This course will provide you with an overview of the most important health challenges facing the world today. You will gain insight into how challenges have changed over time, we will discuss the likely determinants of such changes and examine future projections. Successful international strategies and programs promoting human health will be highlighted and global health governance structures will be mapped and the role of the key actors explored.
9.1: Environmental Health Challenges (F Konradsen)
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Environment, Climate and Migration
In the fifth module we are looking at some great global crises that profoundly impact the health of populations, namely environment, climate change, and migration. We will examine the health acpect of these mega trends - how are they influencing and challenging policy, health systems, and the health of individuals in both low and high income countries?
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Flemming KonradsenProfessor, Director
Copenhagen School of Global Health
[MUSIC]
Welcome.
In this session, the aim is to introduce you to the
general links between the state of the environment and human health.
Furthermore, you'll be provided with estimates of
the environmental health related burden of disease.
Towards the end of the presentation, I'll briefly talk on some
of the key environmental health interventions
supported by national and international organizations.
As you will learn from this presentation, I subscribe to the idea that human health
and quality of life depend upon global and local ecology and the way it's managed.
To get started let me provide you with the WHO definition of
Environmental health as formulated in 1993 at a consultation in Sofia, Bulgaria.
Environmental health comprises of those aspects
of human health, including quality of life.
That are determined by physical, chemical, biological,
social and psychosocial factors in the environment.
It also refers to the theory and
practice of assessing, correcting, controlling, preventing those factors
in the environment that can potentially affect
adversely the health of present and future generations.
Next lets talk about the estimated global
burden of disease linked with environmental factors.
In 2006 the WHO published a
report titled Preventing Disease Through Healthy Environments.
The report addresses the key question.
How much disease burden can be prevented by environmental interventions.
Considering the part
of the environment that can possibly be changed by existing interventions.
The report estimated that 24% of the global
disease burden was linked with environmental risk factors.
This estimate compares well with previous assessments.
In the 2006 WHO report, diseases with
a major fraction attributable to modifiable environmental factors
included diarrheal diseases with a 94%
fraction, lower respiratory infections, malaria, unintended injuries.
All with a fraction attributable to
modifiable environmental factors at around 40%.
In children, 34% of the disease burden is attributable to the
environment, and much of this burden is placed in low income countries.
Turning to some of the major topics and
global mega trends impacting this state of the environment and population health.
I would like to begin with highlighting some of the traditional
environmental health hazards associated with a lack of development and poverty.
After, which, I'll present some of
the modern hazards associated with unsustainable development.
Poor quality water, insufficient access to
water, lack of appropriate sanitation and poor
personal hygiene.
Especially the insufficient hand washing with soap,
among the essential environmental factors impacting human health.
Such factors greatly increased our real disease,
intestinal worm infections, skin and eye diseases.
And a number of other water and hygiene related problems.
In addition, lack of access to
basic sanitation, insufficient water supply significantly
impact on the quality of life and school
performance by preventing girls especially from attending schools.
Increasing the access to appropriate water and sanitation is regarded a human right.
According to the 2011 figures included in the 2013 update
from the WHO UNICEF joint monitoring program on water supply and sanitation.
The world seem to be untracked
to meet the millennium development goals for water supply.
With 89% of the world population having access to safe drinking water.
However, it's important to acknowledge that the world still hosts around
770 million people having to rely upon unimproved drinking water sources,
as seen from the global map of drinking water coverage from the JMP update.
Most people with
lack of safe water supply live in Africa, south of the Sahara.
When it comes to sanitation coverage, the world is off
track, and is unlikely to meet the millennium development goals.
By the end of 2011, there was still a staggering 2.5 billion people who did
not use an improved sanitation facility, mainly in
South Asia and Africa, south of the Sahara.
As a separate sanitation issue
obtain forgotten.
Authorities from local to regional levels need to expand their regulatory
framework and technologies to improve management
and potential reuse of waste water.
In additional to the biological contaminates and nutrients
in the water, waste water such future Water management
plans will have to consider the increase in chemicals,
metals included in the water, due to growing industrialization.
Another environmental factor consistently highlighted as a, as
a risk to human health is air quality.
As part of the global burden of disease study published in
2012, an estimate of the importance
of many different risk factors was undertaken.
Of all the 67 different risk factors assessed, indoor household air pollution
from solid fuels ranked third in contribution to the global disease burden.
Add to this the burden caused by outdoor air pollution
and it's clear that air quality's a very significant risk factor.
Cooking
and heating with solid fuels and open fires or traditional stoves, in often
poorly ventilated rooms, result in high
levels of indoor health damaging air pollutants.
This may be the case in rural areas as well as urban settings.
Often women and small children are most exposed.
The increased use of motor vehicles, industrial
production, burning of waste, inefficient local energy production.
And the use of solid fossil fuels for heating, results
in elevated levels of air pollution, especially in urban areas.
This includes particulate matter, carbon monoxide and ozone impacting on
respiratory diseases in a range of all the health outcomes.
The urban pool including the approximate one billion living
in urban slums and using solid fuels for cooking may
be hard hit by exposure to both poor indoor and outdoor air quality.
To address the overwhelming challenges of air pollution, huge
investments in new technologies will have to be made.
But we also have to consider fundamental changes to our resource use.
And the way we plan transport, energy,
industry, housing, and many other sectors of society.
The question is of course, if we're willing
to make such changes to our societies, to protect future generations.
