COMMUNITY MEDICINE

Lecture: Introduction to Environmental Health

TRANSCRIBER/S: MAALA C., GROUP 3B EVALS 7

Objectives:

• Discuss the most important environmental

threats to health in low and middle-income
countries
• Define environment and environment
health
• Name and categorize by their level of
impact some examples of environmental
health issues, their determinant and
consequences
• Enumerate and define environmental
health hazards
• Briefly discuss the 5 principal
environmental exposure pathways (PEEPs)
• Present existing laws related to ● Death is more attributed to the environment
Environmental health than to infectious disease.

INTRODUCTION

● Family using firewood for cooking due to its

accessibility and availability
○ Disadvantage: exposure to smoke that
would lead to respiratory diseases,
deforestation, nutrient depletion in the
soil that would later affect the flora and
fauna and eventually biodiversity ● Cardiovascular diseases has the largest
● In a study done in 2012 (WHO, 2016): contribution from the environment
○ 12.6 M deaths globally (23% of all followed by diarrhea, lower respiratory
deaths) were ascribed to the infections and cancers.
environment
○ Among under 5 children, 26% of
deaths could have been prevented if
environmental risks were removed
○ These include: poor water quality,
availability and sanitation; vector-
borne diseases; poor ambient and
indoor air quality; toxic substances;
and global environmental change

1 of 7

AREA OF CONCERN IN ENVIRONMENTAL HEALTH
5.
● For children under 5 yrs. old, the number 1
disease that has the largest contribution from
the environment is lower respiratory
infection.
● Cause: exposure to smoke when using
firewood, smoker in the family, burning of
garbage
● Considering all the age group, the number 1
disease that has the largest contribution from
the environment is cardiovascular diseases.
● 8.4% of global burden disease in low to
middle income countries is the result of 3
environmental conditions:
○ Unsafe water, hygiene, excreta
disposal
○ Urban pollution
○ Indoor smoke
● Deaths in low and middle income countries by
rank and causes are:
○ 3rd- respiratory infection
○ 6th- COPD (chronic obstructive
pulmonary disease)
○ 7th- Diarrheal disease
● Approx. 30% of deaths in 0-14 years age
in low to middle income countries are due
to:
2nd – Lower Respiratory
○
Conditions
○ 3rd – Diarrheal Diseases
IN THE PHILIPPINES
1. Water, Sanitation and hygiene
2. Quality of the physical environment: control of
outdoor and indoor air pollution, waste
management, chemical safety, and noise
pollution control
3. Health in specific settings such as workplaces,
public places and housing
4. Emergency preparedness and response
Adaptation to climate change
ENVIRONMENTAL HEALTH
● Environment
○ Everything that is not genetic
○ Physical, chemical, biological agents
that directly affect health
● Set of public health efforts that are concerned
with preventing disease, death and disability
by reducing exposure to adverse
environmental conditions and promoting
behavior change
● Focuses o n the direct and indirect causes
of disease and injuries
● Taps resources inside and outside the
healthcare system to help improve health
outcomes
● Comprises aspects of human health,
including quality of life
○ Determined by physical, chemical,
biological, social and psychosocial
factors in the environment
● Refers to the theory and practice of
assessing, correcting, controlling and
preventing factors on the environment
that can potentially affect adversely the health
of the present and future generations. (WHO,
1993)
● The control of all those factors in man’s
physical environment which exercise, or may
exercise, a deleterious effect on his physical
development, health or survival. (WHO)
● Aspect of public health that is concerned with
the forms of life, substances, forces and
conditions in the surroundings of man that may
exert an influence on human health and well-
being
2 of 7
 ○ Glove boxes: where a
chemical is ventilated in an
enclosed space and the
employee works with the
gloves that are built in
(isolation in ICU)
○ Abrasive blasting cabinets:
sound reducing enclosure
for noisy equipment
○ Remote control devices
○ Negative pressure fume
hoods in laboratory
settings
■ To know the
direction of the
wind you can light
a candle.
● SUBSTITUTION
● Use of other material products,
activities, processes/operations,
methods, machines and other
equipment instead of hazardous
Figure 1. Typical Environmental Health Issues: ones
Determinants and Health consequences ● Modification
● Ways of being away
MAN-ENVIRONMENTAL RELATIONSHIPS from hazard
○ Reduce number of
The Environmental System
hours of exposure
● The status of human health represents the ○ Work rotation
result of complex interactions between the ● Examples of substitution
internal biological system & the total external
environmental system

