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Attaining Health Millennium Development Goals (MDG) through Healthy Environment__________________________
Melvin B. Marzan, RNM Sc Tropical Medicine II
University of the East Ramon Magsaysay Medical CenterGraduate School
Section A: Millennium Development Goals (MDGs)_________________________
The 1990s: a decade of faltering progressprogress continued… but too slowly to reach agreed targets… and slowing down
Why the MDGs ?
Under-5 mortality rate Maternal mortality rate Child malnutrition Water and sanitation Income poverty Primary education
MDGs are meant to accelerate progress…
?What are the MDGs
? MDGs were set by all Government leaders at the UN Millennium Summit, September 2000)
? All UN organisations decided to be guided by MDGs in their future action: unity of purpose, coherent action, synergies and strategic approaches by the UN system as a whole (guided by CEB)
? Leaders pledged to strive, individually and collectively, towards these goals through international, regional and national action, concerted by the UN.
MDGs are a combination of…
Millennium Goals …– Emanate from UN Summits and Conferences of the 1990s…– … proposed in the UN Secretary-General’s Millennium Report: « We, the peoples: the role of the United Nations in the 21st century »
– … and endorsed in the United Nations Millennium Declaration (8 September 2000)
7 areas explicitly addressed in the Millennium Declaration:• Peace, security and disarmament• Development and poverty eradication• Protecting our common environment• Human rights, democracy and good governance• Protecting the vulnerable• Meeting the special needs of Africa• Strengthening the United Nations
MDGs are a combination of…
… and of International Development Goals (IDGs)
• For several of these key areas, specific indicators were included in the Millennium Declaration – constituting the international development goals (IDG)
• Subsequently, IDGs from other declarations were combined and harmonised with the IDGs set in the Millennium Declaration goals
• The resulting set of goals, numerical targets and quantifiable indicators to assess progress constitute the Millennium Development Goals…
• … presented in the SG’s “Road map towards the implementation of the United Nations Millennium Declaration” (September 2001)
Goal 1:Eradicate Extreme Poverty and Hunger
Goal 2: Achieve Universal Primary Education
Goal 3: Promote Gender Equality and Empower Women
Goal 4: Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6: Combat HIV, Malaria and other diseases
Goal 7: Ensure Environmental Sustainability
Millennium Development Goals
Goal 4: Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6: Combat HIV/AIDS, Malaria and other diseases
Health MDGs
Section B:Progressing Towards Health Related (MDGs) by means of Environmental Health_________________________
Environment in the Context of Health
In the medical sense, Environment includes the surroundings, conditions or influences that affect an organism (Davis, 1989)
“All of which is external to the human host. Can be divided into physical, biological, social, cultural, etc., any or all of which can influence health status of populations…”
-International Epidemiological Association (2001)
Definition of Environment
Definition of Environment
Environmental Health
Environmental Health
MDGs Environmental Health Components
• Goal 4: Reduce Child Mortality– Mortality rate in children <5 yrs. from
environmentally-mediated disease conditions is 180 times higher in the poorest performing region, as compared to the rate in progressive countries
– In terms of diarrhea and lower respiratory infections, two of the most significant childhood killers, environmental interventions could prevent the deaths of over 2 million children under age of five every year
MDGs Environmental Health Components
• Goal 5: Improve Maternal Health– Environmental Health interventions can
contribute to this MDG by providing a safe home environment, which is of great importance to the health of children and pregnant mothers. Conversely, a contaminated home environment is a threat to the mother and her unborn child.
MDGs Environmental Health Components
• Goal 6: Combat HIV/AIDS, Malaria and Other Diseases– Results of the Study done by the WHO indicate
that over half a million people die every year from malaria and over a quarter of a million people die from HIV/AIDS, as a result of environmental and occupational cause. A large proportion of malaria, in particular, may be attributable to readily modifiable factors, such as land use, irrigation and agricultural practices.
