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PubMed2004

Environmental health disparities: a framework integrating psychosocial and environmental concepts.

Although it is often acknowledged that social and environmental factors interact to produce racial and ethnic environmental health disparities, it is still unclear how this occurs. Despite continued controversy, the environmental justice movement has provided some insight by suggesting that disadvantaged communities face greater likelihood of exposure to ambient hazards. The exposure-disease paradigm has long suggested that differential "vulnerability" may modify the effects of toxicants on biological systems. However, relatively little work has been done to specify whether racial and ethnic minorities may have greater vulnerability than do majority populations and, further, what these vulnerabilities may be. We suggest that psychosocial stress may be the vulnerability factor that links social conditions with environmental hazards. Psychosocial stress can lead to acute and chronic changes in the functioning of body systems (e.g., immune) and also lead directly to illness. In this article we present a multidisciplinary framework integrating these ideas. We also argue that residential segregation leads to differential experiences of community stress, exposure to pollutants, and access to community resources. When not counterbalanced by resources, stressors may lead to heightened vulnerability to environmental hazards.

Environment↗
PubMed2004

Environmental health physics-50 years of progress.

Environmental health physics is an interdisciplinary field, involving study of the release, transport, and fate of radioactive material in the environment. Further, it addresses the interaction of humans with radioactive materials within the ambient (outdoor) environment and with the environments associated with modern technology and lifestyles. It also involves both naturally occurring and artificially produced radionuclides with the former generally being by far the highest source of exposure. In fact, doses from naturally occurring radionuclides are increasingly being used as a benchmark for the establishment of dose rate limits for people. Because of the pioneering work of early environmental health physicists, models exist today that can be used to assess the potential impacts of new nuclear facilities prior to their operation. In fact, these people represent the branch of the health physics profession who conducted environmental monitoring programs and performed the associated research studies that led to the identification of the principal radionuclides of interest, the major pathways and mechanisms through which they expose people, and the doses that may result from radioactive materials in the natural and technologically enhanced environments. One of their most important contributions was the identification and quantification of many of the key parameters that serve as input to such models. Monitoring of nuclear weapons development facilities used during and after World War II was the initial stimulus for the establishment of environmental health physics programs. Thereafter, these programs were expanded both nationally and globally, as a result of the atmospheric weapons testing programs of nations such as France, the People's Republic of China, the former Soviet Union, the United Kingdom, and the United States. Additional stimuli were provided by the development of the commercial nuclear power industry. Current environmental programs, particularly within the U.S., focus on decontamination and decommissioning of dormant facilities from these earlier defense and commercial programs. The range of the environmental health physics aspects of these activities is the subject of this paper. Presented at the end of the paper is a summary of some of the more important lessons that have been learned. As will be noted, this is an exciting field that will present challenges to health physicists for years to come.

Background Radiation↗
PubMed2005

Environmental health physics: 50 years of progress.

Environmental health physics is an interdisciplinary field, involving study of the release, transport, and fate of radioactive material in the environment. Further, it addresses the interaction of humans with radioactive materials within the ambient (outdoor) environment and with the environments associated with modern technology and lifestyles. It also involves both naturally occurring and artificially produced radionuclides with the former generally being by far the highest source of exposure. In fact, doses from naturally occurring radionuclides are increasingly being used as a benchmark for the establishment of dose rate limits for people. Because of the pioneering work of early environmental health physicists, models exist today that can be used to assess the potential impacts of new nuclear facilities prior to their operation. In fact, these people represent the branch of the health physics profession who conducted environmental monitoring programs and performed the associated research studies that led to the identification of the principal radionuclides of interest, the major pathways and mechanisms through which they expose people, and the doses that may result from radioactive materials in the natural and technologically enhanced environments. One of their most important contributions was the identification and quantification of many of the key parameters that serve as input to such models. Monitoring of nuclear weapons development facilities used during and after World War II was the initial stimulus for the establishment of environmental health physics programs. Thereafter, these programs were expanded both nationally and globally, as a result of the atmospheric weapons testing programs of nations such as France, the People's Republic of China, the former Soviet Union, the United Kingdom, and the United States. Additional stimuli were provided by the development of the commercial nuclear power industry. Current environmental programs, particularly within the U.S., focus on decontamination and decommissioning of dormant facilities from these earlier defense and commercial programs. The range of the environmental health physics aspects of these activities is the subject of this paper. Presented at the end of the paper is a summary of some of the more important lessons that have been learned. As will be noted, this is an exciting field that will present challenges to health physicists for years to come.

