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1 Chapter 1-Laying the Foundations of Environmental Health
What is Public Health and Environmental Health
Before we get started into the various aspect of environmental health it is important to understand the basics of what is public health and what is environmental health. The field of public health includes professionals in the areas of following fields:
Some examples of the many fields of public health:
First responders
Restaurant inspectors
Health educators
Scientists and researchers
Nutritionists
Community planners
Social workers
Epidemiologists
Public health physicians
Public health nurses
Occupational health and safety professionals
Public policymakers
Environmental Health Specialist
The video above describes what is Public Health
What is Environmental Health
The broad field of environmental health covers many topic as was explained in the video. Often times it is the basics of environmental health that must be addressed in a society to crate a health community. Those foundational aspects are clean water, proper sewage disposal, safe food and proper solid and hazardous waste disposal.
Environmental Health Saves Lives, Saves Money and Saves the Future
This project builds on recommendations from a 20061 report that emphasized the need to explore the value of environmental health services. The Value of Environmental Health Services: Exploring the Evidence 2016 report summarizes the literature on economic evaluation of environmental health interventions.
And it yielded a number of important findings.
A report by the National Environmental Health Partnership Council 2016 looked at the following programs in environmental health: Food Quality, Water Quality, Lead Exposure, Mercury Exposure, Climate Change, Housing and Special populations, including children and environmental justice communities[1]
Key Findings
For every $1 invested in lead paint hazard control, a return of invest- ment of $12–$155/household or a net savings of $124–188 billion was realized (Gould, 2009).
Higher local health department spending on food safety and facility sanitation activities was linked to a lower incidence of restaurant related foodborne illness in Washington and a lower incidence of facility inspection-related waterborne disease in New York.
Four major categories of chronic childhood conditions linked to the environment – lead poisoning and methyl mercury exposure, child- hood cancer, developmental disabilities, and asthma – cost the US $76.6 billion in 2008.
Mercury-related losses of cognitive function in children, and decreased economic productivity, resulted in diminished intelligence over a lifetime. The annual estimated economic cost of births was $8.7 billion.
Evidence suggests urban development strategies and reduction of pollution exposure from roadways would significantly cut health care spending, particularly in low-income neighborhoods.
The cost of running a heat–health warning system for Philadelphia was relatively small ($210,000) compared with the benefits of saving lives ($468 million) from 1995–1998.
Every $1 spent in CDC’s National Asthma Control Program saved $71 in asthma-related expenditures.
An estimated 12.6 million deaths each year are attributable to unhealthy environments[2]
15 March 2016
News release
GENEVA
An estimated 12.6 million people died as a result of living or working in an unhealthy environment in 2012 – nearly 1 in 4 of total global deaths, according to new estimates from WHO. Environmental risk factors, such as air, water and soil pollution, chemical exposures, climate change, and ultraviolet radiation, contribute to more than 100 diseases and injuries.
Noncommunicable diseases contribute to largest share of environment-related deaths
The second edition of the report, “Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks”, reveals that since the report was first published a decade ago, deaths due to noncommunicable diseases (NCDs), mostly attributable to air pollution (including exposure to second-hand tobacco smoke), amount to as much as 8.2 million of these deaths. NCDs, such as stroke, heart disease, cancers and chronic respiratory disease, now amount to nearly two-thirds of the total deaths caused by unhealthy environments.
At the same time, deaths from infectious diseases, such as diarrhoea and malaria, often related to poor water, sanitation and waste management, have declined. Increases in access to safe water and sanitation have been key contributors to this decline, alongside better access to immunization, insecticide-treated mosquito nets and essential medicines.
Healthier environment: healthier people
“A healthy environment underpins a healthy population,” says Dr Margaret Chan, WHO Director-General. “If countries do not take actions to make environments where people live and work healthy, millions will continue to become ill and die too young.”
The report emphasizes cost-effective measures that countries can take to reverse the upward trend of environment-related disease and deaths. These include reducing the use of solid fuels for cooking and increasing access to low-carbon energy technologies.
“There’s an urgent need for investment in strategies to reduce environmental risks in our cities, homes and workplaces”, said Dr Maria Neira, WHO Director, Department of Public Health, Environmental and Social Determinants of Health. “Such investments can significantly reduce the rising worldwide burden of cardiovascular and respiratory diseases, injuries, and cancers, and lead to immediate savings in healthcare costs.”
Environmental risks take their greatest toll on young children and older people, the report finds, with children under 5 and adults aged 50 to 75 years most impacted. Yearly, the deaths of 1.7 million children under 5 and 4.9 million adults aged 50 to 75 could be prevented through better environmental management. Lower respiratory infections and diarrhoeal diseases mostly impact children under 5, while older people are most impacted by NCDs.
