Setting the Context: Environmental Health Practitioner Competencies. (Guest Commentary)
Gordon, Larry, Journal of Environmental Health
Editor's note: The author gave a version of this paper as the keynote presentation at an American Public Health Association--National Center for Environmental Health workshop in February 2000. The views expressed in it do not necessarily reflect those of the National Environmental Health Association.
Important change requires time and persistence. Inasmuch as I have articulated many of the observations and recommendations that I am making today for a number of years, I offer the following quotation attributed to Albert Schweitzer:
No ray of sunshine is ever lost, but the green which it awakes into existence needs time to sprout, and it is not always granted to the sower to see the harvest. All that is worth anything is done in faith.
Current State of Affairs
* Environmental health and protection is a high-priority issue in our society. It is demanded by the public, the media, and political leaders and is widely considered to be an entitlement.
* Environmental health and protection is a profoundly complex, multifaceted, multidisciplinary, and interdisciplinary field of endeavor engaged in by a wide spectrum of disciplines, professions, and others within a complex array of public and private organizations.
* The field of public-health practice has evolved into at least two major systems for the delivery of comprehensive public-health services at the state and federal levels, the major areas being personal public health and environmental health and protection.
* Environmental health and protection is the responsibility of numerous agencies at the federal, state, and local levels, as well as in the private sector.
* At the state level, 90 to 95 percent of environmental health and protection activities are assigned to agencies other than health departments, and there appears to be a similar trend at the local level.
* Expenditures and numbers of personnel for environmental health and protection account for roughly 50 percent of the field of public-health practice and are, therefore, the largest single component of the field of public health. Few public-health leaders acknowledge this because the annual reports of the Public Health Foundation do not include the expenditures of the 90 to 95 percent of environmental health and protection activities that are not in health departments. This under-representation of environmental health and protection expenditures continues to make environmental health and protection appear to be but a bit player in the field of public health.
Definitions are essential. In the absence of standard definitions, every group confuses and garbles the issues by reinventing the wheel. A product cannot be uniformly understood or marketed if we don't know whether we're dealing with a buggy whip or a rocket ship. Therefore, I will define and comment on a few key terms.
The standard definition for environmental health and protection was developed for a widely peer reviewed report, "The Future of Environmental Health," and should provide a framework for our discussions (NEHA Committee on the Future of Environmental Health, 1993):
Environmental health and protection is the art and science of protecting against environmental factors that may adversely impact human health or the ecological balances essential to long-term human health and environmental quality. Such factors include, but are not limited to: air, food and water contaminants; radiation; toxic chemicals; wastes; disease vectors; safety hazards; and habitat alterations.
Most environmental health and protection practitioners may be classified as environmental health and protection professionals or as professionals in environmental health and protection. All are essential components of any comprehensive effort. The following definitions are found in the 1991 booklet Educating the Environmental Health Science and Protection Work Force: Problems, Challenges, and Recommendations (Health Resources and Services Administration, 1991):
Environmental health and protection professionals are those who have been adequately educated in the various environmental health and protection technical (programmatic) components, as well as in epidemiology biostatistics, toxicology, management, public policy, risk assessment and reduction, risk communication, environmental law, social dynamics and environmental economics. …