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1 Introduction REMARKS AND CHARGE TO PARTICIPANTS Samuel H. Wilson, M.D. Deputy Director, National Institute of Environmental Health Sciences This workshop was designed to assist the Institute of Medicine’s (IOM) Roundtable on Environmental Health Sciences, Research, and Medicine in clarifying the scope of the term environmental health. The presentations and discussions will help to define and shape the future Roundtable activities and outreach. This talk will focus on the working goals of environmental health and the challenges faced by individuals both now and in the future. At the conclusion of this talk, we will discuss the charge to the speakers and participants. The goals of environmental health include the following: (1) establishing and maintaining a healthy livable environment for humans and other species and (2) promoting an environment that improves well-being and a high quality of mental health. In addition, this environment must be sustained into the future and be a setting in which population growth, manufacturing, and agriculture can thrive. We all recognize that in recent decades, many important achievements have helped create a cleaner, healthier environment, yet our national needs in environmental health are not being fully met. The infrastructure for linking environmental health and public health is not working as well as it should. Moreover, environmental health at the local level has become narrowly focused, very much defined around regulations and the attendant regulatory debates. A key to success in the future is to define broader environmental health goals that call for better linking of environmental and public health. There is no doubt that environmentally related diseases will continue to pose problems in the future. The amount of chemical and biological waste generated by human activity will increase, the total environmental burden will grow due to population growth and industrial development, and pollution will continue to be gener-
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ated in all parts of the world. Failure to understand and manage this environmental challenge could have truly disastrous consequences. The charge to the workshop speakers and participants is that environmental health in the future requires an expanded vision, which is the focus of this workshop, specifically: What are the approaches that will maintain and extend environmental health beyond the traditional regulatory approach? What are the approaches for building environments that actively improve human health? How can we obtain the involvement and leadership of citizens, business leaders, public health workers, and others in addressing environmental health at the local community level? What new mechanisms are needed to realize the breadth of environmental health? How can we raise awareness and promote community-based environmental health? How can we build educational approaches, federal and state programs, and economic incentives to enhance environmental health? How can we encourage university scientists to participate in developing effective environmental regulations? How can we promote environmental health that is both sensitive to the needs of local communities and flexible enough to allow a range of approaches? Finally, how can we integrate environmental health with pressing economic development and social issues and changes in the global environment? This talk has posed many open-ended questions that are intrinsically very difficult to answer. Nevertheless, these questions will form the framework for the workshop discussions. The challenge will then be to the leadership of the federal environmental agencies and other leading thinkers in this field to look for answers to these questions and to help us all move forward with the challenges facing the field of environmental health. STATEMENT OF WORKSHOP OBJECTIVES Lynn R. Goldman, M.D., M.P.H. The Johns Hopkins School of Public Health The title of this workshop is Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century. Why do we need a new vision? First, the local infrastructure for delivering environmental health is not working. It is overtaxed; in so many communities, the demands on public health simply to deliver medical services to the poor have overshadowed almost all public health functions. Very little has been done to rebuild and repair that system, yet evidence is solid that the public strongly supports public health,
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particularly environmental health. Despite this support, there is little doubt that in this country the science issues in environmental health and the functions of our environmental regulatory system are extremely adversarial. Too often we are fighting with each other rather than searching for solutions to problems. Those in the profession of environmental health are very much a part of the problem. All too often we are not engaged in the real issues in environmental health—such as land and energy use, transportation, and consumption. Rather, we tend to focus narrowly on specific issues—for example, the question of which oxygenate should be present in fuel—rather than on the question of how to reduce pollution from our transportation system and energy use. So although we are focused on the details of how to ensure environmental health, we have lost sight of the big picture. There are some positive signs of change in federal agencies, such as the environmental justice initiatives, urban health centers, and children’s health centers at the National Institute of Environmental Health Sciences. In addition, the Centers for Disease Control and Prevention and the Healthy People 2010 plan define objectives for environmental health protection using public health goals that can be tracked. However, these efforts do not go far enough. During the last decade, despite a near doubling in the size of the National Institutes of Health budget, there has not been a comparable increase in the investment in public and environmental health, particularly in the area of prevention. One of the great challenges facing environmental health is population growth. According to the recent National Research Council (1999) report, Our Common Journey: A Transition Toward Sustainability, we need to begin today and have only two generations in which to complete action in order to cope with the changes associated with the enormous success that we have had as a species on this planet. While we have a strong infrastructure for building a global economy, we do not have the necessary infrastructure for managing the environmental impacts of that economy. This workshop aims to address the connections between human health and the natural environment. Another issue is the relationship between human health and the built environment; this is where the discussions must focus on acting locally. Most of the things that need to be done to address environmental issues, even global problems, have to be done at a local level. We need to understand the environmental consequences of how we build our homes, buildings, and cities. The social environment and its impact on human health also deserve consideration. Because it is our species that is shaping the evolution of the planet, the major problems that face us frequently involve human behavior. Thus, we must find better ways of educating the population about consumption and resource use. We need to recognize the broad range of people who are involved in environmental health, especially the general public and communities at all levels. We have only two generations in which to act. This means that we and the next generation will shoulder much of the responsibility for solving the problems that we have both inherited and created. We need nothing less than a new vision of environmental health for the 21st century.
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