Community Survey of Perceived Environmental Health Risks in Western Australia

Transcription

1 P U B L I C H E A L T H D I V I S I O N Community Survey of Perceived Environmental Health Risks in Western Australia 2009

2 Community Survey of Perceived Environmental Health Risks in Western Australia Acknowledgements The Department of Health would like to thank the University of Western Australia, School of Population Health for their input and assistance with the design, execution, analysis and write-up of the survey. The Department of Health also extends its thanks to the Curtin University of Technology, Public Health Advocacy Institute of WA for their review and input into the report, as well as to the people of Western Australia who participated in the health risk perception survey and all our colleagues and specialists in the field who contributed to this research Community survey of perceived environmental health risks in Western Australia Prepared by: Krista Coward, Narelle Mullan and Zack Alach Science and Policy Unit Environmental Health Directorate Public Health Division Department of Health Western Australia Title: Community survey of perceived environmental health risks in Western Australia Keywords: Perceived health risk, environmental health policy, perceived responsibility of health risks Government of Western Australia

3 Table of contents 1. Introduction 4 2. Executive summary 5 3. Methods Survey Instrument Survey Population Survey Implementation Statistical Analysis Risk Perception Index 9 4. Results Survey Population Perceived Risks to Western Australians Gender differences Age Differences Education Differences Geographic Differences Industrial Activity Differences Health Status Differences Differences Based on Perceptions of Control Over Health Risks Differences Based on Ratings of their Environment Perceived Risks to Respondents and their Family Gender differences Age Differences Education Differences Geographic Differences Industrial Activity Differences Health Status Differences Differences Based on Perceptions of Control Over Health Risks Differences Based on Ratings of Their Environment Risk Perception Index Confidence in Sources of Information Perceived Responsibility for Health Risk Protection Opinions about the Local Environment Comparison of wa survey 2007 with wa sample from the national survey Discussion References 44 1

4 Community Survey of Perceived Environmental Health Risks in Western Australia Appendices Appendix 1 Survey instrument 45 Appendix 2 List of experts 56 Appendix 3 Introductory letter 57 Appendix 4 Appendix 5 Table 6. Perceived health risk of twenty-three hazards to Western Australians 58 Table 7. Perceived health risk of ten hazards to respondents and their family 59 List of figures Figure 1. Perceived health risk of twenty-three hazards to Western Australians (%) 14 Figure 2. Perceived high health risk to all Western Australian by gender (%) 15 Figure 3. Perceived high health risk to all Western Australians by age group (%) 16 Figure 4. Perceived high health risk to all Western Australians by education (%) 18 Figure 5. Figure 6. Figure 7. Perceived high health risk to all Western Australians by geographic region (%) 20 Perceived high health risk to all Western Australians by level of industrial activity (%) 22 Perceived health risk of ten hazards to the respondent and their family (%) 24 Figure 8. Perceived high health risk to respondents and their family by gender (%) 25 Figure 9. Figure 10. Figure 11. Figure 12. Perceived high health risk to respondents and their family by age group (%) 26 Perceived high health risk to respondents and their family by education (%) 27 Perceived high health risk to respondents and their family by geographic region (%) 28 Perceived high health risk to respondents and their family by level of industrial activity (%) 29 Figure 13. Confidence in information on health risks from selected sources (%) 32 Figure 14. Perceived degree of responsibility for protecting the public against health risks (%) 33 2

5 Figure 15. Perceived fulfillment of responsibility for protecting the public from health risks (%) 34 Figure 16. Attitudes and opinions statements (%) 36 List of tables Table 1. Response fraction 10 Table 2. Profile of survey respondents 11 Table 3. Self reported health status, level of control and rating of environment 12 Table 4. Rating of health status by level of control over risks to health 12 Table 5. Rating of environment by industrial activity 13 Table 6. Mean risk perception ratings (the Risk Perception Index) 31 Table 7. Responses to attitudes and opinions statements (%) 35 Table 8. Attitudes and opinions by self reported health status 36 Table 9. Table 10. Table 11. Table 12. Table 13. Responses to attitudes and opinions statements by level of control over risks to health 37 Perceived high health risks to all Western Australians by terminology common to the WA Survey 2007 and the National Survey Perceived high health risks to all Western Australians by terminology similar to the WA Survey 2007 and the National Survey Perceived high health risks to the respondent and the respondent s family by terminology common to the WA Survey 2007 and the National Survey Perceived high health risks to the respondent and the respondent s family by terminology similar to the WA Survey 2007 and the National Survey

6 Community Survey of Perceived Environmental Health Risks in Western Australia 1. Introduction Health planning and decision making are influenced by a number of factors including identified need, amenability to change, political support and community opinion to name a few. In 2000, a national survey measuring public perception of environmental health risks was undertaken in an effort to quantify community opinion of selected environmental health risks (Starr, Langley and Taylor, 2000). The Environmental Health Directorate of the Western Australian Department of Health wished to gauge current public opinion on similar environmental health risks in order to inform its strategic planning and ongoing decision making. The survey aimed to identify existing and emerging environmental health concerns across different sections of the Western Australian community. The objectives were: 1. To describe the community s perceptions of risk for a range of environmental health issues. 2. To compare perceptions of environmental health risks for the individual and their family with those of all Western Australians. 3. To compare perceptions by differing socio-economic characteristics, level of industrial activity and geographical locations. 4. To provide baseline data to enable perceptions of environmental health risk to be monitored over time. 5. To describe the community s level of confidence in sources of information about environmental health. 6. To describe the community s views on who has responsibility for managing environmental health and how well they are doing this. 7. To enable improvements in communication and decision making regarding environmental health issues. 4

7 2. Executive summary The telephone survey of randomly selected Western Australian adults (n=1710) was modeled on a national survey undertaken in To enable comparisons to be made across industrial areas, households from industrial areas were over-sampled. This was adjusted for in the statistical analyses, as was the weighting for population distribution. Respondents were asked to rate the degree of risk over a range of environmental health hazards, from global issues, e.g. climate change, to issues related to the individual behaviour, e.g. misuse of chemicals and poisons in the home and garden. The perceptions of risk were rated at two different target levels the degree of risk for all Western Australians and then for the respondent and their family. The top three hazards perceived to be the highest risk to health for all Western Australians were passive smoking, water scarcity and sun exposure. Approximately two-thirds of respondents rated these hazards as a high risk to health. The top three hazards perceived to be the highest risk to the health to the respondent and their family were: misuse of chemicals and poisons in the home and garden, food additives and germs in food. More than 20% of respondents rated these hazards as a high risk to health. Those most likely to rate hazards as a high risk to health were women, those aged over 55 years, those with secondary school only education, those with a poor self reported health status, those perceiving little control over health risks and those rating the environment where they live as Fair/Poor. Level of industrial activity did not significantly affect perceived risks to health. However, industrial areas were more likely to rate their environment as Fair/Poor. The survey measured the level of confidence in selected sources of health risk information. The source with the greatest level of confidence was medical doctors, followed by State Departments of Health and Environment. The least confidence in the range of sources was the internet and industry. The survey determined perceptions of who is responsible for protecting the public from health risks ranging from government agencies to community groups and queried how well they are doing their job. State and Commonwealth government departments were most frequently cited as having a lot of responsibility and respondents generally rated that they did their job Adequate or better. Medical doctors were seen to have a greater responsibility than local government. Two-thirds of respondents disagreed that the environment is a source of health problems where [they] live but most (71%) agreed that the land, air and water around us are, in general, more contaminated than ever before. 83% of respondents indicated that experts are mostly or sometimes able to make accurate estimates of health risks from chemicals in the environment. 5

