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The Environmental Risk Transition

The Environmental Risk Transition. comes before the Epidemiologic Transition which comes before the Demographic Transition. Traditional Diseases, e.g. infectious. Modern, e.g. non-communicable. Non-transitional, e.g., injuries. The Environmental Risk Transition. Traditional Risk.

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The Environmental Risk Transition

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  1. The Environmental Risk Transition comes before the Epidemiologic Transition which comes before the Demographic Transition

  2. Traditional Diseases, e.g. infectious Modern, e.g. non-communicable Non-transitional, e.g., injuries

  3. The Environmental Risk Transition Traditional Risk Risk Development

  4. The Environmental Risk Transition Traditional Risk Risk Modern Risk Development

  5. Smoking and Lung Cancer in Brazil 20-30 year time lag Cigarettes/adult Male Lung Cancer 1980 1940

  6. The Environmental Risk Transition Traditional Risk Risk Modern Risk Risk Overlap Development

  7. The Risk Overlap • Risk Genesis: new types of risk created • Risk Transfer: attempts to control one type can make other types worse • Risk Synergism: risk of one type changes sensitivity to other risks

  8. The Kuznets Curve Inequity Increasing Wealth Simon Kuznets, Nobel Economist, writing about 1960

  9. The Kuznets Environmental Curve Pollution Increasing Wealth

  10. The Environmental Kuznets Curve Urban Air Pollution and Development

  11. The Environmental Risk Transition Household Sanitation Urban Pollution Severity Increasing Wealth Shifting Environmental Burdens Local Community Immediate Delayed Risks to Human Health Risks to Life Support Systems

  12. The Full Environmental Risk Transition Household Sanitation Urban Pollution Severity Greenhouse- gas emissions Increasing Wealth Shifting Environmental Burdens Local Global Immediate Delayed Risks to Human Health Risks to Life Support Systems

  13. How Much Ill-Health can be Attributed to Environmental Factors?

  14. Almost 10% of the Entire Global Burden of Disease is Due to 3 Environmental Diseases inJust 2 Regions Source: World Health Report, 2001

  15. How Much Ill-Health can be Attributed to Environmental Factors? • What do we mean by “ill-health?” • What do we mean by “environmental?” • What do we mean by “attributed?”

  16. Ill-Heath? Lost healthy life years - DALY As tabulated in the Global Burden of Disease

  17. Environment? • Everything • Non-Genetic • And Non-Behavioral • And Non-Social • And Non-Natural

  18. Natural Environmental Hazards • Constant search for sufficient food and water while avoiding natural toxins • Infections and parasites that spread from person to person or animal to person • Dust, damp, woodsmoke, pollen, and other airborne hazards • Injuries from falls, fires, and animals • Heat, cold, rain, snow, wind, natural disasters, and other adverse conditions

  19. Environmental Factor? • Everything • Non-genetic • Non-Behavioral • Non-Social • Non-Natural • Everything non-genetic, not behavioral, non-social, non-natural, where there is a measurable physical, chemical, or biological agent passing through environmental pathways to reach humans

  20. Attributable Risk? • The amount of ill-health that would not exist today if the exposure to the risk factor had not occurred in the past. • Assumes all other risk factors remain constant • Counter-factual level important, i.e., what lower exposure level would have been possible?

  21. Characteristics of Attributable Risk • All attributable risks for a disease often add up to much more than 100% • Size of attributable risk for a particular risk factor depends on order that different factors are examined • Presumes the existence of a feasible intervention to lower exposure.

  22. How attributable risks can add to more than 100%

  23. Attributable Risks Malnutrition 35% Better Housing 40% Breastfeeding 10% 3 million ARI Deaths in Children Under 5 Diarrhea 20% Air Pollution 30% Measles 10% Case-management 65% Vaccines 25% Rough estimates only

  24. General Principles of EBD Determination • Environmental control is a viable intervention • Environmental control taken first, i.e., prevention is emphasized • As with nutrition, recovery from all diseases/injuries can be delayed by poor environment. (5% minimum for all diseases)

  25. Exclusions • Genetic risk factors • Diet, but do include food additives and contamination • Active smoking, but do include passive smoking • Sexual behavior, alcohol, drug abuse, and criminal violence

  26. Inclusions • All workplace injuries/diseases, including those in the military • Household, community, and larger-scale behavioral factors related to hygiene • Road accidents, falls, drownings • “Housing complex,” = combination of crowding/ventilation/chilling/drainage • “Natural” disasters

  27. Environmental Burden of Disease = 25-40% of total Environmental Brden of Disease Percent of Total

  28. Thank you

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