|Proceedings of a Workshop—in Brief|
Toward a Future of Environmental Health Sciences
Proceedings of a Workshop—in Brief
What could the future of environmental health sciences hold, and what steps might be taken now to guide the field’s trajectory? To envision a future research enterprise that integrates environmental health sciences, biomedical science, prevention research, and disease-specific research across the continuum from fundamental discovery research through the application of this research to population health, the National Academies of Sciences, Engineering, and Medicine hosted a workshop titled Towards a Future of Environmental Health Sciences on April 26–27, 2022.
In presentations and structured discussions, panelists explored expanding the mental model (a representation of how something works) and normalizing the language of environmental health, along with frameworks for identifying the breadth of stakeholder diversity needed. The panelists took a scenario-based approach to envision an integrated research enterprise, explore possible routes to reach this research future, and examine key scientific, technical, and policy gaps. The scenario-based exercises1 were designed to facilitate a welcoming space for an open discussion across different perspectives. The virtual event convened speakers and panelists from government, academia, and community and nonprofit organizations with expertise in environmental health sciences, environmental justice, social and behavioral sciences, biomedical science, public health, and policy. This Proceedings of a Workshop—in Brief provides the rapporteur’s high-level summary of the topics addressed in the workshop, including participants’ suggestions for advancing research, improving models, and approaches to integrating environmental health across research areas and applications. Additional materials, including recordings from the workshop, are available online.2 This proceedings highlights potential opportunities for action but these should not be viewed as consensus conclusions or recommendations of the National Academies of Sciences, Engineering, and Medicine.
1 Scenarios for the sessions are described in the agenda. See https://www.nationalacademies.org/event/04-26-2022/towards-a-future-of-environmental-health-sciences-a-workshop (accessed July 19, 2022).
2 See https://www.nationalacademies.org/event/04-26-2022/towards-a-future-of-environmental-health-sciences-a-workshop (accessed June 16, 2022).
Workshop Impetus and Organization
Kim Boekelheide (Brown University) set the stage for the discussions. The workshop was organized under the purview of the National Academies’ Standing Committee on the Use of Emerging Science for Environmental Health Decisions, which examines issues regarding the use of new science, tools, and research methodologies for environmental health decisions. In addition to providing a venue for exchange among the scientific community, the Standing Committee’s activities also help to inform government agencies on emerging issues and science in the area of environmental health. As part of a broader effort to gather input to envision the future of the environmental health sciences field, Boekelheide described the workshop’s objective of exploring the 10-year horizon for environmental health sciences and the near-term research activities that can contribute to that future.
PART 1: SCANNING THE ENVIRONMENTAL HEALTH HORIZON
The first part of the workshop focused on envisioning examples of future priorities and directions for the field of environmental health sciences. Speakers discussed the 10-year horizon for the field overall and examined particular considerations for advancing knowledge and decision making in precision medicine, environmental justice and the exposome,3 and climate change and health.
EMERGING TRENDS AND PRIORITIES
To open the workshop and set the stage for the discussions to follow, Melissa Perry (George Washington University) moderated a panel focused on envisioning the 10-year horizon for redesigning environmental health sciences. Panelists Kristen Malecki (University of Wisconsin–Madison), Nicky Sheats (Kean University), Andrew Geller (U.S. Environmental Protection Agency [EPA]), and Kate Marvel (Columbia University and NASA Goddard Institute for Space Studies) highlighted key research questions and directions as well as technologies and methodologies needed to enable progress in these areas.
In outlining her vision for the future of environmental health sciences, Malecki emphasized systems thinking, translational research, and equity. While the traditional environmental health paradigm connects the dots between hazards exposures and the development of disease, Malecki said that emerging tools and technologies open opportunities to consider more upstream factors and understand the hallmarks of disease risk before disease starts. A broader, more systems-level paradigm suggests a need for enhanced tools to address the complex interplay among the chemical environment, the built environment, the social environment, and individual behaviors.
Pointing to the dramatic health disparities across U.S. populations—evident in patterns of expected lifespan at birth and exacerbated by the COVID-19 pandemic4—Malecki stressed the need to capture the unique drivers of disease susceptibility with an equity lens and identify what steps might be taken to protect groups with the highest vulnerability. She noted that emerging innovations present opportunities to advance predictive toxicology and reduce the reliance on animal models; to elucidate the role of the gut microbiome; and to continue to expand understanding of how multiple exposures interact. Highlighting the National Institute of Environmental Health Sciences (NIEHS) environmental health research translation framework,5 she underscored the importance of translating environmental health sciences insights not only into clinical practice but also into communities. “Looking to the future of environmental health, we need to capitalize on past successes and strengths to advance new areas of environmental health sciences through innovation, translation, and equity,” she said.