Burden of disease in WHO Regions
Regionally, the report finds, low- and middle-income countries in the WHO South-East Asia and Western Pacific Regions had the largest environment-related disease burden in 2012, with a total of 7.3 million deaths, most attributable to indoor and outdoor air pollution. Further regional statistics listed in the report include:
2.2 million deaths annually in African Region
847 000 deaths annually in Region of the Americas
854 000 deaths annually in Eastern Mediterranean Region
1.4 million deaths annually in European Region
3.8 million deaths annually in South-East Asia Region
3.5 million deaths annually in Western Pacific Region
Low- and middle-income countries bear the greatest environmental burden in all types of diseases and injuries, however for certain NCDs, such as cardiovascular diseases and cancers, the per capita disease burden can also be relatively high in high-income countries.
Top causes of environment-related deaths
Looking across more than 100 disease and injury categories, the report finds that the vast majority of environment-related deaths are due to cardiovascular diseases, such as stroke and ischaemic heart disease:
Stroke – 2.5 million deaths annually
Ischaemic heart disease – 2.3 million deaths annually
Unintentional injuries (such as road traffic deaths) – 1.7 million deaths annually
Cancers – 1.7 million deaths annually
Chronic respiratory diseases – 1.4 million deaths annually
Diarrhoeal diseases – 846 000 deaths annually
Respiratory infections – 567 000 deaths annually
Neonatal conditions – 270 000 deaths annually
Malaria – 259 000 deaths annually
Intentional injuries (such as suicides) – 246 000 deaths annually
Strategies to reduce environmental disease burden
The report cites proven strategies for improving the environment and preventing diseases. For instance, using clean technologies and fuels for domestic cooking, heating and lighting would reduce acute respiratory infections, chronic respiratory diseases, cardiovascular diseases and burns. Increasing access to safe water and adequate sanitation and promoting hand washing would further reduce diarrhoeal diseases.
Tobacco smoke-free legislation reduces exposure to second-hand tobacco smoke, and thereby also reduces cardiovascular diseases and respiratory infections. Improving urban transit and urban planning, and building energy-efficient housing would reduce air pollution-related diseases and promote safe physical activity.
Many cities around the world are already implementing many of these cost-effective measures. Curitiba, Brazil has invested heavily in slum upgrading, waste recycling, and a popular “bus rapid transit” system which is integrated with green spaces and pedestrian walkways to encourage walking and cycling. Despite a five-fold population increase in the past 50 years, air pollution levels are comparatively lower than in many other rapidly growing cities and life expectancy is 2 years longer than the national average.
Through WHO’s water safety plans, which work to identify and address threats to drinking-water safety, Amarapuri, Nepal identified open defecation as a water quality hazard contributing to diseases in the area. As a result, the village built toilets for each household and was later declared an Open Defecation Free Zone by the local government.
Currently, WHO is working with countries to take action on both indoor and outdoor air pollution. At the World Health Assembly in May, WHO will propose a road map for an enhanced global response by the health sector aimed at reducing the adverse health effects of air pollution.
One Health is an approach that recognizes that the health of people is closely connected to the health of animals and our shared environment. One Health is not new, but it has become more important in recent years. This is because many factors have changed interactions between people, animals, plants, and our environment.
Human populations are growing and expanding into new geographic areas. As a result, more people live in close contact with wild and domestic animals, both livestock and pets. Animals play an important role in our lives, whether for food, fiber, livelihoods, travel, sport, education, or companionship. Close contact with animals and their environments provides more opportunities for diseases to pass between animals and people.
The earth has experienced changes in climate and land use, such as deforestation and intensive farming practices. Disruptions in environmental conditions and habitats can provide new opportunities for diseases to pass to animals.
The movement of people, animals, and animal products has increased from international travel and trade. As a result, diseases can spread quickly across borders and around the globe.
These changes have led to the spread of existing or known (endemic) and new or emerging zoonotic diseases, which are diseases that can spread between animals and people. Every year, millions of people and animals around the world are affected by zoonotic diseases. Examples of zoonotic diseases include:
Learn about zoonotic diseases, how they spread, and how to prevent them
Rabies
Salmonella infection
West Nile virus infection
Q Fever (Coxiella burnetii)
Anthrax
Brucellosis
Lyme disease
Ringworm
Ebola
Animals also share our susceptibility to some diseases and environmental hazards. Because of this, they can sometimes serve as early warning signs of potential human illness. For example, birds often die of West Nile virus before people in the same area get sick with West Nile virus infection.
What are common One Health issues?
One Health issues include emerging, re-emerging, and endemic zoonotic diseases, neglected tropical diseases, vector-borne diseases, antimicrobial resistance, food safety and food security, environmental contamination, climate change and other health threats shared by people, animals, and the environment. For example:
Antibimicrobial-resistant germs can quickly spread through communities, the food supply, healthcare facilities, and the environment (soil, water), making it harder to treat certain infections in animals and people.
Vector-borne diseases are on the rise with warmer temperatures and expanded mosquito and tick habitats.
Diseases in food animals can threaten supplies, livelihoods, and economies.
The human-animal bond can help improve mental well-being.
Contamination of water used for drinking, recreation, and more can make people and animals sick.
