Environmental Sustainability and

Emerging Diseases
Bambang Wispriyono, PhD.
 Human and Environment Interaction

The scale and nature of human activities

(agricultural, industrial and energy production, the use and management of water and
wastes; urbanization; the distribution of income and assets within and between
countries; the quality of health services; and the extent of protection of the living,
working, and natural environment

Health
Physical and chemical environment Biological environment
(air, water, food and soil chemical (type and distribution of
Composition including radiation; pathogens and vectors, as
Climate Including temperature, well as their habitats)
Humidity, Precipitation, and seasonal
changes)

Yassi, Annalee et al.; Basic Environmental Health; Oxford Univ. Press, NY, 2001
 Pollution and Community Risk

Chemical
Water
Suplay, Microbiology
Pesticide
hygiene &
sanitation Ketahanan
pangan
Arbo-virus
Pb dan proto-
zoa
Air Polution

Occupational Watter

Physic Agriculture
Kec-
elaka- Vector
an Lalu
lintas Kondisi alam- resiko
tinggi;
mis. Rawa

Accident

General
Risk Factor: Environment
Media
Type of Environmental
Hazard
Specific Agent
Sumber: WHO; 2002.
 Environment Related- Issues
• Global Health
• Climate Changes and Global Warming
• Urbanization and Population
• Natural resource depletion
• Loss of biodiversity
• Deforestation
• Ocean acidification
• Ozon layer depletion
• Air Pollution
• Water Supply
• Waste disposal management
• Injuries and Safety
• Unintentional poisonings
• Technology Innovation in Environmental Health
• Environmental and Disasters Management
• Nutrition and Food Security
• Economic Growth Development
• Health Care and Services System
Sustainable Development Goals and targets: deconstructing environmental
sustainability for health and well-being
 Sustainable Development Goal’s (SDG)

Goal 1 End poverty in all its forms everywhere

Goal 2 End hunger, achieve food security and improved nutrition, and promote
sustainable agriculture
Goal 3 Ensure healthy lives and promote well-being for all at all ages
Goal 4 Ensure inclusive and equitable quality education and promote life-long
learning opportunities for all
Goal 5 Achieve gender equality and empower all women and girls
Goal 6 Ensure availability and sustainable management of water and sanitation
for all
Goal 7 Ensure access to affordable, reliable, sustainable, and modern energy for
all
Goal 8 Promote sustained, inclusive and sustainable economic growth, full and
productive employment and decent work for all
Goal 9 Build resilient infrastructure, promote inclusive and sustainable
industrialization and foster innovation
 Sustainable Development Goal’s (SDG)

Goal 10 Reduce inequality within and among countries

Goal 11 Make cities and human settlements inclusive, safe, resilient
and sustainable
Goal 12 Ensure sustainable consumption and production patterns
Goal 13 Take urgent action to combat climate change and its impacts
Goal 14 Conserve and sustainably use the oceans, seas and marine resources
for sustainable development
Goal 15 Protect, restore and promote sustainable use of terrestrial
ecosystems, sustainably manage forests, combat desertification, and halt and
reverse land degradation and halt biodiversity loss
Goal 16 Promote peaceful and inclusive societies for sustainable
development, provide access to justice for all and build effective, accountable
and inclusive institutions at all levels
Goal 17 Strengthen the means of implementation and revitalize the global
partnership for sustainable development
 Urban Population:

In 1990 fewer than 4 in 10 people lived in

urban areas. In 2010, more than half live
in cities, and by 2050 this proportion will
grow to 7 out of every 10 people. The number
of urban residents is growing by nearly 60
million every year.

