2What is this option about? Synoptic contextPeoplePlacePowerWho 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 ChallengesA2 unit 3 Contested Planet if done pre Unit 4Climate changeMegacities- pollution and healthWater conflicts-pollutionEnergy- CO2 and Global WarmingBridging the Development Gap-aidTechnological Fix-polluter pays, patents
3The complex causes of risks Pollution and health risk CONTENTSWhat are the risks?The complex causes of risksPollution and health riskManaging health risksClick on the information icon to jump to that section.Click on the home button to return to this contents page
4What 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.
5The health risk equation Actual physical threats to humans: toxic substance, trauma, virus, bacteria, psychological trauma + mental illnessRisks to reduction of quality of health, morbidity + mortalityHealth risk=health hazard exposure + vulnerability - managementSome health risks easier to manage. Depends onInternal factors: Individual perception of risk-smoking, dietExternal factors –pollution, hazardsVulnerability depends onHuman characteristicsEnvironmentLifestyle choicesHealthcare servicesGlobal health risk means health problems that so large they have a global political and economic impact or burden, as well as localised distributions.
6The Option summarised Enquiry Question 1 What are the health risks? What are the complex causes of health risk?Enquiry Question 3What is the link between health risk & pollution?Enquiry Question 4How can the impacts of health risk be managed?Types of risk, short term to chronic , pandemic, epidemic or endemicGeographical pattern at global/ national/local scales?Temporal patterns, link to epidemiology model and WHO transition modelHealth and quality of life and economic developmentRange of causesRelationship to socio-economic status?Links to geographical features / pathwayModels eg diffusionTypes and sources of pollutionDirect and indirect effectsLink with economic development and Kuznet modelPollution fatigueSocio-economic and environmental impactsEffectiveness of management strategy/policyAgencies involved, especially InternationalRole of long term sustainable or short term management
7Enquiry Q 1 What are health risks? InfectiousDegenerative, chronic health risksTraumasoften communicableoften acute ie rapid onset or intense symptoms.Split into:endemicepidemics,PandemicsCan beVectored orNon vectoredoften resulting from longevity, not communicable split intoChronic- (lasting over 3 months)CardiovascularRespiratory,chronic pulmonary (COPD)Obesity related DiabetesCancerDepressionMaternal/ peri natalDegenerativeArthritisAlzheimer’sOsteoporosiseg from work related accidents or transport accidentsPollution 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?
8Complex Causes of Health Risk Human factorsPersonal lifestyle choices including diet, exercise, smoking, alcohol consumption. Poor choices linked to cancer, diabetes, obesity and depressionExternal Factors including pollution, quality of housing, residential environment, working conditions, road safety levels, economic and political structuresPhysical factorsWater qualityGeology- uranium decayEcosystem healthInsect and animal vectorsOzone depletionWeather shocksClimate changeAll interlinked
9Epidemiology Model Red= degenerative diseases Blue= infectious diseasesStages or Age of :1The age ofPestilence + famine2The age of Receding Pandemics3The age of chronic diseases4Age of emerging /re-emerging infectious diseasesCauses of health riskLarge number infectious, acute diseases.reduction in the prevalence of infectious diseases +fall in mortalityDegenerative + human induced diseases of affluence suffered by ageing populations.Newor the re-emergence of “old” diseasesExamples of types of health riskMainly respiratory + infectious diseases: Measles, smallpox, malaria, typhoid, cholera, tuberculosis, enteritis, diarrhoea, pneumoniacancersrespiratory diseases including asthmaHIV/AIDSSARSAvian InfluenzaMeasles TBLink to pollutionlocalised pollution, especially water bornerise in all types of pollution as industrialisation increases.Environmentally conscious but consumerist societyReduced water +land pollution, but increased air pollutionIn Low to middle income countries high rates of all types of environmental pollutionLink to economic developmentLow income countries UK in 17th CCurrently Ethiopia, Bangladesh , although most moving to 2nd stageIndustrialisation; UK in 19th C. Currently Low to Middle income countries eg India, Western and rural ChinaPost-industrialisation:UK in 20th C and currently Upper income countries +NICs/RICsEastern and urban ChinaAgeing populations in urbanised societies.Low to middle income countries, less able to cope with the ‘double burden ‘of health risk , late 20th CHuge rise in HIV/AIDs, smoking, hypertension, toxic effects of widespread environmental pollution, not under control
10Enquiry Q 2 Complex causes of health risk Direct factor: contact with risk :pollutant pathogenVirus trauma…Root factors: lifestylepovertycorruptionnatural hazardsenvironmental….Different causes?Relationship to socio-economic status?Role of geographical features?Models?
