Global Environmental Health Exam 2
Physiologic monitoring
Blood pressure Heart rate Body temperature Treadmill test Pulmonary function testing EKG, EEG, EMG
travel/commerce factors that facilitate emerging diseases
Bubonic plague with rat flea via silk route from Asia, smallpox to Aztecs by Spaniards, Yellow fever with mosquito on ships from Africa to N-America, cholera from Ganges to Middle East to Europe
FEMA - Project Impact
Building a Disaster Resistant Community $20 billion spent by FEMA on repairs over the past 10 years, more by insurance companies Often rebuilding communities multiple times Three principles: - Preventive actions must be decided at the local level - Private sector participation is vital - Long-term investments in prevention measures are key
Earthquakes may cause:
Building and bridge collapse Floods Fires Tsunami (tidal wave) Landslides Dam ruptures
Food Insecurity
A situation that exists when people lack secure access to sufficient amounts of safe and nutritious food for normal growth and development and an active and healthy life. It may be caused by the unavailability of food, insufficient purchasing power, inappropriate distribution or inadequate use of food at the household level. may be chronic, seasonal or transitory.
Undernourishment or Chronic Hunger
A state, lasting for at least one year, of inability to acquire enough food, defined as a level of food intake insufficient to meet dietary energy requirements
7 steps of the HACCP system
(1) Analyze potential hazards (→what can go wrong) (2) Identify critical control points (CCPs) (→when/where) (3) Establish preventive measures with critical limits for each control point (4) Establish procedures to monitor the critical control points. (5) Establish corrective actions to be taken when a critical limit has not been met (6) Establish procedures to verify that the system is working properly (7) Establish effective record keeping to document the HACCP system
Between reservoir and host there may be
-An intermediate host (e.g. animal), -A vector (e.g. insect), -or a source (e.g. feces, vomit etc.)
Effective Disaster Plans Should:
-Be simple and well understood before the event -Be adaptable and geared to likely events -Establish realistic goals for those involved -Contain an effective command structure -Contain pre-determined means of communication -Contain provisions for an Emergency -Operations Center -Be drafted by participants in the plan -Be practiced by all participants and then refined
Famine
-Commonly follows natural disasters or warfare -Leads to clustering into refugee camps -Sanitation is problematic -Increases risk of infectious diseases -Rapid burial of corpses is essential but may be hindered by resources or local customs
Williams-Steiger (OSHA) Act (1970)
-Created to reduce exposure to hazardous conditions in the occupational environment -Passed in 1970 and amended 5 times -Broad powers to Secretary of Labor -Created OSHA -Created permissible exposure limits (PELs)
ecological factors that facilitate emerging disease
-Deforestation (more deer -> Lyme disease in NE-USA) -Expanded agriculture (hemorrhagic fever) -Changing agriculture (pigs with ducks = influenza) -Water use and handling (dams -mosquitoes)
Superfund Amendments and Re-Authorization Act, SAR
-Emergency Planning -Emergency Notification -Community Right to Know Reporting -Toxic Chemical Release Inventory Reporting
how are global temps measured?
-Fahrenheit mercury -robinson anemometer -crookes radiometer -ARGO buoys -remote sensing
The US EPA is mandated to abate noise under the
-Federal Noise Control Act (1972) -Quiet Community Act -the Office of Noise Abatement and Control in the EPA has not been funded since 1982, and not much is happening.
Emotional stress
-Following floods, fires, earthquakes, hurricanes and tornadoes, survivors are subject to depression, divorce, extreme stress, increased suicide rates. -Post-traumatic stress disorder -Response to disasters must address emotional needs as well as physical needs
Federal Emergency Management Agency, FEMA
-Founded in 1979, now part of the Dept. of Homeland Security -Budget for natural disasters cut drastically in the 1990s -Mission: To reduce loss of life and property and protect our nation's infrastructure from all types of hazards through a comprehensive, risk-based, emergency management program of mitigation, preparedness, response and recovery
Communicable diseases follow disasters b/c
-Increased population density increases transmission -Promotes contact with foreign pathogens -Numbers of vectors typically increase -Water supplies, sewer systems, medical facilities overwhelmed
Non-Governmental Disaster Response
-International Committee of the Red Cross and Red Crescent -American Red Cross -World Health Organization, Division of -Emergency and Humanitarian Action Many religious organizations
Noise Control Principles
-Low frequency sound travels around objects and through openings -Low frequency noise is less disturbing -High frequency sound is strongly directional and more easily reflected -High frequency sound is greatly reduced by passing through air -Air flow past hollow openings (pure tones) are worse than white noise
moisture: water activity
-Microorganisms need water in an available form -Solutes (Salts and Sugars) decrease the available water -Aw= ratio of vapor pressure of foods compared to water (a measure of moisture content) -Typical Aw values (Fresh Fruits, Meat, Cheese 0.95 -1.00; Crackers 0.10) -FDA defines those foods with an Aw > 0.85 as "potentially hazardous"
Occupational Injury Prevention Strategies
-Modify job or tools to improve safety -Substitution of machines for workers or mechanical assistive devices -Use personal protective equipment -Provide worker training & education -Selection/placement (history of previous back problems may be risk factor) -Systematic repeated workplace inspection with punitive measures -Top to bottom concern for safety
floods, flash floods
-Most common natural disaster -Population growth moves people to low lying areas -Floods destroy infrastructure in cities -Floods destroy crops and erode soil in rural areas -Caused by hurricanes, storms, tidal waves, heavy rainfall, snowmelt, forest fires, dike rupture -Early weather prediction has decreased fatalities
Persistent Organic Pollutants (POPs)
-Persistent, lasting for years or decades before degrading -Often highly toxic, damaging the CNS, endocrine system, reproduction and others -Evaporate and travel long distances; since this depends on the temperature, POPs travel from warm to cold climates -Accumulate in fatty tissue; this leads to "bioaccumulation" and "biomagnification"
Economic obstacles to improving WASH access
-Poor pay more for water -Perceived value and affordability of sanitation (install, maintain) -US water is subsidized so it doesn't cost as much for us
Trends That Increase Psychological Disorders
-Shift of jobs to health and service sectors -Increased use of computers and robotics -Increased jobs filled by women -Increased jobs with limited opportunities for growth and benefits -Increased numbers of workers assigned to each supervisor
What can be done: Awareness of Silence
-Silent meditation increases/improves ability to concentrate and learn -Incorporated times of silence increases empathy and peacefulness in disputes -Silences improves healing -Oases with less noise (small parks, backyards isolated from traffic, ...) increase well-being and enhance quality of life
WHO publishes list of top emerging diseases likely to cause major epidemics
-The initial list of disease priorities needing urgent R&D attention comprises: Crimean Congo haemorrhagic fever, Ebola virus disease and Marburg, Lassa fever, MERS and SARS coronavirus diseases, Nipah and Rift Valley fever. -The list will be reviewed annually or when new diseases emerge.
