M15.5 Final Post

Closing Thoughts

As the saying goes, knowledge is power. Nothing has been truer for me about the knowledge I have gained from this course. I now have the tools to be an educated consumer and to know what is in the products I purchase. I feel I've had a significant paradigm shift because I had no idea so many of things I previously bought contained toxic chemicals. Moving forward, I plan to change many of my lifestyle habits. I have already made some small changes which include buying organic food, using less plastic, researching items on Skin Deep to ensure my personal care products are nontoxic, and buying with intention. I also feel I have gained the knowledge and resources to better educate my patients about environmental health. Thank you for truly opening my eyes to the importance of sustainable living! 

In terms of the blog, it was nice to have the opportunity to get to know my classmates and converse about new topics. Online classes can be tricky so the blogging allowed us to stay connected. Even though it was difficult at times due to heavy workloads in all of my classes, I definitely learned a lot this semester! Thank you Samuel and Yeana for sharing! It was great learning with you! 

M14.4 Disaster Preparedness

Think About It-Website Exploration

The National Center for Disease Medicine and Public Health (NCDMPH) website had great information and resources related to natural disasters and infectious diseases. I specifically looked at information regarding influenza outbreaks, mass gatherings & explosions, and earthquakes because these are the most likely situations to affect me. While reading through the materials, I learned several things I had not even previously thought of. For example, there are standardized steps to take when an unaccompanied minor is found after a disaster like an earthquake. Another example includes how to talk to a child after a bombing or an explosion. I remember the fear I felt after 9/11 and it was nice to have supportive adults to talk to. With the rise of social media since then, it is more important than ever before to know how to talk to children about traumatic events. Furthermore, I learned there is significant public health planning prior to a mass gathering. Mass gatherings for an event like the Super Bowl can dramatically increase infectious disease transmission and tax local resources. Having a website like the NCDMPH is extremely useful for all healthcare professionals, not just those in public health, in order to learn how to prevent and prepare, as well as mitigate the effects from an event. However, many of the links were broken suggesting the website is not regularly maintained. 

The disaster healthcare volunteer site is a wonderful idea to help connect local personnel during a disaster. Within my county specifically, there is a unit called Medical Volunteers for Disaster Response (MVDR). MVDR has three main objectives: to assist in medical/health emergencies and mass casualties, as well as participate in community outreach to raise awareness. Several modules have inspired me over the course of this semester, but I feel extremely compelled to volunteer as a disaster relief provider after reading through the materials in this module. It seems to be the perfect combination of my professions (nursing and public health). One easy way to start this journey could be to volunteer via this website. I'd also be interested in further trainings related to disaster response. Notably, hospitals should also use this concept as a model so they can easily identify staff who live close and would be willing to work extra shifts during times of disaster. This is another way we can prepare as healthcare professionals. 

References

https://ncdmph.usuhs.edu/KnowledgeLearning/2012-Learning1.htm

http://ncdmph.usuhs.edu/Learn/PedsTR/images/cards/USUHS_TR_card_detailed.pdf

http://www.nctsn.org/sites/default/files/talking_to_children_about_the_bombing.pdf

https://disaster.nlm.nih.gov/enviro/massgatherings.html#a3
https://www.sccgov.org/sites/ems/Pages/mvdr.aspx

M12.9 Climate Change

Reflections on Climate Change

1) What do you personally find most troubling about climate change?

            On a personal level, I am most concerned about the melting ice caps and the subsequent rise in the sea level. According to the BBC movie, Earth Under Water (2010), it is estimated that the sea level will rise between four or five meters each century. Even a rise of three feet will start to cause severe changes to life as we know it. For example, Miami will be flooded by the end of this century if we do not make drastic efforts to reduce our carbon emissions. A rise in ocean level will put significant strain on our Earth’s already maxed out resources. There will be severe financial loss, fresh water sources will be contaminated, food supply will be compromised, land will be lost, and thousands if not millions of people will be displaced as refugees. These severe changes will instill widespread panic and fear among the remaining population.

2) As a public health professional, what do you think needs the greatest attention right now?

           

            As a public health professional, the greatest efforts need to be placed on reducing carbon emissions, lessening greenhouse gases, and subsequently slowing the increase in Earth’s temperature. We can attribute the deleterious effects of climate change to the massive amount of carbon emissions we produce as a society. If we can eliminate our reliance on plastics and fossil fuels, we can make a positive impact by stopping the rise in Earth’s temperatures. However, this will require extreme effort and commitment from the global community. Public health professionals need to advocate for the government to acknowledge global warming as a serious threat and stop allowing conglomerates to dictate US policy. We will be in imminent danger if we do not start allocating resources to solving the problem of climate change.

3) If you were visiting with a long-lost relative who had never heard about climate change, how would you describe it and its attendant human health and ecological threats?

Climate change is a multi-faceted and complex issue that stems from generations of unsustainable practices. In short, climate change is a series of changes in weather patterns secondary to a rapid increase in carbon dioxide and other greenhouse gasses. Many of our everyday practices cause a rise in carbon dioxide. The burning of fossil fuel is one of the largest contributors. Changing weather patterns cause planetary destabilization through severe droughts and heatwaves, more frequent natural disasters, high intensity storms, extreme swings in weather, and a rise in sea level. These events have a significant impact on humans including financial loss; food insecurity; higher rates of water-borne illnesses, food-borne illness, vector-borne illnesses; increased morbidity/mortality; exacerbations of chronic diseases; and an increase in reactive airway disease due to pollution. There will also be millions of people displaced due to extreme natural disasters and flooding, which will exacerbate the spread of disease and shortages of resources. (Sattler, 2017).

References

Remme, T. (Writer & Director). (2010). Earth under water [Television broadcast]. United States: Picture Films, Ltd. for National Geographic Channel. 

Sattler, B. (2017). Climate change: A public health perspective [PowerPoint slides]. Retrieved from https://usfca.instructure.com/courses/1569184/pages/m12-dot-1-personal-account-of-katrina-relief-and-its-implications-for-climate-change-preparedness?module_item_id=16450475

M10.1 Occupational Health

Occupational Health and Safety

As an inpatient nurse, I face chemical, biological, radiological, and ergonomic exposures on an almost daily basis. Some of the more common hazards I encounter include, infectious diseases, chemotherapy, radiation, and strenuous patient handling. Because it is impossible to eliminate or even substitute these sources of harm from the work environment, other methods must be utilized to maintain the health and safety of the hospital’s employees.

• Engineering Controls: negative pressure rooms, hoods, closed system tubing, walls resistant to X-Ray waves, separate chemo disposal bins, sharps containers, adjustable beds, lift assistant devices, and safety needles
• Administrative Controls: mandatory annual online training modules that review health and safety topics, required vaccinations, implementation of policies and procedures, audits, exposure plans, and mandatory lifetime radiation exposure trackers
• Personal Protective Equipment: goggles, face shields, gloves, gowns, booties, chemo gloves, surgical masks, PAPR, and respirators (along with annual fit testing)

In reality, all of these interventions are taking place due to the strict regulations that were established to protect workers in hazardous occupations. Working at a unionized hospital is also advantageous because union representatives fight for the implementation of safe practices to protect their members. The only area I find hospitals lacking in is the Hazard Communication Standard. As stated in the presentation, most companies provide a general out of the box training module that is not tailored to the specific chemicals in each individual unit.

Workers may be fearful to report violations of health and safety regulations for a variety of reasons. Barriers include a fear of retribution, fear of financial loss, fear of job insecurity (getting fired), fear of social isolation, and fear of deportation based on immigration status. Laws, such as the Whistleblower Protection Act, were enacted to help protect employees when reporting such violations. 

