6GEO4 Unit 5 Pollution and Human Health at Risk. What is this option about? The Pollution and Human health at Risk option focuses on risks at different.

6GEO4 Unit 5 Pollution and Human Health at Risk

What is this option about?

• The Pollution and Human health at Risk option focuses on risks at different spatial scales. You will study the patterns and trends in health risks over time and space, globally and locally, and evaluate the factors involved and how it impacts on quality of life.

• You will include the role of environmental pollution .This has changed from localised to global in the last century associated with huge shifts in lifestyle linked to industrialisation, global shift , deindustrialisation and globalisation.

Synoptic context

People Place Power

Who is involved?How?Why?

Where?When?

Who is responsible?How? Why?

AS-Global Challenges

A2 unit 3 Contested Planet if done pre Unit 4

•Climate change•Megacities- pollution and health

•Water conflicts-pollution•Energy- CO2 and Global Warming•Bridging the Development Gap-aid•Technological Fix-polluter pays, patents

1. What are the risks?2. The complex causes of

risks3. Pollution and health risk4. Managing health risks

CONTENTS

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What is health?

• The UN World Health Organisation (WHO) is the largest global organisation devoted to health risk:

• ‘Better health is central to human happiness and well-being. It also makes an important contribution to economic progress, as healthy populations live longer, are more productive, and save more’.

• Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”(WHO).

• There are many complex inter related factors influencing health risk.

• It includes morbidity, and mortality.

The health risk equation

Health risk=health hazard exposure + vulnerability - management

Risks to reduction of quality of health,

morbidity + mortality

Actual physical threats to humans: toxic substance, trauma, virus, bacteria, psychological trauma +

mental illness

Vulnerability depends on Human characteristics

EnvironmentLifestyle choices

Healthcare services

Some health risks easier to manage. Depends on

•Internal factors: Individual perception of risk-smoking, diet•External factors –pollution, hazards

Global health risk means health problems that so large they have a global political and economic impact or burden, as well as localised

distributions.

The Option summarised

Enquiry Question 1What are the health risks?

Enquiry Question 2What are the complex causes of health risk?

Enquiry Question 3What is the link between health risk & pollution?

Enquiry Question 4How can the impacts of health risk be managed?

Types of risk, short term to chronic , pandemic, epidemic or endemic

Geographical pattern at global/ national/local scales?

Temporal patterns, link to epidemiology model and WHO transition model

Health and quality of life and economic development

Range of causes

Relationship to socio-economic status?

Links to geographical features / pathway

Models eg diffusion

Types and sources of pollution

Direct and indirect effects

Link with economic development and Kuznet model

Pollution fatigue

Socio-economic and environmental impacts

Effectiveness of management strategy/policy

Agencies involved, especially International

Role of long term sustainable or short term management

Enquiry Q 1 What are health risks?• What are

the range of risks?

• Spatial Patterns ?

• Temporal patterns ?

• Health and quality of life and economic development?

Infectious Degenerative, chronic health risks

Traumas

•often communicable• often acute ie rapid onset or intense symptoms. Split into:• endemic•epidemics, •Pandemics Can be •Vectored or• Non vectored

often resulting from longevity, not communicable split into•Chronic- (lasting over 3 months)Cardiovascular Respiratory, chronic pulmonary (COPD)Obesity related DiabetesCancer Depression Maternal/ peri natal•DegenerativeArthritisAlzheimer’s Osteoporosis

eg from work related accidents or transport accidents

Pollution created/related health risks:Cholera Radiation Asthma Respiratory infections Melanoma…….

Complex Causes of Health Risk

• Physical factors• Water quality• Geology- uranium

decay• Ecosystem health • Insect and animal

vectors• Ozone depletion • Weather shocks• Climate change

Human factors

•Personal lifestyle choices including diet, exercise, smoking, alcohol consumption. Poor choices linked to cancer, diabetes, obesity and depression

• External Factors including pollution, quality of housing, residential environment, working conditions, road safety levels, economic and political structuresAll interlinked

Epidemiology Model

Stages or Age of :

1The age of Pestilence + famine

2 The age of Receding Pandemics

3The age of chronic diseases

4Age of emerging /re-emerging infectious diseases

Causes of health risk

Large number infectious, acute diseases.

reduction in the prevalence of infectious diseases + fall in mortality

Degenerative + human induced diseases of affluence suffered by ageing populations.

