We could save up to 13 million lives each year if we made the environment healthier. This is the startling insight gained from the first-ever country-by-country analysis on the environmental impact on health in 192 countries released by the World Health Organization (WHO) on 13 June 2007.

About one quarter of diseases worldwide is caused by preventable environmental factors that we are able to change, notes WHO. Household interventions could significantly reduce the death rate, according to the assessment, and these include using cleaner fuel like gas or electricity and better cooking devices, improving ventilation and modifying people's behaviour, for example, by keeping children away from smoke. "Solutions are available, and it is our international responsibility to promote the health and well-being of those affected, mostly women and children", said Susanne Weber-Mosdorf, WHO Assistant Director-General for Sustainable Development and Healthy Environments. "These country estimates are the first step towards assisting national decision-makers in the sectors of health and environment to set priorities for preventive action", she added.

The data, covering an eight-year period, show that human health could be improved by reducing environmental risks, such as pollution, occupational factors, ultraviolet radiation, agricultural methods and climate and ecosystem changes. In some countries, according to the analysis, more than one third of the disease burden could also be prevented by improving the environment. Indoor air pollution in 11 countries, including Afghanistan, Angola, Burkina Faso, Ethiopia, India, and the United Republic of Tanzania, contributes to a total of 1.2 million deaths per year, WHO states.

Kolkata, India. Photo courtesy of UNCCD/ © Asis Sanyal

The data further show that two environmental risks-unsafe water (including poor sanitation and hygiene) and indoor air pollution (from cooking with solid fuels, which is one of the ten most significant threats to public health) -contribute to more than 10 per cent of deaths in 23 countries worldwide. The analysis aims to provide guidance to countries to improve their own research on environmental health impact, country-by-country, and highlights possible areas of opportunities for disease prevention through improvement of the environment. "Disease prevention is, in many countries, not given the attention it deserves", said Dr. Annette Prüss-Üstün, a scientist at the WHO Public Health and the Environment Department, adding that African countries have the highest potential for disease prevention through healthier environment.

Africa: The population of Africa, compared to other regions, is more exposed to environmental risks, Dr. Lucien Manga from the Division of Healthy Environments and Sustainable Development of the WHO Regional Office for Africa told the UN Chronicle, adding that women and children in the region "are more affected by risk factors, such as unsafe water and sanitation or indoor air pollution". Citing an example of those living in rural areas, where solid fuel usage is beyond 80 per cent, Dr. Manga noted that women are more exposed than men to smoke from solid fuel due to the time they spend in cooking.

Children under five are the main victims, comprising 74 per cent of deaths due to diarrhoeal disease and lower respiratory infections, according to WHO. In rural areas in Africa, these children tend to spend more time with their mothers, thus disproportionately exposing them to the smoke from cooking. "These two groups, children particularly, are biologically more vulnerable, and they will be more severely affected by certain diseases, such as diarrhoea", Dr. Manga pointed out. With the support of local and international partners, as well as non-governmental organizations, African countries have made progress with their programmes on safe drinking water and water sanitation. "Kenya is successfully scaling up its programme on household water treatment and safe storage", he said. However, African countries are challenged with limited technical and financial capacities to establish and deliver strong programmes to prevent or mitigate environmental risks, noted Dr. Manga, adding that "in many African countries, staffing for policy-making and programme implementation are insufficient". Limited funding in Africa also needs to deal with issues like HIV/AIDS, malaria and tuberculosis. "We are helping countries to understand that their investment plans should be better balanced and that prevention is cheaper and more sustainable compared to cure", he emphasized.

Europe: The WHO analysis indicates that no country is immune from environmental impact on health, even in areas with better environmental conditions. Low-income countries suffer the most from environmental health factors, losing about 20 times more healthy years of life per person every year. "In high-income countries, the greatest environmental impacts are seen from non-communicable diseases, such as cardiovascular disease and cancer, which may be caused by air pollution, stress at work and carcinogens in the environment", Dr. Prüss-Üstün pointed out.

Copsa Mica, Romania. UN photo/ R.Marklin

Every year, more than 280,000 premature deaths are attributed to air pollution in the 25 countries of the European Union (EU), WHO estimates. There is a clear difference in environmental death rate within the region. "There is a remarkable difference in exposure and environment-related diseases between people of different social classes, which also resembles the difference observed in Europe between the western and eastern part of the region", Dr. Roberto Bertollini, Director of Special Programme on Health and Environment, WHO Regional Office for Europe, told the UN Chronicle. In some European countries, including the Baltic States that recently became EU members, death rates are twice as much as those in countries with better environmental conditions. "The implementation of existing legislation regarding air pollution in 25 EU countries would save about 80,000 out of a total of 280,000 deaths due to air pollution per year", Dr. Bertollini pointed out.

Asia: In the Western Pacific region, "inadequate water supply and sanitation, and indoor smoke from burning solid fuels, are often found in poor communities", said Dr. Hisashi Ogawa, Regional Advisor for Healthy Settings and Environment of the WHO Western Pacific Regional Office. Speaking of the WHO effort in improving the environmental condition, he told the UN Chronicle that the WHO Asia and the Pacific Office is supporting mostly developing countries in the region to develop and implement a national environmental health action plan. He explained: "NEHAP addresses not only water, sanitation and indoor air pollution problems, but also other issues, such as the management of toxic chemicals, solid and hazardous waste, urban air pollution, and climate change." Dr. Ogawa also informed that along with the United Nations Environment Programme (UNEP) and hosted by the Thai Government, WHO will hold its first Ministerial Regional Forum on Environment and Health in Southeast and East Asian countries in Bangkok in August 2007.

Note: For WHO country-by-country data and regional profiles on the environmental impact on health, please visit:
www.who.int/quantifying_ehimpacts/countryprofiles/en/index.html