Though I didn’t originally want to, I’m going to have to put MoGreenStats on a break until mid-June. I’m traveling, and while I hoped to be able to write as I travelled, I’m moving each day. I don’t have the chance to research an environmental report and write a post on it.

I will return home in June, and I should be able to have a new post prepared shortly after. Until then, be well.

The last original post I made on this blog was September 27. I want to thank my readers for being patient with me while I struggled with my wife’s sudden illness and death. It has been difficult, and there has been an unbelievable amount to do. Hopefully I can now pick the blog back up and resume my once-weekly schedule of posts on Thursday mornings.

A couple of very important reports have come out since October 1 The first was the IPCC Special Report 15, Global Warming of 1.5°C. This report had been published online a few months previously, but had not completed the review process by the involved nations. It now has, and it is available for distribution and quotation. It still has some editing and layout revisions to undergo before the final copy is available, but the content has been approved.

This document is different from the IPCC assessment reports in that it seeks to answer a couple of basic questions: is it possible to limit the increase in global mean surface air temperature (GMST) to 1.5°C? What would be required to keep the increase within that limit? What would be the benefits and costs of doing so compared to a larger increase? It’s an important document, and the news is not encouraging.

The second is the Fourth National Climate Assessment published by the U.S. Global Change Research Program. This is the official U.S. government report on climate change, published every two years. This year, the authors felt that their understanding of how climate change would play-out has increased sufficiently to allow them to address its economic effect.

I’m not in love with economic analyses of environmental issues. Sometimes it is necessary to do uneconomic things. If all the values and services provided by the environment could be given an economic value that reflected their true worth, such an analysis might be possible. But we haven’t achieved that level of wisdom yet, so such analyses can be misleading. Still, this is an official government publication, and it is used by policymakers. Cost vs. benefit is an important consideration in making national policy, so it is important to have estimates of just how much climate change is going to impact the economy if we let it rampage unchecked. Again, the news is not good.

I will start with the IPCC report in my next post, and then move on to the National Climate Assessment.

Thanks for sticking with me.

In the last two posts I looked at a report that attempted to quantify the burden of disease attributable to environmental factors. It was produced by the World Health Organization (WHO), and its analysis concerned the whole earth.

The Missouri Department of Health and Senior Services produced a report on the burden of chronic diseases in Missouri in 2013. The report makes interesting reading, though it is not equivalent to the WHO report.

Figure 1. Source: Yun et al, 2013.

Of the top 8 causes of death in Missouri during 2010, 7 were chronic diseases. (Figure 1) Together, they caused 68.2% of all deaths in Missouri. Heart disease and cancer caused by far the most, between them accounting for almost half of all deaths.

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Figure 2. Source: Yun et al, 2013.

If one defines premature death as death occurring before age 65, then 14,827 Missourian’s died prematurely in 2010. As shown in Figure 2, chronic diseases caused 58.4% of the deaths, cancer and heart disease again leading the way, causing 46% of all premature deaths.

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Figure 3. Source: Yun et al, 2013.

Almost 3 in 4 Missourians (74.4%) were affected by at least one of 13 major chronic conditions, as shown in Figure 3 (individuals may be affected by more than one condition, thus the percentages do not sum to 100%). More than 1/3 of Missourians were living with cholesterol and hypertension, conditions which are not fatal in themselves, but which contribute to many other diseases that are. The prevalence of each of these conditions was higher in Missouri than nationally, except for vision impairment, which occurred in Missouri about at the same rate that it does nationally.

The mortality rates for heart disease, cancer, stroke, and diabetes all declined significantly in Missouri between 2000 and 2009. Prevalence rates did not, however, and for some chronic diseases prevalence rates actually increased. Thus, it seems that Missouri has made progress managing chronic diseases, but not preventing them.

The Missouri report did not address environmental factors that cause disease. To the extent that the report did consider risk factors, it focused on demographic characteristics, personal habits, and the social environment, such as the availability of health care, the availability of healthy food, and second-hand smoke. While some of these overlap with the WHO report to a limited degree, the Missouri report did not consider ecological factors such as air pollution and exposure to toxic chemicals. Despite the fact that ecological factors contribute strongly and obviously to several of the chronic conditions from which Missourians suffer, such as cancer and chronic lower respiratory disease, I could find no report addressing the issue in Missouri. If any of you know of one, please let me know.

