NCM 113 Community Health Nursing 2

Environmental Health and Sanitation

Presented by: Mrs. Ivy V. Rosales, RN, MAN (CAR)

Learning Objectives ROLE OF MAN:

1. Discuss the legal mandates that provide the  To manipulate the environment to prevent
framework for the various environmental contracting the disease by blocking disease
health and sanitation programs in the agents from entering and attacking his
Philippines body. However, if the man fails to keep the
2. Describe the elements of ecologic model of environment clean and healthy, this
health as it applies to environment health and provides a good breeding place for the
sanitation disease agents or vectors to live,
3. Describe the different programs and policies propagate, and eventually attack man who
related to major environmental health and will now serve as the host of the parasite or
sanitation activities disease-causing microorganisms. In order
4. Define the specific and varied roles that CHN to prevent this from happening, we need to
nurses play in environmental health have preventive strategies.

Preventive Strategies
ENVIRONMENTAL
ENVIRONMENTALHEALTH
HEALTH
1. Change people’s behavior to manipulate the
Branch in public health that deals with the environment and reduce exposure to
study of preventing illness by managing the biological and non-biological disease agents.
environment and changing people’s behavior to 2. Manipulate the environment to prevent
reduce exposure to biological and non-biological production or presence of disease agents.
agents of disease and injury. R.A. 9275 Clean Water Act of 2004 - aims to
abate and control water pollution from land-
What are the different environmental health
based resources.
problems?
3. Increasing the persons resistance to infectious
• Air, land, water, and noise pollution diseases as demonstrated in the various
maternal and child health programs of
Most of these environmental health
Expanded Program for Immunization (EPI)
problems are a result of man’s lifestyle, behavior
and Nutrition.
and the lack of concern for future generations.

Other causes include: waste products of

modernization and globalization. Laws to Enact Environmental Protection and
Conservation
If environmental health problems are not
Declaration of Policy:
prevented, this will result to depletion of the ozone
layer and global warming, depletion and pollution ✓ Right of people to a balance and healthful
of water supply, destruction of forests. ecology
✓ Promote and protect the global
environment
✓ State recognizes the principle that
polluters must pay
✓ State recognizes that a clean and healthy
environment is for the good and concern
of all.

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NCM 113 Community Health Nursing 2
Environmental Health and Sanitation
Presented by: Mrs. Ivy V. Rosales, RN, MAN (CAR)

ENVIRONMENTAL AND OCCUPATIONAL 3. Solid waste management (refuse and garbage

HEALTH OFFICE (EOHO) disposal)
4. Insect vector and rodent control
Under the National Center for Disease 5. Food sanitation
Prevention and Control Program of DOH, 6. Air pollution
responsible for the promotion of healthy 7. Proper housing
environmental conditions and prevention of 8. Noise
environmental related diseases. Strategies include: 9. Radiological Protection
Environmental and Occupational Health Office 10. Institutional sanitation
(EOHO) Strategies 11. Stream pollution

1. Water quality and surveillance Priority Environmental Health Issues

2. Evaluation of food establishments
3. Proper solid and liquid waste management 1. Biologically dead rivers due to water pollution
4. Sanitation of public places 2. Presence of smoke belching motor vehicles
5. Sanitation management of disaster areas causing air pollution
6. Impact assessment of environmentally 3. Rapid population growth
critical projects 4. Inadequate sewerage system and sludge
7. Enforcement of sanitation laws, rules, management system for septic tanks
regulations and standards 5. Inadequate monitoring of drinking water
sources
Two Divisions of EOHO 6. Absence of a rationalized land use plan
1. Water and Sanitation Division 7. Improper and indiscriminate disposal of solid
2. Healthcare Waste and Toxic or Hazardous and wastes
Division 8. Unregulated management of toxic and
hazardous chemicals and substances
Among the projects of EOHO are Water for 9. Loss of primary agricultural lands
Life, Hospital Waste Management, Urban Health 10. Weak implementation and enforcement of
and National Projects, and the Pasig River environmental laws and regulations
Rehabilitation Project. 11. Inappropriate assessment of adverse impacts
Basically, environmental health mainly focuses on the development or industrialization to
on preventing diseases through integration of the affected stakeholder, i.e., local communities
different programs, such as the Child Survival 12. Traditional approach in environmental
Programs, Immunization or EPI, the Center for governance: regulatory versus development
Disease Development and other health programs 13. Sustainable development concerns are not
of the DOH. fully integrated in planning, programming and
policy making
ENVIRONMENTAL SANITATION 14. Lack of logistic and facilities

