Environmental justice: building a unified vision of health and the environment

The assorted and multidimensional concerns that give rise to the issue of environmental justice have proved to be intellectually daunting and highly resistant to positive change. Low-income, people of color, and tribal communities confronting environmental stressors are beset by stressors in both the physical and social environments. For this reason, while the bifurcation of the public health and environmental fields taking place over the past several decades has yielded generally negative impacts in areas of public health, environment, and planning, the consequences for low-income and disadvantaged communities have been especially grievous. This commentary builds on the recent Institute of Medicine workshop titled "Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century." The workshop organizers posited that only by thinking about environmental health on multiple levels will it be possible to merge various strategies to protect both the environment and health. In this commentary we examine how such a new vision of uniting public health and the environment can contribute to attaining environmental justice for all populations.     

Reflections on and contributions to the Ministry of Health's Integrated Plan on Health Surveillance Actions for People Exposed to Pesticides

This paper highlights the issue of human and environmental contamination caused by abusive and undue use of pesticides and of its consequences for human health and the environment. It seeks to present reflections on and contributions to the Ministry of Health's Integrated Plan on Health Surveillance Actions for People Exposed to Pesticides arising from the Federal District Assessment and Control Project for Human and Environmental Exposure. The methodology used in this study consisted of reading and analysis of reports from the aforementioned projects, as well as participating in preliminary meetings for drafting the General Coordination Plan for Environmental Health Surveillance and the workshop entitled "The integration of Occupational Health Surveillance and Sanitary Vigilance: the information issue." This was coordinated by the Occupational Health Working Group of the Brazilian Public Health Association and in meetings and workshops of the Federal District Project. The outcome of the discussions suggests that the investigation strategy used is a positive contribution and that the Federal District Project may serve as a pilot project for the Ministry of Health's Integrated Plan.     

Summary of a workshop on the development of health models and scenarios: strategies for the future

A workshop was convened in July 2003 by the Global Change Research Program, Office of Research and Development at the U.S. Environmental Protection Agency, to review current strategies for developing human health models and scenarios in the context of global environmental change, particularly global climate change, and to outline a research agenda that effectively characterizes the interplay of global change with the health of human populations. The research agenda developed at the workshop focused on three issues: a) the development of health models, b) the development of health scenarios, and c) the use of health models and health scenarios to inform policy. The agenda identified research gaps as well as barriers to the development and use of models and scenarios. This report summarizes the workshop findings.     

Health, environment and sustainable development: identifying links and indicators to promote action.

This paper discusses the links among health, environment, and sustainable development and presents a framework that extends from the epidemiological domain to the policy domain and includes the driving forces that generate environmental pressures, creating changes in the state of the environment and eventually contributing to human exposures. Health effects are the end result of this complex net of events. Environmental health interventions should not be limited to treatment of cases and directly reducing human exposures. The paper discusses the need for integrated action at all levels and, in particular, on the need to focus on long-term action directed at reducing the driving forces that generate the environmental health threats. Only this approach can achieve sustained health benefits and environmental protection in accord with the principles of sustainable development.     

National environmental public health tracking program: bridging the information gap

In January 2001 the Pew Environmental Health Commission called for the creation of a coordinated public health system to prevent disease in the United States by tracking and combating environmental health threats. In response, the Centers for Disease Control and Prevention initiated the Environmental Public Health Tracking (EPHT) Program to integrate three distinct components of hazard monitoring and exposure and health effects surveillance into a cohesive tracking network. Uniform and acceptable data standards, easily understood case definitions, and improved communication between health and environmental agencies are just a few of the challenges that must be addressed for this network to be effective. The nascent EPHT program is attempting to respond to these challenges by drawing on a wide range of expertise from federal agencies, state health and environmental agencies, nongovernmental organizations, and the program's academic Centers of Excellence. In this mini-monograph, we present innovative strategies and methods that are being applied to the broad scope of important and complex environmental public health problems by developing EPHT programs. The data resulting from this program can be used to identify areas and populations most likely to be affected by environmental contamination and to provide important information on the health and environmental status of communities. EPHT will develop valuable data on possible associations between the environment and the risk of noninfectious health effects. These data can be used to reduce the burden of adverse health effects on the American public.     

