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Ethical issues in international environmental health research.

Environmental health problems are among the world's most significant health concerns. Although environmental risks are experienced disproportionately by people in developing countries, environmental health research (EHR) is conducted primarily in developed countries. Human subjects participate in five main types of EHR: (1) documentation and quantification of exposure to potentially hazardous substances; (2) elucidation of biological responses to these materials; (3) characterization and measurement of susceptibility to harmful effects of hazardous materials; (4) trials involving environmental interventions to reduce risk; and (5) documentation and measurement of various manifestations of disease putatively linked to environmental exposures. Although existing frameworks for the ethics of international clinical research are generally relevant to EHR, they currently lack the specificity necessary to confront three inherent problems in EHR, namely under-determination in EHR findings, the unavoidable nature of some environmental hazards, and environmental justice implications. We examine these issues as they relate to community partnership, risk assessment, and the assessment and management of economic and political interests in EHR. We believe that there are 3 general features of ethical EHR, it has health promoting value, the populations studied are not restricted in their ability to avoid environmental hazards by economic or political repression, and the justification for conducting EHR on populations with known exposure to environmental hazards gets stronger as the limits on populations to reduce the hazards or remove themselves from them becomes greater, as long as the first and second conditions are also met.

Bioethical Issues↗

Social determinants of health: implications for environmental health promotion.

In this article, the authors draw on the disciplines of sociology and environmental and social epidemiology to further understanding of mechanisms through which social factors contribute to disparate environmental exposures and health inequalities. They propose a conceptual framework for environmental health promotion that considers dynamic social processes through which social and environmental inequalities--and associated health disparities--are produced, reproduced, and potentially transformed. Using empirical evidence from the published literature, as well as their own practical experiences in conducting community-based participatory research in Detroit and Harlem, the authors examine health promotion interventions at various levels (community-wide, regional, and national) that aim to improve population health by addressing various aspects of social processes and/or physical environments. Finally, they recommend moving beyond environmental remediation strategies toward environmental health promotion efforts that are sustainable and explicitly designed to reduce social, environmental, and health inequalities.

Community Health Planning↗

Preventing person-to-person spread following gastrointestinal infections: guidelines for public health physicians and environmental health officers.

This guidance updates advice on preventing person-to-person spread of gastrointestinal infections in the general population, first published in 1983 by the Public Health Laboratory Service and last updated in 1995. It represents a consensus of informed opinion and is particularly aimed at those public health physicians and environmental health officers who do not specialise in communicable disease control. It addresses predominantly the organisms that more commonly present them with problems. The guidance considers general measures, enteric precautions, exclusion from work, school and other settings and groups that pose an increased risk of spreading infection.

Communicable Disease Control↗

Management of environmental health issues for the 2004 Athens Olympic Games: is enhanced integrated environmental health surveillance needed in every day routine operation?

BACKGROUND: Management of environmental health issues is an integral part of public health systems. An active integrated environmental health surveillance and response system was developed for the Athens Olympics to monitor and prevent exposure to environmental hazards. The potential for permanent implementation of the program was examined. METHODS: The environmental health surveillance and response system included standardization, computerization and electronic transmission of data concerning environmental inspections of 17 site categories (restaurants, swimming pools etc) of public health interest, drinking and recreational water examinations and suggested corrective actions. The Olympic Planning Unit integrated and centrally managed data from 13 public health agencies, recommended, supervised and coordinated prompt corrective actions. Methods used to test the effectiveness of the program were the assessment of water quality test and inspection results trends over time using linear regression and epidemiological surveillance findings. RESULTS: Between January 2003 and September the 30th, 2004, 196 inspectors conducted 8562 inspections, collected 5024 water samples and recommended 17 027 corrective actions. In 10 cruise ships used as floating hotels inspectors conducted 10 full inspections, 2 re-inspections, and 27 follow-up inspections. Unsatisfactory inspection results (r = 0.44, p < 0.0001) and positive water quality tests (r = 0.39, p < 0.001) presented an overall decrease trend over time. In August, 2003, an outbreak of salmonellosis was linked to a hotel restaurant which accommodated athletes during a test event. CONCLUSION: Lessons learned for future events include timely implementation and installation of communication processes, and rapid and coordinated response to unsatisfactory inspection results. Routine national programs need to adopt enhanced environmental health surveillance aimed at public health decision-making, but with a different perspective.

