Air pollution and public health

This is the general collection of information for TL purposes.

1. Unit 2: Air and health of the public By: Nabin Lamichhane Assistant Professor, Purbanchal University Gothgaun

2. 2 A Lecture notes Preapared by Mr. Nabin Lamichhane

3. Healthful Air Air that has, appears to have or helps to produce good health. The degree of air quality which is suitable or cleans enough for humans, animals or plants to remains healthy. Air, water, Soil etc are the natural resources that we cannot live without. 3 A Lecture notes Preapared by Mr. Nabin Lamichhane

4. Healthful Air… To understand that human beings (as well as other animals) perform the respiration process because we need air to breathe and because oxygen is ultimately the fuel that allows our cells to produce energy from the food we eat. 4 A Lecture notes Preapared by Mr. Nabin Lamichhane

5. Healthful Air Air is a mixture of various gases like nitrogen, oxygen and carbon dioxide, and others in traces; along with water vapor perceptible as humidity and suspended solids in particulate form. Hippocrates: “ About, air water and location” 5 A Lecture notes Preapared by Mr. Nabin Lamichhane

6. Healthful Air Pure air is the first food and the first therapeutic drugs. Per day: We eat 3 kg water and 15 kg Air (equivalent to 3 kg oxygen) 22000 times breaths per day. 6 A Lecture notes Preapared by Mr. Nabin Lamichhane

7. Properties of Healthful Air Physical Properties Odorless Tasteless Takes some space Warm air rises and cool air fall Not have fixed shape, Has Volume, expands and compresses. Weight and pressure on earth (Atmospheric Pressure) Resistant for motion Generally Colorless (Transparent) Gas at room temperature. Chemical Properties Carbon dioxide, Oxygen, Nitrogen, and trace elements. Oxygen is highly a reducing gas. Rusting Combustibility Flammability Slightly soluble in water 7 A Lecture notes Preapared by Mr. Nabin Lamichhane

8. Properties of Healthful Air Gaseous Properties Air is not a single gas. It’s a mixtures of gases. A breathing gas must Have: Sufficient oxygen to support life, consciousness and work rate of the breather. Must not contain harmful gases.  Carbon monoxide  and  carbon dioxide  are common poisons which may contaminate breathing gases. There are many other possibilities. Must not become toxic when being breathed at high  pressure  such as when  underwater . Oxygen and  nitrogen  are examples of gases that become  toxic  under pressure. Biological Properties Oxygen (O 2 ) must be present in every Healthful air. Oxygen binding capacity Can help in the production of Energy Animal Excretes CO2 and many others substance in breathing Green plant use CO2 gas for photosynthesis. 8 A Lecture notes Preapared by Mr. Nabin Lamichhane

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10. Air Quality The term "air quality" means the state of the air around us. Good air quality refers to clean, clear, unpolluted air. Clean air is essential to maintaining the delicate balance of life on this planet - not just for humans, but wildlife, vegetation, water and soil. Poor air quality is a result of a number of factors, including emissions from various sources, both natural and "human-caused." Poor air quality occurs when pollutants reach high enough concentrations to endanger human health and/or the environment. Our everyday choices, such as driving cars and burning wood, can have a significant impact on air quality. A Lecture notes Preapared by Mr. Nabin Lamichhane 10

11. Need for healthful air for healthful living The human body uses air in several ways. Without it we wouldn't be able to live. 11 A Lecture notes Preapared by Mr. Nabin Lamichhane

12. Physical Needs Breathing in Oxygen Exhaling Waste: O2 is primarily combined with carbon in our bodies to produce CO2 which is exhaled. Plant : Use CO2 (together with sunlight and water) to produce energy and give out Oxygen as a by-product. This oxygen is what almost all animals need to survive. Regulating Temperature : The air around us helps to keep us warm. In the absence of any heat in the air, our bodies lose heat quickly. If we are working hard or exercising we generate excess heat. The air provides some cooling to help the body maintain an ideal temperature of 37 degree C. 12 A Lecture notes Preapared by Mr. Nabin Lamichhane

