We agree with the authors of “Addressing Gaps in Public Health Education to Advance Environmental Justice: Time for Action” (p. 69) that revisions to the Council on Education for Public Health (CEPH) accreditation requirements appear to be having a negative impact on the environmental health education of public health professionals and that there has never been a more important time for such education. As chairs of departments of environmental health, we have observed reductions in environmental health education over the past five years. Many schools no longer require an environmental health course; environmental content has been integrated to varying degrees across other core courses, sometimes with a substantial reduction in content.
We emphasize that environmental health cannot be adequately taught using environmental examples in the teaching of core concepts in biostatistics or epidemiology. Environmental health is not merely a topical area or a series of issues and applications, but a body of theoretical, empirical, biophysical and causal methods that are used to design effective strategies to mitigate the deleterious effects of exposures. Environmental health teaches unique methods to quantify and compare environmental risks, demonstrate the biological plausibility of a potentially causal association, identify the sources of a chemical or biological exposure (i.e., source tracking, source apportionment), and design effective risk mitigation strategies using predictive models based on chemistry, biology, and physics.
Foundational knowledge in these areas is crucial for all public health professionals, not just those specializing in environmental health. In fact, environmental health knowledge is central to many of the major threats being addressed across public health. For example, environmental health methods are needed to understand the roles of ventilation, filtration, exposure time, occupancy, and masking on COVID-19 transmission risk. Although COVID-19 will eventually be behind us, the need to understand the sources and environmental transformations of chemical and infectious agents, routes of exposure, and mechanisms of action to design effective interventions will remain.
Ultimately, climate change is the biggest threat to global public health, including impacts from droughts, floods, fires, heat waves, and hurricanes. Many of these extreme events have further environmental and public health consequences that exacerbate inequities (e.g., toxic releases, air pollution, water insecurity, crop failure, displacement). Cities around the world will be taking steps to reduce carbon emissions (mitigation) and protect populations from climate change (adaptation); all those measures will have health consequences. Educating public health students about the connections between environment, climate, and health is necessary but not sufficient; our students need environmental health tools that enable them to evaluate the benefits of proposed action and advocate optimal approaches.
Furthermore, it is increasingly important for public health students to have a sophisticated understanding of environmental health disparities. Environmental health provides important case examples of the implications of structural racism on health and well-being (e.g., via climate change, COVID-19, lead in drinking water, urban heat islands). Broadly, like the pandemic, climate and environmental change have the potential to have long-lasting and devastating effects on community resilience and health equity. In addressing these challenges, we need educated public health professionals who can help to ensure that the needs of the most vulnerable are centered and that mitigation and adaptation strategies are designed with cobenefits for health equity.
In conclusion, we urge a recentering of the methods of environmental health in public health education. The foundational public health knowledge set forth in the CEPH accreditation criteria only includes “Explain effects of environmental factors on a population’s health.” This is neither specific nor rigorous. Public health students need knowledge and skills to address the climate crisis, pandemics, and racial injustice, issues that they are truly committed to solving.
ACKNOWLEDGMENTS
This editorial is a product of curriculum discussions held over several weeks between all authors. Others wishing to add their names as signatories are encouraged to contact the corresponding author. Signatories will be posted here: https://docs.google.com/document/d/1hSCCCGbsV7u6zPvaZRTN64L3NgvNslDBH_WRWrHN3IQ/edit?usp=sharing.
CONFLICTS OF INTEREST
The authors have no conflicts of interest or funding associated with this editorial to declare.