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Air pollution is a global public health emergency. Ninety-

one per cent of the world’s population lives in places
where air quality exceeds WHO limits. About seven
million deaths – one in eight deaths worldwide – is due
to air pollution-related diseases. Air pollution is one of
the largest causes of the four top non communicable
diseases – stroke, lung cancer, chronic respiratory
disease and heart disease – accounting for between a
quarter and over one third and one quarter of those
deaths. Air pollution is also responsible for more than
50% of childhood pneumonia deaths.

WHO Air quality guidelines WHO’s guidelines are a basis

for formulating national standards and policies.These
cover.

1. Ambient air quality: health relevant limits for pollutant

concentrations indoors and outside.
2.Household fuel combustion: defines clean fuels and
technologies, with reference to emissions targets for
healthdamaging pollutants.

3. Chemical indoor pollutants: limits for pollutants from

indoor sources, such as building materials and
furnishings.
4. Biological indoor air pollutants: indicators for mould
and control measures.

• About half of the world still cooks over smoky stoves

using biomass, coal, charcoal, dung or agricultural
residues.
• Everyone’s health is affected by air pollution, but low-
and middle-income countries as well as poor and
marginalized groups in high-income countries are at
greater risk. Children, older people, and people with
respiratory or heart diseases also are more vulnerable.
 • Air pollutants such as methane and black carbon are
powerful short-lived climate pollutants (SLCPs) that
contribute to climate change. Black carbon, a component
of PM, is one of the largest contributors to global
warming after CO2.

Drinking water quality is paramount for public health.

Despite improvements in recent decades,
access to good quality drinking water remains a critical
issue. The World Health Organization
estimates that almost 10% of the population in the world
do not have access to improved drinking
water sources , and one of the United Nations
Sustainable Development Goals is to ensure universal
access to water and sanitation by 2030.

Water's direct impacts on human health come mainly

from contaminants, which
can be placed into broad classes: 
 Chemical contaminants: natural or human-created
chemicals, and the focus of this page
 Biological contaminants: microbes including
bacteria, viruses, protozoa, fungi, algae, amoebas, and
slime molds
 Radiological contaminants: radiation from decaying
radioactive elements, both naturally occurring from soil
and bedrock and from radioactive waste deposited or
leaking into water supplies
Thermal contamination, excess heat that impairs a water
ecosystem's ability to sustain its lifeforms, is also a class
of contamination. Although heat can impair an
ecosystem's ability to produce food and other valuable
services to humans, its direct impacts on human health
are minimal.
Among other diseases, waterborne infections cause
diarrhea,
which kills nearly one million people every year. Most are
children under the age of five. At the
same time, chemical pollution is an ongoing concern,
particularly in industrialized countries and
increasingly in low and medium income countries
(LMICs). Exposure to chemicals in drinking water
may lead to a range of chronic diseases (e.g., cancer and
cardiovascular disease), adverse reproductive
outcomes and effects on children’s health (e.g.,
neurodevelopment), among other health effects.
Although drinking water quality is regulated and
monitored in many countries, increasing
knowledge leads to the need for reviewing standards and
guidelines on a nearly permanent basis,
both for regulated and newly identified contaminants.
Drinking water standards are mostly based on
animal toxicity data, and more robust epidemiologic
studies with an accurate exposure assessment
are rare. The current risk assessment paradigm dealing
mostly with one-by-one chemicals dismisses
potential synergisms or interactions from exposures to
mixtures of contaminants, particularly at
the low-exposure range. Thus, evidence is needed on
exposure and health effects of mixtures of
contaminants in drinking water.
In a special issue on “Drinking Water Quality and Human
Health” IJERPH, 20 papers were
recently published on different topics related to drinking
water. Eight papers were on microbiological
contamination, 11 papers on chemical contamination,
and one on radioactivity. Five of the eight papers
were on microbiology and the one on radioactivity
concerned developing countries, but none on
chemical quality. In fact, all the papers on chemical
contamination were from industrialized countries,
illustrating that microbial quality is still the priority in
LMICs. However, chemical pollution from a
diversity of sources may also affect these settings and
research will be necessary in the future.
Concerning microbiological contamination, one paper
deals with the quality of well water in
Maryland, USA, and it confirms the frequent
contamination by fecal indicators and recommends
continuous monitoring of such unregulated water.
Another paper did a review of Vibrio pathogens,
which are an ongoing concern in rural sub-Saharan
Africa.