13. Physical Needs Transmitting sound : Our sense of hearing relies on sound energy being transmitted through the air. Without air, no sound would reach our ears. Transmitting light : If all of the air was suddenly removed from the room you would still be able to see for the few last brief moments of your life. But consider that the air might be replaced with something else that is breathable but not transparent. If the air were not transparent, you'd have trouble using your eyes. Fresh air is good for digestion: Fresh air helps you to digest food more effectively. That is why it’s great to take a small walk outside after you eat. From all the health benefits of fresh air, this one is really important if you are trying to lose weight. Improves blood pressure and heart rate : If you have a problem with blood pressure, you should avoid polluted environments and try to stay in surroundings that have a good supply of fresh air. Dirty environment forces the body to work harder, to get the amount of oxygen it needs. Strengthens your immune system: White blood cells kill and fight bacteria and germs. They need enough oxygen to work and function properly. Fresh air cleans your lungs: Fresh air helps the airways of your lungs to dilate more fully and improves the cleansing action of your lungs. When you exhale and breathe out through your lungs, you release airborne toxins from your body. 13 A Lecture notes Preapared by Mr. Nabin Lamichhane

14. Mental Feelings of freshness Cool air give sense of happiness with joy. The smells in fresh air bust stress and increase happiness. More oxygen supply in prevents from brain hemorrhage, MI etc. Fresh air makes you happier because the amount of serotonin is affected by the amount of oxygen you inhale. Serotonin can significantly lighten your mood and promote a sense of happiness and well-being. Fresh air will leave you feeling more refreshed and relaxed. Healthy air will bring more energy and sharper mind Fresh air helps to think better and increases energy level. Brain needs twenty percent of body’s oxygen. 14 A Lecture notes Preapared by Mr. Nabin Lamichhane

15. Social Healthy surrounding –Healthy air Wide space is good path of communication air- Good housing- Good Social status Every people wants to live in cool weather, clean environment with healthy water, healthy society. Health Air helps to make a healthy society House with good ventilation and wide space around gives a sense of prestige among the society. 15 A Lecture notes Preapared by Mr. Nabin Lamichhane

16. Importance of Healthy Air on Human Health Healthy air reduces the burden of disease from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma. Better the air quality , better the cardiovascular and respiratory health of the population will be, both long- and short-term. 16 A Lecture notes Preapared by Mr. Nabin Lamichhane

17. Mechanism of contribution of healthy air to human health 17 A Lecture notes Preapared by Mr. Nabin Lamichhane

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20. Basic Mechanisms Air Travels: Nose- Lungs- Alveoli- Blood- cells- energy yielding 20 A Lecture notes Preapared by Mr. Nabin Lamichhane

21. Mechanisms Respiration  is the release of energy from glucose in the muscles. When the body is at rest this is  aerobic  respiration. As you exercise you breathe harder and deeper and the heart beats faster to get oxygen to the muscles. Glucose + oxygen → energy + water + carbon dioxide When exercising very hard, the heart cannot get enough oxygen to the muscles. Respiration then becomes  anaerobic . Glucose → energy + lactic acid Oxygen  is by far the most  important  necessity of  human life . ... Energy is  life  and the production of energy in the body depends upon  oxygen . The second  important function of  oxygen  is to combine with metabolic waste products to allow their elimination from the body. This process is called the oxidation reduction cycle. 21 A Lecture notes Preapared by Mr. Nabin Lamichhane

22. Ways of promoting and maintaining healthful air 22 A Lecture notes Preapared by Mr. Nabin Lamichhane

23. Ways of promoting and maintaining healthful air Green belts Trees help in removing carbon dioxide and other pollutants from air and by release of oxygen into the air thereby improving air quality. A green belt development can also help in removing particulate matter from the air by trapping such particulate matter. Green belt land has become the key in protection of natural and semi-natural environment as well as a retreat for wildlife. Access to an open space provides a number of recreational and educational opportunities, while the physical barrier between urban areas and the countryside improves air quality in urban centers. Ventilation, Doors and Windows. Bio- gass Promotion 23 A Lecture notes Preapared by Mr. Nabin Lamichhane

24. Making home as a smoking free Proper housing environment Concept of Cycle cities Proper use of fans and coolers Regular cleaning (Vacuum Cleaners) Air conditioning: Air conditioners are beneficial in so much as they help circulate and filter indoor air. Almost all air conditioners contain a filter that will remove allergens and other pollutants as it pulls air from inside the room. Adequate Spacing Educational Approaches Ways of promoting and maintaining healthful air 24 A Lecture notes Preapared by Mr. Nabin Lamichhane

25. Measurement of healthful air quality Clean air is considered to be a basic requirement of human health and well-being Intended to inform policy-makers and to provide appropriate targets for a broad range of policy options for air quality management. 25 A Lecture notes Preapared by Mr. Nabin Lamichhane

