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1.
Global Health ; 15(1): 65, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31847867

RESUMO

BACKGROUND: The circular economy framework for human production and consumption is an alternative to the traditional, linear concept of 'take, make, and dispose'. Circular economy (CE) principles comprise of 'design out waste and pollution', 'retain products and materials in use', and 'regenerate natural systems'. This commentary considers the risks and opportunities of the CE for low- and middle-income countries (LMICs) in the context of the Sustainable Development Goals (SDGs), acknowledging that LMICs must identify their own opportunities, while recognising the potential positive and negative environmental health impacts. MAIN BODY: The implementation of the CE in LMICs is mostly undertaken informally, driven by poverty and unemployment. Activities being employed towards extracting value from waste in LMICs are imposing environmental health risks including exposure to hazardous and toxic working environments, emissions and materials, and infectious diseases. The CE has the potential to aid towards the achievement of the SDGs, in particular SDG 12 (Responsible Consumption and Production) and SDG 11 (Sustainable Cities and Communities). However, since SDG 3 (Good Health and Well-Being) is critical in the pursuit of all SDGs, the negative implications of the CE should be well understood and addressed. We call on policy makers, industry, the health sector, and health-determining sectors to address these issues by defining mechanisms to protect vulnerable populations from the negative health impacts that may arise in LMICs as these countries domesticate the CE. CONCLUSION: Striving towards a better understanding of risks should not undermine support for the CE, which requires the full agency of the public and policy communities to realise the potential to accelerate LMICs towards sustainable production and consumption, with positive synergies for several SDGs.


Assuntos
Países em Desenvolvimento , Saúde Ambiental/economia , Humanos , Desenvolvimento Sustentável
2.
Rev Environ Health ; 34(2): 171-186, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-30990788

RESUMO

In developing countries, one of the most severe modern-day dilemmas is the management of industrial wastewater. In these countries, industrial wastewater effluents are directly discharged into the natural drain, a sewer system, an internal septic tank or a nearby field. Some of these industrial wastewater effluents are inadequately treated or untreated before being discharged. In recent years, in developing countries, urbanization and industrial activities have led to environmental deterioration. This paper was designed to review the health and environmental impacts of inadequately treated or untreated industrial wastewater effluents in Pakistan. The quality of industrial wastewater effluents is responsible for the degradation of the receiving water bodies. This is due to the reason that inadequately treated or untreated industrial wastewater effluents may cause eutrophication in the receiving water bodies and also form a favorable condition for toxin-producing waterborne pathogens. In order to comply with the wastewater guidelines and legislations, there is a need for proper treatment before discharge. In order to minimize the risk to the environment and public health, there is a need for proper treatment processes for industrial wastewater effluents. To achieve unpolluted discharge of industrial wastewater into the receiving water bodies, regular monitoring, proper and suitable treatment, careful planning and appropriate legislation are recommended.


Assuntos
Saúde Ambiental , Monitoramento Ambiental , Resíduos Industriais/efeitos adversos , Águas Residuárias/análise , Poluentes Químicos da Água/efeitos adversos , Saúde Ambiental/economia , Saúde Ambiental/legislação & jurisprudência , Saúde Ambiental/estatística & dados numéricos , Eutrofização , Humanos , Resíduos Industriais/análise , Paquistão , Eliminação de Resíduos Líquidos , Águas Residuárias/legislação & jurisprudência , Poluentes Químicos da Água/análise
3.
Environ Int ; 115: 220-229, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29604538

RESUMO

Economic impact assessments of air pollution-related health effects from a sectoral perspective in China is still deficient. This study evaluates the PM2.5 pollution-related health impacts of the road transport sector on China's economy at both national and provincial levels in 2030 under various air mitigation technologies scenarios. Health impacts are estimated using an integrated approach that combines the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) model, a computable general equilibrium (CGE) model and a health model. Results show that at a national level, the road transport sector leads to 163.64 thousand deaths per year, increases the per capita risk of morbidity by 0.37% and accounts for 1.43 billion Yuan in health care expenditures. We estimate 442.90 billion Yuan of the value of statistical life loss and 2.09 h/capita of work time loss in 2015. Without additional control measures, air pollution related to the transport sector will cause 177.50 thousand deaths in 2030, a 0.40% per capita increase in the risk of morbidity, accounting for 4.12 billion Yuan in health care expenditures, 737.15 billion Yuan of statistical life loss and 2.23 h/capita of work time loss. Based on our model, implementing the most strict control strategy scenario would decrease mortality by 42.14%, morbidity risk by 42.14%, health care expenditures by 41.94%, statistical life loss by 26.22% and hours of work time loss by 42.65%, comparing with the no control measure scenario. In addition, PM2.5 pollution from the road transport sector will cause 0.68% GDP loss in 2030. At a provincial level, GDP losses in 14 out of 30 provinces far exceed the national rate. Henan (1.20%), Sichuan (1.07%), Chongqing (0.99%), Hubei (0.94%), and Shandong (0.90%) would experience the highest GDP loss in 2030. Implementing control strategies to reduce PM2.5 pollution in the road transport sector could bring positive benefits in half of the Chinese provinces especially in provinces that suffer greater health impacts from the road transport sector (such as Henan and Sichuan).


