This is basically a protocol upon the basis of P.G Public Health presentation on behalf of the Health effects due to environmental pollution on population.

1. Health Effects Due To Environmental Pollution In Population
Delhi Pharmaceutical Sciences & Research University
SCHOOL OF ALLIED HEALTH SCIENCES (SAHS)
Presenter
Debraj Mukhopadhyay
MPH – Master of Public Health
03/Master of Public Health/DPSRU/19
Supervisor
Dr. J. Swaminathan
Assistant Professor
DPSRU, New Delhi
Journal Club Presentation

2. Aims & Objectives
Introduction
Search Methodology
Review of literatures
Findings and results
Novelty of this research model
References
Table of Contents

3. Aim & Objectives
The aim of this kind of research on population health is to raise global
awareness of pollution, end neglect of pollution-related disease and mobilize the
resources need to effectively confront pollution.
Objectives:
1. To assess the soil contamination with heavy metal and its consequences to
public health.
2. To assess the bioaccumulation of heavy metal (Cd, Co, Cr, Cu, Mn, Ni, Pb,
and Zn) in topsoil (0-20 cm) and crops and associated health risks of their
consumption.
3. To assess the particulate matter (PM) in the ambient air and its association with
respiratory health problems among the population.
4. To understand the role of risk based strategy in betterment of water safety

4. Introduction
Pollution is the largest environmental cause of
disease and premature death in the world today.
Diseases caused by pollution were responsible for
an estimated 9 million premature deaths in
2018—16% of all deaths worldwide— three
times more deaths than from AIDS, tuberculosis,
and malaria combined and 15 times more than
from all wars and other forms of violence. In the
most severely affected countries, pollution-
related disease is responsible for more than one
death in four.

5. In some regions this has caused serious agricultural land and food pollution,
especially for heavy metals. It is important, therefore, that issues threatening food
safety such as combined pesticide residues and heavy metal pollution are addressed
to reduce risks to human health. The increasing negative effects on food safety from
air, water and soil pollution have put more people at risk of carcinogenic diseases
which appear to correlate strongly with the main food producing areas [1].
In India, household air pollution (HAP) and ambient air pollution (AAP) are
estimated to account for 6% and 3% of the total national burden of disease,
respectively, with approximately 1.04 million premature deaths and 31.4 million
disability adjusted life years (DALYs) attributable to HAP, and 627 000 deaths and
17.8 million DALYs attributable to AAP [2].
Continue……

6. Search methods: Search methods: To find the relevant articles
Boolean operator “OR” and “AND” will be
used. “OR” will be used to find the articles
with more than one search terms and
synonyms and “AND” will be used to
combine the different concepts. To ensure that
different forms of a word and spelling has
been included in the search, truncation and
wildcards will be utilized. Subheadings will
be used and “keywords” where relevant for
given databases.
Search engines: Search of the literature had
done in the ProQuest, SCIENCE DIRECT,
Google Scholar, PubMed.

7. Concept - 1 And Concept - 2 And Concept - 3
List of all key
words/terms as
started in topic
description above
Impact of Pollutants on
Health
Environment
Pollution and Health
Impacts
Bio-accumulation and
Environmental Health
research studies
OR OR
List of search terms Air, water and soil
pollutants
Environment
pollutant monitoring
and its health
assessment
Effects of heavy metals
on health
OR OR
Final searching
terms/words in
search engine
Health risk assessment,
Bio-concentration
factors of environmental
pollution
Contamination of
heavy metals in
water, soil and air
Health problems among
the population due to
pollutants of
environment
Creating Search Plan – Search Strategy

8. Literatures related to air pollution
and respiratory health

9. Review of literatures
•Saha et al., conducted a cross sectional study in a small village of western India on
adults (n=369 165 males and 204 females) fuel used was assessed using a
questionnaire and pulmonary function was measure by using spirometer. FEV1
(p<0.05), FEV1% (p<0.01), PEFR (p<0.05) and FEF25-75 (p<0.01) values were
significantly lower in biomass fuel using females than non-users. It was concluded
that traditional biomass fuels like wood have adverse effects on pulmonary functions
(1).
•Dave et al., tested the hypotheses that exposure to biomass fuel, poor ventilation or
cooking in living space were associated with reduced lung function by using cross
sectional data from WHO study on Global Ageing and Adult Health conducted in
India. He found that the use of biomass fuels was associated with decrease in FEV1
and FEV1/ FVC ratio compared with those who use electricity or gas (2).
Indoor air pollution:

