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Environment, Sanitation, and Health

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 ENVIRONMENT, SANITATION AND HEALTH

S.N. Uchegbu
Department of Urban and Regional Planning
University of Nigeria, Enugu Campus,
Enugu, Nigeria
Abstract
Man's activities on the environment has tended to degrade and make the environment untidy and
unfit for human habitation because of its poor sanitation nature. Public health can be seen as a
s-fate of well-being due to the influences and impacts of the physical environment and sanitation
on man or indeed on a community. This paper presents a perspective discussion on environment,
sanitation and public health.
Key Words: Environment, Pollution, Sanitation, Public Health.

1. Introduction
The term environment means different things from different perspectives. Darling
V.F. (1971) views the environment in terms of ecology and defines it as the science of the
organism in relation to other organisms of different species, and to those of its own kind. The
Oxford Advanced Learners English Dictionary defines the environment as conditions,
circumstances etc. affecting people lives. Haggett (1975) on his part defines the environment
as the sum total of all conditions that surround man at any point in time on the earth's surface.
On his part, Canter (1977) categorised the environment into air environment, water
environment, noise environment, biological environment, cultural environment, and
socio-economic environment. The last definition is all embracing. However, all the
definitions are important in their own angles for the environmentalist, the environment is
normally viewed in the physical sense which Holderness and Lambert (1982) said is made up
of air, water and land. Therefore, environment refers to the natural environment in which
man, animals and plants live and interact and it includes basically the land, water and air. It is
upon this natural surrounding that all creatures depend for their existence and sustenance. Put
more succinctly, this physical environment can be taken to be all the natural creations of God
such as the laud bodies, waterbodies, vegetation etc. which harbour a variety of living and
non-living things. The interesting thing to observe is that the living components of creation
are found in all facets of the physical environment. Under a normal condition, the living
things interact symbolically among themselves and with lite physical environment. The great
philosopher Louis Pastur had noted that before man came to (he scene, the physical
environment was as pure as the spring water.
However, man's activities on the environment has tended to degrade and make the
environment untidy and unlit for human habitation because of its poor sanitation nature.
Sanitation can be said to be the state of cleanliness. It is a broad concept and connotes the
process of keeping something clean. According to Kpatrick (1980), sanitation is the
arrangement for protecting the health, especially the removal of the human, industrial and
domestic wastes. Sanitation is also a process embarked upon to keep the total of man's
environment hazard free.
Generally speaking, sanitation is geared towards the protection and promotion of
public health which meant the improvement of the environment.
Thus the three concepts of environment, sanitation and public health are inter-related
because each one of them affects the other.
Health has been defined by the Oxford Dictionary as the condition of the body or
mind. The World Health Organisation (WHO) which is an authority on health matters defines
health as a state of complete physical, mental and social well-being, and not merely the absence
of disease or infirmity. WHO's definition emphasises sound mind in a sound body all things
being equal and this positive definition has led modern general practice approach in which health
comes to be connoted in the physical, psychological and social terms. Thus health can be seen as
a state of well-being due to the influences and impacts of the physical environment and sanitation
on man. Good health is thus part of the overall development of a community.
The issue of public health is a concern to the citizen and everybody or organisation,
Professor Winslow related the issue of public health to sanitation. According to him, "It is the
science and art of preventing diseases, prolonging life, promoting physical and mental health and
efficiency through organised community efforts through the sanitation of the environment, the
control of community infection... all of which will ensure a standard of living for every
individual in the community, adequate for the maintenance of health".
The Webster New International Dictionary defines public health as a science and art that
deals with the protection and improvement of community health by organised community effort
and including preventive medicine, sanitary and social services.
Accordingly, public health is an effort organised by society to protect, promote and
restore the peoples health and is the combination of sciences, skill and beliefs that are directed to
the maintenance and improvement of health through collective and social action. It emphasises
the prevention of diseases and this can be achieved through proper sanitation. Sanitation whether
in the urban or rural area protects or enhances the environment and by extension the health of the
citizens. Sanitation is thus that aspect of our environment which may affect the health of the
citizen.