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Saúde Ambiental , Veículos Automotores , Material Particulado , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/economia , China , Saúde Ambiental/economia , Saúde Ambiental/estatística & dados numéricos , Humanos , Morbidade , Material Particulado/análise , Material Particulado/economia , Transportes
4.
Ecohealth ; 15(1): 209-227, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29330676

RESUMO

Having gained momentum in the last decade, the One Health initiative promotes a holistic approach to address complex global health issues. Before recommending its adoption to stakeholders, however, it is paramount to first compile quantitative evidence of the benefit of such an approach. The aim of this scoping review was to identify and summarize primary research that describes monetary and non-monetary outcomes following adoption of a One Health approach. An extensive literature search yielded a total of 42,167 references, of which 85 were included in the final analysis. The top two biotic health issues addressed in these studies were rabies and malaria; the top abiotic health issue was air pollution. Most studies described collaborations between human and animal (n = 42), or human and environmental disciplines (n = 41); commonly reported interventions included vector control and animal vaccination. Monetary outcomes were commonly expressed as cost-benefit or cost-utility ratios; non-monetary outcomes were described using disease frequency or disease burden measurements. The majority of the studies reported positive or partially positive outcomes. This paper illustrates the variety of health challenges that can be addressed using a One Health approach, and provides tangible quantitative measures that can be used to evaluate future implementations of the One Health approach.


Assuntos
Saúde Ambiental/organização & administração , Saúde Única , Pesquisa/organização & administração , Saúde Ambiental/economia , Saúde Ambiental/normas , Prática Clínica Baseada em Evidências , Relações Interprofissionais , Pesquisa/normas
5.
Lancet ; 391(10119): 462-512, 2018 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-29056410
6.
Environ Health ; 16(1): 123, 2017 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-29202828

RESUMO

Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal criteria, and is hampered by gaps in environmental exposure data, especially from industrializing countries. For these reasons, a recently calculated environmental BoD of 5.18% of the total DALYs is likely underestimated. We combined and extended cost calculations for exposures to environmental chemicals, including neurotoxicants, air pollution, and endocrine disrupting chemicals, where sufficient data were available to determine dose-dependent adverse effects. Environmental exposure information allowed cost estimates for the U.S. and the EU, for OECD countries, though less comprehensive for industrializing countries. As a complement to these health economic estimations, we used attributable risk valuations from expert elicitations to as a third approach to assessing the environmental BoD. For comparison of the different estimates, we used country-specific monetary values of each DALY. The main limitation of DALY calculations is that they are available for few environmental chemicals and primarily based on mortality and impact and duration of clinical morbidity, while less serious conditions are mostly disregarded. Our economic estimates based on available exposure information and dose-response data on environmental risk factors need to be seen in conjunction with other assessments of the total cost for these environmental risk factors, as our estimate overlaps only slightly with the previously estimated environmental DALY costs and crude calculations relying on attributable risks for environmental risk factors. The three approaches complement one another and suggest that environmental chemical exposures contribute costs that may exceed 10% of the global domestic product and that current DALY calculations substantially underestimate the economic costs associated with preventable environmental risk factors. By including toxicological and epidemiological information and data on exposure distributions, more representative results can be obtained from utilizing health economic analyses of the adverse effects associated with environmental chemicals.


