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Study: Environmental Exposures Linked to One-Third of Childhood Disease

GENEVA, Switzerland, - Globally, more than 33 percent of disease in children under the age of five is caused by environmental exposures, the World Health Organization WHO said in a sweeping report issued today. The lives of as many as four million children a year could be saved by preventing environmental risk, the world health body concludes. Taking children and adults together, as much as 24 percent of disease is caused by environmental exposures that could be averted by targeted interventions, the WHO report shows.

"The report issued today is a major contribution to ongoing efforts to better define the links between environment and health," said Dr. Anders Nordstrom, acting WHO director-general. "We have always known that the environment influences health very profoundly, but these estimates are the best to date."

The analysis breaks new ground in understanding the interactions between environment and health. WHO says it presents the best evidence available today on environmental links to health in 85 categories of disease and
injury.

"This will help us to demonstrate that wise investment to create a supportive environment can be a successful strategy in improving health and achieving development that is sustainable," Dr. Nordstrom said.

In Huamachuco, Chile schoolchildren, some wearing facemasks and gloves, help clean up a roadside wasteland area that has become an unofficial dump for household and industrial waste as part of an environmental health education
campaign. (Photo by Andy Crump courtesy WHO/TDR)

The report, "Preventing disease through healthy environments - towards an estimate of the environmental burden of disease," is the most comprehensive and systematic study yet undertaken on how preventable environmental hazards contribute to a wide range of diseases and injuries.

Surveys of over 100 experts worldwide and systematic review of literature went into the report, which identifies specific diseases impacted by certain well-known environmental hazards - and by how much.

The evidence shows that environmental risk factors play a role in more than 80 percent of the diseases regularly reported by the World Health Organization.

The four main diseases influenced by poor environments are diarrhea, the biggest killer; lower respiratory infections, the second most deadly; various forms of unintentional injuries not due to road traffic, and malaria.

More than 94 percent of deaths from diarrheal diseases, and 40 percent of deaths from malaria - two of the world's biggest childhood killers, could be prevented through better environmental management, the report indicates.

Two of the measures that WHO says could be taken now to reduce this environmental disease burden are water related - the promotion of safe household water storage and better hygienic measures as well as better water resource management.

The use of cleaner and safer fuels, increased safety of the built environment, more judicious use and management of toxic substances in the home and workplace are also recommended to prevent environmentally caused disease and injury.

The report estimates that more than 13 million deaths annually are due to preventable environmental causes. Nearly one third of death and disease in the least developed regions is due to environmental causes.

"For the first time, this new report shows how specific diseases and injuries are influenced by environmental risks and by how much," said Dr. Maria Neira, director of WHO's Department for Public Health and Environment. "In effect, we now have a hit list for problems we need to tackle most urgently in terms of health and the environment," she said.

To prevent malaria, a nurse is working with this pregnant woman at Kenya's Kilifi District Hospital. She will be given a medical examination, counselled about HIV/AIDS and given sulphadoxine/pyrimethamine tablets to combat any possible malaria infection, as well as a tetanus injection. (Photo by Andy Crump courtesy WHO/TDR) The report ranks diseases with the largest total annual health burden from environmental factors, in terms of death, illness and disability in terms of DALYs - Disability Adjusted Life Years.

DALYs are the sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability.

Diarrhea - 58 million DALYS per year; 94 percent of the diarrheal burden of disease largely from unsafe water, sanitation and hygiene Lower respiratory infections - 37 million DALYs per year; 41 percent of all cases globally largely from air pollution, indoor and outdoor.

Unintentional injuries other than road traffic injuries - 21 million DALYs per year; 44 percent of all cases globally, classification which includes a wide range of industrial and workplace accidents.

Malaria - 19 million DALYs per year; 42 percent of all cases globally, largely as a result of poor water resource, housing and land use management which fails to curb vector populations effectively.

Road traffic injuries - 15 million DALYS per year; 40 percent of all cases globally, largely as a result of poor urban design or poor environmental design of transport systems.

Chronic Obstructive Pulmonary disease COPD - a slowly progressing disease characterized by a gradual loss of lung function - 12 million DALYs per year; 42 percent of all cases globally largely as a result of exposures to workplace dusts and fumes and other forms of indoor and outdoor air pollution.

Perinatal conditions - 11 million DALYS per year; 11 percent of all cases globally.

Most of the same environmentally-triggered diseases also rank as the biggest killers outright - although they rank differently in order of lethality. Diseases with the largest absolute number of deaths annually from environmental factors that could be changed using available technologies, policies, preventive and public health measure are: 2.6 million deaths annually from cardiovascular diseases 1.7 million deaths annually from diarrheal diseases 1.5 million deaths annually from lower respiratory infections 1.4 million deaths annually from cancers 1.3 million deaths annually from chronic obstructive pulmonary disease 470,000 deaths annually from road traffic crashes 400,000 deaths annually from unintentional injuries Dr. Neira said the report shows the gains that could be made by public health and by the general environment with a series of "straightforward, coordinated investments."

The World Health Organization is calling on ministries of health, environment and other partners to work together to ensure that these environmental and public health gains become a reality.

To read the report and executive summary, "Preventing Disease Through
Healthy Environments: towards an estimate of the environmental burden of disease," click here http://www.who.int/quantifying_ehimpacts/publications/preventingdisease/en/i ndex.html

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