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HEALTH CARE ENVIRONMENT

INTRODUCTION
Good health is fundamental right of every human being. Good Health is essential to
lead a quality and successful life. Environment is a multidisciplinary subject. The
environment is an open system which is every changing. The system of interaction between
biological and physical environment is called as ecological system. Every change in the
environmental conditions affects the health; clean and safe environment can be termed as the
basis of good health.

Nursing as a health care profession and environmental health as a public health


discipline share many of the same roots. Since environmental health is “a good fit with the
values of the nursing profession regarding disease prevention and social justice.

DEFINITION
HEALTH

 Health is a state of complete physical, mental and social well-being and not merely an
absence of disease or infirmity(WHO)

ENVIRONMENT

 Environment refers to the sum total of conditions which surround a man at a given point in
space and time.(Chris Park)
 Environment is the sum total of all external conditions and influences on the development
cycle of biotic elements over the Earths surface(Herskovits)

ENVIRONMENTAL HEALTH

 According to WHO, environmental health is defined as the control of all those factors in
man’s physical environment while exercises or may exercise harmful affect on his physical
development, health and survival.
 According to Judith Ann Allender and Barbara Walton is defined environmental health is
concerned with assessing, controlling and improving the impact of the environment on them.
 According to K.K Gulani, environmental health can be defined as an act and science
promoting positive environmental factors and prevention and control of all the potential
hazards including physical, chemical, biological and social factors which have deleterious
effect on health of people.

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THEORY OF NURSING
FLORENCE NIGHTINGALE’S ENVIRONMENTAL THEORY OF NURSING

The core concept that is most reflective of Nightingale’s writings is that of environment.
Although she tends to emphasize the physical more that the psychological or social
environment, this needs to be viewed in the context of her time and her activities as a nurse
leader in a war-torn environment.

The environment is viewed as all the external conditions and influences affecting the life
and development of an organism and capable of preventing, suppressing or contributing to
disease or death. Nightingale’s writing speaks of providing such things as ventilation, clear
air and water, cleanliness and warmth, so the reparative process that nature has instituted will
not be hindered.

Medical practice is not viewed as a curative process but as having the function of
assisting nature. Thus, nursing is also a non-curative practice in which the patient is put in
the best condition for nature to act. This condition was seen by her as enhanced by providing
an environment conducive to health promotion.

At this point, it is helpful to think of a patient who has had surgery and to relate what
Nightingale proposes. Medicine is seen as functioning to remove the diseased part, whereas
nursing places the patient in an environment in which nature can assist postoperative patient
to reach his optimal health condition

NIGHTINGALE’S ENVIRONMENTAL CONCEPTS

Major areas of concentration Examples


1. Ventilation Fresh air, which is of primary importance, can be
achieved through open windows. An outlet is needed
for impure air. Drafts caused by open windows and
doors are to be avoided.
2. Light Second only to the need for fresh air is the value of
light. Beds should be placed in such position as to
allow the patient to see out the window – the sky and
sunlight.
3. Warmth Guarding against the loss of vital heat is essential to the
patient’s recovery. Chilling is to be avoided. Hot
bottles and drinks should be used to restore lost heat.
4. Effluvia (smells) Sewer air is to be avoided and care is needed to get rid
of noxious body odour caused by disease.
5. Noise Intermittent sudden noise causes greater excitement
that continuous noise, especially during patient’s first
sleep. Whispering, or discussing a patient’s condition
just outside his or her room is cruel.

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IMPORTANCE OF ENVIRONMENTAL HEALTH
a) Improving the individual and community health status.

Many factors influence health and wellbeing in a community and many


entities and individuals in the community have a role to play in responding to community
health needs. The committee sees a requirement for a framework within which a community
can take a comprehensive approach to maintaining and improving health; assessing its health
needs, determining its resources and assets for promoting health, developing and
implementing a strategy for action, establishing where responsibility should lie specific
results

b) Protection against diseases.


Healthy habits and healthy surroundings helps to protect from diseases.
c) Controlling the environmental pollution and protecting the environment.
Environmental pollution can be reduced by decreasing the population,
industrialisation, also prevent the human activities such as agriculture and deforestation.
d) Providing healthful environment.
By controlling pollution, effective use of natural resources and keep the
environment clean.
e) Encouraging the environmental education.
Education given regarding the protection of the environment, eradication of poverty,
minimization of inequalities and insurance of sustainable development
f) Coordination with in the efforts of environmental health team.
Environmental health can be achieved through coordinated efforts; therefore
community health nurse should be aware of the environmental health team. Members of this
team include physician trained in public health, public health nurse or community health
nurse, epidemiologist, public health engineer, sociologist, economist, health inspector, town
planner and auxiliary staff.

ENVIRONMENT – A GLOBAL CONCERN


Awareness about environment has increased over past few years all over the
world. This thought has gained momentum that, environment protection is very important for
maintaining the social and economic progress of a country.

According to expert committee of public health system says that agricultural rural,
industrial, urban development affects the environment and the imbalance or disturbing of
environment has undesirable effect on health. It also assessing the ill effect of large
development plans over the health should be an integral part of the assessment of plan itself.

 . Earth summit

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In 1992 Earth summit was held at Rio-de-Janeiro, in which more than 100 countries
has accepted the agenda-21 under international work plan. The agenda of this conference was
focused on overall environmental duties of nation in their totality, while whole-heartedly
supporting their development. In June 1997, this agenda was again discussed in the special
session of the general assembly of UN on environment. Now it has been accepted that there
should be proper balance between the limits of natural resources and maintenance and
developmental needs of a nation.
India has signed agenda-21.The policies of Indian government about environment,
population and conversation of forests and natural resources have always reflected the effects
of agenda-21.India believes that the issues of international environment –depletion of ozone
layer, green house gas effect and the atmospheric changes caused by it, damage to the bio
diversity etc are the results of industrialization in developed countries.

 United Nations Framework convention on Climate change-UNFCCC.


UNFCCC is an international environmental treaty produced in the earth summit
held in Rio-de-Janeiro in1992.The objectiveof the treaty is to stabilize green hose gas
concentrations in the atmosphere at alevel that would prevent dangerous anthropogenic
interference with the climate system. UNCCC entered in to the force in 1994
 Johannesburg summit.
After 10 years of earth conference, Johannesburg summit was organised in 2002(26
august 2002 to September 2002).It was the biggest conference on environment. The main
objective of the summit was reweing the agenda 21 which was accepted in Rio-de-Janeiro in
1992.Head ot their representative of more than 190 countries joint the summit. India was the
prominent figure in Johannesburg summit and we were able to raise the issues in the interest
of developing countries. After long discussion summit accepted the disputed work plan on
poverty and environment. Although there were lot of discrepancy among the developed,
undeveloped and developing countries but at the end, all countries agreed on the action plan.
The main attention of summit was on water, energy, health, agriculture and biodiversity.
 Kyoto protocol
The Kyoto Protocol is a protocol to the United nations Frame work convention on
Climate Change (UNFCCC).The protocol was initially adopted on December 1997 in
Kyoto(Japan) and entered in to force on 16 February 2005.As of November 2009,187
Governments have signed and ratified the protocol.
Under the protocol,37 developed countries (called annex I countries) commit themselves
to a reduction of four greenhouse gases( carbon dioxide,methane,nitous oxide,sulphar hexa
fluoride) by them, and all member countries give general commitments. It is important to
mention that protocol allows for several flexible mechanisms to industrial countries.
 Copenhagen Summit
The United Nations climate Change Conference known as Copenhagen summit was held
in December 2009 at Copenhagen(Denmark).The aim of Copenhagen summit was to make

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agreement on a new climate treaty to replace the Kyoto protocol which is in force from 2005
and end in 2012.The Copenhagen summit included the 15th conferences of the parties(COP-
15) to the UNFCCC and the 5 th meeting of the parties(COP-5)to the Kyoto Protocol. Total
192 parties had joined the summit.
The Copenhagen accord was drafted by the US, China<India<Brazil and South
Africa. But it was not passes unanimously. The document recognized that climate change is
one of the greatest challenges of the present day and that action should be taken to keep any
temperature increases to below 2degree Celsius. Many countries and organisation opposed
the agreement, but as of Jan, 2010, 138 countries have signed the agreement.

