Principles of Environmental Health (EH202)

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Principles of Environmental Health(EH202)

• Spring 2009
• Molly Kile, ScD
• Doug Dockery, ScD
• http//isites.harvard.edu/icb/icb.do?keywordk3767
  9pageidicb.page163101

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Top Ten Causes of Death
Low-income countries of deaths Middle-income countries of deaths High-income countries of deaths
Lower respiratory infections 11.2 Stroke and other cerebrovascular disease 14.2 Coronary heart disease 16.3
Coronary heart disease 9.4 Coronary heart disease 13.9 Stroke other cerebrovascular diseases 9.3
Diarrhoeal diseases 6.9 Chronic obstructive pulmonary disease 7.4 Trachea, bronchus, lung cancers 5.9
HIV/AIDS 5.7 Lower respiratory infection 3.8 Lower respiratory infections 3.8
Stroke other cerebrovascular diseases 5.6 Trachea, bronchus, lung cancers 2.9 Chronic obstructive pulmonary disease 3.5
Chronic obstructive pulmonary disease 3.6 Road traffic accidents 2.8 Alzheimer and other dementias 3.4
Tuberculosis 3.5 Hypertensive heart disease 2.5 Colon and rectum cancers 3.3
Neonatal infections 3.4 Stomach cancer 2.2 Diabetes mellitus 2.8
Malaria 3.3 Tuberculosis 2.2 Breast cancer 2.0
Prematurity low birth weight 3.2 Diabetes mellitus 2.1 Stomach cancer 1.8
World Health Organization Fact sheet No 310 /
November 2008
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Haiti Life Expectancy 53.2 yrs
Dominican Rep.Life Expectancy 74.9 yrs
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What is environmental health?

• At its most general, it encompasses the study of
  the health effects of all situation and risk
  factors outside of genetic factors.
• In practice, most environmental health involves
  the study of exogenous factors over which the
  persons (or animals) affected have limited
  individual control.
• Tony Fletcher, London School of Hygiene

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Underlying Principles of Public Health
Behaviors
Environment

• Disease does not occur at random
• Disease has causal and preventive factors

Genetics
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Patterns of disease change as nations develop

• Infectious diseases decline in frequency and
  severity
• Life expectancy increases
• Infant mortality declines
• Chronic diseases become increasingly prevalent

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Age of Receding Pandemics Reduction of infectious
diseases leads to demographic transition
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Public Health Benefits FromWater Treatment in US

• Between 1900-1940
• Mortality from diarrheal disease decreases from
  140 ? 20 per 100,000
• Child mortality rates decrease from 130 ? 60 per
  1000 live births
• Life expectancy at birth increased by 16 years
• Cholera and typhoid fever virtually eliminated
• Cost-benefit analysis conducted by Cutler
  Miller, 2005
• 123 cost-benefit ratio
• Every life saved cost 500 resulting in 11,500
  gain
• A 1 reduction in annual deaths corresponds to a
  social rate of return of 160 billion annually

2002 US
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Age of Man-made Diseases Chronic diseases are the
principal causes of illness, hospitalization and
death in Industrial nations
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Increases in Neurological Disabilities

• In Children
• ADHD, Autism, Mental Retardation
• Affect 3-8 of all children
• In Elderly
• Alzheimers
• 3 ages 65 to 74
• 50 ages 85

Photograph by Peter Essick, Chemicals Within Us,
National Geographic Oct 2006
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Photograph by Peter Essick, Chemicals Within Us,
National Geographic Oct 2006
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Asthma Epidemic
NEJM 2006 355, 2226

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Age-Adjusted Testicular Cancer IncidenceAges
20-49, All Races
SEER Data, NCI
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Evidence for Environmentally-Related Cancer

• Radiation
• Radon
• Arsenic
• Aflatoxin
• Solvents, especially benzene
• Pesticide exposure

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Most Chemicals Have Not Been Adequately Tested
for Toxicity

• 80,000 chemicals in commerce
• 2,863 produced or imported in quantities of 1
  million pounds or more per year (HPV)
• No basic toxicity information is publicly
  available for about half of HPV chemicals
• Information on developmental toxicity is publicly
  available for fewer than 20 of HPV chemicals

