1. Health Risks From Environmental Exposures 2009 CASN Nursing Research Conference- Interrelationships Between Theory, Research and Practice Barbara MacKinnon

2. Laws Regulations Research Emissions Exposure Health effects Education Government Policies Private Sector Policies Health Care

3. There is a long list of important biological, physical and chemical exposures of concern to human health: Asbestos Benzene Dioxins Dump site contaminants Electromagnetic fields Endocrine disruptors Environmental tobacco smoke Fossil fuel radiation/emissions Heavy metals Other organic pollutants Biological sources Tobacco smoke Pesticides Phthalates Polycyclic aromatic hydrocarbons Radio frequency waves Radon Ultraviolet radiation Volatile organic compounds Water disinfection by-products (trihalomethanes) Living near nuclear plants (Kreiger, N. et al. 2003 Env Health Perspect)

4. Sources of Environmental Exposures and Risks  Indoor Exposures- Smoking, Radon, Consumer Products, Wood stoves  Water, Food  Outdoor Exposures- Pesticides, Ambient Air Pollution (Traffic, Industrial)  Noise  Climate Change Impacts- Flooding, Heat, Storms

5. Health Outcomes from Environmental Exposures Outcomes are exposure specific:  Birth defects  Learning disabilities  Reproductive system impacts  Epigenetic impacts  Respiratory illnesses  Cardiovascular illnesses  Diabetes  Immune system illness- either deficiency or auto-immune  Multiple chemical sensitivity disorders  Cancers Health Impacts Depend On  Genetic predisposition  Type of exposure  Duration  Intensity  Other determinants of health have synergistic effects

6. Example- Outdoor Air Pollution Particulate Matter PM Sulphur oxides Nitrogen oxides Volatile Organic Compounds VOCs Carbon Monoxide “Toxics” Carbon Dioxide  Secondary PM  Ozone

7. Penetration of smallest particles into lung tissues, secondary effects on immunological and neural pathways affecting other systems (ie. cardiovascular) Respiratory symptoms:  Mucus production, cough, airway obstruction, inflammation, exacerbation of asthma and COPD Cardiovascular symptoms:  Higher fibrinogen, vaso-construction  Increased heart rate, BP, blood viscosity & blood coagulation, arrhythmia  Heart attacks and strokes Other:  Low birth weight  Impaired immune system, reduced macrophage function  Cancers PM 2.5 Health Outcomes

8. Vulnerable Populations  People with pre-existing respiratory or cardiovascular illness  The elderly or very young  Diabetics  People doing strenuous activities outdoors Recommended actions  Health care professionals should advise patients of the health risks from air pollution.  Listen to Air Quality Health Index announcements.  Reduce activity levels during high pollution days.  Vulnerable people should avoid spending long periods outdoors. When possible stay in a healthier environment.  Take personal and policy actions to reduce air pollution

9. The AQHI example Research Research – Health effects of exposure to multiple pollutants, modelling to create Index Research Research- Behaviour change, mental models, focus testing, market research Health messages and design template Calculation of Air Quality Health Index Provincial policies Provincial policies to implement new Index Federal policy Federal policy to support process to develop AQHI- Government, Researchers, NGOs, Healthcare Professionals Publichealth professionals education Public, health professionals and multi-stakeholder education to understand and use Index Public actions to reduce exposure Health risk from air pollution Research Research- Is the AQHI effective? Reduced Ambient air quality monitors

10. www. airhealth.ca www. coteairsante.ca

11. The new AQHI encourages people to assess their own symptoms when air quality is poor “I’m sorry, I didn’t hear what you said. I was listening to my body.”

12. What Health Professionals Can Do  Include exposure history during diagnosis  Provide general public prevention education especially during preconception and pregnancy– awareness and advice on avoidance of toxins  Include toxic reduction and avoidance education for patients  As individuals and through professional associations, support legislation and policies that reduce the use and release of toxic chemicals Links to information-rich websites are available on the Information Portal at www. cnhhe-rcshe.ca