FACTORS AFFECTING HEALTH


Major issues

Seven major issues which will directly or indirectly affect health have been
identified.

 Population: There was little change in population growth rates by the year 2000.Now the
world population is 7.6 billion,Indias population is 1.34 billion and in kerala 34.5 million
 Food Production: Worldwide food production as projected to increase by 90% between
1970 &2000.However, the largest increase of food will occur in richer countries and the
countries of middle east. Africa and southern Asia will continue to have inadequate amount
of food for their people.
 Natural Resources: Non fuel resources appeared sufficient to meet demands through the
year 2000, but discoveries and investments will be needed to maintain reserves
 Water: Shortages will become more severe, over-pumping of ground water, poor land use
practice and pollution of existing water supplies will reduce the availability of water at a time
of rising need.
 Forests: Loss of forests will continue over the next 20 years.
 Wild life: Rates of extinction will increase sharply resulting in loss of hundreds of thousands
of species, especially in the tropical forest regions.
 Pollution: increased emissions of carbon dioxide and chlorofluorocarbons in the atmosphere
are threatening to alter the world’s climate and upper atmosphere significantly by 2050. Acid
rain from the burning of fossil fuels is affecting increasingly wider areas with damage to
lakes, soil and crops.

Global warming.

As a result of increased burning of fossil fuels, deforestation and the production of


certain synthetic chemicals, there is dramatic increase in heat trapping gases in the
atmosphere. Carbon dioxide is the major offender, allowing energy from the sun to pass
through, while absorbing radiation from the earth and creating a planetary hot house.

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NASA (National Aeronautics and Space Administration) has reported that the
atmospheric ozone layer, which protects life from harmful ultraviolet radiations, has begun to
think globally. As ozone layer diminishes in the upper atmosphere, the earth receives more
ultraviolet radiations, which promotes skin cancers and cataracts and depresses the human
immune system.

Acid rain

Acid rain is caused by emission of sulphur dioxide and nitrogen oxides. Nitrogen
oxide, formed when fuel is burnt at high temperature, come principally from motor vehicle
exhaust, electric utilities and industrial boilers that burn coal or oil. Once released into the
atmosphere, these compounds can be carried long distances by prevailing winds until they
return to the earth as acid rain, snow, fog or dust. Fish and wildlife suffer harm, lakes are
contaminated, buildings and statues deteriorate and people experience health problems such
as respiratory impairment.

ENVIRONMENTAL INFLUENCES ON HEALTH AND ITS MANAGEMENT


A. Toxic agents
Asbestos: It has been linked to disease such as ling and GI cancer and mesothelioma
Lead: Lead biologically interferes with blood formation often resulting in anaemia. It can
also cause kidney damage, birth defects injury to the CNS, poor memory, hair loss,
hypertension, mental retardation convulsion, coma and death.
Pesticides: pesticide residues are contact poisons and tend to accumulate in fatty tissues in
living organisms and remain in the body indefinitely.
B. Air pollution
Air is the basis of life for all creatures, clean air is essential to have good
health. Change in the composition of air generates dangers for health. From a developing
country like India to developed countries like Japan, America and England etc, air pollution
has become a health hazard. The WHO estimates that about two million people die
prematurely every year as a result of air pollution. Air pollution is responsible for the
disorders of respiratory and nervous system, heart diseases; TB etc.Air pollution has become
a serious threat to the health.
Pollution is the process of mixing of the elements of natural environment with those
of the external environment and becoming active in a negative and destructive direction,
leaving their natural course of action. In perspective of this definition, air pollution is a
condition in which dust, smoke, toxic gases, chemical vapours and scientific experiments
affect the natural composition of air. In other words when air becomes harmful for the man
and his environment due to excess of external elements that condition is termed as air
pollution.
Causes of air pollution

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It is necessary to know about the sources and cause of air pollution so that proper
assessment of the air pollution can be made.
(i) Industrial source
Smoke, carbon dust and gases emanated by different chemical industries, oil
refineries, fertilizers and insecticide factories, metal extraction units pollutes air. The
combustion performed in industry is mainly responsible for air pollution.
(ii) Domestic source
Wood, coal, gas, oil etc are used as fuel in homes for cooking food and other works,
smoke, dust, carbon and other gases produced by these influence the composition of air.
(iii) Scientific Research
Explosions and reactions performed for the research and development of nuclear
techniques, space journeys and atomic power, pollute the environment. Destruction of
spacecrafts, missiles and weapons radioactivity and imbalance in the temperature ultimately
result in environmental pollution.
(iv) Transportations
The increasing number of private vehicles, not only in cities but also in small towns
and the uncontrollable traffic are becoming major sources of air pollution. More than 60% of
air pollution is due to traffic or transportation.
Almost all means of transport, tractor, bus, scooter, motorcycle, jeep, car, jugad (a
vehicle used in rural areas that runs on diesel) are responsible for air pollution. They keep on
expelling hydrocarbons, carbon monoxide, nitrogen oxide, lead and particles of soot and
other substances in the environment. Vehicles running on diesel, produce lot of smoke and
thus, increase air pollution.
(v) Other substances
Other than these, following sources are also responsible for air pollution:
 Spraying fertilizers and insecticides.
 Burning waste (plastic, tyres etc )
 Greenhouse effect and change in ozone layer of the atmosphere.
 Decreasing forest resources and reckless cutting of trees for industrial use/housing etc.
 Use of chemical gases in war.
 Spilling of petrol and oil in the sea and its burning.
Air pollutants

A large number of substances responsible for air pollution. The air


pollutants can be kept in two categories:

 Primary pollutants: These are emitted directly from identifiable sources, which may be due
to natural events or human activities, it includes; carbon oxides ( CO and CO2), Nitrogen
oxide, Sulphur oxide, volatile organic compounds and suspended particulate matter (SPM).

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 Secondary pollutants: These are produced in the atmosphere when certain chemical reactions
occur among the primary pollutants. It includes sulphuric acid, carbonic acid, nitric acid etc.

Cleansing mechanism of Air

Proportion of various gases and other substances remains almost stable in the
composition of air. If external substances do not interfere in the arrangement of nature, the
process of cleansing the air continues automatically and uninterruptedly in the environment.
Following factors play an important role in this process:

 Flow of Air: Movement of air dilutes or weakens the impurities. They drift away or do not
get collected at one place, due to which clean air continues to replace the dirty air.
 Rain: It washes the air and removes the external particles floating in it. This is why; the
environment appears very clean and pleasant after rain.
 Oxygen and ozone: They continue to clean the air, by oxidizing the carbonic substances
present in it.
 Sunlight: The light and the temperature of sun continue to clean the air, by destroying
bacteria present in the environment.
 Vegetative life: Plants with green leaves consume carbon dioxide during the day and release
oxygen, thus increasing the availability of oxygen essential for life. This is the one main
reason for giving maximum importance to plantation, in conservation of environment.