● SHIELDING

o Setting up of physical barriers between the

Figure 2. Environmental system
• 5 basic principle of environmental control
o Isolation
o Places the hazardous process
“geographically” away from the
majority of the workers
● Aims to keep the chemical/agent
“in” and the worker “out” (or vice
versa)
● Examples:
source of the problem or hazard of man
o Equipment guarding will prevent workers
from contact with moving parts
○ Examples:
■ Table saw with cover
■ Conveyor belt with guard
■ Separating vehicle and
pedestrian traffic
■ Shield radioactive materials
• TREATMENT
o Involves measures to terminate the
existence of a hazard through destruction

3 of 7
 Examples:
○ ■ Studies of health impacts on
■ Water treatment facility in people (biological exposures,
factories epidemiological studies, and
■ Air pollution control device notifiable disease and registry
• PREVENTION data)
■ Demographic data (housing
o Eliminating effects of or exposure to a types, water supply, income
hazard and employment)
○ Examples:
■ Prophylaxis
■ Immunization 5 PRINCIPLE ENVIRONMENTAL EXPOSURE
PATHWAYS (PEEPS)

ENVIRONMENTAL HEALTH OUTCOMES AND 1. Urban Air Pollution Pathway (UrbAir)

EXPOSURE PATHWAYS
2. Urban Water Supply Pathway (CommunWater)
Human health conditions identified to be “related 3. Pathways where fertilizers and pesticides affect
to environmental pollution”:
● Diarrhea food, workers, health, and rural water supplies
● Bronchitis (Pest/Rural/Food)
● Asthma
● Malignant neoplasms: lung, liver, nasal, 4. Urban Solid Waste Pathway (UrbWaste)
bladder, leukemia, lymphoma 5. Rural “Point Source” Pathway (RurSource)
● Ischemic Heart Disease
● Hepatitis URBAN AIR POLLUTION PATHWAY (URBAIR)
● Pneumoconiosis, occupational cancer, chronic
• Cover communities where household, motor
chemical poisoning syndromes
vehicle and multiple industrial emission
● Typhoid/paratyphoid/salmonella & others
sources mix together in an urban air
● Dengue
• Affects:
● Cholera
o Transport workers
● Lead poisoning (acute and chronic)
o Children
● Other heavy metal and chemical poisoning
o General population
● Upper Respiratory Tract Conditions
● Skin rashes/ ear infections

Principal environmental exposure pathways -

(PEEPs)

● We must know the origin and the effect so that

we may know where to intervene. Also, we
need to know which agency (private or
government) which we will contact.
● Describe the origin of the environmental
pollution that affects humans or the source
● Steps in the environment transmission and
human exposure
● Characterization involves tracking down
information as it is applied to each PEEP and
collating what was available
○ Information includes:
■ Responsible agencies at each Figure 5. UrbAir Pathway (notes written below)
point in each pathway
■ Volume/type of industrial NOTES:
chemicals used and emissions/
effluents from point sources • Covers communities where household, motor
and diffuse sources vehicle and industrial emission sources mix
■ Ambient concentrations of key together in an urban air shed.
toxics in workroom, air, • Emission from vehicles on the road mix with
community air, drinking water, industrial sources (from factories) to pollute
food and soil the air
■ Estimates of the size of • 3 exposure scenarios:
exposed populations 1. Transport workers - exposed to
air pollution at the roadside level daily.
4 of 7
 2. Children - directly inhaling airborne
emissions and indirectly to soil
contaminated by deposition from the
air (passively ingest dust through hand
to mouth spread)
3. General population - inhale dust
particles coming from urban air,
smoking and poorly ventilated indoor
cooking and smoking; cause
respiratory diseases

