International Journal of Environmental Research and Public Health

Research

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18 pages, 2524 KiB

Open AccessArticle

Development of Policy Relevant Human Biomonitoring Indicators for Chemical Exposure in the European Population

by Jurgen Buekers, Madlen David, Gudrun Koppen, Jos Bessems, Martin Scheringer, Erik Lebret, Denis Sarigiannis, Marike Kolossa-Gehring, Marika Berglund, Greet Schoeters and Xenia Trier

Int. J. Environ. Res. Public Health 2018, 15(10), 2085; https://doi.org/10.3390/ijerph15102085 - 21 Sep 2018

Cited by 30 | Viewed by 7101

Abstract

The European Union’s 7th Environmental Action Programme (EAP) aims to assess and minimize environmental health risks from the use of hazardous chemicals by 2020. From this angle, policy questions like whether an implemented policy to reduce chemical exposure has had an effect over [...] Read more.

The European Union’s 7th Environmental Action Programme (EAP) aims to assess and minimize environmental health risks from the use of hazardous chemicals by 2020. From this angle, policy questions like whether an implemented policy to reduce chemical exposure has had an effect over time, whether the health of people in specific regions or subpopulations is at risk, or whether the body burden of chemical substances (the internal exposure) varies with, for example, time, country, sex, age, or socio-economic status, need to be answered. Indicators can help to synthesize complex scientific information into a few key descriptors with the purpose of providing an answer to a non-expert audience. Human biomonitoring (HBM) indicators at the European Union (EU) level are unfortunately lacking. Within the Horizon2020 European Human Biomonitoring project HBM4EU, an approach to develop European HBM indicators was worked out. To learn from and ensure interoperability with other European indicators, 15 experts from the HBM4EU project (German Umweltbundesamt (UBA), Flemish research institute VITO, University of Antwerp, European Environment Agency (EEA)), and the World Health Organization (WHO), European Core Health Indicator initiative (ECHI), Eurostat, Swiss ETH Zurich and the Czech environmental institute CENIA, and contributed to a workshop, held in June 2017 at the EEA in Copenhagen. First, selection criteria were defined to evaluate when and if results of internal chemical exposure measured by HBM, need to be translated into a European HBM-based indicator. Two main aspects are the HBM indicator’s relevance for policy, society, health, and the quality of the biomarker data (availability, comparability, ease of interpretation). Secondly, an approach for the calculation of the indicators was designed. Two types of indicators were proposed: ‘sum indicators of internal exposure’ derived directly from HBM biomarker concentrations and ‘indicators for health risk’, comparing HBM concentrations to HBM health-based guidance values (HBM HBGVs). In the latter case, both the percentage of the studied population exceeding the HBM HBGVs (PE) and the extent of exceedance (EE), calculated as the population’s exposure level divided by the HBM HBGV, can be calculated. These indicators were applied to two examples of hazardous chemicals: bisphenol A (BPA) and per- and polyfluoroalkyl substances (PFASs), which both have high policy and societal relevance and for which high quality published data were available (DEMOCOPHES, Swedish monitoring campaign). European HBM indicators help to summarize internal exposure to chemical substances among the European population and communicate to what degree environmental policies are successful in keeping internal exposures sufficiently low. The main aim of HBM indicators is to allow follow-up of chemical safety in Europe. Full article

(This article belongs to the Special Issue Environmental Health Indicators for Policy Support)

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22 pages, 663 KiB

Open AccessArticle

The Importance of Using Public Health Impact Criteria to Develop Environmental Health Indicators: The Example of the Indoor Environment in New Zealand

by Kylie Mason, Kirstin Lindberg, Deborah Read and Barry Borman

Int. J. Environ. Res. Public Health 2018, 15(8), 1786; https://doi.org/10.3390/ijerph15081786 - 20 Aug 2018

Cited by 9 | Viewed by 7831

Abstract

Developing environmental health indicators is challenging and applying a conceptual framework and indicator selection criteria may not be sufficient to prioritise potential indicators to monitor. This study developed a new approach for prioritising potential environmental health indicators, using the example of the indoor [...] Read more.

