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 conce rns. This paper reports on consultations we held with four Ontario communit ies as part of the development of health-based indicators of air quality (H BIAQ). Jointly with local non-governmental organizations, our university-ba sed team invited a diverse group of participants representing a spectrum of stakeholders in air quality issues to evening consultations lasting 4 h. P articipants identified a wide range of directly observable indicators of ai r quality based on all five senses. They were aware of relationships betwee n air pollution and adverse health impacts, but felt that current air quali ty indicators did not easily permit this linkage. Participants thought that useful indicators should be relevant to community concerns, credible in th eir linking of observable air pollution and health outcomes, and communicab le to distinct audiences in ways that stimulate changes in behaviour Signif icant improvements in participants' self-reported ability to assess and rul e air quality indicators were documented by pre- and post-questionnaires. S uggestions 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 m easurements by government agency staff expert interpretation versus communi ty "complaints"; neighbourhood versus urban/rural area versus wider region; change in public behaviour versus reductions of point sources; and resourc es internal versus external to communities. Evaluation of the utility of HB IAQ as health promotion fools must await their implementation.