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The State of Health in New Mexico 2018

13. Environmental Health

Interacting with Our Physical and Social Environments

Environmental health addresses the interaction between human health and the chemical, physical, biological, and social factors in the environment. It also refers to the theory, science, and practice of assessing, correcting, and preventing those factors in the environment that may adversely affect the health of present and future generations of New Mexicans. Healthy People 2020 has a goal of promoting health for all through a healthy environment because it is central to increasing quality of life and years of healthy life.

Toxic Substances

Exposure to many toxic substances can be determined through testing biological samples, such as blood, urine, or hair. As part of New Mexico's notifiable disease surveillance, laboratory reports that indicate exposure to mercury, arsenic, uranium, lead, pesticides, nitrates, and carbon monoxide are collected and investigated. Lead exposure, for example, can be determined through blood testing. Even small amounts of lead can affect brain development in fetuses, infants, and children, while high levels in adults can contribute to high blood pressure and other health problems. Thus, lead testing combined with case management, in which the NMDOH helps families find and control the sources of lead exposure, for lead-poisoned children and adults are very important to public health. In recent years, the percentage of children tested for lead has increased from 7.1% of children under age 6 years of age tested in 2008 to 12.8% of children tested in 2016. Children with a blood lead level >5 mcg/dL, the level at which families are offered case management, has decreased from 6.2% of children screened in 2008 to 2.0% of children screened in 2016. The Northwest and Southwest New Mexico health regions had the highest rates of elevated lead levels in young children.

Air Quality and Health

Air pollution has been linked to many health problems, such as heart disease, asthma, and other respiratory diseases. Two types of air pollution with dangerous health effects are ozone and particle pollution. Wildfires can generate high levels of particulate matter pollution, which refers to particles suspended in air, such as dust, dirt, soot and smoke, and little droplets of liquid. Particles can range in size from large, such as soot or dense smoke, to too small to be seen. Industries adversely affecting air quality include power plants, oil and gas exploration, and confined animal feeding operations. Short-term exposure to high particle pollution contributes to increased mortality from cardiovascular events and may result in increased hospital admissions for several cardiovascular and pulmonary diseases, including heart attacks, congestive heart failure, stroke, asthma, and chronic obstructive pulmonary disease. The cardiovascular disease (CVD) death rate is highest in the Southeast region of the state and particle pollution may play a role. Long-term exposure to high levels of particle pollution can reduce overall life expectancy by a few years. However, the state has not installed air quality monitors in every county. Areas of the state with high CVD risk where air quality is not monitored are being prioritized for installation of an NMDOH air quality monitor.

Water Quality and Health

Water quality can negatively affect health if it contains unsafe levels of certain biological organisms or chemicals. Most New Mexicans have access to drinking water that meets standards under the national Safe Drinking Water Act and many get their drinking water from community water systems, for which the U.S. Environmental Protection Agency (EPA) sets regulations for a variety of microorganisms, chemicals and radionuclides.

Routine sampling and analysis of the state's water reveals that the quality is generally good, but problems can occur. When a public water system has a violation exceeding the Maximum Contaminant Level for a contaminant such as nitrates or E. coli, the New Mexico Environment Department's Drinking Water Bureau (NMED-DWB) issues a water/boil water advisory that is in place until the water system's testing results meet the drinking water standard. Those advisories are listed on the NMTracking.org Alerts and Hazard Warnings page. In 2017, six boil water advisories were issued. During such advisories, educational materials and public health expertise to prevent illness and be on heightened alert for potentially related cases are provided.

An estimated 400,000 people in New Mexico (about 20% of the population) receive their water from a private well. The water quality of a private well is unregulated in New Mexico. Owners of private water wells are the best protection of their water supply. Private well water quality can be influenced by natural sources, man-made sources, and/or natural disasters.

Asthma

Asthma is a chronic condition with symptoms that can occur or worsen with triggers (e.g., flu, stress, and cold air), and environmental irritants (e.g., cigarette smoke, smog, and dust), and allergens (e.g., pollen, mold, and dust mite). These irritants and triggers can exist in both the indoor and outdoor environment.

