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INTRODUCTION TO ENVIRONMENTAL HEALTH Transcribed by: Alfonso Martin E. Plantilla Lecturer: Queenie G. Dacayo, M.D.,
INTRODUCTION TO ENVIRONMENTAL HEALTH
Transcribed by: Alfonso Martin E. Plantilla
Lecturer: Queenie G. Dacayo, M.D., FPAFP, DPCOM
Reference: Powerpoint Presentation

OBJECTIVES:

Discuss the most important environmental threats to health in low and middle income countries

Define environment and environmental health

Name & categorize by their level of impact some examples of environmental health issues, their determinants and consequences.

Enumerate and define environmental health hazards.

Environmental control measures.

Briefly discuss the five Principal Environmental Exposure Pathways (PEEPs).

Present existing laws related to Environmental health

SCENARIO

Rashmi lived in the eastern part of Nepal in a modest home. Rashmi often had difficulty of breathing. She cooked with a stove inside the house not vented outside. Cow dung or wood used as cooking fuel. She cooked meals twice a day on the stove and she often held her baby on her back. She heard about different stoves and about using kerosene for fuel but she lacked enough budget to buy a new stove or to fuel it with kerosene.

Myrna lived in Zambales in Central Luzon. Myrna often had difficulty of breathing. She cooked with an improvised three-stone stove inside the house not vented outside. Wood used as cooking fuel. She cooked meals thrice a day. She heard about different stoves and about using kerosene or liquified petroleum gas but preferred to utilize wood bec. her family can easily get firewood for free.

NOTE:

8.4% of the global burden of disease in low to middle income countries is the result of three environmental conditions:

o

Unsafe water, hygiene, excreta disposal

o

Urban air pollutionm

o

Indoor smoke

Between 25 and 33 percent of the global burden of disease can be attributed to environmental risk factors

Deaths in low and middle income countries by rank and cause are:

o

3rd – Lower respiratory infection

o

6th – COPD

o

7th – Diarrheal disease

~ 30% of deaths in 0-14 years age in low to middle income countries are due to:

o

o

2 nd – Lower Respiratory Conditions

3 rd – Diarrheal Diseases

KEY LINKS BETWEEN ENVIRONMENTAL HEALTH & MILLENIUM DEVELOPMENT GOALS

Goal 1: Eradicate Extreme Hunger & Poverty

o Reducing environmental risk factors is central to eradicating poverty by reducing the burden, which falls largely on the poor, of environmentally related morbidity and mortality.

Goal 2: Achieve Universal Primary Education

o

Children that do not have access to clean water and sanitation are more likely to suffer from undernutrition due to vicious cycle of diarrheal disease and malnutrition. There is a correlation between nutritional status and learning.

o

Children with poor nutritional status are not as likely to stay in school or learn as much as healthy children.

Goal 3: Promote Gender Equality and Empower Women

o Improving the access to water can improve the lives of poor women in the developing world by reducing the amount of time required to get water.

o Reducing indoor air pollution can substantially improve the lives of women because they suffer a disproportionate burden when they are cooking.

Goal 4: Reduce Child Mortality

o

Addressing environmental risk factor can reduce the leading causes of death in children.

o

Diarrheal disease is improved by improved access to clean water and sanitation.

o

Pneumonia can be reduced through improvements in indoor air quality.

o

Reducing the amount of time required to get water.

Goal 5: Reduce Maternal Health

o Diarrheal disease associated with poor sanitation and unsafe water can harm the nutritional status of the mother.

Goal 6: Combat HIV/AIDS, Malaria and other diseases

o Link: Environmental improvements can reduce the breeding grounds for malarial mosquitoes and vectors of some other disease, such as schistosomiasis and dengue fever

Goal 7: Ensure Environmental Sustainability

o Link: Measures to improve water supply, sanitation & personal hygiene promote sustainability, especially when they are carried out in community-based ways.

KEY CONCEPTS

Enivonment

Everythng that is not genetic

Physical, chemical, biological agents that directly affect health

Environmental Health

Generally refers to a set of public health efforts that “is concerned with preventing disease, death and disability by reducing exposure to adverse environmental conditions and promoting behavior change.

It focuses on the direct and indirect causes of disease and injuries and taps resources inside and outside the healthcare system to help improve health outcomes.

Environmental health comprises those aspects of human health, including quality of life, that determined by physical, chemical, biological, social and psychosocial factors in the environment.

It also refers to the theory and practice of assessing, correcting, controlling and preventing factors on the environment that can potentially affect adversely the health of the present and future generations. (WHO,

1993).

ENVIRONMENTAL HEALTH

the control of all those factors in man’s physical environment which exercise, or may exercise, a deleterious effect on his physical development, health or survival. (WHO).

