Deliverable 6.14 - Report on controversies between "radon as treatment in radon spas" and "radon as threat in health communication campaigns"

One of the objectives of WP6 in the RadoNorm project is to gain understanding in the controversies between “radon as treatment in radon spas” and “radon as threat in health communication campaigns”. This Deliverable provides on overview of the research conducted to explore this controversy. Results
are presented on radon perceptions, enactments, and communication by radon spas and the public, aiming to understand this controversy and furthermore provide recommendations for different stakeholders on how this controversy can be handled.
A preparatory desk research identified several key issues, including a lack of academic research on radon spas from a social science perspective (Tomkiv et al., 2021, pp. 146–147; Mihók, 2021, p. 61), and challenges in primary social science research due to its inter-disciplinary nature and ethical considerations (Mihók, 2021). Moreover, we have found out variations in legal frameworks regarding radon content in spa waters in Central and Eastern European states: 1500 Bq/L in the Czech Republic (Goliáš et al., 2022, 2016), 666 Bq/L in Germany (The European Committee of the Regions, 2024), 370 Bq/L in Austria (Ritter and Gaisberger, 2020), and 74 Bq/L in Poland (Szabó, 2023). Furthermore,
in the context of the non-existence of a definition of the term “spa” in social/tourism science, our research revealed significant differences in definitions of spas and non-spa facilities offering radon medical
therapy (Mihók and Marčeková, 2022). Despite that some of these spa facilities might not meet the national laws to be officially considered as a radon treatment facility, we refer to these facilities as "radon spas" in this Deliverable.
Key empirical attention was directed at radon framing on the websites of radon spas. 26 radon spa facilities were identified across the European Union that advertise radon treatments on their websites, mainly in Germany and Austria. A framing analysis of these websites was then carried out, of which the results are reported in a scientific article (Geysmans et. al, 2022). While some websites acknowledged the potential risks associated with radon exposure, many downplayed or counteracted these concerns.
Many websites presented radon as a natural, exclusive, and rejuvenating substance, often using visual imagery to reinforce these frames. In summary, five frames were identified, which present radon respectively as a a) source of health, b) natural gas, c) (non) risk, d) luxury and e) fountain of youth.
These five partly overlapping frames are at times in clear contrast with the ways in which radon is presented in a public health context.
To further investigate the perception of radon in radon spas, 16 semi-structured interviews were conducted in spa facilities in Austria and Germany. Interviews were conducted with a) people working in or managing the spas and b) representatives of health and radiation protection authorities.
Stakeholders from the first group believe in radon’s therapeutic potential and perceived radon to have healing capacities, based on anecdotal evidence and positive experiences. Some believed health benefits were scientifically proven, but disagreement existed on this point. Representatives of health authorities, radiation protection authorities and scientists are rather cautious about the healing effects of radon but noted potential positive effects in certain situations. Most of the interview respondents that work in radon spas have little self-reported knowledge of radon. Interview results furthermore revealed that radon used in treatments is considered a controllable risk by several respondents, with measures such as medical follow-up, continuous monitoring and time limits for treatment. Paracelsus’ quote that “the dose makes the poison” was referred to often in interviews with both stakeholder groups to emphasise the importance of dosage when considering radon benefits and risks. Some stakeholders from radon spas believe risk-emphasising communication about radon risks is justified. Representatives from health authorities argue that it is challenging to explain the health risks of radon spas to the broader public. In this context, some highlighted the challenges of effective risk communication due to the presence of spas, making it difficult to inform the public about health risks of indoor radon.
The survey results from the RadoNorm European Radon Behavioural Atlas (Perko et al., 2024) are used in this study to investigate the attitudes and beliefs of the population towards radon in radon spas. The harmonised questionnaire was additionally expanded in Austria, Germany and the Czech Republic to include specific questions on radon spas. The survey results show significant variation in knowledge about radon among respondents in Germany, Austria, and the Czech Republic. Particularly striking is that only slightly more than half of the people gave the correct answer that radon is linked to lung cancer.
The results furthermore indicate that the majority of respondents are familiar with radon spas or caves. The highest level of familiarity was found in Austria and the lowest in Germany. The survey also revealed that a significant proportion of respondents believe in the healing power of radon. However, a large
proportion of respondents disagreed with the statement that radon gas is not dangerous due to its natural origin, contradicting the general assumption of its safety. The majority did not agree with the statement about radon's effect on ageing. In all three countries, radon spas are perceived at least as a potential risk to health within the next 20 years, compared to other radiological risks. The high proportion of "don't know" answers in Germany and Austria compared to other possible risks highlights the large gaps in knowledge about radon and the uncertainty associated with possible risks.
Based on the research conducted on this topic, recommendations are formulated which emphasise the importance of recognising the existence of two radon realities, which should both be recognised and clearly communicated to the general public, especially in areas where radon spas are located.