Polly's DFPH > 2F. Environment > Flashcards

2F. Environment Flashcards

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1
Q

What is ‘environmental health’?

A

It is concerned with all aspects of the natural and built environment that may affect human health i.e. physical, chemical and biological factors.

Now encompasses all external factors including diet, housing, and water quality.

Can be included in all layers of Dahlgren and Whiteheads rainbow of wider determinants of health except inner layer of ‘age, sex, and constitutional factors’.

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2
Q

How can the environmental determinants of health be categorised?

A
  • Global factors
  • Living and working conditions
  • Traditional environmental hazards
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3
Q

What are the greatest environmental PH risks?

A

As per WHO: air pollution, climate change

  • WHO 2023 Global Burden of Diseases report stated that the 3 environmental determinants directly responsible for the greatest loss of DALYs were:
    ○ Household air pollution from solid fuels
    ○ Ambient particulate matter air pollution
    ○ Lead exposure
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4
Q

What is environmental injustice?

A

A cause of health inequalities - Exposure to environmental risk factors generally highest among most deprived people, despite wealthier people generally being responsible for more pollution and carbon emissions.

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5
Q

What are some examples of environmental injustice at a local and global level?

A

Local: Wealthier people cause more pollution from cars, but health effects fall disproportionately on deprived groups who live in cheaper housing close to busy roads.

Global: Most C02 released by developed countries, but those living in developing countries most likely to suffer worst effects of climate change.

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6
Q

What is a Just Transition?

A

A framework for shifting to a green, sustainable economy (the “transition”) in a way that is fair, inclusive, and equitable for all, especially workers, communities, and vulnerable groups affected by the move away from fossil fuels. It ensures environmental goals don’t worsen inequality by creating decent, quality jobs, providing social protection, fostering new skills, and involving impacted people in decision-making, ensuring benefits are shared and no one is left behind.

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7
Q

What is an environmental risk and an environmental hazard?

A

HAZARD - An environmental hazard is a factor that may harm health e.g. pollution, chemicals, radiation, extreme temperatures).

RISK - An environmental risk is the probability of an unfavorable event x consequence of the event (e.g. radiation exposure, storm, flooding). Different to epi definition of a risk!!

Hazard only leads to a risk when exposure occurs so must focus on limiting exposure to hazards!

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8
Q

What does environmental risk management involve?

A
  1. Initial response
    - Info seeking
    - Forming appropriate MDT (define membership)
  2. Risks assessment/characterisation
    - Estimating the occurrence of any adverse health effects in a defined population.
    - 3 steps: hazard ID, dose-response assessment, exposure assessment.
  3. Risk management
    - Involves: risk evaluation, risk perception and communication, control of exposure, risk monitoring
  4. Risk communication
    - Designate spokespersons
    - Dissemination of health information

Can use ECCM+L framework (evaluation, communication, control, monitoring, lessons learned)

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9
Q

What is Sandman’s concept of risk?

A
  • Takes into account public’s response to a hazard
  • Defines risk as being what people feel is likelihood of event, rather than epi likelihood
  • Divides risk into technical (hazard) and non-technical (outrage)
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10
Q

What are technical and non-technical risks as per Sandman?

A

In risk communication, Peter Sandman defines “technical” as the objective scientific data (hazard) and “non-technical” as the audience’s emotional response (outrage), famously summarized as Risk = Hazard + Outrage

Technical (hazard) -
- Relates to magnitude and probability of undesirable outcomes e.g. increase in cancer rate

Non-technical (outrage) -
- Perceived negative features of the situation itself (as opposed to those of outcomes)

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11
Q

What did Sandman suggest that communication of risk depends on?

A

Securing appropriate degree of outrage in public, so that they are neither unnecessarily frightened nor apathetic about real problems.

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12
Q

What are factors that can increase or decrease outrage?

A

Sandman listed 9 factors:
1. Voluntariness
2. Control
3. Fairness
4. Process
5. Morality
6. Familiarity
7. Memorability
8. Dread
9. Diffusion in time and space

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13
Q

What is the main cause of human induced (anthropogenic) climate change?

A

Increased levels of greenhouse gases, esp. C02 and methane

Greenhouse gases trap heat arriving from sun (rather than earth reflecting heat back into space)

Increased C02 arises from deforestation and increased combustion of fossil fuels

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14
Q

What are planetary boundaries?

