The role of environmental health in disaster management: an overview and review of barriers and facilitators for action

Environmental health has a significant role to play in all stages of disaster management, from planning through to recovery. The conceptualizetion of the environmental health role by environmental health practitioners and other disciplines involved with disaster management is the focus of this review. To provide context for this discussion, we present an overview of disasters and disaster management and the public health and environmental health impact of disasters. The literature indicates that the role of environmental health in disaster management is not clearly conceptualized, and the following barriers have been identified: the continued emergence of environmental health as a professional discipline, ambiguity about environmental health functions in disasters, limited representation in disaster planning, low visibility profile of the profession, positioning of environmental health within public health, power and politics within agencies that result in a narrow assignment of the environmental health role, and a top-down approach to disaster management. The Australian experience indicates that if environmental health practitioners can overcome such barriers and increase their involvement in disaster management, then this achievement will raise the profile of the profession and renegotiate the environmental health role in disaster management. Ultimately, this success will also improve our capacity to manage disaster situations, and the higher profile, greater recognition, and representation of environmental health that is gained will then be able to flow into normal day-to-day activities.     

Learning from Each Other

Summary

Australian social workers in health care have become important members of hospital disaster response teams. The development of the role and its integration into the mainstream disaster response has progressed over the last two decades. Recent international events have given affirmation to the importance of this role.

The development of national and state based disaster management plans in Australia began in the mid 1970s. Recognition of the need for experienced, skilled workers to provide emotional support, practical assistance and grief and bereavement counselling has resulted in the inclusion of social workers in several key parts of the disaster management response including the specialised area of disaster victim identification.

Following the Bali Bombing in October 2002, social workers worked with the police missing persons unit to provide support to families and facilitate the collection of ante mortem information.

The process by which new services come about can be intricate and complex. In the field of health social work, the contribution of international programs such as the Mt. Sinai Leadership Enhancement Program cannot be underestimated. As the Social Work Director of Westmead Hospital, one of the largest hospital social work departments in the country, participating in this program provided opportunities to share professional experience with international colleagues, many of whom are experts in their field.

The social work role in disaster response has become internationally recognised and is an example of how collaboration and shared information and learning can result in a profession working together to support key principles and values of practice for the benefit of those in need.     

Quality management of occupational health services: The necessity of a powerful medical profession

Over the past few years there has been a growing interest inquality management in occupational health services. In thisarticle the central role of the medical profession in this areais highlighted from a personal point of view. It is argued thata powerful and active profession is needed as a countervailingpower in the field of tension between employees and the company,and for balancing the interests of these two main clients. Therefore,the medical profession should develop a policy on quality andapply quality management on national and local levels to reacha high professional level. In this way the profession can maintainthe clinical autonomy that is necessary to be a countervailingpower. Elements of such quality management are national guidelines,local peer review and intercolleagual visitation. These activitiesmust be incorporated in the quality management of the occupationalhealth services unit.     

Learning from each other: The social work role as an integrated part of the hospital disaster response

Australian social workers in health care have become important members of hospital disaster response teams. The development of the role and its integration into the mainstream disaster response has progressed over the last two decades. Recent international events have given affirmation to the importance of this role. The development of national and state based Disaster Management Plans in Australia began in the mid 1970's. Recognition of the need for experienced, skilled workers to provide emotional support, practical assistance and grief and bereavement counselling has resulted in the inclusion of social workers in several key parts of the disaster management response including the specialised area of Disaster Victim Identification. Following the Bali Bombing in October 2002, social workers worked with the Police Missing Persons Unit to provide support to families and facilitate the collection of ante mortem information. The process by which new services come about can be intricate and complex. In the field of health social work, the contribution of international programs such as the Mt Sinai Leadership Enhancement Program cannot be underestimated. As the Social Work Director of Westmead Hospital, one of the largest hospital social work departments in the country, participating in this program provided opportunities to share professional experience with international colleagues, many of whom are experts in their field. The social work role in disaster response has become internationally recognised and is an example of how collaboration and shared information and learning, can result in a profession working together to support key principles and values of practice for the benefit of those in need.     

Critical thinking among environmental health undergraduates and implications for the profession

During a study conducted in 2000-2002, the critical-thinking dispositions of undergraduate environmental health students at Illinois State University were found to have significant shortcomings. The critical-thinking-disposition scores were comparable to those of other undergraduates throughout the United States and Canada; nevertheless, these findings have significant implications for environmental health academic programs and the profession. Environmental health professionals commonly confront "ill-structured" problems, for which critical thiking is an essential skill. In addition, the challenges faced by the profession in terms of recognition, funding, and public support require a high level of critical thinking. This paper provides a number of recommendations for academic programs and professionals.     

