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Effects of Air and Water Pollution on Health




    Najibullah Safi, MD, MSc. Health Policy and Management
         PHC Advisor, WHO Country Office - Afghanistan
What is pollution?

• It is the introduction of contaminants (pollutant) into
  an environment that causes instability, disorder,
  harm or discomfort to the ecosystem i.e. physical
  systems or living organisms
       – A pollutant is a waste material that pollutes air, water or
         soil
       – Three factors determine the severity of a pollutant:
          • Its chemical nature
          • The concentration
          • The persistence

Thursday, July 26, 2012       Afghan Media and Environmental Protection   2
Environmental health hazards

• Any external factor that negatively affects health can
  be considered an environmental health “hazard“
       – It is a generic term for any situation or state of events
         which poses a threat to the surrounding environment
       – Common environmental health hazards include indoor and
         outdoor air pollution, contaminated food and water
       – This term incorporates topics like pollution and natural
         hazards such as storms and earthquakes




Thursday, July 26, 2012     Afghan Media and Environmental Protection   3
Types of environmental hazards

• It include:
       –   Chemical
       –   Physical/mechanical
       –   Biological
       –   Psychosocial




Thursday, July 26, 2012          Afghan Media and Environmental Protection   4
Effects of Air Pollution on Health

More than 3000 people may die in Kabul because of air pollution
        every year (Press Release - MoPH, January 15, 2009 )
Thursday, July 26, 2012      Afghan Media and Environmental Protection   5
Comparison of health indicators
  N                       Indicator                             Afghanistan                     Pakistan
  O
  1     Life expectancy (years)                           Male: 47, Female: 45       Male: 65.2, Female 65.6

  2     Annual growth rate (%)*                                       2                           1.7

  3     Dependency ratio (%)                                         92                           88.3

  4     Under 5 Mortality Rate (Deaths/1,000 live                191 (165)                         90
        births)
  5     Infant Mortality Rate (Deaths/1,000 live                 129 (111)                        70.2
        births)
  6     Total Fertility Rate (Births/Woman)                          6.3                          4.1

  7     Maternal Mortality Ratio (Maternal                      1600 (1400)                       276
        Deaths/100,000 live births)(2000 data)


  Source: HMIS, MoPH, Afghanistan 2006 Health Survey
  * Country Health Profile - WHO


Thursday, July 26, 2012                             Afghan Media and Environmental Protection                  6
Cont.
  N                         Indicator                              Afghanistan                Pakistan
  O
  8     Pregnant women who received 1+ ANC visits (%)                   30


  9     Deliveries attended by skilled health personnel                 19                    100 (2009)
        (%)
  10    Newborns immunized with BCG 2007 (%)                            91                       98


  11    1-year-olds immunized with 3 doses of DPT 2007                  83                       98
        (%)
  12    Children under 2 years immunized with 1 dose of                 70                       100
        measles 2007 (%)
  13    Pregnant women immunized with two or more                       65                       NA
        doses of tetanus toxoid 2007 (%)
  14    Percent of rural population with access to local                66                       NA
        health services

  Source: HMIS – MoPH
  WHO, Country profile http://www.emro.who.int/emrinfo/index.asp?Ctry=afg
Thursday, July 26, 2012                           Afghan Media and Environmental Protection                7
What is air pollution?

• It is the presence of one or more air pollutant in such
  a quantity and duration sufficient to cause harm to
  man, plants animals and property
• Air pollution is the emission into the air of hazardous
  substance at a rate that exceed the capacity of
  natural process in the atmosphere to
       – Convert them,
       – Precipitation (rain or snow ) to deposit them or
       – Of winds and air movement to dilute them



Thursday, July 26, 2012      Afghan Media and Environmental Protection   8
In door air pollution

• Indoor air can be defined as any non-industrial
  indoor space where a person spends a period of an
  hour or more in any day
• This can include the air space in the office,
  classroom, motor vehicle, shopping centre, hospital
  and home




