PUBLIC HEALTH

Environmental Health deals with:

Health effects of pollution

Preventive Strategies

1. Change people's behavior to manipulate environment and reduce their exposure to biological and non- biological agents

Changes in people’s behavior

1. Food safety practices leads to prevention of disease

- clean

- separate

- cook

- chill

1. Manipulate the environment to prevent production or presence of disease agents

2. Treatment of wastewater

3. Uncontaminated groundwater in the environment

4. safe and clean drinking water

1. increase man’s resistance in community or resistance to disease agents.

2. Human immunization in the community

Environmental Sanitation

• The study of all factors in man’s physical environment, which may exercise a deleterious effect on his health, well being and survival.

Included in these factors are:

1. Water sanitation

2. Food sanitation

3. Refuse and garbage disposal

4. Excreta disposal

5. Insect vector and rodent control

6. Housing

7. Air pollution

8. Noise

9. radiological protection

10. Institutional sanitation

11. Stream pollution

Major Environment Sanitation and Health Programs

HEALTH SANITATION

• Environmental Health and Sanitation is still a health problem in the country

• Diarrheal diseases ranked 1st in the leading causes of morbidity among the general population .

Other Sanitation:

1. Pneumonia

2. Tuberculosis

3. Intestinal Parasitism

4. Schistosomiasis

5. Malaria

6. Infectious Hepatitis

7. Filariasis

8. Dengue Hemorrhagic Fever

PD 856, 1978 – Sanitation Code of the Philippines.

Water Supply Sanitation Programs:

1. Approved Types of Water supply

• a protected well or a developed spring with in an outlet but without a distribution system

• adaptable in rural areas were houses are thinly scattered

• normally serves around 15-25 households and its outreach must not be more than 250 meters from the farthest user

• yield or discharge is generally from 40 to 140 L per minute

1. Communal Faucet System or Stand – Posts

• a system composed of a source reservoir

• a piped distribution network and communal faucets

• located at not more than 25 meters from the farthest house in rural areas

• the system is designed to deliver 40-80 liters of water per capita per day to an average of 100 households

• with on faucet per 4-6 households

• houses are clustered densely to justify a simple piped system

1. Waterworks System or Individual House Connections

• a system with a source

• a reservoir

• a piped distribution network & household taps

• generally suited for densely populated urban areas

• require a minimum treatment or distinction

Unapproved Type of Water Facility:

• water coming from doubtful sources such as wells

• unimproved springs

• wells that need priming and the like shall not be allowed for drinking water unless treated through proper container disinfection.

Access to safe and potable water drinking water

• all households shall be provided with safe and adequate water supply

Waterworks/water system & well construction

• Well sites shall require the prior approval of the Secretary of health or his representative

• water supply system shall supply safe and potable water in adequate quantity

• Water shall be made readily available to consumers/users preferably through water piped directly to homes to minimize contamination and encourage personal and home sanitation.

• adequate pressure and volume shall be provided in the water system distribution line.

• no booster pump shall be allowed to boost water from water distribution.

Food Sanitation Program

• Filipinos' rapid change of eating habits particularly in fast food chains increases the risk of food-borne infection due to unsanitary handling of preparation of food.

• Banning of shellfish consumption period to reduce poisoning

Food Sanitation Policies

Food establishments shall be appraised as to the following sanitary conditions

1. Inspection / approval of all sources, containers , transport vehicles.

2. Compliance to Sanitary Permit Requirements for all Food establishments.

3. Provision of updated Health certificate for food handlers, cooks, and cook helpers which include monitoring as to presence of intestinal parasites and bacterial infection.

4. DOH’s Administrative Order No.1 – 2006 requires all laboratories to use formalin Ether Concentration Technique instead of the direct fecal smear in the analysis of stools of food handlers.

5. Destruction or banning of food unfit for human consumption

6. Training of food handlers and operators on food sanitation

7. Food establishment shall be rated and classified as:

• Class A – Excellent

• Class B - Very Satisfactory

• Class C – satisfactory

1. Ambulance food vendors shall comply with the requirements as to the issuance of health certificates which also include monitoring of parasite and bacterial infection.

Four Rights in Food Safety:

1. right source

2. always buy fresh meat, fish , fruits, & vegetables

3. Always look at the expiry dates of processed foods & avoid buying the expired drugs

4. Avoid buying canned foods with dents, bulges, deformation , broken seals, and improper seams

5. Use water only from clean and safe sources

6. When in doubt of the water source , boil water for at least 2 minutes ( running boiling )

7. Right Preparation

8. Avoid contact between raw food and cooked foods

9. Always by pasteurized milk & fruit juices

10. Wash vegetables well if to be eaten raw such as lettuce , tomatoes , and carrots

11. Always wash hands & kitchen utensils before and after preparing food

12. Sweep kitchen floor to remove food droppings to prevent the harbor of rats and insects.

13. Right Cooking

14. Cook food thoroughly & ensure that the temperature is on all parts of the food should reach temperature is on all parts of the food should reach 70 degrees.

