Abstract
Physicians are in a unique position to be first-hand observers of the effects of environmental factors on population health. As a source of information which is highly trusted, they are also well-suited to raise awareness about the linkages between ecosystem and population health. Yet, current clinical practice in many parts of the world rarely includes environmental health assessments and patient education. The empirical evidence on the reasons for this lack of engagement is limited by the small number of studies published, its narrow geographical scope and the dearth of multivariate statistical analysis. This study used a mixed-methods approach to investigate the determinants of whether physicians at selected hospitals in Thailand assess the environmental history of their patients and provide environmental health advice. Using an ordered logistic regression model, it was found that physicians’ engagement was associated with their knowledge, personal motivation, perception of being supported by senior staff and ability to discuss with colleagues. According to key informants, possible remedies for the observed lack of physicians’ engagement include revisions of the medical school curriculum, clear strategies for addressing eco-health linkages in the clinical context at the national and hospital level, and better cooperation between relevant government institutions in Thailand.
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References
Abbas RA, Alghobashy AA (2012) Effect of an environmental health educational programme for paediatricians in an Egyptian university hospital: Before and after study. Journal of the Royal Society of Medicine 3(12):1–9
Aitchison J, Silvey SD (1957) The generalization of probit analysis to the case of multiple responses. Biometrika 44(1/2): 131-140
Atreya K, Johnsen FH, Sitaula BK (2012) Health and environmental costs of pesticide use in vegetable farming in Nepal. Environment, Development and Sustainability 14(4):477–493
Balbus JM, Harvey CE, McCurdy LE (2006) Educational needs assessment for pediatric health care providers on pesticide toxicity. Journal of Agromedicine 11(1):27–38
Bedsworth L (2012) California’s local health agencies and the state’s climate adaptation strategy. Climatic Change 11(1):119–133
Buka I, Rogers WT, Osornio-Vargas AR, Hoffman H, Pearce M, Li YY (2006) An urban survey of paediatric environmental health concerns: Perceptions of parents, guardians and health care professionals. Paediatrics and Child Health 11(4):235–238
Campbell K, Cooper D, Dias B, Prieur-Richard AH, Campbell-Lendrum D, Karesh WB, Daszak P (2012) Strengthening International Cooperation for Health and Biodiversity. EcoHealth 8(4):407–409
Cullagh MC (1980) Regression models for ordinal data (with discussion). Journal of the Royal Statistical Society: Series B 42: 109-142
EEA (European Environment Agency) (2015) The European environment—state and outlook 2015: synthesis report. Copenhagen: European Environment Agency
Friel S, Dangour AD, Garnett T, Lock K, Chalabi Z, Roberts I, Butler A, Butler CD, Waage J, McMichael AJ, Haines A (2009) Public health benefits of strategies to reduce greenhouse-gas emissions: food and agriculture. The Lancet 374(9706):2016–2025
Gehle KS, Crawford JL, Hatcher MT (2011) Integrating environmental health into medical education. American Journal of Preventive Medicine 41(4):S296–S301
Global Green and Healthy Hospitals (n.d.). Available:http://www.caha.org.au/globalgreen_healthyhospitals. Accessed August 9, 2018
Hamilton WJ, Ryder DJ, Cooper Jr HP, Williams DM, Weinberg AD (2005) Environmental health: a survey of Texas primary care physicians. Texas Medicine 101(10):62–70
Hawkins IW, Balsam AL, Goldman R (2015) A Survey of Registered Dietitians’ Concern and Actions Regarding Climate Change in the United States. Frontiers in Nutrition 2(21):1–8
Johnson A, Baum F (2001) Health promoting hospitals: a typology of different organizational approaches to health promotion. Health Promotion International 16(3):281–287
Karr C, Murphy H, Glew G, Keifer MC, Fenske RA (2006) Pacific Northwest health professionals survey on pesticides and children. Journal of Agromedicine 11(3–4):113–120
Kilpatrick N, Frumkin H, Trowbridge J, Escoffery C, Geller R, Rubin L, Teague G, Nodvin J (2002) The environmental history in pediatric practice: a study of pediatricians’ attitudes, beliefs, and practices. Environmental Health Perspectives 110(8):823–827
Krewski D, Lemyre L, Turner MC, Lee JE, Dallaire C, Bouchard L, Brand K, Mercier P (2006) Public perception of population health risks in Canada: Health hazards and sources of information. Human and ecological risk assessment 12(4):626–644
Maibach EW, Chadwick A, McBride D, Chuk M, Ebi KL, Balbus J (2008) Climate Change and Local Public Health in the United States: Preparedness, Programs and Perceptions of Local Public Health Department Directors. PLoS ONE 3(7):e2838
Markandya A, Armstrong BG, Hales S, Chiabai A, Criqui P, Mima S, Tonne C, Wilkinson P (2009) Public health benefits of strategies to reduce greenhouse-gas emissions: low-carbon electricity generation. The Lancet 374(9706):2006–2015
