Read Article: The Complexities of Environmental Health, by Catherine Feinman
Listen to Podcast: The Broad Topic of Environmental Health &Security, by Justin Snair
Occasionally, single events have the ability to transform society – instigating dialogue, prompting resource allocation, and changing national policy. The 9/11 attacks in 2001, the subsequent mailing of anthrax letters in October of that same year, Hurricane Katrina in 2005, and the catastrophic failure at the Fukushima Daiichi Nuclear power plant in March 2011 all illustrate the power that traumatic events possess to catapult issues onto the national and international stage.
Some issues, however, are often a story of trends and long-term impacts, marked only by occasional incidents that gain widespread attention. Unfortunately, the collective impact of these individual events is not always recognized, and dangerous trends often continue undetected. Environmental health issues frequently fall into this latter category, compromising the health, welfare, and security of the nation.
Defining Environmental Health
The World Health Organization defines environmental health as “all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviors. It encompasses the assessment and control of those environmental factors that can potentially affect health.” The environment, both built and natural, affects personal and population health. Exposure to harmful substances and organisms can result in negative health outcomes through food, water, and air consumption, as well as contact with soil.
As mentioned in a 2008-2009 project published by the National Environmental Public Health Leadership Institute, many jurisdictions in the United States have traditionally addressed environmental health issues by developing “new, narrowly focused initiatives to tackle each specific issue individually.” This approach often results in the creation of programmatic silos that frequently are relegated to a subordinate position as one of many components of the public health system. National public health preparedness policy reflects this subordination, consistently positioning environmental health as a public health system component, rather than a separate, equally important issue in its own right.
Although environmental threats certainly can affect the health of entire populations, the central focus of the public health system, mitigation, prevention, and response to environmental threats cannot always be addressed solely through public health interventions. The drivers often are outside the direct influence of the public health system.
In recent years, an increase in extreme weather – attributed to climate change – has prompted acknowledgments of the effects that environmental threats can have. As a result, climate change is increasingly included in political discussions and national policy, which have catalyzed collective, strategic actions from a diverse set of disciplines. This issue illustrates that, although a threat can be of particular concern to the public health system, addressing it may require a more unique and multidisciplinary approach. Unfortunately, many other environmental threats that affect the security and health of the nation, such as those illustrated in Figure 1, have not found widespread and coordinated attention.
National Health & Security Strategy
Moreover, segmenting environmental health policy and strategy into issues that impact public health and those that affect the security of the nation creates a false dichotomy, unnecessarily complicating efforts to strategically address the issues. A cohesive and holistic national environmental health and security (EHS) strategy, which considers environmental health drivers and consequences on national security and public health through a distinctive lens, would overcome the current segmentation to more effectively and comprehensively address the full spectrum of environmental health threats. Examining national policy and practice around this issue would be helpful before considering what an EHS-focused paradigm would look like.
Figure 1. Environmental security construct, drivers, and consequences. Adapted with permission from, “There’s a Pattern Here: The Case to Integrate Environmental Security into Homeland Security Strategy,” by James D. Ramsay and Terrence M. O’Sullivan (2013).
Currently, national policy surrounding environmental health security is largely a subordinate component of the public health system. The U.S. Department of Health and Human Services’ (HHS) National Health Security Strategy (NHSS), which frames public health as a national security issue, “acknowledg[ing] the interdependent relationship between national security, homeland security, and national health security,” includes the prevention or mitigation of environmental and other emerging threats to health as a strategic objective.
The NHSS recognizes, at least from a public health perspective, the capacity of negative environmental conditions to “compromise a society’s ability to provide food, water, health care and, more broadly, economic productivity[,] endanger[ing] the security and stability of that society.” The NHSS further underscores the need for the public health system to coordinate with and leverage the resources of those organizations and individuals responsible for food safety, environmental protection, and workplace safety.
The subordination of environmental health to public health continues under the Department of Homeland Security’s (DHS) National Response Framework (NRF), which presents the “guiding principles that enable all response partners to prepare for and provide a unified national response to disasters and emergencies.” Within the NRF, Emergency Support Function (ESF) #8 provides the mechanism for coordinated federal public health and medical services, as well as assistance to supplement state, tribal, and local resources in response to a public health and medical disaster, to potential or actual incidents requiring a coordinated federal response, and/or during a developing potential health and medical emergency.
Environmental health security concerns – food safety and security, vector control, and potable water – are included in ESF #8, but once again enveloped into the public health agenda. The deeper causes of environmental problems are often overlooked in favor of a focus on the more immediate human health outcomes. Such an approach leads to more intense issues in the future and potentially greater harm to the public and environmental health.
Environmental Health Threats & Security
Recognition of the fact that environmental drivers have the capacity to influence national security has not just recently emerged. Historically, environmental conditions affecting national security – mostly those related to water, food, energy resources, shelter, and economic productivity of a nation – have been considered an issue of military defense or international relations. Rooted in this perspective, environmental security is often defined as “a process for understanding how extreme environmental or climatic events, acting locally or trans-nationally, can destabilize countries or regions of the world, resulting in geopolitical instability, resource conflicts, and subsequently enhanced risk to critical infrastructure, or a combination of these.”
In the past, threats and disruptions to key natural or built environments by specific threat actors, such as domestic and international terrorist groups or competing nations, have undermined national security and welfare. Disputes between nations – such as the conflict between Israel and Arab states from 1964-1967 over the control of the water resource of the Jordan River drainage basin – illustrate this issue.
