| Popis: |
Seminal studies commissioned by The World Bank in the 1990s to quantify the health of populations and the burden of disease globally and regionally led to multiple approaches to assess how much the modifiable environment contributes to the disease burden. The two major methodological approaches are (1) exposure-based methods and (2) expert opinion-based methods. In exposure-based methods the relationships between exposure and response to specific risk factors are defined through epidemiologic studies and the estimated attributable fractions are used to generate disease burden expressed quantitatively. Disability-Adjusted Life Years (DALYs), a composite measure of morbidity and mortality associated with risk factors, has become a universal index of disease burden. Expert opinion-based methods rely on systematic literature reviews and surveys of experts across disciplines and geopolitical regions, who are asked to judge which fraction of the total burden of disease can be attributed to a specific factor. While global burden of disease quantifies the amount of disease due to specific causes, global Environmental burden of disease (EBD) estimates which fraction of the total burden of disease can be attributed to environmental risks. Studies based on both methods have revealed considerable disparities across regions and countries in the EBD, ranging in African countries from one-tenth to more than half of the total attributable burden of disease that can be prevented through improving environmental quality. These differences are not only caused by actual dissimilarities in underlying environmental quality, but also by differences in calculation approaches and assumptions made. |
