Lecture_9_Sustainable_health_and_ethical_responsibilities.ppt

Lecture 8Lecture 8Lecture 8Lecture 8

Sustainable Health Care Sustainable Health Care and Emerging Ethical and Emerging Ethical

Responsibilities, Vulnerable Responsibilities, Vulnerable Populations and Populations and

Environmental Health and Environmental Health and ChildrenChildren

Goals Today• Reminder: Thursdays Lecture:

Feb 5:– from 1-2:30 in Cadboro Commons,

Haro Room , “The Application of a Population Health Approach to Seniors Health Services, by Dr. Kelly Barnard and Dr. Weiman Hu.

• In-class exercise – continued discussions and report

back• Precautionary Principle (Ch14)

goes to Feb 9th. Today we discuss, Sustainable health care (Ch17), Vulnerable Populations (Ch15) and begin Environmental Health and Children as Vulnerable Populations

Sustainable Health Care and Emerging

Ethical Responsibilities

• LE in the world; 46 in 1958 to 66 in 1998

• Canada LE 82.2 years women, 77.1 years men

• However in long run human health requires a healthy ecosystem

• Estimates 25% of health problems are environmental in origin

Sustainable Health Care and Emerging

Ethical Responsibilities

• Environment affects health• Health care services affect

the environment• US health care generates 3

million tons of solid waste per year:– Human tissues, blood,

biohazardous wastes( heavy metals and radioactive wastes

Sustainable Health Care and Emerging

Ethical Responsibilities

• Mercury in health care products

• PVC incineration releases carcinogenic toxins

• IV bags release toxins into patients

• Degree to which health care processes and services affect the environment is hard to assess

Sustainable Health Care

• The current environmental crisis is a function of population growth, consumption patterns and technology

• Scale of consumption is represented by the “ecological footprint”

• Estimate of how much space it takes to generate the energy, food, pasture, consumer goods to maintain each of us.

• Estimates suggest humanity uses 1/3 more resources and ecoservices than nature can regenerate

Sustainable Health Care

• US ecological footprint 9.6 ha per capita

• Canada 7.2 on average• World 1.7 per capita

available• Challenge is to reduce

our footprint and reduce consumption

Sustainable Health Care and

bio-ethicists• Bedside concerns and

environmental global well-being

• Societally, health care has a responsibility to meet current needs in a sustainable way

• Humans have a responsibility to the natural world

• 80% of world’s wealth benefits only 20% of population

• Justice and sustainability require more equitable allocation of resources

Ecosystem health

• Fosters the importance of people’s connectedness with others and with the natural world

• Tensions between:– Individual vs whole society– Sustainability vs social

justice– Sustainability vs health

Tensions• Individual to whole:

from a physician/health practitioner focus emphasis is on physician-patient relationship

• -emphasizing do all that is possible rather than do no harm, or do consider the environmental impacts of health care

Tensions• Environmental

sustainability and social justice

• Mutually reinforcing goals of population health

• Yet their scale is so broad• Scope of world’s present

distributive injustice• Sheer number of people

struggling to live with very little

Tensions• Sustainability vs Health• 20th century gains in health

attributed to economic development

• Improved health through industrial and technological growth that:– Stabilized food supplies– Processed sewage– Cleaned and transported water– Developed vaccines– Medical surveillance– Medical technologies

Tensions• Sustainability vs

Health• Today, intensity of

agriculture, industry and energy sectors is connected with increasing health problems

Environmental Justice

Considerations in Canada by Draper and

Mitchell, 2001

• 1982 Warren County decision catalyzed environmental justice movement

• PCB site near low income primarily African-American community

• Post- environmental equity, environmental racism, environmental classism emerged in literature

• 1999 in Canada (CEPA) acknowledges that environmental protection is essential to Canadians well-being.

Environmental Justice

Considerations in Canada by Draper and

Mitchell, 2001• Canadians should have the

right to safe air, water and soil.

• McMaster School of Geography and Geology and the Institute of Environment and Health is the most active environmental justice group.

Environmental Justice

Considerations in Canada by Draper and

Mitchell, 2001

• 1990s characterized by federal and provincial government focus on deficit and debt reduction

• Sharp reductions in environmental agencies followed– E.g., Environment Canada’s budget

cut by 35%– In Ontario the Common Sense

Revolution closed water testing laboratories in 1996 without considering the capacity of local municipalities to take on manage water.

