B y t

sc khe mi trng
Sch dng o to c nhn y t cng cng M s 14 Z03

Nh xut bn Y hc H Ni - 2006

Ch bin:

PGS. TS. Nguyn Vn Mn

Th k bin son:

CN. Trn Th Tuyt Hnh CN. Nguyn Hu Thng ThS. V Th Thu Nga ThS. Nguyn Ngc Bch
Nhng ngi bin son:

PGS. TS. Bi Thanh Tm PGS. TS. Nguyn Vn Mn PGS. TS. ng c Ph GS.TS. Trng Vit Dng TS. Nguyn Huy Nga PGS. TS. L nh Minh PGS. TS. Lu c Hi ThS. L Th Thanh Hng ThS. Nguyn Trinh Hng

Tham gia t chc bn tho:

ThS. Ph Nguyt Thanh v nhm th k

Bn quyn thuc B Y t (V khoa hc v o to)

Li ni u

Thc hin Ngh nh 43/2000/N-CP ngy30/8/2000 ca Chnh ph quy nh chi tit v hng dn trin khai Lut Gio dc, B Gio dc & o to v B Y t ph duyt, ban hnh chng trnh khung cho o to c nhn y t cng cng. B Y t t chc bin son b ti liu dy - hc cc mn hc c s v chuyn mn theo chng trnh mi nhm tng bc xy dng b sch chun trong cng tc o to c nhn y t cng cng. Sc khe mi trng l ti liu c bin son theo chng trnh gio dc ca Trng i hc Y t cng cng trn c s chng trnh khung c ph duyt. Nm 2005, cun sch ny c Hi ng chuyn mn thm nh sch gio khoa v ti liu dy - hc ca B Y t thm nh. B Y t thng nht s dng lm ti liu dy - hc chnh thc ca ngnh trong giai on hin nay. Trong thi gian t 3 n 5 nam sch cn c chnh l, b sung v cp nht. Ni dung sch Sc khe mi trng bm st c cc yu cu v kin thc c bn, chnh xc khoa hc, cp nht v thc tin ca Vit Nam nhm cung cp cho sinh vin nhng kin thc c bn v sc khe mi trng, nhng vn cp bch v sc khe mi trng hin nay Vit Nam v cc yu t nguy c cho sc khe mi trng. Sch dng o to c nhn y t cng cng, ng thi cng l ti liu tham kho tt cho sinh vin cc chuyn ngnh khc v cc cn b y t quan tm n lnh vc sc khe mi trng. V Khoa hc v o to, B Y t xin chn thnh cm n cc ging vin Trng i hc Y t cng cng tch cc tham gia bin son cun sch ny. y l lnh vc khoa hc mi pht trin nn cc ni dung bin son khng trnh khi nhng thiu st v cn c b sung cp nht. V Khoa hc v o to mong nhn c nhiu kin ng gp ca c gi v ng nghip cun sch ngy cng hon thin hn.

V Khoa hc v o to B Y t

Mc lc

PHN 1. Dnh cho c nhn y t cng cng nm th 2

Bi 1. Nhp mn Sc kho mi trng PGS. TS. ng c Ph - ThS. L Th Thanh Hng Bi 2. Qun l nguy c t mi trng GS. TS. Trng Vit Dng Bi 3. C s sinh thi hc ca sc kho v bnh tt PGS. TS. Nguyn Vn Mn ThS. L Th Thanh Hng Bi 4. nhim khng kh ThS. Nguyn Trinh Hng - ThS. L Th Thanh Hng Bi 5. Qun l cht thi rn v cht thi y t TS. Nguyn Huy Nga - ThS. L Th Thanh Hng Bi 6. Nc v v sinh nc PGS. TS. L nh Minh

9 26 58 86 110 141

PHN 2. Dnh cho c nhn y t cng cng nm th 3

Bi 7. An ton mi trng PGS. TS. Bi Thanh Tm Bi 8. Kim sot vc-t truyn bnh PGS. TS. Nguyn Vn Mn Bi 9. Pht trin bn vng PGS. TS. Lu c Hi Bi 10. Qun l sc kho mi trng GS. TS. Trng Vit Dng

169 183 201 222

Phn 1

Dnh cho c nhn y t cng cng nm th 2

BI 1

NHP MN SC KHO MI TRNG

MC TIU

1. Trnh by c cc thnh phn chnh ca mi trng. 2. Nu c cc kha cnh lch s ca sc kho mi trng. 3. Trnh by c mi quan h gia sc kho v mi trng, cc chnh sch v sc kho mi trng v qun l mi trng. 4. Gii thch c nhng vn sc kho mi trng mang tnh cp bch a phng v trn th gii. Sc kho mi trng l nn tng ca y t cng cng, cung cp rt nhiu l lun c bn nn tng cho mt x hi hin i. Qu trnh ci thin tnh trng v sinh, cht lng nc ung, v sinh v an ton thc phm, kim sot bnh tt v ci thin iu kin nh l nhim v trung tm ca qu trnh thc hin vic nng cao cht lng cuc sng v tip tc nhng kinh nghim qu bu ca c th k qua. Tuy nhin, hin nay cuc sng ca ngi dn trong thi k i mi c nhiu thay i: vic th ho, tng dn s, thay i li sng, nn ph rng, tng s dng ho cht bo v thc vt trong nng nghip, dng cc hormon tng trng trong chn nui, s pht trin cng nghip v khng kim sot c nhng cht thi cng nghip,.... lm cho mi trng ang b suy thoi. Trong nhng nm qua, thm ha thin nhin gy nn nhiu thit hi ln nh l qut Lai Chu, Sn La; ng lt ng bng Sng Cu Long; hn hn nhiu ni nh Ty Nguyn. Hin nay, nhng trng hp b nhim c ho cht, ng c cc ho cht bo v thc vt v ng c thc phm vn xy ra thng xuyn. C nhiu ch th v ngh quyt bn v phng hng pht trin bn vng, ngha l bo m cho mi trng v mi sinh trong sch, gim thiu nhim, nhm nng cao sc kho con ngi nh Lut bo v mi trng Vit Nam nu. Bn cnh cn phi k n mi trng x hi, mi trng lm vic cng c nhiu nh hng n sc kho con ngi. Do vy, vic nghin cu, x l, phng chng nhim mi trng v ci thin mi trng x hi l mt vic ht sc cn thit. Mun lm c iu mi ngi, mi t chc trong x hi m trc ht l hc sinh, sinh vin - nhng ngi lm ch tng lai t nc phi cng nhau tham gia gii quyt th mi t c kt qu. l nhng vn mi trng nh hng n i sng x hi, n kinh t t nc. Cn mi trng nh hng n sc kho con ngi c th nh th no? Th no gi l sc kho mi trng? Chng ti s trnh by nhng khi nim ny phn sau.

1. CC THNH PHN C BN CA MI TRNG 1.1. Mi trng l g?

Theo Lut bo v mi trng Vit Nam (1993): mi trng bao gm cc yu t t nhin v yu t vt cht nhn to quan h mt thit vi nhau, bao quanh con ngi, c nh hng ti i sng, sn xut, s tn ti, pht trin ca con ngi v thin nhin.
1.2. Cc thnh phn ca mi trng

Cc yu t k trn cn gi l cc thnh phn ca mi trng bao gm: khng kh, t, nc, kh hu, m thanh, nh sng, sc nng, bc x, ng thc vt thuc cc h sinh thi, khu dn c, khu sn xut, cnh quan thin nhin, danh lam thng cnh, di tch lch s, khu vui chi gii tr, v.v.... Tm li, cc thnh phn ca mi trng bao gm mi trng vt l, mi trng sinh hc v mi trng x hi.
1.2.1. Mi trng vt l

Mi trng vt l bao gm cc yu t vt l nh: kh hu, ting n, nh sng, bc x, gnh nng lao ng. Bn cnh cc yu t vt l cn c nhng yu t ho hc nh bi, ho cht, thuc men, cht kch thch da, thc phm, v.v...
1.2.2. Mi trng sinh hc

Mi trng sinh hc bao gm: ng vt, thc vt, k sinh trng, vi khun, virus, cc yu t di truyn, v.v...
1.2.3 Mi trng x hi

Mi trng x hi bao gm: stress, mi quan h gia con ngi vi con ngi, mi trng lm vic, tr lng, lm ca, v.v....
2. CC KHA CNH LCH S CA SC KHO MI TRNG 2.1. Khi nim v sc kho mi trng

Sc kho mi trng l g? Theo quan im ca nhiu ngi sc kho mi trng chnh l sc kho ca mi trng. y l cc nim v i sng hoang d, v rng, sng, bin, v.v.... v theo h th sc kho mi trng ng ngha vi vic bo v mi trng. Nhng ngi khc th cho rng sc kho mi trng l cc vn v sc kho ca con ngi c lin quan n iu kin sng, s ngho nn, lc hu, khng nc sch, l lt, s ph hoi ca cn trng v sc vt c hi - tt c cc thch thc chng ta tri qua, chng tr trong sut qu trnh hnh thnh v pht trin ca con ngi v cuc sng (nht l nhng nm gn y) v chng ta chin thng.

10

C hai quan im ny u cha ng, cha chnh xc, sc kho mi trng khng ng ngha vi sc kho ca mi trng v bo v mi trng v cng khng b hp trong vic kim sot cc loi dch bnh ca th k qua. Cho n hin nay nhiu tc gi a ra khi nim v sc kho mi trng nh sau:Sc kho mi trng l to ra v duy tr mt mi trng trong lnh, bn vng nng cao sc kho cng ng.
2.2. Lch s pht trin ca thc hnh sc kho mi trng

Mi sinh vt trn tri t u c mi trng sng ca ring mnh, nu thot ra khi mi trng t nhin hoc s bin i qu mc cho php ca mi trng m chng ang sng th chng s b cht v b hu dit. Do , m bo s n nh mi trng sng l iu kin c bn duy tr s sng ca mi loi sinh vt trn tri t. Nhng v d rt gin n m mi ngi u bit l ng c oxyd carbon (CO) nhng ngi i kim tra cc l gch th cng t bng than hoc c cht do nc b nhim ho cht ca nh my phn ln Vn in, v.v... iu c ngha l mi trng, con ngi v sc kho con ngi c mi lin quan mt thit vi nhau v c th ci n l nhn qu ca ci kia. Khng phi n by gi con ngi mi bit ti mi quan h ny, m t hng ngn nm trc ngi Trung Quc, n , Ba T, Ai Cp c i bit p dng cc bin php thanh khit mi trng ngn nga v phng chng dch cho cng ng v qun i. Cc t liu lch s cho thy t nhng nm trc cng nguyn, thnh Aten (Hy Lp) con ngi xy dng h thng cng ngm thi nc bn, bit dng cc cht thm, dim sinh ty u khng kh trong v ngoi nh phng cc bnh truyn nhim. Ngi La M cn tin b hn: khi xy dng thnh La M, ngi ta xy dng mt h thng cng ngm dn ti mi im trong thnh ph thu gom nc thi, nc ma dn ra sng Tibre, ng thi xy dng mt h thng cung cp nc sch cho dn chng trong thnh ph. Vo thi k ny, cao ca nh , b rng cc ng i li trong thnh u c quy nh v tiu chun ho, nhng ngi em bn loi thc phm gi mo, thc n i thiu u phi chu ti. Theo thi gian, cng vi s pht trin ca x hi, dn s, nhim mi trng v phng chng nhim mi trng cng c tng cng v pht trin. Nh chng ta bit, cc nhn t sinh hc, cc ho cht tn ti mt cch t nhin v cc nguy c vt l tn ti trong sut qu trnh pht trin ca lch s loi ngi. ng thi cc cht nhim mi trng do hot ng ca con ngi sinh ra cng c qu trnh pht trin t t v lu di. Cuc khng hong mi trng ln th nht xut hin Chu u ln u tin vo th k 19, nguyn nhn l do thc phm km cht lng, nc b nhim nh hng n sc kho cng ng. Cuc cch mng cng nghip Anh lm cho nc Anh tr thnh x s sng m do nhim khng kh, thi gian ny vn nhim cng nghip l mt vn ht sc nghim trng nhng b chnh ph l i v cn nhiu vn x hi khc quan trng hn, mc d nm 1848 Quc hi Anh thng qua Lut Y t cng cng u tin trn th gii. Trong qu trnh pht trin cng nghip, nhim ko di cho n gia th k 20 v hng lot nhng nhim mi song song vi 11

nhim cng nghip l nhim ho hc, ho cht tng hp, nht l trc v sau chin tranh th gii ln th 2. Nhng tin b ca k thut, lnh vc ho hc, c bit l ngnh cng nghip ho cht to ra cc ho cht tng hp nh cao su tng hp, nha, cc dung mi, thuc tr su v.v... to ra rt nhiu cht kh phn hu v tn d lu di trong mi trng nh DDT, 666, dioxin v.v... gy ra nhim mi trng nng n, dn ti s phn i kch lit ca cng ng nhiu nc trn th gii trong sut thi k nhng nm 60 v 70 ca th k 20 (xem hp 1.1).
Hp 1.1. Cc v d v nhng s kin sc khe mi trng quan trng
1798 - Thomas Malthus xy dng l thuyt v phn b ti nguyn v dn s 1848 - Quc hi Anh thng qua Lut Y t cng cng 1895 - Svante Arrhenius m t hin tng hiu ng nh knh 1899 - Hip nh Quc t u tin v cm v kh ho hc 1956 - Anh thng qua Lut Khng kh sch 1962 - Vic xut bn cun sch Ma xun lng l (silent spring) ca Rachel Carson thu ht c s ch ti vn thuc tr su v mi trng 1969 - Hip nh quc t u tin v hp tc trong trng hp nhim bin (vng bin pha Bc) 1972 - Hi ngh ca Lin hip quc v Mi trng v Con ngi, Stockholm; DDT b cm s dng M 1982 - Hi ngh a phng v s acid ho mi trng khi u qu trnh dn ti chnh thc tha nhn vn nhim xuyn bin gii v nhu cu v s kim sot quc t 1986 - Hi ngh quc t u tin v nng cao sc kho (health promotion) thng qua Hin chng Ottawa, trong nh ngha nng cao sc kho l to iu kin cho con ngi kim sot nhng yu t quyt nh ti sc kho ca h. 1987 - Bo co ca U ban Brundtland "Tng lai chung ca chng ta" (Our Common Future) ku gi hng ti "pht trin bn vng"; Ngh nh th Montreal v hn ch pht thi clorofluorocarbon (CFC) vo khng kh gim tc suy gim tng ozon tng bnh lu 1992 - Hi ngh thng nh tri t (Hi ngh ca Lin hip quc v Mi trng v pht trin), Rio de Janeiro 1994 - Hi ngh quc t v Dn s v Pht trin, Cairo 1995 - Hi ngh Thng nh ca Lin hip quc v Pht trin x hi, Copenhagen 1996 - Hi ngh ca Lin hip quc v vn nh c (HABITAT II), Istanbul 1997 - Hip nh khung ca Lin hip quc v thay i kh hu, Kyoto

Ngun: Yassi v cng s, 2001 Ln sng ln th hai v cc vn mi trng xy ra vo nhng nm gia ca th k 20 vi hai phong tro ln l mi trng v sinh thi. Phong tro mi trng l vic bo tn ti nguyn thin nhin, nht l nhng ti nguyn khng ti to. Kt qu l 12

ng vt trn t lin nhiu vng thin nhin hoang d, cc vng t, bin qu him khc, cnh quan thin nhin c bo tn v tn to. V phong tro sinh thi tp trung vo cc cht c th gy c cho con ngi hoc c kh nng gy hu hoi mi trng. Kt qu ca nhng phong tro ny cng vi Hi ngh ca Lin hp quc v mi trng v con ngi c t chc vo nm 1972 thuyt phc c nhiu chnh ph cc nc thng qua lut l nhm hn ch nhim cng nghip v pht thi rc, phng chng nhim ho hc, m bo cht lng v v sinh an ton thc phm, thuc, v.v... Ln sng ln th ba v cc vn sc kho mi trng l t nhng nm 80, 90 n nay, ngoi nhng vn nhim cng nghip, ho cht cn c cc vn v dioxyd carbon, clorofluorocarbon gy thng tng ozon, vn cn bng mi trng, pht trin bn vng, mi trng ton cu thay i, kh hu ton cu nng ln, v.v... s cn phi gii quyt trong nhiu thp k ti.
3. NI DUNG MN SC KHO MI TRNG

Tt c cc kha cnh ca sc kho mi trng l xc nh, gim st, kim sot cc yu t vt l, ho hc, sinh hc v x hi c nh hng n sc kho con ngi. Thc hnh sc kho mi trng bao gm: nh gi, kim sot v phng nga cc yu t trong mi trng nh hng tiu cc n sc kho con ngi, ng thi pht huy cc yu t mi trng c li cho sc kho. Vic ny bao gm tt c cc bin php cn thit i mt vi cc vn : nh suy thoi mi trng, thay i kh hu, cc nguy c mi trng (nh: nhim t, nc, khng kh, nhim thc phm), tip xc vi ho cht v vn rc thi hin nay. Thc hnh sc kho mi trng cn to iu kin, c hi nng cao sc kho bng cch lp k hoch nng cao sc kho v tin ti xy dng mt mi trng c li cho sc kho. Cc hot ng sc kho mi trng c thc hin tt c cc cp, bao gm: Xy dng, pht trin cc chin lc v tiu chun, gm: + + + + + + + An ton dn s. T vn cng ng, bo v sc kho trong cc trng hp khn cp. Theo di, quan trc v xy dng cc tiu chun nh tiu chun v nh v.v... Nng cao pht trin sc kho.

Pht trin v a ra cc khuyn co v sc kho mi trng: Cung cp thng tin cho cng ng v sc kho mi trng. Nghin cu sc kho mi trng. Gio dc sc kho mi trng.

Cn phi c k hoch xy dng lut sc kho mi trng.

13

 Qun l mi trng vt l: + + + + + + + + + + + + + + + + An ton nc, nht l an ton nc khu gii tr. An ton thc phm. Qun l cht thi rn. An ton v sc kho ngh nghip. Phng chng chn thng. Kim sot ting n. Sc kho v cht phng x.

Qun l nguy c sinh hc: Kim sot cn trng v cc ng vt c hi. Qun l bnh truyn nhim qua vt ch trung gian truyn bnh. Kim sot vi sinh vt.

Qun l nguy c ho hc: Xy dng cc tiu chun an ton ho hc cho khng kh, t, nc sinh hot, nc thi v thc phm. S dng thuc bo v thc vt an ton. nh gi v qun l cc nguy c sc kho cc vng b nhim v d nh dioxin, v.v... Kim sot thuc, cht c, cc sn phm y dc khc. Cht c hc. Kim sot thuc l.

Bn cnh cn nhiu cc yu t khc cn phi kim sot nh: cung cp thc n dinh dng, cung cp nc sch, iu kin v sinh v x l rc thi nht l nng thn hin nay, cung cp nh v bo m mt dn s v.v... Ngoi ra, cn mt s cc yu t khc nht l kh nng tim tng ca cc nguy c mi trng v suy thoi mi trng tc ng ln sc kho do cc c im sau: Thng xy ra sau mt thi gian di tip xc. Cc bnh lin quan n mi trng thng do hoc lin quan n nhiu nguyn nhn khc nhau, v d nh vim ph qun mn tnh c th l do mi trng b nhim, do vi khun, th lc v.v. Thc hnh sc kho mi trng s dng kin thc v k nng ca nhiu lnh vc khc nhau tp trung gii quyt cc vn sc kho tim tng.

14

Loi ngi l trung tm ca pht trin bn vng. H c quyn sng mt cuc sng kho mnh v ho hp vi t nhin. (Tuyn b Rio de Janero v Mi trng v Pht trin)
4. QUAN H GIA SC KHO V MI TRNG

Khi con ngi u tin xut hin trn tri t, tui th trung bnh ca h ch khong t 30 n 40 tui. Do sng trong mi trng khc nghit, tui th ca h thp hn nhiu so vi tui th ca con ngi trong x hi hin nay. Tuy vy, 30 - 40 nm cng cho h c th sinh con ci, t thit lp cho mnh cuc sng vi t cch l mt loi c kh nng cao nht trong vic lm thay i mi trng theo hng tt ln hay xu i. c th sng st, nhng ngi tin s phi i mt vi nhng vn sau y: Lun phi tm kim ngun thc n v nc ung trong khi trnh n phi nhng thc vt c cha cht c t nhin (v d nm c) hoc cc loi tht b i thiu, nhim c. Bnh nhim trng v cc k sinh trng c truyn t ngi ny sang ngi khc hoc t ng vt sang con ngi thng qua thc phm, nc ung hoc cc cn trng truyn bnh. Chn thng do ng, ho hon hoc ng vt tn cng. Nhit qu nng hoc qu lnh, ma, tuyt, thm ho thin nhin (nh bo lt, hn hn, chy rng v.v.) v nhng iu kin khc nghit khc. Nhng mi nguy him i vi sc kho con ngi lun lun xy ra trong mi trng t nhin. Trong mt s x hi, nhng mi nguy him truyn thng trn y vn l nhng vn sc kho mi trng c quan tm nhiu. Tuy nhin, khi con ngi kim sot c nhng mi nguy him ny mt s vng, th nhng mi nguy him hin i do s pht trin k thut, cng nghip to ra cng tr thnh nhng mi e da u tin i vi sc kho v s sng ca con ngi. Mt s v d v cc mi nguy him mi trng hin i l: Mi trng t, nc nng thn b nhim nghim trng do s dng ha cht bo v thc vt khng ng chng loi, liu lng v khng ng cch. Cc s c r r cc l phn ng ht nhn/nh my in nguyn t, v.v... S thay i kh hu ton cu, hiu ng nh knh, v.v... Trong mt vi thp k va qua, tui th ca con ngi tng ln ng k hu ht cc quc gia. Cc nh iu tra cho rng c 3 l do c bn dn ti vic tng tui th ca con ngi: + + + Nhng tin b trong mi trng sng ca con ngi. Nhng ci thin v vn dinh dng. Nhng tin b trong chn on v iu tr y hc i vi cc loi bnh tt. 15

Nhng tin b trong y t lun i cng vi vi nhng ci thin v cht lng mi trng, dinh dng v chm sc y t. Ngy nay, nhng ngi m yu c c hi sng st cao hn nhiu do h thng chm sc y t c ci thin. Rt nhiu ngi lun sng kho mnh, do c ngun dinh dng tt v kim sot tt cc mi nguy him v sc kho mi trng. Khoa hc mi trng l mt mn hc rt cn thit v quan trng da trn hai l do cn bn sau y: + + Nghin cu nhng mi nguy him trong mi trng v nhng nh hng ca chng ln sc kho. ng dng nhng phng php hiu qu bo v con ngi khi nhng mi nguy hi t mi trng.

Mun vy chng ta hy xem xt th no l sc kho v th no l mi trng? Trc ht chng ta hy im qua vi nt v h sinh thi: Ra i t nhng nm 1930, thut ng h sinh thi c th c nh ngha nh l mt h thng gm nhng mi quan h tng tc qua li gia cc sinh vt sng v mi trng t nhin ca chng. l mt thc th ng t c cc c ch t n nh v ni cn bng, tin ho qua hng th k. Trong mt h sinh thi n nh, mt loi ny khng loi tr mt loi khc, nu khng th ngun cung cp thc n cho nhng loi n tht s khng tn ti. Cc h sinh thi n nh v cn bng s c tui th cao nht. Mt h sinh thi s khng th duy tr c mt s lng ln vt cht v nng lng c tiu th bi mt loi m li khng loi tr mt loi khc v thm ch cn gy nguy him cho kh nng tn ti ca ton b h sinh thi. Tng t nh vy, kh nng ca mt h sinh thi trong vic cha ng cht thi v ti to t, nc ngt khng phi l v hn. Ti mt thi im no , nhng tc ng t bn ngoi s ph v cn bng ca h sinh thi, dn n s thay i nhanh chng hoc lm hu dit h sinh thi . nh ngha sc kho v mi trng: Theo nh ngha ca T chc Y t Th gii (1946) th sc kho l trng thi thoi mi v c tinh thn, th cht v x hi ch khng ch n thun l v bnh, tt. Khi nim bnh, tn tt v t vong dng nh c cc nhn vin y t cp ti nhiu hn so vi khi nim l tng ny v sc kho. Do vy khoa hc sc kho hu nh tr thnh khoa hc bnh tt, v n tp trung ch yu vo vic iu tr cc loi bnh v chn thng ch khng phi l nng cao sc kho. Tng t nh vy, nhiu nh ngha v mi trng trong bi cnh sc kho c cp. Theo nh ngha mi nht (1995), mi trng l tt c nhng g bn ngoi c th con ngi. N c th c phn chia thnh mi trng vt l, sinh hc, x hi, vn ho... Bt k mi trng no hay tt c cc mi trng trn u c th nh hng ti tnh trng sc kho ca qun th. nh ngha ny c da trn quan im 16

l sc kho ca con ngi ch yu c xc nh do yu t di truyn v mi trng. Yu t di truyn (gen) do cha m truyn li, bao gm ADN trong mi t bo c th. Cc gen ny tn ti khi phi c hnh thnh v khng c s thay i no v di truyn trong sut qu trnh pht trin ca con ngi. Nu nh c s thay i gen (nh trong trng hp t bin), n c th dn ti s mt chc nng, cht t bo v ung th ( mt s trng hp t bin c th). C s vt cht di truyn ca mt c th l mt trong nhng yu t chnh xc nh vic c th b nh hng nh th no bi cc yu t mi trng. Mt s c th s b nh hng khi tip xc vi cc cht c hi, cc nguy him mi trng vi hm lng ln. Mt s c th khc li b nh hng mc thp hn, bi v h c cc yu t nguy c / iu kin kp hoc nguy c / iu kin c t trc. Mt s ngi b nh hng mt mc rt thp do tnh nhy cm di truyn. iu minh chng cho nhng nh hng ca mi trng i vi sc kho. Tuy nhin, mt thi chnh con ngi lm hu hoi v suy thoi mi trng. V suy thoi mi trng nn c nh hng ti sc kho cng ng nh ung th da tng ln Australia khi tng ozon b suy gim. Con ngi ph rng trong qu trnh pht trin ca mnh v hu qu l con ngi phi chu nhng hu qu ca l qut, ca thay i kh hu ton cu, ca nhim cc cht thi cng nghip. Khi con ngi hu hoi mi trng th theo quy lut nhn qu hc, con ngi cng phi chu nhng mi e da t mi trng, l nhng mi nguy him hin i v truyn thng. Khi nim v sc kho mi trng: Hin nay trn th gii, vn cn nhiu tranh ci v cc nh ngha nh mi trng l g? Sc khe mi trng l g. c bit vic phn bit s khc nhau gia hai phm tr mi trng v sc khe mi trng l rt kh khn. Sc khe mi trng l mt thut ng khng d nh ngha. Nu chng ta cho l Sc khe ca mi trng th dng nh chng ta khng quan tm ti mt loi no c th, v d loi ngi. Nhng nu mt ai li mun nh ngha thut ng ny m ch ti sc khe con ngi th iu ny li cn qu nhiu ch tranh ci. Hai nh ngha di y, nh ngha u tin quan tm ti nhng nh hng ca mi trng ln sc khe trong khi nh ngha th hai quan tm ti nhng dch v sc khe mi trng. nh ngha 1: Sc khe mi trng bao gm nhng kha cnh v sc khe con ngi (bao gm c cht lng cuc sng), c xc nh bi cc yu t vt l, ha hc, sinh hc, x hi v cc yu t tm l trong mi trng (theo nh ngha trong Chin lc Sc khe Mi trng Quc gia ca Australia - 1999). nh ngha ny cng m ch ti c l thuyt v thc tin ca vic quyt nh, kim sot v phng nga i vi nhng yu t trn trong mi trng, nhng yu t c th c nh hng tim tng bt li i vi sc khe ca cc th h hin ti cng nh cc th h tng lai.

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nh ngha 2: Cc dch v sc khe mi trng l nhng dch v nhm ci thin cc chnh sch v sc khe mi trng qua cc hot ng gim st, kim sot. Chng cng thc hin vai tr tng cng s ci thin nhng gii hn ca mi trng v khuyn khch vic s dng cc cng ngh sch v khuyn khch nhng thi cng nh nhng cch c x tt i vi mi trng v sc khe. Nhng dch v ny cng c vai tr quan trng trong vic pht trin v xut nhng chnh sch mi v sc kho mi trng.
5. TC NG CA DN S, TH HO LN SC KHO CNG NG V MI TRNG

Nhng thch thc v dn s Vit Nam l rt nghim trng i vi tt c cc vn mi trng v ti nguyn thin nhin. Tng dn s vn mc cao 1,7% (1999) v di dn ni b t cc khu vc ngho ti nguyn v kinh t km pht trin vn ang tng ln v khng kim sot c. Theo d bo n nm 2020, dn s nc ta xp x 100 triu ngi, trong khi cc ngun ti nguyn t, nc v cc dng ti nguyn khc c xu th suy gim, vn ngho i cc vng su, vng xa cha c gii quyt trit (hin c nc c 1750 x din i ngho). Qu trnh th ho v pht trin kinh t bng con ng cng nghip ho i hi nhu cu v nng lng, nguyn liu ngy cng to ln, ko theo cht lng mi trng sng ngy cng xu i nu khng c cc bin php hu hiu ngay t u. Mt khc, qu trnh th ho v cng nghip ho nhiu khu vc, vng lnh th li khng c qun trit y theo quan im pht trin bn vng, ngha l cha tnh ton y cc yu t mi trng trong pht trin kinh t x hi. Theo d kin, tc tng trng GDP phi t xp x 7%/nm v c duy tr lin tc n nm 2010. Theo tnh ton ca cc chuyn gia nc ngoi, nu GDP tng gp i th nguy c cht thi tng gp 3 - 5 ln. V nu nh trnh cng ngh sn xut, c cu sn xut, trnh qun l sn xut, trnh qun l mi trng khng c ci tin th s tng trng s ko theo tng khai thc, tiu th ti nguyn v nng lng. iu ny dn n khai thc cn kit ti nguyn thin nhin, to ra s gia tng cc loi cht thi v nhim mi trng gy nn sc p cho mi trng. Trong khi mi trng th, cng nghip v nng thn tip tc b nhim. n nm 1999, dn th l 23% so vi dn s c nc, d kin nm 2010 l 33% v 2020 l 45%. Mi trng th nc ta b nhim bi cc cht thi rn, nc thi cha c thu gom v x l theo ng quy nh. Kh thi, bi, ting n v.v... t cc phng tin giao thng ni th v mng li sn xut quy m va v nh cng vi c s h tng yu km cng lm cho iu kin v sinh mi trng nhiu th ang thc s lm vo tnh trng ng bo ng. H thng cp v thot nc lc hu, xung cp, khng p ng c nhu cu. Mc nhim khng kh v bi, cc kh thi c hi nhiu ni vt tiu chun cho php nhiu ln, nht l ti cc thnh ph ln nh H Ni v thnh ph H Ch Minh vt tiu chun cho php 2 - 3 ln.

18

Mi trng nng thn ang b nhim do cc iu kin v sinh v c s h tng yu km. Vic s dng khng hp l cc ho cht nng nghip v ang lm cho mi trng nng thn nhim v suy thoi. Vic pht trin cc lng ngh tiu th cng nghip lm nhim mi trng nghim trng. Nc sinh hot v v sinh l vn cp bch, t l h x hp v sinh nng thn ch t khong 34% v ch khong 46% s h dn nng thn c dng nc hp v sinh (Trung tm Nc sinh hot v V sinh nng thn 2001). Theo B Nng nghip v Pht trin nng thn, n ht nm 2002, ch mi 50% s dn nng thn c s dng nc sch. Nn khai thc rng ba bi, thm ch xy ra c cc khu rng cm, rng c dng; nn t ph rng gy ra nhng thm ho chy rng nghim trng nh v chy rng nc mn U Minh va qua; ng thi, vic sn bt ng vt hoang d cng ang lm suy gim a dng sinh hc v gy hu hoi mi trng. Nhng vn ca mi trng x hi ngy cng tr nn bc xc nh ma tu, HIV/AIDS v bo lc. Nhng vn mi trng ton cu nh tng ozon b suy gim, hiu ng nh knh, kh hu ton cu nng ln, thay i kh hu, mc nc bin dng cao, hin tng En Nin; La Ni-na gy nn cc hin tng hn hn, l lt xy ra nhiu ni trn th gii trong c Vit Nam; ng thi, nn chuyn dch nhim sang cc nc ang pht trin cng l mt vn cn ch trng. T nhng vn trn thc t i hi phi c mt chnh sch v mi trng, sc kho mi trng mt cch ng n, ng b v hp l trong giai on pht trin mi ca t nc ta.
6. NHNG NH HNG C BN CHO MI TRNG LNH MNH 6.1. Bu khng kh trong sch

Khng kh rt cn thit cho s sng, nu thiu khng kh, con ngi s cht ch sau mt vi pht. nhim khng kh l mt trong nhng vn mi trng trm trng nht trong cc x hi tt c cc cp pht trin kinh t khc nhau. Trn th gii, hng ngy c khong 500 triu ngi phi tip xc vi mt hm lng ln nhim khng kh trong nh cc dng nh: khi t cc l si khng kn hoc l si c thit k ti v khong 1, 5 t ngi cc khu vc thnh th phi sng trong mi trng b nhim khng kh nng n (WHO, 1992). S pht trin ca ngnh cng nghip i i vi vic thi ra s lng ln cc kh v cc cht ht t qu trnh sn xut cng nghip v t qu trnh t chy cc nhin liu ho thch cho nhu cu giao thng vn ti v ly nng lng. Khi cc tin b cng ngh bt u ch trng n vic kim sot nhim khng kh bng cch gim vic thi ra cc cht ht th ngi ta vn tip tc thi ra cc cht kh, do vy nhim khng kh vn cn l vn ln. Mc d hin nay nhiu nc pht trin c nhng n lc ln kim sot c vic thi kh v cc cht ht, nhim khng kh vn l nguy c i vi sc kho ca nhiu ngi.

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 nhng x hi pht trin nhanh chng, vic kim sot nhim khng kh khng c u t thch hp v cn nhng u tin khc v kinh t v x hi. Vic pht trin cng nghip nhanh chng nhng nc ny xy ra ng thi vi vic gia tng lng t v cc loi xe ti khc, nhu cu in thp sng ti cc h gia nh cng tng ln, dn s tp trung cc khu th hoc cc thnh ph ln. Kt qu l mt s thm ho nhim khng kh ti t nht trong lch s th gii xy ra. cc quc gia ni m vic s dng cc ngun nng lng sch cc h gia nh vn cha c ch trng, nhim khng kh tr thnh mt vn trm trng v nng lng dng si m v un nu cn thiu v sn sinh ra rt nhiu khi, dn n nhim trong nh v ngoi tri. Kt qu l con ngi c th b kch thch mng nhy, mc cc bnh h hp, bnh phi, cc vn v mt v tng nguy c b ung th. Ph n v tr em nhng cng ng ngho kh ti cc nc ang pht trin l nhng ngi c bit phi tip xc nhiu vi nhim khng kh. Cht lng khng kh trong nh cng l vn nghim trng nhiu nc pht trin v cc to nh c thit k theo kiu kn gi v c hiu qu cao v mt nng lng. H thng l si v h thng lm lnh, khi, hi t cc vt liu tch tr trong nh to ra nhiu cht ho hc v gy ra nhim khng kh.
6.2. C nc sch cho n ung v sinh hot

Nc cng rt cn thit cho s sng. Trung bnh mi ngi cn phi ung ti thiu 2 lt nc/ngy. Nu sau 4 ngy khng c nc, con ngi s cht. Nc cng cn thit cho thc vt, ng vt v nng nghip. Trong sut lch s pht trin, con ngi lun tp trung sng dc theo cc b sng, ven h ly nc cho sinh hot v nng nghip. Nc cng cung cp phng tin vn chuyn t nhin, c s dng x l cht thi v ng mt vai tr quan trng trong cc ngnh cng nghip, ng nghip v cc trang tri. Mc d nc ngt c coi l mt ngun ti nguyn c th ti s dng, nhng nc ngt cng khng phi l mt ngun v hn. Hn na, nc c phn b khng ng u cc khu vc a l v dn c trn th gii. Ti rt nhiu ni, vic thiu nc tr thnh tr ngi ln i vi vic pht trin cng nghip v nng nghip. Trong mt s trng hp, vic thiu nc gy ra nhiu cuc xung t (v d: nhng xung t tranh chp nc ngt cc nc khu vc Trung ng), vic khan him nc dn n i ngho v lm cn ci t ai. Rt nhiu thnh ph v cc khu vc nng thn khai thc nc t cc tng nc ngm vi s lng rt ln, ln hn c kh nng m bn thn cc tng nc ngm ny c th t b sung li c. Cht lng ca nc ngt c tm quan trng rt ln trong vic duy tr sc kho con ngi. Rt nhiu bnh truyn nhim e do s sng v sc kho con ngi c truyn qua nc hoc thc phm b nhim bn. Khong 80% cc bnh tt cc nc ang pht trin l do thiu nc sch v thiu cc phng tin ph hp x l phn (WHO, 1992). C khong mt na dn s trn th gii mc phi cc bnh do thiu 20

nc hoc nc b nhim bn, gy nh hng ch yu i vi tng lp ngi ngho tt c cc nc ang pht trin. C khong 2 t ngi trn tri t c nguy c mc phi cc bnh a chy ly lan qua ng nc hoc thc phm, y l nguyn nhn chnh gy ra t vong khong gn 4 triu tr em mi nm. Cc v dch t thng c truyn qua nc ung b nhim bn, ang tng ln nhanh chng v mt tn sut. Bnh sn mng (200 triu ngi nhim bnh) v bnh giun (10 triu ngi b nhim bnh) l 2 dng bnh ph bin trm trng nht c lin quan ti nc. Cc vect cn trng sinh sn nh nc cng truyn cc bnh e do s sng ca con ngi, chng hn nh st rt (267 triu ngi b nhim), giun ch (90 triu ngi nhim), v st xut huyt (30 - 60 triu ngi nhim) (WHO, 1992). Vic thiu nc thng dn n cc vn c lin quan ti cht lng nc. Nc thi sinh hot, nc thi cng nghip - nng nghip v cc khu th lm vt qu kh nng ca cc vc nc t nhin trong vic phn hu cc cht thi c kh nng phn hu sinh hc v ho tan cc cht thi khng c kh nng phn hu sinh hc. nhim nc xy ra trm trng nht cc thnh ph ni m vic kim sot cc dng thi cng nghip khng cht ch v thiu cc ng, rnh dn nc thi, thiu cc nh my x l nc thi.
6.3. thc phm v thc phm an ton

Thc phm cung cp nng lng cho c th con ngi. Tu vo trng lng c th v cc hot ng v th lc m c th con ngi cn khong 1000-2000 calo nng lng mi ngy. Nu nh khng c thc phm, con ngi s cht sau 4 tun. Thc phm cng cung cp cc vitamin v cc cht vi lng, nu khng c cc cht ny, con ngi cng s mc mt s bnh thiu ht. Trong vi thp k va qua, h thng sn xut lng thc ca th gii p ng so vi nhu cu tng trng dn s (hnh 1.3). Tuy nhin, nhng thnh cng trong nng nghip ton cu cng khng c phn b ng u, v d: cc nc chu v chu M La Tinh tng sn lng lng thc trn u ngi mt cch ng k, nhng sn lng lng thc ca cc nc chu Phi vn cha theo kp c mc tng trng dn s ca h; cc nc thuc Lin X c cng gim st sn lng lng thc mt cch ng k. i vi phn ln dn s trn th gii, suy dinh dng v cc bnh lin quan ti suy dinh dng vn cn l mt nguyn nhn chnh gy ra tnh trng m yu v cht yu. Cc tc nhn gy bnh qua thc phm gy ra hng triu ca a chy mi nm, bao gm c hng nghn ngi nhng nc pht trin. Vic phn b v s dng thc n khng hp l l th phm chnh gy ra cc ca bnh ny. Vic suy thoi t v cn kit cc ngun nc mt cch nhanh chng cng to ra mi e do nguy him i vi vic sn xut lng thc trong tng lai.

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Hp 1.2. Khi nim mi trng h tr sc khe

Trong khi nim mi trng h tr sc kho, ngi ta bn ti cc yu t quyt nh sc kho ca ton b qun th, bao gm cc yu t sau: Vai tr ca cc yu t mi trng a phng trong s pht trin lnh mnh ca mt cng ng Mt cch tip cn to iu kin nng cao sc kho cng nh bo v khi tip xc vi cc yu t nguy c mi trng Xy dng cng bng trong y t i vi mt cng ng Tm quan trng ca pht trin bn vng nh l mt vn sc kho Tm hiu bit ca con ngi v mi trng trn mt din rng Nhn thc ca con ngi v s quan tm v tham gia ca c nhn nhm duy tr hoc to ra mt mi trng lnh mnh Ngun: Haglund v cng s, 1992.

7. TNG QUAN V CHNH SCH V QUN L SC KHO MI TRNG 7.1. Tnh hnh thc hin chnh sch v qun l mi trng

V chnh sch bo v mi trng: vo nhng nm 80, ln u tin cc nh khoa hc a ra d tho chin lc bo v mi trng quc gia. Thng 12/1992, Hi ngh Quc t v Mi trng v Pht trin bn vng thng qua k hoch 10 nm v mi trng, y c coi nh mt chin lc quc gia v mi trng cho giai on 1991 - 2000. Trn c s , nhiu chnh sch, vn bn php lut, hng lot cc hot ng v qun l mi trng c ban hnh nh Lut Bo v Mi trng (1993), Ngh nh 175/CP v "Hng dn thi hnh lut bo v mi trng", Ngh nh 26/CP v " X pht hnh chnh trong lnh vc bo v mi trng". c bit nm 1998, B chnh tr Ban chp hnh Trung ng ng ban hnh Ch th 36/CT-TW v " Tng cng cng tc bo v mi trng trong thi k cng nghip ho, hin i ho t nc". H thng qun l nh nc v bo v mi trng t trung ng n a phng c hnh thnh v i vo hot ng n np. Nhng iu ny gp phn khng nh ngn chn nhim, suy thoi v s c mi trng, gp phn ci thin ng k cht lng mi trng nc ta. V chnh sch qun l sc kho mi trng, trong thi gian qua, ngnh y t c mt s nhng chnh sch, chin lc ring l cho nhng hot ng v sc kho mi trng nh qun l cht lng v sinh v an ton thc phm (Cc Qun l cht lng V sinh - An ton thc phm, Vin Dinh dng,...), nhng chnh sch v v sinh hc ng, xy dng cc ch s nh gi cht lng nc sinh hot, xy dng tiu chun v v sinh lao ng v xc nh nhng bnh ngh nghip v.v... Mt vn c bn l 22

ngnh y t c mt h thng hon chnh, hot ng c hiu qu t trung ng n a phng, l h thng y hc d phng, cc hot ng v sc kho mi trng u thng qua h thng ny. y l iu kin thun li cho vic thc thi cc chnh sch v chin lc v sc kho mi trng. Tuy nhin, cho n nay chng ta cha c mt hi ngh no c tm c quc gia bn v chin lc, cc chnh sch ring, c th cho sc kho mi trng bi l chng ta cng cha ra c mt nh ngha r rng hay mt khi nim c th v sc kho mi trng Vit Nam. y l mt vn trong thi gian ti cc cp, cc c s y t trong ton quc cn phi quan tm v tin hnh. C quan gi vai tr quan trng trong vic ny l V Y t D phng - B Y t trong vic phi hp vi ngnh mi trng cn ngh Chnh ph c mt Hi ngh quc gia bn v chnh sch v chin lc quc gia v sc kho mi trng.
7.2. Thc trng v chin lc v sc kho mi trng

Tuy Vit Nam t nhiu kt qu v bo v mi trng, trnh hiu qu xu tc ng ln sc kho con ngi, nhng cn nhiu vn bt cp trong qun l mi trng v sc kho mi trng nh: quy hoch mi trng cha lng ghp vi pht trin kinh t - x hi, gio dc - o to, nng cao nhn thc mi trng, quy hoch pht trin th, quy hoch qun l tng th rng, vng ven bin, bo tn a dng sinh hc, v.v.... H thng t chc qun l, c ch v chnh sch cn nhiu hn ch. Kinh ph t, u t dn tri nn kt qu nhiu khi khng thy r rng, lm cho cng ng dn c thay i nhn thc cn qu chm, lm cho mi trng v sc kho mi trng hin ti cn nhiu iu cn bn.
7.2.1. Thc trng

a. Mi trng tip tc xung cp Rng tip tc b suy thoi. a dng sinh hc trn t lin v di bin tip tc b suy gim. Cht lng cc ngun nc tip tc xung cp. Mi trng th v cng nghip tip tc b nhim. Cht lng mi trng nng thn c xu hng xung cp nhanh. Mi trng lao ng ngy cng b nhim c. S c mi trng gia tng mnh. Mi trng x hi: phn ho giu ngho ngy cng tng, t nn x hi, v.v.... b. Tc ng ca mi trng ton cu Vn mi trng ca lu vc Sng M Kng v Sng Hng. Vn mi trng ca cc rng chung bin gii. 23

 Vn ma acid. Vn nhim tng kh quyn, hiu ng nh knh v suy gim tng ozon, hu qu ca vn ny gy ra: + S thay i kh hu ca tri t n n s mt cn bng ca h sinh thi. + Mc nc bin dng cao do nhit tri t tng. + Hin tng En Ni-n v La Ni-na lm gia tng ma bo v hn hn nghim trng. + Vn nhim bin v i dng. + Vn chuyn dch nhim. c. Thch thc ca mi trng nc ta trong thi gian ti Xu th suy gim cht lng mi trng tip tc gia tng. Tc ng ca cc vn mi trng ton cu ngy cng mnh v phc tp hn. Gia tng dn s v di dn t do tip tc gy p lc ln mi trng. Tng trng nhanh v kinh t cng vi vic cng nghip ho, hin i ho t nc v ang tc ng mnh ln mi trng. Hi nhp quc t, du lch v t do ho thng mi ton cu s gy ra nhiu tc ng phc tp v mt mi trng. Nhn thc v mi trng v pht trin bn vng cn thp km. Nng lc qun l mi trng v sc kho mi trng cha p ng yu cu. Mu hnh tiu th lng ph hay kht tiu dng.

7.2.2. Chin lc

Phng nga nhim. Bo tn v s dng bn vng ngun ti nguyn thin nhin, a dng sinh hc Ci thin mi trng t nhin v x hi.
7.2.3. Gii php

Tng cng gio dc v nng cao nhn thc v mi trng v sc kho mi trng. Tng cng vai tr s tham gia ca cng ng, doanh nghip, t nhn trong bo v mi trng. Tng cng v a dng ho u t bo v mi trng. Tng cng nng lc qun l nh nc v mi trng v sc kho mi trng. M rng hp tc quc t v thu ht ti tr nc ngoi. Kt hp chin lc bo v mi trng quc gia vi chin lc pht trin kinh t - x hi. Cn c mt chin lc quc gia v sc kho mi trng. 24

T LNG GI

1. 2. 3. 4. 5. 6. 7. 8. 9.

Hy nu khi nim v mi trng theo Lut Bo v mi trng Vit Nam 1993. Hy trnh by cc thnh phn ca mi trng. Hy nu khi nim v sc kho mi trng. Cuc khng hong mi trng ln th nht xut hin u? Nu r nguyn nhn. Vo nhng nm gia th k XX, ngi ta gii quyt c nhng vn mi trng g. Hy in t thch hp vo cu sau: Tt c kha cnh ca sc kho mi trng l xc nh, gim st, kim sot cc yu t .........., .............., ............ v ............ c nh hng n sc kho con ngi. Hy trnh by cc hot ng qun l mi trng vt l, ho hc v sinh hc. Nu nh ngha v sc kho mi trng theo nh ngha ca T chc Y t Th gii (1948).

10. Hy nu tc ng ca dn s v vic th ho ln sc kho cng ng v mi trng. 11. Nu cc bnh ph bin lin quan n nhim nc. 12. Hy nu cc yu t quyt nh n sc kho ca ton b qun th trong khi nim mi trng h tr sc kho. 13. V chnh sch qun l sc kho mi trng, ngnh y t Vit Nam c nhng chnh sch, chin lc g? 14. Hy nu tm tt thc trng mi trng Vit Nam. 15. Nu Chin lc Bo v mi trng Vit Nam. 16. Trnh by cc gii php nhm gii quyt cc vn sc kho mi trng Vit Nam.

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BI 2

QUN L NGUY C T MI TRNG

MC TIU

1. Phn tch c cc nguyn tc qun l nguy c. 2. Xc nh c cc yu t tc ng da trn s nhn bit nguy c v nh hng ti qu trnh thng tin v nguy c. 3. Trnh by c nhng u, nhc im ca cc gii php phng chng nhim. 4. M t c cc bin php theo di, gim st nguy c t mi trng.
1. T VN

Mi trng c nh hng trc tip n tnh trng sc kho ca mi c nhn, cng ng v quc gia. S tc ng ca mi trng c th theo hai chiu hng: c hi cho sc kho v khng c hi cho sc kho, hoc cng c th va c hi va khng c hi. Qun l mi trng m chng ta s cp ti trong bi ny l qun l cc yu t nguy c mi trng c hi cho sc kho. V danh t "qun l" y c s dng vi ngha xc nh mc ca nguy c v nu xc nh nguy c l cn thit phi phng chng th ra cc gii php phng chng cc tc hi t nhim mi trng, qu trnh qun l nguy c bao gm cc bc chnh sau: Lng ho mc nhim. Nhn thc v chuyn ti cc thng tin v tnh trng nhim. D phng v kim sot tnh trng tip xc qu mc. Theo di v gim st cc nguy c nhim mi trng. Qun l nguy c l mt qu trnh phc tp, i hi s tham gia ca nhiu ngnh, nhiu bn lin quan ngay t bc xc nh vn v la chn nguy c u tin cn phi gii quyt. Qun l nguy c mi trng khc vi cc dng qun l nguy c khc nh qun l nguy c ti chnh, qun l nguy c ca mt doanh nghip v. v. do n mang y cc c im phn nh bn cht phc tp ca mi trng. Mt v d chng minh tnh phc tp trong vic xc nh cc nguy c t mi trng l ng c ch. Mt ngi trng thnh c chn on l c cc triu chng ca nhim ch th s thm nhim c th t rt nhiu ngun v kh xc nh u l ngun chnh. Cc ngun c th l ch do kh x ng c ca cc phng tin giao thng s dng xng pha ch, c th trong ngun thc n c nhim ch, ngun nc s dng nhim ch hoc thm ch anh ta lao ng trong mt mi trng phi nhim vi ch hoc nng ch trong mu ca anh ta l kt qu ca qu trnh phi nhim vi hai hoc thm ch tt c cc ngun trn. 26

Chu trnh qun l nguy c c khi qut theo s sau

Xc nh vn

nh gi can thip

Phn tch mc nguy him

Cc bn lin quan

Tin hnh can thip

La chn gii php

Ra quyt nh can thip

Hnh 2.1. S chu trnh qun l nguy c

Trc khi a ra cc bin php phng chng tc hi ca nhim mi trng, ngi ta phi xc nh xem: (1) yu t nhim l yu t no; (2) nhng c trng nhim l g sau khi bit mi quan h gia tip xc vi nhng hu qu i vi sc kho cng nh gia tip xc vi qu trnh thm nhim, mc thm nhim. V d: trc y khi ngi ta s dng xng pha ch th nhim ch trong khng kh l mt vn sc kho cng ng kh r, c bit i vi tr em. Bng nhiu bin php khc nhau, ngi ta tnh ton c cc con ng tip xc v hp th ch vo c th, trong c mt lng ch ng k t khi kh x ng c. Ngi ta cng bit c khi ch xm nhp vo c th lm tng lng ch tch lu trong cc m (xng, tc, rng, mu...) v tng lng ch trong nc tiu. Lng ch c trong c th c coi l s thm nhim. Mc nhim ch trong mi trng cng cao th mc thm nhim cng ln. Mc thm nhim cng ln cng c th lm tn thng n cc h 27

thng c quan cc mc di lm sng hoc lm sng. Liu tip xc cng ln c th lm cho mc tn thng c th cng ln (mi lin quan liu - hu qu). Cc mi lin quan gia nhim vi tip xc, tip xc vi thm nhim, thm nhim vi cc hu qu tn thng h thng c quan ca c th cng nh tnh trng bnh l cng cc yu t lm tng cng hoc hn ch cc mi quan h trn c coi l cc c trng ca nguy c do nhim ch trong khi kh x ng c dng xng pha ch. khng ch cc tc hi ca nhim ch trong mi trng, ngi ta phi qun l nguy c nhim ch t ngun xng pha ch. Trong phi o lng cc yu t nguy c ln sc kho m nhim ch gy ra, sau tm hiu xem cng ng thc c cc hu qu ln sc kho cha v bng cch no thng bo cho cng ng bit. Cng lc cng phi a ra cc gii php nhm hn ch hoc ngn nga tnh trng tip xc vi hy vng gim nguy c hoc loi tr nguy c (cm khng bn xng pha ch). Sau cng, qun l nguy c ngi ta phi tip tc theo di, gim st qu trnh gy nhim (v d: c thc hin bn xng khng pha ch hay khng), tnh trng sc kho cng ng v mc thm nhim (v d: hm lng ch trong tc, trong mu...), v tnh trng nhim c di lm sng (v d: theo di ALA trong nc tiu, tnh trng thiu mu, pht trin tr tu ca tr em...). Mt khi cc bin php kim sot nhim bng hn ch hoc cm bn xng pha ch c ban hnh, vic thc hin cc quy nh ny ra sao vn tip tc c theo di, cnh bo v x l vi phm khi hon ton khng cn xng pha ch bn ra th trng trong mt vi nm th vic qun l nguy c mi kt thc.
2. LNG GI NGUY C 2.1. Gii thiu v lng gi nguy c

C kh nhiu yu t bnh thng vn tn ti trong mi trng nhng tr thnh yu t nguy c vi sc kho mt khi vt qu gii hn cho php. Lng gi nguy c gip ta xc nh c mc nhim, mc nguy c. lng gi nguy c cn phi so snh mc nhim vi cc tiu chun hoc cc bng ch dn, B Y t ban hnh cc vn bn Tiu chun v sinh quy nh cc mc nhim ti a cho php trong mi trng sinh hot, mi trng thc phm v mi trng lao ng. B Khoa hc cng ngh v Mi trng cng ban hnh cc vn bn v tiu chun mi trng. Nhiu B, Ngnh c cc vn bn lin b, lin ngnh quy nh cc tiu chun v sinh lin quan n qun l Nh nc i vi cc lnh vc khoa hc, cng ngh, mi trng, cc sn phm hng ho c lu thng trn th trng. Trc y, cc vn bn Tiu chun v sinh ca nc ta ch yu da trn cc tiu chun v sinh, cc quy nh v sinh ca Lin X. Cho ti nay, nhiu tiu chun mi s dng cc tiu chun ca mt s nc khc, trong c cc tiu chun ca M, Anh, Php, c v c bit l c xu hng sa i tiu chun theo cc quy nh ca T chc Y t Th gii (WHO), T chc Lng nng Quc t (FAO) v T chc Lao ng quc t (ILO). Vic s dng tiu chun no u da trn cc cn c: 28

 C s khoa hc: m bo mc tip xc ti a cho mi i tng trong cng ng khng b nh hng cp tnh hay mn tnh. Kh nng kim sot mi trng. Kh nng thc thi v gim st thc thi da trn cc tiu chun. Nu s dng mt tiu chun vi an ton cao, kh nng kim sot nhim, p dng cc tiu chun trong thc t kh khn th hiu qu ca ca vic p dng tiu chun nhm bo v sc kho cng ng kh c tnh kh thi. Tng t nh trng hp a ra mt lut l m kh nng p dng lut khng c th lut khng c hiu qu. Nhng ngi c trch nhim qun l Nh nc v mi trng cng nh nhng c s qun l s nghip v mi trng mi khi nhn nh v tnh hnh nhim mi trng cng nh mi khi ra quyt nh cc bin php x l nhim mi trng cn phi hiu y v cc tiu chun v sinh.
2.2. Nhng kh khn ca vic lng gi nguy c

Trn thc t, vic lng gi nguy c gp khng t kh khn v k thut, quy trnh, nhng kh khn hn l s s dng kt qu lng gi nh th no trong qu trnh ra quyt nh x l. iu ny kh r khi chng ta thy mi trng b nhim nng n, rt nhiu nguy c t mi trng c xc nh, song khng th a ra mt gii php no, khng phi v khng th tm gii php m chn gii php no kh thi, khng khi p dng mt gii php th hu qu ca gii php li mang li cc nh hng khc n iu kin kinh t, x hi ca cng ng, t li gy ra cc hu qu sc kho khc, to ra cc nguy c mi (ng ca nh my c th lm cng nhn tht nghip, nh nc mt ngun thu ngn sch...). Mt im ng lu khc khi xc nh nguy c l vic o c mc nhim mi trng khng phi l mt vic d dng. Th nht, v mt k thut: c rt nhiu yu t nhim kh xc nh, cn s dng nhiu phng php khc nhau. Nu bit yu t nhim l g, phi chn k thut o c nhy. Nu cha bit yu t nhim l g th phi tin hnh cc nghin cu dch t hc sng lc, tm ra cc yu t nguy c sau o lng mc nhim. V d: mt lng, ngi ta thy rt nhiu ngi b mt bnh ging nhau l vim tc tnh mch chi di. C rt nhiu gi thuyt c t ra, trong c vn ngun nc ngm b nhim. Sau khi tm c mi lin h gia s dng nc ngm vi cc trng hp tc tnh mch chi, ngi ta tin hnh phn tch thnh phn ho hc trong nc ngm, kt qu l xc nh c mc arsenic cao bt thng. Kt qu ny cng ph hp vi nhng kin thc v c cht hc l arsenic c th gy vim tc tnh mch. Giai on tip l ly mu v phn tch mc nhim arsenic v cc quy lut nhim (o lng mc nhim - mc nguy c).

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Th hai, v mt nhn nh kt qu, i chiu kt qu vi tiu chun: quy lut nhim ca mt yu t trong mi trng rt khc nhau. o lng mc nhim i hi k thut phi c nhy v c hiu nht nh. Thm vo , sai s do qu trnh phn tch mu trong phng th nghim c th khng ln bng cc sai s khi ly mu. Ch cn t mu sai v tr, s mu t, thi im ly mu khng ng, khng thi gian th sai s c th gp nhiu ln, c khi ti hng trm ln so vi mc thc, trong khi mc sai s trong khu phn tch mu ch mc vi phn ngn, phn trm hoc phn mi (v d, sai s do ly mu bi khng ng c th lm mt v tr c mc nhim 1mg/m3 tng ln ti 10mg/m3 hoc hn, trong khi sai s trong khi phn tch mu bi ch cho php mc 1/10mg). i vi cc yu t nhim trong mi trng lao ng thng c mc gii hn ti a cho php cao hn vi cng cht cho mi trng sinh hot. Do mi trng sinh hot l ni ngi ta phi sng khng ch trong thi gian lm vic (nh mi trng lao ng) v i tng tip xc l ton b dn c, trong c tr em, ph n, ngi gi, nhng ngi khng kho mnh l cc i tng d b nh hng hn. Trng hp cc c s sn xut ti khu dn c hoc ngay trong nh , khi i chiu mc nhim phi so snh vi tiu chun cho mi trng sinh hot. Trong thi k pht trin cng ngh rt nhanh chng v a dng cng vi nhng quy nh b mt cng ngh, vic nh sn xut hoc ngi phn phi hng ho khng sn lng cung cp thng tin (c th do khng hiu bit hoc c tnh du) v cc yu t c th c hi cho sc kho nn vic xc nh, o lng nguy c nhim rt kh khn. khc phc iu ny khng ch c cc gii php k thut, ti chnh m cn cn cng c h thng php lut v h thng thanh tra mi trng.
2.3. Cc phng php lng gi nguy c

lng gi nguy c mi trng ngi ta c th s dng phng php nh tnh v /hoc nh lng xc nh xem mc trm trng ca nguy c, liu nguy c c cn phi gii quyt hay khng v trong mt bi cnh c nhiu nguy c e da sc kho ca cng ng. Vic lng gi nguy c gp phn gip cc nh hoch nh chnh sch, cc bn lin quan a ra quyt nh xem nguy c no cn u tin gii quyt, nguy c no c th tm thi cha gii quyt khi ngun lc cn hn ch.
2.3.1. S dng phng php nh tnh lng gi nguy c

Phng php nh tnh c s dng lng gi nguy c thng qua s nh gi mt cch nh tnh v cc hu qu c th c do nguy c gy nn v kh nng xy ra ca nguy c (cc bng 2.1, 2.2, 2.3).

30

Bng 2.1. Cc mc nh tnh o lng cc hu qu ca nguy c

Mc 1 2 3 4 5 M t Thm khc Ln Trung bnh Nh Khng r rng V d Cht ngi, ng c, thit hi gh gm v ti chnh Chn thng, gim kh nng, thit hi ln v ti chnh Cn c can thip y hc, c thit hi v ti chnh Cn s cu, tiu phu, thit hi nh v ti chnh Khng c bnh, chn thng, thit hi ti chnh khng ng k

Bng 2.2. Cc mc nh tnh o lng kh nng xy ra ca nguy c

Mc A B C D E M t Chc chn xy ra Gn nh chc chn s xy ra C th xy ra Cha chc chn c xy ra hay khng Him khi xy ra V d c cho l s xy ra mi hon cnh C th xy ra mi hon cnh C th xy ra C th xy ra nhng khng chc chn Ch c th xy ra trong mt vi trng hp rt c bit

Bng 2.3. Bng lng gi mc nguy c

Kh nng xy ra 1 A B C D E E E E E H 2 E E E H H Hu qu 3 E H H M M 4 H H M L L 5 H M L L L

Trong mc nguy c c din gii nh sau: E (Extreme): H (High): Nguy c nghim trng, cn phi gii quyt ngay Nguy c cao, cn c s quan tm qun l c bit

M (Moderate): Nguy c trung bnh, c trch nhim phi qun l L (Low): Nguy c thp, c th c qun l bng quy trnh thng quy

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Vic lng gi nguy c bng phng php nh tnh do da vo nh gi ch quan ca cc bn lin quan nn thiu tnh khch quan. Mc d cc nh gi v kh nng xy ra v cc tnh nghim trng ca cc hu qu do nguy c c th gy ra c th c da trn bng chng ca cc bo co trc y, cc nghin cu v liu - p ng, liu hu qu v. v. Tuy nhin, vic a ra cc tiu ch cao hay thp hon ton ph thuc vo u tin gii quyt v kh nng ti chnh trong bi cnh qun l nguy c hin ti. V d: cng mt thng tin v thc trng chn thng giao thng do vn an ton mi trng giao thng c th c coi l nghim trng (E) quc gia tng i pht trin nh c, nh cng c th c nh gi mc trung bnh (M) quc gia c nn kinh t km pht trin hn nh Thi Lan, ni m cc vn v cc bnh ly truyn qua ng tnh dc c nh gi l cn u tin gii quyt hn.
Bng 2.4. M ho cc mc lng gi nguy c
TT Yu t Cc mc Thm khc, cht ngi, thit hi > 1. 000.000 USD 1 Hu qu Cht nhiu ngi, thit hi 500.000 - 1. 000.000 USD C cht ngi, thit hi 100.000 - 500.000 USD Chn thng nghim trng (c th dn n tn tt vnh vin), thit hi 1.000 - 100.000 USD Chn thng, thit hi di 1000 USD Chn thng, bnh, thit hi khng ng k Lin tc (hoc nhiu ln trong ngy) 2 Tnh trng phi nhim Thng xuyn (mt ln trong ngy) Thnh thong (t mt thng/ln n 1 tun /ln) t (t mt ln /nm n mt ln/thng Him ( tng xy ra) Kh c th xy ra (cha tng nghe ni c xy ra) Chc chn 100% s xy ra 3 Kh nng xy ra C th xy ra kh nng 50:50 C th xy ra mt cch trng hp, khng thng xuyn Xy ra mt cch trng hp, him gp Cha xy ra sau nhiu nm phi nhim, tuy nhin c th xy ra Khng th xy ra Ngun: NSCA (1973). Phn loi cc yu t trong h thng lng gi nguy c mi im nguy c lc ny c tnh bng R=CxExP Trong R: im nguy c E: Tnh trng phi nhim C: Hu qu c th xy ra P: Kh nng xy ra ca nguy c M ho 100 50 25 15 5 1 10 6 3 2 1 0, 5 10 6 3 1 0,5 0,1

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2.3.2. Lng gi nguy c bng phng php nh lng

Cc nghin cu dch t hc ng vai tr quan trng trong vic lng gi nguy c nh lng ny. Cc nghin cu v mi quan h nguyn nhn - hu qu s ch ra mt yu t nguy c (ho cht, sinh hc v. v.) c th gy ra cc nguy c nh th no cho mt cng ng, c bit l cc nh hng ln sc kho. Cc nghin cu dng gim st sinh hc c th ch ra mc tng t bin cn phi gii quyt ca mt ho cht hoc mt cht c no trong mi trng. Cc thng tin nh lng thu c s c i chiu vi cc tiu chun, cc ngng cho php theo quy nh xc nh mc ca nguy c
2.3.3. Lng gi nguy c bng phng php bn nh lng (semi - quantitative)

Vic lng gi nguy c bng phng php bn nh lng c ngha l s dng cc bng chng, thng tin t cc phng php nghin cu nh lng da vo thang phn loi nh gi nguy c. Cc s liu nh lng thu thp c t cc nghin cu dch t hc s c m ho theo cc tiu chun nh sn. T cc m chun v hu qu, s ngi phi nhim v kh nng xy ra ca nguy c t c th lng gi c mc ca nguy c (bng 2.4).
3. THNG TIN V MI TRNG

Ngi ta nhn thy rng nhn thc ca cng ng v mi thnh vin trong cng ng khng hon ton ging nhau v cc nguy c nh hng ti sc kho ca cc yu t mi trng. Ngi ta nhn bit c tc hi ca mi trng cc mc khc nhau, ng thi khi nhn thc c yu t tc hi ri th cch phn ng vi yu t tc hi cng khng ging nhau. V d: trong trng hp ng c c nc, do c thng bo trn cc phng tin truyn thng i chng, rt nhiu ngi bit n c nc c th b ng c v thm ch gy t vong. Mt s ngi khng c thng tin nn khng bit. Mt s ngi ch bit i khi m cha bit phn bit c nc vi cc loi c khc. Thm vo , khi bit ri nhng nhiu ngi vn mua v n, vn mang i bn ngha l vn chp nhn nguy c (v khng phi c n c nc l chc chn b nhim c). C rt nhiu v d khc tng t trong thc t. Ng c thc phm do ho cht xy ra thng xuyn to ra mt bu khng kh lo u v mt an ton thc phm nhng phn ng ca cng ng rt khc nhau. iu ny ph thuc vo mc truyn thng v c thc ca cng ng. Thng tin v mi trng khng phi ch t pha cc c s y t, c s khoa hc cng ngh mi trng n ngi dn - nhng ngi c th gnh chu hu qu ca nhim mi trng m cn ti cc c s, cc c quan ca chnh quyn chu trch nhim trong vic ra quyt nh x l nhim mi trng v ti cc c s sn xut, cc nh doanh nghip, nhng ngi phn phi hng ho l nhng ngi c trch nhim trong vic gy nhim, to nguy c, phn pht cc yu t 33

nhim. Cc c quan thng tin i chng, cc hip hi trong c Hi Bo v ngi tiu dng cng cn c thng tin. Thng tin khng c ngha l thng bo cho ai bit mt thng ip no m cn c vic khuyn khch vic cung cp thng tin phn hi. Kt qu ca thng tin l t c mt s nhn bit, thay i hnh vi v c c quyt nh nhm lm gim nh nguy c, gii quyt cc hu qu v ngn nga cc yu t nguy c mi. Thng tin mi trng nhm trao i thng tin v vic c hay khng tn ti mt yu t nguy c trong mi trng; c im ca yu t nhim, yu t c hi hay nguy c; dng tn ti ca yu t nhim; mc nhim v mc chp nhn c ca yu t nhim, ca nguy c. Khi thng tin, mc tiu quan trng nht l t c mt s quyt nh ca cng ng trong vic phng nga nguy c bng nhng gii php hu hiu, kh thi v bn vng. Cc gii php (hay chin lc) nhm khng ch nguy c ca mi trng ph thuc vo cc loi nguy c, vo mc nhn thc hay quan tm, lo lng ca cng ng vi nguy c. Khi tip xc mt cch t nhin vi nguy c mi trng nh vi nhim khng kh, nhim ting n l iu m ngi ta thy khng th trnh c ( nhim khng kh...) hoc kh trnh c (khi thuc l ca ngi khc ht). Gii php qun l mi trng l gio dc cng ng h nhn bit c nguy c hoc to ra cc iu kin khng ch (cm ht thuc ti ni lm vic, ni cng cng...). Khi mt s nguy c mi trng thng xuyn c thng bo qua cc phng tin truyn thng i chng hoc cnh bo ti ni lm vic mt cch rng ri, c th nhn thc ca cng ng ch l ch nhiu hn ti tc hi th gii php a ra s nhm tng cng, duy tr s ch ca cc phng tin truyn thng v lm cho vic truyn thng rng ri hn, thc hn, khng che du thng tin. Khi mt nguy c mi trng to nn tm l s hi, lo lng v s mt an ton trong cng ng c th lm cho mt b phn cng ng qu s hi hoc ngc li, c mt s ngi cho rng khng h ng s v tr thnh qu thng tnh (v d: ngi lm vic trn cao d dng b tai nn do ng, ai cng bit tai nn ny cng thng xy ra lm cho mt s ngi qu s hi hoc ngc li, cho l chuyn thng). Cch gii quyt s phi nhm a ra cc lut l (v d nh iu l an ton lao ng). Khi mt nguy c mi trng ch tc ng khu tr trong mt nhm ngi, mt s nguy c c th gy cht ngi, gy tai nn chn thng, tn ph trong mt s trng hp c bit. Gii php y l a ra cc thng bo cho cc cng ng ny v mc nguy hi c th vt qu nhng g m h bit, hoc phng i hn nhng trng hp b nh hng lm cho cng ng ch ti nhng hu qu so vi vic cnh bo v xc sut s xy ra hu qu.