15. Eat cooked food immediately

16. Wash hands thoroughly before and after eating

17. Right Storage :

18. All cooked shall be left at room temperature for not more than 2 hours to prevent multiplication of bacteria

19. Store food carefully . Be sure to use tightly sealed containers for storing food

20. Be sure to store food under hot conditions ( at least or above 60 degrees or in cold conditions ( below or equal to 10 degree Celsius ).

21. Food is vital if stored for more than 4-5 hours because microbial microorganisms easily within 10-60 degree Celsius.

22. Foods for infants should always be freshly prepared and not to be stored at all.

23. Do not burden the refrigerator by filling it with too large quantities of warm food.

24. Reheat stored food before eating . Food should be reheated to at least 70 degree Celsius.

25. Rule : “When in doubt throw it out”

Proper excreta and Sewage Disposal Program

Policies :

Approved types toilet facilities

• Level 1

Non-water carriage toilet facility – no water is necessary to wash the waste into the receiving space. Example pit latrines, reed odorless earth closet

• Level 2

Toilet facilities require a small amount of water to wash the waste into the receiving space.

Example: pur flush toilet and aqua privies

on site toilet facilities of the water carriage type with water sealed and flush type with septic vault and tank disposal facilities.

• LEVEL 3

- water carriage types of toilet facilities connected to septic tank and or sewerage system to treatment plant

- in rural areas , “The blind drainage” type wastewater collection and disposal facility.

Sewage Disposal

• consist of liquid waste from household effluents, commercial effluents, and industrial liquid wastes.

• carried in a system of pipes and other means of conveyance called sewage system

• Primary purpose of sewage system is to prevent spread of disease among human beings

• sewage treatment protects household supplies, protects fish and aquatic life, protects food by preventing soil pollution and protects livestock
  

Sewage Treatment:

Preliminary ( Main sewer )

• mechanically or manually operated rakes clean the debris & dumb it into receptacles where it is burned

• some community sewage plants use shredders or communitors which cut coarse materials into fine enough particles to pass through the effluent for further treatment

• Prechlorination

• sedimentation or clarifier tanks are about 10 feet deep

• to aid this sedimentation, chemicals are added to form a gelatinous floc that settles, carries suspended solids to the bottom and forms sludge

• digestion of the sludge by anaerobic bacteria take place in the sedimentation process tank on in septic tanks

• effluent

Secondary treatment:

• Trickling fibers are constructed of concrete with a bed gravel crushed stone or similar material which provides good ventilation of the bed.

Tertiary treatment:

• Final clarifier

• Chlorination

• Receiving Waters

• Once the wastewater leaves the primary treatment steps, it enters secondary treatment. The first step in the secondary treatment process is the aeration tank.

• The types of bacteria utilized in wastewater processing can be categorized based upon their necessary or intolerance of oxygen to survive. Those bacteria that require oxygen to convert food into energy are called aerobic, those that will perish in the presence of oxygen are anaerobic, and finally facultative anaerobes may thrive in either the presence or absence of oxygen.

• Typically aerobes, which can degrade pollutants 10-100 times faster than anaerobes, are utilized most frequently. Increases in temperature and pollutant food source have shown to increase the rate of degradation, but if all elements necessary for conversion of food to energy are not in balance, the microbial degradation will be thwarted.

Hospital Waste Management

• disposal of infectious, pathological and other wastes from hospitals which combine with the municipal and domestic wastes health hazards to the people

• Very few hospitals have treatment facilities like incinerators or disinfectants to prevent transmission of diseases.

• Most hospitals utilize the Municipal Refuse Disposal System (MRDs ) for disposing hospital wastes.

Policies :

• All newly constructed/authorized & existing government & private hospitals shall prepare & implement a Hospital Waste Management Program as a requirement for registration & renewal of licenses.

• DOH Hospital Waste Management guidelines/policies shall be guided by existing legislative health & environmental protection laws policies on waste management.

• training of all hospital personnel involved in waste management shall be an essential part of the hospital training program.

Recent national & International Environmental Laws and DOH Policies Affecting Environmental Health and Sanitation:

• RA 6969 – “ Toxic Substances and Hazards & Nuclear Waste Control Act of 1990” – regulating the importation , use, movement , treatment and disposal of toxic chemicals, hazardous and nuclear wastes in the Philippines.

