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4.4.5: Environmental Hazard Reduction - Biology

4.4.5: Environmental Hazard Reduction - Biology


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Public Health Organizations

A large number of international programs and agencies are involved in efforts to promote global public health. Among their goals are developing infrastructure in health care, public sanitation, and public health capacity; monitoring infectious disease occurrences around the world; coordinating communications between national public health agencies in various countries; and coordinating international responses to major health crises. In large part, these international efforts are necessary because disease-causing microorganisms know no national boundaries.

International public health issues are coordinated by the World Health Organization (WHO), an agency of the United Nations. Of its roughly $4 billion budget for 2015–16, about $1 billion was funded by member states and the remaining $3 billion by voluntary contributions. In addition to monitoring and reporting on infectious disease, WHO also develops and implements strategies for their control and prevention. WHO has had a number of successful international public health campaigns. For example, its vaccination program against smallpox, begun in the mid-1960s, resulted in the global eradication of the disease by 1980. WHO continues to be involved in infectious disease control, primarily in the developing world, with programs targeting malaria, HIV/AIDS, and tuberculosis, among others. It also runs programs to reduce illness and mortality that occur as a result of violence, accidents, lifestyle-associated illnesses such as diabetes, and poor health-care infrastructure.

WHO maintains a global alert and response system that coordinates information from member nations. In the event of a public health emergency or epidemic, it provides logistical support and coordinates international response to the emergency. The United States contributes to this effort through the Centers for Disease Control and Prevention (CDC), an agency of the Department of Health and Human Services (figure (PageIndex{a})). The CDC carries out international monitoring and public health efforts, mainly in the service of protecting US public health in an increasingly connected world. Similarly, the European Union maintains a Health Security Committee that monitors disease outbreaks within its member countries and internationally, coordinating with WHO.

Figure (PageIndex{a}): The Centers for Disease Control and Prevention is charged with protecting the public from disease and injury. Image by CDC (public domain).

One way that the CDC carries out this mission is by overseeing the National Notifiable Disease Surveillance System (NNDSS) in cooperation with regional, state, and territorial public health departments. The NNDSS monitors diseases considered to be of public health importance on a national scale. Such diseases are called notifiable diseases or reportable diseases because all cases must be reported to the CDC. A physician treating a patient with a notifiable disease is legally required to submit a report on the case. Notifiable diseases include HIV infection, measles, West Nile virus infections, and many others. Some states have their own lists of notifiable diseases that include diseases beyond those on the CDC’s list.

Notifiable diseases are tracked by epidemiological studies and the data is used to inform health-care providers and the public about possible risks. The CDC publishes the Morbidity and Mortality Weekly Report (MMWR), which provides physicians and health-care workers with updates on public health issues and the latest data pertaining to notifiable diseases. Table (PageIndex{a}) is an example of the kind of data contained in the MMWR.

Table (PageIndex{a}): Incidence of Four Notifiable Diseases in the United States, Week Ending January 2, 2016
DiseaseCurrent Week (Jan 2, 2016)Median of Previous 52 WeeksMaximum of Previous 52 WeeksCumulative Cases 2015
Campylobacteriosis4068691,38546,618
Chlamydia trachomatis infection11,02428,56231,0891,425,303
Giardiasis11523033511,870
Gonorrhea3,2077,1558,283369,926

The current Morbidity and Mortality Weekly Report is available online.

Strategies for Reducing Environmental Hazards

Providing access to clean water is an important strategy for reducing environmental hazards. Because lack of clean water is responsible for diarrheal and other infectious diseases, particular in developing countries, access to clean water limits disease spread (a biological hazard). Furthermore, clean water reduces exposure to toxins (chemical hazards). This can be achieved through digging wells and establishing water treatment facilities. Improving sanitation and hygiene (for example, by supplying latrines, [figure (PageIndex{b})] and handwashing stations) further reduces the spread of infectious disease.

Figure (PageIndex{b}): When adequate plumbing is not available, latrines, such as this pit latrine, prevent sewage from polluting water supplies. Image by SuSanA Secretariat (CC-BY).

In Sub-Saharan Africa and South Asia, the use of pipe filters helped eradicate Guinea worm disease, which is caused by a parasitic worm. People are infected by this disease when they drink water contaminated by small animals called copepods that house the larvae. Once in the body, the larvae mature in the abdomen, and adult worms eventually (and painfully) exit through the skin. If an infected person enters a body of water at this stage, adult worms release more larvae into the water, continuing their life cycle. Pipe filters are straw-like structures that contain openings small enough to allow the passage of water but not copepods, preventing infection.

Another strategy to limit exposure to biological hazards is to reduce exposure to disease vectors. Depending on the specific vector and disease this could involve removing standing water (which facilitates mosquito reproduction), application of pesticides, or use of netting (figure (PageIndex{c})). Biological control is also slowly emerging in vector control in public health and in areas that for a long time mainly focused on chemical vector control of the Anopheles mosquito (the vector of malaria) and the black fly (the vector of river blindness, caused by a parasitic worm). The release of sterile males has been used to control the tsetse fly, the vector of African sleeping sickness. Vaccinating animals that harbor diseases (reservoirs) can also limit the chance of infection.

Figure (PageIndex{c}): A net excludes mosquitos, which are disease vectors. The Anopheles mosquito is only active at night, and thus sleeping inside of a net can limit exposure to malaria. Image by Presidents Mosquito Initiative a component of the U.S. Government's Global Health Initiative (public domain).

Because air pollution exposes individuals to toxins, limiting air pollution is another means of reducing environmental hazards. This can involve energy conservation, using clean energy, such as solar or wind (rather than burning fossil fuels), enforcing air pollution standards on industry, and implementing pollution-reducing technologies, at an industry or household scale. A main source of indoor air pollution is cooking using a fire indoors. Solar ovens provide a pollution-free alternative for people who do not have access to electricity or gas for cooking (figure (PageIndex{d})).

