Presented by: JOSELITO M.RIEGO DE DIOS,CE,SE, MPH OIC, Water and Sanitation Division, Environmental and Occupational Health Office National Center for Disease Prevention and Control Department of Health, Manila
JOSELITO M.RIEGO DE DIOS,CE,SE, MPH - PSENSE …psense.org.ph/wp-content/uploads/2011/12/De-Dios.pdf · JOSELITO M.RIEGO DE DIOS,CE,SE, MPH. OIC, Water and Sanitation Division, Environmental
JOSELITO M.RIEGO DE DIOS,CE,SE, MPHOIC, Water and Sanitation Division, Environmental and Occupational Health
OfficeNational Center for Disease Prevention and Control
Department of Health, Manila
OutlineOverview on Environmental Health DOH MandatesPlans, Programs and ProjectsInstitutional Partners
addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours.encompasses the assessment and control of those environmental factors that can potentially affect health.targeted towards preventing disease and creating health‐supportive environments.
Environmental Health
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Our environment plays a significant part of the health and well-being of human beings. Invariably, our interaction with the environment affects our health one way or the other.
ENVIRONMENTAL HEALTH
- refers to the theory and practice of assessing, controlling andpreventing those factors in the environment that can potentiallyaffect adversely the health of present and future generations(WHO, 1993)
BIOLOGICAL PHYSICAL, CHEMICAL
SOCIAL PSYCHOSOCIAL
HUMAN HEALTHQUALITY OF LIFE
Environmental health concerns• Environmental health addresses all human‐health‐related aspects of
both the natural environment and the built environment. Environmental health concerns include:
• Air quality, including both ambient outdoor air and indoor air quality, which also comprises concerns about environmental tobacco smoke.
• Body art safety, including tattooing, body piercing and permanent cosmetics.
• Climate change and its effects on health. • Disaster preparedness and response. • Food safety, including in agriculture, transportation, food processing,
wholesale and retail distribution and sale. • Hazardous materials management, including hazardous waste
management, contaminated site remediation, the prevention of leaks from underground storage tanks underground storage tanks and the prevention of hazardous materials releases to the environment and responses to emergency situations resulting from such releases.
• organization, management, education, enforcement, consultation, and emergency response for the purpose of prevention of environmental health hazards and the promotion and protection of the public health and the environment
Environmental hazards/ecosystem degradation are a root cause of a significant health burden:
25% of the burden of disease globallyup to 35% of disease burden in very poor regionssuch as sub‐Saharan Africa.
(Smith KR et al. Epidemiology, 1999)
THE HEALTH AND ENVIRONMENT NEXUS
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Ironically, the environmental hazards introduced by humans and the degradation of ecosystem are the major factors affecting the health. 25% percent of the burden of disease globally can attributed to environmental hazard/degradation. This study was in 1999 and I would imagine that a lot has changed in 12 years and it would fairly safe to say that it has not decreased. Environmental hazards are responsible for as much as a quarter of the total burden of disease worldwide, and more than one-third of the burden among children. This includes diarrhea, lower respiratory infections, various forms of unintentional injuries and malaria. The disease burden is much higher in the developing world, although in the case of certain non-communicable diseases, such as cardiovascular diseases and cancers, the per capita disease burden is larger in developed countries. Health impacts of environmental hazards run across more than 80 diseases and types of injury. Well-targeted interventions can prevent much of this environmental risk. Worldwide, as many as 13 million deaths could be prevented every year by making our environments healthier.
poor water quality, availability, and sanitation;poor ambient and indoor air quality; toxic substances; vector‐borne diseasesglobal environmental change
Key Areas of Risk
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A significant proportion of that overall environmental disease burden can be attributed to the key areas of risk. poor water quality, availability, and sanitation: Deals with access to quality water and sanitation. Mostly in rural areas and poor communities poor ambient and indoor air quality; Pollution, smoking, etc. toxic substances; Chemicals, pesticides, etc vector-borne diseases Dengue global environmental change Adverse weather conditions which leads to flooding Of course, we can include here road safety which also a major cause of morbidity.
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Here we see the Disability Adjust Life Years attributed to environmental health risks. Almost half of the environmental health risk related disability life years can be attributed to unsafe water, sanitation, and hygiene. This means if we are able to provide safe water and adequate sanitation, we will be able to prevent a lot of illnesses and loss of productivity.