A disputed occupational boundary: operating theatre nurses and Operating Department Practitioners

Traditionally, surgeons (and to a lesser extent anaesthetists) have been assisted primarily by nurses. This role has been threatened in recent years, in the UK NHS (and elsewhere), by a relatively new profession, that of the Operating Department Practitioner (ODP). The ODP profession is still in the process of establishing itself as a 'full' profession within UK health care. While occupational boundary disputes between professions are common in health care, it is unusual for them to become as overt as the dispute we will analyse in this paper. Drawing on fieldwork observations and interviews conducted in operating theatres, as well as documentary sources, we will show how this dispute arose, how it is manifested at both the micro and the macro level, and how both groups involved justify their positions, drawing on surprisingly similar rhetorical strategies. A further unusual feature of this dispute is the fact that, unlike many attempts by managers to substitute one type of labour for another, issues of cost are relatively unimportant, as both theatre nurses and ODPs earn similar salaries.     

Psychosocial and environmental factors in the prognosis of individuals with chronic pain and comorbid mental health

Chronic pain has considerable medical, social, and economic implications as its high prevalence rate and negative societal burden provides justification that it is a major health issue. The value of understanding psychological, social, and environmental factors in chronic pain has become widely recognized and accepted as a biopsychosocial phenomenon in which the social work perspective offers a valuable lens. Through the critical application of systems theory and ecological perspective, accompanied with the diathesis stress model, this article examines psychosocial and environmental influences as being contributory factors in the prognosis of individuals with chronic pain and comorbid mental health disorders. The social work profession will also be explored as playing a definite role in addressing elements pertaining to pain management depicted from these theories. Lastly, implications for research, policy, and practice will be reviewed to better understand the association between psychosocial and environmental influences of individuals with chronic pain and comorbid mental health issues.     

Swedish Medical Students' Views of the Changing Professional Role of Medical Doctors and the Organisation of Health Care

Medical students will influence future health care considerably. Their professional orientation while at medical school will be related to their future professional development. Therefore, it is important to study this group's view of the role of medical doctors, especially because Swedish health care is currently undergoing major changes and financial cut backs. Here, the theoretical framework was contemporary theories of competence development, which has shown that people's understanding of their work influences their actions. The aim of this study was to describe medical students' views of their future professional role in health care. In total, 57 fourth-year medical students at a Swedish university were asked to write a short essay about how they conceptualised their professional role in future health care. Fifty-three students (93%) replied. The essays were analysed qualitatively in three steps and four themes were subsequently identified: the professional role in change, organisation of health care, working conditions and the possibilities of having a balanced life. Some factors mentioned that would strongly influence the professional role were being team leader, increased specialisation, supporting the patient and computer science and technology. The students expressed ambiguous feelings about power and leadership. The results indicate that the students share a rather dark view of both the medical profession and health care, which seems to be related to stress and financial cut backs. Mentoring, time for reflection and changes in the curricula might be needed.     

卫生防护距离标准体系研究

目的研究制定卫生防护标准,使工业企业项目在投产后产生的污染物不影响居住区人群身体健康。方法在《国民经济行业分类》（GB／T4754—2002）基础上,介绍了定量计算、引用类比等方法研究制定我国卫生防护距离标准体系。结果利用该方法研究并制定了卫生防护距离标准体系,根据国家标准《国民经济行业分类》（GB／T4754—2002）中有关国民经济行业分类分析,其中可能产生有害气体无组织排放并需要设置卫生防护距离的有17大类。结论卫生防护距离体系标准有利于卫生行政部门、环境管理部门在卫生、环境管理方面的决策,同时在我国建设项目选址、建设项目评价等领域,为保障人民身体健康、促进国民经济可持续发展起到了积极作用。     

Evaluating the communication of environmental permitting decisions in diverse communities

Environmental communication plays a critical role in addressing the public's growing awareness and apprehension about environmental health risks. Although opportunities for public participation in environmental health assessments have greatly increased, environmental communication among key stakeholders is an evolving process. The authors evaluated the communication that occurred among a state environmental agency, six Title V operating facilities, and the public concerning environmental permitting decisions perceived to impact environmental and human health. The authors identify environmental concerns of diverse communities, analyze communication among key stakeholders regarding environmental permitting decisions, and propose recommendations for practitioners to improve environmental communication strategies among these key stakeholders in either urban or rural communities.     

