# A Plan to Articulate and Market the Value of the Environmental Health Infrastructure and Environmental Health Service Delivery

# 2005 - 2006 

# 

# Environmental Public Health Leadership Institute Fellow:

# David W. Pluymers, MSTHA, RS

*Director of Public Health Preparedness,*

*Wisconsin Division of Public Health*

*1 West Wilson Street, P.O. Box 2659*

*Madison, Wisconsin 53701-2659*

*608-261-6867*

*pluymdw@dhfs.state.wi.us*

# Mentor:

### **Mark D. Miller, MPH, RS**

*Captain, U.S. Public Health Service*

*Senior Environmental Health Officer*

*Centers for Disease Control and Prevention*

*National Center for Environmental Health*

*Environmental Health Services Branch*

**Coach:**

# Louis Rowitz, Ph.D.

# *Professor, Community Health Sciences School of Public Health University of Illinois at Chicago*

# 

# Acknowledgements:

### **Brian Hanft, MPA, REHS**

*Environmental Health Service Manager, Cerro Gordo County Dept. of
Public Health*

**Joy Harris, MPH**

*Community Health Consultant, Iowa Department of Public Health*

**Tracynda Davis, MPH**

*Program Manager -- Water Attractions, Wisconsin Division of Public
Health*

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# EXECUTIVE SUMMARY:

Without a modern and comprehensive plan for articulating and marketing
the value of the environmental health (EH) infrastructure and the
benefits of EH service delivery, the field of EH will struggle to obtain
and sustain adequate financial, technical and human resources. In an
effort to achieve the National Center for Environmental Health's
strategic priority to communicate and market EH services, a plan was
developed to research, conceive, promote, and distribute the ideas and
services that satisfy environmental health objectives. Significant
priority was placed on performing the research necessary to effectively
shape, target and evaluate EH marketing messages and activities. A key
output of plan will be the creation of EH marketing tool kit for
federal, tribal, state and local EH programs. The project's overall goal
will be to improve and sustain the capacity of EH programs to deliver EH
services and, thereby, reduce the incidence of environmentally-based
illness, injury and death.

# INTRODUCTION/BACKGROUND:

The following report details a plan for articulating and marketing the
value of the EH infrastructure and the value of EH service delivery. The
plan is too large to be accomplished within a single Environmental
Public Health Leadership Institute (EPHLI) session. Ideally, this plan
will serve as a roadmap for marshaling and coordinating the resources
within the EH profession to perform an appropriate level of marketing
research and to develop marketing messages, instructions and tools that
can be placed in the hands of working EH professionals. The overall goal
of this plan is to improve the capacity of federal, tribal, state and
local environmental health programs and professionals to deliver
environmental health services and thereby reduce the incidence of
environmentally-based illness, injury and death.

**Problem Statement:**

Without a modern and comprehensive plan for marketing the value of the
EH infrastructure, the EH profession will struggle to obtain and sustain
adequate financial, technical and human resources.

**Build a Strong Container for Change:**

To create change within an organization, the leader must create
alignment around a vision for a future state. The individuals within the
organization will be energized by building a shared vision.

The purpose of container building is to build sufficient discomfort and
safety so that people are ready to change (Goodman, 2004). Container
building steps include:

-   Identify Key Stakeholders.

-   Develop an initial statement of the vision: what people want to
    create.

-   Clarify the level of felt need, including the costs of *not*
    changing.

-   Test for preconditions of change.

Identify Key Stakeholders:

