Public Health and the Environment - Second Edition: Uncovering Key Social, Ecological, and Economic Connections

By Edna L Negrón Martínez

Public Health and the Environment presents a timely pathway articulating the connections between the social, ecological, and economic factors<

• Language: English
• Publisher: PAS
• Release date: Apr 16, 2021
• ISBN: 9781732975439

Edna L Negrón Martínez

Edna L. Negrón Martínez holds a seasoned career and vast experience teaching, doing research and services in environmental health sciences, applied microbiology, and public health as a faculty member for more than three decades in the Graduate School of Public Health of the University of Puerto Rico. She obtained a bachelor's degree in Natural Sciences and Medical Technology and a master's degree in Environmental Health Sciences, both from the University of Puerto Rico. Her doctoral degree, focused on Environmental Health Education, is from the Interamerican University, Puerto Rico, including specialized courses taken in the Harvard School of Public Health.She has serviced and led graduate student's thesis projects; capacity building funded projects for the public health workforce on Preparedness and Response, among other diverse themes;and appointed as a consultant to higher education councils in environmental public health. Also, have the expertise as a peer-reviewer of proposals and journals submissions to assess and evaluate the whole product: purpose, focus, coherence, and manuscript organization.Dr. Negrón is the author of Public Health and the Environment- Uncovering Key Social, Ecological, and Economic Connections (English language). Presently, she is giving presentations at local and international virtual conferences.

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About the Author

Edna L. Negrón-Martínez has a multidisciplinary educational background and a seasoned career of more than thirty years in the Department of Environmental Health, Graduate School of Public Health of the Medical Sciences Campus, University of Puerto Rico (UPR). Her previous teaching, mentorship, and research experience include environmental health sciences, applied microbiology, and public health courses.

Professor Negrón-Martínez’s appointment to leadership positions included Program Coordinator of the Environmental Health Department, Academic Senator of the Graduate School of Public Health, and Chair of numerous institutional and scientific committees. She also led many graduate student’s research committees during all stages, including the written thesis, pursuing their master’s degree in Environmental Health. Many of those studies’ outcomes were published and presented jointly with her alumni in Puerto Rico Scientific Conferences and abroad.

Dr. Negrón served in the Center for Public Health Preparedness of the Medical Sciences Campus, the Council of Education for Public Health (CEPH), and the Journal of Microbiology & Biology Education (JMBE) Editorial Board. Also designated in various Consultative Boards by the Puerto Rico Council of Higher Education to oversee, assess, and report viability to grant programs a License and Accreditation. In 2012-2015 the U.S. Environmental Protection Agency appointed her to the National Environmental Education Advisory Council (EPA-NEEAC) as a Representative of Colleges and Universities. She has been newly reappointed as a Regular Scientific Member in the Institutional Review Board of the Medical Sciences Campus (IRB-MSC) to ensure compliance with ethical standards in biomedical and social sciences research.

Dr. Negrón earned her Bachelor’s degree in Natural Sciences and Medical Technology and a Master’s degree in Environmental Health Sciences from the University of Puerto Rico. Her doctoral degree focused on Environmental Health Education is from the Interamerican University of Puerto Rico, Metropolitan Campus, including credits earned at the Harvard School of Public Health.

Reviewers

I would like to extend my deep appreciation to the following professionals who reviewed one or more chapters of the book in draft form based on their diverse perspectives and technical expertise of the topics. Accordingly, they provided the author many constructive comments and suggestions. Likewise, to support the author in making the published book as sound as possible while meeting objectivity, evidence, and comprehensive standards. Responsibility for the final content of the book rests entirely with the author.

Fernando Abruña, PhD, President of Abruña & Musgrave Architects, Puerto Rico

Heidie Calero, Esq., President of H. Calero Consulting Group, Inc., Puerto Rico

Lorraine Lugo, BS Pharm, Former Pharmacy Manager of the Department of Veterans Affairs, New Jersey, USA

Carl Axel Soderberg, Eng., Senior Advisor, Former Director of US EPA Caribbean Division

Chapter 1

Landmarks in the Relationship between Health and the Environment

1.1 INTRODUCTION

A paradigm shift has emerged signaling a new era of global public health. Past and ongoing human activities mostly rooted in environmental, demographic and technological changes are influencing the complexity of challenges to improve the global public health landscape. These include multi-layered changes in the atmosphere as global warming; fresh water-depletion and contamination, land degradation, and increases in urban population.