Thursday, July 26, 2012   Afghan Media and Environmental Protection   9
Common indoor air pollutants
 • Second-hand tobacco                    • Chemicals released by:
   smoke                                         • Dry cleaned clothes
 • Lead-impregnated dust                         • Cleaning products
                                                 • Room deodorizers
   from old paint,                               • Office supplies
   cockroach shedding                            • Paints
 • Dust mite particles                           • New furniture and
                                                   pressed wood
 • Combustion gases                              • Personal care products;
   released by stoves,                             and
   heaters, candles and                          • Pesticides
   fireplaces



Thursday, July 26, 2012   Afghan Media and Environmental Protection      10
Outdoor air pollutants

•    Ozone (O3)
•    Particulate matter
•    Carbon monoxide (CO)
•    Nitrogen oxide (Nox)
•    Sulfur dioxide (SO2)
•    Lead (Pb)
•    Volatile organic compounds …



Thursday, July 26, 2012   Afghan Media and Environmental Protection   11
Sources of air pollution

• Transportation (mobile sources )
   – Motor vehicles, rail, shipping, aviation
• Industry sources
   – Power stations, petroleum refining, chemical
     manufacturing
• Power plants
• Central heating
• Incineration of domestic wastes



Thursday, July 26, 2012   Afghan Media and Environmental Protection   12
13
Thursday, July 26, 2012   Afghan Media and Environmental Protection
Health effects of air pollution
•    Irritation of nose, eye, and throat
•    Respiratory diseases (Bronchitis, Asthma, cough, …etc.)
•    Cardiovascular diseases
•    Toxicity (CO)
•    Decrease of pulmonary function and restricted activities
•    Cancers (Benzene)
•    Neurological impairments, such as seizures, mental
     retardation, and behavioral disorders, learning disabilities,
     apathy and behavior abnormalities (Pb)
•    kidney/liver damage, CNS disorders (Arsenic, cadmium, lead,
     mercury, nickel, and chromium)
•    Increased hospital admissions and ER visits
•    Anemia as a complication of chronic lead exposure
•    Premature death
Thursday, July 26, 2012      Afghan Media and Environmental Protection   14
Air pollution in Kabul




Thursday, July 26, 2012   Afghan Media and Environmental Protection   15
Cont.




Thursday, July 26, 2012   Afghan Media and Environmental Protection       16
Cont.




Thursday, July 26, 2012   Afghan Media and Environmental Protection       17
Conti.

       – High amount of dust and concentration of poly aromatic
         hydrocarbons (originated from cars)*
       – A pollutant: Benzo-a-pyrene which increase the risk of
         lung cancer
       – Presence of duct increase the potential risks of BP
       – Combination of drought and loss of vegetation are
         contributing factors to the increased dust level



       *Afghanistan post conflict environmental assessment conducted by UNEP in
          Kabul, Balkh, Herat and Kandahar in 2002

Thursday, July 26, 2012          Afghan Media and Environmental Protection        18
Control measures

• Scientific group studies on the damaging
  effects on plant, animal, and human life
• Legislative bodies to set up the standards and
  enforce laws to control emission
• Health professional and media to educate the
  population about the health effects of the pollution
• Media – advocacy, public awareness



Thursday, July 26, 2012   Afghan Media and Environmental Protection   19
At the individual level

• As transportation is a major source of pollution so
       – Limit driving
       – Use public transportation, use carpools, bike
       – Maintain your car regularly especially the emission control
         system
• Reduction at the emission source is very important in
  stationary plants




Thursday, July 26, 2012     Afghan Media and Environmental Protection   20
Community level

• They should continue to exert their pressure on the
  government to carry on ongoing continuous
  surveillance monitoring for air pollution/ pollutants
  in order to place more astringent standards when
  required
• To encourage the researches on the subject under
  study




Thursday, July 26, 2012   Afghan Media and Environmental Protection   21
Effects of Water Pollution on Health

4 billion cases of diarrhea worldwide each year
Some facts

• Parasites Intestinal Worms infect about 10% of the
  world population
• About 200 million people are affected by
  schistosomiasis, with 200,000 dying each year
• Diarrheal diseases have killed more children in the
  past ten years than all the people lost to armed
  conflict since World War II
• WHO estimated that 88% of diarrheal disease is
  caused by unsafe water supply, and inadequate
  sanitation and hygiene

Thursday, July 26, 2012   Afghan Media and Environmental Protection   23
Cont.

