Edited by Howard Frumkin

San Francisco:Jossey-Bass, 2005. 1,108 pp. ISBN: 0-7879-7383-1, $75.00

Howard Frumkin has been a leader in expanding the definition of environmental health beyond the effects of toxic chemicals. His eloquence and breadth of understanding are evident in the introductory chapter to this textbook, as well as in his chapter “Nature Contact: a Health Benefit?” The book’s 36 chapters contain highly pertinent insights and information on environmental issues that go beyond the usual boundaries of classic environmental health. Among the many excellent chapters are ones on climate change, ecology, urbanization, environmental justice, developing nations, health care services, energy production, genetics, indoor air pollution, religious issues, clinical services, legal remedies, environmental health policy, and transportation. This breadth makes the book a very useful reference source. Unfortunately, so much of the basics of classic environmental health are omitted or insufficiently presented that the book is not suitable as a textbook for standard undergraduate or graduate environmental health courses.

Core concepts in classic toxicology and in risk assessment related to environmental chemicals receive minimal attention. For example, there is little or nothing on such topics as threshold and nonthreshold dose responses; traditional chemical safety factors; reference doses; weight of evidence for carcinogenicity; and other standard approaches to evaluating personal and community risk from chemicals. The linkage between environmental exposure and dose, including internal dose and dose to target tissue, is only scantily presented. Classic environmental health concepts such as bioavailability, bioaccumulation, and biomagnification are not systematically addressed. The risk assessment chapter focuses almost totally on cancer risk, but without mentioning the International Agency for Research on Cancer or the National Toxicology Program processes for hazard identification of carcinogens. Cumulative risk is briefly touched on in the excellent chapter on environmental justice—but with no mention of aggregate risk. Environmental indicators are discussed only in relation to water pollution, and the exciting new advances in this area are not integrated or referenced; biomonitoring is only briefly mentioned in the discussion of industrial hygiene; and biomarkers only in relation to exposure, but not to effect or susceptibility. These basic concepts, as well as information about the health effects and mechanisms of toxicity of major environmental chemicals, are central to teaching the environmental health sciences to undergraduate and graduate students.

Emblematic of the disconnect between the excellence of a chapter and value as a textbook is the treatment of exposure assessment and of informatics. The superb chapter on industrial hygiene only peripherally addresses environmental exposure assessment, a crucial component of classic environmental health. Omitted are conceptual and technical advances that have contributed heavily to advances in environmental protection. This chapter does contain a brief discussion of dose issues missing from the toxicology chapter, although its example of carbon monoxide is unfortunate in omitting time to equilibrium and CO production through normal metabolism. Similarly, informatics has developed two major areas in environmental health: geographic information systems (GIS) and computational chemical toxicology. GIS receives a full and informative chapter, but the impact of informatics on computational toxicology is barely mentioned.

The coverage of toxicity and health effects is excellently provided for radiation and for pesticides. For each major type of radiation energy, Arthur C. Upton discusses sources, mechanisms of action, acute and chronic effects, assessment of exposure and risk, effects in susceptible populations, and prevention and mitigation. Similarly, an excellent chapter on pesticides describes pests and their impact on human health, classifies pesticides by target and chemical structure, discusses pesticide use and exposures and the regulation of pesticides, and describes integrated pest management. But there is nothing like this for the chemical agents that remain classic areas of concern for environmental health.

Some missing chemicals and concepts are covered in passing in other chapters. Unfortunately, the index is very poorly done. For effective use as a textbook, the index must be a means for the student to pursue specific topics. Yet major items are unaccountably left out. As examples, despite four different references to benzene among the chapters, benzene is not listed in the index; CO is indexed as a criteria air pollutant, but not to the other two chapters in which it is discussed; Frumkin’s introductory discussion of dioxins does not lead to a listing in the index; and the only index listing for lung cancer is to a page that devotes twice the space to leukemia—but leukemia is not indexed.

The authors are to be commended for using a fact-based approach, although there is occasional preaching. Joel A. Tickner, a lucid advocate of the precautionary principle, does not address its track record of being misused for economic advantage, and erroneously asserts that “strong” epidemiologic evidence of risk is needed for preventive approaches based upon risk assessment. We can agree with Barry S. Levy and Victor W. Sidel that public health personnel should advocate action against the evils of landmines without being told that we have a “responsibility” to advocate for a specific treaty.

Among the superb chapters in this book are those by Sarah Kotchian on the practice of environmental public health and by Vincent T. Covello on the communication of environmental health risk. But students not only must learn who should communicate, and how, but also understand the basics about chemicals and their effects. This would be expected in a textbook for a course adhering to the recent core competency project of the Association of Schools of Public Health (http://www.asph.org/UserFiles/FinalVersion2.1.pdf). Perhaps revision for the next edition of this otherwise superb reference work will make it suitable as a textbook for undergraduate and graduate courses in environmental health.

Environmental Health: From Global to Local

The COVID-19 pandemic has introduced a number of added obstacles to safe employment for already-challenged essential workers. Essential workers not employed in the health sector generally include racially diverse, low-wage workers whose jobs require close interaction with the public and/or close proximity to their coworkers, placing them at increased risk of infection. A narrative review facilitated the analyses of health outcome data in these workers and contributing factors to illness related to limited workplace protections and a lack of organizational support. Findings suggest that this already marginalized population may also be at increased risk of "moral injury" due to specific work-related factors, such as limited personal protective equipment (PPE) and the failure of the employer, as the safety and health "duty holder," to protect workers. Evidence suggests that ethical and, in some cases, legally required safety protections benefit not only the individual worker, but an employer's enterprise and the larger community which can retain access to resilient, essential services.

https://www.mdpi.com/1660-4601/18/4/1446/pdf

COVID-19 and Essential Workers: A Narrative Review of Health Outcomes and Moral Injury.