Mauna Loa Observatory
-The place where atmospheric carbon has been measured since 1958. The undisturbed air, remote location and limited influence of vegetation and humans make it ideal. -spikes show seasonal effects when plants are growing/not growing
Volcanoes
-Toxic gases are emitted -Scalding hazards exist -Landslides are a problem -Sea waves (Krakatoa) -Destruction or burial of property or towns -Refugee problems (e.g. Mt. Pinatubo) -Weather changes -Agriculture is affected which causes starvation
integrated pest management
-Understand the pest to be controlled -Understand environmental factors -Know available control approaches -Develop strategy to take advantage of pest's weaknesses, control strengths, environmental opportunities
viruses
-Vary widely in ability to withstand heat & cold -Do not increase in # while they are in food -Do not require specific foods to survive -Food & food-contact surfaces serve only to transport viruses -Reproduce once in a human host -Outbreaks are almost always due to poor personal hygiene or a contaminated water supply
vector-borne transmission
-Vectors: Mosquitoes, flies, fleas, ticks, lice -Carry microbes from reservoir to host -Mosquito takes blood meal from infected host and passes agent to naïve host on next blood meal -Flies carry fecal microorganisms to a food item later consumed by humans who become infected
Disproportionally higher burden to women's health and wellbeing
-Violence - rape, peeping -Social dignity -Marginalization - shaming, hazing -Bacterial vaginosis and urinary tract infections -Increased risk of adverse pregnancy outcomes -Infection from infectious diseases -Psychosocial stress -Physical injury -Fatigue -Loss of economic opportunity -Often are the ones going to get the water
National Disaster Medical System
-Volunteer medical professionals, under the control of the U.S. Public Health Service, with the ability to quickly move into a disaster area and provide medical care. -State based. Focus is on preparedness and team training. -Includes the National Veterinary Response Team
the birth of Millennium development goal era
-WHO and UNICEF establish Joint Monitoring Program for Water Supply and Sanitation to help make better decisions about resource allocation, planning, and management -no simple measurable indicators -no universal, comparable global monitoring tools -shift to collecting data through national surveys and censuses -develop new indicators for monitoring hygiene, water quality, management of excreta, and WASH in schools and health facilities -increasing focus on sanitation and inequalities in access
prions
-abnormal proteins -Mad Cow Disease -wasting disease -resistant to destruction by heat, UV light, ionizing radiation, sterilizing processes, disinfectants, phenols -transmission from cows to humans through dietary supplements, cosmetics, food additives, infant formulas, food, drugs, medical devices, and vaccines -can transmit to other humans through blood, tissue, and transplantation
natural toxins: fungi, algae, animal
-acutely toxic -> food poisoning -animals: puffer fish -fungi: mushrooms, molds -algae: shellfish poisoning
how is malaria controlled?
-aerial spraying of insecticide -natl Malaria Eradication Program
geoengineering ideas
-aerosols in stratosphere -iron fertilization of sea -pump liquid CO2 into deep sea -giant reflectors in orbit -pump CO2 into rocks -chemicals to save ozone -grow trees -cloud seeding -genetically engineered crops -greening deserts -pump sulfates into the air (volcano effect) -artificial trees capture and sequester CO2 -solar umbrella
PBDEs exposures by
-air (bound to dust particles) -food (fish and others)
metals in food contamination
-arsenic -cadmium -mercury
handwashing ladder
-basic: hand washing facility with soap and water in household -unimproved: handwashing facility without soap or water -no facility: no handwashing facility
the future with COVID
-better treatments -vaccines -testing -tracing -dogs
prevention for diarrhea
-breastfeeding -clean drinking water -safe food preparation -hand washing -barriers between animals and where children live -toilets --septage treatment systems, watershed management
climate change concerns
-changes in distribution of arable land -loss of polar land and sea ice -increased coastal flooding (displaced pops and increasing infectious disease) -deaths from heat waves, hurricanes, floods, climate disasters -global warming-inducted changes in major ocean currents -species extinctions and biodiversity loss
food contamination
-chemicals -natural toxins -biological contaminants
'new' infectious diseases
-ebola -HIV -dengue -chagas -cholera -yersinia pestis -vCID -malaria -TB
PBDEs used in..
-electronic equipment -polyurethane foams -hard plastics
SDGs Goal 6: water and sanitation for all
-eliminate open defecation -improve water quality by reducing pollution, eliminating dumping, and minimizing release of hazardous chemicals -achieve universal and equitable access to safe and affordable WASH -increase water-use efficiencies -eliminate inequalities in access (special attention to women and girls)
Federal agencies for occupational health
-environmental protection agency -occupational safety and health agency -national institute for occupational safety and health
climate change and water scarcity
-expected to worsen with pop growth, climate change, and inefficient use of existing resources
alcoholism
-expensive to treat alcohol abuse -many deaths due to abuse
exposure of PCBs
-food (bioaccumulation and biomagnification) -air (buildings sealants, caulking, paint) -air (pigments in paints)
why food insecurity and obesity in southern states?
