This book evolved from the need to address a number of fundamental questions relating to environmental health for which there were no simple answers. These questions ranged in scope and depth, from issues related to basic statistics on health and the environment to the use of information in the management of problems associated with environmental health. Many of these questions were concerned with the way in which information is, or can be, used to help address environmental health problems, and with the role and value of environmental health indicators. Examples of these questions are:
How can one collect and present information which is useful in shaping and making decisions at the local level?
What does a national indicator (e.g. infant mortality rate or access to water and sanitation) mean in the face of large disparities at the sub-national level?
Why is it not always possible to quantify indicators at the sub-national level, if national-level indicators exist?
What do environmental exposure indicators mean beyond the local level, where people are affected?
Such questions indicate a need to address issues relating to the requirements and use of local-level information. Other questions were of a more technical nature, for example:
What is the health impact in terms of morbidity and mortality of a given environmental exposure?
How does the impact vary according to age, gender, geographical location and socio-economic group?
How are environmental health problems ranked and prioritised at the local level?
Further questions referred to policy and decision-making issues, for example:
How does the environmental health decision-making process operate locally?
How are locally collected data transformed into information and used in decision-making, or if such information is not used, what are the reasons?
This book addresses these and other related issues. It proposes a model for decision-making in environmental health based on the involvement of relevant stakeholders and the use of scientifically sound data and appropriate analytical methods. It also proposes a framework for understanding