Lecture notes

Course : Communication for Behavioral Change (CBC) - Community Health -

Health and Development

Chapter one

Introduction

1.1Definition of communication and Behaviour communication change

Behaviour change communication (BCC) is an interactive process with communities (as

integrated with an overall program) to develop tailored messages and approaches using
a variety of communication channels to develop positive behaviours; promote and
sustain individual, community and societal behaviour change; and maintain appropriate
behaviours.

Communication: the imparting or exchanging of information by speaking, writing, or

using some other medium.

1.2. Examples of behaviour change

Depression.

Anxiety Disorders. ...

Eating Disorders. ...

Personality Disorders. ...

Dementia

1.3Stages of Behaviour change.

- Precontemplation - In this stage, people do not intend to take action in the

foreseeable future (defined as within the next 6 months). People are often

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 unaware that their behavior is problematic or produces negative consequences.
People in this stage often underestimate the pros of changing behavior and place
too much emphasis on the cons of changing behavior.
- Contemplation - In this stage, people are intending to start the healthy behavior in
the foreseeable future (defined as within the next 6 months). People recognize
that their behavior may be problematic, and a more thoughtful and practical
consideration of the pros and cons of changing the behavior takes place, with
equal emphasis placed on both. Even with this recognition, people may still feel
ambivalent toward changing their behavior.
- Preparation (Determination) - In this stage, people are ready to take action within
the next 30 days. People start to take small steps toward the behavior change,
and they believe changing their behavior can lead to a healthier life.
- Action - In this stage, people have recently changed their behavior (defined as
within the last 6 months) and intend to keep moving forward with that behavior
change. People may exhibit this by modifying their problem behavior or acquiring
new healthy behaviors.
- Maintenance - In this stage, people have sustained their behavior change for a
while (defined as more than 6 months) and intend to maintain the behavior
change going forward. People in this stage work to prevent relapse to earlier
stages.
- Termination - In this stage, people have no desire to return to their unhealthy
behaviors and are sure they will not relapse. Since this is rarely reached, and
people tend to stay in the maintenance stage, this stage is often not considered
in health promotion programs.

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1.4Causes of behavioural change

- Human behavior is the potential and expressed capacity (mentally, physically,

and socially) of human individuals or groups to respond to internal and
external stimuli throughout their life. While specific traits of
one's personality, temperament, and genetics may be more consistent, other
behaviors change as one moves between life stages—i.e., from birth
through adolescence, adulthood, and, for example, parenthood and retirement.

- Behavior is also driven, in part, by thoughts and feelings, which provide insight
into individual psyche, revealing such things as attitudes and values. Human
behavior is shaped by psychological traits, as personality types vary from person

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 to person, producing different actions and behavior. Extraverted people, for
instance, are more likely than introverted people to participate in social activities
like parties.
- The behavior of humans (just as of other organisms) falls upon a spectrum,
whereby some behaviors are common while others unusual, and some are
acceptable while others beyond acceptable limits. The acceptability of behavior
depends heavily upon social norms and is regulated by various means of social
control, partly due to the inherently conformist nature of human society in
general. Thus, social norms also condition behavior, whereby humans
are pressured into following certain rules and displaying certain behaviors that
are deemed acceptable or unacceptable depending on the given society or
culture

1.5Behavioural change communication strategy

A behavioral change can be a temporary or permanent effect that is considered a

change in an individual's behavior when compared to previous behavior. It is
sometimes considered a mental disorder, yet it is also a strategy used to improve
such disorders. This change is generally characterized by changes in thinking,
interpretations, emotions, or relationships. These changes can be either good or bad,
depending on which behavior is being affected. Often, it takes much more work to
change behavior for the better than it does to experience a negative change.
Medications can cause this change as a side effect. The interaction between
physiological processes and their effect on individual behavior is the basis of
psychophysiology. Several theories exist as to why and how behavioral change can
be affected, including behaviorism, Self-efficacy theory, and the stages of change
mmodel Behavioral change can be very beneficial to an individual, an annoying side-
effect, or a life-altering condition which takes considerable effort to repair. Two such
theories on the subject include behavior modification theory and cognitive
behavioral theory. Both of these seek to help a patient engage in a positive
behavioral change. Both legal and illegal drugs have been shown to alter behavior,

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 both acutely and chronically. In both cases, following common sense harm reduction
strategies can potentially reduce these side-effects. With mental illness, behavioral
change is a menace, with drugs it is expected, and with the right techniques it can be
a method to improve quality of life. In recent decades we have gained knowledge on
common causes of these changes, such as mental illness and drug use, while also
developing and applying several psychological fields to the study of inducing
beneficial changes in individuals, resulting in a variety of novel solutions.

Importance of BCC

o Increase in knowledge and attitude of the people.

o BCC helps to trigger and stimulate people for adopting positive

behavioral approaches.

o BCC promotes appropriate and essential attitude change.

o As BCC strategies and messages are tailored for specific target

groups, these strategies are efficient and effective.

o BCC approaches are more sustainable and acceptable

o BCC helps to increase learning and skills

o It improve aptitudes and feeling of self-adequacy.

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Chapter two.

Determining health problems of a community

2.1 Definition of community health

Community health is the part of medicine which is concerned with The health of the
whole population and the prevention of diseases from which it suffers.

The WHO defines community health as:

Environmental, social, and economic resources to sustain emotional and physical

well being among people in ways that advance their aspirations and satisfy their
needs in their unique environment.

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2.2 Different Types Of Communities:

Interest. Communities of people who share the same interest or passion.

Action. Communities of people trying to bring about change. Place. Communities of

people brought together by geographic boundaries.

Practice. Communities of people in the same profession or undertake the same

activities. Circumstance. Communities of people brought together by external
events/situations

.2.3.Factors that Affect Community and Population Health.

There are four categories of factors that affect the health of a community or
population. Because these factors will vary in separate communities, the health
status of individual communities will be different. The factors that are included in
each category, and an example of each factor, are noted here.

Physical factors—geography (parasitic diseases), environment (availability of natural

resources), community size (overcrowding), and industrial development (pollution).

Social and cultural factors—beliefs, traditions, and prejudices (smoking in public

places, availability of ethnic foods, racial disparities), economy (employee health
care benefits), politics (government participation), religion (beliefs about medical
treatment), social norms (drinking on a college campus), and socioeconomic status
(number of people below poverty level).

Community organization—available health agencies (local health department,

voluntary health agencies), and the ability to organize to problem solve.

Individual behavior—personal behavior (health-enhancing behaviors like exercising,

getting immunized, and recycling wastes;

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Hospitals and community stakeholders go through a process to distinguish the
most pressing community health needs based on the data collected. The identified
priority health needs will be addressed through the implementation strategies.

