INTRODUCTION TO ENVIRONMENTAL HEALTH/MEDICINE

Henroy P. Scarlett, MPH, BHSc. (Hons), DCH (Hons) PHI Lecturer Department of Community Health & Psychiatry UWI, Mona Tel. 927 2476/1752 henroy.scarlett@uwimona.edu.jm

Objectives
List and explain the major determinants of health Differentiate between environmental health and environmental medicine Outline the importance of environmental health/medicine Explain how chemicals enter into the environment

Objectives
Explain the role of the physician in environmental medicine Explain the factors to consider in human exposure to toxic chemicals Enumerate and explain the various categories of environmental hazards Explain the factors to consider in environmental toxicity Outline principles of environmental control

Major Determinants of Health

Socioeconomic determinants (income, education, occupation, family structure, sanitation, social support, racial discrimination) Personal behaviors and lifestyles Physical environment Access to and quality of health services Genetics

Environmental Health
Comprises those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social and psychological factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations (WHO Regional Office for Europe)

Environmental Health
Study of the effects upon human beings of external physical, chemical, and biologic factors in the general environment. Physical factors? Chemical factors? Biological factors? Social factors?

Environmental Medicine
Branch of medical science that addresses the impact of chemical and physical stressors on individuals and groups. (ACOEM)

Environmental Medicine
Focuses on evaluation, documentation, modification and prevention of environmental exposures Diagnostics, assessment and management of the individual patient or community

Why is it important?
Thousands of chemicals of known formula are currently used in agriculture, manufacturing and medical applications Pesticides are a major group of chemicals impacting human health and the environment Several new chemicals are synthesized weekly There is no scientific study of many chemicals released into our environment

The case of the US

US produces/imports close to 3,000 chemicals at over 1 million pounds/year EPA reviewed publicly available data on these chemicals and learnt that most of the chemicals may have never been tested to determine toxicity to humans or the environment International authorities agree that 6 basic tests are necessary for a minimum understanding of a chemicals toxicity

Six basic tests

These tests are called the Screening Information Data Set (SIDS), cover: - Acute toxicity - Chronic toxicity - Developmental and reproductive toxicity - Mutagenicity - Ecotoxicity - Environmental fate

Case of the US contd

93% of the 3,000 high production volume chemicals are missing one or more of the basic tests 43% of these chemicals are missing ALL of these tests Only 7% of these chemicals have all six of the most basic screening tests. (EPA)

Why is it important?
Humans are virtually never exposed to only one chemical The complexity of interactions among hazardous agents, the environment (including non-human life forms), and humans is so great that untoward and unexpected human outcomes, both good and bad can result from a chemical release to the environment

Why is it important?
Have you ever been concerned about how the environment may affect your health? or those of people you know? Consider the importance of cancer in todays society - Life time probability of developing and dying from cancer: males 41.2% and 27.4% respectively - Life time probability of developing and dying from cancer: females 37.6% and 23.1% respectively (National Cancer Institute of Canada, 2003)

Why is it important?
Up to 70% of cancers is preventable Preventable cancers have non-genetic cause, presumably are caused by environmental factors 4-20% of cancers are work-related Cancer is arguably the single most important end point for society with regard to environmental issues For the physician, What environmental exposures a patient may be concerned about?

Role of the physician

As medical investigators As communicators of risk

History of Environmental Health/Medicine

Environmental health (1950s) emerged after WW11 as a public health discipline to study the control of environmental factors harmful to human health, focus on sanitation and control of communicable diseases Environmental science (1960s) Pollution in air, water and soil did not emerge as a discipline until 1960s

History
Environmental medicine (1970s) - Preventive and clinical arm of environmental health - Focus on how pollution enter the body and cause harm

How do people get exposed?

Four (4) important considerations: - Route - Magnitude - Duration of exposure - Frequency

How do people get exposed?

