 Good morning everyone. My name is Lily Luhachak from the National Academies of Sciences, Engineering, and Medicine. I'd like to welcome everybody to this exciting workshop Towards the Future of Environmental Health Sciences, a workshop by the Standing Committee on Emerging Science for Environmental Health Decisions and sponsored by the National Institute of Environmental Health Sciences. Just before we kick off this workshop, I want to go over a few housekeeping rules before we get started. So this is a public webcast workshop. It's a place to discuss and exchange data and ideas. We encourage you to be active participants. Right below the video player should be a Q&A box where you can input questions or submit questions to our speakers or panelists. You want to say that thoughts shared during the course of the workshop should not be interpreted as the opinion of the National Academies, except for these housekeeping rules, of course. If you're on Twitter or active on social media, please use our hashtag ESEHD Workshop for your post about this workshop. The full workshop will be recorded and posted to the workshop webpage in about a week. And for all those who registered we will send an email notifying you when the recordings are posted. In addition to that, a brief written summary, the proceedings in brief, which is a free summary of this workshop and all the discussions discussed here will be published in a few months. So with that, I would like to turn it over to the co-chair of the Standing Committee for Emerging Sciences for Environmental Health Decisions for Opening Remarks. Dr. Kim Buckelhide, take it away. Thank you, Lily. So my name is Kim Buckelhide. If we could go to the next slide. And welcome to the future of environmental health sciences. So I'm co-chair of the Standing Committee along with Melissa Perry. I'll introduce the members of the committee shortly. It's a pleasure to have you join us. I'm Professor of Pathology and Laboratory Medicine at Brown University. And let me see here. I need to... Okay, here we go. You know, the goal of the Standing Committee is to examine scientific advances to ride the crest of the wave of the new science, the emerging science, bring it to the attention of the environmental health community and stakeholders in environmental health, and inform our sponsor, the National Institutes of Environmental Health Sciences, and the academic and government liaison communities of this emerging science and the work that we're doing. The session that we're going to partake in today is about the future of environmental health sciences. And that's an activity that we are engaging in throughout this year with workshops and future casting exercises. And our goal is to explore what kinds of research we can use to contribute to making the future 10 years from now and beyond what we want it to be for environmental health sciences. So if I could have the next slide, please. So the Standing Committee is an existing committee that's been here at the academies for a dozen years. The members are shown on this slide, myself and Melissa Perry are co-chairs. And it's really been a terrific committee. Members serve for terms of three years that are renewable. And as you can see, we have around 15 members on the committee from a broad range of backgrounds, NGOs, academics, industry, international, and U.S. committee members. So it's really been a terrific pleasure to work with this committee. And we've really made tremendous progress. So let's go to the next slide, please. There's also in our process as a Standing Committee an ongoing interaction with federal government liaisons. And they have a group of their own that participates in committee activities. And you can see the participants and their logos listed on this slide. It's an active collaboration. And of course, part of the goal of the work of the committee is to inform, broadly speaking, government agencies on emerging issues and science in the environmental health arena. So let's go to the next slide. The areas that we have focused on in exploring the crust of the wave of science are emerging research strategies and analytic methodologies, emerging areas of convergence that is bringing transdisciplinary, interdisciplinary groups together to create new areas of exploration, and emerging advances in science and technology. And you can see on the list here that over the dozen years of our existence, we've held a number of workshops, typically two or three a year, on these broad topics, and that are really bringing attention to the areas of science that we believe will serve the environmental health community with large in the long term. So the next slide please. So, importantly, we always seek your ideas. Send an email to the address shown on the screen here with your ideas for how we can bring a research topic to the attention of the world that will help the environmental health sciences going forward. You know, as I said, we're looking for topics at the crust of the wave, and that can actually help us get to the future that we all want, and that we'll be talking about over the next couple of days for the environmental health sciences. So next slide, please. So, you know, this year, as I said, unlike in the past years, we're spending our workshop time and experiences as a committee looking at what that future could be, having future casting exercises, exploring the possible futures, thinking about what direction environmental health sciences can go in, and sharing that with broad communities such as yourself listening into this workshop today. So, you know, this is an important service of this committee to the broader scientific community to find out what the possibilities are for us to evolve over the next decade, and we seek your input in making that future a reality. So please let us hear from you and participate in this workshop over the next couple of days to the fullest, send your ideas and questions, and, you know, engage with us, you know, in the discussion that takes place. Next slide, please. Okay, the committee that worked to arrange this workshop that, you know, we're bringing here over the next couple of days was chaired by Kristen Malecki. And the members are shown on this slide, Karen Bailey, Shondra Jackson, Patrick McBowling, Gary Miller, and Christina Park. And a big round of applause and thanks to the hard work of this committee, you know, making this workshop that we're all participating in possible. Next slide, please. So the organization of the next two days is shown here, you know, first we'll hear from leaders with different expertise on their visions of the future of environmental health. Then we'll have panels in various areas of environmental health, and from outside environmental health to engage in dialogue that explore possible future scenarios. And these facilitated conversations are designed to create, you know, a welcoming space for open discussion and input towards what that future could be. So please join us today and tomorrow and hear from, you know, leaders in this possible future. So what I'd like to do now is turn to my co-chair, Melissa Perry, and have her as moderator of this workshop kick off the workshop. So thank you all. Welcome and looking forward to the discussions. Kim, that was fantastic. Thank you for that excellent introduction. I'm delighted to be here. I'm Melissa Perry, Professor of Environmental and Occupational Health at George Washington University and co-chair of our standing committee. In this time of disconnection, it is fantastic to have all of you connected with us because the work that we do in this committee has everything to do with your input, your involvement, your attendance, your engagement. As Kim said, this has been a unique and unusual year for us in the sense that we have been so forward thinking and so engaged in this notion of future casting, that this entire workshop is based on this theme. And I can say that for myself personally, and I think some other members of the committee that have been engaged that initially this was brand new. We as scientists really love to stay focused on the concrete and going into the abstract has been a bit out of my comfort zone, but at the same time that's where the fun has been and that's where it's been most thought provoking and stimulating. And thanks to this superb organizing committee chaired by Kristen Malecki, we have two days of thought provoking engagement and dialogue. And so for this first panel, our job is actually to think 10 years down the road on a 10-year horizon with an eye toward an optimistic view and also to bring in a variety of different perspectives, community perspectives, scientific perspective, policy perspectives to really ask and put forward questions about methodologies, technologies, what are the right research questions? Where should we be going? And what exactly do we want to be a part of? As I mentioned, the engagement in future casting for me was a bit out of my comfort zone until I realized that, oh, yeah, we all have a role not only in trying to predict the future, but actually making it happen. And so with that goal in mind, we engage in this next panel with some great thought leaders. So to kick it off, I'm going to turn things over to Kristen Malecki, who will be bringing the first perspectives on the future of environmental health for a 10-year horizon. Kristen, take it away. Thank you all. And thank you, Melissa. It is an honor and a privilege to be here today, to be with all of you, to discuss the future of environmental health sciences. I am an associate professor in the Department of Population Health Sciences at the University of Wisconsin-Madison. And I thought to give you a sense of how does my view of the future, how is it framed based on the experiences that I have, we all bring unique experiences to the table. And they really shape not only who we are as scientists, but how we think about not only the present day, but where we're going. So I was born and raised in the Midwest. I was born in Milwaukee, Wisconsin. And I took an opportunity to leave the Midwest to go to college at in New York City. So it's probably the most opposite from where I was. I went to a very large city. And there I studied metropolitan studies in a broad framework, thinking about how and it was the first time that I was really exposed to how dramatic the places we live, even within a large city, can impact the health and well-being that we have. Immediately after graduating from as an undergrad, I went into foster care and adoption, which is so far removed from environmental health sciences. And yet it brings to light some really important foundations and perspectives about how important individuals are to the work that we do. And if we really are going to advance health and well-being, we need to think about the journeys that people are on and how environmental factors might intersect with those different journeys to influence vulnerability. I then went on to graduate school and moved into applied epidemiology. Most of the work that I was interested in doing was really to say, can we take the really cutting edge science that we have available to us today to really make advances in environmental health? And so for the last 15 years, I've had the pleasure of being faculty at the University of Wisconsin working in the Molecular Environmental