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To date, there are few examples of implementation science studies that help guide climate-related health adaptation. Implementation science is the study of methods to promote the adoption and integration of evidence-based tools, interventions, and policies into practice to improve population health. These studies can provide the needed empirical evidence to prioritise and inform implementation of health adaptation efforts. This Personal View discusses five case studies that deployed disease early warning systems around the world. These cases studies illustrate challenges to deploying early warning systems and guide recommendations for implementation science approaches to enhance future research. We propose theory-informed approaches to understand multilevel barriers, design strategies to overcome those barriers, and analyse the ability of those strategies to advance the uptake and scale-up of climate-related health interventions. These findings build upon previous theoretical work by grounding implementation science recommendations and guidance in the context of real-world practice, as detailed in the case studies.

The effects of climate change are accelerating and undermining human health and well-being in many different ways. There is no doubt that the health care sector will need to adapt, and although it has begun to develop more targeted strategies to address climate-related challenges, a broad knowledge gap persists. There is a critical need to develop and cultivate new knowledge and skill sets among health professionals, including those in public health, environmental science, policy, and communication roles. This article describes specific initiatives to train future leaders to be proficient in understanding the linkages between climate change and health. We present an agenda for expanding education on climate and health through health professional schools and graduate and postgraduate curricula, as well as in professional and continuing education settings. Our agenda also identifies ways to promote sustainability in clinical practice and health care management and policy. Throughout, we cite metrics by which to measure progress and highlight potential barriers to achieving these educational objectives on a larger scale.

Environmental health indicators are helpful for tracking and communicating complex health trends, informing science and policy decisions, and evaluating public health actions. When provided on a national scale, they can help inform the general public, policymakers, and public health professionals about important trends in exposures and how well public health systems are preventing those exposures from causing adverse health outcomes. There is a growing need to understand national trends in exposures and health outcomes associated with climate change and the effectiveness of climate adaptation strategies for health. To date, most indicators for health implications of climate change have been designed as independent, individual metrics. This approach fails to take into account how exposure-outcome pathways for climate-attributable health outcomes involve multiple, interconnected components. We propose reframing climate change and health indicators as a linked system of indicators, which can be described as follows: upstream climate drivers affect environmental states, which then determine human exposures, which ultimately lead to health outcomes; these climate-related risks are modified by population vulnerabilities and adaptation strategies. We apply this new conceptual framework to three illustrative climate-sensitive health outcomes and associated exposure-outcome pathways: pollen allergies and asthma, West Nile virus infection, and vibriosis.

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The role of meteorological and air quality factors in moderating the transmission of SARS‐CoV‐2 and severity of COVID‐19 is a critical topic as an opportunity for targeted intervention and relevant public health messaging. Studies conducted in early 2020 suggested that temperature, humidity, ultraviolet radiation, and other meteorological factors have an influence on the transmissibility and viral dynamics of COVID‐19. Previous reviews of the literature have found significant heterogeneity in associations but did not examine many factors relating to epidemiological quality of the analyses such as rigor of data collection and statistical analysis, or consideration of potential confounding factors. To provide greater insight into the current state of the literature from an epidemiological standpoint, the authors conducted a rapid descriptive analysis with a strong focus on the characterization of COVID‐19 health outcomes and use of controls for confounding social and demographic variables such as population movement and age. We have found that few studies adequately considered the challenges posed by the use of governmental reporting of laboratory testing as a proxy for disease transmission, including timeliness and consistency. In addition, very few studies attempted to control for confounding factors, including timing and implementation of public health interventions and metrics of population compliance with those interventions. Ongoing research should give greater consideration to the measures used to quantify COVID‐19 transmission and health outcomes as well as how to control for the confounding influences of public health measures and personal behaviors., Key Points The 61 peer‐reviewed epidemiological studies described in this analysis used a wide variety of methods to explore associations between meteorological and air quality factors and COVID‐19 health outcomes associated with the pandemicThe majority of studies did not adequately account for temporal and geographic uncertainty when using proxy measures of SARS‐COV‐2 transmission, such as laboratory testing reportsFuture studies should appropriately account for assumptions about transmission timing and control for a baseline set of confounders

