Eco-Health Relationship Browser Notecards:
Single-sided (no
These materials are part of EPA Report #EPA/6oo/R-17/310.
Instructions:
SEPA
United States
Environmental Protection
Agency
1.
2.
3-
4-
5.
Print out these Notecards SINGLE-sided (preferably in
color so that the categories are visibly distinct for
students (ecosystems in green, ecosystem services in
blue, and health outcomes in red).
Optional; If you have time, cut out and laminate the cards. If you
don't have time, students can just hold the paper cards in their
hands. You could also slide the pieces of paper into sheet protectors
for a quick lamination substitute.
Punch holes in the black circles on the Notecards (or, if
in sheet protectors, use the existing holes in the sheet protectors).
Using yarn or string, tie a loop (long enough to drape
the card around the neck) around the Notecards.
Follow the instructions in the Lesson Plan: Connecting
ecosystems and human health.
Store for use in future years—just a one-time set-up!
(notecards last updated 9/8/2017)
Have time?
Laminate and
hole-punch the
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Arthritis
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time? Use
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Protectors!

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Urban
Ecosystems
Urban ecosystems are dynamic systems that
contain both built and natural environments.
Urban ecosystems include all green and blue
spaces within the area, such as parks,
cemeteries, lakes and streams, along with
human components. Urban ecosystems can
mimic the function of natural ecosystems and
thus provide their own important ecosystem
services that contribute to human well-being in
those urban areas.
Aesthetics &
Engagement
with Nature

Air Quality
Water Quality
Urban
Ecosystems
Heat Hazard
Mitigation
Waier Hazard
Mitigation
Recreation &
Physical
Activity
Ail information available from www.epa.gov/EnviroAtlas

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Agro-Ecosystems
Agro-ecosystems are ecosystems that have been modified
by humans for the primary purpose of producing food,
fiber or agricultural products (Huggins, 2000). Agro-
ecosystems can provide various ecosystem services such as
regulation of soil and water quality and carbon
sequestration (Power, 2010). Agro-ecosystems may
contain cover crops, wetlands, wind rows and wildlife
habitats. They can also assist with pollination and pest
control/regulation and are often popular for recreation and
with bird watchers and hunters.
Aesthetics &
Engagement
with Nature
Water Quality
All information available from www.epa.gov/EnviroAtlas

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Forests
Forest ecosystems are dominated by trees,
where the crown cover exceeds 10% and the
area is larger than 0.5 hectares. There are
multiple types of forests: tropical, wetland, and
community-managed forests. Forests are made
up of different tree and plant species that vary
according to climate, geography, and
hydrology. Forests are often managed for the
goods that they provide, such as timber and
paper products. Forests also provide other
services, such as filtering pollutants from water
and air that would be virtually impossible to
replace using technology. Forests are also used
for recreation activities such as hiking and
^amping.	^Il information available from www.epa.gov/EnviroAtlas
Aesthetics &
Engagement
with Nature
Air Quality
Recreation &
Physical
Activity
Water Hazard
Mitigation

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Wetlands
Wetlands are lands transitional between
terrestrial and aquatic systems where the
water table is usually at or near the surface
or the land is covered by shallow water.
Some common wetlands in the US include
coastal salt marshes, peat bogs, lowland
swamps, and even rivers and lakes.
Wetlands are often rich in bird species and
thus are prime bird watching areas. They
also provide opportunities for other
recreation activities such as fishing and
hunting.
Water Quality
Aesthetics &
Engagement
with Nature
Wetlands
Recreation &
Physical
Activity •
Water Hazard
Mitigation
All information available from www.epa.gov/EnviroAtlas

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Definition:
Organ System:
Demographic:
Trend in
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Rate:
Known
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Factors:
ADHD
Attention-deficit/hyperactive disorder (ADHD)
is the most common neurobehavioral
disorder of childhood. It manifests as an
unusually high and chronic level of
inattention, impulsivity/hyperactivity or both.
Nervous System
ADHD is a common condition that affects
children and adolescents, while ADD is more
common in adults.
ADHD affects more than 2 million school-aged
children. Recent statistics indicate that
among children aged 6 to 11 years the
incidence of ADHD is approximately 7%.
Premature Birth, Fetal Trauma (including that
from infection or drug/alcohol exposure)
All information available from www.epa.gov/EnviroAtlas
Aesthetics &
Engagement
\with Nature "
ADHD
Water Quality
Recreation &
Physical
Activity

