Environmental Issues in Public Health

Hui Hu Ph.D.

Department of Epidemiology

College of Public Health and Health Professions & College of Medicine

July 25, 2017







Phenotypes are a function of inherited and environmental factors

P = G + E




T2DM, Cancer, LBW, PTD


Infectious agents





  • There are exquisite tools that have been developed to sequence the human genome and to interrogate individual susceptibility through genome-wide association studies (GWAS)
  • Thousands of GWAS


  • However, there was a lack of comparable tools in relation to exposure assessment
    -  almost uniquely focused on single exposure-health effect relationships and no global view of how various types of exposures co-exist and jointly affect health
  • A similar platform for discovery should exist for E
    - why?

  • Heritability: the range of phenotypic variability attributed to genetic variability in a population
    -  indicator of the proportion of phenotypic differences attributed to G
H^2={{\sigma^2_G}\over {\sigma^2_P}}
H2=σG2σP2H^2={{\sigma^2_G}\over {\sigma^2_P}}


  • To draw attention to the critical need for more complete environmental exposure assessment
    -  environment is defined in this context as 'non-genetic' factors
    -  exposome complements the genome
  • The exposome is composed of every exposure to which an individual is subjected from conception to death
    -  the nature of those exposures
    -  their changes over time
  • Expanded and dynamic exposure assessment across multiple domains
  • Integration of data on exposure and response across multiple scales of variation
  • Use of the resulting high dimensional information on multiple exposure-response relationships for data-driven discovery

Three domains of exposome

  • Three broad domains of non-genetic exposures:
    -  internal
    -  specific external
    -  general external

Source: Wild CP. The exposome: from concept to utility. International journal of epidemiology. 2012 Feb 1;41(1):24-32.

Three domains of exposome (continued)

  • There is overlap in the three domains
    -  physical activity can either be internal or specific external
  • The domains can also be considered as intertwined
    -  the internal may at least partially be a response to the external
  • Measures in one domain or another may reflect to differing degrees one component of the exposome:
    -  the urban environment (general external)
    -  air pollution (specific external)
    -  inflammation (internal)

Source: Wild CP. The exposome: from concept to utility. International journal of epidemiology. 2012 Feb 1;41(1):24-32.

Individual's Health

Behavior and Intrinsic Biological Factors

The Total Environment




Ultraviolet radiation:

  • May cause skin cancer and melanoma
  • Recent studies also showed associations between UVR and increased mortality due to CVD, cancer, and respiratory diseases

Radon gas:

  • Natural radioactive decay of uranium
  • May cause lung cancer

Air pollution:

  • Clean Air Act (1970, 1990)
  • Outdoor air pollution:
    6 criteria air pollutants - PM, SO2, CO, NOx, O3, Pb
  • Indoor air pollution: tobacco smoke, combustion products, radon gas

Climate change:

  • Extreme temperature and precipitation
  • Associated with increased mortality and morbidity

Food access, Walkability, and Greenness

  • Associated with physical activity, obesity, and cardiometabolic outcomes 


  • No safe level of lead exposure has been identified
  • Even low levels of lead can cause neuropsychiatric function and potentially lead to behavior problems

Education, Poverty, and Safety

  • Important health determinants


Natural Environment

  • Natural environment includes all things naturally occurring on Earth
  • Physical, chemical, and biological components or contaminants in soil, air, water
  • Exposure to these agents are usually unknown or unsensed by the exposed individual
    -  the exposure cannot be recalled or recorded by the study subject
    -  it can only be documented through measurements in the environment

Two types of errors

  • Error variance (lack of precision) in the measure
    -  individual levels of exposure are over- or underestimated but the mean exposure of a group is correct
    -  usually leads to attenuation of the observed relationship of the exposure to outcome
  • Systematically incorrect estimation of exposure levels
    -  the mean exposure level for a group is over or under-estimated
    -  can lead to over- or underestimation of the risk at a fixed level of exposure


  • A study trying to assess the association between exposure to magnetic field and childhood asthma
  • The authors obtained geocodes for all the participants, and linked them to the data from electrical utility companies which include all existing and historical 132-400 kV overhead trasmission lines.
    -  they assigned each home exposure levels 0 μT, 0.1 μT, 0.2 μT, or 0.4μT

