Sep 24 - 30, 2007

Epidemiological analysis is primarily conducted to answer questions such as who is affected by a particular disturbance in any field; in what circumstances, under what conditions, at what times; and what factors are associated with their occurrence.

A healthy population is not only valued in its own right, but it also raises the human capital of a country thereby positively contributing to the economic and social development. The term health has a greater scope as it has been beautifully appraised in the Economic Survey of Pakistan for the year 2006-07 that "health is a vital component of a good quality of life". That is why access to good health is recognized as a basic human need and a fundamental human right. The WHO's definition of health as "a state of complete physical, mental and social well being and not merely the absence of disease or infirmity" applies to all human beings regardless of age gender, nationality and culture. Inequalities and deficiencies in health thus affect the well being of an individual and welfare of a society as a whole.

All developing and developed countries of the world now recognize the importance of incorporating environmental concerns being a part and parcel of social well being phenomena. In Pakistan, the environmental degradation is intrinsically linked to poverty because of the overwhelming dependence of the poor on natural resources for their livelihoods-whether agriculture, forestry, fisheries, hunting etc. Poverty combined with a burgeoning population and rapid urbanization, is leading to intense pressures on the environment. To arrive at sustainable solutions to environmental problems, this "environment poverty nexus" needs to be addressed. Apart from socio economic significance of health, a right based approach has remained an integral part of all Governmentís overall policies.

The Environmental issues cover a whole bunch of areas that need to be addressed in any particular health policy of a country. However the following are the main avenues of environmental risks have been discussed by the World Health Organization that needs to be treated:

* Risk of Accidents and Injuries: Each year around 400,000 people are affected by unintentional injuries around the world. Most of such injuries occur in developing countries. Many of such injured persons survive for life long disabilities. Regulatory measures, environmental changes, and education can play a crucial role in the prevention of injuries and accidents. However, the most successful interventions are those where these three approaches are combined.

* Risk of Air pollution: It is a major environment-related health threat and a risk factor for both acute and chronic respiratory disease. While second-hand tobacco smoke and certain outdoor pollutants are known risk factors for acute respiratory infections, indoor air pollution from biomass fuel is one of the major contributors to the global burden of disease. Air pollution primarily has two types which are indoor and outdoor air pollution. The indoor pollution is caused by indoor cooking and heating with biomass fuels (agricultural residues, dung, straw, and wood) or coal produces high levels of indoor smoke that contains a variety of health-damaging pollutants whereas outdoor pollution is largely and increasingly a consequence of the combustion of fossil fuels for transport, power generation and other human activities.

* Risk of Addictive Substances: People around the world use a variety of addictive substances. These addictive substances are primarily of three types: .

1. Smoking and Oral Tobacco Use: Smoking causes substantially increased risk of mortality from lung cancer, upper aerodigestive cancer, several other cancers, heart disease, stroke, chronic respiratory disease and a range of other medical causes. The rapid evolution of the tobacco epidemic is illustrated by comparing these estimates for 2000 with those for 1990: there are at least a million more deaths attributable to tobacco, with the increase being most marked in developing countries.

2. Alcohol Use: Alcohol has been consumed in human populations for millennia, but the considerable and varied adverse health effects, as well as some benefits, have only been characterized recently. Worldwide, alcohol causes 3.2% of deaths (1.8 million).However, the mortality due to alcohol is much higher in developed countries where in the Americas and Europe, where it ranges from 8% to 18% of total burden for males and 2% to 4% for females.

3. Illicit Drug Use: Illicit drug use includes the non-medical use of a variety of drugs that are prohibited by international law. The mortality risks of illicit drugs increase with frequency and quantity of use. Globally, 0.4% of deaths (0.2 million) are attributed to overall illicit drug use. Attributable burden is consistently several times higher among men than women.

* Selected Occupational Risks: Throughout the world many adults, and some children, spend most waking hours at work. While at work, people face a variety of hazards almost as numerous as the different types of work, including chemicals, biological agents, physical factors, adverse ergonomic conditions, allergens, a complex causal network of safety risks, and many and varied psychosocial factors. These may produce a wide range of health outcomes, including injuries, cancer, hearing loss, and respiratory, musculoskeletal, cardiovascular, reproductive, neurotoxic, skin and psychological disorders.

* Risk of Unsafe Water, Sanitation and Hygiene: Adverse health outcomes are associated with ingestion of unsafe water, lack of access to water (linked to inadequate hygiene), lack of access to sanitation, contact with unsafe water, and inadequate management of water resources and systems, including in agriculture. Infectious diarrhoea makes the largest single contribution to the burden of disease associated with unsafe water, sanitation and hygiene. Six broad scenarios were characterized; these included populations with no access to improved water sources or no basic sanitation; those with access to fully regulated water supply and sanitation services; and an ideal scenario in which no disease transmission is associated with this risk factor.

* Risk of Climate Change: Humans are accustomed to climatic conditions varying daily, seasonally and yearly. The recent concern over global climate change arises from accumulating evidence that, in addition to this natural climate variability, average climatic conditions measured over extended periods (conventionally 30 years or longer) are now also changing. The most recent report (2001) from the United Nations Intergovernmental Panel on Climate Change (IPCC) estimates that the global average land and sea surface temperature has increased by 0.6 0.2 C since the mid-19th century, with most change occurring since 1976. The 1990s was the warmest decade on record. Warming has been observed in all continents, with the greatest temperature changes occurring at middle and high latitudes in the northern hemisphere. Patterns of precipitation have also changed: arid and semiarid regions are apparently becoming drier, while other areas, especially mid-to-high latitudes, are becoming wetter.

* The Joint Effects of Selected Risk Factors: The multicausal nature of disease often provides a choice among different preventive strategies and offers great potential benefit from simultaneous interventions. For example, modest reductions in blood pressure, obesity, cholesterol and tobacco use would more than halve cardiovascular disease incidence, if these reductions were population-wide and simultaneous. The distribution of risks across levels of poverty as referred here in above, both within and between regions, suggests they are likely to explain a large proportion of current inequity in healthy life expectancy. The multicausal nature of many diseases means that tackling major risks at a population-wide level offers opportunities to lessen these differentials, whatever their initial cause. The Commission on Macroeconomics and Health recently estimated that a 10% increase in life expectancy might increase GDP by 0.3% in the poorest countries of the world. It is clear that many different combinations of reductions in these major risks could increase healthy life expectancy by at least 10% in these countries, especially if they were simultaneous and population-wide.