Mortality and burden of disease from unhealthy environments: In 2016, 13.7 million people died as a result of living or working in an unhealthy environment, representing 24% of all deaths. When accounting for both death and disability, the fraction of the global burden of disease due to the environment is 23%. In children under five years, up to 28% of all deaths could be prevented, if environmental risks were removed. 68% of these attributable deaths and 51% of attributable DALYs could be estimated with evidence-based comparative risk assessment methods, the impacts of other environmental exposures were assessed through expert opinion.

The WHO report on the burden of disease from environmental risks analysed the 133 diseases listed in the WHO’s Global Health Observatory and found 101 linked to the environment.

# An estimated 12.6 million deaths each year are attributable to unhealthy environments
# 24% of all estimated global deaths are linked to the environment ...That’s roughly 13.7 million deaths a year
# Children under five and adults between 50 and 75 years old are most affected by the environment.
# Low- and middle-income countries bear the greatest share of environmental disease.
# In 2016, household air pollution was responsible for 3.8 million deaths, and 7.7% of the global mortality

This report presents a wide-ranging assessment and detailed findings to show by how much and in what ways improving the environment can promote health and well-being.
The realization of just how much disease and ill health can be prevented by focusing on environmental risk factors should add impetus to global efforts to encourage preventive health measures through all available policies, strategies, interventions, technologies and knowledge.
Armed with the evidence of what is achievable – and needed – health-care policy-makers and practitioners alike should be encouraged in their efforts to promote healthy environments.

Our evolving knowledge about environment-health interactions will support the design of moreeffective preventive public health strategies and interventions, directed at eliminating health hazards and reducing corresponding risks to health. The report’s findings result from a systematic process: literature reviews for all the disease categories addressed; compilation of available risk factor-disease estimates; and surveys of more than 100 experts worldwide. The best available scientific evidence together with approximations and expert evaluations for knowledge gaps are combined to provide up-todate estimates. The data and methods underlying the health statistics for the previous and current editions have, however, undergone major modifications, and thus the trend analysis is restricted to selected parameters.

Findings confirm that 23% of global deaths and 26% of deaths among children under five are due to modifiable environmental factors. Heading this list are stroke, ischaemic heart disease, diarrhoea and cancers. ( see infographic).This environmentally mediated disease burden is much higher in lower income countries with the exception of certain noncommunicable diseases, such as cardiovascular diseases and cancers, where the per capita disease burden is greater in the developed world.

Crucially, the report strongly supports the notion that the environment is a sound platform for good public, community and individual health. Many measures can be taken immediately to reduce the disease burden attributable to environmental determinants. Examples include the promotion of safer household water storage and better hygiene measures, the use of cleaner fuels and safer, more judicious use and management of toxic substances at home
and in the workplace, and occupational safety and health measures. At the same time, actions by sectors such as energy, transport, agriculture and industry are vital, in cooperation with the health sector, to address the root environmental causes of ill health.

Thus, actions do not need to come from health alone, but rather from all sectors making decisions which impact on environmental determinants of health. Acting together on coordinated health, environment and development policies can strengthen and sustain improvements to human well-being and quality of life via multiple social and economic co-benefits. Repositioning the health sector to work more intersectorally on effective preventive health policies is the way forward to address environmental causes of disease and injury, and, ultimately, in transforming the global burden of disease.