2.4 What is a Community Health Needs Assessment?

A Community Health Needs Assessment (CHNA) is a systematic process involving

the community to identify and analyse community health needs. The process
provides a way for communities to prioritize health needs, and to plan and act upon
unmet community health needs. CHNAs may be conducted by a variety of
organizations. Many methods exist for conducting an assessment, but generally
include:

Stakeholder meetings

Community focus groups

Surveys

Interviews with community leaders

Population health and other health-related data

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 Chapter Three

Prioritization criterion

3.1. priority definition

the fact or condition of being regarded or treated as more important than others

3.2. purpose of Prioritization

Hospitals and community stakeholders go through a process to distinguish the

most pressing community health needs based on the data collected. The identified
priority health needs will be addressed through the implementation strategies.

3.3. identify criteria for prioritization

 Identify criteria for prioritization

 Hospitals are at their discretion to develop prioritization criteria and processes. A set
of criteria should be determined to guide the prioritization process. Typically, three
to six priorities are selected, based on:

 Magnitude of the problem

 Severity of the problem

 Need among vulnerable populations

 Community’s capacity and willingness to act on the issue

 Ability to have a measurable impact on the issue

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 Availability of hospital and community resources

 Existing interventions focused on the issue

 Whether the issue is a root cause of other problems

 Trending health concerns in the community

 Additional prioritization criteria can include:

 The importance of each problem to community members

 Evidence that an intervention can change the problem

 Alignment with an organization’s existing priorities

 Hospital’s ability to contribute finances and resources to address the health concern

 Potential challenges or barriers to addressing the need

 The opportunity to intervene at the prevention level

3.4. selecting community health priorities

Select community health priorities

Priorities can be selected as part of an established process informed by contributing

partners, including community stakeholders, health departments, social service
agencies, policy makers and hospital leadership. Action steps to be considered are:

Select a prioritization committee – Members can be from hospitals, community

stakeholder organizations and other organizations/institutions with specialized
knowledge or constituents.

Discuss the data – Present the qualitative and quantitative data to the prioritization
committee. Make sure that the data are presented in a format that is accessible for
the individuals on the committee. Foster an environment for open dialogue to

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discuss the identified health needs thoroughly.

Review community assets – Reflect back on your asset map to identify what
resources exist in your community to address the need. Take stock of what
resources (staffing, in-kind, financial, etc.) in your hospital could potentially be
leveraged to address that need.

Select priorities – Decide which approach you want to use to determine priority
needs.

3.5. Description of needs not prioritized

Describe which needs were not prioritized

It may not be possible to address all community health needs at once. If there are
significant needs that are not prioritized or will not be addressed, you should be able
to describe what the needs are and why you have chosen not to address them.

community Balance and mobility scale

3.5 Definition: The Community Balance and Mobility Scale (CB&M) was designed to
evaluate balance and mobility in patients who, although ambulatory, have balance
impairments which reduce their full engagement in community living

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 Chapter four

Development of a plan of action in community health

4.1 WHAT IS A COMMUNITY HEALTH ACTION PLAN(CHAP)

A CHAP is a written document that lists plans for achieving health improvements in
the community. This is developed in Response to needs and gaps identified from
data collection. The plan is written by the community coalition and typically includes
Establishing and clarifying desired outcomes, goals, objectives, activities,
assignments, and deadlines for coalition members Supporting the action plan. A
CHAP offers built-in deliverables and focuses on doing work in the community to
support priority Health needs.

4.2 Reasons for action plan development

- Developing an action plan is a critical first step toward ensuring project success.

- An action plan may lend credibility to your organization and its initiative, increase
efficiency, and provide accountability.

In addition, the action plan provides a tool for mobilizing the community or group and
encouraging members to share responsibility for solving the problems and improving
the situation you have decided to change.

4.3 WHO DEVELOPS THE ACTION PLAN?

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You can invite these people to help prepare an action plan:

 Influential people from all groups affected

 People directly involved in the problem or issue

 Members of grassroots organizations

 Members of ethnic and cultural groups of the community

 Different sectors of the community: media/business community/religious

groups/schools/youth organizations/social service organizations/health
organizations

4.4 HOW TO DEVELOP AN ACTION PLAN?

First, clarify your charge. Is it to work to reduce adolescent pregnancy in your

community? Or are you working to increase the rate of sensitisation on HIV? Your
goal will provide the backbone of your action plan.

Your action plan should include the strategies you plan to use and the action steps
you will take to achieve your goals and objectives. It should also identify a role for
each sector of the community or group involved in your effort.

For each action step or change to be accomplished, list the following, with a due
date for each:

 What actions or changes will occur-by when?

 Who will carry it out-by when (or for how long)?

 What resources are needed-by when?

 Communication (who should know what)-and when?

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4.5 A SUCCESSFUL PLANNING PROCESS

A. Be inclusive

B. Manage conflict

C. Use brainstorming rules

D. Be efficient

E. Communicate product of planning

F. Provide support and encouragement

Chapter Five

The techniques of communication

5.1 Definition of communication and communication techniques

Communication is a form of transferring information or message from one person

to another, from one place to another place. There are different forms of
communication such as verbal and non-verbal, written and visual, etc. Through
which transfer of information takes place.

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Now coming to communication techniques, these are the different techniques
adopted by different people to enhance the level of communication. Some
techniques are non-therapeutical and others are therapeutical.

5.2 What Is Therapeutic Communication?

Therapeutic communication is a collection of techniques that prioritize the physical,

mental, and emotional well-being of patients. Nurses provide patients with support
and information while maintaining a level of professional distance and objectivity.
With therapeutic communication, nurses often use open-ended statements and
questions, repeat information, or use silence to prompt patients to work through
problems on their own.

5.3. Therapeutic techniques nurses should adopt

1. Using Silence: At times, it’s useful to not speak at all, It may give patients the time
and space they need to broach a new topic. Nurses should always let patients break
the silence

2. Accepting: Acceptance isn’t necessarily the same thing as agreement; it can be

enough to simply make eye contact and say “Yes, I understand.” Patients who feel
their nurses are listening to them and taking them seriously are more likely to be
receptive to care.

3. Giving Recognition: saying something like “I noticed you took all of your
medications” draws attention to the action and encourages it without requiring a
compliment.

