The document summarizes environmental health goals and initiatives under the MDGs, including reducing indoor and outdoor air pollution, improving access to safe drinking water and sanitation, and reducing the disease burden from these environmental factors. It provides case studies on handwashing promotion in Senegal and total sanitation programs in India and Indonesia, outlining challenges addressed and strategies used, such as behavior change communication campaigns, private sector partnerships, and community-led approaches.

1. MDG 7: Environmental
Health
By: Madison Bailey
Joshua deGuzman
Elizabeth Villegas

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

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

10. Emissions of Carbon Dioxide

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

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

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

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

18. Water-related Diseases
Water-borne (bacteria, feco-oral contamination)
dysentry, diarrhea, cholera, typhoid, hepatitis, polio
Water-based (toxic material)
ascariasis, clonorchiasis, schistosomiasis, guinea worm
Water-related vectors
malaria, filaria, dengue

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

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

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
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"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.
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