Environmental Health

Under supervision

Prof. Dr / Nabila Elsayed Saboula

Prepared by

C.I/Amira Ezzat El-sedawy

Faculty of nursing
2021

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Objectives of the lecture:-
 Identify the concepts, importance and benefits of environmental health.

 Determine different aspects of environmental health.

 Discuss different ways to manage various environmental problems.

 Describe the role of the nurse in environmental health.

 Demonstrate different examples of environmental health problems.

 Application of three levels of prevention on environmental health .

Outlines: -

- Introduction

- Definition of environmental health terms

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 - Determinants of environmental health

- Importance of environmental health

- Benefits of environmental health

- Aspects of environmental health

- Examples of environmental health problems

- The responsibilities of the C.H.N in relation to environmental factors

- Nurse responsibilities in primary, secondary and tertiary prevention

- References

Introduction

Environmental health is the branch of public health that focuses on the

relationships between people and their environment; promotes human health
and well-being; and fosters healthy and safe communities. Environmental health
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is a key part of any comprehensive public health system. It concerned with
developing policies and programs to reduce pollution in air, water, soil and food
to protect people and provide communities with healthier environments.

Healthy People 2030 focuses on reducing people’s exposure

to harmful pollutants in air, water, soil, food, and materials in homes and
workplaces. The environment can directly and indirectly impact our health and
wellbeing. As when we talk about environmental health, we mean the way our
health is affected by the world around us and also how our activities affect the
health of the world around us. If our food, water, and air are contaminated, they
can make us sick. If we are not careful about how we use the air, water, and
land, we can make ourselves and the world around us sick. By protecting our
environment, we protect our health. Improving environmental health often
begins when people notice that a health problem is affecting not just one person
or group but is a problem for the whole community. When a problem is shared,
people are more likely to work together to bring about change.

Definition Of Terms: -
Environment
The term environment derived from old French word En means (in) viron
means (circle). It includes everything external to us. circumstances, objects or
conditions by which one is surrounded.
Health
It is a state of complete physical, mental and social wellbeing, and not merely
absence of disease or infirmity.
Environmental Health
It is defined by WHO as all aspects of human health (including quality of life)
that are determined by physical, chemical, biological, social and psychosocial
factors in the environment. And practices of assessing, correcting, controlling,

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and preventing those factors in the environment that can potentially affect the
health.

- DETERMENANTS OR CONTRIBUTORS TO THE ENVIRONMENT

 ▸ Physical: Air, water, soil, housing, climate, geography, heat, light,
noise, debris, etc.
e.x Air pollutants, toxic wastes, pesticides etc.

 ▸ Biological: Virus, bacteria and other microbes, insects, rodents,

animals and plants.
e.x Disease producing agents, reservoir of intermediate host and
reservoir of infection
 ▸Social / psychosocial / socioeconomic: Culture, values, customs, habits,
morals, religions, education, lifestyle, community life, health services,
social and political organizations.

-Determinants of environmental health and well-being-

Why environment is important for health?

Many aspects of our environment both built and natural environment can impact
our health. We need safe, healthy and supportive environments for good health.

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The environment in which we live is a major determinant of our health and
wellbeing, as we require:
- Clean air - Adequate waste disposal
- Healthy food - Stable global environment
- Safe drinking water - Vector control
- Safe places to live
Importance of environmental health
 Providing healthful environment.
 Controlling the environmental pollution and protecting the environment.
 Preventive: a sanitary clean environment provide protection against
environmental diseases.
 General welfare and health promotion of the population.
 Comfort, increased quality of work and productivity.
 Ethics: a clean environment is essential for human dignity.

Health effects related to the environment

Many aspects of the environment can affect our health. More than 12
million people around the world die every year because they live or work in
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unhealthy environments. Environmental pollutants or hazards can increase the
risk of health problems like respiratory diseases, heart disease, and some types
of cancer.
An environmental health hazard is a substance that has the ability to
cause an adverse health event.
There are about 13 million deaths worldwide that could be prevented every year
by making our environments healthier. Among the children below the age of
five, one third of all diseases are caused by environmental factors, such as
unsafe water and air pollution. An improved environmental management could
prevent about 40% of deaths from malaria, 41% from lower respiratory
infections and 94% from diarrheal diseases – which considered the third world
biggest child killers.

