Pienkowski Thomas, Dickens Borame Lee, Sun Haoyang, Carrasco Luis Roman
Department of Biological Sciences, National University of Singapore, Singapore, Singapore.
Department of Biological Sciences, National University of Singapore, Singapore, Singapore.
Lancet Planet Health. 2017 Aug;1(5):e180-e187. doi: 10.1016/S2542-5196(17)30081-5. Epub 2017 Aug 4.
Potential synergies between public health and environmental protection that offer new opportunities for achieving health and sustainable development targets have been postulated. However, empirical evidence of the effect of ecosystem degradation and protection on public health outcomes is scarce, which restricts policy makers' ability to assess the net health effects of land-use change.
We used generalised linear mixed-effects models to analyse data for 35 547 households in 1766 communities from the Cambodian Demographic Health Surveys to investigate the relation between health and protected areas across deforestation gradients in Cambodia between Feb 1, 2005, and April 30, 2014. Diarrhoea, acute respiratory infection, and fever in children younger than 5 years were used as population health indicators. Dense and mixed forest coverage were derived from Open Development Cambodia, and forest loss was calculated from 2000 to 2004, 2004 to 2009, and 2009 to 2014. The incidence of non-specific illness and injury in people older than 15 years was used as a negative control. Our analyses included rich pseudo-panel data (combining cross-sectional datasets from 2005, 2010, and 2014) that accounted for socioeconomic, demographic, and behavioural characteristics, and had a negative control, approximating a quasi-experimental study design.
Deforestation of dense forest was associated with an increased incidence of diarrhoea (p=0·007), fever (p=0·0495), and acute respiratory infection in children (p=0·003). For example, a 10 percentage point increase in loss of dense forest was estimated to be associated with an increase of 14·1% (95% CI 2·6-35·8) in the incidence of diarrhoea in children younger than 5 years per household in the 2 weeks before the Cambodian Demographic Health Surveys. Protected area coverage, but not type, was associated with decreased incidences of diarrhoea (p=0·028) and acute respiratory infection (p=0·030). Apart from an association between mixed forest coverage and increased incidence of diarrhoea, forest coverage was not associated with any health outcomes.
Deforestation is associated with increased risk of several major sources of global childhood morbidity and mortality. Although causal mechanisms are unclear, our findings suggest that protected areas could help to alleviate the global health burden, presenting new possibilities for simultaneous achievement of public health and conservation goals.
Ministry of Education of Singapore.
有人推测，公共卫生与环境保护之间存在潜在协同效应，可为实现健康和可持续发展目标带来新机遇。然而，生态系统退化和保护对公共卫生结果影响的实证证据稀缺，这限制了政策制定者评估土地利用变化对健康净影响的能力。
我们使用广义线性混合效应模型，分析了柬埔寨人口与健康调查中1766个社区35547户家庭的数据，以研究2005年2月1日至2014年4月30日期间柬埔寨森林砍伐梯度上健康与保护区之间的关系。5岁以下儿童的腹泻、急性呼吸道感染和发热被用作人群健康指标。茂密和混合森林覆盖数据来自柬埔寨开放发展组织，森林损失是根据2000年至2004年、2004年至2009年以及2009年至2014年计算得出的。15岁以上人群非特异性疾病和损伤的发病率用作阴性对照。我们的分析包括丰富的伪面板数据（结合了2005年、2010年和2014年的横断面数据集），这些数据考虑了社会经济、人口和行为特征，并设有阴性对照，近似于准实验研究设计。
茂密森林的砍伐与腹泻发病率增加（p = 0.007）、发热（p = 0.0495）以及儿童急性呼吸道感染发病率增加（p = 0.003）相关。例如，据估计，在柬埔寨人口与健康调查前2周，每户5岁以下儿童腹泻发病率每增加10个百分点，茂密森林损失就会增加14.1%（95%置信区间2.6 - 35.8%）。保护区覆盖范围而非类型与腹泻发病率降低（p = 0.028）和急性呼吸道感染发病率降低（p = 0.030）相关。除了混合森林覆盖与腹泻发病率增加有关外，森林覆盖与任何健康结果均无关联。
森林砍伐与全球儿童发病和死亡的几个主要来源风险增加相关。尽管因果机制尚不清楚，但我们的研究结果表明，保护区有助于减轻全球健康负担，为同时实现公共卫生和保护目标带来了新的可能性。
新加坡教育部
