 Welcome back. My name is Patrick McMullen. I am the director of computational toxicology of activation and I will be your host for the third session today on our dialogues this dialogue is on decision making for climate change and help format will be very similar to for those of you who have been with us the whole day that that you've seen throughout the throughout the afternoon here. We, we have a great panel of experts from from diverse areas that are here to share with us their their insights about where they see environmental health science going and where we can expect it to interact with the prevailing issue of climate change over the next 10 years. So to begin we're going to have each of our panelists take about five minutes to discuss who they are, what their perspective is on the issue and kind of set up their, their history and their thoughts on the, the workshops, the far and kind of where we're going in environmental health science in the next 10 years. And then we're going to turn to a dialogue on a scenario based session that focuses on addressing global health challenges in particular climate change. So, just like the other sessions. We certainly invite you to participate in the under the video viewer in the event page, you will see a dialogue box that lets you submit questions via platform called Slido. Please do that and our, our staff is, is moderating those and we'll, we'll pass them our way for for discussion. So, with that, I want to introduce our first first panelist. Dr. Dr. Karen Bailey will start us off for the session. Dr. Dr. Bailey is from the environmental studies program at University of Colorado Boulder, and I will pass the conch to her, as she will explain a bit more about her perspective on the future of environmental health sciences. Dr. Bailey the floor is yours. All right, thank you so much for having me today. I'm so eager and excited to be able to participate in this, and as a panel on this broader discussion, sort of the future of all the work that we're thinking about and doing in the realm, broadly defined as environmental health. So, but about me, I am a social scientist who really shifted from being kind of a purely ecological scientist and environmental scientists. After doing some work in Southern Africa and studying in the ecological systems and wildlife in landscapes where that were explicitly and really profoundly experiencing the brunt of climate change on their livelihoods, their health and their well being. And so it was that during that time that my dissertation about 10 years ago, where I was struck by my broader interest in human environment interactions have broadly defined in the context of climate change and global global change more broadly defined. And so I decided to challenge a shift from being an ecologist where the majority of my training at the point to being a social scientist and that that shift. It really drives a lot of my thinking on what I hope for in terms of the future of environmental health in the context of climate change. So a lot of my experience in this topic does come from working with communities and low and middle income settings, living in rural areas, directly feeling the impacts of climate change on health, well being, livelihoods and relationships with the environment. And so thinking about the future of climate change and environmental health, a few key themes came to mind when I was preparing for today. So my thinking is that when we can create enabling conditions to achieve these themes will be closer to the goal of kind of addressing environmental health underachieving climate. So the first theme is sort of broadly intersectionality and interdiscipline. Really, I think we've seen and I think a lot of people have discussed throughout the different panels and talks today that the siloing of disciplines and the siloing of societal problems and the separation of societal problems and environmental problems and justice issues. And as so many other intersectional and inherently intersectional issues has led to strategies for solving problems that sometimes have exacerbated them or led to increase margillism. So when we're thinking about where we should be going, strategies that are aimed at conserving nature that have in the past, for example, led to exclusion or of other ways or no availing or disconnection of our relationships with the environment. These are the sort of, this is the history of the way we've been thinking about environmental challenges and addressing the issues of climate change that we need to move past. And so, when we don't think about this intersectional components, we run the risk of making things work. So this first theme of intersectionality and interdisciplinarity really highlights the need to bring scholars from across disciplines together to solve problems and consider them in ways that are inherently intersectional. And when I use the word intersectional, I am intentionally sort of thinking of the word of Kimberly, Kimberly crunch off, who coined the term the critical feminist scholar and critical theorists and also said, when they enter, we all enter when we solve problems for the most vulnerable and excluded marginalized among amongst really we all went. So the third strategy and I think or sorry, the second theme is is this idea of humanity. And I and I think about this in the context of sort of a life scientist trained as a life scientist and studying environmental challenges ecology. And so, and really seeing that I wasn't represented in those fields in my communities and their, their relationships with the environment weren't represented in those fields. And I think part of the reason the fields of environment environmental health and climate research, at least in the US context, really struggle with issues related to equity and inclusion and justice is because we have excluded ourselves, our humanity, our values, our communities in our work. And I often cite some work that was recently published by I believe it's top at all in 2019 that shows that black scientists for 20% less likely to receive funding from the National Institutes of Health and white scientists. And this is something that people have been talking about for a while but it's a trend that's persist. And the gap is largely explained by the types of research questions for stew. In this particular sample, black scientists were more likely to propose research focused on people communities populations interventions, rather than biological and physiological processes on their own. And seeing humanity in their research, they saw to understand health disparities patient focused interventions and consistently as unfortunately panelists view this research is less impactful and less worthy of funding, leading to this 20% discrepancy and in funding success. And so we really need to advance research that sees people and community and our humanity in our science if we want to address these environmental health challenges. And the last theme and I'll wrap up here is this idea of I think restoration and healing. I currently have a student who's looking at the links between critical theories like feminist theory, indigenous thought and restorative justice and environmental work, and it's highlighting the need for healing in the fields of environmental health and climate change research. I'm not leaning too heavily into the language of the perpetrator we can't really think about how to solve problems of the future how to allocate resources how to get everyone to the table how to solve the problems without thinking about how to heal past injustices and restore relationships. As we bring those people to the table. My hope is that we do better with considering all the voices and thinking about intersectionality, humanity and restoration. And that's sort of how I approach this work. I'll pause there a little over time. Wonderful. Thanks so much, Dr Bailey. I think that was a beautiful, beautiful setup for our discussion. I think that a prevailing theme through this workshop so far has been the complexity of looking at the intersection between exposures and as you put it, humanity, and some of these environmental justice and vulnerability considerations. So I think that that's a great, a great way to set up our discussion. So, with that, I'm going to turn things over to Dr Christine Johnson and Dr Johnson I think your slides are in presenter view so if you could switch that I think it would be helpful. And while she's doing that Dr Johnson is the professor of epidemiology and ecosystem health and the director of the epicenter for disease dynamics at the One Health Institute. So we're looking forward to getting her perspective one health has has come up a number of times already in this workshop as a way to kind of reframe the way we think about environmental health science. And, and, and I've been I've been looking forward to hearing hearing her perspective all day long. So, with that, Dr Johnson and I'll turn it to the floor. Thank you so much. Dr McMillan is that is that a better view for the slides. It's perfect. That's perfect. Thank you. Thank you. I'm really excited to be on this panel, especially after the opening remarks from from Dr Bailey just now. So I'm an infectious disease epidemiologist I've worked largely on infectious diseases I have also worked on some non infectious diseases specifically focusing on wildlife as sentinels for environmental change. And so I wanted to be a little bit more sharing of my perspective, and how I think about emerging trends and future casting for patterns around health outcomes that we're concerned about. And specifically, I wanted to highlight how I think about environmental risk at some of the broadest global scales, using the special case of emerging infectious diseases. And we think about forecasting future risk we generally look at the past trends, which can definitely shed light on the drivers of those trends and here