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Tuesday, October 30, 2012

Environmental Health Council organizes training on Biogas Digester


The Environmental health Officers registration council of Nigeria [EHORECON] organizes a workshop training on construction of biogas digester at the Federal University of Technology, Owerri.

 The participants include students of environmental health, Masters of Public Health and practitioners engage in teaching at various schools of health technology across south-south and south-east states.

The programmes starts monday 29th october 2012, and ends 31. The Team leader of the training is Prof. MCK Sridhar.

Sunday, October 28, 2012

Evolution of Environmental Health and Emerging Challenges: The Role of Practitioners


By Prof M.K.C. Sridhar
nkcsridhar@yoo.com
Abstract
Evolution of environmental health is more than two hundred years old. Through the timeline, the earlier concerns on the communicable diseases due to polluted water and poor housing and sanitation have drifted to more complex chemical pollution, contamination of water and food, air pollution, and industrial disasters. Some of the newer challenges include hitherto unnoticed or less suspected bacteria, protozoa, HIV/AIDS, avian flu and their relation to poor hygiene and sanitation or inadequate waste management practices. Newer monitoring tools, technologies and procedures have become challenges for the environmental practitioners. Environmental Health Officers in particular have to be geared to meet such challenges and implement national edicts and guidelines in protecting the environment and safeguarding the health of the communities.
Key Words: environment, practitioner’s pathogens, pollution, communicable diseases Environment Health and Environmental Practitioners.
Environmental health is “the control of all those factors iii man s physical environmental, which exercise or may exercise deleterious effect on his physical, mental or social well being“. The scope of environmental health is broader as compared to sanitation in that it embraces a wide variety of components. In particular, as defined by WHO in 1 952, ii refers to the control of water supplies, to ensure that they are pure and wholesome, methods for the disposal of excreta, sewage and community wastes to ensure that they are adequate and safe, housing, to ensure that it is of a character likely to provide as few opportunities as possible for the direct transmission of disease (especially respiratory infections), and encourage healthful habits in (lie occupants, milk and other food supplies, to ensure that they are safe, personal and 1iuhlic habits of cleanliness, especially in relation to disease, arthropod, rodent, mollusk or other alternative hosts associated with human disease, and atmospheric conditions to ensure that the external atmosphere is free from deleterious elements and that the internal conditions of workshops, houses, etc. are suitable for the occupations undertaken in them”.
Environment belongs to every profession and every skill or expertise has a role to play. It cuts across all disciplines, walks of life and even international boundaries. Anybody with environmental concerns and skills t improve his immediate environment is a practitioner. While addressing the environmental matters one has to follow ecosystem approach so that a holistic approach is made in the control of man made mistakes. This paper addresses the challenges that pose to modern day Environmental Practitioners and in particular the Environmental health officers who have a major role to play at grass root level in implementing the national policies and guidelines.
Evolution of Environmental Health
Environmental health had its roots in castern religion, particularly Hindu Vedic scriptures. In the words of Rabindranath Tagore (Poet Nobel Laureate of India), the culture of the forest has fueled the culture of India”. Three to live thousand years ago, Taoism and Confucianism explained and helped people follow the patterns of nature. In the west, Egyptian, Sumarian, Babylonian and other civilizations have extensive and intricate links between nature and the divine. The revered prophets of Judaism, Buddhism, Christianity and Islam also renewed their link to the divine by retreating into nature. The earliest recorded mention of any form of health control is contained in the Bible when Moses led the children of Israel out of Egypt, the eating of the flesh of swine was forbidden because the animal was considered ‘unclean’.
The biggest advance in promoting health came with the Romans. They devised the first while carriage sewage disposal, hot and cold running water, central beating and regular bathing. Evidence of these advances arc found in the remains of Roman Settlements throughout Europe and the U.K. Archimedes of Eurcka frame, even made a contribution wit Ii the Archimedes Screw, a device used to raise water from a lower level e.g. a stream, to a higher level. All these benefits were lost or forgotten a for I lie departure of (ho Roma us, and Britain, together with the rest of’ the civilized world for several hundred years sank into an environmental limbo.
The industrial revolution of the [8th century while bringing material gains also brought new problems — slums, accumulation of refuse and human excreta, overcrowding and a variety of social problems. Frequent outbreaks of cholera added to the woes. Chadwick’s report (2) of 1842 on ‘The Sanitary Conditions of Labouring Population focused the attention of the people and Government on the urgent need to improve public health. Filth and garbage were recognized as man’s greatest enemies and it lead to great sanitary awakening bringing Public Health Act of 1848 in England, in acceptance of (lie principle that ‘(lie state is responsible for the health of the people’. The act was made more comprehensive when Public Health Act (I 875) was enacted. Environmental Health Officers (formerly Sanitary Inspectors amid Public Health Inspectors) have been looking after the public’s health since 1848. The work today reflects both (lie problems brought about by modern lifestyles, and some o (lie older problems which still face many members of the community.
The public health movement in USA followed closely the English pattern. The origin of the PHS in USA can be traced back to the Act for the Relief of Sick and Disabled Seamen that was signed by President John Adams on July 16, I 798. The organized professional body, American Public Health Association was formed in 1872.
