2f Environment

Question 1

What is the environment?

Answer 1

The surroundings and external conditions, especially as affecting human lives.

It is usually thought of as including the physico-chemical, biological, social and cultural factors, which individually and in combination influence human health and well-being.

Question 2

What is environmental justice?

Answer 2

The notion of equity and justice in relation to environmental exposures and related health burdens born by groups defined on the basis of such factors as socio-economic status, ethnicity and gender.

Question 3

What is the link between socio-economic status and environmental risk factors?

Answer 3

Socio-economic deprivation is important as a frequent determinant of environmental exposures (on average poorer people tend to live in more polluted, less healthy areas) and are more vulnerable to the effects of such exposures by virtue of their health status and poorer access to services.

At the same time, people in more deprived areas, who tend to consume fewer resources, are typically responsible for fewer of the emissions that cause environmental contamination. This is often labelled the issue of environmental justice (or injustice).

Question 4

Give an example of environmental injustice.

Answer 4

Exposure to road traffic: poorer people tend to have poorer access to cars, but are often more exposed to traffic-related emissions, and more likely to live on main roads where there is cheaper housing;

Climate change: those in the richer countries are larger per capita contributors to the problem (produce more CO2), yet the burdens are likely to be greatest in low-income countries.

Question 5

Give an example of a serious pollution episode.

Answer 5

1952 London smog, which was responsible for probably several thousand deaths in London as a result of the build up of sulphurous air pollution during a period of unusual meteorological conditions (temperature inversion) which reduced the dispersion of air pollutants.

1956 episode of organic mercury poisoning in Minamata, Japan, which arose from the release of methyl mercury in the industrial wastewater from a chemical factory, and its bioaccumulation in shellfish and fish in Minamata Bay, which were then when eaten by the local population.

1984 Bhopal disaster, in the Indian state of Madhya Pradesh, often considered the world’s worst industrial disaster, in which a release of 40 tonnes of methyl isocyanate gas from a subsidiary plant of the Union Carbide company killed several thousand people, many instantly, and injured many more.

1986 Chernobyl nuclear accident which resulted in the release of a plume of radioactive dust which drifted over the western Soviet Union (especially the Ukraine and Belarus), parts of Europe and eastern North America.

Question 6

What are the global environmental effects of human life?

Answer 6

Global climate change (see section 3), arising from the emission of carbon dioxide and other greenhouse gases

Stratospheric ozone depletion, arising from the catalytic destruction of atomic chlorine and bromine derived from chlorofluorocarbons (CFC) and other ozone-depleting substances, with consequent reduced protection to harmful ultraviolet-B(UVB) radiation at wavelengths 270 to 315 nm.

Question 7

What is the environmental Kuznets’ curve?

Answer 7

It has been observed that exposures tend to follow an inverted-U trajectory over time as exposures rise and then fall in parallel with increasing wealth, literacy and technological development. This is referred to as the ‘environmental Kuznets’ curve.

Question 8

In which ways are low, middle and high-income populations generally affected by environmental exposures?

Answer 8

Low-income populations tend to suffer most from household exposures, such as those relating to lack of access to clean water and sanitation, and exposure to indoor pollution from the inefficient and inadequately ventilated burning of biomass fuels for domestic cooking and heating.

Middle-income populations on the other hand suffer more from community-level pollution, such as urban outdoor air pollution, contaminated water sources, and occupational hazards.

High-income populations have, for the most part, reduced these risks, but contribute disproportionately to global problems, including greenhouse gas emissions, persistent organic pollutants (POPs), ozone-depleting gases, and urban non-biodegradable waste.

Question 9

What is the international Global Burden of Disease?

Answer 9

An initiative to derive estimates of mortality and disability-adjusted life years (DALYs) for selected causes, including environmental exposures.

For the environment they indicate that the largest burdens globally arise from unsafe water and sanitation and indoor smoke (both mainly affecting populations in the developing world), and outdoor air pollution (mainly affecting middle-income populations, especially in Asia). The effects of global climate change are expected to grow substantially over time.

Estimates suggest that somewhere between a quarter and a third of the global burden of disease and premature death is attributable to direct environmental risk factors.

Question 10

What are the challenges with assessing the disease burden of different environmental exposures?

Answer 10

Difficult definition of environmental exposure
Incomplete evidence about aetiology
Complexities of assessing exposures and their longer-term effects.

Question 11

What is exposure in terms of environmental health?

Answer 11

The (degree of) contact with a hazardous agent of disease such that harmful effects or disease transmission may occur.

