Chapter 10: The Physical Environment and It’s Influence on Health

- explore critically how our physical environment impacts our health and health experience

- chapter will :

- 1) give an overview > drawing on the key features of one of the outer 'onion' rings of Dahlgren and Whitehead's (1991*) framework for identifying and understanding influences on health

>> agriculture and food production (1)
>> water and sanitation (2)
>> housing (3)
>> the working environment (4)
>> unemployment (5)
>> education (6)
>> health care services (7)
( 4 and 5 can be part of the same aspect of the physical environment and health)

- 2) consider the relevance of the discussion to health studies

- 3) case study is presented that considers the different aspects of living and working conditions > Cape Malay families of the winelands of Western Cape in South Africa

- discussions will be simplified

- two theoretical frameworks for understanding physical influences on health will be discussed
1) Lalonde's (1974, cited in Earle, 2007b) Health Field Concept
2) Busfield (2000) typology of health and illness

( **** = this chapter focus)

- the Lanlonde report - A new perspective on the Health of Canadians > signalled a shift in the way health was thought about > influenced the development of public health and health promotion over the past few decades > central to this doc was a model by Lalonde ** The health Field Concept ** > proposed that health could be improved by addressing 4 factors
1) individual lifestyle
2) health services ****
3) human biology / genetics
4) environmental influences ****

- Busfield offers 4 types of explanation of health and illness as follows :
T1) to do with individual behavior
T2) to do with individual attributes and circumstances
T3) to do with the material environment and allocation of resources ****
T4) to do with social relationships and human subjectivity

- Green and Tones (2010) argue health is influenced by the environment in many direct and indirect ways > physical environment specifics

(a) agriculture and food production
> food is vital > malnourishment and over consumption issues for long an short term health
> food availability, type, and production are vital contributing factors for health
> influenced by many different things including manufacturing, marketing processes, political systems and economics
--- connect to health in many different ways > food > material for shelter > source of livelihood
--- recent debates about nature of scares associated with production and manufacturing process globally
> Busfield argues that:
>>>contamination and adulteration of food is always a major threat
>>> globalization = food manufacturers are now owned and governed by large multi-national companies with increased control / regulation of food production is increasingly centralized
>> > 2 key issues > 1) distribution issues > Lee and Collin (2005) point out that there is enough food to feed everyone in the planet > 2) food security = access to and availability of food
+ food desert = neighborhoods and communities that have limited access to affordable and nutritious foods
+ excess calorie intake > increase in weight in certain populations > obesogenic environments

(b) water and sanitation
> key requirements for good health
> just under 1 billion people do not have access to clean water and 1.2 billion have no access to sanitation facilities and have to practice open defecation
--- Community-led total sanitation (CLTS)
> contamination of water sources > fecal matter and or chemicals and industrial waste remains a threat to health globally > estimates that "water problems" affect around half of humanity
> water as a scarce resource > recent droughts

(c) housing
> difficult to control cofounding factors when researching the link between housing and health
> issues :
--- rapid urbanization started in the 19th century > led to overcrowding and therefore rampant disease and communicable infections
--- damp and cold housing linked with respiratory illnesses
--- poor quality housing adds to general burden of stress
--- homelessness and living in temporary accommodations leads to increased risk of mental and physical illness
** these are global issues ** > UN refugee agency estimated that as of July 2009 there are 42 million uprooted people waiting for a home
--- growth of urban slums > as of 2005 1 billion people living in slum conditions > many threats of living in this conditions
--- clean indoor air > 2.5 billion people in developing countries have to rely on solid fuels to meet their energy needs = 1.8 million people die each year globally > cigaratte smoke = 2nd hand smoke exposure to children > other sources of indoor pollution chemicals that affect health in complex ways

(d) the working environment
> amount of time spend begs consideration about impact on health
> to be done in terms of
---working patters
* regularity of shifts > disruption of sleep patterns + stress
--- the physical working environment > sick building syndrome (SBS)
--- psycho-social impact > two longitudinal studies carried out on British civil servants ~ the Whitehall studies have sought to investigate the social determinants of health; findings = low levels of work demand, control and support result in higher absence + hierarchical workplace relationships and perceptions of imbalance of power result in workplace bullying