Even the fields of chronic disease, mental health, injury, occupational health, and noncommunicable diseases can benefit from a One Health approach involving collaboration across disciplines and sectors.
How does a One Health approach work?
The Foundation of One Health
Communication
Coordination
Collaboration
Among human, animal, environmental health, and other relevant partners.
One Health is gaining recognition in the United States and globally as an effective way to fight health issues at the human-animal-environment interface, including zoonotic diseases. CDC uses a One Health approach by involving experts in human, animal, environmental health, and other relevant disciplines and sectors in monitoring and controlling public health threats and to learn about how diseases spread among people, animals, plants, and the environment.
Successful public health interventions require the cooperation of human, animal, and environmental health partners. Professionals in human health (doctors, nurses, public health practitioners, epidemiologists), animal health (veterinarians, paraprofessionals, agricultural workers), environment (ecologists, wildlife experts), and other areas of expertise need to communicate, collaborate on, and coordinate activities. Other relevant players in a One Health approach could include law enforcement, policymakers, agriculture, communities, and even pet owners. No one person, organization, or sector can address issues at the animal-human-environment interface alone.
The One Health approach can:
Prevent outbreaks of zoonotic disease in animals and people.
Improve food safety and security.
Reduce antibimicrobial-resistant infections and improve human and animal health.
Protect global health security.
Protect biodiversity and conservation.
Connecting human, animal, and environmental health
More than half of all infections that people can get can be spread by animals. Diseases like rabies, Salmonella, and West Nile virus infections are examples of zoonotic diseases (or zoonoses)—diseases that can be shared between animals and people.
Every year, tens of thousands of Americans will get sick from diseases spread between animals and people. Animals can sometimes serve as early warning signs of potential illness in people. For example, birds often die of West Nile virus before people get sick with West Nile virus fever.
CDC’s One Health Office recognizes that the health of people is connected to the health of animals and our shared environment. A One Health approach encourages collaborative efforts of many experts (like disease detectives, laboratorians, physicians, and veterinarians) working across human, animal, and environmental health to improve the health of people and animals, including pets, livestock, and wildlife.
What The One Health Office Is Doing In The U.S.
Working with multiple partners to educate rural youth in agricultural organizations like 4-H and the Future Farmers of America about preventing the spread of diseases shared between people and animals like zoonotic influenza viruses. These newly formed One Health teams have reached thousands of young people and their families in states across rural America.
One important outcome was the rapid response to an outbreak of flu in people who had attended agricultural fairs in Ohio and Michigan. These new One Health teams helped pinpoint the source of the illness—infected swine exhibited at the fairs.
Responding to outbreaks and public health emergencies, such as examining the risk of Ebola and Zika viruses to pets and other animals.
Protecting Americans by preventing diseases they can get from their pets like Salmonella infection and rat bite fever.
Due to an increasing number of outbreaks, the One Health Office is leading the Zoonoses Education Coalition. This public-private partnership is developing evidence-based recommendations to prevent diseases for pet owners, breeders, and stores.
These recommendations were used during an outbreak of Seoul virus that was spread to people by pet rats.
The One Health Office shares tips about how to stay healthy while enjoying pets on CDC’s Healthy Pets, Healthy People website.
Each year around the world, it is estimated that zoonoses (diseases shared between people and animals) cause 2.5 billion cases of sickness and 2.7 million deaths
What The One Health Office Is Doing Around The World
Diseases can spread around the world very quickly, so it’s important for CDC’s One Health Office to work closely with other countries to build strong partnerships with human, animal, and environmental health organizations. This protects Americans from illnesses that cross borders and affect travelers.
Globally, the One Health Office is taking a strategic, targeted approach to control and prevent infectious diseases. For example, experts from the One Health Office lead One Health Zoonotic Disease Prioritization Workshops so that countries can focus limited resources on their top zoonotic diseases of greatest national concern. Zoonotic diseases commonly prioritized include viral hemorrhagic fevers such as Ebola virus and Rift Valley fever, zoonotic influenza viruses, rabies, and anthrax.
Workshop participants include a wide-ranging group of people who protect health—of people, animals, or the environment—and they identify a country’s top 5 diseases to target for One Health collaborations.
Workshop participants develop strategies to tackle the newly prioritized zoonotic diseases. For example, having a dog vaccination campaign for rabies can lead to fewer human rabies deaths in a country.
Prioritizing diseases means countries can more efficiently build lab capacity, conduct disease surveillance, plan outbreak response and preparedness activities, and create disease prevention strategies to reduce illness and death in people and animals.
the person’s individual characteristics and behaviours.
The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants—or things that make people healthy or not—include the above factors, and many others:
Income and social status – higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.
Education – low education levels are linked with poor health, more stress and lower self-confidence.
Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions
Social support networks – greater support from families, friends and communities is linked to better health. Culture – customs and traditions, and the beliefs of the family and community all affect health.
Genetics – inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.
Health services – access and use of services that prevent and treat disease influences health
Gender – Men and women suffer from different types of diseases at different ages.
