Lecture Flashcards
Rate of tuberculosis is ____ in Canadian communities
high
how do we measure health?
it depends what field of research and the researchers background is, many different variations of research opportunities
Sickle cell is a trait that is passed on and can offer benefits for avoiding _____(disease), but can also result in an early death.
malaria
genetic makeup reduces negative associations with malaria
health
not an absence of disease but aspiration of healthy life ideal
environmental health
anything outside your body, external
ex: climate change allowing new vectors to come into play
epidemiological transition
gone from the past(environmental and infectious disease) to present(lifestyle, diseases pertaining to life)
what are the three main dimensions of human-environment interaction
Human Activities—Biological Environment–Physical and Chemical Environment= Health
Population Health Definition
Population health refers to the health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development, and health services.
Determinants of health versus Social Determinants of health
Social determinants are only the socially oriented determinants of health which makes up about 75%
National Population Health Framework
should recognize different geographic and social factors
fomites
Inanimate that can carry disease
bug that can be passed through clothing and bedding
Urban Heat Island
KNOW THESE FOR EXAM, AVAILABLE ON PAWS
.HUMIDITY EFFECTS
.ANTHROPOGENIC
PYLL
premature death based on the age of death and life expectancy
Western Canada tend to have _____ PYLL then the rest
higher
Boabang Owusu
Healthy Aging: .65 and over counts as aging .aboriginal research uses 55 years as aging because of earlier death rate .Canada's population is seen as an aging population .2015: 16% of Canadians were aging .2036: 25% of canadians .Canadian population aging because of -decline in fertility -decline in death rate .What is healthy aging -Not an absence of diseases -Autonomy -Independence -Active Social Life
Why interest in aging?
- aging workforce
- consequences in how we organised our communities
- support services for the aged
- health care system
- keeping older people active and connected
- concern for indigenous populations due to health inequities
His research was in Ile-a-la-crosse very Northern SK
- Healthy aging for Aboriginal context
- holistic perspective of health
- attitude of people as they age is willingness to transmit the traditional knowledge
Four steps of a risk assessment
- hazard identification
- dose/response effect
- Exposure assessment
- Risk characterization
Warren county
Love Canal
Sarnia
was the beginning of the need for EPA because of companies dumping unregulated substances
-PCBs
-chronic health problems
-close proximity to the community
-looked at the area as low income and educated
risk perception: dumping was occurring until community outrage(4 years)
-environmental justice movement(6 weeks)
-socio-economic reasons for choosing site
individual preventative methods
-not a high profile location so news coverage limited
-monitored after the fact about more then just the chemical
Part of Niagra falls that was used as a dumping toxic waste ground that affected residents
The most polluted air in canada-Chemical valley
Be able to name 5 of the major outdoor air pollutants and where they come from
ex: aerosol, solvents, asbestos, BOC’s,
London “FOG”
essentially SMOG and they had no solution or aid for people
- masks didn’t help, all for show
- new power plants powered by coal
- cold air trapped under hot air held pollutants at ground level
- 12,000 people died 1952
- burning coal released sulphur dioxide
- politicians more on the side of industry
- switch from electric trams to diesel buses
Saskatoon rated poorly for air quality
.lack of quality control and criterion put forward by government
.really good air quality but no polices to keep it that way
.graded a D in 2006
_% of earths water is actually drinkable
_% is surface water and easy to access
3
waterbourne disease example ______
cholera
Food Deserts
Food Swamps
Food Mirage
area where there is no access to healthy foods
area where there is really only access to unhealthy food
The mirage of having food access in an area
Food covenants are hugely responsible for food deserts
Define Health
a state of complete physical, mental and social well-being and not merely the absence of disease.” (WHO 1948)
define environment
“[All] that which is external to the individual human host.” (Last 1995)
Gradual development of ______ led to population growth (environmental pressure), exposure to new zoonotic infections (from animals) dietary disorders (from reliance on a single crop)
Ca. 6,000-5,500 years ago first urban civilizations (Sumer in Mesopotamia, Indus Valley, ancient Egypt) led to increased economic specialization, emergence of “________” (e.g. smallpox, measles, etc.)
Later ______ development created localized pollution (e.g. lead smelting, tanning)
______ Revolution (late 18th century) led to large-scale industrial pollution, greater income for some (diseases of modern lifestyles)
agriculture
Crowd Diseases
industrial
Industrial
almost continuous ____ in death rates since the 18th century
decline
define epidemeology
4 steps
“the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems.” (Last 1995)
Step 1: define the health problem (what is the concern being studied? E.g. malaria, mercury poisoning, murders).
Step 2: describe case distributions by time, place and person (Incidence=new cases occurring during a set period of time; Prevalence=existing cases either at a point in time or during a period).
Step 3: define the population at risk (divide into those at risk due to some characteristics–e.g. age, gender, location–and those not at risk).
Step 4: compare calculated rates to a reference or control population.
from high death rate, high birth rate to low D.R. and low B.R.
a shift from mainly deaths due to communicable diseases to deaths due to chronic non-communicable disease.
demographic transition
epidemiological transition
DALY
an attempt to assign a number to loss of productive years in a population due to specific diseases or disabilities.