Advantages of environmental measurements

  • Objectivity: depends on two steps
    -  the sampling of the environment
    -  the measurement procedure proper
  • In some case, both steps can be highly objective (e.g. measure the concentration of gaseous air pollution using personal sampler)
  • Often only the second step is objective, while identification and selection of the sample involves substantial subjectivity
    -  rely on information provided by the study subject to identify environmental materials to be sampled (e.g. use residential history to assess air pollution exposure)

Advantages of environmental measurements (continued)

  • Analytic specificity and sensitivity
  • If the exposure is a mixture of chemical, measurements specific for a single chemical may be inappropriate if
    -  that chemical is not the one responsible for the biological effect under study,
    -  and its concentration is not highly correlated with that of the active agent or with the total activity in the mixture
  • Cost and feasibility of use on a large scale

Advantages of environmental measurements (continued)

  • Individualized:
    -  can be achieved only when personal sampling is practicable over repeated and extended periods of time
  • In many cases, it can only be approximated by average measurements over time or groups of persons
    -  estimating air pollution exposure using a stationary air monitor
  • Errors in obtaining the original specimens from the environment and in sub-sampling for lab analysis may be the main source of error in environmental measurements

Sampling and measuring present exposures

  • Two main purposes:

    -  to be used as such in prospective cohort studies aimed at relating present exposure to future disease occurrence

    -  to be entered as one element in the process of estimating past exposure within cross-sectional, retrospective cohort, or case-control studies

Methods of environmental sampling

  • Measurement at fixed points within the environment and inferring individual exposure from the concentration of contaminants measured in the parts of the environment covered by each sampler
  • Measurement of the immediate and continually changing environment of individual subjects by some form of personal sampling
    -  this is preferred since it takes into account the subject's position in the environment, and concentrations of the environmental agent there, and behaviors which may modify exposure in particular circumstances

Selecting subjects for environmental sampling

  • Continuous sampling of the environment of each subject throughout all periods of exposure relevant to the study
    -  relatively simple in some settings: e.g. film-badge monitoring of exposure to ionizing radiaiton
    -  usually impracticable and unnecessary
  • Sampling both subjects and exposure time
  • Two main approaches:
    -  random selection of subjects and then grouping those appearing to share common levels of exposure to the environmental agent
    -  pre-definition of strata presumptively homogeneous with respect to the exposure and sampling randomly within the strata

Sampling and measuring past exposures

  • Measurements of present exposure in the environment are applicable to cross-sectional, case-control, or retrospective cohort studies only when it can be reasonably assumed that measurements in the present environment are highly correlated with the past
  • Records of past measurements of relevant exposures can be sought.
  • Three scenarios:
    -  complete data
    -  incomplete data
    -  data unavailable
  • It is practically impossible to monitor all agents present in the environment

Complete past measurements

  • Usually, the measurements on natural environment available were collected to check compliance with regulatory standards
  • Important to ascertain the purpose of the measurements and the frame within which they were collected
    -  they determine the way in which the samples were selected and the way they reflect the pattern of exposure of the study subjects
  • Example:
    -  measurements of only a fraction of the mixture of interest
    -  measurements only in "maximum risk employees"

Incomplete past measurements

  • Incomplete:
    -  lack of spatiotemporal coverage
    -  measured by sub-optimal methods
    -  measured only some correlate of the exposure of interest
  • Methods to address these problems:
    -  spatiotemporal interpolation
    -  calibration and conversion
    -  predictive models

Built Environment and Social Environment

Built Environment

  • Emcompasses all man-made surroundings that provide the setting for human activity 
  • Examples:
    -  green space
    -  sidewalks/trails
    -  parks/recreational services
    -  food access

Social Environment

  • Important health determinants
  • Examples:
    -  demographics
    -  economy
    -  social capital
    -  safety

US Census Geographic Entities


Group Discussion

  • Read the article below (
  • What do you think about population-level vs. individual-level environmental interventions? Discuss their strengths and limitations.


By Hui Hu


Slides for the Guest Lecture, Summer 2017, PHC4101 Public Health Concepts

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