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Current problems in occupational and environmental
health: overview
Wai-On Phoon
Pro fe s s o r o f Oc c upatio nal He alth, Unive rs ity o f Sydne y, Pymble , NSW, Aus tralia
Reports that among the major current problems in Asia-Pacifi c countries are those due to heat, heavy metals, organic solvents, pesticides, carcinogens, dusts, reproduc-tive hazards, biological haz-ards, and psychosocial prob-lems, including work stress. The relative importance differs from country to coun-try.
For m ost of t h e cou n t r ies in t h e Asia -P a cifi c r e gion su r veyed , t h e in for m a t ion con cer n in g t h e p r eva len ce or in cid en ce of occu p a t ion a l or en v ir on m en t a l d isea ses is eit h er in com p let e or ver y sca n t y. T h er e is oft en u n r e p or t in g of ca ses or in com p let e cover a ge of p r even -t ive p r ogr a m m es for occu p a -t ion a l d isea ses. T h is is sim ila r ly t h e ca se for h ea lt h p r oblem s d u e t o en v ir on m en t a l fa ct or s.
H ow ever, a s Ta ble I sh ow s, con d it ion s fr om a lm ost t h e en t ir e r a n ge of occu p a t ion a l d is-ea ses, p h y sica l, ch em ica l, b iologica l a n d p sych osocia l, a r e r e p or t ed a s of con sid er a ble im p or t a n ce in a ll t h ose cou n t r ies.
N oise a n d v ib r a t ion , follow ed by solven t s, p est icid es, d u st s a n d m u scu losk elet a l d isor -d er s, seem t o b e t h e m ost im p or t a n t p r oblem s w h ich r eq u ir e a d d r essin g.
It is of in t er est t h a t J a p a n a n d N ew
Zea la n d , t wo of t h e d evelop ed cou n t r ies in t h e r e gion , h a d p r oblem s w it h m ost of t h e en t i-t ies lisi-t ed , lik ew ise Sou i-t h Au si-t r a lia , on e of t h e Au st r a lia n st a t es su r veyed .
Accidents
Accid en t s r em a in on e of t h e m ost im p or t a n t occu p a t ion a l h ea lt h p r oblem s in t h e Asia P a cifi c r e gion . Un d er r e p or t in g of occu p a -t ion a l a ccid en -t s is b elieved -t o exis-t in m a n y of t h e less d evelop ed cou n t r ies t h er e, w h er e low levels of lit er a cy, u n fa m ilia r it y of t h e wor k er s w it h m od er n m a ch in es, a n d la ck of w ell-t r a in ed sa fet y p er son n el a ll con t r ibu t e t o h igh n u m b er s of su ch a ccid en t s.
Heat
Ma n y of t h e cou n t r ies su r veyed a r e in t h e t r op ics. H ea t st r ess m ay occu r fr om t h e oft en h igh t em p er a t u r es a n d h u m id it ies in t h ose cou n t r ies, in com b in a t ion w it h ot h er fa ct or s, su ch a s su d d en p h y sica l exer t ion . H ow ever, a r t ifi cia l sou r ces of h ea t , su ch a s fu r n a ces a n d b oiler s, m ay a lso ca u se h ea t p r oblem s.
Noise and vibration
T h e t ech n ology for t h e con t r ol of n oise a n d v ib r a t ion h a za r d s is q u it e w ell-k n ow n . It is
t h er efor e r a t h er su r p r isin g t h a t t h ese a r e st ill p r oblem s in m ost Asia -P a cifi c cou n t r ies. Som et im es t h e w r on g ea r p r ot ect ion is u sed . Som et im es t h e em p loyer d oes n ot p r ov id e t h e eq u ip m en t . At ot h er t im es t h e wor k er s d o n ot u se ea r p r ot ect ion even w h en p r ov id ed w it h it . T h e join t effor t s of b ot h em p loyer s, wor k er s a n d t h e gover n m en t a r e t h er efor e essen -t ia l (Ch ava li-t sa k u lch a i a n d Sh a h va n a z, 1989). In Sin ga p or e, n oise-in d u ced d ea fn ess is t h e m ost p r eva len t occu p a t ion a l d isea se. E ver y yea r, over 500 n ew ca ses of t h is con d it ion occu r (Tay, 1996).