An environment is defined as the surrounding conditions that affect humans and other organisms during their life cycle. The natural and human-made (built) environments in which humans live determine their aspirations and possibilities. Conservation of the environment is an essential part of peoples’ heritage and a source of well-being. Laws passed to promote positive actions and practices or to punish negative ones evidence this attention to the environment. There is global consensus that the environment has a significant impact on human health.

Environmental health addresses all physical, chemical, and biological factors external to a person, and all related behaviors. This field of study aims at preventing and controlling disease, injury, and disability related to the interactions between people and their environment. The focus is placed on those settings that can be modified shortly or otherwise longer term, to be more policy-oriented (WHO, 2015). Many public health challenges of the 21st century—especially those associated with climate change, major demographic displacements, growing health inequalities and the increasing incidence of non-communicable and emerging infectious diseases—have complex connections to the physical environment (WHO, 2013).

Public health is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals", as defined by C. E. A. Winslow in 1920 and still widely cited. Indeed, public health envisions health and well-being for all individuals and societies. To attain this goal a comprehensive understanding of the relationship between public health and the environmental determinants is needed among all.

This chapter examines the significance of the relationship of public health with the environment by recounting some of the field’s most important landmarks over the past two centuries. Furthermore, it signifies that connection to economic development and social factors in many societies. Also, this chapter describes the interdependence of humankind with nature and its ecosystems services and provisions.

An inter-disciplinary, population-focused and systematic approach would support the identification and analysis of environmental and social factors that contribute to the disease burden (EEA, 2013; Gohlke & Portier, 2007). Likewise, this review highlights the importance of consolidating alliances between public health and environmental sustainability efforts.

1.2 EVOLUTION OF PUBLIC AND ENVIRONMENTAL HEALTH IN A SNAPSHOT

The association of the human disease with environmental pollution dates back to ancient times. Hippocrates, considered the father of modern medicine, first suggested in the fifth century B.C., that the consumption of stagnant water might be related to the occurrence of malaria (Hennekens & Buring, 1987). In 1895, following the discovery of the Anopheles mosquito as a carrier of malaria, governments around the world set out to eradicate those insects by draining wetlands and spraying infested areas with insecticides (Wilson, 1999). Today we know transmission of malaria disease occurs through the bite of an infected female of the Anopheles mosquito species bearing protozoan blood parasites of the genus Plasmodium (Cooke, 2008).

In the 17th century, various investigators related the causes of infectious diseases to invisible living creatures. The first microscopic observations were made by Francesco Stelluti (1630) and Robert Hooke (1665) (as cited, in Willey et al., 2008). However, the first person to publish extensive observations of microorganisms was the amateur microscopist Anthony van Leeuwenhoek in 1676 (Willey et al., 2008). Strong support for the germ theory prevailed from the early 19th century up to the beginning of the 20th century, when cholera and typhoid fever became epidemic diseases (Leavitt & Numbers, 1997).

By the mid-19th century, John Snow, a British physician, conducted studies concerning the origins of a cholera epidemic in London. Based on the available descriptive data and his work, Snow postulated that contaminated water transmitted cholera through a then-unknown mechanism. Today, it is well-known that the transmission of cholera occurs via the ingestion of water or food contaminated with the bacterium Vibrio cholerae.

During his investigation, Snow identified several water companies in London that provided drinking water to residents. Also, he observed that death rates were unusually higher in areas of London that received water from two different water companies, the Lambeth Company and the Southwark and Vauxhall Company, both of which piped water from sites of the Thames river contaminated with sewage (Hennekens & Buring, 1987; Rothman & Greenland, 1998). Between 1849 and 1854 the Lambeth Company changed its water source site to Thames Ditton, an area of the Thames free of water mixing with sewage from London. Subsequently, the rates of cholera decreased in those areas of the city served by Lambeth, whereas there was no change in those areas receiving water from the Southwark and Vauxhall Company. In 1854, an outbreak of cholera deaths in districts near the Broad Street pump struck the wealthy and poorest households, alike. This area was served entirely by Southwark and Vauxhall Company.

Snow’s experimental design consisted of the comparison of the rates of cholera mortality between the residents of areas served by the two water companies, and also by the confirmation of the collected data with individual visits to affected residents. Snow visited house by house, collecting information where cholera mortality occurred and asking the surviving occupants for the name of their water company provider. The ecologic intercommunity comparisons of districts in London were complemented by property value data to show there was no linkage between the water source and the wealthy places, thereby confirming there was not any association due to this potential confounder (Hennekens & Buring, 1987; Rothman & Greenland, 1998).

