2011-2016年广东省农村环境卫生状况调查

目的 了解广东省2011-2016年农村环境卫生状况及其变化趋势,为农村环境卫生整治提供科学依据。方法 于2011-2016年每年的7-8月,按比例分层随机抽样方法,选取19个县(市、区),每个县20个村,每村选择不少于5户为调查对象,采用统一调查表进行调查,内容包括基本情况、垃圾与污水情况、病媒生物防制等。结果 2011-2016年广东省农村垃圾和污水处理厂的覆盖人口比例逐渐增加,分别从40.72%提高到61.29%、39.15%提高到55.07%;生活垃圾的收集方式均以定点堆放为主(52.33%),以填埋为主要处理方式(57.93%);生活污水排放方式主要以明沟为主占34.01%,排放地点以河流为主,占40.37%;环境卫生经费投入逐年增长,大部分的调查点都制定了环境卫生管理制度、有环境卫生规划、开展了环境卫生宣传教育及灭鼠、灭蝇等相关病媒生物控制工作。结论 2011-2016年广东省各地农村的卫生基础设施、垃圾污水处理、卫生管理、病媒生物控制等方面情况有所改善,但也存在一些不足,建议采取多种措施进一步改善农村环境卫生状况。     

Environment, wealth, inequality and the burden of disease in the Accra metropolitan area, Ghana

The study examines environmental problems and adverse impacts on the health of urban households in the Accra metropolitan area, Ghana. Accra is faced with severe inadequacy of urban infrastructure in the face of rapid population growth in the metropolis. More than half of the city's population do not have access to solid waste collection services. Only 39.8% of households have indoor pipe and over 35.0% of households depend on unsanitary public latrines whilst 2.5% do not have access to toilet facilities. Human excrement, garbage and wastewater are usually deposited in surface drains, open spaces and streams in poor neighbourhoods. The resultant poor sanitation has serious health impacts as more than half of reported diseases are related to poor environmental sanitation. The majority of households depend on solid fuels for cooking and this leads to indoor air pollution and high incidence of respiratory infections. Poor households bear a disproportionately large share of the burden of environmental health hazards than their wealthy counterparts, due to their particular vulnerability resulting from inadequate access to environmental health facilities and services.     

Quality of health care, survival and health outcomes in Ghana

This paper analyzes the effect of quality and accessibility of health services and other public infrastructure on the health of children in Ghana. We focus on child survival, child height and weight using data from the Ghana Living Standards Survey. The results suggest an important role for public health policy in eliminating the rural-urban disparities in health status and particularly in improving the health status of rural children and reducing their mortality rates. Increased availability of birth services and other related child programs, as well as Improved water and sanitation infrastructure would have an immediate payoff.     

Local heat stroke prevention plans in Japan: characteristics and elements for public health adaptation to climate change

The adverse health effects from hot weather and heat waves represent significant public health risks in vulnerable areas worldwide. Rising temperatures due to climate change are aggravating these risks in a context of fast urbanization, population growth and societal ageing. However, environmental heat-related health effects are largely preventable through adequate preparedness and responses. Public health adaptation to climate change will often require the implementation of heat wave warning systems and targeted preventive activities at different levels. While several national governments have established such systems at the country level, municipalities do not generally play a major role in the prevention of heat disorders. This paper analyzes selected examples of locally operated heat-health prevention plans in Japan. The analysis of these plans highlights their strengths, but also the need of local institutions for assistance to make the transition towards an effective public health management of high temperatures and heat waves. It can also provide useful elements for municipal governments in vulnerable areas, both in planning their climate change and health adaptation activities or to better protect their communities against current health effects from heat.     

Putting the capital "E" environment into ecological models of health

The recent public health reawakening to the role of the built environment has largely excluded consideration of the natural environment. This exclusion is despite the fact that land conservation, or green infrastructure, supports the most fundamental human needs and healthy lifestyles. Although the contemporary public health paradigm acknowledges the environment as an important construct in an "ecological" approach to health, environmental protection is not commonly viewed as an upstream approach to preventing disease. This guest commentary suggests that environmental health research and practice should consider green infrastructure as germane to a healthy human environment.     

