BizHealthCheck: An Ounce of Prevention: A Primer on the Human Health and the Environment

The impact of the environment on human health can't be underestimated. Being educated about potential hazards is the first step toward protection.

The numbers alone are staggering. Take, for example, the 2,242 bodies of water, including lakes, streams and rivers, in 41 states have been determined to be so polluted that people are advised not to eat fish and seafood from these bodies of water (EPA, 2001b). And, according to the U.S. Department of Health and Human Sciences, approximately 113 million Americans live in areas where federal health-based air quality standards are not met for one or more of the six commonly found air pollutants.

These numbers are not representative of isolated incidents. Environmental hazards like these and others are ubiquitous in the United States and abroad. Despite the prevalence of hazards in air, soil and water, comprehension of the gravity of the situation is lacking. It often takes high-profile media coverage of large-scale hazardous situations, such as the 21,000 tons of chemical waste found under the Love Canal in New York in 1978, the accident at the Three Mile Island nuclear power plant that same year, or in movies like 1998's "A Civil Action" or 2000's "Erin Brockovich," to make a significant impact on the public consciousness.

Increasing media coverage of hazardous incidents has hit its mark, though, as individuals and communities across the nation voice growing concerns about the health effects of exposure to hazards in their workplace, home and community. This concern is well founded because there is clear evidence today that the environment is a primary determinant of health status. This budding realization presents an important opportunity, though, because as renowned environmental health authority Philip Landrigan noted in 1992, "The tragedy of environmental diseases is that they are highly preventable." Understanding the different types of hazards, causes and prevention methods is the first step to protecting yourself, your employees, and your company from the harmful effects that the environment may have on human health.

Getting to the Root of the Problem

Since the mid 1970s, 70,000 chemicals have been produced annually in the United States (EPA, 2001a). There are more than 15,000 high-volume production chemicals with a per-year production of more than 1 million pounds, not to mention many more man-made chemicals in use with hundreds more introduced every year. More than half of them have never been tested for human toxicity (Landrigan, 2000). The ability to produce new chemicals has far exceeded the capacity to test them. In addition, the EPA estimates that it would cost the chemical industry approximately $427 million to fill the basic screening data gaps for the high-volume production chemicals alone (EPA, 2001a).

It is widely acknowledged that many acute and chronic health problems have their roots in the environment. Pesticides in food and drinking water, ozone depletion, outdoor and indoor air quality, and improper toxic waste disposal are but a few examples of environmental conditions that have potential for serious health effects. In fact, environmental degradation may represent the "ultimate threat to human health."

As early as 1979, the U.S. Surgeon General wrote that 20 percent of deaths in the United States were attributable to pollution and toxic chemicals in the environment (USDHHS, 1979). Over time, we have learned that environmental exposures do not only cause or contribute to chronic illness but have important implications for vulnerable populations such as the developing fetus. Environmental exposures have the potential to cause birth defects like neural tube defects and cardiac malformations in this particular population (Bove, 1996; Lybarger, 1998; Vrijheid, 2000).

Routes of Exposure

Environmental hazards can be manmade (e.g., pesticides, auto emissions) or naturally occurring (e.g., arsenical contamination of drinking water or radon in indoor environments). Health threats by toxic agents in the environment depend on environmental distribution. Movement of these substances, or distribution, is influenced by chemical and physical properties, reactivity and toxicity. For example, some chemical contaminants can be absorbed by certain types of soil and are therefore prevented from entering groundwater. However, other chemicals can easily move through the same type of soil and become a drinking-water contaminant.

The means by which the environmental hazard actually enters the body is termed the route of exposure. Potential routes include:

  • Dermal [through the skin] absorption (e.g., direct contact with chemicals);
  • Inhalation (e.g., breathing air pollution containing lead dust or hydrogen sulfide fumes);
  • Iingestion (e.g. water/food contaminated with pesticide or chemical residue); and
  • Transplacental, where toxic substances, including lead, carbon monoxide and organic mercury can reach the developing fetus.

