Environmental pollution, health, and development: a Lancet–Global Alliance on Health and Pollution–Icahn School of Medicine at Mount Sinai Commission
2015; Elsevier BV; Volume: 386; Issue: 10002 Linguagem: Inglês
10.1016/s0140-6736(15)00426-2
ISSN1474-547X
AutoresPhilip J. Landrigan, Richard Fuller, Richard Horton,
Tópico(s)Global Public Health Policies and Epidemiology
ResumoEnvironmental pollution is a large, costly, inequitably distributed, and preventable cause of disease and death in countries around the world. The links between pollution and health, while very strong, have been insufficiently appreciated in the global health agenda, and the international and domestic resources allocated to pollution control have not been commensurate with the great magnitude of the problem.WHO estimates that, in 2012, household air pollution caused 4·3 million deaths, ambient air pollution caused 3·7 million deaths, and unsafe water, poor sanitation, and inadequate hygiene caused 842 000 deaths.1WHOBurden of disease from household air pollution for 2012. World Health Organization, Geneva2014http://www.who.int/phe/health_topics/outdoorair/databases/FINAL_HAP_AAP_BoD_24March2014.pdf?ua=1Google Scholar, 2WHOBurden of disease from ambient air pollution. Global Health Observatory Data.http://www.who.int/gho/phe/outdoor_air_pollution/burden_text/en/Date: 2014Google Scholar, 3WHOPreventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries. World Health Organization, Geneva2014http://www.who.int/water_sanitation_health/gbd_poor_water/en/Google Scholar Contaminated soil at active and abandoned mines, smelters, industrial facilities, and hazardous waste sites has killed tens of thousands of people and injured hundreds of thousands more.4Chatham-Stephens K Caravanos J Ericson B et al.Burden of disease from toxic waste sites in India, Indonesia, and the Philippines in 2010.Environ Health Perspect. 2010; 121: 791-796Crossref Scopus (45) Google Scholar By contrast, HIV/AIDS causes 1·5 million deaths per year, tuberculosis 1·2 million deaths per year, and malaria fewer than 1 million deaths per year.5WHODeaths: estimated deaths, data by region. Global Health Observatory Data Repository. World Health Organization, Geneva2014http://apps.who.int/gho/data/node.mainGoogle ScholarThe health effects of pollution fall most heavily upon the world's poor,6Laudato Si'Encyclical letter on care for our common home. The Holy See, Vatican City2015Google Scholar and more than 90% of pollution-related deaths occur in low-income and middle-income countries (LMICs).1WHOBurden of disease from household air pollution for 2012. World Health Organization, Geneva2014http://www.who.int/phe/health_topics/outdoorair/databases/FINAL_HAP_AAP_BoD_24March2014.pdf?ua=1Google Scholar, 2WHOBurden of disease from ambient air pollution. Global Health Observatory Data.http://www.who.int/gho/phe/outdoor_air_pollution/burden_text/en/Date: 2014Google Scholar, 3WHOPreventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries. World Health Organization, Geneva2014http://www.who.int/water_sanitation_health/gbd_poor_water/en/Google ScholarIn the world's poorest countries, household air pollution and contaminated drinking water are long-established forms of pollution. In rapidly developing countries, however, ambient air pollution, toxic chemicals, and pesticides are emerging as environmental hazards. These forms of pollution are linked to non-communicable diseases, such as asthma, neurodevelopmental disorders, and birth defects among children and heart disease, stroke, and cancer in adults.Toxic chemicals have become an increasingly important component of pollution in LMICs.7Laborde A Tomasina F Bianchi F et al.Children's health in Latin America: the influence of environmental exposures.Environ Health Perspect. 2015; 123: 201-209PubMed Google Scholar Economic growth, production outsourcing, and the relocation of chemical manufacture, recycling, shipbreaking, and other heavy industries to LMICs are driving this trend. In poor countries without environmental controls or public health infrastructure, environmental degradation and disease result. Examples include the export to poor countries of 2 million tons per year of newly mined asbestos;8Frank A Joshi TK The global spread of asbestos.Ann Glob Health. 