ENVIRONMENTAL HEALTH OFFICERS IN NIGERIA IN THE 21ST CENTURY: ADVOCACY AND RAISING PUBLIC AWARENESS

ealthy environment is important for the well-being of mankind and environmental factors play a crucial role in the spread of diseases, especially in the 21st century. Environmental health officers are stakeholders in this regard and in the sustainable development goals. This paper discussed the interplay between the environment and health, the importance of environmental officers in Nigeria and factors that influence their activities. A narrative review was carried out using secondary data from various databases and organizational websites. In Nigeria, an environmental health officer must be registered with the Environmental Health Officers Registration Council of Nigeria (EHORECON) in line with Act 11, of 2002 and requires investigative, analytical, communicative and educational skills, among others to function effectively. They are important stakeholders in environmental issues with roles in sanitary inspection of premises, prevention and control of diseases, disasters, antimicrobial resistance, food hygiene and safety, ecological health, planetary health and environmental impact assessment, among others. The challenges they face during their work include lack of enabling laws to deter defaulters, shortage of manpower, poor knowledge and access to various standardized tools, among others. The role of environmental health officers cannot be over-emphasized, especially in this 21st century. However, these professionals need to think outside the ‘box’ to address arising challenges.


INTRODUCTION
A healthy environment has a crucial role to play in the prevention of about 25% of the global disease burden.
Modifiable risk factors in the environment are responsible for over 13 million deaths annually. Over 90% of the deaths from diarrhoea and about 40% of the deaths from malaria and upper respiratory tract infections can be prevented by health interventions targeting the environment (Pona et al., 2021). Environmental determinants of health include physical, chemical and biological factors which are external; and all related human behaviour (PAHO/WHO, 2022).
The United Nations Sustainable Development Goals have the overarching goals of eliminating poverty, hunger and disease with environmental health as a key element (WHO/SDG, 2022). The impact of environmental health hazards is borne disproportionately by people in low-and middle-income countries with far-reaching consequences. Morbidity and mortality indices in these regions are still high despite the global concerted efforts to address environmental issues (GEHSD, 2022).
Nigeria is the most populous African nation with the majority of the population living below the poverty line and exposed to poor environmental conditions. The poor conditions are as a result of the interrelationship of a multitude of factors (natural and man-made). The man-made factors could be direct or indirect. Land, air and water pollution have a direct effect while low socio-economic status, lack of education, poor political will, poor health systems, poor health behaviour, lack of enforcement of environmental health policies and rapid urbanization indirectly affect the environment (Aliyu and Amadu, 2017). This leads to mortality from largely preventable conditions. The prevalence of diseases such as diarrhoea, malaria, respiratory tract infections among under-fives in Nigeria is among the highest in sub-Saharan Africa. The periodic outbreaks of Lassa fever and cholera point to the abysmal state of the environment within which a great proportion of the population live and carry out routine daily activities (Chandra et al., 2019;Liu et al., 2016). Against this backdrop, bridging the gap between the current situation and the ideal environmental health conditions is of utmost importance.
In view of the fact that the ideal first contact with health care for any society is primary health care, environmental health officers are considered integral to the success of achieving health for all (Joubert et al., 2020).
They are indispensable members of the public health team. They are tasked with promoting health, preventing disease, improving and sustaining the environment. They carry out their functions via health education, consultation, environmental monitoring and surveillance and enforcement of public health legislation (Beaglehoe et al., 2003;Musoke et al., 2016). However, in resource-poor settings like Nigeria, their activities are impeded by several challenges such as poor capacity, inadequate funding, lack of required infrastructure and inequitable distribution of available resources, among others (Beaglehoe et al., 2003).
This article gives an overview of basic concepts in health, environmental health and environmental health officers in Nigeria in the 21st the century. It also aimed at raising awareness about the roles of environmental health officers in environmental health.

