Environmental Health and Nursing Nursing began with a

Environmental Health and Nursing

Nursing began with a focus on environmen tal 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: – – 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 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/photo 2. 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

© Her Majesty the Queen in Right of Canada, represented by the Minister of

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: – – – – – 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 – – 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 PM 10) and fine particles (known as PM 2. 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 (SO 2), and ammonia.

© Environment Canada http: //www. ec. gc. ca/Enviro. Zine/english/issues/47/feature 1_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 PM 10 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.