Metals
In Sin ga p or e, st a t u t or y m ed ica l exa m in a t ion s h ave b een r eq u ir ed sin ce 1985 for wor k -er s exp osed t o sp ecia l h a za r d s. In 1988 su ch wor k er s t ot a lled 39,782. In 1989, wor k er s exp osed t o lea d n u m b er ed 786, t o a r sen ic 144, t o m a n ga n ese 101 a n d t o m er cu r y 67, m a k in g a t ot a l of 1,098 exp osed t o m et a ls. T h e la r gest n u m b er of wor k er s exp osed t o lea d w er e in t elecom m u n ica t ion s a n d t h ose m a n u fa ct u r -in g elect r on ic, p la st ic, st or a ge a n d p r im a r y b a t t er ies. T h e m ost com m on exp osu r e t o a r sen ic w a s in t h e m a k in g of elect r on ic p r od u ct s a n d com p on en t s a n d t h e wood p r eser va -t ion in d u s-t r ies (Ch ia et a l., 1993).
Solvents
E xp osu r e t o or ga n ic solven t a p p ea r s t o b e in cr ea sin g in m ost Asia -P a cifi c cou n t r ies. In a st u dy on n eu r ob eh av iou r a l sy m p t om s a m on g wor k er s exp osed over a lon g p er iod of t im e t o t olu en e, d ifficu lt ies of con cen t r a t ion a n d slee p in g, excessive sw ea t in g, fa t igu e, a n d t a ch yca r d ia w er e 1.8 t im es m or e p r eva len t a m on g t h e exp osed gr ou p t h a n con t r ols, a n d t h e sy m p t om s scor e w a s a lso sign ifi ca n t ly m or e in t h e h igh est exp osed gr ou p t h a n t h e low est exp osed gr ou p (Foo et a l., 1988).
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Country Under-reporting Heat vibration hazards M etals Solvents Pesticides Carcinogens Dusts Reproductive Biological M usculoskeletal Psychosocial stress hours work Others
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d ist u r b a n ces, or t h ost a t ic gid d in ess a n d sw ea t y p a lm s a n d soles. P er for m a n ce on m ost of t h e n eu r ob eh av iou r a l fu n ct ion t est s w a s gen er a lly p oor er in t h e exp osed gr ou p (N g et a l., 1990).
In Kor ea , a n ou t b r ea k of h a em a t op oiet ic a n d r e p r od u ct ive d isor d er s occu r r ed ow in g t o solven t s con t a in in g Z-b r om op r op a n e in a n elect r on ic fa ct or y. T h e ch em ica l w a s a m a jor com p on en t in a clea n in g solu t ion a n d w a s ea sily a b sor b ed t h ou gh t h e sk in . Fem a le wor k er s h a d a m en or r h oea a n d m a le wor k er s d ecr ea sed sp er m cou n t s. P la t elet s a n d leu cocy t es in t h e blood w er e r ed u ced . It w a s con -clu d ed t h a t t h e effect s w er e m ost lik ely d u e t o Z-b r om op r op a n e (P a r k et a l., 1997).
Pesticides
Pesticide poison in g is a com m on pr oblem in m ost Asia -Pa cific cou n tr ies. A colla bor a tive stu dy con du cted in fou r su ch cou n tr ies sh owed r epor ted r a tes per 1,000 a gr icu ltu r a l wor k er s a s 13.3 for In don esia , 132.8 for Ma laysia , 45.7 for Sr i La n k a a n d 81.3 for Th a ila n d.
Or ga n oph osph a te com pou n ds wer e th e m ost fr equ en tly r espon sible pesticides in In don esia , Ma laysia a n d Sr i La n k a (P h oon , 1993).
Carcinogens
Au st r a lia p r ob a bly lea d s t h e wor ld in t h e r e p or t ed in cid en ce of m a lign a n t m esot h e-liom a ca ses. Ab ou t 80 p er cen t of a ll n ot ifi ed ca ses h ave a d efi n it e h ist or y of exp osu r e t o a sb est os, m ost ly t o cr ocid olit e (Leigh , 1995).
Du r in g t h e p er iod 1979-81, a p p r oxim a t ely 500,000 wor k er s w er e exp osed t o b en zen e or b en zen e m ixt u r es in Ch in a . N in e ca ses of leu k a em ia w er e fou n d a m on g t h ose wor k er s (Yin et a l., 1987).
Wor k er s in sm a ll-sca le in d u st r ies a n d t h e la r ge n u m b er s of ch ild wor k er s in d evelop in g cou n t r ies oft en con st it u t e t wo h igh -r isk gr ou p s exp osed t o ca r cin ogen s (For a st ier i a n d Ma t es, 1994).
