[MUSIC] Welcome. In this session, the aim is to introduce you to the general links between the state of the environment and human health. Furthermore, you'll be provided with estimates of the environmental health related burden of disease. Towards the end of the presentation, I'll briefly talk on some of the key environmental health interventions supported by national and international organizations. As you will learn from this presentation, I subscribe to the idea that human health and quality of life depend upon global and local ecology and the way it's managed. To get started let me provide you with the WHO definition of Environmental health as formulated in 1993 at a consultation in Sofia, Bulgaria. Environmental health comprises of those aspects of human health, including quality of life. That are determined by physical, chemical, biological, social and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, preventing those factors in the environment that can potentially affect adversely the health of present and future generations. Next lets talk about the estimated global burden of disease linked with environmental factors. In 2006 the WHO published a report titled Preventing Disease Through Healthy Environments. The report addresses the key question. How much disease burden can be prevented by environmental interventions. Considering the part of the environment that can possibly be changed by existing interventions. The report estimated that 24% of the global disease burden was linked with environmental risk factors. This estimate compares well with previous assessments. In the 2006 WHO report, diseases with a major fraction attributable to modifiable environmental factors included diarrheal diseases with a 94% fraction, lower respiratory infections, malaria, unintended injuries. All with a fraction attributable to modifiable environmental factors at around 40%. In children, 34% of the disease burden is attributable to the environment, and much of this burden is placed in low income countries. Turning to some of the major topics and global mega trends impacting this state of the environment and population health. I would like to begin with highlighting some of the traditional environmental health hazards associated with a lack of development and poverty. After, which, I'll present some of the modern hazards associated with unsustainable development. Poor quality water, insufficient access to water, lack of appropriate sanitation and poor personal hygiene. Especially the insufficient hand washing with soap, among the essential environmental factors impacting human health. Such factors greatly increased our real disease, intestinal worm infections, skin and eye diseases. And a number of other water and hygiene related problems. In addition, lack of access to basic sanitation, insufficient water supply significantly impact on the quality of life and school performance by preventing girls especially from attending schools. Increasing the access to appropriate water and sanitation is regarded a human right. According to the 2011 figures included in the 2013 update from the WHO UNICEF joint monitoring program on water supply and sanitation. The world seem to be untracked to meet the millennium development goals for water supply. With 89% of the world population having access to safe drinking water. However, it's important to acknowledge that the world still hosts around 770 million people having to rely upon unimproved drinking water sources, as seen from the global map of drinking water coverage from the JMP update. Most people with lack of safe water supply live in Africa, south of the Sahara. When it comes to sanitation coverage, the world is off track, and is unlikely to meet the millennium development goals. By the end of 2011, there was still a staggering 2.5 billion people who did not use an improved sanitation facility, mainly in South Asia and Africa, south of the Sahara. As a separate sanitation issue obtain forgotten. Authorities from local to regional levels need to expand their regulatory framework and technologies to improve management and potential reuse of waste water. In additional to the biological contaminates and nutrients in the water, waste water such future Water management plans will have to consider the increase in chemicals, metals included in the water, due to growing industrialization. Another environmental factor consistently highlighted as a, as a risk to human health is air quality. As part of the global burden of disease study published in 2012, an estimate of the importance of many different risk factors was undertaken. Of all the 67 different risk factors assessed, indoor household air pollution from solid fuels ranked third in contribution to the global disease burden. Add to this the burden caused by outdoor air pollution and it's clear that air quality's a very significant risk factor. Cooking and heating with solid fuels and open fires or traditional stoves, in often poorly ventilated rooms, result in high levels of indoor health damaging air pollutants. This may be the case in rural areas as well as urban settings. Often women and small children are most exposed. The increased use of motor vehicles, industrial production, burning of waste, inefficient local energy production. And the use of solid fossil fuels for heating, results in elevated levels of air pollution, especially in urban areas. This includes particulate matter, carbon monoxide and ozone impacting on respiratory diseases in a range of all the health outcomes. The urban pool including the approximate one billion living in urban slums and using solid fuels for cooking may be hard hit by exposure to both poor indoor and outdoor air quality. To address the overwhelming challenges of air pollution, huge investments in new technologies will have to be made. But we also have to consider fundamental changes to our resource use. And the way we plan transport, energy, industry, housing, and many other sectors of society. The question is of course, if we're willing to make such changes to our societies, to protect future generations. Moving from air quality to the topic of urbanization is an obvious next issue to address. Urbanization is a process ongoing at rapid pace, changing societies and environmental landscape on every continent. Urbanization is a result of population migration from rural to urban areas, plus of course urban demographic growth. Rapid unplanned and unsustainable patterns of urban development are making developing cities focal points for many emerging environmental hazards. This includes solid waste disposal, waste water management, provision of safe water, sanitation, noise. Food safety