This week, we will be celebrating the 30th anniversary of the doctoral program in environmental health at SPH. Many of our alumni will be joining us on November 1-2 to tell us about the work they are doing and to connect with current students, staff, and faculty. This milestone naturally leads to thoughts about where the field of environmental health has been, where it is going, and its role in public health.
In a 2016 Dean’s Note on the aspirations and strategies of public health, George Annas and I wrote, “Public health continues to be about the conditions that make people healthy.” These conditions are largely social, economic, political, and environmental. Since then, I have written often on the many ways the health of our environment shapes the health of populations—through examples like climate change and natural disasters, and the water crisis in Flint, Michigan. These examples speak to the fundamental immediacy of environmental health, how the conditions of the natural and human-made world around us shape our health each day in often profound ways. When our environment is safe, clean, and sustainable, health is able to thrive. When it is not, health cannot help but suffer.
The link between health and the environmental has been at the core of public health since the field’s earliest days. The work of John Snow to stop the cholera outbreaks in the Broad Street area of London is one the core iconic stories that animate public health. Importantly, the Broad Street pump saga is an environmental health story—an infectious agent was found in drinking water, leading to steps being taken to break the connection between the source of pollution and health. The Welch-Rose report, which provided the impetus for the development of schools of public health more than 100 years ago, had a strong foundation in sanitation and hygiene, reflecting in part the influence of housing conditions in inner-city tenements, places where immigrant populations faced crowded conditions where infectious diseases spread easily in the late 19th and early 20th centuries.
Fast-forward to the present time, and many of the most complex public health challenges we face globally have environmental exposures at their core. The recent report from the Intergovernmental Panel on Climate Change regarding the potentially catastrophic impacts of climate change emphasized the influence of air pollution, heat, and vector-borne diseases on human health. The recent hurricanes and other climate-influenced natural disasters have both acute and chronic impacts on health, as emphasized by the recent report that estimated nearly 3,000 excess deaths in Puerto Rico in the months following Hurricane Maria. More broadly, the Global Burden of Disease Study has estimated that 9 million deaths per year can be attributed to environmental or occupational factors such as air pollution or unsafe water, sanitation, and hand washing. This represents three times more deaths than those caused by AIDS, tuberculosis, and malaria together, and 15 times more than the deaths caused by all wars. Environmental exposures are important for non-fatal illness throughout the lifecourse, with significant impacts on birth outcomes, pediatric asthma, cardiovascular health, and other diseases. As with many risk factors for health, the environmental burden of disease disproportionately falls on lower-income populations and developing countries, who tend to have higher exposures and greater vulnerability.
Many of the solutions to environmental challenges require expertise across multiple disciplines. As such, environmental health is inherently interdisciplinary, and there are natural and sustained connections to most branches of public health. For example, while environmental health scientists are concerned about the health and climate implications of the burning of solid fuels for cooking, this is a global health challenge that relates to sustainable development goals, disproportionately affects women, and can only be solved with expertise in monitoring and evaluation given the complexities of on-the-ground implementation. Water is a key resource that requires sustained public health attention. By documenting the connections between drinking water exposures and poor health outcomes, we provide information and data to inform both prevention and intervention strategies. The lack of control of lead in drinking water in Flint, Michigan, and the lack of attention to the aging infrastructure in many cities, represents an intertwined environmental and public health failure. These challenging situations call for a social justice lens, with public health the goal, requiring expertise in nutrition, water systems, health law, population surveillance, and community engagement. In general, many environmental exposures derive from the underlying social conditions of a given community, and only through understanding the root causes can we devise logical and sustainable solutions that truly improve the public’s health.
Over the past three decades, doctoral students in environmental health at SPH have studied an amazing array of topics, reflecting the spectrum of work within environmental health. The throughline of this has been work with and for vulnerable communities, especially in urban settings, to understand the exposures they face and help devise solutions. The title of our two current PhD training grants—“Environmental Epidemiology in Community Settings” and “Boston UniverCity: Partnering Graduate Students with Cities to Tackle Urban Environmental Challenges”—speak volumes about what we emphasize. The mission of the Department of Environmental Health is nested within the mission of SPH to improve the health of local, national, and international populations, particularly the disadvantaged, underserved, and vulnerable, through excellence and innovation in education, research, and service. The Department of Environmental Health achieves these goals by working with and for communities to improve health through the development, translation, and dissemination of knowledge about environmental hazards.
Ultimately, environmental exposures affect everyone—we all breathe air, drink water, eat food, and spend time in homes and workplaces. At SPH, we have spent decades training future public health leaders to understand the importance of environmental exposures to help reduce disease burdens, and we look forward to doing so for many decades to come.
We hope everyone has a terrific week. Until next week.
Sandro and Jon
Sandro Galea, MD, DrPH
Dean and Robert A Knox Professor, Boston University School of Public Health
Jonathan Levy, ScD
Professor, Environmental Health, Boston University School of Public Health