Mary Fox | Johns Hopkins University (original) (raw)
Papers by Mary Fox
ISEE Conference Abstracts
ISEE Conference Abstracts, 2013
Journal of Transport & Health, 2021
Introduction: Transportation is an integral part of our daily lives, giving us access to people, ... more Introduction: Transportation is an integral part of our daily lives, giving us access to people, education, jobs, services, and goods. Our transportation choices and patterns are influenced by four interrelated factors: the land use and built environment, infrastructure, available modes, and emerging technologies/disruptors. These factors influence how we can or choose to move ourselves and goods. In turn, these factors impact various exposures, lifestyles and health outcomes. Aim and methods: We developed a conceptual model to clarify the connections between transportation and health. We conducted a literature review focusing on publications from the past seven years. We complemented this with expert knowledge and synthesized information to summarize the health outcomes of transportation, along 14 identified pathways. Results: The pathways linking transportation to health include those that are beneficial, such as when transportation serves as means for social connectivity, independence, physical activity, and access. Some pathways link transportation to detrimental health outcomes from air pollution, road travel injuries, noise, stress, urban heat islands, contamination, climate change, community severance, and restricted green space, blue space, and aesthetics. Other possible effects may come from electromagnetic fields, but this is not definitive. We define each pathway and summarize its health outcomes. We show that transportation-related exposures and associated health outcomes, and their severity, can be influenced by inequity and intrinsic and extrinsic effect modifiers. Conclusions: While some pathways are widely discussed in the literature, others are new or underresearched. Our conceptual model can form the basis for future studies looking to explore the transportation-health nexus. We also propose the model as a tool to holistically assess the impact of transportation decisions on public health.
Science of The Total Environment, 2020
• Non-Kuwaiti males and in working age were vulnerable to hot temperatures with doubling to tripl... more • Non-Kuwaiti males and in working age were vulnerable to hot temperatures with doubling to tripling risk of mortality. • Extreme cold temperatures were associated with increased risk of death among elderly (65+ year) Kuwaitis. • In the Gulf states, nationality can be an important effect modifier in the temperature-mortality relationship • Important environmental justice questions need answers.
PLOS Climate, 2022
Over the last decade many large world cities have scaled up efforts at climate adaptation, a prim... more Over the last decade many large world cities have scaled up efforts at climate adaptation, a primary focus of which is protecting population health. With extreme weather disasters increasing worldwide, public health agencies are among local institutions under greatest stress; the Covid-19 pandemic has only heightened pressure on these agencies. Yet the limited literature examining adaptation actions across world cities suggest few, mainly high-income cities report health-related adaptation, while city public health agency engagement in adaptation has received little research attention. In this comparative review, we aimed to characterize the public health role in the adaptation plans of 22 large cities pre-identified as highly health-adaptive, by examining five health-associated adaptation activities chosen as “promising practice” based on evidence synthesized from evaluation research and practical experience: (i) hazard and vulnerability mapping; (ii) extreme weather preparedness a...
Journal of Healthy Eating and Active Living
Commercial drivers are essential to the economic recovery, yet their work exposes them to many he... more Commercial drivers are essential to the economic recovery, yet their work exposes them to many health and safety hazards. Research to improve driver health should be designed with an understanding of both the complex occupational environment and the risk management context. We present results of a small pilot study of driver health concerns and behaviors to illustrate concepts and frameworks from human health risk assessment and management that may assist in the design and translation of driver and other worker health research. The pilot study surveyed eighteen long-haul truck drivers at a truck stop using an instrument adapted from the International Physical Activity Questionnaire and a transient community needs assessment developed for the US Antarctic Program Recreation and Wellness Survey. Respondents’ characteristics and health concerns reflect existing literature: mostly male of older age with musculo-skeletal and chronic health conditions. The two most common barriers to phys...
Johns Hopkins APL …, 1999
Page 1. JOHNS HOPKINS APL TECHNICAL DIGEST, VOLUME 20, NUMBER 3 (1999) 405 ENVIRONMENTAL HEALTH R... more Page 1. JOHNS HOPKINS APL TECHNICAL DIGEST, VOLUME 20, NUMBER 3 (1999) 405 ENVIRONMENTAL HEALTH RISK ASSESSMENT METHODOLOGY The Johns Hopkins University School of Hygiene and Public Health is developing ...