Newor the re-emergence of “old” diseases

Examples of types of health risk

Mainly respiratory + infectious diseases: Measles, smallpox, malaria, typhoid, cholera, tuberculosis, enteritis, diarrhoea, pneumonia

cancersrespiratory diseases including asthma

HIV/AIDSSARSAvian InfluenzaMeasles TB

Link to pollution

localised pollution, especially water borne

rise in all types of pollution as industrialisation increases.

Environmentally conscious but consumerist society Reduced water +land pollution, but increased air pollution

In Low to middle income countries high rates of all types of environmental pollution

Link to economic development

Low income countries UK in 17th C Currently Ethiopia, Bangladesh , although most moving to 2nd stage

Industrialisation; UK in 19th C. Currently Low to Middle income countries eg India, Western and rural China

Post-industrialisation: UK in 20th C and currently Upper income countries +NICs/RICsEastern and urban China Ageing populations in urbanised societies.

Low to middle income countries, less able to cope with the ‘double burden ‘of health risk , late 20th C Huge rise in HIV/AIDs, smoking, hypertension, toxic effects of widespread environmental pollution, not under control

Red= degenerative diseasesBlue= infectious diseases

Enquiry Q 2 Complex causes of health risk

• Different causes?

• Relationship to socio-economic status?

• Role of geographical features?

• Models?

A typology of health risks from geographical features and environmental change

Dams, Canals, irrigation...breeding ground ---eg Malaria, Schistosomiasis,...

Agricultural intensification...vector resistance ,rodents, direct contact— eg Haemorrhagic fever

Urbanisation...sanitation, hygiene, water contamination....eg Cholera, Dengue...

Deforestation..breeding sites + vectors, immigration of susceptible people..eg Malaria, Oropouche

Increased precipitation ... Pools for mosquito breeding ......eg Rift Valley fever

Ocean warming...toxic algal blooms-......Red tides

Burdens of heath risk• There are huge health inequalities globally, both in terms of health

during life and age of death (longevity).• Measured by for example the W.H.O.’s DALYs- the years of life spent

with reduced functions resulting from health conditions of varying severity.

• Globally, 1 in 3 deaths are from infectious or communicable diseases such as HIV, but most of these are in poorer areas and linked with malnutrition.

• The biggest risk is from non communicable chronic diseases, especially cardiovascular diseases.

• The W.H.O. divides the world into high and low mortality regions, correlating strongly with industrialisation and GNP/GNI.

• The speed by which many transition economy countries have changed their socio-economic structure over the past few decades has created a double burden of health risk

High Income--------- - Middle Income-----------Low incomeChronic/degenerative ------chronic+ infectious+ Traumas..............infectious

The top 10: Projected Trends in leading causes of mortality by the W.H.O.

2004 % Deaths

Rank

2030 rank

Heart disease 12.2 1 Heart disease 14.2 1

Cerebro-vascular 9.7 2 Cerebro-vascular 12.1 2

Respiratory infections 7 3 COPD 8.6 3

COPD 5.1 4 Respiratory infections 3.8 4

Diarrhoeal diseases 3.6 5 Road traffic accidents 3.6 5

HIV/AIDs 3.5 6 Trachea bronchus lung cancers

3.4 6

TB 2.5 7 Diabetes 3.3 7

Trachea bronchus lung cancers

2.3 8 Hypertensive Heart disease 2.1 8

Road traffic accidents 2.2 9 Stomach cancer 1.9 9

Prematurity/low birth weight

2 10 HIV/AIDs 1.8 10

Models to help describe and explain patterns and trends

1 Expansion diffusion• Red= place of origin and continuation of

disease in this location. • Green = new areas of disease 2. Relocation diffusion• Original disease shifts from place to

place leaving behind its source EG some influenza epidemics

3 . Contagious diffusion• direct contact is needed between hosts

of the disease, the black squares, and new hosts infected, the blue squares. EG: measles

4. Hierarchical diffusion • 1 ,2 and 3 represent differing locations • 1 is often the largest , and the infection

gradually spreads out to increasingly smaller centres 2 and 3

• EG: The spread of HIV/AIDS from larger to smaller centres in the United States and SARs outbreak in China 2003

1. Origin

2

3

Topical case studies :Swine Flu 2009• There is a tendency of

pandemics to encircle the globe in at least two, sometimes three, waves, with mutations occurring frequently and unpredictably

• 1918: Spanish flu was the most devastating outbreak of modern times. Caused by a form of the H1N1 strain of flu up to 40% of the world's population were infected. Over 50 m people died, with young adults particularly vulnerable.