RESULTS AND DISCUSSION
Health is a fundamental Human Right as enshrined in Article 25 of the Universal Declaration of Human Rights (UNDHR, 1948). The preamble of the WHO Constitution affirms that health is one of the fundamental rights of every human (WHO, 1948). It is central to the concept of quality of life, an integral part of development and it involves individual, community, state and international responsibility. It is inter-sectoral, its maintenance is a major social investment and health is a world-wide social goal (Park, 2015). It is the responsibility of the governments to ensure that the people have access to the basic elements that would enable families and individuals to maintain good health and have access to good quality health care (Lucas and Gilles, 2003). Good health promotes development, and development promotes health and education promotes health. The strong association between health and level of education is particularly marked with regard to women's education. It affects their health status and behaviour as well as that of their children (Lucas and Gilles, 2003).
The environment is an important determinant of an individual's health, be it at the household, community, state, country, continent and planetary level and therefore, its importance cannot be over-emphasized, especially in the 21 st century. Environmental health comprises those aspects of human health, including quality of life, that are determined by physical, biological, social, and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations (Fitzpatrick and Kappos, 1999).
No single professional can alone play the role of ensuring a positive interaction between the environment and humans alone; so environmental health involves the collective services of qualified public health doctors, practicing physicians, environmental health officers, epidemiologists, sanitary engineers, public health nurses, town planners, veterinarians, toxicologists, chemists, sociologists, economists and health inspectors, among others. With the emerging concept of 'One Health', the interactions between humans, the environment and animals are receiving more global attention with the global problems of zoonoses and antimicrobial resistance, climate change, disasters, sustainable development, planetary health and ecological health (EcoHealth), among others being brought to the fore (Unuraye and Olojobe, 2005;Obionu, 2018;Lueddeke, 2019).
A healthy environment is important for the well-being of mankind, because continuous interaction between man and his social or psychological environment may influence his health either positively or negatively. In developing countries (Nigeria inclusive), the major causes of morbidity and mortality are traceable to factors arising from poor environmental sanitation among others.
The importance of environmental health could be more appreciated by looking at its components which includeprovision of adequate, safe, potable, wholesome water supply; proper and safe disposal of sewage (excreta disposal); proper disposal of solid waste (refuse); food hygiene and safety; provision of shelter/ housing and planning; control  EHORECON, 2007). In addition to the above-mentioned requirements, an EHO requires investigative, analytical, communicative, educational, organizational, attitudinal skills, among others to function optimally (EHORECON, 2007;Ibrahim and Adebanjo, 2014). For effective management of the environment, these professionals need qualified and adequate number of personnel.

THE ROLES OF ENVIRONMENTAL HEALTH OFFICERS
These roles of environmental health officers are as numerous as the components of environmental health. However, the professional body should know that the roles are not automatic, especially in Nigeria where there is professional rivalry and no clear job descriptions in most public jobs. They have to make themselves relevant and also let government at various levels in the country know that they know their jurisdictions in whatever policies and programmes that are being implemented, e.g., being an important player in EIA programmes, among others. The professional body is expected to liaise with the relevant government agencies for their roles in the society to gain more prominence. Additionally, the body is expected to carry out an enlightenment campaign of the benefits of keeping the environment healthy. Health is wealth.
Environmental Health Officers play very important roles in every society. Inspections of premises in environmental health practice is a fundamental oversight function of these professionals. In their practice, the word 'premises' describes passage, building, land, vehicle, ship or vessel and aircraft in any port or on any inland waters used or intended for use by man. Premises that are usually encountered by field environmental health officers include but are not limited to residential premises, food premises, recreational facilities, hotels, industries, business centre, hospitals, clinics, markets, schools, slaughterhouses. Registration of food premises and pest/vector control outfits are within their purview.
They promote clean and healthy environment, by preventing sanitation related diseases such as cholera, malaria, typhoid, scabies, Lassa fever, among others.
1. Promoting awareness and education of neighbourhood nuisance and abate them appropriatelythe EHO should not only be seen as an inspector and environment law enforcement officer but also an educator because experience has shown that an attempt to perform public health work through law enforcement alone does not produce the best results (Lucas and Gilles, 2003). Cooperation of the individual is very important.
2. Investigating complaints from residents about nuisance. 10. Teaching, training and retraining of environmental health personnel, and other related health workers and community members on issues that relate to the environment and public health, among others 11. Food hygiene and safety-The sanitary inspector role is not only to inspect the dairies, but more importantly to ensure that good quality milk is produced for the community. It is the responsibility of the EHOs not merely inspecting the premises, rather to ensure that the business premises is safe, sanitary means of excreta disposal and safe water supply system for every home are well executed for the benefits of man and the environment (FMOE, 2005a).
A story has been told of a highly specialized mechanic who was called in, after several had failed, to determine what was wrong with a certain complicated engine that could not be started. After examining the engine very carefully for a few minutes, the mechanic selected a particular part of the engine and struck one blow with his hammer, whereupon the machine started immediately. He then rendered a bill for $500 for his services. The owner of the engine objected to what he thought was an overcharge and demanded an itemized statement. The statement received read, "Five dollars for one tap, and $495 for knowing where to tap (Waller, 1934)"