Humans vary widely in their susceptibility to potential environmental hazards. The response may vary with several personal characteristics including age, weight, gender, nutritional status, physiologic status, pre-existing disease states, previous exposures and even behavior and lifestyle factors. Children, especially those in the fetal stage, are particularly sensitive to environmental hazards.

Air Pollution

Everyone breathes approximately 20 times a minute, so it's not surprising that that pollution in the air can affect health. In fact, according to a 2000 report by the U.S. Department of Health and Human Services, exposure to outdoor air pollutants resulted in an estimated annual health costs of $40 to $50 billion, with an associated 50,000 premature deaths. Air pollutants reach the general population through direct assimilation into the respiratory system and even through the food chain as toxins are deposited into the air from industrial processes or waste incineration and redeposited on land or water. Airborne contaminants could also contribute to the development of cancer, birth defects and other serious health effects as well as potentially cause damage to the respiratory, nervous and immune systems.

Indoor air pollution has become a health concern in recent years because of building designs that restrict air exchange to control energy costs, as well as the increased use of synthetic materials in construction and furnishings. Because most people spend the majority of their time indoors, poor indoor air quality may pose a greater risk to health than outdoor pollution. All of the outdoor contaminants regulated by law are found at a higher concentration indoors than outdoors, with the exception of sulfur dioxide and ozone (Nadakavukaren, 2000).

Common sources of air pollution in the home and work environments include chemicals off-gassing from building materials and furnishings, cleaning materials, chemicals emitted from office machines, pesticides, environmental tobacco smoke, combustion products from cooking and fireplaces, molds and fungus. Strategies for preventing or minimizing exposures in the workplace include removing pollution at the source before it is dispersed into the workplace air through the use of hoods and proper ventilation, the selection of lower emitting materials, and proper maintenance of the HVAC system.

Water Pollution

In 1999, the American Society of Microbiology estimated that waterborne infectious disease kills 900 Americans and sickens as many as 900,000 annually. Even modern, efficient water treatment operations cannot render drinking water completely risk free. The microbial contaminants of greatest concern in drinking water include bacteria, viruses and protozoa that are usually of human or animal fecal origin.

Pollutants can enter water through well-defined locations termed point sources (e.g., industrial wastewater discharge through pipes or outfall). Non-point source pollutants run off or seep into waterways from land. These include agricultural and urban runoff, soil contamination and atmospheric deposition. Both point and non-point sources can contaminate surface waters directly and seep into underground aquifers to contaminate groundwater, an important source of drinking water in the United States. There are enforceable maximum contaminant levels for approximately 100 pollutants. However, there are thousands of unregulated pollutants.

Chemical contaminants in drinking water are currently the cause of a great deal of concern. There are more than 100,000 synthetic or organic chemicals found in drinking water supplies across the United States. Many of these substances are only present in concentrations measured in parts per million or even parts per billion. However, many of them are mutagenic or carcinogenic, raising concerns about the long-term health effects of daily ingestion (EPA, 1999).

Synthetic organic chemicals contaminating surface and groundwater include industrial solvents, polychlorinated biphenyls (PCBs), pesticides and even disinfectant byproducts that occur as the result of efforts to remove microbial contaminants. Originating from chemical manufacturing, petroleum refining, iron and steel production, wood pulp processing, textile manufacturing and agriculture, these chemicals enter surface water through runoff, direct and indirect discharge, or volatilization and subsequent fallout during precipitation. Many pesticides and herbicides are found in low concentrations in drinking water. Used in agriculture, on lawns and golf courses many are carcinogens and pose other chronic health risks.

Strategies for prevention in the workplace include responsible waste discharge. On a personal level it is important to note that, at hundreds of times the cost, bottled water is not necessarily any better. Requirements for testing are in many cases not as stringent as those for tap water. Therefore, it is in everyone's best interest to protect the water supply.

Prevention

Environmental exposures can occur in the home, workplace and the community. Some are evident, but many cause serious illness silently. Some possible preventive measures include environment-conscious purchasing policies on the part of industry can help decrease waste, hazards and cost at the source. In addition, pollution-prevention policies can be formed that focus on preventing the release of chemical contaminants by reducing generation of wastes. Finally, toxic-use reduction consists of workplace practices that reduce or eliminate the use of toxic chemicals in the production process in order to reduce the generation of hazardous waste.

