The Environment

and Community
Health
Presented by Alexandra Jemmott
Family Nurse Practitioner
Objectives
At the end of the module, the learner will be able to:
1. Discuss the impact of the environment on health.
2. Evaluate environmental health.
3. Discuss concepts and theories central to environmental health.
4. Discuss major global environmental concerns.
5. Outline primary environmental threats to individuals, families and communities.
6. Examine industrial chemicals, which threaten the general welfare of communities.
7. Explain the concept of sustainable development.
8. Outline the threat of and protective measures against bioterrorism.
9. Discuss relevant national environmental regulations.
10. Propose the role of professional nurses in environmental health.
Environment and Health
❑Environmental health involves actions that
➢Addresses all the physical, chemical and biological factors
external to a person, and all the related factors impacting
behaviours.
➢It encompasses the assessment and control of those
environmental factors that can potentially affect health.
➢It is targeted towards preventing diseases and creating health-
supportive environments.
(WHO 2011)
The Impact of Environment on
Health
➢In 2016, as much as 24% of all deaths worldwide were attributable
to the environment.
➢Factors include air pollution, water and sanitation, increasing heat
waves and severe weather events, harmful exposure to chemicals
and more.
(Estimating environmental health impacts (who.int))
Environment and Health
Many environmental forces influence human health
➢Micro-organisms such as bacteria, viruses, and fungi cause
communicable diseases
➢Animals contributes to the spread of these diseases
➢Plants contribute to accidental poisoning or to allergies
➢Industry, vehicles and buildings add to air and water pollution
➢Climate and terrain contribute to natural disasters, may promote
water and air pollution
Environment and Health
Human health requires :
➢A viable environment that incorporates the local ecosystem,
including the air, water and soil
➢Availability of safe and adequate food
➢Sustainable development
Definitions
❑Ecology
❑Ecosystem
❑Eco-tourism
❑Sustainable development
 ECOLOGY

• Ecology is the study of

organisms, the environment and
how they interact with each other
and their environment.
• It covers various levels, such as
organism, population, community,
biosphere and ecosystem.
 Ecosystem
• An ecosystem is a geographic area
where plants, animals, and other organisms, as well
as weather and landscape, work together to form a
bubble of life.
• Ecosystems contain biotic or living, parts, as well as
abiotic factors, or nonliving parts.
• Biotic factors include plants, animals, and
other organisms.
• Abiotic factors include rocks, temperature,
and humidity.
 Eco-tourism
• Ecotourism is a form of tourism marketed as
"responsible" travel to natural areas, conserving the
environment, and improving the well-being of the local
people.
• The stated purpose may be to educate the traveler, to
provide funds for ecological conservation to directly
benefit the economic development and political
empowerment of local communities, or to foster respect
for different cultures and human rights
Sustainable Development

• Sustainable development is economic

development that complies with maintaining
the function and integrity of the ecosystems
that support human societies and things that
they value.
Concepts of Sustainable Development
GOALS
✓ No poverty ✓ Reduced inequalities
✓ Zero hunger ✓ Sustainable cities and communities
✓ Good health and well being ✓ Responsible consumption and production
✓ Quality education ✓ Life below water
✓ Gender equality ✓ Life on land
✓ Clean water and sanitation ✓ Climate action
✓ Affordable clean air ✓ Peace, justice and strong institutions
✓ Decent and economic growth ✓ Partnerships
✓ Industry , innovation and infrastructure
Components of the
Human Environment
1. Natural environment
2. Built environment
3. Social environment
Natural Environment
Natural Environment
➢The natural environment consists of those features of the
environment that exist in a natural state
➢It is unmodified in any significant way by humans

➢Elements of the natural environment includes:

