Экологическая медицина = Ecological medicine

УДК 61:[574.2+502/504](075.8)
ББК 58
	
Э40
А в т о р ы: В.Н. Бортновский, Л.П. Мамчиц, В.Б. Масякин, М.А. Чайковская, 
А.А. Лабуда, Д.Б. Сахарова
Р е ц е н з е н т ы: кафедра экологической и профилактической медицины УО «Витебский государственный ордена Дружбы народов медицинский университет» 
(заведующий кафедрой экологической и профилактической медицины кандидат 
медицинских наук, доцент Н.И. Миклис); заведующий кафедрой общей гигиены 
и экологии УО «Гродненский государственный медицинский университет» доктор 
медицинских наук, профессор И.А. Наумов; доцент кафедры современных технологий перевода Минского государственного лингвистического университета кандидат 
филологических наук, доцент Т.И. Голикова
Все права на данное издание защищены. Воспроизведение всей книги или любой ее 
части не может быть осуществлено без разрешения издательства.
ISBN 978-985-599-937-0 	
©	Учреждение образования
	
	
«Гомельский государственный
	
	
медицинский университет», 2024
 	
©	Оформление. Республиканское
	
	
унитарное предприятие 
	
	
«Издательство “Адукацыя 
	
	
і выхаванне”», 2024

ABBREVIATIONS
CNS – central nervous system
DDT – dichloro-diphenyl-trichloroethane
DR – dose rate
EAS – erythemal action spectrum
EF – environmental factor
EMF – electromagnetic field
EMR – electromagnetic radiation
HSH – hexachlorocyclohexane
IR – infrared
LOC – level of concern
LP – lipid peroxidation
MED – minimal erythema dose
MF – microwave frequency
PL – permissible limit / level
SI – International System of Units
UHF – ultra high frequency
UV – ultraviolet
WHO – World Health Organisation

INTRODUCTION
Modern conditions of social development are characterised by an active 
human interference with the environment. The advent of new technologies, 
industries, and intensive agriculture are associated with the increasing use of 
chemical compounds, physical and abiotic factors. There are currently 4 million toxic substances registered in the external environment and this number 
continues to increase annually by 6,000. The human body receives about 
100 thousand xenobiotics, and every fourth inhabitant of the Earth is suffering from allergies and autoimmune diseases, more than 80% of diseases are 
caused by environmental stress. The most severe effect of biosphere pollution 
is the genetic consequences. Nowadays, there are more than 2,500 types of 
impairments or disabilities at the gene and chromosomal levels. Every year 
the proportion of the social component in the comprehensive assessment of 
the health of modern human is increasing. Stresses are regarded as the leading risk factor negatively affecting human health and contributing to the 
emergence of new forms of environmental illnesses. Various forms of peculiar 
non-specific diseases have appeared over the recent decades. Some of these 
diseases are manifested in the form of extreme fatigue, or “living death.” The 
concept of “eco fatigue” has been introduced into the scientific discourse. 
Under these conditions, the importance of training doctors to carry out 
measures to protect and preserve the health of the population becomes all 
the greater. The formation of an integrated and harmonious system of 
knowledge and thinking in this area is a necessary component for a fullfledged medical practice. This will enable the specialist to take into account 
the effect of environmental factors and lifestyle on the individual’s health 
and adequately adjust the examination and treatment of patients. The 
knowledge gained when studying environmental medicine is necessary for 
carrying out targeted preventive measures among critical groups. Teaching 
Environmental Medicine makes it possible to develop an ecologically-oriented thinking and produce certain results while studying clinical specialties.
With the introduction of medical and environmental monitoring, there 
is a real opportunity to combine the results of many scientific disciplines 
involved in ecology and medicine, as well as to justify the overall system of 
knowledge about the protection of nature and human health – medical 
ecology or environmental medicine.
The task of environmental medicine is to identify patterns (trends) in the 
morbidity due to the peculiarities of complex influence of environmental 
factors and to develop considered recommendations and productive environmental and health measures to protect against the adverse effects and factors.

