Cross-disciplinary communication needed to promote the effective use of indicators in making decisions.

This paper examines problems of assessment and decision-making that result from poor or inadequate communication of indicators among the disciplines of public health, the physical sciences, and economics. The specific examples used are drawn from climate impacts in the Americas although the issues are more general to environmental health. In terms of physical processes, problems arise in confusion about indicators at different steps along the DPSEEA framework of environmental health indicators and general scientific uncertainty about the underlying physical processes. Communication between public health and economics is hindered by a lack of understanding of economic costs used in making decisions and the presence of implicit value judgments in economic analysis. Organizational structures may further inhibit the effective use of indicators. Finally, the paper discusses the Pan American Health Organization proposal to enhance the communication of indicators by using information technology networking to support communication among program managers and decision-makers at the national and local levels. The aim of this initiative is to establish a better environment for making decisions. The problem of cholera in Peru is shown as an example of the need for better communication.