Principles of PH Chpt 8-10

Adult health

Adult middle years are known as "sandwich years" -Responsible not only for their own health, but also their children & their aging parents -Adults are a gateway for health information and education for these other groups (children & seniors)

Aids & HIV- Conclusions

After rapidly increasing since the 1980s, the annual rate of death due to HIV disease: -peaked in 1994 or 1995 - decrease rapidly through 1997 -decline decreased until 2013 -progress in reductions have stalled (stopped) CDC research suggests its because effective HIV prevention & treatment are not adequately reaching those who could most benefit from them (uneducated people) -increased gaps in rural areas in the south

Elder Health Definitions

Aged: state of being old (at risk for health concerns) Aging: changes that occur as living things grow older Gerontology: study of aging from the broadest prospective Geriatrics: medical practice specializing in treatment of the aged Age is and always will be a relative concept

municipal solid waste production (EPA,2017)

Americans produce ~270 million tons of municipal waste per year (wrappers), this does not take into account industrial, agricultural, and mineral wastes -In the US, ~4.5 pounds of trash per day, per person. Enough trash to fill 63,000 garbage trucks everyday. Almost 1/3 of the waste generated in the US is packaging -Americans throw away 2.5 million plastic bottles every hour. NYC alone throws out enough garbage each day to fill the Empire state building Disposable diapers: An average child will use between 8000 to 10000 disposable diapers before being potty- trained. Each year, parents dispose of about 18 billion (49 million diapers per day) -We will pay an average of $350 million annually to deal with their disposal. We still be in the landfills 300 years from now

Stroke

Annually ~795k people in the US have a stroke every 4 mins. someone dies from it Stroke ranks the 5th among all causes of death -Leading cause of long-term disability -Significant increase in younger adults & adolescents -possible link to obesity (again) Direct & indirect cost of stroke in the US ; estimated $65.5 billion Each year, stroke kills twice as many women as breast cancer Stroke is technically a type of cardiovascular disease, it occurs when a blood vessel that carries oxygen & nutrients to the brain is either blocked by a clot or bursts. The brain cannot get the oxygen it needs, so it starts to die

Leading causes of death

CDC 2018 (first cause), Cancer is the #1 killer for 45-64 year old's (lung, colorectal, breast, prostate) -Screenings important to catch early 2019, "Unintentional injuries" (second cause) - Typically refers to automotive incidents ; First year where accidental overdose is #1 unintentional injury death cause ; ~70% related to opioids Actually lowered life expectancy in 2017 from 78.7 to 78.6 years ~1.2 months of life lost Second time in 3 years there as been a decline

Cancer- Disparities

Cancer death rates vary by gender, race, and ethnicity For example in men: -Lung cancer incidence rates have declined since 1980s For women: -Lung cancer incident rates have just started to decrease in 2000s -since 1987, more deaths than breast cancer

What is cancer?

Cancer develops when cells in a part of the body begin to grow out of control - Normal body cells grow, divide, & die - Instead of dying, cancer cells outlive normal cells & continue to form new abnormal cells Most cancer usually forms as a tumor Cancer spreads by: - Direct spread- growing into surrounding tissues - Lymph channels - Bloodstream Metastasis: Cancer cells traveling to other parts of the body, growing and replacing normal tissue

cesspool (cesspit) / Septic tank

Cesspool: common through early 20th century in USA, hole in ground , 8-10 ft in. diameter, 10-25 ft deep, lined with staggered brick or cinderblock -Solids digested by bacteria, effluent percolates through moles in the sides -Rather archaic system but relatively efficient of disposal (not good at treatment, banned today) Septic tank: solid tank, no holes on the side Protects the soil and ground water by retaining the solid waste in a contained tank (anaerobic decomposition) First component in any modern septic system Separation of materials (three layers): -solids settle to bottom, -liquids pass to leach field, -Grease, gases, light solids float on top (scum) Leach field or trenches: house connected to a septic tank, discharged from tank to distribution box, effluent dispersed evenly to perforated laterals from distribution box, percolated through treatment & disposal zones, GIVES MOST PROTECTION TO GROUNDWATER, Laterals are only 3 to 4 ft under the surface Failing septic systems can cause: pollution of ground water & wells with bacteria, pollution of surface waters Can provide a breeding area: Mosquitos, flies & other vermin -odors

Other important water uses

Clean water is essential for healthy food supplies (fish, shellfish, and aquatic plants) Clean water is needed for recreational purposes (swimming, boating, and fishing) NJ water use- ~1.2 billion gallons of potable each day. each resident uses ~70 gallons a day (increased demand in south jersey) 85% of NJ's population obtains its drinking water from a public water system Where does all the water come from? 71% of the Earth's surface is covered by water, 97.4% is saline or undrinkable, 2% in glaciers & ice caps Less than 1% is available as fresh water, Contained in rivers, lakes, streams groundwater & vapor in atmosphere. 96.5% of all freshwater is groundwater

Influenza

Contagious respiratory illness caused by influenza viruses - Can have mild to severe & life-threatening complications (fever (usually high), headache, extreme tiredness, Dry cough, sore throat, runny or stuffy nose, muscle aches) Influenza viruses are spread from person to person in respiratory droplets of coughs & sneezes - Incubation period of 1-4 days Fomite spread (touching something then touching face) Epidemics typically occur during the winter months (Average of ~36,000 deaths/ year in the US) An estimated 10-20% of US residents contract flu annually -200,000 people are hospitalized for flu-related complications Rates of infection are highest among children (but they don't die) Rates of serious illness & death are highest: Among persons aged > 65 years ; Persons of any age who have an underlying medical condition

Substandard housing (slums)

Contaminated water, water supply outside, shared or outside toilet, shared or outside bath, more than 1.5 persons per room, overcrowding of sleeping quarters, <40 ft 2 of sleeping room per person, lack of dual exits, installed heating lacking in 3/4 of rooms, lack of electricity, lack of windows, deterioration Housing problems can be addressed with regulation -building and zoning ; Housing, health, and property maintenance codes -New structures or remodeling must conform to current regulations Crowding: habitable space, any room used for sleeping, eating, or cooking (not toilets, closets, utility rooms, or hallways) Habitable space required: minimum of 150 ft squared and ceiling maximum 7 ft (less than 5 ft should not be used for living) - 2+ people share room for sleeping: 70 ft squared minimum for 1st person: 50 ft squared minimum 2nd+ ; easy access to a bathroom and No rooms below ground without egress (unable to escape a fire)