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Aggression
Definition:
Organ System:
Demographic:
Known
Contributing
Factors:
Aesthetics &
Engagement
with Nature
Aggression
Recreation &
Physical
Activity
Aggression often manifests in the form of hostility - a
multidimensional construct consisting of cognitive,
affective and behavioral dimensions. These include
cynicism and mistrust; feelings of anger, irritation, rage,
contempt; and various acts of physical and verbal
aggression.
Nervous
Individuals from any race, ethnicity, gender or age group
can experience hostility. Men, especially between the
ages of 20 - 30, exhibit more physical aggression and
hostile behavior than women. Evidence suggests,
however, that women in romantic relationships may
exhibit as much hostile behavior as their partner.
Low Economic Status, Vitamin Deficiency, Alcohol Use,
Testosterone
All information available from www.epa.gov/EnviroAtlas

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Anxiety
Definition:
Anxiety is characterized by excessive and
unrealistic worry about everyday tasks that
interferes with normal functioning. Several
types of recognized anxiety disorders exist.
Organ System:
Nervous
Demographic: Children and adults
Trend in
Incidence Rate:
Known
Contributing
Factors:
Anxiety disorders are the most common
mental illness in the U.S., affecting 18% of
adults, according to leading specialists in
anxiety treatment.
Chemical Imbalance in the Brain, Lack of
Exercise, Poor Diet, Stressful Environments
All information
Aesthetics &
Engagement
Anxiety
Air Quality
Recreation
Physical
\ Activity
Heat Hazard
Mitigation
available from www.epa.gov/EnviroAtlas

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Definition:
Organ System:
Demographic:
Trend in
Incidence Rate:
Known
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Factors:
Arthritis
Arthritis is inflammation of one or more joints, which
results in pain, swelling, stiffness, and limited
movement. There are over 100 different types of
arthritis.
Skeletal, Muscular, Immune
Most people over age 60 have arthritis to some
degree, but its severity varies. Even people in their 20s
and 30s can get arthritis. In people over 50, more
women than men get arthritis.
Arthritis affects nearly 27 million Americans. The
chance of developing the disease increases with age.
Heredity, Injury to Joints, Abnormal Metabolism,
Blood Infections, Aging
Arthritis
Air Quality
All information available from www.epa.gov/EnviroAtlas

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Asthma
Definition:
Organ System:
Demographic:
Trend in Incidence
Rate:
Asthma is a chronic disease of the airways that makes breathing
difficult. With asthma, there is inflammation of the air passages
that results in a temporary narrowing of the airways that carry
oxygen to the lungs.
Respiratory
Both children and adults have asthma, although in 2009 a higher
percentage of children (9.6%) were reported as having asthma
when compared to adults (7.7%). Diagnoses were especially high
among boys (11.3%). In 2009, the highest rate of asthma among
racial/ethnic groups was 17% for non-Hispanic black children.
Asthma affects 24.6 million Americans. The CDC reports that the
number of people in the U.S. diagnosed with Asthma grew by
4.3 million, from 7.3% of the population to 8.2%, between 2001
and 2009.
Air Quality
Asthma
Water Hazard
Mitigation
All information available from www.epa.gov/EnviroAtlas

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Definition:
Organ
System:
Known
Contributing
Factors:
Birth Outcomes
For the purposes of the browser, birth
outcomes can mean multiple adverse
outcomes or issues associated with
pregnancy or birth. These may include
preeclampsia, high blood pressure, preterm
birth, low birth weight, birth defects, and
miscarriage.
Main: Reproductive, other systems
Obesity, Older age, First Pregnancy, Multiple
Pregnancy (twins+)
Air Quality
Birth
Outcomes
All information available from www.epa.gov/EnviroAtlas

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Definition:
Organ System:
Demographic:
Trend in
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Bronchitis
A condition resulting when the bronchial tubes,
which carry air to the lungs, become inflamed
and irritated. When this happens, the tubes swell
and produce mucus. This results in coughing and
wheezing that can last for up to 8 weeks.
Respiratory
Bronchitis is equally distributed among men and
women.
In the US, it has been estimated that almost 5% of
the general population develops acute bronchitis
each year.
Cigarette Smoke, Compromised Immune System,
Air Pollution/Irritants
All information available from www.epa.gov/EnviroAtlas
Air Quality
Bronchitis

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Cancer
Definition*	Cancer is the uncontrolled growth of abnormal cells in
the body. Cancerous cells are also called malignant cells.
Organ System:
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Trend in
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Known
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Factors:
Cancer
Air OuJ*y
Wattr QuaNty
www.epa.gov/EriviroAtlas
Roughly 1.65 million new cancer cases were estimated
to be diagnosed in the year 2015. Cancer is the second
most common cause of death in the U.S. with more than
1,600 people a day dying from it.
Diet, Tobacco, Air/Water Pollution, Alcohol, Radiation,
Medications, Genes
All information available from
Multiple
Anyone can develop cancer, although the risk of being
diagnosed with cancer increases with age. In 2007, there
were 11.7 million Americans living with a history of
cancer. About 78% of all cancers are diagnosed in
persons 55 years of age or older.

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Definition:
Organ
System:
Demographic:
Trend in
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Rate:
Known
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Cardiovascular Disease
Cardiovascular Diseases are a group of diseases that affect the
heart and blood vessels. These include several types of heart
diseases, cerebrovascular disease, and arterial disease. Coronary
heart disease, which is the leading cause of cardiovascular-related
deaths, is a narrowing of the small blood vessels that supply blood
and oxygen to the heart.
Cardiovascular System
CVDs are the leading cause of death worldwide. Those in low and
middle income countries are disproportionately affected - roughly
80% of cases take place in these countries. In the U.S., CHD affects
men roughly 40% more than women, while hypertension is slightly
higher in women.
Worldwide, the number of people with cardiovascular diseases is
rising and WHO estimates that by 2030, almost 23.6 million people
will die from CVDs, mainly heart disease and stroke. In the United
States, age-adjusted prevalence for coronary heart disease
declined overall from 6.7% to 6.0% between 2006 and 2010.
Diet, Physical Inactivity, Tobacco Use, Alcohol Abuse, High
Cholesterol, Access to Health Care, Socioeconomic Status
Aesthetics &
Engagement
with Nature
Cardiovascular
Diseases
Heat Hazard
Mitigation
All information available from www.epa.gov/EnviroAtlas

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Cognitive Function
Definition:
Trend in
Incidence
Rate:
Known
Contributing
Factors:
Cognitive function refers to a person's ability to
process thoughts. Cognition primarily refers to things
like memory, the ability to learn new information,
speech, and reading comprehension. Cognitive
function can become impaired as a result of aging,
head trauma or the presence of disease such as
Alzheimer's.
Organ System: Nervous
Cognitive function can become impaired as people
grow older and may develop conditions such as
dementia. Alzheimer's disease is the 5th leading cause1
of death among those 65 and older in the United
States
Exercise, Diet, Sleep, Aging, Disease
Aesthetics &
Engagement
with Nature
Cognitive
Function
Air Quality
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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Confusion
Definition:
Organ System:
Demographic:
Known
Contributing
Factors:
Aesthetics &
Engagement
with Nature
Confusion
Recreation &
Physical
Activity
Confusion is the inability to think with one's usual
speed or clarity. This includes difficulty in
remembering, paying attention or making
decisions.
Nervous
Confusion is more common in the elderly.
Alcohol intoxication, Head Trauma, Brain Tumor,
Low Blood Sugar, Infection, Drug Use
All information available from www.epa.gov/EnviroAtlas

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Definition:
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Trend in Incidence
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Known
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:actors:
COPD
Chronic Obstructive Pulmonary Disease (COPD) is a disease of the
lungs that makes it difficult for one to breathe. The term COPD
most often includes two conditions: chronic bronchitis and
emphysema. With chronic bronchitis, the lining of the lung airways
becomes irritated, thickens, and produces large amounts of
mucus. With emphysema, the walls between the lung's air sacs
become damaged and deflate, reducing gas exchange in the lungs.
Respiratory
Worldwide, 64 million people have COPD. Typically, people
between the ages of 65 - 84 develop COPD. Men and women are
affected by the disease equally at present. Those who smoke are
much more likely to develop the disease.
In 2012, more than 3 million people died of COPD and WHO
predicts that by 2030 it will be the third leading cause of death
worldwide. The number of women with COPD is increasing due to
increased tobacco use in high-income countries and exposure to
indoor air pollution in low-income countries.
Smoking, Exposure to Air Pollutants, Indoor Air Quality, Outdoor
Air Quality
Lrgagement
COPD
Ar Quality
All information available from www.epa.gov/EnviroAtla

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Diabetes
Definition:
Organ System:
Demographic:
Trend in Incidence
Rate:
Known Contributing
Factors:
Diabetes is a disease in which blood glucose levels are above normal.
When people have diabetes, their bodies either do not make enough
insulin or cannot use it as well as they should.
Diabetes can affect major organs, including heart, blood vessels,
nerves, eyes, and kidneys.
Compared with non-Hispanic whites, members of racial and ethnic
minority groups are more likely to have diagnosed diabetes. During
their lifetime, half of all Hispanic men and women and non-Hispanic
black women are predicted to develop the disease.
Over the past 32 years, from 1980 through 2012, the number of adults
with diagnosed diabetes in the United States nearly quadrupled, from
5.5 million to 21.3 million. Among adults, about 1.7 million new cases of
diabetes are diagnosed each year.
Obesity, Sedentary Lifestyle, Heredity, Hypertension (High Blood
Pressure), Low levels of HDL and Elevated Levels of Triglycerides in the
blood.
Recreation &
Physical
Activity
K
Diabetes
All information available from www.epa.gov/EnviroAtlas

