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Cumulative and Integrated Health Impact Assessment

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Guest Editor
Maastricht University P.O. Box 616 6200 MD, Maastricht, The Netherlands
Interests: Risk analysis, public and environmental health, risk governance

Special Issue Information

Dear Colleagues,

Many assessments of the impact of the environment on health, focus on a single environmental factor: A specific population group is exposed and health effects are assessed for a limited time span. This may be relevant if that factor is dominant, as, for example, in chemical accidents. However, in the real world, and also in the aftermath of such accidents, people are subjected to a variety of environmental factors from nature and from past and present human activities, which can start even before conception, and continue throughout their whole lifespan. Positive and negative effects of these exposures will lead to accumulating health effects, depending on the vulnerability and resilience of the exposed people at the time of exposure and thereafter. To assess the impact of human activities on the health of people affected by such activities, this demands a cumulative or integrated heath impact assessment (see: The Cumulative Effects Assessment Working Group, Cumulative Effects Assessment Practitioners’ Guide, 1999; Briggs, D.J. 2008, doi:10.1186/1476-069X-7-61).

In this Special Issue we want to explore the state of the art of cumulative and integrated health impact assessments. Our focus is on public health effects from changes in environmental exposures. The exposome concept is a promising method of incorporating comprehensive health impact assessments (see: Wild, C.P., 2008, doi:10.1186/1476-069X-7-61). However, health and health impacts can only be properly understood when taking cultural, social and psychosocial factors into account (see: Huynen, M.M., et al., 2005, doi:10.1186/1744-8603-1-14). Therefore, we hope to receive contributions on the following aspects:

  • How to assess past, present and future exposures and their impacts in present and future generations?
  • Exposure indicators: how to characterize the exposome?
  • Determining the geographic scale of exposures and health impact assessment.
  • Health indicators: how to characterize health impacts?
  • Dominant exposures and multiple effects, e.g. agricultural pesticides in rural communities.
  • Multiple exposures and dominant effects, e.g. cancer in urban environments.
  • Gene-environment interactions: influence on vulnerability and resilience.

Prof. Dr. Wim Passchier
Prof. Dr. Luc Hens
Guest Editors

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Keywords

  • health impact assessment
  • cumulative assessment
  • integrated assessment
  • exposure assessment
  • biomonitoring
  • health indicators
  • human vulnerability
  • human resilience

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Published Papers (8 papers)