Sheats outlined how focusing on cumulative impacts can form the basis for a community-centered, multidisciplinary approach to environmental health and environmental justice. “Cumulative impacts can be arguably thought of as the preeminent environmental
3 Exposome can be defined as the totality of environmental exposures and corresponding biological responses over a lifespan. See https://factor.niehs.nih.gov/2021/7/feature/3-feature-niehs-council/index.htm (accessed July 15, 2022).
5 See https://www.niehs.nih.gov/research/programs/translational/framework-details/index.cfm (accessed July 19, 2022).
justice issue in the country,” he said, defining cumulative impacts as the combined effects of multiple pollutants, usually from multiple sources, as they interact with social and other factors in the community. The current regulatory framework addresses individual pollutants, but communities can experience impacts from cumulative exposures even if no individual pollutant standard is violated. Compounding this challenge is the fact that the cumulative amount of pollution a person is exposed to in the United States is connected with race and income, leading to a disproportionate pollution load and contributing to persistent health disparities across groups. A focus on cumulative impacts captures this complexity by spanning not only the pollutants people are exposed to but also the social factors that may contribute to a community’s vulnerability to adverse health impacts from those exposures, Sheats said.
Expanding further on the theme of social determinants of health, Geller outlined his vision for a future of environmental health sciences that more fully addresses groups’ vulnerability to environmental stressors and health disparities. Because social determinants of health can exacerbate the impacts of environmental exposures, he stressed that reducing vulnerability is critical to reducing health disparities: “The challenge is not simply environmental health, but understanding and eliminating health disparities,” he said.
Noting that EPA defines cumulative impacts as the total burden of health-affecting conditions or circumstances on an individual or community, Geller said that there is a need for more data relevant to incorporating vulnerability into exposure and risk estimates, including through epidemiological studies that reflect the full diversity of the U.S. population. He said to move from the traditional chemical risk assessment paradigm toward a more complex view that incorporates non-chemical stressors, it will be useful to define the constellation of environmental and social factors relevant to identifying “vulnerable” phenotypes, which in turn helps to identify groups that experience accelerated aging and health disparities. In this way, the notion of cumulative social stress, operationalized as molecular biomarkers like epigenetics, provides a framework to move from a single-exposure, single-outcome approach to a more nuanced, context-sensitive perspective to inform decision making.
Climate change is causing a wide range of health impacts in communities around the world. To provide a basis for the workshop discussions on how the field of environmental health sciences can best contribute to knowledge and decision making around climate and health, Marvel outlined the physical science basis for climate change and its impacts. She emphasized the scientific consensus that humans are responsible for observed warming trends, largely through greenhouse gas emissions, and noted that the addition of aerosols, such as particulate matter pollutants, also plays an important role in the physical processes under way in the atmosphere, as well as having important health effects. She discussed how climate change is increasing the frequency and severity of extreme weather events, such as heat waves, downpours, and hurricanes, as well as contributing to sea-level rise and its subsequent impacts.
While she said it is too late to prevent the near-term impacts of climate change, Marvel stressed that the actions taken today do make a difference for the longer-term impacts of climate change. In addition, she highlighted that many climate mitigation strategies have co-benefits for health and other factors that communities can begin to reap in the near term. In the discussion, Sheats added that decision makers and communities should prioritize policies that have co-benefits for addressing climate change and curbing the disproportionate impacts of greenhouse gas emissions in environmental justice communities. To advance the science and inform decision making, Marvel added that it will be important to have effective dialogue between climate scientists and the environmental health community to help identify what questions physical scientists should focus on.
The panelists discussed the evolving conceptions of what defines environmental health sciences and cumulative impacts, as well as how existing and emerging knowledge and tools can be leveraged to move the needle on
improving population health. Malecki said a critical shift for environmental health is an increasing focus on prevention—opening opportunities to be proactive, rather than reactive, in preventing harmful exposures before they occur. For example, she posited that –omics (e.g., genomics, transcriptomics, proteomics, metabolomics) technologies are posed to advance understanding of cumulative risk and could also be used to derive molecular signatures of the body burdens of emerging chemicals. Geller added that there is a growing emphasis on forms of knowledge beyond traditional data sources, recognizing the value of a community’s knowledge and history, economic data, and other forms of information that are relevant to a community’s own goals. As communities and scientists continue to improve the tools and amass knowledge, Sheats added that it is important to continue to make decisions even when the information is incomplete or the tools are not fully mature. “We don’t have to have perfect knowledge before we act on the knowledge that we do have,” Sheats concluded.
