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Environmental health issues in public health 

Environmental health issues in public health
Chapter:
Environmental health issues in public health
Author(s):

Chien-Jen Chen

DOI:
10.1093/med/9780199218707.003.0050
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date: 12 December 2017

Human beings live in complex environments. The importance of environmental factors in human health has long been investigated. Both genetic and environmental factors are involved in the development of human diseases, but the relative importance of environmental factors in comparison with genetic factors varies as a continuous spectrum for various diseases. Environmental causes of disease include physical, chemical, biological, behavioural, and social components. Human behavioural responses to environments are also important in determining the occurrence of various diseases. Three disease models have been proposed to describe the interaction between host and agents in environments. The epidemiologic triangle model emphasizes the importance of a unique agent for a specific disease, the ecological wheel model points to host–environment interactions and the multifactorial aetiology of environmental diseases, while the evolutionary spiral model highlights the progression of multistage pathogenesis with differing multifactorial aetiology at various stages of the disease natural history. Environmental health hazards are assessed through ecological studies, cross-sectional surveys, case-control studies, cohort studies, and intervention studies. Consistent findings in both observational and interventional studies at aggregate and individual levels may provide strong evidence of causation between the disease and environmental agents. These study designs are illustrated by the elucidation and confirmation of the pleiotropic health effects of arsenic in drinking water and the multifactorial aetiology of hepatitis B-related hepatocellular carcinoma. Molecular and genomic biomarkers are used to explore the gene–environment interaction in the development of environmental diseases. They include the biomarkers of internal dose and biologically effective dose of exposure to environmental agents; the molecular, cellular, histological, and preclinical biomarkers of health effect; and genetic and acquired susceptibility to environmental diseases. Environmental health intervention may not only promote public health but also yield long-term social benefits other than health. Global partnerships need to be strengthened to achieve interrelated goals of health, environmental sustainability, and development.

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