Env-107 - Lecture note

Prof. Dr. Md. Anisur Rahman Khan (ARK)

ENVIRONMENTAL HEALTH
Health : The World Health Organization (WHO) defines health as a state of complete
physical, mental, and social wellbeing, not merely the absence of disease or infirmity.
By that definition, we all are ill to some extent. Likewise, we all can improve our health
to live happier, longer, more productive, and more satisfying lives if we think about what
we do.
Disease : A disease is an abnormal change in the body's condition that impairs important
physical or psychological functions. Diet and nutrition, infectious agents, toxic substances,
genetics, trauma, and stress all play roles in morbidity (illness) and mortality (death).
Environmental health focuses on external factors that cause disease, including elements of
the natural, social, cultural, and technological worlds in which we live.
In the past, health organizations have focused on the leading causes of death as the best
summary of world health. Mortality data, however, fail to capture the impacts of nonfatal
outcomes of disease and injury, such as dementia or blindness, on human well-being.
When people are ill, work isn't done, crops aren't planted or har vested, meals aren't
cooked, and children can't study and learn. Health agencies now calculate disabilityadjusted life years (DALYs) as a measure of disease burden. DALYs combine premature
deaths and loss of a healthy life resulting from illness or dis ability. This is an attempt to
evaluate the total cost of disease, not simply how many people die.
A full understanding of health requires that humanity be seen as part of an ecosystem.
The human ecosystem includes in addition to the - natural environment, all the dimensions of
the man-made environment - physical, chemical, biological, psychological: in short, our
culture and all its products. Disease is embedded in the ecosystem of man. Health, according
to ecological concepts, is visualized as a state of dynamic equilibrium between man and his
environment.
By constantly altering his environment or ecosystem by such activities as urbanization,
industrialization, deforestation, land degradation, construction of irrigation canals and
dams, man has created for himself new health problems. For example, the greatest threat
to human health in India today is the ever-increasing, unplanned urbanization, growth of
slums and deterioration of environment. As a result, diseases at one time thought to be
primarily "rural" (e.g., filariasis, leprosy) have acquired serious urban dimensions. The
agents of a number of diseases, for example, malaria and kala-azar, which were effectively
controlled have shown a recurrence. The reasons for this must be sought in changes in the
human ecology. Man's intrusion into ecological cycles of disease has resulted in zoonotic
diseases such as rabies, yellow fever, monkeypox, lassa fever, etc.

The Bhopal gas tragedy in 1984 highlights the danger of locating industries in urban area.
The nuclear disaster in Soviet Russia in April 1986 is another grim reminder of
environmental pollution. The construction of dams, irrigation systems and artificial lakes has
created ecological niches favouring the breeding of mosquitos, snails and spread of
filariasis, schistosomiasis and Japanese encephalitis. In fact, ecological factors are at the root
of the geographic distribution of disease. Therefore it. has been said that good public health
is basically good ecology.
Some have equated ecology with epidemiology. The main distinction between epidemiology
and ecology is that while epidemiology is the study of the relationship between variations in
man's environment and his state of health (or disease), ecology embraces the
interrelationship of all living things. In this regard, epidemiology constitutes a special
application of human ecology or that part of ecology relating to the state of human health.
It is now being increasingly recognized that environmental factors and ecological
considerations must be built into the total planning process to prevent degradat!on of
ecosystems. Prevention of disease through ecological or environmental manipulations or
interventions is much safer, cheaper and a more effective rational approach than all the other
means of control. It is through environmental manipulations that diseases such as cholera,
typhoid, malaria and hookworm disease could be brought under control or eliminated. The
greatest improvement in human health thus may be expected from an understanding and
modification of the factors that favour disease occurrence in the human ecosystem.
It was Hippocrates who first related disease to environment e.g., air, water, climate etc.
Centuries later, Pettenkofer in Germany revived the concept of disease environment
association.
Environment is classified as "internal" and "external". The internal environment of man
pertains to each and every component, part, every tissue, organ and organ system and
their harmonius functioning within the system. The external or macroenvironment
consists of all those components to which man is exposed after conception. It is defined as "all
that which is external to the individual human host", living or nonliving, and with which he is
in constant interaction. For descriptive purposes, the environment of man has been divided
into three components
(1) Physical environment,
(2) Biological environment, and
(3) Psycho-social environment
All of these can affect the health of man and his susceptibility to a disease.
Biological environment includes all living things viz: viruses and other microbial
agents, insects, rodents, animals and plants. These are constantly struggling for their
survival, and in this process some of them act as disease producing agents, reservoirs of infection, intermediate
hosts and vectors of disease. For the most part, the partners manage to affect a harmonius inter-relationship, to
achieve a peaceful co-existence. However, if for any reason this harmonius relationship is disturbed, ill health
results. Biological agents of disease include viruses, rickettsiae, fungi, bacteria, protozoa and metazoa. A wide

