Rebuilding the Unity of Health and the Environment

The Greater Houston Metropolitan Area: Workshop Summary

Lovell Jones, John Porretto, and Christine M. Coussens, Editors

Roundtable on Environmental Health Sciences, Research, and Medicine

Board on Health Sciences Policy

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary Rebuilding the Unity of Health and the Environment The Greater Houston Metropolitan Area: Workshop Summary Lovell Jones, John Porretto, and Christine M. Coussens, Editors Roundtable on Environmental Health Sciences, Research, and Medicine Board on Health Sciences Policy INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for this project was provided by the National Institute of Environmental Health Sciences, National Institutes of Health (Contract No. 282-99-0045, TO#5); National Center for Environmental Health and Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention (Contract No. 200-2000-00629, TO#7); National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (Contract No. 0000166930); National Health and Environment Effects Research Laboratory and National Center for Environmental Research, Environmental Protection Agency (Contract No. 282-99-0045, TO#5); American Chemistry Council (unnumbered grant); and Exxon-Mobil Corporation (unnumbered grant). The views presented in this book are those of the individual presenters and are not necessarily those of the funding agencies or the Institute of Medicine. This summary is based on the proceedings of a workshop that was sponsored by the Roundtable on Environmental Health Sciences, Research, and Medicine. It is prepared in the form of a workshop summary by and in the names of the editors, with the assistance of staff and consultants, as an individually authored document. International Standard Book Number 0-309-09442-9 (Book) International Standard Book Number 0-309-54646-X (PDF) Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, N.W., Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2005 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Adviser to the Nation to Improve Health

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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council www.national-academies.org

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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary ROUNDTABLE ON ENVIRONMENTAL HEALTH SCIENCES, RESEARCH, AND MEDICINE Paul Grant Rogers (Chair), Partner, Hogan & Hartson, Washington, DC Lynn Goldman (Vice Chair), Professor, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD Jacqueline Agnew, Professor, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD Jack Azar, Vice President, Environment, Health and Safety, Xerox Corporation, Webster, NY Roger Bulger, President and Chief Executive Officer, Association of Academic Health Centers, Washington, DC Yank D. Coble, Immediate Past President, American Medical Association, Neptune Beach, FL Henry Falk, Assistant Administrator, Agency for Toxic Substance and Disease Registry, Atlanta, GA Baruch Fischhoff, Professor, Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA John Froines, Professor and Director, Center for Occupational and Environmental Health, Southern California Particle Center and Supersite, University of California, Los Angeles, CA Howard Frumkin, Professor and Chair of the Department of Environmental and Occupational Medicine at the Rollins School of Public Health, Emory University, Atlanta, GA Michael Gallo, Professor of Environmental and Community Medicine, University of Medicine and Dentistry, New Jersey–Robert Wood Johnson Medical School, Piscataway, NJ Paul Glover, Director General, Safe Environments Programme, Health Canada, Ottawa, Ontario, Canada Bernard Goldstein, Dean, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA Charles Groat, Director, U.S. Geological Survey, Reston, VA Myron Harrison, Senior Health Advisor, Exxon-Mobil, Inc., Irving, TX Carol Henry, Vice President for Science and Research, American Chemistry Council, Arlington, VA John Howard, Director, National Institute Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC Richard Jackson, Senior Advisor to the Director, Centers for Disease Control and Prevention, Atlanta, GA Lovell Jones, Director, Center for Research on Minority Health; Professor, Gynecologic Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, TX

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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary Alexis Karolides, Senior Research Associate, Rocky Mountain Institute, Snowmass, CO Fred Krupp, Executive Director, Environmental Defense, New York, NY Donald Mattison, Senior Advisor to the Directors of National Institute of Child Health and Human Development and Center for Research for Mothers and Children, National Institutes of Health, Bethesda, MD Michael McGinnis, Senior Vice President and Director of the Health Group, Robert Wood Johnson Foundation, Princeton, NJ James Melius, Administrator, New York State Laborers’ Health and Safety Fund, Albany, NY James Merchant, Professor and Dean, College of Public Health, Iowa University, Iowa City, IA Sanford Miller, Senior Fellow, Center for Food and Nutrition Policy, Virginia Polytechnic Institute and State University, Alexandria, VA Alan R. Nelson, Special Advisor to the Chief Executive Officer, American College of Physicians–American Society of Internal Medicine, Fairfax, VA Kenneth Olden, Director, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC John Porretto, Chief Business Officer, Health Science Center, University of Texas Houston, Houston, TX Peter Preuss, Director, National Center for Environmental Research, U.S. Environmental Protection Agency, Washington, DC Lawrence Reiter, Director, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, NC Carlos Santos-Burgoa, General Director, Equity and Health, Secretaria de Salud de México, México D.F., México Michael Shannon, Chair of the Committee of Environmental Health, Associate Professor of Pediatrics, Children’s Hospital, Boston, MA Samuel Wilson, Deputy Director, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC IOM Health Sciences Policy Board Liaisons Lynn R. Goldman, Professor, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD Bernard D. Goldstein, Dean of the University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA

