Introduction to Environmental Health and Policy

This is an unedited transcript.

0:05
Hello, and welcome. I am Kathryn Martucci, director of Policy and Programs at the Alliance for Health Policy.

0:13
For those of you who are not familiar with the Alliance, welcome, We are a nonpartisan resource for the policy community dedicated to advancing knowledge and understanding of health policy issues.

0:26
We appreciate you joining today’s briefing, Introduction to Environmental Health and Policy, and we’re excited to be looking at this issue today. It’s a vast, highly interdisciplinary field within public health. And the field extends beyond analysis of the natural environment, investigates where you live, what we eat and drink, how and where we work, and the relationships we have with other parts of our ecosystem. So really looking forward to hearing from our esteemed panelists today. I also want to thank our generous partnership with the National Institute of Health Care Management Foundation, NIHCM, and Foundation for their support of today’s briefing.

1:10
Then we’d also really like you all to get involved. So, you can join today’s conversation on Twitter, using the hashtag all health lies.

1:19
And join our community at all health policy, as well as on Facebook and LinkedIn, And then please get involved in the Q&A section as well. So, you should see a dashboard on the right side of your web browser that has a speech bubble icon with a question mark.

1:38
You can use that speech bubble to submit questions you have for the panelists, and anytime will collect these and address them throughout the broadcast. And you can also chat about any technical issues you may be experiencing.

1:53
So now I’d like to introduce our moderator for today’s event, Kathryn Santoro, Director of Programming at NIHCM. She joined NIHCM, in 2004, and currently leads the organization’s Health Policy Portfolio.

2:08
In this capacity, she conducts research and analysis on health policy issues in support of improving practices used by healthcare decision makers and industry leaders. In 20 19, Ms. Santoro completed the Emerging Women Executives in Healthcare Leadership Program at TH Chan School of Public Health at Harvard University. And she received her Master’s Degree in Public Policy and Women’s Studies from the George Washington University and graduated with a Bachelor’s Degree in Political Science and Women’s Studies from Villanova University. So, glad to have you here today, Catherine. I will turn it over to you.

2:44
Thank you, and thank you to Sarah Dash, Kathryn, and the Alliance team for convening this important discussion today. Your webinars are a valuable resource to decision makers.

2:56
Before we move forward, I want to briefly set the stage for our discussion today.

3:01
All Americans deserve the opportunity to live and halsey environmental conditions, including fair and equitable access to clean air, pure water, healthy soil, and quality food.

3:14
Yet more Americans are being exposed to environmental health hazards than ever before.

3:20
and these risks are unevenly distributed, creating new inequities, and exacerbating those that already existed.

3:28
… Foundation recently released an infographic on the impact of the changing environment on human health, and this slide outlines some of these hazards.

3:39
The new infrastructure law will invest 350 billion to address long ignored environmental threats, and we know we need to devote more resources to places that are facing the greatest threats.

3:52
A foundational knowledge of environmental health as a field helps us think about more challenging and complicated applications of policy, such as trying to mitigate climate change and its effects on health.

4:08
Let’s dive into the basics today so we know where our barriers and facilitators lie across stakeholders.

4:15
I’m now excited to introduce the panelists who will be joining us for today’s briefing.

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Our panelists full biographies are available on the Alliance website.

4:24
First, we’re joined by doctor Keshia Pollack Porter, Vice Dean for Faculty and a Bloomberg Centennial Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.

4:38
In addition to these appointments, Dr. Pollack Porter also directs the Bloomberg Scores Institute for Health and Social Policy and as part of the Leadership team at the Hopkins Center for Health Disparities Solutions.

4:51
Doctor Pollack, Porter is a health equity scholar, studying active play, an active transportation, safe environments, and then the access of transportation and health.

5:03
Next, I’m pleased to introduce doctor Lynn Goldman, the Michael and Laurie Malkin Dean, and professor of Environmental and Occupational Health at the Milken Institute School of Public Health at George Washington University.

5:18
Doctor Goldman was previously the Assistant Administrator for Toxic Substances at the US Environmental Protection Agency, where she directed the Office of Chemical Safety and Prevention, and Chief of the Division of Environmental and Occupational Disease Control at the California Department of Public Health.

5:38
She is or a sub recipient of the Heinz Award for Global Environmental Change and the American Public Health Association Environment Sections, Palmer and Calvert Award.

5:51
Finally, we are joined by doctor Richard Jackson, Professor Emeritus at the University of California, Los Angeles Fielding School of Public Health.

6:01
A pediatrician, doctor Jackson has served on many leadership positions within the California Health Department, including the HIAs as the State health officer.

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For nine years, he was Director of the c.d.c.s National Center for Environmental Health, and received the Presidential Distinguished Service Award.

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He’s received the hero award from the Breast Cancer Fund, Lifetime Achievement Awards from the Public Health Law Association, and the new Partners for Smart Growth, John hynes word for national leadership and the environment, the … model, the highest Award of the American Public Health Association. I’m so honored to be joined by this esteemed panel of experts today will begin with some opening remarks from each of our speakers and then turn to your questions.

6:53
Doctor Pollack, Porter, let’s start with you.
6:59

Great.
6:59
Thank you so much, Katherine. I really appreciate the kind introduction, and I want to welcome all of you today. I thank the Alliance for inviting me to be part of this panel, and I’m thrilled to share the stage with my colleagues.

7:13
You can go to the next slide, please.

7:17
In my opening remarks today, I’m just going to chat for a few minutes about health equity. I’m a health equity scholar, and how that connects to environmental health. And just leave you with a few comments that I hope we’ll be able to unpack a bit during the Q and A at the end of all of our comments.

