Environment PDF

Climate Change The main causes of anthropogenic (human-induced) climate change are increased levels of greenhouse gases, especially carbon dioxide (CO) and methane. Most of the heat arriving from the sun is reflected off the earth back into space. But so-called greenhouse gases trap some of this war...

Climate Change The main causes of anthropogenic (human-induced) climate change are increased levels of greenhouse gases, especially carbon dioxide (CO) and methane. Most of the heat arriving from the sun is reflected off the earth back into space. But so-called greenhouse gases trap some of this warmth. As the concentration of greenhouse gases increases, so the planet's temperature is predicted to rise. Increased atmospheric levels of CO, result from deforestation (trees would normally convert CO, to oxygen through photosynthesis) and from increased combustion of fossil fuels. Increased energy in the earth's atmosphere is already bringing increased frequency of extreme events, for example, storms, heat waves, periods of cold temperatures (snow and ice), extreme rain- fall, as well as rising sea levels and floods. Further climate change is expected to bring warmer wetter winters and hotter dryer summers. Global warming Average global temperatures have risen over the past century due to both natural and human factors. Climatologists predict that extreme weather such as floods, hurricanes, and droughts will become more frequent because of global warming. Temperatures rose from 1906 to 2005 by 0.74°C on average across the world. Responding to climate change The response to climate change involves both mitigating the extent of climate change (by limiting greenhouse gas emissions) and adapting to the effects of climate change. Mitigation Reducing CO2 emissions is the most important action to limit anthropogenic climate change. This may be achieved either by Using less energy from fossil fuels Behaviour change (e.g. active forms of travel) Energy efficiency measures (e.g. improving insulation of housing) Using alternative energy sources (e.g. renew- able energy or nuclear power) Legislation is an important tool for limiting green- house gas emissions (e.g. the Kyoto Protocol) and preventing deforestation. Other mechanisms that have been proposed for mitigating climate change include pollution abatement, for example, CO, scrubbing and geo- engineering methods using technologies, such as carbon capture and storage, and releasing reflective particles into the atmosphere. Adaptation Various mechanisms may be needed to adapt to the effects of climate change and limit its effects on public health. These include: Infrastructure developments (e.g. flood barriers, shade, and passive cooling in buildings) Information dissemination, for example, warning systems (e.g. heat wave-health warning systems) Vaccination against infectious diseases Protection from the sun (e.g. 'slip, slap, slop' campaigns using sun creams and clothing) Preparing for increased migration The United Nations framework convention on climate change The United Nations Framework Convention on Climate Change (UN FCCC) was agreed at the United Nations Conference on Environment and Development (the Earth Summit) in Rio de Janeiro in 1992. It had the primary objective of 'stabilising] greenhouse gas Environment Page 1 Environment and Development (the Earth Summit) in Rio de Janeiro in 1992. It had the primary objective of 'stabilising] greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate system'. The UN FCCC is not legally binding; however, it enables legally binding treaties to be negotiated. An annual climate change conference is held during which the 194 signatory countries meet. Some of the key milestones include the following: Kyoto Protocol 1997 The protocol is a legally binding agreement for developed countries to cut emissions of the six main green- house gases. It came into force in 2005, but while 191 countries have ratified the protocol, one of the biggest producers of greenhouse gases-the United States-rejected the treaty, and Canada renounced the treaty in 2011. The original Kyoto Protocol lasted until 2012. 15th United Nations Climate Change This conference aimed to establish a new global climate agreement to follow the expiry of Conference (Copenhagen, 2009) the Kyoto Protocol in 2012; however, the agreement was not achieved. 16th United Nations Climate Change During this conference, it was agreed that future global warming should be limited to below Conference (Cancun, 2010) 2.0°C above preindustrial levels. A $100 billion per year Green Climate Fund was proposed to help poor countries adapt to climate change; however, the funding was not agreed. 17th United Nations Climate Change This conference resulted in agreement that a new, legally binding deal should be prepared by Conference (Durban, 2011) 2015 to take effect by 2020 to replace the Kyoto Protocol. Many scientists felt that action should begin far sooner than this. There was also some progress made on the Green Climate Fund, including its official launch. 18th United Nations Climate Change An eight-year extension of the Kyoto Protocol was agreed (until 2020) but only with the Conference (Doha, 2012) scope to influence 15% of global emissions due to the nonparticipation of some key developed countries (Canada, Japan, Russia, Belarus, Ukraine, New Zealand, and the United States) and the fact that developing countries that are major emitters (such as China, India, and Brazil) are not subject to emissions reductions. The concept that developed nations could be financially responsible for other countries for not reducing carbon emissions was strengthened; however, little progress was made on the funding of the Green Climate Fund. Environment Page 2 targets & projections Targets: < 2 C rise requires total anthropogenic CO2 emissions to be kept < 2900 billion tonnes (GtCO2 ) by the end of the century Projections: expected to exceed 2900 GtCO2 in the next 15 30 years = 2.6 - 4.8 C rise by 2100 This distribution uneven: ‘polar amplification’ phenomena may cause 11 C increase in part of the Arctic by 2100. Paris Agreement: full implementation of all mitigation actions pledged by national governments would limit average global warming to around 3.2 C by 2100 Environment Page 3 Environment Page 4 by 2050, 80% of the world's population will be living within 80km of the ocean Environment Page 5 CLIMATE CHANGE, OBESITY & HEALTH Many factors influence the atmosphere's uptake and distribution of energy (heat). Energy-trapping greenhouse gases (esp. CO2, water vapour, CH4) absorb outgoing re-radiated infrared radiation. This raises the earth's surface temperature. Human activity is dramatically increasing the concentration of greenhouse gases, with CO2 concentration increased from 275 parts per million (ppm) to 380 ppm over past century. "GHG emissions have grown largely as a result of industrialised societies' demand for ever increasing volume of production and consumption, along with increasing numbers of consumers globally as a result of population growth." (Friel et al., 2011) Environment Page 6 consumers globally as a result of population growth." (Friel et al., 2011) Global obesity rates have increased dramatically since the 1980s. Simultaneously global greenhouse gas (GHG) emissions have increased in a similar trend. Between 1970 and 2004 GHG emissions increased by 70% according to the European environmental agency. Consider some of the lifestyles and behaviours that have caused the simultaneous rise of obesity and greenhouse gases. Lifestyle Behaviours Sedentary behaviours are associated with rising rates of obesity. Extensive screen time (television, computer/internet use, video gaming) Sitting at work Not enough time for physical education in schools Car culture (driving or riding in cars) Physical Activity Sedentary behaviours and low levels of physical activity, both associated with increased obesity are also associated with lower levels of active transport e.g. walking and cycling and increased use of carbon-emitting, fossil fuel powered transport. Dietary Behaviours Dietary patterns based on high intakes of ultra-processed foods are significantly associated with increased risk of obesity and higher population prevalence of obesity. These diet patterns are also directly associated with poorer environmental outcomes. For example, in comparison with the highly processed westernized diets, more traditional plant-based diets are associated with fewer greenhouse gas (GHG) emissions. Industrial Farming and human consumption of meat is an issue that impact both health (prevalence of obesity) and is a major contributor to climate change. Prevalence of obesity is directly linked with increased meat, and in particular processed meat consumption. Conversely increased meat production is associated with increased greenhouse gas emissions. Climate change and food security Our changing climate and extreme weather events have a direct impact on food production and supply in both developing and developed countries. It is important to note that changes in food production in one part of the world may affect the availability or price of food in another part of the world, therefore climate change is a global issue. In a response to climate change, the food industry may adapt farming and food systems to reduce GHG emissions associated with the food chain, leading to changes in food choice, nutritional content as well as food safety, thus having important impacts on health. Climate change will affect all four dimensions of food security: Environment Page 7 Climate change will affect all four dimensions of food security: 1. food availability 2. food accessibility 3. food utilization 4. food systems stability It will have an impact on human health, livelihood assets, food production and distribution channels, as well as changing purchasing power and market flows. Its impacts