Assuntos
Exposição Ambiental/efeitos adversos , Saúde Ambiental/economia , Poluentes Ambientais/toxicidade , Poluição do Ar/efeitos adversos , Efeitos Psicossociais da Doença , Disruptores Endócrinos/toxicidade , Exposição Ambiental/economia , Poluentes Ambientais/economia , Humanos
7.
Artigo em Inglês | MEDLINE | ID: mdl-28858270

RESUMO

An economic analysis of housing's linkages to health can assist policy makers and researchers to make better decisions about which housing interventions and policies are the most cost-beneficial. The challenge is to include cobenefits. The adoption in 2015 of the UN Sustainable Development Goals underscores the importance of understanding how policies interact, and the merit of comprehensively evaluating cobenefits. We explain our approach to the empirical assessment of such cobenefits in the housing and health context, and consider lessons from empirical economic appraisals of the impact of housing on health outcomes. Critical assumptions relating to cobenefits are explicitly examined. A key finding is that when wider policy outcome measures are included, such as mental health impacts and carbon emission reductions, it is important that effects of assumptions on outcomes are considered. Another is that differing values underlie appraisal, for example, the weight given to future generations through the discount rate. Cost-benefit analyses (CBAs) can better facilitate meaningful debate when they are based on explicit assumptions about values. In short, the insights drawn from an economic framework for housing-and-health studies are valuable, but nonetheless contingent. Given that housing interventions typically have both health and other cobenefits, and incorporate social value judgements, it is important to take a broad view but be explicit about how such interventions are assessed.


Assuntos
Análise Custo-Benefício , Saúde Ambiental , Habitação , Saúde Mental , Saúde Ambiental/economia , Habitação/economia , Humanos , Saúde Mental/economia , Nova Zelândia , Emissões de Veículos/análise
8.
Trends Biotechnol ; 35(12): 1119-1121, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28890138

RESUMO

Fulfilling the promise of marine biotechnology as a source for environmental and biomedical applications remains challenging. New technologies will be necessary to harness marine biodiversity, and collaboration across government, academic, and private sectors will be crucial to create mechanisms of technology transfer and promote the development of new marine biotechnology companies.


Assuntos
Biodiversidade , Biotecnologia/economia , Biotecnologia/tendências , Países em Desenvolvimento/economia , Biologia Marinha/economia , Biologia Marinha/tendências , Aquicultura/economia , Aquicultura/tendências , Organismos Aquáticos , Tecnologia Biomédica/economia , Tecnologia Biomédica/tendências , Saúde Ambiental/economia , Saúde Ambiental/tendências , Humanos , Oceanos e Mares , Organização para a Cooperação e Desenvolvimento Econômico , Transferência de Tecnologia
9.
Ecotoxicol Environ Saf ; 145: 490-495, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28783598

RESUMO

Formaldehyde has been prominent in preserving biological tissues since the nineteenth century. Despite being admittedly harmful to health and to the environment, it is still widely used. The Morphology Department of the University of Brasília - Brazil, applied the rethink, reduce, reuse, recycle and responsibility methodology to their activities in an effort to protect the health of laboratory workers and users, save resources and reduce damage to the environment. Here we evaluate the results obtained a decade after the implementation of this proposal (2005-2015). Formaldehyde was replaced by alcohol and glycerol solutions in corpse conservation. Over five thousand dollars in public funds that would have been destined to buying preserving substances were saved annually, and over a hundred thousand liters of water that would have been contaminated and thrown into the sewage system were spared. The environment used to implement the study was improved and anatomical parts kept for study had their lifespan extended. It is noteworthy that such simple adjustments could cause pronounced changes in laboratory activities. We would avoid contaminating billions of liters of water and it would be possible to save millions if similar practices were implemented in all educational institutions having similar routines.


Assuntos
Cadáver , Embalsamamento/métodos , Saúde Ambiental/métodos , Fixadores/toxicidade , Formaldeído/toxicidade , Preservação Biológica/métodos , Álcoois/toxicidade , Brasil , Conservação dos Recursos Naturais/economia , Conservação dos Recursos Naturais/métodos , Embalsamamento/economia , Saúde Ambiental/economia , Glicerol/toxicidade , Humanos , Preservação Biológica/economia , Soluções
10.
Health Serv Res ; 52 Suppl 2: 2285-2306, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28726250