variety of pathogens (disease-causing organisms) afflict humans, including viruses, bacteria,

protozoans (singlecelled animals), parasitic worms, and flukes. Probably the greatest loss of
life from an individual disease in a single year was the great influenza epidemic of 1918.
These agents exhibit following biological properties.
i.

Infectivity: This is the ability of an infectious agent to produce an infection in the

host.

ii.

Pathogenicity: This is the ability to induce clinically apparent illness.

iii.

Virulence: This is defined as the proportion of clinical cases resulting in severe

clinical manifestations.

Infectious Diseases, Environment and Ecology

An everchanging scenario of infectious disease persists in rich and poor countries,
particularly the latter. Emerging and re-emerging diseases are an index of large scale
environmental change. The rise of HIV/AIDS throughout the world, especially in third world,
cholera in Peru and Equador related to blue-green algal blooms, the emergence of V-cholerae
0139 in South Asia, the re-emergence of malaria, kala-azar and plague in India, the
accentuation of tuberculosis in many developing countries and the recent spread of viral
hemorrhagic fevers in the wake of deforestation and extension of agricultural irrigation,
the recent increase in antibiotic resistance of a variety of microbial pathogens, are the
indicators of environmental borne diseases.
Infection: The entry and development or multiplication of an infectious agent in the body of
man or animals is known as infection. A clinically manifested disease of man or animals
resulting from an infection is known as infectious disease. However, an illness due to a specific
infectious agent or its toxic products capable of being directly or indirectly transmitted
from man to man, animal to animal or from environment to man or animal is called as
communicable disease. A communicable disease is transmitted from the source of infection to
the host. Basically there are three links in the chain of transmission viz. the reservoir,
modes of transmission and the susceptible host. A reservoir is defined as any person, animal,
arthropod, plant, soil or substance (or a combination of these) in which an infectious agent
lives, multiplies and on which it depends for survival and where it reproduces itself in such a
manner that it can be transmitted to a suitable host In short, reservoir is the natural habitat of
the organisms.
The reservoir may be of three types
i.
Human reservoir
ii.
Animal reservoir and
iii.
Reservoir in non-living things
Infectious diseases, spread from the interactions between individuals and food, water, air, or
soil, constitute some of the oldest health problems that humans face. Today, infectious
diseases have the potential to pose rapid local to global threats by spreading in hours
through airplane travelers. Terrorist activity may also spread diseases Inhalation anthrax,
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caused by a bacterium. Diseases that can be controlled by manipulating the environment, such
as by improving sanitation or treating water, are classified as environmental health concerns.
Although there is great concern about the toxins and car cinogens produced in industrial
society today, the greatest mortality in developing countries is caused by
environmentally transmitted infectious disease.
In the world millions of cases of water-borne illness and food poisoning occur each
year. These diseases can be spread by people; mosquitoes or fleas; or contact with
contaminated food, water, or soil. They can also be transmitted through ventilation
systems in buildings.
Mode of Transmission
Communicable diseases may be transmitted from the reservoir or source of infection to a
susceptible individual in many different ways depending upon the infectious agent, port of
entry and the local ecological conditions. As a rule infectious disease is transmitted by
only one route. The mode of transmission of infectious diseases may be classified as follows.
(1) Direct transmission
(a) Direct contact
(b) Droplet infection
(c) Contact with soil
(d) Inoculation into skin or mucosa
(e) Transplacental
(2) Indirect transmission

