Env Midterm

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What's causing the premature deaths from pollution?Air pollution -> water pollution -> occupational Lower middle income level have highest burdenSeminal Env Events-1854: broad streat, water, 600 deaths -1952: London fog, air, 4-10,000 deaths -DDT and silent spring, pesticides -Chernobyl, 1986, radiation, 116,000 deathsExposure intensity - quantifying hazardTotal Ratio (decibels) Unit of concentration (liter)Dose-Measure or estimate of how much a hazard actually gets into body -No dose without exposure -Concentration is not exposure is not doseExposures and does can be-Simple (x-ray): single, short duration, known exposure, known dose -Really complexHazard Source-Stationary (refinery) vs Mobile (automobile) -Point (incinerator) vs area (runoff) -Multiple sources for a single hazard (lead) -Single source for multiple hazards (smokestack)Environmental Fatevector: air, soil, water, food Receptor: people Pathway: path from source to receptorAssessing ExposureDirect-> personal monitoring-> dose of exposure models Direct-> biological monitoring-> PBK modeling-> Dose models Indirect->questionnaires/diaries OR environmental monitoring/modelingPersonal MeasurementMade on or in a person which represents their personal external (or internal exposure) Biomarkers, specimensArea MeasurementMade in an area intended to represent the exposure of a person in that general areaHierarchy of Exposure*From best type of data for est exposure (personal area surrogates) to worst type 1) Quantified personal measurement 2) Quantified area meas in the vicinity of the residence or sites of activity 3) Quantified surrogates of exposure (est of drinking water) 4) Dist from the sites and duration of exposure 5) Distance or duration of residence 6) Residence/employment in the geographical area in reasonable proximity 7) Residence/employment in a defined geographical area (county)Why Exp Assessment is so Important-Foundation of Env health -Essential for characterizing, managing, regulating, -Error in exp est affects est exp-resp rel in epid studiesEnv Health PolicyStatement by an organization of intentions and principles in relation to overall env performance. Provides framework for action and obj. Goal: reduce human risk of env damages resulting from pollution4 PrinciplesPrecautionary principle Env justice Env sustainability Polluter-pays principlePrecautionary PrinciplePreventive, anticipatory measures should be taken when an activity could harm env, wildlife, human health, even if some cause-effect relationships are not fully established. Err on the side of prevention and take prevention measures even without certainty (EU)Env JusticeEqual trt of all people in society Env hazards are often product of disparities in power and privileges -People need to participate, able to influence agencies, and concerns should be considered in decision-makingEnv SustainabilityA strong, just, wealthy society can be consistent with a clean env, healthy ecosystem, and a beautiful planet Tenets: resources cannot be used faster than regenerated and no perm change to env 3 components: materials and energy use, land use, human developmentPolluter-pays PrincipleOECD, 1974: polluter should bear expenses of pollution prevention -Costs of controlling pollution are to be incorporated into prices of associated goods and servicesFives phases of env policy cycle1) Policy definition formulation and reformulation 2) Agenda setting 3) Policy establishment 4) Policy implementation 5) Policy assessmentEPA-Develops and enforces env regulations, edu, funding -Independent agency -Works collaboratively with state -Comprised of many centers that focus on specific topicsUS Agency for Toxic Substances and Disease Registry-Advisory agency with chemical safety focus, toxicological research, edu registries -Works collaboratively with state -Conducts PH assessments and creates toxicological profiles for hazardsEuropean Env Agency (EEA)Gives advisory env info to EU to develop policy. Works collaboratively with EionetEIONETCooperation (national, regional, European, networking) Infrastructure (IT, tools, standards) Content (Monitoring, data, info, assessment, knowledge)Types of Env Standards-EPA sets or rec limits on air and water pollutants, waterborne pathogens, pesticides, radiation -Air conc of a chem below which over a specific time risk of potential health effect is acceptable -Physical agent exposure expected to produce no or small health effect -Amount of pesticide on a food product is acceptable -Amount of a pathogen or conc of a