In districts where no public health inspector is appointed, the chief constable of the district shall act as public health inspector, and all the duties and powers assigned to a sanitary inspector may be performed anti exercised by him, or by any constable designated by him for that purpose. The Chief of Police (Bridgewater Police Department, Nova Scotia, Canada) in 1899 also served as “Sanitary Inspector and Truant Officer”. Typical activities were hiring a horse and wagon to convey prisoners to the Lunenhurg jail, a prosecution for giving tobacco to a minor, enforcing Nova Scotia’s Temperature Act and enforcing quarantine for families and individuals stricken with Diphtheria, Scarlet Fever, Small Pox and the like. The first “lock up,” owned and shared with the Municipality (County), was said to be “not a fit place to put a man” arid “is very unsatisfactory as well as dangerous to prisoners and properly” - no heat ... and damp all the  time and no toilet. These conditions continued till 1918.
Sanitary reforms commenced in Lagos in 1877 with the appointment of the first Inspector of Nuisances. Subsequently by 1897 Lagos had both a Medical Department and Sanitary Department with Dr H. Strachan as Chief Medical Officer, W.M. Mackisen as Sanitary Engineer and W.F. Lumpkin as Inspector of Nuisances. Sir William MacGregor, the first Governor (1899) may be remembered for his contributions to environment as he was the “Golden Age” (Sridhar 1999). Environmental Martyr Ken Sarowiwa (Landow 2006) succinctly put the roles played by the Sanitaory Inspector, not leaving out the corrupt practices of yester years (Box 1)
Today’s public -health movement varies dramatically from the wave of activism in the nineteenth and early twentieth centuries. Then, the main emphasis was stopping ‘contagion’ by altering the conditions under which infectious disease spread. This is still a crucial issue in the South where the basic necessities of clean water and adequate food top the agenda. In the industrial world, however3 the main focus is dealing with chronic diseases (cancers heart ailments) and their causes. The modern ‘environmental movement, born in the crucible of I 960s discontent’, is an important factor in the field of public health
Roles and Responsibilities of EHO
The EHO ensures that the environmental health standards in a community are being developed and maintained at acceptable levels. This is done through health promotion and the identification, evaluation and control of those factors in the environment which could impact negatively on the health of individuals and communities. Local Governments, private companies and other organizations employ EHO, and wherever they work, they have a common goal - to protect the public from environmental health risks. To achieve this goal, EHOs are always ready to give advice to individuals, community groups, companies and committees. Health promotion and health education are used as vital tools to promote environmental health issues and bring about improvements. They can resort .to legal action only when education and persuasion fail.
Sir Benjamin Ward Richardson, president of the Liverpool’s Sanitary Inspectors Association, UK in the 1890s, described EHO as “....someone who would not be afraid to inspect any nuisance or other contagious disorders. It was necessary that he should be what was called a respectable man, and he has to be to some extent presentable in private houses. His duties were labourious, his salary contemptible. I designed him in his first days as the “Forlorn Hope of Sanitation” which may colleague, Edwin Chadwick, thought was a happy description”. The chartered institute of Environmental Health referred EHO as “Amicus Humoni Generis” or “Friend of the Human Race”. To find person and induce him to be responsible to get the job done, and this primarily a problem of policing. Enforcement called for an inspector of robust physique and  ........Character. The forming and humanitarian ideas of the period were accompanied by an often conflicting belief in laisse==faire, and the resistance of owners of unhealthy property was vigorous and unabashed.
There are about 3000 registered EHOs in Nigeria. The work of today’s EHOs is extremely varied. The majority of them is employed by local Government and State and has the task of protecting people living or working in their area. They work in either generalized or specialized department. Generalist EHOs are responsible for all aspects of environmental health in a particular part of the Local Government. For specialists work either singly or as part of a team is responsible for a particular aspect of environmental health, such as air pollution or food safety, throughout the areas.
EHOs also work for private industries, advising companies of their legal duties and helping them maintain good standards from within the organization. In industry abroad they are often referred to as Environmental Health Advisors or consultants. Other EHOs are employed by the Army, Navy and Air Force, Civil Service, Universities and Colleges. In recent years an increasing number have become self-employed, working as consultants for many clients, in both the public and private sector. There are challenges ahead. They have to wake up to the tasks and bring back the glory of what they were intended for in a society. There are many areas other than sanitation in which their services are required particularly during environmental disasters and after (Box 2).
The career of the EHO is a changing and challenging one. It is related to people, their environment, housing, their recreation, prevention of illness, remedying conditions which are a health risk, public guidance and far more. In short, it is the task of the EHO to protect the people of the community where he or she practices from any conditions which could be hazardous to their health.
Challenges of Today
  1. i.          Pollution Monitoring and Control
Pollution of air, water and soil is a growing concern. Newer technologies are adding up more difficultly degradable chemicals requiring innovative technologies to manage them. However, the good news is that of cleaner production technologies and phasing out of zone depleting substances from the industrial menu. National and International consciousness is rising. However, the local action is not matching with the world in general. Monitoring and controlling pollution levels and educating the public in protecting the environment is fundamental to the work of environmental practitioners. An increasingly important aspect is raising environmental awareness and conducting environmental “audits” in industry and communities. If pollution levels are too high and above the national permissible limits set by the Ministry of Environment, the health of both the public and the environment can be put at risk.
