Faculty of Medicine Introduction to Community Medicine Course

Faculty of Medicine Introduction to Community Medicine Course (31505201) Unit 3 Public Health/Environmental Health Introduction to Public Health and Environment Functions and Achievements of public Health B y Hatim Jaber MD MPH JBCM Ph. D 16 -10 -2017 1

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Tenfold increase in childhood and adolescent obesity in four decades: new study by Imperial College London and WHO

Introduction to course 31505201 Course Content • Week 1 Unit 1: Introduction to Health and Community Health • Week 2 Unit 2 Nutrition and Nutrition Assessment and Diet • Week 3 Unit 2 (cont. ) Nutrition and Nutrition Assessment and Diet • Week 4 Unit 2 (con. . ): Infant and Breast Milk Characteristics • Week 5 Unit 3: Public Health/Environmental Health • Week 6 Public Health/Environmental Health • • • Week 7 Unit 5: Epidemiology : Study design Primary Health care Week 8 Unit 6: Demography, Data and Biostatics Week 9 Midterm assessment (Exams. )15 -11 -2017 Week 10 Unit 8 Public Health Surveillance Week 11 Unit 9: Prevention and Control of Diseases Week 12 Unit 10: Health Education and Communication Week 13 Unit 11: Screening Week 14 Unit 12: Health Administration and healthcare management Week 15 Unit 13: Health Research Week 16 Final assessment (Exams. ) 5

Introduction to Unit 3 Public Health and Environment 4 lectures 1. Introduction to Public Health and Environment-- 16 -10 -2017 2. Environment 1 - Air pollution— 18 -10 -2017 3. Environment 2 - Water Quality 23 -10 -2017 Environment 3 -Waste Management 4. Occupational Health -25 -10 -2017 6

Presentation outline Time Introduction to Unit 3 Public Health 08: 15 to 08: 25 Public Health definition, dimension and components. 08: 25 to 08: 40 Achievements of Public Health Approach 08: 40 to 09: 00 Environmental Health : Concepts and Definitions Air Pollution : Definition and Health Impact 09: 00 to 09: 15 to 09: 30 7

Public health • The WHO has defined it as “The science and art of preventing disease, prolonging life, and promoting health through organized community efforts” • Public health is a combination of scientific disciplines (e. g. , epidemiology, biostatistics, laboratory science, social science, demography) and skills and strategies (e. g. , epidemiological investigations, planning and management, intervention, evaluation) that are directed to the maintenance and improvement of the health of people. • Public health is both a body of knowledge and also means to apply that knowledge 8

Health is… and… …a dynamic state of complete physical, mental, spiritual, and social well-being and not merely the absence of disease or infirmity. * Public health is “What we society as a do collectively to assure the conditions in which people can be healthy. ”** Public health is thus a social institution, a discipline, and a practice

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What does What does medicine do? public health do? Saves lives one at a time Saves lives millions at a time Both of these disciplines are based on science, however, please note: Public health touches EVERY individual, EVERY day. Addressing the cause of death and emergencies cannot be done person at a time. Population-based public health means strategy is needed. It is important to understand the difference between medicine and public health because while medicine saves one life at a time, public health saves millions of lives at a time.

What is Public Health? • The sum of all official or governmental efforts to promote, protect, and preserve the people’s health. 13

Who is Responsible for the Public’s Health? • Government agencies – federal, – state and – local • Non-governmental agencies, such as nonprofit organizations. 14

Three Core Functions of Public Health �Assessment ◦ What are the health problems of a population or individual? �Policy Development ◦ Collectively deciding which actions or interventions are most appropriate for the problems identified. �Assurance ◦ The necessary interventions will be put into place, assuring conditions in which people can be healthy. 15

16 http: //www. health. gov/phfunctions/public. htm

Public Health Accomplishments- Achievements 1. Vaccination 2. Motor-vehicle safety 3. Safer workplaces 4. Control of infectious diseases 5. Decline in deaths from coronary heart disease and stroke 6. Safer and healthier foods 7. Healthier mothers and babies 8. Family planning 9. Fluoridation of drinking water 10. Recognition of tobacco use as a health hazard 17

Public Health Approach 1. 2. 3. 4. 5. Define the health problem. Identify risk factors associated with the problem. Develop and test community-level interventions to control or prevent the cause or the problem. Implement interventions to improve the health of the population. Monitor those interventions to assess their effectiveness 18

Public Health Approach Surveillance: What is the problem? Problem Implementation: How do you do it? Intervention Evaluation: What works? Risk Factor Identification: What is the cause? Response 19

A Sampling of Public Health Professions • • • Alcohol, tobacco and other drugs Chiropractic health care Community health planning and policy development • Environment • • Epidemiology Food and nutrition Gerontological health Health administration HIV AIDS Injury Control and Emergency Health Services International Health Maternal and Child Health • • Medical Care Mental Health • Occupational Health and Safety • • Oral Health Podiatric Health Population, Family Planning & Reproductive Health Public Health Education and Health Promotion Public Health Nursing School Health Education and Services Social Work 20