Business and industry can play an important role in protecting the health of workers and the larger community through worker education, pollution prevention policies, and toxic use reduction. Workers should be educated about the responsible handling of hazardous waste and its potential to adversely affect the larger environment and human health. Being knowledgeable and aware of your surroundings is the first step to overcoming adversity, including environmental hazards. After all, an ounce of prevention is worth a pound of cure.

To learn more about environmental hazards in the home and workplace visit:

Environmental Protection Agency www.epa.gov

Agency for Toxic Substances and Disease Registry www.atsdr.cdc.gov

National Center for Environmental Health www.cdc.gov/nceh

American Association of Occupational Health Nurses www.aaohn.org

Children's Environmental Health Network www.cehn.org

About the author: Stephanie M. Chalupka, EdD, APRN, BC, CETN, is associate professor and director, undergraduate nursing education, College of Health Professions, University of Massachusetts, Lowell; and visiting scientist in occupational and environmental health, Harvard School of Public Health, Boston. Chalupka is a member of the American Association of Occupational Health Nurses and presented on the topic of environmental health at the American Occupational Health Conference in 2002.

References

American Society for Microbiology (1999). Microbial pollutants in our nation's water: Environmental and public health issues. [Online] Available: www.asmusa.org/pasrc/pdfs/waterreport.pdf.

Bove, F. (1996). Public drinking water contamination and birthweight, prematurity, fetal deaths and birth defects. Toxicology and Industrial Health, 12 92), 255-266.

Landrigan, P. J. (2000). Disease of environmental origin in American children: Prospects for research and prevention. Testimony before the Committee on Appropriations U.S. House of Representatives, Washington, DC.

Lybarger, J. A., Lee, R., Vogt, D. P., Perhac, R.M., Spengler, R.F., & Brown, D. R. (1998). Medical costs and lost productivity from health conditions at volatile organic compound contaminated Superfund sites. Environmental Research, 79, (1), 9-19.

Nadakavukaren, A. (2002). Our global environment: A health prospective. Prospect Heights, IL: Waveland Press.

National Environmental Trust, Physicians for Social Responsibility, Learning Disabilities Association of America. Polluting our future: Chemical pollution in the U.S. that affects child development and learning. Washington, D.C.

Tarcher, A. B. (1992). Principle and practice of environmental medicine. New York: Plenum Publishing Co.

United States Department of Health and Human Services (2000). Healthy people 2010. Washington, D.C.

United States Department of Health and Human Services (1978). Healthy people

The Surgeon General's report on health promotion and disease prevention. Rockville, MD: U.S. Government Printing Office.

United States Environmental Protection Agency (2001a). Chemical hazard data availability study. (Last updated 4-01-01). [On-line]. http://www.epa.gov/opptintr/chemtest/hazchem.

United States Environmental Protection Agency (2001b). Mercury update: Impact on fish advisories. EPA-823-F-01-011 (Last updated June 2001). www.epa.gov/ost/fishadvise/mercupd.pdf.

United States Environmental Protection Agency (1999). Children and drinking water standards (EPA 815K-99-001). Washington, DC:

Vrijheid, M., Dolk, H., Stone, D., Abramsky, L., Alberman, E. and Scott, J. E. (2000). Health effects of residence near hazardous waste landfill sites: A review of epidemiologic literature. Environmental Health Perspcetives, 108, (Suppl 1), 101-112.

BizHealthCheck is an online column produced for Occupationalhazards.com by the American Association of Occupational Health Nurses (AAOHN) In its 60th year, the American Association of Occupational Health Nurses is a 12,000-member professional association dedicated to advancing the health, safety, and productivity of domestic and global workforces by providing education, research, public policy and practice resources for occupational and environmental health nurses. These nurses are the largest group of health care providers serving the worksite. For more information, visit www.aaohn.org".

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