INTRODUCTION TO ENVIRONMENTAL HEALTH Lecturer: Queenie G. Dacayo, M.D.
, FPAFP, DPCOM
Transcribed by: Alfonso Martin E. Plantilla
  Reference: Powerpoint Presentation
OBJECTIVES:
• Discuss the most important environmental threats to
health in low and middle income countries
• Define environment and environmental health
• Name & categorize by their level of impact some
examples of environmental health issues, their
determinants and consequences.
• Enumerate and define environmental health hazards.
• Goal 4: Reduce Child Mortality
• Environmental control measures.
• Briefly discuss the five Principal Environmental Exposure
Pathways (PEEPs).
• Present existing laws related to Environmental health
SCENARIO
Rashmi lived in the eastern part of Nepal in a modest
home. Rashmi often had difficulty of breathing. She cooked
with a stove inside the house not vented outside. Cow dung or •
wood used as cooking fuel. She cooked meals twice a day on
the stove and she often held her baby on her back. She heard
about different stoves and about using kerosene for fuel but
she lacked enough budget to buy a new stove or to fuel it with •
kerosene.
Myrna lived in Zambales in Central Luzon. Myrna often
had difficulty of breathing. She cooked with an improvised
three-stone stove inside the house not vented outside. Wood •
used as cooking fuel. She cooked meals thrice a day. She
heard about different stoves and about using kerosene or
liquified petroleum gas but preferred to utilize wood bec. her
family can easily get firewood for free.
  KEY CONCEPTS
NOTE:
• 8.4% of the global burden of disease in low to middle
income countries is the result of three environmental
conditions:
o Unsafe water, hygiene, excreta disposal
o Urban air pollutionm
o Indoor smoke
• Between 25 and 33 percent of the global burden of
disease can be attributed to environmental risk factors
• Deaths in low and middle income countries by rank and
cause are:
o 3rd – Lower respiratory infection
o 6th – COPD
o 7th – Diarrheal disease
• ~ 30% of deaths in 0-14 years age in low to middle income
countries are due to:
nd
o 2 – Lower Respiratory Conditions
rd
o 3 – Diarrheal Diseases
KEY LINKS BETWEEN ENVIRONMENTAL HEALTH &
MILLENIUM DEVELOPMENT GOALS
• Goal 1: Eradicate Extreme Hunger & Poverty
o Reducing environmental risk factors is central to
eradicating poverty by reducing the burden, which
falls largely on the poor, of environmentally related
morbidity and mortality.
• Goal 2: Achieve Universal Primary Education
o Children that do not have access to clean water and
sanitation are more likely to suffer from
undernutrition due to vicious cycle of diarrheal
disease and malnutrition. There is a correlation
between nutritional status and learning.
o Children with poor nutritional status are not as
likely to stay in school or learn as much as healthy
children.
• Goal 3: Promote Gender Equality and Empower
Women
o Improving the access to water can improve the lives
of poor women in the developing world by reducing
the amount of time required to get water.
o Reducing indoor air pollution can substantially
improve the lives of women because they suffer a
disproportionate burden when they are cooking.
o Addressing environmental risk factor can reduce the
leading causes of death in children.
o Diarrheal disease is improved by improved access to
clean water and sanitation.
o Pneumonia can be reduced through improvements in
indoor air quality.
o Reducing the amount of time required to get water.
Goal 5: Reduce Maternal Health
o Diarrheal disease associated with poor sanitation and
unsafe water can harm the nutritional status of the
mother.
Goal 6: Combat HIV/AIDS, Malaria and other diseases
o Link: Environmental improvements can reduce the
breeding grounds for malarial mosquitoes and vectors
of some other disease, such as schistosomiasis and
dengue fever
Goal 7: Ensure Environmental Sustainability
o Link: Measures to improve water supply, sanitation &
personal hygiene promote sustainability, especially
when they are carried out in community-based ways.
• Enivonment
• Everythng that is not genetic
• Physical, chemical, biological agents that directly
affect health
• Environmental Health
• Generally refers to a set of public health efforts that
“is concerned with preventing disease, death and
disability by reducing exposure to adverse
environmental conditions and promoting behavior
change.
• It focuses on the direct and indirect causes of disease
and injuries and taps resources inside and outside
the healthcare system to help improve health
outcomes.
• Environmental health comprises those aspects of
human health, including quality of life, that
determined by physical, chemical, biological, social
and psychosocial factors in the environment.
• It also refers to the theory and practice of assessing,
correcting, controlling and preventing factors on the
environment that can potentially affect adversely the
health of the present and future generations. (WHO,
1993).
ENVIRONMENTAL HEALTH
• the control of all those factors in man’s physical
environment which exercise, or may exercise, a
deleterious effect on his physical development, health
or survival. (WHO).
• It is that aspect of public health that is concerned
with those forms of life, substances, forces and
conditions in the surroundings of man that may exert
an influence on human health and well-being.
 CHEMICAL HAZARDS
• Increasing; being used by developing world specially
in the field of agriculture.
§ Pesticides are the most common used and
manufactured in this country.
§ Examples:
• Organophosphates
• Organochlorine
• Most exposed population groups:
§ Formulators
§ Farmers
• Region 3, rice granary of the Philippines – high cases
of pesticide poisoning

