Ch 6: Environmental Health

Healthy People 2020 Objectives for Environmental health

*Reduce proportion of persons exposed to air that does not meet US EPA health based standards for harmful air pollutants *Increase use of alternative modes of transportation to reduce motor vehicle emissions to improve air quality *Improve air quality by increasing use of cleaner alternative fuels *Reduce air toxic emissions *Increase proportion of persons serviced by community water systems that receive supply of drinking water that meets regulations of safe drinking water act *Reduce waterborne disease outbreaks arising from water intended for drinking in community water systems *Reduce per capita domestic water withdrawals *Increase proportion of assessed rivers, lakes, and estuaries that is safe for fishing and recreational purposes *Reduce number of beach closings that result from presence of harmful bacteria *Reduce potential exposure to chemicals by fish contaminant levels *Eliminate elevated blood levels of lead in children *Minimize risks to human health and the environment posed by hazardous sites *Reduce pesticide exposures resulting from visits to healthcare facilities *Reduce amount of toxic pollutants released, disposed of, treated, or used for energy recovery *Increase recycling of municipal solid waste *Reduce indoor allergen levels

Environmental Principles

*everything is connected to everything else *everything has to go somewhere *the solution to pollution is dilution *todays solution may be tomorrows problem

Risk communication

An area of both practice and of skill. Includes general principles of good communication: - the right information - the right people - the right time Involves understanding outrage factors relevant to he risk being addressed so that both can be incorporated in the message - resulting in action to ensure safety, or that unnecessary fear is reduced.

Describe the skills needed by nurses practicing in environmental health, and apply the nursing process to the practice of environmental health.

BASIC KNOWLEDGE & CONCEPTS: scientific principles and the relationship between individuals or populations and the environment, including work environments. Includes paths to exposure to health hazards, basic prevention and control strategies, interdisciplinary nature of effective interventions, and the role of research. ASSESSMENT & REFERRAL: successfully complete environmental health history, recognize potential environmental hazards, sentinel illnesses, and make appropriate referrals for conditions with probable environmental causes. ADVOCACY, ETHICS & RISK COMMUNICATION: knowledge of the role of advocacy (case and class), ethics, and risk communication in client care and community intervention with respect to potential adverse effects of the environment on health. LEGISLATION & REGULATION: understand policy framework and major pieces of legislation and regulation related to environmental health.

Risk Assessment

Divide into functional locations such as: home, school, workplace, and community. Each location will have unique environmental exposures, as well as overlapping. Determine whether exposure is in: air, water, soil, or food, or a combination. Determine whether it is chemical, biological, or a radiological exposure. Assessment should cover past as well as present conditions at home, school, work, and community environments. 1. What are your longest held jobs, present and past? 2. Have you been exposed to any radiation or chemical liquids, dusts, mists, or fumes? 3. Is there any relationship between current symptoms and activities at work or at home?

Governmental environmental protection

EPA FDA USDA Local health departments Manage environmental exposures through the development and enforcements of standards and regulations. Educates public about risks and risk reductions.( Education is the primary prevention strategy)

Epidemiological Triangle

Epidemiologic Triangle: Agent = may include chemical mixtures Host = may refer to community w/different ages, genders, ethnicities, cultures, and disease states Environment = may include air, water, soil, food, temperature, humidity, wind.

Environmental Justice

Equal protection from environmental hazards for individuals, groups, or communities, regardless of race, ethnicity, or economic status. Certain environmental health risks disproportionately affect poor people and people of color in the US. More likely to: *live near a hazardous waste site or incinerator *have children who are lead poisoned *have children with asthma Campaigns to improve the unequal burden of environmental risks strive to achieve ENVIRONMENTAL JUSTICE, or environmental equity. In 1993, the Environmental Justice Act was passed. Policies were created to mandate that every federal agency act in a manner to address and prevent illnesses and injuries.

Ethics

Essential for nurse to be able to make own choices, to describe issues and options within groups, and in advocating for ethical choices. Skillful nurses can promote a conversation from "either/or" to "both". Possible ethical issues related to environmental health decisions: *who has access to info and when? *how complete & accurate is the info? *who is included in decision making, and when? *what & whose values and priorities are given weight in decisions? *how are short-term and long-term consequences considered?

Nursing influence on environmental health

FLORENCE NIGHTINGALE: known as the "Mother of biostatistics", because of her compilation of date regarding conditions regarding health. She wrote about the quality o the environment and the influence of health and recovery from illness. Also, she talked about the importance of fresh air, pure water, adequate food, good drainage, cleanliness, and the importance of sunlight. LILLIAN WALD: coined the term "Public Health Nurse" MARY BREWSTER: worked to improve the environment, and aimed to improve physical environment and social conditions that affected health. BOTH Lillian Wald and Mary Brewster used their networks of influential contacts to make many changes in the physical environment and social conditions that affect health. HEALTH PEOPLE 2020: environmental health is one the priority areas

Environmental Health Assessment: I P-R-E-P-A-R-E mnemonic

I - INVESTIGATE potential exposures (when in contact with something, when at home or work) P - PRESENT WORK (what exposed to, MSDS location, PPE, coworkers with health problems) R - RESIDENCE (age, location, heating type, stored chemicals, drinking water source) E - ENVIRONMENTAL concerns (concerns about air, water, soil in neighborhood; industries / farms / landfill / waste-site nearby) P - PAST WORK ******(experience, longest work period, military, farm, seasonal or volunteer work)******** IMPORTANT****** A - ACTIVITIES (hobbies, burn / solder / melt, garden / fish / hunt, eat what is grown or hunted, alternative healing) R - REFERRALS & RESOURCES E - EDUCATE (materials available to client, plan for followup)

Describe legislative and regulatory policies that have influenced the effect of the environment on health and disease patterns..

