Global Warming and its adverse effect on Human Health

Air and water are essential natural resources for the survival of all living beings on this planet. After the industrial revolution, some 250 years back, the population of human beings started increasing rapidly due to improvements in the global standard of life. Presently, the population stands at 7 billion plus. More than 55 % of the world’s population resides in urban areas. Energy is the main driving force for this growth. The main sources of this energy are fossil fuels like coal and petroleum products like diesel, petrol, LPG, CNG etc.

Alongside providing energy, these fossil fuels generate emissions, such as CO2, CO, NO2, SO2 when used for producing energy. These emissions are known as Greenhouse Gases (GHGs), because they tend to trap heat on the planet. This is leading to a phenomenon widely known as Global Warming.

Forests cover 31 percent of the earth’s surface - just over 4 billion hectares. This is a huge reduction from the pre-industrial coverage of 5.9 billion hectares. This loss of forest cover has also contributed towards global warming, because forests absorb pollutants and greenhouse gases. Trees also help percolation of rainwater to maintain groundwater table.

However, due to our uncontrolled use of fossil fuels for energy and massive deforestation, we have started polluting the Earth at a faster rate than at any other time in history. Every single day of every single year, energy equivalent to that released by 400,000 Hiroshima type bombs spreads in the Earth’s atmosphere. 90 % of this energy is absorbed by the ocean. This is increasing ocean temperatures, directly impacting marine life like fish, coral reefs, etc. Also, warmer oceans are thought be the reason behind the increased severity of  typhoons and cyclones. Warm waters are also affecting monsoon rains. Monsoons in India are increasingly delayed. There has also been an increase in heavy rainfall, flooding and longer monsoon seasons.

Let us analyse how the above mentioned factors are affecting our health:

Air Pollution

1.     Construction - source of PM 2.5 and PM 10. particles in the air along with dust

2.     Transportation - source of CO2, CO, Methane, NO2, SO2 and other emission by-products  in the air

3.     Untreated Waste - source of methane, which has 25 times more impact on Climate Change than CO2.

4.     Dry Waste Burning - source of CO, CO2 & other harmful gases due to burning of plastics & thermocol.

5.     Industry - source of dust, smoke, PM10, CO, CO2 etc

6.     Water bodies - stagnated & polluted water bodies are a source of methane gas

7.     Thermal Power Plants - source of Ash, hot air & other harmful gases

8.     Warm, stagnant air tends to increase the formation of ozone, climate change is likely to increase levels of ground-level ozone in already-polluted areas like Delhi. Warmer temperatures during winter is conducive for formation of ground level Ozone.

Effect on Human Health

Polluted air has long term & short term effects on human health. As air pollution rises, respiratory diseases start rising due to the presence of harmful gases as well as particulate matter. Particulate matter is the term for a category of extremely small particles and liquid droplets suspended in the atmosphere.

1.     A new UNICEF report states that high levels of air pollution is a potential cause of neuro-inflammation, damaging cognitive development in young children.

2.      Ground-level ozone can damage lung tissue, reduce lung function, and inflame airways, thereby aggravating asthma or other lung diseases. Children, older adults, outdoor workers, and those with asthma and other chronic lung diseases are particularly at risk

3.     Inhaling fine particles can lead to a broad range of adverse health effects, including lung cancer, chronic obstructive pulmonary disease (COPD), and cardiovascular disease

4.     Particulate matter from wildfire smoke can often be carried very long distances by the wind, affecting people who live far from the source of this air pollutant. Fires from Punjab & Haryana fields is adversely affecting the health of Delhi

5.     Older adults are particularly sensitive to short-term particle exposure, with a higher risk of hospitalization and death.

Water Pollution  

Most of the domestic sewage, industrial effluents & agriculture run-off is released directly, untreated, into our water bodies. Almost all Indian rivers are now sewage lines due these contaminants. Remember, water is essential not only for survival of all beings, but also for agriculture. Water exists in a finite quantity on our planet. 97 % of all available water is in the oceans. Only 1% of all water on Earth is usable by us. Part of this water is surface water, which is increasingly getting polluted and the rest is underground.

The present status of groundwater in India is quite alarming. Due to unsustainable extraction of ground water, it is depleting rapidly. Groundwater is also getting contaminated due to water soluble salts in the soil and due to seepage of contaminated water from garbage dumps, industrial waste etc. The WHO reports that 80% of all diseases are water-borne. Of the 9 million people who died due to pollution-related diseases in 2015 globally, 2.5 million were recorded in India - the highest in any country. 

According to an international study published in The Lancet, pollution caused three times more deaths than AIDS, malaria and tuberculosis put together in 2015. India not only recorded the maximum deaths in the year, but also the most due to air pollution: 1.8 million…and half a million died due to water pollution.