ENVIRONMENTAL HEALTH AND PRECISION MEDICINE
Building on the discussion of the 10-year horizon, panelists Julia Brody (Silent Spring Institute), Brandon Pierce (University of Chicago), Elena Rios (National Hispanic Medical Association), and Alicia Zhou (Color Health) discussed the frameworks, people, and approaches that may help to address opportunities and challenges in integrating environmental and exposures data into precision medicine. Weihsueh Chiu (Texas A&M University) moderated the session, which used the scenario of a patient’s interaction with their primary care physician to envision how access to –omics data, environmental and exposures data, and lifestyle and behavioral information could inform a better understanding of health conditions within a family or neighborhood. In brief introductory remarks, Brody outlined her vision for a decision framework based on identifying relevant exposures, integrating exposure measurements into routine care, and using the results to enable personalized exposure reduction, targeted medical monitoring, and public health surveillance. She said that equity and community-engaged partnerships are critical to environmental health studies and interventions, highlighting examples of effective coalitions from studies of chemical exposures and breast cancer and fire retardant chemicals. To connect research with individual decision making, she added that it is vital for researchers to make results available to participants and offer contextual information about what is important and what individuals can do with the knowledge gained.
Pierce and Zhou described innovative approaches to tracing gene–environment linkages and feeding that information back to individuals to help inform decision making. Pierce highlighted his studies of arsenic exposure in Bangladesh, which are designed to help people determine whether they may face an increased risk of health effects from their personal level of arsenic exposure. Zhou described how her organization takes a genotype-first approach to predict how a person’s genes might influence their phenotype and to identify opportunities to prevent certain health problems before they emerge. She said that by generating clinical-grade information that has value for patients and physicians that this approach can shed light on individual susceptibility and inform interventions to reduce the burden of key diseases, such as cancer and heart disease.
Precision medicine approaches have both benefits and potential pitfalls in the context of disparities in health and environmental health. Pointing to her work with Hispanic communities, Rios underscored the need for policies to reduce exposures and increase the involvement of underrepresented communities in research, including through thoughtful training for researchers aiming to work with communities that have a different social or ethnic background than their own. Brody noted that building trust with communities is essential; she said that researchers should attend to privacy risks in data collection and take steps to ensure that the data are used for the benefit of the individuals and avoid fueling stigmatization. Zhou added that it is important to collect data in an unbiased way, for example, by ensuring that the devices used to measure exposures are effectively deployed across all communities and not only concentrated in affluent areas. She said unconscious bias has contributed to major knowledge gaps, including a dearth of exposure data in many rural communities. Rios urged a focus on community-based research, and Pierce
added that a community’s goals and priorities should take a lead role in setting the research agenda itself.
Exploring the scenario posed to them and questions submitted by attendees throughout the discussion, the panelists considered how physicians could utilize a variety of data sources to provide actionable information for patients. Brody speculated that 10 years from now there will be more exposure monitoring devices in the environment, offering a clearer picture of the exposures that may be relevant to a particular patient. Rios said that one challenge for precision medicine tools of the future will be to not only identify likely exposures but also to correlate exposure times and locations.
Brody noted that some automated tools are being developed to help clinicians access relevant and meaningful exposure information, adding that there are also opportunities for researchers and clinicians to use wearables or other emerging technologies for personalized exposure monitoring. Despite the promise of these approaches, she said that it is important not to oversell what they can offer. “We need to share the information that we know—and also let people know what we do not know,” she said. Zhou added that inconsistencies in the terminology used for environmental exposures and health impacts can lead to confusion among clinicians and ultimately patients. She suggested that the research community should play a lead role in establishing a shared framework and nomenclature that is consistent and understandable.
To realize the promise of precision medicine for environmental health, the panelists pointed to several examples of priorities for research, funding, and collaboration. Pierce and Zhou underscored the value of leveraging large collections of data from diverse populations to extract meaningful information about exposures. Zhou added that this will require investments in data infrastructure, which can be costly but is critical to maintain. Rios suggested identifying which communities face the highest risks and prioritizing research funding and policy interventions accordingly. She also stressed the importance of building trust within the community and finding actionable solutions and clear messages to effect real change. “We have to think in terms of policies that can help with changing behavior,” she concluded.
