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    Country Profiles of Environmental Burden of Disease for LAC

    By Keith R | August 3, 2007

    Topics: Environmental Protection, Health Issues, Sanitation, Water Issues | No Comments »

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    Several weeks ago the World Health Organization (WHO) released what it billed as "the first ever country-by-country analysis of the impact environmental factors have on health."  It phrased it that way ("country-by-country") because it released a more global analysis of the issue last year — in fact, that report was the subject of one of my first blog posts and has been added to the health section of the Temas Recommended Reading List

    The types of "environmental factors" WHO is speaking of include exposure to hazardous substances in polluted sites, noise pollution, workplace environmental hazardous, indoor air pollution, lack of potable water, poor sanitation, ultraviolet (UV) radiation, and even climate change (which, for example, can extend the range of traditionally tropical diseases). 

    WHO maintains that research has shown that 13 million deaths worldwide could be prevented just by making environmental conditions healthier, and that in some countries, as much as one-third of their disease burden is linked to environmental factors (it calculates, for example, that Mexico alone could save 80,000 lives per year).  In its preliminary calculations for the Latin American and Caribbean (LAC) nations, WHO has found the burden to be as high as 24% for Bolivia, 23% for Guatemala, 22% for Nicaragua, 20% for Honduras and Peru, 19% for Belize and Suriname, and 18% for Brazil, El Salvador, Guyana, Panama and Paraguay.

    reader's guide to WHO country profiles on environmental health (click to enlarge)The one-page country profiles are useful in helping provide a snapshot of the principal environmental risk factors for each nation, and for drawing comparisons between nations.  This can help policymakers, multinational and bilateral aid entities and others set priorities and better target their work on environmental health.  If, for example, it is true that a major risk is the use of solid fuel (primarily wood) for cooking indoors, and you know that among the LAC nations those with more than half their population cook this way are Guatemala, Guyana, Haiti, Honduras, Nicaragua, Paraguay and St. Lucia, then any aid program to tackle that issue may wish to focus on those countries first.

    You can download the entire pack of profiles for all WHO member states in the Americas as a single PDF file, or go to an alphabetized list of countries and pick-and-choose.  For a sample of a country profile page with a guide as to how to read it, click the image at right to see a larger version.

    estimated deaths & DALYs in LAC attributable to select environmental risk factors (click to enlarge)I have put together a table for the LAC countries (see right — click to enlarge) based on a WHO country-by-country comparison of data for three of the environmental risk categories that usually affect public health in most countries, namely water (sanitation and hygiene), indoor air pollution and outdoor air pollution. 

    One of the first things that struck me thumbing through the country profiles for the Americas are the many data gaps.  Data gaps are hardly new or unusual in LAC, and I have discussed this problem before several times.  My hope is that, now that these country profiles have been published showing clearly who's missing what data, that WHO, PAHO, the national governments and various aid agencies will work to plug them. 

    Some of the missing data is frankly puzzling.  For example, is it really impossible to determine whether or not leaded gasoline is still being offered in Grenada, Paraguay, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, and Suriname???

    The data also produced some surprises — well, to me, anyway.  Why, for example, is the average measurement for airborne particulates (PM10) so high in Barbados (95 ug/m3)?

    Why is the cancer rate so high in Grenada?

    Why is the rate for chronic obstructive pulmonary diseases (COPD)  in Guatemala among the world's highest? 

    Why is the asthma rate in Costa Rica among the world's highest?  Why is the asthma rate so high in Belize, Brazil, the Dominican Republic, El Salvador, Panama and Peru? 

    Why is the DALY rate for neuropsychiatric disorders so high in Argentina, Brazil, Chile, Guyana and St. Kitts and Nevis? 

    And why on earth are Cuba, Peru and Venezuela still using leaded gasoline?  [Particularly Venezuela, which if memory serves me, exports unleaded gasoline, so it must have the capacity to produce it locally!]

    Perhaps the citizens of these nations need to demand answers of their officials, and if the latter claim not to know or to be investigating the root causes, then demand that they do.

    — Keith R 


    From the World Health Organization (WHO):

    New country-by-country data show in detail the impact of environmental factors on health

    The World Health Organization (WHO) is today releasing the first ever country-by-country analysis of the impact environmental factors have on health. The data show huge inequalities but also demonstrate that in every country, people's health could be improved by reducing environmental risks including pollution, hazards in the work environment, UV radiation, noise, agricultural risks, climate and ecosystem change.

     The new data show that 13 million deaths worldwide could be prevented every year by making environments healthier. In some countries, more than one third of the disease burden could be prevented through environmental improvements. The worst affected countries include Angola, Burkina Faso and Mali, as well as Afghanistan.

    In 23 countries worldwide, more than 10% of deaths are due to just two environmental risk factors: unsafe water, including poor sanitation and hygiene; and indoor air pollution due to solid fuel use for cooking. Around the world, children under five are the main victims and make up 74% of deaths due to diarrhoeal disease and lower respiratory infections.

    Low income countries suffer the most from environmental health factors, losing about 20 times more healthy years of life per person per year than high income countries. However, the data show that no country is immune from the environmental impact on health. Even in countries with better environmental conditions, almost one sixth of the disease burden could be prevented, and efficient environmental interventions could significantly reduce cardiovascular disease and road traffic injuries.

