Jack Caravanos

Jack Caravanos
Clinical Professor of Environmental Public Health Sciences in the Department of Global and Environmental Health
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Professional overview
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For Dr. Jack Caravanos, life in the field ranges from jumping onto a motorcycle and navigating the jungles of Madre de Dios in the Peruvian Amazon studying toxic substances to traveling to remotes areas in Zambia, Indonesia, and Bolivia studying lead and other toxic wastes. By cooperating with local governments, his work provides safe, healthy, and evidence-based solutions for pollution problems in low- and middle-income countries.
In partnership with Pure Earth, an international non-profit organization, Dr. Caravanos is studying the impact of gold extraction with mercury in Peru and Indonesia. Since miners are in danger of mercury poisoning, his research team is planning interventions that teach safer techniques for gold extraction. In Kabwe, Zambia - a mining town with exposure to lead - his research will provide methods to institute safer mining practices and policy recommendations to improve environmental remediation laws.
Dr. Caravanos teaches Environmental Health for graduate students and Environmental Health in a Global World for undergraduate students. He also provides opportunities for student researchers in his ongoing projects, including in Indonesia (mercury) and Ghana (e-waste).
To learn more about Dr. Caravanos and his work, visit his website.
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Education
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BS, Health Science, Hunter College, New York, NYMS, Environmental Health Engineering, New York University, New York, NYDrPH, Environmental Health, Columbia University, New York, NY
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Honors and awards
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Presidential Award for Excellence in Community Service, Hunter College (2013)Presidential Award for Excellence in Teaching, Hunter College (2006)
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Areas of research and study
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Artisanal Gold MiningDissemination and Implementation of Evidence-based ProgramsEnvironmental Public Health ServicesGlobal HealthLead poisoning
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Publications
Publications
Measurement of Soil Lead Levels Adjacent to Lead-Sheathed Communications Cables
Caravanos, J., Landrigan, P. J., Nelson, B. K., Neisler, J. P., & Chang, H. Y. (n.d.). In Environmental health perspectives (1–).Publication year
2024Volume
132Issue
3Structured expert judgement approach of the health impact of various chemicals and classes of chemicals
Marti, D., Hanrahan, D., Sanchez-Triana, E., Wells, M., Corra, L., Hu, H., Breysse, P. N., Laborde, A., Caravanos, J., Bertollini, R., Porterfield, K., & Fuller, R. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
6AbstractIntroduction Chemical contamination and pollution are an ongoing threat to human health and the environment. The concern over the consequences of chemical exposures at the global level continues to grow. Because resources are constrained, there is a need to prioritize interventions focused on the greatest health impact. Data, especially related to chemical exposures, are rarely available for most substances of concern, and alternate methods to evaluate their impact are needed. Structured expert judgment (SEJ) process A Structured Expert Judgment (Research Outreach, 2021) process was performed to provide plausible estimates of health impacts for 16 commonly found pollutants: asbestos, arsenic, benzene, chromium, cadmium, dioxins, fluoride, highly hazardous pesticides (HHPs), lead, mercury, polycyclic-aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), Per- and Polyfluorinated Substances (PFAs), phthalates, endocrine disrupting chemicals (EDCs), and brominated flame retardants (BRFs). This process, undertaken by sector experts, weighed individual estimations of the probable global health scale health impacts of each pollutant using objective estimates of the expert opinions' statistical accuracy and informativeness. Main findings The foremost substances, in terms of mean projected annual total deaths, were lead, asbestos, arsenic, and