A global vision : the burden of disease attributable to the environment

While, for multifactorial pathologies, it is generally impossible to attribute the occurrence of a disease to a specific exposure at the individual level, it is possible, by changing the scale, to quantify the number of cases attributable to this factor in a population. The generalization of this approach to quantitative health risk studies makes it possible to provide an estimate of the simultaneous impact of several factors, to seek to prioritize them, and to carry out cost-benefit studies to feed decision support. We will discuss estimates of the burden of disease associated with available physico-chemical factors, those attributable to so-called lifestyle factors, and some of the methodological issues (notably in relation to assessing the level of evidence and taking uncertainty into account) of these studies. This will put into perspective most of the factors discussed in the lecture, and shed light on what could become a central tool in public health decision-making.