MODULES
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A. Introduction |
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C. Food Safety |
Modules
Introduction
Objective: to provide definitions that are basic to the the practice of environmental health.
1. Environmental Health:
"The area of public health that studies how the environment affects human health."
In order to fully appreciate this definition, it is not enough to look at it in isolation! There are three terms within the above definition (public health, environment, and health) that need further definition. We will do that in the definitions below, but for now, there is a critical relationship we need to ponder:
environment <----> humans
Certainly the environment effects all organisms, but environmental health is centrally concerned with the effects on human health.
3. Public Health:
- the prevention of disease
- and the promotion of health
- from the community perspective.
Public Health is an extremely broad collection of professions as well as disciplines, and it is expanding all the time. Indeed, environmental health is expanding all the time! However, the above definition provides us with a philosophical base: the field is concerned with the prevention of disease and not merely the treatment of it. Taking what we know about the prevention of disease, we also promote healthy practices. And finally, we treat much more than the individual -- we treat the community.
A relatively simple example may help. If a cholera epidemic is spreading throughout a community, it is not enough (under this definition) to simply take the victims to a doctor. It's expensive to take this approach, and some of the victims will die even when medical treatment is available. If we find the cause of the problem (for example, contaminated water supplies), we can prevent cholera by promoting healthy practices (for example, by boiling the water or, better yet, chlorinating the water). Finally, it has to be a community effort to be most effective -- ultimately it's easier and more effective to chlorinate the community water supply before it is delivered to the individual.
4. Health (defined by the World Health Organization in 1948):
A state of complete physical, mental, and social well being and not merely the absence of disease or infirmity.
Under this definition, health is an ideal that is never achieved! At first, this may sound very negative -- after all, it declares all humans to be not healthy! But at second glance, this can be an inspiring definition: it says that we can never take health for granted. The mere fact that you have no apparent disease or infirmity is no reason to be complacent. Environmental health professionals are constantly surveying the environment in search of health risks and ways to control them.
Another example may help. As of this writing, we have not seen any follow-ups to the anthrax bioterrorism that followed the 9/11 attacks on America. Does this mean that we no longer need to be concerned about anthrax? Hardly. All the experts have said that the anthrax episodes could happen again, and common sense tells us that we need to be ever vigilant. I'm not talking about panic or irrational fears, but about a reasonable and watchful eye over the broad range of risks in our environment. The good news: this is exactly what environmental health professionals have been doing for over a century.
5. Environment:
The sum of all external conditions and influences in human's surroundings, which include biological, chemical, physical, psychological, and sociological hazards.
I have a more informal definition of environment:
anything that is not me.
Notice that this includes not only biological, chemical, and physical hazards (e.g., microbes, toxic chemicals, or radiation), but also the psychological and sociological hazards. Sometimes it is the fear that is more important than the risk itself. Make no mistake about it. environmental helath professionals have to recognize the psychological and sociological elements of a risk to be effective in managing it.
6. Epidemiology:
The study of the distribution and determinants of disease.
By determinants I mean the "cause" of a disease. We do this by examing the distribution rates. Some more important rates are defined below:
- prevalence: # of existing cases ("sick people") divided by the total population
- incidence: # of new cases in a time frame dvided by the # of people exposed
We will be discussing a wide range of diseases, but for now there are three terms to define:
- carcinogenesis: to cause cancer
- mutagenesis: to cause genetic disorders
- teratogenesis: to cause birth defects
7. Interaction of contaminants:
Finally, we need to be aware that exposures do not normally occur one at a time, but in combinations. We therefore need to study the interaction of contaminants. Three terms speak to this issue:
- synergism: two or more contaminants may act to multiply the health effects to an extent that would not be predicted simply by adding them together. For example, both asbestos and smoking are related to lung cancer, but the combination results in a risk far higher than would be predicted simply by adding them. I like to simplify this relationship in the following way:
1 + 1 = 3- potentiation: A normally harmless agent may combine with a risky agent to magnify the effect. I express this as:
1 + 0 = 2- antagonism: finally, there are times when two agents can cancel each other out, and the effect is far less than you would predict. I express this as:
1 + 1 = 0The fundamental problem we face is this: among the literally thousands of agents to which we are potentially exposed, some may form synergims, some may form antagonisms, and some may combine with normally harmless agents to have a potentiation effect. To sort out these relationships is a daunting task!
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For more information, try: Introduction
Objective: to provide a model for analyzing the various risks associated with environmental health.
Given the previous discussion of a context for environmental health, we need analytic tools that help understand these challenging issues. Those analytic tools can be found in the area of risk analysis. Risk analysis is a broad term that represents a collection of approaches and disciplines devoted to all aspects of risk issues. At a minimum, risk analysis includes 1) risk assessment, 2) risk communication, and 3) risk management (all defined below).
