A world fit to live in / Monroe T. Morgan

A world fit to live in hat determines the health of the some five billion people in the world? What determines the health of people in developed and in less developed countries of the world? The pressure of rising health care costs increases the need to document and analyse the determinants of health and to delineate the role of environmental health in the health care system. There are surely four basic determinants of health: heredity or biological factors. medical care, lifestyle, and environment. Heredity or biological factors Human biology is largely con- trolled by one's genetics. One may be healthy in every other aspect but may have inherited from one's fore- bears such problems as haemophi- lia, diabetes. mental retardation. :g eye defects and lack of resistance ~ to disease. Research findings now 0 indicate that even whether or not ~ you may become addicted to alco- - hol or another drug may depend on your mothyr and father. Medical care Two princip9l aspects of medical care affect all of us. One is tech- nology. For several decades technological advances in the health field have been responsible for adding productive years to thousands of I ives. Examples include such devices as sophisti- cated equipment for kidney patients. artificial organs, m on i- taring instruments for the foetus in the mother's uterus, and electro- cardiogram devices worn by patients to detect the onset of a heart attack. These amazing , costly instruments have captured the fancy of society and in the industrialised world account for a large portion of the cost of health care. The second trend in health care is the increased interest in medic-al self-help on the part of the public. This emphasises self-examination of the skin. breasts. mouth. eyes. nails, to name a few. WORLD HEALTH, May 1989 Monroe T. Morgan Growing up amid urban squalor in a fast-growing European city. Proper disposal of solid and haz- ardous waste is one way of improving the environment. Lifestyle Lifestyle is a significant determi- nant of health. For example. lack of sleep and rest reduce our resistance to infectious or chronic degenera- tive diseases. Many Americans indulge in high-fat high-sugar, high-salt low-fibre diets; millions throughout the world are suffering from vitamin deficiency diseases. While there is over-consumption of protein in some countries, many in other lands are victims of kwashiorkor. Everywhere. people tend not to incorporate sufficient exercise into their lives. The heart like all muscles, will atrophy if not used. When this is coupled with high-fat high-cholesterol diets, it is easy to see · why heart disease is the number one killer in many parts of the world . Other diseases associa- ted with lifestyle are among the leading killers. Yet lifestyle could be the easiest of all the determinants to control so as to enhance one's health. Environment Taking the world as a whole, the environment more strongly affects the health of the public than any of · the other factors. Environmental health practice encompasses, as the name suggests, complex rela- tionships between the environment in which people live and the health which they enjoy. Human involve- ment has been selective, hence man has adapted to the environ- ment in which he finds himself by producing biological defences against disease- in which term we include deviation from the normal physiological states of the host. As the direct result of this evolution, man has also acquired intelligence. expertise. and the knowledge to make significant changes in his environment and thus create con- 25 A world fit to live in George McBean ditions which will lessen the likeli - hood of degrading health. This is accomplished mainly by controlling the causative agents of disease while they are in the environment. before they get to man and poss- ibly overcome the body's defence to the point where it requires therapeutic medicine. Some important aspects of environmental health management - the first line of defence against disease - include: - Water quality management - ensuring that potable water is available by carrying out appro- priate treatment of water supplies. - Proper human waste disposal - requiring that human wastes are adequately disposed of in pit latrines. septic tank systems and sewage treatment plants. it is esti- mated that five million children die each year from diarrhoea! diseases; that is 20 deaths every minute of every year. These diseases are the result of drinking water infected with disease-causing micro- organisms. The water is infected 26 because it has somehow received human wastes. either directly or indirectly. - Solid and hazardous waste man- agement - properly disposing of solid and hazardous waste. - Rodent control - removing potentia l habitats and sources of food for rats and other vermin. - Insect control - biological or other methods of insect control. Each year pests and disease con - sume or destroy about 45 per cent of the world's food supply. This leads to annua l crop losses worth about US$ 20 billion . WHO esti - mates that around the world each year more than 500,000 farm workers, pesticide plant employees. and children become seriously ill. and about 5,000 to 20.000 people die, from exposure to toxic insecticides. - Milk sanitation - ensuring that all milk for human consumption is produced under sanitary conditions and is pasteurised Salmonellosis outbreaks are still occurring today because of unpasteurised or Living conditions for this Napalese family have been improved by installing a smokeless stove, marketed through the Agricultural Development Bank. Smoke-filled kitchens and (facing page) gross industrial pollution put lungs at risk all over the world. improperly pasteurised milk. - Food quality management - maintaining surveillance over the food from the farm to the consumer so as to prevent contamination. Occupational health practice - making sure that a healthy and safe work environment is available. - Interstate and international travel sanitation - preventing the spread of communicable diseases between states and nations. - Air pollution control - controlling the emissions of harmful pollutants to the atmosphere. - Water pollution control - reduc- ing the effects of industrial and other wastes on water supplies and WORLD HEALTH, May 1989 WORLD HEALTH, May 1989 A world lit to live in recreational areas by the pre- treatment of industrial and dom- estic effluents. - Environmental safety and acci- dent prevention - designing into the environment those things that will compensate for people's inadequacies. such as pedestrian ramps. - Noise control -controlling noise in industrial settings and in the community to prevent noise from degrading the public's health. - Housing hygiene - ensuring that housing contains conditions necessary for the physiological, psychological, and physical well- being of humans. (Overcrowding has been found to have a corre- lation with deaths from all causes, infant deaths, suicide, tuberculosis, venereal disease, mental hospi- talisation. illegitimate births. juvenile delinquency and imprisonment.) - Radiation control - supervising radioactive sources such as nuclear fission plants and nuclear waste. - Recreational sanitation - moni- toring the environment to prevent unsafe conditions at swimming pools, parks and other recreational areas. - Institutional environmental man- agement - controlling the environ- ment to prevent the spread of infections among hospital patients. - Land use management - zoning so as to restrict the use of land for uncontrolled urban expansion, and so on. - Product safety and consumer protection - ensuring that drugs, toys and appliances are safe for use by humans. - Environmental planning - apply- ing environmental design in order to minimise human stress and accidents. Better funding for WHO What the world needs is more environmental health programmes, more and better prepared environ- mental health professionals and a better educated public. If the gen- eral public of the developed nations knew the role that the environment plays in determining the health of everyone - in rich and poor countries alike - they would guarantee better funding for WHO and other health agencies. If they knew the vital role that is played by environmental health practice, they fu would want to do more to en- 3 courage it and to support other ~ ways of improving the quality of _,_ ____ ~...._..,.,.,......,.__.~-~-..,,....~-.,...____, ~ life for all . • 27