Environmental Health: Issues And ImpactIssues And Impact

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LEARNING MODULE #17: ENVIRONMENTAL HEALTH: ISSUES AND IMPACTEnvironmental Health:Issues and ImpactCarol Ann Gross-Davis, PhD, MSAdjunct Assistant ProfessorDrexel University, School of Public HealthDepartment of Environmental and Occupational Health

Overview and outline of the lectureEnvironmental Health and Healthy People 2020goalsl- Air pollutionx Indoor and Outdoor- Toxics and Waste- Global Climate Change and Air Pollution- Summary key points2

Environmental HealthHealth- what exactlydo we mean?The World Health Organization definesEnvironmental Health as:“EnvironmentalEnvironmental Health addresses all thephysical, chemical, and biological factorsexternal to a person, and all related factorsimpacting behaviors. It encompasses theassessment and control of those environmentalfactors that can potentially affect health.health It istargeted towards preventing diseases andcreating health supportive environments ”3

Healthy People 2020 Goals andObjectives:The Healthy People 2020 Environmental Healthobjectives focus on 6 themes, each of which highlights anelement of environmental health: Outdoor air qualitySurface and ground water qualityToxic substances and hazardous wastesHomes and communitiesInfrastructure and surveillanceGlobal environmental healthCreating health-promotinghealth promoting environments is complex andrelies on continuing research to understand more fullythe effects of exposure to environmental hazards onpeople’ss healthpeople4

Healthy People 2020 objectiveshi hli h d forhighlightedf today’sd ’ llectureAir Quality- EH-1 Reduce the number of days the Air Quality Index (AQI) exceeds 100, weighted bypopulationl ti andd AQI- EH-3 Reduce air toxic emissions to decrease the risk of adverse health effects causedby mobile, area, and major sources of airborne toxicsToxics and Waste- EHEH-88RReducedbloodbl d lleadd llevelsl iin childrenhild- EH-8.2 Reduce the mean blood lead levels in children- EH-9 Minimize the risks to human health and the environment posed by hazardoussites- EH-20EH 20 ReduceR dexposure tto selectedl t d environmentalit l chemicalsh i l ini ththe population,l tiasmeasured by blood and urine concentrations of the substances or their metabolitesGlobal Environmental Health- EH-24 Reduce the global burden of disease due to poor water quality, sanitation, andinsufficient hygieneEmerging Issues in Environmental Health- Climate Change: Air and Water pollution and Public Health Risks for specificPopulations- Vulnerable Populations: To acquire an awareness of the increased risk ofenvironmental pollution to certain populations.5

Why Is Environmental HealthIImportant?The WHO estimated in 2006 that nearly 25 percent ofall deaths and the total disease burden globally canbe attributed to environmental exposuresPoor environmental quality has its greatest impacton peoplel whosehhhealthlth statust t iis alreadyl d att riski kTherefore,Thfenvironmentalit l healthh lth mustt addressddththesocietal and environmental factors that increase thelikelihood of exposurepand disease6

Improving Human Health and the EnvironmentEnvironmentalStewardship modelEnvironmentClinical Intervention modelXXPublicDiseasePublic Health Intervention modelSource: Adapted from Moeller, D. W.7XDeath

Module #17: Environmental Health: Issues and ImpactPart 1: Air PollutionEH-1 Reduce the number of days the Air QualityQ ) exceeds 100,, weightedgbyy ppopulationpIndex ((AQI)and AQIEH-3 Reduce air toxic emissions to decrease therisk of adverse health effects caused by mobile,j sources of airborne toxicsarea,, and major8

Air PollutionIn 2014 the World Health Organization (WHO)released new estimates of premature deathlinked to air pollution.“WHO reports in 2012 around 7 million peopledied- one in eight of total global death as a resultof air pollution.This doubles previous estimatesC fiConfirmsthatth t airi pollutionll ti iis ththe world’sld’ llargesttsingle environmental health risk.”(WHO, 2014)9

Causes of death from air pollution,reportedd byb theh WHOSpecifically this reveals a stronger link betweenb h indoorbothdandd outdoordair pollutionllexposure:x CardiovascularC dil didiseasex Stokes, ischaemic heat diseasex Cancerx Respiratory diseasesx Acute respiratory infectionx ChronicCh i obstructiveb t ti pulmonaryldidisease10

