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4
Demands for Exposure Science
INTRODUCTION
Knowledge of exposure is key to predicting, preventing, and reducing en-
vironmental and human health risks. A robust exposure science is necessary to
support policy decisions for managing potentially harmful exposures without
adversely affecting economic activities, personal liberties, and the health of peo-
ple. The need for exposure science extends beyond policy considerations, how-
ever, and includes societal goals related to population health, economic security,
and human well-being. This chapter addresses the demands for exposure science
that the committee's proposed vision will help to meet. The committee's vision
will help transform exposure science into a more forward-looking discipline that
supports universal exposure surveillance and integrated predictive systems that
facilitate early detection of and even anticipate harmful exposures.
The committee's vision (Chapter 2) arises in part from multiple and com-
plex scientific, societal, commercial, and policy demands. The committee did
not attempt to develop an exhaustive list of those demands but rather selected
examples to illustrate their nature and their importance in shaping research
needs for exposure science in the 21st century. This chapter builds on the con-
cepts and terminology in Chapter 1 and the applications of exposure science in
Chapter 3. It sets the stage for Chapter 5, which identifies scientific and techno-
logic advancements needed to support the committee's vision.
The committee broadly explored research-based and decision-based activi-
ties to identify emerging needs for exposure information. This exploration re-
veals that the demand for exposure information is growing. One example of this
is the knowledge gap resulting from the introduction of thousands of new
chemicals into the market each year. The U.S. Toxic Substances Control Act
and the Green Chemistry Initiative of the California Department of Toxic Sub-
stances Control (CA DTSC 2008) demonstrate that the rate of introduction of
new substances exceeds our ability to design and conduct exposure assessments
of these new chemicals and their mixtures that enter the market. Other examples
90
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Demands for Exposure Science 91
of emerging demands for exposure information are EPA's Premanufacturing
Notice requirements and the European Union's program for the Registration,
Evaluation, Authorization and Restriction of Chemicals. The industries that
market chemicals and the government agencies that regulate them need more
and better exposure information to conduct screening and regulatory assess-
ments.
Another example is the increasing need to address long-term health effects
of low-level exposures to chemical, biologic, and physical stressors over years
or decades, such as low-level radiation exposure. A dearth of exposure data con-
tributed to uncertainty in communicating the radiation risk posed by the Fuku-
shima incident in Japan to policy-makers and the public. Previous opportunities
to reduce uncertainties through the collection of more and better exposure data
have been missed, including opportunities in the aftermath of the Soviet Union's
April 1986 Chernobyl nuclear incident, which spewed radionuclides over a large
swath of Europe (Normile 2011). There were few systematic or sustained appli-
cations of exposure-science techniques in the collection of radiation-exposure
data at Chernobyl (UNSCEAR 2011).
Growing efforts to collect, organize, and evaluate medical-surveillance
data in the absence of corresponding efforts to assemble, evaluate, and track
exposure data present another example of the need for data. The paucity of ex-
posure data has been observed repeatedly--in the followup of health effects in
veterans of the Gulf War (IOM 2000), in the Centers for Disease Control and
Prevention (CDC) Health Tracking Program (CDC 2011a), and in the monitor-
ing of the health of volunteers and professionals after exposures to the 2010
Gulf Oil Spill (IOM 2010; King and Gibbons 2011).
The committee defined the complex and overlapping needs for exposure
information in four broad categories: health and environmental science, market,
societal, and policy and regulatory (illustrated schematically in Figure 4-1).
Health and environmental sciences require reliable quantitative data on human
and ecosystem exposures. Market demands require the identification and control
of exposures resulting from the manufacture, distribution, and sale of products
and the provision of services (for example, energy, transportation, and health
care). Societal demands arise from the aspirations of individuals and communi-
ties--relying on an array of health, safety, and sustainability information--for
example, to maintain local environments, personal health, the health of workers
who make consumables, and the health of the global environment. Policy-
makers drive the need for exposure science when they require knowledge to
inform their actions--particularly the setting of policies directed at mitigating
environmental risks and avoiding hazards in cost-effective ways. Policy-makers
need to establish a balance among the different science (health), market, and
societal demands as they establish regulations and set budgetary priorities. The
remainder of this chapter explores the four categories of needs for exposure sci-
ence information. The committee recognizes that many of these demands can
conflict. For example, individuals and communities may have different goals
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92 Exposure Science in the 21st Century: A Vision and A Strategy
FIGURE 4-1 The four major demands for exposure science.
and aspirations with respect to research and policies to maintain the environ-
ment, the health of individuals, and communities. Similarly, policy makers and
regulatory agencies often have different and even competing goals, and each
will be interested in exposure studies that support their particular perspectives.