I'm showing a list of novel viruses that have emerged since 1912. And I'm also noting just briefly that wild animals were the most likely source original source for just about all of these. And also worth noting that all but the Spanish flu have occurred since the 1950s. And that and if you look to the figure on the right from our world and data corresponds very closely to massive gains in global population growth which, I think very closely parallels accumulation of environmental hazards, and the way we tend to think about environmental health traditionally, which is linked to industrialization a lot of the process that came along with that. So we also similarly suspect that emerging infectious diseases is related to major environmental change on the global scale, especially our ability to alter the landscape, and that that increases opportunities for new animal human interactions and so we think about emerging infectious diseases. As a result of landscape change for agriculture and development primarily, also social and economic inequalities, especially where we're pathogens first emerge and affect local communities, as well as trade and travel and and most recently thinking about this in terms of climate change. And so underlying all of these trends is is is sort of this idea behind large scale environmental change which oftentimes starts with deforestation and habitat loss loss of native habitat especially for wildlife species and wildlife species that then need to move around. They may be reservoirs for infectious diseases and as they find the suitable habitat. Invariably that increases opportunities for animal human contact, including contact with vectors. So, so that's sort of the underpinning and sort of the, the traditional thinking that we have around infectious diseases but it's important. Now to bring that towards climate change which we think of just as another impending driver of ecological change. Some of which were already strained to witness events around how that will affect infectious disease in particular, but a lot remain to be seen and we really need to work on an evidence base to tie into these outcomes to environmental change at the local scale these broad patterns only get you so far. We really need to think about how these, how these infectious diseases are directly tied to the local change that's occurring. And this means close integration of animal human and environmental health and research efforts we also want to hear that the points of entry to mitigate the frequency of emerging infectious diseases are going to be primarily in this pre emergence and early emergence phase, especially if we want to minimize the impact of emerging infectious pathogens. And so that's really what drives my perspective around what's needed in the future and so to do this we're going to need to capitalize on some of the technical innovations that actually that we heard about a lot this morning in terms of precision medicine, and that field and how we can apply that that detection of trends and patterns early on to the landscape specifically. So for improved in an early detection, ideally of these emerging fat and threats. Currently right now we rely on clusters of basically severe disease and people, and that's noticed unusual illness of enough severity to get on to a syndromic surveillance sort of catchment that then will say there's something unusual going on, so effectively using the population as sentinels. And we should be detecting outbreaks well in advance of that so, so hoping that we can all work together from for this sort of future scenario I've been recently had the good fortune to work with a lot of engineers and computer scientists and data scientists around how we can integrate this or this new technology some of which is just recently come about, and even further much more from the pandemic, and how we can integrate that into surveillance for emerging fat effects for one more thing I wanted to just show show similar as was mentioned in the last session, and very well highlighted by Dr Bailey right now is that we really need to think about these participatory approaches or citizen science, and the natural feedback that that's going to have between our ability to protect change on the landscape and then bring that back to the community in a meaningful way. This has a major role to play in these future efforts. And I think we're really going to need to up our game if we're going to hope to keep pace with emerging infectious disease, and inform preventive measures that eventually move us away from basically using our most at risk communities as the first indicator of a new threat. Thank you. Thank you. Thank you, Dr Johnson very, very, very timely. I know that there are our communities right now that are concerned about some localized outbreaks of h5 and one, and I'm sure they could they could use some guidance from from you and your team. Our next panelist I'd like to introduce is Dr. Dr Patrick Kenny. Dr. Dr Kenny is from Boston University at the Institute for Sustainable Energy and the BU School of Public Health. And so Dr Kenny I will turn the floor over to you for you to introduce yourself further and give a little bit of perspective. Thanks very much Patrick and thanks to the organizers for including me in this in this meeting today I really enjoyed hearing the different perspectives over the course of the day, to the extent that I've been able to join some of the sessions and the breadth and diversity of the current session is a good example of that. I'm going to say a few words about my my own journey towards climate and health. I was trained as an air pollution epidemiologist back in the 1980s. I was worked on something called the Harvard six cities study, which was published that sort of the main results of that study were published in 1993 and there was another subsequent study called the American Cancer Society cohort study of air pollution that was published a couple of years later, and one of those studies pointed to this new pollutant PM 2.5 as being really critically important in terms of long term exposures causing life shortening. And it led fairly rapidly in the 1990s to the development of the first PM 2.5 standard, which came out in 2000. And, you know, it really has kind of underpinned our understanding of air pollution health effects ever since in terms of the burden of disease. And interestingly I was thinking back and I remember giving a talk back in 1995, where I said something like, you know, we know enough now about the health of air pollution to take action we don't really need to do any more epidemiology. We, you know, we need to do research on which particles are responsible which components. That's really a question best suited for toxicology, like, I thought the epidemiologists were kind of done now. That was sort of naive and aspirational to say, and it certainly hasn't been the case that we you know people stop doing air pollution epidemiology in the meantime but my own, my own interest started to sort of look elsewhere. I started looking for new challenges where I could apply my environmental epidemiology skills and I turned in two directions one was towards global air quality because obviously there were still a lot of big air quality problems around the around the world, even if the United States was on track to cleaning up its air. Africa was an emerging place where air pollution was completely unregulated. China was really bad in India so I started doing research in those places but I also started. I had the opportunity to start doing research on climate change around the millennium. I was at Columbia University at that time. And I had the good fortune to come into contact with people from the Goddard Institute for space. The group that Kate Marvel works at she gave a really compelling talk earlier today in this session in the early in the morning session about the science of climate change and some of her her colleagues back at at Columbia University approached me about doing sort of an integrated assessment of climate change impacts, and I thought it would be interesting to look at the health impacts of climate change. It was an issue that the environmental health community really hadn't engaged with. And yet it was a looming threat that looked really important. And so, you know I connected with those folks and we started looking at how we can combine their physical science knowledge at the Goddard Institute for space studies they do they they're one of the leading groups that does climate modeling. In the world, the sort of projecting future impacts of human activities on climate change. We started looking at how to connect their models to epidemiologic tools and models to try to project how climate change could could impact air quality and impact public health in the future, initially through the air quality pathway that I already knew so I'm also looking at things like extreme heat pollen and other risk pathways, of which will probably get a chance to talk more about, and that experience working in climate change has sort of led me to sort of three main lessons I just want to throw out there and I think some other insights might come up in the discussion but here are three, three of the insights that I come to appreciate through that work. First of all to tackle the health impacts of climate change. We really need to expand the scope of what we think of as environmental health, sort of away from just the molecular scale, which is sort of traditionally the way a lot of environmental health is to start to forge stronger links with sciences like the atmospheric sciences, the social sciences, ecology, policy, and, you know, community engagement, and easier domains if historically really haven't been thought of as falling under environmental but they're critical to really solve this problem. Secondly, unlike with air pollution or chemical exposure generally which, you