1. 6GEO4 Unit 5 Pollution and Human Health at Risk

2. What is this option about?
Synoptic context
People
Place
Power
Who is involved?
How?
Why?
Where?
When?
Who is responsible?
The Pollution and Human health at Risk option focuses on risks at different spatial scales. You will study the patterns and trends in health risks over time and space, globally and locally, and evaluate the factors involved and how it impacts on quality of life.
You will include the role of environmental pollution .This has changed from localised to global in the last century associated with huge shifts in lifestyle linked to industrialisation, global shift , deindustrialisation and globalisation.
AS-Global Challenges
A2 unit 3 Contested Planet if done pre Unit 4
Climate change
Megacities- pollution and health
Water conflicts-pollution
Energy- CO2 and Global Warming
Bridging the Development Gap-aid
Technological Fix-polluter pays, patents

3. The complex causes of risks Pollution and health risk
CONTENTS
What are the risks?
The complex causes of risks
Pollution and health risk
Managing health risks
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4. What is health?
The UN World Health Organisation (WHO) is the largest global organisation devoted to health risk:
‘Better health is central to human happiness and well-being. It also makes an important contribution to economic progress, as healthy populations live longer, are more productive, and save more’.
Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”(WHO).
There are many complex inter related factors influencing health risk.
It includes morbidity, and mortality.

5. The health risk equation
Actual physical threats to humans: toxic substance, trauma, virus, bacteria, psychological trauma + mental illness
Risks to reduction of quality of health, morbidity + mortality
Health risk=health hazard exposure + vulnerability - management
Some health risks easier to manage. Depends on
Internal factors: Individual perception of risk-smoking, diet
External factors –pollution, hazards
Vulnerability depends on
Human characteristics
Environment
Lifestyle choices
Healthcare services
Global health risk means health problems that so large they have a global political and economic impact or burden, as well as localised distributions.

6. The Option summarised Enquiry Question 1 What are the health risks?
What are the complex causes of health risk?
Enquiry Question 3
What is the link between health risk & pollution?
Enquiry Question 4
How can the impacts of health risk be managed?
Types of risk, short term to chronic , pandemic, epidemic or endemic
Geographical pattern at global/ national/local scales?
Temporal patterns, link to epidemiology model and WHO transition model
Health and quality of life and economic development
Range of causes
Relationship to socio-economic status?
Links to geographical features / pathway
Models eg diffusion
Types and sources of pollution
Direct and indirect effects
Link with economic development and Kuznet model
Pollution fatigue
Socio-economic and environmental impacts
Effectiveness of management strategy/policy
Agencies involved, especially International
Role of long term sustainable or short term management

7. Enquiry Q 1 What are health risks?
Infectious
Degenerative, chronic health risks
Traumas
often communicable
often acute ie rapid onset or intense symptoms.
Split into:
endemic
epidemics,
Pandemics
Can be
Vectored or
Non vectored
often resulting from longevity, not communicable
 split into
Chronic- (lasting over 3 months)
Cardiovascular
Respiratory,
chronic pulmonary (COPD)
Obesity related Diabetes
Cancer
Depression
Maternal/ peri natal
Degenerative
Arthritis
Alzheimer’s
Osteoporosis
eg from work related accidents or transport accidents
Pollution created/related health risks:
Cholera Radiation Asthma Respiratory infections Melanoma…….
Enquiry Q 1 What are health risks?
What are the range of risks?
Spatial Patterns ?
Temporal patterns ?
Health and quality of life and economic development?

8. Complex Causes of Health Risk
Human factors
Personal lifestyle choices including diet, exercise, smoking, alcohol consumption. Poor choices linked to cancer, diabetes, obesity and depression
External Factors including pollution, quality of housing, residential environment, working conditions, road safety levels, economic and political structures
Physical factors
Water quality
Geology- uranium decay
Ecosystem health
Insect and animal vectors
Ozone depletion
Weather shocks
Climate change
All interlinked