2. Housing Environment, Water Quality and Health

Housing environment no doubt affects sanitation, and hence the health of the people. Good
housing environment starts with good housing design. Efobi (1992) has summarized good
housing environment to include:
- provision of facilities for entrance and exit of the housing area,
- guaranteeing easy circulation of traffic and good relationship between the dwelling units,
community facilities and services
- Ensuring safety of the dwelling units from natural danger, heat, rain, cold, wind etc.
- provision of facilities and amenities for comfortable living.
When the above features are taken into account in the design of the housing environment
then a lot is achieved in the sustenance and enhancement of sanitation and therefore good public
health. Okoye (1977) found that poor housing environment leads to the springing up of some
diseases such as Cholera, Gastroenteritis, Tuberculosis, Polio etc. He noted that about 58% of the
housing environment in Lagos is poor and result to (he outbreak of diseases and hence death. A
comparative analysis for example on the source of drinking water to dwelling units in Lagos,
Ibadan, Benin and Enugu is represented in table 1.1 below.

Table 1.1 Comparative analysis of Source of Drinking Water

Water Supply Lagos % Ibadan % Benin % Enugu %
of total of total of total of total
Pipe borne water connected to buildings 10.5 6.3 12.9 13.0
Public taps 14.5 65.8 55.5 18.9
Wells 55.3 6.0 21.6 13.0
Rivers/Streams 4.0 15.9 5.0 42.1
Others 15.7 6.0 5.0 13.0
Source: NISER Field Surrey 1982
Inadequate water supply is a source of poor sanitation and hence ill health. Water is needed
for many purposes. But the water if it should be good should be free from germs, and
pollution. The table above shows that the percentage of buildings with pipe borne water is
low about 10.7% on the average. While Ibadan and Benin can boast of better public tap
provision 65.8% and 55.5% respectively, Lagos and Enugu are worse off with 14.5% and
18.9% respectively. However the issue of wells is predominant in Lagos with 55.3%, while
fetching water in. streams, rivers thrive in Enugu with 42.1 %. All iii all, places which get
their water supply from streams/rivers, seem to be at higher risk of having water borne
diseases. By and large, the table also shows that the provision of water supply hi quantity and
quality is still a problem hi Nigeria with its adverse effects on sanitation and health. For water
to be considered fit for domestic use, it must be clear, tasteless, odourless, colourless and
sedimentless, Eguabor (1998).
Water supply requires good sanitation to make it fit for human drinking. Thus the
environment in which the natural water is located should be in a clean state devoid of
pollution of any sort. In the same way, artificial water supplies should be protected from
pollution and filthiness.
Generally, both the natural water supplies and the artificial water supplies should be
treated adequately to an acceptable worldwide standard before drinking if illhealth
emanating from water sources should be avoided. It is on record that for instance, in a study
of diarrhoea diseases in 1990, Idi-Araba, Ogunlade and Abidoye found out that only 2.6% of
children with diarrhoea diseases are from home with pipe borne water. The remaining 97.4%
obtained their water supply from well as water vendors, leaving a strong association between
diseases and sources of water supply. The above is an indication of the enormous
contribution of impure water to illhealth.
In a related study in Enugu Metropolis, it was found that the combined factors of
occupancy rate, water supply sanitary/environmental condition contribute significantly to the
health of her citizens. Two low density areas and too high density areas in the Metropolis
were compared and it was found that those factors (above) are inadequate in the high density
neighbourhoods and accounted for high incidence of illhealth (49.4%) average, while in the
low density neighbourhoods, these factors arc moderately present and the incidence of
illhealth is low (20.2%) average. The table 1.2 below summaries the finding.

Table 1.2 Public Health Factors in Enugu

Neighbourhood (Enugu ) Occupancy Domestic Sanitation Illhealth

Rate Water Supply Condition
Independence Layout 1.89 30.19 0.00 10.79
GRA 10.45 29.85 20.90 29.67
Asata/Ogui New Layout 43.45 79.17 27.08 49.83
Coal Camp 81.58 89.58 39.47 48.92,
Source: Duru (1999)

In the final analysis, it is clear from the table above that health condition has high correlation
with sanitary/environmental condition, occupancy rate. and domestic water supplies in both
neighbourhoods.
The major diseases in the environment in Enugu Metropolis which are occasioned by
poor sanitation in the high, medium and low residential neighbourhoods was investigated to
sharpen the strength of the problem. Table 1.3 represents the information (in terms of cases
observed).

Table 1.3 Poor Sanitation and Disease in Enugu

Disease High Density Medium Low
Malaria 243 88 02
Typhoid 53 5 11
Gastro-entritis 30 5 5
Cholera 17 5 4
Hookworm 11 4 4
Source: Duru (1999)

All in all, disease are higher in high density areas due to mainly poor environment and
sanitation.