Commonly used to refer a measure of the amount of a hazardous agent to which an individual is exposed.

Question 12

What is a hazard in terms of environmental health?

Answer 12

A factor or exposure that may adversely affect health; anything that has the potential to cause harm.

Question 13

What is the hazard rate in terms of environmental health?

Answer 13

A theoretical measure of the risk (probability) of occurrence of an event, e.g. death or new disease, at a point in time, t.

This is sometimes referred to simply as ‘the hazard’, hence ‘hazard function’.

Question 14

What is rate in terms of environmental health?

Answer 14

The number of new disease cases occurring among a defined population calculated per person-time of follow-up.

Question 15

What is the difference between the classical epidemiological definition of risk and the risk management definition?

Answer 15

(1) Epidemiological definition
The probability that an event will occur e.g. that an individual will become ill or die within a stated period of time or age. Formally defined as the proportion of initially disease-free individuals who develop the disease over a defined period of observation.

(2) Risk management definition
The probability that an adverse event will occur (such as exposure from a chemical incident) times the consequences of the adverse event

Question 16

What is the Relative risk/risk ratio

Answer 16

The ratio of two risks (or, informally, of rates or odds) comparing the risk of disease or death among the exposed to the risk among the unexposed.

Question 17

What is the risk management definition of risk?

Answer 17

Risk = probability of an accident X losses per accident

Thus similar risk may be obtained by high impact but low probability or by low impact and high probability of occurring. By this definition, risks are assessed by rating their impact and their probability to yield a product risk score.

Question 18

What is the risk management definition of risk?

Answer 18

Risk = probability of an accident X losses per accident

Thus similar risk may be obtained by high impact but low probability or by low impact and high probability of occurring. By this definition, risks are assessed by rating their impact and their probability to yield a product risk score.

Question 19

Which factors influence the way people interpret environmental risks?

Answer 19

The degree to which the risk is perceived as controllable or exposure as avoidable

The level of knowledge/certainty about its nature and effects

The trustworthiness of the authorities that provide information about it and are responsible for managing it.

Question 20

What are the main ways that climate change can impact public health?

Answer 20

The direct impact of climate change e.g. flooding, temperature changes

The indirect effects of having to move to a more environmentally friendly world e.g. Changes in energy use & transportation

Question 21

What is meant by adaptation in the field of environmental health?

Answer 21

Strategies, policies and measures undertaken now and in the future to reduce potential adverse impacts of climate change.

Question 22

What is the climate?

Answer 22

The average state of the atmosphere and the underlying land or water in a specific region over a specified time scale (usually longer term).

Should be distinguished from weather, which is the atmospheric conditions at a specific place and time, usually the day to day variations.

Question 23

What is climate change?

Answer 23

A statistically significant variation in either the mean state of the climate or in its measurable variability, persisting for an extended period (typically decades or longer).

Question 24

What are Greenhouse Gases (GHGs)?

Answer 24

Gases present in the Earth’s atmosphere which reduce the loss of heat into space and therefore contribute to global temperatures through the greenhouse effect.

Question 25

What is the Intergovernmental Panel on Climate Change (IPCC)?

Answer 25

An international body of scientists tasked with evaluating the risk of climate change caused by human activity. It was established in 1988 by the World Meteorological Organisation (WMO) and the United Nations Environment Programme (UNEP), two organisations of the United Nations.

Question 26

What is meant by the term mitigation in relation to environmental health?

Answer 26

A human intervention to reduce the sources or enhance the sinks of greenhouse gases.

Question 27

Why do carbon emissions matter?

Answer 27

As greenhouse gas emissions (including CO2) from human activities increase, they build up in the atmosphere and warm the climate

Question 28

What are the direct impacts of climate change on health?

Answer 28

Health impacts of temperature extremes, specifically of heat waves. Increased frequency of extreme weather events, including severe storms, floods and droughts. Sea level rise which will threaten many low-lying areas with inundation. Increased frequency of food- and water-borne diseases. Potential for change in the seasonal patterns or geographical distribution of some vector-borne disease. Interactions with air pollution and effects on the seasonality and duration of aeroallergens.

Question 29

What are the indirect health impacts of climate change?

Answer 29

Impacts on water resources and agricultural productivity – with potential for socio-economic dislocation and mass migration of environmental refugees.

Question 30

What is the difference between mitigation and adaptation in relation to combating climate change?

Answer 30

Adaptation controls for the current effects of climate change e.g. preparing for floods or droughts, vaccinating against disease, and preparing housing for mass migration. Mitigation aims to reduce any further climate change e.g. Moving to non-fossil fuels.

