Harmful Environmental Exposures and Vulnerable Populations Environmental Health in Nursing

Unit II: Harmful Environmental Exposures and Vulnerable Populations Environmental Health in Nursing Unit 1I: Harmful Environmental Exposures and Vulnerable Populations INTRODUCTION Unit 1 highlighted various roles of the nursing profession where knowledge of environmental exposures is central to practice. In Unit 2, the focus is upon population groups who are most vulnerable to harmful environmental exposures. While risks to adverse health outcomes can vary according to geography, housing and location of environmental exposures, some humans are at greater risk due to their biophysical and sociopolitical vulnerability. Unit 2 explains risk and vulnerability across the lifespan with a focus upon specific vulnerabilities and harmful effects at various developmental stages. A second chapter highlights anticipatory guidance for parents and caregivers to reduce environmental exposures for children from infancy to adolescence. Third, Unit 2 considers the impact of social determinants of health, which are commonly referred to as factors where people live, learn, work, play and pray. Social determinants at neighborhood and community levels impact individual level exposures. Finally, Unit 2 includes a chapter about the effects of social determinants on the vulnerability of immigrants and refugees. See Unit 5: Sustainable Communities, for the chapter about Environmental Justice, which addresses the adverse outcomes for those who live in more environmentally hazardous areas. Page 23 Alliance of Nurses for Healthy Environments Unit II: Harmful Environmental Exposures and Vulnerable Populations Environmental Health in Nursing HARMFUL ENVIRONMENTAL EXPOSURES AND factors that result in variability of outcomes across VULNERABLE POPULATIONS populations. Jeanne Leffers, PhD, RN, FAAN Risk and vulnerability are related to each other. Some Professor Emeritus describe vulnerability as a series of threshold factors that University of Massachusetts College of Nursing increase or amplify risk and lead to poorer health Dartmouth, MA outcomes. Others argue that vulnerability can vary All humans are at risk for harmful effects of environmental according to the capacity of the individual and many not hazards. For certain human populations the risks of harm lead to poorer health outcomes. This view says that are greater due to biologic, social, economic, or other positive attributes of those identified as vulnerable can factors. Such population groups are often referred to as enable them to overcome risk and vulnerability, leading to vulnerable populations. A vulnerable person or group has better outcomes (Leffers et al, 2004). The North Carolina “aggravating factors that place them at greater risk for Preparedness and Emergency Response Research Center ongoing poor health status than other at-risk (NCPERRC) makes a similar distinction between risk and persons” (Maurer, 2013, p. 528). Some vulnerable groups vulnerability. They note that risk is directly affected by a include children, the poor, those without homes, refugees, hazard while the degree of vulnerability is defined as “the those with disabilities and those with mental illness. These characteristics of person or group and their situation that vulnerable populations have been identified through influences their capacity to anticipate, cope with, and epidemiological studies as having poorer health outcomes. re s i s t a n d re c ove r f ro m t h e i m p a c t o f a n This paper will discuss various factors that make specific emergency” (NCPERRC, 2012). populations across the life span more vulnerable to poor The notion of “windows of vulnerability” refers to specific health outcomes from environmental stressors. times during human development that have been identified RISK AND VULNERABILITY for higher risks to health. For example, at times a child Risk is the likelihood that a harmful health event will can have better recuperative capacity than adults. In other occur in a given population during a specific time period. situations, children are at far greater risk (Brent, Tanski, & Our knowledge of risk emerges from the science of Weitzman, 2004; Sanchez, Hu, Litman & Tellez-Rojo, 2011). epidemiology. Epidemiology is the study of health and Various populations have been identified as more illness in human populations. Epidemiological studies show vulnerable to environmental hazards. As stated earlier, that environmental hazards can cause poorer health. individual and experiential factors can lead to different Environmental hazards can increase human risk of illness, vulnerability across populations. These factors include disability and premature death. The Environmental those whose biophysical characteristics make them more Protection Agency (EPA) defines risk as the “chance of