Download PDF
CC BY-NC-ND 4.0 · Gesundheitswesen 2018; 80(02): 154-159
DOI: 10.1055/s-0043-110851
Übersichtsarbeit
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Das Konzept der umweltbedingten Krankheitslast

The Environmental Burden of Disease Concept
Myriam Tobollik
1   Fachgebiet Expositionsschätzung, gesundheitsbezogene Indikatoren, Umweltbundesamt, Berlin
4   Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld
,
Dietrich Plaß
1   Fachgebiet Expositionsschätzung, gesundheitsbezogene Indikatoren, Umweltbundesamt, Berlin
,
Nadine Steckling
2   Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, WHO Collaborating Centre for Occupational Health, Klinikum der Universität München, München
4   Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld
,
Hajo Zeeb
3   Abteilung Prävention und Evaluation, BIPS - Institut für Epidemiologie und Präventionsforschung, Bremen
,
Dirk Wintermeyer
1   Fachgebiet Expositionsschätzung, gesundheitsbezogene Indikatoren, Umweltbundesamt, Berlin
,
Claudia Hornberg
4   Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld
› Author Affiliations
Further Information

Publication History

Publication Date:
10 October 2017 (online)

Also available at
   Permissions and Reprints

Zusammenfassung

Ziel der Studie Umweltrisikofaktoren haben häufig eine hohe gesundheitliche Relevanz mit einem großen und z. T. nicht ausreichend genutzten Präventionspotenzial. Das Wissen über die komplexen Wirkungszusammenhänge zwischen Umwelt und Gesundheit ist für einige Umweltrisikofaktoren begrenzt. Ein Instrument, das bestehende Evidenz nutzt, um die gesundheitlichen Auswirkungen für eine Bevölkerung oder Bevölkerungsgruppe zu quantifizieren, ist das Konzept der umweltbedingten Krankheitslast (Environmental Burden of Disease, EBD). Ziel des Beitrages ist es, das Konzept der umweltbedingten Krankheitslast vorzustellen sowie den Nutzen aber auch die Kritikpunkte zu benennen.

Methodik EBD fasst Morbiditäts- und Mortalitätsdaten in einem Summenmaß, dem Disability-Adjusted Life Year (DALY), zusammen und ermöglicht eine vergleichende Darstellung von Krankheitslasten. Hierfür werden Lebensjahre als Einheit genutzt. Mithilfe des attributablen Anteils kann ermittelt werden, welcher Anteil der Gesamtkrankheitslast auf umweltbedingte Risikofaktoren zurückzuführen ist.

Ergebnisse Das EBD-Konzept wird, trotz seiner zunehmenden Anwendung im internationalen Raum, häufig kritisch diskutiert, da die Einschränkung des mehrdimensionalen Konstrukts Gesundheit in einer Maßzahl zusammengefasst wird. Weitere Kritik bezieht sich auf die sozialen und normativen Konventionen, die das Konzept beinhaltet. Fehlende oder unzureichende Eingangsdaten können zudem die Qualität und Aussagekraft von EBD-Schätzungen limitieren.

Schlussfolgerung Es bedarf eines wissenschaftlichen Diskurses, in welchem Rahmen das Konzept in Deutschland genutzt werden kann und sollte.

Abstract

Goal of the study Environmental risk factors are of great importance for public health with a considerable but often unused potential for prevention. However, knowledge about the complex associations between the environment and health effects is limited for some risk factors. A concept, which is using the existing evidence on associations between the impact of environmental factors and health effects, is the environmental burden of disease (EBD) concept. The aim of this article is to present the quantification method of the EBD concept and to discuss the advantages and its points of criticism.

Methods The EBD concept combines morbidity and mortality data in a single measure (Disability-Adjusted Life Year, DALY) to enable a comparative description of the burden of disease. Life years are used as measurement unit. The environmental share of the total DALYs is quantified by using the attributable fraction.

Results Despite its increasing application especially in the international context, the method is still criticized, because by summarizing the complex construct of health in one single measurement unit, much important information about quality of life is lost. A further criticism refers to partly arbitrarily set social value choices. Additionally, missing or insufficient data can limit the quality and validity of EBD estimations.

Conclusion A scientific discourse is needed to decide to what extent the EBD approach can and should be used in Germany.

