Shared Vision
Scientific Capacity Needed for Future Environmental Public Health Activities
A variety of expertise and tools are needed to address the environmental public health
threats facing our nation to:
- identify the problems,
- treat or fix the problems, and
- assess the effectiveness of our programs and interventions and replicate the best
ones at the State, local, and international levels.
To identify and manage environmental public health problems, we need to utilize the
scientific model of determining exposure to environmental insults, including those
associated with disasters; evaluating the health risk for various populations to these
insults; and identifying and subsequently preventing adverse health outcomes in these
populations.
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The following expertise and tools are needed to conduct health and exposure
assessments to identify the problems: |
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laboratory
sciences |
Together NCEH and ATSDR have a
strong base in these areas with the notable exception of surveillance.
We have only the beginnings of exposure surveillance and, as the Pew
Commission pointed out, little in the way of disease surveillance. We need
to develop tracking mechanisms for diseases and conditions such as
multiple sclerosis, Parkinson's disease, amyotrophic lateral sclerosis, heavy
metal and pesticide poisoning, autism, and asthma to determine their possible
link to environmental causes. |
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biomonitoring |
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environmental
monitoring |
epidemiology/biostatistics |
surveillance/tracking |
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disease |
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exposure |
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behavior |
genetics |
toxicology |
medical sciences |
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environmental sciences (air, water, soil, food,
other physical agents) |
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risk assessment |
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risk analysis |
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community/Tribal involvement |
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information systems/informatics |
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(including geographic information systems) |
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Addressing an identified problem involves:
- changing or controlling the environmental condition so it no longer causes
a problem (e.g., providing a safe, alternative drinking water supply), or
- changing the behavior of individuals so they avoid contact with the environmental
condition (e.g., avoiding eating contaminated fish), or
- changing behaviors to reduce the risk for disease development among populations exposed
to past environmental insults (e.g., promoting smoking cessation among people with past
exposures to radon), or
- providing, or facilitating the provision of, appropriate medical treatment
(e.g., training physicians to use the most appropriate tools to more
accurately diagnose disease among exposed populations).
The first approach is most often accomplished by enacting regulations, enforcing laws, and
managing risk. NCEH/ATSDR are responsible for advising regulatory agencies (e.g., EPA, FDA, CPSC)
about how best to eliminate the adverse environmental public health condition.
The second and third approaches, both involving changing personal behaviors, are
more challenging and require a variety of methods including health education, risk
communication, media campaigns, and behavioral research. The fourth approach,
providing medical treatment, is outside of NCEH’s and ATSDR’s purview; however, we do
provide guidance to medical-care providers on how best to diagnose and treat illness in
patients who have been exposed to environmental insults. Related to this approach,
new ways need to be identified to better manage the transition from the public
health infrastructure to the health-care infrastructure once disease and illness have
been identified.
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The following expertise and tools are needed to treat or “fix” the problems: |
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community and Tribal involvement |
Although ATSDR has developed some
capacity in these disciplines, both NCEH and ATSDR need to greatly
strengthen their capacity in these areas if they are to effectively address
environmental public health issues. |
public health ethics |
health education for communities |
risk communication |
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(including media campaigns) |
advice/guidelines
for the regulators |
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(e.g.,
safe level of toxicants for human health
and land-use policy) |
advice/guidelines for health-care professionals |
genetics |
behavioral change research |
medical screening/treatment facilitation |
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NCEH/ATSDR need to continue to assess the effectiveness of our public health interventions
and transfer the best of them to our State and local public health partners. We also are
obligated to share our knowledge with, and learn from, other countries. For example, assisting
a country in conducting an epidemiologic investigation of an environmentally-related disease
outbreak can ameliorate suffering and prevent disease; develop new scientific information of
benefit to people worldwide, including the United States; and help build lasting public health
capacity in the country. Environmental pollution and many disasters respect no boundaries, and
can contaminate environments or affect populations thousands of miles from the point source.
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The following tools and expertise are needed to determine whether our efforts
have prevented or controlled disease, and then to replicate successful
programs in other venues: |
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program effectiveness evaluation |
NCEH and ATSDR have grant and
cooperative agreement programs with State and local health departments.
Both organizations need to ensure the provision of resources to these
departments to cover an array of environmental public health issues and
to build State and local laboratory, epidemiology, health promotion, and
surveillance capacities as well as to promote community and Tribal
involvement |
cost-benefit analysis |
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(prevention effectiveness) |
capacity building |
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technology transfer |
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training and education |
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funding for grants and cooperative
agreement
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