2014; 80: 257-262Summary Full Text Full Text PDF Scopus (110) Google Scholar lead exposure from backyard battery recycling;9Haefliger P Mathieu-Nolf M Lociciro S et al.Mass lead intoxication from informal used lead-acid battery recycling in Dakar, Senegal.Environ Health Perspect. 2009; 117: 1535-1540Crossref PubMed Scopus (151) Google Scholar mercury contamination from artisanal gold mining;10Wade L Mercury pollution: gold's dark side.Science. 2013; 347: 1448-1449Crossref Scopus (26) Google Scholar and the global trade in banned pesticides.11United NationsFood and Agriculture OrganizationPrevention and disposal of obsolete pesticides.http://www.fao.org/agriculture/crops/obsolete-pesticides/why-problem/pesticide-bans/en/Google ScholarSubstantial economic costs arise from the diseases caused by pollution in LMICs. Alongside medical care and health-care system costs, there are opportunity costs related to the diminished productivity of populations damaged by pollution. In the USA, the annual cost of diseases among children caused by environmental pollution was about US$76·6 billion in 2008.12Trasande L Liu Y Reducing the staggering costs of environmental disease in children, estimated at $76·6 billion in 2008.Health Aff (Millwood). 2011; 30: 863-870Crossref PubMed Scopus (126) Google ScholarThe good news is that pollution can be prevented. Pollution is not the inevitable consequence of economic development. In high-income countries, cost-effective and replicable control strategies have been developed for many of the worst pollution problems. These strategies rely on a combination of technological and legal approaches. The most effective strategies, such as the removal of lead from gasoline, stack scrubbers, and national bans on asbestos, contain pollution at source and have yielded great health and economic benefits.13Grosse SD Matte TD Schwartz J Jackson RJ Economic gains resulting from the reduction in children's exposure to lead in the United States.Environ Health Perspect. 2002; 110: 563-569Crossref PubMed Scopus (245) Google Scholar Investment in pollution-control strategies will enable emerging economies to leapfrog over the mistakes of the past.Despite its huge human and economic costs and proven amenability to control, environmental pollution has received little international development assistance. This neglect reflects an absence, until recently, of robust information on the magnitude of the health and economic effects of pollution, as well as fragmentation of the pollution agenda into diverse topics—eg, chemicals, hazardous waste, toxic chemicals, urban air, cook stoves, and sanitation.The Lancet, in partnership with the Global Alliance on Health and Pollution and the Icahn School of Medicine at Mount Sinai in New York, NY, USA, is launching a Commission on Pollution, Health, and Development. The Commissioners are drawn from academia, government, and international agencies in diverse countries and have a broad range of backgrounds, including medicine, economics, policy, and engineering. The work of the Commission is expected to last for about 18 months.The Commissioners will develop robust and scientifically credible analyses that quantify the effects of pollution on health, economics, and development. They will analyse past successes in pollution control to seek cost-effective solutions for the future. Their work will build on recent scholarship improving quantification of the health effects of pollution, on advances in environmental economics, and on previous Lancet Commissions, notably those on investing in health,14Jamison DT Summers LH Alleyne G et al.Global health 2035: a world converging within a generation.Lancet. 2013; 382: 1898-1955Summary Full Text Full Text PDF PubMed Scopus (767) Google Scholar the political origins of health inequity,15Ottersen OP Dasgupta J Blouin C et al.The political origins of health inequity: prospects for change.Lancet. 2014; 383: 630-667Summary Full Text Full Text PDF PubMed Scopus (339) Google Scholar climate change,16Watts N Adger WN Agnolucci P et al.Health and climate change: policy responses to protect public health.Lancet. 2015; (published online June 23.)http://dx.doi.org/10.1016/S0140-6736(15)60854-6Google Scholar and planetary health.17Whitmee S Haines A Beyrer C et al.Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health.Lancet. 