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Research

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1521 KiB  
Article
Combined Effects of Prenatal Exposures to Environmental Chemicals on Birth Weight
by Eva Govarts, Sylvie Remy, Liesbeth Bruckers, Elly Den Hond, Isabelle Sioen, Vera Nelen, Willy Baeyens, Tim S Nawrot, Ilse Loots, Nick Van Larebeke and Greet Schoeters
Int. J. Environ. Res. Public Health 2016, 13(5), 495; https://doi.org/10.3390/ijerph13050495 - 12 May 2016
Cited by 96 | Viewed by 8584
Abstract
Prenatal chemical exposure has been frequently associated with reduced fetal growth by single pollutant regression models although inconsistent results have been obtained. Our study estimated the effects of exposure to single pollutants and mixtures on birth weight in 248 mother-child pairs. Arsenic, copper, [...] Read more.
Prenatal chemical exposure has been frequently associated with reduced fetal growth by single pollutant regression models although inconsistent results have been obtained. Our study estimated the effects of exposure to single pollutants and mixtures on birth weight in 248 mother-child pairs. Arsenic, copper, lead, manganese and thallium were measured in cord blood, cadmium in maternal blood, methylmercury in maternal hair, and five organochlorines, two perfluorinated compounds and diethylhexyl phthalate metabolites in cord plasma. Daily exposure to particulate matter was modeled and averaged over the duration of gestation. In single pollutant models, arsenic was significantly associated with reduced birth weight. The effect estimate increased when including cadmium, and mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP) co-exposure. Combining exposures by principal component analysis generated an exposure factor loaded by cadmium and arsenic that was associated with reduced birth weight. MECPP induced gender specific effects. In girls, the effect estimate was doubled with co-exposure of thallium, PFOS, lead, cadmium, manganese, and mercury, while in boys, the mixture of MECPP with cadmium showed the strongest association with birth weight. In conclusion, birth weight was consistently inversely associated with exposure to pollutant mixtures. Chemicals not showing significant associations at single pollutant level contributed to stronger effects when analyzed as mixtures. Full article
(This article belongs to the Special Issue Cumulative and Integrated Health Impact Assessment)
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760 KiB  
Article
Rapid Assessment of Environmental Health Impacts for Policy Support: The Example of Road Transport in New Zealand
by David Briggs, Kylie Mason and Barry Borman
Int. J. Environ. Res. Public Health 2016, 13(1), 61; https://doi.org/10.3390/ijerph13010061 - 22 Dec 2015
Cited by 20 | Viewed by 10029
Abstract
An integrated environmental health impact assessment of road transport in New Zealand was carried out, using a rapid assessment. The disease and injury burden was assessed from traffic-related accidents, air pollution, noise and physical (in)activity, and impacts attributed back to modal source. In [...] Read more.
An integrated environmental health impact assessment of road transport in New Zealand was carried out, using a rapid assessment. The disease and injury burden was assessed from traffic-related accidents, air pollution, noise and physical (in)activity, and impacts attributed back to modal source. In total, road transport was found to be responsible for 650 deaths in 2012 (2.1% of annual mortality): 308 from traffic accidents, 283 as a result of air pollution, and 59 from noise. Together with morbidity, these represent a total burden of disease of 26,610 disability-adjusted life years (DALYs). An estimated 40 deaths and 1874 DALYs were avoided through active transport. Cars are responsible for about 52% of attributable deaths, but heavy goods vehicles (6% of vehicle kilometres travelled, vkt) accounted for 21% of deaths. Motorcycles (1 per cent of vkt) are implicated in nearly 8% of deaths. Overall, impacts of traffic-related air pollution and noise are low compared to other developed countries, but road accident rates are high. Results highlight the need for policies targeted at road accidents, and especially at heavy goods vehicles and motorcycles, along with more general action to reduce the reliance on private road transport. The study also provides a framework for national indicator development. Full article
(This article belongs to the Special Issue Cumulative and Integrated Health Impact Assessment)
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788 KiB  
Article
Climate Change Effects on Heat- and Cold-Related Mortality in the Netherlands: A Scenario-Based Integrated Environmental Health Impact Assessment
by Maud M. T. E. Huynen and Pim Martens
Int. J. Environ. Res. Public Health 2015, 12(10), 13295-13320; https://doi.org/10.3390/ijerph121013295 - 23 Oct 2015
Cited by 41 | Viewed by 19488
Abstract
Although people will most likely adjust to warmer temperatures, it is still difficult to assess what this adaptation will look like. This scenario-based integrated health impacts assessment explores baseline (1981–2010) and future (2050) population attributable fractions (PAF) of mortality due to heat (PAF [...] Read more.
Although people will most likely adjust to warmer temperatures, it is still difficult to assess what this adaptation will look like. This scenario-based integrated health impacts assessment explores baseline (1981–2010) and future (2050) population attributable fractions (PAF) of mortality due to heat (PAFheat) and cold (PAFcold), by combining observed temperature–mortality relationships with the Dutch KNMI’14 climate scenarios and three adaptation scenarios. The 2050 model results without adaptation reveal a decrease in PAFcold (8.90% at baseline; 6.56%–7.85% in 2050) that outweighs the increase in PAFheat (1.15% at baseline; 1.66%–2.52% in 2050). When the 2050 model runs applying the different adaptation scenarios are considered as well, however, the PAFheat ranges between 0.94% and 2.52% and the PAFcold between 6.56% and 9.85%. Hence, PAFheat and PAFcold can decrease as well as increase in view of climate change (depending on the adaptation scenario). The associated annual mortality burdens in 2050—accounting for both the increasing temperatures and mortality trend—show that heat-related deaths will range between 1879 and 5061 (1511 at baseline) and cold-related deaths between 13,149 and 19,753 (11,727 at baseline). Our results clearly illustrate that model outcomes are not only highly dependent on climate scenarios, but also on adaptation assumptions. Hence, a better understanding of (the impact of various) plausible adaptation scenarios is required to advance future integrated health impact assessments. Full article
