Waste management and environmental health impact: sustainable laboratory medicine as mitigating response.

When it comes to the regulation of hazardous chemicals, change in any direction tends to proceed at a snail’s pace. The primary law governing chemicals and health, the Toxic Substances Control Act (TSCA),1 has not been revised since it was passed in 1976, due in part to legislative gridlock and lack of consensus among stakeholders. So it may come as something of a surprise that over the past two years there has been a broad-based, intense, and relatively rancor-free effort to revitalize and rationalize how we manage hazardous industrial and naturally occurring chemicals. The National Conversation on Public Health and Chemical Exposures,2 brainchild of former Agency for Toxic Substances & Disease Registry (ATSDR) director Howard Frumkin, delivered its final product—the Action Agenda3—on 9 June 2011. “Most of us would agree we don’t want to be around dangerous chemicals. That’s a fairly widely shared value,” Frumkin says. “But you wouldn’t know it based on the amount of polarization and shouting that goes on.” Now dean of the School of Public Health at the University of Washington, Frumkin became frustrated during his years at the ATSDR, where he concurrently directed the National Center for Environmental Health (NCEH), part of the Centers for Disease Control and Prevention. He wanted to improve federal agency coordination, identify areas of overlapping or redundant responsibility, make information about chemical health effects easily accessible to the general public, streamline and integrate the enormous amount of scientific data on chemicals, and reduce children’s exposure to harmful chemicals. He also wanted to re-establish a strong connection between the public health community and the environmental and occupational health communities. And he sought a fundamental change of perspective from a system based on what the Action Agenda describes as reliance on “treatment after harm has occurred”3 to one that prevents health problems.

A workshop titled "Using Sentinel Species Data to Address the Potential Human Health Effects of Chemicals in the Environment," sponsored by the U.S. Army Center for Environmental Health Research, the National Center for Environmental Assessment of the EPA, and the Agency for Toxic Substances and Disease Registry, was held to consider the use of sentinel and surrogate animal species data for evaluating the potential human health effects of chemicals in the environment. The workshop took a broad view of the sentinel species concept, and included mammalian and nonmammalian species, companion animals, food animals, fish, amphibians, and other wildlife. Sentinel species data included observations of wild animals in field situations as well as experimental animal data. Workshop participants identified potential applications for sentinel species data derived from monitoring programs or serendipitous observations and explored the potential use of such information in human health hazard and risk assessments and for evaluating causes or mechanisms of effect. Although it is unlikely that sentinel species data will be used as the sole determinative factor in evaluating human health concerns, such data can be useful as for additional weight of evidence in a risk assessment, for providing early warning of situations requiring further study, or for monitoring the course of remedial activities. Attention was given to the factors impeding the application of sentinel species approaches and their acceptance in the scientific and regulatory communities. Workshop participants identified a number of critical research needs and opportunities for interagency collaboration that could help advance the use of sentinel species approaches.

