Environmental Health – Part I: An Introduction

1. Environmental Health – Part I:An Introduction John Mulvaney, MHA, Ph.D. student Walden University PH 8165-4 Instructor: Dr. Raymond Thron Spring, 2009

2. Outline • Brief video • Introduction to environmental health • Definition(s) • Types of Hazards • Regulation • Discussion

3. Introduction • What is meant by environmental health (EH)?

4. Introduction • There are a number of “acceptable” definitions for the environment as it relates to health: • Inner vs. Outer Environment: in this context, the environment is described in terms of within our bodies (inner) and external to our bodies (outer). • Personal vs. Ambient Environment: differentiates based upon the environment we control (personal) and the environment in which we have very little or no control (ambient/work/outside). • Gaseous, Liquid, and Solid Environments: describes the environment in terms of the state of matter (solid, liquid, gas) and how they interact with people (Moeller, 2005).

5. Introduction • Yet another, more encompassing definition is one that includes (Moeller, 2005): • Chemical Factors • Biological Factors • Physical Factors • Socioeconomic Factors

6. Introduction • Types of environmental hazards: • Radiation • Mercury • Lead • Pesticides • Industrial Chemicals • Violence?

7. Figure 1: Interaction with humans Source: Moeller, 2005

8. Introduction

9. Environmental Hazards: Radiation • Ultraviolet light from the sun – skin cancer and melanoma • Radon gas – natural radioactivity – lung cancer? • Early scandals with patent medicines and radium led to regulation • X rays used in medicine and dentistry • Lessons on health effects of radiation learned from atomic bombings in Japan

10. Environmental Hazards: Lead • Harmful to brain and nervous system, especially of children • Contamination of drinking water by lead pipes and lead solder for copper pipes • Air pollutant from use in gasoline until banned in the 1980s • Was used in paint until 1977 – still a threat in old housing – peeling paint or contaminated dust • Young children should be screened for blood lead levels • Permissible levels have been steadily lowered Source: Schneider, M. (2006). Introduction to public health, second edition. Jones & Bartlett: Sudburry, MA.

11. Environmental Hazards: Pesticides • Pesticides and Industrial Chemicals • Rachel Carson’s Silent Spring – 1962 – beginning of environmental movement • DDT and other pesticides– now banned • PCBs – industrial uses • Hudson River – contaminates fish • Yusho accident (Japan) – contamination of cooking oil – other similar accidents • Production halted in US by 1977 • Endocrine disrupters, affect reproduction, nervous system, immune system, maybe cancer • Soluble in fat, persist in environment, very stable Source: Schneider, M. (2006). Introduction to public health, second edition. Jones & Bartlett: Sudburry, MA.

12. Environmental Hazards • If interested in further information relating to these and other hazards please see the following: • Koller, K., et al, Recent Developments in Low-Level Exposure and Intellectual Impairment in Children. Environmental Health Perspectives, 112 (2004): 987-994 • Clarkson, T. The Three Modern Faces of Mercury. Environmental Health Perspectives 110, Suppl. 1 (2002): 11-23 • Alavanja, M., et al. Health Effects of Chronic Pesticide Exposure: Cancer and Neurotoxicity. Annual Review of Public Health 25 (2004): 155-197 • Centers for Disease Control and Prevention. Third National Report on Human Exposure to Environmental Chemicals. Accessed at: http://www.cdc.gov/exposurereport/pdf/thirdreport.pdf on March 18, 2009.

13. Regulation

14. Multitude of regulatory bodies involved with protection of the environment. Environmental Protection Agency http://www.epa.gov NIOSH (Occupational Safety) http://www.cdc.gov/niosh/ Nuclear Regulatory Commission http://www.nrc.gov Laws/Regulations: Clean Air Act Clean Water Act Executive Orders Case law EH cases that went to court and have had a judgment rendered. Can be used to set a precedent for other cases or rulemaking. Regulation

15. Environmental Health – Part II:Mitigating the law of unintended consequences. An application of systems thinking to environmental health. John Mulvaney, MHA, Ph.D. student Walden University PH 8165 - 4 Instructor: Dr. Raymond Thron Spring, 2009

