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Environmental Threats Global Health
- 1. Global Health Chapter 7 The Environment and Health Overview What are the most important environmental threats to health in low- and middle-income countries? What are the burdens of disease and consequences related to these threats? What can be done in cost-effective ways to reduce the global burden of these threats? Key Links between Environmental Health and the MDGs The Importance of Environmental Health Environmental risk factors account for 25-33% of global burden of disease Leading causes of death in low- and middle-income countries: 3rd: Chronic obstructive pulmonary disease (COPD) 4th: Lower respiratory infections 5th: Diarrheal diseases Central to achievement of MDGs Key Concepts Environment - “external physical, chemical, and microbiological exposures and processes that impinge upon individuals and groups and are beyond the immediate control of
- 2. individuals” Key Concepts Environmental health - efforts that are “concerned with preventing disease, death, and disability by reducing exposure to adverse environmental conditions and promoting behavior change.” Typical Environmental Health Issues Key Environmental Health Burdens Household Air Pollution 3 billion people in the world depend on solid fuel for cooking and heating Poorer populations more susceptible Short-term problems: conjunctivitis, upper respiratory infection, acute respiratory infection, and carbon monoxide poisoning Long-term associations: cardiovascular disease, chronic obstructive pulmonary disease, and cancer Key Environmental Health Burdens Ambient Air Pollution Common effects are respiratory symptoms, including cough, irritation of the nose and throat, and shortness of breath Older and younger people tend to be more susceptible Common Air Pollutants and their Health Effects
- 3. Key Environmental Health Burdens Water, Sanitation, and Hygiene Failure to properly dispose of human waste associated with increase in transmission of pathogens through oral-fecal route, spread of parasitic worms, and trachoma Waterborne pathogens are associated with diarrhea and other gastrointestinal problems Selected Waterborne Pathogens Examples of Water-related Infections Waterborne – cholera, amebiasis Water-washed or water scarce – scabies, trachoma Water-based – schistosomiasis, Guinea worm Water-related – malaria, yellow fever, dengue, Zika Burden of Environmentally Related Diseases Household Air Pollution 3.5 million deaths and 4.3% of total DALYs in 2010 4th most important risk factor in high mortality low- and middle-income countries 41% of all deaths attributable to indoor air pollution are among females Burden of Environmentally Related Diseases Ambient Air Pollution 3.1 million deaths and 3.1% of global DALYs in 2010 53% of deaths among men, 44% among women, and 3 %
- 4. children under five India and China have major burdens of disease, along with other countries in Asia and Eastern Europe Burden of Environmentally Related Diseases Sanitation, Water, and Hygiene 0.3 million deaths and 0.9% of DALYs in 2010 Burden falls primarily on children and the poor and less well- educated people in the poorer countries of South Asia and sub- Saharan Africa Unsafe sanitation, unsafe water, poor hygienic practices and burden of diarrheal disease are closely linked The Costs and Consequences of Key Environmental Health Problems Because of the high burden, social and economic consequences are enormous Burden falls disproportionately on relatively poor people Negative consequences on productivity Reducing the Burden of Disease Ambient Air Pollution Introduction of unleaded gasoline Low-smoke lubricant for or banning of two-stroke engines Shifting to natural gas to fuel public vehicles Tightening emissions inspections Reducing the burning of garbage Reducing the Burden of Disease Household Air Pollution Improved cooking devices
- 5. Use of less polluting fuels Reducing need for fuels by using solar cooking and heating Mechanisms for venting smoke Using dried fuels for cooking Keeping children away from cooking area Reducing the Burden of Disease Sanitation Simple methods of sanitation and excreta disposal are low-cost and relatively effective Barriers include lack of knowledge, cost, construction, and local laws Government subsidies and regulations for installing latrines Promotion through public-private partnerships headed by NGOs Selected Sanitation Technologies Reducing the Burden of Disease Water Supply Improved water sources: House connection Standpost Borehole Dug well Rainwater collection Investments in water alone do not have greatest impact on reductions in diarrheal morbidity Hygiene investments are critical to realizing water and sanitation benefits
- 6. Reducing the Burden of Disease Reducing the Burden of Disease Hygiene Hygiene promotion can lead to a 33% reduction in diarrhea morbidity Focus should be on simple messages about handwashing and enabling handwashing Handwashing associated with significant reductions in acute respiratory infections Reducing the Burden of Disease Integrating Investment Choices about Water, Sanitation and Hygiene In order of priority: 1) Hygiene - important for its own sake and to maximize effect of other investments 2) Sanitation - government promotion of low-cost sanitation schemes 3) Water - development of low-cost water supply schemes Cost per DALY Averted of Selected Investments in Water, Sanitation, and Hygiene Future Challenges Population growth Pollution management Community-based approaches to reach rural populations
- 7. Better information Engaging sectors beyond health Further Exploration Arsenic mitigation in Bangladesh http://www.unicef.org/bangladesh/Arsenic.pdf Climate change and health http://www.who.int/mediacentre/factsheets/fs266/en/ Videos WHO Calls Air Pollution in Chinese Cities a Crisis-BBC (2:11min) Pro-World Improved Stove (4:27 min) AID Africa Build Clean Rocket Stoves (3:00 min) Why Care About Water? Nat’l Geo. (2:30 min) Water & Public Health - Water for People (3:31 min) Ethiopia Daily Struggle for Clean Water-PBS (6:47 min) WASH Building Latrines – (4:39 min) Young People Help to Improve Sanitation in Haiti- UNICEF- (3:25 min)