13.2.3. Burden of diseases attributable to specific health determinants.

Attributable fractions of total disease burden for the developed world (reference year 2000) were estimated as follows: 13.2% of total disease burden due to tobacco use, 10.9% attributable to hypertension, 7.4% and 7.4% to high cholesterol and obesity. Worldwide, these fractions were estimated to be 4.1%, 4.4%, 2.8%, 2.3%, respectively. Worldwide, childhood malnutrition attributed the highest disease burden, i.e. 9.5%. Estimations of environmental disease burden for the developed world range from 2-6%.

Table 13.4. Burden of disease in 2000 due to selected health determinants for Western Europe, Europe and worldwide

The first three determinants in Table 13.6 are typically associated to poverty in developing countries. Worldwide malnutrition, poor sanitation and indoor air pollution still produce a substantial burden of disease. Tobacco and alcohol use, physical inactivity and unhealthy diets are considered to be typical life-style choices, although one has to consider the important interaction with the social and physical environment. For instance, people do not choose to be born into families of lower socioeconomic status. Hypertension, unfavourable blood lipid composition and obesity are ‘endogenous’ characteristics that develop as a result of life-style, depending on a person’s genetic make-up. Finally, urban air pollution and occupational risks are typically the result of exposure to hazards that are produced collectively within societies.

Globally, an estimated 24% of the disease burden (healthy life years lost) and an estimated 23% of all premature mortality were due to environmental factors. Potentially sensitive groups at higher risk for damage or disease from environmental pollutants are children, people with existing health problems such as diabetes, respiratory disease, or heart disease and people with compromised immune systems, including those who have HIV/AIDS or are undergoing cancer chemotherapy. Poor or other disadvantaged populations who may live in more polluted environments are exposed to higher concentrations of pollutants. Children living in particularly adverse conditions, such as poor and abandoned children, street children and those who are exploited are at a higher risk of injuries due to environmental factors. Moreover, certain populations who live in increasingly agricultural regions, for example, agricultural workers and their families are especially vulnerable to poisoning from pesticides. A fetus can be exposed in uterus when their mothers use pesticides, work in sprayed fields, or work near spraying operations. According to a study made on children aged 0-4 years living in the WHO-Europe region (51 countries), 2-6 % of deaths from all causes were due to outdoor air pollution. Acute lower respiratory tract infections due to indoor air pollution accounted for 5% of all deaths and 3 % of DALYs (disability adjusted life years). Mild mental retardation resulting from lead exposure accounted for 4 % of DALYs.

In the Netherlands, lost DALYs have been calculated for 49 selected conditions. Table 13.7 presents a comparison of the health loss (in DALYs) due to unhealthy diet and unsafe food and that due to other lifestyle factors in perspective. A comparison is also carried out with the health loss due to a number of significant diseases. The comparison shows that the overall health loss due to an unhealthy diet is similar to that caused by smoking. The theoretical health gains which could be achieved merely by adopting a proper dietary composition (based on all five factors studied) is in second place and is of the same order as that of reducing obesity (shown here as “energy balance”), or of increasing physical activity. Moreover, it is shown that a proper dietary composition could provide health gains equivalent to the overall health loss due to the most common diseases in the Netherlands, including coronary heart diseases and depression. Table 13.7 also shows that the demonstrable health loss due to microbiological contamination of food is comparable to that due to a number of significant infectious diseases such as AIDS. In the case of chemical contamination, the health loss is lower than that of a number of major environmental factors. However, the health loss due to allergens and acrylamide is greater than that caused by various substances found in the environment. In the context of health protection, allergens must be considered separately, since most are normal constituents of certain foods that elicit greatly differing effects in different people.