Chapter 7 Environmental and health service pollution
Chapter 8 Environmental pollution - data, surveillance and health impacts Chapter 9 Measurement and communication of health risks from pollution The last section of my report covers three areas where we have addressed, and need to do more to address, the health impacts of pollution. The three areas might not appear to be direct responses to pollution but are important and share a number of facets: these areas are a) not specific to any one pollutant, b) collaborative, and c) strive to ‘join up’ our response. These are not a series of interventions and solutions, examples of which are given through the whole report. Nor are these exhaustive, answering all threats to all pollution. Good work in these and other areas will make lasting and fundamental changes to our health in England.
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Chapter 7 Environmental and health service pollution
Chapter 7 explores how those working across environmental health are faced with the health consequences of pollution on a daily basis. Specialists in environmental health, and all allied practitioners working to curb pollution, are a vital resource to improve the public’s health and prevent chronic disease.
The environmental health workload can often be at the acute end of the response to the health impacts of major pollutants. As well as working to control the immediate acute health impact of pollution, the chapter describes how environmental health professionals engage in proactive and preventive work. They can use their
considerable expertise in the planning processes, for housing, transport and more, to create an environment where it is easy for the public not to pollute nor be affected by pollution. Practically, the skills and responsibilities to do this locally now lie in one place – local authorities.
Polluters often do the minimum to reduce their health impact, often just meeting legal requirements. The chapter explores the need to forge an environment where
individuals, institutions and public bodies find it easy not to pollute – where making the no/low pollution choice is the norm, and where pollution levels are reduced as far as possible to improve health. It describes how this will require the provision of information to aid decisions, real leadership and structural changes to make the ‘right’ choice easier.
Many pollutants are continually produced as we live our daily lives. Other pollution events are sporadic and short lived. Fire reduction represents a great success, although there is more work to do. Fires produce acute, high concentrations of poor air quality. Reductions in fires associated with the waste disposal sector (where risk has increased with recycling) represent an excellent example of the multi-agency, multi-sector working that is needed to prevent pollution and prevent ill health.
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Chapter 8 Environmental pollution - data, surveillance and health impacts This chapter discusses the difficulty of studying and monitoring the health impact of pollution.
There is a proliferation of data, across pollution exposures and health outcomes, ‘Joined-up data’ increases size and richness of datasets, and can add a longitudinal component – all of which increases the ‘power’ of these data to answer question about the health impacts of pollution. Achieving this needs close collaboration and partnership between many institutions, the health sector, national and local
government, academic and others. Data not only need integrating but also needs to be published, whilst ensuring that appropriate governance procedures remain. Access, particularly to routine monitoring data, must be fast enough to respond to emerging health threats from pollutants.
The UK is well placed to remain a world leader in understanding pollution;
methodological advances could allow us to capitalise on existing datasets to improve our knowledge.
Biomonitoring has great potential to transform how we gather knowledge on the health impacts of pollutants. Using biomarkers means we can overcome difficulties in relating environmental pollutant concentrations to the exposure faced by individuals: they can give us an exact, person specific measure. When combined with health outcomes we can improve estimates of risk from pollutants and strengthen causal inferences to ill health. Internationally, biomonitoring data sets have provided valuable insights, and the chapter describes how an annual biomonitoring dataset would help us examine current and future pollutant threats, protecting the public’s health and monitor our actions.
In England we have an excellent and comprehensive set of surveillance systems for most infectious diseases. NCDs, however, do not yet receive the same attention in terms of surveillance. Environmental public health tracking, a set of techniques to carry out surveillance of the NCDs caused by pollutants, could fill this gap.
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Chapter 9 Measurement and communication of health risks from pollution This chapter expands on the difficulties in measuring the health risks from pollution, and the challenge of communicating risk levels.
It is important to remember the context in which pollution sits when considering its health impact. Most pollution arises out of an activity that someone chooses to do: therefore there is always some inertia to maintain the status quo. Practically, this means we must be confident (not necessarily precise) about the health impact of a pollutant. We must then communicate this in an impactful way in order to elicit changes (a necessary – not sufficient requirement).
One question, across pollutants, is understudied; what is the balance in harm
between short term exposure to high level and long term exposure to lower levels of pollutants? This has an obvious implication for measuring the total burden of
pollutants, but also has implications for the policy response. The fastest way to address one type of exposure may not address the other. This chapter discusses the advantages collaboration across disciplines provides when trying to establish
causation, and trying to synthesise results.
There is an existing body of evidence – often not from the world of pollution itself – to draw on upon when communicating risk. Valuable insights can be provided. For example, risk perception theory shows us the value of the emotive communication, and behaviour change theory highlights the importance of self-efficacyix in making changes.
The chapter describes other facets of successful risk presentation and
communication. It explores openly stating both confidence in, and precision of, best risk estimates as a way to overcome the uncertainty we have around risks of
pollutants, without compromising action. This openness and using emotive messages are two lessons for pollution risk communication.
Bandura described ‘self-efficacy’ as a personal judgement of "how well one can execute courses of action required to deal with prospective situations.” Bandura, A. (1982). American Psychologist, 37(2), 122-147
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