CFM1_airwater

Environmental Issues in Health: Clean Air and Water

CFM I: Family and Preventive Medicine

Louricha A. Opina-Tan, MD, FPAFP

Community and Family Medicine

Objectives

1. Define environmental health.

2. Appreciate environmental condition as a

social determinant of health.

2. Discuss outdoor and indoor air quality

3. Discuss global effects of air pollution

4. Discuss different types of water system

5. Describe a safe drinking water

6. Discuss strategies for meeting standards

Environmental Health

addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours

encompasses the assessment and control of those environmental factors that can potentially affect health

targeted towards preventing disease and creating health-supportive environments.

World Health Organization

Environmental Health

concerned with preventing illness through managing the environment and by changing people's behavior to reduce exposure to biological and non-biological agents of disease and injury

concerned primarily with effects of the environment to the health of the people.

Department of Health, Philippines

- year 2004 - 24 global risk factors

Health Risk

A factor that raises the probability of adverse health outcomes

Measured thru:

Mortality

Disease Adjusted Life Years

World Health Organization, 2009

Criteria for choice of Risk Factor

A potential for global impact

A high likelihood that the risk causes each associated disease

A potential for modification

Being neither too broad not too specific

Reasonable complete data were available for that risk

World Health Organization, 2009

Environmental Risks

Global climate change

Urban outdoor air pollution

Lead exposure

Indoor smoke from solid fuels

Unsafe water, sanitation and hygiene

nearly 10% of deaths and disease burden globally

around 25% of deaths and disease burden in children under 5 years old

AIR POLLUTION: Indoor and Outdoor

Air pollution

Contamination of the indoor and outdoor environment by any chemical, physical or biological agent that modifies the natural characteristics of the atmosphere.

Outdoor or Indoor

Air Pollution

More than 2M premature deaths each year can be attributed to the effects of urban outdoor air pollution and indoor air pollution

More than half of this disease burden is borne by the populations of developing countries

Outdoor (Ambient) Air Pollution

Ozone (Ground-level)

Particulate matter

Carbon monoxide

Nitrogen oxides

Sulfur dioxide

Lead

ES Environmental Protection Agency

Pollutant Source Effects

OZONE (O3) Chemical reaction between oxides of Nitrogen and volatile organic compounds Industrial facilities and electric utilities, motor vehicle exhaust, gasoline vapors and chemical solvent

Children are at highest risk Sensitive vegetation especially during growing season

Particulate Matter

Complex mixture of very small particles and liquid droplets (acids, organic chemicals, metals and soil or dust particles) 10u or less because they can enter lungs**

Reduced visibility Lung problems

Carbon monoxide

Colorless, odorless gas emitted from combustion processes (vehicles)

Reduce the oxygen-carrying capacity of the blood

Pollutant Source Effects

Nitrogen Oxides

From emissions from cars, trucks, buses power plans and off-road equipments Contributes to ground-level ozone and particulate matter

Airway inflammation and increased respiratory symptoms in people with asthma

Sulfur dioxide

Fossil fuel combustion at power plants and industrial facilities

Bronchoconstriction and increased asthma symptoms

Lead Fuels in on-road motor vehicle gasoline Lead smelters, ore and metals processing and piston-engine aircraft operating on leaded aviation gasoline

Absorbed and accumulates in the bone, affects the nervous system, kidney function, immune system, developmental systems and cardiovascular system Affects oxygen-carrying capacity of blood

HAP video 1

Indoor (Household) Air Pollution

Global Burden of disease

Exposure to HAP

Results to around 4M premature deaths

Nearly 5% of the global disease burden

Single most important environmental risk factor

Household Air Pollution

Caused by household energy practices Use of solid fuels and simple stoves for cooking