Organization and approach to environmental protection vary somewhat among states, but the common essential strategies of prevention and control via the permitting process, establishment of environmental standards, and monitoring, as well as compliance and enforcement, are found in every state. PERMITTING: process by which the government places limits on the amount of pollution emitted into the air or water - industries or businesses whose processes result in releases (discharges/emissions) that have potential for harm must obtain permit to construct and operate. ENVIRONMENTAL STANDARDS: permitted levels of emissions, maximum contaminant levels allowed, an action level for environmental cleanup. or a risk-based calculation. MONITORING PROCEDURES approved by the EPA, must be followed, once environmental standards are set. Two steps - inspections, and testing. Also, facility can self-report. COMPLIANCE: the process for ensuring that permitting requirements are met. Voluntary compliance may be negotiated for rapid and effective action to correct a problem. ENFORCEMENT: may be taken when voluntary compliance is not achieved. May include fines or penalties, suspension of specific operations, or closure of a facility CLEANUP, or remediation of environmental damage is the final step. May be done by Federal, State, or contracted to private companies with official oversight. Part of the decision process involves public information and citizen advisory panels or community forums for future land use and remediation.

Levels of prevention: related to the environment

PRIMARY PREVENTION: to prevent lead poisoning, instruct families not to use lead-based paint. If used, instruct them in removal, and repainting with non-lead based paint. SECONDARY PREVENTION: ID any household members whose blood lead level is rising. TERTIARY PREVENTION: Initiate treatment for lead poisoning that will reduce blood lead levels UNIQUE ENVIRONMENTAL HEALTH THREATS: health care settings synthetic chemicals Dioxin Lead

Right to Know Laws

Public right to know about hazardous chemicals in the environment. www.scorecard.org = website maintained by environmental defense fund (nonprofit org), with date from the EPA. Major pollutants released in area (by zip code). CCR - consumer confidence report - results of testing must be reported to those who purchase water. If there is an immediate threat, the water provider must send emergency warning to the community via local newspapers, radio, and TV. Risk assessment: process to determine probability of a health threat associated with an exposure. In vulnerable populations: 1 access toxicologic data to see if chemical related to neg. health effects 2 determine if the chemical is in the environment - air, water, soil, food 3 estimate how much chemical might enter the human body and by what route 4 attempt to predict the potential for harm on the basis of the estimated exposure

Assessing risk in vulnerable populations

Risk assessment: process to determine the probability of a health threat associated with an exposure. 1. access toxicologic data to see if a chemical is know to be associated with negative health effects. 2. determine if the chemical has been released into the environment via air, water, soil, or food. 3. estimate how much of the chemical might enter the human body and by which route 4. attempt to predict the potential for harm on the basis of the estimated exposure. CHILDREN: especially at risk for environmental hazards because of factors such as poverty, lack of healthcare access, dangerous environment, situations in the community they live. Toxins, lead, pesticides, mercury, air pollutions, solvents, asbestos, and radon get into homes, schools, childcare centers, and playgrounds. Exposed children at risk for dev. learning disabilities, behavioral disorders, chronic diseases, and illnesses from CNS damage. Because children breath more rapidly than adults - greater exposure to air pollutants. Childrens bodies different = blood-brain barrier, kidneys, growth Cancer is still leading cause of death from Disease in children younger than 15 years old. Leukemia and tumors of the CNS combined account for approx. 50%. PREGNANT WOMEN: careful of infant development. 23 states issued mercury contam. advisories for fish in every lake and river within their borders. Over 1 million women eat enough mercury contam. fish to risk brain dev. of children. Preg. women are warned to limit fish intake to one portion / week for certain fish, including tuna. 75% of synthetic chemicals in air, water & food have little or no toxicity testing.

Toxicology

The basic science that studies the health effects associated with chemical exposures. Negative effects of chemical exposures are studied (the science that studies the negative effects of chemicals). Pollution can enter the body via: lungs (inhalation), GI tract (ingestion), skin & mucous membranes (dermal absorption),placental barrier (NLM) National Library of Medicine database provides access to medical databases to be searched for possible environmental linkages to illnesses using illness and symptom search terms. Some potential environmental threats to health can be understood or ruled out.

Explain how the environment influences human health and disease.

The environment = everything around us. The quality of our lives = the quality of our environment. A healthy environment = optimal health and health care Chemical, biological, and radiological exposures affect our health: air we breath, water we drink, food we eat, products we use.

Epidemiology

The science that explains the strength of association between exposures and health effects in human populations. Environmental epidemiology: the study of the effect on human health of physical, chemical, and biological factors in the external environment.

Which disciplines work most closely with nurses in environmental health.

Toxicology & Epidemiology Earth Sciences: geologists, meteorologists, chemists (how and when humans may be exposed to hazardous chemicals, radiation, and biological contaminants) Food safety specialists, Sanitarians, Radiation specialists, Industrial hygienists

Most important step in community survey

Windshield survey.

Role of nurses in environmental health

community involvement & public participation individual and population risk assessment risk communication epidemiologic investigations policy development