Occupational and

Environmental Health
Overview
Prof. Tan Malaka, MD,MOH, DrPH, SpOk,
Tri Hari Irfani, M.D.,M.P.H.

Dept of Public Health School of Medicine,

Sriwijaya University.
The Scope of Public Health
Public Health: Combination of science, practical
skills and beliefs directed to the maintenance
and improvement of the health of the people.
Goals of Public Health determined by:
Values of Society (child abuse, violence on
women)
Knowledge (tele-medicine, water purification,
vaccination)
Ability to resolve perceived public health
problems.
Environment n Health
HEALTH and ENVIRONMENT
Ecosystem: a system of dynamic
interdependent relationship among living
organisms and their physical environment.
It is a bounded entity that has self-stabilizing
mechanism (Gaia Hypothesis: earth has
global homeostatic mechanism).
Stable and balance ecosystem will survive
longest (Watershed and water supply);
Ecosystem capacity is not unlimited (carrying
capacity)
waste (water, soil, air);
Material and energy consumption;
Availability of arable land, fresh water;
Collapse of ecosystem (e.g. traffic);
The law of minimum (Justus von Liebig).
HEALTH and ENVIRONMENT
F (human health)= G (DNA) + E (P,C,B)
Impediments to health: Poverty, Poor living and
working condition, lack of education
Social and Economic condition.
Health is only possible where resources available
to meet human needs and where living and
working environment is protected from life-
threatening and health-threatening pollutants,
pathogens and physical hazards.
Message: Health professional have a special role
in the environmental health but they need to
work with all groups.
Agent Environment Population
Env. and. Occ Health defined
Occupational and Environmental Health is
the multidiciplinary approach to the
recognition, diagnosis, treatment and
prevention and control of diseases,
injuries, and other adverse health
conditions resulting from hazardous
expsoures in the workplace, the home, or
the community. (Levy and Wegman, et al
2006).
 HEALTHY PEOPLE 2010, USA.

Physical and social environments play major roles

in the health of individuals and communities. The
physical environment includes the air, water, and
soil through which exposure to chemical,
biological, and physical agents may occur. The
social environment includes housing,
transportation, urban development, land use,
industry and agriculture and results in exposures
such as work-related stress, injury and violence.

Friis, 2007.
Healthy People 2010, USA
Environmental Health
Outdoor Air Quality
Water Quality
Toxics and Wastes
Healthy Homes and Healthy
Communities
Infrastructure and Surveillance
Global Env Health.
 Demographic Characteristics,
Indonesia 2010.

PARAMETERS
Population (million) 235.5
Birth Rate/1000 population 20
Death Rate/1000 population 6
Natural Increase (%) 1.4
Infant Mortality Rate 30
Life expectancy at birth (both sexes) 71
Percent Urban 43
Population Density / Square Kilometer 124

% of population with improved sanitation

- Urban 67
- Rural 36
Dikompilasikan Oleh Malaka T 2010.
Sumber: Population Reference Bureau 2010.
 Basic Requirements for A
Healthy Environment
Clean Air: Indoor, Out door (ambient, work
environment).
Safe and Sufficient (fresh) Water: quality,
quantity, accessibility.
Adequate and safe food (starvation, food
borne diseases, junk food)
Safe and peaceful settlements (overcrowded:
drug abuse, urban violence, contagious
diseases)
Stable Global Environment
Long range transport;
Climate change, etc.
Ways to promote good health:

Safe environment (physical, chemical,

biological)
Enhance immunity to infection
(vaccination, nutrition, physical fitness)
Behave sensibly (drugs and alcohol,
exercise, safe sex, stress management);
Satisfactory nutrition (well balance diet)
Well born children (MCH)
Prudent health care (cautious in adopting
new technology)
 Examples of Hazardous
Exposures
Contamination of air, water and soil, by a factory
where workers are also exposed.
Agriculture workers application of pesticides that
may contaminate surface and ground water.
Workers bringing asbestos, lead and other
hazardous materials home on their work cloth,
skin and hair.
Exposure of workers and community residents to
hazardous wastes that have been
inapproppriately disposed of by industries.
Environmental and Occupational
Health Hazards
Natural and anthropogenic sources.
Biological (bacteria, viruses, parasites, BBP
etc.).
Chemical hazards: heavy metals, solvents,
pesticides, carcinogens.
Physical hazards: noise, vibration, thermal,
radiation, illumination.
Mechanical (motor vehicles, workplace
injury)
Ergonomics: repetitive, awkward positions.
Psycho-social: stress, lifestyles.
 Scale and Nature of Human
Activities (agricultural, industrial,
energy production, urbanization)

HEALTH

Physical and Chemical Biological Environment:

Environment (air, pathogens, vectors and
water, soil, food) Habitats.