The study of all factors in man’s physical Key areas that require improvement:
environment which may negatively affect his
health and well-being. Factors: 1. Specific policies and legislation for
environmental health
1. Water supply sanitation 2. Institutional development and intersectoral
2. Proper excreta disposal collaboration
3. Human resource development

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NCM 113 Community Health Nursing 2
Environmental Health and Sanitation
Presented by: Mrs. Ivy V. Rosales, RN, MAN (CAR)

4. Monitoring and Surveillance × RA 6969 (Toxic Substance and Nuclear Waste

5. Integration of Health and Environment in Control Act of 1990; Its implementing rules and
International and Regional Agreements regulations regulates the importation, use,
movement, and treatment and disposal of toxic
chemicals and hazardous and nuclear waste in the
INTER-AGENCY COMMITTEE ON
Philippines.)
ENVIRONMENTAL HEALTH (IACEH)
× RA 8749 (The Clean Air Act of 1999; Its
- Formed through EO 489 of 1991 provisions include: This provides comprehensive air
- Composed of 11 members chaired by the pollution management and control program to
secretary of DOH, with secretary of DENR achieve and maintain healthy air.
(Department of Environment and Natural 1. Section 20 bans the use of incineration for
Resources) as vice chair. Committee members municipal, biomedical, and hazardous
from DPWH (Department of Public Works and waste, but allows the traditional method of
Highways), DA (Department of Agriculture), small-scale community burning.
DILG (Department of the Interior and Local 2. All motor vehicles are required to pass the
Government), DTI (Department of Trade and smoke emission test prior to registration.
Industry, DOTC (Department of Transportation 3. The leaded gasoline should be faced out by
and Communications), DOST (Department of the end of the year 2000.
Science and Technology), DOLE (Department of 4. Lowering of the sulfur content of all
Labor and Employment), NEDA (The National automotive diesel fuel
Economic and Development Authority) and PIA 5. Decreasing the aromatic and benzene
(Public Information Agency) levels in unleaded gasoline
6. Smoking in public places are banned. This
Functions of Inter-Agency Committee on includes public transport.
Environmental Health (IACEH) × RA 9003 (The Ecological Solid Waste
Management Act of 2000. It declares the adaption
1. Formulate policies and guidelines and develop of a systematic, comprehensive, and ecological
programs for environmental health protection waste management program as a policy of the
2. Coordinate, monitor and evaluate EH state using the community-based approach and
(Environmental Health) programs and mandating waste diversion through composting
development projects and recycling.)
3. Undertake information dissemination and × RA 9275 (The Clean Water Act of 2004. This
education campaigns on EH programs aims to establish waste water treatment facilities
4. Coordinate, assist, and/support the conduct of that will clean waste water before it is released into
research and relevant activities for the bodies of water. It also requires the local
environmental maintenance and protection government unit to form water management areas
that will manage waste water in their respective
Laws and Policies that Affect Environmental areas.)
Health and Sanitation
× Supplemental IRR (Implementing Rules and
× Senate Resolution 676 (The use of POP or Regulations) of Chapter II of Sanitation Code of
Persistent Organic Pollutants was banned for use in the Philippines (This states that water refilling
households and industries. POPs consist of so- stations should regularly monitor their drinking
called dirty dozens of pesticides, industrial water quality using the following schedules:
chemicals, and intentional products of burning.) o Monthly – for bacteriological quality

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NCM 113 Community Health Nursing 2
Environmental Health and Sanitation
Presented by: Mrs. Ivy V. Rosales, RN, MAN (CAR)