10. •Study by Kumar et al., done in Ashok Bihar, Delhi depicted that the levels of
pollutants like SO2, NO2, and SPM levels were significantly high where unclean
fuels were used for cooking (p<.001, p=0.029, and p=0.029, respectively). Whereas
there was a significant increase in SO2 and SPM in houses where there was a
positive family history of smoking (p=0.014 and p=0.017 respectively). Levels of
SPM was significantly high if occupancy per room was more than four persons
(p<0.001). Outdoor air pollutants also contribute to indoor air quality. This had
been observed by Kumar et al in the households close to industrial areas and by
Lawrence et al., in the house holds close to traffic congestion sites (3).
Review of literatures

11. Review of literatures
•Assad et al., reviewed the relationship between biomass smoke exposure and
chronic lung diseases. The odds ratios (OR) for biomass smoke ranged from 1.5 to
3.0 for airflow obstruction in exposed study subjects in low income countries (4).
•Agrawal et al., studied the effect of indoor air pollution from biomass and solid
fuel combustion on symptoms of preeclampsia/eclampsia. The OR was found to
be 2.21 (5).

12. •Fullerton et al., conducted community based cross-sectional observation study
among adults elder than 30 years in urban and rural districts of southern
Malawi to study the differences in lung functions between individuals who
burnt different types of biomass fuel. Results showed that individuals who used
wood as the main domestic fuel had significantly worse lung function then those
who used other fuels. Wood smoke exposure and poverty contributed to reduced
lung functions and COPD is common in this population (6). Relationship between
dampness and mould exposure at home and its effect on lung function was
studied on the basis of population based cross sectional study by Hernberg et al.,
among 269 non asthmatic adults aged 21-63 years in South Finland. Exposure to
mould order at home or at work was related to reduce FEV1 and FVC levels
(7).
Review of literatures

13. Review of literatures
Ambient air pollution:
•Rahul et al., conducted mix study designs (longitudinal and cross-sectional study) for
assessing short and long-term exposure to ambient air pollution (AAP). 59 studies
reviewed for examining respiratory diseases. Short term exposure (n=23), long term
exposure (n=18), premature mortality (n=18) were considered. Study revealed short
term exposure increases incidence of COPD, respiratory illness and
hospitalization. Long term exposure lead to asthma, IHD, CVS mortality,
premature mortality. PM2.5, PM10 mainly responsible for respiratory health
problems (8).
•As per TERI’s inventory (Sharma et al., 2016), the share in PM2.5 emissions are
dominated by the industrial (36%) and residential combustion (39%) sectors.
Transport contributes to just 4% of PM2.5 emissions at the National scale (9).

14. Review of literatures
Effects of air pollution on respiratory health
•The growing atmospheric pollution has resulted in various acute and chronic respiratory
diseases including Chronic Obstructive Pulmonary Disease (COPD) and asthma (10, 11).
•Bran et al reported that in India, the simulated PM2.5 mass concentration was high over the
states, where the reported respiratory problems were high (12). The prevalence of respiratory
symptoms was determined through a structured respiratory symptom logy questionnaire and
personal interviews. Air quality data were collected from Central and State Pollution Control
Boards and also obtained by direct measurements using a portable aerosol monitor. Based on the
data collected on the cohort of children participating in this study, 32.1% of children in Delhi
suffered from respiratory problems in contrast to 18.2% of rural children (control). The
respiratory symptoms were more prevalent in girls than in boys. A strong, statistically
significant positive association was observed between PM10 level in Delhi’s air and the
prevalence of lower respiratory tract symptoms (13).