Schlüsselwörter

Umweltbedingte Krankheitslast - Disability-Adjusted Life Year - DALY - Umwelt und Gesundheit - Summenmaß der Bevölkerungsgesundheit

Key words

Environmental Burden of Disease - Disability-Adjusted Life Year - DALY - environment and health - summary measure of population health
 

  • Literatur

  • 1 Briggs D. Environmental pollution and the global burden of disease. British Medical Bulletin 2003; 68: 1-24
    CrossrefPubMedGoogle Scholar
  • 2 European Commission. Opinion on risk assessment on indoor air quality. Brussels: European Commission, Scientific Committee on Health and Environmental Risks (SCHER); 2007
    Google Scholar
  • 3 Nowotny H. Experten, Expertise und imaginierte Laien. In: Bogner A, Togersen H. Hrsg Wozu Experten? Ambivalenzen der Beziehung von Wissenschaft und Politik. Wiesbaden: VS Verlag für Sozialwissenschaften; 2005: 33-44
    Google Scholar
  • 4 Knol AB, Briggs DJ, Lebret E. Assessment of complex environmental health problems: framing the structures and structuring the frameworks. The Science of the total environment 2010; 408: 2785-2794
    CrossrefPubMedGoogle Scholar
  • 5 Prüss-Üstün A, Mathers C, Campbell-Lendrum D. et al. Introduction and methods. Assessing the environmental burden of disease at national and local levels. Geneva: World Health Organization; 2003
    Google Scholar
  • 6 Murray CJ, Ezzati M, Flaxman AD. et al. GBD 2010: design, definitions, and metrics. Lancet 2012; 380: 2063-2066
    CrossrefPubMedGoogle Scholar
  • 7 Gao T, Wang XC, Chen R. et al. Disability adjusted life year (DALY): A useful tool for quantitative assessment of environmental pollution. The Science of the total environment 2014; 511C: 268-287
    PubMedGoogle Scholar
  • 8 Murray CJL, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge: Harvard School of Public Health on behalf of the World Health Organization and the World Bank; 1996
    Google Scholar
  • 9 Murray CJL, Salomon JA, Mathers CD. et al. Summary measures of population health: concepts, ethics, measurement and applications. Geneva: World Health Organization; 2002
    Google Scholar
  • 10 Field MJ, Gold MR. Summarizing population health: Directions for the development and application of population metrics. Washington DC: National Academy of Sciences; 1998
    Google Scholar
  • 11 Murray CJ. Quantifying the burden of disease: The technical basis for disability-adjusted life years. Bull World Health Organ 1994; 72: 429-445
    PubMedGoogle Scholar
  • 12 Mathers C, Vos T, Lopez A. et al. National burden of disease studies: A practical guide. Geneva: World Health Organization (WHO); 2001
    Google Scholar
  • 13 Murray CJL, Salomon JA, Mathers CD. A critical examination of summary measures of population health. In: Murray CJL, Salomon JA, Mathers CD. et al. (Hrsg.) Summary measures of population health; concepts, ethics, measurements and applications. Geneva: World Health Organization; 2002: 13-40
    Google Scholar
  • 14 McMichael A, Pastides H, Prüss A. et al. Update on World Health Organization's initiative to assess environmental burden of disease. Epidemiology 2001; 12: 277-279
    CrossrefPubMedGoogle Scholar
  • 15 World Bank. World Development Report 1993. Oxford: World Bank; 1993
    Google Scholar
  • 16 WHO. The global burden of disease: 2004 update. Geneva: World Health Organization; 2008
    Google Scholar
  • 17 Begg SJ, Vos ET, Barker B. et al. The burden of disease and injury in Australia 2003. Canberra: Australian Institute of Health and Welfare; 2007
    Google Scholar
  • 18 Lai T, Habicht J, Kiivet RA. Measuring burden of disease in Estonia to support public health policy. Eur J Public Health 2009; 19: 541-547
    CrossrefPubMedGoogle Scholar
  • 19 Hornberg C, Claßen T, Steckling N. et al. Abschlussbericht des Projektes “Verteilungsbasierte Analyse gesundheitlicher Auswirkungen von Umwelt-Stressoren”. Dessau-Roßlau: Umweltbundesamt (UBA); 2013
    Google Scholar
  • 20 Plass D, Vos T, Hornberg C. et al. Entwicklung der Krankheitslast in Deutschland: Ergebnisse, Potenziale und Grenzen der Global Burden of Disease-Studie. Dtsch Arztebl International 2014; 111: 629-638