The goal is to explore the various demands, recognizing the potential for com-
peting and conflicting demands.
HEALTH AND ENVIRONMENTAL SCIENCE DEMANDS
The need to protect human health has been and will continue to be an im-
portant demand for exposure information (NRC 2009a). Accurate assessment of
human exposures is a critical component of environmental health research
(McKone et al. 2009). Air pollution epidemiology, risk assessment, health track-
ing, and accountability assessments are examples of health research studies that
require but often lack adequate exposure information (McKone et al. 2009). The
expanding number of environmental factors that are or will be the focus of
health research creates a continuing demand for exposure information. In many
health studies the lack of accurate exposure information has led to the use of
questionnaires and qualitative assessments in place of more robust quantitative
observations.
Demand for health and environmental science information includes the
need for more and improved data on broad issues, such as direct stressortarget
relationships--for example, air pollution and health and the multiple, complex,
and sometimes indirect linkages among environmental exposures and ecosys-
tems, water and land resources, and the built environment. Demands for expo-
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Demands for Exposure Science 93
sure information also arise from specific health or environmental issues--for
example, a rise in autism, asthma, or childhood brain cancer; reproductive fail-
ure in specific wildlife populations; or deterioration of popular local habitats.
There is also a need to integrate health and ecologic sciences to support a more
harmonized framework for assessing the fate and effects of industrially pro-
duced and naturally occurring pollutants. Protecting human health and ecosys-
tem integrity requires long-term and spatially and temporally resolved tracking
of multiple stressors. For humans, that type of tracking has been conceptualized
as the "exposome", defined as collective exposures from conception on (Wild
2005, 2012). An analogous ecologic-science approach is the National Ecological
Observatory Network (NEON)--a continental-scale research instrument pro-
posed by the National Science Foundation (NSF) to provide a nationally net-
worked research, communication, and informatics infrastructure for biologic
systems (NEON 2011)--intended to assess the direct effects and feedbacks be-
tween environmental change and biologic processes. A similar NSF program,
the Long Term Ecological Research network, has been in operation since 1980
(LTER 2012).
Environmental exposures contribute substantially to human health risks,
accounting for a greater fraction of risk than genetic variation (Rappaport and
Smith 2010). New analytic capabilities are needed for environmental surveil-
lance and biomonitoring and for linking biomarkers to stressors on the basis of
pharmacokinetic and pharmacodynamic models (Sohn et al. 2004; Clewell et al.
2008).
Health
With regard to the influence of environmental exposures on health, direct
causeeffect relationships are sometimes apparent, as in the cases of radiation
from nuclear weapons in Japan; dioxin in Seveso, Italy; and methyl isocyanate
in Bhopal, India. Such relationships can be evident even if there is a substantial
lag in the development of health effects, as in the 10- to 50-year delay in devel-
opment of mesothelioma from asbestos exposure.
More commonly, however, exposureeffect relationships are difficult to
establish because of other variables. For example, studies of cancer risk in mi-
grants show that environmental factors can cause large increases in risk (see
Ziegler et al. 1993). The increase in risk is attributed to lifestyle differences,
such as differences in air and water, food, pharmaceuticals, and many household
and occupational exposures. Effective monitoring methods, such as CDC's Na-
tional Health and Nutrition Examination Survey (NHANES), directly reveal
such health changes as the rise in obesity. An ability to link those changes rap-
idly to specific exposures--for example, endocrine-disrupting chemicals (Hein-
del 2003), diet, and urban patterns--requires continuing exposure assessment.
The need for innovative and cost-effective means of separating and measuring
specific exposures constitutes an important demand for exposure science.