contam in drinking waterTypes of Env Exp Limits-1 hr avg or max exp limits: designed to protect against acute health effects that occur quickly -8 hrs avg exp limit: designed to protect against subacute hlth effects -1 yr avg exp limit: designed to protect against chronic hlth effects -Maximum contam limit for water: max allowable concen of contam in water3 Main Types of Evaluating Policy Impacts*Env impact assessment Health impact Benefit-cost analysisEnv Impact Assessment-Focused on env. Triggered by req National Env Policy Act -Process that reviews env conseq of anthropogenic activities -Focuses on: quality of env media, landscape, geological, climatological analysis, ecological analysis6 Steps EIAScreening (what assessment needed) Scoping (issues?) Assessment (need/impact/baseline) Management and monitoring Synthesis statement Review and decision makingExamples of EIAsoil contamination levels air pollution levelHealth Impact AssessmentDeveloped from EIA - focus on health. Process for describing est effects of policy on pop hlth. Ex) incidence, prev, YLLHealth Impact Assessment StepsScreening SCoping Appraisal Reporting MonitoringBenefit-cost analysisEconomic -Useful for comparing favorable vs unfavorable effects of policy -Agencies should be allowed to consider economic factors in setting regulatory priorities -BCA should be req for all major reg decisions -Agencies should not be bound by strict BCA tests -Best BCA est should be accompanied by a description of uncertainties -Greater external review yields better regulatory analyses -Common economic assump should be used for all BCA -BCA should focus on main association between benefits and costsMost vulnerable and susceptible*childrenFour Critical Points1. Understanding systems related to humans requires understanding people 2. Efforts to achieve larger, systemic understanding don't negate need for specialization 3. Requires info exchange and synthesize across org boundaries 4. Many different methodologies available to approach systems thinking Can be challenging to match methodology to PH issuesPath Dependency TheorySeeks to explain why processes with similar starting points can lead to different outcomes even if they follow same rules Outcomes sensitive to initial conditions as well as choices made along the wayAgent-based ModelingVirtual representation of a complex system Model individual agents who interact with each other and env Interactions based on simple pre-defined rules (Like a flowchart)Scenario PlanningStrategic planning method Identify, analyze possible future events and alternative outcomes Quantitative projections or qualitative judgements Biggest value from learning from planning process, not actual plans or scenarios (like venndiagram)Casual Loop DiagramQualitative picture of mental model Highlights causality and feedback loops within a system Types of variables can be categorized and relationships quantified (like a DAG) Counterclockwise loop and R or + and - or B is balancing clockwiseProcess MappingTools that provide a pictorial representation of a sequence of actions and responses Can make clear current processes, identify bottlenecks or inefficiencies, or produce map of "ideal" process Fairly common in medical lit Exposure-dis frameworkUS Annual Occupation Fatalities4-6k injuries 49-60K illness $52B Globally, 2.8 mill diePrimary US occupational health agency is OSHA-Est in 1970 -Very broad powers to regulate workplace conditions -Many regulatory exp limits adopted from voluntary guidelines set in 1968 -Most standards and limits have never been updated -General duty clause to correct unsafe conditions even when no standard or limit -No jurisdiction over fed or state workers -Small agency, 1 inspector for every 60,000 workers but covers 9 million workplaces (doesn't cover all, fed and state exempt) -Odds of inspection: once every 57 years -OSHA recs other limits -PELS for only 500/85,000 chemicals and hazards - many outdatedExamples of OSHA StandardsProvide fall protection Prevent exp to infectious diseases Ensure safety of workers in confined spaces Prevent exposure to harmful chemicals Put guards on dangerous machines Provide respirators and other safety equipment Provide safety and health training Communicate info about workplace hazardsTypes of Work DeterminesTypes of hazards Degree of exp Magnitude of riskMost Common Workplace Hazards-Commonly cited violations: safety, chemical. OSHA focuses more on safety than health -Causes of death Fatal and nonfatal injuries, decrease in vehicle and machines, homicides are increasing5 Sources of PH authorityUS