Handling “wicked” environmental hazards and the risk to health

 Assessing and responding to the health impacts of environmental pollution

 By Dr Alex Stewart  


Image credit: Pollution by Petter Rudwall. CC0 Public Domain via Unsplash. 

At times it appears as if the world is falling apart, with threats to health around any and every corner with lead in water in Flint, Michigan, severe smogs in Chinese and Indian cities, fracking and unconventional gas mining controversies in Europe, the banning in Paris of cars registered before 2000, increasing awareness and reporting on carbon emissions and consequent environmental dangers. 

To make matters worse, few of these issues are simple. Indeed, our understanding can change with each attempt at resolution. Or is it the problem itself that changes? Like slippery eels, wriggling away, they reappear in another guise, taunting our limited ability to control them. 

Taking a concept first described in management science (Churchman 1967) and initially developed in social policy planning many years ago (Rittel and Webber 1973), we may call these tricky environmental issues “wicked problems”. 

Wicked problems are characterised as problems which cannot be solved in any traditional, linear fashion; each attempt to solve them changes our understanding of the issues; solutions are not right or wrong but "better," "worse," "good enough," or "not good enough”; approaches to management demand a shared understanding and shared commitment from involved parties. 

A shared approach is a proven way of responding to health risks from the environment. One such well-tested approach involves a risk assessment of the magnitude of the health issue, which is then evaluated in the light of all relevant contexts (e.g. wider epidemiology, legal issues, historical situation) and the interests of all involved parties (including the local community, relevant agencies, national partners) are identified before the shared approach is decided upon (Mahoney et al 2015). 

Health protection consists of three interlocking domains: (a) communicable disease control, (b) emergency preparedness, resilience and response and (c) environmental public health. There are wicked problems in all areas: (a) an outbreak of measles or meningococcal meningitis, (b) planning for pandemic flu or an industrial accident and (c) contaminated land or clusters of disease.

Given the nature of the problems and the differing directions of the pull of various involved parties, success is not guaranteed, but community or agency issues can be can be clearly dealt with (Stewart et al 2010a). Nevertheless, real progress can be made around the health risks and contaminated land and air pollution issues have been improved with risks reduced or better understood (Stewart et al 2010; Mahoney et al 2015). Checklists (read this freely available chapter), for such an approach are now available for all three domains of health protection (Ghebrehewet et al 2016), as well as worked examples in environmental public health Mahoney et al 2015


Churchman, C. West. “Guest Editorial: Wicked Problems.” Management Science, vol. 14, no. 4, 1967, pp. B141–B142. www.jstor.org/stable/2628678. 

Ghebrehewet S, Stewart AG, Shears P, Baxter D, Kliner M (editors). 2016. Health Protection: principles and practice. Oxford: Oxford University Press. 

Mahoney G, Stewart AG, Kennedy N, Whitely B, Turner L, Wilkinson E. 2015. Achieving attainable outcomes from good science in an untidy world: Case studies in land and air pollution. Environmental Geochemistry & Health. 37: 689-706. 

Rittel, H.W.J. & Webber, M.M. Policy Sci (1973) 4: 155. doi:10.1007/BF01405730

Stewart AG, on behalf of the incident team (R Adams, R Keenan, G Kowalczyk, H Lamont, W Meredith, L Shack). 2010a. Remembering Sharon and Rebecca – investigating leukaemia and chemical pollution in Cheshire. Chemical Hazards and Poisons Report. 17: 15-17.
https://www.gov.uk/government/publications/chemical-hazards-and-poisons-report-issue-17. See also The Incident Team.  2008. Remembering Sharon and Rebecca.  Report into the circumstances around two cases of Acute Myeloid Leukaemia. https://www.researchgate.net/publication/224805680_Remembering_Sharon_and_Rebecca_-_investigating_leukaemia_and_chemical_pollution_in_Cheshire 

Stewart AG, Luria P, Reid J, Lyons M, Jarvis R. 2010b.
Real or Illusory? Case Studies on the Public Perception of Environmental Health Risks in the North West of England. Int. J. Environ. Res. Public Health 2010, 7(3), 1153-1173.  

Dr Alex Stewart worked as a Consultant in Health Protection in Cheshire and Merseyside for the past 11 years, concentrating on difficult and complex environmental threats to health. His environmental interests and his skills in handling "wicked" problems were developed during his 20 years as a very rural GP in the Karakoram mountains of northern Pakistan. In retirement, Dr Stewart continues to be involved with environmental threats to health, enjoying being able to pursue these (and other) interests in new and different ways. 

Alex is also co-author of Health Protection: Principles and practice, available in print and online. 

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