Environmental Health. Improving Health Outcomes from Outside the Healthcare Sector

Transcription

1 Environmental Health Improving Health Outcomes from Outside the Healthcare Sector

2 Structure of Presentation How much does environmental health matter? Is it specific to the poor? What kind of environmental health interventions improve health outcomes? How cost-effective are they?

3 What is Environmental Health? Environmental health tends to consider health risks from exposure to biological agents (bacteria, parasites etc) chemical agents (pollution, pesticides etc) disease vectors (mosquitoes, snails etc) Involves thinking across sectoral, socioeconomic and physical boundaries Focus on prevention of health risks at the source

4 Section 1 Does environmental health matter to the poor?

5 Environmental factors play major part in some of the biggest killers of the poor % of B.O.D. associated with Environment 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% ARI CRI Diarrhea Malaria Injuries Cancer Other All Env related

6 30% of illness and death in Sub-Saharan Africa relates to environmental factors % of DALYs Lost : Sub - Saharan Africa 13% 9% 6% Water supply and sanitation Malaria Indoor air pollution 72% Non environmental causes Source : Murray and Lopez, Data mostly pre-date the effects of AIDS

7 Environmental health and healthcare interventions can have equal impact 44% % DALYs Potentially Reduced in SSA % 28% 12% 8% Indoor air pollution Water supply, sanitation and waste management Vector control, sanitation and drainage Healthcare and education Other measures Improved environment can reduce burden of disease by 23-29% in SSA Healthcare interventions aimed at same can reduce a further 23-28%

8 Section 2 : How specific is environmental health to the poor?

9 The poor have worse health outcomes Peru 1996 Health Outcomes Deaths of children <5 per 1,000 l.b. % stunted (<2 s.d. z scores height for age, children <5) 0 Poorest 20% Richest 20% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% U5 Mortality % Stunted Wealth Quintiles

10 The poor have less access to services that protect from environmental harm Peru 1996 Water Supply % of total households Poorest 20% Richest 20% Private Piped Surface Water Wealth Quintiles Peru 1996 Toilet Facilities % of total households Poorest 20% Richest 20% Private Toilet No Toilet Wealth Quintiles

11 Section 3 : What kind of environmental health interventions can improve health outcomes of the poor?

12 Interventions to improve environmental health cut across sectors Infrastructure -- e.g. water supply, water storage, latrines, improved drainage Private goods -- e.g. cookstoves, ventilation in houses, bednets Behaviour change -- e.g. hygiene practices, handwashing

13 Interventions have public and private character Combination of private willingness to pay with public benefit e.g. household latrine is a private good and households often willing to pay for it latrine coverage in community is important determinant of health outcomes whether a particular household has a latrine or not

14 Section 4 : How cost effective are they?

15 Environmental health interventions can be highly cost-effective Cost effectiveness of Env Health interventions cost per DALY saved $160 $140 $120 $100 $80 $60 $40 $20 $0 $120 Improved sanitation $20 Hygiene education $40 Malaria prevention $50 Improved cookstoves $150 "Cost Effective" healthcare intervention Note : estimates vary widely, depending on circumstances. These are considered high estimates. Estimate for healthcare comes from WDR 1993

16 Difference between cost and private willingness to pay raises interesting financing questions Preliminary results from India show costs to public sector of improving public health net of the amount households would pay for services Private water Private toilets % with no toilet < 40% Total cost in Rs 000 per DALY saved Rural Urban Note : Net cost = total cost - estimated willingness to pay for the service

17 Conclusion : EH can be cost effective means to improve health of the poor Requires explicit focus on the health outcome in design of the intervention Requires combination of activities e.g. combining health education with increased water and sanitation coverage Requires consideration of levels of coverage within a community e.g. when latrine coverage exceeds 60% households benefit whether or not they have a latrine