Question

All a-d

a. Referencing at least two of your learning resources, describe at least three ways the environment can impact your health. Discuss the six levels of air quality and what each level means. How is the air quality in Denver? Are there any areas in the United States where air quality is worse than “good” or “moderate”? Finally, discuss how poor air quality might impact human health.

b. Briefly discuss the seven core concepts of environmental health. Discuss the problem (including issues surrounding health disparities), how this community took action, and the outcomes. What core environmental principle was addressed in this video?

c. Discuss the concept of obesogens and how they work in the body.

d. Discuss the concept of geomedicine and ways in which geomedicine could be used by a preventative medicine (lifestyle medicine) practitioner. Currently, lifestyle medicine does not include an environmental component. Would you advocate to include an environmental component? Why or why not?

Answer 1

a. Referencing at least two of your learning resources, describe at least three ways the environment can impact your health. Discuss the six levels of air quality and what each level means. How is the air quality in Denver? Are there any areas in the United States where air quality is worse than “good” or “moderate”? Finally, discuss how poor air quality might impact human health.

ENVIRONMENTAL IMPACT ON HEALTH

The environment can affect health through physical exposures, such as air pollution (OECD, 2012b). A large body of work has documented the effects of exposure to particulate matter (solid particles and liquid droplets found in the air) on cardiovascular and respiratory mortality and morbidity (Brook et al., 2010; Laumbach and Kipen, 2012; Mustafić et al., 2012; Tzivian, 2011). Research has identified specific physiologic mechanisms by which these exposures affect inflammatory, autonomic, and vascular processes (Brook et al., 2010; Tzivian, 2011).

The effects of particulate matter on mortality appear to be consistent across countries. For example, a recent review of studies from the late 1990s to mid-2000s found a consistent inverse relationship between airborne particulate matter and birth weight in Australia, Brazil, Canada, France, Italy, the Netherlands, South Korea, the United Kingdom, and the United States (Parker et al., 2011a). Another notable example is the evidence linking lead exposures to cognitive development in children (Bellinger, 2008; Levin et al., 2008). The evidence of environmental effects of air pollution and lead has been reflected in legislation in many countries directed at reducing levels of these pollutants in the environment.

Increasing attention has focused on the implications for health behaviors and social interactions that are created by the built environment. The built environment refers to the presence of (and proximity to) health-relevant resources as well as to aspects of the ways in which neighborhoods are designed and built (including land use patterns, transportation systems, and urban planning and design features). An important example is evidence that links proximity to healthy or unhealthy food stores with dietary behaviors and related chronic disease outcomes (Babey et al., 2008; Larson et al., 2009; Moore et al., 2008; Morland et al., 2006).4 Food availability and food advertising influence energy intake and the nutritional value of foods consumed (Grier and Kumanyika, 2008; Harris et al., 2009; Institute of Medicine, 2006a).

Another large body of work has documented how walking and physical activity levels are affected by access to recreational facilities, land use mix, transportation systems, and urban planning and design (Auchinloss et al., 2008; Diez Roux et al., 2001; Ding et al., 2011; Durand et al., 2011; Gordon-Larsen et al., 2006; Heath, 2009; Kaczynski and Henderson, 2008; McCormack and Shiell, 2011; Transportation Research Board, 2005). Studies conducted in the United States and other high-income countries have found that “walkability” (which is measured by such proxies as building density, land use mix, and street connectivity) predicts walking patterns (Durand et al., 2011; Inoue et al., 2009; Sundquist et al., 2011; Van Dyck et al., 2010). Across countries, studies have also shown that physical activity by children is associated with features of the built environment, including walking-related features, and physical activity resources (Bringolf-Isler et al., 2010; Davison and Lawson, 2006; Galvez et al., 2010; Sallis and Glanz, 2006).5

Although more definitive evidence is needed (see Feng et al., 2010), it has been hypothesized that these environmental features may contribute to the obesity epidemic (Galvez et al., 2010; Papas et al., 2007; Sallis and Glanz, 2009). The importance of residential environments to obesity and related conditions, such as diabetes, was recently highlighted by a randomized housing intervention: low-income participants who were randomly assigned to move into low-poverty areas experienced significant improvements in weight and diabetes indicators (Ludwig et al., 2011). Unfortunately, the study was not designed to identify the specific environmental features responsible for the observed effect.