Question 31

What key legislation does the UK follow in relation to climate change?

Answer 31

The Paris UN Climate Change Agreement: on 22 April 2016 – 175 world leaders signed the Paris Agreement at the United Nations Headquarters. Adopted in Paris by the 196 parties to the UN Framework Convention on Climate Change (UNFCCC) at a conference known as (COP21), the Agreement’s objective is to limit global temperature rise to well below 2 degrees Celsius, and to strive for 1.5 degrees Celsius. At least 55 countries, accounting for 55 per cent of global greenhouse gas emissions, deposit their instruments of ratification. The UK Climate Change Act 2008 requires the net UK carbon account for all six Kyoto greenhouse gases for the year 2050 is at least 80% lower than the 1990 baseline, towards actions avoiding dangerous climate change, and a 35% reduction by 2020 for the UK. The Act promotes the UK to become a low-carbon economy and gives ministers powers to introduce the measures necessary to achieve a range of greenhouse gas reduction targets. An independent Committee on Climate Change was created under the Act to provide advice to Government on these targets and related policies

Question 32

What have been the main impacts of unsustainable human habits globally?

Answer 32

Biodiversity loss (loss of whole species and many local populations) Changes to the composition of the atmosphere Over-exploitation of the great aquifers Reduction of productive soils Depletion of ocean fisheries Growing demand for energy based on the exploitation of fossil energy sources An increasing problem of waste disposal.

Question 33

What is agenda 21?

Answer 33

A United Nations programme on sustainable development that sets out a 'comprehensive plan of action to be taken globally, nationally and locally by organisations of the UN, governments and major groups in every area in which humans impact on the environment'. The number 21 refers to the 21st century.

Question 34

What is sustainable development?

Answer 34

Development of resources that meets the needs of the present without compromising the ability of future generations to meet their own needs in a similar manner

Question 35

What is the UN CSD?

Answer 35

United Nations Commission on Sustainable Development

Question 36

What are the UN sustainable development goals?

Answer 36

Goals which target sustainable development, especially democratic governance and peacebuilding, climate and disaster resilience. SDGs Number 1 on poverty, Number 10 on inequality and Number 16 on governance are particularly central to UN development programmes current work and long-term plans.

Question 37

What is the history of climate change agreements globally?

Answer 37

Agenda 21 Developed (1980-1990) Agenda 21 formalised along with the Rio Declaration (1992) The WHO Commission on Sustainable Development (CSD) was formed in 1992 to monitor these. UN Millennium Declaration set out the Millennium Development Goals (2000). UN sustainable development goals build on the MDG's (2016)

Question 38

What is the HHSRS?

Answer 38

The Housing Health and Safety Rating System This is a health-based risk assessment procedure for residential properties, which replaced (in 2006) the previous housing fitness standard. Local authority Environmental Health Officers conduct this risk assessment on rented, social housing and Houses of Multiple Occupation (HMOs). Its principles are that * Any dwelling should be free from both unnecessary and avoidable hazards; and * where any hazard is necessary and unavoidable, then the likelihood of a harmful occurrence and the potential harm which could result should be reduced to a minimum. Some elements include: Protection from cold/Energy efficient Protection from overheating Protection from falls Damp and mould exposure limited Carbon Monoxide exposure limited Radon exposure limited

Question 39

What is housing fitness?

Answer 39

A set of basic requirements that homes should meet in order to be considered as acceptable places to live. Often directly or indirectly based on health criteria

Question 40

How are housing and public health related?

Answer 40

The relationship between housing and health is multi-faceted. A healthy home needs to have sound structure, to be free of hazards, to provide adequate facilities for sleeping, personal hygiene, the preparation and storage of food, to be an environment for comfortable relaxation, for privacy and quiet, and to provide the facility for social exchange with friends, family and others. The local environment is also important in determining such factors as fear of crime, access to local services and facilities and in promoting social interaction.

Question 41

Why can building and developing health housing be challenging?

Answer 41

Expensive Have to invest resources to regulate There have to be trade-offs: E.g. Higher energy efficiency often involves reducing ventilation rates.

Question 42

What are the health risks of flooding?

Answer 42

Physical risks, from drowning and injury, due to floodwaters, unstable buildings and debris Mental health aspects, from being displaced, loss of property, possessions, despair, loss of community Contamination of water supplies, due to surface or groundwater flooding, by sewage Lack of drinking water, mains supply and services, e.g. electricity and gas supplies being cut off Disrupted access to services, e.g. transport, community services, schools, health services, postal deliveries, etc. Carbon monoxide poisoning, due to the use of standby generators in unventilated spaces, or heaters used to dry out property or effects. Increased risk of infectious diseases, especially water borne e.g. cholera, gastrointestinal diseases and from overcrowding and lack of fresh water supplies.

