Epidemiological

Environment
 Definition
Epidemiology
oIt is the study of frequency, distribution, and determinants of
diseases and other health-related conditions in a human
population

oThe application of this study to the prevention of diseases

and promotion of health
Components of the definition
1. Study:
o Systematic collection, analysis, and interpretation of data
o Epidemiology involves collection, analysis and
interpretation of health related data
o Epidemiology is a science
Components of the definition
2. Frequency:

o Epidemiology studies the number of times a disease occurs

o It answers the question How many?
oEpidemiology is a quantitative science
Components of the definition
3. Distribution

o Distribution of an event by person, place and time

o Epidemiology studies the distribution of disease
oIt answers the question who, where and when?
o Epidemiology describes health events
Components of the definition
4. Determinants
o Factors the presence/absence of which affect the occurrence
and level of an event
o Epidemiology studies what determines health events
o It answers the question of how and why
o Epidemiology analyzes health events
Components of the definition
5. Diseases and other health related events
o Epidemiology is not only the study of diseases
o The focus of Epidemiology are not only patients
o It studies all health related conditions
o Epidemiology is a broader science
Components of the definition
6. Human Population
o Epidemiology diagnoses and treats
communities/populations
o Clinical medicine diagnoses and treats patients
o Epidemiology is a basic science of public health
Components of the definition
7. Population
oEpidemiological studies have direct and practical
applications for the prevention of disease and promotion of
health
o Epidemiology is a science and practice
o Epidemiology is an applied science
ENVIRONMENTAL EPIDEMIOLOGY

o The study of the determinants of the distribution of

disease that are exogenous to and nonessential for the
normal functioning of human beings
Determinants of
Medical Ecology
 Biological Determinants
oThe physical and mental traits of every human being are
determined by the nature of his genes at the moment of
conception.
oThe genetic make up is unique in the sense it cannot be
altered after conception.
oA number of diseases are now known to be genetic origin
(e.g. Chromosomal anomalies, errors of metabolism,
mental retardation)
 Biological Determinants
o Medical genetics offers hope for
prevention and treatment of wide
spectrum of diseases, thus, the prospect
of better medicine and longer and
healthier life.

o A positive health advocated by WHO

implies that a person should be able to
express as completely as possible the
potentialities of his genetic heritage.
 Behavioral and Socio-Cultural Determinants
o Lifestyle denotes “the way that people
live” reflecting the whole range of social
values, attitudes, and activities.

o It is composed of cultural and

behavioral patterns and life long
personal habits.
o Alcoholism, Smoking that have
developed through the process of
socialization.
 Behavioral and Socio-Cultural Determinants

o Lifestyles are learned through social interaction with parents and

per groups, friends, siblings and through school and mass media.

o Many current health problems such as coronary heart disease,

obesity, lung cancer, drug addiction are associated with lifestyle.
 Socio Economic Determinants
o The health of a person is primarily dependent upon the level of
social economic development.
 Per Capita income – is the most widely accepted measure of general economic
performance.
 GNP
 Education – is the second influencing factor in affecting the health of the
 population.
 Nutrition
 Employment - Unemployment usually shows a higher incidence of ill health and death.
 Housing and Political system of the country – health is closely related to the political
system of a country. Often the main obstacle to the implementation of health technologies
are not technical rather, political.
Socio Economic Determinants
 Factors, Categories
Factors, Categories
and Classes
and Classes of
of
Personal and
Personal and
Community Diseases
Community Diseases
Factors of Personal and Community Diseases

TOBACCO
TOBACCO
 Is the single greatest
preventable cause of death in
the world today.

 Kills 5.4 million people a year. If left unchecked that number will
increase to more than 8 million a year by 2030.

 Contains the highly addictive psychoactive ingredient,

nicotine.
 TOBACCO
 In industrialized countries, where smoking has
been common for decades, it is estimated to
cause over 90% of lung cancer in men and
about 70% of lung cancer among women, and
about 22% of all cardiovascular disease.

