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SUMMARY 1 Summary This is a summary of the workshop Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century. The goal of this workshop was to emphasize the connection between human health and the natural, built, and social environments. This workshop integrated talks from many fields and created a dialogue among various environmental health stakeholders. The language presented in this respect should not be viewed as an endorsement by the Environmental Health Sciences Roundtable or the Institute of Medicine of what action is needed for the future, but rather as an effort to synthesize the various perspectives presented. The introductory presentations laid the overarching arguments for sponsoring the workshop. These talks highlighted that many individuals believe that a new vision is needed because the infrastructure for linking environmental health and public health is not working as well as it should. Commonly one finds that environmental health at the local level has become narrowly focused, very much defined around regulations and the attendant regulatory debate. Instead, asserted many workshop participants, environmental health needs to be concerned with establishing and maintaining a healthy livable environment for humans and other species. This environment must coexist with a setting in which population growth, manufacturing, and agriculture can thrive. Twenty years of research since the Safe Drinking Water Act of 1974, the Clean Air Act Amendments of 1977, the Clean Water Act of 1977, and the Superfund statute of 1980 have provided a wealth of new knowledge, including the special vulnerability of children. Yet scientists and policymakers have not drawn the clear connections between education, health, and the environment, asserted
SUMMARY 2 keynote speaker Timothy Wirth, president of the United Nations Foundation. Money has not been invested in the research needed to build on the accomplishments of the 1970s, said Lynn Goldman of Johns Hopkins University. Despite a near doubling in the size of the National Institutes of Health budget, there has not been a comparable increase in the investment in public and environmental healthâparticularly in the area of prevention, she noted. Several speakers highlighted a number of challenges we face in the future, including population growth, urban sprawl, and energy use. Many speakers emphasized that the natural environment and human health have strong connections. Research has demonstrated this connection, and our own behavior reflects this link: people flock to our national parks and zoos, and pet ownership remains high year after year. Many Americans search for solitude or a place to commune with nature. As urban sprawl continues, communities increasingly are relying on federally owned land as a place to provide much needed green space, according to David Hayes, U.S. Department of the Interior. He noted that this is providing an increasing strain on the environment, and other speakers, such as Mayor J. Christian Bollwage of Elizabeth, New Jersey, emphasized the need to protect our green space. Advances in the field of environmental health have taught us much about human health hazards. For example, air pollution can cause respiratory disease, heavy metals can cause neurotoxicity, and global climate change is likely to fuel the spread of infectious disease, said Howard Frumkin, Rollins School of Public Health. Thomas Lovejoy of the World Bank spoke about how biodiversity is a necessity for human health. For example, many microbes are essential for cleaning up environmental health hazards, while other organisms provide vital products (e.g., cyclosporin) for use in the treatment of human disease. The challenges of pollution control, sustainability, and maintaining biodiversity will require a more holistic and integrated approach to assessing and redressing the impact of the environment on human health. The built environmentâthat is, the environment designed and constructed by humansâpresents as many opportunities as challenges to environmental health, according to many speakers. Cities and designers have created places in which we work and live as if the individuals will leave and move to a new place, noted William McDonough, University of Virginia. Several speakers asserted that modern society needs to develop a new strategy, assigning a true value to building materials and embracing the notion that everything can be recycled. For example, interior environments should be designed with human needs and health in mind; people should be provided with natural daylight and fresh air that can be delivered under their control. Providing a healthy environment must extend to all people regardless of race, socioeconomic status, or location, said several speakers. Thirty years after studies documented the toxicity of lead, childhood lead poisoning still occurs, noted Mindy Fullilove of Columbia University. She added that false dichotomies often are constructed when trying to resolve environmental issues in the built environment, such as jobs versus the environment or jobs versus health.
SUMMARY 3 Nancy Adler, University of California, San Francisco, addressed the added adverse impact of poverty beyond environmental stress; poorer neighborhoods tend to have few doctors and pharmacies, inadequate transportation, unsafe or inconvenient recreational facilities, and low availability of affordable, healthy food. Add to this the destruction of a community as a result of an environmental insult, and there is a loss of a sense of community, said Fullilove. Communities store things in their common memories, and this is lost when a community is destroyed. The challenge, according to speakers and panelists, is to ensure equal enforcement of laws and regulations, and involve members of the community, regardless of economic status, early on in the process of remediation. Historically, the role of people and social activity as part of the environment has received less attention but is the most immediate proximate cause of many adverse consequences to the environment and health, according to several speakers. For example, the United States has experienced an increase in obesity in recent years, which has direct connections to our health and the environments we have created, said Bill Dietz of the Centers for Disease Control and Prevention. Many of the speakers pointed to a need to feel safe in neighborhoods as a way to increase physical activity, for example, creating connectivity in the built environment (direct paths for getting from one place to another). Increased community planning and promotion of physical activity were suggested as two ways to encourage better exercise habits. All speakers highlighted the central conclusion that improving our health through a better environment requires the cooperation of many stakeholders outside traditional health care systems. The speakers and panelists discussed many ideas and actions. The challenge remains for the various stakeholders to collaborate in actively rebuilding the environment to promote better health for all species.