Figure (PageIndex{d}): Solar ovens are a pollution-free option for cooking food if electricity or gas is not available. Image by SUN OVEN (public domian).

The public have an important role in environmental hazard reduction. Firstly, the public must engage in behaviors to prevent disease spread and minimize contact with toxins, and public health education is critical to this. In the case of Guinea worm disease, individuals learned how to use pipe filters and shy they must avoid submerging wounds from the worms in bodies of water to limit disease spread. In the case of COVID-19, individuals are learning to reduce disease transmission by employing frequent handwashing, mask wearing, and social distancing (figure (PageIndex{e})).

Figure (PageIndex{e}): The California Department of Public Health website includes guidelines for limiting disease spread. Image from the CDPH website (public domain).

The public can also support policies that reduce exposure to environmental hazards. For example, many states have laws that reduce exposure to secondhand smoke. The Toxic Substances Control Act (TSCA) bans or regulates harmful chemicals, such as asbestos and heavy metals (figure (PageIndex{f}))..

Figure (PageIndex{f}): Asbestos removal from a building in the United Kingdom (UK). While asbestos is fully banned in the UK, only certain uses of asbestos are banned in the United States under the Toxic Substances Control Act . Image by Fevs101 (CC-BY-SA).

Many strategies for reducing environmental health hazards directly align with the United Nations Sustainable Development Goals, particularly goals 3 (Good Health and Well-Being) and 6 (Clean Water and Sanitation).

Modified by Melissa Ha from the following sources:

  • Disease and Epidemiology from Microbiology by OpenStax (licensed under CC-BY)
  • Sustainable Agriculture from Environmental Biology by Mathew R. Fisher (licensed under CC-BY)

Hazards, Disasters, and Risks

In this chapter, we will elaborate on three basic terms in the field of disaster risk science: hazards, disasters, and risks. We will also discuss the classification, indexes, temporal and spatial patterns, and some other fundamental scientific problems that are related to these three terms.

In this chapter, we will elaborate on three basic terms in the field of disaster risk science: hazards, disasters and risks. We will also discuss the classification, indexes, temporal and spatial patterns, and some other fundamental scientific problems that are related to these three terms.


Abstract

Inherent safety has been of great interest to regulators, process designers and investors. The idea behind this is that a process design is more economic when it is inherently safer. Inherent safety is known as the safety intrinsic to a process the spirit of which is to mitigate hazards within the process. It is also possible to achieve inherently safer design by diminishing the hazards in multi-component streams during process design. Hazards reduction during the design phase is a challenging task. A decrease in hazards in a process design not only improves process safety, but also protects the environment from potential impacts of the process. Current methodologies for risk assessment at the conceptual design stage of a chemical process need detailed process data, which is usually unavailable at such a phase. This paper presents simple new indices that require minimum data for risk evaluation of chemical processes at the conceptual design phase. The indices are applied to a hydrogenation case study to choose inherently safer designs among different alternatives. As an important result, total capacity of a process among other design array does not suffice for decision making unless the mass fraction of hazards in product streams are appreciably low.


Biological and Environmental Hazards, Risks, and Disasters

Biological and Environmental Hazards, Risks, and Disasters provides an integrated look at major impacts to the Earth’s biosphere. Many of these are caused by diseases, algal blooms, insects, animals, species extinction, deforestation, land degradation, and comet and asteroid strikes that have important implications for humans.

This volume, from Elsevier’s Hazards and Disasters Series, provides an in-depth view of threats, ranging from microscopic organisms to celestial objects. Perspectives from both natural and social sciences provide an in-depth understanding of potential impacts.

Biological and Environmental Hazards, Risks, and Disasters provides an integrated look at major impacts to the Earth’s biosphere. Many of these are caused by diseases, algal blooms, insects, animals, species extinction, deforestation, land degradation, and comet and asteroid strikes that have important implications for humans.

This volume, from Elsevier’s Hazards and Disasters Series, provides an in-depth view of threats, ranging from microscopic organisms to celestial objects. Perspectives from both natural and social sciences provide an in-depth understanding of potential impacts.


Table of contents

Volume I &ndash Introduction

Volume II &ndash General Methodology (Volume Editor: Suresh D. Pillai)

Section 2.1 &ndash Culture-Based and Physiological Detection (Section Editor: Yoichi Kamagata)

Chapter 2.1.1 &ndash Detection of specific taxa using chromogenic and fluorogenic media (Mohammad Manafi)

Chapter 2.1.2 - Anaerobic cultivation (Takashi Narihiro, Yoichi Kamagata)

Chapter 2.1.3 - New devices for cultivation (Yoshiteru Aoi, Slava Epstein)

Section 2.2 &ndash Microscopic Methods (Section Editor: Cleber Oeverney)

Chapter 2.2.1 - Gold-based in situ hybridization for phylogenetic single-cell detection of prokaryotes in environmental samples (Thilo Eickhorst, Hannes Schmidt)

Chapter 2.2.2 - Assessment of prokaryotic biological activity at the single cell level by combining microautoradiography and fluorescence in situ hybridization (FISH) (Cleber C. Ouverney)

Section 2.3 - Target-Specific Detection (Section Editor: Douglas R. Call)

Chapter 2.3.1 - Antibody-based technologies for environmental biodetection (Cheryl L. Baird, Susan M. Varnum)

Chapter 2.3.2 - PCR, real-time PCR, digital PCR and isothermal amplification (Rachel A. Bartholomew, Janine R. Hutchison, Timothy M. Straub, Douglas R. Call)

