PEAK food conditions/ Public Health Response

One of the major themes of this semester has been sustainability. The rate at which we are using resources is just simply not sustainable. Humans are straining resources and that's creating issues and challenges. We need to be using resources that are renewable and that are not depleting our earth's natural resources to extinction.

While it may seem like a stretch, Dr. Robert Lawrence, the director of the Center for a Livable Future at the Johns Hopkins Bloomberg School of Public Health, offers some insight into the nature of peak food conditions and the public health implications. He offers big picture items:

 1) Move away from heavy reliance on fertilizer and pesticides

2) Use science to improve food shelf life

3) Reduce refrigeration and freezing 

4) Increase food system energy efficiency and further reliance on renewables

5) Eat less meat, and eat less processed food and reduce long distance fuel transportation

As individuals, Dr.Lawrence recommends the following: eat less meat and dairy; eat more seasonal, low-processed, local, organic food; reduce the number of trips we take to the store; use less packaging and bring our own bags; and waste less food- 40% of food produced gets wasted. While these changes are probably difficult for the average consumer, public health campaigns can do their part to promote behavior change and maintenance of that change. 

We are on a collision course with food insecurity worldwide. As public health professionals, it should be a priority for us to respond to this emerging crisis. Public health implications would include methods to enable the community to make changes and sustain those changes. Public policies should focus on subsidizing healthier foods and making easy for communities to provide organic food options for its pupils. Additionally, federal dollars should be spent to increase public awareness of ways to improve sustainability of food production. 

Finally, the diagram below gives a visual demonstration the potential impact changing diets from animal based to plant based. 

Material Safety Data Sheet (MSDS)

Material Name: Fluorouracil Injection
Trade Name: Fluoroblastin;Fluroblastin;Adrucil
Chemical Family: Mixture
Intended use: Antineoplastic

Health Risks: The health risks associated with this chemotherapy drug include both long term and short term. In the short term, if this drug is absorbed through the skin or if swallowed it can cause systemic effects. In the long term, repeat-dose studies in animals have shown a potential to cause adverse effects on blood and blood forming organs.

Known clinical effects: GI disturbances such as nausea, dyspepsia, and vomiting and gastrointestinal irritation. Effects on blood forming organs are also noted.

Statement of hazard: May impair fertility. May cause harm to the unborn child. May cause heritable genetic damage.

Exposure Control: The material safety data sheet recommends four different kinds of Personal Protective Equipment or PPE. To protect the hands, disposable gloves (double suggested) are recommended if skin contact with drug product is possible and for bulk processing operations. To protect the eyes, safety glasses or goggles are recommended. To protect the skin, the MSDS recommends wearing impervious disposable protective clothing. Finally, if airborne exposures exceed the occupational exposure band range, respirators are recommended.

Training: I have received extensive training on the proper handling of chemotherapy. I have had the opportunity to work in seven different organizations and each time I have gone through orientation, I have received training about proper safety measures when handling chemo drugs. It is well known that chemo drugs are unsafe for pregnant women so nurses who are pregnant or could be pregnant are not given patients receiving chemo just to be extra cautious.

ToxNet Findings: I did not find any discrepancies between what was reported on the MSDS and ToxNet. ToxNet reported some studies that showed less potential for poor outcomes when exposed. However, I did find an interesting section that was not included on the MSDS. ToxNet included a section on signs and symptoms of exposure to fluoroblastin. Toxicity could lead to short term and long term neurotoxicity. Typically, acute neurotoxicity presents itself as an encephalopathy. The good news is that acute toxicity is generally self-limiting and should resolve. Delayed neurotoxicity is immune mediated and typically responds to treatment with corticosteroids. This is important for clinicians to be aware of potential sign/symptoms of toxicity if a patient receiving this drug presents with neurologic problems.

MSDS Tool: I think this is an adequate tool for helping nurses understand proper techniques to reduce their risk of exposure to chemotherapuetic agents. I think a good quality improvement project for local hospitals would be to analyze and update their MSDS tools to include signs and symptoms of toxicity.

Acts that save lives

Both the Clean Water Act of 1972 and the Safe Drinking Water Act of 1974 are critically important to public health. The Clean Water Act was initially vetoed by President Nixon, but later congress over road his decision. Prior to the passing of this act, only about 1/3 of the nation's water was safe to fish in or drink. Much of the water in United States had been contaminated by phosphorus, nitrogen, and compounds like dioxin. Water treatment facilities only served about eight million in the United States. Water was so polluted that rivers in Ohio would catch fire. The Safe Drinking Water Act was established to protect the quality of drinking water in the U.S and focuses on all the waters actually or potentially designed for drinking use, i.e. above ground or underground sources. Under the act, the EPA established minimum standards to protect tap water and minimum standards for state programs that protect underground sources of drinking water.