+-----------+-------+------+------------------------+-----------------+
| **Stak    | **Cu  | *    | **Stakeholder's        | **What You Can  |
| eholder** | rrent | *Des | Motivation**           | Do**            |
|           | Supp  | ired |                        |                 |
|           | ort** | S    |                        |                 |
|           |       | uppo |                        |                 |
|           | (-3   | rt** |                        |                 |
|           | to    |      |                        |                 |
|           | +3)   | (-3  |                        |                 |
|           |       | to   |                        |                 |
|           |       | +3)  |                        |                 |
+-----------+-------+------+------------------------+-----------------+
| State EH  | +3    | +3   | Secure adequate level  | Provide EH      |
| Directors |       |      | of funding for state   | marketing       |
| (ASTHO)   |       |      | EH programs            | research data,  |
|           |       |      |                        | marketing plan  |
|           |       |      |                        | and materials.  |
+-----------+-------+------+------------------------+-----------------+
| Wisconsin | +2    | +3   | Secure adequate level  | Provide EH      |
| Envi      |       |      | of funding for state   | marketing       |
| ronmental |       |      | and local EH programs. | research data,  |
| Health    |       |      | Elevate status of EH   | marketing plan  |
| As        |       |      | profession and EH      | and materials.  |
| sociation |       |      | professionals.         |                 |
+-----------+-------+------+------------------------+-----------------+
| NCEH's    | +1    | +2   | Secure tool for Goal   | Provide EH      |
| Envi      |       |      | IV of A National       | marketing       |
| ronmental |       |      | Strategy to Revitalize | research data,  |
| Health    |       |      | Environmental Public   | marketing plan  |
| Services  |       |      | Health Services:       | and materials.  |
| Branch    |       |      | "Communicate and       |                 |
|           |       |      | Market".               |                 |
+-----------+-------+------+------------------------+-----------------+
| As        | +1    | +3   | Increase funding for   | Provide EH      |
| sociation |       |      | and enrollment in EH   | marketing       |
| of        |       |      | academic programs      | materials       |
| Envi      |       |      |                        | consistent with |
| ronmental |       |      |                        | those under     |
| Health    |       |      |                        | development by  |
| Academic  |       |      |                        | AEHAP and       |
| Programs  |       |      |                        | partners.       |
+-----------+-------+------+------------------------+-----------------+
| Wi        | 0     | +1   | Stop change. Benefit   | Provide         |
| sconsin's |       |      | from an elevated       | benefits        |
| EH        |       |      | status their           | resulting from  |
| I         |       |      | profession. Higher     | successful EH   |
| nspectors |       |      | wages.                 | marketing.      |
| and Field |       |      |                        |                 |
| Staff     |       |      |                        |                 |
+-----------+-------+------+------------------------+-----------------+
| Su        | +2    | +3   | Higher profile for EH  | Deliver EPHLI   |
| pervisor/ |       |      | services in Wisconsin. | Product with    |
| Wisconsin |       |      | Development of         | value to the    |
| EH        |       |      | professionals.         | Wisconsin       |
| Director  |       |      |                        | Bureau of       |
|           |       |      |                        | Environmental   |
|           |       |      |                        | and             |
|           |       |      |                        | Occupational    |
|           |       |      |                        | Health          |
+-----------+-------+------+------------------------+-----------------+

**Initial Statement of Vision:**

EH leadership recognizes that the nation's environmental health and the
field of environmental public health would benefit significantly from
the development of a research-based plan, product and tools for
marketing the value of the EH infrastructure, the environmental public
health profession and environmental health professionals.

Costs and Benefits (the "readiness" for change):

+-------------------------------------+--------------------------------+
| **1a. Benefits of Changing:**       | **2a. Benefits of Not          |
|                                     | Changing:**                    |
| -   Adequate level of funding for   |                                |
|     the national, tribal, state and | -   No need to learn/develop   |
|     local delivery of EH services,  |     new skills,                |
|                                     |                                |
| -   Elevated status and profile of  | -   Retain comfort level with  |
|     EH profession and               |     existing method of         |
|     professionals,                  |     practice.                  |
|                                     |                                |
| -   Improved health of the          |                                |
|     community,                      |                                |
|                                     |                                |
| -   Improved environmental quality, |                                |
|                                     |                                |
| -   Improved workforce capacity,    |                                |
|     competency, morale              |                                |
|                                     |                                |
| -   Increased wages for EH          |                                |
|     professionals.                  |                                |
+-------------------------------------+--------------------------------+
| **1b. Costs of Changing:**          | **2b. Costs of Not Changing:** |
|                                     |                                |
| -   Possible alienation of some     | -   Static or reduced funding  |
|     older and resistant members of  |     for national, tribal,      |
|     the EH workforce,               |     state and local EH         |
|                                     |     programs,                  |
| -   Increased draw of EH activities |                                |
|     to higher profile agencies      | -   Loss of workforce capacity |
|     (environmental protection,      |     and competency due to      |
|     agriculture) resulting in       |     forecasted high level of   |
|     increased fragmentation of EH   |     retirements,               |
|     practice,                       |                                |
|                                     | -   Loss of workforce capacity |
| -   Increased expectations for and  |     due to decreased           |
|     resulting scrutiny of EH        |     enrollment in EH academic  |
|     practice and professionals.     |     programs.                  |
+-------------------------------------+--------------------------------+

**Tests for Preconditions of Change/Do the pre-conditions for change
exist?**

Evidence that the pre-conditions for change exist:

-   In its September 2003 document, [A National Strategy to Revitalize
    Environmental Public Health Services]{.underline}, the National
    Center for Environmental Health focused one of its six priorities on
    "Communicate and Market."

