Environmental health

Environmental hazards are responsible for as much as a quarter of the total burden of disease world-wide, and more than one-third of the burden among children.

Heading that list are diarrhoea, lower respiratory infections, various forms of unintentional injuries and malaria.

The disease burden is much higher in the developing world, although in the case of certain non-communicable diseases, such as cardiovascular diseases and cancers, the per capita disease burden is larger in developed countries.

Health impacts of environmental hazards run across more than 80 diseases and types of injury. Well-targeted interventions can prevent much of this environmental risk.

Worldwide, as many as 13 million deaths could be prevented every year by making our environments healthier.

Environmental health addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours.

It encompasses the assessment and control of those environmental factors that can potentially affect health.
It is targeted towards preventing disease and creating healthsupportive environments.

This definition excludes behaviour not related to environment, as well as behaviour related to the social and cultural environment, and genetics.

Indoor air pollution and health

Fact sheet N292 September 2011

Around 3 billion people cook and heat their homes using open fires and leaky stoves burning biomass (wood, animal dung and crop waste) and coal.
Nearly 2 million people die prematurely from illness attributable to indoor air pollution from household solid fuel use.

Nearly 50% of pneumonia deaths among children under five are due to particulate matter inhaled from indoor air pollution.

More than 1 million people a year die from chronic obstructive respiratory disease (COPD) that develop due to exposure to such indoor air pollution.
Both women and men exposed to heavy indoor smoke are 2-3 times more likely to develop COPD.

IONIZING RADIATION, HEALTH EFFECTS AND PROTECTIVE MEASURES

Ionizing radiation is a type of energy released by atoms in the form of electromagnetic waves or particles.
People are exposed on a daily basis to natural sources of ionizing radiation, as well as human-made ionizing radiation sources.

Ionizing radiation has many beneficial applications, including uses in medicine, industry, agriculture and research. As the use of ionizing radiation increases, so does the potential for health hazards if not properly used or contained.

Acute health effects such as skin burns or acute radiation syndrome can occur when radiation doses exceed certain levels. Low doses of ionizing radiation can increase the risk of longer term effects such as cancer.

Air quality and health

Fact sheet N313 Updated September 2011

Air pollution is a major environmental risk to health.

By reducing air pollution levels, we can help countries reduce the global burden of disease from respiratory infections, heart disease, and lung cancer.

The lower the levels of air pollution in a city, the better respiratory (both longand short-term), and cardiovascular health of the population will be. Indoor air pollution is estimated to cause approximately 2 million premature deaths mostly in developing countries.

Almost half of these deaths are due to pneumonia in children under 5 years of age.
Urban outdoor air pollution is estimated to cause 1.3 million deaths worldwide per year.

Those living in middle-income countries disproportionately experience this burden.

Exposure to air pollutants is largely beyond the control of individuals and requires action by public authorities at the national, regional and even international levels The WHO Air quality guidelines represent the most widely agreed and up-to-date assessment of health effects of air pollution, recommending targets for air quality at which the health risks are significantly reduced.

The Guidelines indicate that by reducing particulate matter (PM10) pollution from 70 to 20 micrograms per cubic metre, we can cut air quality related deaths by around 15%.

Electromagnetic fields and public health: mobile phones

Fact sheet N193 June 2011

Mobile phone use is ubiquitous with an estimated 4.6 billion subscriptions globally. The electromagnetic fields produced by mobile phones are classified by the International Agency for Research on Cancer as possibly carcinogenic to humans.

Studies are ongoing to more fully assess potential long-term effects of mobile phone use. WHO will conduct a formal risk assessment of all studied health outcomes from radiofrequency fields exposure by 2012.

Environmental and occupational cancers

Fact sheet N350 March 2011

Cancer is a leading cause of death worldwide, with 12.7 million new cases and 7.6 million deaths in 2008. Globally, 19% of all cancers are attributable to the environment, including work setting resulting in 1.3 million deaths each year.

WHO has classified 107 agents, mixtures, and exposure situations as carcinogenic to humans.
External environmental causes of cancer are factors in the environment that increase risk of cancer such as air pollution, UV radiation and indoor radon.

Every tenth lung cancer death is closely related to risks in the workplace. Lung cancer, mesothelioma, and bladder cancer are among the most common types of occupational cancers.

Asbestos: elimination of asbestos-related diseases

Fact sheet N343 July 2010

About 125 million people in the world are exposed to asbestos at the workplace.
According to WHO estimates, more than 107 000 people die each year from asbestos-related lung cancer, mesothelioma and asbestosis resulting from occupational exposure.