Aspects of Environmental Health

:Air Quality and Health -1
Importance of air for human life
▪ Gas exchange that vital for human life.

▪ Cooling power that allows heat loss from the body.

▪ Feeling of comfort and better performance of work.

- Pollution: refers to the act of contaminating the environment to the extent

that is negatively affects people health.
- Air pollution: is the contamination of the air we breathe, indoors or
outdoors, by any chemical, physical or biological agent that change the
natural characteristics of the atmosphere.
- It is especially prevalent in highly industrialized and urban areas where
concentrations of motor vehicles and factories produce large volumes of
gaseous pollutants.

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 - Studies have shown that air pollution effects on humans are a significant
public health concern, not only because of their role in climate change, but
also because exposure to air pollution can increase morbidity and mortality.

According to the WHO, air pollution effects on humans are significant.

For example, air pollution causes:
 29% of all global deaths from lung disease
 24% of all global deaths from stroke
 17 % of all global deaths and disease from acute lower respiratory infection.

- Classification of air pollution according to occasion of exposure:

1. Outdoor Air pollution: the pollutant (s) is present in the atmosphere outside
homes or workplace.

2. Indoor Air Pollution: the pollutant (s) is present inside homes or workplace.

Sources of outdoor air pollution:

1) Natural sources:
Earthquakes, volcanic eruptions, windstorms, forest fires, formation of
radioactive particles from gases such as radon and decomposition of plants and
animals.
2) Human generated pollutants:

a- Mobile sources: include different methods of transportation.

b- Stationary sources: e.g. power plants and factories.

c- Garbage incineration and burning.

Indoor Air pollution

The air we breathe indoors, whether at home or at workplace, may represent a

bigger threat to human health than outdoor air pollution.

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Factors affecting indoor pollutant levels include; inadequate ventilation,
smoking, high temperature and humidity.

Sources of indoor air pollution:

 Tobacco smoke is very hazardous through passive smoking leading to
all the complications of smokers (heart attacks, strokes, lung cancer, etc.)

 Household cleaning products, solvents and pesticides. These can remain

in the air for long periods.

 Central heating and cooling systems and humidification devices.

 Excess moisture and inadequate ventilation.

 Building materials and furnishings as:
o Newly installed flooring or carpet

o Cabinetry or furniture made of certain pressed wood products

Governmental role:
Public heath effort is needed to help identify pollution sources and related
health hazards.
Prevention and control of air pollution:
▪ Replacement of dangerous source of energy by safe or less dangerous
source e.g., electricity.
▪ Put firm lows and regulation to control industrial wastes and vehicle
exhausts.
▪ Increase growing green belt and green area in industrial and residential
areas. Use less energy.
▪ Proper disposal of wastes and hazardous substances.
▪ Recycle and Reuse: The concept of recycle and reuse is not just
conserve resources and use them but also helps in reducing pollution
emissions.
Community Health Nurse Role:

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 Nurse can promote health by helping to detect indoor pollutants and
inform people of existing or potential dangers as:
 Cigarette and cigar smoke are common in door pollutants that can
have ill effects on non-smokers as well as smokers.
 Infants and other vulnerable persons are at risk to such exposure.
 Carbon monoxide poisoning may result from stave and furnace
emissions or car exhaust accumulating in a garage.
Nurses can assist with prevention or elimination of these health hazards
by ensuring a well-ventilated (oxygenated) indoor environment.

2- Water Quality and Health:

Water covers 71% of the Earth's surface. It is vital for all known forms of life.
Safe drinking water is essential to humans and other forms of life. Access to
safe drinking water has improved over the last decades in almost every part of
the world, but approximately one billion people still lack access to safe water

It is estimated that 80% of sickness and disease is related to inadequate water.