26. Measurement of healthful air quality The "WHO Air quality guidelines" provide an assessment of health effects of air pollution and thresholds for health-harmful pollution levels. Policies and investments supporting cleaner transport, energy-efficient housing, power generation, industry and better municipal waste management would reduce key sources of urban outdoor air pollution. The 2005 "WHO Air quality guidelines" offer global guidance on thresholds and limits for key air pollutants that pose health risks. The Guidelines indicate that by reducing particulate matter (PM 10 ) pollution from 70 to 20 micrograms per cubic metre ( μg /m), we can cut air pollution-related deaths by around 15%. 26 A Lecture notes Preapared by Mr. Nabin Lamichhane

27. Measurement of healthful air quality Setting the healthy level of air quality. Ensuring that the air quality standard are met. Ensuring healthy sources of Air. Evaluating the effectiveness of the ambient air quality monitoring. 27 A Lecture notes Preapared by Mr. Nabin Lamichhane

28. How can you say that our surrounding’s air is healthful? International Level: International Regulations Campaigns Collaborations National Level: Creating and enforcing regulations Appropriate plans, policies, laws, acts and their Implementation. National Air Quality Policy Small installation’s emissions regulated Criteria setup Vehicle emission limit Emission regulations for industries Level of morbidity and mortality etc Coordination Mechanism 28 A Lecture notes Preapared by Mr. Nabin Lamichhane

29. How can you say that our surrounding’s air is healthful? Community Level: Commitment Solid waste management practices etc. Coordination with stakeholders Community Actions Household Level: Proper use of Ventilation, doors and Windows Physical Infrastructure Location Wide yard Proper disposal of Waste and smoke Solid waste management policies Socio-economic status Individual Level: Level of Awareness etc. Income 29 A Lecture notes Preapared by Mr. Nabin Lamichhane

30. OSHA (Occupational Safety and Health Administration) and NIOSH (National Institute for Occupational Safety and Health) define an oxygen deficient atmosphere as any atmosphere containing oxygen at a concentration below 19.5% at sea level, which includes a safety factor. At concentrations below 16%, decreased mental effectiveness, visual acuity, and muscular coordination occur. 30 A Lecture notes Preapared by Mr. Nabin Lamichhane

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33. Some indicators for Measuring Healthful Air Air Temperature Air Temperature and Humidity Cooling Power ( Kata Thermometer) Effective Temperature Corrected Effective Temperature McCARDLE’S Maximum allowable sweet rate 33 A Lecture notes Preapared by Mr. Nabin Lamichhane

34. Air Quality Index The AQI is an index for reporting daily air quality. It tells you how clean or polluted your air is, and what associated health effects might be a concern for you. The AQI focuses on health effects you may experience within a few hours or days after breathing polluted air. 34 A Lecture notes Preapared by Mr. Nabin Lamichhane

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37. CHEMICAL CHANGES : The air becomes progressively contaminated by carbon dioxide and the oxygen content decreases due to metabolic processes. PHYSICAL CHANGES : Rise in temperature Increase of humidity Decrease in air movement Body odours Bacterial pollution Unless the vitiated air is replaced by fresh air, it may adversely affect the comfort. health and efficiency of the occupants. It is known that a feeling of suffocation or discomfort is experienced by the occupants in insufficiently ventilated rooms and also complaints of headache, drowsiness and inability to concentrate. There is also the risk of droplet infection and lowered resistance to disease (on prolonged exposure). 37 A Lecture notes Preapared by Mr. Nabin Lamichhane

38. Characteristics of Unhealthy (Polluted air)? Air contamination- Polluted air—Unhealthy Air. A air is said to be unhealthy when there is excessive presence or concentration of foreign materials in the air, which adversely affect the well being of the individuals and causes damage to the property. (American Medical Association) 38 A Lecture notes Preapared by Mr. Nabin Lamichhane

39. Characteristics of Unhealthy (Polluted) air? Presence in the outer atmosphere of substances or contaminants put there by man, in quantities and concentrations and of a duration as to cause any, discomfort to a substantial number of inhabitants of an area which are injurious to public health or to human, plant or animal life or property or which interfere with the reasonable comfortable enjoyment of life and property throughout the state or through out the territories or areas of state. 39 A Lecture notes Preapared by Mr. Nabin Lamichhane

