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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/9780199661756.003.0133
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date: 17 October 2019

Both host and environmental factors are involved in the development of human diseases, and the relative importance of environmental to host factors varies as a continuous spectrum for different diseases. Environmental components in causes of human diseases have long been elucidated. Environmental causes of disease may be classified as physical, chemical, biological, behavioral and social factors. Human behavioral responses to environments are also important in the occurrence of various diseases. Three disease causal 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 emphasizes host-environment interactions and the multifactorial etiology of environmental diseases, while the evolutionary spiral model highlights the progression of multistage pathogenesis with different multifactorial etiology at various stages of the disease’s natural history. Environmental health hazards are assessed through ecological studies, cross-sectional surveys, case-control studies, cohort studies and intervention trials. Consistent findings in both observational and interventional studies at aggregate and individual levels provide strong evidence of causation between diseases 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 etiology in the natural history of hepatocellular carcinoma caused by chronic hepatitis B. Molecular and genomic biomarkers are increasingly used to explore the host-environment interaction in the development of human 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 diseases. Risk calculators combining multiple biomarkers for the prediction of long-term risk of diseases are developed. 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 human health, environmental sustainability, and socioeconomic development.

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