefi-
cial. We have modified Bloom’s taxonomy
to enable targeted interventions for each
stage of attainment in EHL. Our model
should be tested and others developed or
adapted, perhaps by utilizing or extending
existing instruments from related fields to
accurately measure and quantify the stages
of EHL. Ideally, models should account
for sociocultural context and how it influ-
ences EHL, and they should acknowledge
skills and empowerment at each measurable
stage of EHL.
Use EHL as a tool for all partners. NIEHS
embraces the evolution of EHL as an empow-
ering component of community-engaged and
environmental public health research. EHL
research should include community partners
in the research and provide capacity building
and education at various levels of literacy
for individuals and communities at risk
from environmental exposures. Such educa-
tion should extend beyond simply providing
descriptions of specific risks to including some
elucidation of the pace of science, the uncer-
tainty principle, and the relevance of various
risk measurements (e.g., ppb and levels of
concern). Additionally, education and training
of investigators in effective and appropriate
communication modalities and creation of
active partnerships with affected individuals
will improve the development of culturally
relevant messages. Health care professionals
are another stakeholder group that could
benefit from targeted education and training
to enable them to recognize symptoms caused
by environmental exposures and to diagnose
environmentally induced diseases.
Conduct EHL research. NIEHS is
committed to advancing EHL, expanding
on existing efforts, and addressing gaps in
knowledge and practice. This commitment
could include investigations to
• characterize the process for increasing envi-
ronmental health literacy
• develop and validate measures of EHL at
both individual and community levels
• assess the effectiveness of existing environ-
mental risk messages
• measure the extent of behavior change based
on health risk messaging
• create or adapt environmental risk messaging
to increase the EHL of specific audiences
• identify statistical methods or develop models
that correlate the role of EHL to improving
the understanding of complex risk and
health outcomes.
To be most effective, this research will
require a transdisciplinary or team science
approach, community–academic partner-
ships, and sufficiently broad expertise to allow
development and dissemination of targeted
messaging for local communities in modalities
and languages that are culturally and linguisti-
cally appropriate. Special attention could be
given to improving the EHL of low-literacy
and non–English-speaking individuals or that
of individuals living and working in health-
disparate and low-income communities.
Additionally, these projects should broaden
the identification of relevant stakeholders and
raise the EHL of not only affected community
members but also that of health care profes-
sionals, public health and lay health workers,
decision makers, teachers, and students.
Coordinate federal resources. We recog-
nize that NIEHS is only one player in the
advancement of EHL and must work together
with our federal partners such as the National
Library of Medicine, the Centers for Disease
Control and Prevention, the U.S. EPA, the
National Science Foundation, and the Agency
for Healthcare Research and Quality. As a
coordinated group, representatives of these
agencies could catalog and make available
Finn and O’Fallon
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existing educational resources for the general
public and for researchers working with chron-
ically affected communities. Such a compi-
lation of resources could provide a reliable,
evidence-based source of information to the
general public that may help to counteract the
unsubstantiated (mis)information available
on the Internet or disseminated through the
media and films about environmental risks.
This coordination will maximize the federal
investments to date and help to ensure that
research builds on previous efforts and utilizes
effective tools and validated approaches
developed in related fields.
Finally, the concept of EHL has emerged
and is being embraced by investigators as a
relevant research topic within environmental
health sciences. We believe that the defini-
tions and scope of EHL will continue to
evolve and that research will help define the
optimal approaches for measuring and raising
EHL. Ultimately, efforts to improve EHL are
intended to prevent environmentally induced
disease and to empower individuals to gain a
sense of control through understanding the
environmental risks that affect their families
and their communities.
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