SPACE EXPLORATION | Expanding the boundaries of human understanding
29 July 2008
Environmental and Occupational Health for Developing Democracies
Thomas Cook, PhD, is a professor of Occupational and Environmental Health at the Center for International Rural and Environmental Health in the College of Public Health at the University of Iowa.
At the University of Iowa, we began working with health professionals from Central and Eastern Europe in 1996 to help these low- and middle-income countries build their capacity to improve occupational and environmental health. Today, professionals from Hungary, Poland, Slovakia, and Romania work with us as part of the Fogarty International Training and Research Program in Environmental and Occupational Health, and program activities have included health professionals from as many as 13 countries throughout the region.
Environmental health issues can include water quality and the health effects of poor water quality, air and industrial pollution, and soil pollution by fertilizers, pesticides, heavy metals, and other contaminants. Occupational health issues include injuries and trauma in the workplace, industrial and agricultural injuries, and work-related chemical exposures.
There's a close link between occupational and environmental health issues, particularly in rural areas. Our focus at the University of Iowa is rural health. In the 1950s, we had one of the first centers for agricultural medicine in the United States, so we're very interested in rural health issues and have a fair amount of experience and expertise in issues like pesticide poisonings and water contamination in rural areas.
Some people believe living in the countryside is healthy and wonderful, but the data worldwide tell you differently—a large number of serious health issues are related to rural and remote populations. These include the lack of preventive health and emergency services for people who live long distances from medical facilities, and water contamination by pesticides and fertilizers. In several Central/Eastern European countries, as many as 80 percent of the rural villages have water supplies with chemical or biological contamination.
We help people in Central/Eastern Europe deal with environmental and occupational problems by training physicians and public health professionals in a wide range of specialties—people who know how to test well water, how to recognize health problems, and how to collect data so policies and regulations and laws can be changed. We've trained nurses, engineers, physicians, epidemiologists, and public health media specialists.
In each country, we identify at least one institution that is responsible for rural and environmental health and work with them to select and train the people they need. For example, the Nofer Institute for Occupational Medicine in Lodz, Poland, is that country's leading occupational health institution. We will soon welcome the seventh health professional from that institution to our training program on the University of Iowa campus. The model we use is what Fogarty International Center calls intermediate-term training, meaning the students come to the University of Iowa for a 15-week semester. We and our collaborators jointly identify a student, who travels to the United States and takes graduate-level courses in the College of Public Health or a related college. The student is also matched with a faculty mentor who has expertise in the student's field.
While they are at the University of Iowa, students formulate a small research project that will be funded and that they will work on when they return home. Within a year after they return home, their faculty mentor travels to the country and together they present a continuing education program for the student's colleagues and other professionals from the region. It gives the trainees recognition as experts, and they are able to share what they have learned. We think it's a great program.
It takes a few years for the training to pay off - to get a critical mass of experts in each country. In northwestern Romania, for example, the country's third largest city, Cluj-Napoca (population 350,000), is in a very rural area. To date, we've had five trainees from Cluj, young, energetic physicians who are working hard to expand the scope and impact of public health in their country. We've found resources to fly experts there to conduct seminars and workshops, and we've significantly expanded our use of Internet-based education programs to help in capacity-building efforts throughout the region.
The opinions expressed in the preceding articles do not necessarily reflect the views or policies of the U.S. government.
From the October 2006 edition of eJournal USA.