The Jungle Search for Viruses
Looking to avoid the next aids epidemics by looking at the source rather then treating the result
-Jungle meat can be tested and monitored to find and montior viruses
global viral forcasting initiative
The coming neurological epidemic
projected population patterns demonstrating most being over 65 will create a greater need for disease prevention and avoidance
Human-Environment Interaction
Health= _____________________Environments+_______ and _________ Environment+_________ Ennvironment
Health= The Scale and Nature of Human Environments+Physical and Chemical Environment+Biological Ennvironment
Lalonde Report
In 1974, the federal government’s White Paper, A New Perspective on the Health of Canadians (Lalonde Report), proposed that changes in lifestyles or social and physical environments would likely lead to more improvements in health than would be achieved by spending more money on existing health care delivery systems. The Lalonde Report gave rise to a number of highly successful, proactive health promotion programs which increased awareness of the health risks associated with certain personal behaviours and lifestyles (e.g., smoking, alcohol, nutrition, fitness).
define population health
Population health refers to the health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development, and health services
determinants of health (5)
Genes and biology Social environment or social characteristics Health behaviors Physical environment or total ecology Health services or medical care
GREAT SLAVE HELICOPTERS PROTECT HEALTH
health equity
Health equity is when everyone has the opportunity to attain their full health potential.
Social Determinants of Health (10)
Transportation Social and economic disadvantage Racism Unemployment Safe working conditions Social exclusion Access to healthy foods Addictions Early childhood development Unsafe/unsanitary housing conditions
TED SAW RED UNDERWEAR, SONIA’S SEXY ASS APPARENTLY EATS UNDERWEAR
Framework of Health Determinants
A range of biological, socio-economic, behavioral, and environmental components that can provide indication of overall health and well-being
Each of the determinants is not only important to health in its own way but they are also interrelated
Vunerable groups: (4)
Children
Women
Elderly
Indegenous
5 Actions to adress the SDOH’s
A national population health framework that is responsive to evolving knowledge on social determinants of health, and which integrates considerations for
structure, process, and funding, holds promise for achievement of goals for reduction of health disparities.
The national framework needs to explicitly include linkages with jurisdictions, sectors, and stakeholders.
Short-term and long-term goals, objectives, and targets are important for the framework to have the greatest chance of influence in the reduction of health disparities.
A national population health framework to set the stage and lead the way.
A coordinated and integrated population health-information infrastructure that includes culturally appropriate, community-relevant indicators.
A plan to assess population health initiatives and relay the information to policy makers.
A life-course perspective on health disparity issues and setting priorities.
Education, research, training, and professional opportunities that build capacity for innovation and implementation of the interdisciplinary, interprofessional, and multijurisdictional strategies for societal action on the determinants of health.
risk
“The probability that an [unfavourable] event will occur.” The quantitative measure of a particular outcome, such as disease, death or injury.
hazard
“A factor or exposure that may adversely affect health.” Qualitative expression of a potential source of danger.
_____ ______ is commonly used to identify actions or characteristics that may increase the probability of a harmful outcome.
risk factor
Hazard Classification(4)
By nature (biological, chemical, physical, mechanical, or psychosocial);
By route of exposure (e.g. air, water, food or land);
By setting (e.g. home, workplace, hospital or community)
Economic or environmental context (e.g. agriculture, industrial, etc.)
Hazard Matrix: 3
Agent/source: the material cause of the hazard (especially a disease)
Vector: “A person, animal, or plant which carries a pathogenic agent and acts as a potential source of infection for members of another species.(OED)” [For infectious disease a vector is biological, distinct from mechanical vehicles of spread–e.g. flies.]
Route: the path by which the agent or source attaches to or enters the body.
Sources of Biological Hazards (3)
Reservoir: a source in which a disease agent is constantly present (e.g. animal reservoir–trichinosis [pigs] or rabies [bats, foxes], environmental reservoir–anthrax [soil] or cholera [water], human reservoir–HIV/AIDS, measles).
Zoonosis: a biological disease that is normally confined to animal populations but that can infect humans incidentally/accidentally (e.g. brucellosis, bubonic plague, bovine spongiform encephalopathy). Zoonoses; epizootic.
Emerging infectious disease: a ‘new’ disease that was previously unseen, or an existing disease that has extended or reclaimed lost territory (West Nile Virus, SARS, tuberculosis [MDRS]). Now often associated with vector expansion (e.g. tick or mosquito), resistance to drug therapy, or the ‘leap’ of animal infections.
Spread of Biological Diseases: (6)
Infectious: able to be spread to a human by a specific organism or entity, directly or indirectly.
Communicable: able to be spread from one person to another.
Direct spread: through person to person contact.
By air: indirect through airborne transmission.
By water: ingested or through contact.
Vehicles: inanimate contaminated objects or animal carriers (food, clothing [fomites and smallpox], flies).
Components of Pathogens: (5)
Host-individual that contracts the disease
Agents-micro-organisms that are the direct cause of the disease
Vectors-living things involved in the transmission of the disease
Intermediate hosts-in which the agent multiplies
Reservoir-which maintain the agent
Jaques May classification of infectious diseases
2 factor diseases-host and agent (e.g. measles)
3 factor diseases-host, agent and vector (e.g. malaria)
4 factor diseases-host, agent, vector and reservoir (e.g. scrub typhus)
2 factor disease-host and agent ex:
measles
3 factor diseases-host, agent and vector
malaria
4 factor diseases-host, agent, vector and reservoir
scrub typhus
______ _____:(disease name)
Apparent increase in distribution/territory in UK in 1940s
A 4 factor disease—hosts (humans), agent (a worm), intermediate host (snails), reservoir (aquatic birds)
Preferred environment is freshwater lakes
Apparent increase was due to increased recreational use of preferred environment
swimmers itch
physical hazards(2)
noise
temp
__ dB a standard threshold for safety
85
Mechanical Hazards
Health hazards–injury or trauma–posed by transfer of mechanical or kinetic (motion) energy.
