This symposium on Rebuilding the Unity of Health and the Environment: The Greater Houston Metropolitan Area focused on a region whose urbanization in recent decades, elevated pollutant emissions, and other environmental insults have taken their toll on residents’ health and well-being. Famous as a great business center, Houston is also infamous as a land of seemingly endless sprawl, criss-crossed by highways, burdened with traffic congestion, and heavily punctuated by refineries and other industrial facilities that in the past were not especially reticent about exploiting the local environment for their own immediate needs. However, as the region’s population has grown more sophisticated and as political and business leaders have become more aware of the practical advantages of actively protecting public health and quality of life, Houston has begun to address its environmental problems and is acting to ensure a more attractive future.
The lessons one may draw from this meeting’s presentations and discussions apply to other regions that are undergoing similar changes and that must also contend, as does Houston, with the legacies of insufficient planning, environmentally deficient planning, or sometimes, no planning at all.
Rather than summarize here the symposium’s proceedings in a speaker-by-speaker or subject-by-subject fashion, this summary is organized to briefly characterize the fundamental themes that emerged. Some of them were Houston specific; others, although clearly pertinent to Houston, were also typical of many other cities throughout the country. In any case, these themes should be central to the region’s strategies for achieving sound environmental health and greater equity in its distribution.
A TRUE MELTING POT
Houston is one of the most ethnically diverse cities in the United States. With Hispanics, Caucasians, African Americans, and Asians almost equally represented and none dominating, all Houstonians are minorities. Further, some
observers see Houston not only as the site of a demographic revolution, but also as a critical test bed for the state of Texas and the nation as they too move toward a “majority minority” population. Although ethnic diversity can provide a rich social environment for all residents, it can also be a source of strife as cultural misunderstandings and conflicts arise. In fact, such confrontations are presently the exception rather than the rule—given the remarkably spread-out nature of the metropolitan area, different ethnic groups tend to live in their own separate enclaves. Nevertheless, Houstonians are increasingly building social capital and showing tolerance and pride in their city’s diversity; citizen groups, for example, strive to involve all local ethnicities in their deliberations.
Houston residents routinely list poor air quality as the region’s worst pollution problem—the result of a broad array of highways, refineries, and other industrial facilities, many of them in close proximity to where people live, work, or go to school. Compounding this situation is the city’s heat island effect—that is, elevated urban temperatures that in addition to being a risk in their own right enhance the formation of photochemical smog. Results of such exposures are higher levels of respiratory diseases and cancer incidence. Major air pollution problems also result from indoor allergens and irritants such as dust mites, mold, pet-derived allergens, air fresheners, cigarette smoke, and cleaning solvents. Although after-the-fact fixes can improve the situation at the margin, experts suggest that the greatest improvements will come from longer-term and supply-side solutions such as partnership with industry and regulators; smart growth in community development (with improved public transportation options); green buildings (which are energy efficient and built with more healthful materials); reflective surfaces and trees; and devices, systems, and creative economic policies for reducing emissions from cars, trucks, and stationary sources.
TRAFFIC CONGESTION AND SPRAWL
The landscape of much of the Houston area, and indeed of so many other cities in the United States, is characterized by sprawl—poorly designed and often unchecked growth in outlying low-density areas, with little or no attention paid to the resulting social, environmental, and human health impacts. One very tangible set of outcomes is the dominance of the automobile and the near inevitability of traffic congestion, with extended times for commuting and virtually any other vehicle usage (i.e., running errands, picking-up children), enhanced risk of accidents and exposure to exhausts, and heightened stress and frustration. In many polls, traffic is listed as the region’s greatest problem, ranking higher than pollution, the economy, crime, and schools.
AN OBESITY EPIDEMIC
Another important impact of the suburban sprawl pattern is residents’ reduced levels of physical activity. Where homes are built in clusters that are well removed from services—where walking or bicycling to distant destinations is inconvenient or even dangerous, sidewalks are often lacking, and a major roadway is usually part of the route—excess weight problems can occur in epic proportions. This in turn leads to greater incidence of illnesses such as diabetes, heart disease, hypertension, gall bladder disease, and several different types of cancer. Houston, like many regions of the country, is struggling with a growing obesity problem.
