Inventory of environmentally related complaints and disease clusters in the Netherlands
Inventarisatie van milieu-gerelateerde klachten en ziekteclusters bij Nederlandse Gezondheidsdiensten (GGD-en)
van Poll R, Drijver M
RIVM Report 268826001
Regularly, community health services (GGD) are confronted with (health)complaints or signs of alleged raised prevalence of diseases (clusters). Typically, these complaints and clusters are attributed to the state of the local environment. This study presents an inventory of environmentally related complaints and disease clusters, with the aim of assessing the number and type of complaints and clusters. Method: Information on complaints and clusters was collected by means of a written questionnaire sent to civil servants at all of the 54 GGDs in The Netherlands. The inventory of complaints was confined to the year 1997, while disease clusters were inventoried over a five-year period (1993 - 1997). Results: The 35 GGDs (65%) participating in this study were presented with, on average, about 40 complaints; the most important (frequent) complaints on health were respiratory complaints, annoyance and headaches. Concern about the state of the environment was found to be an important complaint as well. Frequently mentioned indoor environmental factors were mould/dampness and bad odours. Air and soil pollution were found to be the most important outdoor environmental factors. The total number of clusters reported was 120. This is on average less than one cluster per GGD per year. The majority of the reported clusters (73%) concerned cancer morbidity and/or mortality. The mean numbers involved was 17 persons per cluster (median: 10). Typically, disorders were observed over a long period of time (years to decades). Most of the clusters (80%) were observed at the neighbourhood or lower levels (streets, dwellings). Over the past 15 years the number of clusters has increased from about 1 (1982 - 1987) to about 3.5 (1993 - 1997) per GGD over a five-year period. The prevalence of cluster signals is more than one (1.36) per 100,000 inhabitants over a five-year period. Conclusion: The observed number of complaints associated with feelings of concern and the observed increase in reported alleged disease clusters over the past years justifies monitoring these signals. Concern is assumed to be an important motive for reporting an alleged cluster. As such, concern has a negative effect on liveability (perceived quality) of the local environment.