title: Environmental risks to public health in the United Arab Emirates: a quantitative assessment and strategic plan.
abstract: BACKGROUND
  Environmental risks to health in the United Arab Emirates (UAE) have shifted rapidly from infectious to noninfectious diseases as the nation has developed at an unprecedented rate. In response to public concerns over newly emerging environmental risks, the Environment Agency-Abu Dhabi commissioned a multidisciplinary environmental health strategic planning project.
  
  
  OBJECTIVE
  In order to develop the environmental health strategic plan, we sought to quantify the illnesses and premature deaths in the UAE attributable to 14 environmental pollutant categories, prioritize these 14 risk factors, and identify interventions.
  
  
  METHODS
  We estimated the disease burden imposed by each risk factor using an attributable fraction approach, and we prioritized the risks using an empirically tested stakeholder engagement process. We then engaged government personnel, scientists, and other stakeholders to identify interventions.
  
  
  RESULTS
  The UAE's environmental disease burden is low by global standards. Ambient air pollution is the leading contributor to premature mortality [~ 650 annual deaths; 95% confidence interval (CI): 140, 1,400]. Risk factors leading to > 10,000 annual health care facility visits included occupational exposures, indoor air pollution, drinking water contamination, seafood contamination, and ambient air pollution. Among the 14 risks considered, on average, outdoor air pollution was ranked by the stakeholders as the highest priority (mean rank, 1.4; interquartile range, 1-2) and indoor air pollution as the second-highest priority (mean rank 3.3; interquartile range, 2-4). The resulting strategic plan identified 216 potential interventions for reducing environmental risks to health.
  
  
  CONCLUSIONS
  The strategic planning exercise described here provides a framework for systematically deciding how to invest public funds to maximize expected returns in environmental health, where returns are measured in terms of reductions in a population's environmental burden of disease.
authors.affiliation: Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599-7431, USA. jackie.macdonald@unc.edu
authors.forename: Jacqueline MacDonald
authors.initials: JM
authors.lastname: Gibson
authors.forename: Zeinab S
authors.initials: ZS
authors.lastname: Farah
mesh_terms: D004781:Environmental Exposure; D006801:Humans; D011634:Public Health; D018570:Risk Assessment; D014479:United Arab Emirates