HHPs. Lead surpasses the others by a large margin, with an estimated median value of 1.7 million deaths annually. The three other substances averaged between 136,000 and 274,000 deaths per year. Of the 12 other chemicals evaluated, none reached an estimated annual death count exceeding 100,000. These findings underscore the importance of prioritizing available resources on reducing and remediating the impacts of these key pollutants. Range of health impacts Based on the evidence available, experts concluded some of the more notorious chemical pollutants, such as PCBs and dioxin, do not result in high levels of human health impact from a global scale perspective. However, the chemical toxicity of some compounds released in recent decades, such as Endocrine Disrupters and PFAs, cannot be ignored, even if current impacts are limited. Moreover, the impact of some chemicals may be disproportionately large in some geographic areas. Continued research and monitoring are essential; and a preventative approach is needed for chemicals. Future directions These results, and potential similar analyses of other chemicals, are provided as inputs to ongoing discussions about priority setting for global chemicals and pollution management. Furthermore, we suggest that this SEJ process be repeated periodically as new information becomes available.Efficacy of Grignard Pure to Inactivate Airborne Phage MS2, a Common SARS-CoV-2 Surrogate
Desai, G., Ramachandran, G., Goldman, E., Esposito, W., Galione, A., Lal, A., Choueiri, T. K., Fay, A., Jordan, W., Schaffner, D. W., Caravanos, J., Grignard, E., & Mainelis, G. (n.d.).Publication year
2023Journal title
Environmental Science and TechnologyVolume
57Issue
10Page(s)
4231-4240AbstractGrignard Pure (GP) is a unique and proprietary blend of triethylene glycol (TEG) and inert ingredients designed for continuous antimicrobial treatment of air. TEG has been designated as a ″Safer Chemical” by the US EPA. GP has already received approval from the US EPA under its Section 18 Public Health Emergency Exemption program for use in seven states. This study characterizes the efficacy of GP for inactivating MS2 bacteriophage─a nonenveloped virus widely used as a surrogate for SARS-CoV-2. Experiments measured the decrease in airborne viable MS2 concentration in the presence of different concentrations of GP from 60 to 90 min, accounting for both natural die-off and settling of MS2. Experiments were conducted both by introducing GP aerosol into air containing MS2 and by introducing airborne MS2 into air containing GP aerosol. GP is consistently able to rapidly reduce viable MS2 bacteriophage concentration by 2-3 logs at GP concentrations of 0.04-0.5 mg/m3 (corresponding to TEG concentrations of 0.025 to 0.287 mg/m3). Related GP efficacy experiments by the US EPA, as well as GP (TEG) safety and toxicology, are also discussed.Lead Levels in a Potters Population and Its Association With the Use of Different Glazes: Cross-Sectional Evaluation of the Approved Pottery Program
Peralta, N., Cantoral, A., Téllez-Rojo, M. M., Trejo-Valdivia, B., Estrada-Sánchez, D., Richardson-L, V., Caravanos, J., & Fuller, R. (n.d.).Publication year
2022Journal title
Frontiers in ToxicologyVolume
4AbstractLead is one of the most harmful toxic metals to humans. In Mexico, though most potters still use a lead-based glazing process, a new lead-free glaze has been introduced to the production of pottery. The Approved Pottery Program (APP) promotes the production of lead-free pottery. As a component of the APP, we aimed to document in this pilot study the blood lead levels (BLLs) of a sample of potters and the association with the type of glaze used. A cross-sectional study was conducted based on information from 46 potters grouped by 26 workshops. We measured general sociodemographic characteristics, capillary BLLs, and the lead levels of the dirt floors of the workshops. The evaluation of associations and comparisons between glaze types was performed based on a regression model clustered by workshop. The median BLL measured was 13.6 μg/dl (IQR: 7.8–20.4 μg/dl), and 70% of the BLLs were greater than 10 μg/dl. Workshop managers presented higher BLLs compared to others working in the same workshop (median of 14.1 μg/dl (IQR: 11.6–25.3 μg/dl) versus 10.1 μg/dl (IQR: 5.2–16.7 μg/dl), respectively). The median BLLs of potters who used lead-free glaze in at least 80% of production were 8.8 μg/dl (95% CI: −17.3 to −0.3 μg/dl) lower than the BLLs of those who used lead-free glaze in less than 30% of production, adjusted by workshop role. Additionally, the lead levels were significantly lower in workshop dirt floors where lead-free glaze was used in at least 80% of the production compared to those that use less than 30% (180 versus 916 mg/kg; p < 0.05). The use of lead-free glaze in the production of pottery was associated with both lower BLLs in potters and lower soil lead levels in the workshop area.Pollution and health: a progress update