16. Outline • Law of unintended consequences • Example: • DDT and Malaria • A systems approach

17. Law of Unintended Consequences • Roughly equivalent to a really big “oops – didn’t see that one coming” • Similar concept in other disciplines: • Economics: externalities • Physics: Newton’s 2nd Law of Thermodynamics • For every action, there is an equal and opposite reaction

18. Example: DDT and Malaria • DDT had been used extensively to fight malaria since the 1940’s • Worked well for many years but… • 1972 book Silent Spring connected the use of DDT with health effects on birds • Created a groundswell to eliminate the use of DDT as a means of controlling the vector which spreads malaria (mosquito).

19. Example: DDT and Malaria • Dramatic increase in the number of reported cases and deaths from malaria from the 70’s forward (Roberts, 1997). • The alternative approach was to use non-DDT saturated bed nets (Economist, 2008). • Argument has been made that the ban was directly responsible?

20. Example: DDT and Malaria • The good news: • There is a strong push to make the eradication of Malaria a reality • Realization that although DDT may have some long-term effects, particularly in infants, the risks are not outweighed by benefits in the measured use of DDT in endemic countries (Mandavilli, 2006).

21. The Systems Approach • A systems approach makes reference to the concept of taking in the full picture with respect to an issue. • Draws from multiple disciplines in a concept that links the disciplines towards a common goal • Offers the public/environmental health community a “new frontier” in the ongoing effort to understand and prevent disease (Leischow, 2006).

22. The Systems Approach • More precisely: • Systems approaches draw from areas such as control theory, social network theory, cellular automata, computational simulation… • While the magnitude of approaches are vast, the concepts unify around a couple of core concepts • dynamics and complexity • mechanical vs. biological (Trochim, 2006)

23. The Systems Approach • Trochim et al., 2006 • Used a concept mapping approach to comprehend the vast literature regarding systems theory • While there is a great deal of interest and momentum in systems theory in public health, there are some barriers/issues that need to be addressed

24. The Systems Approach • Concept mapping revealed 8 clusters of challenges • Support dynamic and diverse networks • Inspire integrative learning • Use systems measures and models • Foster systems planning and evaluation • Show potential of systems approaches • Explore systems paradigms and perspectives • Expand cross-category funding • Utilize systems incentives

25. The Systems Approach • How would a systems approach have changed the DDT scenario? • Dynamics • Account for the alternative of changes in genetic adaptation of insects to build resistance to DDT • Study and understand implications of banning a previously effective strategy (prior to banning it) • Complexity • Understand the interactions of SES and disease as they relate to alternate strategies for Malaria eradication • If a more expensive alternative to DDT is developed, how will that impact the lesser developed countries in which the disease is endemic

26. The Systems Approach • Mechanics vs. Biology • Modeling the potential impact from a change in use of DDT with bed nets • What are the biologic consequences to animal populations, human populations, and the infectious agent from the different approach

27. The Systems Approach • Addressing the common misconceptions • Not a rejection of traditional scientific views • Actually enables a more broad and encompassing application of solid scientific evidence • Does not lack scientific rigor • Takes a more nuanced view of the situation • Roots are based in mathematics, biology, physics (Trochim, 2006)

28. The Systems Approach • Any questions?

29. References: • Leischow, S., & Milstein, B., (2006). Systems thinking and modeling for public health practice. American Journal of Public Health, 96(3), 403-405. • Mandavilli, A., (2006). DDT returns. Nature Medicine. 12(8), 870-871. • Roberts, D., Laughlin, L., Hsheih, P., & Legters, L., (1997). DDT, global strategies, and a malaria control crisis in South America. Emerging Infectious Diseases. 3(3), 295-302.

30. References: • The Economist, (2008). One quick shot may not be enough. April 10, 2008 edition. Accessed at: http://www.economist.com/world/internati onal/displaystory.cfm?story_id=11019802 • Trochim, W., Cabrera, D., Milstein, B., Gallagher, R., & Leischow, S., (2006). Practical challenges of systems thinking and modeling in public health. American Journal of Public Health, 96(3), 538-546.