3. The Role of Waste Management

Poor waste management is an important contributor to environmental degradation and
hence to the prevalence of diseases. Environmental degradation is the alteration of the
environment in a manner as to constitute danger to the safely, aesthetics, convenience and
amenity. Hence, poor waste management is manifested in poor waste collection, disposal and
treatment and end result of these lapses show in pollution of all soils - land pollution, air pollution
and water pollution. Households generate an enormous quantity of waste daily ranging from
effluents, solid wastes to sewage. The same is true of commercial and industrial activities where
an appreciable quantity of wastes are generated. As a result of poor waste collection in Nigerian
cities probably due to shortage of personnel, equipment and poor financing, wastes find their way
on the ground and water bodies causing pollution. Most deaths occur through the cumulative
effects of air pollution. Continuous inhaling of toxic/acidic gases in the air by humans later
culminate in respiratory disorders, eye problems, cancer etc. The same is true of water pollution,
which apart from killing or polluting aquatic animals also cause respiratory diseases, poisoning
etc. Some of the disease which emanate from this kind of unclean environment include among
others malaria, skin disease, diarrhoea, bronchitis, asthma, typhoid etc.

4. Eating Place Environment and Health

I have observed that most eating places such as hotels, bukas, restaurants and even mobile
food sellers are sources of diseases. Most of these cookings, especially the open air cooking
(bukas) are done in filthy environment. This places and its likes are sure sources for the
generation and transmission of diseases such as faecal oral infection manifested in worms,
typhoid, hepatitis and diarrhoea, for the road side eating places, the sources of the raw food
cooked and the water served which mostly come from dug wells, broken pipes, streams,
constitute serious health hazards. Certain authorities have asserted that poor environment,
sanitation, poverty and malnutrition are contributory factors to illheallh. Part of the issue-is that
despite the problems associated with these eating places, (heir establishment have been on the
increase. An appreciable number of high ranking Nigerians patronize the food which the open
kitchens display under conditions exposing the items to germs. flies, dust, and automobile fume.
Such foods are equally hawked in unclean environments such as streets, under the bridges, near
or at waste sump depots, infact on every available space no matter the sanitary condition of such
places

5. Oil Industry and Pollution

The environment is usually put to unnecessary jeopardy through the activities of oil
industries manifested in oil prospecting, drilling, refinery, transportation etc. All these cause land
degradation and pollution of all soils Sanitation is no more guaranteed in those oil areas. In
addition, the issue of gas flaring pollutes both the land, water and air. The effects are expected -
killing of aquatic animals, fauna, vegetation and man. The constituents of the air pollutants are
toxic and even hazardous, the ailments associated with this kind of air pollutant include cancer,
respiratory and cardio - pulmonary ailments, asthma bronchitis etc.

6. Other Environmental Factors

There are other environmental problems which affect health of man. This is with
reference to the workplaces of people and the environmental condition they are exposed to.
Among the hazards are dangerous concentration of toxic chemicals and dusts, inadequate
lighting, ventilation problems, space problems, inadequate protection of workers from
machinery, noise pollution (Oguariri R. 1998). A study of about 111 workers working in
petrochemical factories brings out clearer the problem. The study showed that the most
common complaints were excessive sweating 68.5%; headache 67.5%; excessive salivation
67.5%; respiratory symptoms 48% and dermatosis 3.65%. The work environment of such
factories are unconducive, psychological stress, fatigue and illhealth common among the
workers.

6.1 Global Environmental Problems and the Effects.

There is no clear distinction or demarcation between an environmental problem in
one country and others. The world is now a global village (Clinton 1998). What constitutes
an environmental problem in one country will naturally affect the other countries. The
following are the major global environmental problems: global warming, ozone layer
depletion, land degradation, bio-diversity, deforestation and desertification.

i. Global Warming: This is the continued buildup of green house gases in the atmosphere.
The gases include, carbon dioxide, methane, nitrox oxide, chlorofluorocarbons (CFCs)
etc. These global warmings led to the rise in sea level leading to soil erosion, flooding
and drought.

ii. Land Degradation: Land degradation is one of the worst environmental problems lacing
many people worldwide. This has led to food shortages and health problems in Nigeria.
Some of the causes of this land degradation are over grazing, flooding, strip mining,
destruction of wetlands and improper resources management.
iii. Bio Diversity: Bio diversity is simply a variety of life and its processes. This includes all
forms such as fungi, bacteria etc. Recently, we have loss of these biodiversity as a result
of destruction of habitats as land is cleared for agricultural and development purposes.
iv. Ozone Layer Depletion: The ozone layer absorbs harmful ultra-violet radiation
emanating from the sun. It therefore shields plants, and animal life from all ultraviolet
rays which in high doses can be damaging to natural lives. Recently the ozone layer has
 been depleted by the release of high level of compounds such as chlorine and bromide.
These compounds result mainly from emission of CTC's used as coolant in refrigerators
and the air conditioners, aerosol propellants and foaming and cleaning agents and halons
used in lire extinguishing.

