Well-being and disease prevention by improving environment management

Introduction

Some of the environmental factors of risk to health are well known: unsafe drinking-water, inappropriate sanitation, indoor air pollution, infectious and non communicable disease; others less known, are climate change and the built environment.

The realization of just how much disease and ill health can be prevented by focusing on environmental risk factors should add a significant impetus to global efforts to encourage adapted preventive health measures through all available policies, strategies, interventions, technologies and knowledge.

In this context, estimating the burden of disease that could be reduced by taking measures to decrease these environmental risks to health is a key step in identifying and evaluating the most important priorities for targeted environmental action.

What are the main findings of the report?

This report presents the latest wide-ranging evidence on environment-disease links and their devastating impact on global health assessment, and detailed findings and assessment to show by how much and in what ways improving the environment can promote health and well-being.

Total environmental deaths are unchanged since 2002, but show a strong shift to non communicable diseases mainly due to a reduction in the environmental risks causing infectious diseases.

Among the elements influencing this situation, one element is the uneven impact on health across life course and gender. Another element is that these environmental risk factors affect more low- and middle-income countries.

The main disease burden that could be prevented through healthier environments are stroke, ischaemic heart disease, diarrhoea and cancers. This environmentally-mediated disease burden is much higher in poorer countries with the exception of certain non communicable diseases, such as cardiovascular diseases and cancers, where the per capita disease burden is greater in the developed world.

Examples of possible actions to address environmental risks include the promotion of safer household water storage and better hygiene measures, the use of cleaner fuels and the safer, more judicious use and management of toxic substances at home and in the workplace, as well as occupational safety and health measures.

What are the main environmental factors that affect health?

Eight main categories of environmental factors were identified:

1. Pollution of air (including from second-hand tobacco smoke and smoke from cookstoves, the most important environmental risk), water or soil with chemical or biological agents ;
2. Ultraviolet (in particular, protection from) and ionizing radiation
3. Noise, electromagnetic fields ;
4. Occupational risks, including physical, chemical, biological and psychosocial risks, and working conditions ;
5. Built environments, including housing, workplaces, land-use patterns, roads
6. Agricultural methods ;
7. Man-made climate and ecosystem change ;
8. Behaviour related to environmental factors, e.g. the availability of safe water for washing hands, physical activity fostered through improved urban design, more healthy diet.

How can the health impact of environmental factors be reduced?

A change in perception to view the environment as an essential element of health protection would greatly benefit people’s health. The environment should be viewed as a key element for health protection and reduction of health inequalities and placed at the centre of primary prevention. It is estimated, for example, that 42% of the global malaria burden could be prevented by environmental management. To be most effective and sustainable, these prevention measures need to be designed and implemented holistically, and action is needed at all levels of governance.

The determinants of diseases linked to the environment often lie within the sphere of action of sectors other than health or environment (e.g. energy, industry/manufacturing, water and sanitation, agriculture, housing, transport), and coordinating. For example, the use of clean fuels for cooking reduces acute respiratory infections, chronic respiratory diseases, cardiovascular diseases and burns. Therefore acting across sectors will be necessary.

More specifically, attention should be drawn to:

• Cities. By 2050, 66% of the world’s population will be living in cities, and thoughtful planning and management is needed, since they are often characterized by heavy traffic, pollution, poor housing, limited access to safe water and sanitation services, and other health risks.
• The workplace. In a number of countries at least two thirds of workers are employed in dangerous, dirty and demeaning working conditions.
• Climate change and ecosystem change. These also need to be tackled urgently as they are set to become the most challenging risks populations will face in the coming decades.

What link can be made between actions to prevent environmental disease and the Sustainable Development Goals (SDGs) of the United Nations?

Environment-health interventions are based exactly on the SDGs principles and, as evidenced in this report, can make a significant contribution towards achieving the SDGs and improving life and health for all.

Within the 17 Sustainable Development Goals (SDGs), adopted by heads of state at the UN General Assembly in September 2015, there are clear health-related targets, but these sit alongside environmental and other sectoral areas that also strongly influence determinants of health.