9. Epidemiology Model Red= degenerative diseases
Blue= infectious diseases
Stages or Age of : 1
The age of
Pestilence + famine 2
The age of Receding Pandemics 3
The age of chronic diseases 4
Age of emerging /re-emerging infectious diseases
Causes of health risk
Large number infectious, acute diseases.
reduction in the prevalence of infectious diseases +
fall in mortality
Degenerative + human induced diseases of affluence suffered by ageing populations .
New
or the re-emergence of “old” diseases
Examples of types of health risk
Mainly respiratory + infectious diseases: Measles, smallpox, malaria, typhoid, cholera, tuberculosis, enteritis, diarrhoea, pneumonia
cancers
respiratory diseases including asthma
HIV/AIDS
SARS
Avian Influenza
Measles TB
Link to pollution
localised pollution, especially water borne
rise in all types of pollution as industrialisation increases.
Environmentally conscious but consumerist society
Reduced water +land pollution, but increased air pollution
In Low to middle income countries high rates of all types of environmental pollution
Link to economic development
Low income countries UK in 17th C
Currently Ethiopia, Bangladesh , although most moving to 2nd stage
Industrialisation; UK in 19th C. Currently Low to Middle income countries eg India, Western and rural China
Post-industrialisation:
UK in 20th C and currently Upper income countries +NICs/RICs
Eastern and urban China
Ageing populations in urbanised societies.
Low to middle income countries, less able to cope with the ‘double burden ‘of health risk , late 20th C
Huge rise in HIV/AIDs, smoking, hypertension, toxic effects of widespread environmental pollution, not under control

10. Enquiry Q 2 Complex causes of health risk
Direct factor: contact with risk :
pollutant pathogen
Virus trauma…
Root factors: lifestyle
poverty
corruption
natural hazards
environmental….
Different causes?
Relationship to socio-economic status?
Role of geographical features?
Models?

11. A typology of health risks from geographical features and environmental change
Dams, Canals, irrigation...breeding ground ---eg Malaria, Schistosomiasis,...
Agricultural intensification...vector resistance ,rodents, direct contact— eg Haemorrhagic fever
Urbanisation...sanitation, hygiene, water contamination....eg Cholera, Dengue...
Deforestation..breeding sites + vectors, immigration of susceptible people..eg Malaria, Oropouche
Ocean warming...toxic algal blooms Red tides
Increased precipitation ... Pools for mosquito breeding eg Rift Valley fever

12. High Income--------- - Middle Income-----------Low income
Burdens of heath risk
There are huge health inequalities globally, both in terms of health during life and age of death (longevity).
Measured by for example the W.H.O.’s DALYs- the years of life spent with reduced functions resulting from health conditions of varying severity.
Globally, 1 in 3 deaths are from infectious or communicable diseases such as HIV, but most of these are in poorer areas and linked with malnutrition.
The biggest risk is from non communicable chronic diseases, especially cardiovascular diseases.
The W.H.O. divides the world into high and low mortality regions, correlating strongly with industrialisation and GNP/GNI.
The speed by which many transition economy countries have changed their socio-economic structure over the past few decades has created a double burden of health risk
High Income Middle Income Low income
Chronic/degenerative chronic+ infectious+ Traumas infectious

13. The top 10: Projected Trends in leading causes of mortality by the W.H.O.
2004
% Deaths
Rank
2030
rank
Heart disease
12.2 1
14.2
Cerebro-vascular
9.7 2
12.1
Respiratory infections 7 3
COPD
8.6
5.1 4
3.8
Diarrhoeal diseases
3.6 5
Road traffic accidents
HIV/AIDs
3.5 6
Trachea bronchus lung cancers
3.4 TB
2.5
Diabetes
3.3
2.3 8
Hypertensive Heart disease
2.1
2.2 9
Stomach cancer
1.9
Prematurity/low birth weight 10
1.8

14. Models to help describe and explain patterns and trends
1 Expansion diffusion
Red= place of origin and continuation of disease in this location.
Green = new areas of disease
Relocation diffusion
Original disease shifts from place to place leaving behind its source EG some influenza epidemics
3 . Contagious diffusion
direct contact is needed between hosts of the disease, the black squares, and new hosts infected, the blue squares. EG: measles
4. Hierarchical diffusion
1 ,2 and 3 represent differing locations
1 is often the largest , and the infection gradually spreads out to increasingly smaller centres 2 and 3
EG: The spread of HIV/AIDS from larger to smaller centres in the United States and SARs outbreak in China 2003
1. Origin 2 3