EHOs keep a close check on the levels of air, water and noise pollution in their designated areas, and communicate this information in a way that is meaningful to the public. Shortage coupled with poor distribution system has contributed to the increasing cases of water-borne diseases including typhoid, cholera, gastroenteritis, and more than 20 other infections in the country. Newer infections such as legionella (first reported in 1976), cryptosporidium (first case diagnosed in 1976), Helicobacter pylori (linked to gastric acidity 1982) and Campylobacter, E. coli 157:H7 (recognized as pathogen in 1982) and HIV/AIDS (antigens found in medical wastes in 1982 are emerging and challenging the public health practitioners. Disinfection resistance is also on the increase and the occurrence of opportunistic pathogens is on the increase. The monitoring of pollution is also changing from water borne pathogens of last century and persistent organic pollutants of modern day. Endocrine disruptors, PCBs, trihalomethanes and a host of very risky chemicals are entering the water distribution system and EHOs are to be prepared for recognizing their sources and prevent their entry into water and food chain. Hazard Analysis Critical Control Points (HACCP) as a tool which has been used in food premises is being extended to water quality and the environmental practitioners are to acquaint themselves of this latest tool.
EHOs are responsible for monitoring the levels of airborne emissions from small and medium sized industrial processes and can take action to cut the levels if necessary. Noise is also considered as a pollutant, from equipment, power generating sets, industrial boilers and compressors, fans to late music nights or burglar alarms and EHOs have to be impartial and find a dangerous waste is a potential danger to health. Recent incidents such as ‘Koko’ waste dump, and several oil spills in the Niger Delta State are eye openers. This area is an example of how EHOs work alongside other professionals, such as land developers, architects and engineers, to provide a multi-disciplinary approach to problems.
On the infrastructure scenario, there is a lot to be done in Nigeria. There are no laboratories which are well equipped (except a few private ones serving oil companied) which can cater to the needs of environmental monitoring. Many a time the results reported are questionable and do not tally with inter-laboratory quality control or quality assurance indices. It is high time that every state should have at least one well equipped laboratory manned by a qualified Scientist. These scientists are to be certified from time to time trained and retrained and QA and QC should be made mandatory at regular intervals. Even the equipments they use should be checked by qualified maintenance engineers and should be condemned if they do not meet the quality criteria.
  1. ii.           Food Sanitation and Hygiene Control
Ghana played a prominent role in the West African region in 19th century. Food and sanitary inspectors monitored markets and kept an eye on the conditions under which food was sold. An indoor market was a radical re-definition of the West African concept of the marketplace. In Ghana, fish sellers were strictly female, though men were the fishermen. As the fish was transferred from the canoes to the women (“fishwives”), it entered a distinctly feminine ..... market hygiene was valued.
................................ In Nigeria today are deplorable. Every year thousands of people suffer silently from food poisoning and food borne infections. Chemicals, heavy metals, parasites, fungi, viruses and bacteria can cause food borne illness. Bacteria related food poisoning is the most common, but fewer than 20 of the many thousands of different bacteria actually are responsible. More than 90 percent of the cases of food poisoning each year are caused by Staphylococcus aureus, Salmonella sp., Clostridium perfringens, campylobacter jejuni, Listeria monocytogenes, vibrio parahaemolyticus, Bacillus cereus, and Enteropathogenic Escherichia coli. These bacteria are commonly found on many raw foods. Salmonella is now considered as a dangerous organism, small in size and migrate from the egg shell into the yolk unnoticed. Inspection for food safety should focus on the processes that the foods undergo, with particular attention to possible sources of contamination to which foods are exposed; modes of contamination; effects of the process on the level of contamination; probability of microorganisms surviving processing and chances that bacteria or moulds will multiply during processing or storage. Food safety rests on controlling food operations from receipt of ingredients until the processed or prepared foods are distributed, sold or eaten. Surveillance should emphasize operations rather than physical ..........
Only now the Federal Ministry of Environmental is putting in place a Policy and Food Sanitation Officer or Environmental Health Officers are concerned with ensuring the safety of food, at all stages of production and distribution, until it reaches the consumer. EHOs inspect food premises and advise managers on hygiene and safety matters. If the conditions in premises are a risk to health, the EHO may take legal action by serving an improvement notice, or in very extreme cases, close the premises until the problems are put right. However, the vast majority of EHO work in this field is concerned with advising businesses on food law and regulations and helping them to safeguard their customers. EHOs may also run courses to educate food handlers and promote initiatives to raise the consumer awareness of how to prevent poisoning in the home.
  1. iii.        Housing
In the early 1840s, and perhaps ten percent lived in cellars in UK. The borough engineer (New Castle-Up-On Tyne painted a lurid picture of the conditions in the early 1860s, enplaning how courts had no through ventilation and normally contained ‘the privy or ash pit common to all the wretched dwellings, with its liquid filth oozing through their walls, and its pestiferous gases flowing into the windows’. Conditions within the houses were no better. Good housing comes high on most people’s list of priorities for a decent standard of living. Environmental Health Officers monitor housing standards and can ensure that repairs to properties are carried out in order to make a house suitable for habitation. In many cities and large towns, slums are growing unchecked. Pressure of populations and unmatching infrastructure have resulted in poor structures and degraded environmental sanitation. EHOs are responsible for ensuring that people living in these premises are protected from fire and hygiene hazards. With little space available around the residential houses, some of the earlier guidelines are to be changed and supplemented with improvements in building technologies. It is estimated that in 1997 there were still around 1.5 million unfit houses in England. Lagos has been classified as a megacity Abuja is growing out of control and soon competing with Lagos. There are still lots of work to be done in the area of urban housing by the EHOs in association with town planners and other professionals. Provision of parks is to act as ‘lung’ for the cities, and this is neglected by most of the modern day administrators.
