 Welcome back to our meetings toward a future of environmental health sciences. I'm Patrick McMullen and I am charged with giving a recap of some of the topics that we discussed yesterday. I wanted to give a an overview of what was discussed but also also spend a little bit of time talking about kind of the larger vision of what we're what we're trying to do here. The, as you heard already, this is this is a part of a broader efforts by by the standing committee and by the National Institutes of Environmental Health more broadly to do a little bit of strategic planning in imagining what the future might might look like in environmental health sciences. We don't have me. I'm sorry. Sorry about that. I was reading what's written on this slide. What is the future of a research enterprise that fully integrates environmental health science, biomedical science, prevention science and disease specific research, and it's conducted across the continuum of fundamental research through through applications to the research to public health. So we've touched on a lot of topics adjacent to this and I just wanted to capture that a big piece of this is the, you know, looking about looking at what this might look like, you know, 1010 years from now, what does this research enterprise that fully integrates these, these, these topics would look like. But then our charge also is to think about kind of what are the steps that that it would take to get there so I would challenge us to and I think we've done a great job of this so far but to really take the take the restraints off to to identify, you know, what we want things to look like and then what what barriers we have to break to get there. So, in that regard, and Kristen mentioned this earlier this morning, we certainly invite your input we have a very simple questionnaire on the. If you're watching in the web browser scroll up about half the screen you'll see the link to a questionnaire where you can, where you can make your make your make your input heard, and we will integrate it into the discussion later today. And then also in follow up activities that we have. So, back to the material that was discussed yesterday we started started the day with with a with a group that that really set the stage and painted painted a picture for us of what I see as the two key themes that have emerged over the course of this meeting. And those are the need to embrace systems level thinking, and to address the complexity of understanding environmental health outcomes. The one of the keys there is are the socio economic factors that are the major determinants of health outcomes so we heard from a number of our speakers in the in the morning. So some great examples of this and highlighting the opportunities and the challenges that we have ahead of us for integrating a broader picture of what environmental health means so Dr. I highlighted an example of in the lower left here of a map county by county census block by census block of the life expectancy as a geography and I think it's there are some clear spatial correlations here. Dr. Geller highlighted, and this is the rates here. An example of how mortality risk, when you stratified by race revealed that black Americans are at three times, three times higher higher risk to for mortality, resulting from exposure to PM 2.5 exposures. So, you know, I think that these these are the kind of examples that really kind of bring out what the magnitude of our of our challenges and also the opportunity of what we have ahead of us. In that regard, Dr. Dr. Nikki sheets did a great job of describing cumulative impact scores. Again, another example those those also increase as a function of communities that are have have high high percentage minority and high high poverty levels. And the second theme that that really came out of this was that that environmental health is integrative, and that the science needs to reflect the fact that that environmental health is integrative so we have a history, especially in in fields like psychology of taking a very reductionist approach, looking chemical by chemical in attacking problems in isolation and you know I think that that's the talk by Dr. sheets really did a great job of highlighting where that isn't effective and how in a lot of cases it's disproportionately impacts communities that that that are being they'll use by by by a variety of stressors, both in the traditional sense in terms of chemicals in the environment and also socio economic factors that that we've heard over the past day and a half, also our major environmental health outcomes. So I think Dr. Marvel also did a did a great job of highlighting how climate change and evolution climate change has has has has has has brought about a situation where environmental health disparities and environmental health determinants are not are not directly accessible by a chemical by chemical approach and and and we need to take a more kind of holistic view of the of the situation. So, not, not that everything is doing doom and gloom in that regard. Dr sheets shared a success story where he and others in New Jersey have been able to impact legislation and rulemaking around citing citing of of industrial operations and other other other facilities that would lead to an increased cumulative burden of stressors. And I also wanted to highlight Dr sheets is plea that you know there's a lot of work to do here scientifically but there's a lot that we already know. And we need to, we need to capitalize on that we need to, we need to, we need to act now on things that we can do and not wait till we have all the information to take action. So, so following these these stage setting talks, we had a series of dialogues. That we're kind of an extended extended panel discussion we brought in experts that that covered the field that the that the scenarios were built around and also kind of adjacent fields to get to try to build a diverse perspective of what are the factors that that we need to consider to build a environmental health science enterprise that can effectively attack some of these these major pressing problems that we that we have in society today. So the first was a dialogue on environmental health and precision medicine. The dialogue was, was included panelists, Julia Brody, Brandon Pierce, Elena Rios, and Alicia style. And there was some great discussion here about the evolution of precision medicine and and thinking of that as an example of a field where where we have applications today that is the field that integrates complex data. And we're able to do things that we weren't able to do 10 years ago so so in my mind this this provides maybe a bit of a template for how we would, how we would integrate some of these work, more, more, more complicated disciplines and data data types and decision frameworks into environmental health sciences. And there was this great discussion about the challenges and the, the, and how those were addressed in precision medicine so when one of these these challenges that that is still an issue that received a lot of discussion is this representation in for instance the Elena Rios mentioned that, you know, less than less than 1% of trial studies trial participants are Hispanic less than 5% are black. This certainly does not represent demography in the US. And what what and what what are the kinds of challenges that have have led us to that place. And what are the possible paths forward for for overcoming that, both in precision medicine and more broadly in environmental health sciences so a lot of discussion about how communication can help communication between researchers and clinicians so, for instance, there, there's some there's clarity about the relationship between, for instance, an exposure and health outcome, and then also communication between physicians and patients and that the need to make sure that we're, we're educating, educating patients and providing genetic counseling and other other resources to under in relationship between gene status and cancer risk was highlighted as a as an example. And the analogy was made that I thought was was was very impactful that that we have taken in environmental health sciences a kind of monochemical by a by monochemical approach where where where what we really need is a transition, much like happening genetics over the past 10 years from another to an understanding that that's environmental health outcomes are the, the integration of a number of factors not not just a response to a single chemical. There's there's obviously challenges there but doctors now highlighted data advances and data integration as a powerful tool for helping to to integrate those aspects and you'll mention that that wasn't something that we had in our toolbox. We were facing these same problems with with genetics. Dialogue number two was was focused on the intersection of the exosomics and environmental justice, there were some some some some great participants in this discussion some of the the most impactful leaders at the intersection of those two fields. Communication once again emerged as a team. Dr Wilson just cost the need to increase trust and science and scientific literacy and the need to build relationships across communities and in between communities and decision makers so this is this is something that came up again in the third session and you know I think that there's there's a lot of opportunity for us to explore further by supporting supporting those kinds of relationships institutionally, both, you know through through academic channels and through funding mechanisms. Dr. Dr Dickerson highlighted the need that we need we need to to to ensure a strong strong communication as well and they'll trust in in those relationships. There was also a great discussion Bob right and Amy soda. Talked a lot. This is a team that that came up again and again, how we how we develop communication that is effective, you know, communication in terms of in terms of in terms of social in terms of traditional print media. We've developed a lot over the last 10 years. There are