P O P U L AT I O N P R E S S U R E

1. POPULATION, RESOURCE USE, AND ENVIRONMENT

a) Measuring Population Impact
There is no easy way to measure the impact of human activities, including
population growth, on an agreed-upon environment or approach. However
Several approaches have been developed that demonstrate complex
relationships involved (Cohen, 1995; Ehrlich and Holdren, 1971;
Goodland, 1992). One approach to measuring the impact of human use of
natural resources is placing economic value on environmental goods and
services. This includes natural resources such as unpolluted fresh water,
clean air, marine life, forests, and wetlands — resources traditionally
thought of as free goods or common property resource.
 Robert Repetto (1989) of the World Resources Institute, in
criticizing critic this approach, noting that “countries can
deplete their mineral resources, reducing its forests, erodes its
soils, pollutes its aquifers, and hunts its wildlife and fisheries
for extinct, but measurable income will not be affected
because these natural assets are lost” (pp. 2 – 3).
2. POPULATION AND URBANIZATION
If natural resources were valued in the same way that manufactured
assets are valued, that might help economies to use them more effi ciently
and to conserve them in order to ensure continued use in the future. Such
valuations might help indicate the economic as well as ecological benefi ts
of protecting the environment. In other terms, instead of drawing down
their environmental capital, economies could begin to live on its interest
(Goodland, 1992 ).
I=PxAxT

In this equation, I is environmental impact, P is population (including

size, growth, and distribution), A is the level of affl uence (consumption
per capita), and T is the technology used to provide the level of
consumption. The equation also helps to show the importance of slowing
population growthas part of any strategy to reduce humanity ’ s impact on
the environment.
 For example, even if per capita resource consumption ( A) declined or
technologies ( T) improved enough to reduce the environmental impact ( I)
of humanity by 10 percent, this gain would be eroded in less than a decade
if global population ( P) were growing at 1.17 percent per year (UN
Population Fund, 1991 ; UN - DESA, Population Division, 2007)
3. POPULATION AND ENVIRONMENT
Making calculations of how many people could exist on
the Earth under a variety of different scenarios probably is less
important than determining how resources can be used wisely
and managed sustainably to improve living standards without
eventually destroying the natural environment that supports
life itself. Environmentalists, economists, and demographers
increasingly agree that efforts to protect the environment,
achieve better living standards, and slow population growth
tend to be “ mutually reinforcing ”(Roodman, 1998 ). The
World Bank ( 1992 ) too has pointed out that reducing poverty,
protecting the environment, and slowing population growth
are closely linked.
 4.POPULATION - ENVIRONMENT SCORECARD
In 1992, concerned about worsening environmental conditions,
delegates to the United Nations Conference on Environment and
Development (UNCED), held in Rio de Janeiro, Brazil, stressed the need
for action. This Earth Summit , as it was also called, set specifi c goals for
making environmental improvements. Five years later, however, in 1997, a
special session of the UN General Assembly, known as the Rio Plus Five
Conference, found that little progress had been made toward meeting any
of the goals (United Nations Environment Programme, 2000 ). The UN
also found that poverty had increased, in part because of rapid population
growth (UNDP, 1998 ).
a) Arable Land
b) Freshwater
c) Oceans
d) Forests
e) Biodiversity
f) Climate Change
6. POPULATION AND POVERTY
Rapid, unsustainable population growth is a principal
contributor to poverty. Currently, between one in four and one
in fi ve of the Earth ’ s people live in extreme poverty, defi ned
by the World Bank as earning less than $ 1.25 per day (World
Bank, 2008a). Each day, over a billion people in the world
cannot satisfy their basic food needs. This level of poverty
raises profound social justice concerns, and it has obvious
health implications. Each day, 35,000 children under the age
of fi ve die from starvation or from preventable infectious
diseases aggravated by malnutrition.
C L I M AT E C H A N G E
LIMATE change is but one component of global environmental
change that poses widespread risks to human health and well - being.
Among the other aspects of global environmental change are ecosystem
degradation and land use change (discussed in Chapter One ), petroleum
depletion (Chapter Thirteen), urban sprawl (Chapter Fourteen), and water
scarcity (Chapter Fifteen).