Soil has a considerable effect on human health, whether

those effects are positive or negative, direct or indirect.
Soil is an important source of nutrients in our food supply
and medicines such as antibiotics. However, nutrient
imbalances and the presence of human pathogens in the
soil biological community can cause negative effects on
health. There are also many locations where various
elements or chemical compounds are found in soil at
toxic levels, because of either natural conditions or
anthropogenic activities. The soil of urban environments
has received increased attention in the last few years,
and they too pose a number of human health questions
and challenges. Concepts such as soil security may
provide a framework within which issues on soil and
human health can be investigated using interdisciplinary
and transdisciplinary approaches. It will take the
contributions of experts in several different scientific,
medical and social science fields to address fully soil and
human health issues. Although much progress was made
in understanding links between soil and human health
over the last century, there is still much that we do not
know about the complex interactions between them.
Therefore, there is still a considerable need for research
in this important area. Soil degradation affects human
nutrition and health through its adverse impacts on
quantity and quality of food production. Decline in crops'
yields and agronomic production exacerbate food-
insecurity that currently affects 854 million people
globally, and low concentration of protein and
micronutrients (e. g., Zn, Fe, Se, B, I) aggravate
malnutrition and hidden hunger that affects 3.7 billion
people, especially children. Soil degradation reduces crop
yields by increasing susceptibility to drought stress and
elemental imbalance. Strategies include: improving
water productivity, enhancing soil fertility and
micronutrient availability, adopting no-till farming and
conservation agriculture and adapting to climate change.
There are also new innovations such as using remote
sensing of plant nutritional stresses for targeted
interventions, applying zeolites and nanoenhanced
fertilizers and delivery systems, improving biological
nitrogen fixation and mycorrhizal inoculation, conserving
and recycling (e. g., waste water) water using drip/sub-
drip irrigation etc. Judiciously managed and properly
restored, world soils have the capacity to grow adequate
and nutritious food for present and future populations.

Community-led total sanitation (CLTS) is an approach

used mainly in developing countries to
improve sanitation and hygiene practices in a
community. It focuses on spontaneous and long-
lasting behavior change of an entire community. The goal
of CLTS is to end open defecation. The term "triggering"
is central to the CLTS process. It refers to ways of igniting
community interest in ending open defecation, usually by
building simple toilets, such as pit latrines. CLTS involves
actions leading to increased self-respect and pride in
one's community.[1] It also
involves shame and disgust about one's own open
defecation behaviors.[1]
The concept was developed around the year 2000 by
Kamal Kar for rural areas in Bangladesh. CLTS became an
established approach around 2011. Non-governmental
organizations were often in the lead when CLTS was first
introduced in a country. Local governments may reward
communities by certifying them with "open defecation
free" (ODF) status. The original concept of CLTS
purposefully did not include subsidies for toilets as they
might hinder the process.
CLTS is practiced in at least 53 countries. CLTS has been
adapted to the urban context. It has also been applied to
post-emergency and fragile states settings.
Challenges associated with CLTS include the risk
of human rights infringements within communities, low
standards for toilets, and concerns about usage rates in
the long-term. CLTS is in principle compatible with
a human rights based approach to sanitation but there
are bad practice examples in the name of CLTS. More
rigorous coaching of CLTS practitioners,
government public health staff and local leaders on
issues such as stigma, awareness of social norms and pre-
existing inequalities are important. People who are
disadvantaged should benefit from CLTS programmes as
effectively as those who are not disadvantaged.

