Parallels between community environmental health and occupational health.

W. Hinds
{"title":"Parallels between community environmental health and occupational health.","authors":"W. Hinds","doi":"10.1136/EWJM.176.3.162","DOIUrl":null,"url":null,"abstract":"Since September 11, 2001, there has been increased attention on whatindividuals and communities can do to minimize the effects of terroristattacks, and other disasters, on the health and safety of our family, friends,and community.1 Thearticle by Mott and colleagues focuses on one such disaster—a forestfire. It provides retrospective data that can give us some idea about whichinterventions work and which do not in preventing respiratory healthproblems. \n \nUnlike most disaster situations, the forest fire that occurred from Augustto November 1999 near the Hoopa Valley National Indian Reservation in northernCalifornia caused a gradual buildup of smoke concentration in the residentialarea of the reservation. This gradual buildup provided an opportunity forlocal health officials to implement health-protective measures. The results ofa follow-up study, reported here, provide some guidance for health planning infire-prone areas and more generally for response to other natural andhuman-made disasters. \n \nOver the 7-week period of the fire, smoke particulate concentration(PM10) exceeded 150 μg/m3 for 15 days and reached apeak of more than 500 μg/m3 for 3 days. The EPA has designatedthe health-based national air quality standard for PM10 as no morethan 150 μg/m3 (measured as a dailyconcentration).2Hence, the PM10 in the study area reached hazardous levels. Toreduce the health effects of the smoke exposure on susceptible members of thecommunity, local health officials implemented four types of interventions:distributing respiratory protective masks, providing free vouchers to stay athotels in nearby towns, providing portable HEPA filter units to residences,and releasing PSAs. After the fire, a study was conducted to determine thehealth effects of the fire and the effectiveness of the interventions. \n \nThe situation faced by these health officials is analogous to thatfrequently encountered in the field of industrial hygiene, so it is ofinterest to compare the approaches taken by community health officials withthose used to address chemical exposures in industrial settings. The basicindustrial hygiene paradigm includes three steps: recognition, evaluation, andcontrol.3 The firststep is to identify the contaminant. In the case of the forest fire, it wasidentified as smoke particulate, although irritating gases in thesmoke—such as aldehydes—could also have been present. Theevaluation step is a quantitative measurement of the environment and anassessment of the health risk it presents. This was done in Mott andcolleagues' study by comparing air-monitoring data with EPA standards. Thethird step, to control the exposure to safe levels, was undertaken by the fourinterventions mentioned above. \n \nIn industrial hygiene, control methods are ranked hierarchically byefficacy andreliability.4 Thebest methods are engineering controls, such as substituting safer materials,isolating workers from the exposure, and ventilation. The analogy for thiscategory would include evacuation and the use of HEPA filter units. Furtherdown the list is modification of work practices, which include training in thenature of the hazard and what exposed persons can do to minimize theirexposure. This is analogous to the PSAs that were disseminated. Finally, theleast effective is personal protective equipment, in this case, respirators.Respirators are the least effective because it is difficult to get a good fit,they cannot be used effectively while eating or sleeping, and they causeconsiderable discomfort when worn for long periods. \n \nIn this study, how successful were the different interventions? Before wecan answer this question, we need to be cautious in interpreting the databecause they are observational and retrospective, so they are prone toconfounding and bias. The data show associations between an intervention andan outcome, but there is no proof that the intervention caused the outcome.With this caveat in mind, the data do seem consistent with the industrialhygiene control hierarchy in that the use of HEPA air cleaners and therecollection of PSAs were both associated with reduced odds of reportingadverse respiratory effects. The possible protective effects of PSAs suggestthat people are prepared to take steps to protect their health if they areinformed of the risk and the steps to be taken to minimize that risk. \n \nIn the industrial hygiene control hierarchy, we would expect evacuations tobe effective. Yet, evacuation in this case did not appear to be protective. Itis unclear why. Particulate concentrations in the nearby communities are notreported in the study, and perhaps these were elevated. Also, only a few ofthe participants were evacuated for the entire period of highestconcentration. \n \nThe study provides useful information for health planning in areas prone toforest fire. It also serves as a model for planning public health response toother types of natural and human-caused disasters. It underscores the need tokeep good records of the implementation of interventions for lateranalysis.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"25 1","pages":"162-3"},"PeriodicalIF":0.0000,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"4","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Western journal of medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/EWJM.176.3.162","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 4