11A 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 feverUrbanisation...sanitation, hygiene, water contamination....eg Cholera, Dengue...Deforestation..breeding sites + vectors, immigration of susceptible people..eg Malaria, OropoucheOcean warming...toxic algal blooms Red tidesIncreased precipitation ... Pools for mosquito breeding eg Rift Valley fever
12High Income--------- - Middle Income-----------Low income Burdens of heath riskThere 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 riskHigh Income Middle Income Low incomeChronic/degenerative chronic+ infectious+ Traumas infectious
13The top 10: Projected Trends in leading causes of mortality by the W.H.O. 2004% DeathsRank2030rankHeart disease12.2114.2Cerebro-vascular9.7212.1Respiratory infections73COPD18.104.22.168Diarrhoeal diseases3.65Road traffic accidentsHIV/AIDs3.56Trachea bronchus lung cancers3.4TB2.5Diabetes3.32.38Hypertensive Heart disease2.12.29Stomach cancer1.9Prematurity/low birth weight101.8
14Models to help describe and explain patterns and trends 1 Expansion diffusionRed= place of origin and continuation of disease in this location.Green = new areas of diseaseRelocation diffusionOriginal disease shifts from place to place leaving behind its source EG some influenza epidemics3 . Contagious diffusiondirect contact is needed between hosts of the disease, the black squares, and new hosts infected, the blue squares. EG: measles4. Hierarchical diffusion1 ,2 and 3 represent differing locations1 is often the largest , and the infection gradually spreads out to increasingly smaller centres 2 and 3EG: The spread of HIV/AIDS from larger to smaller centres in the United States and SARs outbreak in China 20031. Origin23
15Topical 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 conditionIt 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 riskManagers at community and national level have used containment and ‘outbreak management’ strategies, including vaccination of most vulnerable groups and advice on basic hygieneThere is a tendency of pandemics to encircle the globe in at least two, sometimes three, waves, with mutations occurring frequently and unpredictably1918: 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.
16Enquiry Q 3 Pollution and health risks Key termsPollution = presence of substances that create a risk to health and well-beingPoint Based – from a specific source: often a mine or factory/industryDiffuse- from many often difficult to pin point precise sources eg nitrates in water, CO2 in atmosphereSustained pollution- pollution over a long time periodPollution Incident- often accidental and point basedExternalities = the side effects, positive and negative, of an economic activity that are experienced beyond its siteExternality field = the geographical area within which externalities are experiencedToxicity = a measure of the degree to which something is poisonous. Often expressed as a dose-response relationshipWhat 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
17Spatial patterns pollution-health risk: hot spots RussiaNoriskDzerzhinskRudnaya PristanChernobyl Ukraine nuclear explosionAccording 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 KyrgyzstanLinfen ChinaHaina Dominican RepublicRanipet IndiaKabwe ZambiaLa OroyaPeru
18Household Sanitation + water quality The Environmental Risk TransitionINDIVIDUALHousehold Sanitation + water qualityMESO SCALE Community Urban Pollution rises with rapid urbanisation then falls with good managementGLOBALClimate changeGlobal warming is this century’s biggest pollution riskSeverityOf impactIncreasing Wealth/ developmentShifting Environmental BurdensGlobalLocalImmediateDelayedRisks to Human HealthRisks to Life Support Systems
19Economic 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 & LEDCsScales of pollution impact:LocalRegionalNationalInternationalPoor- rich divide- who is most affected?Role of companies, businesses, governments, NGOs ?Green groups may result /thriveThis 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
20Continuum model for pollution’s affects on people Acutely toxic, causing rapid deathMajority of pollutants are sub-lethal, ie do not cause death but make existing problems worseSlow accumulations over a long time period. May weaken individual so they die from another disease or pollutantNo pollutant lasts forever, but some pollutants last longerPersistent/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 waterSynthetic organic compounds also accumulate over time in the food chain, eg organochlorides like DDT( now banned in Europe & N AmericaThere are fears- not totally proven, of the health risk link to pollutants withDrinking water contaminants (heavy metals and nitrates, chlorinated and aromatic solvents, and chlorination by-products)Residence near waste disposal sites and contaminated landPesticide exposure in agricultural areasAir pollution and industrial pollution sourcesFood contaminationdisasters involving large scale accidental, negligent or deliberate chemical releasesThe Precautionary Principle is therefore advisable!
