Building New York State Centers of Excellence in Children's Environmental Health: A Replicable Model in a Time of Uncertainty.

Public health programs may be seriously affected in periods of federal retrenchment. During these times, state-based strategies provide an alternate pathway for advancing public health.A 12-year campaign to secure state support for a network of Centers of Excellence in Children's Environmental Health (CEH) promoting health of children across New York State is described. It was driven by rising rates of asthma, birth defects, developmental disorders, and other noncommunicable diseases in children; growing evidence associating hazardous environmental exposures with these conditions; and recognition that federal resources in CEH are insufficient.Critical campaign elements were (1) formation of a statewide coalition of academic health centers, health care providers, public health officials, community advocates, and other stakeholders; (2) bipartisan collaborations with legislative champions and government leaders; (3) assessment of the burden of developmental disorders and noncommunicable diseases associated with environmental exposures among children; (4) maps documenting the presence of environmental hazards in every county statewide; (5) iterative charting of a changing political landscape; and (6) persistence. The 2017 award of a 5-year, $10 million contract to establish Centers of Excellence in CEH demonstrates the value of this statewide strategy.

Economic, human and environmental health benefits of replacing formaldehyde in the preservation of corpses.

Formaldehyde has been prominent in preserving biological tissues since the nineteenth century. Despite being admittedly harmful to health and to the environment, it is still widely used. The Morphology Department of the University of Brasília - Brazil, applied the rethink, reduce, reuse, recycle and responsibility methodology to their activities in an effort to protect the health of laboratory workers and users, save resources and reduce damage to the environment. Here we evaluate the results obtained a decade after the implementation of this proposal (2005-2015). Formaldehyde was replaced by alcohol and glycerol solutions in corpse conservation. Over five thousand dollars in public funds that would have been destined to buying preserving substances were saved annually, and over a hundred thousand liters of water that would have been contaminated and thrown into the sewage system were spared. The environment used to implement the study was improved and anatomical parts kept for study had their lifespan extended. It is noteworthy that such simple adjustments could cause pronounced changes in laboratory activities. We would avoid contaminating billions of liters of water and it would be possible to save millions if similar practices were implemented in all educational institutions having similar routines.

Can property values capture changes in environmental health risks? Evidence from a stated preference study in Italy and the United Kingdom.

Hedonic models are a common nonmarket valuation technique, but, in practice, results can be affected by omitted variables and whether homebuyers respond to the assumed environmental measure. We undertake an alternative stated preference approach that circumvents these issues. We examine how homeowners in the United Kingdom and Italy value mortality risk reductions by asking them to choose among hypothetical variants of their home that differ in terms of mortality risks from air pollution and price. We find that Italian homeowners hold a value of a statistical life (VSL) of €6.4 million, but U.K. homeowners hold a much lower VSL (€2.1 million). This may be because respondents in the United Kingdom do not perceive air pollution where they live to be as threatening, and actually live in cities with relatively low air pollution. Italian homeowners value a reduction in the risk of dying from cancer more than from other causes, but U.K. respondents do not hold such a premium. Lastly, respondents who face higher baseline risks, due to greater air pollution where they live, hold a higher VSL, particularly in the United Kingdom. In both countries, the VSL is twice as large among individuals who perceive air pollution where they live as high.

Estimación de los beneficios económicos en salud asociados a la reducción de PM10 en Bogotá / Estimating air quality change-associated health benefits by reducing PM10 in Bogotá

Objetivo Estimar los beneficios en salud asociados a la reducción de la concentración promedioanual de material particulado PM10, entre el 2010 y el 2020 a 50 μg/m³, por Unidades de Planeamiento Zonal en Bogotá. Materiales y Métodos Se determinaron los casos de morbilidad y mortalidad atribuibles a la contaminación por PM10 y se estimó su valoración económica año por año usando BenMap®, consolidando los resultados por localidad y por Unidades de PlaneamientoZonal. Se utilizó funciones de concentración-respuesta para determinar los casos atribuibles en mortalidad y hospitalizaciones por causas respiratorias y cardiovasculares, mientras que para los demás servicios hospitalarios analizados, se usaron proporciones del servicio con respecto a la tasa de hospitalización. Resultados Podrían evitarse 21 000 muertes para mayores de 30 años y 900 muertes en menores de un año por exposición a largo plazo.Para menores de 5 años, podrían evitarse 1 2000 hospitalizaciones por causas respiratorias, 3800 atenciones en salas de urgencias, 34 000 visitas a salas ERA y 2 500 visitas a las unidades de cuidados intensivos. Para mayores de 5 años, se evitarían alrededor de 44 000 hospitalizaciones por causas respiratorias, 350 hospitalizaciones por causas cardiovasculares (en mayores de 65 años), y 155 000 atenciones en las salas de urgencias en todo el período. Conclusiones Se obtendrían beneficios económicos alrededor de 180 mil millones de pesos en los costos de enfermedad y un beneficio económico de más de 21 billones de pesos en mortalidad, entre el 2010 y 2020 para Bogotá.