An evidence base about the impact that projects, programmes and policies have had on health is required to carry out health impact assessment (HIA). The best available evidence is used within the appraisal stage of HIA to determine what impacts may occur (both positive and negative), the size of the impact (if possible) and the distribution of that impact in different population groups. It is generally assumed that the evidence for health impacts exists, and that searching and collating will provide the necessary evidence. Unfortunately this is not often the case, and the evidence of health impacts is often not available. This is because of the long causal pathway between the implementation of a project/programme/policy and any potential impact on population health, and the many confounding factors that make the determination of a link difficult. Within the HIA it is important therefore to be explicit about sources of evidence and to identify missing or incomplete information.
Providing a comprehensive review of the evidence base is not simple. It needs to draw on the best available evidence – that from reviews and research papers, and including qualitative and quantitative evidence. This information must be supplemented with local and expert knowledge, policy information, and proposal specific information.
Transport
Accidents between motor vehicles, bicycles and pedestrians (particularly children and young people).
Pollution from burning fossil fuels such as particulates and ozone.
Noise from transportation.
Psychosocial effects such as severance of communities by large roads and the restriction of children’s movement.
Climate change due to CO2 emission
Loss of land
Improved physical activity from cycling or walking
Increased access to employment, shops and support services
Recreational uses of road spaces
Contributes to economic development
Vector borne diseases
Food and Agriculture
Agricultural production issues and manufacturing
Tobacco farming and its impact on heart disease, stroke, certain cancers and chronic respiratory disease. Including passive smoking and impact of fetal development. Pesticide policies on tobacco crops require consideration.
Changes in land use, soil quality, choice of crop, use of agricultural labour and occupational health.
Mechanisation of work previously done by hand, and plantation agriculture.
Fisheries – biotoxins, pollution, chemical use, wastewater, processing, and occupational health
Forestry – vector borne diseases, occupational health, and food security.
Livestock use – vector borne diseases, drug residues, animal feed, waste, and food security.
Sustainable farming including chemical and energy use, biodiversity, organic production methods, and diversity of foods produced.
Fertiliser use – nitrate levels in food, pollution of waterways, re-use of agricultural waste.
Water – irrigation use and its impact on river/water-table levels and production outputs.
Pesticide usage and veterinary drugs– legal requirements, best practice, consumer issues.
Food packaging, preservation and safety, and avoidance of long storage and travel.
Access to, and distribution of food
Household food security – appropriate food being available, with adequate access and being affordable (location of markets, supermarkets and closure of small suppliers creating food deserts in cities).
Food supplies, including national and regional food security, and regional production.
National food security – able to provide adequate nutrition within a country without relying heavily on imported products
Cold-chain reliability – the safety of transporting products that deteriorate microbiologically in the heat.
Dietary patterns, diversity of food available and home production, particularly:
Fruit and vegetable consumption on reduced stroke, heart disease and risk of certain cancers,
Total, saturated and polyunsaturated fat, carbohydrates and sugars consumption on obesity, heart disease, stroke and other vascular diseases.
Alcohol consumption and impact on social effects related to behaviour (traffic accidents, work/home accidents, violence, social relations, unwanted pregnancy and STDs), and toxic effects (all-cause mortality, alcoholism, certain cancers, liver cirrhosis, psychosis, poisoning, gastritis, stroke, fetal alcohol syndrome and others).
Micronutrients such as iron, vitamin A, zinc and iodine and their impact on deficiency syndromes.
Food safety and foodborne illness hazards
Food and water are the major sources of exposure to both chemical and biological hazards. They impose a substantial health risk to consumers and economic burdens on individuals, communities and nations.
Microorganisms such as salmonella, campylobacter, E. coli O157, listeria, cholera.
Viruses such as hepatitis A, and parasites such as trichomonosis in pigs and cattle.
Naturally occurring toxins such as mycotoxins, marine biotoxins and glycosides.
Unconventional agents such as the agent causing bovine spongiform encephalopathy (BSE, or “mad cow disease”),
Persistent organic pollutants such as dioxins and PCBs. Metals such as lead and mercury.
New foods developed from biotechnology such as crops modified to resist pests, changes in animal husbandry, antibiotic use and new food additives.
Housing
Evidence of health impacts focus on:
Improvements in housing and improved mental health and general health
The possibility of improved housing leading to rent rises, impacting negatively on health.
Movement of original tenants after housing improvement and therefore not benefiting from the improvements.
Housing tenure, outdoor temperature, indoor air quality, dampness, housing design, rent subsidies, relocation, allergens and dust mites, home accident prevention, and fire prevention.
Homelessness.
Waste
Evidence of health impacts focuses on environmental and social determinants related to:
the transmission of agents of infectious disease from human and animal excreta (sanitation, hygiene and water-related);
exposure to toxic chemicals in human and animal excreta; and in industrial wastes discharged into the environment;
environmental degradation, direct and indirect impacts on health;
exposure to radioactive wastes;
exposure to health-care wastes;
exposure to solid wastes and involvement in informal waste recycling; and
breeding of disease vectors.
