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Environment and development AL-BIA WAL-TANMIA Leading Arabic Environment Magazine

 
 
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PREVENTING DISEASE THROUGH HEALTHY ENVIRONMENT: ASSESSMENT OF THE BURDEN OF DISEASE FROM ENVIRONMENTAL RISKS IN ARAB COUNTRIES Mazen Malkawi and Basel Al-Yousfi
01/06/2017
The realization of how many diseases and illnesses can be prevented by focusing on the management of environmental risks adds impetus to efforts to encourage preventive health measures through all available policies, strategies, interventions, technologies and knowledge. This is generally true to sustain development in most countries of the world, but is more significant in Arab countries where environmental risks are higher and rates of development slower.
 
Sustainable development offers significant “win-win” scenarios for health, climate and the environment, and provides benefits almost immediately. The Sustainable Development Goals (SDGs), with their underpinning holistic approach, offer tangible opportunities to make a lasting contribution to reducing the global disease burden attributable to environmental risk factors, and help “ensure healthy lives and well-being for all at all ages”. Armed with the evidence of what is achievable, and needed, health-care policy-makers and public health practitioners alike are encouraged in their efforts to promote sustainable development through healthy societies.
 
 
The World Health Organization (WHO) estimated in 2016 that environmental degradation is causing more than 420,000 premature deaths in the Arab region, representing 20 percent (95 percent CI: 13–34 percent) of all deaths. When accounting for death and disability, the fraction of the global burden of disease due to the environmental risks is about 19 percent (95 percent CI: 13–32 percent), or in other words Arabs are losing approximately 24 million disability-adjusted life years (DALYs) annually due to environmental degradation. Unfortunately, the toll is notably higher when it comes to children under five years: up to 26 percent (95 percent CI: 16–38 percent) of all recorded deaths.
 
Arab countries differ greatly in terms of their socioeconomic, demographic, environmental, and health conditions; accordingly the toll of this burden varies across countries as shown in Figure B1.
 
The last decade has seen a shift away from infectious, parasitic and nutritional diseases to non-communicable diseases (NCDs) and injuries, not only in terms of the environmental fraction but also in the total burden. This shift is mainly due to a global decline in infectious disease prevalence rates and a reduction in the environmental risks triggering infectious diseases outbreaks, i.e., a higher share of people with access to safe water and improved sanitation, and a lower share of households using solid fuels for cooking. In terms of the total disease burden, NCDs have increased globally and to a large extent in most of Arab countries (see Figure B2).
 
 
Similar to other parts the world, the key diseases with the largest environmental fraction in Arab countries include: cardiovascular diseases, diarrheal diseases, lower respiratory infections, cancers, and unintentional injuries. Ambient and household air pollution, lack of access to water, sanitation and hygiene, exposure to wastes and harmful chemicals and road traffic accidents are the main environmental risk drivers of these disease groups.
 
Environmental exposures are one of the key determinants of health across the life course. The enormity of the environment-related burden of disease means that these exposures and related health risks cannot be addressed effectively if they are addressed separately. It is essential to adopt and implement an integrated “ecological public health approach” which recognizes the complex interactions between biological, behavioral, environmental, social and developmental factors. It is clear that reducing the environmental burden of death and disease is entirely possible through cost-effective interventions. However, to be most effective and sustainable these measures need to be designed and implemented holistically.
 
 
Environmental protection is a sound platform for good public, community and individual health. Many measures can be taken immediately to reduce the disease burden attributable to environmental determinants. Examples include the promotion of safer household water storage and better hygiene measures, the use of cleaner fuels and safer energy, more judicious use and management of toxic substances at home and in the workplace, and occupational health and safeguarding measures. Accordingly, in cooperation with the health sector, actions taken by the energy, transport, municipality, agriculture and industry sectors are vital to address the environmental root causes of ill health. Clearly, actions do not come from the public health sector alone, but rather from all sectors impacting environmental determinants of health. Acting collectively for coordinated health, environment and development policies will strengthen and sustain improvements to human well-being and quality of life via multiple social and economic co-benefits.
 
 
By 2050, 68 percent (646 million) of the Arab populations will live in urban areas that are often characterized by heavy traffic, polluted air, poor housing, limited access to water and sanitation services and other prominent environmental health risks, including those pertinent to the workplace (in 2014, 51 percent of the population was economically active and in a number of countries workers were employed in the informal sector with dangerous, dirty and demeaning working conditions). Repositioning the health sector to work more intersectorally on effective preventive health policies is the way forward to address environmental causes of disease and injury, and to ultimately curtail the global burden of disease.
 
Finally, the direct and indirect impacts of emerging environmental risks, such as climate change and ecosystems and biodiversity deterioration, need to be tackled urgently in the region, as they are set to become the most challenging risks Arab generations will face in the upcoming decades. Considering the high burden of modifiable environmental risk factors for communicable and noncommunicable diseases in the Arab region, and the availability of cost-effective environmental health interventions from prevention to mitigation to control, it is vital that a collaborative multidisciplinary approach is adopted, and that resources are made available to carry it out forward.
 
Note
1. Data extracted from “Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks”, Geneva, WHO 2016.
 
 
 
 
 
 
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