Building Bridges: Systems Approaches to Local Environmental Health Problems

Abstract

public health and managing the environment. Although one of the main goals of environmental management is to protect human health, there are significant gaps in the current system’s ability to identify, prevent, or address health hazards resulting from cumulative environmental exposures at local scales. At the same time, the public health community has become more aware of how social, economic, and environmental health determinants contribute to the health problems facing our society and particularly to the health disparities facing lowincome urban areas and communities of color. The widely recognized paradox of the U.S. health care system is that it spends more per person than any other country, and yet its health status is worse than many countries that spend far less on health care (Brink 2017; Fox 2016). The diseases that dominate health costs and drive health inequities are chronic conditions like obesity, diabetes, and heart disease. These same diseases are influenced by factors including people’s education, income, and environment. Such social determinants of health may affect health directly through increasing people’s exposure to environmental hazards, crime, and poor nutrition or indirectly by shaping individual behaviors and people’s access to preventive services and care. Social determinants of health, in turn, are shaped by policies, systems, environments, and institutions outside the purview of the health care system. Recognition of the importance of social determinants of health has encouraged public health professionals to work toward changing policies that shape social, economic, and environmental conditions. This “Health in All Policies” (HiAP) approach encompasses a range of environmental policy 3 Building Bridges: Systems Approaches to Local Environmental Health Problems