The topic of research needs and priorities was  highlighted at a special lunchtime session at the recent meeting of the International Society for Environmental Epidemiology (ISEE) in Columbia, South Carolina in late August, 2012. The keynotes of the session were the presentations of the new strategic plan for the National Institute of Environmental Health Sciences (NIEHS) and the research objectives of the Environmental Protection Agency and the World Health Organization.

The Centers for Disease Control and Prevention (CDC) representative, Tom Sinks, presented a review of current activities and future trends in environmental health activities at the CDC, including a description of newborn screening and how it evolved from early research findings on phenylketonuria (PKU) into a full-blown multi-continent public health program preventing many genetic conditions.

Strategic Plan

Richard Woychik, Deputy Director of the NIEHS, described 8 broad subject domains that NIEHS has prioritized for future work over the 5 year period 2012-2017, including:

 1) fundamental research, 2) exposure research, 3) translational science, 4) health disparities and global environmental health, 5) training and education, 6) communications and engagement, and cross-cutting areas, 7) knowledge management, and 8) collaborative and integrative approaches.

Concrete Goals

In more concrete terms, the agency formulated specific goals intended to achieve progress in the 8 priority areas. These goals include such activities as improved understanding of common biological pathways (e.g., inflammation or epigenetic changes), identifying critical windows of susceptibililty to the effects of exposures in a life course approach, defining the concept of exposome, assessing combined exposures from multiple insults, responding to environmental threats, conducting community-based participatory research, developing publicly available information resources, and providing knowledge to empower individuals to make better health decisions. The complete strategic plan with its themes and goals can be viewed at: www.niehs.nih.gov/strategicplan

Woychik was emphatic in telling the group that this plan would not have the fate of many other plans which end up shelfbound. He stated that NIEHS would fund activities designed to make progress on each of the specific goals over the next five years.

WHO Priorities

WHO’s Michal Krzyzanowski, head of the European Center for Environmental Health, told the audience that an estimated 24% of the global burden of disease is

linked to environmental factors. He noted that greater emphasis on the social determinants of health was a priority for the European region as stated  in the PARMA Declaration on Environment and Health in 2010.

New Concept For EPA

Wayne Cascio, Director of EPA’s Environmental Public Health Division, highlighted his presentation by describing the concept of sustainability and noted this concept represents a fundamental change in EPA’s thinking that will lead to increased consideration of the role of a broad range of social influences on environment and health. To illustrate the concept, he gave the example of a peat fire at Pocosin Lakes in North Carolina. In that environmental incident, land use practices that were decided upon 50 years earlier led to the conditions which facilitated the fire.  These in turn had health effects in a population where poverty and income inequality were the best predictors of negative health consequences.

Air Quality Index

Cascio noted that while EPA is not normally seen as a public health agency, it does sponsor activities which have the potential to improve public health. He gave the example of the Air Quality Index and how greater use of this index could help at risk persons to modify their behaviors and thus their exposures when the index indicates this would be desirable. He claimed that greater education about the Air Quality Index as part of the ongoing Million Hearts Campaign has the potential to decrease heart attacks and strokes in the US.

Today’s Research, Tomorrow’s Gains

CDC’s Tom Sinks sought to make a different point during his presentation. By giving examples using newborn screening, human biomonitoring, and disaster epidemiology, Sinks told the researchers present that their research innovations create a platform from which future opportunities to prevent disease will arise. The remarkable success of newborn screening programs has its roots in a study done in the 1930’s which identified phenylpyruvic acid in urine which later led to diet interventions and eventually to blood spot testing of newborns in 1961 and to mass screening of newborns today for up to 29 different conditions in the US, the Americas, Asia, and Europe. Sinks said he hoped that autism in the US might be controlled on the basis of innovative discoveries being made today.