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:

1. identify the problems,
2. treat or fix the problems, and
3. 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.

	The following expertise and tools are needed to conduct health and exposure assessments to identify the problems:
	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.
		biomonitoring
		environmental monitoring
	epidemiology/biostatistics
	surveillance/tracking
		disease
		exposure
		behavior
	genetics
	toxicology
	medical sciences
		environmental sciences (air, water, soil, food, other physical agents)
		risk assessment
		risk analysis
		community/Tribal involvement
		information systems/informatics
		(including geographic information systems)

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.

	The following expertise and tools are needed to treat or “fix” the problems:
	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
		(including media campaigns)
	advice/guidelines for the regulators
		(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

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.

	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:
	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
		(prevention effectiveness)
	capacity building
		technology transfer
		training and education
		funding for grants and cooperative agreement