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Khi mt nguy c mi trng tc hi trn tr em, gii php phi nhm vo c cng ng v tng gia nh sao cho mi ngi, mi nh u nhn thc ng v nguy c ny cng nh mc nguy hi ca n khng ch cho tr em hm nay m ko di n khi trng thnh. Hu qu khng ch hm nay m cn trn th h sau. Thng tin v cc mi nguy c trong mi trng l mt hot ng ca qun l nguy c. Nhng ngi cung cp thng tin v mi trng bao gm cc c s y t m trc ht l h thng y t d phng thng bo v cc nguy c, thc trng nhim mi trng t, nc, khng kh, mi trng thc phm, mi trng lao ng. Cc thng tin v cc v dch bng n khng ch do nhim khun m cn do nhim c hoc cc nguy c vi bc x ion ho, cc yu t vt l, cc nguy c thm ho do con ngi hoc thm ho t nhin, cc iu kin pht sinh cng nh cc c hi, cc yu t lm tng gim nguy c. Cc thng tin t c s y t cng phi cnh bo cng ng v s mt cnh gic, s bt cn ca c nhn, s th chm ch trong vic ra quyt nh x l ca cc c quan hu trch v c s mt cnh gic ca c quan y t. i vi h thng bnh vin, cc phng khm cung cp thng tin v cc trng hp nhim c, nhim trng hoc tai nn do nhim mi trng, cnh bo cng ng qua cc s liu v trng hp cp cu, t vong hoc tn ph lm cho cng ng nhn thc y hn v cc mi nguy c, khuyn khch h p dng cc bin php phng chng bo v cho cng ng v cho tng gia nh, tng c nhn. Cnh bo cc nh sn xut, nhng ngi cung cp hng ho khng an ton v to p lc d lun, p lc x hi trn nhng ngi chu trch nhim v nhim mi trng. Thng tin khng phi lc no cng ch ch ti quyn li ca ngi dn m cn gp phn bo v quyn li ca nhng ngi sn xut, lm h ng tnh ng h v cng tham gia vo qu trnh khng ch cc yu t nguy hi t mi trng, v d nh vic a ra cc khuyn co v gii php khng ch nguy c c chi ph thp v hiu qu cao, gii php d phng trnh xy ra ri ro, gim chi ph do phi bi thng. Theo nh x hi hc v l chuyn gia v thng tin cc nguy c mi trng (Tin s Peter Sandman (1987)) th nguy c c nh ngha bng tng ca cc yu t nguy c v nhng phn ng bt bnh t pha cng ng: Nguy c = Yu t nguy c + Phn ng bt bnh ca cng ng (Risk = Hazard + Outrage) i vi cc chuyn gia th nguy c ng ngha vi t l t vong c tnh hng nm. Nhng i vi cng ng (v thm ch i vi c cc chuyn gia khi h nh) th nguy c cn mang nhiu ngha khc. Cng ng thng ch qu t ti yu t nguy c thc s, cn cc nh chc trch th li khng ch ti phn ng bt bnh ca cng ng. V vy, khi cc nh chc trch v cng ng xem xt nh gi mt nguy c th h s c cc kt qu khc nhau. Theo Peter Sandman (1987), c hn 20 yu t khc nhau gy bt bnh, gin d trong cng ng. Mt s v d in hnh l: nguy c t nguyn th s khng gy ra bt bnh trong cng ng v c mi ngi chp nhn hn nguy c b p buc (v d hy

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so snh trng hp bn b mt nh chc trch bt trt xung mt ngn ni bng tuyt m ch dng hai cy trt vi vic bn quyt nh i trt tuyt vo cui tun); nguy c t nhin s c chp nhn nh l "ti tri" cn nguy c nhn to th s gy ra bt bnh v kh c chp nhn; nguy c quen thuc th d c chp nhn hn nguy c mi (v d nguy c b bnh a chy th rt quen thuc v cng ng d chp nhn hn so vi nguy c b bnh than, mc d s t vong m bnh than gy ra l rt nh) v. v. Cc thng tin c truyn thng ti cng ng phi lun lun c lp i lp li v gy ch nh nguyn tc qung co. ng thi, thng tin phi c cng ng chp nhn, li cun h tr thnh nhng ngi truyn thng t ngi ny sang ngi kia. Thng tin cng cn r rng, thu ht; va phi thn thin khng kch ng nhng va phi thng thn v ci m ph hp vi trnh hc vn, tp qun tn ngng, dn tc v i chng nht l cc dn tc t ngi v ng thi cng phi ph hp vi ni dung truyn thng p ng yu cu ca phng tin truyn thng i chng. Thng tin phi nhm thu c cc phn hi t cng ng, cc bn c lin quan iu chnh. Sau cng, song cng khng km phn quan trng l thng tin phi da trn vic xy dng k hoch ph hp v c nh gi hiu qu c chin lc tt hn, k hoch ph hp hn.
4. PHNG CHNG TC HI CA NHIM MI TRNG

Mt b phn quan trng ca qun l nguy c l d phng v khng ch tip xc vi cc yu t tc hi trong mi trng. Ging nh cc dy truyn dch t hc, khng ch yu t nhim mi trng cng bao gm ba khu: Khng ch ngun gy nhim. Ngn chn s pht tn yu t nhim. Bo v nhng i tng tip xc. Mc d phng c chia lm ba cp nh sau: D phng cp 1: bo v khi cm th, khng tip xc qu mc vi cc yu t nguy c khng b bnh. D phng cp 2: bo v nhng ngi v ang tip xc qu mc vi cc yu t nguy c, khng cc tn thng di lm sng hoc lm sng gy ra cc hu qu lu di trn sc kho (pht hin sm v x tr ng, kp thi). D phng cp 3: khng xy ra cc ri ro, hu qu gy cht ngi do nhim mi trng. Trong y t d phng, ngi ta ch ch ti d phng cp 1 v cp 2, cn d cp 3 thuc v trch nhim ca h thng khm cha bnh. Vic phng nga cc yu t tc

36

hi c trng s c trnh by cc bi sau. Bi ny ch trnh by cc nguyn tc d phng cc tc hi, cc nguy c t mi trng chung nht.
Cc gii php d phng cp 1

Cc gii php d phng cp 1 bao gm: Khng ch nhim ti ngun pht sinh. Thay th cc yu t c hi bng yu t khng c hi. Thay th cc quy trnh cng ngh pht sinh c hi nhiu bng cc quy trnh khng pht sinh c hi, t pht sinh c hi hn hoc quy trnh cng ngh pht sinh c hi nhng d khng ch s lan to cc yu t c hi ra mi trng xung quanh hn. Khng yu t c hi pht sinh bng thng gi, thong kh. Khng ch s pht tn cc yu t c hi vo mi trng sn xut hoc mi trng xung quanh: + + p dng bin php che chn, bao bc cch ly ngun pht sinh nhim. Ht cc b hoc to cc mng ht, hp th yu t nhim ti ngun.

Bo v ngi tip xc S dng cc trang b bo h c nhn phng chng tc hi t mi trng. Gio dc sc kho mi trng cho cng ng. Cc gii php t chc, hnh chnh.
4.1. Khng ch nhim ti ngun pht sinh

Thay th cc nguyn liu, nhin liu pht sinh c hi bng nguyn liu hoc nhin liu t c hi hn hay hon ton v hi s gii quyt tn gc ngun nhim. Mt khi ngun nhim ch hn ch mc gy hi cn p dng cc bin php thng thong gi hoc a gi vo lm thong bt nng cht nhim trc khi b thi vo mi trng trong c s sn xut: m thm ca thng thong, s dng qut thi, qut ht. Khc vi vic thay th cht c, y nh cp mt lng kh ln lm cho nng cht c hoc bi trong khng kh b long ra t c di mc cho php. Vic khng ch cht c ti ngun c thc hin qua cc tiu chun sn phm v cc tiu chun v quy trnh hoc tiu chun cht thi. 4.1.1. Cc tiu chun sn phm Nu mt cht cha c bit v ngng cho php hoc vn cha c th nghim mt cch y , c th thc hin gim tc hi bng cch thit k li sn phm sao cho hn ch ti a khi lng cn s dng sn xut ra sn phm hoc 37

i tm nguyn liu thay th. V d: benzen l mt cht c hi, c th s dng xylen hoc toluen thay th l cc cht t c hi hn, hoc thay th mt phn benzen bng cc dung mi khc. Mt v d khc: vic thay xng pha ch bng xng khng c ch loi b nguy c nhim ch do kh x ng c dng xng pha ch trc y. Trong nhiu trng hp, tiu chun ho cc thnh phn ca nguyn liu v nhin liu khng ch mc thi cht c vo mi trng. 4.1.2. Cc tiu chun v quy trnh sn xut Nu c mt yu t nhim thi vo mi trng trong qu trnh sn xut th Chnh ph (thng qua B Khoa hc cng ngh v Mi trng, B Y t...) c th a ra cc chnh sch thu u i cho cc quy trnh cng ngh khng hoc t gy hu hoi mi trng. Khuyn khch cc quy trnh cng ngh sch cng nh nh thu cao vi cc cng ngh lc hu hoc a ra cc yu cu x l cht thi (kh thi, rc thi, nc thi) mt cch nghim ngt. 4.1.3. Cc tiu chun v cht thi Cc cht thi cng nghip vo mi trng t, nc, khng kh c ban hnh hng chc nm nay. Nhng tiu chun ny c th th hin qua vic quy nh cc nng ti a cho php v hm lng cht nhim trong kh x, nc thi. Cng c cc mc quy nh cht thi theo n v thi gian hoc theo n v sn phm hoc n v nhin liu, nguyn vt liu tiu th. Cc tiu chun c t ra cn phi cn nhc ti thc t sn xut, thc t th trng. Cc tiu chun quy nh cho o to cng nhn, tiu chun ng gi v dn nhn hng ha, tiu chun ct gi s dng v vn chuyn cng nh hu b, x l cc cht c.
4.2. Khng ch s pht tn yu t c hi vo mi trng

y l gii php tip theo gii php khng ch nhim ti ngun, mt khi gii php cha t yu cu. i vi cht c, bin php ht cc b nhm hn ch s pht tn cht c vo mi trng khng kh. Ht cc b s rt hu hiu nu kt hp vi cc bin php che chn, lm kn ngun pht sinh. Cc cht c, k c bi sau khi c ht s c x l, lm sch trc khi thi vo mi trng. Nhiu trng hp ch ht sau li a vo ng khi thi ra mi trng xung quanh (lc nng cht c c th b long ra) v lm nhim pht tn i xa hn, cho d khng cn mc gy hi nhng qu trnh tch lu c th li gy hu qu lu di. i vi cc yu t nhim l ting n hoc bc x, vic ht cc b khng c tc dng, thay vo l cc b phn bao bc, cc tm ht m, chn bc x. Kt cu tng v trn nh ph hp c th lm gim mc n. Tn dng quy lut gim cng theo khong cch, c th to khong cch cch ly xa ngun pht sinh cng bo v c 38

cng nhn. Bn cnh cc xa l c mt giao thng ln, ngi ta thit k cc h thng cn m hoc trng cy hai bn ng.
4.3. Bo v ngi tip xc

Bo v ngi tip xc rt thng p dng trong mi trng lao ng qua vic s dng cc trang thit b phng h c nhn: qun o bo h, gng ng, knh, nt tai, mt n, khu trang. Bo v ngi tip xc cng c thc hin qua gim thi gian tip xc, gim s ngi phi tip xc. Cc bin php phng h c nhn ch c coi l gii php b tr khi hai gii php trn b hn ch. Cc bin php phng h c nhn rt kh p dng cho cc loi nhim mi trng xung quanh. Vic eo khu trang trong 8 gi lao ng kh khn th vic s dng trong mi trng sinh hot cng cn hn ch hn rt nhiu. Vic s dng cc ti th khi mi trng nhim qu nng ch c th thc hin cc nc giu mt cch hn ch. cc nc ngho, vng ngho, ngi ngho phi sng ti cc v tr m ngi giu khng , v d nh gn cc ngun cht thi (gn cc cng thi, bi rc, cc nh my). Trong iu kin th ho mnh m nh hin nay, khu vc ni thnh pht trin dn dn c quy hoch hn, song khu vc ngoi thnh li l ni hng chu nhng hu qu ca th, cng l ni nhn cc ngun rc thi, kh thi, nc thi t thnh ph. T nn x hi cng t thnh ph nh hng ti khu ngoi . y l hin tng bng rp th nh c cp ti cc nc trong khu vc t hng thp k trc y. Vic qun l mi trng cng cn ch trng c n kha cnh cng bng x hi, ngha l phi dnh nhng khon kinh ph thch ng cho cc chng trnh lm sch mi trng, xy dng thnh ph lnh mnh c hai khu vc nng thn ngoi thnh v thnh th, khu vc cng nghip v vng ph cn. y cng l mt yu t ca pht trin bn vng. Bo v ngi tip xc khi cc nguy c t mi trng, ngoi nh my, ngoi khu th phi c thc hin bng cc lut l v bng cc chin lc tng th, khng phi bng cc phng tin phng h c nhn.
4.4. Gio dc sc kho mi trng

Gio dc sc kho mi trng l mt b phn ca qun l mi trng. Ngi dn phi nhn thc c cc vn mi trng m h ang sng. Nhng ngi lnh o cng ng cng cn c trang b kin thc v cht lng mi trng, bo v mi trng trong qu trnh quy hoch sn xut, quy hoch khu cng nghip v th c thi x tr ng. Gio dc sc kho mi trng bao gm: Cc hot ng truyn thng nhm nng cao hiu bit ca ngi dn v cc yu t nhim mi trng v nh hng ca cc yu t ln sc kho. 39

 Hng dn cng ng cch to ra mi trng sch hn, an ton hn. Thay i cch ng x ca cng ng vi nhim mi trng do sinh hot, do lao ng sn xut v mi trng thc phm khng an ton. Nc ta l mt nc nng nghip ang trn cng nghip ho. Gnh nng mi trng va mang c trng ca mt nc ang pht trin vi nhim cc ngun cht thi sinh hot, cc mm bnh nhim trng v k sinh trng, va chu nh hng ca nhim cng nghip, nhim th. Trong khi mc tip cn vi cc ngun nc sch cn hn ch, tnh trng thiu cng trnh v sinh c bn nh h x, nh tm, nh hp v sinh, h thng x l rc thi, phn gia sc, ... th nhim v ca cc nh v sinh mi trng vn cn ch trng rt nhiu ti cc hot ng gio dc sc kho mi trng vi c trng nng thn. Bn cnh , cc c im th ho thiu quy hoch, t c kim sot bng lut l, to ra tnh trng nhim th rt phc tp. y vic gio dc mi trng c th thc hin qua cc chng trnh gio dc sc kho nng thn. Mt trong nhng im lu ca truyn thng gio dc sc kho l trnh lp i lp li qu nhiu nhng kin thc rt ph thng nh: cn n chn ung si... v nhng iu ny n nay qu thng thng. Dn tr pht trin, ngi dn cn bit nhiu hn v cc bnh tt gy ra do mi trng t c thi ng x ph hp. Mt nghin cu ca Trng i hc Y H Ni ti H Nam cho thy rng kin thc v cc yu t nhim mi trng ca ngi dn khng km, nhng hiu bit ca h v cc bnh do mi trng gy ra cn qu t. Do cha hiu bit y v cc bnh do mi trng, ngi dn cha c cc cch ng x ph hp trong vic ci to cc cng trnh v sinh v bo v ngun nc. Vic gio dc v sinh cho cc cng nhn trong nh my d dng hn do y c cc chng trnh o to v v sinh an ton lao ng mt cch nh k, bt buc. i vi mt s cng nhn cng nh ch sn xut ca cc c s sn xut nh, cng ngh lc hu, pht sinh nhiu c hi, h thng phng h lao ng s si, cng nhn thng l tm tuyn, tay ngh thp v gn nh rt t tip cn vi cc chng trnh truyn thng gio dc sc kho. H l cc i tng rt d b tn thng v phi l i tng trng tm ca cc chng trnh gio dc sc kho mi trng, nht l trong iu kin cc x nghip nh ngy cng pht trin nh hin nay cc th cng nh ti cc lng ngh nng thn. Nu cc gii php trn khng p dng c hoc c nhiu hn ch, khng m bo bo v khng gy tc hi trn sc kho, lc mi p dng cc gii php d phng cp 2.
5. THEO DI, GIM ST MI TRNG V CC HU QU CA NHIM LN SC KHO CNG NG

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5.1. Theo di v gim st mi trng

y l h thng k thut nhm pht hin tnh trng nhim mi trng v cnh bo v cc nguy c gy nhim.
5.1.1. H thng ly mu v phn tch mu

Hin nay h thng ny nc ta cn hot ng kh ri rc, th ng v thiu chun mc. H thng gim st mi trng cc a phng cha mang tnh d phng m mang nng tnh v vic khi c vn nhim xy ra hay c nhng khiu kin ca ngi dn hay ca cc c quan. Vic ly mu rt t c ch v tiu chun, i vi tng yu t nhim, tng loi ngun pht tn nhim, cc quy lut nhim rt khc nhau. Cu hi t ra l: cn ly bao nhiu mu cho mi im l ? ly u? ly vo thi im no? (chin lc ly mu ra sao?). Trn thc t, ngi ta t ti chin lc ly mu m ch nhiu ti cc k thut phn tch mu. Cc my ly mu v phn tch mu t ng (my hin s) cho php cng mt lc thu v phn tch nhiu loi cht nhim. Tuy nhin, nhy ca cc thit b ny b gii hn cng nh tnh chnh xc ca cc kt qu a ra t cc my hin s cng kh c chun ho (nht l cha c mt c quan no c mt la b chun hiu chnh cc thit b ny). nhng nc tin tin, chin lc ly mu v gim st mi trng c quan tm rt nhiu. Cc phng tin thu mu v phn tch mu nh k theo thi gian, thng bo kt qu v mc nhim ca mt s yu t ch im cho mi ngi cng bit (c th nhn thy bng bo nhim ngay trn trc ng cao tc). Vi k thut ny cng ng c thng tin rng ri v thc bo v mi trng ca h qua c nng ln. Trong thc t, khng phi lc no cng d dng thu mu v phn tch cc mu. C nhiu cch nh gi mc nhim mi trng khc khng ch da trn k thut kinh in phn tch trong la b. Sau khi ly mu, phn tch mu nh gi mc pht tn cc yu t nhim trong mi trng, ngi ta phi tnh ton tip cc ch s o lng tip xc.
5.1.2. o lng tip xc

Thut ng tip xc (exposure) trong mt s ti liu c gi l phi nhim, cng c ti liu nh ngha l yu t c nghin cu v nhiu trng hp khng c biu hin g ca tip xc hay phi nhim (v d tnh trng cng thng tinh thn, stress trong mi trng x hi, trong mi lin quan nhn - qu vi chng suy nhc thn kinh, tnh trng trm cm, t t, ly hn). Trong thc t, tip xc c ngha rt rng: nu nghin cu nh hng ca ngh nghip vi mt c trng no , tip xc c th l: lm ngh g? lm ngh bao nhiu nm? yu t nhim l g? mc nhim nh th no; nu nghin cu nh hng ca kh thi nh my ra mi trng xung quanh th tip xc c th l: loi nh my? cht thi ch yu trong khi ca nh my l g? lng cht thi ca nh my thi vo mi trng xung quanh trong mt nm l bao nhiu? vo 41

tng ma, tng hng gi, nng cc cht nhim cc khong cch khc nhau ra sao? V d, tnh hnh ung th trong cng nhn ngnh cao su (tip xc l ngnh cao su) hoc tnh hnh bnh h hp v nhim kh CO2 t nh my nhit in (nng SO2 theo cc thi im, khong cch l tip xc). o c nhim bng phng tin xt nghim l cch nh gi trc tip tnh trng tip xc. Song khi s mu khng ln, khng i din, k thut phn tch khng nhy s khng ni ln mc nhim. Mt khc nhng ch s v nhim khng km phn chc chn nh tng lng nc thi, tng lng tro to vo mi trng xung quanh cng c th s dng c tnh tip xc. Di gc ca nh gi tip xc, mi trng c chia ra thnh 2 loi: (1) mi trng khch quan (l hc, ho hc, sinh hc v x hi hc); (2) mi trng ch quan hay cn gi l mi trng cm nhn c mu, mi, v. Mi trng cn c phn chia thnh: Mi trng gia nh (vi mi trng) bao gm: nh , cc thi quen, s thch, nghin ht, s dng m phm, thuc st khun s dng trong vn. Mi trng lm vic: vi nhng tip xc ngh nghip, ch lm vic, quan h ch th, quan h ng nghip. Mi trng a phng: l nhng ni tip xc vi nhng yu t mi trng sinh hot. Mi trng khu vc: iu kin a l, kh hu ca mt vng. Trong nh gi tip xc ca c nhn, mt cng ng vi cc tc nhn no phi tnh n mc tham d ca mt hoc nhiu trong nhm trn. Tip xc khc vi yu t tc hi, v khng phi lc no tip xc cng gy ra tc hi. Nhiu khi tip xc li l yu t c li cho sc kho trong trng hp nghin cu yu t lm tng cng sc kho (v d: ch n hp l, th thao). Trong nghin cu c cht hc, dc hc ngi ta cn dng thut ng liu (dose) ch khi lng cht hp th v ch sut liu (dose-rate) ni ln liu a vo trong mt n v thi gian. Trong dch t hc kh c th xc nh liu mt cch chnh xc, nn thng dng thut ng tip xc. Tip xc cng c tnh tng t nh ch sut liu bng con s tng hp tip xc v thi gian tip xc (trong ca, thng, trong nm hoc tui ngh vi cng vic ). Nhiu trng hp mc tip xc ph thuc cht ch vo thi gian tip xc hn l cng nhim (v cng nhim dao ng rt ln gia cc mu o trong cng mt thi im v khc nhau gia cc thi im ti mc xt nghim cc mu cht c, bi trong mi trng cng ch mang ngha nh tnh: vt tiu chun hay di tiu chun cho php), cch tnh nng cht nhim theo thi gian TWA (Time Weighted - Average) l mt v d (TWA = Nng cht c trong mi trng Thi gian tip xc). Cc dng tip xc Khc vi cc con ng tip xc, cc dng tip xc mang ngha rng hn, n bao gm 4 dng c bn: 42

 Tip xc bn ngoi theo ngha chung: y l cng hin c ca cc yu t nhim trong mi trng nh t, nc, khng kh, thc n, c mi lin quan ti tn sut v thi gian tip xc. Tip xc bn ngoi theo ngha hp: s hp thu l khi lng cht nhim hp thu vo c th. Khi lng ny khng ch tu thuc vo mc nhim trong mi trng m cn tu thuc vo thi gian tip xc trong ngy, tun, nm. Phng thc tip xc: vi liu cao ngn hay liu thp ko di. Tnh trng c th, vi cng mt nng cht nhim trong mi trng, nu lao ng th lc nng, vi kh hu nng, mc tip xc s cao hn hoc ngi nh cn s phi chu nh hng cao hn so vi ngi c cn nng hn h cng mi trng; ch n, khi lng thc n cng l yu t nh hng ti tip xc qua thc phm. Tip xc bn trong: khi ht th phi hi kh c, bi, khng phi tt c u c hp thu. Cng nh th vi cht c qua ng tiu ho, qua da. T l hp thu khc nhau theo tng yu t v c i vi th trng c th. Tip xc ti c quan chnh: mi tc nhn c hi c mt vi c quan ch, ni chu tc ng ca chng. Nng cht c nhng c quan ny cng cao, tc hi ca chng cng ln. Vic xc nh hm lng yu t c hi ti c quan ch khng phi lc no cng t c. Trong mt s trng hp, khi c mi lin quan thun, cht ch gia nng cht c mt s t chc, dch sinh hc d ly bnh phm xt nghim (nh tc, rng rng ca tr em, sa mu) vi hm lng ti c quan ch mt cch gn ng (v d: lng ch trong tc phn nh s nhim ch tu xng - c quan ch). Trong tm hiu tip xc, trong cng nghip nht l cng nghip s dng ho cht lm nguyn liu, nhin liu, c nhng trng hp cht c ch l cht ln nhim do ho cht s dng khng tinh khit (v d: dioxin ln trong cht gy rng l, dit c; benzen ln trong xng...). nh gi s b nh tnh: nh gi nh tnh c ngha l xc nh xem tip xc vi yu t g, trong khong thi gian bao lu v tt hn nu c c nhng khi qut v cng nhim: vt qu mc cho php, vt qu mc cho php 2 ln, vt qu mc cho php trn 2 ln, di mc cho php. K thut lit k nhanh (rapid inventory technique) ngy cng t ra c tnh thc tin trong nh gi mi trng cc nc ang pht trin, ni thiu thn cc k thut o c mi trng. Nguyn tc ca k thut ny l tnh ton lng cht nhim thi vo mi trng xung quanh da trn c s: tng s cht thi t mt c s sn xut, mt quy trnh cng ngh t l thun vi sn phm lm ra ca c s (mc hot ng). T l gia lng cht thi vi mc hot ng (gi l lng thi) c th c xc nh cho mi nh my, mt quy trnh cng nghip. T y cho php c tnh mc

43

thi ra mt cht c, bi t nh my hay mt quy trnh cng ngh bit tng sn phm lm ra ca c s trong mt thi gian nh trc. Cng thc: e(j) = E(j)/SA Trong : e(j): lng thi do cht j tnh bng kg trn n v sn phm trong mt khong thi gian (nm). E(j): lng cht thi j tnh bng kg /nm. SA: mc hot ng tnh bng n v sn phm /nm. Yu t lng thi e (j) ph thuc vo: Loi ngun thi, loi nh my. Quy trnh cng ngh v /hoc cc ch s thit k. Tui ca ngun thi, trnh cng ngh. Loi v cht lng nguyn liu s dng. iu kin xung quanh. Nhng yu t khc v mu thit k, h thng iu khin. Bng k thut ny cho php c tnh mc nhim mt cch gin tip song rt thc t v ng tin cy. nh gi nh lng v tip xc: y l phng php nh gi cht ch, ng tin cy song tn km v kh thc hin rng ri. Khi nh gi tip xc cn da vo h thng gim st mi trng: l h thng ly mu, o c nhim mt cch c h thng. Trong nghin cu dch t hc, h thng ny cho php nh gi gn ng vi mc tip xc. Khi thit k h thng gim st, cn t ra cc cu hi sau: Cc cht nhim no cn c nghin cu? Ly mu phi tin hnh trong cc khong thi gian bao lu v mu c ly bao nhiu ln? im ly mu phi t u? Cht lng ly mu, phn tch mu cn theo tiu chun no? Cn dng phng tin g v k thut phn tch no? Trong thc t, kh c th t c tt c nhng yu cu trn. Cng c th h thng ly mu, theo di mi trng nc ta cha m bo l h thng gim st mi trng cho d i ly mu nh k hng nm (song s thay i mc nhim xy ra hng gi, hng pht), c phn tch mu song s lng mu thng rt t, 44

khng i din v cha ni ti nng lc phn tch mu rt thp so vi yu cu ca phn tch mt s cht nhim c bn ch bng k thut n gin (bng 2.5).

Bng 2.5. Mt s ch s dng theo di, gim st cht lng mi trng

Yu t c hi Cht lng khng kh SO2 NO2, NO Cc ht l lng (bi), vi sinh vt (vi khun, nm mc) Cht lng nc Nc sinh hot b nhim ho cht, cht hu c nhim vi sinh vt gy bnh Mt s cht c chung Kim loi nng (Cd, Pd, As, Hg) Ho cht bo v thc vt Ch s Nng trong khng kh Nng trong khng kh Nng trong khng kh Ngun nhim Khi cng nghip, kh x, s dng than un nu Khi cng nghip, kh x, s dng than un nu Khi cng nghip, kh x, s dng than un nu

cng, mu, mi, v, pH, NO2, NO3, oxy ho tan, BOD5 Coliform, Colifeacal trong 100ml

Cc ngun nc thi, nhim t, nhim nc ngm nhim mi trng cng nghip, thc phm, a cht

Nng cht c trong cc dch sinh vt v m ca ngi DDT, dioxin trong m sinh vt. Nng cc cht chuyn ho c trng trong nc tiu, mu... Cc ch s nhim vi sinh vt Cc ch s nhim khng kh bi mt s cht gy d ng Liu sinh hc Mt phng x Mc n

nhim nng, lm nghip; nhim thc phm

Mt s cht gy nhim trng v gy d ng

Mt s cht phng x Ting n

Cc ngun phng x v cc cht ng v nhim cng nghip, sinh hot, giao thng

T h thng theo di mc nhim, hoc cc ch im ca nhim, o lng mc tip xc, ngi ta tp hp v phn tch cc s liu a ra cc cnh bov: Loi yu t nhim hoc cc nhm yu t nhim. Mc nhim (qua i chiu vi cc tiu chun, cc iu l v sinh). Cc yu t v cc ngun pht sinh nhim (s dng nhin liu, tc pht trin th, quy trnh cng ngh pht sinh nhim, sn lng ca tng ngnh cng nghip...). 45

 D bo xu hng tng gim loi yu t v mc nhim trong tng lai gn v tng lai xa da trn cc yu t tc ng hoc pht sinh nhim. D bo cc nguy c trn sc kho cng ng. xut cc gii php nhm gim nh nguy c, hn ch nhim.
5.2. Gim st cc hu qu ca nhim

theo di v gim st cc hu qu ca nhim ngi ta da trn cc h thng thng k bnh tt bit cc tc hi ca tnh trng nhim mi trng trc hoc khm sng lc pht hin mt s nguy c gy bnh lin quan n nhim (cc bnh ch danh) v khm chn on cc bnh c th do nhim.
5.2.1. Thng k tnh hnh mc bnh v t vong

Tnh hnh mc bnh v t vong c phn tch da trn cc s liu thng k t bo co ca h thng bnh vin nh nc ch phn nh mt phn tnh trng sc kho cng ng. Rt nhiu trng hp m n y t t nhn hoc t cha. Rt nhiu trng hp m ch n trm y t c s x, phng nn ch th hin s mc. Thng k bnh tt c th c tnh ton theo tn sut mc trn 100. 000 dn v /hoc theo cu trc m hnh bnh tt - phn b cc loi bnh trong s cc trng hp n bnh vin khm cha bnh. Cc s liu thng k trn c tp hp trong cc nhm bnh theo phn loi quc t v bnh tt ln th 10 (ICD10) vi cc mc chi tit khc nhau: t theo tn bnh n cc mc di nhm v nhm bnh. Phn tch theo tn bnh cho tt c cc trng hp m gm 312 bnh, 21 chng l rt kh v nhiu khi khng cn thit. Ch nn chn mt s bnh c tnh cht ch danh nh: hen ph qun, bnh phi ph qun mn tnh tc nghn (vim ph qun mn tnh co tht), ung th phi, leucose, ung th d dy, cc khi u trung biu m, ung th da, cc bnh d ng hoc qu mn, cc bnh nhim trng, cc d tt bm sinh, cc bnh gan mn tnh, cc bnh ngh nghip, cc bnh nhim c cp tnh... Bnh tt c gp li thnh tng nhm phn tch qua so snh s khc nhau theo vng, theo nhm dn c cc khu vc c c trng mi trng khc nhau, theo thi gian, theo nhm ngh nghip. Vic gp cc nhm bnh theo tng nhm khng thc t bng vic gp thnh ba nhm: Cc bnh ly nhim, bnh ph n, tr em suy dinh dng. Cc bnh khng ly nhim. Cc tai nn, chn thng (do con ngi, thm ho, chin tranh, bo lc, t t...) Bng 2.6 v hnh 2.2 a ra v d so snh tnh hnh bnh tt theo cc nm.
Bng 2.6. Xu hng bnh tt t vong (n v: %)
Nhm bnh I. Bnh ly Mc Cht 1976 55, 50 53, 06 1986 59, 20 52, 10 1996 37, 63 33, 13 2000 32, 11 26, 08

46

II. Bnh khng ly III. Tai nn, ng c, chn thng

Mc Cht Mc Cht

42, 65 44, 71 1, 84 2, 23

39, 00 41, 80 1, 80 6, 10

50, 02 43, 69 12, 35 23, 20

54, 20 52, 25 13, 69 21, 67

(Ngun: Nin gim thng k y t nm 2000 - B Y t) 70 60 50 40 % 30 20 10 0 1976 1986 Nm

Hnh 2.2. Xu hng mc bnh

Bnh ly Bnh khng ly Tai nn, ng c, chn thng

1996

2000

Vi kt qu trn cho thy c cu bnh tt (ca cc trng hp n bnh vin cng cc tuyn) thay i r rt qua cc thi k. T nm 1976 - 1986: khi kinh t chm pht trin, mi trng nhim ch yu bi cc yu t sinh vt hc, cc bnh dch chim u th. Tai nn chn thng c xu hng tng nh. T nm 1986: khi ci cch kinh t bt u, cng nghip pht trin, mc sng c nng cao, mi trng c th c ci thin, v vy nhim bi cc yu t sinh vt hc gim i lm thay i c cu bnh tt. Cc bnh khng ly nhim chim u th, cng vi n l s gia tng mnh t l tai nn, chn thng. S liu trn s c gii thch mt cch r rng hn nu a ra cc s liu v cht lng mi trng v cc ch s v tng trng kinh t. V d: t nm 1990 - 1999 hng nm (tng lng cht thi do phng tin giao thng tng 6 - 8%) tng lng rc thi nm 1977 l 19 tn tng ln 25 ngn tn vo nm 1999; s xe t nm 1990 l 27.400 chic tng ln 57.822 chic vo nm 1999 (ngun s liu: Tng cc Thng k. Tnh hnh kinh t - x hi Vit Nam 10 nm 1991 - 2000).
5.2.2. Ngun s liu t khm sng lc, pht hin nguy c trn sc kho

Trong khm sng lc c th s dng cc xt nghim o lng mc thm nhim: cht c xm nhp vo c th nhng c th cha gy hu qu. Th hin bng nng cht c trong mu, trong cc m (xng, m, tc), hay cc cht c v cht chuyn ho ca n c o thi qua nc tiu, qua hi th (v d: xt nghim phenol trong nc tiu; xt nghim ch trong tc...). 47

Khm sng lc cng c th s dng cc test lm sng hoc cc xt nghim cn lm sng pht hin tnh trng bnh l di lm sng hoc lm sng. V d: xt nghim ALA niu khi c tip xc vi ch; o ngng nghe khi tip xc ci ting n; xt nghim trng giun trong phn, tm ngi lnh mang trng; o chc nng h hp cho hng lot ngi tip xc vi bi v hi kh kch thch; khm pht hin ngi b vim ph qun mn tnh. Khm pht hin mt s bnh c trng do mi trng: mt ht, nhim c ngh nghip, bi phi, d ng da vi yu t mi trng c trng. i tm mi lin quan gia tip xc trong qu kh v biu hin bnh l hin ti khng d dng (k c t chc khm v lm xt nghim quy m ln), nht l khi c nhiu yu t tc hi cng tn ti v bnh th khng c hiu (v d vim ph qun mn tnh c th do nhim khi v bi trong mi trng sinh hot, cng c th do tip xc vi khi bi trong mi trng lao ng v cng c th do ht thuc l). Kinh nghim cho thy, khm lm sng rng ri cc bnh tt ca cc cng ng dn c thng t khi p ng c nhu cu thng tin, trong khi vic t chc khm li rt tn km v i hi phi t chc cng nh tp hun cc bc s rt k v theo nhng quy trnh, tiu chun chn on thng nht. V vy, nn t chc khm chuyn khoa, tp trung vo mt s bnh c trng cho tng loi nhim. Cng c th ch khm cho mt s nhm i tng c nguy c cao, lm cc ch im v hu qu ca mi trng nhim vi mt hoc vi yu t nhim c trng.
5.2.3. Phng php phng vn v tnh trng sc kho cng ng (iu tra h gia nh)

y l phng php kh ph bin v c p dng cc hnh thc khc nhau: hi mt ngi trong h gia nh bit tnh trng sc kho ca mi ngi trong h trong khong thi gian 2 tun hoc 4 tun. Cng c th hi tng ngi i vi cng nhn, i vi nng dn hi tng ngi trong h (tr em th hi m) v nhng triu chng bnh va mc trong 2 tun trc . Ngoi nhng thng tin v bnh tt hoc t vong, cn c nhng thng tin khc c pht hin bng phng vn nh tnh trng nhn khu hc, kinh t, ngh nghip, kin thc v sc kho - mi trng, thi v thc hnh (bit g, thi v nhng iu mnh bit nh th no: lo s, th , cn thn v thc t lm g?), cch ng x y t v mi trng, kin thc v sinh an ton lao ng, hiu bit v cht c, tc hi ngh nghip, thi ng x vi tnh trng thiu nc sch v cng trnh v sinh...
5.2.4. Cc ngun s liu sn c

Bo co tng kt s khm cha bnh nh k hng thng, qu, nm qua h thng thng k. Nhng cn ch : t l ngi dn mi khi b m n c s y t nh nc ch khong 20 - 30%. V vy, nu ly s liu thng k s b st rt nhiu cc trng hp m t cha (chim a s) v n y t t nhn; cn c s sn xut th 80% cc trng hp m n y t c quan hoc c s bnh vin, phng khm a khoa.

48

a. Ngun s liu t thng k bnh vin Ngun s liu ny ch phn nh cc trng hp bnh nng (nh ca tng bng ni), hoc cc bnh kh cha, cc bnh ca ngi dn gn bnh vin, bnh nhn bo him y t. Cho d s liu thng k bnh vin c chn on chnh xc nht song vn phn nh y hu qu ca mi trng ln sc kho, bnh tt, t vong ca qun th c nguy c. b. Ngun s liu ngh m ti cc c s sn xut y l nhng s liu qu v c qun l kh cht ch. Mi trng hp m v ngh m u c ghi chp. Mt khc, mi trng sn xut tc ng mnh nht trc ht n cng nhn nh my, sau mi tc ng n dn chng xung quanh. Tuy nhin, nh hng trn sc kho i khi li khng r v hiu ng cng nhn kho (thng cng nhn c tuyn vo nh my l nhng ngi kho hn nhng ngi khc). Ngi dn xung quanh nh my c nhng nhm tui nhy cm hn v thi gian tip xc di hn (khng ch 8 ting).
5.2.5. Ngun s liu t khai bo t vong

Trng hp khng c m t thi th nguyn nhn t vong thng kh chnh xc. C th dng k thut gii phu li ni (hi t m triu chng trc khi cht vi bng cu hi tiu chun) c th cho php nhn nh nguyn nhn cht kh ng. D ngun s liu no, cu hi chung nht vn lun l: i tng no b nh hng? Bnh hoc nh hng l g? Xy ra u v khi no? gp phn tm hiu nguyn nhn v cc kh nng can thip vo cng ng vi cc loi ngh nghip v tnh trng tip xc khc nhau, cn t cu hi nh: bit g v cc yu t mi trng ? Bnh hoc nh hng trn sc kho l g? Thi i vi mi trng v bnh do mi trng ra sao? lm g gii quyt nhng vn v mi trng xung quanh b nhim? Mc tiu ca gim st mi trng (cc tc nhn nhim): gim st hu qu ca mi trng nhim trn sc kho l nhm cung cp cc thng tin cho vic xc nh cc vn tn ti v mc trm trng ca n trn sc kho cng ng, sau l chn ra cc vn cp bch nht nhng c gii php x l v c ngun lc cn thit a ra cc u tin. Khi chn c cc vn u tin, chn gii php thch hp (kh thi, khng tn km, c hiu qu cao, kp thi...) cn ln k hoch tng bc can thip gim nh nguy c. Cc bn k hoch phi c nhng ngi ra chnh sch ng h bng ch trng, bng ti chnh v cam kt duy tr. Cc bn k hoch cng cn c s tham gia ca ng ng trong vic xc nh cc vn , chn gii php, ng gp cng sc v ti chnh (nu c), theo di, gim st, nh gi cc hiu qu ca gii php can thip p dng. 49

5.3. V d minh ha v qun l nguy c mi trng

Qun l nguy c l mt qu trnh xut pht t vic xc nh xem c yu t nguy c no ( nhim mi trng bi yu t g), nh gi mc nguy c (o lng mc nhim). Chn cc gii php can thip lm gim nguy c, thc hin cc gii php . Thc hin qun l nguy c cng phi tnh n cc gii php no va khoa hc, va kh thi v phi va c hiu qu cao, chi ph thp. Khi chn gii php cng phi da trn cc quy nh php l, cc chun mc vn ha, x hi, o c cng nh ng li chnh tr. Nh vy c nhiu mi lin quan n qu trnh qun l nguy c, khng phi ch c ngi dn chu tc hi, ngi gy nhim v c quan y t. Sau y l bi tp tnh hung m t 6 bc trong chu trnh qun l nguy c.
BI TP TNH HUNG Mc tiu

1. p dng c cc nguyn tc qun l nguy c Sc kho mi trng vo cc trng hp thc t 2. p dng ng cc bc ca chu trnh qun l nguy c.
Tnh hung

T hp cng nghip TPI l mt khu cng nghip gm 50 c s sn xut: lc du, cng nghip ho du, x nghip ha cht, x nghip sn xut phn bn ho hc, x nghip cn thp. y c mt nh my nhit in s dng nhin liu l than , c mt bn cng, mt nh my x l rc thi v mt knh dn nc thi. Quanh khu cng nghip ny l mt vng nng nghip, y c trng hc v khu dn c chuyn ra t vng t xy dng khu cng nghip. Nhng nm gn y ngi dn ngi thy mi kh chu v ngi ta phn nn l b m au nhiu hn. Cc hu qu ny ln ti mc chnh quyn a phng, cc thy c gio hc sinh v c cha x trong vng cng phi ln ting phn nn qua h thng truyn hnh a phng. Ngoi ra n kin cn c gi ln S Cng nghip a phng, ln c Chnh ph. Do c n kin ny, Trung tm Y t B Cng nghip t chc mt on cn b v a phng vi nhim v: o mi trng pht hin c cht c g v mi t khi l g, ngun pht sinh t u ? Xc nh mc nhim v mc tip xc ca nhn dn quanh khu vc TPI. Xc nh mc nh hng n sc kho c dn ni b nhim. Ni dung kho st ca on kim tra bao gm cc vn sau: 50

(1). Xc nh vn nhim mi trng Xc nh v m t cc c im ca vn sc kho mi trng. a ra nhn nh v mc nh hng n sc kho cng ng cng nh vn sinh thi. t ra cc mc ch ca vin qun l mi trng (kim sot nhim). Chn ngi ch o c thm quyn xut v thc hin cc gii php. T chc cuc hp lin tnh vi cc n v, t chc c lin quan (cc bn c lin quan). on cng tc n lm vic vi t hp cng nghip, gp gim c v phng k thut : + + ngh cung cp bn quy trnh cng ngh v b tu mt bng cc c s sn xut Tng c s sn xut lin k cc loi nguyn vt liu s dng, nhin liu v bn bo co v cc loi kh thi, cht thi lng, cht thi rn. Lu lng cht thi trong mt ngy m vo mi trng xung quanh. Cc bin php x l cht thi trc khi thi vo mi trng. Yu cu cung cp thng tin v chiu cao ng khi, cc ng dn nc thi v cc phng tin vn chuyn rc thi, ni rc thi. Sau khi lm vic vi gim c ca tng c s sn xut, lm vic vi cc k s cng nghip, k s an ton lao ng, on c c mt bn bo c nhng kt qu sau:

+ +

C 3 trong 50 c s sn xut c b tr mt bng bt hp l: qu gn khu dn c, khng c khong cch bo v v b tr ng khi hng gi m vo ma ng khi c th thi ngc v khu dn c. 49/50 c s c s dng nguyn vt liu c th gy nhim mi trng. c bit c mt c s s dng nhiu nguyn liu ho hc v thi khi c cht c vo mi trng. y cng chnh l 1 trong 3 c s c b tr mt bng bt hp l trn. Khi c cung cp cc thng tin v cc cht c thi vo mi trng khng kh, on cng tc c bit c ti 48 cht c khc nhau. Do khng th o c hm lng cht c ca tt c 48 cht c , on quyt nh:

Yu cu bo co v tng s nguyn liu pht sinh cht c trong 1 ngy m v trong 1 nm. T s liu c cung cp, s dng phng php c lng bng bng kim k. Kt qu cho thy c mt s nguyn liu c th pht sinh cht kh kch thch h hp SO2, SO3, vi hm lng rt ln hng tn khi ny / nm. 51

o nng cht SO2 trong khng kh ti cc im trong khu dn c vo cc thi im khc nhau. Kt qu cho thy: Ti tt c cc im o, nng SO2 vt qu tiu chun ti a cho php vi khu dn c (cho d im o trong nh my khng vt qu tiu chun cho php). c bit c thi im nng SO2 vt ti 20 ln tiu chun cho php. Vi kt qu kim tra nh trn, on cng tc ch a ra kt lun chung chung v cc loi yu t nhim v nguy c thi cht nhim vo mi trng xung quanh (qua kim k ngun nguyn liu, nhin liu). Kt qu o SO2 trong mi trng khng kh khu dn c ch l mt yu t ch im ca nhim, khng phi tt c cc yu t m ngi dn phi tip xc, nhng mc nhim u vt qu nng ti a cho php. Mt nhn nh v mc nh hng n sc kho cng ng l: nhim ch yu qua ng h hp v l cht kh kch thch. Ngi dn c th b nh hng trn h thng h hp, nht l tr em v ngi gi. Ngoi ra c th lm tng nguy c mc cc bnh vim kt mc v bnh da. Vi mc nhim ny c th nh hng ti cy ci trong vn v la. Cc nguy c nhim c mt s ho cht khc c th nh hng ti gan, thn, mu v thn kinh trung ng. ngh c kim tra sc khe v lm mt s xt nghim cho nhn dn nh: nh lng phenol trong nc tiu, nh lng ch trong tc tr em, xt nghim mu tm hng cu ht kim (v trong cht c c kim k c ch, benzen l ng quan tm nht).

Ngay t khi cha c kt qu iu tra nh hng ca nhim mi trng trong cng ng dn c, on kim tra phi a ra nhng quyt nh sau: + + + + Nng cao chiu cao ng khi Lp t h thng kh c trc khi khi thi ra mi trng Ln k hoch chuyn di mt s h sng gn nh my Thit lp khong cch bo v vi khu vc cy xanh

Ch nh mt ban ch o gii quyt hu qu mi trng; trong Ch tch UBND huyn lm Trng ban, Ph ban l Gim c Trung tm Y t d phng tnh v Tng gim c t hp cng nghip. Cc thnh vin ca y ban ny c i din ca Hi ng nhn dn x, to n huyn... U ban ny s xem xt vic thc hin cc kin ngh chuyn mn do Trung tm Y t ngnh v Trung tm Y t d phng tnh xut. (2) Phn tch mc nguy him ca vn nhim Nguy c c xc nh v tnh cht, biu hin, mc nh hng trn sc kho hoc tn hi ti mi trng xung quanh (la, c, ng vt, cy ci trong khu vc).

52

Vic m t nguy c da trn cc kt qu o mi trng v nhn nh cc mc tip xc cng mt lc vi nhiu yu t qua kin ca cc chuyn gia c kinh nghim v cc bng chng khoa hc. Cc thng tin v tnh trng nhim, mc nh hng trn sc kho c cung cp cho cc n v, t chc, cng ng c lin quan. Sau khi Ban ch o c thnh lp ra quyt nh yu cu thu thp thng tin v tnh trng sc kho, bnh tt nhn dn khu vc tip xc. S liu c thu thp t hai ngun: T trm y t x qua s sch khm cha bnh ti trm y t. T mt cuc iu tra do Trung tm Y t d phng tnh v Trung tm Y t B Cng nghip phi hp t chc: khm pht hin tnh trng bnh ng h hp (VPQ cp v ARI), lm xt nghim sinh ho nc tiu tm phenol niu v ch trong tc, xt nghim mu tm thy hng cu ht kim trong 10% s dn bng phng php chn ngu nhin cc h gia nh Kt qu phn tch s khm bnh trm y t x cho thy: + T l ngi m n trm y t x khm tng 2, 5 ln so vi trc khi t hp cng nghip ny c a vo hot ng, trong t l tr em m tng gp bn ln. Bnh ng h hp trc y chim 35% s trng hp n khm, nay tng ln 65%, trong tr em n trm y t nhn thuc ca chng trnh ARI tng ln gp 4 ln. Cc xt nghim cho thy:

Hm lng phenol trong nc tiu nhng ngi c xt nghim khng vt qu gii hn bnh thng nhng gn vi gii hn trn ca mc bnh thng. Khng c ai xt nghim (+)v hng cu ht kim. Lng ch trong tc ca tr em cao mt cch bt thng so vi nhm i chng. Khi c bo co v kt qu iu tra sc kho, mt nhm chuyn gia y t c mi v a phng nh gi kt qu. Kt lun ca nhm chuyn gia ny l:

nhim khi nh my nh hng r rt ti tnh trng bnh h hp trong nhn dn, c bit ti tr em. Cn tip tc kim tra nhim mi trng bi hi benzen v cc ngun nhim ch t nh my.

53

Phi tin hnh ngay cc bin php x l (nh nu) v thng bo cho nhn dn c bit v cng tc trong vic gii quyt vn . T cng tc cng ngh vi Ban ch o, vi chc nng hnh chnh ca UBND huyn ra cc quyt nh hnh chnh nhm ngn nga nhim v bo v sc kho nhn dn.

(3). Xem xt v la chn cc bin php can thip Da trn cc kt qu iu tra mi trng v sc kho v cc kin thc cng nh nhng quy nh x l nhim mi trng, ngi ta i n quyt nh chn mt s gii php. Qu trnh chn gii php c s tham gia ca cc bn c lin quan bao gm cc cn b k thut, cc nh qun l, lnh o a phng, i din ca nhn dn v c quan y t. Qua tho lun ngi ta tm v chn ra nhng gii php loi b nguy c va c tnh kh thi, khng tn km, m bo ng lut song c cng ng, cc ch doanh nghip v c s sn xut chp nhn. Cc gii php ban u do on cng tc ca TTYT B Cng nghip c cc chuyn gia chp nhn v mt khoa hc. Tuy nhin do phi di di dn nn thng qua UBND x phi hp hnh ng v tho thun vi gim c t hp cng nghip ny thc hin cc gii php khng ch ti ngun, nng ng khi v n b cho cc gia nh phi di di, h tr kinh ph cho trm y t x khm cha bnh cho nhn dn. Tt c cc quyt nh u do Ban iu hnh ch tr v c bin bn vi cc bn c lin quan. (4). Quyt nh gii php can thip sau khi tha hip gia cc bn c lin quan + + + + + + + Da trn cc nghin cu khoa hc, khch quan v tnh n cc yu t kinh t. cn c trn tnh trng tip xc rt a dng, a yu t. tnh n tnh kh thi vi mc hiu qu ti u nhng vi chi ph chp nhn c. t ra cc u tin va ngn nga nhim, va hn ch hu qu. cn nhc, so snh gia nhiu gii php c th p dng m bo khng nh hng ti an ninh chnh tr, ti cc chun mc vn ho - x hi v m bo ng lut. Trong trng hp ny cc gii php u m bo tnh kh thi, hiu qu. Tuy nhin, vn nc thi ca khu cng nghip ny cn c nghin cu tip sau khi cc gii php xut c thc hin.

(5). Tin hnh can thip 54

 Cc gii php can thip c c s khoa hc v theo quy trnh c hng dn. m bo trong qu trnh can thip c s kim sot v h tr ca cc bn c lin quan. Ban ch o c cn b ca Trung tm Y t huyn trc tip gim st vic thc hin cc quyt ngh ca Ban, giao cho to n nhn dn huyn vic n c tin thc thi cc gii php. Hi ng nhn dn huyn theo di tip tc vic khiu kin ca nhn dn v bo co vi UBND huyn kp thi. (6). nh gi hiu qu can thip Khi nh gi hiu qu can thip ngi ta da vo nhng thng tin v: Tnh hiu qu ca gii php c c nh mc tiu mong i trc khi can thip khng? C cn phi chn cc gii php no khc mang li kt qu tt hn khng? thng tin nh gi cha? Cn thm thng tin g na? C cn phi thay i hay iu chnh g trong gii php can thip khng? Cc bn c lin quan chp nhn mc no, h ng gp hoc chu trch nhim i vi qu trnh can thip nhiu hay t v vi thi ra sao? Sau khi nh gi, nu cc mc tiu can thip t nh yu cu, qu trnh qun l nguy c c th kt thc bng mt bo co nh gi v rt kinh nghim tnh hnh nhim khng xy ra khu cng nghip khc cng nh khng ti xut hin khu cng nghip ny. Nu cha t yu cu th nguyn nhn do u v cn lm g tip theo. Nh vy qu trnh qun l nguy c li phi tip tc t bc 1 n bc 6 Sau 2 nm thc hin cc gii php. on cng tc ca TTYT B cng nghip t chc nh gi v np bo co cho UBND huyn: + + + + +
Bi tp

Nh my nng cao ng khi m bo ng tiu chun k thut. t chc di di dn, to khong cch bo v quanh nh my nh ng yu cu trong bin bn. T l tr em b ARI n trm y t x gim, song s bnh nhn n trm khm cha bnh ch gim 20%. Khng c trng hp no b nhim c benzen v nhim c ch trong nhn dn. Trong bo co cng a ra ngh trin khai vic nh gi hu qu mi trng do nc thi nh my v c Ban ch o chp nhn.

Da vo ni dung ca bi tp tnh hung trn y, bn hy gii quyt nghin cu trng hp sau:

55

Ti mt Trung tm Y t d phng tnh, ngi ta nhn c mt n khiu ni ca mt t dn ph v tnh hnh nhim mi trng do mt x nghip mi xy dng trn a bn. Trong n c vit: .................. Nhn dn t dn ph chng ti rt lo ngi v hin nay c mi khi ng khi ca x nghip x khi mu vng, mi hc rt kh chu, thm ch c ngi ho sc sa, dn c nc mt, khi ng kn ca vn cn mi. C l v khi m mt s chu cy cnh cng b a l. Thm vo , nc thi ca x nghip ny li chung vo cng cng cng, mi khi tri nng cng nc bc mi rt kh chu. Cng ny li chy ngang qua khu nh tr ca phng, chng ti rt lo ngi... T dn ph ngh Trung tm Y t d phng can thip x nghip trn khng tip tc gy nhim cho khu dn c chng ti. .................. Nu bn l cn b tham mu cho lnh o ca Trung tm Y t v c giao nhim v trc tip gii quyt vic ny, bn hy: (1) Lit k nhng vic cn phi lm. (2) a ra mt bn d tho k hoch nh gi mc nhim mi trng, iu tra cc hu qu ca nhim trn sc kho nhn dn khu dn c, lm vic vi c quan truyn hnh chun b a tin ln chng trnh ti vi.
T LNG GI

Hy nh du X vo 1 la chn duy nht 1. Khi nim qun l mi trng cp trong bi c O ng ngha l qun l tt c cc yu t mi trng c li v c hi cho sc kho 2. Thng thng, cc sai s do qu trnh phn tch mu O ng trong phng th nghim b hn cc sai s khi ly mu 3. Gii hn ti a cho php ca 1 cht nhim trong mi O ng trng lao ng thng cao hn trong mi trng sinh hot 4. Nguy c = yu t nguy c - phn ng bt bnh ca cng O ng ng (Risk = Hazard Outrage) 5. Bo v khi cm th khng tip xc qu mc vi cc yu O ng t nguy c l bin php d phng cp II 6. Khng ch s pht tn cc yu t c hi vo mi trng O ng sn xut hoc mi trng xung quanh l bin php d phng cp I 7. Bo v ngi tip xc l gii php ti u nht trong cc O ng 56

O Sai O Sai O Sai O Sai O Sai O Sai O Sai

gii php d phng tc hi ca nhim mi trng Hy khoanh trn vo mt la chn duy nht 8. Vic khng ch cht nhim ti ngun KHNG c thc hin qua tiu chun no sau y? A. Tiu chun nhin liu B. Tiu chun sn phm C. Tiu chun quy trnh D. Tiu chun cht thi 9. theo di v gim st cc hu qu ca nhim ngi ta KHNG: A. Da vo cc h thng thng k bnh tt B. o nng cc cht nhim C. Khm sng lc D. Khm chn on cc bnh c th do nhim
Hy tm cc cm t thch hp in vo ch chm:

10. Gii php khng ch yu t nhim mi trng gm ba khu, l: ..................................................................................,..................................................... ........ .........................., .............................................................................................. 11. Bo v ngi tip xc c thc hin qua vic s dng cc trang thit b bo v c nhn,........................................................., v ....................................................... 12. Hy v s minh ha cc bc ca chu trnh qun l nguy c.

57

BI 3

C S SINH THI HC CA SC KHO V BNH TT

MC TIU 1. M t c mi quan h gia cc hot ng ca con ngi vi mt cn bng

sinh thi.
2. Trnh by c nhng tc ng ca thay i h sinh thi ln sc kho con ngi. 3. Gii thch c mi quan h gia sc kho con ngi vi mi trng xung quanh.

4. Trnh by c mt s bnh truyn nhim v khng truyn nhim lin quan n mi trng.

1. CON NGI V H SINH THI 1.1. Th no l mt h sinh thi?

H sinh thi l mt qun x ng vt, thc vt v vi sinh vt sng, tc ng qua li vi nhau v vi mi trng xung quanh. H sinh thi bao gm c thnh phn l hc v ho hc nh t, nc v cc cht dinh dng cung cp cho cc sinh vt sng trong n. Nhng sinh vt ny c th l nhng ng vt, thc vt bc cao, vi cu trc c th phc tp nhng cng c th l cc vi sinh vt nh b. H sinh thi bao gm nhng mi tc ng qua li gia cc sinh vt sng trong mt sinh cnh nht nh v con ngi l mt phn ca h sinh thi. Sc kho v s phn thnh ca x hi loi ngi ph thuc vo nhng li ch m h sinh thi mang li. Con ngi c hng rt nhiu sn phm ca cc h sinh thi t nhin nh thc n, ng - thc vt lm cnh, g xy dng v lm nhin liu, cng v vn cc loi ng vt, thc vt rt c gi tr trong cng tc phng v cha bnh. Nhng sn phm ny chim mt phn quan trng trong nn kinh t ca cc quc gia. Tuy nhin, gn y ngi ta mi nhn thy rng cc h sinh thi t nhin cn ng nhiu vai tr ht sc quan trng khc cho s tn ti v pht trin ca con ngi. Mt s vai tr quan 58

trng c th c k n l kh nng lm sch khng kh v nc, gii c v phn gii cc loi rc thi, iu ho kh hu, tng s mu m cho t, kim sot hu ht cc ng - thc vt c hi cho nng nghip, to ra v duy tr a dng sinh hc cung cp ging cho nng nghip, nguyn vt liu cho cng nghip, dc liu v.v. Nhng li ch ny tng ng hng nghn t la mi nm, tuy nhin hu nh khng c quy thnh tin c th thc tnh nhn thc con ngi nhm thay i cc hnh vi lm tn hi ti h sinh thi .
1.2. Cc hot ng ca con ngi v nhng tc ng ln h sinh thi

Cc h sinh thi t nhin tham gia vo rt nhiu qu trnh khc nhau v c nh hng trc tip hay gin tip ti con ngi v cc sinh vt khc. Nhng hot ng ca con ngi trong mi trng , ang v s lm thay i rt nhiu qu trnh t nhin ny theo mt chiu hng bt li cho sc kho v s phn thnh ca chnh x hi loi ngi. Bng 3.1 tm tt mt s qu trnh t nhin v nhng tc ng ca con ngi ln nhng qu trnh ny.
Bng 3.1. Nhng nh hng ca con ngi ln mt s qu trnh din ra trong h sinh thi
Cc qu trnh ca h sinh thi Qu trnh to t Tc ng ca con ngi Cc hot ng trong nng nghip tng s tip xc ca lp t b mt vi ma nng, cng vi vic s dng cc loi thuc bo v thc vt v kch thch sinh trng lm gim ng k lp t b mt mu m Vic cht ph rng ba bi v cc hot ng khc ca con ngi gy ra lt li, l qut hay hn hn nhiu ni Nc thi, rc thi khng qua x l v nc thi chy t ng rung, trang tri chn nui lm tng nhim nc Mt s ngnh cng nghip v nh my ht nhn lm tng nhit ca bu kh quyn bao quanh tri t. Cc hot ng t chy nhin liu ho thch s pht thi ra cc kh nh knh v c th dn dn lm tng nhit tri t (hiu ng nh knh) Vic s dng cc nguyn liu khng phn hu c v cc hot ng chn lp rc ngn cn qu trnh hon tr li mi trng nhiu nguyn liu hu ch

Kim sot chu trnh nc

Phn gii cc loi rc thi

Dng nng lng

Chu trnh t nhin ca cc cht dinh dng

Con ngi l mt phn ca h sinh thi trn tri t. Nhng hot ng ca con ngi c th c li hay c hi i vi s cn bng ca h sinh thi. Vic ph hoi ni

59

sinh sng ca cc loi ng - thc vt do cc hot ng v tnh hay c ca con ngi, u e da n s cn bng ca cc h sinh thi trn tri t. Nu nhng tc ng ny khng c gii quyt th s n nh ca nhiu h sinh thi s b ph v m khng c kh nng phc hi. Con ngi c th nh hng ln h sinh thi theo nhiu kha cnh khc nhau (bng 3.2).

Bng 3.2. Nhng tc ng tiu cc m con ngi gy ra cho cc h sinh thi

Hot ng ca con ngi Gia tng dn s Tiu th t nh hng ln h sinh thi Gia tng dn s dn n gia tng tc tiu th ngun ti nguyn thin nhin ti to v khng ti to trn tri t Nn cng nghip nhng nc pht trin tiu th nhiu ti nguyn trn u ngi hn nhng nc ngho v chm pht trin Sn xut ra v ng dng v vn cc k thut hin i m khng hiu r nhng tc ng tim tng m n s gy ra cho mi trng sinh thi Lm mt i mt din tch rt ln rng nhit i v cc sn phm ca a dng sinh hc trong cc khu rng ny nhim t, nc, khng kh v phng x c nhiu nh hng tiu cc ti h sinh thi Bao gm s gia tng ca cc kh nh knh m ch yu l hu qu ca qu trnh t chy cc loi nhin liu ho thch v s suy gim ozon tng bnh lu

Cc k thut tin tin

Cht ph rng Lm gia tng nhim mi trng Gy ra nhng thay i trong kh quyn

Gia tng dn s tc ng trc tip ti qu trnh th ho v s lan trn bnh dch. Trong mt nghn nm qua, dn s th gii gia tng vi mt tc chng mt. Bng 3.3 a ra s liu c lng v dn s trn th gii vo mt s nm c th t nm 1000 n nm 2050.
Bng 3.3. Dn s th gii c tnh vo mt s thi im nht nh
Dn s th gii vo mt s thi im 1000 1650 1850 1950 2000 2050 5 triu 500 triu 1 t 2, 5 t 6 t 8-12 t (c tnh)

60

Ngun: Sir McCartney P.(2002). Global Environmental Change: Human Impacts ...in this ever-changing world in which we live in.

Gia tng dn s lm tng tc th ho, ngi dn nng thn di c ra thnh ph mu cu mt cuc sng tt p hn cho bn thn cng nh cho tng lai ca th h con chu. Trc nhng nm 1950, dn s sng th trn th gii ch chim khong di 30%, nhng n nm 2050 th con s ny c tnh s tng ln ti hn 60%. Vo nm 2000, trn th gii c khong 20 thnh ph vi s dn vt qu 10 triu ngi (McCartney, 2002). iu kin sng ng c cht hp, v sinh mi trng km do qu trnh th ho xy ra mnh m nhiu ni to iu kin cho cc bnh truyn nhim pht trin v ly lan. Mt s bnh dch ph bin trn th gii, c bit l cc nc ang pht trin lm nhiu ngi mc v cht l cc bnh tiu chy, lao phi, st rt v t. Ngoi ra cn c nhiu bnh mi ny sinh hay cc bnh c quay tr li do s thay i cc h sinh thi. iu ny chng t mi tng quan cht ch gia gia tng dn s, thay i mi trng sinh thi v sc kho con ngi. Cc hot ng ca con ngi trong thi gian qua c nhng nh hng tiu cc ti trng thi cn bng ca nhiu h sinh thi. Mi e da trc mt l s ph hoi nhng ni sinh sng t nhin ca sinh vt cng nh s xm nhp ca cc loi l xy ra sau khi sinh cnh b tn ph. i vi h sinh thi bin th vic nh bt c v cc loi hi sn trn lan l mt mi e da ln ti s cn bng v phn thnh ca cc h sinh thi y. Mt trong nhng tc ng ln nht m con ngi gy ra cho h sinh thi l lm mt a dng sinh hc t nhin. Theo c tnh ca Lawton v May (1995), c mi gi qua i trn th gii s c mt loi b tuyt chng nhng ng tic l trong qu trnh tin ho phi mt ti 10.000 nm hoc thm ch lu hn mi sinh ra c mt loi mi. Cc mi e da khc ti h sinh thi bao gm s thay i chu trnh carbon, nit v cc cht ho hc khc trn tri t do tc ng ca qu trnh t chy cc nhin liu ho thch, s dng phn bn cha nit trong sn xut nng nghip vi mt lng ln v.v. Tuy nhin, mt trong nhng nh hng ln nht do cc hot ng ca con ngi gy ra v thng c bn ti trong nhng nm gn y, l s thay i kh hu trn ton cu. Tc ng ny s nh hng trc tip ti cc h sinh thi cng nh ti sc kho ca con ngi.
1.3. Hu qu ca thay i kh hu v bin i h sinh thi

Theo nhiu nh khoa hc, s thay i kh hu m nguyn nhn l do chnh cc hot ng ca con ngi gy ra - c bit l s m ln trn ton cu (global warming) do s gia tng nng kh carbon dioxyd v cc kh nh knh khc trong kh quyn gy ra nhng tc ng tiu cc ln sc kho ca cng ng. Cc nh kh tng hc d on rng, do s tch t ca cc kh nh knh m kh hu ton cu s thay i vi mt tc nhanh hn rt nhiu trong khong thi gian k t 10.000 nm tr li y. Trong th k qua, nhit trung bnh trn b mt tri t tng khong 0,30C n 0,60C. Theo Sidney v Raso (1998), cc m hnh d bo kh hu ton cu c thc hin trn my 61

vi tnh hin i tin on rng: nu nng cc kh nh knh vn tip tc tng nh d on th n nm 2100 nhit trung bnh trn tri t s tng ln t 10C n 3,50C. Nhit tng ln s thay i h sinh thi v nh hng ti sc kho con ngi nh th no? Liu chng ta c th d on c mt cch chnh xc cc hu qu ca s thay i kh hu ln cuc sng t c nhng hnh ng hay chng trnh bo v sc kho ca cng ng? Cho ti nay, c rt nhiu ngi trong s chng ta cn cha hiu c nhng tc hi m vic thay i kh hu c th gy ra cho sc kho con ngi. Mi lin h s tr nn r rng hn mt khi chng ta nhn ra rng sc kho con ngi v s phn thnh ca x hi ph thuc vo s phn thnh ca cc h sinh thi t nhin trn tri t, ng thi nhng thay i trong m hnh kh hu v nhng nh hng ln h sinh thi s l nguy c cho sc kho con ngi. Cc nh khoa hc d on rng kh hu thay i s c nhiu tc ng m hu ht l tiu cc ti sc kho cng ng. Xem hp 3.1 v tc ng ca En Ni-n ln sc kho cng ng. Mt s tc ng tiu cc ca kh hu thay i v mt cn bng sinh thi ln x hi chng ta s c trnh by trong hp 3.1.
Hp 3.1. En ni-n v sc khe cng ng
nhiu vng trn th gii, trong thi gian xy ra En Ni-n th cc bnh truyn qua vc-t v cc bnh truyn qua nc tng ln r rt. L lt sinh ra nhng vng cha nc ngt to iu kin cho mui sinh si ny n. t En Ni-n xy ra vo nm 1997-1998 c xem l mnh nht trong th k 20 gy hu qu nhiu ni trn th gii. Hn hn nng v chy rng xy ra nhiu nc thuc chu , cc nc vng a Trung Hi, vng Amazon, cc khu rng nhit i Mexico, Trung M v cc bang California, Florida M; nga mt d ng, cc bnh ng h hp v tim mch tng vt nhng vng ny. Hn hn v l lt xy ra nhiu vng nhit i lm dch t lan trn. Sng nhit lm hng ngn ngi n v hng trm ngi chu u v M b t vong. Trung Quc v Bngladesh th l lt xy ra vi sc tn ph gh gm. vng mm ca chu Phi, trn i hng thu xy ra gy lt li vo cui nm 1997 lm gia tng bnh dch t, st rt v st Thung lng Rift (Rift Valley fever) lm nhiu ngi v gia sc b cht. chu M La Tinh, lt li xy ra dc theo bin i Ty Dng v vng pha nam Brazin lin quan vi s bng n bnh t v cc bnh truyn qua vc-t, cn nhiu vng pha Nam nc M th xy ra cc v dch hantavirus do chut truyn. y l bnh mi ny sinh v xut hin ln u tin nc M, l mt quc gia c nn y t cng cng pht trin vo bc nht trn th gii. En Ni-n hay cn gi l giao ng nam l mt chu trnh kh hu t nhin. Tuy nhin, s hp th nhit ca i dng do nhit tri t tng ln c th lm o ln chu k t nhin ca En Ni-n v lm cho chng xy ra thng xuyn hn v d di hn. Trong thi gian xy ra En Ni-n, nhng thay i ca thu triu v gi vng ng Thi Bnh Dng s lm thay i gi xoy v cc m hnh kh hu trn ton cu.

