importance of environmental sanitation essay

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Essay on Environmental Sanitation

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Essay Contents:

• Essay on Environmental Sanitation of Urban Area

Essay # 1. Introduction to Environmental Sanitation:

“Once we can secure access to clean water and to adequate sanitation facilities for all people, irrespective of the difference in their living conditions, a huge battle against all kinds of diseases will be won.” — WHO

Environmental sanitation envisages promotion of health of the community by providing clean environment and breaking the cycle of disease. It depends on various factors that include hygiene status of the people, types of resources available, innovative and appropriate technologies according to the requirement of the community, socioeconomic development of the country, cultural factors related to environmental sanitation, political commitment, capacity building of the concerned sectors, social factors including behavioural pattern of the community, legislative measures adopted, and others.

India is still lagging far behind many countries in the field of environmental sanitation. The unsanitary conditions are appalling in India and need a great sanitary awakening similar to what took place in London in the mid-19th century. Improvement in sanitation requires newer strategies and targeted interventions with follow- up evaluation.

The need of the hour is to identify the existing system of environmental sanitation with respect to its structure and functioning and to prioritize the control strategies according to the need of the country. These priorities are particularly important because of issue of water constraints, environment-related health problems, rapid population growth, inequitable distribution of water resources, issues related to administrative problems, urbanization and industrialization, migration of population, and rapid economic growth.

ADVERTISEMENTS: (adsbygoogle=window.adsbygoogle||[]).push({}); Essay # 2. Current Scenario of Environmental Sanitation :

As per estimates, inadequate sanitation cost India almost $54 billion or 6.4% of the country’s GDP in 2006. Over 70% of this economic impact or about $38.5 billion was health-related, with diarrhea followed by acute lower respiratory infections accounting for 12% of the health- related impacts.

Evidence suggests that all water and sanitation improvements are cost-beneficial in all developing world sub-regions sectoral demands for water are growing rapidly in India owing mainly to urbanization and it is estimated that by 2025, more than 50% of the country’s population will live in cities and towns.

Population increase, rising incomes, and industrial growth are also responsible for this dramatic shift. National Urban Sanitation Policy 2008 was the recent development in order to rapidly promote sanitation in urban areas of the country. India’s Ministry of Urban Development commissioned the survey as part of its National Urban Sanitation Policy in November 2008.

In rural areas, local government institutions in charge of operating and maintaining the infrastructure are seen as weak and lack the financial resources to carry out their functions. In addition, no major city in India is known to have a continuous water supply and an estimated 72% of Indians still lack access to improved sanitation facilities.

Essay # 3. Strategies of Environmental Sanitation :

A number of innovative approaches to improve water supply and sanitation have been tested in India, in particular in the early 2000s. These include demand-driven approaches in rural water supply since 1999, community-led total sanitation, public-private partnerships to improve the continuity of urban water supply in Karnataka, and the use of microcredit to women in order to improve access to water.

Total sanitation campaign gives strong emphasis on Information, Education, and Communication (IEC), capacity building and hygiene education for effective behaviour change with involvement of panchayati raj institutions (PRIs), community-based organizations and non-governmental organizations (NGOs), etc.

The key intervention areas are individual household latrines (IHHL), school sanitation and hygiene education (SSHE), community sanitary complex, Anganwadi toilets supported by Rural Sanitary Marts (RSMs), and production centers (PCs). The main goal of the government of India (GOI) is to eradicate the practice of open defecation by 2010.

To give fillip to this endeavor, GOI has launched Nirmal Gram Puraskar to recognize the efforts in terms of cash awards for fully covered PRIs and those individuals and institutions who have contributed significantly in ensuring full sanitation coverage in their area of operation. The project is being implemented in rural areas taking district as a unit of implementation.

A recent study highlighted that policy shift to include better household water quality management to complement the continuing expansion of coverage and upgrading of services would appear to be a cost-effective health intervention in many developing countries.

Most of the interventions (including multiple interventions, hygiene, and water quality) were found to significantly reduce the levels of diarrheal illness, with the greatest impact being seen for hygiene and household treatment interventions. Interventions to improve water quality at the household level are more effective than those at the source.

Unfortunately, in developing countries, public health concerns are usually raised on the institutional setting, such as municipal services, hospitals, and environmental sanitation. There is a reluctance to acknowledge the home as a setting of equal importance along with the public institutions in the chain of disease transmission in the community.

Managers of home hygiene and community hygiene must act in unison to optimize return from efforts to promote public health. A survey through in-depth interviews with more than 800 households in the city of Hyderabad in India concluded that, even if provided with market (not concessional) rates of financing, a substantial proportion of poor households would invest in water and sewer network connections.

The role of the WHO Guidelines for Drinking Water Quality emphasizes an integrated approach to water quality assessment and management from source to consumer. It emphasizes on quality protection and prevention of contamination and advises to be proactive and participatory, and address the needs of those in developing countries who have no access to piped community water supplies.

The guidelines emphasize the maintenance of microbial quality to prevent waterborne infectious disease as an essential goal. In addition, they address protection from chemical toxicants and other contaminants of public health concern.

When sanitation conditions are poor, water quality improvements may have minimal impact regardless of amount of water contamination. If each transmission pathway alone is sufficient to maintain diarrheal disease, single-pathway interventions will have minimal benefit, and ultimately an intervention will be successful only if all sufficient pathways are eliminated.

However, when one pathway is critical to maintaining the disease, public health efforts should focus on this critical pathway. The positive impact of improved water quality is greatest for families living under good sanitary conditions, with the effect statistically significant when sanitation is measured at the community level but not significant when sanitation is measured at the household level.

Improving drinking water quality would have no effect in neighbourhoods with very poor environmental sanitation; however, in areas with better community sanitation, reducing the concentration of fecal coliforms by two orders of magnitude would lead to a 40% reduction in diarrhoea.

Providing private excreta disposal would be expected to reduce diarrhoea by 42%, while eliminating excreta around the house would lead to a 30% reduction in diarrhoea. The findings suggest that improvements in both water supply and sanitation are necessary if infant health in developing countries is to be improved.

They also imply that it is not epidemiologic but behavioural, institutional, and economic factors that should correctly determine the priority of interventions. Another study highlighted that water quality interventions to the point-of-use water treatment were found to be more effective than previously thought, and multiple interventions (consisting of combined water, sanitation, and hygiene measures) were not more effective than interventions with a single focus.

Studies have shown that hand washing can reduce diarrhoea episodes by about 30%. This significant reduction is comparable to the effect of providing clean water in low-income areas.

Lack of safe water supply, poor environmental sanitation, improper disposal of human excreta, and poor personal hygiene help to perpetuate and spread diarrheal diseases in India. Since diarrheal diseases are caused by 20-25 pathogens, vaccination, though an attractive disease prevention strategy, is not feasible.

However, as the majority of childhood diarrhoeas are caused by Vibrio cholerae, Shigella edysenteriae type 1, rotavirus, and enterotoxigenic Escherichia coli which have a high morbidity and mortality, vaccines against these organisms are essential for the control of epidemics. A strong political will with appropriate budgetary allocation is essential for the control of childhood diarrheal diseases in India.

Management Approach based on Community:

National water policies are shifting to community-based management approach because local authorities are in daily contact with users, of whom about 50% are women. Historically, national policy shifted from attention to distribution of investments in the water sector to reorganization of water agencies and to building up the capacity of private or voluntary agencies.

The local context allows for more efficient and effective responses to local conditions. Local institutions and groups are better equipped to solicit local participation. Local water resource planning is very important in strengthening the economic and individual capacity of poor people in under-developed areas.

Experience in Mahesana, Banaskantha, and Sabarkantha in Gujarat state supports this lesson learned. One of the obstacles in Gujarat to water resource development is identified as increased demand for public water services and inadequate provision of services due to remoteness of the area and financial limitations of central agencies. Infrastructure is also poorly maintained.

Providing private excreta disposal would be expected to reduce diarrhoea by 42%, while eliminating excreta around the house would lead to a 30% reduction in diarrhea. The findings suggest that improvements in both water supply and sanitation are necessary if infant health in developing countries is to be improved. They also imply that it is not epidemiologic but behavioural, institutional, and economic factors that should correctly determine the priority of interventions.

Morbidity and mortality due to waterborne diseases have not declined commensurate with increase in availability of potable water supply. More importantly, young children bear a huge part of the burden of disease resulting from the lack of hygiene. India still loses between 0.4 and 0.5 million children under 5 years due to diarrhoea.

While infant mortality and under 5 mortality rates have declined over the years for the country as a whole, in many states, these have stagnated in recent years, one of the reasons is the failure to make significant headway in improving personal and home hygiene, especially in the care of young children and the conditions surrounding birth.

Few More Developments:

The agriculture sector accounts for between 90 and 95% of surface and groundwater in India, while industry and the domestic sector account for the remaining. At the same time, several important measures are being taken to deal with the above issues, on the water resources management front, the National Water Policy, 2002 recognizes the need for well-developed information systems at the national and state levels, places strong emphasis on non-conventional methods for utilization such as inter-basin transfers, artificial recharge, desalination of brackish or sea water, as well as traditional water conservation practices such as rainwater harvesting, etc., to increase utilizable water resources.

It also advocates watershed management through extensive soil conservation, catchment area treatment, preservation of forests, and increasing forest cover and the construction of check dams. The policy also recognizes the potential need to reorganize and reorient institutional arrangements for the sector and emphasizes the need to maintain existing infrastructure.

While no comprehensive study on equity issues relating to water supply, sanitation, and health has been conducted for the country as a whole, common equity issues that plague the sector in most developing countries also hold true for India. In addition, comprehensive studies on the economic value of the water and sanitation sector in India also do not exist.

It is important to reiterate the need for Rural Water Supply and Sanitation [RWSS] and Urban Water Supply and Sanitation [UWSS] agencies to operate hand-in-hand with their health and education counterparts to jointly monitor indicators of RWSS, UWSS, health, education, poverty, and equity in order to make significant headway in the respective sectors. Existing health promotion and education programmes should be made more effective and geared toward achieving behavior changes needed to improve hygiene.

Essay # 4. Environmental Sanitation of Urban Area:

Percent of urban population without proper sanitation in India is 63%. The 11th Five Year Plan envisages 100% coverage of urban water, urban sewerage, and rural sanitation by 2012. Although investment in water supply and sanitation is likely to see a jump of 221% in the 11th plan over the 10th plan, the targets do not take into account both the quality of water being provided, or the sustainability of systems being put in place.

Increasing emphasis on use of information technology applications in urban governance and management to ensure quick access to information, planning, and decision support systems are the primary concern areas related to environmental sanitation. Solid waste management is also increasingly seen as an important area in UWSS.

Legislation on municipal waste handling and management has been passed in October 2000. Some strategies on solid waste management include preparation of town-wise master plans, training of municipal staff, IEC and awareness generation, involvement of community-based and non-governmental organizations, setting up and operation of compost plants via NGOs and the private sector, enhancement of the capacities of some state structures such as State Compost Development Corporations with emphasis on commercial operations and private sector involvement.

Variations in housing type, density and settlement layout, poverty status, and access to networked services will lead to different solutions for sanitation in different parts of the city or within the same neighbourhood.

Challenges Ahead:

1. Prevention of contamination of water in distribution systems,

2. Growing water scarcity and the potential for water reuse and conservation,

3. Implementing innovative low-cost sanitation system,

4. Providing sustainable water supplies and sanitation for urban and semi-urban areas,

5. Reducing disparities within the regions in the country,

6. Sustainability of water and sanitation services.

The public health challenge inherent in meeting the MDG targets is ensuring that improvements result in access to water and sanitation for the critical at-risk populations. Innovative approaches are required to ensure the availability of low-cost, simple, and locally acceptable water and sanitation interventions and integrating these approaches into existing social institutions such as schools, markets, and health facilities.

Finally, it is concluded that implementation of low-cost sanitation system with lower subsidies, greater household involvement, range of technology choices, options for sanitary complexes for women, rural drainage systems, IEC and awareness building, involvement of NGOs and local groups, availability of finance, human resource development, and emphasis on school sanitation are the important areas to be considered.

Also appropriate forms of private participation and public private partnerships, evolution of a sound sector policy in Indian context, and emphasis on sustainability with political commitment are prerequisites to bring the change.

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Sustainable development goal 6: clean water and sanitation.

The Sustainable Development Goals were adopted by the United Nations in 2015 to work toward a sustainable and poverty-free world by 2030. Goal 6, in particular, seeks to ensure that people have access to clean water and adequate sanitation services worldwide.

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The members of the United Nations (UN) adopted the Sustainable Development Goals (SDGs) in 2015. These 17 goals are designed to unite nations in the common cause of ensuring the general welfare of all humans by the year 2030. These goals include a focus on ending poverty, tackling climate change , and maintaining high standards of resources.

SDG 6 focuses on ensuring a clean and stable water supply and effective water sanitation for all people by the year 2030. The goal is a reaction to the fact that many people throughout the world lack these basic services. About 40 percent of the world’s population is affected by a lack of water. As global temperatures rise, that total is expected to increase. Already, some of the poorest countries in the world are affected by drought , resulting in famine and malnutrition . Throughout the world, about 1.7 billion people live in a watershed where water is used faster than the watershed can be replenished. According to some estimates, if such trends continue, one in four people, or more, might experience water shortages on a regular basis by the year 2050.

Compounding the problem of water scarcity is the lack of reliable sanitation throughout the world. More than two billion people worldwide lack basic sanitation services, such as simple latrines or toilets. More than 890 million of those people live in regions where “open defecation” occurs. This means that human waste is left in the open. Adding to the issue is the fact that 80 percent of wastewater throughout the planet is emptied into the ocean or rivers without proper waste removal.

Alarmed by these problems, the UN established SDG 6 in an effort to make adequate sanitation and water services available to all people by the year 2030. As many as 800 million people, or more, would require the construction of facilities to provide consistent clean water and waste removal. To succeed in their vision, the UN developed a series of targets. These targets include restoring and protecting river ecosystems throughout the world, eliminating sources of water pollution , and increasing international cooperation to bring services throughout the world.

In an effort to reach the targets outlined by SDG 6, some water companies have installed smart meters in places where water scarcity is a concern. These meters track and charge for every drop of water used in a household, which has led to higher water conservation in countries like The Gambia and Tanzania. The CEO of one such company, eWATERpay, claims that these meters have reduced water waste by 99 percent.

Such efforts take time and require many countries to work together. While some strides have been made, based on information from a 2017 UN study, not enough has been done to ensure that this goal will be met by 2030. Managing these targets properly is the only way to make certain all people will benefit from clean water and effective sanitation in the years ahead.

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Water, sanitation and hygiene (WASH)

Safe drinking-water, sanitation and hygiene are crucial to human health and well-being. Safe WASH is not only a prerequisite to health, but contributes to livelihoods, school attendance and dignity and helps to create resilient communities living in healthy environments. Drinking unsafe water impairs health through illnesses such as diarrhoea, and untreated excreta contaminates groundwaters and surface waters used for drinking-water, irrigation, bathing and household purposes.  Chemical contamination of water continues to pose a health burden, whether natural in origin such as arsenic and fluoride, or anthropogenic such as nitrate. Safe and sufficient WASH plays a key role in preventing numerous NTDs such as trachoma, soil-transmitted helminths and schistosomiasis. Diarrhoeal deaths as a result of inadequate WASH were reduced by half during the Millennium Development Goal (MDG) period (1990–2015), with the significant progress on water and sanitation provision playing a key role. Evidence suggests that improving service levels towards safely managed drinking-water or sanitation such as regulated piped water or connections to sewers with wastewater treatment can dramatically improve health by reducing diarrhoeal disease deaths.

Safe drinking-water, sanitation and hygiene (WASH) are crucial to human health and well-being. Safe WASH is not only a prerequisite to health, but contributes to livelihoods, school attendance and dignity and helps to create resilient communities living in healthy environments. Drinking unsafe water impairs health through illnesses such as diarrhoea, and untreated excreta contaminates groundwaters and surface waters used for drinking-water, irrigation, bathing and household purposes. This creates a heavy burden on communities. Chemical contamination of water continues to pose a health burden, whether natural in origin such as arsenic and fluoride, or anthropogenic such as nitrate. Safe and sufficient WASH plays a key role in preventing numerous neglected tropical diseases (NTDs) such as trachoma, soil-transmitted helminths and schistosomiasis.

However, poor WASH conditions still account for more than one million diarrhoeal deaths every year and constrain effective prevention and management of other diseases including malnutrition, NTDs and cholera.

Evidence suggests that improving service levels towards safely managed drinking-water or sanitation such as regulated piped water or connections to sewers with wastewater treatment can dramatically improve health by reducing diarrhoeal disease deaths.

WHO develops, updates and disseminates health-based guidance documents and best practice guides, norms and standards that support standard-setting and regulations at national level, particularly for drinking-water safety, effective surveillance approaches, recreational water quality, sanitation safety, safe wastewater use, WASH in health and educational facilities, and WASH monitoring.

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WHO provides reliable and credible WASH data to inform policies and programmes including on WASH risk factors and burden of disease, the status of key output indicators for WASH, progress towards relevant WASH-related SDG targets, the enabling environment for WASH including WASH finance, and wastewater and SDG 6 interlinkages.

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WHO promotes integration of WASH with other health programmes, for example disease programmes for cholera and NTDs, emergencies programmes, quality care and infection prevention control, especially through WASH in health care facilities, nutrition programmes and antimicrobial resistance programmes. 

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Sanitation is essential to children’s survival and development..

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Sanitation is about more than just toilets. Behaviours, facilities and services together provide the hygienic environment children need to fight diseases and grow up healthy.

3.5 billion people still do not have safe sanitation services, while 419 million people practice “open defecation”. 

Poor sanitation puts children at risk of childhood diseases and malnutrition that can impact their overall development, learning and, later in life, economic opportunities. While some parts of the world have improved access to sanitation, millions of children in poor and rural areas have been left behind.

Lack of sanitation can be a barrier to individual prosperity and sustainable development. When children, especially girls, cannot access private and decent sanitation facilities in their schools and learning environments, the right to education is threatened. As adults, wage earners who miss work due to illness may find themselves in financial peril. And when health systems become overwhelmed and productivity levels fall, entire economies suffer.

Without basic sanitation services, people have no choice but to use inadequate communal latrines or to practise open defecation, posing a risk to health and livelihoods.

Even in communities with toilets, waste containment may not be adequate. If they are difficult to clean or not designed or maintained to safely contain, transport and treat excreta, for example, waste might come into contact with people and the environment. These factors make sustainable development nearly impossible.

Open defecation

The practice of defecating in the open (such as in fields, bushes, or by bodies of water) can be devastating for public health.

Exposed faecal matter contaminates food, water and the environment, and can spread serious diseases, such as cholera. Coupled with poor hygiene practices, exposure to faecal matter remains a leading cause of child mortality, morbidity, undernutrition and stunting, and can negatively impact a child's cognitive development. 

Harmful to community health and well-being, open defecation can also undermine individual dignity and safety – especially for girls and women. When forced to travel greater distances from home to reach adequate hygiene facilities, girls are women are put at greater risk of violence.

