RN No HarmRN No HarmEnvironmental HealthEnvironmental Health

September 21, 2005 September 21, 2005

Alexandria, VirginiaAlexandria, Virginia

Introduction to the ProjectIntroduction to the Project

• In July, 2002,In July, 2002, the Beldon Fund the Beldon Fund Foundation awarded a grant to the Foundation awarded a grant to the American Nurses Association (ANA) American Nurses Association (ANA)

through American Nurses Foundation through American Nurses Foundation (ANF) for an exciting new (ANF) for an exciting new

environmental health project called environmental health project called

• RN No HarmRN No Harm. .

Nurses as Environmental Nurses as Environmental Health AdvocatesHealth Advocates

• The RN No Harm projectThe RN No Harm project seeks to seeks to activate nurses as environmental activate nurses as environmental

health advocates. health advocates. • Nurses are already patient advocatesNurses are already patient advocates

• ANA views nurses as potentially ANA views nurses as potentially powerful voices for the environmentpowerful voices for the environment

• Environmental Advocacy - Environmental Advocacy - community as patientcommunity as patient

Nursing, health and the Nursing, health and the environment IOM Report environment IOM Report

• 1995 published: Pope, 1995 published: Pope, Snyder, Mood.Snyder, Mood.

• General environmental General environmental health competencies health competencies for nursesfor nurses– Basic knowledge & Basic knowledge &

conceptsconcepts– Assess and referAssess and refer– Advocacy, ethics, and Advocacy, ethics, and

risk communicationrisk communication– Legislation & regulationLegislation & regulation

• Freedom from Freedom from illness or injury illness or injury related to exposure related to exposure to toxic agents and to toxic agents and other other environmental environmental conditions that are conditions that are detrimental to detrimental to human healthhuman health

Significance: What we knowSignificance: What we know

Heritability estimates in Heritability estimates in 28 types of cancer 28 types of cancer examined in 45,000 examined in 45,000 twin pairstwin pairs

• 0% heritability (100% 0% heritability (100% for environmental) for for environmental) for cervical cancercervical cancer

• 27% (73%) for breast27% (73%) for breast

• 42% (58%) for 42% (58%) for prostrateprostrate

“ “ . . .the overwhelming . . .the overwhelming contribution to the contribution to the causation of cancer in causation of cancer in the populations we the populations we studied was the studied was the environment”environment”

Lichtenstein et al. NEJM, Lichtenstein et al. NEJM, 2000:343 (20).2000:343 (20).

Significance: what we knowSignificance: what we know

• Environmentally Environmentally attributable fraction attributable fraction for 4 pediatric for 4 pediatric conditionsconditions

Lead poisoning = 100%Lead poisoning = 100%

Asthma =~ 30%Asthma =~ 30%

Cancer = ~ 5%Cancer = ~ 5%

Neurobehavioral =10%Neurobehavioral =10%

Annual cost = $54.9 Annual cost = $54.9 billionbillion

Landrigan et al. Landrigan et al. “Children’s health and “Children’s health and the environment”the environment”

Environmental Health Environmental Health

Perspectives, 2004.Perspectives, 2004.

SignificanceSignificance

• Louisiana known as Louisiana known as “cancer alley” as a “cancer alley” as a result of the result of the petroleum and petroleum and polyvinyl chloride polyvinyl chloride manufacturing manufacturing The ‘oily dog’The ‘oily dog’

Foundations in PolicyFoundations in Policy

• ANA Positions (www.nursingworld.org)ANA Positions (www.nursingworld.org)– 1997 HOD Report: Reduction of Health Care 1997 HOD Report: Reduction of Health Care

Production of Toxic PollutionProduction of Toxic Pollution– 2003 Precautionary Principle2003 Precautionary Principle– 2004 Environmental Health Principles in Nursing 2004 Environmental Health Principles in Nursing

• AORN Recommended Practices for AORN Recommended Practices for Environmental ResponsibilityEnvironmental Responsibility

• ICN Position Statements (www.icn.ch)ICN Position Statements (www.icn.ch)– 1986 Nursing and the Natural Environment1986 Nursing and the Natural Environment– 1998 Medical Waste: Role of Nurses and Nursing1998 Medical Waste: Role of Nurses and Nursing– 2003 Access to Safe Water2003 Access to Safe Water

ANA ActionsANA Actions

• 1997 Joined HCWH: Campaign for 1997 Joined HCWH: Campaign for Environmentally responsible health careEnvironmentally responsible health care

• 1998 Participate in negotiation of MOU 1998 Participate in negotiation of MOU between AHA and EPA creating H2Ebetween AHA and EPA creating H2E– Minimize waste volume & toxicityMinimize waste volume & toxicity– Eliminate mercury use by 2005Eliminate mercury use by 2005

• 2002 RN No Harm project launched2002 RN No Harm project launched

• 2005 Lawsuit against EPA over mercury 2005 Lawsuit against EPA over mercury emissionemission

SuccessesSuccesses

• Get the lead out! Of Get the lead out! Of gasoline resulted in gasoline resulted in decreased lead levels decreased lead levels in childrenin children

• Closure of 700 medical Closure of 700 medical waste incinerators led waste incinerators led to reductions in dioxin to reductions in dioxin emissionsemissions

• DDT ban resulted in DDT ban resulted in the Bald Eagle’s the Bald Eagle’s removal from removal from endangered species listendangered species list

Beldon Fund Vision & Beldon Fund Vision & MissionMission

• Our vision for the future is a planet Our vision for the future is a planet with healthy people living in healthy with healthy people living in healthy

ecosystems.ecosystems.

• By supporting effective, nonprofit By supporting effective, nonprofit advocacy organizations, the Beldon advocacy organizations, the Beldon

Fund seeks to build a national Fund seeks to build a national consensus to achieve and sustain a consensus to achieve and sustain a

healthy planet.healthy planet.

““No amount of No amount of medical medical knowledge will knowledge will lessen the lessen the accountability for accountability for nurses to do what nurses to do what nurses do, that is, nurses do, that is, manage the manage the environment to environment to promote positive promote positive life processes.”life processes.”

ResourcesResources

• www.Nursingworld.owww.Nursingworld.org/rg/

rnnoharmrnnoharm or or gova/state.htmgova/state.htm

• www.enviRN.umarylwww.enviRN.umaryland.eduand.edu

• Noharm.orgNoharm.org• H2e-online.orgH2e-online.org• SustainablehospitalsSustainablehospitals

.org.org• Cheforhealth.orgCheforhealth.org