those at different levels of the SES hierarchy. SES environments differ in the relative exposure to carcinogens and pathogens. Poorer neighborhoods have higher rates of toxic exposure; similarly, lower-SES jobs are more likely to involve such exposure. If one expands environment to include the social environment, SES has even greater effects. A key aspect of environments is the extent to which they are experienced as stressful by those who inhabit them. At both work and home, higher-SES individuals are less likely to confront uncontrollable stress. Research on British civil servants has shown that a sense of control over work varies directly with occupational grade and accounts for much of the effects of occupational level on mortality. Community-based research has shown that in urban environments, neighborhoods that demonstrate a sense of “collective efficacy” and social cohesion have lower rates of violence as well as lower mortality from other causes of death; these associations hold even when controlling for traditional socioeconomic level.

Another pathway from SES to health is through health behaviors. Health-risking behaviors, including cigarette and other substance use, high-fat diets, and sedentary life-style, vary inversely with SES; lower SES is associated with higher rates of all these behaviors. Although these are individually based behaviors, they are shaped by physical and social environments. Neighborhoods constrain the choices individuals can make; poorer neighborhoods provide more access to health-damaging goods (e.g., alcohol, tobacco) and less access to goods that foster health (e.g., fresh fruit and vegetables, low-fat food). Poorer areas also have fewer recreational facilities and safe areas for walking and jogging, thus discouraging exercise.

SUSTAINABLE DEVELOPMENT, ENVIRONMENT, AND HEALTH

Nicholas Ashford

Progress in environmental health is hampered by the balkanization of the knowledge base. People and organizations are working on pieces of the problem, but they are not connected and communicating. The role of the government has focused on regulation, but it has past information rather than the state of the art. States such as Massachusetts, New Jersey, and Minnesota have taken a lead by requiring industries to talk about what they could be doing rather than what they are doing.

In order to address and set priorities for environmental and public health problems, there is a significant need for industrial transformation or displacement of technologies and sectors that give rise to serious environmental and public health problems. This is especially true for those industries that have remained stagnant for some period of time and are ripe for change. Achieving sustainable production and consumption requires (1) a shift in policy focus from assessing and characterizing problems to designing solutions; (2) an appreciation of the differences between targeting technological innovation and diffusion



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