How environmental health risks change with development: The epidemiologic and environmental risk transitions revisited

Transition frameworks are used to envision the important changes that occur during economic development from poor to middle-income or rich countries. We explain the derivation of and use data from the Global Burden of Disease (GBD) and Comparative Risk Assessment (CRA) projects of the World Health Organization (WHO) to explore the classic epidemiologic transition framework, which describes the changes in causes of illness and death during economic development. We provide the first full empirical test of the environmental risk transition framework, which describes the shift in environmental risks during development from household, community, and global risk factors. We find that the simplistic conclusions commonly drawn about the epidemiologic transition, in particular the increase in chronic diseases with development, are not supported by current data; in contrast, the conceptual framework of the environmental risk transition is broadly supported in a cross-sectional analysis. We also describe important kinds of environmental health risks and diseases that are not well estimated using current methods.