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  • INTRODUCTION TO ENVIRONMENTAL HEALTHDr.Qomariyatus Sholihah,Amd.hyp,ST.MKesUniversity of Lambung Mangkurat Banjarbaru, South KalimantanFeb 2014

    *Supporting text used:

    Moeller, Dade W. Environmental Health. Harvard University Press, Cambridge Massachusetts. 1992

    Yassi, A., Kjellstrom, T., de Kok, T., and Guidotti, T. Basic Environmental Health. Oxford University Press for the World Health Organization. 2001.

  • OutlineDefinition of Environmental HealthInterdependent RelationsEnvironmental Effects on HealthSystematic Approach Interdisciplinary Roles

    *

  • Definition: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity(WHO, 1948)Health is only possible where resources are available to meet human needs and where the living and working environment is protected from life-threatening and health threatening pollutants, pathogens and physical hazards(Who, 1992a)

    *To start, we must have an understanding of what variable or aspect of an individual is compromised. Ones health is what is vulnerable to lack of exposures to nutrients and to exposures to hazardous agents. Change in a health state is measured or characterized by a change in the degree of functionality. If someone is in poor health they cannot function to their average potential.

  • Definition: Environment[All] that which is external to individual human host. [It] can be divided into physical, biological, social cultural any or all of which can influence health status in populations. (WHO, 1995)

    *The first definition alludes to the interdependence of health and accessibility of resources in the surrounding environment. This definition defines what an environment is.

  • Definition: Environmental Healthcomprises those aspects of human health, including quality of life, that are determined by physical, biological, social and psychosocial factors in the environment. It also, refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations (WHO, 1993a)

    *The term environmental health is used to describe problems that arise in the relationship of the environment and health of populations within the environment.

  • Definition: Health Effectis the specific damage to health that an environmental hazard can cause an individual person. Often the same hazard can cause a range of different effects of different severity. (Yassi et al., 2001)

    *This definition emphasizes the adverse effects that the environmnet may have on health. In truth, the environment also has beneficial effects which are not implied in this definition. The environment may also provide nutrients and medicines to remediate dysfunctionality.

  • InterdependenceHealth depends on resources. Good health depends on accessibility to sustainable resources. Bad health results from inaccessibility to sustainable resources or exposure to a hazard.Sustainable resources and hazards exist in the environment.Therefore, quality of health depends on the environment

    *

  • Interdependent EnvironmentsA relational definition of environment is a function of scale, boundaries, spatial proximity and recipient populationsWhen considering a global scale, focus is on the effect of an unbounded environment, e.g. air, on all populations anywhere

    *

  • Interdependent EnvironmentsWhen considering local scale, focus is on effect of both a bounded and an unbounded environment, e.g. water and air, on a subpopulation closest to the exposure eventThe local scale is a subpart of the global scale

    *

  • Population Perspective of RelationsIndividualFamilyCommunity, nationHuman populationAll populations

    *Problem definition involves many different perspectives. The first perspective shown here, is to define and approach environmental health problems by focusing on the indicator of change. Here, either and individual or a population may show a change in their health. The change may be positive (beneficial by a gain in health quality, e.g. increased longevity) or it may be negative (adverse by a loss in health quality, e.g. decreased functionality).

  • Health and Environment Perspective of Relations PersonalHealthFamily HealthOccupational HealthPublic HealthEnvironmental health

    *In contrast, another perspective may focus on the scale of the environment in which the individual or populations lives. Sudden changes in personal health results more from incidental exposure. These sudden changes in personal health are highly dependent on the frame of reference at a time of exposure. As the population size and scope increases, time becomes less important but still necessary and location becomes more important in identifying changes in health.

  • Environmental Effects on HealthThe indicators of beneficial environmental effects are longevity and sustained functionality.Two degrees of adverse environmental effects are: injury (syn. include: debilitating, dysfunctional, lame) with decreased longevity or death (syn. include: life-threatening, terminal, deleterious)

    *Now lets focus of the possible health effects of the environment. Health effects are indicated by changes in two factors, longevity and functionality. Good health is reflected in ones ability to act or function in their environment over a period of time. Longevity depends on accessibility to resources that sustain quality of life.Decreased longevity is an significant indicator of poor health. As well, decreased functionality is another significant indicator of compromised health, not necessarily poor health. Handicapped people are still functional, just not to the same normal capacity as a majority of people. The inability to function to a personal norm is an indicator of poor health.

  • Environmental Effects on HealthInjury does not prematurely end life, but can hinder the capacity to function to the fullest potentialDeath does end life and is the most extreme adverse state of healthThis means of classification is simple and rigorous

    *With injury, adverse health effects can be reversed to varying states and normal health can be restored.

  • Environmental Effects on HealthAn individuals response to an environmental effect is a function of their physical environment, their health state, and their culture.

    *Alluded to in the definition of environmental health, sometimes culture and interpersonal relationships within the population can lead to health effects. Adverse health effects can arise from prolonged stress and depression, an emotional reaction, over limited resources or limited access to resources. The adverse health effects can range from injury, e.g. a stroke, to death by suicide.

  • Systematic ApproachIn the absence of a universal definition of good health, at least a universal concept of adverse health effect, e.g. sick, illness, dysfunctional, not normal or not well, must exist such that understanding the concept results in a response

    *Thus far, we have 1) defined the scope of the problem ( factors in the environment affect health of population in the environment), 2) defined the scales of the problem (personal, local, global), and 3) identified indicators of change (decreased longevity and decreased functionality). We can now formulate a means to monitor and measure the problem and attempt to implement controls where possible. Control can occur 1) if the problem is well defined such that any means or any resources to minimize, remove or reverse the effect can be identified, 2) if the identified resources exist and 3) if the means is possible.

  • Systematic ApproachIn order to identify and investigate adverse states of health, a fundamental systematic approach of health problem identification and characterization must exist and be implementedThis approach is summarized as follows:

  • Systematic ApproachDetermine the source and nature of hazards Determine the exposure pathwayMeasure the effectsApply controls however possible

    (Moeller, 1992)

  • Interdisciplinary RolesTo implement the systematic approach, role players are neededThree major classes of role players are: the environmental health problem investigators, the environmental problem responders and the health problem responders

    *In the following slides, note the degree of multi-classification of certain role players. While these players may apply to two or more roles, the people who pursue these disciplines are only as versatile in their application as their experience and interest allows them to be.

    Also, in spite of the structure used to present the disciplines the lines between the disciplines can be breached because of interest.

  • Interdisciplinary RolesHealth problem investigators: monitors populations to identify health trends, in an attempt to distinguish that which is harmful from that which is harmlessmeasures the range of effects of health trends to characterize degrees of adverse intensityidentify potential hazards, potential pathways of hazards, and populations susceptible to hazards

  • Related Disciplines

    EpidemiologistsRisk AssessorsBiostatisticiansToxicologistsMicrobiologistsHealth ServiceAdministratorsSocial WorkersBehavioral PsychologistsPublic Health Educators

  • Interdisciplinary RolesEnvironmental problem responders: focus on the health hazard that has been identified and characterizedanalyze the environment of the exposed population to see what controls are needed and what controls can be implemented to minimize risk of recurrence and risk of future occurrencewhere means of control does not exist, it may be necessary to inv