Accident Prevention↗

Ethical issues in environmental health research.

Environmental health research encompasses a wide range of investigational topics, study designs, and empirical methodologies. As that arm of public health research concerned with understanding the health effects of the many environments in which humans live and work, the field is intimately connected with social concerns about environmental quality and disparities of power and privilege that place differential burdens upon members of underserved communities. Environmental health researchers thus engage many ethical and social issues in the work they do. These issues relate to the choice of research topics to study, the methods employed to examine these topics, the communication of research findings to the public, and the involvement of scientific experts in the shaping of environmental policy and governmental regulation. These and other topics are reviewed in this article. These ethical, legal, and social issues are becoming increasingly more complex as new genetic and molecular techniques are used to study environmental toxicants and their potential influence on human and ecologic health.

Environmental Exposure↗

The riskscape and the color line: examining the role of segregation in environmental health disparities.

Environmental health researchers, sociologists, policy-makers, and activists concerned about environmental justice argue that communities of color who are segregated in neighborhoods with high levels of poverty and material deprivation are also disproportionately exposed to physical environments that adversely affect their health and well-being. Examining these issues through the lens of racial residential segregation can offer new insights into the junctures of the political economy of social inequality with discrimination, environmental degradation, and health. More importantly, this line of inquiry may highlight whether observed pollution--health outcome relationships are modified by segregation and whether segregation patterns impact diverse communities differently. This paper examines theoretical and methodological questions related to racial residential segregation and environmental health disparities. We begin with an overview of race-based segregation in the United States and propose a framework for understanding its implications for environmental health disparities. We then discuss applications of segregation measures for assessing disparities in ambient air pollution burdens across racial groups and go on to discuss the applicability of these methods for other environmental exposures and health outcomes. We conclude with a discussion of the research and policy implications of understanding how racial residential segregation impacts environmental health disparities.

Air Pollution↗

An integrative model for environmental health research.

Environmental health research must achieve an integration of understanding, reaching from physiological research on health effects of toxic agents to actions that people may take, individually and collaboratively, to reduce their risks. This article proposes an integrative model of environmental health, encompassing four broad domains and their interrelationships: physiological, vulnerability, epistemological, and health protection. If we wish to empower communities to make the tough decisions necessary to truly protect the well-being of their most vulnerable members, each domain must be attended to, and links between scientific knowledge and social processes must be understood.

Environmental Exposure↗

Chattanooga Creek: case study of the public health nursing role in environmental health.

Public health nurses have two primary roles in protecting their communities from hazardous substances: community assessment and health education. Developing assessment skills in environmental health enables public health nurses to collaborate with other federal, state, and county agencies in identifying public health hazards and making health-based recommendations at hazardous waste sites needing remedial or removal interventions. Community health education empowers communities to minimize their exposure to hazardous wastes in their environment. Methods for community environmental health assessment and interventions are demonstrated in this article by activities conducted at the Chattanooga Creek site in Chattanooga, Tennessee. A thorough assessment and collaborative approach between government agencies, local health professionals, and community members resulted in a successful community health education program and this site's placement on the National Priorities List.

Environmental Health↗

Environmental health training within public health medicine.

Environmental health was reported in the UK Acheson Report to have 'become something of a backwater for public health doctors'. In this review, the background educational issues are explored, present postgraduate training opportunities are identified, and intersectoral approaches in Europe that support the WHO Health for All strategy, are outlined. It is anticipated that closer links between epidemiology, clinical practice and environmental protection in the 'new' public health will help to improve medical interest and input to environmental health.

Curriculum↗

Training in environmental health research for action: the Shanghai-California Environmental Health Training Program.

The Shanghai Center for Disease Control and Prevention (SCDC) was created in 1998; in 2001, with support from Fogarty International Center, the intergovernmental Shanghai-California Environmental Health Training Program was formed. Providing U.S.-based training to SCDC managers allows them to return to Shanghai and share their knowledge. Indexing Chinese journals will enable more exchange of information and will support improvements in Chinese scholarship. Increased international contact will result in greater trust and more rapid warnings to international colleagues, with resultant faster responses to emerging public health threats. Building research capacity in SCDC will allow for more rapid translation of results to policy. The progress of the Program toward establishing a regional (Shanghai) biological specimen bank is an example of building institutional capacity to enhance research that can serve as a lasting foundation for public health research and policy decisions in both Shanghai and China.