7:37
I encourage you to reach out to me via e-mail if you have questions after today, or also feel free to send me a note via Twitter.

7:46
Next slide, please.

7:50
Whenever I start comments like this, or presentations like this, I like to lean in and remind us all about the various sectors that influence health.

8:01
As Kathryn explained during my bio, I’m a health equity scholar, and I’ll define that in a moment just to make sure we’re all on the same page.

8:08
But, in the context of today’s topic, when we think about environmental health, I want to emphasize the important role that many sectors have on what impacts our environment. And that environment can include where people work, where they live, where they learn, when they play, where they pray. And what you see in this image is health is right in the center, and it’s connected to a number of sectors and areas of society.

8:35
So, for example, as Catherine shared, I, in my bio, I do some work in the built environment and transportation, while we know the important role of public transit and active transportation when we think about the environment.

8:49
And I’ll come back to that as well.

8:51
We know the important role of a fair and justice system, A fair justice system, when we think about health, or about green, and sustainable development, or about the schools, where, where people are attending are a number of different elements.

9:06
And the important thing to remember is as we think about environmental health, and how to improve environmental health, is that many decisions that are made in these other sectors impact our environment, impact the health of the environment, impacts our population’s health.

9:22
Why this matters is that these sectors don’t have often don’t have in population health or positive health or good health as their number-one goal.

9:31
I work a lot with transportation planners, who, of course, want to ensure people move safe from point A to point B, but are oftentimes moving forward their actions that get people efficiently from point A to point B So, what we have in public health are a number of tools to help us think about how decisions in these other sectors can impact health. Next slide, please.

9:54
And why this matters is because I believe health equity is critical for this country, and when I say health equity, I’m referring to everyone, having a fair opportunity to live a long and healthy life.

10:08
And although we’re focusing on on US Context, I also want to acknowledge the importance of health equity for populations around the world.

10:17
And why we, why I think health equity matters is, and why, and how I define health equity, is that we’re talking about ensuring that every single person. As I just said, Well, whether you, where you were born, your zip code, where you live work, learn, play, pray, you have the opportunity to be as healthy as possible.

10:36
And in order to achieve health equity, we have to remove obstacles to positive health, and that includes obstacles such as racism, poverty, discrimination, lack of access to good jobs to healthcare. All of those images, those sectors that I just showed you in that prior slide, are really important for us as we think about how to improve health.

10:58
Next slide.

11:01
one of my areas of expertise is something called Health in All Policies. You may be familiar with this term, or high app. I know my colleagues on this panel are familiar with health and All Policies, and I mentioned health and all policies, because I think this is a real opportunity to advance. There’s a real opportunity to advance health in all policies and advanced population health and address some of our environmental health drivers, high, up, or health and all policies is a collaborative approach.

11:28
It involves working across sectors and systematically taking into account the health implications of decisions to improve population, health, and well-being and health equity.

11:38
Health in All Policies is a data driven approach. So, this really involves relying on data from various sectors to understand how decisions that are made and transportation or housing can affect health.

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Health in all policy also refers to systems level change.

11:55
Health and all policies seek synergies, and involves collaborations, and it’s really important as we think about the potential implications of decisions so that we can improve health and health equity, so we can improve well-being.

12:08
So, if we go back to that image I shared, when I first started my comments.

12:13
We can use health and all policies, strategies, or strategies to advance health and all policies to ensure that the decisions we’re making can support positive health, can reduce or mitigate the opportunities to harm health, and can also be used to help support health equity.

12:31
Next slide, please.

12:36
There are a number of strategies to achieve health and all policies, and here are just a few of them on this slide. There are many examples of cross sector government structures that have been created in Maryland. I’ve been part of of of one at the state level and also one at the local level in Baltimore City. California’s Health and All Policies Task Force, is probably the most widely known that we have in this country.

13:01
We’ve also seen examples where health has been integrated into planning processes.

13:06
So for example, the zoning code update or zoning updates broadly, You know, in a municipality, you can imagine efforts to increase how health is considered in these efforts, or and also a general plan that’s being updated.

13:21
There have been efforts to integrate health language into requests for proposals, or using health related grant scoring criteria as decisions are made about who receives funds. Will those funds actually promote health or not harm health?

13:36
Finally, there are tools out there, tools like Health Impact Assessment. You may be familiar with Environmental Impact assessments or Environmental impact Review. There are many of us in this country who are HIA practitioners. And we look at proposals. That can affect health broadly and determine how health could be impacted if that proposal moves forward into a decision with the goal of trying to promote the aspects of our proposal that can support health, and also to mitigate the ones that can harm health.

14:07
I also helped create a tool called the Health Note, which applies the same concept, but for legislative proposals. And I’m really excited about what we’re doing with legislatures across the country.

14:18
Next slide.

14:20
I want to just end my time today by just lifting up a few areas where I think we can really lean into environmental health and all policies consistent with what I’ve talked about today, which really involves collaborating across sectors.

14:34
So you’re gonna hear more about examples in the environment that relate to some of the areas up on this slide. So, for example, housing policy, I think there are many examples where we can think about reducing falls or thinking about lead in homes, and these are important examples of how we can see environmental impacts of housing policy.

14:56
Or if we think about food policy, and we can look at the devastating impact of climate, climate change on farming, on agriculture, on thinking about workers and worker health. As we think about changes in ambient air, and extreme heat, and other extreme weather events, clearly making food policy and environmental health issue as well.