incentives for researchers to publish scientific papers. Those scientific papers probably have very little impact on direct impact on community. So how do we bridge that gap I think is is an open open question and how do we incentivize better better engagement better communication between our folks on the front lines doing the research and the folks in communities that actually need to be to understand what's what's due. Session session three was a dialogue on the intersection between climate climate change and health. And the major one of the major themes there is how we can be more proactive instead of reactive. What are the actions we can take to minimize climate change. How do we, how do we triage decision making if, if for instance, we have money coming in at the federal level. How do we decide what goes where, you know, in a way that is, that is sensitive to social and environmental disparities across the country. And how do we, how do we take into into into account some of the some of the economic considerations that would need to be captured there. So, stepping back a little bit some of the themes, I would say the biggest the biggest thing that come out of this for me so far is the need to embrace complexity. And in the way we're thinking about intersectionality between compounds between health outcomes, the between social social factors and what what we traditionally think of as as as toxicological effects. To set the definition of environmental health to better reflect for instance cumulative impacts by integration across hazard. Vectors, both conventional and less, less traditionally acknowledged, ie the social determinants of health, and to include a more kind of cooking up a more community centric approach with more direct acknowledgement of environmental justice. So, I talked a lot about kind of moving from from theory to operational operationalization, I think that's a major question mark of how, how we, how we make that make some of these big concepts happen over the next 10 years and I hope that's something we'll continue to discuss in the meeting. And then also as I mentioned setting our attitudes on communication training and funding as we move forward. So, I think that's my time to summarize the topics from yesterday and with that I will yield the floor to to Dr Christina Park from the National Institute of Health who will will be guiding you through session number five. Thank you very much. Thank you, Patrick for that nice summary of day one. So, hello, everyone, welcome to the final session of this workshop. My name is Christina Park, and I'll be moderating the session. I'm a program officer for the environmental influences and child health outcomes program referred to as echo, which is administered from the office of the director and IH. In this final session titled new voices and new collaborations, the speakers will explore how how to reach desired futures of a research enterprise enterprise that fully integrates environmental health science into broader studies of human health, and how this can be accomplished through building new collaborations and sectors. So the first day session and this morning as you heard from Patrick, we heard a lot about the need for multidisciplinary collaborative efforts, and for engaging communities in the research, particularly those that had been marginalized and disadvantaged. This session will be truly exciting as speak as this will have a to 10 minutes of talk, followed by the 20 minute panel discussion. I'd like to remind all the audience members to submit your questions below the video player, and those will be addressed during the discussion time. The speaker is Dr. Jomaji. Wenaji and where I am. Dr. Wenaji and where I am is an emergency medicine resident physician and adjunct assistant professor of environmental health at Emory University School of Medicine and Emory Rowland School of Public Health. An emerging leader in health, having received numerous recognition and fellowships already, including the agents of change and environmental justice fellowship. So, Jomaji, please take it away. In his 2011 state of the union speech from a president Obama stated that the future is ours to win. We cannot stand still. As we reflect on the future of environmental health, those words from over a decade ago remain so relevant. We can't just stand still. So important is that specific word still. I emphasize still because it doesn't just mean simply doing nothing. It means not evolving. To win a healthier future for all of us, we really must constantly reexamine and improve all that we do. In the next few minutes, I hope to offer you five important considerations for moving forward with environmental health biomarkers. I hope that we currently use in research, but hope to one day use in the medical management of patients. First, frame of time matters. We oftentimes think about this when defining exposures. For instance, long term exposure to metals, or short term exposure to BOCs. This happens less often when speaking about environmental health biomarkers. But this matters. Imagine that I'm managing a patient with a severe infection. There are a range of different measures that I might rely on. I may elect to measure their vital signs every 30 minutes. Just because they no longer have a fever, or just because they no longer have a fast heart rate, does not mean that their infection has subsided. Vital signs can fluctuate in a matter of seconds or minutes. For some reason, I'm also likely to measure leukocytes as well as lactic acid every six or so hours. And that's because leukocytes and lactic acid give me longer term information about this patient's status. With those new environmental health markers, we must always remember how fast or how slow we expect our markers of interest to evolve, which brings us to our second consideration objective. What is our end goal for the bio marker? If a person is suspected of having dangerous lead exposures, we can measure lead in them and manage them with medicines such as a chelating agent. However, their management doesn't stop there. With further investigations, we work to identify where those harmful exposures came from. And then we attempt to remove those exposures. Novel biomarkers are exciting because they offer the prospect of being able to identify harmful exposures before the development of symptoms. That's right. Before people even know that they are sick. That would be absolutely revolutionary when it comes to smoldering exposures. However, we must remember that the objective is still the same. Manage the patient in the healthcare environment, and then work to mitigate exposures outside of the hospital. And that many of the markers that we study now are associated with a number of different exposures. So maintaining an exosomic perspective will be of the utmost importance. Our third point is risk. Often biomarkers are framed from the perspective of personal or individual risk. For finding particles in the air, and for many of the exposures that we study and hope to act on. The individuals most affected oftentimes can do very little to personally mitigate their exposures is often impossible for a person to stop working in a certain area, or to move from the area where they live. As such, these markers could be an immense resource for population health advocacy. Healthcare bodies in various areas that are highly impacted can be important partners for helping to organize any interventions aimed at making meaningful impacts. Population risk goes hand in hand with considerations of health equity. In previous national academies workshops, we've discussed important steps to ensure that biomarkers work for everyone. For instance, we've recommended that biomarker development happen with diverse populations and with diverse research staff. Also important is the language used to describe risks. Risk should not be falsely assigned to social constructs like race. Lastly, it is undeniable that there are a number of remaining steps before many of the leading markers that we study can be applied to medical management. We should not allow our lack of understanding of these markers to delay our assessments of marker usefulness. Both things can be done side by side. So this day, we recognize that amyloid beta and tau peptides are features of Alzheimer's dementia. However, we still do not fully understand the mechanisms that link these markers to dementia pathology. In summary, when performing environmental health biomarker research or considering any any interventions that may use these markers, the root mnemonic risk objective usefulness or utility versus understanding time frame and equity can be useful for helping us to make comprehensive assessments of our work. The future really is ours to win. But to get there, we can't just stand still with the root framework that path onwards is hopefully more apparent. Thank you. Thank you to Margie. That was great. So we'll move on to the next speaker, who is Dr. Martin mobile. He is the co founder and a partner in safer made, which is a mission driven venture capital fund investing in companies and technologies that reduce human exposure to harmful chemicals. So he'll bring interesting industry perspectives to this session. Excellent. Thank you for the invitation to be here today. I feel a little out of place but honored to share what I see as some of the developments in the future of safer chemistry. The industry, as you all know, has certainly had a large impact on environmental health and the health of both humans and the resilience of ecosystems. And so I want to talk about the paths forward for the industry. And some of the ways that the environmental health community and the chemistry communities can work more closely together to ensure we get to an end state, which is what I think we're all looking for safer chemicals and safer products for all of us to bring into our home. So as we look forward to the future of chemistry, there are two distinct pads, because we are already shifting the way that we produce chemistry. So, as the petrochemical industry stops