Wednesday, 09 March 2011 14:25

Water Pollution

Rate this item
(54 votes)

For at least two millennia natural water quality has deteriorated progressively and reached contamination levels where water uses are severely limited or the water can be harmful to humans. This deterioration is related to the socio-economic development within a river basin, but long-range atmospheric transport of contaminants has now changed this picture: even remote areas can be indirectly polluted (Meybeck and Helmer 1989).

Medieval reports and complaints about inadequate excreta disposal, foul and stinking water courses within overcrowded cities and other similar problems were an early manifestation of urban water pollution. The first time that a clear causal linkage between bad water quality and human health effects was established was in 1854, when John Snow traced back the outbreak of cholera epidemics in London to a particular drinking water source.

Since the middle of the twentieth century, and concurrent with the onset of accelerated industrial growth, various types of water pollution problems have occurred in rapid succession. Figure 1 illustrates the types of problems as they became apparent in European freshwaters.

Figure 1. Types of water pollution problems

EHH060F1

In summarizing the European situation it can be stated that: (1) the challenges of the past (pathogens, oxygen balance, eutrophication, heavy metals) have been recognized, researched and the necessary controls identified and more or less implemented and (2) the challenges of today are of a different nature—on the one hand, “traditional” point and non-point pollution sources (nitrates) and ubiquitous environmental contamination problems (synthetic organics), and, on the other                                                                                                                       hand, “third generation” problems interfering with global cycles                                                                                                                      (acidification, climate change). 

In the past, water pollution in the developing countries resulted mainly from the discharge of untreated wastewater. Today it is more complex as a result of the production of hazardous wastes from industries and the rapidly increasing use of pesticides in agriculture. In fact, water pollution today in some developing countries, at least in the newly industrializing ones, is worse than in industrialized countries (Arceivala 1989). Unfortunately, developing countries, on the whole, are badly lagging behind in getting control over their major pollution sources. As a consequence, their environmental quality is gradually deteriorating (WHO/UNEP 1991).

Types and Sources of Pollution

There are a large number of microbial agents, elements and compounds which may cause water pollution. They can be classified as: microbiological organisms, biodegradable organic compounds, suspended matter, nitrates, salts, heavy metals, nutrients and organic micropollutants.

Microbiological organisms

Microbiological organisms are common in freshwater bodies polluted particularly by discharges of untreated domestic wastewater. These microbial agents include pathogenic bacteria, viruses, helminths, protozoa and several more complex multicellular organisms that can cause gastro-intestinal illness. Other organisms are more opportunistic in nature, infecting susceptible individuals through body contact with contaminated water or by inhalation of poor quality water droplets in aerosols of various origins.

Biodegradable organic compounds

Organic substances of either natural origin (allochthonous terrestrial detritus or autochthonous debris of aquatic plants) or from anthropogenic sources (domestic, agricultural and some industrial wastes) are decomposed by aerobic microbes as the river continues its course. The consequence is a lowering of the oxygen level downstream of the wastewater discharge, impairing the quality of the water and the survival of the aquatic biota, particularly of high-quality fish.

Particulate matter

Particulate matter is a major carrier of organic and inorganic pollutants. Most toxic heavy metals, organic pollutants, pathogens and nutrients, such as phosphorus, are found in suspended matter. An appreciable amount of the biodegradable organic material responsible for consumption of dissolved oxygen from rivers is also found in suspended particles. Particulate matter comes from urbanization and road construction, deforestation, mining operations, dredging operations in rivers, natural sources which are linked to continental erosion, or natural catastrophic events. Coarser particles are deposited on river beds, in reservoirs, in the flood plain and in wetlands and lakes.

Nitrates

The concentration of nitrates in unpolluted surface waters ranges from less than 0.1 to one milligrams per litre (expressed as nitrogen), so nitrate levels in excess of 1 mg/l indicate anthropogenic influences such as discharge of municipal wastes and urban and agricultural run-off. Atmospheric precipitation is also an important source of nitrate and ammonia to river basins, particularly in areas not affected by direct pollution sources—for example, some tropical regions. High concentrations of nitrate in drinking water may lead to acute toxicity in bottle-fed infants during their first months of life, or in the elderly, a phenomenon called methaemoglobinaemia.

Salts

Water salinization may be caused by natural conditions, such as geochemical interaction of waters with salty soils or by anthropogenic activities, including irrigated agriculture, sea water intrusion due to excessive pumping of groundwaters in islands and coastal areas, disposal of industrial wastes and of oilfield brines, highway de-icing, landfill leachates and leaking sewers.