Developing environmental health indicators is challenging and applying a conceptual framework and indicator selection criteria may not be sufficient to prioritise potential indicators to monitor. This study developed a new approach for prioritising potential environmental health indicators, using the example of the indoor environment for New Zealand. A three-stage process of scoping, selection, and design was implemented. A set of potential indicators (including 4 exposure indicators and 20 health indicators) were initially identified and evaluated against indicator selection criteria. The health indicators were then further prioritised according to their public health impact and assessed by the five following sub-criteria: number of people affected (based on environmental burden of disease statistics); severity of health impact; whether vulnerable populations were affected and/or large inequalities were apparent; whether the indicator related to multiple environmental exposures; and policy relevance. Eight core indicators were ultimately selected, as follows: living in crowded households, second-hand smoke exposure, maternal smoking at two weeks post-natal, asthma prevalence, asthma hospitalisations, lower respiratory tract infection hospitalisations, meningococcal disease notifications, and sudden unexpected death in infancy (SUDI). Additionally, indicators on living in damp and mouldy housing and children’s injuries in the home, were identified as potential indicators, along with attributable burden indicators. Using public health impact criteria and an environmental burden of disease approach was valuable in prioritising and selecting the most important health impacts to monitor, using robust evidence and objective criteria. Full article

(This article belongs to the Special Issue Environmental Health Indicators for Policy Support)

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19 pages, 2251 KiB

Open AccessArticle

Air Health Trend Indicator: Association between Short-Term Exposure to Ground Ozone and Circulatory Hospitalizations in Canada for 17 Years, 1996–2012

by Hwashin Hyun Shin, Wesley S. Burr, Dave Stieb, Lani Haque, Harun Kalayci, Branka Jovic and Marc Smith-Doiron

Int. J. Environ. Res. Public Health 2018, 15(8), 1566; https://doi.org/10.3390/ijerph15081566 - 24 Jul 2018

Cited by 11 | Viewed by 4347

Abstract

The Air Health Trend Indicator is designed to estimate the public health risk related to short-term exposure to air pollution and to detect trends in the annual health risks. Daily ozone, circulatory hospitalizations and weather data for 24 cities (about 54% of Canadians) [...] Read more.

The Air Health Trend Indicator is designed to estimate the public health risk related to short-term exposure to air pollution and to detect trends in the annual health risks. Daily ozone, circulatory hospitalizations and weather data for 24 cities (about 54% of Canadians) for 17 years (1996–2012) were used. This study examined three circulatory causes: ischemic heart disease (IHD, 40% of cases), other heart disease (OHD, 31%) and cerebrovascular disease (CEV, 14%). A Bayesian hierarchical model using a 7-year estimator was employed to find trends in the annual national associations by season, lag of effect, sex and age group (≤65 vs. >65). Warm season 1-day lagged ozone returned higher national risk per 10 ppb: 0.4% (95% credible interval, −0.3–1.1%) for IHD, 0.4% (−0.2–1.0%) for OHD, and 0.2% (−0.8–1.2%) for CEV. Overall mixed trends in annual associations were observed for IHD and CEV, but a decreasing trend for OHD. While little age effect was identified, some sex-specific difference was detected, with males seemingly more vulnerable to ozone for CEV, although this finding needs further investigation. The study findings could reduce a knowledge gap by identifying trends in risk over time as well as sub-populations susceptible to ozone by age and sex. Full article

(This article belongs to the Special Issue Environmental Health Indicators for Policy Support)

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12 pages, 688 KiB

Open AccessArticle

Children’s Environmental Health Indicators in Context of the Sustainable Development Goals for Small Island Developing States

by Eun Mi Jung, Paul Jagals, Claire Brereton, Peter D. Sly, Rokho Kim, Eun Mee Kim and Eun Hee Ha

Int. J. Environ. Res. Public Health 2018, 15(7), 1404; https://doi.org/10.3390/ijerph15071404 - 3 Jul 2018

Cited by 2 | Viewed by 4451

Abstract

The unique environmental vulnerability of small island developing states (SIDS) is likely to impact negatively on children’s health. Children’s environmental health indicators (CEHI) are standardized measures that can be used to assess the environmental exposures and their resulting health outcomes in children. This [...] Read more.