May be gradual (e.g. carpal tunnel syndrome) or immediate (e.g. industrial accidents ).
Culturally mediated–e.g. risk taking behaviour (masculine hegemony and poor male rural health, suicides, etc.) and class-differences (poor at increased risk).
Injuries: main locations where they occur
Occupational injuries: greater exposure to risk than elsewhere. Key settings: primary industries (forestry, farming, mining, etc.); also health care (back injuries!); clerical–repetitive strain injuries. Mainly working ages, males especially for fatalities.
Traffic-related injuries: due to poor roads, vehicle conditions, poor driving habits (and lack of education). Tends to be age and sex related: highest among young adults (inexperienced, risk-takers) and males. Declining rates in developed world (high among First Nations).
Home-related injuries: U-shaped curve (affects very young and elderly). Falls, burns, drowning, accidental poisoning, strangulation major causes.
_____ Rank #1 in deaths North Americans aged 1-44. 63% of all deaths among Canadians aged 1-24
injuries
Define the two intervention strategies
Passive intervention strategies: those requiring little or no action.
Active intervention strategies: those requiring initiatives on the part of an individual.
toxicity
inherent capacity to cause injury to a living organism (person, animal or plant)
risk
the possibility of harmful effects to humans, a function of toxicity (determines minimum harmful amount) and the extent of exposure (how long and how intimate the exposure
Inorganic vs. Organic Chemicals
Inorganic Chemicals: “A broad class of substances encompassing all those that do not include carbon and its derivatives as their principal elements. However, carbides, carbonates, cyanides, cyanates, and carbon disulfide are included in this class.” Major hazards include: Halogens; Corrosive Materials; Metals.
Organic Chemicals: Compounds whose molecules contain carbon. Examples: PCBs (polychlorinated biphenyls); VOCs (Volatile Organic Compounds); Dioxins; Chlorine.
Stages of Carcinogenesis (4)
Initiation: genetic changes in the DNA of a cell caused by an external stimulus (chemical, radiation, virus).
Promotion: the transformation of the initiated cell into an abnormal cell through the action of a promoter, leading to tumours.
Progression: transformation of tumour cells into malignant cells, with unrestrained growth and expansion into neighbouring cells.
Metastases: transport of cancerous cells from the original site throughout the body, leading to new tumours.
4 types of carcinogens
Organic compounds: e.g. VOCs (benzene, formaldehyde and percholroethylene).
Asbestos and synthetic mineral fibres (e.g. glass fibres, aluminum oxide).
Ionizing and ultraviolet radiation–skin cancer.
Viruses (e.g. hepatitis B virus and liver cancer, Human papilloma virus–cervical; Epstein Barr virus–nasopharyngeal).
LD50
LC50
ED50
“the amount of a substance that, when administered by a defined route of entry (e.g. oral or dermal) over a specified period of time, is expected to cause the death of 50 per cent of a defined animal population.”
LC50: The lethal concentration of a substance in air required to kill 50 percent of the test population.
“The statistically derived single dose of a substance that can be expected to cause a defined non-lethal effect in 50 per cent of a given population of organisms under a defined set of experimental conditions.”
By 2036- ____ million (25% of population)
By 2036- 10.4 million (25% of population)
DEFINITION of healthy aging
Aging individuals can expect to be free of all mental, emotional and physical health concerns associated with age related decline; rather healthy aging advocates urge that this decline should be well managed” (Bacsu et al., 2012)
Not the absence of diseases
Independence (Autonomy)
Active social life
Ile-a-la-crosse example of
Healthy aging in Aboriginal context
-holistic perspective
Rural Aging characteristics: (4)
Fertility rates have declined
Increased life expectancy
Massive rural-urban migration of the young
Face challenges of meeting the health needs of the aging population
Aboriginal population is on the trend towards aging
Aboriginal people have fairer/poorer health compared to the general population
Rural seniors have
poorer physical health status,
Poor access to healthcare services
higher prevalence of functional disability,
increased sedentary lifestyle,
less use of preventive care, and
report more chronic illness than urban seniors (Crowther, Scogin, & Johnson Norton, 2010)
PRC-HAN Environmental Audit Tool
Facilitates quantitative and qualitative inquiry into community-scale and street-scale factors associated with mobility in older adults.
Define Risk Assessment
The evaluation of scientific information on the hazardous properties of environmental agents (hazard characterization), the dose-response relationship (dose-response assessment), and the extent of human exposure to those agents (exposure assessment). The product of the risk assessment is a statement regarding the probability that populations or individuals so exposed will be harmed and to what degree (risk characterization).”
Risk Assessment Stages: (4)
- Hazard Assessment
Which are the health effects that this agent can cause? - Dose Effects/Dose Response
What is the relationship between dose and occurrence of health effects? - Human Exposure Assessment
What exposures are experienced/anticipated under different conditions? - Risk Characterization
What is the estimated occurrence of the adverse effect in a given population?
cohort study
A study in which a cohort (a group of similar people) with a common attribute (e.g., smokers) is followed prospectively (over time) and compared for some outcome (e.g., lung cancer) with another cohort not possessing the attribute. Initially, neither group would have the outcome (disease).