While hampering beneficial uses, particularly for irrigation of sensitive crops or for drinking, salinity in itself may not, at even quite high levels, be directly harmful to health, but the indirect effects can be dramatic. The loss of fertile agricultural land and reduced crop yields caused by waterlogging and soil salinization of irrigated areas destroy the livelihood of whole communities and cause hardships in the form of food shortages.

Heavy metals

Heavy metals such as lead, cadmium and mercury are micro-pollutants and of special interest as they have health and environmental significance due to their persistence, high toxicity and bio-accumulation characteristics.

There are basically five sources of heavy metals contributing to water pollution: geological weathering, which provides the background level; industrial processing of ores and metals; the use of metal and metal compounds, such as chromium salts in tanneries, copper compounds in agriculture, and tetraethyl lead as an anti-knock agent in gasoline; leaching of heavy metals from domestic wastes and solid waste dumps; and heavy metals in human and animal excretions, particularly zinc. Metals released to the air from automobiles, fuel burning and industrial process emissions may settle on land and ultimately run off to surface waters.

Nutrients

Eutrophication is defined as the enrichment of waters with plant nutrients, primarily phosphorus and nitrogen, leading to enhanced plant growth (both algae and macrophytes) which results in visible algae blooms, floating algal or macrophyte mats, benthic algae and submerged macrophyte agglomerations. When decaying, this plant material leads to the depletion of the oxygen reserves of water bodies, which, in turn, causes an array of secondary problems such as fish mortality and liberation of corrosive gases and other undesirable substances, such as carbonic gas, methane, hydrogen sulphide, organoleptic substances (causing taste and odour), toxins and so on.

The source of phosphorus and nitrogen compounds is primarily untreated domestic wastewater, but other sources such as drainage of artificially fertilized agricultural land, surface run-off from intensive livestock farming and some industrial wastewaters can also substantially increase the trophic level of lakes and reservoirs, particularly in tropical developing countries.

The main problems associated with eutrophication of lakes, reservoirs and impoundments are: oxygen depletion of the bottom layer of lakes and reservoirs; water quality impairment, leading to treatment difficulties, particularly for the removal of taste- and odour-causing substances; recreational impairment, increased health hazards to bathers and unsightliness; fisheries impairment due to fish mortality and the development of undesirable and low-quality fish stocks; ageing and reducing the holding capacity of lakes and reservoirs by silting; and increase of corrosion problems in pipes and other structures.

Organic micropollutants

Organic micropollutants can be classified in groups of chemical products on the basis of how they are used and consequently how they are dispersed in the environment:

  • Pesticides are substances, generally synthetic, that are deliberately introduced into the environment to protect crops or control disease vectors. They are found in various distinct families, such as organochloride insecticides, organophosphate insecticides, herbicides of the plant hormone type, triazines, substituted ureas and others.
  • Materials for widespread household and industrial use comprise volatile organic substances used as extraction solvents, solvents for degreasing metals and dry-cleaning clothes, and propellants for use in aerosol containers. This group also includes halogenated derivatives of methane, ethane and ethylene. As they are widely used their rates of dispersion in the environment, compared with the amounts produced, are generally high. The group also contains the polycyclic aromatic hydrocarbons, whose presence in the environment results from the extraction, transport and refining of petroleum products and the dispersion of combustion products resulting from their use (petrol and heating oil).
  • Materials used essentially in industry include substances which are direct or intermediate agents of chemical synthesis, such as carbon tetrachloride for synthesizing freons; vinyl chloride for polymerizing PVC; and chlorinated derivates of benzene, naphthalene, phenol and aniline for manufacturing dyestuffs. The group also contains finished products used in closed systems, such as heat-exchange fluids and dielectrics.

Organic micropollutants are generated from point and diffuse sources, either urban or rural. The largest part originates in major industrial activities such as petrol refining, coal mining, organic synthesis and the manufacture of synthetic products, the iron and steel industries, the textile industry and the wood and pulp industry. Effluents from pesticides factories may contain considerable quantities of these manufactured products. A significant proportion of organic pollutants are discharged into the aquatic environment as run-off from urban surfaces; and in agricultural areas, pesticides applied to crops may reach surface waters through rainwater run-off and artificial or natural drainage. Also, accidental discharges have led to severe ecological damage and temporary closure of water supplies.

Urban Pollution

Owing to this continuously expanding, aggressive and multi-faceted pollution scenario, the problem of maintaining the quality of water resources has become acute, particularly in the more urbanized areas of the developing world. Maintaining water quality is hampered by two factors: failure to enforce pollution control at the main sources, especially industries, and inadequacy of sanitation systems and of garbage collection and disposal (WHO 1992b). See some examples of water pollution in different cities in developing countries.