Dusts
By ssin osis is st ill p r eva len t in som e Asia -P a cifi c cou n t r ies. Text ile m ills in In d ia a pp ea r t o st ill h ave a h igh p r eva len ce of t h a t d isea se. In a st u dy of t h r ee t ext ile m ills, t h e m ea n p r eva len ce in t h e blow sect ion w a s 29.2 p er cen t a n d in t h e ca r d sect ion 37.83 p er cen t . In Sh a n gh a i, Ch in a , t h e over a ll p r eva len ce of by ssin osis in t wo t ext ile m ills w a s on ly 8 p er cen t , bu t n o a n a ly sis of p r eva len ce w a s p r o-v id ed for t h e d iffer en t sect ion s. In Hon g Kon g, t wo st u d ies of ca r d er s gave p r eva len ce r a t es of 59 a n d 74 p er cen t r esp ect ively (P a r ik h , 1992).
Silicosis is st ill p r ob a b ly t h e m ost com m on t y p e of p n eu m ocon iosis in t h e less d evelop ed cou n t r ies of t h e r e gion , bu t a sb est os-r ela t ed d isea ses a r e t h e m ost com m on in t h e m or e d evelop ed cou n t r ies.
Reproductive hazards
Re p r od u ct ive h a za r d s in t h e r e gion in clu d e “t r a d it ion a l” on es, su ch a s lea d , a n d m or e r ecen t on es, su ch a s v isu a l d isp lay t er m in a ls.
In a Ch in ese st u dy, t h e in cid en ce of con gen i-t a l d efeci-t in i-t h e offsp r in g of fem a le wor k er s exp osed t o ca r b on d isu lp h id e w a s fou n d t o b e sign ifi ca n t ly h igh er t h a n in con t r ols. T h e sp on t a n eou s a b or t ion r a t e of fem a le wor k er s exp osed t o t h a t ch em ica l, a s well a s of w ives of m a le wor k er s so exp osed , w a s a lso sign ifi -ca n t ly h igh er t h a n in con t r ols (Wa n g a n d Zh a o, 1987).
Biological hazards
In T h a ila n d a r ea son for t h e u p su r ge of m a la r ia ca ses in t h a t cou n t r y w a s fou n d t o b e t h e m igr a t ion of wor k er s fr om n on -m a la r ia l a r ea s t o t h e ea st er n r e gion , a n en d em ic a r ea for m u lt i-d r u g-r esist a n t p la sm od iu m fa lci-p a r u m in fect ion (Ka m ol-Ra t a n a k u l a n d P r a ssit t isu k , 1992).
Sch ist osom ia sis is st ill a p r oblem a m on g fi sh er m en in Ch in a . In H u n a n , it w a s fou n d t h a t t h er e w a s a p r eva len ce of Sch ist osom a ja p on icu m in fect ion of 41 p er cen t in a fi sh in g com m u n it y loca t ed n ea r a la k e (Li a n d Yu , 1992).
H IV a n d t h e h e p a t it is v ir u ses, B a n d C, a r e occa sion a lly t r a n sm it t ed fr om p a t ien t s t o m em b er s of t h e h ea lt h or r escu e p r ofession s or v ice ver sa t h r ou gh n eed lest ick in ju r ies bu t r a r ely by ot h er m ea n s (P h oon , 1995).
Musculoskeletal problems
Ba ck a ch e a n d t en o-sy n ov it is of t h e u p p er lim b s (som et im es ca lled r e p et it ion st r a in in ju r y (RSI) or occu p a t ion a l over u se sy n -d r om e (OOS)) a r e fr eq u en t ly r e p or t d , esp e-cia lly in t h e m or e d evelop ed cou n t r ies. RSI w a s, q u it e w r on gly, r e ga r d ed a s a n
“Au st r a lia n d isea se” in t h e la t e 1980s. In fa ct , t en o-sy n ov it is h a s b een k n ow n for h u n d r ed s of yea r s in m a n y ot h er cou n t r ies, a lb eit u n d er d iffer en t n a m es (Qu in la n a n d Boh le, 1991).
