Last month I reviewed the first seven chapters of Municipal and Rural Sanitation by Ehlers and Steel, sixth (and last) edition published in 1965. These chapters give a picture of the diversity of the profession of Environmental Public Health Specialist, historically, sanitation practiced by sanitarians. This month I want to continue to review the chapters.
Chapter 8 – Disinfectants and Insecticides – Knowledge of pesticides and disinfectants has been, and continues to be, important to environmental public health practice although more limited than in the past. Concerns with insect and rodent control in food establishments, food storage facilities, lodging establishments and other regulated facilities continue to be a regular responsibility of environmental public health. Knowledge of the means of disinfection and fumigation, while not as often needed as in the past, may still be called upon to address specific problems.
Chapter 9 – Insect Vector and Rodent Control – Like death and taxes, insects and rodents will always be with us. Because of effective mosquito control programs, mosquito–borne illnesses in the United States have declined to very low levels. Death from mosquito–borne diseases is rare and illness in uncommon. This is not true in other places around the world. Forty percent of the world's population lives in climates conductive to mosquito breeding. Every year, 500 million people become severely ill with this disease and many die. The United States used to suffer from mosquito caused seasonal outbreaks of malaria and encephalitis. Today, though, mosquito control programs, along with aggressive seasonal public education campaigns, have been highly effective in reducing illness and death. Rats have also been a huge problem historically. Rats transmit disease, bite sleeping infants and cause structural damage. Urban rodent control programs of the 1960's and 1970's and more modern trash containers and methods of trash collection have dramatically reduced the problem rat population in the United States. Environmental Public Health Specialists have been at the forefront of these successful mosquito control and rat control efforts.
Chapter 10 – Ventilation and Air Conditioning – Although Environmental Public Health Specialists may be called upon when there is a complaint about ventilation, air handling systems have become so complex now that this is a very specialized field. In large public or private structures this is often a responsibility of facilities maintenance professionals.
Chapter 11 – Plumbing – Plumbing is now generally a responsibility of code enforcement officials. However, reviewing food establishment plans to assure adequate plumbing and the absence of dangerous cross–connections is still a responsibility of environmental public health professionals during plan review.
Chapter 12 – Public Bathing Place Sanitation – The days of large public bathhouses and swimming facilities with sand and gravel filtration are a thing of the past. Nonetheless, public pools and spas and other aquatic recreational facilities are still a major regulatory concern and aquatic and recreational facility codes are common in more densely populated areas.
Chapter 13 – Light – As with ventilation and air conditioning, lighting and lighting quality have become more specialized. Environmental Public Health Specialists still regulate lighting levels in tattooing and piercing establishments in some jurisdictions.
Chapter 14 – Housing – Again, as with chapter 13 and 14, housing is no longer a primary focus of Environmental Public Health. Code enforcement programs have taken over most housing concerns. Prevention of vermin entry and adequate hot water were focuses into the late 1960's but those have subsided with improved housing stock and aggressive code enforcement.
Chapter 15 – Institutional Sanitation – Most institutional settings are now regulated by state, national or professional organizations. Some regulation of food service still takes place at the local health department level if the food is served to the public but most other functions are now state level. That means that while local environmental public health professionals are not involved, state-level sanitarians (and nurses) are.
Chapter 16 – Occupational Health – When Municipal and Rural Sanitation was written it did not include OSHA, the federal Occupational Safety and Health Administration. Federal regulation under OSHA has mostly supplanted local, and even state, involvement in occupational health.
Chapter 17 – Radiological Sanitation – Most oversight and regulatory activity of in this area is now state and federal. With the relatively new concern for "dirty bombs" being used as a tool for terrorism, more training is needed again at the local level.
As lengthy as they are, I hope that this and last month's From the Director have been interesting and informative to those who have wondered about the people who inspect restaurants and swimming pools and who drive the noisy trucks that "fog" for mosquitoes in the summer months.
For those interested in contemporary environmental public health practice the following links may be interesting:
St. Charles County Environmental Public Health Pages
Seattle and King County Health Department (extensive information throughout the site on Environmental Public Health)
National Environmental Health Association
US Food and Drug Administration
FDA Center for Food Safety and Applied Nutrition
Centers for Disease Control and Prevention Environmental Health
Extensive set of links to other environmental health associations throughout the United States