Environmental Health & Housing-2023 4th yr ANMC.pptx

Environment & Health
(ANMC-2020)
Prof. Dr Rizwan Saeed
(MBBS, MBA, MPH, DOMS, MME)
Professor of Community Medicine
Associate Dir. Medical Education
&
Director Students Affairs
Azra Naheed Medical College
Superior University, Lahore
< dr.rizwansaeed@gmail.com >

Environment
• The World Health Organization (WHO)
defines environment, as it relates to health,
as “all the physical, chemical, and biological
factors external to a person, and all the
related behaviors.”

Environment & Health
1. Air
2. Water
3. Noise
4. Radiation
5. Soil
6. Housing & Health

Air pollutants
1. Biological contaminants
1. Particulates
2. Pollens, fungal spore, aerosols
3. Moulds in moist areas 10-1:>% of pop. Allergic
4. Dust mites
5. Bacteria survives as spores and aerosols
6. Pollen (seasonal and out door)

2. Chemical contaminants
– Ground level Ozone
• Contributes to GREEN HOUSE EFFECT main component of
smog
• Worsens asthma, irritates URT
• Skin cancers, cataract, depressed immune function
• ACID RAIN (SO2, Nitrogen oxide)
3. Physical contaminants
• Radiation  CFCs
• GLOBAL WARMING
• Dust & Bacteria
Air pollutants

Ventilation
• Process of replacing used and stagnant air with fresh and
moving air
• Standards:
– There should be 1000-1200 cubic feet air space / person
– 2-3 times air change/hr in living room
– And 4-6 hrs in work place is important
– Windows should be 1/5 or 20% of total floor area
– Doors plus windows should be 40% of total floor area
• Types
– External
• Open spaces
• Wide roads
• Straight roads and streets
– Internal [natural (wind, diffusion)or artificial (exhaust, plenum)]

2. Global warming: direct effect is
• increased temperatures world
wide
• increase in sea levels and
• melting of ice from colder
regions and icebergs
• displacement and loss of habitat
EFFECTS OF AIR POLLUTION

3. Acid Rain: Harmful gases like nitrogen oxides
and sulfur oxides are released into the
atmosphere during the burning of fossil fuels.
When it rains, the water droplets combines
with these air pollutants, becomes acidic and
then falls on the ground in the form of acid
rain.
Acid rain can cause great damage to human,
animals and crops.

4. Eutrophication: a condition
where high amount of nitrogen
present in some pollutants gets
developed on sea’s surface and
turns itself into algae and
adversely affect fish, plants and
animal species. The green
colored algae that is present on
lakes and ponds is due to
presence of this chemical only.

5. Effect on Wildlife: Just like
humans, animals also face some
devastating affects of air
pollution. Toxic chemicals
present in the air can force
wildlife species to move to new
place and change their habitat.
The toxic pollutants deposit over
the surface of the water and can
also affect sea animals.

SMOG
• Smog is a type of intense air pollution. The
word "smog" was coined in the early 20th
century, and is a contraction of the
words smoke and fog
• SMOKE + FOG = SMOG
• smoky fog due to its opacity, and odor

• Smog is a serious problem in many cities and continues
to harm human health. sulphur dioxide, nitrogen
dioxide and carbon monoxide are especially harmful
for senior citizens, children, and people with heart and
lung conditions such as emphysema, bronchitis,
and asthma.
• It can inflame breathing passages, decrease the lungs'
working capacity, cause shortness of breath, pain when
inhaling deeply, wheezing, and coughing. It can cause
eye and nose irritation and it dries out the protective
membranes of the nose and throat and interferes with
the body's ability to fight infection, increasing
susceptibility to illness.
• Hospital admissions and respiratory deaths often
increase during periods when ozone levels are high.

CONTAMINANTS
AIR : Biological = (pollen, fungal, spores, particulates, moulds)
CHEMICAL: Ground level = Ozone  Green house effect
CO  fossil fuels related
SO2  acid rain
PHYSICAL: Radiation = energy transfer  Radon produced by soil
TRACE GASES: Argon, Krypton, Xe, He
DUST & BACTERIA: ill ventilated room, Industry,
Agriculture

Air Purification
A. Natural methods
1. Sunlight neutralize bacteria
2. Rain settle down suspended particles
3. Plants purify by photosynthesis
4. Winds purify by dilution
B. Artificial methods
1. Containment  arresting polluted air at source
2. Replacement  electricity in place of coal
3. Dilution  green belt establishment
4. Disinfection  UV radiation
5. Chemical mist  triethylene vapours are effective bacteriacides
6. Dust control  oil application to floor reduces accumulation of
bacteria

1. Use public mode of transportation
2. Conserve energy
3. Understand the concept of Reduce, Reuse and
Recycle
4. Emphasis on clean energy resources (solar,
wind geothermal etc.)
5. Use energy efficient devices
6. Encourage forestation
7. Treat industrial smoke
Solutions for Air Pollution

Purification on Large scale
• When sources of water are
Rivers,Streams,Lakes etc. then water is
Purified by
Storage
Sedimentation
Filtration(rapid sand & slow sand)
Disinfection(chlorination)

Purification on Medium Scale
• When sources of water are wells, Springs,
Tanks etc. Then water is purified by the
addition of
• Bleaching powder/Chlorinated Lime as it is
Cheap
Easy to use
Reliable and safe

Purification on Small Scale(Domestic
Methods)
• BOILING: for 5-10 minutes kills almost all
organisms & removes temporary Hardness.
• DISTILLATION: not commonly used due to
higher cost, used in Labs. etc.
• ADDITION OF CHEMICALS
 Bleaching Powder: 5% solution is used Dose:
3-6 drops/L contact time of ½ hour.

