Abstract
We introduce a conceptual framework for improving health and environmental sanitation in urban and peri-urban areas using an approach combining health, ecological, and socioeconomic and cultural assessments. The framework takes into account the three main components: i) health status, ii) physical environment, and iii) socioeconomic and cultural environment. Information on each of these three components can be obtained by using standard disciplinary methods and an innovative combination of these methods. In this way, analyses lead to extended characterization of health, ecological, and social risks while allowing the comprehensive identification of critical control points (CCPs) in relation to biomedical, epidemiological, ecological, and socioeconomic and cultural factors. The proposed concept complements the conventional CCP approach by including an actor perspective that considers vulnerability to risk and patterns of resilience. Interventions deriving from the comprehensive analysis consider biomedical, engineering, and social science perspectives, or a combination of them. By this way, the proposed framework jointly addresses health and environmental sanitation improvements, and recovery and reuse of natural resources. Moreover, interventions encompass not only technical solutions but also behavioral, social, and institutional changes which are derived from the identified resilience patterns. The interventions are assessed with regards to their potential to eliminate or reduce specific risk factors and vulnerability, enhance health status, and assure equity. The framework is conceptualized and validated for the context of urban and peri-urban settings in developing countries focusing on waste, such as excreta, wastewater, and solid waste, their influence on food quality, and their related pathogens, nutrients, and chemical pollutants.
Similar content being viewed by others
References
Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE (2003) The Community Guide’s model for linking the social environment to health. American Journal of Preventive Medicine 24:12–20.
Baccini P, Brunner PH (1991) Metabolism of the Anthroposphere, New York: Springer.
Beaglehole R, Bonita R, Kjellström T (2005) Basic Epidemiology, Geneva: World Health Organisation.
Belevi H (2002) Material flow analysis as a strategic planning tool for regional waste water and solid waste management. In: Proceedings of the GTZ/BMZ & ATV-DVWK Workshop “Globale Zukunft:Kreislaufwirtschaftskonzepte im kommunalen Abwasser- und Fäkalienmanagement,” Munich, May 13–15, 2002
Benke KK, Hamilton AJ (2008) Quantitative microbial risk assessment: uncertainty and measures of central tendency for skewed distributions. Stochastic Environmental Research and Risk Assessment 22:533–539.
Binder CR (2007) From material flow analysis to material flow management. Part I: social sciences modeling approaches coupled to MFA. Journal of Cleaner Production 15:1596–1604.
Bonfoh B, Roth C, Traore AN, Fane A, Simbe CF, Alfaroukh IO, et al. (2006) Effect of washing and disinfecting containers on the microbiological quality of fresh milk sold in Bamako (Mali). Food Control 17:153–161.
Bonfoh B, Wasem A, Traore AN, Fane A, Spillmann H, Simbe CF, et al. (2003) Microbiological quality of cows’ milk taken at different intervals from the udder to the selling point in Bamako (Mali). Food Control 14:495–500.
Brunner PH, Rechberger H (2004) Pratical Handbook of Material Flow Analysis, Boca Raton, FL: Lewis Publishers.
Chambers R (1989) Editorial Introduction: Vulnerability, coping and policy. IDS Bulletin 20.
Eisenberg JNS, Moore K, Soller JA, Eisenberg D, Colford JM (2008) Microbial risk assessment framework for exposure to amended sludge projects. Environmental Health Perspectives 116:727–733.
Forget G, Lebel J (2001) An ecosystem approach to human health. International Journal of Occupational and Environmental Health 7(Suppl):1–38.
Gold MR, Siegel JE, Russell LB, Weinstein MC (1996) Cost-effectiveness in Health and Medicine, New York: Oxford University Press.
Haas CN, Rose JB, Gerba CP (1999) Quantitative Microbial Risk Assessment, New York: John Wiley & Sons.
Hetzel M, Bonfoh B, Farah Z, Traore M, Simbe CF, Alfaroukh IO, et al. (2004) Diarrhoea, vomiting and the role of milk consumption: perceived and identified risk in Bamako (Mali). Tropical Medicine & International Health 9:1132–1138.
Howard G, Pedley S, Tibatemwa S (2006) Quantitative microbial risk assessment to estimate health risks attributable to water supply: can the technique be applied in developing countries with limited data? Journal of Water and Health 4:49–65.
Huang DB, Bader HP, Scheidegger R, Schertenleib R, Gujer W (2007) Confronting limitations: new solutions required for urban water management in Kunming City. Journal of Environmental Management 84:49–61.
Hutton G (2000) Considerations in Evaluating the Cost-effectiveness of Environmental Health Interventions: Protection of the Human Environment, Geneva: World Health Organization.
Jagals C, Jagals P (2004) Application of HACCP principles as a management tool for monitoring and controlling microbiological hazards in water treatment facilities. Water Science and Technology 50:69–76.
Kleinman A (1981) Patients and Healers in the Context of Culture, an Exploration of the Borderland between Anthropology, Medicine and Psychiatry, Berkeley, CA: University of California Press.
Kytzia S, Faist M, Baccini P (2004) Economically extended—MFA: a material flow approach for a better understanding of food production chain. Journal of Cleaner Production 12:877–889.
Mara DD, Sleigh PA, Blumenthal UJ, Carr RM (2007) Health risks in wastewater irrigation: comparing estimates from quantitative microbial risk analyses and epidemiological studies. Journal of Water and Health 5:39–50.
Marmot M (2005) The social environment and health. Clinical Medicine 5:244–248.
Marmot MG (1998) Improvement of social environment to improve health. The Lancet 351:57–60.
McMichael AJ (2000) The urban environment and health in a world of increasing globalization: issues for developing countries. Bulletin of the World Health Organization 78:1117–1126.