 Characteristics of safe water

▸ Free from pathogenic agents

▸ Free from harmful chemical substances
▸ Tasteless and free from color and odor
▸ Suitable for human use
▸ Useable for domestic propose
- Water requirement for drinking purpose: 2 liter/person/day
- Domestic purpose: 150-200 liter/person/day

Sources of water in Egypt:

 Major sources:

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 1. Surface water: The Nile and its branches provide 1800 million cubic
meters per year (about 95% of water).

 Underground water: shallow or deep, obtained by wills and springs, which

provides 1300 million cubic meters per year.

 Minor sources:
1. Rainwater: is naturally pure and does not cost money but is not always
available.
2. Distilled sea water: Sea water is distilled by special apparatus and treated to
use it for drinking or other domestic purposes.
Water can be contaminated and become unsafe by:
1. Bacteria or parasite that causes disease.
2. Toxic substance such as pesticides.
3. Industrial wastage
4. Pollutants may upset the ecosystem, affecting natural organisms that
help purify water systems.
5. Recreational uses of water such as public swimming make lakes, oceans,
rivers carry infection agent and result a number of health problems such as
itching, diarrheal disease.
Governmental role:
 Government should set standards to keep drinking water safe.
 Put firm lows and regulation to control water pollution.
 Maintain safe and enough water for all population.

Community Health Nurse Role:

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Although water quality monitoring is ultimately the responsibility of
environmental health authorities, the nurse has a role as a collaborating member
of health team, to observe and report any information that would meet the goal
of safe and healthy water for communities.

3- Housing:
Most people today spend about 80% of their time at home. According to WHO,
housing is termed as residential environment that not only provide shelter, but
also the services necessary for the physical, mental, and social wellbeing of
individual and family. Housing is of central importance to quality of life, If the
house is not clean, dry, safe, well ventilated, at a comfortable temperature and
free from insect vectors, vermin, and parasites the residents become ill.
Health effects of poor housing
▪ Household crowding increases the risk of infectious diseases, including lower
respiratory tract infections, meningococcal disease, and gastroenteritis and lack
of privacy and home accidents.
▪ Second-hand smoke can increase the risk of asthma, lower respiratory tract
infections, sudden unexpected death in infancy (SUDI), middle ear infections,
and low birth weight in children, and ischemic heart disease, stroke, and lung
cancer in adults and many other problems.
▪ Cold and damp housing can worsen asthma symptoms and is also associated
with an increased risk of asthma development and respiratory tract infections.
▪ Skin infections such as scabies, leprosy, and ring worms.
▪ Oral-faucal infection.
▪ Mental stress.

Governmental role:

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 WHO identifies nine features of the housing environment that have
important direct or indirect effects on health:
1. The structure of the shelter (Does I protect the occupant).
2. Provision of adequate quality and quantity of water supply.
3. The effectiveness of provision for the disposal of excreta and liquid
and solid wastes.
4. The quality of housing site (provision to protect it from
contamination).
5. Overcrowding control which can lead to increased transmission of
air borne infection as (T.B, pneumonia and respiratory disease).
6. The presence of indoor air pollution associated with flues, used for
cooking and heating.
7. Food safety standards.
8. Vectors and hosts of disease associated with the domestic
environment.
9. The home as a workplace. Where the use and storage of toxic or
hazardous chemicals and unsafe equipment may present health
hazards.
Community Health Nurse Role:
 The nurse's commitment to the community focuses on assessment,
Planning, intervention, and evaluation of a client's home and
surrounding environment.
 Client education about home improvements.

 Advocacy for routine maintenance of rental housing conditions.

 Assisting clients who are homeless or have no shelters to locate and
secure more permanent and adequate safe housing.