A

Safe operating space for humanity

6/9 boundaries crossed and close to crossing a 7th

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15
Q

What is the inverse climate/care law?

A

Inverse climate law - ‘Whether people are healthy or not, is determine by their circumstances and environment’ (WHO).

The inverse care law is the principle that the availability of good medical or social care tends to vary inversely with the need of the population served.

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16
Q

What are some direct effects of climate change?

A
  • Extreme heat waves
  • Fewer hypothermia deaths
  • Extreme weather events e.g. floods
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17
Q

What are some indirect effects of climate change?

A
  • Changing epi of infectious diseases
  • Changing patterns resp illness
  • Droughts and changing food availability
  • Reduced agricultural productivity and water resources has socio-economic impact on communities
  • Increased pressure on resources leads to deaths from conflicts and war
  • More skin cancers
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18
Q

How might mitigation against climate change be achieved?

A

Reducing C02 emissions v important, achieved by:
○ Using less energy from fossil fuels
○ Behaviour change (e.g. active forms of travel)
○ Energy efficient measures (e.g. improving insulation in housing)
○ Using alternative energy sources (e.g. renewable energy)

Legislation is an important tool for limiting greenhouse gas emissions!! E.g. Kyoto protocol, Paris agreement

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19
Q

What is the UN framework convention on climate change?

A

Agreed at UN conference on environment and development (Earth Summit) in Rio in 1992.

Primary objective of stabilising greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with climate system.

Not legally binding, but enables legally binding treaties to be negotiated.

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20
Q

What is the Paris Agreement?

A
  • The Paris Agreement is a legally binding international treaty on climate change. It was adopted by 195 Parties at the UN Climate Change Conference (COP21) in Paris, France, on 12 December 2015. It entered into force on 4 November 2016.
  • Its overarching goal is to hold “the increase in the global average temperature to well below 2°C above pre-industrial levels” and pursue efforts “to limit the temperature increase to 1.5°C above pre-industrial levels.”
  • However, in recent years, world leaders have stressed the need to limit global warming to 1.5°C by the end of this century.
  • That’s because the UN’s Intergovernmental Panel on Climate Change indicates that crossing the 1.5°C threshold risks unleashing far more severe climate change impacts, including more frequent and severe droughts, heatwaves and rainfall.
  • 2024 first year to exceed 1.5C above pre-industrial levels
  • The long-term 1.5C global warming target has not yet been breached, but based on current rates of warming, the world could pass 1.5C around year 2030.
  • Donald Trump has vowed to remove US from deal (again - he did this in his first term and Biden re-joined).
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21
Q

What are some mechanisms to adapt to effects of climate change and limit effect on PH?

A
  • Infrastructure development
  • Info dissemination
  • Vaccination against infectious diseases
  • Protection from sun
  • Preparing for increased migration
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22
Q

What are the 5 principles of sustainable development, as per DEFRA?

A
  • Environmental limits
  • Healthy and just society
  • Good governance
  • Responsible use of science
  • Sustainable economy (polluter pays principle)
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23
Q

What makes it difficult to assess, isolate, or modify the overall effects of poor housing?

A

People living in poor housing conditions typically experience other forms of deprivation as well e.g. poor education, unemployment, ill health and social isolation.

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24
Q

In what way can housing conditions affect health?

A

Temperature (e.g. fuel poverty)
Damp and mould
Chemicals (e.g. lead, asbestos)
Radiation
Design
Noise
Overcrowding

