Integrating Environmental Health into Clinical Practice: A Collaborative Model for Chronic Disease Prevention

Abstract

Chronic diseases are the leading causes of death and disability in Canada and worldwide. Scientific investigations have established that harmful environmental exposures increase chronic disease risk. Emerging evidence has begun to quantify the environmental contribution to chronic disease burden. Primary care practice represents an important entry point for addressing chronic disease risk and the environmental determinants of health because of its extensive reach.

Alberta Health Services developed an ecological model of chronic disease prevention to guide its chronic disease prevention framework (Raine et al., 2006). This framework explicitly recognizes the environment and supports an integrated collaborative approach to the chronic disease prevention role of Alberta Health Services and partnered organizations. Preventing chronic disease by reducing exposure to harmful environmental substances and pollutants is consistent with this model and clearly positioned within the ecological framework. Within this context, a collaborative model is proposed to support the integration of environmental health into the clinical diagnosis, care, and management of chronic disease (E. Sears & J. Genuis, 2012). This approach encompasses multiple levels of activity at the individual, population, and systems levels and can readily be adapted to diverse jurisdictions, populations, conditions, and associated health professions.

Environmental health includes the study of environmental hazards, such as chemicals, radiation, and biological agents, and their interactions with the human biological system and other contextual features of human habitation, including food, work, and shelter. Elements or conditions of the environment that are associated with interactions between an exposure, a biological system, and a health outcome are referred to as environmental determinants of health. Chronic diseases commonly cited in the environmental health literature include cancers, cardiovascular disorders, developmental disorders, diabetes, infertility, kidney disorders, mental health conditions, neurological disorders, obesity, reproductive disorders, respiratory diseases, skin conditions, and urinary tract disorders (Reis et al., 2015).