Climate change impacts on health – including increased exposures to heat, poor air quality, extreme weather events, altered vector-borne disease transmission, reduced water quality, and decreased food security – affect men and women differently, depending on local geographic and socioeconomic factors. As a result of this differential impact, climate change threatens to widen existing gender-based health disparities, especially in low- and middle-income countries. Gender differences in health impacts are mediated through socioeconomic, cultural, and physiologic factors. Therefore, policy action targeted toward these factors, which are often modifiable, can decrease negative health outcomes. The integration of a gendered perspective into existing climate, development, and disaster risk reduction policy frameworks requires improvement in data acquisition, monitoring of gender-specific targets, coordination between sectors and equitable stakeholder engagement.

Peer review is at the heart of the scientific endeavor, ensuring that high‐quality discoveries are communicated in effective and impactful ways. As a voluntary and mostly anonymous effort, peer review is often poorly recognized. But it is so valuable to journal Editors, and we are often so impressed by the incredibly detailed, constructive, and informative reviews that we get back from reviewers. In 2019, GeoHealth benefited from more than 94 reviews provided by 73 of our peers for papers submitted to the journal. Thank you all for being such an important part of the scientific process, advancing the communication of discoveries at the intersections of the environmental and health sciences to improve society.

BACKGROUND: The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation (IHME), produces influential, data-driven estimates of the burden of disease and premature death due to major risk factors. Expanded quantification of disease due to environmental health (EH) risk factors, including climate change, will enhance accuracy of GBD estimates, which will contribute to developing cost-effective policies that promote prevention and achieving Sustainable Development Goals.OBJECTIVES: We review key aspects of the GBD for the EH community and introduce the Global Burden of Disease-Pollution and Health Initiative (GBD-PHI), which aims to work with IHME and the GBD study to improve estimates of disease burden attributable to EH risk factors and to develop an innovative approach to estimating climate-related disease burden-both current and projected.METHODS: We discuss strategies for improving GBD quantification of specific EH risk factors, including air pollution, lead, and climate change. We highlight key methodological challenges, including new EH risk factors, notably evidence rating and global exposure assessment.DISCUSSION: A number of issues present challenges to the scope and accuracy of current GBD estimates for EH risk factors. For air pollution, minimal data exist on the exposure-risk relationships associated with high levels of pollution; epidemiological studies in high pollution regions should be a research priority. For lead, the GBD's current methods do not fully account for lead's impact on neurodevelopment; innovative methods to account for subclinical effects are needed. Decisions on inclusion of additional EH risk-outcome pairs need to be guided by findings of systematic reviews, the size of exposed populations, feasibility of global exposure estimates, and predicted trends in exposures and diseases. Neurotoxicants, endocrine-disrupting chemicals, and climate-related factors should be high priorities for incorporation into upcoming iterations of the GBD study. Enhancing the scope and methods will improve the GBD's estimates and better guide prevention policy. https://doi.org/10.1289/EHP5496.

Using examples from the year 2012, a new study estimates the health costs of deaths and illnesses associated with climate-sensitive events.

The accelerating health impacts of climate change are undermining global health, and the roles of the health sector in addressing the many challenges of climate change are being articulated by governments, multilateral institutions, and professional societies. Given the paucity of physician engagement on this issue to date, there now exists a clear need for health professionals to meet this new challenge with the development and cultivation of new knowledge and skill sets in public health, environmental science, policy, and communication. We describe a novel GME fellowship in climate and health science policy, designed to train a new generation of clinicians to provide the necessary perspective and skills for effective leadership in this field. This fellowship identifies available university resources and leverages external collaborations (government, medical consortiums, affiliate institutions in public health, and environmental science), which we describe as being replicatable to similar training programs of any number of medical specialties and likewise bring meaningful opportunities to their respective training programs and academic departments. The creation of this novel fellowship in climate and health policy provides a roadmap and potential path for similar programs to join us in addressing the defining health issue of this generation and many to follow.

