2024-03-11 22:00:00
Public Health France is conducting, as part of the 4th National Environmental Health Plan (PNSE4), a program on quantifying the environmental and professional burden of the disease. The work resulting from this program aims to improve the estimation and provision of health indicators at the national and subnational level, and more broadly to estimate the impact of the environment on health. To do this, a preliminary step was carried out to identify the disease-risk factor pairs to be studied as a priority. The first results of this program present the prioritization method applied by Public Health France and the list of prioritized couples with a view to carrying out an initial estimate of the environmental and professional burden of the disease in France. It constitutes the scientific base on which the Agency will rely to develop and guide its future work on this theme.
How is the environmental and professional burden assessed and for what purposes?
The estimation of the environmental and occupational burden of disease aims to assess the overall impact of the environment (general and occupational) on health based on a synthetic health indicator combining mortality data with morbidity data: the DALY (Disability Adjusted Live Years or Disability-Adjusted Life Years in French). This approach makes it possible, using a single metric, to compare and prioritize environmental and professional risk factors according to their impact on health and constitutes a real tool for prioritization, monitoring and advocacy with a view to guiding policies. public health and prevention strategies in environmental and occupational health.
Public Health France’s work to estimate the environmental and occupational burden of disease falls at the crossroads of two of the six strategic issues in Public Health France’s work program (Issue “Burden of diseases and their determinants, effectiveness of interventions and return on investment in prevention” and Issue “Environmental health, climate change and working environment”) and contribute to Action 19.2 of the PNSE4.
A pragmatic and operational prioritization method
The prioritization method implemented by Public Health France is based on a rational approach structured in two successive and complementary stages. Each is based on the comparative analysis of the most recent and most complete national burden estimates (in terms of diseases and risk factors considered) available to date for France and produced within the framework of the two health programs. ‘estimate of the global burden of disease driven byInstitute for Health Metrics and Evaluation (MIRACLE) (Global Burden of Disease – GBD) et the World Health Organization (OMS) (Global Health Estimates – GHE).
The first step is to prioritize the diseases and injuries that contribute the most to the total disease burden in terms of overall disease burden (measured by DALYs), mortality or morbidity. The second step consists of prioritizing the environmental or occupational risk factors contributing the most to the burden of diseases or injuries prioritized in step 1.
At the end of these two stages, Public Health France was thus able to establish a reduced list of disease-risk factor pairs on which to prioritize an initial estimate of the environmental and professional burden of the disease in France.
Nine prioritized disease-risk factor pairs
Three couples concern cancers of the trachea, bronchi and lung linked to: occupational exposure to asbestos; exposure to ambient pollution with fine particles (PM2.5); exposure to residential radon. Two couples focus on ischemic heart disease linked to: exposure to ambient PM2.5 pollution; exposure to low temperatures. Two pairs focus on cerebrovascular accidents (CVA) linked to: exposure to ambient PM2.5 pollution; exposure to low temperatures. A couple focuses on lower back pain linked to exposure to ergonomic risk factors. A couple focuses on accidental falls linked to occupational accidents.
The prioritized couples are consistent with those documented in the national and international literature. This work also made it possible to highlight the main limits and uncertainties associated with each of the two data sources used. In fact, the programs GBD et GHE offer the possibility of having standardized estimates of the burden on a global scale with a view to making international comparisons but do not allow the specificities linked to each territory to be taken into account.
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Prioritization of disease-risk factor pairs for the estimation of the environmental and occupational burden of disease in France…Find out more
What are the next steps in the project?
The next stage of this project will aim to evaluate the feasibility of estimating the burden associated with one of the nine prioritized pairs (Stroke-PM2.5). This work will thus make it possible to identify all the methodological prerequisites necessary for estimating the overall impact of the environment on health in France.
Furthermore, Public Health France will continue its involvement in the European Best-Cost project which aims to define standardized methodologies making it possible to estimate the economic and health burden associated with environmental factors.
Public health issues in France and the burden of disease
Burden of disease (BoD) is a scientific method aimed at systematically and comparatively quantifying the extent of health deterioration or loss linked to diseases, injuries and risk factors by age , gender and geographic area at a given time. Public Health France is committed to the definition, development and provision of reliable indicators to inform public health policies. In the area of environmental health, the agency assesses and quantifies exposure to environmental and occupational risk factors that inform estimates of the environmental and occupational burden of disease. In the field of monitoring, the agency maintains close links with the main producers of territorial and national environmental data. Finally, at the international level, Public Health France is involved in the European Best-Cost project on estimating the environmental burden of chronic pathologies and is part of the Cost-Action European Burden of Disease Network.
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