FINAL Flashcards
What is environmental health?
- The branch of public health that focuses on all aspects of the natural and built environment that may affect human health.
- Field of EH tends to focus on man-made (anthropogenic) environmental hazards that lie outside of an individual’s immediate control (involuntary)
What is epidemiology
The study of the distribution and determinants of disease frequency in human populations……and the application of this study to control health problems; “population medicine”
What is environmental epidemiology
- Focuses on diseases linked to environmental exposures/hazards
- Usually focuses on factors that are beyond a persons control
goal of environmental policy
To reduce human risks or environmental damages resulting from pollution or environmental hazards
principles of environmental policy development
Precautionary principle
Environmental justice
Environmental sustainability
Polluter Pays Principle
principles of environmental policy development: Polluter Pays Principle
Polluter should bear the expenses of carrying out the pollution prevention and control measures introduced by public authorities, to ensure that the environment is in an acceptable state
principles of environmental policy development: Environmental Sustainability
Resources should not be depleted faster than they can be regenerated
There should be no permanent change to the natural environment
principles of environmental policy development: Environmental Justice
Fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income, with respect to environmental laws and policies
principles of environmental policy development: Precautionary Principle
Look before you leap – err on the side of caution
Take preventative measures even if cause and effect relationship is not definitive
What trends do we see in chemical production in the USA?
increase in chemical production
chemical hazard regulations
The Toxic Substances Control Act of 1976
The Toxic Substances Control Act of 1976
authorized the EPA to both assess new chemicals before they enter the marketplace and to review chemicals already on the market.
When the law was enacted, thousands of chemicals already being used were grandfathered in and accepted as just being okay in commerce
EPA has taken actions to regulate exposure to about 3,500 of 32,000 new HPV (High Production Volume - >1,000,000 pounds produced each year) chemicals submitted for review since TSCA was enacted
toxicology
the study of the adverse effects of chemical, physical or biological agents on living organisms and the ecosystem, including the prevention and amelioration of such adverse effects.
Goal of toxicology
To understand the causal relationships between toxicant exposure and adverse human health effects
Experimental Methods of toxicology
Highly controlled experiments, usually in a laboratory setting, typically using animals
Epidemiological Methods of toxicology
Observations on uncontrolled populations, usually in the natural environment
toxicology basic understanding:
Even innocuous (non-harmful) substances can become toxic in high doses
High O2 can lead to O2 intoxication
Too much water can cause osmotic imbalance or brain damage
Dose-response relationship
Type of correlative relationship between “the characteristics of exposure to a chemical and the spectrum of effects caused by the chemical”
Dose-response Curve
type of graph
Used to describe the effect of exposure to a chemical or toxic substance upon an organism such as an experimental animal
identify the minimum dosage needed to produce a biological effect
understand the rate of accumulation of harmful effects
Different curves used for individuals v populations
most rapid route of absorption, distribution, and excretion
most rapid effect: intravenous
ingestion: GI tract –> feces
Inhalation: lungs –> GI–> (either straight to feces or to liver to bile back to GI back to feces)
dermal: blood and lymph (urine or expired air)
Pesticide
Substances or mixture thereof intended for preventing, destroying, repelling or mitigating any pest.
ALSO any substance or mixture intended for use as a plant regulator, defoliant or desiccant.
Insecticide
pesticide used to kill insects
Herbicide
a chemicals to control or
destroy plants, weeds or grasses
Fungicide
used to deter or destroy fungi
Nematocide
chemical agents destructive to nematodes
Rodenticide
chemical or agent used to destroy rats or other rodent pests
Fumigant
vaporized to kill pests
pesticide classes
Organophosphates
Carbamates
Organochlorines
Herbicides/Defoliants
Organophosphates
organic esters of phosphoric acid
Carbamates
salts or esters of carbamic acid
Organochlorines
chlorinated hydrocarbon-based
Herbicides/Defoliants
Mixed structure; often hormone derived
atrazine
Invented by geigy in 1958
Binds to electron transport chain in chloroplasts (which animals lack)
Plants die of starvation & oxidative damage
The most commonly detected pesticide in drinking water in the USA
Banned in European Union in 2004
what is lead
Lead is a toxic heavy metal
Lead is a soft gray metal element that occurs naturally in the earth.
sources of lead
lead was added to paint, gasoline, ongoing or historic mining, commercial or industrial operations
Lead from old lead paint may contaminate household dust and nearby soil.
Soil may still have high lead levels resulting from pre-1976 gasoline.
Lead enters the dust or air in businesses that involve lead.
Lead mines or smelters may contaminate nearby soil or water.
how can people be exposed to lead?
- Inhalation of lead dust contributes to a build up in the body and may be the major route for workers in lead-related occupations..
- Ingestion of foods, water, and alcohol may be significant for certain populations.
- Ingestion is the primary way the general population, especially children, are exposed to lead.
- Ingestion of certain home remedies.
- Ingestion of lead paint or inhalation of lead dust or fumes is a major source for children in the United States.
Primary prevention of lead hazards
Lead hazard mitigation law (LHML) 2002
Intent: To prevent childhood lead poisoning in RI by:
Increasing the supply of safe rental housing in Rhode Island
Improving public awareness of lead issues
LANDLORD RESPONSIBILITIES FOR PREVENTION
Take a lead hazard awareness seminar Evaluate the property for lead hazards Correct identified lead hazards Get an independent clearance inspection Get a Certificate of Conformance
Landlord complaints for prevention
Costly
Burdensome
Should be responsibility of parents
No children at my property- why do I have to comply?
Compliance is low because there is no enforcement of the law: New in 2011 Code can cite if no COC
three ways to classify metals
major toxic metals, essential metals, metals and medicine
three ways to classify metals: major toxic metals
Not necessary to sustain life
Toxic at both acute and chronic exposure levels
Arsenic (semimetal), beryllium, cadmium, chromium, lead, mercury, nickel
three ways to classify metals: essential metals
Essential for life at trace amounts, but have the potential for toxicity at high concentrations
Iron, copper, magnesium, zinc
three ways to classify metals: metals and medicine
Metals used for medical therapy
Aluminum, lithium, platinum
Top three metals humans are exposed to
- Arsenic
- Lead
- Mercury
example of ways heavy metals are in the biota
biomagnification/bioaccumulation (mercury in fish) Organotin pesticides (End up in water → fish) Leaded glaze and glass (Paprika and wheat)
Biomagnification/bioaccumulation
The gradual buildup of substances, such as pesticides, or other chemicals in an organism
Note, this is not the same as a persistent chemical building up in an individual, rather this is the gradual accumulation of a chemical or substance through the food chain
What is emergency preparedness
To achieve the vision of the Federal Emergency Management Agency (FEMA):
“FEMA will work to prepare the Nation for disasters by encouraging individuals, government entities, and public and private groups at all levels to become informed of the risks they face, to make decisions that help keep people, property, and institutions out of harm’s way, and to possess the capability and knowledge needed to act when disasters occur.”
The role of environmental health in emergency preparedness
To ensure that the vulnerable areas of our environment are protected from accidental or intentional contamination
National center for environmental health
Biological and infectious waste, building environment, food protection, general preparedness, hazardous materials, radiation, shelter, vector control, water security
Vaccine preventable diseases
- measles, whooping cough, chicken pox
respiratory diseases
legionella, influenza outbreaks
agents of bioterrorism
anthrax, ricin poisoning, smallpox, plague
other diseases
healthcare acquired infections, invasive bacterial diseases, multi-drug resistant organisms
foodborne and waterborne diseases
salmonella, giardia, e. coli
vectorborne diseases
lyme disease, babesia, anaplasma
Vector control
-Zika Virus
-West Nile Virus
-Category B Agents
——VEE
——EEE
-Post-disaster
—–Dog bites
—–Snake bites
—–Rodents
—–Insects
Disease vectors
-mice and rats
-mosquitoes
-ticks
Eastern Equine Encephalitis
rare but severe mosquito-borne illness
—33% mortality rate
—significant brain damage among survivors
incubation period: 4-10 days
symptoms:
—sudden onset of headache, high fever, chills, and vomiting
—encephalitis, disorientation, seizures, coma, and death
prevention of mosquitos
Pesticides for the prevention of mosquitoes
—Larvicide: Targeted environment where EEE is know to amplify- freshwater, hardwood
swamps
—Adulticide: Aerial spraying in high-risk areas
Pesticide used was sumithrin
—very low volume
—aprox. 3/5 of an ounce aerosolized over each acre of land
—Very precise distribution
—Very sophisticated calculation that account for wind speed and direction
—Safest chemical for humans and the environment – Breaks down rapidly when exposed to air/sun
—toxic to invertebrates and fish
Concerns regarding pesticides
Potential harm to workers
Undesirable effects on cattle or other animals in ‘spray zones’
Unintentional adverse effects on pets
Drifting into residential areas
Ionizing radiation
Radiation with enough energy to eject electrons from atoms, creating ions
Occurs naturally
non-ionizing radiation
Radiation with enough energy to excite atoms but NOT to eject electrons
Types of ionizing radiation
Alpha particle
This is a helium nucleus (2 protons and 2 neutrons)
Beta particle
An energetic electron
Gamma ray or X-ray
