Medicine (held at the University of Iowa, Iowa City, on November 29 and 30, 2004), the Roundtable addressed rural environmental health issues in an interactive way, with those attending the discussions participating in a free exchange of views on how to rebuild the unity of health and the environment in rural America. The remainder of this chapter and the chapters that follow describe and summarize the participants’ presentations to the Roundtable members and the discussions that the members had with the presenters and participants at the workshop.


According to the World Health Organization (WHO), environmental health is defined as “those aspects of human health, including quality of life, that are determined by interactions with physical, chemical, biological and social factors in the environment” (WHO, 1986). Environmental health thus focuses on the quality of life and not simply on the absence of disease, and all the factors that contribute to environmental health, including the environment, are assessed when the environmental health of a population or region is evaluated.

Many researchers and investigators have created their own image of the interactions among health, behavior, biology, and genetic factors and the outcome, whether it is disease or health and function. Overlying these interactions are social, natural, and built environmental factors, remarked Roundtable member Donald Mattison. In developmental health, for example, researchers are beginning to realize that many of the events that lead to health disorders occur in utero or early in childhood, so it is important to understand the factors that ultimately lead to these disorders in adults. Most aspects of health are a direct result of the environments in which humans grow up, live, work, and play. Therefore, the solutions to public health problems cannot be left solely to the health care system; they require interactions among a broad group of individuals with expertise in a variety of areas.

Risk reduction and health promotion influence the development of health. Thus, consider a graph with health development—e.g., pulmonary function, cognitive function, or executive function—along the vertical axis and time along the horizontal axis. Mattison noted that because of a range of exposures or other factors, the trajectory that an individual might have followed across some period of time might be lower than what the optimum trajectory for health development for that individual could have been. However, if health promotion and risk reduction strategies had been put into place, the same individual might have been able to move through various stages of life and reach or approach the optimum trajectory. From what is known about the early origin of diseases in adults, it can be concluded that it is most important to act early to reduce risks and put in place strategies that promote health.

Obesity is a good example, noted Mattison. A lot of the focus on obesity has

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