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8 Where Do We Go from Here?* In the spirit of analyzing the symposium's sessions and specifying appropri- ate steps to ensure environmental health in postindustrial cities and elsewhere, a group of panelists from government, industry, academia, and the public-interest arena were asked to consider the following questions: · What new issues and possibilities did you see in today's discussion? · What actions do you see as logical next steps? · Are there natural alliances among environmental and health communities that should be made? · Are there conflicts between environmental and health issues that need to be resolved? · What basic research would you most like to see? · What are the critical local data-collection needs? · What kinds of coordinating bodies are needed? · Who is missing from policy making on environmental health MORE AND BETTER FEEDBACK LOOPS issues? Several panelists observed that the workshop's sessions had been eye-opening with regard to linkages between environmental and health issues. They noted the need to make these connections better understood by community members as well as by experts, who are sometimes unaware of their work's relevance to other fields or to many of its practical applications. "I have made many presenta- tions using a lot of the same images of development and highways, but I always *This chapter was prepared from the transcript of the meeting by Steven J. Marcus as the rapporteur. The discussions were edited and organized around major themes to provide a more readable summary and to eliminate duplication of topics. 61
62 ENSURING ENVIRONMENTAL HEALTH IN POSTINDUSTRIAL CITIES talked about them, and everyone else in my professional realm talked about them, in terms of impact on the environment such things as storm-water runoff and air pollution. We never, or rarely, linked back to actual people, health, mortality, illness, and psychological states," said Caren Glotfelty, director of the Environment Program at the Heinz Endowments. "I will never look at these issues in quite the same way again." "Environmental issues, public health, and community design are often treated separately, but they are inexorably linked at the hip," agreed Court Gould, director of Sustainable Pittsburgh. "When we hurt the environment, we hurt others. Fore- most, we hurt ourselves. But it is often hard to see the relationships between these issues. There are not enough feedback loops from which to get information." Gould noted that several workshop participants, both at the podium and in the audience, had pointed out the need for more and better feedback loops. Kathleen McGinty had referred to the 1993 tragedy in Milwaukee, where drink- ing water contaminated by Cryptosporidium caused the deaths of some 40 to 100 people and produced 400,000 cases of illness. Had a system like PAIRS (the Pennsylvania Incident-Response System) been in place there to detect the threat- ening situation, much or all of that harm might have been averted. Similarly, Farley Toothman (county commissioner of Greene County, Pennsylvania), in his impassioned comments, talked about the need for feedback loops that link cancer rates in his county to water-quality problems there. Richard Jackson showed how it was the Olympics that raised public awareness to the impacts of vehicular travel and air pollution in Atlanta, as revealed by increases in insurance health- claim rates and frequency of visits to hospital emergency rooms. Gould cited Senator Robert F. Kennedy's observations on the inadequacy of many of our existing feedback loops and the need to do better. For example, gross domestic product, according to Kennedy, is an inadequate gauge of well- being because "it measures everything . . . except that which makes life worth- while!" "What he meant," Gould maintained, "was that it includes just about all we do and know about money, but it fails to account for our overall conditions of well-being and quality of life." INFORMATION SHARING GETS RESULTS On the subject of well-being and quality of life, Esther Bush, president and CEO of the Urban League of Pittsburgh, stressed that ordinary citizens, especially those in greatest need, must be involved in improving their situation and shaping their future. "Race and poverty are absolutely two issues that have to be explored and have to be included when we talk about areas of environment," she said, which means that "community individuals must be at the table." Only then will they "have the information to know how to build something that would be more healthy." Information, agreed Raymond F. Vennare, president and CEO of ImmunoSite, Inc., gives people the power to work successfully for the common good. In the
WHERE DO WE GO FROM HERE? 63 absence of individuals in the community sharing information that is, "if we all operate in silos" nothing much is going to happen. Or as Stephen Thomas, director of the University of Pittsburgh's Center for Minority Health, put it: "Knowledge, information, and sustained education at the community level can help give people a voice to come up with options that work for everybody." And "everybody" means everybody, several participants noted. Enlightened information-sharing approaches are not only valuable for people in greatest need but for all who do the sharing. For example, Bush noted that, by partnering with community-based organizations, University of Pittsburgh researcher Herbert Needleman gained local support and credibility, which helped him build trust among those in the community who could provide him with the lead-exposure data he needed. All parties gained useful information for their lives and