College Of Medicine & Health

Sciences

Department Of Environmental Health

Introduction to Public health

(EnvH1091)

By: Mistir Lingerew, 2017

 Part I: Environmental Health
 common terms in Environmental Health
 History/ Evolution of Environment Health
 Focus areas of Environmental Health
 Approaches to Environmental Health
 Environmental Agents initiating diseases
 Routes of hazards to human body
 Dose/ Response to exposures
 Individual susceptibility
 Environmental Health careers
 Environmental actions
 Summary
An ounce of prevention is worth a pound of cure

(Henry De Brakton, 1240)

(Note: an ounce~28gm & a pound~454gm)

 Sanitation is a way of life. It is the quality of living
that is expressed in:
 the clean home,
 the clean farms,
 the clean business,
 the clean industry,
 the clean neighbourhood,
 the clean community

(National Sanitation Foundation)

 Definition of Common TERMS:
The term Environment refers to many
things

“. . . the complex of physical, chemical, and biotic

factors (as climate, soil, and living things) that act
upon an organism or an ecological community
and ultimately determine its form and survival.”

The trees, air,

& soil around
us
ALL the places we
live, work & play

Our fields,
farms & the
food we
Our oceans, lakes,
grow
and rivers
 Definitions …
Health
 It is a complete mental, physical and social
wellbeing not merely the absence of disease or
infirmity (WHO 1948)
Regular exercise helps
keep us strong and
healthy

Nutritious foods help us

stay healthy

Doctors, hospitals &

medicines help us get
healthy if we’re sick
 Definition …
 Disease: Trouble or a condition of the living
animal or plant body or one of its parts that
impairs the performance of a vital function

 Safe: Free from harm or risk; Secure from threat

of danger, harm, or loss; Zero risk

 Contamination: Pollution; inclusion of

unwanted substance or factor

 Agent: An active and efficient cause; capable of

producing a certain effect
Definitions …
 Definitions …
An Ecosystem is a dynamic complex
 “… of plant, animal, and microorganism
communities and the non-living environment
interacting as a functional unit”
Millennium Ecosystem Assessment, 2003

 Carcinogen: something that causes cancer

 Contagious: when germs have the ability to

spread from a person or animal to another
person or animal
 Definitions …
Environmental Health (#1)
(The WHO, 2004)

 “Environmental health comprises those aspects

of human health, including quality of life, that
are determined by physical, chemical,
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”
 Definitions …
Environmental Health (#2)
(The U.S. Department of Health and Human Services,
1998)

 “Environmental health is the branch of public

health that protects against the effects of
environmental hazards that can adversely
affect health or the ecological balances
essential to human health and environmental
quality”
 Definitions …
Environmental Health (#3)
(The European Charter on Environment and Health, 1990)
 “Environmental health comprises those aspects of
human health and disease that are determined by
factors in the environment. It also refers to the
theory and practice of assessing and controlling
factors in the environment that can potentially
affect health.

 It includes both the direct pathological effects of

chemicals, radiation and some biological agents,
and the indirect effects on health and wellbeing of
the broad physical, psychological, social and
aesthetic environment, which includes housing,
urban developmental land use and transport”
 Definitions …
Environmental Health (#4)
(The National Center for Environmental Health, 1998)

 “Environmental health is the discipline that

focuses on the interrelationships between
people and their environment, promotes
human health and well-being, and fosters a
safe and healthful environment”
 Definitions …
Environmental Health (#5)
 Combination of scientific, technical, regulatory,
and administrative aspects of public health to
reduce and prevent environmental-related
human diseases . . .
 (Draft) Definition …
Environmental Health (#6)
 Environmental health is the science and practice
of promoting optimal human health and
preventing illness and injury by identifying
sources and evaluating and controlling levels of
and exposure to physical, chemical and biological
agents in air, water, soil, food, and other media
that may affect the quality of environmental
settings or disrupt ecological conditions, and
directly or indirectly contribute to adverse impact
to health and well-being
Key Terms in Environmental Health
 Toxicity: The ability of a chemical, biochemical,
or radiological substance to produce an
unwanted adverse effect (“Response”) when it
has reached a certain dose at an exposure site
(“Target”)

 Infectivity: The ability of a biological agent to

produce an unwanted adverse effect when it has
reached a certain population size at an exposure
site
 Terms…
 Allergenicity: The ability of a chemical,
biochemical or biological agent to produce an
unwanted adverse effect when it has reached a
certain dose at an exposure site