15. Topical case studies :Swine Flu 2009
2009 Swine flu is a respiratory disease, caused by a new strain of the influenza type A virus known as A(H1N1), spread from person to person by coughing and sneezing . Fatal for a small minority, it particularly attacks younger people and those with an underlying medical condition
It emerged in Mexico in April , possibly linked to intensive pig farming. It rapidly spread globally and is the first official flu pandemic for 40yrs. By November over 6000 official deaths .
In UK a management first of self diagnosis over internet began with automated prescriptions for antiviral drugs to reduce inundation in doctor surgeries and spread.
Chief players:
W.H.O. Global Alert and response (GAR) and The Global Outbreak Alert and Response Network (GOARN ) established 2000, co-ordinating research, monitoring and advice to individual governments on management. The WHO issues Phase warnings from 1-6, 6 being the pandemic phase of widespread risk
Managers at community and national level have used containment and ‘outbreak management’ strategies, including vaccination of most vulnerable groups and advice on basic hygiene
There is a tendency of pandemics to encircle the globe in at least two, sometimes three, waves, with mutations occurring frequently and unpredictably
1918: Spanish flu was the most devastating outbreak of modern times. Caused by a form of the H1N1 strain of flu up to 40% of the world's population were infected. Over 50 m people died, with young adults particularly vulnerable.
1957: Asian flu killed 2 m people, with the elderly particularly vulnerable.. Rapid action by WHO and Government authorities minimised effects by identification then vaccine.
1968: Hong Kong flu, H3N2, killed up to 1m people globally, with over 65 year olds most likely to die.

16. Enquiry Q 3 Pollution and health risks
Key terms
Pollution = presence of substances that create a risk to health and well-being
Point Based – from a specific source: often a mine or factory/industry
Diffuse- from many often difficult to pin point precise sources eg nitrates in water, CO2 in atmosphere
Sustained pollution- pollution over a long time period
Pollution Incident- often accidental and point based
Externalities = the side effects, positive and negative, of an economic activity that are experienced beyond its site
Externality field = the geographical area within which externalities are experienced
Toxicity = a measure of the degree to which something is poisonous. Often expressed as a dose-response relationship
What is the link between different pollution types and health risk?
Incidental versus sustained pollution?
Link between pollution and economic development?
The role of pollution fatigue?
SOURCE---PATHWAY---SINK

17. Spatial patterns pollution-health risk: hot spots
Russia
Norisk
Dzerzhinsk
Rudnaya Pristan
Chernobyl Ukraine nuclear explosion
According to the NGO Blacksmith Institute2009 : Pollution likely affects over a billion people globally, with millions poisoned and killed each year. 
The W.H.O. Estimates that 25 % of all deaths in the developing world are directly attributable to environmental factors.
There has been a global shift in location in the last century- from developed to developing nations.
Maivv Suu Kyrgyzstan
Linfen China
Haina Dominican Republic
Ranipet India
Kabwe Zambia
La Oroya
Peru

18. Household Sanitation + water quality
The Environmental Risk Transition
INDIVIDUAL
Household Sanitation + water quality
MESO SCALE Community Urban Pollution rises with rapid urbanisation then falls with good management
GLOBAL
Climate change
Global warming is this century’s biggest pollution risk
Severity
Of impact
Increasing Wealth/ development
Shifting Environmental Burdens
Global
Local
Immediate
Delayed
Risks to Human Health
Risks to Life Support Systems

19. Economic development and pollution relationships
Economy matures: more wealth throughout society, more pressure for clean up. In MEDCs shift to service + lighter manufacturing industry as global shift continues to transfer heavy polluting sources to NICs & LEDCs
Scales of pollution impact:
Local
Regional
National
International
Poor- rich divide- who is most affected?
Role of companies, businesses, governments, NGOs ?
Green groups may result /thrive
This also shows pollution fatigue in reducing health risk, ie the backlash from the public to pressurise for effective management and control ..
Start of industrialisation, high pollution