(This article belongs to the Special Issue Cumulative and Integrated Health Impact Assessment)
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851 KiB  
Article
Climate Change and Infectious Disease Risk in Western Europe: A Survey of Dutch Expert Opinion on Adaptation Responses and Actors
by Su-Mia Akin, Pim Martens and Maud M.T.E. Huynen
Int. J. Environ. Res. Public Health 2015, 12(8), 9726-9749; https://doi.org/10.3390/ijerph120809726 - 18 Aug 2015
Cited by 7 | Viewed by 6731
Abstract
There is growing evidence of climate change affecting infectious disease risk in Western Europe. The call for effective adaptation to this challenge becomes increasingly stronger. This paper presents the results of a survey exploring Dutch expert perspectives on adaptation responses to climate change [...] Read more.
There is growing evidence of climate change affecting infectious disease risk in Western Europe. The call for effective adaptation to this challenge becomes increasingly stronger. This paper presents the results of a survey exploring Dutch expert perspectives on adaptation responses to climate change impacts on infectious disease risk in Western Europe. Additionally, the survey explores the expert sample’s prioritization of mitigation and adaptation, and expert views on the willingness and capacity of relevant actors to respond to climate change. An integrated view on the causation of infectious disease risk is employed, including multiple (climatic and non-climatic) factors. The results show that the experts consider some adaptation responses as relatively more cost-effective, like fostering interagency and community partnerships, or beneficial to health, such as outbreak investigation and response. Expert opinions converge and diverge for different adaptation responses. Regarding the prioritization of mitigation and adaptation responses expert perspectives converge towards a 50/50 budgetary allocation. The experts consider the national government/health authority as the most capable actor to respond to climate change-induced infectious disease risk. Divergence and consensus among expert opinions can influence adaptation policy processes. Further research is necessary to uncover prevailing expert perspectives and their roots, and compare these. Full article
(This article belongs to the Special Issue Cumulative and Integrated Health Impact Assessment)
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4995 KiB  
Article
The Impact of Ambient Temperature on Childhood HFMD Incidence in Inland and Coastal Area: A Two-City Study in Shandong Province, China
by Lin Zhu, Zhongshang Yuan, Xianjun Wang, Jie Li, Lu Wang, Yunxia Liu, Fuzhong Xue and Yanxun Liu
Int. J. Environ. Res. Public Health 2015, 12(8), 8691-8704; https://doi.org/10.3390/ijerph120808691 - 23 Jul 2015
Cited by 41 | Viewed by 7512
Abstract
Hand, foot and mouth disease (HFMD) has been a substantial burden throughout the Asia-Pacific countries over the past decades. For the purposes of disease prevention and climate change health impact assessment, it is important to understand the temperature–disease association for HFMD in different [...] Read more.
Hand, foot and mouth disease (HFMD) has been a substantial burden throughout the Asia-Pacific countries over the past decades. For the purposes of disease prevention and climate change health impact assessment, it is important to understand the temperature–disease association for HFMD in different geographical locations. This study aims to assess the impact of temperature on HFMD incidence in an inland city and a coastal city and investigate the heterogeneity of temperature–disease associations. Daily morbidity data and meteorological variables of the study areas were collected for the period from 2007 to 2012. A total of 108,377 HFMD cases were included in this study. A distributed lag non-linear model (DLNM) with Poisson distribution was used to examine the nonlinear lagged effects of daily mean temperature on HFMD incidence. After controlling potential confounders, temperature showed significant association with HFMD incidence and the two cities demonstrated different impact modes ( I2= 96.1%; p < 0.01). The results highlight the effect of temperature on HFMD incidence and the impact pattern may be modified by geographical localities. Our findings can be a practical reference for the early warning and intervention strategies of HFMD. Full article
(This article belongs to the Special Issue Cumulative and Integrated Health Impact Assessment)
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929 KiB  
Article
Occupational Exposure of Diesel Station Workers to BTEX Compounds at a Bus Depot
by Raeesa Moolla, Christopher J. Curtis and Jasper Knight
Int. J. Environ. Res. Public Health 2015, 12(4), 4101-4115; https://doi.org/10.3390/ijerph120404101 - 13 Apr 2015
Cited by 60 | Viewed by 9022
Abstract
Diesel fuel is known to emit pollutants that have a negative impact on environmental and human health. In developing countries like South Africa, attendants are employed to pump fuel for customers at service stations. Attendants refuel vehicles with various octane unleaded fuel, lead-replacement [...] Read more.
Diesel fuel is known to emit pollutants that have a negative impact on environmental and human health. In developing countries like South Africa, attendants are employed to pump fuel for customers at service stations. Attendants refuel vehicles with various octane unleaded fuel, lead-replacement petrol and diesel fuel, on a daily basis. Attendants are at risk to adverse health effects associated with the inhalation of volatile organic compounds released from these fuels. The pollutants released include benzene, toluene, ethylbenzene and xylenes (BTEX), which are significant due to their high level of toxicity. In this study, a risk assessment of BTEX was conducted at a diesel service station for public buses. Using Radiello passive samplers, it was found that benzene concentrations were above recommended international standards. Due to poor ventilation and high exposure duration, the average benzene concentration over the sampling campaign exceeded the US Environmental Protection Agency’s chronic inhalation exposure reference concentration. Lifetime cancer risk estimation showed that on average there is a 3.78 × 10−4 cancer risk, corresponding to an average chronic daily intake of 1.38 × 10−3 mg/kg/day of benzene exposure. Additionally, there were incidences where individuals were at potential hazard risk of benzene and toluene that may pose non-carcinogenic effects to employees. Full article
(This article belongs to the Special Issue Cumulative and Integrated Health Impact Assessment)
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Review

