Research > Environmental Health Studies

Research efforts related to the environment should include the effects of the environment on human health. Research into human health effects can include a very broad range of measures of health and health outcomes, applicable to different environmental exposures or effects. Studies of disease and physiology are predominant among most environmental health programs. A broader conception of health will also encompass social and psychological factors.

The outcome of common concern to public health is the effect of the environment on the morbidity and mortality from diseases linked to environmental exposures. For example, mortality studies have linked air pollutants to increased rates of mortality from cardiovascular and pulmonary diseases; occupational cancer studies have linked environ-mental pollutants to and excess of cancer deaths. The occurrence of new cases of diseases, or the worsening of existing diseases, is also a concern. For example, air quality has been linked to increased hospitalizations for asthma among children. The critical disciplines to this type of study are epidemiology, occupational, and environmental medicine, and disciplines able to quantify exposures, such as environmental engineering and environmental chemistry.

Closely linked to morbidity and mortality are studies of biomarkers or physiologic processes that result from exposure. Examples include DNA adducts, measures of bone or tooth lead, and measures of airway responsiveness following exposure to air pollutants. These markers are often detectable in people with no diagnosed disease, but are thought to predict future disease or to help understand the mechanisms of disease.

A broader view of health includes factors such as physical fitness or activity (affected by the design of streets and sidewalks), healthy diet (affected by the availability of healthy foods), and overall well-being. Income and educational disparities are often compounded by disparities in exposure to environmental pollutants and lack of access to safe physical activity or to affordable healthy foods. Broader views of health also encompass psychological health and social structures that directly affect or mediate other determinants of health.

Key issues:

• Asthma. The prevalence of this common disease continues to rise, particularly among African-Americans. Air pollution and indoor air quality (including mold and insects) are significant contributors to asthma in children; workplace exposures are a major contributor in young adults.
• Lead exposure. Pediatric lead exposure is a major concern in the urban core of St. Louis, as well as in surrounding areas (such as Herculaneum). This is a legacy of lead-based industries and of lead paint in our older housing stock.
• Housing patterns and the effects of the environment on health behaviors. The concentration of people in the urban core, as well as the sprawl around St. Louis, contributes to a number of health problems beyond air quality and lead exposure. The physical layout of housing and workplaces can either encourage or discourage exercise; ability to purchase healthy food nearby changes dietary habits; long commutes are stressful; etc. Existing research programs on health behaviors, diet, and exercise would aid this line of research.
• Neurological disorders. Chronic neurological disorders are receiving a great deal of attention now from NIEHS and other funding agencies. A research program in Parkinson's disease related to welding fume exposure is in early stages of development at the School of Medicine; the considerable strengths of the school in neuroscience could be an advantage here.
• Cancer: Occupational and environmental cancers are a major health concern. Though the School of Medicine has little ongoing research relevant to environmental cancers, the Siteman Cancer Center and the wealth of basic research in cancer mechanisms may be helpful here.
• Emerging Infections. Environmental changes promote the emergence of infections that affect humans and animals. Examples include the avian flu and the generation of antibiotic-resistant human pathogens through the use of antibiotics in livestock. The School of Medicine has significant strengths in infectious disease research; there are existing collaborations with the Danforth Campus faculty.

Interactions:

Researchers in the School of Medicine are just beginning to collaborate with researchers on the Danforth Campus in the areas related to the environment. More synergies are to be realized, and establishment of the Institute will promote collaborative efforts. Environmental health has linkages to all the centers-aerosols and air quality (some work has been initiated already), rivers, ecosystems, and energy.

Washington University Strengths:

• Very strong basic science research in many areas relevant to human health
• Access to large patient populations
• New emphasis on clinical research that could encompass environmental health (BioMed 21, proposed Division of Clinical Sciences)-these currently are planned but not actualized
• New pre-doctoral and post-doctoral training programs (K-12 and T-32) centered at the medical school offer the opportunity for non-clinicians to get training in clinical research (broadly defined).

Key players:

Mario Schootman (geocoding and cancer epidemiology; health behavior research); Mario Castro (asthma research); Sam Klein (obesity, physical activity); Brad Evanoff (environmental medicine); Brad Racette (neurological disorders); Vicky Fraser (infectious diseases); Sam Stanley (emerging infections); Gary Weil (parasitic infections in developing nations); Maxine Lipeles (health policy and law); Bill Peck (health policy); Jay Turner (air pollutants); Pratim Biswas (air pollutants, nanoparticles); School of Social Work faculty. St. Louis University School of Public Health (SLUSPH)-Ross Brownson (physical environment and physical activity); David Sterling (lead exposure and remediation); Roger Lewis (occupational health); Mark Buller (infectious diseases).

Areas that need further development:

• Public health. Washington University is among the few universities with a top-ranked medical school but without a school of public health. Most schools of public health have a department of environmental health focused on research in this area.
• Epidemiology. Few researchers at Washington University are studying the distribution and determinants of health in populations of people or animals.
• Toxicology / biomarkers. Though some existing research at the School of Medicine could be relevant to these areas, or shifts in emphasis encouraged by funding, these areas are quite underdeveloped.
• Faculty visibility/ faculty recruiting. Few faculty at the School of Medicine are visibly involved in environmental health related research; no faculty are primarily identified as doing research in environmental health.
• Cooperative projects between theDanforth Campus and the School of Medicine. Cooperative projects between Washington University and the St. Louis University School of Public Health (SLUSPH). Washington University could better realize complementary strengths between these different groups to encourage multidisciplinary research.

Summary:

The center will bring together researchers in the field of environmental health. The potential of this field will be demonstrated, and justification for the goal of having a school of public health can be provided.