M11.5 Zero Waste Life

Reflections on Zero Waste Living

I was beyond impressed with Lauren Singer's motivation to live with intention and her success at producing zero waste. I, like many people, often make the excuse that I do not have enough time to live a zero waste life, but Lauren exemplifies how this is possible while still being a student and a working professional. When reflecting on what I could do better to live a waste free life, I immediately think of my guilty pleasure-- shopping! I love buying shoes, clothes, purses, and accessories. My sense of style and fashionable trends have changed many times over the years. For example, when I moved two years ago, I donated seven garbage bags full of clothes to Goodwill! This shows the extreme excess of items I own. 

I recently read a magazine article about having a capsule closet, meaning you limit yourself to 30 items in your closet. This includes shirts, pants, jackets, and shoes. The purpose of this limited closet is to allow the owner to focus on what is important, live with intention, and learn to take better care of those pieces. Now imagine if you did this with your whole life. I believe you would feel a sense of freedom and as Lauren spoke to, have a greater appreciation for your things. From now on, I plan to shop with intention meaning I will only buy things that I really need and that are exactly what I have been looking for. I will not impulse shop or buy things just because.

In addition, I would really like to learn how to make some of my own personal care products. Through this class I have learned the hidden dangerous chemicals most of these products contain and would like to lessen my exposure to these toxins. When looking at recipes on the blog site, Zero Waste Home by Bea Johnson, I found a recipe for lip/cheek stain. This is a product I currently use and would be interested in trying this all-natural recipe as a replacement. The recipe calls for red beet juice as the color additive. I also found many other creative and fun ideas on both Bea and Lauren's websites. I look forward to trying these and implementing sustainable lifestyle practices in my own home. 

M10.5 Occupational Safety

Cal/OSHA and the Adult Film Industry

In 2004, there were several new cases of HIV among workers in the Southern California adult film industry. This exposed the potentially dangerous hazards of the employees in this industry. Since then, officials have been working with the adult film industry to ensure workers know their rights and employers are compliant with state regulation.

Under the California Health and Safety Act, the adult film industry is required to create a healthy work environment for its employees. Some of these provisions include an injury and illness prevention program, employee training, bloodborne pathogen transmission reduction, sanitation, and electrical safety.

Within the adult film industry, employees are at greatest risk for bloodborne pathogens and other STIs. Prevention methods are closely aligned with those of universal precautions, which treat all bodily fluids as hazardous. Engineering practices were established to protect the employees. Examples include simulation of sexual acts with fake bodily fluid, ejaculation outside of the body, use of barriers (condoms), readily available sharps containers, and plastic sheets for easy set clean-up. Personal protective equipment must also be provided to further protect the employees (condoms, dental dams, gloves, and eye shields). Notably, producers are not required to show these barrier methods or other engineering practices in the final version of the movie. Another prevention measure includes vaccinating all employees who may be exposed to bodily fluids with the Hepatitis B vaccine. 

Additionally, all employers must have a written exposure control plan and policies to prevent disease transmission. If exposure to bodily fluids does occur, employers must provide medical evaluation and any necessary treatment to the exposed individual. Furthermore, if a worker tests positive for a bloodborne pathogen, the employer must notify all exposed contacts. This can be done anonymously.

Lastly, many workers in the adult film industry are categorized as independent contract workers. The provisions of the California Health and Safety Act applies to independent contract workers and full-time employees alike.

Complaints against the adult film industry can also be filed confidentially at 714-558-4300

Reference

https://www.dir.ca.gov/dosh/adultfilmindustry.html

M10.2 MSDS and ToxNet

Chemicals at Work

I chose to research Sani-Cloths because I have high exposure to the chemicals in these wipes and I see many health care staff using the wipes without PPE.  

MSDS

1. What are the health risks associated with this chemical?

According to the MSDS, the HMIS/NFPA rated this chemical product as a level 3, which indicates serious health risk. Potential health risks include irreversible eye damage, harmful effects if absorbed through skin, and moderate irritation with skin contact (drying, cracking, redness, defatting, dermatitis, and edema). 

2. Is the chemical a carcinogen?

Isopropanol is not classified as a human carcinogen. 

3. What personal protective equipment or special precautions should be taken when working with this chemical?

The MSDS instructs users to "wear gear as deemed necessary. Follow label directions." The label instructs users to "wear disposable protective gloves, protective gowns, masks, and eye coverings when handling HIV-1, HBV or HCV infected blood or body fluids." It does not indicate what PPE is needed when you are using a wipe to clean a surface that does not contain one of these microbes. 

4. If this is a chemical found in your workplace, what training/education were you given about any risks associated with this chemical? 

We were trained on proper usage and what microbes are killed by this product. I was instructed to use gloves as a student nurse when touching these wipes. However, I was not informed about the health side effects associated with this chemical. 

ToxNet

Isopropanol is extremely dangerous by ingestion and can be fatal at a dose of 250mL. Other side effects caused by ingestion/inhalation/skin absorption include persistent nausea, vomiting, diarrhea, abdominal pain, hematemesis, generalized muscle tenderness, hypotension, CNS depression, areflexia, decreased respirations, coma, and oliguria. Prolonged skin contact can cause corrosion. 

Reflection

The MSDS does not accurately describe the severe side effects that isopropanol can have. It states that inhalation and ingestion are "not a normal route of exposure." Therefore, it does not elaborate any further on ant associated signs or symptoms. Additionally, it simply states that the chemical can "be harmful if absorbed through skin." However, it does not further explain the side effects associated with this route of exposure. Lastly, it does not clearly identify what PPE is needed when handling the wipes. It assumes the reader is already familiar with the product because it instructs the user to "wear gear as deemed necessary." 

The MSDS was not clearly written for several reasons. First, there was medical/industry jargon used throughout. For example, a lay person most likely would not know what edema or defatting means. As mentioned previously, it also assumes the reader has prior knowledge about proper procedure and protective gear. The MSDS could be revised to make it more user-friendly, especially for non-medical personnel. 

References

http://www.unimedcorp.com/MSDS/sds_Sani-ClothAF3.pdf
https://www.toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~E6Q29F:3

M9.4 Heavy Metals

Lead Exposure

It is shocking to learn that the toxic effects of lead have been known for over a century, yet lead was still commonly used up until 1978 in the United States. The authors hinted that because lead was so effective, regulatory bodies may have overlooked it's detrimental and hazardous side effects. 

Lead can affect populations throughout their lifespan. When fetuses are exposed while in utero, they are at greater risk for stillbirth and neonatal death, as well as neurodevelopmental issues early on in life. Childhood lead poisoning is exhibited by behavioral changes, seizures, encephalopathy, anemia, hyperactivity, learning deficits, etc. More recently, researchers have discovered that even at low levels of exposure, children can have cognitive behavioral problems and social issues. Interestingly, children are more sensitive to the effects of lead and more readily absorb lead through their GI tract than adults do. When adults are exposed (typically through occupational hazards), sequelae include cardiovascular effects, decreased kidney function, infertility in both men and women, and neurological effects. Notably, exposure to lead has also been linked with an increased likelihood of committing a crime and other deviant behavior. Lower crime rates over the last several decades have been associated with decreased environmental lead exposure. Lastly, older adults can have high blood lead levels through bone resorption. Elder adults with high blood levels are found to have higher rates of dementia with decreased executive function, memory, and dexterity. They are also at greater risk for mortality. Lead causes significant societal burden and continued efforts need to be implemented in order to decrease exposure; prevention is key! If exposure goes unchecked, deleterious results can occur. This is exemplified by the case study in Nigeria where over 400 children under the age of five died in one year. 