1. GREENHOUSE GASES
Higher greenhouse gas concentrations have contributed to warming of
the Earth - an effect called positive radiative forcing - by absorbing and
reemitting infrared radiation toward the lower atmosphere and the Earth ’ s
surface. (Figure 10.1 summarizes the principal components of radiative
FIGURE 10.1 Components of Radiative Forcing
2. A WARMING EARTH: FROM PAST TO FUTURE
Long - term climate change, whether from natural sources or from
human activity, can be observed as a signal against a background of natural
climate variability (Figure 10.2 ).
3. EARTH SYSTEM CHANGES
For these reasons the term climate change is more accurate
than global warming and is the accepted term for this set of
changes. Accordingly, the accelerating temperature changes
noted earlier have been associated with corresponding Earth
system changes (see Table 10.2 ). Since
4. Ocean Temperatures and Hurricanes
Records indicate that sea surface temperatures have
steadily increased over the last one hundred years, and more
sharply over the last thirty - five years. The period from 1995
to 2004 saw the highest average sea surface temperature on
record (Trenberth, 2005 )
FIGURE 10.3 The Melting of Arctic Ice, 1980 - 2007
a) Particularly Vulnerable Regions
Certain regions and populations are more vulnerable than others to the
health impacts of climate change (Hess, Malilay, and Parkinson, 2008 ).
These vulnerable areas include

 Areas or populations within or bordering regions with a high endemicity of

climate - sensitive diseases (for example, malaria)
 Areas with an observed association between epidemic disease and weather
extremes (for example, El Ni ñ o – linked epidemics)
 Areas at risk from combined climate impacts relevant to health (for
example, stress on food and water supplies or risk of coastal fl ooding)
 Areas at risk from concurrent environmental or socioeconomic stresses
(for example, local stresses from land use practices or an impoverished or
undeveloped health infrastructure) and with little capacity to adapt
 5. FOOD PRODUCTION AND MALNUTRITION
Climate change is likely to have major effects on crop and
livestock production and on the viability of fi sheries
(Schimhuber and Tubiello, 2007 ; Tubiello, Soussana,
Howden, and Easterling, 2007 ; Brown and Funk, 2008 ).

a) Drought and Food Production

A recent study using data from twenty - three global
climate models shows a high probability that by the end of the
century, the average growing season temperatures will exceed
the hottest temperatures on record from 1900 to 2006 (Battisi
and Naylor, 2009 ) (Figure 10.4 ).
FIGURE 10.4 Projected Summer Average Temperatures
b) Fisheries and Ocean Warming and Acidification
In addition to warming oceans, climate change is
associated with the acidifi cation of oceans, resulting from
higher CO 2 levels. The threat of ocean acidifi cation has been
relatively recently recognized. Although the effects of ocean
acidification are not fully understood, this process may
threaten marine shell - forming organisms (such as corals) and
their dependent species (Solomon and others, 2007 ). Other
aspects of climate change may also threaten fi sh populations.
For example, the recent slowing of the North Atlantic Gulf
Stream may reduce the abundance of plankton, a major source
of food for many fi sh larvae (Pauly and Alder, 2005 ).
Declining larval fi sh populations will affect the capacity of
overexploited fi sh stocks to recover.
 6. WEATHER EXTREMES
a) Heat Waves Extremes

Modeling studies project that by the end of the twenty - fi rst century, the number
of heat wave days could double in Los Angeles (Hayhoe and others, 2004 ) and
quadruple in Chicago (Vavrus and Van Dorn, forthcoming) if emissions are not
reduced. A recent analysis of twenty - one U.S. cities found that the average
number of deaths due to heat waves could more than double by 2050, even after
controlling for acclimatization (Kalkstein and others, 2008 ).
b) Natural Disasters
Floods, droughts, and extreme storms have claimed
millions of lives during the past twenty years and have
adversely affected the lives of many more millions of people
and caused billions of dollars in property damage.
7. AIR POLLUTION
Climate change may affect exposure to air pollutants in many ways
because it can influence both the levels of pollutants that are formed and
the ways these pollutants are dispersed. Air quality is likely to suffer with a
warmer, more variable climate (Bernard and others, 2001 ).