ENVIRONMENTAL JUSTICE AND THE EXPOSOME
How might information about the exposome be operationalized to address environmental justice issues? In this session, the panelists examined frameworks, stakeholders, and approaches needed to address challenges related to health disparities as well as to advance environmental justice over the next 10 years. The panelists included Aisha Dickerson (Johns Hopkins University), Sacoby Wilson (University of Maryland), Robert Wright (Icahn School of Medicine at Mount Sinai), and Ami Zota (George Washington University); Chandra Jackson (NIEHS) moderated the discussion. As a starting place, the panelists focused on the scenario of predominantly African American communities adversely affected by swine industrial livestock operations in Eastern North Carolina. Given the availability of comprehensive data on biomarkers of dietary, chemical, and pollution exposures, the panelists discussed how policy makers, environmental scientists, and community members might leverage this information to develop a plan for remediation and address environmental justice concerns in the affected community.
Emerging –omics tools offer opportunities to characterize the exposome and advance cumulative risk assessment. Wilson said that these technologies can help to close the gaps where knowledge of the health impacts of exposures is not keeping pace with the exposures people are experiencing. He posited that –omics data, which have proved instrumental in helping communities document harm in some cases, should be incorporated into cumulative risk assessment. Building on this point, Zota said that researchers need to focus on intersectionality and combine qualitative data with exposome measurements. Noting that risk assessments often focus on particular disease outcomes but fail to account for the ways disease outcomes influence each other, Wright suggested that risk assessment approaches should also take a cumulative approach to outcomes. “We think of the exposures as mixtures; in fact, the outcomes are also mixtures but we rarely think of them that way,” he said.
The panelists said that environmental justice communities are eager to shift from characterizing or drawing attention to problems to actually taking steps to address them. “Doing good science is not enough to actually move us toward justice and equity—we have to do something with the science,” Zota said. “That takes work; that takes innovation; that takes community engagement. It cannot be an afterthought.”
When the goal is to influence action, Dickerson pointed out that it is helpful to establish priorities, rather than simply creating lists of problems. Translating research into solutions requires disseminating evidence to politicians and community members who are in a position to take action, she said, and it requires that funding agencies support solutions-oriented research. Zota and Wilson added that coalition building and communication are essential to generating the political will to act. This could entail bringing together stakeholders who have an interest in the problem, as well as using traditional media, social media, and other channels to amplify the voices and concerns of those stakeholders. “We have to do better in increasing the accessibility of our information,” Zota said. She and Wright also noted that the approach to communication should be inclusive and appropriate for the intended audience, recognizing that some groups may be better reached through physical outreach in the community; others will be better reached through traditional media channels; and others can be effectively engaged via social media. Wilson added that metrics, such as environmental justice scorecards, can also resonate with politicians and community groups to help spur advocacy and track progress.
Panelists noted that listening to communities is essential. Wright cautioned that even when a problem seems clear-cut, listening to the community’s concerns can surface important considerations. For example, designating an area as a Superfund site can influence property values and create a stigma; while residents may have an interest in having the site cleaned up, researchers should not assume they would be in favor of a Superfund designation. “Nothing is ever unanimous,” Wright said. “There are going to be competing voices, and we do need to listen to them.” Zota added that community input is also critical in informing what research questions to study, pointing to a need for more bidirectional communication between researchers and communities to elucidate how exposome research could fit with community priorities.
Looking forward, Wright speculated that low-cost, accessible sensors and mapping tools will help to enable more community-based research and allow many communities to take the lead role in gathering and using their own data. Dickerson added that it is important not only to develop these tools but also to disseminate them effectively; many people simply are not aware of resources such as free water testing kits available from health departments or EPA’s environmental justice screening and mapping tool.6 In addition to awareness, Zota and Wilson said that for communities to fully engage with researchers and public health organizations also requires building trust, which can pose special challenges for communities that have historically faced discrimination in science and health care. To build that trust, Wilson said that it is important for researchers to focus on solutions in areas communities care about. “You have to connect the issues you are working on … to the stuff that is important to folks: food, faith, family, health, and jobs,” said Wilson. “It just cannot be the discovery science. It has to be at the point where you have good investment in engagement and good investment in solutions.”
