Environmental health decision making can be a complex undertaking, as there is the need to navigate and find balance among three core elements: science, policy, and the needs of the American public. Policy makers often grapple with how to make appropriate decisions when the research is uncertain. The challenge for the policy maker is to make the right decision with the best available data in a transparent process. The Environmental Health Sciences Decision Making workshop, the first in a series, was convened to inform the Roundtable on Environmental Health Sciences, Research, and Medicine on emerging issues in risk management, "weight of evidence," and ethics that influence environmental health decision making. The workshop, summarized in this volume, included an overview of the principles underlying decision making, the role of evidence and challenges for vulnerable populations, and ethical issues of conflict of interest, scientific integrity, and transparency. The workshop engaged science interest groups, industry, government, and the academic sector.

Natural gas extraction from shale formations, which includes hydraulic fracturing, is increasingly in the news as the use of extraction technologies has expanded, rural communities have been transformed seemingly overnight, public awareness has increased, and regulations have been developed. The governmental public health system, which retains primary responsibility for health, was not an early participant in discussions about shale gas extraction; thus public health is lacking critical information about environmental health impacts of these technologies and is limited in its ability to address concerns raised by regulators at the federal and state levels, communities, and workers employed in the shale gas extraction industry. Health Impact Assessment of Shale Gas Extraction is the summary of a workshop convened in 2012 by the Institute of Medicine (IOM) Roundtable on Environmental Health Sciences, Research, and Medicine to discuss the human health impact of shale gas extraction through the lens of a health impact assessment. Eminent scientists, physicians, public health experts, and representatives from government agencies at federal and state levels, from nongovernment organizations, from the business sector, and from interest groups representing the interests of the citizens met to exchange ideas and to inform on hydraulic fracturing as a means of extraction of natural gas. This report examines the state of the science regarding shale gas extraction, the direct and indirect environmental health impacts of shale gas extraction, and the use of health impact assessment as a tool that can help decision makers identify the public health consequences of shale gas extraction. Table of Contents Front Matter 1 Introduction 2 Opening Session 3 Geographic Footprint of Shale Gas Extraction 4 Occupational Health and Community Impacts 5 Air Quality 6 Water Quality 7 Sustainable Energy 8 Research Opportunities: Research Community 9 Research Opportunities: Federal Representatives Appendix A: Agenda Appendix B: Speaker Biosketches Appendix C: Acronyms

The issues surrounding water services are some of the most critical challenges facing not only the United States, but also the global community today. The Roundtable on Environmental Health Sciences, Research, and Medicine of the Institute of Medicine convened a workshop in October 2007, summarized in this volume, to address objectives related to Sustainable Water, Sanitation, and Hygiene Services. One of the objectives of the workshop was to think about the interdependence of environmental health and human health as connected through water. Organizations cannot discuss water without considering the interrelationship of sanitation and hygiene. It is the convergence of these strategies that promotes healthy outcomes for both individuals and the environment. A second objective of the workshop was to consider how planning, management, and interdisciplinary approaches-including technology, social behavioral issues, gender, health, environment, economic, and political aspects-can be integrated to arrive at sustainable solutions. Many organizations and agencies are trying to forge a path toward sustainable practices in water, but the various sectors utilizing and governing water services are not interconnected. More integration and a greater understanding of holistic approaches are needed. Table of Contents Front Matter 1 Workshop Introduction 2 Global Water Services: Short- and Long-Range Views 3 The Technology Pillar of Sustainable Water: Technology, Economics, and Health 4 Panel Discussion: Coordination and Prioritization of Water Needs 5 Achieving Water and Sanitation Services for Health in Developing Countries 6 The Environmental Pillar of Sustainable Water: Ecological Services 7 The Social Pillar of Sustainable Water: Health Research Gaps 8 Panel Discussion: Moving Forward 9 Thinking About New Visions of Water Services 10 Breakout Group: Meeting Goals for Water, Sanitation, and Hygiene References Appendix A: Workshop Agenda Appendix B: Speakers and Panelists Appendix C: Workshop Participants

