Hutton Guy
Water and Sanitation Program, World Bank.
Environ Health Insights. 2008 Dec 19;2:137-55. doi: 10.4137/ehi.s1152.
Environmental burden of disease represents one quarter of overall disease burden, hence necessitating greater attention from decision makers both inside and outside the health sector. Economic evaluation techniques such as cost-effectiveness analysis and cost-benefit analysis provide key information to health decision makers on the efficiency of environmental health interventions, assisting them in choosing interventions which give the greatest social return on limited public budgets and private resources. The aim of this article is to review economic evaluation studies in three environmental health areas-water, sanitation, hygiene (WSH), vector control, and air pollution-and to critically examine the policy relevance and scientific quality of the studies for selecting and funding public programmers. A keyword search of Medline from 1990-2008 revealed 32 studies, and gathering of articles from other sources revealed a further 18 studies, giving a total of 50 economic evaluation studies (13 WSH interventions, 16 vector control and 21 air pollution). Overall, the economic evidence base on environmental health interventions remains relatively weak-too few studies per intervention, of variable scientific quality and from diverse locations which limits generalisability of findings. Importantly, there still exists a disconnect between economic research, decision making and programmer implementation. This can be explained by the lack of translation of research findings into accessible documentation for policy makers and limited relevance of research findings, and the often low importance of economic evidence in budgeting decisions. These findings underline the importance of involving policy makers in the defining of research agendas and commissioning of research, and improving the awareness of researchers of the policy environment into which their research feeds.
疾病的环境负担占总体疾病负担的四分之一，因此需要卫生部门内外的决策者给予更多关注。成本效益分析和成本效益分析等经济评估技术为卫生决策者提供了关于环境卫生干预措施效率的关键信息，帮助他们在有限的公共预算和私人资源条件下选择能带来最大社会回报的干预措施。本文旨在回顾三个环境卫生领域——水、环境卫生与个人卫生（WSH）、病媒控制和空气污染——的经济评估研究，并严格审视这些研究对于选择公共项目并为其提供资金的政策相关性和科学质量。对19991990年至2008年的医学期刊数据库（Medline）进行关键词搜索，共找到32项研究，从其他来源收集的文章又发现了18项研究，总计50项经济评估研究（13项水、环境卫生与个人卫生干预措施，16项病媒控制措施和21项空气污染措施）。总体而言，环境卫生干预措施的经济证据基础仍然相对薄弱——每项干预措施的研究数量过少，科学质量参差不齐，且研究地点各异，这限制了研究结果的普遍性。重要的是，经济研究、决策制定和项目实施之间仍然存在脱节。这可以解释为研究结果缺乏转化为决策者易于获取的文件，研究结果的相关性有限，以及经济证据在预算决策中往往不太重要。这些发现凸显了让决策者参与研究议程的定义和研究委托的重要性，并提高研究人员对其研究成果所应用的政策环境的认识。