Contnd.-----------
 Chlorine Tablets/Halazone Tablets. one
tablet/litre.
 Iodine Solution: 02 drops of 2% Soln./litre
 KMnO4: an amount that gives just pink
coloration to the Water.
 Alum: used for turbid water in a dose of 0.1-
0.4 grains/5 litres of Water.

Purification of water in
Emergency/Epidemic
• Boiling: for 5-10 minutes.
• High Test Hypo chlorite: used in granular form
Dose: 01gm./10 litres of water.
• Liquid Bleach/5% Sodium Hypo chlorite
solution: Dose: 14 ml./1000 litres of water.
• Bleaching Powder: used in a dose of
2.3gm./1000 litres of water.

Purification of water on Large Scale
• On large scale purification, water is disinfected
by addition of Chlorine after filtration.
• On large scale, water is purified through the
following processes.

Contnd.---------
A. STORAGE:
 Not a sole measure of purification but
valuable as a preliminary to other processes.
 There is fall in ammonia & rise in nitrates
due to oxidation of organic matter by
aerobic bacteria.

Contnd.----------
Sedimentation, may be hastened by the
addition of Alum in a dose of 35 mg./ litre for
a detention period of 4-6 hrs.
Sedimentation will prevent clogging of the
filters.
Limitation to storage includes algae growth
which can be controlled by addition of CuSo4
in a dose of 1-5 Kg. / 5000 cu.m.

Contnd.---------
B. FILTRATION:
 Filtration through sand is the oldest and
universally, most accepted method through
out the world.
 98-99% bacteria are removed along with
other impurities through filtration.

Types of Filters
• Slow sand/Biological filters.
• Rapid sand filters/Mechanical filters.

Slow Sand Filtration
• First used in 1804 in Scotland & subsequently
in London.
• During 19th.Century used through out the
world.
• Slow sand filter consists of concrete/brick
work rectangular basin containing carefully
selected graded sand supported on gravel and
stones.
Slow sand filter

Contnd.-----------
• ELEMENTS:
1. Supernatant (raw) water:
 Upper most layer of raw water(1-1.5M)
 It provides a constant head of water
 It provides a waiting period of 3-12 hours

Elements contnd.-----
2. Sand Bed:
 It is 1 M thick supported by a layer of fine and then
coarse gravel and finally by the stones.
3. Drainage System for filtered water:
 It consists of perforated pipes
4. Filter Control Valves:
 Valves & Devices incorporated in the outlet-pipe
system to maintain a constant rate of filtration
 Venturi meter measures bed resistance or loss of
head.

Actions of slow sand filter
• Physical: Mechanical
straining/sedimentation
• Chemical: Oxidation of organic matter by
aerobic bacteria.
• Biological: Occurs through “Vital layer”
Efficiency of the filter depends upon the “Vital
layer”

Vital Layer
• Slimy growth known as “Schmutzdecke”, Vital
layer, zoogleal layer or biological layer
• The layer is slimy & gelatinous
• It consists of threadlike algae & numerous
forms of life plankton, diatoms and bacterias
• Ripening of the filter
• Vital layer is the “heart” of slow sand filter

ADVANTAGES
• Simple to construct and operate
• Cost of construction cheaper than rapid sand
filter
• Process: physical, chemical and biological
• Bacterial count reduction is 99.9% to 99.99%
and E.coli reduction is 99% to 99.9%

DISADVANTAGES
• Old fashioned and outdated method of water
purification (but still in use)
• Initial cost is low but maintenance cost is
much more than rapid sand filter
• These filters need a lot of space

RAPID SAND FILTERS
• In 1885, first rapid sand filters were installed
in USA, since that time they are gaining
considerable popularity in highly industrialized
countries as well as developing world.

Contnd.---------
• TYPES:
1. Open / Gravity type (Peterson’s Filters)
2. Closed / Pressure type (Candy’s Filters)
RAPID SAND FILTERS

Contnd.----------
• STEPS / PROCESSES IN RAPID SAND FILTERS
1. COAGULATION:
 Raw water is first treated with Alum in a dose
of 5-40 mgs./L
pH has to be adjusted by addition of lime or
soda ash as Alum needs CaCo3 to form the
flock.

Contnd.---------
2. RAPID MIXING:
 Water is mixed rapidly with Alum for a few
minutes in mixing chamber.
3. FLOCCULATION:
 From mixing chamber water is moved into the
Flocculation chamber where it rests for half an
hour.

Contd.--------
4. SEDIMENTATION:
 The coagulated water is now led into the
sedimentation tank where it is detained for 2-
6 hours.
 Flocculant precipitate together with
impurities & bacteria settle down in the tank

Contnd.--------
5. FILTRATION:
 Partially clarified water is now subjected to
the rapid sand filtration.
 Depth of the sand bed is 1 M & each rapid
sand filter unit has a surface of about 80-90
Sq.M.
 Oxidation of NH3 also takes place in these
filters.