On a side note, I found it very fascinating that ancient Roman aristocrats used to drink lead-laden wine, which caused psychosis and infertility. In fact, it is thought that high lead exposure contributed to the downfall of the Roman Empire! 

M9.3 Green Chemistry

Green/Sustainable Chemistry

What are your thoughts on green chemistry?

Green chemistry is absolutely essential to the health of the environment. As the movie mentioned, every single molecule of plastic ever produced is still on Earth because it is virtually indestructible. Now it is killing our wildlife and destroying our ecosystems. Scientists and government officials should have had more foresight and recognized this could have been a problem back when plastics were first developed. I guess they always say hindsight is 20/20 for a reason. I'm glad to learn that some scientists are taking an active role to ensure less pollution is produced in the future through the green chemistry movement.

Have you heard of or seen any examples of green chemistry in your work or daily life? 

I have not heard or seen any examples of green chemistry in my daily life-- at least none that I know of. As I have mentioned previously, I work in a hospital and feel I'm exposed to harsh cleaning products/chemicals on a regular basis. However, I learned in one of the movies that Kaiser Permanente has banned triclosan-containing products. I would be interested to learn about what products they are using instead and if any of these products are considered to be apart of the green chemistry movement. 

What are your thoughts on the 12 principles of green chemistry? 

I find the 12 principles to be comprehensive and sensible. It is interesting that we rely on products made from non-renewable resources so heavily in our everyday lives. Examples of these resources include fossil fuel and coal. Therefore, it is important that scientists focus on researching chemicals made from renewable feedstocks or resources (#7). I am also greatly in support of efforts to design chemicals that degrade after use (#10) because we produce an extraordinary amount of waste. This concept is related to principle #1 that calls for a prevention of waste so no chemicals are left to clean up. These principles are important for reasons I discussed above in question #1. For the well being of our planet, I hope that the green chemistry movement becomes better funded and more widespread. The 12 principles of green chemistry will help move us into a healthier future. 

M9.2 Six Chemical Classes

Chemical Summary

1. Highly Fluorinated Chemicals 

• man made chemical that has been in production since 1940
• two most well known chemicals in this class are PFOS and PFOA (C8)
• resistant to breakdown in the environment and in organisms 
• high levels found in the animals even in remote areas
• used on products such as carpeting, upholstery, apparel, food packaging, non-stick cookware, paint, and dental floss to provide oil and water repellency 
• particulate molecules are found in air, dust, and groundwater, which are the main sources of exposure for animals and humans 
• human health effects include cancer, thyroid disease, delayed puberty, early menopause, decreased testosterone, infertility, decreased immune response, and increased cholesterol 
• C4 and C6 may not be safer alternatives (more research is needed)
• it is most likely that highly fluorinated chemicals are not necessary in most applications 

2. Antimicrobials

• specifically looking at the widespread use of triclosan and triclocarban 
• increasing use in everyday products such as personal care products, soaps, deodorant, clothing, toothpaste, cosmetics, kitchen supplies, furniture, toys, sporting equipment, and school supplies
• not bioaccumulative, but humans and animals are exposed at high levels especially through direct contact and water contamination 
• human health effects include endocrine disruption (estrogen-enhancing and testosterone-blocking), thyroid disease, and increased childhood allergies 
• safer alternatives are alcohol based products 
• triclosan and triclocarban are often unnecessary because they are not proven to be any more effective than traditional cleaning products. 
• increased use also potentiates risk for microbial resistance 

3. Flame Retardants 

• class includes PBDEs, brominated and chlorinated-containing chemicals (mostly organhalogens)
• added to products to meet safety standards established in the 1970s
• mostly used in electronics, wires/cables, polyurethane foam, building materials, furniture, and some baby/children products
• when materials that contain flame retardants burn, more toxic soot is released
• flame retardants are semi-volatile meaning they are released into the air which cases particulate matter to settle in dust à increases risk for toddlers d/t hand-to-mouth behaviors 
• human health effects are cancer, immunosuppression, delayed neurodevelopment, endocrine disruption, learning disabilities, ADHD, and infertility 
• no evidence suggests these chemicals improve fire safety 
• regrettable substitutes were put into place without proper safety and efficacy testing (example: firemaster 550 is possibly linked to obesity and anxiety) 

4. Bisphenols and Phthalates 

• these chemicals are dangerous because only a small amount can cause permanent harm due to endocrine disruption
• found in food, soil, air, and water which increases human exposure rates 
• Bisphenols include chemicals like BPA and BPS, which make plastic harder and clearer
• this class of chemicals is used in products like eyeglasses, water bottles, baby bottles, epoxy resins, and thermal paper 
• chemicals leach into products and are directly ingested or are inhaled via dust
• the adverse effects or BPA are numerous: reproductive harm, thyroid disease, immunosuppression, metabolic disorders (obesity, Type I DM), spontaneous abortion, childhood obesity/asthma, and neurodevelopmental issues 
• the alternative BPS may be equally as harmful 

• Phthalates make plastic more flexible and fragrances last longer, which contributes to their widespread use in personal care products, household products, and building materials 
• humans are exposed through many routes: skin absorption, inhalation, and absorption
• prenatal exposure has been linked with incomplete testicular descent, hypospadias, obesity, early breast development, and asthma
• we currently do not have enough data/research to know if the alternatives are safer 
• humans rely heavily on plastics in our everyday lives, so to reduce risk we should use glass whenever possible, avoid receipts, and demand labeling of products 

5. Organic Solvents: 

• purpose and function is to dissolve and disperse materials, act as a carrier, cleaning/stripping agents, and mixers 
• examples include the following:
• hydrocarbon solvents: petroleum distillates and mineral spirits
• chlorinated solvents: paint strippers and dry cleaning chemicals 
• oxygenated solvents: nail polish, nail polish remover, janitorial cleaners, personal care products 
• cyclosiloxanes: dry cleaning chemicals, cosmetics/personal care products, and conditioners 
• humans are exposed through inhalation of volatile vapors as well as through water pollution 
• these chemicals are neurotoxic, nephrotoxic, hepatotoxic, carcinogenic, and cause contact dermatitis/reproductive toxicity 
• the environment is also impacted by these chemicals through ozone and water pollution 
• scientists are currently researching safer alternatives to limit human exposure

6. Some Heavy Metals

• naturally occurring in the environment and never breakdown (meaning they are bioaccumulative in humans)
• interact with oxygen and acid 
• readily conduct heat 
• some metals are beneficial to human health, whereas others are toxic even at low levels 
• toxic metal examples include: lead, arsenic, mercury, chromium, and cadmium
• found in products such as gasoline (prior to late 1970s), paint, treated wood, toys, tattoo inks, beads, blinds, lipsticks, protein drinks, mascara*, fluorescent light bulbs*, and chicken/hog feed* (*these products unintentionally had metals added to them) 
• lead's effect on human health: attaches to RBCs, replaces calcium in bone, neurotoxic, crosses placenta, developmental deficits, kidney failure, etc. 
• arsenic's effect on human health: binds to RBCs, skin lesions, cancer, paresthesia, anemia, vascular disease, etc. 
• to reduce human exposure better recycling of metals should occur and safer alternatives should be used as metals are mostly unnecessary in everyday products 

M8.5 Ideal Chemical Policy

Essential Components of Ideal Chemical Policies

An ideal chemical policy would implement much stricter regulations than what are currently in place. This is necessary to better protect the health of all living beings and the environment. Currently, significant resources are used to create new chemicals every year. Moving forward, these resources should be redirected to make the chemicals currently being used safer. This will help to create a more sustainable way of life.