Toxicology Program and within the Department of Population Health Sciences. And this is really, this journey has led me to envisioning the future of environmental health sciences with four important considerations. The first of that really being systems thinking, the second being cumulative risk, the third really thinking about environmental health sciences and in translational research. And what I mean by that is thinking about how environmental health sciences can lead us to better policymaking, better decisions and better actions for protecting the public's health. And fundamentally underlying all of the work that we do and think about both now and in the future is the importance of equity on human health. And because I've had the honor of being both within a School of Medicine and Public Health and at a large institution where I work very closely with the Molecular Environmental Toxicology Program, I've had this unique opportunity to bridge both population health sciences and environmental health research. And I feel that population health sciences asks some fundamental questions that we can learn a lot from in environmental health sciences. And this quote at the bottom of this slide, in a resource limited world, what is the ultimate per capita investment to improve health and wellbeing in the population? And that's really the population health sciences question. But I think as we think towards the future of environmental health sciences and we think about the investments we can make, we also should be really understanding that we do live in a resource limited world, but we have some significant challenges. And we need to think to the future so that our investments are well spent and we use our time wisely. Going back to a systems thinking approach to environmental health sciences, when I began as an environmental scientist in my training in graduate school, we were taught that the chemical environment influenced health and wellbeing through two different mechanisms. For cancer risk assessment, we had a linear dose response. For non-cancer risk assessment, the dose response curve looked a little bit different. But we needed to look at chemicals one chemical at a time. And we needed to needed to consider how increasing levels of chemicals led to increased impacts. But the reality is that we live in a much more complex world. And today, we think about environmental health in a much broader sense. And so systems thinking really shows us that our chemical environment is really nested within the built environment, which is again nested in our social environment, which then is nested in our individual behaviors. And all of those factors really intersect to get under our skin and embody our health and wellbeing across the life course. So in thinking about the future of environmental health, we need to have tools that allow us to address this. A final consideration is cumulative risk. So in the systems thinking framework, we know that we're not exposed to one chemical at a time and that chemicals come to us in mixtures. And we've made a lot of progress in considering what mixtures look like. But cumulative risk also considers unique vulnerabilities and susceptibility. And I think when we think about health equity, it's this not susceptible subgroup for which we need to really think towards the future. And how do we create science that better understands what drives susceptibility in the population, as well as what actions need to be taken to really protect those susceptible at risk groups. And we have some major environmental and population health challenges. This is just one indicator of health that I often think about. And it's life expectancy at birth across the United States. The dark red census block groups, the dark red dots across this map show life expectancy in birth in those specific locations being almost 20 years lower than those individuals who live in counties or census block groups in the dark blue. So we have significant disparities from the time one is born here in the United States in how long we would expect that individual to live at birth across the population. This map highlights that life expectancy is an environmental health problem. The changes in life expectancy post COVID-19 are changing at a rate that is more rapid than genetics alone can explain. And these distribution of changes in life expectancy across the United States also really point to the role that the environment broadly defined can play in shaping our life across from inception onward. And so this is just an example of how life expectancy is changing over time. And from 2020, the gray bars show the decrease in life expectancy across the population in the United States and how we're lagging well behind our peers as a result of the COVID-19 pandemic. And over on the right, it shows that amongst sub-populations within the United States, those individuals who identify as Hispanic or non-Hispanic Black had much dramatic, much larger declines in life expectancy. So our experiences and the experiences of the emerging pandemic are really shaped by environmental factors and are inequitable. On the other hand, there are numerous opportunities for innovation and novel approaches to the work that we've been doing. And so environmental health sciences is rapidly evolving. We used to rely mostly on animal models for the work that we do. And now we have computer new omic tools and modeling approaches that can support predictive toxicology that reduces our dependence on animal models. And yet we still have this question of how does this translate to human health? But on the other hand, we still have a number of different additional innovations around the use of multi-omic tools to begin to advance these questions and thinking largely of the exposome. I want to thank Gary Miller for providing this slide. And his work really focuses how do we take these new omic technologies and tools to better address environmental health sciences? And one of the questions we have as part of this workshop is how do we take this and translate this further into public health protection? There are a number of other emerging opportunities. Some of the things that I find most exciting in my work is thinking about the gut microbiome as a modifiable risk factor for how we respond to chemicals. The gut microbiome also leads us to questions about how does environmental health influence antibiotic resistance, emerging infectious diseases, or other issues such as aging and health? The gut microbiome plays a critical role in our metabolism and maintaining homeostasis on our bodies. So if we take a systems thinking approach, the gut microbiome is a key element in that homeostasis. So this diagram here shows that what we bring into our body, including foods and other factors, can lead to what we call dysbiosis over here on the right. In a dysbiosis or a disrupted microbiome or ecosystem in our gut, our bodies do not produce our healthy metabolites that will maintain health and well-being across time. And in this slide, we see short chain fatty acids. Short chain fatty acids have been proven to be critical in maintaining health and well-being across the population. And what we know is that when the ecosystem within our guts is disrupted, the ability for those, for our healthy bacteria in our gut to produce these short chain fatty acids is reduced and we no longer have the healthy metabolites needed to maintain health and well-being in the population. And this is just a quick overview, but it shows the excitement and the resources and the science and the tools that we have available to us. We also have data that shows in animals that environmental toxicants and xenobiotics such as lead can really reduce the abundance of some really important gut microbiome factors. And we need to think about how do we take this basic science research and translate it into human and population health. So that's really the crux of some of the work that I've been doing. And when I think about translational research, I think about translational research not only into clinical practice from patients to practice, but also translation into communities. The National Institute for Environmental Health Sciences created this environmental health research translation framework, which I think is really sets a good foundation for looking towards the future. At the core of this is what we see called environmental health is foundational environmental health research and that we need to have science that allows us to think about fundamental research questions addressing all levels of biological organization from the molecular biological pathway cell tissue organ model organisms to humans and population. So what might this look like moving into the future? Oftentimes we have observations in toxicological and ex vivo or mouse models, but we don't often know how this plays out in real world scenarios. So some work from our existing cohort, the Survey of the Health of Wisconsin, we know that obesity is highly correlated. This figure shows increasing rates of obesity from overweight, class one, class two, class three obesity in the state of Wisconsin, about two thirds of the state population is obese or overweight. And amongst those 35% we see a number of adverse chronic conditions. What we don't often ask about in environmental health is how does this obesity amongst individuals who are exposed to environmental toxicants versus not exposed differ in our ability to process metabolize and respond to these environmental threats. So we set up a very simple experiment where we looked at 25 smokers and 25 non smokers of equal body mass index. And then we looked at gene expression across a number of different toxicological pathways, stress and toxicity pathways, including this top one, DNA damage. And what we found in the very top slide is that this gene Gad 45 a is a tumor suppressor gene. And amongst individuals who have a BMI in the normal range, when you are a smoker, and you have a normal BMI, you have high levels of this tumor gene tumor expression. So your defense mechanisms and your tumor suppression genes are being expressed at a higher rate. However, amongst individuals with a BMI greater than 30 who are smokers, that expression of that gene is somewhat depressed. So this was an observation, there's a lot more to take from the observations into a causal framework, in which case we need to move forward and take this fundamental observation and translate it back into our in vivo and vitro models where we can really begin to understand is this a real mechanism by which environmental factors may influence health and well being. And the science and the tools are available to do this, we have enormous opportunities with big data metabolomics, lipidomics, and the exposome to move this forward. This is a very recent paper that was just published, looking at disrupted metabolic pathways in both animals and humans. And we can start to see that we are we have the information to begin to validate what happens in these animal models in human settings. So I would just like to say, I think I have a little bit more time. When we think about environmental health, we also need to have broader frameworks. So in the middle of this very busy slide is a traditional toxicological paradigm by which I was trained in environmental health, where we go from