Summary

Samenvatting - Environmental Health (UA_2108WETEHS_2324)

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Module
Environmental Health (UA_2108WETEHS_2324)

Institution
Universiteit Antwerpen (UA)

This document is a summary of “Environmental Health” given at the University of Antwerp by Lidia Casas Ruiz in the Environmental Science course. The summary follows the structure of the lessons and summarizes the essentials in bullet points. The summary uses Dutch and English interchangeably.

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Uploaded on January 10, 2024
Number of pages 61
Written in 2023/2024
Type Summary

pollution
daly
environmental health
burden of disease
exposure
dose
effect
green spaces
pesticides
pfas
health protection
precautionary principle

Institution
Universiteit Antwerpen (UA)
Education
Milieuwetenschappen
Module
Environmental Health (UA_2108WETEHS_2324)

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Universiteit Antwerpen Master Milieuwetenschappen
Docent: Lidia Casas Ruiz 2023 – 2024
UA_2108WETEHS_2324

Inhoud
1 Environmental Health and the Burden of Disease ....................................... 1
1.1 Context ................................................................................................. 1
1.1.1 What is health?................................................................................ 1
1.1.2 What is public Health? ..................................................................... 2
1.1.3 What is Environmental Health?........................................................ 2
1.2 Historical case studies ........................................................................... 3
1.2.1 The Meuse Valley fog (12/1930) ....................................................... 3
1.2.2 The London fog (12/1952) ................................................................ 3
1.2.3 Investigation of 12 asthma outbreaks in Barcelona (1981 – 1986) .... 3
1.2.4 Conclusie......................................................................................... 3
1.3 Environmental pollution and the burden of disease ............................... 4
1.3.1 Pollution .......................................................................................... 4
1.3.2 DALY’s (Disability-adjusted life-year) ................................................ 4
1.3.3 Premature deaths ............................................................................ 4
1.4 Current topics in environmental Health ................................................. 4
1.4.1 Radiofrequency ................................................................................ 4
1.4.2 Water pollution ................................................................................ 4
1.4.3 (non-infectious) biological agents ..................................................... 5
1.4.4 Air pollution..................................................................................... 5
1.4.5 Noise pollution ................................................................................. 5
1.4.6 Climate change ................................................................................ 5
1.4.7 Green spaces ................................................................................... 5
1.4.8 The exposome .................................................................................. 5
2 Basic Principles in Environmental Health ................................................... 6
2.1 Exposure ............................................................................................... 6
2.2 Dose ...................................................................................................... 6
2.3 Effect ..................................................................................................... 6
2.4 Biomarkers............................................................................................ 7
2.5 Relationship between exposure and effect .............................................. 7
2.5.1 Spectrum from exposure to health effect .......................................... 7
2.5.2 Complex relationship between exposure and effect ........................... 7
2.5.3 Risk and ratio of risk ....................................................................... 8

1

,3 Developmental Origins of Health and Disease (DOHaD) ............................... 9
3.1 Concept ................................................................................................. 9
3.1.1 DOHaD key concepts ....................................................................... 9
3.2 DOHaD in Environmental Epidemiology ................................................ 9
3.2.1 The early life time window ................................................................ 9
3.3 Examples ............................................................................................ 10
3.3.1 The brain ....................................................................................... 10
3.3.2 Aging ............................................................................................. 10
4 Air quality................................................................................................. 11
4.1 Outdoor air quality .............................................................................. 11
4.1.1 Outdoor air pollutants ................................................................... 11
4.1.2 Exposure sources, pathways and routes ........................................ 12
4.1.3 Health effects ................................................................................. 13
4.1.4 Mechanisms of the health effects ................................................... 14
4.1.5 Health protection ........................................................................... 15
4.1.6 COVID-19 preventive measures and air quality .............................. 16
4.2 Indoor air quality ................................................................................. 16
4.2.1 Indoor chemicals: radon, PM, (s)VOCs............................................ 16
4.2.2 Biological agents ............................................................................ 18
4.2.3 Asthma .......................................................................................... 19
4.2.4 Promoting indoor microbiota .......................................................... 20
4.2.5 Mouldy buildings ........................................................................... 21
4.2.6 The indoor exposome ..................................................................... 21
5 Noise pollution .......................................................................................... 22
5.1 Basic concepts..................................................................................... 22
5.1.1 Sound ............................................................................................ 22
5.1.2 What is noise? ............................................................................... 22
5.2 Health effects ...................................................................................... 22
5.2.1 Local effects: tinnitus ..................................................................... 22
5.2.2 Systemic effects ............................................................................. 23
5.3 Health protection ................................................................................. 24
5.3.1 EU regulations ............................................................................... 24
5.3.2 WHO recommendations ................................................................. 24
5.3.3 How to reduce noise? ..................................................................... 25