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Definition:
Organ System:
Demographic:
Trend in Incidence
Rate:
Depression
Depressive disorders are characterized by persistent low mood,
loss of interest and enjoyment, and reduced energy, causing
varying levels of social and occupational dysfunction.
Nervous
Women are affected twice as often as men. In patients with an
affected first-degree relative, the lifetime risk of depression
increases to 1.5 to 3.0 times average. First onset occurs most
frequently in patients aged 12 to 24 years and in those older
than 65 years.
In people aged 18 to 44 years, depression is the leading cause of
disability and premature death. Depression is predicted to be
the second leading cause of disability in people of all ages by
the year 2020.
All information available from www.epa.gov/EnviroAtlas

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Definition:
Organ System:
Demographic:
Known
Contributing
Factors:
Fatigue
Fatigue is a feeling of tiredness, weariness or lack of
energy. It can be a normal response to physical or
emotional stress among other factors but can also be a
sign of more serious conditions.
Fatigue can affect the entire body or be localized in
certain systems.
Any person from any race, ethnicity, gender, or age
group can experience fatigue.
Anemia, Depression, Certain Medications, Sleep
Disorders, Malfunction of Thyroid Gland, Chronic
Disease, Malnutrition, Exertion
Aesthetics &
Engagement
with Nature
Fatigue
Recreation &
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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Gastrointestinal
Definition:
Organ System:
Demographic:
Trend in
Incidence Rate:
Known
Contributing
Factors:
Water Hazard
Mitigation
Gastrointestin
al Illness
Water Quality
Illness
Gastrointestinal infections (GIs) can be caused by a host of different
parasites, viruses and bacteria and often result in diarrhea, nausea,
cramping and vomiting. Bacterial gastroenteritis (food poisoning) is
commonly caused by E.coli, Salmonella, and Staphylococcus. Enteric
viral gastroenteritis, often called stomach flu, is caused by viruses such
as adenovirus and rotavirus.
Digestive
Those with the highest risk for severe gastroenteritis include the young,
the elderly, and people who have suppressed immune systems.
Each year in the US, foodborne illness causes 48 million gastrointestinal
illnesses. Incidence rates for foodborne illnesses fluctuate yearly,
although in the US, the general trend from 1996 - 2010 has shown a
decrease in illnesses as a result of Campylobacter and Shigella, while
there has been an increase in illnesses associated with Salmonella.
epa.gov/EnviroAtlas
Tainted Food or Water, Contact with an Infected Person (viral)
All information available from www.

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Definition:
Organ System:
Demographic:
Trend in
Incidence Rate:
Known
Contributing
Factors:
Happiness
Happiness is a specific emotion that people feel when good
things happen and is considered by psychologists to be one
of the few basic emotions (cannot be broken down
further) that humans experience.
Nervous
Those who live in countries with higher incomes and less
suffering typically have higher life satisfaction. A 2010
Gallup Poll found that European countries such as Denmark
and Finland have high happiness ratings while many
countries in Africa shared the lowest ratings.
Up to a threshold point, people who gain wealth are
happier. In 2007, a Pew study found that happiness in many
countries globally was increasing largely due to economic
growth. As of 2006, in the US, happiness inequality among
demographic groups had decreased considerably since the
1970s.
Quality of Life, Social Relationships, Income
Aesthetics &
Engagement
with Nature
Recreation &
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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Definition:
Healing
To heal is to mend or make better and includes
recovery from injury and surgery. For the purpose
of this browser, healing refers to physical and
mental recovery.
Aesthetics &
Engagement
with Nature
Healing
All information available from www.epa.gov/EnviroAtlas

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Heat Stroke
Heat stroke is the most severe heat illness, and occurs when
body temperature reaches 104° Fahrenheit. Heat stroke is
typically preceded by other heat illnesses such as heat
exhaustion and dehydration.
Multiple
Any person can suffer from heat stroke, though children, the
elderly, those who work outdoors, and obese people are at
higher risk of developing heat illness.
Serious heat illnesses occur most often during the summer
Trend in Incidence months and during heat wave events. As the global climate is
Rate:	expected to warm, it is likely that heat wave events and heat
illnesses will increase in many areas.
Known
Contributing	High temperatures, High humidity, Dehydration
Factors:
Definition:
Organ System:
Demographic:
Heat Hazard
Mitigation
All information available from www.epa.gov/EnviroAtlas

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Definition:
Organ
System:
Demographic:
Trend in
Incidence
Rate:
Known
Contributing
Factors:
High Blood Pressure
High blood pressure (HBP), also called hypertension, is when a
person's blood pressure is at or above 140/90 mmHg most of the time.
HBP is a serious condition and can lead to coronary heart disease, heart
failure, stroke, and kidney failure, among other problems.
Cardiovascular
Risk of getting HBP increases with age as the blood vessels becomes
stuffer. African Americans are particularly prone to HBP along with
those who are overweight or obese. Hypertension affects
approximately 30% of US adults.
In the US, hypertension increased from 23.9% (1988 - 94) to 28.5%
(1999-2000). Though hypertension prevalence did not change between
2000 and 2008, hypertension control increased to roughly 50%. In
2000, the global number of adults with hypertension was estimated at
972 million with 2025 future projections reaching 1.56 billion.
Overweight, Smoking, High Salt Intake, Alcohol Consumption, Stress,
Age, Genetics
Aeslhetics &
Engagement
with Nat.irfty
High Blood
Pressure
Rpcreatinn A
Physical
, Activity
All information available from www.epa.gov/EnviroAtlas

