Environmental health is very important for the overall status of health in our population. In a recent review, the Centers for Disease Control and Prevention (CDC), listed 10 public health achievements, that are largely responsible for the fact that life expectancy in our country has increased by 30 years in the last century. A number of these are environmental health measures, such as improved sanitation, better nutrition, and better housing. In fact, environmental health measures are responsible for more than three-quarters of these improvements. Medical care, although important, made a relatively modest contribution to our increased longevity (CDC, 1999).

Houston, like many local regions in the United States, is concerned with chronic disease—and for good reason. For the nation as a whole, chronic disease has become the number one killer, and it is responsible for the majority of our health care costs (Figure 2.1). At the same time, we are challenged by infectious disease—particularly from new threats such as SARS (severe acute respiratory syndrome), West Nile virus, and other pathogens that seem to be emerging from the environment. We also have the threat of terrorism and consequent demands on the public health system to address all of these concerns. I don’t think there has ever been a time when people appreciated the public health system more, but I also think that there has never been a time when the public health system was more overtaxed.

In addressing these challenges, the Roundtable believes we should think systemically. Environment, after all, has three interacting aspects—the natural

FIGURE 2.1 The U.S. population spends as much on the burden of chronic disease as the U.S. government spends on Medicare and Medicaid and the defense budget. SOURCE: Jim O’Hara, unpublished. Reprinted with permission.



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