Health Determinants - Environmental and Occupational

The environment in which we live presents a number of risks to health, including risks associated with food, air, water, soil, and the built environment. The environment is a determinant of population health and can be define as all the physical, chemical and biological factors external to a person, and all the related behaviors. It is possible to evaluate Environmental Burden of Disease, a quantification of health impacts caused by environmental risk factors on a population basis, by estimating in deaths (premature mortality), quality adjusted life years (QALYs) and disability adjusted life years (DALYs).

A recent 2006 WHO report estimates that approximately one-quarter of global burden of illness and more than one-third for children is attributable to modifiable environmental risk factors. Modifiable environmental risk factors considered by WHO are:

• Air, water and soil pollution by chemical or biological agents
• Ultraviolet light (UV) and ionizing radiation
• Noise, electromagnetic fields
• Occupational risks
• Built environments; housing, land use patterns, roads
• Agricultural methods, irrigation schemes
• Man-made climate change, ecosystem change
• Behavior related to availability of safe water and sanitation facilities

The federal government currently has in place over a dozen legislative statues to control
environmental health risks. In order for regulatory approaches to environmental health risk management to be effective, however, regulations must be based on the best available methods in health risk science. Health risk science provides the basis for evidence based risk policy analysis, and, ultimately, for cost-effective risk management decisions.

A number of environmental risk factors have been linked to adverse health effects including outdoor air pollution and radon. In developing countries, infectious disease is a significant contributor to environmental health risk and needs to be integrated in risk management strategies to reduce disease. However, in developed countries, environmental factors have a higher per capita impact on cardiovascular diseases and cancers.

It is challenging to establish connections between environmental exposures and disease, as exposure to an environmental pollutant is rarely the sole cause of a health condition. Many factors including social and genetic can play a role in many diseases.

Workplace exposures to chemical, radiological, microbiological and other hazards can present risks to the health of exposed occupational groups. A number of workplace carcinogens have been identified by the International Agency for Research on Cancer (IARC). In 2006, an IARC monograph identified 30 human occupational carcinogens, 29 probable carcinogens, and another 113 substances as possible carcinogens.

Respiratory health including asthma and lung cancer is of great concern to workers exposed to occupational exposures to airborne dusts and fumes. Occupational radiation exposures can occur in medical staff (radiologists), nuclear workers, and miners. Low chronic exposures to occupational radiation have been recently shown to result in a small excess risk of cancer.  Pesticide workers are another group affected by occupational exposure and health concerns are primarily from exposure to insecticides, nematicides, and fungicides. Injuries in the workplace are important occupational risk factors and guidelines have been established to protect individuals and provide safe working environments.