Экологическая медицина = Ecological medicine. Учебное пособие

Chapter 8

ENVIRONMENTAL MONITORING AND HEALTH

STATUS OFTHE POPULATION

Motivational characteristic of the topic. Monitoring (lat. “monitor” – reminding, supervising, checking) of the environment (biosphere) is a state system of systematic observations of the state of physical, chemical, and biological factors in the environment. These observations in ecological medicine are for detection and prevention of critical anthropogenic impacts at different levels of ecosystems (local, regional, global). The anthropogenic contamination of different areas of an ecosystem is harmful and unfavourable for the health of people, organisms, and communities as a whole. Monitoring of changes in the biosphere is necessary to predict the undesirable effects of social-hygienic, demographic, bioproductive, and climatic changes.

The doctor needs knowledge on the regularities of natural phenomena, limiting factors, groups of eco-medical risks of non-infectious pathology development to substantiate a set of preventive measures to preserve the health of the population, taking into account the impact of environmental factors.

The objective: to understand the institutional framework for monitoring the environment and public health, as well as the regulatory framework for protecting the biosphere and public health.

Tasks:

1.  To understand the essence and practical significance of the medi- cal-environmental information system (MEIS) and environmental monitoring.

2.  To introduce students to monitoring types.

3.  To study the main normative legal documents on environmental protection and public health.

4.  To master practical skills for solving situational tasks.

Requirements for students’ initial knowledge level. To fully master the topic of the chapter, a student should revise the relevant material from the following disciplines:

1.  General and Bioorganic Chemistry: “Chemistry of the environment”.

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2.  Medical Biology and Genetics: “Ecosystem, biosphere, ecology, and human practices”.

3.  Medical and Biological physics: “Mathematical modelling in medi­ cine”.

Review questions from the related disciplines:

1.  Define the concepts of environment and biosphere. 2.  Describe the major ecological systems.

3.  The cycle of matter in the biosphere, the anthropogenic cycle of matter.

4.  Biotic factors of the environment and their characteristics. 5.  Abiotic factors of environment and their characteristics.

6.  Anthropogenic and technogenic influence on the biosphere.

Questions related to the topic of the chapter:

1.  Monitoring definition. 2.  Monitoring tasks.

3.  The importance of monitoring data for the medical practice. 4.  Biosphere (global) monitoring.

5.  International monitoring. 6.  Regional monitoring.

7.  National monitoring. 8.  Local monitoring.

9.  Sanitary-hygienic monitoring.

10.  The essence of medical-environmental information system (MEIS). 11.  The main law of the Republic of Belarus – Constitution of the Re-

public of Belarus.

12.  The law “On sanitary and epidemiological welfare of population”. The essence and purpose of monitoring.

13.  Statute of the Ministry of Natural Resources and Environment to preserve the purity of the biosphere and human health.

LEARNING MATERIAL FOT THE CHAPTER

Objectives, content, and characteristics of monitoring. Monitoring of the environment is currently one of the most significant tasks of the environmental management system.

Monitoring is a complex system of observation, assessment, and forecasting of changes in the environment under anthropogenic factors. This term appeared before the Stockholm Conference of the United Nations on the environment in addition to the concept of “control”.

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The need for systems that collect information, analyse it and warn about possible dangers to humans or human society initially emerged in hydrometeorology. Natural disasters such as hurricanes, earthquakes, and volcanic eruptions have caused enormous destruction and victims. It was necessary to create and develop a system of observation and forecasting, allowing the population to be prepared for the upcoming test. Initially, monitoring systems that observed changes in the natural environment, i.e., ecological monitoring, were developed. For such tasks monitoring was defined as a complex system to observe certain objects and phenomena of the natural environment and to warn of their occurrence, changes, critical situations, harmful or dangerous for human health, organisms, natural and anthropogenic objects.

Global monitoring system, developed by R.E. Munn and approved by the First Intergovernmental Meeting on monitoring within UNEP (United Nations Environment Program), held in Nairobi in 1974, includes:

yyorganisation and expansion of a warning system for human health threats;

yyassessment of global atmospheric pollution and its impact on the climate;

yyassessment of the amount and distribution of contaminants in biological environments, especially in food chains;

yyassessment of critical problems arising from agricultural activities and land use;

yyassessing the response of terrestrial ecosystems to environmental impacts;

yyassessment of ocean pollution and effects on marine organisms; yydevelopment of an improved disaster warning system internationally. The main tasks of monitoring are observation of the state of the bio-

sphere, assessment and forecasting of the natural environment, identification of factors and sources of anthropogenic impacts on the environment. Thus ultimately forms information support for decision-making in the field of environmental protection activities and environmental safety. The moni­ toring system includes the following main procedures:

yyselection of the observation object; yyexamination of the selected observation object;

yycompilation of the information model for the observation object; yymeasurement planning;

yyassessment of the observation object state and its information model identification;

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yyprediction of changes to the state of the observation object; yypresentation of information in a user-friendly form and its delivery to

the consumer.

