Florida Red Tide, Education Through
2007 - 2008
Environmental Public Health Leadership Institute Fellow: Charles H. Henry, R.S., M.P.A.
Environmental Health Director, Sarasota County Health Department
1301 Cattlemen Rd. Bldg. A
Sarasota, FL 34232
Hank Topper, PhD
Co-chair, EPA’s Community Action for a Renewed Environment (CARE) Program EPA,
Office of Prevention
I would like to thank the following individuals for the support and assistance provided
during my fellowship in the EPHLI
William Little, M.P.H., M.B.A.
Administrator, Sarasota County Health Department Andrew Reich, M.S., M.S.P.H.
Coordinator, Aquatic Toxins Program
Bureau of Community Environmental Health
Florida Department of Health
2007–2008 Fellow Project National Environmental Public Health Leadership Institute 197
A lack of community knowledge concerning health impacts of Florida Red Tide blooms increases human exposures during near shore Florida Red Tide events. As a result, Florida’s Red
Tide harmful algae blooms (HABs) cause significant increases in acute respiratory illness, as well as, skin and eye irritations. Efforts were made in Sarasota County, Florida, to inform the public during Florida Red Tide blooms using press releases and posting of signs at affected beaches. While successful, this effort also resulted in complaints and political pressure from the tourism industry which experienced cancellations and a drop in tourism revenue. Since tourism is Sarasota County’s largest industry, the question of how to inform the public, without adding to
existing economic impacts, became an important challenge. Applying a systems-thinking approach (Senge, Kleiner, Roberts, Ross, & Smith, 1994) the Sarasota County Health Department (CHD) began developing better ways to educate the public on health impacts of Florida Red Tide. The process required Sarasota CHD to become facilitators and supporters instead of regulators which allowed difficult, but necessary discussions to occur. This new approach resulted in an on-going collaboration with local and regional stakeholders, as well as, tourism industry support for the development of an on-line public information system for our Sarasota County beaches.
Over the past few years, Florida Red Tide blooms have occurred along coastal Sarasota County with alarming frequency and, at times, with great intensity. This led to intensive scientific research activities into the causes, contributing factors, and effects of Florida Red Tide Blooms. Two areas in particular became a concern to the Sarasota CHD. The first issue was the lack of effective public notification when blooms were occurring. The second issue was a lack of public understanding about the potential human health effects associated with exposure to these blooms.
Recent studies, conducted by harmful algae bloom (HAB) researchers, indicate statistically significant increases in acute respiratory symptoms when humans are exposed to the aerosolized toxin (brevetoxin) produced by the organism that causes Florida Red Tide blooms, Karenia
brevis. Researchers have also linked residence in beach communities during Florida Red Tide events with significant increases in numbers of patients diagnosed with pneumonia at a local hospital (Fleming, et al., 2007). Because of these identified human health impacts, informing and educating the public took on a real importance for the Sarasota CHD.
K. brevis is an unarmored marine dinoflagellate algae that produces a toxin known as brevetoxin. The toxin is released and aerosolized as these single celled algae are destroyed or damaged through the normal surf action along the shore (Steidinger, 2005). As waves break, the toxin is released and picked up by marine particulates (such as salt and dust) and transported by sea breezes. If a consistent on-shore wind is present, these toxins can be carried several miles inland (Backer, et al., 2005). The understanding of these brevetoxin transport mechanisms resulting in
2007–2008 Fellow Project National Environmental Public Health Leadership Institute 198
human exposures becomes important to consider when developing a warning or notification system for the public.
Red Tide has been present in Florida for hundreds of years (Steidinger, 2005) and is a natural ecological component to the Gulf of Mexico. In recent years, there seems to have been an increase in the frequency and intensity of the blooms along Florida’s gulf coast. These blooms have resulted in massive fish kills and deadly health impacts to marine mammals, such as, dolphins and manatees. Researchers are discovering that the Florida Red Tide toxin produces both hemolysin and neurotoxin effects which have powerful adverse impacts on marine life (Steidinger, 2005). Florida Red Tide blooms have also impacted the quality of life for both residents and visitors to Sarasota County’s 34 miles of beautiful beaches. Aside from the smells
and problems created by large numbers of dead fish washing ashore, almost everyone experiences watering of the eyes, runny nose, and a cough (locally called the “Red Tide Tickle”)
when exposed to the aerosolized toxins from an intense bloom. Even worse, for those residents and visitors who already suffer from chronic respiratory disease, impacts are much greater (Fleming, et al., 2007). Because of Sarasota’s beaches, tourism is a key industry in the local economy. In fact, tourism in Sarasota accounts for over 15,000 jobs and more than 24 million dollars in gross sales annually (Sarasota County Government, 2007). The recent increased occurrence of Florida Red Tide in the Sarasota area has been blamed for causing negative economic impacts on the local tourism industry. Dead fish washing up on the beaches and the toxin’s affect on beach goers were having negative impacts on the local tourism industry. When Sarasota CHD began to warn the public about potential health impacts, (through alerts in the local media and the posting of warning signs on the beach), it only heightened the stress levels of a tourism industry who was already dealing with negative economic impacts. Lodging cancelations increased and economic pressures mounted to find alternative solutions to inform the public without scaring them away from the local business community.
