#  Florida Red Tide, Education Through Community Collaboration

# 2007 - 2008 

#  Environmental Public Health Leadership Institute Fellow:

# Charles H. Henry, R.S., M.P.A.

*Environmental Health Director, Sarasota County Health Department*

*1301 Cattlemen Rd. Bldg. A*

*Sarasota, FL 34232*

*(941) 861-6134*

*Charles_Henry@doh.state.fl.us*

# Mentor:

### **Hank Topper, PhD**

*Co-chair, EPA's Community Action for a Renewed Environment (CARE)
Program* EPA, Office of Prevention

# Acknowledgements:

I would like to thank the following individuals for the support and
assistance provided during my fellowship in the EPHLI

### **William Little, M.P.H., M.B.A.** 

*Administrator, Sarasota County Health Department*

### Andrew Reich, M.S., M.S.P.H.

*Coordinator, Aquatic Toxins Program\
Bureau of Community Environmental Health\
Florida Department of Health\
*

> ![](media/image1.jpeg){width="1.3736111111111111in"
> height="0.6347222222222222in"}

# EXECUTIVE SUMMARY:

A lack of community knowledge concerning health impacts of Florida Red
Tide blooms increases human exposures during near shore Florida Red Tide
events. As a result, Florida's Red Tide harmful algae blooms (HABs)
cause significant increases in acute respiratory illness, as well as,
skin and eye irritations. Efforts were made in Sarasota County, Florida,
to inform the public during Florida Red Tide blooms using press releases
and posting of signs at affected beaches. While successful, this effort
also resulted in complaints and political pressure from the tourism
industry which experienced cancellations and a drop in tourism revenue.
Since tourism is Sarasota County's largest industry, the question of how
to inform the public, without adding to existing economic impacts,
became an important challenge. Applying a systems-thinking approach
(Senge, Kleiner, Roberts, Ross, & Smith, 1994) the Sarasota County
Health Department (CHD) began developing better ways to educate the
public on health impacts of Florida Red Tide. The process required
Sarasota CHD to become facilitators and supporters instead of regulators
which allowed difficult, but necessary discussions to occur. This new
approach resulted in an on-going collaboration with local and regional
stakeholders, as well as, tourism industry support for the development
of an on-line public information system for our Sarasota County beaches.

# INTRODUCTION/BACKGROUND:

Over the past few years, Florida Red Tide blooms have occurred along
coastal Sarasota County with alarming frequency and, at times, with
great intensity. This led to intensive scientific research activities
into the causes, contributing factors, and effects of Florida Red Tide
Blooms. Two areas in particular became a concern to the Sarasota CHD.
The first issue was the lack of effective public notification when
blooms were occurring. The second issue was a lack of public
understanding about the potential human health effects associated with
exposure to these blooms.

Recent studies, conducted by harmful algae bloom (HAB) researchers,
indicate statistically significant increases in acute respiratory
symptoms when humans are exposed to the aerosolized toxin (brevetoxin)
produced by the organism that causes Florida Red Tide blooms, *Karenia
brevis*. Researchers have also linked residence in beach communities
during Florida Red Tide events with significant increases in numbers of
patients diagnosed with pneumonia at a local hospital (Fleming, et al.,
2007). Because of these identified human health impacts, informing and
educating the public took on a real importance for the Sarasota CHD.

*K. brevis* is an unarmored marine dinoflagellate algae that produces a
toxin known as brevetoxin. The toxin is released and aerosolized as
these single celled algae are destroyed or damaged through the normal
surf action along the shore (Steidinger, 2005). As waves break, the
toxin is released and picked up by marine particulates (such as salt and
dust) and transported by sea breezes. If a consistent on-shore wind is
present, these toxins can be carried several miles inland (Backer, et
al., 2005). The understanding of these brevetoxin transport mechanisms
resulting in human exposures becomes important to consider when
developing a warning or notification system for the public.

