Environmental Influences in Community Health Care (2)

8/3/2019 Environmental Influences in Community Health Care (2)

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Environmental Influencesin Community Health

Care

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Environmental Influences

in Community Health Care

hapter 13

• Overview.

• Sources of environmental hazards.• Environmental issues for the 21st century.

• The nurse’s responsibilities in primary,

secondary, and tertiary prevention.• The future of environmental health nursing.



Overview

Understanding the effect of environment

factors on health and disease requires a social,cultural, political, economic and physical

forces interact with the psychological rhythms

that form the foundation of human existence.

Environmental health is one of humanity's

oldest concernsPrehistoric times, people often attributed

disease to their gods and therefore sought to

pacify these gods.



The Hippocratic concludes that the well-

being of man is influenced by allenvironmental factors : the quality of the

air, water, and food, the wind and the

topography of the land.Great Roman Aqueducts and highly

developed sewage system are testaments to

their concern about the spread of disease.



Environmental improvement and effort

toward the control of communicable disease

continued in the 20th century with widespread use of immunization and the

discovery antibiotics

Then Florence Nightingale identified the

need for a clean environment; she outlined

five essential points in securing the health of houses; "pure air, pure water, efficient

drainage, cleanliness and light.



20th the nurse programs, principles of

public health and community hygiene were

including curriculum. Topics including

"sanitation of food and water, sanitation

system for sewage disposal, adequate

housing, the control communicable disease,

community health problem in child bearing

and childhood and organization of public

health services to maintain health (Grander ;

1936)



What is 'Environmental Health'?

Definition of Environmental Health by WHO Environmental health comprises those aspects of

human health, including quality of life, that are

determined by physical, chemical, biological, socialand psychosocial factors in the environment.

It also refers to the theory and practice of assessing,

correcting, controlling and preventing those factorsin the environment that can potentially affect

adversely the health of present and future

generations.

D fi i i f E i l H l h b



Definition of Environmental Health by

National Institute of Environmental Health

Sciences

Environmental health is the branch of public

health that is concerned with all aspects of the

natural and built environment that may affect

human health. The priorities of the

Environmental Health lie in areas related to

contamination of the environment and thepossible adverse effects of environmental

pollutants on human health.



A conceptual Model of Ecological

System

1. Micro Systems

Are closest to the human population,

the micro systems includes : – The environment immediately

surrounding the person (e.g. the

family and the home).Environment constitute the macrosystem.



A conceptual Model of Ecological

System 2. Macro System

Is the largest context in which the microsystem is embedded. – Culture, traditions, customs, societal,

norms, government, economic

policies, and physical



Sources of Environmental

Hazards

1) Environmental Hazards at Home

2) Environmental Hazards in theOccupational Setting

3) Environmental Hazard in theCommunity



Sources of Environmental

Hazards1. Environmental Hazards at Home

Poisoning: is the major cause of accidental death (lead poisoning,Pesticide poisoning, Mercury

poisoning, Carbon Monoxidepoisoning)



Environmental Hazards at Home

Falls: falls is the other major cause of

accidental death most such accident

happen in the older (poor light, loose

electric cords and rugs). In children,

windows that do not have guards arehazard.



Environmental Hazards at Home Burns: fire and burns are third highest

cause of home death

Suffocation and Drowning: are a seriouscauses of accidental death nearly 800reported death in USA in 1995.

Firearms: it occur annually while peopleare playing with or cleaning firearms, thenumber highest for the 15-24 year oldgroup. and it increased to double insuicidal and more in homicide



Environmental Hazards at Home Garbage:

– A potential source of disease that often taken for grantedis the method of garbage disposable.

– Gaza strip produced 0.68 MCM solid waste .

– Garbage lead to contamination of water supplies

contribute to breeding of bacteria and virus that can

transmitted to humans via insect and rodent and possible

serve as reservoir for disease "gastroenteritis, hepatitis,

polio".Radon: radon has been of great concern in recent

years. radon is an odorless, colorless and tastelessradioactive gas that is the by product of the decay of

uranium it occur natural in the soil.



Environmental Hazards at

Home Lead: lead poisoning is one of the most

significant public health achievement in

recent years (see table1)... Lead - basedpaint, including dust and chips, airborne

from steel structure, contaminated



Table 1: Lead Poisoning And Symptom

Effect

≤ 9 µg/dl

Tranplacental transfer, minimal observable effect

10-20 µg/dl cause toxicity, affect on growth, hearing, IQ.