know which is what I was trained to understand, we don't have an easy regulatory solution. You know we can't we don't set a standard for temperature or for coastal storms or wildfires, they're going to be happening and we have to, we have to figure out, like where they're happening who they're going to be affecting and how to, how to protect those people. So we have to sort of, you know, use different tools to try to reduce risks rather than just going after the chemical that we've always been able to do in the past, but we also need to promote solutions that reduce carbon emissions and reduce climate change over the long run and as, as Kate mentioned earlier today, many of those carbon neutral solutions those those carbon reduction solutions bring really immediate and local health benefits, especially through improved air quality but also through other pathways. And then finally my third point is that really the to be most impactful it really requires partnerships that involve academic research researchers, along with public health practitioners and city and local governments, as well as community organizations to put their heads together and work on really the tangible that they're really on the ground problems that really are being faced at the local level. And we, you know, I've been fortunate working in New York City and now in Boston with with local practitioners to this to truly try to you to address some of the climate challenges that are emerging, things like, you know, spring pollen risks that are getting earlier and longer things like heat waves and where the heat vulnerability is greatest and where we can sort of target our resources to be most effective. I'm going to stop right there and then hope to be able to participate in the early discussions. Thank you. You mentioned something that's been kind of a recurring theme that I hope we come back to in the discussion. Regarding this definition, you know how we define environmental health, kind of where do we set the where we set the boundaries of that scope. It's something that I'm hoping that Dr Johnson's way in on it from a from one health perspective and then also tomorrow morning we have. We have some some leaders from various public health and adjacent organizations that are going to help help to give some insights on on how they're thinking about the definition of that in in neighboring neighboring fields of study. So with that, I want to introduce our final of our four panelists. Dr Nataki Osborne Chilks. Dr Osborne Chilks is an assistant professor in environmental health sciences at Stelman College in Atlanta, and a member of the National Environmental Justice Advisory Council. So, Dr Osborne Chilks, I'll hand it to you. Thank you so much for for that introduction and thank you to the organizers of the session for the invitation to share. So I'll, I guess kind of start as others have started and talk a little bit about my path in environmental health, and really, I started off studying engineering, but began to quickly understand. Well, one, how engineering environmental engineering in particular, you know contributes to health, but I got really interested in looking at environmental health issues. After really just, you know, recognizing some of the challenges in some of the places where I grew up. I've been a part of my childhood in Baton Rouge, Louisiana, and in what some people call the cancer alley corridor. And, you know, just to understood the realities of living in close proximity to a petrochemical facility. Also making some anecdotal, you know, some observations, I should say about my experience the pollution index was always high. The water smelled bad the water smelled and tasted bad. And then in terms of, you know, health is my own personal health issues as well as health issues of family members. It wasn't that I could connect what we may have been exposed to to those diagnoses and the things that we experienced but really just the fact that that possibility existed was what got me engaged in doing and studying and being involved in environmental work. So what I'd like to kind of lift up does build upon what's a couple of our previous speakers have already said, but maybe I can sort of put my own spin on it just a bit. When, if I can just lift up and I took some notes here. Dr Bailey talks about both intersectionality and interdisciplinary, interdisciplinary. And so those are our two terms that I think are important from my perspective on this work and the future of this work. In particular, I am very interested in cumulative risks and impacts. When I think about things from an environmental justice frame and that often is the frame that I am using based on my lived experience growing up and even where I live in the city of Atlanta, where I live in a specific neighborhood, specific neighborhoods in Atlanta. You know, we can talk about a number of different characterizations but we can talk about the effects of exposure to extreme heat, and we can talk about soil and water contaminants, air pollution issues around water quality, etc. So the challenge, however, is that these communities don't have one single stressor there isn't one single set of exposures, there are chemical exposures non chemical stressors and exposures as well. And so I think we have to really really look a lot more at combined risk, looking at environmental hazards but then also looking at the interplay of social vulnerability and how that impacts the health of groups that are already vulnerable. So when we think about climate change, and how the same populations will experience changes now in those chemical exposures as well as changes in social vulnerability. There is the potential for there to be an exacerbation of negative health impacts. And so I think that there is an urgent need for us to understand, you know how climate environment and social and social vulnerability interact to affect health. So that would be a particular concern for individuals that have increased susceptibility due to pre existing health conditions, things such as asthma, maybe mental health challenges, obesity sensitive conditions, etc. The other thing that I would mention in, in addition to looking a lot more at cumulative risk and impacts and looking at this interplay of chemical stressors and non chemical stressors. In, in that in terms of the non chemical stressors we can also think about, you know, some of the hyper local impacts of climate change like flooding, which might bring contaminants with it but you know there are a lot of other challenges associated with things like you know flooding and we're seeing that quite a bit especially not just in coastal areas but also in urban areas which is where I tend to do my work. And so really looking at these things over the life course or lifespan is really important, I believe the other, I think, opportunity that we have with respect to to looking at a path forward especially in the context of climate change and bringing the climate change analysis into the traditional work that is done in environmental health I'd like to echo what was just said by Dr Kenny in terms of thinking about, you know, even things like community engagement, and how important that is, and not really working not only with, you know, local government agencies not only working with public health practitioners but working with community residents in those community based organizations who can be collaborators in the research that we need to get done. And that tends to focus a lot or at least increasingly lately on community science initiatives, you know, how can we get community residents engaged in helping to collect data that we hope will be actionable data that we can use to press for, you know, different changes systems change policy change social change. You know, how can we, you know, look at public health practice in a different way. Look at the management of our natural resources in a different way, based on that actionable data. And then how can we look at the policy change that is also needed. I just want to emphasize that, you know, lived experience local community knowledge that community residents have, I think it's critical to adding that as a part of the equation to how we address these issues. And, you know, really looking at the capacity that community residents and community based organizations have to help collect that on the ground, you know, street level data in, you know, localized areas which I think can help to fill in some important gaps when we are trying to not only understand what the environmental conditions are, but how that is impacting the health of those populations as well. And I'll stop and pass it back over to Patrick. Thank you very much, Dr. Osborn-Chelks. I, you know, I think that your, you know, your discussion on the community based work and your experience activating citizen science apparatus in Atlanta and other places. I think that's, I think that's something that we want to drill into a little bit more in this panel discussion. So, with that, I'm going to introduce the scenario that we have set up in this panel discussion. So, with that, I'm going to introduce the scenario that we have set out, and I'm just digging it for myself here. And again, this is a session on the intersection between the climate change and health and how we can use the tools we have in hand and the tools that we expect to emerge over the next 10 years to make decisions that are responsible for both of those situations and triaging possible activities, possible research directions, possible community actions based on the way that climate change and health interacts with the scenario is that the U.S. is budgeting $1 billion nationwide for community-driven initiatives to help address climate change and related health issues. A governor's meeting is convened to determine how to allocate $1 billion to communities across the U.S. Scientists and community leaders