•Ozone
•Aeroallergens
•Allergens and
Contact Dermatitis
 7. INFECTIOUS DISEASES
a) Water - and Food borne Diseases Waterborne
diseases are likely to become a greater problem as
climate change continues and affects both
freshwater and marine ecosystems.

•Freshwater Ecosystems
•Marine Ecosystems
•Food borne Diseases
•Vector - Borne Diseases
•Mosquito - Borne
Diseases
•Tick - Borne Disease
•Rodent - Borne Diseases
•Land Use, Local Climate,
and Infectious Disease
 8. PUBLIC HEALTH RESPONSE TO CLIMATE CHANGE
a) Mitigation and Adaptation
b) Co - Benefi ts
c) Unintended Consequences
d) Climate Change Policy
e) Ethical Considerations
 Cartogram comparison of undepleted cumulative carbon dioxide (CO 2 )
emissions (by country) for 1950 to 2000 (upper map) versus the regional
distribution of four climate - sensitive health effects (malaria, malnutrition,
diarrhea, and inland fl ood - related fatalities) (lower map). This is only a partial
list of potential health outcomes, and there are signifi cant uncertainties in all
the underlying models. These estimates should therefore be considered a
conservative, approximate estimate of the health burden of climate change.
DEVELOPING NATIONS
1. ONE EARTH, THREE WORLDS
People in most countries of the Third World are
disproportionately exposed to the so - called traditional
hazards (generally associated with lack of development),
which differ from the modern hazards (Second World) of
uncontrolled industrial development and the postmodern
hazards (First World) of sedentary lifestyles and material
excess. In many countries of the Second and Third Worlds,
the processes of globalization and industrialization often
result in simultaneous exposure to both traditional and
modern environmental hazards, a double jeopardy known as
risk overlap .
 2. DRIVERS OF ENVIRONMENTAL HEALTH
a) Vulnerability and Coping Capacity
b) Globalization: Bad Medicine for Developing
Countries
c) Agriculture
d) Urbanization
 Urbanicity and Urbanization
 The Growth of Slums
 Urban Health in Developing Nations
 3. AIR POLLUTION
a) Indoor Air Pollution
 Biomass Burning
 Cooking Emissions in Food
Smoking and drying are common, age - old food preservation
techniques in developing countries
 Other Sources of Indoor Air Pollution Although the bulk of
indoor air pollution in developing countries results from
burning biofuels, signifi cant contributions also derive from
environmental tobacco smoke, pesticide sprays and mosquito
coils, and household furnishings and products (Smith and
Mehta, 2003 ; Schmidt, 2007 )

b) Lead Poisoning
Lead poisoning remains one of the most preventable diseases
of environmental origin in the world today
4. SANITATION AND WATER QUALITY AND
QUANTITY
5. INJURIES
PART THREE

ENVIRONMENTAL
HEALTHONTHE REGIONAL
SCALE
AIRPOLLUTION
1. HISTORY OF AIR POLLUTION
Air pollution has long been a contributor to ill health. With the
discovery of fi re, humans began to pollute the air, both the air in the
places they lived and the outside air. As urban areas developed, pollution
sources, such as chimneys and industrial processes, were concentrated,
leading to visible and damaging pollution dominated by smoke. The
harmful effects of air pollution were recognized early. In “ Air, Water,
and Places, ” written nearly 2,500 years ago, Hippocrates noted that
people ’ s health could be affected by the air they breathe and that the
quality of the air differed by area (Hippocrates, 1849 ).
2. TYPES OF AMBIENT AIR POLLUTION
The ambient concentration of an air pollutant in a particular location
depends on many factors, including emissions sources, weather (for
example, temperature, wind speed and direction, and precipitation), and
land patterns.
London 1952: One of the World ’ s Worst Air Pollution Disasters By
the 1950s high concentrations of air pollutants in London were common,
with levels far above modern – day regulatory standards.
 3. STUDIES OF AIR POLLUTION AND HEALTH

