Upstream Reflections on Environmental Health: An Abbreviated History and Framework for Action

Abstract

Upstream thinking considers the social, economic, and environmental origins of health problems that manifest at the population level. The upstream thinking perspective is applied to an examination of environmentally associated health problems and the opportunities that citizens have (or do not have) to access information and resources to make health-promoting choices in response to environmental health risks. A proposed framework for nurses to reduce environmental health risks includes distributive and strategic actions. Distributive actions include tracking, embedding, and translating; strategic actions include discovering through etiologic research, discovering through community-based research, advocating, and reframing. Together these actions can help formalize nursing's role in responding to citizens' concerns about environmental health problems.

Talking With Patients About Environmental Health

“…Descriptive data were also used to identify the sociodemographic, health, and environmental characteristics associated with the 11 census tracts. After a careful review of the distribution of scores for the item, "I talk to nurses or doctors about how to reduce the effects of pollution on my health," this item was dichotomized into 2 categories: "Little or no talk" to provider (0-3) and "More talk" to provider (4)(5)(6)(7)(8)(9)(10). This dichotomized variable was then used as criterion in the bivariate analysis.…”

“…Extra attention needs to be given to those individuals considered to belong to groups with heightened vulnerabilities including children, the chronically ill, or urban residents. 7,13 The second area, "Teach," reminds the nurse to instruct the patient about how work and home environments may affect their health. Content needs to include information on how individuals should self-monitor symptoms: types of symptoms, times of symptoms, and frequency of symptoms.…”

“…Because nursing does not regularly practice from a true holistic perspective in terms of environmental health, further studies are necessary to clarify the role of nursing in environmental health as it is now in order to envision how this role could be enhanced to achieve its fuller potential. 3,4,7 …”

Emphasizing Sustainable Health and Wellness in a Health Education Curriculum

“…About 23% to 33% of the global burden of disease (years of life lost to ill health) is linked to environmental sources. 8 Using air quality standards established by the World Health Organization (WHO), it is estimated that 1.3 billion of the world's urban inhabitants breathe air that does not meet these quality standards. Environmental factors are thought to contribute to many forms of cancer including cervical, prostate, and breast cancers.…”

“…Elevated blood levels of lead continue to be an important problem in the United States with nearly 1 million children exceeding the threshold for acceptable blood lead levels. 8,9 Healthy People 2010 goals and objectives address a number of environment-related issues such as health problems related to air quality, use of pesticides and herbicides, water quality, toxic chemicals and waste, as well as the infrastructure and surveillance of healthy homes and communities. 10 The recent wave of environmental concern has drawn attention to population growth, industrialization, and urbanization.…”