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PubMed1995

Environmental and policy approaches to cardiovascular disease prevention through nutrition: opportunities for state and local action.

This article reviews environmental and policy intervention approaches to cardiovascular disease prevention through nutrition and recommends opportunities for state and local health departments to initiate and participate in environmental and nutrition policy initiatives. By addressing these complementary aims, the authors hope to stimulate further efforts to achieve progress in nutrition promotion among state and local health-related organizations. Key categories of opportunity to develop new or expanded nutrition policies and environmental strategies include economic incentives, food assistance and feeding programs, regulations for institutional food service operations, and nutrition services in health care. Environmental strategies to reduce barriers to following dietary guidelines, such as point-of-choice programs and school nutrition programs, should be tailored for local communities and widely disseminated. In addition, current federal policy efforts, notably nutrition labeling rules, will provide a valuable focal point for state and local advocacy, education, and monitoring.

Cardiovascular Diseases↗
PubMed2004

Policy and environmental indicators for heart disease and stroke prevention: data sources in two states.

INTRODUCTION: Investigators in South Carolina and Alabama assessed the availability of data for measuring 31 policy and environmental indicators for heart disease and stroke prevention. The indicators were intended to determine policy and environmental support for adopting heart disease and stroke prevention guidelines and selected risk factors in 4 settings: community, school, work site, and health care. METHODS: Research teams used literature searches and key informant interviews to explore the availability of data sources for each indicator. Investigators documented the following 5 qualities for each data source identified: 1) the degree to which the data fit the indicator; 2) the frequency and regularity with which data were collected; 3) the consistency of data collected across time; 4) the costs (time, money, personnel) associated with data collection or access; and 5) the accessibility of data. RESULTS: Among the 31 indicators, 11 (35%) have readily available data sources and 4 (13%) have sources that could provide partial measurement. Data sources are available for most indicators in the school setting and for tobacco control policies in all settings. CONCLUSION: Data sources for measuring policy and environmental indicators for heart disease and stroke prevention are limited in availability. Effort and resources are required to develop and implement mechanisms for collecting state and local data on policy and environmental indicators in different settings. The level of work needed to expand data sources is comparable to the extensive work already completed in the school setting and for tobacco control.

Alabama↗
PubMed1995

Environmental and policy interventions to control tobacco use and prevent cardiovascular disease.

Despite its declining prevalence during the past few decades, tobacco use remains one of the most significant public health issues of the 1990s. Environmental and policy interventions are among the most cost-effective approaches to control tobacco use and prevent cardiovascular diseases. In this article, the authors review and offer to state and local health departments and other public health partners a summary of recommended policy and environmental interventions that have either reduced or show potential to reduce tobacco use. Priority recommendations include clean indoor air policies, restrictions on tobacco advertising and promotion, policies limiting youth access to tobacco, comprehensive school health programs, and excise taxes and other economic incentives. Many of these recommendations should be integrated with other health promotion interventions to also improve nutrition and physical activity. The authors also highlight several successful interventions and strategies used to establish policies at the state and local levels.

Adolescent↗
PubMed2006

Environmental performance policy indicators for the public sector: the case of the defence sector.

The development of environmental performance policy indicators for public services, and in particular for the defence sector, is an emerging issue. Despite a number of recent initiatives there has been little work done in this area, since the other sectors usually focused on are agriculture, transport, industry, tourism and energy. This type of tool can be an important component for environmental performance evaluation at policy level, when integrated in the general performance assessment system of public missions and activities. The main objective of this research was to develop environmental performance policy indicators for the public sector, specifically applied to the defence sector. Previous research included an assessment of the environmental profile, through the evaluation of how environmental management practices have been adopted in this sector and an assessment of environmental aspects and impacts. This paper builds upon that previous research, developing an indicator framework--SEPI--supported by the selection and construction of environmental performance indicators. Another aim is to discuss how the current environmental indicator framework can be integrated into overall performance management. The Portuguese defence sector is presented and the usefulness of this methodology demonstrated. Feasibility and relevancy criteria are applied to evaluate the set of indicators proposed, allowing indicators to be scored and indicators for the policy level to be obtained.

Conservation of Natural Resources↗
PubMed2005

Policy perspectives in environmental health: nursing's evolving role.