• In Afghanistan during 2009 water borne diseases
  contributed to almost 1/4 of diseases outbreaks
  which included cholera, Hepatitis A & E and typhoid
  fever
• Water borne diseases are huge burden on already
  strained health system as almost 1/5 of patients at a
  health facility are due to diarrheal diseases alone
  throughout the year



Thursday, July 26, 2012   Afghan Media and Environmental Protection       24
What is water pollution?

• Introduction of harmful substances or products into
  water

Causes of water pollution
• Factors that contribute to water pollution can be
  categorized into two different groups
       – Point sources
       – Non-point sources



Thursday, July 26, 2012   Afghan Media and Environmental Protection   25
Point sources

• Some point sources of water pollution include
       –   Waste products from factories
       –   Waste from sewage system
       –   Waste from power plants
       –   Waste from underground coalmines
       –   Waste from oil wells …
• They are called point sources because they are direct
  sources of water pollution and can be reduced and
  monitored


Thursday, July 26, 2012   Afghan Media and Environmental Protection   26
Non-point sources

• The term non-point source encompasses a large
  range of sources such as:
       – When rain or snow moves through the ground and picks
         up pollutants as it moves towards a major body of water
       – The runoff of fertilizers from farm animals and crop land
       – Air pollutants getting washed or deposited to earth
       – Storm water drainage from lawns, parking lots, and streets
         …




Thursday, July 26, 2012   Afghan Media and Environmental Protection   27
Water hazardous substances

•   Heavy metals
•   Other inorganic elements
•   Acids/bases
•   Oxidants
•   Volatile organic compounds
•   Hydrophobic organic compounds
•   Petroleum additives
•   Pesticides
•   Micro-organisms
•   Radioactive …                                                     28


Thursday, July 26, 2012   Afghan Media and Environmental Protection    28
Harms of water pollution

• Virtually all types of water pollution are harmful to the health
  of humans and animals
• Suspended particles in freshwater reduces the quality of
  drinking water for humans and the aquatic environment for
  marine life
• Heavy metals from industrial processes can accumulate in
  nearby lakes and rivers. These are toxic to marine life such as
  fish, and subsequently to the humans who eat them
• Industrial waste often contains many toxic compounds that
  damage the health of aquatic animals and those who eat them
• Microbial pollutants from sewage often result in infectious
  diseases
The main water-borne/fecal oral diseases

•    Typhoid fever
•    Giardia
•    Dysentery
•    Cholera
•    Diarrhea (caused by a variety of pathogens)
•    Hepatitis
•    Polio
•    Worms

Thursday, July 26, 2012   Afghan Media and Environmental Protection   30
Drinking water quality in Afghanistan

• Cross contaminated by sewage*
• High level of contamination with Coliform bacteria
  (18-100 count in 100 ml)
• 70% of shallow wells infected by bacteria




*Afghanistan post conflict environmental assessment conducted by UNEP in Kabul,
   Balkh, Herat and Kandahar in 2002
Thursday, July 26, 2012       Afghan Media and Environmental Protection           31
Water pollution control

• Pollution prevention
• Minimize pollution
   – Recycling and re-use; treatment; encourage cleaner
     production technologies; encourage good
     housekeeping
• Disinfection (Chlorination)
• Disposal or discharge of waste water



                                                                      32


Thursday, July 26, 2012   Afghan Media and Environmental Protection    32
WHO publication on air pollution and health

• WHO air quality Global update 2005:
  http://whqlibdoc.who.int/hq/2006/WHO_SDE_PHE_OEH_06.02_en
  g.pdf
• WHO indoor air quality: dampness and mould:
  http://www.euro.who.int/en/what-we-do/health-
  topics/environmental-health/air- quality/publications/2009/who-
  guidelines-for-indoor-air-quality-dampness-and-mould
• Methodology for assessing the burden of diseases of outdoor air
  pollution:
  http://www.who.int/quantifying_ehimpacts/publications/ebd5.pdf
• Air quality and health (questions and answers):
  http://www.who.int/phe/air_quality_q&a.pdf