  1. iv.        Waste Management
Urban development unless properly planned is closely associated with unsanitary conditions and accumulation of filth and garbage. Technology is contributing to the changing composition of the waste. The older concept of target collection bins is being replaced by JRs (......... Recycle). More and more developed countries are advocating zero discharge to dump sites. Waste to energy concepts is replacing the traditional landfills and pyrolysis. Hazardous wastes, medical and infectious wastes from healthcare facilities, emergency wastes arising from such epidemics are avain flue are challenges and there is a need for emergency preparedness in handling,     transportation and disposal. Incineration and sanitary landfill are well known options, for Nigeria, recycling of non-biodegradable waste and concerting organic waste into compositing are the best environmentally friendly approaches. Biogas production is another viable option for organic waste management. This technology, once promoted will catch up as energy demand keeps on increasing with the developmental activities. In Nigeria there is no sewage system in any city (inclusive of Abuja). Open drains and septic tank system are the order of the day. In the long run centralized sewage system is more economical and efficient in managing waste waters from mega cities.
  1. v.           Health and Safety at Work
The industrial Revolution brought with it the many advantages of mass production, efficiency and quality, but also produced, in some circumstances, horrific working conditions. Over the past 150 years in United Kingdom various legal measures have resulted in continually improving safety standards. EHOs are responsible for enforcing the Health and Safety at Work (etc) Act 1974 in more than one million commercial and recreational premises employing some 9 million people. EHOs inspect premises and offer advice on how to protect employees and members of the public using the premises. They may also be called to investigate an accident and may prosecute if the firm is negligent. The main concern of the EHO is that conditions at work or in leisure facilities should not be detrimental to health. In the increasingly information-intensive environment of tomorrow’s health and safety, the role of Geographic Information System (GIS) will have greater importance due to its abilities to integrate a wide range of data sources, from legacy systems to image data, and to make complex data more quickly and easily understood. Unknowingly in the earlier years (1855) John Snow established the relation between broad street water source and the cholera outbreak in London. Snow took days to calculate his polygon around the Broad Street pump, something the GIS program does in seconds. Secondly, it provides an array of potent techniques-like nearest neighbor analysis and the spatial (or weighed mean) unavailable to snow and his contemporaries. Third, the ability of the GIS database to summarize and analyze data at a range of scales-local, regional, national and international-is an enormous boon. The breakdown of Health and safety inspection in a GIS perspectives is just one aspect of Environmental Protection and Health and Safety.
  1. vi.        Other Emerging Roles
Sustainable development is a catchy word since Rio conference. All the developmental activities before embarking are tied to environmental sustainability. Thus every country embraced the Environmental Impact Assessment, Environmental Audit and Health impact Assessment as part of their responsibilities. Every industry is mandated to develop environmental policies and environmental management plan. While technologically advanced countries adopted these almost immediately in their planning, the developing countries including Nigeria has started implementing very seriously. However, there are some basic problems affecting the quality of such studies and implementing the mitigation measures particularly in Nigeria. Pseudo environmental practitioners, say contractors get the jobs which are supposed to be technical in nature and hire unqualified environmental specialists to carry out the data collection. Here again, EHOs play very prominent roles at various stages.

Conclusions
Environmental practitioners of today have evolved over the centuries. Sanitary reform, especially developed by the Public Health Acts (187.., 1875) needed a well trained body of sanitary inspectors. The sanitary institute and other professional organizations set about improving the qualifications and standing of the people who were charged with creating a healthier urban environment on a day-to-day basis. The structures created at that time have changed much, but the posts, the professional associations and the journals that were created in late Victorian times are still valid today. There is no gain saying that we adhere to the older ways only. There is need to review the changing times and assign newer responsibilities and train them to fully equip themselves with the fast growing knowledge and technologic and procedures. The EHO is an environmental practitioner, a professional, a counselor, and a friend in deed to the communities at the grass roots.
Recommendations
  • Environment is dynamic and changes occur at short notice. Constant surveillance and action are necessary in remediating any irreparable damages.
  • In dealing with the environment, multidisciplinary nature of the management techniques should be realized and appropriately qualified or skilled personnel should be put in place with no bias or prejudice; Environmental practitioners should practice a multi-disciplinary approach by increasing diversification and breadth, rather than specialization and expertise.
  • One must recognize that traditional health promotion and education activities have often focused on messages to the individual regarding lifestyle choices to understand what is bad and what is good for them which has a minor impact on public health. This must expand to include broader communities and institutions
  • Any new approach must recognize that environment has a direct impact on health-through pollutants in the air, water and food-but also that environment affects the lifestyle, travel, food security, access to education, culture, green surroundings and social interactions
  • Unhealthy environment begets unhealthy lifestyles which in turn beget unhealthy environments. This can lead to a depressing spiral of decline. Environmental change can be achieve only through billions of individual lifestyle decisions.
