Introduction to Environmental Health and Policy

[00:00:00] Speaker 1: Hello and welcome. I am Katharine Martucci, Director of Policy and Programs at the Alliance for Health Policy. 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. 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 we 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 Healthcare Management Foundation, NICM Foundation, for their support of today's briefing. And then we'd also really like you all to get involved. So you can join today's conversation on Twitter using the hashtag #AllHealthLive and join our community @AllHealthPolicy 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 and you can use that speech bubble to submit questions you have for the panelists at any time. We'll collect these and address them throughout the broadcast. And you can also chat about any technical issues you may be experiencing. So now I'd like to introduce our moderator for today's event, Catherine Santoro, Director of Programming at NICM. She joined NICM in 2004 and currently leads the organization's health policy portfolio. 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 2019, Ms. Santoro completed the Emerging Women Executives in Healthcare Leadership Program at T.H. 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. [00:02:42] Speaker 2: Thank you. And thank you to Sarah Dash, Catherine, and the Alliance team for convening this important discussion today. Your webinars are a valuable resource to decision makers. Before we move forward, I want to briefly set the stage for our discussion today. All Americans deserve the opportunity to live in healthy environmental conditions, including fair and equitable access to clean air, pure water, healthy soil, and quality food. Yet more Americans are being exposed to environmental health hazards than ever before. And these risks are unevenly distributed, creating new inequities and exacerbating those that already existed. Niccum Foundation recently released an infographic on the impact of the changing environment on human health. And this slide outlines some of these hazards. 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. 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. Let's dive into the basics today so we know where our barriers and facilitators lie across stakeholders. I'm now excited to introduce the panelists who will be joining us for today's briefing. Our panelists' full biographies are available on the Alliance website. First, we're joined by Dr. Keisha 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. In addition to these appointments, Dr. Pollack-Porter also directs the Bloomberg School's Institute for Health and Social Policy and is part of the leadership team at the Hopkins Center for Health Disparities Solutions. Dr. Pollack-Porter is a health equity scholar studying active play and active transportation, safe built environments, and the nexus of transportation and health. Next, I'm pleased to introduce Dr. Lynn Goldman, the Michael and Lori Milken Dean and Professor of Environmental and Occupational Health at the Milken Institute School of Public Health at George Washington University. Dr. Goldman was previously the Assistant Administrator for Toxic Substances at the U.S. 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. She is a recipient of the Heinz Award for Global Environmental Change and the American Public Health Association Environment Section's Homer M. Calver Award. Finally, we are joined by Dr. Richard Jackson, Professor Emeritus at the University of California, Los Angeles Fielding School of Public Health. A pediatrician, Dr. Jackson has served in many leadership positions within the California Health Department, including the highest as the State Health Officer. For nine years, he was Director of the CDC's National Center for Environmental Health and received the Presidential Distinguished Service Award. 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, the John Heinz Award for National Leadership in the Environment, and the Sedgwick Medal, the highest award of the American Public Health Association. I'm so honored to be joined by this esteemed panel of experts today. We'll begin with some opening remarks from each of our speakers and then turn to your questions. Dr. Polak-Porter, let's start with you. Dr. Polak-Porter: [00:06:59] Speaker 3: Great. 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. You can go to the next slide, please. 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&A at the end of all of our comments. I encourage you to reach out to me by email if you have questions after today or also feel free to send me a note via Twitter. Next slide, please. 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. As Katherine 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. 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, where they play, where they pray. And what you see in this image is health is right in the center and is connected to a number of sectors and areas of society. So for example, as Katherine shared in my bio, I do some work in the built environment and transportation. Well, we know the important role of public transit and active transportation when we think about the environment. And I'll come back to that as well. 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 people are attending, or a number of different elements. 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, impact our population's health. And why this matters is that these sectors don't have, often don't have, I mean, population health or positive health or good health as their number one goal. Right. 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. 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. And although we're focusing on US context, I also want to acknowledge the importance of health equity for populations around the world. 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, where, 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. 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. Next slide. 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 in all policies. And I mentioned health in all policies, because I think this is a real opportunity to advance. There is a real opportunity to advance health in all policies and advance population health and address some of our environmental health drivers. High app or health in all policies is a collaborative approach. 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. 