Abstract: Many cities and towns are established on the banks of rivers. People have long relied on rivers for trade, transportation, fishing and recreation as well as for cleaning and waste removal. Historically, the Buriganga River, which crosses Dahka, the capital of Bangladesh, has facilitated the urbanisation of the country. The physical nature of the river however is being constantly changed due to human intervention. Its ecologicalhealth is now threatened; it has become a dying river both hydrologically and biologically. The government and city authorities find it difficult to provide the funds for cleaning up the river and preventing further pollution. Using an extended contingency valuation approach, this paper argues that there are resources available within the community that can be mobilised to improve the ecologicalhealth of the river. It also proposes government-community-private sector partnerships for restoring the ecologicalhealth of the river as well as eliminating or abating the potential sources of pollution. Part of this model is a decentralised system for waste collection, processing and management.
The river was once a natural free-flowing stream which provided many beneficial uses, such as water supply, groundwater recharge, recreation and fisheries. It was used for agricultural, sanitary and industrial purposes. Always a threat through periodic floods, the river remained an intrinsic part of the city until the early 1980s. However, since the 1980s, intensive human interventions have greatly influenced its flow and function. Once determining factor for urbanisation, trade and source of industrial growth (predominantly small and medium scale enterprises), it was later degraded by industrial and residential develop- ments along its banks and in its catchment. The situation deteriorated further because of the lack of proper solid waste management and sew- erage disposal system in the city, particularly in the vicinity of the river. Furthermore, a group of unscrupulous people started to grab the off- shore land since the early 1980s building illegal encroachments without any waste disposal and sanitation facilities. The indiscriminate dumping of domestic and industrial wastes, the failure on the part of the authorities to enforce rules and regulations pertaining to the ecologicalhealth of the river further aggravated the situation. As a result of all these actions and non-actions, the Buriganga River is dying biologically and hy- drologically.
species and ecosystems on the other. It focuses on the study of the ecological context of health and the remediation of ecologicalhealth problems. In response to the growing health implications of environmental degradation, conservation medicine purview includes examining the linkages among a) changes in habitat structure and land use; b) emergence and re-emergence of infectious agents, parasites and environmental contami- nants; c) maintenance of biodiversity and ecosystem functions as they sustain the health of plant and animal communities including humans. Conservation medicine is concerned with the effects of disease on rare or endangered species and on the functioning of ecosystems. It is also concerned with the impacts of changes in species diversity or rarity on disease maintenance and transmission. The dynamic balance that we term “health” is viewed on a series of widely varying spatial scales by many disciplines including human and public health, epidemiology, veterinary medicine, toxicology, ecology and conservation biology. Conservation medicine represents an approach that bridges these disciplines to examine health of individuals, groups of individuals, populations, communities, ecosystems and the land- scapes in which they live as an indivisible continuum, it is truly a transdiscipline. By reaching out to multiple disciplines, conservation medicine provides new skills, tools and vision to the field of both conservation biology and medicine. This includes bringing biomedical research and diagnostic resources to address conservation prob- lems, e.g., development of new non-invasive health monitoring techniques; training veterinarians, physicians and conservation biologists in the promotion and practice of ecologicalhealth; and by establishing trans- disciplinary teams of health and ecological professionals to assess and address ecologicalhealth problems [4-7]. The ecological impacts of humans can ripple throughout ecological communities. The demise of one species, or the rise of one species at the expense of another may establish a trophic cascade of ecological responses. When predator- prey or species competition relationships are disrupted, ecological impacts may extend beyond the predator and prey or the competitors [8-10]. The spread of Lyme disease as a result of the changing ecology of white-tailed deer (Odocoileus virginianus) and white-footed mice (Peromyscus leucopus) in a landscape devoid of large predators and diminished biodiversity is a good example of ecological magnification of disease. Until recently we are beginning to understand the “dilution effect” as empirical evidence that host diversity decreases infection and transmission of infectious diseases .
