Environmental health is the branch of public health that is concerned with all aspects of the natural and built environment that may affect human health. Other terms that refer to the discipline of environmental health include environmental public health and environmental health and protection.
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Environmental health is defined by the World Health Organisation as:
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.
Environmental health as used by the WHO Regional Office for Europe, includes both the direct pathological effects of chemicals, radiation and some biological agents, and the effects (often indirect) on health and wellbeing of the broad physical, psychological, social and aesthetic environment which includes housing, urban development, land use and transport
Tuesday, March 3, 2009
Environmental health services
those services which implement environmental health policies through monitoring and control activities. They also carry out that role by promoting the improvement of environmental parameters and by encouraging the use of environmentally friendly and healthy technologies and behaviours. They also have a leading role in developing and suggesting new policy areas.
Environmental health practitioners may be known as sanitarians, public health inspectors, environmental health specialists or environmental health officers. Many states in the United States require that individuals have professional licenses in order to practice environmental health. California state law defines the scope of practice of environmental health as follows:
"Scope of practice in environmental health" means the practice of environmental health by registered environmental health specialists in the public and private sector within the meaning of this article and includes, but is not limited to, organization, management, education, enforcement, consultation, and emergency response for the purpose of prevention of environmental health hazards and the promotion and protection of the public health and the environment in the following areas: food protection; housing; institutional environmental health; land use; community noise control; recreational swimming areas and waters; electromagnetic radiation control; solid, liquid, and hazardous materials management; underground storage tank control; on-site septic systems; vector control; drinking water quality; water sanitation; emergency preparedness; and milk and dairy sanitation.
The environmental health profession had its modern-day roots in the sanitary and public health movement of the United Kingdom. This was epitomized by Sir Edwin Chadwick, who was instrumental in the repeal of the poor laws and was the founding president of the Association of Public Sanitary Inspectors in 1884, which today is the Chartered Institute of Environmental Health.
Environmental health practitioners may be known as sanitarians, public health inspectors, environmental health specialists or environmental health officers. Many states in the United States require that individuals have professional licenses in order to practice environmental health. California state law defines the scope of practice of environmental health as follows:
"Scope of practice in environmental health" means the practice of environmental health by registered environmental health specialists in the public and private sector within the meaning of this article and includes, but is not limited to, organization, management, education, enforcement, consultation, and emergency response for the purpose of prevention of environmental health hazards and the promotion and protection of the public health and the environment in the following areas: food protection; housing; institutional environmental health; land use; community noise control; recreational swimming areas and waters; electromagnetic radiation control; solid, liquid, and hazardous materials management; underground storage tank control; on-site septic systems; vector control; drinking water quality; water sanitation; emergency preparedness; and milk and dairy sanitation.
The environmental health profession had its modern-day roots in the sanitary and public health movement of the United Kingdom. This was epitomized by Sir Edwin Chadwick, who was instrumental in the repeal of the poor laws and was the founding president of the Association of Public Sanitary Inspectors in 1884, which today is the Chartered Institute of Environmental Health.
Monday, March 2, 2009
Environmental health concerns
Environmental health addresses all human-health-related aspects of both the natural environment and the built environment. Environmental health concerns include:
Air quality, including both ambient outdoor air and indoor air quality, which also comprises concerns about environmental tobacco smoke.
Body art safety, including tattooing, body piercing and permanent cosmetics.
Climate change and its effects on health.
Disaster preparedness and response.
Food safety, including in agriculture, transportation, food processing, wholesale and retail distribution and sale.
Hazardous materials management, including hazardous waste management, contaminated site remediation, the prevention of leaks from underground storage tanks and the prevention of hazardous materials releases to the environment and responses to emergency situations resulting from such releases.
Housing, including substandard housing abatement and the inspection of jails and prisons.
Childhood lead poisoning prevention.
Land use planning, including smart growth.
Liquid waste disposal, including city wastewater treatment plants and on-site waste water disposal systems, such as septic tank systems and chemical toilets.
Medical waste management and disposal.
Noise pollution control.
Occupational health and industrial hygiene.
Radiological health, including exposure to ionizing radiation from X-rays or radioactive isotopes.
Recreational water illness prevention, including from swimming pools, spas and ocean and freshwater bathing places.
Safe drinking water.
Solid waste management, including landfills, recycling facilities, composting and solid waste transfer stations.
Toxic chemical exposure whether in consumer products, housing, workplaces, air, water or soil.
Vector control, including the control of mosquitoes, rodents, flies, cockroaches and other animals that may transmit pathogens.
Air quality, including both ambient outdoor air and indoor air quality, which also comprises concerns about environmental tobacco smoke.
Body art safety, including tattooing, body piercing and permanent cosmetics.