4: Offering Self: Hospital stays can be lonely, stressful times; when nurses offer their
time, it shows they value patients and that someone is willing to give them time and
attention

5: Giving Broad Openings: “What’s on your mind today?” or “What would you like to

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talk about?” can be a good way to allow patients an opportunity to discuss what’s on
their min

6. Active Listening: By using nonverbal and verbal cues such as nodding and saying
“I see,” nurses can encourage patients to continue talking. Nurses can offer general
leads such as “What happened next?” to guide the conversation or propel it forward.

7.Seeking Clarification: Saying something like “I’m not sure I understand. Can you
explain it to me?”

8. Placing the Event in Time or Sequence: Asking questions about when certain
events occurred in relation to other events can help patients (and nurses) get a
clearer sense of the whole picture. It forces patients to think about the sequence of
events and may prompt them to remember something they otherwise wouldn’t.

9. Making Observations: Observing that they look tired may prompt patients to
explain why they haven’t been getting much sleep lately; making an observation that
they haven’t been eating much may lead to the discovery of a new symptom.

10. Encouraging Descriptions of Perception: For patients experiencing sensory

issues or hallucinations, it can be helpful to ask about them in an encouraging, non-
judgmental way. Phrases like “What do you hear now?” or “What does that look like
to you?” give patients a prompt to explain what they’re perceiving without casting
their perceptions in a negative light.

11. Encouraging Comparisons: Often, patients can draw upon experience to deal
with current problems. By encouraging them to make comparisons, nurses can help
patients discover solutions to their problems.

12. Summarizing: It’s frequently useful for nurses to summarize what patients have
said after the fact. This demonstrates to patients that the nurse was listening and
allows the nurse to document conversations. Ending a summary with a phrase like
“Does that sound correct?” gives patients explicit permission to make corrections if
they’re necessary.

13. Reflecting: Patients often ask nurses for advice about what they should do about

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 particular problems or in specific situations. Nurses can ask patients what they think
they should do, which encourages patients to be accountable for their own actions
and helps them come up with solutions themselves.

14. Focusing: Sometimes during a conversation, patients mention something

particularly important. When this happens, nurses can focus on their statement,
prompting patients to discuss it further. Patients don’t always have an objective
perspective on what is relevant to their case; as impartial observers, nurses can
more easily pick out the topics to focus on.

15. Confronting: Nurses should only apply this technique after they have established
trust. It can be vital to the care of patients to disagree with them, present them with
reality, or challenge their assumptions. Confrontation, when used correctly, can help
patients break destructive routines or understand the state of their situation.

16. Voicing Doubt: Voicing doubt can be a gentler way to call attention to the
incorrect or delusional ideas and perceptions of patients. By expressing doubt,
nurses can force patients to examine their assumptions.

17. Offering Hope and Humor: Because hospitals can be stressful places for
patients, sharing hope that they can persevere through their current situation and
lightening the mood with humor can help nurses establish rapport quickly. This
technique can keep patients in a more positive state of mind.

5.4 Non therapeutic communication

nontherapeutic communication involves various words, phrases, actions, and tones

that make a patient feel uncomfortable, increase their stress, and worsen their
overall mental, and perhaps even physical, wellbeing.

Assignment: give 10 differences between therapeutic and non therapeutic

communication

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1..Advising: telling the client what to do

Rationale: Giving advice implies that only the nurse knows what is best for the client

Example: I think you should do this”

“Why don’t you do that.”

2.Agreeing: indicating accord with the client

Rationale: Approval indicates the client is “right” rather than “wrong.” This gives the
client the impression that he or she is “right” because of agreement with the nurse.
Opinions and conclusions should be exclusively the client’s. When the nurse agrees with
the client, there is no opportunity for the client to change his or her mind without being
“wrong.” Example “That’s right.”

“ i agree.”

3.Belittling feelings expressed: Misjudging the degree of the client’s discomfort

Rationale: When the nurse tries to equate the intense and overwhelming feelings the
client has expressed to “everybody” or to the nurse’s own feelings, the nurse implies
that the discomfort is temporary, mild, self-limiting, or not very important. The client is
focused on his or her own worries and feelings; hearing the problems or feelings of
others is not helpful.

Example: Client: “I have nothing to live for . . . I wish I was dead.”

Nurse: “ Everybody is going to die one day”

4.Challenging: demanding proof from the client

Rationale: Often the nurse believes that if he or she can challenge the client to prove
unrealistic ideas, the client will realize there is no “proof” and then will recognize reality.
Actually challenging causes the client to defend the delusions or misperceptions more
strongly than before. Example “But how can you be the king, everyone knows who the
king is?” “If you’re dead, why do you still breathing?”5.Defending: attempting to protect
someone or something from verbal attack

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Rationale: Defending what the client has criticized implies that he or she has no right to
express impressions, opinions, or feelings. Telling the client that his or her criticism is
unjust or unfounded does not change the client’s feelings but only serves to block
further communication.

Example “This hospital has a fine reputation.” “I’m sure your doctor has your best
interests in mind.”

6.Disagreeing: opposing the client’s ideas

Rationale: Disagreeing implies the client is “wrong.” Consequently the client feels
defensive about his or her point of view or ideas.

Example “That’s wrong”, “ i definitely disagree with . . .” “I don’t believe that”

5.5. Types of communication

 VERBAL COMMUNICATION

Verbal communication occurs when we engage in speaking with others. It can be face-
to-face, over the telephone, via Skype or Zoom, etc. Some verbal engagements are
informal, such as chatting with a friend over coffee or in the office kitchen, while others
are more formal, such as a scheduled meeting.

 NON-VERBAL COMMUNICATION

What we do while we speak often says more than the actual words. Non-verbal
communication includes facial expressions, posture, eye contact, hand movements, and

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touch. For example, if you’re engaged in a conversation with your client , and she
complains of headache while holding her stomach, it should tell you the nurse that
something is wrong somewhere.

 WRITTEN COMMUNICATION

Whether it is an email, a memo, a report, a Facebook post, a Tweet, a contract, etc. All
forms of written communication have the same goal to disseminate information in a
clear and concise manner – though that objective is often not achieved. In fact, poor
writing skills often lead to confusion and embarrassment, and even potential legal
jeopardy. As a nurse, you make use of this communication method especially when you
have to close your shift, report vital signs, drugs administered, etc.

 LISTENING

The act of listening does not often make its way onto the list of types of communication.
Active listening, however, is perhaps one of the most important types of communication
because if we cannot listen to the person sitting across from us, we cannot effectively
engage with them. Think about a negotiation – part of the process is to assess what the
opposition wants and needs. Without listening, it is impossible to assess that, which
makes it difficult to achieve a win/win outcome.

