Addressing the environmental and health impacts of microplastics requires open collaboration between diverse sectors

Public concern over the environmental and public health impacts of the emerging contaminant class “microplastics” has recently prompted government agencies to consider mitigation efforts. Microplastics do not easily fit within traditional risk-based regulatory frameworks because their persistence and extreme diversity (of size, shape, and chemical properties associated with sorbed chemicals) result in high levels of uncertainty in hazard and exposure estimates. Due to these serious complexities, addressing microplastics’ impacts requires open collaboration between scientists, regulators, and policymakers. Here we describe ongoing international mitigation efforts, with California as a case study, and draw lessons from a similarly diverse and environmentally persistent class of emerging contaminants (per- and polyfluoroalkyl substances) that is already disrupting traditional regulatory paradigms, discuss strategies to address challenges associated with developing health-protective regulations and policies related to microplastics, and suggest ways to maximize impacts of research.

Mounting concerns regarding the deleterious effects of plastic pollution have prompted recent government mitigation efforts, but microplastics challenge traditional risk-based regulatory frameworks due to their particle properties, diverse composition and persistence. Using California as a case study, the Essay suggests strategies to address challenges with regulations, policies and research, drawing parallels with a similar class of emerging contaminants (per- and polyfluoroalkyl substances).     

Demand for patient care.

A study was performed to determine the extent to which patients of all types were receiving inappropriate levels of care. The needs of patients in acute and supporting hospitals, people in residential homes, and patients cared for at home were assessed. A sixth of the hospital inpatients did not need hospital care, while 5% of those in residential homes and 5% of those at home did need hospital services. These findings indicate that a realistic provision of hospital beds would be 4 per 1000 population for all specialties except regional specialties, psychiatry, mental subnormality, obstetrics, and paediatrics. About a third of these beds need to be acute, while the rest may be in supporting or community hospitals. Thus the current provision of acute beds (2-0 to 2-5 per 1000 population) exceeds actual need.     

Information retrieval for patient care.

Doctors need clinical information during most consultations with patients, and much of this need could be satisfied by material from online sources. Advances in data communication technologies mean that multimedia information can be transported rapidly to various clinical care locations. However, selecting the few items of information likely to be useful in a particular clinical situation from the mass of information available is a major problem. Current information retrieval systems are designed primarily for use in research rather than clinical care. The design, implementation, and critical evaluation of new information retrieval systems for clinical care should be guided by knowledgeable clinical users.