Concept of Health and Environmental Medicine
Los determinantes de la salud se clasifican en torno a cuatro grandes categorías: medio
ambiente, estilo de vida, biología humana y servicios de atención.
Según el célebre Informe[4] de Marc Lalonde,[5] la salud y/o la enfermedad no están relacionadas meramente con factores biológicos o agentes infecciosos, de hecho desde hace décadas se enfatiza que la mayoría de las enfermedades tienen una base u origen marcadamente socioeconómico-ambiental. Este informe fundante fue aclamado internacionalmente por su enfoque orientado a la promoción de la salud y a la prevención de las enfermedades.
La salud ambiental estudia factores del ambiente y entorno que afectan a humanos, vegetales y animales. Involucra el proceso mediante el cual se evalúan, corrigen y controlan aquellos factores ambientales que puedan influir negativamente en la salud de las personas.
En México, se estima que los factores ambientales son responsables de entre el 25 y 33% de la carga global de la enfermedad, afectando primordialmente a la población menor de cinco años.
La medicina ambiental (en sus aspectos asistenciales) se centra en los agentes productores de enfermedad introducidos en el medio ambiente por actividades humanas, así como en el conocimiento de dichos agentes tanto con finalidad preventiva como terapéutica.
Si bien estudia y trata a las enfermedades ambientales, se ocupa en gran parte de aspectos de investigación y preventivos. Solo recientemente ha avanzado sobre los aspectos de impacto sobre la salud humana.
La medicina ambiental es una rama de la salud ambiental que establece el efecto sobre la salud humana de los factores físicos, químicos, biológicos, psicosociales, ergonómicos y de seguridad.
La terapéutica ambiental es una rama de la medicina ambiental que se ocupa del tratamiento de las enfermedades ambientales. Como tal, ante la multiplicidad de síntomas y signos nosológicos, recurre a todas las formas terapéuticas posibles, desde las convencionales hasta las alternativas y complementarias.
La prevención ambiental en salud apunta a diagnosticar, evaluar y corregir los factores ambientales, en especial aquellos perjudiciales para la salud humana, animal y vegetal.
El estudio de lo que apunta a la Seguridad y Salud Ambiental sirve a la sociedad y a las organizaciones de transformación y de servicios, aplicando conocimientos, destrezas y habilidades con una visión integral y actitud eficiente en la prevención, evaluación y control de los factores del ambiente laboral, de seguridad, salud ambiental y de gestión administrativa, ante las instituciones públicas y privadas.
Máxime considerando que las instituciones internacionales contemplan que los problemas de salud relacionados con lo medioambiental en contextos laborales, son susceptibles de prevención por definición, dado que sus factores determinantes se encuentran precisamente en las condiciones de trabajo.
En este sentido, en las últimas décadas se han fortalecido las acciones de los actores gubernamentales, empresariales y sindicales orientadas a la promoción y la protección del bienestar de los trabajadores mediante la prevención y el control de los accidentes de trabajo y las enfermedades profesionales, así como la eliminación de los factores y condiciones que ponen en peligro la salud y la seguridad.
En la misma línea, se han fortalecido los programas que tienen como eje la Salud Ocupacional tratada en forma multidisciplinaria para proteger el bienestar de los trabajadores. Esta serie de estrategias procura generar y promover el trabajo seguro y sano, así como buenos ambientes y organizaciones de trabajo, al realzar el bienestar físico, mental y social.[6].
Chemical factors
They refer to the chemical characteristics of the medium - whether gaseous, liquid (water) or solid, salinity, acidity (pH) or alkalinity (pOH) and natural or synthetic chemical elements or compounds, including nutrients. They are among the most common.
Social factors
Our relationship with the psycho-sociocultural environment is a continuous "feed back", we provide mutual feedback in a positive or negative way.
The environment, the environment, gives us what we need to live, however, human beings are increasingly misusing their availability. Continuously for hundreds of years, we are damaging the environment with our human activities and this has its nemesis.
Although it is true that nature sometimes behaves strangely, the hand of man has a lot to do with it. And this behavior of nature (including social) and the environment affects our health.
A non-exhaustive multidimensional approach allows us to point out the multiple incidence factors, some such as:
It is true that the population is increasingly aware and more committed to the environment, after witnessing ecological disasters such as those experienced in recent years such as oil spills, forest fires or nuclear leaks, among others. Awareness campaigns have increased and the measures being taken towards a future that is not very favorable for our future generations are increasing without greater efforts towards a healthy environment.
Ergonomic and safety factors
Ergonomic factors or variables are related to the adaptation of the individual to the task and/or their adaptation to the instrument, for example, machine or seat where they perform it.
The spaces where tasks are carried out are also related, especially if they are excessively small or too large.
The general security of tasks within the job is also codified in several institutions.
Mixed factors
Rarely do the factors described above occur in isolation. For example, a volcanic eruption causes: vibrations; particulate matter emissions; gas emissions, all these factors originating from a single natural phenomenon are harmful to human health, also affecting animals and plants present in the affected areas, which can cause food insecurity, general insecurity problems, unemployment, among others.
In urban environments the action of mixed factors is verified more clearly. The combined action of most agents in the cause of environmental diseases is observed, for example, in the syndrome of multiple chemical sensitivities (in English, Multiple Chemical Sensitivity). In SSQM - referred to as "a modern epidemic" by some quarters and as a manifestation of depression and anxiety by others - these detrimental interactions could be revealed.
Beyond multiple chemical sensitivity (SSQM) and perhaps in relation to SSQM, it is worth mentioning drug intoxication, its abuse and polypharmacy or simultaneous administration of remedies and medications with contradictory and paradoxical actions (here not only their action but also their incompatibilities and those of vehicles, improvers, preservatives, etc.) intervene.
The growing dependence on medications in "advanced" societies results in new environmental factors of morbidity and mortality such as drug resistance.
Scope of environmental medicine
Although environmental medicine is quite effective when it comes to establishing diagnoses and possible causes of pathologies, when it comes to providing treatment it is more limited. For example, in communities massively affected by combinations ("mixtures") of factors (chemical, physical, social), the solution to their diverse impact on individual and collective health ("epidemics" of cancer, congenital malformations) is usually partial, ineffective and inefficient. Even so, it is a branch of extraordinary importance that provides us with security in the face of environmental dangers and risks.
Toxicology is one of the most useful disciplines of environmental medicine when diagnosing, treating and prognosing environmental diseases.
The environmental clinic is underdeveloped in general. Some environmental clinical histories have been established but have not entered massively into medical practice. For this reason, most environmental diseases go undiagnosed and therefore untreated.
Environmental therapy is very broad and ranges from the remediation or exclusion of a contaminating factor or place to the clinical and pharmacotherapeutic treatment of the condition itself. For this, both conventional medicine and disciplines such as homeopathy, psychotherapy or so-called alternative and complementary medicines are used.
The driving forces model
The driving forces model -MFM-")[20] consists of a methodological instrument through which it is intended to establish a cause-effect link between health and the environment. It focuses, in particular, on the establishment of actions that allow intervention on the structural conditions that determine the state or quality of the environment, which in turn affects human health.