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TOPIC 1
KA 40503 KEJURUTERAAN ALAM SEKITAR

Public Health and Tropical

Medicine

contents
1.
2.
3.
4.
5.

Introduction
Health aspects of water supply
Classification of water-related
infections
Water-related diseases
Diseases and defective sanitation
-NB-

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What is Environmental Engineering?

BOTH thought and practice in the solution of
problems of:
Control & manage water, soil and the atmosphere
Safe, portable public water supplies
Environmental sanitation
Drainage of urban & rural areas
Proper disposal or recycle of waste water and solid waste
To control the environment and its social impacts

Environmental Engineering?
Concerning engineering problems
in the field of:
Public health
Pollution elimination and health
hazards
Sanitation
Effect of technological advances on
the environment

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What is the differences between scientist

and engineer?
Scientist discover things.
Engineers who make them work

Engineers

?
Scientists

Approaches in environmental studies:

1. Conventional model

2. Sustainable model

3. Induced model

-NB-

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The scope

Conventional model

Environmental
engineering
Public health engineering
Sanitary engineering
Water supply
Wastewater
Solid and hazardous waste
Air pollution
Environmental
management and policy

-NB-

Sustainable model
Involve all engineering
disciplines
Business model
+engineering paradigm
into sustainability not
merely pollution control

Renewable energy
Low carbon tech
Clean product
Green building

-NB-

Sustainability measurement
criteria? Based on:
Health
Environment
Economy
Socio-culture
Technical functiom

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Induced model
Environmental components
in engineering disciplines
Pollution control

Reduce SOx, NOx engines

Green engines
Low energy system
Urban green
Env. Management & policy

-NB-

Public health?
Public health = The science and art (practice) of :
protecting and improving the health of a community,
as by preventive medicine/ injury, health education,
control of communicable diseases, application of
sanitary measures, promote healthier lifestyle and
monitoring of environmental hazards.
Tropical = (adj)of weather or climate; hot and humid as
in the tropics; "tropical weather

-NB-

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Impact of public health

Improve quality of life
Increase life expectancy
Reduce infant and child mortality
Eliminate/ reduce communicable
desease

-NB-

Public health

An act of:
Preventing disease, prolonging life, promoting
physical health

Efforts to achieve PH
Example: environmental sanitation, personal
hygiene education, organizational of medical &
nursing services

By who?
Nurse, Doctor, Engineer, Politicians
The careers in PH
-NB-

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10 essentials PH functions
1. Monitor health status
2. Diagnose and investigate
health problems
3. Inform, educate and empower
people about health
4. Solve health problems
5. Develop policies and plans to
support health efforts
-NB-

10 essentials PH functions..Cont.
6. Enforce laws and regulations
7. Link people to needed personal
health services
8. Assure public health and
personal healthcare
9. Evaluate effectiveness,
accessibility and quality
10. Do Research and innovative
solutions to health problems
-NB-

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An illustration of Social-economic
determinants of health
indicating the link between socio-economic and health (through FIVE aspects)

Socio economic
Culture

General Environment

Environmental
condition

Living & working conditions

Social & community networks
Food, water,
education, work

Individual
Lifestyle

Sanitation, health
care, house

Age, sex &

Genetic
factors
-NB-

Public health policy

systematically and transparently incorporates concern for population health and
well-being into the planning and implementation of policies, programs, projects and
services by government, non-government and the private sectors by proposing
actions to minimise health risk, promote health and reduce health inequity.
Healthy public policy/target?
improve the conditions under which
people live
-for example good housing, safe
communities, access to adequate fresh
water and nutition, services, transport,
education and employment.
Health public policy aims to maximize
the benefit of all policies on the health
of populations.
Source: Dahlgren G, Whitehead M (1991) Policies and Strategies to
Promote Social Equity in Health, Institute of Futures Studies:
Stockholm

-NB-

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Health promotion
Illustrate the hierarchy toward population health

-NB-

Another example of public health holistic approach

Evaluate effectiveness,
accessibility, and quality of
personal and populationbased health services.

Research for new insights and

innovative solutions to health
problems

Diagnose and investigate

health problems and health
hazards in the community.

Assure a competent public

and personal health care
workforce.

Inform, educate and

empower people about health
issues.

Link people to needed

personal health services and
assure the provision of health
care when otherwise
unavailable.
Enforce laws and regulations
that protect health and ensure
safety.

Monitor health status to identify

and solve community health
problems.

Mobilize community
partnerships and action to
identify and solve health
problems.
Develop policies and plans
that support individual and
community health efforts.
-NB-

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Public health quantification? How much or how valuable?

Studies in the US public opinion polls in 1999 (Public health: what it is and how it works 4th ed.
By Bernard J. Turnock, Jones & Bartlett Publishers, 2009)

91% - adults believe prevention of

spread
of
infection
disease
(tuberculosis, measles, flu and aids) as
very important
88% - conducting reseaqrch into the
causes and prevention as very
important
87% - immunization to prevent desease
as very important
85% - work to reduce death and injuries
from violence
68% - encourage people to live healthier
lifestyles, eat well and not smoke
66% - reduce death and injuries from
accidents at work, in home and on
street

What can be observed

from this values?