Climate change impacts on health, including increased exposures to heat, poor air quality, extreme weather events, and altered vector‐borne disease transmission, reduced water quality, and decreased food security, affect men and women differently due to biologic, socioeconomic, and cultural factors. In India, where rapid environmental changes are taking place, climate change threatens to widen existing gender‐based health disparities. Integration of a gendered perspective into existing climate, development, and disaster‐risk reduction policy frameworks can decrease negative health outcomes. Modifying climate risks requires multisector coordination, improvement in data acquisition, monitoring of gender specific targets, and equitable stakeholder engagement. Empowering women as agents of social change can improve mitigation and adaptation policy interventions., Key Points Climate change impacts on health affect men and women differently due to underlying socioeconomic, cultural, and physiologic factorsClimate change threatens to widen existing gender‐based health disparities, especially in India and other low‐ and middle‐income countriesIntegration of a gendered perspective into existing climate, development, and disaster‐risk reduction policy frameworks can decrease negative health outcomes

Public trust in science, effective science communication, and rapid and constructive response to authors about their submissions are of paramount importance to the scientific enterprise and indeed to society itself. This is really at the heart of peer review—providing thoughtful insights into both the scientific quality and importance of work, and also how it is communicated to other scientists and increasingly to a broader audience. Very few opportunities exist to acknowledge the mostly anonymous process of peer review, especially given the huge increase in review requests and the relatively mechanical nature of online reviewing platforms. We continue to be humbled by the time, effort, and careful insights that our colleagues share with each other through the process of peer review. In 2018, GeoHealth benefited from more than 83 reviews provided by 53 of our peers for papers submitted to the journal. Thank you all for your awesome efforts toward advancing geohealth now and for the future., Key Point In 2018, GeoHealth benefited from more than 83 reviews provided by 53 of our peers for papers submitted to the journal

The UN-led discussion about the post-2015 sustainable development agenda provides an opportunity to develop indicators and targets that show the importance of health as a precondition for and an outcome of policies to promote sustainable development. Health as a precondition for development has received considerable attention in terms of achievement of health-related Millennium Development Goals (MDGs), addressing growing challenges of non-communicable diseases, and ensuring universal health coverage. Much less attention has been devoted to health as an outcome of sustainable development and to indicators that show both changes in exposure to health-related risks and progress towards environmental sustainability. We present a rationale and methods for the selection of health-related indicators to measure progress of post-2015 development goals in non-health sectors. The proposed indicators show the ancillary benefits to health and health equity (co-benefits) of sustainable development policies, particularly those to reduce greenhouse gas emissions and increase resilience to environmental change. We use illustrative examples from four thematic areas: cities, food and agriculture, energy, and water and sanitation. Embedding of a range of health-related indicators in the post-2015 goals can help to raise awareness of the probable health gains from sustainable development policies, thus making them more attractive to decision makers and more likely to be implemented than before.

Background: Policy decisions regarding climate change mitigation are increasingly incorporating the beneficial and adverse health impacts of greenhouse gas emission reduction strategies. Studies of such co-benefits and co-harms involve modeling approaches requiring a range of analytic decisions that affect the model output. Objective: Our objective was to assess analytic decisions regarding model framework, structure, choice of parameters, and handling of uncertainty when modeling health co-benefits, and to make recommendations for improvements that could increase policy uptake. Methods: We describe the assumptions and analytic decisions underlying models of mitigation co-benefits, examining their effects on modeling outputs, and consider tools for quantifying uncertainty. Discussion: There is considerable variation in approaches to valuation metrics, discounting methods, uncertainty characterization and propagation, and assessment of low-probability/high-impact events. There is also variable inclusion of adverse impacts of mitigation policies, and limited extension of modeling domains to include implementation considerations. Going forward, co-benefits modeling efforts should be carried out in collaboration with policy makers; these efforts should include the full range of positive and negative impacts and critical uncertainties, as well as a range of discount rates, and should explicitly characterize uncertainty. We make recommendations to improve the rigor and consistency of modeling of health co-benefits. Conclusion: Modeling health co-benefits requires systematic consideration of the suitability of model assumptions, of what should be included and excluded from the model framework, and how uncertainty should be treated. Increased attention to these and other analytic decisions has the potential to increase the policy relevance and application of co-benefits modeling studies, potentially helping policy makers to maximize mitigation potential while simultaneously improving health. Citation: Remais JV, Hess JJ, Ebi KL, Markandya A, Balbus JM, Wilkinson P, Haines A, Chalabi Z. 2014. Estimating the health effects of greenhouse gas mitigation strategies: addressing parametric, model, and valuation challenges. Environ Health Perspect 122:447–455; http://dx.doi.org/10.1289/ehp.1306744