20. Continuum model for pollution’s affects on people
Acutely toxic, causing rapid death
Majority of pollutants are sub-lethal, ie do not cause death but make existing problems worse
Slow accumulations over a long time period. May weaken individual so they die from another disease or pollutant
No pollutant lasts forever, but some pollutants last longer
Persistent/non biodegradable substances cannot be broken down by living organisms, and hence accumulate in an organism even small amounts over time.
Heavy metals, eg lead, arsenic, mercury, cadmium, may be ingested in water
Synthetic organic compounds also accumulate over time in the food chain, eg organochlorides like DDT( now banned in Europe & N America
There are fears- not totally proven, of the health risk link to pollutants with
Drinking water contaminants (heavy metals and nitrates, chlorinated and aromatic solvents, and chlorination by-products)
Residence near waste disposal sites and contaminated land
Pesticide exposure in agricultural areas
Air pollution and industrial pollution sources
Food contamination
disasters involving large scale accidental, negligent or deliberate chemical releases
The Precautionary Principle is therefore advisable!

21. Enquiry Q 4 Managing health risks
Do nothing (ignore the risk)
Move to a safer location
Attempt to prevent the health hazard
Adapt lifestyle to the health hazard
What are the socio-economic and environmental impacts/ burdens?
Differing management strategies and policies?
Different players involved ?
Role of Sustainable management?

22. Increasing health burdens + strategies
Short term health risks : mental and physical traumas from disasters
Long term public heath care
The short and long term impacts, or burden of health risk, have become more complex with the so called ‘health divide’ becoming an increasing issue for the sustainability of our natural and socioeconomic environment. Health is a major driver of global and local economies, but the costs of health care are escalating because of:
Population increase especially an ageing population
Rise in both poverty and a more vociferous middle class with higher expectations of health care
Technology and medical expertise :availability of often expensive technology and care in prevention and treatment
Consumer demand, increased by the media, internet knowledge and demands for more social equity in health care.
Rise in pollution and environmental health risks from workplace and indirectly from climate change
Global interconnectivity: globalisation of health expectations and faster movement of infectious diseases because of migration and travel. Also :real time news linked with panic from health issues such as SARs and Avian influenza

23. Climate change and health risk
Most people will be affected in some way by climate change in the early 21stC
Health risks will increase because of changes to existing patterns of disease, water and food insecurity, shelter and human settlements, extreme climatic events, population growth and migration.
Direct influence: Expansion of Vector-borne diseases and mortality will increase , especially among elderly people, because of heat waves.
Indirect effects: on water, food security and extreme climatic events are likely to have the biggest effect on global health. Increase stress and anxiety also involved
Climate change is potentially the biggest global health threat in the 21st century. (W.H.O. + UCL and The Lancet 2009)
The response needs a new public health movement that has coordinated thinking and action across governments, international agencies, NGOs, and academic institutions.
However, this adaptive response must parallel primary mitigation: reduction in greenhouse gas emissions.

24. Management classification
Direct management
- preventative and palliative
indirect management
- reducing exposure to risks which may lead to poor health
methods of
intervention
The players
The whole public,
eg school food campaigns, non smoking legislation in public places.
Targeted individuals, especially if they occur in sizeable numbers. This is the high risk approach, for individuals with a combination of risk factors
males, who are obese, smokers and take little exercise
babies vulnerable to sun burn.
Reduce poverty
improve housing
improve water supply and sanitation
improve education
legislation
tax
financial incentives education
campaigns
technology, from safety belts, efficient boilers, syringes and medicine to taps.
governments-
NGOs
TNCs and private organisations
locals

25. Types of public heath care
Public health intervention
Aims to prevent rather than treat diseases, with education a priority Currently targeted by the W.H.O. It includes surveillance, vaccination and family planning.
Health care
involves prevention, treatment, and management to individuals and communities by medical, nursing and associated health sectors. Prevention is preferable, but often more difficult to achieve than treatment, although simple schemes can produce great positive results, eg malaria nets.
More aggressive and/or shocking types of health risk (such as HIV/AIDs, SARs) get higher priority than for instance mental illness
A key player may be the media in mobilising public opinion
health systems ,such as in the UK, aim to promote, restore or maintain health. They have an integrated set of facilities and personnel, and have a hierarchy of primary GP type care, secondary care by specialists in outpatient units, tertiary care as inpatients for a minority of patients and research by Universities and private companies.Health systems have evolved from informal, small scale, often family based systems into large, often government run systems. There has been a rise in private organizations catering for the more affluent, eg BUPA, and charitable organizations for the inevitable ’gaps’ in the system, eg Red Cross

