High quality and accurate environmental investigations and analysis are essential to any assessment of contamination and to the decision-making process thereafter. Remediation decisions may be focused by health outcomes, whether already present or a predicted risk. The variability inherent in environmental media and analysis can be quantified statistically; uncertainty in models can be reduced by additional research; deep uncertainty exists when environmental or biomedical processes are not understood, or agreed upon, or remain uncharacterized. Deep uncertainty is common where health and environment interact. Determinants of health operate from the individual’s genes to the international level; often several levels act synergistically. We show this in detail for lead (Pb). Pathways, exposure, dose and response also vary, modifying certainty. Multi-disciplinary approaches, built on high-quality environmental investigations, enable the management of complex and uncertain situations. High quality, accurate environmental investigations into pollution issues remain the cornerstone of understanding attributable health outcomes and developing appropriate responses and remediation. However, they are not sufficient on their own, needing careful integration with the wider contexts and stakeholder agendas, without which any response to the environmental assessment may very well founder. Such approaches may benefit more people than any other strategy.
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