15:18
Earlier, when we started today, Kathryn mentioned clean water. We can think about what our policy and examples, Of course, that came out of Flint, Michigan, showing how water policy is an environmental health policy.

15:29
And finally, in the work I do, around transportation policy, I would be remiss not to mention the Federal Infrastructure Bill where we see tremendous opportunities to amplify considerations to improve environmental health, improve population, health, and health equity, as we think about how we are redesigning communities, the things like smart growth policies and complete streets and safe systems. As we look to promote safe walking and biking for individuals all to improve health, again, reminding us that all of these policies can also be environmental health policies.

16:03
So with that, I will wrap up my time, my opening comments. I look forward to our questions and answers at the end. Thank you.

16:11
Thank you, doctor Pollack, Porter, and now, I’ll turn it over to doctor Goldman.

16:19
And hello, everybody. It’s my pleasure to join you, and thank you so much to doctor Pollock’s, wonderful opening remarks. I can have my next slide.

16:29
So, um, environmental health policy. Next slide.

16:35
To give kind of a general overview, I always start with a definition of health care mind.

16:41
Us all that it’s health is not just about physical well-being but also mental and social well-being. And it’s not just about the absence of disease or infirmity.

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Next slide.

16:54
Environmental health, and advance the slide. three more text has differences from other areas of health policy, in that we’re working on establishing healthy, livable environment for humans, but also other species.

17:09
That we want an environment that improves our well-being, and high quality and mental health, as far as physical health, And we want the environment to be sustainable for the future.

17:20
Yet, we have, as a society, a desire to continue to have population quoth to have manufactured, to have agriculture. And there’s a lot of tension there between sustainability and growth that we’re always dealing with.

17:35
Next slide.

17:38
So, as doctor Pollack very eloquently said, environmental health is a very complicated beast. and I actually simplified what she presented.

17:46
And that it really, it’s, it’s components of the natural environment that we need to maintain our health, the built environment that can include our homes or buildings or transportation systems, but also our social environment, How we deal with the environment, whether at a very high level politically, or right down, at the level of our own behavior, in terms of how we use environmental resources or contribute to the environment.

18:14
Next slide.

18:17
So, I would be remiss if I didn’t point this out, that environmental health has been responsible for the major gains in life expectancy that we have seen in our own nation and worldwide over a number of years. And so, for a very long time, life expectancy actually was fairly low in the mid thirties.

18:41
Why? Well, there wasn’t a lot of biological pressure for living longer than that we reproduce.

18:46
We can even have grandchildren by the time we’re 35 or 36 years old, But we saw, in the middle of the, between 851,900, a steep rise in life expectancy. That didn’t come about because of healthcare. That did not become about because of drugs. That came about because of basic environmental protections, and has continued mostly Thursday, although we’re beginning to see a fall off.

19:14
We also see in terms of what doctor Paulette said, that there continue to be inequities across the world in the access to these benefits, these environmental benefits among people across the world and that in Africa, in fact, in Asia, there is less life expectancy than in, in, in the America and in Europe, and the Americans have been falling behind Europe a little bit, which has not been a good thing. Next slide.

19:46
Why has life been prolonged over this time?

19:49
Much of that has been due to environmental factors, like sanitation that reduces deaths, especially among infants, better food, more nutritious and safer food cleaner, air reductions in air pollution, but many other things as well.

20:04
Improvements in how we take care of mothers and infants, of course, immunizations eventually into the 19 hundreds of antibiotics and other interventions, including health care, which certainly contribute, but to a far more minor extent than actually improvements in the environment.

20:24
Next slide.

20:26
So environmental policy there are a number of really important principles. And this is very different than the rest of health policy.

20:34
And you already have that from what doctor Pollack told you that we need to be looking at health and all policies.

20:42
That isn’t true for all of health policy. But in environmental policy, that is true, because anything that we do that impacts the built environment impacts the natural environment can impact our health.

20:54
And so, but prevention should be the tool of first resort cleanup, is a tool of last resort when we pollute the world, we often can’t clean it up. It is not efficient to try to clean it up. And we certainly don’t want to be putting persistent toxic substances X lead or the pelvic floor needed chemicals, other chemicals that we can clean out of the environment into our environment.

21:22
Environmental justice, fairness, equity, doctor Pollock, very well to discuss that children’s health and inter-generational equity how we’re impacting the health of future generations, either thing in health impacts on children or is it a problem with climate by putting in place processes that are going to leave our children, our grandchildren and our great grandchildren with a much worse future protection of ecosystems and communities.

21:54
That isn’t enough to deal with environmental policy one pollutant at a time. We have to think about the health of the entire system.

22:03
And then there are considerations of cost and effectiveness of our expenditures and bouquets a fundamental principle being that the polluter should pay and why to disincentivize the pollution and because of the principle of fairness and equity.

22:21
So next slide.

22:25
Policies operate at multiple levels. And again, this is very different than a lot of health policy. But environmental policy is a very complicated thing.

22:34
There’s global issues like climate, pollution, and persistent pollutants or national level issues like control of air pollution, registry of chemicals and pesticides, dealing with clean water and waste standards across our borders. There are state and local, specific issues.

22:52
But there’s a lot of non governmental policy, such as E S, T policies, environmental, social, and governance policies that corporations and other companies need to be following. And then, even at an individual level, we have policies, How do we use energy in our household? Do we recycle our consumer choices around how we are impacting the environment?

23:16
that’s life?

23:20
So the Planet Earth is itself of a large and complex system. But it’s a far more fragile system than we have realized. And increasingly, environmental policy is focused on planetary health, the health of our entire planet. How do we assure that and how do we do that in a way that is fair and equitable for everybody who lives on the planet?

