Environmental Risks to Public Health in the United Arab Emirates: A Quantitative Assessment and Strategic Plan

Article excerpt

BACKGROUND: Environmental risks to health in the United Arab Emirates (UAE) have shifted rapidly from infectious to noninfectious diseases as the nation has developed at an unprecedented rate. In response to public concerns over newly emerging environmental risks, the Environment Agency Abu Dhabi commissioned a multidisciplinary environmental health strategic planning project.

OBJECTIVES: In order to develop the environmental health strategic plan, we sought to quantify the illnesses and premature deaths in the UAE attributable to 14 environmental pollutant categories, prioritize these 14 risk factors, and identify interventions.

METHODS: We estimated the disease burden imposed by each risk factor using an attributable fraction approach, and we prioritized the risks using an empirically tested stakeholder engagement process. We then engaged government personnel, scientists, and other stakeholders to identify interventions.

RESULTS: The UAE's environmental disease burden is low by global standards. Ambient air pollution is the leading contributor to premature mortality [~ 650 annual deaths; 95% confidence interval (CI): 140, 1,400]. Risk factors leading to > 10,000 annual health care facility visits included occupational exposures, indoor air pollution, drinking water contamination, seafood contamination, and ambient air pollution. Among the 14 risks considered, on average, outdoor air pollution was ranked by the stakeholders as the highest priority (mean rank, 1.4; interquartile range, 1-2) and indoor air pollution as the second-highest priority (mean rank 3.3; interquartile range, 2-4). The resulting strategic plan identified 216 potential interventions for reducing environmental risks to health.

CONCLUSIONS: The strategic planning exercise described here provides a framework for systematically deciding how to invest public funds to maximize expected returns in environmental health, where returns are measured in terms of reductions in a population's environmental burden of disease.

KEY WORDS: environmental burden of disease, environmental priorities, risk assessment, strategic planning. Environ Health Perspect 120:681-686 (2012). http://dx.doi.org/10.1289/ehp.1104064 [Online 22 February 2012]

The United Arab Emirates (UAE) has modernized more rapidly than any nation in world history. In the 40 years since its founding, the UAE has grown from a primarily nomadic and subsistence fishing population of < 400,000 to a multicultural population of > 4.4 million with a diverse industrial base (Cassen 1978; United Nations 2007). It is home to two international urban centers, Dubai and Abu Dhabi, the latter of which is now, by some measures, the world's wealthiest city (Gimbel 2007). This rapid development has been made possible by oil exports: The UAE owns approximately 8% of the world's remaining oil reserves, most contained in the emirate of Abu Dhabi, the largest of the UAE's seven emirates (U.S. Energy Information Administration 2010). With 97.8 billion barrels of proven reserves (five times the remaining U.S. supply), the UAE ranks sixth among all countries in future oil production potential (U.S. Energy Information Administration 2009, 2010).

The UAE's rapid modernization has brought remarkable advancements in public health. For example, during 1970-1975, female life expectancy averaged 46.5 years (Cassen 1978); by 2005-2010 it had increased by > 75%, to 81.5 years--higher than that in the United States (United Nations 2007). However, modernization also has brought new risks. As infectious disease rates have declined, disease patterns have shifted to resemble those in developed countries, with increases in non-infectious conditions such as cardiovascular diseases, cancer, and diabetes. Some of this disease burden may he attributable to environmental pollution that has accompanied the nation's economic growth. Fear about environmental risk factors (whether or not such fear is warranted on technical grounds) is increasing, as evidenced by frequent reporting on environmental risks in the local news media, including headline news stories that have raised alarms. …