Demonstrate prominent health

disparieties and inequities in low- and high-
income countries
 Impact of Urban-Poor Situation:
• Density of Population
• Increase in inhabitable areas
• Supporting population needs
• Waste / externalities from
human activities
• Securing access to water
 Water Supply Challenge in Indonesia:
• Quality and Quantity of water intake
•Total Population (238.5 million in year 2010 to 305.6 million
estimated in year 2035) and Population growth (1.3%)
• Only 47.71% have access to clean water
• Piping’s Water supply coverage (8% to 20% coverage)
• Differences of urban and rural’s water supply demand (120
ltr/d/kapita in rural and 60 ltr/d/kapita)
• Good governance in Water Supply Management
 Climate Change
• Rise in atmospheric temperature
• Impact on
– Habitable places, arable land
– Food production (land, sea)
– Disease patterns
• Extreme weather
• Access to water issues
 Globalization:
• An extremely complex phenomenon
• Interactive co-evolution of multiple
technological, cultural, economic, institutional,
social and environmental trends at all
conceivable spatiotemporal scales.
• Important features of the globalization process:
– Global governance structures
– Global markets
– Global communication and diffusion of information
– Global mobility, cross-cultural interaction
– Global environmental changes

(Huynen et al., 2005)

 Aspects of Globalization that
may effect Health

• General effect on health from changes in national

economic growth – link between ‘health and
wealth’
• Environmental degradation (e.g. air, water pollution)
• Improved access to knowledge and technology
• Marketing of harmful products &
unhealthy behaviours
• Conflict & security
• Cross-border transmission of disease
Ppt presentation: Richard Smith; Reader in Health Economics
School of Medicine, Health Policy & Practice
 Wastes and Sources
• Municipal Solid wastes: Solid wastes that include household garbage, rubbish,
construction & demolition debris, sanitation residues, packaging materials, trade
refuges etc. are managed by any municipality.
• Bio-medical wastes: Solid or liquid wastes including containers, intermediate or
end products generated during diagnosis, treatment & research activities of
medical sciences.
• Industrial wastes: Liquid and solid wastes that are generated by manufacturing &
processing units of various industries like chemical, petroleum, coal, metal gas,
sanitary & paper etc.
• Agricultural wastes: Wastes generated from farming activities. These substances
are mostly biodegradable.
• Fishery wastes: Wastes generated due to fishery activities. These are extensively
found in coastal & estuarine areas.
• Radioactive wastes: Waste containing radioactive materials. Usually these are
byproducts of nuclear processes. Sometimes industries that are not directly
involved in nuclear activities, may also produce some radioactive wastes, e.g.
radio-isotopes, chemical sludge etc.
• E-wastes: Electronic wastes generated from any modern establishments. They
may be described as discarded electrical or electronic devices. Some electronic
scrap components, such as CRTs, may contain contaminants such as Pb, Cd, Be or
brominated flame retardants.
 Wastes and Effects on Human Health

• Hazardous wastes
Substances unsafe to use commercially,
industrially, agriculturally, or economically and
have any of the following properties- ignitability,
corrosivity, explosiveness, activity & toxicity.

• Non-hazardous
• Substances safe to use commercially, industrially,
agriculturally, or economically and do not have
any of those properties mentioned above. These
substances usually create disposal problems.
 HAZARDOUS WASTE

INFECTIOUS
Biological waste material
Human tissue from surgery, used bandages and
hypodermic needles, microbial materials
Waste from hospitals and biological research centers

RADIOACTIVE
Ionizing radiation harms living organisms
Persist in the environment for thousands of years before
decay appreciably
Separated from other wastes
 Municipal solid waste

• Municipal solid waste is also referred to as trash or

garbage
• Paper, organics, and plastics are the
principal components of municipal solid
waste
• In developing countries, food scraps are the primary
contributor to solid waste
– Wealthy nations invest more in waste collection
and disposal
• In Year 2019 total garbage in Indonesia
will be 68 million tons
•14 percents (9.52 tons) of total garbage
is plastics
• Indonesia only has about 500 central
dumpsites (TPA) with total daily
capacity about 23,204 tons, Indonesia
can only process about 13 percent of all
MSW
• In 2008 it was estimated that the
country has around 1.2 million waste
pickers
Garbage Production in Indonesian’s Big Cities
 Sustainable Development Goal’s (SDG)

Goal 6 Ensure availability and

sustainable management of
water and sanitation for all
In addition to sanitation, targets be consolidated and
framed around three general themes:
(I) water, sanitation and health;
(II) reducing pollutant and untreated waste
water discharge into rivers and water bodies;
and
(III) reducing water scarcity by protecting water
sources, increasing the efficiency of water use, and
better governance.
 Contamination of water