23:45
Thank you.

23:48
Thank you, doctor Goldman, and next, we will hear from doctor Jackson.

24:00
Might still muted. Miko?

24:06
We can hear you.

24:08
OK, thank you.

24:09
Go ahead, it says Using O All right.

24:15
Let me have the next slide, please, and thank you for the lovely introduction.

24:19
And you’ve already said things so, and I’ve been very focused on built environment. That’s not what I’m going to talk about today, because I want to go through a concrete example of a important success story. Next slide, please.

24:32
Lynn, show WHO Definition of Health well-being.

24:37
Overall, I’m going to talk about the fact that public health really needs to assure conditions where people can be healthy. I somewhat disagree with Keyshia slide because I didn’t like public health sitting aside from everything else.

24:52
It really is encompassing within health of the whole thing that you’ve showed keyshia. Next slide, please.

25:01
When I started medical school, I did a rotation at Mount Sinai in New York and I went on the ward. And I was, I was only a first year medical student. I asked the attending there were about 20 little kids running around hyperactive as could be in some way or they hear they looked fine. He said they’re being …

25:19
for lead poisoning and he took me down the end of the hall and there was a baby.

25:24
Convulsing who eventually died of lead poisoning and every year in New York and in Baltimore and other major cities. We had killed about 10 children a year, dying of lead poisoning.

25:34
We thought anything under a blood lead of 60 was perfectly fine, and I actually got my blood lead done. And I was an average American. I had a blood lead of 22.

25:44
Next slide, please.

25:46
So, and I remember talking to Members of Congress and they thought, Well, lead can’t be bad for you, because I have led in me and my brain and muscles and the rest of my body. But really where we were seeing most of the damage from lead poisoning. And you know, this was particularly an old housing.

26:01
We use an enormous amounts of lead in paint, about £2 per capita between 802,940 every year. You imagine taking a highly toxic material then painting, friction surfaces, windows, doorways.

26:15
And frankly, putting him exactly at the mouth level of a little child wandering around, there were so many lawsuits that pediatricians were involved in where a landlord would be sued and the defense in those. Lawsuits was those children are being poisoned because of bad mothers and the subtext of racism was very evident on that as well. Next slide please.

26:38
So, about £2 per person. Next slide, please.

26:43
And lead was present in our water. When I was a child, a typical baby formula was evacuated, milk mixed with water and all those cans. Food cans were sealed with lead solder. Next slide, please.

26:57
And the lead industry, particularly whereas the pediatricians raised more and more attention to the fact that lead was bad and children went to a whole rebranding strategy, which frankly has been used by the tobacco industry and the sugar industry and others. And this when they took what they are most afraid of the hazards to children, and invented the Dutch boy and beautiful paints of a child painting his hobby horse and the rest cater to the children. Next slide.

27:26
Well, by about the late 19 thirties, the using lower quality gasoline, meant that the compression on high compression engines wasn’t as good.

27:36
So, it was discovered that Tetra Ethyl lead is Tetra Ethyl bonded with lead could make gasoline noch less and they could improve the octane rating of gasoline.

27:50
I always find this amazing 2.5 grams of basically elemental lead in a in 12 gallons of in each gallon of gasoline, which meant if you filled your car with account 12 gallons of gasoline.

28:06
You put in the equivalent of one fishing, sinker one ounce of lead in there that’s going to be burned it thousand degree temperatures and then spewing across the environment next week.

28:21
So used enough leaded gasoline that, for example, most states, about £4 per person of lead was putting gasoline every year, about £6 in Texas. Next slide, please.

28:37
And as lead went down in paint because of the concerns about that, lead was going up in gasoline. And the problem, as I said, felt insurmountable. Next slide, please.

28:50
And one of my heroes is Herb Needleman a pediatrician and psychiatrist who was asked to see children who were behavior problems who were having difficulty in school weren’t learning well who were hyperactive needed A very simple test of children now years after being led poison and could shows their reaction times were slower than children who had not been led poison. So, he received funding. Next slide, please, too.

29:17
Um, and next slide, please. Sorry.

29:21
He received funding.

29:23
two.

29:24
Do a study looking at children who now are 67 years old, look to be fine.

29:29
And the reason we focused on kids and Lynn was a major leader, particularly around pesticides and food. and the fact that children eat, drink and breathe 2 to 3 times as much as adults do. When behaviors are significantly different from adults. Children are not little adults.

29:45
Next slide, please.

29:49
So doctor Needleman study that came out shows that, when they got the children’s teeth, that are a reflection of how much, this is baby teeth that they then shed. The lead in their tastes was a reflection of how much lead they had in their bodies.

30:05
In the first couple of years of life, then did separate interfuse blind interviews of the teachers about children’s behavior. Next slide, please.

30:13
We see that the children who had more increasing levels of lead in their bodies, functioning at lower levels, next please.

30:27
This led to the push of really trying to protect children. But the other thing we need to do, and this is one of my big themes here, is when you do things to protect people, you can protect the environment. And when you do things to protect the environment, you can protect people.

30:41
Los Angeles and you all know, California has more stringent air pollution and other kinds of regulations and the rest of the United States.

30:48
In part, because there were slightly exaggerated, there were children grew up in Los Angeles, didn’t know it was surrounded by mountains.

30:55
The air pollution was so bad you couldn’t see a block in the early 19 sixties because of air pollution, nitrous oxide, and other pollutants. Next slice.

31:04
And so the California Air Resources Board and working, really superb scientists develop the catalytic converter that would destroy oxides of nitrogen and other oxides. But it use very valuable metals to destroy them.