Dioxins and their effects on human health

Fact sheet N225 May 2010

Dioxins are a group of chemically-related compounds that are persistent environmental pollutants.
Dioxins are found throughout the world in the environment and they accumulate in the food chain, mainly in the fatty tissue of animals.

More than 90% of human exposure is through food, mainly meat and dairy products, fish and shellfish.

Many national authorities have programmes in place to monitor the food supply.

Dioxins are highly toxic and can cause reproductive and developmental problems, damage the immune system, interfere with hormones and also cause cancer.

Due to the omnipresence of dioxins, all people have background exposure, which is not expected to affect human health. However, due to the highly toxic potential of this class of compounds, efforts need to be undertaken to reduce current background exposure.

Prevention or reduction of human exposure is best done via sourcedirected measures, i.e. strict control of industrial processes to reduce formation of dioxins as much as possible.

Sunbeds, tanning and UV exposure

Fact sheet N287 Interim revision April 2010

The key reasons why regulations are necessary Increase in the number of unsupervised commercial sunbeds - Without trained staff and adequate health care advice, the potential for harm to the uninformed consumer is much greater. This, combined with competitive pricing strategies such as unlimited sessions within a specific time frame, increases the likelihood of skin damage.

High intensity of UV output - Some machines have the capacity to emit very high levels of UV, many times stronger than the midday summer sun in most countries.
In a largely unregulated industry where training of staff is not mandatory, this increases the health risks considerably.

Exposure time and intervals between tanning sessions - Reasonable sunbed use includes keeping to recommended exposure times (which depends on the type of machine used) and having sufficiently long breaks between tanning sessions.
Normally at least 48 hours are needed between tanning sessions for repair of UVinduced DNA damage in skin cells

Eyewear - UV protective eyewear (such as goggles) must be worn during tanning sessions to protect the eyes.
Effect of certain drugs and cosmetics - Some drugs, for example anti-depressants, antibiotics, psoralens, antifungals, and antidiabetics as well as some cosmetics make the skin more photosensitive and therefore decrease the time it takes for the skin to burn.

The size of the skin area exposed - Modern clam-type sunbeds and canopies can expose more skin area to UV than outdoor situations, therefore increasing the health risk. Here young people, , are more sensitive to UV-induced damage from this "all-over" tanning.

Climate change and health

Fact sheet N266 January 2010

Climate change affects the fundamental requirements for health clean air, safe drinking water, sufficient food and secure shelter. The global warming that has occurred since the 1970s was causing over 140 000 excess deaths annually by the year 2004.

Many of the major killers such as diarrhoeal diseases, malnutrition, malaria and dengue are highly climate-sensitive and are expected to worsen as the climate changes.

Areas with weak health infrastructure mostly in developing countries will be the least able to cope without assistance to prepare and respond.
Reducing emissions of greenhouse gases through better transport, food and energyuse choices can result in improved health.

Radon and cancer

Fact sheet N291 Updated September 2009

Radon is the second most important cause of lung cancer in many countries.
Radon is estimated to cause between 3% and 14% of all lung cancers, depending on the average radon level in a country.

Radon is much more likely to cause lung cancer in people who smoke, and is the primary cause of lung cancer among non-smokers.

Radon-induced lung cancers are mainly caused by low and moderate rather than by high radon concentrations, because of the large number of people exposed to indoor radon in homes with such low concentrations.

The lower the radon concentration in a home, the lower the risk as there is no known threshold below which radon exposures carries no risk.

Waste from health-care activities

Fact sheet N253 November 2011

Of the total amount of waste generated by health-care activities, about 80% is general waste.

The remaining 20% is considered hazardous material that may be infectious, toxic or radioactive.

Every year an estimated 16 000 million injections are administered worldwide, but not all of the needles and syringes are properly disposed of afterwards.

Health-care waste contains potentially harmful microorganisms which can infect hospital patients, health-care workers and the general public.

Ultraviolet radiation and human health

Fact sheet N 305 December 2009

Skin cancer is caused primarily by exposure to ultraviolet (UV) radiation either from the sun or from artificial sources such as sunbeds.

Globally in 2000, over 200 000 cases of melanoma were diagnosed and there were 65 000 melanoma-associated deaths. Excessive sun exposure in children and adolescents is likely to contribute to skin cancer in later life.

Worldwide approximately 18 million people are blind as a result of cataracts, of these 5% of all cataract related disease burden is directly attributable to UV radiation exposure.
Sun protection is recommended when the ultraviolet index is 3 and above.