Productivity improvement and job satisfaction among public health nutritionists.

A workshop for public health nutritionists which scrutinized ways to improve productivity and job satisfaction is reported. Participants believed that productivity could be improved most by improving the execution of tasks, followed by better planning of programs, office management, and skills in group education, and by delegation of non-professional activities to lesser-trained personnel. Job satisfaction of public health nutritionists could be increased by reducing stress and discomfort and promoting feelings of personal effectiveness and efficiency through role clarification and by management training. There is a large potential for greater productivity in the profession. Realization of this potential will contribute measurably to the cost-effectiveness of nutritional services.     

Keep calm and carry on: the 2009 NEHA sabbatical exchange ambassador report

Sabbatical goal as an environmental health specialist working with the California Department of Public Health as an emergency planner, I was interested in the NEHA sabbatical exchange program for the opportunity it affords its awardees to see how Canada and the United Kingdom utilize their environmental health workforce. Specifically, I wanted to examine the role environmental health has in the preparations being made for the 2012 Olympic Games to be held in London. I had a special interest in the emergency preparedness efforts related to the games as my work involves promoting the integration of environmental health into the emergency response structure. In California, environmental health services are delivered by several state agencies as well as 62 local jurisdictions. This multifaceted system tends to diminish the important role environmental health plays in disaster response and recovery operations due to the lack of a central focus, and as a result, environmental health is often an overlooked resource. This situation is not unique to California, as the emergency management system in the U.S. has traditionally focused primarily on "blue light" first responders: police, fire, and emergency medical services. After an article caught my eye on involving environmental health in emergency planning, posted on the Chartered Institute of Environmental Health (CIEH) (NEHA's counterpart in the UK) Web site, I became intrigued and used it to form the basis of my sabbatical mission.     

Health facilities safety in natural disasters: experiences and challenges from South East Europe

The United Nations named 2010 as a year of natural disasters, and launched a worldwide campaign to improve the safety of schools and hospitals from natural disasters. In the region of South East Europe, Croatia and Serbia have suffered the greatest impacts of natural disasters on their communities and health facilities. In this paper the disaster management approaches of the two countries are compared, with a special emphasis on the existing technological and legislative systems for safety and protection of health facilities and people. Strategic measures that should be taken in future to provide better safety for health facilities and populations, based on the best practices and positive experiences in other countries are recommended. Due to the expected consequences of global climate change in the region and the increased different environmental risks both countries need to refine their disaster preparedness strategies. Also, in the South East Europe, the effects of a natural disaster are amplified in the health sector due to its critical medical infrastructure. Therefore, the principles of environmental security should be implemented in public health policies in the described region, along with principles of disaster management through regional collaborations.     

A socio-ecological autopsy of the E. coli O157:H7 outbreak in Walkerton, Ontario, Canada

The socio-political context of modern environmental health disasters tends to be defined as being outside the scope of official public health and epidemiological investigations into the causes of such disasters. On the other hand, popular accounts of these disasters tend to focus exclusively on the role of particular individuals and/or political actors, while minimizing the role of ecological factors. It is argued that an exclusive focus on either set of causal factors gives an incomplete or distorted picture of the origins of an environmental health disaster. In this paper, a socio-ecological analysis is developed to demonstrate how the largest outbreak of waterborne E. coli O157:H7 in Canadian history was the emergent product of a complex interplay and intertwining of social and ecological processes. The socio-ecological autopsy approach that is developed here traces the social and ecological chain of events that ultimately led to the outbreak and demonstrates, in particular, the need for investigative analysis to focus on the socio-ecological "incubation" of an environmental health disaster. Drawing from both the social sciences (particularly, the sociology of disasters and organizational sociology), and from the ecological sciences (particularly disease ecology), the analysis developed here responds to the call for the application of a more transdisciplinary approach to the study of contemporary environmental health problems.     