2015; (published online July 16.)http://dx.doi.org/10.1016/S0140-6736(15)60901-1PubMed Google ScholarThe Commission will make recommendations and will seek to inform heads of state, global funders, and other key decision makers about the enormous scale of pollution and the great magnitude of its health and economic effects. It will explore the links between pollution and global climate change. It will argue that widespread pollution undermines societal development and inequitably condemns future generations in LMICs to an endless cycle of poverty and poor health that, in turn, encourages social unrest, war, and migration.The Commission will urge national leaders in LMICs to break this cycle by adopting a trans-sectoral approach to pollution control that works across government agencies and joins health with environment, finance, transportation, urban planning, and education.The Commission will educate global donors, both governmental and private, that controlling pollution is an effective way to reduce burden of disease, accelerate national development, and enhance return on development investment.Pollution is a problem that can be solved in our lifetime. The Commission will lay the foundation for its solution by defining pollution's many effects on health, economics, and development and then presenting this information to world leaders. The Commission's ultimate goal is to raise the priority of pollution control in the international development agenda, and thus increase the resources allocated to this pressing global health problem.We declare no competing interests. PJL and RF are Co-Chairs of the Lancet–Global Alliance on Health and Pollution–Icahn School of Medicine at Mount Sinai Commission on Pollution, Health, and Development. The Commissioners are: Neric Acosta (Philippines), Robert Arnold (USA), Kenneth J Arrow (USA), Siti Nurbaya Bakar (Indonesia), Li Bingbing (China), Palaniappan Chidambaram (India), Thomas C Chiles (USA), Richard Fuller (USA), Michael Greenstone (USA), David Hunter (USA), Philip Landrigan (USA), Bindu N Lohani (Philippines), Keith Martin (Canada), Karen Mathiasen (USA), Christopher J L Murray (USA), Ramon Paje (Philippines), Frederica P Perera (USA), Janez Potočnik (Slovenia), Jairam Ramesh (India), Johan Rockström (Sweden), Carlos Salinas G (Mexico), Aitkul Samakova (Kazakhstan), Leona D Samson (USA), Peter Sly (Australia), Kirk R Smith (USA), Achim Steiner (Kenya), Richard B Stewart (USA), William Suk (USA), Chulabhorn Mahidol (Thailand), and Ma Zhong (China). Environmental pollution is a large, costly, inequitably distributed, and preventable cause of disease and death in countries around the world. The links between pollution and health, while very strong, have been insufficiently appreciated in the global health agenda, and the international and domestic resources allocated to pollution control have not been commensurate with the great magnitude of the problem. WHO estimates that, in 2012, household air pollution caused 4·3 million deaths, ambient air pollution caused 3·7 million deaths, and unsafe water, poor sanitation, and inadequate hygiene caused 842 000 deaths.1WHOBurden of disease from household air pollution for 2012. World Health Organization, Geneva2014http://www.who.int/phe/health_topics/outdoorair/databases/FINAL_HAP_AAP_BoD_24March2014.pdf?ua=1Google Scholar, 2WHOBurden of disease from ambient air pollution. Global Health Observatory Data.http://www.who.int/gho/phe/outdoor_air_pollution/burden_text/en/Date: 2014Google Scholar, 3WHOPreventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries. World Health Organization, Geneva2014http://www.who.int/water_sanitation_health/gbd_poor_water/en/Google Scholar Contaminated soil at active and abandoned mines, smelters, industrial facilities, and hazardous waste sites has killed tens of thousands of people and injured hundreds of thousands more.4Chatham-Stephens K Caravanos J Ericson B et al.Burden of disease from toxic waste sites in India, Indonesia, and the Philippines in 2010.Environ Health Perspect. 