International Journal of Health Services, 2020
The early 2020 response to COVID-19 revealed major gaps in public health systems around the world... more The early 2020 response to COVID-19 revealed major gaps in public health systems around the world as many were overwhelmed by a quickly-spreading new coronavirus. While the critical task at hand is turning the tide on COVID-19, this pandemic serves as a clarion call to governments and citizens alike to ensure public health systems are better prepared to meet the emergencies of the future, many of which will be climate-related. Learning from the successes as well as the failures of the pandemic response provides some guidance. We apply several recommendations of a recent World Health Organization Policy Brief on COVID-19 response to 5 key areas of public health systems – governance, information, services, determinants, and capacity – to suggest early lessons from the coronavirus pandemic for climate change preparedness. COVID-19 has demonstrated how essential public health is to well-functioning human societies and how high the economic cost of an unprepared health system can be. Thi...
Environmental Health Perspectives, 2022
Background: In 2016, Congress enacted the Frank R. Lautenberg Chemical Safety for the 21st Centur... more Background: In 2016, Congress enacted the Frank R. Lautenberg Chemical Safety for the 21st Century Act (“the Lautenberg Act”), which made major revisions to the main U.S. chemical safety law, the 1976 Toxic Substances Control Act (TSCA). Among other reforms, the Lautenberg Act mandates that the U.S. Environmental Protection Agency (U.S. EPA) conduct comprehensive risk evaluations of chemicals in commerce. The U.S. EPA recently finalized the first set of such chemical risk evaluations. Objectives: We examine the first 10 TSCA risk evaluations in relation to risk science recommendations from the National Academies to determine consistency with these recommendations and to identify opportunities to improve future TSCA risk evaluations by further implementing these key approaches and methods. Discussion: Our review of the first set of TSCA risk evaluations identified substantial deviations from best practices in risk assessment, including overly narrow problem formulations and scopes; insufficient characterization of uncertainty in the evidence; inadequate consideration of population variability; lack of consideration of background exposures, combined exposures, and cumulative risk; divergent approaches to dose–response assessment for carcinogens and noncarcinogens; and a flawed approach to systematic review. We believe these deviations result in underestimation of population exposures and health risks. We are hopeful that the agency can use these insights and have provided suggestions to produce chemical risk evaluations aligned with the intent and requirements of the Lautenberg Act and the best available science to better protect health and the environment—including the health of those most vulnerable to chemical exposures. https://doi.org/10.1289/EHP9649
Association of markers of chronic viral hepatitis and blood mercury levels in US reproductive-age... more Association of markers of chronic viral hepatitis and blood mercury levels in US reproductive-age women from NHANES 2001–2008: a cross-sectional study
Journal of Dietary Supplements, 2020
Military personnel use dietary supplements (DS) for performance enhancement, bodybuilding, weight... more Military personnel use dietary supplements (DS) for performance enhancement, bodybuilding, weight loss, and to maintain health. Adverse events, including cardiovascular (CV) effects, have been reported in military personnel taking supplements. Previous research determined that ingestion of multi-ingredient dietary supplements (MIDS), can lead to signals of safety concerns. Therefore, to assess the safety of MIDS, the Department of Defense via a contractor explored the development of a model-based risk assessment tool. We present a strategy and preliminary novel multi-criteria decision analysis (MCDA)-based tool for assessing the risk of adverse CV effects from MIDS. The tool integrates toxicology and other relevant data available on MIDS; likelihood of exposure, and biologic plausibility that could contribute to specific aspects of risk. Inputs for the model are values of four measures assigned based on the available evidence supplemented with the opinion of experts in toxicology, modeling, risk assessment etc. Measures were weighted based on the experts' assessment of measures' relative importance. Finally, all data for the four measures were integrated to provide a risk potential of 0 (low risk) to 100 (high risk) that defines the relative risk of a MIDS to cause adverse reactions. We conclude that the best available evidence must be supplemented with the opinion of experts in medicine, toxicology and pharmacology. Model-based approaches are useful to inform risk assessment in the absence of data. This MCDA model provides a foundation for refinement and validation of accuracy of the model predictions as new evidence becomes available.
International Journal of Environmental Research and Public Health, 2021
Protecting worker and public health involves an understanding of multiple determinants, including... more Protecting worker and public health involves an understanding of multiple determinants, including exposures to biological, chemical, or physical agents or stressors in combination with other determinants including type of employment, health status, and individual behaviors. This has been illustrated during the COVID-19 pandemic by increased exposure and health risks for essential workers and those with pre-existing conditions, and mask-wearing behavior. Health risk assessment practices for environmental and occupational health typically do not incorporate multiple stressors in combination with personal risk factors. While conceptual developments in cumulative risk assessment to inform a more holistic approach to these real-life conditions have progressed, gaps remain, and practical methods and applications are rare. This scoping review characterizes existing evidence of combined stressor exposures and personal factors and risk to foster methods for occupational cumulative risk asses...
International Journal of Environmental Research and Public Health, 2021
Tens of millions of individuals go to gasoline stations on a daily basis in the United States. On... more Tens of millions of individuals go to gasoline stations on a daily basis in the United States. One of the constituents of gasoline is benzene, a Group 1 carcinogen that has been strongly linked to both occupational and non-occupational leukemias. While benzene content in gasoline is federally regulated, there is approximately a thirty-year data gap in United States research on benzene exposures from pumping gasoline. Using a novel self-sampling protocol with whole air canisters, we conducted a gasoline pumping exposure assessment for benzene, toluene, ethylbenzene, and xylene (BTEX) on Baltimore, MD consumers. Geometric mean exposures (geometric standard deviations) were 3.2 (2.7) ppb,9.5 (3.5) ppb, 2.0 (2.8) ppb, and 7.3 (3.0) ppb, respectively, on 32 samples. Using the benzene exposures, we conducted consumer and occupational probabilistic risk assessments and contextualized the risk with ambient benzene exposure risk. We found that the consumer scenarios did not approach the 1:1,...
© Journal of Public Health and Emergency. All rights reserved. J Public Health Emerg 2020;4:27 | ... more © Journal of Public Health and Emergency. All rights reserved. J Public Health Emerg 2020;4:27 | http://dx.doi.org/10.21037/jphe-20-34 Local public health departments form the backbone of the US health system, and the hazards associated with a changing climate create health and preparedness challenges that are often unfamiliar to the workforce in many of these hardworking agencies (1-3). This is occurring in a context in which America’s local public health and preparedness efforts have been underfunded for more than a decade (4,5) and in which priorities among health and preparedness have sometimes been at odds (6). The COVID-19 pandemic has brought these issues sharply into focus. At the same time, it is now well recognized that upstream health determinants and complex sectoral interconnections play an important role in climate-relevant health outcomes. Such connectedness requires public health agencies to partner with others in ways many may not have previously done (3,7,8). Track...
BMJ Global Health, 2020
As a marginalised subpopulation, migrant workers often fall short from protection by public polic... more As a marginalised subpopulation, migrant workers often fall short from protection by public policies, they take precarious jobs with unsafe working and living conditions and they grapple with cultural and linguistic barriers. In light of the current COVID-19 pandemic, migrant workers are now exposed to additional stressors of the virus and related responses. We applied a comprehensive qualitative cumulative risk assessment framework for migrant workers living in Kuwait. This pandemic could be one of the few examples where the stressors overlap all domains of migrant workers’ lives. No single intervention can solve all the problems; there must be a set of interventions to address all domains. Local authorities and employers must act quickly to stop the spread, ensure easy access to testing and treatment, provide adequate housing and clear communication, encourage wide social support, safeguard financial protection and mental well-being and continuously re-evaluate the situation as mo...
