Welcome to

Public Health Oriented Program II

(Environmental Health)
 DR.Ardini S Raksanagara,dr.,MPH
Date of Birth : 21st May 1960
Education :
1986 : MD,Faculty of Medicine, Unpad
1992 : MPH, University of Wollongong, Australia
2004 : DR, University of Padjadjaran
Work Experience :
1987 : Staff of Public Health Department, FK Unpad (Lecturer)
2007 : Director of Postgraduate Program of Public Health,
Faculty of Medicine, Padjadjaran University
2010-2011 : Head Department of Public Health
2009- now : Occupational & Environmental Health
Coordinator

ARDINI SAPTANINGSIH RAKSANAGARA

Address : Jalan Pasang 26
Phone number : 022-7276326
Mobile phone : 0811237159
Email address : araksanagara@yahoo.com
 Topics in Session 1
1. Introduction
2. Environment & Health
3. Nature of Environmental Health
Hazards
4. Polllution
 Learning Objective
the student should be able to explain :
• the relationship between environment and health
• the nature of environmental health hazards (pollution)
• the relationship between air and human health
• the effect of water and wastewater to health
• the effect of land pollution and noise to human health
• the housing, residential and public facilities sanitation
• domestic and hospital waste disposal
• the food hygiene and vector control
• global health and climate changes
 Teaching-learning strategies

1. T C L
2. S C L  seminar (student presentation)
Assessment Methods

• Written test: MCQ

 Team Teaching
1. Dr. Ardini S. Raksanagara, dr., MPH (ASR)
2. Irvan Afriandi, dr., MPH., PhD (IA)
3. Sri Yusnita Irda sari, dr., MSc (SY)
 Content outline
T op i c
1. Introduction of environment and health & TCL ASR
The nature of environmental health hazards

2. Polution (source, type and mechanism) TCL ASR

3. Air pollution SCL ASR

4. Air and human health SCL ASR

5. Water pollution SCL IA

6. Water, wastewater and health SCL IA

7. Land contamination SCL IA

8. Unwanted Sound/Noise SCL IA

 T op i c
9. Housing and residential sanitation SCL SY

10. Public facilities sanitation SCL SY

11. Waste disposal sanitation (particularly residential and domestic SCL SY

waste)

