Presentation Transcript

1. Bridging Health Care Practice with Environmental Health Advocacy

   Leadership in Human and Environmental Health Karen Bowman, MN, RN, COHN-S WSNA Environmental Health Specialist
2. Pollution During Fetal Development Every person born in the world today is exposed to persistent bioaccumulating toxins. 1 U.S. industries manufacture and import approximately 86,000 chemicals, 3,000 of them at over a million pounds per year.
3. Chemical Policy Reform and the Toxic Substance Control Act (TSCA) 1976 Regulates the introduction of new or already existing chemicals (PBTs) It grandfathered most existing chemicals
4. Hazard CommunicationsOSHA 1910.1200/WAC 296-800-170 Right to Know OSHA has estimated that more than 32 million workers are exposed to 650,000 hazardous chemical products in more than 3 million American workplaces. This poses a serious problem for exposed workers and their employers. http://www.lni.wa.gov/Safety/Topics/AtoZ/Hazcom/default.asp
5. Pharmaceuticals All Other Chemicals Sattler, Barbara
6. Representing over 3 million nurses Representing over 75,000 strong
7. WSNA Environmental Health Action Plan Inform the organization/constituents and community about environmental health issues Chemical Policy Reform and Persistent bioaccumulating toxins (PBT) Form strategic alliance with local env. health advocacy groups Develop a step-system approach for nurses to engage in env health issues at their own level Model leadership in political activism; grassroots activism, lobbying etc Goal: Support environmental health policy
8. The Toxic-Free Legacy Coalition and more than 50 other organizations in Washington State working together to eliminate persistent toxic chemicals
9. Human & Environmental Health “Conditions that ensure that all living things have the best opportunity to reach and maintain their full genetic potential.” S. Gilbert (1999)
10. What are Persistent Bioaccumulating Toxins (PBT) PERSISTENT- stay around in the environment, wildlife, and in people’s bodies for long periods of time BIOACCUMULATIVE- build up in the food chain, increase in concentration as they move up the food chain TOXIC-extremely toxic in small amounts, causing health problems such as birth defects and diseases such as cancer s.diver, inharmsway 110503
11. Persistent Toxic Pollution Cycle s.diver, inharmsway 110503
12. Contamination and Recontamination of Our Waterways Duwamish River Superfund Site Cleanup completed in 2004 Phthalate recontamination detected in 2005 from stormwater runoff Commencement Bay $103 million Superfund Cleanup Phthalate recontamination ongoing
13. Water and Health PCBs & PBDEs in Puget Sound Wildlife Puget Sound Chinook - higher PCB & PBDE levels than other West Coast salmon Puget Sound harbor seals - higher PCB levels than Georgia Basin seals levels of PBDEs doubling every 4 yrs Southern resident Orcas have 3x more PCBs and 4x more PBDEs than Northern residents.
14. What’s Going Wrong in Washington State? Washington state - highest rates of breast cancer Washington state has one of the highest rates of multiple sclerosis (MS) in the nation. (http://www.swedish.org/110345.cfm) Childhood brain cancer on the rise 17% of school-aged children have learning disabilities from “Economic Costs of Diseases and Disabilities Attributable to Environmental Contaminants in Washington State” July 2005 by Kate Davies, Antioch University http://washington.chenw.org/RIgroup/
15. Costs of Environmental Diseases from “Economic Costs of Diseases and Disabilities Attributable to Environmental Contaminants in Washington State” July 2005 by Kate Davies, Antioch University http://washington.chenw.org/RIgroup/
16. Costs of Environmental Diseases Conclusions from the WA state economic study… $1.9 billion = annual cost of these 5 childhood diseases attributable to environmental contaminants If adult and childhood costs are combined,total = $2.7 billion annually This accounts for almost 5% of total health expenditures in Washington state in 2004 dollars, see Kate Davies’ study online at http://washington.chenw.org/RIgroup/