Question 43

How can water pollution levels be tested?

Answer 43

Water tests are performed to test the suitability of drinking water supplies, which include physical properties (taste, colour and smell), bacteriology and chemical composition.

Question 44

In what ways can water become polluted?

Answer 44

Low water supply - e.g. in droughts, where contaminants and pathogens can be concentrated. S Contamination by bacteria in sewage Chemical pollution - Can be natural e.g. arsenic in groundwater from geology. Or can be man-made e.g. industrial pollution. Contamination by fertilisers (nitrates or phosphates) Pollution by heavy metals (e.g. lead in water from domestic water plumbing, lead pipes or solder in pipes).

Question 45

What is bio-monitoring in relation to environmental health?

Answer 45

Monitoring biomarkers in samples or humans, that focus on environmental exposures, diseases and/or disorders and genetic susceptibility, and their potential relationships.

Question 46

What is a disease cluster?

Answer 46

An unusual aggregation of health events that are grouped in space and time.

Question 47

What is HACCP?

Answer 47

Hazard Analysis and Critical Control Points – A systematic preventive approach to food and pharmaceutical safety that addresses physical, chemical and biological hazards as a means of prevention rather than finished product inspection. It aims to identify potential hazard points, so that key actions, known as Critical Control Points (CCP's) can be taken to reduce or eliminate the risk of the hazards being released.

Question 48

What are the different types of data that may be used to assess environmental hazards?

Answer 48

Emissions inventories (records of the permitted or actual level of emissions from specified sources) Environmental data (measurements of the concentrations of pollutants in the environment) Bio-monitoring data (measurements of specific agents or their metabolic products in biological samples) Health data: * Routine (surveillance) data (e.g. Health care utlilisaiton data, cancer registrations etc) * Clinical surveillance (relevant to specific exposed populations)

Question 49

What are the steps to controlling environmental hazard exposure?

Answer 49

1) Defining acceptable levels of exposure and hence health risk (or taking a precautionary approach in the absence of clear evidence) 2) Determining the levels of control needed to keep exposure below the specified thresholds.

Question 50

What are the possible methods of environmental hazard control?

Answer 50

Licensing / banning specific substances (e.g. CFCs) Setting of emissions controls (e.g. vehicles exhausts, industrial emissions) Enforcement of concentrations or exposure limits for specific target groups (e.g. radiation workers) Enforcement of health and safety protection (e.g. for workers handling biological agents). Setting of guidelines/standards relating to environmental levels (e.g. air pollution monitoring)

Question 51

In what ways are the environmental hazards in food and water controlled?

Answer 51

Quality standards are set for the physical, chemical and biological characteristics of drinking water and monitored throughout the water treatment and distribution network through to the household tap. Tests and specified limits relate to pH, microorganisms' chlorination by-products, dissolved metals, salts and metalloids (lead, mercury, nitrates, arsenic, etc.), organic matter and radon. Biological and chemical testing is also carried out in the food industry, where the approach is based on the principles of Hazard Analysis and Critical Control Points (HACCP), which seeks to identify potential hazard points, so that key actions, known as Critical Control Points (CCP's) can be taken to reduce or eliminate the risk of the hazards being released. The system is used at all stages of food production and preparation processes including packaging, distribution, etc.

Question 52

In what way are air pollution environmental hazards controlled?

Answer 52

Poor air quality affects respiratory health. Burning fossil fuels not only produces CO2, promoting global warming, but also other by-products of combustion, NOx, SO2, CO, Particulate matter. WHO guidelines exist to limit outdoor air quality in urban areas, but also more recently the health burden from indoor air prompted limits from biomass burning in domestic settings. Europe set a series of directives to target poor air quality, which member states implemented in national air quality strategies. The cornerstone of the UK strategy to meet air quality objectives is the system of Local Air Quality Management, introduced in the 1995 Environment Act. UK Local authorities are required periodically to review and assess the current and likely future air quality in their areas against national air quality objectives for seven air pollutants included in regulations for that purpose. Where any objective is unlikely to be met by the relevant deadline, local authorities must designate those areas as air quality management areas (AQMAs) and take action, along with others, to work towards meeting the objectives. Local measures may include: Work with highway teams and/or environmental regulation on emission reduction measures Local traffic management schemes e.g. low emission zones and congestion charging Commitment to developing or promoting green travel plans and/or to using cleaner-fuelled vehicles Information dissemination to the public

Question 53

How does noise pollution affect health and how is it controlled for?

