Skip to main content
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2002 Apr;94(4):185–193.

Environmental factors influencing public health and medicine: policy implications.

Rueben Warren 1, Bailus Walker Jr 1, Vincent R Nathan 1
PMCID: PMC2594229  PMID: 11995631

Abstract

Environmental health threats are increasing throughout the United States, particularly in low-income populations and in communities of color. Environmental science researchers are investigating plausible associations between the environment and human health. As a result, the role and responsibility of the primary care physicians and other health care providers are changing. This paper highlights selected lines of evidence suggesting that clinicians should now consider interactions between humans and their environment as central to providing effective primary care. Subject areas include: exposure to environmental agents, reproductive toxicity, pulmonary disease, neurobehavioral toxicity, endocrine disruptors, mechanisms of environmental disease, and cultural competence. Concerns about these and other environmentally related issues influence the manner in which primary care is practiced now, and will be practiced in the future. Biomedical technology and community awareness demand that physicians pay more attention to advances in environmental medicine. Ironically, one of the least taught subjects in medical school is environmental medicine. To effectively respond to growing concerns about the role of the environment in human health, clinicians, researchers, educators, public policy officials, and the general public must join together to reduce the risk of environmental health threats and improve quality of life.

Full text

PDF
185

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abbott B. D., Birnbaum L. S., Diliberto J. J. Rapid distribution of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) to embryonic tissues in C57BL/6N mice and correlation with palatal uptake in vitro. Toxicol Appl Pharmacol. 1996 Nov;141(1):256–263. doi: 10.1006/taap.1996.0282. [DOI] [PubMed] [Google Scholar]
  2. Achanzar W. E., Diwan B. A., Liu J., Quader S. T., Webber M. M., Waalkes M. P. Cadmium-induced malignant transformation of human prostate epithelial cells. Cancer Res. 2001 Jan 15;61(2):455–458. [PubMed] [Google Scholar]
  3. Adami H. O., Bergström R., Möhner M., Zatoński W., Storm H., Ekbom A., Tretli S., Teppo L., Ziegler H., Rahu M. Testicular cancer in nine northern European countries. Int J Cancer. 1994 Oct 1;59(1):33–38. doi: 10.1002/ijc.2910590108. [DOI] [PubMed] [Google Scholar]
  4. Adami H. O., Lipworth L., Titus-Ernstoff L., Hsieh C. C., Hanberg A., Ahlborg U., Baron J., Trichopoulos D. Organochlorine compounds and estrogen-related cancers in women. Cancer Causes Control. 1995 Nov;6(6):551–566. doi: 10.1007/BF00054165. [DOI] [PubMed] [Google Scholar]
  5. Ashby J., Houthoff E., Kennedy S. J., Stevens J., Bars R., Jekat F. W., Campbell P., Van Miller J., Carpanini F. M., Randall G. L. The challenge posed by endocrine-disrupting chemicals. Environ Health Perspect. 1997 Feb;105(2):164–169. doi: 10.1289/ehp.97105164. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Atkinson R. W., Anderson H. R., Sunyer J., Ayres J., Baccini M., Vonk J. M., Boumghar A., Forastiere F., Forsberg B., Touloumi G. Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Air Pollution and Health: a European Approach. Am J Respir Crit Care Med. 2001 Nov 15;164(10 Pt 1):1860–1866. doi: 10.1164/ajrccm.164.10.2010138. [DOI] [PubMed] [Google Scholar]