o Every 6 months – for physical and chemical ▪ Generally suitable for rural areas
properties where houses are clustered densely to
o Annually – for biological quality and justify a single pipe system.
radiological properties when the need ✓ Level III or Waterworks System
arises ▪ Individual House Connection Type
× PD 856 (There is a supplemental IRR on chapter ▪ Is composed of a source, a reservoir, a
17 on sewage collection and excreta disposal and pipe distribution network, and
drainage of the sanitation code of the Philippines, household taps.
regulates and provides proper guidelines for LGUs ▪ Generally suited for densely populated
and establishments involved in dislodging, urban areas and requires minimum
collection, handling, and transport, and disposal of treatment for disinfection.
domestic sludge from pools, communal septic
UNAPPROVED TYPES OF WATER SUPPLY
tanks, domestic sewage treatment plants or
facilities, and seepage from household septic × Open Dug Wells
tanks.) × Unimproved Springs
× Wells That Need Priming
WATER SUPPLY AND SANITATION These types of water supply are unapproved
PROGRAM because the water comes from doubtful sources.
APPROVED TYPES OF WATER SUPPLY DOH Secretary/duly authorized representative:
✓ Level I or Point Source Type issues the certification of potability of existing
▪ Protected well or developed spring water source
with an outlet but without a
distribution system
WATER QUALITY AND MONITORING
▪ Generally adaptable for rural areas
SURVEILLANCE
where the houses are thinly scattered
▪ Can normally serve 15 to 25 - By government or private laboratories duly
households and its outreach must not accredited by DOH and meets the provisions of
be more than 250 m from the furthest National Standards of drinking water
user. - Yearly
▪ Its yield discharge is from 40 to 140
liters per minute. WATER SUPPLY SANITATION-RELATED
✓ Level II or Communal Type DISEASES
▪ Communal Faucet System is otherwise
- Cholera (Commonly manifests first as diarrhea)
known as Standpost Type
- Typhoid fever (Accompanied by high fever,
▪ Composed of a water source, a
headaches, weakness, and constipation or
reservoir, a pipe distribution network,
abdominal discomfort)
and communal faucets.
▪ Designed to deliver 40 to 80 liters of
WATER SOURCES REQUIRING DISINFECTION
water per capital per day to an
average of 100 households with one 1. Newly constructed water supply facilities
faucet per 4 to 6 households 2. Water supply facility that has been
▪ Should be located not more than 25 m repaired/improved
from the furthest home 3. Water supply sources found to be positive
bacteriologically by laboratory analysis

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NCM 113 Community Health Nursing 2
Environmental Health and Sanitation
Presented by: Mrs. Ivy V. Rosales, RN, MAN (CAR)

4. Container disinfection of drinking water ▪ Non water carriage toilet facility (ex. Pit
collected from water facilities subject to latrines or Reed Odorless Earth closet)
recontamination (examples of this are: open
dug wells, unimproved springs, surface water)

HOUSEHOLD WATER TREATMENT

1. Boiling (Heating water to boiling point can

destroy pathogenic microorganisms.)
2. Chemical Coagulation (This is the use of
aluminum sulfate to coagulate suspended
materials in water.)

3. Filtration (What do we use as filter? We can use ▪ Small amount of water required to wash
sand, piece of cloth, or any material to remove the waste (ex. Aqua privies/water sealed
suspended materials for water.) latrines)
4. Chlorination (Adding chlorine to water to kill
pathogenic microorganism)
5. Softening (Through boiling or adding certain
chemicals to reduce calcium and magnesium
salts which are believed to cause water to be
hard. A softened water does not cause
precipitates in pipes and tanks. The chemicals
used for softening water are: Ammonia, Borax,
Calcium hydroxide or Trisodium Phosphate.)

PROPER EXCRETA DISPOSAL PROGRAM

APPROVED TYPE OF TOILET FACILITIES 2. Level II Types (This includes on-site toilet
facilities of the water carriage type with
1. Level I Type water seal and flush type with septic vault
- 2 categories: or tank disposal facilities.)

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NCM 113 Community Health Nursing 2
Environmental Health and Sanitation
Presented by: Mrs. Ivy V. Rosales, RN, MAN (CAR)

3. Level III Types (This is the water carriage  Antipolo Type – This is an elevated toilet
type of facilities connected to septic tanks house. The shallow pit is extended upwards.
or to sewerage system connected to
treatment plants.)
“Blind drainage” type of waste water collection
and disposal facility in rural areas. (This shall
continue to be the emphasis in rural areas until
sewer facilities and off-site treatment facilities
shall be made available to clustered houses in
rural areas.)
Conventional Sewerage facilities for población
and cities. (Promoted for construction in order
to attain control and prevention of fecal and
water borne disease.)
 Water Sealed Latrine – A water sealed toilet
Terminologies Used in Proper Excreta bowl is placed over a pit privy.
Disposal Program  Flushed Type Latrine – Waste is disposed by
flushing water through pipes into a septic tank
 Pail System – A pail or a box is used, and a
or a sewerage system.
ballot system is included.
 Open Pit Privy – This is a pit covered by
platform with uncovered hole. SOLID WASTE MANAGEMENT/GARBAGE
 Closed Pit Privy DISPOSAL
 Bored Hole Latrine – This is a deep but
• SOLID WASTE
relatively narrow hole made with a boring
• HAZARDOUS WASTE – Toxic wastes generated
equipment.
from large industries, hospitals.