• Chemicals are also used in industries:

§ Semiconductor & Electronic companies
MAN – ENVIRONMENTAL RELATIONSHIPS § Battery making
§ Clothing industry
The Environmental System § Paint manufacturing
• The status of human health represents the result of § Printing Industry
complex interactions between the internal biological • Release of chemicals into the environment depends
system & the total external environmental system. mostly on the type of waste generated by the
industries & the presence of pollution control devices.
• Consumer products, including food preservatives,
are the next most common sources of chemicals in
our environment
§ Batteries, soap and dishwashing fluids, light
bulbs and fluorescent are sources of tungsten,
mercury and the like.
• Tocino – nitrate compounds
• Vehicles – sulphur oxides, lead, carbon monoxide,
hydrocarbons, etc.
• The severity of risk arising from chemical exposure
depends on these factors:
§ Type of Chemical
§ Amount of chemical
§ Duration of exposure
§ Environmental conditions
CLASSIFICATION OF ENVIRONMENTAL HAZARDS § Nature of job operation
§ Availability of ventilation or exhaust systems
• Biological
• Chemical PHYSICAL HAZARDS
• Physical
• Noise
• Psychological o One of the most common occupational hazards
• Sociological o Common to industries such as bottling, steel
• Site and location hazards manufacturing, garment factories, vehicle
BIOLOGICAL HAZARDS manufacturing; airports
o Effects:
• Are concerned with infectious agents which could gain § Noise-induced hearing loss
entry into the human body § Tinnitus
• Take the form of viruses, bacteria, parasites and fungi § Auditory fatigue
• Present in human body fluids, animal or animal o When a worker talks louder than usual during
products, soil clay, sewage,plant materials, laboratory normal conversations, this may be a sign of
cell cultures exposure to high level noise and may be
manifesting noise-induced hearing loss.

 
 • Radiation MAJOR ENVIRONMENTAL HEALTH DISASTERS (2005
o Electromagnetic – 2008)
• Ionizing – alpha, beta particles, gamma
rays, x-rays
• Ultraviolet – from light
o Infrared – emiited by hot furnances, ovens
o Microwave – communication & radar stations
o Visible light – glaring & bright illumination
• Temperature
o Temperature extremes can be experienced in the
workplace in either a hot or cold environment.
o Temperatures below 35 degrees centigrade and
above 45 degrees centigrade can be tolerated for
brief periods (Kenney,1998)
o When the temperature is too high, heat stroke may
occur, an indication that the thermoregulatory
mechanism of the body has shut down(Ogawa,
1998).
o The primary adaptive reaction of the body to heat
is increased capacity to sweat.
o Heat exposure: agriculture, construction, bakeries,
steel mills
o Exposure to cold is mainly in the industries
Examples: meat processing and packaging, Diving
and commercial fishing, frozen foods
5 BASIC PRINCIPLES OF ENVIRONMENTAL
o Effects:
CONTROL
• Frostbite and trench foot
▪ Isolation
• Slips of tools ▪ Substitution
• Chills ▪ Shielding
• Vibration ▪ Treatment
o It usually comes from a vibrating tool or ▪ Prevention
machinery. ISOLATION
o It can involve the arms and hand à hand-arm
vibration when using vibrating tools and can ▪ Isolation places the hazardous process
cause Reynaud’s disease "geographically" away from the majority of the
o It can involve the whole body à whole body workers.
vibration when driving a truck, operating heavy ▪ These methods aim to keep the chemical/agent "in"
industrial equipment can affect the central and the worker "out" (or vice versa).
nervous system ▪ Examples:
▪ "glove boxes" (where a chemical is in a
• Physical Design of Equipment and Environment ventilated and enclosed space and the
o Equipment: employee works with the material by using
§ Displays are not adequately lit gloves that are built in)
§ Hand tools cause pain in the wrist ▪ Abrasive blasting cabinets(sound reducing
§ There are sharp edges on the tools enclosure for noisy equipment)
§ Handles are too heavy to operate ▪ Remote control devices
o Environment: ▪ Negative pressure fume hoods in laboratory
§ Layout causes unnecessary motion settings
§ Inadequate space for storage
§ No clearance for pushing or pulling SUBSTITUTION
materials
• It is the use of other materials products, activities,
SOCIOLOGICAL AND PSYCHOLOGICAL HAZARDS processes/operations, methods, machines, & other
• Overcrowding equipment instead of hazardous ones.
• Work stress – multi-tasking, overload, excessive overtime • “Modification”
• Boredom • Reduce number of hours of exposure
• Monotony of work • Work rotation
• Isolation
SITE AND LOCATION
▪ “Natural hazards” in terms of geographical location are
usually associated with natural phenomena or events
leading to disaster
▪ Examples:
▪ Construction of a nuclear power plant near an
active volcano
▪ Construction of a residential village in a former
landfill site of hazardous wastes
▪ Construction of a subdivision along the faultline

