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© 2007 American Public Health Association
DOI: 10.2105/AJPH.2006.095869
EDITORIAL |
The author is with the Edward J. Bloustein School of Planning and Public Policy, Rut-gers University, New Brunswick, NJ.
Correspondence: Requests for reprints should be sent to Michael R. Greenberg, PhD, Edward J. Bloustein School of Planning and Public Policy, Rutgers University, 33 Livingston Ave, Suite 100, New Brunswick, NJ 08901-1958 (e-mail: mrg{at}rci.rutgers.edu).
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INTRODUCTION |
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 TOP INTRODUCTION NEW APPLICATIONS OF...ETHICS AND RISK ASSESSMENTEXPANDING SURVEILLANCEOBESITY AND THE ENVIRONMENTRISK COMMUNICATIONUNDERSTANDING COMPLEXITYCONCLUSIONReferences |
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Sunday, April 22, 2007, will mark the 37th anniversary of the first Earth Day, a grassroots event at which 20 million US residents declared war on water, air, and land pollution. Core support disproportionately came from young, liberal, and highly educated non-Hispanic Whites.1 They were excited about the creation of the US Environmental Protection Agency and the passage of the National Environmental Policy Act and about a dozen other laws that promised to control emissions from factories, cars, power plants, and other sources and to better protect the health of workers. The results of these policies included the reduction of emissions into water bodies and the air from sewage treatment systems, factories, electricity-generating stations, and motor vehicles, and the cleanup and control of some of the nation’s worst hazardous waste sites.
Thirty-seven years after the celebration of the first Earth Day, the federal government and the American public are focusing more on war, terrorism, and the economy than they are on environmental protection.2 Yet Earth Day is celebrated worldwide; in some locations, it has the feel of a major holiday. Core supporters of environmental protection include a greater diversity of age groups, political perspectives, ethnic/racial groups, and socioeconomic groups than 3 decades ago.3 I believe that the values that gave birth to Earth Day have become mainstreamed in the United States. What society considers "environmental protection" has broadened, and the tools we use to devise policy have adapted to these contemporary challenges. Ten papers in this and the May 2007 issue of the Journal illustrate the broadening of environmental issues and tools.
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NEW APPLICATIONS OF ENVIRONMENTAL IMPACT ANALYSIS |
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TOPINTRODUCTIONNEW APPLICATIONS OF...ETHICS AND RISK ASSESSMENTEXPANDING SURVEILLANCEOBESITY AND THE ENVIRONMENTRISK COMMUNICATIONUNDERSTANDING COMPLEXITYCONCLUSIONReferences |
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The National Environmental Policy Act, which mandated environmental impact statements, was one of the first important pieces of federal environmental legislation. Lawmakers intended the act to focus attention on the environmental impacts of major federally sponsored dams, highways, and other massive projects. Bhatia’s description of the adaptation in San Francisco to study the health effects of local land use decisions shows the evolution of the National Environmental Policy Act applied to local public health concerns.4
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ETHICS AND RISK ASSESSMENT |
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TOPINTRODUCTIONNEW APPLICATIONS OF...ETHICS AND RISK ASSESSMENTEXPANDING SURVEILLANCEOBESITY AND THE ENVIRONMENTRISK COMMUNICATIONUNDERSTANDING COMPLEXITYCONCLUSIONReferences |
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The lead standard was the first national ambient air quality requirement based on children’s health, rather than on a mythical average middle-aged man’s health. Derived from analysis of environmental dose and response data, with a safety protection factor added, the underlying ethical principle was that the government should protect children because of their elevated risk for neurological damage. Resnik and Wing illustrate how far we have come in understanding that quantitative risk analysis is necessary but not sufficient to protect children’s health.5 They present 5 ethical concerns that should be met before pursuing research about indoor hazardous agents that affect children. Their essay elevates the dialogue about ethical considerations in environmental health research.