--any contamination of water with chemicals

or other foreign substances
•Fertilizers
•pesticides from agricultural runoff
•sewage and food processing waste
•lead, mercury, and other heavy metals
•chemical wastes from industrial discharges
• chemical contamination from hazardous
waste sites.
 Liquid Wastes

Housing

Farming
Agriculture Contaminants
Mining Contaminants
 Kegiatan di Gardu Tol
Kegiatan di Gardu Tol
Pemasangan alat Personal Dust Sampler

Kegiatan di Kantor Kelurahan Jgkarsa

Filter sampel debu sebelum & sesudah pengukuran

Pengukuran Suhu & Kecepatan Aliran Udara
Chemicals in Home Industries and
Agriculture
 Water Supply Challenge in Indonesia:

• Quality and Quantity of water intake

•Total Population (238.5 million in year 2010 to 305.6
million estimated in year 2035) and Population growth
(1.3%)
• Only 47.71% have access to clean water
• Piping’s Water supply coverage (8% to 20% household
coverage)
• Differences of urban and rural’s water supply demand
(120 ltr/d/kapita in rural and 60 ltr/d/kapita)
• Good governance in Water Supply Management
 Global Health
“An area for study, research, and practice that places
a priority on improving health and achieving equity
in health for all people worldwide…emphasizes
transnational health issues, determinants and
solutions: involves many disciplines within and
beyond the health sciences and promotes
interdisciplinary collaboration; and is a synthesis of
population-based prevention with individual-level
care.”

(Kaplan et al. Towards a common definition of global health, The Lancet, vol. 373, June 6, 2009)
 Risk Factors for Diseases:

– Heredity
– Aging
– Environmental Conditions
– Organism Resistance
 Relationships among
Demographic, Epidemiologic, and
Health Transition
Health Transition

Demographic Transition Epidemiologic Transition

Urbanization Fertility declines Population Chronic &

Urbanization
Industrialization ages NCD
Industrialization Infectious Disease Mort. declines emerges
Rising Incomes
Rising Incomes
Expansion of
Education
Expansion of
Education
Improved Persistence or reemergence of communica
Economic
medical
Improved& PH recession
technology
medical & PH &
technology increasing
inequity

Protracted –polarized
epidemiologic
transition
Source: WH Mosley, JB Bobadilla and DT Jamison, 1993
 Emerging Infectious Diseases

Emerging Infectious

Source : Emerging & Re-Emerging Infectious Disease Challenges. Nature 430: 242-49 (Morenz. DM et al,
2004)
Levels of causation and corresponding types of intervention

SOCIAL STRUCTURE • Social class

(social position) • Age HEALTHY PUBLIC POLICY

• Ethnicity

• Geographic
ENVIRONMENTAL
location ORGANISATION AND COMMUNITY INTERVENTION
INFLUENCES
• Housing
(places) Conditions
• Occupational risks
LIFESTYLE • Access to services
• Smoking PRIMARY AND SECONDARY PREVENTION
INFLUENCES
(individual behaviours) • Nutrition
• Physical activity
• Psychosocial factors
PHYSIOLOGICAL
PRIMARY AND SECONDARY PREVENTION
INFLUENCES • Blood pressure
(the body) • Cholesterol
• Obesity
• Blood glucose
Health care
services
Noncommunicable Tertiary Prevention
(the system)
Diseases

Death
 CONCLUSION
• Pollutants from environment are determinant risk factors
for both Non Communicable and Communicable emerging
diseases

• Controlling program and investigating determinants are

needed for both rising prevalence of non-Communicable
Diseases like blood hypertension, Cerebrovascular
Disease/Stroke, Ischaemic Heart Disease, Diabetes Mellitus,
Liver Cirrhosis, Chronic Kidney Disease and Communicable
Diseases like Tuberculosis, Diarrheal Diseases, Pneumonia,
Typhoid Fever, Malaria, Dengue

• Action Plan for Management of Environment and Emerging

Diseases
CONCLUSION