Modelo DPSEEA e vigilância em saúde ambiental em Portugal: doenças oncológicas
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2017
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Em Portugal o cancro é a principal causa de morte em todas as idades. Estima-se que mundialmente a proporção de casos de
cancro atribuíveis a fatores de risco modificáveis exceda um terço do total de casos de
cancro. Estes são casos evitáveis.
O modelo de organização de indicadores DPSEEA: Força Motriz-Pressão-
Situação-Exposição-Efeito-Ação organiza os indicadores de saúde ambiental,
simplificando a descrição e a análise das relações entre desenvolvimento, ambiente e
saúde, visando auxiliar a tomada de decisões.
Através de uma pesquisa aplicada, descritiva e documental procurou-se elaborar
um quadro de indicadores alicerçado no modelo DPSEEA, otimizando a utilização da
informação disponível para uma leitura da situação e evolução da saúde ambiental em
Portugal com impacto na área das doenças oncológicas.
Foram consultados os sites de 41 entidades públicas de nível mundial, europeu
e nacional, e selecionados 81 potenciais indicadores. A seleção dos 18 indicadores mais
adequados, 3 por cada dimensão do modelo DPSEEA, foi efetuada com a colaboração
de um painel de peritos com 21 contributos efetivos, organizados por grupos de forma
aleatória e estratificada por áreas de formação. Os indicadores foram classificados numa
escala de Likert quanto à validez, solidez, relevância, sensibilidade e qualidade
estatística.
Estatisticamente as diferenças nas pontuações observadas para os diferentes
indicadores em todas as dimensões são estatisticamente significativas e o conjunto de
3 indicadores escolhidos para cada dimensão é igualmente relevante em 95% dos
mesmos (p<0,05).
O desempenho do país foi determinado pela classificação de 0 a 100 obtida pelo
cálculo de três números índice: o índice desempenho, para cada um dos 18 indicadores,
o índice dimensão para cada uma das 6 dimensões, e o índice global:
Í𝑛𝑑𝑖𝑐𝑒 𝐷𝑒𝑠𝑒𝑚𝑝𝑒𝑛ℎ𝑜 =
𝑥 − 𝑥𝑚𝑖𝑛
𝑥𝑚𝑎𝑥 − 𝑥𝑚𝑖𝑛
×100
Í𝑛𝑑𝑖𝑐𝑒 𝐷𝑖𝑚𝑒𝑛𝑠ã𝑜 = 𝐼𝑛𝑑1×0.5 + 𝐼𝑛𝑑2×0.25 + 𝐼𝑛𝑑3×0.25
Í𝑛𝑑𝑖𝑐𝑒 𝐺𝑙𝑜𝑏𝑎𝑙 = (𝐼𝐷𝐹𝑀 + 𝐼𝐷𝑃 + 𝐼𝐷𝑆 + 𝐼𝐷𝐸𝑥 + 𝐼𝐷𝐸𝑓 + 𝐼𝐷𝐴)/6
O índice desempenho é um índice relativo que considera os resultados dos países
da Europa dos 15: Alemanha, Áustria, Bélgica, Dinamarca, Espanha, Finlândia, França,Grécia, Irlanda, Itália, Luxemburgo, Países Baixos, Portugal, Reino Unido e Suécia, sendo
os outros dois dependentes deste.
Com a metodologia descrita obteve-se um índice global de valor 55 integrado
num painel constituído pelos seguintes indicadores e respetivos resultados para
Portugal:
i. Força Motriz – taxa de motorização: 100, uso de princípios ativos pesticidas por área
de culturas aráveis e arvenses: 29, notificações de exportações de produtos
químicos, misturas ou artigos sujeitos a prévia informação e consentimento: 80.
Índice dimensão: 77;
ii. Pressão – tabagismo atual de qualquer produto de tabaco (>15 anos): mulheres 100
/ homens 60, variação nas emissões de PCB: 0, variação nas emissões de dioxinas e
furanos: 64. Índice dimensão: 56;
iii. Situação – nível de média diária de radiação ultravioleta ambiental: 13, índice de
qualidade do ar: 90, amostras não conformes de deteção de resíduos em animais
criados destinados a alimentação: 83. Índice dimensão: 50;
iv. Exposição – população exposta a níveis de PM2.5 superiores aos limites da WHO: 68,
mercúrio ingerido através da alimentação: 0, população a viver em áreas urbanas:
99. Índice dimensão: 59;
v. Efeitos – taxa de mortalidade por neoplasmas malignos em tecidos linfoide e
hematopoiético: 56, taxa de incidência de melanoma (<55 anos): 98, taxa de
incidência de cancro: 34,5. Índice dimensão: 61;
vi. Ação – Número de locais públicos livres de fumo: 37,5, amostras para controlo de
resíduos em animais criados destinados a alimentação: 26, despesa consolidada em
ambiente dos organismos da administração pública em proteção da qualidade do ar
e clima: 2,5. Índice dimensão: 26.