-food deserts -healthy food too expensive
Campylobacter
-found in intestinal tracts of animals and birds, raw milk, untreated water, and sewage sludge -transmitted by contaminated water, raw milk, raw/undercooked meat / shellfish -all cases occur as isolated, sporadic events -many undiagnosed or unreported
E.coli
-found in intestinal tracts of mammals, raw ilk, unchlorinated water -transmitted by contaminated water, raw milk, raw/rare ground beef, unpasteurized apple juice/cider, uncooked fruits and veggies, person-to-person
clostridium food poisoning
-found in soil, dust, sewage, and intestinal tracts of animals and humans -transmission from food left for long periods in steam tables or at room temperature
botulism
-found in soil, water, plants, intestinal tracts of animals and fish -transmitted by improperly canned foods, garlic in oil, vacuum-packed and tightly wrapped food -main kinds of botulism: foodborne; infant; wound
staphylococcus food poisoning
-found on humans (skin, infected cuts, noses, throats) -transmitted by people to food through improper food handling -multiple rapidly at room temp to produce toxin
protozoa
-from fecally-contaminated food (lettuce): irrigation of veggie crops with inadequately treated wastewater
roundworms
-from improperly cooked infected pork products -more common to contract from wild game
hierarchy of controls in occupational health top to bottom
-from most effective to least elimination - physically remove hazard substitution - replace hazard engineering controls - isolate people from the hazard administrative controls - change the way people work PPE - protect worker with PPE
cross-contamination
-good hygiene habits -proper storage of foods -proper storage of toxic items
socio-political obstacles to improving sanitation access
-governance: investment in sanitation considered low priority by households and governing ministries relative to water, vaccines, drugs -civil factors: lack of systems to ensure sustainable management of facilities and sewage; limited capacity in urban slums (high tenancy, informal settlements, space, infrastructure)
therapeutic/treatment for diarrhea
-health knowledge -oral rehydration salts -accessible, affordable care (knowledgeable CHWs) -antibiotics, IV, cold storage systems for vaccines -trained, prepared health care system
Neurotoxic Shellfish Poison (NSP)
-highly poisonous neurotoxin produced by algae -red blooms cause red tide which indicates possibility of contamination of shellfish -NSP toxins accumulate in shellfish making them harmful when eaten
defining improved sanitation
-impermeable barriers between users and human excreta -private -septage tank or sewer connection
PCBs use
-in capacitors, transformers -in plasticizer, surface coatings, sealants -in adhesives, cutting oils -pesticide extenders production stopped in US in 1970s
Should we in the USA be concerned about infectious diseases?
-increased prevalence of infectious and parasitic diseases -drug resistance -cost (25% of all visits to docs attributed to infectious disease -(re)emerging infectious diseases
10 indicators of a warming world
-increasing air temp near surface -increasing humidity -increasing temp over oceans -increasing sea surface temp -increasing sea level -increasing ocean heat content -increasing temp over land -decreasing glaciers -decreasing snow cover -decreasing sea ice
severe traumatic injuries
-intentional (workplace violence) and unintentional -2nd leading cause of unintentional death on job -most preventable
obesity leads to morbidity and mortality
-leads to sex hormone imbalance which leads to hormone dependent tumors -leads to increased free fatty acids which leads to metabolic syndrome which leads to type 2 diabetes and cardiovascular disease -leads to mechanical stress which leads to sleep apnea, osteoarthritis, low back pain, shortness of breadth
reasons for hunger
-limited food production (from poor soil, loss of fertile soil to urbanization, wash off) -wars, civil unrest (production and distribution problems) -climate change (heat, flooding, drought, pests) -poverty and increasing income inequality (more personal income = more heat
climate change impacts...
-more extreme weather -rising sea level -increasing CO2 levels -rising temps
influenza
-multiple pandemics -usually from birds to humans -antigenic drift -antigenic shift (2+ strains combine0
arsenic in foods
-natural soil and ground water component -pesticides -computer chips, semiconductors -glassware, paints -occurs in food and water
biological contaminants
-parasites (roundworms, protozoa) -bacteria (salmonella, shigella, listeria) -viruses (Hep A) -prions
secondary barriers to diarrheal disease
-personal, household, and food hygiene -water quality
contributing factors to foodborne illness
-poor personal hygiene -improper holding -inadequate cooking -unsafe source -other -contaminated equipment/environment
what changed in past 20 years to lead to obesity?
-portion sizes and eating patterns -sedentary lifestyle -less strenuous work
measuring basic handwashing
-presence of a device to contain, transport, or regulate flow of water -observe not self-reported
Infection means that the causative organism is:
-present in the host -actively replicating such that the host develops subclinical or clinical disease.(Infection is more than just colonization)
factors that influence potential incidence of vector-borne disease
-prevalence of vectors and reservoir -temperature range, rainfall, winds -climate change -life cycle of vectors -seasonal fluctuation of vectors and reservoir -disasters (natural and man-made)
defining improved water source
-proportion of people using household piped water connection; public standpipe; borehole; protected dug well; protected spring; rainwater -accessible -free of contamination
mercury in food
-released by coal burning, waste incineration, metals processing -due to human activities -biotransformation of Hg to more toxic organic form -bioaccumulation
cadmium in food
-released from mining, smelting, coal burning -industrial use -exposure in food from plant uptake, accumulation, and high levels in shellfish -exposure in smoking -long half life
hierarchy of noise controls (top to bottom)
-remove the noise sources from the workplace -replace the noise sources -reduce noise levels -change work practices to reduce duration of exposure to noise levels -protect hearing with hearing PPE
where was contaminated food consumed (in order of high to low)
-restaurant or deli -banquet facility -private home -other -school -prison, jail -hospital, nursing home -church
natural toxins: bacteria
-staphylococcus -clostridium -campylobacter -E.coli -produce -> enterotoxins
local level response to disasters
-state Emergency response commission -community disaster plans -hospital disaster plan -NGO response plans
examples of neglected tropical diseases
-trachoma -soil transmitted helminths -schistosomiasis -diarrheal disease
Hep A
-transmitted by contamination of foods by infected workers in food processing plants and restaurants
shigella
-transmitted by food (especially salads) prepared/handled by workers using poor personal hygiene
salmonella
-transmitted by raw or undercooked eggs, poultry, and meat; raw milk and dairy products; seafood and food handlers
norwalk virus
-transmitted by raw shellfish and veggies, prepared salads and water contaminated by human feces
listeria
-transmitted by soft cheese, raw milk, improperly processed ice cream, raw leafy veggies, meat, and poultry -at risk pops: pregnant women, newborns, persons w weakened immune systems
Noise
-undesirable sound -sound that causes problems with sleep, learning, communication, safety, physical or mental health
symptoms of food-borne diseases
-upper/lower gastrointestinal tract symptoms (nausea, vomiting, cramps, diarrhea) -infection symptoms (fever, chills, aches, malaise) -neurological symptoms (visual disturbances, vertigo, tingling, paralysis)
primary barriers to diarrheal disease
-vet care -food safety -sanitation and animal containment
what is the threshold of hearing?
0 dB
ARGO buoys process
1. 6-12 hours at surface to transmit data to satellite 2. descent to depth 3. drift 9 days 4. float descends to begin profile from a greater depth 5. salinity and temp profile recorded during ascent
Department of Homeland Security 4-point agenda
1. Border Security and Enforcement 2. Combating Terrorism and Countering Emerging Threats 3. Cybersecurity, Critical Infrastructure Protection, Election Security 4. Disaster Response and Building Resilience
Essential Indisputable Facts about climate change
1. Carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O) are greenhouse gases (GHGs) that trap heat and warm the earth 2. Atmospheric concentrations of CO2 have increased dramatically since 1850 (the industrial revolution) from burning fossil fuels for energy (285à410 ppm) 3. The increase in GHGs has produced global warming, sea level rise, ocean acidification and extreme weather events 4. Once released to the atmosphere, GHG require decades to centuries to return to baseline 5. Global warming produces climate change marked by extreme weather events and species extinctions 6. The longer we wait to begin serious mitigation, the tougher it will be to adapt
Department of Homeland Security 6-point agenda
1. Increase overall preparedness, particularly for catastrophic events 2. Create better transportation security systems 3. Strengthen border security & interior enforcement and reform immigration processes; 4. Enhance information sharing with our partners 5. Improve DHS financial management, 6. Realign the DHS to maximize mission performance
8 reasons why zero hunger changes the world
1. Zero hunger could save the lives of 3.1 million children a year 2. Well-nourished mothers have healthier babies with stronger immune systems 3. Ending child undernutrition could increase a developing country's GDP by 16.5 percent 4. A dollar invested in hunger prevention could return between $15 and $139 in benefits 5. Proper nutrition early in life could mean 46 percent more in lifetime earnings 6. Eliminating iron deficiency in a population could boost workplace productivity by 20 percent 7. Ending nutrition-related child mortality could increase a workforce by 9.4 percent 8. Zero hunger can help build a safer, more prosperous world for everyone
4 steps of climate change mitigation
1. massive cuts in global CO2 emissions by 80% 2. stabilization of world pop at 8 billion 3. eradication of global poverty 4. restoration of forests, soil, aquifers, and fisheries
an increase of 20 dB equals a __-fold increase in pressure
10-fold
Fatal Fire in Bangladesh Highlights the Dangers Facing Garment Workers
111 people died Saturday and Sunday in a fire at a garment factory
what is the pain threshold for sound levels?
140 dB
forest sound pressure
18 dB
US Health and Safety Milestones
1890 - Wrongful death suits against employers 1908 - Federal Workers' Compensation Act 1930 - Gauley Bridge Project -476 silicosis deaths 1936 - Walsh-Healey Public Contracts Act 1938 - ACGIH (American College of Governmental Industrial Hygienists) founded to develop list of TLVs (Threshold Limit Values) 1968 - Farmington WV coal mine explosion kills 80 1969 - Coal Mine Safety and Health Act 1970 - Williams-Steiger (OSHA) Act: Created OSHA & NIOSH 1976 - Toxic Substances Control Act: Right-To-Know
Svante August Arrhenius
1896 -On the Influence of Carbonic Acid in the Air upon the Temperature of the Ground "Hothouse Effect" later renamed the Greenhouse Effect He predicted a doubling of the CO2concentration would produce an average temperature increase of about 5°C
FQPA (Food Quality Protection Act)
1996, amended parts of FFDCA and FIFRA FDA enacted measures to prevent BSE/vCJD epidemics, i.e. ruminant feed ban (1997), mammalian feed ban, BSE surveillance program (3 BSE cows so far)
how much of an increase in health care spending over last 15 years attributable to obesity?
25%
diarrhea is __ leading cause of death in children
2nd
The Greenhouse Effect
30% of incoming solar radiation is reflected by clouds, particulates, and the earth's surface 70% is absorbed and must be dissipated The absorbed energy heats the atmosphere and surface and is then re-radiated as long-wave infrared radiation Water vapor and GHGs interfere with dissipation and keep the surface ~33°C warmer This makes the Earth inhabitable
how many premature deaths annually associated with obesity?
300 thousand
conversational speech sound pressure
60 dB
Threshold Limit Values (TLVs) range from
80 dBA for a 24-hour period to 139 dBA for 0.11 seconds
average street traffic sound pressure
85 dB
what is OSHA Action Level?
85 dBA
what is OSHA permissible exposure limit (PEL)?
90 dBA
Bhopal Disaster
A Union Carbide India Limited (UCIL) pesticide manufacturing plant leaked a mixture of 32 tons of deadly gases including methyl isocyanate, leading to the world's worst industrial disaster
disaster definitions
A disaster is an occurrence causing widespread destruction and distress; a catastrophe. A disaster is a natural or man-made event that negatively affects life, property, livelihood or industry often resulting in permanent changes to human societies, ecosystems and environment.
Triangle Shirtwaist Factory Fire
A dropped match on the 8th floor of the Triangle Shirtwaist Factory sparked a fire that killed over a hundred innocent people trapped inside
types of anthropogenic disasters
Chemical releases Radiological releases Fires Air pollution emergencies Famines Train/plane wreck Terrorist actions Warfare Explosions
disaster management factors
Command and control is important: Disasters do not respect jurisdictional boundaries. Disasters are dynamic -Accurate, up-to-date information is the most important resource Time: Rescue of trapped victims must occur within 18 hours. Survival falls markedly thereafter
Assessment of Measurement Results in occupational health
Compliance with ACGIH guidelines (not enforceable) -TLV - threshold limit value -BEI - biological exposure indexes compliance with government standards (legally enforceable) -PEL-Permissible Exposure Limit set by OSHA -Safety standards -Noise standards -Housekeeping & record keeping requirements
Social and cultural determinants of WASH access
Consistent availability (Ownership) Time and physical challenges (Heavy jerry cans) Conflict and violence Cultural value (Some don't want to bring a toilet into the home because it is seen as dirty)
Approaches to Noise Control
Construct equipment to emit less noise Isolate source Reduce vibration Machines should be vibration isolated Eliminate pure tones Interfere with transmission Protect receiver
reduction of vector-borne infectious disease
Control of the reservoir (Humans Rats, Mice Deer (herd control →Lyme disease, Mad deer dis.) Birds (West Nile Virus →sentinel chicken)) Control of the vector Mosquitoes Mites, Lice Ticks Roaches Others
Psychological Disorders with occupations