Throughout much of its history, the United States was predominantly a rural society. The need to provide sustenance resulted in many people settling in areas where food could be raised for their families. Over the past century, however, a quiet shift from a rural to an urban society occurred, such that by 1920, for the first time, more members of our society lived in urban regions than in rural ones. This was made possible by changing agricultural practices. No longer must individuals raise their own food, and the number of person-hours and acreage required to produce food has steadily been decreasing because of technological advances, according to Roundtable member James Merchant of the University of Iowa. The Institute of Medicine's Roundtable on Environmental Health Science, Research, and Medicine held a regional workshop at the University of Iowa on November 29 and 30, 2004, to look at rural environmental health issues. Iowa, with its expanse of rural land area, growing agribusiness, aging population, and increasing immigrant population, provided an opportunity to explore environmental health in a region of the country that is not as densely populated. As many workshop participants agreed, the shifting agricultural practices as the country progresses from family operations to large-scale corporate farms will have impacts on environmental health. This report describes and summarizes the participants' presentations to the Roundtable members and the discussions that the members had with the presenters and participants at the workshop. Table of Contents FrontMatter Summary Introduction 1 Environmental Health in Rural America 2 The Social Environment in Rural America 3 The Role of the Natural Environment in Rural America 4 The Built Environment and Health in Rural Areas References A Workshop Agenda B Speakers and Panelists C Meeting Participants

The Roundtable on Environmental Health Sciences, Research, and Medicine wanted to address the link between environmental factors and the development of cancer in light of recent advances in genomics. They asked what research tools are needed, how new scientific information can be applied in a timely manner to reduce the burden of cancer, and how this can be flexible enough to treat the individual. Table of Contents Front Matter Summary 1. Charge to Participants and Workshop Objectives 2. Keynote Addresses 3. The Links between Environmental Factors, Genetics, and the Development of Cancer 4. Gene-Environment Interaction in Special Populations 5. Gene-Environment Interaction in Site-specific Cancers 6. Special Address: A Novel Approach to Cancer Treatment Based on Immune Stimulations and Other Environmental Approaches 7. Cancer and the Environment: A View from the Hill 8. Moving Forward Abstracts of Talks References Appendix A Glossary Appendix B Workshop Agenda Appendix C Speakers and Panelists Appendix D Workshop Participants

Biological threats like SARS and natural disasters like the tsunami in Indonesia have devastated entire regions, and quickly exhausted budgetary resources. As the field of environmental health continues to evolve, scientists and others must focus on gaining a better understanding of the links between human health and various environmental factors, and on creating new paradigms and partnerships needed to address these complex environmental health challenges facing society. Global Environmental Health in the 21st Century: From Governmental Regulations to Corporate Social Responsibility: Workshop Summary discusses the role of industry in environmental health, examines programs designed to improve the overall state of environmental health, and explores how governmental and corporate entities can collaborate to manage this industry. Stakeholders in both the public and private sectors are looking for viable solutions as the complexity of societal problems and risks associated with management and varying regulatory standards continue to increase. Global Environmental Health in the 21st Century draws critical links and provides insight into the current shape of global environmental health. The book recommends expanding environmental management systems (EMS) to encompass a more extensive global network. It also provides a complete assessment of the benefits and costs resulting from implementation of various environmental management systems. Table of Contents Front Matter Summary Introduction 1 Tools for Monitoring Environmental Health 2 Moving Beyond Compliance: Can Industry Get Ahead of the Curve? 3 Global Implication of Environmental Standards 4 Improving Community Health Globally 5 Corporate Social Responsibility 6 Panel Discussion References Appendix A Workshop Agenda Appendix B Speakers and Panelists Appendix C Workshop Participants

This is a summary of the workshop Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century. The goal of this workshop was to emphasize the connection between human health and the natural, built, and social environments. This workshop integrated talks from many fields and created a dialogue among various environmental health stakeholders. The language presented in this respect should not be viewed as an endorsement by the Environmental Health Sciences Roundtable or the Institute of Medicine of what action is needed for the future, but rather as an effort to synthesize the various perspectives presented. Table of Contents Front Matter Summary 1 Introduction 2 Keynote Address 3 Human Health and the Natural Environment 4 Human Health and the "Built" Environment 5 Human Health and the Social Environment 6 Toward an Integrative Approach to Environmental Health References Abstracts of Talks APPENDIX A Workshop Agenda APPENDIX B Speakers and Panelists APPENDIX C Workshop Participants