Week 8 Community Health

• Nursing began with a focus on environmental health
• There is an increasing evidence relating to the effect of the environment on the health of the population
• 24% of global disease is a result of environmental exposure
• 25% cases of these diseases are caused by preventable environmental factors
• The health sector has a shared responsibility with other sectors to protect and improve public health security
• Environmental Health


  Addresses the physical, chemical and biological factors in the environment
• Risk


  Chance that a health problem will develop in a population due to exposure of certain environmental factors
• Goal of environmental health

  Reduce environmental risks and create healthier environments to support population health
• Risk involves toxic chemical or properties
• Contaminated air, water, or soil
• Population lives within the exposure pathway
• Route of exposure = inhalation, ingestion or skin absorption
• Adequate amount of exposure to result in harm
• 4 Principles of Environmental Health

  • Everything is connected
  • Everything has to go somewhere
  • Impact is proportional to dose
  • Today's solution may be tomorrow's problem
• Physical Environmental Determinants of Health

  • Air pollution
  • Contaminated drinking water
  • Neurotoxins
  • Other toxins, such as mercury in the food supply
• Psychosocial Environmental Determinants of Health

  • Long hours and heavy demands at work
• Environmental health indicators developed to measure the relationship between environment and health
• Canadian Environmental Sustainability Indicators (CESI) include air quality, greenhouse gas emissions, water quality
• Environment Canada enforces the Canadian Environmental Protection Act
• Key Areas of Concern Related to Environmental Health

  • Indoor Air Quality
  • Outdoor Air Quality
  • Water
  • Food
• Indoor Air Quality


  Concerns include carbon monoxide, dusts, molds, cleaning and personal care products, lead, and tobacco smoke due to a rise in asthma incidence
• Outdoor Air Quality


  Pollution from motor vehicles and burning fossil fuels is declining, but climate change may prove to have health consequences
• Water


  Necessary for all forms of life and for production of food, affects the quality of soil, discharges into water bodies from industries, farm animal waste, and wastewater treatment systems can degrade quality
• Food


  Most food-borne illnesses can be avoided by good food preparation practices, other concerns are pesticides, hormones and antibiotics given to food animals, radiation and genetic modification of food
• Environmental Epidemiology


  The study of the effects of physical, chemical and biological factors in the environment on human health, examining specific groups and populations exposed to certain factors allows for understanding of risk and resiliency factors
• Risk Assessment


  Evaluation of the risk to human health or the environment by the actual or potential presence or use of specific pollutants, focused on characterizing the hazard, properties, toxicity, other elements, mode of transmission, route of exposure, receptor population and dose
• Precautionary Principle


  Government policy currently incorporates precautionary principle, when credible doubt exists, action should be on the side of caution (Example: Bisphenol A)
• Risk Communication


  Principle of effective communication about health or environment risks, getting the right information to the right people at the right time, CHNs act as risk communicators when they inform or educate on safe drinking water, handwashing techniques, food preparation, communicable diseases, and unintentional injury
• Strategies for Reducing Environmental Health Risks

  • Prevention is more cost effective
  • Education as a primary prevention strategy
  • Risk management involves selecting and implementing a strategy to reduce risks
  • In workplaces, community health professionals work with a list of precautions for avoiding or minimizing employees' exposure to potentially hazardous chemicals - WHMIS
  • The "4 Rs" for reducing environmental pollution: reduce, reuse, recycle, and recover
• Environment and Children's Health

  Children are not fully developed and their body systems are more susceptible to damage from environmental toxicants, they eat, drink, and breath more than adults, risk is greatest in the womb, the leading cause of death in children and youth in Canada is INJURY, the built environment can be redesigned to reduce injury
• Environmental Justice


  From a population health perspective, this the effort to reduce the impact of health inequalities and socioeconomic marginalization of persons resulting from environmental conditions affecting adequate nutrition, shelter, sanitation, and safe working conditions
• Reasons Why CHNs Should Know About Environmental Health

  • Environmental factors have an impact on health
  • Nurses are positioned to teach about health
  • Nurses are the largest professional group working in healthcare
• Human activities leading to the release of greenhouse gasses that are trapped in the lower atmosphere are affecting the global climate
• Resulting Effects of Climate Change

  • Warmer temperatures
  • Rising sea levels
  • Changing precipitation patterns
  • More frequent and extreme weather events
• Climate Change as a Public Health Issue

  • Extreme heat
  • Allergens and air pollution can aggravate respiratory problems and diseases
  • Extreme precipitation can cause injury, illness, and death
  • Atmospheric changes can exacerbate vector, food, and waterborne diseases
  • Wildfires cause injury and death
• Ecological Determinants of Health

  • Oxygen
  • Water
  • Food
  • Waste decomposition and recycling
  • Fuel and various natural resources
  • Detoxifying processes
  • The ozone layer
  • A reasonably stable and habitable climate
• Ecosystem Services


  A stable and biodiverse global ecosystem provides the necessary ecosystem goods and services needed to survive and thrive
• Indicators of Climate Change in Canada: Ontario


  • Extreme heat and cold
  • Freezing rain and winter storms
  • Floods
  • Wildfires
  • Outdoor air pollution
  • Water and food contamination
  • VBD and Zoonotic diseases
• As Canada's climate continues to warm there are expected changes that impact the occurrence of vector-borne diseases
• Changes that Impact Vector-Borne Diseases

  • Changes to the environment factors influencing the evolution of vectors
  • Change in location where transmission cycles occur
  • Change to number of pathogens and vectors
  • Alterations to human activity