NewPublicHealth Interview: Susan Dentzer, Editor-In-Chief of Health Affairs

May 10, 2011, 5:23 PM, Posted by NewPublicHealth

The May issue of Health Affairs features the journal’s first issue about environmental health concerns. NewPublicHealth spoke with Health Affairs Editor-In-Chief Susan Dentzer about the issue.

NPH: One of the articles in the May issue is by Aaron Wernham, director of the Health Impact Project, on conducting health impact assessments when making environmental and land-use decisions. Why is that important?

Susan Dentzer: It’s often, if not always, the case that in almost every jurisdiction--before you build a major highway or other major projects, you have to do a very systematic assessment about the overall impact on the environment. So, obviously what should take place is--in addition to that-- is to find out what is going to be the impact on health. For example, what if you build a major highway and it happens to go by a school?

Other studies in the issue draw on information that we already are well-aware of, which is that if you have particulates in the atmosphere, or other forms of air-pollution through auto exhaust, that’s going to have an impact on the kids in the school. So, using the health impact assessment tool before any major [environmental] project seems a good place to start in terms of understanding what the impact is going to be on health. The assessment lets you get health into the mix of the decision-making process and you can weigh the pros and cons and the trade-offs of any kind of community-level initiative.

NPH: Three of the articles focused on environmental factors that have been shown to impact children’s health. Can you tell us about some of the findings?

Susan Dentzer: Absolutely. We've known for some time now that exposures that children undergo can have a bigger impact on children than they do on adults. For a few reasons. One is, just by virtue of the concentration of these things in the atmosphere or and children’s’ body weight --proportionately, these things have a bigger impact. Plus, we know from the way children develop that there are these windows of exposure as children’s’ bodies are changing very, very rapidly. Cells are multiplying, brain cells are growing in infancy and toddler-hood. All of those things create vulnerability so that any kind of toxic substance that may not be so toxic to adults will be potentially much more toxic to children. And we know this, for example, from lead exposure, which unequivocally caused a decline in brain function in many children. Several IQ points or more for children who have been exposed to lead are lost.

So, what a number of studies in our new issue do is take that knowledge forward and say, for example, what is the cost of this exposure to children? One of the studies suggests that the health care related costs alone of chemical and other toxic exposures to children is about $77 billion dollars annually. That’s about 3 ½ percentage points of U.S. health care costs. Now, that’s not 100 percent, but we could all acknowledge we’d rather have that money to spend on other things, like keeping children healthier. And, if you just put that up against say, what we spend on the Children’s Health Insurance Program, which isn’t by any means the only way we help to cover kids in America, it greatly exceeds our annual expenditure on children’s health insurance alone.

So, in a crazy way, we’re exposing kids to a lot of things that are harmful to them and then spending a lot of money on the other side fixing them up. And a classic case of this is asthma. We know that lots of asthma in children now is caused by exposures to pollutants, second-hand smoke, those kinds of things. So, we in effect-make these children sick and then we pay to get them healthier or to stabilize their disease.

NPH: The studies about children and environmental exposures were posted on your web site last week. Have you already received comments?

Susan Dentzer: Certainly from academics. For one thing, everybody notes that we do have this sort of crazily siloed health and health care, and even policy related to health and environment in this country, where the environmental science people have known for some time that these threats and exposures are real. They’ve kind of been, frankly, ignored by others who are so busy focusing on other things--like finding a way to produce high quality health care for children with asthma. So, what people have said to us is great. Now, we’re going to help break down these silos so that we can understand what the effects are of these exposures and actually incorporate that into the health care that we deliver to children and families. For example, one of the pieces in our issue has a so-called navigation guide which is really a very elaborate way of helping the health care community understand the evolving science on the environmental health side and be able to make explicit recommendations to people about what they should do to protect their health.

When you are looking at something like environmental science, frankly we’re not going to do a whole lot of randomized controlled trials and randomize children into camps of some who are exposed and camps of children who are not exposed and then decide what the exposure is. That’s unethical. So, what we have to do is a very, very different kind of science. But, getting the clinical community to understand how that’s done is a challenge. So this navigation guide basically says, here’s how you can walk through the environmental health science and use that to decide what recommendations should be made to patients and incorporate these into, not only guidelines for clinicians about what to do, but also, how they communicate these risks to patients and explain to patients what steps there are available so they can avoid these exposures when possible.


This commentary originally appeared on the RWJF New Public Health blog.