Fuller, R., Landrigan, P. J., Balakrishnan, K., Bathan, G., Bose-O’Reilly, S., Brauer, M., Caravanos, J., Chiles, T., Cohen, A., Corra, L., Cropper, M., Ferraro, G., Hanna, J., Hanrahan, D., Hu, H., Hunter, D., Janata, G., Kupka, R., Lanphear, B., … Yan, C. (n.d.).Publication year
2022Journal title
The Lancet Planetary HealthVolume
6Issue
6Page(s)
e535-e547AbstractThe Lancet Commission on pollution and health reported that pollution was responsible for 9 million premature deaths in 2015, making it the world's largest environmental risk factor for disease and premature death. We have now updated this estimate using data from the Global Burden of Diseases, Injuriaes, and Risk Factors Study 2019. We find that pollution remains responsible for approximately 9 million deaths per year, corresponding to one in six deaths worldwide. Reductions have occurred in the number of deaths attributable to the types of pollution associated with extreme poverty. However, these reductions in deaths from household air pollution and water pollution are offset by increased deaths attributable to ambient air pollution and toxic chemical pollution (ie, lead). Deaths from these modern pollution risk factors, which are the unintended consequence of industrialisation and urbanisation, have risen by 7% since 2015 and by over 66% since 2000. Despite ongoing efforts by UN agencies, committed groups, committed individuals, and some national governments (mostly in high-income countries), little real progress against pollution can be identified overall, particularly in the low-income and middle-income countries, where pollution is most severe. Urgent attention is needed to control pollution and prevent pollution-related disease, with an emphasis on air pollution and lead poisoning, and a stronger focus on hazardous chemical pollution. Pollution, climate change, and biodiversity loss are closely linked. Successful control of these conjoined threats requires a globally supported, formal science–policy interface to inform intervention, influence research, and guide funding. Pollution has typically been viewed as a local issue to be addressed through subnational and national regulation or, occasionally, using regional policy in higher-income countries. Now, however, it is increasingly clear that pollution is a planetary threat, and that its drivers, its dispersion, and its effects on health transcend local boundaries and demand a global response. Global action on all major modern pollutants is needed. Global efforts can synergise with other global environmental policy programmes, especially as a large-scale, rapid transition away from all fossil fuels to clean, renewable energy is an effective strategy for preventing pollution while also slowing down climate change, and thus achieves a double benefit for planetary health.Probabilistic estimates of prenatal lead exposure at 195 toxic hotspots in low- and middle-income countries
Zajac, L., Kobrosly, R. W., Ericson, B., Caravanos, J., Landrigan, P. J., & Riederer, A. M. (n.d.).Publication year
2020Journal title
Environmental ResearchVolume
183AbstractBackground: Prior estimates of pediatric lead-related disease burden in low- and middle-income countries (LMICs) used population estimates of maternal blood lead levels (BLLs). This approach may underestimate fetal BLLs by not considering potentially high prenatal lead exposure from toxic hotspots. Objectives: We developed a probabilistic approach to using the Adult Lead Methodology (ALM) to estimate fetal BLLs from prenatal exposure to lead-contaminated soil at hotspots in the Toxic Site Identification Program (TSIP). Methods: We created distributions for each ALM parameter using published literature and extracted soil lead measurements from the TSIP database. Each iteration