A lack of knowledge and understanding about the health impacts of Florida Red Tide increases the occurrence of respiratory illness in residents and visitors of Sarasota County during near shore Florida Red Tide blooms.
2007–2008 Fellow Project National Environmental Public Health Leadership Institute 199
Behavior Over Time Graph:
Knowledge about the health impacts of Florida Red Tide has increased dramatically for health officials, but not for the general public. This graph over time represents the gap between the knowledge level of health officials and the general public.
This graph also shows the perceived economic impacts faced by the tourism industry and the increasing frequency of Florida Red Tide blooms.
2007–2008 Fellow Project National Environmental Public Health Leadership Institute 200
Causal Loop Diagram and applicable archetype:
This diagram shows how the initial attempt to simply notify the public actually shifted the burden to the tourism industry until collaborative solutions were developed.
2007–2008 Fellow Project National Environmental Public Health Leadership Institute 201
10 Essential Environmental Health Services:
This project links closely with four of the ten Essential Environmental Health Services.
Inform, educate, and empower people about environmental health issues: The main focus of this
project was to enhance and improve our ability to inform, educate, and empower citizens and visitors with the information needed to avoid or reduce exposure to Florida Red Tide toxins.
Mobilize community partnerships and actions to identify and solve environmental health
problems: The Sarasota CHD also focused on mobilizing community partners to work collaboratively on this project.
Monitoring environmental and health status to identify and solve community environmental health problems: This project seeks to monitor the respiratory health of residents and visitors in Sarasota County to help determine the true impacts from exposure to Florida Red Tide.
Developing policies and plans that support individual and community environmental health efforts: This project has secondary goals of working with local policy makers to establish policies that are protective of public health and policies that help reduce nutrients that may be contributing to Florida Red Tide blooms.
Figure 1: Osaki, Ten Essential Environmental Public Health Services
2007–2008 Fellow Project National Environmental Public Health Leadership Institute 202
National Goals Supported:
Centers for Disease Control and Prevention, Health Protection Goals:
This project seeks to support “Healthy People in Healthy Places”; specifically, in the area of
Healthy Travel and Recreation through promoting healthy and safe beach recreation habits through education and information about Florida Red Tide. This project also supports the area of Healthy Communities through the distribution of information on safe shellfish consumption and ways to reduce exposures to airborne toxins.
National Strategy to Revitalize Environmental Public Health Services:
Goal IV (Communicate and Market): The collaborative nature of this project supports
communication among environmental public health agencies. An example of this effort is the increased communication between the local and state health departments, environmental health researchers, community partners, and finally, policy makers.
Goal VI (Create Strategic Partnerships): The collaborative nature of this project supports
creation of partnerships between the local health department and other organizations also working on Florida Red Tide issues. During this project, partnerships were created or strengthened with the Florida Fish and Wildlife Commission’s Research Institute, Healthy Gulf
Coalition, Sierra Club, Solutions to Avoid Red Tide (START), and the Mote Marine Laboratory.
Goal II (Support Research): This project seeks to support research through engagement of the community. Community education and information dissemination helps to increase support for environmental public health research related to Florida Red Tide.
Environmental Health Competency Project: Recommendation for Core Competencies for Local Environmental Health Practitioners:
This project supports the competency project primarily under the Communication Competencies of education and communication. Improving Florida Red Tide educational resources and communication between agencies is one of the primary goals of our Sarasota CHD collaboration. There is also support of the Management Competencies of problem solving, economic and political issues, and partnering. Florida Red Tide has caused significant economic impacts to Sarasota. Efforts to address Florida Red Tide issues requires problem solving, political awareness, and a willingness to partner. Finally, this project supports the Assessment Competencies of research, data analysis, and evaluation. The key to understanding, and ultimately having a positive effect on the health impacts of Florida Red Tide, is research and data analysis. As support grows for research, so too will the knowledge and understanding required for Florida Red Tide health interventions.
2007–2008 Fellow Project National Environmental Public Health Leadership Institute 203
Project Logic Model:
Lack of knowledge and understanding about the health impacts of Florida Red
Tide increases the occurrence of acute respiratory illness in residents and Long-Term Outcomes visitors of Sarasota County during near shore Florida Red Tide blooms. 90% of all residents and visitors in Sarasota County will avoid exposure to Florida Red Tide toxins during blooms. Goal The number of residents seeking treatment for acute All residents and visitors in Sarasota County will have: respiratory illness during Florida Red Tide blooms will be 1. Knowledge and understanding of the health risks associated with Florida Red Tide. reduced by 50%. Tourism will benefit, due to visitor 2. Access to reliable information on the status of current Florida Red Tide blooms in Sarasota County. confidence in availability of Florida Red Tide data.