  7. Bonvallot V., Baeza-Squiban A., Baulig A., Brulant S., Boland S., Muzeau F., Barouki R., Marano F. Organic compounds from diesel exhaust particles elicit a proinflammatory response in human airway epithelial cells and induce cytochrome p450 1A1 expression. Am J Respir Cell Mol Biol. 2001 Oct;25(4):515–521. doi: 10.1165/ajrcmb.25.4.4515. [DOI] [PubMed] [Google Scholar]
  8. Brown D. M., Wilson M. R., MacNee W., Stone V., Donaldson K. Size-dependent proinflammatory effects of ultrafine polystyrene particles: a role for surface area and oxidative stress in the enhanced activity of ultrafines. Toxicol Appl Pharmacol. 2001 Sep 15;175(3):191–199. doi: 10.1006/taap.2001.9240. [DOI] [PubMed] [Google Scholar]
  9. Castoldi A. F., Coccini T., Ceccatelli S., Manzo L. Neurotoxicity and molecular effects of methylmercury. Brain Res Bull. 2001 May 15;55(2):197–203. doi: 10.1016/s0361-9230(01)00458-0. [DOI] [PubMed] [Google Scholar]
  10. Davey Smith G., Ebrahim S. Epidemiology--is it time to call it a day? Int J Epidemiol. 2001 Feb;30(1):1–11. doi: 10.1093/ije/30.1.1. [DOI] [PubMed] [Google Scholar]
  11. Donaldson K., MacNee W. Potential mechanisms of adverse pulmonary and cardiovascular effects of particulate air pollution (PM10). Int J Hyg Environ Health. 2001 Jul;203(5-6):411–415. doi: 10.1078/1438-4639-00059. [DOI] [PubMed] [Google Scholar]
  12. Ekman P. Genetic and environmental factors in prostate cancer genesis: identifying high-risk cohorts. Eur Urol. 1999;35(5-6):362–369. doi: 10.1159/000019910. [DOI] [PubMed] [Google Scholar]
  13. Frampton Mark W., Boscia Joseph, Roberts Norbert J., Jr, Azadniv Mitra, Torres Alfonso, Cox Christopher, Morrow Paul E., Nichols Joan, Chalupa David, Frasier Lauren M. Nitrogen dioxide exposure: effects on airway and blood cells. Am J Physiol Lung Cell Mol Physiol. 2002 Jan;282(1):L155–L165. doi: 10.1152/ajplung.2002.282.1.L155. [DOI] [PubMed] [Google Scholar]
  14. Gilbert M. E. Repeated exposure to lindane leads to behavioral sensitization and facilitates electrical kindling. Neurotoxicol Teratol. 1995 Mar-Apr;17(2):131–141. doi: 10.1016/0892-0362(94)00064-k. [DOI] [PubMed] [Google Scholar]
  15. Gore A. C. Environmental toxicant effects on neuroendocrine function. Endocrine. 2001 Mar;14(2):235–246. doi: 10.1385/ENDO:14:2:235. [DOI] [PubMed] [Google Scholar]
  16. Hawkes W. C., Turek P. J. Effects of dietary selenium on sperm motility in healthy men. J Androl. 2001 Sep-Oct;22(5):764–772. [PubMed] [Google Scholar]
  17. Hoek G., Fischer P., Van Den Brandt P., Goldbohm S., Brunekreef B. Estimation of long-term average exposure to outdoor air pollution for a cohort study on mortality. J Expo Anal Environ Epidemiol. 2001 Nov-Dec;11(6):459–469. doi: 10.1038/sj.jea.7500189. [DOI] [PubMed] [Google Scholar]
  18. Iyengar G. V., Rapp A. Human placenta as a 'dual' biomarker for monitoring fetal and maternal environment with special reference to potentially toxic trace elements. Part 3: toxic trace elements in placenta and placenta as a biomarker for these elements. Sci Total Environ. 2001 Dec 3;280(1-3):221–238. doi: 10.1016/s0048-9697(01)00827-0. [DOI] [PubMed] [Google Scholar]
  19. Kilburn K. H. A paradigm for environmental epidemiology: why are effects of environmental exposures different from occupational effects? Arch Environ Health. 2000 Sep-Oct;55(5):295–296. doi: 10.1080/00039890009604019. [DOI] [PubMed] [Google Scholar]