The linear materials economy has many other flaws quite apart from its more direct impact on human and ecologicalhealth. Consider also the volume and value of resources consumed and ultimately disposed of with no attempt made by the manufacturer, to re-capture the valuable and finite materials used in production and lost at the end of a products life to land-fill. In the US in 2000 4.7 pounds per person per day or 0.8 tonnes per person per year of refuse waste was either sent to landfill or incinerated. This compares to 2.7 pounds per person per day in 1960 (US Environmental Protection Agency 2002. cited in Kumar. 2006). This dramatic increase in waste displays not only the consumer’s insatiable and growing appetite for consumption, but also the wasteful attitudes of the manufacturer who misses the opportunity to increase their potential profitability through waste management and product and resource reutilisation. In 2004 the UK commercial and industrial sectors produced 83000 thousand tonnes of waste constituting 25% of all UK waste. This figure disregards the waste passed on to the consumer who must deal with the end-of-life disposal of products, domestic waste constituting a further 9% (DEFRA 2004). Indeed the efficient use of raw materials in itself reduces waste output whilst making financial sense for SMEs competing in highly competitive national and global economies. Research has indicated that for SMEs the increase in materials efficiency is a natural aim and not viewed as an environmental activity, but rather a process necessary for sustainability (Ilomaki. 2001). But this is only one facet of a complex problem.
35 2.6.2 Macrophyte community types
In South African estuaries nine different macrophyte community types are recognised. These include the Open surface water area; Intertidal sand and mudflats; Submerged macrophyte beds; Macroalgae; Intertidal salt marsh; Supratidal salt marsh; Reeds and sedges; Mangroves and Swamp forest (Adams et al., 1999). The spatial distribution of different macrophyte communities depend on the salinity gradient along the length of the estuary created by a continual flow of freshwater into the system. This spatial distribution is of significance as it gives a good indication of the health of the estuary. A previous study conducted on the South African estuaries indicated that estuaries with a continual freshwater input have a different distribution of macrophyte habitats from the mouth to the head compared to systems with no freshwater inflow which have low macrophyte diversity (Adams et al., 1992). Macrophytes fulfil a very important ecological function as growth and decomposition influences other biotic and abiotic components and also it serve as a habitat for fauna as it provides a physical structure in the littoral zone (Wortmann et al., 1998). Macrophytes oxygenate the water column, anchor the sediment, absorb nutrients both from the overlying water and from the bottom sediments (Aseada et al., 2001) and increase the depth of the oxidized microzone at the sediment. Submerged macrophytes are capable of improving the clarity of the water as they trap suspended sediment and decrease the effect of the wave action. Salt marsh vegetation stabilizes the sediment and therefore protects the banks of the estuary from eroding away. The aforementioned also acts as filters of sediment and pollutants as well as are zones of nutrient production and retention and are therefore important inorganic and organic nutrient sources for the estuarine ecosystem (Adams et al., 1999). In addition macrophytes consequently also play an important role in terms of nutrient trapping and recycling as well as provide a food source and reproduction sites for invertebrates and fish (Carr et al., 1997; Adams et al., 1999; Riddin and Adams, 2010).
The HFSS is a key arena in which the principles within the EPH agenda could be embedded, due to its unique relationship with nutrition and its endemic unsustainable practices, and yet no studies have been found that connect nutrition, ecologicalhealth and sustainability in this setting. Hospital food is studied from many diverse perspectives, and selective narrow routes through are common. As will be discussed in detail in the methodology chapter, systemic approaches are advocated as “in order to understand an organized whole we must know the parts and the relation between them” (Von Bertalanffy 1972, p. 411). In the context of the principles of EPH, the HFSS clearly addresses more than the characteristics of the food procured, embracing a wider systems perspective where other systemic elements, such as menu planning and food service, can be explored . While EPH has been explored in a number of ways, including through historical investigations of sectors and problems (e.g. the food sector and the obesity crisis) (Lang and Rayner 2007; Lang et al. 2009), through its emergence in policy (Lang and Barling 2013), and through its bridging of health and the environment within policy (Morris 2010), as yet the paradigm principles have not been used in detail as a framework to empirically investigate a food system in practice. As such the following study will address the gaps identified, in that it will develop a methodological approach centred on the principles of EPH to empirically investigate a complex food system, the HFSS. Complexity, Rayner and Lang propose, does not mean ‘complicated’, but rather,
Nevertheless, some factors hamper the real monitoring of the level and the maternal mortality tendency, as the sub formation and the sub-registration, re- sulting of the incorrect filling of the death declarations, when it is hidden that the death was related to the pregnancy, to the childbirth or to the postpartum, or for the non-registration of the death on the notary office. This is because of the ignorance by the professionals and the general population about the importance of that information and the document as health data source   .
