Health Affairs

The Link Between Environment and Health: A Call for Health Policy Makers to Weigh Factors Such as Air and Water Quality, Food Policy, Chemical Exposure, and the Built Environment

Health Affairs' First Thematic Issue on Environmental Health Identifies Challenges and Potential for Policy Change

Bethesda, MD -- Despite potential progress under national health reform, significant improvements in the nation's health will not be achieved without also addressing factors in our environment--from air and water quality to availability of nutritious foods to public transportation. For the first time, Health Affairs focuses on how environmental health concerns connect to health and health care, and the potential to take action to improve both.

"Efforts to improve America's health will continue to fall short until policy makers from all sectors--not only public health and health care, but also agriculture oversight, environmental regulation, transportation, urban planning, and others--assume shared responsibility for their role in fostering the public's health," said Health Affairs Editor-In-Chief Susan Dentzer. "We'll have to break down the silos of conventional policymaking and work together on practical approaches that integrate 'health into all policies' with these other environmental sectors."

The studies shed light on a variety of policy considerations related to addressing the impact of environment on overall health. Children, for example, may be most susceptible to negative health effects from environmental influences. As a result, policy makers may need to fundamentally change their approach to such questions as how to test the toxicity of chemicals already on the market, or how to locate schools in areas with less pollution.

This issue of Health Affairs was funded by the Kresge Foundation, a private, national foundation that seeks to influence quality of life for future generations through its support of nonprofit activities in areas including the environment and health and human services. With support from the Foundation, Health Affairs will publish new environmental health research and analysis on an ongoing basis.

The May issue provides an overview of the large body of evidence demonstrating the impact of environment on health and health care costs, in areas as diverse as air and water quality, food policy, the built environment, and genetics. Studies include the following:

• According to Linda Birnbaum at the National Institute of Environmental Health Sciences, and coauthors, the negative health effects of poor environments are particularly pronounced in children, who may be exposed to them much earlier in their lives than adults, sometimes even before birth. The authors call for an environmental health research strategy that integrates "the best new methods and technologies to provide usable data and information for its multiple audiences," adding that "prevention, education, and policy should be critical components of research, informing how scientists think about environment health and how they formulate hypotheses."
  
  
• Not only is environment connected strongly to health, but environmental health action has a critical role to play in improving the cost-effectiveness of the U.S. health care system, according to an analysis by Bobby Milstein at the Centers for Disease Control and Prevention, and colleagues. Efforts to expand health insurance coverage and deliver better preventive and chronic care have value, but would be greatly enhanced when combined with efforts to protect health, for example, by supporting healthier behaviors and improving environmental conditions, the authors say. Compared to a strategy focused on coverage and care alone, the researchers found that adding health protection could save nearly twice as many lives and reduce costs by a third in 10 years. Moreover, their study demonstrates that whereas the improvements from coverage and care tend to plateau, the investment in healthier behaviors and safer environments is likely to yield even larger returns over time.
  
  
• Policy makers need to factor in health risks when making environmental and land-use decisions, says Aaron Wernham of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. He argues for the use of health impact assessments that bring together scientific data, public health principles, and stakeholder input in a structured process to identify the potential health effects of proposed policies or programs. Health impact assessments can be used in areas such as urban planning, transportation, agriculture and the built environment, and to provide health-based recommendations.
  
  
• Despite the clear links between environment and health, the relevant scientific evidence is not always accessible to clinicians or understandable to them in ways that could help them in advising patients. To bridge the gap between clinical care and environment health sciences, Tracey Woodruff and Patrice Sutton of the University of California, San Francisco and the Navigation Guide Work Group, developed the Navigation Guide, an innovative methodology to help professional societies, health care organizations, government agencies and others evaluate the quality of evidence about environmental impacts on health, and craft consistent and timely recommendations to improve health outcomes for patients and communities. For example, organizations such as physician specialty societies could use the guidelines to develop evidence-based recommendations for preventing environmental threats to reproductive health.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at www.healthaffairs.org. You can also find the journal on Facebook and Twitter and download Narrative Matters on iTunes. Address inquiries to Sue Ducat at (301) 841-9962 or sducat@projecthope.org