  20. Long C. M., Suh H. H., Kobzik L., Catalano P. J., Ning Y. Y., Koutrakis P. A pilot investigation of the relative toxicity of indoor and outdoor fine particles: in vitro effects of endotoxin and other particulate properties. Environ Health Perspect. 2001 Oct;109(10):1019–1026. doi: 10.1289/ehp.011091019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Mattingly R. R., Felczak A., Chen C. C., McCabe M. J., Jr, Rosenspire A. J. Low concentrations of inorganic mercury inhibit Ras activation during T cell receptor-mediated signal transduction. Toxicol Appl Pharmacol. 2001 Nov 1;176(3):162–168. doi: 10.1006/taap.2001.9272. [DOI] [PubMed] [Google Scholar]
  22. Mott L. The disproportionate impact of environmental health threats on children of color. Environ Health Perspect. 1995 Sep;103 (Suppl 6):33–35. doi: 10.1289/ehp.95103s633. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Moynihan J. A., Ader R. Psychoneuroimmunology: animal models of disease. Psychosom Med. 1996 Nov-Dec;58(6):546–558. doi: 10.1097/00006842-199611000-00003. [DOI] [PubMed] [Google Scholar]
  24. Murata J. E., Patrick Mace J., Strehlow A., Shuler P. Disease patterns in homeless children: a comparison with national data. J Pediatr Nurs. 1992 Jun;7(3):196–204. [PubMed] [Google Scholar]
  25. Nazarenko D. A., Dertinger S. D., Gasiewicz T. A. In vivo antagonism of AhR-mediated gene induction by 3'-methoxy-4'-nitroflavone in TCDD-responsive lacZ mice. Toxicol Sci. 2001 Jun;61(2):256–264. doi: 10.1093/toxsci/61.2.256. [DOI] [PubMed] [Google Scholar]
  26. Nguyen T., Thomas W., Zhang X. D., Gray C., Hersey P. Immunologically-mediated tumour cell apoptosis: the role of TRAIL in T cell and cytokine-mediated responses to melanoma. Forum (Genova) 2000 Jul-Sep;10(3):243–252. [PubMed] [Google Scholar]
  27. Perera F. P. Environment and cancer: who are susceptible? Science. 1997 Nov 7;278(5340):1068–1073. doi: 10.1126/science.278.5340.1068. [DOI] [PubMed] [Google Scholar]
  28. Rohlman D. S., Anger W. K., Tamulinas A., Phillips J., Bailey S. R., McCauley L. Development of a neurobehavioral battery for children exposed to neurotoxic chemicals. Neurotoxicology. 2001 Oct;22(5):657–665. doi: 10.1016/s0161-813x(01)00049-3. [DOI] [PubMed] [Google Scholar]
  29. Shannon M. Lead poisoning treatment--a continuing need (commentary). J Toxicol Clin Toxicol. 2001;39(7):661–663. doi: 10.1081/clt-100108506. [DOI] [PubMed] [Google Scholar]
  30. Telisman S., Cvitković P., Jurasović J., Pizent A., Gavella M., Rocić B. Semen quality and reproductive endocrine function in relation to biomarkers of lead, cadmium, zinc, and copper in men. Environ Health Perspect. 2000 Jan;108(1):45–53. doi: 10.1289/ehp.0010845. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Verdina A., Galati R., Falasca G., Ghittori S., Imbriani M., Tomei F., Marcellini L., Zijno A., Vecchio V. D. Metabolic polymorphisms and urinary biomarkers in subjects with low benzene exposure. J Toxicol Environ Health A. 2001 Dec 21;64(8):607–618. doi: 10.1080/152873901753246214. [DOI] [PubMed] [Google Scholar]
  32. de la Taille A., Katz A., Vacherot F., Saint F., Salomon L., Cicco A., Abbou C. C., Chopin D. K. Cancer de la prostate: influence des facteurs nutritionnels. Vitamines, antioxydants et oligo-éléments. Presse Med. 2001 Mar 24;30(11):557–560. [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES