CHAPTER 5 Health roblems Related to Work and Environment Women’s health and the environment ——E he links berween human health and the environment have long been recognized. The physical, biological and social environment in waich we live affects our physical and mental well-being in significant ways The discussion in this section, however, will focus on aspects of the biophysical environment that most affect buman health. The biophysical environment may be seen as comprising the immediate home and work environments, as well asthe larger regional, sational and global environments. It includes both natural and constructed elements such as clean air, water and forest resources, houses and factories, and vectors and pests. Such definition allows ws to avoid arbitrary distinctions between natural and built environments urbaa and rural areas, and developing and developed countries. 1) While the last decade bas seen much work done on identifying the linkages between gender and the environment, the interaction between environmental factors and gender on women's health remains a relatively unexplored area, The preseat discussion remains illustrative rather than substantive, owing to the serious limitation of hard data — both qualitative aad quantitative — that reveal the interaction between gender, health and environment. The important biological differences by sex which put women and men at differential risks from environmental factors have often been recognized when examining environmental health issues. When compared to men women have ¢ smaller statur: Health Problems Related to Work and Environmes their vital capacity is 11% less, and their haemoglobin is roximately 20% less. They ave a larger skin surface area when compared to circulating volume, and more fa: content it their bodies. Moreover, women’s role in biological reproduction exposes them as well as th unborn children to addicion health risks. 2) However, this constitutes only one part of a gendered understanding of environmental alth issues. In almost all societies, women and mea tend ro occupy, use and manage aspects of the biophysical envi- ronment in a gender differen- tiated manner. Women and men engage in different spheres of activity, and the amount of time they spend interacting with various elements of the environment tend to vary. It may therefore be anticipated that the nature and degree of the environmental health risks to which women and mea are exposed would be different Despite this, few studies have examined environmental risks and health consequences from such a perspective Environmental health hazards include traditional hazards arising from human ity and natural phenomena, h as poor sanitation and contaminated drinking water and indoor air pollution. T! also include modern hazards, such as outdo: ‘ir pollution, water pollution from industrial effluents and the lowering of the water table, chemical and radiation hazards, and depletion of natural resources that have resulted from che pattern of economic development adopted by most countries 123Poor sanitation and con- raminated drinking water are two of the most common envi- ronmental hazards in many countries of the world. Us- sanitary excreta disposal and contamination of drinking water by pathogens are associated with diarrhoeal diseases which kill approximately three million children annually, and schisto- somiasis and imestinal helminth infection which affect hundreds of millions each year 0. The lack of adequate sanitation facilities and unsafe drinking water represents a serious health threat in countries of the South-East Asia Region, where in the majority of countries, 30-75% of the population are not covered by sanitation facilities, (Table 54). In crowded settlements and areas lacking adequate sewage facilities. contamination of ground and surface water sources used for drinking, washing and cleaning is common. For example, untreated sewage is discharged into the Ganges river in India, the Kelani river in Colombo, and in canals and rivers near Bangkok, causing high levels of faecal coatamination of water used for fnuman consumption 1 424 Women of South-East Asia: A Heal Table 54: Percentage of population covered by sanitation facilities, 1999s} Faecal contamination of drinking water and food is associated with hepatitis A, a common viral infection in all countries of the Region. Most countries are also highly endemic for hepatitis E, an infection with potentially fatal consequences to pregnant women (see Chapter 2) Data gathered by WHO show that more than 60 water-borne outbreaks of hepatitis E were reported from Bangladesh, India, Indonesia, Myanmar and Nepal during the last 20 years Approximately four million cases of HEV infection occur in the Region every year. (61 Although not having re- solved the water pollution problems irom poor quality water supply and lack of sanitation facilities countries of the Region are, at the same time, faced with “modern” pollution problems from organic matter contained in industrial effluents. Many rivers and water bodies are becoming saturated with organic compounds from industrial effluents, posing a major chreat to both human health and aquatic life jg). For example, leather and textile industries, “traditional” organic toxic Profile Bangladesh hutan 7 DER Korea [tee ina po indonesia | 46.1 Maldives (ose Myanmar I 57.2 Nepal cos Sr Lanka 0 [| Thaliand { 964 387 which are among Bangladesh's most important export prospects, are polluting the rivers in Dhaka, Chittagong and Khulna. The Haza- ribagh area of Dhaka has 250 leather factories which dump toxic effluents into the Buriganga river 7. Haphazard construction of industries in areas with access to one of the major river systems, and direct dumping of untreated industrial effluents into Nepal's Bagmati and Bishnumatl rivers, have resulted in high concen- trations of sodium, potassium and chlorine /8. In Indonesia (4) the results of about 20 studies on rivers have shown that even those used to supply drinking water are heavily polluted. Water from the lakes of Sewu in Yogyakarta previously used for household purposes and for drinking are now polluced and unfit for human conssm- ption. This is also true of wells In the Jakarta area which have wen found to be contaminated by detergents and nitrates, while shallow wells have significant levels of organic and coliform ungcontamination. Pollution of water sources previously fit for buman consumption adds ro women's workload in fetching water from alternative sources. Arsenic contamination of ground water, the main source of drinking waver, has bee detected in 7 districts of West Bengal, India and in 23 districs of Bangladesh (5,70. Levels up to 79 times hhigher than the national drinking water standards of 0.05 me/l have been found in both countries, The contamination is due to the ecology of the region Although there are no reliable data on the incidence of arsenic poisoning, about 30 million people are believed to be at risk of exposure (1h Arsenic poisoning is slow and cumulative, and is tal several years for symptoms to appear. Sy include melanosis (abnormal black-brown pigmentation of the skin), hyperkeratosis (thickening) of the alms and soles, gangrene of the lower es s, and skin cancer reme cases of hyperkeratosis, the soles aad palms of the patient are covered by black bulbous swellings. proms “The disfigurements caused by arsenic poisoning often the social ostracisation of the persons affected, much like in the case of leprosy. The consequences to women are especially harsh, and several cases of desertion and divorce have deen documented in field report from one of the many affected disericts (72 Air pollution is a serious environmental health hazerd affecting the populations of developing and developed countries alike, Indoor air pollution is mainly with the use of biomass fuels for cooking in settings with poor ventilation. Industrial emissions and automobiles are the principle sources of outdoor air pollution. sociated Suspended particulate matter (SPM) including lead, gaseous inorganic pollutants such as sulp! dioxide, carbon monoxide and nitrogen oxides, as well as hydrocarbons and volatile organic compounds are among some of the major air pollutants ‘All of these cause considerable damage to health. Suspended particulate matter contribute to respiratory problems, and this is especially true of SPM under 19 microns, which are so small that they penetrate deeply into the lung, SPM under 10 microns are also more closely linked to cancer, particularly if they are of hydrocarbon origin. (177 Lead affects the circulatory ous and systems as well as Carbon monoxide, if inhaled by pregnant women, may threaten the growth and elopment of the foetus Nitrogen oxides increase sasceptibility to viral infections and can irritate the lungs and cause bronchitis and pneumonia, /23) meatal Indoor air pollution is a greater threat to health than outdoor air pollution. The “rule of 1000” states that a pollutant released indoors is 1090 times more likely to reach people's lungs than a pollutant released outdoors, since it is released at close proximity. Pollutant concentrations can be extremely high, exceeding WHO guidelines by a factor of more than 100 (1 The use of biomass fuels, such as wood, dung, agricultural lth Problems Related to Work and Environment 125