• Plants, animals, biological agents (bacteria, viruses)
• Weather and climate
• Terrain (mountains, rivers, oceans)
• Natural resources (air, wood, water, fuel)
Natural Environment
❖Concerns related to natural environment
➢Air and water pollution
➢Global climate change and its consequences
➢Radiation and temperature extremes
➢Biological hazards
➢Depletion of natural resources
Plants, Animals and Biological Agents
➢A variety of living organisms found in the environment affect
human health.
➢They can be beneficial to humans or contribute to a variety of
health problems.
PLANTS serve as food sources for humans.
➢On the other hand, they can be poisonous if ingested, can cause
allergies through pollens, or toxins (poison ivy)
Plants, Animals and Biological Agents
ANIMALS have both beneficial and negative effects on human
health.
➢They can serve as food sources for humans
➢Serve as a source of companionship and promote psychological
health for many
➢Help control other nuisance organisms (birds eat insects that can
destroy crops or may cause human disease)
➢On the other hand, they (pets and wild) can contribute to
zoonoses (diseases transmitted from animals to human).
Plants, Animals and Biological Agents
ANIMALS
❑Growth in human population causes encroachment on the habitats of
wild animals,
❑This interaction can lead to disease transmission and injury
❑For example, diseases- Lyme disease (caused by ticks from wild
animals
There are other settings that promotes animal-human interaction zoos,
circus, farms, pet stores, educational settings.
E.g. Tuberculosis from elephant to human handler; plague (from fleas);
cat-scratch disease from pets to human; salmonella infection from
exotic pets ( African dwarf frog)
Plants, Animals and Biological Agents
BIOLOGICAL AGENTS
➢Are microorganisms that cause diseases
➢They are transmitted from human-to-human through social
interaction
➢They are transmitted by food and water (Foodborne, waterborne
illnesses )
Plants, Animals and Biological Agents
BIOLOGICAL AGENTS
➢Food borne disease outbreaks occur through contaminated food with
pathogens and other disease-causing agents.
➢Contamination may occur when the food is being produced, during
processing, or prior to consumption
➢produced - growing fish in contaminated waters, using human waste
as fertilizers, untreated wastewater for food crops
➢Processing- failure to properly refrigerate foods
➢Prior to consumption- during preparation in the home using the
chopping board to chop fruits that contaminated meat was used to
prepare.
Weather and Climate
Weather has multiple effects on human health
▪ These includes deaths, injuries and millions in damages
▪ Deaths due to exposure to excessive heat, hypothermia
▪ Poor weather conditions contributing to motor vehicular
accidents
Weather and Climate
▪ Global climate change described as the “biggest global health
threat of the 21st century
▪ Climate change is a natural phenomenon but is occurring much
more rapidly that it normally would be due to human activities
▪ Climate change has both direct and indirect health effects
DIRECT EFFECTS
➢Severe weather events
➢Impact on human health
Weather and Climate
INDIRECT EFFECTS
➢Asthma prevalence and severity
➢ Insect-borne diseases
➢Mental health issues
➢Increasing health disparities between segments of populations

Climate change and insect-borne disease: Facts and figures

(scidev.net)
Weather and Climate
▪ Role of the populating health nurse
✓ Educate individuals, families and communities to prevent
weather related mortality
✓Be informed of environmental legislation
✓Motivate the public to speak out against actions that jeopardize
the environment
Table 4-1 Health Effects and Populations Affected by Selected Weather Event (page 80)
Weather Event Health Effects Populations Most Effected

Heat waves Heat stress Extremes of age, athletes, people

with respiratory disease
Extreme weather events (rain, Injuries, drowning Coastal, low-lying land dwellers,
hurricane, tornado, flooding) low SES
Drought, floods, increased mean Vector-, food-, and waterborne Multiple populations at risk
temperature diseases
Sea level rise Injuries, drowning, water and soil Coastal areas, low SES
salinization, ecosystem and
economic disruption
Drought, ecosystem migration Food and water shortages, Low ES, elderly, children
malnutrition
Extreme weather events, drought Mass population movement, General population
international conflict
Increases in ground-level ozone, Respiratory disease Elderly, children, those with
airborne allergens, and other exacerbations (COPD, asthma, respiratory disease
pollutants allergic rhinitis, bronchitis)
Climate change generally, Mental health Young, displaced, agricultural
extreme events sector, low SES
Preventing Heat-Related Deaths
During heat waves
❑Check on infants, young children, elderly, disabled,
mentally ill, or homebound persons frequently.
❑Evaluate persons at risk for heat-related death frequently
for heat-related hazards and illnesses and take
appropriate preventive action.
❑Never leave anyone unattended in a closed vehicle.
❑Drink plenty of fluids. Refrain from alcohol consumption.
❑Stay indoors or seek air-conditioned environments.
❑Take cool showers or baths.
❑Wear lightweight, light-colored, loose-fitting clothing.
Preventing Heat-Related Deaths
If exposure to heat cannot be avoided
❑Reduce, eliminate, or reschedule strenuous activities.
❑Limit activity to morning and evening hours.
❑ Reduce exercise or replace fluids and electrolytes during
exercise.
❑Drink water or nonalcoholic fluids frequently.
❑Wear a wide-brimmed hat and sunglasses and use broad
spectrum (UVA/U VB protection) sunscreen of SPF 15 or
higher.
❑Avoid direct sunlight and rest in shady areas.
(Page 80, Client Education)
Pollution
➢Water pollution
➢Air pollution
➢Radiation
 Water Pollution

