Global Environmental Challenges in Our Region PDF

Global environmental challenges in our region Dr Heena Akbar School of Public Health 5th August 2024 Acknowledgement of Country The University of Queensland (UQ) acknowledges the Traditional Owners and their custodianship of the lands on which we meet. We pay our respects to their Ancesto...

Global environmental challenges in our region Dr Heena Akbar School of Public Health 5th August 2024 Acknowledgement of Country The University of Queensland (UQ) acknowledges the Traditional Owners and their custodianship of the lands on which we meet. We pay our respects to their Ancestors and their descendants, who continue cultural and spiritual connections to Country. We recognise their valuable contributions to Australian and global society. The Brisbane River pattern from A Guidance Through Time by Casey Coolwell and Kyra Mancktelow. 2 CRICOS code 00025B Commitment to Diversity and Inclusion Diverse perspectives, abilities, experiences and backgrounds inspire creativity, encourage innovation and enrich our communities. Members of our broad community are valued and respected for their individuality. UQ strives to create a culturally safe, welcoming and inclusive workplace, with strong community connections and partnerships. 3 Learning outcomes At the end of the session, students should be able to Apply understanding of environmental exposures and the socio-economic determinants of health. Explain the environmental exposures such as air pollution, climate change, urbanisation that impact on health Describe the global environmental challenges in Australia and the region Understand the national and international efforts to address these challenges. Identify the role of medical practitioners in addressing these challenges 4 Environmental Determinants of Health WHO definition “exposure to pollution and chemicals (e.g., air, water, soil, products), physical exposures (e.g, noise, radiation), the built environment, other anthropogenic changes ( e.g, climate change, vector breeding places), related behaviours and the work environment”1 1.Prüss-Ustün A, Wolf J, Corvalán C, Neville T, Bos R, Neira M. Diseases due to unhealthy environments: an updated estimate of the global burden of disease attributable to environmental determinants of health. J Public Health (Bangkok) [Internet]. 2016. p. 1–12. 5  Active Learning One word that describes environmental determinants on health, disease and clinical care! https://apps.elearning.uq.edu.au/wordstream/39227 6 7 Type of Environmental Determinants Built environment and health - human-made surroundings where people live, work and recreate. It includes buildings and parks as well as supporting infrastructure such as transport, water and energy networks Natural environment and health - comprises the atmosphere, land, water, oceans, and the diversity of living things providing essential resources* for health and wellbeing (AIHW) 8 https://www.aihw.gov.au/reports/australias-health/built-environment-and-health 9 Impacts of environmental factors on health Examples of the environment factors leading to chronic diseases 1. Air pollution (road, industrial) or dampness or mould exposure leading to respiratory diseases and infections increased asthmatic episodes 2. Noise 3. Environmental toxins 4. High UV exposure leading to higher rates of skin cancer 5. Urban planning or design of the environment such as street connectivity, land use patterns, green space, residential density can encourages physical activity and active forms of transport – can result in inverse relationship with obesity 10 Environmental risk factors Health outcomes linked to risk factors as determined from a review of evidence of previous GBD studies. https://link-springer- com.ezproxy.library.uq.edu.au/chapter/10.1007/978-3-319-71812- 5_37 11 Definition of global health Area for study, research, and practice that places priority on improving health, achieving equity in health for all people worldwide. Emphasises transnational health issues, determinants, and solutions; Involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; Synthesis of population-based prevention with individual-level clinical care. Koplan etal, Towards a common definition of global health. Lancet. 