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Summary Bernard D. Goldstein It is, of course, no coincidence that our symposium on "Ensuring Environ- mental Health in Post-Industrial Cities" took place in and applies directly to Pittsburgh a city whose industrial past featured the dirtiest of workplaces but that today boasts a clearer atmosphere, stronger links to its historic rivers, new commercial and residential structures where major industrial facilities once stood, and a more modern designation. No longer the Steel City, Pittsburgh is now thought of as the Knowledge City, given the knowledge-intense, research-and- development orientations of its academic, governmental, and private-sector institutions. The lessons we draw from this meeting's presentations and discussions nat- urally apply to other regions that have undergone similar change and that also must contend, as Pittsburgh does, with the legacies of past incarnations. But these lessons apply as well to virtually any region whether post-industrial, pre- industrial, or just plain industrial determined to face up to its environmental- health issues and do something about them in order to better serve its people and ensure a viable social and economic future. Rather than summarize here the symposium's proceedings in a speaker- by-speaker or subject-by-subject fashion that is the purpose, after all, of the succeeding pages we thought it more useful in this Summary to briefly char- acterize the several cross-cutting themes that emerged, from virtually speak- er after speaker, and that clearly must be central to regions' strategies for achiev- ing sound environmental health: Take advantage of the genuine interest and concern of the general public and decision makers. People really do care about the environment and, of course, about their own health and that of their families. And they are willing to act on those concerns, as poll after poll reveals. *This chapter is an edited transcript of Dr. Bernard Goldstein's remarks at the workshop.

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2 ENSURING ENVIRONMENTAL HEALTH IN POSTINDUSTRIAL CITIES Involve the public and all stakeholders early and often. We must communi- cate openly and effectively, and ensure that environmental justice is served. Most of us have heard of NIMBY "not in my backyard" but a good way to communicate the essence of environmental justice is WIMBY, or "why in my backyard?" This is the situation, resulting from powerlessness, imposed by wak- ing up one day to find that a whatever-it-is-that' s-questionable is already in- stalled in your backyard without your ever having had a chance to be among the empowered stakeholders, without your being part of the group that participated in this issue. Under the circumstances, there is no reason for the affected party to accept the solution, even if it happens to be seen by some as a good one. Partnerships are essential. Whether the partnerships are between universi- ties, or between universities and citizen groups, or between citizen groups and industry, or between any combination of sectors one can name, including gov- ernment, such collaborations are critical given the inevitably diverse array of stakeholders for addressing environmental health issues. Match vision with realism. This idea was phrased throughout the day in different ways, but by whatever name, our approaches should be practical. We must rationally match our visions to who we are and what we are realistically hoping to do. Reduce fragmentation. As noted in one of the presentations, the 11-coun- tries in the Southwestern Pennsylvania region have 492 individual entities that provide water or sewage service to the population. Such fragmentation can make partnering or establishing any kind of central direction much less pursuing a common vision highly elusive. ALCOSAN (the Allegheny County Sanitary Authority, which serves 83 communities, including the City of Pittsburgh) is an example, though an incomplete one, of multiple entities managing to work to- gether. It's progress. Similarly, there has been progress in alleviating federal- level fragmentation. This meeting, for instance, saw the head of the National Institute for Environmental Health Sciences, the head of the Agency for Toxic Substances and Disease Registries, and the head of CDC's Center for Environ- mental Health all in the same room an occurrence that would have been highly unlikely 5 or 10 years ago. Instead of competing, they are now cooperating in pursuit of common goals and employing, wherever possible, common approach- es. Integrate our environmental future within goals for economic growth. In other words, we must aim for "sustainable development." Determine options' true costs. We cannot do cost/benefit analysis if we only to use one example price out the cost of asphalt versus the cost of con- crete for a road and do not include their respective heat-island effects. Surely the elevated risk of heat stress and its effects on the community have a rightful place in our planning efforts; the environmental costs must be considered along with the economic costs. We have to understand the consequences of inaction. We could always just

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SUMMARY 3 "do nothing" an option made more likely by excessive fragmentation. But this too has its costs, economic as well as environmental, and should be chosen only if it's the most attractive option among others; it should not merely be the default position resulting from administrative paralysis. More research is needed. This predictable statement could well be a macro on most researchers' computers, but in the case of environmental health it's exceptionally valid, and not just regarding basic research. It also pertains to the acquisition of pertinent data, the formulation of environmental indicators, and the transcending of mere effluent measurement to assess the effects on the human body to what is happening in the environmental receptors of concern. We need more research, in effect, to better link decision processes to the end points. Finally, although regions and individual people grow and evolve, and as we shape our present environment to our present needs, it makes sense not to forget where we came from and the things that informed us, enriched us, and made us unique and that have equipped us to better respond to present chal- lenges. Pittsburgh, being the Knowledge City, will inevitably grow farther and farther from its manufacturing-industry past. Yet can anyone imagine a time when that football team across the river will be called the Pittsburgh Knowledgers? Of course not. It will remain the Pittsburgh Steelers because that is our heritage. It's always going to be part of who we are, something to be reflected and cherished even as we go forward.