Abstract

Since September 11, 2001, there has been increased attention on whatindividuals and communities can do to minimize the effects of terroristattacks, and other disasters, on the health and safety of our family, friends,and community.1 Thearticle by Mott and colleagues focuses on one such disaster—a forestfire. It provides retrospective data that can give us some idea about whichinterventions work and which do not in preventing respiratory healthproblems. Unlike most disaster situations, the forest fire that occurred from Augustto November 1999 near the Hoopa Valley National Indian Reservation in northernCalifornia caused a gradual buildup of smoke concentration in the residentialarea of the reservation. This gradual buildup provided an opportunity forlocal health officials to implement health-protective measures. The results ofa follow-up study, reported here, provide some guidance for health planning infire-prone areas and more generally for response to other natural andhuman-made disasters. Over the 7-week period of the fire, smoke particulate concentration(PM10) exceeded 150 μg/m3 for 15 days and reached apeak of more than 500 μg/m3 for 3 days. The EPA has designatedthe health-based national air quality standard for PM10 as no morethan 150 μg/m3 (measured as a dailyconcentration).2Hence, the PM10 in the study area reached hazardous levels. Toreduce the health effects of the smoke exposure on susceptible members of thecommunity, local health officials implemented four types of interventions:distributing respiratory protective masks, providing free vouchers to stay athotels in nearby towns, providing portable HEPA filter units to residences,and releasing PSAs. After the fire, a study was conducted to determine thehealth effects of the fire and the effectiveness of the interventions. The situation faced by these health officials is analogous to thatfrequently encountered in the field of industrial hygiene, so it is ofinterest to compare the approaches taken by community health officials withthose used to address chemical exposures in industrial settings. The basicindustrial hygiene paradigm includes three steps: recognition, evaluation, andcontrol.3 The firststep is to identify the contaminant. In the case of the forest fire, it wasidentified as smoke particulate, although irritating gases in thesmoke—such as aldehydes—could also have been present. Theevaluation step is a quantitative measurement of the environment and anassessment of the health risk it presents. This was done in Mott andcolleagues' study by comparing air-monitoring data with EPA standards. Thethird step, to control the exposure to safe levels, was undertaken by the fourinterventions mentioned above. In industrial hygiene, control methods are ranked hierarchically byefficacy andreliability.4 Thebest methods are engineering controls, such as substituting safer materials,isolating workers from the exposure, and ventilation. The analogy for thiscategory would include evacuation and the use of HEPA filter units. Furtherdown the list is modification of work practices, which include training in thenature of the hazard and what exposed persons can do to minimize theirexposure. This is analogous to the PSAs that were disseminated. Finally, theleast effective is personal protective equipment, in this case, respirators.Respirators are the least effective because it is difficult to get a good fit,they cannot be used effectively while eating or sleeping, and they causeconsiderable discomfort when worn for long periods. In this study, how successful were the different interventions? Before wecan answer this question, we need to be cautious in interpreting the databecause they are observational and retrospective, so they are prone toconfounding and bias. The data show associations between an intervention andan outcome, but there is no proof that the intervention caused the outcome.With this caveat in mind, the data do seem consistent with the industrialhygiene control hierarchy in that the use of HEPA air cleaners and therecollection of PSAs were both associated with reduced odds of reportingadverse respiratory effects. The possible protective effects of PSAs suggestthat people are prepared to take steps to protect their health if they areinformed of the risk and the steps to be taken to minimize that risk. In the industrial hygiene control hierarchy, we would expect evacuations tobe effective. Yet, evacuation in this case did not appear to be protective. Itis unclear why. Particulate concentrations in the nearby communities are notreported in the study, and perhaps these were elevated. Also, only a few ofthe participants were evacuated for the entire period of highestconcentration. The study provides useful information for health planning in areas prone toforest fire. It also serves as a model for planning public health response toother types of natural and human-caused disasters. It underscores the need tokeep good records of the implementation of interventions for lateranalysis.