 


Examples of water pollution in selected cities

Karachi (Pakistan)

The Lyari river, which runs through Karachi, Pakistan’s largest industrial city, is an open drain from both the chemical and the microbiological point of view, a mixture of raw sewage and untreated industrial effluents. Most industrial effluents come from an industrial estate with some 300 major industries and almost three times as many small units. Three-fifths of the units are textile mills. Most other industries in Karachi also discharge untreated effluents into the nearest water body.

Alexandria (Egypt)

Industries in Alexandria account for around 40% of all Egypt’s industrial output, and most discharge untreated liquid wastes into the sea or into Lake Maryut. In the past decade, fish production in Lake Maryut declined by some 80% because of the direct discharge of industrial and domestic effluents. The lake has also ceased to be a prime recreational site because of its poor condition. Similar environmental degradation is taking place along the seafront as a result of the discharge of untreated wastewater from poorly located outfalls.

Shanghai (China)

Some 3.4 million cubic metres of industrial and domestic waste pour mostly into the Suzhou Creek and the Huangpu River, which flows through the heart of the city. These have become the main (open) sewers for the city. Most of the waste is industrial, since few houses possess flush toilets. The Huangpu has essentially been dead since 1980. In all, less than 5% of the city’s wastewater is treated. The normally high water table also means that a variety of toxins from industrial plants and local rivers find their way into groundwater and contaminate wells, which also contribute to the city water supply.

São Paulo (Brazil)

The Tiete River, as it passes through Greater São Paulo, one of the world’s largest urban agglomerations, receives 300 tonnes of effluents each day from 1,200 industries located in the region. Lead, cadmium and other heavy metals are among the main pollutants. It also receives 900 tonnes of sewage each day, of which only 12.5% is treated by the five sewage treatment stations located in the area.

Source: Based on Hardoy and Satterthwaite 1989.


 

Health Impacts of Microbial Pollution

Diseases arising from the ingestion of pathogens in contaminated water have the greatest impact worldwide. “An estimated 80% of all diseases, and over one-third of deaths in developing countries are caused by the consumption of contaminated water, and on average as much as one-tenth of each person’s productive time is sacrificed to water-related diseases” (UNCED 1992). Water-borne diseases are the largest single category of communicable diseases contributing to infant mortality in developing countries and second only to tuberculosis in contributing to adult mortality, with one million deaths per year.

The total annual number of cholera cases reported to the WHO by its member states has reached levels unprecedented during the seventh pandemic, with a peak of 595,000 cases in 1991 (WHO 1993). Table 1 shows the global morbidity and mortality rates of the major water-related diseases. These figures are, in many cases, grossly underestimated, since reporting of disease cases is done quite erratically by many countries.

Table 1. Global morbidity and mortality rates of main diseases related to water

 

Number/Year or Reporting Period

Disease

Cases

Deaths

Cholera - 1993

297,000

4,971

Typhoid

500,000

25,000

Giardiasis

500,000

Low

Amoebiasis

48,000,000

110,000

Diarrhoeal disease (under 5 years)

1,600,000,000

3,200,000

Dracunculiasis (Guinea Worm)

2,600,000

-

Schistosomiasis

200,000,000

200,000

Source: Galal-Gorchev 1994.

Health Impacts of Chemical Pollution

The health problems associated with chemical substances dissolved in water arise primarily from their ability to cause adverse effects after prolonged periods of exposure; of particular concern are contaminants that have cumulative toxic properties such as heavy metals and some organic micropollutants, substances that are carcinogenic and substances that may cause reproductive and developmental effects. Other dissolved substances in water are essential ingredients of dietary intake and yet others are neutral with regards to human needs. Chemicals in water, particularly in drinking water, may be classified into three typical categories for the purpose of health impact (Galal-Gorchev 1986):

  • Substances exerting an acute or chronic toxicity upon consumption. The severity of the health impairment increases with the increase of their concentration in drinking water. On the other hand, below a certain threshold concentration no health effects can be observed—that is, the human metabolism can handle this exposure without measurable long-term effects. Various metals, nitrates, cyanides and so on fall within this category.
  • Genotoxic substances, which cause health effects such as carcinogenicity, mutagenicity and birth-defects. According to present scientific thinking there is no threshold level which could be considered safe, since any amount of the substance ingested contributes to an increase in cancer and similar risks. Complex mathematical extrapolation models are used to determine such risks, since very little epidemiological evidence exists. Synthetic organics, many chlorinated organic micropollutants, some pesticides and arsenic fall within this category.
  • For some elements, such as fluoride, iodine and selenium, the contribution made by drinking water is crucial and, if deficient, causes more or less severe health effects. At high concentrations, however, these same substances cause equally severe health effects, but of a different nature.