and state constitutions, statutes, rules, court opinions, executive ordersHealth OfficierMakes determination of threat Relies on everybody for information --- everybody is decision makerPH Decision Making ToolSituation (facts, threat) Consequences Likelihood Mitigation (how to address threat) Certainty (action now or later) CommunicationHealth Impact InterventionsTop down from smallest to largest impact Counseling impact -> clinical interventions -> long-lasting protective interventions (vaccine) -> changing the context to make individuals' default decisions healthy (fluoridation) -> socioeconomic factorsImminent Danger OrdersA public health officer can issue an order to avoid, remove or correct an imminent danger Doesn't require declaration of emergency Powerful, fast, flexible, Ex) vaccine shortage. State order limit of vaccinations.Who has legal authority to exclude unvaccinated children from public school during an outbreak?Local health officer, MDHHS director, superintendent of schoolJacobson vs MAstates can enforce vaccination lawsEst of workforce injuries accounting for underreporting~9million nonfatal injuries and illnesses (mostly injuries) ~53,000 fatal Estimates of fatal don't differ from actual Reduced in 2008 from decreased employment Self-employed don't follow OSHA Employers with 50-249 employees have highest possibility Highest for malesMost dangerous industryRate vs absolute (number lives lost) Absolute: construction, transportation and warehousing, agriculture Rate: agriculture, transportation and warehousing, miningOccupational Health AgenciesFragmented A) Research (make rec) CDC and NIOSH B) Regulators (enforce and set standards) OSHA, MSHA, FRA, FAAOccupational Safety and Health Act 1970OSHA and NIOSH OSHA two means of protecting workers: statutory general duty to provide safe and healthful workplace and adherence to specific standards Rec hazards may be substance/expFed Agencies - Occupation HealthHave jurisdiction on their employees. State plansKey Industries Not or Not Well CoveredForestry, farming, fishing Oil Offshore workTypes of StandardsA) Permissible exp limits (OSHA i: daily limit (time-weight avg over 8 hr shift, designed to protect health effects 40 yrs ii: Short-term (TWA over 15 mins, protect acute health) iii: Ceiling limit (level never to be exceeded) iv: emergency chemical limit (airborne concen that may be lethal) B) Air concentration C) Physical agent expected to produce no or small health effects D) Number of hours in a day or trucker can workHow to Track Occupational HealthBLS (survey, census) Insurance (workers comp, health insur) Under-reporting is a HUGE problemInternational Occupational HealthInternational Labor Org -Promote rights at work, inform legislation, anticipate emerging issues, develop standards Multinational companies can also play a role -large employment, subject to regulations, may adopt most protective lawHierarchy of Controls (From most effective to least)1) Elimination: remove hazard/ reduce quantity (ban asbestos, zero emission vehicle) 2) Substitution: replace hazard/ reduce quantity (water detergents instead organic solvents, ultra low sulfur diesel) 3) Engineering controls: isolation/ prevent contact (needle safety, smokestack, scrubber) 4) Admin controls: change work, inform (warning signs, air quality index) 5) PPE: burden on individualAir Pollution-Mixx of thousands of components -Killed 7 million in 2012 -not a new problem -Varies over time and spaceBiggest Air Pollution ChallengesStratospheric ozone depletion Atmospheric deposition (mercury) Urban smog (ozone, PM) Climate change (GG) Indoor pollutionHarvard Six Cities StudyAmbient air pollution and mortality Adults 1970s-1980s Strong, positive correlation btw levels of air pollution and mortality Individuals in highly polluted areas Chronic exp to air pollutants independently related to CVD Steubenville OH, Portage WI, Watertown MA, Topeka KS, Harriman TN, St Louis MODeveloping countries have larger air pollution impacts due to-Higher household exp due to biomass fuels -More rapid and disharmonic industrialization, urbanization, and transportation development -Fewer preventive services and less surv -Higher maternal exp during preg -Higher childhood expTypes of Air PollutantsA) Particulate Matter -Complex mixture of extremely small particles and liquid droplets suspended in air -Acids, organic chems, metals, soil and dust Types: primary particles emitted directly from air pollution sources (diesel) AND secondary particles formed in atmosphere from gaseous air pollutants (SO2) B)Gases and vapors -Hydrocarbons, CO -Ground level ozone, nitrogen oxides, volatile organic compounds containing compounds that evap under normal atmospheric temp and pressure, GG C) Smog: ground level ozone from temp inversion (cool air trapped by warm air above, pollution is trapped near ground)PM Air Pollution and AirwaysUpper: filtration in nose, impaction of large particles onto mucous membranes, remove particles by swallowing, coughing Lower: impaction of small particles in bronchial tubes, lung tissue, absorption of small particles by blood streamIndoor air pollution concernsAsbestos, radon, mold, biomass combustion products, VOCsHave air pollution control efforts worked?