Public Health

–Tobacco smoke

–Wood-burning stoves, fireplaces

Gas ranges and furnaces

• •Sick
• Building Syndrome” – Symptoms that disappear when occupants go outdoors
• second hand smoke

•


•Second Hand smoke

• Insulation
• of particleboard, plywood, some floor coverings and textiles

• pesticides,
• dry-cleaning solvents, paints and paint thinners, hair spray, air fresheners

•Microbes such as legionella, hantavirus

• •Allergens such as mold, house
• mites, animal dander

• •Acid rain damages forests and
• crops, turns lakes and rivers acidic, kills fish and plants

• •Lake Michigan, Chicago; Cholera –
• 1885

Minamata Bay, Japan; Mercury – 1950s

• •Hudson River, New York – PCBs –
• 1970s
• •Lake Superior, Duluth
• – Asbestos -- 1970s
• •James River, Virginia; Kepone – 1960s
• •Cuyahoga River, Ohio; Caught fire
• (oil) – 1969

• •Lake Michigan, Milwaukee –
• Cryptosporidiosis -- 1993

–Requirements for treating wastewater

–Sewage treatment plants or septic systems

–Treat with chlorine or other disinfectant

–Sludge; Congress prohibited ocean dumping

–Pretreatment of industrial wastes

–Agricultural runoff

–Urban runoff

–Air pollutants deposited by rain

–Coagulation and flocculation

–Settling

–Filtration

–Disinfection

• •Most water on earth’s surface is
• salt water or ice

•


•Less than 1% is fresh water

•

• •Water shortages in many parts of
• the world
• •Water shortages in U.S. south and
• west

•Political disputes

•Disinfectants; Chlorine

•Disinfection byproducts; Chlorite

• •Inorganic chemicals – metals,
• asbestos, cyanide

• •Organic chemicals; Herbicides,
• pesticides, PCBs

• •Microorganisms; Bacteria,
• viruses, cryptosporidium

•Radionuclides

•Turbidity

•Open dumps

• –Outlawed by Resource Conservation and Recovery Act (RCRA),
• 1976
• •Burned in incinerators or in the
• open

–Outlawed by Clean Air Act, 1970

• •Poured into rivers, lakes, or
• oceans

• –Outlawed by Clean Water Act (1972) and Marine Protection,
• Research, and Sanctuaries Act (1972)

• •Site should be dry, impervious
• clay soil

•Lined with plastic

•Drains for liquids

• •Vents to control explosive gases
• •Tipping fee:

–Cost of disposing of one ton of municipal waste

–Highest cost is in northeast

• •New York City; Fresh Kills,
• Staten Island

•Three R’s: Reduce, Reuse, Recycle

•Reduce: Buy only what’s needed; Avoid excessive packaging

•Reuse: Use reusable items rather than disposable



•Recycle

–Encouraged by deposits on bottles and cans:

–Yard sales

–Composting

–


•Waste to energy incineration:

–Special incinerators; Still concern about pollution






•Recycle

–Encouraged by deposits on bottles and cans:

–Yard sales

–Composting

–


•Waste to energy incineration:

• –Special incinerators; Still concern about pollution
• •Recycle
• –Encouraged by deposits on bottles and cans:
• –Yard sales
• –Composting
• •Waste to energy incineration:

–Special incinerators; Still concern about pollution

•Household Waste

•Harvesting crops

• •Raising animals
• •Over-mining (Returning to old
• sites
• •Ash from emission of fossil fuels
• (Coal, oil and natural gas)
• •Drilling fluids other waste
• associated with oil, gas and geothermal energy production
• •Electronics – 2.2 Millions Tons
• •Contains – Accounts for 80% -
• Deposed
• –Mercury

• –Lead
• -Cadium
• •Flourescent bulbs
• –Radiation Hazards
• –Handle with Care
• –Plastics – No technology to get rid of empty containers

• •Landfills
• •Incineration
• •Deep sea burial
• •Source reduction

•Bacteria:

–Salmonella; Eggs, poultry, meat

• –E. coli O157:H7; Ground beef, alfalfa sprouts, unpasteurized
• apple juice, raw milk, lettuce

•Viruses:

–Hepatitis A; Green onions from Mexico, shellfish

• –Norwalk virus; Shellfish
• •Parasites:

• –Cyclospora; Raspberries from
• Guatemala

–Parasites in sushi, sashimi, ceviche

• •Responsibility is divided among
• many agencies

• •Department of Agriculture (USDA);
• Meat, poultry, processed eggs

• •Food and Drug Administration
• (FDA); All other foods
• •States regulate shellfish
• •State and local governments
• regulate stores, restaurants, institutions (schools, nursing homes)

• •USDA has bigger budget, more
• authority:

–Regulates 20% of food

–Detailed laws on regulation of meat

• •FDA has smaller budget, less
• authority:
• –Regulates 80% of food
• –Inspects only 1% proportion of imported food:
• •80% of seafood is imported
• •60% of vegetables and
• are imported

• DNA
• fingerprinting of bacteria

• •Tobacco
• •Poor diet and physical inactivity
• •Alcohol consumption
• •Microbial agents
• •Toxic agents
• •Motor vehicles
• •Firearms
• •Sexual behavior
• •Illicit drug use

• •Cancer
• •Cardiovascular disease
• •Chronic obstructive lung disease
• •Infant deaths due to low birthweight
• •Burns

• •Obesity
• •Heart disease and stroke
• •Diabetes
• •Cancer

• •Dramatic increases in
• the 1990’s
• •Health Police and
• Libertarians – Those who object to being told by gov’t what to
• do
• •High Blood Pressure

• •Motor vehicle fatalities
• •Chronic liver disease and
• cirrhosis
• •Home injuries

• •Motor vehicle fatalities
• •Chronic liver disease and
• cirrhosis
• •Home injuries

• •Education
• •Regulation
• •Prohibition?

• •1964
• Surgeon General Report – Smoking and Health - Initial decline in smoking

•

• •FDA role in improving
• dietary habits

•

• •Role of government
• and controversies
• •Joycelyn Elders’
• Comments
• •Just Say no
• •Regulation – “The
• Common Good” – STD Prevention – Closing of Gay Bathhouses – 1985 NYC
• •Prohibition – 1919 –
• 18th
• Constitutional Amendment – A failure – Public Health benefit – Decline in cirrohosis of the
• liver
• •Drinking drove men to
• violence
• •What about today’s
• prohibitions: Drug Use – Impact on
• Crime and Corruption

• •Laws against murder and assault
• •Traffic regulations
• •Restrictions on alcohol, drugs,
• and tobacco
• •Age restrictions on many
• behaviors
• •Sexual behavior is hard to
• regulate

• •Health belief model (HBM):
• –I am vulnerable to the threat
• –The threat is serious
• –By taking action I can protect myself

• •Locus of control theory
• (Self-efficacy):
• –Self-efficacy is increased by previous successful performance
• –Self-efficacy is increased by seeing others successfully
• perform, especially if model is a peer

–

• •Public health message
• – Informing persons that they are vulnerable – The threat is serious – They can
• take actions to protect themselves
• •Breast self
• examination (BSE) – Application of model
• •People who are
• confident to control their lives – High Self-efficacy
• •People who believe
• their lives are subject to chance – Low Self-efficacy
• •Learned helplessness vs Learned
• helpfulness – Doing all you can to overcome vs giving
• up – Woe is me
• •People with internal
• locus of control or high self-efficacy = More likely to engage in health
• promoting activities
• •Theories are used for programs to
• promote behavior change; Document evidence-based

• 1.Intrapersonal
• – Knowledge – Attitudes - Skills of the individual
• 2.Interpersonal
• – Family – Friends – Coworkers (Personal hygiene, Eating habits – Peer
• Pressure) – Diverse friends help
• 3.Institutional (Organizational)
• – Schools – Workplace – Stress impact – Safe environment – Cultural supporting
• positive interactions – Good health conscious menus
• 4.Community
• factors – Faith-based orientation – Access to unhealthy life choices
• 5.Public
• Policy – Regulations supporting or not supporting good public health practices
• – Walk-able communities

• •Motor vehicle injuries
• •Firearms injuries
• •Poisoning
• Falls
• •Suffocation
• •Drowning
• •Fires/burns
• •Cut/pierce

•Education

•Enforcement

•Engineering

• Stress: physical and social conditions associated with lower SES may act directly by affecting physiological processes and indirectly by influencing behavior behavior
• well establish contributor to heart disease
• Education: provides the info and skills to solve problems
• Social Support: can provide emotional instrumental assistance can buffer stress