have gathered to present data on the impact of severe weather events, including wildfires impacting air quality and probably informed by data using real-time air pollution monitoring. Severe drought and the impact on farmers and rural communities flooding and extreme winter storms. So, we've heard a lot from Kate Marble and others throughout the day about the intersection between the environment and climate and health concerns. And one question that I want to start with with this group is what are the major actions that we could be taking now to minimize the impact of climate change? And I'm particularly interested in kind of the specifics, but also kind of the what's the rationale for making those selections, right? If you've got kind of the universe of things you could do, I mean, Dr. Johnson, you spoke to some of the impacts from an ecological perspective. So, in terms of intervention along the ecological perspective versus the community-based health outcomes, disease concerns versus property damage, local versus regional and local. How do we decide where to invest these resources? And what do we need to develop over the next 10 years from a science perspective and from an institutional decision-making perspective that would help us to determine how to use the money fast? Over to me first. Okay. Happy to go ahead. I think my colleagues still have a lot to say on that front. But I guess, certainly, the most important part of the conversation that I've had with the members of the community is that there's going to be a period of adaptation while we witness warming as well as these very adverse sort of disaster-oriented situations that are going to be really driving sort of the not just our health, but I think environmental health in general, I feel one thing, one perspective that I think of in terms of how to integrate across a more broader set of disciplines is to really think about the environment and ecosystems as a sort of providing an ecosystem service and we know that it provides a service around air quality and water quality and so I think that's a really important part of the conversation. And one thing, one perspective that I think of in terms of how to integrate across a more broader set of disciplines is to really think about the environment and ecosystems as sort of providing an ecosystem service and we know that it provides a service around air quality and water quality and similarly we know that it provides a service around climate regulation and I think one thing that climate science has really done is to highlight how far we have really gone off the rails in terms of what we expect to be normative patterns and the disease risks from my own sort of specialized perspective are similarly sort of going off the rails in that way with the likelihood for increasing risk around disease emergence and even just the normal other infectious diseases that we know to go side by side with some of these big climate disasters that are in the scenario that we're proposing right now so I think there has been innovation technological innovation in the space. A lot of it has been directed in terms of human health and now is the time to really bridge those disciplines to spread sort of the wealth of those innovations those technological innovations out towards animal health because we know that that can't be left behind we know that that is important in terms of understanding environmental change but also zoonotic disease risk which is a big part of a consequence of climate change going forward, but also we need those those same sort of new innovations to bring us to a better understanding of what has changed in the environment what is different on the landscape and specifically when we have more localized changes on the landscape that we can understand better through sensors and ways of remote data collection, and things that have have started to emerge, how can we then tie that to an evidence base that's ultimately going to be needed for policy. Thank you. Anybody else have thoughts on on how, how we would be making making these decisions of prioritization. I'll just jump in for a second and then I think Karen might want to say something to. Yeah, that was that was an interesting set of points Christine. I just wanted to say that, you know, climb the pathways that link climate change to health are quite complex. And, and, and they're very like place specific. We're talking about extreme heat, you know we start we start to think more about like cities and the heat island and who's living in those cities and who has housing and resources to protect themselves from heat or not. So that would be like a priority. We're talking about coastal storms and it's like obviously it's the coastlines it's the low lying areas. Again, it's like which people are living in dwellings that are near the coastline that, that are most vulnerable or that have a few as resources for getting away when they need to. My point is that it's very pathway specific sort of the, it's a complex question that you're asking Patrick, and the answer is, is also complex and it really needs to be divided up into these different sort of silos. So I'll stop there and let others weigh in. I think you, you brought up some really great questions. And I think kind of expanding on that is the importance of usable and actionable and really empowering data. And if we're thinking about these communities that might be sort of frontline communities are more or exposed to compound hazards or cumulative effects or sort of all these terms that, that talk about sort of the myriad of ways people are exposed to risk as a result of both environmental, you know, hazards and then also climate change. We think about the need for often in some places where there is a more vulnerability where there might be a history of marginalization the need for collective action. Right. And so we're thinking about how to engage communities in that collective action, providing and asking questions about what type of data is actionable. And what type of data is empowering right and not just sort of adding to the nearly out of data sets that already exist out there that feel separate or at a non relevant scales or sort of not most closely linked to what's on people's minds on a basis, but sort of conducting research and engaging with communities in place that does make the usable actionable and empowering for decision making or collective action for individual action. And, you know, I think often about collective action, particularly for vulnerable communities. So I'm thinking about all the different ways that improved and sort of its accessibility. I just add just a couple of quick things to that really to build on what Karen was just mentioning. When you talk about that data that's usable that's actionable that's empowering. I want to point back to really the utility of engaging the community in an authentic way. You know, we've also heard someone else that I can who said it just a minute ago that these things are very contextualized or very place based. And so really engaging those communities is important. I also think that as we look at a lot of the technical issues around climate change that we can't forget to look at these intersecting issues of social vulnerability. When we talk about the impacts of climate change, you know, we're all impacted, obviously, you know, we're all in the same storm but we're not all in the same boat. You know, some communities are a lot more vulnerable that vulnerability is not innate to who they are it's not in their DNA per se, but there have been policies that have been implemented that have increased the vulnerability of certain populations and communities. And so we've got to lift that up as well. And make sure that as we are thinking about solutions we're thinking about those communities those populations that are most vulnerable and if we can really begin to address these issues for them both on a, you know, let's slow down, you know, and kind of turn turn the clock around on climate and also in terms of the adaptation space, then, then that is going to bode well for all of us, but we've got to not forget those who are most vulnerable. Oh, I just wanted to take a minute to jump in on that exact last few points actually that were made really eloquently around the need for community based sort of integration into the research effort and it was made a bit in the last. sort of session that we had that was very much based on environmental justice and focused on that. And it was brought up then the issues that we have around misinformation and, and it was definitely alluded to and I think important to just bring up again within the context of this scenario that engaging the communities and the citizens in the early aspects of the research as we're as we're saying, these are really complex and also very locally specific problems that are going to be need to be assessed locally and involving sort of the community at the time that the research gets started engaging them all along the way and bringing back sort of what are the research findings so that they are part of the process I think could go a really long way towards that that issue around misinformation and people actually wanting to take action actually understanding the reasons for action, feeling in the evidence base, and ultimately that having a much better trajectory for, for uptake of mitigation that's going to, you know, of course it's going to take effort to change some of these trends so so I think that as everyone is saying is how we get the buy in. So I'm hearing a repeated theme that's, that's, regardless of what the actions are that that that we decide to take with our with our million dollars that needs to be a consideration at the committee level and a better integration of the voices at that level. If that's, if that is going to be true 10 years from now, as probably as today, what, what, what would have to