Effect

21-44 µg/dl vitamin D metabolism, Hb synthesis, mild fatigue

45 - 69 µg/dl Myalgia , irritable, lethargy, gastrointestinal complaint

≥70 µg/dl paralysis, encephalopathy, coma, seizure, colic



Formaldehyde: including carpets, draperies,shampoos, and cosmetics.

Carbon Monoxide: is a colorless and odorless gasthat is a byproduct of combustion. sources areimproperly vented furnaces, blocked flues orchimneys and automobile exhaust, CO can causedizziness, headache, drowsiness, nausea, or flu- likesymptom.

Environmental Tobacco Smoke:

a major source in door air pollution is environmentaltobacco smoke. tobacco has been recognized ascauses of lung cancer and other respiratory diseases

in smoker.





Implication for Nurses

Promotion health and prevent illness

some time primary prevention, involve

education people to eliminate hazardbefore exposure occur. Secondary

prevention or screening for environment

hazardous



Key Area To Assess In The Home

Environment

Neighborhood:

Proximity to industry, highways, land fill,

availably of basic service (health care),transportation, population density, andnoise.

Physical structure:

Cracks in foundation or window, peelingpaint, stair.



Safety issue:

Storage for medication, cleaning supplies, chemical,

firearms, emergency escape, locks on door, outsideplay area.

Sanitation:

water and sewage system, laundry, rodent, pets, andinsect.

Space:

Sleeping area. privacy for members of householdand lighting.

Temperature regulation: type of heat and air

condition and types of insulation



2. Environmental Hazards in the

Occupational Setting

Environmental hazards in the occupational

setting are characterized by a wide range of

health and safety hazard that may result in

the occurrence of occupation injuries and

illness.



Top occupation illness:

1. Disorder with repeated trauma

2. Skin disease and disorders

3. Respiratory disease caused by

toxic agent

4. Poisoning

5. Dust disease of the lung.

R l d F ti f O ti



Role and Function of Occupation

Health Nurse

• Promotion, protection, andmaintenance of the health and safetyof workers.

• Emphasis on wellness and life stylechanges in addition to reduction of risk associated with environment

exposure.



Description of Roles of Occupational

Health and Safety Specialist

1. Toxicologist: studies and describe the

toxic prosperities of agent used in work

application to which worker may expose

2. Industrial hygiene: control and

evaluation toxic exposure and hazard inthe work environment.



3. Occupation physician: focus on prevention,

detection and treatment of work related to work

disease and injuries4. Safety specialist: including safety engineering

and other safety professional also focus on

prevent of occupation disease and injuries5. Ergonomist: studies, designs and promotes the

healthy interface of humans, their tools, and their

work.6. Epidemiologist: studies describe the natural

history of occupational disease and injuries.



Responsibilities of the OHN

• Primary care provider.

• Counselor.

• Advocate / liaison.• Administrator

• Educator.

• Monitor.• Professional member of the health team.

• Researcher.

E i l H d i h



Environmental Hazard in the

Community

• Chemical hazard1. Insulation (formaldehyde CH2O):

expected harmful effect (respiratory allergies)

2. Automobile exhaust (lead):expected harmful effect (behavior disorder,neurological symptom)

3. Pesticides (polychlorinated biphenyls {PCB}):

expected harmful effect (Chloracne, liver disease)



• Biological: (Infectious)

1.Water supply (Giardia lamblia): expected

harmful effect (diarrhea, bloating, mal

absorption)

2.Food (Salmonella): expected harmful effect

(fever, nausea, diarrhea)

3.Mosquito (Malaria): expected harmful effect

(fever, chill)



• Physical 1. Physical hazard (faulty construction):

expected harmful effect (death or injuries)

2. Noise (motor vehicles i.e. airplanes, cars,motorcycle) expected harmful effect (hearing

problem stress fatigue)3. Radiation (radon gas): expected harmful

effect (infertility, birth defect, leukemia).



• Psychological

1.Natural disaster (e.g. flooding): expected

harmful effect (hypertension)

2.Low economic status (unemployment):

expected harmful effect (heart disease, ulcer)

3.Multiple role demand (working parent):

expected harmful effect (depression, anxiety).