Miller GW (2006) Integrated concepts in water reuse: managing global water needs. Desalination 187:65–75.
Montangero A (2007) Material Flow Analysis for Environmental Sanitation Planning in Developing Countries—An Approach to Assess Material Flows with Limited Data Availability. PhD thesis, Innsbruck, Austria: Leopold-Franzens-University.
Montangero A, Cau LN, Anh NV, Tuan VD, Nga PT, Belevi H (2007) Optimising water and phosphorus management in the urban environmental sanitation system of Hanoi, Vietnam. Science of the Total Environment 384:55–66.
Montgomery MA, Elimelech M (2007) Water and sanitation in developing countries: including health in the equation. Environmental Science & Technology 41:17–24.
Moore M, Gould P, Keary BS (2003) Global urbanization and impact on health. International Journal of Hygiene and Environmental Health 206:269–278.
Morris GP, Beck SA, Hanlon P, Robertson R (2006) Getting strategic about the environment and health. Public Health 120:889–903.
Murray C, Lopez A (1996) The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020, Cambridge, MA: Harvard University Press.
National Advisory Committee on Microbiological Criteria for Foods (1997) HACCP Guidelines, Washington, DC: U.S. Food and Drug Administration, U.S. Department of Agriculture, National Advisory Committee on Microbiological Criteria for Foods.
Nhapi I, Gijzen HJ, Siebel MA (2003) A conceptual framework for the sustainable management of wastewater in Harare, Zimbabwe. Water Science and Technology 47:11–18.
Obrist B (2006) Struggling for Health in the City: An Anthropological Inquiry of Health, Vulnerability and Resilience in Dar Es Salaam, Tanzania, Bern, Switzerland: Peter Lang.
Obrist B, Iteba N, Lengeler C, Makemba A, Mshana C, Nathan R, et al. (2007) Access to health care in contexts of livelihood insecurity: a framework for analysis and action. PLoS Med 4:e308.
Parkinson J, Tayler K (2003) Decentralized wastewater management in peri-urban areas in low-income countries. Environment and Urbanization 15:75–89.
Patz JA (2006) EcoHealth ONE: Forging collaboration between ecology and health. EcoHealth 3:66–67.
Schaffner M (2007) Applying a Material Flow Analysis Model to Assess River Water Pollution and Mitigation Potentials. A Case Study in the Thachin River Basin, Central Thailand. PhD thesis, Bern, Switzerland: University of Bern.
Schandl H, Eisenmenger N (2006) Regional patterns in global resource extraction. Journal of Industrial Ecology 10:133–147.
Schertenleib R (2005) From conventional to advanced environmental sanitation. Water Science and Technology 51:7–14.
Seidu R, Heistad A, Amoah P, Drechsel P, Jenssen PD, Stenstrom TA (2008) Quantification of the health risk associated with wastewater reuse in Accra, Ghana: a contribution toward local guidelines. Journal of Water and Health 6:461–471.
Sun Y-M, Ockerman HW (2005) A review of the needs and current applications of hazard analysis and critical control point (HACCP) system in foodservice areas. Food Control 16:325–332.
Surinkul N, Koottatep T (2009) Advanced sanitation planning tool with health risk assessment: case study in a peri-urban community in Thailand. Human and Ecological Risk Assessment 15:1–14
United Nations (2006) The Eight Millennium Development Goals (MDGs). Available: http://www.un.org/millenniumgoals/index.html [accessed December 18, 2006]
van Lieverloo JHM, Blokker EJM, Medema G (2007) Quantitative microbial risk assessment of distributed drinking water using faecal indicator incidence and concentrations. Journal of Water and Health 5:131–149.
Vose D (2000) Risk Analysis: A Quantitative Guide, 2nd ed., Chichester, UK: John Wiley & Sons.
Weiss MG (2001) Cultural epidemiology: an introduction and overview. Anthropology & Medicine 8:1–29.
Westrell T, Schonning C, Stenstrom TA, Ashbolt NJ (2004) QMRA (quantitative microbial risk assessment) and HACCP (hazard analysis and critical control points) for management of pathogens in wastewater and sewage sludge treatment and reuse. Water Science and Technology 50:23–30.
WHO (2006a) WHO Guidelines for Drinking-water Quality, 3rd ed., Incorporating First Addendum, Vol. 1: Recommendations, Geneva: World Health Organization.
WHO (2006b) WHO Guidelines for the Safe Use of Wastewater, Excreta and Greywater, Vol. 2: Wastewater Use in Agriculture, Geneva: World Health Organization.
WHO/TDR (2006) Gender and tuberculosis: cross-site analysis and implications of a multi-country study in Bangladesh, India, Malawi, and Colombia. Social, Economic and Behavioural Research. Report Series No. 3, Geneva: WHO/TDR, pp 1–97.
WHO/UNICEF (2006) Meeting the MDG Drinking Water and Sanitation Target: The Urban and Rural Challenge of the Decade, Geneva: WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation.
Yen IH, Syme SL (1999) The social environment and health: a discussion of the epidemiologic literature. Annual Review of Public Health 20:287–308.
Acknowledgments
We gratefully acknowledge the contributions by Mr. Christoph Lüthi, Dr. Peter Odermatt, Prof. Mitchell Weiss, and Dr. Voranuch Wangsuphachart during the discussions of this framework. This work has been supported by the Swiss National Science Foundation (SNSF) and the Swiss Agency for Development and Cooperation (SCD), through the program of the National Center for Competences in Research (NCCR) North–South.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nguyen-Viet, H., Zinsstag, J., Schertenleib, R. et al. Improving Environmental Sanitation, Health, and Well-Being: A Conceptual Framework for Integral Interventions. EcoHealth 6, 180–191 (2009). https://doi.org/10.1007/s10393-009-0249-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10393-009-0249-6