In Partial Fulfillment of the Requirement in Introduction to Philosophy of the
Human Person
NOVEMBER 2023
“Environmental Pollution”
I.Introduction
Despite the major efforts that have been made over recent years to clean up the
environment, pollution remains a major problem and poses continuing risks to health.
The problems are undoubtedly greatest in the developing world, where traditional
sources of pollution such as industrial emissions, poor sanitation, inadequate waste
management, contaminated water supplies and exposures to indoor air pollution from
biomass fuels affect large numbers of people. Even in developed countries, however,
environmental pollution persists, most especially amongst poorer sectors of society. In
recent decades, too, a wide range of modern pollutants have emerged—not least, those
associated with road traffic and the use of modern chemicals in the home, in food, for
water treatment and for pest control. Most of these pollutants are rarely present in
excessively large concentrations, so effects on health are usually far from immediate or
obvious. As Taubes has noted, few of the problems of environmental exposure that
concern us today imply large relative risks. Detecting small effects against a
background of variability in exposure and human susceptibility, and measurement error,
poses severe scientific challenges.
The progressively larger number of people exposed to environmental pollution (if
only as a result of growing population numbers and increasing urbanization)
nevertheless means that even small increases in relative risk can add up to major public
health concerns. The emergence of new sources of exposure and new risk factors,
some of them—such as endocrine disruptors—with the capacity to have lifelong
implications for health, also means that there is a continuing need for both vigilance and
action. As the impact of human activities and issues of environmental health become
increasingly global in scale and extent, the need to recognize and to address the health
risks associated with environmental pollution becomes even more urgent. Effective
action, however, requires an understanding not only of the magnitude of the problem,
but also its causes and underlying processes, for only then can intervention be targeted
at where it is most needed and likely to have greatest effect. As background to the other
chapters in this volume, therefore, this chapter discusses the nature of the link between
environmental pollution and health and considers the contribution of environmental
pollution to the global burden of disease.
Relationship between Environmental Pollution and Human Health
Environmental pollution can be simply, if somewhat generally, defined as the
presence in the environment of an agent which is potentially damaging to either the
environment or human health. As such, pollutants take many forms. They include not
only chemicals, but also organisms and biological materials, as well as energy in its
various forms (e.g. noise, radiation, heat). The number of potential pollutants is
therefore essentially countless. There are, for example, some 30,000 chemicals in
common use today, any one of which may be released into the environment during
processing or use. Fewer than 1% of these have been subject to a detailed assessment
in terms of their toxicity and health risks. The number of biological pollutants is truly
unquantifiable. They include not only living and viable organisms, such as bacteria, but
also the vast array of endotoxins that can be released from the protoplasm of organisms
after death. There is, therefore, no shortage of potential environmental risks to health.
What is lacking, for the most part, is an understanding of the nature and mechanisms of
these risks.
Source-Effect Chain
The link between pollution and health is both a complex and contingent process.
For pollutants to have an effect on health, susceptible individuals must receive doses of
the pollutant, or its decomposition products, sufficient to trigger detectable symptoms.
For this to occur, these individuals must have been exposed to the pollutant, often over
relatively long periods of time or on repeated occasions. Such exposures require that
the susceptible individuals and pollutants shared the same environments at the same
time. For this to happen, the pollutants must not only be released into the environment,
but then be dispersed through it in media used by, or accessible to, humans. Health
consequences of environmental pollution are thus far from inevitable, even for pollutants
that are inherently toxic; they depend on the coincidence of both the emission and
dispersion processes that determine where and when the pollutant occurs in the
environment, and the human behaviours that determine where and when they occupy
those same locations.
The whole process can simply be represented as a causal chain, from source to
effect. It derive from human activities such as industry, energy production and use,
transport, domestic activities, waste disposal, agriculture and recreation. In some cases,
however, natural sources of pollution may also be significant. Radon, released through
the decay of radioactive materials in the Earth’s crust, arsenic released into
groundwaters from natural rock sources, heavy metals accumulating in soils and
sediments derived from ore-bearing rocks, and particulates and sulphur dioxides
released by wildfires or volcanic activity are all examples.
