Environmental Health and Child Survival: Epidemiology, Economics, Experiences

As the developing world industrializes, it is likely to experience an epidemiologic transition not unlike what has occurred in the United States and other countries in the developed world, with increasing prevalence and incidence of chronic conditions such as asthma and neurodevelopmental disorders. Environmental prevention has been proven to reduce childhood morbidity, yet interventions to abate environmental hazards can be quite costly. Economic data on the costs of these conditions— and the failure to prevent them, which is ultimately borne by society— may persuade policy makers that the benefits of proactive reductions in toxic environmental exposures are worth the investment. It is within this context that the Environmental Health Anchor Program of the World Bank has developed analyses that document the burden of environmentally mediated diseases in developing countries. These analyses build on groundbreaking work by the World Health Organization (WHO) to estimate the global-and country-specific burden of disease that can be attributed to environmental factors. The authors quantify the economic costs that can be attributed to a subset of the environmental factors that the WHO has analyzed—urban air pollution, indoor air pollution, and water sanitation/hygiene. They also quantify direct and malnutrition-mediated health consequences of poor water, inadequate sanitation, improper personal/household hygiene, and inadequate water resource management. The World Bank team compiled data for Ghana and Pakistan as two illustrative examples, quantifying mortality from pneumonia/acute lower respiratory illness, diarrhea, and malaria as well as prevalence data for diarrhea and malnutrition. They then applied WHO environmentally attributable fractions for these conditions, and applied a human capital approach to quantify lost wages that result from environmental risk factors. Although past studies have assessed the direct impact of these factors, this project also examines indirect consequences of increased malnutrition due to environmental factors—an underrecognized yet significant burden on society that had not yet been incorporated. The direct and indirect costs associated with environmental risk factors in Ghana and Pakistan are 9.3% and 8.8%, respectively, of these countries' gross domestic product (GDP). The authors estimated that 35,702 deaths in Ghana and another 187,429 in Pakistan annually can be attributed to environmental risk factors for the health problems studied. Adding educationally derived lost income (> US$400 million in Ghana and > US$5.2 billion in Pakistan annually), the annual costs of these environmental risk factors total US$1.0 billion in Ghana and US$9.9 billion in Pakistan. These costs are representative of their WHO regions, and were chosen …