Section C: MDG Goal 4 (Reduce Child Mortality)_________________________
Life expectancy
… is the average
lifespan a newborn can expect
… is short when
child deaths are common
20 000 $2000 $200 $Income per person (comparable dollars per year)
100
80
60
40
20
0
Life
exp
ecta
ncy
(yea
rs)
1000
100
1Population(millions)
50 years
Burundi
81 years
Sweden
20 000 $2000 $200 $
Income per person (comparable dollars per year)
100
80
60
40
20
0
Life
exp
ecta
ncy
(yea
rs)
1000
100
1Population(millions)
50 yearsBurundi
Burundi
C a n y o u g e t o l d i n B u r u n d i ?
200720 000 $2000 $200 $
Income per person (comparable dollars per year)
100
80
60
40
20
0
Age
(yea
rs)
Life
exp
ecta
ncy
(yea
rs)
50 years
1000
100
1Population(millions)
Burundi
Burundi2007Burundi
200720 000 $
2000 $200 $ Income per person (comparable dollars per year)
100
80
60
40
20
0
Ag
e (y
ears
)L
ife
exp
ecta
ncy
(y
ears
)
50 years
1000
100
1Population(millions)
Burundi
Burundi2007
Look at the expected life of five newbornBurundians…
100
80
60
40
20
0
Ag
e (y
ears
)
SarahAnnJeanLizPierre
Burundi2007
…if conditions remain as in Burundi in 2007during their whole lifetime?
How long will they live…
100
80
60
40
20
0
Age
(yea
rs)
SarahAnnJeanLizPierre
Burundi2007 84
7257
36
1
100
80
60
40
20
0
Age
(yea
rs)
SarahAnnJeanLizPierre
Burundi2007 84
7257
36
1
child
adult
old
So yes, 2 of 5get old in Burundi
100
80
60
40
20
0
Age
(yea
rs)
SarahAnnJeanLizPierre
Burundi2007 84
7257
36
1
This is the Life Expectancy
50 years
Calculate the mean…1+36+57+72+84
5= 50
20 000 $2000 $200 $
Income per person (comparable dollars per year)
100
80
60
40
20
0
Life
exp
ecta
ncy
(yea
rs)
8472
57
36
1
Burundi
1000
100
1Population(millions)
Burundi2007
50 years
81 yearsSweden
31 years
20 000 $2000 $200 $
Income per person (comparable dollars per year)
100
80
60
40
20
0
Life
exp
ecta
ncy
(yea
rs)
1000
100
1Population(millions)
81 yearsSwedenSweden
D o a l l S w e d e s l i v e 3 1 y e a r s l o n g e r
t h a n t h e B u r u n d i a n s ?
200720 000 $2000 $200 $
Income per person (comparable dollars per year)
100
80
60
40
20
0
Life
exp
ecta
ncy
(yea
rs)
1000
100
1Population(millions)
81 years
Look at the expected life of five newbornSwedes…
2007Sweden Sweden
Age
(yea
rs)
100
80
60
40
20
0
Age
(yea
rs)
SaraAntonJanLisaPer
How long will they live…
…if conditions remain as in Sweden in 2007during their whole lifetime?
2007Sweden
100
80
60
40
20
0
93Ag
e (y
ears
)
SaraAntonJanLisaPer
Sweden2007
6377 84 88
1 adult
4 old
100
80
60
40
20
0
93Ag
e (y
ears
)
SaraAntonJanLisaPer
Sweden2007
6377 84 88
63+77+84+88+935
=81
81 years
Calculate the mean…
Sweden2007
100
80
60
40
20
01000
100
1Population(millions)Li
fe e
xpec
tanc
y (y
ears
)Sweden
81 years
20 000 $2000 $200 $
Income per person (comparable dollars per year)
Let’s compareSweden
Burundi
20 000 $2000 $200 $
Income per person (comparable dollars per year)
100
80
60
40
20
0
Life
exp
ecta
ncy
(yea
rs)
1000
100
1Population(millions)
81 yearsSweden
50 yearsBurundi
100
80
60
40
20
0
Age
(yea
rs)
200781
50
100
80
60
40
20
0
Age
(yea
rs)
2007
But “dying young” in Swedenis very different
from “dying young” in Burundi
So, no,
all Burundians do not live 31
years shorter than Swedes
“To live long” in Swedenis almost the same as
“to live long” in Burundi
Life expectancy… is an average
… is low when child-deaths are common
-Most Burundians get older than 50-Some die in childhood
-It is low in Burundi not because all die a bit earlier
-But because some die much younger
MDG Goal 4: Reduce Child MortalityMain Diseases Contributing to the Environmental Burden of
Disease, Among Children 0-14 Years
Facts:Children suffer a disproportionate share of
environmental health burden:
• Globally, the per capita number of healthy life years lost to environmental risk factors was about 5-fold greater in children under 5 years of age than in total population
• On Average, children in developing countries lost -8 times more healthy life years than their counterparts in developed countries.