Effects: As a result of the thinning of the ozone layer, the ultra violet rays now initiate a
number of chemical and biological processes which can damage living organisms. For
humans, can cause skin cancer, eye cataract, sunburn, snow blindness, skin ageing and the
depression of immune system

6.2 Major Ozone Layer Depleting Substances mid Alternatives

CFC's found in air conditioning units and refrigerators, halons mostly used as fire
extinguishing agents, HCFC's (Hydio-Chloro fluorocarbons) which are less toxic are used in
refrigerators and aerosol sprays, melthybromide mostly used for agricultural, soil fumigation
31% of total emission, biomass burning 22% . gasoline additives 7%, fumigation of buildings
and containers 3%, industry 2% and ocean release 35%.
Other sources of ozone layer depletion include volcanic eruption, increase concentration
of green house gases, emission of nitrogen oxides, water vapour, sulphur dioxide, air craft
exhaust etc. fable 1.4 shows global annual production of CFC's. HCFC's and HFC between
1980 and 1995.

Table 1.4 Annual Production of Greenhouse gasses (1980,- 1995)

Year CFC. CFC. CFC CFC HCF HCFC HCFC HFC 134a
11 12 113 114 115 C.22 I42b 141b
1000
tonnes
1980 289.6 350.2 103.7 15.0 9.3 126.3
1981 286.9 351.3 108.5 14.0 10.0 130.8 2.6
1982 271.4 328.0 113.0 13.6 10.4 123.6 1.9
1983 291.7 355.3 132.7 14.8 11.6 143.9 2.2
1984 312.4 382.1 171.1 15.6 11.2 152.4 2.4
1985 326.8 376.3 187.0 17.1 10.0 153.4 1.4
1986 350.1 398.4 196.6 19.1 11.8 165.0 7.1
1987 382.1 424.7 225.8. 17.1 12.8 173.3 6.9
1988 376.0 421.0 247.4 16.5 13.6 203.5 7.8
1989 302.5 379.8 251.3 15.0 14.2 219.5 10.3
1990 232.9 231.0 174.8 8.3 11.3 213.7 18.8 0.1 0.2
1991 213.5 224.8 147.6 6.7 1.2.3 236.8 27.2 1.5 2.2
1992 186.4 216.2 107.5 4.7 10.7 245.7 30.7 13.3 6.4
1993 147.1 214.7 48.0 4.6 11.4 240.6 33.7 43.3 26.5
1994 60.2 133.6 29.5 3.2 6.8 239.4 28.4 81.2 50.4
1995 32.7 82.8 23.3 3.1 3.7 243.5 38.7 113.2 73.8
Source: AFEAS, 1997

Furthermore, the Montreal protocol, a conference on how to save our ozone

layer us shown in on saving the ozone layer developed a programme table 1.5
Table 1.5 Phase-out dates for developed countries for ozone-depleting substances
Substance Year Montreal Protocal
Halon 1994 100% phase-out (of production)
CFCs, 1996 100% phase-out (phase-out of CFCs and CCl4 by 1995 in EU)
CCI4CH3CCI3
HBFCs 1996 100% phase-out
HCFCs 1996 freeze on calculated consumption at 2.8% of CFC consumption in 1989 plus
total HCFC consumption in 1989 (calculated at 2.6% of CFC consumption
in EU)
CH3Br 1995 freeze on production and consumption at 1991 levels
1999 25% reduction from the above (25% reduction within 1998 in the EU)
200 50% reduction
2005 phase-out with possible exemption for critical agricultural uses
Note: the phase-out schedule for methyle bromide has been updated with the last agreements reached in
Montreal in 1997.
Source: SORG, 1996
The conference called on developing countries to use CFC's until 2010. The developing countries
have to freeze their consumption of HCFs in 2016.
From the table (Table 1.4) we can see that the annual production of CFC's is decreasing
while that of HCFC's is increasing indicating that HCFC's are better alternative to CFC's.
The foam blowing sector will now be made using water, carbondioxide and
hydro-carbons. The refrigeration and air condition will now largely depend on HCFC's.
Companies and organisations that manufacture lire fighter equipment will now rely on
other agents such as carbondioxide, water, foam and dry powder. However, emphasis should be
placed on prevention practices by use of lire resistant materials and the appropriate designs for
buildings which will reduce significantly the need for halon systems.
In Nigeria, the anxiety of these global problems especially the ozone layer depletion has
centered on the impact of inadequate rainfall which militates against water availability and
quality, agriculture, fisheries, energy, tourism, transportation and human health and safety.
Most of these ODS substances are generated and used by the developed countries. The
developing countries consume less than 0.3kg per capital. Nigeria which had an ODS
consumption per capita of 0.01 kg in 1995 is qualified to draw from super fund set up by the
world body for programmes on ODS.
The multi-lateral Fund that came up as a result of the Protocol Conference has its
secretariat in Montreal and is directed by an executive committee. The Fund is implemented
through the following agencies and each participating country has the right to draw from the
fund. The agencies are UNFP, UNDP, and the World Bank. Organisations and bodies that use
ODS substances can equally draw from the Fund.
The phase out of methyl bromide is a more difficult issue because alternatives are less
available. The major use is in agriculture mainly for fumigation to control pests and weeds.
Furthermore, the following can serve us locally: planting grasses that are known to
prevent mosquitoes within our homes, planting trees that are known to supply oxygen and absorb
carbondioxide thereby cooling our homes, mixing detergent with water which are known to be
used to light lire etc.

