Health-and-Environment Indicators in the Context of Sustainable Development

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Correspondence: World Health Organization, 20 Avenue Appia, Geneva 27, Switzerland 1211, Tel: 41 22 791 3533, Fax: 41 22 791 4153, E-mail:

"Indicators are a way of seeing the big picture by looking at a small piece of it."

Jackson Community Council, quoted in Plan Canada 1999(1)

Information for decision-making

Chapter 40 of the global action plan on sustainable development, Agenda 21, dealing with information for decision-making, states that "in sustainable development, everyone is a user and provider of information in the broad sense."(2) While health, environment and development problems differ in various parts of the world, as do priorities with respect to their management, there is a need in all situations for decision-makers and the public to have ready access to accurate information on health hazards associated with the linkages between development and the environment.

Information is needed to monitor and assess trends, identify and prioritize problems, develop and evaluate policies and plans, guide research and development, set standards and guidelines, monitor progress and inform the public. It is important that these data be conveyed in a readily comprehensible way, but with due regard to the complexities and uncertainties inherent in the data.

Role of indicators

Indicators can play an important role in turning data into relevant information for decision-makers and the public. They can help to simplify a complex array of information with respect to the health-environment-development nexus and in this way provide a "synthesis" view of existing conditions and trends. They have become well established and widely used in many different fields and can be used at the global, regional, national, local or neighbourhood level, as well as at the sectoral level.(3) (see Figure 1)

Briggs et al.(4) have defined an environmental health indicator as: "An expression of the link between environment and health, targeted at an issue of specific policy or management concern and presented in a form which facilitates interpretation for effective decision-making." Embodied in this definition is the concept of a linkage between a factor in the environment and a health outcome.

Examples of indicators are numerous and include such measurements as GDP (Gross Domestic Product) as a way of assessing aspects of economic development in a country, the infant mortality rate (IMR) as an indicator of the health status of a community, or the rise in ambient temperatures, worldwide, as an indicator of climate change.

Criteria for indicators

To be useful, indicators should be user-driven, and not just technically relevant or relevant to the providers of data. The actual choice of indicators depends on factors such as the purpose for which they are to be used, and the target audience. Many organizations have attempted to define criteria for the construction and selection of indicators and have included various factors such as transparency, scientific validity, robustness, sensitivity and the extent to which they are linkable.(5) Further, they could be assessed according to whether they are relevant to the issue they are intended to describe, whether they relate to changes in policy and practice, or whether or not they are resonant with their intended audience.(5)

Criteria which could be used in the development of indicators are given in Figure 2. The applicability of the criteria will depend on the indicator in question, and the purpose of the indicator to be used. However, no single set of criteria will be applicable to all indicators as each situation will have its own priorities for data collection and analysis.


Indicators may be specific, or may be composites which condense a wide range of information on different (but related) phenomena into a single measure or index. The construction of composite indicators is challenging, and demands high levels of statistical and measurement competence in weighting and combining various variables. …