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. Health in all policy also refers to systems level change. Health in all policy seeks 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. So if we go back to that image I shared when I first started my comments, we can use health in all policy strategies or strategies to advance health in 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. Next slide, please. There are a number of strategies to achieve health in 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 uncreated. In Maryland, I've been part of one at the state level and also one at the local level in Baltimore City. California's health in all policies task force is probably the most widely known that we have in this country. We've also seen examples where health has been integrated into planning processes. So, for example, a zoning code update or zoning updates broadly in a municipality. You can imagine efforts to increase how health is considered in these efforts or in also a general plan that's being updated. 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 and not harm health? 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 a proposal that can support health and also to mitigate the ones that can harm health. I also helped create a tool called a 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. Next slide. 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. So, you're going to hear more about examples in the environment that relate to some of the areas up on the 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. Or if we think about food policy and we can look at the devastating impact of 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 an environmental health issue as well. Earlier when we started today, Catherine mentioned clean water. We can think about water policy and examples of course that came out of Flint, Michigan showing how water policy is an environmental health policy. 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 through 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. So, with that, I will wrap up my time, my opening comments. I look forward to our questions and [00:16:08] Speaker 2: answers at the end. Thank you. Thank you, Dr. Polak-Porter. Now I'll turn it over to Dr. Goldman. [00:16:18] Speaker 4: And hello, everybody. It's my pleasure to join you. And thank you so much for Dr. Polak's wonderful opening remarks. I can have my next slide. So, environmental health policy. Next slide. To give kind of a general overview, I always start with a definition of health to remind us all that 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. Next slide. Environmental health advances by three more ticks has differences from other areas of health policy in that we are working on establishing a healthy, livable environment for humans, but also other species. That we want an environment that improves our well-being and high quality of mental health as well as physical health. And we want the environment to be sustainable for the future. Yet, we have, as a society, a desire to continue to have population growth, to have manufacture, to have agriculture. And there's a lot of tension there between sustainability and growth that we're always dealing with. Next slide. So, as Dr. Pollack very elegantly said, environmental health is a very complicated beast. And I actually simplified what she presented in that, really, 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, the environment that we're dealing with, whether at a very high level we're dealing with at a very high level. We're dealing with environmental health that we're dealing with at a very high level. So, I would be remiss if I didn't point this out that environmental health has been responsible for many 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-30s. Why? Well, there wasn't a lot of biological pressure for living longer than that. We reproduced, we can't even have grandchildren by the time we're 35 or 36 years old. But we saw in the middle of the, between 1850 and 1900, a steep rise in life expectancy. That didn't come about because of healthcare. That did not come about because of drugs. That came about because of basic environmental protections and has continued mostly through this day, although we're beginning to see a fall off. We also see in terms of what Dr. Pollack said that there continued 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 the Americas and in Europe. And the Americas have been falling behind Europe a little bit, which has not been a good thing. Next slide. So why has life been prolonged over this time? Much of it 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. And improvements in how we take care of mothers and infants, of course, immunizations eventually into the 1900s, antibiotics and other interventions, including healthcare, which certainly contribute, but to a far more minor extent than actually improvements in the environment. Next slide. So environmental policy, there are a number of really important principles, and this is very different than the rest of health policy. And you already have that from what Dr. Pollack told you, that we need to be looking at health in all policies. That isn't true for all of health policy, but environmental policy, that is true, because anything that we do that impacts the built environment, impacts the natural environment, can impact our health. 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 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 like lead, or the polyfluorinated chemicals, other chemicals that we can't clean out of the environment, into our environment. environmental justice, fairness, equity. Dr. Pollack very well discussed that. Children's health and intergenerational equity, how we're impacting the health of future generations, either in health impacts on children, or as it's a problem with climate, by putting in place processes that are going to leave our children, our grandchildren, our great grandchildren with a much worse future. Protection of ecosystems and communities, that it isn't enough to deal with environmental policy, one pollutant at a time. We have to think about the health of the entire system. And then there are considerations of cost and effectiveness of our expenditures and who pays. A fundamental principle being that the polluter should pay. And why? To disincentivize the pollution. And because of the principle of fairness and equity. So next slide. 