Environmental determinants of health Clarendon high school March 5, 2019

1. Environmental determinants of healthClarendon high schoolMarch 5, 2019 David P. Kelly, MPH, MIM, MA, BA (Hons) Global Public Health Practitioner (Note: The opinions expressed in this presentation do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention.)

2. Presentation Overview • Presentation Objectives • Environmental Determinants of Health • Climate and Health • Safe Water and Poor Sanitation and Hygiene • Human Exposure to Environmental Chemicals • Connections Between Land Use and Health • Questions

3. Presentation Objectives • Understand what the environmental determinants of health are. • Know the global and U.S. burden of disease due to environmental factors. • Identify specific environmental hazards (pollution, chemical interactions, lack of clean water and proper sanitation) and how they contribute to disease.

4. Environmental Determinants of Health • Defined as the chemical, biological, and physical agents that effect health. • Includes local health hazards – pollution of the air, water, and land – as well as global hazards such as stratospheric ozone depletion and climate change. • Greatest global burdens of disease from environmental factors are climate change, unsafe drinking water, poor sanitation and hygiene, and air pollution.

5. Table 1. Leading Causes of Death in the U.S. and Worldwide – 2016 Sources: 1 National Center for Health Statistics. Health, United States, 2016; https://www.cdc.gov/nchs/data/hus/hus16.pdf 2 World Health Organization. Disease Burden and Mortality Estimates; https://www.who.int/healthinfo/global_burden_disease/estimates/en/

6. Table 2. Leading Causes of Morbidity in the U.S. and Worldwide – 2016 Sources: 1 Institute for Health Metrics and Evaluation, Global Burden of Disease – United States; http://www.healthdata.org/united-states 2 World Health Organization, Global Health Estimates 2016 Summary Tables; https://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html

7. Environmental fraction of burden of selected diseases Source: Prüss-Ustün, A., Wolf, J. Corvalán, C. Neville, T, Bos, R., Neira, M. Diseases due to unhealthy environments: an updated estimate of the global burden of disease attributable to environmental determinants of health. Journal of Public Health, September 12, 2016

8. Total environment attributable Disability Adjusted Life Years (DALY) rate per 100,000 population, 2012 Source: Kaiser Family Foundation analysis of data from the WHO Global Health Observatory Data Repository (Accessed on August 14, 2017).

9. Air pollution The Environmental Protection Agency has identified six pollutants as “criteria” air pollutants: • Carbon monoxide – flu-like symptoms; death • Lead – damage to brain and nervous system, slowed growth and development, learning and behavior problems, hearing and speech problems • Nitrogen oxides – eye, nose, throat, and lung irritation; serious burns • Ground-level ozone – difficulty breathing; can make asthma, bronchitis or emphysema worse • Particle pollution – eye, nose, throat, and lung irritation; can make asthma, bronchitis or emphysema worse; lung cancer • Sulfur oxides – eye, nose, throat, and lung irritation

10. Safe Water And Poor sanitation and hygiene • 2.1 billion people lack safe drinking water at home • 4.5 billion people lack safely managed sanitation • Many homes, healthcare facilities and schools also still lack soap and water for handwashing. • 361,000 children under 5 years of age die due to diarrhea • Poor sanitation and contaminated water are linked to transmission of diseases such as cholera, dysentery, hepatitis A, and typhoid.

11. Human Exposure to Environmental Chemicals • Acrylamide • Arsenic • Benzene • Benzophenone-3 (BP-3) • Bisphenol A (BPA) • Cadmium • Chlordane and Heptachlor • Cotinine • Dichlorodiphenyltrichloroethane (DDT) • Dioxins, Furans and Dioxin-Like Polychlorinated Biphenyls • Disinfection By-products (DBPs) • Mercury • Methyl tert-Butyl Ether (MTBE) • NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) • Organophosphorus Insecticides: Dialkyl Phosphate Metabolites • Parabens • Per- and Polyfluorinated Substances (PFAS) • Polybrominated Diphenyl Ethers (PBDEs) and Polybrominated Biphenyls (PBBs) • Polycyclic Aromatic Hydrocarbons (PAHs) • Perchlorate • Perfluorooctanoic Acid (PFOA) • Phthalates • Styrene • Thallium • Triclosan

12. Climate and Health • Climate is causing existing health threats to intensify and new health threats to emerge. • The health effects of these disruptions include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health. • Extreme rainfall and drought can impact our health • Warmer water and flooding increases the risk of illness or injury • Climate change decreases air quality • Extreme heat increases heat stroke and other related illnesses including respiratory problems • Climate change increases the risk of vector-borne diseases

13. Connections Between Land Use and Health • Concentrated Animal Feeding Operations (CAFOs) and health hazards – antimicrobial resistant bacteria, foodborne illness, and respiratory disease • Deforestation increases human interaction with reservoirs of disease, particularly vector-borne disease, as well as loss of habitat • Smart land use enhances our physical activity, helping prevent the spread of non-communicable disease • Built-up areas create problems in air and water quality • Residential segregation • Traffic safety

14. Questions?