• Chronic Obstructive Pulmonary Disease

(COPD)- more prevalent among jeepney
drivers than among commuters and air
conditioned bus drivers
• Airborne lead levels in Manila tend to be way
above levels on other cities in the world.
• There is an observable child IQ decline with
lead exposure.
Figure 6. Observable child IQ decline due to lead
exposure
• URBAN WATER SUPPLY PATHWAY
(COMMUNWATER)
o Types of water supply:
• Level I
o Open dug wells
o Developed springs
o Public wells
o Private wells with or without faucets
o Tubed/piped/improved dug wells
• Level II
o -Community public taps
• Level III
o Population is supplied with piped water
in their households
o Likely to be chlorinated
• Urban dwellers in the Philippines may get their
water from Level I, II, or III supply types.
• but all 3 could potentially be polluted with sewage
and/or industrial liquid waste.
Figure 7. CommunWater Pathway
NOTES:
• Industrial effluents and sewage can
contaminate all of the levels of water supply.
• Effluent - outflowing of water from a natural
body of water, or from a man-made structure.
• Metro Manila - highest degree of Level III
water supply.
• Access to sanitary toilets is also an important
protective factor against the spread of
waterborne diseases.
• Urban communities are better off than rural
communities.
• In the 1990s, 84% of urban households had
sanitary toilets compared to 52% of rural
households.
• Inadequate maintenance of existing sanitation
in Metro Manila reduces the preventive effect
of having sanitary toilets
• There is increased risk of diarrheal disease &
skin disease by using public or the neighbor’s
water supply, & living in a household without a
toilet
• Supplementary risk to these diseases is
associated with crowding.
PATHWAYS WHERE FERTILIZERS AND
PESTICIDES AFFECT FOOD, WORKERS, HEALTH,
AND RURAL WATER SUPPLIES
(PEST/RURAL/FOOD)

Figure 8. Pest/Rural/Food Pathway

5 of 7
NOTES:

• Begins with the importation of pesticides and

fertilizers and their formulations in the
Philippines.
• Formulators are directly exposed to chemical.
• On the farms and plantations, workers and
families are exposed due to pesticide
application
• Crops are affected through direct application
and through contamination of water in the
fields
• Waters may also be contaminated by sewage
• Fish in fish – rice operations are exposed by
waterborne route due to adjacent waterways
• Fish and crops are brought to the market place NOTES:
where handling, cleaning, storage and cooking
● Solid wastes are generated from
will make the difference in their hygienic
households, institutions and industries
quality.
● Non-collection would mean that those living
• Contamination of water by fertilizers, around are in direct contact with the potential
pesticides & sewage may also affect the hazards
drinking water of those living within & around ○ Open dumpsites have potential
farms impacts on air & water quality
• Unsafe practices in the use of Pesticides: (illustrated by the Smokey Mountain
• Few farmers wear full protective clothing when site)
they spray and spray against the wind ● In areas where garbage is collected, the
• Unsafe storage ractices and disposal of garbage collector is exposed as well as
pesticide bottles the scavengers and their families.
• Lack of knowledge in the recognition and ● Leakage from the solid waste may contaminate
understanding of hazard rankings of pesticides the groundwater
• There are pesticide users who reported ○ Contains nitrates and coliforms
symptoms related to pesticide poisoning ■ Public health significance
affecting the eye, skin, respiratory, nerves among those who use the
and gastrointestinal tract water for drinking, cleaning or
recreational purposes
URBAN SOLID WASTE PATHWAY (URBWASTE)

• Solid Wastes - wastes that should not be

poured into a sewer or waterway Include the
residential, institutional, and industrial wastes
that are either collected and disposed of in an
organized system, or strewn about squatter
communities, roadsides, or vacant lot

6 of 7
RURAL “POINT SOURCE” PATHWAY
(RURSOURCE)

Rural "Point Source" Pathway

NOTES:

● In rural areas of the Philippines,

○ Mines, discrete industrial point sources,
or small groups of industrial
establishments are significant sources
of contamination of air, recreational or
drinking water and soil
● Children in the industrial areas had higher
rates of cough with phlegm and bronchitis
(Torres and Subida, 1992)
○ Type of fuel for cooking - most
important factor of all
○ Children in households using
firewood or coal - more than 16x
higher risk of below normal pulmonary
function than households using
alternative fuel

--END—
“Give yourself a chance and believe that you can
achieve all that you desire.” – Liane White

REFERENCES:
● Recordings
● Lecture notes
● PPT

7 of 7