Risk assessment is the characterization of adverse effects from exposure to hazards. Probably the simplest example of this characterization is to say "the risk of cancer from a lifetime of exposure to "chemical X" is greater than one out of a million." More formally, risk assessment includes four steps defined below: hazard identification, dose response assessent, exposure assessment, and risk characterization.
Hazard identification is to determine whether a particular agent is causally linked to particular health effects. For example, does this chemical cause cancer?
Dose-Response Assessment is to determine the relationship between the magnitude of exposure and the probability of occurrence of health effects in question. For example, one ounce of "chemical X" will kill 50% of laboratory mice.
Exposure Assessment is to determine the extent of human exposure (this is especially useful both before or after the application of regulatory controls). For example, after the Clean Air Act revisions have been put into place, the exposure to the average citizen to "chemical X" is 50% of the allowable standard.
Risk characterization is to describe the nature and often the magnitude of human risk, including attendant uncertainty. For example, "chemical X" may cause cancer deaths in anywhere from 3 to100 people in Los Angeles over the next 20 years.
Risk communication is an interactive exchange of information and opinions among individuals, groups, and institutions regarding risk.
Risk management is the evaluation, selection, and implementation of alternative risk control actions.
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For more information, try: Introduction
Objective: to provide legal definitions that form the basis for environmental controls.
NOTE: By necessity, these definitions are introductory. I recommend the environmental health law course for a much more complete discussion of these concepts.
A. General
1. law: binding requirements imposed by government.
Law is a general term that includes the wide variety of legal tools that are used by government. Fundamental to understanding legal relationships are the next two terms: rights and duties.
2. rights: a power, privilege, or interest, protected by law.
For example, environmental health professionals are accorded special legal powers in carrying out their job. Some of these powers are discussed below in section C.
3. duties: the corresponding responsibility to respect a right.
Just as environmental health professionals have special legal powers, they also have special duties that are beyond those of average citizens. Some of these duties are discussed in section D.
4. stare decisus: a latin phrase that means "the decision stands."
This concept is critical in legal research because it says that the most recent legal decision rendered by a court stands as a precedent (unless it is overturned). In practice, this means that the most recent legal decision is often the best predictor of future legal decisions. While by no means a hard and fast rule, it does mean that legal research is one of the best ways to predict court action.
B. Types of law (by precedence)
5. constitutional: fundamental laws of a government (the highest precedent of law)
Most people are aware of federal and state constitutions, but city charters are also included under constitutional law.
6. statutory: laws passed by vote of legislature or public.
This includes state and federal statutes, of course, but also includes local ordinances and public referenda.
7. administrative: laws written by appointed officials (i.e., agencies)
The last century has seen a huge growth in administrative law. One reason for this: scientific expertise is more likely to be found found within various agencies, and not within our legislatures. Therefore, our elected officials pass statutory law that instruct agencies to develop the specific standards. In other words, the statutes lay out the principles, and the administrative law implements those principles. Administrative law includes regulations and rules.
8. common: laws taken from previous court decisions.
What if there are no statutes or regulations that address a specific legal issue? It is still possible to challenge environmental activities under common law, which refers to the accumulation of previous court decisions that are separate from statutes, regulations, or contracts. Common law is the lowest precedent in this group, and includes nuisance laws and eminent domain (discussed in the next section).
C. Other fundamental powers
9. nuisance laws: government may limit use of property if it harms others or is "unreasonable."
The problem here is that it is often difficult to predict what is "unreasonable." Consider this simple example: if dog droppings are three feet deep and the odor is detectable to 500 homes in the area, we could be confident that this is a public niusance. If there is only one dog dropping that is detectable to nobody in the area, we could be equally confident that it is not a nuisance. However, at what point do these accumulation of dog droppings start to be considered a public nuisance (i.e., unreasonable)? This is a difficult question to answer, and represents the kind of issues we find under nuisance laws.
10.eminent domain: government may "take" property if:
it is for the public interest, and fair compensation is made. It is possible that fair compensation may be zero dollars, but it may also be substantial. An example of eminent domain is the embargo of faulty restaurant equipment, if that equipment represents a risk to food safety to the public.
11.police power: government must have power to enforce its own regulations
This constitutional power refers to more than simply the development of a police force. It is a justification for the creation of agencies, and it is the fundamental power that environmental health professionals have in enforcing environmental health laws.
12.subpoena: a court order for records or witnesses in court.
I like to mention this power because it involves more than witnesses. Almost everyone knows that they could receive a subpoena to testify in court, but fewer realize that their records are subject to subpoena. Virtually everything that an environmental health professional writes could be subject to subpoena. Certainly it is wise to consider this possibility in everything that you write.
