**Appendix A**

The current inequitable access to services is the greatest limitation in ensuring universal health care coverage in Bangladesh [27]. As the program currently stands, it is also inadequate in addressing environmental health due to the SES disparity across the country, lack of trained professionals and surveillance of environmental issues, which cause many com-

Firstly, the appropriate approach to integrating EH and UHC must be chosen based on the country's status and needs. All components of this approach must contain clear (SMART) objectives and build collaboration between private and public sectors. Secondly, the approach must be efficient. It has been shown that 20–40% of resources spent on health care are wasted [1]. In implementing universal health care systems, it is imperative to utilize health care services efficiently. This can be addressed in a variety of timeframes—at the "pre" public health community level by educating community members on environmental health exposures and the "post" clinician level, prescribing generic medications and lastly implementing policies,

LMIC are notoriously blindsided when it comes to protecting workers' health, especially in terms of child labor and environmental exposures; therefore, public-private partnerships and legislation will be very useful in providing long-term solutions here. Additionally, international efforts to lessen environmental contaminants can be strengthened. This is a much larger issue than EH and UHC, but some of the international topics include global warming and climate change, import and export of goods leading to additional water and air contaminants, global health disparities and inequity in food quality for high- and low-income populations. The issue of manpower also comes into play when considering the challenges of providing a stable environment for UHCs to flourish. As mentioned previously, intergovernmental agency collaboration and community engagement are vital in EH and UHC in order for the health system and environmental component to work in sync. In order for the EH within UHC to be addressed successfully, programs must provide sustainable solutions to environmental health exposures. The Bangladesh case study proves the need to implement a multipronged and multisectoral approach to ensure success of EH within UHC. Developing relationships through sectors at the regional and local levels would strengthen the likelihood of long-term

As stated by Margaret Chan, Director-General of WHO, "Universal Health Coverage is the single most powerful concept that public health has to offer" [28]. Environmental health must be included within the implementation of a universal health care system due to the high burden of environmentally mediated diseases (~83%) [3]. This further justifies the importance of integrating the two. Despite the multitude of challenges as seen in the Bangladesh case study, there

municable and noncommunicable diseases along with infrastructure.

**7. Sustainability**

142 Advances in Health Management

**8. Conclusion**

which protect the health of the public [1].

sustainability after specific programs or projects have ended.

**Figure 6.** Diseases with the largest environmental contribution (adapted from http://www.who.int/quantifying\_ehimpacts/ publications/preventingdisease.pdf).

**Figure 7.** Environmental sources of exposure and impact on health (adapted from http://www.neha.org/about-neha/ definitions-environmental-health).