Case-control Study
Compares two very similar groups of people: those with the disease under study (cases) and those who do not have the disease (controls). Researchers study their medical and lifestyle histories retrospectively (looking backward) to establish what factors are associated with the disease.
Rate of Disease= __________/_________
Number of cases of Disease in population at risk/
Numbers of persons in population at risk
Risk Ratio
Rate of disease in population with the risk factor/
rate of disease in population without risk factor
SMR
Standardized Mortality Ratio=
Observed Deaths/Expected Deaths x 100%
.Standardization involves the use of data from two populations: population of interest and a standard (reference) population (e.g. Canadian population for 2001).
The resultant calculated SMR indicates what % above or below the expected mortality was found.
allows comparison between populations with differing age and sex structures.
ED
Expected deaths are those calculated as if the population of interest had the same age and sex structure as the larger reference population (derived by breaking population into age and gender strata e.g. M 0-10; F 11-20).
Define Causation and Association
Causation: An environmental agent or other stimulus induces a disease. A leads to B.
Association: A risk factor appears more often than expected where a disease appears. There is no implied cause and effect relationship.
Dr.John Snow: Clusters
Cholera in london
An unexpectedly high occurrence of disease cases in a given geographic area over a given time period.
Issues of data reliability: is there a valid causal relationship; is it significant? Is it chance/coincidence?
Opportunities for research by geographers (GIS, spatial statistics).
Dose/Effect
Dose effect: The severity of the health effect in an individual varies with the dose. This may involve a hierarchy of effects from minor ailments to death.
Dose/Response
Dose response : The dose varies in a defined way with respect to the proportion of the exposed individuals in a group (e.g., higher dose may mean a larger part of the population develops a condition).
NOAEL
NOEL
LOAEL
No Observed Adverse Effects Level (NOAEL): threshold for clinical symptoms or detection of health risks.
No Observed Effects Level (NOEL): Same, but refers to good or bad impact (e.g. effectiveness of drug doses).
Lowest Observed Adverse Effects Level (LOAEL) lowest level at which symptoms are found.
TDI
TOLERABLE DAILY INTAKE:
The measurement of the amount of any chemical substance that can be safely consumed by a human being in a day.
Calculations are usually based on the maximum level of a substance that can be fed to animals without producing any harmful effects.
Human Exposure Assessment
Human Exposure: “The opportunity for absorption into the body or action on the body as a result of coming into contact with a chemical, biological, or physical agent.”
Key measures:
Dose: amount of contaminant that a human has received (taken in) during a period of time.
Exposure: amount of contaminant that a human has been exposed to (some of which may not have been taken in).
Environmental Concentration: amount of contaminant in the environment to which a human may be exposed (not used for exposure assessment).
Multistage Sampling
A system of sampling in which representative samples are derived from progressively smaller geographical units.
Risk Characterization
- Exposure
- Risk
- Lifetime individual Risk
- Risk to exposed population
Kampala, Uganda
EX: Health Risk Assessment Along the Wastewater and Faecal Sludge Management and Reuse Chain
Define Risk Management
A process by which health risks are evaluated in light of the public’s perception and community or scientific standards, and are controlled through interventions.
Guidlines vs. Standards
Guidelines are non-binding (voluntary) levels
Standards are binding levels established by government agencies that often carry penalties for exceeding them.
Risk perception
Risk Perception varies among the public and may not reflect actual risk (may be overblown or understated).
5 public coping strategies
Risk reduction: attempts to improve situation through direct action.
Information gathering: decrease negative mental strategies, improve behaviours.
Seeking help
Seeking distractions: avoidance behaviour through immersion in other activities (e.g. sports, hobbies).
Emotional modification: coping through use of distracting substances (e.g. drugs, alcohol).
Framework of exposure control (4)
Control at the source (best: e.g., substitution or enclosure of the hazard, or elimination entirely through imposition of standards, clear disease reservoirs)
Control along the path (intercept hazard before interacting with the individual: e.g., barriers, ventilation, elimination of disease vectors)
Control at the level of the person (e.g., personal protective equipment, administrative controls, training, immunization, limit duration)
Secondary prevention (least effective: dealing with the hazard after exposure)
Risk monitoring
Routine assessment of health indicators in order to monitor the effectiveness of risk management programs and environmental health in general.
Indicators are basic variables that can be measured consistently over time and are closely related to environmental health risks. They must be closely associated in time with exposure.
Growing movement internationally to establish a common set of indicators, allowing for broad comparison of health conditions.
risk communication
“The purposeful exchange of information about the existence, nature, form, severity, or acceptability of risks.”
BCA & CEA
Benefit-cost analysis (BCA): Compares present value of benefits to present value of costs to determine the net present value of interventions. Three steps: identification of type of effects; quantification of effects; valuation and conversion to common currency.
Cost-effectiveness analysis (CEA): Determines the costs of intervention in relation to non-financial indices (better health, longer lives).