Environmental Health: Concepts and Definitions 21

What is environment? Environment is defined as “the surroundings in which an organization operates including air, water, land natural resources, flora, fauna, humans and their inter relations” – ISO Definition. Webster's Dictionary defines the environment as, "The circumstances, objects, conditions by which one is surrounded, the complex of physical, chemical and biotic factors, that act upon an organism, or an ecological community and determine its form and survival, the aggregate of social, cultural factors that influence the life of an individual or community. " 22

ENVIRONMENT All that which is external to man is the environment broadly speaking. The concept of environment is complex. The external environment or the Macro-environment is said to be responsible for millions of preventable diseases originating in it. Micro-environment is the Domestic environment in which man lives. The term Internal environment is some time used for the environment inside the body EXTERNAL ENVIRONMENT: “All that is external to the individual human host, living and non-living, and with which he is in constant interaction”. 23

ENVIRONMENTAL IMPACT Environment (Physical, biological and psychosocial) Human activities health of individual 24

EPIDEMIOLOGICAL TRIAD ENVIRONMENT VECTOR AGENT HOST 25

Health and Environment Perspective of Relations Environmental health Public Health Occupational Health Family Health Personal Health 26

Environmental Health? Air Sunlight Food Noise Water Soil The study of how the environment affects your health. 27

• The purpose of environmental health is to create and maintain ecological conditions that will promote health and thus prevent disease.

Health and environmental relationship 1 - Environmental conditions help to determine peoples health and how long they will live. - They can affect reproductive health and choices related to number of children. 2 - They can help determine prospect of social cohesion and economic growth, with further effects on health. 3 -Changes in the environment i. e. Pollution and degradation, climate change, extremes of weather also change the prospects for health and development. 29

Health and environmental relationship cont. . 4 - Environmental condition contribute significantly to communicable diseases, which account for about 20 – 25 % of deaths annually world wide. 5 - Unclean water and associated poor sanitation kill over 12 million people each year. 6 - Air pollution kills nearly 3 million or more. 7 - Change in land use can create new breeding grounds of vectors, Schistosomiasis in Sudan and Egypt 30

Health and environmental relationship cont. . 8 - The cleaning of the tropical forest creates hardpan on which rainwater can collect and mosquito can breed. Malaria results over 1 million death each year and accounts 300 million new clinical cases each year. Malaria causes 10 % of the death in sub – Sahara Africa. 9 - It has been estimated that roughly - 60% of the global burden of disease from acute respiratory infections. - 90% from diarrhoeal disease, - 50% from chronic respiratory condition and - 90% from malaria could be avoided by simple environmental intervention. 31

COMPONENTS OF ENVIRONMENT For descriptive purpose, environment has been divided into three components, all closely related : • (i) Physical Water, air, soil, housing, wastes, radiation, etc. • (ii) Biologic Plant and animal life including bacteria, viruses, insects, rodents and animals. • (iii) Social Customs, culture, habits, income, occupation, religion etc.

Hazards Bacteria & viruses Harmful chemicals Tobacco smoke Stress Loud noises A hazard is anything in the environment that can hurt you or make you sick. 33

I- Biological hazards These are living organisms or their products that are harmful to humans A. Water-borne diseases are diseases that are transmitted in drinking water 1. Examples are polio virus, hepatitis A virus, Salmonella, Shigella, cholera, amoebic dysentery, Giardia, and Cryptosporidium. 2. These disease organisms are shed into the water in feces, and can produce illness in those who consume untreated, contaminated water. 3. Our municipal water treatment facilities are usually able to purify water by removing these agents or killing them by disinfecting the water. 34

B. Food-borne diseases are diseases transmitted in or on food 1. Examples of food-borne agents are the bacteria Salmonella, serotype enteritidis, Escherichia coli, as well as other agents. 2. To protect against food-borne diseases, sanitarians from local health departments routinely inspect food service establishments (restaurants) and retail food outlets (supermarkets) to verify that food is being stored and handled properly. 35

C. Vector-borne diseases are those transmitted by insects or other arthropods 1. Examples are St. Louis encephalitis and La Crosse encephalitis transmitted by mosquitoes and plague and murine typhus transmitted by fleas. 2. Improper environmental management can cause vectorborne disease outbreaks. 36

II. Chemical hazards result from mismanagement or misuse of chemicals resulting in an unacceptable risk to human health A. Pesticides are chemicals that have been manufactured for the purpose of reducing populations of undesirable organisms (pests) 1. Examples of categories of pesticides are herbicides and insecticides. 2. Most pesticides kill non-target organisms as well as the target, or pest species. 3. The wise use of pesticides can protect human health and agricultural crops. 37

II. Chemical hazards B. Environmental tobacco smoke (ETS) is an environmental hazard produced by millions that smoke 1. Diseases associated with ETS include lung cancer and perhaps heart disease. 2. ETS contains 4, 000 substances. 3. The EPA has classified ETS as a Class A carcinogen. 4. Smoking has been increasingly restricted from public buildings and from many private work sites. 5. Regulation of smoking seems to be the best approach to controlling this pollutant 38

