Decision-making in environmental health.

Despite our current knowledge about harmful exposures obtained from environmental epidemiology studies, preventive action is lacking in many fronts. To reverse this trend, results from environmental epidemiological studies must be translated from theory into public health practice more efficiently. This process requires epidemiology to provide the right type of data for decision-making and to communicate the results of environmental epidemiology studies in a form understandable to the community at large and to those empowered to take action. Tools for decision-making based on epidemiological data need to be developed further, and the epidemiologist has a role to play in the process of addressing the solutions to the problems they study. Similarly, while those with decision-making responsibilities are not expected to be directly involved with technical aspects of conducting epidemiological studies, it is necessary that they learn new ways of thinking and of evaluating information on health. They have a responsibility to understand the implications of the uncertainties in the information and the value this information has for decision-making. Decision-making involves choosing among alternative ways of meeting objectives. Often, however, there may be a number of objectives that may be in competition or conflict. Not infrequently, this combination of uncertainty and conflict produces diverse conclusions about the "best alternative" when viewed by different observers. A decision-maker must choose between competing alternatives, and may face uncertainties and difficulties at every step. These difficulties, however, should not serve as excuses for lack of action. While it is true that increasing evidence about a potential environmental health problem would aid the decision-making process, lack of action while waiting for more evidence may also carry significant adverse consequences.