title: The impact of the environment on health by country: a meta-synthesis.
abstract: BACKGROUND
  Health gains that environmental interventions could achieve are main questions when choosing environmental health action to prevent disease. The World Health Organization has recently released profiles of environmental burden of disease for 192 countries.
  
  
  METHODS
  These country profiles provide an estimate of the health impacts from the three major risk factors 'unsafe water, sanitation & hygiene', 'indoor air pollution from solid fuel use' and 'outdoor air pollution'. The profiles also provide an estimate of preventable health impacts by the environment as a whole. While the estimates for the three risk factors are based on country exposures, the estimates of health gains for total environmental improvements are based on a review of the literature supplemented by expert opinion and combined with country health statistics.
  
  
  RESULTS
  Between 13% and 37% of the countries' disease burden could be prevented by environmental improvements, resulting globally in about 13 million deaths per year. It is estimated that about four million of these could be prevented by improving water, sanitation and hygiene, and indoor and outdoor air alone. The number of environmental DALYs per 1000 capita per year ranges between 14 and 316 according to the country. An analysis by disease group points to main preventions opportunities for each country.
  
  
  CONCLUSIONS
  Notwithstanding the uncertainties in their calculation, these estimates provide an overview of opportunities for prevention through healthier environments. The estimates show that for similar national incomes, the environmental burden of disease can typically vary by a factor five. This analysis also shows that safer water, sanitation and hygiene, and safer fuels for cooking could significantly reduce child mortality, namely by more than 25% in 20 of the lowest income countries.
authors.affiliation: World Health Organization, Department of Public Health and Environment, 20 Avenue Appia, 1211 Geneva 27, Switzerland. pruessa@who.int
authors.forename: Annette
authors.initials: A
authors.lastname: Prüss-Ustün
authors.forename: Sophie
authors.initials: S
authors.lastname: Bonjour
authors.forename: Carlos
authors.initials: C
authors.lastname: Corvalán
mesh_terms: D000397:Air Pollution / Q000009:adverse effects*; D003296:Cooking / Q000379:methods; D003967:Diarrhea / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects*; D004782:Environmental Health; D014943:Global Health; D006801:Humans; D006920:Hygiene; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012307:Risk Factors; D014876:Water Pollution / Q000009:adverse effects*; D014944:World Health Organization