Environmental health and primary health care: towards a new workforce model

Abstract: Public health was once synonymous with environmental health, but the two fields diverged as living conditions improved. Environmental factors are again harming human health. Increasing global reliance on agricultural and veterinary chemicals over recent decades has emerged as a serious public health concern as evidence of their toxicity accumulates, prompting international efforts to minimize, monitor and manage exposure risks. Direct involvement of the primary health care workforce is seen as critical to this process, yet little data exists on the health burden on Australian rural communities imposed by these chemicals. The study presented here attempts to explore the impact of these chemicals on two rural communities, and ascertain the how the existing primary heath care system responds to exposure issues. The client -provider interface is not an entity acting in isolation from other frameworks. It has evolved against a background of legislation and provider training. Other factors also impinge, such as the structure and focus of the health sector, and Australia's systematic approach to environmental and chemical management. Examination of this underlying infrastructure in Australia provided the background against which the issue of exposure to agricultural and veterinary chemicals was explored. A brief summary of international developments in this area served to provide insight as to what interventions may be introduced to address this issue. A CATI survey of 1050 households sought the perspectives from two Victorian agricultural communities to gather self-reported exposure and health data, whether respondents perceived their health problems were linked to exposure. Respondents were also asked to comment on their experiences encountering primary health care providers, and which services they prefer to seek for health advice. Perspectives were then sought from all primary health care providers servicing these communities on their level of expertise in diagnosing, and managing exposure related illness, via face-to-face interviews, focus groups and paper surveys. These rural communities have a long history of hazardous exposure to toxic AgVets. Awareness of toxicity risks is growing, yet further scope exists to improve safe handling of chemicals. High levels of illnesses known be associated with AgVet exposure exist in these communities. Many believe their own ill-health is linked to exposure, and they express strong dissatisfaction with the apparent lack of environmental health expertise especially among their GPs. Health providers demonstrated limited understanding of the health impacts of AgVet exposure. The lack of expertise in the existing primary health care workforce means that these conditions are not being identified, and the absence of health intelligence hampers health planning. In Australia, the health, environment and primary industries sectors function in effect, as distinct silos, with little cross-fertilisation. The United States has combined its agricultural chemical legislative authority with a focus on human health, where there are direct links between programs designed to protect human heath, and biomonitoring. The U.S. also has developed environmental health expertise at the primary health care level to address community needs as they arise. Strategies are required to connect environmental, chemical management and health portfolios in Australia, with respect to the emerging environmental issue of chemical exposure. There is a need also in Australia to inject environmental health capacity into the primary health care practice.

Originally part of the Australasian Digital Theses (ADT) database.

Submission note: A thesis submitted in total fulfilment for the requirements for the degree of Doctor of Philosophy [to the School of Public Health], Faculty of Health Sciences, La Trobe University, Bundoora.