UNICEF's response

UNICEF is on the ground in more than 100 countries to provide safe sanitation for the world's most vulnerable communities in rural and urban areas, and during emergencies.

We mobilize communities, build markets for sanitation goods and services, and partner with governments to plan and finance sanitation services.

In emergencies, UNICEF provides urgent relief to communities and nations threatened by disrupted services and the risk of disease outbreak.

We also support innovation in sanitation; improving sanitation technology; ensuring basic toilets are affordable, accessible and safe; and finding effective, sustainable solutions for sanitation challenges that harm children.

Ending open defecation

Ongoing investment in sanitation services by households, communities and governments is necessary to shift community behaviour so that ‘toilet use by all’ becomes the new norm.

Many countries are off track to end open defecation by 2030. UNICEF’s commitment to meet this challenge has been mapped in our ‘game plan’ to end open defecation, a strategy for reaching the 26 countries that account for over 90 per cent of global open defection.

We support governments through community- and market-based approaches in rural areas and in urban slums, where most people defecating in the open live. Communities are encouraged to carry out an analysis of existing defecation patterns and to use local resources to build low-cost household toilets and ultimately eliminate the practice.

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Essay on Clean Environment

Students are often asked to write an essay on Clean Environment in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Clean Environment

Importance of a clean environment.

A clean environment is vital for all living beings. It keeps us healthy and happy. It’s where clean air, water, and land are free from pollution.

Our Responsibility

We should reduce, reuse and recycle waste. We should not litter and keep our surroundings clean. Planting trees can also help.

Benefits of a Clean Environment

A clean environment reduces diseases and increases lifespan. It brings happiness and enhances the quality of life. It’s our home, let’s keep it clean.

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250 Words Essay on Clean Environment

The imperative of a clean environment.

A clean environment is not just an aesthetic luxury, but a fundamental necessity for the survival and well-being of all life forms. It is intrinsically linked to our health, economic prosperity, and overall quality of life.

The Health Connection

A clean environment reduces the prevalence of diseases and enhances physical health. Polluted air is a potent carrier of respiratory diseases, while contaminated water can lead to numerous waterborne illnesses. Hence, maintaining cleanliness in our surroundings directly contributes to our health.

Economic Impact

Environmental cleanliness also has a profound economic impact. A polluted environment can deter tourists, affecting the tourism industry. Moreover, the cost of treating diseases arising from environmental pollution can drain a nation’s financial resources. Thus, a clean environment is economically beneficial.

Role of Individuals and Governments

The responsibility of maintaining a clean environment falls on both individuals and governments. Individuals can contribute by adopting eco-friendly habits like recycling and reducing waste. Governments, on the other hand, can enforce stringent environmental regulations and promote sustainable practices.

Preserving Biodiversity

A clean environment is crucial for preserving biodiversity. Pollution disrupts ecosystems, leading to the extinction of various species. By keeping our environment clean, we can protect these species and maintain the delicate balance of our ecosystem.

In conclusion, a clean environment is pivotal for our health, economic prosperity, and biodiversity. It is a collective responsibility that requires the participation of all stakeholders. By understanding the importance of a clean environment, we can contribute to a healthier, prosperous, and more sustainable world.

500 Words Essay on Clean Environment

Understanding the concept of ‘clean environment’.

A clean environment is one that is free from pollutants and harmful substances, fostering healthy living for all species. It is characterized by clean air, pure water, fertile soil, and a balanced ecosystem. This is not merely an aesthetic or luxury concept; rather, it is a fundamental requirement for the survival of all life forms.

Maintaining a clean environment has numerous benefits. Firstly, it promotes good health by reducing the risk of diseases caused by environmental pollution, such as respiratory illnesses and cancers. Secondly, it supports biodiversity by providing a conducive habitat for various species. Thirdly, a clean environment enhances mental well-being, as nature has been proven to reduce stress and promote relaxation. Moreover, it supports economic activities such as tourism and agriculture, which rely on a pristine environment.

Threats to a Clean Environment

Strategies for maintaining a clean environment.

Education plays a critical role in this regard. By integrating environmental education into curriculums, we can nurture a generation that values and prioritizes environmental cleanliness. Additionally, technological innovations can help monitor and control pollution, and develop cleaner production methods.

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Water, Sanitation and Hygiene, or WASH, are issues that affect the health and wellbeing of every person in the world. Everyone needs clean water to drink. Everyone needs a safe place to pee and poop. And everyone needs to be able to clean themselves. For many people, WASH concerns are taken for granted and their combined impact on life isn’t always appreciated.

But for hundreds of millions of others, water, sanitation and hygiene are constant sources of stress and illness. The quality of water, sanitation and hygiene in a person’s life is directly correlated to poverty, as it is usually joined by lack of education, lack of opportunity and gender inequality.  

What’s the scope of the problem?

780 million people do not have regular access to clean water.

2.4 billion people, or 35% of the global population, do not have access to adequate sanitation.

A local resident washes in an Indian slum colony in New Delhi Image: Flickr: Gates Foundation

Inadequate sanitation generally means open defecation. When people defecate in the open without a proper waste management system, then the feces generally seeps into and contaminates water systems. Just standing in an open defecation zone can lead to disease, if, for instance, the person is barefoot and parasites are there.

The problem is concentrated in Sub-Saharan Africa, Southern Asia and Eastern Asia. The country with the most people lacking adequate WASH is India.

Girls are the hardest hit by lack of clean water and sanitation for a few reasons. When schools lack functional toilets or latrines, girls often drop out because of the stigma associated with periods. Also, when families don’t have enough water, girls are generally forced to travel hours to gather some, leaving little time for school. This lack of education then contributes to higher poverty rates for women.

What are the health risks?

There are a lot of health risks associated with inadequate WASH. Just imagine what it would be like if you were drinking contaminated water and everyone in your community defecated in the open.

801,000 kids under the age of 5 die each year because of diarrhea. 88% of these cases are traced to contaminated water and lack of sanitation.

More than a billion people are infected by parasites from contaminated water or open defecation. One of these parasites is called the Guinea Worm Disease, which consists of worms up to 1 meter in size that emerge from the body through blisters.

Image: Flickr - Andrew Moore

The bacterial infection Trachoma generally comes from contaminated water and is a leading cause of blindness in the world.

Other common WASH-related diseases include Cholera, Typhoid and Dysentery.

And, again, step back to consider what life without clean water and adequate sanitation would be like. A lot of your time would be spent trying to get clean water and avoid sanitation problems in the first place. And the hours not revolving around these concerns would probably be reduced quality of life because of the many minor health problems associated with poor water quality. Ultimately, inadequate WASH leads to reduced quality of life all the time.

What’s being done?

For every $1 USD invested in WASH programs, economies gain $5 to $46 USD. In the US, for instance, water infrastructure investments had a 23 to 1 return rate in the 20th century. When people aren’t always getting sick, they’re more productive and everyone benefits.

While the numbers are daunting, a lot is being done. And the economic benefits of WASH investments make the likelihood of future investments and future progress much higher.

Some investments are small-scale, others are large-scale. On the smaller side of the spectrum, investments can go toward water purification methods, community wells or sources of water and the construction of community latrines.

Image: Michael Sheldrick

For instance, in a slum in Nairobi, Kenya, the government recently installed ATM-style water dispensers that provide clean water to the whole community.

Larger scale investments include piped household water connections and household toilets with adequate sewage systems or septic tanks.

An often overlooked aspect of WASH involves behavioral hygiene, and, more specifically, hand washing. Simply washing your hands with soap can reduce the risk of various diseases, including the number 1 killer of the world’s poorest children: pneumonia .

What progress has been made?

In 1990, 76% of the global population had access to safe drinking water and 54% had access to adequate sanitation facilities.

In 2015, even though the population had climbed by more than 2 billion people, 91% of people had access to safe drinking water and 68% had access to improved sanitation.

That means in 25 years, 2.6 billion people gained access to safe drinking water and 2.1 billion gained access to improved sanitation.

India is currently in the process of an unprecedented WASH investment program. At the 2014 Global Citizen Festival, Prime Minister Narendra Modi committed to end open defecation in the country and has since mobilized substantial resources with the help of The World Bank .

What role does Global Citizen play in all this?

Global Citizen puts pressure on world leaders to focus on and direct money to poverty solutions around the world. When it comes to WASH, global citizens have helped raise awareness of the various associated problems and motivate politicians to invest in specific programs.

Head over to our Impact page to read more about specific achievements. 

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Why Clean Water, Sanitation And Hygiene Are So Important

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GOAL 6: Clean water and sanitation

Learn more about SDG 6

Ensure availability and sustainable management of water and sanitation for all:

Sustainable management of water resources and access to safe water and sanitation are essential for unlocking economic growth and productivity, and provide significant leverage for existing investments in health and education. The natural environment e.g. forests, soils and wetlands contributes to management and regulation of water availability and water quality, strengthening the resilience of watersheds and complementing investments in physical infrastructure and institutional and regulatory arrangements for water access, use and disaster preparedness. Water shortages undercut food security and the incomes of rural farmers while improving water management makes national economies, the agriculture and food sectors more resilient to rainfall variability and able to fulfil the needs of growing population. Protecting and restoring water-related ecosystems and their biodiversity can ensure water purification and water quality standards.

UNEP is working to develop a coherent approach to measuring water-related issues included through. All the SDG indicators under Goal 6 are coordinated by UN Water and UNEP actively works with UN Water and the UN Water partners on these indicators. UN Water has developed a data portal as a hub for SDG 6. Additionally, the Global Environmental Monitoring Initiative for SDG 6 acts a coordinating initiative for all SDG 6 methodologies (all SDG 6 methodologies, including the ones UNEP has developed are available as part of this initiative).

Sustainable Development Goal 6 goes beyond drinking water, sanitation and hygiene to also address the quality and sustainability of water resources, which are critical to the survival of people and the planet. The 2030 Agenda recognizes the centrality of water resources to sustainable development and the vital role that improved drinking water, sanitation and hygiene play in progress in other areas, including health, education and poverty reduction.

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Tapping the Benefits of Clean Water, Sanitation, and Hygiene

By Guest Blogger on July 6, 2017

By Katie Dahlstrom, Nestlé Corporate Communications Manager and Helen Medina, Nestlé Senior Public Affairs Manager, Government and Multilateral Relations

Clean water is one of the few things in life that never fails to live up to expectations.

It is difficult to overstate the importance of having it. In fact, it’s probably impossible. Clean water changes almost everything. This is also why access to and management of clean water, sanitation, and hygiene are included in the Sustainable Development Goals (SDGs), specifically, SDG 6, which Nestlé is contributing directly through our partnership with the International Federation of Red Cross and Red Crescent Societies (IFRC). But how are we doing this?

Tapping the benefits

Having clean water and sanitation means being able to avoid exposure to countless diseases.

Every year, millions of people die from diseases caused by inadequate water supply, sanitation, and hygiene. Other than pneumonia, diarrhea is the  main cause of death  in children under age 5.

Poor sanitation and unsafe water  cause nearly 20% of workplace deaths . It costs around  $260 billion  in lost productivity every year.

But the benefits of having a source of clean water in a community are much wider. When women and girls no longer have to walk miles to fetch water each day, they have more time to learn. Literacy rates rise. And when schools build proper toilet facilities,  girls spend more time in school and less time at home.  

The  United  N ations  estimates that every Swiss franc invested in water and sanitation leads to four francs in economic returns – which is why investing in this area is such an effective way of creating stronger, more resilient communities.

Connecting communities

In Côte d’Ivoire,  63% of the population lacks access to proper sanitation . People must often walk miles to collect water, which may not even be safe to drink, as well as use open air, unhygienic shared toilets.  

The IFRC is working across Côte d’Ivoire to extend access to clean water, sanitation, and hygiene.

As the IFRC’s longest-standing corporate partner, Nestlé has helped to deliver clean water and sanitation to almost 110,000 people in Côte d’Ivoire’s cocoa-growing communities for the past 10 years.  

A total of 181 water pumps and 93 blocks of school toilets have been built or renovated as well as more than 7,000 family latrines.  

Education has been an essential part of the effort too. More than 200 community water and sanitation committees and 93 school hygiene clubs have been established since 2007.  

Their members promote hygiene in their local area. They teach people how to store water safely and build safe sanitation facilities, and children how to wash their hands well. Sometimes it is the simplest measures that have the biggest effect.  

“Our grandchildren will not suffer…”

Adjoua is a 55-year-old widow from the village of Ndri Koffikro in the south of Côte d’Ivoire. She recalls that ever since she was young, her community’s biggest wish has been to have access to safe drinking water. Traditionally, residents relied on ponds and a river nestled in a forest two kilometers away for their water.

Before the IFRC committed to building a water point in the village, it made sure a viable management system could be set up with community members. A management committee, which consists of six women and two men from the village, oversees the operation and maintenance of the water point and handles the accounts related to the income generated from selling water.

It ensures that the investment made in the water point will live on for generations.  

“Now, I and my community members will have more time and energy to take care of our family as well as our farming activities,” says Adjoua. “Our grandchildren will not suffer all the pains we went through.”

Safe water and better hygiene reduce the burden of ill health on families and allow women more time to earn their own income. An end to open defecation means people are safer – particularly at night – and the land is cleaner and the crops healthier.  

Meaningful progress

Education programs teach school children good hygiene habits. Some  768 million people still do not have access to an improved source of drinking water ; 40% of them in sub-Saharan Africa. There is still a long way to go, but progress is being made.

With the program up and running successfully in Côte d’Ivoire, the next phase of the project has already begun in Ghana, where wells are now being constructed. Over 76,000 people in cocoa producing communities that Nestlé works with will have better access to clean water and sanitation by April 2018.  

By bringing basic hygiene knowledge alongside clean water, the IFRC program ensures that the health benefits of its work endure.  

[Photo: Copyright Nestlé S.A. and by Remo Naegli]         

This post is part of the “SDG Solutions” series hosted by the United Nations Foundation, Global Daily, and +SocialGood to raise awareness of ways the international community can advance, and is advancing, progress on the Sustainable Development Goals. As the international community prepares to gather at the UN for the High-Level Political Forum on Sustainable Development from July 10-19, this series will share ideas and examples of action. Previous posts in the series can be found here .

Nestlé   is a part of the Every Woman Every Child movement, launched in 2010 and led by the UN Secretary-General, to intensify commitment and action by governments, the UN, multilaterals, the private sector, and civil society to keep women’s, children’s and adolescents’ health and wellbeing at the heart of development. As a multi-stakeholder platform to operationalize the Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health, the movement mobilizes partnerships and coordinated efforts across sectors to ensure that all women, children and adolescents not only survive, but also thrive to help transform the world. Learn more : http://www.everywomaneverychild.org/

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What is environmental health?

Examining a massive influence on our health: the environment..

We've been reporting on environmental health for 20 years. But what is environmental health? You've got questions, and we have answers.

Environmental health is a branch of public health that monitors the relationship between human health and the environment, examining aspects of both our natural and human-made environment and their effect on human wellbeing.

What is an example of environmental health?

Living near factories or heavy traffic worsens air quality and leads to health impacts on the lungs and heart.

Credit: Kouji Tsuru / Unsplash

Environmental health is a broad area of study — everything from the climate to the food we eat to the air we breathe plays into environmental health. A few specific examples include:

• Air pollution: Living near factories or heavy traffic worsens air quality and leads to health impacts on the lungs and heart such as asthma and increased risk of heart attacks or stroke.
• Water contamination: Drinking lead-contaminated water can cause IQ loss, behavioral issues, learning disabilities and more. Infants and young children are most at risk.
• Toxic chemicals in consumer products: Phthalates, a class of chemicals that are widely used in consumer products, are known endocrine-disruptors, meaning they hijack your body’s hormones and can cause a wide array of health impacts including increased risk of cancer and fertility issues.

What is the role of environmental health?

The role of environmental health research is to examine areas of the environment that impact our health so that we can make personal and policy changes to keep ourselves safe and improve human health and wellbeing.

Why is environmental health important?

Credit: Viki Mohamad / Unsplash

Environmental health impacts every one of us.

We reap the benefits of clean air, clean water, and healthy soil. If our environment is unhealthy, with toxic chemicals saturating our resources and pollution abundant, then our health also suffers.

It is also an important field of study because it looks at the “unseen” influences on your health.

Many individuals may not associate their health problems with air or water quality, or with what clothes they wear, makeup and household goods they use, or food they eat.

That’s because not every example of environmental health problems are obvious: some chemicals, for example, build up slowly over time in your body: a small dose may not seem to bring harm, but repeated small doses can lead to later impacts.

• BPA absorbed through plastic containers, cans, receipts, etc. lingers in the body and the build-up over time increases risk of cancer, diabetes, liver failure, and more.
• PFAS are known as ‘forever chemicals ’— they don’t break down and are widely used, so small exposures are frequent and contribute to immune system and reproductive damages, heightened cholesterol levels, and more.
• Mercury from eating seafood and shellfish can impact neurological development of fetuses in the womb, and populations that regularly consume mercury-heavy seafood have shown mild cognitive impairment.

Also, individual susceptibility can differ: for example, one member of a household can experience illness, asthma, migraines, etc. from chemicals found in their water supply while another member of the same household is just fine, such as the case in a young girl’s reaction to benzene in her water from living near fracking wells.

Certain variables play a role in susceptibility and level of adverse health effects such as age, gender, pregnancy, and underlying health conditions. Studies suggest fetuses, infants and children are much more at risk to experience lifelong health problems from toxic chemical exposure.

Rate, duration, and frequency of exposure to toxic chemicals and other influences from our environment all factor into our health.

Good environmental health = good human health.

What environmental health problems affect our health?

Two women extracting from a well in Senegal.

Credit: JordiRamisa

There are many environmental health issues that affect human health. These include:

Air pollution — nine out of 10 people currently breathe air that exceeds the World Health Organization’s guideline limits for air pollution worldwide. This mainly affects people in low and middle-income countries, but in the United States, people that live in cities, or near refineries or factories, are often affected as well.

Air pollution also ramps up during wildfire season.

Read more: Breathless: Pittsburgh's asthma epidemic and the fight to stop it

Water pollution — as of 2014, every year more people die from unsafe water than from all forms of violence, including war. Water is the ‘universal solvent’, meaning it can dissolve more substances than any other liquid on Earth. Thus, it is too easy for toxic chemicals to enter our water supply.

Read more: Sacred Water: Environmental justice in Indian Country

Lack of access to health care — yes, this is an environmental health issue! Having an accessible health care system is part of one’s environment. Difficulty getting health care can further impact one’s health.

Poor infrastructure — from “food deserts” to lack of transportation services, living in an area with poor infrastructure can impact your health.

Read more: Agents of Change: Amplifying neglected voices in environmental justice

Climate change — climate change-induced heat waves, increased frequency and severity of large storms, droughts, flooding, etc. have resulted in health problems and even death.

Chemical pollution — chemical pollution can be sneaky: the chemicals in your everyday products, from shampoo to deodorant to your clothing to the food you eat, can directly affect your health. These chemicals are often not on the label or regulated at all.

Read more: Exposed: How willful blindness keeps BPA on shelves and contaminating our bodies

How can we improve our environmental health?

