Models of environmental health indicators

Dr.Ahmed-Refat AG Refat
Community Medicine Dept. FOM-ZU
APRIL 2016
Environmental Health
Indicators Models

www.SildeShare.net/AhmedRefat2
Environmental Health Indicators
Models
“Indicators are
a way of seeing the
big picture by
looking at
a small piece of it”
(Environment Canada, 2001).
Ahmed-Refat
April 2016

Contents
 Definitions , uses and types of indicators
 Features of the good indicator
 Limitations of indicators
 Conceptual Frameworks for Indicators
 PSR –Model
 DSR –Model
 DPSIR –Model
 DPSEEA –Model
 MEME –Model

PART- I
*********
INDICATORS
DEFINITIONS AND CONCEPTS

It is estimated that
about
23% of the world’s total
DALY burden is
associated with
environmental factors.

There are links
between
development,
health and the
environment.

Complex Interrelated Links

Indicators were
developed to
measure the complex
relations among
environment ,
development and
health issues

Definitions

Definitions
https://stats.oecd.org/glossary/detail.asp?ID=830

Definitions
Indicator
Index
Parameter
Health Indicator
Environmental Health Indictor

Indicator
A key statistic that
indicates or points
to another measure.

Indicator
“A summary measure that aims
to describe - in a few numbers as
much detail as possible- about a
system to help understand,
compare, predict, improve,
and innovate.” DEF + USES !!!!!

Definition & Terminology
Indicator:
A parameter, or a value derived
from parameters, which points to,
provides information about,
describes the state of
a phenomenon/ environment/area,
with a significance extending
beyond that directly associated
with a parameter value.

Index
A set of aggregated
or weighted parameters
or indicators.

Parameter
A property that is
measured or observed..

Health Indicator
Health indicator are …
summary measures that
are designed to describe
particular aspects of
health or health system
performance.

Environmental Health Indicator
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”

Related Terms
Leading Indicator
Lagging Indicator
Proxy Indicator
Hybrid Indictor
Composite & Compound Indictor
Indicator’s Typology
 Metrics of Indicators

Leading indicators
Leading indicators are associated
with proactive activities
that identify hazards and assess,
eliminate, minimize and control risk

Leading indicators
 Before-the-fact indicators.
 Activities indicators
 Upstream indicators
 Inputs indicators
 Do not reach the threshold of causality to create an incident
 Measure safety-relevant activity, not safety per se

Leading indicators
are conditions, events or measures
that precede an undesirable event
and that have some value in
predicting the arrival of the event,
whether it is an accident, incident,
near miss or undesirable safety
state.

Lagging indicators
Also known as
Outcome indicators,
Down-stream , and
After-the-fact indicators .

Lagging indicators
Measure the extent of harm that has
occurred
( Past performance - Reactive)
Provide historical information about
health and safety performance .
Measure unexpected failures
occurring in normal operations .
Measure real failed … outcomes

Proxy Indicator
Sometimes, it is too hard to get data for
an indicator.
That indicator can be replaced with
another easier-to-obtain one that gets
close to what we’re interested in.
The alternate measure serves as a proxy
/a “stand-in”.
Example : uses school absenteeism as a
proxy for (possible) influenza
outbreaks.

Hybrid Indicators
Exposure-effect indicators
Combine information on the
outcomes and their
determinants.
Examples :
‘incidence of work accidents due to falling’
‘incidence of occupational diseases due to
exposure to asbestos’.

Simple vs Composite Indicators
A simple (non-composite)
indicator
summarizes information only on one
aspect of the phenomena under
study.
A composite indicator summarizes
information on related simple
indicators describing the same
phenomena. = index

Simple vs Compound Indicators
Simple ind.
Ind.target a specific element of the system.eg
Hospital admissions for acute respiratory infs.
Compound ind., Inds. that combine
different elements into a single measure.
Example : overall air quality index - obtained
by combining concentrations of particulates,
nitrogen oxides, benzene and ozone).