17. Cause for Concern…Is this a Sustainable Future We’re exposed to many toxic chemicals every day, at or near harmful levels Special concern for toxic exposures during fetal & infant development Rising incidence of environmentally linked diseases PBTs from consumer products and industrial processes build up in our environment and food web, exposing generations to come
18. Phthalates~ the everywhere chemical
19. Phthalates and PVC Polyvinyl Chloride (PVC) Dioxin Di-ethylhexyl phthalate (DEHP)
20. Polyvinylchloride (PVC) Vinyl chloride polymer; VC made from chlorine and ethylene Many applications (building material, furnishings, multiple products) Produced with fillers, stabilizers, pigments, plasticizers, lubricants, flame retardants Stabilizers – lead, cadmium, organotins Plasticizers – phthalates; di-ethylhexyl phthalate (DEHP) used in medical devices
21. PVC - Disadvantages Cradle to Grave Problems dioxin/furans during production and incineration leaching of plasticizers, stabilizers (often metals) in landfills difficult to recycle Potential impacts on direct patient health and safety – leaching of DEHP
22. Dioxin Persistent Environment – up to decades Humans – half-life 7 years Bioaccumulative Toxic carcinogen, reproductive toxicant, endocrine disruptor
23. Di-ethylhexyl phthalate (DEHP) Phthalate Plasticizer 2 million tons/year Ubiquitous exposure General Uses Building materials Clothing Packaging Medical Devices Medications
24. Di-ethylhexyl phthalate (DEHP) in Medical Devices Makes PVC flexible 20% - 40 % by weight Leaches from medical devices – not bound to the plastic Leaching increased by lipid-like content of fluids, temperature, agitation, storage time
25. Sources of Medical Exposure to DEHP Intravenous fluids, medications Blood transfusions Extra corporeal membrane oxygenation Dialysis Surgery, e.g. cardiopulmonary bypass Hyper-alimentation Gloves Gastric feeding, NG tubing Artificial ventilation
26. Public Health Notification (2002) “PVC devices that do not contain DEHP can be substituted, or devices made of other materials … can be used, if available.” FDA recommends alternatives when “high-risk procedures are to be performed on male neonates, pregnant women who are carrying male fetuses, and peripubertal males.”
27. National Toxicology Program of the US Department of Health 2000 In animal studies DEHP had various adverse effects Developing male reproductive system and production of normal sperm Interferes with testosterone synthesis Animal studies are relevant to humans
28. What are the Possible Health Effects of Phthalates? Reduced testosterone production and anogenital distance Hypospadias Malformed or absent epididymis Decreased sperm count Haden, Megan(2006) Phthalates
29. Highest Risk of Excessive Exposure to DEHP (may exceed the FDA’s TI) Exchange transfusion in neonates ECMO in neonates Total parenteral nutrition (TPN) in neonates (with lipids in PVC bag) Enteral nutrition in neonates and adults Aggregate dose in patients receiving a heart transplant or undergoing coronary artery bypass graft surgery. Massive infusion of blood into trauma patient Transfusion in adults undergoing ECMO Cumulative exposures from multiple procedures
30. New Research on Priming Solutions, PVC and implications for ECMO (2009) Evaluate the effects of both short and long-term storage and priming fluid type on plasticizer migration from 4 commonly used PVC tubes in ECMO therapy circuits. two DEHP one tri(2-ethylhexyl) trimellitate (TOTM), one dioctyl adipate (DOA) Leaching DEHP was higher than TOTM and DOA over both the short and long-term exposure levels. Conclusion: Leaching was greatly affected by both the priming fluid, tubing type and time. J Extra Corpor Technol. 2009 Dec;41(4):199-205.
31. Phthalates - DEHP Exposure Schreder, Erika (2006). Pollution in people: A study of toxic chemicals in washingtonians

