Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Environ Health Perspect. 2024 Nov;132(11):115001. doi: 10.1289/EHP14513. Epub 2024 Nov 14.
In environmental epidemiology, we use an array of tools from various, related disciplines to answer key questions about environmental exposures in relation to health outcomes. Typically, we ask questions related to what, who, where, when, and how. We value these questions because they contribute to novel scientific discovery and our understanding of disease etiology linked to environmental exposures. In addition, these questions help us better understand who might be at highest risk of exposure and subsequent risk of disease. Although necessary for the goals of environmental epidemiology, these questions are insufficient for addressing environmental health disparities. Specifically, these questions may be able to help us describe exposure-health outcome associations but are limited in their ability to move beyond identification to intervening on observed disparities to achieve environmental health equity.
We sought to emphasize the need to value and routinely add the key question of "Why?" in environmental epidemiological studies. In asking this additional critical question, we can identify and incorporate the structural determinants and drivers of environmental exposure disparities and determine whether these factors are linked to existing and historically recalcitrant health disparities. Further, we can design effective studies that build on existing frameworks to address the fundamental causes of environmental health disparities.
This commentary underscores the need to routinely incorporate "why" questions in the practice of environmental epidemiology. By asking and addressing "Why?" we can employ better, more solution-oriented study designs, improve data collection, and enhance our ability to collaborate with diverse study populations through trust-building and community-engaged research. Incorporating these approaches will move environmental epidemiology forward from mostly documenting to actively addressing environmental health disparities. https://doi.org/10.1289/EHP14513.
在环境流行病学中，我们利用来自不同相关学科的一系列工具来回答有关环境暴露与健康结果之间关系的关键问题。通常，我们会提出与“什么”、“谁”、“哪里”、“何时”和“如何”相关的问题。我们重视这些问题，因为它们有助于新的科学发现和我们对与环境暴露相关的疾病病因的理解。此外，这些问题还帮助我们更好地了解谁可能面临最高的暴露风险和随后的疾病风险。尽管这些问题对于环境流行病学的目标是必要的，但它们不足以解决环境健康差异问题。具体来说，这些问题可能有助于我们描述暴露-健康结果关联，但在超越识别以干预观察到的差异以实现环境健康公平方面能力有限。
我们试图强调在环境流行病学研究中重视并经常添加关键问题“为什么？”的必要性。通过提出这个额外的关键问题，我们可以确定和纳入环境暴露差异的结构决定因素和驱动因素，并确定这些因素是否与现有的和历史上顽固的健康差异有关。此外，我们可以设计基于现有框架的有效研究，以解决环境健康差异的根本原因。
本评论强调了在环境流行病学实践中经常提出“为什么”问题的必要性。通过提问和回答“为什么？”，我们可以采用更好、更注重解决方案的研究设计，改进数据收集，并通过建立信任和社区参与研究来增强与不同研究人群合作的能力。纳入这些方法将使环境流行病学从主要记录环境健康差异转变为积极解决环境健康差异。https://doi.org/10.1289/EHP14513.