Summit Discusses Public Health Implications of Fracking

With the speed of industrialization in today’s global community, the costs of disparities in environmental health and risk assessment can be dangerously high in developing countries without broad, stable regulatory and protective measures in place. Addressing capacity-building problems will depend largely upon the implementation of proactive measures within the borders of these developing nations—measures that participants sought to create at the Risk Assessment and Quality Assurance Training Workshop of the African Society for Toxicological Sciences (ASTS), held 21–28 October 2006 in Limbe, Cameroon. The workshop was cosponsored by the NIEHS as part of its efforts to expand global environmental health initiatives, as outlined in the institute’s Strategic Plan. Forty-seven experts in toxicology research, environmental policy, and government from Cameroon, Nigeria, Sudan, South Africa, the United States, and Europe convened for the purpose of generating ideas for new sustainable development initiatives. Attendees also took part in training modules and a site visit to a local oil refinery. Sanmi Areola, a toxicologist with the Metro Nashville/Davidson County (Tennessee) Public Health Department and incoming ASTS president, says that organizations such as the ASTS serve as necessary bridges of communication between developed and developing nations. “Continuing and emerging environmental [and] public health issues present differently in Africa compared to the developed countries of the world primarily because of the lack of enforceable policies and regulations and the nonexistence of infrastructures, [which are] poor where and when they exist,” says Areola. He explains that the negative impacts of environmental stressors on public health in Africa are exacerbated by poverty, political instability, urbanization, and overpopulation, among other factors. “These issues must be addressed through a multifaceted, multidisciplinary, region-specific approach where the identification of hazards and characterization of the risks take into consideration the uniqueness of the African geopolitical and ecological divides,” he says. According to Areola, the ASTS is uniquely positioned to provide a platform and serve as the facilitator for a collaborative partnership with agencies from developed nations to build approaches for managing and alleviating these risks. In the past 10 years, the ASTS has built solid networking structures, working with policy makers, scientists, and agencies within and outside Africa. Outgoing ASTS president Hoffman Moka Lantum, director of practice variance with Excellus BlueCross BlueShield, agrees, saying that a multidisciplinary, international exchange of ideas has been and will continue to be integral to the success of the ASTS’s efforts. He points out that very few data are based on studies done in Africa despite exponential growth in the use of large-volume chemicals in the petrochemical, mining, agrochemical, textile, and food industries, plus disproportionate underlying disease and nutritional disorders from food deficiency and toxicity. “The effects of the chemical burden from imported new classes of drugs, detergents, and industrial hydrocarbons on the biology and ecology of Africa are largely unknown and unappreciated, and may never be talked about if our colleagues in developed countries do not participate in this [ongoing] discussion,” he says. Kenneth Olden, a founding member of the ASTS and past director of the NIEHS and the National Toxicology Program, says all parties can benefit from such collaborative efforts. “Environmental health issues are national in scope, so it is important that nations, including the United States, cooperate in research, training, and exchange of prevention and remediation technology. All nations, including the African nations, have much to contribute to environmental protection,” he says.

Last summer ushered in a new era in the regulation of chemicals. On 1 June 2007, REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals), the expansive scheme by the European Union (EU) to regulate chemicals used in commerce and consumer products, took effect. REACH applies to chemicals manufactured or marketed in Europe, and its regulations affect companies exporting chemicals to Europe as well as those located there. REACH puts the burden on chemical companies to provide information on how the chemicals they make affect human health and the environment. REACH has two parts: the collection and sharing of data throughout supply chains, and the authorization of chemicals of higher concern to human and environmental health.

Introduction: Environmental health is deteriorating worldwide. Evidence shows that exposure to air, water and soil pollution has caused many deaths worldwide, a trend that is increasing day by day. Health consequences from exposure to environmental pollutants range from cancer, lung disease, heart disease and a series health problems which often lead to death. The majority of pollution related deaths happens mostly in low and middle-income countries. Environmental and pollution health related issues are not getting the attention they deserve in Albania. The main purpose of this article is to identify the relationship between environmental problems and public health consequences, by analysing public policies, case studies and instruments for measuring environmental health indicators. The article also presents suggestions regarding development of Environmental Medicine in Albania, and Public Health Tracking methods. Methods: Qualitative method is thoughtfully used in this article. Specifically, literature review methodology is used to identify environmental indicators that directly affect public health, adequate policies and instruments for the protection of public health, as well as environmental health at the international and national level. Qualitative method is used to reveal and evaluate the topic through multiple facets covering relevant contextual conditions. This method helps identifying the link between public and environment health indicators in a real-life situation, and to understand the relationship between these indicators in the Albanian context. Results and Discussion: Albania lacks a specific measurement system of Environmental Public Health Tracking, as well an established methodology for linking environmental and public health. Potential capacities for measuring environmental and health indicators are limited at the national level, thus, the public health policies do not clearly and fully integrate environmental health indicators for the protection of public health. Vocational training in health and environment is being practiced through various disciplines, but there is a need for specialized environmental medicine health professionals, with adequate competences in the field. Conclusions: The correlation between environment and public health is gaining attention nationally and globally. As in other countries, the need for Environmental Medicine professionals is growing also in Albania. Strong correlations between of environmental pollution indicators (air, water, land pollution) and public health indicators (such as infant and general mortality, morbidity rates, respiratory diseases, etc.) have increased in the last years. Use of instruments (such as EPHT), a fully integrated university curricula and a specific discipline of Environmental Medicine should be made a priority not only nationally, but also globally as environmental problems such as climate change do not recognize national borders. In order to manage the rising cases, states need to be resilient, and build appropriate research based policies and action plans to prevent the occurrence of environmental related public health consequences. Doi: 10.28991/SciMedJ-2021-0302-3 Full Text: PDF

