As revealed in the figure above, systems thinking can help identify the primary drivers contributing to environmental and occupational cancer risks and the range of risk-reduction interventions that are needed, including cultural, market, and policy shifts.

• Cultural shifts involve changing dominant norms and narratives that have contributed to inaction on reducing environmental and occupational cancer risks. This includes bringing greater support and funding to cancer prevention research and implementation and addressing myths such as “cancer is the result of bad luck” or “cleaning up the environment is not going to make much difference in cancer rates,” among others.
• Market shifts push manufacturers and retail stores away from selling products containing carcinogens and support the implementation of safer alternatives. Consumers should not be expected to be chemists to vet product labels to avoid purchasing products with harmful substances. Consumer education that creates demand, coupled with pressure from the public health community, can change the behavior and practices of businesses, even in the absence of government mandates. For example, consumer pressure and the leadership by major retailers – not legislation – caused the first wave of businesses in 2008 to remove the chemical and possible carcinogen, bisphenol-A (BPA), from polycarbonate plastic baby bottles and reusable drink containers.
• Policy shifts are necessary to “stop the bad” and “grow the better”. Policies can be issued by institutions such as companies or schools and government authorities. Policies “stop the bad” by disincentivizing the use of known carcinogens in products or processes, such as  bans or financial instruments, including fees/taxes. Policies can also “grow the better” by incentivizing the adoption of safer alternatives that are health promoting, such as through technical assistance, grants, or subsidies that support behavior change among companies and the public. Policies supporting research that identify, evaluate, and implement alternatives as substitutes for carcinogens are also needed in specific applications of priority concern.

The goal of using systems thinking is to become more strategic in promoting change that leads to sustainable and effective actions.

UNDERSTANDING KEY TRENDS AND FACTORS THAT REVEAL THE UNDERLYING SYSTEM OF THE ENVIRONMENTAL/OCCUPATION CANCER PROBLEM

When environmental and occupational cancer is new for your cancer coalition, it is helpful to bring partners together to begin mapping the system that needs to change. Two exercises are important first steps: (1) trend analysis and (2) understanding factors that are impeding cancer risk reduction and influencing cancer risks.

1. What key trends illuminate the environmental/occupational cancer risk we are trying to reduce?
   Trend analysis invites coalition partners to collectively identify trends they think are most relevant in understanding the inter-relationships between environmental/occupational cancer risk reduction needs and opportunities. These trends should be supported by the published literature as well as local expert knowledge.