Pakistan is blessed with natural and human resources and is one of the most populous countries of South Asia but 35 per cent of the environmental diseases in the region are in Pakistan. About 6 per cent of GDP and Rs380 billion per year are lost due to environmental degradation. The root cause of diseases (including genetic diseases) is poor environment. Environment related diseases are preventable. The most vulnerable population is elderly people, women, children and the poor.

Environmental health is a multi-disciplinary and multi-sectoral issue, involving several ministries and agencies. Several policies (including health) exist at national and international level, but there is very little mention or role of environmental health. Environment and health go hand-in-hand. Environmental health is a bridge between the two, thus facilitating each other. Major environmental health issues in Pakistan include water supply, sanitation and hygiene, solid and hazardous wastes, healthcare waste, air pollution, climate change and noise pollution.

Those communities which are provided with unsafe water and inadequate sanitation can face up to 40 per cent of burden of disease and sickness (cholera, typhoid, dysentery, hepatitis, and cryptosporidiosis and guinea worm infections). About 25 to 30 per cent of total child patients taken to hospitals suffer from diarrhea. As per a USAID report, 250,000 child deaths occur each year in Pakistan due to waterborne diseases. The total health cost associated with the morbidity and mortality, resulting from diarrheal diseases is around 1.8 per cent of the GDP (Rs114 billion).

More than 10,000 people die annually of renal infections due to polluted water. Healthcare waste is another sore point in the environmental health issue. Prevalence rate of 3-4 per cent for HBV and 4-6 per cent for HCV has created a pool of 12-13 million exposed to chronic liver disease in Pakistan. Food contamination and safety account for 57 per cent of total outbreaks. Over 80 per cent of disasters (natural and man-made) are related to environmental factors (e.g. climate change), resulting in outbreaks of diseases (diarrhea, typhoid, etc).

World Health Organisation has recently issued a report saying that during 2012 around 7 million people died -- one in eight of total global deaths -- as a result of air pollution. This recent estimate suggests that the problem of air pollution has increased two-fold as compared to the previous estimates. The situation calls for serious steps to control air pollution and save millions of lives. In particular, the new data reveals a stronger link between both indoor and outdoor air pollution exposure and cardiovascular diseases, such as strokes and heart disease, and cancer. This is in addition to air pollution’s role in the development of respiratory diseases, including acute respiratory infections and chronic obstructive pulmonary diseases.

Regionally, low and middle income countries in the South-East Asia and Western Pacific regions had the largest air pollution-related burden in 2012, with a total of 3.3 million deaths linked to indoor air pollution and 2.6 million deaths related to outdoor air pollution. Cleaning up the air prevents non-communicable diseases as well as reduces disease risks among women and vulnerable groups, including children and the elderly. Poor women and children pay a heavy price due to indoor air pollution since they spend more time at home breathing in smoke and soot from leaky stoves that run on wood and coal. The risks from air pollution are now far greater than previously thought or understood, particularly for heart disease and strokes.

Health professionals link 4.3 million deaths in 2012 to cooking over coal, wood and biomass stoves. The new estimate is explained by better information about pollution exposures among the estimated 2.9 billion people living in homes using wood, coal or dung as their primary cooking fuel, as well as evidence about air pollution’s role in the development of cardiovascular and respiratory diseases, and cancers.

In the case of outdoor air pollution, it is estimated that there were 3.7 million deaths in 2012 from urban and rural sources worldwide. Excessive air pollution is often a by-product of unsustainable policies in sectors such as transport, energy, waste management and industry. In most cases, healthier strategies will also be more economical in the long term due to healthcare cost savings as well as climate gains. Health sector has a unique role in translating scientific evidence on air pollution into policies that can have impact and save lives.

Environmental health is a multi-sector issue and calls for action from all walks of life including business, commerce, industry, agriculture, food, housing, physical planning, traffic, highways, social welfare, religious affairs etc. Communication support for policy advocacy, opinion building and social mobilisation for action is also required at all levels.