2F Environment

Question 1

What are the environmental determinants of health?

Answer 1

Can argue that everything in the Dahlgren and Whitehead model except for ‘age, sex and constitutional factors’ is ‘environmental’

Global factors:
- Climate change
- Global warming
- Sustainable development

Living and working conditions:
- Housing
- Transport
- Occupational health
- Water and sanitation
- Agriculture and food
- Air quality

Traditional environmental hazards:
- Physical factors e.g. noise, temperature, radiation
- Chemical agents
- Biological agents e.g. infectious diseases

Question 2

What is environmental injustice?

Answer 2

Exposure to environmental risk factors tends to be greatest among more deprived people, despite wealthier people being responsible for more pollution and carbon emissions

Question 3

What is a risk and a hazard?

Answer 3

Hazard = factor that may harm health

Risk = probability of an unfavourable event x consequence of the event

NB this differs from epi definition of risk

Question 4

What are the stages of risk management?

Answer 4

RISK ASSESSMENT (also known as QRA - quantitative risk assessment)
- Hazard identification
- Dose-response assessment
- Exposure assessment (field measurements)

RISK MANAGEMENT
- Risk evaluation (comparison to known standards)
- Risk perception and communication (appropriate + honest communication is key)
- Control of exposure, which can be
–> At the source
–> Along pathway before hazard reaches a person e.g exhaust abatement
–> At the person level e.g. PPE
–> Secondary prevention
- Risk monitoring (surveillance systems)

Framework for questions:
- Evaluation
- Communication
- Control
- Monitoring
- Lessons learned

Question 5

What is Sandman’s concept of risk?

Answer 5

Risk = hazard + outrage

This redefines hazard to be probability of event x consequence (what is usually called risk in this context)

Question 6

What are the main drivers of climate change?

Answer 6

• Increased levels of greenhouses gases, especially CO2 and methane
• CO2 rising due to deforestation and fossil fuel combustion

Question 7

What are direct and indirect effects of climate change?

Answer 7

Direct
- Heat waves –> mortality
- Extreme weather e.g. floods –> mortality, injuries

Indirect
- Spread of vector borne diseases
- Flooding leading to more water-borne diseases
- Droughts –> famine, refugees
- Vulnerability to rising sea levels –> environmental refugees
- Reduced water and agricultural productivity –> socioeconomic impacts, famine
- Pressure on resources –> conflict
- Ozone depletion –> skin Ca

Question 8

What are the two broad approaches for responding to climate change?

Answer 8

MITIGATION

Reduce CO2 emissions via:
- Less fossil fuel combustion
- Use of renewable energy
- Behaviour change e.g. active travel
- Energy efficiency measures e.g. insulation

ADAPTATION
- Infrastructure development e.g. flood barriers
- Information dissemination e.g. heat wave warning
- Vaccination for infectious diseases
- Sun protection
- Preparation for migration

Question 9

What is the Paris Agreement?

Answer 9

Legally binding international treaty to limit global warming to well below 2C, preferably 1.5C above pre-industrial levels

Question 10

What are some examples of unsustainable use of resources?

Answer 10

• Reduction globally in productive soils for agriculture
• Depletion of ocean fisheries
• Use of fossil fuels

Question 11

What are the principles of sustainable development?

Answer 11

• Respecting environmental/resource limits
• Healthy and just society where everyone’s needs are met, including future populations
• Good governance, engaging all levels of society
• Responsible use of science (evidence-based practice, and use of the precautionary principle)
• Sustainable economy that provides prosperity for all + has principle of polluter pays

Question 12

In what ways can housing conditions affects health?

Answer 12

Temperatures
- Cold temperatures (poor insulation, fuel poverty)
- Heat (poor ventilation, poorly insulated roofs)

Damp and mould
- Damp and moulds –> aeroallergens –> resp issues

Chemicals
- Carbon monoxide
- Lead
- Asbestos

Radiation
- Radon –> lung Ca

Design
- Falls risk
- Fire risk

Noise
- Poor sound insulation
- Leads to poor sleep, depression, CVD

Overcrowding
- Psychological impacts
- CDs e.g. TB

Question 13

Causes of inadequate water supplies

Answer 13

• Lack of water supply e.g. drought
• Biological contamination e.g. E. Coli and cryptosporidia
• Fertiliser contamination - nitrates and phosphates
• Metal contamination e.g. aluminium and lead
• Organic waste slurry entering water supplies
• Sewage entering water supplies

Question 14

Health consequences of inadequate water supply

Answer 14

Range of CDs, due to:
- Ingestion of faecal contaminants due to lack of water for adequate hygiene or contaminated water
- Water-based microbial agents e.g. schistosomiasis
- Water related vectors e.g. malaria

Question 15

Health consequences of waste disposal practices

Answer 15

Incineration: generates ash which can be harmful, including carcinogenic

Landfills:
- Rotting rubbish emits explosive gases e.g. methane
- Noxious liquids can pollute waterways
- Odours, smoke, lorry traffic, pests

Hazardous waste

Question 16

What components of water are monitored as part of water safety monitoring?

