1. Radiation Protection Bureau / Bureau de la radioprotection Environment and Health Dr. Jack Cornett Director, Radiation Protection Health Canada Jack_cornett@hc-sc.gc.ca 613 954 6647

2. Radiation Protection Bureau / Bureau de la radioprotection Environmental Health Goals Increase awareness of influence of environmental factors in disease and health Develop an approach to identify the problems Approach Environmental Health Policy Framework Discuss some common environmental exposures Examples of Case histories - questions and tools.

3. Radiation Protection Bureau / Bureau de la radioprotection Environment and Environmental Exposures Environment: External to the individual human body Environmental exposure: Broad sense: includes all non-genetic factors Narrow sense: exogenous to and nonessential for the normal function of body Key Points Exposures alter patterns of disease and health Largely involuntary

4. Radiation Protection Bureau / Bureau de la radioprotection Environmental Health - Case Patient 40 year old man works as an accountant Headaches over past ~ 3 yrs Difficulty concentrating & remembering detail Fatigue, stuffy noise and blocked ears No other family members with these symptoms What Questions and Case History information would help with the diagnosis?

5. Radiation Protection Bureau / Bureau de la radioprotection “The area of environmental impacts on health has been seriously neglected in Canada and requires urgent investment.” National Advisory Committee on SARS and Public Health 2003 Environmental Health Policy

6. Radiation Protection Bureau / Bureau de la radioprotection Concerns have a factual basis Air pollution causes thousands of premature deaths, tens of thousands of hospitalizations, and hundreds of thousands of days absent from work and school annually Dramatic increase in childhood asthma High profile water contamination events Increases in cancers with known environmental connections (skin, lung) Thousands of cases of poisoning

7. Radiation Protection Bureau / Bureau de la radioprotection Canadians are worried 90% of Canadians believe that environmental pollution is harming their health or the health of their children “Pollution” ranks second after “stress” when Canadians are asked to rank the main factors negatively affecting their health

8. Radiation Protection Bureau / Bureau de la radioprotection Costs are high OECD estimates direct health care costs at 0.5- 1.0% of GDP, or $5-10 billion annually for Canada Ontario government estimates health care costs of air pollution in that province alone at more than $3 billion annually Canada has not conducted a national burden of disease study to assess the magnitude of environmental impacts on health

9. Radiation Protection Bureau / Bureau de la radioprotection Impacts are inequitably distributed Certain groups are particularly vulnerable Children Aboriginal people Low income Canadians Inequitable burden of environmental health hazards has a major impact on public policy Different susceptibility

10. Radiation Protection Bureau / Bureau de la radioprotection Focus Past: Biologic agents and factors: water distribution systems sewage collection food handling Current: Chemical and physical agents: volatile organic compounds metals particulate matter pesticides radiation

11. Radiation Protection Bureau / Bureau de la radioprotection Other Factors in Environmental Health Social factors frequently affect the exposure to environmental agents. Life-style and behavioural factors are important determinants of some diseases that also are related to environmental pollution. Workplace pollution and ambient environmental pollution are sometimes correlated. These sub-disciplines use similar epidemiological, statistical and toxicological techniques

12. Radiation Protection Bureau / Bureau de la radioprotection Environmental Health - Case Patient 8 year old boy accompanied by mother Stomach pain, some flu-like symptoms Sporadic problem over past ~2 months No other family members with these symptoms What Questions and Case History information would help with the diagnosis?