Affective disorders (anxiety, depression) Behavioral problems (sleep difficulties) Substance abuse Causes: work overload, lack of control, repetitive tasks, rotating and night shifts, machine-paced work, non-supportive coworkers, role ambiguity
National Occupational Research Agenda (NORA) Disease and injury priorities
Allergic & Irritant Dermatitis Asthma and Chronic Obstructive Pulmonary Disease Fertility and Pregnancy Abnormalities Hearing Loss Infectious Diseases Low Back Disorders Musculoskeletal Disorders of the Upper Extremities Traumatic Injuries
NIOSH recommends noise exposure criteria of
An eight hour TWA limit of 85 dBA
Industrial hygiene
Anticipation- anticipate hazardous situations and design safe processes Recognition- recognize dangers Evaluation- quantify hazards and set priorities Control- conceive and implement controls Management- coordinate resources, provide training, maintain records
Examples of Preventable Occupational Lung Diseases
Asbestosis Byssinosis Coal Workers' Pneumonconiosis Silicosis Lung Cancer Occupational Asthma Hypersensitivity Pneumonitis
Hearing Conservation Program
Assessment of noise exposure Audiometric testing of exposed workers & notification of deficits Noise reduction through engineering controls or new equipment Maintenance of records of noise and hearing data Proper fit of personal hearing protection devices Worker training and education
spoilage
Damage to the edibility of foods (unacceptable taste, smell, or appearance)
Paracelsus
Declared "the amount makes the poison"
Agricola
Described the hazards of mining and metal production
Pre-Event Period
Develop disaster response plan -Chain of command -Communications plan -Availability of resources -Evacuation routes Mobilization of personnel Training and drills Public Education
The HACCP System: Hazard Analysis& Critical Control Point System
Developed for NASA to prevent food-borne illnesses among astronauts Emphasizes prevention rather than detection Incorporated into FDA's "Food Code" USDA uses HACCP for the meat and poultry industry
Centers for Disease Control and Prevention (CDC)
Devoted to preventing unnecessary disease, disability and premature death -Surveys and studies various environmental and chronic health problems -Administers national programs for prevention and control of vector-borne diseases -Investigates outbreaks of food-borne illness
occupational medicine
Diagnosis Treatment Surveillance Prevention of diseases
P. Pott
Discovered Chemical Carcinogenesis
climate factors that facilitate emerging diseases
Dry spells, torrential rains, heat, Global Climate Change?! (Vibrio cholera in oceans, hantavirus in deer mice, expanding mosquito habitat)
types of natural disasters
Earthquakes Hurricanes Floods, tidal waves Tornadoes, windstorms Landslides Severe temps Volcanoes
National Occupational Research Agenda (NORA) Workforce Environment Priorities
Emerging Technologies Indoor Environment Mixed Exposures Organization of Work Risk Assessment Methods Special Populations at Risk
Occupational hazards
Ergonomics & Vibration Noise Heat & Cold Stress Illumination Electromagnetic Radiation Chemical Agents Radiologicals Biological Agents Stress
Why should an employer invest in occupational health programs
Ethics: doing what is "right" Policemen: OSHA inspections and fines Hammer: liability lawsuits Carrot: increased productivity and profits Goodwill: reputation for social responsibility (PR)
Occupational Cancer detection
Evaluation of clusters in industry and Medical-Legal evaluations for "causal connection" same tumor sites and types length of exposure intensity of exposure Latency confounding factors contributing factors
food safety agencies
FDA USDA EPA CDC
EPA laws
FIFRA (Federal Insecticide, Fungicide, and Rodenticide Act, 1972): Bases for regulation, sale, distribution and use of pesticides in the U.S. FFDCA (Federal Food, Drug, and Cosmetics Act): authorizes EPA to set maximum residue levels for pesticides used in or on foods or animal feed. FQPA (Food Quality Protection Act) 1996, amended parts of FFDCA and FIFRA exempts pesticides from Delaney clause
disaster response entities in US
Federal Emergency Management Agency National Disaster Medical System
Pakistani Factory Fires
Fire ravaged a textile factory complex killing almost 300 workers trapped behind locked doors
USDA services
Food Safety and Inspection Service (FSIS) -Inspection of meats, poultry, eggs for bacterial contamination and residues of pesticides, drugs and other chemicals (National Residue Program) -Less sample inspections (sniff and poke), more HACCP Agricultural Marketing Service (AMS) -standardization, inspection and grading services with respect to meat, poultry, eggs Federal Grain Inspection Service (FGIS) -Inspection of corn, sorghum and rice for mycotoxins, as well as the quality of domestic and exported grain, rice and related commodities.
Alice Hamilton
Founder of American Industrial Hygiene
Ramazzini
Founder of Occupational Medicine
methods to reduce water activity
Freezing Dehydrating Mixing with a solute (salt or sugar) Cooking (e.g. bacon)
High Middle Ages worker protection
Guilds had assistance programs for disabled members
Half of all deaths among young working age adults and children worldwide are caused by just SIX infectious diseases
HIV/AIDS TB Diarrheal diseases Malaria Measles Acute respiratory infections such as pneumonia
Occupational Cancers -Preventive Measures
Health protection -understand causes -reduce exposures Health promotion -smoking cessation -lifestyle changes Health services -early detection and treatment
Occupational Lung Diseases
High prevalence among specific groups -coal miners, sand blasters Long latency may impair recognition -asbestosis, silicosis Cigarette smoking may obscure relation between disease and work exposures Early recognition of asthma and hypersensitivity pneumonitis (HP) are crucial to prevent chronic disease
Occupational Cancers
High relative risk among some groups Long latencies between exposure and clinical disease Interactions with other exposures (e.g. cigarettes) and behavioral factors (e.g. alcohol and diet)
Worker's Compensation in the US
Historically: -employee must sue employer and prove causation and negligence -employer claims assumption of known risk and contributory negligence by employee or co-worker Legislated Worker's Compensation (1906): -payment of medical costs for loss of gainful employment without assumption of fault -each state has their own system and rate schedule
Triage Categories
I. RED - Severe injuries, life threatening II. YELLOW - Major injuries III.GREEN - Walking wounded IV. BLACK - Dead or soon to be dead Principle: Greatest good for greatest number of persons with the least depletion of available resources
psychological disorders prevention in occupational health
Improve working conditions (schedules, control, workload, content, roles) Surveillance for psychological disorders and risk factors Education and training Enrichment of psychological health services Prevention of bullying, hazing, discrimination Culture of teamwork and appreciation