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Hospital Admissions
^ .. . . The "hospital admissions" portion refers to people who were admitted to a healthcare
Definition: , ... ^ r .... ,. .
facility to receive illness diagnosis and/or treatment.
from www.epa.gov/EnviroAtlas
Air Quality
Hospital
Admissions
Water Hazard
Mitigation
Heat Hazard
Mitigation

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Kidney Malfunction
The kidneys are two small organs that are connected to
the urinary bladder. Their main function is to remove
waste products and excess water from the blood. The
kidney plays a major role in regulating levels of various
minerals in the body as well as producing some important
hormones. Damage to the kidneys can be caused by a
number of factors and if serious, can result in kidney
failure.
Definition:
Organ System:
Demographic:
Known
Contributing
Factors:
Urinary
Issues with the kidneys become more common as people
age. In the US, more than 10 percent of people, or more
than 20 million, ages 20 years and older have chronic
kidney disease.
Genetics, Diabetes, High Blood Pressure, Aging, Illness,
Injury
All information available from www.epa.gov/EnviroAtlas
Heat Hazard
Mitigation
Kidney
Malfunction

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Longevity
Definition:
Life expectancy is the average number of years a person is
expected to live from birth and is often used as a measure
of overall quality of life in a country.
Organ System: Life expectancy is affected by all organ systems.
Demographic:
Trend in
Incidence
Rate:
Known
Contributing
Factors:
Life expectancy varies among countries and regions. In
2009, the lowest average life expectancy was 47 years for
those who live in Malawi and the highest was 83 years for
those from Japan. The United States' average life
expectancy is 79 years. Low income countries generally
have lower life expectancies.
Life expectancy has increased globally by four years since
1990. However, in many African countries it has actually
decreased, largely due to HIV/AIDS.
Access to Medical Treatment, Quality of Life, Chronic
Disease, Infectious Disease, Nutrition, Lifestyle
Aesthetics &
Engagement
with Nature
Longevity
Air Quality
Recreation a
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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Definition:
Low Birth Weight
An infant is considered to have a low birth weight if
it weighs less than 5lbs 8 oz. (2500 grams) at birth.
Organ System: Reproductive
Demographic:
Trend in
Incidence Rate:
Known
Contributing
Factors:
Roughly 30 million babies are born with low birth
weight annually. Low income or developing
countries have higher numbers of low-weight births
than higher income countries.
Globally, prevalence of low-weight births is slowly
decreasing.
Multiple Pregnancy (twins+), Previous Chronic
Conditions, Smoking, Drug and Alcohol Use,
Uterine or Cervical Issues
Aesthetics &
Water Quality
Low Birth
Weight
Air Quality
Fhysical
Activity
All information available from www.epa.gov/EnviroAtlas

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Definition:
Demographic:
Known
Contributing
Factors:
Mental Health
Mental health is a state of well-being in which
an individual realizes his or her own abilities,
can cope with the normal stresses of life, can
work productively and is able to make a
contribution to his or her community.
Organ System: Nervous
Mental and behavioral disorders are
estimated to account for 12% of the global
burden of disease. Mental and behavioral
disorders are common, affecting more than
25% of all people at some time during their
lives. Around 20% of all patients seen by
primary health care professionals have one or
more mental disorders.
Social Relations, Social Support,
Spirituality/Religion, Physical Health,
Substance Abuse, Trauma, Stress
Aesthetics &
Engagement
with Nature
Mental Health
Heat Hazard
Water Hazard
Mitigation
Mitigation
Recreation &
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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Definition:
Organ System:
Demographic:
Known
Contributing
Factors:
Migraine
A migraine is a type of severe headache caused by abnormal
brain activity that is often accompanied by nausea, vomiting
or sensitivity in light.
Nervous
Migraine afflicts 28 million Americans, with females
suffering more frequently (17%) than males (6%). This trend,
where roughly 6% of men and 15-18% of women are affected
by migraines is also seen in Europe and Central and South
America. Migraines affect women 2 - 3 times more than men
in most countries that have been studied.
Stress, Alcohol Use, Allergic Reactions, Certain Foods,
Environmental Factors (these are thought to have an effect
on migraines)
Air Quality
All information available from www.epa.gov/EnviroAtlas

