University of Pennsylvania
Graduate Program in Public Health Studies
Spring 2009
Title:
PUBH503 Environmental and Occupational Health
Welcome to the Course
Why have this Course
Fundamental Subject in the Field of Public Health
4 Essential courses for an MPH degree, the four cornerstones of Public Health
Epidemiology
Biostatistics
Health Services Administration
Environmental Health
Other things are important, highly desirable and attractive but these four are the
absolute essentials.
Certification as a Medical Specialist in Preventive Medicine
Requires the above 4 courses and in addition “a course in the behaviorial aspects of
health”
Why is the Course designed as it is, what is the pediologic basis?
In a broad sense heath is a product of an individual’s genetic makeup, the environment in which
he or she lives, and the interaction between the two.
For much of human history and the history of pre human species, the interaction was primarily
on e of adaptation to the ambient environment, and evolutionary selection of the fittest to adapt
to that environment.
We did develop some technologies to help us in that adaptation, but they were limited:
Such adaptations as:
Wearing skins, both for warmth, and adornment, but also as protection
Sleeping or storing food in lean-to’s and huts
Cooking meat and fish
Use of fire for warmth and so on.
But by and large these were fairly minor and mostly local changes.
More recently the interaction between man and his environment has changed.
As humans have dominated, and exploited the resources of the planet and have multiplied to
intensively occupy virtually all the easily inhabited parts of the earth, we have increasingly
altered the earth’s environment as a result of our activities. This is particularly true of the
environments we spend most of our time in.
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For example most residents of Philadelphia now spend at least 90% of their time indoors,
wearing clothes, drinking processed water or other fluids, eating complex processed foods,
applying manufactured cosmetic products to their skin, traveling inside manufactured
transportation at historically extremely rapid speeds…. the list goes on.
The flip side of our capacity to alter the environment is that as we have developed technically,
economically, and sociologically we have also acquired an increasing capacity to modify our
environment in ways that are beneficial to our health and welfare, although these modifications
may be costly.
The rise of Public Health as a necessary discipline was heavily influenced by the need to design
systems to combat the environmental health problems that were appearing with increased
urbanization, the need for safe community water supplies (the story of the Broad Street pump),
the need to provide recreation in the new cities, and to control effects of air pollution such as
intense unpleasant odors and smoke from domestic cola or wood fires and industrial sources.
Leading up to the 1970s a series of disasters, and otherwise notable events, raised public
sensitivity to potentially harmful environmental health effects. - examples of the Donora PA air
pollution disaster, and the Cuyahoga River fire in Cleveland. These lead to an unprecedented
series of important environmental laws in the late 1960’s and 1970’s that still form the backbone
of our regulatory approach to environmental and occupational health today. The immediate
benefits form these legal and regulatory approaches were certainly positive, they continue today.
However we are now recognizing that the regulatory approach has limitations. It is increasingly
difficult to keep up the momentum of regulation, not all administrations have the commitment or
political support to make the choices. Some problems are not easily solved, if they are solvable
at all, through a regulatory approach. Regulations may be effective at controlling the actions of
major corporations, but what about the problems that arise collectively from all of our actions. In
a free society, can we, and do we desire, to control all the day to day decisions and actions by
many parties that may harm the environment.
As we reach some of the limits of a paternalistic regulatory approach to develop solutions to
contemporary environmental hazards I put to you that we can and must develop more
sophisticated concepts of our role as public health workers in making our environment healthier.
It is almost axiomatic that every human activity has a can environmental health consequence,
good or bad. It is the role of public health to facilitate, in whatever ways are legally, morally and
economically possible, those decisions that will positively impact on the environmental and
health,
I conceptualize our primary role in Public Health as one of translating scientific knowledge of
environmental health issues into the decisions that public and private organizations, and
individuals make that affect the environment.
Translation is complex because environmental health outcomes are shaped by the decisions of
individuals and by organizations, public and private. This includes the choices each individual
makes: how they live their lives, the products they consume, their occupation, the transportation
they use, their consumption of energy and their recreation. It includes the choices that
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organizations make: the selection of products and services they provide; the items they purchase
and the processes through which they generate goods and services. Accordingly, if we are to
maximize the impact of the scientific knowledge from environmental health and related research
outcomes we face the challenge of providing relevant, usable environmental health information
to beneficially influence decision making at the individual, non-government and government
policy levels. The other face of our public health challenge is to stimulate, facilitate or perform
the type of research that is needed to beneficially obtain these outcomes.