Challenge: Difficulties in Recognition of Occupational Diseases
Inadequate training of health professionals Hidden Risks Non-specificity of clinical manifestations Long latent periods Non-occupational confounding exposures
pathogen
Infectious or parasitic agent that causes harm to human health
Occupational Diseases and Injuries (by organ or type)
Injury: Traumatic and Musculoskeletal Lung Cancer Skin Hearing Cardiovascular Reproductive Neurologic -Psychologic
Iowa Department of inspections and appeals
Inspects and licenses food-related establishments, egg handlers, and food warehouses
bioterrorism (anthropogenic)
Intentional release of infectious agents or toxins into air, water or food with the intent to cause harm and produce chaos emerging concern -antibiotic resistant organisms -genetically engineered organisms -extremely virulent viruses
Emergency Preparedness in Iowa
Iowa Homeland Security and Emergency Management Iowa Department of Public Health Bureau of EMS Iowa Emergency Management Association
What can be done for occupational health
Isolation of the stressor/toxicant Local & general exhaust ventilation Personal protective equipment Worker screening Automation Wellness programs Exposure assessment & biomonitoring Needed: Research data; Enforcing agency
geoengineering
Large-scale intervention in the climate system to mitigate global warming
muscoloskeletal injuries
Leading cause of disability among workers Large cost to industry (esp. low back pain) Increases projected -Aging workforce -More service and information jobs (VDTs) Trend toward enhanced performance
Holding temperatures should be:
Less than 40°or Greater than 140°
Musculoskeletal Injuries: Etiologic Factors
Manual handling of materials -Low back injuries Repetitive motion -Cumulative trauma disorders Vibration exposure -Vibration syndrome -Vibratory White Finger
Reproductive disorders problem
Maternal effects and paternal effects Difficult to quantify problem Many different types of adverse effects: Infertility, impotence, menstrual disorders, spontaneous abortion, low birth weight, birth defects, congenital mental retardation, genetic diseases
Sound
Mechanical vibration traveling through a medium (usually air) as a waveform and can be "heard"
chemical contamination
Metals Pesticides Hormones(DES) →endocrine disruption? Antibiotics(→resistance, allergies?) Industrial organic contaminants Packaging and cookware material residue
Warning Period
Meteorology systems Communications systems (sirens, media) Citizen corporation Put rescue personnel on alert Evacuation (e.g. hurricanes)
pH and bacteria
Microorganisms of food safety concern grow best at neutral pH (~7) These organisms do not grow, or grow very slowly below a pH of 4.6 Spoilage organisms can grow at low pH
noise-induced hearing loss
Millions of workers exposed to more than 85 dBA(usual standard) 500,000 manufacturing sector workers have moderate to severe hearing loss Irreversible sensorineural condition that progresses with exposure Insidious loss eventually causing impairment in understanding speech
Criteria for Intervention: Creating a healthy work environment
Mortality: ensuring simple elements of survival Morbidity: prevention of disease or disability -Acute, chronic or delayed responses Transient effects: prevention of reversible effects -Fatigue, intoxication, sensory irritation Comfort: preservation of well-being -Odors, thermal discomfort Non-health-based criteria -Economic losses, technological or psychosocial feasibility
National Marine Fisheries Service (NOAA)
NOAA Fisheries conserves, protects, and manages living marine resources -To ensure their existence as functioning components of marine ecosystems and as economic opportunities Magnuson-Stevens Fishery Conservation Act (reauthorized 2006) -Deals with 1) Overfishing, 2) environmental degradation, 3) incidental catching of fish other than desired species
urbanization factors that facilitate emerging diseases
No adequate water, sewage, housing results in fecal contamination, contact with parasites
incident definition
One occurrence of a highly characteristic illnesses such as botulism. number of cases of a given illness that have been recorded in one outbreak.
dermatologic conditions
Overrepresented because easier to report and record than other occupational diseases 1/3 of all chronic occupational diseases Largest number of cases in manufacturing sector Highest rate of cases in agriculture/fishing/forestry sector
Disaster Response Requires Cooperation
Police Fire Fighters Medical Facilities Utilities (water, sewer, gas, electric, telephone) Public Sanitation Officials (solid waste, rodent & insect control) National Guard (quick mobilization of labor) Citizens
HACCP Final Product = Flow Chart
Possible Hazard CCP (?) Operational Step Type of Monitoring Corrective Action if Standard Not Met Standard or Criteria Applied (verify) Applicable Records
Occupational Cardiovascular Diseases
Problem: Occupational causes for CVDs are overshadowed by personal risk factors (smoking, blood lipids) Importance: to prevent even small occupational risks for CVD (additive or even synergistic effects) Risk factors for CVDs: carbon monoxide, carbon disulfide, nitroglycerin, halogenated hydrocarbons, noise (!)
EPA (Environmental Protection Agency)
Protection of human health and the environment by writing and enforcing legislation
Response Period
Quick mobilization Maintenance of law and order Prioritization of response actions Triage of victims Housing, water, food, sanitation Infectious disease prevention
Principal contaminants of concern
Radioiodine Radiostrontium Radiocesium
US Department of Agriculture (USDA)
Regulates and monitors the safety and labeling of domestic and imported grains, meat and poultry products and certain egg products Authorization from (among others): -Meat Inspection Act (1906), amended to -Wholesome Meat Act (1967) -Poultry Productions Inspection Act (1957)
Sampling Objectives in occupational health
Research or epidemiologic study -Characterize hazards -Characterize exposures -Test hypotheses regarding dose-response Engineering -Source identification and control Compliance -OSHA -Evaluate likely maximum exposed worker
pesticide use factors that facilitate emerging disease
Resistance of vector, too expensive, too toxic
Environmental Protection Agency (EPA)
Responsible for regulating pesticides used in growing foods -Sets tolerances or limits for the amount of pesticide residues that lawfully may remain in or on foods marketed in the United States -The agency also works with state governments to establish permissible levels of contaminants in seafood harvesting waters
Recovery period
Restoring infrastructure Financial assistance Post-traumatic stress Education and outreach activities
What does SIR stand for in epidemic models
S: susceptible (healthy) I: infected (sick) R: removed (immune/dead)
what does sound pressure level (SPL) equal?