Typology OF Env. Indicators
Type A Descriptive indicators
Type B Performance indicators
Type C Efficiency indicators
Type D Total welfare indicators
THE EUROPEAN ENVIRONMENT AGENCY (EEA)

Type A
Descriptive indicators
- what is happening to the
environment or human health,
(e.g., emissions and
concentrations of pollutants)

Type B
Performance indicators
linked to a reference value or
policy target, illustrating how
far the indicator is from a
desired level are is increasing

Type C
Efficiency indicators
illustrating the efficiency of
production and consumption
processes,
for example energy
consumption per unit of output

Type D
Total welfare indicators
which aggregate together
economics, social and
environmental dimensions to
illustrate whether, overall,
welfare is increasing

Metrics can be of three types:
• Descriptive –
a condition measured at a certain
point in time
• Threshold –
compares data from descriptive metric
to tolerance levels
• Trended –
change in descriptive metric over time
Metrics OF Indicators

Uses of health indicators
Indicators quantify information
so its significance is more
readily apparent;
Indicators simplify information
about complex phenomena to
improve communication

1. Indicators are used to support planning
(identify priorities, develop and target
resources, identify benchmarks) and
track progress toward broad community
objectives
2. Indicators are powerful tools for
monitoring and communicating critical
information about population health.
3. .

3. Engagement of partners into a
collaborative action (build awareness of
problems and trends, generate
interventions).
4. Inform policy and policy makers, and
can be used to promote accountability
among governmental and non-
governmental agencies.

Database of Environ & PH
Indicators
International
Roles in
Metrics
Development

Database of Environ & PH Indicators
 World Health Organization (WHO)
 The United Nations (UN)
 TheWorld Bank (WB)
 Organization for Economic Cooperation and
Development (OECD)
 United Nation’s Children’s Fund (UNICEF)
 Food and Agriculture Organization (FAO)
 United States Environmental Protection Agency (USEPA)
 World Resources Institute (WRI)
 Worldwatch Institute
 International Institute for Sustainable Development
(IISD).
 Pan American Health Organization (PAHO)

WHO Classification
 Health Status Indicators: Mortality
Health Status Statistics: Morbidity
Health Services Coverage Statistics
Risk Factors Statistics
Health Systems Statistics
http://www.who.int/whosis/indicatordefinitions/en/index.html



EC Classification 88 Indicator
 Demography and socio-economic
situation
 Health status
 Determinants of health
 Health interventions: health services
 Health interventions: health
promotion

The Organization for Economic Co-
operation and Development (OECD)
OECD has developed:
1.Core environmental In.
2. Key environmental In.
3.Sectoral environmental In.

The Organization for Economic Co-
operation and Development (OECD)

OECD set of
key environmental indicators

The Organization for Economic Co-operation and
Development
1.core env. indicators –
a set of 50 indicators
designed to track
environmental progress and
analyze performance of
environmental policies in
OECD member countries

Development
2. key env.indicators
- a subset of Core
environmental indicators that
inform the public and provides
key signals to policy makers
on important environmental
issues and trends

Development
3.sectoral env.indicators
–
a set of indicators intended to
help integrate environmental
concerns into sectoral
policies, such as
transportation, energy, and
agriculture.

UN-CSD
UN Commission on
Sustainable Development
(UN CSD)
Has developed indicators of
sustainable development
(A set of 58 Indicators)

UN-CSD
UN CSD developed a
"theme based Ind. ”
1.social, 2.environmental,
3.economic, and 4. institutional
Each of these four themes is broken
down into sub-themes and
associated indicators

WBDI
World Bank Development
Indicators (WBDI)
more than 900 indicators
in over 80 tables
organized in 6 sections:

World Bank Development
Indicators (WBDI)
Sections ofWBDI :
1. world view;
2. people;
3. environment;
4. economy,
5. states and markets;
6. and global links.

Indicator’s Limitations
No indicator tells us all we need
to know
 We cannot develop indicators
for everything
To be effective, information must
be selective (target the key issues
and communicate concisely)

The Global
Reference List of
100 Core Health
Indicators

The Global Reference List of 100
Core Health Indicators
is a standard set of 100 indicators
prioritized by the global
community to provide
information on the health
situation and trends, including
responses at national
and global levels.

