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Environmental and Occupational Epidemiology (EPI 256) Unit 1: Introduction

Environmental and Occupational Epidemiology (EPI 256) Unit 1: Introduction. Robyn R.M. Gershon, MHS, DrPH UCSF April 4, 2012. Overview of Field of Occupational Epidemiology. Historical context Occupational health Early 1900s Led by medical scientists and practitioners, field emerged

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Environmental and Occupational Epidemiology (EPI 256) Unit 1: Introduction

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  1. Environmental and Occupational Epidemiology(EPI 256)Unit 1: Introduction Robyn R.M. Gershon, MHS, DrPH UCSF April 4, 2012

  2. Overview of Field of Occupational Epidemiology • Historical context • Occupational health • Early 1900s • Led by medical scientists and practitioners, field emerged • Field of toxicology started to form • Government – US PH Service • Public oversight • Infrastructure for surveillance and oversight • Passage of first workers’ compensation laws (economic) • Health care coverage (injury centric)

  3. Overview of Field of Occupational Epidemiology • Role of the occupational physicians • Emerged from industry • Labor unions 1910 – 1920 pushed for agenda on occupational health • First textbook on occupational medicine (A. Hamilton, 1925) ...but field languished for over a decade.

  4. Emerging Professionalism • Spurred by disasters such as Gauley Bridge Disaster (epidemic silicosis) • National Conference of Gov’t Industrial Hygienists (1938) • American Industrial Hygiene Association (1939) • Consensus approaches to control measures • New courses in occupational health launched at Harvard, Michigan, U.C, Columbia, Yale. • State laws (Department of Labor) ↑↑

  5. Post WWII • American Academy of Occ Med formed, bridging academics/practitioners. • 1950s – worker and public interest waned • Landmark: 1969 – 1970 • Mine and Occupational Health & Safety Admin.

  6. Enhanced Professionalization and Specialization • Occupational medicine • In nursing • In research • In industrial medicine • Diffusion into mainstream • Occupational research + occupational epidemiology • New paradigm linking work/working conditions and health away from clinical observation or toxicology experiments towards analysis of exposure

  7. Enhanced Professionalization and Specialization (cont’d) • Assessment of workplace hazards, standards development, and control of worker injury and disease • Worker “Right to Know” • Development of databases • Formation of funded Centers throughout US.

  8. Enhanced Professionalization and Specialization (cont’d) • Expansive view and move towards tasks associated with all environments, not just work • Environmental epidemiology

  9. Tensions in the Field • Labor/Management/Professional • Inter-professional • Role of financial incentives

  10. Future Hazards • Deep shifts in the public’s expectations and concerns regarding health • “Exuberant” fascination with the environment and concerns about health hazards, associated with environment, including work environment • Uncertain future • Soft money • Uneasy alliance with industry • Outsourcing/contract • Gov’t role, labor/health

  11. How Safe and Healthy Are Our Workplaces (2010) • 130 million workers • 4,547 fatalities (3.5/100,000 FTE workers) • Down from 13k deaths/year • 3,063,400 injuries (4/100 workers) • Down from 10.9/100 workers in 1972 • Most dangerous jobs

  12. Risk Management • OSHA – develops and enforces regulation • 10 regional offices + 90 local offices • 2700 inspectors • 573 million budget/year • 40k inspections/year • 2k whistleblower inspections • NIOSH – also formed by the OSH Act 1970 • Part of CDC • Research, information, education, training

  13. Preparedness and Response embedding to a great extent within the Public Health System Process • A continuous cycle of gathering information, deciding, acting, evaluating • Public health is always evaluating the health of the community

  14. Goals of Public Health During Emergency Response Two Roles Maintain Services Acute Response Continue to provide essential public health services Respond to public health needs created by the emergency

  15. Categories of Disasters and Public Health Emergencies • Natural • Man-made, accidental • Man-made, deliberate • Complex • Sudden vs. slow onset

  16. Common Features of Large Scale Disasters/Emergencies • Pose a threat to public health & safety • May disrupt social and economic infrastructure of the community • May require large scale mobilization of resources to manage consequences and prevent additional damage or injury to the citizens and society

  17. Disasters: How common are they? (Source: Sunders, 2003)

  18. Natural Emergencies/Disasters • Results of …ecological disruptions that exceed the ability of the community to adjust. • They are generally of sudden onset and can pose serious and immediate threats to public health.

  19. Natural Disasters • Tornadoes • Large scale fires • Hurricanes/cyclones • Floods, sea surges, tsunamis, tidal waves • Snow storms • Volcanoes • Landslides • Severe air pollution (smog) • Heat waves • Epidemics • Earthquakes

  20. Natural Disasters - Vulnerabilities • Low-lying coastal areas • Hurricane storm paths • Severe weather paths • Drought prone areas • Earthquake zones • Human development (over development and development in high risk areas) • Overpopulation

  21. Vulnerable Populations • Overpopulated areas • Displaced persons • Elderly, children, disabled • Isolated, marginalized • Underprivileged

  22. Technological Disasters • Explosions • Building collapse • Ecological contamination • Toxicological release • Industrial accidents • Nuclear plant or radiological accidents • Information technology failure • Pollution

  23. Man-Made Disasters • Civil unrest • Forced migration • Population movements • Violence • Terrorism

  24. Epidemics • Can be the disaster • Can follow other disasters: • Food/water borne illnesses (e.g., typhoid, cholera) • Vector borne illnesses (e.g., plague, malaria) • Diseases spread person to person (e.g., hepatitis A, shigellosis) • Diseases spread by respiratory route (e.g., measles, influenza) • Most preventable through: • Environmental sanitation • Disease surveillance • Preventive medicine (immunizations) • Treatment

  25. Impact of Disasters • Death • Injury, including psychological injury • Destruction of property • Increased risk of communicable diseases • Damage to food/water supplies/systems • Population movement • Financial • Disruption of social order and functions

  26. Disaster Outcomes • Injuries ↑ deaths • Explosions, typhoons, hurricanes, fires, tornadoes, epidemics • Deaths ↑ injuries • Landslides, avalanches, volcanoes, tidal waves, floods, earthquakes

  27. Fundamental Aspects of Disaster Management • Disaster prevention • Disaster preparedness • Disaster response • Disaster mitigation • Rehabilitation • Reconstruction

  28. Disaster Phases Hazard Mitigation Hazard Vulnerability Pre-Impact Peri-Impact Post-Impact

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