• RA 8749 – “ Clean Air Act” provides a comprehensive air pollution management and control program to achieve and maintain healthy air .

• Section 20 , bans the use of incinerators and allows only the traditional method of small scale community burning.

• R.A. 9003 – “ Ecological Solid Waste Management Act of 2000” – It declares the adoption of a systematic , comprehensive , & ecological solid waste management program as a policy of the state.

• R.A. – “ Clean Water Act of 2004”

This law aims to establish wastewater treatment facilities that will clean waste water before releasing into the bodies of water like rivers and the seas.

Housing Sanitation

1. Crowding – increases the transmission of communicable

Diseases

2. Indoor air – insufficient ventilation, inadequate artificial lighting and lack of sunshine can adverse effect on air quality and health

3. Structural – defective heating units cause carbon monoxide poisoning and fires.

Defective or deteriorated floors, stairs, railings etc. account for high rates of injuries.

4. Lead Paint – major source of poisoning typically occurring under 6 years old living in deteriorated pre – World War II housing.

5. Mental health – poor housing conditions can be depressing and can lead to a decline in pride and motivation

uncleanliness & disorder is often associated with standard housing carelessness in living practices.

• Air pollution

-A broad term applied to chemical , physical or biological agents that modify the natural characteristics of the atmosphere.

-An undesirable state of the environment where the air is contaminated with substances harmful to human health

-Industrial air pollution from an industrial plant discharging contaminants into the atmosphere.

• Acid precipitation ( rain ) – occurs when acids are formed in the atmosphere when industrial gas emissions ( primarily Sulphur dioxide and nitrogen oxides ) combine with water.

• Small – particle pollution – is caused by fine particles of soot produced by power plants or diesel engines

• Smog - is a air pollution that is a mixture of smoke and fog

6 pollutants dangerous to humans:

1. Carbon monoxide – a colorless , odorless gas that forms when carbon in fuel is not completely burned ( forest fires and transportation )

2. lead – a metal found in manufactured products and in the environment ( paint, batteries )

3. nitrogen Oxide – are colorless and odorless gasses that contain nitrogen and oxygen in varying amounts ( Combustion )

4. Ozone – ground level & ozone located miles above the earth’s surface have the same chemical structure ( serve as protective layer against harmful rays from the sun ).

5. particulate matter – consists of a complex mixture of extremely small particles and liquid droplets suspended in air. It is made up of : nitrates and sulfates , organic chemicals , metals, soil and dust particles and allergens ( fragments of pollen and mold spores )

6. Sulfur dioxide – forms when fuel containing sulfur such as coal & oil is burned. Extraction of gasoline from oil or metals in ore also produces SO2.

• Epidemiology

- is the study of factors that determine the frequency , distribution and determinants of disease in human populations and ways to prevent, control or eradicate diseases in populations.

1. Infectious disease – is a disease that is caused by pathogens.

2. Communicable disease – disease that is transmissible from one human to another

3. Contagious disease – is defined as a communicable disease that is easily transmitted from one person to another.

4. Zoonotic disease – infectious disease acquire from animals

5. Incidence - defined as the number of new cases of that disease in a defined population during specific time period.

6. Morbidity rate – usually expressed as the number of new cases of a particular disease that occurred during specified time per a specifically defined population.

7. Prevalence – is the number of cases of the disease existing in a given population during a specific period .

Eg. Total number of gonorrhea that existed in the Philippine population during 2011 . 35,0000

1. Point of prevalence – is the number of cases of disease existing in a given particular moment of time.

2. Mortality Rate – is the ratio of the number of people who died of a particular disease during a specified time period per specified population.

Example number of people who died of a particular disease in 2010 per 100,000 of the Philippine population.

• Sporadic Disease

- Is a disease that occurs only occasionally (sporadically ) within the population of a particular geographic area.

example : botulism, cholera, gas gangrene , plague, tetanus and typhoid fever

• Endemic diseases

- are diseases that are always present within the population of a particular geographic area. the number of disease fluctuate but the disease never dies out completely

Example: tuberculosis, STDs ( gonorrhea, syphilis viral diseases: common cold, influenza, chicken pox & mumps )

• Endemic - greater than usual number of cases of a disease in a particular region, usually occurring within a relatively short period of time.

Example : Food poisoning caused by gram positive bacteria.

• Pandemic – is a disease that is occurring in epidemic proportions in many countries simultaneously and sometimes worldwide.

Example : HIV, AIDS ,TB Malaria