ENVIRONMENT AND HUMAN HEALTH

Why to study environment and human health

Climate change is already happening and represents one of the greatest environmental, social and economic threats facing the planet.

 Aflatoxins has been identified as risk factors for

developing liver cancer in people infected with hepatitis B virus_ (EHP 118:818-824 Liu and Wu)  Study shows association between psychological stress and adverse physiological effects from exposures to air pollution (EHP 118:769-775; Clougherty et al)  Chlorine gas released in Shivari, 3 died 60 affected

water contamination. Population growth and the associated pressures of development are increasing the difficulties associated with sustaining effective public health practices and policies.Why to study environment and human health Public health problems caused by environmental contamination and emerging infectious diseases are a growing concern worldwide. airborne contaminants. . bioaccumulation of contaminants in the food chain. and environmental threats to public health the world over require marshalling of all our scientific knowledge and knowhow to develop new solutions. Vector-borne disease. These public health threats are affected by the relationship between people and the physical. Understanding environmental and ecological health is a prerequisite to protecting public health. chemical. and biological nature of our natural environments.

Environmental health is the branch of public health that is concerned with all aspects of the natural and built environment that may affect human health. Other terms that concern or refer to the discipline of environmental health include environmental public health and environmental health and protection. .

urban development. psychological. includes both the direct pathological effects of chemicals. social and aesthetic environment which includes housing. and the effects on health and wellbeing of the broad physical. Environmental health as used by the WHO Regional Office for Europe.Environmental health is defined by the World Health Organization as: Those aspects of the human body human health and disease that are determined by factors in the environment. radiation and some biological agents. land use and transport . It also refers to the theory and practice of assessing and controlling factors in the environment that can potentially affect health.

Environmental health services are defined by the World Health Organization as: implement environmental health policies through monitoring and control activities. promoting the improvement of environmental parameters and by encouraging the use of environmentally friendly and healthy technologies They also have a leading role in developing and suggesting new policy areas. .

land use. who was instrumental in the repeal of the poor laws and was the founding president of the Association of Public Sanitary Inspectors in 1884. recreational swimming areas and waters. which today is the Chartered Institute of Environmental Health. . vector control. The environmental health profession had its modern-day roots in the sanitary and public health movement of the United Kingdom. solid. institutional environmental health. drinking water quality. enforcement. and hazardous materials management. community noise control. but is not limited to. housing. emergency preparedness."Scope of practice in environmental health" means the practice of environmental health by registered environmental health specialists in the public and private sector within the meaning of this article and includes. on-site septic systems. liquid. education. underground storage tank control. consultation. and emergency response for the purpose of prevention of environmental health hazards and the promotion and protection of the public health and the environment in the following areas: food protection. electromagnetic radiation control. water sanitation. organization. management. This was epitomized by Sir Edwin Chadwick. and milk and dairy sanitation.

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Appreciation of this scale and type of influence on human health requires a new perspective which focuses on ecosystems and on the recognition that the foundations of long-term good health in populations rely in great part on the continued stability and functioning of the biosphere's life-supporting systems. .INTRODUCTION Large-scale and global environmental hazards to human health include climate change. stratospheric ozone depletion. It also brings an appreciation of the complexity of the systems upon which we depend. loss of biodiversity. changes in hydrological systems and the supplies of freshwater. land degradation and stresses on food-producing systems.

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Climate variability and change cause death and disease through natural disasters. Concerted action to strengthen key features of health systems. and changes the way we must look at protecting vulnerable populations. . and in densely populated coastal areas. such as heat waves. can enhance public health now as well as reduce vulnerability to future climate change. floods and droughts. The most recent report of the Intergovernmental Panel on Climate Change confirmed that there is overwhelming evidence that humans are affecting the global climate. The impacts of climate on human health will not be evenly distributed around the world. Fortunately. and to promote healthy development choices. are considered to be particularly vulnerable.Climate Change and Human Health Climate change is a significant and emerging threat to public health. and highlighted a wide range of implications for human health. arid and high mountain zones. Developing country populations. particularly in Small Island States. much of the health risk is avoidable through existing health programmes and interventions.

There are also well founded concerns about the need to understand and assess the impacts of modern food biotechnology on human health. many of nature's chemicals and genes. An important consequence for humans is the disruption of ecosystems that provide nature's goods and services. .Biodiversity There is growing concern about the health consequences of biodiversity loss and change. Biodiversity loss also means that we are losing. before discovery. of the kind that have already provided humankind with enormous health benefits.

. compaction. Land change damaged by erosion.Desertification Increasing pressures of agricultural and livestock production are stressing the world's arable lands and pastures. which include increased poverty. population displacement. salination or chemicals . water.borne diseases.foodand vector. and we observe impacts related to nutrition.has impacts on health. and air pollution. Desertification affects human health through complex pathways.