Zota noted that while there are good publicly accessible tools available for some types of exposures, actual exposome data such as biomarkers are not something most people can readily obtain, making cost and accessibility important barriers to translating these types of data to awareness and decision making. Wright added that researchers also face barriers in using these data to derive insights and suggested that federal agencies could fund databases and other tools to help toxicologists and epidemiologists better understand exposome data. “Until we make that investment so that we actually have the tools to actually interpret exposomic data, it is going to
be really hard when you measure 10,000 things to know what is important and what is not,” he said.
CLIMATE CHANGE AND HEALTH
Climate change has many impacts on the health of individuals and communities. Patrick McMullen (ScitoVation) moderated a discussion among Karen Bailey (University of Colorado Boulder), Christine K. Johnson (University of California, Davis), Patrick Kinney (Boston University), and Na’Taki Osborne Jelks (Spelman College) focused on new frameworks, people, and inclusive approaches that may be helpful to incorporate science into climate adaptation, policy planning, and public health in inclusive and equitable ways. Panelists considered the scenario of allocating a $1 billion budget for community-driven initiatives to help address climate change and related health issues nationwide, with particular attention to wildfires and their impact on air quality, severe drought and its impact on farmers and rural communities, and the impacts of other severe weather events such as flooding and extreme winter storms.
Health and climate intersect on a range of fronts. Johnson discussed how climate change and related shifts in land use are creating new opportunities for interaction between people and wild animals, raising the risk of zoonotic disease transmission. To track these impacts at the local scale and enable better surveillance for early detection of emerging infectious diseases, Johnson said it will be important to closely integrate animal, human, and environmental research, taking advantage of technological innovations such as precision medicine and remote data collection and emphasizing community-driven and citizen science approaches. In addition to infectious diseases, climate change brings health risks from extreme heat, exposure to contaminated floodwaters, increased pollen production, increased air pollution, severe weather events, and other pathways. Kinney said that the breadth of these impacts suggests a need to expand the scope of environmental health sciences beyond the traditional molecular-scale focus and forge stronger links with atmospheric scientists, social scientists, policy makers, and communities.
Intersectionality and interdisciplinarity will likely be critical to advancing solutions-oriented research surrounding climate and health. Bailey said that siloing can exacerbate challenges. An interdisciplinary team science approach in research studies can lead to solutions. Osborne Jelks added that the cumulative nature of many health impacts of climate change also elevates the importance of intersectionality. Climate change has the potential to exacerbate the negative health impacts that many people already experience from both chemical hazards and social factors over the course of their lifetimes, particularly for vulnerable communities such as those with preexisting health conditions.
Considering the scenario focused on resource allocation, the panelists stressed the important role of community-level research and action. Kinney noted that the pathways linking climate change to health are complex and place-specific. Given that there is no simple regulatory solution—governments do not set standards for temperatures or wildfires the way they do for toxic chemicals—Kinney said that partnerships among academic researchers, public health organizations, and community organizations are critical to developing tangible solutions to on-the-ground problems at the local scale. Osborne Jelks pointed to the value of community science models in which community organizations play a lead role in identifying the key questions to ask, collecting actionable data, and using that data to press for change. Drawing knowledge and data from the residents living in a community can help to fill gaps in understanding the impacts of climate and other stressors and inform solutions, she said.
In prioritizing what types of data to collect, Bailey said that the focus should be on data that will be usable, actionable, and empowering for individual and collective action in vulnerable communities. Osborne Jelks noted that it is important to recognize the social vulnerabilities that some communities experience as a result of policy structures: “We’re all in the same storm,” she said, “but we’re not in the same boat.” Bailey added that bringing a sense of humanity and a focus on healing is important
to addressing past injustices while working toward future solutions.
The panelists suggested that successful community-based work requires time, investment, and the right mindset. There are already good models to draw from: Kinney pointed to NIEHS’s programs in environmental justice7 and community-based participatory research8 as examples of successful investments that have not only advanced research but also helped to build capacity in many communities. Bailey noted that agencies have established useful frameworks for engaging with local communities, although they are not always adhered to well. Osborne Jelks stressed the importance of capacity building within communities, which requires sustained funding to support community organizations that work collaboratively with academic researchers and public health practitioners, not only through sub awards but also through sizeable and direct grants. In addition, she suggested that, where possible, funding structures should allow sufficient time for researchers and community organizations to cultivate relationships and co-develop projects, a process that can take longer than traditional academic funding cycles allow.