Chapter 2.3.3 - Microarray-Based Environmental Diagnostics (Darrell P. Chandler)

Chapter 2.3.4 - Field Application of Pathogen Detection Technologies (Timothy M. Straub, Douglas R. Call, Cindy Bruckner-Lea, Heather Colburn, Cheryl L. Baird, Rachel A. Bartholomew, Richard Ozanich, Kristin Jarman)

Section 2.4 - Microbial Community Analysis of Environmental Samples with Next Generation Sequencing (Section Editor: Stefan J. Green)

Chapter 2.4.1 &ndash Introduction to Microbial community analysis of environmental samples with next-generation sequencing (Stefan J. Green, Josh D. Neufeld)

Chapter 2.4.2 &ndash Microbial Community Analysis Using High-Throughput Amplicon Sequencing (Danny Ionescu, Will A. Overholt, Michael D. J. Lynch, Josh D. Neufeld, Ankur Naqib, Stefan J. Green)

Chapter 2.4.3 &ndash Functional Metagenomics: Procedures and Progress (Laura S. Morris, Julian R. Marchesi)

Chapter 2.4.4 &ndash Metagenomics: Assigning Functional Status to the Community Gene Content (Naseer Sangwan, Rup Lal)

Chapter 2.4.5 - Generation and Analysis of Microbial Metatranscriptomes (Neha Sarode, Darren J. Parris, Sangita Ganesh, Sherry L. Seston, Frank J. Stewart)

Section 2.5 - Qa/Qc In Environmental Microbiology (Section Editor: Yildiz T. Chambers)

Chapter 2.5.1 &ndash Introduction (Kevin K. Connell)

Chapter 2.5.2 &ndash General Quality Control (Robin K. Oshiro)

Chapter 2.5.3 &ndash Quality Control for Bacteriological Analyses (Ellen Braun-Howland)

Chapter 2.5.4 &ndash Quality Control for Virological Analyses (Richard E. Danielson)

Chapter 2.5.5 &ndash Quality Control for USEPA Method 1623 Protozoan Analysis and PCR Analyses (George D. Di Giovanni, Gregory D. Sturbaum)

Chapter 2.5.6 &ndash The Role of Statistical Thinking Statistical Thinking in Environmental Microbiology (J. Vaun McArthur, R. Cary Tuckfield)

Chapter 2.5.7 &ndash Study Design(Yildiz T. Chambers, Robin K. Oshiro)

Section 2.6 - Sampling Methods (Section Editor: J. Scott Meschke)

Chapter 2.6.1 &ndash Water Sampling and Processing Techniques for Public Health-Related Microbes (Vincent Hill)

Chapter 2.6.2 &ndash Surface Sampling (Laura J. Rose, Judith Noble-Wang, Matthew J. Arduino)

Chapter 2.6.3 &ndash Soil Sampling for Microbial Analyses (John Brooks)

Chapter 2.6.4 &ndash Microbiological Sampling of Wastewater and Biosolids

Volume III - Environmental Public Health Microbiology (Volume Editor: Marylynn V. Yates)

Section 3.1 &ndash Water (Section Editor: Gary Toranzos)

Chapter 3.1.1 &ndash Detection of Microbial Indicators in Environmental Freshwaters and Drinking Waters (Tasha M. Santiago-Rodriguez, Julie Kinzelman, Gary A. Toranzos)

Chapter 3.1.2 &ndash Best Practices for Cyanobacterial Harmful Algal Bloom Monitoring(Timothy G. Otten, Hans W. Paerl)

Chapter 3.1.3 &ndash Assessing the Efficiency of Wastewater Treatment (Graciela I. Ramírez toro, Harvey Minnigh)

Chapter 3.1.4 &ndash Epidemiologic Aspects of Waterborne Infectious Disease (Samuel Dorevitch)

Chapter 3.1.5 &ndash Waterborne Enteric Viruses: Diversity, Distribution and Detection(Morteza Abbaszadegan, Absar Alum)

Chapter 3.1.6 &ndash Detection of Protozoa in Surface and Finished Waters (Absar Alum, Eric N. Villegas, Scott P. Keely, Kelly R. Bright, Laura Y. Sifuentes, Morteza Abbaszadegan)

Chapter 3.1.7 &ndash Drinking Water Microbiology

Section 3.2 &ndash Aerobiology (Section Editor: Mark P. Buttner)

Chapter 3.2.1 &ndash Introduction to aerobiology (Paula Krauter, Linda D. Stetzenbach)

Chapter 3.2.2 - Sampling for Airborne Microorganisms (Sergey A. Frinshpun, Mark P. Buttner, Gediminas Mainelis, Klaus Willeke)

Chapter 3.2.3 - Analysis of Bioaerosol Samples(Patricia Cruz, Mark P. Buttner)

Chapter 3.2.4 - Fate and Transport of Microorganisms in Air (Gary S. Brown, Alan Jeff Mohr)

Chapter 3.2.5 - Airborne Fungi and Mycotoxins (De-Wei Li, Eckardt Johanning, Chin S. Yang)

Chapter 3.2.6 - Airborne Bacteria and Endotoxin (Peter S. Thorne, Caroline Duchaine, Pascale Blais Lecours)

Chapter 3.2.7 - Airborne Viruses (Syed A. Sattar, Nitin Bhardwaj, M. Khalid Ijaz)

Chapter 3.2.8 - Aerobiology of Agricultural Pathogens (Estelle Levetin)

Chapter 3.2.9 - Legionellae and Legionnaires' Disease (Claressa E. Lucas)

Section 3.3 &ndash Soil (Section Editor: Ed Topp)

Chapter 3.3.1 &ndash Pathogenic Viruses and Protozoa Transmitted by Soil (Pascal Delaquis, Julie Brassard, Alvin Gajadhar)

