Collaboration on Human Health and the Environment:
A New Imperative
Philip R. Lee, MD and Steve Heilig, MPH

First published in San Francisco Medicine, a publication of the San Francisco Medical Society, June 2002.

How many clinicians are aware that environmental pollutants are increasingly implicated as causal factors in a growing list of diseases? How many inquire about such factors as part of taking a history or of diagnosis and treatment of such diseases?

The answers to these questions are "few" and "fewer." There are many reasons this is true, including a perceived lack of any good science backing up "environmental" causality, a lack of training in such matters, an unfortunate association of "environmentally caused disease" with hypochondria, and the usual constraints of time to cover anything in a patient visit and to read the full literature even as it might apply to one's practice.

Yet compelling scientific evidence increasingly indicates that a potentially important factor in the incidence of these diseases and conditions is the proliferation of synthetic chemicals and their byproducts of modern, industrial society. Since World War II, more than 85,000 synthetic chemicals have been registered for use in the United States and another 2,000 are added each year. Such chemicals may include industrial chemicals, pesticides, pharmaceuticals and the chemicals to which families are exposed at home, at work, in schools, in transportation, and in other facets of daily life.

These chemicals are in our air, water, soil, food, homes, schools, and workplaces. The developing human fetus appears to be at particular and unique risk of harm from environmental toxicants, and such damage can be profound and permanent. The depth and quality of the evidence of such risk and harm varies with respect to individual toxicants and diseases under consideration, and much more research is needed to determine the mechanisms, levels and types of exposure that can adversely affect health, including interactions among chemicals. But there is no longer any real question that environmental toxicants are increasingly important contributors to human disease.

Recognizing this, the U.S. Institute of Medicine emphasizes the importance to health of minimizing environmental exposures to "chemical and physical hazards in homes, communities and workplaces through media such as contaminated water, soil and air." And the CMA, in a new policy drafted at the SFMS, urges better research into these concerns and more cooperation among those involved.

The Collaborative on Health and the Environment
To address these needs, the SFMS and Commonweal, a Marin County-based health and environmental research institute, co-presented a conference on the role of environmental toxicants on human health on March 21, 2002. The morning session was devoted to summary presentations by distinguished scientists, indicating that about 25 diseases have a clearly established connection to known toxicants, over 50 have good evidence at high-dose exposure, and another 50-plus have good animal research evidence. The afternoon discussions with established expert and patient advocates, including the American Cancer Society, Endometriosis, Learning Disabilities, Parkinson's, and other associations, confirmed a need for a new "wide umbrella" forum for furthering the shared goals of reducing exposure and helping patients.

The Need for New Models of Collaboration in Environmental Health
Efforts in environmental health have too often been fragmented. Medical, patient, public health and environmental groups that share some of the same concerns too often have not worked together toward common goals. A diverse and inclusive collaboration is essential to success in reducing public exposure to environmental toxicants and developing preventive strategies. Established researchers and health-affected (or patient) groups can collaborate in conducting important new research. Medical organizations can also work with health-affected groups toward better approaches to treatment. Organizations engaged in the issues of environmental justice, poverty, civil rights and human rights must be represented. Everyone concerned-health-affected groups, scientists, health professionals, and environmental organizations-can serve as resources for each other in collaborations that will help reduce public exposure to environmental toxicants.

Arising out the March SFMS meeting, the Collaborative on Health and the Environment (CHE) has been established to address this need, and to take environmental health efforts into a new era of improved scientific understanding, cooperation among diverse interests sharing similar goals, and better policies and preventive efforts aimed at the ultimate goal of reducing exposure to harmful environmental contributors to disease. We welcome inquiries and new partners. Contact Jeanette Meyers at 415/868-0970 or jeanettemeyers22@aol.com for more information.

Dr. Lee is a former U.S. assistant secretary of health and human services, past chancellor of UCSF and current professor of human biology at Stanford University. Steve Heilig is director of public health and education for SFMS and co-editor of the Cambridge Quarterly of Healthcare Ethics.