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lecture_11_vulnerable_populations

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									         Lecture 10



Vulnerable Populations: Children and
             Workers
Goals Today
 • Future Goals
 • Posters or papers
 • Finish Vulnerable Populations: Children
   and Workers (Ch 15)
 • Precautionary Principle
POSTERS OR PAPERS
 – See notes posted on website
 – Please check ideas with me
 – Public education campaign
 – Emphasize raising issues and posing
   solutions
 – Marking Guidelines
POSTER OR PAPER
  Marking Guide
  Name of Individual/Group Membership
  A. Introduction:
  Clear statement of purpose and Identification of
  Problem/Issue (5)
  Approach, definitions, literature (5)
  B. Body:
  Organization and presentation (5)
  Writing style (clarity, grammar) (5)
  Development of solutions and conclusions (5)
  Use of references and supportive documentation (5)
  C. Presentation:
  Time (5)
  Style and key points identified (5)
  Paper A & B             /30
  Poster A, B and C       /40
                Individuals Vulnerable          Concepts
                            Sub-groups
Concepts     Communities                        Risk
Risk                                            Social Justice
Social Justice             Health
                                                Sustainability
                           Health
Equity                                      Precautionary
Inequality       Populations---EnvironmentPrinciple
Needs                                           Holism

Opportunities               Health              Biodiversity

 Frameworks and                                  Ecological
 Methods                                         footprint
                                     Social, physical,
                                                 Stability
                                     economic, ecosystems
 Vulnerable Populations
• Children and Workers
• Children:
  – Developmental processes
  – Unique patterns of exposures:
    • Live close to ground; live hand to mouth
• Workers:
  – Exposures to high concentrations of toxins
    more often and earlier than for general
    public
Vulnerable Populations
 • Traditional Risk Assessment
 • Ignores special risks of children, workers,
   elderly, immuno-compromised
 • assumes everybody is a 70kg adult male
 • ALL lives are important but certain
   populations deserve special consideration:
   – Children
   – Racial classism siting of noxious facilities
   – OTHER VULNERABLE GROUPS?
Global Burden of Childhood Illnesses
“epidemiologic transition”
 •   The is a term that refers to:
 •   shifting mortality patterns from
     infectious to chronic diseases in
     developing societies
Vulnerable Populations: Mortality and Income
Vulnerable Populations
 • Children’s diseases today:
 • New pediatric morbidity
 • Classic infectious diseases reduced
 • Asthma (doubled in recent years), childhood
   cancers, neurodevelopmental*, congenital
   birth defects, second-hand smoke.
 _____
 * in the form of physical, cognitive, sensory and
   speech impairments, including in particular
   learning disabilities and intellectual
   retardation.
Vulnerable Populations
 • Children’s diseases today:
 • 10-20% genetic; rest ?
 • LEAD: neurological behaviour, IQ loss,
   disabilities
 • In utero exposures to PCBs and
   methylmercury affect intelligence
 • Last 50 years, 80,000 new synthetic
   compounds developed
   – Testing is inadequate
Children’s Exposures
 • Air, water, food crops, communities, waste
   sites, homes
 • Fewer than half chemicals tested for potential
   toxicity
 • Especially to fetuses, infants and children
 • Pound for pound children drink more water,
   eat more food and breathe more air than
   adults
 • Hand to mouth behaviour and living close to
   the ground can also increase risk
Children’s Exposures
 • Metabolic pathways are immature
 • Undergo rapid growth and development
   and therefore organs/brain/tissues
   more vulnerable to toxins disrupting
   developing systems
 • Exposures in childhood can produce
   illness at later stages of life
Case Studies of Children’s Health

   • 1904 Queensland, Australia epidemic of
     lead poisoning in young children;
     – Ingestion of lead paint playing on verandas
       lead to banning of lead paint
     – 1950s leukemia in Hiroshima and
       Nagasaki exposure to ionizing
       radiation due to atomic bombings
     – Subsequent studies established the
       sensitivity of infants and fetuses to
       radiation
Case Studies of Children’s Health
 • 1960s: Minimata Japan epidemic of
   cerebral palsy, mental retardation,
   convulsions due to ingestion of
   fish/shellfish contaminated with
   methylmercury
 • Source of mercury was a plastics
   factory discharging mercury into the
   bay; bioaccumulated up the food chain
Case Studies of Children’s Health
 • “Subclinical toxicity”:
 Dose-dependent continuum in which
   clinically obvious effects have their
   subclinical counterparts
 Needleman in the US: film Kids and
   Chemicals (Feb. 16) will feature his
   work
Occupational Exposures/Workers
 • Many environmentally induced diseases
   observed in workers:
   – E.g. cancer of the scrotum/testes in
     chimney sweeps
   – Coal miners lung cancers
Workers
 • Workers constitute well-defined groups
 • Nature and extent of exposures is
   known
 • These features lend themselves to
   epidemiologic studies
 • Occupational toxins may be transported
   home on clothing of workers
Workers
 • Occupational diseases (OD) are under-
   diagnosed
 • Physicians have little training in OD
 • One problem is that many diseases
   present the same set of conditions
 • Long latency period is a barrier to
   accurate diagnosis
Occupational Diseases

   • Lung Disease                • Disorders of
      – Asbestiosis,               reproduction
        pneumoconiosisi, lung       – Infertility,
        cancer, asthma                teratogenesis
   • Musculo-skeletal            • Noise-induced
     back, trunk, neck             hearing loss
   • Cancers other than Lung     • Dermatological
      – Leukemia, bladder,         conditions
        stomach
                                    – Rashes, scalds, burns
   • Occupational Traumas:
                                 • Psychological
      – Loss of limbs,
        amputations, fractures     disorders:
                                    – Alcoholisms, drug
                                      dependency
Prevention of Occupational Disease
 • Primary Prevention
   – Eliminate or reduce hazardous exposures
 • Secondary Prevention
   – Effectively identify work-related illness
     through symptoms/screening procedures
 • Tertiary Prevention
   – Reduce complications and disability caused
     by existing disease
Effective Prevention Strategies to reduce
exposures

    o Substitute a less hazardous material
    o Engineering controls, e.g., ventilation, process
      isolation or enclosure
    o Alteration of work practices: e.g., wet sweeping
      asbestos
    o Administrative controls: worker rotation, time
      away from hazard
    o Personal hygiene programs e.g., showers at end
      of workday
    o Protective equipment: respirators, gloves, ear
      plugs, muffs
    o Biological markers: to assess exposure – blood-
      lead levels
Effective Prevention Strategies to reduce
exposures

    o More widespread testing of chemical
      substances---pre-market evaluation
    o Occupational surveillance systems
    ___________________
    Children
    -Longitudinal studies
    -”right to know” legislation
    -surveillance systems for children’s diseases
References
 •   McCally, M. (2002) Life Support: Environment and Human Health
     Chapters 15 (Landrigan and Garg) and 5 (Spiedel)

								
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