Environmental knights of the roundtable.

A key challenge in environmental health is the joining of disparate influences and perspectives to create a unified understanding of issues pertinent to the field. Committed to this quest are the members of the Institute of Medicine Roundtable on Environmental Health Sciences, Research, and Medicine, which draws on the varied expertise of representatives from government agencies, academia, and industry to foster communication on environmental health topics. The Institute of Medicine is part of the National Academies.

Christine Coussens, program officer of the Institute of Medicine Board of Health Sciences Policy and study director of the roundtable explains that the group, which first met in October 1998, does not intend to dictate solutions. "The purpose is really to generate dialogue among the stakeholder groups and also to discuss a series of mutual concerns. The idea is not to come to a consensus on an issue but rather to inform the debate," she says. The roundtable is sponsored by the NIEHS, the Centers for Disease Control and Prevention, the U.S. Environmental Protection Agency, the American Chemistry Council, and Exxon Mobil Corporation.

This dialogue is invaluable, according to Myron Harrison, senior health advisor for Exxon Mobil Corporation and a roundtable member. "The roundtable is trying to get a better grasp on ways to make progress on environmental health," he explains.

The roundtable does not address single issues, Harrison says, but rather takes a more holistic approach to environmental health and to how the United States as a country and as a culture can make more progress. That progress will come through partnerships and collaboration, he says--not through arguing, regulating, and fighting debates out in court.

The cornerstone of the roundtable's outreach is its series of workshops, interdisciplinary symposia that evolve from discussions held at biannual roundtable meetings. Four major workshops have been held to date. The first was Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century, held 20-21 June 2000. Participants at this workshop considered the natural, built, and social environments and how these contribute to good public health. The second workshop, Cancer and the Environment: Gene-Environment Interactions, was held 16-17 May 2001. This workshop featured information on genetic and environmental factors that are known or suspected to affect cancer incidence. The third workshop, The Role of Environmental Toxicants in Premature Birth, was held 2-3 October 2001. It included presentations on the current understanding of premature birth, potential environmental influences on the length of pregnancy, and related knowledge gaps and research needs. The most recent workshop, Environmental Health Indicators: Bridging the Chasm of Public Health and the Environment, was held 10-11 April 2002. This workshop focused on the need to mesh public health indicators with environmental exposure data. The next workshop, scheduled for 16 October 2003 and titled Source Water to Drinking Water, will look at critical issues in protecting the U.S. water supply.

These workshops have stimulated a broader understanding of the topics they covered and have created a foundation for further work, according to roundtable members. Samuel Wilson, NIEHS deputy director and a roundtable member, indicates that the first workshop yielded several beneficial developments, especially with regard to increased recognition of how the built environment affects human health. "That [concept] was not very well articulated or understood around the membership of the roundtable prior to the roundtable meetings. I think now, after a number of roundtable discussions and the first symposium that the roundtable sponsored, the idea has been reinforced," he says.

Further reinforcement has occurred through related regional workshops in Atlanta and Pittsburgh, and this reinforcement may prompt more focused research. "The NIEHS and other agencies have actually started to consider a research agenda around this topic," says Wilson. "I think a lot of that momentum came from the initial work of the roundtable."

Regional workshops are a continuing activity of the roundtable. "In order to be healthy individuals, we need to have ... a healthy natural, a healthy built, and a healthy social environment," says Coussens. Coussens also says the roundtable is looking at ways to ensure good environmental health on a global scale--a topic for which industry is an important partner--and methods for increasing outreach to health professionals.