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. There's global issues like climate pollution and persistent pollutants. They're national level issues like control of air pollution, registry of chemicals and pesticides, dealing with clean water and waste standards across our borders. There's state and local specific issues. But there's a lot of non-governmental policy, such as ESG 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? Next slide. So planet Earth is itself 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 it's fair and equitable for for everybody who lives on the planet. So thank you. [00:23:47] Speaker 2: Thank you, Dr. Goldman. And next, we will hear from Dr. Jackson. [00:23:55] Speaker 5: I'm still muted, Moiko. Hello? We can hear you. [00:24:06] Speaker 6: Okay. Thank you. Go ahead and -- it says using -- oh, all right. Let me have the next slide, please. And thank you for the lovely introduction. And you've already said things, so -- and I've been very focused on built environment, but that's not what I'm going to talk about today because I want to go through a concrete example of an important success story. Next slide, please. Lynn showed WHO definition of health, well-being 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 Keisha's slide because I didn't like public health sitting aside from everything else. It really is encompassing within health of the whole thing that you showed, Keisha. Next slide, please. When I started medical school, I did a rotation at Mount Sinai in New York, and I went on the ward, and I was only a first-year medical student. I asked the attending -- there were about 20 little kids running around hyperactive as could be. And I said, "Why are they here? They look fine." He said, "They're being chelated for lead poisoning." And he took me down the end of the hall, and there was a baby convulsing who eventually died of lead poisoning. Every year in New York and in Baltimore and other major cities, we had about 10 children a year dying of lead poisoning. 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. Next slide, please. And I remember talking to members of Congress, and they thought, "Well, lead can't be bad for you because I have lead 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 in old housing. We used enormous amounts of lead in paint, about two pounds per capita between 1900 and 1940, every year. Can you imagine taking a highly toxic material and painting friction surfaces, windows, doorways, and frankly, putting them exactly at the mouth level of a little child wandering around? There were 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 in that as well. Next slide, please. So, about two pounds per person. Next slide, please. And lead was present in our water. When I was a child, a typical baby formula was evaporated milk mixed with water. And all those cans, food cans, were sealed with lead solder. Next slide, please. And the lead industry, particularly as the pediatricians raised more and more attention to the fact that lead was bad in children, went through a whole rebranding strategy, which frankly has been used by the tobacco industry and the sugar industry and others. And this one, they took what they're most afraid of, the hazard to children, and invented the Dutch boy and beautiful paints of a child painting his hobby horse and the rest. So, cater to the children. Next slide, please. Well, by about the late 1930s, using lower quality gasoline meant that the compression on high compression engines wasn't as good. So, it was discovered that tetraethyl lead, tetraethyl bonded with lead could make gasoline knock less and they could improve the octane rating of gasoline. I always find this amazing. Two and a half grams of basically elemental lead in each gallon of gasoline, which meant if you filled your car with 12 gallons of gasoline, you put in the equivalent of one fishing sinker, one ounce of lead in there that's going to be burned at a thousand degree temperatures and then spewn across the environment. Next, please. So, we used enough lead and gasoline that, for example, most states, about four pounds per person of lead was put in gasoline every year. About six pounds in Texas. Next slide, please. 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. 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. And he did a very simple test of children now, years after being lead poisoned, and could show that their reaction times were slower than children who had not been lead poisoned. So, he received funding. Next slide, please. Next slide, please. Sorry. He received funding to do a study looking at children who now were six, seven years old, look to be fine. And the reason we focus on kids, and Lynn was a major leader, particularly around pesticides and food, and the fact that children eat, drink, and breathe two to three times as much as adults do. And behaviors are significantly different from adults. Children are not little adults. Next slide, please. So, Dr. Needleman's study that came out showed that when they got the children's teeth that were a reflection of how much - this is baby teeth that they then shed - the lead in their teeth was a reflection of how much lead they had in their bodies in the first couple years of life, and then did separate interviews, blind interviews, of the teachers about children's behavior. Next slide, please. We see that the children who had more increasing levels of lead in their bodies functioning at lower levels. Next, please. Well, 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. Los Angeles, and you all know California has more stringent air pollution and other kinds of regulations than the rest of the United States, in part because there were - slightly exaggerated - there were children that grew up in Los Angeles, didn't know it was surrounded by mountains. The air pollution was so bad you couldn't see a block in the early 1960s because of air pollution, nitrous oxide and other pollutants. Next slide. And so the California Air Resources Board, working really superb scientists, developed the catalytic converter that would destroy oxides of nitrogen and other oxides, and it used very valuable metals to destroy them. But you could not put leaded gasoline in a car that had a catalytic converter because you destroyed that $1,000 catalytic converter. So that was the beginning of unleaded gasoline in 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 could 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 U.S. Next slide, please. So as you can see, the green line was lead going down in paint, and the blue line was lead going down in gasoline. So back when it felt so insurmountable and we were seeing so many children rightly dying of lead poisoning, we're now down to virtually no lead in gasoline by the year 1990. Well, lead, that long-term damage, and this is work done by Joel Schwartz and others, every time your blood lead goes up 10 points, you have an average IQ loss of about two and a half 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. 