Health Risks From Environmental Exposures

2009 CASN Nursing Research Conference- Interrelationships Between Theory,

Research and Practice

Barbara MacKinnon

Laws Regulations

Res

earc

h

Emissions

Exposure

Health effects

Education

Go

vernm

ent P

olicies

Private S

ector P

olicies

Health Care

There is a long list of important biological, physical and chemical exposures of concern to human health:

Asbestos

Benzene

Dioxins

Dump site contaminants

Electromagnetic fields

Endocrine disruptors

Environmental tobacco smoke

Fossil fuel radiation/emissions

Heavy metals

Other organic pollutants

Biological sources

Tobacco smoke

Pesticides

Phthalates

Polycyclic aromatic hydrocarbons

Radio frequency waves

Radon

Ultraviolet radiation

Volatile organic compounds

Water disinfection by-products (trihalomethanes)

Living near nuclear plants

(Kreiger, N. et al. 2003 Env Health Perspect)

Sources of Environmental Exposures and Risks

Indoor Exposures- Smoking, Radon, Consumer Products, Wood stoves Water, Food Outdoor Exposures- Pesticides, Ambient Air Pollution (Traffic, Industrial) Noise Climate Change Impacts- Flooding, Heat, Storms

Health Outcomes from Environmental Exposures

Outcomes are exposure specific: Birth defects Learning disabilities Reproductive system impacts Epigenetic impacts Respiratory illnesses Cardiovascular illnesses Diabetes Immune system illness- either deficiency or auto-immune Multiple chemical sensitivity disorders Cancers

Health Impacts Depend On

Genetic predisposition Type of exposure Duration Intensity Other determinants of health have synergistic effects

Example- Outdoor Air Pollution

Particulate Matter PM

Sulphur oxides

Nitrogen oxides

Volatile Organic Compounds VOCs

Carbon Monoxide

“Toxics”

Carbon Dioxide

Secondary PM

Ozone

Penetration of smallest particles into lung tissues, secondary effects on immunological and neural pathways affecting other systems (ie. cardiovascular)

Respiratory symptoms:

Mucus production, cough, airway obstruction, inflammation, exacerbation of asthma and COPD

Cardiovascular symptoms:

Higher fibrinogen, vaso-construction

Increased heart rate, BP, blood viscosity & blood coagulation, arrhythmia

Heart attacks and strokes

Other:

Low birth weight

Impaired immune system, reduced macrophage function

Cancers

PM 2.5 Health Outcomes

Vulnerable Populations

People with pre-existing respiratory or cardiovascular illness

The elderly or very young

Diabetics

People doing strenuous activities outdoors

Recommended actions

Health care professionals should advise patients of the health risks from air pollution.

Listen to Air Quality Health Index announcements.

Reduce activity levels during high pollution days.

Vulnerable people should avoid spending long periods outdoors. When possible stay in a healthier environment.

Take personal and policy actions to reduce air pollution

The AQHI example

ResearchResearch – Health effects of exposure to multiple pollutants, modelling to create Index

ResearchResearch- Behaviour change, mental models, focus testing, market research

Health messages and design template

Calculation of Air Quality Health Index

Provincial policiesProvincial policies to implement new Index

Federal policyFederal policy to support process to develop AQHI- Government, Researchers, NGOs, Healthcare Professionals

PublicPublic, health professionalshealth professionals and multi-stakeholder educationeducation to understand and use Index

Public actions to reduce exposure

Health risk from air pollution

ResearchResearch- Is the AQHI effective?

Reduced

Ambient air quality monitors

www. airhealth.ca www. coteairsante.ca

The new AQHI encourages people to assess their own symptoms when air quality is poor

“I’m sorry, I didn’t hear what you said. I was listening to my body.”

What Health Professionals Can Do

Include exposure history during diagnosis

Provide general public prevention education especially during preconception and pregnancy– awareness and advice on avoidance of toxins

Include toxic reduction and avoidance education for patients

As individuals and through professional associations, support legislation and policies that reduce the use and release of toxic chemicals

Links to information-rich websites are available on the Information Portal at www. cnhhe-rcshe.ca