Cleveland, Ohio 1969

Cuyahoga river fire, sparks from train passing over bridge ignited industrial waste in the water. flames were 5 + stories high, only burned for about 30 minutes but gained national attention (American people tired of their rivers being polluted)

Breast cancer worldwide

Despite all medical advancements & educational campaigns ~5% are diagnosed at late stage - After the cancer has metastasized -Rate hasn't changed significantly since 1975 - Only ~20% survive

Sewage treatment- disinfection and sludge

Disinfection: chlorination is used most often, UV light i& ozone are also options frequently, kills diseases causing organisms that are still present in the wastewater after secondary or tertiary treatment Sludge: Disposal Anaerobic digestion (produces methane & heat energy), Incinerated (air pollution, ash disposal) Disposed at sea (environmental issues), Landfills (space limitations), Used as fertilizer on golf courses, lawns (pathogens, heavy metal contamination) Septic Systems (Onsite Sewage treatment): necessary for all construction in areas without sewer system. Particular concern due to frequent presence of wells. ~20% of Americans have septic systems. Type: common outhouse or privy, cesspool, septic tank, seepage pit, trench or leach field, Generally it will be: septic tank, distribution box, leach field Services of contaminants: Human- feces, urine, oral/nasal Other- pet wastes, food wastes, cleaning solutions

Adults- Suicide Mystery (CDC)

Dramatic increase in adult suicides Between 2000 & 2016: -women 45-64 60% increase -men 45-64 37% increase Suspected contributing factors: - problems with intimate partners & family - Job/ finances - Health - Criminal/ legal problems Some studies suggest "life satisfaction" hits all time low in middle age (how they feel about their life progress made)

AIDS, HIV, & Hepatitis C - 2012

Each year ~15,000 dies as a result of HIV (2010) 16,500+ died as a result of HCV ~75% were 45-64 y/o Prescription medication ~$1,100 a week Primarily spread through blood-to-blood contact (IV drug use, transfusions (prior to 1992), tattooing / piercing) , possibly spread through sexual contact (MSM)

Trends in Mortality

Early 1900s: Most mortality caused by infectious diseases (Disease we just knew about didn't have antibiotics yet) ; we were just under Today: Chronic diseases & non-communicable events -Risk factors are related to lifestyle: - 40% of all cancers associated with smoking - 38% of cancers linked to poor dietary habits

Elder education, economic status, and races

Education: Percentage of elders who completed high school rose from 28% in 1970 to 79.5% in 2010 -29% of elders had a bachelor's degree or higher in 2018 Racial & Ethnic Composition: US older population growing more diverse 2010 elders: white 80%, black 9%, Hispanic 7%, Asian 3% 2050 elders: white 58%, Hispanic 15%, black 11%, Asian 8% Economic status: 1970: 25% of elders lived in poverty 2017: 9% lived in poverty Might be as high as 14% depending on $ measure Source of Income: Social security (reported by 87% of elders) Income from assets (53%) Private pensions 28% Gov. employee pensions 14% Earnings 26%

Community Health Strategies

Emphasis on individual responsibility for health Primary: exercise & nutrition programs Secondary: self & clinical screenings to identify & control disease processes Tertiary: medication compliance

Stroke symptoms

Face drooping (ask person to smile, 1 side droops) Arm weakness (only 1 arm goes up, ask to raise arms) Speech difficulty (slurred or strange) Time to call 911 if you observe above symptoms

elder abuse

Female elders are abused at a higher rate than men. In 90% of abuse cases the perpetrator is a family member. 67% of the perpetrators are adult children or spouses Self abuse/ neglect: Typically depressed, confused, or extremely frail; Vulnerable to scams & theft of benefit checks Community Facilities and Services: Older Americans Act of 1965 (OAA) to increase services and protect rights of elders. National Nutritional programs for elders & State and Area agencies on aging Services can vary greatly across the country: - community programs- meals on wheels - muncipal social services -Injury prevention programs: driving, medication use - Transportation programs: Dial-A-Ride -Leisure activities: senior outings Additional programs: Adult day care (provides care for seniors left alone all day), respite care, home health care, senior centers, homemaker service (enables elderly to remain in their own homes), chore & home maintenance service, visitor service

Cancer Survival Rates (2020)

Five-year relative survival rates commonly are used to monitor progress in the early detection and treatment of cancer The 5-year relative survival rate for all cancer combined has increased substantially since the early 1960s -Broadly from ~30% to ~70% -Highly varied based on race Improvements in survival reflect advances in treatment - Early diagnosis for some cancers also critical (colon cancer) -Survival varies greatly by cancer type, as well as stage and age at diagnosis

Water Treatment

Fluoridation: intentionally adding fluoride to water after disinfection prior to distribution Nationally 72% of Americans receive fluoridated water. Only 14% of NJ public water is fluoridated Numerous studies demonstrate reduction of cavities by 25% -CDC estimates every $1 spend on fluoride saves $38 in dental costs Treatment of water: Aquifers vs surface waters Minimal treatment: aeration, filtration, and disinfection are necessary - undesirable for human consumption ; impurities & coloration issues

Peak Month of Flu activity

Get flu shot in Oct. or Nov. Dec- March Feb- highest (peak month) Influenza General Prevention: Get Vaccinated!

Adult infectious diseases

HIV/AIDS , Influenza, Pneumonia Acquired Immunodeficiency Syndrome (AIDS) - Aids is caused by infection with a virus (HIV) ; Estimated 38K incidence in 2018 2018 Prevalence: ~1.2 million persons aged 13 & older - 14% (1 in 7) don't know it & need testing -69%-gay, bisexual men who have sex -7% were opioid users/inject drugs 24% were straight HIV Transmission Unprotected sex; injecting drugs; pregnancy, childbirth, & breastfeeding; Working in healthcare; blood transfusions & organ/tissue transplants

Cardiovascular Disease (CVD) Risk Factors

High blood pressure: about 90% of middle-aged Americans will develop high blood pressure in their lifetime; 70%+ of people with high blood pressure do not have it under control - High blood pressure is greater than 140/90 (130/80) systolic above 160 or diastolic above 115 is SEVERE The sooner to identify, the better health outcomes (check now, in teen years & watch over the years) Blood pressure: heart pumps blood through the arteries, the blood put pressure on the artery walls

Senior sexual health issues - viagra

Impotence no longer an issue By mid to late 50s, 25% of men are impotent By mid to late 60s, 50% are impotent By mid-20s, most are impotent In march 1999, Viagra arrived By 2006, 25% of men are using it Viagra works in 90% of sexual dysfunctional cases that have biological causes 60 to 70% rate of effectiveness overall Senior citizens- STDs and HIV CDC reports: Ages 50+ makeup> 51% of total HIV cases in this country; HIV cases are increasing among people in their 60s and 70s; HIV cases up to 500% among senior citizens over 9 year period (16,000 in 1995 and 90,000 in 2003) HIV incidence between 2014-2018 decreased 6% why are they contracting it? -Senior citizens did not have formal sex education as teens -Formerly married for a long period of time, people aged 50+ find it unnecessary to wear a condom. -91% of men 50+ do not use condoms for sex with a date or casual acquaintance -70% of men 50+ do not use condoms when having sex with someone they just met Many of older men "date" more than 1 women at a time - Older women unable to get pregnant, see no need to use any type of birth control, which includes condom. STDs and Medicare: As of 11/2011- prior test coverage target high-risk women (pregnant). Feds announce coverage for 65+: syphilis, chlamydia, gonorrhea, hepatitis B, behavioral counseling

Lead-Health effects

In adults: lower sperm count, malformation in fetuses, high blood pressure, kidney damage, digestive problems, headaches, memory & concentration problems, mood changes, sleep disturbances, nerve disorders, muscle or joint pain - high doses can cause blindness, coma, convulsions, and death In children: small amounts can cause damage to brain & nervous system, behavioral & learning problems, Lower IQ scores, slowed physiological growth, hearing problems, kidney damage, high doses: blindness, convulsions, coma & death

Types of strokes

Ischemic: clots that block an artery , most common type of stroke (88%) Hemorrhagic (bleeding): Ruptured blood vessels (blood leaks out)

Primary Prevention- Health Promotion

It is estimated that 50%+ of cancer can be prevented through smoking cessation and improved dietary habits Overall, physical activity and weight control also can contribute to cancer prevention Skin cancers could be prevented by simply limiting exposure to the sun, wearing protective clothing, and by using sunscreen

domestic water wastage

It takes 2 gallons to brush your teeth, 2 to 7 gallons to flush a toilet, 25 to 50 gallons to take a 10 minute shower - A leaking faucet can waste up to 100 gallons of water a day -Domestic water conservation: water-saving toilets, faucet efficiency, use the dishwasher, fix leaks, switch to front loading washers, ditch the bottled water -Use rain gauges to assist with lawncare. Lawns generally need inch of rain/week. 30-60% of outdoor water use is for lawns. Ditch the bottled water: US goes through about 50 billion bottles a year. 21 gallons of bottled water per person, annually. Quality: Depending on the brand, it might be filtered tap water. Various tests have demonstrated little quality difference, might be worse Pollution: 80%+ of recyclable plastic bottles end up in landfills

Milwaukee Cryptosporidium Outbreak (1993)

Largest documented waterborne illness outbreak ~400K people (25% of total population) 69 deaths, all of who had AIDS -led to increased filtration and treatment nationwide Never solved: snow-melt in cow pastures draining into lake Michigan is leading suspect

Mortality

Mainly from chronic diseases (unhealthy behaviors & poor lifestyle choices) - Lifestyle improvements & public health advances have led to decline in death rates for adults

Lead Poisoning

Major problem in old & substandard homes. Both adults & children are at risk. (children are more susceptible) Approximately 500,000 US children aged 1-5 years have blood lead levels greater than the CDC recommended level of 5 ug of lead per dL of blood Lead poisoning can affect nearly every system in the body. No obvious symptoms; frequently goes unrecognized. -Even children who appear healthy can have dangerous levels of lead , Can harm young children, Can harm babies even before they are born Lead base paint was used in a variety of housing including single family homes & high risk apartment buildings If house was built before 1940: 87% contaminated with lead 1940-1959: 69% 1960-1978: 24% all housing: 40%

Lead paint- History

Manufacturers INTENTIONALLY put lead in paint. Banned for residential use in 1978 by Consumer Product Safety Commission - Around 64 million dwellings built before 1978 contain lead-based paint - 24 million housing units in the US have deteriorated leaded paint and elevated levels of lead-contaminated house dust - more than 4 million of these dwellings are homes to one or more young children Lead based paint is any paint or surface coating that contains more lead than 0.5% or 5,000 ppm by dry weight or 1.0 mg/cm squared Why was lead used in paint? Primary pigment, added color, durability, drying agent, mildew inhibit or, corrosion inhibitor Who's at risk? Children <6 are growing rapidly and put their hands or other objects into their mouths Children from all social and economic levels, children living at or below the poverty line who live in older housing are at greastest risk -Some racial and ethnic groups are disproportionately affected

Demographics

Millennials (ages 23-38 in 2020) : 72 million More diverse than older cohorts- 50% + identifying minority status Prior to 2019 Boomers were largest cohort of adults

Breast Cancer

Most common cancer among women in the US In 2020 (estimates): ~276K women and ~2600 men diagnosed ~42,000 women & ~500 men deaths 75% of cases are in women > 50 years of age Death from breast cancer can be reduced substantially if the tumor is discovered at an early stage -Mammography (most effective) - Breast self exam (BSE)

Lead Problems

Myth: eating chips is a major problem. Reality #1: lead dust Dust is created at friction points: door opening & closing, window opening & closing, walking upstairs Renovations of old homes: children crawl on floors, in soil from renovation or paint removal Lead dust is created during renovations or remodeling of older homes - lead dust is heavy Infants and children crawl around the floor, pick up lead dust on their toys and hands and then put these objects or hands into their mouths Lead dust can also be in the soil or outdoor play areas from paint or gasoline residue

Electronic waste

NJ - Electronic waste management act: As of 2011 it is illegal to mix with solid waste: monitors, computers, televisions, laptops ~2% of the municipal solid waste stream, exporting to impoverished countries Substances of potential concern: lead, mercury, cadmium, brominated flame retardants Waste to energy: If all the solid waste in the US were converted to energy, it would equal more than 206 million barrels of oil per year 70-80% of residential and commercial solid waste is combustible Waste to energy plants work very much like coal-fired power plants. Use garbage, not coal to fire industrial boilers, ~2000 lbs of garbage=~500 lbs of coal - The same steps are used to make electricity in a waste to energy plant as in a coal-fired power plant -Incinerated garbage heats water, producing steam; Steam turns blades of a turbine, generating electricity Reduces volume of MSW by ~8.7% - Currently ~90 waste to Energy Plants in the US (NJ has 5: Warren, Gloucester, Essex, Camden, Union) Generating capacity by state- 2015 At the end of 2015, the United states had 71 waste-to-energy plants that generated electricity in 20 US states, with a total generating capacity of 2.3 gigawatts. In total these plants provided about 0.4% of total electrical generation in the US

Top 3 Cancers in Men and women

New cancer 2020 Men: Prostate, Lung & bronchus, colon & rectum Women: breast, lung & bronchus, colon and rectum Cancer deaths Men: Lung & bronchus, Prostate, colon & rectum Women: Lung & bronchus, breast, colon and rectum #1 Lung cancer for both

HIV myths & Rumors

No incidents of ketchup dispensers being contaminated with HIV-infected blood have been reported to CDC -CDC has no reports of HIV infection resulting from eating food - A mutated airborne version of HIV doesn't exist ; It is no possible to get HIV from mosquitos or ticks HIV infected needles have not been found: -in pay phone or vending machine coin returns -movie theater seats - gasoline pumps

Prostate Cancer Risk Factors

Non-modifiable Prostate Cancer Risk Factors: -age, ethnicity, family history, & genetic background Modifiable (possible) Prostate Cancer Risk Factors: -Diet-less red meat and high-fat dairy -Obesity & exercise - STDs (Gonorrhea, chlamydia)- increased risk - Vasectomy before age of 35 Incidence rates for prostate cancer spike dramatically in the late 1980s & early 1990s - related to surge in screening with the prostate- specific antigen (PSA) blood test Changes in rates continued (+/-) since 2000, Based on changes in recommended ages & use of PSA test Main problem: To convince men that they need to be screened (resistance)

Breast Cancer Risk Factors

Non-modifiable breast cancer risk factors: -Age, family history - Reproductive history, mammographic densities -Previous breast disease, race & ethnicity Speculated Modifiable breast cancer risk factors: - weight -diet & exercise (studies on, increase the risk) Unsupported risk factors: - Pre-menopausal obesity -Exposure to low-dose ionizing radiation in mid life - High intake of phytoestrogens ("dietary estrogens") - Electromagnetic fields -Breast trauma - Use of antiperspirants

colorectal cancer risk factors

Non-modifiable: - age -personal & family history of polyps of colorectal cancer - Inflammatory bowel disease Modifiable: -physical inactivity (colon only) - obesity - alcohol use - Diet high in fat & low in fruits & vegetables Early detection: -Fecal occult blood test - sigmoidoscopy -Barium enema & colon oscopy (diagnostic test) Found early & treated, the 5-year relative survival rate is 90%

Stroke risk factors

Non-modifiable: -increasing age, gender, more common in men than women (women account for >1/2 of all stroke deaths; Women who are pregnant have a higher stroke risk) Heredity (family history) & race - significant disparities Prior stroke or heart attack (80% are preventative) Modifiable Risk Factors: - High blood pressure, Tobacco use, diabetes mellitus, high blood cholesterol, some illegal drugs (cocaine, heroin, amphetamines) , physical inactivity & obesity, excessive alcohol use (5+ drinks a day)

Types of water

Nonrenewable water: water in aquifers and other natural reservoirs . Not recharged by the hydrological cycle. recharged so slowly that significant withdrawal for human use causes depletion (ex: Fossil aquifers Ground water: comes from earth's core; recharged by the infiltration and perlocution of rain water and runoff through the ground. More mineralized than surface waters, minerals and salts dissolve as water flows through -The minerals & salt effects the water look, taste, and smell. The deeper you go-> the older the water is (healthier and cleaner) Source does not lose water through evaporation. Unlike reservoirs, you don't need large appropriations of land Aquifer: a layer or section of earth or rock that contains freshwater (groundwater). Water that is stored naturally underground. water that flows through rock or soil.

Cancer Tumors

Not all tumors are cancerous or malignant - Benign (non cancerous) tumors do not spread to other parts of the body (metastasize) and with very rare exceptions, are not life threatening Most common cancer sites across all racial and ethnic populations in the United States: - skin - lung & bronchus - female breast - prostate - colon & rectum Represent over half of all newly diagnosed cancers 1.8 Million + new cancer cases are expected to be diagnosed in 2020 ~ 606,520 Americans are expected to die of cancer in 2020 -1,660 deaths per day

Obesity and smoking with elders

Obesity: -Number of obese elders have increased (follows patterns of other cohorts), In 2020: 29% of those 65+ were obese, only 25% of elders are in healthy weight range Cigarette smoking: About 8% of elders are cigarette smokers, has decreased significantly over past few decades Special concern: Elders who are former smokers - still at increased risk

Lung Cancer Risk

Other risk factors include: - Occupational exposures (Radon, Asbestos) - Indoor & outdoor air pollution (Radon, ETS) ~1% of lung cancer deaths are attributed to air pollution After 10 years of abstinence, smoking, cessation decreases the risk of lung cancer ~30-50% of that of continuing smokers

point source pollution vs. Non point source pollution

Point source pollution: single identifiable source that discharges pollutants into the water (EX: discharge pipe from an industrial plant, discharge pipe from a sewerage treatment facility). Non Point source pollution: Pollution that comes from many diffuse sources rather than from a specific point. (runoff, seepage, or falling of pollutants into the water) -Can contaminate both ground and surface waters, also called point-less pollution & runoff pollution Water and its pollutants: Water quality in US has deteriorated because: population growth, increase in chemical manufacturing, reckless land use, disposal of hazardous wastes

Prostate Cancer

Prostate cancer is the most commonly diagnosed form of cancer in males and the 2nd leading cause of cancer death among males in the US. -About 1 in 6 will be diagnosed with prostate cancer (only 1 man in 35 will die) - In 2020 (estimates) ~192K men will develop prostate cancer; ~33K men will die Prostate cancer is the most common in men aged 65 years & older (80% of all cancers) Early detection: -Digital rectal examination (DRE) - primary screening -Prostate-specific antigen (PSA) test - cheap/quicker

Reduce, Reuse, Recycle

Reduce: buy only what's needed, avoid excessive packaging Reuse: use reusable items rather than disposable Recycle: encouraged by deposits on bottles & cans, yard sales, composting EPA's Hierarchy for Management of MSW Most preferred: Source reduction & reuse, Recycling, composting , Energy recovery, Treatment and disposal

Effects of Aging

Reduction in the metabolic rate (slowing of the rate of cell repair) -Fatty tissues & cells dry out (bones become more brittle) Decreased: Speed of muscular response, muscular strength, increased chances of slips and falls (they may feel young but body is still old) Heart disease is the #1 killer for 65+ year olds -Screenings still important to catch early, minimize risk Morbidity: activity limitations increase with age, chronic conditions, substantial burden on health & economic status of individuals, families ; 1/2 report limitation of activity due to chronic conditions Impairments: very prevalent in older adults; may be sensory, physical, memory

chronic obstructive pulmonary disease (COPD)

Refers to a group of diseases that causes air flow blockage & breathing- related problems (Emphysema, Chronic bronchitis, Possibly asthma) Annual cost to the nation for COPD is $37+ billion ~135,000 deaths annually Significant gender discrepancies; Women are 2x more likely to be diagnosed with chronic bronchitis -2005 was the first year in which more women than men died from COPD

Strategies for solid waste management

Resource Conservation & Recovery Act of 1976: referred to as RCRA Federal legislation: designed to manage hazardous solid & hazardous waste, includes guidelines on used motor oil, underground storage tanks Solid waste management: collection, transportation, disposal The cost of solid waste: The cost for removal of solid waste is enormous. 10 billion dollars annually. 80% of that money goes for waste collection and transportation Problems: A large number of existing landfills do not meet current federal standards. Only 25% of currently operating landfills monitor for groundwater pollution, Less than 16% have natural or artificial liners, only 5% collect the polluted leachate & only half of those collecting it, treat it -50% of landfills lack controls for runoff pollution from rain, 22% of the sites on the EPA's superfund national priorities list are municipal landfills

Secondary Prevention - screening

Screening reduces mortality (Mammograms, Pap smear, DRE, PSA, Fecal occult blood tests, sigmoidoscopy) Screening problems: access to those tools, money a barrier, testing tools Three case-control studies showed a 59-79% reduction in CRC in age groups 45+ Cancer Risk Factors General : Tobacco use, Family history or genetics, alcohol, repeated viral infections, asbestos, exposure to radiation, diet, some occupational chemicals

transitional periods

Stress can cause physical & psychological illness Relocation: -Types: from 1 home to another within the same community, community to community, home to institution, from institution to institution -Factors Affecting stress or relocation: Amount support provided, degree of change; degree of preparation, duration of move, degree of control, voluntary or involuntary move Retirement: -Reasons: retire freely, health reasons, after job loss, face compulsory retirement (management) -Problems: skills and trades may be obsolete, misconceptions about seniors (slower, higher injury illness, & absenteeism rates) Many today retire at 65 but have 15-20 more years of life left Widowhood and bereavement: -Complex issue: Loss of financial resources & economic status, decline in social interaction/ isolation, depression/ alcoholism - Risk factors associated with adverse effects: In adequate income, poor health, lack of a support group, lack of social involvement or employment

Chronic Disease

Systemic health problem> 3 months, typically 1+ year -cause of death for 70% of Americans -cause extended pain and suffering Decreased quality of life - Leading drivers $3.5+ trillion in annual health care costs

Colorectal Cancer

The 3rd leading cause of cancer-related deaths in the US In 2020 (estimates): ~148K new cases ~53K deaths Overall, the death rate from colorectal cancer has been going down for the past 15+ years (fewer cases) -Colorectal cancer screening (earlier is better) - Rates for adults 55+ decreasing -Rates for adults <55 increasing (unclear as to why (obesity?), ACS recommended changing screening age from 50 to 45 in 2018)

Cancer Death Rates (2020)

The overall age- adjusted cancer death rate rose during most of the 20th century, peaking in 1991 at 215 cancer deaths per 100,000 people. Strongly linked to smoking epidemic. As of 2017, the rate had dropped to 152 per 100,000 (a decline of 29%) - reductions in smoking - improvements in early detection & treatment Translate into more than 2.9 million fewer cancer deaths from 1991 to 2017 - Driven by steady declines in death rates for the four most common cancer types (Lung, colorectal, breast, & prostate)

sewage treatment

The overall goals: improve quality of waste water, reduce organic material/biological contaminants, return water to environment Primary sewage treatment: use of a sedimentation tank, sometimes referred to as a clarifier -Sludge: layers of solids that settle to bottom of tank, contains: bacteria, viruses, organic matter, Heavy metals and organic chemicals -Scum: layers of oils, fats, and foam on top Both are removed; clarified water moves to next step Secondary sewage treatment: Designed to breakdown and remove organic waste. Aerobic bacteria and oxygen added to water. Goal is to reduce BOD of dissolved organic matter. (reduced 90-95%) Additionally sedimentation, then disinfection. Water can be released to environment after this step Tertiary Sewage treatment (not required): Additional filtration of wastewater, use of sand or carbon media. Lagoons. reduces any remaining dissolved pollutants -Advanced levels: remove nitrogen, phosphorus, & carbon compounds, Eutrophication reduction. It is not required universally

Biological Oxygen Demand (BOD)

The quantity of oxygen required to satisfy the oxidation demands of the sewage. The strength of the sewage depends on the organic load, the greater the organic load, the harder it is to decompose A high BOD indicates a high sewage concentration. The BOD of drinking water should be less than 1. Raw sewage may run to several hundred

sewage and wastewater

This is used water supply of a community, combination of wastes from homes, businesses and industries -it can contain groundwater, surface water, and storm water (depends on community) Can contain: human and animal feces, laundry bath & shower water, kitchen wastes, garbage grindings, dishwashing residue, street washings (grit, sand, leaves, dirt), runoff, agricultural, domestic & industrial wastes Sewage is 99.9% water, other.1% is solids, suspended solids, & dissolved solids Fresh sewage: gray in color and has a musty odor Old sewage: black in color and develops a foul odor (septic)

chronic obstructive pulmonary disease (COPD) Risk factors

Tobacco use Approximately 80-90% of cases are caused by smoking. A smoker is 10x likely than a non smoker to die of COPD (20% never smoked) Asthma -exposure to air pollutants in the home & workplace. genetic background, and respiratory infections

