Conclusions and Recommendations

On the basis of a review of the available scientific literature and the information obtained from the various site visits, the committee concludes that there are identifiable communities of concern that experience a certain type of double jeopardy in the sense that they (1) experience higher levels of exposure to environmental stressors in terms of both frequency and magnitude and (2) are less able to deal with these hazards as a result of limited knowledge of exposures and disenfranchisement from the political process. Moreover, factors directly related to their socioeconomic status, such as poor nutrition and stress, can make people in these communities more susceptible to the adverse health effects of these environmental hazards and less able to manage them by obtaining adequate health care.

The committee perceived that the minority and low-income communities that it chose to visit have had disproportionately higher levels of exposure to environmental stressors compared with those for the general population. Furthermore, the committee found that those with impoverished social, economic, and political support were also least able to effect change and create solutions for the broad range of problems that they experience. During the site visits, the committee members were told by those whom they met of the many social, economic, and geographic barriers that can separate vulnerable and minority or low-income citizens from healthy environments and adequate health care.

As a result of its deliberations, the committee formulated four overarching recommendations related to public health research, education, and health policy. Strategies for implementing the recommendations are contained in the body of the full report. Together, these constitute a framework for further action.

Research

The committee believes that a public health approach should be the central means of dealing with the environmental health problems in disadvantaged communities. Conventional epidemiology will encounter difficulties, however, because of shortcomings in existing databases, the small populations typically involved, and cultural differences of researchers with residents of the communities of concern. Public health efforts should use new and appropriately creative methods for data collection and analysis and ensure community involvement throughout the process.

Recommendation 1. A coordinated effort among federal, state, and local public health agencies is needed to improve the collection and coordination of environmental health information and to better link it to specific populations and communities of concern.

Public health research related to environmental justice is a legitimate and valuable endeavor and is important to the communities of concern and to national



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