The World Health Organisation (WHO) defines health as complete physical, emotional and social wellbeing and not just the absence of disease; the environment impacts on all of these aspects. Clean air and water are essential to health, but physical activity, activities of daily living, transportation, urban design, community participation, food supply and nutrition also impact on health and are directly related to both the environment and wellbeing. When ecosystems are maintained in good condition they provide direct health benefits: a growing body of evidence demonstrates the value of contact with nature in the prevention/treatment of conditions including stress, depression and obesity.
Pollution in the environment can harm health. The WHO estimates that environmental hazards are responsible for as much as a quarter of the total burden of disease worldwide and that as many as 13 million deaths could be prevented every year by improving environmental quality. The causes of most of these deaths are air pollution, poor water quality and insufficient sanitation. These risks to human health are not confined to the developing world but also exist to a greater or lesser extent in all countries, including Ireland, as do risks posed by environmental chemicals, noise and waste. For this reason the protection of public health is a fundamental driver of environmental protection legislation and practice in Europe and Ireland. Vulnerable groups such as those on low incomes, children and the elderly may be disproportionately exposed to poor environmental conditions, giving rise to health inequalities. Sustainable management of the environment is fundamental to addressing health inequalities and achieving health for all.
The overall quality of the Irish environment is good and damage to health associated with environmental pollution in Ireland is likely to be far less than that caused by lifestyle factors such as poor diet, lack of exercise and tobacco use. To minimise future risks and capture benefits to health, protection of Ireland’s high-quality environment is vital.
Environmental Benefits to Health
The environment offers a wealth of benefits to health and wellbeing. Natural ecosystems and the biodiversity that they support not only provide essential food but also help to break down waste, purify water, cleanse the air and even serve as a source of pharmaceutical drugs, many of which have been derived from micro-organisms, fungi, plants and animals. The global value of these ecosystem services has been estimated to be US$16–54 trillion (€12–40 trillion) per year; for Ireland, ecosystem services are estimated to have a value of over €2.6 billion per annum.
At the start of the industrial revolution, large numbers of people moved into towns and cities, leaving rural, outdoor lifestyles behind. Since that time, the world population has increased from 1 to 7 billion people, with 85 per cent of Europeans now living in urban environments. Average lifespan has increased dramatically, from around 60 up to 80 years. One unexpected consequence of the transition to urban settings has been that many people have lost the intimate connection their ancestors had with nature. The newly adopted indoor lifestyles are often associated with reduced exercise; increasing rates of obesity, diabetes and heart disease; and higher incidence of depression.
Green Spaces and Health
The natural environment can play an important role in reducing this burden of chronic disease. Motivating people to spend time participating in one or more of a range of outdoor activities in natural environments will help maintain good health. When people are outdoors they tend to be active, whether taking a gentle walk or a dip in the sea, gardening or participating in more vigorous activities such as surfing or long-distance running. The availability of high-quality green spaces (parks, woods, countryside) and blue spaces (ponds, river banks, lakeshores and seashores) helps to foster activity on the road to better health.
An estimated 2,000 people die prematurely due to obesity-related illness in Ireland each year. While diet clearly has a large part to play in tackling this major threat to human health, good physical planning can also play an important part. Houses and estates scattered around the country, poorly linked by public transport and dependent on private cars, militate against physical activity. Safe walking and cycling paths and accessible sports facilities have a major role to play in tackling this important public health problem.
Research has shown a positive impact on mental health from exposure to the natural environment. As well as tangible improvements in wellbeing, activity in green spaces has been linked to improvements in social networking, feelings of connectivity and companionship, an increased appreciation of nature and improvements in self-esteem. An additional benefit is that reconnecting with natural environments highlights their importance and why they need to be managed in a sustainable way.
Water and Health
Most tap water in Ireland is drawn from surface water sources (i.e. rivers and lakes), with the remainder originating from groundwater and springs. For the majority of people who live in urban areas the water is supplied by the local authority following extensive treatment. Smaller communities use private water schemes, while single houses in rural areas tend to rely on groundwater wells with little or no water treatment.
The EU Drinking Water Directive sets quality standards for water at the tap. The most important indicator for drinking water is the microbiological content, in particular the bacterium Escherichia coli. The presence of E. coli in drinking water provides a good indication that either the source of the water has become contaminated by faecal pollution or the treatment process at the water treatment plant is not operating adequately.