4- Food supply:
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Good nutritious food is necessary for good health. The quality of food is affected
by the environment.
Types of hazardous foods:

1. Inherently harmful foods

The general public can identify and avoid harmful plant and substance. But
more children are at risk because some barriers or colorful flowers that attract
them.
2. Contaminated foods
Contaminated foods pose a more serious health problem, as food may contain
harmful bacteria such as, salmonella staphylococcus and clostridium botulinum
causing outbreaks of disease. For example, salmonellosis is characterized by
sudden onset of headache, abdominal pain, diarrheal nausea, vomiting, fever
and dehydration.
3. Food with toxic additives
A third health hazards from food comes from the intentional introduction of
additives to food products to meet consumer’s demand. Businessmans want to
produce food items with enhanced flavor and long shelf lives, many foreign
chemicals and synthetic products have been added to foods. Animals that are
raised for food such as chickens and beef cattle, are often fed or injected with
substances to speed their growth.
Rules for safe food preparation:
- Cook food thoroughly
- Eat cooked food immediately
- Store cooked food carefully
- Reheat cooked food thoroughly
- Wash hands repeatedly
- Keep all kitchen surfaces and materials thoroughly clean
- Protect foods from insects, rodents, and other animals

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 - Use pure water.
Governmental role:
a. Food and drug administration and the departments of agriculture and
health and human services are all necessary to help ensure the purity
commercial food product.
b. Licensing requirements, sanitation standards and inspections serve as
control measures with the wide variety of possible contaminants and
potential dangers, consumers best protection is to supervise their own
food quality.
c. Awareness campaigns about food safety.
Community Health Nurse Role:
a. Community health' nurses can have a significant impact through health
education. Nurses can teach the basics for food purchasing,
preparation, storage and discarding.
b. Nurses can emphasize cleaning tools used in food processing, washing
hands and inspection of food. Nurses can educate people to assess
signs of contamination.

5-Waste Disposal:
Definition of waste: Something which the owner no longer wants it at
given place and time.

Waste produced in the form of household garbage, human excreta and

agricultural and industrial products which including hazardous chemical and
radioactive substance.

Disposal of human wastes

One of the oldest environmental health hazards comes from improper
disposal of human excreta. It continues to be widespread in developing
nations and in rural, poverty communities. Human excreta are a source of
infection. It contains biological agents such as Viruses, bacteria,

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 protozoa, parasites and their eggs, which can contaminate water, food,
soil and breeding of flies, and direct contact can cause infection. Disposal
of Garbage through Dumping, burning and burying are the most common
disposal methods.

Governmental Role:
a. The public sewage system handles waste by treating raw sewage and
disposing it into a body of water. People learn not only to dispose of
wastes safely to protect humans, the environment, and future generation
but also look seriously at other options.

b. Educating the public and promote greater sensitivity among citizens to

the problems of accumulating waste with its potential health hazards.

c. Community awareness and adequate controlling programs.

6-Insect and Rodent Control:

All huma communities are affected by the insects and rodent living in their
environment they can cause irritation, and discomfort. They can contaminate
food. The most serious health hazards they possess is their role as a vector. The
most common vectors are mosquitoes, flies, ticks, roaches, fleas and rats.

Methods of disease transmission

▪ Direct method: the arthropods are directly transmitted from man to man by
direct contact such as, scabies, pediculosis.
▪ Mechanical method: vectors carry the organisms on their body parts and
spread infections from place to place such as flies spread disease agent through
contaminating food.
▪ Biological method: the disease agent undergoes some developmental changes
in the insect hosts such as mosquito transmit malaria and filaria.

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Governmental Role:
a. Vector survey, research and control are left to local and state health
department.
b. Community awareness and adequate controlling programs.

c. Removing or reducing areas where vectors can easily breed can help limit
their growth. For example, stagnant water removal, destruction of old
tires and cans which serve as mosquito breeding environments, and good
management of used water can reduce areas of excessive vector
incidence.

d. Health workers can help to control through many methods, poisoning,

spraying with pesticides and trapping rodents.
e. Proper sanitary landfills.
Community Health Nurse Role:
a. Nurse can contribute through awareness of the presence and
possible health threat of rodents and insects.
b. Nurse can take measures to educate affected person and notify
proper authorities when corrective action is needed.
c. Promote preventive efforts through education and influencing
policy makers.
d. Limiting exposure to insects or animals that are known disease
vectors can reduce infection risks significantly. For example, bed
nets, window screens on homes, or protective clothing can help
reduce the likelihood of contact with vectors.
7- Exposure to Toxic Chemical:
Substance such as zinc, cadmium, lead, iron, calcium, sodium, potassium,
magnesium and copper often play an important and healthful role in human
physiology, but they become toxic if a person is exposed large quantities.

