Environmental Health

Environmental Health

1. epidemiology and health surveillance

   • epid: study factors determining and influencing the frequency and distribution of disease, injury, and other health-related events and their causes
   • Health surveillance: activity which involves obtaining information about EMPLOYEES health and which helps protect employees from health risks
     • • Protecting the health of employees by early detection of adverse changes or disease;
       • • Collecting data for detecting or evaluating health hazards;
         • • Evaluating control measures.
     • • there is a disease associated with the substance in use (e.g. Asthma, Dermatitis, Cancers);
       • • it is possible to detect the disease or adverse change and reduce the risk of further harm;
         • • the conditions in the workplace make it likely that the disease will appear.
   • Definitions
     • Cause; an event, characteristic or condition that precedes a disease without which the disease or condition would not have occurred.
       • Determinant; attribute or circumstance that effects the liability of an individual to be exposed or when exposed to develop the disease or condition
         • Confounding variable; factor significantly associated both with the cause and disease in the population, but not the cause itself e.g. smoking/ Cancer
           • Distinguishing cause from association using evidence linked to;
             • Strength of association, Time, Distribution, Gradient, Consistency, Specificity, Biological Plausability, Models, Trials
           • Risk; Absolute; incidence of disease within a defined population. Relative; ratio of incidence rate in an exposed group. Attributable = difference
             • Descriptive Studies; Demonstrate patterns of disease within a population that can track mortality or morbidity over time and compae inc/prev.
               • Cohort Studies and Case Control Studie areObservational studies designed to test specific hypotheses, and aim to define the determinants of a disease
                 • Cohort; Longitudinal study where a group/population is identified as being possibly exposed to an agent under investigation.
                 • Case-control; recruitment of individuals already having the disease, with their case histories compared to a control group of subjects
               • Intervention Experiments designed to test efficacy of health care interventions or compare different methods. These are effectively clinical trials,

2. environmental protection: water

   • Water Treatment
     • Extraction --> Storage --> Screening --> Coagulation --> Floculation --> Sedimentation --> Filtration --> Disinfection
   • Wastewater Treatment
     • Screening --> Grit removal --> sedimentation --> activated sludge --> bacteria beds --> tertiary filtration
     • Urban Wastewater treatment directive, Urban waste water treatment, environment act (1995)
   • Integrated Water Management involves the basic principle of managing the hydrological cycle, through supply, distribution and waste control.
     • Areas of control include catchment areas, rivers systems and estuarine environments.
   • Related departments and bodies (UK)
     • The National Rivers Authority + Her Majesty’s Inspectorate for pollution = Environment Agency
     • OFWAT and DWI
   • Monitoring involves looking for nitrates, pesticides and crypto
     • for rivers it wlso considers suspended solids, BOD and chemical oxygen demand.
   • EU directives
     • regulation of quality of surface water for abstraction for drinking water, Drinking Water Directive, Exploitation & marketing of natural mineral water
   • IOM's IRIS scheme influenced by Water Bathing Directive and Blue Flag Scheme (in UK)

3. food safety

   • Environmental Health Offices allied to public health will also engage in tracking of outbreaks and education.
   • Control of Foodstuffs Directive (89/397/ECC) set out standards of hygiene and control for all member states
   • Food Standards Authority (FSA) in 2000, as a result of the Food Standards Act (1999) has strengthened enforcement of legislation to protect the public
     • FSA Responsibilities
       • • Food Safety Policy Group. • The Enforcement and Food Standards Group. • The Corporate Resources and Strategy Group.
       • Power of inspection and enforcement of Food Safety Act 1990
     • Food Safety Act 1990
       • not to:- sell food not complying w food safety requirements - render food injurious to health - sell food which is not of the nature/substance/quality
   • Product Specific Management
     • HACCP
       • 1. Identify any hazards that must be prevented eliminated or reduced;
         • 2. Identify the critical control points (CCPs)
           • 3. Establish critical limits at CCPs;
             • 4. Establish procedures to monitor the CCPs;
               • 5. Establish corrective actions to be taken if a CCP is not under control;
                 • 6. Establish procedures to verify whether the above procedures are working effectively; and
                   • 7. Establish documents and records to demonstrate the effective application of the above measures.
       • Case Study. Implementation in Meat plants.
         • In meat plants HACCP plans will focus on control measures that can reduce the likelihood of contamination of meat during production
           • from microbiological hazards, such as Salmonella, E.coli O157 and Campylobacter,
             • These meat-borne pathogens can be carried by healthy animals and cannot be detected by sight or smell.
               • Although thorough cooking kills most bacteria, meat may be handled by lots of people before it is cooked and the bacteria will spread to other foods
                 • Bacteria multiply very quickly, especially in warm conditions
                   • Retailers and consumers need to take precautions, including temperature controls & keeping raw meat & cooked meat & other ready to eat foods separate
       • Identification and control of microbiological, chemical and physical food safety hazards during product development.
   • Local legislation includes the Food Act 1997 and the Food Hygiene Regulations 2007

4. Risk Assessments and Health and Safety

   • DEFRA tiered approach to risk assessment and management.
   • Environmental health practitioners are concerned by risk arising from environmental stresses.
     • Hazard is a property or situation that in particular circumstances could lead to harm.
     • Risk is the probability that and adverse situation could occur in a give period of time
     • Risk Assessment, term used to describe a study of decisions to uncertain consequences
       • identification of risks, identification of outcomes, estimation of magnitude of consequences, estimation of probability of outcomes, significance
     • Risk Management, links risk estimation and evaluation to implementation of decisions to minimise risk.

