2. Goal 7: Ensure Environmental Sustainability
7.A: Integrate the principles of sustainable development into country policies and programs and
reverse the loss of environmental resources
7.B: Reduce biodiversity loss
7.C: Halve the proportion of the population without sustainable access to safe drinking water and
basic sanitation
7.D: Achieve, by 2020, a significant improvement in the lives of at least 100 million slum dwellers
3. What is Environmental Health?
• Environmental health addresses all the physical, chemical, and biological
factors external to a person, and all the related factors that can potentially
affect health (WHO 2015)
• It is targeted towards preventing disease and creating health-supportive
environments
4. Environmental Health Burdens
• Indoor air pollution
• WHO relates this pollution to those using solid fuel for cooking and heating
• Outdoor air pollution
• carbon monoxide, lead, nitrogen dioxide and nitrogen oxides, particulate matter, smog,
sulfur dioxide, and volatile organic compounds
• Sanitation, water, and hygiene
5. Costs and Consequences
• Constitute 8.4% of total deaths in low and middle-income countries and
7.2% of total burden of disease
• The burden of environmental problems falls mainly on the poorer people in
low and middle-income countries
• Women and children suffer the most and result in a loss of productivity and
the burden spills over onto the rest of the family
6. Reducing the burden of disease
Outdoor Air Pollution
• Introduction of unleaded gasoline
• Low-smoke lubricant for 2-stroke engines
• The banning of 2-smoke engines
• Shifting to natural gas to fuel public vehicles
• Tightening emissions inspections on vehicles
• Reducing the burden of garbage
7. Reducing the Burden of Disease
Indoor Air Pollution
• Improved cooking devices
• Using less polluting fuels
• Using solar cooking and heating
• Ventilation mechanisms in the house
• Using dried fuels
• Keeping children away from the cooking area
• Promoting information and education about indoor air pollution and how to reduce it in the
community
• Tax policy to reduce cost of cooking appliances and fuels that will reduce pollution
8. Reducing the Burden of Disease
Sanitation
• Explaining the standard of sanitation facilities and making sure that people in communities know
that they have sanitation facilities
• Providing communities with brochures that show them the different types of sanitation technologies
so that they can pick the most cost-effective method for their community
• Action by the public and private sectors to enforce regulations and require the use of toilets
• Promotion of improved sanitation by public and private partnerships led by NGOs
9. Where Do We Stand?
• Deforestation has slowed, but global greenhouse gas emissions continue their upward trend
• Ozone-depleting substances have been virtually eliminated and the ozone is expected to
recover by the middle of the century
• Global emissions of carbon dioxide have increased by 50% since 1990
• As of 2015, 90% of global population uses an improved drinking water source
• Since 1990, 2.1 billion people have gained access to improved sanitation
• The proportion of people practicing open defecation has fallen by more than half
• The proportion of people living in the slums has dropped from 39.4% to 29.7% as of 2014
11. Case Study: Handwashing with Soap in Senegal
• Handwashing with soap prevents the spread of disease by killing disease
agents
• In Senegal, the rate of handwashing is relatively low
• According to a study in 2004, the rate of handwashing with soap was 18%
before handling food, 18% after cleaning a child, and 23% after going to the
toilet
• Barriers to handwashing in Senegal include: distance between soap and
water source, soap being controlled by people who don’t want to share it,
and lack of a designated place for handwashing
12. Case Study: Handwashing with Soap in Senegal
• Public-Private Partnership for Handwashing with Soap (PPPHW) was
created in Senegal in 2003
• Their mission was to promote handwashing with soap
• PPPHW launched a communications campaign in 2004 with the goal of
educating people about the importance of using soap when washing hands
and when the most critical times are for hand washing
• “Water Rinses but Soap Cleans”
13. Case Study: Handwashing with Soap in Senegal
• The campaign used multiple methods of communication
• Television and radios broadcasted the message at times when mothers were most likely
preparing meals
• Billboards were also used
• The campaign hosted interactive local community events to extend its
messages to the population
• local markets and schools hosted live entertainment and demonstrations to educate women
and children about the importance of handwashing
• Small group discussions were held at women’s associations and waiting
rooms of local health centers
14. Case Study: Handwashing with Soap in Senegal
• The 2nd phase of the project began in 2008 after
being incorporated into the Water and Sanitation
Program’s Global Scaling Up Handwashing
Project
• This expanded the project to reach 8 out of 11
regions in Senegal
• target on women of reproductive age and
primary school-aged children
• Goal: improve handwashing with soap practices
of over 500,000 mothers and children
• Encouraged mothers to designate a special place
for handwashing with soap
• 150 trained workers helped mothers set up these
designated areas and made sure that water and
soap were accessible and available
15. Case Study: Handwashing with Soap in Senegal
Challenges to the Project
• Engaging local partners while maintaining the message
• local advertising agencies broadcasted negative messages of disease rather than positive
outcomes of handwashing with soap
• Making sure the outreach workers who visited homes went beyond offering
information, by discussing mothers’ obstacles and providing solution ideas
• Making sure that men get the message as well
• Men are the decision-makers in the households
16. Water Access
• Over 1 billion people in the world do not have access to water
• Water is not delivered through water pipes to homes
• People have to walk distances in search of water for daily needs
• Distances vary 2-6 km
• Women and children fetch water
• Carry loads of 20 kg on heads