Answer 53

Noise is a complex exposure, as its effects on health and well-being are a function of multiple parameters, including: its intensity, its duration, its intermittency, its nature and quality, and its origin. Loud noise may cause deafness, but constant background noise (e.g. from heavy traffic) is often tolerated better than intermittent noise from a neighbour. In implementing the EU’s Environmental Noise Directive, the UK’s Department of the Environment, Food and Rural Affairs (DEFRA) generated noise maps to provide an overview of the ambient noise climate in cities and major transportation sources in England. The Noise Policy Statement sought to reduce noise exposure through management and land use planning.

Question 54

How does noise pollution affect health and how is it controlled for?

Answer 54

Noise is a complex exposure, as its effects on health and well-being are a function of multiple parameters, including: its intensity, its duration, its intermittency, its nature and quality, and its origin. Loud noise may cause deafness, but constant background noise (e.g. from heavy traffic) is often tolerated better than intermittent noise from a neighbour. In implementing the EU’s Environmental Noise Directive, the UK’s Department of the Environment, Food and Rural Affairs (DEFRA) generated noise maps to provide an overview of the ambient noise climate in cities and major transportation sources in England. The Noise Policy Statement sought to reduce noise exposure through management and land use planning.

Question 55

How is environemtal radiaiton exposure controlled?

Answer 55

Some governments recommend that households in high radon areas have radon monitoring carried out and then use engineering solutions to reduce levels if found to be above the action limit. Workers in the nuclear industry, or in other fields where there is exposure to ionising radiation (e.g. medical imaging), are required to wear radiation badges to monitor personal exposure. Removal from further exposure is required if a personal dose limit is reached. For non-ionising radiation sources, there are published guidelines on exposure limits to static magnetic fields and to time-varying electric, magnetic and electromagnetic fields e.g shielding or limiting frequent use (e.g. mobile phones).

Question 56

What is the challenge with using disease clusters to identify environmental exposures in a local area?

Answer 56

A disease cluster is any unusual aggregation of cases of illness or disease that are grouped in space and time. The issue with using these is that in such circumstances it is very difficult to interpret the significance of the observation, as the cases may reflect no more than normal variation or randomness in time and space. The hypothesis of an unusual level of disease occurrence is formulated after seeing that there appears to be a high number of cases. As the hypothesis of a ‘cluster’ is post hoc – developed after the observation – and therefore almost impossible to interpret appropriately.

Question 57

What are the different types of legislation that can be used in Environmental health?

Answer 57

Directives: European Union Directives are a type of legislation promulgated by the European Parliament and the Council of the European Union that binds member countries to achieve stated objectives within a certain time limit, but allows the national authorities in each country to choose the choice of form and means to be used to meet those objectives. Regulations: A rule or order issued by a government department or administrative agency, usually under the authority of a statute, enforcing or amplifying enacted laws. This may include: * Guidance (not compulsory, but aimed at helping compliance with the law) * Approved Codes of Practice (support good practice, and have legal status in that an employer may be found at fault if they have not followed relevant provisions) * Full Regulations (legal requirements) White papers: A detailed outline of a policy, which gives Parliament and outside organisations the opportunity to comment on future legislation. White papers often become the basis for a bill.

Question 58

Give an example of historical environmental health legislation.

Answer 58

Public Health Act (1848) Local Boards of Health in England and Wales were created under The Public Health Act of 1848 in response to cholera epidemics. Their responsibility was to improve the sanitary conditions of urban areas including through control of sewers, street cleaning, the provision of public lavatories, the supply of water and other measures. Clean Air Act (1956) The Clean Air Act of 1956 was enacted following long debate about the adverse effects of air pollution, which came to the fore with the London smog of December 1952 and the evidence of its adverse effect on health. The Act aimed to control urban pollution by introducing smokeless zones. Power stations were also relocated away from urban areas. These measures helped to reduce air pollution levels in cities. The Climate Change and Sustainable Energy Act 2006, which aims to increase electricity microgeneration to help to cut carbon emissions and reduce fuel poverty The Climate Change Act 2008: to ensure that the net UK carbon account for all six Kyoto greenhouse gases for the year 2050 is at least 80% lower than the 1990 baseline.

Question 59

What are the types of environmental regulation?

