Consulting the community for environmental health indicator development: the case of air quality

As health promotion practitioners advocate for an integration of health and environmental concerns, they must struggle with the role of environmental health indicators in fostering and monitoring change to address these concerns. This paper reports on consultations we held with four Ontario communities as part of the development of health-based indicators of air quality (HBIAQ). Jointly with local non-governmental organizations, our university-based team invited a diverse group of participants representing a spectrum of stakeholders in air quality issues to evening consultations lasting 4 h. Participants identified a wide range of directly observable indicators of air quality based on all five senses. They were aware of relationships between air pollution and adverse health impacts, but felt that current air quality indicators did not easily permit this linkage. Participants thought that useful indicators should be relevant to community concerns, credible in their linking of observable air pollution and health outcomes, and communicable to distinct audiences in ways that stimulate changes in behaviour. Significant improvements in participants' self-reported ability to assess and use air quality indicators were documented by pre- and post-questionnaires. Suggestions emerged for resolving some tensions inherent in the development of environmental health indicators: measures of air quality versus measures of potential health outcomes; observations by residents versus technical measurements by government agency staff; expert interpretation versus community ‘complaints'; neighbourhood versus urban/rural area versus wider region; change in public behaviour versus reductions of point sources; and resources internal versus external to communities. Evaluation of the utility of HBIAQ as health promotion tools must await their implementation.