Das Konzept der umweltbedingten Krankheitslast

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

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