Environmental
Epidemiology
Understanding the impact of environment
on health
By
Akash Ajay
Jiwan Chauhan
SPH&CM
BPKIHS 2024
General Outlines
• Introduction
• Historical Background
• Key concepts in environmental epidemiology
• Methods and tools
• Major environmental exposures
• Case studies
• Challenges in environmental epidemiology
• Today’s scenario
• Opportunities
• Recent advances and future direction
• Conclusion
• References
Introduction
• Human environment consists of very basic elements: the air we
breathe, the water we drink, the food we eat, the climate surrounding
our bodies and the space available for our movements.
• In addition, we exist in a social and cultural environment, which is of
great importance for our mental and physical health.
• Most diseases are either caused or influenced by environmental
factors.
Contd…
• Therefore, we need to understand the ways in which specific
environmental factors can interfere with health to design effective
prevention programmes.
• Environmental epidemiology provides a scientific basis for studying
and interpreting the relationships between the environment and
population health.
• Before the second half of 20th century, environmental epidemiology
focused on disease-causing infectious agents or pathogens and
factors such as water and food quality as well as waste control.
Contd…
• Increasing life expectancy and movement from infectious to chronic
diseases has changed the environmental epidemiology focused from
disease-causing infectious agent to chemical and physical agents that
have large impacts on chronic illnesses.
• Environmental epidemiology studies the distribution and
determinants of health and diseases, morbidity, injuries, disability,
and mortality in populations as they relate to environmental factors.
Environmental Change and Health
• Changes in the environment may cause adverse health effects to
human.
• Human have caused environmental problems by interfering with the
hydrological cycle, nitrogen cycle, phosphorus cycle, sulfur cycle
and carbon cycle.
• Climate change may affect human health through temperature-
related illness or death.
• Stratospheric ozone depletion may cause ULV radiation.
Types of Environmental exposures
1. Point Source
is a specific source of pollution that can be identified.
2. Non Point Source
Broad, diffuse areas (cannot be traced to a single site of discharge)
Difficult to identify and control.
Historical Background
It has a long history that dates back 2000 years or more years.
In about 400 BC the ancient greek authority Hippocrates explained
the role of environmental factors such as water quality and air
causing diseases.
He produced the well known book on Air, water and Places.
Historical corner stone of Environmental epidemiology.
Sir Percival Pott (Surgeon, London) thought to be the first individual
to describe an environmental cause of cancer.
Contd…
In his book ( Chirurgical observations relative to the cataract, the
polypus of the nose, the cancer of the scortum, the different kinds of
ruptures and the Mortification of the toes and feet, 1755) he wrote a
chapter called A short Treatise of the chimney sweeper’s cancer.
Provided the clear description of an environmental cause of cancer.
Established an occupational hygiene control measures.
John Snow, English Anesthesiologist linked a cholera outbreak in
London to contaminated water from the Thames River.
1854 Cholera Outbreak Cluster
Key concepts in environmental
epidemiology
Exposure Assessment: Methods to measure the intensity, frequency,
and duration of exposures to environmental agents.
• Tools include personal monitors, biomonitoring (measuring chemicals
in body fluids/tissues), and environmental sampling.
Environmental Agents:
• Chemical: Pesticides, heavy metals (lead, mercury), solvents.
• Physical: Radiation, noise, heat.
• Biological: Bacteria, viruses, Mold.
Cont..,
• Dose-Response Relationships: Concept that the magnitude of
exposure to a risk factor correlates with the severity of the health
outcome.
• Helps in establishing causal relationships and setting regulatory limits.
Contributions of Epidemiology to
Environmental Health
Epidemiology is important to the study of environmental health
problems because
Many exposure and health effects associated with the environment
occur at the population level (Concern with Population).
The epidemiologic methods of natural experiments and observational
techniques are appropriate (use of observational data).
Cont..,
The study design used in epidemiologic research can be applied
directly to the study of environmental health issues and
(methodology for study design).
Epidemiology aids in the development of hypothesis and the study
of causal relationships (descriptive and analytic studies).
Methods and Tools
Study Designs:
• Cohort Studies: Follow a group of people over time to see how
exposures affect outcomes.
• Case-Control Studies: Compare individuals with a disease (cases) to
those without (controls) to identify exposure differences.
• Cross-Sectional Studies: Analyze data from a population at one
specific point in time.
Cont..,
Data Collection:
• Surveys: Questionnaires to collect self-reported data on exposures and
health outcomes.
• Biomonitoring: Measuring chemicals or their metabolites in
biological specimens like blood or urine.
• GIS (Geographic Information Systems): Mapping and analyzing
spatial data to study environmental exposures and health outcomes.