Climate change and its effects on health.
Disaster preparedness and response.
Food safety, including in agriculture, transportation, food processing, wholesale and retail distribution and sale.
Hazardous materials management, including hazardous waste management, contaminated site remediation, the prevention of leaks from underground storage tanks and the prevention of hazardous materials releases to the environment and responses to emergency situations resulting from such releases.
Housing, including substandard housing abatement and the inspection of jails and prisons.
Childhood lead poisoning prevention.
Land use planning, including smart growth.
Liquid waste disposal, including city wastewater treatment plants and on-site waste water disposal systems, such as septic tank systems and chemical toilets.
Medical waste management and disposal.
Noise pollution control.
Occupational health and industrial hygiene.
Radiological health, including exposure to ionizing radiation from X-rays or radioactive isotopes.
Recreational water illness prevention, including from swimming pools, spas and ocean and freshwater bathing places.
Safe drinking water.
Solid waste management, including landfills, recycling facilities, composting and solid waste transfer stations.
Toxic chemical exposure whether in consumer products, housing, workplaces, air, water or soil.
Vector control, including the control of mosquitoes, rodents, flies, cockroaches and other animals that may transmit pathogens.
Maternal health care
Maternal health care is a concept that encompasses family planning, preconception, prenatal, and postnatal care. Goals of preconception care can include providing education, health promotion, screening and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies. Prenatal care is the comprehensive care that women receive and provide for themselves throughout their pregnancy. Women who begin prenatal care early in their pregnancies have better birth outcomes than women who receive little or no care during their pregnancies. Postnatal care issues include recovery from childbirth, concerns about newborn care, nutrition, breastfeeding, and family planning.
Most women do not have access to the health care and sexual health education services that they need.
In many developing countries, complications of pregnancy and childbirth (mainly at the level of preconception and prenatal care) are the leading causes of death among women of reproductive age. More than one woman dies every minute from such causes; 585,000 women die every year (WHO). Less than one percent of these deaths occur in developed countries, demonstrating that they could be avoided if resources and services were available (WHO). Any woman can experience sudden and unexpected complications during pregnancy, childbirth, and just after delivery. Although high-quality, accessible health care has made maternal death a rare event in developed countries, these complications can often be fatal in the developing world.
Consequently, mothers in developing nations die in childbirth at a hundred or more times the rate in developed nations (MDG). Access to emergency obstetric care, the most important remedy for women in these regions is not highly regarded as a priority.According to Rafiqul Chaudhury and Zafrullah Chowdhury, in countries like Bangladesh, 68.7% of the women give birth without the assistance of trained birth attendants. Instead relatives or traditional midwives, who are often not capable of handling complications during the delivery serve as birth assistants.
Factors that prevent women in developing countries from getting the health care they need include distance from health services, cost (direct fees as well as the cost of transportation, drugs, and supplies), multiple demands on their time, and women’s lack of decision-making power within the family. The poor quality of services, including poor treatment by health providers, also makes some women reluctant to use services.
According to the World Health Report in 2004, bad maternal conditions account for the fourth leading cause of death for women after HIV/AIDS, malaria, and tuberculosis. Ninety-nine percent of these deaths occur in low-income countries; while only 1 of 4,000 women have a chance of dying in pregnancy or childbirth in a developed nation, a woman in Sub-Saharan Africa has a 1 in 16 chance of dying. Furthermore, maternal problems cause almost 20% of the total burden of disease for women in developing countries.
Almost 50% of the births in developing countries take place without a medically skilled attendant to aid the mother and the ratio is even higher in South Asia (UNICEF). Women in Sub-Saharan Africa mainly use traditional birthing attendants, with little or no medicinal training.[citation needed] This largely accounts for the high numbers of maternal deaths in this region.
Consequently, mothers in developing nations die in childbirth at a hundred or more times the rate in developed nations (MDG). Access to emergency obstetric care, the most important remedy for women in these regions is not highly regarded as a priority.According to Rafiqul Chaudhury and Zafrullah Chowdhury, in countries like Bangladesh, 68.7% of the women give birth without the assistance of trained birth attendants. Instead relatives or traditional midwives, who are often not capable of handling complications during the delivery serve as birth assistants.
Factors that prevent women in developing countries from getting the health care they need include distance from health services, cost (direct fees as well as the cost of transportation, drugs, and supplies), multiple demands on their time, and women’s lack of decision-making power within the family. The poor quality of services, including poor treatment by health providers, also makes some women reluctant to use services.
