In this module, we're discussing environmental health policies, and the agencies that set and enforce those policies. I want to ask you though, take a moment and think about the first environmental health-related agency that comes to mind. For most of us here in America, that's probably the Environmental Protection Agency, and they absolutely do set policy. But I want to make it clear in this module that there are many different agencies, nationally, locally, all the way up to the global level, that have some role in setting environmental health policy. Before we dive into that, I just want to refresh us on the environmental policy cycle. So we've covered this in a previous module, but I want to emphasize that we have multiple steps here to the policy cycle. The first being formulating and defining the goals of the policy, setting an agenda for what we're hoping to accomplish, actually establishing the policy legally, and then implementing it on the ground, and finally, assessing how well the policy is working, and making tweaks as necessary. So that's the policy cycle, but I also want to emphasize the link between environmental health science and policy-making. In any type of scientific endeavor, we typically start with a hypothesis, and we gather scientific evidence to evaluate that hypothesis, we then synthesize that evidence, and use that evidence as part of our decision-making process. So now, we've entered the realm of policy with this step, and finally, we set our policy. So we can think about some of the additional components that are not previously shown on this graphic. So in terms of scientific evidence, that could include environmental data that we collect in communities around the world, it could include observational data of people's behavior, it could also include experimental data, where we evaluate a particular hypothesis and test it. In terms of synthesizing evidence, this is often done with statistical modeling, or with what's called risk assessment, which we'll cover in a different module in the class. For decision-making, we always have to ask ourselves, what is the strength of the evidence? Is there enough evidence here to suggest that we need to move forward with the policy? We also absolutely have to acknowledge uncertainty, what don't we know, and how might that impact the effectiveness of our policy? There's many different values that go into the decision-making process too. Those can be social, ethical, moral values. There's also issues around the cost of implementing this policy. Finally, there's also political concerns with crafting and getting the policy passed. I want to give you just a very brief overview of some environmental health related agencies, from a global scale all the way down to a very local scale. So at the left side of this figure, we're looking at a global agency, in this case, the World Health Organization, which isn't associated with any one country, but actually is part of the United Nations. At the national level, here in the US, we have the Environmental Protection Agency, or EPA, but then each of our 50 states also has agencies that are very much involved in environmental health. So I'll show you three examples here. Michigan is the example in the top row. We have a number of agencies that do environmental health related work. The Department of Natural Resources, the Environment Great Lakes & Energy Department, which is concerned with the quality of the environment, and how it impacts health. Air Quality Division that deals specifically with air pollution, and an Environmental Science Board. There are examples of states that have a simpler structure. In New York, for example, there's a Public Service Commission, and the Department of Environmental Conservation. It's also not always that simple. The bottom row here is the state of California, which has its own Environmental Protection Agency, an Air Resources Board, specifically focused on air pollution, an Integrated Waste Management board for other types of waste in the environment, an Energy Commission, and a Public Utilities Commission, and local cities and counties may have additional agencies. So there's a great deal of variability between our states, even though they're all trying to accomplish the same mission. So there's many different agencies at all levels of government, locally, all the way up to globally. I'd like to walk you through a couple of examples of agencies you may already be familiar with. The first one I'll start with is the United States Environmental Protection Agency, or EPA. EPA has a couple of different jobs. One is to develop and enforce environmental regulations, another is to provide educational material, and a third is to fund scientific research on the environment. EPA is an independent agency, it's not aligned with any cabinet level departments in the US, and staff at the EPA work collaboratively with state programs in all 50 states. The EPA is actually a very complex agency, in that it's comprised of many different centers, each of which focuses on a specific topic. So for example, air, or water, or radiation, environmental assessment, et cetera. A second agency I'd like to talk about is the US Agency for Toxic Substances and Disease Registry, or ATSDR. This agency differs from the EPA in that it doesn't set regulations. It's an advisory agency, with a focus on chemical safety. They conduct toxicological research. They also conduct educational outreach, and they host registries for types of exposures and diseases that are related to the environment. ATSDR also works collaboratively with state programs, and they conduct public health assessments, and create toxicological profiles, basically, massive scientific volumes, compiling our knowledge about specific hazards. Zooming out to the international level, the European Union has something