The nursing community has become increasingly active in the environmental health policy arena by exerting its influence at the local, state, and national environmental health policy levels; on media-specific issues; and in the work-related venues where they have influence. Nurses are valued and trusted by policy makers, and should be active in policy efforts to increase access to public health information such as potentially hazardous chemicals in the air, water, food, soil, and land. Given the global nature of environmental contamination, it is critical that nursing's international organization becomes active in environmental health policies. Promotion of healthy environments should be translated to organizational position papers and practice recommendations within nursing and nursing specialty organizations.

Environmental Health↗
PubMed1990

Prologue: agricultural occupational and environmental health: policy strategies for the future.

The conference "Agricultural Occupational and Environmental Health: Policy Strategies for the Future" documented for the public record the epidemic of occupational and environmental deaths, diseases, and injuries experienced by America's farm families and agricultural workers. The conference also gave life to a process aimed at reducing those hazards. The outcome of long-range objectives of lowering death, injury, and disease rates in our agricultural population will not be known for several years. However, there was unanimous consensus that the major short-range objectives were achieved. Extensive regional and national media coverage helped meet the goal of facilitating public awareness of the issues. In addition, a prioritized policy agenda, soundly based on recent scientific information, was produced. This agenda was the product of collaboration between the scientific community, farm constituency groups, farm equipment and chemical manufacturers, and representatives from state and federal governments. Primary changes resulting from the conference include an increase in general awareness and a sense of urgency that agricultural health problems must be addressed. In addition, the conference spawned a new organization called the National Coalition for Agricultural Safety and Health (N-CASH) to help assure a vibrant continuation of conference issues. This coalition will live on to help disseminate the spirit, information, and specific policy recommendations of the conference to the public sector and private institutions. Two years of planning and work by 18 individuals occurred even before the start of the conference. During the conference, 176 individuals put in an equivalent of three and a half person years of work. However, the work is just beginning. This effort is justified if it results in one less death or serious injury in a farm family.

Accidents, Occupational↗
PubMed2001

Environmental and policy determinants of physical activity in the United States.

OBJECTIVES: This study examined (1) descriptive patterns in perceived environmental and policy determinants of physical activity and (2) associations between these factors and behavior. METHODS: A cross-sectional study was conducted from 1999 to 2000 among US adults; individuals at lower income levels were oversampled. RESULTS: Availability of areas for physical activity was generally higher among men than among women. The 4 most commonly reported personal barriers were lack of time, feeling too tired, obtaining enough exercise at one's job, and no motivation to exercise. Neighborhood characteristics, including the presence of sidewalks, enjoyable scenery, heavy traffic, and hills, were positively associated with physical activity. There was a high level of support for health policy-related measures. Up to one third of individuals who had used environmental supports reported an increase in physical activity. CONCLUSIONS: An array of environmental and policy determinants, particularly those related to the physical environment, are associated with physical activity and should be taken into account in the design of interventions.

Adolescent↗
PubMed1991

[Veterinary practice and the environment: what to do and what to omit].

A veterinary practice supplies services and goods, both sections involving acts affecting the environment. Until recently, little attention was paid to the environment, but today far more is known concerning the manner in which veterinary practices should handle the environment. Among other things, this paper will be concerned with the groups of various substances which constitute a menace to the environment, the relevant environmental policy as well as the approach to environmental policy in practice and to the function of the veterinary surgeon as distributor of veterinary drugs respectively. Instruction of the users of veterinary drugs as regards storage and exposure to pollution are discussed. Finally, the economic aspects of a modern environmental policy in veterinary practice are referred to.

Environmental Pollution↗
PubMedDate not supplied

Environmental and policy factors associated with overweight among adults in Missouri.

