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In last month's column, I considered the remarriage of environmental health and environmental protection. I gave the example of Lincoln Lancaster County Health Department in Nebraska, where the two have been remarried within a local health department setting. I also pointed out that some environmental health departments, particularly in the western U.S., are no longer housed in public health departments.
If environmental health remains situated in the public health (PH) system for the large proportion of this country, what are the likely implications that we need to be aware of as we consider long-term marketing efforts for environmental health?
* There is a bleak financial picture within PH, and the pressure to bring in environmental health fees in order for programs to survive will continue to grow.
* The competition from retail big-box stores for medical and PH services is likely to increase. At these stores, shoppers are already able to buy food and supplies, get the oil changed in the car, have their blood sugar levels checked, or get their flu vaccine, all in one visit. This is a rapidly growing phenomenon and may increasingly take large numbers of individuals away from local PH clinics.
* The 1988 Institute of Medicine report, The Future of Public Health, reaffirmed that in the minds of the public, public health is often equated with medical care of the indigent. The 1988 report, and the updated report of 2002, made very little mention of environmental health.
* Much of the last century dealt with infectious diseases. The "new" killers are chronic diseases, many of which have a large environmental component, e.g., the built environment. Yet many environmental health (EH) and PH units are not positioned to make positive contributions in these areas.
* The various tools created in the PH arena in...