Ramona Trovato, Environmental Protection Agency: National Prevention Strategy Series
In a new interview with Ramona Trovato, Deputy Assistant Administrator of the Environmental Protection Agency (EPA), NewPublicHealth continues its conversation series about the National Prevention Strategy. The strategy was released last year by Surgeon General Regina Benjamin, MD, MBA, to help create a healthier and more fit nation.
Earlier this year the Surgeon General’s office released the Strategy’s National Action Plan, designed to show how the 17 Federal Agencies charged with advancing the National Prevention Strategy are implementing its vital components. The EPA has several partner initiatives critical to the health of the nation, which include:
- Partnership for Sustainable Communities: The EPA is a partner, together with the Department of Transportation and the Department of Housing and Urban Development, in this partnership to help communities improve access to affordable housing and transportation while protecting the environment, all critical aspects of healthy living.
- Green Ribbon Schools: EPA is a partner with the Department of Education and other agencies for this recognition award that encourages state education agencies and schools to recognize the links between education, health, and the environment, and to make all three of these areas a priority.
- Safe routes to school: Agencies including HHS, EPA and the Department of Transportation support efforts to improve the ability of students to walk and bicycle to school safely.
- Task Force on Environmental Health Risks and Safety Risks to Children: This multi-agency task force, which includes the EPA, recommends strategies for protecting children's health and safety, including specific priorities around asthma, unintentional injuries, lead poisoning, cancer, and environmental health in schools.
- Aging Initiative: This EPA initiative aims to prioritize environmental health hazards that affect older persons, focus on “smart growth” principals to support active aging, and examine the environmental impact of an aging population, and encourage civic involvement among older persons in their communities to reduce hazards.
Ramona Trovato shared with us EPA’s long history of health promotion and its current efforts to help improve population health as a member agency of the National Prevention Council.
NewPublicHealh: How does the Environmental Protection Agency (EPA) align itself with the National Prevention Strategy?
Ramona Trovato: The EPA is really pleased to be part of the National Prevention Council and the National Prevention Strategy. We firmly believe in preventing ill health and in promoting wellness, and it’s something that matters to us in all the work that we do. We have very successfully partnered with Department of Health and Human Services in the past and with a number of other federal agencies including the Consumer Product Safety Commission, the Department of Transportation and the Department of Housing and Urban Development to benefit the public’s health.
NPH: What are the key roles of the Environmental Protection Agency in protecting the nation’s health?
Ramona Trovato: The EPA’s mission since 1970 when it was created is to protect human health and the environment. I think we’ve been especially effective in talking about what we do to protect the environment. There’s so much improvement in the environment, and you can see it, and we’ve been good about communicating that. What I think we have not been strong communicators about is the fact that every one of those things that improve the environment had the additional, and perhaps the primary, benefit of improving health. By cleaning up the air, we’re protecting hearts, lungs, and respiratory systems. By cleaning up the water, we’re protecting gastrointestinal systems. By making sure the land is clean, we’re making sure that schools are built on property that’s not contaminated, and that food is grown on land that is clean and safe for growing. Every one of these actions contributes to the overall health of the population. It’s been a very, very serious commitment on the agency’s part.
The majority of the regulations we write are health based. And, in every one of these areas, there have been economic benefits because either jobs were created through new technologies or in new fields that didn’t exist before as we created better ways to protect the environment. People didn’t get sick as much and so there were savings from avoiding illness and promoting wellness.
NPH: What is a good example of an EPA project that has generated significant community benefit?
Ramona Trovato: Through the Brownfields Program, we’ve cleaned up properties all over the country and a lot of them in urban areas. By working with the community to figure out how they wanted to use those properties, we’ve been able to create playgrounds, parks, ball fields and new business opportunities. It really creates improved communities that people want to be part of and are well grounded in and are proud of. So, in all these many ways, EPA has been really focused on protecting health and the environment.
NPH: What are some short and long-term goals of the Partnership for Sustainable Communities and what progress has there been so far?
Ramona Trovato: We have worked together on children’s health for a really long time, and now we’re also looking at ways to work together on proposals and new ways of coming together to secure support from outside the government, whether it’s through contracts or grants or research to better understand how to promote wellness. There are a number of efforts underway to promote children's environmental health in early learning environments. These include pilot projects co-sponsored by EPA and the HHS Agency for Children and Families; joint training efforts; and grant funding to build capacity for addressing environmental exposures in child care centers in underserved communities. EPA launched a child care resource directory this year as a "one-stop-shop" for child care professionals to access information on how to identify and eliminate environmental contaminants in childcare settings.