环卫规划与地域特色——以西藏环卫规划为例

以西藏环卫规划为例,结合西藏社会经济水平、城镇发展、产业发展、自然环境、气候条件等方面特色,从规划层次划分及目标设定、垃圾产生量及性质预测、垃圾处理技术选择、环卫基础设施建设投融资机制构建等方面阐述了环卫规划如何与地域特色紧密结合。     

Environmental risks in the developing world: exposure indicators for evaluating interventions, programmes, and policies

BACKGROUND: Monitoring and empirical evaluation are essential components of evidence based public health policies and programmes. Consequently, there is a growing interest in monitoring of, and indicators for, major environmental health risks, particularly in the developing world. Current large scale data collection efforts are generally disconnected from micro-scale studies in health sciences, which in turn have insufficiently investigated the behavioural and socioeconomic factors that influence exposure. STUDY DESIGN: A basic framework is proposed for development of indicators of exposure to environmental health risks that would facilitate the (a) assessment of the health effects of risk factors, (b) design and evaluation of interventions and programmes to deliver the interventions, and (c) appraisal and quantification of inequalities in health effects of risk factors, and benefits of intervention programmes and policies. Specific emphasis is put on the features of environmental risks that should guide the choice of indicators, in particular the interactions of technology, the environment, and human behaviour in determining exposure. The indicators are divided into four categories: (a) access and infrastructure, (b) technology, (c) agents and vectors, and (d) behaviour. The study used water and sanitation, indoor air pollution from solid fuels, urban ambient air pollution, and malaria as illustrative examples for this framework. CONCLUSIONS: Organised and systematic indicator selection and monitoring can provide an evidence base for design and implementation of more effective and equitable technological interventions, delivery programmes, and policies for environmental health risks in resource poor settings.     

Estimating the effects of light rail transit on health care costs

In recent years, there has been a proliferation of research on the effects of the built environment, including mass transit systems, on health-related outcomes. While there is general agreement that the built environment affects travel choices and physical activity, it remains unclear how much of a public health benefit (in dollars) can be derived from land use policies that support walking, biking, and transit. In the present study, we develop a model to assess the potential cost savings in public health that will be realized from the investment in a new light rail transit system in Charlotte, NC. Relying on estimates of future riders, area obesity rates, and the effects of public transit on physical activity (daily walking to and from the transit stations), we simulated the potential yearly public health cost savings associated with this infrastructure investment. Our results indicate that investing in light rail is associated with a 9-year cumulative public health cost savings of dollars 12.6 million. While these results suggest that there is a sizable public health benefit associated with the adoption of light rail, they also indicate that the effects are relatively small compared to the costs associated with constructing and operating such systems. These findings suggest that planning efforts that focus solely on the health impact of modifications in the built environment are likely to overstate the economic benefits. Public health benefits should be considered along with broader environmental health benefits.     

Sentinel areas: a monitoring strategy in public health

Available techniques for monitoring the health situation have proven insufficient, thus leading to a discussion of the need for their improvement based on new data collection strategies allowing for data use by local health systems. This article presents the methodological basis for a strategy to monitor health problems utilizing demarcated intra-urban spaces called "sentinel areas" to collect fundamental social, economic, behavioral, and biological data for public health that allow for a closer approach to the reality of complex social spaces. The authors present an experience that is being developed in Salvador, Bahia, Brazil, to evaluate the epidemiological impact of an environmental sanitation program. They discuss selection criteria for the areas and the potential uses of this strategy allowing for the rapid utilization of epidemiological resources by health services and the timely application of the results to reorient and enhance health intervention practices.     

福清市农村环境卫生状况调查分析

目的 通过开展农村环境卫生调查,了解福清市农村环境卫生状况和村民卫生习惯,客观评价农村环境卫生水平,为政府制订涉农政策措施提供依据和支持.方法 采用入户调查方式对分层抽样的40个村、200户居民进行问卷以及现场调查.结果 40个调查村大部分都制定了卫生规划和卫生制度,同时能定期开展环境卫生宣传教育活动;污水排放基本上都通过管道和明（暗）沟排放,垃圾处理均实现了村里定点堆放,镇上统一收集.村民告别了喝生水的习惯,均喝上了安全卫生的饮用水.97％的农户均建有卫生厕所,室内和庭院卫生基本上能保持干净整洁.结论 福清市农村环境卫生状况良好,大部分村都有制定卫生规划和卫生制度,配备专兼职保洁员,污水排放有待于进一步规范,病媒生物控制力度有待于进一步加强,村民的卫生意识形态仍需加强.     

The Component Model of Infrastructure: A Practical Approach to Understanding Public Health Program Infrastructure