Five (5) important diagnostic complications: - Multiple factorial etiology - Lack of specificity - Host susceptibility - Latency - Complexity

Types of environmental hazards

A. Outdoor air pollutants: - Approximately 150 million US citizens live in areas that do not meet standards for air pollution - Largest single source is transportation - Major chemicals of concern: Particulate matter (PM10 and PM 2.5); sulfur dioxide; nitrogen dioxide; carbon monoxide; ozone; lead

Types of environmental hazards

B. Indoor air pollutants: - Volatile organics: benzene in tobacco smoke; perchlorethylene in dry-cleaned upholstery and clothes; formaldehyde in carpets and building materials - Odorants (fragrances & deodorizers): in the fragrance industry there are known mutagens used; likely reproductive toxins; tumor causing chemicals; eye and skin irritants - Biological agents: many associated with allergies-animal dander, dust mites, cockroach allergen; airborne bacteria and viruses

Types of environmental hazards

C. Water pollutants: - Untreated sewage - Oil spills - Ocean dumping of nuclear wastes - Agricultural waste - Industrial wastes

Types of environmental hazards

D. Land and soil pollutants: - Solid waste leachate from landfills - Hazardous waste: Halogenated hydrocarbons (TCE, chloroform, PCBs); Aromatic hydrocarbons (Toluene, benzene, xylene); Metals (Pb, Zn, Cd, As, Cr, Cu, Hg) - Mining wastes; nuclear wastes; nitrates from fertilizers

Environmental Hazards
Site & location (natural hazards) Biological Chemical Physical Sociological and psychological (Diverse environments)

Site and Location

Natural hazards Occupancy of suspect locations Vulnerability issues including contributory human activities Disaster management & mitigation measures Physical planning & zoning considerations

Biological
Infections or parasitic diseases. >50% of diseases attributable to water, food or soil contaminated by human excreta. About 25% believed to be caused by disease-carrying vectors (mosquitoes, flies, rodents, fleas, etc.)

Chemicals
Chemicals ingested (additives, preservatives,
adulterants, residues, pica, etc)

Pollutants inhaled (diverse environments) Skin and ocular exposures Exposure settings (domestic, environmental, occupational) Exposure pathways

Concepts in Toxicology
Toxicology & toxicity Branches of toxicology Toxicity vs. hazard Dose-response relationships Acute vs. chronic exposures

Dose Response Relationships

.
Response

B A

Dose

Factors in Environmental toxicity (1)

Factors related to the toxic agent Chemical composition & reactivity Physical characteristics Presence of impurities or contaminants Stability & storage characteristics Availability of a vehicle to carry the agent Movement of agent through the environment into cells

Factors in Environmental toxicity (2)

Solubility Bioaccumulation and biomagnification Persistence Chemical interactions

Factors related to Exposure

Dose (conc. & volume) Route, rate and site of exposure Duration and frequency of exposure Time of exposure (time of day, season, year)

Host Factors (1)

Resistance to uptake, storage or cell permeability Ability to metabolize, inactivate, sequester, or eliminate agent Tendency to activate or alter nontoxic substances so they become toxic Concurrent infections or physical or chemical stress

Host Factors (2)

Species and genetic characteristics of host Nutritional status of subject Age, sex, body weight, immunological status and maturity

Physical
Temperature & humidity Electromagnetic radiation Mechanical vibration and noise Changes in atmospheric pressure Non-chemically active dusts ??

Sociological and Psychological

Definition issues- unlike biological, chemical Recognition of its importance in any total consideration of mans environment Need for more definitive research into these parameters of environmental design Multi-factorial etiology, lack of specificity, individual susceptibility, etc

Health Risk Assessment

Primary focus on long-term exposures to hazardous substances Upfront-planning critical for success Critical considerations
Types of decisions being considered? What is at stake? What is driving the decision? (Human health vs. ecological risks) What are the uses & who are the users of RA data What is the scope of the assessment?

Risk Assessment & Management Model

Data Analysis & Hazard identification

Dose-response or toxicity assessment Risk characterization

Exposure assessment

Principles of environmental control

Prevention Substitution Isolation (separation by distance or barriers) Ventilation Treatment (destruction, conversion, removal & inhibition) Administrative

Prevention is key
Public health (Environmental health) (prevention)

Environmental Quality (preservation)

Human health & wellbeing

Disease/disability care (treatment)

QUESTIONS ???