-NB-

illustration or image' of a public health

Another way of describing/defining public health
The health of
the public
Public health
Governmental
services
(ie medical care)

The methods (knowledge

and techniques)

The overall and

broad social system
enterprise

The profession

-NB-

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Selected unique features of public health

Basis in social justice philosophy society fairness in any

burden and benefit
Inherent political nature PH and politics support each
other
Dynamic and extending agenda ever increasing
scope/field environment, lifestyle, health service etc.
Government linked law enforcement (eg sewage, water,
food supply, safety)
Attached in the sciences r&d, promote intervention,
education
Prevention as prime strategy immunization at early stage
Uncommon culture and bond PH is an interdisciplinary
approach

Ref: (Public health: what it is and how it works 4th ed. By Bernard J. Turnock, Jones &
Bartlett Publishers, 2009)
-NB-

Health aspects of water supply

Water and Health
-Two precious resources
Water is one of the earths most precious and
threatened resources
Health is one of each persons most precious
resources
We need to enhance and protect them BOTH

-NB-

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Health aspects of water supply

Health issues on water
Quality
Poor? Contaminated?(I.e microorganism, nonmicrobiological: chemical, metal, &
vector/host:mosquito)

Unsuitable Quantity
Too much? flood drowning, home/crop lose,
infection disease
Not enough? draught malnourished, poor
hygiene, disease

-NB-

Water-Health Issues the 2Q

Too polluted?

Too much?

Too little?

-NB-

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Facts associated with water and health

Diarrhea the highest fatal disease to children
around the world
WHO estimates 80% of world diseases are due
to poor sanitation and water
50% of population in developing countries
exposed to polluted water source
2 5 million per year die from water related
disease and poor sanitation

-NB-

Estimates of water related mortality

Source
WHO 2000
WHO 1999
WHO 1996
WHO 1992

Death Per year

2.2 million (diarrhea only)
2.3 Million
> 5 million
5 million

Source: World Water Day, KK May 2004

-NB-

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Water war- disastrous water?

Water can become an enemy and
cause disasters
If there is a political will for peace, water will not be a hindrance.
If you want reasons to fight, water will give you ample opportunities
Steve Lonergan , co-author, with David Brooks, Watershed: The Role of Freshwater
in the Israeli-Palestinian Conflict (IDRC Books, 1994) .
-NB-

Technology

Geopolitical
Political
governance and
implementation

Resources

Water
war

Business and
economic
Property & human capital

Climate change

-NB-

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Water wars is a phrase used to describe

increased competition for water resources
due to:
drought, climate change, or increasing populations;
controversies over and reduced access due to privatization
of water services; or the role of these tensions in leading to
physical conflicts, within or among nations

-NB-

Water war- disastrous water?

Some Contributing factors..

Population growth and water supply

Water crisis
Water consumption increased
Global water requirement increase 50% in the nxt
20 yrs (The 2030 Water Resources Group BBC
News, 22 March 2010)

Sanitation

2.4 billion people lack proper sanitation

Much of this waste enters the river system
untreated reduce clean water sources
-NB-

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Water war

Pollution
Animal

husbandry oil & grease

discharge directly into stream
Untreated industrial effluent
Agricultural discharges (Fertilizer,
pesticides, animal wastes)

Food shortage
According

to FAO- 815 million people

undernourished
25,000 people die every year from
hunger
-NB-

Water war

Floods
Most

destructive natural disasters

Urbanization increase peak discharge
causing more frequent and intensive flooding

Eco-system and climate change

The

depletion and pollution of rivers, lakes and

wetlands will result in degradation of
vulnerable eco-system
By 2100-surface temperature increase 1.5-6
degree and sea level by 10-90 cm (source IPCC20001
Intergovernmental Panel on Climate Change)
-NB-

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Water war

Global water business/ economic

Water gives US$400 billion global market (source:
Goldman Sachs)
Global market for pumps, pipes, filters, and other
purification and sanitation equipment at US share
of the industry amounts to roughly $100 billion in
yearly sales, and growing three to four percent a
year (source: Pacific Institute: Worlds Water).
Japanese government will help the private sector
tap into the water business in other countries,
aiming to garner 6% of global
markets in 2025 i.e. total of 31 trillion by 2025
(source: Japan Times, 13 April 2010)
-NB-

Thus..What are going to do?