NPH: What efforts has the EPA undertaken to help improve community environments?
Ramona Trovato: We are continuing to look at issues around sprawl, around better design of communities, and work with HUD on ways to build public housing so that it’s healthier for kids. Indoor environments are a really critical issue. We don’t regulate indoor environments, but we are allowed to study them. One outcome of our collaboration is that HUD, in one of its regions, has actually built public housing units without gas stoves and without carpeting because that’s healthier for asthmatics and especially for asthmatic kids and older adults. So, when we can find ways to partner together, we do.
NPH: A critical EPA benchmark under the National Prevention Council Action Plan is holding down the number of days that the air quality index exceeds 100. How is this being done?
Ramona Trovato: The EPA has regulations for ozone, particulate material, nitrogen dioxide, sulfur dioxide, and carbon monoxide. By implementing those regulations, we are reducing the burden of pollutants that anyone in that area experiences. The air quality index of 100 is the upper end of “code yellow days.” You’ve probably seen the code yellow days that get reported on television, and those are to help individuals make their own personal choices about how to behave on days that have compromised air quality. They might not want to go outside on those days. That’s a step in the right direction, but the best step forward is to actually reduce the pollution so you don’t even have to make the choice of whether you go out. We continue to work with cities and states to ensure that those regulations get implemented so that that burden doesn’t exist.
NPH: What is EPA’s role in helping to protect the nation, especially children, from second-hand smoke?
Ramona Trovato: A long time ago, probably 20 years ago now EPA wrote a report, “The Respiratory Health Effects of Passive Smoking, Lung Cancer, and Other Disorders.” It was the result of a health assessment that showed that second-hand smoke actually seriously affected the health of people who were exposed to second-hand smoke. And, that small health assessment that we published, provided the critical knowledge and supporting scientific information that there was a link between disease and second-hand smoke. That report led people to take action—the first action was that flight attendants sued airlines for unhealthy working conditions, as a result of which smoking on planes was banned.
So, it wasn’t a federal or a state action. It was action of individuals to protect their own health based upon knowledge provided by public service doing their job. Then that rolled out to states, counties and cities who took actions. Eventually, the federal government banned smoking in several buildings. The report shows that research and science are absolutely critical to health. In the 20 years since that report was released, you can now go sit in a bar in many jurisdictions and not end up breathing everybody else’s cigarette smoke. That has played out because of the role of EPA’s research and science and the policies of state and local governments. So, EPA not only regulates and implements and enforces, but EPA also provides science that helps people make better choices and make better decisions.
NPH: EPA is a partner in the Million Hearts Campaign, a national initiative to prevent one million heart attacks and strokes over five years. What education efforts are underway to inform individuals, communities, and policy-makers about the link between air pollution and heart disease?
Ramona Trovato: We are really fortunate to have some physicians at EPA, including Dr. Wayne Cascio who is director of EPA’s environmental health division. Dr. Cascio is a cardiologist who’s heading up that Green Heart initiative, a complementary program to the Million Hearts campaign. The initiative has several goals including increasing environmental health literacy related to the cardiovascular effects of air pollution in individuals at risk, a focus on middle-aged adults with heart disease and those at risk, and a focus on decreasing morbidity and mortality related to air pollution among those at high risk
From 1970 to 1990—the first 20 years of the Clean Air Act—EPA data show that the clean air program prevented 205,000 premature deaths; 672,000 cases of chronic bronchitis; 21,000 of heart disease; 843,000 asthma attacks; 189,000 cardiovascular hospitalizations; and 18 million child respiratory illnesses. That’s just in the first 20 years. We don’t have the statistics all compiled for the second 20 years yet, but those are enormous contributions to health. The medical interventions coupled with these types of prevention interventions is what the Green Heart initiative is focused on. What we’re trying to do is provide better communication on how changes in the environment can promote health and reduce disease.
We’re really thrilled to be part of the National Prevention Council to continue to promote health and reduce illness. There is so much that, together, we can do to promote the health and the quality of life of all of us, and it just can’t be government alone. It’s got to be government, the private sector, the nonprofit sector and others together. It’s got to be all of us pitching in to help improve the life of all Americans. We are in this together, and together we can solve these problems.