36 Environmental Health NKumar 2024 (1).pptx

ENVIRONMENTAL HEALTH Dr Nitya Kumar Senior Lecturer in Public Health Epidemiology School of Medicine  Learning outcomes 1. List the steps involved in environmental health assessment 2. Describe the sources of water pollution and examples of waterborne diseases 3. Identify the...

ENVIRONMENTAL HEALTH Dr Nitya Kumar Senior Lecturer in Public Health Epidemiology School of Medicine  Learning outcomes 1. List the steps involved in environmental health assessment 2. Describe the sources of water pollution and examples of waterborne diseases 3. Identify the short- and long-term effects of air pollution 4. Outline the potential health effects of climate change and the adaptation measures that may mitigate them 2 Environment and Health “A conceptual domain covering the interrelationship between human health and the environment, linking improvement of human health, now and in future generations, to the protection, restoration Biological Chemical and improvement of environmental quality” Microbial pathogens Tobacco, pesticides, - WHO 2006 heavy metals, etc. Environmental “Environmental health centers on the Factors affecting relationships between people and their environment.. environmental health field Health advances policies and programs that reduce Physical Accidental chemical and other environmental exposures in air, water, soil and food” Noise, radiation, Natural disasters, homelessness, Road traffic - American Public Health Association accidents 2022 climate  Global burden of environmental disease 24% of adults, 26% of children die from environmental causes (WHO 2016) This burden is disproportionately born by countries in the Global South (LMICs) Prüss-Ustün et al. Preventing disease through healthy environments. World Health Organization. 2017. http://apps.who.int/iris/bitstream/handle/10665/204585/9789241565196_eng.pdf?sequence=1  QUESTION: You are a public health medicine specialist working in local government You receive a worried phone call from a member of the public…. “An incinerator is being built at the end of my street and I am pregnant, will it cause birth defects?” The next day a journalist calls: “What How will you is the risk of cancer from approach this nanoparticles emitted from the situation? furnace”  Environmental health impact assessment Translation 1. Identify health hazard – chemical, biological, etc. 1. Is there a 2. Analyse health effects of the hazard problem? – literature search, international levels, dose- 2. How dangerous response is the problem? 3. Measure exposure levels in your population 3. Who all have the problem? 4. Calculate health risk 4. How bad is the – Risk = hazard level X exposure level situation? 5. Manage risk 5. What should we - population health strategies to reduce do about it? exposure (eliminate/ control hazard, change behaviour) - monitor effectiveness (exposure and health Basic epidemiology http://apps.who.int/iris/bitstream/10665/43541/1/9241547073_eng.pdf outcomes) Key environmental health issues WaSH (water, sanitation, hygiene) related disease Air pollution (ambient and indoor) Climate change  Water, Sanitation and Hygiene (WaSH) Access to safe water is not yet universal 3.5 bn in 2022 lack access to safe sanitation ~Half of the 2.2 bn people don’t have world access to safe experienced water in 2022 water scarcity in 2022 SDG6 not on Image courtesy: The Guardian 2021 track Source: Sustainable Development Goals Progress Report 2024 https://unstats.un.org/sdgs/files/report/2024/secretary-general-sdg-repo  Water Supply In Bahrain 10% SourceL Al-Zubari WK, El-Sadek AA, Al-Aradi MJ, Al-Mahal HA. Impacts of climate change on the Desalination municipal water 36% 54% management system Ground water in the Kingdom of Bahrain: Vulnerability assessment and Treated waste adaptation options. Climate Risk water Management. 2018 Jan 1;20:95-110.  How is water treated? Coagulation and Floccuation Sedimentation Filtration Disinfection (with chlorine) – possible addition of flouride  For more see http://en.wikipedia.org/wi ki/Water_purification Sediment sinks to bottom pathogens Sand filters die off Add lime to bring pH to 7.4 Chlorine 0.5 pm Fluorine 0.7 ppm Source: Aqua Treatment System , Inc US 12  FLUORIDATION Water fluoridation is the controlled addition of fluoride to a public water supply where natural fluoride is insufficient. One of the most effective public health interventions to prevent tooth decay that mainly affects children and poor people It is controversial because: – The research showing benefit is not of high quality – Excess amounts are associated with dental fluorosis Ground water in Bahrain has fluoride concentration of 1.0 - 0.5 ppm - within the WHO recommended level Fluoride supplementation of water not done in Bahrain  Health impacts of unsafe water Growth of Water disease contamination vectors in the water Drownin Heavy gs and Sewage Soil related metals Cholera, Malaria, injuries Arsenic Dengue, Giardiasis, poisonin Zika fever, Shigellosis, g Chikunguny Typhoid, E coli a infections campylobac Helminthia ter sis infections, Tetanus  Solution: Monitoring of water supply 1. Microbiological analysis – check for the presence indicator organisms (faecal coliforms, E.coli) 2. Chemical analysis – chemical or metallic contamination (lead, mercury, arsenic, iron, pesticides) – sewage contamination (ammonia, nitrites, chlorides and absorbed oxygen) 3. Physical parameters – Turbidity, opaqueness Exercise: Explore the water quality monitoring methods in Ireland versus USA http://www.epa.ie/water/dw/quality/#.VQ2FzPmsXik Air Pollution  Air Pollution Outdoor Indoor Ambient Air Household Pollution Air Pollution (AAP) New Delhi, India 2020 Refugee Camp, Tanzania (HAP) (source: cnn.com) 2018 (Courtesy: Niall Roche) 3.7 million 4.3 million deaths deaths - World Health Organization, 2016  Sources of Air Pollution HA P P A A Mold, Asbestos, Legionella Domestic fires Use of biomass fuel Industrial indoors exhaust Vehicle exhaust Image source: http://www.dailymail.co.uk/news/article- Source: IEA  Short term health Long-term effects effects Chronic obstructive Headache, pulmonary disease nausea Asth (COPD) ma Irritation of eyes, nose throat Cardiovascular diseases Acute respiratory Cance infections Pneumoni r a (children) burns and poisoning, fuel collection burden on women Catara ct  Solutions? 1. Source of pollution – alternative fuels – improved stoves 2. Living environment/housing – better ventilation – chimneys, smoke hoods with flues, eaves, cooking window 3. User behaviour – dry wood – keep young children away from smoke CLIMATE CHANGE  Climate Change Rise in global Long term shifts temperature in weather patterns Sources: 1.United Nations 2024. https://www.un.org/en/climatechange/what-is-climate- change 2.Environmental Protection Agency (EPA) 2017  Climate change effects Human Ecological Health Heat stress, glacial retreat rising sea level cardiovascular events extreme weather Respiratory conditions events Vector borne diseases species Gastrointestinal extinction infections Mental health effects Source: Intergovernmental Panel on Climate Change (IPCC) 2021  Sea level rise implications for Bahrain All population and development activities close to the coastline Very limited capacity to adapt to sea-level rise. Most coastal areas