Environmental Health and Public Health-The Same but Different
Blake, Rob, Journal of Environmental Health
In last month's column, I considered the remarriage of environmental health and environmental protection. I gave the example of Lincoln Lancaster County Health Department in Nebraska, where the two have been remarried within a local health department setting. I also pointed out that some environmental health departments, particularly in the western U.S., are no longer housed in public health departments.
If environmental health remains situated in the public health (PH) system for the large proportion of this country, what are the likely implications that we need to be aware of as we consider long-term marketing efforts for environmental health?
* There is a bleak financial picture within PH, and the pressure to bring in environmental health fees in order for programs to survive will continue to grow.
* The competition from retail big-box stores for medical and PH services is likely to increase. At these stores, shoppers are already able to buy food and supplies, get the oil changed in the car, have their blood sugar levels checked, or get their flu vaccine, all in one visit. This is a rapidly growing phenomenon and may increasingly take large numbers of individuals away from local PH clinics.
* The 1988 Institute of Medicine report, The Future of Public Health, reaffirmed that in the minds of the public, public health is often equated with medical care of the indigent. The 1988 report, and the updated report of 2002, made very little mention of environmental health.
* Much of the last century dealt with infectious diseases. The "new" killers are chronic diseases, many of which have a large environmental component, e.g., the built environment. Yet many environmental health (EH) and PH units are not positioned to make positive contributions in these areas.
* The various tools created in the PH arena in recent years are often followed by EH look-alikes because EH doesn't fit in very well into PH models. Examples include:
-- Assessment Protocol for Excellence in Public Health (APEX) and Community Environmental Health Assessment (CEHA),
-- Mobilizing for Action through Planning and Partnerships (MAPP) and Protocol for Assessing Community Excellence in EH (PACE EH),
-- 10 Essential Services of PH and 10 Essential Services of EH,
-- PH Competencies and EH Competencies, and
-- National Public Health Performance Standards and National Environmental Public Health Performance Standards.
* Often the constituencies of PH and those of EH within the PH agency are very different.
* The funding mechanisms for most of PH and EH are very different from each other.
* The creation of a single federal food agency may prompt mirror agencies at state and local levels, as happened with the creation of U.S. EPA. This has the potential to either solidify or fracture our field of practice.
As I discussed all these concerns with Nelson Fabian in our regular NEHA president-to-executive-director phone calls, we came up with the idea of a plenary session at the next Annual Educational Conference & Exhibition in Tucson, Arizona. We thought about having a panel of environmental health and protection experts from various viewpoints to begin discussion, and then have the audience participate in trying to answer the following questions:
* Is a combined environmental health and environmental protection model workable?
* What are the strengths and weaknesses of having environmental health in a traditional public health department and having it outside that agency?
* What marketing efforts are needed for our profession?
We have some ambitious ideas for this session:
* pose questions to the panel and also to the audience;
* include local, state, and federal environmental health leaders from both public health and non-public health settings;
* allow audience participation through immediate electronic feedback;
* allow non-AEC attendees to participate through webcasts and blogs; and
* possibly repeat this panel session at other major conferences, such as Association of State and Territorial Health Officials (ASTHO), National Association of County and City Officials (NACCHO), American Public Health Association (APHA), and National Association of Local Boards of Health (NALBOH). …