will be both short term, resulting from more frequent and more intense extreme weather events, and long term, caused by changing temperatures and precipitation patterns, people who are already vulnerable and food insecure are likely to be the first affected. Agriculture-based livelihood systems that are already vulnerable to food insecurity face immediate risk of increased crop failure, new patterns of pests and diseases, lack of appropriate seeds and planting material, and loss of livestock. People living on the coasts and floodplains and in mountains, drylands and the Arctic are most at risk. As an indirect effect, low-income people everywhere, but particularly in urban areas, will be at risk of food insecurity owing to loss of assets and lack of adequate insurance coverage. This may also lead to shifting vulnerabilities in both developing and developed countries. Food Price and Availability If crop production falls as a result of extreme weather events, (for example, the European heatwave in 2003 saw a 25% reduction in the French fruit harvest) it may force people to purchase cheaper (and often unhealthier) foods. For example, fresh fruit and vegetables are often more expensive than energy dense foods which is likely to be more processed with high sugar and high fat content. This in turn could lead to an increased risk of obesity, especially among low income groups, exacerbating health inequalities. Changing Production Methods GHG mitigation initiatives might include introducing high-sugar grasses into the diet of cows, which reduces methane emissions, or alternating the times of year when animal manures are spread onto land to reduce emissions of nitrous oxide. These changes could have implications for nutritional quality and food safety. Shifts to Low-GHG diets 50% of food-associated GHG emissions in Europe are due to meat and dairy consumption. Although a reduction in meat and dairy consumption may lead to public health benefits such as a reduction in heart disease risk, it may also lower the iron and zinc nutritional status, especially among vulnerable groups. Food Sourcing and Composition It may be necessary for food consumed in the future to be sources from different parts of the world. This source may affect the nutrient content as a result of varying soils, growing conditions as well as method of harvesting, processing and storage. (For example, foods grown near the sea are likely to be richer in iodine as a result of the high iodine content present in seaweed.) Human Behaviour Summers are likely to become warmer. Studies have shown that alcohol consumption is higher during warmer weather. This brings about all the risk factors associated with increased alcohol consumption, including various types of cancer, and overweight/obesity. Environment Page 8 Environmental determinants of disease There is a growing focus in public health on the impact of human activity on the environment. Climate change, for example, is now widely considered to be the most important threat to the planet. However, the impact of the environment is itself of profound importance to health: where we live, where we work, our air, our water, and our food. Public health specialists therefore need to appreciate the environment from both perspectives: Human impact on the environment (pollution and climate change) Environmental effects on humans (the environmental determinants of health) In particular, they should understand the range of policy levers available to improve the environment and to reduce the impac t of environmental hazards on health. The field of environmental health traditionally focused on the short-term hazards of different chemical, biological, and physical agents; how- ever, the environment is now generally considered to encompass all external factors including diet, housing, and water quality. Accordingly, in Dahlgren and Whitehead's rainbow of the wider determinants of health, the 'environment' can be taken to include all layers of the diagram except the inner layer of 'age, sex, and constitutional factors'. Environmental burden of disease Most diseases result from an interaction of hereditary (genetic) and environmental factors. The burden of disease attributabl e to environmental factors therefore depends on how environmental determinants are defined. In general, however, environmental risk factors are thought to account directly for around 10%-15% of the global burden of disease. According to the WHO 2010 Global Burden Diseases report, the three environmental determinants that were directly responsible for the greatest loss of DALYS were. Household air pollution from solid fuels Ambient particulate matter air pollution Occupational risk factors for injuries Environmental justice Exposure to environmental risk factors tends to be greatest among more deprived people - despite the fact that wealthier people tend to be responsible for more pollution and carbon emissions. This is known as environmental injustice and it is a cause of health inequalities. Examples of this phenomenon can be seen at a local and a global level. Examples include the following: Local: Wealthier people cause more pollution from cars; however, the health effects of this air pollution tend to fall disproportionately on deprived groups who live in cheaper housing close to busy roads. Global: Most carbon dioxide has been released by developed countries; however, it is people living in developing countries that are more likely to suffer the worst effects of climate change (e.g. desertification in parts of Africa and flooding of s mall island states). Principles of sustainability Environmental sustainability involves balancing the needs of the present generation with those of future generations. In othe r words, it involves long-term considerations about how we use resources. Currently, our rate of resource use is unsustainably high, as is our rate of pollution. Examples of unsustainable exploitation of environmental resources include: The global reduction in productive soils for agriculture Depletion of ocean fisheries Use of fossil fuels causing global warming UK Department for Environment, Food and Rural Affairs (DEFRA) five principles Environment Page 9 Environment Page 10 Monitoring & control of risks & hazards Environmental hazards are factors that have the potential to harm health (e.g. pollution, chemicals, radiation, extreme temperatures), whereas environmental risk is the probability of an unfavourable event (e.g. radiation exposure, storm, floodi ng) occurring multi- plied by the consequences of that event. Note that this definition of risk differs from the epidemiological definition of risk. Since a hazard only leads to a risk when exposure occurs, the field of risk management focuses on minimising exposures to hazards (i.e. both the occurrence and impact). Risk vs. hazard Hazard: Factor that may harm health Risk: (Probability of an unfavourable event) x (Consequence of the event) Risk Risk management Risk management is important in both community and occupational settings. It involves two key stages: risk assessment (or 'risk characterisation') and risk management. The risk is first characterised by estimating the occurrence of any adverse health effects in a defined population. This involves three steps: hazard identification, dose-response assessment, and exposure assessment. Once the risk has been characterised, steps can be taken to limit any effects that a hazard has on health; this risk management includes risk evaluation, risk perception and communication, control of exposure, and risk monitoring. Risk communication The manner of risk communication can determine whether an issue is acceptable or not to the public. Successful risk communication relies on a good understanding of the different concepts of risk and the skills and integrity to communicate ri sk information appropriately and honestly. Poor risk communication not only affects the issue under discussion but may also irreparably damage the trust of the public. Sandman proposed an alternative concept of risk that takes into account the public's response to a hazard. He defines risk as being what people feel is the likelihood of an event rather than the epidemiological likelihood of an event. He divides the ' risk' that people are worried about into two components: technical (or 'hazard') and non-technical (or 'outrage'). Sandman's concept of risk is therefore the sum of these two aspects (i.e. Risk = Hazard + Outrage). Sandman suggested that risk communication depends on securing an appropriate degree of outrage in the public, so that they are neither unnecessarily frightened nor apathetic about real problems. Sandman listed nine factors that can increase or decrease the level of outrage. Public health specialists can communicate risk more effectively by listening to concerns expressed by the public, including t hose voiced by of pressure groups, in order to: Take into account the factors that influence risk perception Understand the strength of feeling and the points of view Use appropriate media and language to communicate relevant information in a meaningful form Environment Page 11 Environment Page 12 Monitoring and control of hazards Environmental hazards must be monitored in order to reduce the risk of exposures that might lead to adverse health effects. Different monitoring systems are used depending on the hazard, but all systems require surveillance data. Food safety Food can affect health not only through its nutritional effects but also through the toxicological safety of any contaminants or additives. Such contaminants may be biological, chemical, or radioactive. The WHO and the Food and Agriculture Organization (FAO) of the UN set standards for food additives and the use of pesticides in their Codex Alimentarius. Atmospheric pollution Air pollution may be indoor or outdoor (atmospheric or ambient). Indoor air pollution Pollution from