7. Recommendation
This paper has demonstrated the relationship between the environment, sanitation and
health.
 However, I will not end the discussion without making some recommendations. On the
remedies to the problem of environment, sanitation and health. Oguariri (1998 pp 152 - 153)
suggested "the improvement of the housing and living environment of the poor majority of the
citizens by proper waste management" He summarized his solutions as follows:
i. provision of safe drinking water for the low income groups
ii. construction of drains to take away waste water
iii. construction of sewers to take away excreta
iv. regular collection of garbage
v. water quality to be regulated
vi. provision of health care services.
What is clear is that proper waste management should be seen as a planned system of
effectively controlling the production, storage, collection, transportation processing and disposal
or utilisation of waste in a sanitary, aesthetically acceptable and economical manner. The
problem in this case is not theoretical explanation/proposition but practical application, if the
environment is to be saved, sanitation maintained and health improved.
Undoubtedly, poor water supply and quality are major problems in our urban areas and
the rural areas. As a result, a lot of diseases emanate from this problem. In other to prevent the
spread of water borne diseases, there should be adequate refuse disposal/treatment, proper siting
of landfills, proper personal hygiene occasioned by proper management of human wastes etc.
There is also the need for an effective town planning programme which Duru (1999),
p. 143, noted would make provision for both the immediate and long term zoning of land use
in our urban centers with appropriate provision for residential areas, industrial layouts, parks,
playground, good drainage system etc. Pail of the problem we experience in our environment
is issued by oil spillage and pollution. There is the need to minimize/eliminate oil spills, gas
flaring and other atmospheric emission and this can be achieved by oil
seminar/environmental awareness, facility upgrading and maintenance, use of trained
personnel recycling and re-use of wastes etc. We should stop engaging in activities that can
generate environmental hazards such as ozone layer depletion, global warming etc. We can
achieve this by stopping overgrazing, deforestation etc.
Also important is to raise the general awareness of the public on the need for clean
environment, proper sanitation and hygiene. This can be achieved through enlightenment
campaigns using the print and electronic media, and by organising workshops at adequate
intervals in our urban and rural areas.
I suggest strongly the need to resuscitate the used of sanitary inspectors because of
their role in wiping out filth and health decadence albeit through the use of force. It seems as
if people do not want to act, until they are forced to do so. Therefore the introduction of
sanitary inspectors would re-enact the early years of the War Against Indiscipline (WAI). To
facilitate the work of the sanitary inspectors, they should be equipped, educated, of high
moral standard, and should be motivated. The rural areas should not be left out. Statistics
indicated that manpower in the health sector is in short supply and the situation is worsened
by the over concentration of the available personnel in the urban areas.
As I said earlier, the problem is not only theoretical solution, but there is the need for
practical application. The most reliable indicator of the overall sate of health in a country can
be life expectancy.
 According to reports, at the end of the 1940's life expectancy in the developing
countries was estimated (o be about 38 years. Currently, it may be in the range of 40-55
years. This is low when compared to the developed nations with about 70 - 75 years life
expectancy. What I am saying in effect is that the cumulative result of proper improvement in
sanitation and the health of the citizens could be eventually manifested in increased life
expectancy, low mortality rate, and low report of diseases by the health institutions.

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