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SDOH Forward: Non-Healthcare Approaches to
Improving Health - Environmental Issues


Environmental Issues : Environmental Health

National Environmental Health Association

To gain a better understanding of cross-sectoral approaches to addressing the social determinants of health, AAHC is interviewing individuals from organizations that utilize non-healthcare approaches to improve health. Here, we look at organizations involved in medical-legal partnerships.

An interview with David T. Dyjack, Dr PH, CIH
Executive Director and CEO of the largest environmental health professional association in the world, the National Environmental Health Association (NEHA)

Describe what you do for work and the vision/mission of your organization.

I am the Executive Director and CEO of the largest environmental health professional association in the world, the National Environmental Health Association (NEHA). NEHA’s mission is to advance capabilities of the environmental health and protection professional for the purpose of providing a healthful environment for all. Membership is drawn from public (80%) and private (20%) sectors.

Tell us about the socio-demographic and socioeconomic factors and conditions in the community, population, or constituency you or your organization serves.

Our 5,000 members represent the continuum of EH professionals all along the pipeline, from students to Board members.

What is the link between the social determinants of health and your work?

The physical environment plays an important role in the health status of community members. Environmental health is profoundly local, and profoundly intimate. In other words, place and income matters, a lot. Think about it. The quality and purity of the water in which you bathe your child, the air you breathe, and the food you place in your baby’s mouth are mediated by the environmental conditions under which they are produced or exist. Do you live in a safe neighborhood? Are there sidewalks, and safe places to play? Are homes and apartments free from recognized hazards, such as mold, lead, asbestos, and radon?

Communities with sufficient resources and influence generally have better health status than those with less. The work of environmental health professionals is increasingly one of assurance and policy development in support of health for all. This is particularly true in support of those communities that systematically experience greater social or economic obstacles to health based on factors historically linked to discrimination or exclusion. There is a direct link between the local environment and community health status.

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Can you provide one or two examples of programs or activities that you are currently working on that is/are aimed at addressing an aspect of the social determinants of health?

Public Health Tracking and Radon
Approximately 21,000 lung cancer deaths are attributed to radon exposure (which is approximately seven times greater than the number of lung cancer deaths due to second hand smoke). Considering how much time we spend in our home, school, work environments, indoor air quality can be a factor in determining the outcome of a person’s health. Lower income people tend to live in rental properties, and property owners aren’t required to test for radon. So many renters (majority are lower income level) may be at increased risk to have adverse health effects because of where they live.

The CDC Public Health Tracking network is tracking radon rates by zip code, on a national scale. EH professionals are the boots on the ground in the community, inspecting homes and schools, educating the public and it’s communities members. They can serve as a direct link to the community to inform, educate and empower change.

Integrated Pest Management (IPM)
There is epidemiologic evidence associating early life exposure to pesticides with pediatric cancers, decreased cognitive function, and behavioral problems. Children and staff spend a significant amount of time in an indoor school environment, with many not implementing IPM. A big trigger of asthma is cockroaches. Cockroaches are more present in rental facilities and lower income housing. Rental property owners are more likely to send in fumigators than to work with an IPM person, thereby increasing risk to adverse health effects because of where they live.

Environmental Health professionals are mandated to visit schools and thereby have the capacity to influence schools to implement better IPM practices. They have a direct link at the local level to the community and schools. They could inform, educate, empower, and influence a healthier environment for the 60 million people in the US school community.

What are you goals for the program(s)? How do you measure and evaluate these goals?

Public Health Tracking and Radon
To look into how radon testing data could be standardized for inclusion on the CDC Tracking Network.  There were a number of Tracking grantee participants (state HDs) that worked together to determine what each state tracked, what they could legally submit and how the data could be uploaded.  NEHA's role then, and in the future, is to provide beta testers to try out how the data is going to be displayed and categorized on the tracking website and promote the standardization of testing and the submission of results. 

Integrated Pest Management (IPM)
To provide education and training on the principles of Integrated Pest Management and pesticide use to health inspectors, pest management professionals, school maintenance staff, child care facilities, hospitals, rental property owners, and homeowners.  Measurement might include establishing a baseline and tracking outreach efforts.

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How do you financially sustain these programs?

They are not sustainable visa via NEHA.

Are there additional resources or partners needed to accomplish these goals? What are they?

A fabric of traditional and non-traditional players necessarily need to be involved. The Federal Reserve, United Way, Federally Qualified Health Centers, local governmental public and environmental health, AAHC members, local for profit industries possibly through the Chamber of Commerce, are a start. Non-traditional partners include state and local departments of transportation, mental health, area agencies on aging, planning, housing, education and employment.

What opportunities do you see for connecting your work with the work of academic health centers?

Public Health is profoundly local. Environmental health is profoundly local and profoundly personal. People act first on their values and beliefs, and secondly on data.  A local network which represents education, training, practice, basic and translational research is potentially a very powerful alliance which can move beyond proximal causes of morbidity and explore root causes.

Explanatory models describing the social determinants are abundant. AAHC members could provide game changing influence by identifying and testing predictive intervention models which address root causes of health inequity.

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“Approximately 21,000 lung cancer deaths are attributed to radon exposure ... indoor air quality can be a factor in determining the outcome of a person’s health. ”


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