BACKGROUND: Precarious employment is a significant determinant of population health and health inequities and has complex public health consequences both for a given nation and internationally. Precarious employment is conceptualized as a multi-dimensional construct including but not limited to employment insecurity, income inadequacy, and lack of rights and protection in the employment relation, which could affect both informal and formal workers. The purpose of this review is to identify, appraise, and synthesize existing research on the effectiveness of initiatives aiming to or having the potential to eliminate, reduce, or mitigate workers' exposure to precarious employment conditions and its effects on the health and well-being of workers and their families. METHODS: The electronic databases searched (from January 2000 onwards) are Scopus, Web of Science Core Collection, and PubMed, along with three institutional databases as sources of grey literature. We will include any study (e.g. quantitative, qualitative, or mixed-methods design) evaluating the effects of initiatives that aim to or have the potential to address workers' exposure to precarious employment or its effects on the health and well-being of workers and their families, whether or not such initiatives were designed specifically to address precarious employment. The primary outcomes will be changes in (i) the prevalence of precarious employment and workers' exposure to precarious employment and (ii) the health and well-being of precariously employed workers and their families. No secondary outcomes will be included. Given the large body of evidence screened, the initial screening of each study will be done by one reviewer, after implementing several strategies to ensure decision-making consistency across reviewers. The screening of full-text articles, data extraction, and critical appraisal will be done independently by two reviewers. Potential conflicts will be resolved through discussion. Established checklists will be used to assess a study's methodological quality or bias. A narrative synthesis will be employed to describe and summarize the included studies' characteristics and findings and to explore relationships both within and between the included studies. DISCUSSION: We expect that this review's findings will provide stakeholders interested in tackling precarious employment and its harmful health effects with evidence on effectiveness of solutions that have been implemented to inform considerations for adaptation of these to their unique contexts. In addition, the review will increase our understanding of existing research gaps and enable us to make recommendations to address them. Our work aligns with the sustainable development agenda to protect workers, promote decent work and economic growth, eliminate poverty, and reduce inequalities. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020187544 .

/pdf/initiatives-addressing-precarious-employment-and-its-effects-4kt5lncvub.pdf

Initiatives addressing precarious employment and its effects on workers' health and well-being: a protocol for a systematic review.

This study aims to estimate the prevalence of the primary occupational exposures, considered risk factors for Cancer in Brazil. We elaborated two exposure scenarios considering the agents' classifi...

Occupational exposure to carcinogens in Brazil: An approach.

Introduction Understanding motivation, identifying motivational factors of health professionals, and recognizing how managers and leaders can successfully motivate healthcare professionals is a growing concern. Objectives To assess the occupational, sociodemographic, and health factors that influence the occurrence of demotivation in the intensive care unit professionals. Methods We performed a cross-sectional study with health professionals from nine intensive care units in João Pessoa, Paraíba state, Brazil. Data were collected using an adapted version of the Health Care Establishment Questionnaire. We built a Logistic Regression model to analyze the influence of variables on the motivational state, and variables were selected by the Backward method. We used 80% of the sample for parameter estimation and the remaining 20% for testing and validation. We used the R software for the analyses, with a significance level of α ≤ 0.05. Results We identify that the variable with the greatest power over the intensivist’s demotivation was shift work (odds ratio [OR] = 4.215, p = 0.006). The number of symptoms (OR = 1.206, p = 0.000) and working time (OR = 1.080, p = 0.031) were also significant risk variables. When the three variables were combined, the professional’s chance of feeling unmotivated increased by 38 times (OR = 38.99, p = 0.000). Conclusions Based on these results, it is possible to identify aspects that will require organizational adjustments so that intensivists remain satisfied and motivated.

Analysis of the influence of occupational, sociodemographic and health factors on the demotivation of the intensivist

Background Despite being largely preventable, many occupational diseases continue to be highly prevalent and extremely costly. Effective strategies are required to reduce their human, economic, and social impacts. Methods To better understand which approaches are most likely to lead to progress in preventing noise-related hearing loss, occupational contact dermatitis, occupational cancers, and occupational asthma, we undertook a scoping review and consulted with a number of key informants. Results We examined a total of 404 articles and found that various types of interventions are reported to contribute to occupational disease prevention but each has its limitations and each is often insufficient on its own. Our principal findings included: legislation and regulations can be an effective means of primary prevention, but their impact depends on both the nature of the regulations and the degree of enforcement; measures across the hierarchy of controls can reduce the risk of some of these diseases and reduce exposures; monitoring, surveillance, and screening are effective prevention tools and for evaluating the impact of legislative/policy change; the effect of education and training is context-dependent and influenced by the manner of delivery; and, multifaceted interventions are often more effective than ones consisting of a single activity. Conclusions This scoping review identifies occupational disease prevention strategies worthy of further exploration by decisionmakers and stakeholders and of future systematic evaluation by researchers. It also identified important gaps, including a lack of studies of precarious workers and the need for more studies that rigorously evaluate the effectiveness of interventions.

A scoping review to identify strategies that work to prevent four important occupational diseases

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A scoping review to identify strategies that work to prevent four important occupational diseases