PURPOSE: To measure the association between environmental and policy factors (i.e., community perceptions, community infrastructure, and worksite infrastructure) and being overweight. DESIGN: Cross-sectional data from the Missouri Cardiovascular Disease Survey, a one-time random-digit-dialed telephone interview of noninstitutionalized adults. SETTING: Missouri, 1999 to 2000. SUBJECTS: The response rate was 69.6%. A total of 2821 adults completed the interview. The sample was weighted to represent the population of Missouri: 52% female, 71% white, and 59% overweight. MEASURES: The survey comprised 92 closed-ended multiple-choice items. Overweight was defined as a body mass index greater than or equal to 25 kg/m2 on the basis of self-reported height and weight. RESULTS: After adjustment for demographic and behavioral factors, environmental variables associated with being overweight included negative (i.e., unsafe and unpleasant) community perceptions (adjusted odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1, 2.3) and the absence of outdoor exercise facilities (OR = 1.2; CI = 1.0, 1.5). Worksite policy variables were not related to the outcome; however, negative community perceptions (OR = 2.8; CI = 1.5, 5.2) and the absence of sidewalks and shoulders (OR = 1.7; CI = 1.3, 2.4) were associated with overweight among employed persons. CONCLUSIONS: An ecological perspective, focusing on the physical and social environment, was adopted to address the subject of overweight and obesity. Results of this study show that negative perceptions of the physical environment and the absence of enabling infrastructure are modestly associated with overweight, in comparison with other known risk factors. Environmental and policy interventions that promote healthier lifestyles by encouraging physical activity and healthy eating may have an effect on reducing the prevalence of overweight and obesity.

Adolescent↗
PubMed2002

Water policy differences between a western democracy and a country in economic transition.

Where environmental policy is concerned Western democracies and transition economies share more similarities than differences. Sound environmental policies require substantial investment. Public-private cooperation can play a major role in the search for solutions, but politicians, environmentalists and academics must act vigorously to ensure that big business does not acquire a final say in the implementation of environmental policy. Lithuania as a transition economy faces major environmental challenges, but international collaboration, including working with the European Union and cross-border cooperation with neighbouring states, is bringing good results. A major unifying factor for the Baltic Sea states is the continuing struggle to purify and protect the Baltic Sea.

Baltic States↗
PubMed2005

Uncertainty of air pollution cost estimates: to what extent does it matter?

How large is the social cost penalty if one makes the wrong choice because of uncertainties in the estimates of the costs and benefits of environmental policy measures? For discrete choices there is no general rule other than the recommendation to always carefully compare costs and benefits when introducing policies for environmental protection. For continuous choices (e.g., the ceiling for the total emissions of a pollutant by an entire sector or region), it is instructive to look at the cost penalty as a function of the error in the incremental damage cost estimate. Using abatement cost curves for NOx, SO2, dioxins, and CO2, this paper evaluates the cost penalty for errors in the following: national emission ceilings for NOx and SO2 in each of 12 countries of Europe, an emission ceiling for dioxins in the UK, and limits for the emission of CO2 in Europe. The cost penalty turns out to be remarkably insensitive to errors. An error by a factor of 3 due to uncertainties in the damage estimates for NOx and SO2 increases the total social cost by at most 20% and in most cases much less. For dioxins, the total social cost is increased by at most 10%. For CO2, several different possible cost curves are examined: for some the sensitivity to uncertainties is greater than for the other pollutants, but even here the penalty is less than 30% and in most cases much less if the true damage costs are twice as high as the ones estimated. The paper also quantifies the benefit of improving the accuracy of damage cost estimates by further research.

Air Pollutants↗
PubMed2002

Environmental and policy factors related to physical activity in rural white women.

Physical activity is an important aspect of health promotion and disease prevention. However, women often have lower rates of physical activity than men. The purpose of this study was to identify environmental and policy determinants to physical activity among rural white women. Six focus groups were conducted with women aged 20-50 years who were not currently regular exercisers. Women reported that the social environment had a strong impact on physical activity level. Factors of the social environment included guilt, family responsibility, and social support. Environmental and policy barriers such as lack of access to places to exercise and safety concerns were also discussed. Intervention suggestions included family exercise and work-site programs. Information gained from this study can be used to fuel further research and inform future physical activity interventions.

Adult↗
PubMed2003

The need for global environmental health policy.

