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The Environmental Health Programme - SRCHC: Hidden Household Hazards

OHPE Bulletin #115.1, The Environmental Health Programme - South Riverdale Community Health Centre: Hidden Household Hazards

by Nita Chaudhuri

Nita Chaudhuri is an Environmental Health Promoter with the South Riverdale Community Health Centre in Toronto, ON.

A. Introduction

The Environmental Health Programme at the South Riverdale Community Health Centre (SRCHC) was developed to address the impact on community health of industrial land use activities in South Riverdale. The most famous example of this work had to do with addressing the effects of a lead based products manufacturer on the blood of South Riverdale children. In 1992 an Environmental Health Promoter position was created to help facilitate community involvement through education, action and research. Several community based projects have evolved since that time, including:

* development of an eco-tour of Riverdale

* linking housing and health issues through extensive work in social housing

* development of an indoor air quality workgroup

* development of popular education tools such as interactive workshops and popular theatre

* the development of a resource guide through action research.

In 1997 several strategies were integrated with a detailed evaluation framework that would allow for reflexive evaluation throughout the process and indicators to determine whether there had been any change as a result of the interventions. The focus of the project was to look at toxins in the indoor environment that affect health. Four target groups were chosen to focus on: low income tenants, high risk pre-natal group members, asthma patients and Chinese ESL class members.

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B. The South Riverdale Setting

The South Riverdale community is situated in south east Toronto. Existing demographics in Riverdale as compared to the rest of Toronto indicate a high incidence of low income families, more families with children (0-4 years), more female headed single parent households, low literacy and older and poorer housing. In addition, there is a large amount of industry and heavily used traffic corridors. Thirty seven percent of the population are new Canadian with Chinese being the second largest linguistic group followed by Greek and Vietnamese communities. Due to economic necessity many of these new Canadians live in crowded housing. These factors characterize a population that has poor health. Vulnerability is increased because of barriers to access to health related information in relevant languages, which includes information on the environment and health.

Surveys on asthma statistics in the neighbourhood conducted by both the City of Toronto Department of Public Health, the South East Toronto Project and the SRCHC clinic records show that breathing problems are a large problem. A recent community survey conducted by the SRCHC through the University of Toronto's Urban Life and Health Initiative, showed that chemical cleaners, solvents, pesticides are identified as being triggers for asthma. This was particularly true for children. Respondents identified that information and access to other healthier products was not readily available.

Many consumer products are purchased with little knowledge of their environmental and health impact. Most of the toxic ingredients are not listed and many low income and new Canadian consumers depend on advertising when making their choices. Very few non-toxic commercial options are easily available, while other alternatives such as baking soda, borax and vinegar are perceived not to be as effective.

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C. Hidden Household Hazards: Project Goal, Objectives and Strategies

Overall Health Promotion Project Goal:

To improve the physical, social, mental and emotional health of low income families, asthma patients, Chinese community and pre-natal groups, while focusing on the indoor environment and its effects on health.

Two sets of objectives exist in order to realize this goal: environmental objectives and social objectives.

Environmental Objectives

1) One thousand households were to be targeted over two years regarding the safe use and disposal of toxic consumer products, as well as the health effects of and alternatives to these products.

2) Five percent of these households were to use the 'toxic taxis' or other safe disposal venues for toxic products.

3) Twenty percent of these households were to switch to non-toxic household products and pest control methods.

4) To provide a new distribution channel.

Social Objectives

1) People understand the relationship between the indoor environment and their health.

2) People have easy access to non-toxic products in the community.

3) People have positive attitudes toward the use of non-toxic products.

4) People have skills and knowledge to create healthy indoor environments

5) People have control over their own internal environment-- "I can do something"

6) To establish the groundwork to enable features of this programme to continue after 1999.

7) People will have more disposable income as a result of spending less on toxic items.

The Strategies

Several different strategies were used with each of the target groups, including:

* a door-to-door questionnaire in two of the housing projects

* workshops on the health effects of toxic products and alternatives to these products

* integrated pest management

* demonstrations

* interactive displays

* an eco-tour of Riverdale and a retail outlet tour.

The thrust of the environmental health programme has always been iterative, participatory, evolving and experiential and the strategies reflect these qualities. The development of a project with the pre-natal group "Healthy Beginnings" will be highlighted below.

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D. Healthy Beginnings

Healthy Beginnings is a pre and post natal support programme for high risk mothers (new immigrant and or low income). The programme provides nursing support as well as ongoing educational sessions on such topics as childbirth and nutrition. The environmental health promoter had been attending these sessions for a number of years, presenting concepts and information on toxic products and alternatives using various popular education methods, including the use of popular theatre. In January 1998, at the beginning of the Hidden Household Hazards project, a series of three workshops, which had a pre and post evaluation component, were given to the group. The group's nature had changed considerably from predominantly English speaking low income women to non-English speaking women. An evaluation matrix was used to analyze the first set of interventions. This matrix was very useful as a midstream evaluation tool.

(The components of the matrix are reproduced in a format suitable for the plain-text transmission of the OHPE bulletin. This matrix would normally be presented as a table.)

The following interventions were used:

1) Questionnaire

General Comments: very long, defeats popular education, many could not read English

Possible Solutions: develop another tool, talk to women one on one

2) Quiz

General Comments: people liked quiz, but explanations were very difficult

Possible Solutions: simplify explanation

3) Demonstrations

General Comments: Women interested in actual products

4) Going through "Hidden Exposures" (booklet for parents prepared by the Indoor Air Quality Workgroup of the South Riverdale CHC)

General Comments: interested in details of book that dealt with children's products, participant teaches class, like a marketplace atmosphere

Possible Solutions: certain things grab women's attention, products relevant to children

Tasks: develop Healthy Homes Marketplace

5) Play

General Comments: very difficult, women were distracted, English was a barrier, not culturally appropriate

Possible solution: develop one or two mime scenes

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E. Healthy Homes Marketplace

The Healthy Homes Marketplace was developed as a result of the mid-stream evaluation of the first set of interventions. It is a display which includes Toxic and Less Toxic cleaning products, pest control products, personal care products and children's products. The tactile and visual nature of the display helps participants understand the concepts "toxic" and "less toxic". It is also fun, as each individual touches and smells the various products. The Healthy Homes Marketplace is always changing as new questions arise and new products are discovered. The categories for the product display arose out of the book "Hidden Exposures"- A Practical Guide to Creating a Healthy Environment for You and Your Children" (see OHPE 115.2, Resources on Healthy Households for information on this book)

Women had a great deal of interest in the products and asked lots of questions. Happy faces, sad faces and faces with a question mark were used as a way to indicate to participants which products were desirable. A traffic light symbol was used along with these faces: red--don't use, green--use and yellow--caution.

The use of an ongoing evaluation process allowed for the development of more useful techniques. Due to the flexibility of SRCHC in programming, tools continue to develop through a participatory community process.