The document discusses how attaining several Millennium Development Goals (MDGs) related to health can be supported through environmental health interventions. It covers MDG goals 4 to reduce child mortality, 5 to improve maternal health, and 6 to combat HIV/AIDS, malaria and other diseases. For each goal, it provides key facts on the environmental disease burden and how interventions like water, sanitation and hygiene improvements can help reduce mortality. The conclusion emphasizes that nearly a quarter of the global disease burden is attributable to the environment, and targeting environmental risk factors can significantly help achieve the health-related MDGs.

1. University of the East Ramon Magsaysay Medical Center
Graduate School
Attaining Health Millennium
Development Goals (MDG)
through Healthy Environment
__________________________
Melvin B. Marzan, RN
M Sc Tropical Medicine II

2. Section A: Millennium
Development Goals (MDGs)
_________________________

3.  Why the MDGs ?
The 1990s: a decade of faltering progress
progress continued
… but too slowly to reach agreed targets
… and slowing down
 Under-5 mortality rate
 Maternal mortality rate
 Child malnutrition
 Water and sanitation
 Income poverty
 Primary education
MDGs are meant to accelerate progress…

4. ?What are the MDGs
MDGs were set by all Government leaders at the
UN Millennium Summit, September 2000)
All UN organisations decided to be guided by
MDGs in their future action: unity of purpose,
coherent action, synergies and strategic
approaches by the UN system as a whole
(guided by CEB)
Leaders pledged to strive, individually and
collectively, towards these goals through
international, regional and national action,
concerted by the UN.

5. MDGs are a combination of…
Millennium Goals …
– Emanate from UN Summits and Conferences of the 1990s…
– … proposed in the UN Secretary-General’s Millennium Report: « We,
the peoples: the role of the United Nations in the 21st century »
– … and endorsed in the United Nations Millennium Declaration (8
September 2000)
7 areas explicitly addressed in the Millennium Declaration:
• Peace, security and disarmament
• Development and poverty eradication
• Protecting our common environment
• Human rights, democracy and good governance
• Protecting the vulnerable
• Meeting the special needs of Africa
• Strengthening the United Nations

6. MDGs are a combination of…
… and of International Development
Goals (IDGs)
• For several of these key areas, specific indicators were
included in the Millennium Declaration – constituting the
international development goals (IDG)
• Subsequently, IDGs from other declarations were
combined and harmonised with the IDGs set in the
Millennium Declaration goals
• The resulting set of goals, numerical targets and
quantifiable indicators to assess progress constitute
the Millennium Development Goals…
• … presented in the SG’s “Road map towards the
implementation of the United Nations Millennium
Declaration” (September 2001)

7. Millennium Development Goals
Goal 1:Eradicate Extreme Poverty and Hunger
Goal 2: Achieve Universal Primary Education
Goal 3: Promote Gender Equality and Empower Women
Goal 4: Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6: Combat HIV, Malaria and other diseases
Goal 7: Ensure Environmental Sustainability

8. Health MDGs
Goal 4: Reduce Child
Mortality
Goal 5: Improve Maternal
Health
Goal 6: Combat HIV/AIDS,
Malaria and other diseases

9. Section B:Progressing Towards
Health Related (MDGs) by
means of Environmental Health
_________________________

10. Environment in the Context of Health

11. Definition of Environment
 In the medical sense, Environment
includes the surroundings, conditions or
influences that affect an organism (Davis,
1989)
 “All of which is external to the human host.
Can be divided into physical, biological,
social, cultural, etc., any or all of which can
influence health status of populations…”
-International Epidemiological Association
(2001)

12. Definition of Environment

13. Environmental Health

14. Environmental Health

15. MDGs Environmental Health Components
• Goal 4: Reduce Child Mortality
– Mortality rate in children <5 yrs. from
environmentally-mediated disease conditions is
180 times higher in the poorest performing
region, as compared to the rate in progressive
countries
– In terms of diarrhea and lower respiratory
infections, two of the most significant childhood
killers, environmental interventions could prevent
the deaths of over 2 million children under age of
five every year

16. MDGs Environmental Health Components
• Goal 5: Improve Maternal Health
– Environmental Health interventions can
contribute to this MDG by providing a safe
home environment, which is of great
importance to the health of children and
pregnant mothers. Conversely, a
contaminated home environment is a threat to
the mother and her unborn child.

