Published on Investing in Health

Targeting environmental risk factors for better health

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As the world marks Earth Day on April 22nd to demonstrate support for environmental protection and the conservation of natural resources, it is important to remember that efforts to prevent climate change are also crucial for the health of the world population.

Environmental hazards—the external physical, chemical, biological and work-related factors that affect a person’s health— cause an estimated 12.6 million deaths globally. They are key drivers of non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, diabetes and chronic lung diseases that kill nearly 41 million people each year. 

Growing evidence indicates that early life exposure to environmental risks, such as chemicals and air pollutants, increases NCD risk throughout the life course.

Acting on environmental risks is thus critical. Alongside interventions to reduce the behavioral risk factors of NCDs such as sedentary lifestyles, unhealthy diet and alcohol abuse, the global health community needs to step up how it coordinates and implements multi-sectoral “health in all policy interventions to address the environmental drivers of health.

Such efforts are essential to mitigate climate change, improve population health and thus strengthen countries’ “human capital” by enabling people to realize their full potential as productive members of society.

The link between environmental risk factors and health

The connection between environmental risk factors and health outcomes is well established. NCDs related to air pollution, chemicals and second-hand smoke, for example, are responsible for 119 million cardiovascular diseases globally each year, 49 million cancers, and 32 million chronic respiratory diseases. 

A recent article by the Saudi Public Health Authority, produced in collaboration with researchers from Colorado State University and the World Bank, and published in the International Journal of Environmental Research and Public Health provided an umbrella review of the most recent evidence of this link in the global literature. The review found 197 global associations among 69 environmental exposures and 83 diseases and death causes reported in 103 publications globally, listing environmental risk factors like air pollution, tobacco smoke, heavy metals, chemicals, ambient temperature, noise, radiation and urban residential surroundings.

Air pollution is of particular concern

Air pollution stands out among environmental risk factors impacting health as the second-largest risk factor causing NCDs globally, after tobacco smoke.  Human activities like transport and industry generate pollutants such as nitrogen oxides (NO and NO2), sulfur oxides (SO2 and SO3) and particulate matter that cause air pollution, which is associated with premature mortality and cardiovascular, cerebrovascular, respiratory, and metabolic disease.

In the Middle East and North Africa (MENA) region, moreover, at least half of air pollution in some seasons occurs from natural sources, such as sand, dust and sea salt, adding to the man-made pollution that requires urgent attention.

Country-focused support to inform planning and intervention  

Personal choices such as reducing meat consumption and transport choices can influence environmental risks an individual faces to some extent, but greater impact requires wide-ranging policy measures incentivizing clean energy and technologies and better urban planning.  

Involving the health sector in the development of policies in other areas where many environmental risks to health are shaped is critical. It should include evidence generation and data collection, tracking health determinants and outcomes, proposing evidence-based solutions and predicting health impacts of policies and projects.

The global commitment and country specific agendas to reduce NCDs, not least to strengthen human capital, provide an entry point for action in the health sector and an opportunity to strategically influence the drivers of pollution and other environmental risks in other sectors.

Support under the HNP RAS in Saudi Arabia

In Saudi Arabia, the World Bank’s Health, Nutrition and Population (HNP) Team is supporting the Kingdom’s efforts to strengthen environmental public health, generating lessons for similar engagement in low- and middle-income countries. A recent paper published in Environmental Research, produced by the Saudi Public Health Authority with support from the Bank’s Reimbursable Advisory Services (RAS) Program, revealed that ambient particulate matter is the fifth health risk factor in the country, contributing to almost 10 percent of total mortality. Drawing on publicly available data, the study also attributed more than 315,000 disability-adjusted life years[1] (DALYs)— corresponding to more than 240,000 lost life years and 74,000 years lived with disability—to air pollution.  

Spurred on by the findings, Saudi Arabia, with World Bank assistance, is now planning its first national Environmental Public Health Plan, closely aligned with overall NCD planning and implementation in the country

Greater investment in policies and measures to reduce environmental risks is urgently needed in all countries to alleviate the health burden on health care systems around the globe  while  mitigating the devastating effects on our planet and its people.

Within and outside the health sector, let’s all step up our commitment to address environmental risk factors and act now before it is too late.   

[1] The sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability.



Wael Alsufyani

Preventive medicine and public health consultant

David Rojas-Rueda

Environmental Epidemiologist

Sameh El-Saharty

Program Leader for Human Development for the World Bank MENA region, sub-region GCC

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