The Neglected Tropical Diseases (NTDs) are highly debilitating diseases caused by a range of viruses, bacteria, protozoa and helminths which infect more than one billion people, a sixth of the world’s population, but predomi- nantly the poorest of the poor (Hotez et al. 2009). An ini- tial assessment suggested that 14 of the major NTDs kill an estimated 534 000 people worldwide every year, while causing a disease burden measured in Disability-Adjusted Life Years (DALYs) that competed with HIV/AIDS, tuber- culosis and malaria (Hotez et al. 2006). However, as the name suggests, NTDs have been identified as diseases that receive less attention and funding compared to those other diseases (Liese et al. 2014). We are, however, currently in an exciting era of disease control, at least with respect to several of the human NTDs (Webster et al. 2014). A subset of seven NTDs are being targeted with preventive chemotherapy through Mass Drug Administration of inexpensive, effective, oral drugs in affected communities (Table 1). The term ‘preventive chemotherapy’ was intro- duced by the WHO to define the strategic approach of treating populations infected, or at risk of being infected, with these NTDs without the need for individual diagnosis (WHO 2006). Some of these diseases have already been tar- geted for elimination (e.g. lymphatic filariasis, onchocercia- sis and trachoma), while successful morbidity control against others (e.g. schistosomiasis and soil-transmitted helminthiasis (STH)) has recently also shifted the current agenda towards ‘elimination as a public health problem by 2020’ (WHO 2012b; Webster et al. 2014).
(review of the literature) of the effects of mental health services interventions for the prevention of suicide found that few interventions were specifically tailored to reduce suicidality . Most of the studies examined in the assessment evaluated the effect of treatment related to mental illness per se. Further: “ the inclusion and exclusion criteria were not always well described and in a number of studies individuals with high suicide risk were not included” . This strategy, according to which suicidality is conceptualised as a symptom of mental illness and prevention of suicide requires treat- ment of the underlying disease, has come under increas- ing criticism [14,39,40]. An alternative strategy has been proposed, namely, a focus on suicidality as the primary clinical target, in which suicidal behaviour and its causes are addressed directly [14,39]. In this approach, the indi- vidual is seen as primarily suicidal with various sub- symptoms of mental illness in need of treatment .
highest income regions. High levels of pollution and wealth were co-located in the highly-populated commer- cial centres of Belgium and the Northern Italian regions involved in high-end automobile and machinery manu- facture. In Eastern Europe, although the lowest-income regions were the most polluted in most years, concentra- tions were lowest in the middle-income regions, hence there was no overall income gradient in air quality. Dawson  observes that, in the transition economies of Eastern Europe, the economic benefits of polluting activities ap- pear to have outweighed potential environmental quality and health concerns. Our finding of no clear relationship between income and air quality in these regions supports this claim.
For research specifically addressing barriers to seeking treatment for Korean-American undergraduate students, findings suggest that women reported significantly higher cultural congruity (individual’s self-reported identity matches with his or her environment’s culture) and more positive help-seeking attitudes than Korean men (Gloria et al., 2008). However, researchers suggest that adherence to Asian (Korean) values were associated with decreased help-seeking attitudes for women and second generation participants only. This first finding contradicts previous research findings that higher cultural congruity or lower levels of acculturation predicted lower rates of formal mental health treatment-seeking. However, this study suggests that it is not primarily adherence to cultural values that regulates an individual’s likelihood to seek psychological treatment, but generational, gender, and acculturation influences that also play a role in Korean American undergraduates’ help-seeking attitudes. Such findings shed light on the complexities and intersectionalities of help-seeking that are often obscured by simplistic racial/ethnic categorizations.