California↗

Does Dixon's Integrative Environmental Health Model inform an understanding of rural parents' perceptions of local environmental health risks?

A qualitative study of parents' perceptions of local environmental health risks was conducted to assess the fit between concepts from Dixon's Integrative Environmental Health Model (DIEH model) and field-generated data. This research was part of a prospective study addressing environmental exposures of rural low-income children. Home visit data from 11 parents were analyzed (1) thematically and (2) according to DIEH concepts. These complementary analyses allowed the researchers to examine perceptions that were congruent with or diverged from the DIEH model. Findings revealed that participants were concerned about children's exposure to pathogenic molds and cigarette smoke and felt uninformed about risks and prevention strategies. Barriers to preventive actions included families' lack of time and a disinterest in brochures. Participants reported being "stuck" in substandard housing by poverty and family demands. They expressed concern about risks, but were unsure "what to worry about." Results provided the researchers with confidence that the DIEH model aligned with participants' cognitive constructions of risk. As a result, the DIEH model was incorporated into the conceptualization for the clinical trial phase of the study. This type of check between a theoretical approach and field data can be a helpful intermediate step for researchers involved in multiyear studies.

Adult↗

Children's environmental health research--highlights from the Columbia Center for Children's Environmental Health.

A growing body of evidence has been generated indicating that the fetus, infant, and young child are especially susceptible to environmental toxicants as diverse as polycyclic aromatic hydrocarbons (PAHs), pesticides, lead, mercury, polychlorinated biphenyls (PCBs), and environmental tobacco smoke (ETS). Exposures to these toxicants may be related to the increases in recent decades in childhood asthma, cancer, and developmental disability. The Columbia Center for Children's Environmental Health (CCCEH), located in New York City, has developed four cohorts around the world to elucidate the relationships between these exposures and childhood illness. This article summarizes the recent findings from the Center's projects in the context of current research in children's environmental health.

Child↗

National environmental health measures for minority and low-income populations: tracking social disparities in environmental health.

Healthy People 2010 [US Department of Health and Human Services, 2004. Healthy People 2010. Available: http://www.healthypeople.gov/Publications/ [accessed May 22, 2004]] has established as a top priority the elimination of health disparities. Current research suggests that characteristics of the social, physical and built environment contribute to these disparities. In order to track progress and to assess the potential contributions of the various components of the "environment," tools specific to environmental health disparities are required. In this paper, we discuss one potential tool, a set of candidate measures that may be used to track disparities in outcomes, as well as measures that may be used analytically to assess potential causal pathways. Several other reports on health and environmental measures have been produced, including the Environmental Protection Agency's (EPA) America's Children and the Environment. However, there has not been a comprehensive discussion about environmental measures that focus on racial, ethnic and socioeconomic disparities in health. Therefore, we focus on measures specific to historically disadvantaged populations. Based on a conceptual framework that views health disparities as partially driven by differential access to resources and exposures to hazards, we group the measures into four categories: social processes, environmental contaminants/exposures, bodyburdens of environmental contaminants, and health outcomes. We provide a few examples to illustrate each category, including residential segregation, PM(2.5) exposures, blood mercury concentrations, and asthma morbidity and mortality. These measures and categories are derived from a review of environmental health disparities from several disciplines. As a next step in a long-term effort to better understand the relationship between social disadvantage, environment, and health disparities, we hope that the proposed measures and literature review serve as a foundation for future monitoring of environmental health disparities. These efforts may aid community organizations, local agencies, scientists and policy makers in allocating resources and developing interventions.

Asthma↗

The interaction between physical and social-psychological factors in indoor environmental health.

Indoor environmental health is now recognized as an important factor in preventing respiratory health problems in the United States. It is also a concern in Canada due to the amount of time that Canadians spend indoors because of cold weather and the potential for increased time indoors during the summer if the climate warms. The negative health effects are often labeled as sick building syndrome, but diagnosing a building or its occupants as sick is complicated by the variety of symptoms, the presence of chronic versus acute symptoms and social and psychological (socio-psychological) factors that may reduce the effectiveness of an engineering solution. As a case study, the contribution of various factors to indoor environmental health, in three buildings at the University of Toronto, was examined using five different methods. The results indicate that the inhabitants of the buildings consider features other than air quality in considering building health such as design, maintenance, funding cuts and socio-psychological factors.

Adult↗