Answer 16

• Physical characteristics e.g. taste, colour, smell
• Chemical composition
• Bacteriology

Question 17

How are different types of food contaminants?

Answer 17

• Biological e.g. food-borne infectious such as Salmonella
• Chemical e.g. pollution such as mercury in fish
• Radioactive i.e. contamination of food after nuclear disaster

Question 18

What are the approaches to improving food quality?

Answer 18

• Production: reduce pesticides
• Processing: reduce biological contamination by drying crops
• Preservation and storage: irradiation, canning, freezing
• Food prep: separate raw and cooked foods; cook to correct temp
• Consumption: adhere to use-by dates

Question 19

How is atmospheric pollution monitored?

Answer 19

• Monitored by DEFRA via automatic stations
• Local authorities have to monitor air quality and produce an action plan where standards are not met

Question 20

How is occupational noise exposure regulated?

Answer 20

• Regulations for occupational exposure in the Control of Noise at Work Regulations 2005
• Employers must take action e.g. hearing protection equipment, where noise is above 80dB

Question 21

How is radiation monitored?

Answer 21

• UKHSA monitors levels
• Environmental agency also plays a role

Question 22

What are the effects of ionising radiation?

Answer 22

• Early: acute radiation sickness - diarrhoea, vomiting, hair loss
• Late: cancer, birth defects, organ damage

Question 23

What are the health effects of non ionising radiation?

Answer 23

Mainly via UV from sun

• UVA causes skin cancer, cataracts and skin ageing
• UVB causes skin cancer, cataracts and sunburn

Question 24

What are different forms of legislation in environmental control?

Answer 24

• Permits or licences for using natural resources, waste disposal etc
• Taxes or levies (e.g. Climate Change Levy - UK tax on energy used by businesses to encourage efficient usage and reduction in emissions)
• Trading schemes (companies can buy or sell excess emission allowances)
• Product labelling e.g. energy efficiency ratings for appliances and building

Question 25

What are different occupational hazards?

Answer 25

Chemical - Coal dust --> pneumoconiosis - Asbestos --> asbestosis and mesothelioma Physical - Heavy machinery noise --> NIHL - Ioning radiation - Hot/cold substances --> thermal injury/burns Mechanical - Moving machinery --> trauma - Lack of barriers of scaffolding --> falls and trauma Biological - Needlestick injuries --> BBV - Raw sewage exposure --> Leptospirosis - Farm animals and waste --> Brucellosis Psychological - Harassment, bullying, discrimination --> stress, anxiety, depression

Question 26

How to reduce occupational risk?

Answer 26

1. Worker-level: - Education and training on health and safety and how to use PPE 2. Work environment - Ensuring processes as safe as possible - Harmful substances/machinery are contained - Monitoring systems in place

Question 27

What are the steps of safety audits in the workplace?

Answer 27

1. Assess hazards 2. Identify those most at risk 3. Surveillance of hazards, incidents and health-related morbidity 4. Action to mitigate hazards 5. Monitoring effect of interventions

Question 28

How to conduct a health impact assessment for environmental pollution?

Answer 28

Usual steps for a HIA are: - Scoping - Screening - Assessment - Recommendations - Monitoring Alternative is the quantitative risk assessment: - Hazard identification - Dose-response assessment - Exposure assessment (field measurements)

Question 29

What is sustainable transport?

Answer 29

Promoting forms of transport that have the potential to maintain longterm well-being, including environmental, economic and social dimensions

Question 30

What are examples of policies to promote more sustainable transport?

Answer 30

Walking - Pedestrian zones - Walking routes Cycling - Cycle lanes - Employer cycle scheme - City cycle share schemes Public transport - Subsidies Employer commuter clubs - Car sharing Reducing car transport - Levies/taxes for road use - Parking restrictions and charges - Share-only lanes to encourage car sharing - Reducing freight transport via and road and increasing freight transport via train

Question 31

What is carbon capture?

Answer 31

- Findings location to store CO2 so it does not reach the atmosphere - Examples include depleted oil and gas fields - This does not actually reduce fossil fuel consumption or CO2 generation - Therefore it is a short term solution - Buys time to develop alternative fuel sources