This is a photon
types of non-ionizing
Ultraviolet Extremely low frequency radiation (ELF) Sound waves Visible light Microwaves Radio waves Electrical power lines
Occupational health
“The promotion and maintenance of the highest degree of physical, mental and social well being of workers in all occupations – total health of all at work”
types of occupational health hazards
physical chemical biological mechanical psychosocial
PHYSICAL occupational health hazards
Temperature Heat / Cold Illumination Noise Vibration Radiation Atmospheric pressure
CHEMICAL occupational health hazards
metals, aromatic hydrocarbons, aliphatic hydrocarbons, gases
-Routes of entry -Inhalation, Ingestion, skin absorption. (inhalation is the main route of entry)
BIOLOGICAL occupational health hazards
bacteria, viruses, protozoa, parasitic, fungal,
-bacteria
(Tetanus, Tuberculosis, Anthrax, Brucellosis (Milkmen), Gonorrhea (Sex workers-Genital organs get affected))
-virus
(Hepatitis, AIDs)
-protozoal and parasitic
(Malaria, hydatid (dog handlers), hookworms, tapeworms (agri-workers), etc)
-fungi – agri-workers
(Tinea-infections, coccidiomycosis, psittacosis, ornithosis, etc)
MECHANICAL occupational health hazards
injuries, ergonomic disorders
Ergonomics: “adjustment of man and machine”
(Application of human biological sciences with engineering science to achieve optimum mutual adjustment of man & his work, the benefit being measured in terms of human efficiency and well being
Tool / machine design to fit to work. Ergo tools/ ergo friendly tools:
Tools which reduce the stresses or problems resulting in CTD’s / MSD’s.) )
PSYCHOSOCIAL occupational health hazards
Behavioral changes, Depression, Anxiety, PTSD, Peptic ulcers, Diabetics, Heart disease
Primary prevention of occupational hazards
Modification of work practices
-Ex: Staying up to date on the gold standards for personal protective equipment for asbestos removal
Administrative Controls
-Ex: offering counseling services to employees following a traumatic workplace event
Engineering Controls
-Ex: Using machinery for heavy lifting instead of asking workers to do it themselves
Characteristics of SARS Co-V 2 (COVID-19)
A coronavirus (an RNA virus) Causes potentially severe respiratory infections in humans
Original animal host unknown
Similar (not identical) viruses found in bats
Some environments facilitate animal-to-human transmission
—Homes in which animals are raised for sale
—Markets in which live animals are sold
Two steps to efficient human-to-human transmission
—Mutation in animal, THEN animal-to-human transmission
—Animal-to-human transmission, THEN mutation in human
Functional human environments and transmission disparities
Residential environments Worship environments Occupational environments Leisure environments Cultural environments School environments
Variants
Variants are categorized according to characteristics that may affect:
- -Transmission
- -Diagnostics
- -Therapeutics
- -Immune escape
Variant Being Monitored (VBM) (alpha)
Variant of Interest (VOI)
Variant of Concern (VOC) (delta)
Variant of High Consequence (VOHC)
Water Quality basic facts
A human can live up to a month without food but can survive for about a week without water.
Average requirement for human consumption of water per day is approximately 2.5 liters (about 2.5 quarts).
About two-thirds of the human body is made up of water.
Average person: about 100 gallons (about 400 liters) of water per day
Average residence: over 100,000 gallons (about 400,000 liters) per year
50%–70% used for outdoor purposes, such as watering lawns and washing cars
Source Water
Untreated water (i.e., raw water) used to produce drinking water
finished water
Water (e.g., drinking water) delivered to the distribution system after treatment, if any
surface water
All water on the surface (e.g., lakes, rivers, reservoirs, ponds, and oceans) as distinguished from subsurface or ground water
ground water
Water that is contained in the interconnected pores in an aquifer
aquifer
A layer or section of earth or rock that contains freshwater, known as groundwater (any water that is stored naturally underground or that flows through rock or soil, supplying springs and wells)
Glaciers and Icecaps
Cover approximately 10% of the world’s landmass
Found primarily in Greenland and Antarctica
Account for about 70% of freshwater worldwide (majority of the world’s fresh water supply)
Hydrological (water) cycle
The natural cycle by which water evaporates from oceans and other water bodies, accumulates as water vapor in clouds, and returns to oceans and other water bodies as precipitation
water treatment
The stages of treatment at a water treatment plant:
- Coagulation–removes suspended material
- Sedimentation–causes heavy particles to settle to bottom of tanks for collection
- Filtration–removes smaller particles
- Disinfection–destroys pathogens
People with a higher risk of foodborne illness
Adults aged 65 and older
Children younger than 5 years
People with weakened immune systems (e.g., due to diabetes, liver or kidney diseases, HIV/AIDS, )
Pregnant women
TOP FIVE FOODBORNE GERMS
- Norovirus: virus, spreads quickly, usually associated
- Salmonella: bacteria, commonly associated with chicken and eggs.