 

Environmental Impacts

The impacts of environmental pollution on freshwater quality are numerous and have existed for a long time. Industrial development, the advent of intensive agriculture, the exponential development of human populations and the production and use of tens of thousands of synthetic chemicals are among the main causes of water quality deterioration at local, national and global scales. The major issue of water pollution is the interference with actual or planned water uses.

One of the most severe and ubiquitous causes of environmental degradation is the discharge of organic wastes into watercourses (see “Biodegradable organic compounds” above). This pollution is mainly of concern in the aquatic environment where many organisms, for example fish, require high oxygen levels. A serious side effect of water anoxia is the release of toxic substances from particulates and bottom sediments in rivers and lakes. Other pollution effects from domestic sewage discharges into watercourses and aquifers include the build-up of nitrate levels in rivers and groundwaters, and the eutrophication of lakes and reservoirs (see above, “Nitrates” and “Salts”). In both cases, the pollution is a synergistic effect of sewage effluents and agricultural run-off or infiltration.

Economic Impacts

The economic consequences of water pollution can be rather severe due to detrimental effects on human health or on the environment. Impaired health often lowers human productivity, and environmental degradation reduces the productivity of water resources used directly by people.

The economic disease burden can be expressed not only in costs of treatment, but also in quantifying the loss of productivity. This is particularly true for primarily disabling diseases, such as diarrhoea or Guinea Worm. In India, for example, there are about 73 million workdays per year estimated to be lost due to water-related diseases (Arceivala 1989).

Deficiencies in sanitation and the resulting epidemics can also lead to severe economic penalties. This became most apparent during the recent cholera epidemic in Latin America. During the cholera epidemic in Peru, losses from reduced agricultural exports and tourism were estimated at one billion US dollars. This is more than three times the amount that the country had invested in water supply and sanitation services during the 1980s (World Bank 1992).

Water resources affected by pollution become less suitable as sources of water for municipal supply. As a consequence, expensive treatment has to be installed or clean water from far away has to be piped to the city at much higher costs.

In the developing countries of Asia and the Pacific, environmental damage was estimated by Economic and Social Commission for Asia and the Pacific (ESCAP) in 1985 to cost about 3% of the GNP, amounting to US$250 billion, while the cost of repairing such damage would range around 1%.

 

Back

Read 11646 times Last modified on Thursday, 13 October 2011 18:31
More in this category: « Land Pollution Energy and Health »

" DISCLAIMER: The ILO does not take responsibility for content presented on this web portal that is presented in any language other than English, which is the language used for the initial production and peer-review of original content. Certain statistics have not been updated since the production of the 4th edition of the Encyclopaedia (1998)."

Contents

Environmental Health Hazards References

Allan, JS. 1992. Viral evolution and AIDS. J Natl Inst Health Res 4:51-54.

Angier, N. 1991. Study finds mysterious rise in childhood cancer rate. New York Times (26 June):D22.

Arceivala, SJ. 1989. Water quality and pollution control: Planning and management. In Criteria for and Approaches for Water Quality Management in Developing Countries. New York: United Nations.

Archer, DL and JE Kvenberg. 1985. Incidence and cost of foodborne diarrhoea disease in the United States. J Food Prod 48(10):887-894.

Balick, MJ. 1990. Ethnobotany and the identification of therapeutic agents from the rainforest. CIBA F Symp 154:22-39.

Bascom, R et al. 1996. Health effects of outdoor air pollution. State of the Art. Am J Resp Crit Care Med 153:3-50.

Blakeslee, S. 1990. Scientists confront an alarming mystery: The vanishing frog. New York Times. 20 February:B7.

Blaustein, AR.1994. UL repair and resistance to solar UV-B in amphibian eggs: A link to population declines. Proc Natl Acad Sci USA 91:1791-1795.

Borja-Arburto, VH, DP Loomis, C Shy, and S Bangdiwala. 1995. Air pollution and daily mortality in Mexico City. Epidemiology S64:231.

Bridigare, RR. 1989. Potential effects of UVB on marine organisms of the Southern Ocean: Distribution of phytoplankton and krill during Austral Spring. Photochem Photobiol 50:469-478.

Brody, JE. 1990. Using the toxin from tiny frogs, researchers seek clues to disease. New York Times. 23 January.

Brody, JE. 1991. Far from fearsome, bats lose ground to ignorance and greed. New York Times. 29 October:Cl,C10.

Carlsen, E and A Gimmercman. 1992. Evidence for decreasing quality of semen during the past 50 years. Br Med J 305:609-613.

Castillejos, M, D Gold, D Dockery, T Tosteson, T Baum, and FE Speizer. 1992. Effects of ambient ozone on respiratory functions and symptoms in school children in Mexico City. Am Rev Respir Dis 145:276-282.

