Environmental Health

Prof. Dr. Zailina Hashim

Dept. of Environmental and Occupational Health
Faculty of Medicine and Health Sciences
Universiti Putra Malaysia
 Environmental Health
This is a discipline of prevention and
promotion of health.

In line with the World Health Organization (WHO)

objectives and resolutions where health is the state of
complete wellness which may encompass physical,
social and mental aspects and not limited to the
absence of diseases and infirmity.
 Environmental Health
• Science discipline related to the control of
biological, chemical, physical and social factors
from the environment that can cause negative
effects directly and indirectly on the physical,
mental health and well being of individual and
community.
 Definition of Environmental Health
Environmental health comprises of those aspects of human
health, including quality of life, that are determined by
physical, chemical, biological, social, and psychosocial factors
in the environment.

It also refers to the theory and practice of assessing,

correcting, controlling, and preventing those factors in the
environment that can potentially affect adversely the health
of present and future generations.

Source : WHO (1993). Definition developed at a WHO

consultation in Sofia, Bulgaria, 1993. 4
 Scope of Environmental Health Proposed by
The World Health Organization (1970)
1. Water supply, with special reference to the provision of adequate
quantities of safe drinking water that are readily accessible to the user,
giving due consideration to other essential uses of water resources.
2. Wastewater treatment and water pollution control including domestic
sewage, and the control of the quality of surface and ground water.
3. Solid waste management, including sanitary handling and disposal.
4. Vector control, including the control of arthropods, molluscs, rodents,
and other alternative hosts of disease.
5. Food hygiene, including milk hygiene, food contamination
6. Sanitation measures associated with epidemics, emergencies,
disasters, and migrations of populations.
7. Prevention or control of soil pollution by human excreta and by
substances detrimental to human, animal or plant life.
8. Control of air pollution.
9. Control of noise control.
 Scope of Environmental Health Proposed by
The World Health Organization (1970)
10. Environmental health aspects of air, sea, or land transport.
11. Radiation control (ionizing and non-ionizing).
12. Accident prevention (home, road and recreational).
13. Housing and its immediate environment, in particular the public health
aspects of residential, public, and institutional buildings
14. Urban and regional planning.
15. Public recreation and tourism, in particular the environmental health aspects
of public beaches, swimming pools, camping sites, etc.
16. Occupational health, in particular the control of physical, chemical,
and biological hazards.
17. Preventive measures required to ensure that the general environment is free
from risk to health.
18. Environmental health preparedness and response in natural and manmade
disasters, including conflicts, riots and wars (additional).
17 Sustainable Development Goals (2015-2030)
with 169 Targets 7
8
 Pathway from Environmental Sources to Human Exposure

9
Source: enHealth, 2012
10
11
12
 AGENT TRANSMISSION IN ENVIRONMENTAL HEALTH
AGENT RESERVOIR *
(EG. ANIMALS, HUMANS
& POLLUTANT SOURCES)

MODE OF RELEASE * (EG. INSECT BITES,

FECES, INDUSTRIAL EFFLUENTS &
EMISSIONS)

AGENT *
(BIOLOGICAL, CHEMICAL &
PHYSICAL)

MODES OF AGENT TRANSMISSION

VECTORBORNE * DIRECT CONTACT VEHICLETRANSMITTED *

(EG. MOSQUITOES, (EG. VENEREAL & (EG. AIR, WATER, FOOD, SOIL
FLIES & FLEAS) SKIN DISEASES) & FOMITES)

INTRINSIC FACTORS
(EG. AGE, SEX,
ETHNICITY, GENETIC &
IMMUNITY)
MODE OF ENTRY
(EG. INHALATION, INGESTION, SKIN
ABSORPTION & INSECT BITES)
HEALTHY EXTRINSIC FACTORS *
HUMAN HOST * (EG. PERSONAL HYGIENE, HABIT,
NUTRITION & OCCUPATION)