A range of other physical environmental features have been linked to other health outcomes. For example, the density of alcohol retail outlets has been linked to alcohol-related health complications (Campbell et al., 2009; Popova et al., 2009), including injury and violence (Cunradi et al., 2012; Toomey et al., 2012). Transportation systems and other aspects of physical environments that influence driving behaviors are also related to injury morbidity and mortality (Douglas et al., 2011). Living in socioeconomically disadvantaged neighborhoods (as a proxy for a range of environmental exposures) has been linked to higher rates of injury in both adults and child1ren (Cubbin et al., 2000; Durkin et al., 1994).

SIX LEVELS OF AIR QUALITY

For the ease of understanding, the AQI is divided into six categories. These categories let you comprehend the air pollution levels in your area so that you can take proper actions.

All these categories also have color-coding. AQI runs between 0 and 500.

According to the AQI, 300 to 500 is considered the most hazardous signified by maroon color and 0 to 50 is signified by green which is deemed to be good quality air.

Let’s check out these categories in detail!

• When the AQI is 0-50, the air quality can be considered reasonable. This is marked by green and no health effects are expected.
• If the AQI is 50-100, air quality is moderate and acceptable. A yellow color marks it.
• The AQI 101-150 is marked by red and is unhealthy. Usually, it won’t affect a healthy person, but people who already have lung issues, older people and children might develop some respiratory problems. It is marked by orange.
• With 151-200 AQI, the air reaches unhealthy levels. Everyone living in such an area is likely to experience discomfort, and sensitive groups might receive adverse effects. It is categorized with red color.
• When the AQI is 201-300, it is considered very unhealthy and is marked by the color purple. It triggers an important health alert because it is very dangerous for every living being.
• Finally, the AQI 301 to 500 is something that is categorized as hazardous. It is an emergency where the whole population is very likely to have some effects. Warnings are issued by the government when they are in this state.

AIR QUALITY IN DENVER

Denver residents have been inhaling hazardous air pollution at elevated levels on more than 260 days a year for the past two years, federal records show, as two new studies released this week ranked metro Denver among the top 10 worst U.S. cities for air quality.

People also are breathing bad air regularly in other cities along Colorado’s Front Range, from Colorado Springs to Fort Collins, according to Environmental Protection Agency records.

This pollution disproportionately hurts sensitive groups — people with asthma, children and the elderly — but affects all residents. Beyond respiratory problems, recent research links poor air quality to chronic inflammation and dementia.

And climate warming is expected to intensify air pollution, federal scientists warn, because heat speeds the formation of ground-level ozone and boosts the frequency and severity of wildfires, which infuse more particles into smog.

Air pollution control officials at the Colorado Department of Public Health and Environment did not dispute the numbers of bad air days tallied by the EPA.

While air pollution levels in Denver generally aren’t as high as they were in the 1980s, health and environmental advocacy groups are questioning whether air-cleaning efforts under Gov. Jared Polis are sufficient to make sure inhaling is healthy under current federal standards.

