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The recent lawsuits against Johnson & Johnson have raised the issue of what and when talcum powder manufacturers knew about the presence of asbestos in their products and what they did or did not do to protect the public. Low-level exposure to asbestos in talc is said to result in either mesothelioma or ovarian cancer. Johnson & Johnson has claimed that there was “no detectable asbestos” in their products and that any possible incidental presence was too small to act as a carcinogen. But what exactly does “nondetected” mean? Here, we examine the historical development of the argument that asbestos in talcum powder was “nondetected.” We use a unique set of historical documents from the early 1970s, when low-level pollution of talc with asbestos consumed the cosmetics industry. We trace the debate over the Food and Drug Administration’s efforts to guarantee that talc was up to 99.99% free of chrysotile and 99.9% free of amphibole asbestos. Cosmetic talc powder manufacturers, through their trade association, pressed for a less stringent methodology and adopted the term “nondetected” rather than “asbestos-free” as a term of art.

In 2011, the US Centers for Medicare & Medicaid Services (CMS) called for health care innovations to advance health care's \"three-part aim,\" while stimulating \"the workforce of the future.\" CMS encouraged innovations targeting underserved communities. Our idea, CommunityRx, was a new e-prescribing system that would make it as easy to connect a patient to community resources as it was to prescribe a drug.In 2012, CommunityRx received a CMS innovation award. We had 6 months to engineer the e-prescribing system and 30 months to implement and sustain it. During this period, CommunityRx integrated with three electronic medical record systems and generated more than 250 000 community e-prescriptions (\"HealtheRx's\") for more than 113 000 Chicagoans. To test a collective social impact model for sustainability, I founded two information technology enterprises -NowPow, LLC, a community e-prescribing company, and MAPSCorps, 501c3, a nonprofit youth asset mapping and workforce development organization. Both entities are headquartered on Chicago's South Side, returning tax base and meaningful information technology jobs (> 70 full-time employees today) to the community.Health care, public health, and community-based organizations in Chicago, Illinois, and eight other US states are now e-prescribing community resources. NowPow participated in the Agency for Healthcare Research and Quality's EvidenceNOW effort, working with hundreds of small Midwest primary care practices in the Healthy Hearts in the Heartland study,3 and it supports several CMS accountable health communities awardees.4 By 2018, MAPSCorps had employed more than 1600 youths (for half in Chicago, it was their first paid job) in an annual asset census that generates public use data for Chicago, New York City, and two rural areas of North Carolina (www.mapscorps.org). As one example of collective impact, NowPow purchases MAPSCorps data, providing NowPow with the most accurate community resource data for e-prescribing and yielding revenue to help sustain MAPSCorps' mission.

Every day, the public is exposed to multiple industrial chemicals via food, water, air, and consumer products. Many are known to be toxic and can increase the risk of adverse health effects, including cancer, asthma, developmental disabilities, and infertility. The US Environmental Protection Agency (EPA) is responsible for making evidencebased policies to limit exposure to dangerous chemicals. To inform potential chemical regulations, a core component of the EPA's duty is to evaluate data on the hazards and risks of industrial chemicals under the 1976 Toxic Substances Control Act (TSCA; Pub L No. 94-469), the law covering chemicals in commerce. Congress reformed the TSCA after widespread recognition of fatal flaws in the 1976 law. Under it, the EPA could not even restrict asbestos, a known human carcinogen. In 2016, President Barack Obama signed the Frank R. Lautenberg Chemical Safety for the 21st Century Act (Pub L No. 114182), overhauling TSCA after 40 years. The TSCA covers more than 40 000 chemicals in the marketplace. The EPA's action (or inaction) on these chemicals has major implications for human health in the United States because of federal law preempting states and beyond the United States because of global commerce and trade agreements.Pursuant to implementation of the new law, the EPA's Office ofChemical Safety and Pollution Prevention recently released a methodology for collecting, evaluating, and interpreting scientific evidence on chemicals (http://bit.ly/2TFEDrF). The EPA officially calls the method a \"systematic review\" framework for TSCA, but it is systematic in name only, as it falls far short of best practices for systematic reviews. Application of the TSCA method will exclude relevant research from chemical assessments, leading to underestimation of health risks and resulting in inadequate policies that allow unsafe chemical exposures, thus harming public health. The TSCA systematic review method could be especially detrimental for populations more vulnerable to chemical exposures, such as pregnant women and children.