 VISUAL COMMUNICATION

We are a visual society. Think about it, televisions are running 24/7, Facebook,
whatsapp is visual with memes, videos, images, etc., Instagram is an image-only
platform, and advertisers use imagery to sell products and ideas. Think about from a
personal perspective – the images we post on social media are meant to convey
meaning – to communicate a message. .

5.6 Meeting

A meeting is a group communication in action around a defined agenda, at a set time,

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for an established duration. Meetings can be effective, ineffective, or a complete waste
of time.

Ways to communicate effectively in meetings

 Be on time. Nothing says that a meeting is not important more than turning up
late to it. ...

 Stay on topic. An agenda should be driven by action and sent to attendees in

advance. ...

 Voice of success. ...

 Word choice. ...

 Watch your body language. ...

 Listen. ...

 Avoid distractions.

5.7. Brainstorming

Brainstorming is a method design teams use to generate ideas to solve clearly defined
design problems. In controlled conditions and a free-thinking environment, teams
approach a problem by such means as “How Might We” questions. They produce a vast
array of ideas and draw links between them to find potential solutions.

Brainstorming combines a relaxed, informal approach to problem solving with lateral

thinking. It encourages people to come up with thoughts and ideas that can, at first,
seem a bit crazy. Some of these ideas can be crafted into original, creative solutions to
a problem, while others can spark even more ideas. E.g nurses trying to find suitable
solution s to preventing late coming amongst them during shifts.

5.8. A conference is generally understood as a meeting of several people to discuss a

particular topic. It is often confused with a convention, colloquia or symposium. While a
conference differs from the others in terms of size and purpose, the term can be used
to cover the general concept. A conference usually requires a large population.

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5.9. Debate

Debate or debating is a method of argument. Disputes and conflicts may be settled by

debate. It is a larger form of argument than logical argument, because in a debate, the
debaters try to influence the feelings of the audience, in order to persuade them on a
topic. The subject or issue of the debate is the question on which the participants
debate. An issue or debate always has two sides or positions. Informal debates like
discussion are very common, but the quality of a debate improves with knowledge and
skill of its participants as debaters.

5.10 counselling

Counselling is:

 The process that occurs when a client and counsellor set aside time to explore
difficulties which may include the stressful or emotional feelings of the client.

 The act of helping the client to see things more clearly, possibly from a different
view-point. This can enable the client to focus on feelings, experiences or
behaviour, with a goal of facilitating positive change.

 A relationship of trust. Confidentiality is paramount to successful counselling.

Professional counsellors will usually explain their policy on confidentiality. They
may, however, be required by law to disclose information if they believe that there
is a risk to life.

Counselling is not:

 Giving advice.

 Being judgemental.

 Attempting to sort out the problems of the client.

 Expecting or encouraging a client to behave as the counsellor would behave if

confronted with a similar problem in their own life.

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  Getting emotionally involved with the client.

 Looking at a client’s problems from your own perspective, based on your own
value system.
The counsellor needs the following basic communication skills to do effective
counselling:

 Attending. Attending refers to the ways in which counsellors can be “with” their
clients, both physically and psychologically. ...

 Listening. ...

 Basic empathy. ...

 Probing or questioning. ...

 Summarising. ...

 Integrating communication skills.

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 Chapter 6.

Community health

6.1 the man l, it’s physical environment

Definition

The physical environment includes land, air, water, plants and animals, buildings
and other infrastructure, and all of the natural resources that provide our basic
needs and opportunities for social and economic development. A clean, healthy
environment is important for people’s physical and emotional wellbeing.

6.1. Types of human environment

To divide environments’ sorts we can mention 3 kinds of environments Natural,

industrial, and social environment.

Natural environment:

Include water, light, land, air and all organisms that live in nature.

Industrial environment:

Include cities, villages, factories and all humans’ synthesis.

Social environment:

Include authorities, universities, schools, companies and other establishments along

with their output legal and their communication ways.

6.2. Environmental factors affecting the health

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A number of specific environmental issues can impede human health and wellness.
These issues include chemical pollution, air pollution, climate change, disease-causing
microbes, lack of access to health care, poor infrastructure, and poor water quality.

6.2.1 WATER POLLUTION

Water pollution occurs when harmful substances—often chemicals or

microorganisms—contaminate a stream, river, lake, ocean, aquifer, or other body of
water, degrading water quality and rendering it toxic to humans or the environment.

6.2.2 What Are the Causes of Water Pollution?

Water is uniquely vulnerable to pollution. Known as a “universal solvent,” water is able

to dissolve more substances than any other liquid on earth. It’s the reason we have
Kool-Aid and brilliant blue waterfalls. It’s also why water is so easily polluted. Toxic
substances from farms, towns, and factories readily dissolve into and mix with it,
causing water pollution.

Clean freshwater is an essential ingredient for a healthy human life, but 1.1 billion
people lack access to water and 2.4 billion don’t have adequate sanitation. Water
becomes polluted from toxic substances dumped or washed into streams and
waterways and the discharge of sewage and industrial waste. These pollutants come in
many forms—organic, inorganic, even radioactive—and can make life difficult, if not
impossible, for humans, animals and other organisms alike.

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6.3 NOISE POLLUTION?

Not all sound is considered noise pollution. The World Health Organization (WHO)
defines noise above 65 decibels (dB) as noise pollution. To be precise, noise becomes
harmful when it exceeds 75 decibels (dB) and is painful above 120 dB. As a
consequence, it is recommended noise levels be kept below 65 dB during the day and
indicates that restful sleep is impossible with nighttime ambient noise levels in excess
of 30 dB.

Causes of noise pollution include

 Catering and night life

 Animals

 Construction sites

 Traffic from cars and air craft

6.4 EFFECTS OF NOISE POLLUTION

As well as damaging our hearing by causing — tinnitus or deafness —, constant loud

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noise can damage human health in many ways, particularly in the very young and the
very old.

6.4.1 Physical

Respiratory agitation, racing pulse, high blood pressure, headaches and, in case of
extremely loud, constant noise, gastritis, colitis and even heart attacks.

6.4.2 Psychological

Noise can cause attacks of stress, fatigue, depression, anxiety and hysteria in both
humans and animals.

6.4.3 Sleep and behavioural disorders

Noise above 45 dB stops you from falling asleep or sleeping properly. Remember that
according to the World Health Organization it should be no more than 30 dB. Loud noise
can have latent effects on our behaviour, causing aggressive behaviour and irritability.

6.4.4 Memory and concentration

Noise may affect people’s ability to focus, which can lead to low performance over time.
It is also bad for the memory, making it hard to study. Interestingly, our ears need more
than 16 hours’ rest to make up for two hours of exposure to 100 dB.

