The Role of Environmental Health in the Health Care System
Morgan, Monroe T., Journal of Environmental Health
What determines the health of the over 6.7 billion people in the world? What determines the health of the over 306 million individuals who currently inhabit the United States of America? The pressure of rising health care costs increases the need to understand the determinants of health and the role of environmental health in the health care system.
Determinants of Health
The four basic determinants of health are hereditary or biological factors, medical care, lifestyle, and environment.
Hereditary or Biological Factors
Major aspects of human biology are controlled by genetics. A person may be healthy in every other way but may have inherited conditions such as hemophilia, diabetes, Down's syndrome, various eye problems, lack of resistance to disease, or any number of other problems.
The medical care we receive during our lifetime can determine our health. For example, if a child develops streptococcal infection and does not get medical care, he or she might develop a rheumatic heart condition. Or, if a youngster breaks a limb and does not receive proper medical care, he or she might end up with a deformed arm or leg.
Ever-increasing technological advances have added productive years to thousands of lives. Technological devices include sophisticated equipment for kidney patients, artificial organs, monitoring instruments for the human fetus, and electrocardiograph devices worn by patients to detect an oncoming heart attack. These amazing instruments have captured the fancy of society and added to the cost of health care.
Lifestyle has a lot to do with one's health. Lack of sleep and rest reduces our resistance to infections and leads to bodily degeneration. A person who has an excellent body but eats poorly, does not exercise enough, smokes, and drinks heavily may develop health problems rather quickly. Many Americans indulge in high-fat, high-sugar, high-salt, low-fiber diets. Moving sidewalks, escalators, elevators, cars, buses, and other means of transportation may be leading people to an early demise. Like all muscles, the heart muscle will waste away if it is not used vigorously. Considering these factors, it is rather easy to understand why heart disease is the number one killer in the United States.
Overall, infectious diseases dominate the health problems of underdeveloped countries. Of all the health determinants, lifestyle may be the easiest to control. Even so, it will require much effort.
Considering the world's population as a whole, the environment affects people's health more strongly than any of the other determinants. The environment encompasses the water we drink, the food we eat, and the air we breathe. In the past, because of poor environmental management, many people died from environmentally related diseases such as typhoid fever. Some estimates, based on morbidity and mortality statistics, indicate that the impact of the environment on health status is as high as 80%.
People have acquired intelligence, knowledge, and expertise that have allowed them to make significant changes in the environment, thereby creating conditions that lessen the likelihood of disease. This is accomplished mainly by controlling the causative agents of disease while they are still in the environment, before they reach people, so the body does not have to produce defenses and therapeutic measures are not required.
Environmental health practice, as the name suggests, refers to the relationship between environment and health. Some important elements of environmental health practice--the first line of defense against disease--(with an example) include the following:
* water quality management--ensuring that potable water is available through treatment of water supplies;
* human waste disposal--disposing of human wastes in septic tank systems and sewage treatment plants;
* solid and hazardous waste management--treating and disposing of solid and hazardous wastes;
* rodent control--removing potential harborage and sources of food;
* insect control--utilizing natural, biological, and other methods to reduce insect populations;
* milk sanitation--ensuring that all milk for human consumption is produced under sanitary conditions and is pasteurized;
* food quality management--maintaining surveillance over food from the farm to the consumer so as to prevent contamination;
* occupational health practice--assuring a healthy and safe work environment;
* interstate and international travel sanitation--preventing the spread of communicable diseases between states and nations;
* air pollution control--reducing the emissions of pollutants into the atmosphere;
* water pollution control--reducing the effects of industrial and other waste on water supplies and recreational areas by the pretreatment of industrial and domestic waste;
* environmental safety and accident prevention--designing features into the environment such as pedestrian ramps that promote safety or compensate for people's inadequacies;
* noise control--abating high noise levels in industrial settings and in the community to avoid health degradation;
* housing hygiene--promoting housing conditions necessary for the physiological and psychological well-being of inhabitants;
* radiological health control--controlling radiation sources such as X-ray equipment, nuclear fission plants, and radioactive waste;
* recreational sanitation--monitoring the environment to prevent unsafe conditions at swimming pools and other recreational facilities;
* institutional environmental management--preventing the spread of nosocomial infections;
* land use management--zoning to direct land use to desirable purposes;
* product safety and consumer protection--ensuring that toys, appliances, and the like are safe for human use; and
* environmental planning--applying environmental design to minimize human stress and accidents. …