Energy
Evidence of health impacts focus on health hazards such as:
Fossil fuels
Biomass fuels
Hydropower and their impact on vector borne diseases, and pollution
Electricity generation and transmission
Nuclear power
Other energy sources
Occupational health effects of energy workers
Impacts on ecosystems, agriculture, forests, fisheries and building materials
Noise
Visual impact
Global warming
Industry
Evidence of health impacts focus on industrial sectors such as:
Asbestos and man made fibres
Basic chemicals
Cement, glass and ceramics
Electronics
Iron and steel
Manufacture of rubber and plastic products
Metal products
Mining
Pesticides, paints and pharmaceuticals
Petroleum products
Pulp and paper
Service industries
Textiles and leather
Wood and furniture.
Urbanization
Evidence of health impacts focus on topics such as:
For this discussion, you will be discussing the topic of water, clean water, and sanitation through a discussion about World Toilet Day. You will respond to several prompts and then share your response with your group on a discussion forum.
Pre-Discussion Work
To begin this assignment, review the pages in the Textbook that discuss under determinants of health -Water Water and Sanitation and the materials on World Toilet Day.
Drafting Your Response
Next, prepare your forum post by creating a Google document. On your document, answer the following questions:
What is your impression of the situation presented on water and Sanitation and World Toilet Day.?
What do you believe might be a solution for the problem?
Would you participate in World Toilet Day? Why or why not?
Be sure to support your responses by referencing materials from this module, in addition to those presented on the World Toilet Day site. Also, once you have answered the questions, be sure to proofread what you wrote before you share it.
Discussing Your Work
To discuss your findings, follow the steps below:
Step 01. After you have finished writing and proofreading your response, click on the link to your group under the My Groups link in the main menu on the left side of this page. Step 02. Once in your group, click on the Group Discussion Board link and locate the Module 01 Discussion Forum 2.
Step 02. Once in your group, click on the Group Discussion Board link and locate the Module 01 Discussion Forum 2.
Step 03. In the Module 01 Discussion Forum 2, create a new thread and title it using the following format: Yourname’s World Toilet Day Post.
Step 04. In the Message field of your post, copy and paste the text of your composition from the Google Document you created– please do not provide a link to that Google Doc.
Step 05. Correct the formatting using the text-editing tools in the Message field. Add bolding, underlining, or italics where necessary. Also, correct any spacing and other formatting issues. Make sure your post looks professional.
Step 06. When you have completed proofreading and fixing your post formatting, click on the Submit button.
Over the past several decades, ever-growing demands for – and misuse of – water resources have increased the risks of pollution and severe water stress in many parts of the world. The frequency and intensity of local water crises have been increasing, with serious implications for public health, environmental sustainability, food and energy security, and economic development. Demographics continue changing and unsustainable economic practices are affecting the quantity and quality of the water at our disposal, making water an increasingly scarce and expensive resource — especially for the poor, the marginalized and the vulnerable.
The importance of water is traced to the 1977 Mar del Plata conference in Argentina which created an Action Plan on “Community Water Supply”, declaring that all peoples have the right to access to drinking water in quantities and quality equal to their basic needs. The importance of water was further raised in the International Drinking Water Supply and Sanitation Decade from 1981 to 1990 and in 1992 at the UN Conference on Environment and Development in Rio de Janeiro (Agenda 21, Chapter 18), as well as at the International Conference on Water and the Environment (ICWE) in Dublin. In 1993 the World Water Day was designated on 22 March by the UN General Assembly, and in 2013 World Toilet Day on 19 November.
In 2000 the Millennium Development Declaration called for the world to halve by 2015 the proportion of people without access to safe drinking water as well as the proportion of people who do not have access to basic sanitation and in 2003 the International Year of Freshwater was declared by the General Assembly, followed by the “Water for Life” Decade from 2005 to 2015.
In order to coordinate the efforts of UN entities and international organizations working on water and sanitation issues, the Chief Executives Board (CEB) of the United Nations established in 2003 UN-Water — a UN inter-agency coordination mechanism for all freshwater and sanitation related issues.
In 2008 the International Year of Sanitation was declared and on 28 July 2010 the human right to water and sanitation was explicitly recognized by the United Nations General Assembly through Resolution 64/292.
In September 2015 the 2030 Agenda for Sustainable Development was adopted at the UN Summit, which includes Sustainable Development Goal (SDG) 6 on water and sanitation and in December 2016 the United Nations General Assembly unanimously adopted the resolution “International Decade for Action – Water for Sustainable Development” (2018–2028) in support of the achievement of SDG 6 and other water-related targets. Water is also at the heart of milestone agreements such as the Sendai Framework for Disaster Risk Reduction and the 2015 Paris Agreement.
