The diagnosis that can be made in the health sector in Algeria is more alarming. The main reason for the failure and total failure of our health system that is, by the extent of dysfunctions, in the disaster, is none other than the terrible result of the flagrant lack of consideration of political and medical authorities towards this sensitive and strategic sector.

The result is, without exaggeration, this advanced state of decay, an archaism excessive and especially the scourge of mediocrity sacred and brood at all levels of the health system. The actions and groping formulas authorities such as the brilliant media agitations to eclipse a dark disturbing reality, generous incantatory speeches and generals, cacophonous statements, propaganda, conventions as well as the foundation, symposia and colloquia unmanned can neither organize nor let alone manage to reform our health care system. These practices clearly insinuate the lack of forward thinking, lack of developed vision and defined mission, in addition to the lack of strategic policies or principles. In fact, the situation can not be qu'affligeant rife incompetence, mediocrity, anarchy, the approximation and quackery. Clearly, everything happens and is done through a real management on sight.

It is important to remind our political and medical authorities that a functioning health system must inevitably be based on the guidelines with overall health perception (which is based on human biology, environment, lifestyle and the organization of care), as defined by the World Health Organization (WHO): "Health is a state of complete physical wellbeing, mental and social, and not merely the the absence of disease or infirmity ". So this is a broad concept influenced by many independent determinants: Genetic factors (heredity), biological (aging), sociocultural (resources, occupation, and housing), behavioral related to lifestyle (nutrition, activities physical, smoking and drug abuse), environmental (hazard biological, chemical and physical) as well as access to quality health services. The WHO definition makes it clear that the environment is a determining factor in health issues. It also stresses that the concept of environmental health also concerns actions to prevent and correct the environmental damage that can be the cause of disorders or diseases, which the WHO slogan: "The environment today, health tomorrow. " Without minimizing the importance of curative medicine (to which we limit our health care system), which is in disrepair, health is also the air we breathe, the water we drink, the food we eat, the medicines we consume, physical activity we do, etc.

In Algeria, the authorities, by stratagem of some and the ignorance of others, do not consider or do not realize the need to implement policies and preventive medicine is making in health public, we do not value, even restricted. The current situation in our health care system (curative) insinuates indeed that environmental health is to say, promoting preventive medicine, will not be part of our project soon public authorities unfortunately. Yet the health effects of Algerians that continues to cause our heavily polluted environment, and keep increasing exponentially.

A large number of disease states ranging from different types of cancers to cardiovascular diseases, through neurological diseases are listed some serious illnesses linked to pollution of our environment and of which thousands of Algerians victims too and in total opacity, because of the confusing and devastating inaction inaction of leaders. Clearly, a breathless health system which is limited to the archaic curative medicine without a clear vision or mission as defined, a dislocated research, health professionals clueless ... So goes our system.

To highlight the importance and relevance of environmental health and preventive medicine in a health system, its role, its objectives, mission and outline, I will limit myself as part of this contribution to briefly introduce an example of a concrete case study of intense pollution and bringing about pollution and lead exposure in Algeria, without minimizing the risk posed by other types of pollutants such as polycyclic aromatic hydrocarbons (PAHs), which are very toxic and have adverse effects on mental abilities as well as lead, which the Algerians are strongly and continually exposed.

Lead toxicity

Algeria is one of the few countries in the world that continues to use additives sinkers in gasoline and paint, knowing that lead is completely banned from use as an additive for twenty years in the world, because his poisoning is completely preventable, which constitutes for the environment and human health, a serious threat, he should be concerned urgently. Lead is a highly toxic substance that builds up in the body and affects multiple organ systems. It is especially harmful to young children. Effectively and according to WHO, lead exposure causes each year hundreds of thousands of cases of intellectual disability worldwide among children.

The evidence of a link with neurodevelopmental effects on children exposed to lead at the lowest measurable levels have led many international government authorities, including EPA (Environmental Protection Agency) in the United States and the World Organisation Health (WHO) to declare that it had not defined the lead harmfulness threshold.

Specifically, there is sufficient evidence to indicate adverse effects, including neurological effects affecting the development, neurodegenerative, cardiovascular, kidney and reproductive effects, even at low concentrations. Among them, the critical effect for risk characterization is the developmental neurotoxicity, for which the evidence of a connection was most important, especially the decline in intelligence quotient (IQ) and disorders Warning. This is why the weight of the most important evidence concerning the neurological effects of lead on children's development, particularly the decline in IQ. IQ is the most commonly measured parameter to evaluate the developmental neurotoxicity due to lead exposure.