17. MDGs Environmental Health Components
• Goal 6: Combat HIV/AIDS, Malaria and
Other Diseases
– Results of the Study done by the WHO
indicate that over half a million people die
every year from malaria and over a quarter of
a million people die from HIV/AIDS, as a
result of environmental and occupational
cause. A large proportion of malaria, in
particular, may be attributable to readily
modifiable factors, such as land use, irrigation
and agricultural practices.

18. Section C: MDG Goal 4
(Reduce Child Mortality)
_________________________

19. average
… is the
lifespan a newborn
can expect
… is short when
child deaths
are common

20. 100
Sweden
Life expectancy (years)
81 80
years
60
Burundi
50
years
40
1
Population
20 (millions) 100
1000
0
200 $ 2000 $ 20 000 $
Income per person (comparable dollars per year)

21. 100
Life expectancy (years)
80
60
Burundi
50 years
40
1
Population
20 (millions) 100
1000
0
200 $ 2000 $ 20 000 $
Income per person (comparable dollars per year)

22. 100
Life expectancy (years)
80
60
Age (years)
Burundi
50 years
40
1
Population
20 (millions) 100
1000
0
200 $ 2000 $ 20 000 $
Income per person (comparable dollars per year)

23. 100
Look at the expected
Life expectancy (years)
80 life of five newborn
Burundians…
Age (years)
60
Burundi
50
years
40
Population 1
20 (millions) 100
1000
0
200 2000 $ 20 000
$ Income per person (comparable dollars $ year)
per

24. 100
80 How long will
they live…
Age (years)
60
…if conditions remain as
40 in
Burundi in 2007
20 during their whole lifetime?
0
Pierre Liz Jean Ann Sarah

25. 100
84
80
72
60 57
Age (years)
40 36
20
0
1
Pierre Liz Jean Ann Sarah

26. 100
old 84
80
72
60
adult 57
Age (years)
40 36
child
20 So yes, 2 of 5
get old in Burundi
0
1
Pierre Liz Jean Ann Sarah

27. 100
Calculate the mean… 84
This is the Life
80
1+36+57+72+84
Expectancy = 50 72
60 5 57
Age (years)
50 years
40 36
20
0
1
Pierre Liz Jean Ann Sarah

28. 100
Sweden84
Life expectancy (years)
81 years
80
72
31 years
60
Burundi
57
50 years
40 36
1
Population
20 (millions) 100
1000
0
1
200 $ 2000 $ 20 000 $
Income per person (comparable dollars per year)

29. 100
Sweden
Life expectancy (years)
81 years
80
60
40
1
Population
20 (millions) 100
1000
0
200 $ 2000 $ 20 000 $
Income per person (comparable dollars per year)

30. 100
Sweden
Life expectancy (years)
81 years
80
60
Age (years)
40
Look at the expected
1
life of five newborn 100
20
Population
(millions)
Swedes… 1000
0
200 $ 2000 $ 20 000 $
Income per person (comparable dollars per year)

31. 100
80
How long will
60
they live…
Age (years)
…if conditions remain as in
40 Sweden in 2007
during their whole lifetime?
20
0
Per Lisa Jan Anton Sara

32. 100 93
84 88
80 77
63
60
Age (years)
40
4 old
20
1 adult
0
Per Lisa Jan Anton Sara

33. 100 93
84 88
81 years
80 77
63
60
Age (years)
40
Calculate the mean…
20 63+77+84+88+93
=81
0
5
Per Lisa Jan Anton Sara

34. 100
Sweden
Life expectancy (years)
81 years
80
60
40
1
Population
20 (millions) 100
1000
0
200 $ 2000 $ 20 000 $
Income per person (comparable dollars per year)

35. Let’s compare

36. 100
Sweden
Life expectancy (years)
81 years
80
60
Burundi
50 years
40
1
Population
20 (millions) 100
1000
0
200 $ 2000 $ 20 000 $
Income per person (comparable dollars per year)

37. 100
81
80
60
Age (years)
50
40
20
0

38. 100
“To live long” in Sweden
is almost the same as
80
“to live long” in Burundi
60
Age (years)
40
20
But “dying young” in Sweden
So, no,
0 allis very different live 31
Burundians do not
from “dying shorter in Burundi
years young” than Swedes