TOOLS FOR ENVIRONMENTAL HEALTH OFFICERS
Just like other professionals require tools to function properly, EHOs also have tools to be employed systematically for inspection. For the sanitary inspection of premises, there is a need to follow an approved protocol. This begins with self-identification followed by external and internal inspection of the premises in question. The various forms that could be used include (EHORECON, 2007;Ibrahim and Adebanjo, 2014).

Sanitary Inspection of Premises (Appraisal) form {Form ES 1}-It is an approved tool to be used by EHOs while
inspecting living premises; usually analyzed weekly or monthly to depict status or trends of sanitary conditions of premises in a particular area or community. Complaint Acknowledgment Form {Form ES 6}-The complaint acknowledgement form is usually completed in triplicate. The complainant receives a copy while a copy is sent to the area office having jurisdiction and the third copy is retained for office use.
Closing Order Form {Form ES 7}-An EHO usually makes a complaint to the court justifying that certain premises are unfit for human habitation or constitutes a threat to public health before this form is issued, which temporarily closes down the premise. This order prohibits further use of the premises until the existing nuisances are removed.
Withdrawal of Prohibition Order Form {Form ES 8}-It is the court that issues out a "withdrawal of prohibition order form" on the request of an EHO that the detected nuisances have been abated in the premises. i. When an individual, private or corporate intends to operate a private slaughterhouse, an initial inspection is required on the premises. If found satisfactory, Form E.S.12G is issued.

School Sanitation Inspection
ii. When an individual, private or corporate also applies for a renewal of a license to continue operation of a private slaughterhouse, a re-inspection of the premises for renewal is required. If such premises were found to be satisfactory, form E.S.12G could also be issued.

CHALLENGES OF ENVIRONMENTAL HEALTH OFFICERS IN NIGERIA
Some of the challenges faced by environmental health officers in Nigeria can be summarized as: kept in a manner or condition as to produce noise that will be injurious to health. There have been reports of industries with high noise pollution located within residential areas. Siting of industries and Environmental Impact Assessment are very important.
8. The establishment of illegal slaughterhouses pose serious dangers to the general public. There are requirements for slaughter houses required to ensure public health in the area of meat safety, among others (FMOE, 2005b).
9. Shortage of environmental health officers. There is a big gap in the ratio of EHO to the population, recruitment, training, re-training and retention.
10. The insecurity in the country affects the effectiveness of these professionals like others. The insecurity has contributed to Internally Displaced Person camps with the consequent health events such as cholera, Lassa fever, among others. Health Services, being active players in promoting the concept of One Health and in the control of antimicrobial resistance, inventing ways of converting waste to wealth, and in provision of innovative port health services in Nigeria.

CONCLUSION
As environmental health officers in Nigeria continue to face many challenges in the course of disease prevention, control and the sustenance of environmental integrity, among others, they must think outside the 'Box' in the 21st century. Their duty is one of the most important parts of essential welfare and a necessary service to humanity and such an EHO should have the satisfaction of rendering practical and necessary service to humanity. Their activities should be directed towards solving societal problems by knowing where and when to "tap". Meaning that environmental health officers should be more innovative and also use evidence to solve environmental problems.
There is need for government at all levels to create an enabling environment for EHOs to be more effective and efficient in carrying out their duties. Furthermore, there is the need to partner with the private sectors for assistance towards ensuring healthy and sustainable environment for all. There should be increase public awareness and education and advocacy for policy makers on the importance of EHOs and the need for partnership.