Man and the environment

By Prof Fathi El-Gamal

The Environment: Concept



Health is multi-factorial Factors which influence health :

 

Individual factors (within the subject) External Environmental factors (surrounding man)

Disease occurrence depends on both factors Interaction between these factors may be:
 

Health promoting Health damaging

Environment

External environment (macro-environment)

Living and non living things surrounding man

Internal environment (micro-environment)

Internal structure of man: tissue, organs and systems and their harmonious functioning

Environment

A stable and harmonious equilibrium between man and his environment is needed :

To reduce mans vulnerability to disease To permit him to lead a more productive life To permit him to lead a satisfying life

Environment is one of the components of the epidemiological triad theory

Epidemiological Triad Theory:

Concern not only about microbe

Environment

Inadequate sanitary environment

Malnutrition Ignorance Low SEC

e.g. Measles

Host
Time

Agent

Environmental Sanitation

It is concerned with health problems related to:

     

Water pollution Over-crowding Inadequate housing Unsanitary disposal of human excreta Unsanitary disposal of refuse Presence of vectors and animal reservoir

Examples of Health problems due to unsanitary environment

      

Diarrheal diseases Poliomyelitis Diphtheria Measles Yellow fever Plague Cholera etc

Environmental Health


This term has replaced Environmental sanitation: Why?

Other problems are emerging due to exposure to new determinants of diseases:

  

Pollution due to air, noise, radiation, chemicals (OPC), consumption of food additives, style of life (stress, sedentary life, smoking, abnormal feeding) etc

Examples of health problems due to these new threats

      

Cancer Cardiovascular diseases Cerebro-vascular accidents Chronic pulmonary diseases Mental health problems Obesity Diabetes mellitus,.. etc

Components of the environment

Biological

Psychosocial

Physical

(A) Biological Environment

Universe of living things surrounding man including man himself. Relation to disease:

 

Produce disease (agent) Reservoir of infection (man; animal) Transmission of disease (vector e.g mosquito) Plant and animals are source of food (e.g mal-nutrition, food poisoning).

(B) Psycho-social environment



Psycho-social factors are those affecting:

  

Personal health Health care system Community well-being

These include the following:

    

Culture * values * habits Attitudes * morals * religion Occupation * life style * income health services political and social organization

* beliefs * education

Impact of Psycho-social Environment

Education and income:

World map of poverty and illiteracy (mainly for women), coincide closely with malnutrition, ill-health, and high mortality

Occupation:

Loss of work means loss of income Un-employment is associated with

 

Mental disorders (e.g. depression, anger, frustration) High incidence of diseases (peptic ulcer, BA, HTN, DM, CHD, and death

Impact of Psycho-social Environment

Culture, habits, beliefs and attitudes:

Evil eye: (particularly for children) Diseases may be due to ghost (e.g. epilepsy); or due to impure blood (scabies) Smoking as a social habit is linked to so many diseases (e.g. CVD, COPD, Cancer, ..etc.) Decrease in moral and religious values particularly among travelers is associated with STDs

Impact of Psycho-social Environment

Culture, habits, beliefs and attitudes:

Foods e.g. egg and fish are harmful during some illnesses e.g. common cold Men eat first then women and lastly children who eat poorly Early marriage, in rural communities is considered as sound and desirable practice The newborn is fed on warm water instead of breast feeding during first three days of life (colostrum is harmful)

Impact of Psycho-social Environment

Culture, habits, beliefs and attitudes:

Family is incomplete without birth of a boy Knowledge, attitude and behavior of the individuals towards the health care delivery e.g. low utilization is due to fatalism and ethnocentrism  Fatalism: the belief in fate  Ethnocentrism : the people reject any new concept (e.g. the traditional birth attendants are more efficient and experienced than medical team

Impact of Psycho-social Environment

Good customs such as:

   

community participation, prolonged breast feeding, exposure to sun and practicing exercise

All have positive impact on health

(C) Physical Environment

It is applied to non living things e.g.

Water Soil Noise Housing

- Air - Lighting - Radiation - electromagnetic waves. etc.

Mans victory over his physical environment has been responsible for most of the improvement of his health and life style.

(C) Physical Environment



Man has altered every thing in his physical environment for his advantage. In the mean time he created for him self a host of new health problems e.g.

Air pollution Food pollution hazard Noise pollution etc

- Water pollution - Radiation - Urbanization,

(C) Physical Environment

Water


Water is one of the components of physical environment It has a profound effect on health either

Directly or indirectly

Water


Direct relation of water to health

1. Water is common vehicle for some communicable diseases

1.Microbes that can be transmitted by ingestion

Bacteria: cholera, typhoid , paratyphoid Viruses: Hepatitis A & E, Polio Parasites: amoebic dysentery and giardiases

Water

2.Contact with water (deposition):

Bilharzias, fungal infection, ear and skin diseases

Water

Change in the chemical quality of water and its relation to health

Sources of water pollution with chemicals:

 

Industrial waste Radioactive waste These chemical are:

. Pesticides . Fertilizers . Human and animal excreta

Nitrates

-arsenic

-iodine

-fluorides

-lead

Water
Indirect relation of Water to health

1. It provides a suitable medium for breading of vectors of diseases (e.g. mosquito) 2. It provides moisture suitable for completion of life cycle of certain parasites (e.g. Ankylostoms) 3. Lack of water supply results in poor personal hygiene that increases the prevalence of skin diseases