• 1957: Asian flu killed 2 m people, with the elderly particularly vulnerable.. Rapid action by WHO and Government authorities minimised effects by identification then vaccine.

• 1968: Hong Kong flu, H3N2, killed up to 1m people globally, with over 65 year olds most likely to die.

• 2009 Swine flu is a respiratory disease, caused by a new strain of the influenza type A virus known as A(H1N1), spread from person to person by coughing and sneezing . Fatal for a small minority, it particularly attacks younger people and those with an underlying medical condition

• It emerged in Mexico in April , possibly linked to intensive pig farming. It rapidly spread globally and is the first official flu pandemic for 40yrs. By November 2009 over 6000 official deaths .

• In UK a management first of self diagnosis over internet began with automated prescriptions for antiviral drugs to reduce inundation in doctor surgeries and spread.

• Chief players:• W.H.O. Global Alert and response (GAR) and The

Global Outbreak Alert and Response Network (GOARN ) established 2000, co-ordinating research, monitoring and advice to individual governments on management. The WHO issues Phase warnings from 1-6, 6 being the pandemic phase of widespread risk

• Managers at community and national level have used containment and ‘outbreak management’ strategies, including vaccination of most vulnerable groups and advice on basic hygiene

Enquiry Q 3 Pollution and health risks

• What is the link between different pollution types and health risk?

• Incidental versus sustained pollution?

• Link between pollution and economic development?

• The role of pollution fatigue?

Key termsPollution = presence of substances that create a risk to health and well-beingPoint Based – from a specific source: often a mine or factory/industryDiffuse- from many often difficult to pin point precise sources eg nitrates in water, CO2 in atmosphereSustained pollution- pollution over a long time periodPollution Incident- often accidental and point basedExternalities = the side effects, positive and negative, of an economic activity that are experienced beyond its siteExternality field = the geographical area within which externalities are experiencedToxicity = a measure of the degree to which something is poisonous. Often expressed as a dose-response relationship

SOURCE---PATHWAY---SINK

Spatial patterns pollution-health risk: hot spots

Chernobyl Ukraine nuclear explosion

Kabwe ZambiaLa Oroya

Peru

Linfen China

Maivv Suu Kyrgyzstan

Russia•Norisk•Dzerzhinsk• Rudnaya Pristan

Ranipet India

According to the NGO Blacksmith Institute2009 : Pollution likely affects over a billion people globally, with millions poisoned and killed each year.  The W.H.O. Estimates that 25 % of all deaths in the developing world are directly attributable to environmental factors. There has been a global shift in location in the last century- from developed to developing nations.

Haina Dominican Republic

INDIVIDUAL

Household Sanitation + water quality

MESO SCALE Community Urban Pollution rises with rapid urbanisation then falls with

good management

Increasing Wealth/ development

Shifting Environmental Burdens

Severity

Of impact

Local

Immediate Delayed

Risks to Human Health

Risks to Life Support Systems

The Environmental Risk Transition

Global

GLOBALClimate changeGlobal warming is this century’s biggest pollution risk

Economic development and pollution relationships

Start of industrialisation, high pollution

Economy matures: more wealth throughout society, more pressure for clean up. In MEDCs shift to service + lighter manufacturing industry as global shift continues to transfer heavy polluting sources to NICs & LEDCs

This also shows pollution fatigue in reducing health risk, ie the backlash from the public to pressurise for effective management and control ..