 Risk: Probability that an adverse effect will

occur when exposed to a given concentration or
in the presence of a given dose
 Terms …
Hazard: Potential for exposure to occur
Bacteria &
viruses
Harmful
chemicals
Tobacco
smoke

Stress

Loud noises

It is anything in the environment that can

hurt you or make you sick
 Terms …
Exposure: is the total amount of a hazard that
comes in direct contact with your body

The The The

Source Environmental Contact
of the hazard Pathway (inhaled fumes)
(bus exhaust) (air)
 Terms … X
X
Exposure
Exposure
Dose / Response
X

X
X X
Dose
Dose X
X
X
X
X X

X = hazard

Dose is the amount of a hazard that actually enters

your body

Response is the health effect/outcome of the dose

(morbidity, injury or death)
Terms …
Dose / Response …
Dose can depend on…
Frequency of Body Size:
Duration of
Exposure: How big or small
Exposure:
How often? are you?
How long?

L
M

S S
Terms …
Dose / Response …
Dose ~ Response Relationships

The larger the dose, the more extreme the

response will be.
1 can of pop 3 cans of pop
in 15 minutes in 15 minutes
The History/ Evolution of Environmental
Health
Ancient Origins
 Our ancestors sought shelter in:
 caves or
 under trees or
 in crude shelters they built

 Our ancestors confronted many challenges:

 food safety
 clean water
 polluted air
 rodents
 Evolution …
Industrial Awakenings
 Issue of sanitation rose with the rapid growth of

cities

 The urban environment fostered the spread of

diseases with:
 crowded, dark, unventilated housing
 unpaved streets littered with horse manure
 inadequate or nonexisting water supplies
 unemptied privy vaults year in & year out
 stagnant pools of water
 Evolution …
The Modern Era
 Started in mid 1900s
 The time of mass production of chemicals which

affected the environment

 E.g., the effect of DDT written in Silent Spring

by Rachel Carson

 She write the effect of DDT on ecosystem,

how it enters in the food chain and how it kills
both targeted and nontargeted pests.
 Evolution …
Modern era …
 The recognition of the relationships between the
natural world and human health and well-being

 The expansion of health care services related to

environmental exposures
 E.g., occupational medicine
 Occupational nursing
Environmental Health is many things

 It is an interdisciplinary academic field

 It is an area of research

 It is an area of applied public health practice

The Focus Areas of Environ Health
Science

 Air Quality:
 Indoor Air
 Outdoor Air

 Water Quality:
 Drinking (Potable) Water
 Recreational Water
 Wastewater
 Irrigation Water
The Focus Areas of Environ Health
…
 Food Quality:
 Farms (Vegetables; Livestock including

Poultry)
 Food Production and Service

Establishments

 Soil Quality:
 Microbial and Chemical Residues and

Wastes
The Focus Areas of Environ Health …

 Disease Outbreaks:
 Communities

 Occupational (Worker) Health:

 Manufacturing
 Agriculture

 Public Health Emergency & Disaster

Preparedness
The Focus Areas of Environmental
Health …

 The environment could have an impact

on comfort and well-being of people

Air Sunlight

Food Noise

Water Soil
Approaches of Environmental Health

 Recognize, evaluate and control releases

of and/or exposures to hazardous physical,
chemical, and biological agents in non-
occupational (non-workplace) and
occupational (workplace) environments
Environmental agents initiating diseases

1. Physical Agents:

 Excessive Sound . . . “Noise”

 Ionizing Radiation (e.g. radon gas)

 Nonionizing radiation (e.g. electromagnetic

energy; Microwaves)
 Environmental agents …
2. Chemical Agents

 Toxic Chemicals

 Flammable

 Reactive
Environmental agents …
3. Biological Agents

 Infectious Microbes

 Allergenic Microbes

 Intoxicating Microbes
 Broader environmental
impacts
 Food insecurity  Land degradation

 Climate change  Stratospheric ozone

depletion
 Deforestation
 Loss of biodiversity
 Desertification
Routes of Hazards to Human Body
Route # 1

Inhalation ((Breathing)

When chemicals enter

the body through this
route of exposure, they
can get stuck in the lungs
and/or be taken up into
the bloodstream
Routes of Hazards …

Route #2

Ingestion (Swallowing )

Usually by eating or
drinking. When chemicals
enter the body through this
route of exposure, they can
easily be taken up into the
bloodstream
 Routes of Hazards …