• Walk 1 - 2.5 hours daily
• Study in Uganda of 715 water journeys
• 75% foot
• 22% bicycle
• 2% vehicle
17. Water and Health
• Strong relationship between availability of clean water and infant mortality
• 2.3 billion people suffer from water-related diseases
• 60% of infant mortality is due to infections and parasitic diseases related to
unclean water
• In Bangladesh, 70% of all illnesses is due to unsafe water and poor
sanitation
• In Pakistan, 25% of all people in hospitals are ill from water-related
problems
19. Water and Sanitation
• 7.C indicator does not consider water quality, which relates to pathogens
and chemicals that can cause disease
• Safe drinking water is defined from an “improved source”, which includes
piped water on premises and channels
• public taps and hand pumps
20. Case Study: Water Sanitation in India
• Interviewer-administered cross-sectional survey at 2 sites in India from May
2013 - October 2013
• Targeting population of households with at least 1 woman with a child (12 -
23 months old)
• Data collected from random sample of 685 households in a New Delhi slum
and 1,192 households in 60 villages of poor rural district of Uttar Pradesh
21. Case Study: Water Sanitation in India
• Recorded household water source
• Tested water for fecal contamination using a UNICEF-validated rapid test
for coliform bacteria
• Tested water in government centers designed for health and welfare of
mothers and children
• Collected data on household characteristics and child health
22. Case Study: Water Sanitation in India
• 99.6% of urban and 99.7% of rural households had access to safe water as
defined by MDG target 7.C indicator
• Water contaminated in 41.5% of urban and 60% of rural households
• About half of the centers in each site had contaminated water
23. Case Study: Total Sanitation In East Java,
Indonesia
• Total Sanitation and Sanitation Marketing (TSSM):
• Development of a strategy for changing behaviors based on consumer research
• Development of an approach to increasing the market for latrines, based on market
research
• A community-led campaign for total sanitation that seeks to make a community completely
free of open defecation
• In East Java, Indonesia
• Sanitation coverage was below 70% in urban areas and below 55% in rural areas
• Intended Outcome: provide access to sustainable sanitation services for 1.4
million people
24. Case Study: Total Sanitation In East Java,
Indonesia
• Districts had to volunteer to participate in the program
• Discussions were held with local and district officials about the economic
impact of poor sanitation at the country and district levels and the social and
economic returns from investing in sanitation improvements
• Used Community-Led Total Sanitation (CLTS) strategy
• Focuses on community-wide sustainable behavioral change
• Tries to help communities understand that regardless of the number of toilets constructed,
there is still a risk of disease if anyone continues to defecate in the open
• Communities develop their own solutions to obtain improved sanitation and become open
defecation free
25. Case Study: Total Sanitation In East Java,
Indonesia
Marketing Techniques
• Advertisements for desirable hygienic behaviors
• Created a communication campaign with a character “Lik Telek” which
personifies open defecation
• Districts fund the campaign with posters, radio commercials, and an 8-
minute video
26. Case Study: Total Sanitation In East Java,
Indonesia
Market research
• No common definition of what the ideal sanitation facility is among consumers, suppliers, and
engineers
• Creation of WC-ku Sehat thumbs up sign to identify facilities that meet improved sanitation criteria
• An institute in East Java holds a mason training program and at least one mason will be available in each
district to work on improved sanitation
• Impression that good sanitation was unaffordable
• Informed Choice Catalogue of improved WC-ku Sehat sanitation options at various prices
• Open defecation into water was considered socially acceptable, convenient, safe, and clean
because the feces are considered invisible and carried away by fish
27. Case Study: Total Sanitation In East Java,
Indonesia
Achievements
• 49% increase in access to improved sanitation within the 18 month period
• 325,000 people gained access to improved sanitation in 21 districts in East
Java
• The poorest households in East Java established 715 open defecation-free
villages and gained access to improved sanitation
28. Main Messages
• Environmental health issues have a large impact on the global burden of
disease
• These impacts occur at the individual, household, community and global
levels
• The risks of environmental factors are greatest for women and children
• The risks of environmental factors are higher in low-income countries
• The most cost-effective approach is to invest in low-cost sanitation and
ventilation in homes
29. Discussion
1)How do you think success with this MDG goal can benefit your group’s MDG
goal?
2)What challenges do you think are impeding the success of this MDG goal?
3)How would you approach the outdoor air pollution problem in a developed
country? How would you address it in a middle-low income country?
4)What do you think would stop a low-income country from investing time,
money, and effort into improving sanitation facilities?
5)How would you address the problem of indoor air pollution in low income
countries? Why?
30. References
Skolnik, Richard L., and Richard L. Skolnik. Global Health 101. 2nd ed. Burlington, MA: Jones & Bartlett Learning, 2012. Print.
"United Nations Millennium Development Goals." UN News Center. UN, n.d. Web. 06 Oct. 2015.
"MDG 7: Ensure Environmental Sustainability." WHO. N.p., n.d. Web. 06 Oct. 2015.
"Millennium Development Goal 7." UNDP. N.p., n.d. Web. 06 Oct. 2015.
"Millennium Development Goals." The World Bank. N.p., n.d. Web. 06 Oct. 2015.
Vidyasagar, D. "Global minute: water and health - walking for water and water wars." Journal of Perinatology 27.1 (2007): 56. Academic
OneFile. Web. 6 Oct. 2015.
Johri, Mira, et al. "MDG 7C For Safe Drinking Water In India: An Illusive Achievement." Lancet 383 North American Edition.9926 (2014): 1379-1379 1p. CINAHL
Plus with Full Text. Web. 6 Oct. 2015.
