**5. Intersection**

#### **5.1. Environmental health through UHC**

Considering the high burden of environmental factors on human disease, universal health coverage can be accomplished significantly through improving environmental health. This is especially true in the aspects of health promotion and disease prevention within UHC. Conclusively, as mentioned previously within the EH section, the main aspects of environmental health that can be investigated in this aspect include:


These major environmentally mediated global health issues can be integrated into UHC, utilizing the "two Pronged" approach, which includes both (1) preventive and (2) treatment aspects [6]. The preventive portion invests in education and major infrastructure, that is, sewage, water treatment and scrubbers on coal-fired boilers. The services included in the prevention aspect also include health education and delivery of services to communities who are challenged in their access to appropriate health care. On the other hand, the treatment side integrates both environmental and occupational health data into the physician's assessment alongside ability and resources in order to "prescribe" reduced exposures, that is, mold within the household and occupational allergens [6]. This could also be viewed as a pre- versus postexposure scenario, with the main focus on mitigating environmental health exposures.

This two-pronged approach can better address environmental health by focusing on the service aspect. As aforementioned, access to health care is a major issue in both developing countries and even developed countries, which encompasses health disparities, primarily due to SES. In order to address these components, the appropriate services must be offered. In some cases, diagnostic tests may prove useful in prescribing correct medications for communicable diseases, while consultations in prevention measures for environmental exposures can be effective in others. It is without a doubt that health consultations from community health care workers and ideally primary health care (PHC) providers should be a priority. PHC is important to assess the patient's health in a holistic manner and applies the most appropriate service. Diagnostics tests may be out of reach for individuals in resource-limited countries and/ or low-income areas, however, proving the need for a different service delivery system. Global initiatives (MDG and SDG) can aid in lessening the disease burden overall, therefore applying less pressure to localized services. It is plausible to utilize epidemiological methods to inform global or even national policy in order to reduce exposures. This would lessen the economic and resource burdens at the local level.

#### **5.2. Integrating environmental health with UHC**

**5. Intersection**

136 Advances in Health Management

**5.1. Environmental health through UHC**

and resource burdens at the local level.

mental health that can be investigated in this aspect include:

Considering the high burden of environmental factors on human disease, universal health coverage can be accomplished significantly through improving environmental health. This is especially true in the aspects of health promotion and disease prevention within UHC. Conclusively, as mentioned previously within the EH section, the main aspects of environ-

• Indoor and outdoor pollution—that is, air pollution leading to respiratory issues • Food safety—that is, mold growth due to climate change (flooding) and cancer

• Hygiene and sanitation—that is, need for clean water to lessen diarrheal diseases

• Vector control—that is, to mitigate vector-borne diseases such as dengue and Zika virus

• Occupational health and industrial hygiene—that is, understanding higher occupational

These major environmentally mediated global health issues can be integrated into UHC, utilizing the "two Pronged" approach, which includes both (1) preventive and (2) treatment aspects [6]. The preventive portion invests in education and major infrastructure, that is, sewage, water treatment and scrubbers on coal-fired boilers. The services included in the prevention aspect also include health education and delivery of services to communities who are challenged in their access to appropriate health care. On the other hand, the treatment side integrates both environmental and occupational health data into the physician's assessment alongside ability and resources in order to "prescribe" reduced exposures, that is, mold within the household and occupational allergens [6]. This could also be viewed as a pre- versus postexposure scenario, with the main focus on mitigating environmental health exposures.

This two-pronged approach can better address environmental health by focusing on the service aspect. As aforementioned, access to health care is a major issue in both developing countries and even developed countries, which encompasses health disparities, primarily due to SES. In order to address these components, the appropriate services must be offered. In some cases, diagnostic tests may prove useful in prescribing correct medications for communicable diseases, while consultations in prevention measures for environmental exposures can be effective in others. It is without a doubt that health consultations from community health care workers and ideally primary health care (PHC) providers should be a priority. PHC is important to assess the patient's health in a holistic manner and applies the most appropriate service. Diagnostics tests may be out of reach for individuals in resource-limited countries and/ or low-income areas, however, proving the need for a different service delivery system. Global initiatives (MDG and SDG) can aid in lessening the disease burden overall, therefore applying less pressure to localized services. It is plausible to utilize epidemiological methods to inform global or even national policy in order to reduce exposures. This would lessen the economic

• Solid waste management—that is, to ensure that water sources are not contaminated

exposures and ensuring worker safety across governmental agencies

Because of the fact that health insurance alone cannot mitigate all of these environmental health factors, a "multipronged" approach has been suggested to alleviate this issue. In general, the three pillars of this approach include (1) responding to existing demand, (2) anticipating healthcare needs and (3) addressing underlying (structural) issues. Responding to demand is imperative in order to provide affordable, equitable high-quality health services from a pluralistic health system. Secondly, in an era of rapid growth and both health and social transition, anticipating community health care needs is an imperative factor to account for. Lastly, in order to make a sustainable system, underlying issues must be addressed to ensure progress [6]. The variance of these three pillars can be personalized per country for optimal success [18, 19]. A recent report by the World Bank Report on universal health coverage for Inclusive and Sustainable Development shows the diversity of this approach. As seen in **Figure 3**, countries in Groups 2 and 3 have implemented or are working toward a multipronged approach [19]. **Figure 3** illustrates the diversity of this approach and flexibility in order to meet the needs of a particular nation. Bangladesh is seen in Group 1 as a pilot multipronged approach to UHC. This case study will be discussed in the next section; it is important to follow early stage programs and survey their effectiveness in UHC.

A "multisectoral" approach could also be employed to include environmental heath factors. This can be accomplished by engaging other instrumentalities of universal health care including (1) health care delivery systems, (2) individuals within the health workforce, (3) health facilities and/or communication networks and (4) governmental agencies and legislators. Delivery systems, health workforce and communication networks can be primarily effective in spreading awareness and mobilizing efforts at the community level, within households. This


**Figure 3.** UHC program countries (adapted from http://apps.who.int/medicinedocs/documents/s21582en/s21582en.pdf).

could educate individuals on the importance of environmental health, including sanitation and ventilation, especially when using indoor cook stoves fueled by biomass [20]. Alternatives such as kerosene or gas energy sources could be encouraged along with handwashing techniques and the use of mosquito nets to lessen vector-borne disease. The use of outreach infrastructure could also be vital in integrating networks from microcredit activities with environmental health initiatives [6].

Utilizing pertinent governmental agencies and legislators is also invaluable to integrating environmental health in specific trades and in general occupational health practices. This relationship to individuals with power could also make equipment available, or aid in subsidizing the purchase of, which aims to improve environmental health, that is, gas-powered stoves, mosquito nets and water sanitation systems. Legislation could be developed and implemented in specific areas for the safety of large groups, for instance, food safety, waste management and occupational health. Policy could too be integrated with local government to support public-private partnerships; Ministries of Public Health, Ministry of Health, Ministry of Environment or Forest/Agriculture and Ministry of Education can all be leveraged here. With support from these powers, community-level efforts to spread awareness about the importance of environmental health in order to control the burden and spread of disease could be a long-term solution to alleviate these health-deteriorating factors. Unfortunately, education will not be the end all solution, however, due to the interconnectivity of universal poverty. Ensuring access to healthy environments is vital in one's overall health to mitigate environmental health factors, which leads to NCDs and a wide array of chronic diseases that put many people out of work and into poverty.