Kinney, Johnson, and Osborne Jelks added that issues at the intersection of climate and health span the missions of multiple agencies—EPA, the National Institutes of Health (NIH), and the National Science Foundation, for example—and suggested that a joint or cross-agency program to address both climate mitigation and adaptation with a focus on local-scale, community-based research could be an effective way to advance progress.
PART 2: CHARTING THE PATH AHEAD
The second part of the workshop focused on identifying funding and collaboration strategies to advance future directions and priorities for the field, with particular attention to opportunities in the areas of precision medicine, environmental justice and the exposome, and climate change and health.
Agency Perspectives and Opportunities
Gary Miller (Columbia University) moderated a session highlighting perspectives and opportunities from federal funding agencies that will likely play an active role in environmental health sciences as the field evolves over the coming decade. Panelists included Rick Woychik (NIEHS), Richard Hodes (National Institute on Aging [NIA]), Shannon Zenk (National Institute of Nursing Research [NINR]), and Gary Ellison (National Cancer Institute [NCI]).
Woychik provided an overview of NIEHS and cross-NIH priorities and initiatives. He said there are many opportunities for partnerships—including purposeful engagement with communities—to study the influence of the environment on the etiology of human disease, adding that this now extends beyond the “usual suspects” to include social determinants of health. The emerging concept of precision environmental health complements precision medicine by recognizing that individuals respond to environmental exposures in different ways as a result of genetic, epigenetic, and other factors, with a focus on preventing disease. The notion of the exposome, reflecting the totality of exposures over the lifespan points to the need to move beyond single exposures, he said. Although this concept is well established, Woychik noted that the scientific community is still grappling with how to operationalize exposomics in research methodology.
Climate change and health has been a major focus for the administration since President Biden took office in 2021. While NIEHS has been a leading institute funding research in this area over the past decade, Woychik said that a new Executive Committee for Climate Change and Health is now working to develop a strategic framework for transdisciplinary, transformative research in health effects, health equity, intervention science, and training and capacity building across the entire NIH.9 Another growing area of interest is mechanistic and translational toxicology with a goal of translating research to predict health effects.
7 See https://www.niehs.nih.gov/research/programs/ehd-ej/index.cfm (accessed July 19, 2020).
8 See https://www.niehs.nih.gov/research/supported/translational/community/index.cfm (accessed July 19, 2020).
Hodes highlighted how NIA activities are helping to elucidate the impacts of environmental exposures on aging and older people. Two key areas of focus are extreme weather and air quality. Noting that older adults suffer disproportionate health impacts from climate change and extreme weather, Hodes said that observational studies of people affected by disasters such as 9/11 and the 2011 Japanese tsunami have provided insights into the health effects of such events for older people. In the area of air quality, he highlighted research in China and the United States aimed at tracing the relationships between air pollution and cognitive decline. As tools for monitoring exposures continue to improve, he said there will be opportunities to better understand how social determinants of health combine with environmental exposures—both at acute timescales and over the course of the lifespan—to affect health as people age.
Nurses were among the first in the health care field to recognize that how people live affects their health and incorporate environmental factors into care. Zenk said that what sets NINR apart is its focus on solutions that work in the context of people’s lives. She continued, environmental health is crucial to health equity and closely linked to social determinants of health. “There are communities, through no fault of their own, [that] lack the resources to live their healthiest lives,” she said. NINR supports research focused on innovation, rigorous research methods, and health impact; advancing equity, diversity, and inclusion; and solutions to optimize health across settings and tackle pressing current and future challenges. Environmental factors cut across many key focal areas at NINR, including health equity, social determinants of health, population and community health, prevention and health promotion, and systems and models of care. As examples of this work, Zenk pointed to the Transformative Research to Address Health Disparities and Advance Health Equity initiative,10 the Community Partnerships to Advance Science for Society program,11 and the NIH-wide Social Determinants of Health Research Coordinating Committee, among others.
Ellison discussed how environmental health fits into the notion of the cancer control continuum, a framework for identifying research gaps and priorities relevant to reducing the burden from cancer at all stages from etiology to survivorship. Cancer is heterogeneous and complex, and the environment is also complex. Previous research on windows of susceptibility for cancer illustrates the key role of transdisciplinary science to accelerate the pace of scientific discovery. While advances in technology and research methods have enhanced the ability to understand how environmental exposures affect cancer susceptibility, Ellison said fully realizing the potential of this will require collaborative approaches to bridge genetics, phenotypes, and environment. As examples of key activities in this area, he highlighted the NCI Cancer Epidemiology Cohort,12 the NCI Cohort Consortium,13 and other initiatives to support research using data from established cohorts and to build the next generation of research cohorts. He argued that expertise in ethics, communications, and quality assessment is important.