Massaquoi LD, Edwards NC (2015) A Scoping Review of Maternal and Child Health Clinicians Attitudes, Beliefs, Practice, Training and Perceived Self-Competence in Environmental Health. International Journal of Environmental Research and Public Health 12(12):15769-15781
McKelvey RD, Zavoina W (1975) A statistical model for the analysis of ordinal level dependent variables. Journal of mathematical sociology 4(1):103–120
MEA (Millennium Ecosystem Assessment) (2005) Ecosystems and Human Well-being: Synthesis. Washington DC: Island Press
Murshed R, Douglas RM, Ranmuthugala G, Caldwell B (2004) Clinicians’ roles in management of arsenicosis in Bangladesh: interview study. BMJ 328(7438), 493–494
Neuman W (2011) Social research methods qualitative and quantitative approaches, 7th ed. Boston MA: Pearson
Nicotera G, Nobile CG, Bianco A, Pavia M (2006) Environmental history-taking in clinical practice: Knowledge, attitudes, and practice of primary care physicians in Italy. Journal of Occupational and Environmental Medicine 48:294–302
Paterson JA, Ford JD, Ford LB, Lesnikowski A, Berry P, Henderson J, Heymann J (2012) Adaptation to climate change in the Ontario public health sector. BMC Public Health 12(452)
Patrick R, Capetola T, Townsend M, Hanna L (2011) Incorporating Sustainability into Community-Based Healthcare Practice. EcoHealth 8(3):277–289
Pelikan JM, Krajic K, Dietscher C (2001) The health promoting hospital (HPH): concept and development. Patient Education and Counseling 45(4):239–243
Prüss-Üstün A, Corvalán C (2006) Preventing disease through healthy environments: Towards an estimate of the environmental burden of disease. Geneva: World Health Organization
Roberts JR, Karr CJ, De Ybarrondo L, McCurdy LE, Freeland KD, Hulsey TC, Forman J (2013) Improving pediatrician knowledge about environmental triggers of asthma. Clinical Pediatrics 52(6):527–533
Roehr B (2007) Doctors should speak out on climate change, expert says. BMJ 335(7621):636
Romanelli C, Corvalan C, Cooper HD, Manga L, Maiero M, Campbell-Lendrum D (2014) From Manaus to Maputo: Toward a Public Health and Biodiversity Framework. EcoHealth 11(3):292–299
Sandifer PA, Sutton-Grier AE, Ward BP (2015) Exploring connections among nature, biodiversity, ecosystem services, and human health and well-being: Opportunities to enhance health and biodiversity conservation. Ecosystem Services 12:1–15
Shaw C, Hales S, Howden-Chapman P, Edwards R (2014) Health co-benefits of climate change mitigation policies in the transport sector. Nature Climate Change 4(6):427–433
Stotland NE, Sutton P, Trowbridge J, Atchley DS, Conry J, Trasande L, Gerbert B, Charlesworth A, Woodruff TJ (2014) Counseling patients on preventing prenatal environmental exposures-a mixed-methods study of obstetricians. PloS One 9(6):e98771
Trasande L, Newman N, Long L, Howe G, Kerwin BJ, Martin RJ, Gahagan SA, Weil WB (2010) Translating knowledge about environmental health to practitioners: are we doing enough? Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine 77(1):114–123
Trasande L, Niu J, Li J, Liu X, Zhang B, Li Z, Ding G, Sun Y, Chen M, Hu X, Chen LC, Mendelsohn A, Chen Y, Qu Q (2014) The environment and children’s health care in Northwest China. BMC Pediatrics 14:82
Trauth JM (1994) A case study of health risk communication: what the public wants and what it gets. Risk 5(1):49–64
Truckner RT (2009) Health care provider beliefs concerning the adverse health effects of environmental and ecosystem degradation. Wilderness and Environmental Medicine 20(3):199–211
Wall DH, Nielsen UN, Six J (2015) Soil biodiversity and human health. Nature 528:69–76.
WHO (2016) World Health Statistics 2016: Monitoring Health for the Sustainable Development Goals (SDGs). Geneva: World Health Organization
Wilkinson P, Smith KR, Davies M, Adair H, Armstrong BG, Barrett M, Bruce N, Haines A, Hamilton I, Oreszczyn T, Ridley I, Tonne C, Chalabi Z (2009) Public health benefits of strategies to reduce greenhouse-gas emissions: household energy. The Lancet 374(9705):1917–1929
Woodcock J, Edwards P, Tonne C, Armstrong BG, Ashiru O, Banister D, Beevers S, Chalabi Z, Chowdhury Z, Cohen A, Franco OH, Haines A, Hickman R, Lindsay G, Mittal I, Mohan D, Tiwari G, Woodward A, Roberts I (2009) Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport. The Lancet 374(9705):1930–1943
Acknowledgements
This research has been funded by Mahidol University (TM 126/2559). The authors would like to acknowledge Churnrurtai Kanchanachitra, Theerathorn Yoongthong, Donlachai Hawangchu and Reena Tadee on their invaluable assistance with this study. Our thanks go to all the key informants cited that gave their times for discussions. Comments by two anonymous reviewers are gratefully acknowledged.
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Völker, M., Hunchangsith, P. Drivers of Physicians’ Engagement in Addressing Eco-health Problems. EcoHealth 15, 853–863 (2018). https://doi.org/10.1007/s10393-018-1372-z
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DOI: https://doi.org/10.1007/s10393-018-1372-z