Credit: instaphotos

Educate yourself. Environmental health is a broad topic, so this can seem overwhelming. Start by taking stock of your own personal environment. Look up air pollution monitoring in your area. Get your water tested to see its chemical makeup. Evaluate the products you use in your life — personal products like shampoo and deodorant, household cleaners, air fresheners, the foods that you eat — and see what you’re bringing into your home.

Explore the Environmental Working Group's guides to check your products for toxic chemicals.

We have additional guides to help you learn more about environmental health. Find guides to plastic pollution , environmental justice , glyphosate , BPA , PFAS and more in the Resources tab at the top of our website.

As individuals we have the power to improve some of our environmental health, but there is a pressing need for systemic change and regulation on a policy level.

We’re actively working with scientists to share their research and knowledge with politicians to advocate for science-backed policy change. But we need your help. Contact your representatives to let them know that environmental health is important to you — whether it’s air pollution in your area, contaminated water, plastic pollution, food deserts in your area, or chemicals in consumer products.

Subscribe to Above the Fold , our daily newsletter keeping you up-to-date on environmental health news.

• Op-Ed: Building a culture of health in the era of climate change - EHN ›
• Pollution and our mental health - EHN ›
• Agents of Change: Amplifying neglected voices in environmental ... ›
• Environmental toll of plastics - EHN ›
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• Biology Article
• Need For Hygiene And Sanitation

Need for Hygiene and Sanitation

What is hygiene.

Hygiene is a set of personal practices that contribute to good health. This includes washing hands, cutting hair/nails periodically, bathing, etc.

What is Sanitation?

Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation.

Also Read:  Health and Hygiene

Read on to explore the importance of hygiene and sanitation.

Importance of Hygiene and Sanitation

Maintaining personal hygiene and sanitation is important for several reasons such as personal, social, psychological, health, etc. Proper hygiene and sanitation prevent the spread of diseases and infections. If every individual on the planet maintains good hygiene for himself and the things around him, diseases will eradicate to a great level.

Importance of Hygiene

Hygiene, as defined by the WHO refers to “ the conditions and practices that help maintain health and prevent the spread of diseases. ”

This means more than just keeping ourselves clean. This means shunning all practices that lead to bad health. Throwing garbage on the road, defecating in the open, and many more. By adopting such a practice, we not only make ourselves healthier but also improve the quality of our lives.

Personal hygiene means keeping the body clean, consumption of clean drinking water, washing fruits and vegetables before eating, washing one’s hand, etc. Public hygiene refers to discarding waste and excreta properly, that means, waste segregation and recycling, regular disinfection and maintenance of the city’s water reservoir. Quality of hygiene in the kitchens is extremely important to prevent diseases.

Diseases spread through vectors. Say the vector is contaminated water as in the case of typhoid, cholera, and amoebiasis (food poisoning). By drinking clean water, we can completely eliminate the chances of getting diseases.

Some diseases are caused by pathogens carried by insects and animals. For eg., plague is carried by rats, malaria, filarial, roundworms by flies and mosquitoes, etc.

Mosquitoes thrive in stagnant water and rats in garbage dumps and the food that is dumped out in the open. By spraying stagnant water bodies with kerosene or other chemicals, we can completely eliminate mosquitoes from our neighbourhood. If that is unfeasible, we can all use mosquito nets prevents us from mosquitoes while we’re asleep. This poses a physical barrier for the mosquito.

Rats thrive on unsystematic waste disposal. By segregating the waste we can ensure that we don’t leave food lying around for rats to eat. Close contact with sick people is also another way of contracting diseases .

A country has to strive to educate more doctors so that medical need of every citizen is taken care of. The importance of cleanliness should be inculcated in every citizen and this will in turn show in the cleanliness of the places we live in.

Importance of Sanitation

Sanitation is another very important aspect. Many of the common diseases mentioned earlier such as roundworms spread through the faeces of infected people. By ensuring that people do not defecate in the open, we can completely eliminate such diseases and even more severe ones such as the one caused by E. Coli. The advancement in biology has given us answers to many questions, we are now able to identify the pathogen and treat an ailment accordingly.

Also Read:  Health and Diseases

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Article contents

The environment in health and well-being.

• George Morris George Morris European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
•  and  Patrick Saunders Patrick Saunders University of Staffordshire, University of Birmingham, and WHO Collaborating Centre
• https://doi.org/10.1093/acrefore/9780199389414.013.101
• Published online: 29 March 2017

Most people today readily accept that their health and disease are products of personal characteristics such as their age, gender, and genetic inheritance; the choices they make; and, of course, a complex array of factors operating at the level of society. Individuals frequently have little or no control over the cultural, economic, and social influences that shape their lives and their health and well-being. The environment that forms the physical context for their lives is one such influence and comprises the places where people live, learn work, play, and socialize, the air they breathe, and the food and water they consume. Interest in the physical environment as a component of human health goes back many thousands of years and when, around two and a half millennia ago, humans started to write down ideas about health, disease, and their determinants, many of these ideas centered on the physical environment.

The modern public health movement came into existence in the 19th century as a response to the dreadful unsanitary conditions endured by the urban poor of the Industrial Revolution. These conditions nurtured disease, dramatically shortening life. Thus, a public health movement that was ultimately to change the health and prosperity of millions of people across the world was launched on an “environmental conceptualization” of health. Yet, although the physical environment, especially in towns and cities, has changed dramatically in the 200 years since the Industrial Revolution, so too has our understanding of the relationship between the environment and human health and the importance we attach to it.

The decades immediately following World War II were distinguished by declining influence for public health as a discipline. Health and disease were increasingly “individualized”—a trend that served to further diminish interest in the environment, which was no longer seen as an important component in the health concerns of the day. Yet, as the 20th century wore on, a range of factors emerged to r-establish a belief in the environment as a key issue in the health of Western society. These included new toxic and infectious threats acting at the population level but also the renaissance of a “socioecological model” of public health that demanded a much richer and often more subtle understanding of how local surroundings might act to both improve and damage human health and well-being.

Yet, just as society has begun to shape a much more sophisticated response to reunite health with place and, with this, shape new policies to address complex contemporary challenges, such as obesity, diminished mental health, and well-being and inequities, a new challenge has emerged. In its simplest terms, human activity now seriously threatens the planetary processes and systems on which humankind depends for health and well-being and, ultimately, survival. Ecological public health—the need to build health and well-being, henceforth on ecological principles—may be seen as the society’s greatest 21st-century imperative. Success will involve nothing less than a fundamental rethink of the interplay between society, the economy, and the environment. Importantly, it will demand an environmental conceptualization of the public health as no less radical than the environmental conceptualization that launched modern public health in the 19th century, only now the challenge presents on a vastly extended temporal and spatial scale.

• environmental and human health
• environment
• environmental epidemiology
• environmental health inequalities
• ecological public health

Introduction

This article traces the development of ideas about the environment in human health and well-being over time. Our primary focus is the period since the early 19th century , sometimes termed the “modern public health era.” This has been not only a time of unprecedented scientific, technological, and societal transition but also a time during which perspectives on the relationship of humans to their environment, and its implications for their health and well-being, have undergone significant change.

Curiosity about the environment as a factor in human health and well-being, and indeed health-motivated interventions to manage the physical context for life, substantially predate the modern public health era. The archaeological record provides evidence of sewer lines, primitive toilets, and water-supply arrangements in settlements in Asia, the Middle East, South America, and Southern Europe, dating back many thousands of years (Rosen, 1993 ). Some religious traditions also imply recognition of the importance of environmental factors in health. For example, restrictions on the consumption of certain foods probably derive from a belief that these foods carried risks to health; a passage in the book of Leviticus conveys the existence of a belief in the relationship between the internal state of a house and the health of its occupants (Leviticus [14:33–45], quoted in Frumkin, 2005 ).

The sixty-two books of the “Hippocratic Corpus” dating from 430–330 bc are the accepted bedrock of Western medicine (Lloyd, 1983 ), not least because they departed from the purely supernatural explanations for health and disease which hitherto held sway. For the first time, ideas about medicine, diseases, and their causes were being written down. Among these were ideas about the environment and its relationship to mental and physical health (Lloyd, 1983 ; Rosen, 1993 ; Kessel, 2006 ). While scarcely a template for how societies would come to think about environment and health in the modern era, one Hippocratic text in particular, On Airs, Waters and Places , introduces several ideas that do retain currency. For example, the simple message that good health is unlikely to be achieved and maintained in poor environmental conditions is enduring. Also, through specific reference to the health relevance of changes in water, soil, vegetation, sunlight, winds, climate, and seasonality, On Airs, Waters and Places conceives an environment made up of distinct compartments and spatial scales from local to global, recognizing that perturbations in these compartments, and on these scales, may result in disease. Such thinking remains conceptually and operationally relevant today. Hazardous agents are still frequently addressed in “environmental compartments” such as water, soil, air, and food or by developing and applying environmental standards for the different categories of place where people work, live, learn, and socialize. In parts, the Hippocratic Corpus also presages the ecological perspectives now coloring 21st-century public health thinking. These include an understanding of the potential for human activity to impact negatively on the natural world and the importance of viewing the body within its environment as a composite whole.

Environment and Health in the Modern Public Health Era

Epidemiology is the basic science of public health and is concerned with the distribution of health and disease in populations across time and spaces, together with the determinants of that distribution. Environmental epidemiology is a subspecialty dealing with the effects of environmental exposures on health and disease, again, in populations. Since the early 19th century , the outputs of epidemiology have been key components of a “mixed economy of evidence” that has shaped and reshaped priorities and informed the decisions society takes to protect and improve population health (Petticrew et al., 2004 ; Baker & Nieuwenhuijsen, 2008 ).

In a classic paper from the 1990s, the respected epidemiologists, Mervyn and Ezra Susser, helpfully described different “epidemiological eras” in modern public health, each driven by a dominant paradigm concerning the causes of disease and supported by a particular analytical approach (Susser & Susser, 1996 ). This differentiation offers a useful framework within which to consider changing perspectives on the role of environment in health since the early 1900s.

The Environment in an “Era of Sanitary Statistics”

The Industrial Revolution came first to 19th-century Britain driven by technological innovation, abundant coal supplies, and supportive political/economic conditions. Also influential was a post-Reformation philosophy that extolled the work ethic and self-sufficiency. The events were to resonate throughout the world, bringing great prosperity to some, but others, especially the urban poor, endured poor housing, severe overcrowding, and an absence of wholesome water or sanitation. The growing industrial cities became crucibles of squalor, disease, and severely reduced life expectancy as their citizens suffered the ravages of typhus, tuberculosis, and successive cholera epidemics. Unhealthy working conditions and grossly polluted air also damaged health and compounded the misery of urban life at this time. Such challenges were common to all locations touched by the Industrial Revolution and became the catalyst for a new public health movement across Europe and North America (Rayner & Lang, 2012 ; Rosen, 1993 ).

Using the new science of medical statistics, investigators quickly established the locations with the poorest living conditions to be also those where disease and early death were most prevalent (Chadwick, 1842 ), fueling an ultimately transformational societal response—a “sanitary revolution” (Rosen, 1993 ). Such was the impact of this mix of slum clearance with the introduction of waterborne sewerage and piped water supplies that readers of the British Medical Journal , voting almost two centuries later, still chose it, from a shortlist of 15, as the most important medical milestone since the Journal was first published in 1840 . The 11,300 readers who voted even placed it above the discovery of antibiotics and the development of anaesthesia (Ferriman, 2007 ).

Despite its impact, the “sanitary revolution” was famously initiated and sustained on a biologically flawed paradigm regarding the mechanistic causes of disease. Yet “miasma” (the transmission of disease through noxious vapors), because it served as a metaphor for squalid insanitary conditions, still drove effective intervention (Morris et al., 2006 ; Nash, 2006 ). During this time, however, the emergence of epidemiology as the primary mode of inquiry of public health was also pivotal to success. Endorsing this view, Susser and Susser labeled the first half of the 19th century an “Era of Sanitary Statistics,” citing the frequent use of district-level data to link disease to, for example: filthy and degraded urban environments; overcrowding and poor housing and working conditions; and social factors like infant care (Susser & Susser, 1996 )).

Thus, recognition that the environment (physical and social) mattered for health and notions of a “permeable” human body in close connection with other organisms and the abiotic environment were embedded at the launch of the 19th-century public health movement. It is notable that the perspective of the reformers was quite properly “proximal,” that is, rooted in an acceptance of the importance of the local environment, physical and social. While the term “ecology” would not be coined until 1866 (Haekel, 1866 ) and “social ecology” much later still (Bookchin, 1990 ), the public health pioneers embraced what, in today’s terms, we would understand as a broadly socioecological perspective and discerned no conflict in this with their efforts to understand the immediate causes of disease and intervene in a focused way to prevent it (Nash, 2006 ).

Especially through the efforts to stop cholera, the sanitarians affirmed the pathogenic potential of unsanitary conditions and pioneered the epidemiological approach, initially as “environmental epidemiology” (Baker & Nieuwenhuijsen, 2008 ). Other legacies of the Era of Sanitary Statistics have been less enduring. Despite recent advocacy of a “precautionary principle” (see, e.g., Martuzzi, 2007 ; European Environment Agency, 2013 ), the willingness to act on the basis of strong suspicion of a societal-level environmental threat to population health has diminished, perhaps an inevitable casualty of increasing sophistication and “evidence-based” approaches in medicine and policy (Kessel, 2006 ; Brownson et al., 2009 ). Many of public health’s greatest triumphs have flowed from interventions that would have struggled to satisfy today’s evidential criteria. Also, despite a recent reconnection with such arguments, the inherent logic of seeing and tackling disease in its social and environmental context, so obvious to the pioneers of public health, has periodically been less visible in the rhetoric and actions of their successors.

It is appropriate at this point to emphasize the international character of the 19th-century public health movement. This movement can all too easily be presented as a British phenomenon, with seminal contributions from John Snow ( 1813–1858 ) on the investigation of cholera (Vinten-Johansen et al., 2003 ); William Farr ( 1807–1883 ), also on cholera but more widely on medical statistics (Susser & Adelstein,, 1975 ); Edward Jenner ( 1749–1823 ) on vaccination (Baxby, 2004 ), and Edwin Chadwick ( 1800–1890 ) on the assembly of data relating disease to the filth and squalor that came with poverty (Chadwick, 1842 ). In reality, public health, then as now, advanced through the contribution of many individuals in many nations. For example, the German pioneer of cellular biology, Rudolf Virchow ( 1821–1902 ), and his fellow countryman, the hygienist Johan Peter Frank ( 1745–1821 ), were hugely important (Rather, 1985 ). In France, Louis-Rene Vilerme ( 1782–1863 ), the doctor and pioneer of social epidemiology, highlighted links between poverty and death rates (Rosen, 1993 ) and, in the United States, the meticulous work of Lemuel Shattuck ( 1793–1859 ) bears direct comparison with that of Chadwick (Rayner & Lang, 2012 ).

It might be supposed that the consolidated outputs of European laboratories, especially in the decades between 1830 and 1870 , would have quickly expunged the miasmic paradigm from 19th-century medicine and public health. Yet, the concept of miasma was so inculcated in Western thought that, for many, it retained significant explanatory power. Thus, for much of the 19th century there was not a single settled view on disease contagion (e.g., see Kokayeff, 2013 ). Indeed, as late as 1869 some distinguished Medical Officers of Health in England still attributed diseases such as typhoid to “the insidious miasma of sewer gases” and dismissed germs as “pure nonsense.”

The Environment in an “Era of Infectious Disease Epidemiology”

Increasingly contested, the miasmic theory of disease was effectively supplanted in the 1880s by broad acceptance of the germ theory, ushering a new “Era of Infectious Disease Epidemiology” (Susser & Susser, 1996 ). In 1882 , Louis Pasteur’s techniques for growing organisms made it possible for Robert Koch ( 1843–1910 ) to demonstrate that a mycobacterium was the cause of tuberculosis and, shortly thereafter, to provide scientific proof that cholera was waterborne (Foster, 1970 ; Collard, 1976 ; Brock, 1999 ). In so doing, Koch established, what had been hypothesized by his teacher, Jacob Henle ( 1809–1885 ), some 40 years earlier that disease was microbial. Henle, Snow, Koch, and the biologist Ferdinand Cohn ( 1828–1898 ) are rightly seen as fathers of the science of medical microbiology that for a time would come to dominate thinking in medicine and public health (Rayner & Lang, 2012 ).

Initially at least, the germ theory did little to diminish interest in the environment as a determinant of health. Indeed, by revealing causal linkages between organisms isolated from their environmental carriers and specific diseases, it conferred scientific coherence on the established sanitary model and vindicated efforts to secure hygienic water, food, and housing. As Lesley Nash has observed, the germ theorists were initially content to meld the insights of bacteriology with longstanding environmental beliefs. Notions of a body in constant interaction with, and closely dependent on, its local social and physical context (in today’s terms a socioecological perspective) did not conflict with the narrower perspectives of laboratory science (Nash, 2006 ).

While relative contributions may be debated, over a short timeframe medical microbiology, isolation, immunization, and improving social/environmental conditions combined to sharply reduce the burden of infectious disease for Western society. Yet, by the early years of the 20th century , the capacity to examine disease at the microscopic level, which was the engine of diagnostics and therapeutics, was beginning to act on the very foundations that support public health. Medical science gradually made its focus the pathogenic agents of disease, moving attention away from the environment and eroding socioecological perspectives. Doctors seemed quite content to express health as an absence of disease, and medical science to project its role as the maintenance and reinforcement of “self-contained” human bodies (Nash, 2006 ). Through a growing tendency to see health, disease, and their determinants as attributes of individuals rather than characteristics of communities, wider society seemed almost complicit in an ‘individualization’ of health status. One implication of this blunting of a social/environmental thrust of public health was to divorce health from place, a development that would have profound implications in the very different epidemiological context that emerged following World War II.

The Environment in an Era of Chronic Disease Epidemiology

The dramatic reduction in infectious disease was certainly one reason why the epidemiological climate in Western society changed substantially in the mid- 20th century . But just as important was the emergence of a quite disparate set of pathologies believed to be of noncommunicable etiology. Coronary heart disease, cancers, and peptic ulcers, which became the targets in a new “Era of Chronic Disease Epidemiology” (Susser & Susser, 1996 ), were thought rather unlikely to have origins in exposure to what was an increasingly regulated and ostensibly improving physical environment. While the outputs of much postwar epidemiology seemed to endorse this view, it is useful, with hindsight, to recognize the influence of what might be seen as “fashions” in epidemiological inquiry. These fashions would influence how medical science and the wider society would come to regard diseases and their causes for a generation.