62

Hn hn bt thng xy ra nhiu ni, cn nhiu vng khc th li phi i mt vi cc trn hng thu v bo lt d di. Cui mi t En Ni-n thng xy ra mt giai on khc ca chu trnh, gi l La Ni-na - s kin tri ngc vi En Ni-n. n , Mexico, v ng Nam nc M phi chu cnh hn hn khc lit trong giai on 1997-1998 do tc ng ca En Ni-n, sau li xy ra cc trn lt ln vo thng 8, thng 9 nm 1998 do nh hng ca La Ni-na. Theo s liu thng k ca Trung tm D liu Kh tng Thu vn Quc gia Hoa K th trong sut th k qua cc thm ha ca thin nhin nh hn hn, l lt, bo v chy gy thit hi nng n nhiu vng trn th gii c v ngi v ca.

1.3.1. nh hng ti nng sut ca ma mng

Kh hu thay i c th gy tc ng ti nng sut ca mt s ma mng nhiu ni. Bt c thay i bt li no trn din rng v cng tc sn xut, cung ng v phn phi cc sn phm nng nghip - c bit l nhng nc ang pht trin cng c th gy ra tc ng nghim trng. T l suy dinh dng v h b i cng c kh nng tng ln. Tri t nng ln gy nhiu hu qu trn ton cu v mt trong s nhng tc ng ng ch l s gia tng mc nc bin do bng hai cc tan ra v s n ca nc bin do nhit . Cc nh thu vn hc d on rng, n nm 2100 th mc nc bin trung bnh trn ton cu s tng ln t 0, 2 n 1, 0 mt v s tip tc gia tng hn na trong nhng th k ti. Mc nc bin gia tng c th lm trn ngp cc khu vc trc y l khu dn c ng c hay lm ngp mn cc vng t canh tc vn d rt hn hp mt s quc gia. c bit, Bangladesh v mt s quc o khc l nhng nc rt d b tn thng. Hn na, lt li nhng cng ng dn c sng vng ven bin s lm cho nhiu gia nh b mt nh ca v buc phi di n sng nhng vng ng c, cht hp ni h rt d b mc cc bnh lao, bch hu v cc bnh tiu chy. Mt khc, nh chng ta bit, c tnh khong 99% cc loi ng thc vt c hi cho nng nghip c th b kim sot bi cc k th trong t nhin nh chim, rn, nhn, ong, nm, cc bnh do virus v nhiu sinh vt khc. Nhng tc nhn kim sot sinh hc t nhin ny gip cho nng dn tit kim c hng t la mi nm bng cch bo v ma mng khi b tht thot v gim nhu cu s dng ho cht bo v thc vt (Naylor v Ehrlich, 1997). Kh hu thay i, h sinh thi t nhin b mt cn bng lm cho qu trnh kim sot sinh hc t nhin b nh hng v iu ny s trc tip lm gim nng sut trong sn xut nng nghip v gin tip tc ng ln nn kinh t v sc kho ca cng ng.
1.3.2. Nhit qu cao v hu qu sc kho

Do s tng nhit , cng ngy chng ta cng thy nhiu trng hp b cng thng do nhit , nhiu trng hp c th dn ti t vong, c bit l ngi gi, tr em v i tng c thu nhp thp. S nhy cm ca cc nhm i tng ny c th do

63

nhiu yu t vt l v x hi khc nhau quyt nh, bao gm: vic h phi sng trong iu kin mi trng khng thong mt, khng c h thng thng gi hay iu ho nhit . Nhng bnh nhn b cc bnh tim mch v h hp mn tnh l nhng ngi c nguy c rt cao. Chng ta chng kin hu qu ca thi tit qu nng bc xy ra Chicago nm 1995 lm 500 ngi cht ch trong mt thi gian ngn. Nhng m hnh d bo gn y cho rng n nm 2050 nhiu thnh ph trn th gii s c thm hng ngn ngi b cht mi nm do nng bc.
1.3.3. Gia tng nhim khng kh v hu qu ca n ti sc kho

Nhit tng ln lm gim cht lng khng kh, ch yu l do vn tng nhim kh carbon dioxyd, nit oxyd, ozon v.v. nhng khu vc th ni mi trng b nhim nng. Nhit v tia t ngoi tng thp ca kh quyn tng ln to iu kin cho cc phn ng ho hc xy ra mnh m v sn xut ra kh ozon. Ozon l mt kh phn ng rt mnh v c th trc tip lm oxy ho cc phn t, to ra cc gc t do cha nhiu nng lng v c th lm tn thng n t bo. Nng ozon cao trong khng kh c th lm gia tng cc trng hp b bnh h hp v bnh tim mch. Ngi ta thy rng, nhng tc ng h hp cp tnh do ozon gy ra c lin quan ti bnh hen suyn tr em. Kh hu m hn v m t hn nhiu vng c th lm tng nng cc loi phn hoa trong khng kh v rt c kh nng s c tc ng tiu cc ln nhng ngi b ri lon d ng, v d nhng bnh nhn b hen suyn hay b st ma c kh (st ma h).
1.3.4. Nhng thay i trong h sinh thi v cc bnh truyn nhim

S kt hp ca thay i kh hu, suy thoi mi trng v mt cn bng cc h sinh thi to iu kin l tng cho s quay tr li cng nh s xut hin v ly lan ca nhiu cn bnh truyn nhim - nhng bnh lm hn 17 triu ngi b t vong hng nm trn th gii. Hnh 3.1 m t mt s v d v cc bnh mi ny sinh v cc bnh c nguy c xut hin tr li cc nc trn th gii.

64

T cu khng Vancomycin Cyclosporlasis E.coli E.coli Bch hu Cm gia cm HSN1 Cryptosporidi Lao khng thuc St rt khng thuc

Hi chng vim phi do Hntvirus

St xut huyt u ma kh ngi T St Lassa St xut huyt do Ebola Dch hch

Hnh 3.1. Mt s v d v cc bnh mi xut hin v cc bnh c nguy c quay tr li

Ngun: Fauci. A.S. "Cc bnh mi xut hin v cc bnh c nguy c quay tr li" - Vin Sc kho Quc gia, Bethesda, Maryland.

Kh hu thay i lm thay i cc h sinh thi, t l gia ng vt sn mi v con mi b mt cn bng dn ti cc phng thc kim sot sinh hc t nhin cng b ph v. Cc loi c nc ngt, chim, lng c v di l nhng loi gii hn s pht trin ca mui (l vc-t truyn cc bnh st rt, st xut huyt, st vng v vim no). Qu, ch si ng c v rn gip kim sot cc qun th gm nhm. Mt s loi gm nhm lm ly truyn cc bnh Lyme, hantavirus, arenavirus (st xut huyt), Leptospiroses v dch hch. Khi k th ca cc vc-t truyn bnh b gim v s lng do tc ng ca thay i kh hu trong lc cc qun th vector truyn bnh li pht trin mnh m th cc bnh truyn qua vc-t s c iu kin lan trn v chng ta kh c th kim sot c. Cc nh khoa hc cho rng kh hu m v m hn to iu kin m rng phm vi hot ng ca nhiu loi bnh truyn nhim. Tin s Epstein trong mt nghin cu gn y v " Sc kho con ngi v s thay i kh hu" cnh bo rng " Thay i kh hu s c nhiu tc ng ln sc kho con ngi v hu ht l cc tc ng c hi" (Epstein, 1998).
1.3.5. Thay i m hnh bnh tt

Trong qu kh c nhiu giai on bnh tt tn ph x hi loi ngi, v d nh bnh dch hch thi trung c xy ra chu u. Vn ny xy ra ng thi 65

vi s gia tng dn s, s th ho v mi trng sng b nhim trm trng. Vi s m ln ca ton cu nh hin nay cng vi s thay i mnh m cc h sinh thi to iu kin cho cc m hnh bnh tt thay i trn mt din rng. Trong nghin cu ca Tin s Epstein, ng a ra 3 tc ng chnh m s thay i kh hu c th gy ra cho sc kho cng ng, l: To iu kin thun li cho s bng n cc v dch bnh truyn nhim. Tng kh nng ly truyn cc bnh truyn qua vc-t v lm hng triu ngi b phi nhim vi cc bnh mi ny sinh cng nh phi nhim vi nhiu nguy c sc kho khc nhau. Cn tr s kim sot bnh dch trong tng lai. Ngoi ra, mt trong nhng nhn t khng km phn quan trng trong vic lm ly lan cc bnh mi ny sinh, gp phn thay i m hnh bnh tt trn th gii l vic i li, thng thng gia cc quc gia bng t, tu cao tc hay my bay. Thi xa xa, phng tin vn ti ch yu gia cc nc l tu bin hay xe th s, v vy thi gian i sang mt vng khc hay mt nc khc l kh lu. Cc vi sinh vt gy bnh truyn nhim c th b cht trn ng i v lm hn ch s ly lan bnh tt gia cc vng. Trong x hi hin i ngy nay, vic i li gia cc nc bng my bay thun tin v nhanh hn nhiu. Theo Alleyne (1998), nm 1995 c hn 1 triu ngi s dng my bay mi ngy. Mc d em li nhiu li ch cho con ngi nhng iu ny cng gp phn lm ly lan bnh tt. Ngoi cc bnh truyn nhim th ngy nay nhiu nc m nht l nhng nc pht trin ang phi ng u vi cc bnh khng truyn nhim nhng c t l t vong cao nh ung th, tiu ng, tim mch, bo ph v.v
2. M HNH BNH TT VIT NAM THEO CC VNG SINH THI

c im chung ca nc ta l i ni chim 3/4 din tch lnh th v ng bng ch chim 1/4 lnh th. Kh hu nhit i, gi ma, pha Bc c 4 ma, pha Nam c 2 ma, nhit trung bnh nm cao 21-260C, m cao. Do nh hng ca gi ma, a hnh phc tp nn kh hu ca nc ta lun thay i trong nm, gia nm ny vi nm khc, gia ni ny vi ni khc, t Bc xung Nam, t ng sang Ty, t thp ln cao. Do c tnh y lm nh hng su sc n i sng x hi nh l li sinh hot: n, mc, v bo v sc kho. Theo a l v thng k y t (2001) nc ta c chia thnh 8 vng sinh thi nh sau: vng ng Bc, Ty Bc, ng bng Sng Hng, Bc Trung B, Duyn hi min Trung, Ty Nguyn, ng Nam B v ng bng Sng Cu Long.
2.1. Min ni Trung du Bc B (ng Bc v Ty Bc)

66

K t nm 2001, Min ni Trung du Bc B c chia thnh vng ng Bc v Ty Bc, gm 16 tnh thnh: H Giang, Tuyn Quang, Cao Bng, Lng Sn, Lai Chu, Lao Cai, Yn Bi, Thi Nguyn, Bc Cn, Sn La, Ho Bnh, Ph Th, Vnh Phc, Bc Giang, Bc Ninh v Qung Ninh.
2.1.1. c im a l, kinh t - x hi

L ni tip gip vi cc nc Lo v Trung Quc, lin k vi ng bng Sng Hng, nn c iu kin giao lu. a hnh ni non him tr, giu ti nguyn, nht l ti nguyn rng v cc khong sn, nhiu sng, sui, bin Kh hu vn l kh hu nhit i, c 4 ma. L ni sinh sng ca nhiu dn tc t ngi nh: Ty, Nng, Thi, Mng, Dao, Mng v.v. L vng cn ngho v kh khn, mc d c nhiu tin b v i sng vn ho x hi, nhng vn cn c nhng phong tc tp qun lc hu, nh hng n cng vic bo v sc kho cng ng.

2.1.2. c im bnh tt

T nhng c im v a l, kinh t nh vy nn ko theo nhng vn v sc kho, bnh tt cng c nhng im khc so vi cc vng khc nh y l ni tp trung kh nhiu nhng bnh lin quan n cn trng, i ngho, phong tc... biu hin qua 10 bnh mc cao nht nh c trnh by trong bng 4.
Bng 3.4. Mi bnh c t l mc cao nht vng min ni Trung du Bc b, nm 1999 v 2001
STT 1 2 3 Min ni Trung du Bc B (nm 1999) Cc bnh vim phi Vim hng amian cp v vim Vng ng Bc (nm 2001) Vim hng v vim amian cp Vim ph qun v vim tiu ph qun cp Cc bnh vim phi Vng Ty Bc (nm 2001) Cc bnh vim phi Vim hng amian cp v vim

Vim ph qun v vim tiu ph qun cp

a chy, vim d dy, vim rut non c ngun gc nhim khun

67

a chy, vim d dy, vim rut non c ngun gc nhim khun Cm

a chy, vim d dy, vim rut non c ngun gc nhim khun Cc tn thng khc xc nh, khng xc nh v nhiu ni Tai nn giao thng Vim d dy - hnh t trng Cm

Cm

Vim nhim c t cung

6 7 8

No ht thai St rt

Tai nn giao thng Vim ph qun v vim tiu ph qun cp Cc tn thng khc xc nh, khng xc nh v nhiu ni Cc bin chng khc ca cha Thng hn, ph thng hn

a chy do Shigella

9 10

Cc tn thng do chn thng Lot d dy-hnh t trng

Gy cc phn khc ca chi Tng huyt p nguyn pht

2.2. ng bng Sng Hng

ng bng Sng Hng gm 9 tnh thnh ph: H Ni, Hi Phng, H Ty, Hi Dng, Hng Yn, Thi Bnh, Nam nh, H Nam v Ninh Bnh.
2.2.1. c im a l, kinh t - x hi

ng bng Sng Hng rng gn 1,3 triu ha, chim 3,8% din tch ton quc vi mt vng bin bao quanh pha ng v ng-Nam. L ni dn c tp trung ng c nht trong c nc, mt dn s trung bnh 1180 ngi/km2 (1999). a hnh bng phng c th mnh v pht trin lng thc, thc phm, khoa hc k thut, cng ngh. Do th mnh v pht trin lng thc thc phm, chn nui, canh tc nng nghip nn gy ra m hnh bnh tt c khc vi cc vng khc. L vng c ngha then cht trong s nghip pht trin kinh t x hi ca t nc.
2.2.2. c im bnh tt
Bng 3.5. Mi bnh c t l mc cao nht vng ng bng Sng Hng nm 1999 v 2001
STT 10 bnh c t l mc cao nht nm 1999 10 bnh c t l mc cao nht nm 2001

68

1 2 3 4 5 6 7 8 9 10

Cc bnh vim phi Vim ph qun v vim tiu ph qun cp Vim hng v vim amian cp I chy, vim d dy, vim rut non c ngun gc nhim khun Sy thai do can thip y t Bnh khc ca b my h hp Bnh khc ca b my tiu ho Bnh giun sn khc Vim khp dng thp v vim khp khc Lot d dy - t trng

Cc bnh vim phi Vim ph qun v vim tiu ph qun cp Cc bnh khc ca b my tun hon Vim hng v vim amian cp I chy, vim d dy, vim rut non c ngun gc nhim khun Tai nn giao thng Vim khp dng thp v vim khp khc Cc tn thng khc do chn thng xc nh, khng xc inh v nhiu ni Vim d dy - t trng Vim nhim c t cung

2.3. Bc Trung B

Bc trung b gm 6 tnh l: Thanh Ho, Ngh An, H Tnh, Qung Bnh, Qung Tr, Tha Thin Hu 2.3.1. c im a l, kinh t, x hi y l vng lnh th hp theo chiu ng Ty nhng di theo chiu Bc - Nam. L vng c c ng bng, min ni cao, l ni c dy Trng Sn chy dc theo chiu Bc - Nam, chy dc theo bin ng, tip gip vi nc Lo. ng x giao thng trong vng cn nhiu kh khn, c ng 1 v ng H Ch Minh chy qua. Kh hu nh hng ca gi lo v ma h nn nng, m, ma l theo ma. L vng chu nh hng kh nhiu thin tai v b tn ph nhiu trong thi gian chin tranh. L vng pht trin c kinh t rng, bin v nng nghip. L ni c tr ca nhiu dn tc khc nhau, cn nhiu dn tc t ngi sng rt su - xa c nhiu phong tc tp qun lc hu. 2.3.2. c im v bnh tt
Bng 3.6. Mi bnh c t l mc cao nht vng Bc Trung b nm 1999 v 2001
STT Mi bnh c t l mc cao nht Mi bnh c t l mc cao nht

69

nm 1999 1 2 3 4 5 6 7 8 9 10 Cc bnh vim phi Vim hng v amian cp Vim ph qun v vim tiu ph qun cp Cm Sy thai do can thip y t St rt a chy, vim d dy, vim rut non c ngun gc nhim khun Chn thng dp nt v ct ct xc nh v nhiu vng trong c th Gy cc phn khc ca chi do lao ng v giao thng a chy do Shigella

nm 2001 Cc bnh vim phi Tai nn giao thng Vim ph qun v vim tiu ph qun cp Cc bin chng ca cha a chy, vim d dy, vim rut non c ngun gc nhim khun Cc tn thng khc xc nh, khng xc nh v nhiu ni Vim hng v vim amian cp St rt Gy cc phn khc ca chi do lao ng v giao thng Bnh khc ca b my h hp

2.4. Duyn hi Nam Trung B

Vng a l Duyn hi Nam Trung B gm 8 tnh thnh l: Nng, Qung Nam, Qung Ngi, Bnh nh, Ph Yn, Khnh Ho, Ninh Thun v Bnh Thun.

2.4.1. c im v a l, kinh t - x hi

Khc vi Bc Trung B, qua o Hi Vn, vng Duyn hi Min Trung c kh hu hai ma l ma kh v ma ma, khng c ma ng, kh hu n ho hn, nhng vn l vng chu nhiu thin tai v hu qu ca chin tranh. Lnh th hp chy dc theo b Bin ng, a hnh c ni i, ng bng ven bin. L ni sinh sng ca nhiu dn tc khc nhau, phong tc c nhng nt khc ca Bc Trung B. Th mnh l ti nguyn rng, che ph ca rng l 34%; ng nghip v nng nghip, chn nui, nh bt thu hi sn, nhiu ngnh cng nghip khai thc, ch bin pht trin. C nhiu khu c th tr thnh khu du lch. Pht trin kinh t- x hi ca vng thc s vn cn kh khn.
2.4.2. c im v bnh tt

70

Bng 3.7. Mi bnh c t l mc cao nht vng Duyn hi Nam Trung B nm 1999 v 2001
STT 1 2 3 4 5 6 7 8 9 10 Mi bnh c t l mc cao nht nm 1999 Cc bnh vim phi Vim hng v amian cp Vim ph qun v vim tiu ph qun cp Cc tn thng khc do chn thng xc nh v nhiu ni a chy, vim d dy, vim rut non c ngun gc nhim khun Chn thng dp nt v ct ct xc nh v nhiu vng trong c th Su rng Cc bin chng khc do cha St rt Bnh vim rut tha 10 bnh c t l mc cao nht nm 2001 Cc tn thng khc do chn thng xc nh v nhiu ni Cc bnh vim phi a chy, vim d dy, vim rut non c ngun gc nhim khun Vim ph qun v vim tiu ph qun cp Cc bin chng khc ca cha Vim hng v amian cp Bnh vim rut tha Vim khp dng thp v vim khp khc St rt Tng huyt p nguyn pht

2.5. Ty Nguyn

Ty Nguyn c 4 tnh l: Gia Lai, Kon Tum, k Lk v Lm ng.

2.5.1. c im a l, kinh t - x hi

y l vng duy nht nc ta khng gip vi bin. Cc tnh ny tip gip vi Lo v Cmpuchia, c v tr quan trng v quc phng v kinh t. a dng v ti nguyn rng v kh hu, l ni c th pht trin thnh nhng khu du lch v ngh mt, c tim nng to ln v nng nghip v lm nghip, c tr nng thu in ln. L ni tha dn nht nc ta, l a bn c tr ca nhiu dn tc t ngi nh: Xu - ng, Ba - na, Gia - rai, - , K Ho, M, M - nng, vi truyn thng vn ho c o H thng y t pht trin tng i tt nhng s dng ca ngi dn cn thp, c bit l cc dn tc t ngi.
2.5.2. c im v bnh tt
Bng 3.8. Mi bnh c t l mc cao nht vng Ty Nguyn nm 1999 v 2001

71

STT 1 2 3 4 5

Mi bnh c t l mc cao nht nm 1999 St rt Cc bnh vim phi Cc tn thng khc do chn thng xc nh v nhiu ni Vim hng v amian cp Sy thai do can thip y t

Mi bnh c t l mc cao nht nm 2001 Vim hng v vim amian cp St rt Cc bnh vim phi Vim ph qun v vim tiu ph qun cp Cc tn thng khc, xc nh, khng xc nh v nhiu ni Tai nn giao thng Cm Gy cc phn khc ca chi: do lao ng v giao thng a chy, vim d dy, vim rut non c ngun gc nhim khun Vim nhim c t cung

6 7 8 9 10

Tai nn giao thng Vim ph qun v vim tiu ph qun cp a chy, vim d dy, vim rut non c ngun gc nhim khun Bnh vim rut tha Cc bnh nhim khun khc

2.6. ng Nam B

Vng ng Nam B gm 6 tnh, thnh: Thnh ph H Ch Minh, Bnh Dng, Bnh Phc, Ty Ninh v ng Nai, B Ra Vng Tu.
2.6.1. c im v a l, kinh t - x hi

L khu vc c din tch nh, mt dn s trung bnh nhng pht trin nht trong c nc v sn lng cng nghip, hng xut khu. t ai mu m, c iu kin pht trin cy cng nghip lu nm v ngn ngy trn quy m ln. L khu vc thu ht mnh lc lng lao ng c chuyn mn cao, th lnh ngh, cc nh khoa hc v l vng c ti nguyn cht xm ln. C iu kin v kh nng pht trin cng nghip, cc hot ng du lch, dch v, ch bin, xut - nhp khu, Khai thc kinh t bin, b bin, pht trin nng nghip v ng nghip. Kh hu n ho, ch c 2 ma ma v kh, thi k ma kh ko di (4 thng) dn n thiu nc sinh hot, nc ti cho cy trng v nc cho cng nghip.
2.6.2. c im v bnh tt
Bng 3.9. Mi bnh c t l mc cao nht vng ng Nam b nm 1999 v 2001

72

STT

Mi bnh c t l mc cao nht nm 1999

Mi bnh c t l mc cao nht nm 2001 Vim hng v vim amian cp Cc bin chng ca cha Vim ph qun v vim tiu ph qun cp Cc bnh vim phi a chy, vim d dy, vim rut non c ngun gc nhim khun Tai nn giao thng Cm Tng huyt p nguyn pht Vim cp ng h hp trn Vim d dy - hnh t trng

1 2 3 4 5 6 7 8 9 10

Cc bin chng do cha Vim hng v amian cp Cc bnh vim phi Vim ph qun v vim tiu ph qun cp a chy, vim d dy, vim rut non c ngun gc nhim khun Sy thai do can thip y t Vim cp ng h hp trn Tng huyt p Cc tn thng do chn thng xc nh v nhiu ni Cm

2.7. ng bng Sng Cu Long

Gm 12 tnh l: Long An, ng Thp, An Giang, Tin Giang, Bn Tre, Vnh Long, Tr Vinh, Cn Th, Sc Trng, Kin Giang, Bc Liu, C Mau.
2.7.1. c im a l, kinh t - x hi

L ng bng chu th ln nht nc vi din tch 4 triu ha, ma ma ng bng b ngp su trong nc, ma kh ch l nhng vng nc t t on, t rng dn tha, cha c khai thc nhiu. C 16,1 triu dn sinh sng ch yu l ngi Kinh v ngi Chm, Kh-me, H thng sng ngi, knh rch chng cht, ct x chu th thnh nhng nn vic giao thng bng ng thu d dng. Kh hu cn xch o, nhit i m, ma kh ko di lm cho t nc b nhim mn vo su t lin. Thm thc vt, ng vt phong ph ch yu l rng ngp mn v rng trm, ti nguyn bin v cng phng ph Thiu nc ngt ang l mt vn v cng quan trng ca ng bng Sng Cu Long
2.7.2. c im v bnh tt
Bng 3.10. Mi bnh c t l mc cao nht vng ng bng Sng M Kng nm 1999 v 2001

73

STT 1 2

Mi bnh c t l mc cao nht nm 1999 Cc bnh vim phi a chy, vim d dy, vim rut non c ngun gc nhim khun

Mi bnh c t l mc cao nht nm 2001 Cc bnh vim phi a chy, vim d dy, vim rut non c ngun gc nhim khun

3 4 5 6 7 8 9 10

Vim hng v amian cp Mt ht St rt Vim ph qun v vim tiu ph qun cp Sy thai do can thip y t Tng huyt p Cc tn thng do chn thng xc nh nhiu ni trn khc Lao b my h hp

Vim hng v vim amian cp Tng huyt p nguyn pht Tai nn giao thng Cc tn thng, xc nh v khng xc nh nhiu ni Lao b my h hp Cm Vim ph qun v vim tiu ph qun cp Vim cp ng h hp trn

Ngun: S liu c ly t Nin gim thng k y t 1999 v 2001, B Y t

y l nhng s tho ban u v cc vn bnh tt theo vng sinh thi. R rng theo s liu thng k th m hnh bnh tt cc vng sinh thi khc nhau l khc nhau v c s thay i trong nhng nm qua. C tc gi nghin cu v i tng vi sinh thi, nhng cho n nay cha c mt nghin cu nghim chnh no v nhng vn ny. Hin trn ton quc vn cha c mt nghin cu chi tit no v vo tr ca nhng bin i ca sinh thi vi nhng thay i ca m hnh bnh tt cc vng. Do vy, nhng nghin cu v mi quan h gia nh hng sinh thi ca cc vng khc nhau cng nh nhng thay i sinh thi hc tng vng vi sc kho v m hnh bnh tt ca cng ng dn c vng s ti l rt cn thit.
3. NHNG THAY I SINH THI HC V MT S BNH PH BIN LIN QUAN N MI TRNG 3.1. Cc bnh truyn nhim 3.1.1. Bnh truyn qua cc vt ch trung gian

Vic gia tng t l mc bnh v t l t vong lin quan ti s nng ln ca tri t c th khng phi l do tc ng trc tip ca sng nhit. C nhiu bng chng cho thy rng mt s bnh truyn nhim nguy him trc y ch ph bin cc nc 74

c kh hu nng m th nay c nguy c lan trn sang nhiu vng khc trn ton th gii. y l mt trong nhng vn quan trng hin ang thch thc cc chng trnh sc kho cng cng. Xu hng th ho, vic cc bin php kim sot vc-t khng pht huy hiu qu v s gia tng ca vic i li thng thng gia cc nc trn th gii cng nh s di c ca ngi dn t nc ny sang nc khc l nhng yu t chnh dn ti s ti xut hin tr li cc bnh truyn qua vc-t. S m rng ca cc vng khng c sng tuyt c th dn ti s di c ca cc loi cn trng v gm nhm lm ly lan cc bnh vng c kh hu nng m ti cc vng cao nguyn, i ni. Nhng g c li cho vi sinh vt c hi th him khi c li cho con ngi. Nhit m ln trong mt thi gian di do kh hu thay i s to iu kin l tng cho cc loi mui v nhiu loi vc-t truyn bnh khc sinh si ny n, lm ly lan cc bnh truyn nhim. a. Bnh st rt Vn ang thu ht c s quan tm rt ln l bnh st rt. St rt hin l mt trong nhng bnh truyn nhim ph bin nht trn th gii v c tnh c khong 300 n 500 triu ngi b mc v c thm khong 1, 5 n 2, 7 triu ngi b cht hng nm v cn bnh ny. Hn mt na trong s cc trng hp b t vong l tr em, c bit l tr em sng nhng vng nng thn ngho nn chu Phi - chu lc c nhiu ngi mc bnh st rt nht (Watson v cng s 1995), 60 trong s 380 loi mui c bit n trn th gii c kh nng truyn bnh st rt. Vit Nam c khong 20 loi mui truyn bnh st rt, trong mt s loi chnh l Anophel minimus, Anophel dirus v Anophel balabasensis Ngi ta cho rng bnh st rt l cn bnh truyn qua vc-t chu nh hng ln nht ca s thay i kh hu, v mui rt nhy cm vi nhng thay i thi tit. Nhng thay i kh hu ko theo thay i v nhit , lng ma, m v gi s nh hng ti vng i v s pht trin ca mui, gin tip nh hng ti s lan trn ca bnh st rt. St rt do mui truyn thng c tm thy nhng vng c nhit thp nht vo ma ng khng di 160C. S m rng ca cc vng c nhit trn 160C vo ma ng ng thi cng ni rng phm vi honh hnh ca cn bnh st rt v gy ra hu qu nghim trng cho sc kho con ngi. Gia nhng nm 1950, nhiu quc gia trn th gii tin chc rng h s thanh ton c cn bnh ny nh phun thuc DDT liu cao dit tr mui Anopheles. Tuy nhin, nhng quc gia ny chu tht bi v mui Anopheles nhanh chng tr nn khng thuc. T u nhng nm 1970, cn bnh ny xut hin tr li nhiu ni trn th gii v di dng nguy him hn. S gia tng s trng hp b st rt trong nhng nm gn y mt phn l do s m ln trn ton cu, ng thi do con ngi xy dng nhiu p nc v cc h thng ti tiu trong nng nghip to iu kin thun li cho cc qun th mui sinh si pht trin mnh m lm ly lan cn bnh ny. Theo T chc Y t Th gii th n cui th k 21, hng nm s c thm khong 50-80 triu trng hp b st rt (WHO, 1996).

75

b. St xut huyt St xut huyt l cn bnh nhit i do mui truyn. y l cn bnh nguy him do virus truyn qua mui vn t ngi vo ban ngy. Kh hu vng nhit i vi nhit giao ng t 15 n 400C v m cao kt hp vi mi trng sng ng c, mt v sinh s to iu kin thun li cho cn bnh ny pht trin. Cn bnh ny c hai th: st Dengue v st xut huyt Dengue. St Dengue c triu chng tng t nh cm cm, thng xy ra tr ln, ngi ln v t khi gy t vong. Tri li, st xut huyt Dengue l th th pht rt nguy him, c xut huyt v bnh nhn c th b cht nu khng c chn on v iu tr kp thi (Nguyn, 1996). St xut huyt l nguyn nhn hng u ca cc trng hp nhp vin v t vong ca tr em cc nc ng Nam v Ty Thi Bnh Dng. Cn bnh c tnh lm tn hi ti khong 30 n 60 triu ngi hng nm (Rodhain, 1996). Vit Nam, st xut huyt xy ra hu ht cc tnh thnh ph vo cc thng ri rc trong nm, nhng tp trung ch yu vo cc thng ma ma t thng 6 n thng 10 (Hong, 2001). Theo d on ca tin s Epstein th thay i kh hu l mt nguyn nhn chnh gy ra s lan trn bnh st xut huyt. Ngy nay, st xut huyt xut hin kh ph bin cc nc chu v chu M La Tinh. Bng chng l ngi ta ghi nhn cc trng hp b st xut huyt nhng vng c cao cao hn trc, v d 1.240 mt Trung M, 1.000 mt Mexico v 2.200 mt Clmbia. V hin nay, st xut huyt cha c thuc iu tr c hiu cng nh cha c vc-xin phng bnh, do bin php phng chng tch cc ch yu da vo s tham gia ca cng ng dit mui truyn bnh. c. Vim no truyn qua cn trng y l mt vn cn c c bit quan tm cc nc n i. Mui c th truyn mt s loi virus gy cc bnh vim no ngi. Mt trong s cc bnh ny l vim no Nht Bn, Eastern Equine (M), Venezuelan Equine v nhiu bnh khc. Ph bin nht M l vim no St. Louis. Cc v dch vim no St. Louis xy ra Trung ng c tng quan vi cc thi k c nhit cao (trn 300C), c bit l vo nhng thng cui ma ng nng, m t v theo sau l ma h hn hn. Cn bnh ny gy ra cho cng ng nhiu v dch, v d nh v dch xy ra M vo nm 1975 lm 1.815 ngi b mc (WHO, 1996). Hin ti, bnh ny ch mi xy ra ch yu cc vng pha Nam nc M, tuy nhin vi tc ng ca s m ln ton cu, s bin i cc h sinh thi th bnh c xu hng lan trn ln mt s vng pha Bc v c th ln tn Canada. d. Hantavirus Cng vi s gia tng ca cc bnh ph bin xut hin t lu th gn y c s xut hin ca mt s bnh truyn nhim mi mt s nc trn th gii. Nhiu loi ng vt nh gm nhm, di v ng vt gy hi tham gia vo s ly truyn cc bnh truyn nhim. V d, s xut hin ca hi chng vim phi do Hantavirus gy ra 76

pha trn v xung quanh vng Navajo Indian Ty Nam nc M nm 1993 l c lin quan vi nhng bin i xy ra trong cc qun th gm nhm trong vng. Hantavirus l mt v d in hnh v vai tr ca nhng thay i trong h sinh thi trong vic xy ra cc v dch bnh truyn nhim trong nhng thp nin gn y. S thay i kh hu b nghi ng l c lin quan ti nhng bin i trong h sinh thi v gp phn lm ny sinh dch bnh ny. Hantavirus c truyn bi chut nht v con ngi c th ht th loi virus ny vo nu trong mi trng khng kh c nc tiu hoc phn ca chut nht. Di iu kin bnh thng th loi chut nht sa mc mang Hantavirus s b kim sot bi cc loi th sn mi trong t nhin. Tuy nhin, vng Ty Nam nc M nm 19911992, hin tng En Ni-n xy ra lm hn hn ko di v hu qu l lm gim s lng c th ca cc qun th ch si ng c, qu v rn. Ma xun nm 1993, ma nhiu hn bnh thng lm cho cy ci v cn trng pht trin mnh, cung cp lng thc n di do cho chut nht v to iu kin cho chng pht trin sinh si ny n nhanh hn cc loi l k th ca chng nh ch si ng c, qu v rn. Cc qun th chut nht tng s lng c th ln khong 10 n 15 ln v vi s lng ng o, chng xm nhp vo nhiu nh vng Ty Nam v dn ti s gia tng ca cc trng hp mi b mc hi chng Hantavirus phi (HPS). Hn 150 ngi mc bnh v hn mt na trong s h b cht (theo Tp ch Y t Cng cng ca M s 85, tc gi Epstein, P. R.). Cc v dch HPS cng xy ra nhiu nc thuc chu M La Tinh t nm 1995.
3.1.2. Cc bnh truyn qua nc

Mi quan h gia sc kho con ngi vi cht lng v s lng nc cung cp cng nh cc vn v v sinh mi trng l kh phc tp. Do vy, vic d on nhng tc ng tim tng m s thay i cc h sinh thi v kh hu c th gy ra i vi cc bnh truyn nhim lin quan n nc l khng d v c hi tip cn vi ngun nc sch v an ton ph thuc vo cc yu t kinh t -x hi. Tuy nhin, nhiu nghin cu cho thy cc trn bo, lt c th lm gia tng nguy c mc bnh truyn qua nc do ngun nc b nhim, v sinh mi trng km hoc do cc yu t lin quan khc. Ma s to c hi cho cc vi sinh vt nhim bn ngun nc ung. V d, mt s v dch Cryptosporidiosis, Giardia, t v cc bnh truyn nhim khc xy ra sau cc trn ma ln Anh v M (Lisle v Rose, 2001). Cc bnh truyn qua nc c th do nhiu loi vi sinh vt gy ra, bao gm virus, vi khun v ng vt nguyn sinh. Mt s bnh truyn qua nc do virus gy ra bao gm vim gan A, Rotavirus v bnh do virus Norwalk. Mt s vi khun gy bnh truyn trong nc bao gm phy khun Cholerae, Legionella, Salmonella typhi v Shigella. Hai loi ng vt nguyn sinh ph bin gy bnh truyn qua nc l Giardia v Cryptosporidum. S thay i ca kh hu, mt cn bng cc h sinh thi v mi 77

lin quan ti mt s bnh truyn qua nc do virus, vi khun v ng vt nguyn sinh s c bn ti sau y. a. Rotavirus Rotavirus thuc h Reoviridae gy vim d dy rut cp tnh. C tt c 6 nhm khc nhau v 3 trong s ny (cn gi l nhm A, B v C) ly nhim v gy bnh cho ngi. Rotavirus nhm A l mt bnh dch ph bin trn ton th gii. y l nguyn nhn hng u gy a chy tr s sinh v tr nh, chim khong mt na cc ca b bnh ng rut phi n bnh vin. Ch ring nc M th hng nm cng c hn 3 triu ca vim d dy rut do Rotavirus nhm A gy ra. nhng vng n i, bnh ch yu xy ra vo ma ng, nhng cc nc nhit i th Rotavirus gy bnh quanh nm. Rotavirus nhm B (hay cn gi l Rotavirus gy tiu chy ngi ln (ADRV)) gy ra nhiu v dch tiu chy nguy him. Rotavirus nhm C lc c gy ra mt vi v dch tiu chy tr em trn nhiu nc. Tuy nhin, nhng v dch u tin xy ra Nht v Anh (C quan Qun l Thuc v Thc phm M, 2002). Cn bnh ny c th t khi, mc c th t nh n nguy him v thng gm cc triu chng nh nn ma, a chy v st nh. Rotavirus c ly truyn qua ng phn - ming. S ly lan t ngi ny sang ngi khc thng qua tay b nhim bn l con ng ly truyn quan trng nht ca Rotavirus trong cc cng ng sng ng c, cht hp. Liu ly nhim c tnh khong t 10 n 100 virus. V ngi bnh thng thi ra virus vi s lng ln (khong 108-1010 virus/100ml phn), do chng ta rt d mc bnh khi tip xc vi tay, bt a hay cc vt dng khc b nhim bn. Rotavirus tn ti kh bn vng trong mi trng, do vy cng tc v sinh an ton thc phm v v sinh mi trng yu km l mt trong nhng nguyn nhn chnh lm ly lan cn bnh ny. Thng 8 nm 1998, C quan Qun l Thuc v Thc phm M thng qua vic s dng vc xin phng Rotavirus cho tr s sinh. b. Bnh t S m ln trn ton cu v nhng thay i v nhit b mt nc bin cng c th dn ti s gia tng cc bnh ly truyn qua ng nc nh bnh t do vi khun t. Ngy cng c nhiu bng chng cho thy cc loi thc vt ph du l ni tr n ca cc vi khun t ging bo t ng, chng tr ng di cc lp to dy. Khi i dng m ln, cc thc vt ph du sinh si ny n v theo cc khun hnh que gy bnh t xut hin tr li di dng ly nhim. Ni mt cch khc, nhng thay i ca h sinh thi i dng ng vai tr ht sc quan trng trong s ly truyn bnh t (Colwell, 1996). Theo Tin s Paul Epstein, mt s bnh ly nhim qua nc nh bnh t ang honh hnh nhiu quc gia v gy hu qu nng n cha tng thy, ng cho rng y l mt trong nhng hu qu ca thay i kh hu v mt cn bng sinh thi. Nm 1991, i dch t lan truyn ti cc nc chu M v trong vng 18 thng u tin c hn na triu ngi mc bnh chu M La Tinh, lm hn 5000 ngi cht. 78

Epstein cng ghi li rng vo cui nm 1992, mt dng phy khun Cholera mi, c gi l O 139 Bengal, xut hin n - dc theo b ca Vnh Bengal. Nhiu cng ng dn c khng c tim phng min dch t trc nn cn bnh ny lan trn sang nhiu nc khu vc ln cn v e da tr thnh i dch t ln th 8 xy ra trn th gii. Theo Epstein, s xut hin ca cn bnh mi ny l kt qu ca s tng tc gia vi sinh vt, con ngi v cc yu t mi trng sinh thi. V dch t ln nht xy ra Rwanda vo nm 1994 lm hn 40.000 ngi b cht ch trong vi tun. c. Bnh l do trc khun Shigella Vit Nam, bnh l trc khun rt hay gp, c bit vo ma h. Vi khun gy bnh ch yu l Shigella flexneri. Vi khun l theo thc n, nc ung b nhim khun vo ng tiu ho. Chng c tr trong rut gi ri sinh sn, v xm nhp vo thnh rut. c t ca chng gii phng ra kch thch thn kinh rut, gy vim lot, xut tit ti ch; do bnh nhn c cm gic au bng qun, mt rn, i ngoi phn c nhy, mu. Nu c chn on v iu tr kp thi s khi, khng c bin chng; nu iu tr mun, bnh nhn c th t vong. Bnh c th gy dch qua ng n ung. Trong cc yu t nguy c th tnh trng suy dinh dng (trng lng theo tui nh hn 70%) l hu qu ca cn bnh ny. Tr s b i tiu ra nhiu m v mu do i trng b vim. Hin tng ny vn tip tc thm ch sau khi iu tr bng khng sinh thch hp. Chn n cng l vn tin s ng quan tm khi tr b nhim Shigella. Khi nhim bnh, tr km hp th v mt cht dinh dng. Vi nhng tr b suy dinh dng, tnh trng dinh dng cng b gim st khi nhim phi bnh ny. Cc thuc khng sinh c tc dng lm gim s lng vi khun i trng cng lm gim tc dng gy hoi t ca c t Shigella, nhng li lm mt nhng cht dinh dng c trng lng ln (protein), dn n tnh trng suy dinh dng tr. Bin php phng bnh ch yu l v sinh phn, nc, rc, qun l v iu tr kp thi bnh nhn, trnh ly lan. d. L amip Bnh do n bo amip gy nn, c th gy l amip cp hoc mn tnh. Bnh d mc khi n ung thiu v sinh, iu kin v sinh mi trng xung quanh km, to iu kin cho rui pht trin v truyn bnh. y l bnh ly qua ng tiu ha. Amip theo thc n, nc ung vo ming; khi n rut th xm nhp vo nim mc rut, gy ra nhng vt lot nh trong lng rut v biu hin bn ngoi bng hi chng l. Thi gian bnh tng i di (7-90 ngy). Triu chng chnh l: bnh nhn au bng m h, n km ngon, ngi mt mi v hay m hi. Tip theo l xut hin hi chng l: au dc theo khung rut gi, i 79

ngoi 5-15 ln /ngy ra cht nhy ln mu v c cm gic mt rn. Bnh nhn khng b st, soi trc trng thy c c vt lot hnh du ngn tay, trn mt ph lp nhy ln mu. Nu cha tr ng v kp thi th bnh nhn s khi hon ton v khng li di chng. Nu cha tr khng kp thi hoc khng ng cch th bnh nhn c nguy c b bin chng p xe gan, xut huyt, thng rut v mt s bin chng khc hoc chuyn sang vim rut mn tnh. e. Bnh do Cryptosporidim Bnh do Cryptosporidium l mt bnh ng rut do ng vt k sinh Cryptosporidium gy ra. Mi nm New York c khong 400-500 ngi b nhim. Cn bnh ny c pht hin ln u tin vo nm 1976 v c a vo danh sch cc bnh truyn nhim M vo thng 2 nm 1994. Triu chng chnh ca Cryptosporidium l a chy, au bng, bun nn, nn, st, au u v n khng ngon ming. Nhiu ngi b nhim Cryptosporidium nhng khng c biu hin lm sng. Tt c mi ngi u c nguy c b nhim bnh. nhng c th kho mnh vi h min dch hot ng bnh thng th cc triu chng s ko di trong vng 2 tun hoc ngn hn. Tuy nhin, nhng ngi b suy gim min dch th cn bnh c th ko di v gy nguy him n tnh mng. Cryptosporidium tn ti trong phn ca ngi bnh hay phn ca ng vt. Bnh c truyn t ngi ny sang ngi khc hay t ng vt sang ngi qua mi trng nc. Nu mt ngi ung phi nc b nhim bn c cha Cryptosporidium m khng c x l cn thn th s b nhim bnh. phng bnh ny, ngoi vic bo v ngun nc khi b nhim phn ngi v ng vt, cc nh my x l nc thi v sinh hot phi p dng cc bin php lc v x l hu hiu th chng ta cn phi thc hin tt cng tc v sinh c nhn v lun n chn ung si. f. Ng c thc phm do to c S m ln ca nc bin cng kch thch s sinh trng v pht trin ca cc loi to c v s kin ny thng c gi l thu triu "red tides". Cc loi c v ng vt c v (nh trai, s, cua, tm ...) n to c v c t s tch t li trong c th ca chng. n lt chng ta n cc loi hi sn ny v b ng c thc phm. Australia v mt s nc khc trn th gii xy ra nhiu v ng c thc phm do thu triu . Tt c nhng vn nu trn y cho thy: kh hu thay i c th to ra nhng thch thc ln cho ngnh y t cng cng trong th k XXI. Chng ta c th phi i mt vi nhiu vn v sc kho v mi trng mt din rng ln m chng ta cha tng gp phi.
3.1.3. Bnh truyn qua khng kh

Bnh truyn qua khng kh in hnh l bnh lao. 80

Lao phi (Tuberculosia - TB) l mt bnh dch e da sc kho cng ng trn th gii. Bnh do vi khun Mycobacterium tuberculosis gy ra v ly lan t ngi ny sang ngi khc qua ng h hp. Vi khun Mycobacterium tuberculosis gy bnh v t vong ngi t hng nhiu th k nay nhng n nm 1882 th Tubercle bacillus mi c bit ti. n nhng nm cui 1940 th thuc chng TB hu hiu u tin (streptomycin v acid p - amino salicylic) mi c sn xut. n nm 1952, ngi ta sn xut ra isoniazid (INH) iu tr TB ( McCray et al. 1997). Trc y, ngi ta ch iu tr TB bng mt loi thuc, tuy nhin n u nhng nm 1950 th c s xut hin ca cc dng vi khun M. tuberculosis khng thuc (v gn y th xut hin cc dng khng t 2 loi thuc chnh iu tr TB tr ln) nn i hi phi c s kt hp ca nhiu loi thuc trong iu tr. M giai on t 1950 n 1985 c nhiu ci cch trong cc chnh sch y t cng cng kt hp vi vic iu tr kt hp nhiu loi thuc nn s trng hp mc TB gim ng k. Tuy nhin, t 1985 n 1992, s trng hp b TB li tng ln rt nhanh. Ngi ta cho rng mt s nguyn nhn dn n s gia tng dch TB l do s xut hin ca i dch HIV/AIDS, vic iu tr TB khng ng hoc khng trit (lm gia tng vi khun khng thuc) v s i li thng thng gia cc nc trn th gii lm ly lan cn bnh ny. T l mi mc vi khun lao khng thuc M tng ln t 2% n 9% trong 3 thp k qua. TB l cn bnh truyn nhim gy t vong hng u trn th gii v hng nm th c khong 3 triu ngi cht v cn bnh ny. T 1992 n nay th s trng hp b TB c xu hng gim xung v M t 1992 n 2000 s trng hp b TB gim c 39%.

3.2. Cc bnh khng truyn nhim 3.2.1. Ung th

Ung th l mt bnh m c ch l c mt s t bo tng sinh hn lon, lin tc v khng kim sot c . Ung th c hn 100 dng khc nhau v l nguyn nhn th hai gy t vong M vi hn 500.000 ca t vong hng nm. C nhiu nguyn nhn gy ung th, cc nguyn nhn chnh gy ung th ngi c xp vo 3 nhm nh sau: cc cht ho hc, virus v phng x.
a. Ho cht

Vi s pht trin ca ngnh cng nghip ho cht, ngy cng c nhiu ngi lm vic trong mi trng c nguy c phi nhim cao vi cc ho cht c hi, c bit l cc cht c kh nng gy ung th. V d, cng nghip ho cht sn xut thuc nhum, cc c s thuc da, sn xut ru sopropyl, nha v cc sn phm ca du m. Phi nhim vi cc ho cht ni lm vic c tnh gy ra 2 n 8% s trng hp ung th. Thuc l gy ra khong mt phn ba s trng hp ung th v tt c cc nguyn nhn. Thuc l lin quan ti ung th phi, ung th ming, c hng, thc qun, 81

lch, bng quang v thn. Nhng ngi va nghin thuc v nghin ru th c nguy c b ung th cao hn nhng ngi khc 35 ln. Nhng cht ho hc trong thc n m chng ta n vo hng ngy c tnh gy ra khong mt phn ba ti mt na s trng hp b t vong. Cht aflatoxin l mt c cht c t nhin trong mt s loi nm mc v c tnh l nguyn nhn hng u gy ung th gan nhng nc ang pht trin.
b. Virus

Mt s loi virus c lin quan mt thit vi ung th ngi nh: virus vim gan B, virus Epstein-Barr, virus Papiloma ngi, virus tn cng t bo lympho T (HTLV1, HTLV-2) v HIV.
c. Phng x

Phng x nguyn t hoc phng x ion ho v tia t ngoi (UV) t mt tri c th gy ung th. Nng phng x ion ho cao lm tng ri ro b ung th, v d nh trong cc tai nn n nh my nguyn t hay trong mt s phng php iu tr bnh. Tuy nhin, i vi phng php iu tr bng tia X quang liu thp th nguy c b ung th l thp. nhim mi trng l nguyn nhn gy ra khong 2% t vong do ung th. Mt trong nhng cht nhim chnh l cc hydrocarbon vng thm, c to ra do hot ng t chy g, thuc l v cc nhin liu ho thch. Cc hp cht cha clo cng l mt trong nhng cht nhim chnh trong nc c lin quan ti ung th ng vt. Mt s hormon tng hp v thuc cng c th gy ung th hay c lin quan ti ung th ngi. V d mt s thuc chng ung th, c bit l cc hp cht ankyl nh cyclophosphamid v chlorambucil; steroid ng ho; estrogen tng hp nh diethylstilbestrol, conjugated estrogens, v thuc trnh thai cha estrogen. Mi trng nhim, h sinh thi thay i c nhiu tc ng n bnh ung th. Ni bt nht l mi tng quan gia suy gim tng ozon v gia tng t l mc bnh ung th da nhiu ni trn th gii, c bit l Australia, New Zealand, v Chile v.v.
3.2.2. Ung th da

Nng ca tia t ngoi ngy nay cao hn nhiu so vi 50 nm hay 100 nm trc y. y l hu qu ca s suy gim tng ozon gy gim ng k lng tia t ngoi chiu vo tri t. Do hot ng ca con ngi trong nhng thp nin gn y, khng kh b nhim, tng ozon b suy gim v chng ta phi nhim vi tia t ngoi nng cao hn trc y. Mt s yu t khc c tc ng n s phi nhim tia t ngoi l: cao, v v s bao ph ca my. cao tng ln th nng UV cng tng ln, v trn cao khng kh long hn mc nc bin, v vy chng hp th UV km hn. Tia t ngoi cng mnh nht vng gn xch o. Tuy nhin, do l thng tng ozon bn cu nam nn Nam Cc, Chile, v New Zealand cng c nng UV cao hn bnh thng. Mt yu t lm gim UV l s che ph ca my. Kh hu v vi 82

kh hu vi my che ph c th lm gim nng UV c th ti 50% tng bnh lu (to ra cc l thng tng ozon).
3.2.3. Hen suyn

Trong nhng thp nin gn y, nhim khng kh vi s gia tng nng ca kh ozon v sng m ho hc cng nh s m ln ca ton cu lm gia tng cc trng hp b hen suyn cng vi nhiu bnh h hp khc. Hen suyn l bnh h hp mn tnh vi cc triu chng kh th do vim ng h hp. C nhiu tc nhn gy kch thch s nhy cm ca ng h hp, lm cho b mt ng h hp b sng ln, lp mng nhy cn tr khng kh chuyn ng v cc c xung quanh ng h hp b tht cht (bronchospasm). Nhng thay i ny lm hp ng h hp v cui cng bnh nhn s cm thy kh th v c cc triu chng ca bnh hen. Cc triu chng ca cn bnh ny c th khc nhau gia cc c th v bao gm cc triu chng sau y: Th kh kh / th gp / ngc b nght. Ho kh kim sot / ho lin tc vo ban m. Kh th khi th ra / kh th trong hoc sau khi lm vic nng nhc hay tp th dc qu sc. Nhng ngi b bnh hen rt nhy cm vi cc tc nhn m c th khng h nh hng ti ngi kho mnh. Nhng tc nhn kch thch chng hen suyn c th khc nhau gia cc c th nhng nhng tc nhn ph bin nht l: + + Cc cht gy d ng (l cc nhn t gy phn ng lm d ng) bao gm: bt/ve t, nm mc, gin v cht thi ca chng Cht gy kch thch trong khng kh, bao gm: khi thuc, khi t t ci, than, chy rng v cc hi khi hoc mi kh chu khc nh cc dung dch dng phun trong nh, sn, du ho, nc hoa v x phng thm, phn hoa. Nhim khun ng h hp nh cm lnh, cm, au c hng v vim xoang. Tp th dc hay mt s hot ng khc lm ngi bnh th mnh hn. Thi tit, c bit l gi kh, khng kh lnh v thay i t ngt

+ + +

c tnh M c 12, 4 triu ngi b hen v 4, 2 triu trong s ny di 18 tui. Hen suyn l mt bnh mn tnh ph bin nht tr em nhiu nc trn th gii.
BI TP TNH HUNG Mc tiu

(1). p dng nhng khi nim l thuyt v c s sinh thi hc ca sc kho v bnh tt trong mt s tnh hung c th trong thc t.

83

(2). M t c nhng thay i v m hnh bnh tt do mi trng b ph hoi.

Tnh hung

Sau y l mt s hnh nh chp ti mt c s ti sn xut giy mt lng ngh ti Vit Nam.

nh 3. Nc thi v cht thi rn t cc c s ti sn xut giy

nh 3. Cnh ng la khng pht trin c, b b hoang, do tc ng ca mi trng b nhim

Nhng im nh du (x) trn bc nh cho thy nh my thi ra mi trng nhiu ho cht khc nhau bao gm natri hypoclorua, cc hp cht cha lu hunh, natri hydroxyd v mt s cht nhum. Cnh ng la cnh c s sn xut ny b 84

 nhim nghim trng v la khng pht trin c. ng thi, nc thi cng gp phn lm cho nng kh sulphua hyr (l mt kh c) tng cao trong lng ny. Hy tr li nhng cu hi sau y: 1. C s sn xut ny , ang v s nh hng nh th no n mi trng -sinh thi a phng? 2. Nhng hu qu v sc kho m cht thi t c s sn xut c th gy ra? 3. Vic thi trc tip cc cht thi (nc, kh v cht thi rn) ra mi trng c th gy ra nhng bnh g? 4. M hnh bnh tt lng ny c th khc vi nhng lng khc (ni khng c cc c s ti sn xut giy) nh th no?
T LNG GI

Hy nh du X vo 1 la chn duy nht 1 2 3 4 5 H sinh thi l mt qun x ng vt, thc vt v vi sinh O ng vt tc ng qua li vi nhau. H sinh thi t nhin ch c nhng tc ng gin tip ti O ng sc kho con ngi Con ngi l mt h sinh thi phong ph nht trn tri t

O Sai O Sai O Sai O Sai O Sai O Sai O Sai

O ng

Nhng hot ng ca con ngi c th c li hay c hi O ng i vi s cn bng ca h sinh thi Theo TS. Epstein (1998), thay i kh hu c kh nng to O ng iu kin thun li cho s bng n cc v dch bnh truyn nhim Theo TS. Epstein (1998), thay i kh hu to iu kin O ng thun li cho vic kim sot bnh dch trong tng lai S nng ln ca tri t m rng phm vi lu hnh ca O ng nhiu bnh truyn nhim nguy him

6 7

8. Trong qu trnh pht trin con ngi c nhng tc ng tiu cc no ti h sinh thi trn tri t? 9. En Ni-n l g? En Ni-n c tc ng nh th no ti sc kho cng ng? 10. Nhng bin i trong qun th gm nhm c lin quan nh th no vi s xut hin ca hi chng vim phi do Hantavirus Ty Nam nc M? 11. Nguyn nhn lm gia tng t l hin mc bnh hen suyn trong nhng thp nin gn y l g?

85

BI 4

NHIM KHNG KH
MC TIU

1. 2. 3. 4. 5. 6.

M t c cc thnh phn ca khng kh. Nu v phn bit c cc cht gy nhim khng kh. Trnh by c kha cnh lch s ca nhim khng kh. Trnh by c cc ngun gy nhim khng kh v m t c cc phng php kim sot cc cht nhim khng kh. M t c mt s hin tng nhim khng kh. Lit k v m t c cc bnh c lin quan ti nhim khng kh.

1. GII THIU CHUNG

Mt ngi c th sng qua nhiu ngy m khng c thc n, mt vi ngy m khng c nc ung. Nhng nu khng c khng kh, con ngi s cht trong vng t 5 n 7 pht. Khng kh m chng ta th l hn hp kh t nhin khng mu, khng mi, ch yu l nit (78%), oxy (21%). 1% cn li ch yu l kh argon (0,93%), kh carbon dioxyd (0,032%) v dng vt cc kh neon, heli, ozon, xenon, hydro, metal, kripton v hi nc. Khi bt k cht no c thm vo hn hp kh t nhin ny l nhim khng kh (NKK) s xy ra. Ni mt cch khc, NKK l kt qu ca vic 86

thi cc cht c hi vo khng kh mt t l vt qu kh nng ca kh quyn (ma, gi) trong vic chuyn i, phn hu v ho tan cc cht c ny. NKK l mt h thng l hc v ho hc ht sc phc tp. N c th c coi l mt s cht kh v ht c ho tan hoc l lng trong khng kh. Rt nhiu cht NKK c th phn ng vi nhau, to ra mt s hu qu xu. Mc trm trng ca NKK thay i theo ma, theo ngy, theo cc hot ng cng nghip, theo thay i trong giao thng, thay i theo lng ma v tuyt. Thnh phn ca NKK bin i t ngy ny sang ngy khc, t tun ny sang tun khc, nhng thng c khuynh hng theo mt chu k. Ni tm li, NKK c th c nh ngha nh sau: nh ngha: nhim khng kh xy ra khi khng kh c cha cc thnh phn c hi nh cc loi kh, bi l lng, khi, mi. Hay ni cch khc nhng cht ny trong khng kh c th nh hng xu ti sc kho hoc s thoi mi ca con ngi, ng vt hoc c th dn n nguy hi i vi thc vt v cc vt cht khc. Trong khng kh b nhim c cha cc loi kh, cc ht vt cht l lng v cc ht cht lng di dng bi (aerosol) lm thay i thnh phn t nhin ca kh quyn. Mt s loi kh l nhng thnh phn ca khng kh sch nh CO2 cng s tr nn nguy hi v l cht nhim khng kh khi nng ca n cao hn mc bnh thng. nhim khng kh c nguy c nh hng ti sc kho con ngi v nhng thnh phn khc ca mi trng nh t, nc.
2. S LC LCH S NHIM KHNG KH

Trc Cch mng Cng nghip - th k th XIX, NKK vn cha phi l mt vn trm trng, v cc cht NKK c dn dn ho tan vo kh quyn v khng to ra nhng khu vc c nng nhim cao. K t khi con ngi bt u s dng cc loi nhin liu t (g, than, v cc cht khc) chuyn nc thnh hi nc quay cc tuc -bin, con ngi bt u phi i mt vi cc vn NKK. Chnh vic to ra ng c hi nc to iu kin cho mt s quc gia trong thi tr nn giu c v hng cng, v cuc Cch mng Cng nghip lm tng mc sng ca con ngi, trong khi li lm gim tm nhn v gy ra mt s loi bnh tt - kt qu ca NKK. Con ngi lun n lc tm kim s giu c m khng coi trng ti nhng nh hng ca s pht trin n x hi v mi trng. Ch ti khi nhng thm ha NKK xy ra vi nhiu trng hp mc bnh v t vong, loi ngi mi bt u quan tm n hin tng NKK. Vo tun cui ca thng 10 nm 1948, mt lng cht gy NKK vi nng rt cao (c gi l khi m - smog) bao ph quanh khu vc Donora, Pennsylvania v cc khu vc ln cn. m khi m ny bao bc ton b th trn Donora vo sng ngy th t 27 thng 10, lm gim tm nhn ca ngi dn a phng. Vo khong 2 gi sng ngy th by, trng hp t vong u tin xy ra. Cc trng hp t vong vn tip tc c bo co ln v ti m ngy th by c 19 ngi b cht. C thm 1 87

ngi na b m nng v cht vo tun sau . Theo thng k ca B Bo v mi trng M (1995), ch trong vng nm ngy t ngy 26 n ngy 31 thng 10, thm ha ny khin cho 20 ngi cht v hn 7000 ngi phi nhp vin hoc m. Ti London, thng 12 nm 1952, 4 nm sau thm ho khi m Donora, mt thm ha NKK khc bao cht thnh ph ny trong vng 5 ngy. m khi m dy mu vng rt m c bao trm thnh ph v ngi ta phi s dng khu trang khi i li, tm nhn gim xung ch cn hn 3,5 mt (hnh 4.1). C khong hn 4000 ngi t vong trong thm ha ny. Thnh ph New York cng phi tri qua mt s thm ha NKK. Ln NKK trm trng nht xy ra vo nm 1965, vi 400 ngi b cht. Nhng thm ha NKK ny khng ch xy ra mt s thnh ph ln hoc nhng thnh ph nm xui theo chiu gi ca nhng thnh ph ln. Nhng thnh ph nh, chng hn nh thung lng Meuse ca B, cng tri qua mt thm ha NKK vo nm 1930, vi 63 ngi cht v 6.000 ngi b bnh. Nhng con s thng k v thm ha NKK xy ra trong lch s c cp bng 4.1

Hnh 4.1. Khi m ti London, nm 1952

Ngun: http://www.met-office.gov.uk/education/historic/smog.html truy cp: 5/1/2005

Bng 4.1. Cc thm ha NKK t nm 1930

Thi gian 1930 1948 1950 1952 a im Thung lng Meuse, Belgian Donora, Pennsylvania Poza Rica, Mexico London S t vong 63 20 22 4.000

88

1953 1956 1957 1962 1963 1966

New York London London London New York New York

250 1.000 700 - 800 700 200 - 400 168

Vo nm 1990, trn ton th gii c ti 100 triu tn cc lu hunh oxyd (SOx), 68 triu tn nit oxyd (NOx), 57 triu tn cc cht ht l lng (SPM) v 177 triu tn carbon monoxyd (CO) c thi vo kh quyn. Trong s , cc nc thuc T chc Hp tc v Pht trin kinh t (OCED) thi ra ti 40% SOx, 52% NOx, 71% CO v 23% SPM.

3. CC NGUN GY NHIM KHNG KH 3.1. nhim do cng nghip

nhim khng kh do cc hot ng sn xut cng nghip c to ra khi ngnh cng nghip thi cc loi kh, cc dng hi, khi m v.v... vo kh quyn v xy ra nhng nh my cng nghip nh: nh my sn xut t, qun o, bt git, thuc ty, sn xut tiu dng v.v... Cc ngnh cng nghip khc nhau sn sinh ra cc loi cht NKK khc nhau. V d, ngnh cng nghip luyn kim to ra cc cht nhim nh SO2, CO, HCN, phenol, NH3 v.v... c c 1 tn thp thnh phm, ngnh luyn kim thi ra 4 kg SO2. ngnh cng nghip sn xut vt liu xy dng nh xi mng, gch, ngi, vi, b tng, cc cht NKK chnh l bi, kh SO2, CO, NOx. i vi cc nc ang pht trin, k thut cn hn ch, trnh sn xut lc hu, cc loi cht gy NKK to ra cn ln hn nhiu. i vi ngnh nhit in, cc loi nhin liu ho thch nh than, du, diezel c t to ra in, sn phm gy NKK ca ngnh ny l bi than, kh SO2, CO, CO2, NOx. M, 15% lng SO2 thi vo kh quyn l t cc nh my cng nghip, 68% l t cc nh my nhit in c s dng than v du. Cn ngnh cng nghip ho cht v luyn kim mu, kh thi ca hai dng ny c trng khng phi qua khi lng cht thi m qua tnh c hi ca cc cht cha trong . l cc hi acid, cc hp cht hu c bay hi VOCs, florua, xyanua v.v. 89

Hin nay, mt bin php x l cht thi th v cht thi y t ang c s dng rng ri l t. D c nhng u im r rng, y cng l ngun gy NKK ng k. Thnh phn ca cc cht gy NKK gm c tro, bi, cc cht kh nh SO2, NO2, CO, HCl, HF. Ngoi ra cn phi k n cc kim loi nng nh: Cu, Zn, Cr, As, Cd, Hg, Pb; cc cht c nh: dioxin, furan, v.v. v nhim ng k v mi.
3.2. nhim khng kh do giao thng

Giao thng cng l mt trong nhng ngun gy NKK chnh, NKK do giao thng c th chim khong 50% NKK. Kh carbon monoxyd (CO) l ngun gy NKK ch yu c to ra do giao thng. Vo nm 1983, trong s lng kh CO c thi vo mi trng, c ti 70% t cc loi ng c giao thng. Ngy nay, cc xe t c sn xut u c gn cc my chuyn i xc tc, do vy, gim ng k lng CO c thi vo mi trng. CO l sn phm ca qu trnh t chy khng hon ton, carbon dioxyd (CO2) l sn phm ca qu trnh t chy hon ton. Nit oxyd v hydrocarbon l nhng sn phm ph khc ca qu trnh t chy cc sn phm xng, du. Nhng sn phm ny thc hin cc phn ng quang ho to ra khi quang ho, y l mt vn nghim trng cc thnh ph ln.
3.3. Nng nghip

nhim khng kh cng c to ra do cc hot ng sn xut trong nng nghip. V d, sn lng ma mng tng ng k t khi ho cht bo v thc vt (thuc tr su, thuc dit c) c s dng. Khi nhng sn phm ny c s dng, chng cng gp phn gy ra NKK. Ngoi ra, vic phn hu cht thi nng nghip trong ng rung, ao h cng to ra cc cht nhim nh mtan (CH4), hydro sulfua (H2S).
3.4. Cc ngun nhim khng kh trong nh

Cc ngun nhim khng kh trong nh c th l thm tri sn, nm gh, giy dn tng, g, cc cht ty ra v dit cn trng..., l nhng ngun pht sinh cc hp cht hu c bay hi v formaldehyd. Khi thuc l cng gp phn vo vic pht sinh cc hp cht hu c bay hi, cc loi cht c khc v bi h hp. Cc thit b vn phng c th pht sinh kh ozon. Cc cht nhim sinh hc nh vi khun, nm mc cng c th pht sinh t cc thp di nhit, t nc ngng ng trong cc ng ng, hoc t thm, giy dn tng, vt liu tiu m hoc cch nhit m t. Ngoi ra cn phi k n kh radon t lng t c th truyn qua cc kt cu xy dng vo nh; bi aming pht sinh t cc hot ng ph d vt liu xy dng c cha aming. y l hai cht nhim gy ra nhng bnh mn tnh, xut hin sau nhiu nm tip xc.