According to the World Health Report in 2004, bad maternal conditions account for the fourth leading cause of death for women after HIV/AIDS, malaria, and tuberculosis. Ninety-nine percent of these deaths occur in low-income countries; while only 1 of 4,000 women have a chance of dying in pregnancy or childbirth in a developed nation, a woman in Sub-Saharan Africa has a 1 in 16 chance of dying. Furthermore, maternal problems cause almost 20% of the total burden of disease for women in developing countries.
Almost 50% of the births in developing countries take place without a medically skilled attendant to aid the mother and the ratio is even higher in South Asia (UNICEF). Women in Sub-Saharan Africa mainly use traditional birthing attendants, with little or no medicinal training.[citation needed] This largely accounts for the high numbers of maternal deaths in this region.
Proposed solutions
The World Bank estimated that a total of 3.00 US dollars per person a year can provide basic family planning, maternal and neonatal health care to women in developing countries.[2] Many non-profit organizations have programs educating the public and gaining access to emergency obstetric care for mothers in developing countries.
The services needed are said to include:
Routine maternal care for all pregnancies, including a skilled attendant (midwife or doctor) at birth
Medical training for traditional birthing attendants might be one way to help provide this service.[citation needed]
Emergency treatment of complications during pregnancy, delivery and after birth
Postpartum family planning and basic neonatal care
Educating women and their communities about the importance of maternal health care, and according women the social status to make health care decisions and seek medical attention.
Any form of education, even 6 years worth of education for girls can drastically improve overall maternal health (UNICEF)
Research on social and psychological factors affecting maternal health
Development of better interventions (and evaluations of interventions) for complex problems (e.g., behavioral, social, biological, cultural) arising in marginalized communities
The services needed are said to include:
Routine maternal care for all pregnancies, including a skilled attendant (midwife or doctor) at birth
Medical training for traditional birthing attendants might be one way to help provide this service.[citation needed]
Emergency treatment of complications during pregnancy, delivery and after birth
Postpartum family planning and basic neonatal care
Educating women and their communities about the importance of maternal health care, and according women the social status to make health care decisions and seek medical attention.
Any form of education, even 6 years worth of education for girls can drastically improve overall maternal health (UNICEF)
Research on social and psychological factors affecting maternal health
Development of better interventions (and evaluations of interventions) for complex problems (e.g., behavioral, social, biological, cultural) arising in marginalized communities
Population health
Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” It is an approach to health that aims to improve the health of an entire population. One major step in achieving this aim is to reduce health inequities among population groups. Population health seeks to step beyond the individual-level focus of mainstream medicine and public health by addressing a broad range of factors that impact health on a population-level, such as environment, social structure, resource distribution, etc. An important theme in population health is importance of social determinants of health and the relatively minor impact that medicine and healthcare have on improving health overall.
From a population health perspective, health has been defined not simply as a state free from disease but as "the capacity of people to adapt to, respond to, or control life's challenges and changes".
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From a population health perspective, health has been defined not simply as a state free from disease but as "the capacity of people to adapt to, respond to, or control life's challenges and changes".
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The role of economic inequality
Recently, there has been increasing interest from epidemiologists on the subject of economic inequality and its relation to the health of populations. There is a very robust correlation between socioeconomic status and health. This correlation suggests that it is not only the poor who tend to be sick when everyone else is healthy, but that there is a continual gradient, from the top to the bottom of the socioeconomic ladder, relating status to health. This phenomenon is often called the "SES Gradient". Lower socioeconomic status has been linked to chronic stress, heart disease, ulcers, type 2 diabetes, rheumatoid arthritis, certain types of cancer, and premature aging.
Despite the reality of the SES Gradient, there is debate as to its cause. A number of researchers (A. Leigh, C. Jencks, A. Clarkwest - see also Russell Sage working papers) see a definite link between economic status and mortality due to the greater economic resources of the better-off, but they find little correlation due to social status differences.
Other researchers such as Richard Wilkinson, J. Lynch , and G.A. Kaplan have found that socioeconomic status strongly affects health even when controlling for economic resources and access to health care. Most famous for linking social status with health are the Whitehall studies - a series of studies conducted on civil servants in London. The studies found that, despite the fact that all civil servants in England have the same access to health care, there was a strong correlation between social status and health. The studies found that this relationship stayed strong even when controlling for health-affecting habits such as exercise, smoking and drinking. Furthermore, it has been noted that no amount of medical attention will help decrease the likelihood of someone getting type 1 diabetes or rheumatoid arthritis - yet both are more common among populations with lower socioeconomic status. Lastly, it has been found that amongst the wealthiest quarter of countries on earth (a set stretching from Luxembourg to Slovakia) there is no relation between a country's wealth and general population health - suggesting that past a certain level, absolute levels of wealth have little impact on population health, but relative levels within a country do.