Chapter 3.3.2 - Natural soil reservoirs for human pathogenic and fecal indicator bacteria (Maria Laura Boschiroli, Joseph Falkinham, Sabine Favre-Bonté, Sylvie Nazaret, Pascal Piveteau, Michael Sadowsky, Murulee Byappanahalli, Pascal Delaquis, Alain Hartmann)

Section 3.4 &ndash Microbial Source Tracking (Section Editor: Valerie J. Harwood)

Chapter 3.4.1 &ndash The Evolving Science of Microbial Source Tracking (Valerie J. Harwood, Charles Hagedorn, Michael Sadowsky)

Chapter 3.4.2 &ndash Validation of microbial source tracking markers and detection protocols: considerations for effective interpretation (Asja Korajkic, Don Stoeckel, John F. Griffith)

Chapter 3.4.3 &ndash Overview of Microbial Source Tracking Methods Targeting Human Fecal Pollution Sources (Orin C. Shanks, Hyatt Green, Asja Korajkic, Katharine G. Field)

Chapter 3.4.4 &ndash Methods of targeting animal sources of fecal pollution in water (Anicet R Blanch, Elisenda Ballesté, Jennifer Weidhaas, Jorge Santo Domingo, Hodon Ryu)

Chapter 3.4.5 &ndash MST: Field Study Planning and Implementation (Julie Kinzelman, Warish Ahmed)

Chapter 3.4.6 - Fecal Indicator Organism Monitoring and Microbial Source Tracking in Environmental Waters: Overview of Existing Modeling Efforts (Meredith B. Nevers, Muruleedhara N. Byappanahalli, Mantha S. Phanikumar, and Richard L. Whitman)

Section 3.5 &ndash Microbial Risk Assessment (Section Editor: Marylynn V. Yates)

Chapter 3.5.1 &ndash Dose Response Modeling and Use&ndashChallenges and Uncertainties in Environmental Exposure (Mark H. Weir)

Chapter 3.5.2 &ndash Exposure assessment (Susan Petterson, Nicholas Ashbolt)

Chapter 3.5.3 &ndash Dose-Response Modeling and Use: Challenges and Uncertainties in Environmental Exposure (Mark H. Weir)

Volume IV &ndash Microbial Ecology (Volume Editor: Robert V. Miller)

Section 4.1 &ndash Theory (Section Editor: Larry Forney)

Chapter 4.1.1 &ndash Phylogenomic Networks of Microbial Genome Evolution (Tal Dagan, Ovidiu Popa, Thorsten Klösges, Giddy Landan)

Chapter 4.1.2 &ndash Evolutionary ecology of microorganisms: from the tamed to the wild (Jay T. Lennon, Vincent J. Denef)

Section 4.2 &ndash Aquatic Environments (Section Editor: Robert H. Findlay)

Chapter 4.2.1 &ndash The Microbial Ecology of Benthic Environments (Robert H. Findlay, Tom J. Battin)

Chapter 4.2.2 &ndash Heterotrophic Planktonic Microbes: Viruses, Bacteria, Archaea, and Protozoa (Jed A. Fuhrman, David A. Caron)

Chapter 4.2.3 &ndash Aquatic Biofilms: Development, cultivation, analyses, and applications (John R. Lawrence, Thomas R. Neu, Armelle Paule, Darren R. Korber, Gideon M. Wolfaardt)

Section 4.3 &ndash Extreme Environments (Section Editor: Brian Hedlund)

Chapter 4.3.1 &ndash The Microbiology of Extremely Acidic Environments (D. Barrie Johnson, Angeles Aguilera)

Chapter 4.3.2 &ndash Life in High Salinity Environments (Aharon Oren)

Chapter 4.3.3 &ndash Microbial life in extreme low-biomass environments &ndash a molecular approach (Kasthuri Venkateswaran, Myron T. La Duc, Parag Vaishampayan, James A. Spry)

Chapter 4.3.4 &ndash Life in High-Temperature Environments (Brian Hedlund, Scott Thomas, Jeremy Dodsworth, Chuanlun Zhang)

Section 4.4 - Animal-Gut Microbiomes (Section Editor: Julian Marchesi)

Chapter 4.4.1 - Invertebrate-gut associations (Daniele Daffonchio, Alberto Alma, Guido Favia, Luciano Sacchi, Claudio Bandi)

Chapter 4.4.2 - Studying the mammalian intestinal microbiome using animal models (Floor Hugenholtz, Jing Zhang, Paul W. O&rsquoToole, Hauke Smidt)

Chapter 4.4.3 - Animal Gut Microbiomes (Richard J Ellis, Chris McSweeney)

Volume V &ndash Biodegradation and Biotransformation (Volume Editor: Cindy H. Nakatsu)

Section 5.1 &ndash Biodegradation (Section Editor: Cindy H. Nakatsu)

Chapter 5.1.1 - Genomic Features and Genome-Wide analyses of Dioxin-Like Compound Degraders (Masaki Shintani and Kazuhide Kimbara)

Chapter 5.1.2 - Biodegradation of organochlorine pesticides (Yuji Nagata, Michiro Tabata, Yoshiyuki Ohtsubo, Masataka Tsuda)

Chapter 5.1.3 &ndash Anaerobic degradation of aromatic compounds (Weimin Sun, Valdis Krumins, Donna E. Fennell, Lee J. Kerkhof, Max M. Häggblom)

Chapter 5.1.4 &ndash Microbial electrochemical technologies producing electricity and valuable chemicals from biodegradation of waste organic matters (Taeho Lee, Akihiro Okamoto, Sokhee Jung, Ryuhei Nakamura, Jung Rae Kim, Kazuya Watanabe, Kazuhito Hashimoto)

