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