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PH22 Public Health and Preventive Medicine Environmental Health
Toronto Notes 2019
Figure 17. Epidemic curves
14 12 10 8 6 4 2
0 1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829 Day of Onset
Figure 17a. Point source epidemic curve
10 9 8 7 6 5 4 3 2 1 0
Infection Control Targets
• interventionsshouldtargethost,agent,environment,andtheirinteractions
host
age, immune response, susceptibility
DISEASE
DEET
plasmodium falciparum eradicate,
genetically modify
nutrition,
sickle cell trait
antimalarials, proper nutrition
MALARIA
remove stagnant water sources
educate, avoid exposed skin at dusk
tropical, stagnant water
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Day of Onset
agent
virulence, toxicity, ability to survive outside body
environment
climate, physical structures, population density
Figure 17b. Extended continuous source epidemic curve
mosquito netting on homes
14 12 10 8 6 4 2 0
1 4 7 101316192225283134374043464952555861646770737679 Day of Onset
Figure 16. Epidemiology triad as framework for infection control interventions: Practical example using malaria
The International Health Regulations (IHR)
• aninternationalagreementinvolving196nationstoprevent,protectagainst,control,andprovidea public health response to pandemics
• apublichealthemergencyofinternationalconcern(PHEIC)is“anextraordinaryeventwhichis determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”
• theIHREmergencyCommitteeprovidestheWHODirector-Generalwithtemporary recommendations on PHEIC events
Environmental Health
Definition
• studyoftheassociationbetweenenvironmentalfactors,bothconstructedandnatural,andhealth
Figure 17c. Propagated source epidemic curve
Environmental Health Jurisdiction - Taking an Environmental Health History
CMAJ 2002 Apr 16;166(8):1049-1055
CH2OPD2 Community Home
Hobbies Occupation Personal habits Diet
Drugs
BPA, The Toxin Concern of 2009
Bisphenol A (BPA) is a chemical compound found in some hard, clear, lightweight plastics and resins. According to the NIH, animal studies suggest that ingested BPA may imitate estrogen and other hormones.
In October 2008, Canada became the first country in the world to ban the import and sale of polycarbonate baby bottles containing BPA, stating that although exposure levels are below levels that cause negative effects, current safety margins need to be higher. The US FDA does not consider normal exposure to BPA to be a hazard, however the NIH has some concern that fetuses, infants, and children exposed to BPA may be at increased risk for early-onset puberty, prostate, and breast cancer
•
•
environmentalexposures
■ four common hazards: chemical, biological, physical, and radiation
■ four main reservoirs: air, food, water, and soil
■ three main routes: inhalation, ingestion, or absorption (skin)
■ usually divided into two main settings:
■ workplace (including schools): may see high level exposure in healthy individuals (see Occupational
Health, PH25)
■ non-workplace: lower levels of exposure over longer period of time. Affects vulnerable populations
more severely, such as at extremes of age, immuno-suppressed. May be teratogenic. healthimpactsoftheenvironmentalsoincludefactorssuchasurbanplanningandhowindividuals interact with the built environment (e.g. safe pedestrian and bicycle paths can facilitate more active lifestyles)
Table 11. Environmental Health Jurisdiction
Public Health Unit
Municipal Government
Provincial and Territorial Government
Federal Government International
Enforcement of water and food safety regulations (including restaurant food safety) Sanitation
Assessment of local environmental risks
Monitoring and follow-up of reportable diseases
Investigation of environmental contamination, clusters of disease
Waste disposal, recycling, water and sewage treatment/collection/distribution
Water and air quality standards Industrial emission regulation Toxic waste disposal
Designating and regulating toxic substances
Regulating food products (e.g. Health Canada (drugs), CFIA)
Setting policy for pollutants that can travel across provincial boundaries
Multilateral agreements (e.g. Kyoto Protocol, UN Convention on Climate Change, International Joint Commission)
Number of Cases Number of Cases
Number of Cases
©Derek Ng 2016