AREAS IN THE UNITED STATES WHERE AIR QUALITY IS WORSE THAN GOOD OR MODERATE

By Year Round Particle Pollution;

#1: Fresno-Madera-Hanford, CA
#2: Bakersfield, CA
#3: Fairbanks, AK
#4: Visalia, CA
#5: Los Angeles-Long Beach, CA
#6: San Jose-San Francisco-Oakland, CA
#7: Pittsburgh-New Castle-Weirton, PA-OH-WV
#8: El Centro, CA
#9: Cleveland-Akron-Canton, OH
#10: Medford-Grants Pass, OR
#11: Missoula, MT
#12: Detroit-Warren-Ann Arbor, MI
#13: Cincinnati-Wilmington-Maysville, OH-KY-IN
#14: Birmingham-Hoover-Talladega, AL
#15: Johnstown-Somerset, PA
#15: Lancaster, PA
#17: Houston-The Woodlands, TX
#18: Philadelphia-Reading-Camden, PA-NJ-DE-MD
#19: Chicago-Naperville, IL-IN-WI
#19: Indianapolis-Carmel-Muncie, IN
#19: Atlanta-Athens-Clarke County-Sandy Springs, GA-AL
#22: McAllen-Edinburg, TX
#22: Shreveport-Bossier City-Minden, LA
#24: Harrisburg-York-Lebanon, PA
#25: Knoxville-Morristown-Sevierville, TN

DISCUSS HOW POOR AIR QUALITY MIGHT IMPACT HUMAN HEALTH

The immediate effects of air pollution are hard to ignore. Watery eyes, coughing and difficulty breathing are acute and common reactions.

An estimated 92 percent of the world’s population live in areas with dangerous levels of air pollution and, even at seemingly imperceptible levels, air pollution can increase one’s risk of cardiovascular and premature death.

Air pollution is almost as deadly as tobacco. In 2016, it was linked to the deaths of 6.1 million people, according the University of Washington’s Institute for Health Metrics and Evaluation.

And it might harm you even before you take your first breath.

Exposure to high levels of air pollution during pregnancy has been linked to miscarriages as well as premature birth, autism spectrum disorder and asthma in children.

Air pollution may damage children’s brain development, and pneumonia, which kills almost 1 million children under the age of 5 every year, is associated with air pollution. Children who breathe in higher levels of pollutants also face a greater risk of short-term respiratory infections and lung damage.

Other conditions associated with high levels of air pollution include emphysema and chronic bronchitis, as well as lung cancer.

Pollutants can affect cardiovascular health by hardening the arteries and increase the risk of heart attack and strokes, and there is even emerging evidence that air pollution may be linked to mental health conditions and degenerative brain diseases such as Alzheimer’s disease, Parkinson’s disease and schizophrenia.

How Air Pollution Damages The Body

While air pollution’s link to respiratory disease may seem obvious, its relationship to heart, brain and fetal health is less so. There are at least two possible mechanisms by which air pollution can harm parts of the body besides the nasal cavity and lungs.

The first has to do with inflammation, which is the body’s way of repairing itself after an injury or illness.

When the toxic soup of chemical particles and liquid droplets emitted by cars, power plants, fires and factories known as particulate matter is inhaled, the microscopic toxic dust can irritate nasal passages and result in an allergic-type response to the pollution, with symptoms like coughing and a runny nose.

Scientists believe that as the particles make their way deeper into the airways and into the lungs, the body may mistake it for an infection, triggering an inflammatory response.

Scientists also suspect that some toxic particles can escape the lungs and enter the bloodstream.

b. Briefly discuss the seven core concepts of environmental health. Discuss the problem (including issues surrounding health disparities), how this community took action, and the outcomes. What core environmental principle was addressed in this video?

BRIEFLY DISCUSS THE SEVEN CORE CONCEPTS OF ENVIRONMENTAL HEALTH

To understand the field of environmental health, you need to understand seven core concepts: Toxicity, Exposure, Dose/Response, Individual Susceptibility, Risks & Benefits, Environmental Justice, and Community Resources & Action.

TOXICITY

Most people working in environmental health-related jobs have taken classes in the science of toxicology. Toxicology is the study of how environmental hazards, such as natural and human-made chemicals, can enter our bodies and make us sick. When scientists study different chemicals in the environment to see if they might be dangerous to humans, they are trying to understand the toxicity of those chemicals.