Sources:

Yun S, Kayani N, Homan S, Li J, Pashi A, McBride D, Wilson J. 2013. The Burden of Chronic Diseases in Missouri: Progress and Challenges. Jefferson City, MO: Missouri Department of Health and Senior Services. Downloaded 5/2/2017 from http://health.mo.gov/atoz/pdf/burdenofchronicdiseasesinmissouri.pdf.

In 2012…12.6 million deaths globally, representing 23%…of all deaths, were attributable to the environment. When accounting for both death and disability, the fraction of the global burden of disease due to the environment is 22%… In children under five years, up to 26%…of all deaths could be prevented, if environmental risks were removed.

So begins the Executive Summary of Preventing Disease Through Health Environments: A Global Assessment of the Burden of Disease from Environmental Risks, a report issued by the World Health Organization (WHO). Those of us who think of the environment as the necessary support of all life on Earth may not find their claim surprising, but it is pretty dramatic: more than 1 death in every 5. Let’s look at what it means. This post will discuss some preliminaries and look at broad conceptual findings. The next post will look at specific disease burdens.

The authors looked at 133 types of diseases or injuries and found that 101 of them had significant links with the environment. They were able to quantify, at least partially, the environmental contribution for 92 of them. The 92 conditions run the gamut, including:

• infectious diseases, such as malaria and diarrhreal diseases;
• neonatal and nutritional conditions, like malnutrition and birth defects;
• non-communicable diseases, like cancer or neurological disorders;
• unintentional injuries, such as road traffic accidents or unintentional poisonings;
• intentional injuries, such as self-harm or interpersonal violence; and
• risk factors that contribute to non-communicable diseases of other types, but which are related to the environment, such as obesity and physical inactivity.

Figure 1. Source: Prüss-Ustün et al, 2016.

Some of these may seem controversial to an American public, seeming like personal choices. The authors contend, however, that each of them contributes to death or disease, and each of them has an identifiable link to environmental factors that are modifiable by people.

As one might expect, the fraction of deaths attributable to the environment is higher in poorer countries, lower in wealthy countries (Figure 1). There are several reasons for this. One is that wealthier nations are able to afford better environmental protections. Another is that wealthier nations have been able to transition to safer methods of doing almost everything (from transportation, to industrial processes, to cooking and home heating).

Figure 2. Percent Attributable to Environmental Causes, by Disease Type and Region. Source: Prüss-Ustün et al, 2016.

The type of disease impacted by the environment also varies by region (Figure 2). In Sub-Saharan Africa environmental factors cause a high number of per capita deaths from infectious, parasitic, neonatal, and nutritional diseases. Examples might include malaria, diarrheal diseases, and malnutrition. But in Europe, Southeast Asia, the Western Pacific, and High-Income OECD Nations, environmental factors cause high numbers of per capita deaths from non-communicable diseases. Examples might include cancer and heart disease.

Some background information may help in understanding the report’s findings. It is rare for the environment to sicken or kill somebody outright. Typically, the environment leads to some other condition that is the direct cause of illness or death. For instance, desertification may lead to famine, but starvation may be listed as the direct cause of death, not desertification. A contaminated water supply may lead to cholera, but cholera may be listed as the direct cause of death, not contaminated water. Asbestos may led to mesothelioma, but mesothelioma may be listed as the direct cause of death, not asbestos.

Figure 3. Conditions Environmentally Caused: Included and Excluded. Source: Prüss-Ustün et al, 2016.

The WHO report defines environmental risks broadly. Figure 3 shows what is included and what is excluded. Diseases that involve person-to-person interaction, or that result from personal habits and choices are excluded. Also excluded are disease vectors that exist in the environment, but which can’t readily be modified (for instance, pollen). Included are factors that most people would regard as environmentally modifiable (e.g. exposure to chemicals or air pollution). Thus, mesothelioma caused by asbestos exposure would be included, but getting the flu from somebody at work would not be.

Nobody keeps records of environmental exposure leading to death, especially in the undeveloped world. Thus, it has to be estimated. The report used several types of estimates which require the use of assumptions and/or expert opinion. Thus, be sure to keep in mind that the report represents an estimate. It is almost certain to contain errors, though it may be the best estimate available.

The next post will look at specific disease conditions, and what fraction of the disease burden can be attributed to environmental factors.

Sources:

Prüss-Ustün, A., J. Wolf, C. Corvalán, R. Box, and M. Neira. 2016. Preventing Disease Through Health Environments: A Global Assessment of the Burden of Disease from Environmental Risks. WHO Press: Geneva. Downloaded 5/3/2017 online from http://www.who.int/quantifying_ehimpacts/publications/preventing-disease/en.