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PREVIOUS DOCUMENTS Estimating economic benefits of environmental health interventions within the context of the HEMA iniciative of individual pollutants are significant, conclusive information regarding health hazard risks of the effects of exposure to trace levels of multiple chemicals in different climatic and other conditions or for a long period of time, are substantial. Most urban populations are commonly exposed to more than 650 different chemicals, a fraction of the total number of different chemicals commercially available and released from industrial as well as multiple non-point sources. 1.1 Vulnerable Groups Environmental health challenges are diverse, with impacts disproportionately affecting the unborn, children, the elderly, and the impoverished living in slums and poor rural areas. Particularly for the poorest, the vicious cycle of underdevelopment, lack of access to basic health care and educational services, and exposure to environmental contaminants, which can lead to learning deficiencies in children, further tightens this poverty trap and undermines the future income potential of workers. Each year, 11 million children die before reaching their fifth birthday, mostly from easily preventable or treatable causes. Of that amount, over 250,000 children per year die from environmental conditions. 7 In all developing countries, more than 2 million people -primarily young children and women- die prematurely from indoor exposure. The health burden on the poor from dirty water, inadequate sanitation and vector-borne illness is larger. 8 According to the World Health Organization, some 1.4 million children die each year because of dirty water or poor hygiene. Diseases transmitted through water or human excrement are the second leading cause of death among children worldwide, after respiratory diseases. 9 By 2050, at least one in four people are likely to live in a country affected by chronic or recurring shortages of freshwater. 10 Throughout the world at least 1.1 billion people lack access to safe water, and 2.6 billion lack access to basic sanitation. Diarrhea kills an estimated 1.6 million children each year. The vast majority of diarrheal disease in the world (88 percent) is attributable to unsafe water, poor sanitation and poor hygiene. Malaria, a water-borne disease, may be exacerbated as a result of poor water management and storage, inadequate housing, deforestation and loss of biodiversity. In the Americas, 36 million people live in areas where there is a high risk of malaria. 11 In developing countries, indoor air pollution is predominant in rural areas, where some 3.5 billion people worldwide continue to rely on traditional fuels such as firewood, charcoal, and cow dung for cooking and heating. Burning such fuels produces large amount of air pollutants in the confined space of the home, resulting in high exposure. Daily averages of pollutant level emitted indoors often exceed current World Health Organization (WHO) guidelines and acceptable levels. Little monitoring has been done in rural and poor urban indoor environments in a manner that is statistically rigorous. The World Health Organization estimates that pesticide poisoning kills 200,000 people every year around the world, up from 30,000 in 1990. Pesticides used heavily in industrial agriculture are associated with elevated cancer risks for workers and consumers and are coming under greater scrutiny for their links to endocrine disruption and reproductive dysfunction. 12 Pesticides and other synthetic chemicals in the environment are also major cause of human cancer. 13 1.2 The Cost and Distribution of Environmental Health Hazards In developing countries, the increasing health burden and other associated costs from exposure to urban, industrial, and agrochemical pollution add to traditional households' risks. The burden of disease from environmental causes varies considerably among regions, but a clear trend emerges regarding how this burden and its components change with income growth. Overall, the environmental health burden as a percentage of the total disease burden is highest in regions that house most of the world's poor. Within individual countries, moreover, the poor suffer disproportionately from unsafe environmental conditions at the household community levels. Of these environmental conditions, inadequate water supply and sanitation pose the largest threat to human health. Evaluating human-health and environmental interactions has improved significantly in the past twenty years (see Box 1). A report by the World Health Organization on world health identifies 44 | June 16 - 17, 2005 - Mar del Plata - Argentina
PREVIOUS DOCUMENTS Estimating economic benefits of environmental health interventions within the context of the HEMA iniciative twenty-seven key risk factors and their impact on global diseases, mortality and incapacity. Of this total, six risk factors relate directly to the environment: unsafe water, health and hygiene, urban air pollution, domestic smoke from solid fuels, exposure to lead, and climate change. 14 Given the myriad ways in which environment and human health interacts, there is a demand for a clearer understanding of the linkages between environment and health, particularly involving the interaction of poverty, exposure to environmental risks in slums and land zoning in the urban periphery; and a regulatory intervention designed to reduce environmental degradation that poses measurable human health hazards, and the resulting impact on the economy. The environmental health policies envisaged in the HEMA initiative demand a multi-disciplinary approach, that is, coherence not only among health and environmental officials, but also engineers, those responsible for zoning, poverty alleviation efforts, architects, economists and others. 15 Integrating health and environment remains conceptually clear, but operationally difficult. Environmental risk transition According to an analysis by the World Health Organization, in today's world a transition is taking place in environmental health risks from traditional risks related to the impact of natural phenomena and insufficient development, to modern risks associated with some features of unsustainable development. In general, developing countries are exposed to both traditional and modern risks. Traditional risks are usually a consequence of poverty or of exclusion from the benefits of development, such as lack of access to drinking water, inadequate disposal of excrements, domestic air pollution caused by dust, fungi and smoke from burning fossil fuels for cooking and lighting, contamination of food with pathogenic substances, exposure to the impact of drought, floods and earthquakes, contamination with lead from ceramics and paints, and accidents or illnesses caused by small-scale or artisanal agriculture and industry. Modern risks mostly originate in industrial processes without sufficient safeguards to prevent or mitigate sanitary and related environmental problems. They include such dangers as accumulation of hazardous solid waste; air pollution from industrial or vehicular emissions in urban zones; pollution of water resources with industrial or agricultural waste and urban sewage; the improper handling of chemical or radioactive substances used in new agricultural or industrial technologies; traffic accidents; emerging or reemerging infectious diseases; climate and atmospheric changes (such as depletion of the ozone layer and the greenhouse effect); violence or other psychological effects of the urban environment; and the abuse of drugs such as tobacco and alcohol. In general terms, traditional and modern risks come from activities that are harmful to health because of the concentration of emissions in the air, water, soils or food. Source: United Nations Environment Programme (UNEP) and Universidad de Costa Rica-Observatorio del Desarrollo (UCR-OdD) (2004), GEO-Latin America and the Caribbean: Environment Outlook 2003 (Costa Rica: Master Litho S.A.). SECTION II - OVERVIEW OF METHODOLOGICAL APPROACHES Numerous methodological challenges are associated with quantifying in economic terms various environmental health linkages. Before outlining some of these challenges, it is worth noting in general that economic benefits associated with regulatory or policy interventions are systematically undervalued. Although the direct cost burden of environmental regulations is fairly well understood, the extent, distribution and long-term repercussion of environmental health benefits are by definition diffusive and largely indirect. General considerations that estimate the direct savings and related welfare benefits of environmental health interventions include: • Savings in costs of curative and preventive care (reduction in disease cases that would have been treated - costs of treatment per case). • Gains in production of cases averted (work days increased - value of average day not worked). • Gains in production of deaths averted (work years increased - discounted value of average income per year). 16 Meeting of Ministers of Health and Environment of the Americas | 45
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(HEMA) Initiative. - OAS

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