Castillejos, M, D Gold, A Damokosh, P Serrano, G Allen, WF McDonnell, D Dockery, S Ruiz-Velasco, M Hernandez, and C Hayes. 1995. Acute effects of ozone on the pulmonary function of exercising schoolchildren from Mexico City. Am J Resp Crit Care Med 152:1501-1507.

Centers for Disease Control (CDC). 1991. Preventing Lead Poisoning in Young Children. Washington, DC: US Department of Health and Human Services.

Cohen, ML. 1987. Prepared statement in “Hearing before the Committee of Agriculture, Nutrition and Forestry”. US Senate, 100th Congress, First Session. (US Government Printing Office, Washington, DC).

Coleman, MP, J Esteve, P Damiecki, A Arslan, and H Renard. 1993. Trends in Cancer Incidence and Mortality. IARC Scientific Publications, No.121. Lyon: IARC.

Davis, DL, GE Dinse, and DG Hoel. 1994. Decreasing cardiovascular disease and increasing cancer among whites in the United States from 1973-1987. JAMA 271(6):431-437.

Davis, DL and D Hoel. 1990a. International trends in cancer mortality in France, West Germany, Italy, Japan, England and Wales and the USA. Lancet 336 (25 August):474-481.

—. 1990b. Trends in Cancer Mortality in Industrial Countries. Annals of the New York Academy of Sciences, No. 609.

Dockery, DW and CA Pope. 1994. Acute respiratory effects of particulate air pollution. Ann Rev Publ Health 15:107-132.

Dold, C. 1992. Toxic agents found to be killing off whales. New York Times. 16 June:C4.

Domingo, M and L Ferrer. 1990. Morbillivirus in dolphins. Nature 348:21.

Ehrlich, PR and EO Wilson. 1991. Biodiversity studies: Science and policy. Science 253(5021):758-762.

Epstein, PR. 1995. Emerging diseases and ecosystem instability. Am J Public Health 85:168-172.

Farman, JC, H Gardiner, and JD Shanklin. 1985. Large losses of total ozone in Antarctica reveal seasonal ClOx/NOx interaction. Nature 315:207-211.

Farnsworth, NR. 1990. The role of ethnopharmacology in drug development. CIBA F Symp 154:2-21.

Farnsworth, NR, O Akerele, et al. 1985. Medicinal plants in therapy. Bull WHO 63(6):965-981.

Federal Health Office (Switzerland). 1990. Bulletin of Federal Health Office. 29 October.

Floyd, T, RA Nelson, and GF Wynne. 1990. Calcium and bone metabolic homeostasis in active and denning black bears. Clin Orthop Relat R 255 (June):301-309.

Focks, DA, E Daniels, DG Haile, and JE Keesling. 1995. A simulation model of the epidemiology of urban dengue fever: literature analysis, model development, preliminary validation, and samples of simulation results. Am J Trop Med Hyg 53:489-506.

Galal-Gorchev, H. 1986. Drinking-Water Quality and Health. Geneva:WHO, unpublished.

—. 1994. WHO Guidelines for Drinking Water Quality. Geneva:WHO, unpublished.

Gao, F and L Yue. 1992. Human infection by genetically diverse SIVsm-related HIV-2 in West Africa. Nature 358:495.

Gilles, HM and DA Warrell. 1993. Bruce-Chwatt’s Essential Malaniology. London: Edward Arnold Press.

Gleason, JF, PK Bhartia, JR Herman, R McPeters, et al. 1993. Record low global ozone in 1992. Science 260:523-526.

Gottlieb, OR and WB Mors. 1980. Potential utilization of Brazilian wood extractives. J Agricul Food Chem 28(2): 196-215.

Grossklaus, D. 1990. Gesundheitliche Fragen im EG-Binnemarkt. Arch Lebensmittelhyg 41(5):99-102.

Hamza, A. 1991. Impacts of Industrial and Small-Scale Manufacturing Wastes On Urban Environment in Developing Countries. Nairobi: United Nations Centre for Human Settlements.

Hardoy, JE, S Cairncross, and D Satterthwaite. 1990. The Poor Die Young: Housing and Health in Third World Cities. London: Earthscan Publications.

Hardoy, JE and F Satterthwaite. 1989. Squatter Citizen: Life in the Urban Third World. London: Earthscan Publications.

Harpham, T, T Lusty, and P Vaugham. 1988. In the Shadow of the City—Community Health and the Urban Poor. Oxford: OUP.

Hirsch, VM and M Olmsted. 1989. An African primate lentivirus (SIVsm) closely related to HIV-s. Nature 339:389.

Hoel, DG. 1992. Trends in cancer mortality in 15 industrialized countries, 1969-1986. J Natl Cancer Inst 84(5):313-320.