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25
What is a Greenfield site and what are some causes of land contamination?
Undeveloped or agricultural land - Spread of chemicals from other areas - Natural contaminants
26
What is a brownfield site and what are some causes of land contamination?
Abandoned or underused industrial or commercial land - Contaminants introduced into land when it was being used for another purpose in the past
27
What is the legal definition of contaminated land?
Legal definition of contaminated land set out in Part 2A of Environmental Protection Act 1990, which requires that ‘significant harm is being caused or there is a significant possibility of such harm being caused’ by the contamination. For land identified as being contaminated, the owner or developer is responsible for the costs of remediation!
28
In England, who is responsible for ID-ing contaminated land in their area?
Local authorities! - LA conducts series of risk assessments - First step is to describe a pathway receptor model that outlines which people may be at risk of harm, together with pathways through which they may be exposed to contaminants. **The Source-Pathway-Receptor (SPR) model is a conceptual framework used to evaluate environmental risks by analyzing how a hazard travels from its origin to impact a receptor. It consists of three components: the Source (origin, e.g., a chemical spill), the Pathway (route, e.g., groundwater), and the Receptor (target, e.g., humans, ecosystems).**
29
In the UK, who regulates quality of water supplied to customers?
Drinking Water Inspectorate (DWI)
30
What characteristics is water tested for in the UK?
Physical e.g. taste, colour, smell Chemical composition e.g. chlorine, nitrogen, calcium, magnesium, oxygen Bacteriology e.g. to detect faecal orgs like E. coli, cryptosporidium
31
What is the risk with private drinking water supplies?
Arsenic concs can be higher in PWS due to underlying geology - this can cause skin lesions and bladder, skin and lung cancers.
32
What are some common water pollutants?
Fertilisers - Nitrogen and phosphates - Can lead to eutrophication Metals - Aluminium, lead, other heavy metals Slurry - Organic waste Sewage
33
How much of the world's population has inadequate water supplies?
Around **15-20%** of world's pop, largely in Asia and sub-Saharan Africa.
34
In what ways can inadequate water supplies lead to infectious diseases?
○ Ingestion of faecal contamination due to lack of water for hygiene or ingestion of contaminated water. ○ Water based microbial agents e.g. schisto. ○ Water-related vectors e.g. malaria.
35
What is sanitation?
Facilities or services for safe disposal of human urine and faeces and waste water.
36
How do different waste disposal options fit into the waste hierarchy?
Waste hierarchy forms part of EU's waste management framework. Incineration or landfill should be last resort!! Should aim to reduce waste as a first line.
37
What are some risks of incineration as waste disposal?
Ash from incinerators often contains harmful toxins!
38
What are some potentially harmful effects of landfill?
○ Rotting rubbish emits explosive gases such as methane ○ Noxious liquids risk polluting waterways ○ Nuisances incl. lorry traffic noise, odours, pests
39
What types of environmental surveillance data exist for monitoring for environmental hazards?
- Emissions inventories - Environmental data - Biological data - Health data
40
How can food contaminants be categorised?
Biological E.g. food-borne infections Chemical E.g. Pollution, food storage/processing Radioactive E.g. contamination of food such as occurred after Chernobyl disaster
41
What are some examples of indoor air pollution?
○ Pollution from open solid-fuel stoves is big issue in developing world, exacerbated by attempts to decrease ventilation in order to improve insulation. ○ Passive inhalation cigarette smoke another issue but improving.
42
What are the principle atmospheric air pollutants?
Carbon monoxide Ozone Nitrogen dioxide Sulphur dioxide Lead Fine particles Volatile organic compounds Radon
43
What are the two different types of radiation?
Ionising: - Most common source naturally occurring is radon - Higher in SW England due to granite - Health effects depend on dose - Early effects = acute radiation sickness - Late effects = cancer, hereditary defects in offspring Non-ionising: - Sunlight main source of UV radiation (UV-A and B) - Exposure to both increases risk melanoma, SCC, BCC, cataracts
44
How can radiation be measured?
Amount of radioactivity in a material = Becquerel Absorbed dose = Gray Risk of exposure or effective dose = Sievert
45
Why is international legislation on tackling pollution and waste production needed?
Environmental hazards seldom limited by geographical boundaries e.g. Acid rain caused by UK power plants in 1970's and 80's mainly fell in continental Europe.
46
Why might compliance with environmental legislation not be ideal?
○ Businesses not always aware of legislation ○ Some countries have more rigorous monitoring than others ○ Penalties for non-compliance being comparatively weak ○ Compliance not always perceived as central to a firm's survival
47
What are the UK agencies involved with occupational health?
**Health and safety executive** Trade unions Local authorities Employers Occy health departments
48
