CREATING SUPPORTIVE ENVIRONMENT FOR HEALTH Prof Dr Jamal

CREATING SUPPORTIVE ENVIRONMENT FOR HEALTH Prof. Dr. Jamal Hisham Hashim Professor of Environmental Health & Research Fellow United Nations University-International Institute for Global Health Kuala Lumpur, Malaysia Presentation at the National Health Communication Conference 2008, Seremban, 30 October, 2008.

Outline of Presentation • Definition of health, environmental health and health promotion. • WHO scope of environmental health. • Environmental health hazards. • WHO report on environmental risk factors and diseases. • Human behaviour and environmental health.

Definition of Health • Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. • The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, religion, political belief, economic or social condition. Based on the Constitution of WHO, 1948.

Definition of Environmental Health Environmental health comprises those aspects of human health, including quality of life, that are determined by physical, biological, social and psychosocial factors in the environment. It also refers to theory and practice of assessing, correcting, controlling and preventing those factors in the environment that can potentially affect adversely the health of present and future generations. (WHO, 1993).

Definition of Health Promotion • Health promotion is the process of enabling people to increase control over, and to improve their health. • To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and realize aspirations, to satisfy needs, and to change and cope with the environment. Based on the Ottawa Charter for Health Promotion, 21 Nov. 1986.

Prerequisites for Health • Peace • Shelter • Education • Food • Income • A stable ecosystem • Sustainable resources • Social justice and equity Based on the Ottawa Charter for Health Promotion, 21 Nov. 1986.

UN Millennium Development Goals n n n n Eradicate extreme poverty and hunger. Achieve universal primary education. Promote gender equality and empower women. Reduce child mortality. Improve maternal health. Combat HIV/AIDS, malaria and other diseases. Ensure environmental sustainability. Develop a global partnership for development

The Environment of Health Model by Blum

Five Levels of Prevention • Health promotion (e. g. environmental health measures and healthy behaviours) • Specific protection (e. g. immunization) • Early diagnosis and prompt treatment (e. g. TB and HIV screening) • Disability limitation (e. g. physiotherapy) • Rehabilitation (e. g. drug rehabilitation).

The World Health Organization (1970) proposed that the scope of Environmental Health should include or relate to the following : 1. Water supply, with special reference to the provision of adequate quantities of safe drinking water that are readily accessible to the user, giving due consideration to other essential uses of water resources. 2. Wastewater treatment and water pollution control including domestic sewage, and the control of the quality of surface and ground water. 3. Solid waste management, including sanitary handling and disposal. 4. Vector control, including the control of arthropods, molluscs, rodents, and other alternative hosts of disease. 5. Food hygiene, including milk hygiene. 6. Sanitation measures associated with epidemics, emergencies, disasters, and migrations of populations. 7. Prevention or control of soil pollution by human excreta and by substances detrimental to human, animal or plant life. Note : Currently, 2. 5 billion of the world's population do not have access to a proper toilet.

Illegal solid waste dumping near Chemor, Perak.

The World Health Organization (1970) proposed that the scope of Environmental Health should include or relate to the following : 8. Control of air pollution. 9. Control of noise control. 10. Environmental health aspects of air, sea, or land transport. 11. Radiation control. 12. Accident prevention. 13. Housing and its immediate environment, in particular the public health aspects of residential, public, and institutional buildings 14. Urban and regional planning. 15. Public recreation and tourism, in particular the environmental health aspects of public beaches, swimming pools, camping sites, etc. 16. Occupational health, in particular the control of physical, chemical, and biological hazards. 17. Preventive measures required to ensure that the general environment is free from risk to health.

PLANE CRASH IN MEDAN, INDONESIA

Air pollution from a coal-fired power plant.

Environmental Health Hazards • Microbiological, chemical and physical contaminants in drinking water and foods. • Microbiological agents, particulates, gaseous pollutants and allergens in indoor air of residential and work environments and in ambient air. • Vectorborne and zoonotic disease agents. • Solid and liquid wastes, hazardous wastes and soil pollutants. • Accidents due to natural disasters, transportation, recreational, home and work environments. • Noise, heat, ionizing and non-ionizing radiation from residential and work environments.

Environment and Health • The World Health Organisation (WHO) conducted a systematic literature review and consulted 100 experts worldwide for their estimates of how much environmental risk factors contribute to the disease burden of 85 diseases. • Environmental risk factors play a role in more than 85 (80%) of the 102 major diseases reported in the World Health Report, 2004 by WHO. • Globally, 24% of the global disease burden (healthy life years lost) and 23% of all deaths (premature mortality) were attributable to environmental factors. • In children (below 15 years old), environmental risk factors can account for 36% of all deaths.