Chapter 1
FUNDAMENTALS OF ENVIRONMENTAL MEDICINE
Motivational characteristic of the topic. Environmental medicine, which 
stems from general ecology and environmental hygiene as a complex interdisciplinary direction in medicine, focuses on the interaction and interdependence of several factors (metoclimatic, geo-ecological, demographic, industrial, domestic, etc.) of the environment and public health. Therefore, it is essential to become aware of the relationship between the anthropogenic impact on the environment and human health. Knowledge of 
these mechanisms will allow implementing a set of measures to prevent 
environmentally dependent and related diseases.
With such rapid environmental pollution, the human being both as the 
initiator of the transformations in nature and the representative of the biosphere animal world is exposed to environmental hazards, and has to constantly mobilize their compensatory-adaptive mechanisms the reserves of 
which may eventually be depleted. The doctor must carry out individual 
and population prevention of ecologically dependent and related diseases, 
effectively pursue training of the population living in conditions of high 
environmental risk. Under these conditions only will there be the possibility of successful treatment and prevention of patients as well as the protection of the population health.
The objective:
1.  To understand the role and place of ecology in the modern knowledge system, to get acquainted with the specifics of the ecological situation 
in the Republic of Belarus.
2.  To get an insight into the regularities that influence the health of 
natural and socio-ecological factors.
Tasks:
1.  To master the theoretical framework of environmental medicine, 
including definitions and research vocabulary. 
2.  To consider crucial risk factors to the human habitat, and their role 
in morbidity.
3.  To master the skills of searching the relationships between the occurrence of diseases and the effect of various environmental factors, to 
recognize their environmenal conditioning.

Requirements for students’ initial knowledge level. To fully master the 
topic of the chapter, a student should revise the relevant material from the 
following disciplines: 
1.  Microbiology, Virology, Immunology: “Environmental factors as a 
cause of modifications and mutations, and selection factor of modified 
forms of microorganisms. Intraspecific, interspecific relationships”. 
2.  General Chemistry: “Distribution of chemical elements in nature. 
Biogenic elements and their compounds as environmental factors”. 
3.  Medical Biology and Genetics: “Ecology as a science, its tasks, importance for modern medicine. Genetic hazards of environmental pollution. Biological and social aspects of human adaptation to living conditions”.
4.  Medical and Biological Physics: “Characteristics of physical properties of air”.
5.  The Normal Human Physiology: “Physiological mechanisms of adaptation and their role in the life Support of the organism”.
Review questions from related disciplines:
1.  What is the importance of ecology as a science for modern medicine?
2.  V.I. Vernadsky’s theory about noogenesis and noosphere.
3.  General characteristics of chemical elements and their compounds.
4.  General characteristics of physical factors.
Questions related to the topic of the chapter:
1.  Environmental medicine, objective, tasks, subject of study, research 
methods.
2.  Environmental factors, classification.
3.  Types of impact and patterns of influence of environmental laws.
4.  Medical prevention and its role in maintaining human health in an 
environmentally unstable world.
LEARNING MATERIAL FOR THE CHAPTER 
The object under the study of Environmental Medicine is the environment, spatial and territorial anthropo-ecological system, and the research 
subject is their properties which are manifested in the influence on the 
health, environmental health prerequisites and diseases.
The objective of environmental medicine is to prevent harmful effects 
of the polluted environment on the body and the human population, i.e., 
to create favourable conditions for human life, activity, and society.

Environmental medicine studies the following issues:
y
y Indicators (parameters) of various functions and systems of the body 
as criteria for assessing the quality of the environment.
y
y The role and place of environmental factors, its impact on health 
(pesticides, radionuclides, mineral fertilisers, other chemicals, electromagnetic fields, etc.).
y
y Environmental aspects of the combined effect of negative and positive 
environmental factors on people.
y
y Assessment of medico-ecological risk and medico-ecological capacity of landscapes.
y
y Development and justification of medical and environmental standards.
The well-known American biologist Barry Commoner explained in a 
very clear and simple form the basic laws of ecology that operate in the 
world around us:
1.  “Everything is connected with everything else”.
Changes made in one component of the ecosystem can lead to adverse 
consequences in the functioning of the entire ecosystem. Reasonable human activity is not always able to foresee the consequences of its activities.
2.  “Everything must go somewhere”.
Household and industrial waste, getting into the natural environment, 
does not disappear without a trace. Nature has fewer and fewer reserves of 
strength to cope with the processing of pollutants, and this fact is the main 
factor destroying the natural ecosystems of the biosphere and having a 
harmful effect on humans.
3.  “Nature knows best”.
Human society transforms nature by disrupting natural processes. The 
consequences of transformations designed to improve the human environment make it less and less favourable for the life of all creatures on Earth, 
and gradually for humans themselves.
4.  “There is no such thing as a free lunch”.
Human beings cannot endlessly waste natural resources and pollute the 
environment. Mankind must realise that any actions are paid for by the consumption of natural resources. Therefore, all kinds of human interaction 
with nature must be evaluated in terms of preservation of natural ecosystems.
Currently, one of the most accessible and widespread areas of study of 
various aspects of the environmental impact on public health is the factor 
approach, i.e., the identification of risk factors directly leading to “environmental” diseases.

