MENGENAL PERKULIAHAN

KESEHATAN LINGKUNGAN

Prof. Dr. Yuanita Windusari. S.Si., M.Si.

Disampaikan pada kegiatan Matrikulasi S2 IKM

angkatan 2021/2022
Tim pengajar :

 Prof. dr. Tan Malaka, MOH., DrPH., SpOK.,

HIU
 Prof. Dr. Hilda Zulkifli, M.Si.
 Prof. Dr. Hj.Yuanita Windusari, S.Si., M.Si
 Dr.rer.med.H. Hamzah Hasyim, SKM., MKM
 Dr. Novrikasari, M.Kes
Kesehatan Lingkungan ??

 Bahasan tentang hubungan antara

lingkungan hidup dan kesehatan masyarakat
 Bahasan tentang ekosistem dan bagaimana
kaitannya dengan kesehatan
 Determinan kesehatan dari aspek
lingkungan, tata cara evaluasi dan
pengelolaannya
Public Health Definition of “The Environment”

 All that which is external to the individual

host. [It] can be divided into physical,
biological, social, and cultural factors, any or
all of which can influence health status in
populations.
(Last, J. M. (Ed.). (1995). A Dictionary of
Epidemiology (3rd ed.). New York: Oxford
University Press.
Definitions: Health
 Kondisi sehat dalam tubuh, pikiran, atau roh
 Kondisi atau kesejahteraan yang berkembang—
bukan hanya ketiadaan penyakit

Atau
 A state of complete physical, mental, and social
well-being and not merely the absence of
disease or infirmity
( WHO, 1948).
Definitions: Disease

 Trouble or a condition of the living animal or

plant body or one of its parts that impairs the
performance of a vital function
Definitions: Safe

 Free from harm or risk

 „ Secure from threat of danger, harm, or loss
 „ Zero risk
Definitions: Risk

 Possibility of loss or injury, peril

 „ The chance of loss; the degree of probability
of such loss
What Is Environmental Health Sciences?

NIEHS charter: “The study of those factors in the environment

that affect human health”
− Factors (“pollutants” or “toxicants”) in air, water, soil, or
food
− Transferred to humans by inhalation, ingestion, or absorption
− Production of adverse health effects
Contributors to the “Environment”

 Chemical
− Air pollutants, toxic wastes, pesticides, VOCs
 „Biologic
− Disease organisms present in food and water
− Insect and animal allergens
 „ Physical
− Noise, ionizing and non-ionizing radiation
Socioeconomic
− Access to safe and sufficient health care
WHO Definition of Environmental Health

Environmental health comprises those aspects

of human health, including quality of life, that
are determined by physical, biological, social,
and psychosocial factors in the environment.
It also refers to the theory and practice of
assessing, correcting, controlling, and
preventing those factors in the environment
that can potentially affect adversely the health
of present and future generations.
Facets of Environmental Health
 Environmental epidemiology : Associations between
exposure to environmental agents and subsequent
development of disease
 „ Environmental toxicology : Causal mechanisms between
exposure and subsequent development of disease
 „ Environmental engineering : Factors that govern and
reduce exposure
 „ Preventive medicine : Factors that govern and reduce
disease development
 „ Law : Development of appropriate legislation to protect
public health
Lingkup kesehatan lingkungan
 gambaran luas dari beberapa tantangan yang paling penting untuk
kesehatan manusia dari faktor risiko lingkungan dan pekerjaan
melalui ketrampilan multi-disciplinary untuk assessment, control,
dan preventif
 ancaman (risiko) spesifik : polusi udara luar dan dalam ruangan,
logam beracun, pestisida, radiasi, dan stresor kerja
 Ancaman (risiko) lingkungan : potensi peniruan hormon dari bahan
kimia plastik dan dampak perubahan iklim global terhadap
kematian akibat panas dan pola pergeseran penyakit menular
 menganalisis dampak penyakit dan cedera tertentu, seperti
penyakit kardiovaskular, asma, kanker, cedera muskuloskeletal, dan
gangguan perkembangan anak
The life of the land is perpetuated in righteousness
 Dalam ekologi penduduk, daya dukung (CC) diartikan sebagai beban maksimal
lingkungan dan hal ini berbeda dengan konsep keseimbangan

 Perbedaannya :
- keseimbangan penduduk dipengaruhi kepadatan penduduk
kelahiran yang menurun atau meningkatnya angka kematian
- sanitasi dan layanan medis mempengaruhi populasi manusia

 Carrying capacity adalah jumlah individu dalam lingkungan yang tdk memberi
dampak negatif terhadap lingkungan

 Daya dukung suatu lingkungan adalah ukuran populasi maksimum suatu spesies
biologis yang dapat dipertahankan dalam lingkungan spesifik tersebut,
mengingat makanan, habitat, air, dan sumber daya lain yang tersedia seperti
kondisi lingkungan yang sehat dan ruang untuk hidup layak

