Global health Issue

Global Health 101 By Richard Skolnik

Chapter Seven The Environment and Health

The Importance of Environmental Health Important contributors to global burden of

disease: • Unsafe water, hygiene, and excreta disposal • Urban air pollution • Indoor smoke from household use of solid fuels Leading causes of death in low- and middle-income

countries linked with environmental factors: • 3rd-Lower respiratory infection • 6th-Chronic obstructive pulmonary disease • 7th-Diarrheal disease

Global Health in the News • William Leber • The lack of affordable housing in areas of the world is a continually existing problem, and this

is especially the case in the United States. According to an article by BBC, the city of Los Angeles is currently experiencing a "homelessness emergency." Within the city's county, there has been a 12% increase in the number of homeless men and women over the last two years and is estimated to include 44,359 people. The disparity is blatantly obvious. For example, there is a distinct, inverse relationship between the number of recovery and housing programs in the city and the amount of money spent on constructing large billion dollar projects. This is an especially difficult issue because how do you properly get such a large number of people off the streets and into healthier settings? This problem is not only specific to Los Angeles, but to a number of cities across the globe. Even from our classroom windows, I can see and find homeless men and women at the McDonalds across the street. This is a major issue that continues to be swept under the rug.

• http://www.bbc.com/news/world-us-canada-34384755

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”

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. It focuses on the direct and indirect causes of disease and injuries and taps resources inside and outside the healthcare system to help improve health outcomes”

Key Environmental Health Burdens Indoor Air Pollution

• Half of all people in the world depend on solid fuel for cooking and heating

• Poorer people tend to use open stoves that are not vented to the outside

• Short-term problems include conjunctivitis, upper respiratory infection, acute respiratory infection, and carbon monoxide poisoning

• Long-term associations include cardiovascular disease, chronic obstructive pulmonary disease, and cancer

• http://www.nature.com/news/global-health-deadly-dinners-1.15286

Key Environmental Health Burdens

Outdoor Air Pollution • Common effects are respiratory systems,

including cough, irritation of nose and throat, and shortness of breath

• Older and younger people tend to be more susceptible

• https://youtu.be/JPY8osKe8qM

Key Environmental Health Burdens

Sanitation, Water, and Hygiene • Only 60% of people in the world have access to improved

sanitation • Poor sanitation leads to increase in pathogens through

oral-fecal route, spread of parasitic worms, and trachoma • One billion people lack access to safe water sources • Waterborne pathogens are associated with diarrhea and

other gastrointestinal problems • https://youtu.be/3jYr8MFTXrM

Burden of Environmentally Related Diseases

Indoor Air Pollution • 3.7% of annual deaths • 3rd most important risk factor in high

mortality low- and middle-income countries • 59% of all deaths attributable to indoor air

pollution are among females

Burden of Environmentally Related Diseases

Urban Outdoor Air Pollution • 1.5% of annual deaths, 0.5% of burden of

disease • India and China have major burdens of disease

related to outdoor air pollution, along with other countries in Asia and Eastern Europe

• https://youtu.be/Ksps_1Zwg5o

Burden of Environmentally Related Diseases

Sanitation, Water, and Hygiene • 3.2% of annual deaths, 3.7% of burden of disease • Burden falls primarily on the poor and less well-educated

people 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

• https://youtu.be/hk8Rm9EsET4

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

Reducing the Burden of Disease

Outdoor Air Pollution • Introduction of unleaded gasoline • Low-smoke lubricant for or banning of two-stroke

engines • Shifting to natural gas to fuel public vehicles • Tightening emissions inspections • Reducing the burning of garbage It will be cost-effective for countries without a

significant burden yet to minimize pollution, instead of mitigating its effects later

Reducing the Burden of Disease Indoor Air Pollution

• Improved cooking devices • Use of less polluting fuels • Reducing need for fuels by using solar cooking

and heating • Mechanisms for venting smoke • Using dried fuels for cooking • Keeping children away from cooking area • Public policies that encourage these practices

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 • Promotion through public-private partnerships

headed by NGOs

Reducing the Burden of Disease Water Supply

• Continuous supply of water with good bacteriological quality can reduce morbidity of a number of diseases

However, • Largest reductions in diarrhea morbidity come from investments in

sanitation only, sanitation and water, or hygiene only • Lowest reductions in diarrhea morbidity come from investments in water

only • Don’t forget hygiene if you want to capture water and sanitation benefits • https://youtu.be/GrQVrmEUuKM

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

Reducing the Burden of Disease

Integrating Investment Choices about Water, Sanitation and Hygiene

In order of priority: • Hygiene - important for its own sake and to

maximize effect of other investments • Sanitation - government promotion of low-cost

sanitation schemes • Water - development of low-cost water supply

schemes