The concept of psychosocial stress attempts to explain how psychosocial phenomenon such as status and social stratification can lead to the many diseases associated with the SES Gradient. Higher levels of economic inequality tend to intensify social hierarchies and generally degrades the quality of social relations - leading to greater levels of stress and stress related diseases. Richard Wilkinson found this to be true not only for the poorest members of society, but also for the wealthiest. Economic inequality is bad for everyone's health.
Inequality does not only affect the health of human populations. David H. Abbott at the Wisconsin National Primate Research Center found that among many primate species, less egalitarian social structures correlated with higher levels of stress hormones among socially subordinate individuals. Research by Robert Sapolsky of Stanford University provides similar findings.
Despite the reality of the SES Gradient, there is debate as to its cause. A number of researchers (A. Leigh, C. Jencks, A. Clarkwest - see also Russell Sage working papers) see a definite link between economic status and mortality due to the greater economic resources of the better-off, but they find little correlation due to social status differences.
Other researchers such as Richard Wilkinson, J. Lynch , and G.A. Kaplan have found that socioeconomic status strongly affects health even when controlling for economic resources and access to health care. Most famous for linking social status with health are the Whitehall studies - a series of studies conducted on civil servants in London. The studies found that, despite the fact that all civil servants in England have the same access to health care, there was a strong correlation between social status and health. The studies found that this relationship stayed strong even when controlling for health-affecting habits such as exercise, smoking and drinking. Furthermore, it has been noted that no amount of medical attention will help decrease the likelihood of someone getting type 1 diabetes or rheumatoid arthritis - yet both are more common among populations with lower socioeconomic status. Lastly, it has been found that amongst the wealthiest quarter of countries on earth (a set stretching from Luxembourg to Slovakia) there is no relation between a country's wealth and general population health - suggesting that past a certain level, absolute levels of wealth have little impact on population health, but relative levels within a country do.
The concept of psychosocial stress attempts to explain how psychosocial phenomenon such as status and social stratification can lead to the many diseases associated with the SES Gradient. Higher levels of economic inequality tend to intensify social hierarchies and generally degrades the quality of social relations - leading to greater levels of stress and stress related diseases. Richard Wilkinson found this to be true not only for the poorest members of society, but also for the wealthiest. Economic inequality is bad for everyone's health.
Inequality does not only affect the health of human populations. David H. Abbott at the Wisconsin National Primate Research Center found that among many primate species, less egalitarian social structures correlated with higher levels of stress hormones among socially subordinate individuals. Research by Robert Sapolsky of Stanford University provides similar findings.
The importance of family planning programs
Family planning programs (including contraceptives) play a major role in population health. For example, the United States Agency for International Development lists as benefits of its international family planning program:
"Protecting the health of women by reducing high-risk pregnancies"
"Protecting the health of children by allowing sufficient time between pregnancies"
"Fighting HIV/AIDS through providing information, counseling, and access to male and female condoms"
"Reducing abortions"
"Supporting women's rights and opportunities for education, employment, and full participation in society"
"Protecting the environment by stabilizing population growth"
[edit] Population health management (PHM)
One method to improve population health is population health management (PHM), which has been defined as “the technical field of endeavor which utilizes a variety of individual, organizational and cultural interventions to help improve the morbidity patterns (i.e., the illness and injury burden) and the health care use behavior of defined populations”. PHM is distinguished from disease management by including more chronic conditions and diseases, by use of "a single point of contact and coordination," and by "predictive modeling across multiple clinical conditions". PHM is considered broader than disease management in that it also includes "intensive care management for individuals at the highest level of risk" and "personal health management... for those at lower levels of predicted health risk.". Many PHM-related articles are published in Population Health Management, the official journal of DMAA: The Care Continuum Alliance
"Protecting the health of women by reducing high-risk pregnancies"
"Protecting the health of children by allowing sufficient time between pregnancies"
"Fighting HIV/AIDS through providing information, counseling, and access to male and female condoms"
"Reducing abortions"
"Supporting women's rights and opportunities for education, employment, and full participation in society"
"Protecting the environment by stabilizing population growth"
[edit] Population health management (PHM)
One method to improve population health is population health management (PHM), which has been defined as “the technical field of endeavor which utilizes a variety of individual, organizational and cultural interventions to help improve the morbidity patterns (i.e., the illness and injury burden) and the health care use behavior of defined populations”. PHM is distinguished from disease management by including more chronic conditions and diseases, by use of "a single point of contact and coordination," and by "predictive modeling across multiple clinical conditions". PHM is considered broader than disease management in that it also includes "intensive care management for individuals at the highest level of risk" and "personal health management... for those at lower levels of predicted health risk.". Many PHM-related articles are published in Population Health Management, the official journal of DMAA: The Care Continuum Alliance
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