ADVANTAGES
• Rapid sand filters deal with raw water directly
• Occupies less space
• Filtration is rapid about 40-50 times as
compared to slow sand filters
• Washing of filter is easy
• More flexibility in operation

DISADVANTAGES
• Preliminary treatment with Alum is required
• Operation is highly skilled
• Removal of color material is less than slow
sand filter
• Reduction of bacterial count is less than slow
sand filter

200 m.g.a.d 2 – 3 m.g.a.d
Comparison of Rapid and Slow sand filters

DISINFECTION OF WATER
• CHEMICAL METHODS / GERMICIDES
1. CHLORINE: is used for purification of water on large scale
2. KMnO4: used for disinfection of water in wells especially
during epidemics
3. CuSO4/CaCl2: used for the removal of algae
4. Lime: used for muddy water
5. Ozonization & U.V. irradiation: both methods are used for
disinfection of water in swimming pools
6. Katadyn Silver: sand coated with silver used in slow sand
filters instead of plain sand
7. Charcoal: used as adsorbent to remove color,odor & taste

Disinfection of Wells
• The most effective & cheapest method of
disinfecting wells is by bleaching powder
• STEPS IN WELL DISINFECTION :
1. Find the volume of water in a well:
a. Measure the depth of water column..(h) M
b. Measure the diameter of well………(d) M
c. Substitute h and d in:

Cotnd…….
3.14 x (d)2 x h
Volume(litres)=------------------------------ x 100
4
d. One cubic meter = 1,000 litres of water
Find the amount of bleaching powder
required for disinfection:
Estimate the Chlorine demand of well water
by HORROCK’S APPARATUS

3. Dissolve Bleaching Powder in water
4. Delivery of Chlorine solution into the well
5. Contact period
6. Orthotolidine arsenite test
Cotnd…….

Chlorination of water
• It is the most widely used method for water
purification, both on large as well as on small
scale.
• It is the most reliable and cheapest method.
• It is supplement but not the substitute to sand
filtration.

Properties of Chlorine
• Killing of pathogenic bacteria by inhibiting their
protein synthesis.
• Oxidizes Iron, Manganese & Hydrogen Sulphide.
• Destroys taste & odor producing constituents.
• It controls algae growth.
• It helps in coagulation and suspension of the organic
matter.

Action Of Chlorine
• When chlorine is added to water it forms HCl
& HOCl.
• The disinfecting action of chlorine is mainly
due to Hypochlrous acid & to a small extent
due to Hypochlorite Ions.
• Hypochorous acid is 70-80 times more
effective than Hypochlorite Ions.

Actions of Chlorine depends upon
the……..
 Organic matter
 Metals
 Bacterial content
 Temperature & pH of water.
 Suspended matter and,
Amount of free residual chlorine in water

Contnd………
• Efficiency of chlorine increases, when it
combines with Ammonia and……
• It decreases, when it combines with
Sulphides, Ferrous salts & inert matter in
suspension form

Principles of Chlorination
• Water to be chlorinated must be free from
turbidity
• Chlorine demand of water should be
estimated
• Contact period of one hour is essential to kill
the bacteria and viruses
• Minimum recommended concentration for
free chlorine is 0.5mg. / liter

Chlorine demand of water
Is the difference between the amount of
chlorine added to water and the amount of
residual chlorine remaining at the end of a
specific period of contact (usually 60 min.) at a
given temperature and pH of water.
ACUAL DOSE OF CHLORINE:
It is the sum of chlorine demand of water and
free residual chlorine

Methods of Chlorination
1. Chlorine gas
2. Chloramine
3. Perchloron (H.T.H.)
TYPES OF CHLORINATION:
a. Superchlorination
b. Break Point Chlorination

Tests for the presence of Chlorine in
Water
 Orthotolidine (O.T.) Test
 Orthotolidine-Arsenite (O.T.A.) Test
 Starch Iodide Test

Surveillance of drinking Water
1. Sanitary survey
2. Sampling
3. Bacteriological surveillance
4. Biological examination
5. Chemical surveillance

Sampling of Water
• Collection, Storage & Transportation of water
samples from……
 Taps
 Rivers
 Streams
 Tanks
 Wells
A. For Physical & Chemical Examination
B. For Bacteriological Examination
 PERTICULARS OF A SAMPLE

Standards of Water
• PHYSICAL STANDARDS
Turbidity
Color
Odor
Taste

Contnd………
• CHEMICAL STANDARDS
 Hardness
 Chlorides
 Ammonia
 Nitrites
 Nitrates
 Absorbed Oxygen
 Dissolved Oxygen

Contnd……..
Toxic substances and a specific group of
chemicals causing Non-Specific diseases of
water
Poly-nuclear Aromatic Hydrocarbons and
Radioactive substances ( a group of chemical
substances of water affecting the acceptability
of water.

Bacteriological Standards
1. BACTERIAL STANDARDS :
W.H.O. recommended these standards in
1984 for Public water supplies
 Ideally all samples taken from the
distribution system should be free from
Coliform organisms
 In Practice this standard is not always
attainable

Recommended Standards for Water
samples collected
• Throughout any year 95 % samples 100 ml.
each should not contain any Coliform
organisms
• No samples should contain E.coli
• No sample should contain more than 03
Coliform
• Any two consecutive samples should not
contain Coliform

Contnd………
In case of Individual / Small water supplies
such as from household Tap, Well, Spring etc.
Coliform count should not exceed 10 /100 ml.
and E.coli should be nil

Contnd………..
2. VIRAL STANDARDS :
 W.H.O. Standards fix the limit for viruses such
as Enteroviruses, Retroviruses & Adenoviruses
in water supplies at 01 Plaque forming unit
 Faecal Bacteroiphage & Enteropathogenic
viruses should be completely absent