Animals as sentinels of human health hazards of environmental chemicals

A workshop titled "Using Sentinel Species Data to Address the Potential Human Health Effects of Chemicals in the Environment," sponsored by the U.S. Army Center for Environmental Health Research, the National Center for Environmental Assessment of the EPA, and the Agency for Toxic Substances and Disease Registry, was held to consider the use of sentinel and surrogate animal species data for evaluating the potential human health effects of chemicals in the environment. The workshop took a broad view of the sentinel species concept, and included mammalian and nonmammalian species, companion animals, food animals, fish, amphibians, and other wildlife. Sentinel species data included observations of wild animals in field situations as well as experimental animal data. Workshop participants identified potential applications for sentinel species data derived from monitoring programs or serendipitous observations and explored the potential use of such information in human health hazard and risk assessments and for evaluating causes or mechanisms of effect. Although it is unlikely that sentinel species data will be used as the sole determinative factor in evaluating human health concerns, such data can be useful as for additional weight of evidence in a risk assessment, for providing early warning of situations requiring further study, or for monitoring the course of remedial activities. Attention was given to the factors impeding the application of sentinel species approaches and their acceptance in the scientific and regulatory communities. Workshop participants identified a number of critical research needs and opportunities for interagency collaboration that could help advance the use of sentinel species approaches.     

Investigation of the relationship between s-methoprene and deformities in anurans

Evidence that amphibian deformities are on the rise has prompted a number of researchers to question a variety of natural and man-made substances, including chemicals such as s-methoprene (trademark Altosid), an insect growth regulator applied to water bodies for mosquito control. Despite conclusions reached by the U.S. Environmental Protection Agency and a considerable body of scientific evidence demonstrating that it is unlikely that s-methoprene or any of its degradation products are causing the high rates of deformities found in Minnesota and other states, concerns persist about potential negative impacts of s-methoprene on nontarget species, specifically anurans. Water analyses in field and laboratory conditions and a comparison of reported Altosid use with reported frog deformities in Minnesota demonstrate that a connection between frog deformities and Altosid use is unlikely. These results indicate that factors other than s-methoprene and its degradation products are contributing to the recent outbreak of frog deformities.     

An exploration of ethical issues in research in children's health and the environment

The consideration of ethical issues relating to pediatric environmental health is a recent phenomenon. Discussions of biomedical ethics, research on children, and environmental health research have a longer history. In the late 1990s, researchers at the Kennedy Krieger Institute in Baltimore, Maryland, undertook a study to compare the effectiveness of several methods of reducing lead risk in housing. In a preliminary finding in the case of Grimes v. Kennedy Krieger Institute, Inc., a Maryland court questioned the ethics of performing research on children when there is no prospect of direct benefit to those children and whether parents can consent to such research. This case dramatically raised the profile of ethical issues among the pediatric environmental health research community. To broaden the discussion of these issues and in response to the Kennedy-Krieger case, the Children's Environmental Health Network held a working meeting on 5 and 6 March 2004 to explore this topic. The articles in this mini-monograph were prepared by the authors as a result of the workshop and represent their opinions. This article is an introduction to the workshop and a summary of the articles to follow.     

Summary of the workshop on methodologies for environmental public health tracking of air pollution effects

The US Centers for Disease Control and Prevention established the Environmental Public Health Tracking (EPHT) program to support state and local projects that characterize the impact of the environment on health. The projects involve compiling, linking, analyzing, and disseminating environmental and health surveillance information, thereby engaging stakeholders and guiding actions to improve public health. One of the EPHT objectives is to track the public health impact of ambient air pollution with analyses that are timely and relevant to state and local stakeholders. To address methodological issues relevant to this objective, in January 2008, government officials and researchers from the USA, Canada, and Europe gathered in Baltimore, Maryland for a 2-day workshop. Using commissioned papers and presentations on key methodological issues as well as examples of previous air pollution impact assessments, work group discussions produced a set of consensus recommendations for the EPHT program. These recommendations noted the need for data that will encourage local stakeholders to support continued progress in air pollution control. The limitations of using only local data for analyses were also noted. To improve local estimates of air pollution health impacts, methods were recommended that “borrow strength” from other evidence. An incremental approach to implementing such methods was recommended. The importance and difficulty of communicating uncertainties in local health impact assessments was emphasized, as was the need for coordination among different agencies conducting health impact assessments.     

环境与人类和谐发展：公共卫生的重要角色——第五届环境与职业医学国际学术研讨会纪要

2010年4月7—10日,以“环境与健康——气候·城市·职业”为主题的“第五届环境与职业医学国际学术研讨会”在四川省都江堰市召开。此次国际研讨会由上海市疾病预防控制中心、上海市预防医学研究院和《环境与职业医学》杂志编委会主办,加州中国科研合作项目（美国国立卫生研究院资助）、美国疾控中心环境卫生中心、美国《环境与健康展望》杂志和四川省都江堰市卫生局合办,42位中外专家和200多名代表出席会议。与会者就“生态、气候与健康”、“城市与健康”、“职业与健康”、“暴露与评估”、“环境铅暴露与健康”等主题进行了深入交流。本次研讨会的顺利举行必将促进环境与职业医学乃至公共卫生学科的持续发展,为科技和经济发展、构建和谐社会服务。     