  • At national level, the policy and guidelines should be backed up by unscrupulous implementation through the services of EHOs at various tiers; they should be strengthened with modern tools and training and retraining programmes.
  • There is need for well equipped laboratories at state or regional level to effectively monitor environment and they should be manned by qualified personnel
  • There is need for a deeper understanding of the factors that are detrimental to environment and health and the forces that encourage unhealthy lifestyles
  • R&D in industry and institutions is vital for coping with the challenges. This should be encouraged and the information obtained should be stored in database and disseminated through media.

Environmental Health in Nigeria and the way forward


By Abiodun  Peter Bamigboye [Now late]
Introduction
Environmental factors play an important role in health and disease among the population of particular concern are young children and other high risk population group. Scientists have long worked to understand the environmental and humanity’s place in it. The search for this knowledge grows in importance as rapid increase in human populations and economic development intensify the stresses human beings place on the biosphere and ecosystems. People want to be warned of major environmental changes and, if the environment is under threat, want to know how to respond. Fortunately, rapid increases in scientific capability-such as recent advances in computing power and molecular biology and new techniques for sensing biological, physical, and chemical phenomena below, on, and above the Earth’s surface – together with the rediscovery that the human-environment relationship is a critical topic for the human sciences, are making it possible for science to provide much of this knowledge. The scientific excitement and challenge of understanding the complex environmental systems humans depend on, making the environmental sciences centrally important as humankind attempts a transition to a more sustainable relationship with the Earth and its natural resources.
The influence of the environment on health are varied and complex. Diarrhea, caused by unsafe water, inadequate sanitation and poor hygiene, accounts for 15 to 18 percent of child deaths annually. Malaria is responsible for 2.5 million deaths each year, mostly among young children. Acute lower respiratory infections (ART), mainly pneumonia – which has been closely associated with exposure to indoor smoke from cooking with biomass fuels, are the leading cause of death for children under five years of age.
A great deal of the underlying causes of disease, injury, and death in developing countries lie beyond the purview of the health care system. They cover a range of physical factors (inadequate sanitation, water, drainage, waste removal, housing, and household energy) and behavioral factors (personal hygiene, sexual behavior, driving habits, alcoholism, and tobacco smoking). Many of these environment- and occupation-related health problems turn into public health problems when they become widespread, a factor aggravated by inadequate public health infrastructure. Yet, policies in the sectors responsible for these negative health impacts are often not based on health criteria. The health sector itself tends to focus its interventions within the health care delivery system, not necessarily in other sectors that are the source of the problem2,3. Similarly naturally occurring ecological factors that can exert negative impacts on all sectors (mosquito-borne diseases, arsenic in the water, floods, droughts, and so on) are seldom addressed systematically by any of the sectors at risk, even though some sectors may be exacerbating their effects (spreading mosquito habitats, consuming great quantities of water, or producing greenhouse gases that may worsen climate change). As a result, the enormity of health benefits possible through interventions outside the health sector is not being tapped. Environmental Health interventions are one of the important of those neglected areas.
The subject of Environmental Health (EH) is undoubtedly one that has generated a lot of debates both locally and internationally. It is a sector or sub-sector that is largely talked about but receiving little or no attention in many places particularly in developing countries of the world. The WHO’s concept of health brought in focus the ecological as well as the sociological paradigms of health with a view to holistically addressing issues relating to health and wellbeing. If health is seen not just as the absence of disease but also as a central goal of human development, then the protection of the environment and the protection and improvement of health are mutually supportive. It is against this background of increasing international focus on environmental sanitation, that the Committee on Environmental Sanitation was established by the first World Health Assembly in l948. The Committee’s first, groundbreaking report, published in 1949, concluded that physical development, health and survival, depended on the management of environmental factors which included excreta and community waste disposal; safe drinking water; food safety; healthy personal habits; understanding the causes of diseases; and, the control of disease vectors. It was decided to focus action on the reduction of infectious diseases by monitoring how they respond to environmental management, and that the lessons learned in public health engineering from the sanitary revolution in Europe and the Americas would be of particular value. Changes from old patterns of life were an essential precondition for the achievement of better environmental health. The historical account of the contribution of EH in 19th and 20th Century United Kingdom in ensuring good health and its adoption by the WHO as a fundamental approach to addressing global health situation underscores the relevance of this sub-sector.
During the 1 990s, a series of reports from think tank agencies, the World Health Organization (WHO), and the Centers for Disease Control and Prevention (CDC) rated environmental concerns among the most important health issues and global threats. They also ranked environmental public health and sanitation accomplishments among public health’s greatest accomplishments. The 30-year increase in life expectancy to 76.7 years from 1900 to 1998 has been attributed to environmental public health monitoring and regulation of the water supply, sewage systems, and food quality, as well as to immunizations and primary preventive care. As a result of proper sanitation, more than 80% of human disease has been eliminated The strong tradition of environmental public health and sanitary services was maintained through the middle 1 960s, when new environmental problems gathered attention: globalization of the food supply; contamination of drinking water; air and noise pollution; ionizing radiation; proliferation of solid and hazardous waste, disease vectors, and wastewater; and degradation of housing, institutional services, and environmental conditions in child-care facilities.
