Healthy People Consortium Meeting and Public Hearing
"Building the Next Generation of Healthy People"
November 12 and 13, 1998
Capital Hilton, Washington, D.C.

Environmental Health

Introductions and Initial Discussion

A number of general questions that mainly revolved around the process and procedure of HP 2010 and the Environmental Health Workgroup were discussed briefly at the beginning of the focus group.

Participants asked questions on data sources and the process of comments becoming incorporated into the overall document. For instance, some participants thought that some areas of the HP2010 document are discouraging because there are various issue areas that do not have any surveillance and probably will not in the foreseeable future; yet, these areas are important to the health of Americans. Also, the importance of developmental objectives should not be under-emphasized and progress on creating data sources should be highlighted.

One participant asked about the EPA contribution on the EH chapter. This question was answered by stating that EPA has contributed and does have a contact on the EH chapter although this contribution has not been substantial. Other EPA sources that have had influence on the EH 2010 objectives include: Environmental indicators - from EPA

EPA milestones - 2005

GPRA project has incorporated EPA milestones

The majority of participants believed that the progress section is essential and must be kept. This section could be made more prominent or clear with a visual display. One example is the "box score" that is used for the 2000 objectives in the progress review for the Surgeon General.

target --> progress --> moving toward or away from goal

Objectives should have need consistent construction in the wording of each.

Purpose and objectives of roundtable

Purpose of the discussion is to review the proposed objectives for the focus area and to commence a discussion on these objectives. Any comments will be taken into consideration. Participants could also submit suggestions via the HP 2010 web site.

Summarized comments follow:

  • No EH objectives that deal w/indoor air - an objective should be created and cross-referenced with the respiratory diseases chapter
  • Indoor quality in schools should be addressed
  • Children's health needs to be included
  • Contact person in children's health office at EPA (?)
  • Children's health section related to asthma could be cross-referenced to respiratory disease chapter or others as appropriate
  • There is a question of how monitoring of objectives will take place - particularly #24 and #33
  • Important to demonstrate monitoring to public - how monitoring is taking place
  • Demonstrate the importance of safety of the food supply - add language to overview
  • Include text that defines monitoring in glossary - add "human biomonitoring" or clarify human biomonitoring in the relevant objectives
  • Proposed water quality objective:
  • Limit increase of MTBE contamination in water supply (surface and ground waters) to 10% of current level data sources: geological survey, NWQA, EPA office of mobile sources - Barbara Corkrin (?) Office of Science and Technology
  • Include an objective on fish advisories as measure of water contamination - similar to objective that was eliminated (EPA office of water may be a contact point)
  • #19B - need clarified - eliminate "lead"
  • possible info sources include NIEHS children's health and asthma centers
  • #20 - carbon monoxide
  • increase # of homes w/carbon monoxide detectors
  • difficult to track and monitor
  • CPSC might have data sources
  • #18 - not consulted on use of data
  • would not have impact on morbidity or mortality
  • list needs to be refined - better data set of the most dangerous poisons and subsets of those
  • #11 - one of the few EH objectives broken into "select populations" categories
  • are there other objectives that should also be broken into similar categories?
  • On page 5-20 "environmental tobacco smoke" and "2nd hand smoke" have the same meaning - these terms should be combined or one should be eliminated
  • A developmental objective could be created that targeted educating physicians on environmental causes of disease, e.g., continuing education classes
  • Perhaps, revise #26 to incorporate this suggestion
  • ** Unanimous concurrence among EH participants that there are not enough objectives to cover the full spectrum of environmental health
  • A number of participants agreed to follow-up with their suggestions (including specific language for new or revised objectives).

The following text is from Lynn Bradley an environmental health breakout group participant.
From: Lynn Bradley []
Lynn Bradley
Director of Environmental Health
Association of Public Health Laboratories
1211 Connecticut Ave., Suite 608
Washington, DC 20036
Phone: 202-822-5227, x 207
FAX: 202-887-5098
Sent: Wednesday, November 25, 1998

The single environmental health goal of HP2010 is restricted to issues where there is solid epidemiological evidence demonstrating adverse health effects to humans, and where the Public Health Service has programmatic resources dedicated to the issue -- this is surely true of all other goals in HP2010. I believe that the individuals responsible for this chapter have operated within this implicit restriction, yet it is this restriction that inhibits participation of the environmental health community in this national effort.

Our nation spends almost half of its public health expenditures on environmental health issues -- this includes the regulatory activities of the Environmental Protection Agency and other departments such as Interior and Agriculture. Regulatory control of harmful exposures should be credited with improving public health, just as public health prevention programs are credited with improving health. For a detailed assessment of federal and state agencies responsible for environmental health issues, please see The environmental Web: Impact of Federal Statutes on State Environmental Health and Protection; Services, Structure and Funding published January 1995 by the US Public Health Service, Health Resources and Services Administration (HRSA), and the expanded document, Who's in Charge? 50-State Profile of environmental Health and Protection Services, published March 1995 by HRSA.