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94 Exposure Science in the 21st Century: A Vision and A Strategy
Scientific advances in epigenomic research (the study of epigenetic modi-
fication at a level much larger than a single gene) have revealed long-term ef-
fects of early-life exposures on modification of DNA-methylation patterns (Jirtle
and Skinner 2007). Relevant exposures and vulnerable life stages are beginning
to be understood, but preliminary results illustrate the need for better exposure
data for assessing long-term disease risks. That need is underscored by concern
about transgenerational risks posed by fetal exposures, including those during
ovarian-cell development, which can affect health outcomes in later generations
(Skinner et al. 2010). These types of observations suggest the opportunity for
novel approaches to translate internal markers into measures of exposure at
critical life stages. To achieve this, scientists need to quantify current exposures
and preserve the data in forms that permit them to be used in the future to eluci-
date transgenerational risks posed by particular exposures.
Increasing use of burden of disease metrics (such as disability adjusted life
years [DALYs]) and comparative risk assessment covering a wide array of risk
factors, including chemical exposures, diet, and lifestyle, to inform policy deci-
sions demands better and more consistent methods of characterizing diverse
exposures in large populations. The problem that arises from this demand is the
need to provide measures of environmental exposures that are consistent in sta-
tistical and causal terms with measures used to characterize exposures to nonen-
vironmental risk factors--such as smoking, unsafe sex, and micronutrient defi-
ciencies. Consistent measures of both environmental and nonenvironmental
exposures are needed if meaningful policy comparisons are to be made.
Environment
There are growing demands for comprehensive information on global, re-
gional, and local environmental problems. Improvements in air and water qual-
ity, mostly in developed countries, have been made possible by advances in sci-
ence and technology. Those improvements will provide a foundation for
addressing future demands stemming from growing populations and shrinking
resources.
Air Quality
Over the last 2 decades, emissions from energy use in transportation,
power generation, industry, and households have steadily decreased in devel-
oped countries as a result of emission-control strategies (HEI 2010; EPA
2011a,b; NRC 2010). This has contributed to decreased ambient concentrations
of particulate and gaseous air pollutants in many cities, and the effects of trans-
ported emissions from other states and countries have become important con-
tributors to total exposures. Those changes drive new needs to monitor fluctua-
tions in ambient air pollutants in space and time, link them to mitigation
strategies, and assess health benefits of reducing human exposures. That will
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Demands for Exposure Science 95
require development and validation of spatiotemporal exposure models that will
use data on land use, human activity, housing characteristics, atmospheric con-
centrations, and personal monitoring. The models need to be specific to different
populations, especially populations that are particularly susceptible, such as
children and people who have pulmonary and cardiovascular diseases.
Water Quality
Water-quality and water-quality impact assessments have changed sub-
stantially over the last several decades with a greater focus on understanding the
complex interactions among human populations and water supplies. This focus
has created a growing demand for water-pathway exposure assessments. The
number and quantities of new chemicals and materials (such as nanomaterials)
now found in waste streams far exceed our capacity to monitor them (Kim et al.
2010; Nowack 2010). An ongoing need is to evaluate and limit adverse water-
quality effects on aquifers, waterways, forests, and agricultural lands. Improved
data on regional and global distribution of persistent chemicals of the types
monitored in air-quality studies are needed to address these critical issues. In
addition, although cumulative effects of mixtures are largely unknown, there is
concern that global accumulations of contaminant mixtures may result in unex-
pected long-term effects on human and ecologic targets and on the water re-
sources themselves (Macdonald et al. 2000; Woodruff et al. 2011).
Global Climate Change
Global climate change is expected to bring increasingly frequent extreme
weather and local environmental changes that have the potential to affect human
health, ecologic health, and key resources in several direct and indirect ways
(Patz et al. 2007; NRC 2009a; USGCRP 2009). The effects will include those
from increased temperature, such as acute and chronic health effects; those from
extreme weather, such as physical injuries and drownings, structural collapses,
and declines in habitability due to mold and other kinds of contamination; and
indirect effects, such as shortages of clean water and increasing concentrations
of contaminants due to drought (Frumkin et al. 2008). The National Research
Council report on global climate change and human health (NRC 2009a) and a
U.S. Council on Environmental Quality Climate Change Adaptation Task Force
report (CEQ 2010) addressed recommendations for protecting against those ef-
fects. Global climate change will bring new needs for exposure science to exam-
ine the effects of climate changes on exposures to new and altered chemical,
physical, and biologic stressors. Programs to address climate change and health
have been established in CDC (CDC 2011b) and the National Institute for Envi-
ronmental Health Sciences (NIEHS 2011). Those programs are seeking more
input from the exposure-science community; see, for example, the CDC national
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96 Exposure Science in the 21st Century: A Vision and A Strategy
conversation with its emphasis on public health and chemical exposures (Brown
2011; CDC 2011c).