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Miscarriage
Definition:
Organ System:
Demographic:
Trend in
Incidence Rate:
Known
Contributing
Factors:
Miscarriage
Water Hazard
Mitigation
A miscarriage is the spontaneous loss of a fetus before
the 20th week of pregnancy.
Reproductive
Miscarriages occur in women who are pregnant and
increase in likelihood as women age. Women over the age
of 30 and those who have previously had a miscarriage
are at greater risk of having a miscarriage.
Studies show that about 8 to 20 percent of women who
know they are pregnant have a miscarriage some time
before 20 weeks of pregnancy; 80 percent of these occur
in the first 12 weeks (Regan 2000).
Diabetes, Chromosomal abnormalities, Drug and alcohol
abuse, Exposure to environmental toxins, Hormone
problems, Infection, Obesity (potential contributing
factors)
All information available from www.epa.gov/EnviroAtlas

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Heat Hazard
Mitigation
Water Quality
Mortality
Water Hazard
Mitigation
Recreation &
Physical
L Activity a
Mortality
Put simply, mortality means death. Infant mortality
Definition: rate is often used an indicator for the health level in
a country.
Organ System: Multiple
Demographic:
Trend in
Incidence
Rate:
Known
Contributing
Factors:
Mortality rates vary among countries depending on
a number of factors. Infant mortality rates range
from 2.60 to 144 deaths/1,000 live births.
Developing countries typically have higher
mortality rates than those in developed countries.
In the United States, the death rate for 10 out of
the 15 leading causes of death has been declining in
the past several years. For the U.S., the death rate
in 2007 was 803/100,000 compared to 2009's rate
of 741/100,000.
Heart Disease, Stroke, Cancer, Infectious Disease,
Malnutrition, Diet, Chronic Disease, Violent Crimes
All information available from www.epa.gov/EnviroAtlas

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Definition:
Demographic:
Trend in
Incidence
Rate:
Known
Contributing
Factors:
Obesity
Obesity is a preventable disease characterized by being extremely
overweight and having a high percentage of body fat or a body mass
index (BMI) of 30 or greater. BMI is a calculated weight to height ratio
used to determine a person's relative body fat amount and is typically
accepted as a good indicator of fat content. A BMI between 18.5 and
25 is considered normal and healthy.
Organ System: Multiple
In 2008,1.5 billion adults (age 20 and older) worldwide were deemed
overweight. Of those, over 500 million were obese. In 2010, around 43
million children under five were overweight, of whom 81% were in
developing countries. In the United States, roughly one third of adults
(33.8%) are obese. In the U.S. more women than men are obese and
non-Hispanic blacks have the highest rate of obesity (44.1%) compared
to non-Hispanic whites who have the lowest rate of obesity (32.6%) of
the reported groups.
Worldwide, obesity has more than doubled since 1980 and along with
being overweight is the fifth leading risk for global deaths.
Lack of Exercise, High Calorie Intake, Genetics, Drug Usage
All information available from www.epa.gov/EnviroAtlas
Obesity
Air Quality

AM

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Preterm Birth
Definition:
Organ System:
Demographic:
Trend in
Incidence Rate:
Known
Contributing
Factors:
A baby is considered preterm, or premature, if it is born at
least three weeks before its due date - or 37 weeks. Of all
neonatal deaths, 28% are due to preterm birth.
Reproductive
Pregnant women worldwide have premature births. In the
United States, 1 in 8 babies is born premature.
In countries where data is available, such as the U.S. and
UK among others, preterm birth rates have risen
dramatically over the past 20 years due to a number of
factors.
Carrying More than One Child, Previous Preterm Birth,
Uterine or Cervical Issues, Previous Chronic Health
Problems; Cigarette Smoking, Alcohol Use, or Drug Use
During Pregnancy
Preterm Birth
Water Quality
Heat Hazard
Mitigation
All information available from www.epa.gov/EnviroAtlas

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PTSD
Definition:
Organ System:
Demographic:
Trend in
Incidence Rate:
Known
Contributing
Factors:
PTSD
Recreation &
Physical
Activity
Post-Traumatic Stress Disorder (PTSD) is an anxiety
disorder that some people get after seeing or living
through a dangerous or traumatic event. People who have
PTSD may feel stressed or frightened even when they're
no longer in danger.
Nervous
Anyone can get PTSD at any age. Roughly 7 or 8 out of
every 100 people will experience PTSD at some point in
their lives.
About 8 million adults have PTSD during a given year. This
is only a small portion of those who have gone through a
trauma. Women are more likely to develop PTSD than
men.
Traumatic Event, Prior Trauma, History of Mental Illness,
Mental Illness in the Family, Genetics, Alcohol Abuse,
Education Level
All information available from www.epa.gov/EnviroAtlas

