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Epidemiology, Economics, Experiences
ENVIRONMENT AND DEVELOPMENT
Environmental
Health
and
Child Survival
Environmental Health and Child Survival
ENVIRONMENT
AND
DEVELOPMENT
A fundamental element of sustainable development is environmental sustain-
ability. Hence, this series was created in 2007 to cover current and emerging
issues in order to promote debate and broaden the understanding of environ-
mental challenges as integral to achieving equitable and sustained economic
growth. The series will draw on analysis and practical experience from across
the World Bank and from client countries. The manuscripts chosen for publi-
cation will be central to the implementation of the World Bank’s Environment
Strategy, and relevant to the development community, policy-makers, and
academia. Topics addressed in this series will include environmental health,
natural resources management, strategic environmental assessment, policy instru-
ments, and environmental institutions.
Also in this series:
International Trade and Climate Change: Economic, Legal, and Institutional
Perspectives
Poverty and the Environment: Understanding Linkages at the Household Level
Strategic Environmental Assessment for Policies: An Instrument for Good Governance
Epidemiology, Economics,
Experiences
Environmental Health
and
Child Survival
© 2008 The International Bank for Reconstruction and
Development/The World Bank
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Washington, DC 20433
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All rights reserved.
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This volume is a product of the staff of the International Bank for
Reconstruction and Development / The World Bank. The findings, inter-
pretations, and conclusions expressed in this volume do not necessarily
reflect the views of the Executive Directors of The World Bank or the
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tion shown on any map in this work do not imply any judgement on the
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endorsement or acceptance of such boundaries.
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ISBN-13: 978-0-8213-7236-4
eISBN-13: 978-0-8213-7237-1
DOI: 10.1596/978-0-8213-7236-4
Library of Congress Cataloging-in-Publication Data
Environmental health and child survival : epidemiology, economics, expe-
riences.
p. ; cm. — (Environment and development)
Includes bibliographical references and index.
ISBN 978-0-8213-7236-4
1. Environmentally induced diseases in children Developing countries. 2.
Malnutrition in children Developing countries. I. World Bank. II. Series:
Environment and development (Washington, D.C.)
[DNLM: 1. Child, Preschool. 2. Environmental Health. 3. Cost of Illness.
4. Developing Countries. 5. Disorders of Environmental Origin. 6.
Malnutrition. WA 30.5 E605 2008]
RJ383.E583 2008
618.92'98 dc22
2008022136
Cover photo:
World Bank Photo Library
Cover design:
Auras Design, Silver Spring, Maryland
CONTENTS
xi Acknowledgments
xiii Abbreviations and Acronyms
CHAPTER 1
1 Introduction
4Objectives
5 Audience
5 A Primer on Environmental Health
6 A Primer on Malnutrition
7 Content and Organization
PART I
15 Epidemiology
CHAPTER 2
17 Environmental Health, Malnutrition, and Child Health
18 Environmental Factors, Exposure, and Transmission Pathways
19 Vicious Cycle of Infections and Malnutrition
23 Environmental Role in Early Childhood Health
28 Averting Cognition and Learning Impacts
30 Key Messages
30 Note
CHAPTER 3
31 How Environmental Health Supplements Other
Child Survival Strategies
32 Adding Value to Health Systems
38 Adapting Environmental Management Programs
39 Adjusting Infrastructure Strategies
43 Key Messages
43 Notes
PART II
45 Economics
CHAPTER 4
47 How Large Is the Environmental Health Burden?
48 Burden of Disease
51 Environmental Health Burdens
58 Areas for Future Research
v
59 Key Messages
59 Notes
CHAPTER 5
61 Estimating the Environmental Health Burden and
Costs at the Country Level
61 Existing Practice in Environmental Health Valuation
62 Building New Estimates for Environmental Health Costs
64 Case Studies of Ghana and Pakistan
66 Results for Ghana and Pakistan
77 Conclusion
79 Next Steps
81 Key Messages
81
Notes
PART III
83 Experiences
CHAPTER 6
85 Approaches to Environmental Health
86 History of Environmental Health
88 Agenda Falling through the Cracks
90 Environmental Health Experiences in Developing Countries
97 Understanding the Enabling Environment
100 Governance and Institutional Implications
104 Institutional Requirements for Successful Environmental
Health Governance
109 A Critical Moment
109 Key Messages
110 Note
CHAPTER 7
111 Conclusion
111 Contributions of This Report
113 Next Steps
Appendixes
117 APPENDIX A: Technical Review of Cohort Studies
117 Background
118 Search Strategy and Selection Criteria
118 Findings and Discussion
122 Experimental Evidence from Deworming
123 Conclusions
125 Notes
141 APPENDIX B: Review of Studies on Nutritional
Status and Education
145 Diarrhea and Education
vi CONTENTS
145 Conclusions
146 Note
147 APPENDIX C: New Estimates for Burden of Disease from Water,
Sanitation, and Hygiene
151 APPENDIX D: Computing Country-Level Environmental Health
Burden of Disease
151 Mortality
160 Education
170 Notes
173 APPENDIX E: Methodological Aspects of Assessing Environmental
Health Burden of Disease
173 From Relative Risks to Attributable Fractions
176 Dealing with Biased Estimates of Relative Risk
177 Notes
179 APPENDIX F: Monetary Valuation of the Cost of Environmental
Health Risks
181 Note
183 References
201 Index
Boxes
2 1.1 What Is Environmental Health?
