Environmental Determinants of Health

A healthy environment is vital to “ensure healthy lives and promote well-being for all at all ages.”⁽¹⁾

As the intersection of environment and public health, in the framework of this Strategy, environmental public health addresses global, regional, national, and local environmental factors that influence human health, including physical, chemical, and biological factors external to a person, and all related behaviors. Collectively, these conditions are referred to as environmental determinants of health (EDHs).

Threats to any one of the EDHs can have an adverse impact on health and well-being at the population level.⁽¹⁾ These environmental threats can occur naturally or because of social conditions and ways people live. Addressing EDHs improves directly the health of populations. Indirectly, it also improves productivity and increases the enjoyment of consumption of goods and services unrelated to health.

(1) Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages. The 2030 Agenda for Sustainable Development.

Key facts

Approximately 83 million people still do not have adequate sanitation systems of which 15.6 million people still practice open defecation and 28 million do not have access to improve sources of safe drinking water, resulting in about 30 thousand preventable deaths each year;
Hazardous chemical risks, such as exposure to toxic pesticides, lead, and mercury tend to disproportionally impact children and pregnant women;
Exposure to toxic chemicals can lead to chronic and often irreversible health conditions such as neurodevelopment problems, and congenital defects and diseases associated with endocrine disruption;
Environmental changes such as climate change increasingly have an impact on people’s health and well-being in the Region by disrupting physical, biological, and ecological systems globally. Extreme weather events have exacerbated food insecurity, air pollution, access to clean water, population migration and transmission patterns of vector-borne illnesses. The health effects of these disruptions may include increased respiratory, cardiovascular, and infectious disease; injuries; heat stress and mental health problems;
Groups in situations of vulnerability to climate-related hazards, such as those living on small islands, are subject to a disproportionate risk due to the greater frequency and severity of extreme weather events and the elevation of sea level or communities living in mountains are subject to a disproportionate risk due to changes in river flows, alterations in flora and fauna, and the increased risk of rock landslides, avalanches, and floods due to melting glaciers and decreasing the layer of snow;
The emergence of new environmental hazards, for example, electronic waste, nanoparticles, microplastics, chemicals that alter the endocrine system and water scarcity;
Complex management challenges posed by interregional pollution (for example, cross-border air pollution and shared polluted basins).

Fact sheet

Five key Sustainable Development Goals (SDGs) of the 2030 Agenda address the environmental determinants of health and contribute directly and indirectly to SDG 3 focused on “health” - ensuring healthy lives and promoting well-being for all at all ages. These SDGs address the issues of water, sanitation and hygiene, air quality, chemical safety, and climate action.

To achieve these objectives, environmental public health programs must evaluate possible health problems attributable to environmental factors; develop inclusive and equitable public policies to protect all people from environmental hazards; and ensure compliance with these policies. This is achieved through inter programmatic, intersectoral, multisectoral, subnational, national and supranational approaches. It is important that environmental public health programs foster an environmentally responsible and resilient health sector and environmentally healthy and resilient communities.

PAHO Response

In order to reduce the burden of disease and inequity in health attributable to environmental determinants of health in the Region of the Americas, PAHO provides technical cooperation to the countries of the region of the Americas to increase the capacity of health actors in the Region to address the environmental determinants of health; emphasizing air quality, chemical safety, factors associated with climate, and water, sanitation and hygiene prioritizing populations living in vulnerable situations.

Specifically, PAHO works with the countries of the Region of the Americas through:

Improving the performance of environmental public health programs
Strengthening environmental public health surveillance
Fostering an environmentally responsible and resilient health sector
Promoting environmentally healthy and resilient communities.

The essential function of PAHO is to harness the power of alliances and knowledge to convene, coordinate and guide processes that have a direct impact on the countries of the Region of the Americas. These processes are implemented by the countries with the support of PAHO and the technical support of the WHO Collaborating Centers and other national reference institutions.

Highlights

International Lead Poisoning Prevention Week 2022

This campaign will take place 23-29 October 2022 with the theme “Say no to lead poisoning” recognizes the urgency of action...

Webinar: Wastewater surveillance of SARS-CoV-2

Date: September 20th, 2022 | Hour: 11:00 a.m. – 12 p.m. (Washington) 10:00 a.m. – 11:00 a.m. (Peru)

Toolkit for Integrated Serosurveillance of Communicable Diseases in the Americas

This toolkit was developed to facilitate the design, implementation, analysis, interpretation, and use of results of...

Evento virtual: Cooperación regional para limpiar el aire que compartimos en América Latina y el Caribe

Campaign: International Clean Air Day for Blue Skies 2022

Date: 7 September 2022

Sustainable health agenda for the Americas 2018-2030

Question and Answers

All the technical guidance materials related to COVID-19 developed by PAHO can be accessed here.

