The field of environmental health has been evolving in the depth of responsibilities for researchers and environmental public health officials. The Honorable Paul G.Rogers of Hogan and Hartsen noted that many are focusing on individual health issues or environmental hazards in isolation, when we need to have a more holistic understanding of the gamut of health and, in particular, environmental health. Henry Falk of the Agency for Toxic Substances and Disease Registry (ATSDR) agreed and noted that if we define environmental disease too narrowly, we miss a number of important conditions such as chronic diseases, where rates are currently rising.

Carol Henry of the American Chemistry Council further noted that in addition to the importance of a strong definition of environmental health, we need a better understanding and agreement as to what constitutes “good” environmental health and greater knowledge of the relative importance of environmental factors in promoting health. Some participants suggested as we move forward in environmental health monitoring, we will have to answer some of these definitional questions to help shape a more usable monitoring system.

What are the next steps to be taken in environmental health monitoring? Samuel Wilson of NIEHS echoed the thoughts of many participants in stating that the highest priority is to establish a national environmental public health monitoring system. For this purpose, public health should be described in the broadest sense possible to encompass chronic diseases, environmental diseases, and environmental circumstances that affect health, such as life-style, nutrition, and social stress. The monitoring system should be in the form of a relational database that could be used to make linkages and eventually to create hypotheses on cause-and-effect relationships. The usefulness of such a system would be immense and could lead to enormous gains in public health. The difficulty according to Baruch Fischhoff of Carnegie Mellon University is that the data collected will be used at a variety of different levels—the international, national, state, and local levels. One would like to have this information presented in a way that many people can make use of it.