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 wanted to know about the costs. Next slide, please. And the average cost per the benefit of one IQ point more is about $15,000 of lifetime income. If you have a good IQ, you stay in school longer. If you stay in school longer, you earn more money. It's a very rough number. I know IQ is biased in certain ways, but it's a pretty good predictor of lifetime income. About $14,000 an IQ point for the rest of every year of your life. Next, please. So we did an estimate, and we came up that about every year's babies accumulated an additional $200 plus billion 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. And so this data was extraordinarily important to lead to. We 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 showed that Americans were showing much lower levels of lead. The same work went on in China as well. And those efforts led to removal of lead from gasoline in Russia, in China, and ultimately for countries around the world. There's still some used, but that's the big step forward. Next. 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. 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 [00:34:40] Speaker 2: good let me stop there thank you very much thank you dr 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 a follow-up for dr goldman you mentioned several times that environmental health policy approaches are very different than traditional health policy why is that and what are [00:35:11] Speaker 4: pros and cons of these differences 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 um you know health care delivery 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 dr jackson pointed out it's the simple things is how we paint our homes what kind of housing policies we have and what we use to fuel our automobiles and so in a sense we're getting our fingers into all kinds of corners that you know a lot of people don't think we belong in um whether it is it is the corporations who make those products or are profiting you know from those technologies or even you know some of our other colleagues in government such as um are there parts of the federal government the department of energy they're in charge you know of of fuel and and how the fuel is used and 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 um and this is much of what we've seen as the problem with climate and health in that we really haven't done the greatest job in 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 so i mean it is it is different uh and then the last thing i would say and and i think dr jackson gave a great example of this with dr needleman and 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 fighting hard as hard as we can and you can look at how hard it is to do public health even without that but just think if there were one like the lead industry and if they were look at all the misinformation we already have just because people don't want limitations of activity they don't want masks they don't want to get a vaccine think of how much worse it would be if there were a coronavirus company like the lend industry used to be putting out information deliberately we deal with that in [00:37:57] Speaker 2: environmental health all the time thank you this question is for any of our speakers can you help us understand how the states and the federal government interact to establish law and regulations in this space as well as how funding federal funding is allocated to states and localities [00:38:24] Speaker 6: this is dick i'm just jump in i'll talk about it from cdc and maybe i'll defer to lynn on from epa you know the data collection of infections and everything is done by the states and it resides with localities and i was the head of infectious disease in california we had to california i'm sorry the state paid us to deliver our tuberculosis and other kinds of the federals 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 so it tended to really leave out more and more localities the way it said and i i think we need a much more blanket kind of funding all the way across so we don't always reward those who have the best consultants and access to data and other systems [00:39:22] Speaker 4: but we don't have to do that we need to do that but i think we need to do that and so you know i another way to understand the federal state uh relationship is it goes back to our constitution and that is that all things that are not specifically delegated uh to the federal government are the responsibility of the states so the states have tremendous um responsibilities i mean a a lot of day-to-day if you're in restaurants or is the food safe is that environment safe the federal government has nothing to say about that kind of thing um even even drinking water to some extent is is handled um by states and um and yet there's also the interstate commerce clause that is what has enabled the federal government to set federal rules and why it is that the federal government can keep our air 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 but there is a lot of tension around this and particularly today with the courts the conservative courts um 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 states and so that is something that we are seeing played 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 um climate gases but 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 or can flow to universities 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 can i just supplement that [00:41:40] Speaker 6: a little bit one is the positive is the states are the laboratory for a lot of federal policies so oftentimes the the policies are really being developed in the state that's a positive the negative for the states is um 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 the next three rows ranks below you are out and uh funding can often be cut unless there's an emergency and then they blame the people that not doing enough that already been cut um 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 yeah and maybe i could just add [00:42:18] Speaker 3: one thing in terms of the work i do with dot and transportation i would just i want to just echo the points that that lynn and dick just both made about the important influence um and the points of implementation right so if we think about where the money is 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 um 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 um right up the street by our city council by our state um officials absolutely right [00:42:59] Speaker 2: thank you all what opportunities would 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 if these federal investments are being delivered to the disadvantaged communities that need them [00:43:17] Speaker 4: the most the two people in dc should answer this one i mean i think that i think that uh kisha said some of it before but i would double down on what she said which is that as these projects are rolling out it's really important