Only a small fraction is available in rivers.Freshwater Freshwater is essential to maintain human health. about 2. Of all the water available on Earth. lakes and underground. and a good part is inaccessible to us. By protecting freshwater ecosystems we are also protecting our health. It is also essential for maintaining many of the ecosystems which provide our food and other essential goods and services. .5% is fresh. Increased water use as well as increased pollution means that the amount of usable freshwater is decreasing.

which in turn increases human exposure to ultraviolet radiation. The World Health Organization. UV radiation and health It has been recognized for several decades that the release of chlorofluorocarbons and other atmospheric pollutants depletes stratospheric ozone.have developed and promote the UV Index. and partner organizations .through the Intersun project . The recognition of direct effects on human health effects was a major stimulus to the Montreal Protocol. which acts to reduce emissions of pollutants that weaken the ozone layer. Although this international agreement is proving highly effective in reducing risks in the long term. causing skin cancer and cataracts. UV radiation remains a health hazard.Stratospheric ozone depletion. a tool to inform and educate the public about sun protection .

and to the development of antimicrobial resistance. The area of special concern in the twenty-first century is diseases due to change in environment and its antimicrobial resistance. The effective control of diseases in the new millennium will require effective public health infrastructures that will rapidly recognize and respond to them and will prevent emerging problems . Changes in society. the reemergence of diseases once controlled. various different diseases remain an important global problem in public health. technology and the microorganisms themselves are contributing to the emergence of new diseases.Changing patterns of diseases Despite a century of often successful prevention and control efforts. causing over 13 million deaths each year.

the environment. and parasitic diseases have emerged within the past two decades. . Addressing emerging infectious diseases will require international and interdisciplinary partnerships to build an appropriate infrastructure to detect and respond to these often unanticipated threats to health. fungal. and these changes have had often unpredictable consequences. At the same time. Important factors influencing emergence include changes in human demographics and behaviour. microbial adaptation and change. and the microbes themselves.contd« Emerging diseases pose important public health problems for both the developed and developing world. increasing and rapid international travel and commerce. technology. many once-controlled infections have re-emerged or become resistant to antimicrobial therapy. viral. changes in economic development and land use. and the breakdown of public health measures. changes in technology and industry. This emergence is the result of changes in society. Many new or previously unrecognized bacterial.

The extent and nature of climate change impacts on human health vary by region. can indirectly impact the incidence of serious infectious diseases. while climate-related disturbances in ecological systems. the prevalence of some diseases and other threats to human health depend largely on local climate. individual behavior and individual vulnerability (e. emotional well-being.g.. warm temperatures can increase air and water pollution. by the extent and duration of exposure to climate change itself and by society·s ability to adapt to or cope with the change. which in turn harm human health. political. In addition. including urbanization. economic. gender and economic status). . Human health is strongly affected by social. age. such as changes in the range of infective parasites. by relative vulnerability of population groups.Health Throughout the world. nutritional status. genetic makeup. Extreme temperatures can directly lead to loss of life. environmental and technological factors. scientific developments. affluence.

eat.Changing pattern of disease with environment changes genetic inheritance plays a limited role in determining our health. and into early and late adulthood. environmental factors either directly impact biological tissues or influence gene expression and shape subsequent disease risks. how we live. . and breathe. work. and play-the quality of what we drink. throughout development. From the time of conception.

Although links between exposures to environmental contaminants and health impacts have been known for centuries. or polychlorinated biphenyls (PCBs) can permanently damage the developing brain of a child Early exposures to dioxin or polychlorinated biphenyls (PCBs) damages the developing immune system Risks of asthma and high blood pressure are increased by early environmental exposures Recent research from Sweden concludes not only that environmental factors play a more important role than genetic inheritance in the origin of most cancers. but also that cancer risk is largely established during the first 20 years of life . recent research documents an expanding list of previously unrecognized effects after fetal or infant exposures The developing fetus and child are particularly vulnerable to toxic insults. mercury. children are often disproportionately exposed to toxic environmental agents lead.

Some birth defects. however. reproductive. are increasingly common Sperm counts and fertility are in decline in some areas of the U. Asthma is more common and more severe than ever before improved understanding of development of the brain and the immune. families. and cardiovascular systems leads to the conclusion that other environmental factors play a major role in determining current patterns of disease. and these numbers appear to be increasing The age-adjusted incidence of melanoma. bladder cancers has steadily increased over the past 25 years. brain. trends are difficult to determine accurately.S (17 percent) suffer from one or more developmental disabilities.S. kidney. disease incidence is increasing.Technological developments have dramatically reduced mortality resulting from many diseases. . lung (female). The burden from current patterns of disease and disability is enormous and extracts a terrible toll from individuals. including disorders of the male reproductive system and some forms of congenital heart disease. non-Hodgkin's. and communities. thyroid. breast. In many instances. Learning disabilities alone affect 5 to 10 percent of children in public schools. liver. respiratory. Nearly 12 million children in the U. and other parts of the world. prostate. although for some conditions without standardized tracking mechanisms.

and mercury contamination of dietary fish.To the limited degree that health care providers address environmental factors at all These are more easily addressed by individuals than more complex problems like air and water pollution. along with the changing pattern of disease and disability. and our increasing understanding of the importance of environmental factors in determining the health of individuals and populations places a new and special responsibility on the medical profession. are changing. agricultural systems that inevitably result in farm worker pesticide exposures. however. Global environmental conditions. . hazardous waste sites.

