title: Environmental attributable fractions in remote Australia: the potential of a new approach for local public health action.
abstract: OBJECTIVE
  To determine local values for environmental attributable fractions and explore their applicability and potential for public health advocacy.
  
  
  METHODS
  Using World Health Organization (WHO) values for environmental attributable fractions, responses from a practitioner survey (73% response rate) were considered by a smaller skills-based panel to determine consensus values for Kimberley environmental attributable fractions (KEAFs). Applied to de-identified data from 17 remote primary healthcare facilities over two years, numbers and proportions of reasons for attendance directly attributable to the environment were calculated for all ages and children aged 0-4 years, including those for Aboriginal patients.
  
  
  RESULTS
  Of 150,357 reasons for attendance for patients of all ages, 31,775 (21.1%) were directly attributable to the environment. The proportion of these directly due to the environment was significantly higher for Aboriginal patients than others (23.1% v 14.6%; p<0.001). Of 29,706 reasons for attendance by Aboriginal children aged 0-4 years, 7,599 (25.6%) were directly attributable to the environment, significantly higher than for non-Aboriginal children aged 0-4 years (25.6% v 18.6%; p<0.001).
  
  
  CONCLUSIONS
  By addressing environmental factors, 20% of total primary healthcare demand could be prevented and, importantly, some 25% of presentations by Aboriginal children.
  
  
  CONCLUSIONS
  KEAFs have potential to monitor impact of local environmental investments.
authors.affiliation: Kimberley Population Health Unit, WA Country Health Services - Kimberley Region, Western Australia.
authors.forename: Cheryl
authors.initials: C
authors.lastname: McMullen
authors.affiliation: Kimberley Population Health Unit, WA Country Health Services - Kimberley Region, Western Australia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Eastwood
authors.affiliation: Kimberley Population Health Unit, WA Country Health Services - Kimberley Region, Western Australia.|School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Ward
mesh_terms: D001315:Australia; D002675:Child, Preschool; D004777:Environment; D004781:Environmental Exposure; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011320:Primary Health Care; D011634:Public Health; D064890:Social Determinants of Health
keywords: environmental determinants; environmental health; primary healthcare; social determinants