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Toward Environmental Justice: Research, Education, and Health Policy Needs (1999)
Institute of Medicine (IOM)

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. "5 Health Policy." Toward Environmental Justice: Research, Education, and Health Policy Needs. Washington, DC: The National Academies Press, 1999.

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of scientific studies, to help citizens understand scientific data, and to help local public health officials and health practitioners deal with environmental health problems. If followed, the committee's recommendations should help establish a more equitable sharing of the burden of proof among the public, government agencies, and those engaged in potentially hazardous activities.

The committee also urges the scientific and political communities to recognize that the environmental problems faced by communities of concern are but one among many different problems they confront, including poor nutrition, limited education, minimal political representation, high unemployment, inadequate transportation, poor sanitation, hazardous workplaces, and insufficient vector control. When a community is under stress, primary attention should be given to attempting to address its health concerns in prudent ways. Secondarily, attention should be directed to identifying the accountable parties because holding people accountable for past misdeeds can be a valuable social function and provide incentives for appropriate behavior in the future.

Expanding the Policy Process

As noted in prior chapters of this report, action, supported by adequate resources, is needed to develop and implement a public health strategy, to improve the science base, and to enhance awareness and understanding of these issues on the part of health professionals, educators, the business community, public officials, and the general public. In addition, policymakers need a more expansive perspective and approach to the development of public policy—and public-sector decisions—that have a bearing on environmental health and environmental justice.

Inevitably, in some situations delaying the decisionmaking process to wait for more data or better research is not a desirable or acceptable course. Delay may mean that a community will forego a significant economic benefit or may suffer further exposure to potentially dangerous environmental hazards. Foreman notes two other reservations about seeking solutions for environmental justice problems predominantly through scientific inquiry. He notes that "science cannot resolve what are ultimately value questions." In addition, he suggests that "calls for more and better scientific studies may, if successful, simply generate more information than policymaking institutions can reasonably digest given their available resources" (1998, p. 112).

These constraints on public policymaking do not mean that decisionmakers should forego evidence-based problem solving. To the contrary, it means that great attention must be paid to making sure that the decisionmaking process is as open as it reasonably can be to ideas, information, and participants derived from affected or potentially affected communities. In the case of existing environmental hazards, members of the local community may be the best available source of information regarding exposures—including multiple exposures or routes of exposure—or about the interplay of exposures and other potentially

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