Committee Recommendation (1985)

Status in 2006

Develop initiatives to minimize exposure to smoke, including bylaws restricting smoking in public places, and public education programs.

• Anti-smoking bylaws and provincial laws are in place.

Undertake action to ensure that patients and others have accurate information about food content, chemicals and other products in everyday use

• Content labelling of personal care products has been required by law since November 2006.
• The Controlled Products Regulations of the Hazardous Products Act does not require that the full content of fragrance mixtures be reported.
• The Food and Drugs Act does not require that all colours or flavours added to food be labelled specifically
• Neither the Hazardous Products Act, the Canadian Environmental Protection Act nor the Pest Control Products Act requires comprehensive labelling of everyday use products (e.g. cleaners). The Domestic Substances List has identified priority substances and these will undergo hazard assessment in 2007.
• In the absence of government action, monitoring and verification of organic agriculture is being carried out by non-governmental groups.
• There are no requirements to label genetically modified food.
• There are no requirements to label ultra-small particles (nano-particles) in products.

Estimate the prevalence of environmental hypersensitivity

• The 2003 national population health survey covered multiple chemical sensitivities.¹⁰
• The 2005 National Survey of the Work and Health of Nurses covered multiple chemical sensitivities.¹¹

Research the diagnostic tests and treatments used by clinical ecologists to determine which are demonstrably useful

• Researchers at the Nova Scotia Environmental Health Centre are conducting research in this area. This facility includes Canada’s only Environmental Control Unit.
• Some tests and treatments are commonly used with good success. Funds are necessary to conduct formal trials to confirm the utility of tests and treatments.

Establish a multi-disciplinary investigative and therapeutic environmental unit for research and for out-patient and in-patient treatment of people with environmental sensitivities.

• In 1994 the Environmental Hypersensitivity Research Unit at the University of Toronto (U of T) was established with total funding of $1.5 million over 10 years. This unit brought together epidemiologists and health care professionals.
• The Unit has published research on diagnosing environmental sensitivities and on the characteristics and genetics markers of patients.
• In 1996 the Environmental Health Clinic, funded by the Ontario Ministry of Health, opened at Women’s College Hospital in Toronto. It is affiliated with the U of T. It does not include an Environmental Control Unit or in-patient facilities. OHIP covers one initial and one follow-up consultation per patient.

Amend the fee schedule to cover the time required to obtain good histories, to counsel a patient on avoidance procedures and to monitor the patient's performance.

• The Ontario fee schedule has a time-based billing code for patients with chronic fatigue syndrome, which compensates doctors for the time required to obtain a full history.

Various recommendations were made for people with limited income

• Routine laboratory tests are funded; testing for toxins is neither readily available nor funded.
• OHIP does not cover several types of treatments.
• Private insurance covers few treatments.
• Medications that patients can tolerate (e.g. with less colouring and other excipients) are not covered for people receiving disability support.

Support the following treatments with public funds:

• avoidance
• the prescription of nutritionally safe diets.

• Tax relief is offered for equipment to assist avoidance (e.g. air and water filters).
• In 2006 the Ontario government discontinued a diet supplement allowance that included organic food.

The environmental unit should undertake public education by:

• producing easily understood pamphlets on the more controversial issues related to environmental hypersensitivity;
• issuing a summary of the Committee's report for a general audience;
• ensuring adequate involvement in conferences, meetings, etc.;
• offering assistance to school boards, public health units, etc. in preparing accurate and balanced documents about environmental sensitivities.

• Information is available about environmental sensitivities, chronic fatigue syndrome and fibromyalgia in pamphlet form and on the Environmental Health Clinic website.
• Educational seminars are provided by the Environmental Health Clinic and partners about numerous environmental health issues such as smoking, pesticides, perfumes, mercury and lead.
• Staff physicians of the Environmental Health Clinic serve on the Environmental Health Committee of the Ontario College of Family Physicians (EHC-OCFP) and many other organizations.

Educate medical health officers and public health nurses so that they are prepared to provide current information on environmental illness and environmental hypersensitivity.

• Some public health units are particularly well-informed about environmental sensitivities and are able to provide current information
• To gain expertise in environmental health, the Environmental Health Clinic trains medical students, residents, fellows and nursing students.
• Environmental Health Clinic engages in public education in cooperation with Public Health Units.

Develop programs of continuing education to provide practitioners with scientific information about theories and beliefs in the field of environmental hypersensitivity (e.g. there is a general lack of understanding of the possibility that indoor air can contribute to illness).

• The EHC-OCFP provides environmental health information, workshops and Continuing Medical Education.
• Some family medicine post-graduate programs cover theories and concepts in the field of environmental sensitivities.

Review basic social assistance programs to ensure that they recognize how disabling environmental sensitivities can be. Regardless of disagreement within the medical profession regarding the causes of environmental sensitivities, people are disabled and are entitled to minimal support.

• As a result of disagreement, people who are disabled due to environmental sensitivities are often left with little or no support. This can lead to more stress, increasing poverty and worsening of their condition.

In cases of genuine financial need (i.e., people receiving social assistance), rent supplements or discretionary payments should be available for those seeking to make modest environmental changes.

• Funding is available for environmental changes only if the changes result in improved energy efficiency.

The environmental unit should provide expert assistance to appeal bodies and be involved in the selection of physicians who are knowledgeable about environmental hypersensitivity and who are willing to assess the patients’ condition irrespective of diagnosis.

• Environmental medicine physicians, and doctors in the Environmental Health Unit provide expert assistance on behalf of patients.

Encourage private insurers to assess the patient’s condition irrespective of the causes of the condition.

• Some private insurers provide limited but unpredictable coverage.

Involve the environmental unit in the development and promotion of special housing such as:

• apartments modified for patients who are participating in the environmental unit's research program;
• special hospital rooms for patients diagnosed as environmentally hypersensitive.

• CMHC and NRC have researched building materials, maintenance and ventilation. CMHC and the Environmental Health Unit have collaborated for many years.
• The Unit and the EHC-OCFP supports housing projects currently being undertaken by Allergy and Environmental Health Association groups in Ontario, Quebec and Manitoba.
• Healthy Indoors Partnership is bringing together many parties, including the Environmental Health Clinic, to compile sources of environmentally preferable materials.
• The Environmental Health Clinic made arrangements with a nearby hotel to provide cleaner-air rooms for patients, at a substantially reduced rate.
• The Canadian Society for Environmental Medicine published hospital staff guidelines to assist with the care of people with environmental sensitivities who are hospitalized.

The environmental unit should develop recommendations regarding possible curriculum changes in medical schools to ensure that issues relating to environmental illness are part of medical education.

• The Continuing Medical Education unit was developed by the OCFP. It is available through the Women’s College Hospital in Toronto.
• In 2006 the EHC-OCFP launched an Environmental Health Scholars Program to introduce environmental health concepts into many aspects of the curriculum in Ontario medical schools.

Hold an interdisciplinary conference to discuss this report and its recommendations. Conferences of this type should be held regularly as part of the environmental unit’s vital educational role.

• Health Canada held conferences in Ottawa in 1990 and 1992.
• The Environmental Health Clinic held a conference in 1998.
• The Environmental Health Clinic and OCFP co-sponsored a Peer Presentation Program on Environmental Health in 2000.
• Since 2000, the Environmental Health Clinic and the OCFP have co-sponsored an annual Environmental Health Day at the OCFP Annual Scientific Assembly.

The Ontario Medical Association should consider establishing an environmental health subsection to bring together practitioners interested in this field.

• OCFP-EHC members collaborate with the Ontario Medical Association on environmental health matters.