Ensuring availability and sustainable management of water and sanitation for all has therefore been for a long time a topic at the United Nations and the priority is now turning the new vision of water related SDGs of the 2030 Agenda into reality, through national leadership and global partnership. Water and sanitation are at the core of sustainable development and the range of services they provide, underpin poverty reduction, economic growth and environmental sustainability. The world needs now to transform the way it manages its water resources and the way it delivers water and sanitation services for billions of people.
https://youtu.be/_B6g92hRzXc
3.6 billion people live without access to a safe toilet. (WHO/UNICEF 2021)
Groundwater accounts for approximately 99 per cent of all liquid freshwater on Earth. (UN-Water 2022)
Groundwater provides half of all water withdrawn for domestic use, including the drinking water for the vast majority of the rural population. (UN-Water 2022)
Globally, at least 2 billion people use a drinking water source contaminated with faeces. (WHO 2019)
Every day, over 800 children under age five years old die from diarrhoea linked to unsafe water, sanitation and poor hygiene. (UNICEF 2021)
World Toilet Day 2022 focuses on the impact of the sanitation crisis on groundwater.[6]
This observance, held annually since 2013, celebrates toilets and raises awareness of the 3.6 billion people living without access to safely managed sanitation. It is about taking action to tackle the global sanitation crisis and achieve Sustainable Development Goal 6: sanitation and water for all by 2030.
The 2022 campaign ‘Making the invisible visible’ explores how inadequate sanitation systems spread human waste into rivers, lakes and soil, polluting underground water resources.
However, this problem seems to be invisible. Invisible because it happens underground. Invisible because it happens in the poorest and most marginalized communities.
Groundwater is the world’s most abundant source of freshwater. It supports drinking water supplies, sanitation systems, farming, industry and ecosystems. As climate change worsens and populations grow, groundwater is vital for human survival.
The central message of World Toilet Day 2022 is that safely managed sanitation protects groundwater from human waste pollution. Currently, the world is seriously off track to meet the promise of Sustainable Development Goal (SDG) 6.2: to ensure safe toilets for all by 2030.
November 19th of each year (Photo of Outhouse [8])
The campaign urges governments to work on average four times faster to ensure SDG 6.2 is achieved on time. Policymakers are also called upon to fully recognize the connection between sanitation and groundwater in their plans to safeguard this vital water resource.
What are the key messages?
Safe sanitation protects groundwater. Toilets that are properly sited and connected to safely managed sanitation systems, collect, treat and dispose of human waste, and help prevent human waste from spreading into groundwater.
Sanitation must withstand climate change. Toilets and sanitation systems must be built or adapted to cope with extreme weather events, so that services always function and groundwater is protected.
Sanitation action is urgent. We are seriously off track to ensure safe toilets for all by 2030. With only eight years left, the world needs to work four times faster to meet our promise.
What is the global sanitation crisis?
Nearly half the world’s population still lives without a “safe toilet”. A “safe toilet” is shorthand for a safely managed sanitation system, which means a toilet not shared with other households, that either treats or disposes of human waste on site, stores it safely to be emptied and treated off-site, or connects to a functioning sewer and treatment plant.
People living without access to safely managed sanitation systems use shared facilities or those that do not safely dispose of human waste. Almost 500 million people relieve themselves outside (‘open defecation’) and 3.6 billion people – nearly half of the global population – are not connected to safely managed sanitation systems, leaving human waste untreated and contaminating communities and water used for drinking, hygiene, recreation and food production.
Urban and rural areas face different challenges. In densely populated urban settings, pit latrines and septic tanks sited close to water points that draw from a shallow aquifer create a potentially serious health risk. In rural settings, mainly due to there being more space, pit latrines and septic tanks can be more easily sited at a safe distance from water points.
This crisis has a profound impact on public health, educational attainment, economic productivity and environmental integrity. For women and girls in particular, the indignity, inconvenience and danger of not having access to safely managed sanitation is a barrier to their full participation in society.
How does inadequate sanitation impact on groundwater?
Groundwater utilization for drinking water is endangered by the uncontrolled disposal of human excreta, especially in densely populated urban settlements, and the absence of sustainable sanitation systems in fast-growing cities and periurban areas. These are five areas of concern:
Pit latrines and septic tanks: In a densely populated community, pit latrines as well as poorly constructed and managed septic tanks can result in significant pollution of shallow aquifers and nearby water bodies. This can lead to disease outbreaks via contaminated waterpoints and harmfully high nutrient loading in water supplies and nearby lakes.
Faecal sludge disposal by landfill: Where human waste is taken from pit toilets and septic tanks and disposed of with other solid waste in landfill sites without impermeable layers and good effluent management, the potential for groundwater pollution is high.
Irrigation with untreated wastewater: Farms and municipal authorities sometimes use untreated wastewater for irrigation. This poses a major health risk for farmers and consumers of leafy vegetables irrigated with this untreated wastewater, as well as when practised near unprotected public water wells and human settlements.
Sewerage outfall: In towns and cities where sewers are used to take away effluent, the arrangements for wastewater disposal and reuse are often inadequate, with significant pollution risks for the aquifers under land or rivers where the sewage is dumped.
