Remarriage of environmental health and environmental protection.

One of the privileges of being on the NEHA Board of Directors, particularly as president, is that many dedicated environmental health professionals throughout the country contact me. Some of these contacts arise in response to a column like this one, and others arise in response to presentations I've made around the country. There has been strong support for the general theme of the need to make the environmental health profession more visible.

When one travels often, occasionally one gets caught in bad weather, which forces a longer-than-planned stay. Recently on one such occasion as I was trying to get back to Atlanta after a couple of back-to-back state meetings, I was delayed in Lincoln, Nebraska. Luckily, this city is the home of one of my best friends, Scott Holmes, who is the manager of the environmental public health division of the Lincoln Lancaster County Health Department (LLCHD). Whenever we meet (as the proverb says), "Iron sharpens iron." Over the past 20 years, we have challenged each other to push our work forward to better protect the health and environment of the communities we have served.

During my unexpected visit to Lincoln, I went out on a rainy evening with Scott and his wife for coffee. Scott asked me what I would like to see in environmental health practice. Earlier that day, I'd given an update on the activities of the CDC Environmental Health Services Branch and then made my Invisible Profession presentation. During various state affiliate presentations I had been challenged by questions on whether marketing efforts for environmental health could be successful if environmental health remained within public health. I had also been challenged to rethink our definition of environmental health to include environmental protection. So, in answer to Scott's question, I said, "I would like to see your department replicated across this country"

Scott has been a visible leader for environmental health in his community for many years. He is a public health professional of the highest caliber and has routinely pushed the envelope in environmental health practice. I first visited his community many years ago to talk to his staff about the chemical right-to-know program in Ann Arbor, Michigan, because his community was aiming to expand a fledgling pollution prevention program. On the first evening of my visit, a very cold and snowy Nebraska night, there was a community stakeholder meeting with hundreds of people in attendance. The excitement in the room about the work of environmental health and other public health programs, in conjunction with other community programs, was very evident. Invisibility was certainly not a problem in this community!

The programs conducted by the Lincoln Lancaster environmental health division have steadily improved the core traditional programs such as food service, onsite wastewater disposal, water wells, and vector control. The programs have also pushed for improvements based on sound epidemiology and an increase in community support.

The Lincoln Lancaster environmental health division is different from many other progressive environmental health programs because the department has continually added environmental protection activities in its mission to better serve the community. In 1970, the creation of the U.S. Environmental Protection Agency (U.S. EPA) forced an artificial separation of environmental health and environmental protection in state and local programs. LLCHD has systematically sought to bring those worlds back together, because in the mind of most community members, there is no logical separation when the environment impacts human health. Furthermore, when community members have concerns about environmental issues, they usually want answers at the local level. Perhaps this broader, more complete definition of environmental health is a key to success in marketing our field.

The environmental health division in Lincoln Lancaster County performs environmental protection activities such as granting and monitoring permits under the Clean Air Act. The division also monitors chemical wastes in industrial and commercial settings and has set up collections for household chemical wastes. The division's activities have been extended to allow the LLCHD to comment on land use decisions about where hazardous materials are stored and transported in relation to housing, schools, and other community centers. The department is heavily involved in storm water runoff, National Pollutant Discharge Elimination System (NPDES) permit review, and preventing accidental releases of potential contaminants. In addition, staff is involved in the community hazmat team in regular emergency responses.

I could say more but this column has a word limit! Let it suffice to say I would like to see well-developed environmental health and environmental protection functions reunified, especially at the local level. A broader definition of environmental health that includes environmental issues is probably easier to "package" and explain in a marketing campaign. The LLCHD example shows this can be done within a public health framework. At the federal level, there is an ongoing collaboration effort between U.S. EPA and CDC/Agency for Toxic Substances and Disease Registry, which exemplifies the reunification of environmental health and environmental protection to better serve communities at the local level.

I also realize, however, that in some communities, particularly in the western U.S., there has been what I call a divorce or separation of environmental health from the traditional public health agency. In many of these departments there has also been a reuniting of the traditional environmental health functions with environmental protection duties. In California, for example, many of the counties have a full array of traditional environmental health functions, but they also have responsibility for many of the environmental protection programs dealing with chemical wastes, underground tanks, emergency response, and so forth. As I mentioned in a previous column about financing programs, these efforts are frequently totally fee funded. The strength of this model is that the environmental health directors have formed a peer group separate from the public health directors. This allows them to lobby directly and improve visibility within the state legislature for environmental health and protection issues. In a public health model, environmental health issues often get submerged beneath the more pressing medical issues. Two weaknesses of this model compared to the LLCHD model, are first, grassroots community support is often not as strong, and second, community environmental health assessments are unlikely to be conducted in a fees-for-service setting. Additionally, in a changing world of threats such as a pandemic flu outbreak and bioterrorism agents, it seems logical to have very strong ties back to other public health disciplines.

So, how could environmental health set itself up for marketing success? A more complete definition of environmental health to include environmental protection would probably assist in attracting a target audience of young people into the profession. I believe that once attracted to this field by a more logical and complete definition of environmental health, this expanded practice would also serve to retain those individuals, meeting some of the workforce issues I mentioned in earlier columns. I believe it would also meet the needs of marketing environmental health issues to the target audience of policy makers, as in California. Also, the third main target audience, the general public, would be better served by the reunification of environmental health and environmental protection, because at the grassroots community level, many do not understand the separation in the first place.

In this column I have presented two models for an expanded view of environmental health, one which is practiced within and one which is practiced outside of a public health agency. I end this month with a question: Are there any other models that need to be considered?

Robert G. Blake

Rob Blake M.P.H., R.E.H.S.

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