EXPOSURE

Everyday our bodies are exposed to all sorts of environmental hazards, such as bacteria, viruses, and the sun’s ultra-violet (UV) rays. Some of these hazards exist naturally and some of them are the result of human activities. There are many possible sources of hazards, such as cars, industry, even volcanic eruptions. In order for us to be exposed, however, the hazard has to get from the source to us. To do this, it travels along an environmental pathway. Pathways include the air we breathe, the water we drink, the food we eat, and even the soil we work in, play in, and use to grow much of our food. Environmental health scientists use the term exposure to describe the total amount of a hazard that comes in direct contact with your body.

DOSE/RESPONSE

“Imagine that someone has been exposed to a hazardous chemical through one of the three possible routes of exposure. They have now received a dose of that chemical. Dose is the amount of the hazard that actually enters your body. The amount someone gets into their body (their dose) depends on many factors, including how long you are exposed, how often you are exposed, and how big or small you are. For instance, if someone is exposed over a long period of time to a hazard, their dose will be larger. For example, 4 hours spent under the bright summer sun would give you a much larger dose of UV rays than 30 minutes spent under the sun. This is called the duration of exposure. The frequency of exposure can also influence the dose. If someone works in a factory and is exposed to a chemical every day at work, their dose might be larger than someone who is only exposed once.

INDIVIDUAL SUSPECTABILITY

“Some people are more likely than others to get sick when they are exposed to environmental hazards. This might be because of their genetics, body size, age, gender or general health. This is called their individual susceptibility.”

“For example, some people are more likely than others to get sick when they are exposed to certain kinds of pesticides, just because of their genes. We all know that genes help determine things like hair color and eye color, but they also lead to some important (and invisible) differences in the way bodies work. It turns out that some people have a more extreme response to certain pesticides because of their genes. These people are said to be more “individually susceptible” to pesticide poisoning. Someone who lives or works on a farm where pesticides are sprayed might want to know how susceptible he or she In order to avoid exposure and stay healthy.

RISKS & BENEFITS

“We live in an industrial society that depends on the use of both natural and human-made chemicals to function. The use of these chemicals results in benefits to society as well as risks. Pesticides, for example, make it easier to grow fruit. Unfortunately, in some cases, pesticides can make people sick. Most of us have heard that we can reduce the risk of getting sick without giving up the health benefits that fruit offers by washing or peeling the fruit before we eat it. Scientific researchers and government officials measure the risks and benefits that we face when we manufacture or use certain products. They work to explain what they have learned to the public and create safety standards that help people protect themselves from unnecessary risk. Their goal is simple – to help us enjoy the greatest benefits from the products that we manufacture, while exposing ourselves to the least possible risk. By understanding the risks and benefits that we face each day, we can make decisions that reduce our risk and keep us as safe and healthy as possible.

ENVIRONMENTAL JUSTICE

Environmental Justice (EJ) means that everyone has a right to live in an environment that doesn’t make them sick, regardless of their race, culture, or income.

Unfortunately, some neighborhoods or communities are exposed to more environmental hazards than others, and may suffer higher rates of health problems. These communities often have less economic or political power in society when decisions are made. For example, toxic waste dumps, polluting factories, and busy highways are often built in lower-income neighborhoods or communities of color. Communities recognize this as an environmental health issue and work to seek environmental justice.

COMMUNITY RESOURCES & ACTION

Where can you go in your own community to collect information about an environmental health issue? You can learn more about specific issues, understand environmental laws or seek environmental justice by using community resources. Community resources include places like the library and city hall. You could search the Internet for local, state, or federal agencies that can give you information about your issue. You can also talk to environmental health scientists at local universities or health departments, and ask your teachers and family members what they know about the issue.