producing as many of its products for fuels. They have made large investments in the plastics infrastructure, and in the specialty chemical infrastructure. These investments are happening in real time, can find a number of reports from United Nations environmental working group from the IEA that point to the large investments these are hundreds of millions and billions of dollars that are being put to instead of turning our petrochemicals and fossil resources into fuels, turning them into plastics and other chemicals. One could throw out their arms and say that this is a hopeless situation. I see this situation as an opportunity to shift production. And that's important because if there's an opportunity to shift production with investments are being made. We can influence what the future of chemistry looks like. I hope the future of chemistry looks more like green chemistry used to run the UC Berkeley Center for green chemistry at UC Berkeley. And this is some of the framework that we would teach our students that green chemistry is chemistry that protects human health in the environment. How do you do that you avoid known chemical classes of concern. I'm going to come back to this, this idea of classes a few times. So things like PFAS, bisphenols, phthalates, heavy metals, things that you've all talked about already. Avoiding those classes, designing chemicals that are optimized for their end of use. And one thing that's relatively easy is designing chemicals that are less persistent in the environment. And finally, in investing in and designing chemicals that are better for climate resilience and when I say that these are chemicals that don't harm not only human health, but environmental health because the resilience of our ecosystems are clearly essential for for all of us to change to adapt to a changing climate. So, what does this mean practically for the future of chemistry. One off-sided alternative to petrochemical resources are bio based chemicals. And so we need to ask the question, will bio based chemicals get us to the future of chemistry that we're looking for. And of course, as has been pointed out that the reality is much more complex than we'd like. So you don't need to worry about these chemical structures but this is this is how a chemist thinks right these are building blocks of either bio based chemical resources on the left, or petrochemical resources on the right. I want to be clear that it's not that one of these is great and the other is evil. It's that they actually look fundamentally different to the eyes of a chemist. The chemicals on the right have a much higher carbon to hetero atom or oxygen ratio than the chemicals on the left. This is often what we see these fossil resources are the the carbon that hasn't broke down over the previous millions of years. And the tools that chemistry that the chemical industries developed have focused on ways of adding complexity to these molecules. To start with the molecules on the left, we actually are focusing now on reducing the complexity of the feedstock to get to things that are useful within the industry. And I put these up to show why we need to engage a wide range of disciplines in the discussion of what we want the future of chemistry to look like. I think we want to avoid persistence and we certainly want to avoid harmful health outcomes but we need to understand how those health outcomes are related to these molecular structures, if we're ever going to communicate across the disciplines of environmental health toxicology which is often the bridge to chemistry. So, the first thing is, what does the future biobase chemistry look like the next and related. It's about bioplastic, one of the things that we see a lot of these days is a shift from petrochemicals to bioplastics or biobased resources. One of the reasons why I bring this up and this is again something that we always talk about in our classes at Berkeley is the importance of definitions as we define what we want the future to look like if we want it to be safer, more renewable, and more resilient. We need to understand what these terms mean and so I put this chart up because it shows how even the term bioplastics has been used to mean a number of different things to different stakeholders. Sometimes bioplastics are the same as their petrochemical alternatives at a molecular level, but are being derived from renewable resources. The examples of sugarcane polyethylene PET are common and actually higher volume production chemicals than biobased chemicals that are actually new, like PLA, PHA, PBS or starch blinds. And the other important thing is not to confuse where carbon comes from with where it'll end up in the environment. So just because something comes from a renewable resource doesn't mean that it'll be benign or break down quickly in the environment. And in fact, you can also use fossil-based building blocks to make chemicals that will break down in the environment or in a managed facility like a compost facility. Now, when you look at the store shelves, it's the Wild West in terms of claims when it comes to biobased and renewable chemistry. This may be a little far afield from traditional environmental health, but the importance of understanding and influencing the definition of these terms will change what the future generations of chemicals look like. One thing that I like to point out is that any product that's based in materials and chemistry is made of usually a base material. So this is your polymer, your fiber, your plastic, your metal. These are the drivers of environmental impacts. Our environmental resilience is dependent on making sure the production of these base materials is done in as safe and sustainable a way as possible. The health impacts on the other hand are actually often driven not by the base materials, not by the choice of plastic versus paper, but by the additive chemistries which are often smaller volume and often harder to identify in our products, that are added to make these base materials functional. For example, the perfluorinated chemicals often used in the paper industry to make paperboard or or papers more grease and oil resistant. Those are the drivers of harm, not the underlying cellulose. Similarly, phthalates that are added to plastic resins as plasticizers smaller volume, but higher impact on human health and the environment. In order for the environmental health world to effectively think about these challenges, the first thing that is needed is transparency. So the ability to not only tell what base material product is made out of but what all of the additives that go into it all. So, all of this takes me the importance of the class approach. And so, I know that you've spent a while talking about the importance of considering mixtures as well as individual chemicals, and they need to shift away from the focus on individual chemicals and toxicology and environmental health to the impact of mixtures. I would add to that the importance of focusing on classes. Classes aren't just chemical classes like bisphenols or perfluorinated alkyl substances. They're also based on endpoints so grouping chemicals that are all persistent based on structure, or there are all endocrine disruptors. We also spend a lot of time grouping chemicals based on function. So when we think about driving towards safer chemicals, it's important to understand what a chemical of concern was doing in the first place. So adhesives, polymers, dyes, these are also relevant classes. And so rather than getting stuck on the definition of the right chemical classes. I encourage everyone to think about how do we use a class approach. How do we take the, the intellectual investment we've made in understanding a given set of chemicals or circumstances into understanding the broader context? What other things could be informed by the research that we do? How can we make groups of chemicals, groups of actions come together? Because I find that as a chemist trying to design chemistries, the more I can understand how group acts, the better I can avoid, better I can do to avoid regrettable substitution in the end. So if you take nothing else from this, this talk, it would be my advocacy for taking a class approach to chemical design, to environmental health, and certainly to toxicology, and increasingly hopefully to public policy. Mike, thank you for inviting me to participate this and I welcome the discussion that will come afterwards. I think it's very important that folks in environmental health, chemistry and toxicology all work together to ensure that as we change production, we do get to the future we want, which is safer and more sustainable. Thank you, Dr. Mulville. We just had two very interesting talks delving slightly deeper into the biomarker, the framework and then the chemistry. Let's turn to our next speaker who is Dr. Chandra Jackson. She is an early statement investigator in the epidemiology branch of the National Institute of Environmental Health Sciences. She has an appointment in the National Institute of Minority Health and Health Disparities. She has received numerous awards for her work, which includes lately the research on physical and social environmental factors that impact health disparities. Thank you. Hello, everyone. I hope you all are doing well. This presentation reflecting my personal current perspective is entitled, rediscovery science, learning from the past to move towards an action oriented future of decision making and unison with the ecosystem. I want to start at the most macro level possible in keeping with the idea of first principles thinking in order to reverse engineer complicated problems. And so I'm sure we can all agree that we're collectively a part of the cosmos or this vast universe where we believe off space matter and energy are contained. And we happen to be in one particular galaxy. And within the galaxy where a part of a solar system bound by the gravitational pull of the sun which supports all life. And it's because of the rotation of the earth on its axis that we all have circadian rhythms that regulate