A Day at an Environmental Health Clinic:
Why We Need More
What are environmental health clinics?
Environmental health clinics are organizations that research, treat, and prevent local environmental health exposures. They address toxic environmental exposures to agents such as pesticides, lead, and carbon monoxide, which are all especially dangerous to children. Such exposures can lead to severe health conditions, including cancer, asthma, developmental problems, and other disorders. Pediatric Environmental Health Specialty Units (PEHSUs), an EPA-funded network of environmental health centers across the United States, feature healthcare workers with specialized knowledge of the risks, prevention, and treatment of exposures, as well as state resources. PEHSUs serve ten regions throughout all 50 states, providing medical care, consults, and education on environmental health issues. PEHSUs work with all levels of education, including healthcare professionals, schools, and families. As such, PEHSUs are an excellent way to address the dangers of toxic substances and to educate the public about them. Through collaboration and uniting resources, patients not only feel supported, but real progress can be made in environmental health- a field typically underrepresented in the traditional medical scene.
One such organization is now in the works for Philadelphia, called the Philadelphia Regional Center for Children’s Environmental Health (PRCCEH). Associated with the University of Pennsylvania and the Children’s Hospital of Philadelphia, it will act as a research hub and clinic to investigate and address local environmental issues like asthma prevention, lead exposure and harm, air pollution, and exposure to endocrine-disrupting toxins.
Centers like these are necessary for our society to be able to work through ever-increasing environmental hazards efficiently. Lead poisoning is particularly prevalent in the US, with some studies projecting that 43% of the US population will have elevated blood lead levels by 2030.
One significant challenge affecting progress in environmental advocacy is the need for more unity and structure for organizations to operate at the highest efficiency. Lack of awareness of environmental exposures and confusion over publicly available resources, particularly in low-income areas predisposed to such exposures, pose a significant public health challenge. Environmental health centers like the PRCCEH provide the structure and unity needed to bring environmental specialists together so that cases can be adequately addressed. The center will consist of 27 experts in various environmental professions, such as epidemiology, occupational and environmental medicine, and toxicology, allowing for a well-prepared and efficient response to these challenges.
A closer look into the day-to-day work at a PEHSU:
Last fall, I had the opportunity to shadow two pediatric environmental toxicologists at the Region 1 PEHSU in Massachusetts: Boston Children’s Hospital‘s Pediatric Environmental Health Center. Physicians in environmental health are frequently pediatricians or toxicologists with backgrounds in public health, given the nature of environmental exposures and the greater risk they pose to children. Most patients that come during clinic hours are victims of lead poisoning, though other common hazards are also seen. Toxicologists will also have emergency department shifts and consult for the poison center or higher-level cases.
Our first patient was a toddler with a blood lead level of 3.5 ug/dL, just at the level the CDC considers elevated for children. The blood lead elevation was found in a capillary test- a portable and fast device great for busy parents- and reconfirmed in a vascular test at the hospital. This was his follow-up visit after being prescribed certain vitamins and iron supplements for reducing lead levels and preventing iron depletion. The toddler’s blood lead level had been elevated for the last two years following a move into a house that wasn’t completely lead-remediated, though the parents became more concerned when the levels persisted following another move that had tested negative for lead. They mentioned that the toddler spent a significant amount of time at a grandparent’s house, but that the husband had grown up there with no problems. The doctor explained that it was hard to say, as lead can store up, increasing in various places. Each child also reacts differently to lead exposure. They decided on having the grounds at the grandparent’s place tested, as the child was observed to have taken a liking to consuming soil. The parents were then connected to the appropriate soil testing resources.
The second patient, a young girl alongside her visibly overworked mother, lived in public housing that was recently found to be contaminated with lead (interestingly, these homes are meant to be inspected for lead beforehand). The inspection was done after the child was screened for and found with elevated blood lead levels, at 18.6 ug/dL. While high, the toxicologist lowered the mother’s anxiety level by noting that it wasn’t high enough for DMSA, an FDA-approved lead chelator for severe cases. He also went on to discuss how developmental side effects aren’t a guarantee in acute cases and that early intervention, as was the case here, often prevents long-term consequences. It was also unclear whether her psychiatric symptoms were caused by lead or a psychiatric disorder. As the parent had recently moved into a new home soon to be re-examined for lead, the doctors decided on establishing a blood lead level trend for now and continuing to monitor iron, vitamin D, liver function, and copper levels. To assess whether her new home had any prominent lead risks, the doctors asked a series of questions about the child’s diet, the parents’ occupations, whether certain antiques are present in the home, and more.
Unlike the previous patient, our last patient had parents on the wealthier end of the spectrum. They had come after a search for the top environmental toxicologist in their state for their infant with a blood lead level of 15.9 ug/dL. They had good news- they’d identified the lead source in their home! It turned out to be the white flashing under their front door. The paint had rusted out, revealing a white powder that was tested and found to have extreme levels of lead. The doctor recommended evaluating for developmental targets and running liver and kidney function tests. He took measures to reduce the couple’s anxiety, while also setting their expectations by explaining it may take years for the lead levels to come down.
Contrary to popular opinion, lead poisoning typically carries little to no symptoms until levels elevate to much more dangerous levels. Hence, lead screening for children is incredibly important for early intervention. Ten states currently have universal childhood lead testing policies, including Massachusetts, which requires lead screening to begin at 9-12 months and continue every year until the child turns five. The CDC’s Childhood Lead Poisoning Prevention Program, available in all states, grants the public free access to home lead inspections. Some states, like Massachusetts, mandate lead remediation, and resources are available at the local level if a homeowner cannot afford it.
Currently, there are 28 environmental health centers in the United States associated with various universities.
While this is encouraging, more environmental health centers could benefit US communities. With the capacity and resources a center has, many environmental exposures can be addressed and treated on an individual and local level in areas all over the United States.
— RCC Fellows Kacy Gao, Sean Vanson
RCC Fellow –Kacy Gao – Drexel University
RCC Fellow Kacy Gao is a Biological Sciences major and Chemistry minor at Drexel University with an interest in environmental health. Having seen the disproportionate impact environmental toxin exposure has on low-income communities through community dialogue and EMS, her goal is oriented advocating for change through policy and activism. She is currently leading a campaign on campus to transition from the use of toxic synthetic herbicides to organic land management, as well as an effort to enforce a similar law in the city of Philadelphia.
RCC Fellow – Sean Vanson – Drexel University
RCC Fellow Sean Vanson is a sophomore at Drexel University in the honors program majoring in Biological Sciences. Originally from Wilmington, Delaware, he is passionate about promoting environmental justice on his campus and his local community in Philadelphia, with emphasis on eliminating the use of toxic synthetic herbicides. After completing his undergraduate education, Sean hopes to attend medical school and obtain a medical degree related to environmental medicine.
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