Chapter 5.1.5 - A basic introduction to aerobic biodegradation of petroleum aromatic compounds (Kengo Inoue, Onruthai Pinyakong, Kano Kasuga, Hideaki Nojiri)

Chapter 5.1.6 - Environmental systems microbiology of contaminated environments (Terry C. Hazen, Gary S. Sayler)

Section 5.2 &ndash Biotransformation (Section Editor: Chris Rensing)

Chapter 5.2.1 &ndash Breathing Iron: Molecular Mechanism of Microbial Iron Reduction by Shewanella oneidensis (Rebecca E. Cooper, Jennifer L. Goff, Ben C. Reed, Ramanan Sekar, Thomas J. DiChristina)

Chapter 5.2.2 &ndash Experimental Geomicrobiology: From Field to Laboratory (Timothy S. Magnuson, Rhesa N. Ledbetter)

Chapter 5.2.3 - Restoration of Metal(loid) Contaminated Soils (Timberley Roane, Munira Lantz)


Nursing, Health, and the Environment (1995)

The most difficult challenges for environmental health today come not from what is known about the harmful effects of microbial agents rather they come from what is not known about the toxic and ecologic effects of the use of fossil fuels and synthetic chemicals in modern society.

Environmental health hazards are ubiquitous, affecting all aspects of life and all areas of nursing practice. As noted by the National Research Council in 1984, more than 65,000 new chemical compounds have been introduced into the environment since 1950, and new chemical compounds enter commerce each year. The post-World War II era brought major technological advances to society, accompanied by the release of an unprecedented amount of synthetic chemicals onto U.S. markets. It is presently estimated that there are 72,000 chemicals currently used in commerce (excluding food additives, drugs, cosmetics, and pesticides), the majority of which have had limited testing for their effects on human health and the environment (INFORM, 1995). Even less is known about simultaneous exposures to a number of different chemicals, which is how most human contact with chemicals occurs.

As early as 1979, the Surgeon General's Report on Health Promotion and Disease Prevention noted, "There is virtually no major chronic disease to which environmental factors do not contribute, either directly or indirectly" (DHHS, 1979, p. 105). Nevertheless, it is impossible to accurately quantify the burden of morbidity and mortality related to environmental exposures for several reasons: poor compliance with reporting requirements for occupational illness, long latency periods between initial exposure and resulting disease, the inability of health care providers to recognize environmental etiologies of diseases, and the absence of national reporting systems for environmentally related illnesses. The extent of the problem is further obscured by the multifactorial etiology of many

environmentally related diseases (e.g., lung cancer caused by exposure to asbestos is more likely to occur among people who smoke tobacco). Nevertheless, the link between adverse health effects and exposure to environmental hazards has been well established, and much can be done to prevent or minimize environmentally related illnesses.

While scientific understanding of the potential adverse health effects of most chemical compounds on humans is incomplete, reports concerning the adverse health affects associated with chemical exposures in other species are frequent. People's concerns about the impact of environmental conditions on their health are often voiced to nurses in the community and at the workplace. However, many nurses do not have the knowledge needed to identify environmental factors that may contribute to illness and injury among the populations they serve.

Environmental hazards may be encountered at home, work, or in the community via several pathways: contaminated air, soil, water, and food (see Figure 2.1). Routes of exposure include: inhalation, such as, of dust or fumes ingestion, such as, of pesticide residues on fruits and vegetables and dermal absorption, such as, of ultraviolet-B radiation from the sun or direct skin contact with caustic household cleansers.

FIGURE 2.1 Exposure pathways. SOURCE: ATSDR, 1992.

This chapter provides an overview of environmental hazards to human health in the home, workplace, community, and globally. It is only an overview, and does not include all environmental hazards or all environmentally related illnesses, nor does it detail all of the hazards to, or specific vulnerabilities of, various subpopulations. It does, however, establish a basis for the need to examine the role of nurses in addressing environmental health issues, particularly for readers who are new to the field of environmental health. Subsequent chapters will link the problems described in this chapter to implications for changes in nursing practice, education, and research to allow for more effective interventions in matters of environmental health.

CLASSIFYING HAZARDS

Although a number of systems are used to characterize environmental hazards, most commonly they are classified as either chemical, physical, mechanical, or psychosocial hazards. Table 2.1 presents this classification scheme, along with examples of hazards that fall into each category. Stevens and Hall (1993) have compiled a list of environmental health problems that are categorized by a variety of broad public health issues (Table 2.2), which is also included to illustrate the range of specific environmental problems that may adversely affect human health.

AIR, SOIL, AND WATER

According to EPA, more than 40 million people live within 4 miles of a Superfund 1 site, and approximately 4 million reside within 1 mile of a site (NRC, 1991). Those people who live near Superfund sites may be at risk for exposure to hazardous substances in contaminated drinking water, contaminated soil in such areas as playgrounds and gardens, or through the siting of homes on contaminated property with the possibility of exposure to toxic substances via numerous routes and pathways.

Safe drinking water is a significant environmental health concern: currently 25 percent of community water systems provide drinking water that does not meet EPA safety standards for biological and chemical contaminants (DHHS, 1990). Contaminated drinking water can be a result of point-source pollutants such as Superfund sites or non-point sources such

Superfund sites are hazardous waste sites designated by the U.S. Environmental Protection Agency (EPA) as a threat to human health. These areas may include leaking underground storage tanks or inactive hazardous waste sites such as municipal dumps and contaminated factories or mines and mills (Chiras, 1994).

TABLE 2.1 Common Classes of Environmental Health Hazards, with Examples

a This category is sometimes included in the class of physical hazards.

as runoff of agricultural fertilizers and pesticides into waterways that supply drinking water.

