UNISA
CMH1503 – HEALTH AND
THE ENVIRONMENT
SUMMARY
IMPORTANT
- This is a summary of UNISA’s semester 1 &2 CMH1503 syllabus
- READ THROUGH YOUR UNISA STUDY GUIDE FIRST!
- While the UNISA Study Guide and the relevant text book have been used to create this summary, this
summary is a broad outline of the syllabus.
- Get an overview of the module and then study each topic individually
- Use this guide in conjunction with the UNISA study guide and text book – it is not a substitute
- Ensure you understand the content of this module in order to pass.
,Learning Theme 1 – Introduction to health, environment and sustainable development
1.0 Frumklin, H – What is environmental health
Environment
Definition: Miriam Webster
1. “The circumstances, objects, or conditions by which one is surrounded”
2. “the complex of physical, chemical and biotic factors (as climate, soil and living things) that act upon an organism
or an ecological community and ultimately determine its forms and survival”
- Human health – all external (or nongenetic) factors – physical, nutritional, social, behavioural and others that act
on humans.
Health
Definition: 1948 constitution of the WHO (2005)
1. “a state of complete physical, mental and social well0being and not merely the absence of disease or infirmity”
Environmental Health
Definition:
1. “Environmental health comprises those aspects of human health, including quality of life, that are determined by
physical, chemical, biological, social and psychosocial factors in the environment. It also refers to the theory and
practice of assessing, correcting, controlling and preventing those factors in the environment that can potentially
affect adversely the health of present and future generations” WHO 2004
2. “environmental health is the branch of public health that protects against the effects of environmental hazards
that can adversely affect health or the ecological balances essential to human health and environmental quality”
Agency for Toxic Substances and Disease Registration – Dept. Human Health and Human Services
Focus: physical & chemical hazards
The Evolution of Environmental Health
- Ancient Origins
o The environment has an impact on our comfort and well-being
o Our ancestors confronted other challenges that we would now identify with environmental health
Food safety e.g. procedures for preserving food, dietary restrictions due to religion or culture
Clean water – not soiling water sources, remains of toilets, water
Control of pests e.g. rodents
Cleanliness e.g. mould, bacteria illness in the Bible etc.
- Industrial Awakenings
o Sanitation issues rose to awareness during the rise of industrialization
o “The urban environment fostered the spread of diseases with crowded, dark, unventilated housing ,
unpaved streets mired in horse manure and littered with refuse; inadequate or non-existent water
supplies; privy vaults unemptied from one year to the next; stagnant pools of water; ill-functioning open
sewers; stench beyond the 20th century imagination; and noises from clacking horse hooves, wooden
wagon wheels, street railways and unmuffled industrial machinery” Leavitt 1982
o Clean water – even more pressing due to greater concentrations of people
o Disease outbreaks – cholera & yellow fever – 18 & 19th Century
o Industrial workplaces – technology advanced rapidly during the 18&19 Century, dangerous machines &
mass production was common
Air, water and soil near industrial sites were badly contaminated
Most abominable conditions: mines, mills and factories
o Charles Turner Thackrah (1795-1833)
Yorkshire physician
Interested in diseases observed among the poor in Leeds
The effects of the principled arts, trades and professions and of civic states and habits of living
on health and longevity with suggestions for the removal of many of the agents which produce
disease and shorten the duration of life (Book)
Proposed guidelines for the prevention of certain diseases e.g. Elimination of lead
glaze in pottery, use of ventilation and respiratory protection to protect knife grinders
Public outcry and efforts of Victorian reformers lead to the Factory Act in 1833 and the Mines
Act in 1842
o Occupational health did not blossom in the US until the early 20th Century
o Alice Hamilton (1869-1970)
A first-hand observer of industrial conditions, documented links between toxic exposure and
illness among miners, tradesmen, factory workers
Helped establish that workplaces could be dangerous environments for workers
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, o Population health – the beginnings of epidemiology
Observers could attribute certain diseases to certain environmental exposures
o John Graunt (1620-1674)
An English merchant and haberdasher analysed London’s weekly death records and published
his findings
First formal analyses of this data source and the pioneering example of demography
o William Farr (1807-1883)
Compiler of abstracts for the Registrar General’s Office (Office of population censuses and
surveys)
Made observations about fertility and mortality patterns, identifying rural-urban differences ,
variations between acute and chronic illnesses a, seasonal trends and implicating certain
environmental conditions in illness and death
Liverpool Sanitary Act of 1846 – created a sanitary code and a public health infrastructure to
enforce it.
o Edwin Chadwich (1800-1890)
Pioneer in combining social epidemiology with environmental health
Helped reform Britain’s Poor Laws
Sanitary conditions of the labouring population drew a link between living conditions and
health. Resulted in Public Health Act of 1848 which created the Central Board of Health
Advocated innovations e.g. urban water systems, per house toilets, transfer of sewage.