The main objectives of environmental monitoring are to provide the environmental management system and environmental safety with up-to- date and reliable information that allows:

yyto evaluate indicators of the state and functional integrity of ecosystems and the human habitat;

yyto identify the causes of changes in these indicators and assess the consequences of such changes, as well as to determine corrective measures in cases where environmental conditions targets are not achieved;

yyto create prerequisites for identifying corrective measures for emerging negative situations before damage occurs.

Pursuant to the main objectives of environmental monitoring, its functions are:

yyobservation of anthropogenic influence sources; yyobservation of anthropogenic influence factors;

yyobservation of the natural environment state and the processes under the influence of anthropogenic influence factors;

yyassessment of the actual state of the natural environment; yyforecasting of changes in the natural environment state under the in-

fluence of anthropogenic factors and evaluation of the predicted state of the natural environment.

Performing these functions allows executive bodies to obtain information for:

yyplanning measures to reduce pollution, selecting priority areas of activity, monitoring and evaluating the effectiveness of environmental measures implementation;

yydeveloping measures to reduce pollution in areas where it has reached dangerous levels;

yychecking compliance with norms and standards of natural object quality;

yyobtaining data for scientific research, in particular for studying the impact of environmental factors on human health and the environment, and introducing relevant legislation.

Monitoring natural and anthropogenic ecosystems requires a variety of observation objects: the global biosphere, regional geosystems, the local bioecological system, the sanitary and hygienic system, and the socio-de- mographic system.

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Biosphere monitoring of the atmosphere, hydrosphere, and lithosphere includes global characteristics of the substance cycle, heat, water, CO2, O2, SO2, NO2, as well as other contaminants in the form of aerosols, fog, smog, dust, and aerons. International monitoring assumes tracking of planet-wide processes and phenomena, including the effects of anthropogenic climate change. Regional monitoring assumes tracking of processes and phenomena within a region. National monitoring is a state system of environmental control within a certain territory of a nation state. Local monitoring ensures that pollution does not spread over significant distances. Social-hy- gienic monitoring is a state system of observation, analysis, assessment and forecasting of public health and the human habitat.

Monitoring of environmental pollution in the Republic of Belarus. The main purpose of environmental monitoring is to observe the state of the environment and the sources of its harmful effects on the environment in order to provide state bodies, other legal entities and citizens with complete and reliable information in this area. This goal is achieved through the National Environmental Monitoring System (NEMS), ­established in 1993.

Ensuring the continuous functioning of the NEMS is one of the main directions of state policy in environmental protection. The country has developed a normative legal framework that includes normative legal acts regulating the functioning of the NEMS as a whole. It also includes individual types of monitoring that make up the NEMS.

The organisation of the NEMS structure takes into account the distribution of spheres of competence of the republican bodies of state administration, responsible for the organisation and conduct for each type of monitoring. The Ministry of Natural Resources and Environmental Protection is defined as the single coordinating body. There is an interagency coordination council, as well as the NEMS information-analytical centre and information centres for monitoring types.

NEMS unites 11 organisationally independent, but functioning and interacting on common principles, types of environmental monitoring (see Table 8.1). NEMS is based on an orderly system of collection, processing, analysis, and evaluation of the information obtained from a scientifically sound network of more than 3,500 observation sites included in the State Register of NEMS observation stations.

Radiation monitoring of the natural environment, organised in Belarus after the Chernobyl accident, allows regular assessment of the radiation situation in the areas affected by radioactive contamination.

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Table 8.1. Types of environmental monitoring and the organisations that carry it out

Ministry of Natural Resources and Environmental Protection

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Monitoring of radioactive contamination of water bodies, soil, air, clarification of radiation situation on the territory of the Belarusian sector of the 30–km zone of the Chernobyl NPP, control of radioactive contamination of territories of settlements and facilities to assess living conditions and production activities in the areas affected by radioactive contamination as a result of the Chernobyl disaster, is conducted by subdivisions of the Ministry of Natural Resources and Environmental Protection of the Republic of Belarus. RCRCEM (Republican Centre for Radiation Control and Environmental Monitoring), part of the Department of Hydrometeorology, is the leading organisation in this field.

Considering the specifics of radioactive contamination of separate regions and their landscape-geochemical peculiarities, a network of permanent environmental monitoring has been organised in the republic, including 121 reference sites and 19 landscape-geochemical polygons.

In order to fully and comprehensively use the information about the state of the environment and the factors affecting it, the NEMS interacts with the system of social and hygienic monitoring, the system of monitoring and forecasting of natural and man-made emergencies.

The National Environmental Monitoring System (NEMS) is based on a network of monitoring stations.