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Definition:
Organ System:
Demographic:
Known
Contributing
Factors:
Respiratory
Symptoms
Common respiratory symptoms include coughing
and wheezing. There are a number of respiratory
symptoms that are associated with serious
respiratory illnesses. These symptoms include the
following: difficulty breathing, rapid breathing,
shallow or deep breathing, and absence of breathing.
Respiratory
Respiratory symptoms can affect any person
regardless of age, race or gender, though women are
more likely than men to develop a chronic cough.
COPD, Infection, Inflammation, Smoking, Heart
Conditions, Irritants, Allergens
Aesthetics »
Engagement
with Nature
Air Quality
Water Hazard
Mitigation
Respiratory
Symptoms
Heat Hazard
Mitigation
Recreation &
Physical
Activity j
All information available from www.epa.gov/EnviroAtlas

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Self-Esteem
Definition:
Organ
System:
Aesthetics &
Engagement
with Nature
Recreation &
Physical
Activity
Self-esteem is used to describe one's overall
sense of self-worth or personal value. Many
experts think self-esteem is a major
component of human existence and plays an
important role in one's construct of identity.
Nervous
All information available from www.epa.gov/EnviroAtlas

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Definition:
Organ System:
Demographic:
Known
Contributing
Factors:
Social and
Community Ties
Social relations, which are often referred to as social
interactions, include the relationships that individuals have
with one or more people. The term includes long-term
relationships and everyday social interactions with others.
Nervous
In general, humans feel the need for contact with other
human beings and interact with others on a regular basis.
Demographic factors that may affect a person's social
connectedness include: age, marital status, church
attendance, home ownership, education and income.
Environment, Development of Social Skills
Aesthetics &
Engagement
with Nature
Social &
Community
Ties
All information available from www.epa.gov/EnviroAtlas

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Stress
Definition:
Organ System:
Demographic:
Trend in Incidence
Rate:
Known
Contributing
Factors:
Stress is a normal feeling that can manifest as a result of an
event or thought that makes people frustrated, upset or
nervous. While some stress can be healthy, chronic and/or
prolonged stress can have negative health effects. Stress affects
people differently and can bring about headaches, muscle pain,
and rapid breathing, among other symptoms.
Nervous System
Stress can affect people of all ages, regardless of sex or
ethnicity. However, one study in the United States found that
women, individuals with lower income, and those who have less
education reported higher levels of stress.
Studies in the US indicate that stress decreases with age and
education level.
Emotional or Important Life Events; Injury or Illness in Yourself, a
Friend, or Loved One; Depression
All information available from www.epa.gov/EnviroAtlas
Aesthetics &
Engagement
with Nature
Recreation &
Physical
Activity

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Definition:
Organ System:
Demographic:
Known
Contributing
Factors:
Thyroid
Dysfunction
The thyroid gland is located in the neck and is a hormone-
producing endocrine gland. When the thyroid gland
malfunctions, it may cause too much or not enough
hormone to be produced. A thyroid gland that is not active
enough (hypothyroidism) may cause weight gain and
fatigue.
Endocrine
People over the age of 50 and females are at higher risk of
hypothyroidism (most common thyroid dysfunction).
Inflammation of the thyroid gland, birth defects
Thyroid
Dysfunction
Water Quality
All information available from www.epa.gov/EnviroAtlas

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Aesthetics &
front
Aesthetics &
Engagement
with Nature^
All information av;
ement with Nature
People enjoy recreating, relaxing, and spending time
outdoors. Scientific studies show that exposure to nature is
positively associated with numerous aspects of health and
good social relations. Causal mechanisms for some of these
associations have been demonstrated in the laboratory:
faster recovery from neurological fatigue appears to be
responsible for the observed effects that greenness has on
mental concentration and the alleviation of ADHD
symptoms in children. Exposure to natural scenery, even
through a window or a photograph, slows the heart rate
and calms anxiety. Humans' innate affinity for nature may
be responsible for observations that people are
preferentially drawn to community green space, where they
are more inclined to interact with neighbors while relaxing
or recreating. Gardens have long been components of
hospital grounds and urban settings for their perceived
benefits to well-being. Engagement with less cultivated
outdoor environments is believed to facilitate exploration,/
creativity, and self-esteem in children (Louv 2005). /
www.epa.gov/EnviroAtlas	S

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Urban
£co»y%t»mi
MofUHly
Air Quality
Longcvty
Hospital
AdmMaton*
Happincts
High Blood
PrMkur*
Air Quality
As industry, urbanization, and use of motor vehicles
have increased, so too has the concentration of
pollutants in the atmosphere. Forests and other green
spaces can reduce the atmospheric concentrations of
many of these pollutants, including those regulated
under the U.S. Clean Air Act: particulate matter (PM 10
and PM 2.5), carbon monoxide, sulfur dioxide,
nitrogen dioxide and ozone. Due to their significant
negative health effects, their natural removal, dilution,
or displacement can protect public health. In heavily
populated areas, even small air-quality improvements
from tree cover are estimated to significantly reduce
incidence and severity of respiratory and related
illnesses, as well as reduce health-care costs and days
missed from work and school. Vegetation can also
increase air pollution through the production of pollen,
fungal spores, and volatile organic compounds, which
contribute to ozone formation.
All information available from www.epa.gov/EnviroAtlas