Background: According to a wide variety of analyses and projections, the potential effects of global climate change on human health are large and diverse. The U.S. National Institutes of Health (NIH), through its basic, clinical, and population research portfolio of grants, has been increasing efforts to understand how the complex interrelationships among humans, ecosystems, climate, climate variability, and climate change affect domestic and global health. Objectives: In this commentary we present a systematic review and categorization of the fiscal year (FY) 2008 NIH climate and health research portfolio. Methods: A list of candidate climate and health projects funded from FY 2008 budget appropriations were identified and characterized based on their relevance to climate change and health and based on climate pathway, health impact, study type, and objective. Results: This analysis identified seven FY 2008 projects focused on climate change, 85 climate-related projects, and 706 projects that focused on disease areas associated with climate change but did not study those associations. Of the nearly 53,000 awards that NIH made in 2008, approximately 0.17% focused on or were related to climate. Conclusions: Given the nature and scale of the potential effects of climate change on human health and the degree of uncertainty that we have about these effects, we think that it is helpful for the NIH to engage in open discussions with science and policy communities about government-wide needs and opportunities in climate and health, and about how NIH’s strengths in human health research can contribute to understanding the health implications of global climate change. This internal review has been used to inform more recent initiatives by the NIH in climate and health.

Global climate change (GCC) is likely to alter the degree of human exposure to pollutants and the response of human populations to these exposures, meaning that risks of pollutants could change in the future. The present study, therefore, explores how GCC might affect the different steps in the pathway from a chemical source in the environment through to impacts on human health and evaluates the implications for existing risk-assessment and management practices. In certain parts of the world, GCC is predicted to increase the level of exposure of many environmental pollutants due to direct and indirect effects on the use patterns and transport and fate of chemicals. Changes in human behavior will also affect how humans come into contact with contaminated air, water, and food. Dietary changes, psychosocial stress, and coexposure to stressors such as high temperatures are likely to increase the vulnerability of humans to chemicals. These changes are likely to have significant implications for current practices for chemical assessment. Assumptions used in current exposure-assessment models may no longer apply, and existing monitoring methods may not be robust enough to detect adverse episodic changes in exposures. Organizations responsible for the assessment and management of health risks of chemicals therefore need to be more proactive and consider the implications of GCC for their procedures and processes. Environ. Toxicol. Chem. 2013;32:62–78. © 2012 SETAC

This is the first of seven papers resulting from a Society of Environmental Toxicology and Chemistry (SETAC) international workshop titled “The Influence of Global Climate Change on the Scientific Foundations and Applications of Environmental Toxicology and Chemistry.” The workshop involved 36 scientists from 11 countries and was designed to answer the following question: How will global climate change influence the environmental impacts of chemicals and other stressors and the way we assess and manage them in the environment? While more detail is found in the complete series of articles, some key consensus points are as follows: (1) human actions (including mitigation of and adaptation to impacts of global climate change [GCC]) may have as much influence on the fate and distribution of chemical contaminants as does GCC, and modeled predictions should be interpreted cautiously; (2) climate change can affect the toxicity of chemicals, but chemicals can also affect how organisms acclimate to climate change; (3) effects of GCC may be slow, variable, and difficult to detect, though some populations and communities of high vulnerability may exhibit responses sooner and more dramatically than others; (4) future approaches to human and ecological risk assessments will need to incorporate multiple stressors and cumulative risks considering the wide spectrum of potential impacts stemming from GCC; and (5) baseline/reference conditions for estimating resource injury and restoration/rehabilitation will continually shift due to GCC and represent significant challenges to practitioners. Environ. Toxicol. Chem. 2013;32:13–19. © 2012 SETAC

Environ Health Perspect 124(4):A59 (2016), http://dx.doi.org/10.1289/ehp.1611410 In the original article, the URL for the report titled “The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment” was http://www.globalchange.gov/health-assessment. In this erratum, the authors provide the URL for the final version of this report, which is available at http://health2016.globalchange.gov.