biological processes impacting every cell tissue and organ in the body. The main circadian clock is actually housed in the super charismatic nucleus of the brain's hypothalamus, and it happens to sit on top of the human spinal cord, which carries nerve or electrical signals throughout the human body and misalignment of these circadian rhythms can influence a wide range of diseases. Also, these brain waves from an electroencephalogram are a depiction of the electrical activity essentially generated from the universe, since is where a group of neurons send electrochemical signals to another group of neurons. So this essentially demonstrates that we are a part of and not separate from what we call the environment. So it's imperative that we operate like we're a mere manifestation of the environment and govern our behaviors based off of the laws of nature that reflect our interconnectedness and like our face are tied together. And I think a prime example is climate change disproportionately affecting socially disadvantaged groups, living in the least desirable conditions. We know that climate change is ultimately threatening all human existence so again we're interconnected. So acknowledging and behaving based off of this interconnectedness within ideally lead to no longer exploiting the land since it would be considered self destructive or counterproductive. So all over the course of this workshop we nicely delineated the complex widespread environmental including social challenges we're facing, but it can be simplified by acknowledging that avoidable exploitation is at the core. For instance, humans are causing soil depletion through intensive farming practices that have amplified food production but also deforestation. And also farming practices that have led to the industrial revolution which contributes to air life and noise pollution, landfill spilling up in heat islands along with anthropogenic and natural chemicals being produced, all directly or indirectly contributing to the type of physiological dysregulation that leads to poor health. You know the ones we're all concerned about. So in order to avoid the land, we also need to stop and avoid future forms of human exploitation like the under or uncompensated human labor used to extract resources from the land. There's been historical attempts to justify subjugation of certain groups for the gain of a few by applying arbitrary labels. And this actually created the social construct of race that led to social stratification and subsequent social being of disease, where outcome severity often mirrors level of disadvantage. But in a perfect world, every human would be born with the right to individual autonomy and groups based off of social identity would be able to practice self determination within a social contract that supports harmony or collaborative societal conditions. And this would happen without interference or domination that restricts freedom and degrades dignity. But as a central example, the Constitution is American social contract, but it was written for and by a select group of people. And at a time when groups like African Americans were officially considered brief as human. And so this history surrounding a lack of equal protection under the law has clearly contributed to environmental injustice issues that we're currently contending with. And also the figure on the right shows a timeline of non exhaustive laws and policies that have systematically excluded or stripped sovereignty from populations identifying as black and indigenous. And so this contributes to the differential exposure burden to adverse environments. And so ultimately these are the types of social ills that lead to recalcitrant health inequities. And to me the only effective solution is to stop these exploitative exclusionary practices, which is what health equity is calling for by defining it as the assurance that populations needed for optimal health among all people, regardless of social group membership. And so the directive is even to value all individuals and populations equally, recognize and rectify historical injustices and provide resources according to need. So not just equally, but according to me. And so when thinking about the role of research, we need to address the limiting hyper focus on illuminating biological mechanisms, which is inefficient to me at least because context is invariably important for our research questions when we're interested in translating the findings to benefit the health of humans. And so this is evidenced by institutions like in IHS being interested in identifying how physical environments impact health while also broadening the definition of environment to include social circumstances, which makes what we've already established as the social and environmental determinants of health, considered the main drivers of health inequities. And these drivers are influenced by fundamental causes including social conditions like structural racism, which includes policies and practices that influence variation in health and disease. So therefore as shown on the left of the slide, we need to dedicate resources to the collection and integration of data on exposures along the entire spectrum of translational research. And this could inform primordial or primary prevention and not just secondary and tertiary like has been the case in the past. And so I believe actually that most resources should be allocated to research that prevents risk factors from even developing. But to get there will need to understand that we currently have an over reliance on intellect or logic, which can't fully capture the effects of environmental influences well beyond our inherently limited perception. We've been trying to capture the essence of the cosmos, which we're a part of. And, for example, we're in hot pursuit of solutions and focusing on leveraging technology in an attempt to capture life and integrate exposures at all of these various levels, including the ecosystem. This effort but more impressive technology won't be the actual solution. For example, two consequences of exploitation include preventable illnesses and hunger and attempted solutions so far in using just human logic have included pharmaceutical drugs and operations for illnesses. And in terms of hunger pesticides fertilizers processed foods, genetically modified organisms, and all of these have side effects, including artificial intelligence where we are already identifying bias algorithms. And so technology used to understand the impact of environmental exposures on health won't automatically address the fundamental issue of land and human exploitation, which we've already identified as leading to climate change and even help inequities. And so I do, however, think that we can direct the use of technologies to disrupt these exploit exploitative practices through efforts like using the tools to help with more citizen science type of efforts that can be scaled at the, from the local to the national global level, but also tools can be used, for instance, like multi omics that open up what was previously a black box in order to support efforts surrounding litigation to stop unfair practices but also legislation and including regulation. And so in closing, I recommend a rediscovery science approach for the future of environmental health, which involves not just thinking, and depending on logic, which is inherently limited, but having our care for fellow humans reflected in our actions, not just conversations, meaning scientists across the research spectrum from all disciplines can focus on efforts that actually disrupt exploitative practices. And so clearly the challenge would be accomplishing this in a capitalist society, where companies are now really pretending to go green for more benefits. And so, nonetheless, we've established the urgency of addressing climate change and taking on environmental justice issues. And it's clear that they're interconnected, since equity involves assuring the conditions needed for optimal health among all people regardless of public membership. And so the solutions are obvious. We need clean air and water, optimal soil and food security, and to get people at least the baseline standard of housing conditions, for instance. So, building a roadmap to achieve these outcomes should be the focus, in my humble opinion, and instead of digging into the analytical complexities of now, we can pivot and focus on creating the world we want, essentially pleasantness within and around us, which I think is a noteworthy barometer of success. And it makes sense to prioritize the most impactful solutions or system changes to get back aligned with the laws of nature and sustainable living. In fact, we could incentivize transdisciplinary scholars and stakeholders from all sectors of society, since we all have a stake. We can incentivize them to be involved in efforts to, for instance, reduce emissions, incredibly important increase tree farming on a large scale to address desertification or soil depletion and also avoid these transdisciplinary scholars and stakeholders to heal the humans who have been disproportionately harmed, like even now they're farmers in India committing suicide at alarming rates. So, I hope there's a sense of urgency that will push us towards action. Thank you, Chandra. That was a very comprehensive and though, provoking presentation. So let's now move to our final speaker, who is Dr. Kim Fortune. Professor and department chair in the University of California Irvine's Department of Anthropology, her research and teaching focus on environmental risk and disaster, including examining how people in different geographic and organizational context, understand environmental problems and environmental health risks. So Dr. Fortune. So, and thank you for the introduction and to all the conference organizers for bringing us together. This has been an impressive and encouraging set of sessions over the last two days. I've titled my presentation environmental health and justice 2030, trying to look towards where we're going but with awareness that