QUESTIONS AND ANSWERS THAT SERVE AS BEST PRACTICES FOR PROTECTING COMMUNITIES:

1. What is household chlorine / bleach?

Bleach is the common name for the mixture of water and the chemical sodium hypochlorite, which is usually sold for household use at concentrations of between 1 - 10%. It needs to be diluted to create the disinfection solutions referred to in the technical notes, such as [].

2. What is the recommended concentration of chlorine to be used to disinfect surfaces in households?

Before disinfection, surfaces should be cleaned with water and soap. Then a sodium hypochlorite disinfection solution at 0.1% concentration should be applied.

Liquide chlorine, technical known as sodium hypochlorite, for domestic use is sold in several different concentrations. All are equally recommended, as a disinfection solution needs to be prepared at 0.1% concentration. The table found in the technical notes shows the quantity of product that needs to be mixed with what quantity of water depending on the product concentration available. [].

3. How long does 62-70% ethanol or a sodium hypochlorite disinfection solution at 0.1% concentration or 0.5% improved hydrogen peroxide take to deactivate SARS-CoV-2 on surfaces?

SARS-CoV-2 is deactivated (reduced by 99.9%) on surfaces following application of one of these disinfection solutions left to act for a minimum of 1 minute.

4. What is the minimum free chlorine residual level recommended for all points of a municipal water systems to effectively treat against SARS-COV-2 and other pathogens?

A free chlorine residual concentration of at least 0.5mg/L, measured at least 30 minutes after the chlorine is added to the water and mixed to ensure a uniform concentration. []

5. What is the recommendation for disinfection of surfaces?

Clean frequently touched surfaces and bathrooms with soap and safe water, followed by a sodium hypochlorite disinfection solution at 0.1% concentration.
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6. Is disinfection recommended for people and outdoor spaces?

The recommendation is to focus cleaning and disinfection on indoor frequently touched surfaces. PAHO does not recommend the use of tunnels or cabins that spray chemicals for the disinfection of humans, or the use of disinfection foot mats, or the spraying of chemicals to disinfect the build environment, such as roads.[]

7. What is recommended for cleaning and disinfection of public transport?

Remove visible dirt from porous surfaces and use cleaning products that are compatible with these surfaces.
At least twice a day clean frequently touched surfaces (handrails, handles etc) with soap and safe water, then apply a sodium hypochlorite disinfection solution at 0.1% concentration and leave to act for at least 1 minute.
Disinfect electronic surfaces based upon the factory recommendations. If none exist use 62-70% ethanol.
Ensure that cleaning and disinfection procedures are followed consistently and correctly.
Clean and disinfect the vehicle interior with the doors and windows open.
When cleaning and disinfecting, individuals should wear Personal Protective Equipment (PPE) such as water-resistant gloves and an impermeable gown.
Encourage the installation of handsfree fare systems.
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8. What is the best way to clean non-medical fabric masks which are commonly recommended for public use?

Items made of cloth can be laundered in hot water and soap and allowed to dry completely to decontaminate.
Clean non-medical fabric masks should be stored in a plastic bag to prevent contamination.

9. How should waste from households with COVID-19 cases be handled?

Dedicate a trash can with lid containing a plastic bag for the infected person and locate it within their room. Tie bags securely and place in a secondary bag before transporting and disposing of trash. Follow the national norms for the disposal of waste from infected persons. Use PPE when handling waste.
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10. What measures should be taken to disinfect products bought from the grocery store?

There is no evidence that supermarket or grocery store products are a source of transmission. In order to reduce the risk of transmission of SARS-COV-2, it is recommended to:

Physically distance and perform frequent hand hygiene when at the grocery store.
Wipe down cart or basket handles with disinfectant wipes.
Hand washing with soap and water upon arriving home and after putting groceries away .
Not touch your face before hand washing can be performed.
Fruits and vegetables should be washed in safe water and thoroughly dried.

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11. What are the recommendations for handling money?

There is no evidence that money is a source of transmission. Emphasis must be placed on hand washing and hand hygiene at critical moments, as per guidelines found at: []

12. Is the spraying of chemicals recommended for disinfection of public spaces and persons?

Spraying chemicals is never recommended on people. This is harmful and can cause adverse psychological and physical health effects, such as irritation in the mucosa, skin, eyes and respiratory tract. The false sense of protection can lead to increased transmission.

The spraying of chemicals is only recommended for highly contaminated empty enclosed spaces and after cleaning.
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13. What are among the key environmental public health recommendations for the prevention of COVID-19 in collective residential places?

