Preface

Throughout much of its history, the United States was predominantly a rural society. The need to provide sustenance resulted in many people settling in areas where food could be raised for their families. Over the past century, however, a quiet shift from a rural to an urban society occurred, such that by 1920, for the first time, more members of our society lived in urban regions than in rural ones. This was made possible by changing agricultural practices. No longer was it necessary for each individual to raise his or her own food, and the number of person-hours and acreage required to produce food has steadily been decreasing because of technological advances.

The result has been a changing rural landscape: once dotted with small family farms, the landscape is now being replaced by larger-scale operations. For better or for worse, the reality is that agribusiness has firmly taken over the traditional family farm. The good news is that through research we have learned about pesticide and chemical applications, so that our ecological footprint is now smaller. The bad news is that considerable research on new technological advances (e.g., contained animal feeding operations) and their impacts on human health is still needed.

As people have moved from the farm to the city, the demographics of the rural population have changed. Currently, the rural population tends to be older and poor, and lacks access to adequate health care coverage or services. Although the common perception has been that most people living in rural America are farmers, the reality is that only a small percentage of individuals living in rural regions are farmers. The majority commute to jobs in neighboring cities. In fact, often one or both spouses living on a traditional family farm are often employed at a job away from the farm.

Like many regions in the country, environmental health is a large concern for individuals in rural areas. Whether it is related to preserving the natural environment, addressing adequate housing, providing safe drinking water, protecting migrant workers’ health, or creating a healthy social environment, the environment in which people live influences the status of their health. The population living in rural America (collectively across the United States) makes up a significant proportion of the U.S. population, and its environmental health concerns are distinct, although those concerns do have some overlap with those of the rest of the population.

The Institute of Medicine’s Roundtable on Environmental Health Sciences, Research, and Medicine held a regional workshop at the University of Iowa on November 29 and 30, 2004, to look at rural environmental health issues. This workshop was a continued outgrowth from the Roundtable’s first workshop, at which its members realized that the challenges facing those in the field of environmental health could not be addressed without a new definition of environmental health—one that incorporates the natural, built, and social environments.

The Roundtable chose to focus this workshop on rural America and concentrated on Iowa as the basis of its discussions. The members of the Roundtable realized that rural America is not homogeneous and that the environmental health challenges in one region of the United States may not be the challenges in other areas of the country. Water was one example, as some regions of the country face problems with water quality issues while other rural regions are experiencing drought conditions. This workshop was not meant to cover environmental health in all rural areas in depth but was conducted to obtain an overview of some of the key environmental health concerns in rural America by using the Midwest as a starting point for discussion.

Early in the planning process, Roundtable members realized that the process of engaging speakers and developing an agenda for the workshop was an important part of the enterprise. In their efforts to encourage the participation of a breadth of participants, the Roundtable members sought the input of individuals from diverse fields—industry, health care, foundations, environmental groups, government, citizen groups, and others. Their input helped shape the agenda. We would like to thank these individuals for their contributions to making this meeting a success.

This workshop summary captures the two-day meeting discussions where the speakers and participants identified areas in which additional research was needed, the processes by which changes could occur, and the gaps in our knowledge. Although the Roundtable defines environmental health in broad terms, not all aspects of environmental health could be discussed in their entirety during the limited time of the meeting. The views expressed here do not necessarily reflect the views of the Institute of Medicine, the Roundtable, or its sponsors.

James Merchant, M.D., member

Roundtable on Environmental Health

Sciences, Research, and Medicine