RESUMO

OBJECTIVE: To assess optimal activity size/mix of Connecticut local public health jurisdictions, through estimating economies of scale/scope/specialization for environmental inspections/services. DATA SOURCES/STUDY SETTING: Connecticut's 74 local health jurisdictions (LHJs) must provide environmental health services, but their efficiency or reasons for wide cost variation are unknown. The public health system is decentralized, with variation in organizational structure/size. We develop/compile a longitudinal dataset covering all 74 LHJs, annually from 2005 to 2012. STUDY DESIGN: We estimate a public health services/inspections cost function, where inputs are translated into outputs. We consider separate estimates of economies of scale/scope/specialization for four mandated inspection types. DATA COLLECTION/EXTRACTION METHODS: We obtain data from Connecticut Department of Public Health databases, reports, and other publicly available sources. There has been no known previous utilization of this combined dataset. PRINCIPAL FINDINGS: On average, regional districts, municipal departments, and part-time LHJs are performing fewer than the efficient number of inspections. The full-time municipal departments and regional districts are more efficient but still not at the minimum efficient scale. The regional districts' elasticities of scale are larger, implying they are more efficient than municipal health departments. CONCLUSIONS: Local health jurisdictions may enhance efficiency by increasing inspections and/or sharing some services.


Assuntos
Eficiência Organizacional/economia , Saúde Ambiental/economia , Administração em Saúde Pública/economia , Controle de Qualidade , Connecticut , Saúde Ambiental/normas , Serviços de Alimentação/normas , Humanos , Intoxicação por Chumbo/prevenção & controle , Eliminação de Resíduos Líquidos/normas , Poços de Água
11.
Environ Health ; 16(1): 55, 2017 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-28599657

RESUMO

BACKGROUND: Socioeconomic analysis is currently used in the Europe Union as part of the regulatory process in Regulation Registration, Evaluation and Authorisation of Chemicals (REACH), with the aim of assessing and managing risks from dangerous chemicals. The political impact of the socio-economic analysis is potentially high in the authorisation and restriction procedures, however, current socio-economic analysis dossiers submitted under REACH are very heterogeneous in terms of methodology used and quality. Furthermore, the economic literature is not very helpful for regulatory purposes, as most published calculations of health costs associated with chemical exposures use epidemiological studies as input data, but such studies are rarely available for most substances. The quasi-totality of the data used in the REACH dossiers comes from toxicological studies. METHODS: This paper assesses the use of the integrated probabilistic risk assessment, based on toxicological data, for the calculation of health costs associated with endocrine disrupting effects of triclosan. The results are compared with those obtained using the population attributable fraction, based on epidemiological data. RESULTS: The results based on the integrated probabilistic risk assessment indicated that 4894 men could have reproductive deficits based on the decreased vas deferens weights observed in rats, 0 cases of changed T3 levels, and 0 cases of girls with early pubertal development. The results obtained with the Population Attributable Fraction method showed 7,199,228 cases of obesity per year, 281,923 girls per year with early pubertal development and 88,957 to 303,759 cases per year with increased total T3 hormone levels. The economic costs associated with increased BMI due to TCS exposure could be calculated. Direct health costs were estimated at €5.8 billion per year. CONCLUSIONS: The two methods give very different results for the same effects. The choice of a toxicological-based or an epidemiological-based method in the socio-economic analysis will therefore significantly impact the estimated health costs and consequently the political risk management decision. Additional work should be done for understanding the reasons of these significant differences.


Assuntos
Disruptores Endócrinos/toxicidade , Exposição Ambiental , Saúde Ambiental/métodos , Poluentes Ambientais/toxicidade , Custos de Cuidados de Saúde , Triclosan/toxicidade , Disruptores Endócrinos/economia , Exposição Ambiental/economia , Saúde Ambiental/economia , Poluentes Ambientais/economia , União Europeia , Humanos , Medição de Risco , Triclosan/economia
12.
PLoS Biol ; 15(5): e2002634, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28557984

RESUMO

The important concept of equilibrium has always been controversial in ecology, but a new, more general concept, an asymptotic environmentally determined trajectory (AEDT), overcomes many concerns with equilibrium by realistically incorporating long-term climate change while retaining much of the predictive power of a stable equilibrium. A population or ecological community is predicted to approach its AEDT, which is a function of time reflecting environmental history and biology. The AEDT invokes familiar questions and predictions but in a more realistic context in which consideration of past environments and a future changing profoundly due to human influence becomes possible. Strong applications are also predicted in population genetics, evolution, earth sciences, and economics.


