Although health, environment, and development problems differ in various regions of the world, as do priorities in respect to their management, in all situations decision makers and the public at large need ready access to accurate information on health hazards associated with the links between development and the environment.
In the health and environment area, as in other areas, information is needed to monitor and assess trends, identify and prioritize problems, develop and evaluate policies and plans, guide research and development, set standards and guidelines, monitor progress, and inform the public. It is important that this data be conveyed in a readily comprehensible way but with due regard to the complexities and uncertainties inherent in the data. This is often a limiting characteristic of health and environment data.
Although there often is an abundance of available data and information (of variable quality) from monitoring and surveillance programs, this information may not always be policy relevant for decision makers. The information may thus be of limited use for informing the public and decision makers of key health and environmental problems and their causes or of possible management actions needed.
Indicators can play an important role in turning health and environment data into relevant information for decision makers and the public. Most important, they can help simplify a complex array of information with respect to the health—environment—development nexus. This way, they provide a synthesis view of existing conditions and trends that provides information for decision making in the public health sector.
Building on commonly accepted definitions of indicators, Briggs et al. (1996) define an environmental health indicator as "an expression of the link between environment and health, targeted at an issue of specific policy or management concern and presented in a form which facilitates interpretation for effective decision-making." Embodied in this definition is the concept of a link between a factor in the environment and a health outcome. An environmental or health outcome indicator can thus be regarded as an indicator of a health—environment relationship if there is some connection between the health indicator and the environment or between the environmental indicator and health.
Although composite measures are often used in health (e.g., a composite measure of the burden of disease based on the concept of disability-adjusted life years combines the years of healthy life lost due to premature death, disability, or disease; Murray and Lopez 1996), simple descriptive indicators are often very useful. They can be used to obtain baseline information on which to formulate subsequent policy options and plans and assess trends.
At all levels (global, regional, local), indicators that describe the overall state (quality) of the environment and highlight factors influencing environmental quality and potential impacts on and links with human health can be useful. They can provide an overview, a snapshot of a situation, or a profile of environment and health conditions, thereby exhibiting links and trends. They are visual depictions of data that, once combined, may reveal something about the assumed link between various factors. In this regard, the indicator framework described in this chapter may be applicable. However, indicators normally should not be used for the purpose of establishing causal links between factors in the environment potentially affecting human health. For this, sophisticated epidemiological studies in various settings and under differing conditions are usually needed and cannot be substituted by indicators.
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