Functioning program infrastructure is necessary for achieving public health outcomes. It is what supports program capacity, implementation, and sustainability. The public health program infrastructure model presented in this article is grounded in data from a broader evaluation of 18 state tobacco control programs and previous work. The newly developed Component Model of Infrastructure (CMI) addresses the limitations of a previous model and contains 5 core components (multilevel leadership, managed resources, engaged data, responsive plans and planning, networked partnerships) and 3 supporting components (strategic understanding, operations, contextual influences). The CMI is a practical, implementation-focused model applicable across public health programs, enabling linkages to capacity, sustainability, and outcome measurement.For decades, infrastructure has been promoted as the key to public health achievements.1–3 General reports, models, and frameworks have intended to clarify infrastructure, including Baker et al. and Turnock, among others.4–8 Historically, when public health infrastructure has been discussed in the literature, it has been in reference to the larger, societal system level.1,2,4–8 This level of infrastructure provides the capacity to respond to threats to the nation’s health.2 In this article, we focus on program infrastructure, which is distinct from, but an essential building block of, the larger system level of public health infrastructure. However, program infrastructure is still broadly described with abstract terms such as “platform” or “organizational capacity” and rarely operationalized in logic models or measured in the public health, intervention, or evaluation literatures.9 There remains a lack of definition and few clear depictions of program-level infrastructure, making it difficult for public health programs attempting to design evaluations and build an evidence base for the role of infrastructure in achieving health outcomes. Program infrastructure is the foundation that supports program capacity, implementation, and sustainability.9,10 Components of a functioning program infrastructure lead to capacity, which enables action (implementation) and is linked to outcomes and sustainability. Therefore, components of program infrastructure are best defined in a practical manner that lends itself to straightforward implementation and evaluation.11In previous work, we reviewed and discussed 1 model of oral health program infrastructure, the Ecological Model of Infrastructure (EMI), and assessed its applicability across a broader context of public health programs.9 Although this model was a first step toward defining program infrastructure, additional work was necessary to fully construct a measurable model of public health program infrastructure. In particular, the EMI was lacking concrete examples and 2 vital elements: outcomes and sustainability. Moreover, the EMI’s narrow focus on state plans overlooked the planning process’s importance to program infrastructure, as well as the significance of other plans (e.g., evaluation, communication, sustainability plans), and did not consider the model as a complex system with connections across its core elements.Our new model of public health program infrastructure addresses the EMI’s limitations and defines infrastructure in a practical, actionable, and evaluable manner. It demonstrates how grant planners, evaluators, and program implementers can ultimately link infrastructure to capacity, measure success, and increase the likelihood of sustainable health achievements. The model contains core and supportive components that link to capacity, outcomes, and sustainability.     

A framework for targeting water,sanitation and hygiene interventions in pastoralist populations in the Afar region of Ethiopia

Globally, many populations face structural and environmental barriers to access safe water, sanitation and hygiene (WASH) services. Among these populations are many of the 200 million pastoralists whose livelihood patterns and extreme environmental settings challenge conventional WASH programming approaches. In this paper, we studied the Afar pastoralists in Ethiopia to identify WASH interventions that can mostly alleviate public health risks, within the population's structural and environmental living constraints. Surveys were carried out with 148 individuals and observational assessments made in 12 households as part of a Pastoralist Community WASH Risk Assessment. The results show that low levels of access to infrastructure are further compounded by risky behaviours related to water containment, storage and transportation. Additional behavioural risk factors were identified related to sanitation, hygiene and animal husbandry. The Pastoralist Community WASH Risk Assessment visually interprets the seriousness of the risks against the difficulty of addressing the problem. The assessment recommends interventions on household behaviours, environmental cleanliness, water storage, treatment and hand hygiene via small-scale educational interventions. The framework provides an approach for assessing risks in other marginal populations that are poorly understood and served through conventional approaches.     

West Nile virus: Success of public health response underlines failure of the system

The West Nile virus outbreak in 1999 demonstrated the country's capacity to meet an emerging public health threat. However, while the tracking and monitoring efforts that were put into place by 2000 were impressive, the response to the West Nile virus underscores a fundamental deficiency in the capacity of public health regarding the nation's environmental health efforts. Chronic diseases such as asthma, neurological diseases, and birth defects and their potential links to environmental factors are not being adequately tracked and monitored. New public health infrastructure resources are required.     

“Stop talking around projects and talk about solutions”: Positioning health within infrastructure policy to achieve the sustainable development goals

Purpose and settingInfrastructure is a global multi-trillion dollar market presenting many opportunities and risks for sustainable development. This article aims to foster better conceptualisation of the connections and tensions between infrastructure policy and public health in the light of the Sustainable Development Goals, especially ‘good health and wellbeing’ (number 3) and ‘industry, innovation and infrastructure’ (number 9), based on findings from interviews with a purposive sample of senior practicing Australian infrastructure policy makers.Principal findingsWe use an institutional framework to explore the ideas, actors, rules and mandates, and procedures underpinning the inclusion of health in infrastructure policy. Informants defined infrastructure as the construction and provision of services that facilitate economic, environmental and social outcomes. The tendency to default to infrastructure as essential for economic success has fundamental challenges for the SDGs, particularly the politically driven pursuit of ‘mega-project’ legacies, sector-specific siloed governance arrangements, and inadequate conceptualisations of costs and benefits.ConclusionsPublic health and infrastructure policy are mutually re-enforcing given they both concern the public interest with implications for all 17 SDGs. Positioning health and wellbeing as fundamental societal outcomes from infrastructure decisions would go a long way to helping achieve the SDGs.     