Hoogenboom-Vergedaal, AMM et al. 1990. Epdemiologisch En Microbiologisch Onderzoek Met Betrekking Tot Gastro-Enteritis Bij De Mens in De Regio’s Amsterdam En Helmond in 1987 En 1988. Netherlands: National Institute of Public
Health and Environmental Protection.

Huet, T and A Cheynier. 1990. Genetic organization of a chimpanzee lentivirus related to HIV-1. Nature 345:356.

Huq, A, RR Colwell, R Rahman, A Ali, MA Chowdhury, S Parveen, DA Sack, and E Russek-Cohen. 1990. Detection of Vibrio cholerae 01 in the aquatic environment by fluorescent-monoclonal antibody and culture methods. Appl Environ Microbiol 56:2370-2373.

Institute of Medicine. 1991. Malaria: Obstacles and Opportunities. Washington, DC: National Academy Press.

—. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: National Academy Press.

Intergovernmental Panel on Climate Change (IPCC). 1990. Climate Change: The IPCC Impacts Assessment. Canberra: Australian Government Publishing Service.

—. 1992. Climate Change 1992: The Supplementary Report to the IPCC Impacts Assessment. Canberra: Australian Government Publishing Service.

International Agency for Research on Cancer (IARC). 1992. Solar and Ultraviolet Radiation. IARC Monographs On the Evaluation of Carcinogenic Risks to Humans. Lyon: IARC.

International Atomic Energy Agency (IAEA). 1991. International Chernobyl Project Assessment of Radiological Consequences and Evaluation of Protective Measures. Vienna: IAEA.

Kalkstein, LS and KE Smoyer. 1993. The impact of climate change on human health: Some international implications. Experiencia 49:469-479.

Kennedy, S and JA Smyth. 1988. Confirmation of cause of recent seal deaths. Nature 335:404.

Kerr, JB and CT McElroy. 1993. Evidence for large upward trends of ultraviolet-B radiation linked to ozone depletion. Science 262 (November):1032-1034.

Kilbourne EM. 1989. Heat waves. In The public health consequences of disasters. 1989, edited by MB Gregg. Atlanta: Centers for Disease Control.

Kingman, S. 1989. Malaria runs riot on Brazil’s wild frontier. New Scientist 123:24-25.

Kjellström, T. 1986. Itai-itai disease. In Cadmium and Health, edited by L Friberg et al. Boca Raton: CRC Press.

Koopman, JS, DR Prevots, MA Vaca-Marin, H Gomez-Dantes, ML Zarate-Aquino, IM Longini Jr, and J Sepulveda-Amor. 1991. Determinants and predictors of dengue infection in Mexico. Am J Epidemiol 133:1168-1178.

Kripke, ML and WL Morison. 1986. Studies on the mechanism of systemic suppression of contact hypersensitivity by UVB radiation. II: Differences in the suppression of delayed and contact hypersensitivity in mice. J Invest Dermatol 86:543-549.
Kurihara, M, K Aoki, and S Tominaga. 1984. Cancer Mortality Statistics in the World. Nagoya, Japan: The University of Nagoya Press.

Lee, A and R Langer. 1983. Shark cartilage contains inhibitors of tumor angiogenesis. Science 221:1185-1187.

Loevinsohn, M. 1994. Climatic warming and increased malaria incidence in Rwanda. Lancet 343:714-718.

Longstreth, J and J Wiseman. 1989. The potential impact of climate change on patterns of infectious disease in the United States. In The Potential Effects of Global Climate Change in the United States, edited by JB Smith and DA
Tirpak. Washington, DC: US Environmental Protection Agency.

Martens, WM, LW Niessen, J Rotmans, TH Jetten, and AJ McMichael. 1995. Potential impact of global climate change on malaria risk. Environ Health Persp 103:458-464.

Matlai, P and V Beral. 1985. Trends in congenital malformations of external genitalia. Lancet 1 (12 January):108.

McMichael, AJ. 1993. Planetary Overload: Global Environmental Change and the Health of the Human Species. London: Cambridge University Press.

Meybeck, M, D Chapman, and R Helmer. 1989. Global Freshwater Quality: A First Assessment. Geneva: Global Environmental Monitoring System (GEMS/-WATER).

Meybeck, M and R Helmer. 1989. The quality of rivers: From pristine stage to global pollution. Paleogeogr Paleoclimatol Paleoecol 75:283-309.

Michaels, D, C Barrera, and MG Gacharna. 1985. Economic development and occupational health in Latin America: New directions for public health in less developed countries. Am J Public Health 75(5):536-542.

Molina, MJ and FS Rowland. 1974. Stratospheric sink for chloro-fluoro-methanes: Chlorine atom-catalyzed destruction of ozone. Nature 249:810-814.