2010; 121: 791-796Crossref Scopus (45) Google Scholar By contrast, HIV/AIDS causes 1·5 million deaths per year, tuberculosis 1·2 million deaths per year, and malaria fewer than 1 million deaths per year.5WHODeaths: estimated deaths, data by region. Global Health Observatory Data Repository. World Health Organization, Geneva2014http://apps.who.int/gho/data/node.mainGoogle Scholar The health effects of pollution fall most heavily upon the world's poor,6Laudato Si'Encyclical letter on care for our common home. The Holy See, Vatican City2015Google Scholar and more than 90% of pollution-related deaths occur in low-income and middle-income countries (LMICs).1WHOBurden of disease from household air pollution for 2012. World Health Organization, Geneva2014http://www.who.int/phe/health_topics/outdoorair/databases/FINAL_HAP_AAP_BoD_24March2014.pdf?ua=1Google Scholar, 2WHOBurden of disease from ambient air pollution. Global Health Observatory Data.http://www.who.int/gho/phe/outdoor_air_pollution/burden_text/en/Date: 2014Google Scholar, 3WHOPreventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries. World Health Organization, Geneva2014http://www.who.int/water_sanitation_health/gbd_poor_water/en/Google Scholar In the world's poorest countries, household air pollution and contaminated drinking water are long-established forms of pollution. In rapidly developing countries, however, ambient air pollution, toxic chemicals, and pesticides are emerging as environmental hazards. These forms of pollution are linked to non-communicable diseases, such as asthma, neurodevelopmental disorders, and birth defects among children and heart disease, stroke, and cancer in adults. Toxic chemicals have become an increasingly important component of pollution in LMICs.7Laborde A Tomasina F Bianchi F et al.Children's health in Latin America: the influence of environmental exposures.Environ Health Perspect. 2015; 123: 201-209PubMed Google Scholar Economic growth, production outsourcing, and the relocation of chemical manufacture, recycling, shipbreaking, and other heavy industries to LMICs are driving this trend. In poor countries without environmental controls or public health infrastructure, environmental degradation and disease result. Examples include the export to poor countries of 2 million tons per year of newly mined asbestos;8Frank A Joshi TK The global spread of asbestos.Ann Glob Health. 2014; 80: 257-262Summary Full Text Full Text PDF Scopus (110) Google Scholar lead exposure from backyard battery recycling;9Haefliger P Mathieu-Nolf M Lociciro S et al.Mass lead intoxication from informal used lead-acid battery recycling in Dakar, Senegal.Environ Health Perspect. 2009; 117: 1535-1540Crossref PubMed Scopus (151) Google Scholar mercury contamination from artisanal gold mining;10Wade L Mercury pollution: gold's dark side.Science. 2013; 347: 1448-1449Crossref Scopus (26) Google Scholar and the global trade in banned pesticides.11United NationsFood and Agriculture OrganizationPrevention and disposal of obsolete pesticides.http://www.fao.org/agriculture/crops/obsolete-pesticides/why-problem/pesticide-bans/en/Google Scholar Substantial economic costs arise from the diseases caused by pollution in LMICs. Alongside medical care and health-care system costs, there are opportunity costs related to the diminished productivity of populations damaged by pollution. In the USA, the annual cost of diseases among children caused by environmental pollution was about US$76·6 billion in 2008.12Trasande L Liu Y Reducing the staggering costs of environmental disease in children, estimated at $76·6 billion in 2008.Health Aff (Millwood). 2011; 30: 863-870Crossref PubMed Scopus (126) Google Scholar The good news is that pollution can be prevented. Pollution is not the inevitable consequence of economic development. In high-income countries, cost-effective and replicable control strategies have been developed for many of the worst pollution problems. These strategies rely on a combination of technological and legal approaches. The most effective strategies, such as the removal of lead from gasoline, stack scrubbers, and national bans on asbestos, contain pollution at source and have yielded great health and economic benefits.13Grosse SD Matte TD Schwartz J Jackson RJ Economic gains resulting from the reduction in children's exposure to lead in the United States.Environ Health Perspect. 2002; 110: 563-569Crossref PubMed Scopus (245) Google Scholar Investment in pollution-control strategies will enable emerging economies to leapfrog over the mistakes of the past. Despite its huge human and economic costs and proven amenability to control, environmental pollution has received little international development assistance. This neglect reflects an absence, until recently, of robust information on the magnitude of the health and economic effects of pollution, as well as fragmentation of the pollution agenda into diverse topics—eg, chemicals, hazardous waste, toxic chemicals, urban air, cook stoves, and sanitation. The Lancet, in partnership with the Global Alliance on Health and Pollution and the Icahn School of Medicine at Mount Sinai in New York, NY, USA, is launching a Commission on Pollution, Health, and Development. The Commissioners are drawn from academia, government, and international agencies in diverse countries and have a broad range of backgrounds, including medicine, economics, policy, and engineering. The work of the Commission is expected to last for about 18 months. The Commissioners will develop robust and scientifically credible analyses that quantify the effects of pollution on health, economics, and development. They will analyse past successes in pollution control to seek cost-effective solutions for the future. Their work will build on recent scholarship improving quantification of the health effects of pollution, on advances in environmental economics, and on previous Lancet Commissions, notably those on investing in health,14Jamison DT Summers LH Alleyne G et al.Global health 2035: a world converging within a generation.Lancet. 2013; 382: 1898-1955Summary Full Text Full Text PDF PubMed Scopus (767) Google Scholar the political origins of health inequity,15Ottersen OP Dasgupta J Blouin C et al.The political origins of health inequity: prospects for change.Lancet. 2014; 383: 630-667Summary Full Text Full Text PDF PubMed Scopus (339) Google Scholar climate change,16Watts N Adger WN Agnolucci P et al.Health and climate change: policy responses to protect public health.Lancet. 2015; (published online June 23.)http://dx.doi.org/10.1016/S0140-6736(15)60854-6Google Scholar and planetary health.17Whitmee S Haines A Beyrer C et al.Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health.Lancet. 2015; (published online July 16.)http://dx.doi.org/10.1016/S0140-6736(15)60901-1PubMed Google Scholar The Commission will make recommendations and will seek to inform heads of state, global funders, and other key decision makers about the enormous scale of pollution and the great magnitude of its health and economic effects. It will explore the links between pollution and global climate change. It will argue that widespread pollution undermines societal development and inequitably condemns future generations in LMICs to an endless cycle of poverty and poor health that, in turn, encourages social unrest, war, and migration. The Commission will urge national leaders in LMICs to break this cycle by adopting a trans-sectoral approach to pollution control that works across government agencies and joins health with environment, finance, transportation, urban planning, and education. The Commission will educate global donors, both governmental and private, that controlling pollution is an effective way to reduce burden of disease, accelerate national development, and enhance return on development investment. Pollution is a problem that can be solved in our lifetime. The Commission will lay the foundation for its solution by defining pollution's many effects on health, economics, and development and then presenting this information to world leaders. The Commission's ultimate goal is to raise the priority of pollution control in the international development agenda, and thus increase the resources allocated to this pressing global health problem. We declare no competing interests. PJL and RF are Co-Chairs of the Lancet–Global Alliance on Health and Pollution–Icahn School of Medicine at Mount Sinai Commission on Pollution, Health, and Development. The Commissioners are: Neric Acosta (Philippines), Robert Arnold (USA), Kenneth J Arrow (USA), Siti Nurbaya Bakar (Indonesia), Li Bingbing (China), Palaniappan Chidambaram (India), Thomas C Chiles (USA), Richard Fuller (USA), Michael Greenstone (USA), David Hunter (USA), Philip Landrigan (USA), Bindu N Lohani (Philippines), Keith Martin (Canada), Karen Mathiasen (USA), Christopher J L Murray (USA), Ramon Paje (Philippines), Frederica P Perera (USA), Janez Potočnik (Slovenia), Jairam Ramesh (India), Johan Rockström (Sweden), Carlos Salinas G (Mexico), Aitkul Samakova (Kazakhstan), Leona D Samson (USA), Peter Sly (Australia), Kirk R Smith (USA), Achim Steiner (Kenya), Richard B Stewart (USA), William Suk (USA), Chulabhorn Mahidol (Thailand), and Ma Zhong (China).
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