WASHINGTON—Understanding the link between environment and public health is critical in moving the public health agenda forward. “More and more we need to learn—as people who care about promoting health—to think about energy and transportation and land use because those are issues that are very pertinent to health,” said Howard Frumkin, M.D., director of Centers for Disease Control and Prevention’s National Center for Environmental Health. “We need to become systems thinkers and combine health concerns with other concerns to which they are directly relevant.”

Dr. Frumkin, who spoke about the connection of health and environment at CDC’s 20th National Conference on Chronic Disease Prevention and Control held in February, said that those in public health must think beyond just public health and must look for the synergies between environmentalism and public health.

“The model of care for the environment, the model of sustainability that has been so much at the core of public discourse in recent years, has a lot to do with health. If we can combine those two ways of thinking into a grand vision we can achieve goals much more effectively than we ever would have,” he said.

Conservation biology, atmospheric science, climatology and earth science, energy policy and urban planning may not traditionally be thought of as important to public health, but they are a part of it.

“I want to make the case to you that other realms of science and thinking than we have ever considered to be a part of public health, really are a part of public health,” Dr. Frumkin said.

Environment and Health

The presence of trees has an impact on health and is an example of the link between environment and public health.

“They cool cities down, that helps protect people from heat waves; they improve air quality in cities; they provide shade, protecting people from the toxic effects of sunlight,” he said.

In one study conducted from 1972-1981, investigators compared patients recovering from a cholecystectomy who were given a hospital room with a view of trees with those who had rooms with a view of bricks in a Pennsylvania hospital. Those who stayed in rooms with a view of trees had shorter hospitalizations in the study (8.70 days vs. 7.96 days).

“It turned out that coincidentally half the rooms on that surgical floor looked out onto trees,” Dr. Frumkin said. “The other half looked out onto a brick wall and you were randomly assigned to one or the other. The investigators examined about 10 years worth of post-cholecystectomies records to see if there was any difference between the patients in the tree-view rooms and the brick-view rooms. It turns out that if you were in a room with a tree view you had a substantially shorter hospitalization, you had less need for pain medications. Something about seeing trees outside your window had a marked salutary effect on surgical recovery.”

Dr. Frumkin also noted that atmospheric science is a part of public health. “You all know that air pollution is bad for health, specifically in terms of its effect on a number of chronic diseases, including asthma and cardiovascular disease,” he said.

During the 1996 Olympic games in Atlanta people were asked to curtail their driving in the city. This resulted in improved air quality and led initially to a drop in pediatric asthma cases, according to a study published in a 2001 JAMA article. “What we found is that pediatric asthma dropped by as much as 44 percent. It came back up to baseline when people resumed driving,” he said.

Another link between environment and health that must be considered, he said, is the link between mental health and disasters due to climate change. “The mental health story is very important to pay attention to,” Dr. Frumkin said. “Not only the mental health consequences of major disasters that we expect to be more frequent with climate change, but also the anticipatory piece—the fact that hearing apocalyptic stories can be depressing and demoralizing.”

Pursuing Environmental Policies

One way in which both environmental and health concerns can be addressed is through urban planning. Green space, access to walkable and livable communities, access to mass transit and clean air are critical elements that are beneficial for both the environment and public health.

“We are caring for future generations by the decisions that we make today. If we build our cities and towns in particular ways, if we make certain energy choices, those inexorably destine those who come after us to certain health outcomes. We need to think in terms of a legacy approach,” he said.

Dr. Frumkin gave an example of the synergy between environment and health with a picture of a parent walking her children to school on a sidewalk in 1956. “What was good about this is that they were getting physical activity by walking instead of driving their cars,” Dr. Frumkin said. “They were also decreasing their contribution to air pollution and promoting respiratory and cardiovascular health. They were decreasing their contribution to climate change by walking instead of driving. They were building social capital, which itself is a very strong derminant of health because they were meeting and greeting neighbors on the sidewalk. The less you have to put into building roads, the more money you have left for healthcare, education and law enforcement and other social goods. Looking for those synergies is keenly important.”