第六届环境与职业医学国际学术研讨会 10月16－18日 中国苏州 征文通知

环境与人类健康息息相关。环境医学与职业医学的交叉融合,是近年来全球性的发展趋势;环境与职业医学也是卫生领域研究最为活跃的重要学科之一。     

The relationship between housing and health: children at risk

In November 2002, the National Center for Healthy Housing convened a 2-day workshop to review the state of knowledge in the field of healthy housing. The workshop, supported with funds from the U.S. Centers for Disease Control and Prevention's National Center for Injury Prevention and Control and National Center for Environmental Health, was unique in that it focused solely on the effect of housing on children's health and the translation of research findings into practical activities in home construction, rehabilitation, and maintenance. Participants included experts and practitioners representing the health, housing, and environmental arenas. Presentations by subject-matter experts covered four key areas: asthma, neurotoxicants, injury, and translational research. Panel discussions followed the presentations, which generated robust dialogue on potential future research opportunities and overall policy gaps. Lack of consensus on standard measurements, incomplete understanding about the interaction of home hazards, inadequate research on the effectiveness of interventions, and insufficient political support limit current efforts to achieve healthy housing. However, change is forthcoming and achievable. Key words: asthma, childhood exposure, environmental toxicants, healthy housing, lead poisoning.     

Workshop summary: connecting social and environmental factors to measure and track environmental health disparities

On May 24-25, 2005 in Ann Arbor, Michigan, the US Environmental Protection Agency, the National Institute of Environmental Health Sciences, and the University of Michigan sponsored a technical workshop on the topic of connecting social and environmental factors to measure and track environmental health disparities. The workshop was designed to develop a transdisciplinary scientific foundation for exploring the conceptual issues, data needs, and policy applications associated with social and environmental factors used to measure and track racial, ethnic, and class disparities in environmental health. Papers, presentations, and discussions focused on the use of multilevel analysis to study environmental health disparities, the development of an organizing framework for evaluating health disparities, the development of indicators, and the generation of community-based participatory approaches for indicator development and use. Group exercises were conducted to identify preliminary lists of priority health outcomes and potential indicators and to discuss policy implications and next steps. Three critical issues that stem from the workshop were: (a) stronger funding support is needed for community-based participatory research in environmental health disparities, (b) race/ethnicity and socioeconomic position need to be included in environmental health surveillance and research, and (c) models to elucidate the interrelations between social, physical, and built environments should continue to be developed and empirically tested.     

Environmental education and nursing: a necessary integration

Environmental issue should be discussed in educational actions, because this debate leads people to reflect on what is ecologically healthy. It was aimed to reflect on Health promotion, Environmental education and Nursing. This is a reflexive study on environmental health in three groups: Promotion of environmental and human health; Educational actions in Environmental health; and Nursing and Health education. It was verified that environmental education is a theme that includes human well-being, being necessary actions of health promotion that qualify individual and community to practice their empowerment and autonomy.     

Environmental health and the family doctors

Medicine, that is human medicine, has a long tradition of the use of biomarkers in assessing multiple departures from the health status: it is assumed that in ecosystem health assessment this experience could be helpfully shared with all those--from many scientific disciplines--involved in this research, crucial for the future of life on earth. The growing importance of ecology is evident in all aspects of modern life. Social and economically the ecological analysis cannot be ignored in future by politicians or medical doctors alike. Environmental Health is thus taking over many responsibilities from the traditional Public Health, mainly the significant challenges put by toxic and hazardous substances released into the environment which is fundamentally an evaluation of relevant environmental data, health outcome and community health concerns associated with toxic exposure. The public has become increasingly concerned about the exposure to synthetic chemical compounds produced by modern industry. Environmental Health is essentially a critical tool to determine the relationship between environmental contamination and human adverse health effects. Environmental Health aims much further than the traditional Public Health. Although Environmental Health has not enjoyed the successes of traditional Public Health such as maternal and child health or the eradication of smallpox, an array of activities is underway that will enhance the health professional's ability to cope with the demanding issue of toxic exposures.     