Snow’s accounts evaluated the consistency of a wide range of information with the hypothesized mode of transmission that the disease was spread through the water distribution system. He suggested that the water was contaminated with fecal matter from infected patients who carried the morbid poison (etiological agent). The classical work of John Snow (1855), On the Mode of Communication of Cholera, charted the frequency and distribution of cholera and also established a cause, or determinant, of the mode of transmission. He sought to reconcile all aspects of the cholera epidemic in London and elsewhere with a unique theory that serves as a model for present-day environmental epidemiology (Rothman & Greenland, 1998).

Bacterial discoveries and scientific publications of etiological agents of human diseases followed, including the works of Pasteur and Koch during the Golden Age of Bacteriology (1857-1914) (Willey et al., 2008). All these contributed to the eventual implementation of residential and city hygiene strategies (garbage collection and filth cleaning), as well as sanitary engineering with improved water supplies and sewerage (Henig, 1997; Leavitt & Numbers, 1997).

1.2.1 Public health and sanitary reform

During the early 20th century, public health rested on the accountability of previous scientific discoveries and successes of clinical medicine and laboratory-based science of bacteriology for the detection and characterization of disease-causing agents. During this time, other researchers made novel discoveries, including the isolation and cultivation of microorganisms, the control of diseases by milk and food pasteurization, and the creation of vaccines for various communicable diseases like diphtheria, tetanus, whooping cough and smallpox (Leavitt & Numbers, 1997; Willey et al., 2008). These contributions influenced the development of public health reform and led to the promotion of sanitary policies, such as housing hygiene and the environmental control of the spread of infectious diseases. Major sponsors of public health reform were governments, the armed forces, along with philanthropic organizations such as The Rockefeller Foundation (McNeill, 2000).

The emergence of sanitary engineering science took place mostly in Western European and North American cities. Environmental actions consisted of the construction of aqueducts and sewerage. Hundreds of filtration plants were built to purify domestic water supplies. Chlorination, which kills most microorganisms, was also used in many plants as a procedure for the disinfection of water. These water treatments contributed to a reduction in urban death rates (McNeill, 2000).

In 1914, the United States Public Health Service adopted total coliform and fecal coliform bacteria as indicators of fecal pollution in drinking water. Although a variety of new indicators are currently in use, the microbial quality and safety of drinking water are still primarily determined, in many countries, by testing for bacterial indicators of fecal pollution, mainly Escherichia coli, a thermo-tolerant fecal coliform (NHMRC, 2003).

Public health reform effectiveness was evidenced by cleaning up physical environments and regulating urban water sources and waste disposal. Despite its great significance, this laboratory-based science of bacteriology was only one of the many determinants of public health (Leavitt & Numbers, 1997). At that time, it was recognized that public health objectives were better addressed within a broader social context (Leavitt & Numbers, 1997).

1.2.2 Social and environmental determinants of health

A social concern was raised during the investigation of the historical public case of Mary Mallon, known as Typhoid Mary (Leavitt & Numbers, 1997; Willey et al., 2008). Mallon has the distinction of being the classic healthy carrier of typhoid fever in North America (Leavitt & Numbers,1997). As early as 1884, Friedrich Loeffler, a German bacteriologist, set forth the concept of a healthy carrier of disease for diphtheria, and in 1893 Robert Koch did the same for cholera. The risk posed by healthy carriers is that they can infect other people without manifesting the disease.

In the early 20th century, Mary Mallon, an Irish-born cook, hired out her culinary services to wealthy New York-area families. She transmitted Salmonella typhi bacilli to members of those families causing several typhoid outbreaks. In a follow-up of samples of her stools, the New York Department of Health found the presence of Salmonella typhi bacilli, and Mallon was sent to a quarantine island in New York. This case strengthened the influence of laboratory-based science of bacteriology in clinical medicine and public health.

However, the isolation and incarceration measures taken to control the dissemination of the disease by Mary Mallon prompted health officials and social reformers to adopt a broader approach to resolve public health problems (Leavitt & Numbers, 1997). Public health officials began to question if laboratory-based germ theory should be still considered as the primary approach in public health. Awareness of public health’s critical roots in society, including links to cultural values, social and political contexts, and personal stories, determined the need to identify more inclusive and sensitive policies for the treatment and control of contagious diseases (Leavitt & Numbers, 1997).