Specific aspects of the policy should include the following:

• Non-chemical interventions should be tried first before farmers introduce pesticides onto their crops.
• Persistent organic pollutants should be banned across all countries.
• Chemical companies must prove the safety and efficacy of chemicals before they are approved for use. This will require extensive longitudinal testing completed by third party companies to reduce bias.
• Chemicals will no longer be sold freely on the open market. All products will be sold and monitored through verified vendors. This will eliminate inappropriate sale and use of chemicals.
• The EPA will work with chemical manufactures to develop sustainable methods of chemical disposal and clean-up. For example, the AUSAID is an international leader in DDT clean-up within the South Pacific. This portion of the policy is hugely important from a public health perspective. Currently, chemicals that are not properly disposed of can cause asthma, allergies, cancer, decreased fertility, as well as having significant impact on soil quality, water cleanliness, and insect pollinators’ well-being. If the issue of chemical exposure is reduced, adverse health outcomes will be markedly reduced. We have gone on far too long by allowing dangerous chemicals to remain in our ecosystem, thus negatively impacting the cycle of life.
• Monocropping must be outlawed. This will reduce the need for widespread use of chemical pesticides.
• Any farmer who needs to use chemical pesticides must be trained on the adverse effects associated with its use.
• Anyone who sprays pesticides must be given proper personal protective equipment to ensure their safety and the safety of their families.
• The safety and efficacy of previously approved chemicals will be reviewed every decade. Every chemical must be reapproved during this review.
• It will be outlawed to support industrial food production through government subsidies. Instead, all government subsidies supporting food production will be given to organic farmers who use sustainable farming practices.

These goals may seem unrealistic and expensive, but these are the steps I believe need to be taken to ensure a safe world for our generation and generations to come.  

M8.4 Chemical Policy Reform

The Louisville Charter for Safer Chemicals

My group suggested numerous ideas to create better chemical policies. The following list is a summary of the overarching themes/elements suggested by the group:

1. Require consumer education about their risk regarding chemical exposure and identify ways they can mitigate their risk.
2. Clearly label chemicals and products that contain chemicals. 
3. Tighter government regulation of chemicals that can cause severe harm (example: mandates restricting gasoline or pesticide usage and requiring smoke or fragrance free environments). 
4. Improved safety testing methods and a longer approval process. 
5. Hold chemical manufacturers more accountable.
6. Remove harmful chemicals off the market as soon as harm is discovered.

These strategies are similar to those of the Louisville Charter for Safer Chemicals. During this convention, authorities agreed that chemical policies should require safer, less harmful chemicals be used as a first-line defense; ban persistent chemicals; provide consumers and workers information about chemicals; quickly follow-up on any early indications that new or existing chemicals may be harmful; mandate comprehensive safety testing on all chemicals; and take immediate action if harmful exposure does occur. My group touched on most of the same points, except for specifically naming persistent chemicals as a class of chemicals to ban and addressing the actions to take if chemical exposure does occur. These are two very important pieces that we did not discuss. 

The most challenging aspects of a task such as the Louisville Charter include identifying priorities among competing areas of need and finding consensus. The authors of this charter also clearly and succinctly explained the importance of each article within the charter. This was an influential document that has affected policy reforms on both micro and macro levels. 

M8.3 Pesticides

What's on my food?

For dinner, I ate a frozen meal from a company called, Beetnik, which focuses on preparing all-natural and organic foods using only simple ingredients. The meal contained the following items (please note that the information listed here would only be applicable if the meal was not organic): 

Onions: no information

Sweet potatoes: 19 pesticidesà reproductive toxicity, bee toxicity, neurotoxicity, carcinogenic

Carrots: 26 pesticidesà reproductive toxicity, bee toxicity, neurotoxicity, carcinogenic

Celery: 64 pesticidesà reproductive toxicity, bee toxicity, neurotoxicity, carcinogenic

Lemons: no information 

Bell peppers: 53 pesticidesà reproductive toxicity, bee toxicity, neurotoxicity, carcinogenic

Garlic: no information 

Ginger: no information 

Poultry: 0 residue

Water treated tap: 59 pesticidesà reproductive toxicity, bee toxicity, neurotoxicity, carcinogenic

In total, I could have been exposed to 221 pesticides. Many of these chemicals are duplicates, but nonetheless, I'd still be ingesting these chemicals multiple times and increasing their bioaccumulation within my body. This is crazy and highlights the importance of washing produce and eating organic. I'd be interested in seeing a comparison list of the chemicals found on organic ingredients, because not all organic food is completely pesticide free. 

I have really been encouraging my family to eat organic, but as a family of four, this is significantly more expensive. For example, my frozen dinner was double the cost of a regular frozen meal ($6.50 versus $3.25 respectively). This cost difference adds up quickly. As I learned in Harvest for Hope, organic food may be more expensive on the front end, but will be more cost-effective long term due to the increased health benefits it offers. However, something needs to be done to better protect citizens as a whole. From a public health perspective, this comes down to implementing stricter policies that are actually enforceable. New policies are needed to foster significant change because this issue affects everyone. See the blog post entitled Module 8.5 to find out more about what these ideal chemical policies should look like! 

M7.8 Topic of Interest

Toxic Metals in Lipstick

As required by the US Food, Drug, and Cosmetic Act, the main regulatory body responsible for safety of cosmetic products, such as lipstick, is the US Food and Drug Administration (FDA). After receiving pressure from the Campaign for Safe Cosmetics (CSC), several Senators, and consumers, the FDA decided to expand upon existing research by conducting a lengthy investigation into lead-containing lipsticks. However, the law does not require cosmetic products or their ingredients, aside from color additives, to have FDA approval prior to product launch. Additionally, the cosmetic companies are not required to give the FDA product safety test results. Yet, there is a limit to the amount of lead that color additives can contain at 10 ppm. The FDA has determined that exposure is minimal to the consumer at this level and therefore, has not required cosmetic companies to rid lead from lipstick. The CSC believes this level is still a harmful amount and further action should be taken by the FDA to protect consumers. 

Resources

https://www.fda.gov/cosmetics/productsingredients/products/ucm137224.htm#expanalyses

http://www.safecosmetics.org/get-the-facts/regulations/us-laws/lead-in-lipstick/  

M7.7 Government Agencies

Agency for Toxic Substances and Disease Registry

The Agency for Toxic Substances and Disease Registry (ATSDR) was created under The Comprehensive Environmental Response, Compensation and Liability Act of 1980 (aka the Superfund Act) and is a program within the US Department of Health and Human Services. The agency's main function is to evaluate the side effects of toxic/hazardous substances and the consequences of exposure. ATSDR's duties include the following: health assessments at waste sites, consultations regarding the effects of hazardous substances, health surveillance, emergency response to hazardous spills, continued research in environmental public health, maintaining toxicological databases, dissemination of information related to hazardous substances, and education/training regarding hazardous substances. In short, the agency assesses the health and environmental risks associated with Superfund sites, decontaminates Superfund sites, and offers solutions to prevent further harm from hazardous substances. In 2014, ATSDR worked in 600 communities with over one million people, responded to 57 emergency hazardous spills, and updated or released 12 new ToxProfiles. The agency attributes its success to their three-step standard operating procedure when addressing an issue: assess available research and data; partner with the stakeholders and the EPA to make a recommendation; collect additional data to ensure evidence-based outcomes. 