It is that aspect of public health that is concerned with those forms of life, substances, forces and conditions in the surroundings of man that may exert an influence on human health and well-being.

MAN – ENVIRONMENTAL RELATIONSHIPS The Environmental System • The status of human health represents the

MAN – ENVIRONMENTAL RELATIONSHIPS

The Environmental System

The status of human health represents the result of complex interactions between the internal biological system & the total external environmental system.

system & the total external environmental system. CLASSIFICATION OF ENVIRONMENTAL HAZARDS • Biological •

CLASSIFICATION OF ENVIRONMENTAL HAZARDS

Biological

Chemical

Physical

Psychological

Sociological

Site and location hazards

BIOLOGICAL HAZARDS

Are concerned with infectious agents which could gain entry into the human body

Take the form of viruses, bacteria, parasites and fungi

Present in human body fluids, animal or animal products, soil clay, sewage,plant materials, laboratory cell cultures

soil clay, sewage,plant materials, laboratory cell cultures CHEMICAL HAZARDS • Increasing; being used by developing

CHEMICAL HAZARDS

Increasing; being used by developing world specially in the field of agriculture.

§ Pesticides are the most common used and manufactured in this country.

§ Examples:

Organophosphates

Organochlorine

Most exposed population groups:

§ Formulators

§ Farmers

Region 3, rice granary of the Philippines – high cases of pesticide poisoning

of the Philippines – high cases of pesticide poisoning • Chemicals are also used in industries:

Chemicals are also used in industries:

§ Semiconductor & Electronic companies

§ Battery making

§ Clothing industry

§ Paint manufacturing

§ Printing Industry

Release of chemicals into the environment depends mostly on the type of waste generated by the industries & the presence of pollution control devices.

Consumer products, including food preservatives, are the next most common sources of chemicals in our environment

§ Batteries, soap and dishwashing fluids, light bulbs and fluorescent are sources of tungsten, mercury and the like.

Tocino – nitrate compounds

Vehicles – sulphur oxides, lead, carbon monoxide, hydrocarbons, etc.

The

of risk arising from chemical exposure

severity

depends on these factors:

§ Type of Chemical

§ Amount of chemical

§ Duration of exposure

§ Environmental conditions

§ Nature of job operation

§ Availability of ventilation or exhaust systems

PHYSICAL HAZARDS

Noise

o

One of the most common occupational hazards

o

Common to industries such as bottling, steel manufacturing, garment factories, vehicle manufacturing; airports

o

Effects:

§ Noise-induced hearing loss

§ Tinnitus

§ Auditory fatigue

o

When a worker talks louder than usual during normal conversations, this may be a sign of exposure to high level noise and may be manifesting noise-induced hearing loss.

Radiation

o

Electromagnetic

Ionizing – alpha, beta particles, gamma rays, x-rays

Ultraviolet – from light

o

Infrared – emiited by hot furnances, ovens

o

Microwave – communication & radar stations

o

Visible light – glaring & bright illumination

Temperature

o

Temperature extremes can be experienced in the workplace in either a hot or cold environment.

o

Temperatures below 35 degrees centigrade and above 45 degrees centigrade can be tolerated for brief periods (Kenney,1998)

o

When the temperature is too high, heat stroke may occur, an indication that the thermoregulatory mechanism of the body has shut down(Ogawa,

1998).

o

The primary adaptive reaction of the body to heat is increased capacity to sweat.

o

Heat exposure: agriculture, construction, bakeries, steel mills

o

Exposure to cold is mainly in the industries Examples: meat processing and packaging, Diving and commercial fishing, frozen foods

o

Effects:

Frostbite and trench foot

Slips of tools

Chills

Vibration

o

It usually comes from a vibrating tool or machinery.

o

It can involve the arms and hand à hand-arm vibration when using vibrating tools and can cause Reynaud’s disease

o

It can involve the whole body à whole body vibration when driving a truck, operating heavy industrial equipment can affect the central nervous system

Physical Design of Equipment and Environment

o

Equipment:

§ Displays are not adequately lit

§ Hand tools cause pain in the wrist

§ There are sharp edges on the tools

§ Handles are too heavy to operate

o

Environment:

§ Layout causes unnecessary motion

§ Inadequate space for storage

§ No clearance for pushing or pulling materials

SOCIOLOGICAL AND PSYCHOLOGICAL HAZARDS

Overcrowding

Work stress – multi-tasking, overload, excessive overtime

Boredom

Monotony of work

Isolation

SITE AND LOCATION

“Natural hazards” in terms of geographical location are usually associated with natural phenomena or events leading to disaster

Examples:

Construction of a nuclear power plant near an active volcano

Construction of a residential village in a former landfill site of hazardous wastes

Construction of a subdivision along the faultline

MAJOR ENVIRONMENTAL HEALTH DISASTERS (2005 – 2008)

MAJOR ENVIRONMENTAL HEALTH DISASTERS (2005 – 2008) 5 CONTROL BASIC PRINCIPLES ▪ Isolation ▪ Substitution

5

CONTROL

BASIC

PRINCIPLES

Isolation

Substitution

Shielding

Treatment

Prevention

ISOLATION

OF

ENVIRONMENTAL

Isolation places the hazardous process "geographically" away from the majority of the workers.