Significant investment in recent years has resulted in increased treatment, storage capacity and continuous online monitoring for drinking water. As a result, the incidence of E. coli in drinking water continues to decrease. In 2011 it was found in 1.3 per cent of public water supplies. The number of private group water schemes where E. coli was detected improved from 56 (11.6 per cent) in 2010 to 46 (10.2 per cent) in 2011. The microbiological quality of private group water schemes remains inferior to public water supplies and is a growing cause for concern.
Sewage and other waste waters contain microbiological and chemical substances that can harm health. Significant investment has gone into improving the water services infrastructure over the past decade, which has resulted in a dramatic improvement in the effectiveness of treatment of urban waste water. Despite these advances, sewage discharges comprise the main municipal pollution source of water and continue to pose a threat to human health and the environment in many areas. Since 2007, local authorities are obliged to obtain a Waste Water Discharge Licence or Certificate of Authorisation from the EPA.
In rural areas most people use individual septic tanks that, if poorly sited and/or not properly maintained, can pollute groundwater, surface water and local drinking water supplies. In 2012 the Department of Environment, Community and Local Government published the Water Services (Amendment) Act to regulate wastewater discharges from all homes that are not connected to the public sewer network. Implementation and enforcement of this legislation regulating septic tanks will reduce the potential threat to public health.
There are 135 designated bathing areas in Ireland. Over the past 10 years the quality of water at these sites has remained high, with the vast majority meeting required EU standards. Various factors contribute to poor bathing water quality at the remaining locations, including inadequate sewage treatment, discharges from combined storm overflows and pump station failures. Under EU law, improvements are required to bring all bathing waters to ‘sufficient’ by 2015.
Monitoring results indicate that there is little risk to bathers’ health from pollution in designated bathing areas of the country. Occasional toxic algal blooms in inland lakes can pose a health threat to bathers, as blue-green algae are toxic to humans and animals. Bathers should avoid waters showing signs of an algal bloom. Members of the public can find out about bathing water quality on the EPA’s SPLASH website.
Air and Health
Harmful substances in the air can cause both immediate and long-term damage to health. They include natural materials and man-made pollutants as well as odour and noise. Protecting clean air is vital to human health.
Outdoor Air Quality
Outdoor air pollution is associated with a range of health problems and causes over 300,000 premature deaths in the EU every year. Air quality in Ireland is generally good and is among the best in Europe. However, monitoring shows that levels of some pollutants in Ireland are at concentrations that may impact on health including nitrogen dioxide in cities from traffic emissions. Traffic emissions will be reduced by introducing and implementing policies to reduce travel demand, to increase use of alternatives to the private car and to continue improving the efficiency of motorised transport. Levels of PM10 and PM2.5, particulate matter with diameters less than 10 micrometres (μm) and 2.5 μm respectively, are also of concern due to the ability of these small particles to penetrate deep into the respiratory tract. In smaller towns, emissions from residential burning of solid fuel are the main source of particulate matter, while in cities traffic emissions dominate. By reducing emissions of harmful pollutants, the bituminous coal ban led to a significant drop in cardiovascular and respiratory deaths since its introduction. Switching from solid fuel to gas or other low-emission fuels effectively reduces domestic emissions of pollution. Where solid fuel is used, it is important that it be burned efficiently; for example, in a modern, serviced stove rather than an open fire.
Indoor Air Quality
There are many sources of indoor air pollution in any building. Those pollutants of most concern from a health perspective are particulate matter, carbon monoxide, formaldehyde, benzene, naphthalene, PAHs, nitrogen dioxide, trichloroethylene, tetrachloroethylene and radon gas. In Ireland, research indicates that indoor tobacco smoke poses by far the greatest health risk to the exposed population.
Radon is a naturally occurring, radioactive, colourless, odourless gas derived from uranium in rocks and in soil. It poses a threat to human health because when high concentrations of the gas are inhaled, it can cause lung cancer. While levels are too low outdoors to affect health, radon seeps into buildings from underground and can accumulate to reach high concentrations. It is estimated that between 150 and 200 deaths from lung cancer each year in Ireland are linked to radon, with smokers a particularly vulnerable group.
While high radon concentrations can be found in any part of the country, the Radiological Protection Institute of Ireland (RPII) has identified certain parts of the country, called High Radon Areas, as being more prone to radon. Approximately one-third of the country, mainly in the west and south east, is classified as a High Radon Area. Reducing the health risk from radon involves a range of interventions that address both prevention in new buildings and identification and remediation of radon problems in existing buildings.