Criteria
for Selecting
health
Indicatorswww.SildeShare.net/AhmedRefat60

7 Core Quality Criteria
1. Policy relevance
2. Availability of data
3. Simplicity
4. Sensitivity
5. Specificity.
6. Validity
7. Reliability

MORE
Quality
Criteria

 Credible—based on a known link between climate and health
 Relevant to an issue of policy or practical concern
 Sustainable—able to provide data for the next 20–30 years
 Consistent and comparable over time and space
 Scalable—capable of being used at different scales
 Robust and unaffected by minor changes in methodology, scale or data
 Unbiased and representative of the conditions and area of concern
 Explicit—identify specific adaptation responses
 Accurate—based on data of a known and acceptable quality
 Understandable, applicable, and acceptable to stakeholders and potential
users
 Measurable—based on available data and manageable methods with
retrospective data available to provide a baseline, against which change can
be measured
 Cost-effective—capable of being constructed and used at an acceptable cost-
benefit ratio
 Selective—in that they help to prioritize key issues in need of action

PART II
*********
Conceptual Models
“Frameworks”

Framework
a hypothetical
description
of a complex
process

Conceptual Models
Conceptual models are
useful tools for issue
framing and to
communicate complex
relationships to a
wider, non-specialist
audience.

Commonly used frameworks
Project-based framework
(the Input-Output-Outcome-
Impact framework),
A framework based on
environmental issues or
themes.

Conceptual Models vs logical
frameworks
A logical frameworks
only provides a hierarchical
description of a project’s
activities ,whereas
a conceptual model often
represents the entire system,
including connections not being
addressed through a project.

A project-based framework

Indicators Framework
A conceptual framework is needed to:
Structure diverse env. information
Make it more comprehensible to
decision makers and the general
public.
Reveal data gaps, thus guiding data
collection .

The advantages of using LFA
 It guides systematic and logical analysis of the inter-
related key elements of the environmental health issues .
 It provides a better basis for planning , systematic
monitoring and analysis of the environmental health
issues.
 It facilitates common understanding and better
communication between decision-makers, managers and
other parties involved in the issue.
 It provides standardized procedures for collecting and
assessing information.
 Widespread use of the LFA format makes it easier to
undertake both sectoral studies and comparative studies
in general..

Common
Environmental
Health Models /
Frameworks75 www.SildeShare.net/AhmedRefat

Common Environmental Health
Frameworks
1. E.PH.I Framework…….. .(CDC)
2. P.S.R Framework …......(OECD)
3. D.S.R Framework ……..(UN )
4. D.P.S.I.R Framework…..(EU)
5. D.P.S.E.E.A Framework. (WHO –
Env Health)
6. M.E.M.E Framework (WHO-Child
Env Health)

Environmental Health Frameworks
1-CDC
Hz.Ex.He.I. Model

Hazard indicators
Exposure indicators
Health effect indicators
Intervention indicator
CDC-EPHI- Types of indicator

Hazard indicators:
Conditions or activities
that identify the
potential for exposure to
a contaminant or
hazardous condition.

Exposure indicators:
Biologic markers in tissue
or fluid that identify the
presence of a substance
or combination of
substances that could
harm an individual.

CDC-EPHI- Types of
indicator
Health effect indicators:
Diseases or conditions
that identify an adverse
effect from exposure to
a known or suspected
environmental hazard.

CDC-EPHI- Types of
indicator
Intervention indicator:
Programs or official
policies that minimize
or prevent an
environmental hazard,
exposure, or health
effect.