Helped est. the role of Public Works – to protect the public’s health
o Thomas McKeown (1979) pointed out that these innovations did more that medical care to improve
public health and well being
o John Snow ( 1813-1858)
Physician, founding member of London Epidemiological society
1854, Cholera outbreak observed the link between cleanliness and water
o Cultural life (parks, art, poetry etc.) reflect another aspect of environmental health.
- The modern era
o Chemical hazards
Rachel Carson – Silent Spring. Silent Spring
1962 publication focused on DDT (pesticide) and it’s increasing use since WW2
Ecosystem effects of DDT – how it entered the food chain, and accumulated in fatty
tissues
Linked to human health – may increase risk of cancer and birth defects
Irving Selikoff (1915-1992)
Mount Sinai School of Medicine studied insulators showed asbestos could cause a
fibrosing lung disease, lung cancer, mesothelioma and other cancers
Herbert Needleman (1927-)
Studied children in Boston/ Philadelphia and Pittsburgh
Showed that lead was toxic to the developing nervous systems causing cognitive and
behavioural deficits
o Environmental psychology
A subspecialty of psychology, building on advances in perceptual and cognitive psychology
Biophillia – the innately emotional affiliation with these organisms has become an innate part
of human nature
EO Wilson (Biologist) humans lived in natural settings interacting daily with plants, trees and
other people
o Ecohealth
Carrying capacity
o Expansion of health care services related to environmental exposures
Occupational medicine and nursing
1.1 WHO – Environmental impacts on health. What is the bigger picture
23% of all global deaths are linked to the environment (12.6m deaths)
- 3.8mSouth east Asia
- 3.5m West Pacific region
- 2.2m Africa
- 1.4m European Region
- 854k Eastern Mediterranean
- 847m Americas
10 causes of death (environmental)
- 8.2m out of 12.6m deaths are caused by the environment are due to non-communicable disease
1. Stroke – 2.5m
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, 2. Ischaemic heart disease – 2.3m
3. Unintentional injuries – 1.7m
4. Cancers – 1.7m
5. Chronic respiratory diseases – 1.4m
6. Diarrhoeal diseases – 846k
7. Respiratory infections – 567k
8. Neonatal conditions – 270k
9. Malaria – 259k
10. Intentional injuries – 246k
How the environment impacts our health
- Air pollution – indoor and outdoor
- Inadequate water, sanitation – and hygiene
- Chemicals – and biological agents
- Radiation – ultraviolet and ionizing
- Community noise
- Occupational risks
- Agricultural practices – incl. pesticide-use, waste-water reuse
- Built environments – incl. housing and roads
- Climate change
Who is the most impacted by the environment
- Environmental impacts on health are uneven across age and mostly affect the poor
- Children under 5 and adults between 50-75 are most affects
- Low and middle income countries bear the greatest share of environmental disease
- Men – slightly more affected due to occupational risks and injuries
- Women – bear higher exposures to traditional environmental risks such as smoke from cooking with solid fuels
or carrying water
We can improve our environment to improve our health
1. Apply low carbon strategies in energy generation, housing and industry
2. Use more active and public transportation
3. Introduce clean fuels for cooking, heating and lighting and clean technologies
4. Reduce occupational exposures and improve working conditions
5. Increase access to safe water and adequate sanitation and promote hand washing
6. Change consumption patterns to lower the use of harmful chemicals, minimize waste production and save energy
7. Implement interventions that can increase sun protective behaviour
8. Pass smoking bans to reduce exposure to second hand tobacco smoke
9. Always use a health in all policies approach to create healthier environments and prevent disease
Learning Theme 2 – The development of public health and the idea of a healthy environment
2.0 UN: Sustainable development goals
1 No poverty End poverty in all its forms, everywhere
2 Zero hunger End hunger, achieve food security & improved nutrition & promote sustainable
agriculture
3 Good health & well Ensure healthy lives and promote wellbeing for all ages
being
4 Quality education Ensure inclusive and equitable quality education and promote lifelong learning
opportunities for all
5 Gender equality Achieve gender equality and empower all women and girls
6 Clean water & Ensure availability and sustainable management of water and sanitation for all
sanitation
7 Affordable & clean ensure access to affordable, reliable , sustainable and modern energy for all
energy
8 Decent work & Promote sustained, inclusive and sustainable economic growth, full and productive
economic growth employment and decent work for all
9 Industry, innovation Build resilient infrastructure, promote inclusive and sustainable industrialization and
& infrastructure foster innovation
10 Reduced inequalities Reduce inequality within and among countries
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