Background

Implications

Regional aspects

Indicators

Management responses

Future directions

Recommendations

Related issues

Background

To care for environmental health is to care about maintaining environments that promote healthy communities, and involves the protection of those aspects of human health determined or influenced by physical, chemical, biological and social factors in the environment (EnHealth 1999). Environmental health is jeopardized by various hazards. Such hazards may be associated with poverty and insufficient development, symptoms of which include:

• lack of access to safe drinking water;
• inadequate basic sanitation in the household and community;
• inadequate waste disposal;
• occupational injury hazards; and
• disease vector prevalence (enHealth 2001).

Hazards can also be associated with the sorts of development that occur without sufficient health and environmental safeguards and that are based on the unsustainable consumption of natural resources including:

• water pollution from populated areas, industry and intensive agriculture;
• urban air pollution from transport and fossil fuel power stations;
• hazardous waste accumulation;
• chemical and radiation hazards resulting from introduction of new technologies;
• deforestation and land degradation; and
• global climate change (enHealth 2001).

Chemical Residues in Food

The Australian National Residue Survey (NRS) is a program conducted by the Residues & Standards Branch in Agriculture, Fisheries and Forestry - Australia (AFFA). The function of the NRS is to monitor chemical residues in food and fibre produced in Australia in the products of participating industries such as crops, meat and grains. Further information is available from National Residue Survey

The 2001-02 report provides the results of the NRS monitoring surveys, for which 24,100 samples were collected between 1 July 2001 and 30 June 2002. The NRS results show that Australian produce is of a high quality with respect to residues and contaminants. The results of 322,274 analyses on the 24,100 samples conducted during the reporting period indicate only 61 analyses detected residues above Australian Standards. These consisted of 47 residues of agricultural and veterinary (agvet) chemicals and 14 of metals. If routine monitoring reveals a residue problem, the source of supply is traced as far as possible and action is taken to avoid future occurrences. DPIWE in Tasmania would be advised of any exceedences occurring in this State.

Implications

Just as we strive to take care of our personal health, and the health and well-being of our communities, so too we must care for non-human nature because its 'health' affects and is affected by our actions. Therefore, environmental health must also be understood as the preservation of the integrity of ecosystems on which human health depends; the two are interdependent.

An example of the link made by people between environmental problems and health outcomes is evident in Tasmania's Healthy communities survey, conducted in 1998 by the Department of Health and Human Services. When asked about a range of environmental issues, the majority of the 15,112 adults who responded to the Survey expressed concern about the impact of pesticides, germs and bacteria in food and water, and the effects of air pollution on the health of their local community.

Concerns about environmental health problems among Tasmanians 18+, 19

Level of concern (%)
Environmental problems	Not at all 1	2	3	4	Great deal 5
Pesticides in food	6.8	11.0	21.9	18.2	37.4
Germs, bacteria or viruses in food	6.2	13.7	20.3	17.6	37.1
Germs, bacteria or viruses in drinking water	9.0	14.8	18.3	15.3	37.0
Pesticides in drinking water	9.6	13.8	17.7	15.2	38.2
Air pollution	11.0	14.2	19.5	19.6	30.7
Industry located close to where I live	31.5	15.7	16.7	11.2	19.0

Source: Department of Health and Human Services 1999

Less concern was noted in relation to the location of industries near residential areas, with 31.5% of respondents showing no concern at all compared to 19% reporting a great deal of concern (Department of Health and Human Services 1999).

Environmental health is important for the State of the Environment, then, because people's actions in the environment result in ecosystemic changes that contribute to respiratory and cardiovascular diseases, psychological and neurological disorders, or the increased incidence of cancer, alongside the degradation of the natural systems on which human health depends. Additionally, the potential for diseases of poverty and overcrowding-such as tuberculosis-to re-emerge in Australia has grown as gaps between rich and poor widen (EnHealth 1999). Thus, contemporary economic activities and long-standing approaches to the environment as limitless source and sink impact on environmental health. So too, many social practices (such as private property rights in which the common interest is neglected, or excessive consumption patterns in which equitable distribution policies are ignored) have significant implications for environmental health.

Regional aspects

A total of 15,112 adult Tasmanians responded to the State's Healthy Communities Survey in 1998. The majority of these reported their health to be good to excellent, though 18.6% felt their health was only fair to poor. Tasmanian adults in rural areas assess their health as slightly poorer than Tasmanian adults in urban areas. A total of 17.8% of Tasmanian adults in urban areas assess their health to be 'fair' or 'poor', compared with 20.5% of Tasmanian adults in rural areas.

Self-assessed health status among Tasmanians aged 18+ 1998

Health Status	Percent (%) of respondents
Poor	3.3
Fair	15.3
Good	35.4
Very good	32.4
Excellent	12.8

Source: Department of Health and Human Services 1999

Regional differences are evident if one examines the survey data by statistical division. relativities of respondent numbers aside, it is clear that respondents living in greater Hobart assess their health status more highly than those in other SDs.