Environment International, 2018
Multiple changes are influencing work, workplaces and workers in the US including shifts in the m... more Multiple changes are influencing work, workplaces and workers in the US including shifts in the main types of work and the rise of the 'gig' economy. Work and workplace changes have coincided with a decline in unions and associated advocacy for improved safety and health conditions. Risk assessment has been the primary method to inform occupational and environmental health policy and management for many types of hazards. Although often focused on one hazard at a time, risk assessment frameworks and methods have advanced toward cumulative risk assessment recognizing that exposure to a single chemical or non-chemical stressor rarely occurs in isolation. We explore how applying cumulative risk approaches may change the roles of workers and employers as they pursue improved health and safety and elucidate some of the challenges and opportunities that might arise. Application of cumulative risk assessment should result in better understanding of complex exposures and health risks with the potential to inform more effective controls and improved safety and health risk management overall. Roles and responsibilities of both employers and workers are anticipated to change with potential for a greater burden of responsibility on workers to address risk factors both inside and *
American Journal of Public Health, 2018
Environmental Health Perspectives, 2017
Public health has potential to serve as a frame to convey the urgency of behavior change needed t... more Public health has potential to serve as a frame to convey the urgency of behavior change needed to adapt to a changing climate and reduce greenhouse gas emissions. Local governments form the backbone of climate-related public health preparedness. Yet local health agencies are often inadequately prepared and poorly integrated into climate change assessments and plans. We reviewed the climate health profiles of 16 states and two cities participating in the U.S. Centers for Disease Control and Prevention (CDC)'s Climate-Ready States and Cities Initiative (CRSCI) that aims to build local capacity to assess and respond to the health impacts of climate change. Following recommendations from a recent expert panel strategic review, we present illustrations of emerging promising practice and future directions. We found that CRSCI has strengthened climate preparedness and response in local public health agencies by identifying critical climate-health impacts and vulnerable populations, and has helped integrate health more fully into broader climate planning. Promising practice was found in all three recommendation areas identified by the expert panel (leveraging partnerships, refining assessment methodologies and enhancing communications), particularly with regard to health impacts of extreme heat. Vast needs remain, however, suggesting the need to disseminate CRSCI experience to non-grantees. In conclusion, the CRSCI program approach and selected activities illustrate a way forward toward robust, targeted local preparedness and response that may serve as a useful example for public health departments in the United States and internationally, particularly at a time of uncertain commitment to climate change agreements at the national level.
Science of The Total Environment, 2016
About 43 million Americans use federally unregulated private wells for drinking water. • Private ... more About 43 million Americans use federally unregulated private wells for drinking water. • Private wells may be contaminated with naturally occurring and manmade chemicals. • Protecting well water requires an "infrastructure for stewardship". • Recommendations to advance private well protection are offered.
ISEE Conference Abstracts
ISEE Conference Abstracts, 2013
Journal of Transport & Health, 2021
Introduction: Transportation is an integral part of our daily lives, giving us access to people, ... more Introduction: Transportation is an integral part of our daily lives, giving us access to people, education, jobs, services, and goods. Our transportation choices and patterns are influenced by four interrelated factors: the land use and built environment, infrastructure, available modes, and emerging technologies/disruptors. These factors influence how we can or choose to move ourselves and goods. In turn, these factors impact various exposures, lifestyles and health outcomes. Aim and methods: We developed a conceptual model to clarify the connections between transportation and health. We conducted a literature review focusing on publications from the past seven years. We complemented this with expert knowledge and synthesized information to summarize the health outcomes of transportation, along 14 identified pathways. Results: The pathways linking transportation to health include those that are beneficial, such as when transportation serves as means for social connectivity, independence, physical activity, and access. Some pathways link transportation to detrimental health outcomes from air pollution, road travel injuries, noise, stress, urban heat islands, contamination, climate change, community severance, and restricted green space, blue space, and aesthetics. Other possible effects may come from electromagnetic fields, but this is not definitive. We define each pathway and summarize its health outcomes. We show that transportation-related exposures and associated health outcomes, and their severity, can be influenced by inequity and intrinsic and extrinsic effect modifiers. Conclusions: While some pathways are widely discussed in the literature, others are new or underresearched. Our conceptual model can form the basis for future studies looking to explore the transportation-health nexus. We also propose the model as a tool to holistically assess the impact of transportation decisions on public health.
Science of The Total Environment, 2020
• Non-Kuwaiti males and in working age were vulnerable to hot temperatures with doubling to tripl... more • Non-Kuwaiti males and in working age were vulnerable to hot temperatures with doubling to tripling risk of mortality. • Extreme cold temperatures were associated with increased risk of death among elderly (65+ year) Kuwaitis. • In the Gulf states, nationality can be an important effect modifier in the temperature-mortality relationship • Important environmental justice questions need answers.