Scales of pollution impact: LocalRegionalNationalInternationalPoor- rich divide- who is most affected?Role of companies, businesses, governments, NGOs ?Green groups may result /thrive

Continuum model for pollution’s affects on people

Acutely toxic, causing rapid death

Majority of pollutants are sub-lethal, ie do not cause death but make existing problems worse

Slow accumulations over a long time period. May weaken individual so they die from another disease or pollutant

•No pollutant lasts forever, but some pollutants last longer•Persistent/non biodegradable substances cannot be broken down by living organisms, and hence accumulate in an organism even small amounts over time.• Heavy metals, eg lead, arsenic, mercury, cadmium, may be ingested in water•Synthetic organic compounds also accumulate over time in the food chain, eg organochlorides like DDT( now banned in Europe & N America

There are fears- not totally proven, of the health risk link to pollutants with• Drinking water contaminants (heavy metals and nitrates, chlorinated and aromatic solvents, and chlorination by-products)•Residence near waste disposal sites and contaminated land •Pesticide exposure in agricultural areas •Air pollution and industrial pollution sources •Food contamination •disasters involving large scale accidental, negligent or deliberate chemical releases

The Precautionary Principle is therefore advisable!

Enquiry Q 4 Managing health risks

• What are the socio-economic and environmental impacts/ burdens?

• Differing management strategies and policies?

• Different players involved ?

• Role of Sustainable management?

Increasing health burdens + strategies

• The short and long term impacts, or burden of health risk, have become more complex with the so called ‘health divide’ becoming an increasing issue for the sustainability of our natural and socioeconomic environment. Health is a major driver of global and local economies, but the costs of health care are escalating because of:

• Population increase especially an ageing population• Rise in both poverty and a more vociferous middle class with

higher expectations of health care• Technology and medical expertise :availability of often

expensive technology and care in prevention and treatment • Consumer demand, increased by the media, internet

knowledge and demands for more social equity in health care.

• Rise in pollution and environmental health risks from workplace and indirectly from climate change

• Global interconnectivity: globalisation of health expectations and faster movement of infectious diseases because of migration and travel. Also :real time news linked with panic from health issues such as SARs and Avian influenza

Short term

health risks : mental

and physical traumas

from disaster

s

Long term public heath care

Climate change and health risk

• Most people will be affected in some way by climate change in the early 21stC

• Health risks will increase because of changes to existing patterns of disease, water and food insecurity, shelter and human settlements, extreme climatic events, population growth and migration.

• Direct influence: Expansion of Vector-borne diseases and mortality will increase , especially among elderly people, because of heat waves.

• Indirect effects: on water, food security and extreme climatic events are likely to have the biggest effect on global health. Increase stress and anxiety also involved

Climate change is potentially the biggest global health threat in the 21st century. (W.H.O. + UCL and The Lancet 2009) The response needs a new public health movement that has coordinated thinking and action across governments, international agencies, NGOs, and academic institutions.However, this adaptive response must parallel primary mitigation: reduction in greenhouse gas emissions.

Management classificationDirect management

- preventative and palliativeindirect

management- reducing

exposure to risks which may lead to poor health

methods of intervention

The players

The whole public, eg school food campaigns, non smoking legislation in public places.

Targeted individuals, especially if they occur in sizeable numbers. This is the high risk approach, for individuals with a combination of risk factors males, who are obese, smokers and take little exercisebabies vulnerable to sun burn.

Reduce poverty

improve housing

improve water supply and sanitation

improve education

legislation tax financial

incentives education

campaigns technology,

from safety belts, efficient boilers, syringes and medicine to taps.

governments- NGOs TNCs and

private organisations

locals

Types of public heath care

•Public health intervention•Aims to prevent rather than treat diseases, with education a priority Currently targeted by the W.H.O. It includes surveillance, vaccination and family planning. •Health care •involves prevention, treatment, and management to individuals and communities by medical, nursing and associated health sectors. Prevention is preferable, but often more difficult to achieve than treatment, although simple schemes can produce great positive results, eg malaria nets. • More aggressive and/or shocking types of health risk (such as HIV/AIDs, SARs) get higher priority than for instance mental illness•A key player may be the media in mobilising public opinion•health systems ,such as in the UK, aim to promote, restore or maintain health. They have an integrated set of facilities and personnel, and have a hierarchy of primary GP type care, secondary care by specialists in outpatient units, tertiary care as inpatients for a minority of patients and research by Universities and private companies.Health systems have evolved from informal, small scale, often family based systems into large, often government run systems. There has been a rise in private organizations catering for the more affluent, eg BUPA, and charitable organizations for the inevitable ’gaps’ in the system, eg Red Cross