Answer 59

Direct regulation – Allows control of emissions or abstractions that may cause pollution. Primarily based on use of licences/permits Environmental taxation – An alternative to conventional regulatory instruments aimed at influencing behaviour through pricing. Examples include the Landfill Tax and the Climate Change Levy. Trading Schemes – A scheme which includes a system for distributing initial allowances and a method for trading them, with penalties for non-compliance within a specified period. For example the UK trading scheme for greenhouse gas emissions. Negotiated or voluntary agreements – Non-statutory mechanisms that are often preferred to conventional regulation where the parties can agree targets, often to avoid legislation. Examples include emission reduction agreements by the motor industry. Education and advice – Helping to meet objectives by raising awareness and encouraging participation among multiple groups.

Question 60

What is meant by health and safety?

Answer 60

Preventing people from being harmed or becoming ill by work by taking the right precautions; providing a satisfactory working environment

Question 61

What is a health and safety risk assessment?

Answer 61

An examination of the potential causes of harm in the workplace, so as to inform the implementation of reasonable measures to reduce health risks The law does not expect the elimination of risk, but it requires that people are protected as far as ‘reasonably practicable’. The principal elements of a risk assessment are: (1) To identify the hazards; (2) To decide who might be harmed and how; (3) To evaluate the risks and decide on precautions; (4) To record and implement findings; (5) To review risk assessment and update if necessary.

Question 62

What are the general workplace factors that impact health?

Answer 62

Temperature and humidity. Ventilation. Ergonomics of work area & equipment. Space, lighting and cleanliness of the work area. Maintenance/repair of building and equipment. Routes for safe movement and emergency exits Safe doors, gates, windows e.g. With opening limiters or shatterproof glazing. Fencing, rails and covering of pits/tanks to prevent the risk of falls. Control of hazardous agents Welfare - Toilets, drinking water, rest, food

Question 63

What are some specific workplace health problems?

Answer 63

Hazardous substances inhalation or burns Falls (especially off ladders), are one of the major contributors to workplace deaths and serious injuries. Musculoskeletal disorders (manual handling, repetitive strain injuries or display screen equipment) Asbestos Exposure Vibration syndromes following use of powered hand tools (hands) or driving (back). Deafness (from loud workplaces) Electrocution (through contact with overhead or underground power cables). Radiation exposure (medical imaging, as well as from radon gas from the ground). This also includes damage and cancer risk from UV radiation (e.g. from sun). Stress

Question 64

What workplace factors can lead to stress?

Answer 64

Lack of control over the way work is done Work overload (or underload) Lack of support from managers Conflicting or ambiguous roles Poor relationships with colleagues (including bullying) Poor management of organisational change

Question 65

Who is responsible for workplace health in the UK?

Answer 65

In England, health and safety within factories, farms and building sites is enforced by the Health and Safety Executive (HSE) In offices, shops, hotels, and catering and leisure facilities by Environmental Health in local authorities

Question 66

What responsibilities do employers and employees have in relation to workplace health?

Answer 66

Employers have a responsibility to ensure the health, safety and welfare of their workforce (with a written policy if they have more than five employees), to assess risks, to ensure implementation of necessary protection measures, to provide relevant staff training, to publicise health and safety information, to report injuries and accidents. Employees have a duty to take reasonable care for their own health and safety and that of others, and to cooperate with an employer on health and safety matters, including by use of protective equipment. Employees can refuse to do something unsafe without being threatened with disciplinary action.

Question 67

What regulations control the exposure to hazardous chemicals in the workplace?

Answer 67

The Control of Substances Hazardous to Health Regulations 2002 (COSHH) sets out steps employers must take in relation to controlling the risk, including assessing risks and preventing and monitoring exposure. These regulations cover substances that are dangerous to health, including biological agents, substances with workplace exposure limits, pesticides, medicines, cosmetics and substances produced in chemical processes. Asbestos, lead, radioactive materials, and substances with explosive or flammable properties are covered by other regulations.

Question 68

What is the job exposure matrix?

Answer 68

A method employed to assign cumulative exposure to workers in epidemiological studies based on the assignment of workers to job categories with quantified exposure levels. All workers with the same job title and duration are usually assigned similar cumulative exposures.

Question 69

What is pneumoconiosis?

Answer 69

A lung disease, characterised by fibrosis and scarring of the lungs, resulting from the repeated inhalation of occupationally associated dust, such as silica, asbestos and coal dust.

Question 70

What is PMR (proportional mortality ratio)?