In New Mexico, 189,868 adults in 2016 and 45,503 children in 2015 reported having asthma. The burden of asthma may best be illustrated by the emergency department visits and hospitalizations for asthma (Figure 1). These rates tend to be highest among children and in the Southeast and Northwest regions of the state. Some of the efforts to address the disparities in asthma burden include: 1) providing asthma self-management education for children with asthma and their families, 2) by training healthcare providers and improving the asthma registry, 3) referring families of children with uncontrolled asthma to quality healthcare and educational resources, and 4) addressing the needs of low literacy and underserved communities to eliminate barriers to accessing quality healthcare.

Tracking Environmentally-related Disease

Linking environmental hazard or human exposure data with health data is needed to better understand how the environment may affect health. Examples include the connections between air quality and asthma emergency room visits, between extreme heat events and heat-related illness, and between arsenic levels in drinking water and bladder cancer incidence.

The NMDOH has been tracking prevalence rates for major birth defects since 1998. The causes of some birth defects are understood, and for these doctors and public health scientists can help women prevent their occurrence. However, the causes for many birth defects are not clearly understood. It is likely that most birth defects happen as a result of the interaction among various factors including the environment. The prevalence of cleft lip with or without cleft palate (Figure 3) varies by health region. Cleft lip with or without cleft palate is the most common craniofacial birth defect identified in newborns, affecting around 6 to 10 infants per 1,000 in the United States. The differences by health region may be connected to a variety of risk factors, including air pollution and maternal smoking.

The Environmental Public Health Tracking website has been developed to disseminate this type of information to New Mexicans. This information can help residents avoid potentially harmful exposures by providing important actionable data for New Mexico communities and public health practice. These data are readily available through Community Environmental Health Profiles. The profiles describe the health, risk, and resilience factors of New Mexico communities, including various socio-economic, environmental, and health indicators and outcomes in individual New Mexico counties.

Contributing Factors

Risk and Resiliency Factors

Housing affects health both directly, through physical, chemical, and biological exposures, and indirectly, through psychological effects. Lower quality housing can increase asthma exacerbation, lead poisoning and radon and mold exposure. There is evidence that indoor environmental exposures are common in low-income housing and usually there are multiple hazards in such homes. There are disparities in the quality of housing conditions across New Mexico. For instance, from 2011-2015, 83.3% of the houses in Lea County were built before 1980, giving them a higher likelihood of lead paint and asthma triggers. And Lea County also had the highest asthma childhood hospitalization rate among all New Mexico counties in 2016.

Despite these risks, New Mexico is fortunate that overall outdoor air and water quality tend to be good, which reduces the overall risk of harmful environmental exposures.

Health Disparities

Racial and ethnic minority populations in the United States are at higher risk for being exposed to indoor pollutants such as lead, allergens, and pesticides and are more likely to live in those counties with the highest levels of outdoor pollution. Socioeconomic factors such as income, education, and recent immigration to the U.S., are associated with the quality of housing, which impacts exposure to indoor pollutants. Those same socioeconomic facts are also associated with outdoor pollutants because lower income communities live near facilities and industries that have made the land less desirable and thus cheaper.

Disparities in asthma hospitalizations and emergency room visits exist among various age and health insurance status groups, between sexes (Figure 1) and geographic locations. For instance, in 2016, the children insured by Medicaid were the group most likely be admitted to a hospital for asthma (10.3 visits per 10,000 children compared to 0.0 visits per 10,000 with self-pay).

Assets and Resources

The New Mexico Council on Asthma (NMCOA) members include public and community-based organizations, physician and health insurance provider groups, community members, academia. The NMCOA focuses on statewide asthma education and outreach, policy development, and members' collaboration to enhance the availability of quality healthcare and education, and to effectively reduce asthma rates among groups with a high burden of asthma.

Schools in New Mexico play an important role with asthma control as well. In many schools, nurses can provide self-management education to children with asthma. The state has a voluntary Stock Asthma Emergency Medications in School Act that was implemented in many schools, so that asthma emergencies can be treated on site. Additionally, the collaboration among the Office of School and Adolescent Health, the University of New Mexico, school districts and nurses, NMCOA, and the Asthma Control Program resulted in a standardized asthma action plan that is currently used in all schools in the state.

Head Start is a federal program that promotes the school readiness of children from birth to age five from low-income families by enhancing their cognitive, social, and emotional development. Head Start (and Early Head Start) programs in the state require a blood-lead test when a child is enrolled, which can provide early management of children being exposed to lead.