Key Principles in pollution control

PrecautionaryBegan 1992 Rio Earth

Summit, linked with sustainable

development . Where a threat

appears to be present, even if not proven,

action needs taking to protect the

environment Eg reaction against

GM foods, 1987 Montreal Protocol on

CFCs and Ozone depletion

Maastrict Treat of EU Even Body Shop has it

enshrined in their corporate plan. 2009

ban by EU of 22 commonly used

chemicals in agriculture

Polluter Pays

Means the costs of

cleaning up pollution should

be borne by those causing it. Started by

OECD 1972.reaffirme

d at Rio Summit

Eg Emissions

Taxing in UK and at

international scale:Kyoto

Protocol

Proximity Principle

Pollution should be tackled as near to

the source as possible, contained,

not allowed to spread

This would apply to eg river pollution

or exporting of toxic waste to poorer less

restricted countries- effectively global shift of ecological

footprints!

Prevention

Try to stop at source rather

than adapt after created

Eg Urban Smokeless

zones, energy efficiencyThe UK

Environment Agency’s guidelines

Examples of successful pollution remediation/elimination and hence reduced health risk

• Models of how international community can work together successfully • Global scaleCFC control Montreal protocol Phasing out of Leaded petrolChemical weapons Convention• More local /regional scale picked by the Blacksmith Institute as examples of

good practice: Accra, Ghana –innovative low tech cooking stoves to reduce indoor air pollution and improve

health of women and children especially Candelaria, Chile- copper mining waste reduced from water supplies Chernobyl affected area E Europe- work by especially the EU to improve lives of those in

radiation contamination ( medical, psychological, educational) Delhi India- reduction of air pollution emissions Haina, Dominican Republic- removal of toxic soil (improper recycling of car batteries- lead

pollution) Kalimantan, Indonesia (new techniques to reduce mercury poisoning from artisanal gold

mining) Old Korogwe, Tanzania( removal pesticides contamination of soil and river) Rudnaya Pristan ,Russia ( removal lead contaminated soil in children's playgrounds) Shanghai 12 year program to clean sewage out of urban waterway used for drinking water W Bengal India (reduction arsenic poisoning through removal of naturally poisoned ground

water)

International Efforts on health management and the MDGsGrowth of international efforts to

tackle health risks is linked to • the increasing scale and issues involved•globalisation and interconnectivity of world economies ,political and financial affiliations, and flows of people and technology

International minimum and ambient standards are now common in both health and pollution management.

These are funded by international institutions like the United Nations or World Bank, or philanthropic NGOs ranging from Oxfam to the Bill and Melinda Gates Foundation. TNCs also play a role. However, it still comes down to individual nations and indeed individuals whether these policies can actually be implemented effectively.

In 2000, the largest-ever gathering of Heads of State adopted the Millennium Declaration, endorsed by 189 countries. This was a roadmap setting out 8 goals to be reached by 2015: to reduce poverty and hunger, and to tackle ill-health, gender inequality, lack of education, lack of access to clean water and environmental degradation. Health is linked directly to 3 goals and indirectly to all.These Goals are to be achieved through trade, development assistance, debt relief, access to essential medicines and technology transfer. There has been a reduction in diseases like HIV/AIDS, malaria and tuberculosis , but most countries are currently off track, especially in sub Saharan Africa and India (World Bank 2008) . This is despite increasing health related aid from a whole range of players. .

W.H.O. projections for future health risk

The aged- both a challenge and opportunity for health care managers: The WHO project by 2050, the number of aged over 60 will more than triple from 600 million to 2 billion. Most of this increase is occurring in developing countries

Life expectancy

Time -

Age of famine + pestilence

Age of receding pandemics

Age of chronic diseases

Age of sustaining health- the ideal- Balance of resources and risk .Effective health systems designed to cope with ageing population. Eradication of most environmentally infectious disease eg malaria. Cooperation between countries. Effective surveillance+ management.

Age of medical technology: Business as Usual scenario: limited co-operation between countries. MEDCs offset increased health risks by wealth + technology

Age of emerging infectious diseases: characteristic of poorer countries, dealing with double burden of infectious diseases and rise in chronic diseases as ageing of population increases