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Figure C shows the location of gas exchange between the capillaries and alveoli . and the capillaries. alveoli.Figure A shows the location of the respiratory structures in the body. Figure B is an enlarged image of airways.

the lungs and linked blood vessels. called bronchioles . or windpipe Tubes called bronchial tubes or bronchi.respiratory system The respiratory system is a group of organs responsible for carrying oxygen from the air to the bloodstream and expelling the waste product carbon dioxide. The main parts of this system are the airways. and the muscles that enable breathing. or voice box Trachea. The airways include the: Nose and linked air passages called nasal cavities Mouth Larynx. and their branches. Airways The airways are passages that carry oxygen-rich air to the lungs and carbon dioxide out of the lungs.

all of the airways have special hairs called cilia that are coated with sticky mucus. coughed.Air first enters the body through the nose or mouth. or sneezed out of the body.) The air then travels through the larynx box and down the trachea. . they are swallowed. which wets and warms the air. These fine hairs then sweep the particles up to the nose or mouth. There. The trachea divides into two bronchi that enter the lungs. Except for the mouth and some parts of the nose. Nose hairs and mouth saliva also trap particles and germs. dry air can irritate the lungs. (Cold. A thin flap of tissue called the epiglottis covers the trachea when a person swallows. The cilia trap germs and other foreign particles that enter the airways when a person breathes in air. This prevents food or drink from entering the air passages that lead to the lungs.

Lungs and blood vessels The lungs and linked blood vessels deliver oxygen to the body and remove carbon dioxide. Inside the air sacs. Some people need to have a diseased lung lobe removed. The heart pumps the oxygen-rich blood out to the body. they can still breathe well using the rest of their lung lobes. carbon dioxide moves from the blood into the air. thinner tubes called bronchioles. the bronchi branch into thousands of smaller. The pulmonary artery and its branches deliver blood rich in carbon dioxide (and lacking in oxygen) to the capillaries that surround the air sacs. The capillaries connect to a network of arteries and veins that move blood through the body. Within the lungs. Each of these air sacs is covered in a mesh of tiny blood vessels called capillaries. Oxygen moves from the air into the blood in the lungs. The left lung is slightly smaller than the right lung to allow room for the heart. . The oxygen-rich blood then travels to the heart through the pulmonary vein and its branches. The lungs are divided into five main sections called lobes. The lungs lie on either side of the sternum (breastbone) and fill the inside of the chest cavity. These tubes end in bunches of tiny round air sacs called alveoli. However.

[2] . Streptococcus pneumoniae or Moraxella catarrhalis Antibiotics have only been shown to be effective if all three of the following symptoms are present:. 50% of patients are colonised with Haemophilus influenzae. increased sputum volume and purulence.increased dyspnoea. Most often it is caused by viral infection and hence antibiotic therapy is not indicated in immuno competent individuals. [ Acute Exacerbations of Chronic Bronchitis (AECB) are frequently due to non-infective causes along with viral ones.Bronchitis can be classified as either acute or chronic. In these cases 500 mg of Amoxycillin orally. every 8 hours for 5 days or 100 mg doxycycline orally for 5 days should be used. Acute bronchitis can be defined as acute bacterial or viral infection of the larger airways in healthy patients with no history of recurrent disease It affects over 40 adults per 1000 each year and consists of transient inflammation of the major bronchi and trachea.

Pneumonia is a serious infection of the small bronchioles and alveoli that can involve the pleura. It is classified as either community or hospital acquired depending on where the patient contracted the infection. It occurs in a variety of situations and treatment must vary according to the situation. A dangerous type of lung infection with a mortality rate of around 25%. The most common treatment is antibiotics and these vary in their adverse effects and their effectiveness. The most common cause of pneumonia is pneumococcal bacteria. . Pneumonia is also the leading cause of death in children less than five years of age. Streptococcus pneumoniae accounts for 2/3 of bacteremic pneumonias.

These muscles include the: Diaphragm Intercostal muscles Abdominal muscles Muscles in the neck and collarbone area .Muscles used for breathing Muscles near the lungs help expand and contract (tighten) the lungs to allow breathing.

viruses.8 million people every year. can be the source of foodborne disease through consumption of the same microorganisms. It was estimated that 88% of that burden is attributable to unsafe water supply. diarrheal disease accounts for an estimated 4. According to the World Health Organization. sanitation and hygiene. used in the preparation of food. Contaminated fresh water. . Waterborne disease can be caused by protozoa. and is mostly concentrated in children in developing countries. or bacteria. many of which are intestinal parasites.Waterborne diseases Waterborne diseases are caused by pathogenic microorganisms which are directly transmitted when contaminated fresh water is consumed.1% of the total and is responsible for the deaths of 1.

the origin of drinking water [3] Diarrhea and wasting in immunocompromised individuals . bloating.Disease and Transmission Microbial Agent Sources of Agent in Water Supply General Symptoms Amoebiasis (hand-tomouth) Protozoan (Entamoeba histolytica) (Cyst-like appearance) Sewage. muscle aches. diarrhea. nausea Sewage. bloating. loss of appetite. fever. animal manure. seasonal runoff of water. Beavers and muskrats create ponds that act as reservoirs for Giardia. non-treated drinking water cramps. leaks. poor disinfection. substantial loss of weight. Diarrhea. and fatigue Giardiasis (oral-fecal) (hand-tomouth) Untreated water. watery diarrhea. weight loss. increased gas. fever Protozoan Cryptosporid (Cryptosporidiu iosis (oral) m parvum) Cyclosporias is Protozoan parasite (Cyclospora cayetanensis) Protozoan (Giardia lamblia) Most common intestinal parasite Protozoan phylum (Microsporidia Collects on water filters and membranes that cannot be disinfected. flies in water supply Abdominal discomfort. vomiting. pipe breaks. nausea. fatigue. abdominal discomfort. Flu-like symptoms. campgrounds where humans and wildlife use same source of water. bloating. and flatulence Microsporidi osis The genera of Encephalitozoon intestinalis has been detected in groundwater. non-treated drinking water. groundwater contamination.