What are safety at work audits?
Procedures to monitor and control health and safety factors at work set out in several steps.
49
What are some health consequences of unemployment?
* Assoc with adverse physical, mental, and social effects. * Phenomena related partly to length of time spent unemployed. - Individual e.g. suicide, CVS mortality - Family e.g. spouse may need to give up work - Society e.g. places burden on society through fewer people making tax contributions * Ill health and healthcare use also associated with job insecurity, esp the anticipation of job losses.
50
When do health impact assessments for environmental pollution need to be done?
UK Planning Act requires assessments on health for new industries involving chemicals, poisons, or radiation. For nationally significant infrastructure planning developments, HIAs increasingly being prepared to consider the impacts on health of developments.
51
What is carbon capture?
Relies on finding locations to store C02 so doesn't reach atmosphere, e.g. depleted oil and gas fields. ○ Carbon capture is a relatively inexpensive short-term solution whose value lies in buying time to develop alternative fuel sources.
52
How can sustainable transport be encouraged?
- Encourage alternatives to cars - Taxation (e.g. ULEZ) - Reducing car usage e.g. through taxes for road users, parking restrictions, encouraging car sharing - Carbon offsetting e.g. air passengers donate to NGO who funds reforestation
53
What do emissions trading schemes do?
Provide economic incentives for industrial polluters to reduce their emissions. E.g. EU Emissions Trading System
54
What is sustainable development?
**'Meeting our needs today without compromising the ability of others to meet their needs tomorrow’** or ‘leaving the planet behind us in a condition fit for our ancestors to inherit' 3 components: Financial / economic Social Environmental
55
What are some examples of unsustainable exploitation of environmental resources?
○ Global reduction in productive soils for agriculture. ○ Depletion of ocean fisheries. ○ Use of fossil fuels.
56
What are the steps involved in risk assessment for contaminated land?
1. **Develop pathway receptor model**: a. ID most vulnerable 'receptor' (person at risk) b. ID possible routes of exposure 2. Conduct generic quantitative risk assessment 3. Conduct detailed quant risk assessment
57
Which chemicals do the DWI test water for?
Chlorine Nitrogen (indicative of decomposing organic matter) Ca & Mg markers hard water Absence of oxygen signals stagnant water (can indicate heavy pollution)
58
How can water availability be promoted?
○ Monitoring water levels in ground waters ○ Requiring water companies to produce long term water resource plan ○ Issuing abstraction licenses to regulate the amount of water that can be taken from water bodies
59
How would you define health protection?
The avoidance or reduction of potential harm from exposures through organised efforts, including direct action with individuals or communities, regulation, legislation or other measures. It aims to minimise preventable health risks.
60
How would you define 'dose' and 'dose-response'?
Dose - **total amount of a substance or agent taken up by, or absorbed by, an organism**. Dose-response - relationship between the dose of substance and the resulting changes in body function or health.
61
What is an exposure assessment?
The process of finding out how people come into contact with a hazardous agent, how often and for how long the amount with which they are in contact.
62
What is risk management?
**Estimating the risk to individuals or populations resulting from hazard, reducing likelihood of occurrence and minimising impact. Requires assessment and management.** Risk communication is very important!!!
63
What are the key steps in risk assessment?
1. Issue identification (including vulnerable groups and inequalities) 2. Hazard assessment, including hazard ID and dose-response assessment 3. Exposure assessment 4. Risk characterisation 5. Risk management
64
What are the direct and indirect effects of extreme cold?
Direct - - Heart attack - Stroke - Resp disease **- Flu - Falls and injuries** - Hypothermia Indirect - - Snow and ice may disrupt healthcare services - Cold homes and fuel poverty linked to poor MH and social isolation - Reduced education & employment success - CO poisoning
65
What are some direct and indirect effects of extreme heat?
Direct - - Dehydration - Heat cramps - Heat rash - Dizziness and fainting - Heat exhaustion & heatstroke - MIs - Increased risk resp illnesses & other diseases Indirect effects - - **Increased demand on healthcare services** - **Power outages** (affects home and healthcare) - **Wildfires** (& by association, smoke inhalation)
66
What is the Climate Change Act 2008?
The Climate Change Act 2008 is a landmark UK law, the first in the world to set a legally binding framework for cutting greenhouse gas emissions. It mandates a 100% reduction in emissions (Net Zero) by 2050 compared to 1990 levels, enforced through 5-year carbon budgets, and established the independent Climate Change Committee.
67
What are some benefits of transport to health?
Employment Availability of goods Social activities Active transport has co-benefits for health and environment
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