Environmental Health and Child Survival:

Transcription

1 Environmental Health and Child Survival: Epidemiology and Economics Presentation by Anjali Acharya Senior Environmental Specialist World Bank

2 What do children die from? Diarrhea kills an estimated 1.6 million children each year, caused mainly by unsafe water and poor sanitation. Indoor air pollution associated with the still-widespread use of biomass fuels kills nearly one million children annually, mostly as a result of acute respiratory infections. Malaria, which may be exacerbated as a result of poor water management, inadequate drainage and vector management kills an estimated one million children under five annually, mostly in Africa. Source: WHO, Factsheet 2005

3 Malnutrition In large populous areas in South Asia and sub-saharan Africa, where environmental health problems are especially severe, malnutrition in young children is also rampant; Children who are malnourished are more susceptible to illness both acute and chronic. In addition, research shows that malnutrition also have learning and cognition impacts which affects educational performance and future productivity; Research, and recent studies, have shown that 50% of malnutrition is in fact caused by bad sanitation and repeated infections; Previous costing studies have not taken this malnutrition linkage into account.

4 Objectives Provide an improved understanding of the linkages between environmental health risks and malnutrition, through a review of literature and research; Analyze recent WHO estimates to better understand which subregions of the world are most impacted by the malnutrition and environmental health linkages; Develop a methodology for valuation of these malnutritionenvironmental health costs, at a country level; and Highlight through illustrative examples how environmental health interventions are being delivered in developing countries through a variety of health, infrastructure and environmental programs Focus on children under five

5 Epidemiology

6 Malnutrition and EH Evidence base of Infection to Malnutrition linkage Strong indirect evidence over the last 100 years Direct proof: 38 longitudinal (cohort) studies reviewed Provides reason for 50% assumption Vicious cycle of diarrhea and malnutrition Case management and increased risk of disease in the malnourished have been tackled over the last several decades Decreased dietary intake Malabsorption Infection Impaired immune function catabolism, nutrient disposal Nutrient sequestration Malnutrition Impaired barrier protection

7 EH in the Life Cycle Pregnancy Early Infancy (0-2 years) Early Childhood (2-5 years) Birth & Perinatal Post-neonatal Post-weaning Health outcomes Acute Chronic Anemia, Placental insufficiency, Fetal loss, Stillbirths Restricted growth (Peri/post)-neonatal deaths; number of infectious disease episodes; Underweight Infant & <5 deaths; Incidence of diarrhea, ARI, malaria; Malnutrition Stunting, cognitive and learning impairments School performance, work productivity Chronic diseases like possibly coronary heart disease, obesity Example of Inputs Env health Other Vector control, Safe water, Improved sanitation, IAP mitigation Antenatal care Safe water; Improved sanitation; Vector control IAP mitigation, Hygiene promotion Proper breastfeeding; Immunizations; Micronutrient suppl.; Better case-management, Safe water; Improved Sanitation; Vector control IAP mitigation; Hygiene promotion Immunizations; Micronutrient suppl.; Better case-management

8 Window of opportunity Source: World Bank Repositioning Nutrition as Central to Development: A Strategy for Large-Scale Action

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10 Complementary role Adding Value to Health Systems Childbirth and infant care programs Immunization programs Micronutrient supplementation programs Adapting Environmental Management Programs Vector control programs Adjusting Infrastructure Strategies Water supply and sanitation systems Rural energy programs

11 Economics

12 Which regions most affected? 2006 WHO report (which focused on WSH, and incorporates the malnutrition linkages) showed revised regional burden of disease Source: WHO 2006 (Preventing disease through healthy environments)

13 Results WPRB SEARD SEARB EMRD EMRB AMRD AMRB AFRE Diarrheal diseases Malnutrition and its consequences Malaria Other WSH Multiplier effect of environmental health interventions on mortality where investments addressing environmental risks (e.g., lack of water and sanitation) not only reduce diarrhea mortality but also reduces mortality from malnutrition related diseases and its consequences on education attainment AFRD DALYs

14 What does it cost a country? Usual valuation of environmental health costs: Environment related disease and deaths converted to DALYs Valued by HCA or VSL approaches Add costs of illness (treatment costs + lost productivity costs) Ecuador Guatemala Bolivia El Salvador Peru Colombia Nigeria Iran Lebanon Morocco Egypt Syria Jordan Tunisia WSH Urban Air Indoor Air Other Percentage of GDP

15 Poor water Inadequate sanitation Improper personal and household hygiene Indoor air pollution Inadequate WRM Direct Diarrhea Acute lower respiratory infections Malaria Diarrhea (WSH) ALRI (IAP) Malaria (IWRM) Tuberculosis (IAP) Protein-energy malnutrition (WSH) Direct Malnutrition (50% from bad sanitation and repeated infections 50% from food availability) Indirect Diarrhea (food) ALRI (non IAP) Infections nonenvironmentally related (excluding HIV)

16 Revised methodology Added in impacts from environmental risks mediated through malnutrition New methodology to cost education and cognition impacts that can be attributed to environmental risks Percent of GDP Ghana Pakistan Direct effect only Direct effect + Indirect (malnutrition mediated) effect Direct + Indirect + Education

17 Next Steps Understand disease transmission better: Further research on the environmental health impacts during pregnancy, additional disease transmission pathways, and better relative risk estimates will help to improve disease burden and costing estimates Prioritize among interventions: Carrying out CE/ BCA at a country-level will help governments to choose among the different environmental health, infrastructure, nutrition, and child survival interventions to improve child health. Proper economic analysis takes temporality into account Enabling environment is critical: Look beyond the generic roles and responsibilities for better environmental health governance. Carry out an in-depth institutional analysis at a country level to better understand the coordination mechanisms between ministries, and how mandates and budgets are assigned.

18 A concerted and continuous effort is needed on behalf of both developed and developing countries to ensure that environmental health is placed high on the development agenda, and corresponding interventions financed and undertaken to improve children s survival and development potential

19 Thank you Reference: Environmental Health and Child Survival: Epidemiology, Economics, Experiences World Bank 2008 Environment and Development Series