 Water pipes are not a safe alternative to cigarette

smoking. Water pipe smokers and second-hand
smokers are at risk for the same diseases as
cigarette smokers such as cancer, heart disease,
respiratory diseases and adverse effects during
pregnancy.
 TOBACCO
 Since people use waterpipes longer than
smokers tend to smoke cigarettes,
someone using a waterpipe may inhale as
much smoke as the equivalent of smoking
100 cigarettes.
 Smokeless tobacco products are not a safe
substitute for tobacco smoking. Harmful
health effects include cancer of the head and
neck, esophagus and pancreas, as well as
many oral diseases There is also evidence
that some forms of smokeless tobacco may
also increase the risk of heart disease and
low-birth-weight babies.
Factors of Personal and Community Diseases

UNHEALTHY
DIETS &
PHYSICAL
INACTIVITY
UNHEALTHY DIETS & PHYSICAL INACTIVITY
 Unhealthy diets (especially those which have a high content in fats,
free sugars and salt) and physical inactivity are among some of the
leading causes of noncommunicable diseases (NCDs) including
cardiovascular diseases (CVD), type 2 diabetes and certain cancers.

 2.7 million deaths are attributable to diets low in fruits and

vegetables. Worldwide, low intake of fruits and vegetables is
estimated to cause about 19% of gastrointestinal cancer, about 31%
of coronary heart disease, and 11% of stroke.
UNHEALTHY DIETS & PHYSICAL INACTIVITY
 1.9 million deaths are attributable to physical inactivity. At least
60% of the global population does not achieve the minimum
recommendation of 30 minutes of moderate intensity physical
activity daily.

 Physical inactivity and unhealthy diets are major contributors to

overweight (Body Mass Index: 25–29.9) and obesity (BMI greater
than 30). Extra body weight increases the risk of serious health
consequences such as: Cardiovascular disease (mainly heart
disease and stroke) Diabetes Breast, colon and endometrial
cancers.
 UNHEALTHY DIETS & PHYSICAL INACTIVITY

 At least 2.6 million people

each year die as a result of
being overweight or obese.

 Overweight and obesity are

now on the rise in low and
middle-income countries,
particularly in urban settings.
Factors of Personal and Community Diseases

HARMFUL USE
OF ALCOHOL
 HARMFUL USE OF ALCOHOL
 Harmful use of alcohol is one of the main factors contributing to
premature deaths and disability and has a major impact on public
health.
 The harmful use of alcohol encompasses several aspects of drinking
such as the volume of alcohol drunk over time; the pattern of
drinking that includes occasional or regular drinking to intoxication;
the drinking context if it increases the public health risks; and the
quality or contamination of alcoholic beverages. Alcohol can
damage nearly every organ and system in the body. Its use
contributes to more than 60 diseases and conditions.
HARMFUL USE OF ALCOHOL

 It is the fifth leading

contributor to the global
disease burden.
Categories and Classes of Personal and
Community Diseases

TOPOGRAPHIC
TOPOGRAPHIC
 Diseases are subdivided into such categories as gastrointestinal
disease, vascular disease, abdominal disease, and chest disease.

 Various specializations within medicine follow such topographic

or systemic divisions, so that there are physicians who are
essentially vascular surgeons, for example, or clinicians who are
specialized in gastrointestinal disease. Similarly, some physicians
have become specialized in chest disease and concentrate
principally on diseases of the heart and lungs.
Categories and Classes of Personal and
Community Diseases

ANATOMIC
ANATOMIC

 Disease is categorized by the specific organ or tissue affected;

hence, heart disease, liver disease, and lung disease. Medical
specialties such as cardiology are restricted to diseases of a single
organ, in this case the heart. Such a classification has its greatest
use in identifying the various kinds of disease that affect a
particular organ. The heart is a good example to consider.
Categories and Classes of Personal and
Community Diseases

PHYSIOLOGICAL
 PHYSIOLOGICAL

 Disease is based on the underlying functional derangement

produced by a specific disorder.
 Included in this classification are such designations as respiratory
and metabolic disease. Respiratory diseases are those that interfere
with the intake and expulsion of air and the exchange of oxygen
for carbon dioxide in the lungs.
 Metabolic diseases are those in which disturbances of the body’s
chemical processes are a basic feature. Diabetes and gout are
examples.
Categories and Classes of Personal and
Community Diseases

PATHOLOGICAL
 PATHOLOGICAL

 Disease considers the nature of the disease process. Neoplastic and

inflammatory disease are examples.

