Foundations of Public Health PH-200 Fall 2008

1. Foundations of Public HealthPH-200 Fall 2008 Week 5 http://www.ochealthinfo.com/

2. Outline • 9:30 AM – 9:45 AM : Questions and Review • 9:45 AM – 11:00 AM : Public Health at the State Level - continued: • The California Department of Public Health • 11:00 AM – 11:15 AM : Recess • 11:15 AM – 12:15 PM : Public Health at the County Level • Orange County Health Care Agency • 12:15 PM – 12:30 PM : Review

3. Pop-quiz

5. Genetically identical agouti mice, one fed a diet of bisphenol A (BPA) (Dolinoy et al. 2007b). Dolinoy DC, Huang D, Jirtle RL. 2007a. Maternal nutrient supplementation counteracts bisphenol A-induced DNA hypomethylation in early development. Proceedings of the National Academy of Sciences of the United States of America 104(32): 13056-61. Dolinoy DC, Weidman JR, Jirtle RL. 2007b. Epigenetic gene regulation: Linking early developmental environment to adult disease. Reproductive Toxicology 23(3): 297-307.

6. Plastic Bottles Release Potentially Harmful Chemicals (Bisphenol A) After Contact With Hot Liquids. ScienceDaily. Retrieved October 29, 2009, from http://www.sciencedaily.com­ /releases/2008/01/080130092108.htm University of Cincinnati (2008, February 4).

7. Government of Canada Protects Families With Bisphenol A Regulations On June 26, 2009, the Government of Canada announced that it is moving forward with proposed regulations to prohibit the advertisement, sale and importation of polycarbonate plastic baby bottles that contain bisphenol A, otherwise known as BPA, to reduce newborn and infant exposure to this substance. Canada was the first country to ban “Bisphenol-A” from consumer plastics, citing the precautionary principle. Both U.S. FDA and the European Union have ruled that Bisphenol-A is “safe,” but scientific uncertainties continue over how to “quantify” the health impacts in a population. http://www.chemicalsubstanceschimiques.gc.ca/challenge-defi/bisphenol-a_e.html

8. News headlines California rejects bill to ban bisphenol A By Rory Harrington, 14-Sep-2009 Related topics: BPA, Quality & Safety, Cleaning / Safety / Hygiene, Packaging Materials The bid to pass a law banning bisphenol A (BPA) in California failed on Friday triggering a bitter backlash from it supporters who accused the chemical industry of dirty tricks in order to defeat the measure. Bill SB 797 was unable to secure the 41 ballots it needed to pass into law after a close-run last round of voting saw a crucial 13 senators abstain. Friday’s vote took place on the day before the State Assembly went into recess, with one source telling FoodProductionDaily.com that the bill would effectively be killed for 12 months if it did not secure passage. Lobbying tatics questioned The measure was finally voted down after a week-long round of behind-the-scenes lobbying that has provoked fury among its supporters. Senator Fran Pavley, who sponsored the bill, accused the chemical industry of an “expensive and shamefully deceptive lobbying campaign”. She alleged that some senators were told that food production plants in their district, such as one run by General Mills, would close if the bill was passed – even those facilities did not produce baby products. “The chemical industry successfully used misinformation and fear tactics to kill my bill,” she said. “Unfortunately, some California lawmakers were unable to see through a web of lies fueled by greed and therefore put our children in harm’s way.” FoodProductionDaily.com was unable to contact any representative from the US chemical industry prior to publication for a comment on the Senator’s allegations. BPA debate The bill would have outlawed use of BPA in the state from 2011 onwards in drink and food containers aimed at children. Specifically, the legislation would prohibit “the sale, manufacture or distribution of a bottle or cup or a liquid, food or beverage in a can, jar or plastic bottle that contains bisphenol A (BPA) if the item is primarily intended for children three years of age or younger”.