6.4.5 Climate Change and Natural Disasters

Another environmental issue with serious ramifications for human health is climate
change, along with the increase in natural disasters that has accompanied the shift in
Earth’s climate. Climate change disrupts the natural world in a number of ways that can
impede health and increase vulnerability to disease; these include increases in the
planet’s temperature and more frequent heavy rains and runoff. The various impacts
may result in greater vulnerability to nervous and respiratory diseases, diarrhea, and
more.

6.4.6 Diseases Caused by Microbes

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Diseases caused by microbes — also known as microorganisms — present another area
of public health concern. Trillions of microbes exist within the human body, and they
also live in water, soil, and air. Most of them have no negative health effects, and many
microbes perform important biological functions, such as supporting digestive and
immune health, according to the National Human Genome Research Institute.

Harmful microbes, which are more commonly called pathogens or germs, can infect
humans and cause illness. Eating is one of the primary ways in which humans can
contract diseases caused by microbes. One example is food poisoning from E. Coli, a
type of bacteria that can be found in the environment and in foods, and which can cause
respiratory illness, urinary tract infections, and other adverse health effects.

There are also a number of harmful microbes that live in the soil. Humans can come
into contact with them by ingesting them (through contaminated food) or through
inhaling them (through soil particles in the air). Tetanus and botulism are examples of
diseases caused by soil-borne microbes.

Infrastructure Issues

Infrastructure issues can also have a major impact on community health. Examples
include the following:

 Poorly maintained roads (increasing risk of car accidents)

 Lack of access to clean drinking water

 Lack of local health care infrastructure, such as clinics capable of giving

vaccinations

 Overcoming poor infrastructure requires the right allocation of resources from

local, state, and federal governments, as well as a qualified workforce to keep
infrastructure properly maintained.

29
Chapter seven

Define, Analyze, and Prioritize Community Health Problem

30
7.1. What is the nature of a health problem?

• A problem is the difference between what is And what should be.

• The cause of a community health problem May be inside or outside of that community.

• Problems occur with different levels of Severity.

7.2 Communities have health problems,

Just like people do

• Communities, like people, can work to Reduce or eliminate their own health Problems.

• Analyzing health problems helps to arrive At effective solutions

7.3. Examples of Community Health

Problems include.

• Accidental Injuries

• Asthma Hospitalizations

• Cancer

• Child abuse

• Diabetes

• Domestic violence

• Access to healthy food

• Heart Disease Hypertension (high blood Pressure)

• Hypercholesterolemia (high Cholesterol)

• Low Birth-Weight Babies

• Depression

31
• Obesity

• Teenage pregnancy

• Tobacco Use

• Substance Use (alcohol, drugs, Tobacco)

• Suicide

• STDs

• Access to clean/safe drinking water.

7.4. Clarifying and defining the health

Problem requires data

• Start with what you know about the Problem (perception, opinion, inference).

• Decide what information you need. (factual Information)

• Gather missing information on the problem. (perception, opinion, facts, inference).

• Define the problem. (Using the “But Why?” technique

7.5. The “But Why” Technique

• To identify “underlying” individual and social “root causes” of a community Issue

• Technique reveals multiple and alternate solutions to a community health Problem.

PROBLEM EXAMPLE: Too many children in this community suffer from foot Infections

• Q: But why?

Ans:.They step on broken glass and sharp objects.

• Q: Could that be prevented?

Ans.Yes

• Q: How?

32
Ans. If children wore shoes.

• Q: But why don’t children have shoes?

Ans. Because the family can’t afford shoes.

• Q. But why?

Ans. The parents are not working .

• Q. But why?(and so forth)

7.6. When should you analyze a community Health problem?

• When the problem lacks a clear definition

• When people are too quick to jump to “solutions”

• When little is known about the problem or its Consequences

• When trying to improve the chances of a successful Solution or intervention

• When trying to: 1) identify actions that best Address the problem, and 2) identify best
Collaborative partners with whom to take action

7.7. Why analyze a community health Problem?

• To know the facts about this problem

• To credibly communicate this information to Others

• To raise community awareness of the Importance and seriousness of this health Issue.

• To be able to compare the problem in your Own county/small area/tribe etc. Against
the Same problem in others.

Health Problem Analyses Criteria

33
• What is the problem? (Achieve consensus on

7.8. Definition and problem statement)

• Why does the problem exist? (Finding Root Causes)

• Who is causing the problem? (Individual, social, Political causes)

• For how long has the problem existed?

• To what extent is the problem occurring? (Impact)

7.9 Criteria for Assessing Problem Impact

• Frequency (How many are affected in your community?)

• Duration (For how long has the problem existed?) Incidence, Prevalence & Time
Trends

• Scope or range (Who all in the community are affected? By age, gender, race/ethnicity,
geography, income, etc.?)

• Severity (How serious or significant are the consequences outcomes of this problem
in this community? (morbidity/mortality/disability from disease, injuries, accidents,
violence & crime associated with this problem?)

• Perceptions (How does the community perceive this problem? town halls, key
informant interviews, focus groups & community surveys

7.10. prioritization process.

• Identify community problems .

• Assess the impact of each problem on the community .

• Prioritize the identified problems for action .

7.11. Prioritization Criteria

• Magnitude of Impact?

34
• What Evidence-Based Strategies Target this Problem?

• Does the problem Impact other Community Issues?

What are they?

• Community Control?

• Time and Resources required?

• Energy (social capital required)

• Timing? Long vs. short term strategy/action?

• Avoid Duplication

• Political Realities

7.12. Criteria for judging the best strategy/solution to a problem

• Costs involved

• Time required

• People required

• Driving forces and obstacles to taking action

• Possible impact of taking action/not taking action

• Community preference of problem as a “priority”

• The likelihood for a successful solution

7.13. Force-Field Analyses Technique

• Looks more broadly at a health problem and multiple

forces surrounding the problem.

• Begin with the existing problem definition

35
• Draw a line down the center of the paper.

• On the top of one /side, write "Restraining Forces“

• On the other sheet/side, write, "Driving Forces."

Brainstorm, list, compare Restraining and Driving Forces

• Rank & Prioritize the driving forces that can be strengthened

• Rank &Prioritize the restraining forces to target for elimination/reduction to allow

action for a positive change.