-Massive growth in terms of economy, travel, population, and energy consumption -Reductions in criteria pollutants -Some growth in carbon dioxide emissions -BUT, overexposures to air pollution continue More than 1 out of 3 people live in a county that has one or more NAAQsGlobal Air Pollution EffortsUN - Montreal Protocol and saw dramatic reductions in chemicals causing stratospheric ozone depletion Global Mercury PartnershipClean Air Act (CAA) of 1970, 1977, 1990Regulates emissions for stationary and mobile sources of pollution, considering: -Relative contributions of each to specific air pollution problems -Relative capacity of different source types to reduce emissionsNAAQS (National Ambient Air Quality Standards)-Six primary criteria pollutants -Air toxics/ hazardous air pollutants (HAPs): 1990 amendment added 189 chemicals -Different levels of exposure and averaging time per pollutant -Primary standards: damage to people -Secondary standards: QOL, damage to propertyWho sets ambient air standardsEPA sets air quality standards with state implementation and enforcement Clean Air Act (CAA) of 1970, 1977, 1990Six Criteria Pollutants***1. CO/Carbon monoxide 2. NO2/Nitrogen Dioxide 3. O3/ ground level ozone 4. Pb/Lead 5. SO2/Sulfur dioxide 6. PM HAPS: range of chemicals with varying properties, 189 Eye, nose, throat irritation; difficulty breathing; cancer;CO/Carbon monoxidecolorless, odorless gas; byproduct of combustion Reduced oxygen in tissues, worst impact on those with HD From highway vehicles, industrial, non-road mobileNO2/ Nitrogen Dioxidehighly reactive, reddish brown gas, sharp, biting odor Aggravates resp dis, esp asthma, respiratory problemsO3/ ground level ozonehighly reactive, colorless gas, odor similar to chlorine Reduced lung function; respiratory symptoms; aggravates asthmaPb/Leadtoxic heavy metal, released through combustion or smelting Neurological, learning, behavioral impacts, esp on children; CVDSO2/Sulfur dioxidecolorless gas, odor like burnt matches Respiratory symptoms, difficulty breathing; aggravates asthma Emissions from power plantsPMsmall particles and droplets suspended in air Harmful to CV system; heart attacks, strokes, asthmaFossil Fuel UsePetroleum highest and increasing followed by natural gas and renewables Coal plateaued Slight decline in nuclearEvaluating Air Pollution-Nationwide network of monitoring stations -Changes in criteria air pollutant emissions over time All pollutant concentrations have declined over time Specific trends vary -Changes in criteria air pollutant concentrations over time All pollutant concentrations have declined over time Specific trends varyPrimary Global Air Pollutant ProblemsStratospheric ozone depletion Atmospheric depletion (mercury, persistent organic pollutants) Urban smog (PM, ozone) Climate change (GG) Indoor pollution (household)Challenges in Exp Assessment for Air PollutionLow exp levels Mixtures of chemicals Large variability over time and space Multiple exposure routes Long-term exposuresChallenges in Assessing Impacts of PolicyChange occurs slowly Sources change due to economic factors Health effects may be caused by multiple exposures Complexity of standard-setting processWater Characteristics97.5% of the Earth is saltwater; 2.5% freshwater Freshwater comes from: 2/3 from glaciers and permanent ice caps (Antarctica), 31% groundwater (Asia, Africa, NA), .3% is traditional water sources (Asia, NA)Number 1 user of freshwater*Agriculture 86% of freshwater consumptionGlobal Water Withdrawal-Increases 10-12% every 10 years -By 2025, agriculture use expected to grow 1.2x it was in 2003 -Varies by country: US: equally split between industry and agricultures Domestic Use: 82 gallons per person per day, 42.3 million gallons per day for whole US (92% from public suppliers) Africa, South Asia: agriculture Canada, Russia, Europe: industry -Developed countries use 10x more water daily than developing countriesWater