Smith Kirk R
Global Environmental Health, University of California, School of Public Health, Berkeley, California, USA.
Ann N Y Acad Sci. 2008 Oct;1140:31-9. doi: 10.1196/annals.1454.032.
Conceptual and methodological issues in calculating and comparing the health impacts from environmental risk factors in ways that are not only compatible across environmental hazards but also can be fairly compared to burdens from nonenvironmental risk factors, such as poor nutrition, unsafe sex, and smoking, are discussed. It is emphasized that a focus on environmental health burden does not always produce priorities that correspond to those related to environmental quality alone. The methods when applied to China's environmental and other risks using the Chinese burden of disease in terms of lost healthy life years as the metric are illustrated. Household environmental risks are still quite important in China, because of rural poverty, but have been exceeded by community environmental risks nationally. Global risks from climate are small at present, but have the potential to rise. Although not a major greenhouse gas emitter on a per capita basis compared to rich countries, China has already passed the threshold of imposing more global risk than it receives. The study ends with the suggestion that environmental risk assessment should use as a baseline estimates that are based on methods developed in international collaborative assessments, such as those in the WHO Comparative Risk Assessment, in order to foster comparability and policy and public confidence in the methods.
本文讨论了在计算和比较环境风险因素对健康的影响时所涉及的概念和方法问题，这些方法不仅要在不同环境危害之间具有兼容性，而且要能够与非环境风险因素（如营养不良、不安全的性行为和吸烟）所造成的负担进行公平比较。需要强调的是，关注环境健康负担并不总是能产生仅与环境质量相关的优先事项。文中举例说明了如何运用这些方法，以因健康生命年损失衡量的中国疾病负担为指标，来评估中国的环境及其他风险。由于农村贫困问题，家庭环境风险在中国仍然相当重要，但从全国范围来看，已被社区环境风险所超越。目前，气候带来的全球风险较小，但有上升的可能。尽管与富裕国家相比，中国的人均温室气体排放量并非主要排放国，但中国已经超过了承受全球风险多于自身造成全球风险的阈值。研究最后建议，环境风险评估应以国际合作评估（如世界卫生组织的比较风险评估）中所采用的方法为基础进行基线估计，以提高方法的可比性以及政策制定者和公众对这些方法的信心。