Environmental and public health professionals have been relatively comfortable with the
translation of environmental health research into broad policy-making decisions by regulatory
agencies that deal with chemical exposures such as EPA, OSHA, NIOSH, NRC, FDA and,
perhaps to a lesser extent, the CPSC, Department of Agriculture and DOT. These agencies make
extensive use of the published literature. The greater challenge is to translate this information in
ways that will guide the actions of individuals, communities, businesses and agencies whose
mission is not primarily to improve health. Yet their actions are important or critical
determinants of whether the environment improves or worsens with respect to human health. on
they key decisions that create or reduce environmental health risk we must inform and educate
other stakeholders specifically including Planning Departments and business
We have designed this course to begin to equip you for such tasks. The course will provide a
broad introduction to the scientific basis of environmental and occupational health, addressing .
issues in the ambient, occupational and global environments. Our objectives are for you to:

Recognize the major health problems associated with the global, ambient,
occupational and indoor environments.
 Understand the risk assessment concepts used to describe, assess, control and
make decisions about environmental health issues.
 Develop skills in analyzing, managing and communicating about environmental
health issues.
The focus of this course is on the effects of the environment on human health, and on the health
and wellness of individuals or groups in the workplace.
Our Faculty:
Edward Emmett MD, MS (Course Director)
Richard Pepino MS
Marilyn Howarth MD
Bei Chen MD Teaching Assistant
Bei is, in a way, the Public Health Worker for the class. She is to monitor for any problems you
may be having, help develop solutions, and ensure that communications are up to date. Please
inform her of any issuesor questions you have.
Format
Lectures, seminars and readings.
Organization and sequence
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Introductory scientific concepts – Toxicology perspective- EAE
Environmental Health- RP – risk assessment and regulatory public health, MH
biomedical sciences
Risk Communications Small group discussions EH into policy
Food Safety –MH
Occupational health & Safety
Disparities/Environmental justice, looking after the interests and the health of the
most vulnerable
Reading assignments will be posted in advance – please read them, we will try to keep
the volume manageable.
How many read for today?
Handouts- will generally post on Blackboard
Consistent with Environmental health objectives would like you to print your own. Is
this feasible?
Small Group Discussion:
Each student will research a discussion item, and participate and make a short
presentation (about 8 minutes) on an aspect of one of three topic areas with policy
implications. The topic areas are:
The Master Tobacco Settlement Agreements – Public Health Implications and State
Responses – Led by Richard Pepino;
The Position of the US on International Treaties or Agreements Addressing
Environmental Health Issues led by Marilyn Howarth; and
Policy Challenges in Promoting the “Healthy Home” led by me.
A short paper (approximately 3 pages should be submitted by each student on their
chosen topic. A list of the topics areas for presentation will be provided at the first class.
After the student presentation, an instructor will lead a discussion on the topic area.
Let Bei know your choice of topic.
Paper/Presentation:
Identify and develop a project/topic in environmental/occupational health that interests
you. During the semester create an original paper that critically reviews and analyzes the
relevant literature, using concepts and information presented in the course. Identify what
is known about the subject as well as important information gaps. Derive conclusions and
recommendations that are supported by your analysis. The paper should be double-spaced
and between 15 to 20 pages long, not including the bibliography. The information should
be logically organized and presented using an accepted format. American Psychological
Association (APA) format is suggested.
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In the penultimate session of the course each student will make an oral presentation of
the selected project/topic, accompanied by a power point presentation. The time
allotted for the oral presentation is 10 minutes with 4 minutes for
questions/discussion.
A paragraph briefly identifying and describing the selected paper topic and reason for
the selection is due electronically on February 23, 2009.
Final papers and Power point are due electronically on April 27, 2009.
Evaluation Methods:
20% - Written mid-term take home examination
20% - Written final examination take-home examination
40% - Submitted paper
20% - Paper and participation in small group discussion
Mid-term & Final Examinations: Written mid-term and final examination will be distributed to
students (on March 2, and April 20 respectively), for completion and electronic return
by March 16, and May 8, respectively.
All assignments are expected on the due dates. Any requested extension must be submitted prior
to the due date for review. Late assignments without an approved extension will be penalized.
The University of Pennsylvania’s Code of Academic Integrity is applicable in all classes and
assignments.
Required Text: Environmental Health: from Global to Local. Frumkin H, Editor. San
Francisco, Jossey-Bass. 2005
Available on Amazon.com new and used
Local Resources:
OSHA Regional Office, Customs House, 200 Chestnut Street, Room 242, 215-597-4955. This
office holds all OSHA publication as well as some NIOSH publications.
EPA Regional office, 1650 Arch Street, Philadelphia, PA. 215-814-5254. This library is open to
the public but an appointment is required.
Bureau of Labor Statistics, Curtis Center, 170 Independence Mall West, Suite 740 West,
Philadelphia, PA. 215-861-4912. This office holds labor data
publications.
Electronic Addresses for Bei and Faculty ? Post
Questions?
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