Red Tide has been present in Florida for hundreds of years (Steidinger,
2005) and is a natural ecological component to the Gulf of Mexico. In
recent years, there seems to have been an increase in the frequency and
intensity of the blooms along Florida's gulf coast. These blooms have
resulted in massive fish kills and deadly health impacts to marine
mammals, such as, dolphins and manatees. Researchers are discovering
that the Florida Red Tide toxin produces both hemolysin and neurotoxin
effects which have powerful adverse impacts on marine life (Steidinger,
2005). Florida Red Tide blooms have also impacted the quality of life
for both residents and visitors to Sarasota County's 34 miles of
beautiful beaches. Aside from the smells and problems created by large
numbers of dead fish washing ashore, almost everyone experiences
watering of the eyes, runny nose, and a cough (locally called the "Red
Tide Tickle") when exposed to the aerosolized toxins from an intense
bloom. Even worse, for those residents and visitors who already suffer
from chronic respiratory disease, impacts are much greater (Fleming, et
al., 2007). Because of Sarasota's beaches, tourism is a key industry in
the local economy. In fact, tourism in Sarasota accounts for over 15,000
jobs and more than 24 million dollars in gross sales annually (Sarasota
County Government, 2007). The recent increased occurrence of Florida Red
Tide in the Sarasota area has been blamed for causing negative economic
impacts on the local tourism industry. Dead fish washing up on the
beaches and the toxin's affect on beach goers were having negative
impacts on the local tourism industry. When Sarasota CHD began to warn
the public about potential health impacts, (through alerts in the local
media and the posting of warning signs on the beach), it only heightened
the stress levels of a tourism industry who was already dealing with
negative economic impacts. Lodging cancelations increased and economic
pressures mounted to find alternative solutions to inform the public
without scaring them away from the local business community.

####### ***Problem Statement:***

A lack of knowledge and understanding about the health impacts of
Florida Red Tide increases the occurrence of respiratory illness in
residents and visitors of Sarasota County during near shore Florida Red
Tide blooms.

#######  

####### ***Behavior Over Time Graph:***

####### ![](media/image2.png){width="8.355555555555556in" height="3.954861111111111in"}

**Knowledge about the health impacts of Florida Red Tide has increased
dramatically for health officials, but not for the general public. This
graph over time represents the gap between the knowledge level of health
officials and the general public. This graph also shows the perceived
economic impacts faced by the tourism industry and the increasing
frequency of Florida Red Tide blooms.**

#######  

####### ***Causal Loop Diagram and applicable archetype:***

####### ![](media/image3.png){width="7.120833333333334in" height="4.877083333333333in"}

**This diagram shows how the initial attempt to simply notify the public
actually shifted the burden to the tourism industry until collaborative
solutions were developed.**

####### ***10 Essential Environmental Health Services:***

This project links closely with four of the ten Essential Environmental
Health Services.

[Inform, educate, and empower people about environmental health
issues:]{.underline} The main focus of this project was to enhance and
improve our ability to inform, educate, and empower citizens and
visitors with the information needed to avoid or reduce exposure to
Florida Red Tide toxins.

[Mobilize community partnerships and actions to identify and solve
environmental health problems:]{.underline} The Sarasota CHD also
focused on mobilizing community partners to work collaboratively on this
project.

[Monitoring environmental and health status to identify and solve
community environmental health problems:]{.underline} This project seeks
to monitor the respiratory health of residents and visitors in Sarasota
County to help determine the true impacts from exposure to Florida Red
Tide.

[Developing policies and plans that support individual and community
environmental health efforts:]{.underline} This project has secondary
goals of working with local policy makers to establish policies that are
protective of public health and policies that help reduce nutrients that
may be contributing to Florida Red Tide blooms.

![](media/image4.png){width="3.745833333333333in"
height="3.808333333333333in"}

Figure 1: Osaki, Ten Essential Environmental Public Health Services

####### ***National Goals Supported:*** 

[Centers for Disease Control and Prevention, Health Protection
Goals:]{.underline}

This project seeks to support "Healthy People in Healthy Places";
specifically, in the area of Healthy Travel and Recreation through
promoting healthy and safe beach recreation habits through education and
information about Florida Red Tide. This project also supports the area
of Healthy Communities through the distribution of information on safe
shellfish consumption and ways to reduce exposures to airborne toxins.