UNHEALTHY
HUMAN HOST
ACUTE HEALTH
CHRONIC HEALTH EFFECTS
EFFECTS
(EG. NONCOMMUNICABLE DISEASES)
(EG. COMMUNICABLE DISEASES)

* CRITICAL POINTS OF ENVIRONMENTAL HEALTH STRATEGIES

SOURCE : JAMAL (1999)
The 3 component of exposure
The The
The
Source Contact
Environmental
of the hazard (inhaled fumes)
Pathway
(bus exhaust)
(air)

Integrated Environmental Health Middle

School Project • University of 14
Washington © 2005
 X
What is dose? Exposure
X
X

X
X
X X Dose X
X X
X

X X

X = hazard

Dose is the amount of a hazard that actually

enters your body.
Integrated Environmental Health Middle
School Project • University of 15
Washington © 2005
Dose can depend on…
Frequency of Body Size:
Duration of
Exposure: How big or small are
Exposure:
How often? you?
How long?

L
M

S S

Integrated Environmental Health Middle

School Project • University of 16
Washington © 2005
Future Challenges in Environmental Health
• Climate change and extreme weather events
• Emerging and re-emerging communicable diseases
• Zoonotic diseases (One Health)
• Trans-boundary pollutant transport
• Health impacts of development projects
• Others (hazardous wastes, e-wastes,
EMF)
• Natural and manmade disasters

UNU-IIGH
International Institute for Global Health
17
 Global Warming and Climate Change
• Observed changes in the climate system is
unequivocal since the 1950.
• In the Northern Hemisphere, 1983–2012 was likely
the warmest 30-year period of the last 1400 years.
• The globally averaged combined land and ocean
surface temperature data show a warming of 0.85
[0.65 to 1.06] °C, over the period 1880 to 2012.
• Changes in many extreme weather and climate
events have been observed since about 1950.

Source : IPCC Assessment Report 5, 2013.

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Global Warming Simulated
with Man-
Man-made Factors Included

19
Peaked at 226 floods in 2006

UNU-IIGH
International Institute for20
Global Health
 Health Effects of Climate Change
• Greater likelihood of injury, disease, and death due to
more intense heat waves and fires (very high confidence).
• Increased likelihood of under-nutrition resulting from
diminished food production in poor regions (high
confidence).
• Increased risks from food- and water-borne diseases
(very high confidence) and vector-borne diseases
(medium confidence).
• Marginalized populations are especially vulnerable to
climate change and also to some adaptation and
mitigation responses.

Source: IPCC Assessment Report 5, 2014 21

New Tools in Environmental Health

• Health risk and impact assessment

• Mathematical modeling
• Remote sensing
• Geographical information system
• Small area health statistics unit

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Environmental Health Profession in Malaysia
• Sanitary and Municipality Board was established by the
British in the 1800’s.
• Training of health inspectors (HI) was conducted at the King
Edward VII College of Medicine in Singapore from 1921 to
1958 (Dip. RSH London). Transferred to Malaya in 1958.
• Training of HI at the PHI in Kuala Lumpur began in 1969.
• First degree programme in environmental and occupational
health was introduced at UPM in 1998.
• First master programme was introduced at UKM in 2005.
• HI post was renamed as Assistant Environmental Health
Officer in 2002.
• The Environmental Health Officer post in the
MOH and local government was established
in 2005. UNU-IIGH
International Institute for Global Health
23
Empowering Environmental Health Practitioners
• Environmental health posts in other regulatory
agencies (DOE, AELB, MOA, DOSH?).
• Delegation of powers under the Environmental
Quality Act, 1974.
• Form professional working committees with
other professions (environmental scientists
engineers, doctors, toxicologists, food
technologies, epidemiologists, biostatisticians,
lawyers) to address national concerns
and issues.
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NATIONAL ENVIRONMENTAL HEALTH
ACTION PLAN (NEHAP) FOR MALAYSIA

25
Ministry of Health,
Malaysia
 Environmental Health in Malaysia

• Malaysia is increasingly urbanized, more populous and

more complex.

