Environmental Health

1. epid: study factors determining and influencing the frequency and distribution of disease, injury, and other health-related events and their causes
2. Health surveillance: activity which involves obtaining information about EMPLOYEES health and which helps protect employees from health risks
   1. • Protecting the health of employees by early detection of adverse changes or disease;
      1. • Collecting data for detecting or evaluating health hazards;
         1. • Evaluating control measures.
   2. • there is a disease associated with the substance in use (e.g. Asthma, Dermatitis, Cancers);
      1. • it is possible to detect the disease or adverse change and reduce the risk of further harm;
         1. • the conditions in the workplace make it likely that the disease will appear.
3. Definitions
   1. Cause; an event, characteristic or condition that precedes a disease without which the disease or condition would not have occurred.
      1. Determinant; attribute or circumstance that effects the liability of an individual to be exposed or when exposed to develop the disease or condition
         1. Confounding variable; factor significantly associated both with the cause and disease in the population, but not the cause itself e.g. smoking/ Cancer
            1. Distinguishing cause from association using evidence linked to;
               1. Strength of association, Time, Distribution, Gradient, Consistency, Specificity, Biological Plausability, Models, Trials
            2. Risk; Absolute; incidence of disease within a defined population. Relative; ratio of incidence rate in an exposed group. Attributable = difference
               1. Descriptive Studies; Demonstrate patterns of disease within a population that can track mortality or morbidity over time and compae inc/prev.
                  1. Cohort Studies and Case Control Studie areObservational studies designed to test specific hypotheses, and aim to define the determinants of a disease
                     1. Cohort; Longitudinal study where a group/population is identified as being possibly exposed to an agent under investigation.
                     2. Case-control; recruitment of individuals already having the disease, with their case histories compared to a control group of subjects
                  2. Intervention Experiments designed to test efficacy of health care interventions or compare different methods. These are effectively clinical trials,

1. Water Treatment
   1. Extraction --> Storage --> Screening --> Coagulation --> Floculation --> Sedimentation --> Filtration --> Disinfection
2. Wastewater Treatment
   1. Screening --> Grit removal --> sedimentation --> activated sludge --> bacteria beds --> tertiary filtration
   2. Urban Wastewater treatment directive, Urban waste water treatment, environment act (1995)
3. Integrated Water Management involves the basic principle of managing the hydrological cycle, through supply, distribution and waste control.
   1. Areas of control include catchment areas, rivers systems and estuarine environments.
4. Related departments and bodies (UK)
   1. The National Rivers Authority + Her Majesty’s Inspectorate for pollution = Environment Agency
   2. OFWAT and DWI
5. Monitoring involves looking for nitrates, pesticides and crypto
   1. for rivers it wlso considers suspended solids, BOD and chemical oxygen demand.
6. EU directives
   1. regulation of quality of surface water for abstraction for drinking water, Drinking Water Directive, Exploitation & marketing of natural mineral water
7. IOM's IRIS scheme influenced by Water Bathing Directive and Blue Flag Scheme (in UK)

1. Environmental Health Offices allied to public health will also engage in tracking of outbreaks and education.
2. Control of Foodstuffs Directive (89/397/ECC) set out standards of hygiene and control for all member states
3. Food Standards Authority (FSA) in 2000, as a result of the Food Standards Act (1999) has strengthened enforcement of legislation to protect the public
   1. FSA Responsibilities
      1. • Food Safety Policy Group. • The Enforcement and Food Standards Group. • The Corporate Resources and Strategy Group.
      2. Power of inspection and enforcement of Food Safety Act 1990
   2. Food Safety Act 1990
      1. not to:- sell food not complying w food safety requirements - render food injurious to health - sell food which is not of the nature/substance/quality
4. Product Specific Management
   1. HACCP
      1. 1. Identify any hazards that must be prevented eliminated or reduced;
         1. 2. Identify the critical control points (CCPs)
            1. 3. Establish critical limits at CCPs;
               1. 4. Establish procedures to monitor the CCPs;
                  1. 5. Establish corrective actions to be taken if a CCP is not under control;
                     1. 6. Establish procedures to verify whether the above procedures are working effectively; and
                        1. 7. Establish documents and records to demonstrate the effective application of the above measures.
      2. Case Study. Implementation in Meat plants.
         1. In meat plants HACCP plans will focus on control measures that can reduce the likelihood of contamination of meat during production
            1. from microbiological hazards, such as Salmonella, E.coli O157 and Campylobacter,
               1. These meat-borne pathogens can be carried by healthy animals and cannot be detected by sight or smell.
                  1. Although thorough cooking kills most bacteria, meat may be handled by lots of people before it is cooked and the bacteria will spread to other foods
                     1. Bacteria multiply very quickly, especially in warm conditions
                        1. Retailers and consumers need to take precautions, including temperature controls & keeping raw meat & cooked meat & other ready to eat foods separate
      3. Identification and control of microbiological, chemical and physical food safety hazards during product development.
5. Local legislation includes the Food Act 1997 and the Food Hygiene Regulations 2007

Anexos:

• DEFRA tiered approach to risk assessment and management.