Objective The health and economic benefits associated with the reduction of the annual average concentration of particulate matter PM10 to 50 μg/m³ between 2010 and 2020 were estimated and disaggregated in Zonal Planning Units in Bogotá. Materials and Methods BenMap® was used for determining attributable cases and their economic valuation year per year, and the results were represented spatially for every borough and zonal planning unit of the city. The study used concentration-response functions to determine the mortality cases attributable to PM10 pollution and hospitalizations related with respiratory and cardiovascular diseases. Results 21,000 deaths associated with long-term exposure could be prevented for people over 30 years old and 900 deaths associated with long-term exposure for children under one year old. For children under five years old, more than 12,000 preventable hospitalizations for respiratory diseases, about 3,800 emergency room visits, over 34,000 Acute Respiratory Diseases (ARD) cases and nearly 2,500 intensive care unit visits. For people over 5 years old, about 44000 hospitalizations for respiratory diseases, 350 hospitalizations for cardiovascular diseases (people over 65 years old), and nearly 155,000 emergency room visits would be prevented. Conclusion Economic benefits for 180 billion Colombian Pesos (95 million U.S. dollars) would be obtained and a benefit higher than 21 trillion Colombian pesos (11 billion U.S. dollars) in ten years, preventing attributable deaths.

Tasman Spirit oil spill in Pakistan: research response and lessons learned.

BACKGROUND: This article presents lessons learned from an investigation of the acute human health effects of the "Tasman Spirit" oil spill from a perspective of conducting rapid response investigations in developing countries. METHODS: We reviewed various steps in our investigation, other studies on oil spills in Pakistan and around the world, and reflected upon our discussions and interactions with various stakeholders. RESULTS: The article highlights the importance of applying a public health, legal, and ethical framework for conducting rapid response investigations, developing a pre-established funding mechanism, and addressing study design issues, exposure and outcome measurements, political issues, community engagement, and communication of results. CONCLUSION: There is need to develop ethical and legal framework and funding mechanism for conducting rapid response research in developing countries. A repository of study protocols, validated tools, and laboratory methods for exposure and outcome assessment would be greatly beneficial.

[Ecological and economic approaches to removing radioactively dangerous objects from service].

The paper considers major ecological and economic problems when removing radiation dangerous objects from service and rehabilitating the areas, which require their solution: the absence of specific guidelines for ranking the contaminated lands exposed to radioactive and chemical pollution from the potential risk to the population and environment; no clear criteria for ceasing area rehabilitation works; radiation exposure levels for the population living in the areas after rehabilitation; allowable levels of residual specific activity, and levels of heavy metals in soil, surface and underground water and bed sediment. The cost such works is the most important and decisive problem. A decision-making algorithm consisting of three main blocks: organizational-technical, engineering, geological and medicoecological measures is proposed to solve managerial, economic, and scientific problems.

Tangible evidence, trust and power: public perceptions of community environmental health studies.

Communities with environmental health concerns in the USA frequently request studies from their local or state departments of public health. This paper presents findings from three focus groups conducted in communities north of Boston that have been the subject of two different environmental health studies. The focus groups were designed to elicit residents' perceptions of environmental health, and of the particular studies conducted in their communities. In all focus groups, participants had difficulty accepting the findings of health studies that contradicted their own experiences of environmental exposures and illness. Our results suggest that lay knowledge, informed in varying degrees by the experience of what we term "tangible evidence," creates a lens through which communities interpret a health study's findings. The differences in reliance on tangible evidence were related to participants' sense of trust in public officials, and the institutions responsible for conducting health studies. Participants from the wealthier, predominantly white communities discussed trust in study design and methodologies used. In contrast, participants from the lower-income, higher-minority communities assessed health studies with reference to their trust (or lack thereof) in study sponsors and public health institutions. Participants' experience of tangible evidence, trust or distrust in health agencies and research institutions, and a sense of relative community power, influence how they assess the findings of environmental health studies and may have implications for pubic health.