open solid-fuel stoves is a major public health problem in the developing world. Current efforts to improve insulation are tending to decrease ventilation, thereby exacerbating the problem. Until recently, passive exposure to cigaret te smoke was another major problem; however, many countries have now banned such exposure in the workplace and in other enclosed public spaces. Environment Page 13 Environment Page 14 Noise Noise can be defined as unwanted sound that causes discomfort. Health effects include stress, depression, sleep disturbance, noise-induced deafness, poor school performance, and cardiovascular disease. Noise may originate from a wide range of sources including Transport (traffic, railways, airports) Industry Neighbours (music, car alarms, shouting) Workplace (heavy machinery) Radiation There are two types of radiation (ionising and non-ionising): Ionising radiation has the ability to ionise atoms (i.e. strip them of electrons) and is characterised by high energy. Ionisi ng radiation is emitted as alpha particles, beta particles, or gamma rays. Non-ionising radiation does not produce sufficient energy to ionise particles. Sources of this type of radiation include sunlight, power lines, and electrical equipment. Environment Page 15 lonising radiation The most common source of naturally occur- ring ionising radiation is radon, a gas arising from uranium in rocks and soils. Radon accounts for about half of UK residents' radiation dose. Naturally occurring levels of the gas are generally low and are not associated with harm. Higher radon levels are found in the South West England due to the granite geology in the area and have been linked to an increased risk of lung cancer-especially in miners. Householders in areas with high radon levels should monitor and reduce the levels of radon in the home. Radon levels should not exceed 200 Bq/m3. Actions to reduce indoor radon concentrations usually involve improving ventilation to expel radon into the atmosphere. Naturally occurring ionising radiation accounts for 84% of the radiation exposure in the population. Around 15% comes from healthcare (including radiotherapy and radiology), with the remainder (50 µg / l-1 8.4% had arsenic concentrations >300 µg / l-1 Environment Page 73 Arsenic contaminated drinking water: a public health emergency At least 100,000 cases of skin lesions caused by arsenic have occurred and there may be many more If exposure continues, skin lesions will continue to occur Skin lesions were occurring in children aged 10 years and younger Large numbers of cancers are predicted to occur in the future, including fatal internal cancers Sustained drinking of water containing 500 µg / l-1 of arsenic may result in 1 in 10 people dying from arsenic related cancers Arsenic caused diseases can be eradicated at relatively low cost Long term solutions for Bangladesh Drill wells deeper than 200 m Regular monitoring of the quality of water in wells Clinical monitoring of people in potentially affected areas by health staff for early signs of arsenicosis Public education and training Alternative water sources, e.g. rainwater Mercury Mercury is classified as a heavy metal It occurs as: Elemental vapour Inorganic compounds Organic forms It is highly volatile and is readily released to the atmosphere from soils It can be leached from soils In water it is associated with dissolved or particulate organic matter Methylmercury Bacterial action, particularly in sediments, can transform inorganic mercury into organic forms such as methylmercury Readily bioaccumulated in animal tissues, particularly fish Subject to biomagnification in the food chain Bioaccumulation refers to the accumulation of a toxic chemical in the tissue of a particular organism. Environment Page 74 Bioaccumulation refers to the accumulation of a toxic chemical in the tissue of a particular organism. Biomagnification refers to the increased concentration of a toxic chemical the higher an animal is on the food chain. Two main sources of mercury exposure: Inhalation Ingestion with food Approximately 80% of inhaled inorganic mercury vapour is retained Gastro intestinal absorption from food: inorganic mercury compounds about 7% methylmercury nearly 100% Elemental mercury, inorganic and organic mercury compounds, can be absorbed through the skin Methylmercury in the body Fairly resistant to biodegradation in the body Can be uniformly distributed in the body High concentrations often found in the brain Easily transferred across the placenta (brain damage can occur in the foetus as a result of exposure by the pregnant mother) Excreted mainly with faeces Retention and Excretion The mean residence times in the body: 100 days for methylmercury 60 days for inorganic mercury compounds Inorganic and elemental mercury are mainly found in the kidneys and brain Longer retention times tend to occur in the brain and kidneys Excretion of mercury can occur in urine and faeces Case Study: Minamata, Japan Mercury poisonings were first observed in Japan in the early 1950s: Symptoms included progressive weakening of the muscles, loss of vision, eventual paralysis and coma Even sea birds and domestic cats suffered similar symptoms By 1975 about 1,000 cases of poisonings had occurred and about 3,000 were suspected About 40% of the people affected died and others suffered permanent damage 1968: The official cause identified as mercury poisoning from an industrial effluent discharged to the bay, accumulating as methylmercury in the fish 1974 646 cases of poisonings reported - Company responsible for the mercury pollution has had to clean up the bay and pay more than £500 million in compensation Environment Page 75 Gold Mining and Mercury use Hg added to rocks and sediments to amalgamate the fine gold particles into an Au Hg complex Hg is filtered and burned off to leave pure gold Workers burning amalgam in pans inhale the mercury vapour Rapidly diffused through the lungs to the blood Gold Mining in Brazil Between 5% and 45% of the total mercury used can be released to rivers Mercury in rivers is accumulated by biota and fish Guideline for safe consumption in food was 0.5 mg Hg kg 1 1991: 30% of the fish in the Amazon region where informal gold miners garimpeiros operate had >0.5 mg Hg kg 1 Eating contaminated fish presents a greater health risk than inhalation of the vapour All fish eating people living in the river basin are at risk of mercury exposure, whether or not they are work in the mines Emerging issues Endocrine disrupting substances Waste pharmaceuticals Waste veterinary products Personal care products Endocrine disruptors An endocrine disruptor is an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects in an intact organism, or its progeny, or (sub)populations Environment Page 76  causes adverse health effects in an intact organism, or its progeny, or (sub)populations Endocrine disruptors include pharmaceuticals, dioxin and dioxin like compounds, polychlorinated biphenyls, DDT and other pesticides, and plasticizers such as bisphenol A From animal studies, researchers have learned much about the mechanisms through which endocrine disruptors influence the endocrine system and alter hormonal functions Endocrine disruptors can ○ Mimic or partly mimic naturally occurring hormones in the body like oestrogens (the female sex hormone), androgens (the male sex hormone), and thyroid hormones, potentially producing overstimulation. ○ Bind to a receptor within a cell and block the endogenous hormone from binding. The normal signal then fails to occur and the body fails to respond properly. ○ Interfere or block the way natural hormones or their receptors are made or controlled, for example, by altering their metabolism in the liver. Examples in nature Eggshell thinning in bird populations due to DDT Abnormal reproductive development in alligators in Lake Apopka, Florida following pesticide spill Nearly complete mortality of young Lake Ontario trout from exposure to dioxin like compounds Simultaneous presence of both male and female reproductive organs (in mollusks exposed to alkyltins) Synthesis in male fish living near sewage outfalls of a hormonally regulated protein (normally found only in female fish) Birth defects in Lake Michigan birds exposed to PCBs and other chemicals Case Study Worldwide, the human live birth sex ratio is remarkably constant, ranging between 102 - 108 male to 100 female live births Although the sex of the human embryo is genetically controlled and determined at the time of conception, there is evidence that the sex ratio can be partially influenced by both endogenous and exogenous factors Endogenous parental hormone concentrations of gonadotropins and/or testosterone at the time of conception are suspected to play a role in determining the sex of offspring Exogenous factors such as stress, parental disease, and exposure to certain chemicals appear to have some influence on the live birth sex ratio It has been hypothesized that some environmental and occupational chemicals may act as endocrine disrupting compounds (EDCs), influencing the sex ratio by changing the hormonal milieu of the parents or by inducing sex specific mortality in utero Aamjiwnaang First Nation community, Ontario, Canada Members of the Aamjiwnaang First Nation living on a reserve near Sarnia, Ontario, have long suspected harmful chemicals were behind an unusually low male birth rate and slew of other reported health issues. Calculated the proportion of male births for the Aamjiwnaang community by dividing the number of male live births by the total of all live births for each year 1984 - 2003. Then used linear regression to examine the trend in the proportion of male births over time. Calculated the proportion of live male births for both 5 and 10 year intervals over the duration of the study period and compared these data to the expected proportion of males for Canada (m = 0.512), as well as a “control” First Nation community (m = 0.520) using Pearson’s chi square analysis. Environment Page 77 Study conclusions Normal variation in sex ratio can be expected in any population, especially with a small sample size however, the extent of the sex ratio deviation for Aamjiwnaang appears to be outside the range of normal Previous studies have demonstrated that populations exposed to environmental contaminants such as endocrine disruptors, either through their close proximity to industrial plants or through other sources such as food, can have significant changes in the reproductive ability of the community, including the sex ratio While the study doesn’t prove that the pollutants are to blame for earlier research that found baby girls outnumbered boys by a two to one ratio in the community, it does suggest a possible link There are 60 industrial facilities found within a 25 kilometre radius of Aamjiwnaang lands. Environment Page 78 Legislation in environmental control The control of environmental pollution and waste production by businesses requires effective legislation because of potential conflict between economic priorities, protecting the environment and human health effects. This tension is particularly pertinent for small businesses and also in developing countries where the information and expertise to implement environmentally friendly measures may be lacking. Environmental hazards are seldom limited by geographical boundaries. For example, acid rain caused by UK power plants in the 1970s and 1980s mainly fell in continental Europe. Therefore, legislation and strategies to tackle pollution and waste production should be set at an international level. Within the EU, such legislation may be primary (e.g. treaties) or secondary (e.g. directives and regulations). European Union Legislation EU European environmental legislation is based on two guiding principles: polluter pays and the precautionary principle. European legislation aims to restrict levels of pollution and emissions and to ensure the safe disposal of waste. Compliance with the terms of permits and regulations can be enforced through Inspections, followed by warning letters or formal cautions Enforcement or prohibition notices Suspension, revocation, or modification of permits Penalties, such as fines and imprisonment Effectiveness of legislation Compliance with environmental legislation is variable. There are many reasons for this inconsistency, including Business not always being aware of legislative requirements Monitoring in some countries being more rigorous than others Penalties for non-compliance being comparatively weak (cf. health and safety offences) Compliance not always being perceived as central to a firm's survival Environment Page 79 Environment Page 80 Legislation in Spatial Planning National Planning Framework Environment Page 81 Regional Spatial and Economic Strategies Environment Page 82 Local Authority Development Plans Projects Environment Page 83 Strategic Environmental Assessment Environment Page 84 Environmental Impact Assessment Environment Page 85 Transport Policies Transport policies need to acknowledge the potential benefits of increased transport and accessibility, which increase employment opportunities, improve the availability of goods, and lead to a greater choice of social activities. It is also important to recognise the health benefits associated with active transport (walking or cycling), as well as the risks associated with non-active forms of transport (e.g. road, rail, and air) which include: Air pollution and global warming Noise pollution Collisions, including road traffic accidents Effects on social cohesion (e.g. from a busy dual carriage-way bisecting a community) Road transport is one of the greatest contributors to air pollution, particularly in towns and cities. However, while emissions from most industrial and transport sources are generally decreasing, the impact of air travel is increasing. According to the European Commission, EU emissions from international aviation now account for 3% of all greenhouse gas emissions in the EU and are projected to increase by around 70% between 2005 and 2020. Sustainable transport Sustainable transport policies promote forms of transport that have the potential for maintaining wellbeing in the long term, which has environmental, economic, and social dimensions. Such policies typically focus on environmentally friendly transportation, taxation, reducing car usage, reducing the environmental impact of transport, reducing emissions, and promoting sustainable forms of transport, for example, car sharing and public transport. Environmental friendly transportation Alternatives to cars can be encouraged by sustain- able transport policies. Active forms of transport, such as walking and cycling, have health benefits for the individual, through increased physical activity, and for the population as a whole through reduced air pollution, reduced greenhouse gas emissions, and reduced noise. Cycling also has health risks including exposure to vehicle emissions and risk of road traffic collisions; however, studies in European settings have shown that the health benefits of cycling to the individual outweigh the risks. Taxation Taxation can be used to encourage industry and consumers to adopt more fuel-efficient vehicles and thereby reduce vehicle emissions. Reducing car usage can be achieved through Levies or taxes for road use (e.g. London con- gestion charge) Parking restrictions and charges Subsidising the cost of public transport Encouraging car sharing through introducing share-only lanes and high-volume occupancy lanes Environment Page 86  Encouraging car sharing through introducing share-only lanes and high-volume occupancy lanes Reducing the transport of freight via road and increasing rail transport of freight Reducing the environmental impact of transport Carbon-offsetting initiatives seek to compensate the environment for emissions of carbon dioxide. Processes that emit carbon dioxide are matched with projects that either reduce the emission of car- bon dioxide or remove an equivalent amount of the gas from the air. For example, air passengers can make a donation to a non -governmental organisation (NGO) that will fund projects designed to increase forestation. Wilkinson described how researchers are exploring the option of carbon capture as an alternative approach to reducing the impact of carbon dioxide production. The damage to the environment results from carbon dioxide in the atmosphere. Carbon capture relies on finding locations to store carbon dioxide so that it does not reach the atmosphere. Depleted oil and gas fields could be ideal carbon capture locations since they have increasing storage space, and the insertion of carbon dioxide could make the continued extraction of gas and oil more straightforward. Note that carbon capture would neither result in a reduction in the use of hydrocarbons nor in the production of carbon dioxide. Instead, it may best be regarded as a relatively inexpensive short- term solution whose value lies in buying time to develop alternative fuel sources. Emissions trading schemes Emissions trading schemes provide economic incentives for industrial polluters to reduce their emissions. One example is the EU Emissions Trading System, which expanded in 2012 to include aviation emissions. Environment Page 87 Waterborne Infection Outbreak Management: Case Study Background Ireland has one of the highest rates of severe E. coli infections in Europe, called Shiga toxin-producing E. coli (STEC) or Verotoxigenic E. coli (VTEC), monitored by the HSE-Health Protection Surveillance Centre. These strains of E. coli are particularly harmful as complications can be life-threatening in 5-10% of infections due to kidney failure, known as Hemolytic Uremic Syndrome (HUS). Vulnerable populations include those with compromised immune systems; children under 5 (immature immunity) and older adults (deteriorating immunity), or patients with chronic disease like cancer (immunocompromised). In Ireland, the Mid-West HSE Area is particularly affected, with one of the top infection rates in the country and the regional HSE- Department of Public Health are often involved in outbreak investigations (see below). A common outbreak scenario for the HSE is described Index case? A child under the age of five is identified as a case of VTEC after drinking contaminated water sourced from a private well ( using the HPSC case definition and surveillance forms). The child’s mother is a healthcare worker, so she was considered as part of a risk group, and could not attend work due to being potentially exposed. Potential onward transmission? The child had been attending the local creche, and after other children at the facility fell ill, a VTEC outbreak was suspect ed. All the other children and the teacher in the infected child's room were excluded from the creche and screened for VTEC (applying the precautionary principle). Outbreak confirmation: A number of children and the teacher from the creche tested positive (using the HPSC case definition and surveillance forms), and an outbreak of VTEC was officially declared. Control measures: Those with confirmed VTEC cases were excluded from attending the creche until they were given the all -clear, and a multi-agency outbreak control team was formed to contain the outbreak (using national guidance). Case outcomes: Most of those affected returned to the creche after two weeks. However, one child’s condition deteriorated, and tests later confirmed they had developed HUS. This child was admitted to an intensive care unit in a pediatric ward, where they made a slow recovery. Outbreak guidance The most common sources of infection with STEC/VTEC are through poor hand hygiene or contaminated water. A one-health approach is used for tackling waterborne illness, described by the HPSC. Risk factors include: drinking untreated water from private wells, contact with farm animals, swimming in streams and lakes, through food and drinks contaminated with microscopic amounts of fecal matter. Infection transmission can occur from person-to-person, particularly with young children, such as in childcare centers or households with children under 5 years old. Therefore, outbreak control measures focus on preventing onward transmission and Public health guidance is available from the HPSC and focuses on awareness of the serious outcomes of illness, the importance of hand hygiene after contact with farm animals and their environment and before and after preparing food (example below). Outbreak communication Rose Fitzgerald, specialist in public health medicine, provided guidance through the media on the increased risks of infections and outbreaks are more during summer. “We are asking the public to be conscious of their activities throughout the summer period, particularly in relation to hand hygiene, drinking treated water, swimming in potentially contaminated fresh waters, and being on farms,” she said. “It is a serious disease that can cause life-changing illness, and while it can last in the system for as short as a week, it can sometimes take several months to clear the infection. Anyone who is infected or is a close contact of a case requires clearance from a public health doctor to attend healthcare, childcare or work that involves food -handling.” Research for quality improvement Costigan et al 2021 HUS Quality improvement research Ireland.pdf Public health legislation People infected with VTEC are more than four times more likely than the general population to have consumed untreated water from private water supplies (Gov.ie). In Ireland, public water supplies or group schemes are legislated by the Environmental Protection Agency). However, authorities do not test the drinking water quality of private water supplies (EPA). The responsibility of testing private well water Environment Page 88 However, authorities do not test the drinking water quality of private water supplies (EPA). The responsibility of testing private well water lies with the owner. Also, the maintenance and servicing of wells is very important for reducing the risk of contamination. In 2020, the Irish government published new legislation to financially assist private well owners with this task, called the HOUSING (PRIVATE WATER SUPPLY FINANCIAL ASSISTANCE) REGULATIONS 2020 Health Protection As the saying goes, prevention is always better than cure and 'up-stream' prevention strategies are vital for public health rather than identifying cases 'downstream'. The HSE-Department of Public Health in the Mid-west launched an awareness campaign in 2022 to encourage people to test their well water every year and ensure they have appropriate protection and treatment systems in place. Environment Page 89 Emergency Sanitation good sanitation results in waste being non-infectious and/or inaccessible it needs to be adapted to legislation, socio-cultural habits and local constraints international standard in emergency settings: aim to have 1 latrine per 20 inhabitants ash from fires may be used as an alternative to soap for handwashing in emergencies know your audience: sitters vs. squatters activities to reduce infection reservoir and interrupt transmission water supply excreta disposal wastewater management solid waste management vector control dead bodies management hygiene education / promotion water supply and excreta disposal are highest priority at the onset of an emergency such as a refugee camp in health structures (e.g. field hospital), all these activities must be carried out at high priority excreta disposal a method is acceptable if: - it contains all excreta at one spot - it won’t pollute the water points / resources - it limits the attraction of insects - it’s accessible for the users - it provides a minimum of privacy - it respects the habits of the population - it is as safe & easy as possible to use - it has facilities for women during menstruation - it has facilities for (temporarily) handicapped people defecation fields last resort in emergencies they do not last very long 1. must be away from water source 2. separated from lodging area 3. in arid areas only - rainwater will spread disease 4. handwashing facilities 5. for one gender at a time only (intimacy, safety) 6. as much privacy as possible - opaque fencing Environment Page 90 simple trench latrines width: 0.3 m, depth: 0.9 - 1.5 m, length: 3.5 m/100 users life span: 2 - 4 weeks keep excavated soil next to the trenches install planks at trench edges (anchoring, prevent users falling in) provide a shovel to the users to cover their excreta communal mostly; families may build personal ones pits must be at least 1.5m higher than the water table the water table is the surface where the water pressure head is equal to the atmospheric pressure Environment Page 91 improved trench latrines NB this is the strict minimum for health structures positioning of users: face-to-face, or back-to-back advantages: comfort, privacy, lid (so you don't have to cover your excreta with soil) pit latrines Environment Page 92 children latrines no doors / privacy - safety is priority handlebars for support - prevent child from falling into hole footrests to ensure correct foot positioning, which prevents insects in the hole from reaching the user's backside pour-flush latrines alternative to direct-drop design need 3-4 litres of water to flush not recommended if lack of water solids used for anal cleansing bad soil infiltration only consider this option in acute emergencies if there is a strict demand Environment Page 93 raised pit latrines indications high water table hard soil / rock risk of flooding VIP (ventilator-improved pit) chimney creates suction effect which mitigates odour must be situated away from trees / building chimney must be south-facing in the northern hemisphere, and vice versa, to improve sunlight pipe must be > 50cm above the highest point not recommended in emergency settings, may be useful in health structures twin pit has chimney as in VIP the latrine in use is continuously alternated, and excrement from the other one is harvested as fertiliser difficult and expensive to make long-term model Environment Page 94 septic tank not for emergencies separates out solid particles in waste, but does not filter pathogens plastic bag latrines invention of slum residents, where there is no space for latrines only to consider in specific circumstances (e.g. floods, slums) & limited periods flexible system need for biodegradable plastic bags need for daily follow up need for good hygiene promotion need for transport means users in slums often throw the bag as far away from them as possible, and will hit other people or structures - "flying toilet" Environment Page 95 dehydration latrines quick to deploy can be transported compartment is small - must be regularly emptied require chemicals to reduce smell ecological benefits control of the humidity inside the pit separation of urine & faecal matter (urine = good fertiliser, faecal matter = good conditioner of the soil) no water to be added in the pit (not for rinsing, separated for anal cleansing) preferably stirring the human waste once in a while to introduce oxygen to obtain an aerobic decomposition (less odours) composting latrine same as dehydration latrine, with addition of wood ash / wood shavings / food residues improves decomposition of excreta relies on prior experience in the population of methods not for use in emergencies otherwise only to consider in chronic emergencies or stabilized situations: where the population knows & uses already this sanitation system if a real sanitation programme with training & promotion is set up & if it’s acceptable culturally (pilot project) Environment Page 96 hygiene containers slabs not recommended: plastic sheets, wooden planks / branches there should always be a cover for the defecation hole latrine desludging sludging occurs due to excess waste or infiltration of rainwater Environment Page 97 sludging occurs due to excess waste or infiltration of rainwater if a water pump is used to desludge, it can never be used again for water hygiene & maintenance one of the main problems in communal latrines is hygiene and maintenance the worse condition a user finds it in, the less likely they are to keep it clean (viscous cycle) cluster latrines are an option to improve this e.g. 1 latrine shared between four families encourages respect and responsibility for the latrine Environment Page 98 The Water Fluoridation Debate Water fluoridation is the controlled addition of a fluoride compound to public water supplies in order to bring the fluoride concentration of the water supply to an "optimal level" (usually around 0.7 - 1 parts fluoride per million parts water) to prevent tooth decay. Fluoride affects demineralisation and remineralisation of the tooth, and has anti-bacterial effects. Water fluoridation schemes are in place in around 30 countries, and it is estimated that more than 350 million people receive a fluoridated water supply worldwide. Some refer to public water fluoridation as "mass medication" or "forced medication" The Fluoridation Debate Public water fluoridation has been a controversial public measure almost from the very first day that the first experimental fluoridation schemes were introduced in the United States in 1945. The debate over the safety and effectiveness of the practice has endured for more than 60 years. One such debate is the fact that it is not ethical to "force" people to consume a chemical compound for which there may be no need as: Fluoride is already present naturally in water Other methods of fluoridation exist that give "choice" to the consumer e.g. most toothpastes today are fluoridated Adverse effects of its consumption are not fully known History Dr. Frederick