[National Strategy to Revitalize Environmental Public Health
Services:]{.underline}

*Goal IV (Communicate and Market):* The collaborative nature of this
project supports communication among environmental public health
agencies. An example of this effort is the increased communication
between the local and state health departments, environmental health
researchers, community partners, and finally, policy makers.

*Goal VI (Create Strategic Partnerships):* The collaborative nature of
this project supports creation of partnerships between the local health
department and other organizations also working on Florida Red Tide
issues. During this project, partnerships were created or strengthened
with the Florida Fish and Wildlife Commission's Research Institute,
Healthy Gulf Coalition, Sierra Club, Solutions to Avoid Red Tide
(START), and the Mote Marine Laboratory.

*Goal II (Support Research):* This project seeks to support research
through engagement of the community. Community education and information
dissemination helps to increase support for environmental public health
research related to Florida Red Tide.

[Environmental Health Competency Project: Recommendation for Core
Competencies for Local Environmental Health Practitioners:]{.underline}

This project supports the competency project primarily under the
Communication Competencies of education and communication. Improving
Florida Red Tide educational resources and communication between
agencies is one of the primary goals of our Sarasota CHD collaboration.
There is also support of the Management Competencies of problem solving,
economic and political issues, and partnering. Florida Red Tide has
caused significant economic impacts to Sarasota. Efforts to address
Florida Red Tide issues requires problem solving, political awareness,
and a willingness to partner. Finally, this project supports the
Assessment Competencies of research, data analysis, and evaluation. The
key to understanding, and ultimately having a positive effect on the
health impacts of Florida Red Tide, is research and data analysis. As
support grows for research, so too will the knowledge and understanding
required for Florida Red Tide health interventions.

####### ***Project Logic Model:***

**Problem Statement**

**Long-Term Outcomes**

**Goal**

**Intermediate-Term Outcomes**

**Short-Term Outcomes**

**Assumptions**

# 

# PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

####### ***Program Goal***

To ensure that all residents and visitors in Sarasota County will have
the basic knowledge and understanding of the health risks associated
with Florida Red Tide and to assure access to reliable information on
the status of current Florida Red Tide blooms in Sarasota County.

####### ***Health Problem***

Aerosolized toxins from Florida Red Tide harmful algae blooms cause
significant increases in acute respiratory illness, as well as, nose and
eye irritation during Florida Red Tide blooms.

####### ***Outcome Objective***

The number of residents and visitors seeking treatment for acute
respiratory illness during Florida Red Tide blooms will be reduced 50%
by January 2009.

####### ***Determinant***

The density of Florida Red Tide organisms present in inshore water
samples and the number of people exposed.

####### ***Impact Objective***

By January, 2009, 80% of all residents and visitors in Sarasota County
will have both the knowledge and understanding to avoid exposure to
Florida Red Tide toxins during near shore blooms.

####### ***Contributing Factors***

1.  The number of days with near shore Florida Red Tide cell counts
    above 5,000 cells per liter.

2.  Lack of public understanding about the effects of wind direction and
    wave action on the areosolization of Florida Red Tide toxins.

3.  Lack of standardized communications systems to ensure that warnings
    and information are distributed through multiple information
    outlets.

4.  Lack of reliable reporting of real-time conditions for all 34 miles
    of beaches located in Sarasota County.

5.  Lack of public awareness on the health effects of exposure to
    Florida Red Tide toxins.

####### ***Process Objectives***

1.  By August, 2007; Collaborate with community partners to work towards
    project objectives and the establishment of regular meetings.

2.  By August, 2008; Work with community partners to compare and make
    available both near shore Florida Red Tide cell counts and acute
    respiratory illness rates in Sarasota County.

3.  By January, 2008; A Florida Red Tide Education and Outreach program
    will be established that has support and cooperation from community
    partners including the tourism industry.

4.  By May, 2008; The project collaboration will establish program
    evaluation tools and procedures to measure the effectiveness of this
    project.