Did you know that….

➢97.5% of the world’s water is either
salt water or is contaminated
➢70% of what remains is frozen in the
polar ice caps
➢Only 0.01% of the earth’s water is for
human consumption
Water Pollution
❑The safety and adequacy of the world’s water supply is of serious
concern.
❑One billion people lack access to safe water throughout the world
❑It is anticipated that this number will increase as populations
grow
❑With water shortages- It is likely that wastewater will be used
increasingly to irrigate food crops
❑This poses the risk of disease transmission through
contamination of food crops with bacteria laden water
Water Pollution
❑In the US, threats to the safety of water supplies arise from an aging water
infrastructure, chemical and pathogenic contamination, impact of climate
change on water availability and the development of new ways to obtain
water.

❑Some health effects of water pollutions

▪ Diarrheal diseases
▪ Malaria
▪ Trachomatis infection
▪ Intestinal helminths
▪ Heavy metal poisoning
▪ Hepatitis A
Water Pollution
Role of Population Health Nurse –
✓Raise awareness of the need for clean water access among the public
and policy makers
✓Document water conflicts and their effects on human health
✓Promote water conservation and efforts to prevent water
contamination
✓Promote proactive cooperation on water issues
✓Work toward achievement of Millennium Development Goal 7 (Healthy
People 2020)
✓Reduce the proportion of people without access to safe water and
basic sanitation
Water Pollution
Safe water recommendations
➢Proper water storage
➢Proper water treatment
➢Adequate personal hygiene
➢Safe disposal of human wastes
Air Pollution
➢Air pollution arises from the release of gaseous and particulate
emissions into the air
➢Four sources of air pollution are
1. Biogenic sources
2. Mobile sources
3. Point sources
4. Area sources
Air Pollution
Biogenic sources
➢Are natural sources of pollutants (volcanic eruptions or wildfires that
create gaseous pollutants and particulate matter)
➢Plant pollen and dust

Mobile sources
➢Include most forms of transportation, lawn mowers and other
devices that move and pollute the air
Air Pollution
Point sources
➢Are stationary sources that arise from a single point
➢Such as a factory

Area sources
➢Are a collection of stationary sources in a specific local
➢For example, a residential area in which many homes use coal or
oil-based heating systems
Air Pollution
Criteria Pollutants (Six major pollutants) affecting air quality are:
1. Carbon monoxide
2. Lead
3. Nitrogen dioxide
4. Volatile organic compounds
5. Particulate matter
6. Sulfur dioxide
Variety of health consequence
Air Pollution
Health consequences of those criteria pollutants include
➢Respiratory effects (lung cancer, exacerbation of asthma,
respiratory conditions)
➢Cardiovascular disease
➢Insulin resistance in persons with Diabetes
Radiation
Human health is affected by two types of radiation
1. Ionizing radiation
2. Nonionizing radiation
Radiation
Ionizing radiation
➢Are of two types
➢Radioactive particles and high frequency electromagnetic
radiation (X-rays)
➢Exposure occurs naturally(radon in the ground) and artificially
(such as medical use, radioactive discharges from nuclear plants)
➢Human effects of ionizing radiation include cancer, genetic
effects, teratogenic effects on infants exposed in utero
Radiation
Nonionizing radiation
➢Is produced by sources such as power lines, mobile telephones
➢Effects of exposure to high levels include heating of body tissue
Environmental Sustainability
Population health nurse
➢Can assist members of the population to recognize sustainability
issues to promote a sustainable environment
• This may be done through-
➢Conservation initiatives
➢Development of more effective and less environmentally
damaging industrial, personal, and transportation-related
activities
Built Environment
The Built
Environment