Stress***-Annual water supplies <1700 m3 per person in a given area -460 million people (8% population) -25% world's pop approaching this -31 countries face chronic freshwater shortagesWater Scarcity***-Annual water supplies <1000 m3 per person -Water withdrawn from lakes, rivers, groundwater so great that water supply no longer satisfies human/ecosystem needs -Results in increased competition between water usersSafe Drinking Water2.1 billion people lack safe water at home 785 million lack safe drinking water services 2.2 billion people lack basic sanitation services 673 million defecate in open surroundingsImpact of Inadequate Drinking Water and SanitationAbout 10% of global burden of disease is water-related Mortality rate in Africa 4x higher than global rate Diarrheal disease from inadequate water and sanitation kills ~830,000 people each year (1 child every 15 seconds)Water Pollution ThreatWidespread and varies by region Health impacts poorly understood 0.8 millions death/year 1.8 million deaths/yearChallenges in Exp Assessment for Water PollutionLow exp levels Mixture of chemicals Large variability over time and space Multiple exp rts Long-term expHierarchy of Controls for Water-Elimination: National Pollutant Discharge Elimination System -Substitution: Using alt chemicals in industrial processes with less severe impacts -Engineering control: treating water, advisory warnings (consumer confidence reports) -PPE: home water filter, disinfection, distillationClean water act (1972) and Safe Drinking Water Act (1974) *****CWA: USED WATER DISCHARGE, wastewater treatment plant, surface water used for industry, recreation, wildlife habitat and fishing, wastewater discharges. Restore and maintain the chemical, physical, and biological integrity of Nation's waters. EPA, states have authority. Protection of fish and wildlife, recreation, agriculture, public drinking supply. SDWA: water systems, ground water, ground water used as drinking water - HUMAN CONSUMPTION Common: surface water used as drinking waterWastewater under CWADomestic sewage (grey water), industrial waste - issues with organic and inorganic compounds, pathogenic microbes In US, 15,000 sewage treatment facilities treat >30B gallons wastewater daily Globally, 79 miles3 of wastewater produced annually 2 millions tons each day By 2050, 70% of world's population in cities will have inadequate infrastructure Enforcement of waste water is under CWA as part of anti-degradationWastewater TreatmentPrimary treatment: heavier solids settle outer, lighter greases/liquids skimmed off surface Secondary treatment: microorgs remove dissolved and suspended biological material, may be bypassed during heavy rainfall in some systems Tertiary treatment: possible chemical/physical disinfectionSafe Drinking Water ActAdministered by EPA, Fed standards, req regular testing Applies only to public drinking water Each state responsible for enforcement Violations not uncommonWater Treatment and Public HealthFoodborne (instead of water) is more of a problem in developed countriesNational Agencies Responsible for Water Contaminant RegulationUS PH Service first drinking water standard in 1914. -1974, EPA authority with Safe Drinking Act. Resp for ID and reg contaminants. Publishes max contaminant level goals.Internal Agencies for Water QUalityWHO first standards in 1958Solid WasteGarbage of Refuse -Sludge: wastewater treatment plant, water supply treatment plant or air pollution control -Other discarded material: industrial, commercial, miningTypes of Solid WasteA) Municipal: residential B) Industrial: chemicals, dyes, metals C) Hazardous: biomedical, industryUS Waste Generation-US generates largest amount per person -260 million tons / year -Largely paper and food -Up to 7.6 billion industrial waste annually -97% industrialUS Waste Regulations-Solid waste disposal act of 1965: tech assistance for solid waste management -Resource conservation and recovery act of 1976: EPA authority over solid waste, min standards landfillsStrategy for Solid Waste ManagementMost preferred to least preferred -Source reduction and reuse -Recycling and composting -Energy recovery -Treatment and disposalUS Waste Generation and Recycling-Generation of waste and recycling have increased -53% is landfill, 26% recycling -1970s transitioned to sanitary landfills -Primarily recycle lead batteries, cans -Controlled combustion -Reduce hazardous characteristics of wasteWaste Management in Developing NaitonsUrban 2012: 3 bill ppl with 1.2 kg waste/person/day 2025: 4.3 bill ppl with 1.4 kg waste/person/day -OECD countries