2

,Samenvatting - inhoudstabel Environmental Health

5.4 Conclusion .......................................................................................... 25
6 Climate Change ........................................................................................ 26
6.1 Concepts ............................................................................................. 26
6.1.1 Weather vs climate......................................................................... 26
6.1.2 Global warming vs climate change ................................................. 26
6.1.3 Greenhouse effect and greenhouse gases ....................................... 26
6.1.4 Global warming ............................................................................. 26
6.2 Health effects ...................................................................................... 26
6.2.1 Floods............................................................................................ 27
6.2.2 Droughts ....................................................................................... 27
6.2.3 Heat and heatwaves ....................................................................... 27
6.2.4 Temperature .................................................................................. 28
6.2.5 Some of the largest disease burdens are climate-sensitive .............. 28
6.3 Mitigation and adaptation strategies .................................................... 29
6.3.1 Mitigation strategies....................................................................... 29
6.3.2 Adaptation strategies ..................................................................... 30
7 Green spaces ............................................................................................ 31
7.1 Health effects ...................................................................................... 31
7.2 Mechanisms ........................................................................................ 32
7.2.1 How does it work? .......................................................................... 32
7.2.2 Mitigation of environmental hazards .............................................. 34
7.2.3 Is any green good for the health? ................................................... 35
7.3 Vulnerable populations ........................................................................ 36
7.3.1 Children ........................................................................................ 36
7.3.2 Lowest socio-economic strata of the population .............................. 36
7.4 Health promotion ................................................................................ 37
7.4.1 WHO recommendations ................................................................. 37
7.5 Conclusion .......................................................................................... 37
8 Pesticides ................................................................................................. 38
8.1 What are pesticides? ............................................................................ 38
8.1.1 Persistent pesticides and POP’s (Persistent Organic Pollutants) ...... 38
8.1.2 Non-persistent pesticides ............................................................... 38
8.2 Exposure sources, pathways and routes .............................................. 39
8.2.1 Sources of exposure ....................................................................... 39

3

, 8.2.2 How can pesticides enter your body?.............................................. 39
8.3 Health effects ...................................................................................... 40
8.3.1 Endocrine system .......................................................................... 40
8.3.2 Neurodevelopment ......................................................................... 41
8.3.3 Thyroid function ............................................................................ 41
8.4 Health protection ................................................................................. 42
8.4.1 Farm to Fork Strategy .................................................................... 42
8.4.2 Scientific research ......................................................................... 42
8.4.3 How can you reduce your exposure to pesticides ............................ 42
9 Per- and polyfluoroalkyl substances (PFAS) ............................................... 43
9.1 What are PFAS? ................................................................................... 43
9.2 Exposure sources, pathways and routes .............................................. 43
9.2.1 Possible sources of exposure .......................................................... 44
9.2.2 How can PFAS enter your body ...................................................... 44
9.2.3 PFAS and PFOS exposure .............................................................. 44
9.3 Health effects ...................................................................................... 44
9.3.1 How might PFAS affect your health? .............................................. 44
9.3.2 Immune system ............................................................................. 44
9.3.3 Liver .............................................................................................. 45
9.3.4 Kidney = nier ................................................................................. 45
9.3.5 Thyroid = schildklier ...................................................................... 45
9.3.6 Reproductive development ............................................................. 45
9.3.7 Metabolic function ......................................................................... 45
9.3.8 Telomere lenght ............................................................................. 45
9.4 Health protection and the precautionary principle ............................... 46
9.4.1 The precautionary principle ........................................................... 46
9.4.2 The Stockholm Convention on Persistent Organic Pollutants .......... 46
9.4.3 Limits in the environment (EU) ...................................................... 46
9.4.4 Limits in Humans .......................................................................... 46
9.4.5 How can you reduce your exposure to PFAS? ................................. 46
9.5 PFAS in Flanders and Zwijndrecht ....................................................... 47
9.5.1 Conclusion .................................................................................... 47
9.6 Take home message of PFAS ................................................................ 47
10 Exposome............................................................................................... 48

4

,Samenvatting - inhoudstabel Environmental Health

10.1 Concept ............................................................................................ 48
10.1.1 Holistic ....................................................................................... 48
10.1.2 Life-course .................................................................................. 49
10.1.3 New tools/technology .................................................................. 49
10.1.4 Mechanistic knowledge (common pathways) ................................ 49
10.1.5 Towards untargeted discovery, unknown exposures, … ............... 50
10.1.6 Personalised prevention?? ........................................................... 50
11 Seminar: Nature – health - complexity .................................................... 51
11.1 Linkage between nature and health .................................................. 51
11.2 Biodiversity and health ..................................................................... 52
11.2.1 The good ..................................................................................... 52
11.2.2 The bad ...................................................................................... 52
11.2.3 The good and the bad.................................................................. 52
11.3 Challenges in nature......................................................................... 53
11.3.1 How can we deal with complexity? .............................................. 53
11.3.2 Critical view on complexity .......................................................... 53
11.3.3 What is IPBES? ........................................................................... 53
11.4 One Health ....................................................................................... 54
11.4.1 What is One Health ..................................................................... 54
11.4.2 Which competences do you need as One Health professional? ..... 55

