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This study explores the combined effect of lead (Pb) exposure and an index of chronic physiological stress on cardiovascular disease mortality using data from the National Health and Nutrition Examination Survey (NHANES) 1999–2008 linked to 1999–2014 National Death Index data. Chronic physiological stress was measured using the allostatic load (AL) index, which was formed by analyzing markers from the cardiovascular, inflammatory, and metabolic systems, with Pb levels, assessed using blood lead levels (BLL). The dataset was analyzed with statistical techniques to explore (a) the relationship between Pb exposure and AL, and (b) the combined role of Pb and AL on cardiovascular disease mortality. Results indicated that AL was more elevated in those with BLLs above the 50th percentile in the US population and that those with elevated AL were more likely to have high BLL. Finally, the interaction of AL and BLL significantly increased the likelihood of cardiovascular disease mortality. These findings highlight the need for considering the totality of exposures experienced by populations to build holistic programs to prevent Pb exposure and reduce stressors to promote optimal health outcomes and reduce cardiovascular mortality risk.

The Deepwater Horizon (DWH) oil spill is the only declared Spill of National Significance in US history, and it significantly impacted the health of people and communities in the Gulf of Mexico region. These impacts amplified adverse effects of prior disasters and may compound those of future traumas. Studies, both to date and ongoing, show some negative mental and physical health outcomes associated with DWH in some spill workers, as well as some coastal residents in all Gulf States. The spill was also associated with negative effects in the living resources, tourism, and recreation sectors, at least in the short term. Compared with others, people dependent on these sectors reported more health and financial concerns. Consumer concerns about the safety and marketability of seafood persisted well after data demonstrated very low risk. Parents were concerned about possible exposures of children as they played on beaches, but this risk was found to be minor. Spill-related stress was an overarching factor associated with adverse health outcomes, and some residents reported greater stress from navigating the legal and claims processes following the spill than from the spill itself. Research revealed a serious lack of baseline health, environmental, and socioeconomic data against which to compare spill effects. This finding highlighted the need for ongoing observing systems to monitor health and socioeconomic parameters and establish continuous baselines of such information.

Water and sanitation (wastewater) infrastructure in the United States is aging and deteriorating, with massive underinvestment over the past several decades. For many years, lack of attention to water and sanitation infrastructure has combined with racial segregation and discrimination to produce uneven access to water and wastewater services resulting in growing threats to human and environmental health. In many metropolitan areas in the U.S., those that often suffer disproportionately are residents of low-income, minority communities located in urban disadvantaged unincorporated areas on the margins of major cities. Through the process of underbounding (the selective expansion of city boundaries to exclude certain neighborhoods often based on racial demographics or economics), residents of these communities are disallowed municipal citizenship and live without piped water, sewage lines, and adequate drainage or flood control. This Perspective identifies the range of water and sanitation challenges faced by residents in these communities. We argue that future investment in water and sanitation should prioritize these communities and that interventions need to be culturally context sensitive. As such, approaches to address these problems must not only be technical but also social and give attention to the unique geographic and political setting of local infrastructures.

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