of the probabilistic ALM randomly selected values from the input distributions to generate a site-specific fetal BLL estimate. For each site, we ran 5000 model iterations, producing a site-specific fetal BLL distribution. Results: 195 TSIP sites, in 33 LMICs, met our study inclusion criteria; an estimated 820,000 women of childbearing age are at risk for lead exposure at these sites. The predicted geometric means (GM) for site-specific fetal BLLs ranged from 3.3 μg/dL to 534 μg/dL, and 98% of sites had estimated GM fetal BLLs >5 μg/dL, the current reference level of the United States Centers for Disease Control and Prevention (CDC), while 11 sites had estimated GM fetal BLLs above the CDC chelation threshold of 45 μg/dL. Discussion: The TSIP soil lead data and this probabilistic approach to the ALM show that pregnant women living near TSIP sites may have BLLs that put their fetus at risk for neurologic damage and other sequelae, underscoring the need for interventions to reduce lead exposure at toxic hotspots.Assessment of the prevalence of lead-based paint exposure risk in Jakarta, Indonesia
Ericson, B., Hariojati, N., Susilorini, B., Crampe, L. F., Fuller, R., Taylor, M. P., & Caravanos, J. (n.d.).Publication year
2019Journal title
Science of the Total EnvironmentVolume
657Page(s)
1382-1388AbstractWhile lead-based paint has been banned for use in residential settings in most high-income countries, it remains commonly available in many low- and middle-income countries (LMICs). Despite its continued availability, little is known about the specific exposure risk posed by lead-based paint in LMICs. To address this knowledge gap, an assessment of home and preschool dust and paint was carried out in Greater Jakarta, Indonesia. A team of investigators used field portable X-ray Fluorescence (pXRF) to measure 1574 painted surfaces for the presence of lead (mg/cm2) and collected 222 surface dust wipe samples for lead loading (μg/m2) from 103 homes and 19 preschools across 13 different neighborhoods of Jakarta. The assessment found that 2.7% (n = 42) of pXRF measurements and 0.05% (n = 1) of dust wipe samples exceeded the commonly applied USEPA guideline values for paint (1 mg/cm2) and dust (floors: 431 μg/m2; window sills: 2691 μg/m2). Thus, contrary to expectations the locations analyzed in Greater Jakarta showed that exposure risk to lead-based paint appears low. Further study is required in other settings to confirm the findings here. Precautionary measures, such as the proposed ban on lead-based paint, should be taken to prevent the significant social and economic costs associated with lead exposure.Conflicting conclusions or competing methodologies? Documenting soil lead pollution in Owino Uhuru, Kenya
Caravanos, J. (n.d.).Publication year
2019Journal title
Journal of Health and PollutionVolume
9Issue
21A meta-analysis of blood lead levels in India and the attributable burden of disease
Ericson, B., Dowling, R., Dey, S., Caravanos, J., Mishra, N., Fisher, S., Ramirez, M., Sharma, P., McCartor, A., Guin, P., Taylor, M. P., & Fuller, R. (n.d.).Publication year
2018Journal title
Environment internationalVolume
121Page(s)
461-470AbstractMultiple studies in India have found elevated blood lead levels (BLLs) in target populations. However the data have not yet been evaluated to understand population-wide exposure levels. We used arithmetic mean blood lead data published from 2010 to 2018 on Indian populations to calculate the average BLLs for multiple subgroups. We then calculated the attributable disease burden in IQ decrement and Disability Adjusted Life Years (DALYs). Our Pubmed search yielded 1066 articles. Of these, 31 studies representing the BLLs of 5472 people in 9 states met our study criteria. Evaluating these, we found a mean BLL of 6.86 μg/dL (95% CI: 4.38–9.35) in children and 7.52 μg/dL (95% CI: 5.28–9.76) in non-occupationally exposed adults. We calculated that these exposures resulted in 4.9 million DALYs (95% CI: 3.9–5.6) in the states we evaluated. Population-wide BLLs in India remain elevated despite regulatory action to eliminate leaded petrol, the most significant historical source. The estimated attributable disease burden is larger than previously calculated, particularly with regard to associated intellectual disability outcomes in children. Larger population-wide BLL studies are required to inform future calculations. Policy responses need to be developed to mitigate the worst exposures.Cost Effectiveness of Environmental Lead Risk Mitigation in Low-and Middle-Income Countries
