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Health Consequences of Environmental Exposures: Causal Thinking in Global Environmental Epidemiology


Peter D. Sly ,

Children's Health and Environment Program, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
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David O. Carpenter,

Institute for Health and the Environment, University at Albany, Rensselaer, NY
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Martin Van den Berg,

Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands
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Renato T. Stein,

Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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Philip J. Landrigan,

Icahn School of Medicine at Mount Sinai, New York, NY
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Marie-Noel Brune-Drisse,

The Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
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William Suk

Hazardous Substances Research Branch; Superfund Research Program, National Institute for Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
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The 2010 Global Burden of Disease estimates indicate a trend toward increasing years lived with disability from chronic noncommunicable diseases (NCDs). Risk factors examined included smoking, diet, alcohol, drug abuse, and physical inactivity. By contrast, little consideration was given to accumulating evidence that exposures to environmental chemicals, psychosocial stress, and malnutrition during fetal development and across the life span also increase risk of NCDs. To address this gap, we undertook a narrative review of early-life environmental contributions to disease. We documented numerous etiologicassociations. We propose that future GBD estimates use an expanded approach for assessing etiologic contributions of environmental exposures to recognized disease risk factors. We argue that broadening the definition of environmental disease, together with improved methods of assessing early life exposures and their health outcomes across the life span, will allow better understanding of causal associations and provide the incentives required to support strategies to control avoidable exposures and reduce disease risk.
How to Cite: Sly, P.D., Carpenter, D.O., Van den Berg, M., Stein, R.T., Landrigan, P.J., Brune-Drisse, M.-N. and Suk, W., 2016. Health Consequences of Environmental Exposures: Causal Thinking in Global Environmental Epidemiology. Annals of Global Health, 82(1), pp.3–9. DOI:
Published on 17 Jun 2016.
Peer Reviewed


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