Abdominal pain. liver enlargement. vomiting. if cysts rupture they can cause anaphylactic shock increases intacranial tension Members of the genus Schistosoma Dracunculiasis (Guinea Worm Disease) Dracunculus medinensis Stagnant water containing larvae Taeniasis Tapeworms of the genus Taenia Drinking water contaminated with eggs Fasciolopsiasis Fasciolopsis buski Drinking water contaminated with encysted metacercaria Hymenolepiasis (Dwarf Tapeworm Infection) Hymenolepis nana Drinking water contaminated with eggs Echinococcosis (Hydatid disease) Echinococcus granulosus Drinking water contaminated with feces (usually canid) containing eggs coenurosis multiceps multiceps contaminated drinking water with eggs . nausea. itching around the anus. cholangitis. obstructive jaundice. Fever. chills. diarrhea. loss of weight.Disease and Transmission Schistosomiasis (immersion) Microbial Agent Sources of Agent in Water Supply Fresh water contaminated with certain types of snails that carry schistosomes General Symptoms Rash or itchy skin. Intestinal disturbances. nervous manifestation Liver enlargement. anorexia. asthmatic attack. cysticercosis GIT disturbance. neurologic manifestations. cholecystitis. cough. and muscle aches Allergic reaction. hydatid cysts press on bile duct and blood vessels. diarrhea. urticaria rash.

Mostly diarrhea. blurred and/or double vision. Lesions may be painless or painful. In severe forms it is known to be one of the most rapidly fatal illnesses known. rare infection since it mostly infects immunocompromised individuals Symptoms include lesions typically located on the elbows. at which point death can occur in 12±18 hours. the very young. nosebleed. coli Infection Certain strains of Escherichia coli (commonly E. marinum infection Mycobacterium marinum Naturally occurs in water. cramps. vomiting. most cases from exposure in swimming pools or more frequently aquariums. and hypovolemic shock (in severe cases). slurred speech. Symptoms include very watery diarrhoea. Can cause death in immunocompromised individuals. . nausea. and the elderly due to dehydration from prolonged illness. vomiting and sometimes diarrhea. Cholera Spread by the bacterium Vibrio cholerae Drinking water contaminated with the bacterium E. and feet (from swimming pools) or lesions on the hands (aquariums). coli) Water contaminated with the bacteria M. knees. Usually lasts 2±10 days.Disease and Transmissio n Microbial Agent Sources of Agent in Water Supply General Symptoms Botulism Clostridium botulinum Bacteria can enter a wound from contaminated water sources. difficulty breathing. Can enter the gastrointestinal tract by consuming contaminated drinking water or (more commonly) food Drinking water contaminated with feces Dry mouth. Campylobac teriosis Most commonly caused by Campylobacter jejuni Produces dysentery like symptoms along with a high fever. rapid pulse. muscle weakness.

and renal failure Otitis Externa (swimmer¶s ear) Caused by a number of bacterial and fungal species. liver damage (causes jaundice). malaise and occasionally diarrhea and vomiting Leptospirosis Caused by bacterium of genus Leptospira Water contaminated by the animal urine carrying the bacteria Begins with flu-like symptoms then resolves. Legionnaires¶ disease has severe symptoms such as fever. pneumonia (with cough that sometimes produces sputum). muscle aches. chills. The second phase then occurs involving meningitis. anorexia. Pontiac fever produces milder symptoms resembling acute influenza without pneumonia. Swimming in water contaminated by the responsible pathogens Ear canal swells causing pain and tenderness to the touch . ataxia. Legionellosis (two distinct forms: Legionnaires¶ disease and Pontiac fever) Caused by bacteria belonging to genus Legionella (90% of cases caused by Legionella pneumophila) Contaminated water: the organism thrives in warm aquatic environments.Dysentery Caused by a number of species in the genera Shigella and Salmonella with the most common being Shigella dysenteriae Water contaminated with the bacterium Frequent passage of feces with blood and/or mucus and in some cases vomiting of blood.

diarrhea. less commonly a rash may occur. and occasionally fever. vomiting. In this case it can last up to four weeks and cause death. fever. . abdominal cramps. Symptoms progress to delirium and the spleen and liver enlarge if untreated. Symptoms include diarrhea. profuse sweating. vomiting. Also got by drinking contaminated water or eating undercooked oysters. nausea.Salmonellosis Caused by many bacteria of genus Salmonella Drinking water contaminated with the bacteria. Vibrio alginolyticus. watery diarrhea. Vibrio Illness Vibrio vulnificus. and abdominal cramps Typhoid fever Salmonella typhi Ingestion of water contaminated with feces of an infected person Characterized by sustained fever up to 40°C (104°F). and Vibrio parahaemolyticus Can enter wounds from contaminated water. Symptoms include explosive. More common as a food borne illness.