The environmental exposure limits designed to protect against contaminants may be in the form of regulatory standards (e.g., maximum contaminant levels (MCLs) for drinking water), action standards (e.g., soil lead levels exceeding 500 ppm), or risk-based standards (e.g., a 10 -4 or 10 -6 excess cancer risk). Environmental standards are often based on retrospective studies of worker exposure (a natural experimental model) or on laboratory studies using animals. A large degree of uncertainty exists when extrapolating from safe levels of exposure for workers based on an 8 hour period within a work site to ambient levels of residential exposure that may occur 24 hours a day outside the worksite (and away from safety systems such as exhaust ventilation). An even greater level of uncertainty and complexity results when studies of small laboratory animals exposed to large quantities of a single substance over a brief period of time are used as the basis for projecting health risk to humans, who are typically exposed to small quantities of multiple substances over extended periods of time.

Air pollution&mdashboth indoor and outdoor&mdashraises another set of environmental hazards. Over 50 percent of the U.S. population lives in areas where the outdoor air did not meet EPA standards for contaminants (e.g., ozone, nitrogen dioxide, sulfur dioxide, particulates, and lead) at some time during the previous 12 months (DHHS, 1990). Most Americans spend the majority of their time indoors, either at home, school, or the workplace, where most of the exposure to foreign proteins via inhalation

TABLE 2.2 Examples of Environmental Health Hazards

&bull Environmental tobacco smoke

&bull Residential lead-based paint

&bull Repetitive motion injuries

&bull Carcinogenic work exposures

&bull Greenhouse gases and global warming

&bull Depletion of the ozone layer

&bull Aerial spraying of herbicides and pesticides

&bull Contamination by human waste

&bull Oil and chemical spills in waterways

&bull Pesticide/herbicide contamination of groundwater and runoff to local waterways

&bull Aquifer contamination by industrial pollutants

&bull Toxic contamination of fish and seafood

&bull Rodent and insect infestations

&bull Particulates from wood-burning stoves

&bull Houses and buildings with poor ventilation systems&mdashsick building syndrome

&bull Off-gases from carpets and plastics used in home construction

&bull Pesticide residues on fruits and vegetables

&bull Disruption of food chain by pollutants

&bull Hormone supplements and antibiotic residues in animal food products

Use of nonbiodegradable products

&bull Contamination of air, soil, and waters due to poorly designed solid waste dumps and inadequate sewage systems

&bull Transport and storage of hazardous waste

&bull Illegal dumping of industrial waste

&bull Abandoned hazardous waste sites (including Superfund sites)

&bull Nuclear facility emissions

&bull Radioactive nuclear waste

&bull Radon gas seepage in homes and schools

&bull Excessive exposure to X-rays

&bull Ultraviolet radiation (UV-B) due to global depletion of stratospheric ozone

&bull Proliferation of handguns

&bull Pervasive images of violence in the media

&bull Violent acts against women and children

&bull Excessive incidents of violence in workplaces, schools, and community settings

SOURCE: Adapted from Stevens and Hall, 1993.

occurs. A large proportion of asthmatics are allergic to indoor allergens, including foreign proteins, and exposure to these allergens can be reduced or minimized through various measures. According to the IOM, improved public and professional education are essential for the prevention and control of indoor allergic disease. Nursing education should emphasize the importance of recognition and proper management of these diseases (IOM, 1993). Paralleling increased pollution of both indoor and outdoor air, the incidence of childhood asthma has risen sharply in the last 2&ndash3 decades. For some age groups (e.g., girls aged 5&ndash14 years) the incidence has doubled or tripled (Yunginger, 1992). In addition, adverse health effects associated with indoor and outdoor air pollution disproportionately affect some populations asthma mortality rates among African Americans are 3&ndash5 times greater than among Caucasians (IOM, 1993).

Pesticide residues on fruits and vegetables, and the bioaccumulation of chemicals in fish and seafood are additional concerns: it is estimated that 25 percent of all rivers, lakes, and streams in the United States cannot support "beneficial uses," including fishing and swimming, due to widespread pollution (DHHS, 1990). Contaminants with the potential to adversely affect human health include polychlorinated biphenyls (PCBs) and mercury. Disadvantaged populations who consume larger quantities of contaminated fish caught in local waters experience a greater burden of exposure than members of other socioeconomic groups. Nurses working in community and public health settings could assist in educating the public about the hazards (or safety) of diets that consist of fish and

seafood taken from local waterways and by explaining appropriate measures for rinsing pesticide residues from fruits and vegetables.

THE WORKPLACE ENVIRONMENT

The workplace is an important setting to consider when studying environmentally related illness environmental hazards and exposures can be substantial in occupational settings. At present, workplace injuries and fatalities are the most well-documented indices of adverse effects of the environment on health. More than 2.25 million work-related illnesses and injuries were reported to the U.S. Department of Labor in 1993 (BLS, April 26, 1995). Three primary occupations with at least 100,000 cases involving work absences 2 &mdashtruck drivers, nonconstruction laborers (except farm), and nursing aides and orderlies&mdashhad larger shares of the injury and illness case total for 1993 than their share of the total workforce (BLS, May 15, 1995). Sprains and strains were by far the leading type of injury, and the parts of the body most often affected were the back, shoulder, and other areas of the upper trunk. The three most common injuries or illnesses in terms of number of lost work days were carpal tunnel syndrome (median = 30 lost days), amputation (median = 22 lost days), and fractures (median = 20 lost days). Men accounted for a larger share (two-thirds) of the survey-wide total absences due to injuries and illnesses than their share (55 percent) of total employment. Women injured on the job accounted for a larger share of repetitive motion disorders (64 percent) and injuries from violent acts (57 percent) than their share of total employment (45 percent).