Panelists discussed the need for continued dialogue and collaboration among federal research funding agencies, as well as other agencies, regulators, and advocacy groups, to translate findings from basic research into actionable solutions that account for the role of environmental exposures in health and disease. Woychik noted that the response to the COVID-19 pandemic demonstrated the value of cross-agency collaboration and said the NIH “All of Us” program14 is a good example of how agencies are increasingly working together to effectively integrate research programs. Hodes noted that the onus is on NIH and its institutes (not researchers themselves) to lead the way on connecting and coordinating research activities across agencies and institutes. Ellison said that it is also important for funding agencies to remain attentive to the concerns and needs of the extramural research community. To realize the potential of exposomics and work toward a future vision for environmental health sciences, Woychik said that it will be valuable to elucidate what tools, methods, and data repositories are needed and to identify
10 See https://commonfund.nih.gov/healthdisparitiestransformation (accessed June 17, 2022).
11 See https://dpcpsi.nih.gov/sites/default/files/2.10PM-Cf-Concept-COMPASS-Zenk-Gordon-FINAL-508.pdf (accessed July 15, 2022).
epigenetic markers that can shed light on developmental exposures. Ellison underscored the need for methods to measure exposures over time and incorporate them into large, longitudinal studies, and Zenk suggested focusing on opportunities to streamline data collection, such as through tools that can be used to assess exposures and behaviors simultaneously.
NEW VOICES AND NEW COLLABORATIONS
For the workshop’s final discussion session, Christina Park (NIH) moderated a conversation about how to achieve a research enterprise that fully integrates environmental health sciences into broader studies of human health and disease through building new collaborations and working across disciplines and sectors. The panelists included Jackson, Kim Fortun (University of California, Irvine), Jamaji Nwanaji-Enwerem (Emory University), and Martin Mulvihill (Safer Made).
Jackson outlined the fundamental principles and goals underlying environmental health sciences. Highlighting the linkage between overexploitation—of both people and resources—and the adverse social and physical environments that cause illness and health inequities, she said that disrupting exploitative practices will be critical to addressing environmental health problems. If the overall goal is for people to die of natural causes after reaching their optimal life (and health) potential, she noted, it is clear that clean air, water, soil, and food security are essential to that fundamental goal. She suggested that people should be viewed as a manifestation of the environment, rather than separate from it, and allocate most research funding toward preventing risk factors from developing, which involves collecting and integrating data along the full spectrum of exposures.
Different stakeholders have different levels of awareness and understanding of environmental hazards. Fortun discussed the role of communication and capacity building in generating knowledge and informing action on the part of individuals, communities, scientists, and governments. In many cases, she said, it cannot be assumed that people are aware of the hazards they face in their home communities; she pointed to creative approaches, such as using art to communicate about science and incorporating environmental health knowledge into K–12 education, as opportunities to increase the public’s ability to access and use information about environmental exposures. She said that community-based organizations often have impressive capacity to build community knowledge infrastructure and suggested that these groups could benefit from greater collaboration with other communities facing similar issues. For their part, Fortun said that scientists are often willing to reach beyond their traditional sphere to make their work relevant to communities, though there are important barriers to this. Finally, she said there is a need to move toward shared governance approaches to facilitate effective government action at the right levels and agencies.
Adaptation can be an important part of making progress in environmental health and environmental justice. Nwanaji-Enwerem stressed the need to constantly reexamine and improve approaches to research and interventions. He outlined five facets of environmental health that are currently used mostly in the context of research but are also potentially relevant for clinical use. The first, timeframe, speaks to the timing and duration of the exposure and how the effects of the exposure evolve over time. The second, objective, refers to how a given marker will be used to inform decisions. The third is utility and understanding. Nwanaji-Enwerem said that researchers should not allow a lack of understanding of biomarkers to inhibit assessments of how to use them. The fourth facet, risk, speaks to what can be done to mitigate exposures and the level at which that mitigation is possible, such as through individual behavior change or through public policy. Finally, he noted that attention to equity is crucial for advancing health research and interventions in ways that work for everyone.