pursuits. Similarly, Michael J. Wright, director of health, safety, and environment for the United Steelworkers of America, noted that workers must be included in policy making on environmental health issues in industry not just manufactur- ing but other industries as well. "The actual workers who are intimately involved in the production process, whether it is production of goods or of services," Wright said, are not only the most directly exposed to the environmental prob- lems in question but are usually the most knowledgeable on the most practical solutions. He cited an example from the early 1990s regarding EPA's new regulations for coke-plant emissions. "The people who really made the difference, who got us an EPA regulation that cut pollution from coke plants more than anybody thought we could, and at lower cost, were workers. They were the ones who knew what you could do and what you couldn't." In some cases, worker and community member might be one and the same. "By training community residents for careers in environmental health," Bush suggested, "this could provide both jobs as well as access to valid and reliable data." Baruch Fischhoff, professor of engineering and public policy at Carnegie Mellon University, said that a program at Xavier University of Louisiana, which "educates African-Americans to do exactly those sorts of jobs, is a sterling example." One participant, noting a need to gather data on long-term cumulative effects of pollutants involving dispersed and labor-intensive data on life histories, residences, and workplaces, among other things, suggested that sec- ondary-school students might serve as information gatherers. This could "actually contribute in significant ways to the real science of these effects," he said, "while also providing job training and educational experiences for high-school kids." MAKING CLEAR THE CONNECTIONS While generally in agreement with the need to create jobs that are meaning- ful both for individuals' careers and the betterment of community environmental health, Wright also sounded a note of caution. "It's hard to gather life histories
64 ENSURING ENVIRONMENTAL HEALTH IN POSTINDUSTRIAL CITIES retrospectively and accurately, and we certainly do need that kind of research. But all of us have seen too many examples where the desire for more research has paralyzed current action. In the Steelworkers Union, this occurred with regard to ergonomic injuries, which has been a huge controversy in the last decade. We have all certainly seen it for things like climate change, where the side in the debate that doesn't want to do anything right now keeps saying, 'We need more research, we need more research.' We certainly do need more research, but we know that there are tonics in our waterways. We know there are problems in our air. We need to take some action now even without all the answers." Vennare pointed out that while there is plenty of data, there is also a sub- stantial need for integrating these existing databases "relationally." In that way, he said, "you turn the data into information, and you can pull out information that has some kind of meaning." Glotfelty noted that one such mechanism is a geographical information system, being developed with the support of the Heinz Endowments, that can collect data and display them at the same scale in the same way across the region. To be offered to the community as a free resource, it would avoid the situation of "isolated bits and pieces of information that we can't pull together one little health study there, one little environmental study here, which don't match up" and instead provide "the beginning of a system that should allow us to look much more comprehensively, layering as much data as we can put into it over time, so that we look across the community." Critical to effective action, panelists agreed, is the presentation of informa- tion to the community in a convenient, readily comprehensible way, and the securing of such information in the first place through collaborative efforts among the numerous and often diverse sources. Communication of environmental health issues requires creativity, said Jerry Thompson, a partner and director at Ketchum Pittsburgh. They are inherently complex, and not always of obvious relevance to people's everyday lives, yet they can often have great impact nevertheless. This may be made clearer and more compelling through simplification and focusing with the aid, wherever possible, of metrics such as cost-benefit ratios. "It can be difficult to connect the dots on how some of these things work together and how they are relational," he acknowledged. "Some of the science can be mind-boggling and wondrous in and of itself, but when it comes to the communications piece it really is a system to be engineered and managed" to show that some very significant health and social issues are at stake. To make these issues more appealing to the average citizen, it's incumbent upon the various experts and public-interest groups that is, professionals who are already aware of the implications, or who at least hold important pieces of the puzzle to collaborate. "The environmental groups involved with issues of land-use planning and sprawl need to reach out to groups focused on environ- mental health," said Glotfelty. "Together, these communities can make clear to
