Life in the 21st Century.

Much has been made of the historic event that will begin with the New Year. The turn of a century is rare enough, but a new millennium? Because of our dependence on information technology, this century change also has a nickname, "Y2K," whose implications consume our attention. Many conversations have been held, and much has been written about how radically different life is in 1999 than it was in 1899, 1799, or 999. The most compelling facts are those that reflect the increasing rate of change in the world, particularly as it relates to advancements in technology.

There have also been many predictions of the future and what life will be like in the 21st century. It is difficult to make comparisons with the past or to grasp the day-to-day impact that the rapid rate of change has on our social structure, economy, health, and environment. Nevertheless, as we wait on the threshold of change--wait, perhaps, for our computers to fail--I will take my turn at looking into the crystal ball and offer some thoughts about where I believe we are headed in the time to come.

A discussion of the year 2000 must work from a few important assumptions. First, technology has overcome the barriers of time and distance, making the world accessible from anywhere and at any time. Second, we are now able to gather much more data than we can analyze and understand. Third, there are no permanent solutions to public health and environmental protection problems. Problems are recognized, analyzed, and resolved according to the understanding of the time. The same problems reappear, however, as circumstances change with time. This column will consider the following examples of issues relevant to the millennium: growth and development, the role of government in public health and environmental protection, individual and community responsibility, the capacity of government to respond, and the management of emerging threats.

Growth and Development

Growth and environmentally sensitive, sustainable uses of land are critical issues in many communities. In the United States, unprecedented economic health has imposed the pressures associated with growth on both large and small communities. The growth that occurs in communities today will directly influence the long-term condition of our natural resources. In addition, larger community health issues are associated with population density, congestion on highways, noise, and other stress-producing conditions. While we do have a sense of the long-term influence of growth, our current land use and development practices still may have unknown and unintended consequences. Growth limitations may not be feasible since the property rights of individuals must be respected. Nevertheless, a new approach to planning must be explored--one that is more cognizant of environmental and health protection. Such an approach would involve identifying and protecting the ecological balance, more intentional assessment of the curren t and future risks planned growth poses for health and the environment, and conservative analyses of the rate at which valuable resources (i.e., drinking-water supplies) will be depleted.

The Role of Government

Beginning with the national environmental protection laws of the 1970s, the command-and-control regulation of business became the primary strategy for protecting public health and natural resources from harmful industrial materials. The purpose of the laws was to clean up the legacy of past practices and to prevent similar circumstances in the future. More recently, as the costs of health and environmental protection became more internalized, businesses began to look for alternatives that would be equally protective while reducing the regulatory burden and associated expense.

As the new millennium approaches, pollution prevention is more prominent than ever as the management tool of first choice for hazardous and toxic emissions. In most states, pollution prevention has remained a voluntary program of incentives to businesses, and the program has been designed to reduce the transaction costs of enforcing regulatory compliance. Government regulators also have embraced a concept called the Supplemental Environmental Project (SEP), which uses administrative penalties to support environmental improvements in communities where environmental laws have been violated. SEP has been a means of turning violations into opportunities for businesses and communities to establish more productive relationships. These examples suggest a trend toward incentives, collaboration, and voluntary compliance (as opposed to high-cost enforcement) as means of achieving the objectives of environmental laws.

In traditional environmental health programs, there is a corresponding movement toward more collaboration with regulated entities and fewer confrontational regulatory enforcement actions. The impetus for this change is the responsiveness of regulated business in achieving voluntary compliance. It is common to find local food protection programs that consist of a program implementation strategy containing a balance of education, consultation, and regulatory compliance actions. Also becoming more common are efforts to increase the investment in public health protection by managers of food service establishments, operators of child care centers and swimming pools, and others responsible for regulated facilities--with enforcement action reserved for the most recalcitrant businesses.

Individual and Community Responsibility

The success of this change in regulatory strategy also involves the recognition that long-term protection is enhanced if individuals acknowledge their responsibilities in protecting the health of their communities. Compliance based on fear of an enforcement action is not likely to be sustained as effectively as compliance based on an understanding of the risks associated with noncompliance and acceptance of responsibility for community protection.

