1. Environmental Impacts On Health Dorothy Cumbey, Ph.D., RN Jerry Dell Gimarc, MA with the special help of Lill Mood, MPH, RN, Community Liaison, EQC South Carolina Department of Health and Environmental Control

2. Developed as part of an Enhanced AHEC Community Partnership for Health Professions Workforce and Educational Reform project funded by the Health Resource and Service Administration (HRSA)

3. Objectives l Discuss environmental impacts on health l Describe the role of public health in responding to environmental threats l Identify your role as citizen and health care provider

4. Environmental Impacts on Health l Much of our health improvement has come from clean water and pure air l Health and the environment are inextricably linked l New data are emerging that demonstrate this linkage

6. Health and the Environment Are Inextricably Linked l Air quality l Water quality l Soil contamination

8. Health Care Providers must be knowledgeable and active to l Relate to patient concerns l Communicate effectively about real concerns and fears l Be active as citizens in policy decisions that affect the environment l Understand how human health is affected

9. Everything Is Connected to Everything l Air to water and soil l Water to air and soil l Soil to water and air l Soil and water to food l Waste has to go somewhere l Population pressures - especially in vulnerable areas like coast

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11. Discussion Time l Identify at least 3 ways your community has been altered in recent times in a way that might affect health status

12. l Growing number and complexity of chemicals in everyday life l No data on small doses of many chemicals over a long term or on vulnerable populations l Continuing data on health effects of small doses of some contaminants (lead) New Concerns

13. Everything Is Connected: The Case of Lead l Naturally occurring l Used for centuries because of its malleablity and chemical properties l Found in air, water, soil and food l Has known health effects

14. Everything Is Connected: The Case of Lead l Children and other vulnerable populations are at particular risk l Removal of lead from gasoline has dramatically lowered children’s blood lead levels l Researchers are identifying impacts at smaller doses

15. Challenges to Minimize Impacts on Health l Challenges s Prevention u Education u Waste Minimization u Land Use Planning

17. Environmental Protection to Minimize Impacts on Health l Challenges s Prevention s Regulation for protection and control u Permitting based on environmental standards u Monitoring u Compliance and enforcement

19. DISCUSSION l Identify roles of health care providers as citizens and professionals in the community

20. Your Role as Citizen and Health Care Provider l Trusted source of information l Interpreter of scientific information l Spokesperson for citizen concerns l Data gatherer on community concerns l Leader in community mobilization l Evaluator of public policy with implications for health

21. Public Communication l Risk s Magnitude X Probability l Perceived Hazard l Outrage Perceived Hazard + Outrage = Perceived Risk

22. Sandman’s Outrage Factors l Decreases Outrage l Voluntary l Natural l Familiar l Not memorable l Not dreaded l Chronic l Increases Outrage l Involuntary (Coerced) l Industrial (Artificial) l Exotic l Memorable l Dreaded l Catastrophic

23. Sandman’s Outrage Factors l Decreases Outrage l Knowable (Detectable) l Individual controls l Fair l Morally irrelevant l Trustworthy sources l Responsive process l Increases Outrage l Unknowable (Undetectable) l Controlled by others l Unfair l Morally relevant l Untrustworthy sources l Unresponsive process

24. Discussion Time l Discuss the difference in challenge to public health when s the threat is real, but not perceived s the outrage exists but has the wrong target

25. Resources for the Health Professional l National Library of Medicine (NLM) National Library of Medicine (NLM) l NLM toxicology data bases NLM toxicology data bases l CDC CDC l EPA EPA l Scorecard Scorecard

26. Summary l The complex environment in which we live will continue to present threats to our health and we must continue to work as a community to minimize those threats