Psychosocial problems
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occu r r ed a m on g fa ct or y wor k er s t h er e. Ot h er cou n t r ies exp er ien cin g t h is p r oblem , w h ich is p r ob a b ly p sych osocia l in n a t u r e, in clu d ed Ma lay sia a n d T h a ila n d . It is b elieved t h a t t h ese m a ss h y st er ia ou t b r ea k s occu r r ed la r gely b eca u se of t h e socia l p r essu r es fr om r a p id in d u st r ia liza t ion , in clu d in g t h e en or -m ou s in fl u x of wor k er s fr o-m t h e r u r a l a r ea s in t o cit ies a n d t h e p sych osocia l p r oblem s a fflict in g m a n y of t h em (P h oon , 1983). In r ecen t yea r s, su ch ou t b r ea k s a p p ea r t o b e com p a r a t ively r a r e, p er h a p s b eca u se of gr a d -u a l st a b iliza t ion of t h e in d -u st r ia liza t ion p r ocess.
In r ecen t yea r s, t h er e h a s a lso b een a n in cr ea sin g n u m b er of sh ift -wor k er s, a n d p sych osocia l a n d h ea lt h p r oblem s h ave b een r e p or t ed a m on g som e of t h em .
Work stress
T h e su b ject of wor k st r ess is ga in in g in cr ea s-in g p r om s-in en ce, esp ecia lly a m on g t h e m or e d evelop ed cou n t r ies. T h e con cer n for im p r ovem en t of wor k in g en v ir on m en t a n d d evelop m en t of a ct ion p la n s for t h e m a n a ge-m en t of occu p a t ion a l h ea lt h h a s a lso cr ea t ed a n u r gen t n eed t o con sid er t h e va r iou s p sy -ch ologica l st r essor s a dver sley a ffect in g t h e q u a lit y of wor k in g life (Ga n gop a d h a , 1996). In J a p a n in r ecen t yea r s, t h e fa m ilies of wor k er s, u su a lly in t h e execu t ive r a n k s, w h o a r e a d ju d ged t o h ave d ied fr om sever e wor k st r ess, a r e eligible t o r eceive fa ir ly la r ge su m s in com p en sa t ion . In m a n y st a t es of Au st r a lia , wor k er s’ com p en sa t ion cla im s for wor k st r ess a r e m ou n t in g q u it e r a p id ly.
In Au st r a lia a r ecen t su r vey by Wor k sa fe Au st r a lia sh ow s t h a t t ea ch er s con st it u t e t h e occu p a t ion a l gr ou p w it h t h e m ost n u m b er of wor k er s’ com p en sa t ion cla im s. Ma n y of t h ese cla im s r ela t e t o wor k st r ess.
Environmental problems
T h er e is a n in cr ea sin g con cer n in t h e Asia -P a cifi c a b ou t t h e con t a m in a t ion of t h e en v i-r on m en t , w a st e of n a t u i-r a l i-r esou i-r ces, ext in c-t ion of p la n c-t a n d a n im a l sp ecies, a n d c-t h e t r a ffic ja m s, a ccid en t s, n oise a n d t h e u n h y -gien ic st a t e of m ay cit ies a n d t ow n s (Wor ld H ea lt h Or ga n iza t ion , 1992). Ma n y of t h ese p r oblem s cou ld b e a scr ib ed t o im b a la n ce of t h e ecosy st em .
H ow ever, ecologica l p r oblem s exist a lso in t h e r u r a l sect ion , a lt h ou gh t h ey m ay b e d iffer en t . A r esea r ch w a s con d u ct ed in eigh t In d on e-sia n v illa ges in J ava a n d Sou t h er n
Ka lim a t a n . A h igh in t est in a l p a r a sit e r a t e w a s fou n d in West J ava , b eca u se fi sh p on d s
w er e u sed a s t oilet s. Am on g t h e Ka lim a t a n v illa ges, w h ich w er e set t led by t r a n sm igr a n t s fr om J ava , m a la r ia w a s a p r oblem , a s t h e t r a n sm igr a n t s ca m e fr om n on -en d em ic a r ea s in J ava . Con ju n ct iv it is con t r a ct ed t h r ou gh m u d sp la sh es w h ile h oein g w et r ice fi eld s, a n d r et a r d a t ion in ch ild gr ow t h , fr om m a ln u -t r t ion , w er e o-t h er com m on p r oblem s id en -t i-fi ed . Sim p le yet effect ive p r even t ive m ea su r es t h r ou gh a n ecologica l a p p r oa ch w er e d ev ised (Su su k i, 1987).
