Odile Mekel

Environmental burden of disease in Europe : assessing nine risk factors in six countries

Background: Environmental health effects vary considerably with regard to their severity, type of disease, and duration. Integrated measures of population health, such as environmental burden of disease (EBD), are useful for setting priorities in environmental health policies and research. This review is a summary of the full Environmental Burden of Disease in European countries (EBoDE) project report. Objectives: The EBoDE project was set up to provide assessments for nine environmental risk factors relevant in selected European countries (Belgium, Finland, France, Germany, Italy, and the Netherlands). Methods: Disability-adjusted life years (DALYs) were estimated for benzene, dioxins, secondhand smoke, formaldehyde, lead, traffic noise, ozone, particulate matter (PM2.5), and radon, using primarily World Health Organization data on burden of disease, (inter)national exposure data, and epidemiological or toxicological risk estimates. Results are presented here without discounting or age-weighting. Results: About 3–7% of the annual burden of disease in the participating countries is associated with the included environmental risk factors. Airborne particulate matter (diameter ≤ 2.5 μm; PM2.5) is the leading risk factor associated with 6,000–10,000 DALYs/year and 1 million people. Secondhand smoke, traffic noise (including road, rail, and air traffic noise), and radon had overlapping estimate ranges (600–1,200 DALYs/million people). Some of the EBD estimates, especially for dioxins and formaldehyde, contain substantial uncertainties that could be only partly quantified. However, overall ranking of the estimates seems relatively robust. Conclusions: With current methods and data, environmental burden of disease estimates support meaningful policy evaluation and resource allocation, including identification of susceptible groups and targets for efficient exposure reduction. International exposure monitoring standards would enhance data quality and improve comparability. Citation: Hänninen O, Knol AB, Jantunen M, Lim TA, Conrad A, Rappolder M, Carrer P, Fanetti AC, Kim R, Buekers J, Torfs R, Iavarone I, Classen T, Hornberg C, Mekel OC, EBoDE Working Group. 2014. Environmental burden of disease in Europe: assessing nine risk factors in six countries. Environ Health Perspect 122:439–446; http://dx.doi.org/10.1289/ehp.1206154

Towards health impact assessment of drinking-water privatization: the example of waterborne carcinogens in North Rhine-Westphalia (Germany)

Worldwide there is a tendency towards deregulation in many policy sectors - this, for example, includes liberalization and privatization of drinking-water management. However, concerns about the negative impacts this might have on human health call for prospective health impact assessment (HIA) on the management of drinking-water. On the basis of an established generic 10-step HIA procedure and on risk assessment methodology, this paper aims to produce quantitative estimates concerning health effects from increased exposure to carcinogens in drinking-water. Using data from North Rhine-Westphalia in Germany, probabilistic estimates of excess lifetime cancer risk, as well as estimates of additional cases of cancer from increased carcinogen exposure levels are presented. The results show how exposure to contaminants that are strictly within current limits could increase cancer risks and case-loads substantially. On the basis of the current analysis, we suggest that with uniform increases in pollutant levels, a single chemical (arsenic) is responsible for a large fraction of expected additional risk. The study also illustrates the uncertainty involved in predicting the health impacts of changes in water quality. Future analysis should include additional carcinogens, non-cancer risks including those due to microbial contamination, and the impacts of system failures and of illegal action, which may be increasingly likely to occur under changed management arrangements. If, in spite of concerns, water is privatized, it is particularly important to provide adequate surveillance of water quality.

Quantitative health impact assessment: taking stock and moving forward

Over the past years, application of health impact assessment has increased substantially, and there has been a strong growth of tools that allow quantification of health impacts for a range of health relevant policies. We review these developments, and conclude that further tool development is no longer a main priority, although several aspects need to be further developed, such as methods to assess impacts on health inequalities and to assess uncertainties. The main new challenges are, first, to conduct a comparative evaluation of different tools, and, second, to ensure the maintenance and continued availability of the toolkits including their data contents.

Assessment of population health risks of policies

Assessment of population health risks of policies / , Assessment of population health risks of policies / , کتابخانه دیجیتال جندی شاپور اهواز

Berücksichtigung von Variabilität und Unsicherheit in quantitativen Risikoabschätzungen (QRA)

