American Heart Month- The Environmental Health Connection

The American Heart Association designates February as American Heart Month.  During the month, much effort is spent on helping the public become aware of the importance of addressing lifestyle factors, like diet and exercise, keeping blood pressure within the optimal range, knowing the signs of heart attack, and being able to perform cardio-pulmonary resuscitation (CPR).  All of these factors and more are important to avoid heart disease and support those who are affected.  Heart disease is the number one cause of death overall for men and women in the United States.

One rarely hears any mention of the role that environmental exposures play in causing or exacerbating heart disease.  Scientists have established that environmental factors increase the risk of cardiovascular disease.  For example, carbon monoxide and ultra-fine particles that result from combustion and the complex mixture of toxic chemicals present in tobacco smoke all have been associated with cardiovascular disease. Sodium, which is a very common ingredient in processed and prepared food, has been connected with elevated blood pressure.  Excessive refined sugar has been shown to be associated with heart disease risk.  Maternal exposure to certain substances in the environment can increase the risk of birth defects in children.

Other connections between heart health and the environment are present.  For example, we know that people prefer to be physically active in settings (i.e., environments) that are clean, well-lighted, safe, and have well-maintained amenities.   Regulation of the environment, coupled with good planning, help to provide places in communities that have healthy places like parks, trails, schools, and other community facilities.  Community blight, neglect, litter, deteriorated housing, and noise levels foster persistent stress among residents and contribute to greater cardiovascular risk.

Environmental Health Professionals can and do contribute to heart health is many ways.  They investigate and evaluate environmental contamination, air pollution, indoor environments, building hygiene, and food establishments and stores.  Environmental Health Professionals work with community members to identify problems, to improve conditions in neighborhoods by eliminating places with improperly disposed trash, to help to get stray animals controlled (who wants to go out and exercise with packs of stray dogs in the streets?), and to eliminate blight.  Environmental Health Professionals help community members improve overall environmental awareness.  They work with city planners to plan, design, and oversee the building of new amenities like parks and trails.  They work with employers to cut down on unnecessary vehicle use by encouraging walking, bicycling, and transit use, and help to ensure that the risks from injury are minimized.

The U.S. Environmental Protection Agency has a healthy heart program that emphasizes the connection between good environment and heart health.  EPA also provides the AirNow web page that forecasts local air pollution levels and lets community members know the when it is safer and healthier to be active outdoors.  The Centers for Disease Control and Prevention also promotes the connection between healthy environment and improved heart health and overall well-being.

Public health approaches that address multiple sets of factors and target multiple levels or domains are the most likely to be successful. Public health professionals and community members should support comprehensive approaches that promote healthy lifestyle through awareness, education, public policy, and improvement of the environment.  Support the efforts to improve heart health and reduce the toll of heart and circulatory diseases throughout the Nation.  Good environment and heart health complement each other nicely!

Smoking and the Surgeon General

In January 1964, the Surgeon General of the United States, Luther Terry, did something extraordinary.  Dr. Terry released a report, on behalf of the U.S. government, that stated to the American people that something in their lifestyle was harming them.  Smoking up to that point was not commonly viewed as a health hazard. The most popular people in America promoted smoking (including a future President). Doctors frequently were smokers (including Dr. Terry) and advice from doctors was prominent in tobacco advertising. At the time, over 40 percent of Americans were smokers. In those days, government health programs were mostly focused on communicable disease prevention efforts.

Dr. Terry's report awoke Americans to an awful truth: smoking is a serious, deadly health problem.  It causes cancer, heart disease, respiratory conditions, pediatric problems, injury from house fires, and more.  Even though the Surgeon General's report began a series of actions to reduce the harmful effects and to counter widespread marketing, sales, and use of tobacco products, we continue to suffer from the burden today, as millions still smoke, many former smokers eventually have compromised health or die early, and many non-smokers (including children) suffer health problems from second-hand smoke.

Since 1964, 29 Surgeon General's reports have been issued.  Topics have ranged from the health risks of specific diseases like cancer, lung, and heart disease to ways to quit.  Another report addressed the health effects from second-hand smoke effects. Many others have become involved, including the CDC, NIH, FDA, World Health Organization (WHO), non-government groups like the American Cancer Society and the American Lung Association, medical doctors, and nearly every state or local health department.

