Environmental factors significantly impact human health, both directly and indirectly. Approximately one-quarter of the global disease burden and one-quarter of all deaths result from modifiable environmental factors (WHO 2006). It is essential to apply appropriate metrics, solid data, and careful analysis to make effective policy decisions aimed at reducing environmental stresses on human health. Policies that produce long-term health benefits require accurate and continuous tracking of all relevant environmental factors.
The inclusion of an independent Environmental Health policy category in the 2008 EPI aims to capture the effect that the environment has on quality of life globally. Reducing the environmental burden of disease is a globally recognized challenge that has been embedded in the MDGs through a variety of indicators, such as those relating to water supply, sanitation, and child mortality. However, the more complete and complex set of relationships between environmental stresses and human health has yet to be explored or combated within the realm of international policymaking. For example, the widespread and often lethal effects of indoor air pollution in developing countries have yet to be adequately addressed. Since evidence shows that environmental risk factors play a role in more than 80% of the diseases regularly reported (WHO 2006), improving environmental health should become a priority for policymakers globally.
Significant gaps exist in the data landscape for Environmental Health. Numerous factors contribute to this lack of data. First, environmental issues can affect human health through many different channels. Determining which factors are directly causal and which indirectly affect health is sometimes difficult. This complexity adds to the already challenging task of data collection, especially when country inclusion is a priority.
The second difficulty with Environmental Health measurement involves bridging the gap between exposure and health effects. Exposure to environmental factors does not automatically lead to consequences in human health, but the best environmental health metrics available are often measurements of environmental exposure. Empirical data on the connection between exposure and effect must be used to calculate the resulting Environmental Health impacts. Empirical connections to health aside, environmental exposure matters from a policy perspective. Exposure metrics can illustrate how a country values environmental health risks.
Compounding this problem of moving from exposure to effect is the fact that not all countries have adequate medical infrastructure. Thus, individuals exposed to environmental factors in one country may suffer greater health effects than those equally exposed in countries with more developed medical infrastructures. The ability to be properly treated for medical conditions can determine both the immediate health effects and the lasting predispositions to disease that an individual faces as a result of exposure to environmental risks. Therefore, it is not surprising that Environmental Health is correlated to wealth: those that have the resources to invest in a strong medical infrastructure will cope better with exposure to environmental stresses.
The 2008 EPI utilizes a number of different indicators to capture the yearly health burden of environmental degradation. We group these indicators according to three main environmental risk factors:- Environmental Burden of Disease,
- Water (access to adequate sanitation and drinking water), and
- Air Pollution (indoor, urban particulates, and local ozone).
Country profiles and datasets maintained by the World Health Organization (WHO) were instrumental in shaping the EH metrics.
An overwhelming majority of the frontrunners in the overall Environmental Health category are developed, industrialized nations. In general, many countries obtain high scores: more than half received scores above 80. However scores remain highly correlated with per capita income. Nonetheless, it is important to note that some industrialized countries do have high levels of outdoor air pollution and ozone in clustered urban areas.
Industrializing countries, such as China and India, fall within the lower ranking (98th and 107th, respectively). High rates of economic growth may cause these and similar countries’ rankings to shift significantly (either for the better or the worse) in future years. Countries receiving the lowest scores are Niger, Angola, the Democratic Republic of the Congo, Mali, and Burkina Faso.
Various elements contribute to poor environmental health, including political, social, economic, and infrastructural factors. Ultimately, this ranking shows that high standards of environmental health are achievable, as many countries have come extremely close to the target. The high correlation with per capita income also suggests that poorly performing countries may simply lack the resources, not the will, to provide for environmental health. Many aspects of environmental health, such as adequate sanitation, generally depend on governments providing infrastructure. The DALYs are also influenced by individual health care access. The generally high levels of performance in this category, with over 100 countries scoring above 80 on the DALYs, reflect policymakers’ commitment to allocate a large percentage of national resources for human health