nausea. gastrointestinal symptoms. jaundice and depression. Enteric Adenovirus. kidneys or can cause progressive multifocal leukoencephalopathy in the brain (which is fatal). JC virus infects the respiratory system. fever. ~80% of the population has antibodies to Polyomavirus . and abdominal pain Symptoms include fever. Adenovirus Astrovirus. headache. malaise. and bronchitis Symptoms include diarrhea. can manifest itself in water. abdominal pain. 4-8% have minor symptoms (comparatively) with delirium.Disease and Transmission Adenovirus infection Microbial Agent Sources of Agent in Water Supply Manifests itself in improperly treated water Manifests itself in improperly treated water Manifests itself in improperly treated water General Symptoms Symptoms include common cold symptoms. myalgia. fever. and sore throat Symptoms are only acute (no chronic stage to the virus) and include Fatigue. The rest have serious symptoms resulting in paralysis or death BK virus produces a mild respiratory infection and can infect the kidneys of immunosuppressed transplant patients. nausea. and Parvovirus Coronavirus Gastroenteritis SARS (Severe Acute Respiratory Syndrome) Hepatitis A Hepatitis A virus (HAV) Can manifest itself in water (and food) Poliomyelitis (Polio) Poliovirus Enters water through the feces of infected individuals Polyomavirus infection Two of Polyomavirus: JC virus and BK virus Very widespread. diarrhea. pneumonia. itching. and occasional seizures. lethargy. 90-95% of patients show no symptoms. and spastic paralysis. fever. Calicivirus. 1% have symptoms of non-paralytic aseptic meningitis. vomiting. croup. cough. weight loss.

it's common among children ages 1 to 5.Cholera In India. it's equally distributed among all age-groups. Causes of Cholera The most common cause of cholera is: It is caused by a germ known as ³Vibrio Cholerae´ Exposure from poor hygiene Eating raw or undercooked food. shellfish Susceptibility to cholera may be increased by a deficiency or an absence of hydrochloric acid. . but in other endemic areas.

uncomplicated diarrhea to severe. Low Blood Pressure. The infected person has several symptoms which can be characterized by: Abdominal cramps. Dry mouth. Some infected people have no symptoms. Without treatment. Vomiting. . Watery diarrhea. Rapid heart rate. Leg cramps. Unusual sleepiness. Tiredness. Dry skin. Low urine output. Diarrhea. Sunken eyes. death can occur within hours. potentially fatal disease. rapid loss of body fluids leads to dehydration and shock.Signs & Symptoms of Cholera Symptoms begin 1 to 3 days after infection and range from mild. In the infected persons. but sometimes can be severe. The infection is often mild or without symptoms. Dehydration. Excessive thirst. Nausea.

A doctor confirms a diagnosis of cholera by recovering the bacteria from rectal swabs or from fresh stool samples. All food isolates must be tested for the production of cholera enterotoxin. Cholera can be confirmed only by the isolation of the causative organism from the diarrheic stools of infected individuals. Cholera requires immediate treatment because of watery diarrhea. . tentative diagnosis. A dark-field microscopic examination of fresh feces showing rapidly moving bacilli allows for a quick. so the doctors are likely to begin dehydration before a definitive diagnosis is made.Diagnosis of cholera Cholera is diagnosed by taking the stool sample and to identify the bacteria that can cause cholera.

Preventions of Cholera Cholera is usually transmitted through contaminated water or food. food safety. and hygiene are inadequate. Outbreaks can occur in any part of the world where water supply. Make sure all vegetables are cooked properly Avoid foods and beverages from street vendors Check for proper sanitation and water purification systems Give liquid bland foods. Drink only boiled water chlorine or iodine treatment Eat only thoroughly cooked food and are still hot Avoid undercooked or raw fish or shellfish. Health education aimed at behaviour change is thus an important component of cholera prevention and control . lemon. onions and mint to the patient Vegetables and fruits must be washed with solution of potassium permanganate New Vaccines for cholera are available and appear to provide a somewhat better immunity and fewer side-effects than the previously available vaccine. sanitation.

Treatments of Cholera Cholera is an easily treatable disease. properly cooked food and cleaned boiled water. The prompt administration of oral re-hydration salts to replace lost fluids nearly always results in cure. Rigid purification of water supply and proper disposal of human excreta. cholera can kill quickly. Water and electrolyte replacement are essential treatments for cholera. . Use of highly hygienic. If left untreated. Use of antibiotics Hands that touch cholera patients or their clothing and bedding should be thoroughly cleaned and sterilized.

Heavy metals induced disease .

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bacteria. Weather affects vector population dynamics and disease transmission. with temperature and humidity considered key variables. the vector. . protozoa. which are commonly arthropods such as ticks or mosquitoes. The distribution of the incidence of vector-borne diseases is grossly disproportionate. and the human host. Nearly half of the world's population is infected by vectorborne diseases. : . or worm. either a virus. resulting in high morbidity and mortality. with the overwhelming impact in developing countries located in tropical and subtropical areas.Changes in the Incidence of Vector-borne Diseases Attributable to Climate Change A vector-borne disease is one in which the pathogenic microorganism is transmitted from an infected individual to another individual by an arthropod or other agent The transmission depends upon the attributes and requirements of at least three different living organisms: the pathologic agent.