9. NIEHS awards Recovery Act funds to address bisphenol A research gaps • http://www.eurekalert.org/pub_releases/2009-10/nioe-nar102809.php • Huge U.S. Study of Toxic Plastic Chemical BPA Launched Bisphenol A (BPA), the controversial chemical used to make clear plastic infant bottles and sippy cups and linked to devastating injuries in children, will be the subject of a $30 million study conducted by the National Institutes of Health, officials said. Numerous scientific studies have found BPA exposure is associated with developmental delays, cancers, and other injuries in developing children who are fed from plastic bottles containing the chemical. In recent years, many consumers rights groups have succeeding in getting bans on the use of BPA in the children’s products. Some of the largest manufacturers of infant bottles have agreed to stop using BPA in their products and local governments from coast to coast have enacted their own laws limiting its use. However, some critics have accused the federal government of dragging its feet in determining the possible adverse effects of exposure to BPA. http://www.attorneyatlaw.com/2009/10/huge-u-s-study-of-toxic-plastic-chemical-bpa-launched/

10. Question • Given what we have discussed about health effects of Pb (lead) in consumer products, explain your agreement or disagreement with: 1. The decision of Canada’s government. 2. The Decision of California Legislature. 3. The Decision of the U.S. Government to spend $30 million on further studies.

11. Milestones - readings • Vaccines and the eradication of smallpox • Automotive Safety • Environmental Health • Infectious Disease Control • Cancer

12. Emerging antibiotic resistance

13. Ecological context of antibiotic resistance among pathogens

14. Behavior modification: Simple Rule, Difficult Implementation

15. Public Health and Cancer Breast cancer Prostrate Cancer Brain Cancer cells Cancer cell being attacked by the immune system

16. Cervical Stomach Lung Breast Prostate

17. Female cancer cases worldwide

18. Cancer Mortality

19. Cost of Cancer Treatment (U.S.A.)

20. Cancer Prevention • Routine Physical Examination • Routine X-ray / Tracers • Genetic Testing • Behavior Modification • no smoking • no sun tanning • Exposure prevention • Radon • Mutagenic chemicals • Disinfection

21. Costs of cancer prevention (cervical) Cheryl F. MacDonald, MSN, MPH, CRNP

22. Genetic testing for cancer • October is breast cancer awareness month • BRCA-1 • Dilemma • http://thewip.net/contributors/2008/10/in_the_family_when_knowing_is.html Mary Claire-King (UW)

23. Public Health at the County-Level • How long have you lived in Orange County? • Where else have you lived? • Are there specific conditions in Orange-County that warrant a particular emphasis in designing our public health infrastructure? That is, why not have a top-down approach (WHO-CDC-CDPH-OCHCA)?

25. Heart Disease Mortality at the National Level

27. Orange County Health Care Agency • The Health Care Agency is a regional provider, charged with protecting and promoting individual, family and community health through coordination of public and private sector resources. • http://ochealthinfo.com/ • HCA's service environment is complex, with 180 different funding sources and over 200 State and Federal mandates. The mandates under which HCA operates require the County to provide for, or to regulate, certain health services. Many also carry specific requirements for staffing, operations, claiming and record-keeping. • http://www.epi.uci.edu/media/docs/cspoc/AnnualReport/OC/orange.htm

28. Many of HCA's services are preventive in nature and therefore are not readily apparent to the public. Some examples of services include: • food protection • hazardous waste regulation • protection from animal-related diseases • water quality monitoring and pollution prevention • mental health services • alcohol and drug abuse services • preventive health services for the aging • healthcare for incarcerated individuals • communicable disease control • child health and disability program • Immunizations • public health field nursing and public health clinics.

29. Mortality in Orange Countyhttp://ochealthinfo.com/pubs/

30. Injury-related health impacts

31. Age distribution of suicides - mental health concerns

32. Drug Abuse Alcohol, Tobacco, and Other Drugs

33. Estimates of Number of Babies Exposed to Dangerous Drugs in utero

34. Emerging Infectious Diseases (West Nile Virus)