39. … is an average
-Most Burundians get older than 50
-Some die in childhood
… is low when child-
deaths are common
-It is low in Burundi
not because all die a bit earlier
-But because
some die much younger

40. MDG Goal 4: Reduce Child Mortality
Main Diseases Contributing to the Environmental
Burden of Disease, Among Children 0-14 Years

41. Facts:
Children suffer a disproportionate share of
environmental health burden:
• Globally, the per capita number of healthy life years
lost to environmental risk factors was about 5-fold
greater in children under 5 years of age than in total
population
• On Average, children in developing countries lost -8
times more healthy life years than their counterparts
in developed countries.
• Although these statistics are alarming, they do not
capture the longer-term effects of exposures that
occur at a young age, but manifest themselves as
disease until years after the exposure

42. Section D: MDG Goal 5
(Improve Maternal Mortality)
_________________________

43. Basic Facts
 Pregnant have increased vulnerability to anemia, vitamin
deficiency, trachoma and hepatitis, all of which can lead to
increased morbidity and mortality.
 The provision of safe water for medical purposes to treat
such illness can improve newborn and child health in
addition to maternal health.
 Currently, health centers providing maternal and delivery
care can expose women to unsafe water, poor sanitation
and poor management of medical waste: 15% of all
maternal deaths are caused by infections in the 6 weeks
after childbirth and have mainly been found to be due to
unhygienic practices and poor infection control during
labour and delivery.

44. Interventions:
 Environmental Health interventions can
contribute to this MDG by providing a safe
home environment, which is of great importance
to the health of children and pregnant mothers.
Conversely, a contaminated home environment
is a threat to the mother and her unborn child.

45. Section E: MDG Goal 6
(Combat HIV/AIDS, malaria
and other diseases)
_________________________

46. Basic Facts:

47. Tidbits:
 Globally more than 1.5 million deaths annually
from respiratory infections are attributable to
the environment, including at least 42% of
lower respiratory infections and 24% of upper
respiratory infections in developing countries

48. Tidbits:
 Globally, about 1.5 million deaths per year from
diarrheal diseases are attributable to
environmental factors, essentially water,
sanitation and hygiene

49. Tidbits:
 Environmental management of malaria
can involve modification or manipulation of
the environment, as well as of human
habitation and behavior.

50. Tidbits:
 Ascariasis, trichuriasis, hookworm disease,
trachoma, schistosomiasis and chagas
disease could largely be prevented through
improved hygiene, water and sanitation, and
housing

51. Tidbits:
 Dengue and dengue hemorrhagic fevers
could be entirely prevented by good
management of water containers in and
around houses.

52. Tidbits:
 HIV epidemic may largely be driven by commercial
sex activities. The impact of prevention that is
targeted to certain occupational groups may
therefore be more far reaching than simply
improving workers’ health.

53. Tidbits:
 Crowding, and certain home or workplace
exposures to air pollutants, are
environmental factors that increase the
burden of disease from tuberculosis

54. Burden of Diseases

55. Impact:
 Every year, there are over half a million deaths
from worldwide and over a quarter of a million
deaths from HIV/AIDS that are related to
environmental and occupational causes. Targeted
environmental interventions could reduce the
impact of major diseases such as these and help
to achieve the MDG. Environmental interventions
could also reduce the number of deaths from
diarrhea and lower respiratory infections by over 3
million each year. With the execution of HIV/AIDS,
all of these diseases affect children in large
number, and even HIV/AIDS can have a major
indirect impact on the health of children.

56. Conclusion:
 Providing sustainable sources of safe water
and clean energy are key environmental
interventions that contribute to MDG.
 Nearly one quarter of the global disease
burden is attributable to the modifiable
environment
 The environmental disease burden is not
distributed evenly across the world, and
some regions carry a disproportionately
heavy burden for specific diseases.

57. Burden of Diseases
 Children suffer a disproportionate share of
the environmental health burden.
 Interventions can be cost-effective and have
benefits that go well beyond health, and
contribute to the overall well-being of
communities
 REDUCING THE DISEASE BURDEN OF
THE ENVIRONMENTAL RISK FACTORS
WILL CONTRIBUTE SIGNIFICANTLY TO
THE MILLENNIUM DEVELOPMENT
GOALS.

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