8 Community Survey of Perceived Environmental Health Risks in Western Australia 3. Methods 3.1. Survey Instrument The questionnaire for the current survey (Appendix 1) was modeled on the questionnaire developed in the Australian survey conducted in 2000 (Starr, Langley, and Taylor, 2000). The broad sections in the WA questionnaire were: Perceived degree of health risks to the Western Australian public as a whole Perceived degree of health risks to the respondent and their family Confidence in selected information sources Responsibility to the public for health risk protection Fulfilment of responsibility for health risk protection Attitudes and opinions toward environment and control of risks Self assessment of health status Demographics. To enable comparisons with the previous Australian survey, it was important that the two were similar. However it was also important that the health risks included in the survey were current and relevant to Western Australia. Hence a panel of experts (Appendix 2) in environmental health was consulted for their input into the questionnaire design. Each expert was asked to decide on the appropriateness of particular hazards to be included in the survey. As a result a number of items were retained from the national survey, some with slight alterations to the language (e.g. the term effluent was replaced with wastewater ). Six additional items were included in order to assess public perception of local and emerging health risks. These were passive smoking, water scarcity, uranium mining, pollution of swimming beaches, rivers and lakes, chemical residues in food, and germs in swimming pools. The health risks ranged from global issues such as climate change, issues that are the responsibility of government, such as chemicals in treated drinking water, through to issues relevant to modern society such as mobile phone towers, and issues related to the behaviour of individuals, such as misuse of chemicals and poisons in the home and garden. Risk Perception The first section of the survey included a list of 23 environmental health issues and respondents were asked their opinion about the degree of risk associated with each. Each potential hazard was rated on a risk scale using None, Low, Moderate or high risk. For the first section respondents were instructed to consider the degree of risk to all Western Australians. They were then presented a list of ten different environmental health issues and were asked to rate the degree of risk using the same scale, to the respondent and the respondent s family. The order in which the hazards were presented to each respondent was randomly altered to avoid bias associated with their sequence. 6

9 The 23 hazards that respondents were asked to rate for all Western Australians were: Climate change Living near high-voltage power lines Sun exposure Pesticides in air or water, such as from spraying of crops or mosquitoes Mobile phone towers Passive smoking Water scarcity Nuclear waste Uranium mining Genetically modified food Pollution of swimming beaches, rivers and lakes Treated wastewater pumped into rivers, lakes and seas Re-use of highly treated wastewater as drinking water Diseases carried by mosquitoes Contamination of soil by industry Air pollution from cars Air pollution from factories Chemical residues in food Ozone depletion Chemical pollution overall, i.e. of air, water, food Pollution of drinking water catchment areas and groundwater Germs in swimming pools Re-use of treated wastewater on market gardens or other crops. The ten hazards that were considered specifically for respondents and their family were: Mobile phone towers Food additives Chemical termite treatments Indoor air quality Loud noise, such as from traffic or industry Smoke from wood heaters Germs in drinking water Misuse of chemicals and poisons in the home and garden Germs in food Chemicals in treated drinking water. 7

10 Community Survey of Perceived Environmental Health Risks in Western Australia Confidence in Information Sources This section of the survey included a list of 12 sources of information on health risks (e.g. media) and respondents were asked to rate their confidence in each as none, a little, moderate amount or a lot. The 2000 Australian survey included questions on the amount of information obtained from each source as well as their confidence in each. The Western Australian survey only asked about respondents confidence, as this was considered the priority. The information sources listed in the survey included mass media, the internet, agencies and groups, friends and family, health professionals, government departments, and industry. Health Risk Protection This section of the survey included a list of ten groups from which respondents were asked to rate the level of responsibility each had in protecting the public from health risks. Respondents were subsequently asked to rate how good a job each is doing in fulfilling that responsibility using the same list. The selected agencies and individuals included government departments at the national, state and local level, medical doctors, community groups, individual citizens and industry. Attitudes and Opinions To determine overall perceptions and the level of control over health risks at the local and global level, respondents were asked to rate their agreement with a series of statements. A selection of statements was obtained from the 2000 national survey. Demographics The survey concluded with questions on the respondent s general health status and demographic items. These included questions to identify age, geographical location, family structure, household income, education level and country of birth Survey Population A stratified random sample of the WA population aged 18 and over was selected. The sampling frame was all residential telephone numbers listed in the July 2004 Electronic White Pages telephone directory, the most current electronic listing at the time. A sample of 3,581 households was drawn to achieve a minimum of 1,200 interviews, based on local experience of response fractions. The sample was stratified on the basis of geographical area, that is, metropolitan, rural and remote areas. To allow comparisons to be made across industrial areas, households located in Industrial areas were over-sampled. Industrial was defined as those Statistical Local Areas that have been identified by the Department of Industry and Resources as containing Heavy Industrial Land (Department of Industry and Resource, 2008). As a result there were six strata: 1. Metro Industrial 2. Metro Non Industrial 3. Rural Industrial 4. Rural Non Industrial 5. Remote Industrial 6. Remote Non Industrial. 8

11 3.3. Survey Implementation The survey was conducted by telephone on a random sample of households in Western Australia. Selected households were posted a letter inviting their participation in the survey (Appendix 3). Up to ten callbacks were made to households in an attempt to reach potential respondents. Telephone interviews were conducted in English by trained interviewers during July 2007 and were approximately 25 minutes in length. The adult respondent, aged 18 years or over and who was last in the household to have a birthday, was selected for interview. Computer Assisted Telephone Interviewing (CATI) technology was used to improve survey administration and data collection Statistical Analysis Data were imported into STATA V9 for analysis. Data were weighted before analysis to adjust for the over-sampling in the industrial areas of WA. They were then adjusted to the age, sex and household size population distribution as described in 2006 Estimated Resident Population supplied by the Australian Bureau of Statistics (ABS). All analyses adjusted for the weighting of these data using the SURVEY commands in STATA. Distributions were determined for perception of risk for each hazard to family and all Western Australians. These are presented as population proportions plus the 95% confidence interval. Differences across sex, age, education, geography, self reported health status and perceived level of control over health risk were assessed using a chi -square test. The proportions indicating high risk were compared with the proportions indicating medium, low or no risk for each hazard. Statistical significance for difference was set at an alpha of 0.01 for all comparisons Risk Perception Index A Risk Perception Index was used to express the propensity of respondents to rate environmental health issues as high health risks. Responses for each hazard were allocated a numerical result, with 1=no risk, 2=low risk, 3=moderate risk, and 4=high risk and a mean response value was calculated for each individual. Under this index, the higher the score, the more likely it was for respondents to rate an issue as a high risk to health. 9

12 Community Survey of Perceived Environmental Health Risks in Western Australia 4. Results 4.1. Survey Population Of the 2211 people contacted to participate in the survey, 1710 (77%) completed the survey, see Table 1. From the initial sample of 3581 households, sample loss of 1370 occurred due to non-connected numbers (927), non-residential numbers (78), fax/modem connections (44) non-contactable householders after 10 attempts (278) and out-of-scope/ineligible (43). Amongst those invited to complete the survey, 68 (3%) did not participate as they were non-english speaking. Given that less than 2% of Western Australians do not speak English well/at all (ABS, 2008), this was slightly higher than expected. Table 1. Response fraction Calls Frequency (n) Per cent Refusals Non English Speaking 68 3 Incapacitated 83 4 Respondent unavailable 43 2 Completed Total The profile of respondents, including demographic characteristics and weighted percentage, is presented in Table 2. 10

13 Table 2. Profile of survey respondents Demographic variable Unweighted sample (n) Total All Respondents 1710 Gender Age Education (a) Male Female years years 55 years and over Secondary school Trade/apprenticeship/diploma Bachelor degree or higher Household income (b) Less than $40,000 $40,000 $80,000 More than $80,000 Marital status Work status Location Type of location Married/defacto Separated/divorced Widowed Never married Employed Unemployed Economically inactive (retired, student etc) Metropolitan Rural Remote Industrial Non-industrial Estimated Population Proportion (%) (a) Data not supplied by 21 respondents. (b) Data not supplied by 158 respondents. All respondents were asked questions about their health status and their level of control over risks to their health (Table 3). The majority of respondents (87%) considered their health as good or better, with only 3% rating their health as poor. This is consistent with statewide data collected in 2003 (Draper, Unwin, Serafino, Somerford and Price, 2005). Respondents from industrial areas ranked their health no differently to those from non-industrial areas (data not shown). 11

14 Community Survey of Perceived Environmental Health Risks in Western Australia Respondents generally considered themselves to have control over the risks to their health with 87% saying they had at least some control (including 54% saying they had a lot/great deal of control). Cross tabulation of these variables revealed that those rating their health as fair or poor were significantly more likely to report little control over risks to their health evident in Table 4. Table 3. Self reported health status, level of control and rating of environment Self reported health status (a) Item Rating Per cent Perceived level of control over risks to health (a) Rating of environment where live (b) (a) Weighted data. (b) Unweighted data. Excellent Very good Good Fair Poor A lot/great deal Some A little Don t know/no opinion Excellent Very good Good Fair/Poor Table 4. Rating of health status by level of control over risks to health Level of control over risks to health (%) Self reported rating of health status (%) Excellent/ Very good Good Fair/Poor A lot/great deal Some A little Note: Weighted data. p<0.01 Cross tabulation of rating of environment with level of industrial activity revealed that respondents from industrial areas were significantly more likely to rate their environment as fair/ poor as can be seen in Table 5. 12

15 Table 5. Rating of environment by industrial activity Industrial activity (Per Cent) Non-industrial Industrial Rating of environment where live (Per cent) Excellent Very Good Fair/Poor Note: Weighted data. p< Perceived Risks to Western Australians The perceived environmental health risks to Western Australians for the 23 hazards considered in this survey are shown in Figure 1, with the hazards ranked according to the percentage of respondents rating it as a high health risk. At the top of the list of hazards were passive smoking and water scarcity. Passive smoking was nominated as a high health risk by 67% of respondents and water scarcity was 66% closely followed by sun exposure (64%). The lowest ranking was re-use of treated wastewater on market gardens or other crops (12%). See Table 6, Appendix 4 for a detailed table of results. 13

16 Community Survey of Perceived Environmental Health Risks in Western Australia Figure 1. Perceived health risk of twenty-three hazards to Western Australians (%) As seen in Figure 1, when ratings of high and moderate are combined, the order of the hazards does not change much. 14

17 Gender differences Overall, the general order of risk perception was consistent for gender. Figure 2 presents the percentage of male and female respondents reporting high health risk. Women were overall more likely to rate hazards as a high health risk as compared to men. Figure 2. Perceived high health risk to all Western Australian by gender (%) P Star denotes a statistically significant difference between subgroups at a 99% confidence level The greatest gender difference in perceived health risk for Western Australians was observed for living near high-voltage power lines, with 21% more women rating it as a high health risk than men. 15

18 Community Survey of Perceived Environmental Health Risks in Western Australia Age Differences Participants 55 years or age or greater tended to be more likely to rate a hazard as a high health risk, as compared with participants aged less than 55 years. The exceptions were ozone depletion and pollution of drinking water catchment areas and groundwater. Figure 3 presents the percentage of respondents reporting high hazards by age group. Figure 3. Perceived high health risk to all Western Australians by age group (%) 16

19 There are no variations to the top three perceived health risks when the results are examined by age group. Statistically significant variations by age (at a 99% confidence level) by sub-groups are as follows: The younger age group (18-29 year olds), were less likely to consider the following as health risks when compared to the rest of the sample: Contamination of soil by industry High voltage power lines Uranium mining Genetically modified foods Mobile phone towers The middle age group (30-54 year olds) were more likely to consider the following as health risks when compared to the rest of the sample: Sun exposure However they were less likely than the rest of the sample to consider Air pollution from factories as a health risk. For the older age group (55+ year olds) were more likely to consider the following as health risks when compared to the rest of the sample: Air pollution by cars Contamination of soil by industry Chemical residues in food Air pollution from factories Chemical pollution overall Pesticides in air or water Disease carried by mosquitoes Pollution of beaches, rivers and lakes Germs in swimming pools Mobile phone towers Re-use of treated wastewater as drinking water Re-use of treated wastewater on market gardens However they were less likely than the rest of the sample to consider Ozone depletion as a health risk. The greatest difference in perceived health risk between age groups was observed for diseases carried by mosquitoes, with 30% more people aged over 55 years rating it as a high health risk than the under 30 years age group. Other hazards in which considerable differences between the older and younger age groups were noted were chemical residues in food, pesticides in air or water, mobile phone towers and high voltage power lines. 17

20 Community Survey of Perceived Environmental Health Risks in Western Australia Education Differences In general, participants with a secondary school only education were more likely to rate a health item as a high health risk, as compared with other participants. The exception was climate change, though there was little difference. Figure 4 presents the high perceived risk results considering educational background. Figure 4. Perceived high health risk to all Western Australians by education (%) By education level the top three perceived health risks remained the same, i.e. Passive smoking, Water scarcity and Sun exposure. 18

21 When comparing respondents with school-level education to the rest of the sample the statistically significant differences (at a 99% confidence level) were higher perceived health risks for: Passive smoking Disease carried by mosquitoes Treated wastewater pumped into rivers, lakes and seas Re-use of treated wastewater as drinking water When comparing respondents with trade-level education to the rest of the sample the statistically significant differences (at a 99% confidence level) were higher perceived health risks for: Air pollution by cars Chemical residues in food Chemical pollution overall Pesticides in air or water Germs in swimming pools Mobile phone towers Disease carried by mosquitoes Re-use of treated wastewater on market gardens When comparing respondents with bachelor-level education to the rest of the sample the statistically significant differences (at a 99% confidence level) were lower perceived health risks for: Air pollution by cars Chemical residues in food Air pollution from factories Chemical pollution overall High voltage power lines Disease carried by mosquitoes Pollution of beaches, rivers and lakes Treated wastewater pumped into rivers, lakes and seas Germs in swimming pools Mobile phone towers Re-use of treated wastewater as drinking water Re-use of treated wastewater on market gardens The greatest difference in perceived health risk between education levels was observed for diseases carried by mosquitoes, with 22% more respondents with school-level education rating it as a high health risk than those with bachelor-level education. Other hazards in which considerable differences between the levels of education were noted were re-use of highly treated wastewater as drinking water, chemical pollution overall and treated wastewater pumped into rivers, lakes and seas. 19

22 Community Survey of Perceived Environmental Health Risks in Western Australia Geographic Differences Figure 5 presents differences in perceived high health risk by geographic region. Generally, those residing in more remote areas were less likely to rate hazards as a high health risk. The significant exception was for diseases carried by mosquitoes. Figure 5. Perceived high health risk to all Western Australians by geographic region (%) Irrespective of location the top three perceived health risks were passive smoking, water scarcity and sun exposure. 20

23 Respondents in the metro region were statistically significantly more likely than their counterparts to rate the following health risks as high: Water scarcity Climate change However they were less likely to rate disease carried by mosquitoes as a high health risk. Respondents in the rural regions were more likely than their counterparts to statistically significantly rate (at a 99% confidence level) the following as high health risks: Chemical residues in food Pollution of groundwater Disease carried by mosquitoes Uranium mining Genetically modified food Germs in swimming pools Respondents living in remote areas were less likely to rate the following as high health risks: Water scarcity Contamination of soil by industry Chemical residues in food Air pollution from factories Climate change High voltage power lines Pollution of groundwater Pollution of beaches, rivers and lakes The greatest difference in perceived health risk between geographical areas was observed for diseases carried by mosquitoes, with 19% more respondents in rural locations rating it as a high health risk than those from metropolitan Perth. 21

24 Community Survey of Perceived Environmental Health Risks in Western Australia Industrial Activity Differences Figure 6 shows differenced in perceived high health risk by level of Industrial activity. Figure 6. Perceived high health risk to all Western Australians by level of industrial activity (%) The top three perceived health risks were again passive smoking, water scarcity and sun exposure. There were no statistically significant differences by industrial area. 22

25 Health Status Differences There were no statistically significant differences in perceived high risk by self reported rating of health status Differences Based on Perceptions of Control Over Health Risks There were no statistically significant differences in perceived high risk by level of control over health risks Differences Based on Ratings of their Environment Generally, the lower the rating respondents gave the environment in which they live, the higher the proportion of respondents rating the hazard as a high health risk. This was statistically significant for the following hazards: Nuclear waste Genetically modified food Re-use of highly treated wastewater as drinking water Air pollution from cars Germs in swimming pools. Those rating the environment as fair were statistically significantly more likely to rate uranium mining as a high health risk to all Western Australians. Those rating the environment as excellent were statistically significantly more likely to rate contamination of soil by industry as a low health risk Perceived Risks to Respondents and their Family The perceived environmental health risks to the respondent and their family for the ten hazards considered in this survey are shown in Figure 7, with the hazards ranked according to the percentage of respondents rating it as a high health risk. At the top of the list of hazards was misuse of chemicals and poisons, with 25% of respondents nominating it as a high perceived health risk. This was followed by food additives (22%) and germs in food (20%). At the bottom of the ranking was indoor air quality (6%). A more detailed table of results is available in Table 7 in Appendix 5. 23

26 Community Survey of Perceived Environmental Health Risks in Western Australia Figure 7. Perceived health risk of ten hazards to the respondent and their family (%) Misuse of Chemicals and Poisons Food Additives Germs in Food Chemical Termite Treatments Chemicals in Treated Drinking Water Germs in Drinking Water Smoke from Wood Heaters Mobile Phone Towers Loud Noise Indoor Air Quality High Moderate Low None Don't Know Overall, the ratings of high risk were substantially lower than when respondents were asked to evaluate risks to the whole of the Western Australian population. This finding remains consistent with the results of the Australian survey in As the overall percentage of perceived high risk is much less when respondents were asked to consider risks to themselves and their family, it is more appropriate to apply a wider risk consideration. When ratings of high and moderate are combined, the order of the hazards does not change dramatically (more than one position in the order), with the exception of misuse of chemicals and poisons which moves from the top of the list to fourth position. 24

27 Gender differences Overall, the general order of risk assessment was consistent between men and women. See Figure 8. Figure 8. Perceived high health risk to respondents and their family by gender (%) P Star denotes a statistically significant difference between subgroups at a 99% confidence level Women were generally more likely to rate hazards as a high health risk as compared with men, however the difference was only statistically significant for four items, those being: Food additives Chemical termite treatments Chemicals in treated drinking water Mobile phone towers Age Differences Figure 9 presents the perceived risk to respondents family by age group. Participants 55 years or age or greater were more likely to rate a hazard as a high health risk, as compared with younger participants. 25

28 Community Survey of Perceived Environmental Health Risks in Western Australia Figure 9. Perceived high health risk to respondents and their family by age group (%) For the most part the top three health risks remained the same for each of the individual age categories, i.e. Misuse of chemicals and poisons, food additives and germs in food. The exception was that of food additives amongst the youngest age group, which was not in their top three, it was replaced by germs in drinking water. Amongst the youngest age group the statistically significant variations from the rest of the sample were lower ratings for the following health risks: Chemical termite treatments Chemicals in treated drinking water Smoke from wood heaters Mobile phone towers Loud noise from traffic or industry Indoor air quality 26

29 Amongst the oldest age group the statistically significant variations from the rest of the sample were higher ratings for the following health risks: Misuse of chemicals and poisons Food additives Germs in food Chemical termite treatments Chemicals in treated drinking water Germs in drinking water Smoke from wood heaters Loud noise from traffic or industry The greatest difference in perceived health risk between age groups was observed for food additives, with 31% more people aged over 55 years rating it as a high health risk than the under 30 years age group Education Differences Figure 10 presents education differences for respondents rating high perceived risk to themselves and their family. Participants with secondary school only education were more likely to rate a health item as a high health risk, as compared to other participants. Figure 10. Perceived high health risk to respondents and their family by education (%) 27

30 Community Survey of Perceived Environmental Health Risks in Western Australia Respondents with school-level education were more likely than the rest of respondents to rate the following health risks as high : Germs in food Chemicals in treated drinking water Germs in drinking water Respondents with bachelor-level education were less likely than the rest of the sample to rat e the following health risks as high : Germs in food Chemicals in treated drinking water Germs in drinking water Smoke from wood heaters Mobile phone towers The greatest difference in high perceived health risk between education levels was observed for germs in drinking water, with 15% difference between school-level education respondents and bachelor-level education respondents Geographic Differences Figure 11 shows differences in perceived high health risk by geographic region. Generally, the more remote the respondent s location, the less likely they were to rate hazards as a high risk to health. Figure 11. Perceived high health risk to respondents and their family by geographic region (%) 28

31 Respondents in the metro area were more likely than respondents who live outside the metro area to rate the following as high health risks: Chemical termite treatments Smoke from wood heaters Mobile phone towers. Respondents who live in remote areas were less likely than respondents who live elsewhere to rate food additives, chemical termite treatments and smoke from wood heaters as high health risks. The greatest difference in perceived health risk between geographical locations was observed for misuse of chemicals and poisons, with 14% more people in metropolitan locations rating it as a high health risk than those in remote locations Industrial Activity Differences Figure 12 shows differences in perceived high health risk by level of industrial activity. There was no statistically significant differences between respondents from industrial and nonindustrial areas. Figure 12. Perceived high health risk to respondents and their family by level of industrial activity (%) 29

32 Community Survey of Perceived Environmental Health Risks in Western Australia Health Status Differences Respondents rating their own health as fair or poor were more likely to rate the hazards to them and their family as a high health risk. This was significant for the following hazards: Misuse of chemicals and poisons in the home and garden Smoke from wood heaters Germs in drinking water Germs in food Differences Based on Perceptions of Control Over Health Risks Respondents rating their level of control over health risks as a little were more likely to rate hazards to themselves and their families as a high risk. This was significant for the following hazards: Mobile phone towers Food additives Indoor air Loud noise, such as from traffic or industry Chemicals in treated drinking water. In addition, respondents rating their level of control over health risks as a lot/great deal were more likely to rate germs in drinking water as a low health risk Differences Based on Ratings of Their Environment Generally, the lower the rating people gave the environment in which they live, the higher the proportion of respondents rating the hazard as a high health risk. This was statistically significant for the following hazards: Loud noise, such as from traffic or industry Smoke from wood heaters Germs in food Chemicals in treated drinking water Risk Perception Index On average across all issues, respondents rated risk as moderate. The mean risk perception index for all respondents, was 3.16 (95% CI: ). The mean risk perception ratings are presented in Table 8. 30

33 Table 6. Mean risk perception ratings (the Risk Perception Index) Index Proportion (%) Note: 1=no risk, 2=low risk, 3=moderate risk, and 4=high risk Overall, the majority of respondents gave an average response to questions about health issues of moderate health risk or greater (equivalent to 3 or higher on the Risk Perception Index). There were differences in the mean the risk perception index with several demographic variables. Respondents in the following categories had higher index scores: Women (p<0.01) Over 55 year olds (p<0.01) Lower income (low compared with high p<0.01) Fair / poor self reported health status (fair versus good p<0.01) Little self reported control over risks to health (not significant) Fair / poor rating of environment where live (not significant) as compared with the other groups in their category. Respondents in the following categories had lower index scores: year olds (p<0.01) Bachelor degree or higher (p<0.01) Remote locations (p<0.01 for rural, borderline for metro) Higher income (p<0.01) Very good / excellent self reported health status (p<0.01) A lot of self reported control over risks to health (not significant) Very good rating of environment where live (not significant) as compared to the other groups in their category Confidence in Sources of Information The level of confidence respondents had in the selected sources of information on health risks is presented in Figure 13. More than two in five respondents (42%) had a lot of confidence in the information from medical doctors. The next most certain sources, with up to a quarter of respondents indicating a lot of confidence, were the State Department of Health (26%) and State Departments of Environment (22%). Industry was the least frequently reported source with a lot of confidence (5%). 31

34 Community Survey of Perceived Environmental Health Risks in Western Australia The national survey in 2000 indicated that the most frequently used source of information about health risks was the media newspaper and magazines, television and radio. Despite this, less than one in ten respondents in this survey indicated they have a lot of confidence in media sources. The same result was observed in the national survey. When the categories of a lot and moderate amount are combined, it is evident that most people are confident in all sources of information except industry and the internet. The latter may be due in part to fewer people accessing information from the internet. Figure 13. Confidence in information on health risks from selected sources (%) Respondent s level of confidence in sources of information on health risks was further analysed to identify differences based on various demographic variables. Women were more likely to rate their confidence in these sources of information as moderate and a lot as compared to men. This was statistically significant for: alternative therapists (75% v 61%) friends and relatives (76% v 63%) environmental groups (76% v 67%) 32