12. Hospital waste control SCL SY

13. Food hygiene and safety SCL SY

14. Vector and pest control SCL SY

15. Transboundary and Global Health (Environmental current issues) SCL ASR

16. Climate Changes & Global Warming SCL ASR

 References
1. Yassi A, Kjellström T, de Kok T, Guidotti TL. Basic Environmental
Health. New York: Oxford University Press, 2001.
2. Smith KR, Corvalán CF, Kjellström T. How Much Global Ill Health Is
Attributable to Environmental Factors. Epidemiology, September
1999, Vol. 10(5):573-584
3. Scannel CH and Balmes JR. Chapter 41: Outdoor Air Pollution. In:
LaDou J, ed. Occupational and Environmental Medicine, 2nd edition.
Stamford: Appleton & Lange, 1997.
4. Conway JB. Chapter 37: Water Quality Management. In: Wallace RB
et al., eds. Maxcy-Rosenau-Last: Public Health and Preventive
Medicine, 14th edition. London: Prentice-Hall International, 1998.
5. Werner SB. Chapter 11: Food Poisoning. In: Wallace RB et al., eds.
Maxcy-Rosenau-Last: Public Health and Preventive Medicine, 14th
edition. London: Prentice-Hall International, 1998.
6. WHO. Foodborne Disease: a Focus for Health Education. Geneva:
World Health Organization, 2000.
7. Last JM. Chapter 40: Housing and Health. In: Wallace RB et al., eds.
Maxcy-Rosenau-Last: Public Health and Preventive Medicine, 14th
edition. London: Prentice-Hall International, 1998.
8. Franceys R, Pickford J, and Reed R. A Guide to the Development of
On-site Sanitation. Geneva: World Health Organization, 1992.
9. Suk WA. Chapter 38: Solid and Radioactive Waste Disposal. In:
Wallace RB et al., eds. Maxcy-Rosenau-Last: Public Health and
Preventive Medicine, 14th edition. London: Prentice-Hall
International, 1998.
10. Prüss A, Giroult E, Rushbrook P, eds. Safe Management of Wastes
from Health-care Activities. Geneva: World Health Organization,
1999
• 11. Suk WA. Chapter 13: Diseases Transmitted Primarily by Arthropod Vectors. In:
Wallace RB et al., eds. Maxcy-Rosenau-Last: Public Health and Preventive
Medicine, 14th edition. London: Prentice-Hall International, 1998.
• 12. Ehlers VM and Steel EW. Municipal and Rural Sanitation, 6th edition. Tata
McGraw-Hill Publishing Co., 1976.
• 13. Harinasuta C. Vector-borne Diseases. In: Phoon WO and Chen PCY, eds.
Textbook of Community Medicine in South-East Asia. Singapore: John Wiley &
Sons, 1986.
• 14. LaDou J, Jackson RJ and Howard J. Chapter 39: Environmental Exposures and
Controls. In: LaDou J, ed. Occupational and Environmental Medicine, 2nd edition.
Stamford: Appleton & Lange, 1997.
• 15. Cullen MR. Chapter 24: Multiple Chemical Sensitivity. In: Wallace RB et al.,
eds. Maxcy-Rosenau-Last: Public Health and Preventive Medicine, 14th edition.
London: Prentice-Hall International, 1998.
•  Moses M. Chapter 26: Pesticides. In: Wallace RB et al., eds. Maxcy-Rosenau-
Last: Public
Millennium Development Goals
Goal 1: Eradicate extreme
poverty and hunger
Goal 2: Achieve universal
primary education
Goal 3: Promote gender equality
and empower women
Goal 4: Reduce child mortality
rate
Goal 5: Improve maternal health
Goal 6: Combat HIV/AIDS,
malaria, and other diseases
Goal 7: Ensure environmental
sustainability
Goal 8: Develop a global
partnership for development
Determinant of Health
The Environment of Health Model
 20 %

20 % 10 %

50 %
The Rainbow model - The main determinants of health

Independent Inquiry into Inequalities in Health report Chairman: Sir Donald Acheson 1998
 culture
community
lifestyle

Personal Psycho-socio-
behavior Economic
spirit Environment

Sick
care body mind work
system

Human Physical
biology environment

Human-Made Environment
The Mandala of Health
biosphere A model of human ecosystem
 Session 1
ENVIRONMENT & HEALTH

Dept. of Public Health

Faculty of Medicine
Universitas Padjadjaran
Bandung
Learning Objective:
• To explain the basic relationship b/w environmental
factors & health, & how the interrelationship b/w
economic development, the environment & health can
be seen in an ecosystem framework
• To interpret environmental health in historical context
w/ respect to changes in technology, economic
development & social organization
• To describe the basic requirements for a healthy
environment
• To explain the basic issues & concerns w/ respect to
methods of measuring environmental quality, exposure
& health effects
• To describe the larger socio-economic issues affecting
environmental health
 What is ‘environment’?
• (all) that which is external to the
individual human host. (It) can be divided
into physical, biological, social, cultural,
any or all of which can influence health
status in populations (Last, 1995)
Ecosystem
 any spatial or organizational unit which
includes living organisms & nonliving
substances interacting to produce exchange of
materials b/w the living & nonliving parts

Basic components:
 abiotic substances
 producer organisms
 consumer organisms
 decomposer organisms
 The scale & nature of human activities
(agricultural, industrial, & energy production, the use &
management of water & wastes; urbanization; the
distribution of income & assets within & between countries;
the quality of health services; & the extent of protection of
the living, working, & natural environment

HEALTH

Physical & chemical environment

Biological environment
(air, water, food & soil chemical composition
(type & distribution of pathogens & vectors, as
including radiation; climate including temperature,
well as their habitats)
humidity, precipitation, & seasonal changes)