McKay (1909) A young dental student from Pennsylvania Dental School moved to Colorado Springs in 1901, to set up his own dental practice. McKay began to notice that a lot of his patients had a particular brown staining on their teeth that he called mottled enamel. He began researching, but could find no evidence of mottled enamel in his research. He undertook a survey of 3,000 school children in public schools in Colorado Springs. The prevalence of mottled enamel in school children in Colorado Springs was 88%. McKay found that occurrences of mottled enamel were localized in definite geographic areas. Only those children who were born and had lived all their lives in these areas had mottled enamel. McKay Environment Page 99 in definite geographic areas. Only those children who were born and had lived all their lives in these areas had mottled enamel. McKay observed that three cities in Arkansas where mottling occurred all received their water supply from the same source. Hypothesis: Mottling was caused by something in the water supply. McKay's hypothesis was accidentally tested by a natural experiment that occurred in an mining town, Bauxite, Arkansas, where no mottling had occurred prior to 1909. In 1909, the town of Bauxite changed its water source from a shallow to a deep well (3,000 ft). Children born and brought up in Bauxite after 1909 and who used the deep well water developed mottling. In 1931, Bauxite water was tested using spectrographic analysis. Fluoride was present at a concentration of 13.7 parts per million. Samples from other areas where mottling occurred also contained high concentrations of fluoride. Dr H. Trendley Dean (1942) Dean was appointed to dental research in the United States Public Health Service in the early 1930s. He carried out a number of epidemiology studies to investigate the extent and geographical distribution of mottled enamel in the United States. In a number of cross sectional studies he observed that the severity of mottling (fluorosis) appeared to increase with increasing fluoride concentration in the drinking water. In areas where there were low concentrations of fluoride in the drinking water only mild forms of fluorosis occurred. Dean also observed that children living in areas with low levels of naturally occurring fluoride in public water supplies appeared to have less dental caries (tooth decay) than children living in 'fluoride free' areas. Dean assessed the dental health of over 7,000 school children (aged 12-14 years) living in 21 U.S. cities with varying concentrations of fluoride in water. His finding concluded that a concentration of 1ppm fluoride in drinking water caused only "sporadic instances of the mildest forms of dental fluorosis of no practical aesthetic significance". Hypothesis: Could the a reduction in tooth decay and minimal fluorosis be achieved by artificially adding fluoride to public water supplies? Adverse effects of fluoride Dental Fluorosis Higher levels of fluoride consumption can cause dental fluorosis. Dental fluorosis, a defect of the tooth enamel, causes visible markings on the teeth. The condition develops during the period of tooth formation (from birth to approximately 6-8 years of age) and is permanent. It can vary from mild speckling to more substantial staining and pitting of the teeth. Excessive incorporation of fluoride into dental enamel disrupts the normal maturation of the enamel. Others have suggested that other harms may be associated with water fluoridation such as bone fractures and cancers, although the evidence for such effects are weak. Skeletal Fluorosis Characterised by skeletal abnormalities and joint pain. It is caused by long term exposure to large amounts of fluoride. About 50% of all ingested fluoride is taken up in the bone. WHO suggests that skeletal fluorosis is observed when fluoride levels are above 3 ppm, and the most severe form occurs when the level is over 10 ppm. Skeletal fluorosis causes failure of bone to mineralise properly. Bones become weaker and more susceptible to fracture. The bones in the legs typically become deformed due to weight bearing. Skeletal fluorosis is a problem in many areas of India and Pakistan, in Sri Lanka and in Rift Valley countries in Africa (Kenya and Tanzania). The abundance of fluoride in Rift valley groundwater is due to the weathering of alkaline volcanic rocks rich in fluoride. Typical fluorine concentrations of towns in the Rift Valley are between 1 and 33 ppm. Ethical Considerations in Water Fluoridation Tensions can arise between competing principles and values within the Stewardship Model. Arguments for fluoridation 1. Reduction in the risk of ill health Environment Page 100  1. Reduction in the risk of ill health The liberal state has a duty to provide interventions to reduce ill health. However, for this principle to carry weight, several questions need to be considered, including the extent of the benefits to health and any risks or harms. 2. Protecting the vulnerable Children represent an especially vulnerable group in many public health contexts. This is especially true in dental health as they are susceptible to dental caries, are less able to make informed choices about their dental health, and are dependent on parents and carers to assist with or promote preventative measures such as brushing. 3. Reducing health inequalities There is considerable inequality in dental health in the UK, due to the fact that only some areas use fluoridated water. Reducing health inequalities should be central to public health and therefore fluoridating the water supply may potentially improve dental health across the population including the lower socio-economic groups. Arguments against fluoridation 1. It doesn't work/no longer needed There are now other sources of fluoride available such as fluoridated toothpastes, milk, salt and fluoride supplements. 2. Respecting important personal values The fluoridation of water may restrict individual choice in a significant way, because individuals exercise little choice over the water they consume. 3. Not intervening without the consent of those affected Drinking fluoridated water be perceived in the same way as taking medicine, and represent ‘forced medication' of the population if consent is not obtained from everyone. Conflicting Evidence It is difficult to measure how effective water fluoridation is on preventing tooth decay. Research that began in 1945 suggests that the measure was highly beneficial in reducing dental caries among children. However, in many of these studies, particularly the early ones, the methodologies used have not been of high quality. A major review of water fluoridation was published in 2000 referred to as The York Report. The findings of the York Report showed no conclusive evidence of benefits or harms mainly due to poor quality of studies reviewed. Subsequent to the publishing of the review, those who advocated water supply fluoridation overemphasised the positive findings, such as reduced incidence of caries in children with no adverse side effects, and those who were opposed to the intervention overemphasised the negative findings, such as brain damage in children and abnormalities in the reproductive system. Thus the debate continued. A more recent report found that water fluoridation is effective at reducing levels of tooth decay among children. The introduction of water fluoridation resulted in children having 35% fewer decayed, missing and filled baby teeth and 26% fewer decayed, missing and filled permanent teeth. They also found that fluoridation led to a 15% increase in children with no decay in their baby teeth and a 14% increase in children with no decay in their permanent teeth. These results are based predominantly on old studies and may not be applicable today. Within the 'before and after' studies, they did not report on the benefits of fluoridated water for adults. They found insufficient information about the effects of Environment Page 101 and after' studies, they did not report on the benefits of fluoridated water for adults. They found insufficient information about the effects of stopping water fluoridation. They found insufficient information to determine whether fluoridation reduces differences in tooth decay levels between children from poorer and more affluent backgrounds. Overall, the results of the studies reviewed suggest that, where the fluoride level in water is 0.7 ppm, there is a chance of around 12% of people having dental fluorosis that may cause concern about how their teeth look. Water fluoridation for the prevention of dental caries (Review) National Pure Water Association NPWA is concerned by other issues considered by the National Research Council’s Toxicological Review team. These are the effects of fluoride on the endocrine system (e.g. thyroid and pineal glands), cellular enzymes, cancer rates, the kidneys and the brain (and particularly the developing brain as a number of studies suggest that fluoride may lower IQ in children). The Debate Continues Water Fluoridation: A Critical Review of the Physiological Effects of Ingested Fluoride as a Public Health Intervention, 2014 This paper reviews the human health effects of fluoride. It concludes that new methods to prevent dental caries need to be introduced and fluoride predominantly in any form constitutes an unacceptable risk to health with virtually no proven benefit. Fluoride has modest benefit in terms of reduction of dental caries but significant costs in relation to cognitive impairment, hypothyroidism, dental and skeletal fluorosis, enzyme and electrolyte derangement, and uterine cancer. Most of the toxic effects of fluoride are due to ingestion, whereas its predominant beneficial effect is obtained via topical application. The paper concludes that given that dental caries is the most common disease globally arising from bacterial infection, efforts to develop safe technologies to