change to be able to bring those community groups to the table to, to empower them with the, with the, with the, with the information as as Dr Johnson was just describing, and then but also empowering them with kind of the organizational tools to, to, to integrate that information and advocates on their own behalf and be heard. You know, when you're talking about prioritization of money available at kind of a federal level. It's easy. I imagine for the community to, to get lost in that so what would need to change in how we, how we, how we organize decision making processes so you know that those, those those communities that are most affected and that needs the most would, would, would feel like they, they were empowered to get those resources. I'm here with a couple thoughts. I think one is, and there's a growing number of these that I think have been discussed and established that aren't necessarily well engineered to, but sort of norms of engaging with government engagement with indigenous communities or local communities, for example, right, these are documents that have been drafted that, you know, leaders and politicians and decision makers have agreed to that say when we talk to these communities, we're going to engage them when we talk to these groups, we're going to engage them this way, and we're going to ensure that they're valued in the process. And I think we need to make, make people more aware that those documents exist, but and also encourage adherence to them so that those voices can be valued in ways that they haven't also very selfishly sort of in a different direction as an early career scholar in an academic setting, we also need to value research that does that in a meaningful way. I talk a lot about sort of how, as an academic at the university I have judged sort of by, you know, grants and publications, largely in addition to my teaching and those don't necessarily value whether or not a community acted on research that I conducted or whether or not decisions were made or whether or not people came together and came up with a solution and we need to value that type of work and empower it amongst academics who are, you know, often in the trajectories towards this type of research. So I think both that kind of in the government sector and sort of the way municipalities think about making decisions, how they engage with communities, and then also how do we train and encourage academics to engage with communities. Thanks Karen. Patrick over to you. Yes, yes, thanks. I just wanted to point out that I think we have a model for how how this could be done in the climate research context. Actually, a model that NIHHS pioneered 15 or 20 years ago, when Kenneth Olden was the director of NIHHS, and he instituted the environmental justice grant program and also the community based participatory research funding program so you know money was research money was directed at environmental health problems that where community members and academics work together to try to solve the problems and do the research and generate the data in the process of, you know, funding those studies, a whole lot of community was built. For example, an organization that I was working with back in those days, West Harlem environmental action was just starting out and they have, you know, become a real powerhouse organization, in part because of that early funding that came from NIHHS under that program. I think that kind of model, you know, if if there were a billion dollars or even, you know, less than a billion dollars but some of that was being was was allocated for community based participatory research kind of program on climate and help. I think that could be really powerful in terms of building that capacity. And at the same time generating the research data that we need to actually take action. I mean, a big, a big, a big piece of why we're, we're creating this group is to identify where groups like an AHS could make that impact. So, you know, the fact that they've they've tried that ground before is something that we will definitely be wanting to highlight with them. Dr. Osborne Jones. So Dr. Kenny actually said several things that I was going to touch upon. So if I could maybe add a couple of things to to grow that conversation just a little bit. You know what I was definitely thinking when you pose the question is that it's about building capacity, building capacity for communities and community based organizations. And I don't think it's about empowering them but it is about setting the conditions so that they can empower themselves. And so access to resources is really important. Being able to access, you know, dollars grant dollars to work, you know, collaboratively with academics and public health, you know, practitioners and others. And that is really critical, because I do think that there is a lot that can be done, you know, at that community scale at that community level to generate the data that we need to help help us to, you know, address and to explore some of these really complex complex problems, excuse me. So that really is is a critical piece of it. And I think, you know, looking within, you know, all of the funding mechanisms, it's going to be important across different types of federal agencies so not just in IHS, you know, EPA and others a lot of groups environmental justice communities in particular tend to work a lot with EPA just because they have a division of environmental justice and have grant funding but in the past, most most of that funding has been really at the small grants level. You know, we're talking 25,000, maybe $30,000 level and really I think there is a need now for larger levels of funding for community based organizations and there have been some, you know, particular programs that did allow for a larger amount, of funding, but you know those you know programs were sunset or you know they didn't happen on a very consistent basis and so I know that there is work happening now to change that to change you know the value of small grants, but that really I think is important because you can't expect, you know, community based groups and and others quite honestly to really work on the systemic level problems by, you know, accessing non renewable, you know one year grants. We're just not going to get where we need to get fast enough if that is the only model that we have to, through which we can access those funding dollars. So that's a very, very, very germane question from the from the audience following on your comments Dr. Osborn-Shell so I'll give you a chance to respond to it and then Dr. Johnson, if you'd like to as well. As previously discussed, community engagement takes time to develop trust and relationships. It is one thing for funding agencies to support existing relationships that have been built. But how can funding agencies foster creation of new relationships, then subsequently foster their success over the longer term. In the current funding process, it's difficult to get a good score and get funded unless you already have a pre existing relationship because it's too risky to invest in something new. I think you touched on, you touched on that point. Anything else to add. The only thing that I would add is that, you know, where there is the potential to include some time for that cultivation, you know, of relationships in the grant, you know, making process I think that would be critical and granted, you know, you can't always put, you know, a time parameter around, you know, what it takes to develop, you know, a solid relationship. But, you know, because I often say that, you know, these relationships kind of move at the speed of trust. But if there is that time, especially in terms of some of the funds funding that I've seen come out of, you know, NIH or NIH when they have, you know, dealt with community based participatory research, you know, there is, you know, some, there could be some time dedicated to, you know, making sure that, you know, communities and the researchers are kind of ground truthing what it is that they're going to work on. Obviously, you come, you know, with certain ideas, but maybe you don't have everything fully baked. And along with that time to get things fully baked, you know, how about including, you know, maybe a first year, at least, you know, in terms of an opportunity for relationships to develop further, you know, there still might need to be some connection that's already been made, you know, may not be able to be something that's completely cold, but, you know, it takes time to develop those relationships. And so, you know, sometimes what's already been invested can be deepened, can be expanded, you know, if there were time within that funding horizon to allow for that to happen. Yeah, absolutely. And to Dr. Bailey's point earlier, if there were incentives at the institutional level for pursuing those kinds of activities. Dr. Johnson, did you have anything you wanted to add on that? You had your hands up before. I think it was somewhat unrelated. I would leave all the ideas around in community engagement and start the level of discussion now to the social scientists because certainly I learned so much from them on, on how to do that well. Awesome. So I guess probably as much as I'm enjoying the drilling in at this level, we should we should take a step back and coming back to the original scenario intersection of health and climate change. What should we be considering in terms of health impacts to measure impacts of climate change? And Dr. Kenny, I'm particularly interested in your thoughts with your experience with PM 2.5 and things like that. You know, how as the molecular diagnostic and the exosomic landscape has evolved, what should we be looking at in terms of health outcomes and maybe even biomarkers of stream of health outcomes to understand the intersection between the environmental climate change and health. That's another hard