Before we go on holiday which environmental health precautions should we take?

Travellers should not think that the only risk they face when they go on vacation is being swept away in a tsunami; conditions in foreign countries pose many dangers quite different from which they may be used to at home. The most important point to remember is the possibility of contagious diseases, and that vaccinations must be appropriate. The different level of hygiene in different countries poses many risks, and these cannot be prevented by vaccination – they depend on one’s own behaviour – mostly on common sense.

Drinking water

Tap water is safe in the developed countries that maintain both good technical quality levels and effective controls. In other conditions, it may be wise to use bottled water. The quality of tap water may vary between locations and during different seasons. Outside the tropics, tap water is usually safe in the big cities. The risk of contaminated water is highest in small towns and villages, especially after heavy rain. Water is safe after it has been boiled for 5 minutes and then it can be stored in clean, closed and disinfected vessels until use.

Chlorine may be used to disinfect water chemically. There must not be any turbidity (tiny suspended particles) in the water to be disinfected, if there is, those must be filtered out first. Chlorine does not kill the cysts of amoebas. In this respect, iodine may be a better solution, because it is also efficient against cysts.

Food hygiene

Diarrhoea is one of the most common health problems a traveller may suffer on holiday. The likelihood of diarrhoea varies considerably depending on the destination and season. The risk is greatest during the hot season in areas where food hygiene is poor because of poverty, ignorance or lack of clean water. If hygiene is suspect, one should not eat any food that is not thoroughly heated.

Urban air

A Dutch researcher Bert Brunekreef once divided Europe into three regions on the basis of air quality, good (the North), bad (Central Europe), and ugly (southern Europe). Several Mediterranean countries are infamous for their poor air quality, especially in the summer. Athens, for instance, lies in a valley surrounded by mountains, and the emissions from the city’s hundreds of thousands of motor vehicles lead to the formation of a choking fog of fine particulates, ozone and nitrogen oxide.

The high concentrations of air pollutants in urban air, in particular ozone can affect anyone, but individuals with heart and lung problems are at special risk. Their symptoms can be exacerbated, especially in sunny and hot regions where traffic is heavy (Los Angeles, Athens). Information on exceptionally poor air quality is often broadcast via public media. It is best to keep inside on those days and avoid physical stress. On most days, the air quality will be much poorer in the megacities of the less developed countries (e.g. Mexico City, Cairo, and Bangkok) than in most towns in Europe or North America.

Hot weather and humidity alone or combined with physical stress may lead to exhaustion because of loss of salt and fluids. In extreme cases, this may proceed to heatstroke that needs urgent treatment. In order to prevent these symptoms, it is necessary to guarantee an adequate intake of water (2–3 litres per day) and also salt. A heat wave caused a chaotic breakdown of the health care services in France in August 2003, and about 15,000 people died as a consequence.

Traffic

Standards of driving and control may not be anything like the traveller is used to when he/she rents a car in a foreign country. There are tenfold differences in rates of traffic accidents between different countries when standardised for traffic density (e.g. per kilometre driven). Risks are high both in the developing countries and in Eastern Europe. There may also be cars on the roads without brakes or lights, to say nothing of general maintenance. In addition, the condition of the roads may be appalling. In fact, traffic accidents are the most common cause of death associated with tourism. This does not only apply to drivers, pedestrians should also not believe that traffic will behave similar to their home country when they try to cross the road. One should always use seat belts or wear a bicycling helmet and never drive when intoxicated, even if local legislation does not prohibit it. Pedestrians should keep a pocket lamp with them. The bedlam from traffic and other noises may be such that earplugs will be needed for sleeping.

High altitudes

At high altitude, low air pressure may cause drowsiness even in healthy people and a worsening of symptoms in those with cardiac or respiratory diseases, even in cities in mountainous areas such as Addis Ababa. When climbing rapidly to altitudes of over 2000 m, one may encounter the symptoms of mountain sickness: headache, nausea, fatigue and insomnia are typical. In more serious cases, it is best to remove the visitor, whose consciousness may be impaired, down from the thin air and to seek medical attention as soon as possible. Adaptation to high altitudes is made easier by taking it slowly, avoiding overstrain and ensuring a sufficient fluid intake.

Swimming

Swimming in warm countries has its own dangers. It is safest to swim only at guarded beaches. One should avoid swimming alone, especially at night. Strong currents may be dangerous as well as loose objects moving in the currents. When walking on the beach, one should use sandals to avoid injury by stinging animals or sharp objects. Sunbathing on hot sand can even be dangerous, a towel may not provide adequate insulation, one needs a mattress or some similar kind of protection.

Indoor air

Indoor air problems have not been appreciated as health problems in many countries. In particular, asthma patients should remember that environmental tobacco smoke may be much worse than at home (e.g. in restaurants, hotels, waiting areas of airports, even homes). This may require an adjustment of their asthmatic drug doses. If a non-smoking room is available, then it is always a good choice. Many allergens (mites, animal allergens) may be also more common in warm countries than at home. Floor carpeting is common in hotel rooms, and this can also be a risk factor for allergic people. Mould damaged buildings are common in all parts of the world.

The tsunami catastrophe in the Far East at Christmas in 2004 emphasized that travelling and tourism may involve environmental risks. An unknown environment can be a risky environment in many ways – the best way to avoid problems is to familiarize oneself with the conditions beforehand.

One level up: Here a risk, there a risk, everywhere risks, risks!

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