Use of kerosene lamps

Aggravated by poorly ventilated dwellilngs

Contributes to ambient air-pollution

High risk for burns, poisoning and injuries

Limits productivity

Takes children away from school

HAP video 2


Interventions to control

1. Changing the source of pollution

Improved cooking devices: biomass stove w/o fuel

Alternative fuel-cooker combinations: LPG, electric

Reduced need for fire: solar water heating



2. Improving the living environment

Improved ventilation: smoke hood

Kitchen design and placement of the stove: separate kitchen



3. Modifying user behavior

Reduced exposure by changing cooking practices: use of pot lids, food preparation to reduce time

Reduction by avoiding smoke: keep children away from smoke

Safe Water

Water in Earth

Only 2.5% of water available on Earth is freshwater, but a significant portion of this is inaccessible

Rivers, lakes, underground

Investments in safe drinking water and improved sanitation show a close correspondence with improvement in human health and economic productivity

Water Sources

Rainwater

Surface water rivers, lakes, streams, ponds, impounding reservoir, seas and oceans

Groundwater spring, well, infiltration galleries / wells

Threats to Water

Land use

Deforestation

Climate change

Increased consumption due to growing populations

Pollution

Water Pollution

Any contamination of water with chemicals or other foreign substances that are detrimental to human, plant or animal health

Importance of Water Safety

Unsafe water and inadequate sanitation and hygiene are significant contributors to the 1.8M deaths caused by diarrhea every year

Water transmits diseases

Water-related diseases

Water-borne

Ingested in drinking water

Water-washed

Associated with inadequate supplies of water for proper personal hygiene

Water-based

Transmitted through an invertebrate host or water-related vector

Interventions for Water-related Diseases

Water-borne

Improvement in sanitation, personal and microbiological water quality

Water-washed

Improvement in water supplies

Water-based

Improvement in water supplies

Water safety = Water quality

Water video

Water Quality

Biological

Bacteria, viruses, protozoa, worms

Chemical

Minerals, metals and other chemicals

Physical

Temperature, color, smell, taste, turbidity

Biological

Bacteria, viruses and protozoa

Major threat from these is diarrhea

Infective dose

Minimum number of pathogens needed to cause illness in a person

Indicator organisms

Presence of absence of certain bacteria is used to determine safety of water

Coliform bacteria is most common indicator (E coli)

Chemical

Usually causes concern only after chronic exposure

Sources

Naturally found (arsenic, calcium, flouride, magnesium, sulfur)

Human activities: agriculture and industry (nitrogen, phosphorus and pesticides)

Chemical

Health effects Arsenic - arsenicosis Flouride damage teeth, crippling skeletal damage Nitrates and nitrites blue baby syndrome of

methemoglobinemia

Other Iron nuisance : color and taste Manganese nuisance: color and taste and stain

Total dissolved solids Inorganic salts (NaCl, Ca, Mg, K) : hard or soft Soap is less effective, can leave residue, flat or bitter

or salty taste

Physical

Aesthetic characteristics

Turbidity, color, taste, smell and temperature

Drinking water

Generally clear, tastes good, has no smell and is cool

Standard values for physical and chemical qualities for acceptability

(Philippine National Standards for Drinking Water, 2007)

Constituent Maximum level or Characteristic

Taste No objectionable taste

Odor No objectionable odor

Color True: 5 NTU, Apparent: 10 NTU

pH 6.5 to 8.5

Turbidity 5 NTU

Aluminum 0.2 mg/L

Chloride 250 mg/L

hardness 300 as CaCO3

Hydrogen sulfide 0.05 mg/L

Constituent Maximum level or Characteristic

Iron 1.0 mg/L

Manganese 0.4 mg/L

Sodium 200 mg/L

Sulfate 250 mg/L

Total Dissolved Solids

500

zinc 5

Millennium Development Goal

To reduce by half the proportion of people without sustainable access to safe drinking water

Water Safety

Ideal:

Provide safe, reliable, piped-in water to every household

WATER DISTRIBUTION SYSTEM

Designed to adequately satisfy the water requirements for a combinations of the following demands: Domestic

Commercial

Industrial

Fire-fighting

Can satisfactorily meet the demands at all times

Water Service Levels

Describes the method by which the water is made available to the consumers


Level I (Point Source)

Provides a protected well or a developed spring with an outlet but without a distribution system

Usually serves an average of 15 households within a radius of 250 meters.