SPL = 20 log_10 p1/p0
antibiotic use factors that facilitate emerging diseases
Selection for resistant forms -Insufficient and/or unsuitable medical use (resistant TB, Cholera) -Use in livestock feed Lack of antibiotics (not profitable, wrong kind, production problems)
Dermatologic Conditions prevention
Substitution Engineering controls Gloves Barrier creams Frequent cleaning Education
Prevention Strategies for Occupational Lung Disease
Substitution or elimination of the hazard Automation, isolation, or modification of the process Increased general or local exhaust ventilation Employ personal protective equipment Increase worker education More rigorous medical surveillance
Time Weighting Exposure Standards
TWA -time weighed average (8 hr) STEL -short term exposure limit (15 min) Ceiling Value -maximum value in real time Which of those 3 is used depends on the nature of the exposures the toxicologic properties of the agent
bacteria requires specific growth factors
Temperature Time pH (neutral environment) Moisture (Water Activity) Oxygen Food (Nutrients)
Adverse Effects of Noise
Temporary or permanent hearing loss Physical and mental disturbances Breakdowns in communication Reduced work efficiency Irritability, stress Disruption of sleep Increased potential for injuries Lower concentration Vasoconstriction, high blood pressure Elevated heart rate Increased risk for heart attacks
building collapse in Bangladesh
The building contained clothing factories, a bank, apartments, and several other shops The shops and the bank immediately closed after cracks were discovered. Garment workers were ordered to return the following day.
What is synergism? Two people get along well Two compounds are equally dangerous Two colors that are in harmony The effect of two compounds together is more than the sum
The effect of two compounds together is more than the sum
disaster management goal
The goal is to limit the impact in terms of lives lost, injuries sustained and damage to the community
outbreak definition
The occurrence of two or more cases of a disease transmitted by a single food source
Transmission
The process by which an infectious agent is transferred from a reservoir to a susceptible host
Industrial toxicology
Toxicity assessment Exposure assessment Risk assessment
U.S. International Disaster Relief
U.S. Agency for International Development (USAID) -Bureau of Humanitarian Response -Office of Foreign Disaster Assistance Department of Defense -logistical support
GMOs
USDA-Regulates plant pests -GM plants might harm beneficial insects, soil microbes FDA-Responsible for food safety -GM plants could be allergenic due to new/changed protein EPA-Registers pesticides and set limits -Some GM plants produce pesticide (Btx), exceed limits? NOAA-Responsible for conservation of fisheries as economic ecosystem -GM fish may destroy ecosystem/natural species by outgrowing them
NIOSH (National Institute for Occupational Safety and Health)
Under CDC Provide research, information, education
OSHA (Occupational Safety and Health Agency)
Under Department of Labor Enforcement of occupational safety and health legislation
Time and bacteria
Under ideal conditions, bacteria double every 10 to 30 minutes Foods must be cooled & heated quickly to avoid time spent at or near ideal conditions -Foods must be reheated to 165°within 2 hours -Foods must be cooled to < 40°within 4 hours -Use a temperature monitor inserted in food to record the change in temperature over time to ensure proper cooling
Food and Drug Administration (FDA)
Under the Department of Health and Human Services (DHHS) Responsible for safety, nutritious value, and labeling of foods sold in interstate commerce(except meat, poultry and eggs, which are under the jurisdiction of USDA) Activities: -Develops food safety standards -Inspects food processing plants -Enforces pesticide policies (but does not establish them)
Irving Selikoff
Unraveled the health effects of asbestos
What was the cause for "The Year without a Summer" -1816 Earthquake in the US Flooding in Europe Volcano eruption in S-E Asia Heat and Drought in Africa Civil war and famine in China
Volcano eruption in S-E Asia
Food poisoning
a sub-form of foodborne illness caused by the ingestion of preformed toxins
what individual factors affect modifying factors in occupational exposure?
additive or synergistic co-exposure genetic susceptibility age, gender, nutrition, behavior
rate of fatal work injuries by industry high to low
agriculture, forestry, fishing, hunting transportation mining construction
more extreme weather leads to
air pollution -asthma -cardiovascular disease changes in vector ecology -malaria, dengue, encephalitis, hantavirus, Rift Valley fever, Lyme disease, West Nile
dirty dozen
aldrin chlordane diedrin endrin heptachlor toxaphene DDT heachlorobenzene mirex dioxins furans PCBs
Food-borne illness
an infection or intoxication that results from eating food contaminated with viable (live) microorganisms or toxins.
Vector
an organism that does not cause disease itself but which spreads infection by conveying pathogens from one host to another
why did life expectancy increase from 50 to 75
antibiotics vaccinations sanitation clean water
National Occupational Research Agenda (NORA)
assist in setting national research priorities convey the concerns of NIOSH to the public (research translation)
state regulation by other agricultural agencies
boards of health department of human/social services environmental and sanitation agencies
where did CO2 go?
cement gas oil coal
virulence
communicability, morbidity, mortality of an agent in populations or clinical severity in individuals
Department of Public Health in Johnson County
conducts inspections distributes educational material
common critical control points
cooking cooling points of cross-contamination reheating holding
# of children <5 that are undernourished has..
decreased
Pliny the Elder
described hazard of dust
Galen
described the hazards of miners
transmission can be
direct: person to person; animal to person indirect: airborne transmission via objects via common vehicle
English Factory Acts
directed toward worker protection, child labor, fire prevention.
Hippocrates
discussed the hazards of metal working
issue with HIV
drug resistance
The world's ability to affordably stop these epidemics might soon disappear because
drug resistance, increased travel, emergence of new diseases, lack of new drugs.
environmental factors that facilitate emerging diseases
ecological climate urbanization travel and commerce pesticide use antibiotic use
earthquake mortality due to
entrapment and fires
Chimney Sweepers Act of 1788
established in England (consequence of Pott's discovery)
OSHA 1910.95
establishes permissible noise exposures (PEL 90 dB) and outlines requirements for protection
disaster response concerns
evacuation medical care housing food water sanitation
what exposure factors affects dose
exposure [] exposure duration exposure frequency
rising temps lead to
extreme heat -heat-related illness and death -cardiovascular failure severe weather -injuries -fatalities -mental health impacts
occupational skin cancer at risk group
farmers, landscapers, foresters construction workers anyone working outside
hearing loss with aging and exposure is less severe for...
females
elements of a sound food sanitation program
follow standards and regulations (cooking, cleaning, chilling) establishes personal training and habits (personal hygiene, separation) uses proper equipment and facilities (safe water; adequate garbage disposal; proper wastewater and sewage disposal; effective insect and rodent control)
factors of foodborne illness and prevention strategies
food from unsafe source - clean contaminated equipment - separate inadequate cooking - cook improper holding temp - chill poor personal hygiene - wash then report
how is pitch measured?