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-   Larry Gordon has called for marketing the value of the EH
    infrastructure,

-   The Wisconsin Environmental Health Association has a formed an
    educational subcommittee to study the development of EH public
    service announcements (PSAs) targeted at communicating the value of
    EH and EH services.

-   The July/August 2005 issue of the Journal of Environmental Health
    featured a cover article entitled, "The Perception Gap - Creating
    Effective Messages About Environmental Health." The article was
    co-written by Alejandra Tres of the Association of Environmental
    Health Academic Programs. (Morrone, 2005)

-   The Association of State and Territorial Health Officers' (ASTHOs')
    state EH directors' workgroup (August 11, 2005) offered to provide
    up to \$35,000 for developing a marketing message or supporting
    AEHAP's efforts.

**Project Focusing Question**:

Why has the environmental public health profession struggled to sustain
adequate financial, technical and human resources?

[System Analysis Questions]{.underline}:

1\. Is the problem chronic? Does it have a known pattern of behavior
over time?

*Yes, the problem is generally chronic. However the problem (inadequate
resources) is temporarily reduced after critical incidents.*

2\. Why has this problem been happening?

*The problem results from a lack of public awareness regarding the need
to sustain quality EH systems. This lack of awareness is due to our
profession's inability to visualize and deliver a coherent message
regarding risks, solutions and the value of the EH infrastructure and EH
services.*

3\. What were the earliest antecedents of the problem?

*This problem has been with us throughout history. As humans, we all
tend to be short-sighted and reactive.*

4\. How would upper management view this problem?

*Upper management would agree that this problem exists. However, the
political components of addressing this problem require that upper
management distance itself from actively participating in some
components of the solution.*

5\. How would stakeholders view this problem?

*When presented with an EH hazard or an EH-related illness or injury,
stakeholders and customers see this problem as very significant. When it
is personalized, the problem is seen as important. However, when the
problem is no longer personalized, it fails to garner adequate
attention.*

6\. What other causes are affecting this system?

*The system tends to draw individuals who are not skilled, trained or
compelled to market the value of the EH infrastructure or the services
they provide. EH professionals do not function well as their own
spokespersons. Also, there is competition for resources and attention
from related or similar problems.*

7\. What part of the issue is internal to my work group? What is a
manageable chunk that relates to my position?

*Internally, my work group (the EH profession) is able to obtain
additional skills, hire outside expertise, and attract individuals
capable of articulating and marketing the value of the EH infrastructure
and EH service delivery.*

8\. In what ways do I or my group create or contribute to the issue
through what I/we say (or choose not to say), do (or choose not to do),
or think?

*We contribute to this issue by not articulating the value of the EH
infrastructure in the media, at public forums, and to policy and
decision makers. We contribute to this problem by continuing to quietly
work in relative obscurity.*

9\. What is the apparent purpose of this system, i.e. what appear to be
the outcomes of people's efforts? How is this different from what people
really want?

*The apparent purpose of this system (inadequate resources for the EH
infrastructure and profession) is to conserve resources by withdrawing
them when no problem appears to exist. When prevention and intervention
efforts succeed, it is assumed that the hazard has been eradicated and
the prevention/intervention activities may be ceased or removed.*

*People want security and assurance of safety. Security and safety from
EH hazards cannot be ensured without sustained financial, technical and
human resources.*

**BEHAVIOR AND TRENDS OVER TIME GRAPH:**

-   Funding for the Wisconsin Bureau of Environmental and Occupational
    Health (BEOH)

-   Staffing within the Wisconsin Bureau of Environmental and
    Occupational Health

-   Graduation rate from the University of Wisconsin -- Eau Claire's
    (UWEC's) Environmental and Public Health (ENPH) Program -
    Wisconsin's only accredited EH program.

