1. 1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 10 Environmental Health

2. 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Explain the relationship between the environment and human health and disease. 2. Understand the key disciplines that inform nurses’ work in environmental health. 3. Apply the nursing process to the practice of environmental health. 4. Describe legislative and regulatory policies that have influenced the impact of the environment on health and disease patterns in communities.

3. 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 5. Explain and compare the roles and skills for nurses practicing in the field of environmental health as well as those practicing in many other fields. 6. Incorporate environmental principles in practice.

4. 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Context  Nightingale and the Crimean War  Lillian Wald and Henry Street neighborhood  1995 IOM report: Nursing, Health, and Environment  Recognized the environment as a significant determinant of health  Acknowledged that this recognition is deeply rooted in nursing’s heritage

5. 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Environmental Health Sciences Toxicology Epidemiology Multidisciplinary Approaches

6. 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Toxicology  The basic science applied to understanding the health effects associated with chemical exposures  Sometimes referred to as the study of poisons  Similar to pharmacology but only negative effects of chemical exposures are studied  Pollutants can enter body from a variety of routes  Epigenetics

7. 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Epidemiology  The science that helps us understand the strength of the association between exposures and health effects  Epidemiologic triangle  Agent, host, and environment  Geographic Information Systems (GIS)

8. 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Multidisciplinary Approaches  Earth sciences help to explain how pollutants travel in air, water, and soil.  Geologists  Meteorologists  Physicist  Chemists  Key public health (PH) professionals:  Food safety specialist  Sanitarians  Radiation specialists  Industrial hygienists

9. 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Global Warming/Climate Change  Global warming and the associated long- term warming trends over the last century have been well-established.  Climate change scientists are projecting substantial disruption in water supplies, agriculture, ecosystems, and coastal communities.  Nurses can play a role in mitigation and response.

10. 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assessment Information Sources Environmental Exposure History Environmental Health Assessment Right to Know Risk Assessment Assessing Risks in Vulnerable Populations

11. 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Information Sources  National Library of Medicine (NLM)  ToxTown Household Products page  Safe Cosmetics database

12. 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Environmental Exposure History  Do an exposure history to:  Identify current or past exposures.  Reduce or eliminate current exposures.  Reduce adverse health effects.  “I PREPARE” mnemonic

13. 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Environmental Health Assessment  Windshield survey  “Nature-deficit disorder”  Positive environmental factors  Features that can positively contribute to a community’s health Green space, bike paths, walkable communities

14. 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Environmental Health Assessment, Cont’d  Air  Air pollution is a significant contributor to human health problems  Clean Air Act  Indoor air quality  Water  Land  Food

15. 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Right to Know  Several environmental statutes give the public the right to know about the hazardous chemicals in the environment.  Health professionals 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 report  Hazard Communication Standard  Material safety data sheet (MSDS)

16. 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Risk Assessment  Refers to a process to determine the probability of a health threat associated with an exposure  Four phases  Determining whether a chemical is known to be associated with negative health effects (in animals or humans)  Determining whether the chemical has been released into the environment: into the air, water, soil, or food  Estimating how much and by which route of entry the chemical might enter the human body  Characterizing the risk assessment process and taking into account all three of the previous steps

17. 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assessing Risks in Vulnerable Populations: Children  Children’s bodies operate differently than adults, potentially increasing their risk for toxic exposure.  Infants and young children breathe more rapidly than adults; this increase in respiratory rate translates to a proportionately greater exposure to air pollutants.  Immature blood-brain barrier  Kidneys less effective at filtering undesirable chemicals

18. 18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Precautionary Principle  With thousands of chemical compounds now creating a chemical soup in air and water, it is increasingly difficult to prove specific hypotheses regarding the relationship of exposure to a singular chemical and disease outcome in humans.  It has been suggested that we adopt a “precautionary approach” when animal research and other indicators demonstrate a possible toxic relationship between a chemical and health effect.

19. 19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Reducing Environmental Health Risks Risk Communication Ethics Governmental Environmental Protection

20. 20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Risk Communication  Risk communication includes all the principles of good communication in general.  It is a combination of the following:  The right information  To the right people  At the right time

21. 21 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Ethics  Ethical issues likely to arise in environmental health decisions:  Who has access to information and when?  How complete and accurate is the available information?  Who is included in decision making and when?  What and whose values and priorities are given weight in decisions?  How are short- and long-term consequences considered?

22. 22 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Governmental Environmental Protection  Environmental Protection Agency  Food and Drug Administration  Department of Agriculture  Permitting  Environmental standards  Compliance  Monitoring

23. 23 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Advocacy Environmental Justice and Environmental Health Disparities Unique Environmental Health Threats from the Health Care Industry

24. 24 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Environmental Justice and Environmental Health Disparities  Certain environmental health risks disproportionately affect poor people and people of color in the United States.  More likely to live near a hazardous waste site or an incinerator  More likely to have children who are lead poisoned  More likely to have children with asthma  1993: Environmental Justice Act was passed  1994: Executive Order 12898, “Federal Actions to Address Environmental Justice in Minority Populations

25. 25 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Unique Environmental Health Threats from the Health Care Industry  Risk of mercury exposure  Synthetic chemicals those do not decompose  Dioxin  Health Care Without Harm  American Nurses Association was a founder

26. 26 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Referral Resources  National Library of Medicine’s ToxTown  World Wide Web  Environmental epidemiology unit or toxicology unit of the state health department  Association of Occupational and Environmental Clinics  Pediatric Environmental Health Specialty Units  Poison control centers  Agricultural extension offices

27. 27 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Roles for Nurses in Environmental Health  Community involvement/public participation  Individual and population risk assessment  Risk communication  Epidemiologic investigations  Policy development