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 impact studies makes it possible to provide an estimate of the simultaneous impact of several factors, to prioritize them, and to carry out cost-benefit studies to feed decision support. We discussed estimates of the burden of disease linked to available physico-chemical factors, those attributable to so-called " lifestyle factors ", and some of the methodological issues involved in these studies (particularly in relation to assessing the level of evidence and taking uncertainty into account). This has helped to put into perspective the essential factors discussed in the lecture, and to shed light on what could become a central tool in public health decision support.