WHERE DO WE GO FROM HERE? 65 the public the connections between human health and the ways we choose to build our buildings and communities." FACILITATING PROGRESS Bruce Dixon, director of the Allegheny County Health Department, para- phrased the famous remark of former Speaker of the House Thomas P. (Tip) O'Neill that "All politics is local." Dixon noted that "All health is local," which implies that local (and, not coincidentally, politically attuned) entities can play important roles in making the needed collaborations a reality, even when rela- tionships between parties are initially contentious. "We [at the Health Depart- ment] have done that quite well," he said. "We deal with people who have environmental interests. We deal with people who have industrial interests. And hopefully we can be the facilitator to bring those two parties together and reach something that is clearly to the betterment of everyone." Glotfelty hailed such facilitation as highly desirable and an encouraging sign of progress. "For a long, long time nobody seemed to be paying attention to that issue [of land-use planning and its relationship to the environment, and hence to health]. But it's really satisfying for me to see that sprawl's negative effects on all aspects of our lives and the environment is now a major topic of conversation. I cochaired Governor Ridge's Twenty-First Century Environment Commission several years ago, and for the very first time in this state we were able to have a set of government agencies openly sponsor conversations all over the state that actually used the terms 'land use' and 'planning'." Such agency involvement is not only desirable but essential, one participant remarked. "Environmental issues, health issues, and public health issues are tech- nical issues and organizational issues, but at base they are political issues, and all of us as citizens need to address them that way." For one thing, as Dixon pointed out, agencies play a central role in "con- stantly having to balance the needs of what is environmentally safe versus the needs of economic development and growth." For another, agencies' regulations and oversight define reality for stakeholders, which ultimately yields positive results. "Everything that has been said could be perceived as bad for business- that businesses leave the region because of compliance, because of local, state, or federal regulations, because of environmental concerns," said entrepreneur Vennare. "But the fact is, I love compliance. I love compliance because it gives businesspeople a blueprint for success. It tells you what the ground rules are. It tells you how to operate your business in the most effective way according to the law." And political entities, centrally positioned for the long term, can provide continuity. As Thompson noted, such consistency is critical for achieving progress: "It takes a long time to make some of these kinds of changes happen,
66 ENSURING ENVIRONMENTAL HEALTH IN POSTINDUSTRIAL CITIES and there has to be a sustained commitment to programming and following through." THE ELEMENTS OF SUCCESS Sustainable Pittsburgh's Gould offered seven recommendations for such political actors, both in and out of government: . . Regulatory reform . We need regulatory reform for solutions on a water- shed, airshed, and ecosystem basis, as opposed to the silo/media approach where we address individual pollutants and often miss the synergistic combinations. Also, we focus too exclusively on geopolitical boundaries. Fiscal reform. We need to tie federal and state dollars to direct support of regional smart-growth strategies that link land-use planning to transporta- tion and other infrastructure. We need to focus on livable-community de- sign, healthy communities, and equity in transportation and environmen- tal impacts. We need to link economic development to workforce issues, affordable-housing development issues. issues, and environmental and sustainable- · Accounting reform. Following on RFK's words, we need to improve the feedback loops. We need to move away from reliance on gross domestic product and move toward, for example, what Canada has adopted the genuine progress indicator, or GPI, which uses a new system of national accounts to prioritize human capital, social capital, and environmental capital as well as economic capital. · Tax reform. Let us follow the lead of northern European countries, which are increasing taxes on energy and material use while decreasing taxes on labor and income. · Economic reform. Remove the subsidies for fossil fuels to make renew- ables more competitive, and particularly find better ways to measure the externalities related to our reliance on fossil fuels. National sustainable-development strategy. Eleven years ago at the 1992 Rio de Janeiro conference, the United States made some proclamations about getting on board with sustainability. However, we have not real- ized as a country many of those early commitments. · Increase support for the research sector. This is particularly needed for linking community health to the built environment. . Vennare endorsed these recommendations and noted that "if you get at the root of each one of them, it is for the quality of life, for the common good, for taking social responsibility (whether at the federal, state, local, or personal level), and the only way you can do that for having personal accountability. I would
WHERE DO WE GO FROM HERE? 67 suggest that that is not only the reason why we are here; it is the reason why we'll succeed." In the final commentary of the session, Dixon summarized the basic elements of that success: "We need to continue the dialogue. Collaboration is extremely important, and collaboration across geopolitical lines a regional approach is especially important. Integration of services is important too, and so is integra- tion of people: we need to have a broad consensus and continued dialogue on what we are doing, where we are headed, and how we get there; and we need to educate people so that they become participants in the whole effort."