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Environmental Quality
The environment directly affects health status and plays a major role in quality of life, years of healthy life lived, and health disparities. Poor air quality is linked to premature death, cancer, and long-term damage to respiratory and cardiovascular systems. Secondhand smoke containing toxic and cancer-causing chemicals contributes to heart disease and lung cancer in nonsmoking adults. Globally, nearly 25% of all deaths and the total disease burden can be attributed to environmental factors.1
Poor environmental quality has its greatest impact on people whose health status is already at risk. For example, nearly 1 in 10 children and 1 in 12 adults in the United States have asthma, which is caused, triggered, and exacerbated by environmental factors such as air pollution and secondhand smoke. Yet:
Approximately 127 million people in the United States live in counties that exceed national air quality standards.2
88 million nonsmokers are exposed to secondhand smoke each year.3
Safe air, land, and water are fundamental to a healthy community environment. An environment free of hazards, such as secondhand smoke, carbon monoxide, allergens, lead, and toxic chemicals, helps prevent disease and other health problems. Implementing and enforcing environmental standards and regulations, monitoring pollution levels and human exposures, building environments that support healthy lifestyles, and considering the risks of pollution in decision-making can improve health and quality of life for all Americans.
The Environmental Quality Leading Health Indicators are:
Health Impact of Environmental Quality
Poor air quality contributes to cancers, cardiovascular disease, asthma, and other illnesses. Poor water quality can lead to gastrointestinal illness and a range of other conditions, including neurological problems and cancer. Some chemicals in and around homes and workplaces can contribute to acute poisonings and other toxic effects.
The built environment (such as schools, parks, greenways, and transportation systems) affects both individual health and environmental quality. For example, supporting bicycling as a primary mode of transportation increases physical activity and reduces pollution and accidents from motor vehicles.4
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Environmental Quality Across the Life Stages
Living environments, including housing and institutional settings, can support health across the life span, from infancy through old age.
Infants and Children
Exposures to environmental and occupational hazards before and during pregnancy can increase the risk of subsequent health problems for infants and children. These problems include birth defects, developmental disabilities, and childhood cancer.5, 6
Children may be more vulnerable to environmental exposures than adults because their bodily systems are still developing and their behavior can expose them more to chemicals and organisms.6
Asthma is the third ranking cause of non-injury-related hospitalization among children age 14 and younger.
Childhood lead poisoning reduces IQ, which can never be regained. Recent studies suggest that children with blood lead levels well below the Federal standard (10 ug/dl) can suffer from diminished IQ and effects on behavior.5
Adults
Work-related factors, including occupational exposures to chemicals, excessive heat or cold, and noise, can create or worsen a variety of health problems, including cancer, chronic obstructive pulmonary disease (COPD), asthma, and heart disease.
Older Adults
Environmental hazards, including extreme temperatures, air quality, and pollution, can pose a significant risk to older adults, especially those with COPD or asthma.
Determinants of Environmental Quality
Many environments in which people live, work, and play expose them to pollution and hazards. Fortunately, homes, communities, workplaces, and schools can be designed to promote healthy choices and improve safety. Healthy community design can improve people’s health and safety by:
Improving air and water quality
Decreasing mental health stresses
Strengthening the social fabric of a community
Providing fair access to employment opportunities, education, and resources
Increasing options for physical activity and healthful diets
Decreasing injuries and accidents
The ability to live in an area with high environmental quality is associated with gender, age, education level, income, race and ethnicity, and geographic location. Many health-related hazards (like mold, allergens, poor indoor air quality, structural deficiencies, and lead) are disproportionately found in low-income housing. Addressing these determinants is key in reducing health disparities and improving the health of all Americans. Efforts are needed to overcome barriers to improving environmental quality.
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Disparities and Environmental Quality
Some populations are disproportionately exposed to environmental hazards. As a result, health disparities exist.
In 2005 to 2008, children age 3 to 11 with private medical insurance had the lowest (best) rate of exposure to secondhand smoke (43.1%). Children with public medical insurance had an exposure rate of 66.4% and children with no medical insurance had a rate of 55.3%.
In 2005 to 2008, children age 3 to 11 who were not obese had a lower (better) rate of exposure to secondhand smoke than children who were obese (50.4% versus 62.1%).
In 2010, non-Hispanic black children were more likely to have asthma (16%) than Hispanic children (8%) or non-Hispanic white children (8%).7
About the Disparities Data
Air Quality (EH-1)
Data for this measure are available annually from the Air Quality System (formerly the Aerometric Information Retrieval System), U.S. Environmental Protection Agency.
The Air Quality Index (AQI) is a tool to let the public know how clean or polluted their air is and what associated health effects might be a concern. The AQI is a numerical scale ranging from 0 to 500. The higher the AQI value, the greater the level of air pollution and the greater the health concern. AQI values below 100 are generally thought of as satisfactory.
Secondhand Smoke Exposure in Children (TU-11.1)
Data for this measure are from the National Health and Nutrition Examination Survey, Centers for Disease Control and Prevention, National Center for Health Statistics.
Children are considered “exposed” to secondhand smoke if they had a serum cotinine level between 0.05 and 10 ng/ml.
All disparities described are statistically significant at the 0.05 level of significance.
References
1 Prüss-Üstün A, Corvalán C. Preventing Disease Through Healthy Environments . Geneva, Switzerland: World Health Organization; 2006. Available from http://www.who.int/quantifying_ehimpacts/publications/preventingdisease.pdf [PDF - 8.4MB]
2 U.S. Environmental Protection Agency. Our Nation’s Air: Status and Trends Through 2008 . Washington, DC: 2010. Available from http://www.epa.gov/airtrends/2010
3 Office of Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Tobacco use: smoking and secondhand smoke. CDC Vital Signs . Atlanta, GA: 2010. Available from http://www.cdc.gov/vitalsigns/pdf/2010-09-vitalsigns.pdf [PDF - 4.43MB]
4 Centers for Disease Control and Prevention. CDC Transportation Recommendations . Atlanta, GA: 2010. Available from http://www.cdc.gov/transportation
5 U.S. Environmental Protection Agency. Fast Facts on Children’s Environmental Health . Washington, DC: 2008. Available from http://yosemite.epa.gov/ochp/ochpweb.nsf/content/fastfacts.htm
6 Office on Women’s Health, U.S. Department of Health and Human Services. The Environment and Women’s Health Fact Sheet . Washington, DC: 2009. Available from http://womenshealth.gov/publications/our-publications/fact-sheet/environment-womens-health.cfm
7 National Center for Health Statistics, Centers for Disease Control and Prevention. Summary Health Statistics for U.S. Children: National Health Interview Survey, 2010. Vital Health Stat . 2011;10(250):16. Available from http://www.cdc.gov/nchs/data/series/sr_10/sr10_250.pdf [PDF - 714KB]
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