Bacteriological Indicators
These are based on organisms indicative of
faecal pollution, These organisms include!
1. E.coli and Coliform group as a whole
2. Faecal Streptococci
3. Clostridium Perfringens
4. Examination for Protozoa, Parasitic worms &
Larvae is also recommended

Contnd……..
• Reasons why Coliform organisms are chosen as
indicators of Faecal Pollution
1. Constantly present in human intestine an average
person excretes 200-400 billions / day of these
organisms in faeces
2. They are foreign to potable water supplies
3. Easily detectable by ordinary cultural methods
4. Survival time is much better than other organisms
5. Have greater resistance to natural forces of
purification

Contnd……..
• FAECAL STREPTOCOCCI :
Faecal Strepococci occur regularly in much
smaller number than E.coli
Their presence is regarded as confirmatory
evidence of recent faecal contamination of
water in doubtful cases

Contnd………
• CLOSTRIDIUM PERFRINGENS :
They are spore bearing organisms
Their presence along with Coliform indicate
recent water contamination
While the presence of their spores but the
absence of Coliform confirms remote
contamination of water

WHO standard for safe water supply
1. Throughout the year 95% of sample should
not contain any coliform organisms in 100 ml
2. No sample should contain E.coli in 100 ml
3. No sample should contain more than 3
coliform organisms in 100 ml
4. Coliform samples should not be detectable in
100 ml of any two consecutive samples

• They are defined as rod-shaped Gram-
negative non-spore forming and
motile or non-motile bacteria which
can ferment lactose with the
production of acid and gas when
incubated at 35–37°C.
• Coliforms can be found in the aquatic
environment, in soil and on
vegetation; they are universally
present in large numbers in the feces
of warm-blooded animals
Coliform bacteria

Information must be given
1. Source of water supply
2. Date , place, time of sampling
3. Geological formation of soil if available
4. Well depth, diameter and use
5. Recent rainfall if there
6. Any suspected pollutant
7. Whether any purification method is used or
not

How to find volume of water in well

• 6 white cups (200ml each)
• 1 black cup with a circular mark on inside
• 2 metal spoons (each holds 2 g bleaching powder when
filled)
• 7 glass stirring rods
• One special pipette
• Two droppers
• Starch-iodide indicator solution
• Instruction folder
Horrocks apparatus

Horrocks App Procedure :
1. Take 1 level spoonful of (2g) bleaching powder in the black cup
and make it into a thin paste. add more water to the paste and
make up the volume up to the circular mark with vigorous
stirring. allow to settle. this is the stock solution
2.Fill the 6 white cups with water to be tested, up to about a cm
bellow the brim.
3.With the pipette add 1 drop of the stock solution to the 1st cup,2
drops to the 2nd cup and so on.
4.stir the water in each cup using a separate rod.
5. Wait for the half an hour for the action of chlorine.
6.Add 3 drops of starch-iodide indicator to starch each of the white
cups and stir again. Development of blue color indicates the
presence of free residual chlorine.
7. Note the first cup which shows distinct blue color. supposing the
3rd cup shows blue color, then 3 level spoonfuls or 6g of
bleaching powder would be required to disinfect 455 liters of
water.

NOISE
UN WANTED SOUND/ HARMFUL SOUND
SOURCES
• AUTOMOBILES
• FACTORIES
• AIR CRAFTS
• RADIO & T.V.
• HUMAN/ANIMAL VOICES

PROPERTIES
• FREQUENCY(no. of waves/sec.)
– INFRA AUDIBLE
– ULTRA SONIC
• LOUDNESS / INTENSITY ( IN DECI BELS dB )
WISHPERING 20 -- 30 dB
CONVERSATION 60 -- 65 dB
STREET TRAFFIC 60 -- 80 dB
BOILERS 120 dB

ACCEPTED LEVELS
• BED ROOMS 25 dB
• OFFICES 35 -- 45 dB
• LIBRARY 35 -- 45 dB
• WARDS 20 -- 30 dB
( WELL TOLERATED 85 dB )

EFFECTS OF NOISE EXPOSURE
A) AUDITORY EFFECTS
- AUDITORY FATIGUE
( MORE THAN 90 dB )
- DEAFNESS
- TEMPORARY
- PERMANENT

B) NON AUDITORY EFFECTS
INTERFERENCE OF SPEECH
ANNOYANCE
LACK OF EFFICIENCY
PHYSIOLOGICAL CHANGES
EFFECTS OF NOISE EXPOSURE

NOISE CONTROL
1. CONTROL AT SOURCE
2. CONTROL AT TRANSMISSION
3. PROTECTION OF EXPOSED PERSON
4. LEGISLATION
5. HEALTH EDUCATION

RADIATION (IONIZING)
SOURCES
• NATURAL
–COSMIC RAYS
–ENVIRONMENTAL
• TERRESTRIAL
• ATMOSPHERIC
–INTERNAL

• MAN MADE SOURCES
–X- RAYS
–RADIO ACTIVE FALL OUTS
–MISCELLANEOUS
–(TV, WATCHES)

TYPES OF RADIATION
ELECTROMAGNATIC RADIATION
X-RAYS, GAMMA RAYS
(SHORT WAVE LENGTH & DEEP PENETRATION)
CORPUSCULAR RADIATION
ALPHA, BETA, PROTONS
(ALPHA ARE MOST HARM FUL BUT LEAST
PENETRATION)