hazards in the environment to the ideological development of disease. And in this particular slide, we're talking about aging related chronic diseases across the population. We have so much more information to understand that we need to pay attention to the upstream social environmental factors that are exposure assessment should consider how we are exposed to these different hazards. And that we also need to be paying attention to individual level, biology and susceptibility. But on the bottom half, it also shows that we have a number of different tools in our toolbox that we've never had before to advance environmental health sciences. Many of the major chronic diseases that we face right now, we're understanding have this constellation of biomarkers, early biomarkers of disease risk. And we have some new opportunities to start to look at how these different biomarkers may be influencing disease before disease happens itself. The one that we look at most often in my work is through epigenetics, which is really looking at, while our genes don't change across our life course, how those genes are expressed and when they're expressed does change. And it really shows us another modifiable factor by which we can understand the impact of environmental exposures on health. And we've been looking in a human population based study to look at chemical exposure, social economic factors and neighborhood built environment factors on biomarkers of epigenetics, including accelerated biological aging. So I can't I don't have time to go through all of this. But what I can tell you is that when we start to look preliminary at preliminarily at our day but data, individuals who experience neighborhood stress at a greater than moderate level, have an accelerated biological age of 2.2 years more relative to others. And that is synonymous with being a current smoker, as well as having a body mass index in an elevated level. So what we can see is that amongst the different risk factors that we might consider in environmental health, the environmental chemicals in this population in this sense aren't necessarily leading to accelerated biological aging using this particular biomarker. But other factors really do matter. Neighborhood stress in the context of the neighborhoods in which we live likely intersect with these chemical environments to really accelerate biological aging. So there are numerous opportunities from this research. So we can further explore the impact of factors known to be related to aging and identified previously unrecognized factors. And we can also use this innovation to improve our understanding of the intersection between race, social environmental toxicants, and really to advance our understanding of aging in the population. So to summarize, I think there are numerous opportunities in future directions that we can explore today during this workshop. But we must also keep our mind on understanding how environmental health and equity intersect. We need to understand and keep our eye on the importance of race as a social construct, how historical and structural racism may also be embodied in individuals increasing susceptibility and vulnerability to disease in the population. We must also continue to be innovative in reaching across disciplines to partner with developmental and other disciplines within environmental health in order to solve some of our pressing complex challenges. This example shows some work that we've done with folks in the learning to capture noise in the home, but not only to capture air pollution in the home, but also capture words that are in the home using these small devices. And so so many opportunities like this really exist to advance environmental health sciences. And then we have real opportunities to make change and policy to improve the communities and design communities in ways that will be healthy and fruitful for our populations. And finally, I think we can't lose sight on the importance of risk communication and communication in general in who we are as scientists. And so investing time and energy and effort into how do we become better communicators so that the work that we do gets to the public and the public is informed and policymakers are informed to make solid and sound decisions. So looking to the future of environmental health, we need to capitalize on past successes and strengths, advance new areas of environmental health sciences through innovation, translation and equity. We really need to encourage the next generation of scholars and practitioners continue to support equity and focus on communication. And finally, I argue that we continue to have a need for systems thinking approaches. And this is a quote that I really think embodies all of what we are talking about today. If we consider disease to be embedded in a complex network in which biological, social and physical factors all interact, then we are impelled to develop new models and adopt different analytic methods. So thank you. And thank you for this opportunity. Kristen, that was fantastic. Thank you so much for such a thought-provoking presentation. You really touched on some powerful themes and set us up so nicely to stimulate larger thinking about the future of environmental health on this 10-year horizon that we're focusing on this morning. With that, I'm going to transition. I wanted to remind everyone that we're accepting questions. We're happy to receive your questions. We'll have some time at the end of this panel to take a look at the questions you have, and I'll pose them to the panelists. But we're going to move right ahead with our next speaker, and I'm delighted to introduce Dr. Nicky Sheets from Keen University in Union, New Jersey, who will be giving us his perspective on environmental science and environmental health for the next decade. Dr. Sheets, please take it away. Thanks, Melissa. Can you hear me and see my slides? Yes, both. I can hear you and I can see your slides. Okay, hopefully that will prove to be a good thing. Today, I'm going to talk to you, but first of all, I want to thank the Academy for inviting me here. It's not a lot of times that folks in the EJ world are invited to speak to the Academy of Sciences, but I think those times are becoming more often to our delight. And I'll talk a little bit about that at the end of my presentation. And I want to talk about cumulative impacts, environmental justice, and environmental health. And Kristen talked a little bit about cumulative impacts. She called cumulative risk already. I'll do so already. I'll do so also, but I think her slides are much better than mine, but I'll do what I can. Here's a game plan for my talk. I'm going to give you a little bit of background on cumulative impacts, including a little bit of a history of it in New Jersey. Then I'm going to do some policy. Going to talk to you about fairly new groundbreaking cumulative impacts and environmental justice law that was adopted in New Jersey. And then I should have about five or six minutes left then. I will argue to you the cumulative impacts could and should be used as a framework to address current and future environmental health issues. And I should have put a slide in. I'm not telling you too much about what I do. Let me just say this, the full transparency. I want you to know that I am a part of the grassroots environmental justice movement. So I'm not neutral, but a lot of what I do is try to help the environmental justice movement develop the best possible public policy from an environmental justice. You'll hear me say EJ from environmental justice a lot, from an EJ perspective. So cumulative impacts, let me give you a definition that we've been using in New Jersey a lot. We being the New Jersey environmental justice community. So here's a definition that we're using the risk and impacts caused by multiple pollutants. And these multiple pollutants are usually admitted by multiple sources of pollution in the neighborhood. So the risk and impacts that these pollutants cause both individually and when they interact with each other and with any social vulnerabilities that exist in the community. Cumulative impacts can be thought of arguably, can be thought of as the preeminent environmental justice issue in the country. Certainly, I think most people would say is one of the most important EJ issues in the country. And hopefully in a few minutes, you'll understand why. So it's a significant, a critical problem in our country for environmental justice communities. And it's been very difficult to address. And that is so for at least two reasons. Kristen mentioned one of them. One of the reasons it's been hard to address is because our country tries to regulate pollution by setting individual standards for pollutants. So we go polluted by polluted and we set a standard. One of the issues with that from the EJ point of view is that if often, usually, if that individual standard is not violated, then local government, state government, and federal governments won't do too much to help communities, at least from the community's point of view, fight pollution. And the problem with that is there can be detrimental health impacts on community residents, even if no individual standard is violated. So we don't have a cumulative standard for amount, for the amount of pollution in the neighborhood. So let me give you a typical EJ problem. I'll give you a real life problem in real life issue. In this case, back in 2011, 12, 13, the Hess Petroleum Company wanted to put a natural gas power plant in the community in Newark. And the community residents of Newark said, no, we don't want this plant. They said this before there was any official government process that was begun to see whether air pollution permit would be granted. So they said this before the formal process, doing a formal process, an active formal process. And the New Jersey Department of Environmental Protection and EPA basically said to the community, we've seen the modeling. Modeling was done by the company, by the way. And we don't see that any individual pollutant standard is going to be violated. So we're going to grant the air pollution permit. Well, what did the community say? They said, but look, we already have more than our fair share of polluting sources in the community. And when we breathe in this pollution, right, it's not like we have petitions in our lungs where the nitrogen and oxides go into one compartment in particular matter goes into another compartment. And you see where I'm going with this, right? All this pollution comes to our lungs together, but you're not taking that into account. That plant is operating in Newark as we speak. Another problem with dealing with cumulative impacts has been its association with race and income. And here is a figure that shows that relationship in New Jersey, is reduced by New Jersey Department of Environmental Protection 2009 using data from the late 1990s, early 2000s. The first thing New Jersey DEP did was they assigned a cumulative impact score to every neighborhood in New Jersey. In this case, you can informally think of cumulative impacts as a very rough estimate of the amount of pollution in New Jersey neighborhoods. And to see what the relationship was between cumulative impacts and this estimate of the total amount of pollution in New Jersey neighborhoods, they grafted and you