Agrotóxicos e saúde: realidade e desafios para mudança de práticas na agricultura / Pesticides and health: reality and challenges for change of practices in agriculture

Este artigo apresenta os resultados de uma pesquisa que teve como objetivo principal caracterizar o contexto e as práticas relacionadas ao uso de agrotóxicos entre agricultores residentes na Serrinha do Mendanha, comunidade agrícola situada em Campo Grande, município do Rio de Janeiro. A proposta metodológica teve uma abordagem qualitativa, sendo a principal fonte de dados a aplicação de questionário semiestruturado. Participaram da pesquisa 38 agricultores familiares. O perfil socioeconômico mostra uma realidade de idosos no trabalho agrícola, percentuais expressivos de analfabetismo e baixa renda. O uso de agrotóxicos é uma rotina para essas famílias. Apesar de existir uma naturalização do uso, a maioria dos informantes acredita que agrotóxicos podem afetar sua saúde, apresenta preocupação com o consumidor e gostaria de conhecer formas alternativas de cultivo. Tais achados apontam para a possibilidade de busca de mudança de práticas. Não se trata de repasse de conhecimento, pois este tipo de informação de alguma forma eles já possuem. Trata-se de desenvolver estratégias objetivando a minimização dos riscos ou mesmo o desuso de agrotóxicos na lavoura.

This paper presents the results of a research which main goal was to describe the context and practices related to the use of pesticides among farmers in the community of Serrinha do Mendanha, Campo Grande, County of Rio de Janeiro. The methodological proposal had a qualitative approach and data was collected through a semi-structured questionnaire. Thirty eight farmers participated in this research. Socio-economic profile shows elderly people working in agriculture, expressive percentile of illiteracy and low income. Despite the natural approach to the use of pesticides, which is a routine to these families, most informants believe that pesticides can affect their health, show some concern about the consumers and would like to know alternatives. These findings point to the possibility of change in agricultural practices. It is not a matter of simply offering information that in some way they already possess; it means developing strategies to reduce or even quit the use of pesticides in plantations.

In search of a common European approach to a healthy indoor environment.

Increasingly, policymakers in Europe and around the world are realizing the importance of healthy indoor environments for public health. Certain member states of the European Union (EU) have already achieved successes in improving indoor environmental quality, such as controlling certain contaminants (e.g., environmental tobacco smoke) or developing nationwide policies that address indoor air generally. However, a common European approach to achieving healthy indoor environments is desirable for several reasons including providing a broader recognition of the problem of unhealthy indoor air, setting a policy example for all 27 EU member states, and achieving greater public health equity across the different European nations. In this article we address the question "Why is it so difficult in the EU to develop a coherent approach on indoor environment?" We identify and describe four main barriers: a) the subsidiarity principle in EU policymaking, introducing decentralization of decision making to the member states; b) fragmentation of the topic of the indoor environment; c) the differences in climate and governance among different member states that make a common policy difficult; and d) economic issues. We discuss potential lessons and recommendations from EU and U.S. successes in achieving healthier indoor environments through various policy mechanisms.

Subsídios para construção da política nacional de saúde ambiental / Subsidies for the Construccion of the Environmental Health National Policy

Este documento traz subsídios para a elaboração da Política Nacional de Saúde Ambiental. Tal política deverá contribuir para proteger e promover a saúde humana por meio de um conjunto de ações integradas com instâncias de governo e da sociedade civil para fortalecer atores sociais e indivíduos no enfrentamento dos determinantes socioambientais e na prevenção dos agravos decorrentes da exposição humana a ambientes adversos. Sendo assim, este documento versa sobre os processos de construção, interlocução, os princípios, as diretrizes e os instrumentos cabíveis à referida política. O conceito de saúde ambiental é trabalhado de forma ampliada e pensado a partir da Reforma Sanitária, sendo entendido como um processo de transformação da norma legal e do aparelho institucional em um contexto de democratização. Tal processo se dá em prol da promoção e da proteção à saúde dos cidadãos, cuja expressão material concretiza-se na busca do direito universal à saúde e de um ambiente ecologicamente equilibrado em consonância com os princípios e as diretrizes do Sistema Único de Saúde (SUS), do Sistema Nacional de Meio Ambiente (Sisnama), do Sistema Nacional de Gerenciamento de Recursos Hídricos (Singreh) e de outros afins. Para a efetivação da Política Nacional de Saúde Ambiental, são sugeridas algumas linhas de atuação: (1) a estruturação e o fortalecimento da Vigilância em Saúde Ambiental; (2) a construção de agendas intersetoriais integradas; (3) o fomento à promoção de ambientes saudáveis; (4) o estímulo à produção de conhecimento e desenvolvimento de capacidades em saúde ambiental; e (5) a construção de um Sistema de Informação Integrado em Saúde Ambiental. A construção de ações intra e intersetoriais é o eixo central para a formulação da Política Nacional de Saúde Ambiental, pois, dessa forma, pode-se compatibilizar os procedimentos da Vigilância em Saúde Ambiental, que estão em desenvolvimento no Sistema Único de Saúde (SUS), com aqueles praticados por outros setores, para que sejam potencializados os recursos disponíveis e seja evitada a superposição de ações e os conflitos de mandatos entre instituições. A Política Nacional de Saúde Ambiental se construirá por meio de articulação, sinergia e integração das ações já empreendidas por várias instâncias de governo situadas em diversos Ministérios, bem como por meio das iniciativas efetuadas pela sociedade civil, para que, ao longo do tempo, vá se conformando como uma sólida Política Pública Integrada de governo legitimada socialmente pela pactuação de uma Agenda Integrada de Saúde Ambiental