90

 nhim khng kh trong nh cn do cc hot ng ca con ngi gy ra. Lng cht NKK do cc hot ng ca con ngi gy ra l rt nh, c th c nh hng xu i vi sc kho ca chnh bn thn con ngi, trc tip nh hng n sinh hot hng ngy. Ngun gy NKK l cc ng khi, kh t cc b pht, t cc l thng hi ca h thng dn nc thi gia nh, mi v t qu trnh nu nng, khi bp do s dng nhin liu t: ga, than, ci, rm v.v... Ngoi ra cn c bi t cc cng trnh xy dng xen ln vo cc khu dn c, do qu trnh qut nh, qut sn v.v... Cc hot ng ny khng nhng gy nhim trong nh m cn nh hng n c cht lng khng kh ngoi nh.
4. CC CHT NHIM KHNG KH V NHNG NH HNG CA CHNG

Cc cht nhim chnh trong mi trng khng kh bao gm: Cc loi kh lu hunh oxyd (SOx), nit oxyd (NOx), carbon monoxyd (CO), hydro sulfua (H2S), cc loi kh halogen (clo, brom, iod). Cc hp cht florua. Cc hp cht hu c bay hi (VOCs). Cc loi bi nh l lng nh sol kh, mui khi, sng m, phn hoa, vi sinh vt,v.v., v cc loi bi nng nh bi t, , bi kim loi, v.v.; Khi quang ho nh ozon, peroxyacetil nitrat, aldehyd, v.v. Cc cht nhim k trn ch yu do qu trnh t chy nhin liu, chy rng, cc qu trnh sn xut cng nghip, giao thng vn ti sinh ra. Ring khi quang ha c to ra trong kh quyn do s tng tc gia nh sng mt tri, hyrocacbon v nit oxyd. Kt qu l ozon tch t li v sinh ra mt s cht nhim th cp nh fomdlehyd, aldehyd, androcarbon, PAN (peroxyacetil nitrat). Cc cht NKK nh hng khng nhng ln sc kho con ngi, s pht trin ca ng thc vt m cn nh hng n cc cng trnh, n tm nhn v sinh hot ca cng ng. Rng hn na, mang tnh ton cu, cc cht NKK cn c nhng tc ng n kh hu ca tri t.
4.1. nh hng ln sc kho

Nhng nghin cu dch t hc cho thy mt hm lng ln cc cht NKK gp phn vo hoc gy ra cc bnh lin quan n ng h hp. Mt nghin cu ca trng i hc Harvard cho thy hng nm c khong 60.000 ngi cht do cc bnh c lin quan n NKK dng ht bi. Ring ti nc M c ti 28 triu ngi mc cc bnh h hp mn tnh vn thng xuyn phi tip xc vi khi m c hi hng ngy lm cho bnh ca h cng tr nn trm trng hn. Di y l mt s bnh lin quan n NKK:
4.1.1. Hen suyn

91

L mt dng kch thch ph qun dn ti kh th nghim trng v l vn y t cng cng ang ni cm hin nay. T 1983 n 1993, t l mc bnh ny M tng 34% (Theo Vin Y t quc gia M). Cc khu vc th, c bit l cc khu c nng cc cht NKK cao l nhng khu vc b nh hng nhiu nht. Cc cht ht v SO2 l nhng cht NKK c lin quan ti mc hen suyn.
4.1.2. Vim ph qun mn tnh

Vim ph qun mn tnh xy ra khi trong ph qun c mt lng ln cc cht nhy c to ra, dn ti ho ko di. Dng nh c mi tng quan rt ln gia t l t vong do vim ph qun mn tnh v nng SO2. SO2 c th gy kch thch mi hng v ph qun. Vic tip xc nhiu ln vi nng cao SO2 c th lm cho c th to ra qu nhiu cht nhy nh l mt cht bo v.
4.1.3. Kh ph thng

Bnh kh ph thng c trng bi vic lm yu thnh cc ti phi v nhng ti khng kh nh b trong phi. Khi bnh pht trin, cc ti kh ny tng v kch thc, gim tnh cht n hi ca n v thnh cc ti ny b ph hu. Th ngn, th gp l du hiu ban u ca bnh ny. NO2 c xc nh l mt trong nhng cht NKK gy ra bnh kh ph thng. Cc cht NKK cn gy nhng nh hng cp tnh, thm ch i khi dn n t vong. V d, cc cht hu c bay hi thng ch gy nhim c cp tnh nh suy nhc, chng mt, say, sng ty mt, co git, ngt, vim phi, v.v. Hoc ch mt lng CO nh ht vo c th cng c th to ra lng cacboxyhemoglobin (COHb) ng k v khi 70% hemoglobin trong mu b chuyn thnh COHb c kh nng gy cht ngi. Hoc tip xc vi kh NO2 nng khong 5ppm sau mt vi pht c th nh hng xu n b my h hp; nng 15-50 ppm sau mt vi gi s nguy him cho phi, tim v gan; nng 100 ppm c th gy t vong sau mt vi pht. Khi quang ho thng l cc cht kch thch, gy ho, au u v cc bnh ng h hp.
4.2. Nhng nh hng khc ca nhim khng kh

SO2, CO, NOx v nhng cht NKK khc khng ch gy nh hng nghim trng ti sc kho con ngi m cn nh hng ti ti sn ca chng ta. Mt s cht NKK ph hoi cy trng, do bao quanh thnh ph. Mt vi dng NKK nh hng trc tip ti l cy, v thu hoch, cy trng khi nhng kh ny xm nhp vo l kh khng trn l. Vic tip xc ko di i vi cc cht NKK (NO2, SO2, v ozon) lm ph v lp bo v bn ngoi, gy ra vic mt nc nghim trng i vi cc loi cy v lm cho chng d dng b bnh tt, su hi, hn hn v sng mui tn cng. Hn na, vic lng ng acid trong t lm mt i mt s cht dinh dng quan trng i vi cy trng nh calci v gy nh hng xu i vi mt s vi sinh vt c ch nh cc sinh vt phn hu. Khi quang ho c th lm gim qu trnh sinh trng ca cy, ph hoi t bo l v gy tn thng nhiu loi cy.
Bng 4.2. Cc c trng ca mt s cht NKK

92

Tn cht Lu hunh dioxyd

Cng thc SO2

Tnh cht Kh khng mu, c kh nng gy ngt mnh, c mi, i khi ho tan trong nc to thnh acid sunfurous (H2SOA3) nng thp c mi trng thi, nng cao khng c mi Kh khng mu

nh hng Gy nh hng ti cy trng, ti sn v sc kho con ngi. SO2 l nguyn nhn ca mt s loi bnh ng h hp nh: hen, vim cung phi v vim kh thng. c tnh rt cao

Hydro sunfua Nitric oxyd Nit dioxyd Carbon monoxyd Carbon dioxyd Ozon

H2S

NO

NO2 CO CO2

Kh c mu, c s dng nh cht chuyn ch Khng mu, khng mi Khng mu, khng mi

O3

C hot tnh cao

c to ra do qu trnh t chy nhit cao v p sut ln. B oxy ho to thnh NO2 Tng i tr, c to ra trong qu trnh t chy Sn phm ca qu trnh t chy khng hon ton, c Sn phm ca qu trnh t chy hon ton. L cht gy ra s thay i kh hu ton cu Gy hi i vi cy trng v ti sn. c to ra ch yu do s hnh thnh khi quang ho

Hng nm, c tnh thit hi do cc cht NKK gy ra i vi cc vt liu khc nhau ti hng triu la. Ozon lm cho cao su d v v mt i tnh n hi. SO2 lm mt bn v lm b mt ca da v cc loi vi si t nhin khc xu i. Cc cht nhim c th gy n mn, xi mn, mt mu v lm bn , kim loi, sn, giy v thu tinh. Bng 4.2 trnh by nhng tnh cht c bn ca mt s cht NKK.
4.3. Cht lng khng kh trong nh /hi chng bnh nh kn 4.3.1. Cht lng khng kh trong nh

Trn th gii, vn cht lng mi trng sng v lm vic c quan tm n t nhng nm 1960. Nhng n nm 1973, tit kim nng lng do gi du la tng nhanh, ngi ta phi tng cng cc bin php nh cch nhit, lm kn nh, thay i mt s gi tr khuyn co nh lng khng kh trong sch, cng chiu sng, nhit khng kh,v.v. V cng bt u t , cng ngy cng pht sinh nhiu nhng li ku ca phn nn v cht lng khng kh bn trong nh (Ting Anh l Indoor Air Quality - IAQ). cc nc ang pht trin, c bit l cc vng nng thn, min ni, kt cu nh ch yu l kt cu thong h, cht lng khng kh trong nh b nh hng su sc bi mc nhim khng kh ngoi nh. Ngoi ra, vic un nu, si m bng cc loi nhin liu ho thch nh than, du, kh t hoc cc loi nhin liu c gc thc vt nh ci, rm r cng nh hng n cht lng khng kh trong nh. Cht lng khng kh trong nh nh hng n sc kho con ngi sng hoc lm

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vic trong , nh hng n cht lng v hiu qu ca cng vic v c th gy nhng bnh lin quan n nh (ting Anh l building-related illness - BRI). a. Ngun nhim khng kh trong nh Ngun nhim khng kh trong nh bao gm cc tc nhn ha hc, cc cht nhim t bn ngoi vo nh. Thng thng l bi, SO2, NOx, HnCm, CO, O3, Pb, phn hoa, v.v., t cc ngun nh giao thng, gara t, cc ng khi, khi quang ha v.v. Thng thng, t l cc cht ny gia trong v ngoi nh l 0,7-1,3. Cc cht nhim pht sinh t cc loi vt liu trong nh: Formaldehyd t nha, h dn, vi, v.v. Aming t cc lp cch nhit, cch m. Bi si t cc lp cch nhit, trn, phin lc Hydrocarbon t cc lp tri sn, cht ty ra, st trng, sn Bi v c v hu c t cc loi thm, giy dn tng, mn treo Cc cht nhim pht sinh bn trong nh t cc hot ng ca con ngi. Khi thuc l: CO, nicotin, cc sn phm hu c, tc nhn gy ung th Cc h thng si: CO, bi, HnCm, NOx, hi nc Cc loi bp un: CO, bi, NOx, cc hp cht hu c Cc cng vic v sinh nh lm sch sn, thm: aerosol, cc hp cht hu c. Cc thit b nh my photocopy, my in: O3, bi. Cc tc nhn sinh hc. Cc loi k sinh trng, da, lng ca gia cm v gia sc. Cc loi nm, mc, vi khun t thm, nm, vi m t. Phn hoa, cc loi su b. Cc tc nhn khc: Cc ion m -dng t cc my ht bi. Tnh in. Bc x in t. Ngoi ra, cc yu t nh hng n cht lng khng kh trong nh cn phi k n l cc yu t vi kh hu (nhit , m, vn tc gi, bc x nhit, metabolisme, qun o), chiu sng, ting n, rung,... v cc yu t tm l nh lo lng, thc c

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tnh trng sc khe, mi quan tm n cng vic, v tr cng tc, mi quan h, mc t ch, khng gian lm vic, v.v... b. Nhng nh hng n sc kho ca nhim khng kh trong nh Theo bo co ca Vn phng T chc Y t Th gii, trn th gii khong 30% cc to nh mi xy hoc mi sa cha c kh nng phi chu t l cao bt thng nhng li ku ca phn nn v cht lng khng kh trong nh. Theo Trung tm Kim sot bnh tt (CDC) ca M th hng nm M c khong t 50 n 10.000 trng hp b mc bnh do legionella do vi khun Legionella gy ra thng xut hin cc h thng iu ho khng kh v t 1 n 27% trng hp b bnh vim phi l do vi khun ny gy ra, trong t 5 n 10% trng hp t vong ri vo nhng ngi b suy gim min dch. Nhng nh hng chnh n sc kho bao gm: au u. Kch thch mt, mi, hng. Tnh trng bun ng, u oi, thn th. Mt mi thn kinh. Tnh trng hn m, ng lm. T vong (do CO, vi khun Legionella).
4.3.2. Hi chng bnh nh kn

Khi nim v Hi chng bnh nh kn (Sick building syndrome- SBS) c s dng m t cc trng hp m nhng ngi sng hoc lm vic trong nhng ngi nh kn chu nhng nh hng cp tnh n sc kho, lin quan n thi gian trong to nh m khng xc nh c c th bnh hoc nguyn nhn gy bnh. Phn ln cc triu chng ca SBS mt i hoc gim nh khi ri khi ngi nh. Theo mt bo co ca Hi ng Mi trng Nh ca Anh cho bit chi ph cho Hi chng bnh nh kn ti Vng quc Anh ln ti khong t 350 n 650 triu bng Anh. Mt s ngun khc li cho nhng gi thit l: ti Thy in, c 4 ngi dn li c 1 ngi b chu nh hng t nhiu ca SBS; M, c 3 to nh th li c 1 nh c kh nng gy SBS. Mc d cha thc s ni cm nh cc loi bnh ngh nghip gy ra trong sn xut cng nghip nhng r rng SBS v ang t ra nhng vn m cc nh khoa hc nghin cu v iu kin lao ng v sc kho rt cn u t xem xt. Nguyn nhn gy ra cc triu chng ny ch yu l do cc yu t nhim khng kh trong nh k trn, ngoi ra l cc yu t c nhn (v d nh tin s bnh tt, thi quen ht thuc l) v cc yu t x hi khc (v d nh cng thng ngh nghip, quan h ng nghip, .v.v.).

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Cc triu chng ca SBS c th chia thnh nm nhm nh sau: Cc triu chng nh hng n cc tuyn nhy v h h hp trn: + + + + + + + + + + + + + Kch thch hoc kh mt, mi, hng. Nga mt, chy nc mt, ngt mi. Ho, ht hi, chy mu cam. Ging ni khn hoc bin i.

Cc triu chng nh hng n h h hp su: Tc ngc, th rt. Hen, th dc.

Cc triu chng nh hng n da: Kh, nga da. Pht ban.

Cc triu chng nh hng n h thn kinh trung ng: Mt mi, kh tp trung, bun ng. au u. Chong vng, chng mt, bun nn.

Cc triu chng kh chu bn ngoi: Thay i v gic. Cm gic mi kh chu.

4.4. Khi quang ho

Khi quang ha c sinh ra trong kh quyn do s tng tc gia nh sng mt tri vi hydrocarbon v nit oxyd. Kt qu l ozon tch t li v sinh ra mt s cht nhim th cp nh formaldehyd, aldehyd, PAN (peroxyacetil nitrat). Cc cht ny thng l cc cht kch thch, gy ho, au u v cc bnh ng h hp. Chng lm gim qu trnh sinh trng ca cy, ph hoi t bo l v gy tn thng nhiu loi cy.
5. MT S TC NG CA NHIM KHNG KH LN KH HU TON CU

Nh ni trn, kh quyn ca tri t c cha khong 78% nit, 21% oxy, 0,9% argon, 0,03 carbon dioxyd, 0 n 4% hi nc v mt s kh vt khc. Khong 96% lng khng kh nm tng i lu, l khong khng gian cao chng 8-12 km so vi b mt tri t (hnh 4.2). Phn ln cc cht nhim khng kh thm nhp vo tng i lu ny. Ti y chng ha trn theo phng vung gc hoc nm ngang 96

v thng tc ng qua li vi nhau hoc vi cc thnh phn t nhin khc trong kh quyn nh kh ozon. Khi mt lng khng kh bc ln trong tng i lu ca kh quyn, n s gim nhit qua vic gin n ng nhit. Vi khng kh kh, t l gim nhit l 0,980C/100m. T l ny c gi l "gradient ng nhit kh"- c gi tr lun m. tng bnh lu, kh quyn rt n nh do gradient nhit bng khng. Cc cht nhim xm nhp vo lp ny (ch yu do ni la) s b gi li lu hn trong trng hp nu nh chng vo lp i lu. NKK khng nhng gy nh hng n sc kho con ngi, s pht trin ca ng thc vt, tui th ca cc cng trnh m cn gy nhng tc ng mang tnh ton cu. Mt s tc ng chnh ca NKK ln s bin i ca kh hu tri t, nh l nguyn nhn ca hiu ng nh knh dn n s nng ln ca tri t, suy gim tng ozon, ma acid v s nghch o nhit.
1. S nng ln ca tri t

Nhit b mt tri t c hnh thnh bi s cn bng gia nng lng mt tri chiu xung tri t v nng lng nhit bc x ca tri t pht vo v tr. Nu cho rng ton b nng lng mt tri chiu ti b hp th bi b mt tri t, ta c nhit trung bnh mt tri t khong 278oK = 5oC, chnh 10oC so vi nhit trung bnh ca b mt tri t (15oC). Thc t, khong 30 % bc x mt tri b phn x li vo v tr bi my, cc b mt nc, bng (h s Albedo ca b mt tri t khong 0,3). Khi , nhit b mt tri t tnh theo phng trnh cn bng nng lng ch c khong 254oK = -19oC. S chnh lch 34oC ny chnh l kt qu ca "hiu ng nh knh" do cc thnh phn ca kh quyn gy ra. iu ny c th gii thch nh sau: bc x mt tri l bc x sng ngn (0,4-0,8 nm), d dng xuyn qua cc lp kh CO2, ozon v hi nc chiu xung tri t. Trong khi , bc x nhit do tri t pht ra c bc sng di hn (10-15m), khng xuyn qua c v b hp th bi cc kh ny trong kh quyn. Do , nhit kh quyn bao quanh tri t tng ln, dn n vic gia tng nhit tri t. Cc kh trong kh quyn c kh nng hp th bc x nhit sng di c gi l kh nh knh v s nng ln ca tri t cn gi l " hiu ng nh knh".

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Tng gia nh bnh lu cao (km)

Tng bnh lu

nh i lu Tng i lu

Nhit

Hnh 4.2. Kh quyn v s bin thin nhit theo chiu cao

Cc kh nh knh chnh l kh CO2, cloroflorocarbon (CFCs), metal, N2O; trong kh CO2 l kh nh knh quan trng nht i vi s bin i kh hu, chim t trng khong 55%. Sau l cc kh CFC, ch yu l CFC-11 v CFC-12, chim khong 24% mc d tc dng hiu ng nh knh ca cc kh ny cao hn kh CO2 (mt phn t kh CFC-11 c tc dng hiu ng nh knh tng ng vi 12.000 phn t CO2). Cc c trng ca kh nh knh xem trong bng 4.3.

Bng 4.3. Cc c trng ca kh nh knh

Loi kh Cng thc ho hc CO2 CH4 Nng trong kh quyn 350ppm 1,7ppm Mc tng nng hng nm (%) 0,5 0,9 H s nh knh tng ng (so vi CO2) 1 20 T trng hiu ng nh knh (%) 55 15 Ngun pht sinh chnh

Carbon dioxyd Metal

t nhin liu ho thch, ph rng t ngp nc, sinh hot con ngi,

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nhin liu ho thch Nitrous oxyd CFC-11 CFC-12 CFC khc N2O 0,31ppb 0,25 200 6 t nhin liu, sn xut phn bn, ph rng Tc nhn lm lnh, sol kh, dung mi

CCl3F CCl2F2

0,28ppb 0,48ppb

4 4

12.000 16.000

17

Vic gia tng lng CO2 vo kh quyn do t chy nhin liu ho thch trong nhng nm gn y chnh l nguyn nhn gy ra vic nng ln ca tri t. Nhit trung bnh ca tri t ch cn tng 2oC cng c th dn n nhng thay i ng k v kh hu v nhiu hu qu khc (bng tan, ma bo, l lt,...).
5.2. S ph hy tng ozon

Sau "hiu ng nh knh", s ph hy tng ozon do NKK gy ra cng l mt trong nhng hu qu mang tnh ton cu. b mt tri t, ozon l mt cht kch thch mt v h thng h hp kh mnh, l mt thnh phn chnh ca khi quang ha. lp bnh lu (cch b mt tri t 12-40km), lp khng kh long c cha 300-500 ppb O3. Ozon l thnh phn duy nht ca kh quyn c kh nng hp th mt cch ng k bc x sng ngn < 0,28m. Nu khng c lp ozon ny, mt lng kh ln tia cc tm vi bc sng 0,2-0,28m c th ti c tri t, gy ra nhng phn ng ha hc vi cc b mt tip xc, c hi i vi con ngi, ng vt v cy ci. Nh vy, ozon l mt cht nhim c hi b mt tri t nhng li l mt tm chn tia cc tm hu hiu tng bnh lu. S ph hy tng ozon ch yu gy ra do cc nguyn t clo, c ch c th hin hai phng trnh sau: Cl + O3 ClO + O2 ClO + O3 Cl + 2O2 Mt nguyn t clo c th chuyn 104-106 phn t O3 thnh phn t oxygen thng thng. Clo c a vo kh quyn thng qua cht CH3Cl, sinh ra t cc qu trnh sinh hc bin. Khong 3% CH3Cl n c tng ozon lp bnh lu. S ph hy ozon do CH3Cl gy ra c cn bng vi vic sinh ra O3 do cc c ch t nhin, do lp O3 lun n nh. Vic sn xut CFCs (cc hp cht c cha clo, flo v carbon, thng gi l freon) dng cho cc t lnh v cc my iu ha khng kh, c bit my iu ha cho t, l nguyn nhn chnh gy ra s ph hy tng ozon. Ngoi ra, kh NO sinh ra t cc my bay cao ln, kh N2O cng gp phn ph hy tng ozon, nhng vi mt t l rt nh so vi CFCs v mt phn t NO ch c kh nng ph hy mt phn t O3. C ch ph hy O3 do NO nh sau: 99

NO + O3 NO2 + O2 T nm 1980, ngi ta pht hin s suy gim ng k lng ozon trong khng kh pha trn ca chu Nam Cc vo khong u xun bn cu nam (thng 10). Nguyn nhn c th gii thch nh sau: v ma ng, lun tn ti mt dng kh xoy ngc ngn cn mi trao i khng kh ti y vi phn cn li trn c hnh tinh. Mt khc, nhit rt thp (-800C) to ra nhng tinh th b nh t hi nc. Trn b mt ca nhng tinh th ny xy ra nhng phn ng sau: ClONO2 + (H2O)s ClOH + (HNO3)s ClONO2 + HCl Cl2 + (HNO3)s

Cc thnh phn clo dng kh pht sinh gi n nh trong sut ma ng, nhng khi ma xun v, di tc dng ca cc tia nng mt tri, cc thnh phn clo ny b quang phn v gii phng nguyn t clo, dn n s suy gim ng k ozon, gi l hin tng "l thng tng ozon". ClOH + h Cl + OH Cl2 + h 2 Cl Chnh s suy gim ng k ozon Nam Cc gy nn nhiu trng hp mc bnh v da v mt ca c dn cc thnh ph pha cc nam ca Chi L, Achentina, Nam Phi.
5.3. Ma acid

Ma acid ch yu to ra do kh lu hunh oxid (khong 2/3) v kh nit oxyd (khong 1/3). Nhng kh ny d dng ha tan vo nc, to thnh acid sunfuric v acid nitric. Cc git acid nh b c gi mang i v theo ma ri xung b mt tri t. acid c o bng pH: pH = -log10(hot tnh ca ion h +, mol/lt) Nc ma mi trng hon ton khng nhim c pH 5,6. Nc ma c pH < 5, 6 c coi l ma acid, nhng tc hi ca n i vi ng, thc vt ch xut hin khi pH 4, 5. cc mc khc nhau, ma acid lm hu dit rng v ma mng, gy nh hng xu i vi con ngi v ng vt, vi cc sinh vt sng di nc. Ma acid cn nh hng n cc cng trnh xy dng, gy han g cu cng, nh ca, tng i v.v.
5.4. S nghch o nhit

tng i lu, trong nhng iu kin thng thng th cng ln cao nhit khng kh cng gim. Trong trng hp ngc li, khi c tn ti mt lp kh nng hn v nh hn pha trn, nhit khng kh cng ln cao cng tng, ngi ta gi l hin 100

tng nghch o nhit. Hin tng ny hay xy ra nhng vng thung lng vo ban m. Vo ma h, bui sng hin tng ny s b mt i cng vi nng lng mt tri t nng tri t. Nhng vo ma ng, c bit nhng ngy c tuyt hoc c iu kin ngng t hi nc, hin tng ny c th ko di nhiu ngy. Hin tng nghch o nhit ngn cn vic ha trn kh quyn, khin cc cht NKK khng thot ln c m tch t li bn di lp kh c hn. Nu hin tng ny ko di nhiu ngy, nng cht nhim c th ln ti mc kh chu, thm ch nguy him, c bit i vi nhng ngi c bnh v ng h hp. Nhng thm ha thung lng Meuse (B), London (Anh)... chnh l hu qu do hin tng nghch o nhit gy ra.
5.5. Hin tng My Nu chu

Trong nhng nm gn y, cc nh khoa hc pht hin mt lp kh nhim ang bao ph c mt min rng ln Nam , v h t tn l My Nu chu . My Nu chu l mt lp kh dy khong 3 km, tri di hng ngn ki-l-mt sut t Ty Nam Afganistan n ng Nam Sri Lanka, bao ph hu ht n . Lp kh ny cha ng rt nhiu loi cht nhim nh bi, tro, mui, mt s loi kh gy acid v c th lan to xa hn na, n c nhng min ng v ng Nam . Lp my nhim dy c ny ngn cn nh sng mt tri chiu xung tri t, gim i khong t 10 n 15%, lm lnh t v nc trn tri t nhng li lm nng ln bu kh quyn. Lp my ny gy nn s thay i kh hu trong khu vc nh gy ma nhiu v l lt Bangladesh, Nepal v ng Bc n ; trong khi li gim i khong 40% lng ma Pakistan, Afganistan, Ty Trung Quc v pha ty Trung , gy hn hn v thiu nc trm trng. Chnh v c cha acid nn lp my ny cn gy ra ma acid c mt vng rng ln. L lt, hn hn, ma acid v gim nh sng mt tri nh hng su sc n nng sut nng nghip. V d, My Nu chu c th gim khong 10% nng sut la v ng ca n . c bit, My Nu chu lm gia tng cc bnh ng h hp v c th chnh l nguyn nhn gy nn hng trm ngn trng hp t vong hng nm do bnh ng h hp ti khu vc. Mt iu ng lo ngi l s nh hng c tnh ton cu ca My Nu chu . Trc y, cc nh khoa hc cho rng ch c cc kh nh nh kh nh knh mi c kh nng di chuyn trn khp tri t th ngy nay h thy ngay c cc lp my bi cng c kh nng . Theo d on, My Nu chu c th di chuyn na vng tri t trong khong mt tun. Nguyn nhn gy ra hin tng ny, ngoi nhng nguyn nhn thng thng gy nn nhim khng kh c bit n l sn xut cng nghip v t chy nhin liu ho thch, y cn c nhng nguyn nhn khc na l s chy rng, t rng lm ry v hng triu cc loi bp l km hiu qu s dng un nu v si m.

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Cc bin php i ph vi hin tng ny l cn phi c lut php v chnh sch bo v rng, khai thc cc ngun nhin liu sch hn ch vic t nhin liu ho thch v a vo s dng cc loi bp l c hiu qu hn ti cc nc ang pht trin.
6. KIM SOT NHIM KHNG KH

Do NKK nh hng ln ti sc kho con ngi, ma mng, cc to nh, v mi trng t nhin, c rt nhiu n lc c thc hin lm gim NKK. Cc b phn chuyn i xc tc c s dng tng hiu qu ca qu trnh t chy cc sn phm xng du, lm gim lng CO, NOx v hydrocarbon trong khng kh. Ngy cng c nhiu loi xe c thit k vi mc ch khng ch tit kim nng lng m cn gim lng kh thi vo mi trng. Cc bin php k thut, cng ngh phi lun i cng vi cc bin php khc nh tng cng hiu lc php lut v kim sot NKK, nng cao nng lc v qun l mi trng, quan trc v gim st cht lng khng kh.
6.1. Cc bin php qun l cht lng khng kh 6.1.1. Tng cng hiu lc php lut v kim sot nhim khng kh

Trc ht, cc tiu chun v cht lng khng kh phi c hon thin ph hp vi iu kin ca tng khu vc, tng i tng c bo v. Hin nay c hai loi tiu chun kim sot NKK l tiu chun pht thi v tiu chun cht lng khng kh xung quanh. Cc tiu chun pht thi a ra i vi tng loi cht nhim, cc nc cng nghip pht trin cn c xc nh c th i vi mi loi ngun nhim khc nhau. l nhng tr s m cc cht thi c hi do ngun sinh ra khng c kh nng gy ra cc nng cht c hi trong khng kh vt qu gii hn cho php i vi ngi, ng vt v thc vt. Tiu chun pht thi Vit Nam l TCVN5939, 59401995 v chun b ban hnh mt s cc tiu chun mi i vi tng vng l TCVN 6992, 6993, 6994, 6995, 6996-2001 sp ban hnh. Cc tiu chun v cht lng khng kh c a ra nhm mc ch bo v sc khe ca con ngi. y l cc tr s cc i cho php, o c tc thi hoc xc nh trong mt khong thi gian no (8 gi hoc 24 gi). Cc tiu chun v cht lng khng kh Vit Nam (TCVN 5937, 5938-1995) c a ra trong iu kin v kh nng khoa hc k thut cng nghip ca nc ta, trn c s cc tiu chun ca th gii v cc kt qu nghin cu v sinh y hc cho ngi Vit Nam.
6.1.2. Cc bin php kim sot hnh chnh

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y l cc bin php thanh tra c tnh hnh chnh trn phm vi quc gia hoc tng a phng, do cc c quan chuyn trch v qun l mi trng, cc t chc thanh tra v kim sot bo v mi trng thc hin. N bt buc cc doanh nghip phi ng k cc ngun nhim, cc cht c hi s dng v pht thi, phi t p dng cc bin php x l nhim mi trng, gim cht thi pht sinh. Cc c quan thanh tra c quyn thu thu, x pht, thm ch nh sn xut nu cc cht thi nhim pht sinh vt qu gii hn cho php. Cc phng tin giao thng vn ti, cc hot ng nng nghip, lm nghip cng c kim sot thng xuyn hn ch nhng nh hng n mi trng khng kh khu vc.
6.1.3. Quan trc cht lng khng kh

Cc h thng quan trc cht lng khng kh thng c b tr cc v tr c kh nng xut hin cc cht NKK nh khu vc quanh cc trung tm cng nghip, gn ng giao thng, khu th. Ngoi ra, cc trm quan trc kh tng cng c kh nng theo di s bin ng ca cc cht trong kh quyn. C hai hnh thc xc nh mc NKK l ngn hn v di hn. Hnh thc quan trc ngn hn: thng cho cc gi tr tc thi hoc xc nh trong khong thi gian ngn. N cho php bo hiu khi mc nhim t n cc gi tr nguy him khin nhng ngi dn trong vng hoc nhng cng nhn ti khu vc nhim phi c nhng bin php phng trnh nh khng ra ngoi ng, hn ch s dng cc phng tin giao thng ng c, cng nhn rt ngay khi v tr nguy him... Hnh thc quan trc di hn: thng thc hin qua nhng mng li quan trc quc gia hoc a phng trong mt khong thi gian di. N cho php ta xc nh c xu th ca mc nhim tng, gim hay n nh v kim sot c s hot ng ca cc chng trnh kim sot nhim .
6.2. Cc bin php quy hoch

Cc bin php quy hoch bao gm quy hoch mt bng th v khu cng nghip, quy hoch ng giao thng, trng cy xanh. Quy hoch mt bng th v v b tr khu cng nghip phi m bo sau khi a vo sn xut, kh thi ca khu cng nghip , cng vi mc nhim nn khng vt qu nhng tiu chun quy nh. V tr t khu cng nghip (hoc nh my) cn t cui hng gi, cui ngun nc so vi khu dn c. Ngay trong khu cng nghip (hoc nh my) cng cn phi c nhng quy hoch hp l hn ch s lan truyn cht nhim t cng trnh ny sang cng trnh khc, tin li cho vic tp trung cc h thng ng ng cng ngh, cc ngun thi v cc h thng x l nhim . Cy xanh c tc dng che nng, ht bt bc x mt tri, gi bi, lc sch khng kh, hp th ting n v to cnh quan cho mi trng th. H thng cy xanh trong

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thnh ph cn phi c quy hoch tng cng c cc tc dng trn. Mt h thng cy xanh hon chnh th cn bao gm: vnh ai cy xanh - mt nc xung quanh thnh ph; vnh ai cy xanh cch ly v sinh xung quanh cc khu cng nghip v ng giao thng chnh; h thng cng vin; vn cy trong cc tiu khu v cc cng trnh c bit nh trng hc, bnh vin, c quan, nh my, cng trnh vn ho.
6.3. Cc bin php k thut

Cc bin php k thut kim sot NKK u nhm mc ch gim s pht sinh cc cht nhim vo mi trng khng kh. Sau y l mt s bin php chnh.
6.3.1. Cc bin php cng ngh sch hn

La chn cng ngh: ngay t khi u t, xy dng ban u nn la chn cc dy chuyn ng b, c km theo cc thit b x l nhim. Nn u tin cc dy chuyn cng ngh hin i. V d, i vi sn xut xi mng, nn la chn u t cng ngh sn xut xi mng l quay phng php kh vi thp trao i nhit v canxin ho nhiu tng. y l gii php tch cc, va m bo cht lng sn phm, bo v mi trng lao ng cng nh mi trng xung quanh, hn ch tai nn lao ng. Gim thiu pht sinh kh SO2 thng qua vic s dng nguyn liu v nhin liu c hm lng lu hunh thp v.v. i vi cc l t nhin liu, c th gim thiu pht sinh cc cht kh NOx v CO thng qua vic hon thin cng ngh t v iu chnh lu lng khng kh ph hp. Hon thin cng ngh sn xut khng nhng nng cao nng sut lao ng v cht lng sn phm m cn gim s pht sinh cht nhim vo kh quyn v mi trng lao ng. Vic ny c thc hin qua vic hon thin thit b cng ngh v quy trnh sn xut hin c (t chc li sn xut, thc hin tt ch bo dng, lm kn thit b v my mc,...); trong iu kin cho php, thay th dn dn bng cc thit b mi hin i. V d thay phng php gia cng vt liu kh pht sinh nhiu bi bng phng php t; thay th cc l nung clinker ng bng l quay hiu qu cao v lng cht thi pht sinh thp, ci tin l ghi t nhin liu kh bng l ghi t nhin liu t nhiu tng.... Hon thin cng ngh cn i theo hng s dng tit kim nguyn liu, nhin liu mt cch ti a, v d s dng cc h thng thu hi kh nng (trong sn xut xi mng, gch l nung tunnel, v.v), s dng nc tun hon, ti ch cht thi rn, s dng li cht thi ca cng nghip ny lm ph gia hoc cht t cho cng nghip khc, v.v. c bit, cc ng c ca cc phng tin giao thng vn ti khng ngng c ci tin, hon thin, khng nhng gim tiu hao nng lng, t gim nhim, m ngay c nng cc cht nhim trong kh thi cng gim. Thay i cc cng on sn xut gy nhim nhiu bng cc cng ngh khc t nhim hn, nh thay cng on nghin kh bng nghin t trong cc nh my sn xut tm lp aming; lm sch vt c bng phng php phun bi trong my phun kn hoc phun hn hp ct - nc thay v phun ct kh; s dng cc loi my khoan 104

, my p, ca ct, nh bng c km phun nc; thay i cng ngh phun sn kh bng sn nhng, sn tnh in, v.v. Thay th cc cht gy nhim, c hi nhiu bng cc cht t c hi hn nh thay th sn cha dung mi bng sn ho tan trong nc; mc in trn c s dung mi hu c bng mc in dng nc; s dng xng khng pha ch; tm kim vt liu thay th cho aming, thay th mt phn cc nhin liu t ha thch bng cc sn phm ph thi v.v. Ti u ho vic kim sot quy trnh cng ngh, bao gm c vic lp t cc h thng iu khin t ng lp trnh, hon thin h thng iu khin nng lng v cc thit b in.
6.3.2. Cc bin php x l khng kh

Trong rt nhiu trng hp, p dng cc bin php cng ngh sch hn vn cha p ng c cc tiu chun pht thi, kh thi ra t cc ng khi vn gy nhim mi trng xung quanh. Thit b kim sot mi trng (hay thit b lm sch khng kh) c chia lm hai loi: thit b lc bi v thit b kh kh c hi. Thit b lc bi c phn loi theo nguyn l hot ng v chia lm 4 nhm: Thit b lc bi kiu trng lc hot ng theo nguyn l s dng lc trng trng, cc ht bi th c lng xung v tch khi dng khng kh. y l dng thit b lc n gin nhng hiu qu thp, khng gian chim ch ln. Chng thng c s dng lc bi th, lc s cp v x l lng khng kh ln. Thit b lc bi qun tnh hot ng trn nguyn l li dng lc qun tnh ca cc ht bi, tch khi dng khng kh khi dng ny thay i hng t ngt. l cc dng xycln, cc thit b c tm chn va p... Ni chung y l cc thit b s dng kh ph bin do tnh n nh, n gin v hiu qu cao hn thit b lc bi kiu trng lc. Thit b lc bi kiu phin lc hot ng trn nguyn l tip xc. Bi th b tch qua hiu ng mng lc, va chm v qun tnh. Bi mn b tch qua hiu ng khuych tn va chm v ht tnh in. Hiu qu lc cao v dao ng ty thuc vo loi vi lc v ch v sinh vi. Thit b lc tnh in hot ng trn nguyn l ion ha bi khi v tch chng ra khi lung khng kh khi i qua trng in t. Hiu qu ca thit b lc tnh in rt cao (98%), ph thuc vo tnh cht khng kh, bn v vn tc khng kh, cc thng s in ca thit b. Thit b x l kh c v mi da trn 3 nguyn l c bn l thiu hy, hp th v hp ph: + Phng php thiu hy c th s dng nhit khi khng kh c cha cht c hi nng cao hoc dng phng php xc tc s dng cc hp kim 105

c bit (bch kim, oxyd ng...) khi cht c hi nng thp. Phng php thiu hy dng cht xc tc r hn 2-3 ln so vi phng php dng l nhit cao. + Phng php hp th l phng php lm sch khng kh trn c s hp th kh c hi bng cc phn ng ha hc vi cc cht lng. Nc l cht lng hp th ph bin nht. Phng php hp ph trn c s hp ph cc cht kh c hi hoc mi vo cc cht hp ph rn nh than hot tnh, silicagel, geolit... y l phng php kh mi ph bin nht.

6.4. Cc bin php kim sot nhim khng kh trong nh 6.4.1. Gim thiu ti a cc cht nhim khng kh bng nhiu bin php:

Tng cng thng gi, gim nhit v m trong phng, s dng cc loi g p dng nha gc phenol. B tr h thng thng gi ht ti khu vc dnh ring ht thuc l, nh v sinh, bp. V sinh hng ngy bn gh v thm tri sn, trc hoc sau gi lm vic; nh k v sinh h thng iu ho khng kh. Ch s dng cc loi cht ty ra v dit cn trng nm trong danh mc cho php, thc hin cc hot ng ny vo nhng thi im c t ngi nht v tng cng hot ng ca h thng thng gi trong qu trnh s dng, phi c phng kho ring bo qun cc cht ny v hn ch ti a vic tch tr, ch mua va lng cn dng. Gim thiu nhim aming bng cch hn ch s dng v tho d vt liu xy dng, cch m, cch nhit c cha aming. nh k kim tra nng kh radon trong khng kh trong nh, tng cng thng gi cng l mt bin php gim thiu kh radon. Sp xp hp l cc trang thit b vn phng, v d, cc loi my c kh nng pht sinh ozon, bc x ion ho v khng ion ho nh my photocopy, my in, l vi sng..., nn b tr vo nhng khu vc ring c t chc thng gi ht; b tr trang b ni tht phi lu khng bt mt cc ca gi v.v.
6.4.2. Nng cao hiu qu ca h thng iu ho khng kh

Nng cao hiu qu ca h thng iu ha khng kh bng mt s gii php nh: Bn thit k h thng iu ho khng kh phi c c quan c chc nng thm nh v thng qua; trong phi c bit lu tm n cc ch tiu v bi s trao i khng kh, lng khng kh sch cn thit, v tr ly gi sch, cch b tr cc ming cp v ht gi, hiu qu ca cc phin lc v b tiu m. nh k v sinh h thng iu ho khng kh, c bit l phin lc m bo hiu qu ca h thng v ngn nga nhim trong phng, c bit l 106

nhim sinh hc. Nhng cn b m trch cng vic ny cn phi c o to v hun luyn. Trong khong 6 thng u sau khi to nh a vo s dng l thi gian m c nhiu cht kh c hi nh VOC pht sinh t vt liu xy dng v trang b ni tht, h thng iu ho khng kh nn s dng ton b l khng kh bn ngoi, gim ti a lng khng kh tun hon.
BI TP TNH HUNG Mc tiu

1. p dng c nhng khi nim l thuyt v nghin cu nhim khng kh trong mt s tnh hung c th trong thc t. 2. Trnh by c mt s phng php c bn v thng k v dch t hc trong nghin cu hu qu sc kho ca nhim khng kh. 3. Xem xt mi tng quan gia nhim khng kh v sc kho con ngi. 4. Hy a ra mt s khuyn ngh cho tnh hung ny gim thiu nhng tc ng ca nhim khng kh ln sc kho con ngi.
Tnh hung

(Bi tp tnh hung ny c da vo mt nghin cu c mt hc vin cao hc thc hin ti Trng i hc Y t cng cng) Mt nghin cu quan trc cc cht nhim khng kh (NO2, SO2, CO) v t l hin mc cc bnh v ng h hp c thc hin ti hai a im X & Y. X l mt huyn gm mt x c lng ngh ti sn xut giy (x A) v mt x c lng ngh ti sn xut kim loi (x B). Y l mt x thuc huyn o ngoi khi. Ti mi a im nghin cu, s liu v nng cc kh nhim nu trn c thu thp trong thng 8/2000. Cng thi im ny, tr em ti cc trng cp 2 trong vng c khm sc kho xc nh cc bnh ng h hp trn ca hc sinh. Kt qu quan trc khng kh v khm sc kho c trnh by trong bng 1, 2, 3 v 4.

Bng 1. Nng cc cht nhim khng kh 3 x A, B (huyn X) v x Y ti thi im thng 8/2000

a im X A X B X Y SO2 (mg/m3) 1,65 1,18 0,52 CO (mg/m3) 0,92 0,08 0,00 NO2 (mg/m3) 1,83 1,13 0,32

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Bng 2. T l hin mc cc bnh ng h hp trn ca hc sinh ti cc trng cp 2 x A, B v Y, thng 8/200...

a im Bnh ng h hp trn Tn s X A (n = 95) X B (n = 70) X Y (n = 109) Tng 61 25 12 98 T l % 64,2 35,7 11,0 35,8

Bng 3. Lin quan gia nng kh nhim vi bnh h hp trn ca hc sinh

Vng nhim SO2 v NO2 C X A X Y Tng 61 12 73 Bnh ng h hp trn Khng 34 97 131 Tng 95 109 204

Bng 4. Lin quan gia nng kh nhim vi bnh h hp trn ca hc sinh

Vng nhim SO2 v NO2 C X B X Y Tng 25 12 37 Bnh ng h hp trn Khng 45 97 142 Tng 70 109 179

Cu hi

1. S dng cc phng php thng k n gin, hy xc nh xem c mi lin quan no gia nng cc cht nhim khng kh vi t l hin mc cc bnh ng h hp trn? Nu c th, bn hy cho bit nhng mi lin quan ny l g? 2. Nhng yu t no c th nh hng ti kt qu ca nghin cu ny? 3. Hy xut mt s bin php nhm gim t l mi mc cc bnh v ng h hp trn ca hc sinh ti cc lng ni trn.

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T LNG GI

Hy khoanh vo ch ci tng ng vi la chn ng nht. Mi cu ch c mt la chn ng. 1. Kh SO2 l mt cht nhim khng kh c c trng: A. Khng mu, khng mi. B. Khng mu, c mi. C. Khng mu, khng mi, c kh nng gy ngt mnh. D. Khng mu, c mi, c kh nng gy ngt mnh. 2. Kh CO l mt cht NKK c c trng A. Khng mu, c mi hi c trng. B. Khng mu, khng mi. C. Khng mu, c mi hi c trng, c. D. Khng mu, khng mi, c. 3. Giao thng ng gp mt phn quan trng vo vn nhim khng kh A. Giao thng c th chim ti 50% NKK. B. Kh CO l ngun gy NKK ch yu c to ra do giao thng. C. Kh CO2 cng l ngun gy NKK c to ra do giao thng, ch ng sau kh CO. D. C A, B, C u ng. E. Ch A v B ng. 4. NKK c th c mt s nh hng ti sc khe con ngi. Mt trong nhng nh hng l: A. Gy bnh hen suyn, cht NKK th phm l SO2 v cc cht ht. B. Gy bnh hen suyn, cht NKK th phm l SOx v cc cht ht. C. Gy bnh hen suyn, cht NKK th phm l NO v cc cht ht. D. Gy bnh hen suyn, cht NKK th phm l NOx v cc cht ht. Hy nh du x vo mt la chn duy nht 5 6 7 8 Kh CO2 l sn phm ca qu trnh t chy khng O ng hon ton Bnh hen suyn c c trng bi s lm yu thnh O ng cc ti phi - nhng ti khng kh b nh trong phi Vim ph qun mn tnh dn ti ho ko di

O Sai O Sai O Sai O Sai

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O ng

CO2 l cht kh th phm chnh gy ra hiu ng nh O ng

knh 9 Ozon l cht kh c kh nng hp th tia cc tm tng O ng i l u

O Sai

BI 5

QUN L CHT THI RN V CHT THI Y T

MC TIU

1. Trnh by c cc vn v pht sinh cht thi rn v cng tc qun l.

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2. Nhn bit v phn loi c cc loi cht thi rn v ngun gc ca chng. 3. Trnh by c nhng tc ng ca cht thi rn ln mi trng v sc kho con ngi. 4. Hiu c cc nguyn l v qun l cht thi v hn ch s pht sinh cht thi. 5. Trnh by c cc vn v cht thi rn y t v cng tc qun l cht thi y t.
1. GII THIU CHUNG

Cc h sinh thi v mt bn cht l bn vng v chng c kh nng phn hu v ti to cc cht dinh dng bng cch ti s dng cc yu t trong h. T xa xa, nhng ngi nguyn thu v nhng nn vn minh c xa khng phi i u vi nhng vn v cht thi rn bi v cht thi ch yu trong nhng thi k ny l nhng cht thi c ngun gc hu c, d b phn hu bi cc vi sinh vt. Hn na, do dn s th gii trong thi gian ny cn t nn lng cht thi to ra cng khng ln. Vn cht thi rn ngy cng tr nn phc tp hn khi dn s th gii ngy cng tng, km theo l cht thi ngy cng gia tng v s lng cng nh chng loi: cht thi ho hc, cht thi lng, cht thi rn, cht thi ht nhn v cc cht thi c hi. Do vy, cc phng php kim sot v qun l cht thi rn c hiu qu cn phi c p dng.
2. NH NGHA CHT THI RN

Cht thi rn l cht thi dng rn pht sinh t cc hot ng sinh hot, thng mi, dch v th, nng nghip, cng nghip, xy dng v.v. Cht thi rn do hot ng sinh hot, th c gi l cht thi rn th; cht thi rn do hot ng cng nghip c gi l cht thi rn cng nghip; cht thi rn do hot ng phng bnh v cha bnh c gi l cht thi rn y t; cht thi rn do hot ng sn xut nng nghip c gi l cht thi rn nng nghip.
3. PHN LOI V THNH PHN CHT THI RN

Hin nay c nhiu cch phn loi cht thi rn. Sau y l mt s cch phn loi thng dng:
3.1. Theo v tr hnh thnh

Ngi ta phn bit rc hay cht thi rn trong nh, ngoi nh, trn ng ph, ch...
3.2. Theo thnh phn ha hc v vt l

Ngi ta phn bit theo cc thnh phn hu c /v c, chy c/ khng chy c, kim loi / phi kim, da, gi vn, cao su, cht do...

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3.3. Theo bn cht ngun to thnh, cht thi rn c phn thnh cc loi 3.3.1.Cht thi rn sinh hot

L nhng cht thi lin quan n cc hot ng sinh hot ca con ngi, ngun to thnh ch yu t cc khu dn c, cc c quan, trng hc, cc trung tm dch v thng mi. Cht thi rn sinh hot c thnh phn bao gm kim loi, snh s, thy tinh, gch ngi v, t, , cao su, cht do, thc phm d tha hoc qu hn s dng, xng ng vt, tre, g, lng g lng vt, vi, giy, rm, r, xc ng vt, v rau qu v.v... Theo phng din khoa hc, cc cht thi ny c th phn bit nh sau: Cht thi thc phm: bao gm cc thc n tha, rau qu... loi cht thi ny mang bn cht d phn hu sinh hc, qu trnh phn hu to ra cc mi kh chu, c bit trong iu kin thi tit nng, m. Ngoi cc thc n d tha t gia nh cn c cc thc n d tha t cc bp n tp th, cc nh hng, khch sn, k tc x, ch... Cht thi trc tip ca ng vt ch yu l phn, bao gm phn ngi v phn ca cc ng vt khc. Cht thi lng ch yu l bn ga cng rnh, l cc cht thi t cc khu vc sinh hot ca dn c. Tro v cc cht d tha thi b khc bao gm: cc loi vt liu sau t chy, cc sn phm sau khi un nu bng than, ci v cc cht thi d chy khc trong gia nh, trong kho ca cc cng s, c quan, x nghip, cc loi x than. Cc cht thi rn khc t ng ph c thnh phn ch yu nh l cy, que, ci, nilon, v bao gi...
3.3.2. Cht thi rn cng nghip

L cht thi pht sinh t cc hot ng sn xut cng nghip, tiu th cng nghip. Cc ngun pht sinh cht thi cng nghip gm: Cc ph thi t vt liu trong qu trnh sn xut cng nghip, tro, x trong cc nh my nhit in. Cc ph thi t nhin liu phc v cho sn xut. Cc ph thi trong qu trnh cng ngh. Bao b ng gi sn phm.
3.3.3. Cht thi xy dng

L cc ph thi nh t, , gch, ngi, b tng v do cc hot ng ph d, xy dng cng trnh...cht thi xy dng gm: Vt liu xy dng trong qu trnh d b cng trnh xy dng. t do vic o mng trong xy dng.

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 Cc vt liu nh kim loi, cht do... Cc cht thi t cc h thng c s h tng k thut nh trm x l nc thin nhin, nc thi sinh hot, bn cn t cc cng thot nc thnh ph.
3.3.4. Cht thi nng nghip

Cht thi nng nghip l nhng cht thi v mu tha thi ra t cc hot ng nng nghip, th d nh trng trt, thu hoch cc loi cy trng, cc sn phm thi ra t ch bin sa, cht thi ca cc l git m... Hin ti vic qun l v x cc loi cht thi nng nghip khng thuc v trch nhim ca cc cng ty mi trng th ca cc a phng.
3.4. Phn loi theo mc nguy hi 3.4.1. Cht thi nguy hi

Bao gm cc loi cht d gy phn ng ph, c hi, cht thi sinh hc d thi ra, cc cht d chy, n hoc cc cht thi phng x, cc cht thi nhim khun, ly lan.... c nguy c e da ti sc kho con ngi, ng vt, cy c v.v... Cht thi nguy hi l nhng cht mang t nht mt trong 4 c tnh nguy hi nh sau: c tnh, d chy, n mn, tnh phn ng. c tnh: c tnh y mang ngha l mc c hi tim tng i vi sc kho con ngi. D chy: cc hp cht d chy l cc cht lng c im bc chy di 60oC hoc cc cht khng phi dng lng c kh nng gy chy thng qua va chm, ht m, hoc thay i ho hc t nhin. Cc dung mi hu c, du, cht do v sn l nhng hp cht d chy. n mn: cc cht thi n mn l nhng cht c pH di 2 hoc hn 12,5; c th ph hu cc m sng hoc n mn cc cht thng qua cc phn ng ho hc. Nhng hp cht n mn ny, chng hn nh cc cht acid, kim, cc cht ty ra, cht thi ca c quy l mi e da ln i vi sc kho con ngi. Tnh phn ng: cc cht thi phn ng gm cc loi n dc c hoc nhng cht thi ho hc nht nh c kh nng phn ng mnh vi khng kh hoc vi nc. Chng c th n v to ra cc kh c hi. Do tnh nguy him ca cht thi rn c hi nh trn, chng ta phi c cc bin php thu gom, bo qun, vn chuyn, v x l thch hp, trnh khng li tc ng xu i vi mi trng v sc kho con ngi.
3.4.2. Cht thi khng nguy hi

Cht thi khng nguy hi l nhng loi cht thi khng cha cc cht v hp cht c mt trong cc c tnh nguy hi trc tip hoc tng tc thnh phn.

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Trong s cc cht thi ca thnh ph, ch c mt t l rt nh cht thi c th s ch dng ngay trong sn xut v tiu dng, cn phn ln l hu b hoc phi qua mt qu trnh ch bin phc tp, qua nhiu khu mi c th s dng li nhm p ng nhu cu khc nhau ca con ngi. Lng cht thi trong thnh ph tng ln do tc ng ca nhiu nhn t nh: s tng trng v pht trin ca sn xut, s gia tng dn s, s pht trin v trnh v tnh cht ca tiu dng trong thnh ph....
4. CHT THI RN TH 4.1. Khi nim

Hin nay vn cha c nhng nh ngha r rng v cht thi rn th. Nh trn trnh by: cht thi rn do hot ng sinh hot, th c gi l cht thi rn th. Theo khi nim Ngn hng Th gii (World Bank), cht thi rn th l loi cht thi rn c pht sinh t nhiu ngun thi nh: sinh hot, thng mi, cng nghip, xy dng, t cc hot ng sn xut, ph hu hoc cc hot ng khc ti th (WB,1999). Trong cc loi cht thi rn, cht thi rn th c coi l loi cht thi c ngun pht sinh a dng nht.
4.2. Lng pht sinh cht thi rn th (LPSCTRT)

Lng cht thi to thnh hay cn gi l tiu chun to rc c nh ngha l lng rc thi pht sinh t hot ng ca mt ngi trong mt ngy m (kg/ngi/ngy m). Theo bo co ca Ngn hng Th gii (WB, 1999), nhng nc ngho c t l phn trm dn th thp nht v lng pht sinh cht thi rn th cng thp nht, khong t 0,4 n 0,9 kg/ngi/ngy m. Cc nc c GNP/ngi thp hn 400 USD c lng pht sinh cht thi rn th di 0,7 kg /ngi/ngy m. Do vy, nn i vi cc nc c t l GNP/ngi mc trung bnh theo nh gi ca WB, t l lng pht sinh cht thi rn th giao ng trong khong 0,5 n 1,1 kg/ngi/ngy. Trong khi cc nc giu, c GNP/ngi cao, t l ny khong 1,1 n 5,07 kg /ngi/ ngy. Bng 5.1 cho thy s khc nhau v lng rc thi rn mt s nc, n cho thy cc nc giu chnh l cc nc phi chu trch nhim chnh v tnh trng nhim hin nay trn phng din ton cu.

Bng 5.1. Lng pht sinh cht thi rn ti mt s nc

Tn nc GNP/ngi (1995 USD) Nc thu nhp thp 490 Dn s th hin nay (%tng st) 27,8 LPSCTRT hin nay (kg/ngi/ngy) 0,64

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Nepal Bngladesh Vit Nam n Trung Quc Nc thu nhp trung bnh Indonesia Philippines Thi Lan Malaysia Nc c thu nhp cao Hn Quc Hng Kng Singapore Nht Bn

200 240 240 340 620 1410 980 1050 2740 3890 30990 9700 22990 26730 39640

13,7 18,3 20,8 26,8 30,3 37,6 35,4 54,2 20 53,7 79,5 81,3 95 100 77,6

0,5 0,49 0,55 0,46 0,79 0,73 0,76 0,52 1,1 0,81 1,64 1,59 5,07 1,10 1,47

(Ngun: World Bank, bng 3, trang 7, 1999 )

Tiu chun to rc trung bnh theo u ngi i vi tng loi cht thi rn mang tnh c th ca tng a phng v ph thuc vo mc sng, vn minh ca dn c mi khu vc.
4.3. Nhng nguy c v nhng vn lin quan ti rc thi rn th

Nu rc thi khng c qun l mt cch hp l, rc thi rn th s gy ra nhiu nh hng xu ti mi trng v sc kho con ngi. Di y trnh by mt trong s nhng nh hng chnh ca s nhim rc thi rn ti th. Rc thi khng c thu gom ti u cui cc cng thot nc ca th c th dn ti tc cc ng cng thot nc, nguyn nhn gy lt khi ma ln v nh hng v sinh mi trng. Cc loi cn trng, sinh vt gy bnh c th pht trin trn mt s loi cht thi. Phn ngi v cc ng vt nui, cc loi thc n thi b l mi trng thun li cho cc loi cn trng trung gian truyn bnh nh: rui, nhng, gin. Trn thc t, phn ln cht thi rn nc ta u c cha phn ngi, giy v sinh. Phn ngi l mt phng tin lan truyn bnh nguy him. Phn ngi ln trong rc thi cha nhiu mm bnh v rt d pht tn ra ngoi. Cc mm bnh trc tip gy tc hi cho sc kho ca cc cng nhn v sinh, nhng ngi nht rc, bi rc v tr em chi trn sn.

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Nc ng ti cc cht thi rn nh can, chai, l b i l mi trng thun li cho s pht trin ca cc loi mui vc-t quan trng trong vic truyn cc bnh st rt v st xut huyt. Ni c tr a thch ca chut l cc ng rc v thc n thi b. Chut khng nhng l nguyn nhn truyn bnh dch hch m cn l nguyn nhn ca nhiu s kh chu khc i vi con ngi. t rc dn ti nhim khng kh do nhng sn phm sau: trong qu trnh t c th cha cc cht c hi nh dioxin, khi t nhng ni t rc c th lm gim tm nhn, nguy c gy chy n nhng bnh kh v nguy c gy ho hon nhng vng ln cn. Mt nguy c nghim trng i vi rc th l cc loi ti cht do tng hp, nhng loi ti ny gy mt m quan th v l nguyn nhn gy cht nhng ng vt n phi. Nhng cht thi nguy him nh cc vt sc nhn, cc cht thi y sinh, cc bnh cha cht c kh nng chy n, cc ho cht cng nghip c th dn n nhng chn thng hoc nhim c, c bit i vi tr em v nhng ngi tip xc vi rc thi. Cc cht nhim t cc bi rc c th ngm vo mt nc ngm gy nhim nc ngm v nhim t xung quanh. Rc thi bnh vin c chung vo rc thi th l ngun nguy him ng k. Cc mm bnh truyn nhim c th theo m lan truyn ra mi trng xung quanh. c bit, rc thi bnh vin trc tip tc ng ln sc kho ca nhng ngi nht rc, bi rc hoc x l rc. Nhng tc ng ca cht thi rn ln mi trng v sc kho ca con ngi cng c th c tm tt theo cch di y: Tc ng ln mi trng th: Cc bi rc ng ngoi tri v cc bi chn lp rc c th gy nhim khng kh, to ra mi kh chu cho mt khu vc rng ln quanh bi rc. Trong qu trnh phn hu, mt s cht to ra cc loi kh c c th gy nh hng xu ti sc kho con ngi, cc loi ng vt v cy ci xung quanh. Cc bi rc ng ngoi tri v cc bi chn lp rc khng c xy dng ng tiu chun cng l ngun tim tng gy nhim ngun nc, c bit l ngun nc ngm. Mt s cht c, kim loi nng c to ra v ngm vo ngun nc, gy nguy hi ti sc kho cng ng v h sinh thi quanh khu vc. Cht thi rn cng c nguy c cao gy nn nhim t. Cc khu vc c s dng chn lp rc, cht thi rn b nhim nng n, dn n vic mt t canh tc. Nhng thay i ny cng dn ti s thay i v mt sinh thi hc, dn n s ph v cn bng ca h sinh thi. 116

 Tc ng ln sc kho con ngi: Cc mi nguy c gy nhim khng kh, nc, t ni trn cng nh hng trc tip n sc kho ca con ngi, c bit ca dn c quanh khu vc c cha cht thi rn. Vic nhim ny cng lm nh hng ti ngun thc n: cc cht nhim c trong t, nc, khng kh nhim vo cc loi thc phm ca con ngi: rau, ng vt v.v... qua li v chui thc n nhng loi cht nhim ny tc ng xu ti sc kho con ngi. Cc bi chn lp rc l ni pht sinh cc bnh truyn nhim: t, l, thng hn v.v... Cc loi cn trng trung gian truyn bnh (rui, mui, gin) v cc loi gm nhm (chut) cng a thch sng nhng khu vc c cha rc thi. Cc bi chn lp rc cng mang nhiu mi nguy c cao i vi cng ng dn c lm ngh bi rc. Cc vt sc nhn, thu tinh v, bm kim tim c v.v. c th l mi e da nguy him vi sc kho con ngi khi h dm phi hoc b co xc vo tay chn. Cc loi ho cht c hi v nhiu cht thi nguy hi khc cng l mi e da i vi nhng ngi lm ngh ny. Cc ng vt sng cc bi rc cng c th gy nguy him ti sc kho ca nhng ngi tham gia bi rc. Cc bi rc cng lm thay i thm m theo hng tiu cc, lm nh hng n m quan khu vc quanh bi rc, to ra nhng mi kh chu cho kho vc xung quanh.
5. QUN L CHT THI RN

C quan Bo v Mi trng Hoa K khuyn co rng: qun l cht thi rn c hiu qu, cn thc hin ng theo trt t cc bc sau: Gim thiu ngun pht sinh. Ti s dng - ti ch. Thu hi nng lng t cht thi rn. Chn lp hp v sinh.
5.1. Gim thiu ngun pht sinh

gim thiu ngun pht sinh, cn thay th hoc loi b hn nhng cht to ra mt lng ln cht thi bng cc cht to ra t hoc khng to ra cht thi. Thay i cng ngh, k thut sn xut hin i to ra t cht thi hn.

5.2. Ti s dng - ti ch

ti s dng - ti ch, cn phi phn loi, cch ly cht thi rn ngay ti ngun pht sinh, khng cc cht thi c hi ln vi cc cht thi khng c hi. i vi 117

cc cht thi c hi, cn c bin php x l ring ph hp. i vi cht thi khng c hi, chng ta c th ti s dng hoc ti ch. Chng hn, i vi cc chai, l thu tinh, cc thng, cha nha/ kim loi c th s dng li dng vo mc ch khc. Mt s loi cht thi rn khc c th ti ch s dng cho mc ch khc: ti ch nha, thu tinh, kim loi v.v...
5.3. Thu hi nng lng t cht thi rn

S dng l t rc cc khu th l mt bin php x l cht thi rn. Nhit trong l rt cao (khong trn 1000-1200oC) phng nga nhim khng kh. Nhc im ca bin php ny l chi ph xy dng cc l t ny rt cao v bt buc phi c b phn x l tro. Vic t chy cht thi rn c th to ra in, nhit, hi nng v.v... cung cp cho ngnh cng nghip, khu dn c, si m cc khu nh cao tng v.v... Vic thu hi nng lng ny c th gip gim bt chi ph cho cc l t hot ng. Cng ngh ny gi l thu hi nng lng hoc t cht thi ti nng lng.
5.4. Chn lp v sinh

y l phng php x l cht thi rn ph bin nht hin nay. Trong mt bi chn lp v sinh, cht thi rn c chn lp v ph t ln trn. Xem chi tit mc 7. X l cht thi rn ti Vit Nam (v chn lp rc).
6. THU GOM V VN CHUYN CHT THI RN

Thu gom l mt khu quan trng trong qun l cht thi rn. Hin ti Vit Nam c hai phng hng thu gom chnh. Thu gom rc t ng ph do cng nhn v sinh lm nhim v qut ng. Cc cng nhn dng phng tin xe y thu gom rc. Rc c mang n mt im tp trung ri c xe ch rc mang n im x l. Hin nay ti cc thnh ph ln c xe ch rc chuyn dng thu gom rc theo gi quy nh. Thu gom rc t cc khu tp th: mi khu dn c c mt a im rc hay b ng rc. Cc gia nh hoc c quan mang rc n vo im tp kt ri sau c xe ch rc i. Vic vn chuyn rc ch yu l do xe ch rc chuyn dng ca cc cng ty v sinh mi trng m nhn. Cng vic ny thng c thc hin vo ban m. Phn bn t cc b pht nh k c cc xe ht phn n ht ch ra ngoi thnh.

7. X L CHT THI RN TI VIT NAM

Cho mi ti tn gn y, cht thi rn vn c ng ngoi bi rc, chn, t v mt s loi rc thi t nh bp, nh hng c s dng lm thc n cho ng vt. 118

Cng ng vn cha nhn thc c mi lin h gia cht thi rn vi chut, rui, gin, mui, rn, nhim t v nc. Ngi ta khng bit rng, cht thi rn trong cc bi rc l ni sinh sng ca mt s loi vc-t truyn cc bnh: st thng hn, st vng, st xut huyt, st rt, t v.v... Do vy, nhng phng php x l cht thi rn r nht, nhanh nht v thun tin nht c s dng. Cc khu vc nng thn v cc th trn nh s dng cc bi rc ngoi tri. Cc th x v cc thnh ph ln hn s dng cc l t nh. Mi sau ny, chn lp v sinh mi tr thnh mt bin php x l cht thi rn c nhiu ni la chn. Vit Nam, c nhiu phng php x l rc nhng ch yu l vo bi rc, chn lp rc, rc v t rc.
7.1. Bi rc

rc vo bi khng c x l l mt bin php hin ti cn ph bin Vit Nam. Nhng th c mt hoc nhiu khu t c dng rc. Rc c cht ng gy nhim t, ngun nc ngm, nhim khng kh v l ni c tr ca cc vt ch trung gian truyn bnh nh rui, mui chut, gin. y l phng php r tin nhng rt nguy him v mt sc kho.
7.2. Chn lp rc

Phng php chn lp rc c p dng nhiu nc pht trin. Ngi ta chn cc vng i ni, thung lng b tr bi chn lp. y ca bi rc c ngn cch vi t v nc ngm bng nhng lp cht do khng thm nc. Rc c vo cc chia sn. Khi cc rc ny y th c lp li bng t v dng xe lu nn cht li sau tip ln cho n khi y h ri ph t (khong 60cm) v trng cy ln trn. Nc trong bi chn lp c thu gom v mt ch v c x l trc khi cho vo sng, h. y l phng php x l cht thi hp v sinh nhng tn km. Thnh ph H Ni hin xy dng bi chn lp rc ti Sc Sn vi thi gian s dng 30 nm.
7.3. X l cht thi rn bng phng php phn (composting)

x l cht thi v tn dng ngun phn bn cho nng nghip ngi ta xy dng cc x nghip x l rc thi thnh phn trn compt. Hin ti, Vit Nam c hai nh my rc Cu Din (H Ni) v Hc Mn (Thnh ph H Ch Minh). Sau mt qu trnh , ln men, cht thi hu c tr nn v hi v l ngun phn bn tt. Tuy vy, cng sut cc nh my ny cn rt nh, khng p ng ni nhu cu x l cht thi ca cc thnh ph ln. V mt v sinh, phng php composting c th m bo nhit ln ti 60C - 65C, do tiu dit c hu ht mm bnh v trng giun sn.
7.4. t rc

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Phng thc t c th gim th tch xung ti 75%, do tit kim c din tch t chn lp. Qu trnh t cng tiu dit c ton b vi trng gy bnh. Nhit lng t rc c th c ti s dng un nc nng cho cc nh tm cng cng. Nhc im ca phng php ny l chi ph cao v c nguy c nhim khng kh.
7.5. Thu hi v ti s dng

Trong cht thi rn thnh ph vn cn cha nhiu vt liu c th thu hi v ti s dng. Vit Nam vn ny cha c ch trng lm v hin ti chng ta c mt s lng ngi o bi rc v thu hi ph liu rt ng o. Tuy vy, vic qun l sc kho ca nhng ngi bi rc li l mt mi quan tm ln.
8. QUN L CHT THI RN Y T 8.1. nh hng ca cht thi rn y t ln sc khe 8.1.1. Nhng nguy c ca cht thi rn y t

Cht thi rn y t bao gm mt lng ln cht thi ni chung v mt lng nh hn cc cht thi c tnh nguy c cao. Cht thi rn y t c th to nn nhng mi nguy c cho sc khe con ngi. a. Cc kiu nguy c Vic tip xc vi cc cht thi rn y t c th gy nn bnh tt hoc tn thng. Bn cht mi nguy c ca cht thi rn y t c th c to ra do mt hoc nhiu c trng c bn sau y: Cht thi y t cha ng cc yu t truyn nhim. L cht c hi c trong rc thi y t. Cc loi ho cht v dc phm nguy him. Cc cht thi phng x. Cc vt sc nhn. b. Nhng i tng c th tip xc vi nguy c Tt c cc c nhn tip xc vi cht thi y t nguy hi l nhng ngi c nguy c tim tng, bao gm nhng ngi lm vic trong cc c s y t, nhng ngi ngoi cc c s y t lm nhim v vn chuyn cc cht thi y t v nhng ngi trong cng ng b phi nhim vi cht thi do hu qu ca s sai st trong khu qun l cht thi. Di y l nhng nhm chnh c nguy c cao: Bc s, y t, h l v cc nhn vin hnh chnh ca bnh vin. Bnh nhn iu tr ni tr hoc ngoi tr.