When North Carolina’s Research Triangle Foundation provided 509 acres of land to the U.S. Surgeon General’s Office in 1967 as the site for the newly established Division of Environmental Health Sciences, the area was probably not foreseen as a hub for companies, institutions, and government agencies working on issues related to environmental health. Then, just two years later, the Division of Environmental Health Sciences was elevated to institute status to form the NIEHS. Since that time, the area now known as Research Triangle Park (RTP) has expanded into a nucleus of intellectual activity in environmental health sciences that includes the National Toxicology Program, the laboratories of the U.S. EPA, the CIIT Centers for Health Research, and environmental research programs at Duke University, the University of North Carolina–Chapel Hill, and North Carolina State University, among other institutions and nonprofit organizations. These organizations are now taking advantage of a unique opportunity to solidify RTP’s reputation as the epicenter for environmental health science research in the United States by creating a forum for discussion and debate of the important public health issues related to environment and health. Prominent individuals in the RTP community—including former North Carolina governor James Hunt, former NIEHS director Kenneth Olden, and William Roper, chief executive officer of the North Carolina Health Care System and former head of the CDC—have been working to bring thought leaders together on these issues in a new initiative that has been dubbed the Research Triangle Environmental Health Collaborative. The mission of the collaborative is to connect organizations and institutions; link research and policy; and join government, academia, industry, and public interest groups for the purpose of mutually considering, discussing, and debating the grand challenges in environmental health at the regional, national, and international levels. Says Olden, “When I came to the NIEHS many years ago, I realized the talent base we have here in RTP. The major environmental health research institutions are all here, the intellectual resources of the major research universities, and also the companies that have evolved around this. No place else in the world can boast this concentration of minds working on environmental public health issues. So we thought that it follows that if you can help to focus these talents in the areas where perhaps the most change can be effected, real progress might be made.”

The intersection of environmental pollution, climate change, and public health represents one of the most pressing challenges of the 21st century, with profound implications for disease prevention and population health outcomes. This comprehensive review examines the conceptual frameworks that link pollution exposure and climate-related environmental changes to public health outcomes, providing a systematic analysis of the mechanisms through which environmental factors influence disease patterns and health disparities. The study synthesizes current research on environmental health determinants, exploring the complex pathways through which air pollution, water contamination, extreme weather events, and ecosystem disruption contribute to disease burden across diverse populations. Through an extensive literature review encompassing epidemiological studies, environmental health assessments, and climate science research, this paper identifies key conceptual models that explain the relationships between environmental exposures and health outcomes. The analysis reveals that environmental health impacts operate through multiple interconnected pathways, including direct toxic effects of pollutants, indirect effects through ecosystem disruption, and social vulnerability factors that amplify exposure risks among marginalized populations. Climate change acts as a threat multiplier, exacerbating existing environmental health risks while creating new exposure scenarios and altering disease transmission patterns. The paper presents a comprehensive framework for understanding these relationships, incorporating concepts of environmental justice, cumulative risk assessment, and adaptive capacity in health systems. Key findings indicate that effective environmental health protection requires integrated approaches that address both immediate pollution control and long-term climate adaptation strategies. The research highlights the importance of place-based interventions, community engagement, and multi-sectoral collaboration in developing effective disease prevention strategies. Policy implications emphasize the need for proactive environmental health governance that incorporates climate resilience, equity considerations, and evidence-based risk assessment. The study concludes with recommendations for strengthening conceptual frameworks through improved environmental health surveillance, enhanced inter-disciplinary research collaboration, and the development of innovative intervention strategies that address the root causes of environmental health disparities. These findings contribute to the growing body of knowledge on environmental determinants of health and provide practical guidance for public health practitioners, policymakers, and researchers working to address the complex challenges at the intersection of environmental change and population health.