Interaction of Human Activities and Environment

Tan Malaka, Dec 2003
Landon, M. 2006
Physical Hazards
Noise:
Occupational Exposure: Noise Induced Hearing
loss;
Ambient Noise: Nuisance;
Vibration:
Hand Arm: Hand arm vibration syndrome;
Whole body: low back pain, etc.
Thermal: Heat related disorders: Stroke,
exhaustion, cramps, syncope; Frostbite.
Barometric pressure: Hyperbaric, aerospace
medicine.
Radiation:
Ionizing: Alpha, Beta, Gamma, Neutron, X-rays
Non Ionizing: UV, IR, Lasers, Microwave, Radio
 Mechanical and Ergonomics
Hazards
Physical Injury:
Traffic;
Workplace.
Home and recreation.
Ergonomics
Designing workplace that can be modified or
adapted to the needs of individual workers.
Cumulative Trauma Disorders (eg. Carpal
Tunnel Syndrome)
Frequency, Strength, position, duration.
 Biological Hazards
Plants, insects, rodents, fungi, bacteria, viruses,
toxins, allergens.
Prion (disease producing protein particle) mad
cow.
Five major killers: respiratory infection, diarrhea,
TB, Malaria, Measles.
Water pollution by human excreta is the main
pathway of cholera, dysentery, typhoid,
hepatitis-A and Schistosomiasis.
Environmental changes: ebola, malaria, Avian
Flu, etc.
HIV/Aids and re-emerged of TB.
Chemical Hazards
10 millions chemicals synthesized, 1 % used
commercially;
3000 chemicals enter the market annually,
1% hazards known.
Most chemicals not adequately tested on
their toxicity;
Inorganic: corrosive materials, metals;
Organics: Hydrocarbons (aliphatic and
aromatic), Halogenated Hc, Alcohols, Glycols
and derivates, Organic solvents (benzene,
trichlorethylene).
Pesticides (organo-chlorine, organo-
phosphorous, Carbamate)
Chemical Hazards: Routes of Absorption,
Distribution and Excretion of Toxic
Substances
Media: Water, Air, Soil, Drugs

Skin Respiratory GI. Tract

Tract

Other
BLOOD
Organs Liver

Kidney

Sweat
Hair Urine Feces
 Psycho Social
Stress:
Depression;
Suicide;
Substance abuse;
Violence
Psycho somatic diseases.
Stressors:
Family related;
Work related:
Interpersonal,
Organizational.
 Top Risk Factors Leading to
Disease, Disability, or Death
(behavior)
Developing Countries Developed Countries
Underweight Tobacco
Unsafe sex High blood pressure
Unsafe water, sanitation Alcohol
and hygiene High cholestrol
Indoor smoke High body mass index
Deficiency vit and min Low fruit and vegetable
High blood pressure intake
Tobacco Physical inactivity
High cholestrol. Illicit drugs
Unsafe sex
Fe Deficiency

Ref. Murphy, E.M (2005). Promoting Healthy Behavior. Population Reference

Bureau. Washington DC, USA.
 Prevention and Control Of
Exposure
Risk assessment:
Hazards identification
Exposure assessment
Risk characterization
Risk Management
Risk evaluation
Control of exposure
Monitoring
 Prevention and control of
exposure
Control at the source:
Substitution eg. Solvent
based to water based;
Engineering control;
Exhaust ventilation.
Control along the path:
General ventilation;
Protective barrier.
Control at the person:
Personal Protective
Equipment
Training
Administrative control (eg.
Working time)
Secondary Prevention (early
detection)
 Risk - Manageability Matrix
Risk
Solvents Noise BBP
Heavy Metals Radiation

Heat Stress
WR-Stress
Ergonomics

Manageability
Additional Challenges for
Developing Countries
Export of Hazards
Infrastructures and Human Resources
Trans-national Problem
Relationships between Workplace and Home
Environment
Economic Development - rapid
industrialization, urbanization.
OH/EH Services and Primary Health Care.
Topics in Env and Occ Health
Quality Air, ambient and indoor.
Domestic Waste Management;
Excreta Disposals;
Water Supply Sanitation;
Housing and Health
Food Sanitation;
Vector Control;
Environmental Pollution and Health
Workers Health Surveillance
Emergency Response Plan
Public Health Risk Assessment.
 Student Projects
Domestic Waste Management;
Excreta Disposals;
Liquid Industrial waste;
Air quality (ambient);
Noise quality (ambient);
Water quality (stream);
Water Quality (surface non stream);
Work related diseases;
Industrial Noise;
Canteen Hygiene;
Food Safety;
Vector Control: mosquitoes.
Housing and health
Indoor Air Quality
Chemical managemet in the work place.