environmental health – part i: an introduction john mulvaney, mha, ph.d. student walden university...
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Environmental Health – Part I:An Introduction
John Mulvaney, MHA, Ph.D. studentWalden University
PH 8165-4Instructor: Dr. Raymond Thron
Spring, 2009
Outline
Brief video Introduction to environmental health
– Definition(s)– Types of Hazards– Regulation
Discussion
Introduction
What is meant by environmental health (EH)?
Introduction
There are a number of “acceptable” definitions for the environment as it relates to health:
– Inner vs. Outer Environment: in this context, the environment is described in terms of within our bodies (inner) and external to our bodies (outer).
– Personal vs. Ambient Environment: differentiates based upon the environment we control (personal) and the environment in which we have very little or no control (ambient/work/outside).
– Gaseous, Liquid, and Solid Environments: describes the environment in terms of the state of matter (solid, liquid, gas) and how they interact with people (Moeller, 2005).
Introduction
Yet another, more encompassing definition is one that includes (Moeller, 2005):– Chemical Factors– Biological Factors– Physical Factors– Socioeconomic Factors
Introduction
Types of environmental hazards:– Radiation– Mercury– Lead– Pesticides– Industrial Chemicals– Violence?
Figure 1: Interaction with humans
Water:GI Tract
Skin
GI Tract:SkinSoil
Food:GI Tract
Air:LungsSkin
Human Being
Source: Moeller, 2005
Introduction
Environmental Hazards: Radiation
Ultraviolet light from the sun – skin cancer and melanoma
Radon gas – natural radioactivity – lung cancer? Early scandals with patent medicines and radium led
to regulation X rays used in medicine and dentistry Lessons on health effects of radiation learned from
atomic bombings in Japan
Environmental Hazards: Lead
Harmful to brain and nervous system, especially of children Contamination of drinking water by lead pipes and lead solder
for copper pipes Air pollutant from use in gasoline until banned in the 1980s Was used in paint until 1977 – still a threat in old housing –
peeling paint or contaminated dust Young children should be screened for blood lead levels
– Permissible levels have been steadily lowered
Source:
Schneider, M. (2006). Introduction to public health, second edition. Jones & Bartlett: Sudburry, MA.
Environmental Hazards: Pesticides
Pesticides and Industrial Chemicals Rachel Carson’s Silent Spring – 1962 – beginning of environmental
movement DDT and other pesticides– now banned PCBs – industrial uses
– Hudson River – contaminates fish– Yusho accident (Japan) – contamination of cooking oil – other similar
accidents– Production halted in US by 1977
Endocrine disrupters, affect reproduction, nervous system, immune system, maybe cancer
Soluble in fat, persist in environment, very stable
Source: Schneider, M. (2006). Introduction to public health, second edition. Jones &
Bartlett: Sudburry, MA.
Environmental Hazards
If interested in further information relating to these and other hazards please see the following:
Koller, K., et al, Recent Developments in Low-Level Exposure and Intellectual Impairment in Children. Environmental Health Perspectives, 112 (2004): 987-994
Clarkson, T. The Three Modern Faces of Mercury. Environmental Health Perspectives 110, Suppl. 1 (2002): 11-23
Alavanja, M., et al. Health Effects of Chronic Pesticide Exposure: Cancer and Neurotoxicity. Annual Review of Public Health 25 (2004): 155-197
Centers for Disease Control and Prevention. Third National Report on Human Exposure to Environmental Chemicals. Accessed at: http://www.cdc.gov/exposurereport/pdf/thirdreport.pdf on March 18, 2009.
Regulation
Regulation
Multitude of regulatory bodies involved with protection of the environment.
– Environmental Protection Agency http://www.epa.gov
– NIOSH (Occupational Safety)http://www.cdc.gov/niosh/
– Nuclear Regulatory Commissionhttp://www.nrc.gov
Laws/Regulations:– Clean Air Act– Clean Water Act– Executive Orders– Case law
EH cases that went to court and have had a judgment rendered. Can be used to set a precedent for other cases or rulemaking.
Environmental Health – Part II:Mitigating the law of unintended consequences. An application of systems thinking to environmental health.