Route # 3

Dermal
Dermal Absorption:
Absorption:
Absorbing a chemical through any part of the skin, including the
eyes. When chemicals come in contact with the skin, they can
sometimes enter the bloodstream through this route of exposure.
 Individual Susceptibility
• Individuals are differently susceptible to hazards

Pregnant women Elderly people

and their whose defense
developing babies mechanisms are less
efficient

g roups
ise
Exerc
and are
f ants who g
In ren opin
ld
Sick people who ch i de v e l
l
have weakened stil
immune systems
Environmental Health Careers
 Develop and manage programs focused on
disease prevention and control

 Perform investigations of disease-outbreaks and

contaminated sites

 Conduct monitoring (e.g. air, water, soil, & food

quality)

 Conduct research, analyze & interpret data to

prepare reports and present findings
Environmental Health Careers
…
People working in the field Work for
of environmental corporations
health . . . making sure
workplaces are
safe for
workers

Work as
scientists in
research Work for the
labs government
writing
regulations
and studying
pollution
Environmental Actions
How do you take community environmental Justice actions?

Write a letter
Inform your
to a
neighbors
newspaper

Make a
Call or write
documentary
an elected
about the
official
problem

Organize a Create a
community petition and
meeting get signatures
 Environmental Action …

• Environmental Justice
Environmental Justice (EJ)

means that everyone has a

right to live in an environment
that doesn’t make them sick,
regardless of their race,
culture, or income
 Environmental Action …

EJ Process

Who is Establish a Empower

producing dialog between community
the hazard? the decision members to bring
makers, about change.
Who is scientists, and
being the affected
exposed? community.
Share information
and decisions
Who are with community
the members.
decision
makers?
A Summarized Environmental Health Model
Part II: Public Health

Healthy People in Healthy Community

Outlines
 Definitions of Public Health
 Common terms in public health
 A public health approach
 History of Public Health
 Core functions of public health
 Essential public health services
 Partners in public health systems
 Determinants of health
 Definitions of Public Health
 “The science and art of preventing disease,
prolonging life and promoting health and efficiency
through organized community action.” (Winslow)

 “Fulfilling society’s interest in assuring conditions

in which people can be healthy” (IOM)
 Definitions …
 Public Health encompasses a population-
focused, organized effort to assist communities,
groups and individuals in the reduction of health
risks, and the maintenance or improvement of
health status

 Healthy environment
 Obtain needed health care services
 Access to health promotion and disease

prevention services

WHO & IOM; ASPH June 2001

 Common Terms in public
Health
 Endemic: a disease that exists permanently in a
particular region or population

 Epidemic: An outbreak of disease that attacks

many peoples at about the same time and may
spread through one or several communities

 Pandemic When an epidemic spreads

throughout the world

 Outbreak: a sudden increase in occurrences of a

disease in a particular time and place
 Terms …
 Sporadic: occurring occasionally, singly, or in
scattered instances

 Health Outcome: result of a medical condition

that directly affects the length or quality of a
person’s life

 Agent (biological): a natural or living thing that

can cause an event or result

 Epidemiology, epidemiologic: the study of the

spread or pattern of sickness in a group of people
 Terms …
 Host: person, animal, or plant that another living
thing lives off or benefits from

 Prevalence: number or percentage of people

with a sickness or condition (Note: Specify the
time period)

 Screening: testing or checking to see if a person

is healthy or sick
 Terms …
 Surveillance: collecting or gathering of
information

 Vaccine: shot, protection against a disease

 Health promotion: the process of enabling

people to increase control over, and to improve
their health

 Determinant: factor that contributes to the

generation of a trait.
A public Health Approach
Public health is an
interdisciplinary approaches:
 Epidemiology
 Biostatistics
 Health services management
 Environmental Health
 Reproductive health
 Behavioral Health
 Health economics
 Public policy
 Mental health
 Occupational health and safety
History of Public Health
 Sanitation and environmental health
 History …
 pandemics
 History …
 Preparedness for disaster response
 History …
 Prevention through policy
Core Functions of Public Health
Essential Public Health Services
 Public Health
 Prevents epidemics and the spread of disease

 Protects against environmental hazards

 Prevents injuries

 Promotes and encourages healthy behaviors

 Responds to disasters & assists in recovery

 Assures the quality & accessibility of health

services
Partners in the Public Health
System
Health Determinants
 Societal
characteristics

 Health behaviors

 Health services
(medical care)

 Genes and biology