– In BC, water quality monitoring positions lost

Environmental Health Indicators• Merging environmental issues

with human health impacts - environmental health indicators

• (see handout from Canadian J of Public Health)

• Global, regional, local indicators that describe overall quality of the environment

• Highlight factors that influence environmental quality and that have potential impact on human health

Environmental health and sustainable

development• To date 130 indicators have

been compiled by the United Nations Commission on Sustainable Development

• Urban/housing indicators:– HABITAT II, – WHO- Healthy Cities Movement– Canada – Population Health

Most countries face problems of global significance

Vulnerable Populations

• Children and Workers• Children:

– Developmental processes– Unique patterns of

exposures

• Workers:– Exposures to toxins often

higher than for general public

Vulnerable Populations

• Traditional Risk Assessment

• Ignores special risks of children, workers, elderly, immuno-compromised

• assumes everybody is a 70kg adult male

• Certain populations deserve special consideration

• But all lives are important

Vulnerable Populations

• Children’s diseases today:• New pediatric morbidity• Classic infectious diseases

reduced• Asthma (doubled in recent

years), childhood cancers, neurodevelopmental, congenital birth defects, second-hand smoke

Vulnerable Populations

• Children’s diseases today:• 10-20% genetic; rest ?• LEAD: neurological behaviour,

IQ loss, disabilities• In utero exposures to PCBs

and methylmercury affect intelligence

• Last 50 years, 80,000 new synthetic compounds developed

Children’s Exposures

• Air, water, food crops, communities, waste sites, homes

• Fewer than half chemicals tested for potential toxicity

• Especially to fetuses, infants and children

• Pound for pound children drink more water, eat more food and breathe more air than adults

• Hand to mouth behaviour and living close to the ground can also increase risk

Children’s Exposures

• Metabolic pathways are immature

• Undergo rapid growth and development and therefore organs/brain/tissues more vulnerable to toxins disrupting developing systems

• Exposures in childhood can produce illness at later stages of life

Case Studies of Children’s Health• 1904 Queensland, Australia

epidemic of lead poisoning in young children;– Ingestion of lead paint playing

on verandas lead to banning of lead paint

– 1950s leukemia in Hiroshima and Nagasaki exposure to ionizing radiation due to atomic bombings

– Subsequent studies established the sensitivity of infants and fetuses to radiation

Case Studies of Children’s Health• 1960s: Minimata Japan

epidemic of cerebral palsy, mental retardation, convulsions due to ingestion of fish/shellfish contaminated with methylmercury

• Source of mercury was a plastics factory discharging mercury into the bay; bioaccumulated up the food chain

Case Studies of Children’s Health• “Subclinical toxicity”:Dose-dependent

continuum in which clinically obvious effects have their subclinical counterparts

Needleman in the US: film Kids and Chemicals (Feb. 16) will feature his work

Workers• Many environmentally

induced diseases observed in workers:– E.g. cancer of the

scrotum/testes in chimney sweeps

– Coal miners lung cancers

Workers• Workers constitute well-

defined groups• Nature and extent of

exposures is known• These features lend them

to epidemiological studies• Occupational toxins may

be transported home on clothing of workers

Workers• Occupational diseases

(OD) are underdiagnosed• Physicians have little

training in OD• One problem is that

many diseases present the same

• Long latency period is a barrier

Occupational Diseases

• Lung Disease– Asbestiosis,

pneumoconiosisi, lung cancer, asthma

• Musculo-skeletalback, trunk, neck

• Cancers other than Lung – Leukemia,

bladder, stomach

• Occupational Traumas:– Loss of limbs,

amputations, fractures

• Disorders of reproduction– Infertility,

teratogenesis• Noise-induced

hearing loss• Dermatological

conditions– Rashses, scalds,

burns• Psychological

disorders:– Alcoholisms,

drug dependency

Prevention of Occupational

Disease• Primary Prevention

– Eliminate or reduce hazardous exposures

• Secondary Prevention– Effectively identify work-

related illness through symptoms/screening procedures

• Tertiary Prevention– Reduce complications and

disability caused by existing disease

Effective Prevention

Strategies to reduce exposures

o Substitute a less hazardous material

o Engineering controls, e.g., ventilation, process isolation or enclosure

o Alteration of work practices: e.g., wet sweeping asbestos

o Administrative controls: worker rotation, time away from hazard

o Personal hygiene programs e.g., showers at end of workday

o Protective equipment: respirators, gloves, ear plugs, muffs

o Biological markers: to assess exposure – blood-lead levels

Effective Prevention

Strategies to reduce exposures

o More widespread testing of chemical substances---pre-market evaluation

o Occupational surveillance systems

___________________Children-Longitudinal studies-right to know legislation-surveillance systems for

children’s diseases

PSR to DPSEEA models

• PSR Pressure-state response

• PSIR Pressure-state-impact-response

• DPSEEA Driving forces, pressures, state, exposures, health effects and actions

References• McCally, M. (2002) Life Support: Environment

and Human Health Chapters 15 (Landrigan and Garg) and 17 (Jameton and Pierce)

• vonShirnding, Y.E. (2002) Health and Environment Indicators in the Context of Sustainable Development, CJPH, Sept-Oct, S9-S15.

• Draper, D. and B.Mitchell Environmental Justice, Canadian Geographer.