Objectives The main objectives of the TSC are as under:

 Bring about an improvement in the general quality of
life in the rural areas.
 Accelerate sanitation coverage in rural areas.
 Generate felt demand for sanitation facilities through
awareness creation and health education.
 Cover schools/ Anganwadi’s in rural areas with
sanitation facilities and promote hygiene education and
sanitary habits among students.
 Encourage cost effective and appropriate technologies
in sanitation.
 Eliminate open defecation to minimize risk of
contamination of drinking water sources and food.
 Convert dry latrines to pour flush latrines, and
eliminate manual scavenging practice, wherever in
existence in rural areas.

Factors affecting health

 Many factors combine together to affect the health of
individuals and communities. Whether people are
healthy or not, is determined by their circumstances
and environment. To a large extent, factors such as
where we live, the state of our environment, genetics,
our income and education level, and our relationships
with friends and family all have considerable impacts
on health, whereas the more commonly considered
factors such as access and use of health care services
often have less of an impact.
The determinants of health include:
 the social and economic environment,
 the physical environment, and
 the person’s individual characteristics and
behaviours.
The context of people’s lives determine their health,
and so blaming individuals for having poor health or
crediting them for good health is inappropriate.
Individuals are unlikely to be able to directly control
many of the determinants of health. These
determinants—or things that make people healthy or
not—include the above factors, and many others:
 Income and social status - higher income and social
status are linked to better health. The greater the gap
 between the richest and poorest people, the greater
the differences in health.
 Education – low education levels are linked with
poor health, more stress and lower self-confidence.
 Physical environment – safe water and clean air,
healthy workplaces, safe houses, communities and
roads all contribute to good health. Employment and
working conditions – people in employment are
healthier, particularly those who have more control
over their working conditions
 Social support networks – greater support from
families, friends and communities is linked to better
health. Culture - customs and traditions, and the beliefs
of the family and community all affect health.
 Genetics - inheritance plays a part in determining
lifespan, healthiness and the likelihood of developing
certain illnesses. Personal behaviour and coping skills –
balanced eating, keeping active, smoking, drinking, and
how we deal with life’s stresses and challenges all
affect health.
 Health services - access and use of services that
prevent and treat disease influences health
 Gender - Men and women suffer from different
types of diseases at different ages.
Factors affecting Death rate in a country
 Medical facilities and health care
 Nutrition levels
 Living standard
 Access to clean drinking water
 Hygiene levels
 Levels of infectious diseases
 Social factors such as conflicts and levels of violent
crime

Mortality in Developed Countries

Statistics on causes of death are reported annually to the

World Health Organization (WHO) by countries with vital
registration systems. These countries--primarily
developed* countries--include Australia, Canada, Israel,
Japan, New Zealand, Union of Soviet Socialist Republics
(USSR), United States of America, all of Europe (except
Albania), and certain Latin American countries. This
report compares mortality data for the latest year
available (ranging from 1984 through 1987) among 33
North American, European, and other selected
developed countries (Table 1). These countries have a
combined population of approximately 1.2 billion, or one
quarter of the estimated world total in 1986. Death rates
are standardized for age but not for race/ethnicity or sex.
In the selected countries, approximately 11 million
persons died annually from 1984 through 1987, an age-
standardized all-cause death rate of 905.2 per 100,000
population per year (Table 1). Mean life expectancy at
birth was 73.7 years and ranged from 69.7 years in
Hungary to 79.1 years in Japan (Table 1). Average life
expectancy at birth was 77.2 years for females and 70.1
years for males.
Approximately 3.3 million (30%) deaths annually were
due to heart disease, 2.3 million (21%) to cancer, 1.5
million (14%) to stroke, 0.9 million (8%) to chronic
respiratory diseases, and 0.8 million (7%) to violent
causes (i.e., intentional and unintentional injuries). An
estimated 1.5 million (14%) deaths annually are
attributed to cigarette smoking.
Years of potential life lost before age 65 (YPLL) (3) is a
measure of premature mortality that considers only
deaths occurring before age 65 and more heavily weights
deaths at younger ages. In the selected countries, 3.4
million (31%) deaths occurred in persons less than 65
years of age. YPLL varied greatly among these countries,
from 3334.3 per 100,000 population in Japan to 10,257.5
per 100,000 population in the USSR (Table 1). Rates of
YPLL were particularly high in eastern Europe.