Treatment. and Control of Vector-borne Diseases .To better understand the potential impact of changes in the incidence of vector-borne diseases attributable to climate change requires examination of the following topics Current Status of Vector-borne Diseases around the World Environmental Parameters That Affect the Incidence of Vector-borne Diseases Models That Predict Changes in the Incidence of Vector-borne Diseases Attributable to Climate Change Possible Direct and Indirect Effects of Climate Change on Specific Vector-borne Diseases Programs for Surveillance.

which are commonly reported from India.falciparum is the most deadly form of malaria. Plasmodium malariae (P.ovale) It is transmitted by the infective bite of Anopheles mosquito Man develops disease after 10 to 14 days of being bitten by an infective mosquito There are two types of parasites of human malaria. Inside the human host.malariae) and Plasmodium ovale (P. Plasmodium vivax. P.vivax). (Plasmodium is a protozoan parasite) The parasite completes life cycle in liver cells (pre-erythrocytic schizogony) and red blood cells (erythrocytic schizogony Infection with P. caused by parasites known as Plasmodium viviax (P.falciparum). Plasmodium falciparum (P. . the parasite undergoes a series of changes as part of its complex life cycle. falciparum.INTRODUCTION Malaria is a potentially life threatening parasitic disease.

Gujarat & Karnataka.84 million P. In spite of the fact that today the causative organism is known. harvesting. Assam.HISTORICAL PERSPECTIVE   Malaria has been a major public health problem in India. Chhattisgarh. with high incidence during the rainy season. the name has stuck to this disease. Meghalaya. West Bengal.  MAGNITUDE OF THE PROBLEM Data for the year 2006 reveals the largest numbers of cases in the country were reported by Orissa.79 million cases of malaria (including 0. Arunachal Pradesh.falciparum cases) and 1707 deaths were reported from the country in 2006. Gujarat & Uttar Pradesh and the largest numbers of deaths were reported by Assam followed by Orissa. Rajasthan. 1. . Maharashtra. West Bengal. They postulated that intermittent fevers were due to the 'bad odour' coming from the marshy areas and thus gave the name 'malaria' ('mal'=bad + 'air') to intermittent fevers. coinciding with agriculture. Mizoram. was first recognized by Romans and Greeks who associated it with swampy areas. Intermittent fever. followed by Jharkhand.

Parasites are carried by blood to the brain (cerebral malaria) and to other vital organs. Prostration (inability to sit). Malaria in pregnancy poses a substantial risk to the mother. Pregnant women are less capable of coping with and clearing malaria infections. loss of consciousness.SYMPTOMS OF MALARIA Typically. altered consciousness lethargy or coma Breathing difficulties Severe anaemia Generalized convulsions/fits Inability to drink/vomiting Dark and/or limited production of urine . vomiting and other flu-like symptoms. The parasite infects and destroys red blood cells resulting in easy fatigue-ability due to anemia. malaria produces fever. the fetus and the newborn infant. headache. adversely affecting the unborn fetus.

LIFE CYCLE OF MALARIA PARASITE IN MAN AND MOSQUITO .

radical treatment is necessary for all the cases of malaria to prevent transmission of malaria. (iii) Personal Prophylatic Measures that individuals/communities can take up . Chloroquine is the main anti-malaria drug for uncomplicated malaria. Alternative drugs for chloroquine resistant malaria are recommended as per the drug policy of malaria.MALARIA CONTROL STRATEGIES Early case Detection and Prompt Treatment (EDPT) EDPT is the main strategy of malaria control . Vector Control Chemical Control Use of Indoor Residual Spray (IRS) with insecticides recommended under the programnme Use of chemical larvicides like Abate in potable water Aerosol space spray during day time Malathion fogging during outbreaks Biological Control Use of larvivorous fish in ornamental tanks. fountains etc. Use of biocides.

Screening of the houses with wire mesh Use of bednets treated with insecticide Wearing clothes that cover maximum surface area of the body 4.Use of mosquito repellent creams.e. mats etc. liquids. Community Participation Sensitizing and involving the community for detection of Anopheles breeding places and their elimination NGO schemes involving them in programme strategies Collaboration with CII/ASSOCHAM/FICCI 5. Monitoring and Evaluation of the programme Monthly Computerized Management Information System(CMIS) Field visits by state by State National Programme Officers Field visits by Malaria Research Centres and other ICMR Institutes Feedback to states on field observations for correction actions. filling of the breeding places Proper covering of stored water Channelization of breeding source 6. Environmental Management & Source Reduction Methods Source reduction i. . coils.

Epidemiology Epidemiology is the study of factors affecting the health and illness of populations. and is highly regarded in evidencebased medicine for identifying risk factors for disease and determining . and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. It is considered a cornerstone methodology of public health research.

and provides health-based guidance on levels of exposure to such contaminants. data collection and analysis including the development of statistical models to test hypotheses and the 'writing-up' of results for submission to peer reviewed journals. Environmental Epidemiology identifies and quantifies exposures to environmental contaminants. . provides medical evaluation and surveillance for adverse health effects. conducts risk assessments and risk communication. to study design.The work of communicable and non-communicable disease epidemiologists ranges from outbreak investigation. Environmental epidemiology Environmental Epidemiology is the branch of public health that deals with environmental conditions and hazards that may pose a risk to human health. Epidemiologists may draw on a number of other scientific disciplines such as biology in understanding disease processes and social science disciplines including sociology and philosophy in order to better understand proximate and distal risk factors.

Epidemiological Approach Population-based health management encompasses the ability to: assess the health states and health needs of a target population implement and evaluate interventions that are designed to improve the health of that population Efficiently and effectively provide care for members of that population in a way that is consistent with the community¶s cultural. . policy and health resource values.