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As lead is a toxic agent that is frequently found in occupational or industrial
setting. Example: it can cause disturbance in early physical and mental growth
in children and later intellectual functioning and academic achievement.

Mercury is also highly toxic. It is used in much scientific instrument electronic

equipment. Example: it can cause interfere with brain development and cause
mental retardation, cerebral palsy in children. Mercury may cause cancer and
damage.
8- Exposure to Radiation
Natural radiation from the sun, soil and minerals can be found in all areas of the
earth's environment, a certain amount of natural radiation exposure from the sun
is important for the absorption of vitamin D. Exposure to very high levels of
radiation, such as being close to an atomic blast, can cause acute health effects
such as skin burns and acute radiation syndrome (“radiation sickness"). It can
also result in long-term health effects such as cancer and cardiovascular disease.
Exposure to low levels of radiation encountered in the environment does not
cause immediate health effects but is a minor contributor to our overall cancer
risk.
9- Exposure to Noise Pollution
Noise has been cited as a major environmental health problem it can cause
temporary or permanent hearing loss, general annoyance, headaches, sleep
disturbances, task interference, alternation in emotions, stress, lowered body
resistance to disease ulcer, and aggravation of existing physical disorders.
Example: Extremely loud noises such as drills or loud rock music can cause
temporary or permanent hearing loss.
10- psychological hazards
psychological hazard is any hazard that affects the mental well-being or mental
health of the individual by overwhelming individual coping mechanisms and
impacting his ability to manage in a healthy and safe manner. There are many

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 sources of psychological hazards as life conflicts, violence, fatigue, depression,
anxiety and age-related factors. Our psychosocial environment includes our
responses to stressors in our lives, from temporary ones such as a traffic jam to
major stressors such as war, homelessness or major diseases.
Health effects from the environment can be both short term (acute) and
longer term (chronic).
Acute (vs.) Chronic
Acute Conditions
• Have a sudden onset, symptoms may worsen or change rapidly.
• Examples: Cold or flu, food poisoning, heart attack
Chronic Conditions
• Develop or worsen over a long period of time.
• Examples: asthma, cancer, diabetes.

Examples of how different aspects of the environment can affect our health

Environmental exposure Examples of health effects

Outdoor air pollution Respiratory conditions, cardiovascular disease, lung cancer
Unsafe drinking water gastrointestinal illnesses as diarrhea
Mosquitoes, ticks and other Malaria, fever
vectors
UV (ultraviolet light) exposure Too much: melanoma, non-melanoma skin cancer, eye
cataracts

Too little: vitamin D deficiency, leading to rickets,

osteoporosis and osteomalacia
Cold and damp housing Infectious diseases, including lower respiratory infections,
excess mortality
Hazardous substances Poisoning, burns, dermatitis
Noise Hearing loss, cardiovascular problems, insomnia,
psychophysiological problems

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The responsibilities of the C.H.N in relation to environmental factors: -
1. Risk identification:
Systemic review of risks knows as quantitative risk assessment. Risk is the
probability of injury, disease, death for individual or population exposed to
hazardous substance.
Steps of environmental risk assessment:
1. Hazards identification: Does the agent cause the adverse effect?
2. Exposure assessment: What exposures are currently experienced or
anticipated?
3. Dose-response assessment: What is the relationship between the dose and
incidence?

4. Risk characterization: What is the estimated incidence of the adverse effect in

a given population?

2. Communicating risk
• Through empowering citizens to address the problem.
• Increase availability of information to the public with-science based.
•Public must understand effect of environment and environmental agent on
human health based on knowledge of relevant epidemiological toxicological
and exposure factors.
Risk communication includes all the principles of good communication in
general. It is a combination of the following:
 The right information. accurate, relevant, in a simple language that
audiences can understand the hazard.
 To the right people. Those affected and those who are worried but may not
be affected (at risk).
 At the right time. For timely action to relieve fear.