Environmental factor is any element of the environment that can have 
a direct or indirect effect on a living organism at least at one of the stages 
of its individual development, or any environmental condition to which the 
organism responds with adaptive reactions. 
Classification of environmental factors:
1)  abiotic:
physical
y
y climatic and meteorological (temperature, air movement, precipitation, heavy rains, hurricanes, droughts, etc.);
y
y orographic (atmospheric rarefaction, avalanches, landslides, mudslides);
y
y geophysical (geomagnetic storms, earthquakes, tsunamis, gravitational and thermal anomalies, electromagnetic fields, noise, vibration);
y
y hydrographic (floods, swamping, drainage, sub-thawing, water supply 
sources, composition of surface and underground waters, their ability to 
self-purify and transfer pollution);
y
y geological (rock composition, tectonic faults, radiation, minerals).
chemical
y
y components of water, air, soil;
y
y acidity;
y
y impurities, etc.;
y
y chemical pollution of plants, animals, food and other objects.
2)  biotic:
y
y fauna (poisonous and dangerous animals; animals as reservoirs and 
carriers of pathogens; animals as food resources);
y
y flora (poisonous and medicinal plants, plants as food resources, air 
purifiers and bioindicators of environmental impact);
y
y microflora (air, water, soil, animals, plants, food, objects);
y
y biological components (toxins, proteins, metabolic products);
biocenoses (natural foci of diseases).
3)  socio-economic:
y
y population (demography, settlement, urbanisation, migration, gender, age and professional composition, culture, lifestyle, customs, confessions, material well-being);
y
y territorial organisation of society, economic use of land;
y
y municipal / utility factors;
y
y sanitary and hygienic condition and the epidemic status;
y
y psychotraumatic factors (stressors, environmental fatigue);
y
y medical and veterinary services, infrastructure.

Effects of environmental factors on organisms:
1)  stimuli – contribute to the emergence of adaptive physiological and 
biochemical changes;
2)  limiters – change the geographical distribution of organisms due to 
the impossibility of existence in these conditions; 
3)  modifiers – cause morphological and anatomical changes in organisms; 
4)  signals – indicate changes in other environmental factors.
General patterns of environmental factors:
1.  The law of optimum (Shelford’s law of tolerance): “Any ecological 
factor has limits of positive influence on living organisms. The distance 
between the minimum and maximum values of the factor is called the ecological valence or tolerance of the organism”. 
2.  The law of ecological individuality of species, formulated in 1924 by 
the Russian botanist L.G. Ramensky: “The ecological characteristics of 
different species do not coincide; each species is specific in its ecological 
capabilities”.
3.  Liebig’s law of the minimum: “The most significant factor for the 
organism is the one that deviates most from its optimal value”.
4.  The law of ambiguous action: “The action of each environmental 
factor is ambiguous at different stages of the development of the organism”. 
5.  The law of direct and indirect influence of factors on organisms. 
6.  The law of interaction of ecological factors: “The optimal zone and 
limits of endurance of organisms towards any factor may shift depending 
on what other factors join the overall influence” (Table 1.1).
Ecopathological conditions are understood by many authors as changes 
occurring in the body (from mild and not having distinct clinical symptoms 
to severe diseases), caused by the influence of adverse environmental factors (Table 1.2). 
Today, there exist environmental diseases which are related to the impact of environmental factors which increase the risk of a disease and affect 
the course of an existing pathology. 
Circulatory system diseases:
1)  atmospheric air pollution with sulphur oxides, carbon, sulphur compounds, fatty acids, ethylene, propylene, hydrogen sulphide, nitrogen, 
butylene, nitro compounds, mercury, lead, iron, cobalt, manganese, etc.;
2)  living conditions;
3)  noise level;
4)  electromagnetic fields;

Table 1.1. The effect of anthropogenic factors on the biosphere, health and well-being of the population (according to Yu.A. Israel)
Factors  
of anthropogenic  
impact
Impact on the biosphere
Impact on health and well-being of population
Changing  
the properties 
 of the biosphere  
main elements
Geophysical  
and geochemical  
consequences  
and effects
Ecological  
and biological  
consequences,
ecosystem  
disturbances
Impact on human 
health and well-being, 
human population
Social  
implications
1
2
3
4
5
6
Release of chemically and physically 
active substances 
into the biosphere
Changes in the 
composition and 
properties of the atmosphere (pollution, electrical conductivity, radiation 
properties)
Global circulation 
changes in the atmosphere and the 
ocean
Changes in terrestrial and aquatic 
ecosystems, violation of their stability
Decreased performance, diseases/
illnesses
Changes in food 
production, malnutrition, hunger
Release of inert material (aerosol particles, etc.) into the 
biosphere
Changes in the composition and properties of waters, land 
(pollution, mineralisation)
Weather and climate change
Changes in ocean 
ecosystems (structural simplifications, 
etc.)
Aesthetic harm, decline in mood
Changes in the energy consumption 
structure
Biosphere direct 
heating
Changes in the composition and properties of the World 
Ocean waters (pollution, etc.)
Redistribution and 
change of renewable non-biological 
resources  – water, 
climate
Genetic effects, rebirth
Diseases/illnesses, 
stressful states
Changes in the economy