The month of April brings two observances of significance for many readers of EHP: National Public Health Week and Earth Day. The first recognizes the importance of prevention efforts in maintaining the health of our nation’s people; the second, our reliance on and obligation to the health of the planet. This year, April also marks the expected final release of a report that brings the convergence of these two ideas into sharp focus. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment (http://www.globalchange.gov/health-assessment), or Climate and Health Assessment, marks a leap forward in our understanding of the public health implications of climate change. The report, developed by the U.S. Global Change Research Program as part of its sustained National Climate Assessment process, is the first major U.S. assessment of the scientific literature on climate change and human health since 2008. The assessment breaks new ground by providing quantitative projections of the influence of climate change on five different environmental public health problems, including extreme heat, air pollution, food- and water-related illness and safety, and vectorborne disease. The report also expands a critical discussion of the mental health implications of climate change, and greatly broadens consideration of the issues facing especially vulnerable populations, such as children, the elderly, and the socioeconomically disadvantaged. Assembled by more than 100 experts over a nearly two-year period, the assessment is a scientific analysis of nearly all the available peer-reviewed literature on the health impacts of climate change and climate-related exposures, as well as much of the gray literature, published in the last half-decade. This highly influential scientific assessment is bolstered by a transparent vetting process, which included vigorous public comment, a National Research Council review, and clearance by the major federal scientific and public health agencies. Thus, it is the best of what we know about how our health is likely to be impacted by climate change. But even as the Climate and Health Assessment shows the progress we’ve made in understanding the current and potential health impacts of climate change, it also points to large gaps in knowledge that impede our ability to project—and therefore, to prepare for—future climate change health impacts. Many of these gaps are due to insufficient research on the relationship between climate variability and human diseases. For example, while the report highlights modeling studies of how disease-causing vectors, such as ticks and mosquitoes, and bacteria may be affected by future climate change, we still have only a rudimentary understanding of how behavioral and social determinants of health may interact with these climate-related factors to lead to human disease. This gap in understanding prevents us from being able to identify where, when, and in whom new outbreaks of climate-affected disease are most likely to occur in the United States. It also impairs our ability to make decisions that will protect people’s health in the coming years. What we do know is that climate change is increasing in significance as a public health stressor (Melillo et al. 2014; USGCRP 2008). It is possible to design and implement interventions to limit the impacts and accompanying human suffering caused by climate change, but only if we make the research investments necessary to improve our understanding of how climate change worsens health and determine the most effective interventions. More targeted research programs like the NIH’s Climate Change and Health: Assessing and Modeling Population Vulnerability to Climate Change (http://grants.nih.gov/grants/guide/pa-files/PAR-10-235.html) are needed to help build the nation’s capacity to conduct these kinds of studies. Because climate change and its impacts vary in different regions of the country due to factors such as geography and demographics, regional centers of excellence in climate change and health would greatly enhance our ability to conduct high-quality interdisciplinary research to inform public health practice at the local and regional levels. Comparable regional centers in climate and earth science are currently supported by the Department of the Interior (https://www.doi.gov/csc) and the National Oceanographic and Atmospheric Administration (http://cpo.noaa.gov/climateprograms/%C2%ADclimateandsocietalinteractions/risaprogram.aspxk). With the release of the Climate and Health Assessment, the climate change and public health communities will now have a greatly enhanced base of integrated knowledge demonstrating how our environment and our health interact. If acted on in comprehensive and innovative ways, this enhanced understanding can point the way towards helping both our communities and our planet become ever more sustainable and resilient, not just for this month, but for all the Aprils to come.

