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Issue Profile

Health Impacts

Health Impacts measures the probability of death between a child’s first and fifth birthdays. During this time, causes of death are strongly influenced by environmental factors, including air pollution, airborne particulates, and lack of access to clean drinking water.

What it measures: Child Mortality measures the probability of a child dying between his or her first and fifth birthday, per 1,000 one-year-old children. 

Why we include it: Environmental factors like polluted air and water are major causes of death for children between the ages of one and five. This indicator is a useful proxy for the effects of pollution and poor sanitation on human health. Reducing child mortality is the fourth Millennium Development Goal (MDG). Achieving it will require great improvements to environmental performance along with access to improved health care.

Where the data come from: United Nations, Department of Economic and Social Affairs, Population Division: World Population Prospects, the 2012 Revision.

Description: On the surface, the environmental implications of Child Mortality may seem indirect at best. The 75 countries that account for 95 percent of child mortality cases all have significant proportions of their population that rank among the world’s poorest. Malnutrition, poverty, disease, inadequate healthcare, and environmental factors all contribute to high child mortality. Disentangling the precise contributions is difficult, yet research shows that diarrheal disease, lower respiratory tract infections, and other preventable diseases are highly linked to water and air pollution. The health and fate of a country’s most vulnerable population is a good measure of the burden of environmental pressures on human beings.

In the policy arena, child mortality is narrowly defined as the death rate of children between the ages of one and five. The narrowness has a purpose. Children between one and five live in a critical phase: beyond the shadow of neonatal complications, but still highly vulnerable to health risks older children tend to overcome. Among these are environmentally borne illnesses, many of which are preventable.

That the two leading causes of child mortality have direct causal links to environmental conditions is a strong rationale for including child mortality in the EPI. Pneumonia, which is the leading cause of child mortality worldwide, is exacerbated by household and outdoor air pollution, both of which are environmental impacts measured by the EPI.1 Diarrhea is the second leading cause, and it is almost always triggered by poor sanitation and lack of access to clean drinking water. It also affects nutritional uptake in the body, thereby contributing to malnutrition. However once it is acquired—via any of a multitude of bacterial and viral agents—diarrhea is easily treated. Whether a country effectively treats its water, how that water is distributed, and access to sanitation and basic healthcare are revealed in figures on diarrhea-related deaths.

Malaria is the third leading cause of child mortality, and a strong case can be made that it too has environmental causes. Among the integrated strategies for fighting malaria sponsored by major international health organizations, control of malaria’s vector—Anopheles mosquitos—figures prominently. Methods to control mosquito populations include reducing deforestation in vulnerable areas, modernized irrigation systems (that also reduce water consumption), and reductions in standing water.2 In many cases, intervention at the environmental and biological levels has been shown to be as effective at reducing malaria rates as the use of insecticides. Also, research is beginning to show strong correlations between a warming climate and an increase in cases of vector-borne diseases like malaria.

The fourth MDG, to reduce child mortality by two-thirds of 1990 levels by 2015, is an ambitious one. Even so, great reductions have been seen worldwide, largely through intervention programs for diseases and increased sanitation. Between the 2012 and 2014 EPIs, child mortality rates have declined dramatically in many countries. Vast improvements in sub-Saharan African countries such as Gambia and Rwanda can be attributed to public health measures like wide distribution of vaccines to guard against pneumonia and diarrhea, mosquito nets for malaria prevention, and more widespread access to healthcare.3 While these policy interventions do not directly tie to environmental factors, there is a clear correlation between reductions in child mortality and access to sanitation and clean drinking water –other indicators in the Environmental Health Objective—which are strong factors in reducing diarrhea among children.4

Despite progress, child mortality rates remain high in many countries in South Asia and sub-Saharan Africa, and a significant reason is that environmental solutions have not kept pace with healthcare-based solutions. India alone accounts for between one-fourth and one-third of all deaths of children under five, mostly because of the effects of diarrhea and pneumonia resulting from water and air pollution.5 Linking public health and environmental solutions is a must. In Afghanistan, for instance, increased access to healthcare, vaccines for diphtheria, pertussis and tetanus, and treatment for malaria and diarrhea, coupled with the huge advances in access to sanitation and clean drinking water have spurred encouraging gains in child—and maternal—survival.6 Unfortunately significant improvement is not the norm. Low-performing countries in troubled regions are unlikely to achieve the goals set forth in the MDGs. This concern has prompted new initiatives to address environmentally borne disease in sub-Saharan Africa and South Asia directly.

For more information, see Alternative Measures of Environmental Health Impacts.

1 Liu, L., Johnson, H. L., Cousens, S., et al. (2012) Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. The Lancet 379:2151-2161.

2 Utzinger, J., Tozan, Y., and Singer, B.H. (2001) Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine and International Health 6:677–687.

3 Black R. E., Cousens, S., Johnson, H. L., et. al. (2010). Global, regional, and national cause of child mortality in 2008: a systematic analysis. The Lancet 375:1969-1987.

4 Bartram, J., and Cairncross, S. (2010). Hygiene, sanitation, and water: forgotten foundations of health. PLoS medicine7:e1000367.

5 Million Death Study Collaborators, Bassani, D. G., Kumar, R., et al. (2010) Causes of neonatal and child mortality in India: a nationally representative mortality survey The Lancet 376:853-1860.

6 Rasooly M. H., Govindasamy, P., Aqil, A. et al. (2013) Success in reducing maternal and child mortality in Afghanistan. Global Public Health. Published online 5 September 2013: DOI: 10.1080/17441692.2013.827733.

Data Explorer

The EPI Data Explorer allows users to dynamically investigate global data: Compare environmental performance with GDP, population, land area, or other variables; create a chart that highlights all 178 ranked countries, only those in a specific region, or a custom-defined group. There's a lot more to the data than rankings, so dive in.

Methods

The Environmental Performance Index (EPI) is constructed through the calculation and aggregation of 20 indicators reflecting national-level environmental data. These indicators are combined into nine issue categories, each of which fit under one of two overarching objectives. Click on "Learn More" to explore the complete methods.