The response of the public health community to the new and alarming “noncommunicable” threats was, logically, to deploy descriptive epidemiology to reveal those most likely to be affected. Perhaps surprisingly, those who traditionally were most vulnerable to disease (the young, the old, the immunocompromised, etc.) did not appear to be at increased risk. Rather, the new epidemics disproportionately affected men in their middle years (Nabel & Braunwald, 2012 ). Supported by enhanced computing power and methodological advance (Susser & Susser, 1996 ), researchers began to converge on specific risk factors that correlated with diseases of greatest concern. Many, it seemed, were aspects of individual lifestyle and behaviors, ostensibly freely chosen. A particular attraction for the proponents of what was to become known as “risk factor epidemiology” was its capacity to represent, mathematically, the “relative risk” of contracting a disease between people exposed to a putative risk and those who were not. Some have dubbed this epidemiological approach to noncommunicable or chronic disease “black box epidemiology” because it can relate exposure to outcomes “without any necessary obligation to interpolate either intervening factors or even pathogenesis” (Susser & Susser, 1996 ). Another unfortunate characteristic of this approach to epidemiology is that, despite its laudable intent to understand and address disease in populations , its focus is on individuals within those populations. As a result, it fails to elucidate the societal forces whose influence and interplay shape the health and health-relevant choices of those individuals. When viewed through a policy lens, this mitigates in favor of simplistic solutions that target individuals divorced from context and that lack the traction to produce meaningful change.

In summary, the desire to create a mathematical measure of relative risk for a specific factor is understandable. However, risk factor epidemiology uses an approach that is much more flexible than material reality. In the real world, many different factors coexist and interact to create and destroy health. This is not, however, to deny risk factor epidemiology’s capacity, particularly in synergy with laboratory-based research, to break new ground. Notably, these methodologically driven approaches were key to elucidating links between smoking and lung cancer, heart disease and serum cholesterol, and between levels of prenatal folic acid intake and neural tube defects (Susser & Susser, 1996 ; Kessel, 2006 ; Perry, 1997 ).

The same basic criticism is voiced where similar “black box” epidemiological approaches are used to explore the contribution of a specific environmental agent, as in the case of much recent air pollution epidemiology (see below) (Kessel, 2006 ). Any specific pollutant under epidemiological investigation inevitably coexists with other pollutants and in a specific exposure context (e.g., prevailing climatic conditions). These coexisting factors may be critical in determining the health outcomes from exposure to the pollutant under investigation. Because the outputs of black box epidemiology are abstractions, the relative risk calculation represents an abstraction that can be limited in its capacity to inform policy.

The decades following World War II were a time of declining influence for public health and population perspectives, largely for reasons we have outlined. Yet, in its rhetoric and activities, the discipline of public health seemed at times almost complicit. Even its defining science of epidemiology seemed for a time more concerned to reinforce the insights of clinical medicine than to play the exploratory role on which its reputation had been founded (Susser & Susser, 1996 ). On the face of it, academic public health and the wider public health discipline had little to say about environment, no longer presenting it as an active component in the then current health challenges for Western society. As Nash has observed, physical environments were “recast as homogenous spaces which were traversed by pathogenic agents.” Nevertheless, divorced from the prevailing rhetoric, in many locations there was a parallel narrative depicting a workforce that continued to work at a local level, within established legal and administrative frameworks, to protect and maintain health-relevant environmental quality standards. However, the environmental health function was often set in the narrow, hazard-focused, and compartmentalized terms framed for it by laboratory science. The task was largely confined to identifying, monitoring, and controlling a limited set of toxic or infectious threats in their environmental carriers. Only when pathogenic organisms or toxic agents demonstrably escaped their industrial, agricultural, or marine confines to damage health and reinforce the porosity of the human body did environment briefly assume a higher profile.

Against this backdrop, it was not necessarily predictable or inevitable that environment would regain a central place in public health. Yet, by the end of the 20th century , a much richer understanding of the environmental contribution to human health and well-being had indeed emerged. This change cannot be attributed to a single factor in isolation. Some point to the key influence of Rachel Carson’s Silent Spring in 1962 (Carson, 1962 ), which expressed grave concern for the ecosystem effects of DDT, the linkage to potential human health effects, and the implications of a growing disconnect between humankind and nature. We do not deny the status of Carson’s work as a seminal text of a modern “environmentalism” that would rapidly gather pace and influence (Nash, 2006 ). However, we submit that it is only now, in the 21st century , when the reality of unprecedented anthropogenic damage to global processes and systems and its health implications is self-evident, that the health sector has fully made common cause with the environmentalist movement (e.g., see Butler et al., 2005 ; Butler & Harley, 2010 ) (We discuss this development later in this article under Ecological Public Health.

However, for reasons that are distinct from a mounting concern over anthropogenic threats to global environmental systems and processes, we argue that the closing decades of the 20th century and the early years of this century did see a rekindling of public health and societal interest in the local or proximal environment. This interest has continued into the 21st century . Developing interest in well-being as a concept, the belief that it is important and that it might be enhanced through the organized efforts of society, continues to engage the attention of academics and policymakers. Although well-being demonstrably impacts health and vice versa, well-being is about much more than health. Rather, it is a measure of what matters to people in every sphere of their lives. Despite its importance, well-being has proved a challenging target for policy. Some of its components are beyond the reach of policy. However, others, including aspects of the built and natural environment and people’s connection to it, are amenable to manipulation. Accordingly, research has been especially concerned to identify the qualities of their environment that are important for different people’s well-being, quality of life, and health at various life stages (Royal College of Physicians, 2016 ). Also, on a practical level, integrating the various well-being frameworks and indices that continue to emerge is an ongoing challenge. However, it is sufficient at this point simply to recognize that elevated concern for well-being and its connection to environment can only broaden and deepen concern for the environment in public health. It will continue to drive renewed interest in matters such as landscape, natural beauty and scenery; crime free, clean places; green, blue, and natural environments; and so on.

Reconnecting Health with Place

Five issues/developments merit particular mention for their role in reestablishing the local environment as a mainstream consideration in health in the developed world in the late 20th century . While recognizing that there is an interrelationship among some of the factors discussed, for simplicity, we discuss them separately here.

Air Pollution

In citing air pollution as a key factor in a late- 20th-century resurgence of interest in the environment, we recognize its much longer history as a contributor to ill health (Evelyn, 1661 ; Lloyd, 1983 ). We acknowledge, too, that accounts of the modern public health era since its inception have been suffused with references to air pollution events, their health implications, and the political and professional campaigns that have sought to mitigate risk (Kessel, 2006 ). However, despite a compelling case for action, the need for urgent intervention was only fully accepted after a number of high-profile air pollution episodes in the 20th century . In 1930 , a severe smog incident in Belgium’s Meuse Valley resulted in the death of sixty people. Prophetically, investigators were quick to highlight the potential for many more deaths, were such an incident to be repeated in a more highly populated area (Bell & Samet, 2005 ). In 1948 , a further twenty people were to die and many more suffer injury after an industrial pollution incident in Donora, Pennsylvania (Hamil, 2008 ), but the tipping point came four years later, with the London Smog of 1952 .

Between December 5 and December 9, a dense fog descended on London where it mixed with air, polluted by domestic and industrial emissions. The resulting thick smog was familiar to many urban dwellers, but in this case, a combination of cold weather and stagnant atmospheric conditions caused sulfur dioxide and smoke concentrations to reach and maintain extremely high levels for a sustained period. The smog had a paralyzing effect on the city’s transport system, and many other aspects of daily life were severely disrupted. But the most dramatic effects were on health. Death rates were to reach three times the normal level for the time of year, and demand for hospital beds far exceeded supply (Baker & Nieuwenhuijsen, 2008 ). While the smog dissipated after a few days, deaths rates remained high for several months thereafter. Subsequent analysis has revealed that, rather than the 3,000–4,000 deaths linked to the episode in at the time, a figure of 10,000–12,000 deaths is more probable (Bell et al., 2004 ).

The London smog is historically important, obviously because of the distressing toll in morbidity and mortality and because it catalyzed long-overdue legislative intervention in the UK in the form of the Clean Air Act of 1956 and the U.S. Clean Air Act 1963 . Critically, however, it reminded the public and politicians of the reality that, given the right conditions, population-level environmental exposures were still entirely capable of producing significant morbidity and mortality.

In combination with other factors, the clean air legislation that emerged in the wake of the smog reduced domestic and industrial fossil fuel emissions, and helped to secure significant reductions in background concentrations of smoke and sulfur dioxide (Royal College of Physicians, 2016 ). However, by the late 1980s, a new, more insidious, urban air pollution threat had begun to emerge. This pollution had its origins not in fixed-point emissions, but in the rapidly increasing numbers of motor vehicles and other fossil fuel-driven forms of transport in towns and cities. The pollutants of concern here, which lacked the visibility of the earlier sulfurous smogs, were fine particles, oxides of nitrogen, and ozone. So-called time-series analyses, using data on the temporal variation in environmental exposure and in health, aggregated over the same time period, were now applied to explore the issue of urban air pollution and health (e.g., see Pope et al., 1995 ; Dockery & Pope, 1996 ; Kessel, 2006 ). The studies revealed the cardiopulmonary effects of long-term exposure to much lower levels of ambient air pollution and, later, following further investigation, the absence of a threshold level for causing health effects. Recent outputs of ‘life-course’ epidemiology have also shown that air pollution affects health, not only through the exacerbation of symptoms in the elderly, but through various processes that have impacts from the womb, through childhood to adolescence, early adulthood, and on into middle and older age (Royal College of Physicians, 2016 ). Also, appreciation that air pollutants can be resident in the air for days or even weeks makes air pollution not simply a local problem, but one that demands source control at city, regional, and international levels. In the UK, for example, the equivalent of around 40,000 deaths every year can be attributed to fine particulates and NO 2 exposure from outdoor air (Royal College of Physicians, 2016 ).

Air pollution is probably the most thoroughly investigated of all environmental threats to health and well-being. Revelations about the true extent of its impact on health keep the issue in the headlines and emphasize the centrality of the physical environment within the public health project. Despite being a focus for academic interest and research fundings, the problem of urban air pollution is a very long way from resolution and is one factor that demands a fundamental reappraisal of how, as a species, we live, consume, and travel. (We discuss a wider, global dimension of the air pollution challenge later in this article.)

Everything Matters: The Environment as an Ingredient in Social Complexity

Another important and often overlooked reason for the late- 20th-century rekindling of interest in the environment and human health can be traced to developments within the wider discipline of public health. Ironically, the thinking behind what, by the 1990s, was being termed the “new public health” had its origins in much older ideas that gave prominence to the social structures in which health is created and destroyed (Baum, 1998 ; Awefeso, 2004 ). If we accept that health, disease, and social patterning in these matters are products of a complex interaction of influences at the level of society with the characteristics of individuals, then such complexity ought to be reflected in the policies and partnerships formed to address them. A growing number of analyses, beginning in the 1970s, would turn a spotlight on this complexity and fundamentally challenge the dominance of the biomedical/health care model and its capacity to solve the problems that beset public. These problems included the intractable burden of noncommunicable disease; growing levels of obesity; diminished psychological well-being; and, not least, stubborn and widening inequalities in the health and well-being of different social groups. Concern also mounted over containing rising, and potentially bankrupting, health care costs.

“A New Perspective on the Health of Canadians,” more commonly referred to as the Lalonde Report, after Canada’s then health minister Marc Lalonde, was published in 1974 (Lalonde, 1974 ). Despite its national focus, the report assumed wider relevance because of its analysis of one of public health’s greatest generic challenges, that of navigating among the many complex and interacting determinants of health to identify effective policies and actions. Implicitly offering a socioecological perspective, the Lalonde Report spoke of a “Health Field,” which included all matters that affect health and comprised four core elements: human biology, environment, lifestyle, and health care organization. Any issue, it was proposed, could be traced to one, or a combination, of these elements, allowing the creation of a “map of the health territory” for any problem (Lalonde, 1974 ). In this way, the contribution and interaction of the elements could be assessed. The analysis affirmed the health relevance of a complex environment comprising interacting physical and social dimensions in interaction with the human body. Lalonde’s message was logical and important, yet more than just an echo of an earlier, more inclusive, understanding of the determinants of health and disease. It recast these largely abandoned perspectives for a more scientific and sophisticated era. The proposal that thousands of “pieces” relevant to health and its determinants could be organized in “an orderly pattern” was alluring and progressive, as was the notion that the exercise alone would allow all contributors to more fully appreciate their roles and influence (Morris et al., 2006 ). In the ensuing years, Lalonde’s proposals for understanding and addressing complexity in the determinants of health have been refined and given greater policy relevance by others. In part, this has been through the development of conceptual models of the socioecological determinants of health. These models have been promoted as tools for presenting evidence that can make their implications more apparent (Evans & Stoddart, 1990 ; Dahlgren & Whitehead, 1991 ). In most of these representations, the local environment is accepted as a key driver of health and well-being (Morris et al., 2006 ).

Despite its inherent logic, the socioecological perspectives that emerged in the closing decades of the 20th century created scientific and policy challenges for all constituencies concerned with public health. There were obvious generic challenges, for example, around which of the models (each, necessarily, a gross simplification of a complex reality) might point to solutions (Morris et al., 2006 ; Evans & Stoddart, 1990 ; Reis et al., 2015 ); around the nature of evidence and its interpretation (Petticrew et al., 2004 ; Tannahill, 2008 ); and how, in practice, to traverse professional and policy silos to produce the interdisciplinary approaches that are inevitably required. In this connection, the task of motivating, supporting, and delivering effective intersectoral working, an abiding challenge for public health policy and practice, assumed a much higher profile in the late 20th century with the emergence of the socioecological model of health.

We emphasize that the continuing failure to adequately confront this challenge has the gravest implications for global public health. As Prüss-Üstün et al. recently observed, “Tackling environmental risks requires intersectoral collaboration. After nearly 50 years of actively promoting this concept, whether referred to as intersectoral action, breaking down silos or the nexus approach, it remains elusive as ever. The statement ‘intersectoral collaboration: loved by all, funded by no-one’ points to obstacles, mainly vested interests, that have burdened this approach ever since it was included as part of the WHO/UNICEF Alma Ata Declaration on Primary Health Care in 1978 . Environmental health, quintessentially intersectoral, has suffered most from this lack of progress” (Prüss-Üstün et al., 2016a ).

With specific reference to the role of the local environment, the recognition of socioecological complexity as the determinant of health meant that strict adherence to narrow hazard-focused and compartmentalized approaches became intellectually unsustainable. Yet, acceptance of the dynamic interaction of environment with other determinants of health demands a richer understanding of the environmental contribution than can be provided by toxicology or microbiology in isolation.

The Role of the Environment in Health Inequalities

The fact that the poorest, most degraded urban neighborhoods were those most blighted by disease and reduced life expectancy was clear even to the public health pioneers of the 19th century . Indeed, throughout much of the modern public health era, an acceptance of the importance of the environment for health and well-being has been accompanied by a recognition of the interplay between sociodemographic, economic, and physical factors in creating and sustaining health inequalities.

The term “health inequalities” refers to general differences in health, however caused. Where the differences in health are unfair, unjust, and avoidable, as they often are when linked to social variables, they should more properly be termed “health inequities.” However, in the extensive literature on the topic and in common usage, inequities are termed inequalities, and we adopt this convention here. Despite their importance, the emphasis on tackling health inequalities has varied considerably over time and according to place.

In 2008 , the final report of the Commission on the Social Determinants of Health (CSDH, 2008 ) elevated the global profile of health inequalities and emphasized the interplay of many societal-level factors in their creation in the 21st century . The significant achievements in public health across the world over nearly two centuries have not been shared equally between countries or by all social groups within countries. An important component has been the health-relevant differences in the physical context for people’s lives—the quality of the physical environment. Sometimes expressed in terms of environmental justice , or elsewhere as environmental health inequalities, attention to this area is key to tackling health inequalities across the world (CSDH, 2008 ; Morris & Braubach, 2012 ).

Estimates of the impact of environmental quality on health and well-being vary widely, depending on the definition of environment used. However, that impact is undeniable. Over a billion people in developing countries, for example, have inadequate access to water, and 2.6 billion lack basic sanitation . The World Health Organization estimates that environmental factors were responsible for 12.6 million deaths worldwide in 2012 , 23 percent of all deaths, and 22 percent of the total burden of disease. Addressing environmental risks could prevent 26 percent of all deaths of children under the age of 5 (Prüss-Üstün et al., 2016b ).

In addition, there is clear evidence that a “good” environment empowers health through access to environmental assets such as green spaces, access to a healthy diet, and safe environments in which to walk, cycle, play, and socialize. However, as these data suggest, there is also a fundamental equity dimension to the distribution of both the cause and distribution of environmental stressors, the susceptibility to exposure, and the adverse effects of those exposures. Deprived communities almost invariably live in poorer quality environments, with higher levels of indoor and outdoor air pollution, contaminated land, polluting industrial processes, overcrowded and poor quality housing, and lower levels of environmental assets (Prüss-Üstün et al., 2016a ; 2016b ; Royal College of Physicians, 2016 ; The Marmot Review Team, 2010 ). Populations in developed countries, including the former communist states of eastern Europe living in areas of high air pollution, are disproportionately deprived, for example (Kriger et al, 2014 ; Bell & Ebisu, 2012 ; Branis & Linhartova, 2012 ; Goodman et al., 2011 ). Poor indoor air quality is associated with unfit or inadequate housing standards, conditions that overwhelmingly affect the deprived (The Marmot Review Team, 2010 ). There is evidence that deprived communities are not only more exposed to environmental hazards but are also more susceptible to the effects of those exposures (Goodman et al., 2011 ; Carder et al., 2008 ; Richardson et al., 2011 ; 2013 ; Vinikoor-Imler et al., 2012 ). There are also concerns that stress, at both the individual and community level, can weaken the body’s defenses against external insult and influence the internal dose of toxicants (Gee & Payne-Sturges, 2004 ).

This effect is also seen in social and physical environments. An adequate and nutritious diet is essential to a healthy, productive, and fulfilling life, and it is a fundamental right predicated by a range of factors including personal knowledge, choice, convenience, availability, quality, cost, and social norms. The evidence is clear that deprivation compounds all these factors, with poorer people buying more unhealthy foods with fewer healthy components while being exposed to circumstances that make such “choices” inevitable (Rudge et al., 2013 ). The proportion of adults considered overweight or obese in 2008 in the 19 EU member states for which data were available ranged between 37 and 57 percent for women and between 51 and 69 percent for men ( EUROSTAT ). English children from deprived areas are almost twice as likely to be obese than those in affluent areas, and adult obesity is also associated with deprivation, particularly in women (Public Health England, 2016 ; National Obesity Observatory, 2013 ).

The poor in developed countries are adept at sourcing cheap calories and are exposed to a large numbers of local outlets selling cheap, calorie-dense takeaway food (Saunders et al., 2015 ). These meals are often super-sized and contain high levels of fats, sugar, and salt. At the same time, many of these areas provide limited access to healthy food options, creating a highly compromised public health environment (Saunders et al., 2015 ).

In addition, environmental stressors seem to have a cumulative impact, exacerbating this inequality. It is evident that poorer people have multiple health, social, and environmental stressors. It is entirely plausible that these stressors modify the effect of exposure to pollutants, as is reflected in the increased vulnerability of obese people to the effects of exposure to air pollutants, including increased risk of diseases such as cardiovascular events and respiratory symptoms (WHO, 2013 ; Jung et al., 2014 ). Long-term exposure to airborne pollutants has also been reported to increase the risk of obesity, and being overweight or obese is associated with an increased susceptibility to indoor air pollution in urban children with asthma (Lu et al., 2013 ).