Ventilation and heating

Ventilation: 4 ft squared window or mechanical ventilation, usually 2-6 changes of air per hour, adequate body heat loss, removes airborne, chemicals, odor, and promotes restful sleep Adequate light- 1 window per room minimum, prevents accidents, promotes health mental attitudes Heating: too little or too much may be problem, from 10/1 through 5/1 (below 55 degree F) Min: 68 F during the days; Min: 65 F at night - CO Poisoning & fires; defective units

Importance of clean water to public health

Waterborne illness can result from exposure to contaminated water by: Ingestion of contaminated water or ice Skin contact during wading, swimming, showering, or bathing Inhalation Ocular exposure Exposures can cause minor irritation, severe illness or even death Waterborne diseases: water contaminated with disease agent is consumed by a susceptible person Waterborne disease outbreak (WBDO) -An event in which at least 2 persons experience a similar illness after ingestion of or exposure to water that is the probable cause of the illness. Can also be caused by excessive levels of fluoride, copper, & nitrates Trends: Drinking water have declined in recent years, recreational have increased Prevention: appropriate plumbing & wastewater treatment

dependence on water

We can go a month without food, but only 5-7 days without water (aggressive option, think about elders or sick children) Human adults is 66% water, blood is 83% water, bones is 25% water, brain is 75% water -water is essential for digestion, transport, & waste removal We require 1-3 quarts per day just to maintain bodily functions In the US, we require about 80-100 gallons per day. Drinking and other domestic purposes. Cost of about 27 cents per day. Typical US household: toilet 24%, shower 20%, faucet 19%, clothes washer 17%, leak 12%, other 8%

Uses of lead

batteries, water pipes, fixtures, solder, pottery, crystal, gasoline, painted toys, stained glass, makeup, slakers, bullets, refinishing furniture, home heath remedy Sun and heat can break down some vinyl mini blinds, releasing lead dust. Look for 'new formulation' or ' new none-leaded vinyl' Used in fixtures, pipes & soldering (can leach into water) -Safe drinking water act of 1986 & 1988 restricts the use of lead in plumbing fixtures Lead in gasoline to stop engine knock, reduced in 1978 by the EPA - Estimated 4-5 million metric tons of lead from gas still in the environment Lead standards for Housing- Detect with paint chips testing, paint chips above .5% by weight are a violation, destructive X-Ray fluorescence Analyzer uses radiation to check painted surfaces for lead (less expensive) - non destructive & instant results "Alligatoring" of aging lead based paint still needs to be tested to verify- visual inspection isn't enough Paint chips in the "drip line" of house (under roof, into the grass)

Chronic Diseases of Adults

cancer, cardiovascular disease, COPD

Biological vs. non-biological water pollutants

either can cause human illness. Non-biological: originate from a non-living source (heat, inorganic chemicals, organic chemicals, radioactive pollutants) - more recently: Endocrine-disrupting chemicals, certain pesticides (organophosphates), BPA (make plastic harder), PCBs, Phthalates, fire retardants -Pharmaceutical & personal care products ; washed off or excreted from the body (EX: antidepressants, cholesterol drugs, oral contraceptives agents) Biological Pollutants: living organisms or their products that make water unsafe for human consumption (viruses, bacteria, parasites) -Cause a variety of diseases & conditions (acute-short; chronic- long)

hydrologic cycle

evaporation/ transpiration: From surface waters & from soil/ plants Condensation: water vapor condenses to form cloud droplets precipitation: rain, hail, sleet, snow Infiltration/Percolation: into soil, runoff back to oceans, lakes, streams, rivers

Management of MSW in the US (2017)

landfilling 52.1%, Recycling 25.1%, composting 10.1%, combustion with energy recovery 12.7% - solid waste disposal: open dumps, disposal at sea (wildlife interact and land on shore), hog feeding, incinerators (burning), sanitary landfill (burried), recycling (in order 1-6)

Social problems of the ederly

loss of income & status, uncertainty about personal worth, insecurity, apprehension about health, difficulty adjusting to retirement, inability to find avenues of personal satisfaction, difficulty handling social change, Viability/activity

Elderly popoulation

number of elders & the proportion to the total population increased significantly in the 20th century Age breakdown: Old: >65 young old: 65-74 middle old: 75-84 old old: >85 Fertility rates: Baby boomers- 1946-1964 Mortality rates: Life expectancy has continued to increase, significant increase in 20th century Migration: movement of people from one country to another can affect population size

source reduction

refers to reducing the amount of waste created, reusing whenever possible, and then recycling what is left Components of source reduction: -Waste reduction aims to reduce the amount of waste produced at the source -Waste recycling refers to reuse of materials in the waste Composting: encouraging biological aerobic decomposition of organic household & yard wastes Eventually produces a useful material that resembles soil & that can be used in gardening Composting success: California & Massachusetts, NYC started in 1990, Princeton has curbside compost pickup -Currently we prevent ~37,500 tons of waste from entering the disposal process Public Health Implications: Biological pathogens, chemical hazards (flammable materials which can cause fire or explosions (methane), physical hazards from broken glass, metal, or medical waste Leachate: May contaminate groundwater or surface water. Disease vectors breed in solid wastes (flies, mosquitos, rodents) (birds, odors & noise)

Methemoglobinemia

septic systems produce nitrates. nitrate is converted to nitrite in the stomach, then absorbed into the bloodstream, interferes with the ability of red blood cells to carry oxygen Symptoms of "blue baby syndrome": -cyanosis (bluish discoloration of the skin and mouth), shortness of breath & fatigue, High enough concentrations can cause coma and death Infants & pregnant women are more susceptible Solid waste: Garbage , Refusal (trash) , sludge (solid waste), Other discarded materials (include glasses oriquids in containers) EX: paper/paperboard, plastics, aluminum, glass, food residue, yard waste, furniture, tires, abandoned automobiles, construction debris, dead animals, agriculture waste, animal manure, appliances Human/ Social Factors to increased waste: Urbanization, industrialization, human population growth, production & use of disposable products