Methods of control and prevention

To solve the problems of air pollution and to develop protective measures against it, various
countries have launched unified programmes under WHO. Lack of awareness and resources,
to solve this problem is a major hindrance in India. Air pollution can be controlled only by
joint efforts. Following measures can be taken for it:

 Primary control

If the sources of air pollution (domestic, industrial, vehicular etc.) are checked at the primary
level itself, then the problem of air pollution can be solved to a large extent. Changing the
quality of fuel, use of smokeless stoves and applying proper methods of waste disposal is
essential for it.

 Primary control related to traffic includes:


 Reducing the number of private vehicles.
 Proper facilities of public transport system.
 Invention and production of vehicles running on solar, water, gas (eg, CNG, LPG) and
electrical energy to replace the vehicles using petrol and diesel.
 Use of unleaded petrol.
 Determining the age of vehicles.

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 Stopping overloading of vehicles.
 Offices and private organizations should use contract buses, chartered buses to discourage the
use of individual motor cycles, cars, scooters and automatic bikes.
 Legal control
 To set-u and strengthen industrial pollution control boards at the state and central level.
 Imposing environment tax to prevent pollution.
 Pollution under control certification should be made compulsory and air law (1981) should be
implemented properly.
 Private organizations should be forced to protect environment.
 Mass Education

It is not possible to control air pollution without the participation of public, therefore
it is significant that due importance is given to air pollution in health education. Citizens
should be made aware of their rights and duties regarding this. Departments of transport,
police, engineering, forest and medical and health should be held jointly and equally,
responsible for it. Voluntary organizations and local administration should also discharge
their responsibilities in this matter.

 Other techniques
 Plantation by government and voluntary organizations should be encouraged.
 Deforestation should be discouraged.
 Industries should be set up away from residential areas.
 Proper methods of waste disposal should be used.
 Pools (sharing of a vehicle by a number of people) should be preferred to travel in private
vehicles.
 Mask, glasses or helmet should be discovered to replace wood.
 Developing green belts around industries and residential areas.
C. Water pollution
The most pressing health problems related to water quality involve contamination of
waterways with the microbial pathogens found in human body wastes, a problem directly
related to lack of or faulty sewage disposal facilities. Swimming facilities such as swimming
pools, hot tubs and natural bathing areas like lakes, rivers, and ponds are sometimes
dangerously polluted and provide a medium to vectors to flourish.
Water pollution is measured in terms of the quality of water. Water that carries
infections, toxic chemical substances, industrial waste, sewage and other impurities, is called
polluted water. Presence of one or more of these substances changes the colour, odour and
portability of water. These also affect the physical and chemical properties of water. In
short, water pollution means contamination of water due to any impurity.
Contaminated and polluted water now kills more people than all forms of violence,
including wars.

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 Sources and Causes of water pollution

Water may get polluted by a number of impurities. Sources of water pollution or the
impurities of water can be divided into two categories:

 Natural Impurities
a) Dust and soluble gases : Carbon dioxide, Hydrogen-Sulphide, Nitrogen, Ammonia etc
b) Soluble Minerals : Calcium, Magnesium, sodium, iron, Lead,
salts of manganese etc.

c) Vegetable impurities : Microplants, algae, dry leaves etc.


d)Pathogenic agents or impurities : Bacteria, virus, ova, worms, cysts etc.

e)Inorganic impurities :sand, soil, sludge, particles of sediments etc.

 Acquired impurities
Human activities are the main source of these impurities. Water pollution is
becoming a serious health problem due to increasing industrialization and urbanization.
Acquired impurities polluting the water include:
a) Sewage: Organic substances present in the sewage absorb the oxygen, kill the fishes and
generate foul smell in water. Pathogenic bacteria and other substances present in sewage
become the cause of waterborne diseases. At most of the places, river water has been
polluted by the sewage.
b) Industrial refuse or waste: Industrial refuse of the industries like paper, cloth, alcohol, jute,
sugar, steel, tanneries, oil refineries, paints and fertilizers completely pollute the water on
being released in it. Properties and potability of water, is destroyed and the toxic substances
present in the wastes become a serious threat to the health. Water or rivers (mainly Ganga
and Yamuna) flowing near factories is not drinkable any more due to industrial wastes
released in it.
c) Agriculture borne pollution: Excessive and indiscriminate use of chemical fertilizers and
insecticides to increase the agricultural production has not only damaged the fertility of soil
but also polluted the water as these substances flow into water and get dissolved into it.
Similarly, disposing off the weeds and other agricultural waste material into water also
pollutes it.
d) Physical pollution: Physical causes like thermal pollution, acid rain and radioactive
substances are also responsible for water pollution.
e) Inappropriate social traditions: Water pollution also increases by disposing of the dead
bodies and carcasses of animals in water collective bathing at religious places and immersing
the used items of worship in water.
PREVENTION AND CONTROL OF WATER POLLUTION

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Like air pollution, water pollution is also controllable. The major concern is for
supply of safe water for drinking in all areas. in response to various potential water pollutants
and their sources, the following measures are being taken to prevent and control water
pollution.
 Safe Disposal of excreta and sewage
In rural areas safe disposal of excreta is encouraged by having sanitary latrines such as
bore hole water seal, septic tank latrines and Sulabh Shauchalaya through education and by
providing technical knowhow assistance. Sulabh Sauchalya which is a water weal type of
latrine is used in many parts of India.
Sulabh International an organization have devised sulabh community Latrines which can
be used by organised community groups in villages, urban slums, during festival and melas
etc.This organisation constructs and maintains these latrines. Delhi Government has adopted
this system of sulabh shauchalya for its slums. These latrines are successful where there is
regular and adequate water supply. But these latrines are eco-friendly and help in prevention
of contamination of underground and surface water both.
In towns and cities, human excreta and waste water from residential; areas are removed
through underground sewerage system to a sewage disposal treatment plant. The
effectiveness of this system depends upon effective system of underground pipe lines for
supply of water and drainage system for carrying sewage. The system requires good
maintenance of pipe line and drains so that there is no cross connections to contaminate
water.
The sewage gets purified by mechanical and biological means by the process of churning,
sedimentation and by action of aerobic and anaerobic respectively. The effluent which is one
of the by products is either used for irrigation or thrown into the river after chlorination. The
sludge which is other by product is converted into manure with the help of aerobic and
anaerobic bacteria and used as natural manure for agriculture.
 Purification of water
It is very important to purify the water before it is used for domestic
puposes.Purification of done at large scale before water is supplied to the people at large
through underground pipes. Purification is also done at small scale especially in the villages.
a) Purification at large scale: It employs three methods which follow one after another.
 Storage: The water from its source is stored in big reservoirs for 10-15 days. During this
period 90% of the suspended impurities settle down in 24 hrs. making water clearer. This
process is hastened by adding alum. Certain chemical changes also take place in the organic
matter present in the water with the help of aerobic bacterial. The pathogenic organisms
gradually die in stored water reducing bacterial count by 90% in the first 5-7 days.]
 Filtration: Filtration is the second next step. Filtration further removes the bacteria and other
impurities. Two types of filters are in common use. These are slow sand and rapid sand
filters. In both these filters, large sand beds are prepared and water is allowed to filter
through these sand beds, leaving impurities behind on the sand beds and the clear water

