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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]:
o Educating families about such hazards;
o Providing bed coverings and cleaning supplies; and
o 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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