-   Retirement rate of EH professionals as determined in an April 2004
    Survey of Wisconsin Registered Sanitarians (RS).

**CAUSAL LOOP DIAGRAMS AND APPLICABLE SYSTEM ARCHETYPES:**

**Limits to Growth**: EH's financial, technical and human resources are
increased in response to a hazard or hazardous incident. As resources
are increased, hazard mitigation and prevention improves and the hazard
decreases. As the hazard decreases, resources are withdrawn and,
eventually, the hazard begins to reappear. A new reaction to the hazard
begins.

**Tragedy of the Commons/Success to the Successful:** The EH
infrastructure -- in the form of federal, tribal, state and local health
departments and agencies -- competes for the finite attention and
financial resources of the public, government decision makers, and
public and private sector policy makers. The "commons" - reflected as
the public's attention and the government's and private sector's
financial resources - is sought by both the EH System and Environmental
Advocates who are seeking political impact and environmental protection.
In this case, success will belong to those who are more successful in
shaping, marketing and communication their message. In her paper,
*Bridging the Great Divide: Environmental Health and the Environmental
Movement*, Rebecca Berg documented and described the tension. (Berg,
2005)

**Accidental Adversaries**: In Wisconsin, environmental public health
services are typically delivered by local public health departments
(LPHDs). The state public health department, the Wisconsin Division of
Public Health (DPH), typically provides epidemiological services,
technical expertise, statewide guidance, policies and procedures. Almost
all state public health functions are funded with federal grants (63%)
or fees (28%). Only 6% of the DPH's budget comes directly from Wisconsin
tax revenues. Conversely, most LPHD activities are supported by local
tax revenues and/or fees. However, LPHDs -- particularly larger urban
health departments -- also receive federal grant funding. Sometimes they
compete with the DPH for those funds.

The DPH performs surveillance and epidemiological services using
statewide data. Those data are often provided to the DPH by Wisconsin's
LPHDs.

Although Wisconsin's state and local EH programs have much to gain by
working together, they act in opposition - sometimes competing for data
and grants.

**Most relevant archetype: Shifting the Burden -- The Immediate is the
Enemy of the Important**

The archetype that most applies to the Environmental Health and the
Public Health infrastructure in Wisconsin is "Shifting the Burden",
where the immediate becomes the enemy of the important. In this
scenario, inadequate resources condition environmental health programs
and public health departments to focus resources and attention on
meeting immediate and short-term needs -- regulatory inspections and
grant funding obligations -- rather than address long-term solutions to
infrastructure capacity needs. In essence, the immediate (short-term
obligations) becomes the enemy of the important (long-term strategic
planning and resource allocation). The environmental health profession
has become addicted to short-term technical, regulatory and
funding-dependent activities and has avoided the planning, communication
and marketing skills necessary to obtain and sustain adequate
infrastructural capacity.

**Limits to Success/Growth:** This project's goal is to build adequate
and sustainable EH system capacity through a strategy to articulate and
market the value of EH service delivery and the EH infrastructure to the
public and policy makers. The strategy should build support for the EH
system among the public and policy makers -- resulting in adequate and
more sustainable capacity. However, several balancing factors will
restrict and slow the growth. It is anticipated that growth will
accelerate as the balancing factors are overcome. Eventually, growth
will slow as adequate system capacity is met.

Limits to Growth Archetype:

**Deeper Questions Concerning the Limits to Growth:**

**Vision**

**Limiting Processes**:

Recommendations/Interventions for Addressing the Limiting Processes:

a.  Perform the necessary marketing research to sufficiently prepare,
    shape, target and test a strategy for articulating and marketing the
    value of EH services and infrastructure.

b.  Provide a sound strategy for articulating and marketing the value of
    EH services/infrastructure.

c.  Create a convincing argument that marketing the value of EH
    services/infrastructure is the best strategy for obtaining and
    sustaining adequate EH system capacity.

d.  Create and provide a EH "tool kit" to assist state and local health
    departments with their efforts to market EH services/infrastructure
    to their communities and health boards.