see the figures. Look at the top figure. What it's showing you is that as a number or what it's given you evidence of in any case is as a number of people of color in the New Jersey neighborhood increases, so does the estimate of total amount of pollution. And the same thing is true for people living in poverty in New Jersey. As a number of low income, a number of people with low income living in New Jersey neighborhood increases, so is the estimate of the total amount of pollution in those neighborhoods. Now, I think everybody will say, we'll see that this is very troubling. I'll say what I've said to all these, it's all over the country. What these figures are providing you evidence of is that if you live in New Jersey, the amount of pollution in your neighborhood is connected to race and income, the color of your skin, the amount of money in your pocket, and that goes against everything that at least we claim we stand for as a state and a country. So let me say a couple of more things about these figures. One is that of course what we're worried about with the disproportionate amount of pollution you see in environmental justice neighborhoods or estimated to be in environmental justice neighborhoods. So environmental justice neighborhoods, those neighborhoods present on the right of your screen, communities of color, low income neighborhoods. What we're worried about is that there is a link between this disproportionate pollution load and the health disparities the Christian talked about that are persistent in our country that are rooted in race and income. And the other thing I would say is the situation is not unique to New Jersey. If other states did similar studies, many of them will probably have similar findings. And in fact, one of the things that started the EJ movement in the late 1980s were national investigations that did have similar findings. So our responses are one of our responses and not just to this. The environmental justice community in New Jersey have been saying for a while, right, that look, we have a problem. So these figures did not surprise us maybe a little bit because it's almost as if we had drawn them ourselves on the back of a napkin, right. But our response to this in part was a policy response also in the organizing response, but in part a policy response. And we developed policies to address cumulative impacts and environmental justice on both a municipal and a state level. I want to talk to you about the state level policy, because that in a way is cured this way led to the state law that I'm going to be talking to you about. So here's a history, here's a grassroots history of cumulative impacts in the state of New Jersey. I won't go through this in detail. You can see we worked on it. We've been working on it a long time. We formed several committees, our first committee in 2007 in that advocacy led to the screening tool that produced the figures that you saw. We developed statewide policies, municipal policies. And in 2017, when Senator Booker came to us, Senator Booker is our senator from New Jersey. When he came to us with an environmental justice bill on the national level, and it did not have cumulative impacts in it, we gave him our statewide cumulative impacts policy. And to their credit, Senator Booker's credit, his staff's credit, they incorporated an altered version of the policy, but a version of the policy, nonetheless, into the national bill. And that eventually, I think played an important role in leading to a New Jersey statewide cumulative impacts legislation that was introduced by a senator, state senator in the southern part of our state, Senator Singleton. And here is the guts of that legislation. It starts off by saying, and I love this picture, I know it's on the clipboard, but I love the picture because that little girl's a member of the environmental justice community. So the legislation says that if a block group is at least 40% of color, or 35% low income, or 40% of his residents are of limited English proficiency, then if you want a major pollution permit in one of those overburdened block groups, if these criteria were defined an overburdened block group, if you want a major pollution permit in one of those block groups, you have to do an environmental justice analysis. And if that environmental justice analysis shows the cumulative environmental and health stressors in the block group, where the facility would be located, would be higher because granting the pollution permit, because of granting pollution permit, if those stressors would be higher in that block group than in other block groups in the state, then if you are requesting pollution permit for a new facility, that permit shall be denied. If you request the permit for an expanded facility, or it's a permit for renewal, even if stressor would be higher due to granting the permit, the permit can't be denied, but conditions can be placed on that permit. So look, this is groundbreaking because it's the first law that we know of that's been adopted that says, based on cumulative impacts and environmental justice, pollution permits under certain circumstances should be denied. In many ways, addressing cumulative impacts in that permitting setting has been a holy grail to EJ community, and this moves us a significant step closer in addressing this issue. Now that you have that background on cumulative impacts, and you know that there's at least a partial policy solution to it, I want to close out by arguing to you that cumulative impacts would be, it could be and should be a good framework and should be used as a framework to address environmental health issues. And to begin that discussion, I'm going to take you back to the definition of cumulative impacts. Risk and impacts caused by multiple pollutants, usually admitted by multiple sources of pollution in the community, and their interaction with each other and with any social vulnerabilities that exist in the community. When I read this to you the first time, I really talk more about the, I talk only about the pollution part, even though I did connect that to race and income, but look at the social vulnerabilities part in this definition. And what I want to argue to you is that when we combine the pollutants and the social vulnerabilities, those elements of the definition of cumulative impacts, that gives us a framework to work across disciplines. Social vulnerabilities, we can think of a lot of them. In my work, we usually talk about health disparities, lack of access to health care, racial discrimination. But again, addressing these social vulnerabilities, as well as the pollution part, forces us, right, calls for us to bring in multiple disciplines, calls for us to work together and across, across discipline lines. And I think the cumulative impacts gives us that framework where we can all fit in to, we can all fit in the framework and we can all bring our various expertises to address multiple problems. And one of them would be environmental health problems, but multiple problems in communities. There are other advantages to using the cumulative impacts framework in addition to the fact that it will facilitate working across disciplines. Another advantage to it is that we already have a movement that's prioritised it. You don't have to convince the EJ movement to address cumulative impacts. EJ movement has been trying to do it for several, several decades now and has made progress. The EJ community is ready to go and is going. And because of the work of the EJ movement, important institutions in our country have already recognised the need to address cumulative impacts, i.e. government. So let me close by saying this. I have to admit to you, April's been a tough month for me. I think we're all overworked. You know that feeling. And I wasn't going to do this panel because I'm thinking, huh, Academy of Science, National Academy of Sciences, I don't want to go there and be so overwhelmed. I can't give a good presentation. But I joined the panel for two reasons. I'm delighted that the Academy of Sciences asked me and another of my colleagues, Jacobi Wilson, to be part of panels today. It shows that the Academy has further interest in environmental justice. And because it has interest in environmental justice, and we're all about centering community and equity, the Academy has an interest in the community-centered approach to science and in solving our problems, solving multiple problems of neighbourhoods. The other reason I did this is because I wanted to walk to talk. I wanted to take a chance. And you have to put aside your vulnerabilities and say, if this is going to help the community, let's do it. So I invite you to take a chance with me. I invite you to come into the EJ world and we'll meld our worlds and use this community-centered approach, this cumulative impact approach to addressing multiple problems in communities that include environmental health problems. I am going to stop there. Thank you for listening. Dr. Sheets or Nikki, if I may, that was fantastic. I'm so glad that you did agree to do the panel. We're delighted to have you here. Thank you so much for such a clear and cogent explanation and perspectives on environmental justice and also cumulative risk assessment. It's making this panel and this dialogue all the more powerful and thoughtful. So we're delighted that you came. Thank you for your thoughts. And I want to remind our audience to please send along your questions. We've received some and we welcome more as we get ready for the question and answer period after the panelists are finished. So thanks again, Dr. Sheets. And with that, I'm very happy to introduce Dr. Andrew Geller from the U.S. Environmental Protection Agency who will be giving us his perspectives on environmental health on a 10-year horizon. So take it away, Andrew. Thank you very, very much, Melissa. Melissa, I'm so excited that you talked about the abstract because I feel like the abstract is where I live these days. Last month for the first time in two years, I was sitting in a hotel room reviewing slides while preparing to give a talk on mapping locations of high lead exposure and thinking about my comments the way we do. And I came to a slide white with simple black lettering that read, percentage of homes built prior to 1940, percentage of homes built prior to 1950, percentage of families whose income to poverty ratio was greater than two, percentage of the population with either a high school degree or higher, percentage of the population who are African Americans. And the take-home message of the slide that these are the best predictors of elevated blood lead level and that these are all social determinants of health struck me even more strongly than it has before. As we consider health disparities in America, social determinants play a huge role in both environmental exposures and vulnerability and susceptibility. Today, I'm going to talk about vulnerability drawn from research on environmental justice, aging, exposure, toxicology and decision science. And I think you'll see a convergence between our talks this morning. The concept of vulnerability is part of much environmental legislation with special attention generally given to life stage vulnerability, mostly children, pre-existing conditions and genetic differences. In 2004, the National Environmental Justice