Transcript Slide 1

Environmental Health and Nursing
Nursing
began with a
focus on
environmental
health
Florence Nightingale, born May 12, 1820, in Florence, Italy,
died August 13, 1910, in London, England
“Despite the fact that a significant proportion of
disease is attributable to environmental factors,
environmental health is often viewed as an
appendage of occupational health nursing rather
than central to nursing’s vision of health.”
Butterfield, 2002, p. 43
Objectives
• The objectives of this class are to:
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identify links between health and the environment
explore the roles of nursing in environmental health
identify examples of environmental health issues
propose ways of incorporating environmental health
principles into nursing practice, education, research
and policy
Identify Links Between Health and the
Environment
What is environmental health?
Environmental health comprises “those aspects of human
health, including quality of life, that are determined by
physical, chemical, biological, social, and psychosocial
factors in the environment.
“It also refers to the theory and practice of assessing,
correcting, controlling, and preventing those factors in
the environment that can potentially affect adversely the
health of present and future generations.”
World Health Organization, 2007
Proximal environmental influences
Myres & Betke, 2002. © Her Majesty the Queen in Right of Canada, represented by the Minister of Health (2005)
Global environmental influences
© WHO, 2006. http://www.who.int/globalchange/en/index.html
Burden of environmental disease by WHO subregion, 2002
© WHO, 2006. http://www.who.int/quantifying_ehimpacts/publications/prevdisexecsume.pdf
Environmental health and social justice
http://news.nationalgeographic.com/news/2007/09/photogalleries/pollution-pictures/photo2.html
Interactions between the human population and the physical
environment (T. Myres, used with permission)
Climate
Urbanization
Poverty
Industrialization
Environmental
Hazards
Pathways of
Exposure
Populations
Chemicals
Air
Children
Microbiological
Water
First Nations
Radiological
Soil
Northern
Climate
Food
Seniors
Noise
Products
Workers
Pesticides
All Canadians
Research and Information
Health
Outcomes
Cancer
Diabetes
Respiratory
Cardiovascular
Neurobehavioural
Injuries
Sensitivities
© Public Health Agency of Canada, 2005
© Her Majesty the
Queen in Right of
Canada, represented
by the Minister of
Health (2005)
Precautionary principle
“In order to protect the environment, the
precautionary approach shall be widely applied
by States according to their capabilities.
“Where there are threats of serious or irreversible
damage, lack of full scientific certainty shall not
be used as a reason for postponing costeffective measures to prevent environmental
degradation.”
Rio Declaration, United Nations, 1992
Explore the Role of Nursing in Environmental
Health
Why should nurses know about environmental health?
1. Environmental factors have an impact on
health:
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Smog and cardiovascular/respiratory diseases
Children’s exposure to lead
Prenatal exposures
Heat waves and elderly people
Women choosing to bottle feed because of
contaminants in breast milk
Concerns over mercury in fish
Indoor air quality and asthma
Emergency planning
Commitment to social justice
Why should nurses know about environmental health?
2. Nurses are very, very good at
teaching about health
• this skill supports work in protecting
individuals, families and communities
from environmental hazards
3. Nurses are the largest
professional group working in
health care
• working together we can be a
powerful force for making
improvements in the environment
The role of nurses in environmental health
• Assess and detect hazards when they exist
• Provide information to individuals and aggregates on the health effects
of environmental toxins and more global hazards
• Report serious environmental threats to appropriate agencies
• Develop and implement school-based and workplace wellness
programs
• Aid in the formulation of public policy and legislation involving the
environment
• Help prevent excessive exposure to immediate toxins and larger,
global hazards
• Help facilitate behaviour change in people
International Council of Nurses
Importance of engaging all nurses
• Health of individuals, families, communities and
populations affected by environment
• Every nurse should be able to:
– Consider environmental factors that may be
contributing to poor health
– Understand environmental hazards and their impact
on health
– Perform an environmental assessment
– Understand the role of individuals and communities in
providing good stewardship of the environment
– Make recommendations about how to reduce or
prevent exposures to environmental hazards
Identify Examples of Environmental Health
Issues
Selected environmental hazards
(Thomlinson, 2003)
• Biological agents: bacteria, protozoa, viruses,
fungi, algae, dust mites, pollen, moulds
• Chemical contaminants
– Organic: fluorine, chlorine, bromine, iodine, nitrogen,
sulfur, phosphorous, PCBs, DDT, dioxins, benzene,
malathion, toluene
– Inorganic: ozone, nitrogen oxides, sulphur dioxide,
lead, mercury, cadmium, arsenic, etc.