These methods aim to keep the chemical/agent "in" and the worker "out" (or vice versa).

Examples:

"glove boxes" (where a chemical is in a ventilated and enclosed space and the employee works with the material by using gloves that are built in)

Abrasive blasting cabinets(sound reducing enclosure for noisy equipment)

Remote control devices

Negative pressure fume hoods in laboratory settings

SUBSTITUTION

It is the use of other materials products, activities, processes/operations, methods, machines, & other equipment instead of hazardous ones.

“Modification”

Reduce number of hours of exposure

Work rotation

equipment instead of hazardous ones. • “Modification” • Reduce number of hours of exposure • Work

SHIELDING

It is the setting up of physical barriers between the source of the problem or hazard and man.

Equipment guarding will prevent workers from contact with moving parts.

o Example: table saw with cover; conveyor belt with guard; separating vehicle and pedestrian traffic; shield radioactive materials

vehicle and pedestrian traffic; shield radioactive materials TREATMENT • This involves measures to terminate the

TREATMENT

This involves measures to terminate the existence of a hazard through destruction.

Examples:

Estimates of the size of exposed populations

Studies of health impacts on people, including biological exposures, epidemiological studies, and notifiable disease and registry data

Demographic data such as housing types, water supply, income and employment

The 5 Principal Environmental Exposure Pathways

Urban Air Pollution Pathway (UrbAir)

Urban Water Supply Pathway (CommunWater)

Pathways where fertilizers & pesticides affect food, workers, health, and rural water supplies (Pest/Rural/Food)

Urban Solid Waste Pathway (UrbWaste)

Rural “Point Source” Pathway (RurSource)

URBAN AIR POLLUTION PATHWAY

Covers those communities where household, motor

vehicle and multiple industrial emission sources mix together in an urban air shed

Affects:

o

Water treatment facility in factories

Ø Transport workers

o

Air pollution control device

Ø Children

PREVENTION

It is eliminating effects of or exposure to a hazard

Example: Prophylaxis; Immunization

ENVIRONMENTAL HEALTH OUTCOMES AND EXPOSURE PATHWAYS

Human

environmental pollution”:

to

Health

Conditions

Identified

to

be

“related

Diarrhea

Bronchitis

Asthma

Malignant

neoplasms:

lung,

liver,

nasal,

bladder,

leukemia, lymphoma

 

Ischemic Heart Disease

Hepatitis

Pneumoconiosis, occupational cancer, chronic chemical poisoning syndromes

Typhoid/paratyphoid/salmonella & others

 

Dengue

Cholera

Lead poisoning (acute and chronic)

 

Other heavy metal and chemical poisoning

 

Upper Respiratory Tract Conditions

 

Skin rashes/ ear infections

 

PRINCIPAL

ENVIRONMENTAL

EXPOSURE

PATHWAYS

(PEEPs)

Concept of Principal Environmental Exposure Pathways

Principal Environmental Exposure Pathways

Describe the origin of the environmental pollution that affects humans or the source, steps in the environment

transmisssion and human exposure

Its characterization involved tracking down information as it is applied to each PEEP and collating what was available.

This information includes:

Identification of responsible agencies st each point in each pathway

Information on the volume/type of industrial chemicals used and emissions/ effluents from point sources and diffuse sources

Ambient concentrations of key toxics in workroom, air, community air, drinking water, food and soil.

Ø General population

air, drinking water, food and soil. Ø General population • It covers communities where household, motor

It covers communities where household, motor vehicle and industrial emission sources mix together in an urban air shed.

Emission from vehicles on the road mix with industrial sources(from factories) to pollute the air. This leads to three exposure scenarios:

§ Transport workers are exposed to air pollution at the roadside level daily

§ Children are directly inhale airborne emissions and indirectly to soil contaminated by deposition from the air. Children passively ingest dust through hand to mouth spread.

§ General population inhale dust particles coming from urban air, smoking and poorly ventilated indoor cooking and smoking that cause respiratory diseases

Chronic Obstructive Pulmonary Disease (COPD) is more prevalent among jeepney drivers than among commuters and air conditioned bus drivers.

Airborne lead levels in Manila tend to be way above levels on other cities in the world. There is an observable child IQ decline with lead exposure.