develop 44% of wasteHazardous Waste-Materials from ~500 industrial waste streams or materials meeting EPA criteria for corrosivity, ignitability, reactivity, and toxicity -US about 40 millions tons and globally about 400 million tonsRisks of Hazardous Waste-Behavioral abnormalities, cancer, mutations, physiological malfunctions, physical deformations -Killing animals and plants, ecosystemResource Conservation and Recovery Act 1976Gave EPA reg authority over solid and hazardous waste Cradle-to-giving tracking of wasteEmergency Planning and Community Right-to-Know Act of 1986-Emergency planning and hazardous waste reporting req for fed, state, and local gov -Req involvement of local communityComprehensive Env Resp, Compensation, and Liability Act of 1980-EPA has authority to clean up hazardous waste sites -Prohibitions and req closed/abandoned sites -Liability of persons resp for waste -Trust fund for cleanup -SuperfundInternational Treaty - WasteUN Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal Intended to stop transfer of hazardous wastes from developed to less developed nations (doesn't cover radioactive waste) Currently 187 parties to the treaty, including 184 UN member states (US not party)Hazardous Event - Love CanalHooker chemical disposed 22,000 tons of chemical waste onsite 1953 Canal covered with dirt and sold to state to build a school Neighborhood grows and complaints of odors Heavy rains led to surfacing of drums 1979 began studying 1978 State of Emergency: fence, bought homes First site on Superfund National Priority List EPA cleaned it up however still monitoring and loss homesDealing with Hazardous WasteMost effective -> least Least expensive -> most -Management support -Source reduction -Reuse/recycling -Volume reduction -- disposalReuse / RecyclingReclamation: processed to recover a usable product Reuse: employed as industrial ingredient Use constituting disposal: recycling that involves direct placement of wastes or products containing wastes on land Burning for energy recovery: burning waste for fuelWhich of the following is NOT a key agency with regards to setting and enforcing regulations relating to occupational hazards in the US?US National Institute for Occupational Safety and healthDose differs from exp because it accounts forThe body mass of the exposed person and amount of agent that accumulates in the bodyMeasuring toxicants in breath, blood, urine, hair and toenails are examples ofbiomarkersIn the hierarchy of controls for health and safety in the workplace, which control should be seen as the MOST preferred?Elimination or substitutionWhich contributed to the major air pollution event in London 1952/-Several days of stagnant conditions including low wind speed and high pressure system -Inversion leading to fog layers at the surface -Extensive use of coal for heating and energy -Uncontrolled fire in the London DocklandsGive an example of a doseMeasurement of the amount of lead in your blood after repainting your old houseWhich of the following is NOT a step in the exp-dis framework?Biotransferrism But source, movement, exp, dose, health effects areApprox how many chemicals are there in commerce in the US?85,000The burden of dis from occupational exp and soil, air, and water pollutionVaries between low-, middle-, and high-income. Varies between dif regions.Which of the following is NOT an example of a biological hazard?PregnancySelect all of the following concepts that are involved in quantifying human exposure to a specific hazardIntensity, frequency, durationWhich of the following does NOT represent an exp vector?Dermal vector Water, air, soil, food doWhich of the following rep philosophies or principles of environmental policy?-Precautionary principle -Env justice -Env sustainability -Polluter-pays principleExamples of env exp limits that might be set by the US EPA-1 hr avg or max concen of a community air contaminant -8 hr avg or max concen of a community air contaminant -1 yr avg concen of a community air contaminant -Max contaminant limit for a community water contaminant -Pesticide concen on a food product NOT max radiation exp or workplace air contaminantSteps of Impact AssessmentScreening Scoping Appraisal Reporting MonitoringWhich of the following describes the systems thinking theory of agent-based modeling?Models individual agents who interact with each other and the env using interactions that are based on simple pre-defined rulesYou wish to create a visualization of the rel betw several factors that can influ PH and ID causality and feedback loops among these factors. To do so, you would employ:Causal loop diagramWhich groups are directly and indirectly impacted by the burden of occupational illnesses and disease?Workers, employers, workers' families, communities, societyWhich of the following represents factors we can assess when evaluating the impacts of environmental health policies intended to reduce motor vehicle fatalities and injuries?