# METHODOLOGY: 

####### ***Events and Activities***

1.  Collaboration with community partners will be established by seeking
    new partnerships and the establishment of regular meetings. The core
    group will identify potential community partners and then work to
    establish relationships with those partners. Educational and
    informational meetings will be held with the help and participation
    of community partners in order to increase community buy-in. Support
    will be provided to community partners for their work and efforts
    related to Florida Red Tide research, outreach, and education.
    Finally, meetings will be held with the local tourism industry in an
    effort to find win-win solutions for the problems Florida Red Tide
    creates for the industry and Sarasota's economy.

2.  Collaborate with community partners to develop processes to collect,
    share, and review data from Florida Red Tide sampling and data from
    acute care facilities related to acute respiratory illness. This
    includes the establishment of working agreements with the Sarasota
    CHD's Epidemiology staff to allow access to acute respiratory
    illness data and to assist in obtaining data sharing agreements with
    local health care providers. Relationships will also need to be
    established with local partners who sample and determine Florida Red
    Tide cell counts. Finally, the collaboration will need to develop
    agreed upon reporting formats for combined data, as well as, the
    frequency of reporting.

3.  Collaborative efforts will be needed to develop a coordinated plan
    for development and distribution of education and outreach
    materials. Web-sites of community partners should be linked and
    outreach efforts should be cooperative, complementary, and not
    competitive. In conjunction with the local tourism industry,
    procedures for posting and removing beach warning signs need to be
    developed and agreed upon. This also includes agreement on
    notification procedures and public messages when Florida Red Tide
    cell counts are high.

4.  The final step in this project is to establish a way to evaluate the
    effectiveness of the broad collaborative efforts. This includes the
    selection or development of evaluation tools, development of
    reports, and obtaining buy-in from collaborative partners on data
    points to be measured.

# RESULTS:

Community collaborations have been established with multiple partners to
include: Mote Marine Laboratory, Sarasota Bay Estuary Program, Health
Gulf Coalition, Sierra Club, Florida Fish and Wildlife Institute, START,
and local governments. Partners meet regularly through the Protocol for
Assessing Community Excellence in Environmental Health (PACE EH) project
team. Mote Marine has developed an on-line daily beach conditions
reporting system that has been extremely successful in Sarasota County.
This system is now being replicated in 3 adjacent counties. Residents
and visitors are able to log-on or call-in to obtain real time beach
conditions that are updated twice daily. Reported conditions include;
water color, wind direction, surf conditions, presence of dead fish,
reports of respiratory irritation, beach flag type, and if red drift
algae is present. This site can be viewed at
<http://coolgate.mote.org/beachconditions/>

A meeting was held with the local tourism industry where topics of
discussion included the language for beach signs, procedures for posting
and removing beach signs, press releases, and visitor education through
on-line links. A web page was established by the Sarasota CHD to provide
up-to-date beach testing data for residents and visitors who want to
check the latest specific beach testing results. The site also includes
Florida Red Tide education materials and links to our community partners
for more in depth information. This site can be accessed at
[www.ourgulfenvironment.net](http://www.ourgulfenvironment.net/) and has
logged over 48,000 hits from 39 countries, and 6 continents over the
last 15 months.

Several successful community education sessions were held to discuss
Florida Red Tide and other harmful algae blooms, as well as,
dissemination of information on reducing nutrient loads to our local
watersheds.

**Next Steps:**

Development of a collaborative process to collect and share data from
acute care facilities, as well as, community partners who sample for
Florida Red Tide cell counts. This includes the establishment of working
agreements with the Sarasota CHD Epidemiology Division for access to
acute respiratory illness data and with community partners who routinely
monitor Florida Red Tide cell counts in local waters. The project
collaborative also needs to develop an agreed upon reporting format for
combined data once it is reviewed, as well as, a frequency for
reporting. Finally, the collaborative group needs to develop an
evaluation process for the existing Florida Red Tide education program.
This would include obtaining community buy-in on evaluation and
assessment needs, selecting evaluation tools, and formats for evaluation
results.

