Environmental Health
S Harper, Oregon State University, Corvallis, OR, USA
Ó 2014 Elsevier Inc. All rights reserved.
This article is a revision of the previous edition article by Chris Theodorakis, volume 2, pp 202–205, Ó 2005, Elsevier Inc.
Potentially harmful agents in the environment include bio-
logical, physical, and chemical agents. Harmful biological
agents, or pathogens, may include bacteria, viruses, and para-
sites. Pathogens spread by person-to-person contact are some-
times included in the field of environmental health, but more
often they are limited to those spread by environmental
contamination as a result of human activities, such as sewage
disposal and livestock production. Environmental health often
addresses diseases caused by noncontagious pathogens and
biotoxins. Noncontagious diseases are contracted directly from
the environment rather than spread person-to-person, such as
anthrax and Escherichia coli infections. Biotoxins are poisons
produced by bacteria or fungi, and may be taken up by inges-
tion or inhalation. Examples include botulinum toxin, afla-
toxins (produced by fungi), and toxins produced by black
mold growing in houses. Diseases spread by arthropod vectors
(mosquitoes, flies, ticks, mites, and fleas) and zoonoses may
also be included under environmental health. Zoonoses are
diseases that are contracted from animals, either by direct
contact (Ebola, hantavirus, rabies, monkey pox, etc.) or via
arthropod vectors (e.g., west Nile virus, St. Louis encephalitis).
In this case, wild or domestic animals may provide a reservoir
for the disease. Within the context of environmental health,
interest in these diseases is often focused on anthropogenic
(artificial) environmental disturbances, for example, global
warming and agriculture affect the spread of such diseases.
Physical agents in the environment that may cause illness
include solar ultraviolet radiation, ionizing radiation
(produced by radioactive materials and X-rays), extreme
temperatures, noise, vibrations, and particulates. The most
famous particulates inducing adverse health effects include
asbestos and silica dust. Other physical agents, such as electric
or magnetic fields and microwaves, may also cause adverse
health effects, but there is yet not enough solid evidence to
support or refute this hypothesis.
Effects of environmental chemical agents on human health
perhaps represent the bulk of environmental health research.
People may be exposed to harmful chemicals in the outdoor
air, surface water (lakes, rivers, oceans, etc.), soil, indoor air, at
the workplace, in food, or from consumer products. Exposures
to chemicals (or other agents) in the workplace are called
‘occupational exposures.’ Food exposure to chemical or bio-
logical agents may occur as a result of agricultural applications,
environmental pollution, or are formed when foods are
cooked. Effects of food additives, chemicals produced by
plants, and organisms associated with spoilage usually come
under the subject of food safety or food toxicology. Consumer
products include objects that may give off gases or vapors or
leach chemicals into the water (e.g., carpeting, upholstery, and
plastics), items that may contain hazardous materials (e.g.,
batteries), or chemicals used in the home, yard, garden, or
garage. Also, exposure to biological or chemical agents as
a result of warfare or terrorist attacks has recently become
a prime concern of environmental health workers.
Encyclopedia of Toxicology, Volume 2 http://dx.doi.org/10.1016/B978-0-12-386454-3.01009-5
Exposure to environmental agents may be through the skin,
lungs, or digestive system. Effects from environmental expo-
sures to harmful agents depend upon duration, frequency, and
severity of exposure, as well as susceptibility of the individual.
Susceptibility may depend upon age, nutritional status, sex, or
genetic makeup (heredity). The duration, frequency, and
severity of exposure depend upon many factors including
locality, occupation, behavior, socioeconomic status, and
population density.
Effects of exposures may encompass environmentally
induced diseases and syndromes such as cancer (including
leukemia), birth defects, neurobehavioral disorders, autoim-
mune diseases, acquired allergies, multiple chemical hyper-
sensitivity, infections, and ‘chronic fatigue syndrome.’ Other
effects of particular concern include effects on the immune,
reproductive (including sterility and fertility), and endocrine
(hormone) systems, nerve toxins, and brain development.