The latest report, The Health Consequences of Smoking: Fifty Years of Progress, documents how we have made progress in addressing this scourge.  The rate of smoking in the U.S. has fall by over one-half. Millions of premature deaths have been prevented because of the efforts of public health workers, politicians, educators, and citizens who have taken a stand against tobacco. The Surgeon General documents many of the personal battles to break free from tobacco addiction.  The report also discusses what needs to be done in the future to eliminate disease, disability, and death from tobacco.

Unfortunately, tobacco continues to be the cause of a huge burden of death and illness. Over 40 million American adults continue to smoke, according to the CDC. The rate of smoking (and health burden) worldwide continues to increase. New challenges have been introduced like e-cigarettes, little cigars, hookah, and flavored tobaccos. Public health personnel, including environmental health, are on the front lines of the effort to address smoking, still rightfully called the leading preventable cause of death in the U.S.  It continues to be a major priority for public health and will continue to be for the foreseeable future.

This is my Fall 2013 Newsletter for Region 7 NEHA members, and you might find the information interesting.

National Environmental Health Association

NEHA Update Fall 2013

John A. Steward, R.E.H.S., M.P.H.

Regional Vice President, Region Seven

We have entered the 2013 holiday season, and all of the officers and staff of the National Environmental Health Association wish you and your family the best as you celebrate your tradition and beliefs.  As Regional Vice President for Region Seven, it is a privilege to serve NEHA members in the seven southeastern states that comprise Region Seven.  This is a short update of recent NEHA activities and news. 

2014 NEHA Annual Educational Conference

The 2014 NEHA Annual Educational Conference will be held July 7-10 in Las Vegas Nevada.  It will be conducted in partnership with the International Federation of Environmental Health, and it will be the first time that the U.S. has hosted the World Congress on Environmental Health.  See http://www.neha2014aec.org/ for more information and to register.  Many nationally and internationally-recognized speakers will be present, and a dynamic slate of learning activities is planned.  We expect great attendance, with people attending from all parts of the world. Look for scholarship opportunities soon to support attendance.  For those who cannot be physically present, NEHA will again arrange a “virtual conference” via web link, which will allow participants online to experience 20-30 sessions live.  Many of the sessions also will be recorded and made available later on theNEHA.org web page. These are available free to NEHA members.  The 2015 AEC will be held in Orlando Florida, followed by a western U.S. site in 2016.

Around the Region

State conferences held this year have included Alabama (April, Birmingham), Georgia (June, Jekyll Island), North Carolina (September, Asheville), Florida (September, Sandestin Resort), and South Carolina (November, Columbia).  In addition, the Interstate Environmental Health Seminar, which draws attendees from the South and Mid-Atlantic areas, was held in Kent Island Maryland in July. The 2014 Interstate Seminar will be held in Savannah Georgia July 16-18. Seehttp://www.wvdhhr.org/wvas/iehs/ for information.

Journal of Environmental Health Now Available Electronically

NEHA’s Journal of Environmental Health has developed an electronic version, and it is being provided to members at no additional charge!  We soon will begin a new international membership, and those members will receive only the electronic Journal.  In the near future, we will do the same for students. For now, regular members will have the option of electronic, print, or both formats of the Journal.  We are exploring strategies to keep membership costs as low as possible.

New Food Safety Credential

NEHA is conducting many activities to support the implementation of the federal Food Safety Modernization Act.  NEHA has a new food safety credential called the “Certified in Comprehensive Food Safety” (CCFS). This credentialed practitioner will have a span of food safety knowledge from “farm to fork.”  See more information athttp://www.neha.org/credential/#ccfs.

Definitions!

NEHA has published new definitions of the terms “environmental health” and “environmental health practitioner.”  The products were the result of a workgroup of NEHA directors and experts, and a public comment period allowed members’ input and helped to shape the results.  Read about the new definitions at:http://www.neha.org/pdf/positions/NEHA_Adopted_EH_Definition_July_2013.pdf.