31:17
But you could not put leaded gasoline on a car that had a catalytic converter because you destroyed that thousand dollars catalytic converter.

31:25
So that was the beginning of unleaded gasoline and the demand you could not sell a car with unless it had unleaded gasoline. And they changed the nozzles going into the car, that you can only put unleaded gasoline into it. This led to the phase out of gasoline in California, which is about 18% of all the cars sold in the United States and completely changed automotive use. In the US. Next slide, please.

31:51
So as you can see, the green line was lead going down in paint, and the blue line was Lead going down and gasoline, so back when it felt so insurmountable.

31:59
And we were seeing so many children likely dying of lead poisoning.

32:03
We’re now down to virtually no leaded gasoline by the year 1890.

32:08
Next please.

32:13
lead that long term damage. And this is work done by Joel Schwartz and others.

32:19
Every time you, your blood lead goes up, 10 points, you have an average IQ loss of about 2.5 points. So, I had lost over five IQ points for the rest of my life, because of my blood lead of 22, back in the day, and we all did.

32:33
So think about the burden to society, and I got thinking about this. And we began to do a paper about the overall burden to society, partly because being in front of Congress, they always want to know about costs. Next slide.

32:47
And the average cost per the benefit of one IQ point more, is about $15,000 of lifetime income.

32:58
You have a good IQ, you stay in school longer. If you stay in school more, you earn more money. It’s a very rough number. I know IQ was biased in certain ways, but it’s a pretty good predictor of lifetime income, about $14,000 of IQ points, for the rest of every year of your life, next, please.

33:14
So we did an estimate and about, we came up that, about, every eight years, babies, accumulated an additional 200 plus billion dollars of lifetime income by not having lead in their brains and bodies. It’s not good for your heart, kidneys or elsewhere as well. Next.

33:39
And so this data was extraordinarily important, too.

33:43
Lead to we, I went to Russia, and I was health and environment representative for Vice President Gore at the time. And we did lead testing on both the vice president and the Prime minister of Russia, and show that Americans were showing much lower levels of lead.

34:00
Same work went on in China as well, and those efforts led to removal of lead from gasoline in Russia, in China, and ultimately, countries around the world. There’s still some used, but that’s the big step forward. Next.

34:18
So, where I’m going with this is everything in environmental health is about money. It’s about politics. It’s about large policy, it’s about vested interests.

34:30
But if you tell the right story, and you really focus on the people who are most impacted, namely, future generations, we can really do a great deal of good. Let me stop there.

34:42
Thank you very much.

34:46
Thank you, doctor Jackson, and all our panelists for your insights. I’m excited to jump into conversation now, and invite everyone to turn on their webcam. So, our first question of follow up for doctor Goldman, you mentioned several times that environmental health policy approaches are very different than traditional health policy. Why is that, and what are pros and cons of these differences?

35:15
Well, I think the reason for that is that we’re not just concerned with how health care is delivered and how we reimburse providers for that, and, and, and do, you know, health information, manage, manage, know, healthcare delivery.

35:36
We’re not just concerned with how we get to individuals and get them in for immunizations and screening, and taking care of their clinical prevention needs, We’re concerned with nearly every aspect of what society does. And so there, because there can be profound impacts on health, as doctor Jackson pointed out, it’s the simple things as we paint our homes, what kind of housing policies we have and what we use to fuel our automobiles.

36:04
And so, in a sense, we’re getting our fingers into all kinds of corners that a lot of people don’t think we belong in, whether it is it is the corporation to make those products are are profiting from those technologies. Or even, you know, some of our other colleagues in government, such, as other parts of the Federal government, the Department of Energy charge, you know, of a fuel, and, and how the fuel is used in.

36:34
And so we have to figure out how we can collaborate with people across a number of disciplines, but we also have to build political work.

36:43
And this is much of what we’ve seen as the problem with climate and health in the we really haven’t done the greatest job, and building support from the public, for the myriad of things that we in environmental health have to be engaged with in order to make the world safer for all of us and climate.

37:04
So, the, it is, it is different.

37:07
And then, the last thing I would say, and I think doctor Jackson gave a great example of this with doctor Needleman in the lead industry, When we’re dealing with the coronavirus, there isn’t a coronavirus industry that’s making the coronavirus and putting it out there and making money off of it. You know, we’re ******* hard as hard as we can.

37:29
And you can look at how hard it is to do public health, even without that.

37:33
But just like if there were one like the lead industry, and if they were, Look at all the misinformation, we already have this because people don’t want limitations of the activity, they don’t want mass, they don’t want to get a vaccine. Summer course, It would be if there were a coronavirus company, like the lemon industry, used to be putting out information deliberately. We deal with that in environmental health, all the time.

38:03
Thank you.

38:05
This question is, for any of our speakers. Can you help us understand how the states and the federal government, and are asked to establish a law and regulations in this space, as well as how funding federal funding is allocated to states and localities.

38:24
This is, Dick. I’m just jump in, and I’ll talk about it from CDC, and maybe I’ll defer to lean on on from EPA.

38:32
No, data collection Infections, and everything’s is done by the states and it resides with localities.

38:39
And I was the head of infectious disease in California.

38:42
We had two California I’m sorry, the state paid us to deliver our tuberculosis and other kinds of the federal’s paid us to deliver that data. And we really need a unified data collection system that’s funded across all of them. And the states that had real infrastructure could attract a lot more federal funding or grant funding than the states that did not have it.

39:06
So it tended to really leave out more and more localities away it said.

39:10
And I think we need a much more blanket kind of funding all the way across.