question that you've posed. You know, in my experience, and I'd be interested what others think about this, but I haven't found as much value in the sort of traditional biomolecular kinds of approaches in the climate change context as has been so helpful in the sort of chemical exposures context. It's much more, I'm sorry about the background noise here, it's much more of a focus on kind of the community scale and larger scale interactions between human activities and the climate, the earth sciences, ecology and sort of sort of at that sort of out of body scale that seems to be kind of like the questions that are most important. But in terms of, you know, how do we prioritize what kind of science is going to be most needed. I think I think it's kind of, you know, all of the above because, again, because climate change and its health impacts are so multi-dimensional. You know, I think it's such a big field that we're going to need to think about sort of dividing up into there's the vector-borne disease approach, you know, that whole set of questions which are really important, you know, mosquitoes that are expanding their range and, you know, all the science of how to do that and how to deal with that. There's the air pollution connections that I work on a lot. Climate makes air pollution worse, but air pollution is like, you know, is really what's responsible for climate change in a sense of these, you know, the carbon emissions that were, so, you know, solving the climate problem is also going to help us solve the air pollution problem which which actually presents tremendous opportunities. Some of the extreme events that we have less control over like heat waves, coastal storms, wildfires. Those are things that are becoming more existentially threatening in the sense that, you know, we don't have easy fixes. And I'm not sure what the right science is. You know, I'm not sure if it's sort of molecular biology or toxicology. Maybe it's more about just understanding sort of spatial vulnerability. I guess I'm rambling, so I'm going to stop rambling and turn it over to others who have insights about this hard question that you've posed. So the thoughts, Dr. Johnson, you highlighted in your introductory remarks that a lot of times we are very, very reactive to the way we approach for zoonotic infections. You know, we wait and see, you know, we wait for much people to get sick and then we backtrack. I'm wondering if that's, maybe that's our best indicator, is people getting sick. But you know, I would love to see 10 years from now something that would be a little bit more predictive. Any thoughts on what that could look like? Dr. Johnson, we don't have your audio. How's that? Sorry. Yep, we got you back. Thank you. Yeah, I mean, I agree with the comments that were just made by by Patrick on the idea that we need to have emerging science. At the local level to really inform, but we have, you know, case studies where we've, you know, once we know about a threat where we can move towards early indicators either in the environment. Or even in animal populations. And I think back to the really early days of West Nile virus when that was newly emerging in the US and it was, you know, first evident in animal populations. And then, you know, the connection was made between the animal and human health where information was shared and then it was recognized as a, as a human threat. And what came out of that for, for a good long period was a pretty effective way of engaging the communities around recognition of an early threat where there was, I don't know if anyone else remembers, but there was the whole dead bird program. And if you see a dead bird in your community, you called a hotline. And I think that was a very effective way to give community members information that there's an outbreak of an infectious disease. As well as tell them, you know, something that they, that they could do about the situation. And I think. And it also was a really important source for surveillance and for public health entities to be able to gauge where there were hotspots and where, where there needs to be more risk mitigation on the mosquito side. And I think that's a pretty prominent example now because we know West Nile is something that is expected to be another problem. Increasingly so with, with climate change, definitely the mosquitoes are likely to put people at more risk with warming trends, given how that the warm weather affects their life cycle. And so, and certainly wet weather. And so I think that's, that's, that's a good example of a way forward for, for sort of the key study back back to your question. Thank you. Dr Osborne jokes, you've had a lot of experience with, with, with activating citizen science and community based research research efforts. Are there, are there, are there, there's things that we could be doing to support those efforts not every community has, has you. So what, what, what do we need to do to, to, to, to make programs like that and work, and to be able to provide actionable data like what Dr. Johnson just talked about with the, with the, you know, bird bird identification and reporting reporting things like that. What would you like to see in place, you know, 10 years from now in terms of institutional support for for those kinds of activities. Thank you great question. Well, I'd like to see maybe a couple of different things one direct support of community based organizations who are doing this work and so Dr Kenny talked a little bit about we act for environmental justice as they're now called in, in West Harlem and you know how they have completely the, you know, they are now, you know, a huge powerhouse such so much so that they're not only making huge impacts in their own community, but they are helping to support and resource and build capacity with other community based organizations across the country having that direct access to funding I think is going to be critical, you know, maybe, you know, just as in some RFPs, you know, there may be academic institutions and others who, you know, have to be the primary applicants for those funds but there might be a requirement that, you know, they're working with the community. And perhaps, you know, there's funding available now for these community based organizations, but, you know, there's this encouragement of that collaboration with academics or others, you know, to bring some other pieces of the puzzle together that I think would be helpful. Even, you know, greater opportunities for, for, you know, academic institutions, since I am with an academic institution, as we work with community based organizations. You know, there, there is a model that some agencies have had NSF is one of those agencies where when they have maybe a large organization research one institution partnering with a smaller, maybe a historically black college or a minority serving institution, there are some avenues where there are almost kind of like two threads of funding that go through that one grant. So the, the smaller entity doesn't have to be just a sub awardee, but they kind of get their own, you know, budget and, you know, opportunity for, you know, you know, the direct indirect cost and all of those things just, you know, just as the academic institutions do. And that kind of creates a situation for more parity. I think in terms of, you know, what those community based organizations are able to get access to any, you know, it may be that their budgets might never be, you know, quite the size of some of these academic institutions, but this might alleviate some of the capping that tends to happen. You know, when you just kind of go this route of, you know, big institution working with the community, you know, there's a sub award, and a lot of times, you know, a lot of that funding gets, you know, eaten up by, you know, indirect sent overhead costs, you know, from those larger institutions, you know, so how can we, you know, sort of raise that cap. So I, I say all that to say funding, you know, will help to help those community based organizations to build capacity. If we're talking about really investing in some of this, you know, community based work, citizen and community science work, then, you know, those institutions that are on the ground, working with communities have to have access to the funding just as, just as the academic and research institutions do. Great thoughts. I hope some of these questions come up again tomorrow when we've got the institute directors online. Dr. Kenny, your thoughts. I just, I just wanted to have a chance to say that I really like this scenario because of the scale of the investment, the billion dollar idea. I think that's sort of the scale of what's really needed on this on this topic. You know, we've known about the health impacts of climate change for a couple of decades and we still don't have any kind of large coordinated federal funding source to do the kinds of studies that we've been brainstorming about here. I think, I think the capacity is there. I think, you know, what lots of academic institutions have built climate and health programs over the last five years. There's a lot of action at the community level. As, as we've heard, you know, community groups are dealing with, you know, they're on the front lines of the impacts of extreme heat and storms. So they're, they're very aware and they're very, they're very anxious to take action. But, you know, cities, city governments are, are mobilized there, you know, because they're dealing with the impacts themselves and trying to figure out how to protect their populations from future impacts. So I think like the stage is set, I think an investment of funding of this, of this sort of magnitude would really, would really be helpful to really start solving this problem really quickly. So, so I want to, I want to piggyback on that because I think that's, that's a piece of what we want to, we want