Emissions to surface water, groundwater and soil
Releases to other media, such as surface waters, groundwaters and soil, also
occur through a range of processes. Deliberate discharge, spillage (e.g. from storage,
during transport, or during processing and usage), leakage and runoff (e.g. of
agricultural chemicals) are all important in terms of aqueous pollutants. Legal limits for
discharges to streams are set for many industries, aimed at keeping levels of
contamination within accepted limits. Illegal discharges, or accidental spillage, however,
sometimes occur and accounted for the majority of reported surface water pollution
incidents in the UK in 2001, for which the cause is known. Dumping (both legally in
landfill sites and illegally) represents a major source of emission of solid wastes, though
final release into the wider environment may only occur when these materials
decompose or break up. Landfill sites may thus be responsible for emissions of a wide
range of pollutants, via different pathways, especially when these sites are inadequately
sealed or poorly maintained. The contribution of informal and illegal dumping to
environmental pollution is, inevitably, only poorly known.
Environmental fate
Once released into the environment, pollutants may be transported via many
different processes and pathways, often moving from one medium to another, and
undergoing a wide range of modifications in the process. Chemical reactions, physical
abrasion, sorting by size or mass and deposition all change the composition of the
pollutants and alter the pollution mix. Dilution occurs as pollutants spread outward into a
wider volume of space; concentration may occur as pollutants accumulate in local
‘sinks’ or in the bodies of organisms, as they pass along the food chain.
In general, these processes tend to result in some degree of distance-decay in
environmental concentrations, if only because the opportunity for dilution,
decomposition and deposition increases with increasing distance of transport. It is
largely on this basis that distance is often used as a surrogate for exposure in many
epidemiological studies. The realities of environmental patterns of pollution are,
however, often much more complex than these simple distance-based models imply.
They also vary greatly between different pollutants and environmental media, because
of the different transportational behaviours that are involved. In addition, dispersion
processes and resulting pollution concentration fields may vary substantially depending
on the prevailing (e.g. meteorological) conditions at the time. Patterns of atmospheric
dispersion, for example, differ not only in relation to windspeed and direction but also
atmospheric stability (e.g. between stable and unstable weather conditions, or when
there is a temperature inversion)6. Movement of many pollutants through soils occurs
mainly as mass flow in water passing through larger pore spaces and fissures: the
irregular distribution of these within highly structured soils means that dispersion often
follows highly discrete pathways. Gaseous pollutants may follow similar preferred
pathways. Releases from landfill sites may thus travel relatively long distances in the
soil or bedrock, before emerging at the surface, where they can cause local hazards
including explosions14. Radon shows the same discrete and complex pattern, such that
concentrations may vary by orders of magnitude from one home to another in the same
district15,16. Modelling these locally variable pathways poses severe challenges.
To a large extent, the increased opportunity for mixing means that dispersion of
pollutants in surface and groundwaters is more regular, leading to more uniform
patterns of contamination, at regional scales. In developed countries, also, considerable
water mixing often occurs during treatment and distribution, so that water quality is
relatively uniform across large areas and populations. Local variations may occur,
however, because of contamination within the distribution system or differences in the
length of the network, and thus in the time available for contamination and
decomposition of the disinfectants incorporated at treatment17. In developing countries,
especially, considerable variations may also occur between waters in shallow wells,
particularly where these are affected by local pollution sources, such as badly sited
latrines or agricultural activities. Again, this makes exposure assessment difficult,
without the ability to collect data on water quality for individual wells.
