Role of Environmental Health in COVID-19 Pandemic : An acknowledgement memoir to the environmental and public health officers in Kenya
On 26th September, 2020, about a week ago, the world celebrated ‘world environmental health day’ whose theme was : Environmental health, a key public health intervention in disease pandemic prevention. A timely theme in the wake of the covid-19 pandemic.
According to the World Health Organization (WHO) , environmental health is a science that addresses all the physical , chemical and biological factors external to a person and all the related factors impacting behaviours. The practice of environmental health encompasses the assessment and control of those environmental factors that can potentially affect health. This is targeted towards preventing disease and creating health supportive environments. As a fundamental component of a comprehensive public health system, Environmental health works to advance policies and programs to reduce diseases and other environmental exposures in air, water, soil and food to protect residents and provide communities with healthier environments.
In summary, environmental health is the anchor on the practice of preventive healthcare — prevention is the key principle.
We have had the saying ‘prevention is better than cure’ many times and it has been used in various contexts including when one wants to stop something they deem dangerous if it is allowed to happen. In 2020, with covid-19 as it has been with other pandemics and epidemics, and even more recently and closer home, the ebola epidemic in West Africa between 2014 and 2016 , this saying rings true.
As various organizations including professional associations, national governments around the continent such as in Zambia, South Africa, Zimbabwe, Namibia marked the world environmental health day through various initiatives and activities, Kenya was somewhat silent.
In Kenya, the practice of environmental health, which is a branch of the wider Public health is practiced by public health officers and technicians in the public sector and environmental health practitioners in the private sector. Indeed, public health officers are health care workers whose work and mandate is within and outside of health facilities. A lot of prevention work happens outside of wards, consultation rooms, laboratories and all other spaces you will encounter when you go to a health facility such as a health centre or hospital. Prevention activities such as ensuring water sources are not contaminated, food safety , disease surveillance including vaccinations, preventing hospital acquired infections, air quality monitoring, environmental sanitation, liquid(sewage) and solid waste management , occupational health and safety, among others are at the core of the profession. Such activities reduce the burden of disease hence improving the quality of life that significantly reduces one’s visits to the hospital. To put into perspective, WHO in its world report on aging and health of 2015 estimated that the 15 of the extra 20 years of life that we now enjoy compared to a century ago is attributable to environmental health interventions.
In the fight against covid-19, the public health officers are at your frontline too.
Though under resourced both in budgetary allocations and human resources , they have been at your points of entry in the country, border points and airports, they are the backbone of contact tracing and surveillance, they are coordinating the burials and handling of deceased covid-19 persons, community engagement on behaviour change and health education, home based care for covid-19 patients, disinfection and decontamination of premises and public places, infection prevention and control in health facilities and isolation facilities, infectious waste management particularly in health facilities and so much more. With this in mind, these officers at every turn of their work, are at risk of contracting covid-19 and this has turned fatal for some. These roles are being performed in addition to other prevention programs that need to keep running in order to not have an upsurge of other diseases such as cholera, malaria, measles that would complicate management of covid-19 and/or overwhelm the healthcare system.
The nature of preventive healthcare is such that the services are almost abstract, invisible to the public eye. The lack of tangible physical representation of a health issue makes it somewhat difficult for the general public to appreciate the work hence can easily be ignored. Suffice to say, the success of environmental and public health officers is somewhat inconspicuous to the general public. In addition, the profession has been greatly misunderstood over the years and in Kenya in particular, I posit that the misunderstanding is largely due to the portrayal of the practice as having an enforcement and regulatory role. This misunderstanding is noted by Tony Lewis in his article on the Royal society of public health platform, that there has been a sustained false belief that we are narrow regulators.
The idea of ignoring environmental health is not a trend in Kenya only, as the world has been defunding preventive health care in favour of curative or pharmaceutical interventions of health care. A quick look up on the literature about adequate rations of health workers per a given population will reveal that the readily available information is on physicians (doctors) nurses and midwives — even while within health care there are very many other different cadres including environmental and public health officers. The effects of these resource constraints are now obvious with the pandemic and it is hopefully going to stir a conversation among governments , global health partners on strengthening environmental health and all its sub-disciplines as such : epidemiology and biostatistics, toxicology, occupational hygiene, environmental engineering among others.
For the here and now, in the face of the covid-19 pandemic and a national health emergency that we have been in since March, Tony Lewis asserts that, “it is crucial that the wider public health community recognizes the environmental health workforce as not only being appropriately skilled but also ready to be called upon”. Indeed, the environmental and public health officers in Kenya are ready and able to stand in the gap in the prevention of future epidemics, a recognition of their role coupled with adequate resource allocation will be important to support this endeavour.
NB: I credit the zeal of being able to write this to being part of the environmental and public health association of Kenya(EPHAK) and the insightful conversations we have been having in the past months.