Once you have gathered your resources and studied the issue carefully, it’s time to take action! First, ask yourself what you as an individual can do to help solve the problem. If you are concerned about air pollution, for example, you might decide to walk to school instead of getting a ride in a car. Next, ask yourself how you can share what you have learned with others so that they can help too. Maybe you could write a letter to the editor of your local newspaper or speak to your community council or school board. Maybe you could create a flyer to hand out in your neighborhood. There are many great ways to get the word out and make positive changes in the world – use your imagination and be creative.

c. Discuss the concept of obesogens and how they work in the body.

Scientists are exploring the role that chemicals may play in weight gain and obesity.

More than 80,000 chemicals are registered for use in the United States. Some of these chemicals are toxic to animals and humans, and some interfere with how the body’s hormones function. The ones that impact hormones are called endocrine disrupting chemicals, or endocrine disruptors, and are linked to a variety of diseases.

Some endocrine disruptors have been shown to be obesogens, or involved in weight gain, and may be contributing to the obesity problem in this country. The term obesogens was coined around 2006, based on the knowledge that exposures during early development to specific chemicals were found to disrupt normal metabolic processes and increase susceptibility to weight gain across the lifespan. Poor nutrition and lack of exercise are known contributors to obesity, but these chemicals may also be contributing.

healthy diet and lack of exercise are the main factors that contribute to weight gain and obesity, but studies have found that obesogens may also be playing a role. Obesogens do not directly cause obesity, but they may increase the sensitivity, or susceptibility, to gaining weight, especially when the exposures occur during development.

Obesogens are believed to work in several ways.

They may change how a person’s fat cells develop, meaning they may increase fat storage capacity or the number of fat cells.

Also, obesogens may make it more difficult to maintain a healthy weight, by changing how the body regulates feelings of hunger and fullness, or increasing the effects of high fat and high sugar diets.

Examples of chemicals that may be obesogens

• Cigarette smoke
• Air pollution
• Tributyltin, a chemical that is widely used as a fungicide and heat stabilizer in polyvinyl chloride (PVC) piping
• Flame retardants
• Phthalates, a broad class of chemicals that are added to many consumer products to make them softer
• Bisphenol A
• Some pesticides
• Polychlorinated biphenyls (PCBs), industrial chemicals that were used widely in the past in products such as paints, cements, fluorescent light ballasts, sealants, and adhesives.

Health consequences

The most sensitive time for exposure to obesogens is during early development — as a fetus or during the first years of life — when the body’s weight control mechanisms are being developed.

Obesity is a disease itself, but other diseases or disorders that develop as a result of, or in combination with obesity, such as cardiovascular disease, liver disease, diabetes, arthritis, and others, also can contribute to health problems associated with weight gain.

Prevention

Try to minimize exposures to environmental chemicals. This is often challenging, since it is hard to know where and what products contain these chemicals.

Some general advice is to:

• Eat fresh fruit and vegetables
• Reduce use of plastics
• Do not use plastics in the microwave
• Purchase furniture that has not been treated with flame retardants
• Choose fragrance-free products

d.Discuss the concept of geomedicine and ways in which geomedicine could be used by a preventative medicine (lifestyle medicine) practitioner. Currently, lifestyle medicine does not include an environmental component. Would you advocate to include an environmental component? Why or why not?

At the present time, very little health-relevant geographic information is available to a clinician at the time of a medical diagnostic encounter, and it is certainly not a typical part of a comprehensive medical record. Geomedicine uses modern information technology to deliver information on a patient’s potential environmental exposures into the hands of the clinician while they are in the examination room. With geomedicine, we will experience an increase in the number of patients who benefit from a more precise clinical understanding of the links between their health and where they live, work, and play.

There is abundant evidence that the use of geographic information has had a dramatic impact on the work of health professionals. Medical epidemiologists, the front line of disease detectives, have used GIS extensively in their fight against diseases that have a clear relationship between person, place, and time. GIS has also played an important role in protecting communities from otherwise overlooked risks and toxic exposures.

Yes, I would advocate to include an environmental component because Mapping our health geographically is a great opportunity for a health department to begin educating the public in ways that make sense to everyone and not just the needs of health professionals.