6GEO4 Unit 5 Pollution and Human Health at Risk
What is this option about?
Synoptic context
• The Pollution and Human health
at Risk option focuses on risks at
different spatial scales. You will
study the patterns and trends in
health risks over time and
space, globally and locally, and
evaluate the factors involved
and how it impacts on quality of
life.
• You will include the role of
environmental pollution .This
has changed from localised to
global in the last century
associated with huge shifts in
lifestyle linked to
industrialisation, global shift ,
deindustrialisation and
globalisation.
People
Place
Power
Who is
involved?
How?
Why?
Where?
When?
Who is
responsible?
How?
Why?
AS-Global
Challenges
A2 unit 3 Contested Planet if
done pre Unit 4
•Climate
change
•Megacitiespollution and
health
•Water conflicts-pollution
•Energy- CO2 and Global
Warming
•Bridging the Development Gapaid
•Technological Fix-polluter pays,
patents
CONTENTS
1.
2.
3.
4.
What are the risks?
The complex causes of risks
Pollution and health risk
Managing health risks
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What is health?
• The UN World Health Organisation
(WHO) is the largest global
organisation devoted to health risk:
• ‘Better health is central to human
happiness and well-being. It also
makes an important contribution to
economic progress, as healthy
populations live longer, are more
productive, and save more’.
• Health is a state of complete physical,
mental, and social well-being and not
merely the absence of disease or
infirmity.”(WHO).
• There are many complex inter
related factors influencing health risk.
• It includes morbidity, and mortality.
The health risk equation
Risks to reduction of quality
of health, morbidity +
mortality
Actual physical threats to
humans: toxic substance,
trauma, virus, bacteria,
psychological trauma + mental
illness
Health risk=health hazard exposure + vulnerability - management
Vulnerability depends on
Human characteristics
Environment
Lifestyle choices
Healthcare services
Some health risks easier to
manage. Depends on
•Internal factors: Individual
perception of risk-smoking, diet
•External factors –pollution,
hazards
Global health risk means health problems that so large they have a
global political and economic impact or burden, as well as localised
distributions.
The Option summarised
Enquiry Question 1
What are the health
risks?
Enquiry
Question 2
What are the
complex
causes of
health risk?
Enquiry
Question 3
What is the link
between health
risk &
pollution?
Enquiry Question 4
How can the
impacts of health
risk be managed?
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Types of risk, short
term to chronic ,
pandemic, epidemic
or endemic
Geographical
pattern at global/
national/local
scales?
Temporal patterns,
link to epidemiology
model and WHO
transition model
Health and quality of
life and economic
development
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Range of
causes
Relationship to
socio-economic
status?
Links to
geographical
features /
pathway
Models eg
diffusion
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
Types and
sources of
pollution
Direct and
indirect effects
Link with
economic
development
and Kuznet
model
Pollution
fatigue



Socio-economic and
environmental
impacts
Effectiveness of
management
strategy/policy
Agencies involved,
especially
International
Role of long term
sustainable or short
term management
Enquiry Q 1
What are
health risks?
• What are the
range of
risks?
• Spatial
Patterns ?
• Temporal
patterns ?
• Health and
quality of life
and economic
development?
Infectious
Degenerative, chronic
health risks
Traumas
•often
communicable
• often acute
ie rapid onset
or intense
symptoms.
Split into:
• endemic
•epidemics,
•Pandemics
Can be
•Vectored or
• Non
vectored
often resulting from
longevity, not
communicable
split into
•Chronic- (lasting over 3
months)
Cardiovascular
Respiratory,
chronic pulmonary (COPD)
Obesity related Diabetes
Cancer
Depression
Maternal/ peri natal
•Degenerative
Arthritis
Alzheimer’s
Osteoporosis
eg from
work
related
accidents
or
transport
accidents
Pollution created/related health risks:
Cholera Radiation Asthma Respiratory infections
Melanoma…….
Complex Causes of Health Risk
•
•
•
•
•
Physical factors
Water quality
Geology- uranium decay
Ecosystem health
Insect and animal
vectors
• Ozone depletion
• Weather shocks
• Climate change
All interlinked
Human factors
•Personal lifestyle choices
including diet, exercise,
smoking, alcohol consumption.
Poor choices linked to cancer,
diabetes, obesity and
depression
• External Factors including
pollution, quality of housing,
residential environment,
working conditions, road safety
levels, economic and political
structures
Red= degenerative diseases
Blue= infectious diseases
Epidemiology Model
Stages or
Age of :
1
The age of
Pestilence + famine
2
The age of
Receding
Pandemics
reduction in the
prevalence of
infectious diseases +
fall in mortality
Causes of
health risk
Large number
infectious, acute
diseases.