Background Radiation↗
PubMed2006

Paediatric environmental health history taking: why bother?

Environmental health history taking is often not part of standard medical history taking for clinical physicians. During recent years attention has been placed on home environments and asthma and allergies, high caloric intake and obesity and type 2 diabetes mellitus, yet environmental health history taking still remains relatively uncharted terrain for the clinical physicians of today. While the reasons for this are certainly varied, ignorance of environmental influences, ignorance of environmental pollutants, politics and prejudices will certainly play a role. We suggest a simple manner of environmental health history taking, and discuss the importance of the subject in our modern-day clinical practice.

Child↗
PubMed2006

Privacy and ethics in pediatric environmental health research-part I: genetic and prenatal testing.

The pressing need for empirically informed public policies aimed at understanding and promoting children's health has challenged environmental scientists to modify traditional research paradigms and reevaluate their roles and obligations toward research participants. Methodologic approaches to children's environmental health research raise ethical challenges for which federal regulations may provide insufficient guidance. In this article I begin with a general discussion of privacy concerns and informed consent within pediatric environmental health research contexts. I then turn to specific ethical challenges associated with research on genetic determinants of environmental risk, prenatal studies and maternal privacy, and data causing inflicted insight or affecting the informational rights of third parties.

Child↗
PubMed2006

Levels of analysis for the study of environmental health disparities.

Reducing racial/ethnic and socioeconomic environmental health disparities requires a comprehensive multilevel conceptual and quantitative approach that recognizes the various levels through which environmental health disparities are produced and perpetuated. We propose a conceptual framework that incorporates the micro level, contained within the local level, which in turn is contained within the macro level. We discuss the utility of multilevel techniques to examine environmental level (both physical and social) and individual-level factors to appropriately quantify and improve our understanding of environmental health disparities. We discuss the reasoning and the methodological approach behind multilevel modeling, including differentiating between individual and contextual influences on individual outcomes. Next we address the questions and principles that guide the choice of levels or geographic units in multilevel studies. Finally, we address the ways in which different data sources can be combined to produce suitable data for multilevel analyses. We provide some examples of how such data sources can be linked to create multilevel data structures, and offer suggestions to facilitate the integration of multilevel techniques in environmental health disparities research and monitoring.

Environmental Exposure↗
PubMedDate not supplied

Health, environmental assessments and population health: tools for a complex process.

Place is more than physical and natural environment. The role of biophysical environment has still to be articulated in population health discourse and its relations with human health are fraught with scientific uncertainty and dissension. An environmental impact assessment (EA) evaluates the environmental effects of a proposal--a rational and technical process. Sometimes health assessments are included, usually by quantitative risk assessments which are subject to the limits of scientific knowledge and bedevilled by data limitations. The goal must be to add health to the process, yet the relevant features to include are complex. Impacts are non-specific and they interact and have spatial and temporal characteristics. To integrate environment into population health, there is a need for a physical environment-health database and inter-sectorial policy and action. There is also a need for different types of indicators to measure process, impact and effectiveness, and for new tools (stories, photography) to account for context and values.

Canada↗
PubMed2002

Restoration, stewardship, environmental health, and policy: understanding stakeholders' perceptions.

In recent years there has been considerable interest in the health of humans and the environment, restoration of contaminated or otherwise degraded lands, and in long-term stewardship of public lands. Unfortunately, it is unclear whether governmental agencies and the public hold similar views about the meanings of these concepts, making policy decisions about restoration and stewardship difficult. In this paper, I explore how the public conceptualizes restoration and stewardship by examining the relative rating of several attributes of restoration, stewardship, environmental health, ecological health, environmental restoration, and ecological restoration. People were interviewed in Santa Fe, New Mexico, USA, near the Department of Energy's Los Alamos National Laboratory. The ratings of attributes of environmental health and ecological health reported in this paper can be used to understand how the public understands these concepts. The attributes rated most highly by the subjects were more similar to definitions in the scientific literature for these terms than they were to those used by the Department of Energy. For environmental health, the highest rating related to human sanitation, while for ecological health the highest rating was for maintaining functioning ecosystems. Reduction of exposure to hazardous substances was rated the second highest for both environmental and ecological health. The wise use of natural resources, preservation of natural resources, and hazardous waste site cleanup were rated the highest attributes of stewardship. These data suggest that both expert and nonexpert perceptions about restoration and stewardship should be incorporated into environmental management decisions.

