Occupational and Environmental Health
Occupational and environmental health is the area of community and public health nursing concerned with how work and the wider physical environment affect health, and with protecting populations from hazardous exposures. Within nursing it joins two closely related fields: the health of working people in relation to their jobs, and the health of communities in relation to the air, water, soil, and built surroundings they share.
Definition
Occupational and environmental health is the field, and nursing practice within it, that studies, monitors, and seeks to prevent the adverse health effects of exposures arising from work and from the physical environment, applying public health and preventive principles at the population level.
Scope
This area orients the reader to the assessment of workplace and environmental hazards, the surveillance of exposure-related disease and injury, programs that promote health and prevent harm at work, and the nurse's roles in protecting both individual workers and exposed communities. It is a reference and educational overview of the field; the detailed essentials are developed in the topics beneath it. It does not provide clinical management instructions.
Sub-topics
Core questions
- What workplace and environmental exposures threaten health, and how are they recognized and measured?
- How is exposure-related disease and injury counted, tracked, and attributed at the population level?
- Which interventions, controls, and programs reduce harm at work and in the community?
- What roles do occupational and environmental health nurses play in assessment, surveillance, and prevention?
Key concepts
- Hazard versus exposure versus risk
- Hierarchy of controls (elimination, substitution, engineering, administrative, personal protective equipment)
- Exposure-disease attribution and the population attributable fraction
- Primary, secondary, and tertiary prevention applied to working populations
- Health surveillance and biological monitoring
- Environmental justice and disproportionate community exposure
Mechanisms
The field rests on a chain that runs from a hazard (an agent with potential to cause harm) to exposure (actual contact, with a dose and duration) to a health effect. Physical, chemical, biological, ergonomic, and psychosocial agents act through this chain, and prevention works by interrupting it as far upstream as possible, which is why the hierarchy of controls favours eliminating or substituting a hazard over relying on personal protective equipment. At the population level, the contribution of an exposure to disease is expressed through measures such as the population attributable fraction, which underpins burden-of-disease estimates for occupational and environmental risks.
Clinical relevance
Understanding work and environmental exposures helps clinicians and public health nurses recognise that many diseases have an occupational or environmental component and that prevention often lies outside the clinic, in the workplace or the community. This area frames how such exposures are identified and addressed at the population level; it is educational and does not direct the diagnosis or treatment of any individual.
Epidemiology
Occupational exposures are a substantial and partly preventable contributor to the global burden of disease: the Global Burden of Disease analysis for 2016 attributed a large share of deaths and disability-adjusted life-years to occupational risk factors, and the World Health Organization has likewise estimated that a sizeable fraction of the total disease burden is attributable to modifiable environmental factors. These population estimates motivate surveillance and prevention as core functions of the field.
History
Concern for the diseases of workers is old, traced in the Western tradition to Bernardino Ramazzini's eighteenth-century treatise on the diseases of tradesmen, and was advanced in the early twentieth century by Alice Hamilton's pioneering studies of industrial toxicology. Occupational and environmental health nursing developed as a distinct specialty over the twentieth century, broadening from the care of injured workers in industry to the assessment of exposures and the protection of both worker and community health.
Key figures
- Bernardino Ramazzini
- Alice Hamilton
- Barry S. Levy
- Bonnie Rogers
Related topics
Seminal works
- gbd-occupational-2020
- who-environment-2016
- levy-wegman-2017
Frequently asked questions
- What is the difference between occupational health and environmental health?
- Occupational health focuses on exposures and risks that arise from work, while environmental health concerns exposures from the wider physical environment shared by a community; the two overlap heavily because many hazards cross between workplace and surrounding community.
- Why are occupational and environmental health grouped within community and public health nursing?
- Both fields apply population-level, preventive thinking to protect groups of people from harmful exposures, which is the core orientation of community and public health nursing rather than individual bedside care.