Climate change impacts: In areas with intensifying rainfall, pit latrines, septic tanks and open sewers can get flooded, spreading human waste into soil and surface water. Conversely, in areas with worsening drought, sanitation systems such as pour-flush latrines may become unusable, forcing people to relieve themselves outside.
Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For three decades, Healthy People has established benchmarks and monitored progress over time in order to:
Encourage collaborations across communities and sectors.
Empower individuals toward making informed health decisions.
Measure the impact of prevention activities.
More than 12 million people around the world die every year because they live or work in unhealthy environments.1 Healthy People 2030 focuses on reducing people’s exposure to harmful pollutants in air, water, soil, food, and materials in homes and workplaces.
Environmental pollutants can cause health problems like respiratory diseases, heart disease, and some types of cancer.2 People with low incomes are more likely to live in polluted areas and have unsafe drinking water. And children and pregnant women are at higher risk of health problems related to pollution.3,4
Tracking environmental pollutants is key to figuring out where and how people are exposed. Laws and policies to reduce different types of pollution can also help prevent many serious health problems and deaths.
Below are listed the Environmental Health Objectives for Healthy People 2030. These are the areas that as a nation the public health sector will focus on to improve the health of the communities:
Reduce exposure to arsenic in the population, as measured by blood or urine concentrations of the substance or its metabolites.
Long-term exposure to arsenic can cause many health problems. Some people in the United States may have arsenic in their drinking water. Studies that track arsenic in urine can help health care providers and public health officials figure out if people have been exposed to high levels of arsenic.
Most Recent Data: 45.8 micrograms per gram (µg/g) (2015-16)
Target: 34.9 µg/g
Desired Direction: Decrease desired
Baseline:
45.8 micrograms per gram (µg/g) was the concentration level of urinary total arsenic (creatinine corrected) at which 95 percent of the population aged 3 years and over was at or below in 2015-16
Reduce exposure to lead in the population, as measured by blood or urine concentrations of the substance or its metabolites.
Adults are most likely to be exposed to lead at work, like at manufacturing plants. Children most often come in contact with lead through lead-based paint at home. High levels of lead in the body can damage the blood, kidneys, and brain — and cause seizures and paralysis. Monitoring levels of lead in the blood is key to identifying and reducing exposure.
Most Recent Data: 2.75 micrograms per deciliter (µg/dL) (2015-16)
Target: 1.74 µg/dL
Desired Direction: Decrease desired
Baseline:
2.75 micrograms per deciliter (µg/dL) was the concentration level of lead in blood samples at which 95 percent of the population aged 1 year and over was at or below in 2015-16
Reduce exposure to mercury among children, as measured by blood or urine concentrations of the substance or its metabolites
Exposure to mercury can damage the brain, lungs, gums, and other parts of the body. Mercury is released into the air from burning coal and trash, mining, and smelting — and mercury from industrial waste can get into water. Tracking mercury in the environment and in children’s blood or urine is critical for reducing exposure.
Most Recent Data: 1.06 micrograms per liter (µg/L) (2015-16)
Target: 0.80 µg/L
Desired Direction: Decrease desired
Baseline:
1.06 micrograms per liter (µg/L) was the concentration level of mercury in blood samples at which 95 percent of the population aged 1 to 5 years was at or below in 2015-16
Reduce exposure to bisphenol A in the population, as measured by blood or urine concentrations of the substance or its metabolites
Bisphenol A (BPA) is a chemical found in many products, like car parts, plastic dinnerware, eyeglasses, toys, and some food containers. A report on the published research about BPA found “some concern” about its effects on the brain, behavior, and the prostate gland in fetuses, infants, and children. Because exposure is common, monitoring BPA levels in blood or urine is important for learning if BPA is linked to any negative health effects
Most Recent Data: 5.30 micrograms per gram (µg/g) (2015-16)
Target: 0.72 µg/g 1
Desired Direction: Decrease desired
Baseline:
5.30 micrograms per gram (µg/g) was the concentration level of bisphenol A (creatinine corrected) in urine samples at which 95 percent of the population aged 3 years and over was at or below in 2015-16 2
Reduce exposure to perchlorate in the population, as measured by blood or urine concentrations of the substance or its metabolites
Perchlorate is a chemical found in rocket propellant, fireworks, and matches — and it’s used in some industrial processes, like leather tanning and fabric dyeing. Perchlorate has been found in drinking water in the United States. When people are exposed to it, it can damage their thyroids. Tracking exposure to perchlorate and regulating its levels in drinking water can help prevent negative health effects.
Most Recent Data: 10.4 micrograms per gram (µg/g) (2015-16)
Baseline:
10.4 micrograms per gram (µg/g) was the concentration level of perchlorate (creatinine corrected) in urine samples at which 95 percent of the population aged 3 years and over was at or below in 2015-16 2
Reduce heat-related morbidity and mortality (Developmental)
This objective currently has developmental status, meaning it is a high-priority public health issue that has evidence-based interventions to address it, but doesn’t yet have reliable baseline data. Once baseline data are available, this objective may be considered to become a core Healthy People 2030 objective.