15. Exposure to ambient air sulphur dioxide (SO2), oxides of nitrogen (NOx) and
suspended particulate matter (SPM) on the day of the interview or in the week
prior, was assessed by ambient air monitoring at 9 centers within the city. The
cumulative incidence of RSC was 1.06 and the incidence density per 100 days of
follow up was 1.63. All three pollutants were positively correlated with each other
and negatively correlated with temperature. Ambient air SPM and SO2 and cooking
and heating fuels like dung cakes, wood, coal and kerosene and remaining indoors
while the food was cooked were associated with increased incidence of RSC,
increased duration of symptoms, or both. We conclude that to improve the
respiratory health of preschool children, ambient air SPM and SO2 levels
should be kept as low as possible and mothers should be advised to keep
children in another room while cooking (14).
Review of literatures

16. Literatures related to Water & Soil pollution
and Health Risk Assessment

17. Review of literatures
Pollutant Source Possible effects
Lead lead paint and gasoline
Brain damage and
learning problems
Coal dust Coal mining Black lung disease
Pesticides Use in agriculture and
Landscaping
Nerve damage, birth
defects, and cancer
Bacteria in
Food
Poor sanitation and poor
food handling
Gastrointestinal
Infections
Particulate
matter
Vehicle exhaust, burning
waste, fires, and tobacco
smoke
Respiratory damage
(asthma, bronchitis,
cancer)
Commonly encountered heavy metals
are chromium, cobalt, nickel, copper,
zinc, arsenic, selenium, silver,
cadmium, antimony, mercury,
thallium and lead etc in polluted soil
& water. These can be chronic
exposure to carcinogenic, due to this
congenital disorders or other chronic
health problem created. Due to
industrial or human made naturally
occurring chemicals as ammonia and
nitrate linked with livestock fertilizer
from land operation, have also been
defined as health dangerous in soil
and groundwater (14).
Types of pollutants

18. Review of literatures
Heavy
Metal
Sources of
Environmental
exposure
Minimum Risk
level
Chronic exposure
toxicity
effects
Lead Industrial, vehicular
emissions, paints and
burning of plastics,
papers, etc
Blood lead levels
below 10 µg/dl
of blood
Impairment of neurological
development, suppression of the
hematological system, kidney failure
Mercury Electronics,
plastic waste,
pesticides,
pharmaceutical
and
dental waste
Below 10 µg/dl of
blood Oral
exposure of
4mg/kg/day
Gastro-intestinal disorders,
respiratory tract irritation, renal failure
and neurotoxicity
Cadmium Electronics,
plastics, Batteries and
contaminated water
Below 1 µg/dl of
blood
Irritation of the lungs, gastrointestinal
tract, kidney damage, lungs cancer

19. Impacts on Public Health Affected
Children
%
Disorders
Dermatological (skin disorders) 48 15.0
Respiratory 96 30.0
Gastroenteritis (GE)
(abdominal, intestinal problems)
39 12.2
Dental disorders 31 9.7
Oto (affecting the hearing system) 15 4.7
Skeletal /muscular systems 8 2.5
Central nervous system 7 2.2
Eye infections 17 5.3
Blood (anemia) 2 0.6
Others 21 6.6
Normal 36 11.3
Review of literatures
Below summarizes the health results of the 320 children aged 2-18Years examined in MIDC Area
of Mahape, Pawane and Taloja Villages

20. This pilot Project has linked environmental pollution and Human health. Soil and
water samples experimented from locations near and within the affected site show
high levels of heavy metals emanating from the site in Mainly cadmium, copper,
chromium, mercury and lead. It is only in the last 50 years, with the expansion of
industry and the chemical interaction of agricultural land, that the inherently
extractive economy has acted as though the renewable resources that support
agriculture are fair targets for exploitation in industrial terms. That is what makes
the modern era different. Guidelines and proper management of keeping in view
should be evolved slag’s including toxic metals techno economic feasibility (14).
Review of literatures

21. Findings and Results -
•Majority of people living in these areas suffering from various water borne
diseases. So through study argues about the requirement and importance of water
purification and water management systems in current times.
•Measuring the PM (2.5,10)and SPM concentration in the ambient air of any particular
region, the acute respiratory cases emphasized on basis of episodes on air pollution.
•These studies proved the operability of the established methodology and verified
relevancy of the human health limits (indication limits of human health protection).
This helped to reveal the areas where the soil did not meet the soil quality standards
and where the human health risks elevate. The characteristic pollution profiles of
soil with elevated human health risks will definitely be defined on the basis of the
results.