The following tasks are solved during monitoring: yyformation of a state information fund;

yyidentification of causal relationships between public health and exposure to environmental factors based on a systematic analysis and assessment of risks to public health;

yyensuring interdepartmental coordination of monitoring activities to provide sanitary and epidemiological well-being of the population, development of proposals for decision-making by the executive authorities.

Monitoring uses observation data on:

a)public health and environmental factors, including biological (viral, bacterial parasitic), chemical, physical (noise, vibration, ultrasound, heat, ionising, non-ionising and other radiations), social (food, water supply, living, working and rest conditions) and other factors (maintained by sanitary and epidemiological service agencies and institutions);

b)natural-climatic factors, sources of anthropogenic impact on the environment, including atmospheric air, surface and groundwater, soil (maintained by the Ministry of Agriculture, the Ministry of Natural Resources and their subordinate organisations);

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c)factors of the human social environment (maintained by the State Committee on Statistics, other concerned executive authorities and their subordinate organisations);

d)safety and working conditions (conducted by the Ministry of Labour and Social Development, the State Statistics Committee, the Ministry of Economic Development and Trade and their subordinate organisations as part of the nationwide monitoring of the social and labour sphere).

Monitoring ensures:

yyidentification of factors that have a harmful effect on humans and their evaluation;

yyforecasting of public health and the human environment; yydetermination of urgent and long-term measures for preventing and

eliminating the impact of harmful environmental factors on public health; yydecision-making on the implementation of measures aimed at pro-

tecting the health of the population and human environment; yyinforming state bodies, local authorities, organisations regardless of

their organisational and legal status, as well as citizens about the results obtained in the course of monitoring.

Basic principles of organising and conducting socio-hygienic monitoring.

Social and hygienic monitoring (SHM) is a system of special observations, assessment, and forecasting of public health in connection with changes in the environment and aimed at identifying the adverse effects of environmental factors and conditions of human activity, the development of health promotion, and preventive measures to avoid and eliminate the harmful effects of these factors on human health.

The basis of the SHM is targeted survey areas, objects, and people to determine:

yyenvironmental factors that negatively affect public health;

yyobjects that most determine the presence of the identified factors on the territory of the district (region).

The basis of the SHM methodology is:

yyassessment and classification of objects, population groups and habitat factors depending on the level, trends of their characteristics;

yyranking environmental factors, objects, and population contingents according to the level of their characteristic indicators.

Information about the state of health (according to medical and demographic criteria) and the state of the territory, supervision objects (according to hygienic and epidemiological criteria) comes to territorial district (city) centres of hygiene and epidemiology from institutions and agencies in accordance with existing guidelines.

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The information obtained is used in two ways:

1)  assessment of the sanitary-hygienic and epidemiological status of facilities and territories as part of state sanitary supervision;

2)  updating the database and its analysis to solve the problems of so- cio-hygienic monitoring.

The first direction is realised using the current sanitary legislation. The second direction is realised by continuous analysis of the state of

health of the population and its environment in the area (city) on the basis of the special system of observations, data from objective observation of the sanitary and hygienic state of the territory and facilities, as well as data from other services and departments. At the regional level, the SHM information base is supplemented with data on the health status of the population from regional health departments, medical and demographic data from state statistical agencies and institutions, and generalised data on the state of the environment from other agencies.

Following the database analysis, specialists of the regional SHM department draw conclusions, make predictions, prepare draft recommendations and measures, which are executed in the form of a project of the regional medical and environmental bulletin. It presents the characteristics of the territory (territories), a dynamic comparative analysis of indicators characterising the medical and ecological situation in the region.

A group of experts from the Department of Health and Sanitary and Epidemiological Service evaluates this document and drafts a conclusion regarding the results of monitoring and a set of measures for improving the medico-environmental situation in the territory.

Under the auspices of the Regional Executive Committee, the document is submitted for discussion by the Regional Advisory Council consisting of physicians, sociologists, statisticians, economists, psychologists, environmentalists, and others.

PRACTICE

Task 1. Calculation and assessment of integral indices of medical and demographic well-being.

Example of solving routine problems

Problem:

Calculate the integral index of medical and demographic well-being in S. according to the following data: in the reporting year, total morbidity

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was 1,050 per 1,000 population, total mortality was 10.5 per 1,000 population, infant mortality was 21.3 per 1,000 births, disability was 8.1; birth rate was 21.0 per 1,000.

Evaluate the results. Explain the integral index calculation methodology.

Stages of solutions:

1.  The integral index of medical and demographic well-being is determined in terms of total mortality, infant mortality, fertility, disability, and general morbidity, taking into account the indicative qualitative assessment of the level of these indices (Table 1).

Table 1. Indicative qualitative assessment of the level of health indices

Note. *Marchenko B.I. “Health at the population level: statistical methods of research (a guide for physicians)”. Taganrog. Sphinx Publ., 1997.

2.  Then all the points assigned to the indices are summed up, and the index of medical and demographic well-being is obtained (the higher the sum of points, the lower the well-being):

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