Source : WHO. 2006. Preventing diseases through healthy environments. Geneva : WHO Press.

Cause of mortality Individual risk Cardiovascular disease 5. 7 x 10 -4 Cancers 2. 2 x 10 -4 Motor vehicle accidents 1. 7 x 10 -4 Pneumonia 8. 7 x 10 -5 Kidney disease 4. 8 x 10 -5 Chronic obstructive pulmonary disease 4. 6 x 10 -5 Liver disease 3. 6 x 10 -5 Drowning 2. 5 x 10 -5 Falls 2. 0 x 10 -5 Asthma 1. 9 x 10 -5 Suicide 1. 3 x 10 -5 DOE’s tolerable risk limit for fatal accident among workers 1. 0 x 10 -5 Homicide 9. 0 x 10 -6 Fires and flames 7. 1 x 10 -6 Accidental poisoning 4. 2 x 10 -6 Accidents due to firearms and explosive 4. 0 x 10 -6 Dengue Fever 2. 1 x 10 -6 Railway accidents 2. 1 x 10 -6 Natural disasters 1. 7 x 10 -6 DOE’s tolerable risk limit for fatal accident among public 1. 0 x 10 -6 Struck by falling objects 8. 9 x 10 -7 Lifetime acceptable risk level of 10 -6 1. 4 x 10 -8

Relationship Between Particulate Matter and Asthmatic Attack % asthmatic attacks = -10. 67 + 0. 21 (PM 10 in g/m 3) + 0. 06 (NO 2 in ppm) + 0. 71 (SO 2 in ppm) Source : Zailina H. et. al, 1997

Source : WHO. 2006. Preventing diseases through healthy environments. Geneva : WHO Press.

Source : WHO. 2006. Preventing diseases through healthy environments. Geneva : WHO Press.

Source : WHO. 2006. Preventing diseases through healthy environments. Geneva : WHO Press.

Lead fumes from a soldering process in an electronic factory.

Source : Shamsul B. S. (2003)

Source : WHO. 2006. Preventing diseases through healthy environments. Geneva : WHO Press.

Source : WHO. 2006. Preventing diseases through healthy environments. Geneva : WHO Press.

Source : WHO. 2006. Preventing diseases through healthy environments. Geneva : WHO Press.

Important Findings • Heading the list of diseases impacted by environmental risks are diarrhoea (90%) lower respiratory infection (20 -42%), unintentional injuries (44%), malaria (42%), road traffic injuries (40%) and chronic obstructive pulmonary disease (COPD) (42%). • Diarrhoeal diseases associated with a lack of access to safe drinking water and inadequate sanitation result in nearly 1. 7 million deaths annually. • Household use of biomass fuels and coal by over half of the world’s population, results in 1. 5 million deaths a year from pollution-related respiratory diseases.

Important Findings • Deaths from environmentally-mediated diseases is much higher in the developing (25%) than in the developed world (17%). • However, for certain non-communicable diseases such as cardiovascular diseases (7 times) and cancers (4 times), the disease burden is higher in the developed countries. • 4 million children worldwide die from environmentally-caused deaths yearly, mostly in developing countries. • Infant death rate from environmental causes is 12 times higher in developing than in developed countries. • In developing countries, diarrhoea, respiratory infections and malaria alone account for 26% of all deaths among children under 5 years old.

Human Behaviours and Environmental Destruction • Poor sanitary practices in slum areas (respiratory, food and waterborne diseases due to poor housing, water supply and sewerage system). • High consumption and disposal society (voluminous generation of domestic waste). • Illegal industrial activities (air and water pollution). • Excessive energy consumption in homes and transportation sector (deteriorating indoor and outdoor air quality; global warming).

Squatter area and river pollution.

Human Behaviours and Environmental Destruction • Indiscriminate use of pesticides in agriculture and homes (cases of pesticide poisoning). • Slash and burn practice in plantation (incidence of haze). • Unhygienic food hygiene practices (foodborne diseases and food poisoning). • Creation of artificial breeding sites (breeding of disease vectors).

An MOH staff checking for mosquito larvae in a discarded tyre.

Thermal fogging of a Dengue case’s home by a MOH personnel.

Conclusion • Public health is a fundamental human right but individuals must be accountable for their own actions. • Environmental improvement must be complemented by desirable behavioural changes. • Creating a supportive environment is a collective responsibility of the government (regulator), employers and individuals. • Health promotion is a mechanism to reinforce environmental health efforts. • Health promotion will assist individuals to acquire the skill to cope with an ever changing environment.

Thank You