A health study requires an extensive commitment of time and resources. Before pursuing a health study, residents and researchers should determine if the proposed study will have a good chance of finding a link between exposure and illness. Residents and researchers evaluated if a health study was appropriate in this situation.
Perhaps there are hundreds of similar facilities around the country in which communities continue to be exposed to this contaminant. If this study enables us to identify a health threat and protect people in similar situations, then the study would have high public health significance.
The study may be important because it can provide information about whether exposure to this air contaminant in a community can cause health problems. The information that is currently available is based on exposures to this chemical at work environments. Exposure levels at the workplace tend to be higher than in the surrounding environment and community. Although we may know that higher doses among workers are a risk to health, learning about potential health effects at the lower doses experienced by community members would generate new knowledge.
A local community group actively investigated the health problems near the facility. This group discussed with researchers what types of studies community members are interested in. Some community group members volunteered to locate lists of former students from the middle school. Others were willing to publicize the study to encourage participation. The elected officials believed that a study could help answer residents' questions. But they were also concerned that the publicity from a health study could harm the town's tourist industry and hurt the local economy. The support of the school district, including the school's principal and teachers, would also be necessary for a health study involving former students.
It's not unusual for there to be mixed feelings about a health study. However, there generally needs to be at least one strong element in the community that supports the study and general support from elected officials in that community.
Residents wanted to learn if contamination in the community caused health effects. Some community members who were sick wanted to know if their health outcome was caused by the contamination. And if the contamination had in fact caused their health outcome, these community members wanted to know if they could be compensated for their medical expenses.
It would be valuable for community members to have an informational discussion with researchers planning a possible health study. Researchers could clarify that it is generally not possible to link a specific case of health outcome to an exposure, even though it is sometimes possible to determine that there was an unusual increase in the number of health outcome cases overall. Health studies themselves have historically not provided the basis for compensation for medical expenses.
Residents were also interested in influencing policy surrounding air contamination in communities near industrial facilities. If a health study showed a link between contamination and health effects, residents would also like to see stricter controls on air emissions to protect health.
Even at the beginning stages of exploring the possibility of conducting a health study, individuals must take on a great deal of responsibility and time commitment. The town residents found it challenging to determine who would coordinate the health study and seek funding. Residents had to figure out what government agencies or academic institutions might be interested in helping them organize a study.
Through a discussion with researchers, residents also learned that it is difficult to get funding for health studies. The Agency for Toxic Substances and Disease Registry (ATSDR) has conducted epidemiological health studies, but funding has been greatly limited in the last few years. Competition for funding from agencies within the National Institutes of Health (NIH) is greater than ever. Independent organizations or foundations, perhaps those focused on a particular disease, may fund health studies. But these grants are likely to be smaller scale. Although some studies can be conducted with limited resources, it would be important to carefully outline how much resources are needed to complete the study. Starting a study without enough resources can cause confusion and disappointment.
Having support from the government can greatly enhance the ability of researchers to conduct a cost-effective study and may increase the likelihood of attracting additional funding. Having integrated support from government agencies is also likely to facilitate implementation of the study in the community.
Residents worked hard to gather the support from various different government agencies. Residents met several times with the county health officer, who was supportive of the study. If the health study were to be conducted, the county was willing to provide a meeting space for study interviews. The county also agreed to allow the posting of flyers to recruit study participants at local health clinics. In addition, the state health department offered to provide data to estimate how much toxic chemical the study participants had been exposed to. Representatives from local and state government agencies were willing to participate on a study advisory board.