Examples of
types of
health risk
Mainly respiratory + infectious diseases:
Measles, smallpox, malaria, typhoid, cholera,
tuberculosis, enteritis, diarrhoea, pneumonia
Link to
pollution
localised pollution,
especially water borne
rise in all types of
pollution as
industrialisation
increases.
Link to
economic
development
Low income countries
UK in 17th C
Currently Ethiopia,
Bangladesh , although
most moving to 2nd
stage
Industrialisation; UK
in 19th C. Currently
Low to Middle
income countries eg
India, Western and
rural China
3
The age of chronic
diseases
4
Age of emerging /re-emerging
infectious diseases
Degenerative + human
induced diseases of
affluence suffered by
ageing populations
.
cancers
respiratory diseases
including asthma
New
or the re-emergence of “old”
diseases
Environmentally
conscious but
consumerist society
Reduced water +land
pollution, but increased
air pollution
Post-industrialisation:
UK in 20th C and
currently Upper income
countries +NICs/RICs
Eastern and urban
China
Ageing populations in
urbanised societies.
HIV/AIDS
SARS
Avian Influenza
Measles TB
In Low to middle income
countries high rates of all types of
environmental pollution
Low to middle income countries,
less able to cope with the ‘double
burden ‘of health risk , late 20th C
Huge rise in HIV/AIDs, smoking,
hypertension, toxic effects of
widespread environmental
pollution, not under control
Enquiry Q 2 Complex causes of health risk
• Different
causes?
• Relationship
to socioeconomic
status?
• Role of
geographical
features?
• Models?
Health risk
Direct factor: contact
with risk :
pollutant pathogen
Virus trauma…
Root factors:
lifestyle
poverty
corruption
natural hazards
environmental….
A typology of health risks from geographical features
and environmental change
Dams, Canals, irrigation...breeding ground ---eg Malaria, Schistosomiasis,...
Agricultural intensification...vector resistance ,rodents, direct contact— eg Haemorrhagic fever
Urbanisation...sanitation, hygiene, water contamination....eg Cholera, Dengue...
Deforestation..breeding sites + vectors, immigration of susceptible people..eg Malaria, Oropouche
Ocean warming...toxic algal blooms-......Red tides
Increased precipitation ... Pools for mosquito breeding ......eg Rift Valley fever
Burdens of heath risk
•
•
•
•
•
•
There are huge health inequalities globally, both in terms of health during life
and age of death (longevity).
Measured by for example the W.H.O.’s DALYs- the years of life spent with
reduced functions resulting from health conditions of varying severity.
Globally, 1 in 3 deaths are from infectious or communicable diseases such as
HIV, but most of these are in poorer areas and linked with malnutrition.
The biggest risk is from non communicable chronic diseases, especially
cardiovascular diseases.
The W.H.O. divides the world into high and low mortality regions, correlating
strongly with industrialisation and GNP/GNI.
The speed by which many transition economy countries have changed their
socio-economic structure over the past few decades has created a double
burden of health risk
High Income--------- - Middle Income-----------Low income
Chronic/degenerative ------chronic+ infectious+ Traumas..............infectious
The top 10: Projected Trends in leading causes of mortality by the
W.H.O.
2004
% Deaths
Rank
2030
rank
Heart disease
12.2
1
Heart disease
14.2
1
Cerebro-vascular
9.7
2
Cerebro-vascular
12.1
2
Respiratory infections
7
3
COPD
8.6
3
COPD
5.1
4
Respiratory infections
3.8
4
Diarrhoeal diseases
3.6
5
Road traffic accidents
3.6
5
HIV/AIDs
3.5
6
Trachea bronchus lung cancers
3.4
6
TB
2.5
7
Diabetes
3.3
7
Trachea bronchus lung cancers
2.3
8
Hypertensive Heart disease
2.1
8
Road traffic accidents
2.2
9
Stomach cancer
1.9
9
Prematurity/low birth weight
2
10
HIV/AIDs
1.8
10
Models to help describe and explain patterns
and trends
1. Origin
1 Expansion diffusion
• Red= place of origin and continuation of
disease in this location.
