Environmental Determinants of Health

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Environmental Determinants of Health

• Dr Fiona Marshall

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Asbestos

• Formed from magnesium-silicate fibres
• Inhalation can cause-
• Cancer
• Asbestosis
• Malignant mesothelioma

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Coal Mining

• Causes respiratory diseases such as-
• Pneumoconiosis
• Emphysema
• Chronic Bronchitis

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Pneumoconiosis

• Produces shortness of breath and chronic cough
• No treatment is available
• Prevented by wearing a mask and limiting the
  permitted dust levels in occupational settings

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Emphysema

• Caused by an over-inflation of the alveoli,
  resulting in their breakdown
• Decreases lung function

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Chronic Bronchitis

• Cilia which normally propel mucus from the
  airways to the throat are paralysed by coal dust
  resulting in long term coughing and spitting

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Government compensation for UK miners

• All coal miners with lung damage are presently
  being compensated
• 226,000 miners compensated by Dec 2004
• Cost 1.2 billion
• Individual payment of up to 370,000 for miners
  or their widow

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Industrial Deafness

• The Noise at Work Regulations 1989, placed the
  following obligations on employers-
• Must carry out a noise assessment
• Must limit the noise exposure by muffling or
  reducing the time spent in noisy environment
• If exposed to noise of 85 - 90dBA, hearing
  protection must be provided if the employee
  requests it
• gt90dBA employer must provide protection and
  ensure that it is properly used

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Smoking

• In 1950, Richard Doll first linked cigarette
  smoking with lung cancer
• Who should pay for the treatment of smokers who
  have started since the link was generally
  accepted?

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The health impacts of smoking

• 90 of men diagnosed with lung cancer are smokers
  (Doll 1988)
• Smoking also causes chronic bronchitis and
  emphysema
• It makes your breath smell disgusting
• BUT there is hope give up now and you will
  probably not suffer permanent lung damage!

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Environmental Tobacco Smoke

• The risk of developing lung cancer in non-smokers
  is increased (by 20-30) if they live with a
  smoker
• The increased risk is dose dependant

1998, Dept of Health review of 37 epidemiological
studies
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What does this risk mean?

• If risk of developing lung cancer in a
  non-exposed, non-smoker is 10 per 100,000
• A 20-30 increased risk in exposed, non-smokers
  would result in a rate of 12-13/100,000 women
  developing lung cancer
• Or an additional 2-3 lung cancer
  cases/year/100,000 non-smokers regularly exposed
  to ETS

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Environmental Tobacco Smoke 2

• Chemical analysis of ETS shows that it contains
  carcinogens
• These have been found in the respiratory tract
  and urine of non-smokers
• The carcinogens have been absorbed into the blood
  stream

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Parental Smoking

• Parental smoking has been linked to-
• Sudden Infant Death Syndrome
• Respiratory illnesses in infants
• Increased risk of asthma in school children

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Smoking while pregnant

• Is this the worst form of Environmental tobacco
  smoke, as the unborn child cannot escape?
• Self directed reading for this week relates to
  this topic.

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Climate

• Heat claimed 15,000 lives in France (Aug 2003)
• Excess winter mortality in UK
• London Smog - Dec 1952 resulted in around 4000
  deaths

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French Heat Wave

• Aug 2003 Government suggest 11,500 people died
  in France. Could have been 15,000
• Temperatures reached 40 C for 2 weeks
• Mainly elderly people affected

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Winter Mortality in UK

• Cold weather causes short-term increases in
  morality in UK
• Mainly due to thrombotic and respiratory diseases
• Cold stress can result from inappropriate
  clothing or poor housing

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London Smog

• 4th Dec 1952 anticyclone settled over London
  for 5 days.
• Wind dropped, air grew damp and thick fog formed
• Sulphur Dioxide conc. increased 7x
• Smoke level 3x higher than normal
• Resulted in the 1st Clean Air Act which aimed to
  control domestic sources of smoke pollution

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Environment, lifestyle and health

• Do the lifestyle choices you make affect your
  health?
• Can these choices be the result of the physical
  environment that you live in?

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Obesity

• WHO definitions-
• Overweight - BMI gt 25 kg/m2
• Obese - BMIgt 30 kg/m2
• WHO consultation concluded that obesity was due
  to sedentary lifestyles and high-fat,
  energy-dense diets
• Complications associated with obesity include
  diabetes, cardiovascular disease, cancers,
  gastrointestinal diseases, arthritis

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What has obesity to do with the Environment?

• Can children run about, outside without being in
  danger from traffic
• Is it safe for children to walk or cycle to their
  nearest school?
• Would cycle lanes encourage you to cycle in
  Aberdeen?

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Social Environment and Health

• Is your environment safe for walking at night?
• If you live in overcrowded accommodation you are
  more likely to become ill
• If your peer group smokes or takes drugs you are
  more likely to do the same
• If you are on a low income you are less likely to
  eat a healthy diet

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Lifestyle Choices and Health

• Do you make choices which limit your daily
  exercise?
• Do night clubs cause Industrial Deafness?
• Do you binge drink?
• Do you smoke cigarettes or live with someone who
  does?

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References

• Evans RG, Barer ML, Marmor TR. Why are some
  people healthy and others not? New York Aldine
  De Gruyter, 1994
• Doll R. Tobacco related disease, WHO First
  European conference on tobacco policy. Madrid
  1988
• Marmot MG, et al. Employment grade and coronary
  heart disease in British Civil Servants. Journal
  of Epidemiology and Community Health 1978 32(4)
  244-249
• Naidoo J, Wills J. Health studies, an
  introduction. Hampshire Palgrave, 2001
• Purves W, et al. Life - The science of biology.
  6th edition. Massachusetts Sinaver Associates,
  2001

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References 2

• Sapolsky RM. Stress in the wild. Scientific
  American 1990 262 (1) 116-123
• Effects of maternal cigarette smoking on birth
  weight and preterm birth. MMWR 1990 39(38)
  662-665. On line at http//www.cdc.gov/epo/mmwr/p
  review/ mmwrhtm/00001782.htm
• Report of the scientific committee on tobacco
  health (prepared 1998) at http//www.archive.offi
  cial-documents.co.uk/document/doh/tobacco/part-2.h
  tm

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References 3

• http//www.gnn.gov.uk/content/details.asp?NewsArea
  ID2ReleaseID143019
• http//www.mesothelioma.com/treatment_info.htm
• Consultation on Obesity by WHO, Geneva, 1997 (at
  http//www.iotf.org)