Chapter Eight

36
 Health of the environment

8.1. Introduction

Humans interact with the environment constantly. These interactions affect quality of
life, years of healthy life lived, and health disparities. The World Health Organization
(WHO) defines environment, as it relates to health, as “all the physical, chemical, and
biological factors external to a person, and all the related behaviors.”1 Environmental
health consists of preventing or controlling disease, injury, and disability related to the
interactions between people and their environment.
Environmental Health objectives here focuses on 6 themes, each of which highlights an
element of environmental health:

1. Outdoor air quality

2. Surface and ground water quality
3. Toxic substances and hazardous wastes
4. Homes and communities
5. Infrastructure and surveillance
6. Global environmental health
Creating healthy environments can be complex and relies on continuing research to
better understand the effects of exposure to environmental hazards on people’s health.

8.2. Why Is Environmental Health Important?

Maintaining a healthy environment is central to increasing quality of life and years of

healthy life. Globally, 23% of all deaths and 26% of deaths among children under age 5
are due to preventable environmental factors.1 Environmental factors are diverse and
far reaching. They include:
 Exposure to hazardous substances in the air, water, soil, and food
 Natural and technological disasters
 Climate change
 Occupational hazards
 The built environment

37
Poor environmental quality has its greatest impact on people whose health status is
already at risk. Therefore, environmental health must address the societal and
environmental factors that increase the likelihood of exposure and disease.

8.3. Understanding Environmental Health

The 6 themes of the Environmental Health topic area draw attention to elements of the
environment and their linkages to health.

8.3.1 Outdoor Air Quality

Poor air quality is linked to premature death, cancer, and long-term damage to
respiratory and cardiovascular systems. Progress has been made to reduce unhealthy
air emissions, but in 2008, approximately 127 million people lived in U.S. counties that
exceeded national air quality standards. Decreasing air pollution is an important step in
creating a healthy environment.

8.3.2 Surface and Ground Water

Surface and ground water quality concerns apply to both drinking water and recreational
waters. Contamination by infectious agents or chemicals can cause mild to severe
illness. Protecting water sources and minimizing exposure to contaminated water
sources are important parts of environmental health.

8.3.3 Toxic Substances and Hazardous Wastes

daThe health effects of toxic substances and hazardous wastes are not yet fully
understood. Research to better understand how these exposures may impact health is
ongoing. Meanwhile, efforts to reduce exposures continue. Reducing exposure to toxic
substances and hazardous wastes is fundamental to environmental health.
8.3.4 Homes and Communities

38
People spend most of their time at home, work, or school. Some of these environments
may expose people to:
 Indoor air pollution
 Inadequate heating and sanitation
 Structural problems
 Electrical and fire hazards
 Lead-based paint hazards

These hazards can impact health and safety. Maintaining healthy homes and
communities is essential to environmental health.

8.3.5 Infrastructure and Surveillance

Preventing exposure to environmental hazards relies on many partners, including state
and local health departments. Personnel, surveillance systems, and education are
important resources for investigating and responding to disease, monitoring for hazards,
and educating the public. Additional methods and greater capacity to measure and
respond to environmental hazards are needed.
8.3.6 Global Environmental Health
Water quality is an important global challenge. Diseases can be reduced by improving
water quality and sanitation and increasing access to adequate water and sanitation
facilities.

8.4 Emerging Issues in Environmental Health

Environmental health is a dynamic and evolving field. While not all complex
environmental issues can be predicted, some known emerging issues in the field
include:

8.4.1 Climate Change

Climate change is projected to impact sea level, patterns of infectious disease, air
quality, and the severity of natural disasters such as floods, droughts, and storms.
8.4.2 Disaster Preparedness

39
Preparedness for the environmental impact of natural disasters as well as disasters of
human origin includes planning for human health needs and the impact on public
infrastructure, such as water and roadways.
8.4.3 Nanotechnology
The potential impact of nanotechnology is significant and offers possible
improvements to:
 Disease prevention, detection, and treatment
 Electronics
 Clean energy
 Manufacturing
 Environmental risk assessment
However, nanotechnology may also present unintended health risks or changes to the
environment.
8.4.5. The Built Environment
Features of the built environment appear to impact human health—influencing
behaviors, physical activity patterns, social networks, and access to resources.7
8.4.5 Exposure to Unknown Hazards
Every year, hundreds of new chemicals are introduced to the U.S. market. It is presumed
that some of these chemicals may present new, unexpected challenges to human
health, and their safety should be evaluated prior to release.
These cross-cutting issues are not yet understood well enough to inform the
development of systems for measuring and tracking their impact. Further exploration is
warranted. The environmental health landscape will continue to evolve and may present
opportunities for additional research, analysis, and monitoring.

8..4.6 Blood Lead Levels

As of 2017, there are approximately 4 million houses or buildings that have children
living in them who are potentially being exposed to lead. Nearly half a million U.S.
children ages 1 to 5 have blood lead levels at or above 5 micrograms per deciliter
(µg/dL), which is currently the reference level at which CDC recommends public health
actions be taken. Even blood lead exposure levels as low as 2 micrograms per deciliter

40
(µg/dL) can affect a child’s cognitive function. Since no safe blood lead level have been
identified for children, any exposure should be taken seriously. However, since lead
exposure often occurs with no obvious signs or symptoms, it often remains
unrecognized.

Chapter Nine

Waste management

9.1 Difinition and introduction

Waste management (or waste disposal) includes the activities and actions required to
manage waste from its inception to its final disposal.This includes the collection,
transport, treatment and disposal of waste, together with monitoring and regulation of
the waste management process and waste-related laws, technologies, economic
mechanisms.

Waste can be solid, liquid, or gaseous and each type has different methods of disposal
and management. Waste management deals with all types of waste, including industrial,
biological and household. In some cases, waste can pose a threat to human health.
Health issues are associated throughout the entire process of waste management.
Health issues can also arise indirectly or directly. Directly, through the handling of said
waste, and indirectly through the consumption of water, soil and food. Waste is
produced by human activity, for example, the extraction and processing of raw

41
material Waste management is intended to reduce adverse effects of waste on
human health, the environment, planetary resources and aesthetics.
Waste management practices are not uniform among countries
(developed and developing nations); regions (urban and rural areas),
and residential and industrial sectors can all take different approaches

9.2 classification and type of waste

 Physical state

Solid waste

Liquid waste

Gaseous waste

 Source

Household/Domestic waste

Industrial waste

Agricultural waste o Commercial waste

Demolition and construction waste

Mining waste

 Environmental impact

Hazardous waste o

Non-hazardous waste

9.3 methods of waste disposal

42
  Recycling

Recycling refers to both the direct reuse of used products (e.g. used clothing and
functioning parts removed from used vehicles) and material recycling, that is the
recovery of raw materials from waste (e.g. production of new glass from fragments, the
melting of scrap iron and the production of recycled building materials from
construction waste).

Downcycling refers to the transformation of waste to materials of lower quality than the
initially used material.

