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Abstract
In the health policy literature, scholars and practitioners distinguish broadly between health care and public health interventions. Both types of policies are indispensable to deal with pressing health problems. Nevertheless, we know very little about how individuals support the principle logic behind these two approaches to health policy. In this paper, we analyze empirically whether individuals prefer either a health care-oriented or a public health-oriented approach to health policy. In addition, we explore political and socio-demographic factors explaining individuals' choices. To conduct this analysis, we use multivariate regression analysis based on data ( N = 5 442 ) from the 2018 wave of the Swiss Household Panel Survey. The survey contains high-quality data from a representative sample of the population living in Switzerland. Our results demonstrate that a majority of citizens prefers public health policies rather than policies ensuring access to health care. Especially, individuals with higher out-of-pocket payments in their health insurance plan support a public health over health care policy approach. Furthermore, those who prefer environmental protection over economic growth support public health over health care policy.
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Affiliation(s)
- Philipp Trein
- University of Geneva, Department of Political Science and International Relations, Switzerland
| | - Michel Fuino
- University of Lausanne, Department of Actuarial Science, Switzerland
| | - Joël Wagner
- University of Lausanne, Department of Actuarial Science, Switzerland
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2
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Wang S, Wu CYH, Richardson MB, Zaitchik BF, Gohlke JM. Characterization of heat index experienced by individuals residing in urban and rural settings. J Expo Sci Environ Epidemiol 2021; 31:641-653. [PMID: 33597724 PMCID: PMC8273073 DOI: 10.1038/s41370-021-00303-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
Heatwave warning systems rely on forecasts made for fixed-point weather stations (WS), which do not reflect variation in temperature and humidity experienced by individuals moving through indoor and outdoor locations. We examined whether neighborhood measurement improved the prediction of individually experienced heat index in addition to nearest WS in an urban and rural location. Participants (residents of Birmingham, Alabama [N = 89] and Wilcox County, Alabama [N = 88]) wore thermometers clipped to their shoe for 7 days. Shielded thermometers/hygrometers were placed outdoors within participant's neighborhoods (N = 43). Nearest WS and neighborhood thermometers were matched to participant's home address. Heat index (HI) was estimated from participant thermometer temperature and WS humidity per person-hour (HI[individual]), or WS temperature and humidity, or neighborhood temperature and humidity. We found that neighborhood HI improved the prediction of individually experienced HI in addition to WS HI in the rural location, and neighborhood heat index alone served as a better predictor in the urban location, after accounting for individual-level factors. Overall, a 1 °C increase in HI[neighborhood] was associated with 0.20 °C [95% CI (0.19, 0.21)] increase in HI[individual]. After adjusting for ambient condition differences, we found higher HI[individual] in the rural location, and increased HI[individual] during non-rest time (5 a.m. to midnight) and on weekdays.
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Affiliation(s)
- Suwei Wang
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA
- Translational Biology, Medicine and Health (TBMH), Virginia Tech, Blacksburg, VA, USA
| | - Connor Y H Wu
- Department of Geospatial Informatics, Troy University, Troy, AL, USA
| | - Molly B Richardson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Benjamin F Zaitchik
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Julia M Gohlke
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA.
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3
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Sullivan M, Sellers C, Fredrickson L, Cordner A, Kohl E, Ohayon JL. Re-envisioning EPA and its work in the post-Trump era: perspectives from EPA employees. J Public Health Policy 2021; 42:281-97. [PMID: 33568747 DOI: 10.1057/s41271-021-00276-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 11/21/2022]
Abstract
The Trump administration has severely curtailed the work of the United States Environmental Protection Agency (EPA). The EPA has rolled back environmental protections, lost ground on addressing climate change and environmental justice, and shed large numbers of experienced staff. All of this has accelerated a longer-term decline in EPA resources, expertise, and authority. Here, we present perspectives of EPA employees and retirees on reconfiguring and strengthening the agency to address current and future environmental health problems, based on qualitative data obtained through 100 semi-structured interviews with 76 current and former EPA employees. Interviewees emphasized a number of internal and external issues, including a hyper-partisan context in which the agency operates, lack of public understanding of the extent of domestic and global environmental problems, budget shortfalls, staffing and leadership challenges, reduced scientific capacity and use of science in decision-making, insufficient attention to environmental justice, and lagging technology. We argue that reforms cannot only be expert-driven but must also come from the public, incorporating community driven solutions and focusing on remedying environmental injustice.