As such, there is a proven need for clear and safe handling practices to be implemented to reduce transmission of dis- eases. Fossa Alternas (FAs) and Urine Diverting Dry Toilets (UDDTs) have been extensively promoted as Ecological Sani- tation (EcoSan) latrine options in Malawi but little was known about whether they were used properly until a qualitative study of EcoSan users was conducted in periurban (Blantyre) and rural (Chikwawa) areas of Malawi in 2016. The study showed that blockages of urine diversion systems, intensive management, and maintenance needed for the latrines were major problems which affected attitudes about EcoSan use. Furthermore, use of soil and ash, urine diverting, use of hot water and chemicals to kill maggots, urinating in the drop-hole of the UDDTs, and poor maintenance of roof were some of the practices reported on use of these latrines . These practices may lead to production of unsafe sludge from EcoSan toilets. Evidence that pathogens are not completely killed in EcoSan sludge has been reported in several studies [28–33]. In Malawi, sludge samples from EcoSan latrines in five districts were found to have viable helminthic ova and E. coli above the World Health Organization (WHO) standards for reuse of faecal sludge for agriculture [33, 34]. Though the assessment was not done to quantify the health risks that users of sludge and general public are exposed to, the study gave evidence of the risk especially with high prevalence of helminthic diseases in the country [35, 36]. Evidence from rural El Salvador showed that using EcoSan sludge which is not solar treated was associated with increased prevalence of enteric parasitic infections . For the sludge to be safe, appropriate procedures during use should be followed, that is, adding at least one cupful of ash and three cups of soil after use including availability of conducive environmental conditions [6, 26, 37]. Despite some latrines meeting these conditions, it has been found that they may still produce unsafe sludge [38, 39]. Despite following all procedures dur- ing use of EcoSan latrines, it is important to consider EcoSan sludge as containing pathogens during emptying the pits and storage and during application in the field. The increasing use of EcoSan latrines and their sludge in Malawi therefore calls for thorough assessment to ensure the technology is safe and promotes public health. This study aimed to assess the health risk for using EcoSan sludge using Quantitative Microbiological Risk Assessment (QMRA) which involved the identification and quantification of the likelihood of hazards occurring resulting from use of EcoSan sludge taking into account the possible harmful effects on people using the sludge . The resultant risk estimates will assist in the development of appropriate interventions to reduce the risks to recommended levels.
Ecosystem health is a desired endpoint of environmental management and should be a primary design goal for ecological engineering. This paper describes ecosystem health as a comprehensive, multiscale, measure of system vigor, organization and resilience. Ecosystem health is thus closely linked to the idea of sustainability, which implies the ability of the system to maintain its structure (organization) and function (vigor) over time in the face of external stress (resilience). To be truly successful, ecological engineering should pursue the broader goal of designing healthy ecosystems, which may be novel assemblages of species that perform desired functions and produce a range of valuable ecosystem services. In this way ecological engineering can achieve its goals, embedded in its deﬁnition as the “design of sustainable ecosystems that integrate human society with its natural environment for the beneﬁt of both.” It allows the beneﬁts of ecological engineering practices ‘to both humans and the rest of nature’ to be assessed in an integrated and consistent way that will allow us to build a sustainable and desirable future.
Negative trends in public health in Russia today develop from exposure to a number of environmental factors associated with the change in socioeconomic and medico-environmental living conditions [5, 6, 7]. Such changes are especially typical of small towns with one core industrial enterprise . Almost 40 % of the total number of cities in Russia is comprised of small towns including, according to the Town Planning Code (2004), towns with the population of 20–50 thousand people which means that every fifth Russian citizen lives here. In Orenburg Region, 42.6 % of the population lives in rural areas (27 % of Russians live in rural areas); 58 % of urban areas are comprised of small towns.
Contaminated freshwater systems are an example of a negative ecological determinant of health. Freshwater lakes provide numerous ecosystem services, including clean water for drinking and agriculture, and fish protein. For these reasons, many urban and agricultural activities are often located in close proximity to freshwater resources. Wastewater, runoff, and airborne dust from cities and agriculture often contain contaminants, such as metals or persistent organic pollutants. Because water bodies are repositories for much of what comes from the land, they often accumulate contaminants and can become an ecological cause of human health problems (Laing, et al., 2007). The study of interactions between human health and environmental health (the ‘social- ecological system’) is called ecosystem health.
The multivariable regression analyses indicated broadly similar associations when controlling for economic trends in each country and country fixed effects. As Table 1 shows, each additional percentage of government expenditure managed at the subnational level reduced the Gini-coefficient of regional GDP by -0.17 points (95% CI -0.33 to -0.01; p= 0.04). With each additional percentage of government expenditure managed at the subnational level the SII of regional life expectancy increased by 23 days (95% CI -2 to 48), although this was just below significance at the 5% level (p=0.07). When additionally controlling for the Gini- coefficient of regional GDP in this model, however, the association increased and was significant (p=0.01). This suggests the association between increased devolution and higher health inequalities was mitigated to some extent through the effect of increased devolution reducing regional economic inequalities. When the mediating pathway between devolution and health inequalities via economic inequalities was held constant (by controlling for it in the analysis), we saw a larger significant association between increased devolution and increased regional health inequalities.