Water, Public Health Problems, and Public Health Solutions: Foreground, to Background, to Foreground

Shiriki Kumanyika, PhD, MPH

PGWI Conference April 2009

Standard Methods for the Examination of Water and Wastewater

Since 1905, Standard Methods for the Examination of Water and Wastewater has represented "the best current practice of American water analysts." This comprehensive reference covers all aspects of water and wastewater analysis techniques. Standard Methods is a joint publication of the American Public Health Association (APHA), the American Water Works Association (AWWA), and the Water Environment Federation (WEF).

Standard Methods for the Examination of Water and Wastewater

Since 1905, Standard Methods for the Examination of Water and Wastewater has represented "the best current practice of American water analysts." This comprehensive reference covers all aspects of water and wastewater analysis techniques. Standard Methods is a joint publication of the American Public Health Association (APHA), the American Water Works Association (AWWA), and the Water Environment Federation (WEF).

Among the best selling publications of the American Public Health Association; more than 100 years of publication

“Why active membership in the American Public Health Association is important to sanitarians, engineers, and environmental health scientists”

Charks L. Senn, P.E., M.S., F.A.P.H.A.

American Journal of Public Health: 1965

# of articles on water and size of the volume of AJPH: 1912-2008

# Articles in the AJPH that carried the label engineers or engineering in the title

Ten Great Public Health Achievements, US, 1900-1999 Vaccination Motor vehicle safety Safer workplaces Control of infectious

diseases Decline in CHD and stroke

deaths

Safer and healthier foods Healthier mothers and

babies Family planning Fluoridation of drinking

water Recognition of tobacco use

as a health hazard

Water and Chronic Diseases: Current Issues Cancer prevention Obesity and diabetes Oral health Food and environmental sustainability

Cancer Prevention Recommendations

World Cancer Research Fund/American Institute for Cancer Research, 2009

Obesity: The Global EpidemicObesity: The Global Epidemic

Overweight and obesity represent a rapidly growing threat to the health of populations and an increasing number of countries worldwide

World Health Organization, Geneva Consultation, June 1997; published as TRS 894

Who Consultation CountriesWho Consultation Countries

Australia, Bahrain, Canada, Chile, China,

Cyprus, Denmark, Egypt, Indian, Ireland,

Japan, Malaysia, Mauritius, Netherlands,

Nigeria, Pakistan, Polynesia, South Africa,

Sweden, Switzerland, Thailand, USA

Major health consequences of obesity Diabetes Cardiovascular diseases Some types of cancer

The Gambia, West Africa

Obesity Amidst PovertyWebb and Prentice

Photoessay Int J Epidemiology, 2005

Source: Luke A. Nutritional consequences of the African diaspora. Annu Rev Nutr. 2001;21:47-71. .

Global Prevalence of Obesity in Adult Males

% Obese

0-9.9%

10-14.9%

15-19.9%

20-24.9%

25-29.9%

≥30%

Self Reported data

North AmericaUSA 31%Mexico 19%Canada (self report) 17%Guyana 14%Bahamas 14%

South Central AmericaPanama 28%Paraguay 23%Argentina (urban) 20%Uruguay (self report) 17%Dominican Republic 16%

AfricaSouth Africa 10% Seychelles 9%Cameroon (urban) 5% Ghana 5% Tanzania (urban) 5%

South East Asia & Pacific RegionNauru 80%Tonga 47%Cook Island 41%French Polynesia 36% Samoa 33%

Eastern Mediterrane

anLebanon 36%

Qatar 35% Jordan 33%Kuwait 28%

Saudi Arabia 26%

European RegionCroatia 31%Cyprus 27%Czech Republic 25%Albania (urban) 23%England 23%

With examples of the top 5 Countries in each Region

With the limited data available, prevalence's are not age standardised. Self reported surveys may underestimate true prevalence. Sources and references are available from the IOTF. © International Obesity TaskForce, London –January 2007

Global Prevalence of Obesity in Adult Females

South East Asia & Pacific RegionNauru 78%Tonga 70%Samoa 63%Niue 46%French Polynesia 44%

AfricaSeychelles 28%South Africa 28%Ghana 20% Mauritania 19%Cameroon (urban) 14%

South Central AmericaPanama 36%Paraguay 36%Peru (urban) 23%Chile (urban) 23%Dominican Republic 18%

North AmericaUSA 33%Barbados 31%Mexico 29%St Lucia 28%Bahamas 28%

Eastern MediterraneanJordan 60%Qatar 45%Saudi Arabia 44%Palestine 43%Lebanon 38%

European RegionAlbania 36%Malta 35%Turkey 29%Slovakia 28%Czech Republic 26%

% Obese

0-9.9%

10-14.9%

15-19.9%

20-24.9%

25-29.9%

≥30%

Self Reported data

With examples of the top 5 Countries in each Region

With the limited data available, prevalence's are not age standardised. Self reported surveys may underestimate true prevalence. Sources and references are available from the IOTF. © International Obesity TaskForce, London –January 2007