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comes out from below the sand beds. The slow sand filters takes more time to filter but water
is 99% pure. The rapid sand filter take less time as water is forced through but water is 90%
pure.
 Disinfection: Disinfection of water is necessary to kill all the rest of pathogenic organisms.
This is done by Chlorination of water. It makes the water sage for drinking. The water is
Chlorinated by adding bleaching powder or chlorine gas.
a) The purification at small scale: The purification of water is required at the community level
and at house hold level in the rural areas in general and also in urban areas as and when
necessary. The methods are described here.
 Sedimentation: if the water is turbid having lot of suspended impurities, it should be stored
in some vessels. The suspended impurities settle down within 24 hours. Some times very
fine particles do not settle down and otherwise also sedimentation takes a very long time. In
that case a weak solution of alum is added to water. The alum collects all impurities together
which settle down quickly. The clear water can be taken into the other vessel. This water
can also be filtered and disinfected to make it more safe.
 Filtration: Filtration at the house hold level is very popular these days. The water is stored in
the filter can which has one to three filter candles. The filter candles are made of porcelain or
kieselgurh a kind of clay, which has tiny pores. The water filters through these candles.
Any kind of impurities including bacteria and eggs of parasites get removed by these candles
and clear water gets collected in the chamber underneath.
The candle filters get blocked after repeated usage and algae may also grow on their surface.
Therefore these candles must be gently scrubbed with soft brush and soap and washed
thoroughly under running water daily. These should be boiled and dried once in a month.
 Chemical Disinfection: The water is usually disinfected by chlorination which is done by
adding bleaching powder, chlorine solution or chlorine tablets.
-Bleaching Powder: Bleaching powder or chlorinated lime (Ca OCl2) is very useful for
disinfection of water. It is cheap, easily available and effective. About 2.5 gms bleaching
powder is needed to disinfect 1000 liters of water or 0.7 mg per litre of water. Bleaching
powder is useful for disinfection of wells.
-Chlorine solution and Chlorine tablets: These are also used for Chlorinating water in small
quantities. These are available from the chemist shop and are expensive, but are very
convenient to use.
-Other disinfectants: These include iodine and potassium permanganate.
Iodine is used only in emergency situations. Two drops of 2% ethanol solution or
iodine is used for one litre of water. It is expensive. It takes 20-30 minutes to disinfect
water.
Potassium Permanganate is not use any more because it is not very effective. It can
destroy only cholera vibrio and no other organisms. It also changes the colour, taste and
smell of the water.

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 Boiling: Boiling of water in a covered vessel for 10 to 15 minutes after it starts bubbling is
very good method of purifying the water. It kills all the organisms. Before boiling the water,
it should be seen that the water is not turbid. Suspended impurities should be removed by
sedimentation and filtering through mulmul cloth or by any other method. Boiling is
convenient for small quantity and for emergency situation. However, on a routine basis it is
cumbersome and expensive.
 Storing of Purified Water: Once the water is disinfected and made safe, it should be stored in
covered utensils and handled carefully. The water should be taken out with a tumbler with
handle. The water should be consumed within 24 to 48 hours. However. The boiled water
should be used within six to eight hours. Same water should not be boiled over and again as
it loses its taste

D. Noise pollution
It can be defined as any unwanted or undesirable sound in the environment. It effects
can range from mildly annoying psychologically and physically debilitating. The most
severe health problem resulting from noise pollution is temporary or permanent hearing loss.
It also affects an individual’s psychological and physical health because it disrupts
communication, sleep, leisure and work activities.

SOURCES OF NOISE POLLUTION

These are various sources of noises which pollute our environment and
differ at various places which are presented underneath:

1. Sources at Domestic sites: These include various types of electronic sound and video
systems e.g. radio, loud speaker, television, record player etc., other electronic machines such
as mixers and grinders, coolers, air-conditioners, Tullu pump, generator and grass cutter
machine etc.
2. Sources at Road sides: These include various types of automobiles, their engines and horns
and sometimes their stereo systems. All these produce high intensity sounds which pollute
the environment. Motor cycle may produce noise at 100db.
3. Sources at Construction sites: These include bulldozers, concrete mixers, cutting and
crushing machines, hammer strikes etc. All these produce thundering and roaring sounds
which cause noise pollution which are very harmful to workers as well as people living in and
around the areas.
4. Sources at Factory sites: These include various types of noise producing machines e.g. drill
and milling machines, rollers, cranes etc. and produce very high intensity sounds which are
deafening and harmful otherwise to workers and people in surrounding areas.
5. Other sources: These include loud speakers, drum beating, rock music, aeroplane, trains,
crackers and fire works etc. Use of loud speakers during various cultural and religious

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functions especially till late nights/whole night which is very disturbing especially for
children, elders, sick etc.

EFFECTS OF NOISE POLLUTION

As per WHO, prescribed optimum noise level is 45 db during the day and 35 db during
night and anything above 80 db is hazardous. Noise pollution can cause several harmful
effects to human beings. These are as under:-

1) Auditory Fatigue: Auditory Fatigue is characterized by whistling and buzzing of ears and
occurs in places where sound intensity is of 90db.
2) Deafness (Hearing loss): The noise can cause temporary and permanent deafness. Usually a
noise of 90db can produce a temporary hearing loss which disappears after 254 hrs. of
exposure to noise. If the ears do not get chance to recover due to repeated or continuous
exposure to noise, the deafness can become permanent. A sound of 160db such as the sound
from the jet aircraft and noise from some factories can cause complete deafness either due to
rupture of eardrum or damage of the inner ear or both. It can cause pain in the middle ear,
loss of equilibrium and dizziness.
3) Changes in psychosocial behaviour: It is observed that repeated or continuous exposure to
noise caused annoyance, tension, nervousness and anxiety, temper tantrum etc. It also causes
fatigue, insomnia, inefficiency at work, impairs concentration etc.
4) Physiological changes: Exposure to noise is found to affect cardio vascular system. It
increases heart rate and blood pressure, decreases peripheral circulation. It also increases
intra cranial pressure and sweat. It is said to affect digestive system and cause peptic ulcer.
It can cause visual disturbances such as constricting of pupils, impaired colour perception,
reduced vision at night etc.
PREVENTION OF NOISE POLLUTION
BY various ways we can prevent the noise pollution
 The noise at source can be reduced by use of good quality silencers and muffin in the
vehicles, use of insulating material at places where noise is produced.Eg: palnting of trees
and hedges along the roads and streets, reducing the volume of musical devices such as
radios, television, record player, loud speakers etc.
 Ear plugs, ear muffs and other barriers should be used in the industrial set up, aeroplanes etc.
 Noise producing activities should be limited to specified hours of the day and night.Eg: air
flights, construction work etc.
 Railway yards, aerodromes, industries etc.should be installed away from residential areas.
Where ever such provisions are not possible green belt should be laid down around these
installations.
 The use of pressure horn and use of loud speakers should be banned in residential areas.
 The workers should be exposed for limited hours to high density sounds in the industries.
There should be frequent changes from high intensity zone to quiet zone.

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 Proper maintenance of motors and machines should be done.
 Education of people regarding noise pollution is very important and should be done.
 Many countries have enacted specific legislation to control noise pollution from various
sources’ .In India making loud sound is punishable by law with imprisonment up to five years
or fine up to one lac or both.