Assuntos
Mudança Climática , Saúde Ambiental/métodos , Modelos Biológicos , Algoritmos , Evolução Biológica , Mudança Climática/economia , Ciências da Terra/métodos , Saúde Ambiental/economia , Saúde Ambiental/tendências , Genética Populacional/métodos , Humanos , Processos Estocásticos , Terminologia como Assunto , Fatores de Tempo
13.
Philos Trans R Soc Lond B Biol Sci ; 372(1722)2017 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-28438919

RESUMO

Several recent initiatives such as Planetary Health, EcoHealth and One Health claim that human health depends on flourishing natural ecosystems. However, little has been said about the operational and implementation challenges of health-oriented conservation actions on the ground. We contend that ecological-epidemiological research must be complemented by a form of implementation science that examines: (i) the links between specific conservation actions and the resulting ecological changes, and (ii) how this ecological change impacts human health and well-being, when human behaviours are considered. Drawing on the policy evaluation tradition in public economics, first, we present three examples of recent social science research on conservation interventions that affect human health. These examples are from low- and middle-income countries in the tropics and subtropics. Second, drawing on these examples, we present three propositions related to impact evaluation and non-market valuation that can help guide future multidisciplinary research on conservation and human health. Research guided by these propositions will allow stakeholders to determine how ecosystem-mediated strategies for health promotion compare with more conventional biomedical prevention and treatment strategies for safeguarding health.This article is part of the themed issue 'Conservation, biodiversity and infectious disease: scientific evidence and policy implications'.


Assuntos
Conservação dos Recursos Naturais , Ecossistema , Saúde Ambiental , Conservação dos Recursos Naturais/economia , Conservação dos Recursos Naturais/legislação & jurisprudência , Saúde Ambiental/economia , Saúde Ambiental/legislação & jurisprudência , Humanos
14.
Rev Environ Health ; 32(1-2): 171-175, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-28231066

RESUMO

BACKGROUND: Monetized environmental health impact assessments help to better evaluate the environmental burden of a wide range of economic activities. Apart from the limitations and uncertainties in physical and biological science used in such assessments, assumptions taken from economic valuation may also substantially influence subsequent policy-making considerations. AIM: This study attempts to demonstrate the impact of normative policy assumptions on quantified external costs using a case study of recently discussed variants of future coal mining and use of extracted coal in electricity and heat generation in the Czech Republic. METHODS: A bottom-up impact-pathway approach is used for quantification of external costs. Several policy perspectives are elaborated for aggregating impacts that differ in geographic coverage and in how valuation of quantified impacts is adjusted in a particular perspective. RESULTS: We find that the fraction of monetized external impacts taken into policy-making considerations may vary according to choice of decision perspective up to a factor of 10. CONCLUSION: At present there are virtually no hard rules for defining geographical boundaries or adjusting values for a summation of monetized environmental impacts. We, however, stress that any rigorous external cost assessment should, for instance in a separate calculation, take account of impacts occurring beyond country borders.


Assuntos
Custos e Análise de Custo , Saúde Ambiental/economia , Política Ambiental/economia , Formulação de Políticas , Carvão Mineral , República Tcheca , Fontes de Energia Elétrica/efeitos adversos , Humanos , Mineração
15.
J Public Health (Oxf) ; 39(3): 506-513, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-27908973

RESUMO

Background: The contemporary environment is a complex of interactions between physical, biological, socio-economic systems with major impacts on public health. However, gaps in our understanding of the causes, extent and distribution of these effects remain. The public health community in Sandwell West Midlands has collaborated to successfully develop, pilot and establish the first Environmental Public Health Tracking (EPHT) programme in Europe to address this 'environmental health gap' through systematically linking data on environmental hazards, exposures and diseases. Methods: Existing networks of environmental, health and regulatory agencies developed a suite of innovative methods to routinely share, integrate and analyse data on hazards, exposures and health outcomes to inform interventions. Results: Effective data sharing and horizon scanning systems have been established, novel statistical methods piloted, plausible associations framed and tested, and targeted interventions informed by local concerns applied. These have influenced changes in public health practice. Conclusion: EPHT is a powerful tool for identifying and addressing the key environmental public health impacts at a local level. Sandwell's experience demonstrates that it can be established and operated at virtually no cost. The transfer of National Health Service epidemiological skills to local authorities in 2013 provides an opportunity to expand the programme to fully exploit its potential.