vulnerable such as the developing fetus, infants, children harmful effects to human health or to ecological systems and older adults. People with acquired biophysical factors resulting from exposure to an environmental such as chronic illness, those with differences in stressor” (EPA, 2015). An environmental hazard is “any functioning due to trauma, and those with altered physical, chemical, or biological entity” that causes harm. immunity also become more vulnerable to poor health The EPA also provides information on risk assessment for outcomes. Additionally those born with congenital such hazards. anomalies and with variations in cognitive and physical abilities may be at more risk from specific toxic Some common factors that affect the risk of harmful exposures. health events cannot be changed. Such factors include age, gender, race or ethnicity. Other factors that affect the risk Behavioral factors such as developmental age appropriate of harmful health events can be changed. These factors behavior, activities, hobbies and occupational exposures all result from biophysical, environmental, psychosocial and raise vulnerability. Social factors such as where a person sociopolitical circumstances (Leffers et al, 2004). When lives, works or spends a great deal of time can also make environmental threats to health are examined, all humans him or her more vulnerable. are at risk in relation to global climate change and the The following discussion will address biophysical, increasing use of untested and toxic chemicals. behavioral and social factors that increase vulnerability. Vulnerability can be defined as “a varying state of For each of the areas, the topic will be addressed across weakness or strength that can be mobilized when one the lifespan from fetal development through the older encounters a threatening event” (Leffers et al, 2004, pg adult population. 19). This definition includes individual and experiential Page 24 Alliance of Nurses for Healthy Environments Unit II: Harmful Environmental Exposures and Vulnerable Populations EMBRYONIC AND FETAL DEVELOPMENT Many adverse health outcomes for the developing fetus Biophysical Factors are referred to as birth defects. Genetic factors as well as environmental exposures interact in ways to create Healthy fetal development requires precise timing and problems with organ structure or function. While feedback for cells to divide and mature properly for scientists agree that environmental exposures are not well necessary cell replication and differentiation. For this to understood, those exposures that are known require occur there is an interaction between genetic and more action and those that are not known require more environmental factors (Schettler, Solomon, Valenti and research (“Environmental Factors in Birth”, 2009). Huddle, 1999; Brent, Tanski & Weitzman, 2004). For the Reported adverse health outcomes from environmental developing fetus the risks are acquired through exposures health threats such as toxic chemicals include low birth across the placenta from the pregnant mother. In fact, any weight infants, congenital anomalies, pregnancy loss from exposure to the fetus from the mother is considered miscarriage, and neurodevelopmental problems (See environmental (“Environmental Factors in Birth”, 2009). Table1). (Swanson, Entriner, Buss, & Wadhwa, 2009; Kim & So, while the only exposure pathway for fetal toxic Cizmadia, 2010) exposures is placental, the fetus is particularly sensitive to the broad range of all environmental toxins that the mother is exposed to before and during her pregnancy. Table 1: Commonly Identified Chemical Exposures and As will be discussed later, the pregnant mother’s exposure Birth Defects risk varies throughout pregnancy due to the variations in Exposure Birth Defect or Low maternal physiology during pregnancy. Toxins may affect Birth Weight both the structural development and biochemical function of cells in fetal organ systems. Fetal sensitivity to toxins Arsenic Cardiac Defects occurs as a result of the flexibility of the cell and the capacity for changes during embryonic development. For Bisphenol A Reproductive system each specific exposure, many things interact to create the anomalies risk and health outcomes. The magnitude of the exposure, Dioxin Neural Tube Defects the dose of the toxin, the embryonic stage, and Neurobehavioral Problems metabolism of the mother and embryo all interact to vary Hypospadias the risk and the outcomes. The embryo is particularly Oral Clefts sensitive to structural damage due to these mechanisms. Additionally, the blood brain barrier is not fully developed Lead Cardiac Defects in the embryo allowing neurotoxins greater access to the Neural Tube Defects fetus (Schettler et al, 1999). Often the woman is unaware Neurobehavioral

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