address the disease deserve high priority. Water Fluoridation and Oral health, 2013 This paper comes to the conclusion that water fluoridation is an effective safe means of preventing dental caries, reaching all populations, irrespective of the presence of other dental services. Regular monitoring of dental caries and fluorosis is essential particularly with the lifelong challenge which dental caries presents. Environment Page 102 Health Impacts of Landfill and Incineration Local Health Impacts Landfill and Incineration are the most commonly used methods of waste management. However, both options can result in dispersal in the environment of materials that are hazardous to health (Sim and McKee, 2011). Landfills: Venting and potential leakage of gases, pests and water contamination are health hazards resulting from landfills. Incineration: Emissions of dioxins and disposal of waste ash are of concern (Crowley et al, 2003). Emissions from Waste Management Sites Exposure to emissions from landfill or incinerator sites requires direct contact. This contact can be by breathing, by eating food or drinking liquids contaminated by emissions, or through skin contact, e.g. children playing in the soil. Factors that will determine whether a harmful or toxic effect is likely to occur include: the dose (how much), the duration (how long) and the route of exposure. Children who have contact with soil may be at greater risk of exposure from emissions from waste management sites e.g. overflow contaminated water. Figure 11.1: Waste materials disposed in landfills can result in the contamination of the environment: Gases and odours are emitted from the surface, going into the air. Contaminated rainwater infiltrates the landfill and leachate (water seeping from the waste) is produced. Rainwater also leads to the production of contaminated surface water which runs off to contaminate ditches and river water. The leachate and seepage in the landfill site infiltrates groundwater and migrates in the soil in unsaturated zones with the potential of affecting the quality of the water supplied by the borehole. Leachate arising from landfills is now being recognized as a potential health risk to both surrounding ecosystems and human p opulations. Methane is also produced by the landfill and migrates through fissure or permeable zones (Pomerleau and McKee, 2005). Environment Page 103 Landfill: Advantages/Disadvantages (Source: Rushton, 2003) Advantages Disadvantages Cheap disposal method Water pollution from leachate and run off Waste used to fill quarries before reclamation Air pollution from anaerobic decomposition of organic matter to produce Landfill gas contributes to renewable energy supply methane, carbon dioxide, nitrogen, sulphur and volatile organic compounds Emission of known or suspected carcinogens or teratogens (e.g. arsenic, nickel, chromium, benzene, vinyl chloride, dioxins polycyclic aromatic hydrocarbons) Animal vectors (seagulls, flies, rats) for some diseases Odour, dust, traffic problems Health Effects of Landfills Cancer Landfill sites contain many toxic substances, e.g. arsenic. Excesses of bladder, lung, leukaemia and stomach cancer among those living in close proximity to a landfill have been reported in some studies but not in others. Teratogenesis An association has been found between adverse birth outcomes (such as low birth weight and birth defects) but cannot be determined as causal. The EUROHAZCON study highlights the risk of congenital anomalies and low birth weight in babies of mothers living within a 3 km radius of a landfill. Residence within 3 km of a site was associated with a significantly raised risk of congenital anomaly (including neural tube defect, cardiac malformations and anomalies of the great arteries and veins). There was a fairly consistent decrease in risk with distance away from the sites. Other Environment Page 104 Other There are also reports of increased respiratory, skin and gastrointestinal illnesses, based primarily on self-reported symptoms. Landfill Examples Ireland National and EU waste policy is based on the waste hierarchy whereby waste should be prevented and where this is not feasible, re-used, recycled or recovered. The least preferred option is disposal to landfill. The net effect of waste policy is to encourage a move towards a recycling and recovery society by diverting waste from landfill through promotion of prevention, recycling and recovery. In 2000, Ireland landfilled approximately 90% of municipal waste arising and while this has reduced to 62.5% in 2008, Ireland remains predominantly reliant on landfill in managing waste (EPA Report, 2010). However, the amount of municipal waste sent to landfill for disposal is still decreasing and 2012 was the first year that the percentage tonnage of municipal waste recovered (59%) exceeded the percentage tonnage disposed (41%). The number of open landfills decreased from over 200 in the mid-1980s to 48 in 2009. Landfill capacity at the end of 2008 was approximately 24 million tonnes and represents 12 years capacity, i.e. to 2020. However, landfill consolidation is on-going with plans to further reduce the number of landfills in Ireland. Landfills are considered an important public health risk despite all efforts being made to minimise the impact of them to the local population. Greece Waste management is a major threat to Greece which buries 80% of its rubbish - over twice the EU average. Approximately 6,000 tonnes of rubbish arrive at the Fyli landfill just outside Athens every day from the capital and neighbouring regions and thousands of tonnes of more waste are dumped in mountainous areas. Kenya Dandora is Nairobi’s main dumping ground. Every day, it receives more than 2,000 metric tonnes of waste. The 30 acre site, which is one of the largest in Africa was once a quarry that the City Council of Nairobi sought to use temporarily. The United Nations Environment Program (UNEP) warned that the Dandora dump has posed a serious health threat to those working and living nearby as far back as 2007. And according to a report by The Endocrine Society and IPEN ((International Pollutants Elimination Network) in December 2020, there is evidence of human health impacts from many chemicals in common plastics including alterations to both male and female reproductive development and infertility. A UNEP report titled 'Implications of the Dandora Municipal Dumping Site in Nairobi, Kenya' - states that skin disorders, cancers, respiratory abnormalities Environment Page 105 report titled 'Implications of the Dandora Municipal Dumping Site in Nairobi, Kenya' - states that skin disorders, cancers, respiratory abnormalities and blood disorders are just some of the public health effects that can be brought about by environmental pollution emanating from the dump site. Incineration From a health aspect, the most important pollutants associated with incineration are particles, metals, acidic gases and aerosols and organic compounds (Rushton, 2003). Advantages Disadvantages Protects sources of potable water supply Odour nuisance Reduces weight and volume of waste Produces hazardous solid waste About 30% of incinerated materials are left as Discharges contaminated waste water ash which can be used for materials recovery Emits toxic pollutants, heavy metals, and combustion products Reduces potential infectivity of clinical waste Produces energy for electrical generation Health Effects of Incineration Some well-designed studies have reported associations between developing certain cancers and living close to incinerator sites. Specific cancers identified include primary liver cancer, soft-tissue sarcoma, lung cancer and laryngeal cancer. Overall, the evidence is not conclusive to establish the occurrence and magnitude of risks. However, long-term low- level exposures to populations living near incinerators are of public health concern. Case Study: Healthcare Waste Incineration and Health - Kenya A study based in two hospitals in Kenya concluded that the incineration of healthcare waste could release dioxins, furans and antineoplastic (cytotoxic drugs) fumes. Health-care waste incineration and related dangers to public health: case study of the two teaching and referral hospitals in Kenya Incineration and Occupational Exposure Hazards In a study by Angerer et al. (1992) concerning waste workers, exposure to substances emitted from a German municipal waste incinerator was examined. It found in 53 municipal waste workers and 431 controls that there were significantly higher values of hydroxypyrene (in urine samples) and hexachlorobenzene (HCB) (in blood samples) in the waste workers. Occupational Effects of Exposure to Emissions from Landfill and Incineration Sites The risk of occupational injuries (fatal and non-fatal) is higher for those working in waste management compared to the general workforce. Among waste management workers, non-fatal injuries are mainly musculoskeletal. Other common injuries include gastrointestinal disorders, bites, and eye, skin and respiratory problems. Epidemiological Evidence A number of studies have been carried out to examine the effects of waste management options on human health. The results of many studies have been inconclusive. Interpreting the evidence from epidemiological studies on waste disposal is difficult. This creates a tension between the Environment Page 106 have been inconclusive. Interpreting the evidence from epidemiological studies on waste disposal is difficult. This creates a tension between the requirement for scientific certainty, and the need to protect public health. The scientific uncertainty creates challenges for politicians, regulatory officials and the public. Environment Page 107 Solid & Water Waste SOLID WASTE problems unsightly and smelly nuisance risk of fire health risks: pollution of surface water and possibly groundwater breeding of flies and cockroaches => transmission