医学生环境意识教育与和谐大学校园建设的探索

目的通过开展大学生环境意识教育及其教育效果评价,为构建和谐大学校园提供理论和实践方面的科学依据。方法选择医学院校四种专业的一年级和三年级的学生435人开展环境意识的问卷调查,其后开展一个月的环境意识教育,并对环境教育的效果进行评价。结果某医学院校大学生（医学生）环境知识的知晓率为68.4%;环境态度的合格率为33.0%;环境行为的合格率为35.4%。不同专业的环境知识知晓率有差异,预防医学、药学专业的环境知识知晓率均高于卫生事业管理专业。不同家庭所在地的大学生环境行为合格率有差异,城市学生的合格率高于农村。男生环境知识的知晓率高于女生。医学生在接受环境知识的教育后,临床医学和卫生事业管理专业学生对环境知识的知晓率明显升高,四种专业的医学生环境保护的态度均得以改善,除药学专业外,其他三个专业的环境行为合格率均明显增加。结论医学院校大学生环境知识的知晓率较高,环境态度和环境行为相对较差。大学生的专业、性别、家庭所在地对其环境意识水平有一定影响。环境教育可提升医学生环境知识的知晓率,改善其环境保护态度和环境保护行为,据此提出＂大一环境课程教育,大二环保活动参与,大三环保实践和调研,大四环保生产实习＂的校园环境意识教育的创新教育模式。     

The impact of the Prestige disaster on human health

The worst environmental disaster of the history of Spain favoured a renewed social awareness of the intimate relationships that exist between the state of the environment and the health of human beings. However, the health of the populations most involved in the Prestige oil spill was initially not the chief concern of political authorities. The main aims of the present paper are: first, to comment succinctly on some of the most significant activities conducted by a variety of social actors during the Prestige crisis; and second, to suggest the main potential objectives and characteristics of the epidemiological studies necessary to assess with a sound rational basis the possible impact of the accident on the health of workers, volunteers and residents in the spill areas. The authors hope that in the near future it will be possible to scientifically assess the results and implications of several studies (epidemiological and of other sorts) well designed and conducted.     

Guided-inquiry learning in environmental health

The field of environmental health requires the knowledge of many facts and terms, and it also requires mastery of an array of concepts that can be difficult for many students to thoroughly comprehend. Guided-inquiry learning is a process by which students "discover" basic concepts through active investigation. In this article, the authors describe several guided-inquiry learning modules used in their undergraduate environmental health program and their experience in using them. Some modules are used in professional courses while others are used in a general education course. Overall, the authors experienced increased student engagement and interest with guided-inquiry learning. Students are able to comprehend some abstract concepts more quickly and seem to retain the concepts longer.     

Training Occupational Therapy Managers

There is a need for occupational therapists to become competent managers in a diverse range of health care settings. In this paper, the author's continuing education course on management which they have conducted at the West Australian Institute of Technology (now Curtin University of Technology) over the past four years. Details of participants, their reasons for attending and their comments on the course are included. The authors emphasise the need for more continuing education in management and the provision of skills for coping with organisational life, in particular in a female dominated profession such as occupational therapy.     

Evidence-based medicine and its implications for the profession of chiropractic

Evidence-based medicine (EBM) has grown in popularity and prominence in the world of orthodox medicine since the 1980s. The focus of this article is on the process of developing practice guidelines (one type of EBM) and its effects upon chiropractic, a profession with a "philosophy, science and art" that is constructed upon divergent epistemological and methodological tenets (namely, the idea of "vitalism"). The EBM movement is conceptualized as part of a larger political economy surrounding the health care environment that creates a new set of imperatives for orthodox medicine, and also branches of alternative medicine that are in the process of professionalization. The quantitative, positivist and empiricist assumptions of EBM dictate which approaches to treatment and which clinical procedures are legitimate and perhaps reimbursable under systems of managed care. The ramifications of practice guidelines and its effects upon the intraprofessional segments of the chiropractic profession are also discussed.     

Management policy-making for work and education in health: the case of the Bahia State Health Department, Brazil, 2007-2008

The construction of Brazil's Unified National Health System (SUS) has raised a set of challenges for the health sector's administrators and personnel, including issues of work management and continuing education for health workers, in view of the financial, political, and organizational constraints in the process of changing the healthcare model. The current study aimed to analyze the process of formulating the Health Work and Education Management Policy by the Bahia State Health Department. Public policy cycle was used as the theoretical framework. The study analyzed data from institutional documents and records of participant observation by one of the authors. The results include mapping the governmental and nongovernmental stakeholders that participated in the process. The analysis highlights a series of problems in the SUS in Bahia related to work management and health workers' profile, taken as the point of departure for priority-setting in the State Strategic Agenda and Health Plan for 2008-2011.