environmental health

by Laura Anderko, PhD, RN, professor and Scanlon Endowed Chair in Values-Based Health Care, School of Nursing & Health Studies, Georgetown University; director, Mid-Atlantic Center for Children’ s Health and the Environment; and co-chair, National Environmental Health Partnership Council

The Value of Environmental Health Services: Exploring the Evidence is a report recently issued by the National Environmental Health Partnership Council( NEPHC), which was formed to increase awareness and understanding of environmental health services. 2 NEHPC is comprised of a variety of agencies and organizations— including APHL— that aims to support healthier environments through education, policies and practices related to environmental health. The American Public Health Association( APHA) provides logistical support to NEHPC, which is funded through a cooperative agreement with the US Centers for Disease Control and Prevention( CDC). 3

This report was created as one component of a larger strategy for expanding and sustaining awareness of environmental health problems and programs. A review was conducted on economic evaluation studies, including return on investment and cost / benefit analyses to better articulate the worth of environmental health programs to the general public and policymakers.

Several environmental public health program areas were explored including: a) housing; b) lead exposures; c) food safety; d) mercury exposures; e) climate change; f) housing; and g) special populations including children and environmental justice communities. There were significant findings for several interventions, including the following:

• Housing: The National Asthma Control Program’ s return on investment is compelling: for every dollar spent on national and state-level programs, $ 71 in asthma-related expenditures is saved. 4

• Lead: A return of investment of $ 12 –$ 155 / household or a net savings of $ 124 – 188 billion resulted for every $ 1 invested in lead paint hazard control. 5

• Food Safety: Higher local health department spending on food safety and facility sanitation activities was related to a lower incidence of restaurant related foodborne illness in Washington and a lower incidence of facility inspection-related waterborne disease in New York. 6

• Children: A 10 percent increase in public health spending over 17 years led to a 4.3 percent reduction in infant mortality. Health gains were 20-44 percent greater when funding was targeted to lower-income communities. 7

• Climate change: Costs of climate change have been slow to emerge in the research literature. Ebi et al.( 2004) reported that the cost of running a heat – health warning system for Philadelphia was relatively small( USD $ 210,000) compared with the benefits of saving lives( USD $ 468 million) from 1995 – 1998.

• Environmental justice: Urban development strategies and reduction of pollution exposure from roadways would significantly cut health care spending, particularly in low-income neighborhoods. 8

Initial studies provide powerful findings, but there is a lack of economic research. Environmental interventions are crucial for lowering both the number of deaths and reducing health care costs, saving 90 percent more lives than health care. 9 It is essential that positive impacts from environmental health interventions are shared with the public and policymakers to increase understanding of the value of environmental health services to public health.

APHL is a member of the National Environmental Health Partnership Council, and also sits on the Council’ s steering committee.

References 1. New York Times / CBS News( November 18-22, 2015). New York Times / CBS News Poll on the Environment. Retrieved from: https:// assets. documentcloud. org / documents / 2623880 / full-resilts-of-the-new-york-times-cbs-news-poll. pdf 2. National Environmental Health Partnership Council( NEHPC, 2016). The Value of Environmental Health Services: Exploring the Evidence. American Public Health Association: Washington, DC. Retrieved from: https:// www. apha. org /~/ media / files / pdf / topics / environment / eh _ values. ashx 3. American Public Health Association( APHA).( 2016). The National Environmental Health Partnership Council. Retrieved from: https:// www. apha. org / topics-and-issues / environmental-health / partners / national-environmental-health-partnership-council. 4. Centers for Disease Control and Prevention( CDC).( 2013). CDC’ s National Asthma Control Program: An Investment in America’ s Health. Available at: http:// www. cdc. gov / asthma / pdfs / investment _ americas _ health. pdf. 5. Gould E.( 2009). Childhood lead poisoning: conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives, 117( 7), 1162-1167. 6. Bekemeier, B., Yip, M. P. Y., Dunabr, M. D., Whitman, G., & Kwan-Gett, T.( 2015). Local health department food safety and sanitation expenditures and reductions in enteric disease, 2000-2010. American Journal of Public Health, 105( S2), S345-S352 7. Mays, G.( 2013) Who Benefits from Public Health Spending and How Long Does it Take: Estimating Community-Specific Spending Effects, 141st Annual American Public Health Association Annual Meeting. Boston, MA. Nov. 2013. Available at: http:// works. bepress. com / glen _ mays / 119. 8. Perez, L., Lurman, F., & Wilson, J. et al.( 2012). Near-roadway pollution and childhood asthma: Implications for developing“ win-win” compact urban development and clean vehicle strategies. Environmental Health Perspectives, 120( 11), 1619-1626. 9. Milstein, B., Homer, J., Briss, P., Burton, D. & Pechacek, T.( 2011). Why Behavioral and Environmental Interventions Are Needed to Improve Health At Lower Costs. Health Affairs, 30,( 5), 823-832.