Thursday, July 26, 2012   Afghan Media and Environmental Protection   33
Thursday, July 26, 2012   Afghan Media and Environmental Protection   34

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Impacts of air_&_water_pollution_on_health

  • 1. Effects of Air and Water Pollution on Health Najibullah Safi, MD, MSc. Health Policy and Management PHC Advisor, WHO Country Office - Afghanistan
  • 2. What is pollution? • It is the introduction of contaminants (pollutant) into an environment that causes instability, disorder, harm or discomfort to the ecosystem i.e. physical systems or living organisms – A pollutant is a waste material that pollutes air, water or soil – Three factors determine the severity of a pollutant: • Its chemical nature • The concentration • The persistence Thursday, July 26, 2012 Afghan Media and Environmental Protection 2
  • 3. Environmental health hazards • Any external factor that negatively affects health can be considered an environmental health “hazard“ – It is a generic term for any situation or state of events which poses a threat to the surrounding environment – Common environmental health hazards include indoor and outdoor air pollution, contaminated food and water – This term incorporates topics like pollution and natural hazards such as storms and earthquakes Thursday, July 26, 2012 Afghan Media and Environmental Protection 3
  • 4. Types of environmental hazards • It include: – Chemical – Physical/mechanical – Biological – Psychosocial Thursday, July 26, 2012 Afghan Media and Environmental Protection 4
  • 5. Effects of Air Pollution on Health More than 3000 people may die in Kabul because of air pollution every year (Press Release - MoPH, January 15, 2009 ) Thursday, July 26, 2012 Afghan Media and Environmental Protection 5
  • 6. Comparison of health indicators N Indicator Afghanistan Pakistan O 1 Life expectancy (years) Male: 47, Female: 45 Male: 65.2, Female 65.6 2 Annual growth rate (%)* 2 1.7 3 Dependency ratio (%) 92 88.3 4 Under 5 Mortality Rate (Deaths/1,000 live 191 (165) 90 births) 5 Infant Mortality Rate (Deaths/1,000 live 129 (111) 70.2 births) 6 Total Fertility Rate (Births/Woman) 6.3 4.1 7 Maternal Mortality Ratio (Maternal 1600 (1400) 276 Deaths/100,000 live births)(2000 data) Source: HMIS, MoPH, Afghanistan 2006 Health Survey * Country Health Profile - WHO Thursday, July 26, 2012 Afghan Media and Environmental Protection 6
  • 7. Cont. N Indicator Afghanistan Pakistan O 8 Pregnant women who received 1+ ANC visits (%) 30 9 Deliveries attended by skilled health personnel 19 100 (2009) (%) 10 Newborns immunized with BCG 2007 (%) 91 98 11 1-year-olds immunized with 3 doses of DPT 2007 83 98 (%) 12 Children under 2 years immunized with 1 dose of 70 100 measles 2007 (%) 13 Pregnant women immunized with two or more 65 NA doses of tetanus toxoid 2007 (%) 14 Percent of rural population with access to local 66 NA health services Source: HMIS – MoPH WHO, Country profile http://www.emro.who.int/emrinfo/index.asp?Ctry=afg Thursday, July 26, 2012 Afghan Media and Environmental Protection 7
  • 8. What is air pollution? • It is the presence of one or more air pollutant in such a quantity and duration sufficient to cause harm to man, plants animals and property • Air pollution is the emission into the air of hazardous substance at a rate that exceed the capacity of natural process in the atmosphere to – Convert them, – Precipitation (rain or snow ) to deposit them or – Of winds and air movement to dilute them Thursday, July 26, 2012 Afghan Media and Environmental Protection 8
  • 9. In door air pollution • Indoor air can be defined as any non-industrial indoor space where a person spends a period of an hour or more in any day • This can include the air space in the office, classroom, motor vehicle, shopping centre, hospital and home Thursday, July 26, 2012 Afghan Media and Environmental Protection 9
