negotiated provide both a local and a global perspective by which to consider environmental health.

Although there clearly is an interdependence between public health and the environment, workshop participants noted that we have limited resources for identifying and understanding challenges to health or implementing intervention strategies. Some of the higher-order issues, such as sustainability, must be addressed if we are to achieve better health, noted Rafe Pomerance. Another central quandary is the reduction and disposition of waste. We cannot continue to have consumption that outweighs the production capacity of our ecosystems, and we cannot continue to produce waste at a rate that outweighs our ability to assimilate it back into the ecosystems without negative impacts, said William McDonough.

A second challenge is to develop baseline data on different environmental stressors. Impacts of a poor environment on public health can be direct or indirect. Speakers noted that we have tended historically to focus on the direct effects of pollution on public health—for example, toxicity or adverse health effects—and less on the bioindicators that can measure direct and indirect effects through impacts on ecological systems.

To meet these challenges, several workshop participants stated that we need to develop more holistic and integrated approaches to environmental health that incorporate considerations of human biological and ecological health and achieve better understanding of these interrelationships. The systems view of the ecologist must be adopted as a new paradigm for the environmental health scientist.

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