 Setiap makluk hidup memiliki carrying capacity yang berbeda meskipun hidup
dilingkungan yang sama
What is carrying capacity?
 ‘SEHAT’
• ‘... is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity’(WHO, 1948)
• ‘HEALTH hanya mungkin jika sumber daya tersedia
untuk memenuhi kebutuhan hidup manusia dan
lingkungan hidup/kerja terlindungi dari polutan,
patogen, dan bahaya fisik yang mengancam jiwa
serta membahayakan kesehatan (Who, 1992)
 KONSEP KESEHATAN holistik adalah
mengakui kekuatan pengaruh sosial,
ekonomi, politik dan lingkungan terhadap
kesehatan
 ‘LINGKUNGAN’
• ‘…[Semua] apa yang bersifat eksternal bagi
manusia secara individu termasuk fisik, biologis,
sosial budaya, dan semua yang dapat mempengaruhi
status kesehatan dalam populasi..’ (WHO, 1995)
Issues related to social carrying capacity considered in terms of
ecological, economic, and social licenses, for a local system
embedded in a larger-scale social-ecological system
KONSEP DARI PENYAKIT

Penyakit muncul akibat interaksi kompleks antara

manusia, agen dan lingkungan.

secara ekologis penyakit didefinisikan sebagai

"ketidakcocokan organisme dengan manusia dan
lingkungan".
 
ENVIRONMENTAL IMPACT

Environment
(Physical, biological and psychosocial)

Human activities health of individual

EPIDEMIOLOGICAL TRIAD

  ENVIRONMENT
 
  

VECTOR
 
  
AGENT HOST
Pengertian ‘dampak kesehatan ’

• ‘… adalah kerusakan khusus pada

kesehatan yang dapat menyebabkan
lingkungan berbahaya terhadap seseorang,
dan seringkali bahaya yang sama dapat
menyebabkan efek berbeda dengan tingkat
keparahan berbeda.’
Saling ketergantungan :

 Kesehatan tergantung pada sumber daya

 Kesehatan yang baik tergantung pada
aksesibilitas ke sumber daya berkelanjutan
 Kesehatan yang buruk terjadi karena tidak dapat
diaksesnya sumber daya berkelanjutan/adanya
paparan bahaya
 Sumber daya dan bahaya berkelanjutan ada di
lingkungan. Karena itu, kualitas kesehatan
tergantung pada lingkungan
Population Perspective of Relations

All populations
Human
population
Community,
nation
Family

Individual
Dampak Lingkungan terhadap kesehatan
 Indikator efek lingkungan yang menguntungkan
adalah umur panjang dan fungsi yang erkelanjutan.
 efek lingkungan yang merugikan adalah : cedera
(melemahkan, disfungsional, lumpuh) dengan
penurunan umur panjang atau kematian
(mengancam jiwa, menghentikan aktivitas,
merusak)
Systematic Approach
 konsep universal tentang efek
kesehatan yang merugikan (sakit,
disfungsional, 'tidak normal' atau
'tidak baik‘) maka diperlukan
pemahaman konsep agar
menghasilkan respons yang sesuai
kebutuhan
Systematic Approach
 Untuk mengidentifikasi dan
menginvestigasi kondisi kesehatan yang
merugikan, harus ada dan diterapkannya
pendekatan sistematis yang mendasar
untuk identifikasi dan karakterisasi
masalah kesehatan
pendekatan sistematik dilakukan dengan cara :

 menentukan sumber dan sifat bahaya

 menentukan jalur eksposur
 mengukur efeknya
 menetapkan kontrol
(Moeller, 1992)
Peran Interdisciplinary
 Untuk menerapkan pendekatan sistematis,
diperlukan peran pengelola lingkungan yang
bertugas sebagai penyelidik masalah kesehatan
lingkungan (health problem investigators),
responden masalah lingkungan (environmental
problem responders), dan responden masalah
kesehatan (health problem responders)
• Air Quality
• Water and Land Pollution
• Biological Hazards
• Toxic Chemicals
air pollution killed 4,000 24 smog-related deaths per day

London 1966 NY City

air pollution killed 50

(10% of pop)

1948 Donora, Pa (noon) Beijing Olympics, 2008

Smog Deaths Led To Clean Air Laws

The atmosphere’s four layers
 The EPA sets standards
• States monitor air quality and develop, implement, and
enforce regulations.
– If a state’s plans are not adequate, the EPA can take over
enforcement.

3 Criteria pollutants judged to pose great threats to human health

NO2
Air pollution has decreased since 1970
Air pollution has decreased since 1970
How would you rate these products?