Resource

https://www.atsdr.cdc.gov/about/index.html

M7.4 Local Environmental Services

County Programs and Services

This list is a compilation and summary of the services and programs offered within my county that are related to the health of the environment: 

• Department of Agriculture: regulates the safe use of pesticides, promotes practices that ensure a healthy food supply, and prevents the introduction/spread of invasive species that could harm the food supply.
• Animal Care and Control: offers short term shelter for animals. This helps to prevent the spread of disease.
• Office of Building Inspection: ensures that buildings are built according to regulatory codes that promote safety. People can apply for solar and renewable energy permits here as well.
• Children’s Health Initiative: provides comprehensive health insurance for all children living in the county who are eligible based on family income. Children need access to medical care to ensure they are reaching developmental milestones, are getting vaccinated, are managing diseases they may develop like asthma, and are being monitored for lead exposures.
• Clean Water Program: protects the water in the county by preventing pollution, following federal regulations, and promoting public awareness.
• Consumer and Environmental Protection Agency: this agency includes three major programs: Department of Agriculture and Environmental Management, Department of Environmental Health, and Vector Control District. The goal of the agency is to protect the environment while promoting the agricultural industry, and ensuring the health and safety of the county’s citizens.
• Consumer Protection Division: protects the health of the people residing in the county. The division inspects food facilities, public recreational water facilities, and wastewater treatment systems. In addition, the division also offers counseling about radon/mold/Psittacosis and investigates lead exposure/foodborne illness outbreaks.
• Department of Environmental Health: In order to promote health and safety for the community, the department strives to protect and improve the environment.
• Integrated Pest Management: monitors pesticide use and coordinates an organized response when pest outbreaks occur.
• Occupational Safety and Environmental Compliance: develops policies and programs that promote the health and safety of the environment. OSEC will also conduct investigations when issues arise.
• Public Health Department: strives to prevent disease and injury within the community at large.
• Recycling and Waste Reduction Division: oversees and fiscally manages the Recycling and Waste Management Commission. Services included are garbage, recycling, composting, and safe medication disposal.
• Solid Waste Programs: preserves the health of the community by ensuring proper disposal of solid waste and medical waste.
• Vector Control District: aims to minimize vector-borne diseases by decreasing issues with mosquitoes, rodents, wildlife, and insects that cause disease.
• Weed Abatement Program: provides education regarding methods to reduce weed invasion in order to preserve the health of the environment and the citizens of the community. 

I was surprised there were so many programs and services dedicated to protecting the health of the environment and the community. Considering my county was consistently rated in the worst 10% in terms of air quality, pollution, and Superfund sites, I would be interested to know if some of these agencies/departments/programs were created in response to these reports.  It also seems that many of the programs do not operate in silo, but instead connect and partner with each other to solve larger issues. Additionally, I was surprised to consider Animal Care and Control under this umbrella. However, it does make sense when you think about it because stray animals can precipitate the spread of disease and lead to unsanitary conditions. 

My county is also running a campaign that emphasizes the proper disposal of medications. This is a large issue that is significantly polluting our waterways. As a healthcare professional, it is part of my responsibility to educate my patients on ways they can safely handle their medications and properly dispose of any extra doses left over. Healthcare facilities are also making efforts to change practice and comply with new regulations regarding proper medication waste disposal. 

M6.7 Obesogens

Local Produce

Locally grown produce are seasonal fruits and vegetables that are grown in close proximity to where one lives. Buying locally sourced food has many benefits. For example, buying locally reduces food miles, also known as the miles the food travels to get from the farm to the consumer. The average food miles for produce in the grocery stores are 1500 miles! As you can see, this has a significant impact on carbon emissions due to airplane travel. Additionally, buying local supports your local economy and puts money directly into the pockets of your hard-working community farmers. Lastly, there is a clear distribution path from the point of harvest to the consumer. This helps mitigate any delay in recalling potentially contaminated foods. Moreover, the consumer can easily identify if the food came from a farm that uses organic and ethical farming practices. 

Hospital Menus  

Hospitals should lead by example and encourage their patients to make healthy dietary choices by supplying locally grown fruits and vegetables. I appreciated that the article provided some tips for hospitals trying to make this transition. Some of these ideas included posting signs to educate patients, starting to offer one meal per week, and using the redesigned menu as a marketing strategy. I worked at a children's hospital that had a terribly unhealthy and processed food menu. After years of receiving complaints, the hospital finally took action. The hospital starting growing fruits and vegetables onsite to supply ingredients for the cafeteria. The menu was also redesigned to include organic foods that were more sustainably produced. This made a significant difference in patient satisfaction rates. Furthermore, it exemplified healthy eating and cooking so parents and children knew what good food choices looked like. 

Harvest Calendar

I have not previously paid much attention to local foods that are in-season when purchasing produce. Using a harvest calendar, I found that artichokes, asparagus*, celery, lemons, brussel sprouts, strawberries, oranges*, tangerines, sweet potatoes, and avocados* are currently in-season within my state. The produce with asterisks are the fruits and vegetables that are available locally. Using a harvest calendar will allow me to explore and get creative with different produce.    

Obesogens

I had never heard of obesogens and found this topic to be quite fascinating. As a healthcare provider, I was also taught that obesity is a result of genetics, poor food choices, and a lack of exercise. With more emphasis always placed on the latter two reasons. After reading this article, I feel I had an "ah-ha" moment. This makes perfect sense as to why there has been an unprecedented increase in obesity rates over the last several decades. With rates rapidly increasing, there must be something besides diet and a lack of exercise causing the problem. Chemicals are mimicking hormones and disrupting natural growth and development. Babies exposed in utero to certain chemicals will have more adipose cells than those babies not exposed. This higher percentage of adipose cells means they will be heavier than their counterparts and will struggle to lose weight. 

For example, one of these chemicals is DDE (dichlorodiphenyldichloroethylene), a chemical that is formed during the breakdown of DDT containing pesticides. DDE has significant side effects when humans are exposed. It is a probable human carcinogen, but evidence is insufficient to definitively classify as one. In animals, it has shown to cause liver and thyroid cancer. Human exposure to DDE can cause incident diabetes, increased risk of testicular germ cell tumors, fetal loss, GI cancers, lung cancer, and preterm labor. It was associated with differences in height and childhood asthma among children exposed in utero. Conversely, DDE exposure was not associated with a difference in birthweight, pancreatic cancer, multiple myeloma, non-Hodgkin lymphoma, breast cancer, or uterine cancer. Interestingly, ToxNet did not reference articles that link DDE to an increased risk of obesity. 

M6.6 Use of Antibiotics

Antimicrobial Resistance and the Overuse of Antibiotics

Having had a patient, who I cared for very much, pass away from septicemia related to a multidrug resistant organism (MDRO) makes this issue very personal. Recently, there has been significant work in the healthcare industry with the implementation of antibiotic stewardship programs to reduce the inappropriate use of antimicrobials. However, the general public also needs to shift its mindset about when antibiotics are necessary. As Dunn (2011) stated, a comprehensive review just determined that antibiotic products do not protect people from gastrointestinal bugs or upper respiratory infections any more so than simply washing with regular soap and water. Additionally, patients need to adjust their expectations regarding antibiotic prescriptions when diagnosed with viral infections because antibiotics have no clinical effect on viruses. This paradigm shift involves thinking more selflessly by putting the greater good of the whole above one's immediate needs. 

After reading that more animals receive antibiotics than humans, with more than 80% of antibiotics in the US being sold for agricultural purposes (Food & Water Watch, 2015), clearly the food industry also needs to significantly change its antibiotic usage practices as well. Notably, livestock are the perfect breeding ground for antimicrobial resistance. Overpopulated factory farms are in much greater need of antibiotics due to poor and unsanitary living conditions (Dallas, 2012). To make matters worse, farmers cannot contain these dangerous bugs within the confines of the farm. Research has found that those who live in close proximity to farms are at greater risk to carry MRSA, even if they do not have direct contact with the livestock or the farms (Dallas, 2012). The need for livestock antibiotics can be resolved by raising animals in better living conditions by allowing them the time and space to roam. 