This neurotoxicity was observed for development at lower levels of lead exposure examined to date, both in the context of observational studies and experiments on animals. There is plenty of studies showing the harmful influence on IQ of early lead exposure in children of school age, data indicating a lower IQ when blood lead concentration increases. Research conducted on this subject show that chronic exposure to lead during the first years of life is associated with lower IQ of children of school age, and globally indicate worrying effects at exposure levels below 100 micrograms / L (Ernhart et al, 1987., 1989 Cooney et al, 1989a, b, 1991. Bellinger et al, 1991., 1992 Dietrich et al., 1992. Schnaaset al, 2006).

The study by Lanphear et al. (2005) regarding the risk characterization on the effects of lead on children's IQ, shows that there is an inverse relationship between blood lead levels and IQ. Thus, it was observed that blood levels from 24 to 100 g / L, 100 to 200 g / L and from 200 to 300 mg / L resulted a lower IQ of 3.9 points, 1.9 and 1, 1 point, respectively. Lanphear et al. (2005) concluded that a maximum blood level of lead less than 75 mg / L results in mental retardation in children. The lowest data point in the study of Lanphear (2005) was 2.4 g / dl. It is important to note that in laboratory animals, it was observed that the neurotoxic effects of lead on the development persisted after cessation of exposure and once blood and brain lead levels returned to normal or rates reference (Rice and Barone, 2000).

Finally, according to the dose-response modeling conducted by the Office of Environmental Health Hazard Assessment of the EPA to the State of California (OEHHA 2007) and the European Food Safety Authority EFSA Food (2010 ), each increase in blood lead concentration of 1 mg / dL lead to a deficiency of one about IQ point.

Sources of chronic lead exposure in Algeria

To determine ways to reduce the exposure of the Algerian population to lead, one must first understand where it occurs and what happens to the lead, both in nature and in industry, of which The ultimate objective is to reduce risks to human health and the environment. In Algeria in 2016 and, unfortunately, there is no national inventory of releases of pollutants to have the precise profile of the different anthropogenic sources of lead emissions to the environment. Actually, the authorities always opt for solutions of its kind to break the thermometer to stop the fever. Thus, emissions of lead in soil and water are still the domain of the unknown. However, discharges of lead in the atmosphere are multiple and the main sources of anthropogenic emissions into the atmosphere are: petrol containing lead, mining, iron and steel industry, foundries and base metal refineries. The most important anthropogenic source of lead emissions in the country comes from the gasoline and hundreds of tons of lead are released annually into the atmosphere to the only region of Algiers, according to several sources who are familiar with This folder. Note that blood lead levels (lead levels in the blood) decreased by 95% since the ban of the use of leaded gasoline in 1986 in the United States, CDC (2005). This same highly significant decrease in blood lead levels is also observed in Canada in the general population in 2007-2008, according to statistics Canada (2010). These results need no comment, inform us how urgent is the rebuilding of the Algerian health system.

Indeed, the example of lead exposure and its health effects mentioned above shows that the health of a population depends not only on a country's health services it is in the main functions of the state: the environment, education, sports, agriculture, town, city, safety, work, research, food, industry, budget, etc. It is clear that it is more essential to ensure cross-management of health which necessarily entails collaboration with the main functions of the state. Health can not depend on the prerogatives of one specialized agency, but it must be multidisciplinary and an element of our common good with respect to all government activities.

In 2016 and while several countries have entered the era of predictive medicine, thanks to the genomic revolution and new technology for early detection of biomarkers associated with disease onset to slow evolution, Algeria, not only we have not yet integrated preventive medicine, but political authorities are far from having an approach and a broad vision of health to abandon the vertical approach and current anarchisée.

It is time to begin the transformation of the health system to adapt to major health issues, technological, economic and social of the century. It is more than necessary to stop limit our health system on curative medicine. It is even time to think about why and how to move from curative to preventive and predictive medicine, which will change fundamentally and thoroughly the establishment and functioning of the institution that will manage our health care system. The integration of preventive medicine involves a profound change of mentality and first means precisely that it is imperative to get out of hospitals and health clinics to expand in schools, in businesses, in sport, in research and in the everyday of every citizen.

In short, sustainable development, having as base the human and environmental health, is the only guarantor of security, stability and prosperity in the 21st century. That is to say, a development that meets the needs of the present without compromising the needs and capacity of future generations. Thus, the nations that actively engage on this path, will certainly play the leading role and will hold the key to sustainable development. Environmental and human health will be the invaluable deposit economic and human wealth in the coming years. He is stunned to see Algeria away this opportunity unfolding before our eyes. However, Algeria has real assets to succeed with this indispensable gloss health innovation to the new reality of our time. It only needs the political will.