39:14
So we don’t always reward those who have the best consultants, access to data and other systems.

39:27
Great. Thank you. A little bit. I get a little bit to that.

39:32
And so, no.

39:33
And another way to understand the federal state relationship is, it goes back to our constitution.

39:41
And that is that all things that are not specifically delegated to the federal government are the responsibility of the states.

39:49
So the states have tremendous responsibilities.

39:54
I mean, I’m aware of day to day, be fair, in restaurants, or is the food safe? Is that environment safe?

40:01
The federal government has nothing to say about that kind of thing.

40:05
Even even drinking water to some extent, is it’s handled by states.

40:11
And, and yet, there’s also the inter-state Commerce Clause, then, is what has enabled the federal government to set federal rules.

40:22
And why it is that the federal government can keep our ears safe, is because air crosses state borders. And it’s just been even, that doesn’t sound like commerce it kind of legally is so that there is a lot of tension around this, and particularly today with the courts.

40:38
The conservative courts are increasingly moving away from providing the federal government with the authority that it has traditionally had to do environmental regulation and increasingly seeing this as a, as a prerogative of the state.

40:56
And so that is something that we are theme for leave out in real time with the litigation that’s before the Supreme Court about the Clean Air Act and the ability of EPA to regulate climate gasses.

41:10
It is true that almost all the science is supported by the federal government, whether it’s at CDC, or the NIH or the EPA. But that money then flows, you know, to states for can flow to universities.

41:23
And that’s another really important point of leverage, is if you can’t do the research, if you can’t do the studies, and if all of the data are coming from industry, then you can’t have that objective view of what’s actually going on.

41:38
Can I just supplement that a little bit?

41:41
one is the positive is the states or the laboratory for a lot of federal policy.

41:45
So oftentimes, the, the policies are really being developed in the state, that’s a positive.

41:50
The negative for the States is many public health folks serve at the pleasure of the elected officials, and you say something that somebody doesn’t want to hear, and you’re out in the next three rows ranks below. You are out. And funding can often be cut unless there’s an emergency and then they blame the people that not doing enough, That’s already been cut. And then they give you an infusion of money, but you don’t have the infrastructure to deal with it. So, the states have a lot of problems here.

42:17
Yeah, Maybe I could just add one thing, in terms of the work I do with ….

42:20
Transportation, I would just, I wanna just echo the points that, that Lynn Invictus both made about the important influence and importance of implementation, right? So if we think about where the money’s flowing from the federal government to states to universities, I mean, there’s a real opportunity for all of you to influence implementation, how are those dollars actually being used on the ground? Certainly, politics comes into play and power and other issues, but I just want to name that so much of what happens with those dollars are actually happening down in the communities where we live in right up the street by our city council, the IIRC officials.

42:55
Absolutely right.

42:59
Thank you.

43:01
What opportunities, what the build back better if it passes and the infrastructure law offer to make progress on environmental health? What was missed and also how do we track FTEs? Federal investments are being delivered to the disadvantaged communities that need them the most.

43:21
The two people in DC should answer this one.

43:24
Mean, I think that, I think that Kisha said some of it before. But I would double down on what she said. Which is, that, as these conflicts are rolling, or for environmental health to be engaged.

43:38
And to make sure that the impacts are positive.

43:41
A thing that I felt was negative is that some of the elements of the bill that would have required more public health and environmental review were not included in the final bill, but that doesn’t preclude people from using, you know, the environmental impact analysis and other try to make sure that’s happening.

44:06
I think that requires mobilization of a lot of people, to make sure people in local communities are getting engaged and are able to participate.

44:17
Um.

44:20
Yeah, and maybe I’ll just add to Lynn’s comments. I was just jotting down a couple of things related to today’s conversation. Certainly, the Build Back Better Act has provisions for combating climate change and increasing affordable housing things that matter for environmental health.

44:36
And I would just say in terms of things that were missed, as we all saw that bill moving forward, and even what happened with the infrastructure bill, there were negotiations. Right? There were things that didn’t make it in the bill. And so, I would just say that there’s a tremendous opportunity to do even more to really address the inequities that we have in this country to continue to advance policies and programs that create conditions where everyone can thrive. And so I think that there’s opportunities there, but certainly a start, and we’ll see where things end up specifically with the build back better.

45:14
Great. Thank you.

45:17
Policymakers often do not consider environmental health to be an essential service. What are the opportunities and challenges with this framing? And how do we address potential workforce shortage issues in the field of public health and environmental health?

45:35
I’m going to just jump in.

45:37
one is, policymakers do not consider environmental health until they’re really in trouble. And then all of a sudden, it’s the most important thing of all. And I can go through story after story, where even Jerry Brown, as governor, sort of pooh poohed this stuff. And then, all of a sudden, bed flyer, …, or other things hit. It becomes right to the four. It makes me think about it.

45:57
How many investigate epidemic investigations this’s back more infectious disease, where people you’d show up to investigate it? And the first thing people will tell you is there’s nothing here.

46:06
Go away, and the same thing happened with meatpacking Plants and Corona virus and other such things.

46:14
So, you know, I think one is, you’ve just gotta have the. pipeline, I am very unhappy with NIH. That they’re only putting about 0.05% of their budget into climate, And I know that will increase, but they’ve got to step up, and do a lot more, because you have to have the pipeline of people. And no young scientist or Physician is going to go into this, unless they are worried about their debt from school.

46:37
They’re worried about their security over time There has to be a stable funding stream, and people are so essential, and we over and over again. Politicians love to stand next to the bright shiny object and say, hey, I got the money for the supercomputer.

