Shared Vision

Positioning NCEH/ATSDR for the Future of Environmental Health

Although numerous agencies and organizations at all levels are working in various facets of infectious disease prevention, CDC is universally recognized as the “go-to” agency when leadership and assistance are needed. This unquestioned leadership role results from CDC’s well-honed and highly effective model that includes staff assignments internationally and to State and local health agencies, training programs, disease tracking, epidemiology support, linkages with all relevant players, health promotion, risk assessment and communication, laboratory expertise, and applied research. The same model is needed regarding health problems related to the environment. Jointly, NCEH and ATSDR can establish this same model and leadership role for environmental public health within the next 5 years while ensuring that NCEH’s and ATSDR’s current programs (e.g., childhood lead poisoning prevention and Superfund) are not attenuated.

NCEH and ATSDR and our partners need to be able to respond to all the environmental public health objectives presented in, Healthy People 2010. The critical importance of achieving these objectives is reflected in the “Environmental Health” component of this document where it states, “Poor environmental quality is estimated to be directly responsible for approximately 25 percent of all preventable ill health in the world...” As a reflection of the pervasive impact of the environment on human health, it is notable that the “Environmental Health” focus area crosscuts with 17 other Healthy People 2010 focus areas.

NCEH/ATSDR need to be able to respond to the challenges posed by many of the Nation’s most prominent public health leaders at the NACCHO focus group discussions. This diverse group of leaders represented academia, public interest groups (e.g., Physicians for Social Responsibility), nonprofit organizations (e.g., National Safety Council, American Lung Association), Tribal representatives, other Federal agencies with environmental responsibilities, and organizations representing the interests of the public health field (e.g., National Association of Local Boards of Health, Public Health Foundation, and National Environmental Health Association). Participants virtually unanimously indicated that expanded national leadership from NCEH and ATSDR must address critical needs such as ensuring National coordination and reducing fragmentation of activities at all levels, promoting the field of environmental public health, aiding in developing the public health workforce through training support, and providing strategic and flexible financial support to State and local public health agencies.

NCEH/ATSDR also need to be able to answer the questions posed by the Pew Commission such as:

• Are environmental exposures related to clusters of childhood cancer and autism?
• What are the impacts of pesticide exposures on children’s health?
• What proportion of birth defects are related to environmental factors?
• Are adult-onset diseases such as Parkinson’s disease and Alzheimer’s disease related to cumulative environmental exposures?
• Are learning disabilities related to environmental exposures?
• How does particulate air pollution increase the risk of death for the elderly?
• Are endocrine-disrupting pollutants in the environment related to the increasing incidence of breast and prostate cancers?

These questions and issues such as health effects that may result from chronic, low-level exposures to a given toxicant or from mixtures of toxicants need to be addressed both for specific communities, and for the population of the United States in general.

To respond to increasing environmental health concerns by the public NCEH/ATSDR need to:

• Establish NCEH/ATSDR teams to provide consultation on and, as warranted, investigate environmentally related disease clusters and outbreaks following the public health model.
• Ensure that NCEH and ATSDR programs complement each other and function in concert.
• Provide assistance to State and local health agencies, professional organizations, and others to broaden their capacity in environmental public health through training, assignment of staff, and funding through grants and cooperative agreements.
• Establish the “Nationwide Health Tracking Network” proposed by the Pew Environmental Health Commission.
• Develop effective methods of preventing environmentally related diseases and effectively diagnosing and facilitating treatment when prevention fails.
• Expand emergency preparedness and response capacity to address the many complex issues of natural and technologic disasters and bioterrorism threats.
• Define and implement a joint applied research agenda for environmental public health.
• Pursue linking biomonitoring, environmental data, and disease tracking to further inform environmental and public health decision makers.
• Aggressively pursue the implications of the “new genetics” to better understand environmental exposure and gene interactions.
• Ensure that environmental justice principles are appropriately considered in all NCEH and ATSDR activities.

Additionally, NCEH/ATSDR need to share technical expertise with other countries and learn more about environmental public health impacts from exposure to toxic substances world wide.