 Neoplastic disease includes the whole range of tumors, particularly

cancers, and their effect on human beings.
Categories and Classes of Personal and
Community Diseases

ETIOLOGIC
 ETIOLOGIC

 Disease is based on the cause, when known. This classification is

particularly important and useful in the consideration of biotic
disease.
 On this basis disease might be classified as staphylococcal or
rickettsia or fungal, to cite only a few instances. It is important to
know, for example, what kinds of disease staphylococci produce
in human beings.
ENVIRONMENTAL
HEALTH
AND
TOXICOLOGY
 ENVIRONMENTAL HEALTH
 Focuses on external factors that
cause diseases, including elements
of the natural, social, cultural and
technological worlds in which we
live.
 Rachel Carson’s Silent Sprint in
1962 focuses on the discharge,
movement, fate, and effects of
synthetic chemical toxins.
HEALTH
 A state of complete physical, mental, and social well-being, not
merely the absence of disease or infirmity.

DISEASE

 Is an abnormal change in the body’s condition that impairs

important psychological or functions.
 Diet and nutrition, infections agents, toxic substances, genetics,
trauma, and stress all play roles in morbidity (illness) and mortality
(death)
 THE GLOBAL DISEASE BURDEN
 Is changing due to public health successes
 Smallpox was completely wiped out on 1977
 Polio has been eliminated everywhere in the world except for a few
remote villages in northern Nigeria.
 Epidemics of typhoid fever are now rarely encountered.
 AIDS has become highly treatable disease.
 According to WHO, chronic diseases now account for nearly 60% of
the 56.5 million total deaths worldwide each year and about half of
the global diseases burden.
 What changes could
you make in your
lifestyle to lessen
your risks from the
diseases in tis table?

 What would have the

greatest impact on
your future well-
being?
TOXICOLOGY

 the study of toxic substances (poisons) and their effects, particularly

on living organisms

 is a broad field, drawing from Biochemistry, Histology,

Pharmacology, Pathology, and many other disciplines
TOXICOLOGY
Toxic Agents
 damage or kill living organisms because they react with
cellular components to disrupt metabolic functions

 many are harmful even in extremely diluted concentrations

 in some cases, billionths, or even trillionths, of a gram can

cause irreversible damage.
TOXICOLOGY
Toxins
 toxic substances produced naturally
 toxic chemicals made in tissues of living organisms
 e.g., plants produce chemicals to ward off being eaten
Toxicants
 toxic substances made by human activities
 people receive toxicants from many sources; we carry
traces of hundreds of industrial chemicals in our bodies
TOXICOLOGY
All toxic substances are hazardous, but not all hazardous
materials are toxic.

• Some substances, for example, are dangerous because they’re

flammable, explosive, acidic, caustic, irritants, or sensitizers.
 
• Many of these materials must be handled carefully in large
doses or high concentrations, but can be rendered relatively
innocuous by dilution, neutralization, or other physical
treatments. They don’t react with cellular components in ways
that make them poisonous at low concentrations.
TOXICOLOGY
Environmental toxicology, or Ecotoxicology
 focuses on the effects of toxic substances on living organisms, and on
the way these substances interact and are transformed as they move
through populations and ecosystems.
 In aquatic systems, special attention is devoted to the ways pollutants
act at the interface of sediment and water, or of water and organisms, or
at the water/air interface.
 In terrestrial environments, the emphasis tends to be on the effects of
metals on the soil fauna community and population characteristics.
Table 8.2
presents a list of
the top 20 toxic
and hazardous
substances
considered the
highest risk by
the U.S.
Environmental
Protection
Agency
Infectious and emergent diseases still kill millions of people.
 A wide variety of pathogens afflict humans, including viruses,
bacteria, protozoans, parasitic worms, and flukes.

 Diarrhea, acute respiratory illnesses, malaria, ,measles, tetanus, kill

about 11 million children under age 5 every year in the developing
country.

 Better nutrition, clean water, improved sanitation, and inexpensive

inoculations could eliminate most deaths,
Emergent diseases are those not previously known or that
have been absent for at least 20 years. Rapid international
travel makes it possible for these new diseases to spread
around the world at jet speed. Epidemiologists warn that
the next deadly epidemic is only a plane ride away.
 Many emergent diseases
originated from anon-
human animal species,
e.g.:

 HIV originated in
chimpanzees
 SARS came from the
Masked Palm Civet, which
is native to China
Factors Contributing To Disease Emergence:
 Microbial adaptation: e.g. genetic drift and genetics shift in
Influenza A.

