Environmental Epidemiology, Volume 2 Use of the Gray Literature and Other Data in Environmental Epidemiology (1997) / Chapter Skim
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1 Environmental Epidemiology: The Context
1 Environmental Epidemiology: The Context
Pages 1-11
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The twin focus on the gray literature and epidemiologic methods fulfills the charge to the committee for its second report to examine state health-department reports and similar analyses that are not generally available in the peer-reviewed literature. As undertaken by the committee, the examination of the gray literature involves developing criteria for
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The World Bank estimates that 1 billion people lack safe water, 1.7 billion are without adequate sanitation, 1.3 billion are exposed to unsafe soot and smoke, and 700 million women and children are exposed to severe air pollution from cooking fires (World Bank, 1992~. The incomplete understanding of causes of many common chronic diseases in both developed and developing countries fuels interest in identifying avoidable environmental hazards.
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Thus, a top priority for environmental-health research is to identify better ways to look for environmental factors that may contribute to disease. DEFINITION OF ENVIRONMENTAL EPIDEMIOLOGY Modern epidemiology, the study of disease patterns in populations, encompasses a broad array of subject matter, including subspecialties that concentrate on such domains as clinical trials of pharmaceutical agents; such outcomes as reproductive and developmental effects, infectious diseases, and chronic diseases; such risk factors as occupation, nutrition, and alcoholism; and special populations.
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This report considers the needs for research in environmental epidemiology in general, extends the assessment of information on the health effects of exposures from hazardous wastes started in the first volume up to the middle 1990s, and includes selected reports in the gray literature. Most of the gray literature examined here comes from state-generated studies or, if they are available to the public, analyses conducted by researchers for use in legal proceedings.
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SPECIAL ISSUES FOR THE STUDY OF ENVIRONMENTAL EPIDEMIOLOGY As indicated in the first report, an optimal analysis of potential public-health consequences of suspect exposures proceeds from an assessment of past, current, or future exposures to the formulation of testable hypotheses of effects to be studied in one or more specific populations. An ideal environmental-epidemiology assessment considers all possible adverse health effects in exposed and unexposed persons and includes relevant contributing factors, including those that could confound, or interfere
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Large sample sizes and long-term followup studies are generally necessary to demonstrate potentially serious effects that involve small increases in relative risk. The chronic effects of ozone exposure and the acute effects of particulate air pollution are instances in which the relative risk may be small, but the population disease burden may be substantial.
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Similarly, hospital admissions for asthma in children were cut in half in a Utah valley when a steel mill closed down, and admissions returned to their previous level when it reopened; this was also not detected by clinicians or the state health department but required the examination of hospitalization data by an investigator (Pope, 1991~. DEVELOPING RELEVANT EXPOSURE GRADIENTS Exposures to synthetic organic chemicals and other modern products cannot be accurately segregated by source, such as air, water, or soil.
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Thus, public-health departments may be asked to study diseases of unknown etiology where there may be insufficient evidence to incriminate the hazardous-waste site or an alternate source and for which there has often been insufficient time since initial exposures (if indeed the exposures were from a waste site) for the presumed latent period to be exceeded.
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Severe indoor particulate air pollution has been documented in the developing world at levels 100 times higher than the US standard of 150 ,ug/m3 for particles less than 10 ,um in diameter (PM~ of, and outdoor pollution is also sometimes extreme. These high levels of air pollution, coupled with other disadvantages in the developing world, may account for the fact that acute respiratory disease is the second leading cause of death in children under 5 years of age in countries of the developing world (Leowski, 1986~.
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However, in many instances, diseases of possible environmental etiology cannot be examined in relation to environmental factors until baseline disease incidences have been determined and appropriate measures or estimates of exposure have been developed. Study of the health outcomes associated with environmental exposures suffers from a lack of sophisticated technology for assessing chronic effects, from basic methodologic limits of study designs, and from the highly charged climate in which such studies are at times conducted.
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Public Health and Hazardous Wastes. Washington, DC: National Academy Press.
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