35 When confidence in these sources of information were compared for different age groups it was revealed that significantly more respondents aged years rated their confidence in local community groups as a little or none as compared with the older age groups (50% v 32%, p<0.01). There were no other differences for information sources based on age. Respondents with a bachelor level of education were less likely to rate their confidence in these sources of information as a little or none as compared with those with school and trade/diploma levels of education, with the exception of friends and relatives and industry. This difference was significant for environmental groups (19% v 30% & 33% respectively, p<0.01). When confidence in these sources of information was compared by geographical location, there were no significant differences. Respondents from industrial areas, however, more likely to rate their confidence as a little or none as compared to those in non-industrial areas, with the exception of newspapers and magazines Perceived Responsibility for Health Risk Protection Figure 14 presents perceived responsibilities for public health protection. State and Commonwealth government departments were most frequently cited as having a lot of responsibility to protect Australians from health risks (up to 70%). Local community groups were the least frequently reported group with a lot of responsibility (26%). There was a moderate to high level of responsibility seen for all the categories, including for individual citizens and local community groups. Medical doctors were seen to have a greater responsibility than local government. Figure 14. Perceived degree of responsibility for protecting the public against health risks (%) 33

36 Community Survey of Perceived Environmental Health Risks in Western Australia Figure 15 presents perceived satisfaction in considering the same public health protection responsibilities. According to the survey, respondents were satisfied with the job these departments and groups do to protect Australians from health risks. More than 73% of respondents indicated that all groups, except industry, do an adequate job or better. Few thought these groups were doing excellent jobs. Despite their lower level of satisfaction, the majority of respondents (53%) felt that industry did an adequate job or better. Medical doctors were cited most frequently as doing an excellent or good job at protecting Australians from health risks a higher rating than any level of government. Figure 15. Perceived fulfillment of responsibility for protecting the public from health risks (%) 4.7. Opinions about the Local Environment The majority of respondents (67%) disagreed with the statement The environment is a source of health problems where I live, however one-quarter (25%) agreed (Table 7). Further analysis revealed that respondents rating their health as fair or poor were more likely to agree with the statement (Table 8). Respondents reporting some level of control over risks to their health were more likely to disagree with the statement (Table 9). Respondents from industrial areas were significantly more likely to agree with the statement compared with those from non-industrial areas (37% v 23%, p<0.01). Almost half (48%) of respondents agreed with the statement I believe my community is becoming a healthier place in which to live, however more than one third (37%) disagreed. Further analysis revealed that respondents reporting little control over risks to their health were significantly more likely to disagree with the statement (Table 9). 34

37 The significant majority of respondents (71%) agreed with the statement The land, air and water around us are, in general, more contaminated than ever before. Further analysis revealed that respondents reporting little control over risks to their health were more likely to agree with the statement. The results presented in Table 7 are consistent with the national survey in 2000, which found that the level of concern about problems at the local level was lower than that expressed at a more global level. Table 7. Responses to attitudes and opinions statements (%) Statement The environment is a source of health problems where I live I believe my community is becoming a healthier place in which to live The land, air, and water around us are, in general, more polluted than ever before Agree Strongly Rating (Per cent) Agree Neutral Disagree Disagree Strongly Don t know/no opinion < Note: Numbers are percentage of sample population (n=1703). Weighted data. 35

38 Community Survey of Perceived Environmental Health Risks in Western Australia Figure 16 presents the results from Table 7 graphically centred about the neutral position. Figure 16. Attitudes and opinions statements (%) Table 8. Attitudes and opinions by self reported health status Rating on statement: The environment is a source of health problems where I live Agree Neutral Disagree Level of control over risks to health A lot/great deal Some A little Self reported rating of health status (Per cent) Very good Good Fair/Poor Note: Numbers are percentage of sample population (n=1703). Weighted data. 36

39 Table 9. Responses to attitudes and opinions statements by level of control over risks to health Rating on statements The environment is a source of health problems where I live Agree Neutral Disagree I believe my community is becoming a healthier place in which to live Agree Neutral Disagree The land, air and water around us are, in general, more polluted now than ever before Agree Neutral Disagree Extent that experts are able to make accurate estimates of health risks Mostly Sometimes Rarely Level of control over risks to health (Per cent) A lot/great deal Some A little Note: Numbers are percentage of sample population (n=1703). Weighted data. Respondents indicated greatest confidence in experts with 83% indicating that experts are mostly or sometimes able to make accurate estimates of health risks from chemicals in the environment. Further analysis revealed that respondents reporting some or little control over risks to their health were significantly less likely to have this opinion 37

40 Community Survey of Perceived Environmental Health Risks in Western Australia 5. Comparison of wa survey 2007 with wa sample from the national survey 2000 Table 10. Perceived high health risks to all Western Australians by terminology common to the WA Survey 2007 and the National Survey 2000 WA Survey 2007 (%) WA sample from National Survey 2000 (Approx %) Sample size Nuclear Waste 52 P 66 Chemical pollution overall 44 P 54 Ozone depletion 50 P 59 Pesticides in air or water Air pollution from cars Contamination of soil by industry Air pollution from factories Disease carried by mosquitoes High-voltage power lines Genetically modified food Climate change 43 P 18 P Star denotes a statistically significant difference between subgroups at a 99% confidence level 38

41 Table 11. Perceived high health risks to all Western Australians by terminology similar to the WA Survey 2007 and the National Survey 2000 WA Survey 2007 Items WA Survey 2007 (%) WA sample from National Survey 2000 (Approx %) WA sample from National Survey 2000 Items Passive smoking 67 P 80 Cigarette smoking Sun exposure Suntanning Chemical residues in food Treated wastewater pumped into rivers, lakes, seas Pollution of beaches, rivers, lakes Re-use of treated wastewater on market gardens P P P Star denotes a statistically significant difference between subgroups at a 99% confidence level Insecticide and weedkiller residue in food Treated sewage pumped into rivers and sea Pollution of reservoir catchment areas Re-use of treated sewage on crops Table 12. Perceived high health risks to the respondent and the respondent s family by terminology common to the WA Survey 2007 and the National Survey 2000 WA Survey 2007 (%) WA sample from National Survey 2000 (Approx %) Sample size Misuse of chemical and poisons 25 N/A Food additives Germs in drinking water Chemical termite treatments Indoor air quality 6 P 12 Smoke from wood heaters 14 P 9 P Star denotes a statistically significant difference between subgroups at a 99% confidence level 39

42 Community Survey of Perceived Environmental Health Risks in Western Australia Table 13. Perceived high health risks to the respondent and the respondent s family by terminology similar to the WA Survey 2007 and the National Survey 2000 WA Survey 2007 Items WA Survey 2007 (%) WA sample from National Survey 2000 (Approx %) WA sample from National Survey 2000 Items Germs in food Food poisoning Chemical in treated drinking water Chemical in drinking water Mobile phone towers Mobile phones Loud noise 11 P 17 P Star denotes a statistically significant difference between subgroups at a 99% confidence level Loud noise from traffic or industry The results of the comparisons in Table 10 and Table 12 show that the results from the Western Australian Perceived Risk Survey 2007 and the WA sample of the National Perceived Risk Survey 2000 are generally similar where common hazard items exist. Where subgroups in these tables have been identified with a statistically significant difference, it is apparent that the WA population in 2007 has perceived a lower degree of high health risk than was evident in the 2000 survey for most hazards. The two exceptions to this trend are Climate change and Smoke from wood heaters. Climate change in particular with its increasing proportion of media coverage has had a substantial increase in its perceived high health risk as evident in the WA Survey An interesting potential is that Smoke from wood heaters is indirectly linked with climate change issues. Table 11 and Table 13 have been included for information purposes. 40