• Green = new areas of disease
2. Relocation diffusion
• Original disease shifts from place to place
leaving behind its source EG some influenza
epidemics
3 . Contagious diffusion
•
direct contact is needed between hosts of
the disease, the black squares, and new
hosts infected, the blue squares. EG: measles
4. Hierarchical diffusion
• 1 ,2 and 3 represent differing locations
• 1 is often the largest , and the infection
gradually spreads out to increasingly smaller
centres 2 and 3
2
•
EG: The spread of HIV/AIDS from larger to
smaller centres in the United States and SARs
3
outbreak in China 2003
Topical case studies :Swine Flu 2009
•
•
•
•
There is a tendency of pandemics
to encircle the globe in at least
two, sometimes three, waves, with
mutations occurring frequently and
unpredictably
1918: Spanish flu was the most
devastating outbreak of modern
times. Caused by a form of the
H1N1 strain of flu up to 40% of the
world's population were infected.
Over 50 m people died, with young
adults particularly vulnerable.
1957: Asian flu killed 2 m people,
with the elderly particularly
vulnerable.. Rapid action by WHO
and Government authorities
minimised effects by identification
then vaccine.
1968: Hong Kong flu, H3N2, killed
up to 1m people globally, with
over 65 year olds most likely to
die.
•
•
•
•
•
•
2009 Swine flu is a respiratory disease, caused by a new
strain of the influenza type A virus known as A(H1N1),
spread from person to person by coughing and sneezing .
Fatal for a small minority, it particularly attacks younger
people and those with an underlying medical condition
It emerged in Mexico in April , possibly linked to
intensive pig farming. It rapidly spread globally and is the
first official flu pandemic for 40yrs. By November 2009
over 6000 official deaths .
In UK a management first of self diagnosis over internet
began with automated prescriptions for antiviral drugs
to reduce inundation in doctor surgeries and spread.
Chief players:
W.H.O. Global Alert and response (GAR) and The Global
Outbreak Alert and Response Network (GOARN )
established 2000, co-ordinating research, monitoring and
advice to individual governments on management. The
WHO issues Phase warnings from 1-6, 6 being the
pandemic phase of widespread risk
Managers at community and national level have used
containment and ‘outbreak management’ strategies,
including vaccination of most vulnerable groups and
advice on basic hygiene
Enquiry Q 3 Pollution and health risks
• What is the link
between
different
pollution types
and health risk?
• Incidental versus
sustained
pollution?
• Link between
pollution and
economic
development?
• The role of
pollution
fatigue?
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Key terms
Pollution = presence of substances that create a risk
to health and well-being
Point Based – from a specific source: often a mine or
factory/industry
Diffuse- from many often difficult to pin point precise
sources eg nitrates in water, CO2 in atmosphere
Sustained pollution- pollution over a long time period
Pollution Incident- often accidental and point based
Externalities = the side effects, positive and
negative, of an economic activity that are
experienced beyond its site
Externality field = the geographical area within
which externalities are experienced
Toxicity = a measure of the degree to which
something is poisonous. Often expressed as a doseresponse relationship
SOURCE---PATHWAY---SINK
Spatial patterns pollution-health risk: hot spots
According to the NGO
Blacksmith
Institute2009 : Pollution
likely affects over a
billion people globally,
with millions poisoned
and killed each year.
The W.H.O. Estimates
that 25 % of all deaths
in the developing world
are directly attributable
to environmental
factors.
There has been a
global shift in location
in the last century- from
developed to
developing nations.
Chernobyl
Ukraine
nuclear
explosion
Maivv Suu
Kyrgyzstan
Linfen
China
Haina
Dominican
Republic
Ranipet
India
La Oroya
Peru
Kabwe
Zambia
Russia
•Norisk
•Dzerzhinsk
• Rudnaya
Pristan
The Environmental Risk Transition
INDIVIDUAL
Household
Sanitation +
water quality
MESO SCALE Community Urban Pollution rises
with rapid urbanisation then falls with good
management
GLOBAL
Climate
change
Global
warming is
this century’s
biggest
pollution risk
Severity
Of
impact
Increasing Wealth/
development
Shifting Environmental Burdens
Local
Immediate
Risks to Human
Health
Global
Delayed
Risks to Life Support
Systems
Economic development and pollution
relationships
Scales of pollution
impact:
Local
Regional
National
International
Poor- rich dividewho is most
affected?
Role of companies,
businesses,
governments,
NGOs ?
Green groups may
result /thrive
Economy matures: more wealth
throughout society, more pressure for
clean up. In MEDCs shift to service +
lighter manufacturing industry as global
shift continues to transfer heavy
polluting sources to NICs & LEDCs
Start of industrialisation,
high pollution
This also shows
pollution fatigue
in reducing health
risk, ie the
backlash from the
public to
pressurise for
effective
management and
control ..
Continuum model for pollution’s affects on people
Acutely toxic, causing
rapid death
Majority of pollutants are
sub-lethal, ie do not cause
death but make existing
problems worse
Slow accumulations over a long
time period. May weaken
individual so they die from
another disease or pollutant
•No pollutant lasts forever, but some pollutants last longer
•Persistent/non biodegradable substances cannot be broken down by living organisms,
and hence accumulate in an organism even small amounts over time.