Portugal detém programas de ação para os domínios ambientais presentes que
importa revisar procurando a sua otimização e uma efetiva intervenção intersectorial
em saúde ambiental da qual resulte a diminuição da exposição a determinantes
ambientais oncológicos.
In Portugal cancer is the main cause of premature death and the second main cause of death for all age groups. It is estimated that, globally, the proportion of cases of cancer caused due to modifiable risk factors exceeds one third of the total number of cases. Such cases can be prevented. DPSEEA: Driving Force – Pressure – State – Exposure – Effect – Action, is the indicators’ model used to organise environmental health indicators, simplifying the description and analysis of the relations between development, environment and health, aiming to aid decision-making. Through an applied, descriptive and documental research it was sought to elaborate an indicators’ chart founded on the DPSEEA model, optimizing the use of information available for a reading of the state and evolution of environmental health in Portugal with impact on oncological diseases. 41 websites belonging to public entities were consulted worldwide and on European and national levels, resulting in the selection of 81 potential indicators. The selection of the 18 most adequate indicators, 3 for each dimension of the DPSEEA model, was carried out by a panel of 21 experts arranged in groups on a random and stratified manner, according to different training areas. These indicators were then classified on a 0 to 100 scale as for validity, solidity, relevance, sensibility and statistical quality. Statistically, the differences observed in the scores relative to different indicators in all dimensions are of significance and the chosen set of 3 indicators for each dimension is equally relevant in 95% of the same (p<0,05). The country performance was evaluated on a 0 to 100 scale, obtained by the calculus of 3 index numbers: performance index, for each of the 18 indicators, dimension index for each of the 6 dimensions, and the overall index: 𝑃𝑒𝑟𝑓𝑜𝑟𝑚𝑎𝑛𝑐𝑒 𝐼𝑛𝑑𝑒𝑥 = 𝑥 − 𝑥𝑚𝑖𝑛 𝑥𝑚𝑎𝑥 − 𝑥𝑚𝑖𝑛 ×100 𝐷𝑖𝑚𝑒𝑛𝑠𝑖𝑜𝑛 𝐼𝑛𝑑𝑒𝑥 = 𝐼𝑛𝑑1×0.5 + 𝐼𝑛𝑑2×0.25 + 𝐼𝑛𝑑3×0.25 𝑂𝑣𝑒𝑟𝑎𝑙𝑙 𝐼𝑛𝑑𝑒𝑥 = (𝐼𝐷𝐷𝐹 + 𝐼𝐷𝑃 + 𝐼𝐷𝑆 + 𝐼𝐷𝐸𝑥 + 𝐼𝐷𝐸𝑓 + 𝐼𝐷𝐴)/6 The performance index is a relative index that considers the results of the countries of the Europe of 15: Germany, Austria, Belgium, Denmark, Spain, Finland,France, Greece, Ireland, Italy, Luxembourg, The Netherlands, Portugal, The United Kingdom and Sweden, being the other two dependents of this. Resorting to the described methodology, an overall index of value 55 was obtained and integrated in a panel constituted by the following indicators, and respective results, for Portugal: i. Driving Force – motorization rate: 100; use of active principles and pesticides by area of arable crops: 29; export notifications of chemical products, mixtures and items subject to prior information and consent: 80; Dimension Index: 77; ii. Pressure – current tobacco use of any tobacco product (>15 years old): women 100 / men 60; variation on PCB emissions: 0; variation of dioxins and furans emissions: 64; Dimension Index: 56; iii. State – level of daily average of environmental ultraviolet radiation: 13; air quality index: 90; non-compliant samples from residues detection on bred animals intended for human consumption: 83; Dimension index: 50; iv. Exposure – Population exposed to PM2.5 superior to WHO’s established limits: 68; mercury ingested through food: 0; population living in urban areas: 99; Dimension index: 59; v. Effects – mortality rate from malignant neoplasm in lymphoid and hematopoietic tissues: 56; melanoma incidence rate (<55 years old): 98; cancer incidence rate: 34,5; Dimension Index: 61; vi. Action – Number of smoke free public places: 37,5; samples for the control of residues from bred animals destined for human consumption: 26; amount spent in the protection of air and climate quality by organisms of public administration: 2,5; Dimension Index: 26; Portugal has action programmes for present environmental domains in need of review so as to optimize these programmes and the efficacy of intersectorial intervention on environmental health, from which results a decrease in the exposure to oncologically determinant environmental aspects.
