Strategies for improving human health in contaminated situations: a review of past, present and possible future approaches

Strategies for improving human health in contaminated situations have traditionally been based on restricting emissions, remedial reduction of exposure and, where appropriate and possible, medical reconnaissance of efficacy. We review these and the broader aspects of general public health approaches, including necessary understanding of epidemiology and the wider social context, before considering a specific local case study involving health issues associated with chromium-contaminated land and its remediation in an area of urban regeneration. The impact of remediation upon the common good, in its broadest environmental, health and socio-economic sense, including enhanced opportunities for members of the community to take personal responsibility for health-improving activities, should be taken into account in addition to conventional theoretical assessments and practical measurements of relief from environmental risk. Rapidly emerging toxicogenomic technologies may have a role to play in informing future risk assessment and remediation approaches in contaminated situations, although the ethical challenges of using personal genetic information could well be considerable.