What do you think of when you hear the term environmental health? Do you think about how healthy the air is? Do you think about that famous picture of Earth from outer space? Do you think of endangered species and polar bears on melting ice? Do you think about the ability to enjoy a safe and comfortable dinner with your family at a local restaurant?
The World Health Organization defines environmental health as "the physical, chemical, and biological factors external to a person and all the related factors impacting behaviors."1 In the broadest sense, environmental health is concerned with assessing, understanding, and controlling the impacts of people on their environment and the impacts of the environment on them.2 Although environmental health might not be a part of the everyday conscience, it is, in fact, something people interact with every day. For example, throughout the world, people are concerned about earthquakes, tsunamis, hurricanes, cleanliness of restaurants and cruise ships, the safety of daycare centers and hotels, and the safety of fresh produce. With changes in weather patterns, more severe and frequent storms, increased global temperatures, attention focused on the development of land, increased burdens of energy costs, and the "green" movement, environmental health is becoming a greater part of the American conscience, even if people do not recognize these concerns as environmental health issues.
Humans throughout history have always looked for safer, healthier, and more comfortable places to live, yet more and more challenges are preventing people from finding those safe and healthy environments. To address such challenges, NACCHO works with local health departments (LHDs) throughout the country to respond to ever-changing and always challenging environmental health concerns. NACCHO has worked for over a decade to ensure that LHDs have the support and information they need to provide effective and cutting-edge environmental health programs and services to the public. Although a trend of relocating local environmental health programs to other agencies, including environmental services, departments of environmental protection, and agricultural departments, is occurring throughout the country, many traditional environmental health issues are being managed at LHDs. According to NACCHO's 2005 National Profile of Local Health Departments, 80 percent of LHDs surveyed have at least one environmental health specialist on staff, 75 percent perform food safety education, and 76 percent perform food safety inspection or licensing.3
Emerging and overarching issues facing environmental health continue to challenge the boundaries of governmental public health and are reaching into areas that cannot be solved through a traditional regulatory and fee-based structure. Such issues must be solved with a focus on creativity and collaboration and must be handled both horizontally across agencies and vertically among local, state, and national entities. These areas include environmental concerns such as global climate change, land use planning and community design, worksite wellness, preparedness for and management of natural disasters, and the promulgation and support of agreed-upon national standards for environmental health services. NACCHO's work with LHDs throughout the country in envisioning programs and developing strategies to address some of these issues is described below.
Community Needs Assessment
NACCHO has developed and promoted a protocol to help communities understand their environmental health needs. More than 200 communities around the country have used the Protocol for Assessing Community Excellence in Environmental Health (PACE-EH) to help make policies to improve the health of communities based on what communities determine to be important. Some successful examples of PACE-EH include an assessment undertaken in Delaware, Ohio, that led to implementing policy on developing walking trails from old rail lines and improving walking routes to schools to improve safety for children and to increase physical fitness levels. In Florida, PACE-EH led to the development of environmental health plans throughout the state; in Wabasso, a predominantly minority community in the country, PACE-EH volunteers have been instrumental in connecting the town to the public water system, raising necessary budgetary funds to develop a community center and build new sidewalks, and developing a coalition of volunteers to build homes for disadvantaged residents.
Environmental Public Health Tracking
NACCHO has been a leading national partner in the work of the Centers for Disease Control and Prevention's (CDC's) development of a National Environmental Public Health Tracking Network. That network, when fully functional, will allow critical environmental health data to be tracked and shared at local, state, and federal levels. In collaboration with the Association of State and Territorial Health Officials and the CDC, NACCHO has engaged LHDs in the process of understanding data standards and data sharing and in being part of development and decision making. The availability of environmental public health data will lead to the following:
1. the ability to make sound policy decisions based on scientific evidence of how environmental exposures in a given community affect public health;
2. the ability for regions, states, and localities to compare themselves to other demographically similar areas to determine if a greater burden of disease needs to be addressed within the community; and
3. the ability to collect and share environmental and health data of all types so that policies and laws can be made proactively before potential damage to a community's health.
Land Use and Community Design
NACCHO has helped LHDs increase their ability to make decisions based on data, community input, and health outcomes in the area of land use planning and community design. Over the last several years, with the CDC's support, NACCHO has advocated for greater use of health impact assessment (HIA), which enables LHDs, planning departments, developers, and community residents to assess whether projects that change the face of the built environment will have a positive or negative impact on people's health. NACCHO has offered trainings, expert presentations, and pilot grants to put HIA into action. Several communities have already seen significant benefits from undertaking HIA by being able to support healthy design and development or modify development that could have had negative impacts on a community's health. For examples of completed HIA models, see http://www.naccho.org/topics/environmental/landuseplanning/HIA.cfm.
Food Safety
Food safety is a traditional and critical part of the work of LHDs, and NACCHO plays a leading role in improving and supporting the nation's food safety system. Although food safety concerns have been in the public conscience more since the spinach outbreak of 2006 and the Salmonella outbreak and tomato scare of 2008, NACCHO has helped the Food and Drug Administration, the Department of Agriculture, and the CDC develop recommendations and strategies to improve the ability not only to recognize and respond to food-borne outbreaks but to improve the system currently in place to protect the public from these potential hazards. In collaboration with the Council of State and Territorial Epidemiologists, NACCHO has been the lead organization on the Council to Improve Foodborne Outbreak Response and has worked with federal and national partners to ensure that the nation's food safety system will work for all levels of government, the consumer, the industry, and the medical profession.
Climate Change
NACCHO believes that public health should be a part of the fervent "green" movement that is sweeping the United States. Those in public health must not only assist communities in understanding the environmental impact that they have on the globe but also provide strategies to help LHDs face vector-borne illnesses and deaths related to environmental exposure as a result of increased severe weather events, drought, and temperatures associated with climate change. NACCHO's Climate Change Workgroup develops educational tools and resources to prompt LHDs to think about how they can get involved with climate change activities, especially those activities that can benefit LHDs if increased services to the community are necessary. The workgroup has also developed policy statements to advocate for LHDs to have sufficient staffing and resources to address climate change issues. Finally, this workgroup will develop a strategy to ensure that LHDs consider climate change an issue of concern and a strategy to ensure that tools and resources are available to LHDs as needed.
Conclusion
Because environmental health is ever changing, even though that change may be gradual, NACCHO and its partners must continue to be at forefront in helping LHDs perform environmental-health-related work. From the permitting and licensing of tattoo parlors in Nebraska, to the insecticiding methods used to prevent the summer onslaught of mosquitoes in Georgia, and to the support and modification of land use development plans in the San Francisco Bay Area, NACCHO is committed to supporting the ongoing and critical role of LHDs in improving public health through improving the natural and man-made environments in which people live. For more information about NACCHO's environmental health programs, visit http://www.naccho.org/programs/environmentalhealth.
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