Ericson, B., Caravanos, J., Depratt, C., Santos, C., Cabral, M. G., Fuller, R., & Taylor, M. P. (n.d.).Publication year
2018Journal title
GeoHealthVolume
2Issue
2Page(s)
87-101AbstractEnvironmental remediation efforts in low-and middle-income countries have yet to be evaluated for their cost effectiveness. To address this gap we calculate a cost per Disability Adjusted Life Year (DALY) averted following the environmental remediation of the former lead smelter and adjoining residential areas in Paraiso de Dios, Haina, the Dominican Republic, executed from 2009 to 2010. The remediation had the effect of lowering surface soil lead concentrations to below 100 mg/kg and measured geometric mean blood lead levels (BLLs) from 20.6 μg/dL to 5.34 ug/dL. Because BLLs for the entire impacted population were not available, we use environmental data to calculate the resulting disease burden. We find that before the intervention 176 people were exposed to elevated environmental lead levels at Paraiso de Dios resulting in mean BLLs of 24.97 (95% CI: 24.45–25.5) in children (0–7 years old) and 13.98 μg/dL (95% CI: 13.03–15) in adults. We calculate that without the intervention these exposures would have resulted in 133 to 1,096 DALYs and that all of these were averted at a cost of USD 392 to 3,238, depending on assumptions made. We use a societal perspective, meaning that we include all costs regardless of by whom they were incurred and estimate costs in 2009 USD. Lead remediation in low-and middle-income countries is cost effective according to World Health Organization thresholds. Further research is required to compare the approach detailed here with other public health interventions.Geo-Spatial Characterization of Soil Mercury and Arsenic at a High-Altitude Bolivian Gold Mine
Johnson, G. D., Pavilonis, B., Caravanos, J., & Grassman, J. (n.d.).Publication year
2018Journal title
Bulletin of Environmental Contamination and ToxicologyVolume
100Issue
2Page(s)
259-264AbstractSoil mercury concentrations at a typical small-scale mine site in the Bolivian Andes were elevated (28–737 mg/kg or ppm) in localized areas where mercury amalgams were either formed or vaporized to release gold, but was not detectable beyond approximately 10 m from its sources. Arsenic was measurable, exceeding known background levels throughout the mine site (77–137,022 ppm), and was also measurable through the local village of Ingenio (36–1803 ppm). Although arsenic levels were high at all surveyed locations, its spatial pattern followed mercury, being highest where mercury was high.Lead intoxicated children in Kabwe, Zambia
Bose-O’Reilly, S., Yabe, J., Makumba, J., Schutzmeier, P., Ericson, B., & Caravanos, J. (n.d.).Publication year
2018Journal title
Environmental ResearchVolume
165Page(s)
420-424AbstractKabwe is a lead contaminated mining town in Zambia. Kabwe has extensive lead contaminated soil and children in Kabwe ingest and inhale high quantities of this toxic dust. The aim of this paper is to analyze the health impact of this exposure for children. Health data from three existing studies were re-analyzed. Over 95% of children living in the most affected townships had high blood lead levels (BLLs) > 10 µg/dL. Approximately 50% of those children had BLLs ≥ 45 µg/dL. The existing data clearly establishes the presence of a severe environmental health crisis in Kabwe which warrants immediate attention.Pollution and global health – An agenda for prevention
Landrigan, P. J., Fuller, R., Hu, H., Caravanos, J., Cropper, M. L., Hanrahan, D., Sandilya, K., Chiles, T. C., Kumar, P., & Suk, W. A. (n.d.).Publication year
2018Journal title
Environmental health perspectivesVolume
126Issue
