Risk communication and public confidence in health departments.

When did the American people lose confidence in their government's ability to protect them?What happened to the "good old days" when elected and appointed officials were respected and trusted?Or have citizens always mistrusted those who govern but only recently become more vocal with questions and opposition?Our country was founded because a group of British citizens objected to the way they were treated by their government in England.They developed a republic in which citizens could select and elect those who made decisions.Thus the government would represent the people's wishes, desires, and values.During the 19th Century, responsibility for protecting individuals from an unhealthy environment was assumed by cities and towns and, later, states.Boards of health passed ordinances related to sewage, rodents, privies, dead bodies, and water supplies.Sanitary inspectors enforced the rules.Eventually departments of public health were created to exercise control over the environment.Such efforts were successful in decreasing morbidity and mortality from orga- nisms spread by food, water, vectors, and unsanitary practices.In those days a public health official who discovered ways to stop an epidemic was a hero.State and local health officers appointed in the early years of the 20th Century stayed in their jobs 20 to 30 years, respected and admired by the people they served.When did the American people lose confidence in the health department's ability to protect them?Was it when we reduced the incidence of vaccine-preventable diseases to the point that the reactions and side effects of the vaccines became the focus of interest?Was it when we stopped distributing free penicillin to prevent rheumatic fever and then the disease reappeared?Was it because of the way Love Canal or Three Mile Island was handled?Was it when we discovered, after 200 years, that disposal of wastes was still a problem, or "miasma," reborn as air pollution, caused illness and death?In the past 30 years the concept of the "environment" has grown to include a whole list of unseen threats to health: fine particulates in the air, radon, hydrocarbons, lead, as- bestos, dioxin, aerosolized pesticides, and viruses.The list seems endless.During this same time television provided dramatic visual access to information on potential threats to health and the actions taken by public officials to contain those threats.This combination of scientific technology, which permits identification of new substances in the envi- ronment, and information technology, which rapidly dissem- inates the news, has heightened the average citizens' concern over what the environment may do to their health.As a