Assuntos
Exposição Ambiental , Saúde Ambiental/organização & administração , Administração em Saúde Pública/métodos , Análise Custo-Benefício , Inglaterra , Exposição Ambiental/efeitos adversos , Exposição Ambiental/prevenção & controle , Exposição Ambiental/estatística & dados numéricos , Saúde Ambiental/economia , Saúde Ambiental/métodos , Inocuidade dos Alimentos , Humanos , Administração em Saúde Pública/economia , Prática de Saúde Pública/economia
17.
Environ Int ; 88: 112-122, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26735349

RESUMO

BACKGROUND: The EU strategy for the Danube Region addresses numerous challenges including environment, health and socioeconomic disparities. Many old environmental burdens and heavily polluted areas in Europe are located in the Danube Region, consisting of 14 countries, with over 100 million people. Estimating the burden of environmental exposures on early-life health is a growing research area in Europe which has major public health implications, but the data from the Danube Region are largely missing. AIM: This review presents an inventory of current environmental challenges, related early-life health risks, and knowledge gaps in the Danube Region, based on publicly available databases, registers, and literature, as a rationale and incentive for a new integrated project. The review also proposes the concept for the project aiming to characterize in utero exposures to multiple environmental factors and estimate their effect on early-life health, evaluate economic impact, as well as identify interventions with a potential to harness social norms to reduce emissions, exposures and health risks in the Danube Region. METHODS: Experts in environmental epidemiology, human biomonitoring and social science in collaboration with clinicians propose to establish a new large multi-center birth cohort of mother-child pairs from Danube countries, measure biomarkers of exposure and health in biological samples at birth, collect centrally measured climate, air and water pollution data, conduct pre- and postnatal surveys on lifestyle, indoor exposures, noise, occupation, socio-economic status, risk-averting behavior, and preferences; and undertake clinical examinations of children at and after birth. Birth cohort will include at least 2000 newborns per site, and a subset of at least 200 mother-child pairs per site for biomonitoring. Novel biomarkers of exposure, susceptibility, and effect will be applied, to gain better mechanistic insight. Effects of multiple environmental exposures on fetal and child growth, respiratory, allergic, immunologic, and neurodevelopmental health outcomes will be estimated. Parent's willingness to pay for reducing health risks in children will be elicited by survey, while values of cost-of-illness will be gathered from literature and national statistics. Effects of risk reducing interventions will be examined. CONCLUSIONS: The proposed project would provide novel estimates of the burden of early childhood diseases attributable to environmental exposures and assess health impacts of different intervention scenarios in the Danube Region, in an integrated approach combining human biomonitoring, epidemiological and social science research.


Assuntos
Exposição Ambiental/efeitos adversos , Saúde Ambiental/métodos , Monitoramento Ambiental/métodos , Poluição Ambiental/efeitos adversos , Criança , Desenvolvimento Infantil , Pré-Escolar , Exposição Ambiental/análise , Exposição Ambiental/estatística & dados numéricos , Saúde Ambiental/economia , Poluição Ambiental/análise , Poluição Ambiental/estatística & dados numéricos , Europa (Continente) , Feminino , Desenvolvimento Fetal , Nível de Saúde , Humanos , Recém-Nascido , Masculino , Exposição Materna , Estudos Prospectivos , Saúde Pública/economia , Saúde Pública/métodos
18.
PLoS One ; 11(1): e0147201, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26808087

RESUMO

Climate change poses multiple risks to the population of Lima, the largest city and capital of Peru, located on the Pacific coast in a desert ecosystem. These risks include increased water scarcity, increased heat, and the introduction and emergence of vector-borne and other climate sensitive diseases. To respond to these threats, it is necessary for the government, at every level, to adopt more mitigation and adaptation strategies. Here, focus groups were conducted with representatives from five Lima municipalities to determine priorities, perception of climate change, and decision-making processes for implementing projects within each municipality. These factors can affect the ability and desire of a community to implement climate change adaptation and mitigation strategies. The results show that climate change and other environmental factors are of relatively low priority, whereas public safety and water and sanitation services are of highest concern. Perhaps most importantly, climate change is not well understood among the municipalities. Participants had trouble distinguishing climate change from other environmental issues and did not fully understand its causes and effects. Greater understanding of what climate change is and why it is important is necessary for it to become a priority for the municipalities. Different aspects of increased climate change awareness seem to be connected to having experienced extreme weather events, whether related or not to climate change, and to higher socioeconomic status.


