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.

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,