Similar difficulties occur in tracking and modelling transport of pollutants in the
food chain. Whilst the general pathways followed by pollutants are often clear in natural
(and some farmed) food chains, in that persistent compounds tend to accumulate as
they pass from one trophic level to another, the detailed patterns of contamination are
often far more complex. Many animals have very restricted feeding behaviours: even in
areas of open grazing land, for example, sheep tend to focus on distinct home ranges
from which they rarely stray. As a result, marked variations may occur in contaminant
uptake by livestock, even over short distances, as illustrated by patterns of
contamination from the Chernobyl incident in the UK. Significant accumulation of these
contaminants in humans likewise tends to occur only where small groups of individuals
rely on local food sources. On the other hand, in many modern food supply systems,
industrial-scale processing and distribution operations mean that foodstuffs often travel
large distances before consumption and are drawn from far-flung sources. In the UK, as
in most developed countries, therefore, the average distance travelled by foodstuffs
before consumption has increased markedly, from an average of about 82 km in 1978
to 346 km in 1998. In the light of these changes, several attempts have been made in
recent years to calculate the distance travelled by ingredients in common food products
or meals (so called ‘food-miles’). In Iowa, USA, for example, ingredients for a standard
meal of stir-fry and salad were estimated to have been transported 20,000 km; in the
UK, Sustain, a pressure group on food and agriculture, estimated that ingredients for a
traditional turkey dinner had been transported some 38,620 km! Apart from implications
for increased energy consumption and environmental pollution, such extended
distribution networks clearly mean that it can be difficult to track and control potential
contamination between source and consumption.
By whatever pathways and processes pollutants pass through the environment,
four related factors are especially important in determining the potential for exposure
and health effects: their persistence, their mobility, their decomposition products and
their toxicity. The problems associated with the release of persistent pollutants into the
environment were highlighted many years ago with recognition of the global extent of
contamination, and wide-ranging environmental and health effects, caused by DDT and
other organochlorine pesticides. The story is in many ways now being repeated in
relation to chlorofluorocarbons and other atmospheric pollutants that act as greenhouse
gases or scavengers of stratospheric ozone, and perhaps also in relation to endocrine
disruptors25. Persistence, however, is not necessarily the most important issue, for
where they persist in inert yet inaccessible forms, pollutants may pose relatively limited
risks. Thus, whereas inorganic mercury is persistent, it is less toxic and less readily
bioavailable than methyl mercury, to which it is naturally converted through chemical
reactions and the action of soil and aquatic microorganisms. Equally, many solid wastes
represent little risk to health so long as they remain in their original form. The problems
in these cases often come when decomposition occurs, either because the
decomposition products are inherently more toxic or because they are more mobile, and
thus are more likely to result in human exposure.
Exposure and Dose
Whilst the potential for health impairment initially depends upon the existence
and concentrations of pollutants in the environment, for health effects to occur
exposures must take place that lead to a dose sufficient to have adverse health
consequences. Exposure in this context is defined as the contact between a hazardous
agent (in this case a pollutant) and an organism. Dose refers to the quantity of the
substance in the body. The absorbed dose refers to the amount of the substance
entering the body as a whole; target organ dose refers to the amount reaching the
specific organs that are affected.
Exposure can take place in many different ways. Three main forms of exposure
are generally recognized: dermal contact, inhalation and ingestion. In some cases,
however, it may also be useful to recognize a fourth—injection—for example, when
pollutants are transmitted by animal bites or by deliberate injection. In each of these
cases, exposure may occur in a range of different environments. Whilst some
exposures occur in the outdoor (ambient) environment, most people spend the majority
of their time indoors, either at home or at their place of work or learning. Indoor
exposures therefore often make up a major proportion of total exposure—although they
tend to be rather neglected in many epidemiological studies. Food and drinking water
are likewise important routes of exposure for many pollutants.
