How Dr. Lloyd Novick Elevated Environmental Public Health

In 1995, as a newly appointed Director of the Division of Health Education and Promotion in the US Agency for Toxic Substances and Disease Registry, I received a call from Dr. Lloyd Novick, an already well-known public health practitioner, to join the editorial board of a new peer-reviewed journal that would focus on the science, practice, and policy of those who served local communities worldwide.1 Would such a journal, to be called the Journal of Public Health Management and Practice (JPHMP) be read, would busy public health practitioners have time to submit manuscripts, and above all, who would want to read about environmental public health? In his quiet but persistent fashion, Lloyd, our public health leader, had convincing arguments for each question. His answer is well captured in Figure 1. The JPHMP embodies our public health home, increasing the visibility of each of the 3 components of the public health system: (1) the public health infrastructure, the most critical, but least supported “floor” of our public health “home”: information and knowledge systems, the public health workforce, and organizational capacity; (2) “the dining room, living room, and kitchen,” often noted to be public health’s essential capabilities: surveillance, laboratory practice, epidemiologic investigation; and (3) the “roof” of the public health home—the portfolio of public health programs and services.FIGURE 1: Public Health Infrastructure The journal, under Dr. Novick’s leadership, substantively focused on the domains of the public health infrastructure. For example, the JPHMP published a substantial number of articles on the environmental public health workforce, providing the opportunity to share evidence-based guidance aimed at strengthening the quantity and quality of those practicing environmental public health.2-6 The impact was exactly what Lloyd had envisioned. Across our nation, public health students and environmental health professionals alike gain competency in environmental public health through a diverse portfolio of learning opportunities, including Formal degree programs offered by schools and programs in public health,7 Credentialing and certificates offered by professional associations such as the National Environmental Health Association,8 and Environmental health section-sponsored sessions at annual meetings of the American Public Health Association.9 To date, the JPHMP has 430 subscribers, 225,382 public health-specialty average monthly page views and over 4,000 article submissions, including over 110 directly focused on environmental public health.10 While other environmental health-related journals exist, none focuses so intently on the public health practice aspect of our discipline. Environmental public health has always been one of the cornerstones of modern public health practice. In the United States, its roots can be traced back to the sanitation and hygiene reforms of the 19th and early 20th centuries—an era when clean water, sewage disposal, and housing conditions were recognized as fundamental determinants of health.11 More recently, the 21st century has seen environmental health broaden to encompass climate change, natural disasters, built environments, and the social and environmental influences on health inequities. The World Health Organization provides a comprehensive definition of environmental health that reflects this breadth: Environmental health addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviors. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments.12 This definition highlights prevention and systems thinking—two key themes that resonate with Dr. Novick’s vision by situating environmental exposures within a broader context of health-supportive environments. It mirrors the multifaceted approach to public health practice that Dr. Novick advanced through his editorial leadership. The JPHMP publications in environmental public health exhibit a 3-pronged distinction: (1) the manuscripts elevate the science of environmental public health; (2) submissions are by frontline practitioners about real-world environmental public health threats and actions to mitigate such threats; and (3) the focus is always on those we serve in our communities, especially those most vulnerable. To illustrate this 3-pronged approach, consider lead exposure, a persistent environmental public health challenge that the JPHMP addresses in diverse ways. A recent study developed a predictive model incorporating housing characteristics to identify areas in Ohio where children are at elevated risk for elevated blood lead levels, thereby improving the accuracy of existing predictive tools and using innovative technologies to advance environmental public health.13 To showcase frontline practice, two articles described a collaboration between New Jersey government agencies, Columbia University, and Hunterdon Healthcare that distributed water-testing kits and integrated drinking water source questions and arsenic testing history into electronic medical records used by primary care providers in the area to address a recurring water quality issue in Hunterdon County, New Jersey.14,15 Finally, to emphasize community engagement, researchers and public health practitioners in Atlanta partnered with local residents to implement a soil screening program for urban gardens, addressing potential contamination risks.16 Together, these examples