Reducing Environmental and Occupational CANCER RISKS TOOLKIT

1. Build a Better Coalition Using Systems Thinking

The health of any individual is determined by that person’s biology and by the larger ecosystem in which they live. Systems thinking is a tool that uses a holistic perspective to assess complex, interconnected factors in that ecosystem that influence a given societal problem and its solutions. Although many cancer risk reduction programs focus on interventions to address modifiable risk factors for specific at-risk populations, a systems approach takes a step back and considers the “bigger picture” instead of narrowly focusing on one dynamic influencing a given cancer risk factor. It analyses relevant trends and considers the interactions among institutions and decision-makers to discern strategies for strengthening dynamics that are aligned with cancer risk reduction and disrupting dynamics that are perpetuating cancer risks.

Use systems thinking to identify key stakeholders that are essential to advancing cancer risk reduction, such as impacted populations; holders of data resources and scientific or technological expertise; people and organizations that implement programs or influence dominant narratives; people and groups that influence policy decision-makers and their constituents; businesses or other organizations capable of more sustainable practices and advocates calling for healthy environments. Consider what these stakeholders could do together to catalyze change in the system, and whether there are any potential partners missing from the table.

Take the example of stakeholders that are relevant to the issue of air pollution in “Centerville County” – a fictional county. These stakeholders include traditional cancer coalition partners that you may already have within your cancer coalition, such as health professionals, universities, and advocacy/community-based organizations and researchers (see the example below). However, given the tendency for health and environmental programs to be siloed one from the other, the individuals from these sectors active in your coalition may not have expertise in air pollution, and air pollution leaders may not perceive their work as cancer risk reduction. Tapping new participants from institutions that are long-time partners can build capacity for addressing air pollution in the coalition.

It is important to consider non-traditional cancer coalition partners such as leaders of asthma programs within state health departments or transportation and economic development agencies. Air pollution is a shared risk factor for asthma and cancer. Thus, capacities developed for asthma programs can be leveraged to support cancer risk reduction opportunities. Government offices such as transportation and economic development are key potential partners to air pollution risk reduction solutions – technological, policy, and program solutions. Although the example below focuses on air pollution, it is meant to be a model for thinking through relevant stakeholders for the broader environmental and occupational cancer risks of interest to the coalition.

example: coalition building in Centerville

Who are the key stakeholders that have capacity to influence air pollution and associated cancer risk in the region? For illustration purposes, not meant to be comprehensive.

Impacted Communities

  • Community-based organizations and residents in areas highly impacted by air pollution

Air Pollution NGOs

  • NGOs focused on air pollution and/or environmental causes of cancer

Government Agencies

  • Air quality (health department or environmental agencies that provide regulatory oversight on air quality and maintain and public air quality reporting data)
  • Transportation (influence transitioning to low-emission vehicle fleets and transportation policies impacting traffic patterns, etc.)
  • Economic developments (influence where and how new business and housing
    infrastructure is located)
  • Environmental justice office/commission (influences how environmental justice communities engage with new policies and programs that could increase/decrease air pollution risks in impacted communities)

Health Professionals

  • Environmental/occupational clinicians including both physicians and nurses
  • Pulmonologists and asthma/allergy specialists (knowledgeable about lung cancer and air pollution)
  • Pediatricians and pediatric oncologists knowledgeable about childhood cancers (primarily leukemia) and air pollution, including professionals employed by or active in Pediatric Environmental Health Specialty Units (PEHSUS)

State Health Department Chronic Disease Programs

  • Asthma program (given links between asthma and air pollution)

Scientific Experts

  • University researchers and other research organizations with expertise in air pollution and users of air quality data

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