PENETRATION ABILITY
Radiation Air Tissue Lead
ALPHA
PARTICLES
4 CM 0.05 MM 0
BETA
PARTICLES
6—300 CM 0.06 – 4 MM .005 - .3 MM
GAMMA
RAYS
400 M 50 CM 30 MM
X – RAYS 120 – 240 M 15 – 30 CM 0.3 MM

BIOLOGICAL EFFECTS OF RADIATION
SOMATIC
• IMMEDIATE EFFECTS
– RADIATION SICKNESS
– RADIATION SYNDROME
• DELAYED EFFECTS
– LEUKEMIA
– CARCINOGENISIS
– SHORTENING OF LIFE

GENETIC EFFECTS
CHROMOSOME MUTATIONS,
INJURIES,
CHANGES IN GENES
(APPEAR IN NEXT GENERATION )

PROTECTIVE MEASURES
• AVOID UN DUE EXPOSURE
• USE OF PROTECTIVE DEVICES (LEAD SHEETS,
APRONS, SCREENS, DISTANT HANDLING)
• SURVEILLANCE OF ENVIRONMENT/EXPOSED.
• ADOPTING THE STANDARDS OF ICRP, IAEA,
WHO

USES OF RADIATION
• MEDICAL
• AGRICULTURAL
• INDUSTRIAL
• ENERGY PRODUCTION
• DEFENCE

Radon (Rn)
• chemical element, a heavy radioactive gas of
Group 18 (noble gases) of the periodic table,
generated by the radioactive decay of radium.
Radon is a colourless gas.
• When radon gas enters the body, it exposes the
lungs to small amounts of radiation. In small
quantities, experts say this is harmless. However,
in persistent exposures or larger quantities, radon
can damage the cells of the lining of the lungs,
increasing a person's chance of developing lung
cancer.

How to Protect Yourself
• If you work around radioactive materials itʻs good to have
a radiation detector. Things change from day to day. Other
workers can forget to replace shielding around sources. X-
ray machines can be be inadvertently activated. Things can
get spilled. Itʻs good to review your environment on a
regular basis.
• Counting on a Dosimeter can leave you
Vulnerable. Dosimeters generally tell you what dose you
have received after the fact.
• Use Time Distance and Shielding to Protect
Yourself. Putting distance and shielding between you and a
radiation source is an immediately effective way of
reducing your exposure. Reducing the time you are being
exposed is another way.

• Use a Respirator or Face Mask if You are exposed to
airborne sources.
• Properly Label Sources and keep them Shielded.
• Be Aware of All Sources of Radiation Exposure. We
are all exposed to radiation every day from natural
sources, outer space, the earth, radon gas in our
homes and businesses.
• Be Thoughtful and Informed about Medical X-
rays. Medical imaging can provide important and life
saving diagnostic information. It is also sometimes
used unnecessarily, so discuss with healthcare
professional first.
How to Protect Yourself

SOIL
SOIL IS THE UPPER LAYER OF EARTH’S CRUST.
IT RESPIRES AND DIGEST THOUNDS OF
ORGANIC MATTER WHICH IS BURIED IN IT.

TYPES OF SOIL
SAND
GRAVEL
CLAY
HUMUS
REH
MADE SOIL
FILL ONLY DRY PLACES AND NO FILLING DURING
RAINS.
NO CONSTRUCTION UP TO 40 YEARS

SOIL - AIR
• AMOUNT OF AIR VARIES WITH LOOSENESS
OF PARTICLES
• COMPOSITION OF SOIL- AIR DIFFERS FROM
ATMOSPHERIC AIR.

SOIL WATER
• WATER IS ESSENTIAL FOR ALL SOIL
ACTIVITIES
• PLANTS TAKE NUTRITION FROM SOIL IN
SOLUTION FORM

NITROGEN CYCLE
• (PROTIENS  SIMPLE INORGANIC
COMPOUNDS
•  PLANTS  ANIMALS / HUMAN)

NITROGEN CYCLE
ANIMAL / PLANT DIES ( PUTRIFACTIVE BACTERIA )
MOISTURE + WARMTH
AMINO COMPOUNDSCO2, NH3  NH4 Cl, /CO3
(OXIDATION BY NITRIFYING BACT)NO2  NO3
PLANTS  ANIMALS / HUMAN  DEATH .

CARBON CYCLE
CHO. OF PLANTS / ANIMALS + ( FERMENTIVE
BACT.)
CO2 , ALCOHAL ORGANIC ACID
 CO3 ( PLANT ROOTS) STARCH / SUGAR

SOIL AND DISEASE
• WORMS
• WOUND INFECTION
• GOITER
• DAMPNESS
• ARTHROPOD TRANSMITTED DISEASES.

HOUSING & HEALTH
by
Dr. Rizwan Saeed

HOUSING
A PHYSICAL STRUCTURE FOR PROTECTION AND
SHELTER
(WHO), A HEALTH FUL HOUSE PROVIDES:-
• PHYSICAL PROTECTION AND SHELTER
• SPACE FOR COOKING , WASHING AND
EXCRETORY FUNCTIONS ETC.