(a) Vehicle born

(b) Vector borne
(i) Mechanical
(ii) Biological
(c) Air borne
(d) Fomite borne
(e) Unclean hands and fingers
Emergent and Infectious Diseases: Although the ills of modern life have become the leading
killers almost everywhere in the world, communicable diseases still are responsible for about
one-third of all disease-related mortality. Diarrhea, acute respiratory illnesses, malaria,
measles, tetanus, and a few other infectious diseases kill about 11 million children under age
five every year in the developing world. Better nutrition, clean water, improved sanitation,
and inexpensive inoculations could eliminate most of those deaths
Emergent diseases are those not previously known or that have been absent for at least 20
years. The story of SARS is a good example of an emergent disease. Although
coronaviruses have long been known to cause a variety of diseases some lethal-in animals,
and two members of this virus family cause about 30 percent of all human colds, the
particularly virulent form that appears to have jumped from wild ani mals to humans in
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southern China had been previously unknown to science. Similarly, in 2004 an avian flu
spread from domestic poultry to humans and then spread rapidly through Southeast Asia.
Although only about 24 people died, millions of ducks and chick ens were slaughtered to
stop the spread of the disease. Altogether, one-third of all global meat exports were banned
in 2004 due to bird flu and other emergent diseases.
The largest recent human death toll from an emergent disease is due to HIV/AIDS. Although
it was first recognized in the early 1980s, acquired immune deficiency syndrome has now
become the fifth greatest cause of contagious deaths. The WHO estimates that more than 60
million people are now infected with the human immune-deficiency virus and that 3 million
die every year from AIDS complications.
Although two-thirds of all current HIV infections are now in sub-Saharan Africa, the disease
is spreading rapidly in South and East Asia. Over the next 20 years, there could be an additional
65 million AIDS deaths.

Major Types of Hazards

The various kinds of hazards we face can be categorized as follows:
Cultural hazards such as unsafe working conditions, smoking, poor diet, drugs, drinking, driving,
criminal assault, unsafe sex, and poverty.

 Chemical hazards from harmful chemicals in the air, water, soil, and food. The bodies of most
human beings contain small amounts of about 500 synthetic organic chemicals-whose health effects
are mostly unknown-that did not exist in 1920.
Physical hazards such as ionizing radiation, fire, earthquake, volcanic eruption, flood, tornadoes,
and hurricanes.
Biological hazards from pathogens (bacteria, viruses, and parasites), pollen and other allergens,
and animals such as bees and poisonous snakes.
According to a 1998 study by Cornell University scientist David Pimentel, environmental factors
such as malnutrition, smoking, cooking fires, skin cancer, exposures to pesticides and other
hazardous chemicals, and air and water pollution contribute to about 40% of the world's annual deaths.
CHEMICAL HAZARDS
Toxic and Hazardous Chemicals: Toxic chemicals generally are defined as substances that
are fatal to more than 50% of test animals (LD50) at given concentrations. Hazardous chemicals
cause harm by (1) being flammable or explosive, (2) irritating or damaging the skin or lungs
(strong acidic or alkaline substances such as oven cleaners), (3) interfering with or preventing
oxygen uptake and distribution (asphyxiants such as carbon monoxide and hydrogen sulfide),
or (4) inducing allergic reactions of the immune system (allergens).
Mutagen: Mutagens are agents, such as chemicals and ionizing radiation, that cause random
mutations, or changes, in the DNA molecules found in cells. Mutations in a sperm or egg cell can
be passed on to future generations and cause diseases such as (1) bipolar disorder, (2) cystic
fibrosis, (3) hemophilia, (4) sickle-cell anemia, (5) Down syndrome, and (6) some types of cancer.
Mutations in other cells are not inherited but may cause harmful effects.
Most mutations are harmless, probably because all organisms have biochemical repair
mechanisms that can correct mistakes or changes in the DIVA code. fnaddition, some mutations
play a vital role in microevolution.
Teratogens: Teratogens are chemicals, radiation, or viruses that cause birth defects while the
human embryo is growing and developing during pregnancy, especially during the first 3
months. Chemicals known to cause birth defects in laboratory animals include (1) PCBs, (2)
thalidomide, (3) steroid hormones, and (4) heavy metals such as arsenic, cadmium, lead, and
mercury.
Carcinogens: Carcinogens are chemicals, radiation, or viruses that cause or promote the
growth of a malignant (cancerous) tumor, in which certain cells multiply uncontrollably.
Many cancerous tumors spread by metastasis when malignant cells break off from tumors
and travel in body fluids to other parts of the body. There, they start new tumors, making