PLOS Climate, 2022
Over the last decade many large world cities have scaled up efforts at climate adaptation, a prim... more Over the last decade many large world cities have scaled up efforts at climate adaptation, a primary focus of which is protecting population health. With extreme weather disasters increasing worldwide, public health agencies are among local institutions under greatest stress; the Covid-19 pandemic has only heightened pressure on these agencies. Yet the limited literature examining adaptation actions across world cities suggest few, mainly high-income cities report health-related adaptation, while city public health agency engagement in adaptation has received little research attention. In this comparative review, we aimed to characterize the public health role in the adaptation plans of 22 large cities pre-identified as highly health-adaptive, by examining five health-associated adaptation activities chosen as “promising practice” based on evidence synthesized from evaluation research and practical experience: (i) hazard and vulnerability mapping; (ii) extreme weather preparedness a...
Journal of Healthy Eating and Active Living
Commercial drivers are essential to the economic recovery, yet their work exposes them to many he... more Commercial drivers are essential to the economic recovery, yet their work exposes them to many health and safety hazards. Research to improve driver health should be designed with an understanding of both the complex occupational environment and the risk management context. We present results of a small pilot study of driver health concerns and behaviors to illustrate concepts and frameworks from human health risk assessment and management that may assist in the design and translation of driver and other worker health research. The pilot study surveyed eighteen long-haul truck drivers at a truck stop using an instrument adapted from the International Physical Activity Questionnaire and a transient community needs assessment developed for the US Antarctic Program Recreation and Wellness Survey. Respondents’ characteristics and health concerns reflect existing literature: mostly male of older age with musculo-skeletal and chronic health conditions. The two most common barriers to phys...
Johns Hopkins APL …, 1999
Page 1. JOHNS HOPKINS APL TECHNICAL DIGEST, VOLUME 20, NUMBER 3 (1999) 405 ENVIRONMENTAL HEALTH R... more Page 1. JOHNS HOPKINS APL TECHNICAL DIGEST, VOLUME 20, NUMBER 3 (1999) 405 ENVIRONMENTAL HEALTH RISK ASSESSMENT METHODOLOGY The Johns Hopkins University School of Hygiene and Public Health is developing ...
International Journal of Health Services, 2020
The early 2020 response to COVID-19 revealed major gaps in public health systems around the world... more The early 2020 response to COVID-19 revealed major gaps in public health systems around the world as many were overwhelmed by a quickly-spreading new coronavirus. While the critical task at hand is turning the tide on COVID-19, this pandemic serves as a clarion call to governments and citizens alike to ensure public health systems are better prepared to meet the emergencies of the future, many of which will be climate-related. Learning from the successes as well as the failures of the pandemic response provides some guidance. We apply several recommendations of a recent World Health Organization Policy Brief on COVID-19 response to 5 key areas of public health systems – governance, information, services, determinants, and capacity – to suggest early lessons from the coronavirus pandemic for climate change preparedness. COVID-19 has demonstrated how essential public health is to well-functioning human societies and how high the economic cost of an unprepared health system can be. Thi...