E i t l I f



Environmental Issues forthe 21 st Century

1. Clean air and water

2. Air pollution

3. Water and soil pollution

4. Hazardous wastes.



The Nurse's Responsibilities

Primary prevention

• Advocate safer environment design of

product, automobile, equipment and

building

• Teach home safety relate to falls and fire.



• Counsel woman of child bearing

• Develop work site health and safetyprogram

• Advocate vehicle protection system

such as seat belt.

• Immunization occupationally exposedworker for hepatitis B

• Support programs for waste educationand recycling



Secondary prevention

• Assess home, schools, worksites andcommunities for environmental hazard

• Screen children from 6 month to 5

years age for blood lead level• Monitor worker for levels of chemical

exposure

• Screening at risk worker for lungdisease, cancer and hearing loss.



Tertiary prevention

• Encourage limitation of activity when air

pollution is high.

• Support cleanup of toxic waste sites andremoval of other hazards.

• Refer homeowners to approved lead

abatement resource



Environmental Health in

Gaza StripEach student should write report abut

environment Gaza Strip



Background of Environmental Health in Gaza Strip

Gaza Strip is a semi-arid region of roughly 365 km2 whichlies on the Mediterranean Sea. On this narrow strip, almost1.4 million of the Palestinian people live and work.

A " Catastrophic" water shortage, water pollution with high

salinity and micro-pollutants, lack of sewage and solidwaste treatment, maritime pollution, overcrowding, povertyand uncontrolled use of pesticides are the most pressingenvironmental problems in Gaza Strip.

Internationally suspended, banned and canceled pesticideswhich considered mutagenic and carcinogenic are still usedin the agricultural environment.



Mediterranean Sea is used for the disposal of sewage

water, solid wastes, agricultural and industrial waste water.

In general these environmental problems have multipliedthe Palestinians human environment problems, socio-

economic problems and increasing health hazards.

Therefore, the environment in Gaza Strip requires a morethoughtful and comprehensive policy and planning of awareness and conservation.



Water Importance

Water is one of the essential components of the human body.It plays active role in the physiological process that is

necessary to human life. Water is essential for heatregulation, acid-base balance, excretions to toxins and wastematerial and metabolism of all food material.

Sources of water

The underground water is the main source of water inGaza Strip. Wells are used to get the underground water.



•Raining water is used in West Bank. The water is collected inprivate store under each house. The family uses this water duringall the year.

Surface water could be from rivers or lakes. Tabria lake is oneof the main water store in Palestine.

The main source of water in Gaza Strip is the ground water(about 5000 well) which is used for irrigation, industrial anddomestic purposes. The consumption about 120 MCM / year andthe recharge about 70 MCM /year. In Fact, per capita waterconsumption in Gaza Strip is less 4 – 5 times other countries.

This has led to the depletion of available quantities in Gaza Stripand reduction of ground water storage as well as the degradationof water quality.



Water Characters:

1- Physical: the water should be colorless, tasteless andodorless. Change of odor, color or taste indicates waterpollution or contamination.

2- Biological: Drinking water should be free from allmicroorganisms. The best indicator for water contaminationis the presence of E. Coli indicates fecal contamination.

3- Chemical: The accepted level of chemical

concentration is referred to the maximum concentration of specific material in water that if exceeded it will endangerhuman heath .

W t ll ti



Water pollution

Types of water pollution:

1- Organic wastes from domestics.

2- Infectious agents contributed by domestic sewage.

3- Plant nutrients as algae.

4- Synthetic organic chemicals as pesticides, detergents… etc.

5- Inorganic chemicals and minerals substances.

6- Sediments that fill stream channels and reservoirs.

7- Radio – active pollution



Health Hazards of Water

Water Sources in Gaza Strip are subjected to excessiveover- exploitation and over - pumping , this has led todegradation of water quality in Gaza Strip , where severewater shortage (about 50 MCM / year) are experiencedand where the situation has become catastrophic.

Water Pollution with different pollutants (Salinity suchas Chloride and Nitrate and Micro - pollutants such asPesticides, Fertilizers & Detergents).

For example chloride and nitrate concentration in somewells reaches more than 1500 and 100 ppm respectively.



Palestinian and German scientists have recommendedto the Palestinian Authority to take immediate measures tocombat excessive nitrate levels in the drinking water.

90 % of Gaza Strip water samples were found to containnitrate concentrations that were between two and eighttimes higher than the limit recommended by the (WHO).