43 6. Discussion The Western Australian Perceived Environmental Health Risk Survey has identified that the issues of most concern to all Western Australians from all of the options presented were: Passive smoking, Water scarcity and Sun exposure. Approximately two-thirds of respondents rated these hazards as a high risk to health. Of the options presented as risks faced directly by each respondent (themselves) and their family, the issue of main overall concern was food additives. While the top three risks to all Western Australians of: Passive smoking, Water scarcity and Sun exposure are clearly evident, there exists a large intermediate group that ranked down from Nuclear waste with an overall perceived high risk response of 52% to Germs in swimming pools with an overall perceived high risk response of 27%. The three of the lowest perceived risks consistently throughout the study, were Mobile phone towers, Re-use of treated wastewater as drinking water and Re-use of treated wastewater on market gardens. This report acknowledges the influence adopted from the study design of the enhealth Environmental Health Risk Perception in Australia (Starr, Langley and Taylor, 2000) which is discussed in section 3.0 Methods. The top three health risks for the national study were Cigarette smoking, Illegal drugs, and Suntanning. The Western Australian study has 11 out of 23 hazard items common to the national study for risks to all Western Australians, and 7 out of 12 hazard items for risk to the respondent and the respondent s family. A general comparison of the two studies has found that the majority of the common items have displayed consistency in their rankings of high perceived risk. The common hazard items which do not display consistency with the national study are: Nuclear waste, Climate change, Chemical pollution overall, Ozone depletion, Indoor air quality and Smoke from wood heaters. The hazard items of Nuclear waste, Chemical pollution overall, Ozone depletion, and Indoor air quality are all perceived as a lower risk in the Western Australian survey 2007 when compared to the Western Australian sample of the national survey Climate change and Smoke from wood heaters are perceived as a higher risk in the Western Australian Survey 2007 when compared to the Western Australian sample of the national survey In the section of the study considering risk to the respondent and the respondent s family, the perceived risk response indications for low and none held the majority of respondent s considerations. The lowest combination of low and none as a proportion of response indications was for Food additives with 40% while Indoor air quality had the greatest overall proportion of 68%. The results detailing confidence in information sources clearly indicated that Medical Doctors were perceived to be the best information source. The State Dept. of Health offered the second best information source with Industry in last place. In the results for perceived responsibility, the State Dept. of Health had the highest ranking with the other listed government departments: Commonwealth Dept. of Health, State Dept. of Environment and Commonwealth Dept. of Environment were all relatively even in ranked order. Local community groups were seen to have the least responsibility. 41

44 Community Survey of Perceived Environmental Health Risks in Western Australia In considering perceived fulfillment of responsibility in protecting the Australian public, this report indicated a rating of 74% for Adequate or better for all agencies with the exception of Industry. The State Dept. of Health recorded Adequate as being the most common response. Overall there was very little difference in ranking between each listed agency with the exception of Industry which had a higher Poor rating and Medical Doctors which had a higher Excellent rating and a lower Poor rating. The published work of Siegrist and Cvetkovich (2000) has considered social trust where it influences both perceived risks and perceived benefits. They suggest that in assessing most technologies people rely on risk-benefit information provided by sources of information that they trust. The trust in government is an ongoing challenge for policymakers. As a concept for future research, the views and perceived risk of Western Australian regulators, scientists and government officials could be considered as independent groups following on the work of Willis and DeKay (2007) in order to attempt to identify perception differences to the general public. Purvis-Roberts et al. (2007) also consider the difference in perception from levels of expertise in their research considering risks in the nuclear industry, where it is generally accepted that the public exhibits higher concern for this hazard. The differences in perceived risk by gender, age and education are important considerations. Results from other studies have also suggested a tendency for gender, age, education and location to each impact society s perceived risk in coordination with social trust. Lemyre et al. (2006) observed that perceived risk was higher among women and respondents with lower education or income. Siegrist et al. (2007) found that that gender was significantly correlated with perceived nanotechnology risks and that women had higher risk ratings than men with these differences attributable to social trust, perceived benefits, and general attitudes toward technology. The results from the Western Australian perceived risk survey consider a range of hazards as well as a range of the overall trust in the institutions designed to protect the public s health. According to Bickerstaff (2004) there needs to be an improvement towards the gap between the expert and general public perceptions of risk (the difference in a statistical risk on the one hand and perceived risk on the other). Thus to balance the public s perceptions for emerging risks such as climate change, all government institutions may need to consider the perceived fulfillment of responsibility to the community and trust in government as an important priority. The aim of the study was to inform the Western Australian Department of Health strategic planning and ongoing decision making processes. The information contained within the study has the ability to achieve this when used in combination with other sources of evidence. The sample size was large enough to provide valuable and useful information, and as this is a duplication of the national risk perception study, there is the ability to make comparisons between Western Australia and Australia. While there are benefits in replicating a national study, the tool itself has many limitations. The phone questionnaire is a long tool and may be onerous for people to complete on the phone. There are no open ended questions, preventing people from offering any comments. The 33 (includes 23 hazards for all WA and the 10 hazards for their family) categories of hazards were pre-defined and these may appear to provide a desired or predetermined outcome. 42

45 Quantitative risk assessment does not necessarily address threats to health as the community perceives them. The challenge for the Department of Health and other guiding agencies is to combine the valuable data provided by the structured methodology of the perceived health risk survey with qualitative approaches that recognise that risk is a contested term. The outcome should be meaningful results for all the stakeholders, including the residents throughout the state. There is a need for the Department of Health and other health agencies to act on the results of this study in a timely manner, as the report outlines the perceived risks at the particular time of the survey. For example, there may be a different response for the category of uranium mining due to the recent political changes in Western Australia. For this report to be a useful policy tool, the information needs to utilized and integrated as soon as possible. There is a valid argument for conducting this survey in 2-3 years time to assess changes in perception over time. 43

46 Community Survey of Perceived Environmental Health Risks in Western Australia 7. References Australian Bureau of Statistics Census Community Profile Series: Western Australia. Bickerstaff, K Risk perception research: socio-cultural perspectives on the public experience of air pollution. Environment International. 30:(2004) Department of Industry and Resources, Western Australia Heavy Industrial Land. Draper G, Unwin E, Serafino S, Somerford P, Price S Health Measures 2005: A report on the health of the people of Western Australia. Perth: Department of Health WA. Lemyre, L., Lee, J.E.C., Mercier, P., Bouchard, L., and Krewski, D The structure of Canadians health risk perceptions: Environmental, therapeutic and social health risks. Health, Risk & Society, June 2006: 8(2): Lomax, G.P From Breeder Reactors to Butterflies: Risk, Culture, and Biotechnology. Risk Analysis, Vol. 20, No. 5, Purvis-Roberts, K.L., Werner, C.A. and Frank, I Perceived Risks from Radiation and Nuclear Testing Near Semipalatinsk, Kazakhstan: A Comparoson Between Physicians, Scientists, and the Public. Risk Analysis, Vol. 27, No. 2, Siegrist, M., Cvetkovich, G Perception of Hazards: The Role of Social Trust and Knowledge. Risk analysis, Vol. 20, No. 5, Siegrist, M., Keller, C., Kastenholz, H., Frey, S. and Wiek, A Laypeople s and Experts Perception of Nanotechnology Hazards. Risk analysis, Vol. 27, No. 1, Starr G, Langley A and Taylor A Environmental Health Risk Perception in Australia: a research report to the enhealth Council. Canberra: Department of Health and Aged Care. Willis, H.H. and DeKay, M.L The Roles of Group Membership, Beliefs, and Norms in Ecological Risk Perception. Risk analysis, Vol. 27, No. 5,

47 Appendices Appendix 1 Survey Instrument WEST Australian Health Risk Perception Survey Introduction Good My name is I m calling on behalf of the West Australian Department of Health. We are conducting a survey on a range of health issues. You would have received a letter recently about the survey on behalf of the WA Department of Health. We recently sent you a letter telling you about the survey. Did you receive the letter? (single response) 1. Yes 3. Unsure/Don t know/can t remember 2. No 4. Refused Could I please speak with the person in the household, aged 18 and over, who was the last to have a birthday. I can assure you that all information given will remain confidential. The answers from all people interviewed will be gathered together and presented in a report. No individual answers will be passed on. On average the survey takes XXX minutes, and participation is voluntary. Section a: demographics As some of the next questions relate to certain groups of people only, could you please tell me: A1. What was your age last birthday? (single response) Enter age A2. Voice (ask if unsure) Male Female A3. Including yourself, how many people aged 18 and over live in this household? (single response enter number of people 18 years and over) Enter number Not stated {999} A4. In general, would you rate the environment where you live? (read options single response) Excellent Very good Good Fair Poor 45