 
SHIELDING
• It is the setting up of physical barriers between the source
of the problem or hazard and man.
• Equipment guarding will prevent workers from contact with
moving parts.
o Example: table saw with cover; conveyor belt with
guard; separating vehicle and pedestrian traffic;
shield radioactive materials
TREATMENT
• This involves measures to terminate the existence of a
hazard through destruction.
• Examples:
o Water treatment facility in factories
o Air pollution control device
PREVENTION
• It is eliminating effects of or exposure to a hazard
• Example: Prophylaxis; Immunization
ENVIRONMENTAL HEALTH OUTCOMES AND EXPOSURE
PATHWAYS
Human Health Conditions Identified to be “related to
environmental pollution”:
• Diarrhea
• Bronchitis
• Asthma
• Malignant neoplasms: lung, liver, nasal, bladder,
leukemia, lymphoma
• Ischemic Heart Disease
• Hepatitis
• Pneumoconiosis, occupational cancer, chronic chemical
poisoning syndromes
• Typhoid/paratyphoid/salmonella & others
• Dengue
• Cholera
• Lead poisoning (acute and chronic)
▪ Other heavy metal and chemical poisoning
▪ Upper Respiratory Tract Conditions
▪ Skin rashes/ ear infections
PRINCIPAL ENVIRONMENTAL EXPOSURE PATHWAYS
(PEEPs)
Concept of Principal Environmental Exposure Pathways
Principal Environmental Exposure Pathways
▪ Describe the origin of the environmental pollution that
affects humans or the source, steps in the environment
transmisssion and human exposure
▪ Its characterization involved tracking down information as
it is applied to each PEEP and collating what was
available.
▪ This information includes:
▪ Identification of responsible agencies st each point
in each pathway
▪ Information on the volume/type of industrial
chemicals used and emissions/ effluents from point
sources and diffuse sources
▪ Ambient concentrations of key toxics in workroom,
air, community air, drinking water, food and soil.
▪ Estimates of the size of exposed populations
▪ Studies of health impacts on people, including
biological exposures, epidemiological studies, and
notifiable disease and registry data
▪ Demographic data such as housing types, water
supply, income and employment
The 5 Principal Environmental Exposure Pathways
▪ Urban Air Pollution Pathway (UrbAir)
▪ Urban Water Supply Pathway (CommunWater)
▪ Pathways where fertilizers & pesticides affect
food, workers, health, and rural water supplies
(Pest/Rural/Food)
▪ Urban Solid Waste Pathway (UrbWaste)
▪ Rural “Point Source” Pathway (RurSource)
URBAN AIR POLLUTION PATHWAY
▪ Covers those communities where household, motor
vehicle and multiple industrial emission sources
mix together in an urban air shed
▪ Affects:
Ø Transport workers
Ø Children
Ø General population
• It covers communities where household, motor
vehicle and industrial emission sources mix together
in an urban air shed.
• Emission from vehicles on the road mix with
industrial sources(from factories) to pollute the air.
This leads to three exposure scenarios:
§ Transport workers are exposed to air pollution
at the roadside level daily
§ Children are directly inhale airborne
emissions and indirectly to soil contaminated
by deposition from the air. Children passively
ingest dust through hand to mouth spread.
§ General population inhale dust particles
coming from urban air, smoking and poorly
ventilated indoor cooking and smoking that
cause respiratory diseases
• Chronic Obstructive Pulmonary Disease (COPD) is
more prevalent among jeepney drivers than among
commuters and air conditioned bus drivers.
• Airborne lead levels in Manila tend to be way above levels
on other cities in the world. There is an observable child
IQ decline with lead exposure.
URBAN WATER SUPPLY PATHWAY
• Types of Water Supply:
o Level I
§ Include open dug wells, developed springs,
public wells, private wells with or without
faucets, and tubed/piped/improved dug wells
o Level II
§ Are alll community public taps
o Level III
§ The population is supplied with piped water in
their households
• Urban dwellers in the Philippines may get their water from