treatment much more difficult. According to the WHO, environmental and lifestyle factors
play a key role in causing or promoting up to 80% of all cancers. Major sources of carcinogens
are (1) cigarette smoke (30-40% of cancers), (2) diet (20-30%), (3) occupational exposure
(5-15%), and (4) environmental pollutants (1-10%). Inherited genetic factors and certain
viruses cause about 10-20% of all cancers.
Typically, 10-40 years may elapse between the initial exposure to a carcinogen and the
appearance of detectable symptoms. Partly because of this time lag, many healthy teenagers
and young adults have trouble believing that their smoking, drinking, eating, and other lifestyle
habits today could lead to some form of cancer before they reach age 50.
BIOLOGICAL HAZARDS: DISEASE IN DEVELOPED AND DEVELOPING
COUNTRIES
Nontransmissible Diseases: A nontransmissible disease is not caused by living organisms
and does not spread from one person to another. Examples are (1) cardiovascular (heart and blood
vessel) disorders, (2) most cancers, (3) diabetes, (4) asthma, (5) emphysema, and (6)
malnutrition. Such diseases typically have multiple (and often unknown) causes and tend
to develop slowly and progressively. The world's population is growing and getting older.
Thus, the incidence of and deaths from many nontransmissible diseases (especially
cardiovascular disorders and cancers) are expected to increase.
Transmissible Diseases: A transmissible disease is caused by a living organism (such as a
bacterium, virus, protozoa, or parasite) and can be spread from one person to another. These
infectious agents, called pathogens, are spread by air, water, food, body fluids, some insects, and
other nonhuman carriers called vectors.

Factors that Affect the Spread of Transmissible Diseases: Outbreaks of infectious

diseases often occur because of a change in the physical, social, or biological environment
of disease reservoirs, carrier vectors, or exposure to new host populations. Important factors
include the following:
Increased international air travel.
Migration to urban areas, which increases the probability of infection from diseases such
as TB (Case Study, above), cholera, and STDs.

 Migration to uninhabited rural areas and deforestation in tropical developing countries, which
can expose people to new diseases and disease vectors such as malaria, sleeping sickness, and
yellow fever.
Migration to suburbs in developed countries. For example, as more people have moved to
wooded suburbs in the eastern United States, they have come into greater contact with ticks
infested with bacteria that cause Lyme disease, which causes fever, lethargy, and (sometimes)
long-lasting arthritis.
Hunger and malnutrition, which increase the number of children killed by infectious diseases
such as measles and diarrhea.
Increased rice cultivation in flooded fields and paddies, which creates ideal breeding
grounds for mosquitoes and other insects that transmit diseases to humans.
Global warming, which is leading to the spread of tropical infectious diseases such as
malaria, yellow fever, and dengue fever (called "breakbone fever" by those who experience
the excruciating pain it causes in joints) to temperate areas.
High winds or hurricanes, which can transfer infectious organisms and carriers of disease
(such as insects) from tropical to temperate areas.
Accidental introduction of insect vectors. The Asian tiger mosquito is a vector for dengue
fever, yellow fever, and other viruses. In 1985, it was brought accidentally to the United States
inside used tires shipped from Asia. Since then, this mosquito species has spread from Texas to
at least 21 other states.
Deliberate introduction of pathogens as an act of bioterrorism. This occurred in 2001 when
strains of potentially fatal anthrax bacteria were introduced into the United States, mostly
through deliberately contaminated letters and packages.
Flooding, which (1) often contaminates water supplies with raw sewage and (2) creates
areas of standing water and moist soil that are ideal breeding grounds for mosquitoes and other
insects that spread infectious diseases.

Toxicology
Toxicology is the study of toxins (poisons) and their effects, particularly on living systems.
Because many substances are known to be poisonous to life (whether plant, animal, or
microbial), toxicology is a broad field, drawing from biochemistry, histology, pharmacology,
pathology, and many other disciplines. Toxins damage or kill living organisms because they react
with cellular components to disrupt metabolic functions. Because of this reactivity, toxins often
are harmful even in extremely dilute concentrations. In some cases, billionths, or even trillionths,
of a gram can cause irreversible damage.
All toxins are hazardous, but not all hazardous materials are toxic. Some substances, for
example, are dangerous because theyre flammable, explosive, acidic, caustic, irritants, or
sensitizers. Many of these materials must be handled carefully in large doses or high
concentrations, but they can be rendered relatively doses or high concentrations, but they can be
rendered relatively innocuous by dilution, neutralization, or other physical treatment. They dont
react with cellular components in ways that make them poisonous at low concentrations.

