A couple of perplexing relationships emerged in this analysis. An example are the relationships among severe housing condi- tions and cancer, cardiovascular disease, and COPD. The correlation coecients sug- gest that states with higher percentages of occupied housing units with environmental health issues—such as a lack of plumbing facilities—have lower percentages of people with cancer, cardiovascular disease, and COPD. In addition, states with the highest levels of asthma also have higher levels of spending on sewer infrastructure and fund- ing from CDC. Discussion and Conclusion The results of this simple correlative approach using state-level comparative data show some promise in identifying relation- ships between environmental health and health that could serve as a foundation for documenting workforce eectiveness. Alter- natively, the results emphasize that there are substantial challenges to accomplishing this goal. State spending on sewer infrastructure and nonhospital health activities is moder- ately associated with overall health status. At
least some measures of environmental quality are also related to health outcomes, both pos- itively and negatively. Even though some rela- tionships emerge here, it requires us to accept data, such as funding levels, as an indicator of workforce eectiveness. This exploration emphasizes the chal- lenges we face in documenting our work. There are no data available on the number of lives saved or illnesses prevented. In this absence, we must use imperfect indicators such as relationships between resources dedicated to environmental health and health status, or we will need additional dis- cussion and agreement on other measures. While there are indicators of environmen- tal quality, health status, specific diseases, and environmental public health spending, there are serious limitations to these indi- cators. For example, food insecurity shows the strongest correlations with health status and two specific health conditions. As food insecurity is related to socioeconomic status in general, states with higher levels of this indicator also have higher levels of poverty. Poverty cannot be understated as an indica- tor of health status.
The work reported here seeks to contrib- ute to the discussion about documenting the eectiveness of environmental health. It is, however, a minor step in what needs to be a major eort to broadcast the suc- cesses of environmental health in response to an emerging consensus that we need to do more to promote how we prevent disease and improve health. Moreover, questions have been raised about what messages we can use to educate the public and policymak- ers in the absence of hard data that provide evidence of our eectiveness. Unless we con- tinue to ensure that environmental health is recognized as a crucial component of public health, progress to shore up the workforce will remain a concern. As we strive to deliver evidence to receive this recognition, we can also aim to improve the status and sustain- ability of the workforce. Corresponding Author: Michele Morrone, Professor, Environmental Health Science and Chair, Department of Social and Public Health, Ohio University, West 355 Grover
Center, Athens, OH 45701. Email: morrone@ohio.edu.
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March 2024 • Journal of Environmental Health
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