Currently, about 23,000 people are dying each year from MDROs, of which 22% are traced back to originate from foodborne pathogens (Food & Water Watch, 2015). Hospitals are also a large source of MDROs. To help mitigate the spread of disease, some healthcare institutions are buying antimicrobial furniture, textiles, and building materials (Schettler, 2016). However, this has unknown safety and environmental consequences. Additionally, such products increase cost and provide a false sense of security. Healthcare organizations should be extremely careful and only buy products that have undergone rigorous EPA investigation (Schettler, 2016). 

BBC just published an interesting article about the dire state of antibiotics. It discusses the history of antibiotics, current unsafe farming practices, and economic incentives that have cut funding for antibiotic research . Follow the link for more information: http://www.bbc.com/news/business-38828079 

Resources

Dallas, 2012: http://www.medicinenet.com/script/main/art.asp?articlekey=163935

Dunn, 2011: https://blogs.scientificamerican.com/guest-blog/scientists-discover-that-antimicrobial-wipes-and-soaps-may-be-making-you-and-society-sick/

Food & Water Watch, 2015:https://usfca.instructure.com/courses/1569184/files/63504203/download?wrap=1

Schettler, 2016: https://noharm-uscanada.org/sites/default/files/documents-files/3854/Antimicrobials%20Report%202016_1.pdf

M6.4 Industrial Farming

Vanishing Bees

I had heard of this issue previously, but never paid much attention to it or researched it any further. However, I was fascinated by the movie and found it very informative as well as emotionally touching. After watching the movie, I checked the label on my current jar of honey and found there was no ingredient list. I think this is odd because just about every edible item has an ingredient list. This made me question if I was eating "funny honey" or not. I was also shocked about the mistreatment of bees, especially the queens, on industrial pollination farms. Additionally, I learned about the devastating effects of colony collapse disorder (CCD). Systemic pesticides are suspected to be the cause of CCD because when this mode of delivery was developed no further safety and efficacy testing was completed. This movie highlights the ineptitude of the regulatory bodies put in place to supposedly protect us. I agree with the farmer who stated that the Environmental Protection Agency should take protection out of their name because they are not protecting anyone. Another farmer called them "pestitutes" because the agency has been corrupted by the large chemical companies. I also want to note that Bayer, the chemical company who makes the most dangerous pesticides, also makes many pharmaceuticals used by patients worldwide. This deserves some further investigation about conflicts of interest, especially of their toxicologists. Regardless, I feel the lack of government regulation and lax policies related to safety testing is to blame for this issue.  

Dirt! The Movie 

I appreciated this movie because I had never considered dirt to be a living thing or vital to our health and well being. This point was driven home when the movie illuminated the fact that most impoverished and destitute communities stem from a lack of healthy soil. Once the water dries up and the soil vanishes, no plants can grow causing the animals starve to death. Jobs are lost and people are hungry. Families are then forced to leave their homes in search of a new place that can sustain them. This really changed my perception on the importance of soil. Additionally, I found it interesting how different cultures use soil. For example, those in India use soil to build homes, whereas, those in Mexico believe soil contains healing power and center a pilgrimage around this belief. Starving people in Haiti will make yellow mud cookies to feed themselves and their children. Interestingly, I remember reading that people who grow up eating dirt often crave the taste of it as adults. Conversely, in America we often take soil for granted by continuing the practice of large monoculture farming. We should learn from history so we can avoid another large scale dust bowl. Lastly, this movie taught me to treat soil as the precious resource that it is! One way to give back to the earth is through composting (more on that below). 

Factory Farming

Luckily, there are no factory farms in my area or even my surrounding area. This makes me glad to know that there are no harmful farms in my community. However, living in an industrialized city does not come without its risks. All the asphalt and pollution from over developing the land can damage the soil as well. 

Composting

I currently live in a county where compost collection is mandatory. My family has significantly reduced our trash accumulation by implementing composting in our household. However, we do not have our own compost pile. The compost bin is collected on a weekly basis with our trash and recycling. I've always been curious as to where the compost goes and what the county uses it for. This module has inspired me to start my own vegetable garden that contains a compost pile and a bee hive. When I own a house this will be a priority of mine. That way I can ensure my food is organic and I'm contributing to renewal of important life-sustaining resources. 

M5.7 Sewage Facilities

The Riconada Water Treatment Plant

Since 1967, the Riconada Water Treatment Plant has served the Santa Clara Valley Water District. The plant processes 80 million gallons of water a day for the following cities: Santa Clara, Campbell, Sunnyvale, Cupertino, Mountain View, Monte Sereno, Saratoga, Los Altos, Los Gatos, and Los Altos Hills. Water purification is completed using microfiltration, reverse osmosis, ultraviolet light. The facility is currently under construction to ensure it continues to meet water quality, seismic stability, and safety requirements. 

The San Jose-Santa Clara Regional Wastewater Facility

This facility is located in San Jose and processes water for eight cities and four sanitation districts: San Jose, Santa Clara, Milpitas, Cupertino Sanitary District, County Sanitation Districts 2 & 3, and Burbank Sanitary District. As the largest tertiary treatment plant in the Western US, the plant treats 110 million gallons of water per day. The facility will be undergoing a thirty year Capital Improvement Program that aims to improve the infrastructure for more cost-effective and efficient processing. 

Resources

https://www.sanjoseca.gov/Index.aspx?NID=1663

http://www.sanjoseca.gov/index.aspx?nid=4544

http://www.sanjoseca.gov/index.aspx?nid=1665

http://www.valleywater.org/Services/RinconadaWTP.aspx

http://www.valleywater.org/SVAWPC.aspx

M5.5 Bottled Water

National Campaign for Tap Water

One of people's largest motivators is money. The video explained that bottled water is 2000x the price of tap water. Notably, several bottled water companies simply use filtered tap water for their products. Other companies do not even meet the same quality standards as tap water. Therefore, buying tap water results in an equal or lesser value product for an astronomically higher cost. This may the most effective strategy when attempting to change behavior of adults. The campaign would also focus on targeting children, teens, and young adults. They are large consumers due to the convenience aspect of bottled water. Parents often pack bottled water for lunch or after school sports. Schools could ban bottled water on campus to help support the campaign. Ambassadors could travel to schools and universities around the country to educate youth and young adults about the dangers of bottled water. This was a successful tactic while I was in college and it influenced me to sign a petition to ban bottled water. Since then, I have not drank out of bottled water. These combined strategies will make for a successful campaign.

Campaign Slogan: "Clap! Clap! Drink outta the tap!"