 Climate and weather: e.g. disease with zoonotic vectors such as

West Nile Disease (transmitted by mosquitos) are moving further
from tropics as the climate warms.

 Change in human demographics and trade: e.g. rapid travel

enabled SARS to rapidly propagate around the globe
Factors Contributing To Disease Emergence:
 Economic development: e.g. use of antibiotics to increase meat
yield of farmed cows leads to antibiotic resistance.
 Breakdown of public health: e.g. the current situation in
Zimbabwe
 Poverty and social inequality: e.g. tuberculosis is primary a
problem in low-income araes
 War and famine
 Bioterrorism: e.g. 2001 Anthrax attacks
 Dam and irrigation system construction: e.g. malaria and other
mosquito borne diseases.
 ECOLOGICAL DISEASES
 Ebola hemorrhagic fever kills up to 90% of its human victims.

 Chronic wasting disease (CWD) is caused by a prion.

 Tropical diseases, such as malaria, cholera, yellow fever, and dengue

fever, have been moving into areas from which they were formerly
absent as mosquitos, rodents, and other vectors expand into new
habitat.
 Conservation medicine is an emerging discipline that
attempts to understand how are environment changes
threaten our own health as well as that of the natural
communities on which we depend for ecological services.
Resistance to drugs, antibiotics, pesticides is increasing
How microbes acquire antibiotic resistance?
a) Random mutations make a few cells
resistant. When challenged by
antibiotics, only those cells survive to
give rise to a resistant colony.
b) Sexual reproduction (conjugation) or
plasmid transfer move genes from one
strain or species to another.
Resistance to drugs, antibiotics, pesticides is increasing
Reasons for antibiotic resistance to develop:
a) Antibiotic do not work against certain diseases, e.g. viral infections.
b) Antibiotics are given when the person could recover fully without
them.
c) Starting and not finishing a full prescription.
d) Widespread use of antibiotics in animal agriculture.
How do toxic
substances affect
us?
TOXINS
1. Allergens
2. Immune System Depressants
3. Endocrine Disruptors
4. Neurotoxins
5. Mutagens
6. Teratogens
7. Carcinogens
1. ALLERGENS
 substances that activate the immune system
 some act directly as antigens; that is, they are
recognized as foreign by white blood cells and
stimulate the production of specific antibodies
(proteins that recognize and bind to foreign cells
or chemicals)
 others act indirectly by binding to and changing
the chemistry of foreign materials so they
become antigenic and cause an immune
response.
1. ALLERGENS
Formaldehyde
 some people suffer from what is called sick
building syndrome: headaches, allergies, chronic
fatigue, and other symptoms caused by poorly
vented indoor air contaminated by mold spores,
carbon monoxide, nitrogen oxides,
formaldehyde, and other toxic substances
released from carpets, insulation, plastics,
building materials, and other sources.
 Poor indoor air quality may cost billions a year
in absenteeism and reduced productivity
2. IMMUNE SYSTEM DEPRESSANTS
o are pollutants that suppress the immune system rather
than activate it
o little is known about how this occurs or which chemicals
are responsible
o immune system failure is thought to have played a role,
however, in the widespread deaths of seals in the North
Atlantic and of dolphins in the Mediterranean. These
dead animals generally contain high levels of pesticide
residues, polychlorinated biphenyls (PCBs) used as
flame retardants and electrical insulators, and other
contaminants that are suspected of damaging the immune
system and making it susceptible to a variety of
opportunistic infections.
3. ENDOCRINE DISRUPTERS
o Because these chemicals
o Some researchers suggest that
often cause sexual
dysfunction (reproductive endocrine disrupters may be
health problems in females or contributing to our obesity crisis
the feminization of males, for o Chemicals that disrupt any of
example), these chemicals are these normal hormone functions
sometimes called can severely damage an
environmental estrogens or organism’s health or
androgens. They are just as reproduction.
likely, however, to disrupt
other important regulatory
functions as they are to
obstruct sex hormones.
3. ENDOCRINE DISRUPTERS
o chemicals that disrupt sex hormones have powerful effects
hormone functions. on how we look, behave, and develop;
- Insulin is a hormone that controls our
 Hormones
uptake of sugars from food;
-are chemicals that
- adrenaline is a hormone that elevates
living organisms use to
our breathing and circulation in
regulate the moments of stress;
development and
- thyroxine helps regulate many
function of tissues and
functions, including heart rate,
organs temperature, and growth.
4. NEUROTOXINS

