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The American Thoracic Society (ATS), in collaboration with George Mason University, surveyed a random sample of ATS members to assess their perceptions of, clinical experiences with, and preferred policy responses to climate change. An e-mail containing an invitation from the ATS President and a link to an online survey was sent to 5,500 randomly selected U.S. members; up to four reminder e-mails were sent to nonrespondents. Responses were received from members in 49 states and the District of Columbia (n = 915); the response rate was 17%. Geographic distribution of respondents mirrored that of the sample. Survey estimates' confidence intervals were ±3.5% or smaller. Results indicate that a large majority of ATS members have concluded that climate change is happening (89%), that it is driven by human activity (68%), and that it is relevant to patient care ("a great deal"/"a moderate amount") (65%). A majority of respondents indicated they were already observing health impacts of climate change among their patients, most commonly as increases in chronic disease severity from air pollution (77%), allergic symptoms from exposure to plants or mold (58%), and severe weather injuries (57%). A larger majority anticipated seeing these climate-related health impacts in the next 2 decades. Respondents indicated that physicians and physician organizations should play an active role in educating patients, the public, and policy makers on the human health effects of climate change. Overall, ATS members are observing that human health is already adversely affected by climate change and support responses to address this situation.

The author reflects on the factors that contribute to the lack of clarity in appreciation of the scope environmental health practice. He cites his experience in working in the public sector in which he learned that infectious disease problems properly belonged to epidemiology and chemical hazards of the environment. The author also suggests several measures that can help address the issue and provide clear definition of environmental health.

Health threats place the military mission and deployed service members at risk. A commander's focus is on preventing acute health risks, such as diarrhea, because these quickly compromise the mission. However, in recent conflicts chronic and long-term illness risks have emerged as concerns. Department of Defense and Joint Chiefs of Staff mandates require documentation of exposures and environmental conditions to reconstruct exposures and evaluate future health risks. Current processes for identifying and assessing hazards, including identification and assessment before deployment and in time to take action to prevent or reduce exposures, when followed, are generally adequate for known hazards. Identifying and addressing novel, unexpected risks remain challenges. Armed conflicts are associated with rapidly changing conditions, making ongoing hazard identification and assessment difficult. Therefore, surveillance of the environment for hazards and surveillance of personnel for morbidity must be practiced at all times. Communication of risk information to decision makers is critical but problematic. Preventive Medicine (PM) personnel should take responsibility for communicating this information to non-PM military medical people and to military commanders. Communication of risks identified and lessons learned between PM personnel of different military units is extremely important when one military unit replaces another in a deployed environment. [ABSTRACT FROM AUTHOR]

Studies of risk communication have identified healthcare providers, especially physicians, as the source of information most trusted by the public on issues of environmental health. Nothing in medical, nursing or most healthcare provider training actually prepares practitioners to play this role and healthcare providers are generally more oriented toward treatment and medical care than prevention and public health. Healthcare providers require education in order to play this role but rarely seek it. Gaps in the knowledge of professional on the issue of Cryptosporidium illustrate the problem. For members of the professional water community, communicating with healthcare providers is best done when messages are delivered in familiar settings, such as hospital Grand Rounds (a universal format for teaching conferences) and provided in a narrative (case-based) form but gaining access is difficult if the topic is not obviously clinical in nature. In addition to being a critically important target group itself, public health professionals are easier to reach and may mediate good working relationships with medical practitioners. we suggest a strategy for water utilities based on partnerships with academic public health and providing education through well-recognized formats in continuing medical and nursing education. [ABSTRACT FROM AUTHOR]

The authors reflect on the process of peer review and its relationship with occupational and environmental health. They believe that the adoption of standardized peer-review guidelines and editorial policies should begin. To achieve this, consistency in the level of quality across whatever discipline, method, or approach applies to the problem under study is suggested.