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EXPANDING SURVEILLANCE |
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TOPINTRODUCTIONNEW APPLICATIONS OF...ETHICS AND RISK ASSESSMENTEXPANDING SURVEILLANCEOBESITY AND THE ENVIRONMENTRISK COMMUNICATIONUNDERSTANDING COMPLEXITYCONCLUSIONReferences |
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The stench of airborne emissions, dead fish, and other obvious signs of contamination of our water and air precipitated the first Earth Day. The early legislation focused on cleaning up the legacy of waste sites, retrofitting facilities, and requiring new facilities and vehicles to reduce emissions. Some of the legacy remains; for example, major US nuclear weapons sites will need to be managed in perpetuity. Yet we have gone beyond the legacy and now look prospectively to try to anticipate problems. For instance, Litt et al. looked at prospective environmental health by describing how environmental public health tracking has evolved during the past 5 years and by describing what changes will make it more successful.6 Kivimäki et al. examined the relationship between adolescents’ risk factors and adult atherosclerosis in the same population 2 decades later, underscoring the wisdom of proactive surveillance of employees, children, and other populations.7
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OBESITY AND THE ENVIRONMENT |
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TOPINTRODUCTIONNEW APPLICATIONS OF...ETHICS AND RISK ASSESSMENTEXPANDING SURVEILLANCEOBESITY AND THE ENVIRONMENTRISK COMMUNICATIONUNDERSTANDING COMPLEXITYCONCLUSIONReferences |
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Some contemporary environmental health issues were not part of the environmental health portfolio on the first Earth Day. Obesity is one. Diez Roux et al. examined the relationship between physical activity and density of recreation resources and found that the existence of multiple resources within 5 miles of a person’s home increased physical activity, especially in poor and minority populations.8 Kivimäki et al. report on coronary heart disease among 50 000 Finnish public sector employees.9 They found the expected relationship between physical inactivity, obesity, and prevalence of coronary heart disease. Yet after accounting for these differences, there remained a socioeconomic gradient in coronary heart disease risk. The surrounding physical environment and land use obviously are only a part of the obesity puzzle, but recognizing the environment as part of the issue has broadened the audience of people with a personal stake in the environmental issues.
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RISK COMMUNICATION |
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TOPINTRODUCTIONNEW APPLICATIONS OF...ETHICS AND RISK ASSESSMENTEXPANDING SURVEILLANCEOBESITY AND THE ENVIRONMENTRISK COMMUNICATIONUNDERSTANDING COMPLEXITYCONCLUSIONReferences |
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Risk communication was born during the 1970s as a response to the contention that risk management policies should be the province of risk assessors, without any public input. We have learned that psychological and cultural factors underlie the public’s risk-estimating process, amplifying some risks and dampening concern about others. This issue of the Journal offers 2 striking examples of environmental risk problems that risk assessment cannot solve. Too much sunlight is surely an environmental problem, and if we know the exposure, we can calculate the likely increase of skin cancer. However, reducing the burden requires risk communication and behavioral change. For example, Mayer et al. tested wide-brim hats and sunscreen as solutions to sunburn among postal workers.10 They found that the intervention group was much more likely to use both than the control group. They recommend that the government disseminate the intervention to postal workers and other outdoor workers. Jones et al. examined the effectiveness of screening mammograms among African American and White women.11 They found that African American women were less likely to understand and respond to the mammogram results than White women. In both of these studies, we see that developing ways of effectively communicating with high-risk populations is essential to reducing morbidity and mortality.
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UNDERSTANDING COMPLEXITY |
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TOPINTRODUCTIONNEW APPLICATIONS OF...ETHICS AND RISK ASSESSMENTEXPANDING SURVEILLANCEOBESITY AND THE ENVIRONMENTRISK COMMUNICATIONUNDERSTANDING COMPLEXITYCONCLUSIONReferences |
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Increasing complexity of issues is another major change in environmental protection. A contemporary example is obesity, which is related to physical activity, which in turn is partly related to the physical design of houses, shops, schools, streets, and other infrastructure. This issue of the Journal offers one other. Schanzer et al. document the high disease burden of newly homeless people and describe the multiple and interactive relationships between being homeless and having mental or physical diseases.12 Conner et al. explore the personal and social environments of rural Chinese who demonstrated suicidal behaviors.13 High intent of suicide was associated with previous exposure to suicide in a family member or friend and a chronically stressed environment.
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CONCLUSION |
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TOPINTRODUCTIONNEW APPLICATIONS OF...ETHICS AND RISK ASSESSMENTEXPANDING SURVEILLANCEOBESITY AND THE ENVIRONMENTRISK COMMUNICATIONUNDERSTANDING COMPLEXITYCONCLUSIONReferences |
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Contemporary environmental concerns include water, air, and land pollution, as they did in 1970. But contemporary environmental problems range from problems inside the home to problems on the global scale. Sitting in front of a computer screen hour after hour, costs related to sprawl, environmental conditions that limit outdoor exercise, and mental and physical stress were not part of the first Earth Day agenda. Contemporary environmental issues also include global environmental risks, such as global warming, flooding, mudslides, and other natural hazards exacerbated by human activity. The tools we use to anticipate and respond to these concerns have evolved from mandated federal control supported by technology, engineering, and government subsidies during the 1970s and 1980s to a broad array of approaches today. With regard to science, retrospective designs now drill much deeper into underlying risk factors, and prospective surveillance has become common. The lost cause of arguing that costs do not count in decisionmaking has yielded to the realization that we need to understand the economic consequences of policies. How organizations function and communicate with the public have become critical elements of contemporary environmental health management rather than afterthoughts.
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References |
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TOPINTRODUCTIONNEW APPLICATIONS OF...ETHICS AND RISK ASSESSMENTEXPANDING SURVEILLANCEOBESITY AND THE ENVIRONMENTRISK COMMUNICATIONUNDERSTANDING COMPLEXITYCONCLUSIONReferences |
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1. Mitchell RC. The public speaks again: a new environmental survey. Resources. 1978;60:1–6.
2. Saad L. Environment not a pressing concern. Available at: http://www.galluppoll.com/content/?ci=11380. Accessed April 19, 2004.
3. Carroll J. Public slightly more negative than positive about quality of the environment. Tuesday briefing. Prince-ton, NJ: The Gallup Organization. Available at: http://www.galluppoll.com/content/?ci=5845. Accessed May 19, 2003.
4. Bhatia R. Protecting health using an environmental impact assessment: a case study of San Francisco land use decisionmaking. Am J Public Health. 2007;97:406–413.
5. Resnik DB, Wing S. Lessons learned from the Children’s Environmental Exposure Research Study. Am J Public Health. 2007;97:414–418.
6. Litt JS, Wismann A, Resnick B, Smullin Dawson RS, Hano M, Burke TA. Advancing health and environmental disease tracking: a 5-year follow-up study. Am J Public Health. 2007;97: 456–463.
7. Kivimäki M, Hintsanen M, Keltikangas-Järvinen L, et al. Early risk factors, job strain, and atherosclerosis among men in their 30s: the Cardiovascular Risk in Young Finns Study. Am J Public Health. 2007;97:450–452.
8. Diez Roux AV, Evenson KR, McGinn AP, et al. Availability of recreational resources and physical activity in adults. Am J Public Health. 2007;97:493–499.
9. Kivimäki M. Socioeconomic position, co-occurrence of behavior-related risk factors, and coronary heart disease. Am J Public Health. 2007;97:In press.
10. Mayer JA, Slymen DJ, Clapp EJ, et al. Promoting sun safety among US Postal Service letter carriers: impact of a 2-year intervention. Am J Public Health. 2007;97:559–565.
11. Jones BA, Reams K, Calvocoressi L, Dailey A, Kasl SV, Liston NM. Adequacy of communicating results from screening mammogram to African American and white women. Am J Public Health. 2007;97:531–538.
12. Schanzer B, Dominguez B, Shrout PE, Caton CLM. Homelessness, health status, and health care use. Am J Public Health. 2007;97:464–469.
13. Conner KR, Phillips MR, Meldrum S. Predictors of low-intent and high-intent suicide attempts in rural China. Am J Public Health. 2007;97:In press.
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