Advisory Council made clear recommendations to address the notion that the cumulative impacts of the physical and cultural environment confer vulnerability. That is, vulnerability can exacerbate the impacts of exposure to environmental toxicants and that incorporating these into our environmental health decision making is critical to reducing health disparities. The attention to vulnerability has been given emphasis through the executive orders and action plans that were just released by EPA and other agencies addressing equity under the current administration. One of EPA's areas of emphasis is defining understanding and incorporating cumulative impacts as Nikki spoke about. That is, in our definition, the total burden of health affecting conditions or circumstances on an individual or community. The vulnerability conferred by this burden and incorporating these into its decision processes. This is the focus of a white paper developed by EPA with broad consultation from state, tribal, academic and community groups including Nikki and under review now by EPA's Science Advisory Board. Why is this important? Well, this is a figure from the Max from the National Air Quality Standard Policy Assessment presented to EPA's Clean Air Science Advisory Council in December 2021. On the left here, we see exposure and risk calculations under different regulatory scenarios based on epidemiological data. In each of these scenarios, we can see that black Americans experience higher exposure to PM 2.5. Immediately adjacent to these data, we see mortality risk estimates based on exposure response data indicating that black Americans carry a three-fold risk of mortality from those exposures. On the right, we see that people of color experience exposures from a much broader set of sources than white Americans, likely due to different living and working conditions and making mitigation of those sources more complex. We can also see that the additional mortality of black Americans is not only due to the diversity of sources since these are experienced by other people of color without the huge increase in risk. So points one and two for our future of environmental health. Point one, the challenge is not simply environmental health, but understanding and eliminating health disparities as illustrated here. Point two, for Kristen, we need more strong epidemiological studies that incorporate the full diversity of the American population in keeping with Executive Order 12898 and its emphasis under Executive Order 14008. These are equity and PGA Executive Orders. We need to produce data that allow for the developing of these type of exposure and risk estimates that incorporate vulnerability into this assessment. These rich data are exceedingly rare. The body of environmental justice research, including recent research associating redlining with air pollution disparities, suggests that these PM 2.5 data are just the tip of the iceberg. Again, we need more data like this. And in its absence, we need to develop ways to incorporate our understanding of vulnerability with other data, such as biomarker and mechanism of action data and use these in our decision processes. In more general terms, we feel fairly comfortable with the source to exposure to dose to effect paradigm for single and multiple chemical assessments. But the question remains, how do we go from this traditional chemical risk assessment paradigm to this paradigm that incorporates nonchemical stressors that undoubtedly play a role in disparate exposures and health outcomes? Let's explore this more fully, taking cumulative assessment for chemical and nonchemical stressors and expanding it. I appreciate Kristen showing this earlier. I've adapted this schematic from a paper that a group of us put together recently on older adults' life-stage susceptibility and vulnerability and environmental health to talk more generally about vulnerability. Let me unpack this for you. Here is the exposure to outcome pathway, exposure to those response of our traditional risk assessment. Moving to this next slide, this top tier comprises the constellation of determinants of health from the physical and social environments broadly on the left and for the individual on the right. Looking at this top tier, we see that environmental factors affecting health and vulnerability swamp inherent factors here denoted by genetics. And we can harken to findings such as that genetics may account for as little as 7% of longevity. An important realization when we're talking about health disparities. Again, thinking about what Kristen presented earlier and noting that in one specific case in Chicago, for example, black residents live on average nine years shorter than white residents. When we include the internal markers of exposure to these determinants of health, we really define the exposal. So now we come to point three. At EPA at least, our research staff still largely comprises natural and physical scientists and environmental engineers. As we consider the future of environmental health science, we clearly need to add the social sciences to more fully characterize the environment. And frankly, to design the studies where we investigate biological impacts. Who do we include in these studies? And how do we characterize their life experiences? I note that this has been recommended many times and EPA is taking action. But again, if we are looking at the next 10 years and making progress on issues of vulnerability and health disparities, this is absolutely critical. Finally, we define the vulnerable phenotype. Both by changes in biological maintenance, repair and adaptive mechanisms and homeostatic processes, and the full constellation of outcomes that we see in overburdened communities with a vulnerable population resulting from the cumulative impacts of lifespan exposure. So this is now point four. It is important that we consider the full constellation of this morbid phenotype. The issue of health disparities is less knocking these off one by one and more addressing a higher node leading to all of these outcomes. So let me summarize this. With this model that I adapted, this model of phenotype that I adapted from Clarence Gravely, noting on top, the nested levels of the expo zone and on the bottom, linked population and systems biology. This model incorporates Nancy previous concept of embodiment and Arlene Geronimus' concept of weathering that healed phenotype. The idea that humans incorporate biologically the material and social world in which we live, and that the cumulative biological impact of being chronically exposed to and having to cope with socially structured stressors can increase health vulnerability and accelerate aging in marginalized populations. The lower half of the figure, the combination of these figures and of the exposure factors and our own biology producing phenotype allows us to think about cumulative social stress, perhaps operationalized through biomarkers of allostatic load with molecular biomarkers that reflect cumulative impact, like epigenetic changes in methylation or telomere short phenotypes that reflect disparate health outcomes. Just to recap where we've been in our traditional risk assessment, we often consider exposure in these innermost boxes. Think of the movement toward personal dosimetry and our focus on single adverse outcomes. What we learn as we consider, for example, those air data is that we need to be thinking of at least social structure and culture as we consider not one health outcome, but the full constellation of health outcomes that define health disparities that face our communities. This is played out in regulatory decisions. The need for data to inform more of these studies and these kinds of analysis is immense. So now we know that if it doesn't kill us, it doesn't necessarily make us stronger. Acknowledging that exposure impacts phenotype can we understand how it does so to operationalize vulnerability and use it in our environmental management? I want to start with this toxicity path schematic from the NRC report on tox testing in the 21st century. This was the future of environmental health science 10 years ago. This framework has helped to frame environmental science's broad progress on high throughput talks by emphasizing the importance of these dynamic responses to toxic exposure and identifying downstream pathways to adverse outcomes. If a response is within a cell's adaptive range, it recovers. If not, it moves toward adversity. A critical metric then becomes the magnitude of the exposure response that exceeds the tipping point measured by these dynamic markets. Now, another definition of tipping point, however, is a perturbation that shifts the cell from its normal function to one that keeps the adaptive response going. So rather than tipping over to overt morbidity or mortality, we modify the tox 21 pathway to add the possibility of a change in homeostasis, a more vulnerable state that is often called allostasis or allostatic load. In aging biology, this kind of homeostatic shift is thought to produce conditions of frailty that affect multiple organ conditions in the body. This is also very much behind the idea of weathering that I spoke of earlier. This is a more latent vulnerability and further challenge on covers of reduced capacity to produce an adaptive response. Now, tipping points have been studied by exposing in vitro systems to environmental chemicals and pharmaceuticals. But is this where our interest lies? I was talking to a friend last week about our experiences at scientific meetings. John is a child psychiatrist and he told me the problem is that whenever I asked a researcher a question, this study has excluded the really interesting cases. So here we are at the interesting cases. Can we identify changes in the homeostatic state associated with exposure to nonchemical social stresses? Can we identify a constellation of stable biomarkers that reflect a broad constellation of changes brought by both chemical exposure and nonchemical exposures that themselves reflect change in homeostatic state reflecting greater vulnerability for their exposures? And finally, can we connect these changes not to a single type of morbidity, but to rather the constellation morbidities that reflect the health disparities and underserved and overburdened communities? So point five is that identifying the stressors that produce a vulnerable allostatic state and characterizing this change in homeostatic state with more stable biomarkers of changes in biological maintenance repair and adaptive mechanisms, mainly especially those that may lead to multiple adverse outcomes. Just to give an example, what does this research look like? Well, here's research by Kevin Ward-Kavin, Ward-Kavinus, and his colleagues, including Jomaji Nwaran, who's going to speak in, I think, two sessions from now. This work is an important example for T-molded impacts because it shows how phenotype is the product of multiple scales of human biology directly impacted by social health department. This project examined how neighborhood stressors accelerate aging in an urban primarily Black population. They use DNA methylation markers to assess accelerated epigenetic aging. Epigenetic aging is a means of assessing biological age, and biological age is responsive to environmental exposures and physiological changes and