 Incineration

Combustible waste from households and waste wood that is not suitable for recycling
undergo thermal treatment in waste incineration plants or waste wood furnaces. The
heat released in the process is used to generate electricity and heat buildings. Waste
with a high calorific value and low level of pollutant contamination can be used in
industrial plants, e.g. cement plants, as an alternative to fossil fuels. Waste that is
contaminated with organic pollutants undergoes separate thermal treatment (e.g. in
hazardous waste incineration plants). Incinerators must have a flue gas treatment
system. The requirements for flue gas treatment and the incineration system are based
on the nature of the waste.

Specialised waste disposal companies treat the waste in accordance with the
requirements of the incineration plant. This guarantees that the fuel will be of a high
quality and reduces the accident risk. The companies ensure, for example, that no
undesirable reactions occur when liquids are mixed. Waste materials that are used as
substitute fuels in cement plants must be crushed in advance and set at a constant
calorific value.

 Chemical-physical and biological treatment

The objective of both chemical-physical and biological treatment is to enable the

removal of pollutants from waste or its safe landfilling. Wastewater and polluted

43
excavated material are typical of the types of waste that are managed in this way.
Following chemical-physical treatment, the pollutants can be disposed of in
concentrated form in facilities suitable for this purpose.

 Landfills

Residues from waste incineration or waste that is not suitable for material recycling or
thermal treatment are deposited in landfills that are compliant with the legal
requirements. If the waste does not fulfil the requirements for landfilling, it must be pre-
treated.

 Collection and logistics

The waste management sector involves many different specialised actors. Their tasks
include the collection of waste at source (industry, commerce and households) in
suitable transport containers, its intermediate storage and handover to waste disposal
operations. The treatment of waste is often based on a cascade of specialised plants.
In all cases, smooth logistics are a precondition for the efficient management of waste.
In the case of hazardous waste, in accordance with the Ordinance on Movements of
Waste, the handover must be documented.

 Waste Compaction

The waste materials such as cans and plastic bottles are compacted into blocks and
sent for recycling. This process prevents the oxidation of metals and reduces airspace
need, thus making transportation and positioning easy.

 Biogas Generation

Biodegradable waste, such as food items, animal waste or organic industrial waste
from food packaging industries are sent to bio-degradation plants. In bio-degradation

44
plants, they are converted to biogas by degradation with the help of bacteria, fungi, or
other microbes. Here, the organic matter serves as food for the micro-organisms. The
degradation can happen aerobically (with oxygen) or anaerobically (without oxygen).
Biogas is generated as a result of this process, which is used as fuel, and the residue is
used as manure.

 Composting

All organic materials decompose with time. Food scraps, yard waste, etc., make up for
one of the major organic wastes we throw every day. The process of composting starts
with these organic wastes being buried under layers of soil and then, are left to decay
under the action of microorganisms such as bacteria and fungi.

This results in the formation of nutrient-rich manure. Also, this process ensures that the
nutrients are replenished in the soil. Besides enriching the soil, composting also
increases the water retention capacity. In agriculture, it is the best alternative to
chemical fertilizers.

 Vermicomposting

Vermicomposting is the process of using worms for the degradation of organic matter
into nutrient-rich manure. Worms consume and digest the organic matter. The by-
products of digestion which are excreted out by the worms make the soil nutrient-rich,
thus enhancing the growth of bacteria and fungi. It is also far more effective than
traditional composting.

Chapter Ten

45
 Controls of vectors

10.1 Definition

Vector control is any method to limit or eradicate the mammals, birds, insects or other
arthropods (here collectively called “vectors”) which transmit disease pathogens. The
most frequent type of vector control is mosquito control using a variety of strategies.
Several of the “neglected tropical diseases” are spread by such vectors.

10.2 Methods of control

Vector control focuses on utilizing preventive methods to control or eliminate vector

populations. Common preventive measures are:

 Habitat and environmental control

Removing or reducing areas where vectors can easily breed can help limit their growth.
For example, stagnant water removal, destruction of old tires and cans which serve as
mosquito breeding environments, and good management of used water can reduce
areas of excessive vector incidence.

Further examples of environmental control is by reducing the prevalence of open

defecation or improving the designs and maintenance of pit latrines. This can reduce
the incidence of flies acting as vectors to spread diseases via their contact with feces
of infected people.

 Reducing contact

46
Limiting exposure to insects or animals that are known disease vectors can reduce
infection risks significantly. For example, bed nets, window screens on homes, or
protective clothing can help reduce the likelihood of contact with vectors. To be
effective this requires education and promotion of methods among the population to
raise the awareness of vector threats.

 Chemical control

Insecticides, larvicides, rodenticides, Lethal ovitraps and repellents can be used to

control vectors. For example, larvicides can be used in mosquito breeding zones;
insecticides can be applied to house walls or bed nets, and use of personal repellents
can reduce incidence of insect bites and thus infection. The use of pesticides for vector
control is promoted by the World Health Organization (WHO) and has proven to be
highly effective.

 Biological control

The use of natural vector predators, such as bacterial toxins or botanical compounds,
can help control vector populations. Using fish that eat mosquito larvae, the use cat fish
to eat up mosquito larvae in pond can eradicate the mosquito population, or reducing
breeding rates by introducing sterilized male tsetse flies have been shown to control
vector populations and reduce infection risks.

10.3. Importance of vector control

For diseases where there is no effective cure, such as Zika virus, West Nile
fever and Dengue fever, vector control remains the only way to protect human
populations.
However, even for vector-borne diseases with effective treatments the high cost of
treatment remains a huge barrier to large amounts of developing world populations.
Despite being treatable, malaria has by far the greatest impact on human health from
vectors. In Africa, a child dies every minute of malaria; this is a reduction of more than

47
50% since 2000 due to vector control. In countries where malaria is well established the
World Health Organization estimates countries lose 1.3% annual economic income due
to the disease. Both prevention through vector control and treatment are needed to
protect populations.
As the impacts of disease and virus are devastating, the need to control the vectors in
which they carried is prioritized. Vector control in many developing countries can have
tremendous impacts as it increases mortality rates, especially among infants. Because
of the high movement of the population, disease spread is also a greater issue in these
areas.
As many vector control methods are effective against multiple diseases, they can be
integrated together to combat multiple diseases at once. The World Health
Organization therefore recommends "Integrated Vector Management" as the process
for developing and implementing strategies for vector control.

Chapter Eleven.

48
 Water supply.

11.1 Introduction

The quality of water, whether used for drinking, agriculture or recreational purposes, is
significant for health in all populations. In Wales, water companies supply drinking
water that is wholesome and safe, in accordance with relevant water quality standards.