we'll be needing to work in many directions at once. So, I borrow my title from a campaign underway by the Louisiana Center for Health Equity la 40 by 230. And in this campaign, they're working in many directions to bring Louisiana from 49th on the list of health status in the United States to 40 by 2030 Louisiana includes what is well known as cancer alley between Baton Rouge and New Orleans where I've done some of my research. The state is complex and so I'm at and an expansive and so imagining what it will take to help Louisiana Center for Health Equity realize their goal, mobilizing the kind of expertise we have here, I find incredibly challenging and motivating. And part of what I think I can share with this group is that I'm a field researcher so I have many of the problems described across the days I've kind of watched unfold at the community level. And my research in the 90s at the site of Union Carbides pesticide plant disaster in Bhopal, India. I wasn't there in the immediate aftermath of the disaster, but in the years that it was being heard in the courts in both the United States and, and and so what I came to want to understand is how do people in different fields of expertise and organizations see the problems were before us how do they characterize them and how does that delimit how they can be addressed. On the upper right, you see a very crude information board used to look for survivors of the of the gas of the gas tragedy. And this this image has really haunted me throughout my career leading me to ask what kind of knowledge infrastructure do we need to scaffold prevention of the kinds of disasters that happened in Bhopal and response to ongoing disasters going forward. So Bhopal my work in Bhopal launched a career of field studies in many settings around the world and across the US focused on what I think of as three kinds of disasters fast, rapid onset acute which mobilizes a certain kind of response, a very different kind of response is mobilized and called for with more routine slow disaster. And what I teach my students as combination disaster which is when you have extreme weather militarization around the world that is just exacerbating and driving the kinds of risk in the other systems, productive of environmental harms. And I'll argue that combo disaster is at this point way beyond the coordination capacities of our educational programs our government agencies, and so on and so it's something for us to to to consider going forward. I want to focus on four things that I've learned through these fields studies that I think are particularly relevant for the discussions here. The first is that I want to emphasize that the people do not know. There is still profoundly insufficient understanding of environmental health hazards and harms in the public sphere. And two examples of that I teach a very large class focused on environmental injustice at a University of California campus that is Hispanic serving, we have many first generation students, many of my students come from very toxic communities across California, far too many of them come into my classroom, completely unfamiliar with the hazards that are in their home communities. One example on the right is a extraordinarily creative and dynamic community organizer Leonel Flores in the Southern California city of Santa Ana. His community, he works for a community organization that has worked for the betterment of the community for 30 years, just three years ago, did they as he puts it learn they were an environmental justice community. The line that he puts in front of his community all the time is that an environmental justice keeps getting bigger every day. So communities on the ground are trying to get their heads around the cumulative risks that we've talked about so much. But it's a for many, there's, it's worked out ahead of them. And I think there's a couple ways that we can address the lack of or build knowledge capacity in the public sphere. One, this is an example of work associated with the metals of Superfund Research Center at the University of New Mexico, where I worked with artist Mallory Koytaki from Zuni Pueblo to do incredibly creative science communication using the aesthetics forms from the communities impacted. And I want to use this slide to point to the need for many kinds of communication. Another example I'll give is that in recent very strong investigative journalism by ProPublica. They knew that many of the communities most impacted by their findings very beautifully displayed data visualizations of air burdens that they wouldn't that the communities most impacted wouldn't be reading their journalism. So they had a side by side postcard campaign that took took their findings kind of to the household level through a different very different mode of communication. So this kind of expansive and creative communications outreach will be critical. I also want to emphasize the importance of K through 12 education. This hasn't come up much in the last few days, but we need to backward engineer environmental health knowledge in across our educational system. And I think that the talks earlier this afternoon emphasize it's not just going to be more stem as usual. We're going to have to think very quickly critically about the kind of content that will grow up our youngest students today into sophisticated environmental health actors tomorrow. The second point is that community based organized organizations can be impressively capable. These are two community organizers I've watched and worked alongside from many years Diane Wilson working on the Texas Gulf Coast and Willis Subra working in Louisiana. On this slide I want to point to the extraordinary data curation that these activists have ended up assuming responsibility for. And so one thing I want to point to is the way we can scaffold or build knowledge infrastructure for communities to give them the capabilities that we know that they need. There are ways that I think we can do this in the in the presentations yesterday. Patrick Kenny mentioned the pioneering effort by Ken Olden it in IHS in the 1990s to build to to enroll community based organizations in scientific research through mechanisms and he pointed to the incredible enduring effects of that visible in the strength of an EJ organization like we act West Harlem environmental action in New York. And so I think that there are ways to build community capacity for the long term. The other thing that was happening in the 90s that I don't see happening now is communities affected by similar problems that classes of problems that we heard about in the previous talk. They aren't connected to each other. And so there's so much learning that could happen across communities, whether they're dealing with hydrofluoric acid or ethylene oxide, you know to build connected communities as part of the knowledge infrastructure. In the image on this slide this is a work that my own research group is doing to help build knowledge digital infrastructure for communities using the kind of virtual research environments that we have available on our university campuses to infrastructure community knowledge. My third point will be quick is that we there is so much important and good work done by our government agencies, but it does largely remain atomized and I know this is not new insight but I see it every day in the communities that I work in. And in many ways, agencies are mission delimited in a way that's very paralyzing. So you really do have as the many community peoples speak it's like problems are just kicked down the road it's always some other agencies problem. And an example brought up in a talk yesterday was that if you want to prevent exposures, you need to prevent permitting, for example, and that's a mix of local and state government, but federal can have kind of a community's back if it's not happening so really imagining the multiple scales at which governance needs to be happen, happen and be interconnected. So with this image I want to suggest the kind of really interconnected dynamic shared governance that we need to create going forward. And last I'll speak about scientists themselves in the almost 30 years that I've been focusing on environmental justice. I have been so impressed and appreciative by what the environmental health sciences become have become. Not only has the science been incredibly impressive, but the willingness of environmental health scientists to reach beyond what they're used to doing to try and make the research relevant in the world. At the same time I think we can think about what makes it hard for environmental health scientists to kind of move in ways that they imagine. And on the left, I'll have an image which is almost a classic image of the hyper focused research scientists and the ideal of focus and elegance being how all of us are socialized to think of good work. And sometimes that's at odds with paying attention to the environs around and the kind of complex problems that communities are facing so on the right is my colleague Don Blake. I'm a really wonderful air chemist at UCI. And I'm working with him partnering with the community on a beyond the tailpipe studies so they're trying to capture gases coming off the breaks that you're seeing in this. But what Don was willing to do in the last couple of months was follow the community's lead where we're working in and he's done canister sampling along in places around this industrial quarter. So just like government agencies need to be responsive to problems, even if they seem kind of outside their mandate. I think we need to really license scientists and fund them to be able to be responsive beyond a given project that's funded and on schedule, etc. There's ways that we can scaffold their work. And then in by returning to a kind of more global statement asking you to look with me at this set of images that I always use to launch a PhD seminar I teach and research design, because I think the lessons are relevant across disciplines. So Disney, what are you seeing here as a set. As Martin said, what do you see, you