The unique environmental vulnerability of small island developing states (SIDS) is likely to impact negatively on children’s health. Children’s environmental health indicators (CEHI) are standardized measures that can be used to assess the environmental exposures and their resulting health outcomes in children. This study sought to utilize the United Nations (UN) global Sustainable Development Goals (SDGs), with their associated targets and indicators, as a framework for a CEHI proposal for SIDS. Exposure-side indicators were taken from key themes from the 2012 Rio+20 UN Conference on Sustainable Development, and health-side indicators were selected based on the most significant contributors to the burden of disease in children. The multiple-exposures–multiple-effect (MEME) framework was then used to show the relationships between environmental exposures and children’s health outcomes. The framework was populated with available data from the World Bank’s DataBank. Whilst there was some data available at a population level, major gaps in both exposure-side and health-side indicators were revealed. In order to progress children’s environmental health in SIDS, a further piece of work is required to propose a fully prioritized set of exposure-side and health-side CEHIs; based on, but not exclusively linked to, the SDGs. Full article

(This article belongs to the Special Issue Environmental Health Indicators for Policy Support)

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13 pages, 1047 KiB

Open AccessArticle

A Novel Environmental Justice Indicator for Managing Local Air Pollution

by Jing Zhao, Laura Gladson and Kevin Cromar

Int. J. Environ. Res. Public Health 2018, 15(6), 1260; https://doi.org/10.3390/ijerph15061260 - 14 Jun 2018

Cited by 17 | Viewed by 4943

Abstract

Environmental justice efforts in the United States seek to provide equal protection from environmental hazards, such as air pollution, to all groups, particularly among traditionally disadvantaged populations. To accomplish this objective, the U.S. EPA has previously required states to use an environmental justice [...] Read more.

Environmental justice efforts in the United States seek to provide equal protection from environmental hazards, such as air pollution, to all groups, particularly among traditionally disadvantaged populations. To accomplish this objective, the U.S. EPA has previously required states to use an environmental justice screening tool as part of air quality planning decision-making. The generally utilized approach to assess potential areas of environmental justice concern relies on static comparisons of environmental and demographic information to identify areas where minority and low income populations experience elevated environmental exposures, but does not include any additional information that may inform the trade-offs that sub-populations of varying socio-demographic groups make when choosing where to reside in cities. In order to address this limitation, job accessibility (measured by a mobility index defining the number of jobs available within a set commuting time) was developed as a novel environmental justice indicator of environmental justice priority areas at the local level. This approach is modeled using real-world data in Allegheny County, PA (USA), and identifies areas with relatively high levels of outdoor air pollution and low access to jobs. While traditional tools tend to flag the poorest neighborhoods for environmental justice concerns, this new method offers a more refined analysis, targeting populations suffering from the highest environmental burden without the associated benefits of urban living. Full article

(This article belongs to the Special Issue Environmental Health Indicators for Policy Support)

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14 pages, 2802 KiB

Open AccessArticle

Measuring the Impact of Environment on the Health of Large Cities

by Christine Stauber, Ellis A. Adams, Richard Rothenberg, Dajun Dai, Ruiyan Luo, Scott R. Weaver, Amit Prasad, Megumi Kano and John Heath

Int. J. Environ. Res. Public Health 2018, 15(6), 1216; https://doi.org/10.3390/ijerph15061216 - 9 Jun 2018

Cited by 13 | Viewed by 6421

Abstract

The relative significance of indicators and determinants of health is important for local public health workers and planners. Of similar importance is a method for combining and evaluating such markers. We used a recently developed index, the Urban Health Index (UHI), to examine [...] Read more.

