10 October 2010

Developmental milestones in children's environmental health

Interesting editorial in the latest issue of Environmental Health Perspectives. Below are the extracts that I liked that has relevance for HIA [emphasis added and phrases in square brackets]:

"...In the early 1900s, the environment was already well understood to  be an important contributor to health, and its importance was routinely taught to [medical and nursing] students. Think of Florence Nightingale’s 6 Ds of disease: dirt, drink (clean drinking water), diet, damp, drafts, and drains  (proper drainage and sewage systems). With the advent of high-tech  medicine, however, these fundamentals began to receive short shrift in  graduate education. At the same time, the house call - a home visit that  allowed the physician to view the environment in which the patient  lived - became increasingly rare, and doctors’ visits began to take place  in the confines of modern offices or hospitals, far removed from the  day-to-day surroundings of the family. Over time, the environment  became “invisible” to the medical practitioner.
...Why has it been so difficult to move from knowing to doing?  First, many of the decisions affecting children are made not by those  in the health sector, but by our professional colleagues in the agriculture, education, energy, housing, mining, and transportation sectors. Just as “men are from Mars and women are from Venus,” it seems  as if professionals in each of these sectors are from different planets.  Although we may speak the same language, we rarely have more  than a cursory understanding of the forces that shape one another’s decisions and other considerations...

Professionals in the health sciences may  work alongside professionals in other sectors, but we are absorbed in our own activities and usually have little interaction outside them. Instead of sitting at the table with urban planners, housing specialists, and energy experts when health professionals are planning an approach to a child health problem such as asthma, we usually move forward to design a study, implement it, analyze the results, and then present it as a fait accompli to our colleagues in other economic sectors, and hope that they will find it useful.

...This is not the ideal way to engage them. We medical professionals  need to fully engage with other sectors as we launch our attempts to  find solutions to child health problems. Major breakthroughs are likely  to occur in protecting children from hazards in the environment only  when we establish strong working relationships with those who haven’t  been trained as we have and who don’t think as we do. One tool that  helps different sectors to interact is Health Impact Assessment, pro- moted by the WHO (2010b) and by many countries including the  United States. Health Impact Assessment helps decision makers make  choices about alternatives and improvements to prevent disease/injury  and to actively promote health. A recent White House Task Force on  Childhood Obesity report recommends that communities consider  integrating Health Impact Assessment into local decision-making  processes before undertaking any major new development or planning  initiative (White House Task Force on Childhood Obesity 2010."

Click here to go to the October 2010 Table of Contents.

Click here to download the article as a PDF.

Image Source: Salim Vohra

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