32. Bisphenol A: Exposures and Effects

33. Bisphenol A—exposures Widespread in general population 93% of representative study population have detectable levels of BPA in urine (NHANES, included no children less than 6 yrs old) National Health and Nutrition Examination Survey Levels higher in children than adults Schettler, T. (2009) HB 1180_WA_BPA_Hearing_Environmental Health Committee
34. BPA in blood and breast milk NTP-CERHR, 2008 Schettler, T. (2009) HB 1180_WA_BPA_Hearing_Environmental Health Committee
35. Bisphenol A metabolism Bisphenol A absorbed from intestinal tract As BPA circulates through the liver, it is ultimately rendered inactive by a process called glucuronidation, which also facilitates excretion Fetus and infant have undeveloped glucuronidation capacity (months before fully developed) Schettler, T. (2009) HB 1180_WA_BPA_Hearing_Environmental Health Committee
36. Health questions about BPA: animal and human studies Impaired brain development Hyperactivity Chromosome abnormalities Prostate, breast cancer Onset of puberty Long-term memory formation Dementia Obesity and diabetes
37. Bisphenol A—toxicity Estrogenic activity through classic estrogen receptor has been known for many years We now know that BPA can also act through other receptors and other mechanisms Therefore, beware when you hear that BPA is only a “weak” estrogenic chemical Concentrate here only on low dose effects Schettler, T. (2009) HB 1180_WA_BPA_Hearing_Environmental Health Committee
38. Bisphenol A—brain Many rodent studies show that early life exposures to BPA alter behavior Decreased response to novelty A significant sex difference in behavior is decreased or eliminated by BPA exposure (Palanza; Environ Res, 2008) New studies in young monkeys show that BPA exposure interferes with development of normal nerve connections in the hippocampus, important for learning and memory (Leranth, PNAS, 2008) Schettler, T. (2009) HB 1180_WA_BPA_Hearing_Environmental Health Committee
39. BPA—breast cancer Mice—peri-natal exposure to environmentally relevant doses of BPA permanently changes the architecture of the mammary glands Female offspring have increased numbers of terminal end buds in mammary glands and intraductal hyperplasia ( a risk factor for breast cancer in humans) Vandenberg et al; Repro Toxicol; 2008 Munoz-de-Toro; Endocrinology; 2005
40. BPA—prostate cancer Mice—prenatal exposure to environmentally relevant doses of BPA causes proliferation of ducts and prostatic intraepithelial neoplasia in male offspring (pre-cancerous lesion) Rats—perinatal exposure to BPA increases precancerous lesions and susceptibility to hormonally related adult prostate cancer (Prins, 2008) Schettler, T. (2009) HB 1180_WA_BPA_Hearing_Environmental Health Committee
41. Bisphenol A—diabetes Bisphenol A causes insulin resistance in mice (Alonso-Magdalena; EHP, 2006; Ropero, Intl J Androl, 2008) Higher BPA concentrations were associated with higher likelihood of having diabetes (OR per 1-SD increase in BPA concentration, 1.39) NHANES ; representative population (Lang et al.; JAMA; 2008)
42. Bisphenol A—heart disease, human Higher urinary BPA concentrations were associated with higher likelihood of cardiovascular diagnoses NHANES; representative population (Lang, et al.; JAMA; 2008)
43. CERHR—Natl Toxicology Program The NTP has some concern for effects on the brain, behavior, and prostate gland in fetuses, infants, and children at current human exposures to bisphenol A. CERHR, Center for the Evaluation of Risks to Human Reproduction NTP-CERHR, 2008

44. Calling Health Care to Action: Becoming Involved in Improving the Health Care Environment

    A Template for change
45. Removing the Barriers-Identifying the Facilitators It’s all about mentoring and support Learning the science and key issues Sharing ideas, knowledge and passions Bridging health care professionals with environmental health advocacy organizations Engaging in health policy Informing legislator Environmental Health Lobby Day WSNA Lobby Day Join WPSR, WSNA or other env. orgs
46. Health Care Industry:Leading the Way in Chemical Reform Creating a “Will for Change” Leveraging out Health care industry to sway the entire chemical production market Empower Downstream Users to Demand Safer Products in Health Care Collaborate with local and national partners Health professionals can support Chemical Policy Reform by working on an institutional level Safer alternatives Green purchasing Transform institution’s vision, values, and organizational objectives that are consistent with a safer chemicals policy practice
47. Nurses and Docs Advocating for Change Advocate for the profession Adopt Safer Products in health care Disaster preparedness and First Receiver Training Increased access and training – PPE (drivers for change) Support TSCA Reform Advocate for change in our communities Deliver the health message related to hazardous chemicals Educate and ask policy makers to adopt safer chemicals legislation
48. Safety & Environmental health Child Safe Products Act PBDE Bill Safe Baby Bottle Act
49. A Child’s Right to Reach Their Full Potential
50. Networking (Resources) Health Care Without Harm, www.hcwh.org Practice Green Health, http://practicegreenhealth.org/ Wash Physicians for Social Responsibility www.wpsr.org Pediatric Tool Kit: http://www.psr.org/resources/pediatric-toolkit.html Going Green’s PVC audit tool, www.noharm.org/goinggreen Sustainable Hospitals Project, www.sustainablehospitals.org Toxic Free Legacy, www.toxicfreelegacy.org Washington State Nurses Association. Wsna.org Washington Toxics Coalition www.watoxics.org Environmental Work Group http://www.ewg.org Toxicology made simple A Small Dose of… http://www.asmalldoseof.org/ Alliance of Nurses for Environmental Health http://e-commons.org/anhe/ Wash State Public Interest Research Group www.washpirg.org Karen Bowman & Assoc., Inc. Karen@Karenbowman.com