Conclusions

This report was prepared to inform employers, service providers and individual Canadians about the medical aspects of environmental sensitivities. It covers the range of symptoms and conditions associated with environmental sensitivities; recognition and awareness by international, national, provincial and municipal bodies; medical research, diagnosis and treatment; issues regarding building codes and practices that affect accommodation of people with sensitivities; accommodation guidelines; and their impact in the workplace.

People’s responses to factors in their environment vary enormously. Some people have debilitating responses to chemicals or electromagnetic radiation. They usually experience neurological difficulties and often have symptoms such as fatigue, burning eyes, headaches, trouble thinking and concentrating, nasal congestion, pain in various parts of the body, respiratory distress and gastrointestinal ailments. These may be accompanied by psychological symptoms. Symptoms are reproducible with repeated exposures, and resolve with avoidance of environmental factors that trigger symptoms. Environmental sensitivities may develop gradually after chronic exposure to relatively low levels of substances found in buildings with poor air quality ("sick buildings") or suddenly after an exposure to an environmental disaster or chemical spill. This condition may be initiated by one or a combination of environmental factors such as mould, pesticides, solvents, chemicals (e.g. 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 impact of environmental sensitivities on workers’ performance may range from mild (e.g. habituation to chronic exposures such that performance may be sub-optimal if not overtly abnormal), to severe impairment such that work is impossible. Sensitivities vary greatly from one individual to another, so the affected worker must be involved in determining accommodations.

Approximately 3% of Canadians have been diagnosed with environmental sensitivities and up to one-third of the population may experience discomfort due to factors in their environment. 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 lifelong.

Recognition of environmental sensitivities is developing internationally and in many Canadian government departments. 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, scents and other chemicals in public places.

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 and that their combined effects are unpredictable. No-smoking, scent-free, pesticide-free, no-idling and least-toxic cleaning policies in health care and other public institutions are increasingly common. Furthermore, the medical community is advocating for broader policies and laws and 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 health care and workplace accommodation. The research indicates that sensitivities have physical causes, with many neurological and psycho-social factors interwoven. Successfully addressing symptoms of sensitivities, with safe housing, workplaces, food and water, may also alleviate psychological symptoms. This is necessary before other interventions may be helpful.

Canadian statutes do not prescribe building standards that protect 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.

Construction, renovation, repair and maintenance should be conducted to minimize the introduction of pollutants, and design and construction should minimize later problems with dampness and moulds. Finishings, furnishings and equipment should contain low toxicity materials, have virtually no emissions, and be low-maintenance. 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 and routine maintenance. Least-toxic pest control, minimizing 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 additional initial costs. Energy-efficient electrical equipment might increase radiofrequencies on electricity lines. Once recognized, however, these problems are amenable to inexpensive engineering solutions. There is a lack of consensus in research regarding the health effects of electromagnetic phenomena. This may be due to methodological limitations including unmeasured and uncontrolled parameters such as the quality of the electrical signal, radiofrequencies, locally elevated exposure levels and ground currents.

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. With education and leadership, people successfully adjust to policies addressing smoking, personal care, building maintenance and foods.

Improving the environmental quality of the workplace promotes workers’ health and productivity and can prevent the development of sensitivities in others. Building or renovating with a view to accommodating people with sensitivities is not costly over the longer term; nor are education and leadership for behaviour change in the workplace.