for environmental health to be engaged and to make sure that the impacts are positive a thing that i felt was a 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 building but that doesn't preclude people from using you know the environmental impact analysis and other positive try to make sure that's happening i think that requires mobilization of a lot of people uh to make sure people in local communities are getting engaged and are able to participate um [00:44:20] Speaker 3: yeah and maybe i'll just add to lynn's comments of um when i was just jotting down a couple of things related to today's conversation certainly the build back better act has provisions for um combating climate change and increasing affordable housing things that matter for environmental health and i would just say in terms of things that were missed um as we all saw um that bill moving forward and even what happened with the infrastructure bill there were negotiations right there were um 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 um to continue to advance policies and programs that create conditions where everyone can thrive um and so i think that there's opportunities there but certainly a start and we'll see where things end up specifically with we build back better [00:45:14] Speaker 2: great thank you policy makers often do not consider environmental health to be an essential service what are the opportunities and opportunities and challenges with this framing and how do we address potential work for shortage issues in the field of public health and environmental health [00:45:34] Speaker 6: i'm going to just jump in one is uh the policy makers do not consider environmental health until they're really in trouble and then all of a sudden is the most important thing of all and i can go through story after story where even jerry brown as governor sort of poo-pooed this stuff and then all of a sudden bedfly or malefine or other things hit and it becomes right to the fore it makes me think about how many investigate epidemic investigations this was back more infectious disease where people you'd show up to investigate it and the first thing people would tell you is there's nothing here go away and you the same thing happened with meatpacking plants and coronavirus and other such things so uh you know i think one is you've just got to have the pipeline i'm i'm very unhappy with nih that they're only putting about 0.05 percent 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 they're worried about their debt from school 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 i politicians love to stand next to the bright shiny object and say hey i got the money for this supercomputer 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 [00:47:03] Speaker 4: i mean i would say also katherine that 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 you know i've worked on a lot of legislation in my career and you've developed 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 in an area like this um we can 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 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 a 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 going to say it that way and they really are and yet the public cares about the environment and the public needs to manifest that care in how they vote and how they interact with their politicians and we need to be spending more time i think understanding how we communicate to that 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 that is against either mitigating or controlling you know climate change it shouldn't even be possible because i mean because that is such a devastating impact on our health our planet future generations but it still is and i mean and 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 our real problem um to be honest you know not the politicians themselves but the way that people uh really don't vote on the basis of those environmental [00:49:29] Speaker 6: votes but people do contribute on that basis lynn could i riff on that just for 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 probably met with nine lobbyists of one form or another every one member of the public that came and talked about what they were concerned about and so and keisha was much deeper on this we need to figure out ways that we can support that kind of public advocacy [00:49:57] Speaker 3: yeah and i'll just add i mean these i strongly echo these comments and just really see a need for um policy advocacy and organizing and really holding our leaders accountable right because even for people who say like i know i have a colleague who talked about climate change and says all kinds of things right but okay fine you want to you want to uh say that that phrase doesn't resonate with you well the fact is we can't disagree with the fact that it is 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 um to hold our leaders accountable for making changes that are going to help every person be able to to thrive the other thing i want to say that i am concerned about is sort of the our public health professionals and um both lynn and dick mentioned this right we know that so many of our public health professionals are under attack people's lives have been threatened particularly in the pandemic i have a colleague who's been looking at this doing 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 if i talk 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 um so i want to name that as something to be thinking about as we look at the pipeline in our future generation our future leaders who might shy away um because of what we're seeing now in terms of the hostility towards public [00:51:25] Speaker 6: health i'm just going to echo one more thing i'm teaching a class at berkeley in a couple hours and it's the last class of the quarter and one of the things i'm going to close with is i have never been bored for one minute doing environmental public health in government and um we said some of these negatives but it's meaningful work and it's very gratifying work yes and it's important [00:51:51] Speaker 4: i'm going to second that it's a lot of fun and i talked about the downside of having to work with all these sectors but it's actually kind of fun because you learn a little bit about a lot of things and if you're curious about how the world works boy environmental health can be incredibly [00:52:06] Speaker 3: gratifying so and i would say i'm not trained in environmental health but as a health equity public health person i am welcomed all the time into the space because we have similar goals we care about similar issues and have similar values um and so i certainly agree um despite the challenges i love what i do and [00:52:22] Speaker 