• Heavy metals, eg lead, arsenic, mercury, cadmium, may be ingested in water
•Synthetic organic compounds also accumulate over time in the food chain, eg
organochlorides like DDT( now banned in Europe & N America
There are fears- not totally proven, of the health risk link to pollutants with
• Drinking water contaminants (heavy metals and nitrates, chlorinated and aromatic
solvents, and chlorination by-products)
•Residence near waste disposal sites and contaminated land
•Pesticide exposure in agricultural areas
•Air pollution and industrial pollution sources
•Food contamination
•disasters involving large scale accidental, negligent or deliberate chemical releases
The Precautionary Principle is therefore advisable!
Enquiry Q 4 Managing health risks
• What are the
socio-economic
and
environmental
impacts/
burdens?
• Differing
management
strategies and
policies?
• Different players
involved ?
• Role of
Sustainable
management?
Do nothing
(ignore the
risk)
Move to a
safer
location
Attempt to
prevent
the health
hazard
Adapt
lifestyle to
the health
hazard
Increasing health burdens + strategies
Short
term
health
risks :
mental
and
physical
traumas
from
disasters
•
•
•
•
•
Long
term
public
heath
care
•
•
The short and long term impacts, or burden of health risk, have
become more complex with the so called ‘health divide’ becoming
an increasing issue for the sustainability of our natural and
socioeconomic environment. Health is a major driver of global and
local economies, but the costs of health care are escalating
because of:
Population increase especially an ageing population
Rise in both poverty and a more vociferous middle class with higher
expectations of health care
Technology and medical expertise :availability of often expensive
technology and care in prevention and treatment
Consumer demand, increased by the media, internet knowledge and
demands for more social equity in health care.
Rise in pollution and environmental health risks from workplace and
indirectly from climate change
Global interconnectivity: globalisation of health expectations and
faster movement of infectious diseases because of migration and
travel. Also :real time news linked with panic from health issues
such as SARs and Avian influenza
Climate change and health risk
•
•
•
•
Most people will be affected
in some way by climate
change in the early 21stC
Health risks will increase
because of changes to existing
patterns of disease, water and
food insecurity, shelter and
human settlements, extreme
climatic events, population
growth and migration.
Direct influence: Expansion of
Vector-borne diseases and
mortality will increase ,
especially among elderly
people, because of heat
waves.
Indirect effects: on water,
food security and extreme
climatic events are likely to
have the biggest effect on
global health. Increase stress
and anxiety also involved
Climate change is potentially the biggest global
health threat in the 21st century. (W.H.O. + UCL
and The Lancet 2009)
The response needs a new public health
movement that has coordinated thinking and
action across governments, international
agencies, NGOs, and academic institutions.
However, this adaptive response must parallel
primary mitigation: reduction in greenhouse
gas emissions.
Management classification
Direct management
- preventative and palliative
The whole
public,
eg school
food
campaigns,
non smoking
legislation in
public places.
Targeted individuals,
especially if they
occur in sizeable
numbers. This is the
high risk approach,
for individuals with a
combination of risk
factors
 males, who are
obese, smokers
and take little
exercise
 babies
vulnerable to sun
burn.
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


indirect
management
- reducing
exposure to
risks which
may lead to
poor health
Reduce
poverty
improve
housing
improve
water supply
and sanitation
improve
education
methods of
intervention
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


legislation
tax
financial
incentives
education
campaigns
technology,
from safety
belts, efficient
boilers,
syringes and
medicine to
taps.
The players
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


governmentsNGOs
TNCs and
private
organisations
locals
Types of public heath care
•Public health intervention
•Aims to prevent rather than treat diseases, with education a priority Currently
targeted by the W.H.O. It includes surveillance, vaccination and family planning.
•Health care
•involves prevention, treatment, and management to individuals and communities
by medical, nursing and associated health sectors. Prevention is preferable, but
often more difficult to achieve than treatment, although simple schemes can
produce great positive results, eg malaria nets.
• More aggressive and/or shocking types of health risk (such as HIV/AIDs, SARs)
get higher priority than for instance mental illness
•A key player may be the media in mobilising public opinion
•health systems ,such as in the UK, aim to promote, restore or maintain health.