However, environmental threats are not solely perpetrated by discrete actors or by one nation to another. In recent years, natural disasters of increasing intensity and frequency have affected millions of people worldwide, caused $2 trillion in economic damage in the past 20 years globally, and disrupted the critical infrastructure essential for producing domestic and global resources and ensuring human welfare. Other broad environmental threats may involve resource competition, consumption, and pollution, and have the potential to degrade U.S. security and affect the health of the population. Examples include the impact of large-scale industrial accidents such as Freedom Industries’ contamination of the drinking water of 300,000 West Virginians in January 2014 or BP’s Deep Water Horizon oil spill in the Gulf of Mexico in April 2010.
Other consequences to consider are the politically destabilizing effects of widespread drought and famine and the effects of global industrial expansion in places like China. The breakdown or collapse of the nation’s built and natural infrastructure caused by environmental hazards such as these threatens not only individual and population health but also regional, national, and global security. The drivers of these threats are: irrevocably connected; complicated with feedback loops and political, economic, and social underpinnings; and outside the traditional role of the public health system.
As one out of ten strategic objectives included in the NHSS and as a small component of ESF #8, the prevention and mitigation of environmental health threats do not receive attention consistent with the magnitude and complexity of the threats themselves. Moreover, the inclusion of environmental health drivers that affect the health of the nation in the NHSS and ESF #8 contributes to a nationwide pattern in which environmental health typically is executed as a component of a broader public health agenda. The inclusion of prevention and mitigation of environmental threats in the NHSS and ESF #8 catalyzes consideration of the impact of the environment on public health security.
However, environmental drivers and consequences are so incredibly interconnected, the positioning of environmental health and security concerns under public health policy limits the efficacy of efforts to improve the national security posture and address the underlying environmental issues. To ensure the security and health of the nation from the aforementioned environmental threats, there needs to be a critical evaluation of how to address environmental health threats and consequences.
Short-, intermediate-, and long-term strategies need to be identified and then implemented at the local, state, federal, and international levels. A starting point for this could be a dialogue at the national level, in which federal agencies (e.g., DHS, HHS, and U.S. Environmental Protection Agency) and nongovernmental organizations (e.g., National Association of County and City Health Officials [NACCHO] and National Environmental Health Association [NEHA]) begin to consider the efficacy of the current approach to environmental health security in the United States.
Promoting Discussion on a National Level
National conferences, meetings, and training events should be leveraged to begin this dialogue. NACCHO has taken a first step in this by making global health security the focus of the 2015 Preparedness Summit. The call for abstracts encourages submissions that address health security issues related to environmental conditions, such as climate change, and other threats – for example, cybersecurity, bioterrorism.
The discussion and strategies must consider all the impacts of environmental health drivers on society, not just those affecting public health. An EHS strategy should rest at the confluence of: environmental disaster prevention, mitigation, and response; domestic and global threat reduction; resource sustainability and scarcity concerns; critical infrastructure protection and adaptation; and environmental monitoring, regulation, policy, and workforce development.
A strategy should include coordination of the healthcare and public health, food and agriculture, water, energy, nuclear, and chemical sectors, which involve many interdependencies and necessitate public and private cooperation for continued availability of resources and services. Factors such as physical, chemical, and biological hazards that directly affect health and the nation’s security should be incorporated. An EHS strategy also should prioritize “modifiable” environment-related factors realistically amenable to change using available technologies, policies, and preventative practices.
Any change in national policy and practice involves a massive undertaking. Factors complicating the nation’s ability to develop and execute an EHS strategy include domestic political agendas, competing public and private economic aspirations, societal and professional norms, and complex international relations. All of these issues serve to shape, and sometimes inhibit, policy- and practice-based responses to threats. The consideration and development of a National Environmental Health Security Strategy likely will take years to accomplish and to change how the nation approaches EHS, thus disrupting conventional practice and wisdom.
Disagreement is expected. Some may question the entire premise. Others may disagree over the approach to the revisioning process and what should be included in an EHS strategy. It may ultimately be determined that the United States does not need a separate EHS strategy, or political and professional incongruence may interfere with or prevent its development. Regardless, a dialogue – including hard questions and evaluation of current practices and policies – between public health, environmental health, and security professionals and agencies is needed. Asking questions and critically considering approaches to environmental health security are necessary for improving the nation’s ability to prevent, mitigate, plan for, respond to, and recover from environmental health threats to the public.
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Justin Snair, M.P.A., CBCP, is the founder and principal consultant with SGNL Health Security Solutions and co-founder of Naseku Goods. Formerly, he was a senior program officer with the National Academy of Sciences, Engineering, and Medicine and directed the Forum on Medical and Public Health Preparedness for Disasters and Emergencies and the Standing Committee on Medical and Public Health Research During Large-Scale Emergency Events. In 2012-2015, he served as a senior program analyst for critical infrastructure and environmental security at the National Association of County and City Health Officials. For six years, he was the local preparedness director and environmental health agent with the Acton Public Health Department in Massachusetts. In 2001-2006, he served as a corporal and combat engineer in the U.S. Marine Corps Reserves and is a veteran of the Iraq war. He holds a Master of Public Administration degree from Northeastern University’s School of Public Policy and Urban Affairs, a Bachelor of Science degree in Health Science from Worcester State University, and is an executive fellow with Harvard University’s National Preparedness Leadership Initiative.
Christopher Mills holds a Bachelor of Science in Biology from Roger Williams University and is a preparedness and environmental health security intern at the National Association of County and City Health Officials. In this roll, he supports project efforts, conducts research, and provides analysis in the fields of radiation, infrastructure, and climate change security.