Cont..,
Statistical Analysis:
• Regression Analysis: Identifying relationships between variables.
• Multivariate Analysis: Analysing multiple variables simultaneously
to control for confounding factors.
• Spatial Analysis: Examining geographical patterns of disease
incidence and exposure.
Major Environmental Exposures
Major Environmental Exposures
1. Air Pollution:
• Sources: Transportation, industrial activities, burning of fossil fuels.
• Pollutants: Particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2),
sulfur dioxide (SO2), ozone (O3).
• Health Effects: Respiratory diseases, cardiovascular diseases, lung cancer.
How Pollution Affects Health
Cont..,
Water Contamination:
• Sources: Industrial discharge, agricultural runoff, improper waste
disposal.
• Contaminants: Lead, arsenic, nitrates, microbial pathogens (E. coli,
cholera).
• Health Effects: Gastrointestinal diseases, neurological disorders,
developmental issues in children.
Cont..,
Soil and Food Contaminants:
• Sources: Pesticides, industrial spills, contaminated water used for
irrigation.
• Contaminants: Pesticides, heavy metals, persistent organic pollutants
(POPs).
• Health Effects: Acute poisoning, long-term health effects including
cancer.
Cont..,
Occupational Exposures:
• Sources: Industrial processes, construction, agriculture.
• Hazards: Chemical solvents, asbestos, noise, ergonomic risks.
• Health Effects: Occupational diseases (silicosis, asbestosis), hearing
loss, musculoskeletal disorders
How Hazardous Wastes Affects Health
How Climate Change Affects Health
Environmental Epidemiology:
Time, Place, Person
• In order to identify and depict patterns of health-related events in
the population, counts or rates of the health events should be
organized according to time, place and person.
• Geographic Information System (GIS) is descriptive methods that are
useful for describing disease pattern by person and place.
• GIS is a technique that combine spatial information with layers of
attribute information.
• The global positioning system (GPS) is a global navigation system of
at least 24 satellites that orbit the earth twice a day.
• Accurately determine longitude, latitude, altitude, velocity and time.
Case Studies
1. The London Smog of 1952:
• Event: Severe air pollution episode in London due to burning of
low quality coal burning.
• Aggravating factor: Windless conditions, cold weather.
• Impact: Estimated 12,000 deaths, thousands of respiratory
illnesses.
• Outcome: Led to the Environmental awareness, Clean Air Act of
1956 in the UK.
2. Pesticide Exposure in Agricultural Workers:
• Issue: Chronic exposure to pesticides in farm workers.
• Aggravating factor: High increase in demand, rapid growth of insects.
• Health Effects: Increased risk of cancers, neurological disorders,
reproductive health issues.
• Outcome: Implementation of strict regulations and protective
measures.
Challenges in Environmental
Epidemiology
Confounding Factors:
● Variables that can distort the true relationship between exposure and
health outcomes.
● Example: Socioeconomic status, lifestyle factors.
Exposure Measurement Errors:
● Inaccuracies in assessing the level and duration of exposure.
● Solutions: Use of advanced monitoring technologies, biomarkers.
Cont..,
Ethical Considerations:
● Ensuring proper informed consent to protect participant
confidentiality.
● Balancing public health benefits with individual rights.
Significant long-term environmental health problems are often related to
ecosystem disruptions.
Other include: Chances of multiple exposures
Today’s Scenarios
Modern epidemiology is struggling with a debate on the focus of
epidemiological studies. Some suggest a shift towards molecular
epidemiology, while others argue for a renewed focus on population-
level studies and public health integration.
There is necessity of a balanced approach, like integration of other
disciplines of epidemiology and tackling of the multifaceted challenges
in environmental epidemiology.
Opportunities
Advancing research methods to better study complex exposures and
their health impacts.
Interdisciplinary collaborations to enhance understanding and
address ecosystem-level health issues.
Prioritizing significant public health problems and avoiding the
neglect of broader environmental impacts.
Recent advances and Future directions
Exposure Assessment Technologies:
● Development of wearable sensors for real-time exposure monitoring.
● Remote sensing technologies for large-scale environmental data
collection.
Big Data and Machine Learning:
● Use of large datasets to identify exposure patterns and health outcomes.
● Machine learning algorithms to predict health risks and identify at-risk
populations.
Conclusion
Environmental epidemiology is crucial for understanding and
mitigating health risks from environmental exposures.
Helps in developing evidence-based policies and interventions to
protect public health.
Continued research, public awareness, and policy efforts are essential
to address environmental health challenges.
References
http://ehpnet1.niehs.nih.gov/docs/2001/109p1-5pekkanen/abstract.h
tml
Environmental Epidemiology: Principles and Methods | American Journal of
Epidemiology | Oxford Academic (oup.com)