####### **PROJECT RELEVANCE TO THE 10 ESSENTIAL ENVIRONMENTAL HEALTH SERVICES AND THE THREE CORE PUBLIC HEALTH FUNCTIONS (IOM):**

More than address any individual Essential Environmental Health Service
or Core Public Health Function, this project was focused on obtaining
and sustaining overall system capacity to ensure adequate and competent
delivery of all environmental health services. If specific Essential
Services were to be chosen, this project would most directly address:

> #3. Inform, educate and empower people about environmental health
> issues, and
>
> #8. Assure a competent environmental health workforce.

By creating messages, instructions and tools for articulating and
marketing the value of EH service delivery, EH professionals will
inform, educate and empower people about environmental health issues.
Through informing and educating, we will build consensus and support for
sustaining an adequate EH infrastructure.

Similarly, creating messages, instructions and tools for marketing EH
will work toward assuring a fully competent environmental health
workforce -- a workforce with both technical and
interpersonal/communication skills. This Essential Service is also
reflected in the Core Public Health Function of "Assurance" where our
profession must seek to assure a competent workforce.

As defined by the [Environmental Health Competency Project --
Recommendations for Core Competencies for Local Environmental Health
Professionals]{.underline}, a core competency of each EH professional
should be, "The capacity to articulate basic concepts of environmental
health and public health and convey an understanding of their value and
importance to clients and the public." By providing insights,
instructions and tools for articulating and marketing EH to clients and
the public, this project is intended to build the competency of the EH
workforce. (CDC, 2001)

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

[CDC Health Protection Goals]{.underline}.

This project to articulate and market the value of the EH infrastructure
and EH service delivery is targeted at building and sustaining overall
EH system capacity. In so doing, this project seeks to support all of
the CDC's Health Protection Goals as well as the Health People 2010
objectives. By creating and sustaining EH system capacity and full
delivery of EH services, this project will work toward assuring the
CDC's goals of:

-   Healthy people at every stage of life,

-   Healthy people in healthy places, and

-   People prepared for emerging health threats.

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

The national strategy for revitalizing environmental health states,
"Goal IV. Communicate and Market: Improve communication and information
sharing among environmental public health agencies, communities,
strategic partners, and other stakeholders and better market
environmental public health services to policyholders and the public."
This project was developed with a strong focus on the National
Strategy's goal to Communicate and Market environmental health. In
particular, this project's key aim is to, "...better market
environmental public health services to policyholders and the public."
(CDC, 2003)

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

The Core Competencies document includes, "C4. Marketing: The capacity to
articulate basic concepts of environmental health and public health and
convey an understanding of their value and importance to clients and the
public." The document also provides an example, "Explain the rationale
for environmental health regulatory requirements and the value produced
by a healthy environment (e.g. less disease, lower health care costs)."
Explaining the rationale for and value of EH services is the primary and
dominant emphasis of this project. (CDC, 2001)

####### **PROJECT LOGIC MODEL:**

The project logic model details the proposed project's inputs,
activities, outputs, outcomes and goals. Because the overall project was
very broad, the activities portion of the logic model was expanded to
show:

-   The steps involved in developing the marketing plan (NIH 1989), and

-   The steps involved in performing the necessary marketing research
    (SBA, 2006 and Turning Point).

Project Logic Models:

  -------- ------------ ----------- ------------ -------------- ----------- ---------
  INPUTS   ACTIVITIES   OUTPUTS     SHORT-TERM   INTERMEDIATE   LONG-TERM   GOALS
                                    OUTCOMES     OUTCOMES       OUTCOMES    

  -------- ------------ ----------- ------------ -------------- ----------- ---------

#  

Project Logic Model Activity Expansion -- Marketing Plan and Marketing
Research Plan

# 

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From the Turning Point Initiative's [The Basics of Social
Marketing]{.underline}:

+-----------------+----------------------------------------------------+
| **Points in the | **Ask or Consider:**                               |
| Marketing       |                                                    |
| Research        |                                                    |
| Process**       |                                                    |
+-----------------+----------------------------------------------------+
| Review the      | -   Are the available resources confirmed?         |
| research plan.  |                                                    |
|                 | -   Are the roles and responsibilities clear?      |
|                 |                                                    |
|                 | -   Do the timelines and budgets appear            |
|                 |     reasonable, and do they fit your departmental  |
|                 |     schedules?                                     |
|                 |                                                    |
|                 | -   Are necessary review/clearance and procurement |
|                 |     mechanisms clear and in place?                 |
+-----------------+----------------------------------------------------+
| Review the      | Can you answer the following questions:            |
| research        |                                                    |
| report.         | -   What most distinguishes between key audience   |
|                 |     segments?                                      |
|                 |                                                    |
|                 | -   Which target audiences appear most ready to    |
|                 |     change? Why?                                   |
|                 |                                                    |
|                 | -   What benefits and barriers to target audiences |
|                 |     ascribe to the desired and competing           |
|                 |     behaviors?                                     |
|                 |                                                    |
|                 | -   What appear to be attractive exchanges for the |
|                 |     respective audience segments?                  |
+-----------------+----------------------------------------------------+