Over the long term they recommend that the bestprotection would be provided by quality managementfor groundwater resources.

In babies younger than six months, nitrate can lead tomethaemoglobinaemia, to diarrhoea and to acidosis. TheWHO recommends keeping nitrate levels to 50 mg/ L orless.



Waste Water

Gaza Strip produced about 35 MCM / Year sewagewater. Unfortunately about 50% the raw sewage isdischarged untreated in the Mediterranean Sea wherethe biological oxygen demand increases.

The rest of sewage is collected in three central sewagecollecting pools with semi treatment such as the firststep of primary treatment which is the aeration and

sometimes the secondary treatment. When these poolsfilled with sewage water, it's flooded aside and pollutesthe ground water because our aquifer is shallow.



Sewage networks cover no more than 70 % of totalresidential areas in the Gaza Strip. So far, there is noadequate sewage collection and treatment facilities where

use of septic tanks to drain waste water is still widespreadthus causing, through leakage , the contamination andpollution of the aquifers and increasingly saline.

Open sewage channels spread in some parts of the GazaStrip, particularly in refugee camps, creating health hazardsthrough the accumulation of garbage and wastes.

The situation is so dramatic that during a visit to the West

Bank and Gaza Strip in January 1988, the BritishMinister of the Foreign Office David Miller described thesituation in the Occupied Palestinian Territories as being anaffront to civilized values.



Waste Water Disposal

Waste water disposal is of great importance for populationhealth because of the main link between human excretaand transmission of disease from one person to another.

It is important that adequate disposal measures areapplied to control this method of disease transmission.

All liquid wastes should be handled properly in a sanitarymanner.

Industrial wastes are a special problem endangers thehealth of communities if not managed properly.



Health Hazards of Waste Water * Disease transmission: most of enteric diseases could be

transmitted from one person to another throughcontaminated environment such as Cholera, Typhoid,Dysentery, Parasites, polio and Hepatitis.* Bad smell resulted in psychological disturbance.* Sewage collection is a breading place for insects asmosquitoes and flies.* Contamination of underground water by biological andchemical pollutants.

Management of Sewage:Treatment: Biological treatment is performed by

these mechanisms:a. Filtration b. Aeration (حيِ وْ رَ ت , َة يِ وْ هَ ت ) c. Disinfection

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Solid Waste Gaza Strip produced about 0.68 MCM/Year solid

waste. There are no enough dumping sites, sanitarylandfills, containers and vehicles. Therefore, thesolid waste is sometimes thrown everywhere.

Gaza Strip utilizes the old method of landfills fordisposal thus negatively affecting the environment.

This of course leads, in turn, to the spread of diseases and increases the difficulties encounteredfor disposal.



Sources of Solid Waste

a- Houses are the main source of the solid waste and arethe main place, which necessitate proper waste disposal.

b- Streets this is mainly dust and the amount of solidwastes depends on the population orientation to theirhealth. Healthy communities have clean streets.

c- Industries result in huge amount of solid waste mainlymetals, containers and carton, this waste could be

dangerous if it contains chemicals or poisonous material.



d- Hospitals, domestic wastes and medical wastes

are thrown daily from hospitals. Hospital wastes shouldbe managed carefully where it contains contaminatedsyringes, gloves, cotton and utensils of patients. Thismaterial could be a source of infection for the community

if not managed properly.



Solid Waste disposalExtensive development of incinerators, improved collection trucksand procedures, solid wastes collection and disposal has assumed

its place as protective measures for the public health.

Hazards of Solid Wastes

1-Socio – psychic:

The population does not accept the sight of wastes. The heaps of waste could result in fire with all the hazards associated with thisunsatisfactory event.

2-Economic:

Disposal of the waste without proper utilization is an economicloss. Recycling is one of the ways were the material could be usedagain .



3-Health Hazards:

1- Fly& Rodent: Refuse is a good media for breading of flies

and rodents. Both of them are harmful for human health.

2- Mechanical injuries: Where children are exposed towounds and injuries if they handle the refuse un- properly.

3- Chemical pollution: Chemical hazards are common infactory waste.

4- Bacterial contamination: The chance of bacterialcontamination is higher when hospital is present. Putrefaction of

the organic material results in production of a great number of pathogens that could influence human.