Awards and More Opportunities

Each year, NEHA gives a number of individual and team awards for career achievement and outstanding programs.  Region Seven has a great record of earning these honors, including CAPT Mike Herring, a current Georgia resident and favorite son of North Carolina, who received the Walter Mangold award at the AEC this year!  New group awards for “Environmental Health Innovation” and “Educational Contribution” were added in 2013.  See information at http://www.neha.org/about/awardinfo.html. Another great individual opportunity is the UL/NEHA Sabbatical Exchange. A NEHA member is awarded a stipend for a trip to either the United Kingdom or Canada.  The application deadline is March 1, and information is found at http://www.neha.org/about/Awards/SabbaticalExchangeAward.html.

Meet NEHA’s President

NEHA’s President this year is Alicia Enriquez Collins, an environmental health professional originally from California who now resides in Atlanta Georgia.  Ms. Collins has been active in governing NEHA as member of the Board of Directors for several years.

Elections

I am completing my three-year term as Regional Vice President next year and have decided not to run for re-election.  NEHA members within Region 7 may submit a self-nomination for the open position until January 1 2014.  If more than one qualified person is nominated, NEHA conducts an election by electronic ballot.  This year, the election of officers will be in March 2014 for a term to begin in July 2014. NEHA members should be alert for an electronic ballot email in late February 2014.  See more information and nomination forms athttp://www.neha.org/about/elections.html. 

If you have not visited NEHA.org recently, check out the great resources including FREE training.  Also, “like” us on Facebook athttps://www.facebook.com/NEHA.org.  Please feel free to contact me at jsteward@gsu.edu. Find me on Twitter at https://twitter.com/jstewardatl, and I write a blog athttp://tinyurl.com/jstewardEHblog.

World Environmental Health Day

September 26 is World Environmental Health Day.  It is a day to celebrate what we do to promote people's health and well-being by taking actions to ensure a healthy environment around the world. To many, the concept "environment" means protecting our planet.  As important as this is, environmental protection is only part of the needed actions.  We also need to ensure that the conditions in which people live provide the opportunities for good health and safety.

Some of our most critical global challenges include the following:

•  For a billion of us, each day is a struggle to obtain water, and often it is contaminated with microbes and chemicals.  Illnesses borne by contaminated drinking water kills a million children a year. 
• In many places, the lack of proper waste disposal systems and practices perputuate a cycle of disease-contamination of water and food- more disease.
• Air pollution kills millions of people each year and causes an even larger burden of disease and disability around the world from exposure to smoke, particles, and gases from unsafe home heating and cooking, cars and other vehicles, industry, and electrical production.
• We continue to introduce chemicals into the environment without adequate testing to fully understand the potential to harm people. Each of us carries a chemical burden in our bodies.
• Our food supply is subject to contamination at many points in the system.  We grow and harvest what is cheap, easy to distribute, and high in calories, but not necessarily what is best for nutrition.  Many question whether chemical and energy-intensive practices of industrial agriculture are sustainable.
• Beginning around 2007, more people in the world live in urban settings rather than the rural places that once predominated. As cities develop, safe and healthy housing and sanitation are not available to many.  The concentration of pollution created by large numbers of people and commerce must be managed.  Urban design principles must consider human health and needs in these burgeoning cities.
• We have yet to develop the will to address the human causes of global climate change or understanding of the profound implications for both the planet and the people.

In the U.S., we are more fortunate than many in the world to have environmental health conditions that promote people's health and safeguards for protection.  We have invested in safe water supplies, sound waste disposal practices, a food supply that protects against food borne illness, worker safety, and protection against illness like malaria and rabies.  Yet, we continue to face significant challenges like ensuring environmental benefits and protection for all Americans, controlling sources of air pollution, and designing communities that encourage people to pursue healthy lifestyles.  We need support in these areas from politicians, government leaders, industry, and most of all each citizen.  World Environmental Health Day is a chance to remind and encourage all to be part of the solution.

Learn more at www.ifeh.org.

NEHA's Annual Educational Conference Recap

Here is a video that gives you an idea of what it was like to attend the June Annual Educational Conference in Columbus Ohio, presented by the National Environmental Health Association.

River Flooding: Man-made or Natural Disaster?

