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Lecture_9_Sustainable_health_and_ethical_responsibilities.ppt Lecture_9_Sustainable_health_and_ethical_responsibilities.ppt Document Transcript

  • Lecture 8 Sustainable Health Care and Emerging Ethical Responsibilities, Vulnerable Populations and Environmental Health and Children
  • 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 9 th . 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
    • 20 th 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-skeletal
    • back, 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
      • Substitute a less hazardous material
      • Engineering controls, e.g., ventilation, process isolation or enclosure
      • Alteration of work practices: e.g., wet sweeping asbestos
      • Administrative controls: worker rotation, time away from hazard
      • Personal hygiene programs e.g., showers at end of workday
      • Protective equipment: respirators, gloves, ear plugs, muffs
      • Biological markers: to assess exposure – blood-lead levels
  • Effective Prevention Strategies to reduce exposures
      • More widespread testing of chemical substances---pre-market evaluation
      • 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.