A Burden of Disease Approach to Prioritizing Environmental Policy Initiatives: A Case Study in the Middle East

Abstract

completed a 2.5-year project to advise a rapidly developing Middle Eastern nation on strategies for reducing environmental risks to public health. The project design, which combined quantitative risk assessment with structured stakeholder engagement, provides a possible template for a strategic assessment of environmental effects on North Carolina medical care costs.A n interdisciplinary team from the University of North Carolina (UNC)-Chapel Hill Gillings School of Global Public Health recently completed a 2.5-year, multimilliondollar project to advise a rapidly developing Middle Eastern nation on strategies for reducing its environmental burden of disease. For this project, we quantified the annual number of deaths and medical visits attributable to environmental risk factors in the sponsoring nation. Risk factors included outdoor air and indoor air pollution, drinking water and surface water contamination, heavy metals in seafood, pesticides on crops, workplace chemicals, leaking waste sites, electromagnetic fields, ozone-layer depletion, nonionizing radiation, and climate change. We then engaged local stakeholders in prioritizing risks on the basis of our quantitative assessments. We guided stakeholders in identifying and evaluating potential interventions and developing a comprehensive strategic plan for the highest-priority risks.The methods we developed could serve as the basis for a similar project in North Carolina. A North Carolina environmental health strategic-planning exercise could identify ways to reduce state medical costs through improved environmental interventions.This article describes how UNC-Chapel Hill became involved in this project, how we quantified the environmental burden of disease, and how we engaged stakeholders in prioritizing risks and interventions. Because of recent political changes in the Middle East, the leaders who commissioned our work wish to remain anonymous. Although they are proud of the results, they have requested that we not reveal details about their identities at this time.