The responsibility for, and relative benefits and costs of, environmental contamination are also important components of inequality. Environmental contamination may be tolerated by communities living in the vicinity of dirty industrial processes if they perceive a benefit in terms of local employment, although that trade-off has largely broken down in developed countries as those industries have declined in the 20th and 21st centuries. On a wider scale, the environmental consequences of contemporary affluent nations’ fuel economies are borne by those populations least able to bear them and with little or no responsibility for their causation (Patz et al., 2005 ). UNICEF has projected that 75–250 million Africans will be exposed to increased water stress due to climate change by 2020 (UNICEF, 2008 ), a phenomenon overwhelmingly caused by the First World. This is a gross injustice. These are also the same people with limited powers to prevent the dumping of rich countries’ waste in their communities. One appalling example is that of the “disposal” of 500 tons of toxic waste in and around Abidjan, the capital of Cote D’Ivoire, in 2006 . This poisonous cocktail of waste oil and contaminants was the result of the trading in, and processing of, hydrocarbon fuels by multinational commodity and shipping companies, criminal levels of cost cutting, and local political corruption, which led to 17 deaths and over 30,000 injuries in one of the poorest communities in the world (Bohand et al., 2007 ) There are many other examples, including the export, often illegally, of hundreds of thousands of tons of e-waste from Western countries to Africa, China, and Asia for recycling or disposal—transferring the costs and dangerous consequences of exposure to workers, including children, and local communities in these countries that do not have the technical or regulatory systems to deal safely with these toxic materials (ILO, 2012 ). Inuit mothers in northern Canada have elevated levels of chemicals such as PCBs—generated many hundreds, if not thousands, of miles away—in their breast milk (Johansen, 2002 ).

The redistribution of the environmental injustices historically endured by the poor also perversely appears to be affecting more affluent communities in the West. The huge expansion of “fracking” in North America, for example, may be leading to an export of risks from traditional “national sacrifice zones” to areas with no previous experience of such industry, creating “profound social, cultural, and economic shocks for middle class communities losing control over their environments” (Lave & Lutz, 2014 ). Despite their relative affluence, this would nonetheless be an injustice given the constraints on local democratic input and highly questionable direct economic benefits to those communities (Kinnaman, 2011 ; Lave & Lutz, 2014 ; Sovacool, 2014 ).

During a period when environmental catalysts for distress migrations are becoming more frequent (Thomas-Hope, 2011 ), there is a moral as well as a professional duty for the Environmental Health community to tackle these inequalities, which otherwise are likely to both widen and deepen.

The Health-Promoting Environment: Green, Blue, and Natural Spaces

While human communities have long valued access to natural resources such as green spaces, the industrialization of the 19th and early 20th centuries saw millions of people deprived of this access. This era did witness some far-sighted philanthropic gifting of areas of open recreational space for the working classes driven by a moral rather than evidence-based imperative. Though welcome, the distribution of, and access to, such resources was limited, inconsistent, unplanned, and vulnerable to the insecurities of voluntary funding. Subsequent local municipal development of parks and other open spaces increased access, and a greater understanding of the benefits of such access blossomed during the late 20th century as research demonstrated and quantified the public health dividends. Access to good-quality green spaces not only makes the places in which we live, work, and play more attractive, but also has a demonstrable effect on improving health and well-being. Green space is linked to lower levels of several diseases and conditions, including lower rates of mortality (Villeneuve et al., 2012 ), increased longevity in older people (Faculty of Public Health, 2011 ), improved mental health (Faculty of Public Health, 2011 ), better outcomes in disease treatment, and reduced medication (Faculty of Public Health, 2011 ), and it also helps reduce health inequalities (Mitchell & Popham, 2008 ; CABE, 2010 ). Plausible mechanisms for these benefits include the provision of a venue for physical activity, promotion of social contact, and the direct impacts of green spaces on psychological and physical health. Natural spaces also promote greater community cohesion and reduce social isolation, providing a platform for community activities, social interaction, physical activity, and recreation (Public Health England, 2014 ). Research from the United States has identified powerful associations between green space and major reductions in aggressive behavior, domestic abuse, and other crime in deprived urban areas (Kuo et al., 2001a , 2001b ).

And yet, there remain great inequalities in the distribution, use, and quality of this empowering resource. People living in the most deprived areas are less likely to live in the greenest areas and therefore have less opportunity to gain the health benefits of green space compared with people living in the least deprived areas (Public Health England, 2014 ). Children living in poor areas, for example, are nine times less likely than those living in affluent areas to have access to green space and places to play (National Children’s Bureau, 2013 ). It is entirely plausible that that this contributes to the sobering reality that children from deprived communities are up to three times as likely to be obese than those children growing up in affluent areas (National Children’s Bureau, 2013 ).

Accessibility, however, is not the same as availability or utility, nor is it simply a function of proximity. It is strongly impacted by the cost of access, whether it is actually physically available, opening times, and the ease of being able to get to it, for example, walking and good public transport. Deprived communities in particular appreciate the value of such spaces, but they tend to underuse them due to concerns about the safety and quality of the spaces (CABE, 2010 ). Experience has shown that quality of the green space is just as important, if not more so, than its size. Post-World War II urban developments in many countries have included large grassy areas, and substantially derelict former industrial sites have often been entirely grassed over. The sterility and sheer size of these sites, the cost of maintenance, and the lack of facilities have often led to misuse and subsequent abandonment by both communities and local municipalities.

The provision, maintenance, and promotion of good-quality and safe , publicly available spaces is not a subsidy; it is an investment delivering economic, health, and regeneration benefits . Research on Philadelphia estimated that maintaining city parks could achieve huge annual savings in health care costs, stormwater management, air pollution mitigation, and social cohesion benefits (The Trust for Public Land, 2008 ). The improved social cohesion associated with natural spaces also has economic benefits. A 2009 Scottish study estimated a £7.36 dividend for every £1 invested in conservation volunteering projects (Greenspace Scotland, 2009 ). It is clear from the evidence that increasing the use of good-quality green space for all social groups is likely to improve health outcomes and reduce health inequalities.

The Reemergence of the Infectious Threat

Among the developments that, for Western societies, consigned environment to the periphery of medical and public health interest in the post–World War II era, we highlighted the epidemiological transition in the mid- 20th century . Indeed, for a period in the 1960s and 1970s it seemed that infectious disease in the developed world had effectively been conquered (Fauci, 2001 ). It was even tempting to suggest that the developing world might eventually follow suit. Yet, within a relatively few years, the twin threats of emerging infectious disease and antibiotic resistance would shatter the earlier confidence and reestablish infection as a live threat to individuals, communities, and populations and one that presented, increasingly, on a global scale.

The term “emerging infectious disease” (EID) denotes an infectious disease, newly recognized as occurring in humans; one that has been previously recognized but is appearing for the first time in a new population or a different geographic area; one that now affects many more people; and/or one that is displaying new attributes, for example, in terms of its resistance or virulence ( adapted from The US Government & Global Emerging Infectious Disease Preparedness and Response ). Although the return of infection was not necessarily anticipated by a confident global community, many predisposing factors were clearly present. Changes in land use, growth and movement of populations, contacts between people and animals, international trade and travel, and, often, an absence of a public health infrastructure all played a part. Where such influences coincided, as in sub-Saharan Africa or parts of Asia, hotspots were created that were conducive to the emergence of infectious disease. Several hundred new infectious diseases appeared across the globe in the period between 1940 and 2004 , with the greatest number emerging in the 1980s (Jones et al., 2008 ). The 1980s was also the decade that notoriously witnessed the late 20th century ’s most sentinel infection event, the first reported cases of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS). By 2014 , AIDS alone would result in approximately 78 million cases worldwide . Although HIV/AIDS engendered particular alarm, the list of late- 20th-century EIDs of medical and public health significance is extensive. Variant Creutzfeldt-Jacob disease (vCJD), H5N1 Influenza and Ebola Virus Disease, the Northern Hemisphere debut of the mosquito-borne zoonotic viral disease, and West Nile Fever in New York City in 1999 were all public health and media events. The process continues unabated in the 21st century with the arrival of Severe Acute Respiratory Syndrome (SARS), H1N1 Influenza (“swine flu”), H7N9 Influenza (“bird flu”), and, despite having surfaced some 40 years earlier, Ebola revealed its potential as a global threat with the West African Outbreak of 2014–2015 . More recently still, the distressing incidence of microcephaly in South America putatively linked to the Zika virus simply emphasizes the abiding challenge posed by infection for public health and global economics (European Centre for Disease Control, 2016 ).

Antibiotic resistance has been a developing public health horror story over, perhaps, 50 years. The therapeutic use of antimicrobials and especially antibiotics was a key factor in slashing the burden of illness from infection in Western countries in the latter half of the 20th century . Yet all classes of organisms—fungi, protozoa, viruses, and bacteria—can develop antimicrobial resistance. Through their genetic processes, bacteria have derived multiple resistance mechanisms to antibiotics used in medicine and agriculture. The threat renders humankind vulnerable to a host of infections, notably in hospital settings where treatment options for many infections are now severely limited. As a consequence, even at the dawn of the 21st century , drug resistance was already being perceived as an increasing threat to global public health, involving all major microbial pathogens and antimicrobial drugs (Levy & Marshall, 2004 )

The challenges of EIDs and antimicrobial resistance are, unquestionably, game changers for medicine and public health in the 21st century . Importantly, they are among the factors that have revealed the true limitations of the biomedical model of health and disease in the 20th century and rekindled interest in the socioeconomic and environmental determinants of disease. HIV/AIDS merits special mention in this regard. Although it is believed to have origins in nonhuman primates in West Africa, it is not an environmental disease in the sense that there is a specific environmental reservoir. Medical sciences and epidemiology have shown transmission of the virus via unprotected sex, contaminated blood transfusions, hypodermic needles, and mother to child transmission during pregnancy, delivery, and breastfeeding. HIV (the infection) and AIDS (the disease) have shown the capacity to extend beyond the initially identified high-risk groups, potentially placing whole populations at risk. In some areas of sub-Saharan Africa where the infection is widespread, it impacts negatively on almost every aspect of society and the economy.

Over 30 years after it first emerged and despite concerted efforts, there is still no cure. In addition to banishing complacency, the infection and the disease call for a much wider perspective than that which took root in the postwar era of scientific positivism and medical paternalism. The failure to manage the threat stems in part from an incapacity to understand where to intervene to change behaviors and to see the disease in its social and environmental context.

Ecological Public Health

Earlier in this article, we identified five issues that helped reestablish awareness of the environment as a key component in the production of human health and well-being in the late 20th century . These issues, and our understanding of them, continue to evolve to challenge the public health community and wider society in the 21st century . In the most general terms, progress seems most likely where issues and challenges are framed with reference to a much wider range of pertinent factors by developing new approaches to evidence and its synthesis; by aligning institutional, physical, and educational infrastructures to the task; and by building governance structures in which all players are accountable and yet are encouraged to unite in common cause.

However, society must now embrace an additional and potentially more devastating threat to health and well-being. Human activity, including economic activity, is now directly and indirectly driving changes to the ecosystems and planetary processes on which we rely for health, well-being, and existence. For too long, human beings have lived, moved, consumed, and pursued health and well-being as if humankind is distinct and separate from nature rather than integral to it. The consequences of this disconnect for the natural world were graphically expressed by Rachel Carson in the 1960s and many others in the ensuing years (e.g., see Rockström et al., 2009 ; Steffen et al., 2015 ). However, developments in science and technology now reveal the true extent of the crisis, its accelerating nature, and its consequences both now and in the medium and longer term.

The term “ecological public health” is increasingly being used to encapsulate a need to build health and well-being, henceforth, on ecological principles. Rayner and Lang ( 2012 ) observe that, despite appearing difficult and complex, Ecological public health “is now the 21st century ’s unavoidable task.” Thus, the already complex challenge of navigating human social complexity to deliver health, well-being, and greater equity, which has defined public health in Western society for several decades, is made more challenging still. The relationship of the environment and human health and well-being must be understood and addressed on vastly extended temporal and spatial scales.

The notion that the planet is a finite resource on which human activity can place intolerable pressure and that the consequences of doing so are potentially catastrophic has been around for some time (e.g., see Carson, 1962 ; Meadows et al., 1972 ). A contemporary evolution of this thinking is expressed by Rockstrom and colleagues. Their sentinel paper, first published in 2009 (Rockström et al., 2009 ) and updated in 2015 (Steffen et al., 2015 ), lists the large earth system processes that are urgently in need of stewardship if humanity is to remain safe into the future. Where applicable, it proposes thresholds beyond which nonlinear, abrupt, and potentially catastrophic changes in these systems might be expected. This thinking is used as a basis for defining a “safe operating space for humanity.” The authors propose nine “planetary boundaries.” Three of these—climate change, ocean acidification, and stratospheric ozone depletion—are major planetary systems where evidence exists of large-scale thresholds in the history of the planet history of the planet. Also included are systems of a rather different sort. These are the slow variables that buffer and regulate planetary resilience. These slow variables comprise interference with the nitrogen and phosphorus cycles; land-use change; rate of biodiversity loss; and freshwater use. Two parameters, air pollution and chemical pollution, are especially difficult to quantify, meaning that thresholds cannot yet be defined. It is emphasized that, while for understandable reasons, the nine systems are often discussed independently, they are interrelated in ways meaning that changes in one system have profound implications for the others. Rockstrom and colleagues observe that in the preindustrial era, all nine parameters were within the safe operating boundaries, and yet by the 1950s, change was underway, most evidently in the nitrogen cycle. By 2009 , according to their analysis, three planetary boundaries had been transgressed: climate change; rate of biodiversity loss; and the nitrogen cycle.

An implicit challenge in limiting global ecosystem damage and its multiple implications is how to achieve recognition among the public and policymakers that the choices they make either directly or indirectly cause ecosystem damage and related environmental change (Morris et al., 2015 ). Climate change is simply the most striking example, but comparable challenges over communication exist in relation to other planetary process and systems. The fundamental rethink of society, the economy, and the environment, which is necessary if health and well-being are to be built on ecological principles, will happen only if the true implications for health and well-being of a “business as usual” approach are understood, communicated, and challenged. For any population, the environmental changes that may ultimately have profound implications may take place in countries and regions well beyond their borders or may not occur for some time, conferring a temporal and/or spatial remoteness that diminishes the sense of urgency. Appreciating the importance of these “distal” pathways of ecosystem damage to human health and well-being demands a greater understanding of ecosystem services (the benefits human beings get from the natural environment) and of why they matter. It also demands a much fuller appreciation of the global connectivity of social, economic, and ecological systems (Morris et al., 2015 ; Adger et al., 2009 ).

When initiating our discussion of the role of environment in health, we observed that the modern public health era was built on an environmental conceptualization of public health. It is now inconceivable that health, well-being, health care, and equity in any of these domains can be delivered without rediscovering an environmental conceptualization of public health for the 21st century .

For Western society, ecological public health is likely to require a rethink of society, the economy, and our stewardship of the natural environment (Rayner & Lang, 2012 ). At the very least, it will demand pursuit, through policy and action, of outcomes that recognize a ‘quadruple bottom line’ measured in health and well-being, environmental quality, equity, and sustainability. The extent to which we embrace ecological principles will be evidenced in policies that address how we live (for example, the energy efficiency of our homes), how we move (particularly our reluctance to substitute travel in fossil-fueled cars with more active forms of travel); how we consume (notably how we source and produce food) and, of course how we obtain and conserve energy.

Taking Stock

Despite being necessarily selective, this article has sought to illustrate how perspectives on the role of the environment in human health and well-being have evolved over the course of the modern public health era. Perspectives can be seen to shift owing to changes in the nature of environmental hazards and risks that are themselves products of the evolution of how societies live, move around, consume, source their energy, and so on. Our understanding of the health relevance of the built and natural environments is also shaped by advances in scientific understanding and technology and a much wider economic, social, cultural, and even political context. In structuring our account, we have adopted a loose framework based on the “epidemiological eras,” elegantly articulated by two of the 20th century ’s leading epidemiologists (Susser & Susser, 1996 ). These eras are differentiated according to the dominant paradigm of the time concerning the causes of disease, each underpinned by analytical approaches to understand and prioritize risk.

The importance accorded to the environment as a mainstream public health issue arguably reached its lowest point in the decades following World War II when the tendency to regard health and disease as characteristics of individuals, rather than communities or populations, gained prominence. This approach diverted attention from social and environmental factors, divorcing health from place. Notions that humans are self-contained and impervious to context have now been largely swept away, not least because denial of a socioecological perspective hugely undermined attempts to address the most serious contemporary health challenges. Also instrumental in challenging the notion of the self-contained body has been an environmentalist movement with a particular interest in pesticide and other chemical contamination of the biosphere. The toxic effects of chemical contamination reinforce the reality of a body that is permeable and invariably in a state of intimate exchange with its surroundings. As Nash ( 2006 ) has observed, “ the singular and self-contained body of the early 20th century came, by the end of that century to seem distressingly porous and vulnerable to the modern landscape” (p. 13). We would simply add that humans exhibit comparable porosity and vulnerability to the social and economic context in which they exist.

We recognize that our account contains only limited reference to the regulatory context that has been so central to controlling the environment for public health. We consider it appropriate to sound a warning in this regard. The processes through which environment is monitored and regulated to protect human health and well-being are sometimes taken for granted. Yet, since the 1980s, pressures have mounted in most Western nations to ‘deregulate’ markets to maximize profit. These pressures have led to environmental and public health regulation being increasingly perceived by governments and markets as “red tape” and a barrier to economic enterprise. Pressure to loosen or even abandon aspects of environmental regulation has weakened formal controls, leaving society vulnerable to corporate excess and irresponsibility, with often serious impacts on public health (Oldenkamp et al., 2016 ). This is not to argue that regulation should be static. Rather, it should adapt to changing technological, social, and economic circumstances and should be appropriately funded whether it relates to the quality of the air we breathe, the water we drink, the buildings we live, learn, and work in, or the nutritional aspects of the food we eat. Neither do we deny the potential to exploit citizen science and the power of new technology to supplement conventional regulation (e.g., enabling vulnerable individuals to avoid hazardous exposures and the opportunities for personal pollution monitoring to improve research).

Mainly anthropogenic damage to planetary resources and ecosystems demands that, wherever we are in the world, public health agencies must understand not just the proximal threats to health and well-being that have been the targets of public health intervention throughout the modern public health era. They must also understand and move to prevent, counteract, and contain more distal threats to health and well-being. The distal threats derive from changes to environments that appear remote in space or time or involve a complex interaction of social, environmental, and economic influences. These are no longer abstract considerations. The unprecedented global connectivity of economic and social systems and the growing understanding of ecosystem interdependencies demand that the implications of human activity for health and well-being be recognized, understood, and addressed on a vastly extended temporal and spatial scale.

Only by build health and well-being on ecological principles (Ecological Public Health) will society effectively address the more distal threats to health and well-being from global ecosystem damage; the socioecological complexity of the proximal environment and the interconnections between these.