46:51
But the more important thing is, I got the money for these hundred future leaders, that is really the thing that counts most, in my opinion.

47:03
I mean, I would say, also, Kathryn, we need to identify and work with the politicians who do care, and do what we can to provide them with the support they need. Because these areas are highly technical.

47:16
And I’ve worked on a lot of legislation in my career, in, you develop a trusting relationship with politicians who care. They can become really, incredibly strong allies. But you have to be patient, because these things are far more complicated than we realize. once we get involved in an area like this.

47:38
We couldn’t get so wrapped up in it. We don’t even understand the extent to which other people don’t necessarily understand everything we’re saying. And I think that’s even true of community members that I’ve worked with. They get so good at understanding the science and everything, that, at some point in time, even, they don’t understand, you know, the extent to which people actually need help, even if they have good intentions.

48:00
But the thing that’s been disturbing, and I think, you know, we’re working with politicians, but it’s really the constituencies that are important that, you know, the politicians are under tremendous amount of pressure by companies, by industry, their local chambers of commerce, Whoever it is to do things that are very anti environmental, I’m just gonna say it that way.

48:24
And they really are, And yet, the public cares about the environment.

48:29
And the public needs to manifest that care in how they flow, and how they interact with their politicians. And we need to be spending more time.

48:38
I think, understanding how we communicate to the public and work with them, it shouldn’t be possible, at this stage of the game, for a member of Congress, to do a vote.

48:51
That is against either mitigating or controlling, you know, climate change.

48:57
It shouldn’t even be possible, because, I mean, that because that is such a devastating impact on our health, our planet future generations. But it still is.

49:07
And I mean, and people should be as passionate about that, as they can be about any other issue, and we haven’t succeeded in building that passion in the electorate. And I think that’s, that’s a real problem.

49:20
To be honest, not the politicians themselves, but the way that people really don’t vote on the basis of those environmental votes.

49:30
But people do contribute on that basis.

49:33
Could I riff on that? Just for us? I, when I was state health officer for California, I was directed by the Governor’s Office to meet with lobbyists on a regular basis. And I’ve probably met with nine lobbyists of one form or another.

49:45
Every one member of the public came and talked about what they were concerned about, And so, the key issue is much deeper on this, we need to figure out ways that we can support that kind of public advocacy.

49:57
Yeah, and I’ll just add, I mean, I strongly echo the comments and just really see a need for policy advocacy, and organizing, and really holding our leaders accountable, Right, Because even for people who say, Mike, I know I have a colleague, who talks about climate change and says all kinds of things, right? But, OK, fine, you want to, you want to say that that phrase doesn’t resonate with you. Well, the fact is, we can’t disagree with the fact that if we have way more days, that are over 100 degrees, there are places where they can’t access water, Right? So people are feeling it, As Lynn said, it’s impacting people’s lives. And, so, I think it’s, it’s up to us to, to hold our leaders accountable for making changes that are going to help every person be able to thrive. The other thing I want to see that I am concerned about is sort of the public health professionals in, both Lynn And Dick mentioned this, right? We know that, so many of our public health professionals are under attack.

50:52
People’s lives have been threatened particularly in the pandemic. I have a colleague, who’s been looking at this, Do some research on this. And, you know, when I talk to people who are there, are people who are now sort of thinking, well, do I want to go into a career in public health, and environmental health. When I know I’ll be attacked by talking about climate change. And I’m saying, yes, we need you. We need you to continue to be in this space, because it matters. It matters for all of our lives. So, I wanna name that is something to be thinking about as we look at the pipeline and our future generations, our Future leaders who might shy away because of what we’re seeing now in terms of the hostility towards public health.

51:27
I’m just going to echo one more thing. I’m teaching a class at Berkeley and a couple hours, and it’s the last class of the quarter, and one of the things I’m gonna close with is, I have never been bored for one minute doing environmental public health in government. And we said some of these negatives, but it’s meaningful work. And it’s very gratifying work.

51:48
Yes, and it’s important.

51:51
I’m going to second that. It’s a lot of fun.

51:53
And I talked about the downside of having to work with all these sectors, that it’s actually kind of fun, because you learn a little bit about a lot of things. And if you’re curious on how the world works. Boy, Environmental health can be incredibly gratifying.

52:08
And I would say, I’m not trained in environmental health, but as a health equity public health person, I welcomed all the time into the space, because we didn’t have similar goals. We care about similar issues, and have similar values. And so, I certainly agree, despite the challenges. I love what I do when I feel like we’re able to really make an impact.

52:29
Lots more questions to get through the next couple of minutes. But I think, doctor Goldman, you might have touched on this briefly in terms of mental health. But what do we know about the impacts of the environment on our mental health, including pollution? Doctor Paul Porter mentioned. Some of, you know, extreme weather events that have displaced families. What additional research do we need to help us understand that, and where, where we go from here?

53:00
We need lots more research.

53:01
So, I mean, we were involved at George Washington University with research on mortality after Hurricane Maria in Puerto Rico, and we weren’t even accurately fully accounting for all of the deaths.

53:14
Don’t even imagine that we understand what the mental health impacts of Hurricane Maria, or, for Adobe population. We do.

53:22
And the result is that we underestimate, we greatly underestimate the public health impacts, including mental health impacts that are being created, whether it is through the fires that we see in California, the storms, or the heat waves in Texas, the freeze that we had.

53:40
I mean, it’s hard to we really grasp the extent to which these these issues are impacting our lives.

53:49
If you live in an Alaskan village that can exist anymore because it’s sinking because the Permafrost, melted, That’s going to have a whole lot of mental health consequences on you and your family.

