- At the top of the list is malnutrition, which, estimates reveal, is responsible for 11.7 percent of total deaths and 15.9 percent of total DALYs. In sub-Saharan Africa, however, it accounts for a staggering 33 percent of the global burden of disease; in India, 22 percent [153]. As described earlier, malnutrition is not an environmental problem per se but interacts strongly with environmental factors to cause disease.
- The combination of poor water supply, sanitation, and personal and domestic hygiene is the next biggest risk factor, accounting for 5.3 percent of total deaths and 6.8 percent of total DALYs. Like malnutrition, these factors in combination contribute to significantly more of the burden in the poorer regions; 10 percent in sub-Saharan Africa, 9.5 percent in India, and 8.8 percent in the Middle East [154].
- Outdoor air pollution accounts for 1.1 percent of total deaths and 0.5 percent of total DALYs, according to GBD estimates. In the developed regions, these numbers rise to 2.5 percent of deaths and 1.5 percent of DALYS, and in the former socialist economies, this factor climbs to 5.5 percent of all deaths and 3.1 percent of DALYs [155].
Using a different approach, the World Bank in 1993 calculated the total burden of disease that could be attributed to the household environment. The Bank defined household environmental problems to include crowding, lack of sanitation and garbage disposal, indoor air pollution, and vector-breeding grounds [156]. (See Disease Burden Associated with Poor Household Environments.)
Their conclusion: 30 percent, 20 percent of which could be averted by modest improvements in the household environment [157].Most recently, a 1997 study by WHO, Health and Environment in Sustainable Development, estimated the proportion of major disease categories that could be attributed to environmental factors. (The WHO study defines the environmental contribution as the specific fraction of disease occurrence that could be prevented through “feasible environmental interventions” [158].) WHO estimated that although virtually all cases have an environmental cause, 90 percent of diarrheal diseases could be averted through feasible environmental interventions [159]. The same study attributes the likely environmental contribution to malaria also at 90 percent, to ARI at 60 percent, and to cancer at 25 percent. All told, WHO estimates that environmental factors – which in their definition includes occupational exposures – account for 23 percent of the global burden of disease.
References and notes
153. Christopher J. L. Murray and Alan D. Lopez, eds., The Global Burden of Disease: Volume 1 (World Health Organization, Harvard School of Public Health, and The World Bank, Geneva, 1996), p. 312.
154. Christopher J. L. Murray and Alan D. Lopez, eds., The Global Burden of Disease: Volume 1 (World Health Organization, Harvard School of Public Health, and The World Bank, Geneva, 1996), p. 312.
155. Christopher J. L. Murray and Alan D. Lopez, eds., The Global Burden of Disease: Volume 1 (World Health Organization, Harvard School of Public Health, and The World Bank, Geneva, 1996), pp. 311, 315.
156. The World Bank, World Development Report 1993: Investing in Health (The World Bank, Washington, D.C., 1993), p. 90.
157. The World Bank, World Development Report 1993: Investing in Health (The World Bank, Washington, D.C., 1993), p. 90.
158. Christopher J. L. Murray and Alan D. Lopez, eds., The Global Burden of Disease: Volume 1 (World Health Organization, Harvard School of Public Health, and The World Bank, Geneva, 1996), p. 173.
159. Christopher J. L. Murray and Alan D. Lopez, eds., The Global Burden of Disease: Volume 1 (World Health Organization, Harvard School of Public Health, and The World Bank, Geneva, 1996), p. 173.