Disorders of various organs that are routes of exposure or
function in detoxification of chemicals – including lungs, skin,
digestive tract, liver, and kidney – are also common. Organs
with high rates of cell division, such as the skin, bone marrow,
gonads, and developing embryo/fetus, are often highly
susceptible to environmental agents. Also, some organs tend to
accumulate (bioaccumulate) toxic chemicals. For example, fat-
soluble chemicals may bioaccumulate in fatty organs such as
liver, brain, and breasts, while certain metals and radioactive
materials may accumulate in bone.
Monitoring
In cases where people may be exposed to hazardous agents on
a regular basis, environmental surveillance may be carried out.
This may consist of regular medical checkups, environmental
monitoring, biomonitoring, and dosimetry. Environmental
monitoring includes collection of environmental media (air,
water, soil) for chemical analysis, or may include real-time
monitoring using devices that detect exposures to hazardous
agents immediately or nearly so. Biomonitoring includes
collection of biological samples, usually fluids or expired air,
for determination of chemical concentrations or biomarker
analysis. Finally, dosimetry is often determined using small
devices worn on the person that give an indication of the dose
of hazardous agents to which people were exposed.
Protecting the public from hazardous agents depends upon
knowledge of the health effects of such exposures. One method
of gathering information on the health effects of environmental
chemicals is by using toxicity tests on animals’ (usually
rodents) in vitro systems (cultured cells or cellular components
in flasks or test tubes). A second method of determining health
effects of hazardous agents is by clinical challenge studies,
clinical observations, and case studies. Challenge studies are
when volunteers are exposed to low levels of chemicals or other
agents under carefully controlled clinical settings. Clinical
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observations involve identifying clusters of disease associated
with toxic exposures. Case studies are indices where individuals
or a small group of people are exposed to high doses of
a contaminant as a result of accidental poisonings or industrial
accidents.
Another tool used by environmental health professionals to
determine health effects of environmental agents is the field of
epidemiology, which studies the incidence and progression of
diseases in populations. Epidemiological studies may be
prospective or retrospective. Prospective studies predict the
scope and magnitude of diseases that have not yet been man-
ifested, while retrospective studies assess the cause and/or
magnitude of disease that had already occurred. Epidemio-
logical studies may also be descriptive or analytical. Descriptive
epidemiology uses vital statistics (birth and death rates),
patterns of disease, or incidence of disease in exposed and
unexposed populations at a single point in time (‘cross-
sectional’ studies). Analytic epidemiology calculates risk factors
for hazardous agents by either identifying exposed and unex-
posed segments of the population and comparing their disease
frequencies (‘cohort’ or ‘longitudinal’ studies), or by identi-
fying diseased and healthy individuals and determining their
exposure histories (‘case–control’ studies). Another branch of
epidemiology is molecular epidemiology, which incorporates
biomarkers into descriptive or analytical studies in order to
determine individual susceptibility to environmental hazards.
Unfortunately, however, assigning a cause to environmen-
tally induced diseases is often difficult for the following
reasons: (1) there is often a latency period of months, years, or
decades between exposure and onset of disease; (2) there are
often multiple causes of each disease; (3) there are few diseases
that are specific to any one agent; and (4) there are usually
a host of confounding factors (e.g., age, gender, socioeconomic
status, and behavioral factors such as smoking and consump-
tion of caffeine or alcohol) that may influence incidence of
disease. For these reasons, epidemiological studies often
employ an established set of criteria for establishing causality
for any environmental disease.
Determination of exposure and toxic effects of chemicals
also requires knowledge of toxicokinetics. Toxicokinetics is the
study of changes in the levels of toxic chemicals and their
metabolites over time in various fluids, tissues, and excreta of
the body, and determines mathematical relationships to
explain these processes. These processes depend upon uptake
rates and doses, metabolism, excretion, internal transport, and
tissue distribution. Methods for determining these processes
include studies with laboratory animals, volunteer human
subjects, persons accidentally exposed to high doses of chem-
icals, and experiments with tissue or organs cultured in the
laboratory. Computer simulations of such processes are often
formulated using complex mathematical equations.
