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Focus On: Public Health and the Environment
by RACHEL MORELLO-FROSCH
 Environment, public health and social justice. In the academic and regulatory arenas these terms are often viewed as three distinct areas of inquiry, but for activists and community-based groups they are inextricably linked. This disconnect is evident as researchers and regulators in environmental health increasingly narrow the scope of their work, emphasizing the molecular (e.g. genetic toxicology, biomarkers of exposure and effect), while activist organizations, occupational health groups and health-impacted communities are doing just the opposite, becoming more holistic in their efforts to make connections between environmental hazards and adverse health effects, and ultimately, to prevent disease from occurring in the first place.
The reflections of ELP fellows reveal the diversity of thinking on the connection between the environment and public health, but they also point to some overarching themes. First, there is a huge gap between how regulatory agencies address environmental health problems and the reality of community vulnerability to toxics. Many regulators are stuck in an old paradigm that emphasizes concern about the acute effects of high level exposures to pollutants, such as particulates, ozone and lead. Early on, this approach resulted in the passage of landmark environmental legislation that has gone a long way toward protecting public health. Unfortunately, we now know that chronic, low-level exposures to toxics where we live, work and play can have adverse health effects, particularly on vulnerable populations such as children. These impacts manifest themselves in ways that scientists could never have initially imagined. For example, low-level lead exposures early in childhood can have subtle, yet permanent, neurological impacts later on in life. These harmful exposures can occur at levels that scientists and regulators had previously assumed were "safe."
 The second overarching theme raised by the reflections of ELP fellows is the importance of environmental justice and the precautionary principle. Environmental justice - with its emphasis on public health, social inequality and environmental degradation - provides a framework for public policy debates about the impact of discrimination on the environmental health of diverse communities in the United States. The environmental justice framework also raises the question of whether disparities in exposures to environmental hazards plays an important, yet poorly understood, role in the complex and persistent patterns of disparate health status among the poor and people of color in the United States - whether it's disparities in infant mortality, cancer, diabetes or childhood asthma rates. In seeking to redress disparities in exposures to toxics, communities organizing for environmental justice give researchers new insights into the junctures of social inequality and public health on one hand and the political and economic forces that lead to environmental inequality on the other. Environmental justice reveals how racism, institutional discrimination and other socioeconomic forces can determine inequalities in community susceptibility to environmental hazards.
Finally, in the never-ending quest for better data and unequivocal proof of cause and effect, some academics and regulators have lost sight of a basic public health principle that underlies much of their work - disease prevention. Activist organizing and models of community-based participatory research have encouraged some academics and regulators to integrate and operationalize the precautionary principle into their work. Practically, this means that in the face of uncertain, but suggestive evidence of adverse environmental or human health effects, regulatory action is needed to prevent future harm. This principle helps mobilize environmental and public health policy-making that otherwise can be paralyzed when implementation is too dependent on scientific certainty. Perhaps even more important, environmental justice and the precautionary principle help move research and policy-making on the environment and public health away from pollution control and toward an emphasis on pollution prevention. Through their reflections in the following dialogue, ELP fellows help us imagine how we can better integrate and strengthen our efforts to advance our work in the realms of public health and the environment.
RACHEL MORELLO-FROSCH is an assistant professor in the College of Health and Human Services, Department of Health Education at San Francisco State University, where she teaches epidemiology, environmental health, and cultural diversity in health promotion.
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