M5.4 Consumer Confidence Reports

Water Quality 

1. What is the source of your drinking water? 
• Cal Water uses local groundwater and purchases water from Santa Clara Valley Water District (SCVWD). This water is supplied by South Bay Aqueduct, Lake Del Valle, and San Luis Reservoir, which all draw water from the Sacramento-San Joaquin Delta watershed. Local sources of water are the Anderson Reservoir and the Calero Reservoir.  
2. What chemicals were found in your water that were higher than expected?
• No chemicals exceeded the established standards. The following list includes the chemicals, elements, and particles tested for: gross alpha particle activity, radium 228, uranium, aluminum, barium, hexavalent chromium, chromium, fluoride, nitrates, perchlorate, selenium, turbidity, total organic carbon, haloacetic acids, trihalomethanes, chloramine, copper, lead, boron, bromide, calcium, chloride, color, hardness, iron, magnesium, manganese, molybdenum, pH, sodium, strontium, sulfate, dissolved solids, vanadium, and chlorodifluoromethane.   
3. What chemicals did you not expect to find in your water?
• There are several chemicals and contaminants in the water from manmade sources. I would prefer to drink water without these additional chemicals. Some examples include the following: barium, hexavalent chromium, chromium, nitrates, perchlorate, selenium, and chlorodifluoromethane. 
4. What are the associated health risks with the chemicals found in your water?
• Chlorodifluoromethane: also known as freon 22 is from refrigerator run-off. Limited data are available about the risks associated with freon 22. Case studies show that exposure is associated with CNS depression, cardiac arrhythmias, atrial hypertension, dizziness, nausea, and coma.   
• Chromium: is most often discharged from electroplating factories, leather tanneries, wood preservation, chemical synthesis, refractory production, textile manufacturing, and steel mills. Presumed to be carcinogenic, mutagenic, and teratogenic.   
• Perchlorate: used in rocket propellant, fireworks, explosives, flares and matches. Water contamination from historic aerospace operations. Health effects include: antithyroid, gastric irritation, nausea, vomiting, fever, skin rashes, lymphadenopathy, nephrotic syndrome, leukopenia, agranulocytosis, pancytopenia, and fatal aplastic anemia. 
• Selenium: natural element that is discharged from petroleum, glass, and metal refineries. Additionally, it is found in livestock lot runoff. Health effects include CNS dysfunction, liver damage, heart damage, liver damage, and teratogenicity.  
5. What did you discover about your water quality?
• Overall, I was pleased that no chemicals exceeded the standards established by regulatory bodies. Additionally, Cal Water does not add extra fluorine to the water because it is naturally occurring within the area. Lastly, Cal Water treats with chlorine to reduce microbial contamination. However, there are other alternatives to treat the water for microbials, which include ozone and ultraviolet lights.  
6.  Do you use a filter for your water? If so, what are you trying to filter out?
• No, I do not use a filter for my water. 
7. Do you drink bottled water? 
• No, I do not drink bottled water. I quit drinking bottled water five years ago. Since then, I have been trying to convince other members of my family to do the same. 

M5.2 Safe Drinking Water

Water

On average, the human body is comprised of about 70% water. As you can see, it is essential to live! But in today's world, more people have a mobile phone than those who have piped water. Unfortunately, 2.5 billion people lack access to adequate sanitation and 780 million lack clean water (UN, 2013). This results in about 7 million deaths annually (UN, 2013). So what are the waterborne illnesses that can make us sick? According to New Health Advisor there are several diseases that are easily spread through contaminated water. 

• Cholera: a bacteria called vibrio cholerae causes diarrhea, vomiting, and abdominal cramps.
• Amoebiasis: this amoeba causes one of the most common waterborne diseases. Symptoms include severe diarrhea. 
• Dysentery: caused by a bacteria that results in fever, vomiting, abdominal pain, and severe diarrhea. 
• Hepatitis A: a virus that is spread through the fecal-oral route. The most common symptoms include fever, nausea, vomiting, diarrhea, and fatigue. 
• Intestinal worms: a variety of parasitic worms can cause diverse symptoms such as malnutrition, anemia, growth restriction, and ulcers. 

Young children, the elderly, and those who are immunocompromised are at increased risk. Severe dehydration from diarrhea and vomiting can lead to fatality. In addition, water is also contaminated with chemical pollution from industrialized manufacturing. High levels of pollution can lead to increased levels of cancer, infertility, and endocrine disruption. Policies, like the Clean Water Act of 1972 and the Safe Drinking Water Act, help by implementing regulations on our drinking water. However, the Clean Water Act is not easily regulated. Only two-thirds of the waterways in the US meet the standards set by the bill. The Safe Drinking Water Act ensures that all public water systems are closely monitored for microorganisms, toxins, lead, chemicals, and disinfectants. Unfortunately, this bill does not have any control over the quality of bottled water. Since bottled water makes up a large majority of human water consumption, many people are drinking poor quality/possibly contaminated water. With an increasing population, it is more important than ever before to learn how to better preserve this precious resource.    

Resources 

http://www.newhealthadvisor.com/Diseases-Caused-By-Water-Pollution.html

http://www.unwater.org/water-cooperation-2013/water-cooperation/facts-and-figures/en/

M4.6 Radon

A National Awareness Campaign: Radon

Radon is an odorless, radioactive gas that is produced by uranium in the soil and rocks. Radon seeps into the home through cracks in the foundation. Radon has serious side effects as it is the second cause of lung cancer, leading to 21,000 deaths per year. However, not many people know about radon or that their home could contain high levels. 

For a national awareness campaign, I propose a partnership between real estate companies and public health departments to help increase the general public's knowledge of radon. For example, realtors could ensure radon tests are completed during home inspections. If high levels are found, the realtor should then advocate for certified radon remediation professionals to complete a thorough inspection. The solution to fix high levels of radon generally includes running pipes through the home that are connected to fans, which draw radon out of the home. Additionally, not every state requires that the results of radon tests be reported. Moving forward, all states should mandate radon test reporting so potential home owners are informed. Lastly, realtors generally maintain relationships with their clients, therefore, realtors should remind their clients when radon tests are due every several years. This way homeowners know the importance of testing and have a reliable source to remind them to do so.

Resources

http://www.consumerreports.org/radon/is-it-safe-to-buy-a-home-with-an-elevated-radon-level/

M4.2 National Library ToxNet

Urea Formaldehyde

According to ToxNet, formaldehyde is mostly used as a fumigant on animal farms and processing plants. Other uses for formaldehyde include: material preservative, antimicrobial, disinfectant, and specimen preserver. Low level inhalation can cause upper airway irritation and lower airway irritation. Contact with formaldehyde can cause skin reactions and eye irritation. More serious side effects include cancer of the nasopharynx, leukemia, sinonasal cancer, infertility, anemia, and low birth weight infants. Animal studies found that drinking water contaminated with formaldehyde can cause gastrointestinal cancers. Lastly, cells exposed to formaldehyde were found to have gene mutations by direct DNA damage and inhibition of DNA repair mechanisms. 

Exposure to formaldehyde can have significant health consequences. While studying anatomy and physiology, I dissected several pigs that were preserved with formaldehyde. The smell would burn my respiratory tract despite there being vents within the laboratory. Hopefully, I did not cause any permanent damage to myself while working in the lab with preserved specimens. 

Bleach

Matulonga et al. (2016) found that women who frequently (at least once per week) cleaned with domestic-grade bleach were found to have higher rates of non-allergic adult-onset asthma when compared to non-users. Positive associations were also found between the frequent use of bleach and bronchial hyperresponsiveness, asthma like-symptoms, and chronic cough. According to the Asthma and Allergy Foundation of America, the financial burden of asthma reached $53 billion (direct and indirect costs) in 2007. It is estimated that this figure has grown significantly since then. Asthma, despite being common, can cause significant harm to individuals and society at large. 

This study further proves that cleaning products "approved" for home use may not be as safe as we assume. Careful consideration should be taken when using harsh chemicals in the home environment. 

Resources

https://www.toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~gTIS5n:3

https://www.toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~StSKy7:1

http://www.aafa.org/page/cost-of-asthma-on-society.aspx

M3.5 Transportation

Public Transportation in California

There are many benefits to living in an area with public transportation, both for the community as a whole and for the individuals who live there. For example, men who commute to work are less likely to be overweight or obese. In fact, one study found that people who commuted to work instead of driving by automobile lost one pound of weight per six weeks of commuting. As for the community, public transportation makes the roads safer by decreasing fatal accidents. Additionally, it reduces social inequities by connecting diverse people and providing reliable access to resources. In terms of the environment, public transportation produces 95% less carbon monoxide and 45% less carbon dioxide when compared to automobiles. 