• Radiation: microwaves, UV rays, noise
• Particulate matter: dust, smoke, asbestos, ETS
Assessing risk
Myres & Betke, 2002. © Her Majesty the Queen in Right of Canada, represented by the Minister of Health (2005)
Risk
Hazard
Adverse health
effects
Probability
Exposure
Susceptibility
How is the impact on health identified?
• Two types of studies assess risk:
– Epidemiological studies look at patterns of health
outcomes following identified exposures.
– Toxicological studies look at the mechanisms of
action of the exposure: i.e., the effects the exposure
has on the body (animal or human).
Examples of environmental hazards and health
outcomes
• Historical
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Methyl mercury and Minamata disease (Japan)*
Lead in paint and reduced IQ in children (North America)
Dioxin contamination and chloracne (Seveso, Italy)
Lead in soil and neuro-developmental delay (Riverdale,
Toronto)
• Current
– Smog and cardiovascular disease*
– Heat stroke and increased mortality among elderly
people
– Lead in paint and reduced IQ in children
– Indoor air quality and asthma
Smog and cardiovascular disease
• There is strong evidence that exposure to air
pollution leads to increased morbidity and
mortality due to cardiovascular disease (CVD).
(Pope & Dockery, 2006)
What is smog?
• The major components of smog are particulate
matter (PM) and ozone.
• PM, which includes both inhalable particles (or
PM10) and fine particles (known as PM2.5), is
emitted directly into the atmosphere from such
sources as:
– Cars, trucks, factories, and wood burning, and
– Can also be formed in the air from precursor gases
such as nitrogen oxides (NOX), volatile organic
compounds (VOCs), sulphur dioxide (SO2), and
ammonia.
© Environment Canada http://www.ec.gc.ca/EnviroZine/english/issues/47/feature1_e.cfm
What is the evidence on PM and CVD?
• Epidemiological studies:
– Mortality and morbidity due to CVD increased on
days with high levels of PM (Pope & Dockery, 2006)
– Response varies by PM concentration
• Hypothesized mechanisms of action:
– Deposition of particles in the lung provoke a
low-grade alveolar inflammation resulting in
downstream exacerbations of CVD
– Fine or ultra-fine particles “enter the blood and
adversely affect the heart by initiating arrhythmias
and sudden death in susceptible subjects”
(Bai et al., 2007, p.18).
Estimated PM10 concentrations in world cities
© Development Economics Research Group & The Environment Department, The World Bank
Propose Ways of Incorporating Environmental Health
Principles into Nursing Practice, Education, Research
and Policy
Nursing Practice (Example: Smog)
• There are three ways that nurses can help
protect the health of people with CVD (and other
vulnerable populations) from smog:
– Being aware of and teaching clients about the Air
Quality Index (AQI) in their community
– Making recommendations on reducing exposure to
emissions
– Promoting steps to reduce emissions
• Health Canada’s It’s Your Health series has
useful fact sheets on environmental health
issues.
Nursing Education
• Undergraduate curriculum
– Include environmental health principles in a range of
courses: maternal health, prevention of falls,
community health, medical-surgical, etc.
• In-service education
– Presentations by green team in hospital addressing
environmental issues within health-care setting or
community
• Ongoing professional development
– CNA website, environmental health journals
(Environmental Health Perspectives, Online Journal
of Issues in Nursing)
Nursing Research
• Nurses as co-investigators
– Working with researchers in a number of areas,
particularly to support understanding of the
perspective of populations on issues
• Nurses as investigators
– Already studying how to modify the environment to
prevent falls; could explore how perception of hazards
affects behaviour
• Targeted funding
– May need to “prime the pump” with funding targeted
at environmental health issues
Policy
Nurses are a credible source of health information
(public opinion polls, 2007)
• Professional associations
– work with members to identify key areas of action
– include environmental health issues in advice to
government
– speak about environmental health issues where
appropriate
• Community-based action
– work with community members on an issue they have
identified, such as concerns over water quality
Where to go for more information
• Environmental health and nursing
– http://www.cna-aiic.ca/CNA/issues/environment/default_e.aspx
• Children’s health and the environment
– http://www.who.int/ceh/en/
• Health Canada: It’s Your Health: Environment
– http://www.hc-sc.gc.ca/iyh-vsv/environ/index_e.html
• Health Canada: Climate Change and Health
– http://www.hc-sc.gc.ca/ewh-semt/pubs/climat/index_e.html
Conclusions
• The environment has an impact on health.
• Nurses have a role in preventing exposures and
reducing risks from environmental hazards.
• Nurses have the skills to be effective in
addressing environmental health issues.
• What is needed is to increase our awareness
and provide tools we can use, no matter what
setting we work in.
Photos: Comstock; Corbis; Getty Images
© Canadian Nurses Association, 2008