• Air, water and soil contamination and persistent chemical

pollutants have become widespread.

• Global climate change presents new environmental health

hazards.

• Contribute to respiratory and cardiovascular diseases,

physiological and neurological disorders, and increased
incidences of cancers.

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• Malaysia to formulate and established the environmental health
framework for planning, control and mitigation of the emerging
health impacts from new environmental health hazards.

• One objective is to achieve a clean, safe, healthy and productive

environment for the present and future generations.

• The Economic Planning Unit of the Prime Minister’s Department has

agreed that NEHAP was to be developed in the 9th Malaysia Plan
(MP) by the Ministry of Health.

• The Engineering Services Division, MOH has been given the task by
the Ministry to coordinate the development and implementation of
NEHAP which is to commence in the 10th MP.
• In December 2007 the Division had also organized the 1st Malaysian NEHAP Seminar which was
attended by relevant stakeholders.
• The current environmental health related programs/activities that are being implemented by
various agencies and stakeholders have been carried out and formed the basis for the
formulation of NEHAP.
• Analysis of the current status included the definition and scope of environmental health in
Malaysia, Government policies, programs and activities that have a bearing on:
i) environmental health;
ii) role of other stakeholders in influencing environmental health;
iii) identifying those areas related to environmental health that do not receive
appropriate attention;
iv) resources and costs that are currently incurred by the Government for the provision
of environmental health related programs and activities; and
v) legal, administrative and organizational system of implementing and managing
environmental health programs and activities.

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 IMPLEMENTATION PROCESS

• The Ministry of Health is responsible which also includes the

Strategic Plan and Action Plan have been prepared to support
the implementation of the framework (TWG1-11).

• They set out strategies to achieve the objectives and specific

actions and assign responsibilities to agencies of government
together with a notional time frame.

• All ministries and other stakeholders, including those from East

Malaysia should take a carefully considered approach to
implement the strategies

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 IMPLEMENTATION MECHANISM

The implementation mechanism comprises of a

three-tier approach and they are as follows:

• Steering Committee (SC)

• Technical Committee (TC)
• Thematic Working Groups (TWGs 1-11)

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 Environmental Health Areas of Concern

• The important environmental health areas of concern are

identified based on the Regional Initiative on Environment and
Health in Southeast and East Asian Countries, and they are as
follows:

i) Air Quality;
ii) Water, sanitation and hygiene;
iii) Solid and Hazardous Waste;
iv) Toxic Chemicals and Hazardous Substances;
v) Climate Change, Ozone Depletion and Ecosystem Change;
vi) Contingency Planning, Preparedness and Response in
Environmental Health Emergencies; and
vii) Health Impact Assessment.
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 Environmental Health Issues in Malaysia Total Score
Children environmental health (birth cohort study, impact of indoor environment).
1 Formulate intervention strategies on how to manage, e.g. schools/homes/childcare 106
centres.
Urban health issues (housing and sanitation, poor drainage, air pollution, migrants,
2 105
urban poor, crime and security, related diseases).
Contamination of drinking water sources and Emerging water pollutants [e.g.
3 endocrine disrupting chemicals (EDCs), pharmaceutical drugs (anti-septics, 105
antimicrobials)].
Vector borne diseases (e.g. dengue and Aedes breeding in junk yards/abandoned
4 102
places/no man’s land; reemergence of malaria).
Food safety and contamination issues (e.g. recycled cooking oil, untrained food
5 handlers especially foreigners, incomplete food labelling on food allergens, non- 99
compliance to food standards).
6 Pesticides contamination in air, water and food. 98
Zoonotic diseases (use ecosystem approach on malaria (Plasmodium knowlesi),
7 96
rabies, leptospirosis, meliodosis).
Human exposure to environmental chemicals (e.g. e-waste, industries and lead in
8 95
paint/consumer products).
9 Climate change adaptation strategies and neglected health issues. 94
10 Exposure to ionizing and non-ionizing radiation. 89
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