The Future of Environmental Health.

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In 2018, we celebrated the 30th anniversary of the doctoral program in the Department of Environmental Health at SPH, which led us to think about where the field has been, including the historical ties between environmental health and public health and key research milestones over the past three decades. However, we spent even more time thinking about where the field is going, given our departmental leadership transition and the current state of the world. We had the opportunity to host a number of leaders and thinkers in environmental health as part of our departmental seminar series, and asked many of them to answer a simply phrased yet challenging question: “What is the future of environmental health?” We also held a departmental retreat to grapple with this question and engaged the broader community via social media (#FutureofEH on Twitter). I am pleased to present the collective wisdom from these many conversations, which is nicely represented by six videos—three from members of our SPH community, and three from other key thinkers who have spent time in academia, government, and nonprofits.

While we heard a number of ideas, and need to keep in mind the old adage that it is difficult to make predictions, especially about the future, there were five overarching themes that we heard repeatedly as key elements of the future of environmental health.

• • Climate impacts and solutions: A recent IPCC report emphasized the growing impacts of climate change on heat waves, vector-borne diseases, food and water insecurity, and other risks to human health. The five hottest years in recorded history have occurred in the past five years, with increasing economic and health impacts from extreme weather events. As cities and countries start to act to limit carbon emissions and adapt to the already changing climate, the strategies that are used will have profound influences on public health. For example, the recent Carbon Free Boston report emphasized that carbon neutrality by 2050 (the stated goal of the city) will require significant changes to transportation systems, buildings, green space, and the fuels we use to generate electricity and to heat our buildings. The Lancet Commission stated that climate change is the greatest global health opportunity of the 21st century, as we rethink how cities function at the same time that the world is rapidly urbanizing. Commenters emphasized that the climate challenge is fundamentally an environmental health challenge, and that environmental health researchers need to connect with other disciplines to develop and evaluate health-protective climate solutions.
  • Community engagement and empowerment: Academic-community partnerships are not new to environmental health; they have been part of a number of research projects and centers for decades, including our own BU Superfund Research Program and Center for Research on Environmental and Social Stressors in Housing Across the Life Course. But multiple commenters emphasized that vulnerable communities are at increasing future risk from the effects of climate change and other environmental stressors, and need relatable and actionable tools to better understand current conditions and to be empowered to advocate for and ultimately implement solutions. The era of ivory tower environmental health research is long gone, and needs to be replaced by authentic partnerships that engage youth and other vulnerable populations who can drive change.
  • Communication and translation: Related to the need for community engagement is the need to communicate clearly about what we know about how the environment influences health, so that communities and policy makers can act. Given the social media environment and skepticism about scientific expertise among some, the need to communicate in novel ways will only increase over time. Multiple commenters emphasized that environmental health researchers need to learn how to communicate more simply and directly. This could be done by following the mantra repeated by Ed Maibach from George Mason University regarding climate and health communication: “Simple, clear messages, repeated often, by a variety of trusted voices.”
  • Personalized/individualized exposure assessment: Personalized or precision medicine has received increasing emphasis and attention in recent years, and these trends will likely continue. Although personalized medicine has focused on drug and other medical interventions, rather than public health measures, the trend toward individualized information has implications for environmental health. There are an increasing number of ways to collect individual data (e.g., smartphones, activity trackers, actigraphy watches, telemetric monitoring systems) that can ultimately empower people to improve their health. Commenters discussed the ways that these and other technologies can also increase our ability to understand our individual environmental exposures, using novel sensors, linking with pollution data at fine spatial scales, and leveraging GPS and other information from smartphones. This could lead to greatly improved epidemiological studies, and could also empower individuals to take actions to reduce their own exposures, with positive health benefits.
  • Complex mixtures of chemical and non-chemical exposures: We live in a world with an ever-increasing number of consumer products and chemicals that contribute to our daily exposures. Over time, the problems of high exposures to a small number of toxicants have been replaced by the problems of lower exposures to many toxicants, at least in the developed world. These trends will continue and even accelerate. This poses challenges for environmental health researchers, in evaluating the levels of exposures to many toxicants and the health effects of their combined exposures. Commenters spoke of the need to broaden our conception of environmental health beyond chemical stressors, taking into account things like temperature, green space, the built environment, and other non-chemical stressors, especially given that many vulnerable populations have elevated exposures to many stressors. Taking a more holistic look at our total environment will require new methods, including better strategies to analyze “big data,” new technologies for measuring exposures, and new statistical methods, all within a broader systems thinking framework.

This is clearly not a complete representation of the future of environmental health, but rather a snapshot in time of what some individuals felt the future would hold. Other environmental health scientists, affected communities around the world, government researchers, and key stakeholders may have come up with a different list. Our point in engaging in this process was not to come up with the one answer to a complicated question with many answers, but rather to launch a much-needed conversation. The environment is a key driver of health and well-being globally, and we can only respond to growing needs by thinking carefully about where the field of environmental health is going and how we can lead it in the right direction.

If you have ideas about the future of the environmental health, join the conversation on Twitter at #FutureofEH, comment on this article, or send your thoughts to us directly.