The Rio+20 United Nations Conference on Sustainable Development represents a crucial opportunity to place environmental health at the forefront of the sustainable development agenda. Billions of people living in low- and middle-income countries continue to be afflicted by preventable diseases due to modifiable environmental exposures, causing needless suffering and perpetuating a cycle of poverty. Current processes of economic development, while alleviating many social and health problems, are increasingly linked to environmental health threats, ranging from air pollution and physical inactivity to global climate change. Sustainable development practices attempt to reduce environmental impacts and should, in theory, reduce adverse environmental health consequences compared to traditional development. Yet these efforts could also result in unintended harm and impaired economic development if the new "Green Economy" is not carefully assessed for adverse environmental and occupational health impacts. The environmental health community has an essential role to play in underscoring these relationships as international leaders gather to craft sustainable development policies.A Conferência da ONU Rio +20 sobre desenvolvimento sustentável representa uma oportunidade crucial para colocar a saúde ambiental à frente da agenda de desenvolvimento sustentável. Bilhões de pessoas que vivem em países de baixa e média renda continuarão a ser afligidas por doenças evitáveis devido a exposições ambientais modificáveis causando sofrimento desnecessário e perpetuando um ciclo de pobreza. Processos de desenvolvimento econômico atuais, enquanto aliviam muitos problemas de saúde e sociais, estão cada vez mais ligados a ameaças de saúde ambiental, abrangendo desde poluição do ar e inatividade física até mudanças climáticas globais. Práticas de desenvolvimento sustentável tentam reduzir o impacto ambiental e deveriam, em teoria, reduzir as consequências adversas da saúde ambiental em relação ao desenvolvimento tradicional. Ainda assim, esses esforços podem também resultar em danos não intencionais e em pior desenvolvimento econômico se a nova "Economia Verde" não for cuidadosamente avaliada para impactos na saúde ambiental e ocupacional adversos. A comunidade da saúde ambiental tem um papel essencial para desempenhar, enfatizando estas relações enquanto líderes internacionais se reúnem para criar políticas de desenvolvimento sustentável.

Background The need to identify and try to prevent adverse health impacts of climate change has risen to the forefront of climate change policy debates and become a top priority of the public health community. Given the observed and projected changes in climate and weather patterns, their current and anticipated health impacts, and the significant degree of regulatory discussion underway in the U.S. government, it is reasonable to determine the extent of federal investment in research to understand, avoid, prepare for, and respond to the human health impacts of climate change in the United States. Objective In this commentary we summarize the health risks of climate change in the United States and examine the extent of federal funding devoted to understanding, avoiding, preparing for, and responding to the human health risks of climate change. Discussion Future climate change is projected to exacerbate various current health problems, including heat-related mortality, diarrheal diseases, and diseases associated with exposure to ozone and aeroallergens. Demographic trends and geophysical and socioeconomic factors could increase overall vulnerability. Despite these risks, extramural federal funding of climate change and health research is estimated to be < $3 million per year. Conclusions Given the real risks that climate change poses for U.S. populations, the National Institutes of Health, Centers for Disease Control and Prevention, U.S. Environmental Protection Agency, and other agencies need to have robust intramural and extramural programs, with funding of > $200 million annually. Oversight of the size and priorities of these programs could be provided by a standing committee within the National Academy of Sciences.

Climate change can be expected to have differential effects on different subpopulations. Biological sensitivity, socioeconomic factors, and geography may each contribute to heightened risk for climate-sensitive health outcomes, which include heat stress, air pollution health effects, extreme weather event health effects, water-, food-, and vector-borne illnesses. Particularly vulnerable subpopulations include children, pregnant women, older adults, impoverished populations, people with chronic conditions and mobility and cognitive constraints, outdoor workers, and those in coastal and low-lying riverine zones. For public health planning, it is critical to identify populations that may experience synergistic effects of multiple risk factors for health problems, both related to climate change and to other temporal trends, with specific geographic factors that convey climate-related risks.