Rationales Resources Activity Groups Outputs
Intermediate-Term Outcomes Part time Technology exists to assistance from 3 monitor inshore Florida Recruit new 1. The community will note a EH Division staff (2 Facilitation Red Tide blooms and community partners decrease in acute respiratory Environmental provide near real-time by August, 2007. illness associated with Specialists & 1 information to residents Coordinate & plan Florida Red Tide blooms. Environmental and visitors in Sarasota meetings with 2. Standardized data Administrator). County. If individuals partners quarterly. Short-Term Outcomes reporting and sharing. have accurate real-time Participation from Weekly Florida Red information, they can multiple community tide sampling for 16 make informed decisions Data Collection Assumptions partners. (Key beaches. Acute about which beaches to participants respiratory illness avoid and/or types of include: Mote data collected and activities to avoid in Buy-in from major stake Marine Research reviewed quarterly. impacted areas. holders. Center, Sarasota Distribute Florida Red Visitors Bureau, Tide materials to all Outreach/Education. Because Florida Red Regular data analysis. and Solution to coastal area lodging Tide is unlikely to impact Avoid Red Tide, facilities. Make the all of Sarasota's 34 miles START). same material of beaches, visitors and Increased availability of Funding for available residents can still enjoy Florida Red Tide information. educational electronically on each beach activities if they material and real- partner’s website. know where to go. time notice Plan to post warning Evaluation systems. Amount signs at impacted
and source is beaches.
undetermined at Develop evaluation this time. tools for the program.
2007–2008 Fellow Project National Environmental Public Health Leadership Institute 204
To ensure that all residents and visitors in Sarasota County will have the basic knowledge and understanding of the health risks associated with Florida Red Tide and to assure access to reliable information on the status of current Florida Red Tide blooms in Sarasota County. Health Problem
Aerosolized toxins from Florida Red Tide harmful algae blooms cause significant increases in acute respiratory illness, as well as, nose and eye irritation during Florida Red Tide blooms. Outcome Objective
The number of residents and visitors seeking treatment for acute respiratory illness during Florida Red Tide blooms will be reduced 50% by January 2009.
The density of Florida Red Tide organisms present in inshore water samples and the number of people exposed.
By January, 2009, 80% of all residents and visitors in Sarasota County will have both the knowledge and understanding to avoid exposure to Florida Red Tide toxins during near shore blooms.
1. The number of days with near shore Florida Red Tide cell counts above 5,000 cells per
2. Lack of public understanding about the effects of wind direction and wave action on the
areosolization of Florida Red Tide toxins.
3. Lack of standardized communications systems to ensure that warnings and information
are distributed through multiple information outlets.
4. Lack of reliable reporting of real-time conditions for all 34 miles of beaches located in
5. Lack of public awareness on the health effects of exposure to Florida Red Tide toxins.
1. By August, 2007; Collaborate with community partners to work towards project
objectives and the establishment of regular meetings.
2007–2008 Fellow Project National Environmental Public Health Leadership Institute 205
2. By August, 2008; Work with community partners to compare and make available both
near shore Florida Red Tide cell counts and acute respiratory illness rates in Sarasota
3. By January, 2008; A Florida Red Tide Education and Outreach program will be
established that has support and cooperation from community partners including the
4. By May, 2008; The project collaboration will establish program evaluation tools and
procedures to measure the effectiveness of this project.
Events and Activities
1. Collaboration with community partners will be established by seeking new partnerships
and the establishment of regular meetings. The core group will identify potential
community partners and then work to establish relationships with those partners.
Educational and informational meetings will be held with the help and participation of
community partners in order to increase community buy-in. Support will be provided to
community partners for their work and efforts related to Florida Red Tide research,
outreach, and education. Finally, meetings will be held with the local tourism industry in
an effort to find win-win solutions for the problems Florida Red Tide creates for the
industry and Sarasota’s economy.
2. Collaborate with community partners to develop processes to collect, share, and review
data from Florida Red Tide sampling and data from acute care facilities related to acute
respiratory illness. This includes the establishment of working agreements with the
Sarasota CHD’s Epidemiology staff to allow access to acute respiratory illness data and
to assist in obtaining data sharing agreements with local health care providers.
Relationships will also need to be established with local partners who sample and
determine Florida Red Tide cell counts. Finally, the collaboration will need to develop
agreed upon reporting formats for combined data, as well as, the frequency of reporting.
3. Collaborative efforts will be needed to develop a coordinated plan for development and
distribution of education and outreach materials. Web-sites of community partners should
be linked and outreach efforts should be cooperative, complementary, and not
competitive. In conjunction with the local tourism industry, procedures for posting and
removing beach warning signs need to be developed and agreed upon. This also includes 2007–2008 Fellow Project National Environmental Public Health Leadership Institute 206