Improving and Expanding Estimates of the Global Burden of Disease Due to Environmental Health Risk Factors

Abstract

Background:The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation (IHME), produces influential, data-driven estimates of the burden of disease and premature death due to major risk factors. Expanded quantification of disease due to environmental health (EH) risk factors, including climate change, will enhance accuracy of GBD estimates, which will contribute to developing cost-effective policies that promote prevention and achieving Sustainable Development Goals.Objectives:We review key aspects of the GBD for the EH community and introduce the Global Burden of Disease–Pollution and Health Initiative (GBD-PHI), which aims to work with IHME and the GBD study to improve estimates of disease burden attributable to EH risk factors and to develop an innovative approach to estimating climate-related disease burden—both current and projected.Methods:We discuss strategies for improving GBD quantification of specific EH risk factors, including air pollution, lead, and climate change. We highlight key methodological challenges, including new EH risk factors, notably evidence rating and global exposure assessment.Discussion:A number of issues present challenges to the scope and accuracy of current GBD estimates for EH risk factors. For air pollution, minimal data exist on the exposure–risk relationships associated with high levels of pollution; epidemiological studies in high pollution regions should be a research priority. For lead, the GBD’s current methods do not fully account for lead’s impact on neurodevelopment; innovative methods to account for subclinical effects are needed. Decisions on inclusion of additional EH risk–outcome pairs need to be guided by findings of systematic reviews, the size of exposed populations, feasibility of global exposure estimates, and predicted trends in exposures and diseases. Neurotoxicants, endocrine-disrupting chemicals, and climate-related factors should be high priorities for incorporation into upcoming iterations of the GBD study. Enhancing the scope and methods will improve the GBD’s estimates and better guide prevention policy. https://doi.org/10.1289/EHP5496

The role of burden of disease assessment in tracking progress towards achieving WHO global air quality guidelines

“…These discrepancies are due to changes in population and demographic characteristics, true exposures and exposure assessment methods used and epidemiological evidence (Ostro et al 2018 ; HEI 2019 ). Recent studies discuss the status of the current risk functions, identify the key uncertainties in the current GBD estimates and recommend solutions (Pope et al 2018 ; Burnett and Cohen 2020 ; Shaffer et al 2019 ). IHME and WHO provide a unified approach to exposure assessment for BoD estimation and have agreed to produce a single GBD Study with the aim of fully unifying methods in the spirit of the WHO/IHME collaboration ( Tichenor and Sridhar 2019 ) .…”

“…BoD calculations must be interpreted carefully because their methodology can be subject to limitations (Cohen et al 2017 ; Shaffer et al 2019 ). Recent evidence has shown that apart from cardiovascular and lung diseases, metabolic and other diseases are also associated with air pollution (Thurston et al 2017 ).…”

New Approaches to Identifying and Reducing the Global Burden of Disease From Pollution

“…This report highlights global research showing that pollution alone kills 9 million people every year (Landrigan et al, 2017), 15 times more deaths than from all wars and violence combined. The quality of air, water, and land is diminishing in many parts of the world because of increasing global pollution (Landrigan et al, 2017;Shaffer et al, 2019), and this degradation is being borne disproportionately by poorer nations without adequate environmental protections in place for their pollutions (Myers et al, 2017). Much of this pollution has a long lifespan in the environment, and thus, if a pollution revolution occurs tomorrow, the legacy contaminants will remain in our environment for centuries (Filippelli, 2018).…”

Materials for CO2, SOx, and NOx Emission Reduction

“…To solve global problems associated with population growth, such as climate change, loss of biodiversity, and environmental pollution, a radical transformation of the economy is needed, primarily related to energy. It has been established that prolonged exposure to air pollution leads to acute respiratory inflammation, asthma attacks, and death from cardiorespiratory diseases [2,[5][6][7]. However, the global economy is still dependent on hydrocarbons and the use of fossil fuels.…”

“…Today, air pollutionboth ambient (outdoors) and household (indoors)poses the greatest health risk. Experts believe that as a result of poor air quality, one out of every nine people dies annually [2,3]. Pollution of the surrounding outdoor air alone kills about three million people each year, mainly from non-communicable diseases.…”