Close to 400 manufacturer-identified nanotechnology-based consumer products are now on the market (Woodrow Wilson International Center for Scholars 2007). Using increasingly sophisticated levels of control over the assembly of atoms and molecules to form substances and devices, nanotech companies are exploiting the size-dependent properties of nanostructured materials for applications ranging from cosmetics to fuel cells (Colvin 2003). Yet our understanding of the potential toxicity of nanoparticles remains rudimentary (Colvin 2003; Oberdorster et al. 2005b). To determine whether the unique chemical and physical properties of new nanoparticles result in specific toxicologic properties, the nanotechnology community needs new ways of evaluating hazard and ultimately assessing risk (Nel et al. 2006). These new strategies must also consider the complexities inherent to studies of chemical mixtures. This workshop’s assessment of the novel aspects of nanotoxicology built on knowledge gained from prior workshops. In 2004, scientists from many different areas of research came together in Gainesville, Florida, to discuss the emerging field of nanotoxicology (Bucher et al. 2004). They described the challenges facing toxicologists in rigorously characterizing the new materials and in understanding how nanostructures might differentially influence toxicity. This theme was further elaborated in a seminal article by Oberdorster et al. (2005a), which provides a general framework for evaluating the toxicity of engineered nanoparticles. More detailed questions regarding exactly how to evaluate the potential health impact of engineered nanoparticles remain. This report captures some of the critical information that is still needed to understand the human health impact of engineered nanoparticles and defines mechanisms to begin to acquire this information. Building on the insight from those previous meetings and published articles—that the structure of nanoparticles brings many new challenges to toxicological evaluation—workshop participants were asked to identify both factors that make nanoparticles different and information specific to these differences that is needed to assess nanoparticle hazards. The group was further charged with making recommendations on how to gather and use that additional information to evaluate health hazards associated with these scale-specific properties. Because of the short duration of this workshop, the scope was limited to consideration of toxic properties of nanoparticles. A full evaluation of human health risks will require development of sufficient techniques for assessing exposure to nanoparticles in addition to consideration of toxicity. E. Silbergeld of Johns Hopkins University opened the workshop with a presentation that explored ways of thinking about and evaluating the potential hazards of nanoparticles. She emphasized focus on the nanoscale interactions that take place in the normal functioning of biological systems in order to understand the positive and negative effects that engineered nanoparticles could have on humans. For example, because the immune system functions through nanoscale intercellular communications, Lynch et al. (2006) hypothesized that engineered nanoparticles can disrupt these processes with deleterious end results. Specifically, they considered unique interactions between native proteins and the highly curved surfaces of nanoparticles, speculating that the protein shape could be modified after binding. This deformation could expose amino acid residues that are normally buried in the core of the protein, and the immune system would then recognize these newly exposed residues as “cryptic epitopes” and mount an unwanted immune response. A 2005 study by Zhao et al. (2005) predicted that DNA repair, another vital biological system that operates at the nanoscale, is also susceptible to modification by nanoparticles. Specifically, this study found through computer modeling that the association in water between C60 and DNA is stronger than the association between two C60 molecules. Therefore, when DNA is damaged, fullerenes can occupy the damaged site, possibly impeding the self-repairing processes of the double-strand DNA and thus negatively impacting the structure, stability, and biological functions of DNA molecules. These unique interactions between nanoparticles and biological systems afford great promise for medicinal applications, but the unintended consequences could be harmful. We know, for instance, that natural and unintentionally produced ultrafine particulate matter, which is in the same size range as engineered nanoparticles, can carry a broad range of compounds, including polycyclic aromatic hydrocarbons, endotoxin, metals, and other toxic chemicals. These complexes can then damage biological systems (Penn et al. 2005; Schwarze et al. 2006). Gutierrez-Castillo et al. (2006) found that particulate matter with chemicals adsorbed to the surface can damage DNA. These examples suggest that the myriad possible interactions between nanoparticles and harmful environmental chemicals may lead to unique exposures and health risks. Conventional knowledge about exposure assessment, fate and transport, and current computer models is not necessarily applicable to nanoparticles. But alternative methods such as toxicogenomic technologies, lower-order animal and in vitro testing, and ultimately the development of structure activity models could prove useful, providing more rapid testing than traditional animal toxicology tests and allowing for explicit experimental design based on mechanism. The development of alternative methods is an ambitious but necessary goal if the large and growing numbers of nanoparticles are to be adequately assessed for toxicity. Silbergeld ended her presentation with a charge for the group: to frame its dialogue both to inform the industry on how to look before leaping into the production of new nanoparticles and to provide guidance for those who have already taken that leap.

