Reducing Environmental and Occupational Cancer Risks Toolkit

1. Leverage Systems Thinking

Systems thinking was used in Module 1 to help identify key stakeholders relevant to environmental and occupational cancer risk reduction needs and opportunities.

Systems thinking can also provide insights into the underlying factors and their interconnections that are creating the dynamics by which cancer risks associated with occupational and environmental exposures unfold. Employing a systems perspective means being able to see the “forest from the trees”—when details start to fade, and patterns of the underlying relationships start to emerge.  Employing a systems perspective stops us from reacting to an apparent cause by invoking “quick fixes” and instead provides us with the discipline to map the system to reveal solutions that balance short-term and long-term strategies that address the root causes of a problem, rather than the symptoms.  

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 the reduction of environmental and occupational cancer risks. This includes bringing greater support and funding to cancer prevention research and implementation as well as addressing myths such as “cancer is 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 in order 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, it was consumer pressure and the leadership by major retailers – not legislation – that caused the first wave of businesses back 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 as well as government authorities. Policies “stop the bad” by disincentivizing the use of known carcinogens in products or processes such as through the use of 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 the provision of 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 in specific applications of priority concern are also needed.

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


When the topic of environmental and occupational cancer is new for your cancer coalition, it is useful 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 are key trends that 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.

Trends of Air Pollution in Centerville  
A group of diverse stakeholders came together in Centerville to discuss air pollution in the region.  Experts (government officials, academic and community-based) identified the following trends in the region. 

  • Centerville County ranks in the top 1 percent of counties in the U.S. for cancer risk from point source air pollution 
  • Both diesel particulate and coke oven emissions are a significant driver of the regional cancer risk.  
  • Extensive air monitoring of black carbon in the Centerville County region has resulted in maps that clearly reveal high pollution levels concentrated in industrial locations and along heavily traveled roadways.  Elevations are also clearly seen within communities located in river valleys. 
  • Data from the Toxics Release Inventory (TRI) reveal a number of carcinogenic emissions from industrial facilities, including heavy metals and VOCs such as benzene and formaldehyde.
  1. What specific factors influence environmental and occupational carcinogen risk in our state?
    Examine and describe the landscape of environmental/occupational risk factors and the system dynamics that amplify or impede them. Work with your cancer coalition to identify and prioritize environmental/occupational carcinogens broadly or focus on specific risk factors. These could include for example air pollution, water contaminants, specific occupations of concern, or specific industries of interest/concern (waste incinerators, power plants, oil and gas infrastructure, and dry cleaning facilities, among others).

Example Topic: Air pollution in our state
Group Discussion Question: What are the factors and key stakeholders influencing the dynamics of carcinogenic air pollution in our state?

  1. What are the key factors? 
  2. Who are the key stakeholders associated with key factors identified? 
  3. Draw linkages between factors.  
    • Which factors reinforce or perpetuate the dynamics impacting carcinogenic air pollution? What factors impede problematic dynamics or support risk reduction?
  4. Look for patterns that emerge.  
    • Are there groups/categories of factors that emerge when thinking about your cancer plan? 

Next steps.  Use the trends and the analysis of dynamics influencing and impeding cancer risks as you think about intervention opportunities (Module 4) and partnerships (Module 1).

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