Not often does a new degree program make headline news, but then, in India there is nothing entirely comparable to the new master’s of public health (MPH) program launched 19 January 2010 at Sri Ramachandra University (SRU) in Chennai. With environmental disease constituting roughly half the country’s total disease burden, India has a dire need of the expertise the program will develop with its focus on occupational and environmental health (OEH). “This program is the first MPH [in India] with an exclusive focus on OEH,” says Kalpana Balakrishnan, a professor of biophysics and head of the Department of Environmental Health Engineering at SRU. “These graduates will be trained in recognition, evaluation, and management of OEH risks to serve industry and governmental organizations in addition to assuming roles as teachers of OEH in [this and other] MPH programs.” India faces a double whammy of traditional and modern OEH problems, including indoor air pollution (primarily due to the use of wood, dung, and other solid fuels for cooking); the microbial and chemical contamination of water; chemical, physical, ergonomic, and psychosocial hazards in the workplace; and contamination of food supplies by heavy metals, pesticides, and microbes. Over 37 million people—more than the total population of California—are affected annually by waterborne disease, according to the international nonprofit WaterAid, and the most recent data available—published by James Leigh et al. in the September 1999 issue of Epidemiology—put the number of occupation-related deaths per year at an estimated 121,000. Yet the country, with one-sixth of humanity and a space program, nevertheless has few professionals trained to tackle such problems and inadequate capacity to undertake related research. The 2-year MPH program is the fruit of a collaboration with the University of California, Berkeley, that began in 2002 with support from the International Training and Research Program in Environmental and Occupational Health (ITREOH), an initiative of the Fogarty International Center, National Institutes of Health, in collaboration with the NIEHS and the Centers for Disease Control and Prevention. “A main objective of this collaboration has been to build the capacity of staff at SRU to deliver the MPH program and undertake research,” explains Kirk Smith, a professor of global environmental health at Berkeley and a principal investigator with ITREOH. Fogarty funds have brought 6 SRU faculty to Berkeley to take advanced courses in biostatistics, epidemiology, and other disciplines. Berkeley aims to continue to provide training support over at least the next 2 years. The new MPH program covers topics such as epidemiology, biostatistics, occupational toxicology, industrial hygiene, occupational and environmental safety, exposure assessment and control, health policy and management, behavioral sciences in health, indoor air quality, analysis of airborne chemical contaminants, occupational health clinics, environmental engineering (including the management of hazardous and biomedical waste), and the use of geographic information systems. With initial graduating classes of just 10 students, Balakrishnan says, “The intake will be expanded once a critical mass of teachers is produced from the first few batches.” She believes it could be at least a decade before much of a dent could be made in the subcontinent’s OEH problems and that to truly meet its challenge, India would need dozens more such programs. “It will be difficult in the short term to find students able to pay their own fees to attend until there are jobs available to make it seem worthwhile,” Smith says. “It’s a chicken-and-egg situation, which is one of the main reasons SRU needs to start small and build up slowly to a larger program.” Smith says other Indian universities are now considering offering new courses with OEH content, but one of the major problems they face remains the recruitment of staff capable of teaching in this area. “The production of the first ‘homegrown’ graduates who can specifically fill these positions, who have firsthand experience of India’s OEH problems, and who can begin research to find new ways of quantifying them and dealing with them will be a big step in the right direction,” he says. “Addressing India’s occupational and environmental health concerns is vital in the future of a healthy India,” remarks Sanjay Zodpey, director of the Indian Institute of Public Health and director of public health education for the Public Health Foundation of India, both in New Delhi. “The MPH program in collaboration with Berkeley will not only address the shortfall in trained manpower in occupational and environmental health, but also strengthen indigenous Indian research capacity in these areas.”

Total Intravenous Anesthetic Versus Inhaled Anesthetic: Pick Your Poison.