Water testing events provide a baseline for understanding individual educational needs and testing barriers. The partnership with New Mexico Environment Department (NMED) on water fairs began in 2013. With participation in joint NMDOH/NMED well water testing fairs and NMDOH water testing events (Figure 2). Both events provide free well water testing and education.

Summary

Environmental factors that may adversely affect human health include but are not limited to air, food, and water contaminants, radiation, toxic chemicals, wastes, disease vectors, safety hazards, and habitat alterations. An assessment of the health outcomes that are a) associated with environmental factors and b) can be tracked indicate that the top priorities include cardiovascular disease, chronic obstructive pulmonary disease (COPD), and asthma. COPD is one outcome that requires more attention and resources to characterize how it is distributed in the state geographically, which residents are most at risk, and potential interventions. References
  1. Healthy People 2020: Environmental Health Overview. U.S. Public Health Service. Accessed 11/14/2017 from: https://www.healthypeople.gov/2020/topics-objectives/topic/environmental-health.
  2. Brook, R.D. et al. (2004). Air Pollution and Cardiovascular Disease: A Statement for Healthcare Professionals from the Expert Panel on Population and Prevention Science of the American Heart Association. Circulation; 109: 2655-2671.
  3. What Causes or Triggers Asthma? Accessed 11/28/2017 from: http://www.aafa.org/page/asthma-triggers-causes.aspx.
  4. Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, Anderson P, Mason CA, Collins JS, Kirby RS, Correa A; National Birth Defects Prevention Network. 2010.
  5. Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Research Part A: Clinical and Molecular Teratology;88(12):1008-16).
  6. Yeyi Zhu, Cuilin Zhang, Danping Liu, Katherine L. Grantz, Maeve Wallace, and Pauline Mendola, 2015. Environ Res. Jul; 140: 714-720.
  7. Xuan Z1, Zhongpeng Y1, Yanjun G1, Jiaqi D1, Yuchi Z1, Bing S2, Chenghao L. 2016. Maternal active smoking and risk of oral clefts: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. Dec;122(6):680-690).
  8. Environmental Conditions in Low-Income Urban Housing. Harvard T.H. Chan School of Public Health, The Center for Health and the Global Environment. Accessed 11/14/2017 from: https://chge.hsph.harvard.edu/resource/environmental-conditions-low-income-urban-housing.
  9. Committee Opinion: Exposure to Toxic Environmental Agents. The American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women, American Society for Reproductive Medicine Practice Committee. The University of California, San Francisco Program on Reproductive Health and the Environment. Accessed 11/14/2017 from: https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Exposure-to-Toxic-Environmental-Agents.


Figure 1. Asthma Hospitalizations and Emergency Department Visits by Sex and Age, New Mexico, 2016 Asthma Hospitalizations and Emergency Department Visits by Sex and Age, New Mexico 2016 Sources: NMDOH HIDD and ED Database Figure 2. Water Testing Event Participation by County, New Mexico, 2011-2017 Water Testing Event Participation by County, New Mexico, 2011-2017 Sources: NMED, NMDOH Figure 3. Cleft Lip with or without Cleft Palate by Health Region, New Mexico, 2011-2016 Cleft Lip with or without Cleft Palate by Health Region, New Mexico, 2011-2016 Source: NMDOH Birth Defects Surveillance Database

What is Being Done?

  • Developing multilingual videos (on healthy homes principles), licensing curricula, and in-person training for local community health workers who conduct home visits to assess asthma triggers.
  • The New Mexico Environmental Public Health Tracking website provides current data and educational and other resources related to environmental health, including air and water quality.
  • In partnership with the Four Corners States Biomonitoring Consortium, free well-water testing events are being provided to better understand environmental sources of exposure to metals.

What Needs to be Done?

  • Expand reimbursement for asthma self-management education policies to include out of healthcare settings (in-home) and para-professional providers (e.g., community health workers).
  • Continue to conduct outreach to domestic wells drinking water users to overcome barriers to testing and provide well owners with needed resources.
  • Provide higher geographic resolution and more timely, and accurate environmental health surveillance data and information to better support public health actions and needs of New Mexico communities.
The information provided above is from the New Mexico Department of Health's NM-IBIS web site (http://ibis.health.state.nm.us). The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Wed, 13 November 2019 from New Mexico Department of Health, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.nm.us".

Content updated: Tue, 20 Mar 2018 15:16:58 MDT