EHJ July 2002, pages 216-217 Tracey Khanna reports on the highlights of the IFEH's 7th World Congess from San Diego in California

The 7th World Congress on Environmental Health got off to a rousing start last month with the classic Neil Diamond song, "America", blasting out from the stage as the past presidents of the International Federation of Environmental Health (IFEH) took their seats to hear the opening address.

The event had been organised by the California Environmental Health Association (CEHA) and incorporated CEHA's 51st Annual Educational Symposium. With representatives from more than 22 nations, the week-long event, held in San Diego, California, was introduced by Ronald Torres, president of CEHA, who said: "This week each of us will find that we all face similar situations in our day-to-day work environment. This is a wonderful opportunity for our association members to share experiences with environmental health colleagues from around the world."

Lars Olsen, IFEH president, talked of the organisation's modernisation over the last few years. "The IFEH is striving to be a body that is capable of influencing political decisions," he said, while urging delegates to respond to issues globally. There was, however, one noticeable absence and Mr Torres dedicated the event to the memory of Eric Foskett, saying that "his spirit is alive at this conference". Mr Foskett, who laid the foundations of the IFEH back in 1982 and was the Federation's first Honorary Executive Secretary, had long planned to attend the event, but sadly passed away in August 2001.

The 2002 IFEH Eric Foskett award, which recognises notable contributions to the IFEH from an individual or organisation, was gifted jointly to John McCandless and the CIEH Northern Ireland Centre during the congress. The awards were received in person by Mr McCandless and Brian Hanna, CIEH president. Mr McCandless thanked the IFEH for such a "huge honour" and the Northern Ireland Centre for giving him "the legitimacy and ongoing support to develop the education initiatives in Tanzania so successfully".

With regard to the educational seminar topics, this year's included a number of topical issues such as bioterrorism and disaster response, the threat to the US of diseases such as West Nile virus, the spread of blood pathogens through unhygienic body art practices and the alarming growth of electronic waste.

The main message to emerge from the keynote speech was that the fragmentation of responsibilities for health and the environment across the different agencies in the US has led to poor management of environmental health hazards.

In a presentation that was as relevant to EHOs in Europe as the US, Dr Richard Jackson, director of the National Center for Disease Control and Protection's National Centre for Environmental Health, said that this diffusion of responsibilities is compounded by the fact that, in the US, the multitude of federal agencies and local and state health departments responsible for health and the environment do not work closely enough together.

He went on to remind delegates such a fragmentation of issues poses a serious danger to human health. "Over the past 20 years or so," he said, "the fundamental environmental health infrastructure has been neglected due to the focus on hard science, such as toxicology and epidemiology".

Using blood lead levels - from exposure to lead paint - in American children as an example, Dr Jackson pointed out that while the US has the lowest blood lead levels imaginable today due to environmental health work, specialists have been so narrowly focused on this issue other areas related to healthy homes had often been overlooked, such as rodents, cold and asthma.

With a rapidly increasing US population, which is expected to double by 2100, he said that the issues surrounding healthy communities will become even more important. "The need for many to live further outside cities due to current housing pressures, over dependence on private cars and the reliance on convenience foods due to the often hectic and stress-filled lifestyles people lead today, all have profound implications for public health," he said. While the environmental health profession often thinks in a holistic way, the design of built environments has not been included in the past. But, he stressed, the planning of healthy communities is imperative to environmental health.

Referring to urban sprawl, Dr Jackson urged environmental health specialists to work more closely with urban planners as changing landscapes, such as tree and vegetation removal for construction purposes, ultimately affect public health. In the US, he pointed out, the continued trend for built environments that inhibit physical and social activity is a direct contributor to the serious health problems many people are suffering today, from chronic diseases like cancer to the obesity epidemic and the sharp rise in adult onset diabetes in children. He pointed to a number of US cities, built around dominant road networks, that have a lack of play areas for children and limited sidewalks, making even simple physical activity like walking almost impossible.

Ending his address with the bioterrorism threat, Dr Jackson said that September 11 had changed the US approach to environmental health irrevocably. In the past, he said, there had been a firewall between agencies, but the lessons learned from the devastating events on that day had changed many things. On a positive note, he said that there was now more support in the US for environmental health efforts than at any time in the past.