illustrate how the JPHMP publications not only advance scientific knowledge but also translate evidence into practice and foster community-driven solutions. The JPHMP, under Dr. Novick’s leadership, collaborated successfully with the US Centers for Disease Control and Prevention not only to highlight their programs in general but specifically to publicize significantly effective programs that may have been less visible. In 2016, for example, the journal published a special supplement on health equity.17 The expansive collection of articles authored by public health professionals from the US Centers for Disease Control and Prevention and state and local public health departments illustrated the impact of health disparities across the United States and provided practical scientific approaches to sustainably counter these disparities and inequities, including those associated with exposures to hazardous chemical exposures. Dr. Novick’s leadership in elevating the role of environmental public health to counter the consequences of chemically induced technological disasters is best illustrated by a special supplement on the Gulf Region Health Outreach Program (GRHOP).18 On April 20, 2010, an explosion of the offshore Deep Water Horizon-operated Macondo well killed 11 people, caused the rig to sink, and over the 87 days it took to cap the well spilled over 4 million barrels of oil in the Gulf of Mexico. While efforts were taking place to address the ecosystem damages, little focus was placed on human health. The GRHOP was designed as a 5-year project to strengthen health care in Gulf Coast communities, with an overall goal to build healthier, resilient communities through regional partnerships. The beneficiaries were communities living in the 17 affected counties and parishes in the affected states of Texas, Louisiana, Alabama, Mississippi, and Florida. These communities faced a triple threat to their health: persistent environmental health threats, intransigent health disparities, and both natural and technological disasters.19 Among the GRHOP-supported efforts was the Environmental Health Capacity and Literacy Project. The project focused on advancing environmental public health by training community health workers to serve in the Gulf South Region’s federally qualified health centers (FQHC); strengthening the knowledge of locally practicing health care providers in environmental public health and occupational medicine; and nurturing emerging scholars in environmental public health. The community health workers’ training embedded content focusing specifically on the role of the environment to negatively influence the trajectory of key adverse health outcomes such as cardiovascular diseases, diabetes mellitus, and childhood asthma.20 A persistent concern among affected communities in the aftermath of the oil spill was that local health care providers could not correctly diagnose and treat health concerns they associated with the oil spill. As part of the Environmental Health Capacity and Literacy Project, we put in place a comprehensive environmental public health and occupational medicine network.21 The program included A case study in environmental medicine focused on how to address the potential exposures associated with oil spill–related chemical compounds. Physicians and other locally practicing health providers who completed the online module earned continuing education credits free of charge; Peer consultations with environmental medicine specialists and an initial visit of an affected community member with their primary care provider during a telemedicine consultation with one of the network’s environmental medicine specialists. All aspects of the clinical encounters were contributed gratis to the community member and their health provider. The most celebrated component of the Environmental Health Capacity and Literacy Project program (often called its “crown jewel”) was the Emerging Scholars Program, which engaged juniors and seniors in high schools located in the affected counties and parishes in immersive environmental public health summer activities. The Environmental Health Science Academy focused on didactic, in-class components, field visits to experience real-world environmental public health threats, and research. The students’ culminating research was organized as a poster session visited by their high school science teachers, parents, and faculty mentors. These programs increased their knowledge and interest in science.22 The Environmental Health Science Academy resulted in most scholars receiving a college education and many pursuing degrees in the health sciences, including medicine and public health. The examples shared in this editorial illustrate Dr. Novick’s commitment to environmental public health practice. Through his leadership as the lead editor of JPHMP, he elevated what once was obscure and neglected to what is now standard practice. He celebrated the work of environmental health professionals in ways no one has. His emphasis on evidence-based practice included highlighting the implications for public health policy. By focusing publications on what future and current environmental public health professionals should know, he increased the visibility and importance of our profession worldwide. I know that I am joined by my peers in our commitment to sustain Dr. Lloyd Novick’s vision of environmental public health as a discipline in service to our most vulnerable communities.