Level II (Communal Faucet System or Stand Posts)

Composed of a source, a reservoir, a piped distribution network and communal faucets

One faucet serves 4 to 6 households within a radius of 25 meters.


Level III (Waterworks System or Individual House Connection)

Includes a source, a reservoir, a piped distribution network and individual household taps

Number of Households by Main Source of Water Supply, Philippines as of year 2000, National Statistics Office

Source of Water Supply Number of Households

% of Total

Own Use Faucet, Community Water System

4 177 722 27.3

Shared Faucet, Community Water System 2 950 891 19.3

Own Use Tubed/Piped Deep Well 1389 768 9.1

Shared Tubed/Piped Deep Well 2 406 228 15.7

Tubed/Piped Shallow Well 1 098 552 7.2

Dug Well 1 209 319 7.9

Spring, Lake, River, etc 1 350 735 8.8

Peddler 348 636 2.3

Bottled Water 55 226 0.4

Others 291 731 1.9

TOTAL 15 278 808 100

Water and Sanitation in the Philippines

Access to safe water supply* declined from 87% (1990) to 85% (2004)

*defined as access to potable water regardless of whether piped systems or lower level

UNICEF and WHO, 2004

Water and Sanitation in the Philippines

Up to 58 % of groundwater is contaminated with coliform

Many areas are experiencing a shortage of water supply during the dry season

Water Safety

In the interim:

Safe water approaches in households

Household Water Treatment and Safe Storage (HWTS)

Treating water and safely storing it in the

home

Treating water at the point of use

Multi-barrier approach


Rationale:

In many settings, both urban and rural, populations have access to sufficient quantities of water, but that water is unsafe for consumption as a result of microbial or chemical contamination


Rationale:

For piped-in water, recontamination can happen leading to microbial infiltration of poorly maintained systems


Rationale:

Household level can remove, kill or inactivate most microbial pathogens

minimizes risk of recontamination since focused at the point of use rather than point of delivery


Rationale:

Works in both development and emergency situations to reduce the number of diarrheal cases


Challenges

establishing microbiological performance

achieving coverage and uptake

Methods of Household Water Treatment

Water source protection

Use the best possible source of water

Poor site selection

Poor protection of the water source against pollution

Poor structure design or construction

Deterioration or damage to structures

Lack of hygiene and sanitation knowledge and practice in the community

Water source protection Regularly clean the area around the water source Move latrines away from and downstream of water

sources Build fences to prevent animals from getting into open

water sources Line wells to prevent surface water from contaminating

groundwater Build proper drainage for wastewater around taps and

wells Stabilize springs against erosion and protection from

surface run-off contamination Ensure watershed use is non-polluting


Sedimentation

To reduce turbidity of water

Letting the water to settle for some time

Can be accelerated by adding coagulants

Alum (aluminum sulfate, aluminum chloride, iron salts

Native plants moringa seeds


Filtration

To reduce turbidity of water and remove pathogens

Involves passing water through filter media (some may have biological layer that kills pathogens)

Biosand filters, ceramic candle/pot filters, membrane filters, activated carbon


Disinfection

To kill or inactivate pathogens

Chlorine disinfection

Solar disinfection

Ultraviolet disinfection

boiling


Distillation

Use suns energy to treat drinking-water

Evaporating water into vapour, then capturing and cooling the vapor so it condenses back into a liquid

