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Review
. 2011 Jul;8(7):2854-75.
doi: 10.3390/ijerph8072854. Epub 2011 Jul 13.

A review of frameworks for developing environmental health indicators for climate change and health

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Review

A review of frameworks for developing environmental health indicators for climate change and health

Tammy Hambling et al. Int J Environ Res Public Health. 2011 Jul.

Abstract

The role climate change may play in altering human health, particularly in the emergence and spread of diseases, is an evolving area of research. It is important to understand this relationship because it will compound the already significant burden of diseases on national economies and public health. Authorities need to be able to assess, anticipate, and monitor human health vulnerability to climate change, in order to plan for, or implement action to avoid these eventualities. Environmental health indicators (EHIs) provide a tool to assess, monitor, and quantify human health vulnerability, to aid in the design and targeting of interventions, and measure the effectiveness of climate change adaptation and mitigation activities. Our aim was to identify the most suitable framework for developing EHIs to measure and monitor the impacts of climate change on human health and inform the development of interventions. Using published literature we reviewed the attributes of 11 frameworks. We identified the Driving force-Pressure-State-Exposure-Effect-Action (DPSEEA) framework as the most suitable one for developing EHIs for climate change and health. We propose the use of EHIs as a valuable tool to assess, quantify, and monitor human health vulnerability, design and target interventions, and measure the effectiveness of climate change adaptation and mitigation activities. In this paper, we lay the groundwork for the future development of EHIs as a multidisciplinary approach to link existing environmental and epidemiological data and networks. Analysis of such data will contribute to an enhanced understanding of the relationship between climate change and human health.

Keywords: DPSEEA; climate change; environmental health; frameworks; indicators; monitoring; policy.

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Figures

Figure 1
Figure 1
Pressure-State-Response framework (reproduced with permission from [33], published by OECD, 1993). Human activities exert pressures on the environment and change its quality and the quantity of natural resources ("State" box). Society responds to these changes through environmental, economic, and sectoral policies ("Societal responses") intended to prevent, reduce, or mitigate pressures, and/or environmental damage. Social responses form a feedback loop to pressures through human actions.
Figure 2
Figure 2
Millennium Ecosystem Assessment framework (reproduced with permission from [42], published by WHO, 2005). Changes in drivers that indirectly affect ecosystems (upper right box) can lead to changes in drivers that directly affect ecosystems (lower right box). The resulting changes in the ecosystem (lower left box) cause ecosystem services to change and thereby affect human well-being (upper left box). These interactions can take place at more than one scale, across scales, and across different timescales. Actions can be taken either to respond to negative changes or to enhance positive changes at almost all points in the framework (cross bars).
Figure 3
Figure 3
Causal web for chronic exposure to lead (reproduced with permission from [44], published by WHO, 2000). A causal web is a hierarchical cause-to-effect framework, categorizing three levels of risk factors: distal, proximal, and direct (physiological) causes. Distal causes operate through proximal, then direct causes on disease outcome.
Figure 4
Figure 4
Driving force-Pressure-State-Exposure-Effect-Action framework (reproduced with permission from [14], published by WHO, 1999). The framework describes the environmental health chain through the following components: Driving force (anthropogenic)—factors that motivate and push the environmental process involved. Pressure (on the environment)—are normally expressed through human occupation or exploitation of the environment. State (of the environment)—status of the environment. Exposure (of humans i.e., interaction between the environment and humans)—take place when humans are exposed to environmental conditions. Effect (in humans)—health effects from exposure to the environmental hazard. Action—policies or interventions aimed at reducing or avoiding health effects, they can be aimed at any point in the framework.
Figure 5
Figure 5
Driving force-Pressure-State-Exposure-Effect-Action framework applied to climate change [7].
Figure 6
Figure 6
Multiple Exposures-Multiple Effects framework (reproduced with permission from [25], published by WHO, 2003). Exposures (left box) in different environmental settings lead to many different health outcomes (right box). Individual health outcomes may be linked back to many different exposures. Both exposures and health outcomes are affected by contextual conditions. Actions can be targeted at exposures or health outcomes or at underlying contextual factors.
Figure 7
Figure 7
Integrated Environmental Health Impact Assessment framework [58]. This is a four-stage process, comprizing of: Issue framing—defines the problem/purpose for assessment. This focuses and limits the scope of assessment and management options. Design—purpose is to convert the conceptual model devised during issue framing into a detailed protocol for assessment. Execution—the core of the assessment process. Appraisal—synthesis and interpretation of results.

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