Some of the substances controlled under environmental regulations are malodorous at concentrations far below those at which toxic effects occur. The WHO notes that although odour annoyance cannot be regarded as an adverse health effect in a strict sense, it does affect the quality of life. Odours are by far the largest cause of complaints by the public to the EPA, with waste management facilities (including landfill sites), rendering facilities, composting activities and intensive agriculture (rearing of pigs and poultry) being typical sources of these complaints. Such odours constitute environmental pollution and may be unlawful, depending on a number of factors including the offensiveness and intensity of the odour, as well as frequency of occurrence. Health effects from exposure to odours include indirect responses such as stress and sleep disturbance through to more direct symptoms including nausea.
Excessive noise can seriously harm human health and interfere with people’s daily activities at school, at work, at home and during leisure time. It is perceived by the public as a significant environmental problem. It can disturb sleep, cause cardiovascular and psychophysiological effects, reduce performance and provoke annoyance responses and changes in social behaviour.
The EU Environmental Noise Directive (END), aims to avoid, prevent or reduce, on a prioritised basis, the harmful effects of exposure to environmental noise. Industrial and waste activities licensed by the EPA have noise restrictions, where relevant, to prevent local noise pollution. Licensees may be required to carry out a noise survey of operations at their respective industrial or waste site and where necessary produce a programme to reduce noise emissions.
Chemicals and Other Threats
Environmental exposure to chemicals, both naturally occurring and manufactured can occur through a number of routes including inhalation, ingestion through food/drink and by physical contact. The health effects of exposure to hazardous chemicals range from skin irritations and chemical burns to cancer and genetic damage. Some of the key regulatory instruments in controlling the use of chemicals are REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) and CLP (Regulation on classification, labelling and packaging of substances and mixtures). These EU-level regulations are implemented in Ireland by the Health and Safety Authority, EPA and other bodies.
Persistent Organic Pollutants (POPs)
Toxic chemicals that do not degrade easily and persist in the environment for long periods are classified as POPs. They are of particular concern because they can be concentrated through the food chain to levels that are dangerous to human health. They include pesticides, for example DDT; industrial chemicals, for example polychlorinated biphenyls (PCBs); and unintentional by-products, for example dioxins. Dioxins arise mainly as unintentional by-products of incomplete combustion and from certain chemical processes. The most recent EPA report on dioxin and PCB levels in the Irish environment shows that the levels in all of the samples tested were well below the relevant EU limits.
Heavy metals occur naturally in the environment and low concentrations of some of these are essential to human health and wellbeing. However, elevated concentrations of many heavy metals are directly toxic to humans, animals and plants. Sources of heavy metals include materials such as paints, batteries and piping and industrial activities including mining and coal-burning electricity generation. Ongoing monitoring of water and air indicates that heavy metal pollution does not pose a significant threat to health in Ireland.
Endocrine Disruptors and Pharmaceuticals
Endocrine disruptors are a diverse group of chemicals that affect human hormonal function and include some pesticides. PCBs, dioxins and some synthetic pharmaceuticals. Research funded by the EPA indicated that although some endocrine-disrupting compounds were detected in the Irish environment, levels are generally low and not regarded as a significant risk.
Pharmaceutical and Personal Care Products
The occurrence and effects of residues from PPCPs, such as medicines and toiletries, discharging into the general environment is an emerging global concern. The main concern is the development of antimicrobial resistance in bacteria. Preliminary research results found antimicrobial residues present in hospital effluent and in municipal sewage in Ireland. At this stage, further investigation is required but the research highlights an issue that is likely to become more significant in the future as a result of increasing pharmaceutical use.
Nanomaterials are a recent technology and offer great potential in a number of areas with environmental benefits such as improved energy efficiency in electronics; more precisely targeted medicines; and applications including water treatment and soil remediation. However, despite their beneficial properties, there is concern that certain nanomaterials are potentially harmful to human health. Research is under way in Ireland and Europe to assess whether the unique properties of nanomaterials present additional concerns not yet addressed, and to develop strategies to address these concerns in a safe and responsible manner.
EM radiation is a non-ionising form of energy generated by electrical charges or magnetic fields. Sources of EM radiation include domestic appliances, high-voltage power lines and mobile phone masts. In Ireland, the Government-appointed expert group on the health effects of EM fields concluded that no adverse short- or long-term health effects have been found from exposure to the EM radiation produced by mobile phones and base station transmitters.
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