Source: Yassi et al., 2001 (adapted from WHO 1992)

 Triangle of Epidemiology

Host

Vector

Environ-
Agent ment

25
Source: adapted from Gordis (1996)
 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
 refers to the theory & practice of assessing,
correcting, controlling, & preventing those
factors in the environment that can potentially
affect adversely the health of present & future
generations
(WHO, 1993)
 Environmental Health Science
• hazards in the environment, their effects on
health & the variations in sensitivity to
exposures within populations
• development of effective means to protect
against hazards in the environment
Humans have extraordinary abilities to adapt to
and influence their environment to meet their needs
 Many ways to make the environment healthier
Environmental health hazards are beyond the
control of the affected individual, e.g.:
• industrial pollution
• poor services of drinking water & sanitation
• poor housing & town planning
• lax control over eating establishments or food
industry
• poor quality roads
• poor conditions in the workplace
Basic Requirements for a Healthy
Environment
• Clean air
• Safe & sufficient water
• Adequate & safe food
• Safe & peaceful settlement
• Stable global environment
 Measurement Methods

Environmental Human Health

Quality Exposure Impact
Monitoring Monitoring Assessment
 OBSTACLES & OPPORTUNITIES
• Demographic issues
Size of the population  level of consumption
• Poverty
The poor usually lack a minimum standard of living (e.g. adequate food, safe &
sufficient supplies of water, secure shelter, access to education & health care, &
provision for the removal of domestic wastes
• Consumption patterns
Major difference in consumption patterns b/w different countries & b/w different groups
within countries
Rees & Wackernagel (1992) characterized the land area necessary to sustain current
levels of resource consumption & waste discharge by a population as its ecological
footprint.
The ecological footprints of high income cities are hundreds of times larger than their
politic or geographical area & are much larger than the ecological footprints of lower
income communities
• Macroeconomic policies
Influence the use & degradation of natural resources, b/c can affect consumer demand
& the prices of natural resources
The effects are felt most directly at the level of an individual’s purchasing power
 EH Professionals
• EH Officer • Occupational Hygienist
• EH Technician • OH Nurse
• Environmental Inspector • OEH Physician
• Epidemiologist • OHS Inspector
• Ergonomist • Sanitary Engineer
• Health Physicist • Safety Professional
• Health Policy Analyst • Statisticians
• Toxicologist
• Laboratory Analytical Scientist
Nature of Environmental
Health Hazards

Department of Public Health

Faculty of Medicine – Universitas Padjadjaran
Bandung
OBJECTIVE:
• To describe the difference between hazard & risk
• To explain the logic of the various methods of classifying
environmental hazards
• To describe a scheme for identifying the level of hazard &
toxicity
• To explain why knowledge of the toxicology, microbiology, or
physical properties of an environmental hazard is essential to
determining the most appropriate approach to its risk
assessment
• To identify different experimental investigative methods
• To explain the biological significance of bio-transformation
process
• To list the basic characteristics of chemical, physical,
biological, mechanical, & psychosocial hazards
Definition

Hazard
 a factor or exposure that may adversely affect
health (Last, 1995)

 a source of danger
 a qualitative term expressing the potential of an
environmental agent to harm the health of certain
individuals if the exposure level is high enough
&/or if other conditions apply
Definition (cont’d)
Risk
 the probability that an event will occur, e.g. that
an individual will become ill or die within a stated
period of time or before a given age; the
probability of a (generally) unfavorable outcome
(Last, 1995)

 the quantitative probability that a health effect

will occur after an individual has been exposed to
a specified amount of a hazard
 Types of EH Hazards
 Biological hazards
e.g. bacteria, viruses, parasites
 Chemical hazards
e.g. toxic metals, air pollutants, solvents, pesticides
 Physical hazards
e.g. radiation, temperature, noise
 Mechanical hazards
e.g. motor vehicle, sports, home, agriculture, & workplace
injury hazards
 Psychosocial hazards
e.g. stress, lifestyle disruption, workplace discrimination,
effects of social change, marginalization, unemployment
 Types of EH Hazards (cont’d)

