Position Statement: Environmental Carcinogens & Health
Recognizing the adverse impact of exposure to environmental carcinogens on health, the Registered Nurses’ Association of Ontario (RNAO) believes those exposures should be minimized.
Environment and Health: A National and International Issue for RNs
From Florence Nightingale onward, nurses and nursing organizations have been at the forefront of recognizing and promoting the importance of healthy environments for clients and their families. Nurses uphold a holistic view of health, and insist that not only should we focus on the treatment and cure of cancer, but also on its prevention. Nurses understand that prevention encompasses not only a matter of individual lifestyle choice, but also of taking collective action to reduce our daily exposure to avoidable carcinogens.
Therefore, RNAO supports an encompassing program to minimize exposure to carcinogens. It supports the principles of environmental protection as enshrined in Canadian law, including the precautionary principle, pollution prevention, virtual elimination of the most persistent and bioaccumulative toxic substances, and the “polluter-pays” principle.RNAO has actively advocated for bans on the nonessential use of pesticides; for clean air and the closure of polluting coal-fired generating plants; for community right-to-know legislation about toxic substances in the environment and in consumer products; and for Canada and Ontario to meet their greenhouse gas reduction obligations under the Kyoto accord.
At the national level, the Canadian Nurses Association (CNA) works with others in the health and social sectors to influence decisions affecting human health through the environment, and supports environmentally responsible activity in the health sector. RNAO supports this stance and works with CNA on environmental and health issues.
Internationally, the International Council of Nurses has long recognized the role of the environment in health:The concern of nurses is for people’s health – its promotion, its maintenance, its restoration. The healthy lives of people depend ultimately on the health of Planet Earth – its soil, its water, its oceans, its atmosphere, its biological diversity – all of the elements which constitute people’s natural environment. By extension, therefore, nurses need to be concerned with the promotion, maintenance and restoration of health of the natural environment, particularly with the pollution, degradation and destruction of that environment being caused by human activities.
The ICN also has position statements on reducing environmental and lifestyle-related health hazards and on occupational health and safety for nurses.
Our colleagues in the United States have advanced environmental health for nurses on many fronts.For example, the American Nurses Association has adopted a precautionary approach with respect to occupational and environmental health, and advocates: the reduction in the use of toxic chemicals; labeling and full disclosure mechanisms; sufficient information on the health effects of chemicals before their introduction; greater ease in removing chemicals from use; right-to-know about potentially hazardous chemicals; and theintegration of environmental health principles into nursing education, practice, research, advocacy and policy
At the same time, international nursing associations spell out very broad expectations on nurses regarding environmental health. For example, the Royal College of Nursing, Australia identifies the following responsibilities of nurses:
- seek to preserve the natural environment as fundamental to the health of all communities and future generations;
- assist communities and governments to reverse environmental degradation and destruction of the life support systems of the planet;
- work to protect natural resources, safeguard non-renewable resources and find ecologically sustainable solutions to environmental issues; and
- utilize their expertise and provide leadership to assist communities to apply the principles of public health and occupational health and safety to preserve health.
Other nursing associations have very detailed recommendations for nurses in the areas of practice, education, research and advocacy.
The Right to a Healthy Environment
Ontario’s Environmental Bill of Rights (1993) asserts:
The people of Ontario recognize the inherent value of the natural environment.
The people of Ontario have a right to a healthful environment.
The people of Ontario have as a common goal the protection, conservation and restoration of the natural environment for the benefit of present and future generations.
While the government has the primary responsibility for achieving this goal, the people should have means to ensure that it is achieved in an effective, timely, open and fair manner.
The stated purposes include: “The prevention, reduction and elimination of the use, generation and release of pollutants that are an unreasonable threat to the integrity of the environment.” The Bill of Rights has improved access to environmental decision-making, largely through the online Environmental Registry, which allows people to read about proposals (e.g., new laws, regulations, policies and programs) on environmental matters by government ministries covered by the EBR, and to file comments. However, critics argue that much morecould be done.
International conventions such as the Rio Declaration reaffirm the right of everyone to a healthy and productive life in harmony with nature.