22. Novelty of this research model
•Health risk assessment measured on the aspect of pollutants from air, water and
soil in a whole-sum manner.
•The project can open a new perspective on heavy metal pollution as a global and
regional issue in Indian context. Calculated loading rates of heavy metals into
the three environmental how that human exercises have major impact on
nature and have serious consequences .
•This research link concentration of an environmental contaminant in air, water,
and soil to human exposure through inhalation, ingestion, and dermal contact
routes.
•This research model will help to implement environment policies to protect
public health.

23. 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals
and air, water and soil pollution and contamination
3.9.1 Mortality rate attributed to household and ambient air pollution
3.9.2 Mortality rate attributed to hazardous chemicals, water and soil pollution and contamination
Transforming our world: the 2030 Agenda for Sustainable Development

24. References -
1. Saha A, Rao NM, Kulkarni PK, Majumdar PK, Saiyed HN. Pulmonary function and fuel use: a population survey. Respire Res.
2018;6(1):127
2. Dave M, Ahankari AS, Myles PR, Arokiasamy P, Khobragade P. Household air pollution and lung function in India adults: a
cross-sectional study. INT J Tuberc Lung Dis.2017;21(6):702-704.
3.Kumar R, Nagar JK, Kumar H, Kushwah AS, Meena M, Kumar P, Raj N, Singhal MK, Gaur SN. Indoor air pollution and
respiratory function of children in Ashok Vihar, Delhi: an exposure-response study. Asia Pac J Public Health. 2008;20(1):36-48.
4. Lawrence A, Fatima N. Urban air pollution & its assessment in Lucknow City--the second largest city of North India. Sci Total
Environ. 2014;488-489:447-55.
5. Assad NA, Kapoor V, Sood A. Biomass smoke exposure and chronic lung disease. Curr Opin Pulm Med 2016;22(2):150.
6. Agrawal S, Yamamoto S. Effect of indoor air pollution from biomass and solid fuel combustion on symptoms of
preeclampsia/eclampsia in Indian women. Indoor Air 2015;25(3): 341–52.
7.Fullerton DG, Suseno A, Semple S, Kalambo F, Malamba R, White S, et al. Wood smoke exposure, poverty and impaired lung
function in Malawian adults. Int J Tuberc Lung Dis.2011;15(3):391-398.

25. 8. Balakrishnan K, Sambandam S, Ramaswamy P, Ghosh S, Venkatesan V, Thangavel G, Mukhopadhyay K, Johnson P, Paul S,
Puttaswamy N, Dhaliwal RS. Establishing integrated rural–urban cohorts to assess air pollution-related health effects in pregnant
women, children and adults in Southern India: an overview of objectives, design and methods in the Tamil Nadu Air Pollution and
Health Effects (TAPHE) study. BMJ open. 2015 Jun 1;5(6):e008090.
9. Hernberg S, Sripaiboonkij P, Jaakkola MS. Indoor molds and lung functions in healthy adults. Respire 2014;108(5):677-84.
10. World Health Organization [Internet]. WHO Geneva: Air pollution. 2018 [cited 2018 Jan 2]. Available from:
http://www.who.int/topics/air_pollution/en/.
11. Bran SH, Srivastava R. Investigation of PM(2.5) mass concentration over India using a regional climate model. Environ Pollut.
2017; 224:484-493.
12. Siddique S, Ray MR, Lahiri T. Effects of air pollution on the respiratory health of children: a study in the capital city of India.
Air Quality, Atmosphere & Health. 2011 Jun 1;4(2):95-102.
13. Awasthi S, Glick HA, Fletcher RH, Ahmed N. Ambient air pollution & respiratory symptoms complex in preschool children.
The Indian journal of medical research. 1996 Oct;104:257-62.
14. Gangadhar ZS. Environmental impact assessment on soil pollution issue about human health. International Research Journal of
Environment Sciences. 2014;3(11):78-81.
15. McGranahan G, Murray F, editors. Air pollution and health in rapidly developing countries. Earthscan; 2012.

26. I would like to give regards and thanking to my supervisor Dr. J. Swaminathan sir and
respected faculties of School of Allied Health Sciences (SAHS), Delhi Pharmaceutical
Sciences and Research University (DPSRU)