Protection of the public from exposures or effects of
chemicals involves constructing safety standards, regulations,
and exposure limits. This process usually relies upon human
health risk assessment, which is a process of quantifying the
likelihood, magnitude, and duration of human health effects
from hazardous environmental agents. Human health risk
assessment of hazardous chemicals consists of the following
steps: (1) hazard definition and identification: establishing
cause and effect relationships using animal or in vitro toxicity
studies, clinical studies, epidemiology, and quantitative struc-
ture activity relationships (prediction of a chemical’s toxicity
from its molecular structure); (2) establishing dose–effect
relationships (i.e., what is the magnitude and duration of an
effect for a given degree of exposure); (3) exposure assessment
includes environmental chemistry and surveillance, mathe-
matical and computer simulation modes of environmental
behavior of chemicals, toxicokinetics, and identification of all
likely exposure pathways (intentional ingestion of contami-
nated food or water; accidental ingestion of soil; inhalation of
gases, vapors, and particles; and absorption through the skin);
and (4) risk characterization, which involves integration of the
above three steps. Like epidemiology, risk assessments may be
prospective (or predictive) or retrospective. Prospective studies
assess possible occurrence and severity of health risks in which
environmental exposure is hypothetical, but likely to occur. In
retrospective studies, humans are environmentally or occupa-
tionally exposed to hazards and the potential for health risks
(and how to mitigate them) is assessed.
Environmental health professionals, policy makers, and
government officials use the outcome of risk assessments for
risk communication (informing the public of possible risks and
how to avoid them) and risk management (weighing policy
alternatives and selecting appropriate regulatory action).
Regulatory actions may include establishing exposure limits for
certain chemicals, setting emission standards for environ-
mental pollutants, or taking protective actions. Protective
actions may include: (1) isolation: prohibiting the public from,
or advising against, entering certain areas; (2) shielding: using
physical shields or protective clothing to prevent exposures; (3)
time: limiting the time people may spend in hazardous areas;
(4) treatment: treating environmental media to reduce or
eliminate toxic or infectious agents; and (5) prevention strat-
egies, such as vaccination against infectious agents or eating
antioxidants to prevent toxic effects of certain chemicals.
To an increasing degree, environmental management
programs are integrating protection of the environment and
protection of human health. This may include integrating human
health and ecological risk assessments. This also includes inte-
gration of effects of pollutants on ecosystem and human health.
For example, an algal bloom caused by fertilizer pollution may
deplete dissolved oxygen in the water and affect the natural
ecosystem, and produce chemicals that are toxic to humans. Such
integrated assessments are a practical means of reducing effort
and money used in environmental management and protection.
See also: Asbestos; Biomarkers, Human Health; Biomonitoring;
Botulinum Toxin; Chemicals of Environmental Concern;
Ecotoxicology; Epidemiology; Pharmacokinetics.
Further Reading
Briggs, D.J., 2008. A framework for integrated environmental health impact assess-
ment of systemic risks. Environ. Health 7, 61.
Christie, P., Stark, C., 1998. Environmental Hazards and Public Health. Wiley,
Hoboken, NJ.
Collins, F.S., Gray, G.M., Bucher, J.R., 2008. Toxicology: Transforming environmental
health protection. Science 319 (5865), 906–907.
 Environmental Health 377

Fuchs, J., Packer, L., 2001. Environmental Stressors in Health and Disease. NetLi- Relevant Websites
brary, Inc., Boulder, CO.
Lippmann, M., Cohen, B.S., Schlesinger, R.B., 2003. Environmental Health Science
http://www.environmentalhealthnews.org/ehs – Environmental Health News.
Recognition, Evaluation, and Control of Chemical and Physical Health Hazards.
http://ehp.niehs.nih.gov/ – Environmental Health Perspectives Journal.
Oxford University Press, New York.
http://www.niehs.nih.gov/ – National Institute of Environmental Health Sciences.
Morgan, M.T., 2002. Environmental Health. Wadsworth Publishing, Belmont.
Paustenbach, J.D. (Ed.), 2002. Human and Ecological Risk Assessment. Theory and
Practice. Wiley, Hoboken, NJ.
Scutchfield, F.D., Keck, C.W., 2000. Principles of Public Health Practice. Delmar
Publishers, Florence, KY.
Sellers, A.C., 1997. Hazards of the Job. From Industrial Disease to Environmental
Health Science. University of North Carolina Press, Chapel Hill, NC.
Yassi, A., Tord Kjellstrom, A., DeKok, T., Guidotti, T.L. (Eds.), 2001. Basic Environ-
mental Health. Oxford University Press, Boston, MA.