1. Water, Public Health Problems, and Public Health Solutions: Foreground, to Background, to Foreground Shiriki Kumanyika, PhD, MPH PGWI Conference April 2009

2. Standard Methods for the Examination of Water and Wastewater Since 1905, Standard Methods for the Examination of Water and Wastewater has represented "the best current practice of American water analysts." This comprehensive reference covers all aspects of water and wastewater analysis techniques. Standard Methods is a joint publication of the American Public Health Association (APHA), the American Water Works Association (AWWA), and the Water Environment Federation (WEF). Standard Methods for the Examination of Water and Wastewater Since 1905, Standard Methods for the Examination of Water and Wastewater has represented "the best current practice of American water analysts." This comprehensive reference covers all aspects of water and wastewater analysis techniques. Standard Methods is a joint publication of the American Public Health Association (APHA), the American Water Works Association (AWWA), and the Water Environment Federation (WEF). Among the best selling publications of the American Public Health Association; more than 100 years of publication

4. “Why active membership in the American Public Health Association is important to sanitarians, engineers, and environmental health scientists” Charks L. Senn, P.E., M.S., F.A.P.H.A. American Journal of Public Health: 1965

6. # of articles on water and size of the volume of AJPH: 1912-2008

7. # Articles in the AJPH that carried the label engineers or engineering in the title

8. Ten Great Public Health Achievements, US, 1900-1999  Vaccination  Motor vehicle safety  Safer workplaces  Control of infectious diseases  Decline in CHD and stroke deaths  Safer and healthier foods  Healthier mothers and babies  Family planning  Fluoridation of drinking water  Recognition of tobacco use as a health hazard

9. Water and Chronic Diseases: Current Issues  Cancer prevention  Obesity and diabetes  Oral health  Food and environmental sustainability

11. Cancer Prevention Recommendations World Cancer Research Fund/American Institute for Cancer Research, 2009

14. Obesity: The Global Epidemic  Overweight and obesity represent a rapidly growing threat to the health of populations and an increasing number of countries worldwide World Health Organization, Geneva Consultation, June 1997; published as TRS 894

15. Who Consultation Countries  Australia, Bahrain, Canada, Chile, China, Cyprus, Denmark, Egypt, Indian, Ireland, Japan, Malaysia, Mauritius, Netherlands, Nigeria, Pakistan, Polynesia, South Africa, Sweden, Switzerland, Thailand, USA

16. Major health consequences of obesity  Diabetes  Cardiovascular diseases  Some types of cancer

17. The Gambia, West Africa Obesity Amidst Poverty Webb and Prentice Photoessay Int J Epidemiology, 2005

18. Source: Luke A. Nutritional consequences of the African diaspora. Annu Rev Nutr. 2001;21:47-71..

19. Global Prevalence of Obesity in Adult Males % Obese 0-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% Self Reported data North America USA 31% Mexico 19% Canada (self report) 17% Guyana 14% Bahamas 14% South Central America Panama 28% Paraguay 23% Argentina (urban) 20% Uruguay (self report) 17% Dominican Republic 16% Africa South Africa 10% Seychelles 9% Cameroon (urban) 5% Ghana 5% Tanzania (urban) 5% South East Asia & Pacific Region Nauru 80% Tonga 47% Cook Island 41% French Polynesia 36% Samoa 33% Eastern Mediterranean Lebanon 36% Qatar 35% Jordan 33% Kuwait 28% Saudi Arabia 26% European Region Croatia 31% Cyprus 27% Czech Republic 25% Albania (urban) 23% England 23% With examples of the top 5 Countries in each Region With the limited data available, prevalence's are not age standardised. Self reported surveys may underestimate true prevalence. Sources and references are available from the IOTF. © International Obesity TaskForce, London –January 2007

20. Global Prevalence of Obesity in Adult Females South East Asia & Pacific Region Nauru 78% Tonga 70% Samoa 63% Niue 46% French Polynesia 44% Africa Seychelles 28% South Africa 28% Ghana 20% Mauritania 19% Cameroon (urban) 14% South Central America Panama 36% Paraguay 36% Peru (urban) 23% Chile (urban) 23% Dominican Republic 18% North America USA 33% Barbados 31% Mexico 29% St Lucia 28% Bahamas 28% Eastern Mediterranean Jordan 60% Qatar 45% Saudi Arabia 44% Palestine 43% Lebanon 38% European Region Albania 36% Malta 35% Turkey 29% Slovakia 28% Czech Republic 26% % Obese 0-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% Self Reported data With examples of the top 5 Countries in each Region With the limited data available, prevalence's are not age standardised. Self reported surveys may underestimate true prevalence. Sources and references are available from the IOTF. © International Obesity TaskForce, London –January 2007

