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					                                NORTHEASTERN UNIVERSITY
                         BOUVÉ COLLEGE OF HEALTH SCIENCES

                                  Department of Health Sciences

                                      Environmental Health
                                       PH214 / PHTH6214

Class Time:            Thursdays, 5:00-730 p.m.
Location:              Barrakis 415
Credits:               3
Instructor:            Russ Lopez, ScD
Office:                n/a
Office Hours:          As arranged individually; as well as before and after class as needed.

Course Description:
The purpose of this course is to introduce the field of environmental health. It is a broad field
that encompasses concerns related to physical, built and social environments. Students will be
asked to think critically about the economic, scientific, social, and political factors that shape
environmental health and to consider how the field is relevant to other public health issues.

The course begins by introducing students to the concept of environmental health, and the tools
used to study environmental exposures and diseases. By the end of the course students will be
familiar with environmental health hazards, the routes by which humans are exposed to hazards,
various media in which they are found, and disease outcomes associated with exposures.
Students will also be familiar with methods used to conduct environmental health research and
the federal and state agencies responsible for protecting environmental health. This course aims
to give students the tools to understand the complexity of environmental health issues so they
participate in current debates about environmental problems.

Prerequisites for the course: MPH Student status or permission of instructor

Course objectives:

After completing this course, students will be able to:

   o Specify major sources and types of environmental health hazards;
   o Specify approaches for assessing, preventing and controlling environmental health
   o Describe federal and state agencies and policies that regulate and control environmental
     health in the US;
   o Describe factors that contribute to susceptibility to adverse health outcomes following
     exposure to environmental hazards;
   o Discuss risk assessment, management and communication approaches;
   o Explain how the concept of health inequality is related to environmental equity.

Class Format / Teaching Methods

The course is primarily conducted as a series of interactive lectures during which comments and
questions by the students are frequently solicited. These lectures are complemented by power
point presentations, and specific examples that draw on the scientific literature, current events
captured by the media, and environmental health controversies. Class sessions will expand on
and further illustrate content in the assigned text and readings.

Assignments will consist of weekly readings – including both a textbook and journal articles.
Most weeks, there will be a detailed discussion of a journal article that illustrates the
methodologies, controversies and values in environmental health. There will be two short policy
memos where students will be asked to address current controversies in environmental health.
Working in a group, students will briefly present on a topic of their choice. Finally, there will be
a final exam, covering the entire readings in the course.

Textbooks and readings
Textbook:   Understanding Environmental Health: How We Live in the World
            Nancy Maxwell, 2008. Jones and Bartlett, Publisher

Readings:      All course readings are posted to the course website

Course Schedule

9/10/09        Session 1 Introduction and overview of environmental health

This session will introduce students to environmental health as an interdisciplinary area of
scientific research and as a field of applied public health practice. It will situate environmental
health as a core function of public health and describe its relationship to other disciplines within
this field. This introductory lecture will provide an overview of current global environmental
health issues and a context for classes throughout the semester.

Students should be able to…

   give examples of and distinguish between, chemical hazards, biological hazards and physical
    hazards in environmental health, as well as natural hazards and anthropogenic hazards.
   describe and give examples of exposure driven and outcome driven environmental health
   distinguish between environmental hazards and other public health issues.
   - Ch 1. Preview of Environmental Health (pps 1 - 4)
   - Ch 2. The Science and Methods of Environmental Health (pps 5 - 18)

9/17/09        Session 2. The science and methods of environmental health,
               regulatory toxicology, exposure assessment and epidemiology

This will be the first of two course sessions that will introduce students to the disciplines that
comprise environmental health sciences, specifically regulatory toxicology, exposure assessment
and epidemiology, and relate the methods of each to environmental health policy and practice.
For chemical contaminants in particular, we will discuss their fate and transport in the
environment, their disposition in the human body and how this all relates to a variety of health

Students should be able to…

   name and give examples of the three primary routes of exposure
   recognize the interrelated processes that together make up toxicokinetics, including routes of
    excretion of chemicals from the body
   analyze a dose-response curve identifying the NOAEL, LOAEL and threshold if they exist,
    and explaining the practical implication of a threshold that is greater than zero
   explain the key difference between a generic dose-response curve for cancer and a generic
    dose-response curve for non-cancer effects
   give the standard units of absorbed dose and explain their meaning
   distinguish between incidence and prevalence, and explain which is most useful for learning
    about risk factors for disease
   - Ch 2. The Science and Methods of Environmental Health (pps 18 - 49)
   - Benzene - Richardson

9/24/09        Session 3. The science and methods of environmental health II:Risk

This session will pick up where the previous week left off. This session will primarily focus on
the practice of Risk Assessment used to regulate environmental chemicals and to examine
potentially hazardous sites.