40. Characteristics of Unhealthy (Polluted) Air Generally Man-made Disease agents may be conveyed by air The characteristics can be observed in: Effects of Air Pollution on Human Effects of Air Pollution in Vegetation Effects of Air Pollution on materials etc. Unhealthy Air causes the increased incidence of respiratory diseases, cardiovascular diseases and many mores ( eg Eye irritation, increased mucous production, cough and shortness of breath etc.) Unhealthy air---Water Pollution (taste of water is altered) Unhealthy Air- Unhygienic Food- different health problems Unhealthy Air results: Climate Change and global warming Acid rain Altered Agricultural Production 40 A Lecture notes Preapared by Mr. Nabin Lamichhane

41. Characteristics of Unhealthy (Polluted) Air The quality of air is being reduced by industrial modernization. Cement factories, mines, steel manufacturers and thermal-power plants are among some of the leading producers of air pollution. The effects of air pollution can be felt thousands of miles from its original source. China's industrial pollution can be felt in Western parts of the United States. Aerial transport has also caused pesticides from farms in South America to arrive in Antarctica. The internal combustion engines of cars and other vehicles produce carbon monoxide, which is a highly poisonous gas. According to the American Heart Association, breathing this form of air pollution over a long period of time can cause serious respiratory problems. Sulfur dioxide, nitrogen oxide and other air pollutants can enter the pores of developing plants and break down the waxy coating that protects them from disease and excess water loss. Volcanic activity can be one of the most significant natural sources of air pollution. When volcanoes erupt, they spew large amounts of ash and toxic chemicals into the air. Desert areas create dust storms that contribute to particulate matter in the atmosphere. Forest and grass fires also produce smoke that causes chemical pollutants to enter the air. 41 A Lecture notes Preapared by Mr. Nabin Lamichhane

42. Sources/Causes of Unhealthy Air Based on Mode of Generation: Natural Sources: Forest fires, Volcanic eruption, Dust storms, Pollen grains. Manmade: Domestic, Industrial, Vehicular etc. Based on the shape of entry of pollution: Point source (single source: Volcano), Line source (Aero planes), Area/volume sources. Based on Origin: Primary: Smoke release from burning coal Secondary: Formed by Primary pollutants. 42 A Lecture notes Preapared by Mr. Nabin Lamichhane

43. Sources/Causes of Unhealthy Air Based on Chemical composition: Organic: Proxy Acetyl Nitrate, Hydrocarbons Inorganic: CO2, SO2, NOx Based on state of Matter: Particulate matter: Finely divided solid and liquid particles Size: 5000 to0.0002 micron) Highly reactive Mostly carried through the smoke, dust etc. Gaseous: CO2, SO2 43 A Lecture notes Preapared by Mr. Nabin Lamichhane

44. Measurement of Unhealthy Air Estimating the adverse effects of Air Pollution Monitoring the level of Air Pollutants 44 A Lecture notes Preapared by Mr. Nabin Lamichhane

45. Adverse effects of Air Pollution Immediate Respiratory system: Acute Bronchitis, Suffocation and Death.( eg Black Hole of Kolkata) Delayed: Chronic Bronchitis, Lung Cancer, Bronchial Asthma, emphysema and respiratory allergies. Lead: Loss of IQ 45 A Lecture notes Preapared by Mr. Nabin Lamichhane

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47. Social and Economic Aspects Deduction of Plant and Animal life Corrosions of Metals Damage to building Cost of cleaning and maintenance and repairs. Reduces the visibility in towns Damage soil and clotings 47 A Lecture notes Preapared by Mr. Nabin Lamichhane

48. Other measurable effects Ozone layer depletion Phtotchemical smog Acid Rain Global Warming 48 A Lecture notes Preapared by Mr. Nabin Lamichhane

49. Monitoring unhealthy air Level of Sulphur dioxide (major pollutant) Smoke or Soiling Index Grit and Dust measurement Coefficient of haze Air Pollution Index 49 A Lecture notes Preapared by Mr. Nabin Lamichhane

50. Air related Human Behaviors Encouraged Banned Smoking, Smoking Zones Plastic related disposal should be recycled Masking construction site should be sealed. Tree plantation Adequate Housing, proper ventilation, Adequate spacing Solar power, Biogas Checking Air filters of the vehicle Use Dustbin Clean the carbon deposit from silencer. Improved version of ‘ Chulo ’ Implementation of Legal provisions Open ventilation and windows Discouraged Smoking (Great exposure to CO) Plastic related waste shouldn’t be burnt Coal combustion, Petrol engines, diesel engine Chemical releasing the fumes Heaters Unnecessary wood fire 50 A Lecture notes Preapared by Mr. Nabin Lamichhane