21. Global Prevalence of Overweight in Girls Prior to 1990 % Overweight < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% Self Reported data

22. Global Prevalence of Overweight in Girls 2000-2006 % Overweight < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% Self Reported data

23. Global Prevalence of Overweight in Boys Prior to 1990 % Overweight < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% Self Reported data

24. Global Prevalence of Overweight in Boys 2000-2006 % Overweight < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% Self Reported data

25. Source: http://www.who.int/diabetes/actionnow/en/mapdiabprev.pdf

26. Ogden CL et al. National Center for Health Statistics, 2007 Changes in the U.S.A. Weight Distribution  Since the 1960’s, average weights of U.S. men and women have increased by ~ 11 kg  Average height has increased by 2.5 cm

27. Source: Kumanyika S, Rigby N, Lobstein T, Leach R, James WPT. Obesity: Global Pandemic, In: Kopelman P, Cateron I, Dietz W, eds. Clinical Obesity in Adults and Children, 3rd Edition (in press)

28. FACTORS INTERNATIONAL Development Globalization of markets School Food & Activity WORK/ SCHOOL/ HOME Infections Labour Worksite Food & Activity Leisure Activity/ Facilities Agriculture/ Gardens/ Local markets COMMUNITY/ LOCALITY Health Care System Public Safety Public Transport Manufactured/ Imported Food Sanitation NATIONAL/ REGIONAL Food & Nutrition Urbanization Education Health O I T Y P R E V A L E INDIVIDUAL Energy Expenditure POPULATION % OBESE Social Security Transport Family & Home Media & Culture Food intake : Nutrient density Media programs & advertising Source: International Obesity Task Force [www.iotf.org] see Kumanyika S et al International Journal of Obesity 2002;26:425-36 OBESITYPREVALENCEOBESITYPREVALENCE Causal Web of Societal Processes influencing the population prevalence of obesity

29. Potential Policy Targets  Globalization  Media  Development  Urbanization  Transport  Health  Social security  Education  Food supply  Worksites  Trade  Advertising  Equity/Sustainability  Community design  Mass transit  Insurance; prevention  Poverty  School environments  Agricultural policies; food industry  Cafeterias; insurance incentives

30. All relevant professionals inside and outside the medical and health professions need to have knowledge of public health to an appropriate degree, build the need to protect public health into their work, and include the effect of their work on public health in assessment by their governing bodies and their peers

31. BMI per Person Target Population DALYs Gross Cost Net Cost TV viewing0.45227,0006,700$54.6M-$2.1M TV advertising0.172.4 M37000$0.13M-$300M Soft drinks0.13119,0001,060$3.3M-$5.2M Family-based targeted program 1.75,8002,700$11M-$4.1M Walking School Bus0.0316,00030$22.8M$22.6M Targeted multi-faceted school-based0.524,300370$0.56M-$0.08 Multi-faceted school-based +PE 1.1115,0008,000$40.4M-$28.7M Multi-faceted school-based –PE0.31115,0001,600$24.3M$11.2M Active After-School0.0799,000449$40.3M$36.6M Orlistat in adolescents0.863,300450$6.4M$4.0M Gastric Surgery (adolescents)13.94,10012,300$130 M$55.0M General practice counseling 0.259,700511$6.3M$3.0M High Projected Population Impact – Results from Australia Source: Haby, Vos, Carter et al.,, 2006

32. Source: Adapted from framework of The First Action Plan for Food and Nutrition Policy, WHO European Region, 2000–2005 Growing, buying, and eating the right kinds of foods can reduce the risk of disease and simultaneously promote a sustainable environment Food S afety Nutrition Sustainable Food Supply

33. www.cdc.gov

34. April 4, 2008  Privatizing water systems  Water safety in U.S. cities  Lead levels in Water in the District of Columbia  Global water and sanitation issues and mortality  Effects of ethanol production on safety of water supply  Effects of agriculture and urban development on U.S. water supply

35. Dec/Jan 2004

36. May 2002

37. March 2007

39. www.drinking-water.org

42. www.apha.org

43. Safe Water? Thank You