Conservation of Natural Resources↗
PubMed1998

Environmental health. Catching up with the developed world.

Environmental health is the ecological balance that must exist between man and his environment in order to ensure his well-being. This paper describes the range of environmental hazards (physical, biological, chemical and social) and discusses the differences in level and quality of environmental health programmes between developed and developing countries. The hazards are the same in both realms; the difference is in the level of advocacy and, thus, the demand for implementation of sound environmental health policies and practices. Issues which developing countries need to address to improve environmental health management are outlined.

Consumer Advocacy↗
PubMed2000

Evaluation and use of epidemiological evidence for environmental health risk assessment: WHO guideline document.

Environmental health risk assessment is increasingly being used in the development of environmental health policies, public health decision making, the establishment of environmental regulations, and research planning. The credibility of risk assessment depends, to a large extent, on the strength of the scientific evidence on which it is based. It is, therefore, imperative that the processes and methods used to evaluate the evidence and estimate health risks are clear, explicit, and based on valid epidemiological theory and practice. Epidemiological Evidence for Environmental Health Risk Assessment is a World Health Organization (WHO) guideline document. The primary target audiences of the guidelines are expert review groups that WHO (or other organizations) might convene in the future to evaluate epidemiological evidence on the health effects of environmental factors. These guidelines identify a set of processes and general approaches to assess available epidemiological information in a clear, consistent, and explicit manner. The guidelines should also help in the evaluation of epidemiological studies with respect to their ability to support risk assessment and, consequently, risk management. Conducting expert reviews according to such explicit guidelines would make health risk assessment and subsequent risk management and risk communication processes more readily understood and likely to be accepted by policymakers and the public. It would also make the conclusions reached by reviews more readily acceptable as a basis for future WHO guidelines and other recommendations, and would provide a more rational basis for setting priorities for future research.

Environmental Health↗
PubMed2004

Environmental health indicators in policy evaluation.

In carrying out two projects involving environmental health indicators--a national environmental health programme evaluation and an international environmental health indicator system--in parallel, it became apparent that an international indicator set has limitations regarding the evaluation of a national programme such as the Swiss National Environment and Health Action Plan (NEHAP). The international indicator set proposed by WHO serves the structured description of the underlying cause-effect chains, allows an integrated monitoring of the general environment and health situation and provides valuable international comparisons. However, the relevance of an international indicator set varies in the national context. Moreover, it does not allow the evaluation of a national implementation process, which is highly important in assessing success or failure of an environmental health promotion programme. For a comprehensive evaluation of such a programme, a specific evaluation concept derived from the formulated goals and targets needs to be developed with emphasis on evaluation of the implementation process.

Environmental Health↗
PubMed1998

Environmental health concerns in urban and rural family practice.

OBJECTIVE: To describe environmental health problems encountered in some Ontario family practices and to describe differences between the environmental concerns of urban (small and large) and rural physicians. DESIGN: A self-completed questionnaire was mailed to 536 family physicians with hospital affiliations in three areas of Ontario. SETTING: Family practices (rural, small urban, and large urban) in Ontario. PARTICIPANTS: Of 521 eligible community family physicians with hospital affiliations, 214 returned usable questionnaires for a 41% response rate. MAIN OUTCOME MEASURES: Environmental health problems encountered in practice were measured using questions about physician concerns, reported patient questions, physician-identified high-risk groups, problems related to environmental exposure, self-rated knowledge, and current and preferred sources of information on environmental health effects. RESULTS: Physicians were highly concerned and reported many patient questions about the health effects of environmental exposures. Pregnant women, agricultural workers, and children were considered important at-risk groups. Self-ratings of knowledge were generally very low. Rural physicians were concerned about agricultural pesticide exposure and their patients about moldy hay. Urban physicians had different concerns about lead and reported patient concerns about exposure to Great Lakes fish. All groups used similar sources of current environmental health information. CONCLUSIONS: Family physicians who participated in this study identified important patient and professional concerns about environmental health issues and reported a lack of resources to meet those concerns. This study provides information to family medicine residency programs and continuing medical education providers to help them enhance their focus on environmental health.

Adult↗