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 Khch ti thm hoc ngi nh bnh nhn. Nhng cng nhn lm vic trong cc dch v h tr phc v cho cc c s khm cha bnh v iu tr, chng hn nh: git l, lao cng, vn chuyn bnh nhn. Nhng ngi lm vic trong cc c s x l cht thi (ti cc bi rc thi, cc l t rc) v nhng ngi bi rc, thu gom rc. Ngoi ra cn c cc mi nguy c lin quan vi cc ngun cht thi y t quy m nh, ri rc, d b b qun. Cht thi t nhng ngun ny c th sn sinh ra t nhng t thuc gia nh hoc do nhng k tim chch ma tu vt ra.
8.1.2. Cc nguy c t cht thi truyn nhim v cc vt sc nhn

Cc vt th trong thnh phn ca cht thi rn y t c th cha ng mt lng rt ln bt k tc nhn vi sinh vt gy bnh truyn nhim no. Cc tc nhn gy bnh ny c th xm nhp vo c th ngi thng qua cc cch thc sau: Qua da (qua mt vt thng, try sc hoc vt ct trn da). Qua cc nim mc (mng nhy). Qua ng h hp (do xng, ht phi). Qua ng tiu ho. Cc v d v s nhim khun gy ra do tip xc vi cht thi y t c lit k trong bng 5.2 qua ng truyn l cc dch th nh mu, dch no tu, cht nn, nc mt, tuyn nhn. Mt mi nguy c rt ln hin nay l virus gy hi chng suy gim min dch (HIV) cng nh cc virus ly qua ng mu nh vim gan B, C c th lan truyn ra cng ng qua con ng rc thi y t. Nhng virus ny thng lan truyn qua vt tim hoc cc tn thng do kim tim c nhim mu ngi bnh. Do s qun l yu km cc cht thi y t ti cc c s y t, mt s vi khun c tnh khng cao i vi cc loi thuc khng sinh v cc ho cht st khun. iu ny c minh chng, chng hn cc plasmit t cc ng vt th nghim c trong cht thi y t c truyn cho vi khun gc qua h thng x l cht thi. Hn na, vi khun E. coli khng thuc cho thy n vn cn sng trong mi trng bn hot mc d c v nh khng phi l mi trng thun li cho loi vi sinh vt ny trong iu kin thng thng ca h thng thi b v x l rc, nc. tp trung ca cc tc nhn gy bnh v cc vt sc nhn b nhim cc vi sinh vt gy bnh (c bit l nhng mi kim tim qua da) trong rc thi y t thc s l nhng mi nguy c tim n i vi sc kho. Nhng vt sc nhn trong rc thi y t c coi l mt loi rc thi rt nguy him bi n gy nhng tn thng kp: va c kh nng gy tn thng li va c kh nng ly truyn cc bnh truyn nhim.
Bng 5.2. Mt s v d v s nhim khun gy ra do tip xc vi cc loi cht thi y t, cc loi vi sinh vt gy bnh v phng tin ly truyn

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Loi nhim khun Nhim khun tiu ho

Vi sinh vt gy bnh Nhm Enterobacteria: Salmonella, Shigella spp.; Vibrio cholerae; cc loi giun, sn Vi khun lao, virus si, Streptococcus pneumoniae, bch hu, ho g. Virus Herpes Neisseria herpes gonorrhoeae, virus

Phng tin ly truyn Phn v /hoc cht nn

Nhim khun h hp

Cc loi dch tit, m

Nhim khun mt Nhim khun sinh dc Nhim khun da Bnh than Vim mng no m do no m cu AIDS St xut huyt Nhim khun huyt do t cu Nhim khun huyt (do cc loi vi khun khc nhau)

Dch tit ca mt Dch tit sinh dc M Cht tit ca da (m hi, cht nhn) Dch no tu Mu, cht tit sinh dc Tt c cc sn phm mu v dch tit Mu Mu

Streptococcus spp. Bacillus anthracis No m cu (Neisseria meningitidis) HIV Cc virus: Junin, Lassa, Ebola, Marburg Staphylococcus spp. Nhm t cu khun (Staphylococcus spp. Staphylococcus aereus); Enterobacter; Enterococcus; Klebssiella; Streptococcus spp. Candida albican Virus vim gan A Virus vim gan B, C

Nm Candida Vim gan A Vim gan B, C

Mu Phn Mu, dch th

8.1.3. Nhng mi nguy c t loi cht thi ho cht v dc phm

Nhiu loi ho cht v dc phm c s dng trong cc c s y t l nhng mi nguy c e da sc kho con ngi (cc c dc, cc cht gy c gen, cht n mn, cht d chy, cc cht gy phn ng, gy n, gy sc phn v). Cc loi cht ny thng chim s lng nh trong cht thi y t, vi s lng ln hn c th tm thy khi chng qu hn, d tha hoc ht tc dng cn vt b. Nhng cht ny c th gy nhim c khi tip xc cp tnh v mn tnh, gy ra cc tn thng nh bng, ng c. S nhim c ny c th l kt qu ca qu trnh hp th ho cht hoc dc phm qua da, qua nim mc, qua ng h hp hoc ng tiu ho. Vic tip xc vi cc cht d chy, cht n mn, cc ho cht gy phn ng (formaldehyd v cc cht

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d bay hi khc) c th gy nn nhng tn thng ti da, mt hoc nim mc ng h hp. Cc tn thng ph bin hay gp nht l cc vt bng. Cc cht kh trng l nhng thnh phn c bit quan trng ca nhm ny, chng thng c s dng vi s lng ln v thng l nhng cht n mn. Cng cn phi lu rng nhng loi ho cht gy phn ng c th hnh thnh nn cc hn hp th cp c c tnh cao. Cc loi ho cht dit cn trng qu hn lu tr trong cc thng b r r hoc ti rch thng c th nh hng trc tip hoc gin tip n sc kho ca bt c ai ti gn v tip xc vi chng. Trong nhng trn ma ln, cc ho cht dit cn trng b r r c th thm su vo t v gy nhim nc ngm. S nhim c c th xy ra do tip xc trc tip vi sn phm, do ht phi hi c hoc do ung phi nc hoc n phi thc n b nhim c. Cc mi nguy c khc c th l cc v ha hon hoc nhim do vic x l cht thi khng ng cch, chng hn nh thiu hu hoc chn lp. Cc sn phm ho cht c thi thng vo h thng cng thi c th gy nn cc nh hng bt li ti hot ng ca h thng x l nc thi sinh hc hoc gy nh hng c hi ti h sinh thi t nhin nhn c s ti tiu bng ngun nc ny. Nhng vn tng t nh vy cng c th b gy ra do cc sn phm ca qu trnh bo ch dc phm bao gm cc khng sinh v cc loi thuc khc, do cc kim loi nng nh thu ngn, phenol v cc dn xut, cc cht kh trng v ty u.
8.1.4. Nhng nguy c t cht thi gy c gen (genotoxic)

i vi cc nhn vin y t chu trch nhim tip xc v x l loi cht thi gy c gen, mc nh hng ca nhng mi nguy c b chi phi bi s kt hp gia bn cht ca cht c v phm vi, khong thi gian tip xc vi cht c . Qu trnh tip xc vi cc cht c trong cng tc y t c th xy ra trong lc chun b hoc trong qu trnh iu tr bng cc thuc c bit hoc bng ho tr liu. Nhng phng thc tip xc chnh l ht phi dng bi hoc dng phun sng qua ng h hp; hp th qua da; qua ng tiu ho do n phi thc phm nhim thuc, ho cht hoc cht bn c tnh c. Vic nhim c qua ng tiu ho l kt qu ca nhng thi quen xu chng hn nh dng ming ht ng pipet trong khi nh lng dung dch. Mi nguy him cng c th xy ra khi tip xc vi cc loi dch th v cc cht tit ca nhng bnh nhn ang c iu tr bng ho tr liu. c tnh i vi t bo ca nhiu loi thuc chng ung th l tc ng n cc chu k c bit ca t bo, nhm vo cc qu trnh c bit trong ni bo nh qu trnh tng hp ADN hoc phn bo nguyn phn. Cc thuc chng ung th khc, chng hn nh nhm alkyl ho, khng phi l pha c hiu, ch biu hin c tnh ti mt vi im trong chu k t bo. Cc nghin cu thc nghim cho thy nhiu loi thuc chng ung th li gy nn ung th v gy t bin. Khi u th pht, xy ra sau 123

khi ung th nguyn pht b tiu dit, c bit hnh thnh do s kt hp ca cc cng thc ho tr liu. Nhiu loi thuc c c tnh gy kch thch cao v gy nn nhng hu qu hu hoi cc b sau khi tip xc trc tip vi da hoc mt (bng 5.3). Chng cng c th gy chng mt, bun nn, au u hoc vim da. Cn phi c bit cn thn trong vic s dng v vn chuyn cht thi genotoxic, vic o thi nhng cht thi nh vy vo mi trng c th gy nn nhng hu qu sinh thi thm khc.
Bng 5.3. Cc thuc c hi t bo gy nguy him cho mt v da
Nhm alkyl ho: Cc thuc gy rp da (*) Cc thuc gy kch thch Nhm thuc xen k Cc thuc gy rp da Cc thuc gy kch thch Asacrin, dactinomycin, daunorubicin, doxorubicin, epirubicin, pirarubicin, zorubicin Mitoxantron Aclarubicin, chlormethin, cisplatin, mitomycin Carmustin, cyclophosphamid, dacarbazin, melphalan, streptozocin, thiotepa ifosphamid,

Cc alkaloid thuc nhm vinca v cc dn xut Cc thuc gy rp da Vinblastin, vincristin, vindesin, vinorelbin Epipodophyllotoxins. Cc thuc gy kch thch
( )

Teniposid

* To thnh cc mn nc

8.1.5. Nhng nguy c t cc cht thi phng x

Loi bnh gy ra do cht thi phng x c xc nh bi loi cht thi v phm vi tip xc. N c th l au u, hoa mt, chng mt v nn nhiu bt thng. Bi cht thi phng x cng nh loi cht thi dc phm, l mt loi c hi gen, n cng c th nh hng n cc yu t di truyn. Tip xc vi cc ngun phng x c hot tnh cao, v d nh cc ngun phng x ca cc phng tin chn on (my X quang, my chp ct lp) c th gy ra mt lot cc tn thng (chng hn nh ph hu cc m, t i hi phi dn n vic x l loi b hoc ct ct cc phn c th) Cc nguy c t nhng loi cht thi c hot tnh thp c th pht sinh do vic nhim x trn phm vi b mt ca cc vt cha, do phng thc hoc khong thi gian lu gi loi cht thi ny. Cc nhn vin y t hoc nhng ngi lm nhim v thu gom v vn chuyn rc phi tip xc vi loi cht thi phng x ny l nhng ngi thuc nhm c nguy c cao.

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8.1.6. Tnh nhy cm x hi

Ngoi vic lo ngi i vi nhng mi nguy c tc ng ln sc kho, cng ng thng cng rt nhy cm vi nhng n tng khi nhn thy loi cht thi thuc v gii phu, cc b phn ca c th ngi b ct b nh t chi, rau thai bo nhi. i vi mt s nn vn ho, c bit l chu , nhng nim tin tn gio v i sng tm linh i hi cc phn ca c th phi c tr li cho gia nh ngi bnh trong nhng chic quan ti nh v c mai tng trong ngha a.
8.2. nh hng ca cht thi y t i vi sc khe cng ng 8.2.1. nh hng ca loi cht thi truyn nhim v cc vt sc nhn

i vi nhng bnh nguy him do virus gy ra nh HIV/AIDS, vim gan B hoc C, cc nhn vin y t, c bit l cc y t l nhng i tng c nguy c nhim cao nht, do h phi thng xuyn tip xc vi nhng vt sc nhn b nhim mu bnh nhn gy nn. Cc nhn vin bnh vin khc v nhng ngi vn hnh qun l cht thi xung quanh bnh vin cng c nguy c ng k, chng hn nh nhng nhn vin qut dn, nhng ngi bi rc ti cc bi rc (mc d nhng mi nguy c ny khng c ti liu ng tin cy chng minh). Nguy c ca loi bnh truyn nhim ny trong s cc bnh nhn v cng ng thp hn nhiu. Cc trng hp tai nn ring l hoc nhim trng th pht do cht thi y t gy ra c chng minh bi nhng ti liu ng tin cy. Tuy vy, nhn chung, rt kh nh gi trc tip nh hng ca cht thi rn y t, c bit l cc nc ang pht trin. T l cc tn thng hng nm do cc vt sc nhn trong cht thi y t v dch v v sinh mi trng c trong v ngoi cc bnh vin gy ra c c quan ng k cc c cht v Bnh tt Hoa K (ATSDR) nh gi. Nhiu tn thng gy ra do kim tim trc khi vt b vo cc thng cha, do nhng thng cha khng kn hoc c lm bng nhng loi vt liu d b rch, thng. Mt s nghin cu ti M cho thy, s nhim virus vim gan B hng nm M do tip xc vi cht thi y t vo khong t 162 n 321 ca so vi tng s 300.000 trng hp do tt c cc nguyn nhn mi nm. C nhng d liu v cc trng hp nhim trng khc lin quan ti cht thi y t nhng khng y c th cho php a ra bt k mt kt lun no. Nhiu khi da trn c s cc ch s vim gan B cho thy tt c cc nhn vin lm nhim v tip xc v vn chuyn cht thi y t nn c tim chng chng li bnh tt. Nh trnh by trn, y t v nhng nhn vin bnh vin l nhng nhm nguy c chnh b tn thng, t l tn thng hng nm ca nhng i tng ny vo khong 10 - 20 phn nghn. Cc nhn vin lao cng v nhn vin x l cht thi l nhng i tng c t l tn thng ngh nghip cao nht trong s cc nhn vin lm 125

ti cc c s y t, t l hng nm M l 180 phn nghn. Cho n thi im hin nay th Vit Nam vn cha c mt cng trnh nghin cu no phn nh c tnh trng tn thng do ngh nghip ca cc nhn vin y t.
8.2.2. nh hng ca cht thi ho cht v dc phm

Trong khi khng c ti liu khoa hc no cho thy mc ph bin ca bnh tt gy ra do cht thi ho cht hoc dc phm t cc bnh vin i vi cng ng, th nhiu trng hp nhim c quy m ln do cht thi ho cht cng nghip xy ra. Ngoi ra c nhiu v tn thng hoc nhim c do vic vn chuyn ho cht v dc phm trong bnh vin khng bo m. Cc dc s, bc s gy m, y t, k thut vin, cn b hnh chnh c th c nguy c mc cc bnh ng h hp, bnh ngoi da do tip xc vi cc loi ho cht dng cht lng bay hi, dng phun sng v cc dung dch khc. hn ch ti mc thp nht loi nguy c ngh nghip ny nn thay th hoc gim lng ho cht c hi xung bt c lc no c th v cung cp cc phng tin bo h cho tt c nhng ngi tip xc trc tip vi ho cht. Nhng ni s dng v bo qun loi ho cht nguy him cng nn c thit k h thng thng gi ph hp, hun luyn cc bin php phng h v cc trng hp cp cu cho nhng ngi c lin quan.
8.2.3. Nhng nh hng ca cc cht thi gy c gen

Cn phi c thi gian thu thp nhng d liu v nh hng lu di i vi sc kho ca cc cht thi gy c gen trong y t, bi v rt kh nh gi nh hng ca loi c cht phc tp ny ln mi nguy c i vi con ngi. Mt nghin cu c tin hnh Phn Lan tm ra mt du hiu lin quan gia sy thai trong 3 thng u ca thai k v tip xc ngh nghip vi cc thuc chng ung th, nhng cc nghin cu tng t ti Php v M li khng xc nhn kt qu ny. C rt nhiu nghin cu iu tra mi lin quan gia nguy c i vi sc kho v vic tip xc vi thuc chng ung th, biu hin ca mi lin quan ny l s tng t bin cc thnh phn trong nc tiu nhng ngi tip xc v tng nguy c sy thai. c mt s nghin cu cho thy rng nhng nhn vin qut dn trong bnh vin phi tip xc vi nguy c, c lng nc tiu tng vt tri so vi nhng y t v cc dc s trong bnh vin . Mc tp trung cc thuc gy c gen trong bu khng kh bn trong bnh vin cng c xem xt trong mt s nghin cu nhm nh gi cc nh hng n sc kho vi vic tip xc vi cc yu t nguy c. Hin vn cha c mt bng chng khoa hc no ghi nhn nhng hu qu bt li i vi sc kho do cng tc qun l yu km i vi cc cht thi gy c gen.
8.2.4. Nhng nh hng ca cht thi phng x

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Nhiu tai nn c ghi nhn do vic thanh ton v x l cc nguyn liu trong tr liu ht nhn cng vi s lng ln nhng ngi b tn thng do tip xc vi yu t nguy c. Brazil ngi ta phn tch v c y ti liu chng minh mt trng hp nh hng ca ung th ln cng ng c lin quan ti vic r r cht thi phng x trong bnh vin. Mt bnh vin chuyn v tr liu bng phng x trong khi chuyn a im lm tht thot ti a im c mt ngun x tr c nim phong; mt ngi dn chuyn n a im ny nht c n v mang v nh. Hu qu l c 249 ngi tip xc vi ngun phng x ny, nhiu ngi trong s hoc cht hoc gp hng lot cc vn v sc kho (IAEA-1988). Ngoi tr bin c xy ra ti Brazil, cn li khng c d liu khoa hc ng tin cy no c gi tr v nh hng ca cht thi phng x bnh vin. C th c nhiu trng hp tip xc vi cht thi phng x bnh vin c lin quan n cc vn v sc kho, song khng c ghi nhn. Ch c nhng bo co cc v tai nn c lin quan n vic tip xc vi cc cht phng x ion ho trong cc c s iu tr do hu qu t cc thit b X quang hot ng khng an ton, do vic chuyn ch cc dung dch x tr khng m bo hoc thiu cc bin php gim st trong x tr liu.
8.3. Ngun pht sinh cht thi rn y t nguy hi 8.3.1. Phn loi cht thi rn y t theo ngun pht sinh

nh ngha: cht thi rn y t nguy hi l cht thi dng rn pht sinh trong cc c s y t, t cc hot ng khm cha bnh, chm sc, xt nghim, phng bnh, nghin cu, o to. Vic phn loi v xc nh cht thi y t c th c tm tt nh sau: Cht thi lm sng bao gm cc nhm A (cht nhim khun: vt liu thm mu, dch, bng gc, bng bng, ti ng dch dn lu), nhm B (cc vt sc nhn), nhm C (cht thi c nguy c ly nhim cao pht sinh t cc phng xt nghim nh gng tay, lam knh, bnh phm), nhm D (cht thi dc phm bao gm dc phm qu hn, b nhim khun, thuc gy c t bo) v nhm E (cc m v c quan ngi, ng vt). Cht thi phng x pht sinh t cc hot ng chn on, ho tr liu v nghin cu nh ng tim, bm tim, giy thm, gc st khun Cht thi ho hc bao gm cc cht khng gy nguy hi v nguy hi nh formaldehyd, ho cht quang hc, cc dung mi, ho cht dng tit khun y t v dung dch lm sch, kh khun. Cc bnh cha kh c p sut. Cht thi sinh hot nh giy loi, vt liu ng gi, thc n d tha v cht thi ngoi cnh.
8.3.2. Khi lng cht thi pht sinh

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Khi lng cht thi y t thay i theo tng khu vc a l, theo ma v ph thuc vo cc yu t khch quan khc nh: C cu bnh tt, dch bnh. Loi, quy m bnh vin. Lng bnh nhn khm, cha bnh; t l bnh nhn ni v ngoi tr. iu kin kinh t x hi ca khu vc. Phng php v thi quen ca nhn vin y t trong vic khm, iu tr v chm sc. S lng ngi nh c php n thm bnh nhn. Tham kho ti liu nc ngoi cho thy khi lng cht thi hng nm thay i theo mc thu nhp (cc bng 5.4, 5.5 v 5.6).
Bng 5.4. Lng cht thi theo u ngi
Ngun thi Nc c thu nhp cao Cht thi bnh vin ni chung Cht thi y t nguy hi Nc c thu nhp trung bnh Cht thi bnh vin ni chung Cht thi y t nguy hi Nc c thu nhp thp Cht thi bnh vin ni chung 0, 5- 3kg/ngi 0,8 - 6kg/ ngi 0,3- 0,4kg/ngi 1,2 - 12 kg/ngi 0,4 - 5,5 kg/ngi Mc thi

Lng cht thi thay i theo tng loi bnh vin Bnh vin i hc y dc Bnh vin a khoa Bnh vin huyn Trung tm y t 4 1- 8,7kg/ging/ngy 2,1- 4,2kg/ging/ngy 0,5 - 1,8kg/ging/ngy 0,05-0,2kg/ging/ngy

Trong mi bnh vin, khi lng cht thi bnh vin pht sinh khc nhau t cc khoa, phng iu dng y t Khoa iu tr Khoa hi sc cp cu Bnh phm 1,5 kg/ging/ngy 1,5 - 3 kg/ging/ngy 3 - 5kg /ging/ngy 0,2kg/ging/ngy

Bng 5.5. Lng cht thi pht sinh ti cc nc trn th gii

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Tuyn bnh vin

Tng lng cht thi y t (kg/ging bnh/ngy)

Cht thi y t nguy hi (kg/ging bnh/ngy) 0,4 -1,6 0,2 - 1,1 0,1 - 0,4

Bnh vin trung ng Bnh vin tnh Bnh vin huyn

4,1 - 8,7 2,1 - 4,2 0,5 - 1,8

Bng 5.6. Lng cht thi pht sinh ti Vit Nam

Tuyn bnh vin Tng lng cht thi y t (kg/ging bnh/ngy) Bnh vin trung ng Bnh vin tnh Bnh vin huyn Chung 0,97 0,88 0,73 0,86 Cht thi y t nguy hi (kg/ging bnh/ngy) 0,16 0,14 0,11 0,14

Hin nay (s liu nm 1999), ton b cc c s do ngnh y t qun l t bnh vin, vin nghin cu, khu iu dng, nh h sinh, phng khm a khoa, phng khm chuyn khoa, khu iu tr phong n trm y t x l 12.772 c s vi s ging iu tr, an dng trong 1 nm l 174.077 ging. Trong c trn 830 bnh vin v vin c ging (29 bnh vin trung ng, 198 bnh vin tnh, 551 bnh vin huyn v 58 bnh vin ngnh) vi tng s 104.065 ging bnh. Tng s ln khm bnh trong mt nm l 127.824.420 ca, s ngi iu tr ni tr l 5.331.241, s ngoi tr l 4.958.430, s ca phu thut l 1.008.966. Tng s ngy nm vin trong mt nm (1999) l 43.782.221. y l cha k ti cc bnh vin ca qun i, cng an, cc bnh vin lin doanh, phng khm t nhn. Tng khi lng cht thi rn t cc bnh vin khong 240 tn mi ngy, trong t 12% n 25 % l cht thi y t nguy hi cn phi x l c bit. Ring thnh ph H Ni mi ngy c trn 12 tn cht thi rn bnh vin cn x l. Lng cht thi rn bnh vin ngy cng tng dn do s gia tng dn s, mc sng, s nng cao cht lng khm cha bnh.
8.3.3. Thnh phn cht thi rn bnh vin

Ngoi bnh nhn v nhn vin y t trong bnh vin ca chng ta hin nay lun c mt s lng ngi nh n thm, trng nom v phc v bnh nhn tng ng hoc nhiu hn s lng bnh nhn nm vin. Chnh hin trng ny lm cho h thng x l cht thi ca bnh vin hot ng ti mc qu ti v nhiu khi chnh cc i tng ny gp phn lm pht tn rc thi nguy him ra mi trng xung quanh.

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Theo mt s kt qu iu tra nm 1998 - 1999 ca cc n v nghin cu, c bit l ca d n hp tc gia B Y t v WHO, thnh phn mt s rc thi bnh vin Vit Nam c thng k trong bng 5.7.
Bng 5.7. Thnh phn rc thi bnh vin Vit Nam
Thnh phn rc thi bnh vin Giy cc loi Kim loi, v hp Thu tinh, ng tim, chai l thuc, bm kim tim nha Bng bng, bt b gy xng Chai, ti nha cc loi Bnh phm Rc hu c t v cc vt rn khc T l % 3 0,7 3,2 8,8 10,1 0,6 52,57 21,03

Tuy vy, y ch l tnh hnh chung, cn thnh phn cht thi rn c th ca tng bnh vin ph thuc rt nhiu vo cc iu kin c th nh: cp bnh vin trung ng hay a phng, mc thu nhp ca khu vc, thi quen tp qun, ch thm ving bnh nhn, loi chuyn khoa v.v.
8.4. Hin trng chung v cng tc qun l cht thi rn y t nguy hi ti cc bnh vin trn ton quc 8.4.1. Nhn nh chung

Phn ln cc bnh vin Vit Nam trong qu trnh thit k v xy dng nm trong giai on t nc cn ngho, tri qua chin tranh li cha c nhn thc ng nn u khng c phn x l cht thi nghim tc, ng quy trnh v ngy nay vn ny tr nn bc xc, gy nhim, bnh tt nghim trng cho mi trng bnh vin v xung quanh bnh vin, gy ra s khng ng tnh ca nhn dn m cc c quan bo ch, truyn hnh phn nh di dng cc phng s iu tra. C s vt cht k thut x l trit loi rc c hi ny thiu nghim trng. Vic thu gom v vn chuyn rc ph thi bnh vin ch yu bng phng php th cng v chuyn rc ra cc b rc, thng cha rc h, vi thi gian lu tr ch chuyn i t 1 n 7 ngy. Thi gian ny qu trnh phn hu cht thi din ra v gy nhim nghim trng, nht l trong iu kin kh hu nng m ca Vit Nam. Thm na, vi s tham gia ca chut, b, cn trng v ngi bi rc lm tng kh nng ly nhim, gy mt v sinh ngay ti bnh vin v mi trng sng xung quanh.

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Nhn thc ca cng ng ni chung v nhn vin y t ni ring v nhng nguy c tim n trong cht thi bnh vin cn rt km do cng tc gio dc, tuyn truyn cha c ch trng ng mc. Hin tng dn vo bi rc ti cc h rc ca bnh vin thu nht ng nha, kim tim, gng tay phu thut thm ch do nhn vin y t a rc ra ngoi ti ch, s dng li din ra mt s ni c cc c quan bo ch, truyn hnh phn nh chnh l do thiu qun l cht ch v cha c quy trnh x l rc trit . S lng bnh vin v c s khm cha bnh rt ln nn y l vn khng ch ca ring cc bnh vin, vn thuc din cc c quan hot ng cng ch, rt ngho v vn v qu ti v cc cng vic hng ngy nn s quan tm ca x hi v chnh ph ht sc quan trng. Nh nc t chc nhiu t tuyn truyn, vn ng cn b qun l, chuyn mn thy r trch nhim trong vn thu gom, phn loi v x l s b, gim thiu c hi trong kh nng hin c v bnh nhn cng gp phn gi gn v sinh mi trng bnh vin. Cht thi ti cc bnh vin thuc cc thnh ph thng c k hp ng thu gom vi cc cng ty mi trng th hoc c x l bng cc bin php t bng cc l t th s, khng t tiu chun v sinh mi trng hoc ngm formaldehyd ri tp trung chn lp ti cc ngha trang hoc trong cc khun vin bnh vin. Rt nhiu ph thi ly nhim, c hi c x trc tip ra bi rc sinh hot ca thnh ph m khng qua bt k mt khu x l cn thit no. Thy r c yu cu cp thit phi hon thin cng tc qun l cht thi y t ti cc c s khm cha bnh ca ngnh, nm 1998 B Y t thnh lp Ban Ch o x l cht thi bnh vin vi nhim v gip B trng trong cng tc ch o, xy dng quy hoch h thng x l cht thi bnh vin trong phm vi ton quc. Ngy 27/8/1999, B trng B Y t ban hnh Quy ch qun l cht thi y t v trong thi gian qua B Y t tin hnh nhiu t tp hun, kim tra n c thc hin quy ch ny. Ngoi ra, nhiu chng trnh nghin cu th im cc l t, chng trnh xy dng quy hoch tng th h thng cc l t trn ton quc ang c trin khai.
8.4.2. Hin trng cng tc qun l cht thi rn ti cc bnh vin

a. Phn loi cht thi bnh vin a s (81,25%) bnh vin thc hin phn loi cht thi ngay t ngun nhng vic phn loi cn phin din v km hiu qu do nhn vin cha c o to. Vic phn loi cha theo chun mc nh: cha tch vt sc nhn ra khi cht thi y t, cn ln nhiu cht thi sinh hot vo cht thi y t v ngc li. H thng k hiu, mu 131

sc ca ti v thng ng cht thi trc khi ban hnh Quy ch qun l cht thi cha thng nht. Cn nhiu bnh vin (45%) cha tch ring cc vt sc nhn ra khi cht thi rn y t lm tng nguy c ri ro cho nhng ngi trc tip vn chuyn v tiu hu cht thi. Trong s bnh vin tch ring vt sc nhn, mt s bnh vin (11,4%) cha thu gom vt sc nhn vo cc hp ng vt sc nhn theo ng tiu chun quy nh, cn li a s cc bnh vin (88,6%) thng ng vo cc vt t to nh chai truyn dch, chai nha ng nc khong.v.v.. b. Thu gom cht thi bnh vin Theo quy nh, cc cht thi y t v cht thi sinh hot u c h l v y cng thu gom hng ngy ngay ti khoa phng. Cc i tng khc nh bc s, y t cn cha c gio dc, hun luyn tham gia vo hot ng qun l cht thi y t. Tnh trng chung l cc bnh vin khng c o bo h v cc phng tin bo h khc cho nhn vin trc tip tham gia vo thu gom, vn chuyn v tiu hu cht thi. c. Lu tr cht thi bnh vin Hu ht cc im tp trung rc nm trong khu t bnh vin, v sinh khng m bo, c nhiu nguy c gy ri ro do vt sc nhn ri vi, nhiu cn trng xm nhp nh hng n mi trng bnh vin. Mt s im tp trung rc khng c mi che, khng c ro bo v, v tr gn ni i li, nhng ngi khng c nhim v d xm nhp. Ch c mt s t bnh vin c ni lu gi cht thi t tiu chun quy nh. d. Vn chuyn cht thi ngoi c s y t Nhn vin ca cng ty mi trng th n thu gom cc ti cht thi ca bnh vin, hin cha c xe chuyn dng chuyn ch cht thi bnh vin, c nhn vin bnh vin ln nhn vin ca cng ty mi trng th u cha c o to, hng dn v nguy c c lin quan n vic thu gom, vn chuyn v tiu hu cht thi. Qua iu tra cho thy a s cc nhn vin bnh vin khng bit ni tiu hu cui cng cht thi u. Vic phi hp lin ngnh km hiu qu trong mi cng on ca quy trnh qun l cht thi bnh vin. Mi c mt vi cng ty bc u nghin cu sn xut c phng tin thu gom v vn chuyn cht thi, tuy nhin cn ang giai on th im, cha sn xut i tr. Cc bnh vin phn loi cht thi y t v cht thi sinh hot tch ring nhng mt s a phng cng ty mi trng th t chi vn chuyn cht thi y t. Ch c 18,75% trong tng s cc bnh vin cht thi c vn chuyn ra khi bnh vin bng xe chuyn dng ca cng ty mi trng th. e. Cc phng php x l v tiu hu cht thi rn y t Thiu t cht thi rn y t:

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Trong nhng nm trc y khi u t xy dng bnh vin chng ta hon ton cha hch ton n khon chi ph cho x l cht thi. Phn ln cc bnh vin t xy dng ly l t ca mnh v sau v cng khng theo mt thit k mu no c. Tnh trng chung ca phn ln cc bnh vin trong c nc hin nay l thiu t cht thi y t ti cc l t th cng, khng c h thng x l kh thi k c nhng bnh vin ln c khi lng cht thi y t cn thiu t rt ng (k nh Bnh vin Vit c H Ni). Trong cc l t th cng xy bng gch, cht thi c t bng ci hoc du, khi bi, mi kh chu bay ra khu dn c. Hin ti, chng ta c mt s l thiu t cht thi rn y t tp trung ti H Ni v Thnh ph H Ch Minh vi cng ngh nhp ca nc ngoi. Thnh ph H Ch Minh c bn n nh c cng tc x l cht thi bnh vin nh c h thng qun l thu gom nng ng. Cn ti H Ni, sau 8 thng th nghim l hot ng tt, tuy vy cng sut ca l t ny cng ch gii quyt c 4 tn /ngy so vi nhu cu ca hng chc bnh vin ti thnh ph l trn 12 tn /ngy. Mt s bnh vin nh Vin Lao v Bnh phi, Bnh vin C Nng, Bnh vin Vng Tu vi s gip ca Cng ty o Wamed Engineering lp t l t cht thi y t Hoval MZ2 ca Thy S c cng ngh hin i vi nhit thiu t c hiu qu. Qua thi gian theo di trn 15 thng ca S Khoa hc - Cng ngh v Mi trng H Ni l t ca Vin Lao v Bnh phi thiu t trn 10 tn rc y t nguy hi vi kt qu tt, m bo an ton v mi trng. Tuy nhin, do s lng cht thi nguy hi ca Vin Lao v Bnh phi t (v tit kim kinh ph phn rc sinh hot ca Vin vn c x l theo hp ng vi Cng ty Mi trng th) nn cng sut thiu t ca l cha pht huy c ti a gy lng ph nhin liu v phng tin. Mt phng n khc phc l thu gom cht thi rn nguy hi ca cc bnh vin ln cn nh Bnh vin 354, Bnh vin Giao thng, Vin Bo v sc khe tr em t chung nh mt l t ca cm bnh vin. Vn t ra l ai s chu trch nhim vn chuyn bng phng tin chuyn dng v kinh ph s c chia s nh th no. Mt s bnh vin lp t l t hin i nhng li khng hot ng c v v tr t l t gn khu dn c v khi vn hnh khng ng k thut c khi en v mi bc ln b ngi dn phn i (Bnh vin Bch Mai) hoc hng cha c ph tng thay th (Bnh vin Hu ngh a khoa Ngh An). c mt s bnh vin lp t v vn hnh l t trong nc sn xut nh Bnh vin a khoa tnh ng Thp, Sc Trng (l t do Trng i hc Bch khoa Thnh ph H Ch Minh thit k v lp t), Trung tm Bo v b m tr em v K hoch ho gia nh tnh Ngh An (Vin Khoa hc vt liu). a s cc bnh vin thiu t trong l t th cng, khng t tiu chun v sinh mi trng. Gn y, T chc Y t Th gii cng vin tr cho B Y t 2 l t cht thi ch to ti nc ngoi trang b cho 2 bnh vin tuyn tnh. Va qua Chnh ph cng ph duyt d n ca B Y t trang b 25 l t cht thi bnh vin kiu Hoval bng ngun vn vay ca Chnh ph o. Cho n nay vn cha c mt nghin cu thng k c th no v cc loi l t hin ang hot ng t cc bnh vin Vit Nam v hiu qu x l ca cc l t thit k v ch to trong nc. Mt

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vn m cc nh mi trng quan tm l cng ngh x l dioxin to ra trong qu trnh t c x l nh th no. Chn lp cht thi rn y t: Trong hu ht cc bnh vin huyn cht thi y t c chn lp ti bi rc cng cng hay chn lp trong khu t ca mt s bnh vin. Trng hp chn lp trong bnh vin cht thi c chn vo trong cc h o v lp t ln, nhiu ch lp t ph trn qu mng khng m bo v sinh. Ti cc bnh vin khng c l t ti ch, bo thai, rau thai v b phn c th b ct b sau phu thut c thu gom em chn trong khu t bnh vin hoc chn trong ngha trang ti a phng. Nhiu bnh vin hin nay gp kh khn trong vic tm kim din tch t chn. Vt sc nhn c chn lp cng vi cc cht thi y t khc ti khu t bnh vin hay ti bi rc cng cng d gy ri ro cho nhn vin thu gom, vn chuyn cht thi v cng ng. Hin ti cn mt s bnh vin cht thi nhim khun nhm A c trn ln vi cht thi sinh hot v c thi ra bi rc ca thnh ph. Cht thi khng c x l c bit g trc khi tiu hu. Tr em c th o bi cc h chn rc ly cc th trong lm chi.
8.5. Cc vn bn php quy ca Vit Nam lin quan n cng tc qun l cht thi bnh vin 8.5.1. Lut Bo v mi trng c Quc hi thng qua ngy 27/12/1993

iu 26: Vic t cc im tp trung, bi cha, ni x l, vn chuyn rc v cht gy nhim mi trng phi tun theo quy nh ca c quan qun l Nh nc v bo v mi trng v chnh quyn a phng. i vi nc thi, rc thi c cha cht c hi, ngun dch gy bnh, cht d chy, d n, cc cht thi khng phn hu c phi c bin php x l trc khi thi. C quan qun l Nh nc v bo v mi trng quy nh danh mc cc loi nc thi, rc thi ni khon ny v gim st qu trnh x l nc thi trc khi thi. iu 29, Khon 3: Nghim cm thi du m, ho cht c hi, cht phng x qu gii hn cho php, cc cht thi, xc ng vt, thc vt, vi khun, siu vi khun c hi v gy dch bnh vo ngun nc.
8.5.2. Ngh nh s 175 - CP ngy 18/10/1994 ca Chnh ph v thi hnh Lut Bo v Mi trng

iu 27: Mc 1: Mi c s sn xut, kinh doanh, bnh vin, khch sn, nh hng v..v... c cc cht thi dng rn, lng, kh cn phi t chc x l t tiu chun mi trng 134

trc khi thi ra ngoi phm vi qun l ca c s mnh, cng ngh x l cc loi cht thi trn phi c cc c quan qun l Nh nc c thm quyn xt duyt.
8.5.3. Php lnh An ton v kim sot bc x c y ban Thng v Quc hi

thng qua ngy 25/06/1996.

8.5.4. Ch th s 199/TTg ngy 03/04/1997 ca Th tng Chnh ph v

nhng bin php cp bch trong cng tc qun l cht thi rn cc th v khu cng nghip.
8.5.5. Ngh nh s 50/1998/N -CP ngy 16/07/1999 ca Chnh ph quy nh chi

tit v vic Php lnh An ton v kim sot bc x.

8.5.6. Quyt nh s 155/1999/Q -TTg ngy 16/07/1999 ca Th tng Chnh ph v vic ban hnh Quy ch qun l cht thi nguy hi. 8.5.7. Cc vn bn lin b

Thng t lin tch s 1590/1997/TTLT-BKHCNMT-BXD ngy 17/07/1997 ca B KHCN & MT v B Xy dng hng dn thi hnh Ch th s 199/TTg ca Th tng Chnh ph v cc bin php cp bch trong qun l cht thi rn cc th v khu cng nghip. Thng t lin tch s 2237/1999/TTLT/BKHCNMT-BYT ngy 28/12/1999 ca Lin B Khoa hc - Cng ngh & Mi trng v B Y t hng dn vic thc hin an ton bc x trong y t, trong c hng dn x l cht thi phng x trong cc c s y t.
8.5.8. Cc vn bn ca B Y t

Thc hin cc vn bn quy phm php lut Nh nc ban hnh, qua nghin cu thc t, B Y t ban hnh mt s vn bn v qun l cht thi y t: Quy ch bnh vin ban hnh theo Quyt nh s 1895/1997/BYT-Q ngy 19/09/1997 c Quy ch cng tc x l cht thi. Quy ch qun l cht thi y t: ngy 27/08/1999 ca B trng B Y t ra Quyt nh s 2575/1999/Q -BYT ban hnh Quy ch qun l cht thi y t lm c s cc c s y t thc hin qun l v x l cht thi y t. Quy hoch tng th h thng x l cht thi rn y t. Xy dng Quy hoch tng th h thng x l cht thi rn y t, lm c s u t xy dng h thng l thiu t cht thi rn y t, m bo tit kim kinh ph u t v vn hnh c hiu qu. Chnh ph Php ng vin tr cho Vit Nam mt khon kinh ph l 300.000 la M thc hin cng vic ny ngay t nm 2000. B Y t ang phi hp vi mt Cng ty t vn ca Php tin hnh xy dng cng nghin cu cng vi vi

135

cc b, ngnh c lin quan xy dng Quy hoch tng th h thng x l cht thi rn y t.

8.6. Nhng tn ti, kh khn trong vic x l cht thi rn y t

Hin nay, cht thi bnh vin ang tr thnh vn v mi trng v x hi cp bch nc ta. Hin trng x l cht thi bnh vin km hiu qu ang gy d lun trong cng ng v t ra nhiu thch thc i vi nhiu cp, ngnh, c bit l ngnh mi trng v y t. Tuy nhin, gii quyt vn ny khng phi mt sm mt chiu v chng ta ang i mt vi rt nhiu kh khn. Ngun kinh ph u t cho x l cht thi y t l rt ln. Theo c tnh s b, tng kinh ph cho ton b chng trnh u t xy dng h thng x l cht thi rn, lng, kh vo khong 1,16 t ng cha k chi ph cho s dng t, phng tin thu gom, vn chuyn, kinh ph vn hnh v bo tr. Vn u t cn c huy ng t cc ngun ngn sch Nh nc, h tr ca cc t chc quc t, ngun gip ca cc t chc chnh ph v cc t chc phi chnh ph. Hin nay, cc bnh vin c l t nhng kinh ph mua nng lng vn hnh, x l tro, tr lng cho nhn cng cn cha c quy nh s ly t u. Cc bnh vin khng th t tin nng gi khm cha bnh b vo chi ph x l cht thi ca mnh. V vy, c bnh vin c trang b l nhng vn khng vn hnh v khng c kinh ph. Nhn thc v thc hnh x l cht thi trong cn b y t, nhn vin trc tip lm cng tc x l cht thi v bnh nhn cn cha cao, lm nh hng khng nh n cht lng phn loi, thu gom, vn chuyn v tiu hu cht thi. Mt s lnh o bnh vin cha thc s quan tm n vic x l cht thi. Vic tuyn truyn gio dc thc cng ng cha su rng, i khi d lun qua bo ch cn lm nhn dn hoang mang, gy tm l qu lo s i vi cht thi bnh vin v t gy sc p khng ng c ln cc c quan qun l chuyn ngnh. Mi trng thc hin php ch cha thun li. Mc d c Lut Bo v Mi trng, Quy ch qun l cht thi nguy hi do Th tng Chnh ph ban hnh v Quy ch cht thi y t do B trng B Y t ban hnh nhng cc vn bn php quy ny cha thm su vo i sng. Vic thc hin tt Quy ch qun l cht thi y t mi ch c mt s t bnh vin. Nhiu ni chnh quyn vn cha quan tm u t kinh ph v phng tin thc hin Quy ch ny. Cc gii php v x l cht thi cha ng b, s phi hp lin ngnh cn km hiu qu trong mi cng on qun l cht thi. Nhiu ni bnh vin phn loi cht

136

thi y t v cht thi sinh hot nhng cng ty mi trng th t chi vn chuyn cht thi y t. Chng ta cha c quy nh c th trch nhim ca tng b, ngnh trong tng cng on qun l cht thi y t.

8.7. Hng dn x l cht thi rn y t ca B Y t 8.7.1. Thiu t cht thi rn y t

a. M hnh thiu t cht thi rn y t nguy hi p dng cho cc thnh ph ln Xy dng v vn hnh l t khu vc t cht thi y t nguy hi tp trung cho ton thnh ph: Cc thnh ph ln nh H Ni, Thnh ph H Ch Minh l nhng ni tp trung nhiu bnh vin ln, lng cht thi rn y t pht sinh nhiu. Cc bnh vin ti y thng nm gn khu dn c, c quan, trng hc. V vy, vic lp t mi bnh vin mt l t cht thi y t l khng c li c v mi trng v kinh t. Vic xy dng v vn hnh l t trung tm c cng sut ln thiu t cht thi rn y t phc v cho cc c s y t cc thnh ph ln va mang li li ch v kinh t v mi trng, va mang tnh kh thi. Trn thc t, mt s bnh vin ti H ni xy dng v lp t l t tng i hin i trong khun vin bnh vin nhng khng th vn hnh c v l t t st vi nh dn, khi l t vn hnh, khi ca l t to ra v ngi dn lm n kin ngh (Bnh vin Bch Mai). L t tp trung nn t ngoi thnh ph, xa khu dn c v c ng giao thng thun tin cho vic chuyn ch cht thi v gn bi chn lp cht thi. Xy dng v vn hnh l t cht thi cho cm bnh vin: L t cht thi cho cm bnh vin c th t ti bnh vin c khun vin thch hp hoc t ti mt khu t ring theo quy hoch ca thnh ph, c ng giao thng thun tin cc c s y t ln cn chuyn ch cht thi y t nguy hi n thiu t. Ti bnh vin t l t cho cm bnh vin, ni lu gi cht thi y t phi c thit k lu gi cht thi cho cc bnh vin trong cm. S dng c s tiu hu cht thi nguy hi cng nghip nu c trong a bn. b. M hnh thiu t cht thi rn y t cho cc th x Xy dng v vn hnh l t cht thi y t theo cm bnh vin. Mt s thnh ph c bnh vin chuyn khoa pht sinh nhiu cht thi c ly nhim cao nh bnh vin lao, bnh vin truyn nhim c th t l t c cng sut nh ti khun vin bnh vin hn ch vn chuyn cc cht thi c ly nhim cao ra ngoi bnh vin. 137

L t trong khu t bnh vin khng c t gn khu dn c, ng khi ca l t phi cao hn khu nh cao tng ln cn, v tr ca l t phi cui hng gi ch o trong nm.

c. M hnh x l cht thi rn y t i vi cc trung tm y t huyn Vi nhng trung tm y t huyn gn c s thiu t cht thi y t khu vc hay cm bnh vin th hp ng vi cc c s ny thiu t cht thi y t Vi nhng trung tm y t huyn xa c s thiu t cht thi th c th p dng thiu t cht thi nguy hi bng l t cng sut nh. Tro v cc thnh phn cn li sau khi t s c chn lp hoc tiu hu cng cht thi sinh hot. d. i vi phng khm a khoa, nh h sinh, trm y t x C th p dng phng php thiu t trong l t th cng hoc thiu t ngoi tri. Kh thi ca l t phi t tiu chun kh thi l t Vit Nam. Tuy nhin, i vi cc bnh vin, cc c s y t nh c lng cht thi rn y t khng nhiu m p dng l t th cng th kh c th t c tiu chun ny.
8.7.2. Chn lp cht thi

a. Quy nh v chn lp cht thi trong quy ch qun l cht thi y t Ch p dng cho nhng c s y t cha c iu kin thiu t cht thi y t nguy hi Khng chn ln cht thi y t nguy hi vi cht thi sinh hot. Ch c php chn cht thi y t nguy hi ti cc khu vc c quy nh. Bi chn lp cht thi y t nguy hi phi p ng cc ch tiu mi trng v cc yu cu k thut do c quan qun l v mi trng hng dn v thm nh. b. Yu cu i vi chn lp cht thi y t Khng p dng phng php ny i vi cht thi y t nguy hi cha qua x l ban u. Cc yu cu ti thiu i vi a im qun l bi chn lp cht thi nh sau: Khng cht thi thnh ng ngoi tri. Nhn vin c kin thc nht nh v qun l cht thi c hi. Thit k ni chn lp cht thi trnh cc vt th lng t bi thi r r ra ngoi mi trng.

138

 Chn lp nhanh cht thi y t trnh ngi v ng vt tip xc. c. Chn lp cht thi ti bi chn lp cht thi ca thnh ph Trong trng hp cht thi y t nguy hi khng c iu kin x l hay tiu hu bng cc phng php khc th ti bi chn lp cht thi ca thnh ph phi dnh mt ni c thit k ring dnh cho cht thi y t nguy hi. Khu vc ny hn ch vic tip cn ca ngi v ng vt, vic chn lp cht thi phi c tin hnh nhanh chng, ng thi phi u t cc phng php x l cht thi thch hp hn. d. Chn lp cht thi trong khun vin bnh vin Phng php ny ch p dng i vi cc bnh vin vng su, vng xa v cng ch l phng php tm thi c p dng theo nhng nguyn tc sau: Vic tip cn ti nhng v tr ny phi c kim sot cht ch. Ni chn lp c lt bng vt liu chng thm. Ch chn cht thi y t nguy hi. Ph t ln trn mi lt cht thi. Trnh lm nhim mch nc ngm.
8.7.3. Phng php chn lp cht thi sau khi ng gi

Phng php ny c thc hin bng cch cho cht thi vo thng kim loi hoc thng nha y n 3/4 ri cho thm bt nha, catbium, va xi mng hoc cht liu lm bng t st. Sau khi kh, gn kn thng v chn lp nhm hn ch s tip xc v pht tn ca cht thi. Phng php ny c th p dng i vi vt sc nhn, ho cht, thuc
8.7.4. Phng php lm tr ho (inertization)

Dng my nghin nt cht thi, trn thm nc vi, xi mng, sau kh, lu gi hoc chn lp, thi vo bi thi ca thnh ph. Phng php ny p dng i vi cht thi ho hc, dc hc v tro ca l t.
BI TP TNH HUNG Mc tiu

1. Trnh by c cht thi rn c pht sinh nh th no trn phm vi a phng. 2. p dng c nhng kin thc l thuyt v qun l cht thi rn trong cc tnh hung c th. 3. xut c nhng gii php kh thi cho vic qun l cht thi rn ti x X. 139

Tnh hung

X X ti tnh Y- Vit Nam c tt c 8 lng vi tng s 12.000 dn. Hu ht dn c trong vng u lm ngh nng, tuy nhin, c hai lng ngh tham gia sn xut gm v thuc da. Trn a bn ca x c mt bnh vin lao (100 ging), hin ti cha c mt phng php chnh thc cho vic thu gom v x l cht thi rn sinh hot ti cc khu dn c trong x. Ngi dn ch yu l cht thi rn lm phn hoc dng bin php t, ng tic l vic t cht thi rn lm nhim khng kh trong vng v mt s tr em b cc bnh v ng h hp trn mt cch thng xuyn. Bnh vin hin ti ang p dng bin php chn lp cht thi rn ti a im trong bnh vin. Din tch dnh cho vic chn lp cng c s dng gn ht.
Cu hi

Hy lp mt k hoch ph hp v kh thi cho x trong vic qun l cht thi sinh hot ti cc lng v cht thi y sinh (k c vt sc nhn v cht thi rn thi ly nhim t bnh vin). Mt s hng dn cho sinh vin trong vic lp k hoch: 1. Lit k nhng vn hin nay lin quan n cht thi rn ca x X bao gm cht thi sinh hot, cht thi y sinh v cht thi ti cc c s sn xut cng nghip c nh. Lit k nhng nh hng sc kho c th xy ra nu khng qun l tt cht thi rn t cc h dn v t bnh vin lao. Xem xt nhng vn mi trng lin quan ti vic chn cht thi bnh vin Hy xem xt xem lm th no kim sot vn ly nhim trc khi cht thi rn c em chn ti bi rc trong bnh vin hoc c a n x l mt ni khc. M t cc gii php kh thi nhm gii quyt vn thu gom v x l cht thi rn ca x vi tc ng ti thiu ln mi trng v sc kho con ngi.

2. 3. 4.

5.

T LNG GI in t thch hp vo ch trng

1. Cht thi rn l cht thi ............... pht sinh t cc hot ng sinh hot, thng mi, dch v th, nng nghip, cng nghip, xy dng, v.v... 2. Cht thi rn c phn loi theo v tr hnh thnh, theo thnh phn ha hc v vt l, theo ....................., v theo ........................ 3. Trong cng tc qun l cht thi rn, cn p dng nguyn tc 3R, l: gim thiu ngun pht sinh, ..............................., v ..........................

140

4. Vit Nam, hin nay c nhng phng php x l rc sau: bi rc, .................., phn (composting), ............................., thu hi v ti s dng. 5. Bn bc trong chu trnh qun l cht thi rn y t m C quan Bo v mi trng Hoa K khuyn co l: ..........................., ti ch v ti s dng, ......................., v chn lp hp v sinh. Hy nh du x vo mt la chn duy nht 6 7 V mt bn cht, cc h sinh thi l bn vng Khi dn s ngy cng tng, vn cht thi rn ngy cng tr nn phc tp, tuy nhin cc h sinh thi c kh nng t phn hy nhng cht thi Cht thi sinh hot l cc cht thi c lin quan n cc hot ng ca con ngi, c to thnh ch yu t cc khu dn c, cc khu thng mi, cc khu cng nghip, cc nh my, v.v... Bn cht mi nguy c ca cht thi rn y t c th c to thnh t mt hoc nhiu c trng c bn: (1) cha ng cc yu t truyn nhim, (2) cht t c hi c trong rc thi y t; (3) cc ha cht v dc phm nguy him, (4) cc cht thi phng x, (5) cc vt sc nhn. Nhng i tng thng xuyn phi phi nhim vi cht thi rn y t bao gm bc s, y t, h l v cc nhn vin hnh chnh ca bnh vin / c s y t

O ng O ng O ng

O Sai O Sai O Sai

O ng

O Sai

10

O ng

O Sai

141

BI 6

NC V V SINH NC

MC TIU

1. Nu v m t c cc ngun nc khc nhau trong t nhin. 2. Trnh by c mi quan h gia cht lng nc v sc kho con ngi. 3. Trnh by v vn nhim nc v qun l cht lng nc.
1. GII THIU V CC NGUN NC TRONG THIN NHIN, VN CUNG CP NC V QUN L NGUN NC 1.1. Ngun nc trong thin nhin

Hnh tinh ca chng ta c din tch khong 510 triu km2, trong bin v i dng l 70,8%, lc a 29,2%. Theo cc nh khoa hc th tng lng nc trn tri t chng 1, 45 t km3 c phn chia nh sau: Bin v i dng chim 93,96%. Nc ngm chim 4,12%. Bng h chim 1,65%. H chim 0,019%. m trong t chim 0,006%. Hi nc trong kh quyn chim 0,001%. Sng chim 0,0001%.

Ni mt cch khc, khong 70% tri t c bao ph bi nc, nhng ch c 2,5% th tch nc trn tri t l nc ngt (l ngun nc m con ngi, ng vt v thc vt c th tiu th); trong 2,5% ny th khong 1,7% l b ng bng v lng

142

cn li ch 0,8% l c gi trong t, sng, h, trong kh quyn v.v. (Postel, Daily v Ehrlich, 1996). Chu trnh tun hon ca nc trong thin nhin: Mi ngi u bit chu trnh chuyn ho ca nc trong t nhin l: gn mt na nc ma bc hi cng t, v cy v ng vt; cn na kia chy vo sng h v ngm xung t. Cui cng nc b mt v nc ngm tp trung bi cc dng chy s tr li bin. Nc bc hi t mt bin v mt t tp hp trong my v chu trnh ti din. Hnh 6.1 trnh by vng tun hon nc trong t nhin.

Nhng m my tch t hi nc

Bc hi khi ma

Bc hi t thc vt Bc hi t ao h

Bay hi t t

Bay hi t cc i dng Bay hi t sng sui

Thm

Nc thm vo t

Hnh 6.1. Vng tun hon nc trong t nhin

1.1.1. Nc bin v i dng

Nc bin v i dng chim mt th tch kh ln vi hm lng mui trung bnh 3,5g/lt. Con ngi cha sc v kh nng s dng d dng ngun nc ny phc v cho nhu cu hng ngy ca mnh.
1.1.2. Nc ngm

Nc nm su trong lng t c tr lng kh ln, ngun nc ngm ti cc khu vc c th khai thc c chim khong 4 triu km3 nhng con ngi cng khng d 143

dng khai thc v s dng. Nc ngm nng cch mt t t 5 -10 m, cht lng nc tt nhng cng thay i, c lin quan mt thit vi nc mt v cc ngun nhim trn mt t, lu lng cn ph thuc theo ma. Nc ngm su c cht lng n nh nhng su t 20-150 m so vi mt t nn vic khai thc gp kh khn. Nc ngm mt s vng ti Vit Nam c hm lng st cao t 1- 20 mg/l. Vit Nam, do lng nc ngm phn b khng ng u, khai thc ty tin v khng c qun l cht ch, thm vo l thc bo v ti nguyn mi trng cn thp nn nhiu ni hin ang phi i mt vi nguy c nhim v cn kit ngun nc ngm cng vi cc nguy c st ln mt t.
1.1.3. Nc sng h (nc mt)

y l loi nc m con ngi c th s dng v khai thc d dng, thun li phc v cho mi hot ng hng ngy nhng li chim t l kh nh 0,0191%, vi tr lng chng 218.000 km3 nc, phn phi u khp mi ni. Vit Nam c mt h thng sng ngi dy c, c tnh c nc c khong 2360 con sng vi chiu di trn 10km. Trong s ny c 8 con sng ln vi tr lng t 10.000 km3 tr ln (World Bank, 2003). Tuy nhin, trong qu trnh hot ng, con ngi thi cc cht bn lm nhim ngun nc mt gy nn tnh trng thiu nc sch nhiu ni.
1.1.4. Nc ma

Bn cht ca nc ma l rt sch. Nhng nc ma c nhc im l khng s lng cung cp nc dng trong c nm cho nhng tp th ng ngi, s lng nc ma ph thuc theo ma trong nm hm lng mui khong thp, ng thi, nc ma phn b khng ng u v mt a l, c nhng vng ma rt nhiu ln trong nm nhng c nhng vng sa mc th lng ma li rt t. Nc ma b nhim bn bi khng kh b nhim, cch thu hng cha ng khng m bo v sinh. Tuy vy, nhng vng khan him nc cn tn dng nc ma n ung.
2.2. Cung cp nc cho cc vng th v nng thn

Trong hn 45 nm qua T chc Y t Th gii (WHO) khng ngng tp trung vo vn cp nc sinh hot v nhng nh hng ti sc kho con ngi. Mt trong nhng mc tiu chnh ca WHO l: Tt c mi ngi, khng phn bit gi, tr, iu kin kinh t -x hi u c quyn c nc an ton cho sinh hot. Theo WHO, t l dn c cung cp nc tng t 79% (4,1 t ngi) nm 1990 n 82% (4, 9 t ngi) nm 2000. Vo u nm 2000, khong 1/6 dn s th gii (1,1 t ngi) khng c cung cp nc sch m ch yu l cc nc chu v chu Phi. Trong 10 nm qua, dch v cung cp nc sch nng thn tng ln nhng thnh ph li gim i.

144

Tuy nhin, t l ngi dn nng thn c cung cp nc sch vn t hn rt nhiu so vi thnh ph. WHO d on rng trong vng 25 nm ti, dn s th chu s tng ln gp i, chu Phi s tng ln hn gp i. Theo nh d on ny th cc thnh ph chu Phi v chu s ng trc mt thch thc rt ln nhm p ng nhu cu v nc sinh hot cho nhn dn. Theo mc tiu ca Hi ng Quc t v Cung cp nc sch v Cng trnh v sinh (WSSCC) th n nm 2025 tt c ngi dn trn th gii s c cung cp nc sch, ngha l s c thm khong 3 t ngi s c nc sch sinh hot hay trung bnh c thm 330.000 ngi c cung cp nc sch mi ngy trong vng 25 nm ti. Theo thng k nm 2000 ca WHO v Qu nhi ng Lin hp quc (UNICEF) th trn th gii c 23 quc gia t mc 100% dn s c s dng nc sch hoc ngun nc c bo v. Theo chng trnh nghin cu chin lc quc gia v cp nc v v sinh mi trng nng thn ca NRWSS (1998) th vng Bc Trung B l vng c t l ngi dn c s dng ngun nc an ton cao nht trn 7 vng sinh thi Vit Nam, nhng t l ny cng ch mi t 35-40%. ng bng Sng Cu Long ch c 25% s ngun nc c xp l an ton. Theo s liu thng k ca Qu nhi ng Lin hp quc v WHO th nm 2000, Vit Nam c 56% dn s c s dng ngun nc an ton hoc c bo v, trong c 81% dn thnh th v 50% dn nng thn. Tuy nhin, theo s liu thng k ca Trung tm Nc sinh hot v V sinh mi trng Nng thn (2004), nm 2000 ch mi c 42% nhng n ht nm 2004 c 58% dn s nng thn c cp nc sch. ng Nam B l vng c t l s dn s dng nc sch cao nht (65%) v Ty Nguyn l vng c t l s dn s dng nc sch thp nht (50%). Theo B Nng nghip v Pht trin nng thn, mc tiu ra n nm 2020 l m bo 100% dn s trong c nc c cp nc sch vi tiu chun 120-150 lt/ngi/ngy, thnh ph ln l 180-200 lt /ngi/ngy. ng thi p ng nhu cu nc cho pht trin cng nghip v cc dch v x hi khc.
2.2.1. Cung cp nc cho th Vit Nam

Nc cung cp cho dn c thnh ph - th c ly t trm cp nc ca thnh ph. Trm cp nc c th chn ngun nc tt nht v a im cng nh v cht lng. Nc c phn phi trong ng ng c s kim sot ca chuyn mn v tiu chun nc n ung v sinh hot. Tu theo ngun nc cung cp cho trm cp nc (nc ngm hay nc mt) m trm cp nc c nhng cng on sn xut nc nh nu trong hnh 6.2. 145

H thng cung cp nc my cho nhn dn thnh ph gm: ni bm nc t sng hoc ging, ni lc nc, ni tit khun nc v ng ng dn nc ti tn ni dng. S mt h thng cung cp nc ly t sng hay h nh sau: ch sch nht ca sng /h t bm ht nc v dn nc v nh my. Nu nc tiu chun v sinh, nc s chy vo b cha nc sch, ri li bm vo cc ng dn ngm ti cc vi nc.

Ngun nc ngm

Ngun nc mt

Ging khoan, trm bm cp

Sng, h trm bm cp 1

B phn kh st

B phn lng s b

nh phn lm trong B lng

B lc Kh khun Mng li phn phi B cha

Hnh 6.2. Cc cng on sn xut nc

mt vi nh my nc, nu nc tiu chun v sinh, ngi ta bm nc sng ln i cha nc cao hn cc nh trong thnh ph, nc theo trng lc t chy xung ng dn n cc vi nc. Nh vy s khng cn n bm. Thng nc bm ln khng ng tiu chun v sinh v cn phi ch ho (lc v tit khun) trc khi vo b cha v ng dn. H thng cung cp nc s gm thm cc b lc sch (nh b lng, b lc). Bm nc sng (hay h) ln b lng ri nc chy sang b lc. Nc lc sch chy vo mt ng chnh nhn liu clo cn thit tit khun, ri ti b cha v bm vo ng dn. 146

Phi gi gn ng dn nc cho tt ngn nga nc bn trn mt t khng th ngm vo. My bm nc bao gi cng phi c sc y nc t ng dn ln cc tng gc cao. Nu dng nc ngm cung cp nc ung cho thnh ph th cch xy ct nh my nc c hi khc. Ging khoan l phng php chnh ly nc ngm. Ging ng thng, hnh tr v xung ti tng nc su. Thnh ging l nhng ng bng kim loi. Ging khoan l phng php chnh ly nc ngm. Ging ng thng, hnh tr v xung ti lp nc su. Thnh ging l nhng ng bng kim loi.
2.2.2. Cung cp nc cho nng thn

Tu theo tnh hnh c th v ngun nc v cht lng nc ca tng a phng m la chn hnh thc cung cp nc n ung v sinh hot cho ph hp. C th p dng mt trong cc hnh thc cung cp nc sau y: a. B cha nc ma Nc ta nm trong khu vc ma tng i nhiu 1900-2000 mm/nm. Tnh trung bnh lng ma l 1600 mm/nm. Tng lng nc c tnh l 600 t m3. B cha nc ma c th p dng cho cc vng: o ging b nc mn (vng ven bin, hi o, ng bng Nam b...). o su khng gp nc ngm. b. Ging khi L hnh thc cung cp nc ph bin nc ta hin nay. Ging khi xy khu: c p dng cho vng c ngun nc ngm cch mt t t 5-10 m. Ging xy bng khu gch hay bng cng b tng. Ging c sn, nn bng gch hay xi mng, c gu mc nc, ging nn xa ngun bn 10 -15 m. Hng nm tng v sinh ging, vt bn y, sa cha thnh vch, sn ging, rnh thot nc bn (xem s ging khi xy khu, hnh 6.3). Ging khi su 3 - 4 m (hnh 6.4): p dng cho vng ven bin, hi o v o su d b nhim mn. ng knh ging 1 - 2 m, su 3 - 4 m. Ging ho lc (hnh 6.5): p dng cho nhng vng o su khng c nc ngm, phi dng nc ao, h, nc sui, nc ging t... Nc c chy vo ging qua mt ho lc ct di y ging. i vi vng ven bin th ho lc cn c bt kn nhim mn. Ging chn i, chn ni (hnh 6.6): p dng cho vng c ni, g, i... a im o ging cn chn ni c nhiu cy c mc quanh nm, hoc ni c mch

147

nc nh chy ra. Khi o ging chn i th xung quanh phi p b xy thnh ging ngn nc bn chy vo ging pha trn khng c ngun nhim bn. Ging bn sng, bn sui, bn h: nc ta c hng nghn con sng ln nh, c 4000 - 5000 h cha nc t nhin v nhn to, c tr lng nc rt ln cung cp nc cho cng nghip, nng nghip v sinh hot hng ngy ca con ngi. Ti nhng a phng ny c th p dng ging ho lc, ly nc t sui, sng, h ...

Rnh thot nc

0,8m 1m

t st

Nc

Hnh 6.3. S ging khi xy khu

1m-2m 1m 0,7 m

3 -4 m

148

Hnh 6.4. Ging khi su 3-4m

1,5-3m Ao h

Ging y

Ho ct lc

Hnh 6.5. Ging ho lc

Hnh 6.6. Ging chn i, ni

c. B cha nc, p cha nc khe ni (hnh 6.7) nhiu vng c ngun nc chy quanh nm khng cn, c th xy b cha hoc p ngn nc ri dn nc v khu vc dn c bng ng ng. Nc c th t chy nh s chnh lch v cao t 30-60 m. thu nc, p ngn nc cn c mi che, xung quanh c hng ro bo v cho h thng thu nc.

149

B cha nc khe ni

ng dn nc

Hnh 6.7. B cha nc, p cha nc khe ni

d. Ging khoan t my bm tay (hnh 6.8) Da vo c im ca nc ngm su l n nh tng i v tr lng v cht lng nc, ngi ta khoan su ly nc ngm phc v cho nng thn. Ging khoan c t my bm tay, gim sc lao ng, cht lng nc n nh v v sinh.

Hnh 6.8. Ging khoan t my bm tay

2. CHT LNG NC, V SINH NC V MI QUAN H CA CHNG VI SC KHO CNG NG 2.1. Cht lng nc v tiu chun

150

Tu theo yu cu ca vic s dng nc vo cc mc ch khc nhau nh nng nghip, cng nghip, ng nghip, vn ho, th dc th thao, phc v n ung v sinh hot m quy nh nhng tiu chun ca ngnh. i vi nc n ung v sinh hot c tiu chun quc t, tiu chun khu vc, tiu chun quc gia v tiu chun a phng. Tiu chun quc t v nc sinh hot l tiu chun ca T chc Y t Th gii (WHO), ban hnh nm 1958 v b sung sa i nm 1963, 1971 v 1984. Tiu chun bao gm 3 nhm ch tiu: vt l, ho hc (cht v c tan, cht hu c) v sinh hc. Nm 2002, vi s gip ca Unicef, B Y t xy dng v ban hnh Tiu chun v sinh nc n ung theo Quyt nh s 1329/2002/BYT-Q ngy 18/4/2002 ca B trng B Y t gim st cht lng nc dng cho n ung v sinh hot. Tiu chun ny quy nh ngng ti a cho php ca 112 ch tiu vt l, ho hc v sinh hc. y l cha kho php l cho c ngi tiu dng cng nh nh sn xut v cung cp nc sch. Tuy nhin, phm vi p dng ch yu l i vi th, cng trnh cp nc tp trung cho 500 ngi tr ln, do vy i vi vng nng thn hin cha phi l i tng p dng bt buc. khc phc hn ch ny, B Y t ban hnh Tiu chun ngnh: Tiu chun v sinh nc sch theo Quyt nh s 09/2005/BYT-Q ngy 11/3/2005 ca B trng B Y t. Tiu chun ny ch quy nh 22 ch tiu c bn v cm quan, thnh phn v c v vi sinh vt. Tiu chun ny p dng i vi cc hnh thc cp nc sch h gia nh, cc trm cp nc tp trung phc v ti a 500 ngi v cc hnh thc cp nc sch khc. Nc sch quy nh trong tiu chun ny ch l nc dng cho cc mc ch sinh hot c nhn v gia nh, khng s dng lm nc n ung trc tip. Nu dng trc tip cho n ung phi x l t tiu chun v sinh nc n ung ban hnh km theo Quyt nh s 1329/Q -BYT ngy 18/4/2002 ca B trng B Y t. Nhn chung, v mt s lng c th chp nhn c mc 30l/ngi/ngy nng thn v 100 - 150l/ngi/ngy thnh th. V mt cht lng, nc dng n ung v sinh hot phi m bo nhng yu cu chung sau y: Nc phi c tnh cm quan tt, phi trong, khng c mu, khng c mi, khng c v g c bit gy cm gic kh chu cho ngi s dng. Nc phi c thnh phn ho hc khng c hi cho c th con ngi, khng cha cc cht c, cht gy ung th, cht phng x... Nu c th phi mc tiu chun nng gii hn cho php theo quy nh ca Nh nc-B Y t. Nc khng cha cc loi vi khun, virus gy bnh, cc loi k sinh trng v cc loi vi sinh vt khc, phi m bo an ton v mt dch t hc.
2.2. V sinh nc v mi quan h ca chng vi sc kho cng ng

Rt nhiu nghin cu trn th gii kt lun rng cht lng nc v dung lng nc sinh hot c nh hng rt ln ti sc kho con ngi. Nhiu v dch bnh lin quan n nc b nhim nh bnh t, thng hn, l, a chy, vim gan A v 151

ang xy ra c nhng nc pht trin v ang pht trin. Thiu nc cng gy nh hng trm trng, c bit l s pht sinh v ly nhim cc bnh v da, mt v cc bnh truyn qua ng phn ming. c tnh trn th gii c khong 6 triu ngi b m do bnh au mt ht v khong 500 triu ngi c nguy c b mc bnh ny. Theo thng k sc kho ton cu ca trng i hc Harvard, ca T chc Y t Th gii v Ngn hng Th gii th hng nm c khong 4 t trng hp b a chy, lm 2, 2 triu ngi cht m ch yu l tr em di 5 tui (tng ng c 15 giy th c mt tr em b cht). Con s ny chim khong 15% s tr em cht v tt c cc nguyn nhn nhng nc ang pht trin. Nng cao cht lng nc sinh hot v cung cp cc cng trnh v sinh ph hp s gim 1/4 n 1/3 s ca b a chy hng nm.
2.2.1. Vai tr ca nc i vi con ngi

Con ngi s dng nc cho nhiu mc ch khc nhau. Nc dng trong sinh hot bao gm nc ung, nc dng trong nu nng, tm git v dng trong nh v sinh. Nc dng cho cng nghip ch yu phc v cc ngnh sn xut giy, xng du, ho cht v luyn kim. Nc dng x l rc thi ch yu l dng trong vn chuyn phn v nc tiu t cc h x t hoi ti nh my x l. Nc dng cho mc ch vui chi gii tr nh bi thuyn, lt vn, bi li v.v. Nc dng ti tiu trong nng nghip v ngoi ra cn dng cho mt s mc ch khc nh chn nui, nui trng thu sn, vn chuyn, sn xut in trong cc nh my thu in v dng trong cc qu trnh lm lnh. i vi s sng th nc cng nh khng kh rt cn thit cho con ngi v cc sinh vt khc. Khong 50 n 65% trng lng c th chng ta l nc v ch cn thay i khong 1-2% lng nc trong c th cng c th gy nh hng n sc kho v gy kht. Mt 5% nc trong c th c th gy hn m v nu mt mt lng khong 10-15% th c th dn ti t vong. Mc d c nhiu bng chng cho thy con ngi c th nhn i trong vi thng nhng trong iu kin kh hu kh nng th chng ta ch c th sng c 1 n 2 ngy m khng tiu th (n v ung) mt t nc no. Trung bnh mi ngi tiu th khong 2 lt nc mi ngy v vi dn s th gii hin nay vo khong 6 t ngi th mi ngy chng ta tiu th ht 12 triu mt khi nc ung. Do , cung cp nc y v trong sch l mt trong nhng yu t c bn bo v sc kho. Chng ta c th tm tt nhng vai tr chnh ca nc i vi c th l: Nc c coi nh l thc phm cn thit i vi con ngi. Nc a vo trong c th nhng cht b ho tan v thi ra ngoi c th nhng cht cn b di dng ha tan v na ho tan. Nc cung cp cho c th nhng vi yu t cn thit nh: flo, calci, mangan v.v Nc rt cn cho v sinh c nhn v v sinh cng cng.