Definition
Built environment are human
made (versus natural)
resources and infrastructure
designed to support human
activity (USDH HS, 2012 p.
64).
The Built Environment
Elements of the built environment include:
➢Homes, schools, workplaces, roads, transportation systems,
highways
➢Electrical transmission and waste management systems
➢ Parks and recreation areas
The Built Environment
❑Built Environment effects on health can be direct and indirect

❑Direct effects- derive from exposure to hazardous conditions arising from

the built environment
Example, is lead poisoning arising from ingestion or inhalation of lead from
older structures painted with lead-based paints or respiratory disease due to
air pollution

❑Indirect effects- are the result of the effects of the built environment
(contamination of air and water) or on human health-related behaviours
Example, air pollution is a result of motor vehicle use in the built environment ,
pollution is worst in areas near highways, heavily travelled areas
The Built Environment
Areas of concern related to built environment
➢Home safety
➢Inadequate housing units
➢Environmental contamination
➢Rural environments (factory farms)
The Built Environment
Support for healthy behaviors
➢Presence of parks and recreation areas
➢Urban sprawl
➢Smart growth
➢Ecological footprints
(page 87)
Social
Environment
Social Environment
• The social environment, also known as the ‘socio-cultural
environment’, refers to :
➢The immediate physical and social setting in which people live or
in which something happens or develops.
➢It includes the culture that the individual was educated or lives in
➢And the people and institutions with whom they interact.
Social Environment
Aspects of Social Environment:
• – Social capital
• – Social policy
• – Energy consumption
• – Waste management
Social Capital
➢Social Capital is defined as the networks of relationships
among people who live and work in a particular society,
enabling that society to function effectively (Oxford Dictionary).
➢It is derived from relationships that make resources available to
members of a group
➢Facilitated by and enabling social and political environment
Social Capital
➢May involve both horizontal and vertical associations
➢ Horizontal relationships are social networks that increase
productivity by facilitating cooperation and coordination.
➢Example, study groups (discussing educational concepts)
➢ Vertical relationships is an enabling environment
➢Example, expertise of nursing faculty may facilitate your learning
➢Open interaction between faculty na students is an enabling
environment
Social Capital
Potential disadvantages of social capital
• – Negative group norms
– Crime, drug rings

