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6 Toward an Integrative Approach to Environmental Health This workshop highlighted the interdependence between public health and the environment. Speakers illustrated that promoting environment protection also promotes health and yields collateral benefits by focusing on the effects of health on a children’s education. There are many constituencies involved; thus, a new vision of environmental health, as discussed by the some speakers, requires crosscutting research and development and the establishment of new linkages between diverse groups, including the medical and public health communities, industry, government, farmers, policymakers, and international groups. There is evidence that contact with the natural offers health benefits. If so, then we need to articulate a broad vision of environmental health, said Howard Frumkin, one that stretches from urban planning to landscape architecture, from interior design to forestry, from botany to veterinary medicine. Such a vision has implications in at least four arenas: research, collaboration, clinical care, and public health advocacy. Also, although we suspect that there is often a relationship between environmental exposures and health effects, we need a research agenda directed not only at exposures suspected to be unhealthy, but also at those suspected to be healthy, and at outcomes that reflect not only impaired health but also enhanced health, concluded several speakers. New research questions pose challenges of defining and operationalizing unfamiliar variables. Landscape architects, horticulturists, and environmental psychologists work with the exposure variables, but those of us in environmental health do not. Similarly, the outcome variables that reflect health instead of disease are less familiar and must be developed and
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validated. These challenges offer broad opportunities for methods development and hypothesis testing. Environmental health specialists, from researchers to clinicians, have long recognized the need to collaborate with other professionals, for example, with mechanical engineers to build exposure chambers, chemists to measure exposures, and software engineers to apply information systems to health data. Workshop participants noted that we also need landscape architects to help identify the salient features of outdoor exposures, interior designers to do the same in micro-environments, veterinarians to help us understand more about human relationships with animals, and urban and regional planners to help link environmental health principles with large-scale environmental design. On the public health level, environmental health has a long history of providing data, and advocating action based on these data, to achieve control of environmental hazards, air and water pollution, pesticides, and workplace and other hazards; in the same way, we need to act on emerging evidence of environmental health benefits, noted several speakers. Environmental health could become a factor in policy decisions that affect human contact with nature—urban design, land use, and regional planning decisions, even forest policy. Environmental health might play a role in policy initiatives to protect green space, conserve trees, build bicycle paths, zone neighborhoods or regions, or design schools. Environmental health could appear in the curricula of schools of architecture and civil engineering. As we learn more about the health benefits of contact with the natural world, we need to apply this knowledge in ways that directly enhance the health of the public, said Frumkin. The solutions for solving many health problems lie clearly outside the health care system. They rest in the environments in which we live, work, go to school, and play. Because of this, they inevitably require innovation and persistence to solve problems. Efforts by designers, engineers, architects, city planners, developers, and communities can change the health status of a community by considering human needs in design and construction. Some participants suggested that the challenge is to get the health sector to recognize some of these issues and collaborate actively in rebuilding the physical community. Natural and social capital are critically important in addressing more than the symptoms of poor health and in getting at the root causes of public health in the broadest sense.
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