**3. Environmental health**

EH is the science behind preventing injury and detrimental exposure to environmental agents that may be physical, chemical, biological or social/cultural. These agents are transmitted primarily by air, water, soil or food [7]. Social/cultural burdens include socioeconomic status (SES), race, ethnicity or any other practices that limit one's social environment or access to healthcare. These factors can be exacerbated by health inequity and the state of climate change, that is, access to healthy and untainted food and water considering one's built environment. EH also includes the assessment and control of disease with environmental etiologies as well, especially those such as vector-borne illnesses such as malaria or diarrheal diseases. The objective is to prevent disease and create health-promoting environments (see Appendix A for additional explanatory **Figures 6** and **7**).

From an epidemiological perspective, because environmental heath factors can occur at the individual, household, community, regional and global levels, EH issues have a great impact on global disease burden [6]. As a whole, it is estimated that environmental risk factors contribute to between 25% and 33% of the global disease burden (**Figure 1**) [8, 9]. Moreover, these environmental risk factors can be broken down into communicable versus noncommunicable linkages.

**Figure 1.** Environmental disease burden per country, 2012 (adapted from https://assets.bwbx.io/images/users/iqjWHB FdfxIU/iI66GxTjwGag/v1/800x-1.png).

Noncommunicable diseases kill 38 million people per year. Furthermore, nearly three-quarters of these diseases occur in low and middle income countries (LMIC), providing evidence for inequity. Some of the major noncommunicable diseases identified by WHO due to their mortality include cardiovascular disease, cancer, respiratory disease and diabetes [10]. Air pollution, particularly particulate matter (PM) from traffic, cooking stoves and incineration, to name a few environmental etiologies, has been linked to cardiovascular disease in a number of epidemiological studies over the past decade [11]. Cancer can be linked to a plethora of toxic chemicals found anywhere from personal care products and cleaning products and to crops contaminated with toxic molds; many of these can be found on the United States Agency for Toxic Substances and Disease Registry (ATSDR) Priority List, signifying their significance in terms of human exposure, toxicity and frequency of exposure [12]. Respiratory diseases can also be linked to chemical exposure and similar etiologies of cardiovascular disease, that is, air pollution (tobacco smoke and PM), exposure to asbestos and other occupational trade industry exposures (wood and leather dust) [13]. Conclusively, diabetes can clearly be linked to individuals' access to healthy food (food deserts) and their ability to maintain a well-balanced diet. Food deserts are a global health equity issue, also found in even high-income countries such as the USA.

on UHC in Bangladesh. This paper will also provide the framework on how to incorporate environmental health into UHC using both the two-pronged approach and the multipronged/

EH is the science behind preventing injury and detrimental exposure to environmental agents that may be physical, chemical, biological or social/cultural. These agents are transmitted primarily by air, water, soil or food [7]. Social/cultural burdens include socioeconomic status (SES), race, ethnicity or any other practices that limit one's social environment or access to healthcare. These factors can be exacerbated by health inequity and the state of climate change, that is, access to healthy and untainted food and water considering one's built environment. EH also includes the assessment and control of disease with environmental etiologies as well, especially those such as vector-borne illnesses such as malaria or diarrheal diseases. The objective is to prevent disease and create health-promoting environments (see

From an epidemiological perspective, because environmental heath factors can occur at the individual, household, community, regional and global levels, EH issues have a great impact on global disease burden [6]. As a whole, it is estimated that environmental risk factors contribute to between 25% and 33% of the global disease burden (**Figure 1**) [8, 9]. Moreover, these environmental risk factors can be broken down into communicable versus noncommunicable

**Figure 1.** Environmental disease burden per country, 2012 (adapted from https://assets.bwbx.io/images/users/iqjWHB

multisectoral approach as feasible solutions.

Appendix A for additional explanatory **Figures 6** and **7**).

**3. Environmental health**

132 Advances in Health Management

linkages.

FdfxIU/iI66GxTjwGag/v1/800x-1.png).

Alternatively, communicable diseases, otherwise known as infectious diseases, are found almost entirely in LMIC. Major risk factors for these outbreaks include flooding, likely caused by global warming and climate change. Flooding contaminates drinking water sources and stimulates mold growth in both crop fields and containers holding water or crops, which leads to an array of water-borne diseases and epidemics including cholera, hepatitis A, typhoid fever and leptospirosis. Additionally, due to the attraction of insects, namely mosquitos, to these environments, vector-borne diseases such as Ebola, dengue, malaria, yellow fever, gangue hemorrhagic fever and West Nile fever have all increased exponentially. Developmental birth defects such as neural tube defects (NTDs) can also result from these diseases, that is, the Zika virus and microcephaly. The lack of availability to clean water also leads to diarrheal disease and ear, nose and throat infections. Additionally, social/cultural practices can contribute to transmission of disease such as the practice of burning an Ebola corpse, which occurred in the Ebola epidemic most recently. Tuberculosis can also be transmitted by corpses along with other blood-borne viruses and gastrointestinal infections [14]. Some communicable diseases can also be contracted at rapid rates by the built environment, for example, tuberculosis, influenza and other air-borne disease causing agents due to overcrowding—prisons in countries such as Russia and slums in many other countries, namely India.

To put the health equity across countries in perspective, in LMIC, lower respiratory infections are the third leading cause of death, while chronic obstructive pulmonary disease (COPD) is the sixth leading cause of death. Disproportionately, when looking at children between the ages of 0 and 14, lower respiratory disease is actually ranked second, while diarrheal disease is ranked third [6]. Globally, more than a third of the disease burden due to environmental factors falls on children [15]. Considering all of these environmental risk factors, the top risk factors have been identified as unimproved water and sanitation and air pollution.