51. Encouraged A Lecture notes Preapared by Mr. Nabin Lamichhane 51

52. Discouraged A Lecture notes Preapared by Mr. Nabin Lamichhane 52

53. Ways of preventing air from becoming unhealthy (Polluted) WHO Recommendation Containment (Enclosure, ventilation, air cleaning) Replacement: ( electricity, solar, natural gas, deleaded petrol) Dilution: Vegetation, Green belts Legislations: Clean air acts, powers to local authority, smokeless zones, punishments etc. International Actions: International Network for laboratories for the monitoring and study of air pollution 2 International centers at Washington and London 3 centers at Moscow, Nagpur and Tokyo. 20 labs in different countries 53 A Lecture notes Preapared by Mr. Nabin Lamichhane

54. Ways of preventing air from becoming unhealthy (Polluted) Zoning: Zoning of industries on the basis of types Air Pollution control at source: Raw material substitution: Low suplure fuels can be used in place of high sulfure fuels in order to control air pollution. Modification of Process: For eg : The use of exhaust hoods and ducts over several types of industrial ovens allow the recovery of various solvents that could have become air pollutants Equipment Alterations 54 A Lecture notes Preapared by Mr. Nabin Lamichhane

55. Ways of preventing air from becoming unhealthy (Polluted) Controlling Air pollution by Devices Cyclone Separator Wet Collector Fabric Filters etc. 55 A Lecture notes Preapared by Mr. Nabin Lamichhane

56. Overview of national policy, strategies, and programs focused on air and health Constitution of Nepal 2072 Part III: Fundamental Rights and duties Article : 30 : Right regarding clean environment Right to live in healthy and clean environment Right to compensation for the victim of environment pollution Legal provisions Article 35: Right to health (including access to safe drinking water and sanitation) Article 36: Right to food Article 37: Rights to housing A Lecture notes Preapared by Mr. Nabin Lamichhane 56

57. Overview of national policy, strategies, and programs focused on air and health A Lecture notes Preapared by Mr. Nabin Lamichhane 57

58. Overview of national policy, strategies, and programs focused on air and health A Lecture notes Preapared by Mr. Nabin Lamichhane 58 Environmental Protection Act 2053. Environment Protection Rules, 2054 (1997). No specific law to address air pollution; Environment Protection Act (1997) and Environment Protection Rules (1999) are umbrella legislation. Nepal ranked 177th out of 178 for air quality in 2014 Environmental Performance Index.

59. Overview of National Plans and Policies National Ambiant Air Quality Standard (NAAQS) was introduced in 2003 and updated in 2012. A Lecture notes Preapared by Mr. Nabin Lamichhane 59

60. Overview of National Plans and Policies Nepal Vehicle Mass Emission Standard (NVMES) was introduced in 2000 and revised in 2012. Now all vehicles except for heavy equipment vehicles imported to Nepal require compliance with EURO III emission standard. Euro III Standard Fuel : Nepal Oil Standard started supplying EURO III standard of fuel since 2010. Emission standards for in-use and new diesel generators (DG) sets, industrial boilers, cement industries and crusher industries were introduced in 2012. However, implementation of the standards and its compliance has not been effective yet. The government has also introduced brick kiln stack emission standard in 2008. A Lecture notes Preapared by Mr. Nabin Lamichhane 60

61. Overview of National Plans and Policies Climate Change Policy 2011 has aimed at moving in low carbon development path, which provide co-benefits for reducing the air pollution. Ambient Air Quality Monitoring System: MoSTE started monitoring ambient air quality through six monitoring stations in 2002. The equipment however stopped functioning in 2007 and in 2013, the Ministry has resumed air quality monitoring in three of the stations: in Bhaktapur , Machhegaun and Putalisadak by measuring PM10 levels on a daily basis. A Lecture notes Preapared by Mr. Nabin Lamichhane 61