Increasing access to handwashing stations
Ensuring safe water with a free chlorine residual of 0.5mg/L
Handwashing with safe water and soap frequently and at critical moments
Cleaning and disinfection of frequently touched surfaces
Safe handling and disposal of solid waste
Ensuring that wastewater is disposed of without contaminating the surrounding environment
Messaging on handwashing and management of solid waste
Ensuring adequate ventilation with a minimum of 2 air changes per hour
Reorganization of communal spaces to ensure physical distancing
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14. What are the recommendations for cleaning electronic equipment?

Electronic equipment should be dusted and then disinfected several times a day, based upon manufacturer guidance, or with 62-70% alcohol. Apply the disinfection product with a cloth, not directly, as moisture or excess liquid can damage the electronics inside.
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15. What are the key recommendations for sanitation service workers?

•   Use appropriate PPE to protect skin and mucous membranes (eyes, nose, mouth).
•   Practice frequent handwashing with soap and safe water []
•   Ensure all safety measures are implemented
•   Maintain physical distancing measures

16. What products can be used to wash hands?

Handwashing is important to prevent the spread of the SARS-CoV-2, as well as other viruses and bacteria, which cause common illnesses.
Regular soap and safe water are effective in the control of COVID-19.
Handwashing following the correct method and time is recommended (40-60 seconds)
If regular soap does not exist other options are:
- Natural soaps from traditional plants with saponins and that have surface-active properties, can be used, such as alfalfa, marigold, guarana, beans, common soapwort, thyme, among others
- Any surface-active agent is effective against viruses because they deactivate the proteins that surround the virus (hair or body shampoo, washes liquid utensils and detergents that contain sodium lauryl sulphate, sodium lauryl ether, linear alkylaryl sodium sulphonate (LAS or LABS) or alcohols fatty ethoxylates)
Do not use products that contain caustic soda, which is in some commercial detergents
If safe water and soap are not an option, 70% alcohol gel can be used for 20-30 seconds

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17. Is it safe to combine cleaning and/or disinfectant products in order to clean surfaces?

Combining cleaning and/or disinfectant products is not safe. As most cleaning and disinfectants are made of chemicals, mixing them can produce noxious vapors and other health hazards.
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18. What general precautions should be taken in the house to prevent COVID-19?

Wash hands with soap and safe water for at least 40-60 seconds upon entering the house from outside, before and after eating, before and after food preparation, after going to the bathroom, before and after cleaning.
Clean frequently touched surfaces at least once a day and apply a sodium hypochlorite disinfectant solution at 0.1% concentration leaving to act for at least 1 minute before being wiped off.
Clean bathrooms at least once a day with a sodium hypochlorite disinfectant solution at 0.1% concentration, leaving the disinfectant to act for at least one minute.
Clean fruits and vegetables with safe water and then dry thoroughly.
Maintain good ventilation with a minimum of 2 air exchanges per hour.
Remove shoes upon entering the house as a general good hygiene measure. []

19. What can be done to conserve water in the context of COVID-19?

While handwashing, only use water to wet and rinse hands. Close the tap during lathering.
Wash dishes in a basin of water, instead of under a running tap. Rinse in a separate basin of water.
Do not wash public or private vehicles that are not used for patient transfer.
Flush the toilet only when it contains solid human waste.
Avoid the use of the public water supply for irrigation:
- Use drip irrigation instead of sprinklers.
- Use rainwater catchment where possible.
- Reuse grey water from laundry and dish washing to water plants.

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20. Is it safe to apply to the body or ingest disinfectant solutions to treat COVID-19?

Under no circumstances should disinfectants be applied on the human body or ingested. Ingesting disinfectants may cause severe poisoning or death. Please consult with your medical doctor about the best treatment options for you.
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21. Can the virus that causes COVID-19 spread through drinking water?

The virus cannot be spread through water that has been treated through conventional procedures that use filtration and disinfection, such as those in most municipal drinking water systems. These procedures inactivate the virus that causes COVID-19. The free residual chlorine concentration should be 0.5mg/L throughout the system.

22. Can the COVID-19 virus spread through sewerage systems?

SARS-CoV-2 virus RNA has been found in wastewater in several countries, prior to treatment. Current scientific knowledge suggests that the virus found is not able to transmit the disease but is a marker of presence. Standard municipal and individual septic system wastewater treatment practices would inactivate any viable SARS-CoV-2.
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23. Should disinfection mats be used in public or private buildings?

The use of disinfection mats is not recommended. The current scientific knowledge does not suggest this would interrupt an important transmission pathway. Chlorine degrades quickly with Ultra Violet Radiation (light), and high temperatures.

24. How should clothes be washed from infected people?

Clothes should be transported to the laundry area in a sealed bag, and care taken not to shake the clothes.
Clothes should be laundered in warm water with soap and should be in contact with the soap for a minimum of 30 minutes.
Dry fully.