Environmental public health law: three pillars.

journal of law, medicine & ethics Most people dread being the subject of interest for doctors, scientists, regulators, and lawyers. While we may joke about the arrogance of the medical profession and the aggressiveness of the legal field, both lie at the core of environmental public health (EPH). They are inseparable, sometimes complementary and other times in tension. The role of medicine and science in EPH is clear, but their relationship with law is often opaque. Yet in no other area of public health, from infectious and chronic disease prevention to providing health care in underserved communities, is law so central as an instrument and partner. In this article we explore the relationship of law and science in the broader context of EPH, beginning with an overview of potential goals and challenges. We then offer three organizing principles that inform and guide the integration of law, science and policy in EPH. The term EPH is used deliberately, in part to distinguish “environmental health” from “environmental protection.” Most people think of environmental protections as the safeguarding of flora and fauna, or clean up of facilities or chemical spills. While these efforts are important and relevant to EPH, they are not its core. The purpose of public health is defined as “fulfilling society’s interest in assuring the conditions in which people can be healthy.”1 No sector of public health is more focused on assuring healthy conditions than EPH. During the 20th century, the average American’s lifespan increased by approximately 30 years, due mainly to advancements in two major areas: (1) changes to environmental conditions — often enabled by better standards of living; and (2) increased rates of immunization.2 Two main conceptual tributaries or foci of EPH are enhancing quantity of life (focusing more on traditional public health concepts such as morbidity and mortality) and improving quality of life (often intermingled with environmentalism). While practitioners and researchers typically treat the two as conceptually and functionally distinct, they are often inextricably interconnected. Reductions in fatality rates of individuals with infectious diseases such as tuberculosis preceded the development and use of medical treatments. Many of the most successful public health interventions, such as waste removal and water sanitation, were accomplished without meaningful knowledge of bacteria, viruses, or underlying causes of disease. Improvements in quality of life through reductions in morbidity and mortality were the result of environmental interventions as well. Clean air, water, and food as well as safer workplaces profoundly improved quantity and quality of life. In this capacity, quality and quantity of life conflate. It is instructive to recognize how quality of life efforts often create benefits long before the impacts on quantity of life. For example, early efforts to reduce smog levels in Los Angeles substantially preceded awareness of the negative health effects of many ground level air pollutants.3 Concern about the environment, or “environmentalism,” is the second tributary flowing into EPH. Public health is undeniably focused upon the protection of human populations rather than plant and animal species, the oceans, and other natural systems. Yet in many cases the same conditions that threaten public health also raise broader ecological concerns. These Richard J. Jackson, M.D., M.P.H., is a Professor and Chair of Environmental Health Sciences at UCLA School of Public Health. Timothy F. Malloy, J.D., is a Professor of Law at UCLA School of Law. Environmental Public Health Law: Three Pillars