What determines levels of exposure is consequently not just the distribution of
pollution within the environment, but also human behaviours and lifestyles, and thus the
sorts of exposure environments in which people spend their time. By the same token,
exposure is not only an environmental process, it is also a social, demographic and
economic one. Indeed, because of the myriad ways in which socio-economic and
demographic factors influence and interact with environmental conditions, exposures,
human susceptibility and health outcome, they may often appear to outweigh the effects
of the environment per se in associations between pollution and health. One expression
of these complex interactions is the patterns of what is often called environmental
injustice that are seen throughout the world: namely, the tendency for environmental
pollution and poverty or other forms of disadvantage to be strongly correlated, such that
poorer people tend to live in more polluted environments. Whilst the reasons for this
association are not fully understood, and may be more subtle than often assumed, the
double jeopardy that it represents seems to be generally reflected in terms of health
inequalities as well. The problem, however, comes in trying to separate the
contributions to these adverse health outcomes from socio-economic and environmental
factors—and thus to quantify the attributable effects of pollution.
It also has to be recognized that pollutants rarely occur in isolation; more typically
they exist in combination. Exposures are therefore not singular. Instead we are usually
exposed to mixes of pollutants, often derived from different sources, some of which may
have additive or synergistic effects. Unravelling the effects of individual pollutants from
this mix is a challenging problem that has yet to be adequately resolved in many areas
of epidemiology.
Estimating the global burden of disease
For all the reasons outlined above, estimating the contribution of environmental
pollution to the burden of disease is far from easy. In general, too little is known either
about the causal links between environmental pollution and health, or about the levels
of exposure across the population, to make reliable assessments of the proportion of
disease or mortality attributable to pollution. These difficulties are severe in developed
countries, where disease surveillance, reporting of mortality, environmental monitoring
and population data are all relatively well established. In most developing countries they
become all but insurmountable, because of the generally impoverished state of routine
monitoring and reporting. Given that controls on emissions and exposures in the
developing world are often limited, it is in these countries that risks from environmental
pollution are likely to be greatest. Such uncertainties thus render any attempt to quantify
the environmental burden of disease highly approximate at best.
Assessments of the disease burden attributable to different forms and sources of
pollution are nevertheless worth the effort. They are needed, for example, to raise
awareness about some of the risks associated with environmental pollution, and as a
basis for advocacy—to ensure that those most in need have a voice. They are needed
to help motivate and prioritize action to protect human health, and to evaluate and
monitor the success of interventions. They provide the foundation, therefore, for
extremely powerful indicators for policy support, and a means of pricking the global
conscience about inequalities in health.
Over recent years, therefore, many attempts have been made to assess the
health status of the population, both nationally and globally, and to deduce the
contribution made by pollution and other environmental factors. In Europe, for example,
more than 50 national environmental health action plans have been developed,
following the Helsinki Conference in June 1994, setting out strategies to tackle problems
of environmental health37. Although these differ substantially in terms of their content
and scope, many have involved attempts to make formal assessments of the disease
burden attributable to different environmental hazards, and to rank these in terms of
their public health significance. Various methods were used for this purpose, though
most relied on some form of expert judgement, informed where available by quantitative
data on mortality or disease rates. Whatever the weaknesses of these assessments,
their practical importance is evident, for they have contributed directly to policy
prioritization and development in the countries concerned.
The same need has arisen to support the development of environmental health
indicators. Since the early 1990s, largely motivated by WHO, increasing attention has
been given to constructing indicators on environmental health at all levels from the local
to the global scale, and a number of indicator sets have been created (and to a lesser
extent used). Environmental pollution is, inevitably, a major focus of concern in these
indicator sets. By definition, also, environmental health indicators provide measures that
link environmental hazards and health effect. As such they depend upon an
understanding of the association between pollution and health, either in the form of what
have been called ‘exposure-side indicators’, which use information on exposures to
imply degrees of health risk, or ‘health-side indicators’, which use information on health
outcome to suggest attributable effects. In both contexts, the ability to make at least
semi-quantitative interpretations of the link between pollution and health, and thus to
assess the contribution to the burden of disease, is assumed.