22
2.1 Impact of Diarrhea on Child Malnutrition:
Evidence from Research
25
2.2 Overweight Mothers Carrying Underweight Children
50
4.1 Why 50 Percent? Supporting Evidence from
Recent Cohort Studies
54
4.2 Revisiting the “Asian Enigma”
56
4.3 The Mills-Reincke Phenomenon
65
5.1 Basic Indicators for Ghana and Pakistan
75
5.2 Attributable Fractions and Burden of Disease
When Multiple Risk Factors Are Present
80
5.3 How Policy-Makers Should Interpret These Results
87
6.1 Combating Disease through Improved Milk
92
6.2 Mexico: Multisectorality through a Diagonal Approach
93
6.3 Thailand’s National Nutrition Program
95
6.4 Ethiopia: The Toilet Revolution
97
6.5 Vietnam’s Dengue Program
101
6.6 Atrophy of Environmental Health Functions in India
102
6.7 Institutional Evolution of Environmental Health:
The Case of Ethiopia
Figures
19 2.1 The F-Diagram: Transmission Routes for Infection
20
2.2 Relationship between Nutrition and Infection
CONTENTS vii
24 2.3 Environmental Health Inputs and Health Outcomes
in the Child’s Life Cycle
27
2.4 The Window of Opportunity for Addressing Undernutrition
32
3.1 Range of Preventive Activities in Child Survival
52
4.1 The Health Effects of Environmental Risks Factors
53
4.2 Water-Related (WSH plus WRM) Burden of Disease in
Children under Five Attributable to Environmental Risk Factors
by WHO Region, 2002
55
4.3 Mills-Reincke Ratios for Subregions
63
5.1 Cost of Environmental Health Risks
70
5.2 Weight-for-Age Distribution of Children in Ghana and Pakistan
71
5.3 Two-Week Diarrheal Prevalence Rate by Age and Underweight
Status in Ghana and Pakistan
73
5.4 Underweight Malnutrition Rates in Children with and without
Diarrheal Infections in Ghana and Pakistan
74
5.5 Calculating Revised Estimates (Indirect and Direct Effects)
78
5.6 Final Results of Ghana and Pakistan Case Studies
152
D.1 Summary of the Methodology
155
D.2 Exposure Categories
159
D.3 Exposure Categories, Population Shares, and Relative Risks
of ALRI in Ghana
Tables
3 1.1 Millennium Development Goals and Environmental Health
10
1.2 Annual Cost of Direct and Indirect Impact of Environmental
Risk Factors in 2005
18
2.1 Water-Related Transmission Routes and Disease Outcome
21
2.2 Impact of Infection on Nutritional Status
33
3.1 Role of Environmental Health in Supplementing Health
System Strategies
49
4.1 Environmental Risk Factors and Related Diseases Included in the
Comparative Risk Assessment
67
5.1 Environmentally Attributable Fractions of Child Mortality,
Keeping Malnutrition Unchanged
67
5.2 Estimated Mortality in Under-Five Children from Environmental
Risk Factors, 2005
68
5.3 Malnutrition Rates in Children under the Age of Five
70
5.4 Malnutrition-Attributable Fractions of Child Mortality
74
5.5 Environmentally Attributable Fractions and Child Mortality with
Malnutrition-Mediated Effects
76
5.6 Effects of Malnutrition on Education
79
5.7 Annual Cost of Direct and Indirect Effect of Environmental Risk
Factors in 2005
126
A.1 Cohort Follow-up Studies Relating Infectious Disease and
Nutritional Status of Children in Developing Countries
142
B.1 Studies of the Effects of Malnutrition on Educational Outcomes
viii CONTENTS
148 C.1 Burden of Disease (in DALYs) in Children under Five Years
Attributable to Water, Sanitation, and Hygiene, by World Health
Organization Subregions, 2002
152
D.1 Causes of Death and Risk Factors Considered in this Study
154
D.2 Estimating the Cost of Environmental Health Risks: Information
Types and Sources
156
D.3 Relative Risks by Exposure Categories, Assuming Cox
Hazard Model
157
D.4 Weight Gain Retardation Factors by Age and z-Score
158
D.5 Weight for Age in Children under Five: Current Rates and
Estimated Rates in the Absence of Diarrheal Infections in Ghana
159
D.6 Estimated Mortality in Children under Five from Environmental
Risk Factors, Ghana
161
D.7 Estimated Annual Cost of Education Outcomes from Stunting
and Share from Environmental Factors in Ghana
162
D.8 Height Growth Retardation Factors by Age and z-Score
162
D.9 Height-for-Age Rates in Children under Five: Current Rates and
Estimated Rates in the Absence of Diarrheal Infections in Ghana
165
D.10 Parameter Values Applied in Estimation of Income Losses
167
D.11 Income Distribution across Malnutrition Categories and Wealth
Quintiles in Ghana
168
D.12 Annual Cost of Environmental Factors (Percentage of GDP in 2005),
Using 3 Percent Discount Rate
169
D.13 Annual Cost of Environmental Factors (Percentage of GDP in 2005),
Using 5 Percent Discount Rate
174
E.1 Environmental Risk Factors and Related Diseases Included
in the WHO Comparative Risk Assessment
CONTENTS ix