Urban planning and public health at CDC

Urban planning, also called city and regional planning, is a multidisciplinary field in which professionals work to improve the welfare of persons and communities by creating more convenient, equitable, healthful, efficient, and attractive places now and for the future. The centerpiece of urban planning activities is a "master plan," which can take many forms, including comprehensive plans, neighborhood plans, community action plans, regulatory and incentive strategies, economic development plans, and disaster preparedness plans. Traditionally, these plans include assessing and planning for community needs in some or all of the following areas: transportation, housing, commercial/office buildings, natural resource utilization, environmental protection, and health-care infrastructure. Urban planning and public health share common missions and perspectives. Both aim to improve human well-being, emphasize needs assessment and service delivery, manage complex social systems, focus at the population level, and rely on community-based participatory methods. Both fields focus on the needs of vulnerable populations. Throughout their development, both fields have broadened their perspectives. Initially, public health most often used a biomedical model (examining normal/abnormal functioning of the human organism), and urban planning often relied on a geographic model (analysis of human needs or interactions in a spatial context). However, both fields have expanded their tools and perspectives, in part because of the influence of the other. Urban planning and public health have been intertwined for most of their histories. In 1854, British physician John Snow used geographic mapping of an outbreak of cholera in London to identify a public water pump as the outbreak's source. Geographic analysis is a key planning tool shared by urban planning and public health. In the mid-1800s, planners such as Frederick Law Olmsted bridged the gap between the fields by advancing the concept that community design contributes to physical and mental health; serving as President Lincoln's U.S. Sanitary Commission Secretary; and designing hundreds of places, including New York's Central Park. By 1872, the disciplines were so aligned that two of the seven founders of the American Public Health Association were urban designers (an architect and a housing specialist). In 1926, the U.S. Supreme Court, in validating zoning and land-use law as a legal government authority in Village of Euclid v. Ambler Realty, cited the protection of public health as part of its justification. Other connections have included 1) pioneering urbanist Jane Jacobs, who during the 1960s, called for community design that offered safe and convenient options for walking, biking, and impromptu social interaction; and 2) the Healthy Cities movement, which began in Europe and the United States during the 1980s and now includes projects in approximately 1,000 cities that in various ways highlight the role of health as much more than the presence of medical care.     

Environmental impact on the bacteriological quality of domestic water supplies in Lagos,Nigeria

OBJECTIVE: To assess the impact of town planning, infrastructure, sanitation and rainfall on the bacteriological quality of domestic water supplies. METHODS: Water samples obtained from deep and shallow wells, boreholes and public taps were cultured to determine the most probable number of Escherichia coli and total coliform using the multiple tube technique. Presence of enteric pathogens was detected using selective and differential media. Samples were collected during both periods of heavy and low rainfall and from municipalities that are unique with respect to infrastructure planning, town planning and sanitation. RESULTS: Contamination of treated and pipe distributed water was related with distance of the collection point from a utility station. Faults in pipelines increased the rate of contamination (p<0.5) and this occurred mostly in densely populated areas with dilapidated infrastructure. Wastewater from drains was the main source of contamination of pipe-borne water. Shallow wells were more contaminated than deep wells and boreholes and contamination was higher during period of heavy rainfall (p<0.05). E. coli and enteric pathogens were isolated from contaminated supplies. CONCLUSIONS: Poor town planning, dilapidated infrastructure and indiscriminate siting of wells and boreholes contributed to the low bacteriological quality of domestic water supplies. Rainfall accentuated the impact.     

The 2011 Japanese earthquake: an overview of environmental health impacts

A magnitude 9.0 earthquake rupturing the Earth's crust nearly 130 km off the east coast of Japan on March 11, 2011, triggered a tsunami that reached the Japanese coast approximately 30 minutes later. The combined effects of the earthquake and tsunami (known as the Tohoku event) devastated the area of northeast Japan, resulting in widespread infrastructure destruction, loss of life, and environmental contamination. Perhaps the longest-lasting impact of the Tohoku event will result from the damage to the nuclear power plants along the coast and the subsequent release of radioactive elements into the environment. This article describes the environmental impacts of the disaster and highlights the interconnectedness among the core areas of environmental health including air quality, water quality, weather/climate change, food safety, healthy housing, waste/sanitation, infectious disease/vector control, radiation, injury prevention, emergency preparedness, and toxicology. The purpose of this article is to provide an overview of the spectrum of the natural disaster and its environmental health impact to the human population. Future scientific analysis may confirm or challenge the information presented here.