Introduction

The Institute of Medicine’s Roundtable on Environmental Health Sciences, Research, and Medicine was established in 1998 as a convening mechanism to discuss both timely and sensitive environmental health issues in a neutral environment. Members come from academia, industry, and government and their discussions serve to facilitate dialogue on various topics in environmental health. This summary report has been prepared by the workshop rapporteurs to convey the essentials of the 2-day workshop. It should not be construed as a statement of the Roundtable, which can illuminate issues but cannot actually resolve them, or as a study of the Institute of Medicine (IOM).

CHARGE TO SPEAKERS AND PARTICIPANTS

Samuel Wilson


The field of environmental health has evolved during the last several years as scientists and others have worked toward better ways to understand linkages between human health and environmental factors. This is a challenge in the United States and around the world as our understanding of the impact of the environment on human health continues to evolve. As we move forward, scientists and policy makers realize that new paradigms and partnerships are needed to address the complex environmental health challenges facing society.

Traditional View and Evolving Definition of Environmental Health

Traditionally, the field of public health has developed a working model of the relationship to health and disease that takes into account the role of such features such as genetic susceptibility, biology, and behaviors in determining health. As illustrated in Figure I–1, these features can interact and converge to result in disease. Environmental health builds on this model by identifying those



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Global Environmental Health in the 21st Century: From Governmental Regulation to Corporate Social Responsibility - Workshop Summary Introduction The Institute of Medicine’s Roundtable on Environmental Health Sciences, Research, and Medicine was established in 1998 as a convening mechanism to discuss both timely and sensitive environmental health issues in a neutral environment. Members come from academia, industry, and government and their discussions serve to facilitate dialogue on various topics in environmental health. This summary report has been prepared by the workshop rapporteurs to convey the essentials of the 2-day workshop. It should not be construed as a statement of the Roundtable, which can illuminate issues but cannot actually resolve them, or as a study of the Institute of Medicine (IOM). CHARGE TO SPEAKERS AND PARTICIPANTS Samuel Wilson The field of environmental health has evolved during the last several years as scientists and others have worked toward better ways to understand linkages between human health and environmental factors. This is a challenge in the United States and around the world as our understanding of the impact of the environment on human health continues to evolve. As we move forward, scientists and policy makers realize that new paradigms and partnerships are needed to address the complex environmental health challenges facing society. Traditional View and Evolving Definition of Environmental Health Traditionally, the field of public health has developed a working model of the relationship to health and disease that takes into account the role of such features such as genetic susceptibility, biology, and behaviors in determining health. As illustrated in Figure I–1, these features can interact and converge to result in disease. Environmental health builds on this model by identifying those

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Global Environmental Health in the 21st Century: From Governmental Regulation to Corporate Social Responsibility - Workshop Summary FIGURE I-1 When taking into consideration the relationship of health and disease we need to take into account the role of multiple contributing factors. SOURCE: Wilson, unpublished. environmental factors that can interact with the features in this primary model (see Figure I-1) to influence the disease state. The definition of environmental health continues to change. In recent years, the field has evolved toward a more holistic view of the effect of environment on health and has recognized the challenges and the opportunities inherent in this broader view in advancing the field. The World Health Organization defines environmental health as the direct pathological effects on health of chemical, physical, and biological agent and of the effects of the broad physical and social environment on human health (World Health Organization, 1986). This definition is one of many examples that not only apply to air, water, and soil, but in the broadest sense to the pathological effect on health of the broad physical and social environment. Considering these and other definitions, the Roundtable began to define environmental health as the human health impact of the holistic environment—one comprised of the natural, built, and social environments. This view superimposes a holistic view of the influence of various environments in which we live, play, and work. The Roundtable continues to look at how socioeconomic factors, the natural environment, and the built environment can interact to impact human health. Environmental Health: New Challenges, New Strategies Medical science is advancing and developing new and far more precise tools to investigate the linkages between health and the environment. One example is

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Global Environmental Health in the 21st Century: From Governmental Regulation to Corporate Social Responsibility - Workshop Summary advances in the field of genetics due to the work under the aegis of the Human Genome Project. With sequence of the 20,000–25,000 genes in human genome DNA, we are beginning a new age from the standpoint of research opportunities on gene-environment interactions. In environmental health, this will have tremendous implication. We will be able to better understand the complex question, Why does one individual when exposed to a toxicant develop disease, while another with the same exposure does not? With the adoption of a broader view of environmental health, environmental health scientists’ strategies for addressing issues have changed. In a speech in 1997, then President of MIT, Charles Vest, suggested that “For the past 30 years, environmental concerns in this country have been dominated by a mentality of government regulation and remediation.” He further noted that, “In the future, industry and academia must instead play an increasingly important role in exercising environmental responsibility. We must educate engineers, managers, scientists, economics and policy experts to analyze environmental issues and synthesize sound solutions. Sound thinking about and commitment to sustainable development and environmental stewardship must be an integral part of the general education and practice of engineering management. Proactive environmentalism is good business in the growing commitment to a healthy environment on the part of both industry and academia in setting the stage for new partnerships between the public and private sectors,” (Vest, 1997). His remarks frame an important concept for industry, for the field of engineering, and for this workshop, in the sense of exploring environmental stewardship. This workshop was planned to examine some of the issues surrounding international regulations and concept of corporate social responsibility (CSR) and to understand the impact they will have for environmental health. Currently, there are pressures from shareholders and environmentally-minded individuals to encourage or require the adoption of “environment-friendly” practices, standards, and policies. Although it is clear that global regulatory standards will always be a major driver in the field of environmental health, there is growing understanding of the value of voluntary standards to fill in gaps or to work in concert with formal regulations. Overall, this workshop was planned to help define the term corporate social responsibility, identify best practices, and consider cost-benefit issues. The workshop planning group hopes to challenge the industry to identify ways that best practices can be more efficiently shared and to address issues of privacy or trade secrets, which will allow for data to be more transparent. Federal research agencies also have roles to play, meaning that research needs to help reduce risk, especially up front, before the harm is introduced into the environment. Finally, the planning group would like to see the workshop define needs for strategic partnerships in global environmental health. This Roundtable has done an excellent job in the past on this point of identifying new partnership opportunities, and this is also a priority as we begin this exciting workshop today.

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Global Environmental Health in the 21st Century: From Governmental Regulation to Corporate Social Responsibility - Workshop Summary FIVE WORKSHOP OBJECTIVES Myron Harrison Environmental health is an extremely democratic and non-elitist issue. Anyone can be a player in environmental health, and anyone and everyone has legitimate contributions to make. The planning group reflected this in the diversity of the speakers on this program. By sponsoring the workshop, the Roundtable wanted to explore the following: Better understand the systems approach, that is, understanding the bidirectional contributions of individual components in environmental health by understanding the linkages and interactions of the elements from a holistic view. Better understand the diversity and inconsistency of global health and environmental issues and regulations. Better understand the challenges of operating responsibly in the absence of either health infrastructure or regulation. Discuss the respective roles of voluntary actions and regulation. Capture learnings that might promote more rapid progress toward a better environment for human health. It is hoped everyone will better understand the challenges of operating responsibly in the absence of regulations. Sometimes from the perspective of corporations, there is too much regulation, but sometimes there is not enough, noted Harrison of ExxonMobil. There are parts of the world where there is no such thing as direction, essentially no government effectiveness of any type; and that makes it very difficult to ensure that company employees and the communities where they work have adequate health infrastructure.