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msJAMA
May 05, 1999

Environmental Medicine: From the Concert Hall to the Barracks

JAMA. 1999;281(17):1656. doi:

Few fields are as diverse as environmental and occupational medicine (EOM), which encompasses health issues at individual, community, and even planetary levels. The estimated disease burden attributed to environmental and occupational medical problems is considerable. Occupational injuries and illnesses in the United States may account for over 46,000 deaths and $171 billion in direct and indirect costs annually.1 Nonoccupational aspects of environmental medicine have been the subject of a growing body of literature.2 The World Health Organization now advocates for sustainable health, an approach based on the premise that technological development should not compromise human health or disrupt regional or global ecosystems.3

The industrialization of the United States during the 19th century marked a time of major development for EOM. As manufacturing became the country's primary economic activity, the first occupational safety regulations were established.4 More recent developments in EOM over the past half century were the AMA's approval in 1955 of certification in occupational medicine and passage in 1970 of the act that created the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health.4

As the new millennium approaches, many longstanding environmental health issues, such as high lead levels in buildings and hazardous working environments, remain unresolved, and new challenges continue to arise. Eli Merritt comments on the training of US medical students to meet these challenges, with special attention to recent curricular innovations. In his companion piece appearing on the MSJAMA Web site (http://www.ama-assn.org/msjama), Merritt critically examines the emerging field of global environmental medicine.

William Clark and Barbara Bohne review the association of noise exposure with auditory injury, reporting on the epidemiology, pathogenesis, and prevention of noise-induced hearing loss. Rosenthal and his colleagues present data on French medical students' experiences with blood exposure accidents. A piece by Joel Schofer explores the controversial ethical issues surrounding guidelines for obtaining informed medical consent in a wartime environment.

References
1.
Leigh  JPMarkowitz  SBFahs  MShin  CLandrigan  PJ Occupational injury and illness in the United States: estimates of costs, morbidity, and mortality. Arch Intern Med. 1997;1571557- 1568Article
2.
Loefler  IJ Environmental medicine: cornered between nature and culture. Lancet. 1997;350 ((suppl 3)) 5Article
3.
Martens  WJSlooff  RJackson  EK Climate change, human health, and sustainable development. Bull World Health Organ. 1997;75583- 588
4.
de la Hoz  REParker  JE Occupational and environmental medicine in the United States. Int Arch Occup Environ Health. 1998;71155- 161Article
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