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Christine Coussens and Erin Rusch, Rapporteurs Roundtable on Environmental Health Sciences, Research, and Medicine Board on Population Health and Public Health Practice

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary 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. This activity was supported by contracts between the National Academy of Sciences and the National Institute of Environmental Health Sciences, American Chemistry Council, Arch Chemicals, and Royal Dutch Shell. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. 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 name of the rapporteurs as an individually authored document. International Standard Book Number-13: 978-0-309-28786-9 International Standard Book Number-10: 0-309-28786-3 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 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. Suggested citation: IOM (Institute of Medicine). 2013. Public health linkages with sustainability: Workshop summary. Washington, DC: The National Academies Press

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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. Ralph J. Cicerone 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. C. D. (Dan) Mote, Jr., 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. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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MEMBERS OF THE PLANNING GROUP FOR THE WORKSHOP ON PUBLIC HEALTH LINKAGES WITH SUSTAINABILITY1 LYNN R. GOLDMAN, George Washington University, Washington, DC CARLOS CORVALÁN, Pan American Health Organization, Washington, DC JOHN M. BALBUS, National Institute of Environmental Health Sciences, Bethesda, MD LINDA A. MCCAULEY, Emory University, Atlanta, GA BERNARD D. GOLDSTEIN, University of Pittsburgh, Pittsburgh, PA 1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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MEMBERS OF THE ROUNDTABLE ON ENVIRONMENTAL HEALTH SCIENCES, RESEARCH, AND MEDICINE1 FRANK LOY (Chair), Washington, DC (from 7/1/2011) LYNN R. GOLDMAN (Vice Chair), George Washington University, Washington, DC JOHN M. BALBUS, National Institute of Environmental Health Sciences, Bethesda, MD LINDA S. BIRNBAUM, National Institute of Environmental Health Sciences, Research Triangle Park, NC LUZ CLAUDIO, Mount Sinai School of Medicine, New York, NY YANK D. COBLE, University of North Florida, Jacksonville, FL (until 12/31/2011) ROB DONNELLY, Shell Oil Company, The Hague, The Netherlands EDWARD DOYLE, JR., West Virginia University School of Medicine, Morgantown, WV (until 12/31/2011) RICHARD A. FENSKE, University of Washington, Seattle, WA LUIZ A. GALVÃO, Pan American Health Organization, Washington, DC PEGGY GEIMER, Arch Chemicals, Inc., Greenwich, CT (until 12/31/2011) BERNARD D. GOLDSTEIN, University of Pittsburgh, Pittsburgh, PA SHARON H. HRYNKOW, U.S. Department of State, Washington, DC (until 12/31/2011) RICHARD J. JACKSON, University of California, Los Angeles, Los Angeles, CA SUZETTE M. KIMBALL, U.S. Geological Survey, Reston, VA LINDA A. MCCAULEY, Emory University, Atlanta, GA DAVID M. MICHAELS, Occupational Safety and Health Administration, Washington, DC CANICE NOLAN, European Commission, Brussels, Belgium HERNANDO R. PEREZ, Drexel University School of Public Health, Philadelphia, PA (until 12/31/2011) MARTIN A. PHILBERT, University of Michigan, Ann Arbor, MI 1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. vi

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CHRISTOPHER J. PORTIER, Centers for Disease Control and Prevention, Atlanta, GA WILLIAM N. ROM, New York University School of Medicine, New York, NY (until 12/31/2011) LEONA SAMSON, Massachusetts Institute of Technology, Cambridge, MA (until 12/31/2011) PAUL SANDIFER, National Oceanic & Atmospheric Administration, Charleston, SC JOHN D. SPENGLER, Harvard School of Public Health, Boston, MA LOUIS W. SULLIVAN, Morehouse School of Medicine, Atlanta, GA WILLIAM C. SULLIVAN, University of Illinois at Urbana, Champaign, IL (until 12/31/2012) CIRO V. SUMAYA, Texas A&M University, College Station, TX (until 12/31/2011) JENNIE WARD ROBINSON, Institute for Public Health and Water Research, Skokie, IL (until 12/31/2011) NSEDU OBOT WITHERSPOON, Children’s Environmental Health Network, Washington, DC HAROLD ZENICK, U.S. Environmental Protection Agency, Research Triangle Park, NC IOM Staff CHRISTINE COUSSENS, Study Director ERIN RUSCH, Associate Program Officer ANDRÉS GAVIRIA, Research Associate MALCOLM BILES, Project Assistant (until 7/2012) ALYSSA KATZENELSON, Christine Mirzayan Science and Technology Policy Fellow HOPE HARE, Administrative Assistant ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice vii

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REVIEWERS This workshop summary 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 workshop summary as sound as possible and to ensure that the workshop summary 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 process. We wish to thank the following individuals for their review of this workshop summary: Robert Goldsmith, Novartis Pharmaceuticals Corporation Susan Santos, University of Medicine and Dentistry of New Jersey Carlos Santos-Burgoa, Pan American Health Organization Juli Trtanj, National Oceanic and Atmospheric Administration Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Melvin Worth. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the authors and the institution. viii

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CONTENTS 1 INTRODUCTION 1 References, 3 2 OVERVIEW OF THE LINKS BETWEEN SUSTAINABILITY AND HUMAN HEALTH 5 Rio+20 and Health: Roads Leading from the Rio Earth Summit in 1992 to 2012, 5 Understanding the Global Commitment to Addressing Environmental and Health Issues, 10 Climate Change: The Need for Linkages for Sustainability and Health, 14 Current and Emerging Challenges and Opportunities for Environmental Health: Sustainability, Noncommunicable Diseases, and Opportunities for Linkages, 18 Sustainability Frameworks and Opportunities for Linkages with Health, 26 Discussion, 32 References, 36 3 LINKS BETWEEN ENERGY, AIR QUALITY, AND HUMAN HEALTH 41 The Role of Public Health in the Energy-Climate Challenge, 41 Energy and Health: Who Is at Risk?, 46 Energy and Noncommunicable Diseases: Household Air Pollution, 49 Discussion, 57 References, 60 4 SUSTAINABILITY LINKS TO FOOD AND WATER RESOURCES 65 Food Systems, Sustainability, and Public Health, 65 Natural Resources, Sustainability, and Health , 74 Discussion, 82 References, 84 ix

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x CONTENTS 5 SUSTAINABILITY LINKS TO OCCUPATIONAL AND CHILDHOOD HEALTH 89 Exposure and Risk Profiles in the Agricultural Workplace: Opportunities for Sustainability, 89 Sustainability and Health: Impacts for Workers, 96 Early Childhood Exposure and Health Risks: Incorporating Sustainability, 98 Discussion, 101 References, 103 6 NEW SUSTAINABILITY FRAMING 105 The Health Lens of Sustainability, 105 Sustainability and Exposure: Insights from the NRC Report, 110 Discussion, 112 References, 114 7 HEALTH MESSAGES AND STRATEGIES FOR DISSEMINATION 117 APPENDIXES A WORKSHOP AGENDA 121 B SPEAKER BIOSKETCHES 127