• Differential access for certain subgroups in population

- example, young people, homeless
Social Policy
Social Policy has multiple effects on environment and human
health and health-related behaviors
Policies may relate directly to environmental conditions or to
behaviors that affect the environment:
– Smoke-free policies
– Clean Air Act of 1970
– Clean Water Act of 1972
– Other social policies (e.g. waste management, radon exposure,
acid rain, lead and other heavy metal exposures, climate change,
pesticide exposures, minimum wage, housing policies)
Energy Consumption
➢Energy consumption arises form social mores (the customs,
norms, and behaviours that are acceptable to a society or social
group) and standards of living.
➢All forms of energy consumptions are contributing to rapid
depletion of natural resources.
➢As a result, there is a need to develop alternative forms of energy
production.
Energy Consumption
➢Some alternative energy sources pose environmental health
hazards
➢For example, depletion of oil resources
➢This has encouraged the development of new methods of natural
gas extraction, which makes natural gas a more cost-effective
alternative fuel than in the past.
➢The extraction process, called fracking uses chemicals that leak
into groundwater supplies and are known to cause damage to
lungs, liver, kidneys , blood and brain.
Waste Management
• Categories of waste include- solid waste, hazardous waste, chemical
waste, heavy metals, and biological waste.
• SOLID WASTE
➢Paper products
➢Glass
➢Metal
➢Plastics
➢Rubber and leather
➢Textiles
➢Wood
etc.
Waste Management
• HAZARDOUS WASTE
➢Is defined as potentially harmful to our health or environment.
➢They can be liquids, solids, gases or sludges
➢They can be discarded commercial products like cleaning fluids or
pesticides.
• CHEMICAL WASTE
➢Are generated by a variety of industrial processes
➢Frequently contaminate water supplies
➢Use of personal products such as cleaning agents in the home
➢Factory farms – ammonia production
➢Agriculture- pesticides and fertilizers contaminate water supplies through
run off
Waste Management
• HEAVY METALS
➢Metal contamination of water supplies or land may also occur as
a result of industrial processes or home use of products that
contain heavy metals such as lead, arsenic, etc
• BIOLOGICAL WASTE
➢Are created by humans, animals, insects, decomposing plant
matter
➢Biological waste become hazardous to human health when they
contain pathogens that contaminate water and food supplies
Interactions Among Environmental
Components
➢Natural, built, and social environments are intimately related
➢For example, industrial and human waste deposited in the ocean
pollutes waters and alter the marine food chain
➢Overfishing in coastal waters has led to increase dependance on
farmed fish, which may have higher level of contaminates than
wild fish, thereby increasing the potential for human health effects
Population Health Nursing and Environmental
Influences on Health
➢Protection of the environment is one of the essential functions of
public health
➢Population health nurses are most likely to become aware of
environmental health problems but…are often unprepared to
recognize and deal with environmental issues
➢Population health nursing activity related to environmental health
issues occur at individual/family client and population levels.
Assessing Environmental Health Influences
➢Assess factors that will improve health
➢Assess the population for factors that may increase the risk or
severity of health effects of environmental conditions
➢Factors in each of the determinants of health categories may be
addressed.
 Biological determinants

Psychological determinants

Health Environmental determinants

Determinants Sociocultural determinants

Behavioural determinants

Health system determinants

Biological determinants

▪ Determine the age composition

of the population
▪ Determine existing genetic and
physiologic conditions
▪ Determine incidence and
prevalence of environmentally
caused diseases
Psychological determinants

▪ Stress
▪ Mental health
Environmental determinants

▪ Extent of air and water

pollution
▪ Weather conditions
▪ Features of the built
environment
Sociocultural determinants

▪ Occupation, income,
educational levels
▪ Cultural beliefs,
behaviors, attitudes
▪ Social and environmental
policies
 ▪ Smoking, use of biomass
fuels for cooking and
heating
▪ Recreational activities
Behavioural determinants
▪ Recycling, energy
consumption, conserve
water
▪ Use of protective measure
Health System determinants

▪ May contribute to or
exacerbate environmental
health problems
Focused Assessment: Assessing
Environmental Influences on Public Health
• What natural, built, and social environmental conditions have the potential to
influence the health of the population? How do these conditions affect
health? What is the extent of their influence on health at the present time?
• What segments of the population are most likely to be adversely affected by
environmental conditions? Why?
• What factors contribute to the presence and influence of environmental
conditions within the population?
• To what extent do environmental conditions arise from or are influenced by
individual behavior (e.g., smoking, recycling, water conservation)?
• What are the attitudes of members of the population to environmental health
issues? What priority is given to resolution of environmental health issues?
Focused Assessment: Assessing
Environmental Influences on Public Health
• What barriers exist to improving environmental conditions?
• What is the potential for eliminating hazardous environmental
conditions? What is the potential for limiting human exposure if
hazardous environmental conditions cannot be eliminated?
• What actions will be required to address environmental health
concerns within the population?
• Does the health care system contribute to environmental health
hazards? If so, how?
• Is the health care system adequate to address environmentally caused
diseases in the population?
• Are health care providers adequately prepared to recognize and treat
environmentally caused diseases in individual clients?
Planning to Address Environmental Health
Issues
• The population nurse assess for environmental hazards present in
the community, the factors contributing to them, and the health
results that result.
• This information is used to plan interventions to address
environmental health problems affecting the population.
• Theses interventions can address promotion, prevention,
resolution and restoration.
 Promotion
Planning to
Address Prevention
Environmental
Health Issues
Resolution