8AbstractSUMMARY: Pollution is a major, overlooked, global health threat that was responsible in 2015 for an estimated 9 million deaths and great economic losses. To end neglect of pollution and advance prevention of pollution-related disease, we formed the Lancet Commission on Pollution and Health. Despite recent gains in understanding of pollution and its health effects, this Commission noted that large gaps in knowledge remain. To close these gaps and guide prevention, the Commission made research recommendations and proposed creation of a Global Observatory on Pollution and Health. We posit that successful pollution research will be translational and based on transdisciplinary collaborations among exposure science, epidemiology, data science, engineering, health policy, and economics. We envision that the Global Observatory on Pollution and Health will be a multinational consortium based at Boston College and the Harvard T.H. Chan School of Public Health that will aggregate, geocode, and archive data on pollution and pollution-related disease; analyze these data to discern trends, geographic patterns, and opportunities for intervention; and make its findings available to policymakers, the media, and the global public to catalyze research, inform policy, and assist cities and countries to target pollution, track progress, and save lives.Prevention-intervention strategies to reduce exposure to e-waste
Heacock, M., Trottier, B., Adhikary, S., Asante, K. A., Basu, N., Brune, M. N., Caravanos, J., Carpenter, D., Cazabon, D., Chakraborty, P., Chen, A., Barriga, F. D., Ericson, B., Fobil, J., Haryanto, B., Huo, X., Joshi, T. K., Landrigan, P., Lopez, A., … Suk, W. (n.d.).Publication year
2018Journal title
Reviews on Environmental HealthVolume
33Issue
2Page(s)
219-228AbstractAs one of the largest waste streams, electronic waste (e-waste) production continues to grow in response to global demand for consumer electronics. This waste is often shipped to developing countries where it is disassembled and recycled. In many cases, e-waste recycling activities are conducted in informal settings with very few controls or protections in place for workers. These activities involve exposure to hazardous substances such as cadmium, lead, and brominated flame retardants and are frequently performed by women and children. Although recycling practices and exposures vary by scale and geographic region, we present case studies of e-waste recycling scenarios and intervention approaches to reduce or prevent exposures to the hazardous substances in e-waste that may be broadly applicable to diverse situations. Drawing on parallels identified in these cases, we discuss the future prevention and intervention strategies that recognize the difficult economic realities of informal e-waste recycling.Characterization and risk of exposure to elements from artisanal gold mining operations in the Bolivian Andes
Pavilonis, B., Grassman, J., Johnson, G., Diaz, Y., & Caravanos, J. (n.d.).Publication year
2017Journal title
Environmental ResearchVolume
154Page(s)
1-9AbstractArtisanal and small-scale gold mining (ASGM) offers low-skilled workers an opportunity to elevate themselves out of poverty. However, this industry operates with little to no pollution controls and the cost to the environment and human health can be large. The objectives of this study were to measure levels of arsenic (As), manganese (Mn), cobalt (Co), lead (Pb), and mercury (Hg) in the environment and characterize health risks to miners and residents in an area with active ASGM operations. An exposure assessment was conducted at two different mining sites and a nearby village in the Bolivian Anders. The resulting measurements were then used to quantify cancerous and noncancerous health risks to children and adults working at and living near ASGM areas. Soil concentrations of As were well above background levels and showed great variations between the village and mining area. Mercury vapor levels at the two mining sites were approximately 30 times larger than the EPA reference concentration. The risk of developing non-cancerous health effects were primarily due to exposure to As and Hg. The probability of individuals developing cancer was considerably increased with adult miners having a probability of 1.3 out of 100. Cancer potential was driven by exposure to As, with de minimus cancer risk from all other elements. Based on the environmental characterization of elements in soils and Hg vapors, the risk of developing cancerous and non-cancerous health outcomes were above a level of concern based on EPA risk assessment guidance. Personal protective equipment was not worn by workers and Hg amalgam is commonly heated in workers’ homes. Better education of the risks of ASGM is needed as well as simple controls to reduce exposure.Environmental contamination in Nigeria
Caravanos, J. (n.d.).Publication year
2017Journal title