Evaluating Interventions (6)
Define scope and objectives Select appropriate outcome measurement Identify, measure and value all costs Identify, measure and value all benefits Compare cost-benefit Define implications of results for decision makers
Warren County
PCB dump was put in the community as it was politically influenced by the economic state of the community
Love Canal
near niagra, potential artificial waterway became toxic waste dump
100’s of homes then built over covered area
Large rainfall alerted residents of th contaminated ground
Chemical Valley(SARNIA, ON)
environmental racism against the first nations in the area
.high density of chemical plants in area
Environmental Justice
EJ usually refers to the belief that all citizens, regardless of ethnicity or socioeconomic class, should equally share in the benefits of environmental amenities and the burdens of environmental health hazards (Pijawka et al. 1998 and Collins 1992).
Distributional Justice: Spatial fairness of the physical distribution of environmental benefits and burdens.
Procedural Justice: Providing equal protection from environmental hazards regarding rulemaking and enforcement.
Process Justice: Providing opportunities for meaningful citizen involvement in decisions that affect environmental health, including access to information and adequate authority for local knowledge (Pena, 2005).
Name some major outdoor polutants
Major outdoor pollutants:
Ground-level ozone (O3)
Total suspended particulate (TSP)
Fine particulate matter <2.5 microns in diameter (PM2.5) or particles <10 microns in diameter (PM10)
Sulphur dioxide (SO2) Carbon monoxide (CO) Nitrogen oxides (Nox) Volatile organic compounds (VOCs) Sulphate (SO4) Nitrates (NO3)
Aeosols
Small contaminants suspended in air; may be solid (dust) or liquid (droplets) particles.
Dust suspended in air is suspended particulate matter.
Smoke solid (and sometimes liquid) products of combustion suspended in air. Composition varies with material being burned.
The effective size of the particle (aerodynamic diameter) determines how far it penetrates into the human body and what kind of damage it does.
Aerosol _______ Size and _______ diameter play a role in whether the human body can filter it out.
Aerosol Particulate Size
Aerodynamic Diameter
Greatest danger in particles ___ m to ___ m Respirable Range (deepest penetration).
10-0.1
Sulphur Dioxide
Source: Biomass and fossil fuel combustion, and industrial emissions.
Health effects: Respiratory tract irritation, impaired pulmonary function, cardiopulmonary disease.
Actions: Cause irritation of the eyes, nose, mouth and other parts of the respiratory tract. High concentrations will cause more severe irritation. Extremely high concentrations can cause damage to the respiratory tract or even respiratory paralysis and death.
Reactivity: Can react with water to form sulphurous acid, which may react further to form sulphuric acid. These acids are formed when sulphur dioxide contacts moist membranes in the eyes or respiratory tract after inhalation.
Solubility: Very soluble, forms acidic solutions which contain sulphite, bisulphite and sulphate ions.
Thermal inversions effect air quality by
Normal pattern: increased elevation yields decreased temperature (Normal Lapse Rate: ~6.5o C per 1000 meters).
Inversion pattern: layer of warm air trapped between layers of cool air. More common in valleys and in coastal areas.
Result: air does not mix, pollutants may become trapped near ground level (as smog).
Duration: may last for several days, until broken by changing weather patterns.
VOC’S
Source: Emitted as gases from certain solids or liquids. Chemical compounds: benzene, chloroform, methanol, formaldehyde, and gasoline (outdoors). Paints and lacquers, paint strippers, cleaning supplies, and pesticides (indoor air). Indoor levels are 2-5 X higher than outdoor; can be 1,000 X for certain activities (e.g. painting)
Health effects: Eye, nose, and throat irritation; headaches, loss of coordination, nausea; damage to liver, kidney, and central nervous system.
Signs/Symptoms: Conjunctival irritation (inner part of eyelids), nose and throat discomfort, headache, allergic skin reaction, dyspnea (painful breathing or shortness of breath), nausea, emesis, epistaxis (nosebleed), fatigue, dizziness.
Mortality effects: Some VOCs can cause cancer in animals; some are suspected or known to cause cancer in humans.
Most polluted city on Earth is ____, China
Linfen
5 Major indoor air contaminants
Carbon dioxide (CO2), tobacco smoke, perfume, body odours – from building occupants
Dust, fibreglass, asbestos, gases, including formaldehyde – from building materials.
Toxic vapours, volatile organic compounds (VOCs) – from workplace cleansers, solvents, pesticides, glues.
Gases, vapours, odours – off-gas emissions from furniture, carpets, paints, radon.
Dust mites – from carpets, fabric, foam chair cushions.
Microbial contaminants, fungi, moulds, bacteria, – from damp areas, stagnant water.
Ozone – from photocopiers, electric motors.
only ___ % of fresh water is easily available
0.3
______ is the industry that uses the most fresh water
agriculture
Currently: __ billion people without safe drinking water.
Predicted: By 2050, - billion people with water scarcity (declining per capita water supply).
Canada: Ranked 2nd to Finland for water quality; middle of the pack for available drinking water (UN)
1.4
2-7
____-_____ irrigation system the most effecient
center-pivot
Classification of Water-Related Disease(5)
Waterborne: Caused by viruses/bacteria carried in faeces and urine (e.g., cholera, cryptosporidiosis).
Water-privation: Caused by a lack of clean water, and spread through direct contact with contaminated people/objects due to lack of washing (e.g., trachoma).
Water-based: Water serves as habitat for a host in which the agent spends part of its life cycle (e.g., schistosomiasis–snails).
