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Lecture 3

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McGill University
GEOG 221
Nancy Ross

GEOG 221 Lecture 3 (Jan. 17 , 2013) Introduction to Environment and Health Life expectancy continues to increase – why?  As we move forward in time, our life expectancies keep going up and up  Some people suggest there is no ceiling to life expectancy: it will continue to increase  Exceptions: in least developed countries, life expectancy is not as high as the world average, but still high chances of living up to 65 (especially in predictions for 2025) Why is it that we keep living longer when we live in a world that keeps getting more dangerous?  Medicine has improved: primary care, comes into play when people are already sick Some ideas:  improvements to our living environments (hygiene, sanitation, in a developed country context especially), improvements in nutrition (not really in distribution but definitely in quality and quantity), improved medical care (all of these) Environmental Health Science: two key things:  Hazards in the environment, their effects on health, and the variations in sensitivity to exposures within populations  The development of effective means to protect against hazards in the environment Definitions of health and environment:  WHO definition of health: health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity o However we usually deal with disease, etc  John Last definition of environment: all that which is external to the individual human host. It can be divided into physical, biological, social, cultural, any or all which can influence the health status in populations  Focus on features of the environment that are modifiable to improve human health  Based on the notion that human health is a function both of our genetic endowments and the environment  Genetic factors often determine susceptibility to environmental exposures  If everyone smoked, lung cancer would be thought of as a genetic disease  The vast majority of historical improvements to health have come with environmental interventions th  Think about improved sanitation in 19 century industrial Britain; changes to the normative environment that did not support smoking  Our historical leanings have been to health/environment improvements Alma Ata Agreement 1978  Goal of the world community should be the attainment by the people of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. It was noted that this could only achieved when the living and working environment is protected from life-threatening and health-threatening pollutants, pathogens, and physical hazards. Historical concern for environment and health – first wave  British public health act of 1848 (widespread cholera outbreaks in London) – concerned mainly with state provision of a clean water supply and efficient removal of sewage (note that three was little concern for air pollution at the time)  Fever districts on a map: compare that map of the commissioners of sewers: wherever the commissioners of sewers have not been, fever is prevalent; on the contrary, wherever they have been, the fever is absent  Creation of local health boards had powers to create infrastructure to support the health of their populations  At the time: very controversial  Physical and material matters, which concern the health and life of large masses of our population who are pent up and crowded in towns and cities, in the case of evils which cannot be remedied otherwise than by some superintending, intervening, central authority it would ... Environmental concern – second and third waves  Second wave: two broad movements – conservation of natural areas and concern for toxic substances (to humans or the environment) – peaked in early 1970s with UN conference on the human environment  Third wave 1980s and 1990s – sustainable development o Too many people on planet earth for it to survive  Recently: fourth wave? o Air pollution? o Greenhouse gases, climate change, how it’s going to affect the future, etc Basic requirements to a healthy environment  Clean air (indoor and outdoor air pollution)  Safe and sufficient water (many diseases transmitted through unsafe water) o Mostly have a handle on it o However, outbreaks during acute environmental crises (ie earthquake, tsunami, floods, etc)  Adequate and safe food (distribution, foodborne diseases, deficiency diseases, obesogenic environments) o Feeding the world is mainly a distribution problem as most health matters have been eradicated in regards to food o Increased risk of diseases out of overconsumption (obesity)  Safe and peaceful settlements (housing conditions, social disorder, crime, alienation) o Zero housing, problems with insufficient housing o Housing as social factor: who we are, how we fit in with society…  Stable global environment (long-range transport of pollutants, stratospheric ozone depletion, carbon emissions and climate change) o Policy surrounding these Demographic Transition  Framework developed in the early 20 century by demographers to describe population growth o Empirically, what’s happened over time  Two key factors: mortality and fertility  Rate of natural increase = birth rate – death rate  Stage 1: high fertility and mortality: fluctuations due to calamity  Stage 2 and 3: high natural increase o Survival into ages where people can naturally reproduce o Improvements to environment  Stage 4: low fertility and mortality – fluctuations due to human decision making o We can control family size o Good handle on major diseases of the day, people tend to live longer Epidemiological Transition  Consistent patterns with the changing infectious disease rates as infectious diseases go down, the population ages, and one sees an emergence of non-communicable diseases o Chronic diseases, diseases of old age etc  3 stages: pestilence and famine, receding pandemics, degenerative diseases  the determinants of this transition: ecobiological (interaction between biology and environment), socioeconomic, psychological and medical (biotechnology, and public health)  Explains general trends globally, but not necessarily in all cou
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