What is EH?
Environmental Health has been defined as the science which study the biological, chemical or physical agents introduced into the environment or occurring naturally and their effects on human health and ecological systems. The field also includes the study of human activities, a vital component in our complex ecosystem 6 (UGA, 2005). In another sense, ER is understood as the science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. Toxicology and occupational health are also included in this category.
Environmental health as used by the WHO Regional Office for Europe, includes both the direct pathological effects of chemicals, radiation and some biological agents, and the effects (often indirect) on health and wellbeing of the broad physical, psychological, social and aesthetic environment which includes housing, urban development, land use and transport. In general term, EH comprises those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations. It would be seen from the foregoing that the scope of this field is wide and varied. These areas in which EH should focus include but may not be limited to those in table 1 below.
Table 1: Typical Responsibilities of Environmental Health and Protection Programs
  • Ambient air quality
  • Indoor air quality
  • Water pollution control
  • Safe drinking water
  • Noise pollution
  • Radiation
  • Food safety
  • Industrial hygiene
  • Childhood lead poisoning
  • Acid deposition
  • Disaster planning and response
  • Cross-connection elimination
  • Healthy housing
  • Institutional environmental control
  • Recreational area environmental control
  • Solid waste management
  • Vector control
  • Pesticide control
  • Toxic chemical control
  • On-site liquid waste disposal
  • Unintentional injury control
  • Bioterrorism
  • Global environmental issues.
These services are provided by various cadres of trained personnel generally referred to as environmental health personnel who serve the general welfare by safeguarding and improving the quality of food, shelter, air, water and other natural resources. The role of EH in health and disease cannot be underestimated. One is quick to refer to the great sanitary reforms which follows the historic cholera outbreak in UK and the various feat achieved in the control and/eradication of some other diseases. The contributions of EH to the global burden of disease is also very significant (see table 2 below).
Table 2: Environmental Factors and the Global Burden of Disease: Proportion of Global DALYs Associated with Environmental Exposures (1990)
DiseasesGlobal DALYs 1000)% attributable to envtal. factorsEnvtal DALYs (1000)% of all DALYs (all age group)
ARI116,6966070,0175.0
Diarrheal diseases99,6319089,6706.5
Vaccine preventable infections71,173109,1170.5
T.B38,426103,8430.3
Malaria31,7069028,5352.1
Injuries Unintended152,1883045,656
Intended56,459NE*NE3.3
Mental health144,9501014,4951.1
Cardio vascular disease133,2361013,3241.0
Cancer70,5132517,6281.3
Chronic respiratory diseases60,3705030,1892.2
Total these diseases975,35033320,47023.0
Other diseases403,858NENE
Total all diseases1,379,23823320,470
Source: WHO (1999). NE-Not Estimated
Failure to address peculiar EH problems has very grievous and economic implications with serious development implications. For instance, it is one record that the global neglect of EH sub-sector has the following development implications:
  • 2.4 billion people lack access to basic sanitation
  • 2 million people die every year from diarrheal diseases (including cholera) associated with inadequate water supply, sanitation and hygiene
  • The majority are children in developing countries
  • Water, hygiene and sanitation interventions reduce diarrhea incidence by 26% and mortality by 65%
  • 200 million people, in 74 countries, are infected with schistosomiasis and soil-transmitted helminthes and 20 million suffer severe consequences
  • Basic sanitation reduces schistosomiasis by up to 77%
  • 500 million people are at risk from trachoma and 146 million are threatened by blindness
  • Trachoma can be prevented by improving sanitary conditions and hygiene practices.
The need to reverse this ugly trend became necessary globally and WHO had many years ago realized this necessity. To spearhead these changes WHO was asked to develop/refine international sanitary standards and guidelines for national health services to involve them in priority environmental health programs, and to educate the public. Specifically the organization undertook to:
  • Link environmental sanitation with other health-related activities
  • Cooperate with other UN bodies
  • Undertake demonstration projects, especially for rural sanitation
  • Promote research and disseminate information
  • Cooperate with governments in strengthening national health services in environmental matters, and develop human resources.
Since its inception in 1948, WHO has had to define how it would pursue the achievement of “The improvement of EH as called for in Article 2(1) of the Constitution. “The First World Health Assembly gave environmental sanitation the same priority as malaria, maternal and child health, tuberculosis, veneral diseases and nutrition and these priorities became known as ‘the big six’. It is a known fact that while some most developed countries have accorded such priority to EH, many of the countries in the South had not.
WHO has always maintained that EH and particularly sanitation is literally the foundation on which a sound public health structure must be built. The organization has also maintained that over 75% of all communicable diseases affecting humans are environmentally related. Over the last 50 years WHO has generated, evaluated and Shared new knowledge on safe disposal of excreta, sewage and community waste and has also been at the forefront of exploring the linkages between environmental pollution and change, and people’s health and livelihoods. There is no doubt that people, especially poor people living in countries where basic infrastructure is lacking, are seriously affected by environmental degradation. In addition, the ongoing and deteriorating situation of sewage causing environmental pollution needs urgent and serious attention.
