Improving People’s Health through Healthy Environments

1. Improving People’s Health through Healthy Environments 7th National Conference on Science, Policy and the Environment Washington, DC, 2 February 2007 Dr. Mirta Roses Periago Director

2. Why public health and environment?

3. Environment and huge health impacts: natural disasters • Hurricane Katrina • Tsunami in SE Asia

4. Environmental changes: second hits of disasters • Health systems are damaged, including hospitals and water and sanitation systems • Other infrastructure damages, including roads, electric power, disrupt health services operations • The overall effects may severely hamper employment, economy, food availability for years

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

6. Distribution of Environmental Risk Factors and Economic Development Transboundary Global Local Chemicals Outdoor Air Workplace Hazards Water Quality Adequate Sanitation Indoor Air Pollution Climate Change UV Radiation Ecosystem Change Environment & Health Damage High Mortality Developing Countries Low Mortality Developing Countries Developed Countries GNP

7. What is the evidence for public health and environment relationship?

8. How much disease could be prevented by modifying the environment? Current Evidence - Best Conservative Estimate 24% for World World average

9. Environmental Disease Burden in DALYs per 1000 People by WHO Subregion, 2002

10. Environmental Fraction Non-environmental Diseases with Largest Environmental Contributions Diarrhea Lower respiratory infections Other unintentional injuries Malaria Road traffic injuries COPD Perinatal conditions Ischaemic heart diseases Childhood cluster Lead-caused MMR Drownings HIV/AIDS 0 1% 2% 3% 4% 5% 6% % of Global Disease Burden in DALYs

11. Environmental Fraction Non-environmental Diseases with largest environmental contributions Malnutrition Cerebrovascular disease Asthma Tuberculosis Suicide Depression Poisonings Falls Hearing loss Violence Lymphatic filariasis Lung cancer 0 1% 2% 3% 4% 5% 6% % of Global Disease Burden in DALYs

12. Health Impact, by Gender: Indoor Air Pollution (IAP) and Chronic Obstructive Pulmonary Disease (COPD) Mortality, by WHO Subregion, 2002 World Health Report 2002: Reducing risks, promoting health life. WHO, Geneva 2002.

13. Main Diseases Contributing to the Environmental Burden of Disease among Children 0-14 Years, 2002 Other 19% Intestinal nematode infections 1.5% Drownings 2% Road traffic injuries 2% Malnutrition 4% Childhood cluster 5% Perinatal conditions 6% Neuropsychiatric disorders 6% Diarrhoeal diseases 29% Lower respiratory diseases 16% Malaria 10%

14. Summary of Health Assessments • Nearly one-fourth of disease burden is due to the environment • Over one-third in children of 0-14 years • 85 of 102 diseases (reported in the WHR) had environmental links • Marginalized populations and environmental disease burden: • 15 times more infectious diseases in developing than in developed countries • 2 times more injuries per capita in developing countries • 2-3 times more cancers and cardiovascular diseases in developed countries • Over 100 times more diarrheal and lower respiratory infections burden if comparing worst and best performing regions

15. What are the common grounds of public health and environment?

16. Health: A state of completephysical, mental, and social well-beingand not merely the absence of disease or infirmity (WHO, 1948) Environment: All that which is external to the human host. Can be divided intophysical, biological, social, cultural, etc., any or all of which can influence health status of populations (J. Last, Dictionary of Epidemiology)

17. Health and Environment Health Domain Environment Domain Health and Environment Domain

18. Structural Determinants Intermediate Determinants Health Outcomes Social Employment Education Violence Demographic change Poor Living Conditions Economic Income Level and Distribution Poverty Globalization Life Expectancy Morbidity Mortality Environmental Risks and Hazards Political Democratization Governance Transparency Accountability Legislation Human rights Health System Financing, Human and Material Resources, Coverage, Organization, Provision Environmental Resource depletion Climate change Vulnerability Pollution Life Style & Behavioral Changes Technological Information Access Innovation and Development Health and its Determinants: Interactions of Health and Environment Human Biology Genetic Make-up Natural Immunity E. Loyola/J. Canela/G. Fernández/C. Castillo-Salgado, 2006

19. Agenda 21 adopted at the United Nations Conference on Environment and Development (Rio de Janeiro, 1992) Millennium Development Goals (2000) Plan of Implementation of the World Summit on Sustainable Development (Johannesburg, 2002) Regional inter-Ministerial processes on environment and health (i.e., Budapest, 2004 and Mar del Plata Ministerial Declaration, 2005) Mandate International Policy Framework for Action

20. Promote primary prevention, health promotion and reduction of environmental hazards to improve public health. WHO/PAHO Mission

21. We have the vision, the evidence, and the strategy.

22. Goal 1: Eradicate Extreme Poverty and Hunger Many environmentally-caused diseases generate lost earnings; malnutrition is 50% attributable to the environment. Goal 2: Achieve Universal Primary Education Providing clean water and sanitation encourage school attendance (especially for girls) and freed time for water and fuel collection could be spent for education. Better education improves employment opportunities and use of information and knowledge. Goal 3: Promote Gender Equality and Empower Women Similarly to goal 2, women generally are the ones collecting water and solid fuels, and looking after children that are sick. Time could be freed for income generation and improving the nutritional standard and health of the family. Environment and MDG Achievement (1)

23. Goal 4: Reduce the Child Mortality The environment is an important contributor to the main diseases affecting children in developing countries, with 180-fold difference between worst and best performing regions. Goal 6: Combat HIV/AIDS, Malaria, and Other Diseases Over half a million environmentally preventable deaths from malaria, over quarter from occupation-related HIV/AIDS; 3 million deaths each year from lower respiratory infections and diarrhea. Goal 7: Ensure Environmental Sustainability Providing sustainable sources of water and clean energy would not only save many lives but also greatly contribute to a sustainable environment. Environment and MDG Achievement (2)

24. Provide health leadership on international environment policy Provide norms, standards, guidelines; evidence and global monitoring Promote healthy public polices Reinvigorate leadership in risk assessment and management Focus attention on priority hazards Strategic Directions (1)

25. Provide “promoting and preventive health" perspective New health sector emphasis on “promotion and preventive actions" addressing environmental risks to health 4 . Focus action through integrated, healthy settings approaches Mobilize local awareness and support through action in communities, homes, markets, workplaces and schools…. Strategic Directions (2)

26. Focus on people, local development and actions upon the social determinants Faces and Places project Prepare for, and respond to, environmental emergencies and disasters Natural and anthropogenic man-made events Strategic Directions (3)

27. Identify and respond to emerging threats Energy and health (radiation and electromagnetic fields) transportation and health (air pollution, traffic accidents, hazardous materials) Intersectoral concerted approach Engage stakeholders and diverse interested parties Community participation in decision-making Strategic Directions (4)

28. Misconceptions About Health & Environment • Environment is a luxury, it is for developed countries • Highest in developing countries • e.g. >30% of Africa's disease 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 • Only increasing GNP will reduce the environmental disease • 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

29. Millions of families in the world exist – or struggle to survive – in wretched, overcrowded and unsafe slums, shacks, tents, ghettoes and settlements. They are exposed to harsh weather. Rats and insects bring diseases to their homes. Poor ventilation, little light and the need for constant repair aggravate the tragedy. These conditions are especially oppressive for children – their bodies, their growth and development and their dreams. They live with no clean water, decent sanitation or basic services that many in the world enjoy daily and take for granted. Yet they are our fellow human beings, a precious human capital, and we have the mission to reduce the environmental hazards they face in order to improve their health. Thank you Dr. Mirta Roses Periago PAHO’s Director