Mortality Differentials by Socioeconomic Status

Several indicators, such as occupational class, level of
education, and income, have been used in studies of
socioeconomic differentials in mortality. Information
about these differentials usually is not available in
regular statistics because the ordinary sources of
mortality statistics do not include reliable information on
the socioeconomic characteristics of deceased persons.
Most knowledge about socioeconomic differences in
mortality comes from studies for which data have been
specifically collected for an analysis of socioeconomic
differences.
Despite the measurement problems there is abundant
evidence from different periods and countries showing
that persons in lower socioeconomic positions die on
average younger than do those in higher socioeconomic
positions. For example, Eileen M. Crimmins and Yasuhito
Saito (2001) estimated that the difference in life
expectancy at age 30 between persons with 13 or more
years of schooling and those with less than nine years
was 6.7 years among white men and 3.8 years among
white women in 1990 in the United States.
Among African Americans these differences were,
respectively, 11.8 years and 10.5 years.
Many hypotheses about the causes of socioeconomic
mortality differences have been offered, but experts
differ about their validity. Some hypotheses emphasize
the causal effects of differences between classes in
working and living conditions, health-related behaviors
(e.g., smoking, alcohol use, diet), the prevalence of
psychosocial stressors, or access to health services.
According to other hypotheses, poor health and certain
characteristics of individuals (e.g., social background and
intelligence) may affect both their socioeconomic
position and their risk of premature death.
Cross-national variation in the extent of socioeconomic
differences in mortality in the 1980s was studied in a
large project coordinated by John P. Machenbach and
Anton E. Kunst from the Erasmus University Rotterdam
(1997). Data for thirteen European countries and
the United States were used. The mortality of men in
manual occupations was higher than that of men in
nonmanual occupations in all those countries. The
relative excess mortality of the manual class was
remarkably similar (ranging from 32% to 44%). However,
larger differences were observed for France, the Czech
Republic, and especially Hungary.
The results for mortality by cause of death showed that
the mortality of manual workers was higher than that of
nonmanual employees for nearly all the causes of death
distinguished in the study. There was, however, an
interesting exception: No class difference was found in
mortality from ischemic (coronary) heart disease in
France, Switzerland, Italy, and Spain. In Portugal
mortality rates were higher in the nonmanual classes
than in the manual classes. However, socioeconomic
gradients in mortality from causes other than
ischemic heart disease were steeper in southern
European than in northern European countries.
Socioeconomic differences in mortality have widened in
almost all the countries for which data are available,
including the United States. The main reason for the
increase has been a more rapid than average decline in
mortality from cardiovascular diseases among persons
with high socioeconomic status.
Demographic variables can have important effects on the
distribution of income. This article discusses effects
on inequality of three demographic variables: (a) age
structure; (b) marriage and household composition; and
(c) differential fertility by income. Research in each area
demonstrates the complex dynamics of demographic
change and measures of dispersion, with few simple
predictions coming out of either theoretical or empirical
analysis. The effects of age structure include both within-
cohort and between-cohort effects. Theoretical and
empirical analysis suggest that population aging is
associated with an increase in within-cohort inequality.
The between-cohort component is less predictable,
however, and may neutralize the effect of rising within-
cohort inequality. Similar decompositions are important
in understanding the role of marriage. Increasing
correlations in spouses' earnings have had a disequalizing
effect in the US in recent decades, but this has been
offset by declining inequality in women's wages. These
offsetting components lead to widely differing
conclusions about the role of increasing women's labor
supply on family income inequality. The effects on
inequality of differential fertility across income classes
depends on patterns in intergenerational mobility.
Models combining population dynamics with economic–
demographic interactions have produced useful insights
about the complex relationship between differential
fertility and inequality.