Level I, II, or III supply types but all 3 could potentially be
polluted with sewage and/or industrial liquid waste.
• Level 3 is likely to be chlorinated
▪ Industrial effluents and sewage can contaminate all of the
levels of water supply.
▪ Effluent is an outflowing of water from a natural body of
water, or from a man-made structure.
▪ Metro Manila has the highest degree of Level III water
supply.
▪ Access to sanitary toilets is also an important protective
factor against the spread of waterborne diseases. Urban
communities are better off than rural communities. In the
1990s, 84% of urban households had sanitarymtoilets
compared to 52% of rural households.
▪ Inadequate maintenance of existing sanitation in Metro
Manila reduces the preventive effect of having sanitary
toilets.
▪ There is increased risk of diarrheal disease & skin disease
by using public or the neighbor’s water supply, & living in a
household without a toilet.
▪ Supplementary risk to these diseases is associated with
crowding.
FERTILIZER, PESTICIDES, FOOD, & RURAL
WATERWAYS PATHWAY
▪ This is the most complex environmental exposure
pathway
▪ It begins with the importation of pesticides and
fertilizers and with their formulations in the
Philippines. Locally, formulators are directly exposed
to chemicals. On the farms and plantations, workers
and families are exposed due to pesticide
application. Crops are affected through direct
application and through contamination of water in the
fields. These waters may also be contaminated by
sewage. Fish in fish – rice operations are exposed by
waterborne route due to adjacent waterways. The fish
and crops are brought to the market place where
handling, cleaning, storage and cooking will make
the difference in their hygienic quality.
▪ Back at the farm, the contamination of water by
fertilizers, pesticides & sewage may also affect the
drinking water of those living within & around farms.
▪ Unsafe practices in the use of Pesticides:
1. Few farmers wear full protective clothing
when they spray and spray against the wind.
2. Unsafe storage practices and disposal of
pesticide bottles.
3. Lack of knowledge in the recognition and
understanding of hazard rankings of
pesticides.
There are pesticide users who reported
symptoms related to pesticide poisoning
affecting the eye, skin, respiratory, nerves and
gastrointestinal tract.
URBAN SOLID WASTE PATHWAY
• Solid Wstes
o Wastes that should not be poured into a sewer or
waterway
o Include the residential, institutional, and industrial
wastes that are either collected and disposed of in
an organized system, or strewn about squatter
communities, roadsides, or vacant lots

• Solid wastes are generated from households, institutions

and industries.
• Non-collection would mean that those living around are in
direct contact with the potential hazards. Open dumpsites
have potential impacts on air & water quality as illustrated
by the Smokey Mountain site.
• In areas where garbage is collected, the garbage collector
is exposed as well as the scavengers and their families.
• Leachate from the solid waste may contaminate the
ground water. This contain nitrates and coliforms which
are of public health significance among those who use the
water for drinking, cleaning or recreational purposes.
RURAL “POINT SOURCE” PATHWAY
• In rural areas of the Philippines, there are many locations
where mines, discrete industrial point sources, or small
groups of industrial establishments are significant sources
of contamination of air, recreational or drinking water and
soil.
• Children in the industrial areas had higher rates of cough
with phlegm and bronchitis according to a study by Torres
and Subida in 1992. The type of fuel for cooking turned
out to be the most important factor of all. Children in
households using firewood or coal has more than 16x
higher risk ofnbelow normal pulmonary function than
households using alternative fuel.

Tables are at the next page …

 
PRIORITY ENVIRONMENTAL HEALTH PROBLEMS

END OF LECTURE
TRANSCRIBED BY: Alfonso Martin E. Plantilla, Grp. 14A