The fi gure shows the

lung structure as well as
the fraction of particles
of different sizes
deposited in the various
parts of the lung. Very
large particles are
stopped at the nose while
very small particles reach
the alveoli and deposit

Source: Oberd ö rster, Oberd ö rster, and Oberd ö rster, 2005 . Reproduced with
permission from Environmental Health Perspectives . Drawing courtesy of J.
Harkema.
 The investigators found that participants in the most
polluted areas had a 17 percent higher mortality rate than
those in the least polluted areas did (Pope and others, 1995,
2002 ).

4. SOURCES AND EFFECTS OF OUTDOOR POLLUTANTS

The health consequences of air pollution are wide -
ranging, extending from effects on comfort and well - being to
respiratory symptoms and even to premature death. This
section reviews the sources and health impacts of the
However, air pollution is actually a complex mixture of
multiple pollutants, such as sulfur dioxide and tropospheric
ozone, which may not act independently.
a) Particulate Matter
PM results from the burning of fuel (for example, emissions from
power plants), driving on unpaved roads, industrial activity, and wood -
burning stoves, and from natural sources such as pollen, dust, salt spray,
erosion, and mold. PM concentrations can vary within a region or even a
city (for example, concentrations will be higher near major highways).
. This followed the 1996 ban on leaded gasoline sales in
the United States. Figure 12.5illustrates the change in young
children ’ s blood lead (PbB) levels in the United States from
1997 to 2006.
5. AIR POLLUTION PREVENTION AND CONTROL
Approaches include controlling emissions at the source, by
such means as scrubbers at coal - fi red power plants; reducing
the volume of emissions, by such means as increased use of
public transportation to lower vehicular air pollutants or
emissions controls for automobiles; and decreasing population
exposure by such means as the EPA ’ s Air Quality Index,
which provides a health warning on high air pollution days to
encourage sensitive individuals to avoid the outdoors.
ENERGY PRODUCTION
1. TECHNOLOGY AND PATTERNS OF ENERGY USE
(Figure 13.2 ); as prosperity increases, societies tend to substitute cleaner,
more effi cient, and more convenient energy sources for the less costly
but more polluting sources at the ladder ’ s base.
Current patterns of energy use exhibit four characteristics that date
from the industrial revolution:
 More developed areas of the world have higher per capita energy

consumption (and higher associated emissions per capita as well).

 More developed areas rely disproportionately on cleaner forms of

energy production that are higher on the energy ladder.

 More developed regions rely more heavily on electricity, a more

effi cient mode of energy production. This translates to greater

economic output per unit of energy input than countries in the
developing world achieve (Grubler, Nakicenovic, and Jefferson,
1996 ).
 Higher levels of development are associated with increased

capacity and willingness to distribute health impacts both onto

distant populations and to future generations (Holdren and Smith,
2000 ).
Pacala and Socolow ’ s Stabilization Wedges
Energy effi ciency and conservation
 Increase vehicle effi ciency.
Reduce use of vehicles.
Increase building effi ciency.
Increase effi ciency of baseload coal plants.
Fuel shift
 Substitute gas for coal for baseload power.

Carbon dioxide (CO 2 ) capture and geological storage

 Capture CO 2 at baseload power plant.

 Capture CO 2 at H 2 plant.

 Capture CO 2 at coal - to - synfuels plant

Nuclear fi ssion
 Substitute nuclear power for coal power.

Renewable electricity and fuels

 Substitute wind power for coal power.

 Substitute solar energy (using photovoltaic cells) for coal power.

 Substitute H 2 in fuel - cells (using wind energy) for gasoline

in cars.
 Substitute biomass fuel for fossil fuel.
Forests and agricultural soils
 Reduce deforestation and increase planting.

 Implement conservation tillage.