John Mulvaney, MHA, Ph.D. studentWalden University
PH 8165 - 4Instructor: Dr. Raymond Thron
Spring, 2009
Outline
Law of unintended consequences Example:
– DDT and Malaria
A systems approach
Law of Unintended Consequences
Roughly equivalent to a really big “oops – didn’t see that one coming”
Similar concept in other disciplines:– Economics: externalities– Physics: Newton’s 2nd Law of Thermodynamics
For every action, there is an equal and opposite reaction
Example: DDT and Malaria
DDT had been used extensively to fight malaria since the 1940’s
Worked well for many years but…– 1972 book Silent Spring connected the use of
DDT with health effects on birds– Created a groundswell to eliminate the use of
DDT as a means of controlling the vector which spreads malaria (mosquito).
Example: DDT and Malaria
Dramatic increase in the number of reported cases and deaths from malaria from the 70’s forward (Roberts, 1997).
The alternative approach was to use non-DDT saturated bed nets (Economist, 2008).
Argument has been made that the ban was directly responsible?
Example: DDT and Malaria
The good news:– There is a strong push to make the eradication of
Malaria a reality– Realization that although DDT may have some
long-term effects, particularly in infants, the risks are not outweighed by benefits in the measured use of DDT in endemic countries (Mandavilli, 2006).
The Systems Approach
A systems approach makes reference to the concept of taking in the full picture with respect to an issue.
Draws from multiple disciplines in a concept that links the disciplines towards a common goal
Offers the public/environmental health community a “new frontier” in the ongoing effort to understand and prevent disease (Leischow, 2006).
The Systems Approach
More precisely:– Systems approaches draw from areas such as
control theory, social network theory, cellular automata, computational simulation…
– While the magnitude of approaches are vast, the concepts unify around a couple of core concepts
dynamics and complexity mechanical vs. biological (Trochim, 2006)
The Systems Approach
Trochim et al., 2006 – Used a concept mapping approach to
comprehend the vast literature regarding systems theory
– While there is a great deal of interest and momentum in systems theory in public health, there are some barriers/issues that need to be addressed
The Systems Approach
Concept mapping revealed 8 clusters of challenges– Support dynamic and diverse networks– Inspire integrative learning– Use systems measures and models– Foster systems planning and evaluation– Show potential of systems approaches– Explore systems paradigms and perspectives– Expand cross-category funding– Utilize systems incentives
The Systems Approach
How would a systems approach have changed the DDT scenario?
– Dynamics Account for the alternative of changes in genetic adaptation of
insects to build resistance to DDT Study and understand implications of banning a previously
effective strategy (prior to banning it)– Complexity
Understand the interactions of SES and disease as they relate to alternate strategies for Malaria eradication
If a more expensive alternative to DDT is developed, how will that impact the lesser developed countries in which the disease is endemic
The Systems Approach
Mechanics vs. Biology– Modeling the potential impact from a change in
use of DDT with bed nets– What are the biologic consequences to animal
populations, human populations, and the infectious agent from the different approach
The Systems Approach
Addressing the common misconceptions– Not a rejection of traditional scientific views
Actually enables a more broad and encompassing application of solid scientific evidence
– Does not lack scientific rigor Takes a more nuanced view of the situation Roots are based in mathematics, biology, physics
(Trochim, 2006)
The Systems Approach
Any questions?
References:
Leischow, S., & Milstein, B., (2006). Systems thinking and modeling for public health
practice. American Journal of Public Health,96(3), 403-405.
Mandavilli, A., (2006). DDT returns. Nature Medicine. 12(8), 870-871.
Roberts, D., Laughlin, L., Hsheih, P., &Legters, L., (1997). DDT, global strategies, and a malaria control crisis in South America. EmergingInfectious Diseases. 3(3), 295-302.
References:
The Economist, (2008). One quick shot may not be enough. April 10, 2008 edition. Accessed at: http://www.economist.com/world/internati
onal/displaystory.cfm?story_id=11019802
Trochim, W., Cabrera, D., Milstein, B., Gallagher, R., & Leischow, S., (2006).Practical challenges of systems thinking
and modeling in public health. American Journal of Public Health, 96(3), 538-546.
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