In 1988, New York City’s West Harlem community had a problem. The recently opened North River Sewage Treatment Plant, which stretches eight blocks along the Hudson River, was doing a poor job of processing about 170 million gallons of raw sewage daily. Residents were concerned about the foul smells coming from the plant, and parents complained that their children were suffering from respiratory problems. The community knew it needed help, but it also needed something else: information on the exposures it was facing, on the health effects of those exposures, and on the courses of action open to the people. When the community mobilized months later to form West Harlem Environmental Action Inc. (WE ACT), it had taken the first step toward cultivating just that sort of environmental literacy.

Healthcare buildings are intimately interwoven with the human experience. As such, they express societal values around health and healing, wellness and disease. The healthcare sector and its practitioners have a legacy of coupling individual health and public health-and of honoring the sanctity of environmental health. However, its buildings have become largely distanced from these values. Resetting the design and regulatory parameters that shape these significant civic structures is both urgent and necessary in light of contemporary global environmental and public health realities. A coordinated research agenda is an essential part of this pursuit. While by no means exhaustive, this paper presents important research topics intimately tied to these 21st-century environmental and public health challenges.Research ContextAs contextual underpinnings for research into sustainable healthcare design, construction, and operations, the precautionary principle and life-cycle multiscale thinking are points of alignment:The Precautionary Principle: Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental (United Nations, 1992).In many cases environmental degradation leads to direct or indirect public health burdens. For instance, a polluted stream can contaminate drinking water; air pollution can lead to more asthma cases. Many of the products and systems incorporated into today's buildings have not been tested for their environmental or health impact. However, the built environment plays a significant role in determining environmental and public health. According to the U.S. Environmental Protection Agency, the U.S. population, on average, spends 90% of its time indoors, where there is direct exposure to these potentially polluting products. Building construction consumes more materials by weight than any other industry in the United States (Horvath, 2004) and constitutes 25% to 40% of the national solid waste stream annually (Whole Building Design Guide, 2007). Recognizing the scale of the building industry's involvement in environmental degradation and its associated public health burden, both the Green Guide for Health Care and the U.S. Green Building Council have adopted the Precautionary Principle as a guiding principle, as have numerous other healthcare systems and environmental health organizations.Life Cycle and Multiscale Thinking: Building-related decisions have consequences both inside and outside the building walls. For example, the choice of grid-connected fuel sources (e.g., coal, natural gas, wind, photovoltaics) results in vastly different environmental and health impact profiles.The Green Guide for Health Care addresses life cycle and multiscale thinking by basing its voluntary credits on three scales:1. Protecting the immediate health of building occupants2. Protecting the health of the surrounding community3. Protecting the health of the global community and natural resourcesVerifying the impact of sustainable practices on several scales ensures that healthcare institutions realize their related missions of providing a healing environment inside the facility and to safeguard natural resources and the environment outside the facility. Toxic chemicals procured and used by healthcare institutions in the course of clinical care and facilities operations can result in the decline of environmental systems and public health even when they are far removed from the waste source, if they are improperly disposed of. Based on the research of 119 pilot projects representing more than 30 million square feet of construction, the Green Guide for Health Care found that connecting sustainable design practices and human health was instrumental in establishing these practices' relevance to the healthcare industry. Since the Green Guide's release in 2003, many healthcare institutions have made the connection between stewardship of the environment and stewardship of the community outlined in their mission statements. …

Background:Environmental health (EH) professionals, one of the largest segments of the public health workforce, are responsible for delivery of essential environmental public health services. The challenges facing these professionals and research needs to improve EH practice are not fully understood, but 26% of EH professionals working in health departments of the United States plan to retire in 5 y, while only 6% of public health students are currently pursuing EH concentrations.Objectives:A groundbreaking initiative was recently launched to understand EH practice in health departments of the United States. This commentary article aims to identify priority EH practice challenges and related research needs for health departments.Methods:A horizon scanning approach was conducted in which challenges facing EH professionals were provided by 1,736 respondents working at health departments who responded to a web-based survey fielded in November 2017. Thematic analyses of the responses and determining the frequency at which respondents reported specific issues and opportunities identified primary EH topic areas. These topic areas and related issues informed focus group discussions at an in-person workshop held in Anaheim, California. The purpose of the in-person workshop was to engage each of the topic areas and issues, through facilitated focus groups, leading to the formation of four to five related problem statements for each EH topic.Discussion:EH professionals are strategically positioned to diagnose, intervene, and prevent public health threats. Focus group engagement resulted in 29 priority problem statements partitioned among 6 EH topic areas: a) drinking water quality, b) wastewater management, c) healthy homes, d) food safety, e) vectors and public health pests, and f) emerging issues. This commentary article identifies priority challenges and related research needs to catalyze effective delivery of essential environmental public health services for common EH program areas in health departments. An unprecedented initiative to revitalize EH practice with timely and strategic recommendations for student and professional training, nontraditional partnerships, and basic and translational research activities is recommended. https://doi.org/10.1289/EHP5161