Management of Solid wastes:

Management of solid wastes includes theseitems:

1- Collection2-Transport

3- Disposal

a- Dumping b- Incineration c- Recycling



Pesticides & Toxic Substances Pollution

More than 350 metric tons of formulated pesticides (more

than 100 pesticides) in addition to 800 metric tons of Methyl Bromide are used annually in Gaza Strip.

Such heavy use of pesticides causes water pollution and

soil degradation and contamination of the agriculturalproducts which finally affect seriously the human andanimals.

It was found that 19 of these pesticides, that have beenused, are internationally suspended, cancelled and bannedpesticides, according to their mutogencity, carcinogencity, teratogencity and delayed neurtoxicity.

Abo t 5800 cases of cance ha e been egiste ed in Ga a



About 5800 cases of cancer have been registered in GazaStrip (1990 - 1999). The distribution of cancer types amongthose patients are lung cancer, breast cancer, lymphoma

and leukemia malignancy, head and neck, gastrointestinalmalignancy, reproductive system, urinary system, softtissue tumors, brain tumors and others .

Consequently, the introduction and heavy use of pesticidesand other toxic substances in the Gaza Strip environment issuspected to correlate with the growing incidence of cancerand other abnormalities in the nation.

Precise determination of the effects of chronic exposure is,therefore, urgently needed. Finally, it is the responsibility of the civilized world to take the initiative towards regulating,production, exportation and importation of any suspected

cytotoxicants.



Air Pollution Definition of Air Pollution: Concentration of foreign matter in the air

which adversely affect the health and welfare of the people or theirenjoyment. The most severe pollution is the chemical pollution.

In Gaza Strip there is a large number of transportation meansestimated at about 35,000 to 45,000 motor vehicles that constitute the

major source of air pollution.

Car exhausts release to the air large quantities of carbon monoxide,carbon dioxide, nitrogen oxides, hydrocarbons and lead that areconsidered very poisonous and some may be carcinogenic and mayaffect the respiratory and nervous system.

Melting Lead and burning solid wastes are other major sources of airpollution in Gaza Strip.



Food HygieneThe primary objective of sanitary supervision over allplaces where food is prepared and served to the public is

to prevent illness and possibly death from spoiled orcontaminated foods.

The local health department is responsible for protecting

the public’s health against food contamination.

Salmonella and staphylococci gastroenteritis germs arevery prevalent and multiply rapidly in food and thus andfood poisoning are the predominant infections transmittedby food.

Other diseases transmitted by food include typhoid fever,amebic dysentery and bacillary dysentery.

FOOD – BORNE DISEASES:



I. Biological Agents

1. Food intoxication and bacterial infections:1-1 Botulism: performed toxins produced by the growth of (Clostridium botulism) in food under anaerobic conditions causeBotulism. Symptoms develop in 2 hs to 8 days.

1-2 Staphylococcus food poisoning: The onset is 1-6 hours after

ingestion

1-3 Amine poisoning:Cheese and alcoholic drinks or certain tranquilizers can result in suchpoisoning

1-4 Salmonellosis:Contamination of food by salmonella poses a significant public healthproblem



Other bacterial infections:- Typhoid fever - Shigellosis - Hemolytic

Streptococcal infections- Enterococci - Brucellosis - Cholera- Dysentery‘s

Viral Infections:-Infectious hepatitis-Others such as: poliomyelitis



• Parasitic infections:- Amebiasis - Tenia - Tape worm diseases- Trichinosis from pork food - Giardiasis - Ascariasis

Chemicals and Radiation:Zinc, lead, Nicotinic acid, mercury acid, mercury,

fluorine, lithium chromium, iodine, silicon, magnesium ..etc. pesticides are famous and known source of healthhazards that endanger human life.



How can the environment affect our health?

For better or worse, chemicals and othercontaminants have become a part of everyday life.They exist in every aspect of our lives even beforewe are born. Hundreds of new chemicals arecreated every year.

Exposure to large amounts of any substance can beharmful to one’s health. However, some

contaminants are more harmful, or toxic, thanothers.



• There are many types of toxicity. When thinking abouttoxicity, researchers consider a chemical’s ability to cause

or promote cancer, or cause neurological problems(damage to the brain and nervous system), respiratoryproblems (like asthma), and reproductive problems(chemicals that may harm the developing fetus, or anindividual's ability to conceive).



It is important to remember that somechemicals in small amounts can improve orprotect one’s health. Chlorine, which is used

to purify drinking water, can be toxic inlarge quantities. In small quantities itprotects us from cholera and other diseases.