Conclusions

In this necessarily brief and artificially linear account, our intention has been to reinforce the enduring importance of the environment for health and well-being. Along the way, we have identified three factors that have marginalized the environment as a component of health and disease. We suggest that they continue to represent clear and present threats, undermining public health and, in the case of the latter, an existential threat to humankind.

The Threat from Medical Reductionism

This tendency to think of disease almost exclusively in terms of pathogenic agents and organic dysfunction marginalizes any influence outside the crucible of the laboratory. This trend was most evident in the decades following World War II but remains an ever-present threat.

The Separation of Health from Place

Closely related to medical reductionism is the tendency to downplay the importance of local context for life. The idea that if local environment matters, it does not matter much and, that when it comes to health and disease, the real action is not out there in the neighborhood and among the community but “over here” in the laboratory and at the level of the individual. Such perspectives are divisive. They create artificial barriers between many academic disciplines, including some medical specialties, and those working to manage and improve the local social and environmental context within which “permeable” human beings live out their lives.

The Denial of Ecology

Science now permits humans to understand the true extent to which their activities are plundering natural resources and harming the planetary systems and processes on which they depend. The pace of change is such that health, well-being, heath care, or anything approaching equity in these things will not be sustained in the medium to longer term without radically rethinking society, the environment, and the economy. The global connectivity of social, economic, and environmental systems means, ultimately, that no one is insulated from the threat whether by distance or socioeconomic circumstance. Ecological public health, the pursuit of health and well-being on ecological principles, has been described as the 21st century ’s unavoidable task. It demands recognition of the dynamic interconnections between people and their environment. Manifestly, we depend on the environment we inhabit, and we powerfully affect it. Among the clearest impediments to delivering ecological public health and preserving a viable environment for future generations are the belief that we can manipulate and conquer the natural environment without consequence, and the irresponsible capitalist imperative that subverts regulatory standards and damages and exploits the environment for profit. Both are revealed as transparent absurdities by an ecological understanding and analysis.

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Importance of Cleanliness Essay

500 words essay on importance of cleanliness.

Each one of us enjoys living in a clean environment. We all have the ability to maintain cleanliness as it is not a tough task. Cleanliness is a habitual process that we must do on a daily basis. For instance, personal hygiene and environmental cleanliness are equally important to lead a happy life. The importance of cleanliness essay will explain this in further detail.

Importance of Cleanliness

Cleanliness is a very essential component of human life in both physical and spiritual terms. Spiritual cleanliness refers to following the beliefs and rituals of your religion. On the other hand, the physical one is essential for the well-being of and existence of humanity.

It is essential to lead a healthy and well life. In fact, health and cleanliness are related to each other. To get good health, one must practice hygiene. It is essential to practice maintaining good health and prevent diseases .

Moreover, equally important is the cleanliness of our environment. When you maintain cleanliness, you can prevent disease and lead a healthy life. Health professionals advocate hygienic practices to prolong the lives of individuals.

Moreover, when the environment is clean, safety is enabled. For instance, we must ensure no spilling of water to prevent people from falling. Similarly, clearing bushes around homes will offer safety from harmful insects and animals.

Further, we must not only clean the environment but organize the environment carefully. In other words, put away harmful objects to prevent accidents. Similarly, in the food industry, cleanliness is of the utmost importance.

It ensures the well-being of the consumers. Most importantly, cleanliness enables the extension of a lifespan of an object. When you keep the metallic objects free from dust and rust, they will have a longer shelf life.

Thus, we see how cleanliness is important in every sphere of life. Whether it is living or inanimate objects, everything requires cleanliness. Moreover, it is also a moral virtue that makes people admirable.

Get the huge list of more than 500 Essay Topics and Ideas

How to Maintain Cleanliness

There are many ways through which one can maintain cleanliness and keep themselves and the environment happy. A major way of maintaining cleanliness is brushing and bathing regularly.

Similarly, it is also important to wash hand as often as possible, mostly before and after meals. With the onset of the coronavirus, it has become even more important to wash our hands repeatedly.

Further, we must keep our nails trimmed and eat healthy food. Moving on to environmental cleanliness, we must clean the mess in our surroundings regularly. Try your best to avoid plastic bags and littering around by throwing garbage carelessly.

It is essential to effectively dispose of waste and wastewater . Most importantly, adopt reusing and recycling techniques to monitor pollution levels. Thus, we must practice all this and more to ensure cleanliness.

Conclusion of Importance of Cleanliness Essay

We must all do our bit to maintain cleanliness in our life. There are many initiatives launched by the government to practice cleanliness but it won’t work unless all of us do. It helps in inculcating good habits in citizens of the country. Along with practising it ourselves, we must also stop others from disturbing cleanliness.

FAQ of Importance of Cleanliness Essay

Question 1: What is the importance of cleanliness?

Answer 1: Maintaining cleanliness is a vital part of healthy living as it helps to improve our personality by staying clean externally and internally. It is everybody’s responsibility and one should keep themselves and their surroundings clean and hygienic.

Question 2: What are the effects of cleanliness?

Answer 2: Cleanliness has many positive effects on everyone. It directly impacts the ability to learn and has a significant effect on the mind of students. When there is a dirty environment, it may increases levels of stress. Moreover, cleanliness keeps one happy.

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• DOI: 10.14321/WATERPATHOGENS.1
• Corpus ID: 134127005

Introduction to the Importance of Sanitation

• C. Naughton , J. Mihelcic
• Published in Water and Sanitation for the… 2019
• Environmental Science
• Water and Sanitation for the 21st Century: Health and Microbiological Aspects of Excreta and Wastewater Management (Global Water Pathogen Project)

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Water, sanitation, and hygiene (wash) in schools: a catalyst for upholding human rights to water and sanitation in anápolis, brazil.

1. Introduction

The human right to water and sanitation in brazil, 2. materials and methods, 2.1. study site, 2.2. data collection, 2.3. data analysis, 2.4. microbiological analysis, 3. results and discussion, 3.1. drinking water, 3.2. sanitation, 3.3. hygiene and education, 4. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

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Pereira, C.T.; Sorlini, S.; Sátiro, J.; Albuquerque, A. Water, Sanitation, and Hygiene (WASH) in Schools: A Catalyst for Upholding Human Rights to Water and Sanitation in Anápolis, Brazil. Sustainability 2024 , 16 , 5361. https://doi.org/10.3390/su16135361

Pereira CT, Sorlini S, Sátiro J, Albuquerque A. Water, Sanitation, and Hygiene (WASH) in Schools: A Catalyst for Upholding Human Rights to Water and Sanitation in Anápolis, Brazil. Sustainability . 2024; 16(13):5361. https://doi.org/10.3390/su16135361

Pereira, Carmencita Tonelini, Sabrina Sorlini, Josivaldo Sátiro, and Antonio Albuquerque. 2024. "Water, Sanitation, and Hygiene (WASH) in Schools: A Catalyst for Upholding Human Rights to Water and Sanitation in Anápolis, Brazil" Sustainability 16, no. 13: 5361. https://doi.org/10.3390/su16135361

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A comprehensive review of the environmental benefits of urban green spaces

• Qian, Haochen

This detailed analysis highlights the numerous environmental benefits provided by urban green spaces, emphasizing their critical role in improving urban life quality and advancing sustainable development. The review delves into critical themes such as the impact of urban green spaces on human health, the complex interplay between urban ecology and sustainability, and the evaluation of ecosystem services using a comprehensive review of existing literature. The investigation thoroughly examines various aspects of green infrastructure, shedding light on its contributions to social cohesion, human well-being, and environmental sustainability in general. The analysis summarizes the study's findings and demonstrates the critical role of urban green spaces in urban ecology, which significantly mitigates environmental challenges. The intricate links between these green spaces and human health are thoroughly investigated, with benefits ranging from enhanced mental and physical well-being to comprehensive mental health. Furthermore, the analysis emphasizes how green spaces benefit urban development by increasing property values, boosting tourism, and creating job opportunities. The discussion also considers possible futures, emphasizing the integration of technology, the advancement of natural solutions, and the critical importance of prioritizing health and well-being in the design of urban green spaces. To ensure that urban green spaces are developed and maintained as essential components of resilient and sustainable urban environments, the assessment concludes with practical recommendations for communities, urban planners, and legislators.

• Urban green spaces;
• Sustainable development;
• Ecosystem services;
• Environmental sustainability;
• Urban ecology;
• Green infrastructure

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OPINION: Discovering strength in unity: the power of community in sobriety

As someone who's walked the path of recovery, I've experienced the value of a sober community. The community is there, too. In the U.S., more than 20 million people consider themselves to be recovering or in recovery, according to the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration. This community is filled with people from all walks of life, from CEOs to dishwashers, all sharing a common goal of sobriety and all acting as a check and balance for each other. In a city notorious for excess and indulgence, Las Vegas is home to a robust network of sobriety groups that meet the needs of our incredibly diverse community.

Why is it important to have a community of sober people in Las Vegas? A sober community, for me, rallies around four main principles: support, accountability, hope and purpose. Especially with the concentration of bars, liquor stores, clubs and casinos across the valley, a supportive group can often be the difference between sobriety and relapse.

Stepping back into the world as someone in recovery can feel lonely and daunting. A community of people who understand where you’ve been and where you’re headed not only makes the sobriety journey more approachable but allows for a support system to help at every point in the journey. I’ve seen it all, too. Whether they’re rallying around someone looking for a job to get back on their feet or in need of housing, this community is there for each other.

While all the resources that come along with this network are important, there’s one aspect of a sober community that stands out from the rest: accountability. In a world where isolation can lead to relapse, you’re with a community of people who call it like it is and aren’t afraid to call you out in order to keep you sober.

With that, too, comes the ability to spot someone struggling even when they claim to say they’re OK. The sober community can see right through the facade and help someone feel safe to open up, be vulnerable and take responsibility for their life and wellness. The moment someone starts to slip in their sobriety or stops coming to meetings, this incredible group of people is there to rally around and ensure you’re on the right path.

There have been times when I haven’t wanted to go to meetings — or I’ll flat out not go to a meeting — and my community here in town has really rallied around me with calls and texts checking in, offering me rides or encouraging me to ask for the time off from work to go to a meeting. That nudge hasn’t only helped me to stay on track and accountable, I’ve seen it countless times with other people.

Given the fast-paced and action-packed environment in Las Vegas, substance use is very prominent within the city. According to the National Survey on Drug Use and Health , nearly 10 percent of Las Vegas residents age 12 or older have a substance use disorder.

Going to meetings and actively participating in a sober community can feel like checking the box at first. That’s how it was for me when I first got sober; I was there to abide by the rules and do the basics. It wasn’t until a few years into my sobriety that I realized just how powerful the groups could be for myself and others.

Sober communities have the power to highlight the hope for living a successful and happy life in recovery. Hope is in every corner of a sober community. It's in the stories of those who've reached milestones, from the first 24 hours to decades of sobriety — that sobriety feels attainable and manageable for my future.

And finally, there's purpose. The opportunity to give back, to be of service to others, really allows me to step outside my personal struggle and feel a sense of accomplishment in helping someone else beat their addiction. It's in lifting others up, in being a guiding light for those still lost in the darkness, that one discovers the true essence of sobriety.

So to anyone embarking on the journey of recovery, remember this: Wherever you go, there you are. But with a sober community by your side, you're never truly alone. You have a lifeline, a network of support ready to lift you up, hold you accountable and remind you that recovery is not just a destination, but a lifelong journey. It doesn’t matter if you move to a new town, state or country, the temptation will always be there and a strong sobriety group can help keep it at bay.

In the chaos of daily life, it's easy to overlook the important role that sober communities play in maintaining long-term sobriety. But dive deeper, and you'll find that these communities are important to lasting recovery. In a world where 40 percent to 60 percent of people tend to relapse, according to the National Institute on Drug Abuse , forging a support system and community has never been more important.

For many, leaving the structured environment of treatment can feel like stepping off a cliff into the unknown. The safety net of therapy sessions and support groups is suddenly replaced by everyday life, with all its triggers and temptations. It's during this uncomfortable transition that the importance of a sober community becomes abundantly clear.

When I left treatment, I thought that was the end of my addiction. I thought that I didn’t need to put in the work and that I didn’t need a community to help me stay grounded and sober. I was wrong. While all the temptations and triggers are around us, our support groups and communities allow us to stay focused and aligned with what’s important in our lives to stay sober. For all of us, our addiction isn’t going anywhere, it’s always going to be there and you can’t let yourself get stagnant or you’ll eventually fall back into old habits.

Four and a half years into my sobriety, I got stagnant and thought I could have a drink. I’m so thankful that the warning lights and alarms went off in my head, and I picked up the phone, called my sponsor and didn’t pick up the drink. I hadn’t really worked with this sponsor but we kept in touch, which ultimately saved me from going down a slippery slope of having a single drink to not being able to stop drinking. Immediately though, my sponsor met me with a “I’m willing to give you my time, if you’re willing to put in your effort.” I committed and fully accepted that I had a lifelong problem, which meant I needed to actively work on this problem and seek lifelong support from my community.

A sober community serves as an invaluable resource and practical support for any person in recovery. Whether it's help finding a job, securing stable housing or simply navigating the complexities of everyday life, there's a wealth of knowledge and assistance to be found within these communities. It's a testament to the collective strength and resilience of those in recovery, who come together to uplift and empower one another.

Hope is perhaps the most powerful currency within a sober community, offering a lifeline to those in every part of the journey to see there is a future out there for us. It's in the stories of resilience and redemption shared by fellow members that we all find the courage to keep moving forward, even in the face of adversity. Whether it's witnessing someone celebrate a milestone in their sobriety or receiving words of encouragement from a trusted mentor, hope is the fuel that keeps the flame of recovery burning bright.

Finally, I found a great sense of purpose in being active and supporting the sober community that was there to support me. For many individuals, addiction can strip away a sense of identity and purpose, leaving someone in a very dark and lonely place. But a sober community provides individuals with the opportunity to rediscover their worth and value after a difficult struggle. Whether it's through volunteering, mentoring others or simply offering a listening ear, each of us has the power to make a meaningful difference in the lives of those around them.

Let this be a call to everyone in the sober community to stay active and support each other in our journeys. Reach out, connect with others and remember you’re never alone on the path of sobriety.

Nicole Montanari is the interim program manager at Desert Hope Treatment Center in Las Vegas.

The Nevada Independent welcomes informed, cogent rebuttals to opinion pieces such as this. Send them to [email protected] .

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Peer-reviewed

Research Article

Food consumption score and predictors among pregnant women attending antenatal care services in health centers of Addis Ababa, Ethiopia: Using ordinal logistic regression model

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Writing – original draft

Affiliation Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia

Roles Conceptualization, Formal analysis, Methodology, Software, Writing – original draft, Writing – review & editing

Roles Formal analysis, Software, Writing – review & editing

Roles Conceptualization, Data curation, Formal analysis, Methodology, Software, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

• Jerusalem Ketema Belay, 
• Solomon Mekonnen Abebe, 
• Lemlem Daniel Baffa, 
• Berhanu Mengistu

• Published: June 26, 2024
• https://doi.org/10.1371/journal.pone.0306169
• Peer Review
• Reader Comments

Poor maternal nutrition during pregnancy creates a stressful environment that can lead to long-term effects on tissue development. Understanding the food consumption score can be used to prevent problems associated with poor dietary intake of pregnant mothers. In Ethiopia, the food consumption score ranges from 54% to 81.5%, which is far below the World Food Program (WFP) recommendation. Thus, this study aimed to assess food consumption score and associated factors among pregnant women attending antenatal care services in health centers of Addis Ababa, Ethiopia.

This study has used institution based cross sectional study. Overall, 999 pregnant women were selected for this study. A multistage sampling technique followed by systematic random sampling was used to include pregnant women coming for antenatal care services in the selected health centers of Addis Ababa from June 07 to July 08, 2022. We used interviewer administered questionnaire using the Kobo toolbox. Food consumption score (FCS) was assessed after collecting data on frequency of eight food groups consumed over the previous seven days, which were weighted according to their relative nutritional value. STATA 14 was used to analyse the data. Ordinal logistic regression was used to identify independent predictors of food consumption score. Those variables having p value < 0.25 in the bivariable ordinal logistic regression were considered for the final model. Crude and Adjusted Odds Ratio were used to assess the strength of the association. In the final model, p value < 0.05 at 95% confidence interval was used to declare statistical significance.

From the total of 949 pregnant women a little over half (51.20% (95%CI: 48.00%-54.40%) had acceptable food consumption score, while just over two fifth (42.60% (95% CI: 39.40%-45.70%)) and a small proportion (6.2% (95%CI: 4.84%-7.94%)) of the study participants had borderline and poor food consumption score, respectively. No meal skip (AOR = 1.37, 95% CI:1.03–1.81), able to read and write (AOR = 3.99, 95% CI: 1.33–11.96), poorest wealth status (AOR = 0.52, 95% CI: 0.34–0.78), positive attitude towards consumption of a diversified diet (AOR = 1.52,95% CI: 1.17–1.98) were independent predictors of acceptable food consumption score.

In this study, considerably low level of acceptable food consumption score among the study participants was observed. Besides, not skipping meal, having better educational status, wealth status and attitude towards consumption of a diversified diet were associated with acceptable food consumption score. Therefore, nutritional education considering important dietary modifications should be intensified targeting vulnerable groups.

Citation: Belay JK, Abebe SM, Baffa LD, Mengistu B (2024) Food consumption score and predictors among pregnant women attending antenatal care services in health centers of Addis Ababa, Ethiopia: Using ordinal logistic regression model. PLoS ONE 19(6): e0306169. https://doi.org/10.1371/journal.pone.0306169

Editor: Girma Beressa, Madda Walabu University, ETHIOPIA

Received: February 8, 2023; Accepted: June 12, 2024; Published: June 26, 2024

Copyright: © 2024 Belay et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: all relevant data are within the manuscript and its Supporting Information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: FCS, Food Consumption Score; WFP, World Food Program; ANC, Antenatal Care; COR, Crude Odds Ratio; SD, Standard Deviation; AOR, Adjusted Odds Ratio; VIF, Variance Inflation Factor

A woman’s nutritional requirements vary during pregnancy as she is now feeding both her unborn child and herself. Although prenatal nutrition has an impact on how a pregnancy develops, there is never a wrong moment to start eating healthily. Therefore, it is imperative to have a sound nutrition during the period of gestation for both the mother and her growing foetus [ 1 – 3 ].

However, poor maternal nutrition during pregnancy that is either due to decreased intake or quality results a range of problems [ 4 ]. It affects the general growth and development of the offspring. These changes can have a significant impact on the overall health and production performance of the offspring [ 5 , 6 ]. Along with its negative impacts on the offspring’s nutritional quality, it also produces a stressful environment that may have long-term or permanent repercussions on tissue development, as seen by the emergence of chronic non-communicable diseases later in life [ 7 – 9 ]. Understanding the food consumption score (FCS) of a pregnant woman will help to prevent the issues linked to poor dietary intake during the period of gestation [ 10 ].