    "These country estimates are a first step towards assisting national decision-makers in the sectors of health and environment to set priorities for preventive action," said Susanne Weber-Mosdorf, WHO Assistant Director-General for Sustainable Development and Healthy Environments. "It is important to quantify the burden of disease from unhealthy environments. This information is key to help countries select the appropriate interventions."

    The country profiles provide a preliminary estimate of health impacts caused by environmental risks. Countries can use these figures to refine their own estimates. Despite the uncertainties involved in these estimates, they indicated opportunities for targeted action to prevent disease.

    For the purposes of this assessment, environmental factors include pollution, occupational factors, UV radiation, noise, agricultural methods, climate and ecosystem change, the built environment and people's behaviour.

    The data show that household interventions could dramatically reduce the death rate. Using cleaner fuel such as gas or electricity, using better cooking devices, improving the ventilation or modifying people's behaviour (such as keeping children away from smoke) could have a major impact on respiratory infections and diseases among women and children.

    Interventions at the community or national level would involve promoting household water treatment and safe storage, and introducing energy policies which favour development and health. For example, reducing levels of air pollution (measured by PM10) as set out in WHO's Air Quality Guidelines would save an estimated 865 000 lives per year.

    Desde la Organización Mundial de la Salud (OMS):

    Una nueva serie de datos por países ofrece información detallada sobre el impacto de los factores ambientales en la salud

     La Organización Mundial de la Salud (OMS) publica hoy el primer análisis por países realizado hasta la fecha sobre el impacto que los factores ambientales tienen en la salud. Aunque los datos ponen de manifiesto la existencia de enormes desigualdades, también demuestran que en todos los países es posible mejorar la salud de la población reduciendo riesgos ambientales como la contaminación, los peligros en el lugar de trabajo, la radiación ultravioleta, el ruido, los riesgos relacionados con la agricultura, el cambio climático y la transformación de los ecosistemas.

     Según se desprende de los nuevos datos arrojados por este análisis, se podrían prevenir cada año a nivel mundial 13 millones de defunciones mediante la introducción de mejoras en materia de salubridad ambiental. En algunos países, estas últimas permitirían prevenir más de una tercera parte de la carga de morbilidad. Entre los países más afectados destacan Angola, Burkina Faso y Malí, así como el Afganistán.

    En 23 países del mundo, más del 10% de las defunciones se deben a tan sólo dos factores de riesgo ambientales, a saber: la insalubridad del agua, incluidas las malas condiciones de saneamiento y la falta de higiene; y la contaminación del aire en espacios cerrados debido a la utilización de combustibles sólidos para cocinar. En términos mundiales, las principales víctimas son los niños menores de cinco años, que representan un 74% de las defunciones atribuibles a enfermedades diarreicas e infecciones de las vías respiratorias inferiores.

    Los países de ingresos bajos son los más afectados por los factores de salud ambiental: en ellos la pérdida de años de vida sana por persona viene a ser unas 20 veces superior a la correspondiente a los países de ingresos altos. No obstante, los datos también revelan que ningún país es inmune al impacto ambiental en la salud. Incluso en los países que disfrutan de condiciones ambientales más favorables, se podría prevenir cerca de una sexta parte de la carga de morbilidad; asimismo, cabría reducir notablemente las enfermedades cardiovasculares y los traumatismos causados por accidentes de tráfico, mediante la ejecución de intervenciones ambientales eficaces.

    «Estas estimaciones por países son un primer paso dentro de una serie de medidas destinadas a ayudar a las instancias decisorias nacionales encargadas de la salud y del medio ambiente a establecer prioridades en su labor de prevención», ha declarado Susanne Weber-Mosdorf, Subdirectora General de la OMS para Desarrollo Sostenible y Ambientes Saludables. «Es importante cuantificar la carga de morbilidad atribuible a los ambientes no saludables. Esta información es fundamental para ayudar a los países a seleccionar las intervenciones apropiadas.»

    Los perfiles nacionales proporcionan una estimación preliminar de los impactos sanitarios causados por riesgos ambientales. Los países pueden utilizar esas cifras para afinar sus propias estimaciones. Estos datos, pese a presentar ciertas incertidumbres, indican la existencia de oportunidades para la adopción de medidas focalizadas de prevención de enfermedades.

    A los fines de este análisis, los factores ambientales incluyen la contaminación, los factores ocupacionales, la radiación ultravioleta, el ruido, los métodos agropecuarios, el cambio climático, la transformación de los ecosistemas, las zonas edificadas y el comportamiento de las personas.

    Los datos demuestran que ciertas intervenciones domésticas podrían reducir sobremanera las tasas de mortalidad. La utilización de combustibles menos contaminantes, como el gas o la electricidad, el empleo de enseres de cocina más seguros, la mejora de los sistemas de ventilación o la modificación del comportamiento de las personas (por ejemplo, mantener a los niños alejados del humo) podrían repercutir considerablemente en las enfermedades e infecciones respiratorias, en particular entre las mujeres y los niños.

    Las intervenciones aplicables a nivel comunitario o nacional incluyen la promoción del tratamiento y el almacenamiento seguro del agua para uso doméstico y la introducción de políticas de energía que promuevan el desarrollo y la salud. Así por ejemplo, la reducción de los niveles de contaminación del aire (medidos en PM10) con arreglo a lo recomendado en las Directrices sobre la calidad del aire de la OMS permitiría salvar unas 865 000 vidas al año.


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