Environmental health scientists forged a new partnership with implementation scientists to discuss how together they could address challenges and improve equity in environmental health, during a workshop two days held on February 28 and March 1.
the Advancing Environmental Health Equity Through Implementation Science The workshop was a joint effort between the NIEHS and the following entities, which are also part of the National Institutes of Health.
Workshop co-chairs included Lindsey Martin, Ph.D.scientific health administrator at the NIEHS Population Health Branch (PHB), Gila Neta, Ph.D.Program Director for Implementation Science at NCI, and Dara Blachman-Demner, Ph.D.scientific health administrator at the OBSSR.
Defining Implementation Science
Implementation Science is the study of methods to promote the adoption, scaling up, and diffusion of evidence-based practices, interventions, and policies to improve population health. Implementation science is part of theme two of the NIEHS strategic plan — Promote the transfer: from data to knowledge into action — to encourage the application of prevention and intervention strategies to reduce or avoid environmental exposures and their resulting health effects.
Martin and Rick Woychik, Ph.D.director of the NIEHS and the National Toxicology Program, gave a concrete example of the Clean Cooking Science Implementation Network which applied implementation science to promote the adoption of clean cooking technology(https://ehp.niehs.nih.gov/doi/10.1289/ehp1018) to reduce household air pollution (PAH).
Unsafe cooking practices drive PAHs into homes around the world and disproportionately affect the health of women and children in low- and middle-income countries. Researchers are studying strategies to promote the adoption and appropriate use of cleaner cookstoves to replace cookstoves that generate PAHs. Understanding related individual, community, societal and policy factors is essential to supporting sustainable adoption.
“Could implementation science be the missing piece to address environmental health disparities through environmental justice research?” asked Melissa Smarr, Ph.D.a Scientific Health Administrator of PHB.
To achieve equity, barriers must first be overcome and understood. For example, structural racism can make implementation more difficult due to long-established interventions that may not serve all people equally. Therefore, removing the implementation may be an equally important consideration, depending on Rachel Shelton, Sc.D.from Columbia University.
“We can introduce new programs and policies, but we also need to think about how we de-implement programs, policies and practices that are already in place and are harmful,” Shelton said. “This is a new and emerging area of implementation science.”
Times of crisis, such as environmental disasters, also provide a unique and challenging setting for implementation science. “Often there are few evidence-based interventions, so this work needs to be developed in concert with risk reduction research to help achieve the public health measures needed to improve the recovery and adaptation of people. affected populations,” said Aubrey Miller, MDNIEHS Senior Medical Advisor.
The unique environments of different environmental disasters (such as wildfires and floods) and the short and often unpredictable windows for implementing evidence-based interventions introduce context-specific challenges for implementation science studies , according to Nicole Errett, Ph.D., from the University of Washington. “Strong and trusting relationships with communities and practitioners, as well as advance planning, are essential,” she said.
Set up a future
“One of the main takeaways is that it’s never too early to think about the science of implementation,” Martin said. “From better understanding feasibility issues to planning for sustainability, you can embed implementation science throughout the research journey.”
The workshop included four round tables on four areas. According to Martin, the fields of environmental health science and implementation science can grow together: environmental health disparities and environmental justice; prevention and intervention; climate change and disasters; and community research.
“Fairness is really the cornerstone, and it must be at the center of our thinking about the future of science,” added Claudia Thompson, Ph.D.head of the PHB, in his closing remarks.
Rosenthal J, Balakrishnan K, Bruce N, Chambers D, Graham J, Jack D, Kline L, Masera O, Mehta S, Mercado IR, Neta G, Pattanayak S, Puzzolo E, Petach H, Punturieri A, Rubinstein A, Sage M , Sturke R, Shankar A, Sherr K, Smith K, Yadama G. 2017. Implementation Science to Accelerate Clean Cooking for Public Health. Environ Health Perspective 125(1):A3–A7.
(Jennifer Harker, Ph.D., is a technical writer-writer in the Office of Communications and Public Liaison at NIEHS.)