Nutritional needs during pregnancy can be satisfied by eating foods from a variety of food groups including fruits, vegetables, dairy products, carbohydrates, fats, and vitamins [ 11 ]. However, poor dietary diversity and FCS have been reported during pregnancy. For example, in Bangladesh acceptable FCS among pregnant women was found to be 58%, different studies in Ethiopia have also revealed a similar figure of FCS among pregnant women:81.5% in East Gojam Zone [ 12 ], and 54% in rural Eastern Ethiopia [ 13 ], which were far below the World Food Program (WFP) recommendations (90%) [ 1 ].

A number of studies have shown the following as independent predictors of having an acceptable FCS during pregnancy: religion [ 12 ], residence [ 12 ], maternal educational status [ 14 ], educational status of the father [ 10 ], wealth status [ 13 , 14 ], attitude [ 13 ], antenatal care (ANC) visit [ 13 ], skipping meal [ 15 ] and consumption of animal source food [ 13 ].

In recent years, introduction of western lifestyles in the big cities of Ethiopia like Addis Ababa has brought a drastic change in food consumption pattern of pregnant women [ 16 ], which runs counter to unrelenting efforts that is outlined in different policies and programmes enacted by the government [ 17 , 18 ]. Socio-cultural factors such as women’s education and employment, food preference, recent epidemics like COVID-19 and cultural practices have also been reported as driving forces for this change [ 19 , 20 ]. In cognizant of this, findings from this study can be used to provide an evidence-based decision to determine factors that influence FCS of pregnant women [ 21 ].

Even though there are a handful of researches that focused on FCS among pregnant women, our study employed a different method-ordinal logistic regression to better understand predictors of FCS among pregnant women [ 22 ]. Thus, this study aimed to assess the food consumption pattern and associated factors among pregnant women attending ANC services in health centers of Addis Ababa, Ethiopia. The goal of this study is to improve the dietary practice of pregnant women, thereby preventing long term ramifications of malnutrition.

Study area, design and period

The study was conducted in the capital city of Ethiopia, Addis Ababa, it is among the fastest growing cities in Africa. It was estimated that 5,228,000 people reside in the ten sub-cities of Addis Ababa in the study period [ 23 ]. The city has a sub-tropical highland climate, and is populated by people from the different regions of Ethiopia. The magnitude of food insecurity among productive safety net program beneficiaries of the city was 77.10% [ 24 ]. There were six publicly owned general hospitals and one hundred two (102) health centers, and eleven privately owned hospitals and 882 clinics in the city. By using cross-sectional study, pregnant mothers who came for ANC follow up from June 07 to July 08, 2022 at the selected health centers were approached to participate in this study. In these health centers, there were 2478 mothers who came for ANC services.

Sample size determination and sampling technique

Sample size was estimated for each specific objective, and the highest was taken for this study. For the first specific objective, by assuming 54.46% proportion of FCS from previous study [ 13 ], 5% margin of error, 1.96 Z value at 95% confidence interval (CI) and by adding 10% non-response rate at 1.5 design effect and it was estimated to be 629. However, the highest sample size was obtained using the second specific objective. Accordingly, epi-info version 7.2.2 was used to estimate the sample size by considering the following assumptions: crude odds ratio of having acceptable FCS among pregnant women who had positive attitude towards consumption a diversified diet, which was 1.6 from a previous study [ 13 ], 80% power and 95% CI, 1.5 designs effect. Therefore, 999 was the final sample size after adding 10% non-response rate.

Pregnant women coming for antenatal care services at the selected health centers were included. However, pregnant women who were seriously ill during the data collection period were excluded in the study. Multistage sampling technique followed by systematic random sampling technique was employed to select the study participants. Out of the ten sub-cities in Addis Ababa, four sub-cities were selected randomly (30%): Nifas silk lafto sub-city, Kolfe keraniyo sub-city, Lideta sub-city and Akaki kality sub-city. In the selected sub-cities, there were 28 health centers. First, nine health centers (one from Nifas silk lafto sub-city, two from Kolfe keraniyo sub-city, three from Lideta sub-city and three Akaki kality sub-city) were selected randomly using a lottery method. Then, the required sample size was proportionated to the selected health centers, and every three (k≈ 2478/999) pregnant woman who was coming for ANC follow up was selected.

Data collection tools and measurement

Data was collected using pretested interviewer administered questionnaire that comprises socio-demographic data, dietary habits, attitude towards consumption of a diversified diet, obstetric history, and food consumption score (FCS). The questionnaire was first prepared in English and then translated into Amharic (Local language). We used kobo toolbox to collect the data. Nine B.Sc. nurses and four public health officers were the data collectors and supervisors, respectively. The questionnaire was pretested at 5% of the final estimated sample size at Arada sub-city. After the pre-test, the question that assessed participants’ residence was excluded as all the study participants were urban residents. On the food frequency questionnaire, necessary modification was made by including foods that were not previously included.

The outcome variable of this study was food consumption score (FCS), information on foods which were consumed in the last seven days prior to the data collection time was gathered. Food consumption score (FCS) is a composite variable that is constructed based on the following criteria: food frequency, diet diversity and relative nutritional value of each food item [ 1 ]. Food consumption score (FCS) was computed after asking the study participants about the frequency and consumption of eight food groups over the period of seven days prior to the data collection period. In the questionnaire, there were 70 food items which were commonly consumed in the study area. The Cronbach’s alpha value (internal consistency) was observed to be 0.82.

Then, the consumption frequencies were summed and multiplied by the standardized food group weight. Finally, it was categorized into three categories; poor food consumption score(FCS)(0–21), borderline food consumption score(FCS) (21.5–35), and acceptable food consumption score(FCS) (>35) [ 1 , 25 ]. The wealth status was determined using principal component analysis which contained 15 items, and it was later categorized into five categories (Poorest to the richest) [ 23 ]. The attitude of the study participants towards the consumption diversified diet was measured using 4 item Likert-scale questions, the response ranges from strongly disagree to strongly agree. It was considered positive attitude when respondents score above the median. The internal consistency of the questionnaire was checked using Cronbach’s alpha (0.78). The trimesters were defined as first trimester (less than 14 weeks), second trimester (14–27 complete weeks) and third trimester (28 complete weeks until delivery). Finally, birth interval was categorized as recommended birth interval when interpregnancy interval was more 24 months otherwise it was categorized as not recommended birth interval [ 26 ].

Data analysis

The collected data using Kobo toolbox was exported to STATA 14 for analysis. A descriptive data was reported as frequencies, percentage, mean(±SD) and presented in tables. Ordinal logistic regression was used to identify predictors of FCS. Multicollinearity was checked using Variance inflation factor (VIF<10). Brant test of parallel regression assumption (p value = 0.66) conferred proportion of odds assumption. After checking the assumptions of ordinal logistic regression, COR and AOR at 95% was used to ascertain predictors of the outcome variable in both bivariable (p value <0.25) and multivariable ordinal logistic regression respectively. Finally, P value < 0.05 was used to determine level of significance in the final model. The final model reached after checking adequacy of the data using the Hosmer and Lemeshow test.

Ethics approval and consent to participate

The study was conducted according to the guidelines of the 1964 Declaration of Helsinki and following amendments. Ethical clearance was obtained from University of Gondar Institutional Review Board of Institute of Public Health (Ref. No IPH/2119/2014). Permission letter was obtained from Addis Ababa Health Office. Written informed consent was obtained from all study participants. Study participants who were unable to read and write signed by fingerprints, while doing so there were two literate witnesses. Data collectors have strictly followed COVID-19 prevention protocols. Confidentiality of the study participants was ensured; no person identifiers were used and the kobo account was password protected-only authorized user was able to access the data.

Sociodemographic characteristics of the study participants

In this study, 949 pregnant women consented to participate in the study period, yielding 95% response rate. The vast majority of the study participants (96.80%) were married. The mean (±Standard deviation (SD)) age of the study participants in years was 27.16(±4.46SD), about two fifth (39.10%) of the study participants were in the age range 25–29 years. Regarding educational status, half of (50.10%) the study participates had accomplished primary education. More than two fifth (43.90%) of the study participants were housewives. Almost a quarter (24.50%) of the participants were from poor households. More than half (57.60%) of pregnant women have positive attitude towards consumption of variety of food ( Table 1 ).

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https://doi.org/10.1371/journal.pone.0306169.t001

Maternal characteristics

As to the maternal characteristics the study participants, more than half (57.6%) were multigravida, almost two third (61.5%) were in the second trimester pregnancy, more than two third (67.02%) had at least one ANC visit, and 69.6% had received nutritional counselling when they came for ANC visit ( Table 2 ).

https://doi.org/10.1371/journal.pone.0306169.t002

Dietary habits of the study participants

Of the study participants, less than half (45.3%) ate three times a day, whereas over half (56.5%) regularly ate snacks. Nearly two thirds (59.2%) skipped meals, with the most common reasons being fatigued or preoccupied with work (19.6%), not wanting to gain weight (19.6%), and other (31.3%) causes such as loss of appetite, vomiting, and discomfort. Likewise, nearly one-third (31.1%) reported a history of food taboos. Lastly, more than a quarter (26.7%) of study participants reported having a history of food cravings ( Table 3 ).

https://doi.org/10.1371/journal.pone.0306169.t003

Food consumption pattern

In this study, practically all of the study participants had consumed common staples, and nearly three quarters (73.2%) of the participants had consumed animal-source food, such as meat ( Table 4 ).

https://doi.org/10.1371/journal.pone.0306169.t004

Food consumption score

This study has revealed that a little over half [51.20% (95%CI: 48.00%-54.40)] had acceptable food consumption score. More than two fifth [42.60% (95% CI: 39.45%-45.74%)] had borderline food consumption, and the small proportion [6.2% (95%CI: 4.84%-7.94%) ( Table 5 ).

https://doi.org/10.1371/journal.pone.0306169.t005

Factors associated with food consumption score

Ordinal logistic regression was used to identify factors associated with food consumption score. The following variables which were significant in the bivariable analysis (p value<0.25): age, husband educational status, husband occupation, maternal education, attitude, wealth status, family size, meal skip, food avoid, food craving, taking supplements, still birth, ANC visit, and nutrition counselling during ANC follow-up were fitted in the final model. However, only meal skip, maternal education, attitude and wealth status were found to be the independent predictors of food consumption score.

The odds of having acceptable food consumption score among study participants who can read and write was 3.99 (Relative to borderline and poor food consumption score) times higher than study participants who were unable to read and write [AOR = 3.99,95%CI: 1.33–11.96]. The odds of having acceptable food consumption score were 49% (Relative to borderline and poor food consumption score) lower among study participants who came from the poorest households when compared to participants who came from the richest households [AOR = 0.52, 95%CI: 0.24–0.78]. The odds of having acceptable food consumption score were 1.36 times higher among study participants who did not skip meal (Versus borderline and poor food consumption score) compared to participants who skipped meal [AOR = 1.36, 95%CI: 1.03–1.81]. Finally, among study participants with positive attitude towards consumption of diversified diet there was 52% increased odds to have acceptable food consumption score (Relative to borderline and poor food consumption score) [AOR = 1.52,95%CI: 1.17–1.98] ( Table 6 ).

https://doi.org/10.1371/journal.pone.0306169.t006

This study sought to examine FCS and associated factors among pregnant women who were having ANC follow up in health centers of Addis Ababa, Ethiopia. The results of this study have showed a little over half (51.20%, 95% CI: 48.00%-54.30%) of the study participants had acceptable FCS, and the small proportion of the study participants had poor FCS (6.20%).

Our report was far below the WFP recommendation [ 1 ]. Furthermore, the finding has showed that the percentage of acceptable FCS was comparatively lower than studies from Bangladesh(58%) [ 27 ], Nigeria (80.3%) [ 28 ] and pocket studies from Ethiopia (81.5% and 54.6% at Shegaw Motta and Eastern Ethiopia, respectively) [ 12 , 13 ]. The study period could explain the decreased rate FCS, for example, the study at Shegaw Motta was conducted in the main harvest season while our study was conducted in fasting season when there is a decreased consumption animal source food [ 29 ]. Methodologically, the use of larger sample size in the current study and difference in outcome ascertainment might explain decreased rate of acceptable FCS in this study. In Ethiopia, pregnant women avoid foods due to cultural and religious reasons, and this might explain the discrepancy between the current the study and study from Nigeria where religion and culture has lesser influence over their food choice [ 30 ].

As to the associated factors of FCS, our study has showed maternal educational status-able to read and write, not being in the poorest wealth status, positive attitude towards dietary diversity, and skipping meal were independent predictors of FCS. Those mothers who were able to read and write had higher odds of having acceptable FCS compared to mothers who were unable to read and write, emphasizing the importance of nutritional educational during pregnancy. This was supported by other similar studies conducted in Nigeria [ 30 ], Ghana [ 31 ], and other studies in Ethiopia [ 32 ]. It is evident that increasing level of literacy is crucial to mitigate the problem even in the poorest households [ 33 ]. Besides, mothers who are able to read and write will have a better access to nutritional information from internet, brochures, newspapers and magazines [ 34 – 36 ]. In the affluents, where the toll of non-communicable disease is spiralling- enhancing level of literacy will play a pivotal role for an appropriate food selection and consumption too [ 37 ].

Being in the poorest wealth status decreases the odds of having acceptable FCS by 49% when compared mothers from the richest wealth status. This was also observed in previous studies conducted in Bishoftu, Oromia [ 10 ]. Pregnant mothers from the poorest households have limited economical accesses to procure and buy a diversified diet. On top of this, different studies have pinpointed that being in the lowest wealth status is associated with decreased consumption of animal source food [ 38 ], which in turn results lower FCS. Mothers who did not skip meal had also higher odds of having acceptable FCS when compared to their counterparts. A similar finding was observed from a study in Eastern Ethiopia [ 15 ]. During the period of gestation, meal patterning is highly important since pregnant women who sustain prolonged periods of time without food by skipping meals or snacks may be inducing a physiologic stress in their pregnancy [ 39 ]. Even though accidentally skipping a meal is not going to be harmful, skipping meals regularly for different reasons is not advisable to have a better pregnancy outcome [ 40 , 41 ]. Moreover, from different studies, it has been seen that skipping meals during this period is associated decreased dietary quality [ 15 ].

The study has also revealed, study participants who had positive attitude towards consumption diversified diet had an increased odds of having acceptable FCS than their counter parts. A similar finding was observed from a study conducted in Eastern Ethiopia [ 13 ]. Different researches have supported that pregnant women with increased level of attitude have a better practice of consuming a diversified diet [ 42 ]. Women with positive feeling towards a diversified diet are also motivated to consume foods from different food groups [ 43 , 44 ].

It should be mentioned that the present study has provided greater evidence on the dietary quality and predictors among pregnant women using ordinal logistic regression [ 22 ]. However, methodological limitation of the study cannot go unnoticed. Despite the use of probes like photographs-to recite memory of the study participants-problem of recall bias cannot be ignored which in turn might overestimate or underestimate the result. On top of that, cross- sectional nature of the study limits detection of causal association between the outcome and predicator variables. Even though FCS is a validated tool to asses calorie intake, the tool has not been validated to measure adequacy of macronutrients and micronutrients. The use of a 4 item Likert questionnaire is another limitation of the current study, while recommending the use of a questionnaire with sufficient numbers questions.

Implication of the study

The findings of this study can be used to implement public health policies and programmes that strive to bring a better pregnancy outcome by promoting a balanced diet to vulnerable groups of the population. Therefore, to meet the WFP recommendation of having 90% acceptable FCS, interventions need to give a due attention to mothers with lower educational status who are from a lower socio-economic status. The implications of this study can be linked to the importance nutritional educations that target to bring a positive attitude towards consumption of a diversified diet. Moreover, findings of the study imply the importance of provision of a diversified diet in deterring the sequala of malnutrition.

The findings of this study have showed that only half of the study participants had acceptable FCS which is far below the WFP recommendation. Besides, able to read and write, not skipping meal, positive attitude towards the consumption variety of foods, not being from the poorest household were significantly associated with having acceptable FCS relative to borderline and poor FCS. Therefore, it is important to give a special attention to pregnant mothers with low socioeconomic status, and mothers who skip meals in order to enhance their food variety score and improve their nutritional intake.

Future researches are encouraged to investigate nutrient adequacy among pregnant women. Finally, future studies triangulated with qualitative research that investigate behavioural factors such as food taboos and norms that influence FCS among pregnant women are also encouraged.

Supporting information

S1 file. fcs plos one..

https://doi.org/10.1371/journal.pone.0306169.s001

Acknowledgments

The authors of this article are grateful for the study participants without whom this would not be possible.

• 1. Wfp V., Food consumption analysis: calculation and use of the food consumption score in food security analysis. WFP: Rome, Italy, 2008.
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• 26. Organization W.H., Report of a WHO technical consultation on birth spacing: Geneva, Switzerland 13–15 June 2005. 2007, World Health Organization.
• 27. Ahmed, E., I. Jahan, and M.A. Islam, FOOD SECURITY STATUS AND FOOD CONSUMPTION AMONG URBAN AND RURAL PREGNANT WOMEN OF JASHORE DISTRICT IN BANGLADESH.

Public ranks long-term challenges and health determinants as top priorities for new EU

To enhance public health, the post-election European Union (EU) should prioritise long-term challenges such as climate change and the ageing population, as well as factors that influence our health, according to a new report . The findings, derived from a seven-month public debate led by the European Observatory on Health Systems and Policies, highlight a collective call for the EU to play a more significant role in health.

The report, which is based on the public debate commissioned by the European Commission’s Directorate General for Health and Food Safety ( DG SANTE ), outlines the key priorities and actions desired by citizens and stakeholders from a wide range of sectors and mostly from Europe. The analysis included more than 800 responses in conference polls and a survey, plus comprehensive inputs across three webinars .

The large and participatory initiative allowed to collect public opinion on nine critical health topics: health security; determinants of health; health system transformation; the health workforce; universal health coverage; digital solutions and AI; performance and resilience; long-term challenges like climate change and ageing; and the EU’s global role in health.

The public’s calls for action – including across sectors

Participants called for the European Commission to coordinate across its different policy branches. Collaborating across sectors is considered key to deliver health priorities, making the concepts of ‘ Health in All Policies’ and ‘Health for All Policies ’ important tools for addressing the determinants of health. Interestingly, the topics which garnered the highest consensus in the discussion framework were those least controlled by the health sector alone.

Significant measures should be taken to mitigate the health impacts of environmental risks, including promoting environmental health and supporting health equity through integrated policies. Participants also considered addressing the needs of an ageing population essential, by improving health services and ensuring that health systems are prepared to meet the demands of older adults.

The public opinion suggested several actions to achieve universal health coverage (UHC) across the EU, such as ensuring equal access to comprehensive health care services for all EU citizens and financial protection for all. Other recommendations ranged from establishing a common minimum coverage package and a European health insurance scheme to focusing on underserved groups, improving health literacy, and including mental health in UHC policies.

What role for the EU?

Participants highlighted the importance of EU legal frameworks and instruments in promoting and safeguarding health, such as funding and technical support. They advocated both for new tools and for better implementation and coordination of existing mechanisms.

Aligning educational standards was raised as a key topic in the context of addressing shortages of health workers , regional disparities and managing the demands for new skills. Better addressing health workforce needs and improving their working conditions to mitigate existing gaps was also discussed. There was consensus on the need for EU approaches to health workforce issues, including better coordination of initiatives and pursuit of EU wide policies.