[...]... million children every year; most of those deaths are attributed to contaminated water and inadequate sanitation and hygiene (WHO 2007b) Each year, approximately 300 million to 500 million malaria infections 1 2 ENVIRONMENTAL HEALTH AND CHILD SURVIVAL BOX 1.1 What Is Environmental Health? Environmental health is defined as those health outcomes that are a result of environmental risk factors The World Health. .. 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 must be financed and undertaken to improve children’s survival and development potential P A R T I Epidemiology C H A P T E R 2 Environmental Health, Malnutrition, and Child Health MALNUTRITION, POOR ENVIRONMENTAL. .. and collaborative way A Primer on Environmental Health Environmental health relates to human activity or environmental factors that have an impact on socioeconomic and environmental conditions with the potential to reduce human disease, injury, and death, especially among vulnerable groups—mainly the poor, women, and children under five (Listorti and Doumani 2001; Lvovsky 2001) The top killers of children... the third describes the experiences of environmental health actions in developing countries Each section strives to present the latest information and data and highlights the reasons environmental health is so critical in the context of child survival and development Epidemiology Chapter 2 argues that improvements in environmental health are very important for child survival and development, especially... improved understanding of the links between environmental health risks and malnutrition through a review of literature and research Moreover, the study discusses the role of environmental health inputs in a child s survival and growth ■ To analyze new data for the environmental health burden of disease (at a subregional level) that relates to children under five These data, which are from a World Health Organization... neglect of environmental health in the development agenda Environmental health actions are the earliest public health activities on record Lessons from history have shown the enormous benefits of multisectoral environmental health actions, with today’s developed countries having undergone an evolution in environmental health functions However, both institutionally and conceptually, environmental health. .. Africa and South Asia, where poor environmental conditions and high malnutrition prevalence coexist—should be especially targeted to fund and implement environmental 12 ENVIRONMENTAL HEALTH AND CHILD SURVIVAL health interventions The multiplier effect of such interventions points to the potential of their significant health externalities At a country level, the burden of disease associated with environmental. .. countries and who are involved in designing policies for and allocating resources to programs that contribute toward improving child health The study will also be useful to state- and locallevel governments, because the actual implementation of programs and initiatives on child health is at the level of communities and households Furthermore, donors and other organizations financing child health improvement... from environmental factors and to the associated economic costs Measuring the burden of disease and subsequent economic costs from environmental health risks is important in helping policy-makers better integrate environmental health into economic development and, specifically, into their decisions relating to the allocation of resources among various programs and activities to improve child health. .. estimates and taking into consideration the links between environmental health, malnutrition, and disease, WHO recently revised the burden of disease estimates taking into account malnutrition-mediated health impacts associated with inadequate water and sanitation coverage and improper hygienic practices (Fewtrell and others 2007) The new WHO estimates reveal that the environmental health burden in children . Epidemiology, Economics, Experiences
ENVIRONMENT AND DEVELOPMENT
Environmental
Health
and
Child Survival
Environmental Health and Child Survival
ENVIRONMENT
AND
DEVELOPMENT
A. Governance
Epidemiology, Economics,
Experiences
Environmental Health
and
Child Survival
© 2008 The International Bank for Reconstruction and
Development/The
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Xem thêm: Tài liệu Environmental Health and Child Survival: Epidemiology, Economics, Experiences docx, Tài liệu Environmental Health and Child Survival: Epidemiology, Economics, Experiences docx, Box 4.1 Why 50 Percent? Supporting Evidence from Recent Cohort Studies, Box 6.3 Thailand’s National Nutrition Program, Box 6.7 Institutional Evolution of Environmental Health: The Case of Ethiopia, Figure 2.1 The F-Diagram: Transmission Routes for Infection, Figure 4.2 Water-Related (WSH plus WRM) Burden of Disease in Children under Five Attributable to Environmental Risk Factors by WHO Region, 2002, Figure 5.5 Calculating Revised Estimates (Indirect and Direct Effects), Figure D.3 Exposure Categories, Population Shares, and Relative Risks of ALRI in Ghana, Tables 5.1 Environmentally Attributable Fractions of Child Mortality, Keeping Malnutrition Unchanged, Tables C.1 Burden of Disease (in DALYs) in Children under Five Years Attributable to Water, Sanitation, and Hygiene, by World Health Organization Subregions, 2002, Tables D.9 Height-for-Age Rates in Children under Five: Current Rates and Estimated Rates in the Absence of Diarrheal Infections in Ghana, Tables D.13 Annual Cost of Environmental Factors (Percentage of GDP in 2005), Using 5 Percent Discount Rate