Safe Water Storage

Have a strong and tightly sealing lid or cover

Have a tap or narrow opening at the outlet for access

Have a stable base so it does not tip over

Be durable and strong

Be easy to clean

Other safe water handling practices

Using a container for collecting and storing only untreated water

Using a separate container for storing only treated water

Regularly cleaning the storage container with soap Storing treated water off the ground Storing treated water away from animals Pouring treated water from the container instead of

scooping the water out of it Using the water as soon as possible after it is treated,

preferably on the same day

Limitations of HWTS

Mainly to improve water quality

Not alternative to reliable, well-managed and safe piped-in water supplies

Should not divert resources away from long-term government efforts

Limitations of HWTS

Mainly improves microbiological water quality and some do not remove all types of pathogens

protozoa cysts (Cryptosporidium) are resistant to chlorine

Filters are not effective in removing viruses

Limitations of HWTS

It must be used correctly, consistently and exclusively, especially among vulnerable groups

Ensure uptake and solutions must be accessible, affordable, acceptable and sustained

National Policies Relevant to Air and Water Pollution

Clean Air Act

Clean Water Act

Philippine Clean Air Act of 1999 (RA 8749)

comprehensive air quality management policy and program which aims to achieve and maintain healthy air for all Filipinos

Philippine Clean Air Act (RA 8749)

sets emission standards for all motor vehicles and issues registration only upon demonstration of compliance

issues pollutant limitations for industry

polluting vehicles and industrial processes must pay a charge

installing pollution control devices can lead to tax rebates, etc

Philippine Clean Air Act (RA 8749)

establishes a research and development program for air pollution reduction mechanisms and technologies

bans incineration and smoking in public places*

governments are allowed to set emission quotas by pollution source

development of recycling programs is encouraged

Philippine Clean Water Act of 2004 (RA 9275)

providing for a comprehensive water quality management and for other purposes


Water Quality Management Area Action Plan

Domestic Sewage Collection, Treatment and Disposal


Prohibited Acts

a) Discharging, depositing or causing to be deposited material of any kind directly or indirectly into the water bodies

b) Discharging, injecting or allowing to seep into the soil or sub-soil any substance in any form that would pollute groundwater.

c) Operating facilities that discharge regulated water pollutants without the valid required permits


Prohibited Acts d) Disposal of potentially infectious medical waste into sea

water e) Unauthorized transport or dumping into sea waters of

sewage sludge or solid waste as defined under Republic Act No.9003;

f) Transport, dumping or discharge of prohibited chemicals, substances or pollutants listed under Republic Act No.6969;

g) Operate facilities that discharge or allow to seep, willfully or through gross negligence, prohibited chemicals, substances

h) Undertaking activities or development and expansion of projects, or operating wastewater/sewerage facilities in violation of Presidential Decree. No.1586


Prohibited Acts

d) Disposal of potentially infectious medical waste into sea water

e) Unauthorized transport or dumping into sea waters of sewage sludge or solid waste as defined under Republic Act No.9003;


Prohibited Acts

f) Transport, dumping or discharge of prohibited chemicals, substances or pollutants listed under Republic Act No.6969;

g) Operate facilities that discharge or allow to seep, willfully or through gross negligence, prohibited chemicals, substances

h) Undertaking activities or development and expansion of projects, or operating wastewater/sewerage facilities in violation of Presidential Decree. No.1586


Prohibited Acts

i) Discharging regulated water pollutants without the valid required discharge permit

j) Non-compliance of the LGU with the Water Quality Framework and Management Area Action Plan

k) Refusal to allow entry, inspection and monitoring by the Department in accordance with this Act;


Prohibited Acts l) Refusal to allow access by the Department to

relevant reports and records in accordance with this Act;

m) Refusal or failure to submit reports whenever required by the Department in accordance with this Act;

n) Refusal or failure to designate pollution control officers whenever required by, the Department in accordance with this Act; and

o) Directly using booster pumps in the distribution system or tampering with the water supply in such a way as to alter or impair the water quality.

Maraming Salamat!

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