2009 12 Elements of global health Health as a human right Interdisciplinarity The right to the highest attainable standard of health (article 12 ICESCR) Mews et al.2018 Global perspective Globalisation “Globalisation, or the increased interconnectedness and interdependence of peoples and countries, is generally understood to include two interrelated elements: the opening of international borders to increasingly fast flows of goods, services, finance, people and ideas; and the changes in institutions and policies at national and international levels that facilitate or promote such flows. Globalization has the potential for both positive and negative effects on development and health” Source - WHO Impact on health Communicable diseases NCDs Health risk factors Trade agreements – access to medicine, food , harmful substances Health and human rights Environmental health Health in war and conflict Health care resources Access to health Current global health challenges Elevating Health in Climate Debate Delivering health in conflict and crisis Making health care fairer Expanding access to medicines Stopping infectious diseases Protecting people from unsafe products Investing in people who defend our health Keeping adolescents safe Protecting people from dangerous substances Earning public trust Harnessing new technologies Protecting the medicines that protect us Keeping healthcare clean (water &sanitation) WHO , Urgent global challenges of the decade 16 Global burden of risk factors Disability-adjusted life years (DALYs) GBD 2019, Lancet 18 Lancet commission of 21st century global health threats 1. COVID-19 Pandemic 2. Climate Change 3. Nuclear Confrontation (Conflict) 4. Rising Antimicrobial Resistance 5. Increasing Obesity 6. Inverted Population Pyramids: 7. Eroding Sexual and Reproductive Rights 8. Food Insecurity 9. Fraying Multilateralism 19 Some global environmental health issues for today’s discussion: Australian Context Air pollution Hazardous wastes in the environment Climate change Environmental disasters Emerging infections Food security Water and sanitation 20 Air Pollution - Air quality and health Air pollution is caused by chemical, physical or biological agents such as those from: household combustion devices motor vehicles industrial facilities bushfire smoke. Can result in allergies and asthma lung and respiratory diseases heart disease some types of cancer. Children, older people, and people with existing conditions are at particular risk. 21 Air Pollution - Particulate matter The GBD Study has shown that outdoor PM2.5 is the most important environmental risk factor in Australia, responsible for 1.6 percent of the total burden of disease in 2017. Health effects because of exposure to PM2.5 depends on: the concentration of PM2.5 in air, the duration of exposure; the person’s age whether a person has existing medical conditions (particularly cardiorespiratory disease or asthma) 22 Air Pollution - Bushfire smoke and particulates Bushfires are becoming more frequent and intense due to climate change. Bushfire smoke and the particulates it contains can cause: lung and respiratory effects cardiovascular effects effects on maternal health and pregnancy carcinogenic effects. The 2 types of particles that affect our health: those that contribute to smoke haze and can irritate eyes, throat and lungs, but are too large to enter the bloodstream those that are too small to see, but when inhaled can enter the lungs and bloodstream (physically distressing process). 23 Air- pollution - Bush fires and health consequence PM2.5 from bushfires is associated with respiratory effects including  exacerbations of asthma  emergency department attendances  hospital admissions  Implications for resources – planning Short-term exposure to PM2.5 is associated with increased respiratory mortality. Occupational exposure to smoke as a firefighter is classified as a possible (Class 2B) carcinogen by the International Agency for Research on Cancer (IARC). Firefighters are regularly exposed to bushfire smoke (seasonally and over their working career). Long term effects – inconclusive 24 Air Pollution - Air quality in Australia Australia has good air quality, but events (like bushfires) and industries can cause temporary or localized reductions in air quality. Bushfires of 2019-20 (NSW) summer – major event The ambient air quality standards of the National Environmental Protection Measures (NEPMs) are set for the protection of human health Air pollutants (current trends that are monitored in Australia) - Fine particulate matter (PM2.5) Current levels are above NEPM standards, predicted set to decrease by 2025 (stricter policies and showing efforts to reduce). - Peak ozone levels are increasing (even though they lie below NEPM) but - Industrial emissions are well controlled (policies – well controlled) - Dust in rural and remote areas - Wood heater smoke –in winter 25 Australia’ air quality monitoring The Department of Climate Change, Energy, the Environment and Water is the main agency responsible for providing national guidance for maintaining our air quality. It delivers Australia’s National Clean Air Agreement, which includes: monitoring ozone layer