reflects future disease risks. The neighborhood built environment was evaluated by trained assessors and validated models for air quality assessments were also used. These studies were performed on cohorts in Detroit, Michigan, and Central North Carolina. The neighborhood environment had a strong impact on accelerated aging, independent of neighborhood perception. They looked at 17 different built environment variables and found that factors like abandoned cars, streets being in poor conditions, and others were actually influenced to this epigenetic marker. This marker also responded to exposure to traffic-related air pollution. So again, we see this convergence of biological changes, biological markers of both social stressors and environmental stressors. Now, I've been discussing using either the latent vulnerability of allostatic load or the overt vulnerability of existing disease due to cumulative impacts as the starting point for environmental decision making. That is environmental rulemaking, standard setting, permitting, and resource decisions. Decision-making, associative cumulative impacts is another ballpark. With this slide, I just want to put in a marker to note that addressing the cumulative impacts is central to addressing environmental justice. Research that establishes association between environmental conditions, biomarkers, and desired health outcomes should ideally be co-produced with community cooperation and input into that problem formulation. And finally, incorporating these data into environmental decision-making requires further development of context-sensitive decision analysis, recognizing that toxicological data is only one aspect of this impact analysis. On the left, we see the continuum of decisions to which cumulative impacts apply, and on the right, I've included this figure produced by frontowits and rabbits in my many discussions of post-normal science. Acknowledging that addressing scientific uncertainty is only one part of policy decision-making, and that the kind of science I've been discussing is only one type of information that should be brought to bear in what are difficult and valuable decisions. So to conclude, the challenge is not simply environmental health, but understanding and eliminating health disparities. We need more strong epic studies that incorporate the full diversity of the American population to produce data that allow for the developing, for developing exposure and risk estimates that incorporate vulnerability into risk assessment. We need to fully add the social sciences to more fully characterize the environment and to contribute to study design when we investigate biological impacts. It is critical that we consider the full constellation of more of the phenotypes. Again, the issue of health disparities is a less one of not being resolved one by one and more addressing the higher load leading to all these outcomes. And finally, research identifying stressors that produce a vulnerable autostatic state and its contribution to a broad range of morbidities may support more fully incorporated vulnerability due to total burden in environmental decision-making. Thanks very much. I want to thank Chris Frey, John Cowden in around Shaw, Aaron Polston, Robin Collin for discussions in the development of this talk. Thanks so much. Dr. Geller, Andrew, that was fantastic. Thank you so much. Thank you for the historical perspective as well. You know, 50, 30, 20 years ago, it was nature versus nurture, gene or environment. And you've done a beautiful job of really explaining the both part and explaining the intersections and the interactions in a very nuanced and thoughtful way. So thank you for laying it out so nicely for us. I have the pleasure to introduce our next and final panelist for this session. And that's Dr. Kate Marble from Columbia University. We're delighted to have Kate here who will be giving us her perspectives on the future of the next decade in environmental health for seeing the future. So let me turn things over to Kate and remind everybody to please send in your questions and we'll be getting to those after Kate's presentation. Thanks so much, Dr. Marble. Thank you so much, Dr. Perry. Thanks for that great introduction. So I want to start by way of introducing myself. I am not an environmental health scientist. I am a physicist and my area of interest is in climate change. So what I want to do here is provide a very broad brushstrokes overview of the physical science basis for climate change in particular how it intersects with human health concerns. And I want to do this by way of setting up a dialogue because I think that there are a lot of areas of overlap between physical scientists, biological scientists, public health professionals and the environmental justice community. So thank you. Next slide please. So the first thing that I want to address is what's causing climate change. And the short answer is humans. It is due to human activities. Next slide please. So while we know that natural factors like changes in the earth's orbit, fluctuations in the sun or large volcanic eruptions that put a bunch of sulfate, aerosol in the stratosphere, those things can change the climate. But we know that human activities are responsible for all of the observed warming that we've seen since pre-industrial, since the industrial revolution. Actually, our best estimate is a little bit more than 100% because we think without these natural factors, the climate would be cooling somewhat. Next slide please. So the second point that I want to emphasize is that humans do multiple things that change the climate. In particular, humans emit greenhouse gases and humans emit aerosols. Next slide please. Next slide please. So the primary greenhouse gas that humans emit is carbon dioxide. Atmospheric carbon dioxide levels, as we can see in the famous Keeling curve, have been steadily increasing since the late 1800s. There's a seasonal cycle on atmospheric carbon dioxide, which is dictated by plants. There's more plants in the northern hemisphere because there's more land in the northern hemisphere. And so there's a seasonal cycle as those plants green up and lose their, in the summer and lose their vegetation in the winter. So atmospheric carbon dioxide concentrations have increased due to human activities by more than 45% since the beginning of the industrial revolution. Next slide please. But carbon dioxide is not the only greenhouse gas that humans emit. Human activities, in particular fossil fuel production and use, and agriculture are responsible for increases in methane, CH4. Now methane is not as long lived in the atmosphere as carbon dioxide. Carbon dioxide, the stuff that we emit today, about 50% of that will still be in the atmosphere decades from now. And about 20% of that will still be in the atmosphere millennia from now. So carbon dioxide is incredibly long lived in the atmosphere. Methane is less long lived. It tends to get flushed out of the atmosphere within a few 10, 12 to 20 years. But methane is an incredibly powerful greenhouse gas. So even though it's shorter lived, it has much more of a global warming potential than carbon dioxide. Next slide please. And there are other greenhouse gases to consider as well. Chlorofluorocarbons, HFCs, and in particular nitrous oxide. So nitrous oxide is another kind of less well-known greenhouse gas that is, again, less low. It stays in the atmosphere for much less time than carbon dioxide, but is much more powerful. And that is emitted primarily by agricultural activities. Next slide please. So if you look at the observations of how much the temperature is warmed, and then you look at how much the temperature would rise if the only thing going on were greenhouse gases, you see something that looks like this. So we have a very robust scientific understanding of what greenhouse gases do to the climate. They make it warmer. But if you look at how much more warm we would expect the climate to be, if there were only greenhouse gases, we would see it's a little bit larger than what we've observed. So we are neglecting an important other impact that humans have on climate. Next slide please. And that other impact is something that we have heard talked about from multiple perspectives already in this workshop. When we hear about particulate matter, the things that we think about as pollution from a health perspective and also from just a human perspective, those things also have very large-scale climate impacts. If you put a bunch of stuff in the atmosphere, a bunch of gas, a bunch of dust, a bunch of particulate matter that we think of as pollution, that has massive impacts on the climate. So that pollution has direct impacts where you put a bunch of stuff in the atmosphere and it blocks the sun. It also has indirect effects of making clouds brighter. And as a result, human-emitted aerosols, next slide please, are responsible for a small but significant counteracting cooling effect. So we need to understand and we need to consider the warming effect of greenhouse gases and the smaller but significant cooling effect of aerosols in order to understand what's going on in the climate. Next slide please. So that's all well and good that we understand what's happening to the global average temperature. But nobody actually lives in the global mean. Nobody experiences the rise in the average temperature of the entire planet. So one of the ways in which we in our local communities during our lifetimes experience climate change is an increase in the risk of extreme weather. Next slide please. So the way that I like to think about climate and the weather is in the context of performance enhancing drugs. When we find out that a cyclist, for example, was using a banned substance, we don't go back and think, well, in this particular race he would have come second, in this race he would have come 17th, in this race he's a good cyclist so he still would have won. We don't take that perspective. We say we know what doping does. So we take action accordingly. And climate change is doping the weather in some ways that we understand very well and in some ways that we understand less well. Next slide please. So the very well understood intersection between climate and extreme events include heat waves. So there is an incredibly robust link between rising mean temperatures and the frequency and severity of heat extremes. The 2003 European heat wave was the first major event to be partially attributed to human cause climate change. We also know that as the world warms up warm air holds more water vapor and that should lead to more and heavier downpours, notably like the rainfall associated with Hurricane Ida that we experienced here in New York City last year. We also know that hot water expands, so thermosterec effects and also ice that used to be on land, melting, both of those things contribute to sea level rise. We also know that warm water is hurricane food, so we expect that warmer sea surface temperatures will feed stronger tropical cyclones. So even though we don't know enough about how the frequency of hurricanes will change in the future, we do expect their severity to increase. Next slide please. Now there are other extreme events where we understand some of the underlying drivers, but they're much more complex. Case and point is fires. We know that fire weather