A BIOMATHEMATICAL SYSTEMS MODEL OF ENVIRONMENTAL RISK EXPOSURE AND POPULATION HEALTH BURDEN IN INDIA

Abstract

Background: Sanitation, drinking water, and household energy are environmental factors that greatly contribute to the population's health, but their effects are usually evaluated separately. The biomathematical systems approach gives an organized approach to combine various exposures to the environment and the interaction of such exposures with the burden of health. Aim: To develop and evaluate a biomathematical systems model of environmental risk exposure and population health burden at the district level in India. Methodology: An ecological, cross-sectional study was conducted using district-level data from the National Family Health Survey (NFHS-5), India (2019-2021). Three environmental variables: lack of clean cooking fuel, unsafe drinking water, and poor sanitation, were used to construct an Environmental Risk Index. A Health Burden Index was derived from indicators of diarrheal disease, acute respiratory infection, child undernutrition, and anaemia. Variables were standardized using z-scores. Descriptive statistics, Pearson correlation, and multivariable regression were applied within a biomathematical framework. Results: A total of 706 districts were analyzed. Poor sanitation showed the strongest association with health burden (r = 0.57). The model explained 33.0% of variance (R² = 0.330; p < 0.001). Poor sanitation was the strongest predictor (β = 0.024, p < 0.001), while unsafe drinking water showed a weaker inverse association (β = -0.006, p = 0.012). Lack of clean cooking fuel was not significant (p = 0.486). Conclusion: The most predominant environmental pathway that is linked to the district-level health burden is poor sanitation. The biomathematical framework provides a practical system-level method of analyzing the environment in terms of health.