- Clostridium perfingens: bacteria, found on raw meat and poultry, in the intestines of animals and in the environment.
- Campylobacter: bacteria, raw or undercooked poultry.
- Staphylococcus aureus: bacteria, 25% of people and animals have staph on their skin and in their nose.
Norovirus
Responsible for roughly 50% of foodborne illness outbreaks
May be brought into a restaurant by a guest who becomes ill at the restaurant
May be a food worker who is working while ill and did not wash their hands properly after going to the bathroom.
Very contagious and transmitted very easily
Symptoms • Vomiting • Diarrhea • Dehydration • Abdominal cramps • Onset: 12-72 hours (typically around 36 hours) • Duration • 1–2days
Epidemiological triangle
Agent (laboratory –> Confirm agent in clinical and/or food samples) —> Environment (environmental health –> Risk Factors/Food and Environmental Samples) —> Host (epidemiology –> Suspect Agent Suspect Food Suspect Establishment) –>
Infamous air pollution episodes
Meuse Valley, Belgium (December, 1930)
—~60 deaths over 3 day period in a region with a population of
approximately 9,000
Donora, PA (October, 1948)
—20 people died and over 7,000 were hospitalized or became ill over a 5 day period in this town of 14,000
London Smog (December, 1952)
—3000 excess deaths and 20,000 excess hospitalizations during the first 3 weeks of December
—12,000 excess deaths through February
Temperature inversion and smog
—The usual temperature gradient allows concentration of warm air from earth’s surface into the upper atmosphere, thus removing pollutants from the breathing zones of people
—A temperature inversion is the reverse of the usual situation in which air closer to the surface of the earth is warmer than the air that is in the upper part of the atmosphere
—An atmospheric condition during which a warm layer of air stalls above a layer of cool air that is closer to the surface of the earth
—During a temperature inversion, pollutants (e.g., smog) can build up when they are
trapped close to the earths surface. Continuing release of smog forming pollutants during an inversion exacerbates air pollution
Pollutants regulated by the EPA
- Nitrogen Dioxide (NO2)
- Carbon Monoxide (CO)
- Particulate Matter (PM)
- ozone
- sulfur dioxide (SO2)
- lead
size fractions of ambient particles
PM2.5 particles are smaller than PM10
PM2.5 particles are more hazardous to human health because they can travel deeper into the lungs when inhaled, and thus are more difficult for the body to clear
Climate Change and Health
It’s real It’s us (caused by humans) Experts agree It affects all of us There’s hope (it’s solvable)
Effects of climate change
More extreme weather ▪ Heat waves ▪ Extreme cold ▪ Heavy rains, floods ▪ Drought ▪ Severe storms ▪ Wildfires Air pollution Sea level rise Health impacts ▪ Death, injury, hospitalization ▪ Asthma exacerbations ▪ Mosquito-borne disease ▪ Water-borne disease ▪ Availability of food and clean water Economic impacts ▪ Property loss ▪ Fishing, ski, and maple syrup ▪ Recreational waters
Impacts of climate change on human health
Picture on slides
How can humans make a difference?
How We Move ▪ Drive less ▪ Walk/bike/carpool more ▪ Fly less What We Eat ▪ Less red meat ▪ Reduce food waste In Our Homes ▪ Use less energy ▪ Use greener energy ▪ Create less waste What We Buy ▪ Buy less ▪ Dress sustainably ▪ Shop sustainably Be a messenger ▪ Talk to your friends, neighbors, patients, clients, customers, employer ▪ Get involved ▪ Vote!