Assuntos
Cidades , Mudança Climática , Tomada de Decisões , Planejamento em Saúde , Prioridades em Saúde , Planejamento Social , Orçamentos , Planejamento de Cidades , Países em Desenvolvimento , Desenvolvimento Econômico , Saúde Ambiental/economia , Grupos Focais , Programas Governamentais , Necessidades e Demandas de Serviços de Saúde , Humanos , Peru , Opinião Pública , Política Pública , Saúde da População Urbana , Abastecimento de Água
19.
Int J Technol Assess Health Care ; 32(6): 400-406, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28065172

RESUMO

OBJECTIVES: Traditional economic evaluations for most health technology assessments (HTAs) have previously not included environmental outcomes. With the growing interest in reducing the environmental impact of human activities, the need to consider how to include environmental outcomes into HTAs has increased. We present a simple method of doing so. METHODS: We adapted an existing clinical-economic model to include environmental outcomes (carbon dioxide [CO2] emissions) to predict the consequences of adding insulin to an oral antidiabetic (OAD) regimen for patients with type 2 diabetes mellitus (T2DM) over 30 years, from the United Kingdom payer perspective. Epidemiological, efficacy, healthcare costs, utility, and carbon emissions data were derived from published literature. A scenario analysis was performed to explore the impact of parameter uncertainty. RESULTS: The addition of insulin to an OAD regimen increases costs by 2,668 British pounds per patient and is associated with 0.36 additional quality-adjusted life-years per patient. The insulin-OAD combination regimen generates more treatment and disease management-related CO2 emissions per patient (1,686 kg) than the OAD-only regimen (310 kg), but generates fewer emissions associated with treating complications (3,019 kg versus 3,337 kg). Overall, adding insulin to OAD therapy generates an extra 1,057 kg of CO2 emissions per patient over 30 years. CONCLUSIONS: The model offers a simple approach for incorporating environmental outcomes into health economic analyses, to support a decision-maker's objective of reducing the environmental impact of health care. Further work is required to improve the accuracy of the approach; in particular, the generation of resource-specific environmental impacts.


Assuntos
Dióxido de Carbono/análise , Saúde Ambiental/métodos , Avaliação da Tecnologia Biomédica/métodos , Administração Oral , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/economia , Quimioterapia Combinada , Saúde Ambiental/economia , Humanos , Hipoglicemiantes/economia , Hipoglicemiantes/uso terapêutico , Insulina/economia , Insulina/uso terapêutico , Modelos Econométricos
20.
Acad Pediatr ; 16(1): 25-33, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26233834

RESUMO

BACKGROUND: In 1998 the Agency for Toxic Substances and Disease Registry (ATSDR) secured the first federal funding to develop an innovative network of public health-oriented entities: Pediatric Environmental Health Specialty Units (PEHSUs). PEHSU goals were to provide pediatric and environmental health education to health care providers and health profession students, to offer consultation to health care professionals, parents, and others regarding environmental health exposures, and to provide referrals to specialized medical resources when necessary. This report analyzes the productivity of US PEHSUs from 1999 to 2014. METHODS: This was a retrospective analysis of federally mandated quarterly reports filed by each PEHSU. These reports document specific goal-related deliverables outlined under cooperative agreements awarded to the Association of Occupational and Environmental Clinics (AOEC) with funding from the Environmental Protection Agency (EPA) and ATSDR. Costs were obtained from grant budget information available from the administrator of the grants, AOEC. RESULTS: Total EPA/ATSDR funding for PEHSUs paid to AOEC during 1999-2014 was $23,847,452. The average cost to the EPA/ATSDR of running each PEHSU in 2014 was $169,256. Through over 8000 consultations and educational activities, PEHSUs reached 702,506 people: 298,936 health professionals, 61,947 health professional trainees, 323,817 members of the public, and 17,806 public health officials and others. CONCLUSIONS: PEHSUs have grown into an established, productive network of clinical and educational centers whose expertise and activities have benefited both the public and health care professionals alike. The federal contributions to the cost of operating these centers have been more than offset by the benefits PEHSUs have conferred on the communities they serve.


Assuntos
Educação Médica/organização & administração , Saúde Ambiental/organização & administração , Pediatria/organização & administração , Saúde Pública , Encaminhamento e Consulta/organização & administração , Saúde Ambiental/economia , Governo Federal , Financiamento Governamental , Humanos , Pediatria/economia , Estudos Retrospectivos , Estados Unidos , United States Environmental Protection Agency
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