From the perspective of human health impacts, both exposures and the resulting human health effects must be represented. These aspects have been taken into account in a further adaptation of the framework for health purposes, the DPSEEA framework (WHO 1995; Briggs et al. 1996). It is a descriptive representation of the way in which various driving forces generate pressures that affect the state of the environment and, ultimately, human health, through the various exposure pathways by which people come into contact with the environment.
People may become directly exposed to potential hazards in the environment when coming into direct contact with these media through breathing, drinking, or eating, for example. A variety of health effects may result, ranging from minor, subclinical effects (i.e., effects that may not manifest in overt symptoms) through to illness and sometimes death, depending on the intrinsic harmfulness of the pollutant, the severity and intensity of exposure, and the susceptibility of the person exposed (e.g., the elderly, the young, and the sick may be more susceptible than others).
Various actions can be implemented at different points in the framework and may take different forms. They might involve the policy development, standard setting, technical control measures, health education measures, and treatment of people with diseases.
Although the DPSEEA framework, like the PSR framework on which it is based, represents the various components in a linear fashion in order to more clearly articulate the connections between factors influencing health and the environment, in reality the situation is much more complex, with various interactions occurring at different levels between various components. The different components of the DPSEEA framework are given in Figure 15.1. The framework can be applied to information gathering and indicator development at the national level, the sectoral level, or the community or neighborhood level (Hammond et al. 1995; WHO 1997).
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