This document discusses key environmental health burdens such as household air pollution, ambient particulate matter pollution, and issues related to water, sanitation, and hygiene. Environmental risk factors are responsible for 25-33% of the global disease burden. The three leading causes of death in low- and middle-income countries are related to environmental health issues. There are high-impact, low-cost solutions to reducing this disease burden, such as improving access to water and sanitation, promoting better hygiene practices, and reducing household and ambient air pollution.

1. Chapter Eight
The Environment
and Health

2. Learning Objectives
• Discuss the most important environmental threats to
health, especially for low- and middle-income
countries
• Review the burden of disease related to
environmental risks
• Comment on the costs and consequences of key
environmental health burdens
• Describe some of the most cost-effective ways of
reducing the global burden of environmental health
problems

3. 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)
– 5th: Lower respiratory infections
– 7th: Diarrheal diseases
• Central to achieving SDGs

4. Key Concepts
Environment
“external physical, chemical, and
microbiological exposures and processes that
impinge upon individuals and groups and are
beyond the immediate control of individuals”
-McMichael, A.J. (2001).
Environmental Health.

5. 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.”
-World Health Organization

6. Key Concepts
Adapted from The World Bank. (n.d.). Environmental health. Retrieved from
http://siteresources.worldbank.org/INTPHAAG/Resources/AAGEHEng.pdf

7. Key Environmental Health Burdens
Household Air Pollution
• Three 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

8. Key Environmental Health Burdens
Ambient Particulate Matter 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

9. Key Environmental Health Burdens
Data from U.S. Environmental Protection Agency. (2007). The plain English guide to the Clean Air Act: The common air pollutants.
Retrieved from https://www.epa.gov/sites/production/files/2015-08/documents/peg.pdf; U.S. Environmental Protection Agency. (n.d.).
Air & radiation: Six common air pollutants. Retrieved from http://www.epa.gov/air/urbanair/

10. Key Environmental Health Burdens
Water, Sanitation, and Hygiene
• WHO estimated that in 2015 about 71 percent of
the global population or about 5.2 billion people
had access to safe drinking water
• 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

11. Burden of Environmentally Related
Diseases
Household Air Pollution
• Eighth most important risk factor for deaths
globally in 2016
• Cause of 3.8 million deaths yearly
• Fourth most important risk factor in high
mortality low- and middle-income countries

12. Burden of Environmentally Related
Diseases
Ambient Particulate Matter Pollution
• Cause of 4.2 million deaths
• 90% of those deaths occur in low- and middle-
income countries
• India and China have major burdens of related
disease, along with other countries in Asia and
Eastern Europe

13. Burden of Environmentally Related
Diseases
Sanitation, Water, and Hygiene
• Burden falls primarily on children and the poor
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

14. The Costs and Consequences of Key
Environmental Health Problems
• Social and economic consequences are
enormous
• Burden falls disproportionately on relatively
poor people
• Negative consequences on productivity,
particularly for women
• Young children are especially at risk for
consequences of environmental issues

15. Reducing the Burden of Disease
Ambient Particulate Matter Pollution
• Introduce unleaded gasoline
• Use low-smoke lubricant for, or ban, two-
stroke engines
• Shift to natural gas to fuel public vehicles
• Tighten emissions inspections
• Reduce burning of garbage

16. Reducing the Burden of Disease
Household Air Pollution
• Improve cooking devices
• Use less polluting fuels
• Reduce need for fuels by using solar cooking
and heating
• Use mechanisms for venting smoke
• Use dried fuels for cooking
• Keep children away from cooking area

17. 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
• Community-based approaches are important

18. 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

19. Reducing the Burden of Disease
Modified with permission from Cairncross, S., & Valdmanis, V.
(2006). Water supply, sanitation, and hygiene promotion. In D. T.
Jamison, J. G. Breman, A. R. Measham, et al. (Eds.), Disease control
priorities in developing countries (2nd ed., p. 776). Washington, DC,
and New York, NY: The World Bank and Oxford University Press.

20. 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, as
well

21. 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

22. Reducing the Burden of Disease
Modified with permission from Cairncross, S., & Valdmanis, V.
(2006). Water supply, sanitation, and hygiene promotion. In D.
T. Jamison, J. G. Breman, A. R. Measham, et al. (Eds.), Disease
control priorities in developing countries (2nd ed., p. 791).
Washington, DC,and New York, NY: The World Bank and
Oxford University Press.

23. Future Challenges
• Population growth
• Pollution management
• Community-based approaches to reach rural
populations
• Better information
• Engaging sectors beyond health

24. Main Messages
• Important environmental health issues include:
the lack of safe water and sanitation, poor
access to hand washing facilities, household
air pollution, and ambient particular matter
• Environmental health issues have a larger
impact on the poor

25. Main Messages
• When accompanied by improved hygiene,
improved access to water reduces the burden
of diarrheal disease
• There are high-impact, low-cost solutions to
environmental health issues, including: using
improved stoves, building latrines, making
accessible handwashing stations, and taking
intersectoral approaches to reducing ambient
particulate matter pollution