EPA Chemical Hazard Data Availability Study, 1998
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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
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Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
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Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
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Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
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Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
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Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
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Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
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Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
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Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
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Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
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Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 20
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Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 20
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Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 20
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 20
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Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2005
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
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Obesity Trends Among U.S. AdultsBRFSS, 2006
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
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Obesity Trends Among U.S. AdultsBRFSS, 2007
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
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• Change to Modern Environment
• Sprawl
• Traffic
• Sedentary life style
• Changing diet

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Environment is a powerful determinant of health
and disease

• Attributable risk of morbidity and mortality
  associated with modifiable environmental factors
• 24 of the disease burden1
• 23 of all deaths 2
• Among children aged 014 as much as 36 of deaths
  2

1 defined as healthy life years lost 2 defined
as premature mortality
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Source WHO
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Environmental risk factors and related diseases
Environmental Risk Factor Related diseases
Outdoor air pollution Respiratory infections, cardiopulmonary diseases, lung cancer
Indoor air pollution (solid fuel use) COPD, lower respiratory infections, lung cancer
Lead Mild mental retardation, cardiovascular disease
Water, sanitation, hygiene Diarrheal disease, trachoma, schistosomiasis, ascariasis, trichuriasis, hookworm
Climate change Diarrheal disease, malaria, unintentional injury, protein-energy malnutrition
Occupational factors (injuries, noise, carcinogens, airborne particulates, ergonomic stressors) Unintentional injuries, hearing loss, cancers, asthma, COPD, low back pain
Comparative Risk Assessment, WHO 2002
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The Clinical ApproachCare for the individual
patient
Death or Disability
Disease
Individual
Dade Moeller Environmental Health
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The Public Health Approach Care for the community
Death or Disability
Disease
Population
Dade Moeller Environmental Health
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The Environmental Health Approach
Environment
Death or Disability
Disease
Population
Dade Moeller Environmental Health
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Prevention Paradox
"A preventive measure which brings much benefit
to the population yet offers little to each
participating individual" ... and thus there is
poor motivation for the subject. ... In mass
prevention each individual has usually only a
small expectation of benefit, and this small
benefit can easily be outweighed by a small risk.
- Geoffrey Rose
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Core Concepts
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All public health graduates should have an
understanding of

• Chemical, physical and biological nature of the
  environment
• Interactions of people with their living and
  working environment
• Concepts of exposure to potentially harmful
  environmental hazards
• Tools for assessing the risk posed by hazards
• Consequences of exposure in terms of toxicology
  and health effects

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Date Topic
Mon, March 30 Introduction to Environmental Health (Kile)
Weds, Apr 1 Introduction to Hazard Identification, Evaluation and Control (Kile)
Mon, Apr 6 Case 1 Can popcorn make you sick? Guest Greg Wagner
Weds, Apr 8 Case 2 Hazardous waste in Ashland, MA Guest Suzanne Condon
Mon, Apr 13 Introduction to Environmental Epidemiology (Dockery)
Weds, Apr 15 Case 3 Ecological study of asthma in Cyprus Guest Diane Gold
Mon, Apr 20 Killer Fog Acute episodes of air pollution and mortality (Dockery)
Weds, Apr 22 Case 4 Clean skies regulating particulate matter in the US Guest Frank Speizer
Mon, Apr 27 Introduction to Risk Assessment (Kile)
Weds, Apr 29 Case 5 Coal Power What is the public health burden? Guest Jonathon Levy
Mon, May 4 Case 6 Phthalates Should they be allowed in childrens toys? Guest Russ Hauser
Weds, May 6 Case 7 Arsenic in drinking water in the US Guest Ronnie Levin
Mon, May 11 Introduction to toxicology (Kile)
Weds, May 13 Case 8 Lead Should CDC lower the blood lead action level? Guest David Bellinger
Mon, May 18 Case 9 Does Bisphenol A pose a human health risk? Guest Karin Michaels
Weds, May 20 Presentations Paper Due
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• Grade Assessment
• Class participation 25
• Environmental Opinion Papers (4) 25
• Group research paper 25
• Group poster presentation 25
• All material posted on website
• http//isites.harvard.edu/icb/icb.do?keywordk3767
  9pageidicb.page163101