Energy Demand
The production and use of energy emit pollutants that have been linked to
diseases (IIASA 2011) through exposure in the ambient environment (for exam-
ple, to power-plant emissions) (NRC 2010) and in the indoor environment (for
example, to cooking and heating emissions) (Smith et al. 2004). NRC (2010)
reported that the quantifiable public-health costs of all energy production, distri-
bution, and use in 2005 totaled $120 billion and were due mostly to criteria air
pollutants. Of that amount, $62 billion was attributable to electricity (mainly
coal) and about $56 billion to transportation; the remainder was attributable to
process heat (for example, industrial boilers) and comfort control (for example,
home or commercial-building heating and air-conditioning systems). There are
expected to be increases in energy use, but an additional demand for exposure
science will occur as a result of transitions from one energy source to another.
Energy sources have different effects throughout the use chain (or fuel life cy-
cle), from resource capture through energy production to conversion, distribu-
tion, and end use. Because the full burden of extant energy systems has not been
adequately characterized (IIASA 2011), there is no appropriate baseline against
which to compare the relative benefits of new systems. As world leaders con-
sider options for changing the portfolio of future energy sources, there is grow-
ing demand for assessments of effects associated with the various options, in-
cluding pollutant exposures, and a need to develop strategies to minimize the
effects.
Sustainability
Sustainability describes both a process to ensure and a goal of ensuring
long-term human well-being and ecologic health (NRC 2011). All technologies
have benefits and effects, and an important aspect of long-term sustainability is
that technologies achieve an overall balance. Increasing use of technology as-
sessment can be expected to avoid strategic errors that could derail a promising
technology and improve policy decisions to avoid long-term adverse effects.
Life-cycle assessment of all stages of a process--including-raw material extrac-
tion, manufacturing, distribution, use, and disposal--is an accepted approach to
evaluating resource consumption and resulting pollution (Guinée et al. 2010).
Such analysis is critical for supporting decision-making (Guinée and Heijungs
1993) to ensure sustainability of the environment and resources and to assess
health and ecologic effects. NRC (2011) recommends that the Environmental
Protection Agency (EPA) develop a "sustainability toolbox" that collectively
makes it possible to analyze present and future consequences of alternative deci-
sion options on the full array of social, environmental, and economic indicators.
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Demands for Exposure Science 97
Because of increasing demands for sustainability metrics, an associated demand
for exposure-science surveillance and for predictive tools to support life-cycle
analysis can be anticipated (see, for example, the USEtox model [USEtox.org
2009]).
MARKET DEMANDS
Industries and investors want to limit their liability for health and envi-
ronmental damages and minimize regulatory oversight, and the rapid increase in
technologic applications in commerce has created market demands for exposure
science that often correspond with demands for information on health and the
environment. For example, industries and investors use electronic media as a
means of promoting and assessing consumption of their products, considering
profitability, regulations, and liability. Organizations and Web sites provide
health and environmental information and product scores or rankings of a wide
variety of consumer products (for example, GoodGuide 2011). Social networks
provide tools for building and exchanging information about the health, envi-
ronmental, and societal effects of consumer products. Organizations, activities,
and tools encourage consumers to consider alternative products and behaviors
that can reduce such effects. Consequently, market demands for exposure sci-
ence include the need for better and more extensive insight into how human ac-
tivities, including consumption habits, contribute to pollutant emissions and how
the emissions contribute to human and ecologic exposures.
