Community and Public Health: "Wicked" Environmental Public Health Problems

Today health outcomes of common non-communicable diseases such as cardiovascular disease are modified by number of risk factors that can be categorized as intrinsic to the individual as determined by genetics or epigenetics, and extrinsic related to behaviors and environmental, social, economic conditions.  Our public health systems, health care systems, and environmental health services and regulatory system are each responsible for individual elements of the risks that adversely affect the wellbeing of the population and individuals.  Yet, substantive gaps exist for certain populations in health outcomes.  Better outcomes could be achieved, and gaps in outcome reduced by greater collaboration among these organizational entities. Greater consideration should be given to environmental public health hazards as well as their modification by social determinants of health.  As such environmental hazards contribute to broader public health concerns where the causes and outcomes are multi-factorial, historical and complex. Solutions for such complex problems need community involvement and multi-sectoral stakeholder engagement.  Electronic health record databases, satellite imaging, and non-targeted analysis are creating new opportunities to gain insight into the health effects of environmental hazards.  There is a need to develop approaches that integrate emerging analytical, imaging and personalized technologies to assess exposure and health responses.  A need exists to effectively communicate evidence to motivate individuals, public health and health care professionals to address all types of risk reduction.  Acquisition of data, the integration of multi-dimensional data, and the meaningful interpretation and communication will be keys to successful community-based decision-making and policy-making.  Ideally, randomized controlled trials are needed to evaluate the efficacy of personal action and population level policies to lower exposure, clinical risk and events and taking a multi-sectoral strategy to motivate action.

Impact/Purpose

Many environmental health challenges, such as particulate air pollution, wildfire smoke, lead exposure, climate change with associated heat waves, drought, wildfire, and extreme weather have complex origins and complex solutions that will require community involvement and multi-sectoral stakeholder engagement.  There is optimism that greater collaboration among public health, healthcare, environmental health and state and local government, and communities will yield better definition of problems, better options for solutions and better outcomes as measured by better wellbeing and longer lives.  Advances in data science and analysis are offering new opportunities to inform decisions that will address problems at an individual and community level.    

Citation

Cascio, W. Community and Public Health: "Wicked" Environmental Public Health Problems. Clinical and Environmental Health Data Workshop, sponsored by RENCI, Chapel Hill, NC, May 19, 2023.

• CASCIO RENCI PRESENTATION 19 MAY 23 FINAL_508 TAGGED.PDF (PDF)  (NA  pp, 1.5 MB, about PDF)