Water-related: Habitat for vectors, especially during early part of the lifecycle (malaria–mosquitoes).
Water-dispersed: Fresh water serves as a habitat for an agent and as a medium of dispersal through the respiratory tract (e.g., Legionella pneumophila [agent] and Legionellosis [disease]).
__% of all diseases caused by contaminated drinking water.
/ of all deaths in developing nations due to water-associated illnesses.
80
1/3
iodine
Source: Occurs naturally in water in the form of iodide (I) and is necessary to avoid iodine deficiencies and goitre (enlarged thyroid gland).
Forms: Dissolved in solution.
Health effects: Used to kill bacteria and viruses in drinking water. Chronic consumption of iodinated drinking-water has not been shown to cause adverse health effects in humans, although some changes in thyroid status have been observed.
Interventions: Generally added to water supply; monitoring water supply is cost-effective.
water quality indicators
Colour; Taste/Odour; Temperature; Turbidity (degree of particulate matter in the water due to organic or inorganic contamination; high levels may protect or encourage pathogens to develop).
Flint
lead leaked into water system from pipes
Typhoid Mary
Mary Mallon worked as a cook and was the cause of several typhoid outbreaks from 1900-1907.
She was the first “healthy carrier” of typhoid fever in the United States, and did not understand how someone not sick could spread disease – so she tried to fight back.
After a trial and then a short run from health officials, she was captured and forced to live in relative seclusion upon North Brother Island off New York until her death in 1938.
Three classes of obessity
1.
2.
3. Morbidly
define obesity
having a body mass index (BMI) of 30 or above (in excess of ~30 lbs over normal body weight).
Vitamin D Deficiency.
rickets and osteomalacia (skeletal diseases that weaken bones, bowed legs)
Calcium deficiency
. Osteoporosis (porous, fragile bones)
Iron Deficiency
. Anaemia (characterized by a lack of red blood cells)
Vitamin A Deficiency
. Xerophthalmia (severe drying of the eye surface caused by malfunction of the tear glands)
Iodine Deficiency Disorders
Goiters (enlarged thyroid), Cretinism (children born with mental deficiency, deaf-mutism)
Biological Contaminants: (4)
Bacterial: Caused by viable organisms that have either been present in the original food source or have entered the food source during preparation (e.g., salmonella bacteria occurring naturally in intestines of pigs, poultry; and Staphylococcus in milk and milk products).
Viral and parasitic: Diseases such as Hepatitis A (carried by shellfish, fruit, water, vegetables) and parasitic diseases caused by a more complex organism, such as giardiasis ( G.I. disease caused by penetration of intestinal walls by giardiasis cysts); trichinellosis (caused by helminth infection, especially from raw or undercooked pork).
Mycotoxins: Secondary metabolites of fungi (especially moulds such as Aspergillus flavus found on corn and peanuts and Aspergillus parasiticus found on black olives). May produce aflatoxin, a carcinogenic substance.
Prions: Diseases caused by an infectious agent composed only of protein. These attack the structure of the brain or other neural tissue (e.g., Bovine Spongiform Encephalopathy (BSE) in cattle and Creutzfeldt-Jakob Disease (CJD) in humans).
Chemical contaminants: (4)
PCBs: Polychlorinate Biphenyls fluids used in industrial applications. PCBs have no TDI and are known to suppress the immune system and have neurotoxic affects. They may also be carcinogenic. Fish are the most common source.
Lead: A metal that has toxic effects on the nervous system and the kidneys. Occurs naturally, but is also found in industrial and domestic products (paint, batteries, insecticides) and may also be found in water supply pipes in some locations. Food sources include shellfish and fish, but may also be found in vegetables, grains and fruit.
Cadmium: A metal that occurs naturally but that is also used in batteries and pigments. Acute exposure leads to : flu-like symptoms of acute pulmonary edema weakness, fever, headache, chills, sweating and muscular pain. Chronic exposure effects can include: cancer (lung and prostate), kidney damage, pulmonary emphysema, anemia, and bone disease (osteomalcia and osteoporosis).
Mercury (Hg): A toxic metal that is commonly found in fish and which may damage the central nervous system, endocrine system, kidneys, and other organs. It is especially toxic to foetuses and children.
Grassy Narrows First Nation example for ______ poisoning
mercury
inorganic mercury is the most toxic
T OR F
T
Methyl Mercury(organic) effects on humans
Latency period in adults from exposure to symptoms (several weeks to a few months)
Damage to endocrine system, kidneys, liver and CNS. Initial symptoms may include tingling or numbness of peripheries or limbs; later vision and speech impairment
Chronic exposure at sufficient levels results in death (poss. damage to immune system and cardiovascular system)
Leads to impaired neurological development (esp. foetus, children), CNS damage. Crosses placental barrier (even asymptomatic moms)
Minamata Disease severe neurological condition: ataxia (uncontrollable trembling); partial paralysis, loss of motor control, memory, cognitive ability [from Minamata, Japan]
Inorganic Hg converted to methyl mercury (organic form) through contact with ________ (greater toxicity).
microorganisms
Grassy Narrows ex
Key factors in Grassy case include narrowness of food chain and reliance on a few species in northern environments.
Mercury released as phenylmercuric acetate from pulp and paper (inorganic).
Adheres to fine-grained (esp. organic) sediments. Limitations on conversion due to cold water, sulphur concentration of sediments and poor solubility of sulphuric mercury.