California's public transportation efforts are proving to be relatively effective. Here is a partial list of rankings and scores: 

• CA is in the 80th percentile for persons who take shared transit as a commute mode.
• CA is in the 89th percentile for persons who ride their bikes as a means of transportation. 
• CA is in the 100th percentile for complete street policies.
• CA is in the 93rd percentile for miles of travel by walking.
• CA is in the 95th percentile for physical activity from transportation. 
• CA is in the 89th percentile for traffic accident fatalities in an automobile.

As you can see, California has made significant strides in promoting the use of public transportation. Nonetheless, due to the sheer volume of people living here, many people still drive automobiles. This increases the risk for fatal traffic accidents (as seen in the above statistic). Additionally, California is a large state and not everyone has access to public transportation. More planning and infrastructure building should occur to ensure equitable access to all. 

M3.4 Pollution

My Community's Pollution Scores

1. Who or what are the top polluters in your zip code?

   
As of 2002, the top five polluters were: 

• Owens Corning Corporation
• Hanson Permanente Cement
• Strongwell Corporation 
• Chevron 
• Headway Techs Inc. 

2. What percent of the homes in your zipcode have lead-based paint?

1% or 3,600 homes have a high risk of lead hazards. Notably, 12% of children under the age of 5 are living below the poverty line. 

3. Are there Superfund sites in your zip?

A Superfund site is a portion of land that has been contaminated with hazardous waste, which could pose risk to the health of the environment and the population living there. The EPA has identified it as a possible clean-up site due to these risk factors. 

    The top 5 nearby Superfund sites include: 

• Advanced Micro Devices, Inc. 
• Advanced Micro Devices, Inc. (BLDG 915)
• Applied Materials
• CTS Printex, Inc.
• Fairchild Semiconductor Corp. 

4. What can you tell us about the Superfund sites that are near where you live?

I have never heard of any of these companies before, which makes me think this is an outdated list. Companies in the Silicon Valley are mostly tech start-ups or are related to computer technology/computer parts manufacturing.

• Advanced Micro Devices, Inc: Develops computer processors and other computer parts
• Applied Materials: Makes semiconductor chips, flat panel computers, smartphones, televisions, and solar products
• CTS Printex, Inc: Manufactured circuit boards until 1985. The EPA has completed soil cleanup of this area and groundwater cleanup is still ongoing. 
• Fairchild Semiconductor Corp: Develops power analog, power discrete, and non-power semiconductors.  

5. What did you learn about the air quality in your zipcode?

I learned that my county has ranked among the dirtiest/worst 10% counties in terms of person-days in exceedance of national air quality standards for the ozone and in terms of an average individual's added cancer risk from air pollutants. Previously, I felt my community was relatively healthy. After review, I realize that many of the companies in the area cause significant pollution. In fact, only 75% of days have good air quality. During the early 2000s, I do recall several spare the air days where we were not allowed to run outside during recess. 

  

    The top five companies responsible for air pollutants include: 

• Kaiser Cement Corp. 
• Owens Corning
• Raisch Products
• Cardinal Cogen A Joint Venture
• Stevens Creek Quarry Inc. 

6. How about the water quality?

As of 1998, 16% of the county's surface waters had a reported problem. Additionally, 29 waterbodies reported problems to the state. The most significant water pollutants are metal and pesticides.

The county ranked 37 out 57 counties in terms of animal waste. Animal waste spillage is known to cause water contamination. 

7. How did your zipcode fair on a social justice/environmental justice basis?
    Persons of Color are:

• 52% more likely than Whites to be exposed to toxic chemicals.
• 13% more likely than Whites to be at risk for cancer due to hazardous air pollutants.
• 12% more likely than Whites to be exposed to air pollutants emitted from facilities. 

    Low income families are: 

• 20% more likely than high income families to be exposed to toxic chemicals. 
• 10% more like than high income families to be at risk for cancer due to hazardous air pollutants.
• 28% more likely than high income families to be exposed to air pollutants emitted from facilities.

  Other pertinent statistics include: 

• Non-high school graduates are 70% more likely than high school graduates to be exposed to toxic chemicals. 
• Working class people are 36% more likely than non-working class people to be exposed to toxic chemicals. 
• Children living below poverty are 22% more likely than children above poverty to be exposed to air pollutants from facilities. 

My county of residence still has work to do to eliminate environmental racism. Based on the graph above, one can see the disparities between minority populations and income differences. The differences are particularly startling when comparing low-income minorities to low-income whites. The only group with less burden of disease for this income category is Native Americans, which is the smallest demographic group in the area. 

M3.3 Environmental Justice

Environmental Justice

2016 was a year filled with a variety of environmental justice issues that were highlighted on a national platform during the presidential race. The environmental justice movement is tied to the social determinants of health concept. The environment that we live in greatly affects our health outcomes. The water we drink, the air we breath, and the house we call home can make us sick, as well as our future generations. In fact, 60% of low socioeconomic status (SES) African Americans live in areas that are situated in close proximity to toxic waste sites. Exposure to such chemicals not only affects their physical health, but also affects their mental health, IQ status, and susceptibility to commit crime. These outcomes are costly to individuals and families, further widening the financial divide between the haves and have nots. This environmental racism perpetuates a cycle that is meant to disempower those of minority backgrounds. Notably, African Americans, regardless of their educational/occupational achievement or SES, will have higher mortality rates than their counterparts of different races. 

This is a moral and ethical issue that should be addressed. African Americans in the US have responded to police brutality and continued racism through the "Black Lives Matter" (BLM) movement. According the the BLM website, the movement is "working for the validity of Black life" and is "a call to action and a response to the virulent anti-Black racism that permeates society." The BLM movement and environmental justice movement are tied because they are fighting for the rights of Black lives, especially those who are disadvantaged. However, environmental justice will not be occur until we as a collective community learn to live cleaner, waste-free lives. 

M3.2 Vulnerable Populations

What makes us sick?

Dr. Manchandra raises some interesting points about our current healthcare system. The United States has a sick care system and not a health care system. As healthcare providers, we excel at intervening once a person already has a disease. However, we significantly lack the resources to prevent disease. He states numerous times that health begins where we live and work. Notably, scientists now believe one's health is more influenced by zipcode than genetic code. In fact, the first environment that we live in—the womb—can already predispose us to significant adverse health outcomes. Dr. Lanphear further explains that fetuses exposed to chemicals will have significantly altered health outcomes. For example, as a mother's PBDE or OP pesticide blood levels increase, the lower her child's IQ will be. This is demonstrated in a dose-response relationship. Additionally, the cumulative impact of multiple chemicals can have an extreme affect on the child's health and development. Dr. Miller poses that exposure to toxic chemicals is a human right issue as this is an unsolicited trespassing on our bodies and the bodies of our children. Unfortunately, those of lower socioeconomic status are at greater risk for exposure. Social determinants of health are often the root cause of disease. If we had more forward thinkers and those willing to address the "upstream" problems, we could start curing disease instead of treating symptoms.   

Public health professionals play an important role in addressing social determinants of health and creating policies to mitigate exposure. They look at the health of the whole person and of the community. Moving forward, we should create regulations that require companies to prove the safety and efficacy of chemical before putting them in products sold to the general public. It is outstanding that several chemicals known to cause harm are not even efficacious (example: PBDE or triclosan).