    CrossrefPubMedGoogle Scholar
  • 21 Anand S, Hanson K. Disability-adjusted life years: A critical review. Journal of Health Economics 1997; 16: 685-702
    CrossrefPubMedGoogle Scholar
  • 22 Vos T, Flaxman AD, Naghavi M. et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2163-2196
    CrossrefPubMedGoogle Scholar
  • 23 Kassebaum NJ, Arora M, Barber RM. et al. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet 2016; 388: 1603-1658
    CrossrefPubMedGoogle Scholar
  • 24 Forouzanfar MH, Afshin A, Alexander LT. et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet 2016; 388: 1659-1724
    CrossrefPubMedGoogle Scholar
  • 25 Salomon JA, Haagsma JA, Davis A. et al. Disability weights for the Global Burden of Disease 2013 study. The Lancet Global health 2015; 3: e712-e723
    CrossrefPubMedGoogle Scholar
  • 26 Devleesschauwer B, Havelaar AH, Maertens de Noordhout C. et al. DALY calculation in practice: a stepwise approach. Int J Public Health 2014; 59: 571-574
    CrossrefPubMedGoogle Scholar
  • 27 Tobollik M, Terschüren C, Steckling N. et al. Disability Weight - ein umstrittenes Maß zur Bewertung von Gesundheitsbeeinträchtigungen. In: László Kovács RK. Ralf Lutz (Hrsg.) Lebensqualität in der Medizin. Wiesbaden: VS Verlag für Sozialwissenschaften; 2016: 237-257
    CrossrefGoogle Scholar
  • 28 Stouthard MEA, Essink-Bot M-L, Bonsel GJ. et al. Disability weights for diseases in the Netherlands. Rotterdam: Department of Public Health, Erasmus University Rotterdam; 1997
    Google Scholar
  • 29 Reidpath DD, Allotey PA, Kouame A. et al. Measuring health in a vacuum: examining the disability weight of the DALY. Health Policy Plan 2003; 18: 351-356
    CrossrefPubMedGoogle Scholar
  • 30 Knol AB, Petersen AC, van der Sluijs JP. et al. Dealing with uncertainties in environmental burden of disease assessment. Environmental Health 2009; 8: 1-13
    CrossrefPubMedGoogle Scholar
  • 31 Prüss-Ustün A, Wolf J, Corvalán C. et al. Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016
    Google Scholar
  • 32 Mathers C, Ezzati M, Lopez A. et al. Causal decomposition of summary measures of population health. In: Murray C, Salomon J, Mathers C. et al. (Hrsg.) Summary measures of population health Concepts, ethics, measurement and applications. Geneva: World Health Organization; 2002: 273-290
    Google Scholar
  • 33 Kay D, Prüss A, Corvalan C. Methodology for assessment of Environmental burden of disease. Geneva: World Health Organization; 2000
    Google Scholar
  • 34 Malsch AKF, Pinheiro P, Krämer A. et al. Zur Bestimmun von “Environmental / Burden of Disease” (BoD/ EBD) in Deutschland. Materialien “Umwelt und Gesundheit”. Bielefeld: Landesinstitut für den Öffentlichen Gesundheitsdienst (lögd) NRW; 2006
    Google Scholar
  • 35 Smith KR, Corvalan CF, Kjellstrom T. How much global ill health is attributable to environmental factors?. Epidemiology 1999; 10: 573-584
    CrossrefPubMedGoogle Scholar
  • 36 Murray CJ, Lopez AD. On the comparable quantification of health risks: lessons from the Global Burden of Disease Study. Epidemiology 1999; 10: 594-605
    CrossrefPubMedGoogle Scholar
  • 37 Lim SS, Vos T, Flaxman AD. et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224-2260
    CrossrefPubMedGoogle Scholar
  • 38 Arnesen T, Nord E. The value of DALY life: Problems with ethics and validity of disability adjusted life years. BMJ 1999; 319: 1423-1425
    CrossrefPubMedGoogle Scholar
  • 39 Sayers BM, Fliedner TM. The critique of DALYs: a counter-reply. Bulletin of the World Health Organization 1997; 75: 383-384
    PubMedGoogle Scholar
  • 40 Nord E. Disability weights in the Global Burden of Disease 2010: unclear meaning and overstatement of international agreement. Health Policy 2013; 111: 99–104
    PubMed
  • 41 Mathers CD, Bernard C, Iburg KM. et al. Global burden of disease in 2002: data sources, methods and results. Global Programme on Evidence for Health Policy Discussion Paper. Geneva: World Health Organization (WHO); 2004
    Google Scholar