If we recognize the scope of environmental issues, and the potential for harm from environmental exposures, we must acknowledge two things: first, environmental exposures can be regulated so as to prevent harm from occurring, and second, there may be health effects from exposure to chemicals (and microbes) in the environment that are not recognized due to lack of awareness by medical professionals, who often fail to consider environmental exposures as potential contributors to, or direct causes of, disease. If we continue not to look for environmentally caused diseases, we certainly will not find them, and will not need to quantify the impacts on human health.

A developmental goal such as "Increase from (4%) to 50% the number of physicians and physicians assistants who are trained to evaluate environmental exposures as potential causes of disease" should be included in the Environmental Health Chapter. Another developmental goal should be to "Initiate a human biomonitoring program to establish the extent of human exposure to persistent organic chemical pollutants" -- this will be the first step in making possible an assessment of whether and what diseases and disabilities are related to environmental exposures.

In the current draft HP2010, personal health issues get individual chapters (diabetes, asthma/respiratory diseases, arthritis, cancer, HIV, heart disease, STDs) while the injurious effects of environmental exposures are combined into one heterogeneous chapter encompassing multiple diseases involving multiple organs, with varying degrees of severity, caused by drinking water exposures to chemicals and microbes, recreational water exposures to microbes and chemicals, exposure to ground and surface waters contaminated by the use of fuel oxygenates as well as improved air quality from these additives, lead paint exposures, pesticide exposures, airborne exposures to chemicals and particles and microbes, radiation exposures, chemical ingestion from contaminated fish consumed by subsistence fishers, diseases caused by living near hazardous waste sites, and environmental tobacco smoke exposures. None of these issues presently have objectives that comprehensively measure the outcomes of regulatory and public health efforts at minimizing damages to health.

Indeed, these issues appear to be disjointedly tossed into a chapter of "miscellaneous" diseases that happens to be named "global environmental." We do ourselves a grave disservice by acting as if, or worse, actuallybelieving, that environmental health issues matter so little to public health; our ignorance of direct cause and effect for environmental diseases will not improve until we look to see how much environmental contaminants actually effect public health.

As has happened with previous versions, we know that this major national effort will spawn many state versions whose objectives comprise a subset of the national goals, prioritized for the particular state. As currently prepared, the national HP2010 effectively precludes comprehensive consideration of environmental health goals by states, due to the "master" document's, HP2010's, inclusion of only fragments of the nation's environmental health protection issues.

I submit that waterborne disease warrants a chapter, just as does arthritis. And radiation exposures other than radon have caused, and continue to cause, measurable health effects in substantial populations -- this warrants a chapter. Air pollution warrants a chapter, and not only for respiratory disease: we now know that airborne transport of persistent organic pollutants occurs worldwide. Basic sanitation warrants its own chapter -- swimming pools and health clubs, beaches, restaurants and retail/wholesale food outlets, parks and campgrounds, and sewage disposal are just a few areas that may not be functions of the federal Public Health Service, but where sanitation is certainly an essential component of a national strategy for improving public health.

I understand that the process of developing HP2010 is nearly at its end, and that reconstructing the document to give environmental health its due is unlikely to occur. I hope that, by the next version (HP 2020) environmental health will be recognized as the major government activity that it is, and allotted a proportionate importance in ensuring the health of the nation's people. Let us, the public health community, work hard over the next decade to integrate health and environment so that, in HP2020, environmental health can be systematically and comprehensively addressed by setting national goals that reflect governmental and private efforts to protect the public's health from disease and disability caused by contaminants in our environment. The lack of input from the environmental regulatory community into HP2010 is directly related to our failure to communicate to the environmental community that they truly are in the profession of protecting human health, rather than complying with regulations.

In the interim, please reconsider the decision to include all environmental health issues in ONE chapter, and allocate the existing objectives among seven (7) chapters, named after the 6 "focus areas" identified in the existing Environmental Health Chapter, plus one "general" environmental health chapter to catch the issue areas that do not neatly fit into these focus areas -- "odds and ends" that require only one objective each, such as fluoride or arsenic in drinking water, or destruction of ecosystems by acidified rainfall.

It may be difficult to quantify some environmental objectives in human health terms, today, but we MUST remember that, if the ecological systems fail, the humans cannot continue to thrive. The public health is contingent upon our ecological "support systems" -- for food, water, and breath; without viable support systems, we can become extinct due to habitat destruction, as other species have. Environmental health is the essential foundation of public health, not an add-on to personal health issues.

Thank you for your attention to my comments.


Bradley, Lynn - APHL
Duran, Victoria - National PFA
Jirles, Bill  - NIEHS
Kochtitzky, Chris - CDC/NCEH
Macdonald, Steven - WA Department of Health
McCurdley, Leyla - Erk, ALA
Perez, Christina L. - Office of Minority Health, San Francisco
Quijada, Caroline - COSSMHO
Schelp, John - NIEHS
Soloway, Rose Anne - American Association of Poison Control Centers
White, Ronald - ALA


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