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3. Assessment and Referral
A critical piece of compressive nursing practice is the identification of high-
risk client so they can be referred for further evaluation and follow up to
provide such care for these clients and nurses must have good understanding
of environmental resources located within geographic area.

Nurse responsibilities in primary, secondary and tertiary prevention

- Primary prevention

• Health promotion and illness prevention in home, at school, at work, and in

the community are aimed at reducing the risk of exposure to illness. Nursing
strategies are directed toward providing people with information about
environmental health risks and assisting them to eliminate or avoid exposure
to hazard
• In home, nurse assess for physical hazard (asthma triggers ,lead, radon,
chemical storage, unsafe play area) provide education for health promotion
and facilitate a health promoting environment .families should be
encouraged to use community resources.
Primary prevention activities as:
1. Advocate safer environmental design of products as needle, automobile,
and building
2. Teach home safety related to falls and fire prevention
3. Support programs for waste reduction, recycling, and effective waste
management
4. Advocate for safe air and water.
5. Counsel women of childbearing age regarding exposure to environmental
hazards
6. Teach avoidance of ultraviolet exposure and use of sunscreen
7. Use and advocate use of environmentally preferable products as less toxic
cleaning supplies and chemicals.

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 - Secondary prevention
 Role of the nurse is to develop appropriate intervention when environmental
exposures are noted. For example, farm worker who are exposed to
pesticides should be screened for neurological and other symptoms. Early
diagnosis and treatment of environmental illness "secondary prevention" is
a part of community health nurse work.

 Community health nurses are involved in surveillance of health conditions

related to environmental exposure through ensuring safe water, food, air
and reporting of disease, follow up.

Secondary prevention activities as:

• Assess homes, schools, work site, and communities for environmental hazard.

• Obtain environmental and occupational health history for individuals, counsel

about hazard reduction and refer for diagnosis and treatment.

• Participate in data collection regarding the incidence and prevalence of injury

and disability in homes, school and work sites.

• Screen children from six months to five years for blood lead level.

• Monitor workers for levels of lung cancer, hearing loss and other diseases.

- Tertiary prevention
Tertiary prevention is aimed at minimizing disability and maximizing
functional capacity. At this level of intervention, treatment strategies are used
to assist the community to adapt changes result from illness. For example,
after nuclear accident in Japan, rapid evacuation of residents is imperative to
minimize the exposure to radiation. Because food and water supply were
contaminated by radiation, it is essential to obtain new sources of food and
water to limit exposure. If malignancies occur following nuclear accident,
treatment, palliative care and risk communication about the environment
hazards with the public are a part of nurse role.

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References

 Bos, R., & Neira, M. (2016). Preventing Disease Through Healthy Enviro
nments: A Global Assessment of the Burden of Disease
from Environmental Risks. Retrieved
from https://apps.who.int/iris/bitstream/handle/10665/204585/978924156
5196_eng.pdf;jsessionid=09B50968F412E8B2DFD3E8FFDA7C200E?
sequence=1 [PDF - 5 MB]

 Brusseau, M.L., Ramirez-Andreotta, I.L., & Maximillain, J. (2019).

Environmental Impacts on Human Health and Well-
Being. Environmental and Pollution Science, 3, 477-
499. https://doi.org/10.1016/B978-0-12-814719-1.00026-4.

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 Rector, C., & Stanley, M. (2021). Community and Public Health Nursing:
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 World Health Organization. (2019). Burden of disease from household air

pollution for 2018. Retrieved from
http://www.who.int/phe/health_topics/outdoorair

 World Health Organization (WHO). 2021. Global status report on

noncommunicable diseases 2010: Description of the global burden of
NCDs, their risk factors and determinants.World Health Organization,
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 Zemek, R., Szyszkowicz, M., & Rowe, B. H. (2020). Air pollution and
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