54:06
I wonder if I could just add one thing. The Term Health Impact Assessment sounds just boring as all ****.

54:13
The truth is that, when you see a clinician and you’re given bad diagnosis and you’ve got the choice between chemo, and radiation, and surgery, et cetera, you sit there and try and figure out how to optimize in a bad situation. And that’s what Health impact Assessment is. What we’ve done.

54:32
With impact assessments, we’ve made it all about consultants with thousand page documents, where they only really address health and about the last three pages. And if we really did a fair assessment of health, as we looked at impact assessments, we would really come out with longer term health, not immediate stuff. We’d come out with much better decisions, and one thing I’d like to see is the National Environmental Policy Act really not necessarily be re-opened but really applied to Health and a much more broad way, so we can make better decisions. And that’s your field fish. I don’t mean to step on the other.

55:07
No step in at all. I think that was well said. I totally agree with you.

55:11
And, And, you know, there are lots of Rapid Health Impact Assessments that are not these hundred page, 200 page, two page documents, but things that are shorter, that are targeted, that can really help to address the potential ways health can be impacted, and equity to. I want to lift that up as well.

55:28
And, you know, giving people more jobs and getting to work more easily And everything else. You might not accumulate that over one year, but you’ll accumulate over 50.

55:42
Another question from our audience is about the healthcare industry itself, being a major, major contributor to polluters, including hospital supply chain. And how we know some of this is necessary for safety reasons especially during the pandemic. What are some innovations to reduce the impact on the planet and their communities?

56:05
I mean, I just started out by what I think could be happening that isn’t happening at a federal level and that is that when we license healthcare facilities, a piece of that should have to do with their efforts to reduce pollution and including climate pollution. And I will tell you the people that I was at EPA and we were dealing with dioxins from incinerators. one of the most Obstreperous industries was a hospital. Let me say, they wanted to keep burning their waste. However, they wanted to burn it. There was nothing about that that made us safer, healthier, and so in a way they can behave like any other industry just wanted to take the cheapest path forward and whatever they’re doing.

56:50
I would also say, you know, what people who make devices and or who are manufacturing, various kinds of medical delivery items, much of that, is involving persistent chemicals and and harmful substances that do not need to be present in those products.

57:11
And we need an FDA that looks at that aspect that cares about the environmental impact of their decisions, because there are often many alternative ways of making these devices and products, and they don’t have to have highly toxic things in them like phthalates or, you know, various polychlorinated, chemicals and and other harmful substances.

57:34
And so I think that’s another area where there’s plenty of room for improvement.

57:40
An example I’ll give the asthma inhalers.

57:44
That was the last product that the fluorocarbons came out of because FDA didn’t think it was important, but how many people every day on a hot day are using an inhaler?

57:55
It was a huge input even though one little bits at a time, it didn’t seem like very much to people and that’s where, you know, we need the engagement of every part of our economy to see that, you know, they have a role including the healthcare industry.

58:10
Yeah, that’s exactly right.

58:12
Health medical care system’s about 18% of the GDP. It’s about 10% of the US workforce and it’s about eight to 9% of the carbon footprint. And they need to look at everything upstream production of products and pharmaceuticals and other things all the way down to the disposal and just mentioned.

58:30
I’m quite concerned that a lot of the are generic drugs are being produced in countries with very poor environmental controls.

58:37
And I know this indirectly that the release of powerful antibiotics into local streams and other such issues is not.

58:45
You know, it really will impact the lives of people in developing countries.

58:54
Thank you. We are almost out of time, so I’m going to ask one final question, and also ask our speakers, if I want to make any closing comments. We have an audience question about how to continue to support opportunities for partnership between public and private entities, and are there any best practices you’ve seen and allowing various sectors to work together to address environmental health?

59:23
Well, I think partnerships are really important to get anything done, and particularly environmental health, but that they have to be done with care.

59:32
If there has to be accountability, it’s important to measure what the what’s being done, and what the results have been are, and it, I think that also, and I hate to say it this way, but I’m just going to say it flat out, that often what motivates people to come to the table as partners is the fear that, if they don’t do something voluntarily, that it will be done through them, through a regulation that they’re not going to want.

1:00:00
So, you can’t abandon regulation, you can’t abandon that threat.

1:00:06
That, you know, if you don’t voluntarily take action that, it, that something will be done.

1:00:17
Lynch said it.

1:00:20
Any closing comments from doctor Jackson.

1:00:25
Know, I think the fact that this is a totally engaging and fascinating world and lends, exactly. Right.

1:00:33
You have no idea how much you get meshed in, whether it’s China or Russia or anywhere else in things you never even dreamed of as you start out doing environmental public health.

1:00:45
Doctor Porter? Yeah, I would just say thank you all for being here today, and I appreciate the time to share some thoughts, and I think all of us, I hope people walking away, it’s important points to, that they resonate with. And that you remember the importance of thinking about equity as we think about environmental health, and the importance of environmental justice, and other issues as we move forward.

1:01:09
Thank you all for your insights on this important type of topic, and, unfortunately, this is all the time we have for today. We invite our audience to complete a brief evaluation survey that they’ll receive immediately after the broadcast, as well as via e-mail later today. We also invite you to join the Alliance Tomorrow for another exciting briefing policymaking to support the health of Native American people at 12 PM Eastern.

1:01:37
A recording of this webinar and additional materials will be available on the alliance website.

1:01:43
This concludes today’s webinar Introduction for Environmental Health Policy, Lynn, Keshia, Richard. thank you all for joining us today.