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Building this network requires improvements in professional and public education. This chapter examines the educational issues in communities of concern, including the education of both health professionals and the general public, and presents an overarching recommendation with related strategies for addressing these issues.
Health Professional Education
During the committee's site visits, the symptoms and health conditions that people commonly tended to attribute to environmental causes included respiratory disorders, skin rashes, hair loss, gastrointestinal stress, blurred vision, fetal abnormalities, blood disorders, and a variety of cancers. It seems clear that physicians in all medical specialties need to be alerted to the possible relationship between these types of complaints and environmental phenomena and that the means of diagnosis of environmental causes of disease and illness need to receive more attention within the community of health care providers. Addressing the problem of diseases caused by environmental and occupational exposures is an issue shared among all health professionals, and it is the major focus of environmental and occupational medicine (EOM). EOM training focuses on diagnosing and caring for people exposed to chemical, biological, and physical hazards in the workplace, home, and community environments. Thus, EOM is the medical discipline most appropriate for addressing health issues related to environmental and occupational exposures. Unfortunately, but as expected, the site visits revealed that primary health care providers in the community lack specific training in EOM and that community residents lack access to clinical EOM services (Institute of Medicine, 1991, 1995a).
Enhancing Health Professional Education
Certain irreducible minimums of education and training need to be established, particularly with reference to minority and low-income communities, if the trends of environmental degradation that have thus far prevailed in many communities are to be corrected and reversed and if any more communities are to be prevented from experiencing the same fate. These minimums are needed in many areas, including medical education, public health professional education, and nursing and allied health sciences.
Most medical students and residents receive very little training in environmental health or occupational medicine. In most medical schools, the average classroom time for occupational and environmental medicine combined is an