  • 10. Common indoor air pollutants • Second-hand tobacco • Chemicals released by: smoke • Dry cleaned clothes • Lead-impregnated dust • Cleaning products • Room deodorizers from old paint, • Office supplies cockroach shedding • Paints • Dust mite particles • New furniture and pressed wood • Combustion gases • Personal care products; released by stoves, and heaters, candles and • Pesticides fireplaces Thursday, July 26, 2012 Afghan Media and Environmental Protection 10
  • 11. Outdoor air pollutants • Ozone (O3) • Particulate matter • Carbon monoxide (CO) • Nitrogen oxide (Nox) • Sulfur dioxide (SO2) • Lead (Pb) • Volatile organic compounds … Thursday, July 26, 2012 Afghan Media and Environmental Protection 11
  • 12. Sources of air pollution • Transportation (mobile sources ) – Motor vehicles, rail, shipping, aviation • Industry sources – Power stations, petroleum refining, chemical manufacturing • Power plants • Central heating • Incineration of domestic wastes Thursday, July 26, 2012 Afghan Media and Environmental Protection 12
  • 13. 13 Thursday, July 26, 2012 Afghan Media and Environmental Protection
  • 14. Health effects of air pollution • Irritation of nose, eye, and throat • Respiratory diseases (Bronchitis, Asthma, cough, …etc.) • Cardiovascular diseases • Toxicity (CO) • Decrease of pulmonary function and restricted activities • Cancers (Benzene) • Neurological impairments, such as seizures, mental retardation, and behavioral disorders, learning disabilities, apathy and behavior abnormalities (Pb) • kidney/liver damage, CNS disorders (Arsenic, cadmium, lead, mercury, nickel, and chromium) • Increased hospital admissions and ER visits • Anemia as a complication of chronic lead exposure • Premature death Thursday, July 26, 2012 Afghan Media and Environmental Protection 14
  • 15. Air pollution in Kabul Thursday, July 26, 2012 Afghan Media and Environmental Protection 15
  • 16. Cont. Thursday, July 26, 2012 Afghan Media and Environmental Protection 16
  • 17. Cont. Thursday, July 26, 2012 Afghan Media and Environmental Protection 17
  • 18. Conti. – High amount of dust and concentration of poly aromatic hydrocarbons (originated from cars)* – A pollutant: Benzo-a-pyrene which increase the risk of lung cancer – Presence of duct increase the potential risks of BP – Combination of drought and loss of vegetation are contributing factors to the increased dust level *Afghanistan post conflict environmental assessment conducted by UNEP in Kabul, Balkh, Herat and Kandahar in 2002 Thursday, July 26, 2012 Afghan Media and Environmental Protection 18
  • 19. Control measures • Scientific group studies on the damaging effects on plant, animal, and human life • Legislative bodies to set up the standards and enforce laws to control emission • Health professional and media to educate the population about the health effects of the pollution • Media – advocacy, public awareness Thursday, July 26, 2012 Afghan Media and Environmental Protection 19
  • 20. At the individual level • As transportation is a major source of pollution so – Limit driving – Use public transportation, use carpools, bike – Maintain your car regularly especially the emission control system • Reduction at the emission source is very important in stationary plants Thursday, July 26, 2012 Afghan Media and Environmental Protection 20
  • 21. Community level • They should continue to exert their pressure on the government to carry on ongoing continuous surveillance monitoring for air pollution/ pollutants in order to place more astringent standards when required • To encourage the researches on the subject under study Thursday, July 26, 2012 Afghan Media and Environmental Protection 21
  • 22. Effects of Water Pollution on Health 4 billion cases of diarrhea worldwide each year
  • 23. Some facts • Parasites Intestinal Worms infect about 10% of the world population • About 200 million people are affected by schistosomiasis, with 200,000 dying each year • Diarrheal diseases have killed more children in the past ten years than all the people lost to armed conflict since World War II • WHO estimated that 88% of diarrheal disease is caused by unsafe water supply, and inadequate sanitation and hygiene Thursday, July 26, 2012 Afghan Media and Environmental Protection 23