CONCLUSION
The complexities involved in the link between environmental pollution and health,
and the uncertainties inherent in the available data on mortality and morbidity, in
existing knowledge about the aetiology of diseases, and in environmental information
and estimates of exposure, all mean that any attempt to assess the environmental
contribution to the global burden of disease is fraught with difficulties. The estimates
produced to date must therefore be regarded as no more than order-of-magnitude
estimates. Despite these limitations, however, several conclusions seem beyond refute.
The first is that environmental pollution plays a significant role in a number of
health outcomes, and in several cases this adds up to a serious public health concern.
Water pollution, sanitation and hygiene, indoor air pollution, and to a lesser extent
outdoor air pollution and exposures to chemicals in both the indoor and outdoor
environment are all important risk factors in this respect. Ionizing and non-ionizing
radiation and noise are also causes for concern in many cases.
Secondly, it is clear that the distribution of risks from these factors is not equal
across the world. The global burden of disease may be difficult to quantify, but stark
contrasts in that burden are evident between the developed and the developing world,
between rich and poor, and often between children and adults. The developed world is
not risk-free, and development is no panacea for all environmental health ills. On
occasions, in fact, the opposite is true: developments, such as increased reliance on
road transport, increased use of chemicals in agriculture, and increased proportions of
time spent in modern, hermitically sealed buildings surrounded by chemically-based
fabrics and furnishings may actually increase exposures and exacerbate health risks.
But overall the developing world is far more severely affected by pollution, and in many
instances becoming more so, as pressures from development add to traditional sources
of exposure and risk.
Thirdly, and perhaps most importantly, many of these risks and health effects are
readily avoidable. Rarely does the solution lie in advanced technologies or even
expensive drugs. Instead, the need is for preventive action to reduce the emission of
pollutants into the environment in the first place—and that is largely achievable with
existing know-how. Indeed, in many cases it has already been implemented in many of
the richer countries. Science, therefore, certainly has a role to play in addressing these
issues. More research is undoubtedly needed on a range of emerging environmental
health issues. But the deficit of action that has allowed environmental pollution still to
take its toll on health derives not so much from failures in science or technology as from
the lack of political will and economic empowerment. It is from that direction that
salvation needs ultimately to come for those at the mercy of environmental pollution.
Reference:
Samet JM , Dearry A, Eggleston PA et al. Urban air pollution and health inequities: A
workshop report. Environ Health Perspect2001; 109 (Suppl. 3): 357–74
Sexton K , Adgate JL. Looking at environmental justice from an environmental health
perspective, J Expos Anal Environ Epidemiol2000; 9: 3–8
Taubes G . Epidemiology faces its limits. Science1995; 269: 164–9
Royal Commission on Environmental Pollution. Chemicals in products: safeguarding the
environment and human health. 24th Report of the Royal Commission on
Environmental Pollution. London: Royal Commission on Environmental Pollution, 2003
Lindley SJ , Longhurst JWS, Watson AFR, Conlan DE. Procedures for the estimation of
regional scale atmospheric emissions—an example from the NW region of England.
Atmos Environ1996; 30: 3079–91
Colvile R , Briggs DJ. Dispersion modelling. In: Elliott P, Wakefield JC, Best NG, Briggs
DJ (eds) Spatial Epidemiology. Methods and Applications. Oxford: Oxford University
Press, 2000; 375–92
National Atmospheric Emissions Inventory
http://www.naei.org.uk/emissions/emissions_2000.php?action=data (date last accessed
29 June 2003)
Jarvis KE , Parry SJ, Piper JM. Temporal and spatial studies of autocatalyst-derived
platinum, rhodium, palladium and selected vehicle-derived trace element in the
environment. Environ Sci Technol2001; 35: 1031–6
Björklund S . Emissioner av partiklar från dieselfordon och vedförbränning. In: Partiklar
och hälsa-ett angeläget problem att undersöka. Skandias miljökommision, rapport
number 5. Försäkringsaktiebolaget Skandia, 1996, S-103 50
Environment Agency
http://www.environment-agency.gov.uk/yourenv/eff/pollution/296030/296054/?
lang=_e®ion= (date last accessed 29 June 2003)