The tier suggests the importance of
the indicator with respect to policy
or program considerations.
Tiers include :
Core, Optional, and
Developmental
measures.
Tiers of indicator

A core indicator
should be included in a state
health department’s basic
environmental public health
surveillance program.
Measurements for these indicators
may be available or could be made
readily available
Tiers of indicator - Core Indicators

An optional indicator
 may be part of a basic environmental public health
program for some states, depending on individual
needs, priorities, and data availability.An indicator in
the optional tier must have at least one optional measure
but can also have developmental measures.When a core
measure is identified, the indicator will change from
optional to core.
Tiers of indicator - Optional Ind

 Developmental:A developmental
indicator or measure is one that may have
environmental public health relevance, but
the measurements either have not yet been
established or pose significant interpretation
challenges.An indicator in the developmental
tier can have only developmental measures. If
optional or core measures are identified, the
indicator will be reclassified.
Tiers of indicator - Developmental ind

 Topics
 Air,Ambient (Outdoor)
 Air, Indoor
 Disasters Lead (Pb)
 Noise
 Pesticides
 Sentinel Events Sun and Ultraviolet Light
 Toxics andWaste
 Water,Ambient
 Water, Drinking
Topics of indicator

2- OCED
P.S.R Model

PSR Model
Pressure-State-Response
Framework
PSR- framework was developed in
1993 by the Organization for
Economic Co-operation and
Development

PSR Model
Three angles of environmental issues.
Based on a concept of causality

The PSR framework is based on a
concept of causality:
 Human activities exert pressures on the
environment and change its quality and the
quantity of natural resources (the "state”)
 Society responds to these changes through
environmental, general economic and sectoral
policies (the "societal response").

Pressures (mainly from
human activities), which cause
changes in the State of the
environment, and in turn led to
policy Responses.

PSR: Application examples from OECD

WASTE:

Issue : OZONE LAYER DEPLETION

Issue : Air Quality

PSR & Environmental Issues

Sectors&PSR , Env. Issues

A development of the
P.S.R framework .
Adopted by the
UN Commission on
Sustainable
Development.
3-D. S. R Model

Driving Force
State
Response
D. S. R Model

D.S.R Model
Driving Force-State-Response
Framework
 Driving force—human activities,
processes, and patterns that impact on
sustainable development;
 State—the ‗state‘ of sustainable
development;
 Response—policy options and other
responses to changes in sustainable
development.

D.S.R Model
Driving Force-State-Response Framework
 The term “pressure” is replaced with
‗driving force‘ to accommodate more
accurately the addition of social,
economic, and institutional indicators.
 The term -driving force‘ also allows for
the impact on sustainable development
to be positive or negative as is often
the case for social, economic, and
institutional indicators

4- D.P.S.I.R Model
Driving Force
Pressure
State
Impact
Response

DPSR Frame work

D.P.S.I.R Model
Driving Force-Pressure-State-
Impact-Response Framework
A further development of the PSR and
DSR frameworks is the European
Union-developed DPSIR framework,
which provides an overall mechanism
for analyzing environmental problems.

D.P.S.I.R Model
Driving Force-Pressure-State-Impact-
Response Framework
Driving forces —such as industry and
transport, produce; Pressures —on the
environment, such as polluting
emissions, which then degrade the;
State —of the environment, which then;
Impact —on human health and
ecosystems, causing society to
RESPOND;

5-WHO
D.P.S.E.E.A
Model

5- D.P.S.E.E.A FRAMEWORK
-Driving Force
-Pressure
-State
-Exposure
-Effect
-Action

DPSEEA FRAMEWORK
-In the early 1990s the WHO
developed a framework that
incorporates transparent
linkages between various one-
dimensional environment or
health indicators and places the
focus on public health

DPSEEA FRAMEWORK
covers the full spectrum of potential
forces and resulting actions and
brings together professionals,
practitioners, and managers from
both environmental and public
health fields to help orient them in
the larger scheme of the problem.

6-M.E.M.E FRAMEWORK
The Multiple Exposures-Multiple Effects
framework
 is a further development of the DPSEEA
framework for use in the context of
children‘s environmental health.
 This framework emphasizes the complex
relationships between environmental
exposures and child health outcomes

Quizes
By Using DPSEEA Model
What is the position
( in DPSEEA model )
of each indicator in
the following lists

THANK YOU

Models of environmental health indicators

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