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Here we see diseases with environmental contributions. The most common diseases that we see in all population groups such as diarrhea and respiratory infections are largely attributable to environmental causes
The Phil EH Scenario• A poor environment contributes to many common health
conditions in the Philippines.• Most important of all environmental factors that contribute
to diseases: air pollution, water pollution, sanitation conditions and hygiene practices
• These accounts for an estimated 22% of the reported illnesses and 6% of the reported deaths
• Faced with double burden of disease
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TRADITIONAL
HAZARDS
MODERN
HAZARDS
INFECTIOUS
TUBERCULOSIS
MALARIA
DENGUE
SCHISTOMIASIS
FILARIASIS
DIARRHEA
COMMUNICABLE:
SAR
AVIAN FLU
HIV/AIDS
NON‐COMMUNICABLE:
HYPERTENSION/CVD
DIABETES
COPD
What Problems Do We Face?
Traditional HazardsRelated to poverty and insufficient development:‐ lack of access to safe drinking water‐ inadequate basic sanitation‐ food contamination with pathogens‐ inadequate solid waste disposal‐ indoor air pollution‐ disease vectors
Modern HazardsRelated to rapid development that lack health and environment safeguards:‐ water pollution‐ solid hazardous waste accumulation ‐ chemical and radiation hazards‐ deforestation, land degradation‐ climate change ‐ ozone depletion
89% of households use an improved source of drinking water. ◦ 1/3 of urban households use bottled water, while another 60% have another improved source of drinking water
◦ Eighty‐four percent of households in rural areas have an improved water source.
2/3 households have access to an improved toilet facility (flush to septic tank, flush to pit latrine, flush to sewer system; 15 percent of rural doesn’t access
Water and Sanitation
NDHS, 2008
Water and Sanitation
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While, the country has made significant inroads in increasing access to basic sanitation. By 2015, the Department of Health projects that sanitation coverage will reach 88% of the population. In urban areas, we know that access to basic sanitation is relatively high but we do recognize that we will encounter pockets like the ones you see in the slide. This is of course, a function of overcrowding and increase population growth. In a report made by the WB, they claimed that around 72% of the total economic costs of poor sanitation amounting to 78 billion is down to its impact on health and poor sanitation particularly affects the poor.
Solid Waste
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Solid waste is considered as one of the most visible environmental priority in the cities and municipalities of the Philippines. Generation of waste is increasing rapidly as consumption rises, while collection efficiencies are dropping as service levels deteriorate. Metro-Manila produces 25% of solid waste in the entire country which is probably around 8,400-8,600 tons a day and is not uncommon to see piles of garbage everywhere. Hospitals in the country generate 6,750 tons/year of hazardous and infectious wastes. Mismanagement of waste has serious environmental consequences: ground and surface water contamination, local flooding, air pollution, exposure to toxins, and spread of disease through vectors. Many of the disposal sites contain infectious material, thus threatening sanitation workers and waste-pickers. According to a 2004 ADB study, the Rodriguez and Payatas waste sites generate an estimated 26 kilograms of lead and 76 kilograms of arsenic annually. These contaminants are released into the water bodies surrounding Metro Manila. The pie chart below is quite staggering. Solid waste can be greatly reduced if we segregated our garbage, recycled plastices and composted our biodegradable wastes. A number of successful community-based ecological waste management projects can now serve as model initiatives. Several LGUs and NGOs have initiated community-based campaigns to reduce and recycle waste. More extensive awareness- raising activities and training on ecological waste management are needed, together with stricter enforcement.
Air Pollution
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It was estimated that in general particulate matter are at acceptable levels as of last year’s monitoring according to the DENR. However, these still exceed standards at most locations in Manila and in many other cities. Use of cleaner fuels and technologies, refined motor engines, and public transport are crucial in ensuring that our people breathe clean air. Perhaps this means stricter implementation of the clean air act. Reliable monitoring is the foundation for sound policy and needs to be established as a priority. Despite national and international interventions and decreases in major pollutant emissions, the health impacts of air pollution are not likely to decrease in the years ahead, unless appropriate and timely action is taken by all concerned sectors.
LeadMercuryCadmium ArsenicChromium Zinc Nick Copper
Toxic Substances
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Toxic substances are ones which harm humans through air, soil, and water pollution. On release to the air, the elements travel for large distances and are deposited onto the soil, vegetation, water which contaminates terrestrial and aquatic organisms and eventually humans. These can harm humans through inhalation, ingestion and skin absorption. Acute and chronic health effects are manifested among those directly and indirectly exposed. Two of these toxic substances that we are particularly concerned with are lead and mercury.