It is widely understood that the aim of public health is to promote and protect the health of populations where they live, learn, work, and play. Yet it is less commonly understood that the cornerstone science of public health, epidemiology, is needed to accomplish this goal. A key feature of our field is to accurately measure and understand exposures and outcomes within populations of people, also known as the public; therefore, it should be part of our training and goals as epidemiologists to inform the public on how they can help themselves stay healthy.Although this call to action seems straightforward, a disconnect remains between those who conduct research and public opinion about evidence-based public health programs in the United States. For example, the most effective evidence-based solutions to our nation's largest public health crisis, the opioid epidemic, are banned from receiving federal funding (e.g., needle exchanges can only receive federal monies to pay for staff and programs, but not for syringes) or are yet to be used at scale (e.g., safe injection sites). How do we, as scientists and public health advocates, translate our science into action and even policy?

Conclusions as to the causation of adverse effects by environmental and occupational agents may have powerful societal consequences, leading to measures to control exposure through removal of products from the marketplace, changes in design and manufacturing processes, regulation, and litigation. We are at a moment when massive and widely publicized litigation is underway in the United States related to carcinogenicity and causation of cancer by two agents, talcum powder and the herbicide glyphosate, sold as Roundup. Verdicts amounting to hundreds of millions of dollars (as much as $4 billion in the case of talc and ovarian cancer) have been reached: for ovarian cancer in talcum powder users and for nonHodgkin's lymphoma in persons exposed to glyphosate. Conclusions of the World Health Organization's International Agency for Research on Cancer (IARC) have figured in this litigation. Through its IARC Monographs, the agency offers evidence-based classifications of the strength of evidence for carcinogenicity of selected agents and exposures.In this issue of AJPH, Rosner et al. (p. 969) comment on how exposure to talc contaminated with asbestos might have occurred, thus leading to increased risk for ovarian cancer. The manufacturers' strategy was to label talcum powder as having \"nondetected\" amounts of asbestos, leaving the possibility that cancer-causing asbestos fibers were present. Today's litigation may be a legacy of this strategy.Here, I focus on the IARC classification of the herbicide glyphosate as \"probably carcinogenic to humans\" (Group 2A) and the aftermath of the classification.1 IARC Monographs have also covered both talc and asbestos and ovarian cancer. Monograph 93 classified talc applied to the perineum as \"possibly carcinogenic to humans\" (Group 2B) while Monograph 100C concluded that asbestos causes cancer of the ovary.There are critical lessons learned from the IARC glyphosate classification and its aftermath around transparency, journals, and unrevealed conflict ofinterest (COI), and on potential consequences for those serving on expert panels. First, I state my own potential biases and COIs; for more than three decades, I have participated in and chaired multiple IARC Working Groups, including chairing the group that recently revised the Preamble to the IARC Monographs. I support the program and have defended it and called out its accomplishments.2 My views are shared by many.

A general problem of contemporary societies is how to synthesize and discretize evidence that is extremely sparse and difficult to manage, do it in a transparent way, and transfer the conclusions into policy decisions. I show here how the monographs of the International Agency for Research on Cancer (IARC) are an ingenious way to address this complex issue.

We live in a curious and frustrating time at the intersection of public health policy and leadership. The quality of science and research that affects public health outcomes has never been higher, but public trust in governments and leadership in the United States has plummeted to an all-time low (https://bit.ly/ 2WSpan3). So, how can elected leaders and research scientists work to improve the handshake between policymaking, science, and health?One instructive story may exist in the recent history of Oklahoma City, Oklahoma. Perhaps out of the limelight, Oklahoma City's recent transformation enabled a serious public policy debate, positively affected health outcomes, and directed hundreds of millions of dollars in public and private investment to health-improving infrastructure and development.In 2004 when I was elected to my first of four terms as mayor, our city was already on a considerable upswing. We had diversified our economy and decided as a population to invest hundreds of millions of public dollars to improve our quality of life. Our goal was to attract recent graduates and growing companies to call Oklahoma City home. After a few years of focused attention, it was working.As a new mayor, my goals were to improve my hometown's brand and build on the momentum my predecessors had already begun. I had no intention of addressing the health and wellness issues of the city. The problem was, I simply could not avoid it. Health is a serious issue and, according to the metrics, we were failing. While I was dealing with the personal dilemma of how to address an issue of which I knew little, along came a ranking that would ultimately change my perspective.