Water


Characteristics of water born epidemic

1. Affects the hole population or a localized sector using the same source of water 2. Affects all ages, sexes and social classes 3. Affects a large number of people within a short period

Water

4. Epidemic disappears suddenly after water treatment, but secondary cases may continue 5. Symptoms of the disease appear in sequence according to the incubation period: diarrhea starts first, then typhoid, and then viral hepatitis 6. Incrimination of water is usually based on epidemiological evidence rather than isolation of the organism

Air pollution

Air is one of the components of physical environment Air pollution is defined as: Presence, in surrounding air, of substances (gases, mixtures of gases and particulates) in a concentration sufficient to interfere:
 

directly with health Or indirectly through affecting the chemicals entering the food chain Or being present in drinking water

Air pollution

Classification of Air pollution

Indoor air pollution Outdoor air pollution

Indoor Air Pollution

Indoor air pollution exposes more people worldwide to air pollution Rural people in developing countries may receive as much as 2/3 of the global exposure to particulate matter Women and children suffer the greatest exposure Levels of indoor pollution many be 2 - 5 times higher (may occasionally be 100 times higher) than outdoor levels)

Indoor Air Pollution

Sources of indoor pollution

Insecticides Tobacco smoke Combustion equipment: stoves, gas cookers, coal combustion (CO, CO2, NO2, SO2) Building materials emit radon; paints emit lead Insulations emit asbestos, and organic solvents e.g. benzene and toluene

Indoor Air Pollution

Carpet adhesives evolve formaldehyde Biological sources e.g.:

 

Substances originating from fungi (molds) Arthropods (house dust mites)

** Exposure occurs when these contaminants become aerosolized

Smog, ozone, and other pollutants in the air we breathe outdoor as well as pollen and other allergens- can easily find access indoors

Indoor Air Pollution



In order to improve indoor air quality: It is preferable to remove the sources Rather than To dilute contaminants by good ventilation

Outdoor Air Pollution

There are thousands of air pollutants in the surrounding air Criteria air pollutants (definition):

Air pollutants that are present everywhere in several places at the same time, and can cause adverse health effects Current criteria air pollutants are:


O3, NO2, SO2,CO, Pb, and particulate matter

Sources of outdoor air pollution

Natural sources:


Volcanoes Forest fires

Sources of outdoor air pollution



Man Made sources

Motor vehicles


(major source in urban areas) Immession of smoke and gases from different industries (e.g. combustion of fossil fuel)

Industries


Indoor activities


Biological sources e.g. pollen, grains, fungi and bacteria

Sources of outdoor air pollution

Others:
  

Burning refuse, incinerators, pesticide spraying, nuclear energy Most important source is organic compounds e.g. chlorofluorocarbons (CFCs) used as refrigerants CFCs are stable, so can be transported to upper layers of the atmosphere (stratosphere).

They release chlorine, which destroys ozone layer results in Ozone hole (ozone depletion) Thus UVRs reach the earch through the hole and produce health effects and affects mans life

Health impact of air pollution



-Immediate:

Sudden and massive exposure to air pollutants results in:  Eye irritation, difficulty of breathing, dry cough, excerpation of asthma,  This is called air pollution episodes

 

Example: Dark cloud blanket which cover Cairo each year Due to burning of hay and other organic matters In addition to metrological condition hich makes the cloud stagnant over cairo

Health impact of air pollution

Delayed:

COPD (chronic bronchitis and emphysema), BA, and Lung cancer Indoor exposure of children to lead may lead to Impaired IQ, and poor educational achievement Ozone depletion:


Damage food chain, skin cancer, cataract, immune system depression

Health impact of air pollution

Global arming

It is the steady increase in the average global temperature of the earth as a result of different mans activities:

( e.g. deforestation, industrialization, combustion of fossil fuel, smoking, using refrigerants, etc..), ( CO2, water vapors, methane, NO2, CFCs, O3, ..etc.)

that emit green house gases

Health impact of air pollution



Global warming leads to:

Increase evaporation:

Increase precipitation of all water ppt in the earth e.g. rain, snow, dew, frost Increase sea level Decrease crop yield

Melting of ice

Dryness of soil

Accelerate reaction between hydrocarbons and NO

Release O3

Obstacles to establish relation between pollution and disease

1. Most diseases are multi-factorial  e.g malaria 2. Great diversity of diseases related to climatic changes  e.g. disease may be acute or chronic 3. Uncertainty about mechanism of diseases 4. Long latency period between climatic changes and health impact 5. Epidemiological studies are local and limited

Strategy for prevention and control of

Air pollution

1. Prevention of the escape of the pollutants into the air

Enclosure Ventilation Filtration Air cleaning

2. Replacing the process causing air pollution by a new one

Examples: Use of electricity, natural gas and central heating Instead of Coal Use of closes incinerators instead of open one

3. Removal of air pollutants

By establishment of green belt between industrial and residential area

4. Use of chemical disinfectants

Such as application of hypo-chlorite as a bactericidal on alls and floors of any health care facilities

5. Legislation to control air pollution

Such as:

Height of the chimney Town planning Certain smokeless zones

6. International actions

Establishment of international laboratories for monitoring and studying of air pollution