know, is this a class that we're looking at. And I can over the years I've gotten very imaginative to narrations of what we're looking at. What I then asked students to look at is what they see when they know that all of these images came from this, these children's books called alphabet city and out city by numbers. What I want them to see is that once they know that's where these images came from. That is all you see, all you can see all that becomes figure in this landscape are the ABCs. I'm going to this lesson because in the urgency to translate environmental health research to practical outcomes. We need to not forget to constantly unsettle how we're thinking about the problem what we see is the problem what we see as solutions. And so the need for dynamic dynamic interconnection between the most basic experimental unsettled approach to the problems and translation and action. We can't let one go without the other. So I'll just end by suggesting that we, the kind of call for translation that has been such a theme in the presentations here. It has all to invest in and I also want us to invest scaffold, the kind of knowledge that we're going to need for problems that we really can't yet can't yet imagine that will be before us in a decade or two or three. So thank you, I look forward to the discussion. I'm very much fortunate for that enlightening talk. And I want to thank all the excellent speakers. You brought such diverse disciplines and perspectives to this session. I think this session was all the more interesting very, very interesting. I want to remind our audience members that if you have any questions that you want to ask the panelists, please enter your questions in the box below the video player. Why, why don't I start with all the panelists. So you've heard each other's talks, and I'm sure a lot of thoughts have crossed your minds as, you know, all the presentations were so different from one another. So as you listen to the speakers. What are your thoughts on. Yeah, what are the new collaboration collaborative efforts that we need to engage in. You know, so can we start with, let's say Jamaji, your impressions of this session and what do you think of the major, you know, things that we need to start collaborating on, or just just in general. One of the, one of the elements that stands out the most to me is the whole idea of reimagining how we educate ourselves as a whole, whether that's from starting with people in medical schools or in professional schools, but all the way back to those who have a third grade fourth fifth right. We see this not only from an environmental health standpoint but from health as a, as a whole, I have patients who have fevers and they come in and they tell me you know, I took benefit drill which is an anti histamine which has really no role for infections. So there's a huge gap in just the way that we as a society have taught health. And I think if we don't focus on that and fixing that many of the problems that we see now are really here to stay. Hey, Marty, your thoughts. Yeah. I was struck by a theme or at least one of the themes I think I heard is that there is no amount of measurement that's going to get us to the one right answer there's no amount of reductionism and evaluation that's going to get everyone on to the same page. So that's the truth the question back to us becomes. Alright, how in the absence of certainty. Do we make steps in the right direction, I think that's the challenge that that we all face, regardless of where we sit and so I'm inspired by the idea that, you know, in something as messy and complicated as environmental health, we still know enough today to take steps in the right direction. And I think that's, that's what we need to challenge ourselves to do is take those steps, even if they're not certain. Yeah, very good point. Thank you. Chandra. I can't agree more that we certainly need to challenge ourselves to take action, especially given the urgency of some matters in terms of climate change, and I'm particularly at somebody who's highly collaborative I can see many combinations of potential effective steps. But I do think we're in environmental health really starting to respect the power in community involvement in research because that will aid in the translation of our scientific findings into action that actually improves the help of the populations who are paying for us to conduct this research. So I really think a focus on the most pressing matters, I can imagine collaborations between farmers and stakeholders with the finances in order to support again the reforming efforts in order to address the adverse impacts that we're having on the environment, but also communities being empowered in order to make policy makers to make decisions that do improve their immediate surroundings because that is well being again pleasantness within you and pleasantness around you. And so I think that understanding can drive decisions that lead to action. I think we all have a role to play. So again, there are many different combinations of potential collaborations. So that's what made me excited and that's potentially why the talks were so diverse. Mm hmm. Thank you, Kim. I want to build from what Jamaji said and that to argue that an important form of collaboration that we need to mobilize is that health scientists need to be shrill ardent advocates of deeper investments in our educational system. You know, it's not, it's ironic that in the last 30 years with the incredible growth of capacity in the environmental health sciences, we've actually defunded our public schools, and like we can't see these as separate anymore. And also acknowledging that the communities that are most vulnerable, one of the indicators is educational attainment. So we can't have community capacity if we don't educate our third graders, which means putting more teachers in the classroom. I mean, we've got incredibly committed teachers that we need to better support. The other part of that which calls for even more investment is all of this happens within a very oily information sphere. There are industrial interests scrambling the airwaves making it harder to understand the problems we deal with what causes them how to fix them. And so there's a, we need to understand that it's not it's a very fraught space that will be doing this which will require even a redoubled effort to use education as a mechanism of change. Tim, in follow up to what you were just saying, do you, I mean, can you offer some solutions to for the public and even the scientists to be able to, you know, make our way better with in this a lot of information search and not knowing what is, you know, truth and what is not what are the really important things that we need to grasp and, you know, push forward. I mean, do you have any suggestions or solutions, how we can deal with this communication problem or the information problem. It's complicated, but I do think that what could be called kind of divisible knowledge you know some people someone knows the epidemiology and someone else knows the green chemistry. It sets us up for a tip for tap where industries claiming this doesn't hurt you and someone else is saying yes it does. But I think if we better coordinate and integrate knowledge that there will be a stronger base to understand from responding to the disinformation and also being ready for that, having the kind of infrastructure where, you know, when, you know, when, when the industry industry Association Louisiana insists that, you know, cancer alley is a no more. You know, we need to be able to respond tomorrow. And, you know, scientists like the ones on this call need to be available to have the backs of communities pushing back against that. Mm hmm. Thank you. Andrew, did you have something to say or Marty go ahead. I say it also comes to we've seen a rapid shift in the availability of both information and disinformation. And that means that we need to focus our education at all levels from elementary through professional training, much less on sharing information and much more on information evaluation. Like most of us on this call grew up at the cusp of the availability of this information so we still spent a lot of time becoming specialists by learning information that wasn't widely available. And so we've challenged ourselves and certainly in the next generation to not worry about getting information information is available and this information is available. So what comes down to the ability to recognize and evaluate and synthesize these are all much more important skill sets. Yeah. And that we have to go to that humbly and recognize that that's a big lift in a big change in how we educate. And just to, you know, get your opinion a little further since you are the closest to the industry. How do we engage industry partners to work with other scientists together to promote environmental health. Yeah, I think this is an important recognition is the industry isn't a monolith. And for any given challenge environmental health or community challenge, there will be industries that will be well aligned and supportive with the outcomes you'd like to see, and industries who whose financial interests are against the outcomes you'd And so it's not about, are you working with the industry or against the industry, you'll find the industry that is aligned with removing chemicals of concern from those communities. Industry too often by academics and and advocacies have been viewed as an evil model with and there's good reasons for that there's plenty of history I don't not judging that, but creating change means finding uncomfortable allies. A great example is like, moving away from halogenated flame retardants, who would have guessed that the polyurethane foam industry, one of the biggest users of halogenated flame retardants would actually come to the aid of that movement away from now, because they didn't want to use them they didn't like their workers getting cancer. They didn't like the additional expense of those added chemicals to their phone products they were much