Environmental toxicology, or ecotoxicology, specifically deals with the interactions,

transformation, fate, and effects of natural and synthetic chemicals in the biosphere, including
individual organisms, populations, and whole ecosystems. In aquatic systems the fate of the
pollutants in primarily studied in relation to mechanisms and processes at interfaces of the
ecosystem components. Special attention is devoted to the sediment/water, water/organisms, and
water/air interfaces. In terrestrial environments, the emphasis tends to be on effects of metals on
soil fauna community and population characteristics.
Table 8.3 is a list of the top 20 toxins compiled by the U.S. Enviromental
Protection Agency from the 275 substances regulated by the Comprehensive
Environmental Response, Compensation, and Liability Act (CERCLA), commonly
known as the Superfund Act. These materials are listed in order of assessed
importance in terms of human and environmental health.
Allergens are substances that activate the immune system. Some allergens 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). Other allergens act indirectly by binding to and
changing the chemistry of foreign materials so they become antiseepic and cause an
immune response.
Formaldehyde is a good example of a widely used chemical that is a powerful
sensitizer of the immune system. It is directly allergenic and can trigger reactions to other
substances. Widely used in plastics_ wood products, insulation, glue, and fabrics,
formaldehyde concentrations in indoor air can be thousands of times higher than in
nornrtl outdoor air. Some people suffer from what is called sick building syndrome:
headaches allergies, and chronic fatigue caused by poorly vented indoor air contaminated
by molds, carbon monoxide. nitrogen oxides, formaldehyde, and other toxic chemi cals released by carpets, insulation, plastics, building materials, and other sources.
TABLE 8.3 : Top 20 Toxic and Hazardous Substances
1. Arsenic
2. Lead
3. Mercury
4. Vinyl chloride
5. Polychlorinated biphenyls (PCBs)
6. Benzene
7. Cadmium
8. Benzo(a)pyrene
9. Polycyclic aromatic hydrocarbons
10. Benzo(b)fluoranthene
11. Chloroform
12. DDT
13. Aroclor 1254
14. Aroclor 1260

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15. Trichloroethylene
16. Dibenz(a,h)anthracene
17. Dicldrin
18. Chromium, hcxavalcnt
19. Chlordane
20. Hexachlorobutadiene
Neurotoxins are 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. Different types of neurotoxins act in
different ways. Heavy metals, such as lead and mercury, kill nerve cells and cause permanent
neurological damage. Anesthetics (ether, chloroform, halothane, etc.) and chlorinated
hydrocarbons (DDT, Dieldrin, Aldrin) disrupt nerve cell membranes necessary for nerve
action. Organophosphates (Malathion, Parathion) and carbamates (carbaryl, zeneb, maneb)
inhibit acetylcholinesterase, an enzyme that regulates signal transmission between nerve cells
and the tissues or organs they innerc7 (for example, muscle). Most neurotoxins are both acute
and extremely toxic. More than 850 compounds are now recognized as neurotoxins.
Mutagens are agents, such as chemicals and radiation, that damage or alter genetic material
(DNA) in cells. This can lead to birth defects if the damage occurs during embryonic or fetal
growth. Later in life, -enetic damage may trigger neoplastic (tumor) growth. When damage
occurs in reproductive cells, the results can be passed on to future generations. 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.
Teratogens are chemicals or other factors that specifically cause abnormalities during
embryonic growth and development. Some compounds that are not otherwise harmful can
cause tragic problems in these sensitive stages of life. Perhaps the most prevalent teratogen
in the world is alcohol. Drinking during pregnancy can lead to fetal alcohol syndrome a
cluster of symptoms including craniofacial abnormalities, developmental delays,
behavioral problems, and mental defects, that last throughout a child's life. Even one alcoholic
drink a day during pregnancy has been associated with decreased birth weight.
Carcinogens are substances that cause cancer-invasive, out-of-control cell growth that
results in malignant tumors. Cancer rates rose in most industrialized countries during the
twentieth century, and cancer is now the second leading cause of death in the United States,
killing more than half a million people in 2000. Twenty-three of the 28 compounds listed by the
U.S. EPA as greatest risk to human health are probable or possible human carcino gens. More
than 200 million people live in areas where the combined upper limit lifetime cancer risk
from these carcinogens exceeds 10 in I million, or 10 times the risk normally considered
acceptable.

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Concept of Dose and Response

Five Centuries ago, the physician and alchemist Paracelsus wrote that everything is
poisonous, yet nothing is poisonous." By this, he meant essentially that a substance in too great
an amount can be dangerous yet in all extremely small amount can be relatively harmless. Every
chemical element has a spectrum of possible effects on a partic ular organism. For
example, Selenium is required in small amounts by living things but may be toxic or
increase the probability of cancer in cattle and wildlife when it is pres ent in high
concentrations in the soil. Copper, chromium, and manganese are other chemical
elements required 'in small amounts by animals but toxic in higher amounts.