-Death rates per million miles driven -Percentage of drivers using safety equipment -Self-reported drunk driving ratesRadon-Naturally occurring radioactive gas without color, odor, or taste -Heaviest gas in nature -Comes from radioactive decay of uranium in soil, rock, and groundwater -Emits ionizing radiation as it decays into several radioactive isotopes (radon decay products) -Variation due to geology and soil composition In MI, 1 in 4 homes in highest radon level category In US, 1 in 15 homes in highest radon level categoryHealth Effects RadonInhaled decay products readily deposit in lungs, irradiate cells in airways EPA class A carcinogen - known to cause cancer in humans Second leading cause of lung cancer is US US EPA est that of 157,400 lung cancer deaths in US in 1995, 21,100 (13.4%) were radon-related Exposure doesn't cause any warning symptomsRisk of RadonRadon results in far more deaths than events commonly viewed as risky Smokers about 9x more likely to develop lung cancer from radon than non-smokers Accounts for 1 in 4 lung cancer deaths among smokersRadon Exp StandardsNo known level of radon Radon quantified using picocuries/liter (pCi/L) of air or water pCi is measure of amount of radioactivity Average home radon levels (national EPA survey, 1991) est as about 1.3 pCi/L inside US homes and about 0.4 pCi/L outside US homes US EPA action level is 4 pCi/LHow to Measure RadonMeasure lowest lived-in level of home Short-term testing: 2-90 days screening test Long-term testing: 90-365 days, more accurate long-term avg levelCommon Radon Exp PathwaysExp occurs primarily indoors (homes, commercial buildings - cracks, gaps) Air pressure differential Stack effectHow to reduce exp of radonNew homes in high exp zones Gas permeable gravel layer under foundation Plastic sheeting on top of gravel, under slab Existing homes (add subslab suction, seal cracks) Air controls may reduce levels by 99% For water, two control options: point-of-entry treatment (effective) and point-of-use (not as effective)Auditory effects of noisePermanent, irreversible, incurable noise-induced hearing loss following chronic exposure to elevated noise and brief exposure to extremely high noise (acoustic trauma) NIHL has profound social, occupational, and psychological impacts Typically suffer series of small temporary hearing losses before permanent damageNon-auditory effects of noiseHypertension HD Stroke Sleep disturbance Psychological effects Cognitive effects Occupational injuries AnnoyanceAssessing noise expArea or activity-based measurements Personal measurements Exposure models SmartphonesNoise exp standards in workplaceTo protect against noise-induced hearing loss OSHA permissible exp limit (enforceable): 90 A-weight decibels avg over 8-hr shift Permissible level not without risk. About 1 in 4 workers will have substantial hearing loss after 40 yearsNoise exp standards for communitiesTo protect against noise-induced hearing loss Recommended limit (not enforceable): 24-hr avg exp LTE 70 dBA, protects everyone against any hearing loss 70 dBA about sound of vaccuum To protect against annoyance/other effects: day or night-time exp btw 35-55 dBA Ex) work, transportation, rec activities, time at home, music, construction, guns In NYC, 73% of time is from home and 16% occupational with annual dose is music and occupationalReducing noise expSubstitution or elimination: avoid exp altogether Engineering controls: change noise source to reduce level Administrative controls: limit length of exp PPE: wear earplugsUrbanization by continent2008: first time 50% of humans lived in urban areas 2018: now 55% Distribution differs by continent 90% of urban population growth happening in low- and middle-income countries -Growth in megacities (urban areas with >10 million or more) primarily happening in developing countriesFactors that influence urban healthUrban governence Population characteristics Natural and built env (including env factors) Social and economic development Services and health emergency management Food securityUrban health risksDistributed unequally among social groups Physical inactivity, obesity CVD and PD (air) HD, cancer Asthma (indoor pollution) Heat-related strokes Injuries