Disease causing organisms are called pathogens.  Some pathogens occur naturally, and others pollute water when human or animal waste washes into the water. Some of the most common illnesses caused by pathogens in water include

·       Typhoid

·       Cholera

·       Dysentery

·       Polio

·       Hepatitis

Climate Change Mitigation and adaptation

Changes in greenhouse gas concentrations and other drivers alter global climate and have serious health implications. Environmental consequences of climate change, such as extreme heat waves, rising sea-levels, changes in precipitation resulting in flooding and droughts, intense hurricanes, and degraded air quality, affect the physical, social, and psychological health of humans. 

For instance, changes in precipitation are creating changes in the availability and quantity of water, as well as resulting in extreme weather events.  Climate change can be a driver of disease migration, as well as worsening health due to the release of toxic air pollutants in vulnerable populations such as children and the elderly.

Certain adverse health effects can be minimized or avoided with sound mitigation and adaptation strategies. Strategies for mitigating and adapting to climate change can prevent illness and death in people, while also protecting the environment and health of future generations.  Mitigation refers to actions being taken to reduce greenhouse gas emissions and to enhance the sinks that trap or remove carbon from the atmosphere. Adaptation refers to actions being taken to lessen the impact on health and the environment due to changes that cannot be prevented through mitigation.

Health Services In India

Status of health services , especially in the rural India is, at best, pathetic. Starting from Sub Centres to Primary Health centres most of the places have no medical officers , authorised medical equipment or medical emergency supplies. In urban areas, Govt hospitals do provide service, but due to ever rising population of cities, these hospitals are unable to provide adequate health care to needy population. The health care is not equipped to meet challenges raised by climate change.

Climate change is now a reality. Health sector has to prepare itself to faces adverse effect on human health due to extreme climatic changes. Environmental consequences of climate change, such as extreme heat waves, rising sea-levels, changes in precipitation resulting in flooding and droughts, intense hurricanes, and degraded air quality, affect directly and indirectly the physical, social, and psychological health of humans. Medical education must include Global Warming and its effect on human health. The climate change will have more severe effect on children and elderly citizens. It is important to note that population of 60+ citizens are rising at faster rate due to better health care. However challenges posed by Air, Water, and Sound and Soil pollution need different approach. For this medical fraternity and Govt needs to work continuously since in coming years, extreme climatic events are going to increase in frequency and severity.

      

Water Management by Healthcare Institutes

Introduction- Water is a major natural resource on our planet. All beings on this planet owe their survival to this life saving elixir. However point to remember is this elixir is in limited quantity at least for the foreseeable future. 75 % of our planet surface is covered with 97 % of available water, 1 % each is locked into North & South Pole ice caps. Balance 1 % is fresh water which is meeting needs of all the three main users, namely Agriculture 70 %. Industry 20 % and balance 10 % for domestic needs. Primary source of water is Rains. With Global Warming, extreme climate events are experienced all across the globe. 93 % of heat generated due to the global warming is absorbed by the ocean waters. One of the major fall out is distorted hydrological cycle which provides us monsoon rain, our life line. All the river systems & other water bodies in India are highly polluted, making surface water unfit for any consumption. With polluted surface water, deficit monsoon we depend more on groundwater resource. Our present attitude towards water Use & Discard needs to change to Use, Recycle grey/ hospital water, Reuse recycled water, Conserve available water, Recharge every drop of rainwater to improve rapidly falling groundwater aquifers, & Discard any balance water.

Role of Water in Healthcare Institutions- More than 2.2 million people die every year due to consumption of contaminated water. Healthcare Institutions require large amount of safe quality of water to meet their needs. Being the part of the society they too face water shortage. Lack of safe drinking water, adequate sanitation hygiene in healthcare is not acceptable, since patients are highly susceptible to infection. Simple thing like hand washing with soap is the single most important practice to reduce transmission of infection in healthcare. However it has been noticed all over in healthcare set up that hand washing compliance is very poor.  This is more prevalent in rural healthcare facilities. Average water consumption in the hospitals is around 750 litres per day per bed. It is used by

·       Sanitation & Hygiene -        40 %

·       Medical Process -                 15 %

·       Food services  -                     10 %

·       HVAC  systems  -                   20 %

·       Laundry    -                             05 %

·       Misc    -                                   10 %

Quality of Water- The quality of water supplied to the healthcare units affects every aspect of hospital operations. It is therefore essential that, water of suitable microbiological quality is provided for drinking, lab procedures & in medical / surgical treatments. Appropriate quality of water is essential for the medical equipment, dietary purposes etc. A regular inspection to check the source of water supply, quality of water transport system, storage & distribution network upkeep. The routine microbiological & chemical analysis of water is of utmost importance. The routine water processing programme in any healthcare unit includes treatment of water, de-ionisation, distillation, filtration & sterilisation.