ZusammenfassungAnhand des Anwendungsbeispiels einer bewohnten Altlast wird eine probabilistische Expositionsabschätzung durchgeführt und es werden Möglichkeiten aufgezeigt, Variabilität und Unsicherheit in der Schätzung separat zu erfassen. Zur Charakterisierung der Variabilität personenspezifischer Variablen (z.B. Körpergewicht) werden in das Expositionsmodell Wahrscheinlichkeitsverteilungen eingesetzt; die stoffspezifischen Expositionsparameter werden konstant gehalten. Zusätzlich wird die Ungewißheit einer ausgewählten Variablen (Bodeningestionsrate) modelliert. Der Vergleich mit denworst-case-Schätzungen zeigt, daß diese in den oberen Randbereichen bzw, außerhalb der Bereiche der probabilistischen Schätzung liegen und somit sehr konservative, u.U. unrealistische Schätzungen liefern.AbstractUsing the example of residential living on a contaminated site, a probabilistic exposure assessment is performed with variability and uncertainty being modelled separately. Probability distributions are used in the exposure model in order to characterize person-related variables (e.g. body weight) only; chemical-specific parameters are being held constant. In addition, uncertainty concerning one selected variable (soil ingestion rate) was modelled. Comparing these results to conventional “worst case” estimates, we find those estimates located in the uppermost range of the probabilistic estimates. The worst case estimates tend to be highly conservative and possibly unrealistic.

Top-Down Policy Risk Assessment

The primary aim of the Risk Assessment from Policy to Impact Dimension (RAPID) 2009–2012 EU project was to develop a methodological guidance for policy risk assessment. The main idea was that the systematic analysis of complex impact schemes requires the description of the “full chain” of causal pathways considering all levels of causality in an integrated manner. The analysis should proceed from the top to the bottom of the causal chain, i.e. from the cause, that is the policy, through health determinants and risk factors to the effect that are health outcomes. The top-down risk assessment approach follows a logical structure that can be readily applied in the risk appraisal phase of policy health impact assessments.

Quantification of Health Risks

Health, health determinants, and also the consequences of (ill) health: all these items imply considerable complexity. When trying to define and operationalize these concepts, especially in quantitative terms, difficulties emerge. Within the field of Public Health, correspondingly, both qualitative and quantitative approaches are established, and they are often used to complement each other.

Risk Assessment, Impact Assessment, and Evaluation

The European Union, first at the Treaty of Maastricht and more explicitly at the Amsterdam Treaty, declared that “a high level of health protection shall be ensured at the definition and implementation of all Community policies activities.” The strategy of “Health in All Policies” (HiAP), adopted at the Finnish European Union (EU) Council Presidency in 2006, has become increasingly important in Europe as governments realize that reducing inequalities and improving health are fundamental enablers for economic development. The second programme of Community action in the field of health (2008–2013) of the European Parliament and Council also calls “to support the mainstreaming of health objectives in all Community policies and activities.”

The feasibility of estimating the total environmental burden of disease due to cadmium: experiences of the VegAS project

Abstract Background Cadmium is associated with several human health effects. Exposure via ambient background air is far less significant than through the food chain. The question is whether current concentrations of cadmium in the air still pose a health threat in terms of attributable cases of lung cancer in Germany. The German VegAS project (long title: Distribution-based analysis of the health effect of environmental stressors) quantified the environmental burden of disease (EBD) of cadmium in ambient air. Methods A comprehensive review of the literature until early 2012 was done to identify cadmium-induced health outcomes and exposure–response functions. Evidence was checked using predefined criteria. National data sources for health and exposure information were consulted to estimate disability-adjusted life-years (DALYs) lost due to cadmium. The range of uncertainty by variation of uncertain parameters was described in detail. Findings DALYs of lung cancer due to inhalation of cadmium in ambient background air in Germany (0·2131 ng/m 3 ) were quantifiable and estimated at 7 DALYs lost (0·0087 DALYs per 100 000 population). Uncertainty analysis using various unit risk estimates yielded a maximum of 348 DALYs. Interpretation By quantifying the EBD of airborne cadmium and lung cancer, only a very small part of the total EBD due to cadmium is quantified. Still, looking only at this small fraction of possible EBD due to cadmium, up to 348 DALYs (range maximum) could be prevented if this toxic substance was reduced to zero. Evidence supports an association between exposure to cadmium and kidney damage; bone disease; and lung, kidney, and prostate cancer. However, incompatibility of data affecting all dimensions of exposure and the EBD model undercut most quantification for supporting a scientifically validated environmental health policy. Funding The VegAS project was funded by the Federal Ministry of Environment, Nature Conservation, and Nuclear Safety in context of the Environment Research Plan 2009. The corresponding author had full access to all the data in the study and final responsibility for the decision to submit for publication.

Bottom-Up Policy Risk Assessment

The top-down risk assessment that fits the classical HIA method and its application on policy was in depth presented in the previous chapter. Many public health experts find large policies difficult to assess as for their impact on health. People knowing health outcome and its societal burden well may find it easier to find proper policies starting from the bottom line—from health outcome. The use of complex causal process diagrams for analyzing health impacts of policy interventions was already described. The RAPID guidance based on bottom-up approach might be helpful to act more efficiently in reducing prevalence of health outcomes by identification and selection of proper policies for structural intervention. The health outcome was taken as a starting point and assessment through levels of risk factors and determinants of health lead to identification of policies needed to reduce burden of health outcome.