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It was recognized many years ago that the effect of a certain chemical on an individual
depends on the dose. This concept is termed dose response. Dose dependency can be
represented by a generalized dose-response Curve such as that shown in Figure 15.11.
When various concentrations of a chemical present in i biological system are plotted against the
effects on the organism, two things arc apparent. First, relatively large concentrations are toxic and
even lethal (points D, E, and Fin Figure 15.12). Second, trace concentrations may be beneficial
for life (between points A and D); and the dose-response curve forms a plateau of optimal concentration and maximum benefit between two points (B and ("). Points A, B, C, D, E, and F in
Figure 15.11 are
important thresholds in the dose-response curve. Unfortunately,, the amounts at which
points E- and F occur are known only for a few substances, for a few organisms, including
people; and the very important point D is all but unknown. Doses that arc beneficial,
harmful, or lethal may differ widely for different organisms and are difficult to characterize.
Fluorine provides a good example of the general dose-response concept. Fluorine forms
fluoride compounds that prevent tooth decay and promote the development of a healthy, bone
structure.
Relationships between the concentration of fluoride (in a compound of fluorine, such
as sodium fluoride, NaF) and health show a specific dose-response curve (Figure 15.12).
The plateau for an optimal concentration of fluoride (point B to point C) to reduce dental
caries (cavities) is from about 1 ppm to just less than 5 ppm. Levels greater than 1.5 ppin do not
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significantly decrease tooth decay but do increase the occurrence of discol oration of teeth.
Concentrations of 4 to 6 ppm reduce the prevalence of osteoporosis, a disease characterized
bv loss of bone mass; and toxic effects are noticed between 6 and 7 ppm (point D in Figure
15.12).

Dose-Response Curve (LD-50, ED-50, and TD-50)

Individuals differ in their response to chemicals, and it is difficult to predict the dose that will
cause a response in a particular individual. For this reason, it is practical to predict what
percentage of a population will respond to a specific dose of a chemical.
For example, the dose at which 50% of the population die is called the lethal dose 50, or
LD-50. The LD-50 is a crude approximation of a chemical's toxicity. It is a gruesome index that
does not adequately convey the sophistication of modern toxicology and is of little use in
setting a standard for toxicity. However, the LD-50 determina tion is required for new
synthetic chemicals as a way of estimating their toxic potential. Table 15.4 lists, as examples,
LD-50 values in rodents for selected chemicals.
The ED-50 (effective dose 50%) is the dose that causes an effect in 50% of the population
of observed subjects. For example, the ED-50 of aspirin would be the dose that relieves
headaches in 50% of the people.3ll
The TD-50 (toxic dose 50%) is defined as the dose that is toxic to 50% of the
population. TD-50 is often used to indicate responses such as reduced enzyme activ ity,
decreased reproductive success, or onset of specific symptoms, such as loss of hearing,
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nausea, or slurred speech.

For a particular chemical, there may be a whole family of dose-response Curves, as
illustrated in Figure 15.13. Which dose is of interest depends on what is being evaluated. For
example, for insecticides we may, wish to know the dose that will kill 100% of the insects
exposed; therefore the LD-95 (the dose that kills 95% of the insects) may be the minimum
acceptable level. However, when considering human health and the exposure to a
particular toxin, we often want to know the Lll-0-thc maximum dose that does not
cause any deaths.3 For potentially toxic compounds such as insecticides, which may
form a residue on food or food additives, wc want to ensure that the expected levels
of human exposure will have no known toxic effects. From an environmental
perspective, this is important because of concerns about increased risk of can cer
associated with exposure to toxic agents.30
Table 15.4 Approximate LD-50 Values (for rodents) for Selected Agents
Agent
LD50(mg/kg)n
Sodium chloride (table salt)
4,000
Ferrous sulfate (to treat anemia)
1,520
2,4-D (a weed killer)
368
DDT (an insecticide)
135
Caffeine (in coffee)
127
Nicotine (in tobacco
24
Strychnine sulfate (used to kill certain 3
pests)
Bonilinum toxin (in spoiled food)
0.00001
Milligrams per kilogram of body mass (termed mass weight, although it really isn't a weight)
administered by mouth to rodents. Rodents are commonly used in such evaluations, in part because they
are mammals (as we arc), are small, have a short life expectancy, and their biology is well known
Source: H. B. Schiefer, D. C. Irvine, and S. C. Buzik,
Uszderstrysadinq Trixicola_qy (Ncw York: CRC Press, 1997).
For drugs used to treat a particular disease, the effi ciency of the drug as a treatment
is of paramount importance. In addition to knowing what the therapeutic value (ED50) is, it is also important to know the relative safety of the drug. For example, there
may be an overlap between the therapeutic dose (ED) and the toxic dose (TD) (see
Figure 15.13). That is, the dose that causes a positive therapeutic response in some
individuals might be toxic to others. A quantitative measure of the relative safety of a
particular drug is the therapeutic index, defined as the ratio of the LD-50 to the ED-50.
The greater the therapeutic index, the safer the drug is believed to be.- 3l In other words,
a drug with a large difference bet-,,,-ccii the lethal and therapeutic dose is safer than
one with a smaller difference.
Threshold Effects
A threshold is a level below which no effect occurs and above which effects begin to
occur. If a threshold dose of a chemical exists, then a concentration of that chemical in