Modern population-based health management is complex (medical. health agency operational research and economics to perform: .) provide efficient and effective health care and health guidance to a population. political. Each of these organizations use a population-based health management framework called Life at Risk that combines epidemiological quantitative analysis with demographics. technological. incidence. mathematical etc. Rick Hansen Foundation. health risk factors. Health Canada Tobacco Control Programs. prevalence and mortality statistics (derived from epidemiological analysis) Examples of organizations that use population-based health management that leverage the work and results of epidemiological practice include Canadian Strategy for Cancer Control. Canadian Tobacco Control Research Initiative.

Population Life Impacts Simulations Labour Force Life Impacts Simulations Economic Impacts of Disease Simulations .

g. temperature. and other substances that humans are exposed to. This may apply to individuals (eg: a small amount has no observable effect.Dose-response relationship The Dose-response relationship describes the change in effect on an organism caused by differing levels of exposure (or doses) to a stressor (usually a chemical). concentration of a pollutant. amount of a drug. or to populations (eg: how many people are affected at different levels of exposure). organism under study). intensity of radiation) to the response of the receptor (e. The response is usually death (mortality). is central to determining "safe" and "hazardous" levels and dosages for drugs. a large amount is fatal). and developing dose response models. These conclusions are often the basis for public policy Dose-response curve A dose-response curve is a simple X-Y graph relating the magnitude of a stressor (e.g. . Studying dose response. but other effects (or endpoints) can be studied. potential pollutants.

and other substances that humans are exposed to. micrograms. with the steepest portion in the middle. Commonly. These conclusions are often the basis for public policy . Studying dose response. it is the logarithm of the dose that is plotted on the X axis.The measured dose (usually in milligrams. potential pollutants. and in such cases the curve is typically sigmoidal. and developing dose response models. or grams per kilogram of bodyweight) is generally plotted on the X axis and the response is plotted on the Y axis. is central to determining "safe" and "hazardous" levels and dosages for drugs.

when the 50% mark refers to LD50). For most beneficial or recreational drugs. .Dose-response curve A The first point along the graph where a response above zero is reached is usually referred to as a threshold-dose. The stronger a particular substance is. undesired side effects appear and grow stronger as the dose increases. Such a curve is referred to as a quantal dose response curve. the desired effects are found at doses slightly greater than the threshold dose. destinguishing it from a graded dose response curve. where response is continuous. At higher doses still. the Y-axis usually is designated by percentages. In quantitative situations. the steeper this curve will be. which refer to the percentage of users registering a standard response (which is often death.

they are not really toxic responses. knowing the dose-response relationship is a necessary part of understanding the cause and effect relationship between chemical exposure and illness. is in regard to true allergic reactions.The science of toxicology is based on the principle that there is a relationship between a toxic reaction (the response) eg poison received (the dose). The toxic effects on an organism are related to the amount of exposure. Allergic responses are the result of a chemical stimulating the body to release natural chemicals which are in turn directly responsible for the effects seen. Keep in mind that the toxicity of a chemical is an inherent quality of the chemical and cannot be changed without changing the chemical to another form. For all other types of toxicity. An important assumption in this relationship is that there is almost always a dose below which no response occurs or can be measured. . One particular instance in which this dose-response relationship does not hold true. Allergic reactions are special kinds of changes in the immune system. A second assumption is that once a maximum response is reached any further increases in the dose will not result in any increased effect. The difference between allergies and toxic reactions is that a toxic effect is directly the result of the toxic chemical acting on cells.

MEASURES OF EXPOSURE Exposure to poisons can be intentional or unintentional. The effects of exposure to poisons vary with the amount of exposure, which is another way of saying "the dose.³ Usually when we think of dose, we think in terms of taking one vitamin capsule a day or two aspirin every four hours, or something like that. Contamination of food or water with chemicals can also provide doses of chemicals each time we eat or drink. Some commonly used measures for expressing levels of contaminants are listed in table These measures tell us how much of the chemical is in food, water or air. The amount we eat, drink, or breathe determines the actual dose we receive. Concentrations of chemicals in the environment are most commonly expressed as ppm and ppb. Government tolerance limits for various poisons usually use these abbreviations. Remember that these are extremely small quantities. For example, if you put one teaspoon of salt in two gallons of water the resulting salt concentration would be approximately 1,000 ppm and it would not even taste salty!

Regardless of how a chemical effect occurs²through binding or chemical interaction²the concentration of the drug at the site of action controls the effect. However, response to concentration may be complex and is often nonlinear. The relationship between the chemical dose, regardless of route used, and the drug concentration at the cellular level is even more complex. Dose-response data are typically graphed with the dose or dose function (eg, log10 dose) on the x-axis and the measured effect (response) on the y-axis. Because a drug effect is a function of dose and time, such a graph depicts the dose-response relationship independent of time. Measured effects are frequently recorded as maxima at time of peak effect or under steady-state conditions (eg, during continuous IV infusion). Drug effects may be quantified at the level of molecule, cell, tissue, organ, organ system, or organism.

Individual Dose-Response Curve .

LD figures depend not only on the species of animal. and other animals die in lethal dose tests performed The most commonly-used lethality indicator is the LD50 (or LD50). a toxic substance inhaled or injected into the bloodstream may require a much smaller dosage than if the same substance is swallowed. in a single dose. but also on the mode of administration." no painkillers are administered.Lethal Dose The lethal dose (or LD) test measures the amount of a toxic substance that will. Animal-based LD measurements are a commonly-used technique in drug research. LD measurements are often used to describe the power of venoms in animals such as snakes. For instance. although many researchers are now shifting away from such methods. rats. about five million dogs. rabbits. a dose at which 50% of subjects will die. . monkeys. Each year. "To avoid interference with results. kill a certain percentage of animals in a test group. LD values for humans are generally estimated by extrapolating results from testing on animals or on human cell cultures.

the decision-maker does not bear all of the costs or reap all of the gains from his or her action.An externality occurs in economics when a decision causes costs or benefits to individuals or groups other than the person making the decision. As a result. In other words.. in a competitive market too much or too little of the good will be consumed from the point of view of society. .