Journal of Health and PollutionVolume
7Issue
13Page(s)
1Burden of disease resulting from lead exposure at toxic waste sites in Argentina, Mexico and Uruguay
Estimating the Prevalence of Toxic Waste Sites in Low- and Middle-Income Countries
Estimating the prevalence of toxic waste sites in low- and middle-income countries: a Ghanaian case study
Dowling, R., Caravanos, J., & Ericson, B. (n.d.).Publication year
2016Journal title
Environmental Monitoring and AssessmentThe Global Burden of Lead Toxicity Attributable to Informal Used Lead-Acid Battery Sites
The prevalence of toxic hotspots in former Soviet countries
Sharov, P., Dowling, R., Gogishvili, M., Jones, B., Caravanos, J., McCartor, A., Kashdan, Z., & Fuller, R. (n.d.).Publication year
2016Journal title
Environmental PollutionVolume
211Page(s)
346-353AbstractUsing a global database of contaminated sites, toxic hotspots in eight former Soviet countries were analyzed to identify the prevalence, types and sources of toxic pollution, as well as their associated potential public health impacts. For this analysis, polluted sites in Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, Russia, Tajikistan, Ukraine, and Uzbekistan were compiled and analyzed. The levels of contamination of seven key pollutants were assessed in each country. 424 contaminated sites were identified using data from Blacksmith Institute. Pesticides, lead (Pb), radioactive metals, arsenic (As), mercury (Hg), chromium (Cr), and cadmium (Cd) were the most commonly identified key pollutants. Collectively, these sites pose health risks to an estimated 6.2 million residents. The existing data on toxic hotspots in former Soviet countries likely captures only a small percentage of actual contaminated sites, but suggests potentially severe public health consequences. Additional assessments are needed to understand the risks posed by toxic pollution in the region.Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013
Failed generating bibliography.AbstractPublication year
2015Journal title
The LancetVolume
386Issue
10010Page(s)
2287-2323AbstractBackground: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian metaregression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.Lead exposure: A pending task in Mexico
Téllez-Rojo, M. M., & Caravanos, J. (n.d.).Publication year
2015Journal title
Salud Publica de MexicoVolume
57Issue
2Page(s)
115-116Protecting communities by remediating polluted sites worldwide
Spatial associations between contaminated land and socio demographics in Ghana
Dowling, R., Ericson, B., Caravanos, J., Grigsby, P., & Amoyaw-Osei, Y. (n.d.).Publication year
2015Journal title
International journal of environmental research and public healthVolume
12Issue
10Page(s)
13587-13601AbstractAssociations between contaminated land and socio demographics are well documented in high-income countries. In low- and middle-income countries, however, little is known about the extent of contaminated land and possible demographic correlations. This is an important yet sparsely researched topic with potentially significant public health implications as exposure to pollution remains a leading source of morbidity and mortality in low-income countries. In this study, we review the associations between several socio demographic factors (population, population density, unemployment, education, and literacy) and contaminated sites in Ghana. Within this context, both correlation and association intend to show the relationship between two variables, namely contaminated sites and socio demographics. Aggregated district level 2010 census data from Ghana Statistical Service and contaminated site location data from Pure Earth’s Toxic Sites Identification Program (TSIP) were spatially evaluated using the number of sites per kilometer squared within districts as the unit of measurement. We found a low to medium positive correlation (ρ range: 0.285 to 0.478) between contaminated sites and the following socio demographics: higher population density, higher unemployment, greater education, and higher literacy rate. These results support previous studies and suggest that several socio demographic factors may be reasonably accurate predictors of contaminated site locations. More research and targeted data collection is needed to better understand these associations with the ultimate goal of developing a predictive model.