E. Accidents
Unintentional injuries like due to falls, drowning and fires kill more than 100,000
people each year and incapacitate millions of others with many lifelong disabilities. Of these,
approx.46000 deaths are motor vehicle related injuries.
Prevention of accidents

Controlling Exposures

A. Workplace hazards in the form of exposure sources or other harmful factors may be
eliminated or mitigated by substitution (e.g., a less harmful chemical may replace a toxic
chemical in a process).
B. Through Technical safety measures, often called engineering controls, consist of separating
persons from harmful factors by encapsulating the harmful elements, or installing barriers
between workers and the factors which may cause injury. Examples of these measures
include, but are not limited to, automation, remote control, use of ancillary equipment and
machine protection (guarding).
C. Organizational safety measures, also known as administrative controls, include separating
persons from harmful factors either by means of special working methods or by separation in
time or space. Examples of these controls include, but are not limited to, reduced exposure
time, preventive maintenance programmes, encapsulating the individual workers with
personal protective equipment, and expedient organization of work.

Controlling Human Conduct

 It is often not possible to isolate all hazards using the above control measures. It is
commonly supposed that accident prevention analysis ends here because it is believed that
the workers will then be able to take care of themselves by acting “according to the rules”.
This means that safety and risk will at some point depend on factors which control human
conduct—namely, whether the individual person has the knowledge, the skills, the
opportunity and the will to act so as to ensure safety in the workplace. The following
illustrates the role of these factors.
 Knowledge. Workers must first be aware of the types of risk, potential hazards and elements
of danger that may be found in the workplace. This usually requires education, training and
job experience. The risks also need to be identified, analysed, recorded and described in a
readily understandable manner so that workers know when they are in a specific risk situation
and what consequences are liable to follow from their actions.
 The opportunity to act. It must be possible for the workers to act safely. It is necessary for
workers to be able to make use of the available technical and organizational—as well as

15
physical and psychological—opportunities for action. Positive support of the safety
programme must be forthcoming from management, supervisors and the surroundings,
including concern about risk taking, designing and following working methods with safety in
view, safe use of the proper tools, clearly defining tasks, establishing and following safe
procedures, and providing clear instructions on how equipment and materials are to be safely
handled.
 . Technical and organizational factors are important with respect to workers’ readiness to
behave in ways that will ensure workplace safety, but social and cultural factors are at least
equally important. Risks will arise if, for example, safe conduct is difficult or time-
consuming, or if it is not desired by management or colleagues, or is not appreciated by them.
Management must be clearly interested in safety, taking steps to prioritize it and displaying a
positive attitude towards the need for safe conduct

F. Social and hazardous wastes

Wastes are being generated at an alarming rate. The amount of solid waste
continues to soar partly as a result of today’s ‘Throwaway’ attitude where many products are
used once and then discarded. In addition to solid wastes the disposal of hazardous waste is a
critical issue.
Management of social and hazardous waste
There are number of concepts used in waste management which vary in their usage between
countries or regions.Some of the general,widely used concepts include:
 waste hierarchy
The waste hierarchy refers to the “3 Rs” reduce, reuse and recycle, which classify
waste management strategies according to their desirability in terms of waste minimization.
The waste hierarchy remains the cornerstone of most waste minimization strategies.
 Solid waste management
Waste management is the
 storage(galvanized steel dust bin, paper sack, public bins),
 collection(house to house collection, collection from the public bins),
 transport and handling(waste is transferred from a smaller collection vehicle to larger
transport equipment),
 recycling(Refers to the collection of waste materials such as empty beverage container)
 disposal and monitoring of waste materials
Method of disposal is through Dumping, contolled tipping, Incineration,
composting,Manure pits, Burial.

PROGRAMMES AND EFFORTS FOR ENVIRONMENTAL PROTECTION


Both, remedial and preventive efforts are needed for environmental protection. Following
methods and programs have been used to protect environment:

 Strengthening the Central Pollution Control Board (CPCB).

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The Central Pollution Control Board (CPCB) of India is a statutory organisation
under the Ministry of Environment, Forest and Climate Change .
Strengthening through promoting cleanliness of stream and wells in different areas of the
States through prevention, control and abatement of water pollution and to improve the
quality of air and to prevent, control or abate air pollution in the country
 Paying attention to the projects related to the control and protection against industrial
pollution.
To control adverse impact of toxic chemicals hazardous waste on human health and
environment we have to paying attention towards those projects.
 Emphasizing the setting up of common effluent treatment plants.
By setting the common effluent treatment plants improves the waste management in
small scale industries.
 Making and developing the environmental statistics, charts and maps.
By using the environmental statistics,cahrts and maps
 Using clean technology in small-scale industries.

The objectives of the scheme on "Adoption of clean technology to the small scale
industries and to extend necessary technical support" are:

 to encourage modernisation of existing industrial units in the small scale sector by assisting
small scale industries for adoption of cleaner technologies by way of interest subsidy;
 to create awareness among the small scale entrepreneurs regarding adoption of pollution
abatement measures and their essentiality from the social angle and also creation of
awareness among the staff of the prospective/existing entrepreneurs;
 to identify clean technologies from the research institutions through bilateral/multilateral
programmes and diffusion of the same to the industries, particularly 17 identified categories
of polluting industries;
 to create a database for the availability of clean technology used in the industries;
 to assist demonstration projects strictly for the isolated units the laboratory or the research
institutions must certify that the demonstration unit is the first case where industrial scale
demonstration is being set up in that category of industry and is not up scaling or transferring
available technology.

 Protecting the Himalayas, Tajmahal and other objects of historical and natural
importance from environmental pollution
.
 Implementing “National lake protection programme
OBJECTIVE
The objective of the scheme is to restore and conserve the urban and semi-urban lakes of the
country degraded due to waste water discharge into the lake and other unique freshwater eco
systems through an integrated ecosystem approach.

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ACTIVITIES COVERED UNDER NLCP Prevention of pollution from point sources by
intercepting, diverting and treating the pollution loads entering the lake. The interception and
diversion works may include sewerage & sewage treatment for the entire lake catchment
area.
(i) In situ measures of lake cleaning such as de-silting, de-weeding, bioremediation, aeration,
bio-manipulation, nutrient reduction, withdrawal of anoxic hypo limn ion, constructed
wetland approach or any other successfully tested eco-technologies etc depending upon the
site conditions.
(ii) Catchment area treatment which may include a forestation, storm water drainage, silt
traps etc.
(iii) Strengthening of bund, lake fencing, shoreline development etc
(iv) Lake front eco-development including public interface.
(v) Solid waste management & provision of dhobi Ghats is generally not covered under
NLCP.
(vi) Prevention of pollution from non-point sources by providing low cost sanitation.
(vii) Public awareness and public participation
(viii) Capacity building, training and research in the area of Lake Conservation.
(ix) Any other activity depending upon location specific requirements.”.

 Protecting the islands.