There is an observable child IQ decline with lead exposure. URBAN WATER SUPPLY PATHWAY • Types

URBAN WATER SUPPLY PATHWAY

Types of Water Supply:

o

Level I

 

§

Include open dug wells, developed springs, public wells, private wells with or without faucets, and tubed/piped/improved dug wells

o

Level II

§

Are alll community public taps

o

Level III

§ The population is supplied with piped water in their households

Urban dwellers in the Philippines may get their water from Level I, II, or III supply types but all 3 could potentially be polluted with sewage and/or industrial liquid waste.

Level 3 is likely to be chlorinated

Industrial effluents and sewage can contaminate all of the levels of water supply.

Effluent is an outflowing of water from a natural body of water, or from a man-made structure.

Metro Manila has the highest degree of Level III water supply.

Access to sanitary toilets is also an important protective factor against the spread of waterborne diseases. Urban communities are better off than rural communities. In the 1990s, 84% of urban households had sanitarymtoilets compared to 52% of rural households.

Inadequate maintenance of existing sanitation in Metro Manila reduces the preventive effect of having sanitary toilets.

There is increased risk of diarrheal disease & skin disease by using public or the neighbor’s water supply, & living in a household without a toilet.

Supplementary risk to these diseases is associated with crowding.

risk to these diseases is associated with crowding. FERTILIZER, WATERWAYS PATHWAY PESTICIDES, FOOD, & RURAL

FERTILIZER,

WATERWAYS PATHWAY

PESTICIDES,

FOOD,

&

RURAL

This is the most complex environmental exposure pathway

It begins with the importation of pesticides and fertilizers and with their formulations in the

Philippines. Locally, formulators are directly exposed to chemicals. On the farms and plantations, workers and families are exposed due to pesticide application. Crops are affected through direct application and through contamination of water in the fields. These waters may also be contaminated by sewage. Fish in fish – rice operations are exposed by waterborne route due to adjacent waterways. The fish and crops are brought to the market place where handling, cleaning, storage and cooking will make the difference in their hygienic quality.

Back at the farm, the contamination of water by fertilizers, pesticides & sewage may also affect the drinking water of those living within & around farms.

Unsafe practices in the use of Pesticides:

1. Few farmers wear full protective clothing when they spray and spray against the wind.

2. Unsafe storage practices and disposal of pesticide bottles.

3. Lack of knowledge in the recognition and understanding of hazard rankings of pesticides. There are pesticide users who reported symptoms related to pesticide poisoning affecting the eye, skin, respiratory, nerves and gastrointestinal tract.

reported symptoms related to pesticide poisoning affecting the eye, skin, respiratory, nerves and gastrointestinal tract.

URBAN SOLID WASTE PATHWAY

Solid Wstes

o

Wastes that should not be poured into a sewer or waterway

o

Include the residential, institutional, and industrial wastes that are either collected and disposed of in an organized system, or strewn about squatter communities, roadsides, or vacant lots

strewn about squatter communities, roadsides, or vacant lots • Solid wastes are generated from households,

Solid wastes are generated from households, institutions and industries.

Non-collection would mean that those living around are in direct contact with the potential hazards. Open dumpsites have potential impacts on air & water quality as illustrated by the Smokey Mountain site.

In areas where garbage is collected, the garbage collector is exposed as well as the scavengers and their families.

Leachate from the solid waste may contaminate the ground water. This contain nitrates and coliforms which are of public health significance among those who use the water for drinking, cleaning or recreational purposes.

RURAL “POINT SOURCE” PATHWAY

In rural areas of the Philippines, there are many locations where mines, discrete industrial point sources, or small groups of industrial establishments are significant sources of contamination of air, recreational or drinking water and soil.

Children in the industrial areas had higher rates of cough with phlegm and bronchitis according to a study by Torres and Subida in 1992. The type of fuel for cooking turned out to be the most important factor of all. Children in households using firewood or coal has more than 16x higher risk ofnbelow normal pulmonary function than households using alternative fuel.

higher risk ofnbelow normal pulmonary function than households using alternative fuel. Tables are at the next
higher risk ofnbelow normal pulmonary function than households using alternative fuel. Tables are at the next

Tables are at the next page

PRIORITY ENVIRONMENTAL HEALTH PROBLEMS

PRIORITY ENVIRONMENTAL HEALTH PROBLEMS END OF LECTURE TRANSCRIBED BY: Alfonso Martin E. Plantilla, Grp. 14A
PRIORITY ENVIRONMENTAL HEALTH PROBLEMS END OF LECTURE TRANSCRIBED BY: Alfonso Martin E. Plantilla, Grp. 14A

END OF LECTURE

TRANSCRIBED BY: Alfonso Martin E. Plantilla, Grp. 14A