more interested in alternative designs for furniture. And then they were for adding more halogenated flame retardants on that flip side, Auburn mile, who makes those halogenated flame retardants is never going to be your ally. So don't try, don't bother, don't worry about what my eyes to say. We need to get much smarter about who our industry allies and potential adversaries are and they might change from from, you know, issue to issue, there is no good industry or bad industry. There's just, they all have their, their interests and they're actually easier to figure out and some other people's interests. Chandra, did you have something to say, or regarding. I was agreeing with this comment. Yeah. So how. So we talked about some infrastructure to bring collaborators and and initiate, you know, dialogue amongst different players. Who should be taking on the sort of leadership role in, you know, creating that infrastructure and bringing all the players together. Any thoughts on that. As I mentioned the reference yesterday to Ken Olden's initiative at NIHS to use basically the design of call for proposals as a way to require. And at first I think there was probably a lot of complaints about being required to do something so you have to have patients to watch it be realized. The other thing I'll note is that certainly for academics and I expect it's the same for intramural scientists. There's real discounting of organizational work of this kind. And I think of it as academic organizing it's like, you know, we know we need labor organizing do you think you create good knowledge with how to like create a organizational effort. And so the kind of treatment of it as service rather than real work is just a big problem. Yeah. We talked a lot throughout the workshop about engaging communities and you know, especially those communities and you know people that have been marginalized and disadvantaged and a lot of these environmental health research. We also recognize that we need to integrate even you know, even beyond the disciplines but integration across local government state and national. So how any thoughts on how that can be that that will facilitate such integration across all different forms of governments and other organizations. I think integration in the abstract is always hard. But integration in the concrete is it's easier to find the people who have interest and ability and so you know this is what I find in in chemical substitution to like getting rid of bad actor X is really hard. Getting rid of bad actor X in a particular function may actually be possible, because now we can talk about what an alternative looks like whereas we can't talk about it in the abstract. And your question was more related to coordination across government agencies and other things but similarly, what what does climate regulation look like across those things and if we, you know, make it more narrow and say this is a focus on on climate. So who who belongs at the table, if you're just organizing. Everyone feels like it's additional work, it's service and not core to you what you're doing and that's not where integration belongs. Yeah, yeah, thank you. And once you create the core set of individuals who would address a particular issue, you clearly find the tentacles, or where you can connect with a different set of core stakeholders around another particular issue, in order to sort of address the fact that everything is sort of interconnected and so you can find ways to identify overlap in order to make anyone effort potentially more impactful. So, I agree that it's complicated but there are ways to operationalize how we become more effective and extensive. Thank you. And just to share, you know, my own experience and the example of the echo program. We try to have this collaborative science because echo. It's a longitudinal cohort study of children's health outcomes, but it is, it leverages existing cohorts, we have over, I think, about 70 different cohorts that have been conducted, the studies have been conducted in the past. So we pull these cohorts together and leverage their extended data as well as moving forward and following up these participants from the existing studies. So from the get go, you know, the initial period of the study, we decided to use the team science principles. And every time the scientists got together, we went over some of the principles of team science and on how to work together, you know, how to communicate better and how to have the, you know, go for the same vision. And I think it really paid off this conscious effort to educate one another and to abide by the collaborative principles really helped us to do a much better job at working together. So yeah, I do agree that collaboration in absent in abstract is really difficult, but when you have some framework and some principles that you educate one another and agree to work together. It really helps to do collaborative science. So I think we're almost approaching the top of our any last word. One thing that I will add is that, you know, one thing that's really unique is that every November vote, right. And there's a power in that. So if we can educate people to really feel as though these issues matter, and they express that whenever they vote for their next leaders whether that be on a local state or federal level. It also helps us to run a lot of these things that were speaking. Yeah, very good point. I'll know, or just remind people that I think this fall will be the 40th anniversary of the mobilization in North Carolina that launched the environmental justice movement in the US. I really imagine what it means to take that movement into its next phase. And there are really exciting developments the Biden administrations call for environmental justice across agencies. I mean, I'm watching agencies scramble to figure out what it means to do that. And it's going to take an all hands on deck because they have not been, you know, these agencies haven't been designed they haven't educated their people to characterize much less respond to environmental injustice so it's another opportunity to come together. It's not quite as delimited as taking one chemical out of a product but it's like, all right, what's it look like to actually hold the core of engineer for example, responsible for environmental justice. And I think that can be a real shared project. Okay, thank you. Thank you for that information. So, I just want to thank all the speakers here. Thank you so much for bringing your perspectives and your background and experience. That was a truly insightful session that we had. So now I'm going to hand it over to Christine Maliki, I believe. Yes, thank you. Thank you so so much for that incredibly incredibly rich discussion. So now I have the honor and privilege and unique challenge of summarizing this these rich discussions that we've been having over the last two days. And so I want to start with this fundamental question that we that we brought to bear in generating this workshop over time. So, first of all, before I begin, I will acknowledge everyone again but I just want to thank this last panel of speakers that we have. The group of scientists looking to the future they're on the cutting edge of the work that they do and as you heard from the rich discussion, they have some incredible ideas about how we move forward in addressing the challenges that we face in environmental health sciences today. So thank you to that group, and thank you Christina for for moderating that session. So again going back to where we started in this workshop. The fundamental question we asked is what is the future of a research enterprise that fully integrates environmental health science biomedical science, prevention research and disease specific research, and is conducted across the continuum from fundamental discovery research through applications of the research to population health. What we wanted to do was start with looking towards the future, where do we want to be in 10 years. And then again thinking about, if we have this future in mind, how do we, what is it, what is it that we need to accomplish over the next 10 years to achieve that future. So some of the questions that we posed to the to the audience, and we've been grappling with in a really rich and dynamic way over the last two days is, what does this say, what are the societal or health challenges that environmental health sciences can address into the future. What are the research topics that we should be prioritizing and addressing in the next five to 10 years. And what are the barriers from scientific understanding tools and technology. So these were the initial questions but I think as we move forward, one of the major themes that came out of the work that we've talked about over the last two days is that we really need more complex models and integration of knowledge and information to advance environmental processes. And as a field, we really need to be embracing this complexity in both acknowledging a critical life course perspective to the work that we do really integrating and considering the social determinants of health that we have addressing cumulative impacts cumulative impacts, identifying not only the negative impacts but what are the assets and resources that support resilience in communities, particularly in communities that are most often underserved. And what we just heard in the last session we also can really look to new opportunities for new biomarkers of exposure and response. So to think about our bio based chemistry and predictive toxicology, all of these new innovative strategies can help to drive solve some of these solutions. So how are we going to get there. We need integration of knowledge across disciplines integration of knowledge across platforms and integration of knowledge from communities. And I think this really should say local to global but understanding that we live in a global context but many of the solutions many of the challenges and how we're going to achieve these complex goals can be driven at a local community level because