Students should be able to…

   define risk assessment, distinguishing between regulatory (i.e., chemical) and site-specific
    risk assessments
   describe the major steps in a risk assessment for the noncancer and carcinogenic effects of a
    chemical, explaining the outcome or product of each step
   explain the role of IARC in classifying carcinogens

   - Ch 2. The Science and Methods of Environmental Health (pps 49 - 63)
   - Cellphones - Schoemaker

10/1/09        Session 4. Waste, water and infectious disease

    In this session, we will introduce students to media-specific environmental health concerns.
The source and fate of infectious and chemical contaminants found in drinking water will be
discussed, as well as the federal regulatory acts to protect water bodies and drinking water in the
US. Drinking water treatment models will be reviewed for their ability to prevent infectious
disease and for additional environmental health concerns they may present.

Students should be able to…

   name the dominant environmental medium in fecal-oral transmission of disease
   describe how a CSO works, its purpose and the practical challenges associated with CSOs
   distinguish between the basic types of processes used in the primary and secondary steps of
    sewage treatment, explaining how sludge results from these treatments
   outline the potential community health problems associated with spreading treated sludge on
   identify the key advantages and disadvantages of chlorination and ozonation as techniques
    for disinfecting drinking water, referring specifically to how trihalomethanes are formed and
    why they are of concern in drinking water
   name the two major laws governing wastewater and drinking water respectively

   - Ch 3. Living with Other Species (pps 67 - 78 and 84 - 92)
   - Ch 7. Living in the World We’ve Made (pps 263 - 288)
   - Nitrates - De Roos


10/8/09        Session 5. Environmental Justice and vulnerable populations

        Risks are not randomly distributed across the population nor is everyone equally
vulnerable to environmental hazards. This class session discusses the science of environmental
justice and describes some of the methods that have been used to identify inequities in health.

Students should be able to:

       Describe the theory of cumulative risk and explain the role of social inequities in health

       Explain some of the methods that have been used to identify environmental injustices and
        racial disparities in health.

       Describe the health impacts that have resulted from inequality of exposures

       Identify methods for addressing environmental injustices

 - Cumulative Risk - Hynes
 - Riskscape - Morello-Frosch

10/15/09               Session 6. Solid waste

Human waste and the products of our consumption are pressing environmental health concerns.
In Week Five we will discuss solid and hazardous waste, where it comes from and where it goes,
who is watching and what is being done to prevent hazardous exposures.

Students should be able to…
   explain why municipal solid waste is challenging to manage and presents a hazard to workers
   name the major law governing waste in the US
   describe the key features of a modern landfill that are intended to prevent pollution
   describe waste-to-energy incineration and two reasons why some environmental health
    advocates find it problematic
   explain the origin of methane gas in landfills and describe strategies for managing methane

   - Read Ch 5. Producing Manufactured Goods (pps 202 - 209)
   - Read Ch 7. Living in the World We’ve Made (pps 288 - 298)

    - Solid Waste - Norton

10/22/09       Session 7. Air pollution

Like water, air is another media of significant environmental health consequence. In this course
session we will discuss the health concerns of criteria air pollutants as well as air toxicants
known as hazardous air pollutants and the federal and state standards in the US that designate
them as such. We will also discuss air pollution in the context of global economic development.

Students should be able to…
   explain why and how lead and mercury exposure can result from the burning of fossil fuels,
    noting the key exposure pathways and media for both.. and not get confused between the two
   explain the relationship between particulate size and the fate of inhaled particulates in the
    body and the health outcomes associated with such exposure
   recall the criteria air pollutants and their sources and explain how non-criteria air pollutants
    are regulated

   - Review Ch 2. The Science and Methods of Environmental Health (pps 12 - 13)
   - Ch 4. Producing Energy (pps 99 - 120 and 126 - 131)
   - Living near roadways - Dales

10/29/09       Session 10. Worker safety and the environment
                      Guest Lecture: Lew Pepper

In this session we will discuss the issues associated with the workplace environment. The vast
majority of adults in our society work at some point in their lives. While at work, they are
exposed to a number of stresses and environmental problems that can have serious health
implications. Workplace health issues were identified centuries ago, more recently, a number of
laws and government agencies have been established to protect workers. In addition, the nature
of work itself has changed over time.