to try to drill into here is what's right. So, as you mentioned, stage is set, you know, we understand the relationship between the health effects and the changing climate. There's no question that climate is changing. There's no question that it's our fault. So, so why is there not a cooperative funding source right like what's the, are we missing political will, are we missing you know what what's that there's something that we, what would have to change. I think we take the, take the shackles off here right like what would, what would have to change over the next 10 years for that to, you know, not be a pipe dream right not for this not to be a, you know, a scenario we're discussing in a workshop. So, let me go first and I'd love to hear the other perspectives. I think it's really political will probably mostly. For example, there, you know, I haven't followed this too closely but others here in this session I'm sure no more about it than I do but like in one of the most in the recent bills that the government passed there was originally going to be $100 million for initial climate and health research that NIH was going to figure out how to spend. I think it was zeroed out sort of at the last minute. I'm not sure why maybe maybe for important reasons to do to do with Ukrainian funding or something like that but, you know, there. That was the closest we've come as far as I've seen to actually having a program that focuses on climate health. I think I think if there's political will it could happen. I think it. Yeah, I'll stop there. It's really important. It's for some reason it hasn't happened. I think one other point is that the topic of climate health because it's a multi disciplinary. It kind of falls between the cracks of some or the between the silos of NIH NSF and EPA. It's like there's no one organization that kind of captures the whole thing. And so I think that makes it hard to like, you know, there's my biomolecular questions that NIH is really good at there's a sort of earth science at NSF is really good at, but it's really the intersection of those two things that's almost needs to be kind of like a joint program. I would I would 100% echo what with Dr. Can you just said and that it's going to require an interagency effort that we have really not seen before and then it's not lost on any of us, I'm sure that that we tend to be quite a bit worse at funding and proactive measures and for a long time climate change sort of fell into that bucket. I think it's only sort of recently that people are starting to feel they're, you know, actually witnessed the effects themselves of climate and so I think, you know, that sort of proactive approach that that's looking long enough in the future way beyond like the four year sort of political cycles that are two year that that a lot of these things happen on is is a pervasive problem that that's going to require investment. Maybe one last thing that I can add, and I totally agree with what has already been said is that a lot of times even you know when you look at some of the climate related funding, you know, even outside of, and I'll talk really outside of the context maybe of federal agencies but just in that broader ecosystem where climate change you know funding is happening you either get funding that's focused on mitigation or it's focused on adaptation. And you don't have a lot of funding sources that are trying to, you know from a solutions perspective look at, you know, both how we, you know how we adapt, you know to this changing climate but at the same time work on measures with respect to mitigation, you know, also. And so, just, you know, putting that in the in the mix I think is also important, as we, you know, hopefully there will be some efforts that eventually will, you know, and not, you know, too long from now, you know come together, in which we can, you know, look at climate change and health in its complexity, and there be, you know, these agencies that are coming together. You know, through these interagency processes. And there are examples, you know, different agencies come together and fund, you know, different types of work I've seen it happen, you know, kind of on the conservation side and you know, that sort of thing but, you know, what about, you know, EPA and NIH and NSF really coming together and looking at ways that they can, can, you know, work together and, you know, fund these cross disciplinary, you know, collaborative, you know, highly collaborative, you know, efforts to help us to address the myriad of complexities that are associated with climate change and the way that it impacts health. That's great. All right, we are, we are running dangerously low on time here. We have four minutes until we have to pass back for the, for the end of the day. I wanted to just come back briefly to a topic that that that was raised and that's kind of this definition of environmental health sciences kind of who has to be. Where do we set the scope? I mean, we just talked about how, you know, it's not, you know, allocating a billion dollars in any one agency's responsibility. Dr. Osborn-Jelks, you said EPA, NIH, NSF, you know, might, you know, might come together to have a hand in it. I mean, how, how does that, that that's that thinking and the fact that it's not, you know, currently maybe under any single agency or any organization's jurisdiction. How does that, how does that impact kind of how we're thinking about how we define environmental health sciences and what other disciplines we have to wrap into it. I mean, this whole, this whole scenario is based on kind of bringing in kind of some of the climate change disciplinary thinking into environmental health. What are the other, what are the other fields of study that are critical to bring in? I'll just jump in. I guess, from my perspective, it's what fields are not relevant. It's hard to imagine. I think we need a much broader transdisciplinary approach than has ever been done before across engineering, biological sciences and all the, the different elements that feed into both of those and physicists and chemists and, and, and I think that is going to be a challenge in and of itself, and that we need to partner on ways to do that effectively, because that is a pretty new task that that I think is going to be a potential. It's a challenge, but more opportunity going forward. So, but over to others for their perspective. Yeah, just a quick perspective as well. I liked Christine's last slide where she had all the sort of new technologies, which, you know, I think really are important. I've seen it in my own field of at least the air pollution epidemiology field over the last decade like satellite remote sensing of air pollution from space has almost revolutionized the field, you know, in terms of, you know, defining exposures at the ground level to PM, both for risk assessment but also for epidemiologies like now people are doing these nationwide epidemiology studies or even global studies that rely on these these remote sensing tools that just weren't available, but we hadn't been figured out how to utilize in the in the past so I think this again points to the way environmental health sciences is expanding beyond what we traditionally thought of as sort of the narrow confines of the field, and it's, I'm sure that will continue. Are we, how are we feeling about kind of as, you know, you know, just this group of thought leaders sees that definition of expanding to the the funding agencies seed expanding or are we missing opportunities to do to work at the intersection of those fields because because we're too close and are thinking. Yeah, I feel like we're starting to see some changes. And I think that they could be accelerated just a little bit more. I think folks are being very thoughtful, especially at, you know, over the last couple of years I feel like I'm seeing a lot more happening that you know it's kind of integrating some of these things that we've talked about, you know, even kind of bringing in the social sciences thinking about things like community engagement and how that plays a role or can play a role in us addressing and looking at and exploring some of these environmental health challenges so I know that we are at a time so I'll stop there. Indeed. So, with that, I want to, I want to thank this, this, this group, Dr. Lauren Jones, Dr. Johnson and Dr. Kenny and also Dr. Dr Bailey had to have to step away. So thank you to the four of you and we appreciate the perspective and look forward to your continued engagement. Thank you. Thank you so much again to all of you and thank you Dr McMillan for that, leaving that great, great, great session. I just, I, there's so much that's been said and yet there are so many common themes for today I try I did my best to try to perhaps wrap this up in day one. But hopefully we have about 15 minutes. So again, just revisioning the goal of what we're trying to accomplish today. We really wanted to look to the future and design a future of environmental health that's really most impactful and we, the goal of this workshop is part of this future casting exercise that this emerging science for environmental decision making group is is charged with is really to bring an amazing is really to broaden the number of voices who are a part of this discussion so one of the really wonderful things and I want to thank all of our speakers and all of our presenters today for bringing those really diverse voices to the table. So in our first vision for environmental health discussion we had Dr sheets and Dr. Geller, who really helped to identify the need for more complex models to advance our understanding of susceptibility and vulnerability. Talking about the importance of, of driving research towards better understanding of cumulative impacts to support future needs that we will be facing 10 years from now. One of the critical points I think that came up in this