The public health infrastructure in the United States changed to provide essential services successfully achieving public health interventions in the 20th century. This broader and multidisciplinary approach to public health extended to European countries at the end of the 19th century. It has also been influential in Latin America since the mid-20th century and has echoes in the Alma-Ata model of primary health care (Beaglehole et al., 2004). Ambiguity about public health’s role in the health care system began to disappear in the 1970s (Henig, 1997).

Ten Successful Public Health Interventions in the US, 1900-1999

Vaccination

Motor-vehicle safety

Safer workplaces

Control of infectious diseases

Decline in deaths from coronary heart disease and stroke

Safer and healthier foods

Healthier mothers and babies

Family planning

Fluoridation of drinking water

Public health anti-smoking campaign

Source: CDC, 1999. Ten great public health achievements–United States, 1900-1999. MMWR, 48(12):241-243. April, 2016.

Gradually new disciplines got involved, aimed at addressing social and environmental determinants of health (Henig, 1997; Leavitt & Numbers, 1997). However, there is consensus more actions are needed from an intersectoral and systemic approach to integrate and bridge rhetoric and the implementation of policies (Beaglehole et al., 2004).

1.2.3 Expansion of industrial production and economic growth

Extraordinary world population growth since the 18th century (See Figure 1.1), followed closely by economic growth, has come at a price (McNeill, 2000). Major changes that have taken place during these past centuries led the way from an agricultural economy to an Industrial Revolution era.

The industrial era’s numerous discoveries and inventions from the 1890s – 1990s were generated by the use of considerable amounts of fossil fuel energy (McNeill, 2000). Coal, oil, and natural gas were used for heating and cooling, electricity, and diverse forms of transport (The Worldwatch Institute, 2015). This industrial revolution brought about an astounding production of goods for humanity, but its processes often included the generation of dangerous amounts of waste (Goodland et al., 1997).

Environmental change of the scale, intensity, and variety observed in the 20th century required multiple, mutually reinforcing causes. The most ecologically influential causes were the extraordinary surge of the global economy, energy use, and industrial output. The global economy increased by a factor of 14, energy use increased 13 times, and industrial production expanded by a factor of 40 (McNeill, 2000).

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Figure 1.1 Human Population Growth Through History. Source: Our World in Data. [World Population over the last 12,000 years and UN projection until 2100]. Retrieved from http://OurWorldInData.org/world-population-growth CC BY-SA

In parallel to the Public Health triumphs of the late nineteenth and twentieth centuries, new shifts in the environment brought adverse effects on people’s health.

The general economic policy of the twentieth century, regardless of the political system, was to make the most use of natural resources. Nature was sought out as a storehouse of endless resources. This economic theory did not conform to the ecological change that it indirectly helped to create. Therefore, the economy continued to prioritize its growth. In turn, economists who challenged this overarching priority of economic growth and defended the value of ecosystem services were left aside, by the end of the 20th century (McNeill, 2000).

World Wars I and II, and a majority of global conflicts in recent decades have produced severe ecological disturbances. For instance, preparations and mobilizations for warfare by major political powers have brought vast deforestation for building military-industrial complexes to produce ships, trucks, aircraft, chemical, and nuclear weapons. A variety of high-tech defoliants and chemical weapons, e.g., Agent Orange, were used for deforestation contaminating the soil to varying degrees of contamination, particularly since World War II. Contaminated land is defined as land which represents an actual or potential hazard to health or the environment as a result of current or previous use (Alloway, 1999). Additionally, these disturbances in diverse environments will remain for an uncertain number of years, probably long-term unless natural or human-mediated remedial processes can restore the ecosystem.

Public awareness of environmental impacts on human health has been evidenced by a series of international meetings convened since the mid-20th century. Also, the growing consensus on the social origin of many environmental issues has prompted education and international agreements for conservation of the environment.

1.2.4 International agreements for environmental education and conservation policies

The historical evolution of Environmental Education (EE) as a pedagogical practice within formal and non-formal education traces back to as early as the 18th century. As referenced in Gough (2013), educational thinkers, including Jean Jacques Rousseau (1712-1778), Sir Patrick Geddes (1854-1933), and John Dewey (1859-1952), emphasized the importance of experiential education linked to the natural environment. More practically, the fields of nature study (the 1900s), outdoor education (1920s), and conservation education (1930s) set the basic stage from which EE emerged. Throughout the 1960s, scientists—Rachel Carson, 1962; Ehrlich, 1968; and Hardin, 1968—also popularized and contributed to public awareness and knowledge about the natural world and emerging environmental challenges (Gough, 2013).