The Millennium Development Goals (MDGs), adopted at the Millennium Summit of the United Nations in September 2000, call for a dramatic reduction in poverty and marked improvement in health h of t he poor. Access to safe water and sanitation is fundamental for better health, poverty alleviation and development; and improving water and sanitation services has been recognized as a crucially important strategy towards meeting the MDGs . Such an achievement is feasible, but given the scale of the problem, especially for sanitation facilities, far from assured.
Experience shows that while the importance of sanitation is recognized, progress is lagging far behind compared to the provision of safe water. The toll on human health is high, resulting in about 2 million deaths per year from diarrheal diseases and approximately 2 billion people infected with schistosommiasis and soil-transmitted helminth infections globally. A host of other diseases are related to poor disposal of human excreta, poorly constructed or managed latrines, and poor solid waste management and drainage. If the toll on human health and human life of all of these sanitation-related conditions could be effectively added up, it would truly reveal a tragedy of grave proportions. Therefore something has to he done.
The Challenges EH
Efforts at improving El-I services must address specific problems and challenges so as to accelerate service delivery for greater effectiveness. Globally, EH challenges operate within the context of the following issues
• Increasing urbanization
• Ageing physical infrastructure coupled with lack of preventive maintenance
• Sharpening inequalities, polarization of society and choices
• Decaying family and community fabric
• An ageing population
• Increasing stress
• Centralization of decision making and power – but local nationalism
• Extremism/fundamentalism/terrorism
• Environmental degradation
• Diminishing natural resources
• Need for sustainable environments and sustainable lifestyles
These challenges are also manifesting in an environment whereby specific issues likely to hinder effectiveness arc apparent. These constitute serious threat to El I services in many places in the world. As a matter of fact, predictions for specific future of EH services should bear in mind:
• Emerging & re-emerging pathogens
• Resistant and virulent strains
• Bio-terrorism
• Global warming – related health problems & natural disasters
• Population movements
• Water shortages. & related conflicts
• Energy shortages
• Infrastructure failures
• Social polarization
• Globalization of markets and products
• Greater awareness of Genetic susceptibility of individuals and groups
• Improved toxicological techniques
• Better informed public; class actions
In Nigeria, efforts directed at improving EH services are challenged by the following factors:
1. Weak Governmental policy and legislations.
Many people had argued that policies are non-existent but the fact is that no nation exists without one form of policy or the other. Policies directed towards improving EH services in Nigeria are weak and ineffective. There also seem to be some constitutional defects in the role definition as regards responsibility for ER matters. While it is generally believed that ER services are largely the responsibility of LGAs. It is a known fact that LGAs as presently constituted, financed and managed would be unable to ensure a healthy environment. The need for a reappraisal may be necessary. The National Policy of Environmental Sanitation championed by the Federal Ministry of Environment is a right step towards addressing this problem. However, its implementation must be devoid of sentiments, and unnecessary bureaucracies.
In addition to this is the fact that most EN legislations are either obsolete, inconsistent or had failed to take cognisance of the cultural settings in which they are supposed to operate. The need for suitable legislations to address specific EH issues is urgent.
2. High level of ignorance.
To a large extent, many people including many of those expected to provide EH services have not fully appreciate the significance of the environmental dimensions of health and the correct issues involved. Specifically many people particularly mothers have not fully understood the link between personal/public hygiene, health and disease as well as the ways to break the link. In addition to these, many policy makers and professionals still hold on to the restrictive bio-medical approach to health and disease.
Where knowledge is low, incomplete or incorrect, there is the tendency that people’s ability to make informed decision about their health would be limited and their exposure to risks aggravated.
3. Poor political will and commitment.
In many places, there is poor political will and commitment. This lack of will also include the lack of will to make realistic plans and the poor will to implement plans. EH services required commitment on the part of all stakeholders towards the realization of program goals. It must be appreciated that mobilization in favor of improved ER has been poor, non-specific and sometimes misdirected. There is need to increase the commitment of all. This is particularly required at the LGA level.
4. Poor funding of EH Services.
Funding for ER services have been poor over the years compared with other sub-sector. Though it is difficult to obtain how much had been spent by each tier of government on ER , it is generally believed that the sector had not been favoured in the allocation of needed resources. In many states of the federation, many LGAs are without a functional refuse van while other implements required are either insufficient or non available. The success of most EH programme is directly dependent on the amount of resource inputs and this has to be appreciated. In addition to this, lack of resourcefulness is another factor that has bedevilled the sector. In most cases, the little resources allocated are really not available to prosecute ER services due to undue corruption. In many places, EH services are seen as one of the main conduit pipes through which funds are siphoned. The need to be more resourceful is considered very important.
5. Training and Human resources Development.
By an large the training of most ER personnel takes place at the state government-owned Schools of Health Technology/Hygiene which are expected to be of the status of a Monotechnic . There are about 35 of such schools in Nigeria. The standard of many of these schools leaves much to be desired. Coupled with this is the fact that the country used to be the pioneer of a University-based ER training programme in Africa. The then UNIFE (Now Obafemi Awolowo University, Ile-Ife) B.Sc EH programme was famous during its years of existence as the only one in Africa. Today the story is different as the programme was rationalized under questionable circumstances around 1990. Training and human resources development must be seen as an important aspect of evidence- based ER service delivery. The Council’s effort in this direction is welcomed and its expected to be complemented by training institutions so that more competent professional could be trained.