Answer 70

The proportion of observed deaths from a specified condition in a defined population divided by the proportion of deaths expected from this condition in a standard population expressed either. In comparison to the standardised mortality rate, the PMR uses data only on the proportion of cases classifiable to a particular cause. Its use is based on the question of whether a particular cause of death or disease is proportionately greater than expected among all deaths or disease cases in the occupational group as a whole. Its advantage is that it doesn’t require the calculation of absolute disease rates. It is usually calculated from age- and sex-stratified numbers.

Question 71

What is SMR (standardised mortality ratio)?

Answer 71

The ratio of the number of events observed in the study group or population to the number that would be expected if the study population had the same specific rates as the standard population. SMR = (Observed cases/Expected cases) x100

Question 72

What is the global burden of occupational illness?

Answer 72

Occupation is a major contributor to injuries and disease as well as economic loss amounting to 4–5% of GDP. The World Health Organisation (WHO) and the International Labour Organisation (ILO) estimate that there are around 2.2 million work-related deaths per year. Globally only 10-15% of workers have access to a basic standard of occupational health services. Worldwide, occupational risk factors were estimated to be responsible for: 37% of back pain; 16% of hearing loss; 13% of chronic obstructive pulmonary disease (COPD); 11% of asthma; 8% of injuries; 9% of lung cancer; 2% of leukaemia These risks at work caused the loss of about 24 million years of healthy life.

Question 73

In what way can the workplace be used positively for public health?

Answer 73

By providing opportunities for social participation and recreation. For setting initiatives aimed at health promotion, e.g. smoking cessation initiatives, cycling to work, and for screening for illness. For studying disease e.g. occupational studies

Question 74

In what ways is transport linked to public health?

Answer 74

Road-traffic injuries Physical inactivity Exposure to urban air pollution Adverse impacts on quality of life and noise exposure Environmental degradation Energy-related conflict Health effects consequent to climate change

Question 75

What is ozone?

Answer 75

A triatomic form of oxygen, which at ground-level ozone is an air pollutant with harmful effects on the respiratory systems of humans and animals. It is formed by photochemical reactions in the atmosphere. Its levels tend to rise during hot weather because its formation is catalysed by sunlight and volatile organic compounds (VOCs) which rise during periods of high temperature. Ozone effects may therefore be greater during heat waves.

Question 76

What is the role of active transport?

Answer 76

50% of car journeys in Europe are less than 5km This can be easily replaced by active transport methods which would offer the daily exercise requirement .

Question 77

What are the public health effects of motor vehicles?

Answer 77

Motor vehicles are one of the main contributors to outdoor air pollution, particularly in urban environments. There are many constituents of such pollution (particles, nitrogen oxides, ozone, sulphur dioxide, carbon monoxide, lead, volatile organic compounds). The evidence for adverse health effects is strongest for particles, specifically for particles smaller than 10 microns in diameter, often referred to as PM10, and PM2.5 (particles less than 2.5 microns in diameter) which are sufficiently small to enter the lower airways of the respiratory tract.

Question 78

Which types of studies are used to assess for the effects of air pollution?

Answer 78

Time-series studies, which examine (usually) day-to-day variation in health events and how it correlates with fluctuation in air pollution levels. This form of study provides evidence mainly about the short term effects of pollution, with influence on disease exacerbation. The semi-ecological cohort study which compares the well-documented health experience of populations exposed to varying levels of air pollution usually measured over a period of years. This form of study is important in providing evidence about long-term effects of air pollution exposure, including disease induction, but it is much less common than the time-series study.

Question 79

What is a chemical incident?

Answer 79

Any event (usually acute) in which there is, or could be, exposure of the public to chemical substances which cause, or have the potential to cause ill health. The most common type of incidents are fires (almost half – 46%), followed by spills (15%) and leakages (14%) and releases (10%). Explosions account for only 1%

Question 80

What is Remediation in terms of environmental health?

Answer 80

Taking action to reduce, isolate, or remove contamination from an environment with the goal of preventing adverse effects on human health.

Question 81

What are the common types of chemical incident?

Answer 81

Chemical spillages from fixed sites or transportation sources Non-domestic fires Release of chemicals into water systems Flood events Chronic contamination of land.

Question 82

Who manages chemical incidents in the UK?

Answer 82

In the UK, the UKHSA provides support to the National Health Service and emergency response agencies in dealing with the management and consequences of chemical incidents'

Question 83

What are the general steps to chemical incident management?

Answer 83

Guidance issued by PHE divides the incident response into four phases: The first few hours; The first 24 hours; The remainder of the management period; Post incident. Key tasks in each of these phases may be divided into: Assessment of the potential adverse risks to public health; Communication: between relevant agencies/organisations and with the public; Action to protect the public or to mitigate adverse health effects. Specific actions will depend on the nature and scale of the hazard.

