Management of Emerging Public Health Issues and Risks

Multidisciplinary Approaches to the Changing Environment

Benoit Roig,Karine Weiss,Veronique Thireau

• Publisher: Academic Press
• Year: 2018
• ISBN:
  9780128132913
• Topic: Medicina
• Subtopic: Tossicologia

Management of Emerging Public Health Issues and Risks: Multidisciplinary Approaches to the Changing Environment addresses the threats facing the rapidly changing world and provides guidance on how to manage risks to population health. Unlike conventional and recognized risks (major, industrial, and natural), emerging risks are characterized by low or non-existent scientific knowledge, high levels of uncertainty, and different levels of acceptability by the relevant authorities and exposed populations. Emerging risk must be analyzed through multiple and crossed approaches identifying the phenomenon linked to the emergence of risk but also by combining scientific, policy and social data in order to provide more enlightened decision making. Management of Emerging Public Health Issues and Risks: Multidisciplinary Approaches to the Changing Environment provides examples of transdisciplinary approaches used to characterize, analyze, and manage emerging risks. This book will be useful for public health researchers, policy makers, and students as well as those working in emergency management, risk management, security, environmental health, nanomaterials, and food science.

• Presents emerging risks from the technological, environmental, health, and energy sectors, as well as their social impacts
• Contextualizes emerging risks as new threats, existing threats in new locations, and known issues, which are newly recognized as risks due to increased scientific knowledge
• Includes case studies from around the world to reinforce concepts

Part 1

New Risks

Outline

1. Chapter 1. Indoor Air and Public Health
2. Chapter 2. Advanced Manufacturing Processes and Technologies
3. Chapter 3. Multidimensional Impacts of Nanotechnology on Public Health

Chapter 1

Indoor Air and Public Health

Denis A. Sarigiannis^1,2, Alberto Gotti², and Spyros P. Karakitsios^{1 1}HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki, Thessaloniki, Greece ²Environmental Health Engineering, Institute for Advanced Study (IUSS), Pavia, Italy

Abstract

This chapter lays out and critically assesses the current evidence on combined exposure to health hazards in specific indoor built environments to identify the most frequent exposure combinations and to estimate the impact of combined exposure on risk ratios for reported health outcomes. Actual exposure within the indoor built environment may vary significantly depending on the proximity to traffic sources (particulate matter [PM], NO₂), the presence of strong indoor emissions from combustion sources such as biomass for space heating (PM, polycyclic aromatic hydrocarbons [PAHs]), smoking (PM, PAHs, volatile organic compounds [VOCs], carbonyls), building materials (VOCs), furnishings (carbonyls and phthalates), and consumer products (phthalates, flame retardants, polychlorinated biphenyls, and pesticides). Assessment of cumulative risks was done following a tiered level of complexity, according to the prototype connectivity approach developed by the authors. Occupants are continuously exposed to a cocktail of carcinogens, endocrine disruptors, and allergens. Based on the concentration levels identified and clustered by indoor setting and country, cumulative cancer risks are in the 10⁻⁴ range. A significant attributable fraction to allergies and asthma is the result of coexposure to PM, VOCs, and biological allergens. Public buildings such as schools/kindergartens and daycare centers are mostly affected by the proximity to traffic sources rather than to contributions from indoor sources. The combined effects of these chemicals are still not sufficiently elucidated, since their physicochemical and biochemical properties would favor multiple ways of interaction upon human uptake; there might be synergies in effect (e.g., PAHs and nitrosamines causing lung cancer), or they might inhibit each other's metabolism (the case of benzene, toluene, ethylbenzene, and xylene mixture).

Keywords

Biological allergens; Chemical mixtures; Cumulative exposure; Indoor; Public health; Risks

Chapter Outline

1. 1. Introduction
2. 2. Indoor Settings
   1. 2.1 Residential Buildings/Dwellings
   2. 2.2 Kindergartens and Schools
   3. 2.3 Daycare Centers
3. 3. Coexposure to Indoor Air Pollutants
   1. 3.1 Chemical Mixtures/Indoor Pollutants
   2. 3.2 Chemical, Biological, and Physical Stressors
4. 4. Impacts of Coexposure to Indoor Air Pollutants
5. 5. Health Risk Modifiers
6. 6. Conclusions
   1. 6.1 Major Health Stressors in the Indoor Environment
   2. 6.2 Main Sources
   3. 6.3 Exposure—Health Associations
   4. 6.4 The Way Forward
7. References

1. Introduction

Millions of Europeans in modern society spend approximately 90% of their time indoors, in their homes, workplaces, schools, and public spaces. It is estimated that approximately two-thirds of this time is spent at home. For many years, the housing environment has been acknowledged as one of the main settings affecting human health. Indoor air quality (IAQ), home safety, noise, humidity, mold growth, indoor temperature, volatile organic compounds (VOCs), lack of hygiene and sanitation equipment, and crowding are some of the most relevant health threats found in dwellings. Many health problems are either directly or indirectly related to the quality of the building, due to construction materials used and the equipment installed, or the size or design of the individual dwellings. The ENVIE project (Carrer et al., 2008) reviewed the main important projects on indoor air-related health effects. Based on this evidence the following diseases have been prioritized as being caused or aggravated by poor IAQ: allergic and asthma symptoms; lung cancer; chronic obstructive pulmonary disease; airborne respiratory infections; cardiovascular mortality and morbidity; and odor and irritation (sick building syndrome [SBS] symptoms).

Problems with building quality disproportionately affect vulnerable population groups in terms of socioeconomic status or class age. Despite undeniable improvements in the quality of indoor environments in the last 20 years, there are still many adverse health outcomes associated with these environments. This has become more evident due to rapid improvement in our understanding of health effects related to the indoor environment over the past decade. In previous years, discussions of indoor environmental quality focused on indoor air constituents (primarily particles, bioaerosols, and chemicals) and comfort factors (temperature, air flow, and humidity). However, despite the scientific progress in understanding the connection between indoor environments and health, such efforts still tend to be categorical; studies frequently tend to address a narrow range of both potential health stressors and associated health concerns, such as VOC exposure, respiratory problems, or injury. Only recently has the scientific community begun to look at the association between the built environment and human health as a complex interaction between building occupants (who they are and what they do) and an array of physical, chemical, biological, and socioeconomic factors. This new integrated vision should guide the development of “primary preventive” measures related to housing construction, renovation, use, and maintenance, which can promote better overall health and finally support the development of international guidance on “healthy housing” to help prevent a wide range of diseases and unintentional injuries that can be effectively addressed through better housing (as stated by an international consultation of 40 experts from 18 countries hosted by the World Health Organization [WHO] in Geneva in October 2010 (WHO, 2010a)). Herewith we aim to explore and emphasize the links between different exposure stressors and modifiers people are confronting in the indoor built environment. Accordingly, this chapter undertakes, summarizes, and presents literature and project reports presenting evidence of multiple or combined risk exposure in indoor built environments. This covers safety threats and injuries, indoor air pollution, use of household chemicals, noise, damp and mold, thermal conditions, crowding, inadequate hygiene standards, and harmful building and equipment/furnishing materials. For clarity reasons regarding the different challenges encountered in different indoor settings, the results are separated by environment type, referring to: (1) residential; (2) daycare; and (3) school and kindergarten settings. Relevant reports that are not necessarily available through journal databases are also incorporated to include recent evidence that might not be published in international literature. To give a better overview of the impact of combined or multiple exposure, we identify the most frequent combinations of stressors and modifiers, as well as the extent to which they affect the risk characterization ratio or the odds ratio (OR) for mortality/morbidity compared to si...