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  • Towards an estimate of the environmental burden of disease

    EXECUTIVE SUMMARY

    PREVENTING DISEASE THROUGH HEALTHY ENVIRONMENTS

  • WHO Library Cataloguing-in-Publication Data

    Prss-stn, Annette.Preventing disease through healthy environments : towards an estimate of the environmental burden of disease : executive summary / Prss-stn A, Corvaln C.

    1.Environmental monitoring. 2.Cost of illness. 3.Risk factors. I.Corvaln, Carlos F. II.World Health Organization. III.Title.

    ISBN 92 4 159420 9 (NLM classification: WA 30.5)ISBN 978 92 4 159420 2

    World Health Organization 2006All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia,1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission toreproduce or translate WHO publications whether for sale or for noncommercial distribution should be addressed to WHO Press, at theabove address (fax: +41 22 791 4806; e-mail: permissions@who.int).The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever onthe part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerningthe delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be fullagreement.

    The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the WorldHealth Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietaryproducts are distinguished by initial capital letters.

    All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However,the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretationand use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

    The named authors alone are responsible for the views expressed in this publication.

  • PREVENTING DISEASE THROUGHHEALTHY ENVIRONMENTS

    Towards an estimate of theenvironmental burden of disease

    A. Prss-stn and C. Corvaln

  • PREF

    ACE

    2 Prevent ing d isease through healthy envi ronments

    HOW MUCH DISEASE CAN BE PREVENTED THROUGHHEALTHIER ENVIRONMENTS?

    his question lies at the heart of our global efforts to address the rootcauses of ill health through improved preventive health strategies -

    using the full range of policies, interventions and technologies in ourarsenal of knowledge.

    Previous World Health Organization studies have examined the aggregatedisease burden attributed to key environmental risks globally andregionally, quantifying the amount of death and disease caused by factorssuch as unsafe drinking-water and sanitation, and indoor and outdoor airpollution.

    Building from that experience, this present study examines how specificdiseases and injuries are impacted by environmental risks, and whichregions and populations are most vulnerable to environmentally-mediateddiseases and injuries.

    This report confirms that approximately one-quarter of the global diseaseburden, and more than one-third of the burden among children, is due tomodifiable environmental factors. The analysis here also goes a stepfurther, and systematically analyzes how different diseases are impacted byenvironmental risks and by 'how much.' Heading that list are diarrhoea,lower respiratory infections, various forms of unintentional injuries, andmalaria. This 'environmentally-mediated' disease burden is much higher inthe developing world than in developed countries - although in the case ofcertain non-communicable diseases, such as cardiovascular diseases andcancers, the per capita disease burden is larger in developed countries.Children bear the highest death toll with more than 4 millionenvironmentally-caused deaths yearly, mostly in developing countries. Theinfant death rate from environmental causes is 12 times higher indeveloping than in developed countries, reflecting the human health gainthat could be achieved by supporting healthy environments.

    This analysis details the health impacts of environmental risks across morethan 80 diseases and injuries. Findings are particularly relevant to healthcare policymakers and practitioners. Our evolving knowledge aboutenvironment-health interactions can support the design of more effectivepreventive and public health strategies that reduce corresponding risks tohealth.

    These estimates involved not only a systematic literature review in all ofthe disease categories addressed, but also a survey of more than 100experts worldwide. As such, this analysis represents the result of asystematic process for estimating environmental burden of disease that is

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    unprecedented in terms of rigor, transparency and comprehensiveness. Itincorporates the best available scientific evidence on population risk fromenvironmental hazards currently available. While not an official WHOestimate of environmental burden of disease, as such, it is an importantinput. More immediately, findings can be used to highlight the mostpromising areas for immediate intervention, and also gaps where furtherresearch is needed to establish the linkages and quantify population risk(burden of disease) for various environmental risk factors.

    Many measures can indeed be taken almost immediately to reduce thisenvironmental disease burden. Just a few examples include the promotionof safe household water storage and better hygiene measures, the use ofcleaner fuels and safer, more judicious use and management of toxicsubstances in the home and workplace. At the same time, actions bysectors such as energy, transport, agriculture, and industry are urgentlyrequired, in cooperation with the health sector, to address the rootenvironmental causes of ill health.

    There is good news in this report, however. These findings underline thefact that environment is a platform for good health that we all share incommon.

    Acting together on the basis of coordinated health, environment anddevelopment policies, we can strengthen this platform, and make a realdifference in human well-being and quality of life.

    Coordinated investments can promote more cost-effective developmentstrategies with multiple social and economic co-benefits, in addition toglobal health gains, both immediate and long term. Repositioning thehealth sector to act more effectively on preventive health policies, whileenhancing intersectoral partnerships, is thus critical to addressing theenvironmental causes of disease and injury, meeting the MillenniumDevelopment Goals, and achieving better health for all.

    Dr. Maria NeiraDirector

    Public Health and EnvironmentWorld Health Organization

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    his global assessment provides quantitative estimates of 'burden ofdisease' from environmental factors across the major categories of

    reported diseases and injuries.

    By focusing on the disease endpoint, and how various kinds of diseases areimpacted by environmental influences, the analysis forges new ground in anunderstanding of interactions between environment and health. The estimates,in effect, reflect how much death, illness and disability could realistically beavoided every year as a result of reduced human exposures to environmentalhazards.

    Specifically considered here are "modifiable" environmental factors realisticallyamenable to change using available technologies, policies, and preventive andpublic health measures. These environmental factors include physical, chemicaland biological hazards that directly affect health and also increase unhealthybehaviours (e.g. physical inactivity).

    The analysis builds upon the Comparative Risk Assessment coordinated byWHO in 2002, which looked at the total burden of disease attributable to someof the most important environmental hazards, and upon other quantitativesurveys of health impacts from the environment. When quantitative data weretoo scarce for meaningful statistical analysis, experts in environmental healthand health care provided estimates. More than 100 experts from around theworld contributed with reference to 85 categories of diseases and injuries.Estimates are quantified in terms of mortality from the attributableenvironmental fraction of each disease condition, and in terms of 'disabilityadjusted life years' (DALYs) a weighted measure of death, illness anddisability. While there are gaps in the reporting of many diseases at countrylevel, this analysis makes use of the best available data on overall diseaseburden, globally and regionally, as reported by WHO (World Health Report,2004).

    The results and conclusions of this assessment are of particular relevance tothe health-care sector, where policies and programmes generally addressspecific diseases or injuries. A better understanding of the disease impacts ofvarious environmental factors can help guide policymakers in designingpreventive health measures that not only reduce disease, but also reduce coststo the health-care system. The findings also are highly relevant to non-healthsectors, whose activities influence many of the root environmental factors such as air and water quality, patterns of energy use, and

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