Beyond Empathy to System Change: Four Poems on Health by Bertolt Brecht.

Bertolt Brecht's poem "A Worker's Speech to a Doctor" is frequently cited as a means to raise awareness among health workers of the health effects of living and working conditions. Less cited is his Call to Arms trilogy of poems, which calls for class-based action to transform the capitalist economic system that sickens and kills so many. In this article, we show how "A Worker's Speech to a Doctor," with its plea for empathy for the ill, contrasts with the more activist and often militant tone of the Call to Arms trilogy: "Call to a Sick Communist," "The Sick Communist's Answer to the Comrades," and "Call to the Doctors and Nurses." We also show that, while "A Worker's Speech to a Doctor" has been applied in the training of health workers, its accusatorial tone towards health workers' complicity in the system the poem is critiquing risks alienating such workers. In contrast, the Call to Arms trilogy seeks common ground, inviting these same workers into the broader political and social fight against injustice. While we contend that the description of the sick worker as a "Communist" risks estranging these health workers, our analysis of the Call to Arms poems nevertheless indicates that their use can contribute to moving health workers' educational discourse beyond a laudable but fleeting elicitation of empathy for the ill towards a structural critique and deeper systemic understanding in order to prompt action by health workers to reform or even replace the capitalist economic system that sickens and kills so many.

Effects of Residential Environmental Screening and Perception Surveys on Superfund Environmental Health Risk Perceptions.

Residents at one of the nation's largest and longest-operating Superfund sites (Butte, Montana) have expressed environmental health risk perceptions that often diverge from those of EPA and other official stakeholders responsible for the investigation and remediation of site contamination aimed at protecting human health and the environment. A random sample of Butte residents participated in a study of how home-based environmental screening influences environmental health perceptions. Participants completed surveys measuring environmental health perceptions before and after a home site screening of soil and drinking water for lead and arsenic conducted by the research team. Local air monitoring for the same contaminants was also completed during the study period. The home-based screening intervention improved the alignment of subjective participant environmental health perceptions with objective environmental screening measures. Key features of the process that helped achieve this effect included (1) co-locating the collection of participant perceptions and individualized screening measurements; (2) sharing environmental screening results in a clear and unbiased manner; and (3) conducting this work independent of agencies and organizations with direct responsibility for Superfund-related cleanup activities. Empowering residents of a Superfund community with knowledge of the specific kinds and levels of environmental contamination in their home environment may help overcome the gap between agency conclusions regarding environmental health risk and the perceptions of community members.

Environmental health perceptions in a superfund community.

A disconnect between community perceptions and officially documented Superfund remedial actions and health outcomes may hinder the essential community engagement at Superfund sites. This study evaluates the extent of one such potential disconnect in Butte, Montana, which is part of the largest U.S. Superfund site in the U.S. Since the 1860s, when mining began in Butte, mine waste disposal practices in Butte and surrounding areas have left behind massive deposits that have contaminated the area's soil, sediment, groundwater and surface water with arsenic and heavy metals. Over the last four decades, a substantial amount of remediation work has been completed along with requisite community engagement and health studies at this Superfund site. The potential disconnect was evaluated using a new survey instrument that covered: (a) general environmental health perceptions, (b) mine-waste specific environmental health perceptions, (c) effectiveness of community engagement, (d) knowledge of health outcomes, and (e) demographics. The survey results demonstrated a disconnect in many instances where objective remedial improvements may not have resulted in improved environmental health perceptions in the community. The disconnect was most pronounced in the case of drinking water protection from mine waste and knowledge of health outcomes (cancer incidence rates and children's blood levels). The use of similar environmental health perception measurements may aid responsible agencies in monitoring for and addressing environmental health perception disconnects through better community engagement for the benefit of the impacted communities.