-NB-

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Water contamination the quality issue

Types of water-related contaminants:
Micro organisms

Viruses
Bacteria
Protozoa
Helminths (worm)

Non microbiological
Chemical compounds
Metals (Ni, Cu etc)

Vectors and intermediate hosts

Mosquito to spread malaria, dengue, yellow fever (virus)
Snail host - schistosomiasis
-NB-

Classification of water-related* infections

(Feacham-Bradley Classification)

Water-borne
infection spread trough water supply poor quality
Water-washed/water scarce
infection spread due to Lack of water for personal
hygiene
Water-based
infection spread due to aquatic invertebrate host
Water-related insect vectors
infection spread trough insects (spreading infections)
ie the insect depends on water

* Water & disease ; Water as route of transmission

-NB-

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Water-borne
The pathogen is
in water that is
ingested

Classification of
water-related
infections

Water-related
insect vectors
Transmission by
insects that breed
in water or bite
near water

Water-washed/
water scarce

Water-based

Person-to-person
transmission because
of a lack of water for
hygiene

Transmission via an
aquatic intermediate
host (for example, a
snail)
-NB-

Risk minimization (Cairncross & Feacham, 1993)

Four types of water related transmission routes for infections & preventions
strategies
Transmission route

Example

Prevention strategies

Water-borne

Cholera, typhoid,
cryptosporidia

-Improve QUALITY of drinking

water
-Prevent casual use of unprotected
sources

Waterwashed/water
scarce

Diarrhoeal diseases

-increase water QUANTITY used

-good access and reliable domestic
water supply
-improve hygiene

Water-based

Schistosomiasis/gui -reduce need for CONTACT, control

nea worm
snail populations, reduce surface
water contamination

Water-related insect Maleria, dengue,

-MANAGE surface water, destroy
vectors
filiariasis
-NB- breeding sites, use mosquito
netting

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Water related disease Barrier prevention onto the routes of

possible water-transmission diseases The F-diagram
Fingers
Flies

Disease
(faeces)

Food

New host

Fields
Fluids
Primary
barrier

Secondary
-NBbarrier

? Give ur example of
barriers?

-NB-

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Diseases and defective sanitation

Water supply and sanitation are intimately
linked to health in several ways:
Disease prevention people must have
access to sufficient quantity of adequate
quality water and sanitation facilities
Lessen poverty some of the poorest people
in the world are also unhealthiest
Basic human rights (safe water and adequate
sanitation) to increase the sense of wellbeing and improve economic and social
productivity
-NB-

Sanitation
Intervention to reduce peoples exposure to disease
by providing a clean environment in which to live;
and do measures to break the cycle of disease.
This includes disposing and hygienic management of
human and animal excreta
Refuse
Wastewater
Control of disease vectors
Domestic hygiene

-NB-

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Sanitation system
May divided into two categories:

On-site sanitation

Some of the common

option are:
Wet type: Pour-flush
toilets, Aqua-privies,
Septic tank
Dry type: Pit latrines

Off-site sanitation
Sewerage

-NB-

On-site sanitation (wet)

Pour-flush toilet

Require water to flush. Usually water sealed

-NB-

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On-site sanitation (wet)

Pour-flush toilet

Some advantages
Long term life
Eliminate odors and
insect breeding
May be applied in-house

Some disadvantages
Quite expensive
Require separate sullage
disposal facilities
Use large quantities of water
(4 liters/person)
Not applicable in high
groundwater areas
Clog easily when bulky anal
cleansing materials are used

-NB-

Aqua privies & Septic tank

On-site sanitation (wet)

Both are sealed tanks (normally

buried below ground), which provide
primary treatment of wastewater

Septic tank located away from

latrine/toilet

Aqua-privy built directly below

the latrine, receiving the water
deposited down a vertical droppipe
-NB-

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Septic tank

Aqua-privy

Fig. Sealed tank

-NB-

-NB-

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On-site sanitation (dry)

Pit latrines

Traditional pit latrines have 2

main disadvantages:
Smell bad - Attract flies and other
disease-carrying insects
Poorly built and dangerous to use

But can be improved by:

Provide tight fitting cover (lid)
Regular addition of ash
Ensure pit stability
-NB-

Fig. example of a simple pit latrine

Air
vent
Air
vent
Latrine
shelter

Foot rest
Gases escape
Liquid
percolate

Solid
decompose

Pit lining extends at least 1.0

m below ground level (deeper
if soil is unstable)

Pit should at least 2 m deep and

1-1.5m round/square
-NB-

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Off-site sanitation - sewerage

Common System features:
usually laid under roads for ease access
(maintenance)
Laid at depth >0.8 m
Gravity system velocity >0.6 m/s during
peak flow

-NB-

Off-site sanitation - sewerage

Several system design features:
Water use type of treatment, loading etc
Blockages maintenance requirement and
schedule
Manholes location and design
Excavation costs gravity flow
Sewer pipe materials, local/soil condition

-NB-

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Illustration of wastewater collection system

3 types:
-Sanitary sewer
- stormwater sewer
-Combined sewer system

carry storm runoff from streets, parking

lots, and roofs through pipes and ditches,
and eventually into streams.

carry raw sewage from homes and

businesses to wastewater-treatment
facilities.

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Some progress in toilet technology

Smart toilet
Health check (sugar
levels, blood pressure,
fat)
on-line to
Hospital/doctor
multi function also as
washing machine
treated on-site with
current technology
-NB-

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Composting toilet

dry toilet, use less water

No liquid discharge
sludge reuse
Suitable to temperate
climate and less water
consumption

-NB-

End of topic

-NB-

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