Relationship between Health MDGs and Environmental Health

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Attaining Health Millennium Development Goals (MDG) through Healthy Environment__________________________

Melvin B. Marzan, RNM Sc Tropical Medicine II

University of the East Ramon Magsaysay Medical CenterGraduate School

Section A: Millennium Development Goals (MDGs)_________________________

The 1990s: a decade of faltering progressprogress continued… but too slowly to reach agreed targets… and slowing down

Why the MDGs ?

Under-5 mortality rate Maternal mortality rate Child malnutrition Water and sanitation Income poverty Primary education

MDGs are meant to accelerate progress…

?What are the MDGs

? MDGs were set by all Government leaders at the UN Millennium Summit, September 2000)

? All UN organisations decided to be guided by MDGs in their future action: unity of purpose, coherent action, synergies and strategic approaches by the UN system as a whole (guided by CEB)

? Leaders pledged to strive, individually and collectively, towards these goals through international, regional and national action, concerted by the UN.

MDGs are a combination of…

Millennium Goals …– Emanate from UN Summits and Conferences of the 1990s…– … proposed in the UN Secretary-General’s Millennium Report: « We, the peoples: the role of the United Nations in the 21st century »

– … and endorsed in the United Nations Millennium Declaration (8 September 2000)

7 areas explicitly addressed in the Millennium Declaration:• Peace, security and disarmament• Development and poverty eradication• Protecting our common environment• Human rights, democracy and good governance• Protecting the vulnerable• Meeting the special needs of Africa• Strengthening the United Nations

MDGs are a combination of…

… and of International Development Goals (IDGs)

• For several of these key areas, specific indicators were included in the Millennium Declaration – constituting the international development goals (IDG)

• Subsequently, IDGs from other declarations were combined and harmonised with the IDGs set in the Millennium Declaration goals

• The resulting set of goals, numerical targets and quantifiable indicators to assess progress constitute the Millennium Development Goals…

• … presented in the SG’s “Road map towards the implementation of the United Nations Millennium Declaration” (September 2001)

Goal 1:Eradicate Extreme Poverty and Hunger

Goal 2: Achieve Universal Primary Education

Goal 3: Promote Gender Equality and Empower Women

Goal 4: Reduce Child Mortality

Goal 5: Improve Maternal Health

Goal 6: Combat HIV, Malaria and other diseases

Goal 7: Ensure Environmental Sustainability

Millennium Development Goals

Goal 4: Reduce Child Mortality

Goal 5: Improve Maternal Health

Goal 6: Combat HIV/AIDS, Malaria and other diseases

Health MDGs

Section B:Progressing Towards Health Related (MDGs) by means of Environmental Health_________________________

Environment in the Context of Health

In the medical sense, Environment includes the surroundings, conditions or influences that affect an organism (Davis, 1989)

“All of which is external to the human host. Can be divided into physical, biological, social, cultural, etc., any or all of which can influence health status of populations…”

-International Epidemiological Association (2001)

Definition of Environment

Environmental Health

MDGs Environmental Health Components

• Goal 4: Reduce Child Mortality– Mortality rate in children <5 yrs. from

environmentally-mediated disease conditions is 180 times higher in the poorest performing region, as compared to the rate in progressive countries

– In terms of diarrhea and lower respiratory infections, two of the most significant childhood killers, environmental interventions could prevent the deaths of over 2 million children under age of five every year

• Goal 5: Improve Maternal Health– Environmental Health interventions can

contribute to this MDG by providing a safe home environment, which is of great importance to the health of children and pregnant mothers. Conversely, a contaminated home environment is a threat to the mother and her unborn child.

• Goal 6: Combat HIV/AIDS, Malaria and Other Diseases– Results of the Study done by the WHO indicate

that over half a million people die every year from malaria and over a quarter of a million people die from HIV/AIDS, as a result of environmental and occupational cause. A large proportion of malaria, in particular, may be attributable to readily modifiable factors, such as land use, irrigation and agricultural practices.

Section C: MDG Goal 4 (Reduce Child Mortality)_________________________

Life expectancy

… is the average

lifespan a newborn can expect

… is short when

child deaths are common

20 000 $2000 $200 $Income per person (comparable dollars per year)

1Population(millions)

50 years

Burundi

81 years

Sweden

20 000 $2000 $200 $

Income per person (comparable dollars per year)

50 yearsBurundi

Burundi

C a n y o u g e t o l d i n B u r u n d i ?

200720 000 $2000 $200 $

50 years

Burundi

Burundi2007Burundi

200720 000 $

2000 $200 $ Income per person (comparable dollars per year)

50 years

Burundi

Burundi2007

Look at the expected life of five newbornBurundians…

SarahAnnJeanLizPierre

Burundi2007

…if conditions remain as in Burundi in 2007during their whole lifetime?

How long will they live…

Burundi2007 84

So yes, 2 of 5get old in Burundi

Burundi2007 84

This is the Life Expectancy

50 years

Calculate the mean…1+36+57+72+84

20 000 $2000 $200 $

Burundi

Burundi2007

50 years

81 yearsSweden

31 years

20 000 $2000 $200 $

81 yearsSwedenSweden

D o a l l S w e d e s l i v e 3 1 y e a r s l o n g e r

t h a n t h e B u r u n d i a n s ?

200720 000 $2000 $200 $

81 years

Look at the expected life of five newbornSwedes…

2007Sweden Sweden

SaraAntonJanLisaPer

How long will they live…

…if conditions remain as in Sweden in 2007during their whole lifetime?