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4
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Arroyave WD, Mehta SS, Guha N, Schwingl P, Taylor KW, Glenn B, Radke EG, Vilahur N, Carreón T, Nachman RM, Lunn RM. Challenges and recommendations on the conduct of systematic reviews of observational epidemiologic studies in environmental and occupational health. J Expo Sci Environ Epidemiol 2021; 31:21-30. [PMID: 32415298 PMCID: PMC7666644 DOI: 10.1038/s41370-020-0228-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 05/05/2023]
Abstract
Systematic reviews are powerful tools for drawing causal inference for evidence-based decision-making. Published systematic reviews and meta-analyses of environmental and occupational epidemiology studies have increased dramatically in recent years; however, the quality and utility of published reviews are variable. Most methodologies were adapted from clinical epidemiology and have not been adequately modified to evaluate and integrate evidence from observational epidemiology studies assessing environmental and occupational hazards, especially in evaluating the quality of exposure assessments. Although many reviews conduct a systematic and transparent assessment for the potential for bias, they are often deficient in subsequently integrating across a body of evidence. A cohesive review considers the impact of the direction and magnitude of potential biases on the results, systematically evaluates important scientific issues such as study sensitivity and effect modifiers, identifies how different studies complement each other, and assesses other potential sources of heterogeneity. Given these challenges of conducting informative systematic reviews of observational studies, we provide a series of specific recommendations based on practical examples for cohesive evidence integration to reach an overall conclusion on a body of evidence to better support policy making in public health.
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Affiliation(s)
| | - Suril S Mehta
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Neela Guha
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
| | - Pam Schwingl
- Integrated Laboratory Systems, Morrisville, NC, USA
| | - Kyla W Taylor
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Barbara Glenn
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Elizabeth G Radke
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Nadia Vilahur
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Tania Carreón
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Rebecca M Nachman
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Ruth M Lunn
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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5
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Ezeudu OB, Agunwamba JC, Ezeudu TS, Ugochukwu UC, Ezeasor IC. Natural leaf-type as food packaging material for traditional food in Nigeria: sustainability aspects and theoretical circular economy solutions. Environ Sci Pollut Res Int 2021; 28:8833-8843. [PMID: 33073308 DOI: 10.1007/s11356-020-11268-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/14/2020] [Indexed: 06/11/2023]
Abstract
Global call for healthy and sustainable food production and consumption has been loud, and the majority of these calls center on ensuring food security through sustainable agriculture. The other parts of the food supply chain such as consumption, packaging, recycling, and food waste management seem to be overlooked especially by developing nations of the world where attention is mainly placed on production. But in the broad sense, public health and environmental quality could be adversely impacted by neglect, mismanagement, or loophole on any of these food management systems. Hence, the current work studies the health and environmental impacts of local food packaging materials, adopting Nigeria as a proxy for the developing world. A review was first conducted to appraise the sustainability aspects of achieving and using natural leaves as a packaging material for traditional foods in Nigeria. The result of the review rightly shows that leaf-type packaging material has several apparent health and environmental advantages for food packaging. In view of this, the current work proposes a theoretical circular economy model that would ensure the constant and sustainable availability of these local packaging materials, especially in the urban centers.
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Affiliation(s)
- Obiora B Ezeudu
- Centre for Environmental Management and Control, University of Nigeria, Enugu Campus, Enugu, 410001, Nigeria.
