Nursing in the Anthropocene

The challenge for ethical practice in an age of environmental chaos

Enviro 610

McGill University

3 December 2012

Fiona Hanley RN, MSc.

“ Nursing has been limited to signify little more than the administration of medicines and the application of poultices.

It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet….

Nightingale: Notes on Nursing (1860)

• Air, water, soil pollution

• Population explosion

• Industrialised food production

• Land use conversion

• Overharvesting

• Chemical and radioactive substances

• Biodiversity loss & Invasive species

• Ozone Depletion

• Garbage: solid, liquid, airborne

• Climate Change

Anthropogenic Threats & Drivers

Nursing in Québec

• Education at CEGEP or university

• Competency based education

• Dec/Bacc program

• Licenced through Order of Nurses Québec

• Largest proportion of health care workforce in Canada • “ ….provide care directed first and foremost toward the health and

well-being of the person, family, or community in their care” (CNA Code of Ethics 2008 p 10)

• “…helps clients use and broaden their personal repertoire of

resources to maintain or improve their health and well-being” ( OIIQ, Outlook on the Practice of Nursing, p.13, 2004)

• Diversity of settings & responsibilities

• Focus at individual, family, community or population level • Health promotion, illness prevention, relief of suffering,

restoration of health, care of the dying

What do nurses do?

Nursing Worldviews

Humanistic and relational science

Knowledge:

• Empiric

• Personal

• Ethical

• Esthetic

• Emancipatory

Historical Legacy

• Florence Nightingale: Founder of modern nursing

• Advocated for nursing’s responsibilities on international stage – “Speaking truth to power”

• From experience in Crimea: legacy as ‘environmental pioneer’

• Idea of manipulating environment to affect health & well-being

• Air, water, food, ventilation, drainage, light

But a Missed Opportunity in contemporary health care….. Few Nurses talk to people about Environment and Health And most people don’t ask nurses about Environment & Health

Nursing Metaparadigm

Person

Health

Environment

Nursing

From CNA, 2012

WHY??

• Lack of attention to environmental factors as contributing to health or illness

• Lack of education • Focus on episodic care & lifestyle factors

– little “upstream” actions & or social dets of health

• Focus on egocentric vs ecocentric perspective • Gaps in understanding interrelations between

social, political, economic structure & origins of health & illness

• Theory inadequate in concept of environment • ‘culture of silence’

Why Nursing and EH?

• Strategically positioned: – Provide health care in schools, workplaces, homes

• Concern for health, well-being

• Care for most vulnerable

• A human relational science/discourse of holism

• Work with people affected by environment

• Access to people ill & well (live, work, play)

• Foundation in compassion, legacy from Nightingale

• Mandate for social justice

• Involved in systems that cause harm

• Health risks r/t work

• Environment as fundamental determinant of health and well-being (WHO, OC)

• Contamination of environment linked to wide range of health disorders

• Individual, family, population

• Include cancers, birth defects, respiratory, neurological, endocrine

• conditions such as Parkinson's, Alzhemiers, diabetes, obesity, ADHD, infertility, reproductive disorders

• Increased cancer in young people (20-44)

• COSTS

Pathways of Human Exposure

Health Canada 1998

Vulnerable Populations

Body Burden — The Pollution in Newborns

Cord Blood Contaminants in Minority Newborns

Body Burden.. What’s in Us?

Increasing congenital anomalies

Decrease of male : female sex ratio at birth

Increasing asthma and obesity

Increasing developmental disorders, cancers

Children’s Health Concerns

Breast Cancer

Endometriosis

Heart Disease

Fertility Challenges

Diabetes

Women’s Health Concerns

• Cancer

• Asthma

• Learning and Developmental Disorders

and Disabilities

• Birth Defects

• Testicular Dysgenesis Syndrome

Boy’s Health Concerns

• Occupational or home exposures can

affect child health outcomes Birth defects

Childhood cancer

Low birth weight

abortion

Fathers

Elderly

• Alzheimers • Parkinson’s • Dementia • Diabetes & Prediabetes • Metabolic Syndrome • Attention span deficits • Disruptive behaviour • Vascular Disease • Heart attacks (MI)

Environmental Threats to Healthy Aging: 2009 Boston PSR

Health Care Paradox

“It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm. .”

F. Nightingale: Notes on Nursing: What

It Is, and What It Is Not

Climate Change

• Heat or Cold Waves, sometimes fatal

• Extreme weather events: habitation loss

• ↑ air pollution, smog , pollen

• Cardiorespiratory disease

• Food and water supplies affected →famine & illness

• ↑ vector-borne disease

• Exacerbation of pre-existing disease (asthma)

• Conflicts –refugees • Mental Stress

Public Opinion

• Environment as important issue for Canadians (CMA, 2007).

• Parents seeking advice from Health Care practitioners about Environmental toxins.....but not receiving any

• Health professionals as trusted source of information

• Poll Pew (2007-2010) majority in every country polled says global warming is a problem or a threat & governments should give it a high priority.

What is Needed?

• Re-examination of relationship with nature & health • Global and Ecocentric health view • Precautionary Principle Approach • Re-thinking Ethics for environmental protection and

respect • Speaking out: Advocacy & leadership • Teaching, education, research, environmental health

assessments, policy, health care structures • Collaborations

– Health Care Without Harm – Canadian Association of Physicians for the Environment – International Council of Nurses – Canadian Nurses for Health and the Environment – Canadian Nurses Association – American Nurses for Healthy Environments

WHO 2008

Thank You!

Ottawa Charter 1986

• Recognition for importance of social conditions and resources on health

• Effective framework for EH promotion

• 5 specific areas for implementation: – Personal skills

– Supportive environments

– Community action

– Reorient health services

– Healthy public policy

• Individual, social, and environmental factors all influence health

http://www.euro.who.int/AboutWHO/Policy/20010827_2