In a large cohort study published in Environmental Health Perspectives, Brenner et al. (2011) confirmed previous results on I-131 exposure and thyroid cancer among a Ukranian population. According to the authors, one motivation to study this association was based on evidence from ecological studies (Jacob et al. 1999) with two methodological limitations: use of grouped doses and poor control of confounding. With these new findings, evidence from ecological, case–control, and cohort studies are consistent; thus, an interesting question is whether there was an ecological fallacy. Although ecological studies are important to epidemiology (especially in environmental and social epidemiology), public health practitioners seem afraid of ecological studies. It is a common practice to assume the presence of ecological fallacy (Robinson 1950) and low-level validity when analyzing an ecological study. Most epidemiologists prefer an exclusive individualistic approach, although the importance of a multilevel causal approach is widely recognized (Diez-Roux 2002). In this sense, some authors suggest that it is as important to recognize the presence of ecological fallacy as to recognize psychologistic or individualistic fallacy (Subramanian et al. 2009) (Figure 1). Figure 1 Levels of analysys in epidemiologic studies and potential fallacies during casual inference. Thus, it is necessary to have clear guidelines on when there is or not an ecological fallacy. In this sense, I propose three criteria for the identification of ecological fallacy; all three of these should be present to confirm its existence: Results must be obtained with ecological (population) data. Data must be inferred to individuals. One use of ecological studies is to explore individual-level association when individual data are not available. When the focus of the study was contextual or based on population effects and there is no inference to individuals, ecological fallacy is not possible. When only the first two criteria are present—which is insufficient to affirm ecological fallacy—it is appropriate to acknowledge that there is a possible relationship and that further study is required. Results obtained with individual data are contradictory. Only when empirical data are available is it possible to confirm that an ecological fallacy is present.

Hurricane Katrina has been called the most devastating natural environmental calamity in U.S. history. Visitors to the scene say the destruction is worse than anyone can imagine. Scientists also say that some perceived health threats have been overblown and others understated. Months after Katrina roared into the Gulf Coast, the environmental health implications of the storm are still being assessed. Katrina presented residents of the Gulf Coast with a bewildering array of environmental health hazards. Aside from standing floodwater, hazards included a lack of potable water, sewage treatment, and electricity; chemical spills; swarms of insects (with anecodotal accounts of vermin and hungry domestic dogs); food contamination; disrupted transportation; mountains of debris; buildings damaged and destroyed; rampant mold growth; tainted fish and shellfish populations; and many potential sources of hazardous waste. Some impacts, such as deaths from drowning and injuries from cleaning up debris, have been relatively easy to determine. Others, such as post-traumatic stress disorder from the loss of homes and loved ones, may never be fully quantified. In the weeks following the storm, federal agencies such as the NIEHS, the Centers for Disease Control and Prevention (CDC), and the Environmental Protection Agency (EPA), as well as state environmental and public health agencies, sent scientists to the region to begin assessing the environmental and human health impact of the disaster. Much of what they found was presented on October 20 at a meeting of the National Academies Institute of Medicine’s Roundtable on Environmental Health Sciences, Research, and Medicine (commonly known as the EHSRT), supported by the NIEHS, the CDC, the EPA, Exxon-Mobile Corporation, the American Chemistry Council, and the Brita Water Research Institute. Still more information continues to emerge today. And much simply remains to be seen.