context really matters in the work that we do. In terms of what are our priorities and what are the themes that that both the audience as well as those speaking today have identified with respect to environmental health. There's not only environmental health impacts of climate change, but also its deep connection with environmental justice. So climate change is closely linked to one health ecosystems landscapes and sustainable living. And oftentimes some of the most impactful solutions to our climate change challenges are local. And I think what these, these are very parallel both from environmental justice, and we heard this time and again, that some of the solutions to climate change, reducing factory admissions in a local community, have the co benefits of not only reducing the cumulative impacts and the cumulative burden on underserved and under, undervalued communities, but also to help in support climate change so we need to look towards these complex solutions that have these co benefits. We also really focus on empowering communities and building capacity to give community based programs, a voice in our research efforts. And then we need comprehensive multi scale regulations that again to address this integrated and interconnectedness. We need multi disciplinary interdisciplinary and collaborative teams. On the last I have the voices of all of the different scientists that we heard over the last day and a half addressing the complexity of environmental health sciences, and the need for this dynamic interaction and working directly with building communities, citizens underserved over burdened voices into the science that we do. And the science that we do should be driven by these voices, and we need to build strong trusted long lasting partnerships, and we can do this through coalition building. We can also do this through decision, bringing collaborative teams together, bringing decision makers and practitioners together to the table with these environmental health scientists and supporting public and private groups moving forward. We need to, we talked a lot about advancing the utility of innovation environmental health sciences so we heard a lot about where the future of innovation will be. We know that technology is advancing rapidly, but we need to also recognize that in order to take advantage of this technology. We need to have new analytic methods that make this technology accessible, not only to scientists but also to community members in order. So we need some new analytic methods to address this complexity. We need more longitudinal cohort and population based studies that also embrace the use of this technology to address this complexity. We know that in order to advance environmental health sciences we heard time and again that we also need to understand human exposures to better support effective action, and not only identify these broad based exposures but we also need these multi omic and systems of research to translate this into biological underpinnings of health and disease. And this can be done as we just heard in this last session with these new biomarkers and models of response. And a key component that both Dr. Geller mentioned yesterday, and we heard again today is that these new biomarker models can be capturing biological effects of environmental exposures before, before we see adverse outcomes happen. So we're going to be looking more upstream. And then we have new approaches and this new technology can classify chemicals so a class approach but we can there's all sorts of this analogy that we just heard around understanding classes of chemicals and and broad based biological effects to advance environmental health sciences goes along with some other themes that we don't need to have all of the answers in place in order to take action. The theme around how do we get there. We heard both from Dr Karen barely yesterday and it was reiterated again by Dr. Shonda Jackson today is that we need to have a focus on intersectionality, humanity and healing if we're really going to go move forward and advancing environmental justice, and we need to acknowledge the cumulative impacts risk and resilience within communities. We need to support lifting community voices. And as Dr. Shonda Jackson said much better than I will be able to do we need a framework that combines both logic and intelligence to address the basic needs of environmental health sciences. And I put just a brief definition of intersectionality here because as environmental health scientists who may not be working with the social scientists when they talk when we talk about intersectionality. Many of us come to the table with different identities and these identities overlap, but these identities can also lead to unique cumulative impacts. And so thinking about that is really a way to move forward in this problem based solution approach to addressing environmental health sciences. Another final theme that we really heard a lot about is communication and communication science. So communication science is needed to advance awareness about environmental health. It's critical to translation translating environmental health sciences for advancing environmental health literacy and advancing environmental justice for information evaluation we need to be able to take communication science, and all of the data and information that we have and really we just heard this again in the last session to recognize evaluate and synthesize the impacts of environmental health sciences into the future. We need to continue to ask these key questions are what are the communication modalities that we need to evolve to effectively recognize change in environmental health sciences. So probably acknowledging social media as one of those platforms is great, but we also need to know that not everybody is hooked in with social media believe it or not. And so we have to think what, how does communication happen to whom and where who are the trusted messengers, and how do we get those messages out the door. So what's come up again and again is that we need solution based approaches to environmental health research and environmental health science. Again, focusing on the social determinants translation environmental health literacy. And finally a theme that we heard in this very last session that I don't think we've heard much before but I think is really critical is supporting education of health scientists and within our educational system. And we also feel very related to things that we heard yesterday about the need to advance political will towards understanding the impact and importance of environmental health sciences in our daily lives. And finally, finally when we think about funding and funding models we need to be a bit more creative and we heard that again just now but we need to provide data and resources that build in both time and money for for these multi disciplinary and community driven research. Another example that I heard yesterday is that maybe these funding mechanisms need one to two years of program planning and relationship building in order to then move towards three to four years of implementation science and develop that then goes into a model of sustainability and funding. We need to reduce the barriers to funding in many different ways, including making sure that those who need access to the funding can get access to the funding, and that community members. We need capacity to work with scientists to it to access the funding that can support the research that we need to do. We need to consider more funding that goes from science to policy. And then we also heard in our first session that these collaborations across NIH institutions we need to hold NIH responsible for furthering a lot of the work that they've already started to advance in terms of collaborative funding models across institutions. Also we need to encourage specific calls for community engagement in research and environmental health leadership. And again, we need partnerships to be advanced and maybe funding to support these partnerships between research and applied practice and environmental health sciences. So in summary looking to the future in a decade and blot beyond we have a need new data discovery and environment, environmental health sciences and the etiology of disease and human exposure assessment. We need to prioritize environmental justice and climate change. We need to drive our science in collaboration with our community partners. We need to embrace and address the complexity and the challenges that are ahead of us. We need to be creative in our funding. We need to advance our own and everyone else's knowledge and communication and communication science. And part of that is really preparing the next generation of scientists. And we need to reimagine how we educate not only ourselves, but politicians, the public about health and environmental health, and all of this can be fostered and facilitated through more translational and team science. So with that, I will end my summary and thank everyone at the National Academy of Sciences engineering and medicine program and staff that made this workshop possible to the standing committee on emerging science for environmental health decision makers for moving in this future and participating in these future casting exercises as well as this workshop to the organizing committee for all of their time and effort and really being thoughtful about who we bring to the table and how we organize a conference to lift the voices. Beyond our own standing committee to really understand where we should be moving forward in addressing the future of environmental health. And finally, to the panelists, the speakers and participants, you made this an incredibly incredibly rich discussion. And we really have led to some strong convergence on where environmental health sciences should be growing in the future. So with that, I want to thank everyone for being here today for spending your time with us today, and we are eternally grateful for everyone and I think we have a wonderful roadmap to move forward.