depletion regulating the use of greenhouse gases 26 Australia’ air quality monitoring The Department of Climate Change, Energy, the Environment and Water, coordinates with states and territories, administers air quality legislation, supports research, and provides policy advice. Australia's air quality is managed collaboratively across all levels of government: Australian Government: Leads national efforts to improve air quality, sets standards, and regulates polluting products. Oversees the National Clean Air Agreement and supports research and policy advice. States and Territories: Handle air quality within their regions, including managing industrial pollution and adhering to national air quality standards. Local Governments: Address local pollution issues such as wood heater smoke and promote awareness about household activities affecting air quality. 27 Key Frameworks and Measures for air quality monitoring National Clean Air Agreement: Guides actions and prioritizes air quality improvements. National Environment Protection (Ambient Air Quality) Measure: Framework for measuring and monitoring outdoor air quality. National Environment Protection (National Pollutant Inventory) Measure: Provides information on emissions. Other Agencies (multisectoral approach): Department of Infrastructure, Transport, Regional Development, Communications and the Arts: Manages vehicle emissions and shipping obligations. National Environment Protection Council: Oversees national environment protection measures, including air quality standards. 28 Environmental toxins Environmental toxins (exposures) and contaminants are physical, chemical and biological pollutants and organisms that can cause: cancer cardiovascular issues endocrine issues respiratory disease. Common contaminants poisonous chemicals and chemical compounds, like pesticides physical materials, like asbestos organisms, like mould and blue-green algae. The Department of Climate Change, Energy, the Environment and Water monitors hazardous waste Maintains the National Pollutant Inventory Informs the community, industry, and government about substance emissions in Australia. 29  Climate Change in Australia Climate change and extreme events | Australia state of the environment 2021 (dcceew.gov.au) https://www.bmj.com/content/351/bmj.h6316/infographic 31  32 https://www.bmj.com/content/351/bmj.h6316/infographic 33 36 37 38 41 42 Australia’s response to climate change This will be discussed in detail in the Master class on Health Care response to climate change 43 Disasters and emergencies With the frequency and magnitude of disasters intensifying, in part due to the impact of climate change, disasters such as bushfires, floods and cyclones are an increasingly major public health problem for Australia Australia’s emergency management arrangements are established through partnerships between the Australian, state and local governments – coordinated efforts Emergency Management Australia (EMA) is a division of the Australian Department of Home Affairs and delivers programs, policies and services that strengthen Australia's national security and emergency management capability. EMA is also home to the Australian Government Crisis Coordination Centre 44 Disaster or emergency 45 Disaster management Disaster and emergency management is comprised of four phases or stages: prevention, preparedness, response and recovery (PPRR). i. Prevention: to eliminate or reduce the level of the risk or severity of emergencies. ii. Preparedness: to build the capacity of communities to cope with the consequences of emergencies. iii. Response: to ensure the immediate consequences of emergencies for communities are minimised iv. Recovery: to support individuals and communities affected by emergencies in reconstructing physical infrastructure and restoring physical, emotional, environmental and economic wellbeing. The PPRR model aims to provide a comprehensive approach towards emergency planning by assessing the risks posed by each disaster management stage and selecting risk reduction measures for each. 46 SaWFISH framework for disaster response Safety Safety of communities – public health advice to be considered in broader context of risk Water and sanitation Ensure that an adequate supply of water is available that meets minimum standards. Ability to safely dispose of human waste, dead stock and animals and ensure that critical community infrastructure poses minimal risk to public health Food safety Providing advice and ensuring minimum standards are met for food quality and security Insects Vector control and management Shelter Minimum accommodation standards for affected people Hygiene promotion and disease Appropriate public health messaging (e.g COVID) control Surveillance, notification ongoing - communicable diseases 47 Emerging infections and outbreaks, urbanisation and infectious diseases Interactions between urbanization and infectious disease are complex, with increased urbanization driving both positive and negative changes to global disease burden. 