26. Key Principles in pollution control
Precautionary
Began Rio Earth Summit,
linked with sustainable development .
Where a threat appears to be present, even if not proven, action needs taking to protect the environment
Eg reaction against GM foods, 1987 Montreal Protocol on CFCs and Ozone depletion
Maastrict Treat of EU
Even Body Shop has it enshrined in their corporate plan ban by EU of 22 commonly used chemicals in agriculture
Polluter Pays
Means the costs of cleaning up pollution should be borne by those causing it. Started by OECD 1972.reaffirmed at Rio Summit Eg
Emissions Taxing in UK and at international scale:Kyoto Protocol
Proximity Principle
Pollution should be tackled as near to the source as possible, contained, not allowed to spread
This would apply to
eg river pollution
or exporting of toxic waste to poorer less restricted countries- effectively global shift of ecological footprints!
Prevention
Try to stop at source rather than adapt after created
Eg Urban Smokeless zones, energy efficiency
The UK Environment Agency’s guidelines

27. Examples of successful pollution remediation/elimination and hence reduced health risk
Models of how international community can work together successfully
Global scale
CFC control Montreal protocol
Phasing out of Leaded petrol
Chemical weapons Convention
More local /regional scale picked by the Blacksmith Institute as examples of good practice:
Accra, Ghana –innovative low tech cooking stoves to reduce indoor air pollution and improve health of women and children especially
Candelaria, Chile- copper mining waste reduced from water supplies
Chernobyl affected area E Europe- work by especially the EU to improve lives of those in radiation contamination ( medical, psychological, educational)
Delhi India- reduction of air pollution emissions
Haina, Dominican Republic- removal of toxic soil (improper recycling of car batteries- lead pollution)
Kalimantan, Indonesia (new techniques to reduce mercury poisoning from artisanal gold mining)
Old Korogwe, Tanzania( removal pesticides contamination of soil and river)
Rudnaya Pristan ,Russia ( removal lead contaminated soil in children's playgrounds)
Shanghai 12 year program to clean sewage out of urban waterway used for drinking water
W Bengal India (reduction arsenic poisoning through removal of naturally poisoned ground water)

28. International Efforts on health management and the MDGs
Growth of international efforts to tackle health risks is linked to
the increasing scale and issues involved
globalisation and interconnectivity of world economies ,political and financial affiliations, and flows of people and technology
International minimum and ambient standards are now common in both health and pollution management.
These are funded by international institutions like the United Nations or World Bank, or philanthropic NGOs ranging from Oxfam to the Bill and Melinda Gates Foundation. TNCs also play a role.
However, it still comes down to individual nations and indeed individuals whether these policies can actually be implemented effectively.
In 2000, the largest-ever gathering of Heads of State adopted the Millennium Declaration, endorsed by 189 countries.
This was a roadmap setting out 8 goals to be reached by 2015: to reduce poverty and hunger, and to tackle ill-health, gender inequality, lack of education, lack of access to clean water and environmental degradation.
Health is linked directly to 3 goals and indirectly to all.
These Goals are to be achieved through trade, development assistance, debt relief, access to essential medicines and technology transfer.
There has been a reduction in diseases like HIV/AIDS, malaria and tuberculosis , but most countries are currently off track, especially in sub Saharan Africa and India (World Bank 2008) . This is despite increasing health related aid from a whole range of players. .

29. W.H.O. projections for future health risk
Age of sustaining health- the ideal- Balance of resources and risk .Effective health systems designed to cope with ageing population. Eradication of most environmentally infectious disease eg malaria. Cooperation between countries. Effective surveillance+ management.
Age of chronic diseases
Age of medical technology: Business as Usual scenario: limited co-operation between countries. MEDCs offset increased health risks by wealth + technology
Life expectancy
Age of receding pandemics
Age of emerging infectious diseases: characteristic of poorer countries, dealing with double burden of infectious diseases and rise in chronic diseases as ageing of population increases
Age of famine + pestilence
Time -
The aged- both a challenge and opportunity for health care managers: The WHO project by 2050, the number of aged over 60 will more than triple from 600 million to 2 billion. Most of this increase is occurring in developing countries