Terminologies Used in Solid Waste

Management/Garbage Disposal

 Hog Feeding – The leftover food or wastes is

used as a hog feed.
 Open Dumping – The garbage is piled in a
dumping place with no soil covering.
 Open Burning – The garbage is piled then later
burned in the open air.
 Overhung Latrine – A toilet house is  Burial in Pit – The garbage is placed in a pit,
constructed over a body of water. uncovered when filled up, with no intention to
use as fertilizer.
 Composting – Biodegradable materials or
garbage are converted into a compost or soil
conditioner.
 Collection – The garbage is collected regularly
by a facility for proper disposal.

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NCM 113 Community Health Nursing 2
Environmental Health and Sanitation
Presented by: Mrs. Ivy V. Rosales, RN, MAN (CAR)

VECTOR CONTROL PROGRAM Laboratory tests for the food handlers:

Focuses on sustainable, preventive, and vector • Stool analysis to check for presence of
control measures against malaria parasite and intestinal parasites such as amoeba and e.
mosquito vector. choli; and bacterial infections such as
typhoid, cholera, dysentery, salmonella,
The objective of the program is to reduce the etc.
source of infection in human population by 2. DOH Administrative Order No. 1-2006
reducing or eliminating man-vector contact, and 3. Destruction or banning of food unfit for human
reducing the density of mosquito vector consumption
population. 4. Training of food handlers and operators on
food sanitation
5. Rating and Classification of food establishment
VECTOR BORNE DISEASES • Class A – Excellent
• Class B – Very Satisfactory
• Malaria – The 8th cause of illness in the
• Class C – Satisfactory
Philippines with around 40,000 cases. Found
6. Ambulant food vendors health certificates
mostly in the southern part of the country.
7. Household sanitation
• Plague
• Dengue hemorrhagic fever

FOUR “RIGHTS” TO FOOD SAFETY

VECTOR CONTROL MEASURES
1. Right Source
1. Insecticide treatment of mosquito nets 2. Right Preparation
2. House spraying insecticide 3. Right Cooking
3. On stream seeding (Involves the construction 4. Right Storage
of bioponds for larvivorous fish propagation by
the LGUs and their corresponding communities
especially in malaria endemic areas.)
4. On stream clearing (Involves removing ENVIRONMENTAL QUALITY
vegetation overhang in order to expose the AIR POLLUTION
stream to sunlight rendering it unsuitable for
vector propagation.) RESPIRATORY DISEASES RELATED TO
OUTDOOR AIR POLLUTION

➢ COPD
FOOD SANITATION PROGRAM
➢ Bronchitis
POLICIES ➢ Chronic Cough
➢ Chronic Phlegm
1. Appraisal of food establishment as to follow ➢ Wheezing
sanitary conditions: ➢ Shortness of breath
a. Inspection/approval of all food sources,
containers, and transport vehicle
b. Compliance of sanitary permit LEGAL ISSUES IN AIR POLLUTION
requirements for all food establishment
c. Provision of health certificate for food ➢ Industries control of air and water
handlers, cooks, helpers pollution and disposal of solid and
hazardous waste
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NCM 113 Community Health Nursing 2
Environmental Health and Sanitation
Presented by: Mrs. Ivy V. Rosales, RN, MAN (CAR)

➢ Buses and jeepney use of second-hand *Road safety is still an important concern in
engines the Philippines.
➢ Smoke belchers

SURFACE AND GROUND WATER POLLUTION

➢ Solid waste disposal

➢ Biologically dead rivers
➢ Use of fertilizers and pesticides

CAPACITY FOR MONITORING ENVIRONMENTAL

QUALITY

CAPACITY FOR DATA COLLECTION AND

PROCESSING

PROPER HOUSING

HOUSING AND THE HOMELESS

- Government provision for social housing to

qualified urban households for unformal
settlers, homeless, and no income poor

DISEASES RELATED TO POOR HOUSING

➢ Pulmonary Disease
➢ Tuberculosis
➢ Bronchitis
➢ Pneumonia

OTHER ENVIRONMENTAL HEALTH

SERVICES

ELECTRICITY

FIREFIGHTING AND EMERGENCY EQUIPMENT

TRANSPORT RELATED ISSUES

▪ Traffic Crashes
▪ Traffic accidents injuries

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