이기영, ScD, CIH, Fellow of ISIAQ 서울대학교 보건대학원 환경보건학과 2015 년 4 월 20 일 보건학개론

Health ( 건강 ) Survival ( 생존에 필요한 인자 ) 물 (limited commodity) 음식 (limited commodity) 공기 Requirement for healthy living ( 건강에 필요한 인자 ) 깨끗하고 충분한 물 ( 식수와 위생 ) 깨끗하고 적절한 먹거리 ( 양 ?) 깨끗한 공기 인간 생명의 값 : 인간의 1 년 생명 값은 ? Priceless US$50,000

환경보건의 정의 Environmental health sciences represent the study of environmental factors including biological, physical and chemical factors that affect the health of a community. This is theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that may adversely affect the health and well-being of present and future generations.

Routes of pollutants 오염 경로 오염원 전달 - Transport/transform 수용체 - Receptor (human) 건강영향 - Health effects

Definition of Exposure ( 노출의 정의 ) Contact of a biological receptor with chemical/physical agent (including biologically generated agent). 수용체와 환경인자 ( 화학, 물리, 생물학 적 ) 의 접촉

Exposure Assessment ( 노출평가 )? 평가와 관리

Exposure Assessment ( 노출평가의 정의 ) Determining how an environmental pollutant comes into contact with the human body 환경오염물질이 인체와 얼마나 접촉이 되 었는지를 평가하는 것

Exposure equation ( 노출공식 ) E = C · T E = Exposure ( 노출 ) C = Concentration ( 농도 ) T = Exposure time ( 접촉시간 )

E = C · T Who? Kiyoung Lee E (exposure) = C (concentration) x T (exposure time) What does it mean? Exposure is associated with concentration in exposure media and the time subject spay in the media. What does it imply? Exposure Science

노출평가 무엇을 노출 (Exposure) 정도 빈도 기간 노출경로 어떻게 측정 (Determination) 추정 (Estimation)

Exposure Path ( 노출경로 )  흡입 Inhalation - Air  섭취 Ingestion  Food  Water  Soil  피부접촉 Dermal Contact

Factors of exposure 오염물질 Toxicity Physical characteristics Environmental media Concentration Temporal profile 수용체 Activity Time and location Risky behaviors

노출평가의 목적 특정인구를 유해로부터 보호하기 위해서 Protect population from risk to certain pollution ( 궁극적 목 적 ) Examine long-term effects of emission control strategies on the exposure to a contaminant in the general population Provide information on exposure magnitude and variance in order to plan and design additional studies Compare exposure levels between various groups of a population Identify high-risk groups And more..

Competencies of MPH Specify approaches for assessing, preventing and controlling environmental hazards that pose risks to human health and safety. Describe the direct and indirect human, ecological and safety effects of major environmental and occupational agents. Specify current environmental risk assessment methods. Describe genetic, physiologic and psychosocial factors that affect susceptibility to adverse health outcomes following exposure to environmental hazards. Discuss various risk management and risk communication approaches in relation to issues of environmental justice and equity. Explain the general mechanisms of toxicity in eliciting a toxic response to various environmental exposures. Develop a testable model of environmental insult. Describe regulatory programs, guidelines and authorities that control environmental health issues. Source: Association of Schools of Public Health, MPH core competency development project

보건학의 전망 1990 년경 미국내 보건대학원 18 개 미만 2014 년 Associations of Schools & Programs of Public Health 정식 회원 49 개 보건대학원

London Smog in 1952

Air pollution kill! London smog

Perception of air pollution

Reality People spend a significant percentage of time indoors. Indoor concentrations are often higher than outdoor level. Large percentage of the overall exposure to some toxic chemicals may occur in indoor environment. The air we breath indoors can lead to significant short-term and long-term health effects

실내환경의 노출 수준 People spend an average of 90 percent of their time indoors while some at-risk subgroups such as the elderly, very young, and chronically ill may spend nearly all their time indoors. Indoor levels of many potentially toxic organic compounds are typically 2 to 20 times greater indoors than outdoors. The ratio is sometimes as much as hundreds of times. 그러면 노출은 ? 실내에서의 노출은 실외보다 배 더 클 수 있다

실내환경의 이해 건물 거주자 오염원

Sources

생활환경시스템 Built Environment System and Technology(BEST)) 개인노출 E=CT 미세환경 실내환경 평가와 관리 실내환경의 오염원 활동패턴 활동패턴의 측정방법 노출에 미치는 영향 생활용품 사용에 따른 노출평가 노출 영향과 관리방안 Dose and Health effects

간접흡연 (Passive Smoking) 간접흡연이란 ? 담배가 탈 때 방출되는 연기와 흡연자의 폐에 서 나오는 연기의 혼합물 간접흡연 = 수동흡연, 이차흡연, 비자발적 흡연 연기를 환경성 담배연기라 함 ETS(Environmental Tobacco Smoke) 또는 SHS (Secondhand Smoke)

담배 만큼 사람을 죽이는 것은 없다. 흡연 음주 간접흡연 교통사고 자살 AIDS Homicides 430, ,095 53,000 46,300 30,906 29,939 24,932 Source: 미국 Centers for Disease Control and Prevention (CDC)

간접흡연이 건강에 미치는 영향 미국의 경우  매년 비흡연자중 3,000 명의 폐암 사망자 가 발생  매년 비흡연자중 46,000 명의 심장병으로 인한 사망자가 발생  매년 430 명의 유아가 유아 돌연사 증후군 (sudden infant death syndrome) 으로 사망 Source: U.S. Surgeon General, 2006

실내금연의 영향 실내공기질의 향상 공중보건 – 흡연율의 감소 지역경제에 영향이 없음 주민과 노동자의 건강이 향상