2007Sweden

SaraAntonJanLisaPer

Sweden2007

6377 84 88

1 adult

SaraAntonJanLisaPer

Sweden2007

6377 84 88

63+77+84+88+935

81 years

Calculate the mean…

Sweden2007

1Population(millions)Li

)Sweden

81 years

20 000 $2000 $200 $

Let’s compareSweden

Burundi

20 000 $2000 $200 $

81 yearsSweden

50 yearsBurundi

200781

But “dying young” in Swedenis very different

from “dying young” in Burundi

So, no,

all Burundians do not live 31

years shorter than Swedes

“To live long” in Swedenis almost the same as

“to live long” in Burundi

Life expectancy… is an average

… is low when child-deaths are common

-Most Burundians get older than 50-Some die in childhood

-It is low in Burundi not because all die a bit earlier

-But because some die much younger

MDG Goal 4: Reduce Child MortalityMain Diseases Contributing to the Environmental Burden of

Disease, Among Children 0-14 Years

Facts:Children suffer a disproportionate share of

environmental health burden:

• Globally, the per capita number of healthy life years lost to environmental risk factors was about 5-fold greater in children under 5 years of age than in total population

• On Average, children in developing countries lost -8 times more healthy life years than their counterparts in developed countries.

• Although these statistics are alarming, they do not capture the longer-term effects of exposures that occur at a young age, but manifest themselves as disease until years after the exposure

Section D: MDG Goal 5 (Improve Maternal Mortality)_________________________

Basic Facts

Pregnant have increased vulnerability to anemia, vitamin deficiency, trachoma and hepatitis, all of which can lead to increased morbidity and mortality.

The provision of safe water for medical purposes to treat such illness can improve newborn and child health in addition to maternal health.

Currently, health centers providing maternal and delivery care can expose women to unsafe water, poor sanitation and poor management of medical waste: 15% of all maternal deaths are caused by infections in the 6 weeks after childbirth and have mainly been found to be due to unhygienic practices and poor infection control during labour and delivery.

Interventions:

Environmental Health interventions can contribute to this MDG by providing a safe home environment, which is of great importance to the health of children and pregnant mothers. Conversely, a contaminated home environment is a threat to the mother and her unborn child.

Section E: MDG Goal 6 (Combat HIV/AIDS, malaria and other diseases)_________________________

Basic Facts:

Tidbits:

Globally more than 1.5 million deaths annually from respiratory infections are attributable to the environment, including at least 42% of lower respiratory infections and 24% of upper respiratory infections in developing countries

Tidbits:

Globally, about 1.5 million deaths per year from diarrheal diseases are attributable to environmental factors, essentially water, sanitation and hygiene

Tidbits:

Environmental management of malaria can involve modification or manipulation of the environment, as well as of human habitation and behavior.

Tidbits:

Ascariasis, trichuriasis, hookworm disease, trachoma, schistosomiasis and chagas disease could largely be prevented through improved hygiene, water and sanitation, and housing

Tidbits:

Dengue and dengue hemorrhagic fevers could be entirely prevented by good management of water containers in and around houses.

Tidbits:

HIV epidemic may largely be driven by commercial sex activities. The impact of prevention that is targeted to certain occupational groups may therefore be more far reaching than simply improving workers’ health.

Tidbits:

Crowding, and certain home or workplace exposures to air pollutants, are environmental factors that increase the burden of disease from tuberculosis

Burden of Diseases

Impact:

Every year, there are over half a million deaths from worldwide and over a quarter of a million deaths from HIV/AIDS that are related to environmental and occupational causes. Targeted environmental interventions could reduce the impact of major diseases such as these and help to achieve the MDG. Environmental interventions could also reduce the number of deaths from diarrhea and lower respiratory infections by over 3 million each year. With the execution of HIV/AIDS, all of these diseases affect children in large number, and even HIV/AIDS can have a major indirect impact on the health of children.

Conclusion:

Providing sustainable sources of safe water and clean energy are key environmental interventions that contribute to MDG.

Nearly one quarter of the global disease burden is attributable to the modifiable environment

The environmental disease burden is not distributed evenly across the world, and some regions carry a disproportionately heavy burden for specific diseases.

Burden of Diseases

Children suffer a disproportionate share of the environmental health burden.

Interventions can be cost-effective and have benefits that go well beyond health, and contribute to the overall well-being of communities

REDUCING THE DISEASE BURDEN OF THE ENVIRONMENTAL RISK FACTORS WILL CONTRIBUTE SIGNIFICANTLY TO THE MILLENNIUM DEVELOPMENT GOALS.

THANK YOU…

References:• Alter MJ (1997). The epidemiology of acute and chronic hepatitis C. Clinics in Liver• Disease, 1(3):559—568, vi-vii.• André C, Platteau JP (1998). Land relations under unbearable stress: Rwanda caught in• the Malthusian trap. Journal of Economic Behavior and Organization, 34(1):1—47.• Anonymous (1994). HIV and STD prevalence among bus and truck drivers in Cameroon.• AIDS Analysis Africa, 4(5):2.• Anonymous (2004). Tuberculosis — the 3rd most frequent infectious disease for health• care personnel. Krankenpflege Journal, 42(1—2):15.• Antunes JL, Waldman EA (2001). The impact of AIDS, immigration and housing• overcrowding on tuberculosis deaths in Sao Paulo, Brazil, 1994—1998. Social Science• and Medicine, 52(7):1071—1080.• Appawu MA, Dadzie SK, Baffoe-Wilmot A, Wilson MD (2001). Lymphatic filariasis in• Ghana: entomological investigation of transmission dynamics and intensity in• communities served by irrigation systems in the upper east region of Ghana. Tropical• Medicine and International Health, 6(7):511—516.• Ault SK (1994). Environmental management: a re-emerging vector control strategy.• American Journal of Tropical Medicine and Hygiene, 50: 35—49.

Relationship between Health MDGs and Environmental Health

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