Regional differences in self assessed health status among Tasmanians 18+, 1998

SD	Excellent or very good	Good or fair	Poor	No response	Total % (#)
Greater Hobart	14.6	19.9	1.6	0.9	37.0 (5,564)
Southern	3.2	4.9	0.4	1.0	9.9 (1,520)
Northern	9.4	17.3	1.5	0.5	28.7 (4,245)
Mersey-Lyell	8.6	13.0	1.2	2.0	24.4 (3,683)
Tasmania	35.8	55.1	4.7	4.4	100.0 (15,112)

Source: Department of Health and Human Services, 1998

In some measure, this difference may be due to the presence in greater Hobart of a wider range of health services than exist in other areas; in part it may be attributed to the fact that rural health outcomes tend to be lower in general; in part it may stem from other variables such as prior experience of illness, age or sex (Department of Health and Human Services 1999).

It is important to note that many regional differences exist in relation to environmental health issues, and that the scope of such differences is too great to elaborate here. Department of Health and Human Services publications and ABS regional statistics contain much useful data and information on these matters.

Indicators

Population Exposure to Pollutants Reported Through The National Pollutant Inventory - at a glance

• Continued in depth

• Tasmania Together defined the standard of reducing reliance on chemical use by primary, secondary and tertiary industry and the domestic sector. It identified the indicator of levels of usage of environmentally toxic chemicals.
   
• The NPI highlights the potential exposure of the Tasmanian population to a range of toxic substances. Strategies to reduce emissions to the environment and manage exposure of the population are needed. Priority should be given to pollutants based on the risk of adverse health consequences, particularly for children.
   
• Last year, leaded petrol was taken off the market and this has resulted in a reduction of the amount of lead in the air. Home renovation will continue to be a risk for young children because of the lead dust generated in renovation activities or the lead dust that already exists in the roof space of old houses. Infromation on lead is available from the Department of Health and Human Services website.
   

Exposure to Hazardous Chemicals and Wastes in The Workplace - at a glance

• Continued in depth

• There has been a reduction in exposure to hazardous chemicals and wastes in the workplace. According to Workplace Safety Board of Tasmania, the decline 'in the number of workplace accidents is in no small part due to the continued success of the Workplace safe campaign' (Workplace Safety Board of Tasmania 2001).
   
• The Workplace safety standards have been in place in this State since 1997. Based on the acronym SAFE, the campaign stresses four actions: Spot the hazard, Assess the risk, Fix the problem, and Evaluate the results. Annual reports of the Workplace Safety Board of Tasmania provide further information.
   

Passive Smoking - at a glance

• Continued in depth

• Exposure to passive smoking is correlated with age, with people aged 18-24 most likely to be exposed to passive smoking-often because of lifestyle activities.
   
• Data from the Healthy communities survey conducted by the Department of Health and Human Services in 1998 show that passive smoking is correlated to age. Younger groups reported significantly more exposure to tobacco smoke than older age groups. The survey found that most Tasmanian adults are not being exposed to passive smoking at home (72.5%), at work (67.2%), or in cars (68.7%). Passive smoking was reported to occur at social events (57%) and in other places (45.7%) (Department of Health and Human Services 1999).
   
• Research conducted in 1997 by the National Health and Medical Research Council (NHMRC) on passive smoking found that involuntary exposure to cigarette smoke increased the incidence of asthma in children, lower respiratory illness, lung cancer and major coronary events as well as a range of other illnesses.
   

Health Literacy and Coping Skills - at a glance

• Continued in depth

• Among other things, health behaviours can be viewed as an indirect measure of the impact of public health promotion campaigns. The Tasmanian community appears to have adopted various healthy behaviours and these may result from campaigns and/or personal beliefs on health, although that is not explicit in the data and may have different effects in different districts of the State.
   
• Many community members are actively engaged in health advancement by avoiding activities that have the potential to negatively impact on their health (such as smoking and drinking), and undertaking activities to improve their health (such as exercise). Others, particularly those in depressed economic or social conditions, such as are evident in different parts of the State, may likely benefit from assistance to build their health literacy and coping skills.
   
• The issue of trust is an important issue in relation to health and general well-being since thrust has been shown to be an essential element in obtaining the cooperation necessary for programs that endeavour to improve collective outcomes, in this case better individual and public health outcomes. Whether community members adopt health information provided by health agencies and other medical authorities is dependent upon the degree to which they trust the sources of information (Myers and Macnaghten 1998). The Healthy communities survey demonstrates that general practitioners are still highly trusted. There is then an important role for general practitioners in advancing the environmental health dimensions of sustainability.
   

Depression and Related Disorders - at a glance

• Continued in depth

• Depression is an indicator of the health of the members of a community and their ability to cope with and enjoy life. People's coping skills may be affected by such things as their socio-economic condition, health status or events that impact on their lives, such as a decline in the health of loved ones.
   
• A Statewide survey would be required to assess the level of depression in the Tasmanian community and determine the reasons for the occurrence of depression. Issues such as depression cannot be adequately dealt with until information is collected on the prevalence and the reasons for the development of depression are identified.
   

