Sometimes it’s hard to get reactions out of students. But when I recently presented a class with a cancer cluster investigation, a look of horror took over their faces. Indignant, they asked me why we didn’t have data about chemical exposures. “Aren’t they measuring this?” they puzzled. Similarly, “How can we change this?” remains the most common question on discussion boards in a massive open online course I teach on chemicals and health, which has enrolled over 40,000.
People care about environmental health, yet support for it remains low when it comes to governmental services that promote it. So how can we change this?
Let’s start by better hearing and engaging communities. If we’re working with them to answer the questions they want answered, then support for our work increases. Too often we start with what we know — air, water, soil, food contamination — but we should start by asking them what they want to know. Sometimes it’s things like lighting and litter.
Someone shocked me this week by talking about “creating space for dignity in neighborhoods.” She was talking about adding benches so people would no longer be seen as loitering or adding public restrooms to prevent public urination. Both of these steps, she says, would give people more dignity, encouraging them to better utilize outdoor space and build social cohesion. While sanitation represents one of the earliest environmental health interventions, how we design neighborhoods represents a shift in thinking for the field.
Someone else surprised me this week by also suggesting that early childhood education and paid sick leave also fall under the environmental health umbrella. “What isn’t environmental health?” is something I often hear, but these items were new even to me. We need to understand that our traditional concept of the environment doesn’t necessarily represent the most holistic concept.
Speaking of a holistic view, we need a systems approach to environmental health — a way of visualizing and quantitatively modeling how things like sidewalks, energy use, housing, agriculture, education and historical injustice influence our health. A colleague once said: “Imagine a tool that allows you to dial up the budget for public transit and dial down the budget for new streets, while also showing you estimated health and economic impacts.” Such a tool, once validated, would allow evidence-based decision-making in both policy and practice, and potentially increase the value placed on environmental health.
When it comes to practice, did you know Google is working to re-build a neighborhood in Toronto using healthy and sustainable principles? They’re using and generating a great deal of data to go along with it. Too often I hear environmental health practitioners say they have so much data but not enough time to analyze it. Our field needs to figure out how to better use big data, especially when it comes to health data. Data ensures that what we’re doing in practice remains measurable and rooted in science, allowing the field to demonstrate its value.
Such efforts demand new partnerships not only between practitioners, academics and the business sector, but also between public health and communities, transportation, planning and energy experts. There is so much more we need to do and it’s overwhelming at times. Yet every day I’m encouraged, mostly by the young people I get to work with at Hopkins and in Baltimore, both in the classroom and out. But I’m also encouraged by new initiatives aimed at transforming the field — from the Bloomberg American Health Initiative to the National Academies to the work being done by the American Public Health Association and the National Environmental Health Association.
Environmental health, often referred to as the grandfather of public health, has evolved before and we can do it again. As Tom Burke, recently said: “We got this!”