The relative significance of indicators and determinants of health is important for local public health workers and planners. Of similar importance is a method for combining and evaluating such markers. We used a recently developed index, the Urban Health Index (UHI), to examine the impact of environmental variables on the overall health of cities. We used the UHI to rank 57 of the world’s largest cities (based on population size) in low- and middle-income countries. We examined nine variables in various combinations that were available from the Demographic and Health Surveys conducted in these countries. When arranged in ascending order, the distribution of UHIs follows the previously described pattern of gradual linear increase, with departures at each tail. The rank order of cities did not change materially with the omission of variables about women’s health knowledge or childhood vaccinations. Omission of environmental variables (a central water supply piped into homes, improved sanitation, and indoor solid fuel use) altered the rank order considerably. The data suggest that environmental indicators, measures of key household level risk to health, may play a vital role in the overall health of urban communities. Full article

(This article belongs to the Special Issue Environmental Health Indicators for Policy Support)

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23 pages, 1184 KiB

Open AccessArticle

Interactive Cumulative Burden Assessment: Engaging Stakeholders in an Adaptive, Participatory and Transdisciplinary Approach

by Rehana Shrestha, Johannes Flacke, Javier Martinez and Martin Van Maarseveen

Int. J. Environ. Res. Public Health 2018, 15(2), 260; https://doi.org/10.3390/ijerph15020260 - 3 Feb 2018

Cited by 17 | Viewed by 5070

Abstract

Cumulative burden assessment (CuBA) has the potential to inform planning and decision-making on health disparities related to multiple environmental burdens. However, scholars have raised concerns about the social complexity to be dealt with while conducting CuBA, suggesting that it should be addressed in [...] Read more.

Cumulative burden assessment (CuBA) has the potential to inform planning and decision-making on health disparities related to multiple environmental burdens. However, scholars have raised concerns about the social complexity to be dealt with while conducting CuBA, suggesting that it should be addressed in an adaptive, participatory and transdisciplinary (APT) approach. APT calls for deliberation among stakeholders by engaging them in a process of social learning and knowledge co-production. We propose an interactive stakeholder-based approach that facilitates a science-based stakeholder dialogue as an interface for combining different knowledge domains and engendering social learning in CuBA processes. Our approach allows participants to interact with each other using a flexible and auditable CuBA model implemented within a shared workspace. In two workshops we explored the usefulness and practicality of the approach. Results show that stakeholders were enabled to deliberate on cumulative burdens collaboratively, to learn about the technical uncertainties and social challenges associated with CuBA, and to co-produce knowledge in a realm of both technical and societal challenges. The paper identifies potential benefits relevant for responding to social complexity in the CuBA and further recommends exploration of how our approach can enable or constraint social learning and knowledge co-production in CuBA processes under various institutional, social and political contexts. Full article

(This article belongs to the Special Issue Environmental Health Indicators for Policy Support)

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Review

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15 pages, 954 KiB

Open AccessFeature PaperReview

Children’s Environmental Health Indicators for Pacific Island Countries

by Claire Brereton, Amelia Turagabeci, Donald Wilson, Peter D. Sly and Paul Jagals

Int. J. Environ. Res. Public Health 2018, 15(7), 1403; https://doi.org/10.3390/ijerph15071403 - 3 Jul 2018

Cited by 6 | Viewed by 4294

Abstract

Healthy environments support the wellbeing of children and the environment thus play a cardinal role in the future of Pacific Island Countries (PICs). Children are more vulnerable and at risk to environmental hazards than adults because they breathe, drink, and eat much more [...] Read more.

Healthy environments support the wellbeing of children and the environment thus play a cardinal role in the future of Pacific Island Countries (PICs). Children are more vulnerable and at risk to environmental hazards than adults because they breathe, drink, and eat much more relative to body weight, resulting in greater exposures in the different environments in which children find themselves every day. We examine the role that children’s environmental health indicators (CEHI) can play for PICs to highlight priorities and we prioritise actions to improve children’s environmental health and thus achieve their ‘Healthy Islands’ vision. We conducted a systematic search of relevant documented and publicly available Pacific Island Country information on children’s environmental health indicators using the general Internet, as well as databases such as PubMed, Google Scholar, relevant UN agencies, as well as regional databases. Information on CEHI was available—mainly in grey literature—but not specifically aimed at PICs. Likewise, similar observations were made for peer-reviewed literature. From this review, we compiled summaries and a framework to propose the requirements as well as provide a foundation for the development of CEHI for PICs. CEHI development for PICs should ideally be a multi-sectoral endeavour within each PIC as well as for the region. This can be achieved through public, private, and academic sector initiatives to draw in all sectors of government as well as the relevant UN agencies and regional PIC-representative organisations. Full article

(This article belongs to the Special Issue Environmental Health Indicators for Policy Support)

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