Unit 9 – Public HealthEnvironmental Issues in Public

Health: Part II

Chapter 22 – Solid and Hazardous Wastes: What To Do With the Garbage?

Before 1970sOpen dumps

Outlawed by Resource Conservation and Recovery Act (RCRA), 1976

Burned in incinerators or in the openOutlawed by Clean Air Act, 1970

Poured into rivers, lakes, or oceansOutlawed by Clean Water Act (1972) and

Marine Protection, Research, and Sanctuaries Act (1972)

Sanitary LandfillsSite should be dry, impervious clay soilLined with plasticDrains for liquidsVents to control explosive gasesTipping fee

Cost of disposing of one ton of municipal wasteHighest cost is in northeast

New York City – Fresh Kills, Staten Island

Alternatives to LandfillsThree R’s: Reduce, Reuse, RecycleReduce: buy only what’s needed; avoid

excessive packagingReuse: Use reusable items rather than

disposableRecycle

Encouraged by deposits on bottles and cansYard salesComposting

Waste to energy incineration Special incinerators -- still concern about pollution

Hazardous Wastes Love Canal, New York – 1978Times Beach, Missouri – 1972-1976Resource Conservation and Recovery Act,

(RCRA), 1976, 1984All hazardous wastes accounted for “from

cradle to grave”Wastes from petroleum refining, pesticide

manufacturing, some pharmaceuticalsIgnitable, corrosive, reactive, toxic wastes

SuperfundComprehensive Environmental Response,

Compensation, and Liability Act – 1980Emergency cleanup of old waste sites, paid

for by a tax on industryMired in controversy; much effort focused on

determining who is liableTax not reauthorized in 1995

NIMBYNot In My Back Yard

Unit 9 – Public HealthEnvironmental Issues in Public

Health: Part II

Chapter 23 – Safe Foods and Drugs: An Ongoing Regulatory Battle

Causes of Food-Borne IllnessBacteria

Salmonella -- eggs, poultry, meatE. coli O157:H7 – ground beef, alfalfa sprouts,

unpasteurized apple juice, raw milk, lettuce Viruses

Hepatitis A – green onions from Mexico, shellfish

Norwalk virus -- shellfishParasites

Cyclospora – raspberries from GuatemalaParasites in sushi, sashimi, ceviche

Government Food Safety ActivitiesResponsibility is divided among many

agenciesDepartment of Agriculture (USDA) – meat,

poultry, processed eggsFood and Drug Administration (FDA) – all

other foodsStates regulate shellfishState and local governments regulate

stores, restaurants, institutions (schools, nursing homes)

Irrationality of SystemUSDA has bigger budget, more authority

Regulates 20% of foodDetailed laws on regulation of meat

FDA has smaller budget, less authorityRegulates 80% of foodInspects only 1% proportion of imported food

55% of seafood is imported 12% of vegetables 30% of fruit

Safety MeasuresHazard Analysis Critical Control Point

(HACCP)Focuses on procedures; reduces need for

inspectionsIrradiation – kills bacteria, parasites, pestsCDC surveillance for food-borne disease

FoodNetPulsenet – DNA fingerprinting of bacteria

Additives and ContaminantsFDA sets tolerance levels for pesticide

residuesHormones

Estrogen banned in chickensBovine growth hormone allowed for cows (does

not get into milk)Antibiotics – causes antibiotic resistanceOrganic foods – USDA set standards in 2004Additives

To prevent deficiency diseasesPreservatives or to improve color, flavor or textureMust be approved by FDA, or GRAS

Drugs FDA must approve after studies by

pharmaceutical companyNew Drug Application Three phases of trial

I. Small number of subjects, measure absorption, distribution, metabolism, excretion; look for side effects and toxicities

II. Signs of effectivenessIII. Clinical trial

Post-marketing surveillance

Food and Drug Labeling and AdvertisingFDA regulates labeling of foods with

information on specified nutrients, recommended daily intakes

FDA regulates labeling of drugsLabeling of over-the-counter drugs is by

Federal Trade Commission

Dietary SupplementsDietary Supplement Health and Education

Act – 1994Forbids FDA from regulating herbs and food

supplementsCan remove substance from market only if

proven harmfulEphedra removed only after many deaths

Politics of the FDAFDA subject to intense political pressuresComplaints it is too slow in approving drugsDrug companies pay a fee to speed up review

processNow complaints that the FDA is too cozy with

industry

Politics of the FDA, ctd.Too many drugs found to be unsafe only

after approved for marketingFen-phenVioxxAntidepressants for children

Problems with the way clinical trials are reported

Calls for a database of all clinical trials, to be registered at the beginning of the trial, with all results to be reported

Unit 9 – Public HealthEnvironmental Issues in Public

Health: Part II

Chapter 24 – Population: The Ultimate Environmental Health Issue

Population BiologyPatterns of population growth: S curve and J curveCarrying capacity – number of organisms that can be

supported without degrading environmentThomas Malthus predicted in about 1800 that

population growth would outgrow food supplyPaul Ehrlich – The Population Bomb, 1968Population growth has slowed, but many negative

effects of overpopulation are occurring

Public Health and Population GrowthPublic health has contributed to population growth by

reducing death rates, especially among children, in developing countries

Birth rates tend to fall as a result of falling death rates – demographic transition

Excess population settles in cities – homelessness, shantytowns – poor sanitation

HIV/AIDS shortening life expectancies in Africa

Depletion of Global ResourcesFresh water

Drinking, cooking, washingAgricultureUnevenly distributed

FuelDeforestation – leads to degradation of land

Arable landAmount of land under cultivation is declining

Food from the seaDecline of harvests of fish and shellfish

Climate ChangeGreenhouse effect from burning fossil fuelsRise of 1 degree during 20th centuryPredict 3 to 8 degree rise during 21st centuryU.S. has 5% of world’s population, contributes 21% of

greenhouse gasesKyoto Protocol – Bush administration has rejected

Prospects for Population ControlU.N. conference in Cairo, 1994

Opposition to contraception by Catholics and MuslimsRich and poor countries blame each other

20 year Programme of Action Education for women Empowering women to choose fewer children

Population stabilization comes with modernization and economic viability