Digital solutions , health security and strengthening the EU’s global voice and leadership were widely discussed but ranked slightly lower. Possible explanations outlined in the report include the “transversal nature of digital solutions, which voters may have perceived as a means to achieving other priorities”. The COVID-19 pandemic and sustained EU action on health security may have elicited some voters to opt for other topics that have received less policy attention in recent years.

Survey, webinars, and conference polls

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Tips for Outdoor Workers in Extreme Heat

Extreme heat is the leading weather-related cause of death in the United States. Some workers are disproportionately impacted by this type of weather, including farmworkers and farmers, fishers, firefighters and construction workers. Since 2011, more than 400 workers have died due to environmental heat exposure, and thousands more are hospitalized every year. As heat waves become more intense and frequent, outdoor workers should adjust their activities based on weather forecasts to minimize risks.

Part of being #SummerReady means understanding extreme heat risks. If you are under an extreme heat warning and must be outside, the following tips will help protect you and your loved ones.

Stay Hydrated and Keep up with Your Electrolytes 

• Drink plenty of water before, during and after working in the heat. Aim to consume at least one cup of water every 15 to 20 minutes.
• Avoid caffeinated and sugary beverages, as they can contribute to dehydration.
• Do not skip meals to maintain healthy levels of sodium and electrolytes in your body during hot days. 
• Although hydrating is important, keep in mind that drinking water does not cool inner body temperatures.

Dress Appropriately 

• Wear lightweight, loose-fitting and light-colored clothing that covers exposed skin.
• Use a wide-brimmed hat to shade your face, head and neck.

Take Frequent Breaks and Refine Work Schedules

• When possible, plan outdoor work during cooler hours, such as early mornings or evenings.
• Use rest breaks to cool down and allow the body to recover from heat stress.
• Find shaded or air-conditioned areas for breaks. 
• Avoid direct sunlight during the hottest parts of the day.
• Avoid strenuous physical activity during peak heat hours, if possible.

Monitor Your Health

Be aware of early signs of heat-related illnesses, such as heat exhaustion or heatstroke.

Heat exhaustion signs and symptoms include heavy sweating, cold, pale and clammy skin, muscle cramps, fatigue, weakness, dizziness, headache, nausea or vomiting and fainting. 

If you are experiencing these symptoms, it is recommended to: 

• Go to an air-conditioned place and lie down. 
• Loosen or remove clothing.
• Put cool, wet cloths on your body or take a cool bath. 

Take sips of water. Get medical attention right away if you are throwing up, your symptoms get worse or your symptoms last longer than one hour. 

Heat stroke signs and symptoms include extremely high body temperature (above 103 degrees) indicated by an oral thermometer; red, hot, dry or damp skin; rapid, strong pulse; headache; dizziness; nausea; confusion; and unconsciousness. 

If you are experiencing these symptoms, seek medical attention immediately:

• Call 9-1-1 or get to a hospital promptly. 
• Move the person to a cooler place until medical help arrives. 
• Help lower the person’s temperature with cool cloths or a cool bath.
• Do not give the person anything to drink.

For more information on responding to a heat stroke, visit Centers for Disease Control and Prevention’s Extreme Heat webpage . 

Communicate and Collaborate with Others

• Stay in touch with supervisors and co-workers to monitor the latest updates and instructions.
• Look out for each other and report any signs of heat-related distress among colleagues.
• Encourage an open dialogue regarding heat safety concerns and potential improvements in workplace practices. Supervisors might monitor worker safety and remind workers to take breaks and hydrate on a set schedule.
• Let friends or family know where you will be located to ensure safety if faced with a heat-related illness. 

Specific Tips for Farmworkers, Farmers, Construction Workers, Firefighters and Fisher Workers

Farmworkers and farmers .

Farmworkers and farmers are especially vulnerable to extreme heat due to prolonged exposure in fields and open areas with limited shade. Due to this vulnerability, agriculture workers compared to other outdoor professions are 35 times more likely to die from extreme heat.  

• Implement shaded rest areas and make them easily accessible. 
• Use mechanized equipment to reduce physical labor when possible. 
• Rotate tasks to reduce continuous exposure to direct sunlight. 
• Educate workers on the signs of heat-related illnesses and proper hydration techniques. 

Construction Workers 

Construction workers often deal with both the heat and physical exertion from manual labor, making them 13 times more likely to die from extreme heat than other outdoor professions.

• Adjust work schedules to start earlier in the day or later in the afternoon. 
• Provide cooling stations on-site with fans, misters and shaded areas. 
• Ensure all workers are trained in recognizing and responding to heat stress. 

Firefighters

Firefighters face unique challenges due to the heavy protective gear and the intense heat from fires . 

• Ensure proper hydration by carrying water and electrolyte solutions in fire trucks.
• Use cooling vests or other wearable cooling devices during and after fire suppression activities.
• Monitor each other for signs of heat stress and take breaks in air-conditioned environments whenever possible . 

Fisher Workers 

Fisher workers often work in direct sunlight on open water, which can increase the risk of heat exposure.

• Ensure access to shaded areas on boats or platforms for regular breaks.
• Rotate tasks to minimize continuous exposure to the sun.
• Encourage hydration by keeping ample supplies of water and electrolyte solutions on board.
• Provide training on the signs of heat-related illnesses and emergency response procedures.

Remember, prioritizing safety and well-being is paramount during extreme heat conditions. Listen to official guidelines and recommendations from local authorities or your employer related to extreme heat safety to limit risks. 

Visit Ready.gov to learn more. Share this information to raise awareness and prevent heat-related incidents. 

Scientific breakthroughs: 2024 emerging trends to watch

December 28, 2023

Across disciplines and industries, scientific discoveries happen every day, so how can you stay ahead of emerging trends in a thriving landscape? At CAS, we have a unique view of recent scientific breakthroughs, the historical discoveries they were built upon, and the expertise to navigate the opportunities ahead. In 2023, we identified the top scientific breakthroughs , and 2024 has even more to offer. New trends to watch include the accelerated expansion of green chemistry, the clinical validation of CRISPR, the rise of biomaterials, and the renewed progress in treating the undruggable, from cancer to neurodegenerative diseases. To hear what the experts from Lawrence Liverpool National Lab and Oak Ridge National Lab are saying on this topic, join us for a free webinar on January 25 from 10:00 to 11:30 a.m. EDT for a panel discussion on the trends to watch in 2024.

The ascension of AI in R&D

While the future of AI has always been forward-looking, the AI revolution in chemistry and drug discovery has yet to be fully realized. While there have been some high-profile set-backs , several breakthroughs should be watched closely as the field continues to evolve. Generative AI is making an impact in drug discovery , machine learning is being used more in environmental research , and large language models like ChatGPT are being tested in healthcare applications and clinical settings.

Many scientists are keeping an eye on AlphaFold, DeepMind’s protein structure prediction software that revolutionized how proteins are understood. DeepMind and Isomorphic Labs have recently announced how their latest model shows improved accuracy, can generate predictions for almost all molecules in the Protein Data Bank, and expand coverage to ligands, nucleic acids, and posttranslational modifications . Therapeutic antibody discovery driven by AI is also gaining popularity , and platforms such as the RubrYc Therapeutics antibody discovery engine will help advance research in this area.

Though many look at AI development with excitement, concerns over accurate and accessible training data , fairness and bias , lack of regulatory oversight , impact on academia, scholarly research and publishing , hallucinations in large language models , and even concerns over infodemic threats to public health are being discussed. However, continuous improvement is inevitable with AI, so expect to see many new developments and innovations throughout 2024.

‘Greener’ green chemistry

Green chemistry is a rapidly evolving field that is constantly seeking innovative ways to minimize the environmental impact of chemical processes. Here are several emerging trends that are seeing significant breakthroughs:

• Improving green chemistry predictions/outcomes : One of the biggest challenges in green chemistry is predicting the environmental impact of new chemicals and processes. Researchers are developing new computational tools and models that can help predict these impacts with greater accuracy. This will allow chemists to design safer and more environmentally friendly chemicals.
• Reducing plastics: More than 350 million tons of plastic waste is generated every year. Across the landscape of manufacturers, suppliers, and retailers, reducing the use of single-use plastics and microplastics is critical. New value-driven approaches by innovators like MiTerro that reuse industrial by-products and biomass waste for eco-friendly and cheaper plastic replacements will soon be industry expectations. Lowering costs and plastic footprints will be important throughout the entire supply chain.    
• Alternative battery chemistry: In the battery and energy storage space, finding alternatives to scarce " endangered elements" like lithium and cobalt will be critical. While essential components of many batteries, they are becoming scarce and expensive. New investments in lithium iron phosphate (LFP) batteries that do not use nickel and cobalt have expanded , with 45% of the EV market share being projected for LFP in 2029. Continued research is projected for more development in alternative materials like sodium, iron, and magnesium, which are more abundant, less expensive, and more sustainable.
• More sustainable catalysts : Catalysts speed up a chemical reaction or decrease the energy required without getting consumed. Noble metals are excellent catalysts; however, they are expensive and their mining causes environmental damage. Even non-noble metal catalysts can also be toxic due to contamination and challenges with their disposal. Sustainable catalysts are made of earth-abundant elements that are also non-toxic in nature. In recent years, there has been a growing focus on developing sustainable catalysts that are more environmentally friendly and less reliant on precious metals. New developments with catalysts, their roles, and environmental impact will drive meaningful progress in reducing carbon footprints.  
• Recycling lithium-ion batteries: Lithium-ion recycling has seen increased investments with more than 800 patents already published in 2023. The use of solid electrolytes or liquid nonflammable electrolytes may improve the safety and durability of LIBs and reduce their material use. Finally, a method to manufacture electrodes without solvent s could reduce the use of deprecated solvents such as N-methylpyrrolidinone, which require recycling and careful handling to prevent emissions.

Rise of biomaterials

New materials for biomedical applications could revolutionize many healthcare segments in 2024. One example is bioelectronic materials, which form interfaces between electronic devices and the human body, such as the brain-computer interface system being developed by Neuralink. This system, which uses a network of biocompatible electrodes implanted directly in the brain, was given FDA approval to begin human trials in 2023.

• Bioelectronic materials: are often hybrids or composites, incorporating nanoscale materials, highly engineered conductive polymers, and bioresorbable substances. Recently developed devices can be implanted, used temporarily, and then safely reabsorbed by the body without the need for removal. This has been demonstrated by a fully bioresorbable, combined sensor-wireless power receiver made from zinc and the biodegradable polymer, poly(lactic acid).
• Natural biomaterials: that are biocompatible and naturally derived (such as chitosan, cellulose nanomaterials, and silk) are used to make advanced multifunctional biomaterials in 2023. For example, they designed an injectable hydrogel brain implant for treating Parkinson’s disease, which is based on reversible crosslinks formed between chitosan, tannic acid, and gold nanoparticles.
• Bioinks : are used for 3D printing of organs and transplant development which could revolutionize patient care. Currently, these models are used for studying organ architecture like 3D-printed heart models for cardiac disorders and 3D-printed lung models to test the efficacy of drugs. Specialized bioinks enhance the quality, efficacy, and versatility of 3D-printed organs, structures, and outcomes. Finally, new approaches like volumetric additive manufacturing (VAM) of pristine silk- based bioinks are unlocking new frontiers of innovation for 3D printing.

To the moon and beyond

The global Artemis program is a NASA-led international space exploration program that aims to land the first woman and the first person of color on the Moon by 2025 as part of the long-term goal of establishing a sustainable human presence on the Moon. Additionally, the NASA mission called Europa Clipper, scheduled for a 2024 launch, will orbit around Jupiter and fly by Europa , one of Jupiter’s moons, to study the presence of water and its habitability. China’s mission, Chang’e 6 , plans to bring samples from the moon back to Earth for further studies. The Martian Moons Exploration (MMX) mission by Japan’s JAXA plans to bring back samples from Phobos, one of the Mars moons. Boeing is also expected to do a test flight of its reusable space capsule Starliner , which can take people to low-earth orbit.

The R&D impact of Artemis extends to more fields than just aerospace engineering, though:

• Robotics: Robots will play a critical role in the Artemis program, performing many tasks, such as collecting samples, building infrastructure, and conducting scientific research. This will drive the development of new robotic technologies, including autonomous systems and dexterous manipulators.
• Space medicine: The Artemis program will require the development of new technologies to protect astronauts from the hazards of space travel, such as radiation exposure and microgravity. This will include scientific discoveries in medical diagnostics, therapeutics, and countermeasures.
• Earth science: The Artemis program will provide a unique opportunity to study the Moon and its environment. This will lead to new insights into the Earth's history, geology, and climate.
• Materials science: The extreme space environment will require new materials that are lightweight, durable, and radiation resistant. This will have applications in many industries, including aerospace, construction, and energy.
• Information technology: The Artemis program will generate a massive amount of data, which will need to be processed, analyzed, and shared in real time. This will drive the development of new IT technologies, such as cloud computing, artificial intelligence, and machine learning.

The CRISPR pay-off

After years of research, setbacks, and minimal progress, the first formal evidence of CRISPR as a therapeutic platform technology in the clinic was realized. Intellia Therapeutics received FDA clearance to initiate a pivotal phase 3 trial of a new drug for the treatment of hATTR, and using the same Cas9 mRNA, got a new medicine treating a different disease, angioedema. This was achieved by only changing 20 nucleotides of the guide RNA, suggesting that CRISPR can be used as a therapeutic platform technology in the clinic.

The second great moment for CRISPR drug development technology came when Vertex and CRISPR Therapeutics announced the authorization of the first CRISPR/Cas9 gene-edited therapy, CASGEVY™, by the United Kingdom MHRA, for the treatment of sickle cell disease and transfusion-dependent beta-thalassemia. This was the first approval of a CRISPR-based therapy for human use and is a landmark moment in realizing the potential of CRISPR to improve human health.

In addition to its remarkable genome editing capability, the CRISPR-Cas system has proven to be effective in many applications, including early cancer diagnosis . CRISPR-based genome and transcriptome engineering and CRISPR-Cas12a and CRISPR-Cas13a appear to have the necessary characteristics to be robust detection tools for cancer therapy and diagnostics. CRISPR-Cas-based biosensing system gives rise to a new era for precise diagnoses of early-stage cancers.

MIT engineers have also designed a new nanoparticle DNA-encoded nanosensor for urinary biomarkers that could enable early cancer diagnoses with a simple urine test. The sensors, which can detect cancerous proteins, could also distinguish the type of tumor or how it responds to treatment.

Ending cancer

The immuno-oncology field has seen tremendous growth in the last few years. Approved products such as cytokines, vaccines, tumor-directed monoclonal antibodies, and immune checkpoint blockers continue to grow in market size. Novel therapies like TAC01-HER2 are currently undergoing clinical trials. This unique therapy uses autologous T cells, which have been genetically engineered to incorporate T cell Antigen Coupler (TAC) receptors that recognize human epidermal growth factor receptor 2 (HER2) presence on tumor cells to remove them. This could be a promising therapy for metastatic, HER2-positive solid tumors.

Another promising strategy aims to use the CAR-T cells against solid tumors in conjunction with a vaccine that boosts immune response. Immune boosting helps the body create more host T cells that can target other tumor antigens that CAR-T cells cannot kill.

Another notable trend is the development of improved and effective personalized therapies. For instance, a recently developed personalized RNA neoantigen vaccine, based on uridine mRNA–lipoplex nanoparticles, was found effective against pancreatic ductal adenocarcinoma (PDAC). Major challenges in immuno-oncology are therapy resistance, lack of predictable biomarkers, and tumor heterogenicity. As a result, devising novel treatment strategies could be a future research focus.

Decarbonizing energy

Multiple well-funded efforts are underway to decarbonize energy production by replacing fossil fuel-based energy sources with sources that generate no (or much less) CO2 in 2024.

One of these efforts is to incorporate large-scale energy storage devices into the existing power grid. These are an important part of enabling the use of renewable sources since they provide additional supply and demand for electricity to complement renewable sources. Several types of grid-scale storage that vary in the amount of energy they can store and how quickly they can discharge it into the grid are under development. Some are physical (flywheels, pumped hydro, and compressed air) and some are chemical (traditional batteries, flow batteries , supercapacitors, and hydrogen ), but all are the subject of active chemistry and materials development research. The U.S. government is encouraging development in this area through tax credits as part of the Inflation Reduction Act and a $7 billion program to establish regional hydrogen hubs.

Meanwhile, nuclear power will continue to be an active R&D area in 2024. In nuclear fission, multiple companies are developing small modular reactors (SMRs) for use in electricity production and chemical manufacturing, including hydrogen. The development of nuclear fusion reactors involves fundamental research in physics and materials science. One major challenge is finding a material that can be used for the wall of the reactor facing the fusion plasma; so far, candidate materials have included high-entropy alloys and even molten metals .

Neurodegenerative diseases

Neurodegenerative diseases are a major public health concern, being a leading cause of death and disability worldwide. While there is currently no cure for any neurodegenerative disease, new scientific discoveries and understandings of these pathways may be the key to helping patient outcomes.

• Alzheimer’s disease: Two immunotherapeutics have received FDA approval to reduce both cognitive and functional decline in individuals living with early Alzheimer's disease. Aducannumab (Aduhelm®) received accelerated approval in 2021 and is the first new treatment approved for Alzheimer’s since 2003 and the first therapy targeting the disease pathophysiology, reducing beta-amyloid plaques in the brains of early Alzheimer’s disease patients. Lecanemab (Leqembi®) received traditional approval in 2023 and is the first drug targeting Alzheimer’s disease pathophysiology to show clinical benefits, reducing the rate of disease progression and slowing cognitive and functional decline in adults with early stages of the disease.
• Parkinson’s disease: New treatment modalities outside of pharmaceuticals and deep brain stimulation are being researched and approved by the FDA for the treatment of Parkinson’s disease symptoms. The non-invasive medical device, Exablate Neuro (approved by the FDA in 2021), uses focused ultrasound on one side of the brain to provide relief from severe symptoms such as tremors, limb rigidity, and dyskinesia. 2023 brought major news for Parkinson’s disease research with the validation of the biomarker alpha-synuclein. Researchers have developed a tool called the α-synuclein seeding amplification assay which detects the biomarker in the spinal fluid of people diagnosed with Parkinson’s disease and individuals who have not shown clinical symptoms.
• Amyotrophic lateral sclerosis (ALS): Two pharmaceuticals have seen FDA approval in the past two years to slow disease progression in individuals with ALS. Relyvrio ® was approved in 2022 and acts by preventing or slowing more neuron cell death in patients with ALS. Tofersen (Qalsody®), an antisense oligonucleotide, was approved in 2023 under the accelerated approval pathway. Tofersen targets RNA produced from mutated superoxide dismutase 1 (SOD1) genes to eliminate toxic SOD1 protein production. Recently published genetic research on how mutations contribute to ALS is ongoing with researchers recently discovering how NEK1 gene mutations lead to ALS. This discovery suggests a possible rational therapeutic approach to stabilizing microtubules in ALS patients.

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