Growth in Consumption and Demand for Sophisticated Consumer
Products
The increase in global, national, and individual purchases of consumer
products places a substantial burden on environmental resources (NRC 2011)
and could continue to for decades before stabilization at a sustainable level
(Hertwich 2005). Many factors affect that burden, such as increased population,
increased personal wealth, and reductions in the useful lifetime of consumer
products. Technologic advances have fueled an expectation for improved prod-
ucts, and that expectation contributes to their relatively short lifetimes (for ex-
ample, mobile telephones, video players, and computers). New products with
enhanced properties also lead to replacement of well-functioning equivalent
products (for example, more efficient light bulbs or programmable appliances
replace existing light bulbs or appliances). Studies of trends in consumer prod-
ucts show that the stability and durability of products have important roles in
exposure potential (Hertwich 2005). Stable and durable products resist degrada-
tion and contribute less to emissions during their lifetime, but their disposal can
be problematic. Information on exposure potential of new products is needed for
evaluation of long-term health footprints of exposures and associated risks.
There is also a need for exposure data to guide policy in the development of
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98 Exposure Science in the 21st Century: A Vision and A Strategy
short-lived products and new products designed to generate premature product
replacement. Consumers can play an increasing role by demanding information
on the effects of products on the climate, resources, and health--including con-
siderations about exposures across the life-cycle of products.
Food Supply
Exposure science provides critical input for ensuring the sustainability and
safety of the food supply. With increasing population growth and internationali-
zation of the food supply, there is expected to be an increasing demand for ex-
posure science (Schmidhuber and Shetty 2005). Demographics of health and
disease suggest that diet is a major source of environmental exposures (Ames
1983; Willett 2002), and the increasing globalization and consolidation of food-
distribution networks have created a potential for rapid, widespread dissemina-
tion of contaminated products (Regattieri al. 2007). In light of economic, politi-
cal, and nutritional advantages of local food production, that has led to programs
to reverse trends in the globalization of the food supply. The competing trend
toward globalization vs localization will demand an expansion of exposure-
surveillance structures to manage and monitor the changing array of agrarian
practices and their influence on environmental quality (NRC 2002). The far-
reaching effects of the changes will require a critical role for exposure science to
support evaluation and development of policies.
Green Chemistry
Green chemistry or, more broadly, green commerce includes the design of
products and processes with a focus on sustainability with regard to resource
consumption and energy use, often accompanied by an effort to limit the human
and ecologic health footprint (CA DTSC 2008).1 Green commerce encounters
the same challenges as other businesses as practical considerations of profitabil-
ity often require use of more available resources according to supply and de-
mand; that is, as the feedstock diminishes and prices rise, manufacturers seek
alternatives. Small businesses are especially vulnerable to such variations and
could benefit from publicly accessible exposure data. New approaches in expo-
sure assessment and information dissemination are critical for decreasing the
pollution footprint of products and services while allowing for adaptive re-
sponses by free enterprise.
1
EPA describes green-chemistry goals as including source reduction and the preven-
tion of chemical hazards, such as through the use of feedstocks and reagents that are less
hazardous to human health and the environment, the design of syntheses and other proc-
esses to be less energy-intensive and material-intensive, the use of feedstocks derived
from annually renewable resources or from abundant waste, the design of chemical prod-
ucts for increased and easier reuse or recycling, treatment to render chemicals less haz-
ardous, and proper disposal of chemicals (EPA 2011a).
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Demands for Exposure Science 99
SOCIETAL DEMANDS
The health, environmental, and market demands discussed above are di-
rect reflections of a society and the complex needs and desires of its constitu-
ents. Over the last century, there has been a dramatic rise in world population
combined with an increase in urbanization, and the result has been profound
changes in not only where people live but how they live. The evolution of the
U.S. and world populations from primarily agrarian communities to megacities
and sprawling suburbs has led to societal (and scientific) questions about effects
on human health and well-being and on ecosystems. Concurrently, there have
been dramatic changes in what is eaten and how, how and how often people
travel, and how technologies are used for communication. Major societal de-
mands for exposure science include the understanding and assessment of the
effects of urbanization and urban land-use modifications and of changes in
manufacturing, consumption, and transportation.
Urbanization and Land-Use Changes
Projections of changes in urbanization and land use indicate both in-
creased need for and more systematic means of exposure surveillance in the
coming decades. The density of economic activity increases with urban popula-
tion density (World Bank 2009); half the world population now lives in cities,
and the UN projects that about 75% will live in cities by 2050 (UN 2008). The
growth of suburban areas is especially pronounced in North America, where
cities are highly energy-intensive and transportation is dominated by automo-
biles, but similar patterns of suburbanization are evident in many other places.