| | - Jonah C Agunwamba
- Centre for Environmental Management and Control, University of Nigeria, Enugu Campus, Enugu, 410001, Nigeria
- Department of Civil Engineering, University of Nigeria, Nsukka, 410001, Nigeria
| | - Tochukwu S Ezeudu
- Institute for Development Studies, University of Nigeria, Enugu Campus, Enugu, 410001, Nigeria
| | - Uzochukwu C Ugochukwu
- Centre for Environmental Management and Control, University of Nigeria, Enugu Campus, Enugu, 410001, Nigeria
| | - Ikenna C Ezeasor
- Centre for Environmental Management and Control, University of Nigeria, Enugu Campus, Enugu, 410001, Nigeria
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Prabhakaran P, Jaganathan S, Walia GK, Wellenius GA, Mandal S, Kumar K, Kloog I, Lane K, Nori-Sarma A, Rosenqvist M, Dahlquist M, Reddy KS, Schwartz J, Prabhakaran D, Ljungman PLS. Building capacity for air pollution epidemiology in India. Environ Epidemiol 2020; 4:e117. [PMID: 33134770 PMCID: PMC7553192 DOI: 10.1097/ee9.0000000000000117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022] Open
Abstract
Air pollution represents a major public health threat in India affecting 19% of the world's population at extreme levels. Despite this, research in India lags behind in large part due to a lack of comprehensive air pollution exposure assessment that can be used in conjunction with health data to investigate health effects. Our vision is to provide a consortium to rapidly expand the evidence base of the multiple effects of ambient air pollution. We intend to leapfrog current limitations of exposure assessment by developing a machine-learned satellite-informed spatiotemporal model to estimate daily levels of ambient fine particulate matter measuring less than 2.5 µm (PM2.5) at a fine spatial scale across all of India. To catalyze health effects research on an unprecedented scale, we will make the output from this model publicly available. In addition, we will also apply these PM2.5 estimates to study the health outcomes of greatest public health importance in India, including cardiovascular diseases, chronic obstructive pulmonary disease, pregnancy (and birth) outcomes, and cognitive development and/or decline. Thus, our efforts will directly generate actionable new evidence on the myriad effects of air pollution on health that can inform policy decisions, while providing a comprehensive and publicly available resource for future studies on both exposure and health effects. In this commentary, we discuss the motivation, rationale, and vision for our consortium and a path forward for reducing the enormous burden of disease from air pollution in India.
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Affiliation(s)
| | | | | | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | | | - Kishore Kumar
- Centre for Chronic Disease Control, New Delhi, India
| | - Itai Kloog
- Ben-Gurion University of the Negev, Beersheba, Israel
| | - Kevin Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Amruta Nori-Sarma
- Center for Environmental Health and Technology, Brown University School of Public Health, Providence, Rhode Island
| | - Marten Rosenqvist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Dahlquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Delhi-NCR, India
- Centre for Chronic Disease Control, New Delhi, India
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
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7
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Kim S, Xiao C, Platt I, Zafari Z, Bellanger M, Muennig P. Health and economic consequences of applying the United States' PM 2.5 automobile emission standards to other nations: a case study of France and Italy. Public Health 2020; 183:81-87. [PMID: 32445933 PMCID: PMC7252081 DOI: 10.1016/j.puhe.2020.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The US has among the world's strictest automobile emission standards, but it is now loosening them. It is unclear where a nation should draw the line between the associated cost burden imposed by regulations and the broader societal benefits associated with having cleaner air. Our study examines the health benefits and cost-effectiveness of introducing stricter vehicle emission standards in France and Italy. STUDY DESIGN Quasi-experimental study. METHODS We used cost-effectiveness modeling to measure the incremental quality-adjusted life years (QALYs) and cost (Euros) of adopting more stringent US vehicle emission standards for PM2.5 in France and Italy. RESULTS Adopting Obama era US vehicle emission standards would likely save money and lives for both the French and Italian populations. In France, adopting US emission standards would save €1000 and increase QALYs by 0.04 per capita. In Italy, the stricter standards would save €3000 and increase QALYs by 0.31. The results remain robust in both the sensitivity analysis and probabilistic Monte Carlo simulation model. CONCLUSIONS Adopting more stringent emission standards in France and Italy would save money and lives.