62. Overview of National Plans and Policies Vehicle Inspection and Emission Testing: Nepal initiated activities for monitoring of exhaust emissions in the valley in 1993 and issuance of Green Sticker system was enforced since December 1999. The vehicle emission testing is only limited within Kathmandu valley and is applicable only to three and four wheelers. However, the inspection and emission testing system has not been effectively implemented. Ban on polluting vehicles : The government banned the operation of heavily polluting diesel three wheelers and import of new two-stroke and second hand vehicles in 1999, in an effort to combat air pollution in Kathmandu Valley. This initiative prompted the scaling up of electric vehicles ( Safa tempo) for public transportation. Ban on the heavily polluting Movable Bull Trench Kiln: In 2003, old polluting brick kilns in Kathmandu Valley were banned by the government following significant protests from the local people. This was followed by the introduction of less polluting technologies, mainly Fixed Chimney & Vertical Shaft Brick Kilns (VSBK). A Lecture notes Preapared by Mr. Nabin Lamichhane 62

63. Overview of national policy, strategies, and programs focused on air and health Restriction on used car importation: vehicles older than 5 years are banned Incentives for clean production and installation of pollution prevention technologies: old brick kiln technology within Kathmandu Valley, and introduction of the cleaner Vertical shaft Brick Kiln technology which provides energy cost savings, better quality and less pollution; Industrial Enterprises Act grants 50% reduction in taxable income for companies that invest in industry process / equipment that controls pollution for 3 years National Indoor air pollution guidelines- 2009 Air Quality Management Action Plan for Kathmandu Valley At present, 3 monitoring stations 2 in Kathmandu valley and 1 in Dulikhel . A Lecture notes Preapared by Mr. Nabin Lamichhane 63

64. Overview of national policy, strategies, and programs focused on air and health Pollution tax on fuel: The government started to collect pollution tax of NRs. 0.5 from each liter of petrol and diesel sold in the Kathmandu Valley in 2007. However the provision to deposit the pollution tax to Environment Protection Fund as decided in Financial Act 2002/03 has not been implemented yet and the amount collected has remained unspent. Road improvement, footpaths and cycle lanes: The government has initiated road expansion campaign to improve the traffic flow, and has built sidewalks and cycle tracks to promote walking and cycling. Under Kathmandu Sustainable Urban Transport Project, the government is improving the public transport system and pedestrianizing the urban core areas. A Lecture notes Preapared by Mr. Nabin Lamichhane 64

65. Overview of Plans and Policies A Lecture notes Preapared by Mr. Nabin Lamichhane 65 Day Celebration (June 5, WED ) Awareness Programs Private Sectors role NGOs, INGOs: Clean Energy Nepal, Environmental Public Health organization, Clean Air Network, International Center for Integrated mountain Development, LEADERS Nepal. International organizations and developmental agencies have played key role in supporting government for improving the air quality such as establishment of air quality monitoring stations by DANIDA, promotion of electric vehicles by USAID, introduction of Vertical Shaft Brick Kiln (VSBK) technology projects supported by Asian Development Bank.

66. International Campaigns A Lecture notes Preapared by Mr. Nabin Lamichhane 66 WHO Responses : Air quality guidelines have been published by WHO in 1987 and they were revised in 1997. Given the wealth of new studies on the health effects of air pollution that have been published in the scientific literature since the completion of the second edition of the Air quality Guidelines for Europe, including important new research from low-and middle-income countries where air pollution levels are at their highest, WHO has undertaken to review the accumulated scientific evidence and to consider its implications for its air quality guidelines. New indoor air quality guidelines for household fuel combustion Household energy database Research and programme evaluation Leadership and advocacy in the health, energy and climate community Global Alliance for Clean Cook stoves and the Climate Clean Air Coalition. UNFCCC, Kyoto Protocol, Montreal Protocol, COPs, Paris Agreement etc.

67. Roles and Responsibilities As a Policy maker Policy, law and regulation analysis : Recommendation Project Design Control Strategy formulation Identification and Assessment As a Program Initiator, Manager Identification of Public health Emergency Monitoring, Implementation of Programs EIA As an Advocator As a Police Inspector of Environment. As a Researcher Report Preparation and Dissemination As a Environmental Health Educator …………………………….??????? A Lecture notes Preapared by Mr. Nabin Lamichhane 67

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70. References A text book of Preventive and social medicine, K Park (24 th edition) WHO website References were tried to put in the respective slides. ( Note: This PPT is only created for the Teaching learning purpose) A Lecture notes Preapared by Mr. Nabin Lamichhane 70

71. Thank You!! A Lecture notes Preapared by Mr. Nabin Lamichhane 71