The ocean covers some 70 percent of the earth’s surface and plays a significant role in
sustaining human life by supplying natural resources and stabilizing climate. Islands serve as
an irreplaceable base from which to protect and develop ocean resources, and conserve the
marine environment and biodiversity
 Ensuring the supply of lead free petrol and improving the quality of diesel or using the
other alternates of fuel. (for example ENG, ethanol mixed petrol-gasohol, or making
petrol from plastic waste etc.).
 Encouraging the setting up of botanical gardens and increasing the forest area.
Its helps to maintain the ecosystem.
 Implementing the water purification projects.
Providing the clean water, thus by avoiding the diseases
 Protecting the barren land and using it for tree plantation.
Under the right conditions, planting trees helps restore damaged lands and provide
firewood, timber, food for people and for animals, and medicine. Planting trees can make
land that is poor and barren become rich and fertile again
 Better implementation of national river protection programme
To conserve the water and to maintain ecological balance.
 Keeping record of natural resources.
Keeping accurate record is important to maintain the environmental healthy function.
 Surveillance and monitoring system for environmental pollution.

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 Assessing the effects of environment.
It helps to know about the environmental pollutants
 Survey and protection of bio-diversity.
Biodiversity surveys and ecological monitoring are key research tools that help define
areas and species of most conservation value and need, and also provide data to allow
effective monitoring and evaluation of implemented conservation measures

 Procuring international help for environmental protection.


 Developing the environmental education, training and information system.
Through United Nations agencies, international organisations, governments,
educational institutions, civil society organisations and the private sector to ensure effective
holistic approach with sustainable outcomes

NATIONAL ENVIRONMENT POLICY


Our country plays an important role in several significant international initiatives
concerned with the environment. The National Environment Policy (NEP) is intended
towards the India’s commitment in making a positive contribution to international efforts
about environment and sustainable development. The national environment policy is also a
response to our national commitment to a clean environment, mandated in the constitution in
Articles 48A and 51A(g),strengthened by the judicial interpretation of article 21.It is
recognised that maintaining a healthy environment is not the state responsibility alone, but
also that of every citizen.

The dominant theme of this policy (NEP 2006) is that while conservation of
environmental resources is necessary to secure livelihoods and well-beings of all, the most
secure basis for conversation is to ensure that people dependent on particular resources obtain
better livelihoods from the fact of conservation than from degradation of the resources.

Objectives

The principal Objectives of this policy are enumerated below. These Objectives relate to
current perceptions of key environmental challenges. They may, accordingly, evolve over
time:
1. Conservation of Critical Environmental Resources:
To protect and conserve critical ecological systems and resources, and invaluable
natural and manmade heritage, which are essential for life-support, livelihoods, economic
growth, and a broad conception of human well-being.

2. Intra-generational equity: Livelihood Security for the poor:

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To ensure equitable access to environmental resources and quality for all
sections of society, and in particular, to ensure that poor communities, which are most
dependant on environmental resources for their livelihoods, are assured secure access to these
resources.

3. Inter-generational Equity
To ensure judicious use of environmental resources to meet the needs and aspirations
of the present and future generations.

4. Integration of Environmental Concerns in Economic and Social


Development:
To integrate environmental concerns into policies, plans, programmes,
and projects for economic and social development.
5. Efficiency in Environmental Resource Use:
To ensure efficient use of environmental resources in the sense of reduction in
their use per unit of economic output, to minimize adverse environmental impacts.
.
6. Environmental Governance:
To apply the principles of good governance (transparency, rationality,
accountability, reduction in time and costs, participation, and regulatory
independence) to the management and regulation of use of environmental
resources.
7. Enhancement of Resources for Environmental Conservation:
. To ensure higher resource flows, comprising finance, technology, management skills,
traditional knowledge, and social capital, for environmental conservation through mutually
beneficial multistake holder partnerships between local communities, public agencies, the
academic and research community, investors, and multilateral and bilateral development
partners.

Principles
This policy has evolved from the recognition that only such development is
sustainable, which respects ecological constraints, and the imperatives of justice. The
Objectives stated above are to be realized through various strategic interventions by different
public authorities at Central, State, and Local Government levels. They would also be the
basis of diverse partnerships. These strategic interventions, besides legislation and the
evolution of legal doctrines for realization of the Objectives, may be premised on a set of
unambiguously stated Principles depending upon their relevance, feasibility in relation to
costs, and technical and administrative aspects of their application. The following
Principles, may accordingly, guide the activities of different actors in relation to this policy.
Each of these Principles has an established genealogy in policy pronouncements,
jurisprudence, international environmental law, or international State practice:

1) Human Beings are at the Centre of Sustainable Development


Concerns:

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Human beings are at the centre of concerns for sustainable development.
They are entitled to a healthy and productive life in harmony with nature.
2. The Right to Development:
The right to development must be fulfilled so as to equitably meet
developmental and environmental needs of present and future generations.

3. Environmental Protection is an Integral part of the Development


Process:

In order to achieve sustainable development, environmental protection


shall constitute an integral part of the development process and cannot be considered in
isolation from it.
4. The Precautionary Approach:
Where there are credible threats of serious or irreversible damage to key
environmental resources, lack of full scientific certainty shall not be used as a reason for
postponing cost-effective measures to prevent environmental degradation.

5. Economic Efficiency:
In various public actions for environmental conservation, economic
efficiency would be sought to be realized. This Principle requires that the services of
environmental resources be given economic value, and such value to count equally with the
economic values of other goods and services, in analysis of alternative courses of action.

Further implications of this Principle are as follows:


a) Polluter Pays :

Impacts of acts of production and consumption of one party may be


visited on third parties who do not have a direct economic nexus with the original act. Such
impacts are termed “externalities”. If the costs (or benefits) of the externalities are not re-
visited on the party responsible for the original act, the resulting level of the entire sequence
of production or consumption, and externality, is inefficient. In such a situation, economic
efficiency may be restored by making the perpetrator of the externality bear the cost (or
benefit) of the same.

The policy will, accordingly, promote the internalization of environmental costs, including
through the use of incentives based policy instruments, taking into account the approach that
the polluter should, in principle, bear the cost of pollution, with due regard to the public
interest, and without distorting international trade and investment.

b) Cost Minimization:

Where the environmental benefits of a course of action cannot, for


methodological or conceptual reasons, be imputed economic value (as in the case of
“Incomparable Entities”, in any event the economic costs of realizing the benefits should be
minimized.

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Efficiency of resource use may also be accomplished by the use of policy instruments that
create incentives to minimize wasteful use and consumption of natural resources. The
principle of efficiency also applies to issues of environmental governance by streamlining
processes and procedures in order to minimize costs and delays.

6. Entities with “Incomparable” Values:

Significant risks to human health, life, and environmental life-support


systems, besides certain other unique natural and man-made entities, which may impact the
well-being, broadly conceived, of large numbers of persons, may be considered as
”Incomparable” in that individuals or societies would not accept these risks for compensation
in money or conventional goods and services. A conventional economic cost-benefit calculus
would not, accordingly, apply in their case, and such entities would have priority in allocation
of societal resources for their conservation without consideration of direct or immediate
economic benefit.

7. Equity:

The cardinal principle of equity or justice requires that human beings cannot be
treated differently based on irrelevant differences between them. Equity norms must be
distinguished according to context, i.e. “procedural equity”, relating to fair rules for
allocation of entitlements and obligations, and “end-result equity”, relating to fair outcomes
in terms of distribution of entitlements and obligations. Each context, in addition, must be
distinguished in terms of “intra-generational equity”, relating to justice within societies, and
in particular, providing space for the participation of the underprivileged, and “inter-
generational equity”, relating to justice
between generations.

Equity, in the context of this policy refers to both equity in entitlements to, and participation
of, the relevant publics, in processes of decision-making over use of environmental resources.

