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OBJECTIVES

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  • Summarize occupational and environmental risks.

  • Review epidemiology of occupational and environmental exposures and illness.

  • Describe occupational and environmental risk assessment.

  • Review preventive and therapeutic interventions to decrease environmental and occupational illness.

  • Review the effect of urban and community planning on health.

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Arnulfo Perez, an undocumented day laborer, receives a laceration falling off a ladder. He works 14 hours a day, primarily in construction or painting projects. He does not have a steady employer, has never received any job safety training, and has never heard about worker’s compensation or unions. He shares a single room apartment with six friends. He is paid in cash. He knows that without a bank account to store his earnings, and fearful of reporting thefts to the police, he is vulnerable to being assaulted.

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INTRODUCTION

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The environmental and occupational safety of residential and work places have an enormous impact on people’s health. Public health measures implemented during the 20th century have improved people’s living and working environments, resulting in increased longevity. However, dangerous occupations and harmful environmental exposures continue to be major contributors to disparities in health.1,2,3 Health-care providers also often ignore these important risk factors for disease.4,5 In addition, it is important to consider how individual susceptibility and social vulnerability may influence the health risks related to specific hazards (see Box 25-1).6

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This chapter reviews adverse health issues attributable to environmental hazards in the workplace and at home, highlighting their disproportionate effect on vulnerable populations and presents practical approaches for preventive and therapeutic interventions to improve screening and care of patients with work and environmentally related illnesses.

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Box 25-1. Susceptibility to Environmental and Occupational Hazards

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Occupational/Environmental Hazard Individual Susceptibility Social Vulnerability

Inadequate housing

  • Heat/cold exposure

  • Chemical: lead, tobacco, indoor air pollution

  • Biological: pests and mold

Neighborhood hazards

  • Lack of green space

  • Food availability

  • Neighborhood violence

  • Pollution: urban air pollution, proximity to sources

Workplace hazards

  • Chemical exposures

  • Accidental injury

  • Heat stress

  • Age

  • Gender

  • Comorbid disease

  • Genetic factors

  • Individual stress

  • Unemployment

  • Economic hardship

  • Job training

  • Use of personal protective equipment

  • Race and ethnicity

  • Social isolation

  • Socioeconomic status

  • Immigration status

  • Political disenfranchisement

  • Job security

  • Educational status

  • Health status

  • Housing insecurity

  • Legal status

  • History of incarceration

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ENVIRONMENTAL AND OCCUPATIONAL CONTRIBUTIONS TO INJURY, ILLNESS, AND DEATH

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UNEMPLOYMENT AND HEALTH

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Unemployment is an important risk factor for the ill health faced by poor and minority populations. Unemployed workers have higher rates of morbidity and mortality caused by multiple diseases, most prominently cardiovascular disease and suicide.7,8,9,10 It has been hypothesized that recessionary economic cycles, characterized by unemployment and decreased income, may have profound negative effects on population health, especially for those on the lower rungs of the socioeconomic ladder....

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