The annual report by the Institute of Health Care (IHC) at the University of Malta this year has a number of articles on the various divisions and courses organised by the IHC. One important unit at the IHC is Environmental Health. Professor Victor Ferrito is the Director of Studies of Environmental Health courses at the IHC.

In his article in the report, Professor Ferrito examines the multiple facets and interdisciplinary nature of this field of specialisation and its implications for the current and long-term health of the population.

The importance of identifying hazards to human health and the urgency of reducing their harmful impact clearly emerges.

Interdisciplinary aspects

The discipline of Environmental Health includes the study of all the environmental factors that can affect the health of the human being, directly or indirectly. This comprises a very wide area of interest, including food safety, health and safety at work, pollution, infectious diseases, port health, health strategy and promotion, cleansing services, animal welfare, public health, pest control, housing and licensing.

The function catering for food safety would include inspections, complaints, handling, food handler training, sampling and testing, export certificates and food standards. Health and safety at work involves inspections of work places, investigation of complaints and accidents, and worker training.

The study of pollution covers air, water, recreational water and land, noise and radiation, and involves complaints handling, sampling and regulation; while a study of infectious diseases includes the issuing of exclusion notices.

Port health is also a function of Environmental Health. This includes food control, hygiene on board ships, airplanes and pest control. The study of health strategy and promotion includes public education, home safety and health education with cleansing services including waste collection, street cleansing, recycling, abandoned vehicles and public conveniences.

Animal welfare issues concern stray dogs and dog fouling, stray cats and other animals such as horses, microchipping, as well as promotion campaigns.

Public health concerns drainage, potable water, statutory nuisances (excluding noise, air and housing) burials, exhumations, cemeteries and mortuaries.

Housing also forms an integral part of Environmental Health. This concerns both private and public stock and includes complaints, area renewal, empty property strategy, harassment, house condition surveys, travellers and caravans.

Finally Environmental Health concerns the granting of licenses and this includes public safety, street trading (including markets), private hire vehicles, gaming, lotteries, amusement licensing, body piercing, late night refreshments, takeaways, pleasure boats, sports grounds and animal welfare.

Responsibilities

All these issues can have negative effects on our health and so need to be monitored and controlled. However, the number of areas is considerable, diverse and requires ever increasing specialisation.

It can also have profound effects on other sectors, such as labour, tourism and agriculture. Responsibilities, therefore, have had to be divided among various ministries and authorities.

For example, occupational health and safety is the responsibility of the Social Policy Ministry; hotels, restaurants and tourist accommodation falls under the responsibility of the Malta Tourism Authority; air pollution is considered the responsibility of the Department for the Environment; and agricultural produce such as meat, vegetables, fish and fruit falls under the responsibility of the Ministry for Agriculture and Fisheries.

These areas may present boundless hazards to human health if proper controls are not in place. Moreover, focusing on specific areas and issues could easily lead to the ignoring of a particular hazard in the area down the line from where it originates.

For example, who should find out whether the antibiotics in livestock feed are endangering our health? This starts off in the domain of agriculture but may exhibit its effect under food safety.

Who is responsible for this trans-boundary effect? Is it the Ministry for Agriculture or the Public Health Department? Who has the expertise to even recognise that such a situation exists, let alone know how to tackle it? Who is the expert and where should we expect to find the expert to deal with the situation?

This expertise is found within the Environmental Health sector. However, the overall responsibility to provide direction and co-ordination to safeguard the citizen's health should lie with the Public Health Department.

Environmental Health is an applied science that draws expert contributions from a number of other pure disciplines and brings together fields such as: human physiology and biochemistry; the pure sciences such as chemistry, physics, biology and mathematics; microbiology, engineering, management and technology.

The objective is to study, understand and eliminate, reduce or control the negative impact that our environment may have on our health, and to enhance our quality of life.

The Environmental Health specialist needs to understand and integrate these various and varied disciplines and use the expertise "to protect and enhance the quality of life of the citizens in respect of the impact the environment, in its widest interpretation, can have and indeed has on the health of the citizen". This is the Mission, the Role that the Environmental Health specialist must assume to fulfil his obligations to society.

Areas of overlap

Environmental Health includes and overlaps with other areas of scientific and technological studies, such as environmental science. An example would be the effects of industrial emissions on air quality on our monuments, rural environment and also our lungs and foods.

A second area is occupational health and safety, nowadays the responsibility of the Department of Labour. One must ensure that the work environment presents no hazards to health and, if it does, the worker must be adequately protected.

A third area is industrial technology, which may have a profound effect on food and so is of great relevance to the Environmental Health specialist. Examples include the irradiation of foods, the effect of heat treatment on foods, the use of preservatives in food and the use of food additives for technological improvements.

A fourth area is agriculture and agricultural practices, for example the use of herbicides and pesticides that find their way into our blood streams through the food we eat; and contamination of primary foods via toxins produced by micro-organisms that grow on them.

The reasons mentioned above require that the country builds an Environmental Health infrastructure comprising properly qualified, suitably skilled and experienced Environmental Health specialists, possessing both theoretical and experiential knowledge and skills in problem solving.

The Institute of Health Care is providing programmes with the above goals in mind and offers Bachelors and Masters degree programmes in Environmental Health as well as a Post Qualification Diploma in Nutrition and Dietetics. The presentation by Professor Ferrito will be concluded in future columns and will consider research projects presented at the unit.

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