NEK Associates LTD, Allston, MA 02134, USA.
E Risk Sciences LLP, Lafayette, CO 80026, USA.
Int J Environ Res Public Health. 2021 Apr 28;18(9):4676. doi: 10.3390/ijerph18094676.
The rise of small-scale and localized economic activities in low- and middle-income countries (LMICs) has led to increased exposures to contaminants associated with these processes and the potential for resulting adverse health effects in exposed communities. Risk assessment is the process of building models to predict the probability of adverse outcomes based on concentration-response functions and exposure scenarios for individual contaminants, while epidemiology uses statistical methods to explore associations between potential exposures and observed health outcomes. Neither approach by itself is practical or sufficient for evaluating the magnitude of exposures and health impacts associated with land-based pollution in LMICs. Here we propose a more pragmatic framework for designing representative studies, including uniform sampling guidelines and household surveys, that draws from both methodologies to better support community health impact analyses associated with land-based pollution sources in LMICs. Our primary goal is to explicitly link environmental contamination from land-based pollution associated with specific localized economic activities to community exposures and health outcomes at the household level. The proposed framework was applied to the following three types of industries that are now widespread in many LMICs: artisanal scale gold mining (ASGM), used lead-acid battery recycling (ULAB), and small tanning facilities. For each activity, we develop a generalized conceptual site model (CSM) that describes qualitative linkages from chemical releases or discharges, environmental fate and transport mechanisms, exposure pathways and routes, populations at risk, and health outcomes. This upfront information, which is often overlooked, is essential for delineating the contaminant zone of influence in a community and identifying relevant households for study. We also recommend cost-effective methods for use in LMICs related to environmental sampling, biological monitoring, survey questionnaires, and health outcome measurements at contaminated and unexposed reference sites. Future study designs based on this framework will facilitate consistent, comparable, and standardized community exposure, risk, and health impact assessments for land-based pollution in LMICs. The results of these studies can also support economic burden analyses and risk management decision-making around site cleanup, risk mitigation, and public health education.
在中低收入国家（LMICs），小规模和本地化的经济活动的兴起导致与这些过程相关的污染物暴露增加，并且暴露社区可能会出现不良健康影响。风险评估是建立模型的过程，根据个体污染物的浓度-反应函数和暴露情景来预测不良结果的可能性，而流行病学则使用统计方法来探索潜在暴露与观察到的健康结果之间的关系。这两种方法本身都不实用或不足以评估与 LMICs 陆基污染相关的暴露程度和健康影响。在这里，我们提出了一个更实用的框架来设计代表性研究，包括统一的采样指南和家庭调查，该框架借鉴了这两种方法，以更好地支持与 LMICs 陆基污染源相关的社区健康影响分析。我们的主要目标是明确将与特定本地化经济活动相关的陆基污染造成的环境污染与家庭层面的暴露和健康结果联系起来。所提出的框架适用于以下三种在许多 LMICs 中广泛存在的行业：手工规模金矿开采（ASGM）、使用过的铅酸电池回收（ULAB）和小型制革厂。对于每个活动，我们开发一个通用的概念性场地模型（CSM），该模型描述了从化学释放或排放、环境归宿和传输机制、暴露途径和途径、处于危险中的人群以及健康结果的定性联系。这种通常被忽视的前期信息对于划定社区的污染影响区域以及确定研究相关的家庭至关重要。我们还建议在 LMICs 中使用具有成本效益的方法，用于环境采样、生物监测、调查问卷以及污染和未污染参考点的健康结果测量。基于该框架的未来研究设计将促进对 LMICs 陆基污染的一致、可比和标准化的社区暴露、风险和健康影响评估。这些研究的结果还可以支持与场地清理、风险缓解和公共卫生教育有关的经济负担分析和风险管理决策。