They have an integrated set of facilities and personnel, and have a hierarchy of
primary GP type care, secondary care by specialists in outpatient units, tertiary
care as inpatients for a minority of patients and research by Universities and
private companies.Health systems have evolved from informal, small scale, often
family based systems into large, often government run systems. There has been a
rise in private organizations catering for the more affluent, eg BUPA, and
charitable organizations for the inevitable ’gaps’ in the system, eg Red Cross
Key Principles in pollution control
Precautionary
Prevention
Try to stop at
source rather
than adapt
after created
Eg Urban
Smokeless
zones, energy
efficiency
The UK
Environment
Agency’s
guidelines
Began 1992 Rio Earth
Summit,
linked with sustainable
development .
Where a threat appears
to be present, even if
not proven, action
needs taking to protect
the environment
Eg reaction against GM
foods, 1987 Montreal
Protocol on CFCs and
Ozone depletion
Maastrict Treat of EU
Even Body Shop has it
enshrined in their
corporate plan. 2009 ban
by EU of 22 commonly
used chemicals in
agriculture
Polluter
Pays
Means the costs
of cleaning up
pollution should
be borne by
those causing it.
Started by OECD
1972.reaffirmed
at Rio Summit
Eg
Emissions Taxing
in UK and at
international
scale:Kyoto
Protocol
Proximity
Principle
Pollution should be
tackled as near to the
source as possible,
contained, not allowed
to spread
This would apply to
eg river pollution
or exporting of toxic
waste to poorer less
restricted countrieseffectively global shift
of ecological
footprints!
Examples of successful pollution remediation/elimination
and hence reduced health risk
• Models of how international community can work together successfully
• Global scale
CFC control Montreal protocol
Phasing out of Leaded petrol
Chemical weapons Convention
• More local /regional scale picked by the Blacksmith Institute as examples of good
practice:
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

Accra, Ghana –innovative low tech cooking stoves to reduce indoor air pollution and improve health
of women and children especially
Candelaria, Chile- copper mining waste reduced from water supplies
Chernobyl affected area E Europe- work by especially the EU to improve lives of those in radiation
contamination ( medical, psychological, educational)
Delhi India- reduction of air pollution emissions
Haina, Dominican Republic- removal of toxic soil (improper recycling of car batteries- lead
pollution)
Kalimantan, Indonesia (new techniques to reduce mercury poisoning from artisanal gold mining)
Old Korogwe, Tanzania( removal pesticides contamination of soil and river)
Rudnaya Pristan ,Russia ( removal lead contaminated soil in children's playgrounds)
Shanghai 12 year program to clean sewage out of urban waterway used for drinking water
W Bengal India (reduction arsenic poisoning through removal of naturally poisoned ground water)
International Efforts on health management and the
MDGs
Growth of international efforts to
tackle health risks is linked to
• the increasing scale and issues
involved
•globalisation and
interconnectivity of world
economies ,political and financial
affiliations, and flows of people
and technology
International minimum and
ambient standards are now
common in both health and
pollution management.
These are funded by
international institutions like
the United Nations or World
Bank, or philanthropic NGOs
ranging from Oxfam to the Bill
and Melinda Gates Foundation.
TNCs also play a role.
However, it still comes down to
individual nations and indeed
individuals whether these
policies can actually be
implemented effectively.
In 2000, the largest-ever gathering of
Heads of State adopted the Millennium
Declaration, endorsed by 189 countries.
This was a roadmap setting out 8 goals
to be reached by 2015: to reduce poverty
and hunger, and to tackle ill-health, gender
inequality, lack of education, lack of access
to clean water and environmental
degradation.
Health is linked directly to 3 goals and
indirectly to all.
These Goals are to be achieved through
trade, development assistance, debt relief,
access to essential medicines and
technology transfer.
There has been a reduction in diseases
like HIV/AIDS, malaria and tuberculosis ,
but most countries are currently off track,
especially in sub Saharan Africa and India
(World Bank 2008) . This is despite
increasing health related aid from a whole
range of players.
.
W.H.O. projections for future health risk
Age of sustaining health- the ideal- Balance of
resources and risk .Effective health systems
designed to cope with ageing population.
Eradication of most environmentally infectious
disease eg malaria. Cooperation between countries.
Effective surveillance+ management.
Life
expectancy
Age of
chronic
diseases
Age of receding
pandemics
Age of famine +
pestilence
Age of medical technology: Business as Usual
scenario: limited co-operation between countries.
MEDCs offset increased health risks by wealth +
technology
Age of emerging infectious diseases:
characteristic of poorer countries, dealing with
double burden of infectious diseases and rise in
chronic diseases as ageing of population increases
The aged- both a challenge and opportunity for health care
managers: The WHO project by 2050, the number of aged
over 60 will more than triple from 600 million to 2 billion. Most
of this increase is occurring in developing countries
Time -