Major environment-related killers in children underfive years of age (WHO)



five years of age (WHO)

Diarrhea kills an estimated 1.6 million children each year,

caused mainly by unsafe water and poor sanitation.

Indoor air pollution associated with the still-widespreaduse of biomass fuels kills nearly one million childrenannually, mostly as a result of acute respiratory infections.

Malaria, which may be exacerbated as a result of poorwater management and storage, inadequate housing,deforestation and loss of biodiversity, kills an estimated

one million children under five annually, mostly in Africa.

Unintentional physical injuries, which may be relatedto household or community environmental hazards, killnearly 300 000 children annually.



The solutions

In many cases, low-cost solutions for environment andhealth problems exist. For instance, simple filtration anddisinfection of water at the household level dramatically

improves the microbial quality of water, and reduces therisk of diarrhea disease at low cost.

Education is also a key - mothers who receive the

information they need to understand the environmentalrisks present in their homes and communities are betterequipped to take appropriate action to reduce exposure.



• Improved stoves reduce exposures to indoor airpollution. Better storage and safe use of chemicals

at community level reduces exposures to toxicchemicals, especially among toddlers, whoexplore, touch and taste the products found athome. Personal protection from malaria through

the use of insecticide-treated mosquito nets has aproven track record of saving lives, particularlychildren's.



What can we do to tackle the environmental risks to

our children?

The Healthy Environments for Children Alliance (HECA)promotes a number of simple, low-cost, effective and

sustainable measures to combat the environmental risks toour children.

Household water security Safe water storage at home – and treatment of water in

the home when its quality is in doubt - reduces watercontamination and leads to proven health benefits.



• Hygiene and sanitation Wash hands with soap before food preparation, before

meals and after defecating significantly reduces the risk of diarrhea disease.

• Follow the WHO Five Keys to Safer Food to reduce

the risk of food borne disease: keep clean; separateraw and cooked; cook thoroughly; keep food at safetemperatures; and use safe water and raw materials.



Air pollution

Good ventilation in the home, clean fuels and improvedcooking stoves decrease indoor air pollution and theexacerbation and development of acute respiratoryinfections.

Disease vectors As children usually go to bed earlier than adults at the timemosquitoes become active, the use of insecticide-treatedmosquito nets and the screening of windows, doors and

eaves provide a very effective means of protecting themagainst malaria.



• Chemical hazards

Ensure safe storage, packaging, use and clear labeling of cleaners, fuels, solvents, pesticides and other chemicalsused at home and in schools.

• Unintentional injuries Advocate for safer roads and organized traffic

Housing and Health



Housing and Health

Housing is a basic determinant of health, andmany organizations, including the World HealthOrganization (WHO) and the American PublicHealth Association (APHA), have developed

standards for healthy housing.

The most important role of housing is to provideshelter from the elements. At its most basic level,

housing needs to keep its inhabitants dry, warm(or cool), and safe.



For more info of what is possible,please refer to the HECA

website:

www.who.int/heca/en



Strategic objectives

*Strengthen the capabilities and information exchangerelated to health, and environment (water, air, hazardouswaste. vectors).

* Protect portable water, indoor and outdoor air frompollution.

* Protect form hazardous waste effects of environment & health



* Protect the public from vectors and toxic materials.

* Collaborate with the national local authorities in thecreation of supportive environment for health.

* Promote the environment of the non- governmental

organization in planning and implementation of national plans and meeting national goals withspecial emphasis on health education.



Recommendations

1- Making environmental assessment by:a. Identifying the hazards present.b. Assess the effect of these hazards on the health of Individual, families and communities.

c. Assess the risk factors.d. Diagnose and reasoning the environmental influence athealth

2- Playing to control environmental hazards by primary,

secondary, and tertiary prevention by increase healthEducation, treatment and rehabilitation.



Conclusion and Comments

The environmental health is very important topic inrelation to health and disease.

Clean air and water and effective waste managementremains critical issues for 21st. century.

Increase scientific knowledge will decrease the hazards,

which result from the environment.

S th f ti l d h



So the use of preventive measures also decrease suchhazards.

Good health education and programs contribute inlarge benefit in the preventive measures.

The degree of development of the country also assists

this subject.

Increase awareness among population also decreasesthe hazards and deceases the number of risks people.



Thank you

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