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the environment below the threshold is safe. If there is no thresh old dose, then even the
smallest amount of the chemical has some negative toxic effect (Figure 15.14).

Whether or not there is a threshold effect for environmental toxins is an important

environmental issue. For example, the U.S. Federal Clean Water Act originally stared as a
goal to reduce to zero the discharge of pollutants into water. The goal implies there is no
such thing as a threshold effect, since no level of toxin is to be legally permitted.
However, it is unrealistic to believe zero discharge of a water pollutant can be achieved
or to believe that we can reduce to zero the concentration of chemicals shown to be
carcinogenic.
A problem in evaluating thresholds for toxic pollutants is that it is difficult to account for
synergistic effects. Little is known about if or how thresholds might change if an organism is
exposed to more than one toxin at the same time or to a combination of toxins and other
chemicals, some of which arc beneficial. Exposures of people to chemicals in the environment
arc complex, and we are only beginning to understand and conduct research on the possible
interactions and consequences of multiple exposures.
Ecological Gradients
Dose-responsc effects differ among species. For example, the kinds of vegetation that can live
nearest to a toxic source arc often small plants with relatively short lifetimes grasses, sedges, and
weedy species usually regarded as pests) that arc adapted to harsh and highly variable environments. Farther from the toxic source, trees may be able to survive. Changes in vegetation with
distance from a toxic Source define the ecological gradient.

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Ecological gradients may be found around smelters and other industrial plants that discharge
pollutants into the atmosphere from smokestacks. For example, ccological gradient patterns can
be observed in the area around the smelters of Sudbury, Ontario, discussed earlier in this chaptcr
(A Closer I,ook 15.1). Near the smelters, an area that was once forest is now a patchwork of bare
rock and soil Occupied by small plants.
Tolerance
The ability to resist or withstand stress resulting from exposure to a pollutant or harmful
condition is referred to as tolerance. Tolerance can develop for some pollutants in some
populations, but not for all pollutants in all populations.
Tolerance may result from behavioral, physiological, or genetic adaptation. Behavioral
tolerance results from changes in behavior. For example, mice learn to avoid traps.
Physiological tolerance results when the body of an individual adjusts to tolerate a higher level
of pollutant. For example, in studies at the University of California Environmental Stress
Laboratory, students were exposed to Ozone (O;), an air pollutant often present in large cities
(Chapter 23). The students at first experienced svmptoms that included irritation of eyes and
throat and Shortness of breath. However, after a few days, their bodics adapted to the ozone, and
they reported that they believed they were no longer breathing ozonc-contaminated air, even
though the concentration of 03 stayed the same. This phenomenon explains why some people
who regularly breathe polluted air report that they do not notice the pollution. Of course, it does
not mean that the ozone is doing no damage; it is, especially in people with existing respiratory
problems. There arc many mechanisins for physiological tolerance, including deto:xifiecrtion, in
which the toxic chemical is converted to a nontoxic form, and the internal transport of the toxin
to a part of the body where it is not harmful, such as fat Cells.
Genetic tolerance, or adaptation, results when some individuals in a population are naturally
more resistant to a toxin than others. They are less damaged by exposure and more successful in
breeding. Resistant individuals pass on the resistance to future generations, who are also more
successful at breeding. Adaptation has been observed among sonic insect Pests fOIIO\X'illg
exposure to some chemical pesticides. For example, certain strains of malaria-causing
mosquitoes are now resistant to DDT (see the discussion in Chapter 12); and some organisms
that cause deadly infectious diseases have become resistant to common antibiotic drugs, Such as
penicillin.
Acute and Chronic Effects
Pollutants can have acute and chronic effects. An acute ef'f'ect is one that occurs soon after
exposure, usually to large amounts of a pollutant. A chronic effect takes place over a long period,
often as a result of exposure to low levels of a pollutant. For example, a person exposed all at
once to a high dose of radiation may be killed by radiation sickness soon after exposure (an acute
effect). Howcver, that same total dose, received slowly in small amounts over an entire lifetime,
may instead cause mutations and lead to disease or affect the person's DNA and offspring (a
chronic effect).