Restoration
Promotion
• Population health nurses can advocate for environments that
promote health and healthful behaviours.
• For example,
1. They can collaborate with segments of the population to foster
built environments that promote activity
2. They can advocate for environments in which access is provided
to healthful and nutritious foods at reasonable prices
Prevention
• The role of the population health nurse as it relates to
environmental health would focus on preventative efforts.
• Prevention strategies may focus on:
✓ prevention on environmental degradation
✓ prevention of human exposure to adverse environmental
conditions
• These activities may include:
✓Education of the pubic regarding prevention
✓Advocacy for environmental policies
Resolution
➢Population health nursing interventions with individuals and their
families would be geared to identifying and resolving existing health
problems caused by environmental conditions.
➢PHN could participate in screening for elevated lead levels or for
hearing loss
➢Referrals for testing of water supplies when concerns arises for
contaminated water
➢Can make referrals for environmentally caused health conditions
➢Engaging in political activity to influence policy makers to provide
adequate access to diagnostic and treatment facilities for people with
health problems caused by environmental conditions
Restoration
➢Population health nurses may need to work with individuals or
families to prevent recurrence for complications of
environmentally caused health problems.
➢For example, the nurse may assist a family in finding housing
where exposure to lead is not a problem
➢Another restoration measure may be to suggest decreasing noise
level in the home to prevent further impairment of hearing.
Evaluating Environmental Health Measures
• Population health nurses evaluate the effectiveness of
environmental control measures.
• Evaluation would focus on the effectiveness of promotion,
prevention, resolution and restoration measures related to
individuals, families, and population group.
Please review the following tables
(pages 95-98)

• Table 4-4 Prevention Measures for Populations, Individuals, and

Families Related to Selected Environmental Concerns
• Table 4-5 Resolution Measures for Individuals, Families, and
Populations Related to Selected Environmental Concerns
• Table 4-6 Restoration Measures for Populations, Individuals, and
Families Related to Environmentally Caused Health Conditions
Bioterrorism
Bioterrorism
Bioterrorism is the intentional release of viruses, bacteria, or other
germs that sicken or kill people, livestock or crops.

Potential agents for bioterrorism are classified as A, B,C based on

the ease of spread of disease and the anticipated severity of
effects.
Bioterrorism
Category A
Includes organisms or toxins that pose the greatest risk to public
health and national security based on :
➢Their ease of transmission
➢High death rates and potential for major public health impact
➢Ability to cause panic and social disruption
➢Requirements for specific public health preparedness activity
Examples of Category A agents include anthrax, botulism, plague,
smallpox, Ebola
Bioterrorism
Category B
➢Include agents that are moderately easily spread
➢Result in moderate illness and low death rates
➢May require specific enhancement of laboratory and disease
surveillance and monitoring systems
Examples include brucellosis, food safety threats (such as
salmonella), psittacosis, Q fever, ricin toxin, water safety threats
(such as cholera)
Bioterrorism
Category C
Agents include emerging pathogens that could be engineered for
mass dissemination in the future due to :
➢their easy availability
➢ease of production and transmission
➢Potential for high morbidity and severe health impact
Examples include Nipah virus and hantavirus
Role of the PHN -Bioterrorism
• The population health nurse can advocate for creation of
surveillance system to identify covert biological terrorism.
• There may be a need to advocate for stricter controls on accesss
to agents that be used for biological terrorism
• Safeguards should be developed related to production, storage,
transport and or use of such substances
Health Promotion and Prevention
Bioterrorism preparedness
The population health nursing interventions
✓Assist in identifying the potential for a bioterrorist event
✓Assist in identifying particularly vulnerable populations and factors
influencing their vulnerability
✓Participate in planning community response to a bioterrorist event
✓Educate the public and other healthcare providers regarding
prevention of illness or self care during a bioterrorist event
✓Educate the public regarding the signs and symptoms of disease
resulting from a bioterrorist event and sources of treatment.
References
1. Estimating environmental health impacts (who.int)
2. Clark, M. J. (2015). Population and Community Health Nursing.
Boston: Pearson.