II. Chemical hazards C. Lead is a naturally occurring element that is used in the manufacturing of many industrial and domestic products 1. Health problems associated with the over exposure to lead are anemia, birth defects, bone damage, neurological damage, kidney damage, and others. 2. Exposure is by ingestion and inhalation. 3. Children are particularly at risk from eating peeling lead paint. 4. The prevalence of very high blood lead levels among young children declined significantly between 1984 and 1994 primarily because the removal of lead from gasoline. 5. Occupational exposure is a major source of lead intake for adults. 39

III. Physical hazards include airborne particles, humidity, equipment design and radiation A. Radon contamination results from over exposure to radon gas. 1. Radon gas arises naturally from the earth and sometimes occurs at dangerous levels in buildings and homes. 2. Breathing in radon gas can cause lung cancer. 3. Homes can be tested for the presence of radon gas for $20. 40

IV. Psychological hazards are environmental factors that produce psychological changes expressed as stress, depression, hysteria. V. Sociological hazards are those that result from living in a society where one experiences noise, lack of privacy and overcrowding. Population growth may be a sociological hazard. 41

Route #1: Inhalation: Breathing. When chemicals enter the body through this route of exposure, they can get stuck in the lungs and/or be taken up into the bloodstream. 42

Route #2: Ingestion: Swallowing (usually by eating or drinking). When chemicals enter the body through this route of exposure, they can easily be taken up into the bloodstream.

Route #3: Dermal Absorption: Absorbing a chemical through any part of the skin, including the eyes. When chemicals come in contact with the skin, they can sometimes enter the bloodstream through this route of exposure.

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Natural Environment • Hydrosphere The hydrosphere represents one component of earth's system, operating in conjunction with the solid crust (lithosphere) and the air that envelopes the planet (atmosphere). According to the research, hydrosphere basically a combined mass of water that is found on earth, that makes up around 71% of the earth surface which is covered with water. Atmosphere Its major components are Nitrogen (78%), Oxygen ( 20. 96% ), Argon ( 0. 93% ), Carbon-dioxide ( 0. 032% ), and other inert gases. The atmosphere filters the incoming ultra-violet (UV) radiation and protects the earth’s surface. Troposphere, Stratosphere, Mesosphere, Thermosphere are the four types of atmosphere. 47

The four types of Atmosphere • Troposphere: 8 -18 km, close to earth surface • Stratosphere: up to 50 km, OZONE - absorbs harmful ultraviolet radiation from sun • Mesosphere: > 50 km • Thermosphere and Exosphere= upper atmosphere 48

Natural Environment • Lithosphere The earth's crust consists of rocks and soils made up of different chemical elements and minerals. The lithosphere occupies 30% of the total Earth’s surface. The lithosphere is about 100 km thick, although its thickness is age dependent (older lithosphere is thicker). Anthrosphere The anthroposphere (sometimes also referred as technosphere) is that part of the environment that is made or modified by humans for use in human activities and human habitats. It is one of the Earth's spheres. As human technology becomes more evolved, so do the impacts of human activities on the environment. Examples: deforestation for housing, land setup, etc. 49

• 1. Natural environment: 4 spheres • 1. 1 Biosphere = Space occupied by life • 1. 2 Atmosphere = Space occupied by air • 1. 3 Lithosphere = Space occupied by solid • 1. 4 Hydrosphere = Space occupied by water 50

Atmosphere Ecosphere Biosphere Hydrosphere Lithosphere

2 Man Made Environment (Socio-cultural) • Cultural OR man made environment : It includes 1)Industries, 2)Transport and communication, 3)Population, 4)Traditions, 5)Political situations etc… 52

Interaction between each biotic level with physical environment through energy, matter, and information produces characteristic functional system. "Biosystem" or "life" 53

What Is An Ecosystem An ecosystem is a natural unit consisting of all a plants, animals and micro-organisms (biotic factors) in an area functioning together with all of the non-living physical (abiotic) factors of the environment. Ecology is the study of ecosystems. 54

Environmental Sanitation: WHO defines environmental sanitation as “the control of all those factors in man’s physical environment which exercise or may exercise a deleterious effect on his physical development, health and survival”. = eliminating or modifying the harmful factors and promoting the beneficial ones towards promotion of human health 55

What is environmental justice? Environmental Justice (EJ) means that everyone has a right to live in an environment that doesn’t make them sick, regardless of their race, culture, or income. 56

Environmental sustainability: ﺍﻻﺳﺘﺪﺍﻣﺔ • Improvements in the standard of living that do not cause long-term damage to the environment that impact future generations. and it includes: • • • 1. Protecting biodiversity 2. Stopping human caused climate change 3. Elimination of acid rain 4. Elimination of damage to ozone layer 5. Reduction of pollution (air, water, noise, etc. ) 6. Management of resources e. g. fish, water 57