The public health impact of these two acts is beyond words, however there are notable holes within the acts that led to later amendments and controversy. One of the biggest accomplishments of the clean water act was that it established the responsibility of water quality at the federal level. Furthermore, the legislation establish a new way of dealing with our nation's water pollution problem by requiring a government permit to discharge pollutants in the first place. Additionally, the act provided generous financial assistance to state and local governments to construct wastewater treatment facilities.

While these acts are forty years old, the work is still not done and we will continue to see the issues of water quality in the near future. Recent findings of health risks associated with fracking and the contamination of Flint's water source continue to demand enforcement of both acts. A comprehensive new look at substantial research demonstrates that fracking inevitably pollutes water and air and harms people. In Flint, Michigan, residents have been dealing with strange colors and smells from their tap water for more than a year. City officials assured the community that everything was OK. In the last few weeks, the city revealed that the water had indeed been contaminated and the children of flint had been found to have increased lead levels in the blood. The plan is to connect Flint's water source back with Detroit's in order to restore and improve the safety and quality of Flint's water.

We know that water is the basis of life. We also know that consuming contaminated water with lead and other chemicals can lead to poor outcomes. In the past forty years, the acts have substantially increased the quality and safety of the United States' water. Today, more than two thirds of water in the U.S. meet EPA standards. Our overall goal should be 100% water quality; however, we have made progress. We must continue to hold companies accountable for water pollution. We must also continue to frequently test our community's water source to ensure its safety and quality. Finally, as public health experts we know anytime you have to weigh money against the health and welfare of people, it always has to be the health and welfare. In the end, these acts have saved countless lives and continue to do so.

Sewage Treatment Facilities

Above is a photo of the Sewage treatment facility for my geographic location, Sacramento, CA. Regional San is responsible for taking the waste out of my drinking water and has been in operation since 1982. In addition to providing standard services by sewage waste treatment facilities such as management of trace metals, organics, bacteria, microbiological and toxicological analysis of water, the lab for regional San also conducts field monitoring. The laboratory collects samples from ground water and monitors the water quality of the Sacramento and American Rivers around Sacramento. At least once a week, workers travel to various parts of the rivers and collect water samples and perform water quality measurements.

Ideal Chemical Policy

I remember sitting in class last Thursday reviewing the Louisville Charter Background papers and being amazed that it is 2015, yet we are still allowing chemicals that could harm us to be used in our everyday hygiene products. My group had very similar ideas on the elements of an ideal chemical policy and those included in the reform measures proposed by the Louisville Charter work group. Below are the elements of what I believe to be an ideal chemical policy.

1. Give the public workers the right to know and participate: I think this is a huge issue. I have a bachelors degree in nursing, yet until taking this course I was very ignorant to my daily exposures to known carcinogens and toxic chemicals. There is a saying, "What you don't know, can't hurt you." I completely disagree. We have been warned time and time again with books such as Silent Spring, Generations at Risk, and Our stolen Future, yet we have not had a change in policy for more than forty years. Furthermore, the idea of a trade secret needs to be addressed. A fragrance can have anything potentially toxic in it and the producer does not have to disclose the ingredients because they have a patent to it. By protecting a company's right to trade secret, the public workers and consumer are not yielded the right to know. Finally, many workers are exposed to known carcinogens on a daily basis and are unaware of the potential hazard. This closely relates to social determinants of health and is a form of social injustice. 
2. Require comprehensive safety data for all chemicals: As of now, it is the burden of the EPA to demonstrate a chemical's safety. This is backwards. We need a chemical policy in the United States that is similar to the REACH model in the UK. It is unethical to be producing personal care products for the masses without demonstrating their safety. We have seen a dramatic increase in the incidence of breast cancer in the United States and many experts in the field believe it has to do with the utilization of chemicals that are estrogen disruptors. 
3. Take immediate action to protect communities and workers: For a long time, Johnson & Johnson, utilized formaldehyde in their baby shampoo. While it is unclear why the company was utilizing the formaldehyde, but it was likely because formaldehyde is an excellent preservative. A group of nurses took action and refused to put the Johnson & Johnson products in the baskets for patients to take home with them until the company removed the known carcinogens form their products. Almost immediately, the company responded by removing the chemicals. While we don't know if formaldehyde will cause cancer in a baby, the real question is why is there a known carcinogen in shampoo? Furthermore, something to consider is that all exposure is cumulative. 
4. Require safer substitutes and solutions: Just as Johnson & Johnson responded rather quickly as they saw their products sales' drastically decline, as consumers we have the ability to put pressure on these other companies to remove harmful chemicals from their products. An ideal chemical policy would require the most safe products available to be utilized. This would tie into the comprehensive safety data and immediate action to protect all consumers. While it may be cost effective for companies to be using toxic, preservative-laden products, it is unethical to continue to expose consumers to these chemicals. 

