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The other carcinogen of concern, with regulations being set by the EPA, comes from the release of asbestos with asbestos removal activities. Not only is asbestos sometimes removed from inside homes, but the tearing off of old roofing material, which is known to contain asbestos in many cases, also puts those nearby at risk and can lead to fines from the EPA if removal is not done properly. The cancers of concern with airborne asbestos include lung cancer and mesothelioma.[7]
Inventory lists of major pollutants.
The EPA documents and publishes inventory lists of major pollutants introduced by industrial sites. This includes a wide range of organic compounds, such as benzene, a cause of leukemia, and other hematologically related diseases, as well as other toxic materials. Major polluters must keep track of their emissions, and these data are collected and then published by the EPA.
Health professionals can support organizations, such as the American Lung Association and the American Thoracic Society, as they endeavor to reduce air pollution. These groups provide written materials for the education of health professionals and the lay public. By further probing patients complaining of respiratory problems and taking an environmental health history, healthcare professionals will gain a better understanding of the source of the problem.
Indoor Air Pollutants
In contrast to the EPA's regulatory activity of outdoor air pollutants, there is little in the way of regulation of indoor pollutants.[8] Even in the case of radon, only guidelines for action are available. One of the only regulatory activities with regard to indoor air quality comes from the rules of the Occupational Safety and Health Administration (OSHA). OSHA requires employers to provide a safe, healthy workplace, but sets no specific limits for indoor pollutants with only a few exceptions, such as CO and CO2 levels. The only other regulatory activity is related to state or local regulations that restrict or do not allow environmental tobacco smoke (ETS).[9] California has the strictest regulations in regard to ETS, and some communities in that state have even gone so far as to try to restrict smoking in one's own apartment when a common ventilation system is shared by several apartment units.
Asthma
As noted above, asthma is more prevalent in communities of color and poorer communities. Children with asthma react to ETS, dust mites, mold arising from dampness in housing units, and the presence of pets in a household. Efforts to do each of the following have been associated with fewer asthma attacks[10,11]:
Educating families about such hazards;
Providing bed coverings and cleaning supplies; and
Fixing leaky plumbing.
It is important to remember that it's not only children who suffer, but parents also experience the consequences, eg, losing workdays -- often uncompensated -- when they must take care of their child and his or her asthma attack.
Another aspect of this problem is control of asthma among children in these populations. Asthma is often not managed as well as it should be in these cases due to lack of education, access to healthcare, and access to drug regimens that prevent recurring attacks.
Children who are taught to monitor their own lung function and are given medications for both chronic and acute use are better able to manage their asthma. Excellent documentation now shows that in communities with special programs to educate families and provide regular medication to children, the number of asthma deaths and visits to emergency departments can be greatly diminished.[12] By working with local hospitals, pediatricians, and community clinics, efforts can be made to further implement programs to reduce childhood asthma. Such programs are often run out of community hospitals or academic health centers.
Among adults, another area of concern is the buildup of potentially harmful materials in indoor air. With the advent in the 1970s of much better insulation of buildings, coupled with far fewer air exchanges per hour, so-called "tight building" or "sick building" syndrome can occur. This is especially prevalent in new or renovated construction when there is off-gassing of potentially harmful materials from carpeting, furniture made from pressed boards with glues, and other products that enter the indoor air and build up over time.[8] Airing out of facilities after construction or renovation can help, as can ensuring sufficient fresh air exchanges each hour.
Conclusion
Health effects of air pollutants need to be better understood and controlled. Future concerns should include an increased focus on the growing use of nanoparticles of many types for many purposes because these, too, may carry significant health risks, and we are only at the beginning of their use.
As outlined, justice-related issues may come into play when communities of color and poorer communities are disproportionately exposed to environmental pollutants. Health professionals should consider the cumulative exposures of their patients that come from work, personal habits, and living locations. Patients with recognized social vulnerabilities need to be appreciated and efforts made to assist individuals in such communities to coalesce around positive changes that could be made in regard to exposures. Interaction with policy makers who often control what occurs in such communities can be helpful. Lastly, healthcare providers should remember their own role in the improvement of the collective health of communities, not just the care and well-being of their own individual patients.
Resource
For more information from the American College of Preventive Medicine (ACPM) on EJ and the legal rights of patients, check out the free CME/MOC Webcast, "The Right to Breathe: The Medical-Legal Effort to Clean Up Indoor Air," available at www.acpm.org/education/IAQ/index.htm.
References
Medscape Education © 2009
https://www.medscape.org/viewarticle/589135
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