Infectious Diseases
Dengue Leptospirosis
22255 Cases from January 1 to Nov 4, 2011 in Metro Manila 22.8% of cases Nationwide (highest) 18% increase from last year
495 cases from January 1 to Nov 4, 2011 in Metro‐Manila 19% of cases nationwide (2nd highest)242% increase from last year
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The environment largely influences the spread of infectious diseases. Here we see two examples of infectious diseases which affected Metro Manila in the past year: Dengue and Leptospirosis. The number of Dengue cases in Metro-Manila is perennially high. This year even as the number of cases in other parts of the country declined, Metro-Manila continued to have high number of cases. As of Nov 4, 2011, cases in Manila reached in 22225 cases which accounts for 23% of the number cases in the country this year. But this only represents an 18% increase which suggests that the Dengue problem in Metro Manila has more to do with its urban setting i.e., over-crowding. Technically, Leptospirosis is not a vector borne disease but environmental degradation has a lot to do with its spread. Flooding which has been frequent these past couple of years largely influences the transmission of Leptospirosis. Our data shows as of Nov 11, 493 Lepto cases have been reported and this represents an over 242% increase for the same period last year. We can point the flooding caused by Pedring, Quiel and other typhoons as a possible culprit.
Climate Change
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Climatic changes already are estimated to cause over 150,000 deaths annually. That estimate includes deaths as a result of extreme weather conditions, which may be occurring with increased frequency. Changes in temperature and rainfall conditions also may influence transmission patterns for many diseases, including water-related diseases, such as diarrhoea, and vector-borne infections, including malaria. This has been evident in several parts of the country for the last five years. I want to particularly talk about Typhoon Ondoy which lives in the memory of the citizens of Metro-Manila. It dumped tremendous amounts of rainfall and flooded large parts of Metro Manila. Death toll was recorded at 464 with 261 deaths coming from Metro-Manila and cost 11 billion pesos in damages nationwide.
The DOH is the principal health agency in the Philippines. It is responsible for ensuring access to basic public health services to all Filipinos through the provision of quality health care and regulations of providers of health goods and services. Given the amndate, the DOH is both a stakeholder in the health sector adna policy and regulatory body for health. As a major player, DOH is a technical resource, a catalyzer for health policy and a political sponsor and advocate for health issues in behalf of the health sector.
DOH Policies • PD 856 of 1975 ‐ Code on Sanitation of the Philippines
and its Implementing Rules and Regulations• PD 522 of 1974 – Prescribing Sanitation Requirements
for the Operation of Establishments for the Operation of Establishments and Facilities for the Protection and Convenience of the Travelling Public
• AO 2007 ‐0012 ‐ Philippine National Standards for Drinking Water
• AO 18‐A s. 1993 – Standards of quality and Requirements for the Provision, Packaging and Labeling of Bottled Water
Other related laws• Joint Administrative Order on Health Care Waste Management (HCWM), 2005• Republic Act No. 9275 – Philippine Clean Water Act of 2004 and its Implementing Rules
and Regulations. • Republic Act No. 9003 – Ecological Solid Waste Management Act of 2001 and its
Implementing Rules and Regulations• Republic Act No. 8749 – Philippine Clean Air Act of 1999 and its Implementing Rules
and Regulations, • Republic Act No. 8172 – An Act Promoting Salt Iodization Nationwide and for Related
Purposes. (Year1995)• Republic Act No. 7160 – The Local Government Code of 1991 and its Implementing
Rules and Regulations.• Republic Act No. 6969 – An Act to Control Toxic Substances and Hazardous and Nuclear
Wastes Providing Penalties for Violations Thereof, and for Other Purposes (Year 1990). • Presidential Decree No. 1586 – Establishing an Environmental Impact Statement
System, Including Environmental Management Related Measures and for Other Purposes (Year 1978).
• Republic Act No. 1378 – National Plumbing Code of the Philippines and its Implementing Rules and Regulations (Year 1959)
• Presidential Decree 1096 – National Building Code of the Philippines and its Implementing Rules and Regulations (Year 1977).
Programs and ProjectsWater and Sanitation ProgramsOccupational HealthEnvironmental Health Risk Assessment concerning Toxic and Hazardous Chemicals/Substances Health Care Waste Management ProgramClimate ChangeSALINTUBIG ProgramWater Safety Plan ProjectHousehold Water Treatment and Safe StorageNational search for Barangay with Best Sanitation PracticesSustainable Sanitation for East Asia Program ‐ Philippines
PlansPhilippine Sustainable Sanitation RoadmapNational Sustainable Sanitation PlanNational Sustainable Sanitation Health Promotion PlanNational Environmental Health Action Plan
Training ProgramNational Sanitarian Training CourseBasic Certification Course for Water Refilling Plant OperatorsEnvironmental Toxicology Course for Health ProfessionalsEnvironmental Toxicology course for Non‐Health ProfessionalsTraining for Volunteer Barangay Sanitary Inspectors