8. Legal Liability:
The present environmental redressal mechanism is predominantly based on
doctrines of criminal liability, which have not proved sufficiently effective, and need to be
supplemented.

Civil liability for environmental damage would deter environmentally harmful actions, and
compensate the victims of environmental damage. Conceptually, the principle of legal
liability may be viewed as an embodiment in legal doctrine of the “polluter pays” approach,
itself deriving from the principle of economic efficiency.

The following alternative approaches to civil liability may apply:

a) Fault Based Liability

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In a fault based liability regime a party is held liable if it breaches a pre-
existing legal duty, for example, an environmental standard.

b) Strict Liability
Strict liability imposes an obligation to compensate the victim for harm resulting
from actions or failure to take action, which may not necessarily constitute a breach of any
law or duty of care.

9. Public Trust Doctrine:

The State is not an absolute owner, but a trustee of all natural resources, which
are by nature meant for public use and enjoyment, subject to reasonable conditions, necessary
to protect the legitimate interest of a large number of people, or for matters of strategic
national interest.

10. Decentralization:

Decentralization involves ceding or transfer of power from a Central Authority to


State and Local Authorities, in order to empower public authorities having jurisdiction at the
spatial level at which particular environmental issues are salient, to address these issues.

11. Integration:

Integration refers to the inclusion of environmental considerations in sectoral


policymaking, the integration of the social and natural sciences in environment related policy
research, and the strengthening of relevant linkages among various agencies at the Central,
State, and Local Self-Government levels, charged with the implementation of environmental
policies.

12. Environmental Standard Setting:

Environmental standards must reflect the economic and social development


situation in which they apply. Standards adopted in one society or context may have
unacceptable economic and social costs if applied without discrimination in another society
or context. Setting environmental standards would involve several considerations, i.e. risks
to human health, risks to other environmental entities, technical feasibility, costs of
compliance, and strategic considerations.

13. Preventive Action:

It is preferable to prevent environmental damage from occurring in the first


place, rather than attempting to restore degraded environmental resources after the fact.

14. Environmental Offsetting:

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There is a general obligation to protect threatened or endangered species and
natural systems that are of special importance to sustaining life, providing livelihoods, or
general well-being. If for exceptional reasons of overriding public interest such protection
cannot be provided in particular cases, cost-effective offsetting measures must be undertaken
by the proponents of the activity, to restore as nearly as may be feasible, the lost
environmental services to the same publics.

AGENCIES
Legislation establishing regulations and policy occurs at national level. The EPA
is an independent agency formed to coordinate environmental programs related to air and
water pollution, solid and hazardous waste management, noise, public water supplies,
pesticides and radiation. The agency also administers the municipal sewage treatment
construction grant program authorized by congress in the 1972 Clean Water Act.

BENEFITS AND BARRIERS

Benfits
As the health care sector expands the concept of “first, do no harm” in ways
that lead to dramatic reductions in health care facilities’ inadvertent negative environmental
health impacts, it has also responded to environmental health threats in surrounding
communities. There are a growing number of hospital-supported programs to remove lead in
community housing, take back unused pharmaceuticals, eliminate healthy food deserts in
cities, and much more.
A. When health care reduces or eliminates the use of persistent, bio-accumulative toxicants,
carcinogens or other high hazard chemicals, we are practicing primary prevention, helping to
reduce the risk of cancer, developmental disabilities and other chronic illnesses in our
communities, and those up and down stream in the supply and disposal chains.
B. When we reduce use of mined metals, minerals and fuels, and increase the proportion of
sustainable, renewable energy and materials, we benefit communities by practicing primary
prevention, helping create green and healthy jobs, and mitigating the adverse health effects of
climate change. The latter include increased respiratory disease, injury from severe weather
events, strengthened infectious disease vectors, psychological trauma, clean water shortages,
and more.
C. When we shift to healthy, sustainably grown food, we help address the growing epidemics of
obesity, diabetes and other chronic illnesses related to poor nutrition. We are also supporting
local economies and farming practices that reduce harm to people and the environment.
D. Because low income and minority communities are disproportionately affected by
environmental hazards and inequity, activities directed at improving environmental health
especially benefit such vulnerable populations. Health programs that simultaneously

24
strengthen access to healthy shelter, food, mobility, participation in decision making, and
connection to community reduce the risk of respiratory and cardiovascular diseases, obesity,
diabetes, some kinds of cancer, and many other outcomes.

Barriers to Healthcare
 Architectural and Programmatic Barriers
 Environmental Barriers
Architectural and Programmatic Barriers
 Patients using wheelchairs rarely get weighed or have their height measured, contrary to
widely accepted practice standards. (Accessible scales exist for this purpose.)
 Patients using wheelchairs are often examined while seated in their chairs when good practice
would require them to be examined while lying supine on a table. (Accessible exam tables
exist for this purpose.)
 Healthcare provider offices, clinics and diagnostic centers have no procedure for determining
in advance whether a patient has an impairment that requires some sort of accommodation
such as lifting assistance, Sign Language Interpreters, materials in non-print formats, or
appointment flex-time, which results in delays. Even when a patient or referring physician
notifies the provider or facility of the person’s needs in advance, frequently no arrangements
are made.
 Sign Language Interpreters are rarely provided to ensure that people who are deaf can
communicate effectively with healthcare practitioners. (Models for efficient delivery of
interpreter services in some settings are in place at a few locations in the country.)
 Healthcare informational, educational and instructional materials are not made available in
formats that are accessible to people who are blind or have visual impairments. (Models are
available for efficiently providing alternative formats such as Braille, Large print, digital, and
audio.)
 Healthcare information is often provided on websites that are not designed to conform with
widely accepted accessibility standards.
 Diagnostic procedures such as MRIs, X-rays, ultrasounds and bone density scans are often
done only after a patient is transferred from her or his wheelchair to the examination table
with great difficulty and risk by unqualified individuals such as security guards.
 Many appointments take an excessive amount of time, involve undue hardship or must be
rescheduled because appropriate staff, methods to ensure effective communication, and/or
adaptable, accessible equipment is not available.
 Additional appointment time is rarely provided even when it is required to ensure effective
communication for people who are deaf or hard-of-hearing, have other communication
disabilities, or to accommodate individual patients who may require transferring assistance.
 Hospital admissions personnel do not assess patients’ needs for accommodations such as
accessible inpatient rooms, beds and bathrooms, and frequently do not have methods to
ensure that patients with mobility disabilities can be placed in such accessible rooms.
 Captioned audio-visual information and Sign Language Interpreters are rarely provided for
hospitalized patients who are deaf or hard-of hearing.

