How much disease burden can be prevented by environmental interventions?

Abstract

There is very little systematically collected evidence on the overall contribution of environmental risk factors to the global burden of disease. The World Health Organization (WHO) recently completed a comprehensive, systematic, and transparent estimate of the disease burden attributable to the environment highlighting the full potential for environmental interventions to improve human health. This report is the result of a systematic literature review on environmental risks completed by a survey of expert opinion using a variant of the Delphi method. More than 100 experts provided quantitative estimates on the fractions of 85 diseases attributable to the environment. They were asked to consider only the contributions of the "reasonably modifiable environment"-that is, the part of environment that can plausibly be changed by existing interventions. The report estimates that 24% of the global burden of disease was due to environmental risk factors. Environmental factors were judged to play a role in 85 of the 102 diseases taken into account. Major diseases were, for example, diarrheal diseases with fractions attributable to the environment of 94%, lower respiratory infections with 41%, malaria with 42%, and unintentional injuries with 42%. The evidence shows that a large proportion of this "environmental disease burden" could be averted by existing cost-effective interventions such as clean water, clean air, and basic safety measures. In children, 34% of the disease burden is attributable to the environment, and much of this burden is in developing countries.