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Abstract

Approximately 3% of Canadians have been diagnosed with environmental sensitivities, and many more are somewhat sensitive to traces of chemicals and/or electromagnetic phenomena in the environment. People experience neurological and numerous other symptoms, and avoidance of triggers is an essential step to regaining health. The Canadian Human Rights Commission commissioned this report to summarize scientific information about environmental sensitivities. For those interested in the original scientific and technical literature, an annotated bibliography is available on request from environmentalhealthmed@gmail.com. This report addresses issues such as the definition and prevalence of environmental sensitivities; recognition by medical authorities; education and training within the medical community; origins, triggers and symptoms of sensitivities; impact of environmental sensitivities in the workplace; government policies and standards for building codes, air quality and ventilation as they affect individuals with environmental sensitivities; and guidelines for accommodation within the workplace. For people with environmental sensitivities, their health and ability to work rests with the actions of others, including building managers, co-workers and clients. Accommodating people with environmental sensitivities presents an opportunity to improve workplace environmental quality and workers’ performance, and may help prevent the onset of sensitivities in others.

Executive Summary

People’s responses to factors in their environment vary enormously. For instance, we all know that blue-eyed red-heads are sensitive to sunshine, burning more readily than dark-skinned people. What may be less well known is that some people have debilitating reactions to other aspects of their environment, such as chemicals or electromagnetic phenomena.

This report was prepared to inform employers, service providers and individual Canadians about the medical aspects of environmental sensitivities. It reviews and summarizes the scientific literature on environmental sensitivities. For those interested in the original scientific and technical literature, an annotated bibliography is provided. The report reviews medical issues including recognition and awareness of environmental sensitivities; the range of symptoms and conditions associated with this condition; the development of scientifically sound diagnostic criteria; medical research and treatment; issues regarding building codes and practices that affect the accommodation of people with sensitivities; and the costs and benefits associated with accommodation in the workplace.

Approximately 3% of Canadians have been diagnosed with environmental sensitivities. They usually experience neurological impairments, and often experience other symptoms including runny eyes and nose, headaches, fatigue, pain and breathing and digestive problems. Environmental sensitivities may develop gradually after chronic exposure to relatively low levels of chemicals as seen in "sick buildings," or suddenly after a major exposure to an environmental disaster or a chemical spill. This condition may be initiated by one or a combination of environmental factors such as mould, pesticides, solvents, chemicals off-gassing from carpets or furnishings, or electromagnetic phenomena.

Once a person has developed environmental sensitivities, reactions may occur to a broader range of factors, at levels of exposure that were previously tolerated and that cause little difficulty to many others. The symptoms are reproducible with repeated exposures, and resolve with avoidance of the environmental factor(s). The impact of environmental sensitivities on workers’ performance may range from mild (e.g. habituation to chronic exposures such that performance may be sub-optimal although not abnormal), to severe impairment such that work is impossible. Early recognition, environmental control, avoidance of symptom-triggering agents, removal of residual toxins from the body, and recovery of normal biological processes are key to regaining and maintaining health for people with sensitivities. However, susceptibility to sensitivities will be life long.

Internationally and in many Canadian government departments, recognition of environmental sensitivities is developing. Environmental sensitivities and related conditions are eligible for compensation by some Workers’ Compensation Boards, although there is marked inconsistency across Canada. Public policy, law and regulation are advancing to protect people from triggers of sensitivities, such as tobacco smoke, pesticides, fragrances and other chemicals in public places.

No-smoking, scent-free, pesticide-free, no-idling and least-toxic cleaning policies in health care and other public institutions are increasingly common, and the medical community is also advocating for broader policies and laws. Consensus is gradually building in the medical community and among academics, as well as in the general population, that many chemicals are not as harmless as we might have believed. The medical community is also increasingly acknowledging environmental sensitivities in medical education.

Modern medicine recognizes that the mind and body are intimately interconnected in the "biopsychosocial model" for health care. However, controversy continues regarding the physical or psychological roots of environmental sensitivities, with ramifications for both health care and workplace accommodation. Research indicates that sensitivities generally have physical causes, with many neurological and psycho-social factors interwoven. Successfully addressing physical symptoms with safe housing, workplaces, food and water may also alleviate psychological symptoms. This is necessary before other psychosocial interventions may be helpful.

Canadian statutes do not prescribe building standards that are protective for people with environmental sensitivities. Building codes focus on topics such as strength of structures. Measures impacting indoor environmental quality, such as building materials or de-gassing of buildings before they are occupied, are not addressed. Insofar as building codes and guidelines are perceived to be sufficiently protective of health and safety, they constitute barriers to research, development, implementation and mandating of safer materials and methods. "Green" guidelines incorporate a wide range of important environmental measures, but do not ensure that indoor environmental quality will be sufficient for people with sensitivities. More stringent guidelines have been developed for schools.

Accommodation of people with environmental sensitivities is an opportunity to improve environmental quality and workers’ performance, and to prevent the development of sensitivities in others. Sensitivities vary greatly from one individual to another, so the affected worker should be involved in determining accommodations to minimize potentially harmful exposures in the workplace.

Construction, renovation, repair and maintenance should be conducted to minimize the introduction of pollutants. Finishings, furnishings and equipment should contain low toxicity materials, have virtually no emissions, and be low-maintenance. Problems with structural dampness and moulds may be minimized with good design and construction. These considerations are increasingly important given the desire to conserve energy by reducing ventilation.

In addition to optimizing air quality and flow, ventilation systems must be maintained to avoid microbial contamination. Air filtration may play a role, but filters require frequent, routine maintenance. Least-toxic pest control that minimizes exposure to pesticides is effective and affordable.

Building and maintaining equipment and infrastructure to minimize exposure to electromagnetic radiation, fields and currents requires attention to detail and may entail limited one-time costs. Energy-efficient electrical equipment may (but not necessarily) increase radiofrequencies on electricity lines. Once recognized, however, these problems are amenable to engineering solutions. Health effects of unmeasured and uncontrolled parameters such as the quality of the electrical signal, radiofrequencies, locally elevated exposure levels and ground currents may have contributed to a lack of consensus in research regarding health effects of electromagnetic phenomena.

Workplace accommodation may include renovations, but some of the most important accommodations involve behaviour changes. These include the use of least-toxic cleaning and pest control practices, and avoidance of scented products. Unlike "built" accommodations such as ramps, accommodating people with sensitivities actively involves many people, such as employers, co-workers, others in the school or workplace, neighbours, etc.

There are high costs to society of not caring for people with sensitivities, and workplace environmental quality affects workers’ productivity, health and attendance. Building or renovating with a view to accommodating people with sensitivities is not usually more costly over the long term, in part because hard, durable surfaces that do not off-gas are longer-lasting and require less maintenance. Education and leadership for behaviour change in the workplace is not expensive. Thus, improving the environmental quality of the workplace is an economically sound decision, as well as the best option for workers’ health.