 a special class of metabolic poisons that specifically attack nerve

cells (neurons). The nervous system is so important in regulating
body activities that disruption of its activities is especially fast-
acting and devastating
 Most neurotoxins are both extremely toxic and fast acting.
5. MUTAGENS

o are agents that damage or alter genetic

material (DNA) in cells.
o Chemicals and radiation can both act as
mutagens.
o Damage to DNA can lead to birth defects if
it occurs during embryonic or fetal growth.
Later in life, genetic damage may trigger
neoplastic (tumor) growth.
5. MUTAGENS
o When damage occurs in reproductive cells,
the results can be passed on to future
generations.
o Cells have repair mechanisms to detect and
restore damaged genetic material, but some
changes may be hidden, and the repair
process itself can be flawed. It is generally
accepted that there is no “safe” threshold for
exposure to mutagens. Any exposure has
some possibility of causing damage.
6. TERATOGENS

o are chemicals or other factors that

cause abnormalities during embryonic
growth and development
o cause birth defects
o the most prevalent teratogen in the
world is alcohol
6. TERATOGENS

o Drinking during pregnancy can lead to fetal alcohol syndrome

—a cluster of symptoms that includes craniofacial
abnormalities, developmental delays, behavioral problems, and
mental defects that last throughout a child’s life.

o Even one alcoholic drink a day during pregnancy has been

associated with decreased birth weight.
7. CARCINOGENS

o are substances that cause cancer - invasive, out of-control cell

growth that results in malignant tumors.

o Cancer rates rose in most industrialized countries during the

twentieth century, cancer is now the second leading cause of
death in the United States, killing 600,000 people in 2018.
According to the American Cancer Society, 1 in 2 males and 1
in 3 females in the United States will have some form of cancer
in their lifetime.
7. CARCINOGENS

Some authors blame this cancer increase on:

• toxic synthetic chemicals in our environment and
diet

Others attribute it mainly to:

• lifestyle (smoking, sunbathing, alcohol) or simply
living longer.
 Some sources
of
Toxic
and hazardous
substances
in a typical
home.
( Cunningham )
 Some sources
of
Toxic
and hazardous
substances
in a typical
home.
( Cunningham )
 How does diet influence health?

• Diet also has an important effect on

health. For instance, there is a strong
correlation between cardiovascular
disease and the amount of salt and
animal fat in one’s diet. There’s
controversy about the role of high-
fructose corn syrup, refined sugar, red
meat, and other components of our
food.
 How does diet influence health?

o Fruits, vegetables, whole grains, complex carbohydrates, and

dietary fiber (plant cell walls) often have beneficial health effects.
Certain dietary components seem to have anticancer effects—
these components include pectin; vitamins A, C, and E; substances
produced in cruciferous vegetables (cabbage, broccoli,
cauliflower, Brussels sprouts); and selenium, which we get from
plants.
 How does diet influence health?
o Many of these substances act on the epigenetic system
Epigenetics - the study of how your behaviors and environment can
cause changes that affect the way your genes work

o Eating too much food is a significant dietary health factor in

developed countries and among the well-to-do everywhere.

o Seventy percent of all U.S. adults are now considered overweight,

and the worldwide total of obese or overweight people is estimated
to be over 1 billion. Every year in the United States, 300,000 deaths
are linked to obesity.
 How does diet influence health?
oDiabetes prevalence (% of population ages 20 to 79) in Philippines
was reported at 7.1 % in 2021, according to the World Bank
collection of development indicators, compiled from officially
recognized sources.

oPhilippine Statistics Authority data showed that deaths due to

diabetes mellitus ranked fourth in 2020 at 37,265, after heart
diseases (99,680), cancer (62,289), and cerebrovascular diseases
(59,736) ( May 7, 2021 )