Photo: It's important to reduce toxics at work and at home

A Toronto sewer bylaw adopted in 2000 restricted what could be discharged into sanitary, stormwater and natural watercourses. The result was that health-care facilities and others requested cleaning products that did not contain the forbidden ingredients. (Credit: D'Arcy Norman via Flickr)

Docs Talk: Why did the Canadian Coalition for Green Health Care decide to review toxic chemicals in cleaning products?

Dr. Marshall: Toxics-use reduction, along with energy and water conservation and increased local food use, is part of health-care providers doing their bit for the health of the people and the communities we serve. While cleaning products must display hazard symbols to warn of acute effects like poisoning or irritation, information about ingredients with potential chronic health effects is not on the label. Not only is there concern for product users' health, but product wastes go down the drain, exposing the local environment to potentially hazardous materials.

A Toronto sewer bylaw adopted in 2000 restricted what could be discharged into sanitary, stormwater and natural watercourses, and the result was that health-care facilities and others, their awareness raised with legal clout, requested cleaning products that did not contain the forbidden ingredients. That led to a win-win reformulation of safer products for all Canadians. The Environmental Reporting and Disclosure Bylaw and ChemTRAC outline 25 priority substances for businesses to report and plan to reduce. Building on this legislative initiative, the Canadian Coalition for Green Health Care established a Safer Chemical Policy alliance, green product assessment criteria, and a database of resources from across the country.

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Docs Talk: What effect can cleaning products have on our health and the environment?

Dr. Marshall: While links between acute effects of ingredients of cleaning products may be fairly obvious (particularly if an asthma attack or rash is triggered), chronic effects on health and the environment are much more subtle. There are diverse ingredients in products at differing doses, varying in their harmful potential, alone or in mixtures. Their impact on the health of individuals varies according to the person's genetic capability1 and age-related ability to metabolize the individual compounds2, and the totality of harmful ingredients to which they are exposed, invariably worse in those with low socioeconomic positions2. The most vulnerable to harm are fetuses and young children because their metabolic systems are still developing, and, if damage to those systems occurs, effects may be lifelong. Children are exposed more to airborne hazards than are adults because they breathe more per kilogram body weight than adults, and they are positioned closer to floors, and use hand-to mouth behaviour to explore3.

Multiple body systems are potentially affected, differing with individuals- neurological (e.g., headache, trouble concentrating), cardiovascular (e.g., cardiac birth defects, low birth weight), respiratory (e.g., itchy eyes, runny nose, wheezing), various cancers2, and/or gastrointestinal tract (e.g., nausea, diarrhea), dermatological allergies (e.g., eczematous contact dermatitis)1.

Docs Talk: In your clinical practice, what adverse health effects have you observed that may be connected to chemicals in household cleaning products?

Dr. Marshall: A case that comes to mind is an unexpected compliment I received from a colleague for "saving his neighbourhood" from "a hellion" who turned into "a really nice kid". When he said his name, I didn't remember him, but I looked up his chart.

Three years previously, "Joey" was an eight-year-old, referred by his family doctor because he had had frequent upper respiratory and ear infections since the age of two, periodic asthma, and was "hyper", irritable, and inattentive in school. Besides a clinical history and physical examination, I took an exposure history, asking about Community, Home and Hobby, Occupation (School in Joey's case), Personal, Diet and Drugs (this type of review is known as CH2OPD2)4.

I determined the family had moved into their compact bungalow, built in the 1970s when Joey was two, and his parents used multiple fragranced cleaning, laundry and personal-care products in the home — not to mention that his mother made scented candles in the kitchen weekly, and his bedroom was crammed with dust-collectors.

Besides checking Joey's blood lead level (low), I suggested various "experiments", whereby the mother would give candle-making a rest, and they would use only water-dampened cloths and baking soda to clean, and they would do laundry and personal care with a minimum of fragrance-free products, plus clear out his bedroom except for absolutely necessary furnishings. I suggested he eliminate a suspect food as well. My aim was to sharply reduce Joey's exposure to the agents I saw were potentially contributing to his health problems. I asked them to keep track of his symptoms, and after about two weeks, to go back to using their former products for a day.

When they returned five weeks later, they reported that all of Joey's symptoms had cleared in the avoidance phase and returned on re-introduction. His symptoms had again disappeared on resuming avoidance, and both mother and son were happy to continue the environmental/dietary controls. I never saw them again!

Docs Talk: What are the main barriers to "going green" when it comes to household cleaning products?

Dr. Marshall: Advertising! Companies are very persuasive that we "need" their products to do a "respectable" job of cleaning at home, and they have to be fragranced to create a "fresh" smell, which is implied to be "essential".

Cleaning at home has fewer requirements than cleaning in a health-care facility, and one could substitute fragrance-free products or one could use inexpensive items like vinegar and water to clean floors, windows and surfaces, and baking soda to scrub sinks and tubs. David Suzuki's Queen of Green and the Less Toxic Guide offer easy and effective recipes for do-it-yourself green cleaning.

Docs Talk: What strategies do you recommend to keep our homes clean, green and healthy?

Dr. Marshall: First of all, I would keep clutter down. (I know, I know, my colleagues recognize that I am not a paragon of virtue with regard to my workspace!) Then, I would follow CPCHE's advice in the Safe at Home pamphlet and video with regard to 1. Bust That Dust, and 2. Go Green When You Clean and the David Suzuki Foundation's 10 tips to green your clean.

Lynn Marshall is a staff physician and medical education liaison of the provincial Environmental Health Clinic at Women's College Hospital, Toronto, and is a faculty member/teacher at the University of Toronto, Northern Ontario School of Medicine, and Lakehead University. She is a long-time member of CAPE and the Environmental Health Committee of the Ontario College of Family Physicians, and president and chair of the Environmental Health Institute of Canada. She has a special interest in the work of the Canadian Partnership for Children's Health and the Environment and the Canadian Coalition for Green Health Care, which recently reviewed less-toxic cleaning products for the health care system Green Products and Services Directory. Docs Talk interviewed Dr. Marshall in relation to the David Suzuki Foundation's green cleaning campaign.


1 Marshall Lynn, Bested Alison, Molot John, Kerr Kathleen, Bray Riina I. Environmental Sensitivities — Multiple Chemical Sensitivities Status Report, Advances in Knowledge, and Current Service Gaps ESMCSStatusReportJune22011.pdf

2 Cooper K, Marshall L, Vanderlinden L, and Ursitti F (2011) Early Exposures to Hazardous Chemicals / Pollution and Associations with Chronic Disease: A Scoping Review. Executive Summary-A report from the Canadian Environmental Law Association, the Ontario College of Family Physicians, and the Environmental Health Institute of Canada

3 Canadian Partnership for Children's Health and the Environment. Child Health and the Environment — A Primer, August 2005.

4 Marshall Lynn, Weir Erica, Abelsohn Alan, Sanborn Margaret D. Identifying and managing adverse environmental health effects: 1. Taking an exposure history. CMAJ Apr. 16, 2002; 166 (8): 1049-55; Marshall Lynn, Weir Erica, Abelsohn Alan, Sanborn Margaret D. Occupational and environmental exposure, response to letter to the editor by Michael Schweigert, CMAJ, Oct. 1, 2002; 167 (7): 744, 746; Marshall L. Taking an Exposure History

April 12, 2012

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