Airborne diseases Waterborne diseases Diarrheal diseasesFactors that influence urban health equityPolitical and economic env: quality of governance, employment opportunities, health services, educ, safety and security, gender equality Physical environment: urban geography, climate, built env, housing cond, access to safe water and sanitation, transport, air quality Social and personal characteristics: age or gender balance, migrants, unemployed, slum-dwellers, cultural factorsSlumsLack access to at least one: safe water, sanitation, safe and secure tenure, durable housing structures Issues: Informal economies (reduced access to jobs) Social exclusion (societal stigma) Underdevelopment Env health hazards 30% population in slumsPromoting urban healthHealthy cities must be created Meet basic needs, clean and safe physical env, stable and sustainable ecosystem, diverse/ vital/ innovative economy, high degree of public participation and control, appropriate and accessible public health and healthcare, high levels of good health, low levels of disModeling Urban Env HealthFocus on urban sustainability. Communication framework: traffic, noise, air quality, accessibility, water, emissions, safety, urban heat, interfacePopulation pressure2014 about 7 billion -> 2025 8 billion -> 2050 9.5-10 billion 99% of growth in world's developing countries (sub-saharan africa, middle east, south asia) Current population growth is slower than expected: ~1% growth Largest urban pop = Tokyo (38 million) Fertility: 2.5 children / woman -> 65 countries now below replacement-level fertility Avg LE: 72 yrs DR: 7.7 per 1000 peoplePopulation growth by regionFastest growth in regions racing highest env hlth hazards: air, water, injuriesEarth's Carrying CapacityMax supportable human population with current 3.5 billion acres of land 10 billion vegetarians 2.5 US omnivores Consensus on population is need to protect env, increase living standards, slow population growthGlobal DisparitiesMore poverty 10% population earns <$1.90/day More than half of extreme poor live in Sub-saharan Africa 11% population cannot satisfy basic daily needs Majority of global poor live in rural areas, are poorly educated, employed in agriculture, and <18 years oldGlobal HealthHealth of populations in a global, rather than individual country Interconnectedness of countries How transportation, commerce, communications, economics, and politics influence health around the world Infectious dis communicability via travel Chronic dis communicability through media, commerceLCOD A) Globally B) low income countries C) High incomeA) HD, stroke, chronic obstructive pulmonary dis, lower respiratory infections B) Lower resp infections, diarrheal, HD, HIV/AIDS, stroke C)HD, stroke, Alzheimer, lung cancersGlobal LE Population GDP70-79 7.6 billion $131 trillionGlobalization-process of integration across world-space arising from interchange of world views, products, ideas, and cultures -Good for economic development and modernization. -Bad for spread of infectious dis, unhealthy lifestyleHazards in Low, Middle, and High Income CountriesLow income: traditional hazards (lack of sanitation, waste accumulation, pests) Middle income: modern hazards (unchecked industrial development) High income: post-modern hazards (sedentary, overconsumption)Demographic TransitionShift towards lower birth and death rates as populations move from low-income economies to high-income economies (pyramid)Epidemiologic ShiftShift from infectious dis to chronic, noncommunicable dis being the primary health problem in a populationBuilt EnvAll aspects of the physical places we live and work (homes, buildings, streets, open spaces, infrastructure) Living and working conditions (transport, water, sanitation, housing)Measuring Built Env-Indirect methods Census, GIS, street network -Intermediate methods Perceived env measures completed by residents, regional land use data from tax assessors, aerial photography, databases -Direct methods In-person audits of envTenets of Modern Community DesignSeparation of land use (zoning) Low density Dispersion of activity centers Automobile-oriented transport Disinvestment in central citiesWhat determines built env?-Building codes set structural and scaling req for buildings, lots Materials used can introduce exp, design can impact exp, and site can impact exp -Zoning codes set locations for specific activities, density req Equity disparities and env justice -Suburban regs set layout and form of individual communities Lower walkability, higher wellbeing Transportation design alt: complete streets