• HELP TO CONTROL COMMUNICABLE
DISEASE
• PROTECTION FROM NOISE AND POLLUTION
• HELPS IN PROMOTING SOCIAL RELATIONS
AND COMMUNITY DEVELOPMENT

STANDARDS FOR HEALTHFUL HOUSE
• SITE
• BUILDING
– ROOMS
– GROUND SPACE
– DOORS & WINDOWS, LIGHT
– KITCHEN
– BATH ROOM / PRIVY /REST ROOM
• REFUSE

EFFECTS OF POOR HOUSING ON HEALTH
• RESPIRATORY DISEASES
• SKIN INFECTIONS
• RAT INFESTATION
• DOMESTIC ACCIDENTS
• RICKETS & OSTEOMALACIA
• RHEUMATIC DISEASE

HOUSING
Physical Structure which provide Safety,
Security & Shelter to Members living in and
the Environment including Services and
Facilities necessary for maintaining optimum
Health by those members.
• It is the place where the members spend most
of their life-time and are reared, thus
determining the culture (social and civil life) of
the family.

Housing not only includes
• “Physical structure”  shelter
but also includes
• Immediate surroundings
• Related community services
• Related community facilities

Immediate surrounding
Housing
• SHELTER
• STRUCTURE
• SECURITY
Related community
services & facilities

Human Settlement
• “ All places in which a group of people reside
and pursue their life goals; the size of
settlement may vary from a single family to
millions of people”

“Residential Environment”
• WHO  “Residential Environment”
“PHYSICAL STRUCTURE THAT MAN USES AND THE
ENVIRONMENT OF THE STRUCTURE INCLUDING ALL
NECESSARY SERVICES, FACILITIES, EQUIPMENT AND
DEVICES NEEDED OR DESIRED FOR PHYSICAL AND MENTAL
HEALTH AND SOCIAL WELL BEING OF FAMILY AND
INDIVIDUAL”
• Immediate surrounding of building 
neighborhood or microdistrict

HOUSING
A PHYSICAL STRUCTURE FOR PROTECTION AND
SHELTER
(WHO), A HEALTH FUL HOUSE PROVIDES:-
• PHYSICAL PROTECTION AND SHELTER
• SPACE FOR COOKING , WASHING AND EXCRETORY
FUNCTIONS ETC.

STANDARDS FOR HEALTHFUL HOUSE
SITE
BUILDING
• FLOOR
• WALLS
• ROOF
• ROOMS
1 ROOM FOR 2 PERSON
2 ROOM FOR 3 PERSON
3 ROOM FOR 5 PERSON
( ADDITIONAL 1 ROOM FOR EVERY 2 PERSON )

GROUND SPACE
• 110 Sq. Ft - 2 PERSON
• 90 –100 Sq. Ft - 1.5 PERSON
(YOUNGER THAN 12 YEARS IS A HALF PERSON )
DOORS & WINDOWS
• 40 % OF THE FLOOR AREA

LIGHT
• MAXIMUM USE OF DAY LIGHT IN SOUTH
FACED HOUSES.
KITCHEN
• GOOD VENTILATION WITH EFFECTIVE EXHAUST
TO OUT SIDE
• GOOD SUPPLY OF WATER

BATH ROOM / PRIVACY
• QUALITATIVE AND QUANTITATIVE WATER
SUPPLY.
REFUSE
• PROPER COLLECTION , STORAGE AND
DISPOSAL

Urbanization, urbanisation or urban
drift is the physical growth of urban
areas as a result of global change.
Urbanization is also defined by the United
Nations as movement of people from rural
to urban areas with population growth
equating to urban migration

Increase in urban population is due to:
• ↑ births
•Rural migration
•Attractive living
•Employment opportunities
•Health
•Education
•Transport
•Entertainment
etc.

URBANIZATION
• Urbanization is a cyclical process through which a
nation normally passes as it evolves from an agrarian
to an industrial society involving three important
aspects
BEHAVIOR
STRUCTURE
DEMOGRAPHY
(process involving the absolute and relative growth of
towns and cities within a defined area )
Pakistan Rural:Uban ≈ 60:40 highest among SAARC countries

HOUSING OBJECTIVES
• Shelter  sanitary shelter most important
• Family life adequate space (living, food storage, sleeping, social
communication & other basic activities etc.)
• Access to community facilities (health, school, shopping
area etc)
• Family participation
• Economic stability  (form of investment, personal saving, family
saving etc.)
• Safety (physical, mental, social, health, environmental etc.)
• Security
• Privacy

REQUIREMENTS OF A HOUSE
A. LOCATION
B. CONSTRUCTION
C. SANITATION
D. COMFORTABLE HOUSE-LIFE

“Everyone has the right to a standard of living
adequate for the health and
well being of himself and of his family, including
food, clothing, housing
and medical care”.
Source- The universal declaration of human rights

Link between poor housing and health
• Increased length of exposure to poor housing leads to
worsened health
• Excess winter mortality 2/2 poor heating, ventilation,
increased respiratory infection
• Mold: respiratory problems, asthma, allergies, eczema
• Indoor pollutants and infestation: asthma
• Overcrowding: increased risk of infectious disease
• Affects mental well-being, depression
• Sress
• Unsafe outside, unhealthy inside

• Mold spores are everywhere!
• Mold growth in a home can affect your asthma in
three ways:
1.Allergen
2.Mycotoxins (toxic mold) –VERY RARE
3.VOCs can irritate the airways and worsen asthma
symptoms.
• Grow everywhere: wood surfaces, insulation
materials, beneath carpets, inside duct work,
bathroom tiles…...
Mold

A Mold Problem is a Moisture Problem

Smoke & Gases- minimize production
• Have the heating system inspected annually.
• Inspect and keep clear the chimney clean-out
opening
• Do not use un-vented space heaters
• Do not use stoves for heating
• Do not use wood burning fireplaces
• Use kitchen exhaust fans
• Do not let the car idle in the garage
•
Courtesy of MCHD Environmental Health