  • 24. Cont. • In Afghanistan during 2009 water borne diseases contributed to almost 1/4 of diseases outbreaks which included cholera, Hepatitis A & E and typhoid fever • Water borne diseases are huge burden on already strained health system as almost 1/5 of patients at a health facility are due to diarrheal diseases alone throughout the year Thursday, July 26, 2012 Afghan Media and Environmental Protection 24
  • 25. What is water pollution? • Introduction of harmful substances or products into water Causes of water pollution • Factors that contribute to water pollution can be categorized into two different groups – Point sources – Non-point sources Thursday, July 26, 2012 Afghan Media and Environmental Protection 25
  • 26. Point sources • Some point sources of water pollution include – Waste products from factories – Waste from sewage system – Waste from power plants – Waste from underground coalmines – Waste from oil wells … • They are called point sources because they are direct sources of water pollution and can be reduced and monitored Thursday, July 26, 2012 Afghan Media and Environmental Protection 26
  • 27. Non-point sources • The term non-point source encompasses a large range of sources such as: – When rain or snow moves through the ground and picks up pollutants as it moves towards a major body of water – The runoff of fertilizers from farm animals and crop land – Air pollutants getting washed or deposited to earth – Storm water drainage from lawns, parking lots, and streets … Thursday, July 26, 2012 Afghan Media and Environmental Protection 27
  • 28. Water hazardous substances • Heavy metals • Other inorganic elements • Acids/bases • Oxidants • Volatile organic compounds • Hydrophobic organic compounds • Petroleum additives • Pesticides • Micro-organisms • Radioactive … 28 Thursday, July 26, 2012 Afghan Media and Environmental Protection 28
  • 29. Harms of water pollution • Virtually all types of water pollution are harmful to the health of humans and animals • Suspended particles in freshwater reduces the quality of drinking water for humans and the aquatic environment for marine life • Heavy metals from industrial processes can accumulate in nearby lakes and rivers. These are toxic to marine life such as fish, and subsequently to the humans who eat them • Industrial waste often contains many toxic compounds that damage the health of aquatic animals and those who eat them • Microbial pollutants from sewage often result in infectious diseases
  • 30. The main water-borne/fecal oral diseases • Typhoid fever • Giardia • Dysentery • Cholera • Diarrhea (caused by a variety of pathogens) • Hepatitis • Polio • Worms Thursday, July 26, 2012 Afghan Media and Environmental Protection 30
  • 31. Drinking water quality in Afghanistan • Cross contaminated by sewage* • High level of contamination with Coliform bacteria (18-100 count in 100 ml) • 70% of shallow wells infected by bacteria *Afghanistan post conflict environmental assessment conducted by UNEP in Kabul, Balkh, Herat and Kandahar in 2002 Thursday, July 26, 2012 Afghan Media and Environmental Protection 31
  • 32. Water pollution control • Pollution prevention • Minimize pollution – Recycling and re-use; treatment; encourage cleaner production technologies; encourage good housekeeping • Disinfection (Chlorination) • Disposal or discharge of waste water 32 Thursday, July 26, 2012 Afghan Media and Environmental Protection 32
  • 33. WHO publication on air pollution and health • WHO air quality Global update 2005: http://whqlibdoc.who.int/hq/2006/WHO_SDE_PHE_OEH_06.02_en g.pdf • WHO indoor air quality: dampness and mould: http://www.euro.who.int/en/what-we-do/health- topics/environmental-health/air- quality/publications/2009/who- guidelines-for-indoor-air-quality-dampness-and-mould • Methodology for assessing the burden of diseases of outdoor air pollution: http://www.who.int/quantifying_ehimpacts/publications/ebd5.pdf • Air quality and health (questions and answers): http://www.who.int/phe/air_quality_q&a.pdf Thursday, July 26, 2012 Afghan Media and Environmental Protection 33
  • 34. Thursday, July 26, 2012 Afghan Media and Environmental Protection 34