21Enquiry Q 4 Managing health risks Do nothing (ignore the risk)Move to a safer locationAttempt to prevent the health hazardAdapt lifestyle to the health hazardWhat are the socio-economic and environmental impacts/ burdens?Differing management strategies and policies?Different players involved ?Role of Sustainable management?
22Increasing health burdens + strategies Short term health risks : mental and physical traumas from disastersLong term public heath careThe 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 populationRise in both poverty and a more vociferous middle class with higher expectations of health careTechnology and medical expertise :availability of often expensive technology and care in prevention and treatmentConsumer 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 changeGlobal 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
23Climate change and health risk Most people will be affected in some way by climate change in the early 21stCHealth 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 involvedClimate 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.
24Management classification Direct management- preventative and palliativeindirect management- reducing exposure to risks which may lead to poor healthmethods ofinterventionThe playersThe 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 factorsmales, who are obese, smokers and take little exercisebabies vulnerable to sun burn.Reduce povertyimprove housingimprove water supply and sanitationimprove educationlegislationtaxfinancial incentives educationcampaignstechnology, from safety belts, efficient boilers, syringes and medicine to taps.governments-NGOsTNCs and private organisationslocals
25Types of public heath care Public health interventionAims 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 careinvolves 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 illnessA key player may be the media in mobilising public opinionhealth 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
26Key Principles in pollution control PrecautionaryBegan Rio Earth Summit,linked with sustainable development .Where a threat appears to be present, even if not proven, action needs taking to protect the environmentEg reaction against GM foods, 1987 Montreal Protocol on CFCs and Ozone depletionMaastrict Treat of EUEven Body Shop has it enshrined in their corporate plan ban by EU of 22 commonly used chemicals in agriculturePolluter PaysMeans the costs of cleaning up pollution should be borne by those causing it. Started by OECD 1972.reaffirmed at Rio SummitEgEmissions Taxing in UK and at international scale:Kyoto ProtocolProximity PrinciplePollution should be tackled as near to the source as possible, contained, not allowed to spreadThis would apply toeg river pollutionor exporting of toxic waste to poorer less restricted countries- effectively global shift of ecological footprints!PreventionTry to stop at source rather than adapt after createdEg Urban Smokeless zones, energy efficiencyThe UK Environment Agency’s guidelines
27Examples of successful pollution remediation/elimination and hence reduced health risk Models of how international community can work together successfullyGlobal scaleCFC control Montreal protocolPhasing out of Leaded petrolChemical weapons ConventionMore 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 especiallyCandelaria, Chile- copper mining waste reduced from water suppliesChernobyl 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 emissionsHaina, 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 waterW Bengal India (reduction arsenic poisoning through removal of naturally poisoned ground water)
28International Efforts on health management and the MDGs Growth of international efforts to tackle health risks is linked tothe increasing scale and issues involvedglobalisation and interconnectivity of world economies ,political and financial affiliations, and flows of people and technologyInternational 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..
29W.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 diseasesAge of medical technology: Business as Usual scenario: limited co-operation between countries. MEDCs offset increased health risks by wealth + technologyLife expectancyAge of receding pandemicsAge of emerging infectious diseases: characteristic of poorer countries, dealing with double burden of infectious diseases and rise in chronic diseases as ageing of population increasesAge of famine + pestilenceTime -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