Montgomery, S. 1992. Grisly trade imperils world’s bears. The Boston Globe. March 2:23-24.

Nelson, RA. 1973. Winter sleep in the black bear. Mayo Clin Proc 48:733-737.

Nimmannitya, S. 1996. Dengue and dengue haemorrhagic fever. In Manson’s Tropical Diseases, edited by GC Cook. London: WB Saunders.

Nogueira, DP. 1987. Prevention of accidents and injuries in Brazil. Ergonomics 30(2):387-393.

Notermans, S. 1984. Beurteilung des bakteriologischen Status frischen Geflügels in Läden und auf Märkten. Fleischwirtschaft 61(1):131-134.

Noweir, MH. 1986. Occupational health in developing countries, with special reference to Egypt. Am J Ind Med 9:125-141.

Pan American Health Organization (PAHO) and World Health Organization (WHO). 1989. Final Report of the Working Group on Epidemiological Surveillance and Foodborne Diseases. Unpublished document HPV/FOS/89-005.

Patz, JA, PR Epstein, TA Burke, and JM Balbus. 1996. Global climate change and emerging infections diseases. JAMA 275:217-223.

Pope, CA, DV Bates, and ME Razienne. 1995. Health effects of particulate air pollution: Time for reassessment? Environ Health Persp 103:472-480.

Reeves, WC, JL Hardy, WK Reisen, and MM Milky. 1994. The potential effect of global warming on mosquitoborne arboviruses. J Med Entomol 31(3):323-332.

Roberts, D. 1990. Sources of infection: Food. Lancet 336:859-861.

Roberts, L. 1989. Does the ozone hole threaten antarctic life. Science 244:288-289.

Rodrigue, DG. 1990. International increase in Salmonella enteritidis. A new pandemic? Epidemiol Inf 105:21-21.

Romieu, I, H Weizenfeld, and J Finkelman. 1990. Urban air pollution in Latin America and the Caribbean: Health perspectives. World Health Stat Q 43:153-167.

—. 1991. Urban air pollution in Latin America and the Caribbean. J Air Waste Manage Assoc 41:1166-1170.

Romieu, I, M Cortés, S Ruíz, S Sánchez, F Meneses, and M Hernándes-Avila. 1992. Air pollution and school absenteeism among children in Mexico City. Am J Epidemiol 136:1524-1531.

Romieu, I, F Meneses, J Sienra, J Huerta, S Ruiz, M White, R Etzel, and M Hernandez-Avila. 1994. Effects of ambient air pollution on respiratory health of Mexican children with mild asthma. Am J Resp Crit Care Med 129:A659.

Romieu, I, F Meneses, S Ruíz, JJ Sierra, J Huerta, M White, R Etzel, and M Hernández. 1995. Effects of urban air pollution on emergency visits for childhood asthma in Mexico City. Am J Epidemiol 141(6):546-553.

Romieu, I, F Meneses, S Ruiz, J Sienra, J Huerta, M White, and R Etzel. 1996. Effects of air pollution on respiratory health of children with mild asthma living in Mexico City. Am J Resp Crit Care Med 154:300-307.

Rosenthal, E. 1993. Hibernating bears emerge with hints about human ills. New York Times 21 April:C1,C9.

Ryzan, CA. 1987. Massive outbreak of antimicrobial-resistant salmonellosis traced to pasteurized milk. JAMA 258(22):3269-3274.

Sanford, JP. 1991. Arenavirus infections. In Chap. 149 in Harrison’s Principles of Internal Medicine, edited by JD Wilson, E Braunwald, KJ Isselbacher, RG Petersdorf, JB Martin, AS Fauci, and RK Root.

Schneider, K. 1991. Ozone depletion harming sea life. New York Times 16 November:6.

Schultes, RE 1991. Dwindling forest medicinal plants of the Amazon. Harvard Med Alum Bull (Summer):32-36.

—.1992: Personal communication. 24 January 1992.

Sharp, D. (ed.). 1994. Health and Climate Change. London: The Lancet Ltd.

Shope, RE. 1990. Infectious diseases and atmospheric change. In Global Atmospheric Change and Public Health: Proceedings of the Center for Environmental Information, edited by JC White. New York: Elsevier.

Shulka, J, C Nobre, and P Sellers. 1990. Amazon deforestation and climate change. Science 247:1325.

Statistisches Bundesamt. 1994. Gesundheitswersen: Meldepflichtige Krankheiten. Wiesbaden: Statistisches Bundesamt.

Stevens, WK. 1992. Terror of the deep faces harsher predator. New York Times. 8 December:Cl,C12.

Stolarski, R, R Bojkov, L Bishop, C Zerefos, et al. 1992. Measured trends in stratospheric ozone. Science 256:342-349.