The way forward
Moving ER service forward in Nigeria requires a radical approach towards the provision of improved services. The services are expected to be universally accessible to people irrespective of where they live. It should also be culturally, economically and socially adapted to each local setting and directed towards addressing specific health and development problems.
To make environmental health a really potent force in the 21st century, important changes are needed. To some extent, these changes are a problem of money and resources and pose a political question: what priority should be given to environmental health within the full array of social needs and wants? But they also raise problems in communication, in education and in technology development itself
Reflecting WHO’s corporate strategy, EH activities should focus on six strategic areas of work which are:
• Ethical and evidence-based policy.
• Stimulating research and development, testing new technologies and comparing performance.
• Technical and policy support for sustainable capacity building.
• Setting. validating, monitoring and guiding the implementation of norms and standards.
• Assessing status and trends.
• Developing tools and guidelines for disease control and risk reduction.
Revitalization of environmental public health services in the country is important for four reasons:
  1. Many environmentally related conditions affect the health and lives of millions of citizens at significant cost,
  2. Many emerging and re-emerging public health problems require innovative enviromnental public health services interventions,
  3. Environmental public health is an important part of the public health response to terrorism and other emergencies, and
  4. Environmental public health services issues are becoming more complex.
Specifically, the following has to be addressed as a way forward for effective ER in
Nigeria:
1. EH policy and Regulation.
There is need for Government at all levels to ensure that policies are directed towards addressing environmental health problems. Policies must clearly indicate what is to be done, by who and also include system for monitoring and evaluation of activities. In addition to this, there is need for appropriate legislations to address specific issues. The obsolete Public Health Laws (1958/59) as applicable in different parts of the country must be reviewed. EHOAN/EHORECON’s initiative to get a suitable legislation should be supported by all. If there are grey areas that need to be addressed, this should be sorted out.
2. Advocacy.
In a system where both government and individual priorities are misplaced in disfavour of ER, the need for a planned advocacy strategy becomes very needful to sensitize all stakeholders towards improved services. There is need for both policy advocacy as well as personal advocacy in favour of ER. To ensure service sustainability requires indigenous advocacy. In this wise everyone must be involved. Everyone who cares can be an effective policy advocates. The media has a unique role in this strategy particularly in providing correct information to members of the public, in letting the government know what they should be doing, and in advocating for good practices.
3. Intensifying Hygiene Education
ER professionals must take leading responsibility in modifying their approach to providing ER services. It must be clear to all that most traditional approaches towards service delivery are no longer fashionable. Efforts must be geared towards achieving positive behavioral changes in matters relating to El-I. This might require a review of the present curriculum of instruction in the training schools as well as a re-orientation of all stakeholders.
4. Inspiring a Shared vision.
Application of the concept of shared vision is important for improved EH services. Efforts directed at improvement as well as the strategies to be adopted must be shared among all stakeholders. Shared vision demands partnership and collaboration which is expected to have multiplier effects towards realization of targets. Coupled with this is the need for team work among all stakeholders. Levels of government must see the joint responsibility in ensuring a safe environment for health.
5. Fostering Leadership
This is important so as to ensure that the goal of ER services is enhanced by environmental public health services and also develop strong working relationships among the stakeholders in EH services and to assist state, tribal, territorial, and local health entities and other stakeholders to improve the practice of EH This goal requires development of a National programme to create a cadre of well-trained specialists who will become leaders at all levels of ER service delivery. The professional association in collaboration with the Council would be expected to champion this course.
6. Communication and Social Marketing
The intent of this goal is to improve communication and information sharing among EH professionals and other public health agencies, communities, policy makers, and others and enhance the significance and understanding of environmental public health. Achieving the goal also will define the structure of an effective system for sharing EH information. This goal will be accomplished by promoting and disseminating strategies. Education approaches, and models of best practices to engage communities and policy makers in discussions about EH issues.
7. Developing the Workforce
This strategy is expected to promote the development of a competent and effective EH workforce to deliver contemporary services and address emerging needs. Implementation of this approach includes defining the scope of work as well as the size, composition, performance standards, and competencies of the ER workforce and its current leadership. Accomplishing this goal will include activities that outline ways to develop an EH workforce training stem. Development of the National Environmental Health Service Corps or a fellowship program is also a critical component. In addition, these activities will support programs to increase the number and elevate the status of ER practitioners who engage in competency-driven continuing education and training.
Conclusion
In today’s world, efforts to ensue or maintain high levels of EH status in addition to traditional concerns need to take account of the broad development agenda as well as a number of often complex processes or phenomenal. In doing this, it is time governments at all levels stop paying lip service to ER matters. It must be appreciated by all that no nation can ache desirable level of development without proper EH delivery Government the people, the professionals and all other stakeholders must champion a course in ensuring a healthy environment in Nigeria and for Nigerians.
References
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  4. WHO (2003). Five Decades of Challenges and Achievements in Environmental Sanitation and Health. WHO Geneva, 2003.
  5. NAP (2001). Grand Challenges in Environmental Sciences. National Academies Press.
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