Although an appropriate level of marketing research may be expensive,
there are compelling reasons why it should be performed. In their
guidance to small business owners, the United States Small Business
Administration (SBA) states, "It is impossible to sell products or
services that customers do not want. Learning what customers want, and
how to present it attractively, drives the need for marketing research."
(SBA, 2006) Similarly, on their website, the Turning Point Initiative
advises, "Know your audience and put them at the center of every
decision you make. Social marketing beings and ends with your target
audience. In order to understand why your audience isn't doing what you
want them to do, you must understand what barriers are getting in their
way. Understand also that you are not the target audience!" (Turning
Point)

# 

# PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

**Outcome Objectives for 2010:**

a.  Reduce the number of Wisconsin residents per Wisconsin Registered
    Sanitarians/Registered Environmental Health Specialists by 5% from
    10,888 Wisconsin residents per RS/REHS in 2005 to 10,343 residents
    per RS/REHS in 2010.

b.  Reduce the number of regulated food safety and recreational
    licensing facilities per Wisconsin Division of Public Health
    inspectors/sanitarians by 25% from 578 facilities per inspector in
    2004 to 433 facilities per inspector in 2010.

c.  Increase the number of local health officers who identify
    Environmental and Occupational Health Hazards as an important issue
    by 20% from 55 in 2004 to 73 in 2010.

**Determinant:**

Wisconsin's state and local health departments will obtain and sustain
adequate funding to increase the number of Environmental Health
professionals.

**Impact Objective:**

By 2009, Wisconsin's state public health department and 100% of local
health departments will have a plan and materials for marketing the
value of the Environmental Health infrastructure.

**Contributing Factors:**

a.  The environmental public health profession lacks a modern and
    comprehensive vision of Environmental Health services.

b.  In Wisconsin, state and local environmental health professionals
    lack a plan and materials for marketing the value of the
    Environmental Health infrastructure.

c.  Without a plan to articulate the vision of Environmental Health
    services and market the value of the Environmental Health
    infrastructure, state and local health departments cannot create a
    base of support among community leaders and decision makers to
    build, strengthen and sustain Environmental Health capacity.

**Project Process Objectives:**

1.  By June 2006, obtain the resources necessary to develop an
    Environmental Health marketing research plan.

    -   [Event]{.underline}: Complete marketing training and education.

    -   [Activities]{.underline}: Read public health marketing materials
        and begin attending continuing education marketing training.

2.  By June 2007, develop a marketing research plan focused on marketing
    the value of the Environmental Health infrastructure in Wisconsin.

    -   Event: Complete a marketing research plan.

    -   Activities: Create a marketing research plan that will identify
        the key elements of product, price, promotion and placement for
        the successful marketing of EH services.

3.  By June 2008, develop and distribute a research-based plan and
    materials for marketing the value of the Environmental Health
    infrastructure in Wisconsin.

    -   Event: Complete and distribute a research-based Environmental
        Health marketing plan and materials.

    -   Activities:

        -   Create the plan,

        -   Develop accompanying marketing materials,

        -   Distribute the plan and materials to all of Wisconsin's
            state and local health departments,

        -   Promote and distribute the plan and materials through the
            Wisconsin Environmental Health Association.

# METHODOLOGY:

Because this report describes the development of a plan, rather than the
execution of a project, the methods reflect activities used to develop
the plan and eventual steps recommended in the plan.