13. Radiation Protection Bureau / Bureau de la radioprotection The EH Paradigm Contaminant Exposure Pathways : How des a contaminant travel through the environment from its source to humans or other living organism? Source of contamination Environmental media (water, soil, air, food product) Point of exposure Receptor (person or population) Route of exposure

14. Radiation Protection Bureau / Bureau de la radioprotection Source of Contamination Exhaust from vehicles Emissions from smokestacks Waste water released by factories and mills Waste disposal sites Closed factories and storage sites Consumer products Natural sources

15. Radiation Protection Bureau / Bureau de la radioprotection Environmental Media Once released from its sources, a contaminant will travel through environmental media to points where human exposure can occur: Water- Groundwater (water below ground, - Surface water Soil- Important carriers of contaminants - Act as a contaminant reserve Air- Capable of transporting contaminants widely and quickly Food-Imported food may contain new strains

16. Radiation Protection Bureau / Bureau de la radioprotection Point of Exposure and Receptor Person/Population Point of exposure: The location where contact with a contaminant occurs Home Office Playground Lakes, rivers …… Receptor person/Population: People who are exposed the contaminant at the point of exposure:

17. Radiation Protection Bureau / Bureau de la radioprotection Route of Exposure The exposure route is the final link in the chain from the contaminant source through the exposure pathway to people: Ingestion: The mouth, throat, stomach, and intestines absorb ingested materials Inhalation: Breathing in a contaminant Dermal (skin) contact: Absorbed through skin

18. Radiation Protection Bureau / Bureau de la radioprotection Environmental Health -Case Patient 10 year old girl accompanied by mother Large blisters and red skin on back of both hands especially deep between fingers 2 nd and 3 rd degree burns but girl healthy and well tanned and states emphatically that she was not scalded or burned. No other family members with these symptoms What Questions and Case History information would help with the diagnosis?

19. Radiation Protection Bureau / Bureau de la radioprotection How Can You Assess Exposure? Interviews Questionnaire, and structured diaries Other approaches ????

20. Radiation Protection Bureau / Bureau de la radioprotection Examples of Exposure Assessment Interviews Questionnaire, and structured diaries Measurements in external media (macro environment) - Metals e.g. (Arsenic) in soil - POPC in food - particulate matter in air - UV index for sun burn

21. Radiation Protection Bureau / Bureau de la radioprotection Examples of Exposure Assessment Concentrations in the personal or micro environment Radiation dosimeters in clinics Concentrations in human tissues Lead in blood Markers of physiologic effects Kidney function for uranium toxicity Individual doses Radiation ingestion at work

22. Radiation Protection Bureau / Bureau de la radioprotection Everyone is Exposed to Lead

23. Radiation Protection Bureau / Bureau de la radioprotection Identifying Individuals at Risk to Pb What questions should a physician use to decide whether to order a blood lead test? Environment? Behaviour? Subpopulation? Pb was ubiquitously used in paint, cosmetics, gasoline …

24. Radiation Protection Bureau / Bureau de la radioprotection Environmental Health -Case Patient Male 40 in good health at check up Mentions that two close neighbours recently were diagnosed with lung cancer His mother died two years previously of lung cancer. All NON smokers and no smokers in family What questions / information might help ?

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26. What are the health effects of radon? The only known health effect associated with exposure to radon is an increased risk of developing lung cancer. In confined spaces like mines or household basements, radon gas can accumulate to relatively high levels. In the open air, the amount of radon gas is very low.

27. Radiation Protection Bureau / Bureau de la radioprotection Radon Mitigation

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29. Environmental Health -Case Patient 45 year old scientist visiting CDN university Staying with a family he has visited in the past Sever headaches since he arrived Dizziness and Nausea No other people in home he is visiting have these symptoms What Questions and Case History information would help with the diagnosis?

30. Radiation Protection Bureau / Bureau de la radioprotection CAUSES OF DEATH IN CANADA -- 1997 All lung cancers15,439 Motor vehicle accidents3026 Accidental falls2622 Lung cancers attributable to radon1589 Accidental poisonings703 Homicides440 Drowning283 Fires272 Air transport accidents73 Lightening6

31. Radiation Protection Bureau / Bureau de la radioprotection Summary Environment is a strong determinant of health Environmental exposures are often involuntary Some populations are more vulnerable or susceptible Usually effects are proportional to exposure & frequency of exposure Use case history and context to ID environmental components Lots of tests available – consult specialists Exposure control is effective at prevention