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Thyroid
Dysfunction
Urban
Ecosystems
Mortality
Water Quality
Kidney
Malfunction
Gastrointestin
al Illness
Water Quality
All information available from
www.epa.gov/EnviroAtlas
When a contaminant is introduced into water, it does not always
remain suspended in the water but can be taken up by plants,
animals, or soil before it reaches a major water body. Ecological
features, whether natural or man-made, with the appropriate
plant species and soil types, can remove up to 100% of certain
contaminants from various landscapes including urban and
agricultural areas.
This process can reduce contamination of aquatic habitats,
drinking-water supplies, and recreational waters. The absence of
adequate natural water filtration due to habitat removal or the
inability of the filtering environment to cope with the volume of
pollution can lead to significant public-health threats. These
threats can be reduced with water treatment systems; however,
this solution is not always an option due to expense or
technology limitations.
One well known example of promoting natural removal of
contaminants as opposed to a water treatment system is that of
the Catskills watershed. Faced with building a water filtration
plant that would cost at least $6 billion to build and $300 million
a year to operate, New York City opted to protect the Catskills
watershed which provides their water supply. An investment of
$1 to $1.5 billion to purchase and restore the watershed allowed
for continued purification and filtration of the City's water
resources without having to invest in a filtration plant.

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Urban
Ecosystems
Vulnerable
Populations
Aniiety
COPD
Respiratory
Symptoms
Heat Hazard
Mitigation
Mortality
Heat Stroke
Hospital
Admissions
Kidney
Malfunction
Heat Hazard Mitigation
All information available from
www.epa.gov/EnviroAtlas
The Urban Heat Island (UHI) effect is a heating
phenomenon that occurs in urban centers and their
surrounding suburban areas. With the UHI effect,
metropolitan areas do not cool down at night due to the
release of heat from dark surfaces that absorb heat
throughout the day.
In UHls, temperatures can be 6 to 8 degrees higher in urban
centers than in nearby woodlands. This fact is especially
important during heat wave events, where those who reside
in urban areas are often most effected due to exposure to
higher maximum temperatures and less nighttime reprieve
from heat. In urban systems, green spaces such as parks,
urban forests and green roofs, can reduce urban
temperatures and mitigate the effects of heat wave events
through evapotranspiration and shading.
The cooling effects of these green spaces may be especially
important during heat waves, where temperatures directly
outside the homes in which people are confined (elderly,
infirm) have an effect on mortality.

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Recreation &
front
Recreation &
Physical
Activity
sical Activity
Regular physical activity is essential to a healthy lifestyle.
Outdoor areas such as parks, forests, and urban green
spaces promote a variety of physical activities such as
walking, biking and exploration. Bodies of water also
provide opportunities for activities like canoeing, fishing,
and water skiing. Though there are numerous
opportunities for indoor exercise at fitness centers, these
options are often costly in terms of time and money and
are not available to everyone. Studies show that many
people prefer exercising outdoors and outdoor exercise
has been shown to have more positive mental and
physical health effects than indoor exercise. The presence
of outdoor green spaces provides more opportunities for
people to recreate and participate in physical activities
outdoors. This planned exercise, combined with the
incidental exercise that comes from walking and biking
from place to place, contributes to overall well-being.
All information available from
www.epa.gov/EnviroAtlas

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Water Hazard
front
Vulnerable
Populations
Urban
Ecosystem*
Wetlands
Respiratory
Symptoms
Mortality
Water Hazard
Mitigation
Miscarriage
Bronchitis
Hospital
Admissions
Mental Health
Gastrointestin
al Illness
Mitigation
All information available from
/ww. epa.gov/EnviroAtlas
Various ecosystems, whether natural or man-made, can buffer
the negative effects that extreme precipitation and weather
events have on surrounding areas. For instance, wetlands
moderate the effects of floods by taking in and holding
floodwaters and protect coastlines from storm events like
hurricanes and tsunamis. Forested ecosystems have also been
shown to reduce flooding and help regulate water flow in-
between precipitation events by intercepting, absorbing, and
slowly releasing water. In urban areas, these forests also
reduce the impacts of stormwater runoff. This water
regulation reduces flooding events and their negative health
effects while also mitigating potential droughts through water
storage. The absence of ecosystems such as wetlands and
forests, which are capable of regulating water, may result in
increased incidence of extreme events such as flooding, as
as exacerbate the effects of events such as hurricanes due to
the lack of a proper buffer from human settlements.

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