Plan development included the preparation of systems thinking exercises
according to the methods presented by Michael Goodman, David Stroh, and
Sherry Immediato during the EPHLI sessions. Additional system thinking
information was provided in session handouts and in Peter Senge's [The
Fifth Discipline Fieldbook]{.underline}. (Senge, 1994). Similarly,
project logic models were developed according to guidance provided
during the EPHLI sessions with additional direction taken from the CDC
Tobacco Control Program's [Introduction to Program
Evaluation]{.underline}. (MacDonald, 2001)

The logic model steps detailing a marketing plan methodology were
developed from the National Cancer Institute's document, [Making Health
Communication Programs Work]{.underline}. (NIH, 1989) The steps
illustrating a method for performing marketing research were derived
from guidance provided by the Small Business Administrations' "Marketing
Basics" website and the Turning Point Intiatives' "The Basics of Social
Marketing." (SBA, 2006 and Turning Point) Recommendations for next steps
were developed from research, from the recommendations of Larry Gordon,
and from conversations with Michelle Morrone of Ohio University and
Alejandra Tres of AEHAP. Because the exact methods of valid marketing
research are varied, complex, and highly specialized, discussions
regarding appropriate marketing research methodologies will be left to
the experts. This plan was intended to provide an overall roadmap for
placing EH marketing messages, instructions, and tools in the hands of
working EH professionals.

# 

# RECOMMENDATIONS AND NEXT STEPS:

Larry Gordon has said, "The benefits of environmental health include:

-   reduced disease and disability,

-   lower health care costs,

-   enhanced community economic vitality,

-   enhanced productivity,

-   enhanced community educational achievement,

-   fewer social problems, and

-   enhanced quality of life in a more livable environment."

Mr. Gordon has also said, "Marketing analysis and research is the
function that links the public to the marketer through information
designed to identify and define marketing opportunities and problems;
that generates, refines and evaluates marketing actions; and that
improves marketing as a process." (Gordon, 2006)

This project plan is to be viewed and used as a roadmap for articulating
and marketing the value of the EH infrastructure and EH service
delivery. Hopefully, the end result will be a set of marketing messages,
instructions and tools for EH professional to employ at the federal,
tribal, state and local level. A key element in the success of this
strategy should be a collaboration and pooling of financial resources
among the National Center for Environmental Health's (NCEH)
Environmental Health Services Branch , the National Institute of
Environmental Health Services' (NIEHSs') Multimedia program, the
National Environmental Health Association (NEHA), the National
Association of City and County Health Officials (NACCHO), the
Associations of State and Territorial Health Officials and the
Association of Environmental Health Academic Programs (AEHAP).

An immediate next step of this process should be the design and
execution of a valid, nationwide public opinion survey or poll performed
by Dr. Michelle Morrone of Ohio University's School of Health Sciences.
(Morrone, 2006) The survey of greater than 1,500 individuals should
consist of a 10- to 15-minute random-dialed interview. Although it may
cost more than \$100,000, the survey would provide invaluable data from
which targeted and effective marketing messages could be developed in
collaboration with the previous work done by Alejandra Tres of the
AEHAP. (Tres, 2006) Financial resources for the project should come from
the NCEH, NIEHS, NEHA, NACCHO and ASTHO.

# EXPECTED OUTCOMES:

The expected outcomes of this project should include greater support for
the EH infrastructure among the public and policy makers which should,
in turn, result in improved and sustained EH capacity and more complete
delivery of the essential environmental health services. Ultimately,
improved service delivery should result in improved health outcomes
through the prevention of environmental hazards, disruption of hazard
exposures and improved health interventions.

# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

####### **David W. Pluymers** 

Overall, the EPHLI provided a tremendous personal growth experience. In
particular, two program elements -- the self assessments and the systems
thinking exercises -- stood out. The greatest benefits were yielded from
the various self-assessment tools and the related coaching provided by
Lou Rowitz of the University of Illinois -- Chicago. The self
assessments (MTBI, Skillscope, CSI) caused me to more closely examine my
personality, my strengths, my weaknesses, how I perceive information,
how my perception differs from others, and how I should integrate others
perceptions and thought processes into my work. The assessment tools
provided the raw information and Lou Rowtiz guided me regarding how I
should put that information into perspective and into use.

The systems thinking demonstrations and exercises also supplied many
useful tools and resources. Systems thinking provided an organized
framework and methodical structure for my thought processes -- allowing
me to more constructively identify workplace systems, the underlying
forces that influences those systems, and how to make minor adjustments
to the systems to correct problems and improve outputs. I have and will
continue to use sytem thinking methods.