25
 Waiting rooms and exam rooms are too small and crowded to accommodate patients using
wheelchairs.
 Patient privacy is compromised due to small exam, testing and interview rooms.
 Privacy is compromised when print materials are not made available in accessible formats
allowing for private, independent review by the patients with vision impairments.
 Architectural barriers exist throughout many facilities, including reception counters that are
too high; narrow hallways cluttered with carts, boxes and unused equipment; house phones
that are out of reach; heavy doors, and lack of Braille and other accessible signage, among
other things.
 Patients with disabilities report feeling frustrated, humiliated or angry on many occasions. In
describing the care they receive they make statements such as: “my doctor doesn’t understand
my disability,” “the doctor only wanted to talk about my disability, not the problem I came in
for,” “the nurse won’t listen to me about my body,” “they treat me like I’m stupid, but I know
what’s going on,” “they think I can read lips, but I can’t. I really need a Sign Language
Interpreter,” or “they blame me because I can’t get up on the table.”
Environmental Barriers
Multiple Chemical Sensitivity (MCS)
MCS means an unusually severe sensitivity or allergy-like reaction to many different kinds of
pollutants including solvents, VOC’s (Volatile Organic Compounds), perfumes, petrol,
diesel, smoke, and “chemicals” in general. MCS often encompasses problems with pollen,
house dust mites, and pet fur and dander.
In health care settings, fragrances present an invisible barrier to care for some people. They
are present in personal care products used by staff and other patients, and in the various hand
cleansers often found in examination rooms. Fragrances are also found in various air
“freshener” products, disinfectants, and cleaning materials commonly used in health care
environments.
SUMMARY
The environment is an open system which is ever changing .Change in the environment
affects health of the people. In the above topic we discussed about the definition, Theory of
nursing, Importance of environmental health, Environment a global concern, factors affecting
health, environmental influences on health and its management, agencies and benefits and
barriers of health care environment.

RESEARCH ABSTRACT
I. DesignQuality in the Context of Healthcare Environments: A Scoping Review
Show all authors
Anna Anåker, MSc, PhD(c), Ann Heylighen, PhD, Susanna Nordin, MSc, PhD(c), ...
First Published December 18, 2016 Research Article.

26
Abstract

Objective:

We explored the concept of design quality in relation to healthcare environments. In addition,


we present a taxonomy that illustrates the wide range of terms used in connection with design
quality in healthcare.

Background:

High-quality physical environments can promote health and well-being. Developments in


healthcare technology and methodology put high demands on the design quality of care
environments, coupled with increasing expectations and demands from patients and staff that
care environments be person centered, welcoming, and accessible while also supporting
privacy and security. In addition, there are demands that decisions about the design of
healthcare architecture be based on the best available information from credible research and
the evaluation of existing building projects.

Method:

The basic principles of Arksey and O’Malley’s model of scoping review design were used.
Data were derived from literature searches in scientific databases. A total of 18 articles and
books were found that referred to design quality in a healthcare context.

Results:

Design quality of physical healthcare environments involves three different themes: (i)
environmental sustainability and ecological values, (ii) social and cultural interactions and
values, and (iii) resilience of the engineering and building construction. Design quality was
clarified herein with a definition.

Conclusions:

Awareness of what is considered design quality in relation to healthcare architecture could


help to design healthcare environments based on evidence. To operationalize the concept, its
definition must be clear and explicit and able to meet the complex needs of the stakeholders
in a healthcare context, including patients, staff, and significant others.

II. Global environmental change and human health: a public health research agenda

27
Johan P Mackenbach

Author information ► Copyright and License information ►

Short abstract
Environmental problems, and our perceptions of their current and future health effects, have
changed over the decades. About 20–40 years back, public health was most concerned about
localised environmental degradation, as exemplified by air and water pollution. Although it
was often difficult to measure the direct health effects, the paradigm of public health worked
reasonably well to cope with these problems. As a result, some of the localised environmental
problems of the 20th century have been solved, at least in the richer parts of the world.1
We have since become aware, however, of the threats to human health which operate at a
much larger geographical scale, and which, because of their non‐localised character, are even
more difficult to investigate. All these “global environmental changes” are due to increased
human pressure on the environment, of which the main drivers are population growth and an
increase in per capita resource use and waste production. Climate change and other changes
to the atmosphere, land use changes and soil degradation, freshwater depletion and
contamination, and biodiversity loss are four important categories of global environmental
change, each of which form potential, although partly or largely unknown, threats to human
health.2 What should public health research do to help humanity cope with these new
environmental problems?

III. Creating Healthy Communities, Healthy Homes, Healthy People: Initiating a Research
Agenda on the Built Environment and Public Health
Shobha Srinivasan, PhD, Liam R. O’Fallon, MA, and Allen Dearry, PhD

Author information ► Article notes ► Copyright and License information ►

Abstract
THE BUILT ENVIRONMENT—human-modified places such as homes, schools,
workplaces, parks, industrial areas, farms, roads and highways—is our most important
habitat, since 80% of North Americans live in towns and cities and spend 90% of their time
indoors. To date, much discussion of the built environment has focused on the challenges of
providing adequate transportation (roads, highways, infrastructure, public transportation),
urban sprawl, air pollution due to increased traffic, the lack of sidewalks, and the diminishing
natural environment. New evidence, however, increasingly recognizes that even the places
we live and work clearly affect our health. Nevertheless, causal relationships between the
built environment and specific human illnesses are often difficult to ascertain.
Recent research explores the effect of improved built environments on physical
activity, asthma obesity, cardiovascular disease, lung cancer mortality and mental
health. However, a pressing need remains for more concerted research to identify
mechanisms by which the built environment adversely and positively impacts health and to
develop appropriate interventions to reduce or eliminate harmful health effects. The growing

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health burden and attendant economic costs associated with higher chronic disease incidence
(e.g., obesity, asthma, cardiovascular disease, cancer) require such research efforts. These
complex diseases are attributable to an interaction of genetic and environmental influences,
and many of the latter can be directly connected to the built environment. While research has
focused on the negative public health consequences of the built environment, there has been
very limited focus on the benefits of living in sustainable communities. A research agenda on
the public health and quality-of-life benefits of sustainable communities is necessary.

IV. Environmental Health and Safety Hazards Experienced by Home Health Care
Providers
A Room-by-Room Analysis
Show all authors

Barbara J. Polivka, PhD, RN, Celia E. Wills, PhD, RN, Amy Darragh, PhD, OTR/L,
FAOTA, ...

First Published August 12, 2015 Research Article

Abstract

The number of personnel providing in-home health care services is increasing substantially.
The unique configuration of environmental hazards in individual client homes has a
significant impact on the safety and health of home health care providers (HHPs). This
mixed-methods study used data from a standardized questionnaire, focus groups, and
individual interviews to explore environmental health and safety hazards encountered by
HHPs in client homes. The participant sample (N = 68) included nurses, aides, therapists, and
owners/managers from a variety of geographic locations. The most often-reported hazards
were trip/slip/lift hazards, biohazards, and hazards from poor air quality, allergens, pests and
rodents, and fire and burns. Frequency of identified key hazards varied by room, that is,
kitchen (e.g., throw rugs, water on floor), bathroom (e.g., tight spaces for client handling),
bedroom (e.g., bed too low), living room (e.g., animal waste), and hallway (e.g., clutter).
Findings indicate the need for broader training to enable HHPs to identify and address
hazards they encounter in client homes.

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CONCLUSION
Environment refers to the physical, biological,and social world in which the system or
man exists. The environment is an open system which is evr changing. Although current
concepts of health and the environment are more complex nursing continues to be concerned
with the human beings interaction with the environment in care and research. So
environmental health is very important for improving the individual and community health
status.

BIBLIOGRAPHY
 Keshav swarnakar(2011).Community Health Nursing; second edition.Indore.N.R Brothers.
Page no:124-200
 I Clement (2008) Basic Concepts of Community Health Nursing; second edition,
Bangalore.Jaypee Publication. Page no:237-254.
 K.K Gulani (2005) Community Health Nursing: Principles and Practices NewDelhi.Kumar
Publishing.237-254.
 Judith Ann Allender,Cherie Retor(2010),Community Health Nursing;Promoting and
protecting the public health.seventh editionphiladelphia.Lippincott Williams and
Wilkims.140-145.

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