lecture_9_sustainable_health_and_ethical_responsibilities.ppt
TRANSCRIPT
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.