Public health officials have the traditional responsibilities of protecting the food supply, safeguarding against communicable disease, and ensuring safe and healthful conditions for the population. Beyond this, public health today is challenged in a way that it has never been before. Starting with the 9/11 terrorist attacks, public health officers have had to spend significant amounts of time addressing the threat of terrorism to human health. In addition, emerging infectious diseases, such as severe acute respiratory syndrome (SARS), West Nile virus, and avian flu, pose challenges to a field that is already overtaxed.
Hurricane Katrina was an unprecedented disaster for the United States. During the first weeks, the enormity of the event and the sheer response needs for public health became apparent. For example, this was one of the first disasters in the United States in which medical assistance beyond the local medical community was required. Given the unprecedented nature of this natural calamity, the first responders deserve a lot of praise for their efforts. This is not likely to be the last major disaster, and therefore public health officials and first responders need to be able to learn from it in order to prepare for potential future events. At the same time, they need to move forward to address the needs and concerns of the people who have been impacted by this disaster.
This workshop summary will inform public health and scientific communities about how the affected community can be helped in both the midterm and the near future. In addition, the workshop’s long-term goal is to consider how to use the information gathered about environmental health during a disaster to prepare for future events.
ROLE OF ENVIRONMENTAL HEALTH
Environmental public health addresses aspects of health that are determined by interactions with the environment and occurs on many scales: genetic, cellular, individual, family, community, regional, national, and global. The environment and its various measurable manifestations can impact us on all these scales. For example, chemicals, agents, and pathogens are undeniably important on genetic and cellular scales. Other aspects, such as the physical and social environments, can also influence health at the community and regional levels. Rockefeller University scientist René Dubos in 1965 noted that indexes of environmental health are “expressions of the success or failure experienced by the first [human] organism in its efforts to respond adaptively to environmental challenges” (Dubos, 1987). The changes that occur in human and natural environments are deeply interrelated. The actions that we take, how we adapt to the environment, and how we manage our relationship to it are all part of environmental health.
When the Roundtable on Environmental Health Sciences, Research, and Medicine convened in 1998, the members suggested that a broader concept of public health—especially environmental public health—needs to be established. Adopting its definition from the World Health Organization (WHO), the Roundtable defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO, 1946). Thus, when individuals discuss health needs after a large disaster, they need to include stress, psychosocial issues, and community structural impacts in addition to physical health issues.
INTEGRATION OF ENVIRONMENTAL HEALTH
When the Roundtable first started, members thought that there had been a focus on the toxicological effects of individual environmental agents to the detriment of a good understanding of the larger picture of what environmental conditions are impacting health. Roundtable members realized that the built environment—where and how we build communities and transportation systems—is very important and relevant to such issues as the impacts of hurricanes. The social environment is important, too—how neighborhoods, cities, and governments are organized to ensure a healthy environment.
The natural environment provides great benefits to human health. For example, regulation of pollutants in the natural environment allows people to enjoy clean drinking water and clean air. Setting aside land for conservation allows the natural environment the ability to address flooding from storm surges. This can be done through wetlands, barrier islands, and parkland, where the natural land provides protection. Finally, not all the benefits of the natural environment are direct. For example, the natural environment provides opportunity for recreation such as hiking, swimming, and biking. This access provides people with the benefit of exercising, which is part of a healthy lifestyle.
Environmental protection laws, such as the Clean Air Act and the Safe Drinking Water Act, are in essence health laws designed to protect human health. A legacy of pollution on the Gulf Coast is irrefutable. Progress in environmental protection has been achieved over the years, including the protection of endangered species such as the brown pelican, the hawksbill turtle, and the blue whale. These success stories are good indicators for the health of the environment and for people. There is still much to be done, however, not only to protect other species but also to protect people.
The public has high expectations for actions to protect health, and the response of public health officials needs to have a strong scientific base to meet these expectations. It is not enough to spend a lot of time, energy, and resources. These investments need to be guided by evidence.