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Environmental Health: The Future Will Ask, “What Did You Do?”

      This month's message focuses on Environmental Health. I am pleased to co-author it with Patricia Butterfield, PhD, RN, FAAN, who serves as chair of the Academy's Environmental & Public Health Expert Panel. The nursing profession has been an early and steadfast leader in recognizing the importance of environmental factors to human health, especially concerning some of our most vulnerable citizens, children and elders. Consistent with our strategic goal of implementing policies that improve the health of populations and achieve health equity, the Academy recognizes that environmental factors, including clean air and water, are essential to health. Without them and without other health-protective policies addressing energy, waste, and food, it is not possible for persons to achieve their full health potential.
      Few areas have received more attention and greater disruption over the past 18 months than those addressing environmental health. As part of a wide-ranging environmental and land management agenda, the current administration reversed or proposed to reverse more than 60 environmental policies. While detailed analyses of their health consequences are still underway, recent estimates have noted that:
      • Repeal of the Clean Power Plan would increase atmospheric particulates and lead to an estimated 36,000 deaths and 630,000 cases of respiratory ailments in children over a decade,
      • Scale backs of lead-risk reduction programs would place children in an estimated four million households at risk for elevated lead levels,
      • Repeal of the Waters of the United States rule would weaken regulatory protections affecting approximately 117 million people, and
      • Proposed changes in chemical policy would increase the number of persons exposed to methylene chloride, trichloroethylene, and N-Methylpyrrolidone (
        • Cutler D.
        • Dominici F.
        A Breath of Bad Air: Cost of the Trump Environmental Agenda May Lead to 80 000 Extra Deaths per Decade.
        ) .
      Policy recommendations by the Academy have addressed both climate change and other antecedents of environmental health. The climate change policy brief dually notes the importance of recommendations addressing both upstream (e.g., pollution prevention) and downstream (e.g., climate adaptation and response) actions. Specific recommendations included:
      • Reducing sources of pollution that contribute to climate change and oppose the rollback of climate protective policies addressing fuel economy standards, power plant emissions, and other sources of atmospheric carbon.
      • Educate the public so that they understand the connections between their health and climate health. An informed citizenry is needed if health protective policies are to be enacted and supported.
      • Increase support for federally funded research aimed at minimizing the local consequences of climate change.
      • Collaborate with governmental and nongovernmental organizations (e.g., Federal Emergency Management Agency, American Red Cross) to adopt or update strategies addressing emergency responses to climate change-related disasters. (
        • Leffers J.
        • Butterfield P.
        Nurses play essential roles in reducing health problems due to climate change.
        )
      In addition to the policy brief addressing climate change, other Academy publications have addressed:
      At the Academy we focus on delineating, highlighting, and promoting policies that advance health, including determinants of environmental health. Profound changes in priorities and approach have occurred in the transition between the two previous presidential administrations. Many have argued that regulatory protections addressing environmental health have devolved remarkably; others support the current administration's approach. As nursing leaders we understand that policies translate into real risks and real benefits. Changes in air and water quality policies mean that the calculus of risk has changed; it is up to us, as individuals and as the Academy, to remain informed. By shining a light on environmental health, the Academy aims to be a central part of the conversations going forward.
      While it is easy to become complacent with a dizzying continuous 24-hour news cycle, we must prioritize those policies that have immediate as well as long lasting and irreversible impact on health. Whether or not the current approach to environmental policy changes in the future, each day that they are in place damage is being done to people, not to mention future generations. The science and the evidence must be our guide.

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