Water

water is the lifeblood of any community. Water is a physiological necessity to humans, it is essential for life (drinking and other domestic use) - Healthful comfortable living depends on: availability adequate supply and safe & good quality water Water- global access 1 in 3 people do not have access to safe drinking water 2.2 B people lack regular access to safe drinking water 4.2 B people lack access to adequate sanitation services 3.0 B lack access to basic handwashing facilities ~5.2 B have a cell phone Water- United states access -more than 30 million Americans live in areas where water systems violated safety rules in 2019 - addition of chemicals; failure to remove substances (lead) American structure of Civil Engineers gave water infrastructure a "D" rating in 2017 ~1 trillion investment needed to upgrade over next 25 years

Cholesterol Risk factors

your body reproduces on it's own Blood cholesterol is measured in mg per deciliter -A total level less than 200 mg/dl is desirable Over 80% of those who have high blood cholesterol do not have it under control A 10% decrease in total blood cholesterol levels may reduce the incidence of CVD by as much as 30% Cholesterol is a waxy, fat-like substance found in the blood stream (2 sources: body & diet) The average high-fat/ high cholesterol diet adds too much cholesterol to the bloodstream - excess accumulates in the walls of the blood vessels Over time, this causes the arteries to become narrow & eventually cuts off the blood flow -heart cut off leads to a heart attack - brain cuts off leads to a stroke

Breast Cancer Donations

"Pinkwashing" : companies during month of October change their products to reflect increase awareness about breast cancer (putting most foods pink) -It's increasing the risk for cancer (fast-food) Breast Cancer Donations: ~6 billion annual raised (distributed to research and awareness) Pink ribbon started in 1993 In 1991: 119 women died each day In 2020: 114 women will die each day (estimate) Simply because a company put a pink ribbon on its package doesn't always mean a good breast cancer charity is benefitting from your purchase

Adults- Health Behaviors

- Risk factors for chronic disease - Most significant for adults: smoking, lack of exercise, BMI, alcohol -Risk factors for personal injury: Motor vehicle safety- seatbelts & alcohol use - Awareness & screening of certain conditions Hypertension, diabetes, cholesterol

3 basic types of wells

-Hand dug well (low quality water): hole dug in the ground, lined with brick, stone or tile; prone to contamination -Driven well: Pipe tipped with a well point driven into the ground with hand or power tools, usually shallow - Drilled well: most common type of well, a rotary drill bit is used Surface water: more prone to contamination (exposed) Contaminated by runoff, spills, dumping, acid rain (lakes, ponds, river, streams, reservoirs)

Health profile

-Health status of elders has improved over the years (living longer and functional health) -Chronically disabled has been decreasing -Health status usually not as good as younger counterparts Health behaviors & lifestyle choices: Report better health behaviors than younger people Less likely to: Consume large amounts of alcohol, smoke cigarettes, be overweight & obese Most important behaviors & choices: diet, exercise, & immunizations Physical activity decreases with age: only 25% report regular physical activity Health profile- Vaccinations - Immune systems tend to weaken with age 2016 (most current data) 70% of elders received flu shot, 67% received pneumococcal vaccination -Vaccination rates among elders have improved over time (racial disparities occur) - Recommended vaccinations for 65+: influenzas, shingles, pneumococcal pneumonia, diphtheria, pertussis

Instrumental Needs of Elders

-Six instrumental needs that determine lifestyle for people of all ages Aging process can alter needs in unpredictable ways 1) Income Change in type of expenses in elder years. Achieving elder status often reduces income needs. Income has improved significantly in recent years (social security is major source of income). Unmarried women & minorities have highest rates of poverty 2) Housing (major needs) Appropriateness, accessibility, adequacy, affordability. Changing residence can have negative effects Variety of housing options available: Independent living, assisted living, affordable housing, continuing care retirement comm., Nursing homes/ skilled nursing facilities 3) Personal care Activity of daily living (ACDLS) : measure financial limitations. Eating, bathing, dressing, toileting, transferring (walking), and continence - Instrumental activities of daily living (IADLS): measure more complex tasks. (cooking, driving, shopping, managing bills) 4) Care Givers Caregivers for elders face number of problems such as increased financial burden, lack of privacy, demands on time & energy. -Need for personal care and paying for long-term care services for elders is projected to increase in coming years. Elder care support for working caregivers a growing concern. National Family Caregiver support program 5) Health Care Elders heaviest users of health care services. Uses of health care services increases with age, most money spent on health care is in last years of life. Medicare primary source of payment for health care services of elders. Will see major change in future years. 6) Transportation Transportation allows elders to remain independent. On average, elders lives 10 years after they stop driving. Greatest influence on transportation needs: Income & health status, many public transportation challenges (seniors can't rely on it)

Lung Cancer

-The number 1 most common cause of cancer death among both females & males in the United States. -More people die from lung cancer than any other type. (Both men and women) -Lung cancer accounts for more deaths than breast cancer, prostate cancer, & colon cancer combined Cigarette smoking is the most important risk factor for lung cancer ~80% of lung cancer deaths in the US attributable to smoking

Symptoms of a heart attack

-Women: jaw pain, shortness of breath / chest discomfort or tightness, backache, extreme fatigue & nausea -Men: sweating, chest discomfort / heartburn , Nausea or vomiting Prevention of heart attack: -Increase the level of aerobic physical activity -Maintaining a healthy weight -Limiting the consumption of alcohol to moderate levels - Reducing sodium intake - Eating a reduced-fat diet that is high in fruits & vegetables The goal is to reduce cholesterol (maintain blood pressure)

The five stages of water treatment

1) COAGULATION: remove suspended material, usually involves flocculant 2) SEDIMENTATION: Water is retained in tanks for 2-6 hours. the floc settles out on the bottom of the tanks and the clearer water is sent to the next tank 3) Filtration: water is passed through a slow sand filter and then through a gravel bed to remove impurities 4) Disinfection: Used to kill pathogens (bacteria, viruses, protozoans) use: chlorine, bromine, iodine, or ozone 5) DISTRIBUTION:

Safe Drinking Water Act (SDWA)

1974; 1st time that public drinking water supplies were protected on a federal (national) level in the US -Amendments were made to the SWDA in 1986 & 1996 Drinking water protection-NJ New Jersey safe drinking water act (1979): Authorized the NJ DEP to assume primacy and enforcement responsibility for the federal safe drinking water program Private well testing act (2001): cannot transfer the title in NJ without water test, 15% of NJ residents use well water (it messed up some things because people were unaware of contaminated water Primary standards- SDWA

Demographics of elder

75% of elder men & <50% of elder women are married -men have shorter life expectancy -men marry younger women; more likely to remarry 67% live with someone else -women more likely to live alone 25% of all seniors in U.S live in 3 states: Florida, Texas, Cali Living style: -vulnerable to loss of spouse changes in SS, Medicare, health problems, inflation Housing: 75% live in single family homes, 20% apartments, mobile homes, assisted living, 5% nursing homes -Most live in adequate, affordable housing (80% own, 20% rent) -Elder homes are more likely to be older, have lower value, need repairs -Elder are less likely to have central heat/air (risk for health problems) ; 30% of elders pay more for housing than they can afford (medicine) Household size: In the US: 27% of adults age 60 & older live alone, globally ranges 5-16% In the US: Age 60+ lives with about one other person; household size of 2.1 people Globally the average is 3.4 people

Risk factors

A habit, trait, or condition in a person that is associated with an increased risk of developing a disease or condition Non-modifiable Risk Factors - Cannot be changed through prevention measures -Sex, age, family history, personality type Modifiable Risk Factors -Those that are amenable to prevention methods - High blood pressure, cholesterol, smoking, diet, exercise, sexual practices Risk Factors- Chronic Diseases - smoking, lack of exercise, alcohol consumption, body weight

Adults

25-64 years old (most productive years of your life) -Ideally some of the most productive years of life - Completed formal education & select career -Potentially raise family - Accumulate wealth - Contribute to community Represent more than half of the US population -Rapidly growing segment, though cohorts are changing (most adults dying from chronic diseases from poor lifestyle choices)

Adults & Health lifestyles

2016 Study The researchers assessed how many people followed four general "principles of unhealthy living" - a good diet - moderate exercise & keeping body fat under control - not smoking Only 2.7% of adults surveyed followed all 4 principles - 71% didn't smoke - 46% got sufficient amounts of physical activity - 38% ate a healthy diet - 10% had a normal body fat percentage

Housing

30 million substandard dwellings in the US. ~22% of all available housing. ~6 million have structural issues, ~ 6 million have lead paint We spend more than 90% of our time indoors. Significant number of fall injuries and deaths; Burns, accidental poisonings and suffocations Good Housing- Public health benefits -Protects against the spread of communicable diseases: Safe drinking water, toiler facilities (collect human waste & remove it), exclusion of vermin (screening to prevent mosquitos), protection from the elements, space to prevent overcrowding, refrigeration for food protection (minimize risk of bacterial growth) Good housing- safety benefits Protects against injury: fire protection, dangers from electric shocks or burns, protection from toxic gas poisonings (CO), well-lit and properly maintained (prevents falls, slips, and tripping injuries) Good housing- Psychological benefits promotes good mental health (if the house looks safe and make you feel safe= positive mindset). Provides for our fundamental psychological needs Good housing- Social benefits Higher income & education= better neighborhoods Access to medical care, access to higher nutrition, social standards for childcare & personal care, and increased levels of sanitation & environment protection Poor housing leads to: A decline in pride & motivation, Feelings of alienation, oppression, & powerlessness, a decline in good study habits in children & lowers educational goals -Lack of privacy leads to feelings of low self esteem

Pneumococcal pneumonia

A bacteria infection caused by streptococcus pneumonia It infects the upper respiratory tracts of adults & children; can spread to the blood, lungs, middle ear or nervous system It primarily cause illness in: Children younger than 2 years old & Adults 65 years or older Person-to-person transmission by respiratory secretion Prevention: The pneumococcal vaccine

CVD- Heart Attack

According to the American Heart association: ~805K Americans will have a heart attack ~200K of those are recurrent About 12% of people who have a heart attack will die from it ~20% are "silent" offering no indication it happened According to a CDC report, almost half of the cardiac deaths occurred before emergency services & hospital treatment could be administered

Secondary drinking water standards

Non-enforceable guidelines that won't affect your health Contaminants that may cause: cosmetic effects (such as skin or tooth discoloration) or aesthetic effects (such as taste, odor, or color) in drinking water. Others: Manganese, pH, silver, sulfate, TDs, Zinc, Iron, aluminum, chloride, copper, fluoride, foaming agents

Cardiovascular Disease (CVD)

Any abnormal condition of the heart or blood vessels This disease includes: - Coronary heart disease, stroke, congestive heart failure, endocarditis, peripheral vascular disease, congenital heart disease Death rates continue to drop: Now cancer is the #1 killer for 45 to 65 year olds Change due primarily to public health efforts: - eating better, increasing exercise, decreasing smoking A leading cause of death for both men & women ; 655,000+ Americans die of CVD annually; 1 death every 36 seconds -About 1 in 4 Americans have some form of CVD

Stroke survivor disabilities

Any or all of these are possible: -limb or body paralysis -inability to walk - Inability to complete daily-life activities (grooming, eating, bathing) Aphasia (trouble speaking or understanding speech) , -depression May require: Outpatient therapy & Admission to nursing home (lose independence)

Ground water contamination

subject to contamination from leaching of landfills or other toxic waste discharges. Once a groundwater aquifer is contaminated with chemicals, it may take years to clean up, if it can be cleaned up at all Septic systems: liquid wastes deliberately discharged to ground, 30% of US households served by septic Waste storage/disposal facilities: septage & leaks from dumps, landfills, waste ponds, USTs

Maximum contaminant level (MCI)

the highest level of a contaminant allowed in drinking water, MCLs are enforceable standards Contaminants: microorganisms (coliform, cryptosporidium, giardia), disinfection by-products (chlorite, THM), disinfectants (chlorine, chloramines), organic chemicals (arsenic lead, nitrate), inorganic chemicals, pesticides, PC, benzene, radionuclides, radium, uranium