Increase the proportion of persons served by community water systems who receive a supply of drinking water that meets the regulations of the Safe Drinking Water Act
Under the Safe Drinking Water Act (SDWA), the U.S. Environmental Protection Agency (EPA) sets standards to keep drinking water safe. These standards apply to public systems that provide water to almost everyone in the United States at some point in their lives. The SDWA provides a framework to help EPA, states, tribes, and water systems work together to make sure water is safe to drink
Most Recent Data: 93.0 percent (2020)
Target: 92.1 percent
Desired Direction: Increase desired
Baseline:
90.2 percent of persons served by community water systems received a supply of drinking water that met the regulations of the Safe Drinking Water Act in 2018
Reduce the amount of toxic pollutants released into the environment
Some industries use chemicals that can cause cancer and other serious health problems, and some of these chemicals can stay in the environment for a long time. The U.S. Environmental Protection Agency’s Toxic Release Inventory (TRI) tracks the release of certain toxic chemicals into the air or water. Information from the TRI is critical for notifying communities about possible exposure to harmful chemicals, and it can inform regulations and policies to decrease the release of these chemicals.
Baseline:
1,970,088 tons of toxic pollutants were released in 2017 2
Reduce the risks to human health and the environment posed by hazardous sites
Sites with toxic or dangerous materials can harm both human health and the environment. Chemicals from these materials can get into drinking water or the air, which can have negative health effects on entire communities. Cleaning up sites with toxic or dangerous materials can help prevent or reduce these health risks.
Most Recent Data: 85.2 percent (2021)
Target: 87.3 percent
Desired Direction: Increase desired
Baseline:
83.8 percent of Superfund Environmental Indicator sites where human exposure is known to be under control in 2018
Reduce the number of days people are exposed to unhealthy air
Exposure to air pollution is linked to many health problems, including cancer, respiratory diseases, and heart disease. Outdoor air pollution is also linked to early death. Taking action to prevent air pollution through laws like the Clean Air Act can lead to major reductions in pollution and help prevent many serious health problems.
Most Recent Data: 4,295,962,018 Air Quality Index (AQI)-weighted people days (2016-18)
Target: 3,866,365,816 AQI-weighted people days
Desired Direction: Decrease desired
Baseline:
4,295,962,018 Air Quality Index (AQI)-weighted people days exceeded 100 on the AQI in 2016-18
Increase the proportion of elementary, middle, and high schools that have official school policies and engage in practices that promote a healthy and safe physical school environment (Developmental)
This objective currently has developmental status, meaning it is a high-priority public health issue that has evidence-based interventions to address it, but doesn’t yet have reliable baseline data. Once baseline data are available, this objective may be considered to become a core Healthy People 2030 objective.
Increase trips to work made by mass transit
Emissions from cars contribute to outdoor air pollution, which is linked to many health problems. Mass transit options, like buses and trains, produce far less air pollution than cars. Communities that invest in mass transit can help reduce air pollution and prevent many serious health problems.
Most Recent Data: 5.0 percent (2019)
Target: 5.3 percent
Desired Direction: Increase desired
Baseline:
5.0 percent of trips to work were made via mass transit in 2017
About 1 in 6 people in the United States get foodborne illnesses every year.1 Healthy People 2030 focuses on preventing foodborne illnesses by improving food safety practices.
Many foodborne illnesses are caused by bacteria, like Campylobacter, E. coli, Listeria, and Salmonella. Each year in the United States, more than 100,000 people go to the hospital and 3,000 people die because of foodborne illnesses.1
But foodborne illnesses are preventable. Interventions in food production, processing, and storage can help prevent food from getting contaminated with bacteria. Teaching people to follow food safety practices when they’re preparing food — like washing hands and surfaces often — can also help prevent foodborne illnesses.
There are 21 objectives under this area of Healthy People 2030. We will not list the specifics of each one as before but just provide a listing of the objectives for the reader to have a feel for the areas for focused efforts under Healthy People 2030.
Goal: Reduce foodborne illness.
About 1 in 6 people in the United States get foodborne illnesses every year.1 Healthy People 2030 focuses on preventing foodborne illnesses by improving food safety practices.
Many foodborne illnesses are caused by bacteria, like Campylobacter, E. coli, Listeria, and Salmonella. Each year in the United States, more than 100,000 people go to the hospital and 3,000 people die because of foodborne illnesses.1
But foodborne illnesses are preventable. Interventions in food production, processing, and storage can help prevent food from getting contaminated with bacteria. Teaching people to follow food safety practices when they’re preparing food — like washing hands and surfaces often — can also help prevent foodborne illnesses.
A line listing of the specifics of each will not be provided. However, if the reader wishes to review the specifics of a particular topic the hotlink is provided.
Most Recent Data: 45.8 
Target: 34.9 
Desired Direction: Decrease desired
