A Story of Health and Wildfires

by Maria Valenti, Director, Health and Environment Literacy Project

As “fire season” arrives, what can we do to protect ourselves and our families from the smoke and air pollution that wildfires bring? A new chapter in a multi-media eBook, created through a collaboration between Commonweal and a group of leading environmental and health organizations and agencies, looks at ways that we can protect ourselves from the health impacts of wildfires.

This chapter is the newest installment in the six-part eBook, A Story of Health, that has been written over the span of 10 years of collaboration. It tells the story of a fictional child, Sofia, and her family as they learn how to protect themselves from wildfire’s immediate and longer-term health dangers. The focus is on children’s health and prevention strategies. Drs. Stephanie Holm and Mark Miller, co-directors at the Western States Pediatric Environmental Health Specialty Unit (WSPEHSU), took a lead in developing the story. Dr. Holm is one of the foremost national experts on the topic.

Sofia’s story covers practical information on topics such as:

• What’s in wildfire smoke and how does it affect health?
• Evidence-based ways to protect health from wildfire smoke through appropriate masking, improving indoor air quality, and other specific measures
• How to access information on outdoor air quality and wildfire status
• How to prepare medical offices before a wildfire event to enable ongoing patient care
• Guidelines on disaster preparedness before, during, and after a wildfire
• Information for families to help children cope with psychological impacts of wildfires
• Finally, policy recommendations to help prevent and mitigate wildfires, address inequities in exposures, and improve air quality and enhance long-term sustainability for all members of society.

Download for free and access free CE credits here.

Where It Began

Ten years ago, A Story of Health began with months of discussions on complexity at Commonweal during 2011 and 2012, led by Commonweal founder Michael Lerner, Elise Miller, then director of the Collaborative on Health and the Environment, Dr. Ted Schettler, Science Director at the Science and Environmental Health Network, myself and others including Dr. Mark Miller. We had discussed and debated how to best illustrate the complexity of environmental and genetic influences on health across the lifespan in a clear way that would resonate with a wide range of people. 

As the conversations on complexity continued, we began to consider a specific project such as a digital publication. We discussed how storytelling is a compelling way to describe complex topics, and was increasingly being used in science communication. 

Ted, Mark, and I met separately to sketch out an introduction that illustrated the environmental and social determinants of health in an ecological framework, and moved into a family reunion from which a series of fictional stories related to diseases and health outcomes could emerge. We wanted to include chapters on certain health outcomes and conditions including asthma, developmental disabilities, childhood cancer, cognitive decline, infertility/reproductive health and diabetes. Some of these topics we had explored in depth in previous print publications including In Harm’s Way: Toxic Threats to Child Development and Environmental Threats to Healthy Aging. Mark was working on childhood cancer issues. 

The chapter on the health effects of wildfires, with a focus on exposures instead of  disease, was published this August, a critical addition to the eBook in light of the evolving fires happening each summer and fall.

Health Care Providers A Key Audience

We knew that health care providers could be an important audience for this information, given their influence on patients, professional societies and the public in general. They could be the champions to bring the concept of prevention, one of our primary concepts, to their patients. Based on surveys of health professionals, we also knew that knowledge of environmental health was lacking. In order to access them, we needed new partners. We thought, “Maybe we can create an eBook for the general public with a spin-off continuing education (CE) course?”

We turned to colleagues at the Agency for Toxic Substances and Disease Registry (ATSDR), including Brian Tencza, team lead in Educational Services, Environmental Medicine and Health Systems Intervention Section. We had worked with Brian before on the Pediatric Environmental Health Toolkit CE course with great success. We discussed with them our ideas for our project, now named A Story of Health, and how offering free CEs could be a major incentive for health professionals to access the stories as a learning course. 

We never anticipated the success of that idea in those early days, or that A Story of Health would rise to the top of the most popular ATSDR CE courses with more than 16,000 registrations by June 2021.

Content Was Driven by Defensible Science

ATSDR supported our ideas and goals and we were off and running. Our “core four” – me, Ted, Mark, and Brian – met several times over the next year to further hash out the stories, identify the experts we need to provide input, and research the scientific references we needed to support our storylines. We fleshed out the characters -– a young boy with asthma in Los Angeles; a pre-teen with developmental disabilities in the South; a toddler with childhood leukemia in the Northeast; a retired veteran in Boston; a California couple trying to conceive; a teenager with diabetes. We outlined their fictional histories, families, environmental exposures and potential impacts. 

We were rolling, and committed to these stories being both interesting and scientifically defensible. It was meticulous and detailed work.

The format – an eBook

At the same time, we needed an artist who could transform our written dream into an e-Book reality. We turned to Stephen Burdick, a designer who had beautifully illustrated many of our past products. With his creative skills he developed an interactive PDF product that was small enough megabyte-wise to download easily onto a computer and could include links to outside resources, videos, and references. Brian drafted a gifted Centers for Disease Control and Prevention (CDC) artist Dan Higgins to illustrate the characters. (Dan also created the iconic COVID-19 virus image.)

We’ll Finish this in A Year

We thought we could complete all six stories in a year. Ha! 

Development of the stories with experts on the topic, internal reviews, revisions, artwork, graphics, videos, references, migration from PowerPoint to PDF eBook format all took time. Original stories were sometimes 50 pages or more. The science had to be right but also delivered in a clear and concise manner. We wanted to include “key concepts” to help unravel some of the complexity, and pop-ups to make the eBook interactive. External peer review was critical to final revisions. We were creating something completely new for which there was no template.

We finally determined that we only had the resources to develop one product, not two, so we strived to make it accessible to the public and health advocates while providing the scientific details health professionals would demand. With ATSDR as a partner, CDC agreed to provide free CE credits to a range of health professionals. This was vital to the success of the project.

Finally, we were ready to launch. 

We released the first three stories on asthma, childhood leukemia, and developmental disabilities in 2015 with a series of webinars hosted by Commonweal’s Collaborative on Health and the Environment. By 2019 we had released two other chapters on infertility/reproductive health and cognitive decline. The eBook and our fictional stories of health were well received. It remains one of the most popular ATSDR CE courses. A Story of Health multimedia eBook won an “Excellence in Communications” award from the National Center on Environmental Health, ATSDR and the CDC.

A Story of Health has been developed by ATSDR, Commonweal, the Office of Environmental Health Hazard Assessment/California EPA, the Science and Environmental Health Network, and the Western States Pediatric Environmental Health Specialty Unit.