2: i feel like we're able to really make an impact we have lots more questions to get through the next couple minutes but um and i think dr goldman you might have touched on this briefly in terms of mental health but what do we know about the impact of the environment on our mental health including pollution um dr polar porter mentioned some of you know extreme weather events that have displaced families um what additional research do we need to help us understand that and where where we go from here [00:53:00] Speaker 4: we need lots more research 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 don't even imagine that we understand what the mental health impacts of hurricane maria were population we do 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 i mean it's hard to really grasp the extent to which these um these issues are impacting our lives um if you live in an alaska village that can't exist anymore because it's sinking because the permafrost has melted that's going to have a lot of mental health consequences um you and your family [00:54:06] Speaker 6: i wonder if i could just add one thing the term health impact assessment sounds just boring as all hell but the truth is that when you see a clinician and you're given a bad diagnosis and you've got the choice between chemo and radiation and surgery etc you sit there and try and figure out how to optimize in a bad situation and that's what health impact assessment is and what we've done with impact assessments we've made it all about consultants with thousand page documents where they only really address health in 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 and longer term health not immediate stuff we'd come out with much better decisions and one thing i'd like to see and uh is the national environmental policy act really not necessarily be reopened but really applied to health in a much more broad way so we can make better decisions and and that's your field keisha i don't mean to step on you there no stepping at all i think that was well said [00:55:09] Speaker 3: i totally agree with you and um and you know there are lots of rapid health impact assessments that are you know not these 100 page 200 page 300 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 too i want [00:55:26] Speaker 6: to lift that up as well and you know giving people more jobs and getting to work more easily and everything else it you might not accumulate that over one year but you'll accumulate over 50. [00:55:42] Speaker 2: another question from our audience is about the healthcare industry itself being a major major contributor to polluters including hospitals 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 [00:56:05] Speaker 4: well i mean i'll just start out by what i think could be happening that isn't happening at a federal level and that is that when we license um healthcare facilities that a piece of that should have to do with um their efforts to reduce pollution and including climate pollution um and uh i will tell you when i was at epa and we were dealing with dioxins from incinerators one of the most obstreperous industries was the hospital industry they wanted to keep burning their waste however they wanted to burn it there was nothing about that that made us safer or healthier and so in a way they can behave like any other industry just want to take the cheapest path forward and whatever they're doing i would also say you know when people who make devices and or who are manufacturing various kinds of medical delivery items much of that is involving persistent chemicals and um and harmful substances that do not need to be present um in those products 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 um polyfluorinated chemicals and and other harmful substances and so i i think that's another area um where there's plenty of room for improvement and an example i'll give the asthma inhalers 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 it was a huge input even though one little spritz 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 you know that's exactly right you know health medical [00:58:13] Speaker 6: care system is about 18 of the gdp it's about 10 of the u.s workforce and it's about eight to nine percent of the carbon footprint and they need to look at everything upstream production of products and and pharmaceuticals and other things all the way down to the disposal and just mentioned i'm quite concerned that a lot of our generic drugs are being produced in countries with very poor environmental controls and i know this indirectly that the release of powerful antibiotics into local streams and other such issues is not you know it really will impact the lives of people in developing [00:58:49] Speaker 2: countries great thank you we are almost out of time so i'm going to ask one final question and also ask our speakers if they 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 in allowing various sectors to work together to address environmental health [00:59:23] Speaker 4: well i think partnerships are really important to get anything done um and particularly environmental health but that um they have to be done with care um there has to be accountability it's important to measure um what the what's being done and what the results of it are and it i think that also um and i 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 it a 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 so you can't abandon regulation you can't abandon um that threat that you know if you don't voluntarily take action that it that something will be done [01:00:11] Speaker 2: uh and lynn said it that's my any closing comments from dr jackson or [01:00:25] Speaker 6: no i i think the fact that this is a totally engaging and fascinating world and lynn's exactly right you know i 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 [01:00:45] Speaker 3: dr polik porter yeah i would just uh say thank you all for being here today and i appreciate the time to share some thoughts and i think all of us um i hope people are 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 um environmental health and the importance of environmental justice um and other issues as we move [01:01:07] Speaker 2: forward well thank you all for your insights on this important topic 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 email later today we also invite you to join the alliance tomorrow for another exciting briefing policy making to support the health of native american people at 12 pm eastern a recording of this webinar and additional materials will be available on the alliance website this concludes today's webinar introduction for environmental health policy lynn keisha richard thank you all for joining us today