Electromagnetic fields and public health Base stations and wireless technologies
Fact sheet N304 May 2006

Mobile telephony is now commonplace around the world. This wireless technology relies upon an extensive network of fixed antennas, or base stations, relaying information with radiofrequency (RF) signals.

Over 1.4 million base stations exist worldwide and the number is increasing significantly with the introduction of third generation technology.

Other wireless networks that allow highspeed internet access and services, such as wireless local area networks (WLANs), are also increasingly common in homes, offices, and many public areas (airports, schools, residential and urban areas).

As the number of base stations and local wireless networks increases, so does the RF exposure of the population.

Recent surveys have shown that the RF exposures from base stations range from 0.002% to 2% of the levels of international exposure guidelines, depending on a variety of factors such as the proximity to the antenna and the surrounding environment.

This is lower or comparable to RF exposures from radio or television broadcast transmitters.

Health effects of the Chernobyl accident: an overview

Fact sheet N 303 April 2006

Background On 26 April 1986, explosions at reactor number four of the nuclear power plant at Chernobyl in Ukraine, a Republic of the former Soviet Union at that time, led to huge releases of radioactive materials into the atmosphere. These materials were deposited mainly over countries in Europe, but especially over large areas of Belarus, the Russian Federation and Ukraine.

Electromagnetic fields and public health Static electric and magnetic fields
Fact sheet N299March 2006

Technologies using static fields are increasingly being exploited in selected industries, such as medicine with magnetic resonance imaging (MRI), transportation systems that use direct current (DC) or static magnetic fields and high-energy physics research facilities. As the field strength of the static field increases, so does the potential for a variety of interactions with the body.

The International EMF Project of the World Health Organization (WHO) has recently reviewed the health implications of high static field exposure and highlighted the importance of public health protection for medical staff and patients (particularly children and pregnant women) and workers in industries producing high field magnets (Environmental Health Criteria, 2006).

Electromagnetic fields and public health Electromagnetic hypersensitivity

Fact sheet N296 December 2005

As societies industrialize and the technological revolution continues, there has been an unprecedented increase in the number and diversity of electromagnetic field (EMF) sources.

These sources include video display units (VDUs) associated with computers, mobile phones and their base stations. While these devices have made our life richer, safer and easier, they have been accompanied by concerns about possible health risks due to their EMF emissions.

For some time a number of individuals have reported a variety of health problems that they relate to exposure to EMF. While some individuals report mild symptoms and react by avoiding the fields as best they can, others are so severely affected that they cease work and change their entire lifestyle. This reputed sensitivity to EMF has been generally termed electromagnetic hypersensitivity or EHS.

Legionellosis
Fact sheet N285

History and overview Legionellosis is a serious and sometimes fatal form of pneumonia. It is caused by the bacterium Legionella pneumophila and other legionella species. These bacteria are found naturally in the environment and thrive in warm water and warm damp places. They are commonly found in lakes, rivers, creeks, hot springs and other bodies of water. They can also be found in soil and potting mix.

The bacterium Legionella pneumophila was first identified in 1977, as the cause of an outbreak of severe pneumonia in a convention centre in the USA in 1976. It has since been associated with outbreaks linked to poorly maintained artificial water systems, particularly cooling towers or evaporative condensers associated with air conditioning and industrial cooling, hot and cold water systems in public and private buildings, and whirlpool spas.

Health-care waste management

To reduce the burden of disease, healthcare waste needs sound management, including alternatives to incineration
Fact sheet N281 October 2011

In the last few years there has been growing controversy over the incineration of healthcare waste. Under some circumstances, including when wastes are incinerated at low temperatures or when plastics that contain polyvinyl chloride (PVC) are incinerated, dioxins and furans and other toxic air pollutants may be produced as emissions and/or in bottom or fly ash (ash that is carried by air and exhaust gases up the incinerator stack).

Exposure to dioxins, furans and co-planar PCBs may lead to adverse health effects.

Depleted uranium
Fact sheet N257 Revised January 2003

Metallic uranium (U) is a silver-white, lustrous, dense, weakly radioactive element. It is ubiquitous throughout the natural environment, and is found in varying but small amounts in rocks, soils, water, air, plants, animals and in all human beings.

Natural uranium consists of a mixture of three radioactive isotopes which are identified by the mass numbers 238U (99.27% by mass), 235U (0.72%) and 234U (0.0054%).

On average, approximately 90 g (micrograms) of uranium exists in the human body from normal intakes of water, food and air. About 66% is found in the skeleton, 16% in the liver, 8% in the kidneys and 10% in other tissues.

Uranium is used primarily in nuclear power plants. However, most reactors require uranium in which the 235U content is enriched from 0.72% to about 1.5-3%.