**6. Conclusions**

From the analysis of situation in the sites at risk of environmental crisis on the Italian territory, the greatest criticalities are represented by the effects of emissions from industrial plants although increasing attention must be paid to the effects of vehicular traffic, as shown by recent data of RTI report, according to which the highest incidence of neoplastic diseases is recorded in areas characterized by the presence of large urban agglomerations.

As regards the comparison between the role of indoor and outdoor pollution in the onset of diseases related to environmental exposure, the second is still predominant and, in the case of sites of national interest, indoor air pollution can be regarded as a factor that may enhance the effects induced by outdoor pollutants.

Pollution situation is controlled through the application of numerous laws on environmental protection, which in our country are very stringent and thanks to which it was possible at least to contain both the emission of pollutants and their effects on human health.

The effect of environmental stressors on human health and policy-making today can be explained using the Driving Force-Pressure-State-Exposure-Effect-Action (DPSEEA) model [62]. Ideal environmental management is based on a reduction of environmental risk exposure, as well as the risks themselves, in all stages of the process. However, this policy-based intervention is not accurate or simple for several motifs (problematic approach for many variables as time lag between exposure reduction to environmental stressor and its negative effects on health or, e.g., as many other variables) that make the intervention very difficult to implement [63]. For DPSSEA model application, the national policy-based intervention, finalized to air pollutants reduction, is very closely to the air quality standards, as the settingup of those standards can lead to management and reduction of sources of pollution so decreasing pollutant concentrations and subsequent relevant health risk factors to ensure healthy residents [62, 64]. Moreover, air quality standards setting may be considered to be a reliable method for reducing exposure to air pollutants.

Although Institutions have implemented several containment measures, environmental pollution neither has nor ceased to be a problem of Public Health. Currently, in Italy, there are about 15,000 sites to characterize, reclaim, and monitor that represent more than 2% of the entire territory and require the allocation of 25–30 billion euros.

To solve this problem, firstly, rigorous epidemiologic studies must be previewed and con‐ ducted, taking into account a careful evaluation phase to confirm the association between environmental exposure and health effects. Epidemiological studies should provide for a careful characterization of the sites, taking into consideration that the great variety of produc‐ tion processes gives rise to an equally wide variety of pollutants not known and for which are not yet known metabolism and mechanisms of interaction with other substances present or released into the environment.

Performing a thorough epidemiological investigation is essential to proceed to risk assessment and risk management. In the management of this route, greater emphasis must be attributed to activities of prevention departments and ARPA and technical committees consisting of experts who can give useful indications to legislators to improve and promulgate laws to protect collective health and must perform a central role. The aim of this cooperation is achieving a "sustainable risk," that is, the risk that remains after the interventions of control and prevention and that can be more easily managed by the competent bodies.

Nonetheless, it is necessary to consider that the bases to make the most of these actions are the training of the operators and the information, so that in this view, activities of continuous updating for public health professionals are promoted.
