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GP: Medical prevention programmes on health effects of environmental pollution - Poland PDF Print E-mail

Joanna Pruchnicka, Janina Wuczyñska, Newsletter, Polish Environmental Health Action Plan, Institute of Occupational Medicine and Environmental Health, Sosnowiec, Vol. 1, 2002

Confirmed incidence of adverse health effects of environmental exposure requires relevant actions in the field of public health. A variety of environmentally – related health disturbances can be noted – from temporary, unremarkable functional disorders to stabilized diseases leading to disability or death. Environmental factors can impose toxic effects on many human organs and systems, they can also be carcinogenic or teratogenic, posing hazard for future generations. Environmental exposure is usually a multimedia exposure to many factors of different concentration or intensity. Health effects of such exposure depend not only on its quantitative and qualitative composition but also on possible interactions among various substances. The outcome health effect is also dependant on personal susceptibility.
From public health point of view, in case of many environmental hazards, total elimination of health risk is not possible. In practice, the priority target should be efficient health protection of populations particularly sensible to specific environmental hazards (children, pregnant women, elderly people). Practical actions oriented towards diseases and disorders resulting from environmental exposure is considered as one of public health priorities in the European Community countries. Actions in this field focus on disease prevention as well as on health promotion and education.

In view of European and worldwide tendencies as well as according to the current state-of-the-art in the field of environmental health, in the year 2000, the Institute of Occupational Medicine and Environmental Health has undertaken actions oriented towards medical prevention of environmentally-evoked health effects. The actions have been launched within the framework of the Long-Term Governmental Programme “Environment and Health”. At the first stage, proposal of organizational solutions and legal background of medical prevention programmes has been prepared.
The medical prevention programmes in Poland are executed on the basis of the Act on General Health Insurance of February 6th, 1997, within funding from the state budget, funds of environmental protection or other national and external funds. According to the proposal prepared by the Institute, medical prevention of health effects of environmental pollution should comprise organized, target-oriented actions performed by health services or other personnel supervised by health professionals. It is necessary to implement a system of undergraduate and postgraduate training of physicians in the field of environmental medicine to build capacity needed for implementation and performance of medical prevention programmes. The education and training system in the field of environmental health should be addressed to general practitioners as well as to other medical specialists.

Medical prevention of environmental health hazards can be oriented both towards individuals and towards populations, and it can be implemented at several levels: as preliminary prevention (1st phase), secondary prevention (2nd phase) and 3rd phase prevention. Actions in the field of health promotion addressed to healthy people/ populations are determined as early prevention. Prevention of the 1st phase is oriented towards health effects of exposure to noxious factors through possibly earliest actions preceding occurrence of any health disorders (educational activities, determination of biological markers of exposure). The target of the 2nd phase of prevention is early detection of health effects, which may result from exposure to environmental hazards (consultation and individual examinations, population-based studies). Prevention of the 3rd phase comprises actions aimed at minimization of further negative health effects in case of individuals in which health disorders or diseases resulting from exposure to environmental factors have already been noted (diagnostic measures, monitoring of health status, therapeutic procedures addressed to individual patients).

The Sosnowiec Institute has designed medical prevention programmes which focus on environmental health hazards for children. The programmes are among others related to environmental lead poisoning, respiratory symptoms and diseases as well as allergic symptoms and diseases. The programmes have been developed on the basis of several years’ experience of the Institute in this field and they focus on priority environmental health problems related to children in Poland. The programmes also follow-up the environmental health priorities in Europe. Several years of practical experience with children exposed to environmental hazards have resulted in elaboration of problem-oriented educational materials addressed to various groups of people who can directly or indirectly influence the pro-healthy behavior of children.
Actions in the field of medical prevention do not only refer to childrens’ populations. One of the tasks of the Long-Term Governmental Programme “Environment and Health” has focused on medical prevention in population environmentally exposed to asbestos (the programme is described under separate article). The preliminary results of this programme do not only justify its usefulness but also confirm good response and lively concern of local community.

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