What’s Next for Environmental Health?
In the fourth segment of our “What’s Next for Health” series, Jonathan Levy, chair and professor of environmental health, discusses the interconnectedness of the field and training the next generation of leaders.
Addressing environmental health concerns is central to our health
Some of the most profound contemporary societal challenges involve the ways humans interact with or manipulate the environment around them. Environmental health (EH) is therefore central to addressing many significant ongoing and evolving challenges, including climate change, energy and sustainability, pandemics, military conflicts, natural disasters, and pollutants in our air, water, and consumer products.
EH has facilitated our understanding of the health effects of climate-driven extremes such as wildfires and heat waves, as well as the health benefits of climate mitigation and adaptation. Policy responses to the COVID-19 pandemic drew heavily upon EH knowledge and methods, including factors that influence exposure disparities and the importance of indoor air. Increasing attention toward aging infrastructure was informed by EH issues such as the implications of combined sewer overflows, lead pipes for drinking water, and urban settings that lack green space. Recent wars and natural disasters have emphasized the importance of safe drinking water and access to sanitation services to avoid infectious disease outbreaks. The threat of perfluoroalkyl substances was crystalized by the recognition that millions of Americans are drinking water contaminated with these “Forever Chemicals.”
On the challenges and evolution of the field
Since EH encompasses so much—our air, water, food, soil, consumer products, and built and natural environment—and leverages a large toolbox of methods that include epidemiology, toxicology, exposure science, risk assessment, community engagement, and much more, we run the risk of being either diffuse or siloed within the field. The flipside is that the inherent interdisciplinarity of EH helps us to address complex problems in a manner that would not be possible within any single discipline. There is opportunity to partner with other disciplines to address some of the leading environmental contributors to global disease burdens and to inform societal investments that will influence health and well-being for decades to come. EH also faces the challenge of large exposure and risk inequities within and between countries, which are based on a complex set of factors including structural racism and inequitable access to resources, but with the opportunity to inform action to reduce those inequities.
To address these and other challenges, the field has been evolving in multiple ways. There is a growing emphasis on solving problems rather than just identifying them, informed by increased partnering with communities and other stakeholders. Methodologically, EH has leveraged ever-expanding geospatial and biological “big data”, which combined with novel data science methods has allowed for exposure and risk characterization at unprecedented scale and resolution. In parallel, there has been increasing availability of relatively inexpensive monitors that give us the ability to measure air pollution or noise levels with phones and other devices, allowing for both individualized insights and measurements in more places. The field has also gained the methodologic capacity to assess the implications of complex exposure mixtures that are more reflective of typical human experiences, including both chemical and non-chemical exposures, allowing for closer connection with social determinants of health and greater insight regarding exposure and health disparities.
At a time when the public health workforce is shrinking and stressed, we need to do everything possible to support the existing workforce while training the next generation.
Nurturing the current and future leaders
Public health professionals of the future need both foundational knowledge and core skills to incorporate EH into their jobs. It is hard to think of a public health job where climate change, pandemic preparedness, or toxic substances in the air, water, and soil of our communities would not have some relevance, and we need to ensure that students receive the requisite education. At BUSPH, we recently launched a new MPH certificate on climate and health that complements multiple areas of study, allowing students with any focus to gain relevant skills and knowledge related to climate and health. We are also evolving our EH curriculum to ensure that it addresses topics and skills relevant to many jobs that public health graduates may have.
We also need to strengthen bridges to other disciplines. Students in fields like engineering, urban planning, and architecture should understand the public health consequences of their work, which invariably runs through EH. Conversely, we should make sure that public health students can connect foundational knowledge and skills in EH with knowledge from disciplines outside of public health. Given the connections between EH and major policy decisions, students need also training in areas such as communications and advocacy to ensure that they can talk to different stakeholders and engage in the policy arena.
Finally, schools and programs of public health need to help build EH capacity in the current workforce. For example, our new Climate Change and Health Research Coordinating Center (CAFÉ) aims to build capacity in climate and health research and to accelerate the translation of that research into practical solutions. Programs such as the New England Public Health Training Center provide opportunities for working professionals to develop knowledge and skills related to both EH and other public health topics. At a time when the public health workforce is shrinking and stressed, we need to do everything possible to support the existing workforce while training the next generation.
There is optimism for action on climate change and the environment
The growing impact of climate change and the persistent impacts of other environmental exposures on health may seem like reasons for pessimism, but the fact that the public is increasingly aware of these issues and their importance makes me optimistic that our work can inform action. For example, 61% of Americans report seeing the impact of climate change in their local community. People can see how wildfires are affecting air quality, feel the effects of unprecedented heat waves, and understand how extreme rain events lead to local beach closures. This creates opportunities to connect EH research with what people experience in their everyday lives. Researchers in the Department of Environmental Health and affiliated with our Center for Climate and Health have had the opportunity to explain the public health significance of environmental topics in the news and to conduct research that can inform policy action.
I am also heartened by the fact that the current generation of students is far more knowledgeable about EH and sophisticated about methods to effect change in the world than I was when I entered the field. The environmental science AP exam is one of the most popular in high schools, with more students taking it than physics or chemistry. Awareness of climate change and support for climate action is highest among younger adults. Through our EH teaching and research, there is a real opportunity to empower the next generation to make lasting change that improves the health of communities around the world.