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Victory for Prevention?

Doctor Woman

As we celebrate Earth Day this Sunday, the author is cautiously optimistic about a new era with a healthier environment.

They’re not copays or premiums yet there’s no doubt that polluted air and water exact a high health cost. Still, the arguments over how to deal with that part of the healthcare equation have gone back and forth for decades. Last year, for instance, an Institute of Medicine study on links between the environment and breast cancer concluded that while some toxins cause cancer, it’s impossible to match one specific chemical to one specific case of cancer.

Now, however, the Affordable Care Act has changed the rules of the game. Its guiding principle is “do no harm,” and the legislation sets out a new standard for evaluating research on the alleged harmful effects of pollution. It’s similar to the different standards of evidence in civil and criminal law. In the past, something like the criminal-law standard of “beyond a reasonable doubt” prevailed. Now the federal government standard in research cases will be the same as in civil law: If a preponderance of the evidence suggests that some substance is harming people’s health, that’s a basis for action.

The details are found in a document called the National Prevention Strategy, released last year as part of a 2010 presidential mandate. It notes, “Safe air, land, and water are fundamental to a healthy community environment.”

Included as a goal of the strategy is to increase the availability of health professionals to “identify, prevent, and reduce environmental health threats.” Clinicians, the document states, “can provide information and counseling on how to prevent, treat, and manage environmental-related exposures, including indoor air pollutants, lead, mercury, and pesticides.” The National Prevention Council is “working diligently toward finalizing the implementation plan and it should be ready in the coming months,” according to a source inside Health and Human Services.

If all goes well, and that’s a big if considering how strongly our political climate favors polluters, this strategy can help turn back the tide of toxins in the environment. For instance, it took 21 years for the new federal mercury standards to become law and it quickly faced a challenge from the Congressional Review Act. Luckily, the objection failed. The new rule which promises to eliminate 90 percent of mercury emissions from coal-fired power plants, can proceed.

Just as environmental improvements brought about by the Clean Air Act have, according to the EPA, prevented some 160,000 premature deaths, the new environmental standards are expected, within a few short years, to greatly reduce the incidence of many health problems in this country, including asthma and heart attacks. The National Strategy provides hope—if it survives the Supreme Court’s ruling on the Affordable Care Act and is sustained by future administrations—of progress against many pollutants, even though neither the strategy document nor the Affordable Care Act grants new government enforcement powers regarding clean air and water.

Still, the raw ambition of this plan is exciting. My recommendations as a keen researcher of activism and politics for making it work:

1. Involve environmental engineers in this prevention strategy. They’ll find solutions for industries rather than just handing down edicts from on high. Face it, environmentalists—we’ve won. It will be a long slog but we now have public health laws on our side.

2. Address environmental racism and low-income biases. Incinerators, for example, are more likely to find homes in politically weak neighborhoods, which not coincidentally are where people of color and those with low income live.

3. Stress job-creating abilities and have fighting words ready when attacked by moneyed interests. Better yet, sell it to the American public now, emphasizing the state and local impacts. Otherwise, it’s too theoretical. The truth is pollution controls don’t cut into job creation. Instead they cut into short-term corporate profits meaning companies don’t plough their profits back into their operations. Hence the corporate resistance to pollution controls.

4. Create incentives for business, not only penalties. Part of the billions of dollars collected in fines each year should be used to entice businesses to invest in environmental cleanup technologies. It could do wonders for their quarterly financial statements and thus their motivation to do good. This wiggle room for corporations could end the “job killer” canard once and for all, when it comes to pollution controls.

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