Global Prevalence of Overweight in GirlsPrior to 1990

% Overweight

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

25-29.9%

≥30%

Self Reported data

Global Prevalence of Overweight in Girls2000-2006

% Overweight

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

25-29.9%

≥30%

Self Reported data

Global Prevalence of Overweight in BoysPrior to 1990

% Overweight

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

25-29.9%

≥30%

Self Reported data

Global Prevalence of Overweight in Boys2000-2006

% Overweight

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

25-29.9%

≥30%

Self Reported data

Source: http://www.who.int/diabetes/actionnow/en/mapdiabprev.pdf

Ogden CL et al. National Center for Health Statistics, 2007

Changes in the U.S.A. Weight Distribution

Since the 1960’s, average weights of U.S. men and women have increased by ~ 11 kg

Average height has increased by 2.5 cm

Example of Trends in Adult Obesity in Developed Countries

0

5

10

15

20

25

30

35

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010Year

% P

erce

nt

BM

I =>

30kg

/m2

Australia

Canada

England

Finland

France (self report)

Iceland

Japan

Netherlands

New Zealand

Norway (Tromoso)

Sweden (Goteborg)

USA (NHANES)

Wales n(self report)

Source: Kumanyika S, Rigby N, Lobstein T, Leach R, James WPT. Obesity: Global Pandemic, In: Kopelman P, Cateron I, Dietz W, eds. Clinical Obesity in Adults and Children, 3rd Edition (in press)

FACTORSINTERNATIONAL

Development

Globalizationof

markets

SchoolFood &Activity

WORK/SCHOOL/

HOME

Infections

Labour

Worksite Food & Activity

LeisureActivity/Facilities

Agriculture/Gardens/Local markets

COMMUNITY/LOCALITY

Health Care

System

PublicSafety

PublicTransport

Manufactured/ImportedFood

Sanitation

NATIONAL/REGIONAL

Food & Nutrition

Urbanization

Education

Health O

ITY

PREVALE

INDIVIDUAL

EnergyExpenditure

POPULATION

%

OBESE

Social Security

Transport

Family &Home

Media &Culture

Food intake :

Nutrient density

Media programs

& advertising

Source: International Obesity Task Force [www.iotf.org] see Kumanyika S et al International Journal of Obesity 2002;26:425-36

OBESITY

PREVALENCE

Causal Web of Societal Processes influencing the population prevalence of obesity

Potential Policy Targets Globalization Media Development Urbanization Transport Health Social security Education Food supply Worksites

Trade Advertising Equity/Sustainability Community design Mass transit Insurance; prevention Poverty School environments Agricultural policies; food industry Cafeterias; insurance incentives

All relevant professionals inside and outside the medical and health professions need to have knowledge of public health to an appropriate degree, build the need to protect public health into their work, and include the effect of their work on public health in assessment by their governing bodies and their peers

BMI per Person

Target Population

DALYs Gross Cost

Net Cost

TV viewing 0.45 227,000 6,700 $54.6M -$2.1M

TV advertising 0.17 2.4 M 37000 $0.13M -$300M

Soft drinks 0.13 119,000 1,060 $3.3M -$5.2M

Family-based targeted program 1.7 5,800 2,700 $11M -$4.1M

Walking School Bus 0.03 16,000 30 $22.8M $22.6M

Targeted multi-faceted school-based 0.52 4,300 370 $0.56M -$0.08

Multi-faceted school-based +PE 1.1 115,000 8,000 $40.4M -$28.7M

Multi-faceted school-based –PE 0.31 115,000 1,600 $24.3M $11.2M

Active After-School 0.07 99,000 449 $40.3M $36.6M

Orlistat in adolescents 0.86 3,300 450 $6.4M $4.0M

Gastric Surgery (adolescents) 13.9 4,100 12,300 $130 M $55.0M

General practice counseling 0.25 9,700 511 $6.3M $3.0M

High Projected Population Impact – Results from Australia

Source: Haby, Vos, Carter et al.,, 2006

Source: Adapted from framework of The First Action Plan for Source: Adapted from framework of The First Action Plan for Food and Nutrition Policy, WHO European Region, 2000–2005Food and Nutrition Policy, WHO European Region, 2000–2005

Growing, buying, and eating the right kinds of foods can reduce the risk of diseaseand simultaneously promote a sustainable environment

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www.cdc.gov

April 4, 2008 Privatizing water systems Water safety in U.S. cities Lead levels in Water in the District of Columbia Global water and sanitation issues and mortality Effects of ethanol production on safety of water

supply Effects of agriculture and urban development on

U.S. water supply

Dec/Jan 2004

May 2002

March 2007

www.drinking-water.org

www.drinking-water.org

www.apha.org

Safe Water?

Thank You