The increasing involvement of community and citizens in health and environmental issues has put pressure on business to be more responsive to fears and concerns about public health and environmental risks. Communities seem to be relying less on the government-led compliance and enforcement process and to be more intent on appealing directly to the offending business to reduce real and perceived risks in the community.

With respect to individuals, however, progress is lagging. Many individuals have not reached an understanding of their responsibility to themselves and others in the community. The current tragedy-of-the-commons culture often results in individual responsibility for community protection being avoided on the grounds that someone else (government) will take responsibility. Individuals covet their freedom of choice but often at the expense of a commitment to the larger community of peers, neighbors, and fellow citizens of the town, state, nation, or world. The future course of efforts to improve community health and protect the environment will rely on the response of individuals through their own actions, their expectations of business, and their support of the regulatory oversight and protection efforts of others.

The Capacity of Government to Respond

Polls show that, for a variety of reasons, the confidence of citizens in government has declined in the past decade. Direct evidence of that decline is provided by successful efforts in many states to cap or reduce property and income tax rates. In some cases, additional limitations have been placed on the total increase in new revenue allowed from year to year. Therefore, while the economy has flourished in recent years, there is not a corresponding windfall for government regulatory and health agencies. There is no indication that this trend will be reversed in the foreseeable future. Given this situation, one could lament the fact that citizens do not have greater respect for government--and then just muddle through. The alternative is to find ways to carry out the public health mission by using resources more creatively. The latter approach seems to be the trend, although not everyone is on board yet.

As described above, agencies are shifting the burden of responsibility to the regulated community. In the past, the response to noncompliance was often more frequent inspections and therefore greater cost. Now, a greater effort is being made to build knowledge and commitment in the regulated community. Also, the additional cost is being shifted from the inspecting agencies to the responsible party. Thus, the business can control the ultimate cost of the compliance process.

One can envision a future role for regulatory agencies that relies less on a legion of inspectors and attorneys and more on technical experts who would provide consultation, scientists who would evaluate risk, policy makers who would develop effective regulatory frameworks based on performance rather than process, and evaluators who would ensure that objectives are reached.

Management of Emerging Threats

One thing will not change in the new millennium. New threats to the health of people and the environment will always emerge. Throughout recorded history, the most compelling stories have been about unanticipated events in which our accumulated knowledge is needed to address a new threat. Furthermore, elimination of a problem does not mean it will not resurface to create a new threat. For example, the smallpox virus was eradicated from the human population through immunization. Work currently is under way, however, to evaluate smallpox as an agent that might be used in bioterrorist acts. Water treatment methods were developed at the turn of the last century to reduce the risks associated with drinking water. While the treatment concepts are still mostly sound, new pathogens and chemical contaminants have prompted a re-evaluation of techniques that were previously thought to be fully protective.

We may continue to succeed in reducing the need for government oversight of business as it relates to health and environmental protection issues. Nevertheless, we always should be ready to respond to unexpected natural and man-made disasters, as well as to the more subtle effects of evolving diseases and other conditions that may affect health, quality of life, and natural resources. It can be expected that such circumstances will require the private sector and academia, as well as federal, state, and local governments, to exercise their expertise on behalf of the citizens. To allow the current response system to erode and the expertise to disappear out of a false sense of security would not be prudent. If there is one thing that we should have learned from history, it is the need to respond quickly and effectively to new threats. The effectiveness of the response is compromised if the capacity to respond is not built until after the threat emerges.

It is unlikely that the course we are on will change dramatically as a result of the coming of the 21st century. The event does, however, provide us with an opportunity to evaluate our progress toward a healthier environment and population. It is imperative that the evolution of our knowledge and our understanding of risks to health and the environment occur in tandem with our understanding of how to apply knowledge to reduce those risks. Success will be defined by the quality of interactions among experts from business, academia, government, and the public, all of whom must gather and analyze the clues as they are presented. It then falls to individuals to apply the knowledge of the experts on behalf of themselves and the population at large--and to ensure that reasonable steps are taken to enhance our quality of life while preserving natural resources for the benefit of future generations.