Recycling of Hospital Water- Healthcare Institutions are significant consumers of water. They generate considerable amount waste water containing,

·        Pathogens & Bacteria

·        Virus

·        Pharmaceuticals

·        Toxic chemicals 

·        Heavy metals,  etc

Water  shortage is going to be routine in rural & urban healthcare centres due to factors like, climate change, rise in population, deficit monsoon etc. Recycling of hospital water attains important attention in water supply management to tide over water shortage. Recycling requires collection of hospital water & subjects the same in a specially designed recycling system. This system is different than normal domestic recycling system; it first uses chemical, agitation, and light processes to clean foul hospital water for gardening and toilet flushing. With, ultra-filtration and reverse-osmosis process the hospital water can be further cleaned to a level suitable for reusing this water in the Hospital’s laundry and cooling facilities. Waste water from the laundry should further be recycled resulting in zero discharge. Such a system require funds for installation & maintenance, but point to note that proper recycling of hospital water can reduce water bill by almost 40 %.

Recharging of Ground Water- local body govt supply of water & recycling of hospital water alone is not going to meet the water demands. Recharging of falling ground water table will be playing very important role in water supply management of every habitat. Somehow we have failed to understand the potential of Rain Water. A 1000 sq ft of catchment area like roof top receives 10,000 litres of rain water when rain fall is 100 mm. Pune receives around 750 mm of average annual rain fall, meaning, every 1000 sq ft of roof top receives 75,000 litres of rain water annually. Mumbai receives 3000 mm of annual average rain fall, amounting to 300,000 litres of annual rain water collection on 1000 sq ft roof top. Today in the absence of recharging of ground water systems this nature’s bounty is going waste. A old & renowned hospital in Pune was Tanker Water dependent to meet their water demands. 5 bore wells & one open well on the hospital campus had gone dry due to falling ground water level. Their annual tanker water demand was 1000 tankers, amounting to 1.20 crore litres of water. In 2006 the hospital installed Roof Top Rain water harvesting ( RWH ) system to recharge ground water through their 5 bore wells. The roof top area available for RWH system was around 27000 sq ft , collecting around 20 lakh litres of water annually. After recharge, the hospital was able to get their need of 1,20 crore litres of water from recharged bore wells. This made them tanker water free. This hospital received around 6 times more water than the amount of rain water channelized in to ground water through bore wells. This potential of rain water combined with RWH system will help meet water demands along with improving ground water table.

Rain Water Harvesting ( RWH ) – RWH is a simple methods we can recharge underground aquifers. Every type of infrastructure has got the basic components of a simple roof top RWH sys. The system has :

·       Roof as a catchment area to receive rain water

·       Down take pipes from roof top to drain out rain water

·       Storage- it can be any type of tanks to store rain water, or open/ bore wells to harvest rain water.

·       Simple RWH filters to filter out any dirt, leaves, twigs, bird droppings etc, from entering rain water storage.

·       Open space to construct recharge pits if surface water RWH systems needs to be implemented.

Since the rain water is directly injected in to aquifers, the 100 % soft rain water instantly raises the underground water level, another advantage is , as the rain water does not travel through the soil to reach the underground aquifers, this water does not absorb water soluble salts from the soil and hence does not get contaminated. Healthcare institutions also need clean water for its use. Also it is prudent to save & recharge every drop of rain water, when water shortage is being faced all over.

Emergency Water Supply Plan- In present global warming environment life saving natural resource WATER is going to be short supply. Recent NASA study shows that 4 billion people all over the world are facing varying degree of water shortage.  In order to maintain daily operations and patient care services, health care facilities need to develop an Emergency Water Supply Plan (EWSP) to prepare for, respond to, and recover from a total or partial interruption of the facilities’ normal water supply. Water supply interruption can be caused by several types of events such as natural disaster, a failure of the community water system, construction damage or even an act of terrorism. Because water supplies can and do fail, it is imperative to understand and address how patient safety, quality of care, and the operations of your facility will be impacted. Below are a few examples of critical water usage in a health care facility that could be impacted by a water outage. Water may not be available for: hand washing and hygiene drinking at faucets and fountains; food preparation; flushing toilets etc.

Conclusion- According to World Health Organisation every penny spent on Quality Water & Sanitation in Healthcare will generate at least FOUR times that amount through increased productivity. "The human right to water entitles everyone to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic uses" as per UN. Healthcare plays very important role in not only assuring sound health to every citizen , but also improves the economic growth of the Nation due to improved Man Days at the work places. Thus it is important that Healthcare institutions make use of all possible water resources like corporation water, Use of Recycled hospital Water, Water Conservation & recharging every drop of rain water to augment their water supply.