HIGH-QUALITY, ABUNDANT, AND SOMETIMES OVERLY ABUNDANT SUPPLIES OF WATER
Although Houston’s waterways have been troubled in the past—the Houston Ship Channel was sometimes referred to as the most polluted waterway in the United States and probably the world—the region has made considerable progress over the past few decades, with the aid of strong federal legislation, in cleaning up its water pollution. Supplies of drinking water, by contrast, have been kept safe in the past by scrupulous treatment, and it is a point of local pride that they continue to be of high quality and readily available into the foreseeable future. Water, however, can sometimes be too available in the region, given the flatness of the terrain and its regular exposure to thunderstorms and hurricanes. Thus, flooding is a frequent local phenomenon, causing major disruptions in transportation systems, businesses, and daily life in general. Solutions being pursued include systems for improved drainage, so-called peak flow attenuation (i.e., holding the water back and releasing it slowly), and dispersed systems using existing structures and wetlands, according to some participants.
Degradation of the natural environment is correlated with risk to human health, although some humans—particularly the poor and the disenfranchised—endure more of it than others. Similarly, environmental regulation in general and the cleanup of hazardous waste sites in particular do not have histories of fairness to all segments of society. For example, 82 percent of Houston’s waste management facilities are located in predominantly African-American neighborhoods, even though the black community comprises just 20 percent of the local population. Thus, the concept of environmental justice has evolved, triggered by a long series of injustices. Steps recently taken in the right direction include federal and state mechanisms for the safe and efficient remediation of brownfields. Meaningful community representation and involvement, however, remain a challenge.
MULTIPLE STRESSORS AND CUMULATIVE RISKS
The analysis of one contaminant at a time generally gives an erroneous and understated expression of the effects of pollution on human health. There is rarely just one causative factor behind a particular environmental health problem, and many effects manifest themselves only after long periods of exposure. Thus, although few studies have done so in the past, combinations of pollutants, including the joint impacts of indoor and outdoor environments, should be taken into account. Similarly, because most professionals in the environmental health field have been trained to focus on the outcomes of present and future environmental health problems, they usually devote insufficient time and attention to the basic underlying causes, much less to dealing with them.
THE NEED FOR PARTNERSHIP
Given the typical extensiveness and complexity of environmental issues, no single person, organization, or government unit, such as the leaders of a single municipality, can solve a problem alone. It is essential that collaborations be formed across traditional boundaries—social, political, and scientific—noted many participants. Communication and partnerships are needed, for example, between urban and suburban jurisdictions and between the public and private sectors. Because the issues of concern are inherently interdisciplinary in nature, they must be approached by investigators in a broad, systematic, and team-like fashion. At the very least, listening to others should become at least as important as speaking one’s own mind; in that way, polarization—an increasingly critical obstacle to progress—may eventually be overcome.
The environment has three interacting aspects: the natural environment, the built environment, and the social environment. These are interconnected in such a way that policies and practices originating in one will inevitably affect the others and, ultimately, people’s health, safety, and well-being. A responsible posture, therefore, should be characterized by environmental stewardship—a holistic approach that delivers progress in full, as opposed to disembodied increments that amount to marginal change or merely the illusion of progress. In this spirit, the public and its leaders should regularly remind themselves that land use and building design decisions, for example, are de facto public health decisions. Moreover, in trying to define environmental health in a more holistic way, they should not limit themselves to regulations designed to fix past mistakes but should look to the future in order to prevent problems in the first place.
INVOLVING INDUSTRY IN THE SOLUTION
As environmental awareness grows and spreads, it is only a matter of time before those who have traditionally been the direct cause of environmental problems begin to conduct business in ways that are not only safer but also more economically efficient. Thus, industry in general—and the chemical industry in particular—has been adopting responsible programs aimed at curtailing pollutant emissions and supporting and employing environmentally sound practices. Companies have been emphasizing their membership in the community, and they are following through, collaboratively, as responsible neighbors. Also, while acknowledging that complete transformation can not be achieved overnight, they do claim to be committed for the “long haul.”
Environmental consciousness within the Houston business community is being stimulated in large part by the area’s residents and their leaders. No longer preoccupied with economic insecurity or personal safety, they may now attend to quality-of-life issues and the physical attractions of the city—assets that will add to the desirability of coming to and staying in Houston, thereby making its future economic viability more likely.
These priorities result mainly from the fact that the area’s primary source of wealth now is knowledge rather than natural resources. Suddenly, or so it seems, factors such as air quality, revitalization of the city’s downtown, and richness of hiking and boating areas have become critical.
Environmental health issues can be creatively addressed when stakeholders listen to each other and work together noted some participants. The mindsets of many of the region’s people and institutions have changed, as have their prospects for a more healthful and vital community.