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Affiliation(s)
- S Kim
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 772 West 168th Street, 10032 New York, New York, United States
| | - C Xiao
- Ecole des Hautes Etudes en Sante Publique, 15 Avenue du Professeur Léon Bernard, 35043, Rennes, France.
| | - I Platt
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 772 West 168th Street, 10032 New York, New York, United States
| | - Z Zafari
- Global Research Analytics for Population Health, Columbia University Mailman School of Public Health, 772 West 168th Street, 10032, New York, New York, United States; School of Pharmacy, University of Maryland, 772 West 168th Street, 10032, New York, New York, United States
| | - M Bellanger
- Ecole des Hautes Etudes en Sante Publique, 15 Avenue du Professeur Léon Bernard, 35043, Rennes, France
| | - P Muennig
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 772 West 168th Street, 10032 New York, New York, United States
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8
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Reis J, Spencer PS. Decision-making under uncertainty in environmental health policy: new approaches. Environ Health Prev Med 2019; 24:57. [PMID: 31521129 PMCID: PMC6745059 DOI: 10.1186/s12199-019-0813-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/27/2019] [Indexed: 01/30/2023] Open
Abstract
Decision-making in environmental health policy is a complex procedure even in well-known conditions. Thus, in the case of uncertainty, decision-making becomes a hurdle race. We address scientific uncertainty, methods to reduce uncertainty, biomedical doubt and science communication, and the role of stakeholders, activists, lobbies and media that together influence policy decisions. We also consider the major responsibility and role of the medico-scientific community in this process. This community can and should teach the principle of scientific uncertainty to all stakeholders, advise policy-makers and underline the ethical issues, considering that our brains are not only the deposit of our humanity but also the route to environmental health and societal harmony.
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Affiliation(s)
- Jacques Reis
- Faculté de Médecine, University of Strasbourg, 4 Rue Kirschleger, 67000, Strasbourg, France. .,Association RISE, 3 rue du loir, 67205, Oberhausbergen, France.
| | - Peter S Spencer
- Oregon Institute of Occupational Health Sciences and School of Medicine (Neurology), Oregon Health & Science University, Portland, OR, 97201, USA
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9
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Casteleyn L, Dumez B, Becker K, Kolossa-Gehring M, Den Hond E, Schoeters G, Castaño A, Koch HM, Angerer J, Esteban M, Exley K, Sepai O, Bloemen L, Horvat M, Knudsen LE, Joas A, Joas R, Biot P, Koppen G, Dewolf MC, Katsonouri A, Hadjipanayis A, Cerná M, Krsková A, Schwedler G, Fiddicke U, Nielsen JKS, Jensen JF, Rudnai P, Közepésy S, Mulcahy M, Mannion R, Gutleb AC, Fischer ME, Ligocka D, Jakubowski M, Reis MF, Namorado S, Lupsa IR, Gurzau AE, Halzlova K, Jajcaj M, Mazej D, Tratnik Snoj J, Posada M, López E, Berglund M, Larsson K, Lehmann A, Crettaz P, Aerts D. A pilot study on the feasibility of European harmonized human biomonitoring: Strategies towards a common approach, challenges and opportunities. Environ Res 2015; 141:3-14. [PMID: 25746298 DOI: 10.1016/j.envres.2014.10.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/21/2014] [Accepted: 10/27/2014] [Indexed: 06/04/2023]
Abstract
In 2004 the European Commission and Member States initiated activities towards a harmonized approach for Human Biomonitoring surveys throughout Europe. The main objective was to sustain environmental health policy by building a coherent and sustainable framework and by increasing the comparability of data across countries. A pilot study to test common guidelines for setting up surveys was considered a key step in this process. Through a bottom-up approach that included all stakeholders, a joint study protocol was elaborated. From September 2011 till February 2012, 17 European countries collected data from 1844 mother-child pairs in the frame of DEMOnstration of a study to COordinate and Perform Human Biomonitoring on a European Scale (DEMOCOPHES).(1) Mercury in hair and urinary cadmium and cotinine were selected as biomarkers of exposure covered by sufficient analytical experience. Phthalate metabolites and Bisphenol A in urine were added to take into account increasing public and political awareness for emerging types of contaminants and to test less advanced markers/markers covered by less analytical experience. Extensive efforts towards chemo-analytical comparability were included. The pilot study showed that common approaches can be found in a context of considerable differences with respect to experience and expertize, socio-cultural background, economic situation and national priorities. It also evidenced that comparable Human Biomonitoring results can be obtained in such context. A European network was built, exchanging information, expertize and experiences, and providing training on all aspects of a survey. A key challenge was finding the right balance between a rigid structure allowing maximal comparability and a flexible approach increasing feasibility and capacity building. Next steps in European harmonization in Human Biomonitoring surveys include the establishment of a joint process for prioritization of substances to cover and biomarkers to develop, linking biomonitoring surveys with health examination surveys and with research, and coping with the diverse implementations of EU regulations and international guidelines with respect to ethics and privacy.
