By Bobby Cochran, Teresa Jacobs, Tess Malijenovsky, and June Reyes Decisions that affect the natural environment’s air, water, or lands typically impact the wellbeing of all species that depend on them. That’s why public health is a cornerstone of our most well-known environmental laws: the Clean Air Act, the Clean Water Act, and the National Environmental Policy Act. Despite the clear connection between the natural environment and public health, however, these fields have not evolved together with a shared vision. Let’s dig into that more. In the Clean Air Act and Clean Water Act there is explicit language promoting health by reducing “significant threats to human health” or removing “acute, subacute, and chronic adverse health effects” from exposure to pollutants and other chemicals. The National Environmental Policy Act of 1969, we think, has an even more proactive vision of public health. It promised to “assure for all Americans safe, healthful, productive, and esthetically and culturally pleasing surroundings,” and included in the charge for the Council on Environmental Quality to “develop and recommend to the President national policies to foster and promote the improvement of environmental quality to meet the conservation, social, economic, health, and other requirements and goals of the Nation.” The connection between health and the environment has traditionally been made in terms of environmental risks that impact human health either by exposing people to harmful agents, or indirectly by degradation of ecosystems that humans depends on. In Oregon, we’ve been working to expand that traditional view. A coalition of business, government, and health leaders are trying to make Oregon the healthiest state. A number of initiatives are underway, like the Oregon Health and Outdoors Action Framework, launched last fall, which is looking at how to catalyze stronger bonds between people and the outdoors in ways that improve both health and environmental outcomes. Conservationists and environmentalists still have a ways to go, but our partners in the field of public health are already adopting a more holistic approach to public health. There is growing emphasis on the social determinants of health—jobs, education, neighborhood and environment, and social and community context. These are the conditions in which people are born, live, work, and age that are mostly responsible for the unfair and avoidable differences in health status within communities. For example, people of lower socioeconomic status typically have more chronic disease, and are more likely to smoke and to be obese, according to the Oregon Health Authority. In other words, according to County Health Rankings, access to clinical care and healthy behavior are only part of a person or a community’s health.. As a result, hospitals, insurers, and state Medicaid programs are investing in ways to improve on these social determinants of health. And, there is already guidance on how to incorporate health into all policies. So, what if we looked at the health world’s efforts to think more systematically about health and apply that growing base of evidence, knowledge, and community participation toward how we implement our environmental policies? We’re not sure what the right answers are, but we want to have that conversation. So let’s think about: What would it take to update the vision of public health in the Clean Air, Clean Water, and other environmental laws? And What would it take to incorporate a vision for a resilient environment into national policies for healthcare and public health?Time to update our vision of public health in environmental policy?
This figure is used by County Health Rankings to illustrate what they understand to be the influences of what makes people sick or healthy.