IMPLEMENTATION OF SOCIAL GOALS
Government should :
1. INTRODUCE SOCIAL HOUSING SCHEMES
2. ESTABLISH BOTH MINIMUM & MAXIMUM
STANDARDS
3. CREATE FINANCIAL AND FISCAL INSTITUTIONS
GEARED TO HELP LOW INCOM PEOPLE

HOUSING LAYOUT
• DETACHED HOUSING (ELITE CLASS)
• SEMI-DETACHED HOUSING(MIDDLE CLASS)
• ATTACHED HOUSING (LOW INCOME )
• MULTI-STORIED HOUSING (METROPOLITAN )

HOUSING STANDARDS
• VARIABLE from country to country & Depends upon:
– Socioeconomic status
– Family size
– Composition
– Cultural practices
– Climate conditions
Generally recommended standards are
SITE SELECTION (high to drain water), FOUNDATION (solid and substantial), CUBIC
SPACE (500 cb-ft/capita-1000 cb-ft/capita)
WALLS (bricks ≥9″, FLOOR (air & water tight), ROOF (flat sufficient slope to drain
rain water), ROOMS (sufficient to prevent over crowding), DOORS &
WINDOWS (cross ventilation , W=30” above floor), LIGHTING AREA,
BATHROOM (not<1 with drainage facility), KITCHEN (not near privy,
VENTILATING AREA (2% of floor area), WATER SUPPLY (individual water source,
safe and wholesome water), NO BACK TO BACK HOUSES,
REFUSE (ash, dust , waste paper etc.) GARBAGE (vegetable and animal matter)
DOMESTIC ANIMALS AWAY FROM LIVING ROOMS

Population Density = persons / mile2
• 15 sq feet / person space (office/ institutes etc)
• 50 sq. feet / person in a room
• Punjab 240 persons / sq km
• Pakistan 206 persons / sq mile(RANK 53)
• 2007 PAKISTAN
• 85 physicians / 100000 persons
• POPULATION DENSITIES
MONACO= 16754.7(2) USA= 31/KM2 (108)
SINGAPORE = 16392 (3) BANGLADESH=1045(11)
ALASKA= 1.03 JAPAN= 337 (30)
INDIA > 349 (33) TOKYO=5433
MACAU=20000 (1)

HOUSING AND HEALTH
• POOR HOUSING  defective ventilation, over-
crowding, affects physical, mental % social
health  ↑morbidity and mortality.
• OVERCROWDING =3 criteria:
• Floor area : Person ratio (110 ft.2 / 2 persons)
• Room : Person ratio (1R=2P; 2R=3P, 3R=5P, 4R=7P,
5+=10 persons)
• Sex separation (overcrowding is considered
10+yr.opposite sex unless husband and wife are obliged
to sleep in same room)
• ↑ humidity, temperature, air stagnation,
• Bad social effect with opposite sex

RESPIRATORY DISEASES d˚ droplet infection e.g
TB
INFLUENZA
STREPTOCOCCAL THROAT INFECTION
ACUTE RHEUMATIC FEVER
COMMON COLD
DIPHTERIA
WHOOPING COUGH
BRONCHITIS

CONTAGIOUS DISEASES
SCABIES
IMPETIGO skin
RINGWORM
LEPROSY
TRACHOMA eye
CONJUNCTIVITIS
WATER BORNE DISEASES
 VIRALHEPATITIS A & E
 BATERIALROTA VIRUS, DIARRHEA
 TYPHOID
 AMOEBIASIS, GIARDIASIS
 HELMINTICASCARIASIS, HYDATID DISEASE
 LEPTOSPIRAL DISEASEWEIL’S DISEASE
Rat  plague

• Accidents
• Morbidity and mortality increases with ↓ house
standards
• Psychosocial effects sense of isolation especially people
living in upper floors of multi storied building
• Arthropods
• Houseflies, houseflies, mosquitoes & bugs

• ISOLATION
• Neurosis
• Psychosis
• Behavioral disorders
• Alcoholism
• Drug addiction

HOUSING INDICATORS
A. Physical indicators
 Construction type
 Floor area
 Persons per room
 Sanitation (lightning, ventilation, drainage, water supply etc.)
B. Economic indicators
 Building
 Luxurious fittings
 Taxes
 Rental level

C Social indicators (UN Seminar -1975)
Theses are further grouped into three subgroups:
a) RELATED TO PREVENTABLE DISEASES
 FREQUENCY OF DISEASE DUE TO OVER CROWDING
 FREQUENCY OF DISEASE DUE TO CONTAMINATED WATER
 FREQUENCY OF DOMESTIC ACCIDENTS
 INSECT BORNE DISEASES
 ZOONOTIC DISEASES
 PROXIMITY TO ANIMALS
b) RELATED TO COMFORT
 THERMAL COMFORT
 ACOUSTIC COMFORT
 VISUAL COMFORT
 SPATIAL COMFORT
c) RELATED TO MENTAL HEALTH & SOCIAL WELL BEING
 FREQUENCY OF SUICIDES
 FREQUENY OFDRUG ABUSE INCLUDING ALCOHOLISM
 FREQUENCY OF PSYHOSES & NEUROSES

RURAL HOUSING
• AT LEAST 2 ROOMS.
• ANIMAL HOUSE AWAY FROM THE RESIDENTIAL
AREA
• PROPER SPACE FOR ANIMALS WITH GOOD
VENTILATION ,
• FEEDING FACILITY, PROPER DRAINAGE etc.