There are now robust data supporting the Developmental Origins of Health and Disease (DOHaD) paradigm. This includes human and animal data focusing on nutrition or environmental chemicals during development. However, the term DOHaD has not been generally accepted as the official term to be used when one is concerned with understanding the pathophysiological basis for how environmental influences acting during early development influence the risk of later noncommunicable diseases. Similarly, there is no global research or public health program built around the DOHaD paradigm that encompasses all aspects of environment. To better inform the global health efforts aimed at addressing the growing epidemic of chronic noncommunicable diseases of environmental origin, we propose a two-pronged approach: first, to make it clear that the current concept of DOHaD comprehensively includes a range of environmental factors and their relevance to disease occurrence not just throughout the life span but potentially across several generations; and second, to initiate the discussion of how adoption of DOHaD can promote a more realistic, accurate, and integrative approach to understanding environmental disruption of developmental programming and better inform clinical and policy interventions. (Endocrinology 156: 3416–3421, 2015)

Nanotechnology, the design and manipulation of materials at the atomic scale, may well revolutionize many of the ways our society manufactures products, produces energy, and treats diseases. New materials based on nanotechnology are already reaching the market in a wide variety of consumer products. Some of the observed properties of nanomaterials call into question the adequacy of current methods for determining hazard and exposure and for controlling resulting risks. Given the limitations of existing regulatory tools and policies, we believe two distinct kinds of initiatives are needed: first, a major increase in the federal investment in nanomaterial risk research; second, rapid development and implementation of voluntary standards of care pending development of adequate regulatory safeguards in the longer term. Several voluntary programs are currently at various stages of evolution, though the eventual outputs of each of these are still far from clear. Ultimately, effective regulatory safeguards are necessary to provide a level playing field for industry while adequately protecting human health and the environment. This paper reviews the existing toxicological literature on nanomaterials, outlines and analyzes the current regulatory framework, and provides our recommendations, as an environmental non-profit organization, for safe nanotechnology development.

Nanotechnology, the design and manipulation of materials at the atomic scale, may well revolutionize many of the ways our society manufactures products, produces energy, and treats diseases. Innovative nanotechnology products are already reaching the market in a wide variety of consumer products. Some of the observed properties of nanomaterials call into question the adequacy of current methods for determining hazard and exposure, and for controlling resulting risks. Given the limitations of existing regulatory tools and policies, two distinct kinds of initiatives are urgently needed: first, a major increase in the federal investment nanomaterial risk research, and second, rapid development and implementation of voluntary standards of care pending development of adequate regulatory safeguards. The U.S. government should increase federal funding for nanomaterial risk research under the National Nanotechnology Initiative to at least $100 million annually for the next several years. Several voluntary programs are currently at various stages of evolution, though the eventual outputs of each of these are still far from clear. Ultimately, effective regulatory safeguards, harmonized globally, are necessary to provide a level playing field for industry while adequately protecting human health and the environment.

New scientific tools spawned by the genomics revolution promise to improve our ability to identify causative factors in human diseases. But as these new tools elucidate the complex interactions between chemical toxins and biologic systems, the strain on traditional ways of understanding toxic effects grows. Despite major advances in the science and technology of these new toxicogenomics tools, scientific and political complexities threaten to delay the use of toxicogenomics to further the public interest or—worse—to advance its use initially to weaken the regulation and safety of widely used chemicals. To gain further insight into the scientific and political landscape of the new toxicology, we interviewed 27 experts from a variety of disciplines and sectors. Interviewees expressed widespread agreement that the new toxicology promises a significant increase in the amount of information available on toxic effects of chemicals. But the interviews show that the promise of the new toxicology will be realized only if technical and political obstacles can be overcome. Although scientific rigor is necessary for the new toxicology to move forward, the scientific and public-interest communities must ensure that inappropriate definitions of rigor, as well as proprietary interests, do not create unnecessary barriers to more effective public health protection.