The incidence of cancer in North America and in other parts of the industrialized world has escalated to epidemicproportions over recent decades, and greater increases are projected. In Canada, the cancer rate has risen to 1in 3 today from 1 in 10 in 1930. The incidence of cancer in Canada has risen from about 74,000 in 1978 to about 160,000 in 2007. The bulk of the rise is due to aging and population growth, but there has been a rise in the age-adjusted incidence rate as well (0.1 per cent annually for men and 0.3 per cent annually for women, over the 1994-2003 period).
A substantial sum of money is spent on cancer services – about $2 billion per year in Ontario alone. However, as the Canadian Strategy for Cancer Control (CSCC) notes, “only a small fraction of resources allocated to cancer control is currently spent on prevention.” Yet, the Provincial Cancer Prevention and Screening Council points out that about half of all cancers diagnosed by 2020 are either preventable or detectable before they become a serious problem. Accordingly, Cancer Care Ontario and the Canadian Cancer Society, Ontario Division developed the Cancer 2020 Action Plan to reduce Ontario cancer incidence and mortality. This action plan sets targets for various risks, including occupational and environmental carcinogens. Organizations such as the Canadian Cancer Society have taken significant steps to address environmental factors. Despite these efforts, much work remains to secure a shift of resources to address the major dangers of involuntary exposures to a wide range of environmental carcinogens.
A positive step was the development of a broad-based Cancer and Environmental Stakeholders Group including RNAO, which identified numerous known or probable environmental carcinogens to which Ontarians are exposed. Its 2007 report listed those carcinogens, identified key policy directions, and called for the implementation of a cancer prevention strategy for Ontario.
The evidence supports an association between cancer and many types of exposures: air pollution, arsenic in drinking water, asbestos, water disinfection by-products, extremely low frequency magnetic fields, solar radiation, and radon. Some pesticides and the components of some plastics have also been linked to cancer. Communities have taken actions to reduce their exposure to carcinogens and toxic substances, but are looking to governments and nongovernmental organizations for leadership and legislation.
Getting Carcinogens out of the Environment
The Cancer and the Environment Stakeholder Group identified key directions for future policy development:
- Development of a comprehensive, integrated provincial regulatory strategy for environmental toxics use reduction. This would include a focus on goals and caps for carcinogen use reduction.
- Establishment and full funding of an arm’s-length Ontario Carcinogen Use Reduction Institute, which would: research substitutes; assist industry in switching to less toxic or non-toxic chemicals (via training, knowledge transfer and direct assistance); track and report annually on carcinogen use; and follow up with industry.
- Tracking would include surveillance of environmentally-related cancer cases and deaths, residential and occupational history, biomonitoring, and trends (regional and provincial) in environmental carcinogens.
- Greatly strengthened regulation that: obliges users, manufacturers, and importers of substances to prove no significant environmental or health risks; and requires inclusion on labeling of consumer products of the presence of any known or suspected carcinogens.
- Provision of tax incentives, professional assistance, and scientific assessment of alternatives to users and manufacturers of chemicals.
RNAO endorses all of these measures as essential elements in a strategy whose ultimate goal is the virtual elimination of anthropogenic carcinogens from the environment.
This strategy must address outdoor and indoor exposures to carcinogens, including occupational exposures,which are often higher than non-occupational exposures.
RNAO will continue to advocate for strengthening the Canadian Environmental Protection Act (1999), which governs toxic releases (including environmental carcinogens).
RNAO will also continue to support provincial and municipal right-to-know initiatives. Existing legislation only captures major polluters; for example, only three per cent of Toronto facilities possibly using chemicals are obliged to report their use, and, as a result, less than 20 per cent of air pollution emissions are reported. This fundamental right of access to information should be recognized in law, and would assist communities and individuals in protecting themselves from carcinogens and other toxic substances in their environment and in consumer products.
Finally, RNAO will continue to promote:
a) the education and mobilization of nurses to address the environmental determinants of health;
b) raising the awareness of clients and the public on the need for cancer prevention;
c) advancing education, research, policy, advocacy and regulation regarding industrial carcinogens in our environment and in our food chain, as well as carcinogenic consumer products; and
d) mobilizing nurses and others to lobby municipalities, the province and the federal government to advance healthy public policy on the environmental determinants of cancer and other health issues (to be done directly and in collaboration with the Canadian Nurses Association
Please see the pdf version of this document for footnotes and references.