among street vendors, traffic, occupational injury prevention and air quality. Across the world, urban slum dwellers are likely to be the most vulnerable to urban environmental risk. Let us turn to another environmental health issue, namely water resources development. Water resources development refer to the infrastructure and management required to control freshwater, to meet demands in agriculture, entity or the reservoir for drinking water. Irrigation schemes, water reservoirs and large dams, among the most important water resources, infrastructures, in this context. During and after the establishment of such infrastructure, a range of potential positive and negative aspects should be considered. Among the potential benefits, I increase agriculture production and income and the availability of an increased amount of water for domestic purposes, impacting positively on human health. However, for many years the expansion of the irrigation has been associated with an increased breeding of mosquitoes or snails in the irrigation canals, small estuaries of the wet fields. Such mosquitoes and snails may increase the transmission of parasitic or virus infections, such as malaria, Japanese encephalitis. Or schistosomiasis, also termed bilharzia. Often knowledge of the local environment, and possibly health impact assessments needed to assess the full risk of mosquito borne diseases, or other [INAUDIBLE] borne diseases. Lets go beyond the management of water to address the wider aspects of natural resources. Shrinking forest cover, unsustainable production system, climate change, and poor management of natural resources significantly impact on livelihood, food security, migration patterns, and of course human health. It is estimated that around half the land currently used for agriculture production is moderately or severely affected by soil degradation resulting from. For example, the loss of top soil due to accumulation of salts in the soil surface. Current loss of arable land is estimated to be 30, 35 times the historic rate. Affecting 1.5 billion people on the planet and undermining the future for generations to come. A particular concern is the loss of biodiversity. There's a growing recognition that the biological diversity is a global asset of tremendous value to present and future generations. But species extinction caused by human activity continue at an alarming rate. Responding to the need to protect land fertility and biodiversity, two key conventions were developed as the result of the Rio Earth Summit. The United Nations Convention to Combat Desertification that brought attention to land degradation in the dry lands. And the Convention on Biological Diversity dedicated to the protection of global biodiversity. In many areas of the world, agricultural production systems become more and more intense, with increased focus upon mono-culture, cast crops. And dependency on inputs such as pesticides, fertilizer and advanced seeds. This may have positive as well as negative impacts on the nutritional status and income levels of the farming households. However, it will at the same time result in an increased level of contamination of land and water. And the increased use and availability of toxic pesticides and farming households will result in increased incidence of acute poisoning. Increasingly agricultural products are traded across countries and regions of the world, and generate a vital source of foreign income and is an important part of global food security. However, such growing trade also places significant responsibilities on the private and government sectors to ensure the protection of global consumers. Waste water contaminated crops, food with significant levels of pesticides or agricultural products carrying pathogens from one part of the world to another, is a growing problem in a globalized world. Governments are working to improve monitoring systems and exchange of information. The private sector aims to improve on quality assurance systems, but the challenges are huge and consumers will increasingly have to consider and cope with potentially new risks. Most important are the capacity and incentive systems promoting safe agriculture products will have to be strengthened among local producers. As already apparent from some of the environmental health topics discussed in this section, many pressing environmental health challenges cannot be addressed only at a local or national level. A further example of this need finds national collaboration is it transboundary movement of persistent organic pollutants such as DDT addressed in the Stockholm Convention. Another more recent example is international adoption of the final legal binding international treaty aimed at reducing mercury emissions. Mercury is recognized as a chemical of global health concern, similar to what has been expressed for the persistent organic pollutants earlier. One area where international efforts need to be continued and strengthened relate to the promotion of occupational health and rights. The International Labor Organization in partnership with national governments, labor unions, the private sector. And civil society work to inform policies, undertake training and formulate standards, among other things. As hazardous jobs are outsourced to low-income settings. And the industrialization process proceeds in lower middle income countries. How should workers needs to be protected. Finally another example to illustrate the need for increase collaboration is the growing trade with various products. The Basel Convention adopted in 1989 is set to control the transboundary movement of hazardous waste, and their disposal. This and other modalities will have to continuously be updated and expanded to deal with new waste categories, emerging markets related to, for example, trade with electronic waste. Before we end this session, I would like to highlight some of the local areas of intervention int he field of environmental health. Such interventions will always be essential components, even of global efforts. At national and local level, countries have established departments and programs to address environmental health challenges. Unfortunately, many such programs are significantly under resourced. Act on the basis of weak policy frameworks, have difficulties in coordinating across sectors, and often have limited capacity to enforce set standards. Intervention that most often be assigned to, for example, environmental health departments, occupational health and safety units, municipalities, departments of agriculture and veterinarian and public health inspectors are giving on the list. Thank you for your attention. [MUSIC]
