Promote health for all through a healthy environment.

The Healthy People 2020 Environmental Health objectives focus on 6 themes, each of which highlights an element of environmental health:

1. Outdoor air quality
2. Surface and ground water quality
3. Toxic substances and hazardous wastes
4. Homes and communities
5. Infrastructure and surveillance
6. Global environmental health

Creating health-promoting environments is complex and relies on continuing research to understand more fully the effects of exposure to environmental hazards on people’s health.

Why Is Environmental Health Important?

Maintaining a healthy environment is central to increasing quality of life and years of healthy life. Globally, nearly 25 percent of all deaths and the total disease burden can be attributed to environmental factors.1 Environmental factors are diverse and far reaching. They include:

• Exposure to hazardous substances in the air, water, soil, and food
• Natural and technological disasters
• Physical hazards
• Nutritional deficiencies
• The built environment

Poor environmental quality has its greatest impact on people whose health status is already at risk. Therefore, environmental health must address the societal and environmental factors that increase the likelihood of exposure and disease.

Understanding Environmental Health

The 6 themes of the Environmental Health topic area draw attention to elements of the environment and their linkages to health.

Outdoor Air Quality
Poor air quality is linked to premature death, cancer, and long-term damage to respiratory and cardiovascular systems. Progress has been made to reduce unhealthy air emissions, but, in 2008, approximately 127 million people lived in U.S. counties that exceeded national air quality standards.2 Decreasing air pollution is an important step in creating a healthy environment.

Surface and Ground Water
Surface and ground water quality applies to both drinking water and recreational waters. Contamination by infectious agents or chemicals can cause mild to severe illness. Protecting water sources and minimizing exposure to contaminated water sources are important parts of environmental health.

Toxic Substances and Hazardous Wastes
The health effects of toxic substances and hazardous wastes are not yet fully understood. Research to better understand how these exposures may impact health is ongoing. Meanwhile, efforts to reduce exposures continue. Reducing exposure to toxic substances and hazardous wastes is fundamental to environmental health.

Homes and Communities
People spend most of their time at home, work, or school. Some of these environments may expose people to:

• Indoor air pollution
• Inadequate heating and sanitation
• Structural problems
• Electrical and fire hazards
• Lead-based paint hazards

These hazards can impact health and safety. Maintaining healthy homes and communities is essential to environmental health.

Infrastructure and Surveillance
Prevention of exposure to environmental hazards relies on many partners, including State and local health departments. Personnel, surveillance systems, and education are important resources for investigating and responding to disease, monitoring for hazards, and educating the public. Additional methods and greater capacity to measure and respond to environmental hazards are needed.

Global Environmental Health
Water quality is an important global challenge. Diseases can be reduced by improving water quality and sanitation and increasing access to adequate water and sanitation facilities.

Emerging Issues in Environmental Health

Environmental health is a dynamic and evolving field. While not all complex environmental issues can be predicted, some known emerging issues in the field include:

Climate Change
Climate change is projected to impact sea level, patterns of infectious disease, air quality, and the severity of natural disasters such as floods, droughts, and storms.3, 4

Disaster Preparedness
Preparedness for the environmental impact of natural disasters as well as disasters of human origin includes planning for human health needs and the impact on public infrastructure, such as water and roadways.5

Nanotechnology
The potential impact of nanotechnology is significant and offers possible improvements to:

• Disease prevention, detection, and treatment
• Electronics
• Clean energy
• Manufacturing
• Environmental risk assessment

However, nanotechnology may also present unintended health risks or changes to the environment.

The Built Environment
Features of the built environment appear to impact human health-influencing behaviors, physical activity patterns, social networks, and access to resources.6

Exposure to Unknown Hazards
Finally, every year, hundreds of new chemicals are introduced to the U.S. market. It is presumed that some of these chemicals may present new, unexpected challenges to human health, and, therefore, their safety should be evaluated prior to release.

These cross-cutting issues are not yet understood well enough to inform the development of systems for measuring and tracking their impact. Further exploration is warranted. The environmental health landscape will continue to evolve and may present opportunities for additional research, analysis, and monitoring.

Blood Lead Levels
The number of children with elevated blood lead levels in the U.S. is steadily decreasing. As a result, determining stable national prevalence estimates and changes in estimated prevalence over time using NHANES is increasingly difficult. Eliminating elevated blood lead levels in children remains a goal of utmost importance to public health. The sample sizes available with the currently structured NHANES are too small to produce statistically reliable estimates and preclude the ability to have a viable target for HP2020 (see Objective 8.1). Efforts must and will continue to reduce blood lead levels and to monitor the prevalence of children with elevated blood lead levels.

References

1World Health Organization (WHO). Preventing disease through healthy environments. Geneva, Switzerland: WHO; 2006.

2US Environmental Protection Agency (EPA), Office of Air Quality Planning and Standards. Our Nation's air: Status and trends through 2008. Washington: EPA; 2010.

3Patz J, Campbell-Lendrum D, Holloway T, et al. Impact of regional climate change on human health. Nature. 2005 Nov 17;438(7066):310-7.

4Kinney PL. Climate change, air quality, and human health. Am J Prev Med. 2008 Nov;35(5):459-67.

5Noji E, Lee CY. Disaster preparedness. In: Frumpkin H. Environmental health, from global to local, 1st edition. San Francisco: Jossey-Bass; 2005.

6Srinivasan S, O’Fallon LR, Dearry A. Creating healthy communities, healthy homes, healthy people: Initiating a research agenda on the built environment and public health. Am J Public Health. 2003 Sep;93(9):1446-50.