5. Definition and Organisation

   • Scope of Environmental Health Services
   • Principles of Environmental Health
     • 1. The maintenance and improvement of human condition is at the centre of all environmental action. A similar principle can found in Agenda 21 address
     • 2. Disadvantaged groups within society are often live in the worst housing, have the most dangerous jobs and limited food.
     • 3. Adoption of democratic principles of government will lead to effective management of environmental health.
     • 4. Co-operation and partnership
     • 5. Sustainable development: policy integration, partnership and appropriate scale
     • 6. Environmental health issues are international
   • Definition (WHO, 2013)
     • Environmental health addresses all the physical, chemical, and biological factors external to a person, & all the related factors impacting behaviours
     • It encompasses the assessment and control of those environmental factors that can potentially affect health.
     • It is targeted towards preventing disease and creating health-supportive environments.
     • This definition excludes behaviour not related to environment, as well as behaviour related to the social and cultural environment, and genetics.
   • Royal Commission for Environmental Health are targets and frameworks for delivery by 2020:
     • • holistic approach • quality of life • inequality • lifestyle • globalisation • democracy • information • integration • sustainable development

6. Environmental Protection: Waste Management

   • Definition
     • b) and any substance or article which requires to be disposed of as being broken, worn out, contaminated or otherwise spoiled
     • a) Any substance that constitutes scrap material or effluent or other unwanted surplus substance arising from the application of any process;
     • It can be divided into sub-areas household, controlled, industrial, commercial municipal and hazardous.
   • Waste Management Planning
     • Following the Earth Summit in Rio de Janeiro (1992) the UK produced the document Sustainable Development: The UK Strategy (1994):
       • 1. minimise the amount of waste produced, 2. make best use of remaining waste 3. and minimise pollution from waste.
   • Waste Management Hierarchy
     • Reduce --> Reuse --> Recycle --> Recover --> Dispose
   • Relevant Documents etc:
     • Making waste work: A strategy for sustainable waste management in England and Wales (1995), and Waste Strategy 2000, reinforced by EPA (SEPA) in 2000
       • • reduce levels of industrial waste going to landfill by 85% of 1998 levels by 2005,
       • • to recover 40% of municipal waste by 2005, 45% by 2010 and 67% by 2015
       • • recycle or compost 17% household waste by 2004
       • • reduction biodegradable municipal waste (BMW) 75% by 2010
     • EU Landfill Directive2002 Landfill Regulations 2002 EU Waste Incineration Directive 2000/76/EC (WID)
     • The Waste Incineration (England and Wales) Regulations 2002. DETR Report of Composting Development Group (1999). Hazardous Waste Directive 91/689/EEC
     • Controlled Waste Regulations 1992
   • Environmental health department with LAs
     • • refuse collection, • disposal sites, allocation planning & monitoring, • hazardous & clinical waste • monitoring of street cleaning & litter & ed

7. Environmental Protection: Air Pollution

   • Definition (WHO, 2013):
     • Contamination of indoor/outdoor environment by any chemical, physical or biological agent that modifies the natural characteristics of the atmosphere
     • Household combustion devices, motor vehicles, industrial facilities and forest fires are common sources of air pollution
     • Pollutants of major public health concern include particulate matter, carbon monoxide, ozone, nitrogen dioxide and sulfur dioxide
     • Outdoor and indoor air pollution cause respiratory and other diseases, which can be fatal
   • Related Documents: Rio and Agenda 21
     • Both documents advocated the “precautionary principle” & “polluter pays principle”, and develop strategies where the private sector makes env costs
     • Conventions on Carbon Dioxide (Kyoto Protocol) and CFC emissions (Montreal Protocol), later followed, tackling specific air pollution issues as identi
     • Air Quality Policy
       • target local levels of emissions with critical limits set by discharge consents (examine activity & risk to env & human health) with risk assessment
         • Key to these assessments is the source of pollution. These include: • road transport • energy production • industrial process • and domestic sources
       • UK
         • London Smog episode of 1952 lead to 1956 Clean Air Act (1968+1993 too)
         • Both central government and local authorities use model of Integrated Pollution Control developed by the Royal Commission on Environmental Pollution
       • Europe
         • Directive 96/62/EC on Ambient Air Quality Assessment aka Air Quality Framework Directive (lead, NOXs, SOXs and particulates)
           • Europe meant UK could develop National Air Quality Standards (NAQS). Environment Act 1995, key objectives were to be met by 2005.
       • Isle of Man
         • The monitoring stations were discontinued further to results indicating continued good air quality.
           • The only occasional exception is of intermittent concern in respect of ozone whose souce is most likely the UK
         • 1997-2009 sttions measured Nox, SO2, CO, PM10 and PM2.5 and O3
         • These are based on those standards detailed within the Air Quality Strategy for England, Scotland, Wales and Northern Ireland issued by DEFRA, 2000
   • It is transboundary and linked to global issues of climate change, acid rain and ozone layer damage