The system through which US government agencies protect the public's health, safety, and environment is being severely challenged. It faces concerted efforts to weaken the laws and regulations that require corporations to limit air and water pollution, clean up land or drinking water they have contaminated, market safe products to consumers, and eliminate workplace hazards. At the same time, there is an exodus of dedicated and experienced civil servants who are frustrated with these new developments. Much effort will be needed to rebuild this system of vital protections.The success of the US regulatory system in safeguarding the public's health is so impressive that we often take it for granted. The work of the Food and Drug Administration (FDA) to protect us from adulterated food or drugs that are ineffective or unduly dangerous is the model for much of the world. Thanks to the Environmental Protection Agency's strengthened requirements, our air and water have become dramatically cleaner than they were when the agency was established almost 50 years ago. The nation's workers are far safer because of the efforts of the Occupational Safety and Health Administration, which has reduced both on-the-job injuries and exposures to known hazards such as asbestos and benzene.

Teaching responsibility is hard. Anyone who's ever been a parent understands that truism. It's especially difficult when the very behaviors you want to prevent are sometimes the ones that secretly make you very proud. I recall when my son was in a soccer league for four-year-olds and was trash-talking other children. I didn't want my kid to be namecalling, but I was also quietly pleased that he had the intestinal fortitude to stand up for himself.Assigning responsibility for problems in health care is much more difficult than overcoming a bit of parental ego. If an individual patient is nonadherent with a prescribed course of care, is that the fault ofthe person or the system? Is it because people lack access to resources or education to help them understand and comply with the recommended plan, or is it because they consciously made a bad choice? (As an emergency physician, most ofwhat I see on shift is a manifestation of bad choices, and most of my efforts at patient education center on the phrase \"Don't do that!\") If we focus on systemic factors at the exclusion ofindividual behaviors, proposed solutions may risk toppling public health from the unbiased moral high ground into the abyss of the partisan wars. If we assign responsibility to the individual, we have a different set of problems. If patients with pulmonary disease continue to use tobacco despite multiple admonitions not to do so, to what extent are they still given carte blanche for care? And if assigning responsibility is difficult, learning accountability- the ability to accept the consequences of our actions-is even harder. Bil Keane, the original artist behind the Family Circus comic strip, used to draw two ghostly children in the house called Ida Know and Not Me. Most of us still have them living somewhere in our emotional basements.

If we seek to improve community and population health through effective interventions targeting social and environmental contexts, who will drive the change? On the basis of our experience in Durham County, North Carolina, we have learned that successful interventions must rely, at least in part, on stakeholders outside the public health and health care sectors, including those in business, education, philanthropy, nonprofit organizations, community development, and government.In Durham County, two health systems-Duke University (an academic health center) and Lincoln Community Health Center (a federally qualified health center)-are estimated to provide health care to more than 95% of county residents. In a new program, the two health systems provide geospatially enabled, aggregated population prevalence health data (e.g., prevalence of chronic diseases such as diabetes) to the public. Prevalence data are derived from county residents' health system electronic health records, which are aggregated at the neighborhood level and carefully deidentified to avoid the risk of individual privacy breach. Health systems summarize the data in reports requested by and provided to the Durham County Public Health Department. Reports are then democratized (i.e., made available to the general public) by the Public Health Department through a partnership with a community-owned nonprofit organization, DataWorksNC. Neighborhood health data are displayed (numerically and on visual maps) and made available (via data downloads) for public use by DataWorksNC on an open source platform called the Durham Neighborhood Compass (https://compass.durhamnc.gov).