Increased automobile use contributes to environmental problems--increased air
pollution, storm-water runoff due to impervious surfaces, and higher intake of
pollutants when roadways are near residences (Hough 1995; Frumkin et al.
2004; Jerrett et al. 2010).
There is a need for a systematic process to evaluate exposures associated
with different layouts and designs of urban areas to guide planning to optimize
urban and suburban structures with consideration of exposures and health (Mar-
shall et al. 2005). The factors that have increased exposures appear to be grow-
ing as many previously poor nations undergo rapid economic transformations
and higher economic growth (Wang et al. 2005). The complexity of those driv-
ing forces and the need to protect human and ecosystem health can be met with
increased and more systematic exposure surveillance in the coming decades of
the 21st century.
Societal Issues in Manufacturing and Transportation
Economic changes in the developing and developed worlds have altered
where and how products are produced and distributed. There is an expectation
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100 Exposure Science in the 21st Century: A Vision and A Strategy
that consumer goods are to be convenient, mobile, and accessible. Rapid
changes in style and capacity (for example, of telephones) lead to quick product
turnover, which results in a growing waste-management challenge. The produc-
tion of steel, electronics, and many consumer products is moving to Asia, leav-
ing the large industrial regions of Europe and North America seeking "rebirth"
and risking decay and abandonment. Transportation systems are facing growing
demands. Web-based purchasing creates a growing need for home-delivery net-
works. Both tourists and business travelers are taking more and longer airline
flights. Those dramatic changes in the world of manufacturing and distribution
give rise to concerns and questions about how they will affect humans and the
environment, motivating the acquisition of information on changing exposure
patterns.
Other Societal Concerns
There are many other societal concerns that demand accurate and more
comprehensive exposure information. For example exposures to biologic stress-
ors in water supplies and food. In urban areas there are significant concerns
about exposure to noise, which is often only well monitored and researched near
"hot spots" such as airports and major roadways. Mixed exposures among
chemical, physical, and biologic stressors are also of concern, but difficult to
track and evaluate (WHO 2012).
For example, studies in the European Union reveal that excessive noise
can harm human health and interfere with people's daily activities. It can disturb
sleep, cause cardiovascular and psychologic stress, reduce performance, and
cause changes in behavior (WHO 2012). Addressing these health concerns re-
quires more reliable monitoring of noise levels over a broad range of geographic
areas.
POLICY AND REGULATORY DEMANDS
Exposure science used in policy-making can provide information to sup-
port environmental protection, resource management, chemical regulation,
manufacturing goals, and health, energy, climate, and economic policies. The
policy and regulatory demands for exposure science are unique in their link to
governments. Policy-makers need to make tradeoffs among a broad array of
outcome options. For example, they use exposure information to address con-
flicting societal, commercial, and scientific considerations, and they use it to
monitor the health and environmental benefits of regulations (NRC 2007). Pol-
icy-makers have the capacity to use exposure information to inform and moti-
vate activities or to address the reluctance of other policy-making entities or
others to take action. For example, robust exposure science is a key asset in an
era of limited resources. It is particularly useful for an agency that has responsi-
bility for promoting the health and sustainability of communities in separating
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Demands for Exposure Science 101
perceived effects and benefits based on anecdotal evidence from those which are
large and well documented, steering limited resources away from ineffective
interventions. (The exposure metric called "Intake Fraction" is an example of a
tool that might be used in regulations to improve health protection, see Chapter
1 discussion.)
Policy-makers and regulators have a demand for exposure information to
inform the concerned public about products and exposures, to establish emer-
gency preparedness and response, to set priorities for research and regulation
among chemicals or stressors of concern, and to allocate funding and set policies
for managing knowledge-integration systems to address health and ecosystem
protection. Adding to the policy demands for exposure science are the commu-
nity demands for access to technologies that allows community members to
work with scientists, to generate their own exposure data, and to more effec-
tively participate in the environmental policy and regulatory processes (Brown
et al. 2012).
BUILDING CAPACITY TO MEET DEMANDS
Health and environmental, market, societal, and policy and regulatory de-
mands are creating increased needs for exposure science in the 21st century.
Meeting those needs will require a scientific framework that supports the devel-
opment of technologies to collect, analyze, and integrate exposure-science data.
The remainder of this report addresses the framework for building the capacity
to meet the demands for exposure science in the 21st century.
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