It is a lso w ise t o h eed t h e w a r n in g
con t a in ed in a sch ola r ly a n d com p r eh en sive m on ogr a p h on “Clim a t e ch a n ge a n d h u m a n h ea lt h ”, “Va r iou s h ea lt h even t s h ave in d eed occu r r ed r ecen t ly t h a t m igh t b e ea r ly sign s of glob a l clim a t e ch a n ge. T h ey in clu d e t h e su b -st a n t ia lly in cr ea sed n u m b er of h ea t -r ela t ed d ea t h s in In d ia , m idw est USA a n d sou t h er n E u r op e in 1995, a n d ch a n ges in t h e
geogr a p h ic r a n ge of som e vect or -b or n e d is-ea se” (Wor ld H is-ea lt h Or ga n iza t ion , 1996). Cer t a in ly t h e “gr een h ou se ga ses” in t h e low er a t m osp h er e, la r gely p r od u ced by fossil fu el com bu st ion , a p p ea r t o h ave h a d a sign ifi -ca n t effect on glob a l w a r m in g.
References
Ch ava lit sa k u lch a i, P. a n d Sh a h va n a z, H . (1989), “T h e n eed for a p a r t icip a t or y con ser va t ion p r ogr a m m e for t h e r ed u ct ion of n oise exp o-su r e t o T h a i fem a le wor k er s”, A sia -Pa cifi c J ou r n a l of Pu blic H ea lth , Vol. 3 N o. 4, p p. 310-14.
Ch ia , S.E ., P h oon , W.H ., Lee, H .S., Ta n , K.T. a n d J eya r a t n a m , J . (1993), “E xp osu r e t o n eu r o-t oxic m eo-t a ls a m on g wor k er s in Sin ga p or e”,
Occu p a tion a l M ed icin e, Vol. 43, p p. 18-22. Foo, S.C., P h oon , W.O. a n d Lee, J . (1988), “N eu r ob
eh av iou r a l sy m p t om s a m on g wor k er s occu p a -t ion a lly exp osed -t o -t olu en e”, A sia -Pa cifi c J ou r n a l of Pu blic H ea lth , Vol. 2 N o. 3, p p. 192-7. One o f the tho us ands o f thriving to wns hips indus trie s in China. This e nte rpris e pro duc e s a famo us brand o f le athe r s ho e s . Unfo rtunate ly, in many s uc h indus trie s , be nze ne and o the r highly to xic c he mic als are s till us e d, o fte n witho ut ade quate pre c autio ns
[ 1 6 6] Wai-On Pho o n Curre nt pro ble ms in o c c upatio nal and e nviro nme ntal he alth: o ve rvie w
Enviro nme ntal Manage me nt and He alth
8 / 5 [1 9 9 7 ] 1 6 2 –1 6 6
For a st ier i, V. a n d Ma t es, E . (1994), “Sp ecia l exp o-su r e cir cu m st a n ces”, Occu p a tion a l Ca n cer in Dev elop in g Cou n tr ies, In t er n a t ion a l Agen cy for Resea r ch on Ca n cer, Lyon , p p. 97-108. Ga n gop a d h ya , A. (1996), “Occu p a t ion a l h ea lt h :
p sych ologica l p er sp ect ives”, In d ia n J ou r n a l of In d u str ia l M ed icin e, Vol. 42 N o. 4, p p. 226-59. Ka m ol-Ra t a n a k u l, P. a n d P r a ssit t isu k , C. (1992),
“T h e effect iven ess of p er m et h r in -im p r e g-n a t ed b ed g-n et s a ga ig-n st m a la r ia for m igr a g-n t wor k er s in E a st er n T h a ila n d ”, A m er ica n J ou r n a l of T r op ica l M ed icin e a n d H ygien e,
Vol. 47 N o. 3, p p. 305-09.
Leigh , J . (1995), “Ma lign a n t m esot h eliom a in Au st r a lia 1982-1995”, E u r op ea n R esp ira tor y J ou r n a l, Su p p lem en t 19, p. 437.
Li, Y.S. a n d Yu , D.B. (1991), “Sch ist osom a ja p on -icu m in fect ion a m on g m igr a n t fi sh er m en in t h e Don gt in g La k e r e gion in Ch in a ”, T ra n sa c-tion s of th e R oya l S ociety of T r op ica l M ed icin e a n d H ygien e, Vol. 85, p p. 623-5.