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Affiliation(s)
| | | | - K Becker
- Federal Environment Agency (UBA), Germany
| | | | | | | | - A Castaño
- Instituto de Salud Carlos III, Spain
| | - H M Koch
- Ruhr Universität Bochum, Germany
| | | | - M Esteban
- Instituto de Salud Carlos III, Spain
| | - K Exley
- Public Health England, United Kingdom
| | - O Sepai
- Public Health England, United Kingdom
| | - L Bloemen
- Environmental Health Sciences International, The Netherlands
| | - M Horvat
- Jožef Stefan Institute, Slovenia
| | | | | | | | - P Biot
- Federal Public Service Health, Food chain safety and Environment, Belgium
| | | | - M-C Dewolf
- Hainaut Vigilance Sanitaire (HVS) and Hygiene Publique in Hainaut (HPH), Belgium
| | | | | | - M Cerná
- National Institute of Public Health, Czech Republic
| | - A Krsková
- National Institute of Public Health, Czech Republic
| | | | | | | | | | - P Rudnai
- National Institute of Environmental Health, Hungary
| | - S Közepésy
- National Institute of Environmental Health, Hungary
| | | | | | - A C Gutleb
- Centre de Recherche Public - Gabriel Lippmann, Luxembourg
| | | | - D Ligocka
- Nofer Institute of Occupational Medicine, Poland
| | - M Jakubowski
- Nofer Institute of Occupational Medicine, Poland
| | - M F Reis
- Faculdade de Medicina de Lisboa, Portugal
| | - S Namorado
- Faculdade de Medicina de Lisboa, Portugal
| | - I-R Lupsa
- Environmental Health Center, Romania
| | | | - K Halzlova
- Urad Verejneho Zdravotnictva Slovenskej Republiky, Slovakia
| | - M Jajcaj
- Urad Verejneho Zdravotnictva Slovenskej Republiky, Slovakia
| | - D Mazej
- Jožef Stefan Institute, Slovenia
| | | | - M Posada
- Instituto de Salud Carlos III, Spain
| | - E López
- Instituto de Salud Carlos III, Spain
| | - M Berglund
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - K Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Lehmann
- Federal Office of Public Health (FOPH), Switzerland
| | - P Crettaz
- Federal Office of Public Health (FOPH), Switzerland
| | - D Aerts
- Federal Public Service Health, Food chain safety and Environment, Belgium
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10
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Petito Boyce C, Goodman JE, Sax SN, Loftus CT. Providing perspective for interpreting cardiovascular mortality risks associated with ozone exposures. Regul Toxicol Pharmacol 2015; 72:107-16. [PMID: 25817736 DOI: 10.1016/j.yrtph.2015.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 03/13/2015] [Accepted: 03/17/2015] [Indexed: 12/31/2022]
Abstract
When identifying standards for air pollutants based on uncertain evidence, both science and policy judgments play critical roles. Consequently, critical contextual factors are important for understanding the strengths, limitations, and appropriate interpretation of available science, and potential benefits of risk mitigation alternatives. These factors include the relative magnitude and certainty of the risks posed by various factors and the impacts of other risk factors on air pollutant epidemiology study findings. This commentary explores ozone's status as a risk factor for cardiovascular mortality in contrast with decades of strong and consistent evidence for other established risk factors. By comparison, the ozone evidence is less conclusive, more heterogeneous, and subject to substantial uncertainty; ozone's potential effects, if any, are small and challenging to discern. Moreover, the absence of a demonstrated causal relationship calls into question efforts to quantify cardiovascular mortality risks attributed to ozone exposures on a population level and highlights the need to explicitly acknowledge this uncertainty if such calculations are performed. These concerns are relevant for other similar policy contexts - where multiple established risk factors contribute to the health impact of interest; exposure-effect associations are relatively small, weak, and uncertain; and a causal relationship has not been clearly established.
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Affiliation(s)
| | - Julie E Goodman
- Gradient, 20 University Road, Ste 5, Cambridge, MA 02138, USA.
| | - Sonja N Sax
- Gradient, 20 University Road, Ste 5, Cambridge, MA 02138, USA.