48 Community Survey of Perceived Environmental Health Risks in Western Australia Section b: risk perception public I will now read out a list of items. Please give your opinion for each one as to whether you consider it to be no risk to health, or a low, moderate, or high health risk. This first section is about health risks to all West Australians. [Randomise order of questions] How much of a health risk to all West Australians is/are: (read options single response) 1 None 2 Low 3 Moderate 4 High 5 Don t know None Low Moderate High 1 Climate change? Living near high-voltage power lines? Sun Exposure? Pesticides in air or water, such as from spraying of crops or mosquitoes? Mobile phone towers? Passive smoking? Water scarcity? Nuclear waste? Uranium mining? Genetically modified food? Pollution of swimming beaches, rivers and lakes? Treated wastewater pumped into rivers, lakes and seas? Re-use of highly treated wastewater as drinking water? Diseases carried by mosquitoes? Contamination of soil by industry? Air pollution from cars? Air pollution from factories? chemical residues in food? Ozone depletion? Chemical pollution overall, i.e. of air, water, food? Pollution of drinking water catchment areas and groundwater? Germs in swimming pools? Re-use of treated wastewater on market gardens or other crops? Don t know 46

49 Section c: risk perception family This section is about health risks to you and your family. [Randomise order of questions] How much of a health risk to you and your family are: (read options single response) 1 None 2 Low 3 Moderate 4 High 5 Don t know None Low Moderate High 1 Mobile phones towers? Food additives? Chemical termite treatments? Indoor air quality? Loud noise, such as from traffic or industry? Smoke from wood heaters? Germs in drinking water? Misuse of chemicals and poisons in the home and garden? Germs in food? Chemicals in treated drinking water? Section d: confidence in information This section is about how confident you are in the information given on health risks. C1 How much confidence do you have in information on health risks from TV and radio? (read options single response) 1 None 2 A little 3 Moderate amount 4 A lot 5 Don t watch or listen 6 Don t know/no opinion C2 How much confidence do you have in information on health risks from Newspapers and magazines? (read options single response) 1 None 2 A little 3 Moderate amount 4 A lot 5 Don t read 6 Don t know/no opinion Don t know 47

50 Community Survey of Perceived Environmental Health Risks in Western Australia How much confidence do you have in information on health risks from? 1 None 2 A little 3 Moderate amount 4 A lot 5 Don t use 6 Don t know/no opinion None A little Moderate amount A lot Don t use Don t know/no opinion C3 Medical doctors C4 Alternative therapists eg. chiropractors, naturopaths How much confidence do you have in information on health risks from? (read options single response) 1 None 2 A little 3 Moderate amount 4 A lot 5 Don t access or use 6 Don t know/no opinion None A little Moderate amount A lot Don t access or use Don t know/ No opinion C5 National and state environmental groups C6 Local community groups

51 How much confidence do you have in information on health risks from? (read options single response) 1 None 2 A little 3 Moderate amount 4 A lot 5 Don t access 6 Don t know/no opinion None A little Moderate amount A lot Don t access Don t know/ No opinion C7 The State Departments of Health C8 The State Departments of the Environment C9 Your local council or shire C10 Friends and relatives C11 Industry C12 The internet

52 Community Survey of Perceived Environmental Health Risks in Western Australia Section e: responsibility for health risk protection degree This section is about who is responsible for protecting the Australian public from health risks. How much responsibility for protecting the Australian public from health risks does..have? (read options single response) 1 None 2 A little 3 Moderate amount 4 A lot 5 Don t know/no opinion None A little Moderate amount A lot Don t know/ No opinion E1 the Commonwealth Department of Health E2 the State Department of Health E3 the Commonwealth Department of the Environment E4 the State Department of the Environment E5 Your local council or shire E6 Medical doctors E7 Industry E8 National and state environmental groups E9 Local community groups E10 Individual citizens

53 Section f: responsibility for health risk protection fulfilment This section is about how good a job these groups are doing at protecting the Australian public from health risks. Sequence guide: If answer in section 0=1 (no responsibility) Skip question in section F. How good a job in protecting the Australian public from health risks is doing? (read options single response) 1 Excellent 2 Good 3 Adequate 4 Poor 5 Don t know/no opinion Excellent Good Adequate Poor Don t know/ No opinion F1 the Commonwealth Department of Health F2 the State Department of Health F3 the Commonwealth Department of the Environment F4 the State Department of the Environment F5 Your local council or shire F6 Medical doctors F7 Industry F8 National and state environmental F9 Local community groups

54 Community Survey of Perceived Environmental Health Risks in Western Australia Section g: attitudes and opinions I will now read out some statements. For each statement please indicate whether you agree or disagree with the statement, from your perspective. The categories are: agree, agree strongly, disagree or disagree strongly. [Randomise order of questions] Agree strongly Agree Neutral Disagree Disagree strongly Don t know/ No opinion G1 G2 G3 The environment is a source of health problems where I live I believe my community is becoming a healthier place in which to live The land, air, and water around us are, in general, more polluted now than ever before I will now read out two questions. For each please indicate a response from your perspective.. H1 To what extent are experts are able to make accurate estimates of health risks from chemicals in the environment. (single response) 1. Mostly { } 2. Sometimes { } 3. Rarely { } 4. Don t know/no opinion { } H2 How much control over risks to your health do you have? (single response) 1. A lot/ great deal { } 2. Some { } 3. A little { } 4. Don t know/no opinion { } Section i. Risk factors Now a general question. I1. In general, would you say your health is (read options single response) 1. Excellent { } 2. Very good { } 3. Good { } 4. Fair { } 5. Poor { } 52

55 Section j. Demographics J1. Including yourself, how people aged 18 years and over live in this household? (single response enter number of people under 18 years. Enter 0 if none) Enter number Not stated {999} J2. What is the postcode of the house? (single response if postcode is not known, enter 9999) Enter postcode Not stated {9999} J3. What town or suburb do you live in? (single response enter town/suburb) Enter town/suburb J4. How many listings do you have in the White Pages telephone book? (Single Response Code Don t Know/Unsure as 998 and Refused as 999) Enter number J5. What best describes your current living arrangements? (Read Options. Single Response) 1. Living with my parent(s) 2. Living with other family members 3. Living with friends 4. Living with a partner and children 5. Living with a partner but no children 6. Living alone 7. Living in a nursing home 8. Living in a retirement village 9. Other living arrangements 998 Unsure/Don t Know/Can t Remember 999 Refused J6. What is your marital status? (Read Options. Single Response) 1. Married 2. Living with a partner/defacto 3. Widowed 4. Divorced 5. Separated 6. Never Married 998 Unsure/Don t Know/Can t Remember 999 Refused 53

56 Community Survey of Perceived Environmental Health Risks in Western Australia J7. I would now like to ask you about your household s income. Before tax is taken out, which of the following ranges best describes your household s income, from all sources, over the past 12 months? (Read Options. Single Response) 1. Under $20, $20,000 - $40, $40,000 - $60, $60,000 - $80, $80,000 - $100, More than $100, Unsure/Don t Know/Can t Remember 999 Refused J8. What is the highest level of primary or high school that you have completed? (Single Response. Interviewer note: Prompt if necessary) 1. Never attended school 2. Currently still at school 3. Year 8 or below 4. Year 9 or equivalent 5. Year 10 or equivalent 6. Year 11 or equivalent 7. Year 12 or equivalent (matriculation/leaving) 998 Unsure/Don t Know/Can t Remember 999 Refused J9. Have you completed any qualifications (since leaving school)? J10. (Single Response. Interviewer note: Prompt if necessary) 0. No (Fix flow so that the next question isn t asked) 1. Yes 998 Unsure/Don t know/can t remember (Fix flow so that the next question isn t asked) 999 Refused (Fix flow so that the next question isn t asked) J11. What is the highest qualification you have completed? (Single Response. Interviewer note: Prompt if necessary) 1. Bachelor degree or higher 2. Diploma or certificate taking more than 12 months full time 3. Diploma or certificate taking less than 12 months full time 4. Trade / apprenticeship 998 Unsure/Don t know/can t remember 999 Refused 54