Comparative risk and policy analysis in environmental health.

There is increasing interest in the integration of quantitative risk analysis with benefit-cost and cost-effectiveness methods to evaluate environmental health policy making and perform comparative analyses. However, the combined use of these methods has revealed deficiencies in the available methods, and the lack of useful analytical frameworks currently constrains the utility of comparative risk and policy analyses. A principal issue in integrating risk and economic analysis is the lack of common performance metrics, particularly when conducting comparative analyses of regulations with disparate health endpoints (e.g., cancer and noncancer effects or risk-benefit analysis) and quantitative estimation of cumulative risk, whether from exposure to single agents with multiple health impacts or from exposure to mixtures. We propose a general quantitative framework and examine assumptions required for performing analyses of health risks and policies. We review existing and proposed risk and health-impact metrics for evaluating policies designed to protect public health from environmental exposures, and identify their strengths and weaknesses with respect to their use in a general comparative risk and policy analysis framework. Case studies are presented to demonstrate applications of this framework with risk-benefit and air pollution risk analyses. Through this analysis, we hope to generate discussions regarding the data requirements, analytical approaches, and assumptions required for general models to be used in comparative risk and policy analysis.

Do people actually pursue risk elimination in environmental risk management?

This study examines whether people pursue the total elimination of environmental risks even if the risk reduction occurs incrementally and requires steadily increasing amounts of money to achieve. Participants' willingness to pay (WTP) was measured for various levels of reduction in the risk of cancer caused by dioxin. Results showed that: (1) people were willing to pay more for an initial reduction in risk than for subsequent reductions, (2) the WTP for the final risk decrement-which achieved total risk elimination-was higher than the WTP for either of the two previous decrements but barely half of that for the first reduction, and (3) the manner in which the questions were framed did not affect participants' responses. These results suggest that the public will not always try to pursue perfect safety at the cost of a large sum of money, but rather may seek a decreasing expenditure as the risk level is reduced.

Estimating the administrative cost of regulatory noncompliance: a pilot method for quantifying the value of prevention.

Routine regulatory inspections provide a valuable independent quality assurance review of radiation protection programs that ultimately serves to improve overall program performance. But when an item of non-compliance is noted, regardless of its significance or severity the ensuing notice of violation (NOV) results in an added cost to both the permit holder and the regulatory authority. Such added costs may be tangible, in the form of added work to process and resolve the NOV, or intangible, in the form of damage to organizational reputation or worker morale. If the portion of the tangible costs incurred by a regulatory agency for issuing NOVs could be quantified, the analysis could aid in the identification of agency resources that might be dedicated to other areas such as prevention. Ideally, any prevention activities would reduce the overall number of NOVs issued without impacting the routine inspection process. In this study, the administrative costs of NOV issuance and resolution was estimated by obtaining data from the professional staff of the Texas Department of Health, Bureau of Radiation Control (TDH-BRC). Based a focus group model, the data indicate that approximately $106,000 in TDH-BRC personnel resources were expended to process and resolve the 6,800 NOVs issued in Texas during 1997 inspection activities. The study's findings imply that an incremental decrease in the number of NOVs issued would result in corresponding savings of agency resources. Suggested prevention activities that might be financed through any resource savings include the dissemination of common violation data to permit holders or training for improving correspondence with regulatory agencies. The significance of this exercise is that any savings experienced by an agency could enhance permittee compliance without impacting the routine inspection process.