The wild weather and disasters that have struck the U.S. this spring have been awesome and disturbing. Many have lost lives,homes, and livelihoods. The flooding along the Missouri and Mississippi Rivers has been at historic levels. People have always feared flooding and for good reason. Floods account for a large toll of lives lost every year. Are the floods we are experiencing man-made or natural disasters?

I think a case can be made that much of the flooding is a man-made event. Obviously, humans don't control the rain and snow melt (I won't consider the effects of humans on climate change at this time). However, humans have made grand designs and structures to control the rivers.* We have channelized the rivers with levees and controlled the flow with dams. This has resulted in people settling and building near the rivers and in areas that would be threatened regularly by flood if not for the built features. Humans also influence the amount of land area available to absorb the runoff from rains and snow melt. Reductions in undisturbed land, vast areas of pavement, and features that channel storm water all affect the amount and rate that water joins streams. The flooding waters carry bacteria, viruses, and parasites as well as an array of chemicals into the affected areas (Black 2008).

The strategies that we use to control flooding are changing. Communities and government officials are realizing that old "nature taming" approaches have been flawed and can make the results of floods even worse while not allowing the natural role of flood waters to be realized. We humans need to be more intelligent in designing our built environment to work with nature, knowing that nature's powerful forces cannot always be overcome. Listen to a discussion among experts about the Mississippi River and flooding broadcast on May 13 on National Public Radio here.

Environmental health professionals often play an important role in preparing for and responding to floods and other natural disasters. It seems time for EH to also become involved in influencing the design of communities and built environment features that influence the frequency and severity of the flooding.

*Everyone knows about the Continental Divide? All of the water that falls on the east side runs to the Atlantic and all that falls on the west side runs to the Pacific, right? This is not correct, due to man made intervention. In 1890, engineers in Colorado's high country built the "Grand Ditch" to capture water on the western slope and carry it to the eastern slope and thus supply thirsty Front Range communities! Water that has fallen on the western slope crosses the divide and flows east in the Ditch!

References
Black H 2008. Unnatural Disaster: Human Factors in the Mississippi Floods. Environ Health Perspect 116:A390-A393. doi:10.1289/ehp.116-a390. Accessed June 6, 2011.
"Struggling To Contain A Rising Mississippi." National Public Radio. May 13, 2011.

There is a new buzz-term in the politicosphere-- "The New Normal." Governor Chris Christie of New Jersey is one leader who uses this term. Gov. Christie calls for dramatic cuts in government spending and services. He touts zero-based budgeting as a solution. Apparently in New Jersey, every year they ask all over again- do we keep the schools open? Do we have roads, sewers, parks, and water running in the pipes? Should we fund police, fire, and of course public health? This is the New Normal.

Should we accept drastically reduced resources for vital government programs as "normal"? What about the role of programs like public health in maintaining our communities as a healthy place, with healthy people? Have the responsibilities and workload of public health decreased in proportion to the cuts? Has the burden of disease and health disparities been reduced sufficiently to warrant the reductions? The statistics and common sense both tell us they have not.

Sorry, I have to label this as bizarre, not normal. I view this as accepting that many people will continue to have reduced life spans and lower quality of life due to inadequate provision of services and features that provide safe, healthful, and decent living conditions.

The role of government has evolved and mostly grown in part because of the success in improving people's lives and longevity. I am completely supportive of examining where we are going as a Nation and conducting our government in a sustainable way, without an undue burden on the next generations. But we have our current health status because of the health-promoting features in our communities, and many are government responsibilities- roads, water supplies, sewerage, oversight of the food supply, environmental monitoring, and public safety are a few, not to mention national defense and homeland security. Should the level of environmental and occupational health and safety be left to employers' discretion and not government regulation? The Centers for Disease Control and Prevention (CDC) reviewed the achievements of the 20th Century that led to a greatly improved health status compared to 1900, and CDC named ten that had the greatest improvement to public health. (read at http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm). Nearly all of the achievements, like improving water systems to provide a safe drinking water, were organized or run by government at either the national, state, or local level.

Should we cut government to the point where our health status may actually slide back to the levels before the 20th century? I believe that poor health for more people is the likely outcome of the "new normal" as it is being implemented. If people consider the consequences, they will reject this approach.