called the European Environment Agency, or EEA. The EEA basically provides advice on the environment to all of the European Union Nations to allow those nations to establish and implement their own national policies. Now, the EEA works collaboratively with something called the European Environmental Information and Observation Network, which actually has established itself across all 33 member countries, and also six additional cooperating countries. To give you a little bit more information about this network, it basically consists of three elements, cooperation infrastructure, and content. In terms of cooperation, this network has national cooperation between countries, there's regional cooperation, and also cooperation across the entire union, all of this involving a lot of international networking. Those efforts are related to infrastructure, so this network basically sets infrastructure standards and tools to make sure that data can be shared broadly among all of these parties. Lastly, cooperation and infrastructure are related to actual contents. So this network is responsible for monitoring environmental conditions, gathering data, looking at that information, assessing it, and passing the knowledge gained along to all of those participating countries. Another agency that you're probably familiar with is the United Nations, which has one component called the World Health Organization, or WHO. The WHO gives advice to the 194-member nations of the United Nations, creates recommendations for global environmental standards on particular hazards, and also creates educational materials that can be used throughout the world. I'll give you just some examples of US environmental health laws, kind of zooming back into America. So we talked in a previous module about the National Environmental Policy Act, or NEPA, passed in 1969, which gave us a very broad framework to allow us to protect the environment going forward. Shortly after that, the Clean Air Act was passed, that set comprehensive regulations on air emissions of pollutants in the US. The same year, the Occupational Safety and Health Act was passed to regulate and make safer and more healthy working environments in the US. In 1974, the Safe Drinking Water Act was passed to protect specifically the quality of our drinking water. A few years later, the Clean Water Act was passed, which gave us comprehensive water pollution regulation, even for bodies of water that we don't directly drink out of. In 1976, we passed the Toxic Substances Control Act to regulate and require the reporting of chemical hazards. That same year, 1976, the Resource Conservation and Recovery Act was passed, which for the first time gave us something called cradle to grave reporting. Basically, this required that people who created hazardous waste had to track it all the way from creation, until it was properly disposed of. Fast forward about 20 years, and we passed the Federal Insecticide, Fungicide, and Rodenticide Act, or FIFRA, which regulated pesticide distribution, sale, and use specifically. So not all standards are created equal when it comes to environmental health policy. If we look, for example, at the EPA, they set or recommend limits on air and water pollutants, on water-borne pathogens, on pesticides, and also on radiation. That's not always true of all types of environmental health agencies however. Zooming in a little bit more, so EPA, when they focus on air pollutants, can set limits of air concentration. Basically how much of a pollutant can be present in the air at a given point in time, or even over a person's lifetime, and what is the risk associated with that exposure. All limits, including those set by EPA, makes some inference or some assumption about an acceptable risk. In the case of EPA, they will often say, for example, with a cancer-causing chemical, or a carcinogen, the risk can be no more than one case of cancer per million people exposed. If we have fewer cases than that, it's acceptable, if more cases than that, the exposure is unacceptable. EPA also sets limits for physical agents, and so those limits are based on levels that are expected to produce either no or a very small health effect. EPA sets limits on the amount of pesticides that can be present on food products. So basically, they say, below these levels, pesticides can be present on food because those low concentrations only present at low or acceptable risk of a health outcome. Finally, EPA can set limits on the amount of a pathogen, or the concentration of a contaminant in drinking water. So EPA regulates different kinds of hazards, they also have different types of exposure limits. So some standards set by the EPA set a one hour average or a one hour maximum exposure. These types of short-term limits are designed to protect you and me, and the public against acute health effects that can happen very quickly. EPA also will establish sometimes an eight-hour average exposure limit, that's designed to protect us against something that's not going to make us sick immediately, but might give us health effects over a portion of the day if we're exposed for that long. In some cases, EPA sets a limit that's based on a one-year exposure average, and that's designed to protect against a chronic health effect. Nothing that's going to happen on a day-to-day basis, but something that could happen if you're exposed for multiple years. Finally, EPA also sets what's called a maximum contaminant limit for water. So that's basically the absolute highest amount of that contaminant that can be in water and still meet the EPA limits. So you can see here, this is a complex environment. There are many types of hazards that are regulated by many agencies, and they have multiple ways that they approach establishing and evaluating these exposures, and then limiting them.
