Primary Prevention

Protecting the health of infants and children from the impact of environmental contaminants has become a compelling priority in recent years. Physicians are particularly well situated to play an essential part in furthering that goal, and they can contribute in a number of different capacities that extend their traditional role as healer.1

Clinicians often detect cases of environmental illness and thereby bring attention to exposures that might have widespread consequences.
They routinely counsel patients on the risks of exposures and therefore must frequently interpret and translate research findings.
Canadian public opinion studies have demonstrated that people trust their doctors as highly credible sources of information about environmental health risks.
Physicians can bring awareness to children’s environmental health issues and can help people understand the connections between their behaviour and subsequent effects on the environment and human health.
They can help engender a major shift in the public mindset to seeing that our survival depends on working with natural systems, not at cross-purposes to them.
Physicians are also increasingly involved as extremely effective and vocal leaders in advocating for children’s health at both the public health and policy levels.
The medical dictum, “first, do no harm,” harmonizes well with the precautionary paradigm that is crucial to protecting children’s health in the face of the enormous scientific uncertainty that surrounds many current environmental health issues.

What Is Primary Prevention?

Primary prevention is the “prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease.” www.worldmedicus.com

In medicine, we recognize that primary prevention not only addresses proactive or prophylactic “treatment” to prevent health problems before they arise, but it also incorporates modification of behaviours or risk factors that are associated with a given health outcome. On a broad scale, these can range from the individual reducing his or her intake of refined sugar to lower the risk of developing diabetes, to promoting healthy, loving family relationships in an effort to prevent mental health problems.

In the realm of environmental health, however, primary prevention clearly encompasses actions on an even broader scale, as the problems of environmental pollution are all-encompassing. They therefore necessitate far-reaching solutions. Environmental health prevention must be founded on the guiding principle that human health and ecosystem health are one and the same; hence, pollution, waste accumulation, loss of habitat, species extinctions and loss of biodiversity, climate change, etc. are all human and ecosystem issues.

What Actions Must Be Taken?

Along the continuum between prevention and treatment, medical practitioners are well versed in the treatment end, with a focus on responding to symptoms of illness.2 Medical practice as it relates to environmental health relies heavily upon the evidence-based approach, which aims at “preventing adverse health effects through education and practical exposure reduction whenever feasible.”3 We are witnessing a transition, however, wherein more physicians are stepping into the health protection realm that places emphasis on prevention and on preservation of not only individual health, but also collective health. In the political economic view of environmental health issues, this represents a move further “upstream,” closer to the source of the problem and toward strategies that are ultimately the most effective in the long run.

Throughout this web resource we have drawn attention to the kinds of counsel that physicians can provide to their patients to reduce environmental exposures. While these are important to support the individual’s quest to protect their own child’s health, such advice does not fundamentally address why there is a need to be more aggressive about furthering the agenda for children’s environmental health in the first place.

The upstream focus that will better safeguard children’s environmental health encompasses action at increasingly broader spheres of influence, from local collective action, to policy and regulatory reform and, finally, to treaties and global action.5 How and where do physicians insert themselves into that scheme to contribute to the protection of children’s health? Borrowing from the mission statement for Environmental Health Watch (EHW), physicians can effectively champion the children’s environmental health agenda (and protection of ecosystem health) by helping:

people protect their children and themselves from serious environmental threats,
influence corporate, government and individual actions and,
avoid both imprudent complacency and unnecessary alarm