I dIndoorAirAi PPollutionll i11

What is a Healthy Home?Goal is to ensure that our housing stock is safe,healthy decent and affordable for all citizens ANDhealthy,To eliminate substandard housing conditions thatthreaten health and safetyEspecially important for vulnerable populations suchas children and the elderly, who spend more time intheh hhomeResearch in how specific housing conditions arerelated to injury and disease has improved ourknowledgeDefined by Housing and Urban Development Department (HUD)12

Healthy Homes: EnvironmentalHHazardsdAsthma triggers-indoortriggers indoor and outdoor air pollution 13Lead exposureInjury hazardsCarbon monoxide exposureRadon exposureEnvironmental tobacco smokeMold and mildewPesticides

Environmental Triggers for AsthmaIndoor Air PollutionEnvironmental tobacco smoke (ETS)- - Each yearyear, 443443,000000 people die of tobacco relatedillness and exposure to secondhand smoke in the U.S-- more than 1,200 a day. This costs Americans 193billion in healthcare costs and lost productivity everyyyear.14 Irritant chemicals and fumes: formaldehyde,VOCs, pesticides, phthalates, etc. Products from combustion devices (CO, NO2,Particulate matter, SO2)

Environmental Triggers for Asthmacon’t’Indoor Air Pollution: Biologic allergens 15Cockroaches-more in urban, low-incomeDust mites-more in rural or suburbanAnimal dander: strongest reaction to catsMold and mildewPests: mice and rats-in 95% of inner-city homes

EnvironmentalE ilTTobaccobSmokeyyyyy16Most common andmost importantindoor irritantIncreases risk ofrespiratory tractillness in infants andchildrenETS is a risk factorprenatally andpostnatally forasthmaAvoid any smoking inth hthehomeRefer to smokingcessation programs

Pediatric Asthma Statistics Increased incidence and mortality in US and otherindustrialized countries; pediatric mortality hasdoubled US prevalence in children 9.6% (2001-2009 data); vs.7.7% in adults; 13.5% in poor children; 17% in Blackchildrenhild Total all ages: 8.2% or 24.6 million Leading cause of hospital admission for urbanchildren Many environmental triggers: some induce allergy,some are irritantsREF: MMWR 201117

Asthma Prevalence andMortality:US and PAUS17.3 M8.1%81%8.7%5 6%5.6%381612.8PennsylvaniaPliAdults with asthma771,8717.6%76%12.8%10 5%10.5%15010.5White adultsBlack adultsHispanic adultsREF: NCEH/CDC, 2008 (www.cdc.gov/asthma)18Deaths all agesAge adjustedAge-adjustedmortality rate

Interventions to Reduce ExposuresMultifaceted comprehensive approach mosteffectiveMultifaceted integrated home interventions havebeen shown to be effective in improving asthmaoutcomes- Should focus on education of patient/caregiverSSchoolh l settingtti iimportantt t environmentit fforinhalant allergen exposures19

Allergen Avoidance InterventionsyDust Mites- Allergen covers formattress and pillow- Wash sheets and blanketsweekly, 130 degrees F- Decrease humidity 40%;A/C duringg warmweather- Remove carpet frombedroom- RemoveRupholsteredh ldfurniture- Decrease stuffed animalsand other dust collectors20yCockroaches,Mice,Cockroaches MicePests- Integrated pestmanagement- Focus on barriers, lowtoxicity preventionyAnimals- Remove animal fromenvironment- Out of bedroom and doorclosed- Remove upholsteredfurniture and carpet- Wash pet weekly- Role of HEPA cleaners

Outdoor Air Pollution21

Outdoor Air PollutionOutdoor Air Pollution: linked to asthmaexacerbations and hospitalizationsFour Criteria Air Pollutants- Ozone (O3)- SO2- NOX- Particulate matter 10 microns (PM10) andparticulate matter 2.5 microns (PM2.5)AIR QUALITY INDEX (AQI)-communicates healthinformation about daily ambient levels of pollutants22

Health EffectsO h AirOtherAi PPollutantsllOxides of Nitrogen (NOx)- Respiratory disease admissions in children aged 1-4 and 5-14years associated with NO2 concentrationsParticulate matter- emergency room visits by asthmatic children- lung function- lung function growth in children23