N g, T.P., On g, S.G., La m , W.K. a n d J on es, G.M. (1990), “N eu r ob eh av iou r a l effect s of in d u st r ia l m ixed solven st exp osu r e in Ch in ese p r in st -in g a n d p a -in t wor k er s”, N eu r otox icolog y a n d T era tolog y, Vol. 12, p p. 661-06.
P a r ik h , J .R. (1992), “By ssin osis in d evelop in g cou n t r ies”, B r itish J ou r n a l of In d u str ia l M ed icin e, Vol. 49, p p. 217-19 (ed it or ia l). P a r k , J .S., Ya n g, K., Don g, W.P., Kyeon g, S.C., P a r k ,
S.H . a n d Moon , Y.H . (1997), “An ou t b r ea k of h em a t op oiet ic a n d r e p r od u ct ive d isor d er s d u e t o solven t s con t a in in g Z-b r om op r op a n e in a n elect r on ic fa ct or y, Sou t h Kor ea ”, J ou r n a l of Occu p a tion a l H ea lth , Vol. 39 N o. 2, p p. 138-43.
P h oon , W.O. (1983), “Ma ss (e p id em ic) h y st er ia a m on g wor k er s”, E n cyclop a ed ia of Occu p a -tion a l H ea lth a n d S a fety, 3r d ed ., In t er n a t ion a l La b ou r Office, Gen eva , p p. 1800-02.
P h oon , W.O. (1993), “E n v ir on m en t a l a n d occu p a -t ion a l h ea l-t h : T h e Asia -P a cifi c Re gion ”,
In ter n a tion a l J ou r n a l of E n v ir on m en ta l M a n -a gem en t -a n d H e-a lth , Vol. 4 N o. 4, p p. 7-14. P h oon , W.O. (1995), “H ea lt h p r oblem s in sm a
ll-sca le h ea lt h est a blish m en t s”, Pr oceed in gs of th e In ter n a tion a l S ym p osiu m on Occu p a tion a l H ea lth R esea rch a n d Pra ctica l A p p r oa ch es in S m a ll-sca le E n ter p r ises, P a t t aya , T h a ila n d , p p. 237-41.
Qu in la n , M. a n d Boh le, P. (1991), “A ca se st u dy of occu p a t ion a l in ju r y : T h e RSI d eb a t e”, in Qu in la n , M. a n d Boh le, P. (E d s), M a n a gin g Occu p a tion a l H ea lth a n d S a fety in A u stra lia, Ma cm illa n , Melb ou r n e, p p. 113-40.
Su su k i, S. (1987), “Com p lex of en v ir on m en t , a ct iv -it y a n d h ea lt h in In d on esia n Ka m p u n gs”, in Su zu k i, T. a n d Oh t su k a , R. (E d s), H ea lth E col-og y of H ea lth a n d S u r v iv a l in A sia a n d th e S ou th Pa cifi c,Un iver sit y of Tok yo P r ess, Tok yo, p p. 149-64.
Tay, P. (1996), “Sever e n oise-in d u ced d ea fn ess – a 10 yea r r ev iew of ca ses”, S in ga p ore M ed ica l J ou r n a l, Vol. 34 N o. 4, p p. 362-8.
Wa n g, Y.L. a n d Zh a o, X.H . (1987), “Occu p a t ion a l h ea lt h of wor k in g wom en in Ch in a ”, A sia -Pa cifi c J ou r n a l of Pu blic H ea lth , Vol. 1 N o. 4, p p. 66-71.
Wor ld H ea lt h Or ga n iza t ion (1992), “H u m a n set t le-m en t s a n d u r b a n iza t ion ”, Ou r Pla n et, Ou r H ea lth ,Re p or t of t h e WH O Com m ission on H ea lt h a n d E n v ir on m en t , Wor ld H ea lt h Or ga -n iza t io-n , Ge-n eva , p p. 197-234.
Wor ld H ea lt h Or ga n iza t ion (1996), “Clim a t e ch a n ge a n d h u m a n h ea lt h ”, McMich a el, A.J ., H a in es, A., Sloof, R. a n d Kor a t s, S. (E d s), An a ssessm en t p r e p a r ed by a Ta sk Gr ou p on b eh a lf of WH O, Wor ld Met er eologica l Or ga n i-za t ion a n d UN E n v ir on m en t P r ogr a m m e, Wor ld H ea lt h Or ga n iza t ion , Gen eva , p. 232. Yin , S.N., Li, Q., Lu i, Y., Tia n , F., Du , C. a n d J in , C.