We should follow the UK lead and develop a program similar to REACH. Burden of proof should not rest of the EPA for demonstrating harmful effects of chemicals. Furthermore, companies should be required to use safe chemicals in their products and take immediate action to remove known carcinogens and harmful substances from personal care products. After all, how sad is it that a human's first exposure to harmful chemicals is now in utero?

Environmental Racism, The Tragedy of Chester, Pennslyvania

In a course I took last Spring, theory of health behavior change, the first class focused completely on social determinants of health. Environmental racism is unfortunately a reality and determinant of health that many races in this country, especially African Americans have to endure. 

One of the most significant examples of this in our history is The Tragedy of Chester, Pennsylvania. Chester, Pennsylvania is predominantly poor and Black (65%) community and home to 42,000 residents. The median family income for Chester is $24,893. Only about one-fourth of residents in Chester have some college education and Chester has a substantial percentage of non-highschool graduates. 

Since the mid 1980's, Chester City has been the home of  four hazardous and municipal waste treatment facilities, including the nation's largest infectious medical waste treatment facility. Unfortunately, those residents live next to one of the largest waste facilities in the country. Furthermore, the facility that burns waste is the seventh largest garbage-burning incinerator in the nation. Sadly, the this facility also burns waste from all over the east coast. 

This exposure to toxic substances and pollution went on for years. The social determinants of living in Chester seriously impacted that quality of life and residents complained of heavy pollution in the air and the side effects of it, i.e. constant headaches, sore throats, skin disorders, and asthma. Property values were also impacted and dropped given the structural damage to homes from trash and waste in community. 

Finally, in 1994, the Environmental Protection Agency (EPA) got involved and after a six month cumulative risk assessment, there was no denying the presence of environmental racism. Through the risk assessment, the EPA identified the following: Chester had the highest percentage of low-weight births in the state, nearly double the rate for the entire county, and a mortality and a lung cancer rate that was 60% higher than the rest of their county. The children of Chester were also tested and were found to have the highest concentration of lead in their bloodstream relative to the children in the rest of the state.  Unfortunately, the EPA ruled that they had no real power to make meaningful change and permits are still be granted to build toxic dump sites. 

 

Consumer Confidence Reports

This was quite the adventure attempting to find my CCR. I even emailed the EPA....then I simply asked my fiance to take a peek and he found the report within 5 minutes. I guess it helps having someone around that has spent the past sixteen years in information security! The good news with finding information this way was I got to include Nathan on my search and discuss with him the implications and risks of having a contaminated water source.

I live in Southeast Sacramento, Rancho Cordova, California. Water is delivered to me in the Cordova System and it is a blend of groundwater, pumped from the Sacramento Valley Groundwater Basin, and surface water treated at Golden State Water Company's Coloma Water Treatment Plant. Groundwater is pumped from the nearby basin through wells. The surface water is delivered from the American River via the Folsom South Canal from Lake Natoma.

According to the report, "Golden State Water strictly adheres to federal and state drinking water quality guidelines required by the United States Environmental Protection Agency (USEPA)," and "they routinely test the water quality for more than 230 regulated and unregulated elements in the water distribution system." I am happy to report that according to the data, there are no detectable levels of any inorganic constituents except nitrate. The level of nitrates found is also well below the maximum contaminant level. The report also states the major source of nitrates is from runoff and leaching from fertilizer use. No volatile organic constituents or radioactive constituents were found either.

Alarmingly, I did find out that lead and copper are present in my water source. They are below the "safe level," however this is very concerning to me. As Dr. Sattler says, "These substances should never be in the human body, at any level." The report suggests that if water has been sitting for several hours, you can reduce your risk of lead exposure by flushing your tap for 30 seconds to two minutes before drinking or cooking. A bit ironic given the state of the drought, eh?

There is some evidence of chloroform bacteria. These are naturally occurring in the environment. I had a microbiology professor tell me once that all water has bacteria in it and that the reason people get diarrhea when they travel is because they are not used to the bacteria in the water. They are essentially used to their bacteria from their water source. I am not overly concerned about this given the above and I do use a filter for my drinking water.

This brings up the interesting topic of bottled water. As discussed in previous posts, I used to drink bottled water all the time. Some of it was out of convenience. Some of it was out of habit and doing what others were doing.  After watching the Story of bottled water and reading my water quality report, I will stick with filtered water and my BPA free plastic reusable water bottle. Now, if I can just get my fiance on board :)