becomes much more likely, but how many fires there actually are, that depends on ignition, which depends on population, crop management, policy and suppression, which also depends on policy and how effective that policy is. So on a global perspective, global burned area is decreasing mostly because of land use changes in Africa, but in the western U.S. fires are increasing and mostly that is due to policy, but also due to hotter, drier conditions. We also know that droughts, drought risk is increasing in the future in some regions. So warm air is thirstier air, but changing rainfall patterns increases in the water use efficiency of plants and increases in plant growth might complicate these projections. We know that as the equator warms and the pole warms, the poles are actually warming faster than almost anywhere on earth. So there is a reduction in the temperature gradient between the pole and the equator and that may be making the jet stream more wobbly, increasing the risk of extreme severe weather in the mid-latitudes where many of us live, but the evidence is not yet conclusive on this. Moreover, we expect climate change to lead to changes in the number of poor air quality days. So even though in the United States, overall on a large scale, aerosol emissions are decreasing, but warmer air, temperature inversions and an increase in wildfires can lead to high particulate matter and also trapping troposphere ozone in the back of the layer. Next slide, please. So a question that I get a lot is, well, does it matter? Does it matter if we take climate action? Because all of this seems very serious and all of this seems very, very dire. So does action matter? And the answer is a resounding yes. Next slide, please. Next slide, please. So if we look at the near future, a few decades in the future, it does seem like from a climate perspective, climate action doesn't matter very much in the near term. And that is because we have so much locked in fossil fuel infrastructure, so much of society is already built that even in the most aggressive mitigation scenario, we are still going to see climate change impacts get worse in the near future. However, if you look to the farther future, it really, really matters. It really matters what we do. Next slide, please. So the action that we, oh, go back, please. Yeah. So the action that we take now determines how severe climate change will become in the future. So I want to put the action that is necessary in order to avoid those high emission futures in the context right now. Next slide, please. The way that I want to put it in context is by talking about the climate impacts of the COVID-19 pandemic. So greenhouse gases dropped around 7% in the year 2020 due mostly to shutdowns related to the pandemic. But it's important to note that greenhouse gases are short-lived. The climate responds to cumulative emissions. What we also saw is aerosol pollution decreasing somewhat in some regions during the COVID pandemic. And because that aerosol pollution blocks sunlight and cools the planet, COVID-related reductions in aerosols actually had a slight warming effect. And as a result, 2020 was the second hottest year on record. So in the long term, to stay below 1.5 degrees Celsius, which is the Paris Agreement's high-emission target, greenhouse gas emissions must fall by 7%, not just in 2020, but every year. Next slide, please. And the longer the world waits to make these cuts, the harder and harder and harder it gets. So right now emissions must fall 7% every year to meet a 1.5-degree Celsius target. But in the recovery from the COVID-19 pandemic in 2021, we actually saw global emissions increase. The longer the world waits to cut emissions, the steeper and steeper and steeper those cuts must be every year, until very soon we reach a point where it becomes impossible, physically impossible to hit that 1.5-degree target. Next slide, please. So a framing that I think is really important and one that I think is important for this community and our community as physical climate scientists is to identify areas of overlap to talk about those near-term effects. Because even though the climate effects of mitigation don't show up for a very long time, the human health, the agriculture, the labor, the co-benefits of many of those mitigation strategies do start showing up in the near term. And I think that is a very important frame to take when we talk about climate change. Next slide, please. So I just want to summarize by saying, first, we know that it's us. Humans are causing more than 100% of the observed warming and we know that leads to extreme weather. There is no guaranteed safe level of warming. Every ton of emissions we avoid matters, every degree of warming we avoid matters. It's not possible to avoid climate change, but it is very possible to avoid the worst-case scenario. And while the climate effects of mitigation are not apparent for decades, co-benefits are immediate. Thank you very much. I'm really looking forward to this discussion. Melissa and I am. Dr. Marvel, Kate, that was fantastic. Thank you so much for such a clear presentation and for laying out so compellingly the influences, the human influences on climate change and what the future holds. Now it's my pleasure to moderate a panel discussion we have cut into some of our Q&A time. So we'll be as efficient as possible so we can have a break before going on to the next session. And while the panelists have been speaking, I've received a number of questions. What's interesting is that several members of the audience are having questions about consensus statements or trying to reach consensus on various topics. So let me share with you some of those questions about consensus. So let's say if we could start out with Kristen and then if others would like to chime in, one question from the audience is, is there a consensus definition for environmental health science? And so many of us are very familiar and have grappled with this issue. And how does it work in the context of a one health science topic? So Kristen, if you'd like to weigh in on that and be delighted to hear from other panelists as well. It's an amazing question. And, you know, with a limited amount of time, I took out the definitions of environmental health sciences from the document. I think that if you look at the World Health Organization, they have a consensus of environmental health as a field encompassing anything that's outside of our body. So anything that's not genetics alone encompasses environmental health. Environmental health sciences, the National Institute for Environmental Health Sciences has a nice definition that puts some additional parameters on environmental health sciences and thinking about the molecular and biological factors that influence health and well-being across the life course. But I think we're at a point in our thinking that we need to really come to some consensus. I'm not sure that there's a full consensus. And some of us who have been thinking about the future of environmental health really see that as an area for future consideration. What really is environmental health sciences? And how do we use that to best improve population health? Thanks so much, Kristen. Would anyone else like to weigh in? Yeah, this is Andrew. I think they appreciate bringing up the one health topic because for, for example, Nikki and I talking about community, we're talking about human communities, but of course we need to think about communities broadly, including the ecological communities and a full understanding that a healthy and secure human society lives inside of a healthy environment. We can see this in things as simple as looking at lead toxicity, where we have to look even at the microbial soil community and its impact on bioavailability to understand that these do have direct effects on us. And of course, as we think, as Kate talked about climate change, we're really thinking dramatically about the life on earth and the full interaction there. Absolutely. And I have, I failed to mention, I hope that many of you can stick with us throughout the day. And Dr. Christina Johnson, who is an expert in one health will be speaking in our climate health scenario group around this topic of expanding definitions to include the concepts of one health. So Melissa, maybe, maybe you can take a page from the EJ community. The definition I presented of cumulative impacts is one that I actually have cobbled together from various definitions. There are a lot of definitions of cumulative impacts, but we looked at it and there are common elements to all those definitions. So we put together a definition that helped us the most in New Jersey, and we live with the ambiguity otherwise, but the definitions are not in conflict. And we think that each brings something to the table. I'm delighted that you mentioned that, Nikki, because that was another question from one of our audience members. And that was getting to a consensus definition of cumulative impacts. And I think you touched on it in your presentation. But if you wouldn't mind reiterating and rearticulating even those sources that were used to come together with this aggregate definition. I think the sources, well, so let me tell you the prominent sources, the one we kind of paid the most attention to. California EPA put out a document on cumulative impacts actually before the screening tool, the California screening tool on cumulative impacts was developed. Andrew referred to NEJAC, National Environmental Justice Advisory Council, had a paper on cumulative impacts with a definition in it. Professor Rachel Morelle Frost wrote an influential article on cumulative impacts that had a definition. And there were elements, though, the common elements that we thought were important is each mentions multiple pollutants, multiple sources, and each in some way mentions social vulnerabilities or criteria or indicators outside of pure science. I should say that NEPA, National Environmental Policy Act, also had a definition of cumulative impacts that was removed by the last administration, but we think maybe already has been brought back by the current administration. But it was those common parts of definitions that we thought were important, we think are important. That makes a lot of sense and very much related to this. I was so struck during your presentation about the precedent setting policy decisions around cumulative impacts and the mandate that any emission activities have to, if it's going to increase cumulative impacts and it's not going to be approved. So that was a very powerful precedent that New Jersey was setting as it related to environmental exposure protections. And I want to say that as listening to Kate's presentation, she mentioned co-benefits at the end. Part of what contributes to cumulative impacts in EJ neighborhoods are power plant emissions and emissions from sources that also emit greenhouse gases. And we have developed a policy that says that climate change mitigation policies should also be used to address cumulative impacts and disproportionate pollution loads in EJ communities. They should do both, right? We're obviously down with fighting climate change, but I think our unique stance is, and just think about this for a minute because it's a hard stance, is that if a climate change mitigation policy does not do