I am very grateful for the opportunity to study and participate in the
EPHLI and I'm particularly grateful to the National Center for
Environmental Health for creating the Institiute and financially
supporting our participation.

# ABOUT THE EPHLI FELLOW:

David W. Pluymers holds a Bachelor of Science in Biology from Hope
College in Holland, Michigan and a Master of Science in Technology and
Human Affairs from the Washington University in St. Louis' Department of
Engineering and Policy. Mr. Pluymers has held public sector positions
with the Illinois Environmental Protection Agency, the Illinois Office
of the State Fire Marshal, Oregon Health Services, the Wisconsin
Division of Public Health and - through an Intergovernmental Personnel
Act agreement - the National Center for Environmental Health. He also
spent several years working for environmental science and engineering
consulting firms. Since entering the Environmental Public Health
Leadership Institute, Mr. Pluymers has become the Director of Public
Health Preparedness for the Wisconsin Division of Public Health.

Mr. Pluymers currently serves as a Regional Vice President of the
Wisconsin Environmental Health Association and as President of the
Madison East Soccer Club. When he is not practicing environmental and/or
public health, David enjoys coaching and playing soccer, kayaking and
rowing around Wisconsin, and creating art with glass and fibers.

**REFERENCES:**

Berg, Rebecca (2005) "Bridging the Great Divide: Environmental Health
and the Environmental Movement", [Journal of Environmental
Health]{.underline}, January/February 2005.

Centers for Disease Control and Prevention -- National Center for
Environmental Health (2003) A [National Strategy to Revitalize
Environmental Public Health Services]{.underline}.

Centers for Disease Control and Prevention -- National Center for
Environmental Health, American Public Health Association (2001)
[Environmental Health Competency Project -- Recommendations for Core
Competencies for Local Environmental Health Professionals]{.underline},
American Public Health Association, Washington, DC.

Goodman M, Stroh D, Immediato S, "Introduction to Systems Thinking",
Bridgeway Partners and Innovation Associates Organizational Learning.
2004 (EPHLI Handout).

Gordon, Larry (2006) "Environmental Health Thoughts for the Day",
personal correspondence, January 5, 2006.

MacDonald, Goldie, Gabrielle Starr, Michael Schooley, Sue Lin Yee, Karen
Klimowski, Katherine Turner, (2001) [Introduction to Program Evaluation
for Comprehensive Tobacco Control Programs]{.underline}, Centers for
Disease Control and Prevention, National Center for Chronic Disease
Prevention and Health Promotion, Office on Smoking and Health

Morrone, Michelle. (2006) Ohio University, Industrial Hygiene and
Environmental Health Science, personal conversation, January 31, 2006.

Morrone, Michelle, Alejandra Tres and Ruben Aronin (2005) "Creating
Effective Messages About Environmental Health", [Journal of
Environmental Health]{.underline}, July/August 2005.

National Institutes of Health -- National Cancer Institute (1989)
[Making Health Communication Programs Work]{.underline}.

Senge, Peter, Art Kleiner, Charlotte Roberts, Richard Ross, Bryan Smith
(1994) [The Fifth Discipline Fieldbook]{.underline}, Doubleday, New
York, New York.

Tres, Alejandra (2006) Association of Environmental Health Academic
Programs, personal conversation, February 2, 2006.

Turning Point Social Marketing National Excellence Collaborative, The
Basics of Social Marketing -- How to Use Marketing to Change Behavior,
Turning Point National Program Office, Seattle, Washington,
www.turningpointprogram.org

United States Small Business Administration (SBA). (2006) "Marketing
Basics", www.sba.gov/starting_business/marketing/basics.html

**ADDITIONAL RESOURCES:**

Adler, Tina (2002) "GE: Marketing the Message", [Environmental Health
Perspectives]{.underline}, Volume 110, Number 10, October 2002.

Bangs, David H., Jr. (2002) [The Market Planning Guide -- Sixth
Edition]{.underline}, Dearborn Financial Publishing, Inc., Chicago,
Illinois.

Munoz, Julie. (2002) [Measuring and Raising Community Awareness of
Environmental Health Services -- A How-to Manual]{.underline}, 2002,
National Environmental Health Association, Denver, Colorado.

National Association of City and County Health Officials (2004)
[Marketing Public Health -- Communications Toolkit]{.underline}.
www.naccho.org/advocacy/MarketingPublicHealth.cfm