Environmental Health Perspectives, 2022
Background: In 2016, Congress enacted the Frank R. Lautenberg Chemical Safety for the 21st Centur... more Background: In 2016, Congress enacted the Frank R. Lautenberg Chemical Safety for the 21st Century Act (“the Lautenberg Act”), which made major revisions to the main U.S. chemical safety law, the 1976 Toxic Substances Control Act (TSCA). Among other reforms, the Lautenberg Act mandates that the U.S. Environmental Protection Agency (U.S. EPA) conduct comprehensive risk evaluations of chemicals in commerce. The U.S. EPA recently finalized the first set of such chemical risk evaluations. Objectives: We examine the first 10 TSCA risk evaluations in relation to risk science recommendations from the National Academies to determine consistency with these recommendations and to identify opportunities to improve future TSCA risk evaluations by further implementing these key approaches and methods. Discussion: Our review of the first set of TSCA risk evaluations identified substantial deviations from best practices in risk assessment, including overly narrow problem formulations and scopes; insufficient characterization of uncertainty in the evidence; inadequate consideration of population variability; lack of consideration of background exposures, combined exposures, and cumulative risk; divergent approaches to dose–response assessment for carcinogens and noncarcinogens; and a flawed approach to systematic review. We believe these deviations result in underestimation of population exposures and health risks. We are hopeful that the agency can use these insights and have provided suggestions to produce chemical risk evaluations aligned with the intent and requirements of the Lautenberg Act and the best available science to better protect health and the environment—including the health of those most vulnerable to chemical exposures. https://doi.org/10.1289/EHP9649
Association of markers of chronic viral hepatitis and blood mercury levels in US reproductive-age... more Association of markers of chronic viral hepatitis and blood mercury levels in US reproductive-age women from NHANES 2001–2008: a cross-sectional study
Journal of Dietary Supplements, 2020
Military personnel use dietary supplements (DS) for performance enhancement, bodybuilding, weight... more Military personnel use dietary supplements (DS) for performance enhancement, bodybuilding, weight loss, and to maintain health. Adverse events, including cardiovascular (CV) effects, have been reported in military personnel taking supplements. Previous research determined that ingestion of multi-ingredient dietary supplements (MIDS), can lead to signals of safety concerns. Therefore, to assess the safety of MIDS, the Department of Defense via a contractor explored the development of a model-based risk assessment tool. We present a strategy and preliminary novel multi-criteria decision analysis (MCDA)-based tool for assessing the risk of adverse CV effects from MIDS. The tool integrates toxicology and other relevant data available on MIDS; likelihood of exposure, and biologic plausibility that could contribute to specific aspects of risk. Inputs for the model are values of four measures assigned based on the available evidence supplemented with the opinion of experts in toxicology, modeling, risk assessment etc. Measures were weighted based on the experts' assessment of measures' relative importance. Finally, all data for the four measures were integrated to provide a risk potential of 0 (low risk) to 100 (high risk) that defines the relative risk of a MIDS to cause adverse reactions. We conclude that the best available evidence must be supplemented with the opinion of experts in medicine, toxicology and pharmacology. Model-based approaches are useful to inform risk assessment in the absence of data. This MCDA model provides a foundation for refinement and validation of accuracy of the model predictions as new evidence becomes available.
International Journal of Environmental Research and Public Health, 2021
Protecting worker and public health involves an understanding of multiple determinants, including... more Protecting worker and public health involves an understanding of multiple determinants, including exposures to biological, chemical, or physical agents or stressors in combination with other determinants including type of employment, health status, and individual behaviors. This has been illustrated during the COVID-19 pandemic by increased exposure and health risks for essential workers and those with pre-existing conditions, and mask-wearing behavior. Health risk assessment practices for environmental and occupational health typically do not incorporate multiple stressors in combination with personal risk factors. While conceptual developments in cumulative risk assessment to inform a more holistic approach to these real-life conditions have progressed, gaps remain, and practical methods and applications are rare. This scoping review characterizes existing evidence of combined stressor exposures and personal factors and risk to foster methods for occupational cumulative risk asses...
International Journal of Environmental Research and Public Health, 2021
Tens of millions of individuals go to gasoline stations on a daily basis in the United States. On... more Tens of millions of individuals go to gasoline stations on a daily basis in the United States. One of the constituents of gasoline is benzene, a Group 1 carcinogen that has been strongly linked to both occupational and non-occupational leukemias. While benzene content in gasoline is federally regulated, there is approximately a thirty-year data gap in United States research on benzene exposures from pumping gasoline. Using a novel self-sampling protocol with whole air canisters, we conducted a gasoline pumping exposure assessment for benzene, toluene, ethylbenzene, and xylene (BTEX) on Baltimore, MD consumers. Geometric mean exposures (geometric standard deviations) were 3.2 (2.7) ppb,9.5 (3.5) ppb, 2.0 (2.8) ppb, and 7.3 (3.0) ppb, respectively, on 32 samples. Using the benzene exposures, we conducted consumer and occupational probabilistic risk assessments and contextualized the risk with ambient benzene exposure risk. We found that the consumer scenarios did not approach the 1:1,...