The products people use can be a source of exposure to chemicals, and the manufacture and disposal of products can release chemical pollutants into the environment. Mulvihill discussed opportunities and questions around the use of alternative materials and methods to prevent environmental exposures. As the petrochemical industry makes large investments in plastics and specialty
chemicals, he said that there is an opportunity to influence what chemicals are made and incorporate a greater emphasis on green chemistry approaches; for example, to avoid producing certain classes of chemicals or designing chemicals that are less persistent in the environment. Bio-based chemicals have been touted as a key opportunity to make greener products, but Mulvihill cautioned that different stakeholders have different conceptions of what makes a product sustainable. For example, while a certain base material may be “greener,” properties such as health impacts and recyclability are often influenced heavily by the additive chemicals that are incorporated for particular functionalities. To address these challenges, Mulvihill stressed the need for transparency and a holistic view of all of the materials and additives that go into a product. Given that no amount of measurement will ever achieve complete knowledge, he said that it would be better to understand how to act in the absence of certainty.
Fortun, Mulvihill, and Nwanaji-Enwerem pointed to the important role of education throughout the lifespan in empowering people to evaluate and synthesize information—and counter disinformation—to support greater awareness and informed action and political engagement around environmental health issues. In addition, Jackson and Mulvihill emphasized identifying areas where the interests of communities, organizations, and governments overlap in order to better integrate efforts and increase impact.
Malecki closed the workshop with a brief synthesis of key themes that emerged in the course of the workshop presentations and discussions as participants considered the societal and health challenges that environmental health sciences can help address, key research topics for the next 5–10 years, and the barriers to achieving the articulated research goals.
One key theme was the potential benefit of more complex models and integration of knowledge. Several participants highlighted the importance of attending to cumulative exposures across the life course, including social determinants of health; identifying assets and resources that support resilience, especially in underserved communities; and advancing new biomarkers, bio-based chemistry, and prescriptive toxicology approaches. The integration of knowledge across disciplines, platforms, and communities from the local to global scale may help to achieve this.
Participants also highlighted the health impacts of climate change—with particular attention to environmental justice—as a key research area for environmental health sciences going forward. Many panelists suggested that work in this area should focus on empowering communities and building capacity for community-based programs, with particular emphasis on local solutions with co-benefits for health and climate. In climate and other areas of environmental health, participants underscored the critical importance of solution-oriented research with an emphasis on prevention.
Additional themes included a focus on collaborative, multidisciplinary teams; intersectionality, humanity, and healing; advancing the utility of innovation in environmental health sciences to address complexity and enable research translation; and advancing awareness and utility of environmental health insights through communication and education. With regard to funding models, several participants underscored the need for continued collaboration across NIH institutes; the importance of addressing barriers for both scientists and community partners; and the need to build in the appropriate amount of time and money to enable multidisciplinary and community-driven research.
WORKSHOP ORGANIZING COMMITTEE: This workshop was organized by the following experts: KRISTEN MALECKI (Chair), University of Wisconsin–Madison; KAREN BAILEY, University of Colorado Boulder; CHANDRA JACKSON, National Institute of Environmental Health Sciences; PATRICK MCMULLEN, ScitoVation; GARY MILLER, Columbia University; CHRISTINA PARK, National Institutes of Health.
ABOUT THE STANDING COMMITTEE ON THE USE OF EMERGING SCIENCE FOR ENVIRONMENTAL HEALTH DECISIONS: The National Academies’ Standing Committee on the Use of Emerging Science for Environmental Health Decisions (ESEHD) examines and discusses issues on the use of new science, tools, and research methodologies for environmental health decisions. The ESEHD is organized under the auspices of the Board on Life Sciences and the Board on Environmental Studies and Toxicology of the National Academies of Sciences, Engineering, and Medicine, and sponsored by the National Institute of Environmental Health Sciences.
REVIEWERS: To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by KAREN BAILEY, University of Colorado Boulder, and CRISEYDA MARTINEZ, Icahn School of Medicine at Mount Sinai. We also thank staff member LIDA BENINSON for reading and providing helpful comments on this manuscript.
STAFF: LYLY LUHACHACK, Board on Life Sciences; NATALIE ARMSTRONG, Board on Environmental Studies and Toxicology; JESSICA DEMOUY, Board on Life Sciences; and DAISHA WALSTON, Board on Life Sciences.
SPONSOR: This workshop was supported by the National Institute of Environmental Health Sciences.
DISCLAIMER: This Proceedings of a Workshop—in Brief was prepared by ANNE JOHNSON as a factual summary of what occurred at the workshop. The statements made are those of the rapporteur or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Future of Environmental Health Sciences: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press: https://doi.org/10.17226/26639.
Division on Earth and Life Studies
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