• Although these statistics are alarming, they do not capture the longer-term effects of exposures that occur at a young age, but manifest themselves as disease until years after the exposure
Section D: MDG Goal 5 (Improve Maternal Mortality)_________________________
Basic Facts
Pregnant have increased vulnerability to anemia, vitamin deficiency, trachoma and hepatitis, all of which can lead to increased morbidity and mortality.
The provision of safe water for medical purposes to treat such illness can improve newborn and child health in addition to maternal health.
Currently, health centers providing maternal and delivery care can expose women to unsafe water, poor sanitation and poor management of medical waste: 15% of all maternal deaths are caused by infections in the 6 weeks after childbirth and have mainly been found to be due to unhygienic practices and poor infection control during labour and delivery.
Interventions:
Environmental Health interventions can contribute to this MDG by providing a safe home environment, which is of great importance to the health of children and pregnant mothers. Conversely, a contaminated home environment is a threat to the mother and her unborn child.
Section E: MDG Goal 6 (Combat HIV/AIDS, malaria and other diseases)_________________________
Basic Facts:
Tidbits:
Globally more than 1.5 million deaths annually from respiratory infections are attributable to the environment, including at least 42% of lower respiratory infections and 24% of upper respiratory infections in developing countries
Tidbits:
Globally, about 1.5 million deaths per year from diarrheal diseases are attributable to environmental factors, essentially water, sanitation and hygiene
Tidbits:
Environmental management of malaria can involve modification or manipulation of the environment, as well as of human habitation and behavior.
Tidbits:
Ascariasis, trichuriasis, hookworm disease, trachoma, schistosomiasis and chagas disease could largely be prevented through improved hygiene, water and sanitation, and housing
Tidbits:
Dengue and dengue hemorrhagic fevers could be entirely prevented by good management of water containers in and around houses.
Tidbits:
HIV epidemic may largely be driven by commercial sex activities. The impact of prevention that is targeted to certain occupational groups may therefore be more far reaching than simply improving workers’ health.
Tidbits:
Crowding, and certain home or workplace exposures to air pollutants, are environmental factors that increase the burden of disease from tuberculosis
Burden of Diseases
Impact:
Every year, there are over half a million deaths from worldwide and over a quarter of a million deaths from HIV/AIDS that are related to environmental and occupational causes. Targeted environmental interventions could reduce the impact of major diseases such as these and help to achieve the MDG. Environmental interventions could also reduce the number of deaths from diarrhea and lower respiratory infections by over 3 million each year. With the execution of HIV/AIDS, all of these diseases affect children in large number, and even HIV/AIDS can have a major indirect impact on the health of children.
Conclusion:
Providing sustainable sources of safe water and clean energy are key environmental interventions that contribute to MDG.
Nearly one quarter of the global disease burden is attributable to the modifiable environment
The environmental disease burden is not distributed evenly across the world, and some regions carry a disproportionately heavy burden for specific diseases.
Burden of Diseases
Children suffer a disproportionate share of the environmental health burden.
Interventions can be cost-effective and have benefits that go well beyond health, and contribute to the overall well-being of communities
REDUCING THE DISEASE BURDEN OF THE ENVIRONMENTAL RISK FACTORS WILL CONTRIBUTE SIGNIFICANTLY TO THE MILLENNIUM DEVELOPMENT GOALS.
THANK YOU…
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