In Portugal cancer is the main cause of premature death and the second main cause of death for all age groups. It is estimated that, globally, the proportion of cases of cancer caused due to modifiable risk factors exceeds one third of the total number of cases. Such cases can be prevented. DPSEEA: Driving Force – Pressure – State – Exposure – Effect – Action, is the indicators’ model used to organise environmental health indicators, simplifying the description and analysis of the relations between development, environment and health, aiming to aid decision-making. Through an applied, descriptive and documental research it was sought to elaborate an indicators’ chart founded on the DPSEEA model, optimizing the use of information available for a reading of the state and evolution of environmental health in Portugal with impact on oncological diseases. 41 websites belonging to public entities were consulted worldwide and on European and national levels, resulting in the selection of 81 potential indicators. The selection of the 18 most adequate indicators, 3 for each dimension of the DPSEEA model, was carried out by a panel of 21 experts arranged in groups on a random and stratified manner, according to different training areas. These indicators were then classified on a 0 to 100 scale as for validity, solidity, relevance, sensibility and statistical quality. Statistically, the differences observed in the scores relative to different indicators in all dimensions are of significance and the chosen set of 3 indicators for each dimension is equally relevant in 95% of the same (p<0,05). The country performance was evaluated on a 0 to 100 scale, obtained by the calculus of 3 index numbers: performance index, for each of the 18 indicators, dimension index for each of the 6 dimensions, and the overall index: 𝑃𝑒𝑟𝑓𝑜𝑟𝑚𝑎𝑛𝑐𝑒 𝐼𝑛𝑑𝑒𝑥 = 𝑥 − 𝑥𝑚𝑖𝑛 𝑥𝑚𝑎𝑥 − 𝑥𝑚𝑖𝑛 ×100 𝐷𝑖𝑚𝑒𝑛𝑠𝑖𝑜𝑛 𝐼𝑛𝑑𝑒𝑥 = 𝐼𝑛𝑑1×0.5 + 𝐼𝑛𝑑2×0.25 + 𝐼𝑛𝑑3×0.25 𝑂𝑣𝑒𝑟𝑎𝑙𝑙 𝐼𝑛𝑑𝑒𝑥 = (𝐼𝐷𝐷𝐹 + 𝐼𝐷𝑃 + 𝐼𝐷𝑆 + 𝐼𝐷𝐸𝑥 + 𝐼𝐷𝐸𝑓 + 𝐼𝐷𝐴)/6 The performance index is a relative index that considers the results of the countries of the Europe of 15: Germany, Austria, Belgium, Denmark, Spain, Finland,France, Greece, Ireland, Italy, Luxembourg, The Netherlands, Portugal, The United Kingdom and Sweden, being the other two dependents of this. Resorting to the described methodology, an overall index of value 55 was obtained and integrated in a panel constituted by the following indicators, and respective results, for Portugal: i. Driving Force – motorization rate: 100; use of active principles and pesticides by area of arable crops: 29; export notifications of chemical products, mixtures and items subject to prior information and consent: 80; Dimension Index: 77; ii. Pressure – current tobacco use of any tobacco product (>15 years old): women 100 / men 60; variation on PCB emissions: 0; variation of dioxins and furans emissions: 64; Dimension Index: 56; iii. State – level of daily average of environmental ultraviolet radiation: 13; air quality index: 90; non-compliant samples from residues detection on bred animals intended for human consumption: 83; Dimension index: 50; iv. Exposure – Population exposed to PM2.5 superior to WHO’s established limits: 68; mercury ingested through food: 0; population living in urban areas: 99; Dimension index: 59; v. Effects – mortality rate from malignant neoplasm in lymphoid and hematopoietic tissues: 56; melanoma incidence rate (<55 years old): 98; cancer incidence rate: 34,5; Dimension Index: 61; vi. Action – Number of smoke free public places: 37,5; samples for the control of residues from bred animals destined for human consumption: 26; amount spent in the protection of air and climate quality by organisms of public administration: 2,5; Dimension Index: 26; Portugal has action programmes for present environmental domains in need of review so as to optimize these programmes and the efficacy of intersectorial intervention on environmental health, from which results a decrease in the exposure to oncologically determinant environmental aspects.
Descrição
Diretores de Tese : Cipriano Pires Justo ; Maria Margarida
André Oliveira Estudante
Palavras-chave
DOUTORAMENTO EM CIÊNCIAS DA SAÚDE, CIÊNCIAS DA SAÚDE, CANCRO, MEIO AMBIENTE, SAÚDE PÚBLICA, SAÚDE AMBIENTAL, HEALTH SCIENCES, CANCER, ENVIRONMENT, PUBLIC HEALTH, ENVIRONMENTAL HEALTH