Question 84

How may you respond to a chemical incident in the first few hours?

Answer 84

The initial stages of incident management focus on information gathering/risk assessment and precautionary actions. Information needs to be gathered rapidly about the location and nature of the incident, the chemicals involved (their identities, quantities, chemical properties, particular dangers, toxicology data), potential human exposure (pathways of exposure, number of people already exposed, number in danger of becoming exposed, likely time course of exposures), and evidence about the contaminant concentrations and their likely dispersion into the local environment (routes of spread in all media – soil, water, air – influence of weather conditions etc). Good communication is important between the emergency services (who are the first responders) and local authority environmental health departments, public health departments, local accident and emergency hospitals, GPs, local resilience forums, and other agencies. Depending on the nature of the hazard, it may be appropriate for contact to be made with water companies, PHE, the Environment Agency, the Drinking Water Inspectorate, the Health and Safety Executive, the Foods Standards Agency etc, and to make initial contact with the press radio and television. Consideration should be given to forming an incident control team with members from key organisations, and necessary facilities and logistical support (rooms, telephones, administrative support). Affected and populations at risk need to be alerted if movement/dispersal of the chemical is expected, and advice given about protection measures (e.g. stay indoors, shut windows, don't drink water) or to evacuate vulnerable populations if circumstances demand. Other alerts may also be needed, e.g. to food manufacturers that use water from sources at risk of contamination. Immediate protection and mitigation measures may include evacuation, decontamination of exposed persons, treatment of the injured. Measures may be needed to try to protect (where possible) vulnerable facilities or environments, such as rivers, aquifers, agricultural land.

Question 85

How may you respond to a chemical incident in the first 24 hours?

Answer 85

After the initial phase of response, and within the first 24 hours, the main tasks are to confirm and improve information about the chemicals, their movement in the environment, population exposures, health risks, and to ensure effective liaison between agencies. Good communication with the public and the media may be important. Consideration may be given to establishing a telephone helpline and holding a public meeting. It may be necessary to enlist the input of additional experts and agencies. It is also the phase in which routine environmental data may be gathered and assessed for evidence about the movement of the chemicals and levels of contamination, and additional environmental sampling may be initiated (e.g. of rivers, water courses) in consultation with appropriate laboratories. Advice to the public and other relevant recipients should be reviewed, and checks made to ensure vulnerable environments are being protected as far as possible, and that actions are being taken to remove and dispose of the contaminants. Consideration should be given to carrying out biological monitoring of exposed people to determine level of exposure and health effects/risks.

Question 86

How may you respond to a chemical incident after the first 24 hours?

Answer 86

In the remainder of the (post-acute) management period, steps are needed to ensure all actions have been carried through appropriately, including the identification and management of exposed persons, the monitoring and management of the contaminants in the environment, and that methods are in place, as appropriate, for gathering, analysing and interpreting needed environmental samples and biological specimens. Further press releases and follow-up information may be necessary about how the incident is being managed. In some incidents it may be appropriate to consider a health survey of the local population. Checks should also be made to ensure that property has been adequately decontaminated, and that evidence-based decisions are made as soon as possible about the safety of drinking water and the like. Once the incident is considered over, the public should be informed.

Question 87

How may you respond to a chemical incident in

Answer 87

There may still be need for further measures after the immediate incident has been resolved. Such measures may include: An epidemiological study using routine monitoring data or specific surveys, or by tagging patients notes to identify future health problems Establishing health checks on the exposed/treated population Ensuring that remediation of the contaminated site is complete, or if full remediation is not possible, that steps are taken to re-settle the population if the health risks are appreciable It is also important to ensure that steps are taken to minimise the risk of a similar incident occurring again, and that lessons are learned to improve the management of similar incidents in future.

Question 88

What extra considerations are required when managing a chemical incident involving water?

Answer 88

Incidents involving water contamination present special risks, and should involve liaison with water companies (for public water supplies), Environmental Health Practitioners (for private wells/springs), and the Environment Agency for incidents affecting surface waters, aquifers, or marine and coastal waters. If the drinking water supply is contaminated or at risk of contamination, the Drinking Water Inspectorate (DWI) needs to be advised and actions would be needed to alert the public not to drink tap water or to boil it. Alternative sources may be needed (e.g. bowers, bottled water distributions). It may also be necessary to stop abstractions from water sources, and to put in place appropriate monitoring. Interruptions of water treatment facilities may have adverse effects on water quality. Floods may affect water supplies and pumping stations.