CONTENTS xiAcknowledgments xiiiAbbreviations and Acronyms CHAPTER 1 1Introduction 4Objectives 5Audience 5A Primer on Environmental Health 6A Primer on Malnutrition 7 Content and Organization PARTI 15 Epidemiology CHAPTER 2 17 Environmental Health, Malnutrition, and Child Health 18 Environmental Factors, Exposure, and Transmission Pathways 19 Vicious Cycle of Infections and Malnutrition 23 Environmental Role in Early Childhood Health 28 Averting Cognition and Learning Impacts 30 Key Messages 30 Note CHAPTER 3 31How Environmental Health Supplements Other Child Survival Strategies 32Adding Value to Health Systems 38Adapting Environmental Management Programs 39Adjusting Infrastructure Strategies 43Key Messages 43Notes PART II 45Economics CHAPTER 4 47 How Large Is the Environmental Health Burden? 48 Burden of Disease 51 Environmental Health Burdens 58 Areas for Future Research 59Key Messages 59Notes CHAPTER 5 61 Estimating the Environmental Health Burden and Costs at the Country Level 61 Existing Practice in Environmental Health Valuation 62 Building New Estimates for Environmental Health Costs 64 Case Studies of Ghana and Pakistan 66 Results for Ghana and Pakistan 77 Conclusion 79 Next Steps 81 Key Messages 81Notes PART III 83Experiences CHAPTER 6 85 Approaches to Environmental Health 86 History of Environmental Health 88 Agenda Falling through the Cracks 90 Environmental Health Experiences in Developing Countries 97 Understanding the Enabling Environment 100Governance and Institutional Implications 104Institutional Requirements for Successful Environmental Health Governance 109 A Critical Moment 109Key Messages 110Note CHAPTER 7 111 Conclusion 111 Contributions of This Report 113 Next Steps Appendixes 117 APPENDIX A: Technical Review of Cohort Studies 117 Background 118 Search Strategy and Selection Criteria 118 Findings and Discussion 122 Experimental Evidence from Deworming 123 Conclusions 125 Notes 141 APPENDIX B: Review of Studies on Nutritional Status and Education 145 Diarrhea and Education 145Conclusions 146 Note 147 APPENDIX C: New Estimates for Burden of Disease from Water, Sanitation, and Hygiene 151APPENDIX D: Computing Country-Level Environmental Health Burden of Disease 151 Mortality 160Education 170Notes 173 APPENDIX E: Methodological Aspects of Assessing Environmental Health Burden of Disease 173From Relative Risks to Attributable Fractions 176 Dealing with Biased Estimates of Relative Risk 177Notes 179 APPENDIX F: Monetary Valuation of the Cost of Environmental Health Risks 181 Note 183References 201Index