Moving from air quality to the topic of
urbanization is an obvious next issue to address.
Urbanization is a process ongoing at rapid pace,
changing societies and environmental landscape on every continent.
Urbanization is a result of population migration from rural to
urban areas, plus of course urban demographic growth.
Rapid unplanned and unsustainable patterns of urban development are
making developing cities focal points for many emerging environmental hazards.
This includes solid waste disposal, waste water
management, provision of safe water, sanitation, noise.
Food safety among street vendors, traffic,
occupational injury prevention and air quality.
Across the world, urban slum dwellers are likely
to be the most vulnerable to urban environmental risk.
Let us turn to another environmental
health issue, namely water resources development.
Water resources development refer to the infrastructure and management
required to control freshwater, to meet demands in agriculture, entity
or the reservoir for drinking water.
Irrigation schemes, water reservoirs and large dams, among
the most important water resources, infrastructures, in this context.
During and after the establishment of such infrastructure, a
range of potential positive and negative aspects should be considered.
Among the potential benefits, I increase agriculture production and
income and the availability of an increased amount of
water for domestic purposes, impacting positively on human health.
However, for many years the expansion of
the irrigation has been associated with an increased
breeding of mosquitoes or snails in the
irrigation canals, small estuaries of the wet fields.
Such mosquitoes and snails may increase the transmission of
parasitic or virus infections, such as malaria, Japanese encephalitis.
Or schistosomiasis, also termed bilharzia.
Often knowledge of the local environment, and possibly health impact assessments
needed to assess the full risk of mosquito borne diseases, or other
[INAUDIBLE]
borne diseases.
Lets go beyond the management of water
to address the wider aspects of natural resources.
Shrinking forest cover, unsustainable production system,
climate change, and poor management of natural
resources significantly impact on livelihood, food security,
migration patterns, and of course human health.
It is estimated that around half
the land currently used for agriculture production is
moderately or severely affected by soil degradation resulting from.
For example, the loss of top soil due to accumulation of salts in the soil surface.
Current loss of arable land is estimated to be 30, 35 times the historic rate.
Affecting 1.5 billion people on the planet and undermining the future
for generations to come.
A particular concern is the loss of biodiversity.
There's a growing recognition that the biological diversity is a
global asset of tremendous value to present and future generations.
But species extinction caused by human activity continue at an alarming rate.
Responding to the need to protect land fertility and biodiversity, two key
conventions were developed as the result of the Rio Earth Summit.
The United Nations Convention to Combat Desertification that
brought attention to land degradation in the dry lands.
And the Convention on Biological Diversity
dedicated to the protection of global biodiversity.
In many areas of the world, agricultural
production systems become more and more intense,
with increased focus upon mono-culture, cast crops.
And dependency on inputs such as pesticides, fertilizer and advanced seeds.
This may have positive as well as negative impacts on
the nutritional status and income levels of the farming households.
However, it will at the same time result in
an increased level of contamination of land and water.
And the increased use and availability of toxic pesticides and
farming households will result in increased incidence of acute poisoning.
Increasingly agricultural products are traded across countries
and regions of the world, and generate
a vital source of foreign income and is an important part of global food security.
However, such growing trade also places
significant responsibilities on the private and government
sectors to ensure the protection of global consumers.
Waste water contaminated crops, food with significant
levels of pesticides or agricultural products carrying pathogens
from one part of the world to another, is a growing problem in a globalized world.
Governments are working to improve
monitoring systems and exchange of information.
The private
sector aims to improve on quality
assurance systems, but the challenges are huge
and consumers will increasingly have to
consider and cope with potentially new risks.
Most important are the capacity and incentive systems promoting safe
agriculture products will have to be strengthened among local producers.
As already apparent from some of the
environmental health topics discussed in this section,
many pressing environmental health challenges cannot be
addressed only at a local or national level.
A further example of this need finds national collaboration is it transboundary
movement of persistent organic pollutants such
as DDT addressed in the Stockholm Convention.
Another more recent
example is international adoption of the final legal
binding international treaty aimed at reducing mercury emissions.
Mercury is recognized as a chemical of global health concern, similar
to what has been expressed for the persistent organic pollutants earlier.
One area where international efforts need to be
continued and strengthened relate to the promotion of occupational
health and rights.
The International Labor Organization in partnership with
national governments, labor unions, the private sector.
And civil society work to inform policies,
undertake training and formulate standards, among other things.
As hazardous jobs are outsourced to low-income settings.
And the industrialization process proceeds in lower middle income countries.
How should workers needs to be protected. Finally another example to illustrate
the need for increase collaboration is the growing trade with various products.
The Basel Convention adopted in 1989 is set to
control the transboundary movement of hazardous waste, and their disposal.
This and other modalities will have to continuously be updated and expanded
to deal with new waste categories, emerging markets
related to, for example, trade with electronic waste.
Before we end this session, I would like to highlight some
of the local areas of intervention int he field of environmental health.
Such interventions will always be
essential components, even of global efforts.
At national and local level, countries have established
departments and programs to address environmental health challenges.
Unfortunately, many such programs are significantly under resourced.
Act on the basis of weak policy frameworks, have difficulties in
coordinating across sectors, and often have
limited capacity to enforce set standards.
Intervention that most often be assigned to, for example,
environmental health departments, occupational health
and safety units, municipalities, departments of
agriculture and veterinarian and public health inspectors are giving on the list.
Thank you for your attention.
[MUSIC]
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