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Risk Assessment
Risk assessment can be defined as the process of determining potential adverse environmental
health effects to people exposed to pollutants and potentially toxic matcrials. Such an assessment
generally includes four steps:
1. Identification of the hazard. Identification consists of testing materials to determine
whether exposure is likeIN, to cause environmental health problems. One method used is to
investigate populations of people who havc been previously exposed. For cxarrip1c, to
understand the toxicity of radiation produced from radon gas, researchers Studied workers in
uranium mines. Another method is to perform experiments to test effects on animals, Such as
mice, rats, or monkeys. This method has drawn ina-casing criticism from groups of people who
believe such experiments are unethical. Another approach is to trv to understand how a particular
chemical works at the molcctilar level on cells. For example, research has been done to
determine how dioxin interacts with living cells to produce an adverse response. After
quantifying the response, scientists can develop mathematical models to predict or estimate
dioxin's risk.l8 This relatively new approach might also be applicable to other potential
toxins that work at the Cellular level.
2. Dose-responase assessment. The next step involves identifying relationships between the
dose of a chemical (therapeutic drug, pollutant, or toxin) and the health effects to people.
Some studies involve administering fairly high doses of a chemical to animals. The effects,
such as illness or symptoms (rash, tumor development) are recorded for varying doses,
and the results are used to predict the response in people. This is difficult, and the results arc
controversial for several reasons:
This is difficult, and the results arc controversial for several reasons:

The dose that results in a particular response may be very small and subject to
measurement errors.
There may be arguments over whether thresholds arc present or absent
Experiments on animals such as rats, mice, or monkws ma\' not be directly applicable
to humans.
The assessment may rely on probability and statistical analysis. Although statistically
significant results from experiments or observations are accepted as evidence to
support an argument, statistics cannot establish that the substance tested caused the
observed response.

3. Exposure assessment.. Exposure assessment evaluates the intensity, duration, and frequency
of human exposure to a particular chemical pollutant or toxin. The hazard to society is directly
proportional to the total population exposed. The hazard to an individual is generally greater
closer to the source Of exposure. I,ilce dose-response assessment, exposure assessment is difficult,
and the results are often controversial, in part because of difficulties in measuring the
concentration of a toxin present in doses as small as parts per million, billion, or even trillion.
Some questions that exposure assessment attempts to answer are:

18

How many people were exposed to concentrations of a toxin thought to be

dangerous
How large an area was contaminated by the toxin,'
What are the ecological gradients for exposure to the toxin?
How long were people exposed to a particular toxin'
4. Risk characterization. During this final step, the goal is to delineate health risk in terms of
the magnitude of the potential environmental health problem that might result from exposure
to a particular pollutant or toxin. To do this, it is necessary to identify the hazard, complete
the dose-response assessment, and evaluate the exposure assessment as outlined above. This
step involves all the uncertainties of the prior steps, and results are again like ly to be
controversial.
In summarv, risk assessment is difficult, costly, and controversial. Each chemical is
different, and there is no one method of determining responses of humans for specific Ells or
TDs. Toxicologists use the scientific method of hypothesis testing with experiments to
generate predictions of how specific doses of a chemical may affect humans. Warning labels
listing potential side effects of using a specific medication are required by, law, and these
warnings result from tOXIC010p' Studies to determine a drug's safety.
Finally, risk assessment requires making scientific judgments and formulating actions to help
minimize environmental health problems related to human exposure to pollutants and
toxins. The process of risk managerment integrates the assessment of risk with technical, legal,
political, social, and economic issues.1s Scientific arguments concerning the toxicity of a
particular material are often open to debate. For example, there is debate con cerning
whether the risk from dioxin is linear. That is, do effects start at minimum levels of exposure
to dioxin and gradually increase, or is there a threshold exposure beyond which
environmental health problems occur?
It is the task of people ill appropriate government agencies assigned to manage risk to make
judgments and decisions based on the risk assessment and then to take appropriate actions to
minimize the hazard resulting from exposure to toxins.

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