Sick Building Syndrome
A term used to describe the situation in which building occupants experience acute health comfort effects that appear to be linked to time spent in a building
Housing quality is associated with morbidity
mental disorders, poor nutrition, infectious disease, injury, chronic illness
Health housing and asthma
Strong association between substandard housing and chronic illness
• Damp, cold, and moldy housing has been associated with asthma
Issues include:
Water intrusion (leading to dampness)
• Overcrowding (poor ventilation, increased moisture)
• Dampness can promote mites, roaches, molds, and respiratory disease
• Dirty carpeting (reservoir for dust, allergens, and chemicals)
• Pest infestations due to structural deficits, inadequate food storage, or
dead space in walls (cockroaches, mouse allergens)
• Frequent fluctuations in indoor temperature (particularly cold housing)
• Passive indoor tobacco smoking (exasperated by poor ventilation, and
nitrogen dioxide)
How can affordable housing promote health?
Freeing up resources for nutritious food and health care expenditures
Well constructed homes can reduce issues associated with poor quality housing
Access to affordable housing allows for escaping abusive homes, improving mental and physical safety
Green building can reduce environmental pollution, improve energy costs, and indoor environmental quality
Alleviating crowding can reduce stress and infectious disease
Improve chronic illness by providing efficient platforms for health care delivery
Residential stability reduces stress and related health outcomes
Affordable homeownership can positively impact mental health
Affordable housing is linked to supportive services for older adults
Access to neighborhoods of opportunity to reduce stress and increase access to health promoting amenities
Settler colonialism
The occupation and control of peoples, land, water, plants, animals, aerial space and ecosystems by another society.
What is Environmental Justice?
fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income, with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. This goal will be achieved when everyone enjoys:
–the same degree of protection from environmental and health hazards, and equal access to the decision-making process to have a healthy environment in which to live, learn, and work.
People of Color Environmental Leadership Summit
October 1991
fought for environmental justice and created principles of environmental justice
Principles of Environmental Justice
2) Environmental Justice demands that public policy be based on mutual respect and justice for all peoples, free from any form of discrimination or bias.
5) Environmental Justice affirms the fundamental right to political, economic, cultural and environmental self- determination of all peoples.
6) Environmental Justice demands the cessation of the production of all toxins, hazardous wastes, and radioactive materials, and that all past and current producers be held strictly accountable to the people for detoxification and the containment at the point of production.
7) Environmental Justice demands the right to participate as equal partners at every level of decision-making, including needs assessment, planning, implementation, enforcement and evaluation.
Obesogens
Exogenous anthropogenic exposure that promotes obesity and related diseases, often by interfering with
biological pathways involved in the development or maintenance of energy metabolism, eating behaviors, adipocytes, or thermogenesis.
Children are Not Little Adults (Environmental Endocrine Disruption & Obesogens)
Difference in physiological, anatomical, and behavioral characteristics
-These change from birth to adulthood
This affects levels and pattern of exposure
These characteristics can affect how exposures are absorbed, distributed, metabolized, and excreted from the body
Behavioral Characteristics Associated with Increased Exposures
SEE IMAGE ON SLIDES
PFAS: Obesogen of Concern
Fluorinated “tail” (hydrophobic) and function group (hydrophilic)
common items with PFAs
- food packaging (microwavable popcorn, sandwich wrappers, take out containers), outdoor gear, nonstick cookware, stain resistant fabric, household items (makeup, floss, waxes, paints, stains), firefighting foam
Number of deaths for 10 leading causes of death (2019)
Heart disease: 659,041
Cancer: 599,601
Accidents (unintentional injuries): 173,040
Chronic lower respiratory diseases: 156,979
Stroke (cerebrovascular diseases): 150,005
Alzheimer’s disease: 121,499
Diabetes: 87,647
Nephritis, nephrotic syndrome, and nephrosis: 51,565 Influenza and Pneumonia: 49,783
Intentional self-harm (suicide): 47,511
EMERGING HALLMARKS OF CANCER
look at pic on slide
US burden of cancer
In US, 1.37 million people are expected to be diagnosed annually
About half will still be alive in 5 years
9.8 million people alive today have ever had a
diagnosis of cancer
About 76% of all cancers are diagnosed in persons 55 and older
What are the main preventable risk factors for cancer?
smoking -- 29-31% of population attributable risk percent diet -- 20-50% alcohol -- 4-6% infection 10-20% occupation 2-4% reproductive hormone 10-20%
Percent of cancer cases attributable to lifestyle and environmental exposures in UK (2010)
highest is tobacco 19.2%
diet (9.2, mostly fruit and veg)
overweight and obesity (5.5%)
alcohol (4%)