Health Effects of GroundGround--Level OzoneV sunlight/heatVsli h /h O3ImpairedIi d lunglffunctioni Severe coughing, SOB, pain when breathing Lung, eye irritation Increased risk of hospital admissions & ER visits for asthma Increased risk of cardiovascular complications in at-riskpopulations Communities with high ozone conc.- rel. risk of developingasthma in children playing 3 or more sports 3.3 (95% CI 1.95 8) compared with children playing no sports5.8)24

What is particle pollution?The particles in particle pollutionare so small, you can’t see justone of them .An average grain oftable salt is 100micrometers across(100 µm)PM10(10µm)PM2.5(2.5 µm) Particle pollution is a complex mixture ofextremely small particles and liquiddroplets. Some of these particles – called fineparticles – are just 2.5 micrometers indiameter. That’sThat s 40 times smaller thanthe average grain of table salt! The size of particles is directly linked toth i potentialtheirt ti l ffor causingi ghhealthlthproblems. Particle ppollution also contributes toreduced visibility, or haze.25

Particle pollution affects yourlungsYou are eYoexposedposed to particle pollpollutiontionsimply by breathing polluted air.Exposure increases when youexercise, because you breathe morevigorously and deeply than usual.usualParticle pollution can penetrate intothe part of your lungs known as thealveoli, which deliver oxygen to thebloodstream.26People exposed to particles mayexperience a number of respiratorysymptoms, including: airway irritation; cough; phlegm; decreased lung function; airway inflammation; asthma attacks; and chronic bronchitis

And particle pollution affectsyour heartParticle pollution has been linked to changes that indicate your heartisn’t as healthy as it should be. Those include: Arrhythmias and changes in heart rate. Changes in the variability of your heart rate. Your heart rate shouldincrease, for example, when you run and return to normal when you sitquietly. Decreased variability is a risk factor for heart attacks. Blood component changes that signal inflammation, and increasedlikelihood of potential blood clots, which can lead to heart attacks.Some studies have shown that particle exposure causes heart attacks. Andparticles are linked with death from heart disease.27

Some groups are at greater riskyPeople with heart or lung diseases are more vulnerable toparticle pollution because of their conditions (such ascongestive heart disease, coronary artery disease, asthma,or chronic obstructive ppulmonaryy disease.))yOlder adults also are considered at risk, because they aremore likely to have heart and lung disease. (Sometimes thatdisease hasnhasn’tt been diagnosed yet.)yChildren are at risk (primarily from chronic exposure),because they are more likely to be active, they breathemore air per pound of body weight than adultsadults, and theirbodies are still developing.28

Check AQI forecasts toprotect your health You can take simple steps toprotect yourselfpyfromparticle pollution. Get in the habit of checkingyour local Air Quality Indexforecast every day. When particle pollution levelsare predicted to be high,change your plans to reducethe amount of pollution thatgets in your lungs.29AQI forecasts tell you whetherparticle levels are expected to be high– and suggests steps you can take toprotect yourself.Those steps vary, depending onwhether you’re in one of the groupsmore at risk from particle exposure.

Who needs to protectpthemselves? How?AQI color code30Who is affected?What is thesignificance?What actionshould peopletake?GreenAir quality is goodEnjoy activitiesYellowPeople who areunusually sensitive toair pollutionAir quality is aconcern for peoplewho are unusuallysensitive to airpollutionPeople unusuallysensitive to airpollution: Planstrenuous activitieswhen air quality isbetterOrangePeople with heart orlung disease(including asthma),older adults, andchildrenAir quality isunhealthy for peoplein sensitive groupsSensitive groups:Cut back orreschedulestrenuous activitiesRedEveryone, especiallypeople with heart orlung disease(including asthma),older adults, andchildrenAir quality isunhealthy foreveryoneEveryone: Cutback or reschedulestrenuous activitiesSensitive groups:Avoid strenuousactivitiesPurpleEveryone, especiallypeople with heart orlungg disease(including asthma),older adults, andchildrenAir quality is veryunhealthy foryeveryoneEveryone:Significantly cutyback on pphysicalactivitiesSensitive groups:Avoid all physicalactivitiesThe table at leftrecommends takingprotective actions atdifferentfflevels offparticle pollution.These messages apply toparticle pollution only.For information aboutprotectingt ti yourselflf fromfozone, or a combinationof ozone and particles,go towww.epa.gov/airnow/

Poor environmental quality has its greatest impact on l h h lth t t i l d t i k people whose health status is already at risk Th f i t l h lth t dd th Therefore, environmental health must address the societal and environmental factors

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