New approaches to problem framing in environmental health: Application to water

Since the late 20th century, public health rhetoric has been increasingly suffused by reference to complexity in the creation and destruction of health and wellbeing. The paradigm for what can be termed an ‘ecological era' is ‘everything matters' and the implicit challenge to the public health community lies in developing an effective policy response. Pragmatic, policy relevant approaches capable of reflecting the complexity of the situation are indicated.

Those concerned with environment and health have overcome significant scientific and technological challenge and for more than 150 years have delivered population health gain through focusing on infectious and toxic hazards in specific environmental carriers. This is nowhere more evident than in relation to water and wastewater yet the delivery of sufficient potable drinking water and the safe disposal of sewage still top the list of public health imperatives for the developing world.

The burden of delivering on this more traditional agenda on water and health can diminish the appetite for exploring new approaches to environmental health policy.

The paper describes new Scottish approaches to problem framing which force consideration of a wider set of public health evidence and apply this in shaping environmental/public health policy. The new approaches are intended to better reflect the health promoting capacity of physical environment; a psychosocial dimension to the relationship between humans and the places they inhabit; the complex interaction of physical environment with a social, behavioural etc context and, critically, to highlight the synergies between public health policy and other crosscutting agendas of government.