On the subject of disaster and terrorism response, Kathy Clark, disaster assistance co-ordinator at the California Department of Mental Health, pointed out that California is one of the most disaster-prone states in the US. "As such," she said, "it is vital that environmental health specialists, who play a vital role in disaster response, are well prepared in advance".

EHOs that respond to an emergency situation will suffer different psychological reactions to man-made versus natural disasters, she said, based on the number of causalities, the urgency, unpredictability and duration of an incident, and the length of exposure and intensity of experience. She urged EHOs to recognise the symptoms of stress, if involved in a disaster situation, and to practise self help techniques to help minimise any long-term effects and mitigate stress and fear. "If you experience 'burnout' symptoms," she said, "work hard on self care, getting better rest and relaxation, and nutrition, and try to take some time to get away." She also stressed the value of professional defusing and debriefing sessions.

Speaking on the threat of hazardous materials, Andrew Mathieson from the University of the West of England, told delegates that all future UK military operations will need to take into account the potential health effects to personnel of environmental as well as toxic industrial hazards. According to Mr Mathieson, examination of recent military deployments has shown that exposures to hazardous material are predominantly environmental or occupational health concerns, rather than disaster scale releases of toxic materials such as the incidents in recent years at Bhopal in India and Chernobyl.

Typical hazards military personnel have faced in the past include oil fires in Kuwait, depleted uranium munitions, the widespread use of pesticides and exposure to dust, asbestos and general waste. The threat is often exacerbated by the absence of effective health and safety or environmental controls in the host country.

Mr Mathieson outlined a number of principles to manage environmental and industrial hazards on military operations, and said that the key was avoidance. Where this is impracticable, a monitoring system, site risk assessment and the implementation of control measures would be vital.

Of the many speakers that tackled the subject of disease control, Kathryn Hartman, an environmental health specialist in the San Diego County Department of Health, made an impassioned plea for the swift introduction of regulations for the body piercing and tattooing industry in California. The significant increase in the popularity of body art and the number of procedures performed over the last 20 years is in part due to the air of respectability that celebrities and sports icons had lent to the practice, she said.

However, she warned that inadequate sterilisation, poor hygiene and cross-contamination leads to the spread of bloodborne pathogens. The diseases of concern in commercial practices, she stressed, include airborne tuberculosis, syphilis, HIV, hepatitis B and, more importantly, hepatitis C. Referring to an international survey of body art practitioners, she said that while many countries do not require body art practitioners to undertake training, a surprisingly high number had done so of their own accord. She also pointed out that practically all those asked felt that the regulations governing themselves were inadequate.

Ms Hartman said that while public health officials in the US are recognising the need to adopt guidelines and/or regulations, any potential regulations "must fuse regulation with education and flexibility". Under the proposed California guidelines, practitioners will be required to take exposure control training "similar to a Haccp plan". Until these regulations are passed, she said, environmental health departments could initiate outreach programmes with practitioners and encourage exposure control training to ensure a higher level of public health safety.

On a completely different note, Melissa Stoneham of Queensland University, told delegates that local government in Australia is spearheading a skin cancer prevention campaign. Australia has the highest incidence of skin cancer in the world and a holistic approach supported by local government driven healthy public policy is vital if the rates are to be reduced, she said.

Incidences of melanoma, which is now the third most common potentially fatal cancer after prostate and lung cancers in men and breast and colon cancer in women, have increased by at least 5 per cent in Queensland over the last ten years - 4.3 per cent per year in men and 1.8 per cent in women.

Ms Stoneham told congress that since 1986, the Australian government has relied on influencing individual behaviour in its efforts to get people to "cover up" when in the sun. However, she said, it had been unsuccessful in creating sustained behavioural change. She suggested that a potential solution to this serious problem is through the provision of shade at local recreational and public facilities. Methods to provide the public with shade could include natural means, such as trees, or artificial means, such as beach umbrellas, buildings or awnings.

While shade only reduces exposure to ultra violet radiation, she said, effective planning that takes into account site planning, design, materials, consistency of cover and the movement of the sun, would provide a vital level of necessary protection.

As for the future, congress closed with the ceremonial handing over of the IFEH flag to the hosts of the 8th World Congress, to be held in Durban, South Africa, in 2004.