(e) unemployment
> 1995 systemic review on impact of unemployment = strong relationship btw unemployment and adverse health outcomes * nature of relationship less clear
> key question = does unemployment cause poor health or is it more likely that poor health causes unemployment *** more epidemiological evidence that unemployment causes ill-health than the other way around
> unemployment and higher death rates > 3 main links ( accounting for confounding characteristics )
1) decreases health status
2) ppl with impaired health status are more likely to become unemployed for periods of time
3) ppl with impaired health status are more likely to remain unemployed

> don't know WHY unemployment is detrimental for health > Kesseler et al. analyzed the experience of being unemployed by considering a range of different stressors created or made worse by it = (1) increased financial pressure (2) increased individual vulnerability to other unrelated life events

> experience is not the same for everyone > gendered health issues = affect men's mental health more than women's

(f) Education
> no obvious causal mechanisms > positive associations btw education and health > Ross and Wu (1995) offer three categories of explanation
(1) work and economic conditions > less unemployment + more likely to have fulfilling work
(2) social-psychological resources > life & resilience skills + sense of control and more social support
(3) lifestyle > less likely to adopt health-damaging practices

> ppl with university degrees have better health than ppl who don't

> quality primary-level education for young girls in low income countries greatly benefits later maternal and child health + self-esteem + sexual health

> children who experience poor health generally do not do as well educationally ( ableism in the educational system + systemic barriers) > as adults lower social status = cycle of disadvantage

(g) health care services
> role is under constant debate
> the quality and availability of health care makes a huge difference to health outcomes within any given pop'n
> evidence
---maternal and infant experiences > differ considerably according to whether a women lives in a low income (1:6 chance of dying ) or high income country ( 1: 4000 chance of dying ) * DISPARITY
--- UK 'post code lottery > health outcomes have been found to be dependent upon where people live > distance, response time, cancer care provision variance from region to region
--- USA > access to health care services is far from equal despite 'wealth' > this type of disparity common place in high income countries > study concluded that even though general practitioner services were relatively evenly distributed ~ better off sections of society made more use of services specially when private care options were offered ( !* Medysis in Cnd)

> Lalonde pointed out in 1974 + others > the physical environment has a large part to play in our experiences of health
--- additional factors in our environment
+ natural and manmade disasters
+ climate change
+ out-door air pollution
+ solid waste disposal
+ transport
> additionally > consider our socio-political environment and how this can impact on our health and well-being
> Green and Tones (2010) > different environmental factors may interact with each other to influence health
i.e. 'poverty is associated with poor housing, diet, education and health care ... leading to fewer life chances overall' >>> POLICY *

- 1) once environmental factors affecting health are identified > we are in a position to address them

-2) potential to influence health policy, how fiscal decisions are made, and where resources to improve health are aimed
** Donaldson and Scally argue (2009) > decisions carried out at a local, national ( and international) governmental level in many different fields - from education to the build environment - may ultimately have an effect on pop'n health **

-3) central underlying principle of health promotion > first mentioned in the Ottawa Charter (WHO, 1991) is that in order to promote health we need to be creating supportive environments = influencing our living and working conditions in order to maximize health gain
> UK Public Health White Paper of 2004 > signals the importance of creating and maintaining environments where people can make better health choices

-4) the settings approach > another key concept in health promotion > takes into account the direct effect of the setting itself on health + providing opportunity for health promotion > covers a wide range of different contexts = a specific context/location from which to carry out health promotion ( vary in the opportunities they carry)

- The physical environment , health and health experience in a South African context
> Cape Malay families of the winelands of the Western Cape in South Africa > specific context
> health care services
--- lacking and can be unaffordable
--- distance issues
> agriculture and food production
--- access to good nutrition greatly affected by financial resources
> water and sanitation
--- access to clean water
--- pipe system lacking
> working environment
--- most work involves manual labor
> housing
--- differing physical standards of housing infrastructure
--- overcrowding

- there are many aspects of the physical environment that impact on health and health experience throughout life through our living and working conditions

- research into these factors + he importance of them > is challenging b/c while positive relationships and associations can be demonstrated ---- the causal mechanisms (HOW & WHY) can be harder to determine

- the relationship between our living and working conditions and the way that we live our lives is very complex and involves the interaction of a large number of different factors that are hard to separate from each other