Public Health Chapter 6

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Ohio State University *

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2010

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Health Science

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Oct 30, 2023

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Public Health Chapter 6: Environmental Health Introduction to Environmental Health  An estimated 24% of the global burden of disease and 23% of all deaths can be attributed to environmental factors  We can examine the environment in 2 ways o Media: air, water, soil, food o Exposures: biological, chemical, and radiological Healthy People 2020 Objectives for Environmental Health  Eliminate elevated lead blood levels in children  Minimize risks posed by hazardous sites  Reduce significant pesticide exposures  Reduce the amount of toxic pollutants  Reduce indoor allergen levels  Decrease lead-based paint or related hazards Historical Context of Environmental Health and Nursing  Nightingale: clean water and sanitation  Lillian Wald and Henry Street neighborhood  Environmental justice  Extrapolation studies  2001: CDC begins biomonitoring o Testing of human fluids and tissues for presence of potentially toxic chemicals Social Determinants of Health and Environmental Justice  Poverty and race o Substandard housing o Hazardous plants and waste sites o Hazardous jobs o Poor nutrition o Less access to health care Environmental Health Sciences  Toxicology: effects of chemical exposures o Increased exposure, increased risk

 Epidemiology  Geographic information systems  Multidisciplinary approaches Epidemiology  Studies the strength of association between exposures and health effects  Uses: o Occupational o Environmental  Epidemiologic triangle: o Agent: lead paint o Host: child o Environment: house Geographic Information Systems  Coding data o Relates it to a place on Earth (“mapping”)  GIS community-based maps o Educate communities and local policy makers o Provide graphic depictions of public health problems  Example: Hill and Butterfield’s model of environmental risks Multidisciplinary Approaches  Earth sciences that show how pollutants travel o Geologists o Meteorologists o Physicist o Chemists  Key public health professions: o Food safety specialist o Sanitarians o Radiation specialists o Industrial hygienists

Climate Change  WHO: “Climate change is a significant and emerging threat to public health, and it changes the way we must look at protecting vulnerable populations”  Nurses’ main roles: o Mitigation: working at individual, community, institutional, and governmental level to ensure energy-conserving policies and practices o Response: public health nurses must be prepared for increased fire and storm- related disasters Applying the Nursing Process to Environmental Health  Note the environment aspects of the problem in every step of the process: o Assessment o Planning o Intervention o Evaluation Environmental Health Assessments  Risks can be categorized as follows: o Medium: air, water, soil, or food o Type: chemical, biological, or radiological o Setting: urban, rural, or suburban o Functional location: home, school, workplace, or community Individual Environmental Exposure History  Use of the “I PREPARE” mnemonic device  Investigate potential exposures  Present work  Residence  Environmental concerns  Past work  Activities  Referrals and resources

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 Educate Information Sources  National Library of Medicine (NLM) o ToxTown  Household Products page  Environmental pages  Skin deep database  “Right to Know” is an American Nurse Association (ANA) environmental health principle that recommends access to all information necessary to make informed decisions to protect our health Environmental Exposure by Media  Air o Sources of pollution  Point sources (identifiable – for example, smokestacks)  Non-point sources (mobile – for example, cars and trucks) o Clean Air Act o Indoor air quality (AIQ)  Water o Consumer Confidence Reports (CCRs) o Sources of pollution  Waste from industry, pharmaceuticals  Storm runoff, erosion, especially due to loss of 80% of the world’s forests leading to massive erosion  Land and soil  Contaminated land designations o Superfund site  Highly contaminated  Threat designated by the Environmental Protection Agency (EPA) o Brownfield site  Previously used  Now slated for redevelopment

 Food o Pathogenic causes: E. coli, salmonella, pesticide, genetically modified organisms (GMOs) o Environmental causes: pesticides, antibiotics in animals Right to Know  Several environmental statutes give the public the right to know about the hazardous chemicals in the environment o Health professions and community members can easily access key information by zip code regarding major sources of pollution that are being emitted into the air or water in their community  Consumer confidence reports  Hazardous communication standard o Material safety data sheet (MSDS) Risk Assessment  Process to determine the probability of a health threat associated with an exposure  Four phases o Assess toxicology and epidemiologic data o Has the chemical been released? o How much and by which route of entry of the chemical? o Risk assessment process  Subject to interpretation Risk Communication  Risk communication includes all the principles of good communication in general  It is a combination of the following: o The right information o To the right people o At the right time Governmental Environmental Protection  Federal agencies for environmental health regulation

o Environmental Protection Agency (EPA), Food and Drug Administration (FDA), Department of Agriculture o United States Department of Health and Human Services (USDHHS)  The National Institute for Environmental Sciences (NIEHS), The National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC) (including the National Center for Environmental Health (NCEH)  Important steps and concepts o Permitting o Environmental standards o Compliance o Monitoring Policy and Advocacy  Nurses can guide and drive policy o 1 in every 100 Americans is a RN o Nurses have a responsibility to be informed and take action in the best interest of public o Nurses can serve as resources for state and federal legislators and staff o Nurses also work as advocates for environmental justice and rights of others  2008 – Alliance of Nurses for Healthy Environments o Created to coalesce nurses and nursing organizations around relevant issues Roles for Nurses in Environmental Health  Community involvement/public participation  Individual and population risk assessment  Risk communication  Epidemiologic investigations  Policy development

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