Tuesday, June 28, 2011

[EQ] Systematic Review of Environmental Burden of Disease in Canada

Systematic Review of Environmental Burden of Disease in Canada

National Collaborating Centre for Environmental Health

Vancouver, BC Canada – 2010

Available online PDF [68p.] at: http://bit.ly/lPhvXB

“…..Potentially preventable illnesses and deaths resulting from exposure to environmental contaminants have been estimated to account for approximately $3.6 to $9.1 billion dollars in annual health care costs in Canada (Boyd and Genuis 2008). These statistics are driven by several primary disease categories (e.g., cardiovascular and respiratory diseases) that may be caused or exacerbated by population exposures to different environmental contaminants (e.g., indoor and outdoor air pollution, lead).

Concerns have also been raised about environmental exposures and potential adverse pregnancy outcomes and childhood diseases in Canada, as well as the economic and social costs attributable to the environmental burden of childhood diseases (Bérubé 2007). According to a recently published report from the United States President’s Cancer Panel, scientific evidence on individual and multiple environmental exposure effects on disease initiation and outcomes, and consequent health system and societal costs, are not being adequately integrated into national policy decisions and strategies for disease prevention, health care access, and health system reform (DHHS 2010).

The concept that the world's disease burden is attributable to a range of environmental and other (e.g., lifestyle, occupational) risk factors has been recognized for many years. Some of the earliest efforts to link specific risk factors, particularly environmental risk factors, to health outcomes initially focused on cancer as an endpoint.

A landmark study by Doll and Peto (1981) estimated the percentage of avoidable cancer deaths in the United States attributable to lifestyle and environmental factors, representing one of the first attempts to quantify the relationship between risk factors and health outcomes. Since then, a number of studies have been conducted (particularly during the 1990s) that have attempted to quantify the burden of disease globally and for different regions or countries.

Specifically, these studies describe public health (mortality and/or morbidity) in terms of disease burden for various categories of disease (e.g., cancer, heart disease, injuries) and risk factors. Most of these studies were not focused on environmental risk factors, however, with the exception of possible environmental pollution in developing countries.

The widely cited Global Burden of Disease (GBD) study was one of the first global efforts of this kind, which evaluated premature mortality and disability from a large number of diseases and injuries due to a variety of population exposures (Murray and Lopez 1996). Health outcomes included in the 1990 GBD study were attributed to eight major risk factors (few of which were specifically related to the environment): malnutrition, poor water sanitation/personal hygiene, unsafe sex, alcohol, occupation, tobacco, hypertension, and physical activity.

A subsequent 2001 GBD study targeted a greater number of risk factors, including several specifically related to environmental exposures (e.g., unsafe water, sanitation, and hygiene; urban air pollution, indoor smoke from household use of solid fuels) (Lopez et al. 2006a).

Because historical burden of disease assessments typically did not address issues specific to environmental health, additional studies have attempted to identify and quantify the environmental burden of disease (EBD) globally and for different countries or regions. These studies have generally been based on or build off of the historical burden of disease approach, and include many different definitions of the environment. The current recommended framework for EBD studies is based on a causal web structure that links environmental hazards and risk factors to disease burden……….”


1.0 Introduction

2.0 Methods

3.0 Background Information

3.1 Original Burden of Disease Studies

3.2 Methodological Approaches to Estimating EBD

4.0 Results

4.1 Global, Regional, and National EBD Studies

4.1.1 Global/Regional EBD Studies

4.1.2 EBD Studies Conducted in the United States

4.1.3 EBD Studies Conducted in Europe

4.2 Canada-Specific EBD Studies

4.2.1 Canadian EBD Studies

4.2.2 Studies Conducted in Canada Related to Specific Environmental Risk Factors and/or Health Outcomes

4.2.3 Other Programs and Workshops in Canada Related to Health and the Environment

5.0 Discussion

5.1 Data Gaps and Research Needs

5.2 Recommendations

6.0 References and Bibliography

*Production of this report has been made possible through a financial contribution from
the Public Health Agency of Canada through the National Collaborating Centre for Environmental Health.

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