Occasionally, elevated levels of harmful chemicals may be present in water, from

natural sources, agricultural or industrial activities, or following accidental release.
Consuming water that has been contaminated with such chemicals has the potential to
lead to both acute and long term health effects. Drinking water may also be responsible
for the spread of infectious diseases if biologically contaminated.

Human health and well-being are strongly affected by the environment in which we live
— the air we breathe, the water we drink, and the food and nutrients we eat. Community
water systems and water safety plans are important ways to ensure the health of the
community.

In many places, communities lack the capacity to effectively adapt their current
systems for water, sanitation, and hygiene to the community’s changing needs
(population growth, changes in water quality).

According to the World Health Organization, the objectives of a water safety plan are to
ensure safe drinking water through good water supply practices, which include:

 Preventing contamination of source waters;

 Treating the water to reduce or remove contamination that could be present to
the extent necessary to meet the water quality targets; and
 Preventing re-contamination during storage, distribution, and handling of drinking
water.

11.2. Sources of water

49
 Community water systems obtain water from two sources: surface water and
ground water. People use surface and ground water every day for a variety of
purposes, including drinking, cooking, and basic hygiene, in addition to recreational,
agricultural, and industrial activities. According to the United States Environmental
Protection Agency (EPA), the majority of public water systems (91%) are supplied by
ground water; however, more persons (68%) are supplied year-round by community
water systems that use surface water. This is because large, well-populated
metropolitan areas tend to rely on surface water supplies, whereas small, rural areas
tend to rely on ground water.

Surface Water

Surface water is water that collects on the ground or in a stream, river, lake, reservoir,
or ocean. Surface water is constantly replenished through precipitation, and lost
through evaporation and seepage into ground water supplies. According to the EPA,
68% of community water system users received their water from a surface water
source, such as a lake.

Ground Water
Ground water, which is obtained by drilling wells, is water located below the ground
surface in pores and spaces in the rock, and is used by approximately 78% of
community water systems in the United States, supplying drinking water to 32% of
community water system users (1). EPA also estimates that approximately 15% of the
U.S. population relies on private ground water wells

11.3. Source Water Protection

Even though most community drinking water (especially from surface water sources) is
treated before entering the home, the cost of this treatment and the risks to public
health can be reduced by protecting source water from contamination. We all live in a
watershed, which is an area that drains to a common waterway such as a stream, lake,
wetland, or ocean. EPA and many other organizations collaborate with communities to
work toward protecting watersheds.

50
In Africa, water sources should be fenced such that roddents, animals don’t invade the
source and contaminate it. Agricultural activities should not be performed in such areas
as well. Pipes connected should be buried a little deep and not exposed to sunlight.

11.4 Water, Sanitation and Hygiene

The benefits of having access to an improved drinking water source can only be fully
realized when there is also access to improved sanitation and adherence to good
hygiene practices. Beyond the immediate, obvious advantages of people being hydrated
and healthier, access to water, sanitation and hygiene – known collectively as WASH –
has profound wider socio-economic impacts, particularly for women and girls.

The fact that WASH is the subject of dedicated targets within the Sustainable
Development Goal (SDG 6) is testament to its fundamental role in public health and
therefore in the future of sustainable development. Indeed, access to safe water and
sanitation are human rights, as recognized in 2010 by the United Nations General
Assembly. For universal fulfilment of these rights to become reality, we will need the
right systems: well-resourced, capable institutions delivering services and changing
behaviour in resilient and appropriate ways.

Water

A person without access to improved drinking water – for example from a protected
borehole well or municipal piped supply for instance – is forced to rely on sources such
as surface water, unprotected and possibly contaminated wells, or vendors selling water
of unverifiable provenance and quality.

For many communities, water sources are usually far from their homes, and it typically
falls to women and girls to spend much of their time and energy fetching water, a task
which often exposes them to attack from men and even wild animals

Sanitation

Without improved sanitation – a facility that safely separates human waste from human

51
contact – people have no choice but to use inadequate communal latrines or to practise
open defecation. For women and girls, finding a place to go to the toilet outside, often
having to wait until the cover of darkness, can leave them vulnerable to abuse and
sexual assault.

In the immediate environment, exposed faecal matter will be transferred back into
people’s food and water resources, helping to spread serious diseases such as cholera.
Beyond the community, the lack of effective waste disposal or sewerage systems can
contaminate ecosystems and contribute to disease pandemics.

Hygiene

In some parts of the world there is little or no awareness of good hygiene practices and
their role in reducing the spread of disease. However, it is often the case that even when
people do have knowledge of good hygiene behaviour, they lack the soap, safe water
and washing facilities they need to make positive changes to protect themselves and
their community.

WASH and health

The impact of universal access to WASH on global health would be profound. There is
the potential to save the lives of the 829,000 people who currently die every year from
diseases directly caused by unsafe water, inadequate sanitation and poor hygiene
practices, and we could also drastically reduce child malnourishment, and help alleviate
physical and mental under-development. Today, 50% of child malnutrition is associated
with unsafe water, inadequate sanitation and poor hygiene. Women and girls would
have the facilities and knowledge to be able to manage their menstrual cycles in safety
and dignity. Similarly, during pregnancy, childbirth, and post-natal care, medical staff,
expectant mothers and their families will be better equipped to ensure newborn children
are given the safest and healthiest possible start in life.

52
Chapter Twelve

Relations environmental factors and rural exodus.

Rural flight (or rural exodus) is the migratory pattern of peoples from rural areas into

53
urban areas. ... Rural flight is exacerbated when the population decline leads to the loss
of rural services (such as business enterprises and schools), which leads to greater loss
of population as people leave to seek those features.

Extreme environmental events such as hurricanes, tsunamis, floods and landslides can
Also cause immediate loss of income and therefore encourage population
displacement. However these displacements tend to be at short distance and often
within the same state.

However, there are multiple drivers of migration and rather than trying to identify
‘environmental Migrants’, which may be difficult or even impossible, it might be more
helpful to examine all Drivers of migration and then focus on how environmental
changes might influence them.

The framework produced for this study does exactly that. On a large scale the

Researchers identified five main factors which influence people’s decision to stay or go:

1. Economic: which includes employment opportunities, income and the price of living.

2. Social: which includes the search for educational opportunities or obligations to kin,
such as marriage or inheritance practices.

3. Political: which includes discrimination or persecution, conflict, levels of security and

policy incentives, for example a change in land ownership policy.

4. Demographic, which includes population density and structure and risk of disease.

5. Environmental, including exposure to hazards and land productivity and habitability.

54