D. Responsibilities
1. malfeasance: unauthorized (wrongful) act by an official.
For example, taking a bribe is clearly an unauthorized act.
2. misfeasance: authorized act in an unauthorized manner.
This term is a reminder that the responsibilities of environmental health professionals go beyond simple malfeasance. A relatively simple example: we have the authority to close down restaurants (thus. it is not malfeasance), but we must do so according to the law.
3. nonfeasance: failure to perform duty (without adequate excuse).
This term is an even deeper reminder that the responsibilities of environmental health professionals are beyond the average citizen. For example, suppose it is 4:30 on a Friday afternoon, and you are inspecting a restaurant. You find human feces flowing down the middle of the food preparation area (incredible as it sounds, this actually happened to me!). The paperwork and the action of closing this place down would take far more than a half hour, and yet the work day (in this example) ends at 5 p.m. However, to simply walk away from this clear public hazard would be an act of nonfeasance. The duty can indeed extend beyond the normal 9 to 5 routine.
4. due process: fairness and completeness of laws
Court cases typically involve multiple reports, letters, pictures, meetings, and so on. Why so much documentation? Due process requires that we demonstrate the fairness and completeness of our actions.
5. equal protection: consistency of law
If we inspected all Mexican restaurants twice as often as all other restaurants, simply because they were Mexican, this would clearly be a violation of equal protection. However, if we inspected a specific, particular Mexican restaurant twice as often as all others (including all other Mexican restaurants) because there was adequate evidence that it had unsafe practices in food preparation, this would be based on risk and would not be a violation. My example is a simple one, and often the real cases are far more challenging.
6. exclusionary rule: evidence must be legally obtained
Television and movies would sometimes have us believe that enforcement is simply a matter of breaking the door down, gathering the evidence, and sending all the bad guys to jail. But "breaking the door down" would often mean that all that evidence was illegally obtained. Again, the burden placed on environmental health professionals (and rightfully so) is to obtain all evidence legally.
7. demurrer: admit to facts but challenge legal propriety
If evidence was illegally obtained, the defendant would be expected to file a demurrer.
E. Approaches:
8. litigation: to settle a dispute in a court of law
9. arbitration: to settle a dispute out of court in a binding settlement with the services a disinterested person
10. negotiation: to settle a dispute out of court in a nonbinding settlement between the interested parties
11. administrative hearings: formal and informal means to gather information and clarify positions
F. Other
12. NEPA: National Environmental Policy Act (1969)
No discussion of environmental law would be complete without mentioning NEPA (in California, the California Environmental Quality Act, or CEQA). All projects funded by the federal government that may have impacts on the environment are required to submit environmental impact statements
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For more information, try: Introduction
Objective: to use the theory of demographic transition in analyzing current issues in population growth and its relationship to environmental health.
The "demographic transition" is a theory with two major elements:
1. It states that economic and technological progress leads to a decline in death rates, which is eventually followed by a decline in birth rates. During this transition period (when the death rate is lower than the birth rate), the result is, of course, population growth. 2. It states that this period is necessary to complete economic growth (this is the more controversial element of the theory).
To understand the roots of this theory, we can look at trends in the so-called "developed countries" (e.g., the U.S.). The decline in death rates did indeed come first. Death rates were fairly high through 1775, but began a slow decline for 100 years, and entered a rapid decline at the beginning of the 20th century.
Also, decline in birth rates did indeed lag behind death rates. In these same countries, birth rates remained high through 1825 (i.e., a 50 year lag), but began a slow decline for the next 50 years, and began a rapid decline for the next 100 years. The large differences between the birth rate and death rate were accompanied by rapid population growth. Both death rates and birth rates are now stable, and population growth has consequently stabilized.
However, is this demographic transition true for the so-called "less developed nations" of today? Reviewing the trends, death rates remained fairly fairly high through 1875, followed by a rapid decline for the next 100 years. This rapid improvement was largely due to the breakthroughs in environmental health practice, and death rates have plummeted in last 30 years. Birth rates remained high through 1925, with a slow decline ever since. While the data are still coming in, it appears that the trend is continuing.
This raises a number of important points:
1. There is a widespread belief that population increase is due to a rise in birth rates (i.e., "having too many babies"). This is simply not true. Rapid population growth is almost always due to a drop in death rates, not a rise in birth rates. Ironically, environmental health has played a role in population growth by lowering death rates.2. The demographic transition of today's "developed countries" were at a time when the world's population was much smaller than today. With much larger populations today, the capacity of our environment to sustain this growth is the subject of much debate. Ironically, just as environmental health has contributed to population growth, it may also contribute to a successful completion of a demographic transition by protecting our environmental resources.
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For more information, try: Introduction
Page updated: 1/19/02