Students should be able to…
   discuss the history of worker safety laws
   describe the magnitude and range of work place hazards and diseases
   understand the programs that have been established to mitigate the impacts of the work
   identify the relationship between workplace environment with the broader health of the
   identify and explain key aspects of the US system of workplace based health insurance.

- Aging workforce - Silverstein
- Occupational health - Cullen
- Sick and tired - Murray

11/5/09        Session 9. Climate change, radiation and nuclear power

This session will include an overview of the science of global climate change and its potential
impacts on human health. It will introduce the topic of radiation to students identifying various
sources, types of radiation and properties of each. Naturally occurring and human-made sources
of ionizing radiation will be discussed, methods for measuring radiation, along with the health
effects of exposures. We will also discuss the question, Is nuclear power the solution to our fuel

Students should be able to…
   name the dominant source of exposure to ionizing radiation, as a global average and a
    different source of exposure to ionizing radiation which, in wealthy countries, is likely to be
    equally important
   be familiar with the front and back ends of the nuclear fuel cycle, and state what happens to
    spent fuel from US nuclear plants today
   name the type of cancer that has been clearly documented as a risk of radon exposure in
    uranium miners
   define stratospheric ozone depletion, its major cause, the “ozone hole” and health concerns
    regarding consequential exposure to ultraviolet radiation
   explain why some gases in the atmosphere are called “greenhouse gases” and why this
    greenhouse effect is important to human beings
   identify the single most important greenhouse gas and its major anthropogenic source
   name and compare the objective and status of two international treaties related to climate
   explain how people are mostly commonly exposed to iodine-131 and strontium-90 after a
    nuclear accident, where each of these radioactive elements becomes concentrated in the
    body, and the type of cancer associated with each

   - Read Ch 4. Producing Energy (pps 120 - 167)
   - Read Ch 5. Producing Manufactured Goods (pps 188 - 189)
   - Living near magnetic fields - Infante-Rivard

11/12/09       Session 10. Measuring chemicals in humans: biomonitoring

This session will address the environmental health consequences of some of the comforts of
living in an industrialized society. We will review common classes of chemical contaminants,
properties of chemicals that influence mechanisms of toxicity in humans and animal models, and
the study of these contaminant in human bodies using biomonitoring. The class will consider the
ethical, social, legal and scientific challenges of conducting human biomonitoring studies and
surveillance programs and become familiar with federal, state and activist efforts to use
biomonitoring technology for the purpose of protecting public health.

Students should be able to…

   explain the industrial use of solvents, the fate in the environment and the bodily system that
    most solvents affect
   know that phthalates are plasticizing agents, explain what that means and explain the primary
    health concern associated with exposure
   explain how dioxins and furans are created
   explain what purpose polybrominated diphenyl ethers (PBDEs) serve, the types of products
    in which they are likely to be present and the human health effect that is currently considered
    most likely for PBDEs
   explain what perfluorochemicals (PFCs) have been used for and the products made that
    involve PFCs, and recognize PFOS and PFOA as being in this group
   evaluate the arguments of the chemical industry trade groups and environmental health
    activists regarding the reporting of biomonitoring results in light of scientific uncertainty of
    the health effects of exposure

    - Read Ch 5. Producing Manufactured Goods (pps 175 - 202)
    - Pthalates - Hatch


11/19/09               Session 12. Pesticides and food contamination

This session will focus on pesticide use in the world today, while glancing back at efforts to
control pests throughout history. We will discuss various problems caused by pests, including as
vectors of disease, examining West Nile Virus as a case study. We will briefly trace the
development and characteristics of pesticides, focusing on organochlorine, organophosphate,
carbamate and pyrethroid pesticides such as DDT and permethrin. Physiological effects of
chemical pesticide exposure will be presented, focusing on human health. Finally, integrated pest
management will be discussed as an alternative method for pest control.