# CONCLUSIONS:

Working with community partners in this collaboration has been extremely
rewarding. Not only has progress been made towards the projects goals,
but the community partners have taken on many significant roles to help
reduce the health impacts of Florida Red Tide. Sarasota County's
lifeguards now report beach conditions to the web site twice daily. This
allows the public to have accurate real-time information so they can
make informed decisions about which beaches are safe. Improved beach
warning signs were also developed, as well as, an agreed upon procedure
for the lifeguards to use when it is necessary to post signage.
Community support in the areas of fertilizer reduction, pond planting,
and watershed management has increased and the Sarasota CHD's project
web-site has become a key source of beach and watershed data for the
public. The site includes: weekly beach bacteria and Florida Red Tide
sample results, watershed information, current news, and links to the
project's key partners. While this collaboration project is still
developing methods to measure the success of our efforts, we believe
that the increased availability of Florida Red Tide information has made
a positive impact towards decreasing acute respiratory illness
associated with Red Tide Blooms. This project has also helped to
increase the community's knowledge and understanding of Florida Red Tide
and its associated links to human health.

# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

####### ***Charles H. Henry***

Being a Fellow of the National Environmental Public Health Leadership
Institute has been an extremely rewarding experience, both personally
and professionally. The opportunity to hear and discuss leadership
concepts and ideas with some of the nation's brightest and best
practitioners, as well as, other environmental public health
professionals from around the nation, has become the most profound part
of the experience for me. From our study and practice exercises in
systems thinking, the self-evaluation tools and professional development
resources, discussions on emerging environmental public health
leadership issues, and the tremendous networking opportunities provided
throughout the program, the Leadership Institute has greatly enhanced my
skills and knowledge. The National Environmental Public Health
Leadership Institute will continue to have a positive impact on my life,
leadership approach, and thinking for years to come.

# ABOUT THE EPHLI FELLOW(s)

Charles Henry is the Director of Environmental Health for the Sarasota
County Health Department in Sarasota, Florida. He holds a Bachelors of
Science degree from Southern Illinois University and a Masters in Public
Administration (Health Care Administration) from Troy State University.
He served in the United States Navy from 1977 to 2001, as a Hospital
Corpsman, Preventive Medicine Technician, and Environmental Health
Officer. His career start in environmental public health began in 1987,
when he was assigned to the Armed Forces Medical Intelligence Center at
Ft Detrick, MD. While there, he authored intelligence studies focusing
on environmental public health issues and conditions in North Africa and
the Horn of Africa. Mr. Henry is credentialed as a Registered Sanitarian
and has been a member of the National Environmental Health Association
since 1997 and the Florida Environmental Health Association since 2000.
He retired from the Navy in 2001 and moved to Florida where he continues
his environmental public health career. In his current position, as
Environmental Health Director, he administers a broad multi-disciplined
environmental public health program serving the citizens of Sarasota
County with a staff of 46. His work interests include; environmental
public health workforce development, smart growth, sustainability, and
the support of healthy communities initiatives.

REFERENCES

1.  Senge, P. M., Kleiner, A., Roberts, C., Ross, R. B., & Smith, B. J.
    (1994). *The Fifth Discipline Fieldbook, Strategies and Tools for
    Building a Learning Organization.* New York: Doubleday.

2.  Fleming, L. E., KIrkpatrick, B., Backer, L. C., Bean, J. A., Wanner,
    A., Reich, A., et al. (2007). Aerosolized Red-Tide Toxins
    (Brevetoxins) and Asthma. *CHEST* , 131(1):187-197.

3.  Backer, L. C., Kirkpatrick, B., Fleming, L. E., Cheng, Y. C.,
    Pierce, R., Bean, J. A., et al. (2005). Occupational Exposure to
    Aerosolized Brevetoxins During Florida Red Tide Events: Effects on a
    Healthy Worker Population. *Environmental Health Perspectives* ,
    113(5): 644-9.

4.  Steidinger, K. A. (2005). *Florida\'s Harmful Algal Bloom Task
    Force: History and Focus.* St. Petersburg: Florida Fish and Wildlife
    Conservation Commission, Florida Marine Research Institute.

5.  Sarasota County Government. (2007). *Economic Report*. Sarasota
    County Government.