Classified according to:

 nature
 natural vs anthropogenic
 traditional vs modern
 route of exposure
 setting
Scope of environmental health
Food
Biological
Living Hazards
Environment Chemical
Hazards
Home Work
Environment Environment Physical
Hazards

Social
Recreational Hazards
Environment
Psychosocial
Hazards
Traditional Hazards
• Disease vectors
• Infectious agents
• Inadequate housing &
shelter
• Poor-quality drinking water
& sanitation
• Indoor air pollution from
cooking
• Dietary deficiencies
• Hazards of child birth
• Wildlife & domestic
animals
• Injury hazards in
agriculture
Modern Hazards
• Tobacco smoking
• Transport hazards
• Pollution from sewage &
industry
• Outdoor air pollution from
industry & motorcars
• Overuse or misuse of
chemicals
• Industrial machinery
• Unbalanced diet
 Biological, chemical & physical hazards
by routes of exposure
Biological Chemical Physical
AIR
Agent/source Microorganisms Fumes, dust, particles Radiation, heat, noise

Vectorial factors Coughing, exhalations Contaminated air Climate, unguarded

exposures
Routes Inhalation, contact Inhalation, contact Inhalation, direct
penetration
WATER
Agent/source Microorganisms, decayed Discharges, teaching, Radiation, heat in power
organic material dumping station cooling water
Vectorial factors Insects, rodents, snails, Contaminated food & Accidents, contaminated
animal excreta, food water food & water
chain
Routes Bites, ingestion, contact Ingestion, contact Ingestion, contact
 Pathway
Inadequate sanitation, the dumping of
untreated sewage into surface water,
poor hygienic practices  water
polluted by human excreta
Overcrowding, poorly ventilated
housing  airborne transmission
Unhygienic animal husbandry 
zoonoses transmission
Stagnant waters, unsanitary housing,
refuse dumping  vector-borne
transmission
Disease
cholera, typhoid fever, dysentry, other diarrheal
diseases, hepatitis A, schistosomiasis
tuberculosis, measles, influenza, pneumonia,
pertussis, cerebrospinal meningitis
plague & hydatids diseases
malaria, trachoma, schistosomiasis, filariasis,
yellow fever, plague, typhus, trypanosomiasis
Growth of biological agents are
slowed down or stopped by:
• defense mechanisms of the body
• drugs
CHEMICAL HAZARDS
Inorganic Substances
- halogens (e.g. fluorine, chlorine, bromine, iodine)
- alkaline compounds (e.g. NH3, Ca(OH)2, KOH, NaOH
- ozone (O3)
- NOx and SOx
- metals (e.g. cadmium, chromium, copper, lead,
manganese, mercury, nickel, arsenic)
Organic Compounds
- aliphatic hydrocarbons (e.g. methane, ethane, propane,
butane, pentane, hexane, heptane, octane)
- alicyclic hydrocarbons (e.g. cyclohexane,
methylcyclohexane, turpentine)
- aromatic hydrocarbons (e.g. benzene, toluene, styrene,
naphthalene)
- halogenated hydrocarbons (e.g. chloromethane,
dichloromethane, chloroform, carbon tetrachloride,
trichloroethyene, polyviyl chloride)
- alcohols (e.g. methanol, ethanol, propanol)
 Route of exposures
Source:
• natural events
• man-made: industrial, agricultural, commercial,
domestic, manufacturing wastes
Exposure:
- inhalation - breastfeeding
- oral ingestion - placental transfer
- absorption via the skin - inoculation & direct penetration
- absorption via the eyes
 Air, water, Food, water,
Exposure Air
dirt, etc drugs
Media
inhalation exhalation ingestion

