Upstream Reflections on Environmental Health: An Abbreviated History and Framework for Action

Patricia G. Butterfield
2002 Advances in Nursing Science  
The environment-the chemical, physical, and biological agents to which we are exposed, along with our lifestyles-plays an important role in the development of chronic diseases such as cancer. The current view is that most chronic diseases arise from complex interactions of multiple genes and environmental exposures. Therefore, the prevention of most human diseases will require a more thorough understanding of both the genetic and the environmental contributions to their etiology. 1(p1965) To
more » ... e, there is an incomplete understanding of the etiology of many cancers, neurologic conditions, respiratory diseases, and disorders of immune functioning. Support for basic research addressing these conditions has increased significantly over the past 5 years; however, the work is remarkably complex, incremental, and time consuming. As the work continues, so do deaths in our clients; in the United States, 32 Upstream thinking considers the social, economic, and environmental origins of health problems that manifest at the population level. The upstream thinking perspective is applied to an examination of environmentally associated health problems and the opportunities that citizens have (or do not have) to access information and resources to make health-promoting choices in response to environmental health risks. A proposed framework for nurses to reduce environmental health risks includes distributive and strategic actions. Distributive actions include tracking, embedding, and translating; strategic actions include discovering through etiologic research, discovering through community-based research, advocating, and reframing. Together these actions can help formalize nursing's role in responding to citizens' concerns about environmental health problems.
doi:10.1097/00012272-200209000-00006 pmid:12889576 fatcat:ka4hmj4srjforhdoi7dcu7sk7q