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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary Study Staff Christine M. Coussens, Study Director Ricardo Molins, Senior Program Officer Dalia Gilbert, Research Associate Erin McCarville, Senior Program Assistant (from August 2004) Division Staff Andrew Pope, Division Director Troy Prince, Administrative Assistant Carlos Gabriel, Financial Associate Steven Marcus, Consultant

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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Dana Easley, Houston Advanced Research Center, The Woodlands, TX Jean M. Hampton, Assistant Professor of Health Sciences, Texas Southern University Houston, TX Jacqueline M. Lentz, Bureau of Air Quality Control, Houston Department of Health and Human Services, Houston, TX Dicksen Tanzil, Research Director, BRIDGES to Sustainability, Houston, TX Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the remarks made nor did they see the final draft of the report before its release. The review of this report was overseen by Melvin Worth, Scholar-in-Residence, Institute of Medicine, who was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary Preface Continuing the theme of the workshop sponsored by the Institute of Medicine’s Roundtable on Environmental Health Sciences, Research, and Medicine in June 2000, Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century, participants at the regional meeting held in Houston expressed similar views that for a long time the world of environment, environmental regulation, environmental control, and engineering had moved in one direction, while the world of health had moved in another. The importance of these views is based on the fact that Houston, Texas has already achieved the demographic composition that will reflect the predicted demographics of the United States by the mid-twenty-first century. Named after Sam Houston, President of the Republic of Texas and general of the Texas army that won independence from Mexico, the city was founded by Augustus and John Allen. They established the city of Houston along the banks of the Buffalo Bayou to provide a needed shipping route from the Texas interior. Houston, however, did not become the port city the Allen brothers originally envisioned until two major events occurred. The Great Storm of 1900 destroyed the port of Galveston and reinforced the need for a protected port, while the dredging of the Houston Ship Channel made it possible to increase shipping. Today, the Houston metropolitan area’s population is the 10th largest in the nation with the landmass consisting of eight counties. Houston has more than 500 cultural, visual, and performing arts organizations, 90 of which are devoted to multicultural and minority arts. More than 90 languages are spoken throughout the Houston area. It is the home to the Texas Medical Center (TMC), the largest medical center in the world, 18 Fortune 500 companies, and more than 5,000 energy-related firms—making it the energy capital of the world. Additionally, the Port of Houston ranks as the nation’s largest port in international tonnage and nation’s second in total tonnage. Houston is at the tail end of a large belt of natural forest continuing down through East Texas with the climate similar to coastal Louisiana and Missis-

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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary sippi—warm and humid with ample rainfall. In undisturbed areas people will find marshy grasslands in the south and woods in the north with ample wildlife. John James Audubon, the prominent naturalist, visited Houston in 1837 studying and painting birds and other wildlife along the Gulf Coast. Contrast the above with the fact that Houston is the only major U.S. city that doesn’t have zoning, allowing the market to determine land-use instead. Houston is struggling with many of the environmental problems that most of the nation’s major metropolitan areas are struggling with—transportation, water and air pollution, flooding, and major demographic changes. Therefore, Houston provided an excellent site for a regional meeting on the relationship between environment and health. The purpose of this regional meeting in Houston was to bring all the stakeholders together—the private and public sector, along with representatives of the diverse communities in Houston—to discuss the impact of the natural, built, and social environments on human health. Prior to the workshop, members of the Roundtable, in conjunction with the Community Relations Core of the Center for Research on Minority Health, contacted representatives for the private and public sector, and for the diverse communities of Houston to participate in focus groups to determine what topics should be covered in a regional meeting. Meetings were held in a number of areas around the region, ensuring that all of the stakeholders were represented. A preworkshop meeting was then held to bring together representatives from all of the focus group meetings to determine the specific topic and suggested speakers. The result of all of these meetings and the participation of all segments of the populace was a balanced program that brought all members to the table to discuss the environmental future of the Houston region. However, it must be stated that this workshop report is an informational document that provides a summary of the regional meeting. The views expressed here do not necessarily reflect the views of the Institute of Medicine, the Roundtable, or its sponsors. Lovell Jones, Roundtable Member John Porretto, Roundtable Member

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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary Contents     SUMMARY   1 1   INTRODUCTION   6      Charge to Speakers and Participants,   6 2   ENVIRONMENTAL HEALTH OVERVIEW   8      What Is Environmental Health?,   8      Environmental Health Challenges in Houston,   13      A Growing Disparity,   14      Who’s on First? What’s on Second?,   15      Broader Issues and Basic Causes,   16      Multiple Stressors and Combined Effects,   17      A Question of Balance,   18 3   NATURAL ENVIRONMENT   19      The Natural Environment and Human Health,   20      Something in the Air,   21      Regional Floods: Continual Challenges,   26      Providing Safe Drinking Water,   29      Learning from Nature,   30 4   SOCIAL ENVIRONMENT   31      The Demographic and Socioeconomic Trends in Houston,   31      Building the City’s Social Capital,   35

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Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area - Workshop Summary 5   BUILT ENVIRONMENT   39      An Impact on Health,   39      Building Healthier Buildings,   46      Turning Down the Heat,   48      Brownfields and Environmental Justice,   50      Environmental Health In Industry: Partnerships and Responsible Care,   52      Coming Together,   55     REFERENCES   57     APPENDIXES     A   Workshop Agenda   61 B   Speakers and Panelists   66 C   Workshop Participants   68