Nancy Adler, University of California, San Francisco, addressed the added adverse impact of poverty beyond environmental stress; poorer neighborhoods tend to have few doctors and pharmacies, inadequate transportation, unsafe or inconvenient recreational facilities, and low availability of affordable, healthy food. Add to this the destruction of a community as a result of an environmental insult, and there is a loss of a sense of community, said Fullilove. Communities store things in their common memories, and this is lost when a community is destroyed. The challenge, according to speakers and panelists, is to ensure equal enforcement of laws and regulations, and involve members of the community, regardless of economic status, early on in the process of remediation.

Historically, the role of people and social activity as part of the environment has received less attention but is the most immediate proximate cause of many adverse consequences to the environment and health, according to several speakers. For example, the United States has experienced an increase in obesity in recent years, which has direct connections to our health and the environments we have created, said Bill Dietz of the Centers for Disease Control and Prevention. Many of the speakers pointed to a need to feel safe in neighborhoods as a way to increase physical activity, for example, creating connectivity in the built environment (direct paths for getting from one place to another). Increased community planning and promotion of physical activity were suggested as two ways to encourage better exercise habits.

All speakers highlighted the central conclusion that improving our health through a better environment requires the cooperation of many stakeholders outside traditional health care systems. The speakers and panelists discussed many ideas and actions. The challenge remains for the various stakeholders to collaborate in actively rebuilding the environment to promote better health for all species.

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