Taylor, HR. 1990. Cataracts and ultraviolet light. In Global Atmospheric Change and Public Health: Proceedings of the Center for Environmental Information, edited by JC White. New York: Elsevier.

Taylor, HR, SK West, FS Rosenthal, B Munoz, HS Newland, H Abbey, EA Emmett. 1988. Effects of ultraviolet radiation on cataract formation. N Engl J Med 319:1429-33.

Terborgh, J. 1980. Where Have All the Birds Gone? Princeton, NJ: Princeton University Press.

Tucker, JB. 1985. Drugs from the sea spark renewed interest. Bioscience 35(9):541-545.

United Nations (UN). 1993. Agenda 21. New York: UN.

United Nations Conference on Environment and Development (UNCED). 1992. Protection for the quality and supply of freshwater resources. In Chap. 18 in Application of Integrated Approaches to the Development, Management and Use of Water Resources. Rio de Janeiro: UNCED.

United Nations Environment Programme (UNEP). 1988. Assessment of Chemical Contaminants in Food. Nairobi: UNEP/FAO/WHO.

—. 1991a. Environmental Effects of Ozone Depletion: 1991 Update. Nairobi: UNEP.

—. 1991b. Urban Air Pollution. Environment Library, No. 4. Nairobi: UNEP.
Urban Edge. 1990a. Reducing accidents: Lessons learned. Urban Edge 14(5):4-6.

—. 1990b. Road safety a lethal problem in third world. Urban Edge 14(5):1-3.

Watts, DM, DS Burke, BA Harrison, RE Whitmire, A Nisalak. 1987. Effect of temperature on the vector efficiency of Aedes aegypti for dengue 2 virus. Am J Trop Med Hyg 36:143-152.

Wenzel, RP. 1994. A new hantavirus infection in North America. New Engl J Med 330(14):1004-1005.

Wilson, EO. 1988. The current state of biological diversity. In Biodiversity, edited by EO Wilson. Washington, DC: National Academy Press.

—. 1989. Threats to biodiversity. Sci Am 261:108-116.

—. 1992. The Diversity of Life. Cambridge, Mass.: Harvard University Press.

World Bank. 1992. Development and the Environment. Oxford: OUP.

World Health Organization (WHO). 1984. Toxic Oil Syndrome: Mass Food Poisoning in Spain. Copenhagen: WHO Regional Office for Europe.

—. 1987. Air Quality Guidelines for Europe. European Series, No. 23. Copenhagen: WHO Regional Office for Europe.

—. 1990a. Acute Effects On Health of Smog Episodes. WHO Regional Publications European Series, No. 3. Copenhagen: WHO Regional Office for Europe.

—. 1990b. Diet, Nutrition and Prevention of Chronic Diseases. WHO Technical Report Series, No. 797. Copenhagen: WHO Regional Office for Europe.

—. 1990c. Global Estimates for Health Situation, Assessment and Projections. WHO Technical Report Series, No. 797. Geneva: WHO.

—. 1990d. Potential Health Effects of Climatic Change. Geneva: WHO.

—. 1990e. Public health impact of pesticides used in agriculture. World Health Statistics Quarterly 43:118-187.

—. 1992a. Indoor Air Pollution from Biomass Fuel. Geneva: WHO.

—. 1992b. Our Planet, Our Health. Geneva: WHO.

—. 1993. Weekly Epidemiol Rec 3(69):13-20.

—. 1994. Ultraviolet Radiation. Environmental Health Criteria, No. 160. Geneva: WHO.

—. 1995. Update and Revision of the Air Quality Guidelines for Europe. Copenhagen: WHO Regional Office for Europe.

—. in press. Potential Health Effects of Global Climate Change: Update. Geneva: WHO.
World Health Organization (WHO) and ECOTOX. 1992. Motor Vehicle Air Pollution. Public Health Impact and Control Measures. Geneva: WHO.

World Health Organization (WHO) and FAO. 1984. The Role of Food Safety in Health and Development. WHO Technical Report Series, No. 705. Geneva: WHO.

World Health Organization (WHO) and UNEP. 1991. Progress in the Implementation of the Mar Del Plata Action Plan and a Strategy for the 1990s. Geneva: WHO.

—. 1992. Urban Air Pollution in Megacities of the World. Blackwells, UK: WHO.

World Health Organization (WHO) Commission on Health and Environment. 1992a. Report of the Panel On Urbanization. Geneva: WHO.

—. 1992b. Report of the Panel On Energy. Geneva: WHO.

World Meteorological Organization (WMO). 1992. GCOS: Responding to the Need for Climate Observations. Geneva: WMO.
Young, FE. 1987. Food safety and FDA’s action plan phase II. Food Technol 41:116-123.