The costs to employers and society of these injuries are high and can be measured in lost work days: 20 percent of injured people were absent from work for 31 days or more. There were 117,000 absences in 1993 from work due to work-related illnesses, including carpal tunnel syndrome and long-term latent diseases, such as skin cancer following exposure to arsenic or ionizing radiation. The incidence of occupational diseases is believed to be understated in the survey because of: (1) the difficulty in relating these illnesses to the workplace, and (2) the failure of health care providers to recognize and report such conditions as being work related (BLS, April 26, 1995).

A total of 6,271 fatal work injuries were reported to the BLS in 1993&mdashhighway traffic incidents were the most common cause of death (20 percent),

An "absence" is defined as one or more work days lost due to a single episode of occupational injury or illness. Thus, five lost work days due to a sprained ankle equals one absence.

followed by homicide (17 percent). Among women in the workplace, homicide was the most frequent cause of death, accounting for 39 percent of their 481 fatal injuries (BLS, May 15, 1995). Gunshot wounds were the cause of death in 82 percent of all workplace homicides. Violence, and the psychosocial conditions that surround violent behavior, is an environmental hazard of epidemic proportions in the home, community, as well as in the workplace. Nurses encounter the results of violence in a number of work settings opportunities for prevention are dependent upon recognition of factors that contribute to violence (e.g., stress, inadequate coping skills, and poor worker-management relationships). Because they frequently conduct their practice in the home, community, and workplace, nurses are often able to directly recognize these factors firsthand.

Nurses are by far the largest group of health professionals providing care in occupational settings (DHHS, 1988). This proximity to the workplace can enable nurses to identify and initiate measures to remediate workplace health hazards if they are adequately educated to do so. Nurses must also recognize a professional obligation to advise employees and employers of real or potential hazards, and where necessary, initiate steps to control or eliminate hazardous conditions.

THE GLOBAL ENVIRONMENT

In addition to exposures at home, in the workplace, and in the community, global environmental conditions may also adversely affect human health. Global warming trends over the last century may have numerous untoward health effects should they continue. For example, it is estimated that mortality during prolonged heat waves may increase 30 percent-50 percent in U.S. cities if warming trends continue (Kilbourne, 1990). Increases in temperature may adversely affect people with a number of major categories of disease, particularly cardiovascular, cerebrovascular, and respiratory diseases (Haines, 1993). Cardiovascular mortality associated with heat waves of 41°C may be due to a rise in heart rate of about 30 beats per minute and a fall in blood pressure that has been demonstrated under such conditions (Keatinge et al., 1986). Morbidity and mortality due to in infectious diseases may also increase, as some organisms now restricted to tropical areas could invade densely populated areas further north as the planet warms (Chiras, 1994).

Depletion of stratospheric ozone by the release of chlorofluorocarbons (CFCs), which has occurred over the Arctic as well as the Antarctic, leaves large populations worldwide at risk for adverse health effects from overexposure to ultraviolet radiation. On a seasonal basis, ozone-depleted vortices (large air streams) break into clumps and flow from the

Antarctic over highly populated areas of Australia, New Zealand, South America, and Africa from the Arctic, ozone-depleted air flows southward over North America and Europe. During these periods, which last for several months, ultraviolet radiation can increase by as much as 20 percent. Exposure to ultraviolet radiation is associated with a variety of adverse health effects (Miller, 1993). The incidence of melanomas has already increased by 83 percent in the United States during the period from 1982 through 1989, and the incidence of skin cancer will continue to increase with continued depletion of the ozone layer (CDC, 1995 Chivian et al., 1993 Longstreth, 1990). Low-intensity ultraviolet radiation (UV-B) from sunlight also alters T-lymphocyte function, thus suppressing cellular immunity and increasing susceptibility to carcinogenic and infectious agents (Daynes, 1990 Hersey et al., 1983). Studies of fishermen on the Chesapeake Bay have demonstrated an increased risk for cataracts associated with exposure to sunlight, an outcome believed to be related to oxygen free radicals generated by UV-B (Chivian et al., 1993 Hu, 1990 Jacques and Chylack, 1991 Rosenthal et al., 1988 Taylor, 1990).

A number of global environmental conditions have the potential for untoward effects on health, and further research is needed to illuminate these potential outcomes. Nurses who are knowledgeable about global environmental conditions, such as ozone depletion, can educate the public about measures to reduce or eliminate their exposure to such hazards, (e.g., by limiting direct exposure to the sun and through the use of sunglasses that limit transmission of ultraviolet radiation) and measures to limit further global changes that may have adverse effects on human health (e.g., by using public transportation or car-pooling when possible to reduce the production of greenhouse gases).

VULNERABLE POPULATIONS

Individuals vary widely in their susceptibility to adverse health effects following exposure to toxic substances. Personal characteristics such as age, gender, weight, genetic composition, nutritional status, physiologic status (including pregnancy), preexisting disease states, behavior and lifestyle factors, and concomitant or past exposures may all affect human responses to environmental conditions. The manner in which these characteristics may enhance or decrease susceptibility to environmental hazards is in some cases fairly obvious, while in others it is less so. The relationship of age and genetic factors to one's susceptibility to adverse effects from environmental hazards are perhaps least obvious to clinicians. Table 2.3 summarizes some of the major genetic factors that may be associated with enhanced susceptibility to chemicals in the environment (Tarcher, 1992). The unique vulnerabilities of individuals at the

TABLE 2.3 Genetic Factors and Susceptibility to Occupational and Environmental Chemicals

Status of Genetic-Environmental Interaction

Glucose-6-phosphate dehydrogenase deficiency

About 12 among African-American males very high in tropical and subtropical countries