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3605 KiB  
Review
Integrated Environmental Health Impact Assessment for Risk Governance Purposes; Across What Do We Integrate?
by Erik Lebret
Int. J. Environ. Res. Public Health 2016, 13(1), 71; https://doi.org/10.3390/ijerph13010071 - 23 Dec 2015
Cited by 12 | Viewed by 7312
Abstract
Integrated Environmental Health Impact Assessment (IEHIA) can be considered as an element in the third phase of environmental risk management. Its focus is on providing inclusive descriptions of multiple impacts from multiple stressors in such a way that they can be evaluated against [...] Read more.
Integrated Environmental Health Impact Assessment (IEHIA) can be considered as an element in the third phase of environmental risk management. Its focus is on providing inclusive descriptions of multiple impacts from multiple stressors in such a way that they can be evaluated against the potential societal benefits of the causes of the stressors. This paper emphasises some differences and difficulties in the integration across professional paradigms and scientific fields, across stakeholder perspectives and differences in impact indicators that emanate from these different fields and paradigms. Full article
(This article belongs to the Special Issue Cumulative and Integrated Health Impact Assessment)
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779 KiB  
Review
Noise Effects on Health in the Context of Air Pollution Exposure
by Stephen A. Stansfeld
Int. J. Environ. Res. Public Health 2015, 12(10), 12735-12760; https://doi.org/10.3390/ijerph121012735 - 14 Oct 2015
Cited by 132 | Viewed by 12434
Abstract
For public health policy and planning it is important to understand the relative contribution of environmental noise on health compared to other environmental stressors. Air pollution is the primary environmental stressor in relation to cardiovascular morbidity and mortality. This paper reports a narrative [...] Read more.
For public health policy and planning it is important to understand the relative contribution of environmental noise on health compared to other environmental stressors. Air pollution is the primary environmental stressor in relation to cardiovascular morbidity and mortality. This paper reports a narrative review of studies in which the associations of both environmental noise and air pollution with health have been examined. Studies of hypertension, myocardial infarction, stroke, mortality and cognitive outcomes were included. Results suggest independent effects of environmental noise from road traffic, aircraft and, with fewer studies, railway noise on cardiovascular outcomes after adjustment for air pollution. Comparative burden of disease studies demonstrate that air pollution is the primary environmental cause of disability adjusted life years lost (DALYs). Environmental noise is ranked second in terms of DALYs in Europe and the DALYs attributed to noise were more than those attributed to lead, ozone and dioxins. In conclusion, in planning and health impact assessment environmental noise should be considered an independent contributor to health risk which has a separate and substantial role in ill-health separate to that of air pollution. Full article
(This article belongs to the Special Issue Cumulative and Integrated Health Impact Assessment)
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