第六届环境与职业医学国际学术研讨会征文通知

环境与人类健康息息相关。环境医学与职业医学的交叉融合,是近年来全球性的发展趋势;环境与职业医学也是卫生领域研究最为活跃的重要学科之一。自2002年以来,《环境与职业医学》杂志编委会及其主办单位上海市疾病预防控制中心已连续成功举办了五届以“环境与职业医学”命名的国际学术会议。     

Identifying priority health conditions, environmental data, and infrastructure needs: a synopsis of the Pew Environmental Health tracking project

In this article we describe the methodologic approaches of the Pew Environmental Health Commission at the Johns Hopkins Bloomberg School of Public Health used to identify priority environmental health conditions and develop recommendations to establish a national environmental public health tracking network. We present the results of a survey of public health and environmental practitioners to uncover state and local health tracking needs and priorities. We describe the steps that combined the findings from the state and local health tracking survey and a review of the state of the science on environmental impacts on health to identify priority health end points. Through an examination of national health and health care databases, we then describe trends and public health effects of those diseases that may be linked to the environment. Based on this analysis, respiratory diseases and neurologic diseases are recommended as priorities for tracking. Specific end points recommended for tracking include asthma and chronic respiratory diseases, and chronic neurodegenerative diseases such as multiple sclerosis. Based on trends in reported prevalence, consideration should also be given to developmental disabilities, reproductive disorders, and endocrine/metabolic disorders. Strengthening of current efforts to track cancer and birth defects should also be included as components of a nationwide health tracking network. Finally, we present the recommendations for environmental public health tracking. These recommendations provided the groundwork for the development of the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Progam that now includes 21 states, three cities, and three academic centers throughout the nation.     

Hazardous wastes in eastern and central Europe: technology and health effects

Issues of hazardous waste management are major concerns in the countries of eastern and central Europe. A National Institute of Environmental Health Sciences-supported conference was held in Prague, Czech Republic, as a part of a continuing effort to provide information and promote discussion among the countries of eastern and central Europe on issues related to hazardous wastes. The focus was on incineration as a means of disposal of hazardous wastes, with discussions on both engineering methods for safe incineration, and possible human health effects from incineration by-products. Representatives from government agencies, academic institutions, and local industries from 14 countries in the region participated along with a few U.S. and western European experts in this field. A series of 12 country reports documented national issues relating to the environment, with a focus on use of incineration for hazardous waste disposal. A particularly valuable contribution was made by junior scientists from the region, who described results of environmental issues in their countries.     

Conceptual model of comprehensive research metrics for improved human health and environment

OBJECTIVE: Federal, state, and private research agencies and organizations have faced increasing administrative and public demand for performance measurement. Historically, performance measurement predominantly consisted of near-term outputs measured through bibliometrics. The recent focus is on accountability for investment based on long-term outcomes. Developing measurable outcome-based metrics for research programs has been particularly challenging, because of difficulty linking research results to spatially and temporally distant outcomes. Our objective in this review is to build a logic model and associated metrics through which to measure the contribution of environmental health research programs to improvements in human health, the environment, and the economy. DATA SOURCES: We used expert input and literature research on research impact assessment. DATA EXTRACTION: With these sources, we developed a logic model that defines the components and linkages between extramural environmental health research grant programs and the outputs and outcomes related to health and social welfare, environmental quality and sustainability, economics, and quality of life. DATA SYNTHESIS: The logic model focuses on the environmental health research portfolio of the National Institute of Environmental Health Sciences (NIEHS) Division of Extramural Research and Training. The model delineates pathways for contributions by five types of institutional partners in the research process: NIEHS, other government (federal, state, and local) agencies, grantee institutions, business and industry, and community partners. CONCLUSIONS: The model is being applied to specific NIEHS research applications and the broader research community. We briefly discuss two examples and discuss the strengths and limits of outcome-based evaluation of research programs.     

Human genetics, environment, and communities of color: ethical and social implications

A conference titled "Human Genetics, Environment, and Communities of Color: Ethical and Social Implications" and a workshop symposium titled "Human Genetics and Environmental Justice" were held by West Harlem Environmental Action, Inc., with cosponsorship by the National Institute of Environmental Health Sciences (NIEHS), the Community Outreach and Education Program of the NIEHS P30 Center for Environmental Health at the Mailman School of Public Health at Columbia University, New York, and the U.S. Environmental Protection Agency. The conference and symposium took place at Columbia University in New York City on 4-5 February 2002. Expert panels composed of public health practitioners, genetic researchers, ethicists, lawyers, social scientists, and community organizations were assembled to explore how genetic research will affect communities of color, specifically in environmental health research. The goal of the conference was to educate participants on the science and ethics of genetic research and to explore the potential benefits and pitfalls of genetic research vis-à-vis new trends in environmental health research, specifically with reference to communities of color. The goal of the symposium was to discuss the major perceptions and concerns for community-based environmental justice advocates and other communities of color regarding environmental health genetic research. The conference and symposium drew more than 300 participants and articulated important perspectives on the opportunities and challenges for environmental justice advocates and other communities of color posed by rapid advances in environmental health genetic research and toxicogenomics.