Types of externalities Pollution by a firm in the course of its production which causes nuisance or harm to others. This is an example of a network externality . This may lead to the general acceptance of these phones. sometimes referred to as the Tragedy of the commons. An individual planting an attractive garden in front of his house may benefit others living in the area. The harvesting by one fishing company in the open sea depletes the stock of available fish for the other companies. external cost. external benefit. This is an example of a common property resource. This is an example of a negative externality. This is an example of a positive externality. beneficial externality. or external economy. Over-fishing may result. or external diseconomy. An individual buying a picture-phone for the first time will increase the usefulness of such phones to people who might want to call him or her.

increased traffic. noise pollution. light pollution. while a detrimental impact is called an external cost or negative externality.An advantageous impact is called an external benefit or positive externality. increased tax base for schools and other infrastructure (positive effect). Example: Effects of locating an oil refinery adjacent to a residential neighborhood: air pollution and associated health effects. risk of industrial accident (all negative externalities) and availability of high-paying jobs. .

Example: Sulfur dioxide pollution created by coal-fired electrical generating plant. refining. or manufacturing processes necessary to deliver goods and service to the consumer. service. pollution) created during the extraction. or effect of an action that cannot be assigned monetary values (text).. .e. cultural or personal values which cannot be measured in monetary terms Residuals: Waste products (i. transportation.Intangibles: A good.

. Example: Cost of monitoring sulfur dioxide pollution created by a coalfired electrical generating plant.Incommensurable: Effects of a given action that can. be assigned monetary value. with some effort.

Strategies for the Including Environmental Cost of Doing Business The problem with Common Property Resources Society Pays Polluter Pays Principle Residual tax Effluent (water discharge) charge Consumer Pays Model Incentive-based regulation .

Particular segments of the population such as those with heart problems. . the elderly. emergency managers. and others plan for and respond to excessive heat events. Municipal officials in both the U.S. Environmental Protection Agency has produced the Excessive Heat Events Guidebook with the National Oceanic and Atmospheric Administration (NOAA). The U.Direct Temperature Effects Climate change may directly affect human health through increases in average temperature. and the Department of Homeland Security (DHS). Such increases may lead to more extreme heat waves during the summer while producing less extreme cold spells during the winter. meteorologists. asthma. Increases in average temperatures are expected to result in new record-high temperatures and warm nights (NRC. the Centers for Disease Control and Prevention (CDC). 2001). the very young and the homeless can be especially vulnerable to extreme heat. Designed to help community officials. the guidebook highlights best practices that have been employed to save lives during excessive heat events in different urban areas and provides a menu of options that officials can use to respond to these events in their communities. and Canada provided useful information that can be used to help the public cope with excessive heat.S.

S. and stress-related disorders. . injuries. An increase in the frequency of extreme events may result in more eventrelated deaths.Extreme Events Extreme weather events can be destructive to human health and well-being. The extent to which climate change may affect the frequency and severity of these events. such as hurricanes and extreme heat and floods. Climate Change Science Program. is being investigated by the U. infectious diseases.

temperature and humidity levels must be sufficient for certain disease-carrying vectors. such as ticks that carry Lyme disease. to thrive. climate change will decrease transmission via reductions in rainfall or temperatures that are too high for transmission. dengue fever. . particularly those diseases that appear in warm areas and are spread by mosquitoes and other insects.Climate-Sensitive Diseases Climate change may increase the risk of some infectious diseases. And climate change could push temperature and humidity levels either towards or away from optimum conditions for the survival rate of ticks. algal blooms could occur more frequently as temperatures warm ³ particularly in areas with polluted waters ³ in which case diseases (such as cholera) that tend to accompany algal blooms could become more frequent. and encephalitis. yellow fever. in combination with favorable rainfall patterns. These "vector-borne" diseases include malaria. Higher temperatures. In other locations. Also. For example. could prolong disease transmission seasons in some locations where certain diseases already exist.

Exposure to particle pollution is linked to a variety of significant health problems. can cause ground-level ozone to increase. and is especially harmful for those with asthma and other chronic lung diseases. Sunlight and high temperatures. combined with other pollutants such as nitrogen oxides and volatile organic compounds. Ground-level ozone can damage lung tissue. Climate change may increase the concentration of ground-level ozone. Another pollutant of concern is "particulate matter." also known as particle pollution or PM. Particle pollution also is the main cause of visibility impairment in the nation¶s cities and national parks. Particulate matter is a complex mixture of extremely small particles and liquid droplets. . these particles can reach the deepest regions of the lungs. When breathed in.Air Quality Climate change is expected to contribute to air quality problems. but the magnitude of the effect is uncertain. Climate change may indirectly affect the concentration of PM pollution in the air by affecting natural or ³biogenic´ sources of PM such as wildfires and dust from dry soils. Respiratory disorders may be exacerbated by warming-induced increases in the frequency of smog (ground-level ozone) events and particulate air pollution.