152

 Nc c th a vo c th nhng cht c hi, nhng vi khun gy bnh khi nc khng c trong sch.
2.2.2. Bnh c lin quan ti nc

Nm 1980 T chc Y t Th gii thng bo 80% bnh tt ca con ngi c lin quan ti nc. Mt na s ging bnh trn th gii l cc bnh c lin quan ti nc v 25.000 ngi cht hng ngy l do cc bnh c lin quan ti nc. Bnh qun trn th gii c 5 ngi th 3 ngi khng c nc dng hng ngy. Cc bnh lin quan vi nc c th c chia thnh mt s nhm chnh: a. Bnh ly lan qua nc n ung Nhng cn bnh ny xy ra do n ung nc b nhim sinh vt gy bnh, v d nh cc bnh ng rut (thng hn, t, vim gan A). Nc l mi trng lm ly lan v gy ra cc i dch bnh ng rut nhiu khu vc khc nhau trn th gii. Cc vi khun ng rut tn ti trong nc kh lu (bng 6.1).

Bng 6.1. Thi gian sng trong nc my ca mt s vi khun ng rut

Tn vi khun Vi khun i trng Thng hn L T Thi gian sng (ngy) 2 - 262 2 - 93 5 - 12 4 - 28

Ngi ta tm thy cc vi khun gy bnh t, thng hn, ph thng hn, l... trong nc my ca thnh ph c ngun nc b nhim bn, hoc ni p dng bin php kh trng khng m bo. ng thi, c nhiu xt nghim cho thy cc vi khun gy bnh a chy tr em nh Leptospira, Brucella, Tularensis; cc virus bi lit, vim gan A, Coksaki tn ti trong nc t nhin v trong nc ung. Bin php d phng cc cn bnh ny l trnh lm nhim bn ngun nc c bit l vi phn ngi v ng vt hoc x l tt nc sinh hot trc khi s dng v thc hin n chn ung si. b. Bnh do tip xc vi nc Nhng bnh ny c th ly truyn qua tip xc trc tip vi cc sinh vt gy bnh trong nc. V d bnh giun Guinea v bnh sn mng (schistosomiases) c th xy ra nhng ngi bi li di nc c loi c b nhim nhng sinh vt gy cc bnh ny sinh sng. Cc u trng ri khi c th c vo nc v sn sng xuyn qua 153

da ca con ngi. Bin php phng chng nhng bnh ny l thu gom, x l phn ngi v ng vt hp v sinh, ng thi ngn khng cho mi ngi tip xc vi nc b nhim bn. c. Cc bnh lin quan n nc Cc bnh trong nhm ny phi k n l bnh st rt, bnh st xut huyt Dengue, bnh giun ch. Cn trng trung gian truyn bnh l cc loi mui, trong nc ng vai tr l mi trng sng ca cc sinh vt truyn bnh. Mui sng trong cc vng c bnh dch lu hnh, qu trnh sinh sn ca mui phi qua mi trng nc. Mui trng trong nc, trng n thnh b gy, b gy thnh cung qung v thnh mui. Bin php d phng l loi b cn trng truyn bnh hoc trnh khng tip xc vi chng. d. Cc bnh do thiu nc trong tm git Mt s v d v loi bnh ny l bnh do Shigella, bnh ngoi da, bnh mt ht v bnh vim mng kt. Theo iu tra dch t hc, cc bnh ngoi da, bnh v mt c t mc bnh lin quan cht ch vi vic cung cp v s dng nc sch. Nguyn nhn ch yu l do k sinh trng, cc vi khun, virus, nm mc gy ra, nhng thiu nc sch v sinh c nhn khng km phn quan trng. Nghin cu ti cc vng trc y c t l mc cc bnh trn cao, sau khi c ci thin vic cung cp nc, v sinh mi trng v gio dc v sinh th t l mc cc bnh trn gim xung r rt. e. Bnh do vi yu t v cc cht khc trong nc Bnh do yu t vi lng, hoc cc cht khc c trong nc gy ra cho ngi l do tha hoc thiu trong nc. Trong nhm ny c cc bnh sau: Bnh bu c: bnh pht sinh nhng ni m trong t, trong nc, trong thc phm qu thiu iod, v d vng ni cao, vng xa bin. Nhu cu hng ngy ca c th l 200mcg it, nu khng tuyn gip phi lm vic nhiu v lm cho bu c to ra. Tuy vy, bnh bu c cn do cc yu t khc nh gii tnh, a d, di truyn, kh nng kinh t v x hi. Bnh v rng do thiu hoc tha flo: flo cn thit cho c th cu to men rng v t chc ca rng. Tiu chun cho php trong nc ung l 0,7-1,5 mg/l. Nu flo nh hn 0,5mg/l s b bnh su rng, nu ln hn 1,5 mg/l s lm hoen men rng v cc bnh v khp. Bnh do nitrat cao trong nc: nitrat l sn phm phn hu cui cng ca cht hu c trong t nhin. Nitrat cao trong nc cn do nc b nhim nc thi. Trong nc c hm lng nitrat trn 10 mg /l c th gy bnh tm ti tr em. Ngi ta thy rng hm lng methemoglobin trong mu cao c tr em v ngi ln khi dng nc c hm lng nitrat cao qu gii hn cho php.

154

 Bnh do nhim c bi cc cht c ho hc: nc c th b nhim bn bi cc cht ho hc dng trong sinh hot hng ngy, trong nc thi sn xut cng nghip v.v. Trong qu trnh lm sch nc n ung nu khng kim sot cht ch cht lng nc theo tiu chun v sinh th cc cht ho hc trong nc c nhiu kh nng gy bnh cho con ngi di dng nhim c cp tnh, bn cp tnh hoc mn tnh. V d, nc b nhim dimetyl thu ngn ngi ta s mc bnh Minamata, nc c qu nhiu catmi s gy bnh Itai -Itai. Trong nc c cc cht gy ung th, con ngi cng c th b ung th khi dng nc ny. Phng nga cc bnh do nc truyn cn c bit quan tm vic gim st cht lng nc theo tiu chun v sinh. Qun l, gim st, thanh tra vic thu gom v x l cht thi mt cch hu hiu trnh lm nhim nc, nhim mi trng xung quanh.
2.3. Cc ch tiu c bn gim st cht lng nc

Thng thng gim st cht lng nc v mt v sinh ngi ta thng quan tm n cc ch tiu c bn sau: Cc ch tiu vt l: pH, c, cht cn l lng, tng hm lng cn. Cc ch tiu ho hc: oxy ho, hm lng amoniac; hm lng nitrit, nitrat, clorua, st tng s, cng ton phn. Cc ch tiu vi sinh: tng s Coliforms, Colifeacal chu nhit hay E. coli. Nhng trng hp c bit nghi ng khc cn xt nghim thm cc ch tiu trong bng tiu chun nc n ung s 1329/ BYT/ Q ngy 13/2/2002.
3. NHIM NC, CC NGUN GY NHIM NC V TC NG CA CHNG LN SC KHO MI TRNG 3.1. nhim nc 3.1.1. nh ngha v nhim nc

Hin chng chu u v nc nh ngha: nhim nc l s bin i ni chung do con ngi vi cht lng nc, lm nhim bn nc v gy nguy him cho con ngi, cho cng nghip, nng nghip, nui trng thu sn, ngh ngi, gii tr, cho ng vt nui v cc loi hoang d nhim nc c ngun gc t nhin: do ma, tuyt tan, gi bo, l lt a vo mi trng nc cht thi bn, cc sinh vt v vi sinh vt c hi k c xc cht ca chng. nhim nc c ngun gc nhn to: qu trnh thi cc cht c hi ch yu di dng lng nh cc cht thi sinh hot, cng nghip, nng nghip, giao thng vo mi trng. 155

Theo bn cht cc tc nhn gy nhim, ngi ta phn ra cc loi nhim nc nh sau: nhim v c v hu c nhim ho cht, nhim sinh hc, nhim bi cc tc nhn vt l.
3.1.2. Hot ng ca con ngi v vn nhim nc

Trong hot ng sng ca mnh, hng ngy con ngi thi vo mi trng xung quanh mt khi lng nc bn tng ng vi khi lng nc sch c cung cp. Nc bn thi ra t cc khu dn c, th, thnh ph, cc nh my x nghip v.v. c cha mt khi lng ln cht bn rt a dng. Khi nc bn chy vo ngun nc s lm thay i nhng c tnh c bn ca ngun nc t nhin. V d nh thay i tnh cht cm quan ca nc, lm cho nc c mu, mi c bit, hoc thay i thnh phn ho hc ca nc, lm tng hm lng cht hu c, mui khong xut hin cc hp cht c hi, hoc thay i h sinh vt trong nc, xut hin cc loi vi khun v virus gy bnh. Ngy nay, vi mt dn th ngy cng tng, chnh ph v cng ng ngy cng quan tm ti lnh vc bo v mi trng, mi lin quan gia cht lng mi trng v sc kho ngy cng c hiu r, ng thi nhng tn tht kinh t do nhim nc gy ra cng c nh gi chnh xc hn nn thc y ci thin cc bin php p dng nhm kim sot nhim.
3.2. Ngun gy nhim nc

Nc c th b nhim bn bi nhiu ngun gc khc nhau, mi ngun gy ra nhim nc li c nhiu tc nhn nhim. Thng thng nc b nhim bn bi:
3.2.1. Cht thi trong sinh hot hng ngy

Cht thi trong sinh hot hng ngy bao gm: Nc dng tm, ra, git qun o. Nc qua ch bin thc n ung. Nc lau c nh ca. Nc tiu, nc t cc h x t hoi. Rc bn trong nh. Phn ngi v gia sc.
3.2.2. Cht thi trong cng nghip

Cc ngnh cng nghip thi ra mt khi lng cht bn v cng to ln. Nc thi ca cc ngnh cng nghip chim mt t l ln, c ni gp 5 - 100 ln lng nc thi sinh hot, v d nh Php hng nm thi ra 100 triu m3 nc thi, trong nc thi cng nghip l 90 triu m3. Nc thi cng nghip hnh thnh do qu trnh s dng nc trong sn xut. iu kin hnh thnh nc thi, s lng v thnh 156

phn nc thi rt khc nhau. Cho ti nay ngi ta bit ti trn 140 loi nc thi cng nghip. Rc thi cng nghip: trong qu trnh sn xut, nhiu ph thi, rc thi c a vo mi trng xung quanh, trong c mi trng nc. B thi cng nghip c khi lng kh ln v d nh x than ca ngnh nhit in; v hoa qu, b ma ... trong ngnh cng nghip thc phm, cc ho cht trong ngnh cng nghip ho cht.
3.2.3. Cht bn do ngnh nng nghip v chn nui

Trong nng nghip ngi ta s dng nhiu loi phn bn tng nng sut cy trng nh phn ngi, phn gia sc, phn xanh, phn ho hc. bo v hoa mu ngi ta dng nhiu loi ho cht tr su, dit c tiu dit su bnh v c di. S d tha ca phn bn v ho cht tr su dit c l nhng tc nhn gy nhim nc.
3.2.4. Cc ngun gy nhim khc

Ngoi cc ngun gc k trn, nc cn b nhim bi cc cht thi trong ngnh giao thng ng thu. Cc cht thi hng ngy trn con tu nh phn, nc tiu, rc, nc ra sn tu, du m v.v. u c xung sng bin. Khng kh bn ti cc khu cng nghip, t bn bi rc, phn trong cc khu dn c cng l ngun gc gy ra nhim nc v nhim mi trng. Rt nhiu con sng chy qua cc thnh ph ln nhng nc ang pht trin v ang ng vai tr nh l h thng cng rnh m dn cc loi nc thi ca thnh ph. Rc thi sinh hot v rc thi cng nghip gia tng tng lng nhim vt xa kh nng t lm sch ca nhng con sng ny. Mt vn khc cng ng quan tm l cc hot ng khai thc nc ngm qu mc dn ti mt s vn v cht lng nc. Khi mc nc ngm t nhin b gim i th nc mn s c ht vo thay th nc ngt. ng thi nc thi t h thng cng rnh c th ngm xung t mang theo cc sinh vt gy bnh v nhiu ho cht c hi do cc nh my thi ra.
3.3. Cc yu t gy nhim nc 3.3.1. Do cc cht hu c d phn hu

Cc cht hu c tho vo sng h c ngun gc t thc vt nh xc cy c, hoa qu, cc cht mn. Nguyn t c bn ca cht bn l carbon. Cc cht hu c c ngun gc ng vt do cc cht thi ca con ngi nh nc ch bin thc n, nc tm git, nc t cc nh tiu t hoi, nc thi ca cc nh my ch bin thc phm, l git m, tri chn nui v.v. Nguyn t c bn trong cht bn l nit. Cc loi vi khun hoi sinh trong nc ng vai tr chnh trong vic phn hu cc cht hu c thnh cc cht v c v hi, ng thi cng lm tng thm lng vi khun trong 1 n v th tch nc. 157

Trong nc b nhim t, hm lng oxy ho tan trong nc trn mc gii hn cho php, cc cht hu c s c phn hu bi cc vi khun hiu kh to thnh cc sn phm cui cng nh nitrat sulphat, phosphat, CO2 v.v. Khi ngun nc b nhim nng v lin tc bi cc cht hu c, hm lng oxy ho tan trong nc gim xung cn rt thp, qu trnh phn hu cc cht hu c do cc vi khun ym kh m nhim v to thnh cc sn phm trung gian, lm cho nc c mi hi, mu en, xut hin cc kh thi nh H2S, NH3, CH4 v aldehyd. nh gi mc nhim bn trong nc bi cc cht hu c, ngi ta thng dng cc ch s sau: Nng oxy ho tan trong nc. Nhu cu oxy v ho hc (COD). Nhu cu oxy v ho sinh hc (BOD). Trong : DO l lng oxy ho tan trong nc cn thit cho s h hp ca cc sinh vt sng trong nc nh c, lng c, ng thc vt thu sinh, cn trng v.v... DO thng c to ra do s ho tan oxy t kh quyn hoc do quang hp ca to. Nng oxy ho tan trong nc thng nm trong khong 8-10 ppm. Tuy nhin, nng ny thay i ph thuc vo nhit , s phn hu cc cht v s quang hp ca to v.v. Khi nng DO thp, cc loi sinh vt sng trong nc gim hot ng hoc thm ch c th b cht. Do vy, DO l mt ch s quan trng nh gi s nhim nc ca cc thy vc. BOD (biological oxygen demand) l lng oxy cn thit vi sinh vt oxy ho cc cht hu c theo phn ng Vi khun CO2 + H2O + T bo mi + Sn phm trung gian Cht hu c + O2 Trong mi trng nc, khi qu trnh oxy ho sinh hc xy ra th cc vi sinh vt s dng oxy ho tan, v vy xc nh tng lng oxy ho tan cn thit cho qu trnh phn hu sinh hc l php o quan trng nh gi nh hng ca mt dng thi i vi ngun nc. BOD cho ta bit lng cht thi hu c trong nc c th b phn hu bng cc vi sinh vt. COD (chemical oxygen demad) l lng oxy cn thit oxy ho cc hp cht ho hc trong nc bao gm c v c v hu c. Nh vy, COD l lng oxy cn thit oxy ho ton b cc cht ho hc trong nc, trong khi BOD l lng oxy cn thit oxy ho mt phn cc hp cht hu c d phn hu bi vi sinh vt. Ton b lng oxy s dng cho cc phn ng trn c ly t oxy ho tan trong nc (DO). Do , nu nhu cu oxyho hc v oxy sinh hc cao th s lm gim nng 158

 oxy ho tan trong nc, c hi cho sinh vt sng trong nc v h sinh thi nc ni chung. Nc thi sinh hot, nc thi cng nghip v nng nghip l cc tc nhn lm gia tng gi tr BOD v COD ca mi trng nc.
3.3.2. Do cc yu t sinh hc

Nc l mi trng trung gian truyn bnh, c bit l cc bnh ng rut v gy ra cc v dch ln nh v t Hm Buc nm 1892 c 18.000 ngi b bnh v lm cht 8.605 ngi, ti Xanh-Petcbua nm 1908 c 20.835 ngi mc bnh v lm cht 4.000 ngi. Nguyn nhn chnh l do nc b nhim phy khun t. T nm 1845 n 1935 c 124 v dch thng hn v ph thng hn. Nm 1965, v dch thng hn M c 16.000 mc bnh v ngi ta tm thy vi khun thng hn trong nc my ca thnh ph. Nhiu cng trnh nghin cu khoa hc tm thy vi khun l, vi khn gy bnh a chy tr em, cc vi khun Leptospira v Tularensia, vi khun ng rut, virus vim gan v.v. Nc cn b nhim bn bi cc loi k sinh trng nh amp, trng giun sn cc loi. Con ngi c th mc bnh k sinh trng khi dng nc khng sch. Bng 6.2 trnh by cc sinh vt gy bnh chnh sng trong nc.
Bng 6.2. Cc sinh vt gy bnh chnh sng trong nc

Sinh vt gy bnh

Tm quan trng ti sc kho con ngi

Thi gian sng st trong ng cung cp nc

Kh nng khng li clo

Liu gy nhim tng i

Tm quan trng ca ng vt trong vic cha sinh vt gy hi

Vi khun
Campylobacter jejuni, C. coli E. coli gy bnh Salmonella typhi Cc loi Salmonella khc Shigella spp. Vibrio cholera Yersinia enterocolitica Pseudomonas aeruginosa Aeromonas spp. Cao Cao Cao Cao Cao Cao Cao Trung bnh Trung bnh Trung bnh Trung bnh Di Ngn Ngn Di C th nhn ln Thp Thp Thp Thp Thp Thp Thp Trung bnh Trung bnh Cao Cao Cao Trung bnh Cao Cao Cao C C Khng C Khng Khng C Khng

Trung bnh

C th nhn ln

Thp

Cao

Khng

159

Virus
Cc Adenovirus Virus ng rut Virus vim gan A Virus vim gan E Virus Norwalk Rotavirus Virus trn nh Cao Cao Cao Cao Cao Cao Trung bnh Di Trung bnh Trung bnh Trung bnh Thp Thp Thp Thp Trung bnh Trung bnh Thp Khng Khng Khng Khng Khng Khng Khng

ng vt nguyn sinh
Entamoeba histolytica Giardia intestinalis Cryptosporidium parvum Cao Cao Cao Trung bnh Trung bnh Di Cao Cao Cao Thp Thp Thp Khng C C

Giun sn
Dracunculus medinensis Cao Trung bnh Trung bnh Thp C

3.3.3. Do cc yu t ha hc

Ngun nc gy ra nhim nc bi cc cht ha hc ch yu l do cht thi cng nghip, c bit l ngnh cng nghip ho cht. Cht c ho hc vo nc lm cho nc c mu sc, mi v kh chu, nh hng rt ln n qu trnh t lm sch t nhin ca nc, c hi n h thng sinh vt sng trong nc b tiu dit hoc di chuyn ni sinh sng, tiu dit hoc lm gim cc ngun thu sn lm thc n cho con ngi v gia sc, nh hng xu ti cht lng nc ngm, nc b mt, l ngun cung cp nc cho cng ng. C ti 55.000 hp cht ho hc thi vo mi trng xung quanh. Nhng ngnh cng nghip tho nc thi c cha cc cht ho hc phi k n ngnh cng nghip khai thc, ch bin du m, cng nghip luyn kim mu, luyn kim en, cng nghip sn xut ho cht ni chung v ho cht tr su dit c, cc bt git. Ngoi cc cht ho hc do con ngi thi vo mi trng th nc cn b nhim bi cc ngun t nhin. Mt v d rt in hnh l nhim arsen trong nc ngm. T chc Y t Th gii m t thc trng nhim arsen ti Bangladesh l mt thm ha mi trng ln nht t trc ti nay. quc gia ng u khu vc chu v s lng ging khoan bm tay ny hin c khong 35 n 77 triu ngi c nguy c b nhim c. Vit Nam, theo mt s nghin cu mi c thc hin ti mt s tnh ng bng Sng Hng, sng Cu Long cho thy nng arsen trong nc ngm vt qu nhiu ln tiu chun cho php ca B Y t v ca T chc Y t Th 160

gii. Ti mt s im ly mu ng bng Sng Hng c ti 80% mu vt qu tiu chun ca WHO (Nguyn, 2005). Ngoi cc tc nhn nhim mi trng nu trn ngi ta cn quan tm ti s nhim nc bi nhit v cc cht phng x.
4. X L NC V KIM SOT NHIM NC 4.1. X l nc n ung, sinh hot 4.1.1. Lc nc

m bo nc n ung v sinh hot t tiu chun v sinh, nc cn phi c x l trc khi s dng. Cn phi lc sch nc nu dng nc sng cung cp nc ung. H thng lc cc nh my nc c mc ch lm cho nc mt cc cht c v tr nn trong, ng thi cng ci thin cc tnh cht l hc (nh mu sc) v gim i mt phn vi sinh vt. Nc sng thng c rt nhiu cht c v dng nc li theo t ct lng sng v hai bn b. Nu cc cht l lng trong nc hi nng hoc to th c th lm trong cc b lng s b. Nhng nu c nhng ht keo nh (nh t st) lm c nc, th khng th lm lng cn trong mt thi gian ngn c m cn phi s dng cht keo t tng nhanh qu trnh ny. a. Lm ng t Mun lm cho nc mt ht cc ht nh, ngi ta p dng phng php lm ng t. Lm ng t l phng php lin kt cc ht phn tn trong nc thnh tng m. Cc dung dch keo c tnh n nh l nh cc ht c mang in tch. Cc ht l lng trong nc thin nhin c in tch m l do tnh cht ho hc ca n. Cc ht keo thng l SiO2 c in tch m nh s phn ly ca cc phn t H2SiO3. Cc ht t st l lng trong nc ch yu l aluminium silicat c nhiu in ly m nn c in tch m. Cc cht mn (humus) trong nc thin nhin cng c in tch m v n c nhiu acid humic c nhiu in ly m. Nu cho cht lm ng t vo nc (ho cht, in cc, cht in tch) th trong nc sn sinh mt hn dch keo gm cc ht c in tch dng. Lc , cc ht ny cng cc ht lm c nc t nhin tc dng ln nhau. in tch m dng ca chng trung ho nhau, ht nhau v ngng t thnh tng m. Khi cc m ngng t lng xung y, chng s ko theo cc cht l lng khc trong nc. Ngi ta dng cc ho cht di y lm ng t: Nhm sulfat: Al2(SO4)3.10H2O. St sulfat: Fe2(SO4)3. St clorua: FeCl3. 161

Khi cho nhm sulfat vo nc s pht sinh cc phn ng ho hc sau y: Nhm sunfat s thu phn v ng thi to thnh mui calci. Al2(SO4)3 + 3Ca(OH)2 + 6 H2O = 2Al(OH)3 + 3CaSO4 + 6H2O Al(OH)3 sn sinh mt dung dch keo m cc ht c in tch dng lm trung ho cc ht c in tch m ca nc c. i vi nc c tnh kim, t nht cn phi cho thm vi ti Ca(OH)2 vo nc trc khi cho cht lm ng. Vic lc trong nc thc hin bng cc phng php sau y: Lm ng ri lm lng hoc lm lng ngay. Lc. Lm lng ngay thng ch c th p dng vi nc cung cp cho cc x nghip. i vi nc cung cp cho nhn dn cng c th lm lng ngay nu nc ch hi c. Thi gian lm lng lu t nht 2-3 gi. cc nh my nc thng dng nc sng, bao gi cng lm ng t ri lm lng. b. B lng: lm lng thc hin cc b cha. Tu theo tnh cht chuyn ng ca nc, ngi ta phn bit hai loi b lng: b ngang v b ng. B lng ngang: dng cc nh my phi cung cp nhiu nc (trn 40.000m3 mi ngy). B o trong t, xy bng b tng ct st hnh ch nht, di 10-30m, rng 5-15m v su 2-6m; tc nc chy l 10-12mm/giy (5mm/giy) nu lm lng ngay. B lng ng: l nhng b xy bng b tng ct st hnh tr (ng knh 6-8m; b cao 3-5m). Nc ngun chuyn ng t di ln trn, vi tc 0,5 -0,75mm/giy. Cc b lng ny dng cc nh my c lu lng va hoc nh. c. B lc: sau khi qua b lng, nc cn c kh nhiu ht nh cho nn cn phi lc c trong hn. C hai loi b lc: + B lc chm: tc lc khng qu 10cm/gi. Trong mt thng, nc lc qua ct cc cht l lng, cc vi sinh vt v vi khun lng thnh vng trn ct; hin nay t khi dng b lc chm. + B lc nhanh: tc lc cao ti 3-5m/gi. L nhng b bng b tng ct st, ng y cui, ct xp ring thnh lp cao tt c 0,7-0,9m. B c hai y, y trn c l thng. T y ln trn c cc lp sau y: cui to di, ct nh trn. Tc lc l 8m /gi. Nc chy t b lng v rnh, ri lc qua lp ct, lp si v theo ng chy sang b cha nc sch. Cc ht l lng ng li trn cc ht ct thnh mt vng lc. Cn phi mt 10-15 pht vng ny hnh thnh. Dn dn cc cht ny ng li s lm bn b lc, cho nn t lu li phi ra sch bng cch cho nc sch chy ngc chiu cc lp lc vi tc 10-15 lt mi m2/giy. Ct, cui s c ra sch bn. Hin nay ngi ta ch xy nhng b lc nhanh. Gn y, ngi ta xy mt kiu mi ng thi lm lng v lc, gi l b lc tip xc. B lc tip xc l mt b 162

bng b tng ct st ng ct. Nc ti pha di b chy qua cc lp ct ht nh dn v lc trong khi ln b mt. Tc ca dng nc l 4,5 - 5,5 m/gi hay 1,25 1,55 mm/giy.
4.1.2. Kh cht st trong nc

Mt s mch nc ngm c nhiu st (ti vi chc mg/lt), cht st d c rt t trong nc ung cng nh hng khng tt ti mi, v, mu sc v trong. Theo tiu chun v sinh th nng st trong nc ung khng c qu 0,3mg/lt. Trong thc t, nu st trong nc ngun qu 1mg/lt th phi kh cht st. Nguyn l ca s kh cht st cn c theo s bin i ca st ho tr 2 thnh st ho tr 3 v c kh nng kt ta. Cch kh st khc nhau, tu theo tnh cht ho hc ca st. Kh st s d nu st trong nc di hnh thi bicarbonat Fe(HCO3)2 v bicarbonat khng bn v d thu phn trong nc: Fe(HCO3)2 + 2H2O = Fe(OH)2 + 2H2CO3 H2CO3 = H2O + CO2 Fe(OH)2 b oxy ho khi tip xc vi oxy ca khng kh thnh Fe(OH)3. 4Fe(OH)2 + H2O + O2 = 4Fe(OH)3 + 2Fe2O3 + 6H20 B lc v b lng dng sau khi kh st cng ging cc b dng lc nc.
4.1.3. Lm mt mi v d v

Nc ung phi khng c mi. Mi l d nh cng kh chu, cho d nc c thnh phn ho hc tt v khng truyn bnh. Nc c mi l v: C H2S (nht l trong nc ngm). C nhiu thc vt sng trong nc (nht l nc h ao). C ln nc bn k ngh (ho hp hu c), cc cht ny ho hp vi cht clo cho thm vo nc ung. Do vy, cn thit phi lm mt mi nc dng cho mc ch n ung v sinh hot. Ty theo ngun gc ca nc m ngi ta s dng cc phng php khc nhau kh mi ca nc. Lm thong kh nc kh H2S bng cch tng din tch tip xc vi khng kh, phun nc; lm nc chy lt lo thnh lp mng trn cc tm vn hoc thi khng kh nn qua lp nc. H2S ho tan trong nc s bay ra khng trung, nh s chnh lch gia p lc ring phn gia khng kh v H2S ho tan. Nu ngun gc ca H2S l sinh vt sng trong nc th loi b n i. Nu nc c H2S v c ln nc bn k ngh th ch ho nc bng sulfat ng, ri bng than hot tnh c kh nng ht rt cao. Cch tt nht l cho thm than bt vo nc, trc khi nc chy vo b lng hay b lc. Than bt s ng thnh vng trn ct ca b lc v ht ht cc cht lm nc c mi, mu v d v. 163

Cch lm mt mi bng clo cng rt tt. Cc liu lng clo thp s ho hp vi cc cht hu c v sinh vt mi l v d v. Liu lng clo cn thit phi tnh th trong phng th nghim. Cn nh rng nc ch ho bng clo s c mi kh chu nu nc ch c vt phenol. Phenol d pha rt long (10 triu ln) cng sinh vi clo cc ho hp c mi, v khng th chu c. Nc thin nhin khng c phenol, ngun gc ca n l nc thi cng nghip. Cch hp l nht trnh phenol l cm tho nc bn cng nghip v cc ngun nc ung. Nu khng th c s phi dng ti amoniac. Clo s ho hp vi amoniac sinh chloramin v s khng c clorophenol. Tuy vy, amoniac khng th lm mt mi c sn.
4.1.4. Gim cng ca nc

Gim cng ca nc l gim nng ca mui calci v magi trong nc. C hai cch thng dng gim cng: Gim cng bng ho cht: x l nc bng cc cht ho hp vi cc in ly Ca++ v Mg++ thnh cc hp cht khng ho tan. Thng thng ngi ta thng x l nc bng cc dung dch vi hoc sa. Vi ti Ca(OH)2 phn ng vi Ca(HCO3)2 hay Mg(HCO3)2 sinh ra carbonat khng ho tan. Ca(HCO3)2 + Ca(OH)2 = 2 CaCO3 + 2 H2O i vi mui khng phi l carbonat s c phn ng sau y: Ca SO4 + Na2CO3 = Ca CO3 + Na2SO4 Vi cc ho cht, ngi ta gim c cng ca nc xung 4o v 6o Gim bng cch trao i cc in ly: lc nc qua cc cht c bit v d cht zeolithes c in ly Na+ v H+ cc in ly Na+ v H+ s thay th cc in ly Ca2+ v Mg2+ trong nc cng. Cc cht trao i in ly m ca n gi l cation, cc cht trao in ly dng ca n gi l anion. Cc phn ng ho hc xy ra trn mt cht zeolithes. Cc lng tng ng in ly trao i vi nhau: tnh trng cn bng c rt mau, trong vi giy u ca phn ng (90-95% in ly trao i vi nhau). gim cng ca nc, ngi ta dng cht c in ly m nh than, nha ho hp. Lc nc qua cht ny s c s trao i gia cc in ly Na vi cc in ly Ca2+ v Mg2+ ho tan trong nc. 2Na-R + Ca(CO3H)2 = CaR2 + 2NaHCO3 Sau mt thi gian s dng, ngi ta ti to cc cht in tch m bng cch ra bng dung dch mui c 5-10% NaCl. CaR2 +2NaCl = 2NaR + CaCl2
4.1.5. Tit khun nc

164

Tit khun l giai on cui cng ca qu trnh x l nc nh my nc. Cc giai on nh phn, lm lng v lc gim nhiu ch s u tin ca vi khun nhng cha trit tiu ht. Nh vy, nc ung cn nguy him v c th truyn bnh cho ngi. Nc sui trong nn khng cn lc, tuy vy, vn cn phi tit khun. i vi cc loi nc khc khng c bo m y v phng din v sinh th bt buc phi tit khun. C nhiu phng php tit khun nc nh tit khun bng clo, tia t ngoi, bc, ozon. Tuy vy, tit khun bng clo l phng php thng dng nht v n gin, khng tn km v c kt qu chc chn.
4.2. X l nc thi

Lm sch nc thi sinh hot v nc thi sn xut trc khi tho ra sng, h l mt bin php ch ng v tch cc nht trong vic bo v gi gn ngun nc trong sch. Vic lm sch nc thi trc khi tho ra sng, h cng cn tu thuc vo mc nhim bn ca nc thi, kh nng t lm sch ca dng sng v mc ch ca vic s dng ngun nc. Ngi ta c th p dng phng php lm sch nc thi nh sau: Lm sch c hc (lng, lc, b t lc, b hai v). Lm sch sinh hc (b lc sinh hc, cnh ng ti, cnh ng lc, ao h sinh hc). Lm sch ho hc, vt l (hp ph, trung ho, keo t, trao i ion ...). Nhng nm gn y ngi ta thit k cc trm x l nc thi ngay ti cc nh my, x nghip. Nc qua x l c ti s dng (nc tun hon), ch thi bn v cn, ngi ta gi l nh my khng c nc thi.
4.3. Kim sot nhim nc v qun l cht lng nc

Ngoi cc bin php c bn bo v ngun nc khng b nhim bn, cng tc kim sot nhim nc l khng th thiu c. Cng tc kim sot nhim nc bng cc k thut t n gin n phc tp, bng cc k thut hin i, nhm pht hin nhanh cc hin tng v nguyn nhn gy ra nhim ngun nc. C quan thanh tra gim st Nh nc, ca a phng xut cc bin php thch hp bo v ngun nc; pht vi cnh nhng c nhn, tp th, c quan gy ra nhim bn cho ngun nc. C quan kim sot ngun nc c k hoch nh k kim tra mi trng nc trong nm, ng thi c th kim tra t xut khi pht hin ngun nc c nguy c b nhim bn. V khung th ch cho qun l cht lng nc, B Y t ban hnh Tiu chun v sinh nc n ung theo Quyt nh s 1329/2002/BYT-Q ngy 18/4/2002 ca B trng B Y t v Tiu chun v sinh nc sch theo quyt nh s 09/2005/BYT-Q ngy 11/3/2005 ca B trng B Y t. B Y t cng thit lp c mt mng li t trung ng n cp huyn nhm kim tra, gim st cht lng nc. 165

 cp trung ng c Cc Y t D phng v Phng chng HIV/AIDS, cc vin thuc h y t d phng quc gia v khu vc vi h thng lab xt nghim hin i. tuyn tnh c trung tm y t d phng tnh. Cc trung tm ny c trang b lab xt nghim thc hin vic gim st cht lng cc ngun nc cp trn a bn tnh. Hng thng cn b trung tm n cc c s cp nc ly mu v tin hnh xt nghim. Tuy nhin, hin nay nng lc xt nghim lab ca cc trung tm y t d phng c th xt nghim c khong 10-15 ch tiu gim st nhm A. Hu ht cc trung tm y t d phng tnh cha phng tin v kh nng tin hnh xt nghim cc ch tiu gim st nhm B, C. i vi cc ch tiu ny, khi c yu cu hoc ch nh cc mu nc c ly di s gim st v ch nh ca trung tm y t d phng v gi ln kim nghim ti cc vin trung ng thuc h y t d phng hoc Tng cc o lng cht lng. Ngoi ra trung tm tham gia thm nh, xt duyt cc d n cung cp nc sch ca a phng. tuyn huyn c i y t d phng huyn c nhim v kim tra, gim st cht lng nc trn a bn huyn. Tuy nhin, tuyn huyn cha nng lc v trang thit b cho cng tc xt nghim nc m ch c th kim tra ngun nc v ly mu nc xt nghim theo yu cu ca trung tm y t d phng tnh. tuyn x, cn b ch phi hp tham gia ly mu v kim tra ngun nc khi c yu cu ch cha nng lc v phng tin xt nghim nc.

166

BI TP TNH HUNG Mc tiu

(1) nh gi nhng yu t chnh quyt nh cht lng nc v mi quan h vi sc kho con ngi trong cc tnh hung khc nhau. (2) Trnh by c nhng vn c th v cc gii php lin quan ti cht lng nc cho nhng ngi khng c kin thc v kinh nghim v cht lng nc.
Tnh hung

Hy tng tng bn l mt chuyn gia v nc Vit Nam v chnh ph yu cu bn vit mt bo co v nc v v sinh nc cc vng khc nhau trn ton quc. Bo co ny dnh cho nhng ngi khng phi l chuyn gia trong lnh vc sc kho mi trng hay qun l ngun nc. Lp s c chia thnh 3 nhm, mi nhm s chun b thng tin cho bo co v nhng ch sau y. Trong bi tp ny, sinh vin khng yu cu phi vit mt bo co hon chnh m ch cn a ra c nhng vn chnh lin quan ti mt trong cc ch sau cho mi vng sinh thi. (1) . Cht lng v s lng (lu lng) nc vi sc kho con ngi khu vc min ni. Khu vc thnh th. Khu vc nng thn. Cc vng chu th. Vng hi o. khu vc min ni. Khu vc thnh th. Khu vc nng thn. Cc vng chu th. Vng hi o.

(2). Cc ngun gy nhim nc

(3). Phng php x l nc sinh hot v nc thi (lit k nhng phng php kh thi c s dng gn y v cc bin php c th p dng trong tng lai) Vng ni. Khu vc thnh th. Vng nng thn v chu th. Hi o.

167

T LNG GI

1. Hy k tn v m t cc ngun nc trong thin nhin. 2. Hy v s m t quy trnh sn xut nc cc nh my nc ti cc th Vit Nam. 3. K tn cc hnh thc cung cp nc ph bin nng thn Vit Nam hin nay. Phn tch nhng u im v nhc im ca cc phng php . 4. Hy trnh by nhng tiu chun chung v mt cht lng ca nc s dng cho n ung v sinh hot. 5. Hy m t phng php tit khun nc bng clo. Hy nh du x vo mt la chn duy nht 6. 7. 8. 9. La chn

Bnh ly lan qua nc l bnh ly truyn qua tip xc O ng O Sai trc tip vi cc sinh vt sng trong nc Bnh sn mng l bnh gy nn do vic n nhng con c O ng O Sai b nhim vi sinh vt gy bnh Bnh st xut huyt Dengue l bnh c lin quan n O ng O Sai nc Mt trong nhng ch tiu c bn nh gi cht lng O ng O Sai nc l ch tiu cm quan Hy khoanh vo ch ci tng ng vi la chn sai, mi cu hi ch c mt la chn sai

10.

Cc yu t gy nhim nc c th phn chia thnh cc nhm sau A. Cc yu t vt l. B. Cc yu t ho hc. C. Cc yu t sinh hc. D. Cc cht hu c khng phn hu.

168

Phn 2

Dnh cho c nhn y t cng cng nm th 3

169

BI 7

AN TON MI TRNG

MC TIU

1. Trnh by c khi nim c bn v an ton mi trng v chn thng khng ch . 2. M t v phn tch c mt s th loi tai nn chn thng khng ch gia nh v ni cng cng. 3. Trnh bi c cc gii php an ton trong nh , trng hc, ni sinh hot cng cng v trn cc phng tin giao thng. 4. Nu c nhng gii php chnh m bo sng an ton v phng nga chn thng khng ch cng ng.

1. TM QUAN TRNG CA AN TON MI TRNG

Sng trong mt mi trng an ton l iu mong c ca tt c mi ngi. Tuy nhin, trong x hi hin i nhng tai nn ri ro vn thng xuyn xy ra v chng c gi chung l chn thng (injuries). C chn thng ch nh git ngi, hnh hung, t t, hnh h tr em, hm hip v nhng hnh ng bo lc khc; c nhng chn thng khng ch , xut hin bt ng, do nhiu loi nguyn nhn khc nhau v gy tn thng c th hoc t vong cho mt hoc nhiu ngi. Phn an ton mi trng trong bi ny ch cp n nhng loi chn thng khng ch v xy ra ngoi ni lm vic. Nhng nm gn y, cc chn thng khng ch (unintentional injuries) l nguyn nhn t vong hng u M i vi nhng ngi di 44 tui v l nguyn nhn ng th t trong tt c cc trng hp t vong M. Theo s liu ca Trung tm Kim sot bnh tt M (CDC) nm 1988, ch s nhng nm sng tim tng b mt (YPLL) do chn thng khng ch ng v tr hng u la tui di 65 vi 2.319.400 nm sng b mt, bng 18,9% tng s YPLL. T l ny i vi bnh ung th l 14,7%, bnh tim mch l 11,9%, t t v git ngi l 11,1% v d dng bm sinh l 5,5%. Vit Nam, theo iu tra lin trng v chn thng Vit Nam do L V Anh v cng s thc hin nm 2003 (VMIS) th chn thng thc s tr thnh nguyn nhn c t l gy t vong ln nht nhm tui di 19. Khi xt cc nhm nguyn nhn chnh dn n t vong th chn thng gy ra 33,1% s trng hp t vong, bnh

169

mn tnh gy ra 57,3%, trong khi bnh truyn nhim ch gy ra 9,6%. Ch tnh ring s tai nn giao thng trong nm 2002 c nc c 27.891 v, lm cho 13.174 ngi cht v 30.987 ngi b thng tt. Theo VMIS th tai nn giao thng l nguyn nhn hng u gy ra chn thng khng t vong vi t sut l 1.408, 5 trng hp trn 100.000 ngi. Nguyn nhn ln th 2 dn n chn thng khng gy t vong l ng vi t sut l 1.322/100.000, tip theo l vt sc nhn vi t sut: 953,3/100.000 v ng vt cn vi t sut: 838,7/100.000. VMIS cho thy chn thng ang dn tr thnh mt trong nhng nguyn nhn quan trng gy t vong Vit Nam. Trong 3 nm (1997-2000), theo thng k cha y trn c nc c gn 1400 v ng c thc phm, hn 25.500 ngi phi vo cp cu bnh vin v 217 ngi b cht. Ring ng c do n c nc ch trong 18 thng (2001 v 6 thng u nm 2002) c 230 ngi b ng c v 42 ngi b t vong. vng ng bng Sng Cu Long, vo ma l lt hng nm c hng trm tr b cht ui, tai nn in git gy cht ngi y cng rt ph bin. Tnh Bn Tre c 80 ngi cht v in git trong 5 nm (1997-2001), tnh An Giang trong 2 nm cht 58 ngi (1997-1998), tnh ng Thp ring 7 thng u nm 2001 c 13 v tai nn in git lm 14 ngi cht. Mt dng chn thng cng tng i quan trng l nhim c thuc bo v thc vt. Vit Nam l mt nc nng nghip, vi gn 80% dn s sng bng ngh nng, hu ht u c s dng thuc bo v thc vt. Theo Nin gim thng k y t (2002), trn c nc c 7.170 v nhim c thuc bo v thc vt, trong c 7.647 ca nhim c v 227 trng hp t vong. S ca nhim c do n ung nhm v lao ng l 1.495, trong c 33 trng hp t vong. Tuy nhin, trong thc t, s ca nhim c cn cao hn nhiu. Chn thng khng ch tr thnh mt trong mi nguyn nhn t vong hng u nc ta hin nay. Vic thng k, phn tch cc trng hp chn thng khng ch cho php tm ra nhng nguyn nhn ph bin dn n chn thng t y ra nhng bin php d phng tch cc. An ton mi trng l mt trong nhng bin php hu hiu hn ch cc tai nn chn thng khng ch xy ra trong cuc sng hng ngy.
2. KHI NIM CHN THNG

Theo T chc Y t Th gii, chn thng l nhng tn thng cho sc kho gy ra bi s truyn nng lng vt qu ngng chu ng ca c th con ngi. Nng lng c th l dng c hc, nng lng nhit, nng lng ho hc, nng lng bc x, nng lng in hay s thiu ht ca cc yu t thit yu nh oxy (s ngt th, cht ui) hoc nhit (s gim thn nhit). Nng lng c hc l nguyn nhn gy chn thng ph bin nht.

170

Theo J. J. Gibbons (1961), tt c mi hin tng chn thng u nm trong nhng tc ng c hi ca 5 dng nng lng l ng nng hoc c nng, ho nng, in nng, bc x v nhit nng. Jr. William Haddon (1963), chia chn thng ra thnh 3 giai on: giai on trc chn thng hay tin s c, giai on chn thng v giai on hu chn thng. mi giai on u c gii php chin lc phng nga tng ng (xem bng 7.1).
Bng 7.1. Gii php chin lc kim sot chn thng 3 giai on khc nhau ca tai nn, chn thng
Giai on chn thng Giai on trc chn thng Mc ch ca gii php Ngn nga nhng iu c th gy ra chn thng Ngn nga chn thng khi s kin xy ra Ngn nga mc nghim trng hoc tn ph khi chn thng xy ra V d ui nc Xy hng ro xung quanh ao h T u c Pht hin v x l bun phin

Giai on xy ra chn thng

Thit b cu h c nhn

Gii hn tng s thuc k n

Giai on sau chn thng

Tr lc tim phi

Loi tr cht c ra khi c th bng cch cho nn hoc thm lc

3. MT S VN AN TON MI TRNG NH V KHU DN C 3.1. An ton mi trng i vi cc sn phm tiu th trn th trng

Cc sn phm bn trn th trng rt a dng v chng loi, mu m v cht lng. Nu chng khng c kim sot tt, hng gi, hng km cht lng trn lan th s gy nguy hi khn lng cho ngi tiu th. M, mi nm c hn 20 triu ngi b chn thng v hn 30.000 ngi cht do cc sn phm tiu th khng t tiu chun gy ra (xem thm hp 7.1). Nm 1972, Quc hi M thng qua b lut An ton sn phm tiu th v thnh lp U ban An ton sn phm tiu th (CPSC: Consumer Product Safety Commission). Ch sau 9 nm c CPSC, s tai nn chn thng h gia nh gim c hn 2,5 ln. CPSC a ra tiu chun cho hn 10.000 sn phm tiu th trong nc.

171

Hp 7.1. Chn thng do thuc M

Nm 1937, mt nh bo ch thuc to ra mt dng thuc sulfa mi bn m ngi mua khng cn theo n. Sn phm c tn l elixir sulfamilamid gm bt sulfua ho trong mt dung mi thng thng l diethylen glycol. Lut l lc by gi khng yu cu phi kim tra an ton. Tuy mi ch c 2000 pints (pints = 0, 47 lt) thuc elixir sulfamilamid c sn xut v ch c 93 pints thuc c tiu th nhng c 107 ngi b cht do tc dng ph ca dung mi.

Vit Nam, ti thnh ph H Ch Minh xy ra trng hp gn 30 chu nh b cht do dng mt loi bt phn rm c ln cht c. Vic mua bn, s dng cc loi thuc dit chut nhp lu t Trung Quc cng gy ra nhng hu qu tai hi. Bnh vin Bch Mai, ring nm 1995 c 51 trng hp cp cu ng c thuc chut, 5 trng hp l do tr em v ngi gi n nhm. Bnh vin Nhi Trung ng ch trong 3 thng (1/1/1997 - 3/4/1997) phi cp cu 36 trng hp ng c thuc chut, c 10 trng hp rt nng v 2 trng hp t vong. Cng do dng thuc chut Trung Quc ba bi m nm 1997 ti x Hi Long, huyn Hi Hu, tnh Nam nh c 500 con ch v 200 con mo bi ng c cht, thit hi ln ti 80 triu ng. Hi Bo v ngi tiu dng c thnh lp Vit Nam v ngy cng pht huy vai tr tch cc trong vic bo v li ch chnh ng ca ngi tiu dng trong nc.
3.2. An ton mi trng khi nh

Chn thng khi nh c hiu l mt chn thng xy ra trong phm vi khu vc nh i vi cc thnh vin ca gia nh hoc nhng ngi khch c mi ca gia nh (Monroe T. Morgan, 1997). Phn ln cuc i ca mt con ngi l sng trong nh v xung quanh nh. Tr em sinh hot nh gn 90% tng s thi gian ca chng. Khi ln ln, tr i hc, thi gian tr sng nh t dn. tui lao ng, ngoi thi gian i lm, con ngi ch yu sng v ngh ngi nh. Khi v hu, ngi cao tui c hn 90% thi gian l sng nh. La tui nh nht v la tui gi nht trong gia nh l nhng ngi c nguy c b tai nn chn thng nh nhiu nht.
3.2.1. Chn thng do ng

Ng l mt trong nhng nguyn nhn hng u gy t vong trong cc trng hp chn thng nh. i vi tr em v ngi gi, ng l nguyn nhn ng u trong danh sch chn thng khng ch ti nh.

172

a. Tr em ng Rt nhiu trng hp tr em ng lin quan n vt trong nh. Mi nm M c khong 9.000 tr chn thng do nm ni, 8.000 tr b chn thng do gh cao v 22.000 tr b chn thng do ging tng, phn ln s ny l do ng. Cho ti 15 thng tui, tr ng khi tp i kh ph bin, 92% cc trng hp ng tp i l chn thng u hoc mt. Cc vt sc nhn, bn ng cc ung nc, mnh thu tinh v sn chi v.v... khi tr ng xung c th gy thng tch phn mm. tui ln, thng trn 5 tui, tr cn hay b ng do leo tro ca s, cy ci. nhng nh gn sng nc, ao h, tr i chi khng c ngi ln trng nom rt d b cht ui do ng xung nc. vng ng bng Sng Cu Long ch trong 2 ma l nm 2001, 2002 c 600 ngi cht ui, 80% l tr em, trong nhiu tr b ng xung nc khi chi nh mt mnh, b m v ngi ln i lm vng. Theo VMIS th ng l nguyn nhn ng th hai sau tai nn giao thng gy ra chn thng khng t vong Vit Nam v c tnh mi nm ton quc c hn mt triu ngi b ng m c nh hng n cng vic, hc tp hay cn chm sc y t. Bin php phng: gi tr cc nh tr, tr nh phi c ngi ln trng coi, ma l lt c nh gi tr vng lt, buc dy an ton gi tr khi tr trong thuyn, b, nh ngp l, khng tr nghch chi sc nhn hoc d gy chn thng, nh ca ngn np, nn nh khng trn... b. Ngi gi ng Khng ging nh tr em, ngi gi ng c th dn n t vong. T l cht do ng ngi gi t 75 tui tr ln ln gp 12 ln t l cht do ng tt c cc la tui khc. Nguy c phi nm bnh vin do ng ngi gi gp gn 7 ln cc la tui khc. C nhiu yu t lm cho ngi gi d b ng: c xng yu, mt km, t g gh, cu thang kh i, thiu nh sng v.v... M, mi nm c hn 7.500.000 trng hp trt ng ng cu thang, ch yu l ngi gi. Theo VMIS th t sut chn thng khng gy t vong do ng ngi gi (t 65 tui tr ln) Vit Nam l 2.861,6/100.000 dn, cao nht trong tt c cc nhm tui. Bin php d phng: ngi gi nn c ngi theo di, chm sc, i li yu nn chng gy, cc li i trong v ngoi nh phi rng, cu thang lm bc khng cao qu 25cm, chiu sng trong nh v cc li i m bo, nh tm nh tiu kh ro, khng trn trt. Tp th dc dng sinh nng cao sc kho cng l mt gii php tt phng chn thng tui gi.
3.2.2. Chn thng do chy, bng

Hng nm M c hn 5.000 ngi cht do ho hon v bng, trung bnh mi ngy c 13 ca t vong. Cht do ho hon v bng l mt trong nhng t l t vong cao nht cc nc cng nghip ho. S ngi da en, ngi ngho, ngi cao tui v tr

173

em c t l cht trung bnh do ho hon gp 2-3 ln t l cht trung bnh do ho hon ca c nc. Nm 1991, chy khu dn c l nguyn nhn ng th 2 ca t vong do chn thng (ch ng sau tai nn giao thng) la tui 1-9 tui v l nguyn nhn ng hng th 6 v t vong do chn thng la tui t 65 tr ln. Ba nguyn nhn gy t vong hng u do ho hon nh i vi tr di 5 tui l: tr chi dim gn ngun bt la (37%), nghch la (19%) v nghch in (11%). Ba nguyn nhn cht hng u do ho hon nh i vi ngi trn 70 tui l bt cn khi ht thuc l (33%), ng chm vo la (19%) v ng chm vo in (12%). Mc tiu gim t vong do ho hon M vo nm 2000 l 1,2 trng hp t vong trn 100.000 dn (nm 1991, t l ny l 1,5 trng hp t vong trn 100.000 dn). Ring vi nhm dn chng c nguy c cao, t l t vong gim xung cng 3,3 trng hp t vong trn 100.000 dn (nm 1991, t l ny nhm tr di 5 tui l 3,7/100.000 tr v nhm ngi gi t 65 tui tr ln l 3,5/100.000 c gi). Vit Nam khng c nhng s liu cng b v t vong do ho hon, c bit l t vong ngi gi v tr em. Nhng cc v ho hon cc khu dn c, ch vn xy ra hng nm, nht l vo nhng ma hanh kh, in hnh l v chy ch ng Xun H Ni, v chy khu Trung tm Thng mi Quc t thnh ph H Ch Minh, cc v chy l t cc khu dn c tp trung ca thnh ph H Ch Minh, v.v... kim sot c vn ny, cn thc hin cc bin php sau: Qun l, kim sot cht ch vic s dng in gia nh. Cn thn khi s dng bp ga, bp du hoc ht thuc l gia nh. Tng h gia nh c phng tin cha chy sn sng. Thng xuyn tp dt cc tnh hung cha chy v cu nn khu dn c khi ho hon xy ra. Lun sn sng phng chy cha chy cc khu thng mi, ch v cn c ng nc cu ho ring. Khi thit k khu thng mi, ch, khu vc dn c phi ch thit k c s h tng cho xe cu ho. Gip ngi dn, ngi kinh doanh c nhn thc v thc tt hn trong cng tc phng chy, cha chy.
3.2.3. Chn thng do ng c

Nm 1961, M cc v ng c cp i sinh mng ca 450 tr di 5 tui. Ngi ta c tnh c c mt tr b cht do ng c th c 80.000-90.000 tr cng tui phi i cp cu do ng c v c 20.000 tr phi nm iu tr ti bnh vin. T l tr b ng c cao nht la tui 1-2 tui. Nguyn nhn ng c ca tr ch yu do cc thuc tn dc, ho cht gia dng nh kem co ru, du tm, sn mng tay v.v Bin php d phng ng c cho tr gia nh l thuc tn dc, cc ho cht gia dng 174

phi ngoi tm vi ca tr em, cc cht ny phi trong l hoc hp kn. Khng c ln ln chai l thuc, ho cht gia dng vi cc chai hp ng n thc ung. Vit Nam, cc trng hp ng c ho cht gia nh ch yu l ng c lng thc, thc phm b nhim ho cht bo v thc vt, ung cc ho cht bo v thc vt (chn thng c ch nh) v ng c thuc bo v thc vt do n ung nhm. Vic s dng bp than t ong gy nhim khng kh bi cc kh c CO, SO2, CO2 cng rt nguy him. Bin php d phng y l phi qun l cht ch v an ton tt c cc loi thuc bo v thc vt, t bp than ch thong gi, tt nht l loi tr hn chng ra khi khu vc nh , thay th bng cc loi bp khc t c hi hn, gio dc cho mi thnh vin trong gia nh thc phng ng c.
3.3. An ton mi trng khi tham gia giao thng

Trong thi i pht trin kinh t, cng nghip ho, th ho trn khp c nc, nhu cu i li v vn chuyn ngy cng tng, s giao lu gia cc vng min, cc quc gia din ra nhn nhp th giao thng vn ti ngy cng ng vai tr then cht. Cc phng tin vn chuyn ngy cng nhiu, a dng v chng loi, sc ti phng tin ln v tc nhanh. nc ta nhng nm va qua tnh hnh cng din ra tng t. Cng vi s pht trin mnh m ca ngnh giao thng vn ti, cc tai nn giao thng cng xy ra thng xuyn v c xu hng ngy cng gia tng. M, hng nm c 5.500 thanh thiu nin v 2.200 tr t 0-12 tui b cht do tai nn t xe my. Tai nn giao thng cn l nguyn nhn t vong chn thng ca hn 6.000 ngi gi (t 65 tui tr ln). T 1966, Chnh ph M a ra mt Chng trnh quc gia v An ton giao thng v thnh lp c quan Qun l an ton giao thng ng b quc gia (NHTSA). Nh vy, t nm 1968 n nm 1991, s ca t vong do ti nn t - xe my gim 21%. Vit Nam, chn thng giao thng xy ra ngy cng nhiu v mc ngy cng nghim trng. Chn thng giao thng khng ch xy ra i vi ngi i t xe my m cn c kh nhiu trng hp xy ra i vi ngi i xe p v i b (xem thm hp 7.2). C nhiu nguyn nhn, nhng yu t quan trng nht vn l yu t con ngi - nhng ngi tham gia giao thng khng c thc v hnh ng t gic chp hnh lut l giao thng. Chin lc quc gia v phng chng tai nn giao thng c Chnh ph cng b. Hng nm, c nc u c mt thng ton dn thc hin an ton giao thng. Nh c nhng gii php ng b v kin quyt, cc v tai nn giao thng v s ngi b thng hoc t vong do tai nn giao thng bc u c km ch.

175

Hp 7.2. Tnh hnh chn thng giao thng Vit Nam

Ring trong thng 7 nm 2002 c nc xy ra 2.118 v tai nn giao thng ng b, lm cht 901 ngi v b thng 2.406 ngi. a bn thnh ph H Ni c 144 v tai nn giao thng, cht 46 ngi v b thng 132 ngi. Trn a bn thnh ph H Ch Minh xy ra 189 v tai nn giao thng, lm cht 101 ngi v b thng 204 ngi. S v v s ngi b tai nn giao thng tuy c gim so vi cng thi k nm trc nhng tnh hnh trt t an ton giao thng vn cn phc tp. Trn cc tuyn giao thng ng st trong thng 7/2002 xy ra 30 v tai nn giao thng, lm cht 15 ngi v b thng 16 ngi. (Bo Cng an Thnh ph H Ch Minh, 28.8.2002)

3.4. An ton mi trng trong cc hot ng vui chi, gii tr 3.4.1 Chn thng khi i chi d ngoi

Thanh thiu nin hc sinh thng thch cc hot ng du lch, i chi d ngoi. y l mt hot ng rt b ch, mt nhu cu rt chnh ng ca gii tr. Tuy nhin, tai nn thng tch vn c th xy ra cho mt s em do c nhng bt cn trong lc i d ngoi nh b rn, cn trng hoc ng vt cn; ng gy chn thng, sa ln xung h su hoc lung nc ngm, tai nn xe c, ng c do n ung nhm v.v. c nhng trng hp t vong rt thng tm v ng tic. V d Vit Nam c nhiu v m thuyn lm hng chc ngi cht mt lc. in hnh l v m thuyn lm cho trn 100 ngi cht v b chn thng Kin Giang. Hng nm du lch ti Sm Sn u c ngi cht ui vng n c Cc. Bin php phng: i chi d ngoi c t chc, chun b chu o, khng liu lnh mo him i vo nhng ni c nguy him, tng cng thc k lut, t gic phng tai nn thng tch cho bn thn v cho tp th.
3.4.2. Tai nn khi bi li (cht ui)

Bi li l mt hot ng th dc th thao c nhiu ngi a thch. Tuy nhin, tip xc vi sng nc, ao h m khng bit bi th li rt nguy him v c th b cht ui. Ngi bi li gii cng c th b cht ui nu bi qu sc, c bnh tim mch, b chut rt hoc bi vo vng nc xoy. Cht ui c hiu l nhng trng hp t vong do b ngt khi b chm lu di nc. Theo T chc Y t Th gii, hng nm c gn 500.000 ngi b cht ui, phn ln cc trng hp cht ui ny xy ra cc nc c thu nhp thp v trung bnh. Trong khi cc nc pht trin, phn ln trng hp tr em b cht ui xy ra trong cc b bi th cc nc ang pht trin, cht ui thng xy ra sng ngi - bin hoc cc ao h v cnh ng la nc.

176

Bng 7.2. Tm tt cc gii php c bn d phng tai nn chn thng trong nh , trng hc v khu dn c
STT Loi tai nn khng ch Chn thng t xe my, xe p v.v. Gii php d phng

Mi ngi hiu bit, tn trng v chp hnh nghim lut giao thng ng b m bo an ton k thut cho phng tin giao thng: n, phanh, ci v.v. i xe vi tc cho php, i m bo him khi i xe my iu khin t, xe my phi c bng li, sc kho tt, khng ung ru bia, khng chch ht ma tu

ui nc

Mi ngi hiu bit v tn trng, chp hnh nghim lut giao thng ng thu Khng tr em mt mnh gn ni sng nc, ao h, ging nc Luyn tp bi li, dng phao cu sinh, c ni trng gi tr trong ma bo lt. Kim tra tu thuyn trc khi xut cng, nghe d bo thi tit. C phng tin thng tin lin lc trn tu thuyn

Chy

S dng in an ton trnh chy do chp in An ton s dng bp ga, bp in C sn phng tin cha chy: bnh bt, thang thot him, dy thot him, nc, ct cha chy cnh nh Khng xng, du ho, cht d chy gn bp, ch nng, trong phng

Ng c thuc

Thuc cha bnh v cc loi ho cht phi ni cao, khng cho tr vi ti c Dng thuc, ho cht c nhn mc r rng, dng ng theo ch dn ca ni sn xut Khng thuc, ho cht cnh ni thc phm, n Qun l cht (kho) cc ho cht c nguy him: thuc c bng A - B, thuc bo v thc vt, thuc dit chut, cc dung dch acid, kim c Thc hin ng cc quy nh s dng an ton thuc ho cht c

in git

Tt in, ngt cu dao in khi ra khi nh cm in an ton hoc t cao, tr con khng vi ti c ng dy in an ton, khng qu ti, khng h, khng t, khng chp in Sa cha in an ton, c phng n phng tai nn in git khi sa in

Chn thng trong sinh hot nh v trng

Ci to ng i trong nh, ngoi ng, xm thn sao cho ngi gi, tr nh khng b vp ng Khng tr nghch, chi nguy him: - La - chi sc nhn - Vt d chy, n - Tro cao

177

STT

Loi tai nn khng ch

Gii php d phng Khng nui ch th rng, tim phng di cho ch mo T chc tt vic chm sc tr em, ngi gi, x l kp thi khi tai nn chn thng sinh hot xy ra

L qut min ni

Khng lm vic hoc lai vng lng sng, sui khi rng c ma to v l c th bt cht v Nh lm ti v tr cao, trn mc nc ca l qut C bin php bo ng tht nhanh cho dn chng khi c l qut

Lc xoy, st nh, ging bo to gy sp nh, chm thuyn, cy...

Thng ngy theo di d bo thi tit, c bit trong ma ma bo Quy t tu thuyn v ni an ton, trnh sng ln. Trn tu thuyn c sn phao cu sinh Nh cao v cng trnh kin trc cao phi lp t ct thu li Khng tr ma di gc cy to d b st nh Ca bt cnh cy, ca b nhng cy b su mt c rng

ng t, st l t

Nh khng nn lm gn chn ni cao, i cao phng b t vi lp bt ng Kin trc nh phi chu c ng t cp 6-7 hoc nh loi n gin nh nhng khng gy nguy him nu b sp

10

Ch, mo hoc ng vt hoang di cn

ng vt nui trong nh phi c s kim sot ca th y Tim vc xin phng di cho ch, mo trong nh Khng th ch, mo chy rng. Khi cho ch, mo ra ph phi em r mm. phng rn cn khi i vo rng X l ngay vt thng v i cp cu kp thi sau khi b ch, mo hoc ng vt hoang di cn

11

Ng c do n ung phi c t

Dng thc phm ti, sch c ngun gc r rng, khng n nm hoc rau qu l khi vo rng, khng n tht c i thiu, hp qu hn s dng Bo qun, ch bin thc phm hp v sinh C du hiu b ng c th phi i cp cu ngay v gi li mu thc phm nghi ng gi xt nghim tm nguyn nhn

12

Chn thng do vt liu n, bnh cao p

R sot cc khu vc cn bom mn ri vi t trong thi k chin tranh Khng o bi, nghch ngm cc loi bom, mn, n cha n; pht hin thy phi bo ngay cho b i hoc cng an ni gn nht x l Khng bun bn, vn chuyn, tng tr, s dng vt chy n ba bi Ch s dng bnh chu p lc, bnh bp gas qua kim nh an ton, khng dng bnh qu c Khng kho n, kho xng du gn khu dn c

178

 M, cht ui l nguyn nhn ng hng th 4 trong cc tai nn thng tch gy t vong ca tr nh, hu ht l tr di 4 tui v tr em nam tui t 15-19 tui. Ti 3 bang ca M (Arizona, California v Florida) cht ui l nguyn nhn t vong chn thng hng u tr 4 tui v ti 90% trng hp tai nn xy ra nhng h bi trong khu dn c. Yu t dn n tai nn trong 40% trng hp l do gim st km, 35% trng hp do ao khng c ro li bo v, 14% l do b bi khng c ca, ca khng ng hoc m ca lu, 11% l cc yu t khc. Phn tch cho thy rng c th ngn nga c 51% cc trng hp cht ui c bo co. Theo VMIS: ti Vit Nam, cht ui l nguyn nhn thng gp nht gy nn t vong tr ni chung v l nguyn nhn hng u gy nn t vong tr tt c cc nhm tui, c bit l nhm tui t 1 - 9. S tr trong tui 5 - 9 chim xp x 1/3 trong s cc trng hp cht ui/gn cht ui. T sut t vong do cht ui Vit Nam l 22,6/100.000. T sut t vong do ui nc nam l 35,2/100.000, cao hn rt nhiu so vi n l 10,7/100.000. Hai vng ng bng sng Cu Long v vng ng bc c t sut cht ui/gn cht ui cao nht. T sut ui nc tr em Vit Nam cao gp 10 ln so vi t sut ny cc nc pht trin, vi hn mt na cc trng hp ui nc dn n t vong. Cc trng hp sut cht ui l nguyn nhn ng th chn trong s cc nguyn nhn hng u gy nn bnh tt tr (37,8/100.000). Bin php phng: gio dc dn chng tun th nhng nguyn tc, ni quy ca b bi, ca nhng vng bin du lch. Kim tra tu thuyn tiu chun mi c php kinh doanh vn ti hnh khch, phi trang b phao cu sinh trn tu thuyn b bi c hng ro bao quanh, c ngi chuyn trch gim st an ton bi li, luyn tp bi c t chc v cc bin php khc (bng 7.2).
3.5. An ton mi trng ti trng hc

a im trng nn t trung tm khu dn c, thi gian hc sinh i t nh ti trung tm khng nn qu 30 pht, khng qu gn trc giao thng chnh trnh tai nn giao thng xy ra. Trng hc cn c hng ro bo v trnh vic hc sinh chy ra ngoi ng ph hoc ng quc l. Sn chi ca cc trng hc cng cn c b tr rng ri, c cy xanh v nu c cc trang thit b sn chi th cn c thng xuyn kim tra, bo dng. Trong qu trnh tr hc v vui chi, cn c s gim st cht ch ca ngi ln (thy c gio, bo v, lao cng, v.v...) trnh nhng tai nn ng tic xy ra (xem thm hp 7.3 v 7.4).

179

Hp 7.3. Khuyn co ca WHO v nng cao sc khe trng hc

1. Lin kt cc cn b y t v gio dc, thy gio v hc sinh, ph huynh v cng ng xy dng trng hc. 2. Nng cao gio dc sc kho v ci thin dch v y t trng hc. 3. Ci thin sc kho cn b, gio vin nh trng v hc sinh. Huy ng s tham gia ca cng ng vo cng tc chm sc, gio dc sc kho trong nh trng.

Hp 7.4. Cc bc trin khai m hnh nh trng nng cao sc khe (BYT, 1998)
1. Phi hp ch o lin b Gio dc & o to v B Y t. 2. Thnh lp ban ch o nh trng nng cao sc kho cp tnh, thnh ph. 3. Trin khai thc hin xy dng nh trng nng cao sc kho ti c s 3.1. Lp ban sc kho ti trng hc. 3.2. Lp phng sc kho (y t) ti trng. 3.3. Xy dng v trin khai ni dung nng cao sc kho trng hc. - Gio dc truyn thng v sc kho v v sinh mi trng. - T chc cc dch v y t CSSK hc sinh v gio vin ti trng. - V sinh trng lp v v sinh an ton dinh dng ti trng hc. 4. Kim tra, gim st, nh gi kt qu v xy dng k hoch mi.

4. KT LUN

An ton mi trng l mong mun hng ngy ca mi gia nh v ca ton x hi. Mi cng dn, gia nh, t chc qun chng, cc cp chnh quyn u c trch nhim xy dng mi trng sng an ton cho cng ng. Li ch ca an ton mi trng l gim bt cc trng hp t vong v chn thng khng ch , to ra mt mi trng sng lnh mnh, an ton, gp phn nng cao cht lng sng cho mi thnh vin, mi gia nh trong x hi.
BI TP TNH HUNG Mc tiu

p dng cc bin php phng nga chn thng/tai nn mt cch thch hp i vi mt tnh hung c th (m ).