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社区环境卫生与职业卫生的相似之处。
自2001年9月11日以来,人们越来越关注个人和社区可以做些什么来最大限度地减少恐怖袭击和其他灾难对我们的家人、朋友和社区的健康和安全的影响莫特和他的同事们的这篇文章关注的就是一场森林火灾。它提供了回顾性数据,可以让我们了解哪些干预措施在预防呼吸系统健康问题方面有效,哪些无效。与大多数灾难不同的是,1999年8月至11月发生在加利福尼亚北部胡帕谷国家印第安人保留区附近的森林大火,导致保留区居民区的烟雾逐渐积聚。这种逐渐积累为地方卫生官员实施健康保护措施提供了机会。本文报道的一项后续研究的结果,为火灾易发地区的卫生规划提供了一些指导,并更广泛地为应对其他自然和人为灾害提供了指导。在火灾发生的7周期间,烟雾颗粒物浓度(PM10)有15天超过150 μg/m3,有3天达到500 μg/m3以上的峰值。美国环境保护署规定,以健康为基础的国家空气质量标准PM10不超过150 μg/m3(按日浓度测量)。因此,研究区域的PM10达到了危险水平。为了减少烟雾对社区易感人群的健康影响,当地卫生官员实施了四种干预措施:分发呼吸防护口罩,提供免费入住附近城镇酒店的代金券,向居民提供便携式高效微粒微粒过滤器,以及发布公益广告。火灾发生后,进行了一项研究,以确定火灾对健康的影响和干预措施的有效性。这些卫生官员面临的情况与工业卫生领域经常遇到的情况类似,因此比较社区卫生官员采取的方法与用于处理工业环境中化学品暴露的方法是有意义的。工业卫生的基本范式包括三个步骤:认识、评价和控制第一步是识别污染物。在森林火灾的情况下,它被确定为烟雾颗粒,尽管烟雾中的刺激性气体(如醛)也可能存在。评价步骤是对环境进行定量测量,并对其带来的健康风险进行评估。莫特和他的同事们通过比较空气监测数据和EPA标准的研究得出了这个结论。第三步,将暴露控制在安全水平,由上述四种干预措施进行。在工业卫生中,控制方法按有效性和可靠性进行分级最好的方法是工程控制,例如替换更安全的材料,将工人与暴露隔离,以及通风。这个类别的类比将包括疏散和HEPA过滤装置的使用。进一步的是工作实践的修改,其中包括关于危害性质的培训,以及受接触者可以做些什么来尽量减少他们的接触。这与传播的公益广告类似。最后,最不有效的是个人防护设备,在这种情况下,呼吸器。呼吸器是最不有效的,因为很难找到合适的呼吸器,吃饭或睡觉时不能有效地使用呼吸器,长时间佩戴呼吸器会引起相当大的不适。在这项研究中,不同的干预措施有多成功?在我们回答这个问题之前,我们需要谨慎地解释数据,因为它们是观察性和回顾性的,所以它们容易混淆和偏见。数据显示干预与结果之间存在关联,但没有证据表明干预导致了结果。考虑到这一警告,这些数据似乎与工业卫生控制等级一致,因为使用HEPA空气净化器和收集psa都与报告不良呼吸反应的几率降低有关。公益广告可能产生的保护作用表明,如果人们被告知这种风险以及将这种风险降到最低的措施,他们就会准备采取措施保护自己的健康。在工业卫生控制层级中,我们期望疏散是有效的。然而,在这种情况下,疏散似乎并没有起到保护作用。原因尚不清楚。研究中没有报告附近社区的颗粒物浓度,也许这些浓度升高了。此外,只有少数参与者在整个高浓度期间被疏散。该研究为森林火灾易发地区的卫生规划提供了有用的信息。它还可作为规划公共卫生应对其他类型自然和人为灾害的模式。 它强调需要保持干预措施实施的良好记录,以供以后分析。
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