Melanoma of The Skin - at a glance

• Continued in depth

In Tasmania the overall incidence rate of melanoma declined in the period from 1994 to 1998. The fall in incidence rates may indicate that the population is becoming increasingly proactive in minimising exposure to direct sunlight. Compared to the rest of the world the Tasmanian incidence rate for melanoma is also falling. A true indication of the impact of health promotion initiatives that discourage exposure to sunlight will be a comparison of current rates to rates in future years. Early exposure to excessive amounts of sunlight must be avoided to minimise the risk of developing melanoma later in life.

Cause Specific Mortality Rates for Different Settlement Types - at a glance

• Continued in depth

Diseases of the nervous system and some diseases of the respiratory system have risen in Tasmania but the incidence of malignant neoplasms has fallen; the reasons for these changes is unknown.

The standardised mortality ratio for different settlement types is not available for Tasmania, and research should be conducted into the causes of mortality in different regions as certain causes of mortality may be more pronounced in certain regions.

Mortality Among Indigenous Australians - at a glance

• Continued in depth

While the data indicate that the standardised mortality ratio for indigenous Tasmanians is lower than the rest of Australia data are limited due to the paucity of information and the small size of the population. Further research into the standardised mortality ratio of the indigenous population is required. The reasons for any differences in standard mortality ratios between indigenous and non-indigenous populations should be investigated and measures should be put in place to improve the health of indigenous Tasmanians.

Hospital Separation, All Causes - at a glance

• Continued in depth

Hospital separations can indicate the accessibility of hospitals or the general health of the population. As the number of separations has decreased the health of the Tasmanian population may be increasing or less separations due to hospital visits may indicate greater difficulty in accessing hospital services.

Life Expectancy - at a glance

• Continued in depth

The median age at death for females (80.5) exceeded the life expectancy for males in 1999 (75.4) by 5.1 years in 1999. Tasmanian males have a median age at death 0.6 years higher than the Australian population and Tasmanian females have a median age at death 0.6 years lower than the Australian population.

Management responses

Community health

The Department of Health and Human Services Healthy communities survey 1998 (Department of Health and Human Services 1999) is an important initiative in the collection of data to enhance the management of community health. Over 15,000 Tasmanians responded to the survey, designed to measure the health and well-being of the Tasmanian population to enhance our collective understanding of why some sections of the Tasmanian community experience better levels of health and well-being than others (Department of Health and Human Services 1999). Annual and five-yearly reports by DHHS are also critical in benchmarking health and well-being outcomes in the State.

The Tasmania Together program is a long-term social, environmental and economic plan for the people of Tasmania to the year 2020. Through extensive community consultation a series of goals and benchmarks will be developed to assess the progress of various aspects of Tasmanian society. Included in Tasmania Together is a vision for the health and well-being of the population. At the basis of the health and well-being of the community is the aim for a 'high quality of life and healthy lifestyle'. The major themes of improving the population's health are quality of life/lifestyle and access and equity (Tasmania Together 2000).

In support of the Tasmania Together initiative the State Government is etablishing partnerships with local governments in developing 10 year plans for healthy Tasmanians. Partnership agreements between Local and State Governments include identifying how services, including health and human services, can be delivered at local levels. Once Tasmania Together and the 10 year plan are in place they will form a significant element of the policy and planning framework for the Department of Health and Human Services (Department of Health and Human Services 2000).

Depression

The Commonwealth Government has developed the National action plan for depression as a major initiative under the National mental health strategy. Previous initiatives aimed at reducing depression include the National depression workshop held in 1997 and the Mental health national health priority areas initiative report focusing on depression released in 1999. The Plan was developed in an attempt to reduce the prevalence and impact of depression in Australia through achieving goal in target areas. Action on depression can be taken in the general community, primary care services, and mental health services (Commonwealth Department of Health and Aged Care 2001).

Passive Smoking

In Tasmania the Public Health Act 1997 has been amended to allow for restrictions on smoking in enclosed public places. The Public Health Amendment (Smoke-Free Act) 2001 prohibits smoking in indoor workplaces and public places such that it is now an offence to smoke in enclosed public places and workplaces and within certain distances from bar areas, entrances, exits and ventilation intakes of certain buildings. Anyone working within an area that is not a designated smoke-free area must be protected as far as practicable and smoking within a work vehicle if another person is present is no longer legal. The changes to the Act have established penalties for the occupier of a smoke-free area if they allow persons to smoke in that area. The new smoke-free areas will result in reduced exposure to passive smoke for all patrons of enclosed public places.

Future directions

Tasmania Together and the RMPS

Relevant Tasmania Together goals and standards for 'Settlements' are listed in the linked file. The Tasmania Together Progress Board reported on progress toward targets for benchmarks set (Tasmania Together Progress Board 2003). Indicators, targets and baseline data are available in the latest Progress Report June 2003. Further information, including progress report updates, is available from Tasmania Together.

Involvement of the community, and the fair and orderly use of resources are also fundamental principles of the RMPS. The RMPS objectives have been developed to advance the principles of sustainable development.

Recommendations

Related issues