frequency (Hz) periodicity of the energy no pure tones in nature
adverse effects of noise
hearing loss, cardio-vascular disease, stress, reduced immune system function, reduction in cognitive function
Reservoirs
humans, animals, plants, inanimate matter (fomites) in which an infectious agent survives and is then transmitted to people
more people die of what every year than AIDS, malaria, and TB together
hunger
wind
hurricanes - N hemisphere typhoons - S hemisphere -extensive prediction, monitoring and advance warning -drowning tornadoes -extensive local damage -less reliable warning derecho - hurricane level, straight wind
The rise in disaster tragedy is at least partly due to
increases in urban populations, ecosystem destruction (deforestation), and global climate change
rising sea levels lead to
increasing allergens -respiratory allergies -asthma water quality impacts -cholera, leptospirosis -harmful algal blooms
indicators of human influence on atmosphere
increasing: -carbon dioxide [] -nitrous oxide [] -methane [] -sulfate aerosols deposited in Greenland ice due to: -increasing use of coal/oil -increasing pop with increasing quality of life
Zoonotic Disease
infectious disease that is naturally transmitted from vertebrate animals (reservoir, host) to humans
how is loudness measured?
intensity (dB) -sound pressure level (i.e. height of wave = amplitude = energy) -more intensity is needed to hear low frequencies
Food-borne diseases may cause
intestinal, neurological, allergic or other symptoms
food insecurity
lack of secure access to sufficient amounts of safe and nutritious food for normal growth and development and an active/healthy life
causes of natural disasters
land movement (earthquake, volcanoes, avalanches) water movement (tsunamis, floods, avalanches) weather (hurricane, tornadoes, droughts, hailstorms, heat waves, blizzards, wildfires) biological (epidemics, pest invasions, fires, famines)
civilian occupations with highest fatal work injury rates
logging fishing aircraft roofers
highest incidence rates of occupational illnesses
manufacturing education and health services natural resources and mining
biologic monitoring
media -urine -blood -exhaled water -hair -adipose tissue analyte -agent -metabolite -biomarker of exposure or effect
first Health Insurance established by
miners in Harz Mountains
why is lyme disease increasing
more deer and mice increasing distribution of ticks
problem with TB
multi-drug resistant TB
reasons for hunger vary by country because..
natural disasters poor infrastructure poor leadership decisions civil unrest
what does emerging mean?
new or increased during last 20 years or threatens to increase in near future
was global sanitation MDG target met?
no- 68% of global pop use improved sanitation facilities 2.4 billion still lack improved sanitation -13% of global pop rely on open defecation -638 mill rely on shared sanitation (increasing w urbanization)
what is the most ubiquitous global pollution?
noise
top 5 pathogens causing domestically acquired foodborne illnesses
norovirus salmonella clostridium campylobacter staphlococcus
what occupational standards effect dose?
occupational health standards PPE engineering and admin controls
Occupations involved in health protection at the workplace
occupational medicine industrial toxicology industrial hygiene MPH
FFDCA (Federal Food, Drug and Cosmetics Act)
originally from 1906, several times amended Bases for FDA approval of new food additives, Accepted standard: GRAS(generally agreed as safe) rule, Delany clause -no additive can be approved that is causing cancer
characteristics of sounds
pitch loudness duration, rate, rhythm
natural toxin: plants
poisonous plants -berries and seeds -roots -stems and leaves (tobacco) -may produce food poisoning
Application of engineering controls is preferable to use of personal hearing protection b/c
poor fit if used improperly can't hear warning devices interference with job performance interference with communication
4 phases of disaster management
preparedness response recovery mitigation
contamination
presence of harmful agents
what can we do about covid?
prevent occurrence -restrict use of antibiotics in animals -forced medication? -mandatory vaccines? -limit ecosystem destructions, slums? handling of outbreak -restricting travel? -quarantine towns, incarcerate people? -stockpiling of drugs?
worksite evaluation
professional hazards inventory -> environmental measurements -> biological measurements -> assessment of measurement results -> assessment of adequacy of guidelines or standards -> develop internal standard based on acceptability of risk -> implement and enforce
what have we progressed on in terms of diarrhea?
progress in reducing diarrhea morbidity but little change in mortality
limiting growth of contamination in foods by
proper cooking and storage
radiation releases (anthropogenic)
reactor meltdown nuclear war on terrorism response -Sheltering and respiratory protection -Administration of stable iodine -Evacuation (difficult) -Decontamination of exposed people -Control of food, water and stored animal feed -Medical care delivery -Decontamination of land areas and buildings
Rhazes
realized the connection between certain occupations with specific medical problems
what numbers tell us about CO2
rise in atmospheric CO2 matches increase in human-generated CO2 emissions radioactivity of the atmosphere has been decreasing showing that the carbon source is fossil fuel ratio of 13C to 12C is decreasing implying that the source of C is organic
earthquake Rescue efforts complicated by
road damage and blockage as well as bridge and tunnel collapse
which foodborne illnesses cause greater economic burden?
salmonella toxoplasma listeria
causes of man-made disasters
social -civil disorder -terrorism -war -arson technological -industry (hazards release) -traffic (plane crash) -power/energy (energy crisis) -food (mercury poisoning)
prevention of foods from becoming contaminated occur at
source cross-contamination personal hygiene
how is duration, rate, and rhythm measured?
time phase repetitiveness
what are mycotoxins?
toxins produced by fungi on vegetation
major events leading to fatal occupational injuries high to low
transportation incidents violence and other injuries by persons or animals contact with objects and equipment falls, slips, trips exposure to harmful substances or environments fires and explosions
why is dengue increasing prevalence?
urbanization poverty insufficient sewage waste treatment relapsing mosquito control deterioration of public health infrastructure increased travel by airplane
vector-borne infectious diseases
viral examples - West Nile virus -dengue fever -hantavirus bacterial examples -plague -lyme disease -cholera parasitic examples -malaria
infectious and parasitic agents
viruses/prions -use host cells to replicate their genetic material) bacteria parasites -protozoa and helminthes fungi
disaster fatalities due to in order from high to low
water wind earthquakes famine civil unrest
increasing CO2 levels lead to
water and food supply impacts -malnutrition -diarrheal disease environmental degradation -forced migration -civil conflict -mental health impacts
WHO pyramid of health effects of noise (top to bottom)
y-axis: severity x-axis: # of people effected -mortality -disease (insomnia, cardiovascular) -risk factors (blood pressure, cholesterol, blood clotting, glucose) -stress indicators (autonomous response, stress hormones) -feeling of discomfort (disturbance, annoyance, sleep disturbance)
did water access improve?
yes- MDG exceeded by 2010, 91% of world pop uses improved source however- 663 million still lack access to improve drinking water and 178 million rely on surface water