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Keynote: Ensuring Environmental Health in Pennsylvanian Kathleen McGinty Most of this country's environmental progress over the years has been engi- neering-intensive, as in attending to many of our infrastructural needs that have environmental components water supply, for example. We have focused far less on the environment's human-health linkages. This is especially true for global environmental issues. It's hard enough to communicate local and immediate environmental concerns to the public, even when there is at least some degree of tangibility to people in the smoke plume or the dirty water, for instance that they may experience directly. But the com- munication problem is magnified in dealing with such abstract things as global warming and climate change, where the health connections are not always so obvious. Here, we especially rely on experts to come forward and provide leadership, not only in explaining things but to persistpush forward on alerting the rest of us to health-environment linkages when they meet with the inevitable indiffer- ence or outright resistance. Eventually, they help us see the light. Often the missing link in environmental discussions is health. When health effects are brought to the forefront, the magnitude of the problem or the solution often becomes clear. For example, Sherry Rowland (a chemist at the University of California, Irvine) discovered the phenomenon of stratospheric ozone deple- tion; he was the first scientist to advance what some wanted to call a wild theory that chlorofluorocarbons might be causing it! But the importance of this work was not recognized until the health connections were made clear he explained that people will suffer cancers because of the stratospheric ozone loss. That missing link was the health link, and this case certainly underscores just how important the work of people engaged in environmental health really is. *This chapter is an edited transcript of Secretary Kathleen McGinty's remarks at the workshop. 10
KEYNOTE: ENSURING ENVIRONMENTAL HEALTH IN PENNSYLVANIA 1 7 The health community brings another dimension to the discussion as well. It is a calming dimension, in that it speaks to where the highest risks are and where the highest risks aren't, or how risk should be handled and understood. For example, the work that the health community has done in helping to answer the question of "How clean is clean?" has made a big difference in determining where our environmental cleanup dollars should go. The health community's willingness to step up to the plate and help federal, state, and local governments address that question to establish priorities is always very much appreciated, especially in tight budgetary times. Such involvement has had the effect, for example, of enabling massive efforts such as Pennsylvania's brownfield cleanups or what we like to call our "industrial-sites recycling effort." Toxic contamination has been cleaned up in this state at more than 1,000 sites, where economic vitality has once again been made possible. This happened because at the same time that the health community was noting where there was a human health threat, it was also willing to distinguish between what was justified and appropriate and what was less so. This ability to calm concerns and fears by putting things into proper perspective is a very important asset. Yet we must also acknowledge the vast arena in which we have very little information and where there is so much to do to fill in the details. For instance, we may know something about the impacts of some individual chemicals, but we don't know enough about the potentially synergistic interactions between them. Not only is our scientific understanding very rudimentary in that regard, but our regulatory programs have not been designed in ways to even consider those synergistic effects. Even though we do talk about watersheds and airsheds, for example, permitting decisions are usually made on the basis of individual requirements for particular pollutants, one at a time. Another gap to fill: Theo Colborn points out in her book Our Stolen Future (which addresses issues related to endocrine disrupters and hormone-mimicking chemicals) that sometimes it isn't the volume of a chemical that might pose the most dangerous threat to a human being but the stage of that person's develop- ment when the exposure occurs. So for a small body that's rapidly developing, a small insult may make a vast amount of difference, much more so than if the insult were larger but happened at a later stage. There, again, health research is so important to our understanding of these complex matters, but it also is impor- tant because it shines a spotlight on some of the inadequacies of our regulatory structures. Meanwhile, things are happening on the detection front. By tracking and monitoring acute and chronic illnesses, we are beginning to make linkages to environmental conditions that may be related to those illnesses. And here I must commend Pennsylvania's Department of Environmental Protection (DEP) for what it has been doing in this regard.
2 ENSURING ENVIRONMENTAL HEALTH IN POSTINDUSTRIAL CITIES We started work several years ago, stimulated by the West Nile virus issue, to develop an innovative information-technology-based tool a shared inter- active database that for the first time brought data together from DEP, the state's agriculture department, and its health department. By including compatible sets of data in one open-architecture system and portal, analysts could see in a very precise way and in real time where incidences of West Nile were occurring, factors (such as weather, or the location of specific animal populations) that were contributing, and what actions would be most appropriate for example, responders could make decisions on where to spray and where not to spray in a much more intelligent fashion. Building on that West Nile database, the state created PAIRS the Pennsyl- vania Incident Response System which was developed in the aftermath of September 11, when it was realized that a much more effective real-time system was needed to gather data and understand situations that might be evolving. It too is a computerized tool that brings together a variety of Commonwealth agencies that can help us to understand, track, and stay on top of emergency incidents, as well as respond to them. What we would now like to do is to build on that architecture even further to make it a robust system that tracks linkages between environmental and health occurrences