Opportunities and Challenges

Opportunities and challenges exist in all six topical areas of Environmental Health and are described below.

Outdoor air quality. EPA has a number of efforts to address the challenges posed by air quality issues. The overall strategy includes a combination of regulatory, market-based, and voluntary programs that target emissions from whole industries or source categories, such as power plants and motorized vehicles. EPA programs address three key air pollutants, including nitrogen dioxide, sulfur dioxide, and mercury. They aim to reduce smog, acid rain, fine particles, visibility impairment, and nitrogen and mercury deposition, using a proven, market-based approach that encourages the use of new and cleaner pollution control technologies.¹ These programs include evaluation of air toxics, expanded monitoring, improvement in assessment tools, and continued research on health effects and exposures. EPA intends to use this information to help set priorities, measure progress, and develop plans for more detailed community assessments that will help identify local hot spots that may exist. Linkage of measured improvements in outdoor air quality with improvements in human health remains a challenging undertaking. EPA and CDC are working collaboratively to develop these methods.

Water quality. The passage of the Beaches Environmental Assessment and Coastal Health (BEACH) Act in October 2000 amended the Clean Water Act to (1) establish a national grants program to improve consistency of water quality standards, beach monitoring, and public notification approaches and (2) strengthen national information collection.¹² EPA established its BEACH program to promote greater consistency in beach health programs and to provide better information to the public. As part of that program, EPA compiles information on beach advisories and closures. It has collected that information using annual questionnaires sent to participating States, Tribes, local governments, and other agencies that maintain swimming beaches. The questionnaire collects information about advisories and closings that have occurred throughout the swimming season.

Toxics and waste. Eliminating elevated blood lead levels in children (8-11) is perhaps the most challenging environmental health objective. One of the most significant public health successes of the 20th century was the almost 10-fold reduction in blood lead levels in the Unites States, primarily because of regulations restricting the use of lead in automotive gasoline.¹³

Strategies that target screening to high-risk children are vital to identify those with elevated blood lead levels. In 2005, CDC issued a statement calling for lead exposure prevention to focus on two main exposures: lead in housing and nonessential uses of lead in consumer products.¹⁴ The infrastructure is in place to monitor high-risk housing.

Lead exposure hazards can be prevented by systematic identification and reduction of residential lead sources, particularly in older, poorly maintained housing, along with regular monitoring of housing conditions to detect new deterioration and resultant lead hazards. In some areas of the United States, as many as 35 percent of children with elevated blood lead levels have been exposed to items decorated or made with lead.¹⁴ Primary prevention is needed to restrict nonessential uses of lead in toys, eating and drinking utensils, and traditional medicines.¹⁵ In some States, health department budgets have been reduced, impeding a health department's ability to perform environmental and medical case management. The impact of State health care reform efforts on public health functions needs to be quantified, and continuance of these critical functions needs to be ensured. Environmental health agencies could (1) develop demonstration programs that involve multiple Federal agencies and include the community as a partner in eliminating childhood lead poisoning; (2) identify ways to use the issue of lead as a catalyst for dealing with other housing and community problems; (3) increase the cost effectiveness of lead poisoning prevention activities through the development of community-based primary prevention programs and coordination with housing and community development projects, with emphasis placed on identifying children who continue to be exposed to lead, but are not identified through current programs; (4) educate physicians about childhood lead poisoning and its prevention; and (5) collect data showing that childhood lead poisoning is a problem and provide clear guidance on when—and when not—to continue universal screening.¹⁶

Healthy homes and healthy communities. No low-cost, practical methods have been available that allow homeowners to assess allergen levels in their homes. Many existing building codes were not developed with health considerations, such as allergen reduction, in mind.¹⁷ Newer building and ventilation practices that may significantly improve moisture control and air quality in homes, and thus impact on indoor allergen levels, have not been widely adopted. Dialog between environmental health scientists, building designers, and the building community is not generally well established. In recent years, awareness of the relationship of the built environment to the heath of occupants has increased. Greater use of building and remodeling practices to control moisture infiltration, reduce moisture buildup, and provide proper ventilation for homes may impact significantly on indoor allergen levels.¹⁷ For example, effective moisture control is essential for controlling both dust mites and cockroaches. Strategies to achieve this control include landscape design to provide proper drainage around the structure, proper air sealing of the building envelope combined with appropriate mechanical ventilation, use of ventilation fans in kitchens and bathrooms, installation of vapor barriers over earthen crawlspaces, and control of condensation from plumbing fixtures.

The Health House program is an example of a national education program intended to raise standards for better indoor environments.¹⁸ EPA is using education and nonregulatory approaches to address indoor air pollution. The HUD Healthy Homes Initiative supports (1) activities that focus on researching and demonstrating low-cost, effective home hazard assessment and intervention methods and (2) public education that emphasizes ways in which communities can mitigate housing-related hazards.⁸

Infrastructure and surveillance. The environment plays an important role in health and human development. Researchers have linked specific diseases with exposures to some environmental hazards, such as asbestos and lung cancer.¹⁹ No systems exist at the State or national levels to track many of the exposures and health effects that may be related to environmental hazards.⁵ Environmental public health tracking (EPHT) is one way to fill these gaps. EPHT is the ongoing collection, integration, analysis, interpretation, and dissemination of data on environmental hazards, exposures to those hazards, and health effects that may be related to the exposures.²⁰ The EPHT goal is to provide information that can be used to plan, apply, and evaluate actions to prevent and control environmentally related diseases.

CDC established the National Environmental Public Health Tracking Program to build a national EPHT network and increase capacity of State and university-based researchers to bridge the information gap between public health and the environment.²⁰ The program supports more than 25 State and local health departments and 4 schools of public health to increase collaboration between environmental and health agencies, identify and evaluate environmental and health data systems, and develop model systems linking environmental and health data that other States or localities can use.

Global environmental health. Water pollution is one of the principal environmental and public health problems facing the U.S.-Mexico border area.²¹ Deficiencies in the treatment of wastewater, the disposal of untreated sewage, and inadequate operation and maintenance of treatment plants result in health risks. Better environmental services, such as sewer service, wastewater treatment service, and safe drinking water, may help achieve a balance among social and economic factors and protect the environment in border communities and natural areas. In addition, the Border Environment Cooperation Commission works to protect and enhance human health and the environment of the U.S.-Mexico border region. It is strengthening cooperation among interested parties and supporting sustainable projects through a binational process in coordination with Federal, State, and local agencies; the private sector; and civil society. Also, EPA, Mexico's Secretariat of Environment and National Resources, Mexico's Secretariat of Health, the U.S. border Tribes, and the environmental agencies from each of the 10 U.S.-Mexico border States have developed the Border 2012 Program.⁶ The mission of the proposed program is to protect public health and the environment in the U.S.-Mexico border region, consistent with the principles of sustainable development. The program is intended to underscore the importance of measurable results, public participation, transparency, and timely access to environmental information.

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