Thereafter leaves sediment and is re-suspended, enters biota (conversion to methyl Hg by sulphide-reducing bacteria).
Accumulates in larger fish in significant concentrations of highly toxic methylmercury form.
Human hair and blood samples in Grassy Narrows and White Dog communities revealed blood mercury levels exceeding the level considered safe for humans
Estimated that __ million Canadians contract foodborne illness per year, most unreported.
2.2
Place matters video
basically speaks to the idea that your individual health is already decided before you are even born by where you will live or your ‘place’
define walkability
“The extent to which the built environment is friendly to the presence of people living, shopping, visiting, enjoying or spending time in an area” (Abley “Walkability Scoping Paper” 21 March 2005).
define a food desert
“a food desert is a neighbourhood with poor access to healthful foods such as fresh fruits and vegetables.”
6 requirements for a sustainabile communities
Adequate, safe water supply.
Adequate vegetation cover.
High quality soils for food production.
Sustainable environments for wildlife (within and surrounding urban area).
Maintain regional food production potential.
Create an urban environment on a human scale.
a megacity has a population of __ million or more
10
define food swamp
Food swamps: Overabundance of unhealthy food.
define food mirage
Food mirage: Grocery stores are plentiful but food prices are unaffordable for low-income households.
Biomass sources account for __-__% of energy used globally
Biomass sources account for 30-50% of energy used globally
hudro power Accounts for about / of the world’s electricity output.
1/4
Accounts for almost __% of the world’s energy
Oil: __%
Coal: __%
Natural gas: __%
Accounts for almost 90% of the world’s energy
Oil: 38%
Coal: 30%
Natural gas: 20%
Components of Environmental Justice (3)
Distributional Justice: Spatial fairness of the physical distribution of environmental benefits and burdens.
Procedural Justice: Providing equal protection from environmental hazards regarding rulemaking and enforcement.
Process Justice: Providing opportunities for meaningful citizen involvement in decisions that affect environmental health (Pena, 2005).
10 m-2.5 m: ____ Particles
<2.5 m: ___ Particles
Coarse
Fine
The five major infectious killers in the world
acute respiratory infections, diarrhea, tuberculosis, malaria, and measles
Diseases that are caused by the toxins that bacteria produce are not contagious.
T OR F
T
The number of bacteria (or viruses, parasites) required to cause a specific disease in an individual is called the_____ _____ _____; exposures below this dose will not result in an infection
The number of bacteria (or viruses, parasites) required to cause a specific disease in an individual is called theminimal infectious dose; exposures below this dose will not result in an infection
Approximately __ million chemical compounds have been synthesized in laboratories since the beginning of the present century
Approximately 10 million chemical compounds have been synthesized in laboratories since the beginning of the present century
classification of chemicals into two major classes:
classification of chemicals into two major classes: (1)inorganic chemicals(which contain none or very few carbon atoms), and (2)organic chemicals(which have a structure based on carbon atoms)
Stochastic vs. nonstochastic effects
The nonstochastic effects follow a dose–effect relationship in a single individual, as in the ingestion of a toxic substance (see Chapter3, Relationship Between Dose and Health Outcome). Stochastic effects occur as an all-or-none outcome with a certain probability following exposure. For example, following exposure to high levels of radiation, a person may have a high risk of developing cancer but any one person will not get more of a cancer with higher exposure.
The annual number of traffic deaths globally is estimated to be __ thousand and is increasing
500
HADDON’ TEN COUNTERMEASURE STRATEGIES FOR REDUCING INJURIES
- Prevent the creation of the hazard in the first place. 2.Reduce the amount of hazard brought into being. 3.Prevent the release of an existing hazard.
- Modify the rate or spatial distribution of release of the hazard from its source.
- Separate, in time or in space, the hazard and that which is to be protected.
- Separate the hazard and that which is to be protected by interposition of a material barrier. 7.Modify the basic qualities of the hazard.
- Make that which is to be protected more resistant to damage from the hazard.
- Counter damage already done by the environmental hazard.
- Stabilize, repair, and provide rehabilitative and cosmetic surgery.
Haddon Matrix(3)
Active vs. passive
pre injury- prevent drunk driving
injury- use seat belt
post injury- prevent hemmouraging
Active strategies are those requiring initiative (such as seat belt whereaspassive strategieslie at the opposite end of the continuum—little or no action is required (such as automobile airbags).
The consensus within the injury prevention field is that passive strategies should be employed wherever available, and when active strategies are necessary, they are most effective when mandated.
Descriptive studies: longitudinal and cross-sectional
Descriptive studies may be longitudinal (often) or crosssectional. Historical studies provide trends over time in an exposure or in the health effects of interest. Cross-sectional descriptive studies provide a snapshot of the exposure or the effects at a given time, or both.
