Cover -- Title Page -- Contents -- Environment and Development -- Acknowledgments -- Abbreviations and Acronyms -- CHAPTER 1 Introduction -- Introduction -- Objectives -- Audience -- A Primer on Environmental Health -- Poor Water and Sanitation Access -- Indoor Air Pollution -- Malaria -- A Primer on Malnutrition -- Content and Organization -- Epidemiology -- Economics -- Experiences -- PART 1 Epidemiology -- CHAPTER 2 Environmental Health, Malnutrition, and Child Health -- Introduction -- Environmental Factors, Exposure, and Transmission Pathways -- Vicious Cycle of Infections and Malnutrition -- Effect of Malnutrition on Disease -- Effect of Infections on Malnutrition -- Environmental Role in Early Childhood Health -- Pregnancy: Protecting the Fetus -- Malaria -- Hookworm infections -- Indoor air pollution -- Early Infancy: The "Window of Opportunity" -- Clean Environments, Healthy Children -- Averting Cognition and Learning Impacts -- Key Messages -- Note -- CHAPTER 3 How Environmental Health Supplements Other Child Survival Strategies -- Introduction -- Adding Value to Health Systems -- Childbirth and Infant Care Programs -- Immunization Programs -- Micronutrient Supplementation Programs -- Adapting Environmental Management Programs -- Adjusting Infrastructure Strategies -- Improving Water Supply -- Improving Sanitation -- Moving up the Energy Ladder -- Key Messages -- Notes -- PART 2 Economics -- CHAPTER 4 How Large Is the Environmental Health Burden? -- Introduction -- Burden of Disease -- Environmental Burden of Disease -- Including the Malnutrition-Infection Link -- Environmental Health Burdens -- The Multiplier Effect for Environmental Health Interventions -- Conservative Estimates -- Areas for Future Research -- Key Messages -- Notes -- CHAPTER 5 Estimating the Environmental Health Burden and Costs at the Country Level -- Introduction.

Existing Practice in Environmental Health Valuation -- Building New Estimates for Environmental Health Costs -- Estimating and Valuing Health Impacts Accounting for Malnutrition -- Valuing Education and Cognition Costs -- Case Studies of Ghana and Pakistan -- Results for Ghana and Pakistan -- The Burden of Environmental Risk Factors If No Change in Malnutrition -- The Burden of Environmental Risk Factors and Malnutrition -- Malnutrition in Ghana and Pakistan -- Health effects of malnutrition -- Infections and malnutrition -- Malnutrition in the absence of infections: the counterfactual -- Calculating the burden of environmental risk factors, including malnutrition-mediated effects -- Impact on Education: Affecting School Performance and Future Work Productivity -- Conclusion -- Next Steps -- Key Messages -- Notes -- PART 3 Experiences -- CHAPTER 6 Approaches to Environmental Health -- Introduction -- History of Environmental Health -- First Generation: Origins of "Miasma" Theory -- Second Generation: Sanitation, Vaccinations, Multisectoral Interventions -- Third Generation: Hands-on Scaling Up -- Fourth Generation: The Invisible Regulator -- Agenda Falling through the Cracks -- Environmental Health Experiences in Developing Countries -- Integrated Child Survival Programs -- Nutrition Programs -- Infrastructure Programs -- Vector-Control Programs -- Understanding the Enabling Environment -- Political Will and Effective Consensus -- Involving and Empowering Communities -- Balancing Private and Public Sector Roles -- Governance and Institutional Implications -- Unraveling the Environmental Health Agenda in the Developed World -- Developing Countries Follow Suit -- Institutional Requirements for Successful Environmental Health Governance -- Roles of National Governments -- Provide the regulatory framework.

Provide the necessary platforms for intersectoral coordination -- Ensure interjurisdictional coordination -- Clarify mandates and appropriate devolution of authority and finances -- Provide technical and policy inputs -- Foster communication, advocacy, and promotion -- Roles of Local Governments -- Promote an integrated approach to local level health -- Provide civic amenities related to environmental health -- Mobilize citizens and support health activities -- Strengthen roles in communication and advocacy -- Reorient the role of an environmental health workforce -- Establish and enforce regulations -- A Critical Moment -- Key Messages -- Note -- CHAPTER 7 Conclusion -- Introduction -- Contributions of This Report -- Next Steps -- Appendix A: Technical Review of Cohort Studies -- Background -- Search Strategy and Selection Criteria -- Findings and Discussion -- Strength of Association -- Consistency -- Specificity (Dose-Response) -- Temporality -- Biological Plausibility -- Experimental Evidence from Deworming -- Conclusions -- Choice of Parameters -- Notes -- Appendix B: Review of Studies on Nutritional Status and Education -- Diarrhea and Education -- Conclusions -- Note -- Appendix C: New Estimates for Burden of Disease from Water, Sanitation, and Hygiene -- Appendix D: Computing Country-Level Environmental Health Burden of Disease -- Mortality -- Step 1: Data Collection -- Step 2: Assessment of the Population at Risk -- Step 3: Assessment of Relative Risks -- Step 4: Calculation of Counterfactual Exposure Categories -- Step 5: Estimation of Deaths Attributable to Environmental Health Risk Factors -- Step 6: Valuation of Attributable Health End Points -- Education -- Step 7: Data Collection -- Step 8: Assessment of Counterfactual Malnutrition-Attributable Loss in School Performance.

Step 9: Assessment of Malnutrition-Attributable Loss in School Performance -- Step 10: Valuation -- Summary of Results for Ghana and Pakistan -- Notes -- Appendix E: Methodological Aspects of Assessing Environmental Health Burden of Disease -- From Relative Risks to Attributable Fractions -- Dealing with Biased Estimates of Relative Risk -- Notes -- Appendix F: Monetary Valuation of the Cost of Environmental Health Risks -- Note -- References -- Index -- Back Cover.