Students should be able to…

   name the body system, in both pests and people, which is the intended target for acute
    exposure to organochlorine and organophosphate insecticides
   describe the key difference in the environmental fate of organochlorine and organophosphate
   name at least four types health effects that have been linked to pesticides exposure
   define IPM and describe the principles of its implementation

   - Review Ch 6. Producing Food (pps 219 - 227)
   -Atrazine - Rusiecki


12/3/09        Session 13. The built environment: neighborhoods, housing and vacant land
               in the urban environment

This session will focus on the built environment and its influence on the quality of life and the
health of urban residents. It will include both discussions of the metropolitan environment and
more local factors that determine health outcomes. Among the topics that we will cover are:
urban sprawl, street connectivity, the health effects of poor housing and the problems posed by
abandoned industrial sites. In addition, we will discuss solutions to these issues: new urbanism,
healthy housing programs and brownfields initiatives.

Students should be able to…

   name the main mechanisms that the built environment impacts health.

   describe how suburban sprawl is defined and measured

   identify the problems that abandoned housing and vacant land pose to urban communities

   describe programs that have been developed to improve the urban environment and/or
    address its impacts on health.

      - Neighborhood greenness - Tilt

12/10/09       Session 14. Class Presentations

12/17/09       Session 15. No class - Final exam due (online).

Grading procedures

Policy memos. Note that each of these assignments will be accompanied by a short handout
explaining the assignment in detail along with readings (if any) for the assignment.

Policy memos

       Lead paint remediation.

               Until it was banned in 1978, lead paint was promoted as being superior to
       alternatives. Now, it presents a serious health problem in older
       communities, particularly deteriorated housing in inner cities. Deleading is
       expensive and if not done properly, can very unsafe. Leaving lead paint
       in place is not an option if it is peeling and deteriorating, but many inner
       city property owners can not afford to delead. This assignment is to
       produce a policy memo to a mayor outlining the issues in deleading and
       what programs and policies the mayor should propose to address this

               15 points

       Pregnant women, mercury and fish consumption advisories.

               Mercury can have important developmental impacts on developing brains,
       but nutrients found in high amounts in fatty fishes can promote greater
       cognition. Given these two conflicting outcomes, what should pregnant
       women be told about eating fish?

               15 points

Class Presentations

Approximately 1/3 of the way through the course, students will be assigned to groups of 3-4 to
develop a presentation on a environmental health topic of their choice. The presentation will be
in class on 12/10. Each group will have 15 minutes to present. Groups will have to submit their
topic for approval by November 5.

               15 points

Final exam

The final exam will cover material in presented in lectures and in the assigned readings.
Questions will be multiple choice and true/false. Each question will be worth one half point.

55 points

Course policies
o Note that there are no penalties for absences and power point slides from lectures will be
   available to all students. However, missing classes will make it difficult for students to be
   adequately prepared for the policy papers and exam. A student who is absent for class will
   still be responsible for timely completion of policy papers and the final exam.

Academic Misconduct
Student’s are expected to adhere to the principles of intellectual honesty outlined in Northeastern
University’s Academic Honesty and Integrity Policy
[Additional Comments re Consequences for Academic Misconduct]

Disability Statement
It is the policy of Northeastern University to accommodate students with disabilities.
Accommodations for students with disabilities are provided by the Disability Resource Center
(DRC), which is located in Dodge Hall, Room 20, 617-373-2675 (TTY: 617-373-2730).
Information is also available on the DRC website, Students planning to use
accommodations should provide notification letters as soon as possible to ensure successful

Helpful tips or strategies
o The policy memos are opportunities for students to apply what they have learned in the
   course to current issues. Each memo will be limited to 2-3 pages. Students will be graded
   based on their ability to use course materials (assignment handouts, readings, lectures) to
   support a policy recommendation. Note that these topics have been selected because of the
   complexity and because there is no clear cut definitive answer to these issues. Given the
   brevity of the assignments, students should focus on arguments backing up their reasoned
   opinions. Note that these policy memos will be available at the beginning of the semester in
   order to encourage students to begin preparing their responses as early as possible.
   Assignments will be due by the beginning of class. They should be submitted via email to
   the instructor.

o   Description of exam. The final exam will consist of multiple choice and true false questions.
    The questions are designed to measure comprehension of the broader context of
    environmental health. For example, they will not ask students to identify a specific odds
    ratio of effect for a toxicant. Rather, they will test concepts such as how and why children
    have differential environmental vulnerabilities than adults. The test is taken online.

o   Descriptions of assignments
                        Policy memo 1. Lead paint.                         Week 5
                        Policy memo 2. Fish consumption.                   Week 12

   Group presentation        Week 14
   Final exam.               Week 15


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