A risk ratio of >_ or _ is usually considered evidence of an important risk. For example, a risk ratio of 5 would mean that the population with the risk factor (e.g., those who are exposed to asbestos) are five times
(p.114) more likely to have or get the disease (e.g., lung cancer) than the population without the risk factor (e.g., those who were not exposed to asbestos)
2 or 3
incremental risk
by subtracting the risk of the unexposed population from the risk of the exposed population
hierarchy of industrial controls (4)
- CONTROL AT THE SOURCE Substitution Engineering controls General ventilation
- CONTROL ALONG THE PATH Exhaust ventilation Protective barriers
- CONTROL AT THE LEVEL OF THE PERSON Personal protective equipment Training Administrative controls (e.g., shift rotation)
- SECONDARY PREVENTION
The linkage between ______ indicators and _______ indicators is key to accurate monitoring of environmental or occupational health risks
The linkage between environmental indicators and health indicators is key to accurate monitoring of environmental or occupational health risks
BCA VS. CEA
The use ofbenefit-cost analysis(BCA) in managing environmental health risks has expanded rapidly in recent years. Basically, in this analytical technique the present value of benefits is compared with the present value of the costs to determine the net present value of the management option under review.Cost-effectiveness analysis(CEA) is similar to BCA in its treatment of costs, however, the consequences of interventions (i.e., results, impacts, effects, outcomes) are not valued. Instead, the purpose of this analysis is merely to determine the costs in relation to the benefit achieved, measured in terms of natural units, e.g., additional years of life, case of disease incidence, etc.
- Define the study scope and objectives.
- Define and measure the outcomes or effects of each option under analysis.
- Identify, measure, and value all costs.
- Identify, measure, and value all benefits. 5.Compare the costs with benefits, along with sensitivity tests of the magnitude of the costs and benefits where uncertainty may exist regarding measures of outcome or its value.
- Define the implications of the results for presentation to decision makers
The human body handles longer and thinner particles, called _____, somewhat differently from particles that are more rounded in shape because _____ are more difficult to remove from the lungs by natural protective mechanisms.
The human body handles longer and thinner particles, calledfibers, somewhat differently from particles that are more rounded in shape because fibers are more difficult to remove from the lungs by natural protective mechanisms.
ex: asbestos
adsorption
Both liquid- and gas-phase constituents of air pollution are often attracted to and ride on the surface of solid particles
London fog’s mostly made up of _____ ______
sulfur dioxide
TYPES OF AIR POLLUTION (3)
Reducing
Photochemical
Point source
_____ is a parasitic tropical disease
schistosomiasis
Some people get infected but do not get the disease symptoms. These people may become carriers of the disease. One of the most famous carriers, known as “______ Mary,” lived in New York (Federspiel,1983).
Some people get infected but do not get the disease symptoms. These people may become carriers of the disease. One of the most famous carriers, known as “Typhoid Mary,” lived in New York (Federspiel,1983).
Importance of Iodine and Flouride in water
Fluoride Fluoride is naturally present in some foods as well as in water, but for the most part, it is the amount provided by drinking water that determines the daily intake. Since fluoride is an important component in bone and tooth structure, it is considered an essential element, ft is also a toxic chemical. Only a relatively (p.216) narrow range of fluoride concentrations in drinking water provides optimal conditions. Too-low levels of fluoride increase the incidence of dental caries whereas elevated levels cause mottling of the teeth as well as skeletal fluorosis. Fluoride is added to drinking water in some countries to improve dental health.
Iodine Water is one of the main sources of dietary intake of iodine. In areas where there is very low concentration of groundwater iodine, resident populations suffer from iodine deficiencies resulting in an enlargement of the thyroid gland (goiter) and, in severe cases, mental retardation and cretinism.
Carbohydrates (sugars and complex carbohydrates) should account for ___-___% of daily energy intake
50%–60% of daily energy intake:
The most clinically obvious effects of _____ deficiency are goiter and cretinism
iodine
_____ defeciency leads to Anemia is a widespread and persistent problem. ____ is necessary to make blood hemoglobin and is present in the oxygen-carrying red blood cells
Anemia is a widespread and persistent problem. Iron is necessary to make blood hemoglobin and is present in the oxygen-carrying red blood cells
______ deficiency causes osteoporosis.Osteoporosisliterally means “porous bones” and can be defined as a disorder of bone metabolism in which bone mass has been reduced to such an extent that the person is at increased risk of fractures.
Calcium deficiency causes osteoporosis.Osteoporosisliterally means “porous bones” and can be defined as a disorder of bone metabolism in which bone mass has been reduced to such an extent that the person is at increased risk of fractures.
food quality is determined by 4 factors
Thus, food quality is determined by four main categories of qualitative properties:
(1) organoleptic aspects (how it affects the senses; its taste and smell),
(2) nutritional value,
(3) functional properties
(4) hygienic properties.
Healthy City actions(4)
- Actions for equity
- Actions for supportive environments and sustainability
- Actions for community involvement
- Actions for reorienting health services
3 Energy human basic needs
Basic human needs (heating, lighting, cooking)
fossil fuels, despite awareness of this, and recent conservation efforts, these fuels continue to provide almost __% of the world’s commercial energy
90
Deterministic (Threshold) Effects
Deterministic effectsare those that are only seen after an acute exposure to high doses of radiation that exceed some threshold. They include skin burns, damage to bone marrow, and sterility. Such exposures have occurred in survivors of the atomic bomb explosions in Japan and in a few workers in Chernobyl (see WHO,1995c). Exposures of this magnitude are rare and occur only in occupational settings or after serious nuclear accidents (WHO,1994b).
Stochastic (Non-Threshold) Effects
Cancer and hereditary effects are classified as stochastic effects. The basic question in assessing risks for workers and members of the public, from the routine operation of the nuclear fuel cycle, concerns the nature of the dose–response relationship at low doses and dose rates (see Chapter3for information on dose–response curves).
