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New Health




Presentation by Thebe A Pule, Directorate National Environmental Health at the National Conference on Environmental Health in Durban, Kwazulu-Natal

on 2nd – 4th August 2000 

Environmental, health and development are inextricably linked. Development without consideration of health are unsustainable, health without environmental consideration is negatively affected, and the environment wherein development occurs has to be carefully considered otherwise development will impact negatively on health. Thus, for the developments to be sustainable, developments have to consider the environment and health. Environmental health is that practice where health considerations of the health of people and the environment are given priority in developments. 

There are many factors to consider when improvements are anticipated and implemented. These may be varying from institutional, legal to human resources. In trying to attack or tackling a problem, consideration of strategy is vital to maximise one’s efforts. Applying a domino theory, improving human resource offers one of the greatest advantages in tackling a problem and this was certainly a case in improving service delivery in environmental health. 

History of Environmental Health

In South Africa, in 1700, Jan Van Riebeck introduced a decree in the Cape Province that washing in Table Mountain be prohibited. In Britain 1800s Edwin Chadwick championed the course of sanitary science, “ all smell is disease.” Dr John Snow demonstrated that disease can be controlled through physical interventions, the Broad Street Pump. John Ruskin, “there is no wealth but life…” that there more healthier the better. The Working Party on the Recruitment, Training, Qualification of Sanitary Inspector on early history of profession once said that “ what needed to be done was usually fairly obvious; the problem was to induce the person responsible to do it, and this was primarily a problem of policing.” This was introducing the element of enforcement. The early history of environmental health evolved from these dimensions and enforcement became one of those slightly emphasised in the profession especially in South Africa. 

Environmental Health is defined, by WH Bassett, as the control and management of factors in man’s physical environment, that exercise or may exercise deleterious effect to man’s health or survival. In the development of sanitarians or Environmental Health Practitioners, technical robustness in identifying factors affecting or likely to affect health were brought to the fore; it was also important to ensure that positive aspects are enforced, this could most of the time be achieved through legislative machinery. Over the years, the importance of the involvement of affected and interested stakeholders was recognised  but not fully exploited as it could have been or should. These aspects could not have been brought more vividly to the fore than in the last thirty years. The concept of Primary Health Care (PHC) was concretised in Alma-Ata, former USSR wherein cooperative governance, community participation, prevention, information sharing were acknowledged as contributors to total health. In 1992 in Rio De Janeiro, Brazil the United Nation Conference on Environment and development (UNCED), brought to prominence the need to consider the relationship between the environment, health and development for developments to be sustainable, Agenda 21, Climate change, Biodiversity and other action plans flowed from these so called Earth Summit. It was during this period that advocacy about the importance of interacting with communities, with other partners outside government came to be realised as an important link in the improvement of the health of communities.

Environmental Health in South Africa    

The changes in South Africa could not have been more dramatic than after 1994, and so was the case in the field of environmental health. The new social dispensation brought with it the Constitutional of South Africa, 1996 (Act 108 of 1996). Striking in the constitution is consideration about the environment, Section 24, Everyone has the right-


a)      to an environment that is not harmful to their health or well-being; and

b)      to have the environment protected, for the benefit of present and future generations, through reasonable legislative and other measures that- 

i)                    prevent pollution and ecological degradation;

ii)                  promote conservation; and

iii)                 secure ecologically sustainable development and use of natural resources while promoting justifiable economic and social development. 

This laid foundation for development of enabling policies. The Department of Health developed a policy, the White Paper on the Transformation of the National Health System in South Africa. Within this policy document was the framework about environmental health, among others, upon which the proposed Implementation Strategy for Environmental Health is based. Other government departments such as education and training developed enabling legislation that gave guidance to the development of human resources in this country, the National Qualification Framework, the National Environmental Management ACT by the Department of Environmental Affairs and Tourism (DEAT). These policy frameworks gave the profession the niche to cart the way forward, albeit grudgingly. 

In 1998, the profession began a process of reviewing the impact of its service delivery in the country. This process led to the Transformation of  Environmental Health Human Resource Development in Environmental Health. This involved assessing factors that enable or  disable service delivery. These were identified as;

The development of the human resource for environmental health, from the institution level to the product;

                       The scope of practice; and                     Legislative machinery. 

Processes and procedures were put in place to begin to tamper and transform all those areas to ensure that service is improved. To date,The Scope of Practice is being reviewed to reflect the practice, that recognises the principles of primary health care- community participation, inter sector collaboration, cooperative governance, data and information management;

The Standard Generation Body (SGB) is being formed through the participation of all stakeholders, to begin the process of developing unit standards for the curriculum of environmental health;  

The review of legislation is in progress; The mechanisms of continuos professional development (CPD) to ensure that practitioners/officers are at the cutting edge of technology and in step with current trends in the field is being put into place; 

All these are captured in the Environmental Health Services: Strategies for accelerated Implementation, 2000 –2004. The document that flowed from the various Provincial and national workshops between 1998 and 1999.

The trend to re-incarnate the field of environmental health is not only experienced in South Africa. Tanzania has just gone through this exercise and Pan American countries have recently adopted a strong primary environmental care  (PEC) strategy. 



Chartered Institute of Environmental Health, U.K, 1998. For  The Common Good of Public Health- An EHJ Commemorative issue.

The Constitution of the Republic of South Africa, 1996(Act 108 of 1996).

 Department of Health, Towards a National Health System in South Africa, 1998

Bassett, WH, 1990, Clay’s Handbook. Oxford Publishing  Press ?

PAHO, 1998, Primary Environmental Care. Pan American Health Organisation (PAHO) Division of Health and Environment, Washington D.C.

Department of Education, National Qualification Framework, 1998

Department of Environmental Affairs and Tourism, National Environmental Management Act, 1998.

Pretoria Declaration in Health and Environment in Africa-Responding to the challenges of Health and Environment Towards Sustainable development, 1997.



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