180

Tnh hung

Vo hi 17h... ngy .... thng .... nm 200..., ti a bn huyn X ca mt tnh min ni thuc khu vc Nam Trung B Vit Nam, mt tp hc sinh cp 2 gm gn 30 em ang trn ng v nh sau gi tan hc. ng v phi qua mt con sng v hng ngy cc em thng i qua sng. Tri sp ma ln nn tt c cc em u mun c ln v nh ngay, nu khng s c l v cc em khng tr v nh c. Tuy nhin, sc cha ca con rt hn ch (ch c ti a l 15 em). V tri sp ma nn ngi li ng tt c cc em ln qua sng. n gia dng, do nc xoy, b lt p v tt c s ngi trn u b ng xung sng. Tuy cng tc cu h din ra rt khn trng, nhng c ti 18 trong tng s gn 30 hc sinh thit mng, s cn li u c cp cu v hi phc sc kho. Tin ny nhanh chng c a ln cc phng tin thng tin i chng: truyn hnh, truyn thanh, bo ch, v.v... Cc gia nh c cc em hc sinh thit mng c u ban cc cp thm hi, an i, v h tr mt phn kinh ph.
Cu hi:

Vi nhng thng tin trn, hy lit k cc yu t dn ti s kin au lng trn vo bng di y (Ma trn Haddon)
Giai on Trc khi xy ra s kin1 (gi : cc yu t dn ti s kin) Khi s kin xy ra2 Sau khi xy ra s kin3 (cc yu t quyt nh hu qu ca nhng chn thng xy ra) Cc yu t Trang thit b (2)

Con ngi (1)

Mi trng xung quanh (3)

(4) (7)

(5) (8)

(6) (9)

Sau khi in vo bng trn (bng 3x3), bn s c mt ma trn vi 9 . Hy xc nh xem bn c th p dng cc chin lc phng nga chn thng no l thch hp nht?

Mc ch ca vic xc nh cc yu t trong giai on 1: tin ti lm gim kh nng xy ra chn thng. 2 Mc ch ca vic xc nh cc yu t trong giai on 2: tin ti lm gim kh nng trm trng ca chn thng.
3

Mc ch ca vic xc nh cc yu t trong giai on 3: tin ti lm gim thng tt do chn thng gy ra trong s nhng ngi b nn.

181

T LNG GI Hy nh du x vo ng hoc sai:

1 2 3

Chn thng do hnh hung, t t c xp vo loi chn O ng thng khng ch YPLL l ch s o s ngy nn nhn phi nm vin do O ng chn thng gy ra Theo kt qu iu tra lin trng v chn thng Vit O ng Nam nm 1993, tai nn giao thng l nguyn nhn hng u gy chn thng khng t vong Hin nay, chn thng c ch nh tr thnh mt O ng trong 5 nguyn nhn t vong hng u Vit Nam

O Sai O Sai O Sai

O Sai

5. in vo ch trng Theo Jr. William Haddon (1963), chn thng c chia lm ............. giai on, l ...................................................................................................................................
Hy tr li cc cu hi di y:

6. Hin nay Vit Nam, chn thng giao thng ang l mt vn y t cng cng cn c quan tm, vi trung bnh hn 30 ngi b t vong do chn thng giao thng mi ngy. Bn hy lp bng ma trn Haddon ra cc gii php kim sot chn thng giao thng ng b cc giai on khc nhau ca chn thng. 7. Theo bn, nhng nhm tui no c nguy c cao b chn thng do ng khi nh? Hy cho bit l do ti sao? v ra mt s gii php d phng. 8. Hy lit k nhng gii php d phng nhm hn ch chn thng do ui nc. 9. Vit Nam, mc d thc hin cc bin php d phng nhng cc v chy vn xy ra thng xuyn gy mt mt ln v ngi v ca. Theo bn c nhng nguyn nhn g dn n tnh trng mt an ton chy n nc ta? 10. Theo bn, mi trng th no c coi l an ton?

182

BI 8

KIM SOT VC - T TRUYN BNH

MC TIU

1. Trnh by c vai tr ca mt s loi vc-t truyn bnh. 2. Lit k v m t c mt s loi vc-t ch yu v mt s bnh chnh do vc-t truyn Vit Nam. 3. M t c mt s bin php kim sot vc-t Vit Nam.
1. GII THIU V VC-T V BNH DO VC -T TRUYN 1.1. Khi nim v vc - t truyn bnh

Trong sut lch s loi ngi, cn trng v gm nhm gy nhiu phin toi v nguy him cho sc kho con ngi. Nhng loi ng vt ny ph hoi cc ngun thc n ca con ngi v truyn cc bnh nguy him sang con ngi. Do vy, cc bnh do vc-t truyn gy ra nhiu ni lo lng v mt sc kho cng nh t vong cho con ngi. Chng ta bit n mt v dch ln xy ra vo nhng nm 40 ca th k 14 (1340s), 1/4 dn s th gii cht v bnh dch hch, mt cn bnh do chut v b cht truyn ( c bit ti vi ci tn ci Cht en The Black Death). Hin nay, cc bnh do vc-t truyn vn l vn ht sc bc xc, c bit l cc nc ang pht trin. Do vy, nhng c gng ngn nga nhng bnh ny l ch trng vo vic phng nga v kim sot vc-t. Vc-t l bt k sinh vt no c kh nng truyn mm bnh hoc tc nhn gy bnh ti khi cm th. Cc bnh ph bin do vc-t truyn l: bnh do ricketsia, dch hch, st rt, st xut huyt, cc bnh thng hn, l trc trng, amp, st do chut cn, a chy v.v. Hai loi vc-t nguy him nht l gm nhm (ch yu l chut) v cn trng thuc nhm chn khp (v d rui, mui, gin, rn, b cht v.v.). Theo c ch truyn bnh, vc-t c chia lm 2 nhm l truyn bnh c hc v truyn bnh sinh hc.
1.1.1. Truyn bnh c hc

Truyn bnh c hc l s truyn bnh vi ngha cn trng trung gian mang mm bnh ti khi cm nhim m khng c s nhn ln ca tc nhn gy bnh trong vt ch trung gian. Nhm truyn bnh rt n gin l mang c hc cn nguyn gy bnh ti khi cm th bi cc loi b st hay cn trng trung gian bit bay qua chn

183

bn hoc vi ca chng, hoc nh nhng k mang theo mm bnh (tc nhn nhim khun) qua ng tiu ho ca chng. Cc vc-t in hnh theo con ng truyn bnh c hc l gin, rui nh. Nhng bnh chng truyn ch yu l thng hn, t, l, mt ht, v.v.
1.1.2. Truyn bnh theo ng sinh hc

Truyn bnh sinh hc c ngha l cn nguyn gy bnh bt buc phi qua vng nhn ln, pht trin v s lng trong c th vt ch trung gian (ng vt chn t) trc khi chng c th truyn tc nhn gy bnh vo vt ch l ngi. Thi k bnh yu cu phi c s thm nhim ca tc nhn gy bnh vo cn trng, thng thng bng ng tiu ho trc khi chng tr thnh tc nhn gy nhim cho ngi. S truyn bnh cho ngi hoc cc loi ng vt c xng sng khc c th tng t nh s tim chch, trong qu trnh ht mu ca cn trng cc mm bnh t cc tuyn nc bt ca chng truyn vo ngi v ng vt hoc s chy ngc tr li vo vt t; c th l s lng ng cc mm bnh t phn vo da v nhng cht c kh nng thm qua vt t hoc nhng vng tn thng do vt gi, vt trt. S truyn bnh ny bao gm nhm truyn bnh sinh hc (tc nhn gy bnh sng cng vi ng vt chn t) v khng phi n gin l mang c hc m vc - t nh l mt phng tin vn chuyn V d: Plasmodium pht trin trong c th mui Anophelles (bnh st rt), hay vi khun dch hch pht trin trong d dy b cht Xenopchylla cheopis (bnh dch hch), virus Dengue pht trin trong c th mui Aedes aegypti (bnh st xut huyt), virus vim no Nht Bn B pht trin v nhn ln trong c th mui Culex taetrinyorhyncus (bnh vim no Nht Bn B) v.v
1.2. Vi nt chung v dch t hc vc - t truyn bnh

a s bnh truyn nhim bao gm 3 yu t trong 2 yu t sng chnh l vt ch v vt k sinh, cn yu t th 3 l ng truyn. Bnh ly qua vc-t truyn bnh bao gm t nht l 3 yu t tham gia vo vi iu kin mi trng thch hp: C th cm th (ngi khng c bo v hoc ng vt). Vc- t truyn bnh (mui, ve, b cht, rui nh, v.v.). Tc nhn gy bnh (virus, vi khun, nm n bo, giun, sn v.v.). Ngoi 3 yu t ni trn, cc bnh gy ra bi vc-t truyn bnh thng bao gm thm yu t tham gia vo qu trnh gy bnh trong iu kin mi trng truyn bnh ph hp nh nhit , m, nh sng v yu t cha. cha c th l nhng bnh thin nhin nh chim, chut hoc nhng ng vt c xng sng khc nh co, chn... hoc nhng tc nhn nhim trng t mi trng b ly nhim, hoc phi hp c 2 yu t . Ngoi ra, cha c th l ngi nh trng hp bnh st xut huyt.

184

VT CH (v d con ngi)

Bnh truyn nhim

TC NHN GY BNH (v d vi khun, vi rus) VC -T TRUYN BNH (v d mui)

S 8.1. Cc yu t chnh ca bnh ly qua vc - t truyn bnh

Do vy, mun khng ch bnh mi trng c hiu qu, ch cn ph v mt khu (mt mt xch) trong qu trnh gy bnh c m t trong s 2.1. V l thuyt: nu c th tiu dit ht tc nhn gy bnh hoc vt ch trung gian hoc tim phng vc-xin cho khi cm th th c th thanh ton c cc bnh truyn nhim. Nhng trn thc t th thng chng ta phi tc ng vo c 3 mt xch trong qu trnh gy bnh mi c th kim sot c mt bnh nhim trng ly no .
1.3. c im sinh hc ca mt s loi vc - t truyn bnh chnh Vit Nam 1.3.1. Mui

a. Phn b Anopheles minimus, An. dirus, An. balabasensis... l nhng loi mui truyn bnh st rt chnh Vit Nam, phn b hu ht cc tnh thnh c st rt lu hnh sut dc chiu di ca t nc ta. Vit Nam, mui Ae. aegypti (gy bnh Dengue xut huyt) gp mi min ca t nc. Culex pipiens quinquefascitus, mui truyn vim no, giun ch phn b khp cc khu vc nhit i v cn nhit i. b. c tnh sinh hc v tp qun Vng i ca mui gm c 4 giai on: trng, u trng, cung qung, trng thnh (s 8.2). Mui thng trng vo mp nc, nhng ni m thp v c kh nng ngp nc. Giai on u trng ko di t 7-10 ngy, nhng c th ko di ti 7 thng nu iu kin ngoi cnh khc nghit. 185

Hnh 8.1. Hnh th ca mui

Trng

u trng

Trng thnh

Cung qung

S 8.2. Vng i ca mui

Giai on nhng: vn chuyn ng, p ng vi nhng kch thch bn ngoi, c th ko di t 1 - 5 ngy. Thi gian hot ng: mui Anopheles v Culex hot ng v m v t khi tri ti. Aedes hot ng vo ban ngy. Ni sng: thng sng nhng ni ti, mt, m trong nh hoc khu vc xung quanh nh . c. Tc hi Mui truyn cc bnh st rt, st xut huyt, vim no, st vng v giun ch, cc bnh ny c th gy ra bt c hu qu no, t st nh ti t vong.

186

S 8.3 di y trnh by mt s bnh do mui truyn xy ra theo con ng ngi mui ngi.
Mui ht mm bnh t ngi nhim bnh Mm bnh pht trin trong c th mui Cc triu chng xut hin v ngi b bnh

Mui b nhim mm bnh

Mm bnh pht trin trong c th ngi Mui nhim mm bnh t ngi khc v truyn mm bnh

S 8.3. S truyn bnh theo con ng ngi - mui - ngi

1.3.2. Rui nh

a. Phn b Musca domestica l loi rui nh ph bin, phn b trn ton th gii. b. c im sinh hc v tp qun (hnh 8.2)

Thn

u Chn Cnh

Bng

Hnh 8.2. Hnh th ca rui nh

Vng i ca rui nh c bn giai on: trng, u trng, nhng v rui trng thnh (s 8.4). Tm hot ng: + Ch hot ng trong nh sng. + Thch u cc dy hp, cc cnh, mp sm mu. + C xu hng u trn cc dy cng theo phng thng ng.

187

Thc n ca rui nh ch yu l cc dung dch nh xi - r, sa, hi nc trn hoa qu, rau thi ra, m m, phn v nc tiu; cc vng da m t nh ming, l mi, mt; vt lot v vt thng; tht, pho mt, ng, cc cht hu c thi ra c ngun gc t ng vt v thc vt (phn sc vt, cht bi tit ca con ngi, rc thi sau khi ch bin thc n, phn hu c...).

Trng

Trng thnh

u trng Trng 2-3 thng 9 - 10 thng Cht

Trng thnh

S 2.4. Vng i ca rui nh

c. Tc hi Mang mm bnh c hc v c th truyn cc bnh ng tiu ho nh l, a chy, thng hn, t, cc bnh giun sn...
1.3.3. Gin

a. Phn b Blatella germanica l loi gin ph bin trn ton th gii. b. c im sinh hc Vng i ca gin gm c 3 giai on: trng, u trng v gin trng thnh (s 2.5). Ni sng: ch m v m nh bp, gn cc dng c nu n, sau ng dn nc nng; sau chai, bt a trong chn; di c, thm v tm lt nh; di cc bn ra; trong cng rnh, nh v sinh, v.v. Thc n: gin n c hu ht tt c mi th, t giy, vi qut tng, tc, lng th vt, si th, kp sch, thc n, mu, m kh v ti. Di chuyn: di chuyn mt cch t do t nh ny sang nh khc, t cng rnh ti cc chung c ca ngi. Chng cng xm nhp vo cc nh xung quanh t khch sn hay nh hng gn .

188

Thn

Ngc

Cn ngten

Chn

Hnh 8.3. Hnh th ca gin

Trng

Trng thnh

u trng Trng 2-3 thng 9 - 10 thng Cht

Trng thnh

S 8.5. Vng i ca gin

c. Tc hi Mang mm bnh c hc, truyn cc bnh: a chy, l, t, st thng hn, cc bnh ly qua thc n. Mang trng k sinh trng, virus gy bnh vim tu xm, cc vi sinh vt khc: vim gan, phong...
3.4. Chut

a. c im sinh hc L loi ng vt c v thuc b gm nhm. L mt trong nhng nhm ng o, d thch nghi vi cc iu kin sng khc nhau.

189

 Rng ca c bit ho gm nhm, mc lin tc trong sut vng i do chng phi gm cc vt mt cch thng xuyn. C khu gic rt nhy, to ra nhiu mi t nhin c trng (pheromone) thu ht ng loi qua cc cht nhn tit ra t ui v do nc tiu. a. Tc hi Mi nguy him v sc kho: + + Chut c th mang trn mnh chng rt nhiu mm bnh, nhiu bnh c th truyn sang ngi. Phng thc gieo rc ngun bnh: trong qu trnh tm thc n hay tm bn tnh vo bui m, chng lin tc thi phn, nc tiu v lng. Nhng th ny c th ri vo thc n, ging, chiu ca con ngi. Chut nh v chut cng c th truyn bnh dch hch, thng hn, st do chut cn, giun, nhim c thc n do thng hn v cc bnh nhim trng khc. c bit, dch hch l mt trong nhng bnh lu hnh ti a phng mt s tnh Ty Nguyn (Gia Lai, k Lk...). Hot ng v m ca gm nhm cn quy ph gic ng ca con ngi, trong mt s trng hp, c th gy nn s hong s, thm ch tai nn nghim trng.

Ph hoi ma mng: Ph hoi hng ngn hecta hoa mu, la, ng..., gy thit hi hng trm t ng mi nm. Lm h hi cc cng trnh v ni tht: + + + Lm h hi cu trc ca cc cng trnh, ng thi thu ht cc ng vt c hi khc. Gy h hi c c bc m, b su tp ca bo tng, cc da, qun o, dy in v cc dng c khc. Gy h hi cho cc khu vn v cy cnh.

1.4. c im ca mt s bnh chnh do vc - t truyn bnh Vit Nam 1.4.1. St Dengue/st xut huyt Dengue

Tc nhn gy bnh: l virus Dengue, c cc typ huyt thanh D 1, 2, 3 v 4 thuc h Flavi virus (Flaviviruses). S lu hnh: cc typ virus Dengue hin nay ang l nguyn nhn gy bnh lu hnh a phng hu ht cc nc vng nhit i. Ti Vit Nam, bnh st xut

190

huyt Dengue thng lu hnh nhng vng ng bng Bc B, cc thnh ph ln nh: H Ni, Hi Phng v hu ht cc tnh ven bin min Trung vo ma h -thu. cc tnh pha Nam, dch lu hnh quanh nm. cha: virus c duy tr trong chu trnh ngi - mui Aedes aegypti ti cc trung tm thnh ph vng nhit i (hnh 8.4) chu trnh kh - mui l cha ca virus ng Nam v Ty Phi. Vc-t truyn bnh: l mui thuc chi Aedes. Vit Nam ch yu bnh c ly truyn qua 2 loi mui l Aedes aegypti ( cc thnh ph) v A. albopictus ( vng Duyn Hi, nng thn). Thi gian hot ng ca mui ch yu vo ban ngy, nht l t 9 gi sng n 3 gi chiu.

Hnh 8.4. Mt s hnh nh v vc-t truyn bnh st xut huyt - mui Aedes aegypti

Cch ly truyn: qua vt t ca mui mang virus. Thi k bnh: 3 - 14 ngy, thng thng t 5 - 7 ngy. Mc nguy him: gy thnh dch ln, c th gy t vong nu khng c iu tr kp thi.
1.4.2. Bnh st rt

Tc nhn gy bnh: Plasmodium falciparum, P. vivax, P. malariae, P. ovale pht trin hu tnh trong c th mui v truyn cho ngi. ngi, Plasmodium pht trin v tnh v c mui ht mu vo trong c th mui, pht trin hu tnh v tp trung tuyn nc bt ca mui.

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 S lu hnh: lu hnh rng ri, nh hng n sc kho nhiu vng nhit i v cn nhit i. Cc vng ly truyn cao: Nam M (Brazil) v ng Nam . Ti Vit Nam, bnh thng lu hnh vng rng ni, ven bin, ng bng Sng Cu Long (hnh 8.5). Vc-t truyn bnh: mui Anopheles ci. Thi gian hot ng ca mui ch yu vo lc chp chong ti. Thi k bnh: + 7 - 14 ngy i vi P. falciparum. + 8 - 14 ngy i vi P. vivax v P. ovale. + 7 - 30 ngy i vi P. malariae. Mc nguy him: gy st rt lu hnh, st rt c tnh v bin chng, c th t vong, c bit l ph n v tr em (xem thm bng 8.1).

Hnh 8.5. Bn phn b bnh st rt trn ton th gii

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Myammar Lo Vit Nam

Thi Lan Campuchia

Philippine

Singapore Indonesia

Hnh 8.6. Bn phn b bnh st rt khu vc ng Nam Bng 8.1. Triu chng ca vt mui t v cc bnh do mui truyn
Mui An. stephensi Ae. aegypti C.p. quinqueasciatus An. minimus, An. dirus.. Ae. aegypti Culex tritaeniorhyncus C. quinquefasciatus C. quinquefasciatus, An. gamblae, An. funestus, Ae.polynesiensis... St rt St xut huyt Vim no Nht Bn B Vim no St. Louis Giun ch Rt run, st, au u v cc chi St, au u, au nhiu ti cc chi v khp. Bin chng: xut huyt au u, st, bun nn sau co git, hn m St, au, au u v hn m St, au u, pht ban, vim hch v mch bch huyt Vt cn Bnh Triu chng chnh Nga v vim d ng, ph khu tr sau mt qung c to thnh

1.4.3. Vim no Nht Bn B

Vim no Nht Bn B l bnh nhim trng ton thn nhng nng n nht l no, gy dch v ma h. Tc nhn gy bnh: Arbovirus nhm B, chng Flavivirus, h Togaviridae.

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S lu hnh: hin nay vim no Nht Bn B ang c chiu hng gim dn Trung Quc, Nht Bn, Hn Quc; nhng li ang c chiu hng gia tng mt s nc ng Nam v Nam : Bngladesh, Burma, n , Nepal, Thi Lan v Vit Nam. Vc-t truyn bnh: Vit Nam, mui Culex tritecniorhyncus ng vai tr quan trng. Mui ny sinh sn v pht trin nhiu ng rung, chng t chim, gia sc v ngi. Mui Culex hot ng trong v quanh nh, ht mu v m, ngng hot ng lc 8 gi sng. T l ly lan bnh ph thuc nhiu vo thi tit chi phi s sinh sn ca vc t truyn bnh v khi cm th. Ngi ln v tr ln thng c min dch nn t l mc bnh cao nht thng gp tr em t 3 n 7 tui. Thi k bnh: trung bnh 1 tun, ti thiu l 5 ngy, ti a l 15 ngy. Mc nguy him: khi pht bnh t 1 n 4 ngy, ngn nht l 12 gi. Bao gm cc triu chng khng c hiu nh: st, ho, mt ng, quy khc. Thi k ton pht: 7 n 10 ngy, bao gm cc hi chng thn kinh, tinh thn phong ph v hi chng nhim trng. C th gy co git, hn m, lit v.v... v thm ch t vong. iu tr: hin nay vn ch iu tr triu chng, khng c thuc iu tr c hiu. ng ly truyn ca bnh (s 8.6).
Chim Chim liu iu Mui D B Ln Mui Ngi

S 8.6. ng ly truyn bnh vim no Nht Bn B

1.4.4. Dch hch

Tc nhn gy bnh: trc khun dch hch Yersinia pestis (hnh 8.7).

Mng vi khun trn phin n mu. Ch cc hnh nh nh chic ghim

Hnh 8.7. Trc khun gy bnh dch hch Yersinia pestis trong mu ngi

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 S lu hnh: bnh thng lu hnh mt s vng thuc min Ty nc M, nhng vng rng ln ca Nam M, Bc Trung - Ty v Nam Phi, Trung v ng Nam . Vit Nam, bnh thng lu hnh Ty Nguyn. cha: cc loi gm nhm hoang di, c bit l chut v sc t l cha t nhin ca dch hch. Nhng ng vt nui trong nh (ch yu l mo) cng c th l ngun truyn nhim ly sang ngi. Vc-t truyn bnh: b cht, c bit l loi Xenopsylla cheopis b cht chut (hnh 8.8). i khi ly lan t ngi sang ngi qua b cht Pulex irritans.
Kch thc thc

Hnh 8.8. B cht Xenopsylla cheopis (vc-t truyn bnh dch hch)

Cch ly truyn: qua vt t ca b cht mang bnh. Thi k bnh: t 1-7 ngy, c th ko di thm vi ngy nhng ngi c tim phng. i vi dch hch th phi tin pht t 2 - 4 ngy, thng l rt ngn, thm ch ch 24 h. Mc nguy him: mc c th, nu khng c pht hin v iu tr sm c th gy t vong mc qun th c th gy nn mt v dch ln trn mt din rng.
2. CC BIN PHP KIM SOT VC - T TRUYN BNH 2.1. V sinh mi trng, v sinh c nhn v v sinh khu vc xung quanh nh / kim sot mi trng

V sinh c nhn: + + + Thng xuyn gi cho c th sch s. Gi v sinh n ung, ra tay trc khi n v sau khi i ngoi.

V sinh mi trng v v sinh khu vc xung quanh nh : S dng h x hp v sinh.

195

Ngn chn ni thm nhp ca vc - t gy bnh: chng li chng mui, rui quanh nh, nm mn, chn cc l m chut c th ra vo v.v... i vi khu vc c coi l c nguy c cao v mui (rng, ni m thp) cn mc qun o di khi i lm. Loi b thc n tha. Loi b ni tr n v ni sinh sn ca cc loi vc-t truyn bnh: Trnh ng nc: khng cc mnh v, v l c cha nc, cc vng nc t ng quanh nh. Che y cc dng c cha nc. Dn dp cc ni m thp c th l ni tr n ca mui, rui, gin, chut. H thng thot nc bn phi c lm tt. Thu gom v x l cht thi hp v sinh.

+ +

Thay i tp qun v sinh, sinh hot v canh tc lc hu hn ch s pht trin ca vc-t Ph v chu trnh sng ca k sinh trng: ung thuc dit k sinh trng st rt. Tng cng cc bin php truyn thng, gio dc sc kho cho cng ng v cc bin php phng chng vc-t truyn bnh v cc bnh do vc-t truyn.
2.2. Bin php ho hc, c hc v sinh hc 2.2.1. Bin php ho hc

mc cng ng: phun ho cht dit cn trng: dit rui, mui, gin v.v... Ti tng gia nh, c th dng hng xua mui, ng xt cn trng, dng b chut nm mn tm ho cht v.v... Ti cc cnh ng: dng hi c hoc mi c dit chut.
2.2.2. Bin php c hc, l hc

V p rui. Hp nh mui. By chut, keo dnh chut, xng khi bt chut v.v.. nh sng.
2.2.3. Bin php sinh hc

S dng mt s ng vt c coi l thin ch ca cc loi vc-t truyn bnh loi tr cc loi vc-t truyn bnh ny.

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 Tng cng nui mo, rn, c dit chut. Cm sn bt tri php mo, rn v c. C th dng b chut vi sinh lm by nh chut. Mc ch ca bin php ny l gy dch cho chut bng cc dng vi khun, chut c th b cht m khng nh hng ti cc vt nui khc. Th mesocyclops v c vo cc b cha nc v cc ao h tiu dit u trng mui. Nm dit b gy.
BI TP TNH HUNG Mc tiu

p dng c cc kin thc l thuyt v kim sot vc-t truyn bnh vo cc trng hp thc t c th. Xc nh c nhng yu t c th dn ti gia tng hoc gim s lng ca cc loi vc-t. a ra mt s gii php kh thi kim sot vc t truyn bnh.
Tnh hung

Vit Nam, c nhiu bnh do vc-t truyn. V d, cc v dch vim no Nht Bn (loi B) xy ra 4 nm mt ln. min Nam, cc v dch v st Dengue xy ra hng nm. nhng vng ven bin, t l b cc bnh sn l kh cao do tp qun n c sng (gi c). Nhiu nghin cu cho thy t l b nhim sn l ch v mo vo khong 90% n 95%. vng ni v cao nguyn nc ta cc v dch hch vn lc c xy ra hng nm. Trong bi tp ny, hc vin s c chia lm 4 nhm. Mi nhm s c a mt bi tp gm mt s cc cu hi. Cc nhm tho lun tr li cc cu hi v trnh by trc lp. Nhm 1. St Dengue. Nhm 2. Sn l gan. Nhm 3. Bnh do Rickettsia. Nhm 4. Dch hch. Mi nhm cn phi tr li c nhng cu hi sau y v ch c phn cng: 1. Sinh vt hoc nhm cc sinh vt no l vc-t truyn cc bnh trn? 2. c im mi trng sng ca cc vc-t ny?

197

3. Cc iu kin lm gia tng hoc hn ch s pht trin v s lng ca vc-t? 4. Cc bin php kim sot nhm gim s lng vc-t?
T LNG GI

Hy nh du x vo ng hoc sai: Cu hi 1 Vo nm 1340s, bnh t (do rui, gin truyn) honh hnh cp i sinh mng ca gn dn s th gii v c bit n nh l ci cht en Vit Nam, mui Aedes dirus v Aedes balabasensis l nhng loi mui chnh truyn bnh st rt Mui Anopheles v Culex ch yu hot ng v t ngi vo ban ngy, c bit l 2 gi sau khi mt tri mc v 2 gi trc khi mt tri ln Rui l vc-t truyn bnh sinh hc, c th truyn cc bnh ng tiu ho nh l, a chy, t, thng hn, cc bnh giun sn... Tc nhn gy bnh st Dengue v st xut huyt Dengue l mui Aedes aegypti Vim no Nht Bn B l bnh nhim trng ton thn nhng nng n nht l no v hin vn cha c thuc iu tr c hiu Tc nhn gy bnh dch hch l trc khun Yersinia pestis Tr li

O ng

O Sai

O ng O ng

O Sai O Sai

O ng

O Sai

O ng O ng

O Sai O Sai

O ng

O Sai

Chn mt cu tr li ng nht v khoanh trn vo la chn (mi cu hi ch c mt la chn ng nht) 8 Mui khng truyn bnh no sau y? A. Vim no B. St vng C. St Q D. Giun ch

198

Cch ly truyn bnh dch hch l A. Qua vt cn ca chut mang mm bnh B. Qua nuc tiu v phn ca chut mang mm bnh C. Qua vt t ca b cht chut mang mm bnh D. Qua vt t ca m mang mm bnh sng k sinh trn chut

10

Triu chng no sau y KHNG phi l triu chng ca bnh st Dengue A. St cao B. au nhc c, khp xng C. Chy mu rng, mu cam E. au sau hc mt

11

Bin php no sau y KHNG phi l bin php kim sot gin A. Thu gom v x l cht thi hp v sinh B. Dng ho cht tiu dit u trng dn C. Dng ho cht dit gin giai on nhng E. Dng ho cht dit gin trng thnh

12. Vit Nam, mui truyn bnh vim no Nht Bn l A. Culex tritaeniorhyncus B. Aedes albopictus C. Aedes aegypti D. Anopheles quadrimaculatus 13. Hy m t s khc nhau c bn ca truyn bnh c hc v truyn bnh sinh hc, cho v d c th. in vo ch trng: 14. Vng i ca rui c chia lm ................ giai on, l .................. ................................................................................................................................. 15. Vng i ca gin c chia lm ................ giai on, l .................. .............................................................................................................................

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TI LIU C THM

1. L nh Cng v cng s (1997). Phng chng bnh st rt v cc bnh k sinh trng, Vin St rt K sinh trng Cn trng, H Ni. 2. Trn Xun Mai v cng s (1994), K sinh trng y hc gio trnh i hc, ti bn ln th nht. Trung tm o to v bi dng cn b y t TP. H Ch Minh.

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BI 9

PHT TRIN BN VNG

MC TIU

1. Trnh by c cc nguyn l c bn ca pht trin bn vng. 2. Hiu c vai tr ca nguyn tc phng nga, nguyn tc cng bng trong cng th h v gia cc th h trong vic xy dng cc chnh sch, chng trnh v qun l sc kho mi trng. 3. Trnh by c mt s ch s v pht trin bn vng. 4. Trnh by c nhng tc ng ca k thut hin i cng nh k thut li thi ln pht trin bn vng.

1. PHT TRIN BN VNG V CC NGUYN TC CHUNG 1.1. Khi nim chung v pht trin bn vng

duy tr s sng ca bn thn v tip tc s pht trin ca ni ging, ngay t thi k nguyn thu ca lch s nhn loi, con ngi c nhng hot ng khai thc ti nguyn thin nhin, ch bin thnh nhng vt phm cn thit cho mnh, hoc ci thin nhng iu kin thin nhin, to nn mi trng sng thch hp vi mnh. Trong lc tin hnh nhng hot ng , con ngi t nhiu bit rng mi can thip vo ti nguyn thin nhin v mi trng lun lun c hai mt li, hi khc nhau i vi cuc sng trc mt v lu di ca con ngi. Mt s kin thc v bin php thit thc ngn nga nhng tc ng thi qu i vi mi trng c c kt v truyn t t th h ny qua th h khc di dng nhng tn ngng v phong tc. Trong cc x hi cng nghip, vi s pht hin nhng ngun nng lng mi, vt liu mi v k thut sn xut tin b hn nhiu, con ngi tc ng mnh m vo ti nguyn thin nhin v mi trng, can thip mt cch trc tip v nhiu khi th bo vo cc h thin nhin. ch ng thin nhin, con ngi nhiu khi to nn nhng mu thun su sc gia mc tiu pht trin ca x hi loi ngi vi cc qu trnh din bin ca t nhin. t ti nhng nng sut cao trong sn xut nng nghip, con ngi chuyn i cc dng nng lng t nhin, ct ni cc mt xch thc n vn c ca thin nhin, n iu ho cc h sinh thi, s dng nng lng b sung to ln duy tr nhng cn bng nhn to mong manh. c bit l trong na cui th k XX, sau nhng nm hi phc hu qu ca th chin ln th hai, hng lot nc t bn ch ngha cng nh x hi ch ngha tip tc

201

i su vo cng nghip ho, nhiu nc mi c gii phng khi ch thc dn cng c iu kin pht trin mnh m nn kinh t ca mnh. Mt s nhn t mi nh cch mng khoa hc v k thut, s bng n dn s, s phn ho cc quc gia v thu nhp to nn nhiu nhu cu v kh nng mi v khai thc ti nguyn thin nhin v can thip vo mi trng. Trt t bt hp l v kinh t th gii to nn hai loi nhim: nhim do tha thi ti cc nc t bn ch ngha pht trin v nhim do i ngho ti cc nc chm pht trin v kinh t. C th ni rng mi vn v mi trng u bt ngun t pht trin. Nhng con ngi cng nh tt c mi sinh vt khc khng th ngng tin ho v ngng s pht trin ca mnh. l quy lut ca s sng, ca to ho m vn vt u phi tun theo mt cch t gic hay khng t gic. Con ng gii quyt mu thun gia mi trng v pht trin l phi chp nhn pht trin, nhng gi sao cho pht trin khng tc ng mt cch tiu cc ti mi trng. Pht trin ng nhin s bin i mi trng, nhng lm sao cho mi trng vn lm y cc chc nng: m bo khng gian sng vi cht lng tt cho con ngi, cung cp cho con ngi cc loi ti nguyn cn thit, ti x l cc ph thi ca hot ng ca con ngi, gim nh tc ng bt li ca thin tai, duy tr cc gi tr lch s vn ho, khoa hc ca loi ngi. Hay ni mt cch khc l pht trin bn vng (PTBV). Pht trin bn vng l s pht trin nhm tho mn cc nhu cu hin ti ca con ngi nhng khng tn hi ti s tho mn cc nhu cu ca th h tng lai. Pht trin bn vng l mt phng hng pht trin c cc quc gia trn th gii ngy nay hng ti, l nim hy vng ln ca ton th loi ngi. Pht trin bn vng c c im: (1) S dng ng cch ngun ti nguyn thin nhin m khng lm tn hi h sinh thi v mi trng. (2) To ra cc ngun vt liu v nng lng mi. (3) ng dng cng ngh sch, cng ngh ph hp vi hon cnh a phng. (4) Tng sn lng lng thc, thc phm. (5) Cu trc v t chc li cc vng sinh thi nhn vn phong cch v cht lng cuc sng ca ng dn u thay i theo hng tch cc. C kh nhiu m hnh pht trin bn vng c xut. Tuy nhin, s kinh in m hnh pht trin bn vng thng c cp nh l s dung ho gia ba lnh vc: kinh t - mi trng - x hi (hnh 9.1).

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Kinh t

X hi

Mi trng

Hnh 9.1. M hnh kinh in v mi quan h gia Kinh t - Mi trng - X hi

1.2. Cc nguyn tc ca pht trin bn vng

Chng trnh Mi trng ca Lin Hip Quc (UNEP) trong tc phm Hy cu ly tri t - chin lc cho mt cuc sng bn vng nm 1991 nu ra 9 nguyn tc ca mt x hi bn vng: (1) Tn trng v quan tm n cuc sng cng ng. (2) Ci thin cht lng cuc sng ca con ngi. (3) Bo v sc sng v tnh a dng ca tri t. (4) Hn ch n mc thp nht vic lm suy gim cc ngun ti nguyn khng ti to. (5) Gi vng trong kh nng chu ng c ca tri t. (6) Thay i tp tc v thi quen c nhn. (7) cho cc cng ng t qun l mi trng ca mnh. (8) To ra mt khun mu quc gia thng nht, thun li cho vic pht trin v bo v. (9) Xy dng khi lin minh ton cu. Tuy nhin, cc nguyn tc ny thc s kh p dng trong thc t ca mt th gii y cc bin ng v chnh tr, kinh t v vn ho. Thc t i hi cn thit lp mt h thng nguyn tc khc c tnh kh thi v st thc t hn. Luc Hens (1995) la chn trong s cc nguyn tc ca ca Tuyn b Rio de Janeiro v Mi trng v Pht trin xy dng mt h thng cc nguyn tc mi ca PTBV. Nhng nguyn tc l:

203

1.2.1. Nguyn tc v s u thc ca nhn dn

Nguyn tc ny yu cu chnh quyn phi hnh ng ngn nga cc thit hi mi trng bt c u khi xy ra, bt k c hoc cha c cc iu lut quy nh v cch gii quyt cc thit hi . Nguyn tc ny cho rng, cng chng c quyn i chnh quyn vi t cch l t chc i din cho h phi c hnh ng ng x kp thi cc s c mi trng.
1.2.2. Nguyn tc phng nga

nhng ni c th xy ra cc s c mi trng nghim trng v khng o ngc c th khng th ly l do l cha c nhng hiu bit chc chn m tr hon cc bin php ngn nga s suy thoi mi trng. Nguyn tc phng nga c xut t cc bi hc kinh nghim ca th gii v pht minh ra thuc tr su DDT v tc hi ca vic khai thc rng ma Brazil. Pht minh ra DDT vo nhng nm 50-60 ca th k XX c xem l pht minh v i ca loi ngi, v n to ra cho con ngi mt loi v kh mnh tiu dit bnh st rt v cc loi cn trng ph hoi ma mng. Tuy nhin, vic pht hin ra tnh cht c hi ko di v kh nng tch lu ca DDT trong cc m m ca c th con ngi v sinh vt v sau dn ti vic cm s dng chng. Th d lin quan n rng ma Brazil cng xy ra vo nhng nm , khi chnh ph Brazil c cc c vn khoa hc t vn rng: pht trin nhanh v kinh t, cn phi khai thc khu rng ma nhit i, ni ch c nhng ngi Indian nguyn thu sinh sng. Chnh ph Brazil cho php m ng khai thc khu vc rng ma. Kt qu l nhiu khu rng b ph hu, tnh a dng sinh hc ca rng suy gim, l phi hnh tinh b thu hp. Bn thn ngi Indian khng pht trin c m cn b tiu dit bi cc chng bnh ca nn vn minh du nhp nh: vim phi, HIV/AIDS, v.v. Nguyn tc phng nga c mt s l do tn ti: khoa hc, kinh t v x hi. L do khoa hc tn ti nguyn l phng nga nh ni trn lin quan n s hiu bit cha y hoc thiu kinh nghim ca con ngi v nh hng ca cc pht minh mi, sn phm mi, hnh ng mi, v.v. L do kinh t ca nguyn l phng nga l bin php phng nga bao gi cng c chi ph thp hn bin php khc phc. L do x hi ca nguyn l phng nga lin quan ti sc kho v s tn ti an ton ca con ngi.
1.2.3. Nguyn tc cng bng gia cc th h

y l nguyn tc ct li ca pht trin bn vng, yu cu r rng rng vic tho mn nhu cu ca th h hin nay khng c lm phng hi n cc th h tng lai tho mn nhu cu ca h. Nguyn tc ny ph thuc vo vic p dng tng hp v c hiu qu cc nguyn tc khc ca pht trin bn vng.

204

Ti nguyn v cc chc nng mi trng ca tri t ang l cc yu t quyt nh s tn ti ca loi ngi chng ta. Ti nguyn v cc chc nng mi trng ca tri t theo kh nng ti to c th chia thnh hai loi: ti to v khng ti to. Loi khng ti to r rng s mt dn i trong qu trnh khai thc v s dng. Loi ti to cng c th suy thoi, cn kit do khai thc qu mc ti to v do nhim mi trng. S pht trin ca loi ngi hin nay ang phi i mt vi hng lot cc khng hong: khng hong nng lng, khng hong lng thc, khung hong mi trng v khng hong dn s. Cc khng hong ny ang lm cn kit cc dng ti nguyn thin nhin, suy thoi cc dng ti nguyn x hi v cc chc nng mi trng. Nh vy, cc th h con chu chng ta trong tng lai s phi i mt vi mt ngun ti nguyn thin nhin c th b cn kit v mt khng gian mi trng sng c th b nhim. thc hin cng bng gia cc th h chng ta cn: khai thc ti nguyn ti to mc thp hn kh nng ti to, khai thc v s dng hp l cc dng ti nguyn khng ti to v thc hin cc bin php bo v mi trng sng ca tri t.
1.2.4. Nguyn tc cng bng trong cng mt th h

Con ngi trong cng th h hin nay c quyn c hng li mt cch bnh ng trong vic khai thc cc ngun ti nguyn v bnh ng trong vic chung hng mt mi trng trong sch. Nguyn tc ny c p dng x l mi quan h gia cc nhm ngi trong cng mt quc gia v gia cc quc gia. Nguyn tc ny ngy cng c s dng nhiu hn trong i thoi quc t. Tuy nhin, trong phm vi mt quc gia, n cc k nhy cm i vi cc ngun lc kinh t - x hi v vn ho. Lch s pht trin ca x hi loi ngi trong qu kh, hin ti ang din ra trong bi cnh s phn chia v cnh tranh giai cp, dn tc v quc gia trong vic xc lp quyn li khai thc, s dng ti nguyn thin nhin v cc chc nng mi trng. Do vy m bo cng bng trong cng mt th h i hi: (1) Xc lp quyn qun l khai thc v s dng ti nguyn ca cc cng ng dn c trong phm v mt a bn lnh th; xc lp quyn qun l quc gia i vi mi ngun ti nguyn thin nhin v x hi trong lnh th quc gia; phn nh quyn qun l khai thc v s dng ti nguyn gia cc quc gia trn phm vi phn lnh th ngoi quyn ti phn ca cc quc gia. (2) Xc lp quyn v ngha v ca cc cng ng v cc quc gia trong vic khai thc v s dng cc chc nng mi trng ca cc vng lnh th v ton b khng gian tri t. (3) Thu hp s chnh lch kinh t gia cc nc cng nghip pht trin v cc nc ang pht trin, km pht trin. Tng vin tr pht trin cho cc nc ngho ng thi vi vic gim s lng ph trong tiu th ti nguyn ca dn c cc quc gia pht trin, gim i ngho cc nc ang pht trin.
1.2.5. Nguyn tc cng bng v quyn tn ti ca con ngi v sinh vt tri t

Con ngi v sinh vt tri t l cc thnh phn hu sinh trong h thng mi trng sng v cng phc tp ca hnh tinh chng ta: t nhin - con ngi v x hi

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loi ngi, cc sinh vt l cc mt xch ca h thng , nn s tn ti ca chng lin quan n s bn vng v n nh ca h thng mi trng. Do vy, cc sinh vt t nhin c quyn tn ti trong khng gian tri t, cho d n c gi tr trc tip nh th no i vi loi ngi. S dit vong ca cc loi sinh vt s lm mt i ngun gen qu him m tri t ch c th to ra n trong nhiu triu nm pht trin
1.2.6. Nguyn tc phn quyn v u quyn

Cc quyt nh cn phi c son tho bi chnh cc cng ng b tc ng hoc bi cc t chc thay mt h v gn gi nht vi h. V vy, cc quyt nh quan trng cn mc a phng hn l mc quc gia, mc quc gia hn l mc quc t. Nh vy, cn c s phn quyn v u quyn v s hu ti nguyn, v ngha v i vi mi trng v v cc gii php ring ca a phng i vi cc vn mi trng. Tuy nhin, a phng ch l mt b phn ca quc gia v l mt phn nh ca cc h thng quc t rng ln. Thng thng, cc vn mi trng c th pht sinh ngoi tm kim sot a phng, v d nh s nhim nc v khng kh khng c ranh gii a phng v quc gia. Trong trng hp , nguyn tc u quyn cn c xp xung thp hn cc nguyn tc khc.
1.2.7. Nguyn tc ngi gy nhim phi tr tin, ngi s dng mi trng phi tr tin

Ngi gy nhim phi chu mi chi ph ngn nga v kim sot nhim i vi mi trng, bng cch tnh y cc chi ph mi trng ny sinh t cc hot ng ca h v a cc chi ph ny vo gi c ca hng ha v dch v m h cung ng. Ngi s dng cc thnh phn mi trng, tng t nh vy cng phi tr thm chi ph v nhng thnh phn mi trng h s dng. Cc nguyn tc ny l c s quan trng tnh thu mi trng, ph mi trng v cc khon tin pht trong s dng ti nguyn v cc chc nng mi trng ca doanh nghip v c nhn.
2. CC CH S V PHT TRIN BN VNG

Pht trin bn vng l mc tiu pht trin ca cc quc gia trn th gii. Tuy nhin, lm th no chng ta c th nh gi c s pht trin ca mt quc gia l bn vng hay khng bn vng? bn vng ca s pht trin thng c nh gi thng qua mc bn vng ca 3 lnh vc kinh t, x hi nhn vn v mi trng.
2.1. Bn vng v kinh t

Bn vng v kinh t c th c nh gi thng qua gi tr v mc n nh ca cc ch s tng trng kinh t truyn thng nh: tng sn phm trong nc GDP, GDP bnh qun u ngi, tng sn phm quc gia GNP, mc tng trng GDP, c cu GDP... Mt quc gia pht trin bn vng v kinh t phi bo m tng trng GDP v GDP bnh qun u ngi cao. Cc nc thu nhp thp c mc tng trng GDP vo

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khong 5%. Nu c mc tng trng GDP cao nhng GDP bnh qun u ngi thp th vn xem l cha t ti mc bn vng (Nguyn, 2003). Ch tiu bn vng mi v kinh t c thit lp trn c s iu chnh cc bt hp l trong cch tnh truyn thng: Ch tiu tng sn phm quc ni iu chnh ANP (Anderson, 1991) c tnh bng cch ly GNP tr vn u t, tn tht ti nguyn thin nhin, cng gi ca lao ng gia nh v dch v thng mi khng tr tin; Ch s phc li kinh t bn vng ISEW (Daly v Cobb, 1989) c tnh bng thu nhp c nhn c b sung gi tr lao ng ti gia nh, gi ca cc dch v tp th cng cng, suy thoi mi trng v suy gim cc gi tr lin quan ti an ton ca con ngi.
2.2. Bn vng v x hi

Tnh bn vng x hi ca mt quc gia c nh gi thng qua cc ch s nh: ch s pht trin con ngi (HDI- Human Development Index), ch s bt bnh ng v thu nhp, ch s v gio dc, dch v y t v cc hot ng vn ha. Ch s pht trin con ngi HDI l ch s tng hp ca o v sc kho ca con ngi th hin qua tui th trung bnh (T1), o hc vn trung bnh ca ngi dn (HV2), o v kinh t th hin qua sc mua tng ng (Purchase Parity Power - PPP/ngi, k hiu l KT3). HDI = f (T1.HV2. KT3) Ch s HDI < 0, 500 l chm pht trin, HDI t 0,501 - 0, 799 pht trin trung bnh, HDI > 0, 800 pht trin cao. Ngoi ch s pht trin con ngi, pht trin bn vng v mt x hi cn c th hin qua ch s bnh ng thu nhp (h s GINI); ch s gio dc o to (thng c c th ha thnh nhng s liu nh t l ngi bit ch theo tui, t l tr em hc tiu hc, trung hc, s sinh vin trn 10.000 dn v.v.); ch s v dch v x hi y t (thng c c th ha thnh s bc s trn 1000 dn, s ging bnh trn 1000 dn, t l % dn c hng dch v y t x hi, t l % dn c s dng nc sch v.v.); v ch s v hot ng vn ha (thng c c th ha bng s t bo, n phm c pht hnh cho 1000 dn, s th vin trn 10.000 dn v.v.)
2.3. Bn vng v mi trng

bo m bn vng v mi trng trc ht cn phi bo m bn vng v khng gian sng cho con ngi. Mun vy th dn s phi khng c vt qu kh nng chu ti ca khng gian; cht lng mi trng c duy tr mc tt hn hoc ti thiu phi bng tiu chun cho php; lng x thi phi khng vt qu kh nng t x l, phn hu t nhin ca mi trng. S bn vng v ti nguyn thin nhin th hin ch lng s dng phi nh hn hoc bng lng khi phc ti to c vi ti nguyn ti to, hoc lng thay th vi ti nguyn khng ti to.

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3. HNH NG CP A PHNG V S BN VNG TON CU 3.1. Chng trnh ngh s 21 ca Vit Nam

Nm 1992, Hi ngh Thng nh th gii v mi trng v pht trin c t chc ti Rio de Janeiro (Brazin) vi 170 nc tham gia. Hi ngh thng qua Tuyn b Rio de Janeiro v mi trng v pht trin gm 27 nguyn tc c bn v Chng trnh Ngh s 21 (Agenda 21). Chng trnh Ngh s 21 vch ra cc hnh ng cho s pht trin bn vng ca ton th gii. Hi ngh khuyn ngh cc quc gia v a phung tng bc cn c vo iu kin v c im c th ca mnh m xy dng Chng trnh Ngh s 21 cho ph hp. Nhm hng ti s pht trin bn vng Vit Nam xy dng Chng trnh ngh s 21 ca Vit Nam. y l nh hng hot ng a t nc chuyn sang con ng pht trin bn vng. Nhn thc c pht trin l mt qu trnh tng th ca tng trng kinh t, nng cao cng bng x hi v bo v mi trng. Chng trnh Ngh s 21 ca Vit Nam nu ln nhng thch thc m quc gia ang phi i mt, ra nhng ch trng, chnh sch v nhng lnh vc hot ng cn c u tin c th pht trin bn vng trong th k XXI. Nhng hot ng cn u tin c cp trong Chng trnh Ngh s 21 ca Vit Nam l: (1) To nhng iu kin cn thit pht trin kinh t nhanh v bn vng, bao gm: tng trng kinh t nhanh, thay i m hnh tiu dng, cng nghip ha sch, pht trin bn vng nng -lm-ng nghip v pht trin bn vng kinh t vng. (2) To iu kin pht trin bn vng v mt x hi: xa i gim ngho, tip tc h thp mc tng dn s, nh hng qu trnh th ha v di dn, nng cao cht lng gio dc, ci thin dch v chm sc sc khe v v sinh mi trng sng. (3) S dng hp l ti nguyn thin nhin v bo v mi trng, gm cc hot ng sau: chng suy thoi v s dng bn vng ti nguyn t, s dng v qun l ti nguyn nc, bo v v pht trin rng, gim nhim khng kh cc khu cng nghip v th, qun l cht thi rn, bo tn a dng sinh hc. (4) T chc qu trnh chuyn sang con ng pht trin bn vng, gm cc hot ng nh: huy ng ton dn tham gia thc hin pht trin bn vng, tng cng vai tr lnh o ca Nh nc trong vic t chc thc hin pht trin bn vng v hp tc v s pht trin bn vng.
3.2. Chin lc mi trng cho pht trin bn vng cp quc gia v a phng

Vit Nam, pht trin bn vng l quan im ca ng v c khng nh trong ngh quyt i hi ng Cng sn ton quc ln th IX, trong Chin lc pht trin kinh t x hi 10 nm 2001-2010 v trong Chin lc mi trng quc gia.

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Chin lc mi trng quc gia c son tho vi s tham gia rng ri ca cc t chc chnh ph, cc on th x hi v i biu cc tng lp nhn dn. K hoch ny bao gm 3 yu t: xc nh cc vn u tin, xc nh cc hnh ng u tin v m bo cho s thc thi thnh cng. chin lc mi trng c th thc thi, cc phn tch kinh t v k thut cn phi c t chc mt cch sc so vi s tham gia tch cc v u thc ca cc i tc. Vic qun l mi trng hu hiu i hi cc i tng chin lc phi thc hin v gn kt vi cc yu cu x hi, kinh t v chnh tr rng ri hn. Vic xy dng khung chin lc mi trng khng nht thit phi xut pht t con s khng m c th c xy dng trn c s cc chnh sch v k hoch c sn ca nh nc hoc cc ban ngnh a phng. Chin lc mi trng khng phi l mt k hoch cng nhc, m cn c lin tc b sung, nn chnh khi c nhng vn mi ny sinh. T vn cho vic xy dng chin lc mi trng phi bao gm nhng ngi c chc trch v mi trng, nhng ngi b nh hng bi cc vn mi trng, nhng ngi kim sot cc cng c gii quyt vn , nhng ngi nm c thng tin v c trnh chuyn mn cao. Cc vn u tin c la chn trn c s cn nhc gia tnh cp bch ca vn , tnh minh bch v chnh tr, kh nng ti chnh, s cn bng cc quyn li chuyn ngnh v a phng, nng lc ca cc c quan s dng u t. S thiu thng tin, thiu minh bch chnh tr, nguy c phc tp ha vn khi c s tham gia ca cng ng, sc p ca cc nhm quyn li hng mnh a phng hoc khu vc, thiu tn trng cc u tin mi trng ca cc c quan a phng... l nhng tr ngi ng k trong sp xp cc vn u tin. m bo trin khai thnh cng chin lc mi trng cn thit phi lng ghp cc mc tiu mi trng vo cc mc ch pht trin rng hn, nh cc d n v chnh sch pht trin ngnh, cc chnh sch kinh t m. Cc mc tiu mi trng trong chin lc cn mang tnh hin thc, c gng gn kt vi vic gim chi ph hoc tng cng sn xut. Ngun ti chnh cho thc thi chng trnh c th c huy ng t ngn sch, ng gp ca ngi gy nhim, ph mi trng do ngi hng dch v mi trng ng gp, ti tr ca cc t chc c nhn; c th thnh lp qu mi trng quc gia v a phng.
3.3. Chnh sch mi trng

Chnh sch mi trng l cc quy nh ca c quan hnh chnh quc gia hoc cng ng nhm s dng hp l ti nguyn v bo v mi trng. Chnh sch c th c dng vn bn php quy (di lut) hoc dng bt thnh vn. Chnh sch mi trng phi c ban hnh v thc hin hp hin, hp php v thng nht, m bo cc nguyn tc:

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(1) Ngi gy nhim v h qu xu phi chu trch nhim chi ph x l nhim, khc phc hu qu v n b thit hi. (2) Hp tc gia cc i tc v c s tham gia ca cng ng. (3) Nguyn tc phng nga. Thng thng c mt chnh sch mi trng tt quan trng hn l c nhiu chnh sch mi trng. Do cn chn u tin cc vn bc xc ra quyt nh. i vi cc nc ang pht trin, cc vn cn c u tin l: khc phc nhng nh hng ca mi trng n sc kho v nng sut lao ng nh nhim nc, khng kh th, qun l t ai, rng, ti nguyn nc; xy dng k hoch hnh ng quc gia v bo v mi trng theo cc vn u tin, v d nh k hoch hnh ng bo v a dng sinh hc ca Vit Nam (Quyt nh 845/TTg ngy 22/12/1995 ca Th tng Chnh ph). Theo Ngn hng Th gii, k hoch hnh ng ton din v mi trng cho cc nc c 5 yu cu chnh: (1) c cu lut php r rng; (2) c cu hnh chnh thch hp; (3) c cc k nng v chuyn mn; (4) ngn sch tng xng; (5) phn quyn trch nhim tt i i vi chuyn giao ti chnh.
3.4. Qun l mi trng

Qun l mi trng l b mn khoa hc c mc ch qun l v iu chnh hot ng ca con ngi da trn s tip cn c h thng, c t chc, c k hoch i vi cc vn c lin quan vi con ngi; c thc hin bng tp hp cc cng c kinh t, x hi, lut php, cng ngh k thut, hng ti pht trin bn vng v s dng hp l ti nguyn. Qun l mi trng s dng cc k thut sau: (1) Gim st mi trng v ra quyt nh. (2) Lut v chnh sch mi trng. (3) Ho gii xung t mi trng. (4) Bo co tng quan mi trng. (5) Cc k thut h tr nh thng tin vin thm, m hnh ton l, nh gi nhanh. (6) Cc cng c kinh t. (7) Truyn thng mi trng.
4. CNG NGH, K THUT BN VNG

Cng ngh l kin thc, kinh nghim, quy trnh, thit b c s dng trong hot ng sn xut ca con ngi nhm to ra ca ci vt cht v ci thin iu kin sng ca con ngi. K thut l tp hp cc cng ngh sn xut ra mt loi sn phm 210

hng ho nht nh no . Cng ngh, k thut bn vng bao gm cc loi cng ngh v k thut cho php khai thc bn vng cc loi ti nguyn thin nhin v x hi, hng ti vic xy dng x hi pht trin bn vng. Tuy cha c cc tiu ch nh gi tnh bn vng ca cng ngh v k thut bn vng nhng mt s mc tiu c bn ca cng ngh v k thut bn vng c th lit k bao gm: Duy tr lu di cc dng ti nguyn khng ti to ca tri t (nng lng, ti nguyn khong sn, gen di truyn, v.v.). Bo tn v duy tr vnh hng cc dng ti nguyn ti to ca tri t (nc ngt, t, sinh hc, rng, bin, v.v.). Nng cao cht lng cuc sng v vt cht ca con ngi (quc gia v vng lnh th) theo 4 o: o kinh t, o mi trng, o x hi v o vn ho. Mt s hng p dng c th ca cng ngh v k thut bn vng bao gm: + Cng ngh v k thut to ra cc ngun ti nguyn v nng lng mi cho loi ngi (v d nh cc loi cng ngh khai thc an ton nng lng phn ng phn r v tng hp ht nhn, cng ngh vt liu mi: gm, cht do, si tng hp t si cellulose si t t , si thu tinh). Cng ngh khai thc cc ngun ti nguyn khng truyn thng v kh tip cn (nh: cng ngh khai thc nng lng mt tri, nng lng thy triu, nng lng lng t, cng ngh kh ha than...). Cng ngh khai thc bn vng cc ngun ti nguyn nng lng sch (nh cng ngh v k thut khai thc nng lng gi dng trong giao thng, sn xut in dn dng, ch bin nguyn vt liu, cng ngh v k thut sn xut thu in v.v.). Cng ngh gim tiu dng nguyn liu v nng lng (v d: cng ngh v k thut tng cng hiu qu t ci, than, du, gim tiu th nguyn liu trong ngnh luyn kim, ho cht, sn xut vt liu xy dng v.v.). Cng ngh v k thut xanh v d: k thut x l cui ng ng nhm phn tn ph thi, x l v tiu hu cht thi, k thut gim thiu cht thi nhim., cng ngh sch v sn phm sch. Cng ngh sinh hc trong nng nghip (v d: cng ngh v k thut lai to ging cy trng v vt nui, canh tc hoc nui trng cy v con, ch bin v bo qun sn phm nng nghip). Cng ngh v k thut gen, l mt dng c bit ca cng ngh sinh hc, da trn vic nghin cu kh nng thay i c im ca gen gc bng cc tc ng ngoi lai hoc cy ghp gen t loi sinh vt ny sang loi sinh vt khc. Bng 9.1 lit k mt s sn phm mong mun v khng mong mun ca cng ngh gen.

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Bng 9.1. Sn phm mong mun v khng mong mun ca cng ngh gen
Cc sn phm mong mun 1. Cy lng thc khng bnh do virus v nm 2. Cy lng thc khng cn trng 3. Cc vc xin phng cc bnh vt nui 4. Tng cng thnh phn cht dinh dng cy lng thc 5. S dng cc ging cy trng vt nui pht trin nhanh ci tin sn xut nng nghip 6. Cy lng thc chu hn 7. Cy lng thc chu mn 8. Cy lng thc chng chu nhit 9. C nh m ng, la v la m 10. Thuc bo v thc vt khi bnh v su b 11. Pht trin cc cy lng thc lu nm 12. Ci tin cc loi thuc tr su cho cy trng nh neem 13. Ti ch ci tin cc cht thi c hi nh cc sn phm ph ca TNT Cc sn phm khng mong mun 1. Hormon tng trng b (BGH) cho b sa 2. Gen ngi c cy ghp sang ln, sang cc loi gia sc khc v cy trng 3. Gen ngi c cy ghp sang bt k loi lng thc no 4. ng dng BT trong nhiu ma v lin tc 5. Cc vi khun qua x l gen gip kim sot sinh hc cn trng c kim sot mt cch t nhin v hiu qu (VD: loi virus Tricoplusiani) 6. a ra s dng cc vi sinh vt bn th c x l gen 7. S khng thuc tr su v thuc dit c cy lng thc ngoi tr mt s trng hp c di k sinh th gii th III. 8. Cc ho cht c sinh ra trong lng thc v cy thc n cho gia sc 9. Cc k thut cng ngh sinh hc trong tng lai lm gia tng cc vn kinh t -x hi trong x hi c th gy hu qu cn ln hn li ch ca n (VD: BGH xem im 1 phn trc) 10. Cc gen c a vo trong cy lng thc c th s chuyn sang vi cc loi cy di gn vi loi (VD: gen khng thuc tr su dit c cy ci c chuyn sang cy ging h ci) 11. S dng cc loi gen lm gim hm lng dinh dng ca hoa qu hoc rau xanh

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Cng ngh v k thut x l cht thi, ti quay vng v ti ch cht thi (v d: cng ngh x l nc thi v s dng nc thi sinh hot nui trng thu hi sn, cng ngh t rc tn dng nng lng cc nc phng Ty, cng ngh ch bin rc thi sinh hot ngun gc hu c thnh phn Compost, cng ngh sn xut kh biogas). Cng ngh v k thut x l, phc hi mi trng, v d: cng ngh v k thut thay th vt liu xy dng gy nhim mi trng, sn xut ho cht bo v thc vt t gy nhim mi trng, thay th cc thit b gy nhim mi trng, cng ngh v k thut x l nhim du, nhim phng x trong t v nc, x l cc h b ph dng, b acid ho v cng ngh iu chnh cn bng sinh thi ca cc vng t nc v h sinh thi.

5. QUN L BN VNG TI NGUYN TI TO V KHNG TI TO 5.1. C s khoa hc ca vic qun l khai thc ti nguyn thin nhin

Ti nguyn thin nhin bao gm cc dng nng lng, vt cht, thng tin t nhin, tn ti khch quan ngoi mun ca con ngi, c gi tr t thn m con ngi bit hoc cha bit v con ngi c th s dng c trong hin ti v tng lai phc v cho s pht trin ca x hi loi ngi. Hin trng s dng ti nguyn ca con ngi ph thuc vo tri thc, trnh khoa hc, cng ngh, kh nng ti chnh, vn ho truyn thng, thi quen, tn gio tn ngng... Tnh thng nht v c quy lut ca t nhin i hi cc hot ng khai thc ti nguyn mi trng phi da trn c s: (1) Hiu bit v c th vn dng cc nguyn l sinh thi, quy lut t nhin khai thc ti u ti nguyn, phng trnh, hn ch ri ro v tai bin thin nhin; (2) Hiu bit y nguyn nhn gy nn cc vn mi trng phng trnh v ng x hp l, hn ch v x l nhim mi trng. C s trit hc ca mi quan h gia con ngi vi thin nhin khng nh s ph thuc ca con ngi v t nhin vo trnh pht trin ca x hi. N cng chng t vai tr iu khin c thc ca con ngi trong mi quan h gia h x hi v h t nhin, vai tr v gi tr ca a dng vn ho trong pht trin. Cc gi tr vn ho truyn thng, hnh thnh mt cch c chn lc trong qu trnh h x hi khng ngng tng tc vi h t nhin, t ra c tnh thch nghi ph hp nht nh vi iu kin a phng, cho php h x hi khai thc bn vng h t nhin ca mnh trong nhng iu kin nht nh, c bit l khi dn s hn ch. Do , chng ta cn bo v v pht huy vai tr ca a dng vn ho, pht huy bi hc truyn thng v chung sng ho bnh, cng tn ti vi thin nhin v nng cao hiu qu ca t chc x hi cc cp trong iu chnh hnh vi s dng bn vng ti nguyn v bo v mi trng.

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Ti nguyn thin nhin c phn thnh 3 loi: Ti nguyn v tn, bao gm nng lng bc x mt tri, thu triu, a nhit, sng, gi... y l dng ti nguyn c kh nng cung cp rt lu di, a phn thuc loi khng cha ng nguy c gy nhim mi trng nn cn c khai thc ti a. Tuy nhin, do cng cp ca cc loi nng lng ny thng nh, bin trnh cp bin ng phc tp v khng trng pha vi nhu cu, cng ngh khai thc hin nay cha hon thin, tiu tn nhiu t ai, nn cha c cc i tng s dng la chn. Ti nguyn c kh nng t ti to, nh: t th nhng, sinh vt, nc... Kh nng t ti to ca cc loi ti nguyn ny l c gii hn v c iu kin, ngha l nu s dng qu gii hn kh nng ti to, hay lm tn thng cc iu kin cn cho kh nng ti to th ti nguyn s b cn kit. Nguyn tc s dng bn vng ti nguyn ny l: s dng trong phm vi kh nng ti to v khng lm tn thng cc iu kin cn cho kh nng ti to. Ti nguyn khng c kh nng t ti to: bao gm cc loi ti nguyn khong sn c kh nng ti ch (nh kim loi) v cc khong sn khng c kh nng ti ch (phi kim, nhin liu ho thch), l ti nguyn b gim dn trong qu trnh s dng v c nguy c b cn kit. Nguyn tc tip cn s dng bn vng ti nguyn ny l: s dng tit kim, hiu qu, tn dng kh nng ti ch v tm kim cng ngh thay th hp l.
5.2. Quy lut t nhin nh hng nguyn tc qun l ti nguyn nc

Ti nguyn nc hnh thnh theo lu vc, do vy qun l ti nguyn nc khng n thun l qun l lng nc c trong sng, m phi bo v ton b cc iu kin hnh thnh dng chy trn lu vc, ngha l qun l pht trin, s dng ti nguyn v bo v mi trng theo lu vc. Ti nguyn nc ca mt a phng bao gm hai loi chnh: ngun ni a, do ma ri trn vng sinh ra v ngun ngoi lai, theo cc sng chy vo. Cht v lng nc ngoi lai khng chu s kim sot trc tip ca a phng, nn nhng chnh sch dng nc da vo ngun cp ny khng m bo an ton v thnh cng cao. Ti nguyn nc c kh nng ti to v lng. Chu k ti to (i mi) cng ngn gi tr s dng ca ti nguyn cng cao. Nc trong kh quyn v sng ngi c tc i mi nhanh nht, nc ngm nm su v nc trong bng tuyt vnh cu c tc i mi chm nht. Mc s dng mt ln lng nc, v mt nguyn tc, khng c vt qu kh nng t ti to v lng, tnh bng tng lng dng chy ca khu vc trong thi gian . Ti nguyn nc bin ng mang tnh chu k ma v nhiu nm r nt, do vy mc trn lng khai thc theo thi gian bin ng theo quy

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lut t nhin. Kh nng iu tit ca kho nc gip iu chnh trn mc khai thc n nh v bng trung bnh (theo chu k trn vn) trn mc khai thc t nhin ca ti nguyn. Trn mc khai thc nc trong thu vc phi m bo khng lm cho mc nc sng xung di mc thp nht m h sinh thi nc ni ring v h sinh thi t nhin lu vc ni chung tn ti c, c th ly bng mc nc trung bnh thng thp nht ng vi nhng tn sut nht nh. Kh nng ti to v cht ca ti nguyn nc c thc hin thng qua cc qu trnh pha long, lng ng, pht tn vt cht theo dng trong chu trnh tun hon, phn ng ho hc to cht mi t c hn, bin i sinh hc v tch lu sinh hc theo dy chuyn thc n. Kh nng t ti to v cht ph thuc vo c im ngun cp, tc i mi nc, c im ho l, sinh khi nc v cc qu trnh ng lc trong n. Khai thc ti u kh nng t lm sch v cht ch thc hin c khi cc iu kin t nhin n nh v cn tho mn cc iu kin: lng thi, cng thi vo thu vc khng vt qu kh nng t lm sch ca n, thnh phn cht thi ch bao gm nhng cht khng c hi cho mi trng hoc nhng cht m thu vc c th lm sch c.
5.3. Chu trnh vt cht trong h kinh t v nguyn tc qun l s dng ti nguyn 3T (tit kim, ti s dng, ti ch)

Ti nguyn thin nhin l mt u vo quan trng ca cc h kinh t. Khi khai thc s dng lng ti nguyn N, mt phn s tn hao bin thnh rc WN, phn cn li c a vo h thng sn xut S. T h thng sn xut c mt phn thi ra ngoi thnh rc WS, phn cn li to thnh hng ho a vo h thng tiu th D. Hng ho sau tiu th s thnh rc WD. Tng cht thi t h kinh t a vo mi trng s l W = WN + WS + WD. Theo nh lut bo ton vt cht th N = W. Mi trng c kh nng t ng ho cht thi mc nht nh Emt trong nhng iu kin nht nh, khi lng thi vo mi trng khng qu ln: Khi Emt > W th cht lng mi trng c m bo v ton b lng thi a ra mi trng s b phn hu v ng ho. Khi Emt < W th cht lng mi trng s b suy thoi do cht thi khng b ng ho tch lu ngy cng nhiu trong mi trng. H kinh t - sinh thi l mt h thng khp kn, trong bao gm nhiu tiu h, b phn; Vt cht thi ra ca mt tiu h, cng on ny c th tr thnh u vo ca mt tiu h hay cng on khc. Do , v nguyn tc, trong mi cng on thi u c nhng c hi tn dng, ti ch, ti s dng, quay vng s dng to ra hai xu th li ch c bn: gim nhu cu khai thc ti nguyn t N xung cn N = N - nTTT v gim lng thi (W = WNT + WST + WDT < N). Vic gim lng thi mt mt gim ngun gy nhim mi trng ni chung, mt khc khi lng thi nh th tc ng ca n ti cc quy lut t nhin chi phi qu trnh t lm sch mi trng s gim, cc chc nng t nhin ca mi trng c c hi c duy tr v pht huy (xem thm hnh 9.2). 215

Kh nng ti s dng ti nguyn b hn ch bi nh lut nhit ng hc hai, pht biu nh sau: Mi qu trnh vt l hay cng ngh u dn n s suy gim nng lng v vt cht t nhng dng tp trung sang nhng dng km tp trung hn. iu c ngha l: (1) Trong h kinh t vt cht sau mi cng on s dng b pht tn v phi chi ph mt lng tin v nng lng nht nh thu gom chng. (2) Vt liu dng sn xut cc sn phm b suy thoi khi ti ch li nhiu ln, do vy s ln ti ch l c hn. (3) Nng lng trong qu trnh s dng b suy gim t dng hm lng cao sang dng hm lng thp hn, do vy khng th ti s dng ton b nng lng tiu th.
N Sn xut D Tiu th D

Ti nguyn TN

WN

WS

WD

WNT

WST

WDT

W = WNT + WST + WDT

Hnh 9.2. S dng ti nguyn trong h kinh t

Rc thi gy nhim mi trng

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5.4. Cng c qun l ti nguyn 5.4.1. Cc nguyn tc o c mi

Pht trin bn vng l s pht trin mang tnh o c, n i hi c nhng thay i quan trng mang tnh nh hng trong quan nim cng nh hnh vi lin quan n khai thc, s dng ti nguyn mi trng, do vy cn thit phi c nhng nguyn tc o c mi da trn nn tng khoa hc ca pht trin bn vng nh phn trn trnh by.
5.4.2. Cng c lut php

Lut php quc t l cc vn kin quc t c k kt gia cc quc gia mt cch t nguyn, nhm n nh, sa i hoc hu b nhng quyn v ngha v i vi nhau, c ni dung ph hp vi nhng nguyn tc c bn c tha nhn rng ri ca lut quc t hin i. Cc vn bn lut php quc t lin quan n qun l ti nguyn mi trng hin nay gm: (1) Hin chng: l mt loi iu c quc t nhiu bn, n nh nhng nguyn tc ln trong quan h gia cc nc vi nhau. (2) Cng c: l nhng iu c quc t c tnh chuyn mn. (3) Ngh nh th: l vn kin dng gii thch b sung, sa i mt iu c quc t c k kt, hoc n nh nhng bin php c th thc hin cc hip c, hip nh no . (4) Tuyn b chung: l vn kin ghi nhn nhng tho thun hai hay nhiu nc v nhng nguyn tc hoc phng hng hnh ng chung i vi mt vn quc t no . (5) Tho c: l iu c quc t c tnh chuyn mn trong mt khu vc. (6) Hip nh: l loi iu c quc t n nh nhng nguyn tc v nhng bin php hnh chnh nhm gii quyt mt quan h c th no gia hai hay nhiu nc. Tnh n cui 1992 c 840 vn bn php l quc t v mi trng hoc lin quan n mi trng c k kt. Lut v chnh sch qun l ti nguyn, mi trng quc gia l cc quy tc ng x mi trng do cc c quan Nh nc ban hnh, nhm iu chnh cc quan h x hi, to ra khun mu ng x thng nht trong lnh vc s dng, khai thc ti nguyn v bo v mi trng. Nguyn tc ch o ca vic ban hnh v thc thi lut v chnh sch l: (1) Hp hin, hp php v thng nht. (2) Ngi gy nhim phi tr tin. (3) Phng bnh hn cha bnh. (4) Hp tc gia cc i tc.