Toxicity Rating

Highly Toxic

Moderately Toxic

Slightly Toxic

Not Toxic
 Toxicity Rating

Highly Toxic

Moderately Toxic

Slightly Toxic

Not Toxic

44
Kapaa Quarry
 Hawaii Clean Energy Initiative
Must supply 70% clean energy by 2030.
• 40% from renewable
• 30% from efficiency

Landfill gas
(Kapaa) Waste to energy
 Harmful Natural Chemicals

ciguatera
HAB
Harmful Natural Chemicals

metals (Al, Mg, Na, K, Cu, Zn, Cd, HG, Pb)

gases: H2O, H2S, HCl, HBr, SO4, NO2, CO2

VOG
 Cultural environmental hazards

 Cultural (lifestyle) hazards: result from the place

we live, our socioeconomic status, our occupation,
our behavioral choices
 Smoking, drug use, diet and nutrition, crime, mode of
transportation
Tobacco

• There are over 4,000 chemicals found in

tobacco smoke and over 400 toxins.
• There are over 60 carcinogens proven to
cause cancer in humans.
• Causes 1 in 5 deaths in U.S.
• Leading cause of cancer deaths
Hawaii Smoking Stats

2015
Infectious diseases kill millions
 Infectious diseases kill
15 million people per
year.
 Half of all deaths in
developing countries
 Developed countries have
better hygiene, access to
medicine, and money.
 Vector: an organism that
transfers pathogens to a
host
Biological hazards

 Result from ecological interactions

 Viruses, bacteria, and other pathogens
 Infectious (communicable, or transmissible)
disease

HIV E. coli TB Malaria

Aedes aegypti and Aedes albopictus mosquitoes

Dengue fever
2015-2016 Leptospirosis
264 confirmed cases 50-100 case/yr
Environmental health hazards exist indoors

 Radon: a highly toxic, colorless, Not a problem in Hawaii

undetectable radioactive gas
 Builds up in basements
 Can cause lung cancer
 Lead poisoning: from lead pipes, paint
 Damages organs, learning problems,
behavior abnormalities, death problem in Hawaii
(<1978)
 Asbestos: insulates against heat, cold,
sounds, and fire
 Asbestosis: scarred lungs don’t function
 Also causes a type of lung cancer
Asbestos removal can
Renovation issues also be dangerous
 Endocrine Disruptors Lake Apopka alligators
 In 1985, alligators had bizarre reproductive problems
 Non-viable eggs, depressed or elevated hormone levels
 The lake had high levels of agricultural chemicals and fertilizers that
were disrupting the endocrine systems of alligators during
development in the egg.
Evidence for hormone disruption
 Frogs also have gonadal abnormalities.
 Male frogs exposed to very low levels of atrazine became
feminized.
 Levels were below EPA standards for human health.

Tyrone Hayes U.C. Berkley

 Point and non-point source water pollution

6/13/06 Alawai Turtle Bay

48 million gallons raw sewage

Ala wai Maui

 Pesticides,
Pesticides, Herbicides
Herbicides &
& other
other organochlorines
organochlorines

• PCBs (Poly Chlorinated Biphenyl)

DDT

Bioaccumulation
Bioaccumulation biomagnification
biomagnification
Common pesticides
Toxicants can accumulate and biomagnify

Biomagnification
 Toxic
Toxic Metals
Metals
Heavy metals resist biodegredation

Natural occurrence- volcanoes

• Mercury (Hg)
• Copper (Cu)
• Lead (Pb)
• Cadmium (Cd)
 Heavy
Heavy Metals
Metals
Minamata Disease (1953-1960)– Japan
• Industrial pollution from plastic plant; dumped
mercuric chloride into bay
• Ingestion of Hg tainted shellfish  43 dead and
700 permanently disabled
 Toxic chemicals
Copper (Cu):
• Tributyl tin (antifouling paint for boats)
• Banned in U.S. 1980s
• Acts as an immunosuppressor
• Accumulations unusually high in small whales
• May be associated with strandings
Toxic chemicals

Lead (Pb):
• Leaded gasoline invented 1920’s
• Enters water from automobile exhaust,
runoff and atmospheric fallout of industrial
waste and landfills, mines, dumps
• Leaded gas banned in US in 1980’s has
reduced pollution in ocean

Bioaccumulation 
Bioaccumulation  biomagnification
biomagnification
Kesimpulan :
 Keinginan manusia untuk memenuhi kebutuhan hidupnya
mendorong untuk memilih produk ttt yang berdampak
terhadap lingkungan dan memiliki konsekuensi terhadap
kesehatan
 Kesehatan lingkungan adalah ruang lingkup yang luas dari
definisi masalah kesehatan
 Kesehatan lingkungan mempelajari dampak lingkungan
terhadap populasi
 Kesehatan lingkungan adalah ilmu berbasis populasi yang
dapat ditingkatkan untuk mempelajari individu dalam
populasi
 Definisi masalah dan resolusi potensial dimungkinkan
melalui penerapan pendekatan yang sistematis