both, does not address the local pollution load as well as the climate change, as well as greenhouse gases, it should not be used. That we have to get a double bang for our buck and that equity and justice is just as important as saving the planet from climate change. Very precedented, very original, I think, of being a real leader for the rest of the country. I might use it as an opportunity to segue slightly to Dr. Marvel. Kate, you mentioned at the beginning that you weren't your physical scientist and that this was a interesting milieu to be in, that your presentation really spoke to the many human contributions to climate change and pointed out that the impacts are very real. You must have been somewhat gratified to be among fellow scientists who are recognizing the health impacts. I know many folks here and certainly in the audience and other panelists have been thinking about the health impacts of climate change as well. Just curious from a physical scientist's perspective, what it's been like to listen to this attempt to think into the near future, what kind of changes could happen to prevent us from going in this direction? Yeah, it's been fascinating. I also want to apologize. I'm on travel for the first time in the pandemic and there is a lot of pollen here, so that's why my voice is kind of going. I think there's a real realization, kind of a revolution in the physical scientific community, that we really do need to be in constant two-way dialogue with not just other physical scientists, but with health scientists, with population scientists, with ecosystem scientists, and with EJ communities, with policy makers. Because in a climate model, you change carbon dioxide in the atmosphere by changing one number. That is not how carbon dioxide accumulates in the atmosphere in the real world. It accumulates in the atmosphere because of a set of decisions which have been made in existing power structures. That is not something that we as physicists are trained to understand or even appreciate. So it's really important for us to understand, okay, well, where are these emissions actually coming from? And then when it comes to understanding the impacts, a climate model can output thousands of different variables at multiple scales. You can look global, you can zoom into the continental scale or the regional scale or the local scale. You can look at things over extremely long, you know, millennia, or you can look at things on three-hourly timescales. And so it's really helpful for us when we're sifting through that data to understand, to have a constant two-way dialogue with researchers in your field to help us identify what do we need to do better? What questions do we need to be asking and what should we be focusing on? So that's my interest in being here, I think. Terrific. Thank you so much. I've got two big questions, meta questions additionally. One relates to a scientific approach or our approaches and that is the notion of accumulation, cumulative, and also mixtures. And I know all too often we discuss this, but let's again, with an optimistic perspective, put our thinking caps on for the next 10 years and seek to push through in a way that's more operational. What needs to happen from your perspectives as panelists? What should we be doing better as it relates to defining accumulation and also mixtures? That's for anybody. I'll wait in cautiously. Well, certainly we already think about mixtures. We look at disinfection byproducts, for example, in drinking water and we use index chemicals to stand for the whole mixture that's in there. When we look at PCBs, we look at index chemicals and develop relative potency factors at superfund sites. We look at total petroleum exposures and calculate hazard indices. So we do this comfortably already and we incorporate it into our decision making at all levels, whether it's a site cleanup or whether it's in regulation. I think we are now, at the federal level, we're figuring out and we are highly motivated to figure out how to more fully incorporate these social stressors. Where we have data, like the data I was able to show on particular matter, where we just see a difference in dose response, a frank difference, it's got to be incorporated. It is incorporated because we are beholden to protect the most sensitive among us. Where we don't have it, I think that's where the science that I was talking about and actually really advancing our decision science to include multi-criteria decision analysis, that includes understanding that these are value-related decisions, absolutely need to be, is one of our areas going forward. Andrew, thank you and yes, I really enjoyed that final slide as it related to the models that you explained and how it had direct relevance to decision making. So thank you and I know that you're right at the forefront of policy making. One final question before, go right ahead, go right ahead, Nikki, before I ask one final question, go ahead. I was going to say I think, and we've been fearful of this in the EJ community, that Andrew talks about making decisions. Let's continue to make decisions while the science is advancing and while we're doing the research on how, what happens when you mix, when you mix the pollutants, that shouldn't paralyze us. One thing we're fearful of is that as we develop more tools around cumulative impacts to talk about additive effects, synergistic effects, antagonistic effects, then everything will stop until we try to get that 100% correct and have 100% knowledge, which we never will. And we don't want to get stuck at the point of developing models. The model should be part of a policy that delivers reductions in pollution to EJ communities. And maybe here's where precautionary principle comes into utilization also, that we don't have to have perfect knowledge before we act on the knowledge that we do have. I think it's a powerful message. Paralysis by analysis and that we have to keep coming back to that reality. It's intellectually we understand it, but it behaviorally we lose sight of it. So thank you for making that point. I think I saw Kristen's hand up. Maybe you wanted to weigh in as it related to accumulation, cumulative risk and also mixtures. I think a lot about how do we use this new omic technology to advance our understanding of cumulative risk and mixtures and still move towards what Dr. C said in terms of decision making. And one of the things in environmental health sciences that I think we've often done, and we see it now with PFAS, we're reacting to sort of the legacy of what's been in the past. And can we use this new technology to look at the mixtures of the future? So we now can have these molecular signatures that we've never been able to have before to really look at body burdens of chemicals that are maybe emerging and new and we need to be paying attention to looking towards the future. So I think that the science of environmental health can also and these new tools and new technology can really help us look to the future for prevention so that 10 years from now we're not saying we have a body burden of legacy chemicals. And when we go to talk to communities, we can tell them to stop drinking the water, but the reality is they've already been exposed for 10 years. And I think those are the cruxes of how we're going to be more proactive in the work that we do in environmental health sciences by bridging tools and technology with a future direction for public health protection and prevention. Excellent. Kristen, thank you. Andrew, did you have another word on this issue? Yeah, because I think the points that Kristen and especially Nikki brought up are really important. And really thinking about the way we're making decisions now. So a process like a health impact assessment brings to bear not only the community's goals and in considering what might be the alternative, you know, if you've got a policy or an action, you've got a bunch of alternatives, then the community is how might this affect our health and the kind of data that are brought to bear are widely varied. Yes, some of it is what we would consider hard science data. It may say doing this, you know, can decrease, you know, asthma burden, for example, or improve air quality. But there's other, there are other forms of data, including community knowledge and history, those historical norms, there's economic data, there's safety data. I think as we consider this, and we're, you know, talking about science or hard sciences here, we have to appreciate the epistemological variety that are out there and appreciate that these other forms of information are absolutely critical for decision making. And we need to be able to not only compare apples and oranges, but use apples and oranges in making those decisions. Again, this is why these structured decision processes are so critical to be able to bring all those data to bear. Thank you for bringing that together so compellingly. I'm actually going to turn this very last more broad question to my co-chair, Kim Buckeleide. In fact, and apologies to the audience members, if we weren't able to get to your questions. Thank you very much for sending them along. Thoughtful questions that we can share with the panelists offline. But Kim, the one question we had was in a time where it looks as though there may be greater pessimism sinking in that members of the public might be skeptical about science and also resistance to health protection and perhaps the anti-vaccine movement was a reflection of that. How do we maintain as physical and environmental health scientists? How do we maintain attention and buy-in and investment in environmental health for the long run? Are you on mute? Nope, still can't hear you. Did we lose Kim's audio? I think we lost your audio, unfortunately. Okay, well, it is with an eye toward optimism. And also, I was thinking of it from a multidisciplinary perspective, too. And we had some questions from the audience about how, for example, our standing committee on emerging sciences for environmental health decisions, how we ensure to incorporate a variety of different disciplines everywhere from economics to philosophy to social sciences writ large to anthropology and sociology. And that is to recognize some of the actual very nuanced frameworks that several of our panelists today have presented to understand what those many intersections are. I think I mentioned about the past 50 years, we had a much more crude notion of nature versus nurture or in genes versus environment. And you can see in the material that was presented today, this a better distillation and a better clarity as to how these forces interact from a variety of different perspectives, from environmental justice to social disparities to the allostatic load and to cumulative risk. We're getting better at indicating and highlighting where those intersections lie. So, Kim, sorry we weren't able to get to you, but I do really want to thank the fantastic panel, very provocative, very, very thoughtful. Thank you for being so generous with your ideas and your thoughts. And I want to say to the audience that we're going to take a 15 minute break. Please join us at, I believe that's a 12, I'm in Europe, so it's quarter of six my time, but I believe it's 12 o'clock. We'll be returning for our next panel, our next dialogue. Thanks very much. Thank you.