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(5) S tham gia ca cng ng. Vit Nam c cc vn bn lut php v ti nguyn v mi trng sau: Lut Bo v Mi trng (1994), Lut Bo v v Pht trin rng (1991), Lut t ai (1993), Lut Du kh (1993), Lut Khong sn (1996), Lut Ti nguyn nc (1998), Php lnh v Thu thu ti nguyn (1989), Php lnh Nui trng thu sn.
5.4.3. Cng c kinh t qun l ti nguyn

Quyn s hu ti nguyn: quyn s hu l c s quan trng cho vic s dng c hiu qu ti nguyn. Khi quyn s hu c xc nh r rng, mang tnh c chim, c m bo, di hn, c th chuyn nhng v c tnh cng ch th ch c ch s hu mi c quyn khai thc ti nguyn. Khi ti nguyn khng thuc s hu ring, v d nh cc ng trng trn bin s xy ra nhng kh nng sau: nu li nhun khai thc ti nguyn ln, chi ph khai thc thp trong khi gi bn cao th nhng ngi mi s b cun ht vo khai thc, gy kh khn cho vic kim sot khai thc theo quy lut sinh thi v bo v mi trng, d gy cn kit ti nguyn (v d nh vic bt voi); khi li ch khai thc ti nguyn khng ln hn li ch trung bnh t cc hot ng kinh t khc trong khu vc, vic khai thc ti nguyn khng nhng khng hp dn thm c ngi mi, m cn khin mt s ngi t b khai thc. R rng, ngho kh, mt bng kinh t thp l nhng nguy c ln gy cn kit ti nguyn a phng. Trong iu kin kinh t m ca, ti nguyn khng c ch s hu ring v bo v, khai thc hp l ti nguyn th mt trong nhng gii php cn l xo i gim ngho. Thu ti nguyn: trc y l loi thu iu tit thu nhp trong hot ng khai thc ti nguyn. bo v ti nguyn, c th s dng thu ti nguyn nh mt cng c gip iu chnh mc khai thc khng vt qu ngng mong mun. Mt s cng c kinh t c vai tr gip bo v mi trng nn cng c ngha tch cc i vi bo v ti nguyn, l: Thu mi trng: l khon thu vo ngn sch nh nc nhm iu tit cc hot ng bo v mi trng quc gia, gy qu ti tr cho hot ng (thu nhim x l hoc n b nhim), b p cc chi ph x hi phi b ra gii quyt cc vn mi trng nh: chi ph y t, ngh cha bnh, phc hi mi trng, phc hi ti nguyn, x l v ngn nga nhim... v cng l hnh thc hn ch mt sn phm hay hot ng khng c li, thc y thay i mt hng, cch sn xut (nh thu cao vo cc hng ho gy nhim trong sn xut hoc tiu dng), khuyn khch cc hot ng tch cc (gim thu cho cc sn phm ti ch, tng thu cc hng ho tiu th ti nguyn gc, ti nguyn khng ti to...). Ph mi trng: l khon thu ca nh nc nhm b p mt phn chi ph thng xuyn v khng thng xuyn v xy dng, bo dng, t chc qun l 218

hnh chnh ca nh nc i vi hot ng ca ngi np thu, v d nh ph x l nc thi, kh thi, chn lp v phc hi mi trng trn bi rc... Ph mi trng c vai tr quan trng nht trong kim sot nhim cng nghip. Ph mi trng c th c thu da vo: lng cht nhim thi ra mi trng, mc tiu th nguyn nhin liu gy nhim, tng doanh thu hoc tng sn lng hng ho, li nhun ca doanh nghip. L ph mi trng: l khon thu c t chc, bt buc i vi cc c nhn, php nhn c hng mt li ch hoc s dng mt dch v no do nh nc cung cp, v d l ph v sinh mi trng, thu gom rc, gim st thanh tra mi trng, cp giy php mi trng... Pht nhim: mc pht hnh chnh nh vo cc vi phm mi trng, c quy nh cao hn chi ph ngn nga pht sinh nhim, nhm mc tiu va rn e i tng vi phm, va c kinh ph cho khc phc nhim. Cta thi (nh mc thi cho php): mc thi cho php c xc nh trn c s kh nng tip nhn cht thi ca mi trng, c chia thnh cc nh mc (cta) v phn phi cho cc c s c quyn pht thi trong khu vc. Cc c s ny ch c quyn pht x theo hn ngch, nu vt qu s b x pht. Trong thc t, nhu cu x thi ca cc c s l khc nhau v thay i theo nhp sn xut; Mt s c s c cng ngh x l cht thi s khng c nhu cu x thi t do. T xut hin cc kh nng tha hoc thiu quyn pht x theo nh mc, dn ti hnh thnh th trng mua bn quyn c x thi, to ra hiu qu kinh t ti u cho khu vc. K qu v hon tr: p dng cho cc ngnh kinh t d gy nhim mi trng trm trng nh khai thc ti nguyn khong sn. Khon k qu phi ln hn hoc xp x kinh ph cn thit x l, khc phc nhim mi trng trong trng hp ri ro. N s c tr li khi nguy c nhim khng cn. Nhn sinh thi: danh hiu ca cc t chc mi trng dnh cho cc sn phm c s dng nhng cng ngh hoc gii php thn mi trng, nhm cung cp thng tin v khuyn co ngi tiu dng la chn hng ho v mc tiu bo v mi trng. Tr cp mi trng: cp pht ngn sch cho nghin cu khoa hc, trin khai cng ngh, p dng k thut mi, khuyn khch v thu v li sut vay vn, qun l mi trng, kim sot mi trng, gio dc mi trng... Tr cp ti chnh c th to ra cc kh nng gim thiu nhim, nhng khng khuyn khch doanh nghip u t cho mi trng, khng to ra cnh tranh bnh ng v tiu tn ngn sch. Qu mi trng: c thnh lp t cc ngun kinh ph khc nhau, nh ngn sch nh nc, ng gp ca cc c s sn xut kinh doanh, ng gp t nguyn, ng gp t cc cng c kinh t mi trng khc, h tr pht trin t nc ngoi...; Dng chi khuyn khch cc hot ng bo v mi trng. Hin c qu mi trng ton cu GEF vi kinh ph hot ng hng nm khong 2-3 t USD. 219

5.4.4. Cng c k thut qun l mi trng

Cng c ny bao gm: thit b o c kim sot mi trng, x l cht thi, cng ngh, k thut bn vng... Tiu chun ISO 14001, do T chc Tiu chun Quc t (ISO) ban hnh, l b tiu chun v thc hin qun l mi trng trong hot ng kinh doanh ca ISO, c nhng tc ng tch cc ti kim sot nhim mi trng.
5.4.5. Qun l hnh chnh v mi trng

Xy dng cc chnh sch mi trng, quy hoch mi trng, chng trnh hnh ng v mi trng, nh gi tc ng mi trng, xy dng b tiu chun mi trng.
BI TP TNH HUNG Mc tiu

1. p dng c nhng khi nim v pht trin bn vng trong tnh hung thc t. 2. Phn tch c mi quan h gia vic s dng khng bn vng cc ngun ti nguyn thin nhin v suy thoi mi trng. 3. xut c nhng chin lc kh thi gim thiu nhng tc ng tiu cc ca con ngi ln mi trng v sc kho cng ng.
Tnh hung

Thng 3 v thng 5 nm 2002, hai v chy rng ln xy ra lm hu hoi khong 5000 hecta rng trm min Nam, Vit Nam. Mt cng ty ln ca M ang xut mt k hoch cho d n pht trin ti khu rng trm ny. K hoch xut xy dng trn khu vc rng va b chy 2 lng vi dn s khong 10.000 dn, mt din tch khong 1000 hc ta dnh cho trng cy keo lai v 1000 hc ta nui tm xut khu sang th trng Hng Kng. Chnh ph Vit Nam rt quan tm ti cng ca d n ny nhng cng ang cn nhc v nhng tc ng tim tng ca d n ln s pht trin bn vng ca khu rng. Chnh v vy, chnh ph yu cu cc chuyn gia v lnh vc pht trin bn vng n t Trng i hc Y t cng cng xem xt cng v bo co li vi chnh ph v nhng tc ng ca d n ln mi trng, con ngi v s pht trin bn vng. Bn l nhng chuyn gia n t Trng i hc Y t cng cng v bn s bo co vi Chnh ph v nhng vn ny. Trong bo co ca bn, hy xem xt nhng cu hi sau y:

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1. Rng trm c nhng vai tr g? 2. Hai v chy trn gy ra nhng tc ng g? 3. Rng trm ny c th ti sinh c khng? 4. Vic pht trin nui trng thu sn s c nhng tc ng g ti mi trng a phng? 5. Theo bn, d n trng cy keo lai c m bo pht trin bn vng?
T LNG GI

1. in t thch hp vo cu sau: Pht trin bn vng l s pht trin nm tho mn cc nhu cu hin ti ca con ngi nhng khng tn hi ti s tho mn cc nhu cu ca................. ............................. 2. Hy nu tn nhng nguyn tc pht trin bn vng ca Luc Hens (1995) 3. Nu nguyn tc ngi gy nhim phi tr tin, ngi s dng mi trng phi tr tin. Nu tc dng c th ca nguyn tc ny. 4. Hy nu tc hi ca vic khai thc rng ma Brazin. 5. Nu khi nim v pht trin bn vng ca y ban Quc t v Mi trng v Pht trin. 6. Hy nu 5 c im ca pht trin bn vng. 7. Nu cng thc nh gi ch tiu pht trin nhn vn HDI. 8. Hy nu mt s hng p dng c th ca cng ngh v k thut bn vng. 9. Hy nu tn cc cng ngh v k thut gen. 10. Gii thch s dng ti nguyn trong h kinh t. 11. Hy nu cc nguyn tc ca trng phi mi trng hc khuyn ngh cho cc nc ang pht trin. 12. Nu mt s cng c quc t v bo v mi trng v ti nguyn m Vit Nam tham gia. 13. Thu v ph mi trng l g? 14. Nu khi nim v Cta thi. 15. Nu tn cng c kinh t qun l ti nguyn.

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BI 10

QUN L SC KHO MI TRNG

MC TIU

1. Trnh by c mt cch tng quan cc khi nim v Qun l Mi trng v cc hot ng ca Qun l Sc kho mi trng. 2. Nu c nhng vn tn ti trong qun l nhim mi trng Vit Nam. 3. Phn tch c tm quan trng ca cng ng trong vic tham gia qun l Sc kho mi trng.

1. KHI NIM V NH NGHA V MI TRNG V SC KHO MI TRNG

Theo Lut Bo v mi trng Vit Nam (1993), mi trng c nh ngha nh sau: Mi trng bao gm cc yu t t nhin v yu t vt cht nhn to quan h mt thit vi nhau, bao quanh con ngi, c nh hng ti i sng, sn xut, s tn ti, pht trin ca con ngi v thin nhin. Sc khe mi trng bao gm nhng kha cnh v sc khe con ngi, bao gm c cht lng cuc sng, c xc nh bi cc yu t vt l, ha hc, sinh hc, x hi v cc yu t tm l trong mi trng (theo nh ngha trong Chin lc Sc khe Mi trng Quc gia ca Australia - 1999). Hay ni cch khc: sc kho mi trng l to ra v duy tr mt mi trng trong lnh, bn vng nng cao sc kho cng ng.
1.1. Mi trng l hc

Mi trng l hc nu vt qua cc gii hn tip xc bnh thng c th nh hng n sc kho. Mi trng l hc bao gm thi tit v kh hu (nhit cao, thp, thay i tht thng, m khng kh, gi) cc loi bc x ion ho v khng ion ho, sng in t, cc loi bc x laser, ting n v rung xc, v.v...
1.2. Mi trng ho hc

Cc yu t ho hc c th tn ti di cc dng rn, lng v dng kh. Cng c cc dng c bit nh bi, kh dung, hi khi... Cc yu t ho hc c th c ngun

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gc t t nhin trong mi trng t, nc, khng kh, thc phm v cng c th pht sinh t cc hot ng sng, sinh hot v sn xut ca con ngi.

1.3. Mi trng sinh hc

Cc yu t sinh hc cng rt phong ph, t cc sn phm ng thc vt n cc loi nm mc, vi khun, virus, k sinh trng v cn trng. Chng c th l cc tc nhn gy bnh song cng c th ch l cc vt ch trung gian truyn bnh, cc sinh vt vn chuyn mm bnh mt cch c hc. Cc yu t sinh hc cng tn ti trong t, nc, khng kh v thc phm.
1.4. Mi trng x hi

iu kin kinh t -x hi nh hng trc tip n sc kho hoc gin tip trn qu trnh nhim, nng lc khng ch nhim bo v sc kho, n cc ng x khc nhau ca cng ng i vi mi trng. Cng vi qu trnh pht trin ca kinh t, x hi to ra cc c hi mi trong khng ch cc tc ng m tnh ln sc kho, ng thi cng c th ny sinh nhiu nguy c mi qua thay i li sng, cch ng x mi trng v gia tng cc stress trong sinh hot v lao ng sn xut. Ch chnh tr ca mt quc gia cng nh s bnh n trong khu vc l yu t tc ng ti mi trng. Chin tranh, mt cng bng x hi, t nn phn bit chng tc, bt bnh ng gii, bt n v chnh tr -x hi lun l cc yu t tn ph mi trng v gy nh hng xu n sc kho. Nghin cu cc mi trng ho hc, sinh hc, l hc phi t trong cc bi cnh mi trng x hi.
2. KHI NIM V QUN L MI TRNG

Qun l mi trng l tng hp cc gii php k thut v gii php hnh chnh nhm bo v mi trng khng b nhim hoc khng ch mc nhim trong cc gii hn cho php, khng gy tc hi cp tnh hay mn tnh ln sc kho. Trong cc trng hp khng th bo v c mi trng khi cc nguy c nhim, qun l mi trng cng cn nhm vo cc gii php bo v cc i tng tip xc, hn ch cc hu qu ca nhim v gii quyt cc hu qu trn sc kho.
2.1. Qun l bng cc gii php k thut i vi mi trng t, nc, khng kh v thc phm

t, nc, khng kh v thc phm c mi lin h khng kht vi nhau. t c th cha cc yu t ho hc, sinh hc v l hc. Cc yu t ny thng xm nhp vo

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cc ngun nc sinh hot ri t tc ng n sc kho con ngi. T t, cc cy trng, lng thc hay ng vt l ngun thc n cho ngi v cc ng vt khc cng c th b nhim. Cc yu t nhim trong t li cng c th t cc ngun nc thi, rc thi cng nh khi bi c cha cc yu t ho hc v sinh hc c hi. Bo v t, nc, khng kh v thc phm khng b nhim nhiu khi phi tin hnh song song. V d, mun ngun nc ging o sch phi ngn nga nhim t cc h x mt v sinh. Mun thc phm sch phi p dng cc bin php khng ch nhim ngun nc, t v cy trng. Cc ngun ti nguyn b khai thc khng c t chc s dn ti ph v mi cn bng sinh thi v cng to ra cc nguy c nhim. Trong sinh hot, bo v mi trng khi cc ngun nhim bao gm tng hp cc gii php khng ch nhim nh: qun l cht thi rn, cht thi lng v khi bi t cc ngun pht sinh, qu trnh vn chuyn v qu trnh thu gom x l. Trong sn xut, bo v mi trng lao ng bao gm vic s dng cc trang thit b v sinh nhm khng ch khng cho pht sinh nhim, lm long, ngn nga pht tn nhim ra mi trng. Nu cc gii php trn khng thc hin c hon chnh, phi b sung cc bin php phng h c nhn. C trong sn xut v sinh hot u phi ch ti vic qun l sc kho cng ng, pht hin sm cc tc hi giai on cn kh nng hi phc iu tr hoc phc hi chc nng nu hu qu trn sc kho l khng cha c. Gim st mi trng v gim st sinh hc l cc hot ng nhm theo di, pht hin tnh trng nhim, tnh trng thm nhim v tnh trng sc kho bt thng t c cc phn ng kp thi. Cc phng php d bo, cc k thut o lng gim st mi trng v sinh hc cn c s dng ph hp vi c im a l, dn c, kinh t, x hi ca mt a bn, mt a phng v quc gia. V d, kh x cc ng c c s dng xng pha ch l ngun nhim rt nguy him vi sc kho cng ng, c bit l sc kho tr em. Qun l nguy c ny c th bng rt nhiu gii php: cm s dng xng pha ch, tng cng giao thng cng cng, gim st mc nhim ch trong khng kh, khm sng lc pht hin tnh trng thm nhim ch qu mc tr em v pht hin cc trng hp nhim c ch iu tr sm.
2.2. Qun l mi trng bng chnh sch, chin lc, cc gii php hnh chnh v lut l

Qun l mi trng khng ch bng cc gii php k thut n thun m cn cc gii php mang tnh tng th, lut v hnh chnh. Do ngun gc ca nhim mi trng l t qu trnh sn xut, cc qu trnh khai thc ti nguyn, cc hot ng ca i sng hng ngy ca tng a phng, tng nhm dn c, tng gia nh v tng c th nn vic qun l mi trng c rt nhiu bn lin quan (stakeholders) ch khng ring g ngnh y t.

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 tm c quc t cng c rt nhiu cc t chc tham gia vo vic hoch nh cc chnh sch bo v mi trng ton cu. V d: Chng trnh Ngh s 21 v Pht trin bn vng ca i hi ng Lin hip Quc thng qua ti Rio de Janeiro thng 6 nm 1992. Mi quc gia li pht trin chnh sch mi trng ring ca mnh. Ngay cc a phng cng cn c cc chnh sch ring c th ho chnh sch quc gia nhm gii quyt cc vn ti a phng. Khng c chnh sch ph hp s thiu kh nng kim sot mi trng tng th cng nh kh pht trin cc gii php k thut; c chnh sch song chnh sch khng c th hin bng cc vn bn php lut, bng cc quy nh hnh chnh th hiu lc ca chnh sch s rt gii hn. nc ta, Lut Bo v mi trng c ban hnh nm 1993. Di lut l cc ngh nh ca Chnh ph nhm hng dn vic thc hin lut. Di cc ngh nh l cc thng t ca chnh ph hoc ca cc b ngnh quy nh chi tit hn cc iu khon nhm a lut vo cuc sng. Nhiu thng t li phi ban hnh di dng thng t lin b mi c hiu lc v c nhng iu lut yu cu nhiu ngnh v nhiu lnh vc tham gia. Trong tng b ngnh, B trng c th ban hnh cc vn bn ch o ngnh dc ca mnh, nh cc quyt nh v cc ch th. Ti tng a phng, y ban nhn dn cp tnh, thnh cng ban hnh cc vn bn ch o trn a bn da trn cc vn bn ca Chnh ph, b ngnh v cn c vo cc quyt nh ca Hi ng nhn dn cng nh c quan ng b a phng. Qua h thng cc vn bn php lut nh trn m bo cho cc gii php k thut c thc thi v mt hnh chnh. Bn cnh , kim sot vic qun l mi trng cn c s tham gia ca h thng thanh tra chnh ph v cc b ngnh, cc a phng.
2.3. Cc nhim v c bn ca ngnh y t trong qun l mi trng

Hin nay, t trung ng n a phng thnh lp c quan qun l nh nc v mi trng. cp trung ng c B Ti nguyn v Mi trng, cp tnh c S Ti nguyn v Mi trng, cp huyn c Phng Ti nguyn v Mi trng v n tn cp x (a chnh). y l cc c quan qun l c v k thut v hnh chnh i vi mi trng. Bn cnh cn c cc c quan qun l nh nc v y t d phng. tuyn trung ng c B Y t (Cc Y t d phng, Cc V sinh an ton thc phm), tuyn tnh c S y t (Trung tm Y t d phng tnh), cp huyn c (Trung tm Y t d phng huyn/i Y t d phng) v cp x c Trm y t x. y l cc c quan tham gia qun l cc vn sc kho mi trng. Nh vy, hin nay vn song hnh hai h thng ca hai b ngnh cng tham gia qun l mi trng cho d c s phn nh ranh gii nhng hot ng chng cho tuyn tnh l kh trnh khi. Ngnh y t chu trch nhim chnh trong gim st cc yu t mi trng trc tip tc ng n sc kho cng ng v sc kho ngi lao ng. Trong khi , ngnh mi trng v ti nguyn qun l tm v m hn nh: nh gi tc ng mi trng, tham gia ph

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duyt cc quy hoch pht trin sn xut, cng nghip, dn s, th v.v... Cc hot ng gim st mi trng cng c c quan ny thc hin ch yu ngoi nh my. Cc b, ngnh sn xut cng c mt s trung tm y t lao ng. y cng l cc h thng qun l mi trng lao ng chu s gim st v ch o chuyn mn nghip v ca cc v, vin thuc ngnh y t.

T chc Y t Th gii khuyn co 10 nhim v i vi cc c s y t nh sau: (1) xut v ph bin cc bin php d phng bo v sc kho cng ng. Cung cp cc c s cng nh tham mu vi chnh quyn cc chnh sch, chin lc bo v sc kho khi cc nguy c t nhim mi trng. Thng tin cho cc b ngnh khc cng nh cc c s sn xut v cc cng ng dn c v cc vn sc kho lin quan ti mi trng. ng thi, khuyn khch cc sng kin nhm ci thin mi trng, thay i hnh vi c li cho sc kho. (2) Nng cao nng lc ca cng ng trong x l cc tc ng ca mi trng ln sc kho, bao gm cc gii php phng bnh do chnh quyn a phng v ngi dn thc hin. (3) Tin hnh nh gi cc nguy c t mi trng v tc ng ca mi trng trn sc kho. y, bao gm cc hot ng theo di mi trng, pht hin nhng yu t c hi i vi sc kho t mi trng sn xut, mi trng sinh hot cng cng v mi trng gia nh. Pht hin cc nguy c do cc hot ng ca cc ngnh khc, nht l cc ngnh sn xut c s dng nhin liu v nguyn liu pht sinh c hi. (4) Tin hnh cc gim st dch t hc i vi cc bnh c lin quan n mi trng. Thng bo hin trng cng nh nhng d bo v tnh hnh sc kho v cc yu t c hi t mi trng cho nhng ngi c thm quyn ra cc chnh sch pht trin kinh t -x hi. (5) o to cn b v sinh phng dch cho cc tuyn v cc ngnh lin quan. (6) Cung cp cc dch v cng nh trin khai cc chng trnh, d n v kim sot mi trng c lp hoc phi hp vi cc ngnh sn xut khc. V d: trin khai chng trnh tim chng m rng, chng trnh nc sch v v sinh nng thn (cng B Nng nghip v Pht trin nng thn) v.v... (7) Sn sng tham gia cng cc b ngnh, a phng khc trong vic ng ph vi cc thm ha t nhin cng nh thm ha do con ngi gy ra. (8) Phi hp vi cc c quan hu quan a ra cc tiu chun tip xc cho php, cc gii hn v chun mc v sinh, chun b cc vn bn c tnh php quy trong bo v mi trng, bo v sc kho trnh cp c thm quyn ph duyt.

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(9) Phi hp nh gi tc ng mi trng (EIA) v ch ng xut cc gii php d phng, cc quy trnh theo di tnh hnh sc kho mt cch c h thng. (10) xut v tin hnh nhng cng trnh nghin cu trong lnh vc sc kho mi trng v cc gii php phng nga.
3. NHNG HOT NG QUN L SC KHO MI TRNG

Nhng cu hi chnh thng t ra cho ngi qun l mi trng gm: C nhng yu t mi trng no c th nh hng n sc kho cng ng? Mc nhim hoc nguy c ca yu t n sc kho cng ng ra sao? C nhng gii php no (hin c) ang c s dng ngn nga nguy c hin ti v tc ng lu di ca nhim mi trng ln sc kho? C nhng khim khuyt no trong cc gii php m c th iu chnh c? C nhng gii php kh thi no khc nhm tng cng sc kho, ci thin mi trng? Cn c cc vn bn g, quy nh hnh chnh no gip cho vic th ch ho, hnh chnh ho cc hot ng qun l mi trng? Hin nay cc lut l cng nh cc vn bn php quy ch o cng tc v sinh phng bnh, ngn nga cc nguy c t mi trng c ph hp khng? im no khng ph hp v cn phi iu chnh? Cn c nhng chin lc no, tiu chun g i vi cht lng mi trng? trin khai cc chin lc cc a phng, cc b ngnh cn c nhng hng dn g? T cc cu hi trn, c 7 nhm hot ng qun l mi trng s c trnh by di y.
3.1. Xc nh v o lng mc nhim mi trng

y l nhim v u tin v cng l hot ng cn nhiu ngun lc nht i vi c s y t d phng a phng. Mi nc vi trnh pht trin kinh t cng nh iu kin a l mi trng, h thng chnh sch x hi khc nhau c nhng quan tm khng ging nhau. cc nc pht trin, ngi ta quan tm nhiu n nhim mi trng cng nghip, th, n vic khai thc cc ngun ti nguyn khng ti sinh, n tng ozon, n kh x ng c v c cc vn m nc ang pht trin t ch ti nh thu triu v tnh trng nng ln ca tri t... Trong khi , cc nc ang pht trin li ch ti cc yu t nhim mi trng truyn thng nh vn cht thi sinh hot, cc yu t nhim vi sinh vt, k

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sinh trng, ho cht bo v thc vt, nhim thc phm v.v... Ngay trong cng mt quc gia, cc mi quan tm v mi trng mi vng cng c cc c trng ring. Trc khi xc nh nhim mi trng ca mt a phng, mt khu vc dn c chng ta cn tm hiu nhng vn quan tm hng u ca cng ng l g, yu t no ang v s gy hu qu ln sc kho, yu t no c nhn bit hoc cha c nhn bit, mc nh hng ra sao, cc kh khn cn tr g trong qu trnh pht hin nhim, theo di, gim st v kim sot nhim v.v... Dn s ang sng trong tnh trng nhim l bao nhiu, cc nhm d b tn thng l nhng ai? Vic xc nh cc yu t nhim c th cn n cc k thut o c, nh gi nhim. Song, khng t trng hp cc yu t nhim ch c ghi nhn c tnh cht nh tnh hoc trn cc suy lun l-gic. V d: khi t l h gia nh c h x hp v sinh cn thp, nguy c nhim vi sinh vt ng rut trong t v c bit l trong nc s rt cao. y, yu t c th o lng c l cc ch s v sinh ca cc ngun nc sinh hot (coliform, BOD5, NH3...) song cc tc nhn gy bnh ng rut khc nh cc virus v vi khun gy bnh tiu chy tr em li rt kh xc nh, nht l khi thiu cc k thut lab hin i, v vy phi "mn" cc ch s v sinh nh gi nhim. Tng t nh th, cc yu t gy ung th trong mi trng rt nhiu song t c kh nng o lng chng, tr mt vi nghin cu c mc u t kh ln. Phng php "kim k" (inventory) cc yu t nhim da trn cc m hnh tnh ton cng c khuyn co p dng mt khi thiu cc k thut theo di - gim st mi trng. V d, xc nh mc nhim kh SO2, SO3 trong mi trng do khi x t cc ng khi nh my s dng than , ngi ta c th s dng phng php ho hc nh lng SO2, SO3 trong khng kh, hoc s dng h thng thit b theo di t ng (monitoring). Trng hp khng c cc k thut trn, ngi ta c th tnh ton lng SO2, SO3 thi vo khng kh trong mt thng (hay 1 ngy m, 1 nm...) qua s liu bo co v lng than s dng (trong than c mt t l lu hunh xc nh, khi t s to thnh SO2, SO3... ). Khi xc nh yu t nhim, cn xc nh c s lng qun th dn c cng nh sinh vt c th chu tc ng trc tip hoc gin tip do nhim mi trng. V d, xem bng 10.1 v tnh hnh nhim SO2 hai thnh ph.
Bng 10.1. Tnh hnh nhim SO2 hai thnh ph A v B
Thnh ph A Dn s Mc nhim SO2 (ppm) Ti a 0,40 1,40 8.000.000 Thnh ph B 1.000.000

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Ti thiu Trung bnh S dn tip xc Ph n Tr em Ngi cao tui

0,10 0,25

0,10 0,25

4.200.000 600.000 800.000

510.000 150.000 100.000

nh gi nhim c th da vo cc mc nhim, trong khng ch ch ti mc nhim trung bnh, t l s mu o vt tiu chun v sinh cho php m cn ch ti mc nhim ti a (c nhng thi im nhim cao nht) c th tc ng cp tnh trn cng ng. Thm vo mc giao ng (ti a, ti thiu) cng cn c ch phn tch v quy lut nhim. Sau cng, song li khng km phn quan trng, l s dn phi tip xc, trong c cc i tng rt nhy cm. Vi v d trn cho thy mc nguy c thnh ph B c phn cao hn song thnh ph A tng s dn tip xc cng nh cc nhm d b tn thng li nhiu hn. R rng l mc u t cho phng chng nhim kh SO2 thnh ph A phi ln hn. Xc nh cc yu t nhim cng c phn theo cc mc khc nhau: Mc h gia nh hay cn gi l "vi mi trng", trong cc ngun nhim t cc cng trnh v sinh, bp, khi thuc l, cc ho cht v c cc thi quen c hi ti sc kho khc. Mc cng ng hay mi trng a phng, trong cc ngun nhim t giao thng, cc cng trnh cng cng, cc c s sn xut trong khu vc... Mc nhim ca mt vng lnh th, vng a l, ni c cc yu t nhim t mi trng thin nhin, cao, vng kh hu. Mc nhim trong cc c s sn xut, trong cc ngh nghip: nng, lm, ng nghip, cng nghip, dch v... Nu phi hp vi cc loi yu t nhim ta s c ma trn h thng ho cc yu t nhim (bng 10.2).
Bng 10.2. Mu ma trn h thng ho cc yu t nhim
Cc loi yu t nhim Ho hc Mc h gia nh Mc cng ng Mc khu vc nhim ti cc c s sn xut, trong cc ngh nghip L hc Sinh hc

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3.2. o lng cc yu t c hi v nh gi cc nguy c cng nh hu qu ln sc kho

Trong mc 3.1 cp ti vic o lng cc yu t c hi, trong c cc bin php s dng thit b k thut v m bng khng s dng thit b k thut m hnh tnh ton qua kim k cc ngun pht sinh. Mc 3.2 ch yu nhm gii thiu cc bin php nh gi tip xc v hu qu ca n ln sc kho.
3.2.1. nh gi tip xc vi mi trng

Mun nh gi mc tip xc vi mi trng, vic u tin l phi ly mu. y c 5 cu hi c t ra l: Cn ly mu trong bao lu v bao lu li ly mu mt ln (tn sut ly mu)? V tr ly mu u? Yu cu v cht lng s liu phn tch n u? Cn c phng tin ly mu g? K thut no s dng trong phn tch mu? Ni dung bi ny khng a ra cu tr li cho cc cu hi trn y m lu chng ta cc cu hi ca ngi qun l mi trng t ra cho cc nh k thut mi trng v s c hc trong nhng bi khc. C khng t trng hp khng th o lng c mc tip xc (nh lng) m ch c lng c nguy c (nh tnh). V d, trong v dch hi chng vim ng h hp cp tnh (SARS) nm 2003, khi tc nhn gy bnh khng bit c th, ch qua cc xt nghim nh nhm virus bit c c th l mt loi corona virus v cng khng th nh lng c s virus trong mt mt khi khng kh. V vy, khng c ly mu v phn tch mu trong mi trng. Kh nng duy nht xc nh nguy c l s ngi tng tip xc gn gi vi ngi bnh in hnh (index case). Mc nhim m mt cng ng phi tip xc cng cao qu tiu chun tip xc cho php th nguy c cng nhiu. Thm vo , thi gian tip xc cng ng vai tr rt quyt nh. Thi gian tip xc cng di th nguy c cng cao. Tuy nhin, c nhng yu t tc hi gy nh hng cp tnh hoc ti cp tnh th ch trong mt thi gian tip xc rt ngn cng c th nh hng ti sc kho, thm ch c th gy t vong (v d, tip xc vi hi kh CO). ly mu, ngi ta c th s dng cc phng tin ly mu c nhn hoc cc phng tin ly mu ngoi cng ng, ni sn xut... phn tch mu thu c ngi ta s dng nhiu k thut phn tch ho hc, l hc, ho l v sinh hc. Cc k thut ny phi do cc chuyn gia v k thut vin thc hin. Kt qu sau khi phn tch c tnh ton theo cc n v khc nhau. T , ngi ta c tnh ra liu tip xc trung bnh, liu tip xc trung bnh theo thi gian, liu tip xc nh. i chiu liu

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tip xc vi cc tiu chun tip xc cho php a ra nhn nh v nguy c v a ra cc phng thc xc nh nhng hu qu ca mi trng trn sc kho mt cch thch hp (trong trng hp c tiu chun tip xc cho php).
3.2.2. nh hng ca nhim mi trng ln sc kho

Trong nhiu trng hp, nh hng ca mi trng ln sc kho c xc nh qua cc ch s mc bnh, t vong do mt s bnh c trng (bnh c hiu ca mt ho cht c, mt yu t l hc hay sinh vt hc) hoc mt s bnh khng c trng (mi trng ch l yu t tc ng lm tng t l mc v cht). V d: nhim c ch, bi phi silic v bnh phi tc nghn mn tnh khng c hiu. Khng t cc yu t mi trng rt kh xc nh tc hi trn sc kho do tnh c hiu qu thp. Trong cng mt iu kin tip xc, thm ch cng liu tip xc song c nhng c th hoc nhm ngi khng hoc t b nh hng hn cc c th, nhm ngi khc. V vy, nh gi nh hng ca mi trng trn sc kho phi da vo quy lut s ng, vo tnh ph bin, tr mt s ngoi l. Vic xc nh nh hng ca mi trng ln sc kho da trn cc s liu thng k v tnh hnh mc bnh v/hoc tnh hnh t vong. Ngoi ra, cn c cc ngun s liu t nhng kt qu khm pht hin bnh nh k, khm sng lc hoc/v lm cc xt nghim c hiu hoc khng c hiu, iu tra phng vn v tnh hnh sc kho, m au ca tng i tng v.v. nh hng ca mi trng ln sc kho thng hay ging vi hin tng "tng bng ni" vi cc mc nh hng khc nhau (s 10.1).

a b c d

a. T vong b. Mc bnh lm sng c. Mc bnh tin lm sng d. Tip xc qu mc, cha mc bnh e. Tip xc trong gii hn cho php

S 10.1. Cc mc nh hng ca mi trng ln sc khe

S trn cho thy: nu ch c mt vi trng hp t vong phi thy rng c rt nhiu ngi ang b bnh th lm sng hoc tin lm sng. Cng nh th, khi mt

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ngi bnh c pht hin cng c th c rt nhiu ngi ang tip xc qu mc nhng cha mc bnh. Trong khi nghin cu nh hng ca mi trng ln sc kho ngi ta c th da vo mt s nhm bnh mang tnh "ch danh". V d, nu thy t l bnh phi tc nghn mn tnh khng c hiu cao, c th ngh nhiu n cc yu t nhim mi trng khng kh l bi, hi kh kch thch v khi. Nu thy t l bnh nhim trng ng tiu ho cp tnh cao, c th ngh ti nhim ngun nc do nc thi sinh hot hoc nhim phn. Mt s yu t nhim c th gy ra cc ri lon trong phn chia t bo hoc ch nh hng ti t bo sinh dc gy ra qui thai hoc d tt bm sinh cho th h sau m khng th hin hu qu trn th h tip xc. Trong trng hp ny i hi phi s dng cc phng php nghin cu di truyn hc. Khi nghin cu hu qu ca mi trng ln sc kho phi ch rng ngoi tc ng ca mi trng, sc kho cn chu nh hng ca nhiu yu t khc nhau nh cc yu t gy stress, tnh trng dinh dng v cc thi quen sinh hot c hi cho sc kho. Thm vo , khi tm hiu nh hng ca yu t c hi ny, phi lu rng c th c cc yu t c hi khc cng tc ng ln tnh trng sc kho cng ng. Cc nghin cu dch t hc vi s h tr ca cc xt nghim mi trng, cc xt nghim sinh hc v cc khm xt lm sng gip cho vic xc nh mi quan h nhn qu gia mi trng v sc kho. Khi xc nh c nhng hu qu ca mi trng ln sc kho cn tm hiu mi quan h nhn qu, xc nh mc nguy c v mc hu qu ca nhim mi trng t xc nh cc vn u tin, cc gii php u tin cho cc hot ng lm gim nh hu qu, bo v sc kho v bo v mi trng.
3.3. xut cc gii php gim nh nguy c, ngn nga hu qu

Da trn cc chnh sch quc gia v bo v mi trng, b lut mi trng v cc iu trong cc b lut khc c lin quan n bo v mi trng, cn c vo nng lc khng ch v kim sot mi trng ca cc c s y t, ca ngnh cng ngh - ti nguyn - mi trng v trn qu trnh phn tch tnh hnh mi trng, hu qu ca mi trng ln sc kho ca a phng xut cc gii php ph hp vi nhng u tin, vi ngun lc c th c c, kh thi v c gii php hu hiu. Nguyn tc ca cc chin lc mi trng da trn cc nguyn l c bn nh: cng bng, hiu qu v cng ng tham gia. Cc gii php c th cc nc khc nhau: D phng cp I: ngn khng xy ra nhim qu mc v khng xy ra hu qu xu trn sc kho. V d: cc chng trnh cung cp nc sch v v sinh nng thn; cc bin php ngn nga nhim ti ngun pht sinh (khng s dng nguyn

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liu pht sinh c hi, hn ch ngun nhin liu pht sinh khi, bi, p dng cng ngh sch, bo v khi cm th v.v.) D phng cp II: trong trng hp khng th khng ch c nhim v hu qu xu ln sc kho xy ra, lc cn phi p dng cc bin php qun l sc kho v iu tr ph hp ngn khng xy ra tai bin hoc cht. V d: chng trnh nhim khun h hp cp tnh (ARI), chng trnh tiu chy tr em (CDD), khm pht hin sm v iu tr cho cc trng hp b bnh do nhim mi trng v bnh ngh nghip. Vic chn cc vn u tin da trn kt qu nh gi tc ng mi trng (EIA); trn nng lc ng ph v mt k thut, v ngun lc sn c, trn din tc ng ca vn , tnh trm trng ca vn v trn c tnh ca cng ng chu nguy c (c im kinh t, vn ho: u tin ngi ngho, vn ho thp v tnh d b tn thng: b m, tr em...). Khi chn cc vn u tin cn c s ch o ca cc cp u ng, chnh quyn, c Hi ng nhn dn ng h, c cc ban ngnh hu quan h tr v cng cng tc. Vic li cun cc c quan nh nc cha , phi c c s tham gia (t nguyn hoc cng ch) i vi cc c s t nhn. Sau cng, phi dung ho c nhng li ch ca cc bn c lin quan, sao cho mc tiu bo v mi trng, bo v sc kho t c nhng khng hoc t gp phi s phn ng ca cng ng hay nhng ngi c quyn ra chnh sch phc li cng cng khc. Trong qu trnh xy dng cc chin lc cn c s tham gia lin ngnh th khi thc thi cng cn c s ng gp ca lin ngnh cng vi s tham gia ca cng ng. Ch ring cc c s y t d phng th khng th gii quyt c cc vn mi trng -sc kho cho d hin nay c lut. Vic iu chnh chnh sch, thay i chin lc cho ph hp vi tng a phng, tng cng ng cc thi im khc nhau l ht sc cn thit. Cc gii php a ra c th theo mt lch trnh di nhiu nm, song cng c th ch trong mt tnh hung, mt thi gian gii hn. Cc gii php di hn phi lng ghp trong quy hoch pht trin kinh t -vn ho -x hi ca a phng hay trong quy hoch pht trin ngnh y t. Cc gii php ngn hn mm do hn, linh hot hn khi ng ph vi cc tnh hung c tnh cp bch song sau phi a ra cc gii php c c s hn v vng bn hn.
3.4. Xc nh tnh kh thi ca cc gii php

Nh trn y trnh by cc yu t cn a ra xem xt khi xc nh cc vn u tin cn gii quyt, trong c tnh kh thi v k thut (ngha l c gii php k thut hiu qu) v kh thi v t chc (ngha l c cc t chc thc hin kh hon chnh thc hin cc gii php k thut). Tnh kh thi cn tu thuc vo kh nng cc ngun lc (nhn lc, ti chnh v thit b). Khng c my no hot ng m khng cn n ngun in hoc nhin liu. Thiu ngun lc cng nh xe t khng c xng, nh mt c s sn xut ngho nn, yu km v khng c nguyn liu, nhin liu. Tnh kh thi cn th hin s cam

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kt ng h ca chnh quyn y v s tham gia ca cng ng. S cam kt khng ch trn giy m phi bng vic m bo cc ngun lc cn thit.
3.5. Xy dng h thng lut php, cc vn bn php quy qun l mi trng

Tt c mi hot ng bo v mi trng cn c th ch ho bng cc lut, php lnh, cc ngh nh ca Chnh ph, Quc hi, cc thng t hng dn ca cc b- ngnh, quyt nh ca cc c quan chnh quyn v s ch o ca c quan ng. Vic thanh tra mi trng cng da trn cc quy nh c tnh php l. Thanh tra mi trng hot ng yu cng ging nh ti ni cng cng khng c s gim st ca lc lng cng an vy.
3.6. iu chnh chnh sch v lut l

Chnh sch khng phi l bt bin. Cc iu lut nh k cng c xem xt, sa i v b sung. Nhim v ca cc c quan y t cng nh c quan mi trng trong khi thc hin cc lut nh phi pht hin nhng im bt hp l, im thiu ht trong cc vn bn v xut nhng sa i ln cp c thm quyn (cp ra vn bn cng l cp phi sa i vn bn khi cn thit).
3.7. Cc chin lc v chun mc trong qun l mi trng

Cc chin lc v mi trng phi ph hp vi hon cnh thc t ca tng quc gia, tng a phng, song cc chun mc v mi trng th li rt t thay i. Hin nay, cc tiu chun tip xc hay tiu chun v sinh cho php ca Vit Nam cng da trn hu ht cc chun mc quc t. Nh vy, s ny sinh mu thun gia nng lc kim sot mi trng cn rt gii hn vi nhng chun mc qu cao so vi kh nng p dng v kh nng tun th trn thc t. Thm vo , cc chun mc phi i km vi k thut chun mc nh gi nhim mi trng. iu ny cng l mt bt cp trong thc t, khi cc k thut nh gi nhim cc tnh hin nay cn rt gii hn. p dng chun mc no, gii hn no l chp nhn c vn l cc cu hi cn c xem xt thm.
4. NHNG VN TN TI TRONG QUN L NHIM MI TRNG VIT NAM

Vn mi trng Vit Nam c ngnh y t cp n u tin v vo nhng ngy u sau cch mng Thng Tm. Lc ny ng v Chnh ph pht ng cc phong tro v sinh phng bnh m ni dung ch yu l gi gn v sinh mi trng sinh hot v v sinh trong gia nh. Hot ng qun l v bo v mi trng l nhim v do ngnh y t m nhim vi vai tr chnh mi ti tn thp k 70. Sau , ngnh cng ngh v mi trng mi c thnh lp v gnh vc nhim v vi vai tr ngy cng tng, khng ch cp quc gia m cn c cc a phng.

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4.1. Cc gii php qun l v sinh mi trng ca ngnh y t

y l tp hp cc hot ng nhm gii quyt cc vn ph n, nc, rc thi trong mi trng sinh hot v gii quyt cc vn nhim mi trng cng nghip, nng nghip v sau l qun l cc cht thi rn v lng quy m ln hn, nht l sau khi c Lut Bo v Mi trng ca Vit Nam (1993). S phi hp ca ngnh y t, ngnh khoa hc cng ngh -mi trng cng vi vic a ra cc php lnh, ngh nh ca Quc hi, ca Chnh ph th ch ho cc bin php bo v mi trng lm cho cc hot ng qun l mi trng c c s hn v c u t tng th hn. Cc vn bn v quy nh tiu chun v sinh ca ngnh y t xut v ban hnh da trn cc tiu chun ca Lin X c v ca T chc Y t Th gii l bn tiu chun rt u vit. Tuy nhin, thc hin cc tiu chun cn gp rt nhiu kh khn do: thc t gic ca cng ng cn thp, kinh t kh khn lm hn ch cc bin php ci thin mi trng, cng ngh lc hu cng gy ra nhng vn nhim rt ng lo ngi, quy hoch th cng nh quy hoch khu kinh t cn rt yu km, di dn thiu t chc, t nn ph rng v dn s gia tng lm cho tc s dng ngun ti nguyn thin nhin tng, cc tp qun lc hu cng cc yu t a l dn c ca nhiu vng vn l mnh t tt cho cc cng trnh v sinh ca h gia nh tn ti cp rt th s (v d: tnh trng s dng cu tiu ao c cc tnh ng bng Sng Cu Long, tnh trng nui tru b di nh sn min ni pha Bc v.v...). c im mi trng nng thn nc ta vn l nhim bi cc cht thi hu c. Thm vo l ho cht bo v thc vt lm nhim ngun nc v lm nhim c cc ng thc vt thu sinh. Cc lng ngh nng thng ang tr thnh ngun nhim mi hin nay. c im mi trng thnh ph l nhim cng nghip trong c s sn xut v nc thi, rc thi ra khu vc ngoi thnh. Tnh trng "bng rp th" cc vng ngoi hng chu nc thi, rc thi ca thnh ph cng c cnh bo, song qun l vn ny cn c nhiu hn ch. Thiu quy hoch th to ra cc yu t nguy c sc kho mi trng nh mt v sinh nh , tnh trng ngp lt trong thnh ph, khi x ca cc ng c, ting n giao thng v.v... Lu thng cc loi thc phm khng hp v sinh c v mt ho hc, l hc v vi sinh vt l cc yu t c hi khn lng. iu ng lu l nhng g ang xy ra i vi mi trng Vit Nam rt ging vi nhng g xy ra cc nc c nn kinh t pht trin hn trong khu vc. y, vai tr hp tc quc t cha pht huy tc dng, nhng sai lm vn b lp li m khng c bin php qun l, phng nga thch hp. Vai tr ca ngnh y t cn rt hn ch trong c ch th trng, ni m cc quy lut v li nhun chi phi rt mnh. Tuy nhin, vic thay i cc quy nh, cc chnh sch c tnh kh thi cao hn, c chp nhn nhiu hn v c hiu qu hn l rt cn thit. Cc quy nh v sinh ban hnh cc nc pht trin cao thng qu kht khe, trong khi kh nng kim sot vic thc thi cc quy nh li rt hn ch. iu ny t ra cho cc nh qun l mi trng vic iu chnh cc vn bn cho ph hp. 235

4.2. iu hnh bng php lut cp quc gia

Nh cp trn, cc vn bn do ngnh y t chun b v ban hnh ch yu tc ng tm vi m nhiu hn l tm v m. V d, a ra cc tiu chun v sinh v ngun nc, v sinh thc phm, v sinh lao ng v.v. Cc vn bn do B Ti nguyn v Mi trng (trc y l B Khoa hc - Cng ngh v Mi trng) ch o cc hot ng bo v mi trng tm v m hn, c tnh ngn nga nhiu hn v hng v bo v cc ngun ti nguyn thin nhin tm chnh sch v chin lc. Ngy cng cn cc vn bn c tnh lin b v vn bn ca chnh ph trong iu phi cc hot ng bo v sc kho mi trng. Cng cng chung vi tnh trng thc hin cc tiu chun v sinh, cc vn bn tuy c tnh php l cao ca ngnh ti nguyn - mi trng cng gp rt nhiu kh khn; trong c nng lc ca nhng ngi qun l cp tnh cn yu, c s bt cp gia cc vn bn yu cu rt cao, rt u vit vi mc u t thp v ngun lc cho cc c quan qun l mi trng.
4.3. Thc hin cc gii php bo v mi trng

Vic thc hin cc quy nh v bo v mi trng ph thuc vo mc thu nhp quc dn v chia lm 2 giai on. Giai on u, khi mc bnh qun thu nhp u ngi mc thp (khong di 1.000 USD/ ngi/ nm) th mc nhim (v d: nhim kh SO2) trong mi trng cng tng. thi gian ny, cc mc tiu kinh t c t ln hng u, trong khi kh nng k thut li cn hn ch, mc u t cho bo v mi trng thp lm cho cng pht trin sn xut th nguy c thi SO2 ra mi trng cng nhiu. n giai on sau, khi nn kinh t pht trin, nhng kh khn giai on u gim i, kh nng u t cho phng chng nhim tng ln, cng ngh trnh cao hn v vy mc nhim s gim i. y l mt v d c th v nhim cht kh SO2 ch im ca nhim mi trng cng nghip nhng cng c th suy lun rng ra cho nhiu yu t nhim khc. Chng ta cng nhn thy vic kim sot bng lut l i vi nhng nc ang pht trin nh Vit Nam l khng d dng. Cng c th d on rng chng ta ang thi k m mc nhim mi trng tng t l thun vi tng trng kinh t. V vy, cc bin php qun l mi trng cn c c bit ch . Rt tic l chng ta cha c cc s liu d bo nhim ng tin cy, cng nh mc u t cho chng nhim cn rt hn ch v kh tnh ton. Nh vy, cu hi t ra cho cc nh qun l mi trng cp v m l cn u t bao nhiu, gii quyt yu t no, yu t no cn u tin gii quyt trc v.v... hin vn cha tm c cu tr li tho ng. Vic vn ng nhn dn lm sch mi trng cn lng tng v cha tm c gii php c tnh duy tr. V d, vo gia nhng nm 90 phong tro xo cu tiu ao c ng bng Sng Cu Long c thc hin rm r, c tnh "xo cu tiu ao c" trong vi thng, song lc khng tm c loi h x no ph hp v c cng ng chp

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nhn nn ch vi thng sau, cc "cu c" li "ti lp" nh trc . V vy, khu vc ny vn lu hnh cc bnh dch ng tiu ho nh thng hn, l v c bnh t. Hin nay, cc phong tro "Lng vn ha - Sc kho" ang c B Y t pht ng, trong c vic khi phc li cc chng trnh v sinh nng thn trc y. thnh ph, nh c s h tr ca T chc Y t Th gii, nhiu ni ang thc hin chng trnh "thnh ph lnh mnh", chng trnh phng chng bnh bi phi silic ang c hin mt s c s c nhim bi v.v. Cho d c khng t c gng ca ngnh y t trong vic kim sot mi trng, tnh hnh nhim vn c xu hng gia tng. Nhng gii php khng ch nhim mi trng hin nay do ngnh y t ch o, bao gm: Hon thin h thng cc vn bn php quy tng cng qun l nh nc v mi trng v bo v sc kho cng ng. (2) Nng cao nng lc h thng y t d phng cc cp: Pht trin nhn lc. u t trang thit b theo di, gim st mi trng v gim st tnh hnh sc kho, bnh tt. m bo ngn sch, k c vic to ngun thu dch v. T chc v qun l b my. (3) Phi hp lin ngnh. (4) X hi ho cc hot ng bo v mi trng, nng cao sc kho.
5. VAI TR CA CNG NG TRONG QUN L MI TRNG V BO V SC KHO

gii quyt vn mi trng, nht l mi trng sinh hot, nh , ng ph, lng xm v ni sn xut cn phi da vo cng ng. y cng l xng sng ca vic x hi ho cc hot ng bo v mi trng v bo v sc kho. Cng ng tham gia vo qun l mi trng trc ht l phi thc c vn mi trng c th nh hng n sc kho ca chnh cng ng v ca tng thnh vin trong cng ng. Ni iu ny rt d, song thc hin li rt kh, mt khi kinh t eo hp, ngi ta ngh nhiu n nng sut v li nhun hn l vic b tin, b cng cho cc hot ng v sinh cng cng. T chu trch nhim vi mi trng sng ca cng ng, ca gia nh v vi sc kho ca mnh l yu t quan trng nht trong li cun cng ng tham gia. Cng ng tham gia cn th hin t chc cc thnh vin trong cng ng thc hin nhng nhim v chung. y, cng ng phi tham gia vo vic theo di mi trng, xc nh nhng vn tn ti trong bo v mi trng sng, mi trng lm vic ca chnh h, tm cc gii php cng nh ngun lc thch hp v ln k hoch, thc hin k hoch lm sch mi trng, phng nga nhim,

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bo v sc kho ca chnh gia nh v cng ng ca mnh. Khng t ngi n nay vn coi x hi ho vi ngha huy ng s ng gp ti chnh ca cng ng. iu ny khng sai, song ch ng c mt phn. Cng khng t ngi li thi phng vai tr ca cng ng trong vic lp k hoch x l mi trng. V bn cht cng nh l lun khng c g sai song mi nc, mi a phng li c lut l, quy nh khc nhau. Nu ngi khng nm ngun lc ti chnh trong tay th lm th no c th lp k hoch kh thi c? Nu ngn sch c ch o t tuyn trn th t mi cng ng c c t chi tiu tin ngn sch khng? nu cng ng khng c qu ring mnh, vic ch ng ng gp ngy cng cha? v.v Nhng ci tin cc b, nhng vic lm trong phm vi gia nh, nhng hot ng chi ph khng nhiu v hon ton c th do cng ng quyt nh t khu xc nh vn , lp k hoch v thc hin. Vit Nam cng c cc bi hc kinh nghim hay trong chng trnh v sinh nng thn v v sinh cng nghip, trong vi s h tr rt t ca c quan y t, t cng ng tin hnh cc hot ng ci thin mi trng sng (v d bi hc ca huyn V Thanh Cn Th). Ngi ta cng a ra khi nim v chm sc mi trng ban u (primary environmental care), trong t cc nhm cng ng t chc vi nhau, s h tr bn ngoi rt nh gip h hiu v p dng cc k thut bo v mi trng da trn nhu cu ca chnh cng ng. Chm sc mi trng ban u da trn nguyn tc phi hp ba thnh t: (a) lm tho mn nhu cu c bn ca cng ng; (b) bo v v s dng ti u cc ngun ti nguyn mi trng v (c) nng cao nng lc bo v mi trng ca cng ng. C 9 hng dn sau y gip cng ng tham gia bo v mi trng ca mnh: (1) Hot ng can thip da trn nhu cu v kin thc sn c ca cng ng. V d, khng ai khng cn c nc sch dng (c nhu cu), t nhiu mt a phng u bit tm ngun nc sch cho mnh. Tc ng bn ngoi ch nhm hng dn h tm ngun nc sch hn, bo v ngun nc v p dng cc bin php un si, lc nc khi ngun nc c nguy c b nhim bn. (2) Da trn t chc cng ng (xm ph) v t chc hnh chnh ca a phng. V d, hin nay c phong tro lng vn ho, lng sc kho, cc hng c ca lng, xm, ph a ra c cc quy nh v sinh ring, cng c nhng cch x pht ngi vi phm. Cng vi nhng quyt nh ca h thng hnh chnh a phng, c th hng cng ng thc hin nhng hot ng bo v v thanh khit mi trng ph hp. (3) Da trn cc ngun lc cng nh cc k thut sn c ca a phng, thm vo l nhng h tr rt nh nhm gii thiu hay iu chnh cc gii php k thut c tnh khoa hc v hiu qu hn (b sung cho cc phng php dn gian, phng php theo kinh nghim).

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(4) Huy ng cng ng tham gia qun l mi trng, lp k hoch, thc hin, theo di v nh gi. (5) Bt u cc hot ng bng mt s cng vic/d n c tnh kch thch, lan to sang cc hot ng khc. V d, chng trnh lng ghp ca UNICEF h tr cho nng thn mt s tnh bt u bng vic ty giun cho tr em nh k v xy dng ba cng trnh v sinh, sau lan sang cc hot ng chm sc sc kho tr em, k hoch ho gia nh v.v. (6) Hot ng phi linh hot, mm do. (7) Cc hot ng cn c duy tr song khng ng khung trong mt s hot ng m b sung thm, iu chnh trong qu trnh thc hin. iu ny rt quan trng, v mi cng ng c cc c im ring, ngay cng mt cng ng cc thi im khc nhau c nhu cu cng nh cch gii quyt khng ging nhau. Thm vo , qu trnh hot ng bo v mi trng l mt chui cc p ng, l mt qu trnh ng v kh bin chng. mt a phng, nu khng khng theo ui mt gii php cng chng khc no c duy tr mt n thuc cha cho nhiu bnh khc sau . (8) Nhn rng cc kinh nghim thnh cng v thng bo, rt kinh nghim cc trng hp tht bi. (9) Cn b d n, ngi ch o tuyn trn phi c thi ng, phi bit lng nghe, bit quan st, bit ngh v bit ra quyt nh da vo nhu cu ca cng ng.
6. LP K HOCH QUN L SC KHO MI TRNG TUYN C S

Vic lp k hoch qun l sc kho mi trng phi da trn cc chnh sch v chin lc ca quc gia, kh nng ca cc ngun lc, nhng vn bc bch ca cng ng a phng v ca cc nhm d b tn thng. K hoch qun l sc kho mi trng c xy dng nhiu cp : cp quc gia, cp vng, cp tnh v c cp c s. K hoch t cp tnh tr ln mang tnh nh hng chin lc u t cho sc kho mi trng. Chng ta cp n vn ny mc 3. Trong mc ny s cp ti k hoch can thip tuyn thc thi cc chnh sch tuyn c s. y cc hot ng qun l mi trng rt c th v rt gn gi vi cng ng. Xut pht im ca cc k hoch khng ch n thun thc hin cc ch tiu k hoch trn giao, thng qua hng dn k hoch ca S y t, Trung tm v sinh phng dch tnh theo mt quy trnh m cn phi c nhng sng to (m bo tnh mm do) cng nh phi p ng nhu cu cp thit nht trn a bn dn c hay c s sn xut. Mun xy dng k hoch da trn nhu cu ca cng ng song li phi tun theo mt quy trnh nht nh, nu khng s ch l cc hot ng i ph, chy theo thnh tch

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 hon thnh k hoch nhng thc th ngi dn li t c hng li, hoc chi ph tn km m li ch thp; hoc gp phi phn ng ca cng ng cng nh ca chnh quyn a phng, phn ng ca cc ch sn xut, lm cho gii php thiu hiu qu v khng c tnh kh thi, tnh duy tr thp. Cch lp k hoch trnh by trong s 10.2 gip gim bt mt s vn tn ti ca cch lp k hoch th ng.

6.1. Cc bc lp k hoch gii quyt vn

Xc nh vn cn can thip (1)

Tm hiu, phn tch k v vn can thip (2)

xut gii php v quy trnh can thip (3)

t k hoch sau can thip (4)

nh gi kt qu

Thc hin k hoch Theo di, gim st

S 10.2. Cc bc lp k hoch gii quyt vn

6.2. Xc nh vn cn can thip

Cu hi t ra cho giai on ny l: cn phi can thip g ci thin iu kin v sinh v tng cng sc kho cho cng ng ca a phng mnh.

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Cc cu hi tip theo l: Vn sc kho mi trng ny c th l g? Lm th no m ta bit c l vn sc kho mi trng? Vn c thng hay xy ra hay khng v ko di trong bao lu? Cc hu qu ca vn mi trng ln sc kho v i sng ca cng ng? Lm th no bit l hu qu gim hoc c gii quyt nu ta a ra gii php can thip?
6.3. Phn tch, tm hiu vn d nh can thip

Khi xc nh c vn cn can thip, bc tip theo l phi phn tch hiu r vn qua vic t mt s cu hi (trc khi can thip) sau y: Ai s tham gia vo qu trnh can thip v ai s c hng li, ai s b nh hng? Vn xy ra u? Vn xy ra khi no? Hu qu ca vn nhim mi trng trn sc kho v kinh t x hi l g? Ti sao c vn ? giai on ny, ngi ta khng nh li vn cn can thip v phn tch cc nguyn nhn dn n vn ny. Cc k thut v cn nguyn, s dng cc ngun s liu sn c v cc kt qu kho st mi trng, nh gi tnh trng sc kho bnh tt s lm cho cc suy lun c c s hn. Cc k thut t cu hi "nhng - ti sao" cng kh ph hp nu khng c kh nng v /hoc khng cn kho st mi trng bng cc thit b k thut. Cc phng php lm vic nhm, phng php chuyn gia kt hp vi cc s liu sn c v sc kho cng ng, vi kinh nghim ca cc a phng khc, nc khc u rt c ch v vi tin cy c th chp nhn c.
6.4. xut gii php v quy trnh can thip

S dng kt qu ca bc (1) v (2) xut cc gii php ph hp. Nu c th c, nn c nhng th nghim din hp rt kinh nghim trong qun l chng trnh can thip, tm ra cc yu t lm tng hiu qu can thip v nht l c cng ng chp nhn cao nht.
6.5. Lp k hoch can thip

k hoch kh thi phi cn nhc 3 yu t: u vo. Gii php k thut, gii php t chc v cc cn tr khi thc hin.

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 Kt qu mong i. Kh c th xc nh mt cch r rng trong ba yu t trn, yu t no l quan trng nht. Nu ch da vo u vo th s d dng bi quan nu u vo khng , nhng s khng th lm g nu thiu ngun lc. Nu da vo kt qu mong i, d lm vo xu hng duy ch, nhng nu khng bit r ci nh cn t th lm sao c th tm kim ngun lc v gii php ph hp c? Trong qu trnh cn nhc gia u vo v kt qu mong i, lun tnh ton cc gii php can thip : s dng ngun lc hn ch mt cch c hiu qu nht t mc tiu ra. Trong bn k hoch phi nh r cc mc tiu, mi mc tiu li c th c thc hin bng mt hoc nhiu gii php. Mi gii php li cu thnh bi nhiu nhm hot ng v hot ng c th. i vi tng hot ng, phi phn cng ngi, c quan chu trch nhim chnh, c quan v t chc h tr. Cc ngun lc cn thit cho cc gii php cng phi c xc nh r: bao nhiu, ai cp, cp khi no, c ch no, vn bn no cho php s dng cc ngun lc . Kt qu u ra cn c th hin r bng cc ch s o lng c. C th c 2 nhm ch s u ra: (1) Ch s v cc hot ng (performance) c thc hin (v d, t l lng rc thi c thu gom v x l, t l tr em c xt nghim phn tm trng giun v.v.). (2) Cc ch s hiu qu (impact) th hin trn cc t l mc, t l cht, hiu qu li ch kinh t v.v. Trong bn k hoch cng phi ghi r c ch t chc, qun l hot ng can thip. Cc hot ng theo di gim st cng nh cng c v phng php theo di gim st cc hot ng can thip. Nhng chi tit v xy dng k hoch can thip sc kho mi trng s c hc c th hn trong bi thc hnh.
BI TP TNH HUNG Mc tiu

1. Gii thch ti sao qun l sc kho mi trng (SKMT) thnh cng phi bt u t phm vi a phng v tin ti nhng phm vi rng hn. 2. p dng c nhng khi nim l thuyt v qun l (SKMT) nhng tnh hung c th trong thc t. 3. Trnh by c nhng chin lc kh thi c xy dng nh th no gim thiu nhng tc ng tiu cc ca con ngi ln mi trng v sc kho mi trng.
Tnh hung

Cc bc qun l sc kho mi trng lin quan ti vn nhim khng kh.

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Cht lng khng kh m chng ta ht th hng ngy c nh hng trc tip ti sc kho. Cht lng khng kh khng m bo v s tn ti ca cc cht nhim c th gy ra nhiu bnh khc nhau nh vim phi, hen suyn hay ung th phi. bo v sc kho cng ng, chng ta cn phi gim tnh trng nhim khng kh nh hin nay tt c cc quc gia trn th gii. Bi tp tnh hung ny s gii thiu vi sinh vin nhng nguyn nhn gy khc nhau nhim khng kh, khi u phm vi a phng v sau tm hiu phm vi ton quc v ton cu. Sinh vin s phi xem xt nhng nguyn nhn ca nhim khng kh v tho lun xem lm th no gim vn ny nhm bo v sc kho cng ng. (1). phm vi phng, x Nhin liu dng trong nu nng: nhin liu nh than, ci gp phn lm nhim khng kh (CO2, CO, SO2, cc ht vt cht, khi, v.v.). y c th l vn nghim trng nhng vng dn c ng c nh thnh ph, th x... (2) Phm vi qun, huyn, th x Giao thng: mt lng ln cc loi xe tham gia giao thng thi ra nhiu cht nhim khng kh khc nhau t ng c hai k (tn d ca du m, cc ht vt cht, khi, CO2, CO, SO2, NOx, VOCs, v.v.). Nhng ng c chy bng diezen khng c bo dng nh k: thi ra cc ht vt cht nh. (3) Phm vi tnh, thnh ph v c nc Cc hot ng cng nghip: Cc c s sn xut cng nghip ln, va v nh. Nhiu cht nhim khc nhau (v d CO2, CO, NOx, SO2, H2S, khi mtan, VOCs, mi hi thi t hn hp cc kh gy nhim, cc ht vt cht v bi ...). Thiu cc bin php ch ti c hiu lc. S xut khu cc cng nghip c hi t nc pht trin sang nhng nc ang pht trin. (4) nhim xuyn bin gii Hin tng My Nu chu . Cu hi dnh cho sinh vin 1. M t nhng ngun chnh gy nhim khng kh mi phm vi: phng (x); qun (huyn), th x; tnh, thnh ph, ton quc).

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2. Tho lun nhng gii php c th gim vn nhim khng kh do giao thng gy ra. 3. Xem xt tnh kh thi ca nhng gii php a ra (cc kha cnh v sc kho, mi trng v kinh t). 4. Tho lun tnh hiu qu ca cc gii php phm vi a phng, quc gia v khu vc. 5. Vic xy dng v p dng nhng chnh sch mang tm quc gia s h tr nh th no cho vic gim vn nhim khng kh.

T LNG GI

1. in t thch hp vo cu sau: Qun l mi trng l tng hp cc gii php .. v gii php ... nhm bo v mi trng khng b nhim hoc khng ch mc nhim trong cc gii hn cho php, khng gy tc hi cp tnh hay mn tnh ln sc kho. 2. Hy trnh by tm tt v nu v d vic qun l mi trng bng cc gii php k thut. 3. Hy trnh by tm tt vic qun l mi trng bng chnh sch, chin lc, cc gii php hnh chnh v lut l. 4. Nu cc nhim v c bn ca ngnh y t trong qun l mi trng. 5. Nu nhng hot ng ca qun l mi trng 6. Hy nu mt v d c th trong vic xc nh v o lng mc nhim mi trng. 7. Bn hiu th no v nh gi tip xc vi mi trng? C th nu v d minh ho. 8. Hy nu nh hng ca nhim mi trng ln sc khe. 9. Nhng gii php khng ch nhim mi trng hin nay do ngnh y t ch o bao gm nhng gii php g? 10. Nu cc xut cc gii php gim nh nguy c, ngn nga hu qu nhim mi trng. 11. Trnh by tm tt nhng vn , tn ti trong qun l nhim mi trng Vit Nam. 12. Hy nu 9 hng dn gip cng ng tham gia bo v mi trng.

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13. Hy nu mt v d v s tham gia ca cng ng trong vic bo v mi trng m bn bit hoc tng tham gia. 14. Nu s cc bc lp k hoch gii quyt vn sc kho mi trng tuyn c s. 15. Hy v d v lp mt k hoch gii quyt mt vn sc kho ni mnh ang sng.

TI LIU THAM KHO

Ting Vit

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