Research priorities in environmental health

Environmental issues are often high up on the political agenda. However, environmental health aspects tend to receive a lower priority. When conflicts of interest occur with other environmental concerns this may result in negative consequences for public health. In Scandinavia, for example, indoor ventilation has been reduced substantially in many dwellings to save energy, but that has led to increased humidity and prevalence of house dust mites.¹ Levels of house dust mites in certain poorly ventilated houses near the polar circle are comparable to those in subtropical areas, contributing to childhood asthma and allergy. Similarly, biomass (wood burning) for local heating is promoted because it is a renewable source of energy, and diesel vehicles are promoted because of their lower emissions of carbon dioxide per kilometre than conventional gasoline engines.² Both, however, lead to increased emissions of fine particulates, which have been associated with adverse health effects at levels below current air quality guidelines in many countries.

How then can environmental health issues receive a higher priority? Increased resources for research in environmental health are one important component. The European Commission recently launched its fifth framework programme, which has more focus on environmental health research than earlier programmes. The environment and health part of the programme has three main objectives: reducing adverse health effects (including allergies) related to environmental factors; assessing and reducing environmental health hazards; and supporting health and environmental policymaking and public information. It is essential that the European initiative is matched by comparable resources at national level.

The European Science Foundation together with the World Health Organisation’s regional office for Europe and the European Commission recently prepared a document on research needs in environment and health.³ This document has been submitted to the Intergovernmental Conference on Environment and Health in London 1999. The aim is to provide policymakers with scientific strategic elements for launching a European wide research effort in environment and health. Eleven research topics were identified without priority order (see box). Under each topic specific research needs were listed in three main categories: basic research, research related to translating basic science results into policy support; and risk management principles/research directly aimed at facilitating or supporting policy decisions.

Proposed European research topics

• Climate change, stratospheric ozone depletion, and human health

• Social variations in health expectancy in Europe

• Environmental effects on cognitive functions

• Cognitive functions as mediators of environmental effects on health

• Children and accidents

• Ambient air particulates

• Indoor air quality and health

• Water quality and drinking water

• Endocrine disruptors

• Assessment of human health effects of immunotoxic agents

• Chemical risk assessment and related toxicological issues

These research priorities seem appropriate. In particular, it is important to strengthen the scientific basis for decision making about environmental health effects in both the public and industrial sectors. More than many other fields environmental health has been plagued by alarming—even alarmist—reports on actual and perceived risks, and these have complicated rational priority setting in environmental and health policy. Both the mass media and scientists have a responsibility to contribute to the knowledge base on which the public may make informed decisions.

Environmental health research is multidisciplinary and should encompass basic science as well as applied research. While epidemiological studies are crucial for assessing effects directly in humans and estimating population attributable risks their resolution power is limited, mainly because of difficulties in estimating exposure precisely and in controlling bias. Toxicological studies are necessary for elucidating causal mechanisms, which may be important for determining dose-response relations and extrapolation to low doses in risk assessment. On the other hand, direct generalisations to humans are often uncertain. Close collaboration between scientists in different disciplines offers a great potential for advancing risk assessment.

International collaboration is often very useful in environmental health research. In epidemiology it may provide a wider range of exposure and a larger study base, enhancing the resolution power of the studies. The European Commission has funded several international collaborative projects in air pollution epidemiology,⁴,⁵ which have been of great importance in risk assessment. The projects were also vital in capacity building, and state of the art studies in air pollution epidemiology can now be performed in several European countries, including some in central and eastern Europe. This experience has had an impact on policy issues as well, and it is important that these efforts to support international collaboration are continued.

Education and debate pp 1678-93