• RURAL HOUSING
• RELATIVELY MODEST STANDARDS DUE TO POOR SOIO-
ECONOMIC STANDARDS
• NO DIRTH OF LAND IN RURAL AREA
• SITE OPEN & SUNNY
• DRY AND WELL-DRAINED
• WATER SUPPLY SOURCE HAND,PUMP, SANITARY WELL
OR A TANK.
• SANITARY PIT LATRINE (DIRECT/INDIRET PIT)
• A CATTLE SHED WITH A PROVISION OF 3 sq m / HEAD
TO BE BUILT 8-10 m AWAY FROMHOUSE

• The lack of affordable housing is one of the most critical
issues facing rural communities
Some of the consequences of this are:
• People have to move away to find affordable housing which
means that families are separated by distance and are less
able support each other by providing childcare or to do
shopping for elderly relatives
• Local services such as schools and shops will become
increasingly difficult to maintain without enough people using
them
• Rural enterprise is stifled as employers are unable to find
workers who can afford to live locally

WHO CRITERIA FOR HEALTHFUL HOUSING
1. Healthful housing provides physical protection and shelter
2. Provides adequately for cooking eating washing and excretory
functions
3. Is designed constructed , maintained and used in manner such as
to prevent the spread of communicable diseases
4. Provides for protection from hazards of exposure to noise and
pollution
5. Is free from unsafe physical arrangements due to construction or
maintenance and from toxic to harmful materials &
6. Encourages personal and community development, promotes
social relationships, reflects a regard for ecological principles, and
by these means promotes mental health

Over crowding
 Schools
 Hospitals
 Clinics
 Parks
 Places of public utility
 Traffic congestion
 Deficiency of food, water, fuel & basic needs
 Sanitation (waste disposal)
 quality of life (diseases)
 Transportation
 Housing
 Degradation of ecological system
 Prisons

• PERSONS / ROOM:
– 1 room  2 persons
– 2 rooms  3 persons
– 5 rooms  10 persons (additional 2 for each further room)
FLOOR SPACE :
– 110 sq.ft (11 sq.m) or more  2 persons
– 90 -100 sq.ft (9-10 sq.m)  1½ persons
– 70 – 90 sq.ft (7-9 sq.m)  1 person
– 50 – 70 sq.ft (5 sq.m)  ½ person
– Under 50 sq.ft (5 sq.m)  nil
• A baby under 12 months is not counted; children between 1
to 10 counted as a half a unit.
SEX SEPERATION : overcrowding is considered if two persons
(opposite sex) over 9 years (not husband & wife are oblige to sleep in
the same room

SLUM
• A slum, as defined by the United
Nations agency UN-HABITAT, is a run-
down area of a city characterized by
substandard housing and squalor
(filth) and lacking in tenure security
(legal security).

• One billion people worldwide live in
slums and the figure will likely grow
to 2 billion by 2030.

Sustainable House
• Green building also known as green
construction  refers to a structure and using
process that is environmentally responsible
and resource-efficient throughout a building's
life-cycle: from siting to design, construction,
operation, maintenance, renovation, and
demolition.

STANDARDS FOR PLACES OF TEMPORARY STAY
• HOSTEL
• LODGING
• REFUGEE CAMP

• A refugee camp is a temporary camp built to
receive refugees. Hundreds of thousands or
even millions of people may live in any one
single camp. Usually they are built and run by
a government, the United Nations, or
international organizations, (such as the Red
Cross) or NGOs

• Refugee camps are generally set up in an
impromptu fashion and designed to meet
basic human needs for only a short time.
Some refugee camps are dirty and unhygienic.
If the return of refugees is prevented (often by
civil war), a humanitarian crisis can result.
• Some refugee camps grew into permanent
settlements, such as Ein el-Helweh, and have
existed for decades, which has major
implications for human rights

• Facilitiesin a refugee camp can include the
following:
• Sleeping accommodations (tents)
• Hygiene facilities (cleaning and toilets)
• Medical supplies
• Communication equipment (e.g. radio)
• Protection from bandits (e.g. barriers,
checkpoints, peacekeeping troops).

DURATION
• People may stay in these camps, receiving
emergency food and medical aid, until it is
safe to return to their homes. In some cases,
often after several years, other countries
decide it will never be safe to return these
people, and they are resettled in "third
countries," away from the border they crossed

• Examples of refugee camps are:
• Camps in the east of Chad, such as Breidjing Camp, hosting
approximately 250,000 refugees from the Darfur region in
Sudan [Starting 2002]
• Camps in the south of Chad, hosting approximately 50,000
refugees from Central African Republic
• Buduburam refugee camp, home to more than 12,000
Liberians [Opened 1990]
• Camps for Sri Lanka Tamils, 110,000 in India in 1998, and
more than 560,000 internally displaced [Starting 1983]

HOSTEL / LODGE HOUSE
1. Merits
2. Demerits
3. Health issues
4. Social issues

• A Common lodging-house is Victorian term for
a form of cheap accommodation in which
inhabitants are lodged together in one or
more rooms in common with the rest of the
inmates, who are not members of one family,
whether for eating or sleeping. The slang term
flophouse is roughly the equivalent of
common lodging-houses. The nearest modern
equivalent is a hostel.

Impact of
Hostel Life
Behavior
Personality
Negative
affects

Healthy living
• PUBLIC POLICY
1) Public sector
2) Social housing schemes
 5 year plan strategy

Environmental Health & Housing-2023 4th yr ANMC.pptx

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