Environmental Health as an Essential Component of Public Health

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Environmental Health as an Essential Component
of Public Health Michael A. Trush,
PhD Professor Department of Environmental Health
Sciences
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Public health saving lives, millions at a
time
Public health is what society does collectively
rather than individually to assure that
populations remain healthy.
Environmental health sciences is an essential
component of public health
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From Healthy People 2010
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environmental health sciences

• Natural environment is that part of physical
  environment not created by humans.
• Built environment is that part of our physical
  environment created by our activities.
• Social environment includes factors other than
  physical processes, such as community
  socioeconomic status, social integration,
  neighborhood safety, level of political
  empowerment.

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Human Environmental Health Issues in our Region
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Health Disparities

• It is widely documented that there are
  disparities in the occurrence of chronic diseases
  between members of racial and ethnic minorities
  and more advantaged populations.
• Health disparities are associated with
  environmental injustice.
• Some chronic diseases for which there are health
  disparities have an environmental component (
  asthma, cancer, cardiovascular disease ,
  neurodegenerative diseases ). We still need a
  better understanding of at what levels and how
  environmental chemicals either CONTRIBUTE to /or
  CAUSE disease.

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Stress Exposure Disease Framework for
Environmental Health Disparities
Gee and Payne-Sturges, 2004
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Environment and Urban Health Status in Baltimore
COPD
Total Cancer
Heart Disease
Poverty

• cancer mortality is highest among all US cities
• incidence of childhood asthma up 200 since 1980
• cancer exceeds heart disease as leading cause of
  death in African-Americans

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The next slide illustrates the area of Wagners
point

• In the slide you will see the various industries,
  the Patapsco wastewater treatment facility and
  the residences that were there at the time

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The next slide illustrates a MTA bus depot in a
Baltimore neighborhood . This facility is in
operation 24X7 . Note the proximity to the
neighboring residences
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An All To Common Scene in Baltimore
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BALTIMORE MEMORY STUDYDirected by Dr. Brian S.
Schwartz

• Noted disparities in cognitive function by
  race/ethnicity (Env. Health Perspectives
  Vol.112, March 2004)
• Lower median household income and assets
• 30 greater bone lead level
• Higher PCB levels in serum
• Greater population report a history of stroke
• Greater of population obese as a function of
  multi-dimensional neighborhood hazards index
  (MNHI). MNHI takes into consideration 12
  neighborhood variables.

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The Built Environment

• In a traditional EH approach, we think about
  how/what humans have created that has resulted
  in hazardous exposures
• In newer approaches, we think about how /what
  humans have created that influences
  health-related behaviors

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The Built Environment Health

• Physical inactivity
• Associated health effects
• Driving ? air pollution ? lung disease (asthma)
• Heat stress
• Climate change
• Motor vehicle and pedestrian injuries
• Water quality
• Mental health
• Social capital
• Disparate impacts justice, equity

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Conceptual Model of the Built Environment
Built Environment
Density
Diversity
Design
Accessibility
Centering
Balance
Nearest Neighbor
Street networks
Major centers
Dissimilarity
Cumulative Opportunity
Streetscapes
Minor centers
Image-ability
Gravity Models
Suburban strips
Visual Enclosure
Human Scale
Transparency
Of Land Use
Of Land Use
Of Land Use
Of Land Use
Complexity
Of Physical Activity Environment
Of Physical Activity Environment
Of Physical Activity Environment
Of Physical Activity Environment
Tidiness
Of Food Environment
Of Food Environment
Of Food Environment
Of Food Environment
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Envisioning Change Re-design
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SOME ENVIRONMENTAL HEALTH LEGACIES OF HUMANKIND
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The best example of human toxicity due to organic
mercury is the tragedy and triumph which occurred
in Minimata, Japan

• Great reference The American Biology Teacher
  ,Vol.61, no.6, pg 413, June1999.

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Brain specimens from individuals chronically
exposed to organic mercury in the fish they were
eating top, normal middle and bottom from
mercury exposed individuals from Minimata,
Japan.
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Some types of fish are a major source of organic
mercury exposure to humans. Thus, we need to
consider the health benefits of eating these
fish versus the risk of mercury exposure in
them.This is illustrated below.
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Dioxin Another Byproduct of Incineration
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The next slide illustrates a North Vietnamese
soldier that was exposed to dioxin-containing
Agent Orange. As a result this individual has
developed skin tumors. The subsequent slide
illustrates the development of chloracne in an
individual that was exposed to dioxin.
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ONeill (2000) Damaged Lives. Pittsburgh
Post-Gazette
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Air Pollutants
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The next three slides illustrate data showing the
relationship between SES status and exposure to
air pollution
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EJ and Childrens Proximity to Traffic - CA
Percent of CA children less than 15 years of age
living in block groups with high traffic density
(gt500,000 VMT/mi2) by ethnicity and SES
Gunier et al., 2003
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Increases in PM10 and Ozone Pollution and NYC
Hospital Respiratory Admissions SES vs. Race
Particulate Matter (PM10)
Ozone
Gwynn and Thurston, 2001
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EJ and Traffic Proximity to Schools - CA
Green et al., 2004
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new world
new challenges
How do environmental factors affect human health?
How can you assess the risks posed by biological,
chemical, and physical agents?
What can you do to reduce the risks of workplace
hazards and injuries?
How can we best achieve effective disaster
preparedness and response?
Some of the most vital issues facing our society
involve environmental health sciences .This
requires scientists approaching these issues from
various facets.
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Slides 46- 52 illustrate faculty from the
Department of Environmental Health Sciences at
the School of Public Health

• 46- Drs. Halden and Schwab
• 47 Dr. Biswal
• 48- Drs.Silbergeld, Kensler and Kanarek
• 49-Dr.Navas-Acien
• 50 Dr. Goodman
• 51-Dr. Agnew
• 52-Drs. Geyh and Links

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Exposure assessment
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Molecular toxicology
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Cancer control and prevention
primary
secondary
tertiary
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Environmental epidemiologystudying disease
patterns
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Environmental risk assessment of susceptible
populations
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Occupational health
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Disaster preparedness and response
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SUMMARY

• Preventing the occurrence of health disparity is
  more economical than treating disease.
• Clearly, the relationships between environmental
  factors and health disparity are complex.
• Solutions to addressing this relationship need to
  include environmental public health tracking
  better data linkage at the individual and
  community levels involving community groups in
  planning and database gathering from the
  beginning. This will require a broad view of
  environmental health and multidisciplinary
  approaches .

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TO PREVENT HEALTH DISPARITY ASSOCIATED with
ENVIRONMENTAL INJUSTICE WE NEED to INSURE THAT
ALL HAVE

• CLEAN AIR and WATER
• AFFORDABLE, ENVIRONMENTALLY SAFE HOUSING
• ACCESS to an AFFORDABLE and HEALTHLY FOOD SUPPLY
• NEIGHBORHOODS THAT ARE ENVIRONMENTALLY FRIENDLY

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Welcome to Tox Town An interactive guide to
toxic chemicals and environmental health risks
you might encounter in everyday life, in everyday
places.
http//toxtown.nlm.nih.gov/