In 2001, following a change in disinfection agent in anticipation of the Environment Protection Agency Disinfection Byproduct Rule, lead levels began rising in drinking water in Washington, District of Columbia, and in 2002, the DC Water and Sewer Authority was found to have exceeded the Environment Protection Agency lead action level, requiring compliance with a series of measures under the Lead and Copper Rule. In 2004, the issue became a public concern, drawing considerable media attention. The problem was eventually resolved through the application of orthophosphate but while it played out, the utility was forced to respond to a novel public health issue with few risk management options. This case study examines the lessons learned. [ABSTRACT FROM AUTHOR]

The threat of bioterrorism has led to a reinvestment in public health, but not necessarily in a manner that ensures efficient, reliable and cost-effective improvement in services. Public health officials fear that homeland security is distorting the priorities of public health and diverting resources from the essential work they are already doing. They fear that homeland security requirements may have erosive effects on confidentiality and in compromising their core mission of health promotion and disease prevention. Specific issues include cutbacks in promised support, diversion of funding to single-purpose projects, concerns over maintaining confidentiality of client services, abuse of the extensive police powers given by state legislation to public health authorities, and lack of integration with existing public health systems. The reasons for these concerns are deeply rooted in the history of public health, in which the legal authority of health agencies included police powers and even detention. Public health leaders would prefer a policy of "dual use" or "dual benefit" in which capacity is added to enhance the operation of the public health system in general while adding new capability in emergency response. Such a policy would ensure benefit from the investment even if no bioterrorism event ever occurred locally and would enhance the reliability of the system. For example, a single-purpose surveillance program for bioterrorism is likely to have an unacceptably a high risk of failure and unreliability in a bioterrorism event if it is not regularly tested by the type of outbreak that occurs many times a week in every metropolitan health department. A small but articulate group of public health leaders, led by Victor W. Sidel, have even questioned the ethics of collaboration between public health and police or intelligence services. This article suggests that such cooperation is actually necessary and recommends advance guidelines and policies, legal... [ABSTRACT FROM AUTHOR]

Human health studies emphasize the link between the human body and the immediate influences upon it. Ecosystem health studies (defined by David Rapport et al., this volume) has, as its primary objective, the relationships and system characteristics of viable ecosystems. As a practical application, ecosystem health studies describe the mechanisms and assesses the potential to threaten or enhance human health. [Copyright &y& Elsevier]

The article explores the extent of the impact and implications of Hurricane Katrina to the U.S. It notes the revelation of the hurricane regarding the possibility of natural disasters and public health crises to be as much threat to national security as intentional assaults. It also mentions the revelation of Katrina of the close interconnection between the natural environment and human health risk. An overview of the strike of the hurricane to the country is offered.

Physicians and public health professionals working with the U.S. Environmental Protection Agency's Region 8 Pediatric Environmental Health Specialty Unit (PEHSU) received several telephone calls requesting information regarding the safety of recycled tire crumb as a playground surface constituent placed below children's play structures. There were no reported symptoms or adverse health effects in exposed children. The literature available on the safety and risk of exposure to crumb rubber constituents was limited and revealed no information quantifying exposures associated with product use. Callers were informed by the PEHSU that no evidence existed suggesting harm from intended use of the product, but gaps in knowledge about the product were identified and communicated. Here the case of crumb rubber on playgrounds is used as a model to present an approach to similar environmental medicine questions. From defining the question, to surveying traditional and nontraditional resources for information, synthesis of findings, and risk communication, the case provides a model to approach similar questions. [ABSTRACT FROM AUTHOR]

The author reflects on issues regarding environmental and occupational health. He mentions the development of several tactics by opponents of scientific evidence-based decision making with an aim to deflect the persuasive power of scientific knowledge as well as to counter individual experts' influence. He discusses partisan tactics including manufactured doubt, multistakeholder bashing, and allegations of conflict of interest.

An introduction for the January 2008 issue of the "Archives of Environmental & Occupational Health" is presented.

The author reflects on the significance of the major community-based study in environmental and occupational health. He discusses the implications of the case studies for public policy, community wellbeing, individual health risk and the local economy. He discusses two studies regarding the roll out the findings of the study.

A letter is presented in regards to school's preparedness regarding a public health emergency.