session is that we shouldn't stop decision making as research continues, but we need to continue this science and emerging science and the exposome and technology and tools can really expand and advance our understanding of vulnerability, but in order to advance this multi disciplinary perspectives are needed to really, really understand how factors intersect. And it's interesting because I think we started the day with these themes and we ended the day just now with these really critical themes as well. So we heard from Dr Kate Marvel, an emerging climate scientist who set us up really well for our last session and thinking about understanding a vision for environmental health. We have so much data and information now to understand climate change and climate change impacts. And so one of the things that she really talked about in her slides here is really moving towards the future and understanding what does all mean and what does it all mean for human health. So we know that humans are causing more than 100% of observed warming and warming means more than extreme weather. But it's really very possible she had a hopeful message that if we act now, and we acted a local scale to address some of the global issues it is very possible to avoid the worst case scenario. And so not all is not is lost but we need action now, and we need new investments towards the future in this interdisciplinary science. So we moved on from there to a number of different dialogues, and we had our dialogue and environmental health and precision medicine, and really this one this discussion let off with 10 years from now will have a proliferation of new exposure measurement devices available to physicians and clinicians and those working in medicine to really advance precision medicine. And so what do we need from a scientific perspective to really take advantage of these tools. What we heard again is that we need a broader representation and perspective on environmental health, particularly for underrepresented underserved communities. We know that low income communities are most likely to live in areas that and our most vulnerable, not only to environmental threats, but two disasters so this theme of climate change came out through whole throughout the whole day. We need to think particularly in Latino X and Latin X and other precarious occupational and worker health scenarios that we really those individuals are also really vulnerable. And we really need more work on translating science to advocacy, and a very good place is to start this as an education and training with physicians. And with that in mind we can get really a lot of important lessons learned from the integration of genomics into precision medicine to better understand how we train medical providers and environmental health. And as these incredible tools are emerging to report information on personal exposure data back to individuals, we really also need to better support information that will help us understand the complex biological processes, and who's exposed to what in order to empower citizens to use this information at the local and community level to advance change. And then some key themes that come up again and again in each of these sessions is that multi multi disciplinary research working across diverse health topics and agencies are needed. We need to acknowledge it more broadly in medicine and public health the importance that environmental health impacts have. So we need science to help us understand how to, how to advance that message. We really should be focusing on the next generation of researchers and encourage involvement along this theme of environmental health not being sort of the flavor of the day but really a critical importance to advancing all population health and well being. And in order to advance science we need training in this next generation and data science, and we need communication science in this theme so you can see I apologize I pulled these together really quickly but you can see the themes that were emerging throughout the day. So we moved on to a second dialogue, similar to the first in which we really started to look at how the ex bosome and this advancing technology could help support population health on a broader scale in the context of environmental justice. And some themes that emerge there is that we need to better and continue our research to better understand the role of environmental stressors both chemical and non chemical across the life course. In order to advance the science we also need strong multi disciplinary multi agency coalitions. We need to continue this emphasis on cumulative risk and cumulative impacts. We really need to integrate the social impacts of environmental regulations in the work that we do so what are the unintended consequences of some of our environmental science and work that we do. On the one hand we have all the information we need to take action so we really need to be focusing on solutions based research. So really, I thought, important example of how omics can help in that many folks in a community around around this hog farms down in down south in North Carolina. So some were trying to say that the hog farms weren't really causing the impact and the disease but when you measure the microbiome in the homes you saw the microbiome of the hogs in the microbiome in the homes of individuals who are most impacted. So we can use this technology to really advance these environmental justice issues. But we also need critical need for translational science and implementation science. And we need engagement. And we need deep investment and understanding what we're measuring with the exposome. So the fact that we can measure all of these things we really need some concerted research over the next 10 years to really understand what it all means for environmental health. So the fifth theme that came out in this second session that really became an important theme throughout the entire day, and was brought on was identified very early on as this important need for intersectionality and I heard intersectionality come up again and with respect to intersect intersectionality of disciplines intersectionality of perspectives in or intersectionality of whose most vulnerable how we're most vulnerable, and really considering intersectionality and social science and, and all of the research in social science that has led us to understanding the importance of intersectionality, we need to begin to apply that to environmental health and environmental health science decision making. And I was trying to take notes while also listening to that really, really rich discussion that you were having in that last session. So this is a lot. But again, these themes of expanding our mental models of environmental health, the shift, the need for shifting our academic structure to include decision making and action oriented research as equally important and as equally as impactful in the work that we do as environmental sciences. The new technologies can really revolutionize our evidence based thinking to address both local and global perspectives. And so we need to capitalize that on that as scientists. We need to build continue to build capacity and setting conditions so that communities can help themselves. And we need to bring dollars into communities so that they can work collectively with diverse scientists to really make an impact. And along with that we need to consider broader funding across multiple agencies for large scale grants. And then we need to, for example, one of the big examples is maybe these new funding approaches are to bacon and initial year of relationship building across these multiple multiple agencies within the funding horizon to make the work happen so that funding acknowledges the really important aspects of intersectionality and multidisciplinary approaches to environmental health sciences. The other theme that I heard a lot in this particular session around climate change and health is that, well, we need to think about these issues as global climate change and we need to think about expanding our models to include ecosystems and land changes into environmental health. A lot of the decisions for how we're going to protect populations and population health will happen at a local level and so we need research that acknowledges investment both at the local as well as the global scale. And then we need to build political will for change. And then we both we need an emphasis both for particularly for climate change both on mitigation and adaptation strategies to fund this new research. And again, we really need to have these interdisciplinary approaches it's often hard to expand how traditional funding has happened, but we hopefully tomorrow we can, we can dive back in there again. And that's sort of the recap of all of the rich and diverse information that we got from all of these amazing voices and I want to really thank everybody for both spending the time for those of you who are here with us today, and thinking about the future and I hope that you can join us again tomorrow morning to wrap this up we have our funding agencies who are going to be here to talk about environmental health sciences across the National Institute of Health and then we have some really new emerging voices to also talk about these issues. A couple things to remember, we have a survey so if your comments weren't provided here there's a survey for anybody if there are emerging questions that you would like addressed, or considered for moving and advancing environmental health sciences forward we'd love to hear your voices. And again the more diverse voices that we have at the table, the better these future casting exercises will be moving forward. And thank you to everyone for being here today. I think I have wrapped things up appropriately. And if you, again, thank you all for joining us and we look forward to seeing you again tomorrow.