of faecal-oral diseases attract rats (& potentially snakes) => plague, leptospiroses, salmonella breeding of mosquitoes: Aedes in clean water in cans => Yellow fever, Dengue; Culex in stagnant water => microfilariases type & quantity depends on: geographic region sociocultural & material level seasonal variations importance and diversity of refuse generating activities packaging of food rations (aid agencies) refugee & IDP camps often lots of organic waste, but more and more non-degradable waste, certain non-organic waste is often recycled quantity: 0.5 – 10 L/pers a day temporary storage 100 litre drum gather the refuse avoid dispersion by wind & animals 2 bins per community (+/- 80 persons) < 15 m from furthest dwelling Environment Page 108 collection & transport constitution of teams (2.5 pers/1000 inhabitants) establishment of cirquits allocation of a cirquit to each team daily collection (cart / vehicle) treatment incineration: not recommended needs lots of fuel bad for the environment harmful to public health increased risk of fire only suitable if professional incinerator and skilled staff composting: not recommended for emergencies aerobic decomposition, thus need for regular mixing difficult to manage need for specialist not always responding to habits and culture not possible for all waste (more & more plastic) dumping: avoid at all times attracts vectors attracts scavengers (animals and human) WASTEWATER problems spread and multiplication of pathogenic agents (e.g. cholera, schistosomes) chemical contamination of potable water resources (e.g. nitrates, detergents) ecological disturbance / pollution of aquatic environments (ground and surface water) Environment Page 109 ecological disturbance / pollution of aquatic environments (ground and surface water) production of noxious and corrosive gases breeding of insect vectors (e.g. mosquitoes) kinds of wastewater domestic wastewater spilled water at water points sewage (black water) sullage (grey water) specific wastewater from sullage coming from laboratories humanitarian interventions liquid residues from water treatment agricultural wastewater pesticides, nitrates, etc. industrial wastewater wastewater from mining contamination of surface water and groundwater by chemicals run-off excess rainwater pre-treatment screen to remove floating and bulky objects sand trap to separate sand and soil, via sedimentation grease-trap to eliminate oily and greasy material (e.g. soap) in wastewater (sullage) sedimentation hole to eliminate flocks from water treatment. septic tank to eliminate faecal material / blood (sluices) in sewage more sophisticated treatment facilities like: wet lands Rotating Biological Contactors (RBC) Environment Page 110 disposal river only if big and/or rapid flowing river e.g. as last resort during rainy season risk for the environment & public health attention for population down flow sewer investigate if the sewer is completely closed, where it ends (outlet) and if wastewater is treated potentially no treatment at all, thus only displacement of problem Environment Page 111 Medical Waste Management issues: unsightly, smelly, fire risk, health risks good medical waste management results in waste being non-infectious and inaccessible it should be adapted to legislation, socio-cultural habits and local constraints general principles on-site management as much as possible - allows for safety, training, adequate PPE minimise handling & manipulation - reduce contamination risk, needlestick, etc. easy to implement technically and economically sound sustainable - essential in long-term structures, not always a priority in emergencies burning undifferentiated medical waste is not safe or effective the content is variable in consistency and water content (e.g. amputated limbs, placenta, plastic) and will not burn properly white smoke is even worse than black smoke - harmful chemicals released to environment a cleaner without gloves segregating sharps from soft wastes in a HIV clinic in Cambodia segregation must be at the time when & at the place where the waste is generated by the medical staff (not cleaning staff) sharps waste should be segregated at the time when & at the place where the waste is generated, by the medical staff disposal sharps boxes are usually too expensive in low-income countries they stop being used after the aid agencies leave useful alternative to sharps box: modified drugs container cardboard boxes are often used, which are not fit-for-purpose, and are very high risk incineration of medical waste sharps is not recommended - often leaves needles intact in the ash Environment Page 112 incineration of medical waste sharps is not recommended - often leaves needles intact in the ash however for mass vaccination, incineration can be used if done safely, due to the massive numbers of needles intact sharps in ash falls straight into pit via safety box if using a sharps underground pit, leave a 1 metre long pipe at point of entry to prevent people trying to steal used needles to sell Environment Page 113 soft waste e.g. surgical masks, syringes, gloves incinerator has two combustion chambers use of industrial incinerator is at least 15-20x greater cost than local ones ashes fall into residue pits Environment Page 114 organic waste e.g. blood, placenta, limbs does not burn well - contains too much liquid, requires a lot more fuel than soft waste all the different waste facilities can be placed together in the waste zone HAZARDOUS WASTE start with national / international legislation pharmaceutical waste expired, damaged, deteriorated drugs laboratory waste expired chemicals & diagnostic test kits Environment Page 115 laboratory waste expired chemicals & diagnostic test kits X-ray related waste developing & fixer liquids expired X-ray film specific hazardous waste radioactive waste small batteries of medical equipment old and broken equipment (e.g. mercury in blood pressure gauge) material related to the ambulance insecticides inappropriate or expired bio-hazardous waste samples of potentially infected persons lab cultures specific body fluids (e.g. sputum of TB patients) internal management encapsulation inertization dissolving dilution evaporation recycling e.g. expired chlorine to disinfect hallways encapsulation pros Immobilisation of drugs Method usable for all drugs Cheap method Training & Implementation by agency No special material required cons Although extremely difficult to access, drugs aren’t eliminated Need of space for burial Special criteria for burial area inertization pros Immobilisation of drugs Drugs eliminated Cheap method Training & Implementation by agency No special material required cons Not possible for all drugs Need for some space Labour intensive dissolving / dilution pros Drugs eliminated No space required (for residues) Cheap method Environment Page 116  Cheap method Training & Implementation by agency No special material required cons Good sewer system or (big) fast flowing river needed Not possible for all drugs Need for big quantities of clean H2O Labour intensive external management incineration return to manufacturer (or donor) incineration pros Destruction method > 1100 - 1200 °C / 2 sec (purpose build, cement factory, high furnace) Nearly all drugs (except possibly ampoules, vials & certainly aerosols) > 850 °C / 2 sec (real domestic waste incinerators) Certain drugs (if mixed with lots of domestic waste) cons Very specific equipment required Out of hands of agency => Risks of fraud and insufficient destruction Transport Potentially very expensive (1.2 to 4.1 $/kg) return to manufacturer pros Possible elimination in a correct way? cons Special authorisations needed to cross the borders Time consuming Transport (Very) Expensive Very difficult or not even possible in most humanitarian situations Environment Page 117 Final Disposition victims of war / famine / natural disaster contrary to popular belief, natural disasters do not commonly lead to outbreaks of disease, and dead bodies as a source is very rare relatives take charge of removal of bodies ideally follow normal cultural & religious procedures e.g. burial / cremation white crosses may be provided to the communities psychological effects: mourning role of NGOs in emergency settings morgue in health structures body dressing: (cloth, coffin, blanket, sleeping mat, body bag) transport selection burial / cremation area big emergencies: burial (not common) victims of epidemics relatives preferably no contact with the dead body (high contamination risk) e.g. Ebola, Covid-19 maintain safe distance is essential if saying farewell to bodies agencies morgue in isolation centre disinfection team for bodies, health structure & living areas body dressing: (body bags, coffin) burial team providing know-how in choosing appropriate burial site burial vs. cremation burial is the preferred method from a public health perspective misconception that the infection may spread through the soil but this is very rare if burial is done correctly burial Environment Page 118 burial appropriate site chosen in collaboration with affected population and local authorities > 50 m away from potable (ground)water resources > 500 m away from habitable buildings (because of smell) 1500 m²/10,000 population (total population, not per 10,000 dead people) preferable: individual graves; if not possible - trenches potentially separate burial areas for different religions burial depth 1.0 m under surface (smell, discourage stray dogs from digging up) 1.5 m above water table cremation only on strict request - otherwise use burial 300 kg of firewood per body (gas is used in high-income countries) if there is insufficient firewood, partially cremated bodies may be thrown into rivers, etc. and pollute water source requires experienced personnel pollution by harmful dioxins risk of starting fires must be > 500m away from dwellings, and downwind Environment Page 119