5

,6

,Samenvatting Environmental Health

1 Environmental Health and the Burden of Disease
09/11/2023

This module introduces the concepts of health, public health and environmental
health. In addition, it provides an overview of the global burden of disease that
is attributable to pollution.

1.1 Context

1.1.1 What is health?
• State of complete physical, mental and social well-being
• There are a lot of factors that influence health
o Work env., education, age, sex, housing, …

1

,1.1.2 What is public Health?
• Preventing diseases
• Prolonging life
• Promoting health

1. Surveillance:
o Collect information on the status of disease
▪ Where, who, when?
o => establish health objectives and priorities
2. Health services
3. Disease prevention
o Primary prevention: prevent getting the disease
o Secondary prevention: screening and early diagnosis
o Tertiary prevention: ziekte vertragen
4. Health promotion
o Empowering people to life more healthy
5. Health protection
o Protect the population against hazards
o Bv: luchtkwaliteit, gezond drinkwater

1.1.3 What is Environmental Health?
• All factors (physical, chemical, biological) external to the human body
which may affect health
• Studies between exposure and development

4 disciplines in env. Health

1. Environmental toxicology:
o Studies in animal models or cells
2. Environmental epidemiology:
o Studies in populations
3. Health protection:
o Minimizing the exposure to health hazards
o By ensuring safety
4. Policy:
o Legislation to protect the population

2

,Samenvatting Environmental Health

1.2 Historical case studies

1.2.1 The Meuse Valley fog (12/1930)
• Zeer dichte mist over heel België
• In de Meuse Vallei:
o 10 keer meer doden dan gewoonlijk
o Ademhalingssymptomen
• What was the cause of symptoms and death?
o Industrie stoot gassen, roken en stof uit
o SO2: concentratie was hoog genoeg om symptomen en doden te
verklaren
• Why the Meuse Valley?
o => Meteorologische omstandigheden:
▪ Anticycloon boven de vallei (er ontstaat inversie, vervuiling
kan niet weg)
▪ Zeer zwakke wind (geen verdunning)
▪ Temperatuur inversie boven de schoorstenen in de vallei

1.2.2 The London fog (12/1952)
• Piek in luchtvervuiling
o Acuut effect: 4 000 extra doden tijdens de week van mist
o Lange termijn effect: 8 000 extra doden in totaal
• Mortality increases with SO2 + long term effect
o SO2 conc. Terug naar normaal, maar aantal doden blijft hoog

1.2.3 Investigation of 12 asthma outbreaks in Barcelona (1981 – 1986)
• Dichtbij de haven
• Uitladen van sojabonen

1.2.4 Conclusie
• Outbreaks: not only about infectious diseases
• Meteorology and air pollution
• Short-term effects vs long-term effects

3

, 1.3 Environmental pollution and the burden of disease

1.3.1 Pollution
“…unwanted, often dangerous, material that is introduced into the Earth’s
environment as the result of human activity, that threatens human health,
and that harms ecosystems.”

• 9 million deaths due to pollution every year ≈ aantal doden door roken
o Meeste doden door luchtvervuiling
o Meeste doden in Afrika en Azië
o Meeste doden in ‘lower and upper middle country income’
▪ => Vooruitgang veroorzaakt veel vervuiling

1.3.2 DALY’s (Disability-adjusted life-year)
• Number of years lost due to ill-health, disability or early death
• Young children are most vulnerable to DALY

1.3.3 Premature deaths
• Elderly are most vulnerable
• Very young children are not so resilient
• Mensen die vroeger sterven dan de verwachting

1.4 Current topics in environmental Health

1.4.1 Radiofrequency
• Ionizing radiation
• Non-ionizing radiation
o Daily use
• Over exposure => damage
o DNA mutations
o Class 2B: Possibly Carcinogenic to humans

1.4.2 Water pollution
• Microbes
• Chemicals
o Chemicals in drinking water
▪ Natural geochemicals
▪ Water treatment
▪ Human activities
▪ Packaging
o Recreational bathing
▪ Chlorine + organic matter => disinfection by-products (DBP)
▪ Can be carcinogenic
• Unsafe water, sanitation and handwashing = 11th cause of death
4

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