1. Environmental health practitioners are concerned by risk arising from environmental stresses.
   1. Hazard is a property or situation that in particular circumstances could lead to harm.
   2. Risk is the probability that and adverse situation could occur in a give period of time
   3. Risk Assessment, term used to describe a study of decisions to uncertain consequences
      1. identification of risks, identification of outcomes, estimation of magnitude of consequences, estimation of probability of outcomes, significance
   4. Risk Management, links risk estimation and evaluation to implementation of decisions to minimise risk.

Anexos:

• Scope of Environmental Health Services

1. Principles of Environmental Health
   1. 1. The maintenance and improvement of human condition is at the centre of all environmental action. A similar principle can found in Agenda 21 address
   2. 2. Disadvantaged groups within society are often live in the worst housing, have the most dangerous jobs and limited food.
   3. 3. Adoption of democratic principles of government will lead to effective management of environmental health.
   4. 4. Co-operation and partnership
   5. 5. Sustainable development: policy integration, partnership and appropriate scale
   6. 6. Environmental health issues are international
2. Definition (WHO, 2013)
   1. Environmental health addresses all the physical, chemical, and biological factors external to a person, & all the related factors impacting behaviours
   2. It encompasses the assessment and control of those environmental factors that can potentially affect health.
   3. It is targeted towards preventing disease and creating health-supportive environments.
   4. This definition excludes behaviour not related to environment, as well as behaviour related to the social and cultural environment, and genetics.
3. Royal Commission for Environmental Health are targets and frameworks for delivery by 2020:
   1. • holistic approach • quality of life • inequality • lifestyle • globalisation • democracy • information • integration • sustainable development

1. Definition
   1. b) and any substance or article which requires to be disposed of as being broken, worn out, contaminated or otherwise spoiled
   2. a) Any substance that constitutes scrap material or effluent or other unwanted surplus substance arising from the application of any process;
   3. It can be divided into sub-areas household, controlled, industrial, commercial municipal and hazardous.
2. Waste Management Planning
   1. Following the Earth Summit in Rio de Janeiro (1992) the UK produced the document Sustainable Development: The UK Strategy (1994):
      1. 1. minimise the amount of waste produced, 2. make best use of remaining waste 3. and minimise pollution from waste.
3. Waste Management Hierarchy
   1. Reduce --> Reuse --> Recycle --> Recover --> Dispose
4. Relevant Documents etc:
   1. Making waste work: A strategy for sustainable waste management in England and Wales (1995), and Waste Strategy 2000, reinforced by EPA (SEPA) in 2000
      1. • reduce levels of industrial waste going to landfill by 85% of 1998 levels by 2005,
      2. • to recover 40% of municipal waste by 2005, 45% by 2010 and 67% by 2015
      3. • recycle or compost 17% household waste by 2004
      4. • reduction biodegradable municipal waste (BMW) 75% by 2010
   2. EU Landfill Directive2002 Landfill Regulations 2002 EU Waste Incineration Directive 2000/76/EC (WID)
   3. The Waste Incineration (England and Wales) Regulations 2002. DETR Report of Composting Development Group (1999). Hazardous Waste Directive 91/689/EEC
   4. Controlled Waste Regulations 1992
5. Environmental health department with LAs
   1. • refuse collection, • disposal sites, allocation planning & monitoring, • hazardous & clinical waste • monitoring of street cleaning & litter & ed

1. Definition (WHO, 2013):
   1. Contamination of indoor/outdoor environment by any chemical, physical or biological agent that modifies the natural characteristics of the atmosphere
   2. Household combustion devices, motor vehicles, industrial facilities and forest fires are common sources of air pollution
   3. Pollutants of major public health concern include particulate matter, carbon monoxide, ozone, nitrogen dioxide and sulfur dioxide
   4. Outdoor and indoor air pollution cause respiratory and other diseases, which can be fatal
2. Related Documents: Rio and Agenda 21
   1. Both documents advocated the “precautionary principle” & “polluter pays principle”, and develop strategies where the private sector makes env costs
   2. Conventions on Carbon Dioxide (Kyoto Protocol) and CFC emissions (Montreal Protocol), later followed, tackling specific air pollution issues as identi
   3. Air Quality Policy
      1. target local levels of emissions with critical limits set by discharge consents (examine activity & risk to env & human health) with risk assessment
         1. Key to these assessments is the source of pollution. These include: • road transport • energy production • industrial process • and domestic sources
      2. UK
         1. London Smog episode of 1952 lead to 1956 Clean Air Act (1968+1993 too)
         2. Both central government and local authorities use model of Integrated Pollution Control developed by the Royal Commission on Environmental Pollution
      3. Europe
         1. Directive 96/62/EC on Ambient Air Quality Assessment aka Air Quality Framework Directive (lead, NOXs, SOXs and particulates)
            1. Europe meant UK could develop National Air Quality Standards (NAQS). Environment Act 1995, key objectives were to be met by 2005.
      4. Isle of Man
         1. The monitoring stations were discontinued further to results indicating continued good air quality.
            1. The only occasional exception is of intermittent concern in respect of ozone whose souce is most likely the UK
         2. 1997-2009 sttions measured Nox, SO2, CO, PM10 and PM2.5 and O3
         3. These are based on those standards detailed within the Air Quality Strategy for England, Scotland, Wales and Northern Ireland issued by DEFRA, 2000
3. It is transboundary and linked to global issues of climate change, acid rain and ozone layer damage