• Products of combustion
• •First regulated total particulate
• •Six Cities Study; Death rates higher in most
• polluted cities
• •Smaller particles penetrate deeper into lungs
• •1987 set standards for PM10
• •1997 set standards for PM2.5
• •Lung cancer, other lung diseases, heart
• disease proportional to PM2.5

·


·

o Mortality and pollution

• o Sources of lead
• emissions

o Radon – Carbon monoxide

o Lead poisoning

• •Weather inversion in London, 1952; More than
• 4,000 deaths
• •Donora, Pennsylvania in 1948; Similar weather
• inversion
• •Smog in Los Angeles in 1950s and 1960s
• •Clean Air Act of 1970
• •Smoke from factories
• – Furnaces – Railroad locomotives – Blackened the air – 4,000 Deaths –
• Respiratory and heart disease
• •British’s first Clean
• Air Act
• •Donora PA – 14,000
• people similar results – Eye – Nose – Throat Irritation – Respiratory problems
• •US – More cars –
• Leaded gas – Photochemical smog
• – Air quality standards – Emission reductions
• •Today air is cleaner
• – Amended in 1977 and 1990

• •Particulate matter
• •Sulfur dioxide
• •Carbon monoxide
• •Nitrogen oxides
• •Ozone
• •Lead
• •Primary"
• standards - Established limits to protect public
• health, including the health of "sensitive" populations such as
• asthmatics, children, and the elderly
• •Secondary"
• standards - Set limits to protect public welfare,
• including protection against decreased visibility and damage to animals, crops,
• vegetation, and buildings.

• •Combustion of sulfur-containing
• fuels, especially coal
• •Irritates respiratory tract
• •Acid rain
• •Irritates the
• respiratory tract – Declined since 1982
• •Released into air by burning of fossil fuels
• •Sulfur is present in
• all raw materials: crude oil,
• coal, ore
• •Carbon monoxide –
• Interferes with oxygen-carrying capacity – Highly toxic – Harmful to
• cardiovascular diseased patients

• •Motor vehicles
• •Responsible for yellowish-brown
• smog
• •Irritates respiratory tract
• •Acid rain
• •Contribute to ozone formation

• •Often colorless and
• odorless

• •Also produced by
• electric utilities, and other industrial, commercial, and residential sources
• that burn fuels
• •Contributes to global
• warming – Market Justice Implications of Global Warming???
• •Much involved in
• formation of ground-level ozone – Triggers serious respiratory problems

• •Damages nervous system, blood,
• and kidneys
• •Used in leaded gasoline, banned
• in 1980s
• •Has decreased dramatically as an
• air pollutant
• •Health risks to children
• •But also through
• accidentally or intentionally eating soil or paint chips, as well as food or
• water contaminated with lead
• •Urban areas with high
• levels of traffic, trasChildren and others can be exposed to lead not only through the
• air
• •h incinerators,
• or other industry, as well as areas near lead smelters, battery plants, or
• industrial facilities that burn fuel, may still have high lead levels in air

•

• •In 1999, several
• areas of the country did not meet the national health-based air quality
• standards for lead

• •Odorless and colorless
• •Formed when carbon in fuel is not
• burned completely
• •Woodstoves, gas stoves, cigarette
• smoke, and unvented gas and kerosene space heaters are sources of CO indoors

• •Was widely used because of fire
• resistance
• •Used in insulation; still used in
• roofing, gaskets, brake linings
• •Was required in schools between
• 1940 and 1973
• •Fibrous dust causes scarring of
• lungs- Lung cancer
• •Affected asbestos workers
• •Manville Corporation bankrupt –
• 1982
• •Libby, Montana
• •World Trade Center

• •Ultraviolet light from the sun;
• Skin cancer and melanoma
• •Radon gas – natural radioactivity
• – lung cancer?
• •Early scandals with patent
• medicines and radium led to regulation
• •X rays used in medicine and
• dentistry
• •Lessons on health effects of
• radiation learned from atomic bombings in Japan

• •Neurological damage in workers
• •Minamata, Japan
• •Emissions from coal-burning power
• plants in US leads to air pollution, water pollution, contamination of fish
• •Concern about fever thermometers,
• school laboratory equipment