2. HEALTH EFFECTS BY ENERGY SOURCE
Peak Petroleum and Public Health Petroleum is of paramount
importance to the current world economy and has a central role as a fuel,
particularly in the transportation sector; it is also a key ingredient in a wide
range of synthetic processes, such as the production of fertilizers, plastics,
resins, textiles, pesticides, and pharmaceuticals, Approximately 84 percent
of petroleum, by volume, is converted to fuel. Petroleum has important
roles in public health and medicine both as a transportation fuel for
patients, health workers, and supplies and as a synthetic precursor for a
wide range of medical devices and pharmaceuticals
HEALTHY COMMUNITIES
1. HEALTH AND THE BUILT ENVIRONMENT
In the fi fth century B.C. , Hippocrates offered this
advice to the readers of his treatise “ On Airs, Waters, and
Places ” : “ When one comes into a city to which he is a
stranger, he ought to consider its situation, how it lies as to
the winds and the rising of the sun; for its infl uence is not
the same whether it lies to the north or the south, to the rising
or to the setting sun ” (Hippocrates, n.d.).
a) From Micro to Macro: Scale in the Built Environment When
we consider how community design affects people ’s health,
we must consider the spectrum of scales within the built
environment.
b) Components of Community Design Community design is an
amalgam of many decisions, made by people in many
different disciplines and professions
 2. THE MODERN METROPOLIS: URBAN SPRAWL
a) The American Dream

The traditional town and city

design in the upper panel
features a gridlike arrangement
of streets, high connectivity,
placement of different land uses
near each other, and high
density. In the “ loop and
lollipop ” arrangement of streets
shown in the lower panel,
different parcels of land are
developed independently and
not linked to each other,
resulting in low connectivity,
low density land use, and
separation of different land
uses.
 3. COMMUNITY DESIGN AND HEALTH
a) Physical Activity and Obesity
Overweight and obesity have rapidly become one of the most
pressing and costly public health crises in the United States (Figure 14.2).
Obesity is a risk factor for overall mortality, cardiovascular mortality,
diabetes, hypertension, depression, and gall bladder disease.
 4. DESIGN FOR HEALTHY COMMUNITIES

Between 1991 and 2008, the City of Portland increased its established bikeways from 79
to 274 miles, and otherwise improved bicycle - related infrastructure. The number of daily
bicycle trips across Portland ’ s four main bridges increased from 2850 trips in 1991 to 16,711
trips in 2008, and the bicycle mode - share as a percentage of all vehicles on those bridges
increased from 2 percent in 1991 to 13 percent in 2008. There was no increase in the number
of automobiles traveling over these bridges during this time, despite a 40 percent increase in
the Portland metropolitan population since 1990.
WATER AND HEALTH
1. THE ROLE OF WATER IN LIFE
The hydrologic cycle teaches us to view water and health
with a holistic perspective. The compartments of the
hydrologic cycle are either directly or indirectly connected,
and perturbation of one compartment is likely to affect all
other compartments and therefore both human and ecological
health. These interconnections are diagrammatically
illustrated in Figure 15.2 .
2. CHEMICAL CONTAMINANTS
3. MICROBIOLOGICAL CONTAMINANTS
After considering sources of microbiological contaminants
and how they may be used to indicate water quality, this
section describes some specifi c environmental pathogens of
concern and the transformation, deposition, storage, and
bioconcentration of microbiological contaminants in the water
supply
4. THE GLOBAL BURDEN OF WATERBORNE
DISEASE
SUMMARY

Water is critical to all forms of life on this planet, yet we would

appear to have been systematically threatening this precious
resource through agricultural, municipal, and industrial
development. This development has happened with little regard for
the amount of water we squander, the wastes we produce, or the
engineering schemes that degrade this resource. The key messages
to be learned from a careful evaluation of the critical role that
water plays in human and ecological health are that we must
conserve the resource, we must reduce our waste production, and
we must recycle what we use. We must also educate communities
on how to reduce their burden of waterborne disease. Finally, we
must improve our abilities to predict future waterborne disease
outbreaks, and be ready to provide public health intervention on a
global scale to prevent future pandemic disease.