NEHA March 2024 Journal of Environmental Health

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 eectiveness. 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 eectiveness. 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 eectiveness of environmental health. It is, however, a minor step in what needs to be a major eort 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 eectiveness. 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:


Brooks, B.W., & Ryan, B.J. (2021). Building environmental public health back better. Environmental Science & Technology Letters , 8 (6), 443–444. Centers for Disease Control and Prevention. (2022). National Envi- ronmental Public Health Tracking: About the program . https://www. Drew, C.H., van Duivenboden, J., & Bonnefoy, X. (2000). Environ- mental health services in Europe 5: Guidelines for evaluation of envi- ronmental health services . World Health Organization, Regional Oce for Europe. Funk, C., Heeron, M., Kennedy, B., & Johnson, C. (2019). Trust and mistrust in Americans’ views of scientific experts . 6. A major- ity of Americans have positive views of environmental scientists, but trust in them varies by politics . Pew Research Center. https://www. have-positive-views-of-environmental-scientists-but-trust-in- them-varies-by-politics/ Gerding, J.A., Brooks, B.W., Landeen, E., Whitehead, S., Kelly, K.R., Allen, A., Banaszynski, D., Dorshorst, M., Drager, L., Eshenaur, T., Freund, J., Inman, A., Long, S., Maloney, J., McKeever, T., Pig- man, T., Rising, N., Scanlan, S., Scott, J., . . . Sarisky, J. (2020). Identifying needs for advancing the profession and workforce in

environmental health. American Journal of Public Health , 110 (3), 288–294. Gerding, J.A., Hall, S.K., & Ortiz Gumina, C. (2020). Exploring the benefits and value of public health department internships for environmental health students. Journal of Environmental Health , 83 (4), 20–25. Goldstein, N.D., Palumbo, A.J., Bellamy, S.L., Purtle, J., & Locke, R. (2020). State and local government expenditures and infant mor- tality in the United States. Pediatrics , 146 (5), e20201134. https:// Heidari, L., Chapple-McGruder, T., Whitehead, S., Castrucci, B.C., & Dyjack, D.T. (2019). Characterizing the roles and skill gaps of the environmental health workforce in state and local health departments. Journal of Environmental Health , 81 (6), 22–31. Hendryx, M., & Luo, J. (2020). COVID-19 prevalence and fatality rates in association with air pollution emission concentrations and emission sources. Environmental Pollution , 265 (Pt. A), Article 115126. Morrone, M. (2020). Ailing in place: Environmental inequities and health disparities in Appalachia . Ohio University Press. https://doi. org/10.2307/j.ctv224twt2

continued on page 32


March 2024 • Journal of Environmental Health

Powered by