Preventing Disease through Healthy Environments

Transcription

1 Preventing Disease through Healthy Environments 1

2 Changing environmental risk factors Local: Transboundary: Global: Chemicals Outdoor air Workplace hazards Water quality Adequate sanitation Indoor air pollution Climate change UV Radiation Ecosystem change High mortality Developing countries Low mortality Developing countries Developed countries GNP 2

3 Health: the ultimate reason for managing global environmental changes 3

4 Cardiovasc. diseases Breast cancer Diabetes Respiratory diseases Malaria Injuries Physical inactivity Climate change Cardiovasc. diseases Malnutrition Transport Social factors not related to environment Chemicals etc. Diarrhoea Injuries etc. Health determinants from the environment Causes of the causes Proximal causes Radiation Health Water, sanitation Trade Lung cancer Air pollution Vector breeding sites Respiratory infections COPD Lung cancer Degraded ecosystems Malaria Dengue Leishmaniasis Desertification Migration etc. Intestinal Diarrhoea parasites Drownings Genetic factors Malnutrition etc. 4

5 How much disease could be prevented by better management of the environment? Current evidence - best conservative estimate 24% World average 5

6 Diseases with largest environmental contributions Diarrhoea Lower resp. infections Other unintentional inj. Malaria Road traffic injuries COPD Perinatal conditions Ischaemic heart dis. Childhood cluster Lead-caused MMR Drownings HIV/AIDS 0 1% 2% 3% 4% 5% 6% % of global disease burden in DALYs Environmental fraction non-environmental 6

7 Environmental burden of disease Nearly one quarter of disease burden is due to preventable environmental risks Over one third in children of 0-14 years Per capita results: 15 times more infectious diseases in developing than in developed countries 2x more injuries per capita in developing countries 2-3x more cancers and CVD in developed countries 7

8 Misconceptions about health & environment Environment is a luxury, it is for developed countries Highest in developing countries e.g. >30% of Africa's burden attributable to the environment Environment mainly affects adults, after many years of exposure Attributable fraction of 37% in the age group 0-4 years We reduce the environmental disease just by increasing GNP? A health enhancing environment can be achieved through education, technology and good management Environmental interventions are expensive Seven fold return investment from water and sanitation; three fold return for improved household energy 8

9 How important is climate to human health? How much of global public health depends on climate as a natural resource? - All of it. 9

10 Climate impacts directly on health Temperature distribution over Europe. August 2003 Daily temperatures and deaths in Paris. Summer

11 Many major killers are climate sensitive Each year: - Undernutrition kills 3.7 million - Diarrhoea kills 1.8 million - Malaria kills 1.1 million Each of these is highly sensitive to temperature and precipitation. (WHO, World Health Report, 2002)

12 Health risks are overwhelmingly concentrated on the poor

13 Health impacts of climate change Density equalling cartogram. WHO regions scaled according to estimated mortality (per million people) in the year 2000, attributable to the climate change that occurred from 1970s to Gibbs et al, in prep. 13

14 Emissions of greenhouse gases Density equalling cartogram. Countries scaled according to cumulative emissions in billion tonnes carbon equivalent in Gibbs et al, in prep. 14

15 Future climate change will increase risks Climate change is expected to increase the proportion of the global population exposed to dengue from about 35%, to 50-60%, by Hales et al, Lancet 2002 A. Current dengue distribution B. Projected distribution in 2080s 15

16 Health sector is first defence against climate change impacts Infectious disease surveillance Integrated vector management Health action in emergencies Diseases affected by climate Environmental health capacity building Safe drinking water Healthy development 16

17 Protecting health, protecting the climate Buildings Indoor air pollution Heat and cold protection Transport Air pollution Traffic injuries Physical inactivity Industry Occupational risks, mining and transport Greenhouse Gas Emissions Energy supply & conversion Occupational risks; Construction and transport Agriculture Nutrition, Water / vector-borne disease Waste Occupational, chemical 17

18 Potential health gains from cleaner transport and energy Each year: Urban air pollution kills 800,000 Road traffic accidents kill 1.2 million and injure over 50 million Physical inactivity causes 1.9 million deaths Indoor air pollution kills 1.5 million For comparison: Malaria HIV/AIDS million million (WHO, World Health Report, 2002)

19 Health sector can help drive climate protection National Health Services Infrastructure Development Agencies Empowered health sector Private Sector Labour Organizations 19

20 Conclusions A relatively stable and predictable climate underpins all human health Meteorological information is a useful resource for protecting health but only if it responds directly to needs of the health sector we are still working out exactly what these are. we should keep talking. 20

21 Thank you 21