Major uptake Respiratory

pathways Skin GI-tract
tract

bile
exfoliation

Transport & Other

distribution organs
Blood Liver

Kidney

Major
excretory Sweat Hair Urine Faeces
pathways

external contamination
Toxicity
any harmful effect of a chemical or a drug on a
target organ
• Systemic toxicity
• Liver toxicity
• Kidney toxicity
• Skin toxicity
• Neurotoxicity
• Immunotoxicity
Toxicity Testing
• Acute toxicity studies
to predict human effects of short-term, high-level exposures; can provide a
measure of the toxic potential of different compounds
ED50 : dose that would cause the effect in half of the test population
LD50 : dose that would kill half of the test population
LC50 : concentration of gas or vapor that kills half the test population
LD50 & LC50 : crude indices of toxicity
• Sub-chronic tests
animals exposed repeatedly to a given chemical over a relatively long period (28
days or longer), normally 10% of the lifetime of the selected animals
• Chronic toxicity testing
performed by exposing animals to the chemical being tested for the whole of the
animal’s lifetime
• Reproductive studies
on parents & offspring
Toxicity Testing (cont’d)

• Genotoxic short-term tests

short-term tests for gene mutation & chromosome alterations
both in vitro & in vivo
• Human studies
clinical or epidemiological studies
• Structure-activity relationships

Right-to-know legislation  hazard identification & control

PHYSICAL HAZARDS
Forms of potentially harmful energy in the
environment that can result in either immediate or
gradually acquired damage when transferred in
sufficient quantities to exposed individuals
e.g.: sound, waves, radiation, light energy, thermal
energy, electrical energy
Other physical hazards:
vibration, radiation, light, lasers, pressure,
temperatures

What are potential health effects of

such hazards?
Mechanical Hazards

those posed by the transfer of mechanical or

kinetic energy (the energy of motion)
 Injury, trauma, accidents

Vulnerable groups:
children, the elderly, & disadvantaged groups
Psychosocial Hazards
Potential sources of work-related psychosocial
stress:
- factors intrinsic to the job
- the role of the worker in the organization
- career development
- interpersonal relationships at work
- organizational structure & climate
Pollution
Source
Type
Mechanism
 Global Warming
• Unpredictable weather
 Global Warming
• Sea Level increase
 Global Warming

• Bandung City Source : BPLHD Jabar

Source : BPLHD Jabar
Ozone hole
Depletion The Ozone Layer
(Ozone depletion process)
• Padalarang Source : BPLHD Jabar
Human Activities
Human activities
Water Pollution
 Clean up the oil
Spencer Grant/Photo Researchers, Inc.

Oil Spill Clean-up

Workers use special nets to clean up a California beach following an oil tanker spill. Tanker spills are an increasing
environmental problem because once oil has spilled, it is virtually impossible to completely remove or contain it.
Even small amounts spread rapidly across large areas of water. Because oil and water do not mix, the oil floats on
the water and then washes up on broad expanses of shoreline. Attempts to chemically treat or sink the oil may
further disrupt marine and beach ecosystems.
Microsoft ® Encarta ® Reference Library 2003. © 1993-2002 Microsoft Corporation. All rights reserved.
 Water Pollution

• Sungai Citepus, Bandung City,2004 Source : BPLHD Jabar

 Water Pollution

• Industrial waste Source : BPLHD Jabar

 Water Pollution

• Sekeloa, Bandung City

• Source : BPLHD Jabar
•Rancaekek Source : BPLHD Jabar
•Leuwigajah Source : BPLHD Jabar
•Leuwigajah Source : BPLHD Jabar
• Dago Resort, Bandung.
•Source : BPLHD Jabar
•Source : BPLHD Jabar
•Source : BPLHD Jabar
a Healthy Environment means
Healthier Kids
THINK GLOBALLY ACT LOCALLY, DON’T FORGET
WE HAVE MORE THAN 230 MILLION INHABITANTS
TO SERVE …

Serve with your heart

THE FUTURE OF YOUR COUNTRY
IS IN YOUR HANDS
Thank you…