The Story of Environmental Health:
A Brief History of Drinking Water
mid 1800s-2000s
Calhoun Beach, Minneapolis, 1917
2003
Goal and Objectives
• Knowing how traditional environmental health
hazards were assessed and controlled helps us
understand, protect, maintain, and improve
modern public health systems.
After the presentation, you should be able to…
1. Identify at least one person that had an impact on
environmental/public health history
2. Describe at least one health hazard posed by an
environmental agent in water
3. Identify at least one environmental intervention that
has led to better health
Presentation Structure
• Background of Public Health and
Environmental Health
• Historical Actions and Figures
• Prevention of Waterborne Diseases
• Actions
Core Functions of Public Health
• Assessing the public’s health
• Promoting sound policies
• Assuring effectiveness
Mission
To protect, maintain and improve the
health of Minnesotans
• Lifespan almost
doubles
• Leading causes of
death: no longer due to
lack of EH controls
Life Expectancy (Years)
U.S. Public Health Figures:
Impressive Gains from 1900s to 2000s
80
70
60
50
40
30
1900
1910
1920
1930
1940
1950
Year of Birth
1960
1970
1980
1990
What is Environmental Health?
“Public health
programs designed to
protect the public
health from hazards
which exist or could
exist in the physical
environment.”
Diagram courtesy of Australia’s EnHealth.
--Minnesota SCHSAC Environmental Health
Leadership Team, December, 2002, Diagram
courtesy of Australia’s EnHealth.
Environmental Links to Health Concerns
•
•
•
•
Drinking Water
Food
Land
Built
Environment
• Indoor Air
• Emergencies
Environmental Conditions
Potential Acute Health Effects
(Source: WHO)
Drinking Water/Food:
Inadequate and unsafe water
supply and unsanitary excreta
disposal
… gastrointestinal disease (e.g.,
cholera) parasitic infections,
eye and skin diseases
Land: Inadequate
solid waste disposal,
Poor drainage
… gastrointestinal and parasitic
diseases (due to increased
vector breading and feeding-rats, mosquitoes)
Built Environment: Toxic
materials (mold, asbestos, lead),
crowded and structurally
inadequate housing
…increased risk of respiratory
disease transmission (e.g.,
tuberculosis), stress and
accidents
Air: Polluted air,
Feedlot odors
…respiratory distress or
infections
Emergencies: chemical and
radiological releases
… distress, short and long-term
health effects (CDC)
More public health figures…
5.
4.
2.
3.
Your Health
Inspectors/
Sanitarians/
Epidemiologists/
Researchers
1.
7.
6.
You
Your Public
Health Nurses
and Educators
Cholera
What do arrows show?
Case shows
illness and death
due to
contaminated
food, a poor
waste disposal
system,
and
overpopulation.
“A Court for King Cholera,” Punch, 1852
http://www.st-and.ac.uk/~city19c/viccity/houshealth.html, accessed 10/4/2002
Cholera & the Broad Street
Water Pump (London, 1850s)
Prison
• Pattern of unusual deaths and
illness
• Problem solving essentials…
– Concern
– Experiment Recognition
– Understanding the
affected communities
– Data to identify
problem (and solution)
• Resistance to changing the
system
The Broad Street Pump
today… no handle
The John Snow pub is visible in the background,
at the corner of Broadwick Street and Lexington Street, London,
near Piccadilly Station. http://www.ph.ucla.edu/epi/snow/snowpub.html, accessed 10/2/2002
Cholera is still with us
Source: CDC Public
Health Image Library,
accessed Oct. 8, 2002
Cases reported to World
Health Organization, 2001
Water Supply and Sanitation:
3 Prevention Elements
1. Availability of safe
drinking water and
sanitary/sewer
separation
2. Knowledge and
behavior for personal
cleanliness
3. Community support
1. Availability of safe drinking water and
sanitary/sewer separation
Marshall, MN, 1921
“Insanitary Privy”
Aitkin County, MN, 2000
Sewage Contaminates Well
“Giardiasis Associated
with Drinking Water at a
National Wildlife Refuge,”
June- July 2000.
• Almost all employees
(92%) were violently ill.
• After reconstruction,
water passed tests in July
2001.
Source: MDH, 2000
Source: MDH files
2. Knowledge and Behavior
3. Community Support
States and Nations Can Request CDC Help to
Investigate and Prevent Outbreaks
Source: CDC Public Health Image Library, #1940, accessed Oct. 8, 2002
Actions
Public Health Similarities:
Cholera and SARS Epidemics
Cholera
• Assessing the public’s health . . .
– Epidemiology identifies fecalwater cross-contamination
• Promoting sound policies . . .
– Environmental Controls
– Education
• Assuring effectiveness . . .
– Controls: Engineering, Planning
– Regular testing and treatment
– Research: evolving to new strains
SARS
– Epidemiology identifies
fecal-water crosscontamination (in hotel
water and food)
– Information Sharing
– Education
– Controls: barriers/masks,
isolation, testing, wash and
sanitize
– Research: sources, vaccine
Ongoing Need to Monitor the Environment
Responses:
• Bacterial Outbreaks
Boil water, disinfect system
• Chemical Contamination
e.g., Blue Baby Syndrome,
Arsenic, Clandestine Labs
(Poisons often flushed)
Replace water. Do not
boil. May work with local
law enforcement.
200 + cases
confirmed, both
drinking water and
recreational waters
Ongoing Need to Monitor Health
Responses:
• West Nile Encephalitis
Empty standing water, cover up
Report dead birds at: www.health.state.mn.us/
divs/idepc/diseases/westnile
or call (612) 676-5414 (Metro area) or
1-877-676-5414 (outside the Metro)
Few waterborne outbreaks occur today.
-- But when they do, the MDH and local public
health officials investigate possible cause(s)
Who is involved?
• Clinicians
• Epidemiologists
• Sanitarians
• Laboratory staff
• Educators
• Policy-makers
• Poison Control staff
• Others …
National Rural Water Association:
“Minnesota #1 Drinking Water Protection Program”
Achieved through
Core Public Health
Activities:
• Assessing the public’s
health
• Promoting sound
policies
• Assuring effectiveness
Summary
Understanding
traditional
environmental
health hazards helps
to protect, maintain,
and improve the
public’s health
today.
Source: http://www.ci.mankato.mn.us/utility/WaterReport.pdf, accessed June 30, 2003
For more information, contact your
local health department or…
Minnesota Department of Health,
Environmental Health Division
Metro Square, 121 East 7th Place
P.O. Box 64975
St. Paul, MN 55164-0975
Phone: 651-215-0700
TTD: 651-215-0707
http://www.health.state.mn.us/divs/eh
References
•
•
•
•
http://www.health.state.mn.us/divs/eh
www.who.int/water_sanitation_health/en/
www.epa.gov
www.bt.cdc.gov