Academic journal article Environmental Health Perspectives

Environmental Burden of Disease in Europe: Assessing Nine Risk Factors in Six Countries

Academic journal article Environmental Health Perspectives

Environmental Burden of Disease in Europe: Assessing Nine Risk Factors in Six Countries

Article excerpt


Scientific evidence shows clearly that environmental risk factors affect human health. Properly targeted and followed-up environmental health policies, such as the coal burning ban in Dublin, Ireland, in 1990 (Clancy et al. 2002) and the smoking ban in public places in Rome, Italy, in 2005 (Cesaroni et al. 2008) have demonstrated significant population health benefits.

To develop effective policy measures and focus research efforts, it is important to prioritize environmental risk factors based on their health impact. Environmental burden of disease (EBD) measures can be used to express diverging health effects in one unit, such as disability-adjusted life years (DALYs). DALYs give an indication of the equivalent number of healthy life-years lost in a population due to premature mortality and morbidity (Murray and Lopez 1996).

The Dutch National Institute for Public Health and the Environment (RIVM) conducted one of the first systematic European studies using DALYs to compare the health impact of various environmental risk factors (de Hollander et al. 1999). The study highlighted that only a few top-ranking risk factors produced > 90% of the EBD.

The World Health Organization (WHO) included a ranking of selected environmental exposures in the World Health Report 2002 (WHO 2003), addressing more than a dozen risk factors from a global point of view (Pruss-Ustun et al. 2003) and providing methodological guidance (WHO 2013). The Organisation for Economic Co-operation and Development (OECD) compared EBD with monetary impacts in the OECD Environmental Outlook (OECD 2001). More specific EBD studies have looked at indoor air (De Oliveira Fernandes et al. 2009; Logue et al. 2012), chemicals (Pruss-Ustun et al. 2011), secondhand smoke (SHS) (Oberg et al. 2011), and foodborne pathogens (Havelaar et al. 2012). Some of these studies used expert elicitation (De Oliveira Fernandes et al. 2009; Pruss-Ustun and Corvalan 2006), and others reviewed results from previous studies (Pruss-Ustun et al. 2011) or used a "bottom up" data-driven approach to calculate DALYs (Havelaar et al. 2012; Logue et al. 2012).

In this review, we aimed to test the availability of data and applicability of methods for a data-driven European multinational comparison of the EBD. By looking at the environmental causes of the burden of disease, we provide important information for prioritizing and motivating preventive policies, such as reducing air pollution, traffic noise, and SHS.


The Environmental Burden of Disease in European countries (EBoDE) project aimed to provide harmonized EBD assessments for the countries participating. Specifically, it aimed to

* Prioritize selected environmental exposures relevant for the European situation based on their annual health impacts

* Make data-driven EBD assessments comparable among countries and among environmental risk factors

* Assess variation and uncertainty in the input parameters and results

* Assess data availability and method applicability for this type of EBD assessment.

In this review we present an overview of the results of the EBoDE project. We focus on the overall results--comparison of the risk factors. More details about the methodology and data are available in the full EBoDE project report (Hanninen and Knol 2011).


The EBoDE project was launched in 2009 at a WHO meeting (WHO 2009a). Below, methods, data, and results are briefly described.

Selection of environmental risk factors, health end points, and exposure-response functions. Environmental risk factors were selected by the project group based on known public health impacts, high individual risks, public concern, economic interests, and pragmatic reasons related to data availability. The nine selected risk factors were benzene, dioxins [including furans and dioxin-like polychlorinated biphenyls (PCBs)], SHS, formaldehyde, lead, traffic noise (including road, rail, and air traffic noise), ozone, airborne particulate matter, and radon. …

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