7&permil&ndash13 among African-Americans 30 of population in parts of Africa

CO, aromatic amino compounds

Methemoglobin reductase deficiency

About 1 of population are heterozygotes

Aryl hydrocarbon hydroxylase induction

High-induction-type Caucasians about 30&permil

Polycyclic aromatic hydrocarbons

Slow acetylator phenotype

Caucasians and African-Americans about 60&permil Orientals about 10&ndash20&permil

Aromatic amine-induced cancer

Caucasians about 50&permil, Orientals about 30&permil, African-Americans about 10&permil

Mainly Japan and Switzerland, reaching 1 in some areas of Japan

30 Caucasians, 10 Chinese, 3 African-Americans

Homozygotes about one in 6,700 North American Caucasians

Respiratory irritants Smoking

About 1:40,000 in all major races

Respiratory irritants, smoking

Unknown, 2 in some occupational populations

SOURCE: Adapted from Tacher, A.B., ed. 1992. Principles and Practice of Environmental Medicine. New York: Plenum Publishing Co. Reprinted with permission.

two extremes of the life cycle, that is, young children and the aged, are similar in many ways due either to the immaturity or normal decline in functioning of major physiologic processes.

Although there are wide individual variations, elderly populations have progressively decreasing function of cardiac, renal, pulmonary, and immune system processes (Tarcher, 1992, p. 198). As a result of these changes&mdashmost of which have been documented in the study of drug therapies in the aged&mdashelderly individuals may have impaired host defenses, impaired immune system function, and changes in their ability to detoxify chemicals. Changes in the stratum corneum of the skin can increase the percutaneous absorption of chemicals. Structural and functional changes that occur in the lung with advanced age, including loss of elasticity and impaired ciliary action, can result in more rapid absorption and decreased clearance of foreign substances in the lung. A decline in the metabolic clearance of certain drugs that require oxidative mechanisms for biotransformation has been noted in aged populations that may also result in a decreased ability to detoxify environmental toxins. Declines in blood flow to both liver and kidney, in part due to declining cardiac output estimated at 1 percent annually after the age of 30, may result in a decreased ability to detoxify and eliminate toxic substances from the body among aged populations. Immune system function is also impaired with aging, including a reduction in cell-mediated immunity and T lymphocytes. Finally, a change in body composition occurs with aging there is a marked increase in adipose tissue mass with a decline in lean body mass. As a result of changes in body composition, water soluble drugs and chemicals have a smaller volume of distribution and greater serum levels, while lipid-soluble substances have an increased volume of distribution. This spectrum of physiologic changes in the aged may increase or decrease both their susceptibility to, and the magnitude of, adverse health outcomes associated with exposure to environmental hazards.

Children are also uniquely susceptible to environmental hazards. They have a higher basal metabolic rate than adults, which affects the absorption and metabolism of toxicants. Children also have a different breathing zone than adults they are closer to the floor, where dust, dirt, and toxic heavy metals such as lead are deposited. The rapid growth and differentiation of cells in young children leaves them more susceptible to genetic alterations associated with many chemical exposures. An increased rate of cell proliferation can indirectly lead to carcinogenesis by increasing the likelihood that spontaneous mutation will occur or by decreasing the time available to repair DNA damage (NRC, 1993b). Moreover, the normal hand-to-mouth activity of toddlers increases the likelihood of exposure through ingestion of toxic substances. Because some

toxicants are retained in ''biologic sanctuaries" (e.g., lead in bone and polycyclic aromatic hydrocarbons in fat), they can cause low-dose chronic exposure for a much longer period of time than would be experienced by exposed adults. Nurses caring for children in any setting&mdashinpatient pediatric units, well-child clinics, home health agencies, and prenatal health centers&mdashneed to understand these factors if they are to detect, or more importantly, prevent adverse environmental exposures in children.

It is estimated that 3&ndash4 million U.S. children have blood lead levels above the defined toxic level of 10 mcg/dl, a level known to cause irreversible deficits in attention and IQ scores (ATSDR, 1988 CDC, 1991a Needleman et al., 1979, 1990). Although lead was banned from household paint in 1971, almost all houses built before 1960 and 20 percent of those built between 1960 and 1974 contain leaded paint (Needleman and Landrigan, 1994). Children at greatest risk for lead poisoning are those living in poorly maintained, substandard housing (e.g., those living in poverty-level conditions). Nurses, including nurse practitioners, must be alert to the risk factors for lead poisoning in young children and aware of measures to reduce those risks. As recommended by the CDC, nurses and other health care providers need to phase-in virtually universal screening of children for blood lead levels (CDC, 1991a). Other environmental hazards in the home that are of concern to both children and adults include radon, environmental tobacco smoke (DHHS, 1986 NRC, 1986), pesticides (Environmental Studies Board, 1988 Miller, 1993 Moses, 1993 Sherman, 1988 Tarcher, 1992), carbon monoxide and airborne particulates from wood-burning stoves (American Thoracic Society, 1990 Samet et al., 1987 Tarcher, 1992), nitrogen dioxide from natural gas stoves (Samet et al., 1987 Tarcher, 1992), formaldehyde and other chemicals that are released as "off-gases" from new carpets, blown-in foam insulation, and synthetic materials covering the indoor surfaces of many mobile homes (Leikauf, 1992 Needleman and Landrigan, 1994 Sherman, 1988 Tarcher, 1992).

ENVIRONMENTAL HEALTH PRIORITIES

Priority environmental hazards and environmentally related illnesses have been established by various public and private-sector organizations, including EPA, NIOSH, and the Agency for Toxic Substances and Disease Registry (ATSDR). A description of priority health conditions that were established by ATSDR is presented here as an example.


Declarations

Author contribution statement

All authors listed have significantly contributed to the development and the writing of this article.

Funding statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Competing interest statement

The authors declare no conflict of interest.

Additional information

No additional information is available for this paper.


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