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11
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Thompson MR, Burdon A, Boekelheide K. Practice-based evidence informs environmental health policy and regulation: a case study of residential lead-soil contamination in Rhode Island. Sci Total Environ 2014; 468-469:514-522. [PMID: 24055667 PMCID: PMC3858391 DOI: 10.1016/j.scitotenv.2013.07.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 05/28/2023]
Abstract
Prior to 1978, the exteriors of Rhode Island's municipal water towers were painted with lead-containing paint. Over time, this lead-containing paint either flaked-off or was mechanically removed and deposited on adjacent residential properties. Residents challenged inconsistencies across state agencies and federal requirements for collecting and analyzing soil samples. The purpose of this case study was to evaluate the efficacy of Rhode Island Department of Health (RIDOH) soil sampling regulations in determining the extent of lead contamination on residential properties using real world data. Researchers interviewed key government personnel, reviewed written accounts of events and regulations, and extracted and compiled lead data from environmental soil sampling on 31 residential properties adjacent to six municipal water towers. Data were available for 498 core samples. Approximately 26% of the residential properties had lead soil concentrations >1000 mg/kg. Overall, lead concentration was inversely related to distance from the water tower. Analysis indicated that surface samples alone were insufficient to classify a property as "lead safe". Potential for misclassification using RIDOH regulations was 13%. For properties deemed initially "lead free", the total number of samples was too few to analyze. Post-remediation lead-soil concentrations suggest the extent of lead contamination may have been deeper than initially determined. Additional data would improve the ability to draw more meaningful and generalized conclusions. Inconsistencies among regulatory agencies responsible for environmental health obfuscate transparency and erode the public's trust in the regulatory process. Recommendations for improvement include congruency across departmental regulations and specific modifications to lead-soil sampling regulations reflective of lowered CDC reference blood lead value for children 1 to 5 years old (5 μg/dL). While scientific research informed the initial development of these environmental health policies and regulations, practice-based evidence did not support their efficacy in context of real world practice.
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Affiliation(s)
- Marcella Remer Thompson
- Brown University Department of Pathology and Laboratory Medicine, Providence, RI 02912, United States; College of Nursing, University of Rhode Island, Kingston, RI 02881, United States.
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12
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Chen CC, Yamada T, Chiu IM, Liu YK. Evaluation of the waste Tire Resources Recovery Program and environmental health policy in Taiwan. Int J Environ Res Public Health 2009; 6:1075-94. [PMID: 19440434 PMCID: PMC2672379 DOI: 10.3390/ijerph6031075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 03/07/2009] [Indexed: 12/01/2022]
Abstract
This paper examines the effectiveness of Taiwanese environmental health policies, whose aim is to improve environmental quality by reducing tire waste via the Tire Resource Recovery Program. The results confirm that implemented environmental health policies improve the overall health of the population (i.e. a decrease in death caused by bronchitis and other respiratory diseases). Current policy expenditures are far below the optimal level, as it is estimated that a ten percent increase in the subsidy would decrease the number of deaths caused by bronchitis and other respiratory diseases by 0.58% per county/city per year on average.
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Affiliation(s)
- Chia-Ching Chen
- New York Medical College School of Public Health, 95 Grasslands Road, Valhalla, New York 10595, USA
- Author to whom correspondence should be addressed; E-Mail:
; Tel.: +1-914-594-3379; Fax: +1-914-594-3481
| | - Tetsuji Yamada
- Rutgers University, the State University of New Jersey, 311 North Fifth Street, Camden, New Jersey 08102, USA; E-Mails:
(T.Y.);
(I-M.C.)
| | - I-Ming Chiu
- Rutgers University, the State University of New Jersey, 311 North Fifth Street, Camden, New Jersey 08102, USA; E-Mails:
(T.Y.);
(I-M.C.)
| | - Yi-Kuen Liu
- Environmental Protection Administration (EPA) of Taiwan, No.83, Sec. 1, Jhonghua Rd., Jhongjheng District, Taipei City 100, Taiwan; E-Mail:
- Department of Public Health College of Medicine, Fu-Jen Catholic University, No.510, Jhongjheng Rd., Sinjhuang City, Taipei County 24205
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