© Journal of Public Health and Emergency. All rights reserved. J Public Health Emerg 2020;4:27 | ... more © Journal of Public Health and Emergency. All rights reserved. J Public Health Emerg 2020;4:27 | http://dx.doi.org/10.21037/jphe-20-34 Local public health departments form the backbone of the US health system, and the hazards associated with a changing climate create health and preparedness challenges that are often unfamiliar to the workforce in many of these hardworking agencies (1-3). This is occurring in a context in which America’s local public health and preparedness efforts have been underfunded for more than a decade (4,5) and in which priorities among health and preparedness have sometimes been at odds (6). The COVID-19 pandemic has brought these issues sharply into focus. At the same time, it is now well recognized that upstream health determinants and complex sectoral interconnections play an important role in climate-relevant health outcomes. Such connectedness requires public health agencies to partner with others in ways many may not have previously done (3,7,8). Track...
BMJ Global Health, 2020
As a marginalised subpopulation, migrant workers often fall short from protection by public polic... more As a marginalised subpopulation, migrant workers often fall short from protection by public policies, they take precarious jobs with unsafe working and living conditions and they grapple with cultural and linguistic barriers. In light of the current COVID-19 pandemic, migrant workers are now exposed to additional stressors of the virus and related responses. We applied a comprehensive qualitative cumulative risk assessment framework for migrant workers living in Kuwait. This pandemic could be one of the few examples where the stressors overlap all domains of migrant workers’ lives. No single intervention can solve all the problems; there must be a set of interventions to address all domains. Local authorities and employers must act quickly to stop the spread, ensure easy access to testing and treatment, provide adequate housing and clear communication, encourage wide social support, safeguard financial protection and mental well-being and continuously re-evaluate the situation as mo...
Environment International, 2018
Multiple changes are influencing work, workplaces and workers in the US including shifts in the m... more Multiple changes are influencing work, workplaces and workers in the US including shifts in the main types of work and the rise of the 'gig' economy. Work and workplace changes have coincided with a decline in unions and associated advocacy for improved safety and health conditions. Risk assessment has been the primary method to inform occupational and environmental health policy and management for many types of hazards. Although often focused on one hazard at a time, risk assessment frameworks and methods have advanced toward cumulative risk assessment recognizing that exposure to a single chemical or non-chemical stressor rarely occurs in isolation. We explore how applying cumulative risk approaches may change the roles of workers and employers as they pursue improved health and safety and elucidate some of the challenges and opportunities that might arise. Application of cumulative risk assessment should result in better understanding of complex exposures and health risks with the potential to inform more effective controls and improved safety and health risk management overall. Roles and responsibilities of both employers and workers are anticipated to change with potential for a greater burden of responsibility on workers to address risk factors both inside and *
American Journal of Public Health, 2018
Environmental Health Perspectives, 2017
Public health has potential to serve as a frame to convey the urgency of behavior change needed t... more Public health has potential to serve as a frame to convey the urgency of behavior change needed to adapt to a changing climate and reduce greenhouse gas emissions. Local governments form the backbone of climate-related public health preparedness. Yet local health agencies are often inadequately prepared and poorly integrated into climate change assessments and plans. We reviewed the climate health profiles of 16 states and two cities participating in the U.S. Centers for Disease Control and Prevention (CDC)'s Climate-Ready States and Cities Initiative (CRSCI) that aims to build local capacity to assess and respond to the health impacts of climate change. Following recommendations from a recent expert panel strategic review, we present illustrations of emerging promising practice and future directions. We found that CRSCI has strengthened climate preparedness and response in local public health agencies by identifying critical climate-health impacts and vulnerable populations, and has helped integrate health more fully into broader climate planning. Promising practice was found in all three recommendation areas identified by the expert panel (leveraging partnerships, refining assessment methodologies and enhancing communications), particularly with regard to health impacts of extreme heat. Vast needs remain, however, suggesting the need to disseminate CRSCI experience to non-grantees. In conclusion, the CRSCI program approach and selected activities illustrate a way forward toward robust, targeted local preparedness and response that may serve as a useful example for public health departments in the United States and internationally, particularly at a time of uncertain commitment to climate change agreements at the national level.
Science of The Total Environment, 2016
About 43 million Americans use federally unregulated private wells for drinking water. • Private ... more About 43 million Americans use federally unregulated private wells for drinking water. • Private wells may be contaminated with naturally occurring and manmade chemicals. • Protecting well water requires an "infrastructure for stewardship". • Recommendations to advance private well protection are offered.