The world economy has been growing by an average of 3.5% a year. Continued global development is sustainable if overall social assets remain constant or rise over time, including manufactured, human, and environmental capital. Sustainable development requires that society not decrease its overall assets. But unregulated global trade may result in long-term loss of environmental capital. Multilateral governance is needed. Classical business models tend to view environmental damage as an externality--an impact on a third party's welfare that is neither compensated nor appropriated. The Rio Declaration on Environment and Development clearly states that economic development must err on the side of environmental integrity. Whereas UN Environmental Program policy requires precaution in the face of scientific uncertainty, World Trade Organization policy requires scientific certainty before precaution can be used. The conflict is obvious. In fact, there is gross lack of policy coordination across institutions. This article looks at some environmental strains and concludes that trade policy must address all aspects of human welfare, not merely the economic.

Journal Article↗
PubMed2001

Quality adjusted life years (QALYs) and dose-response models in environmental health policy analysis -- methodological considerations.

Analyses of competing risks are currently limited by the lack of empirically well-founded and generalizable quantitative methods. Specifically, quantitative methods for comparative risk analysis require the consideration of the population impacted, the duration of impact, the health endpoints at risk, and the impact on individual quality of life. Whereas risk analysis can be used to provide quantitative estimates of disease incidence, environmental health policy analyses do not often account for differences in health impact from alternative disease states. We discuss the methodological issues related to the use of quality adjusted life years (QALY) as a metric for normalizing expected disease incidence to account for health impact. Through a case study of the risks and benefits of fish consumption, we demonstrate the use of QALY weights with dose-response models for environmental health policy decision making. We suggest that, although this approach can be generalized for use in comparative risk and health policy analysis, it is informationally intensive and requires additional assumptions to those used in traditional safety/risk assessment.

Adult↗
PubMedDate not supplied

Informing environmental health policy in urban areas: the HEADLAMP approach.

Urban areas represent complex environments in which to protect health. Accurate and highly resolved information is thus a prerequisite for effective environmental health policy. The HEADLAMP approach is designed to improve decision-making by providing indicators, based on sound science, to all relevant stakeholders, in an appropriate and usable form. The approach comprises three linked stages: categorization of the issues to be addressed, construction of relevant indicators, and policy formulation and implementation. Nevertheless, the application of this approach faces many challenges. The environment-health chain is both lengthy and complex, so that a wide range of indicators is needed from different points in this chain. The DPSEEA framework provides a useful, though limited, structure to help define and organize these indicators. This complexity also means that the indicators have to be linked, so that problems can be tracked from cause to effect and the effectiveness of actions at different points in the DPSEEA chain can be evaluated. Indicators also have to be designed in ways reflecting the spatial and temporal complexity of urban areas--namely, the rapid rates of change in urban environments and the marked spatial variations in environmental and sociodemographic conditions. Effective methods of participation are equally essential if the indicators are to represent the concerns of the stakeholders involved, and if decisions are to be made on a collective basis. Good indicators thus must be designed to fit many different and varying purposes. The challenge is to devise indicators that serve these purposes by representing the intricacies that are inherent in urban areas, rather than by hiding that complexity.

Data Collection↗
PubMed2006

Cross-national comparison of environmental and policy correlates of obesity in Europe.

BACKGROUND: Despite the growing agreement that modern environments fuel increased food consumption and decreased physical activity, few studies have addressed environmental and policy correlates of obesity. This study describes obesity patterns across Europe and identifies macroenvironmental factors associated with obesity prevalence at a national level. METHODS: Data on obesity prevalence and indicators of the physical, economic, and policy environment were assembled from international databases for 24 European countries. Coefficient estimates between overall, male, and female obesity prevalence and each independent variable were calculated using linear regression. RESULTS: The obesity prevalence varied widely across countries and between genders with higher values in Central and Eastern European countries and lower values in France, Italy, and some Scandinavian countries. Statistically significant inverse associations were observed between overall and female obesity prevalence and variables from the following domains: economic (real domestic product), food (available fat), urbanization (urban population), transport (passenger cars, price of gasoline, motorways), and policy (governance indicators). There was also a negative association between overall obesity and available fruits/vegetables, and between female obesity and single-member households. Male obesity was inversely associated with available fruits/vegetables and density of motorways. The magnitude of the coefficient estimates suggests stronger associations for female obesity than for male obesity in all cases. CONCLUSIONS: This exploratory study suggests a need to conduct additional research examining the role of obesogenic environments in European countries, with a special focus on policy-related variables, and to further study gender-specific differences in obesity and its correlates.

Cross-Cultural Comparison↗