57 J12. Which ONE of the following best describes your current employment status? Are you: (Single Response. Read options) 1. Employed for wages, salary or payment in kind 2. Unemployed 3. Engaged in home duties 4. Retired 5. A student 6. Other 998 Unsure/Don t know/can t remember 999 Refused J13. Which geographic area were you born in? (Single Response) 1. UK including Wales, Scotland and Eire 2. New Zealand 3. North America 4. Central and South America 5. Africa 6. Europe 7. Middle East 8. ASEAN Country (These include Burma, Brunei Darussalam, Cambodia, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam) 9. China 10. India 11. Other 998 Unsure/Don t know/can t remember 999 Refused That concludes the survey. On behalf of the Department of Health, thank you very much for taking part in this survey. 55

58 Community Survey of Perceived Environmental Health Risks in Western Australia Appendix 2 List of Experts Ms Jo Clarkson, Healthway Mr Simon Denniss, Environmental Health Directorate, Department of Health Dr Jane Heyworth, University of Western Australia Dr Andrea Hinwood, Environmental Protection Authority Mr Michael Kerr, Department of Environment and Conservation Ms Michele Koscy, Health Consumers Council Dr Andrew Langley, Queensland Health Mr Ross Spark, Queensland Health Prof Jeff Spickett, Curtin University of Technology Mr Richard Theobald, Environmental Health Directorate, Department of Health Mr Llew Withers, Environmental Health Directorate, Department of Health 56

59 Appendix 3 Introductory Letter Dear <<Name of householder>> The Environmental Health Perceived Risk Survey I am writing to ask you to take part in an important Department of Health initiative, the Environmental Health Perceived Risk Survey. The University of Western Australia (UWA) Survey Research Centre conducts the survey on our behalf. We randomly select households to be part of the survey by using a version of the electronic white pages. Your household has been chosen to take part in the survey. In the next few weeks, an interviewer from the UWA Survey Research Centre will telephone your house. The interviewer will ask to speak with one of the people who live in the house aged 18 and over. It may be anyone living in the house. The interviewer will ask the chosen person to take part in an interview over the telephone. The interview will last about fifteen minutes. All information collected will be strictly confidential. While you do not have to participate I hope that you do. We will use the results from the survey to better understand how much certain environmental issues are considered a risk to the health of Western Australians. This valuable up-to-date information will enable us to monitor changes over time and assist in the prioritising of our environmental health services in the future. We want to be more responsive to local needs and it is your response that will help us form a picture about the environmental health risks for your local community. If you have any queries about the survey, please call Vicki Graham or the supervisor on duty on (08) , if you are calling from Perth, or on if you are calling from outside Perth. They will be happy to answer your questions. I would like to thank you in advance for your support and participation in this important initiative. Yours sincerely 57

60 Community Survey of Perceived Environmental Health Risks in Western Australia Appendix 4 Table 6. Perceived Health Risk of Twenty-three Hazards to Western Australians Type of Risk High Moderate Low None Don t Know % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI Passive smoking 66.7 ( ) 22.9 ( ) 9.0 ( ) 1.0 ( ) 0.3 ( ) Water scarcity 66.3 ( ) 24.4 ( ) 6.2 ( ) 2.4 ( ) 0.7 ( ) Sun exposure 63.6 ( ) 30.2 ( ) 5.0 ( ) 0.8 ( ) 0.4 ( ) Nuclear waste 52.0 ( ) 16.2 ( ) 19.6 ( ) 7.2 ( ) 5.1 ( ) Ozone depletion 49.8 ( ) 35.5 ( ) 7.1 ( ) 1.4 ( ) 6.2 ( ) Air pollution from cars 48.5 ( ) 37.5 ( ) 12.1 ( ) 1.2 ( ) 0.7 ( ) Contamination of soil 46.5 ( ) 34.1 ( ) 14.8 ( ) 1.6 ( ) 3.1 ( ) Chemical residues in food 44.5 ( ) 34.7 ( ) 15.3 ( ) 1.3 ( ) 4.2 ( ) Air pollution from factories 44.4 ( ) 37.8 ( ) 14.5 ( ) 1.7 ( ) 1.6 ( ) Chemical pollution overall 44.0 ( ) 38.6 ( ) 15.2 ( ) 1.5 ( ) 0.7 ( ) Climate change 42.7 ( ) 39.9 ( ) 12.0 ( ) 2.2 ( ) 3.2 ( ) High-voltage power lines 39.9 ( ) 32.2 ( ) 18.8 ( ) 3.0 ( ) 6.1 ( ) Pesticides 39.6 ( ) 36.9 ( ) 18.8 ( ) 2.0 ( ) 2.8 ( ) Pollution of groundwater 38.6 ( ) 36.0 ( ) 20.1 ( ) 1.8 ( ) 3.4 ( ) Diseases carried by mosquitoes 37.7 ( ) 38.0 ( ) 21.4 ( ) 0.7 ( ) 2.2 ( ) Pollution of beaches 35.2 ( ) 40.6 ( ) 20.7 ( ) 1.8 ( ) 1.7 ( ) Wastewater pumped into rivers 31.7 ( ) 32.2 ( ) 27.6 ( ) 4.5 ( ) 4.1 ( ) Uranium mining 29.7 ( ) 25.7 ( ) 28.0 ( ) 6.1 ( ) 10.4 ( ) Genetically modified food 27.9 ( ) 32.5 ( ) 26.1 ( ) 4.3 ( ) 9.3 ( ) Germs in swimming pools 27.3 ( ) 37.2 ( ) 28.3 ( ) 2.7 ( ) 4.5 ( ) Mobile phones 20.9 ( ) 38.4 ( ) 26.8 ( ) 3.1 ( ) 10.9 ( ) Re-use of highly treated wastewater as drinking water Re-use of treated waste-water on market gardens 20.7 ( ) 29.6 ( ) 34.6 ( ) 9.6 ( ) 5.5 ( ) 11.8 ( ) 29.9 ( ) 43.9 ( ) 10.1 ( ) 4.3 ( ) 58

61 Appendix 5 Table 7. Perceived Health Risk of Ten Hazards to the Respondent and their Family Type of Risk High Moderate Low None Don t Know % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI Misuse of Chemicals and Poisons 25.0 ( ) 17.1 ( ) 42.9 ( ) 13.7 ( ) 1.3 ( ) Food Additives 22.0 ( ) 37.7 ( ) 32.5 ( ) 6.5 ( ) 1.3 ( ) Germs in Food 20.5 ( ) 23.6 ( ) 45.3 ( ) 8.4 ( ) 2.2 ( ) Chemical Termite Treatments 16.6 ( ) 25.9 ( ) 41.3 ( ) 12.2 ( ) 4.0 ( ) Chemicals in Treated Drinking Water 16.4 ( ) 24.8 ( ) 43.0 ( ) 11.8 ( ) 4.0 ( ) Germs in Drinking Water 15.5 ( ) 20.6 ( ) 49.7 ( ) 11.6 ( ) 2.6 ( ) Smoke from Wood Heaters 13.9 ( ) 25.2 ( ) 39.3 ( ) 20.8 ( ) 0.8 ( ) Mobile Phone Towers 12.5 ( ) 20.7 ( ) 38.4 ( ) 23.1 ( ) 5.3 ( ) Loud Noise 11.4 ( ) 25.2 ( ) 44.2 ( ) 18.4 ( ) 0.9 ( ) Indoor Air Quality 6.2 ( ) 24.7 ( ) 46.7 ( ) 20.5 ( ) 1.8 ( ) 59

62 60 Community Survey of Perceived Environmental Health Risks in Western Australia

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64 Produced by Environmental Health Directorate Department of Health 2009 HP11194 FEB