48 Nature Reviews Microbiology (Nat Rev Microbiol) ISSN 1740-1534 (online) ISSN 1740-1526 (print) Climate change and infections Rapid urbanisation Changing land use patterns Deforestation Loss of natural habitats (in areas more infection with humans) Increased human –animal contact (real threat for future pandermics) Baker, R.E., Mahmud, A.S., Miller, I.F. et al. Infectious disease in an era of global change. Nat Rev Microbiol 20, 193–205 49 (2022). https://doi.org/10.1038/s41579-021-00639-z Emerging zoonotic outbreaks Since the beginning of the 21st century alone-several emerging zoonotic outbreaks including Severe acute respiratory syndrome (SARS)-associated coronavirus (2003), Ebola virus disease (2005 and again in 2017), Influenza - H1N1 flu (2009) Zika virus (2015) Middle East respiratory syndrome coronavirus (2015) COVID-19 (2019) Health of animals, humans and the environment are closely interlinked. Anthropogenic (related to human action e.g climate change or global worming) stressors to the environment enhance and exacerbate diseases that animals mediate to humans. 50 Food security and environment – The 3 Cs and 5Fs BMJ 2022;378:e071534 51 Access to clean water in the Western Pacific Region Access to safe water - crucial for reducing the disease burden attributable to unsafe water, sanitation, and hygiene (WASH). Each year, 525, 000 children aged 5 years and younger die due to diarrhoea In 2018, almost 90 million people in the region did not have access to safe drinking water amenities, and more than 400 million did not have basic sanitation amenities. Inadequate access to WASH (Water, Sanitation and Hygiene)- common in the Pacific Islands. During 2010–20, while access to basic drinking water improved in most Asia–Pacific countries and territories, the Solomon Islands reported the greatest decrease of nearly 10%. Rural areas in the Marshall Islands, the Solomon Islands, and Vanuatu had substantially fewer households with basic water and soap amenities compared with urban areas, hampering public health interventions for COVID-19 and further contributing to socioeconomic inequalities in these Pacific Islands countries. Similar examples in Aboriginal Communities – highlighting disparities in determinants of health and health inequity 52 Global Programmes Water Safety Plans (WSPs) Are You Water Resilient Programme: Spearheaded by the Asian Development Bank Water Sector Group to enhance water security and resilience in Asia and the Pacific. Water Security and Sanitation Project: A collaboration between the World Bank, Australian Department of Foreign Affairs and Trade, and the Global Water Security and Sanitation Partnership. Solomon Islands Urban Water Supply and Sanitation Sector Project: Focuses on upgrading water production, treatment systems, and sewerage. 53 Global efforts to address environmental health issues Climate change One Health Planetary Health SDGs 54 Global efforts on climate change International Agreements- The Paris Agreement, which sets targets for reducing greenhouse gas emissions and limiting global temperature rise. United Nations Framework Convention on Climate Change (UNFCCC)- Coordinates international efforts and negotiations on climate change (Global) National Climate Action Plans- National Climate Act, National Climate Resilience and Adaptation Strategy 2021-2025 (Country Specific, including Australia) Research and Innovation- reduce emissions and enhance resilience. Sustainable health system focus Public Awareness and Education Global Cooperation 55  One Health - integrated, unifying approach One Health Approach aims to sustainably balance and optimize the health of people, animals and ecosystems. Recognizes health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent. More crucial due to human population growth, travel, habitat destruction, and climate change. Zoonoses- 60% of emerging diseases are zoonotic; 75% of new pathogens come from animals. The benefits of one health include – - Early detection of zoonoses - improved food safety - positive impacts on biodiversity and the economy. 56 SDGs and environment SDG 6: Clean Water and Sanitation SDG 7: Affordable and Clean Energy SDG 11: Sustainable Cities and Communities SDG 12: Responsible Consumption and Production SDG 13: Climate Action SDG 14: Life Below Water SDG 15: Life on Land 57 Planetary Health 58  Thank you Dr Heena Akbar [email protected] CRICOS code 00025B 59