Report of the Consultation meeting on environment and health priorities and needs in south-eastern European Member States

Transcription

1 Report of the Consultation meeting on environment and health priorities and needs in south-eastern European Member States Belgrade, Serbia September 2009

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3 CONTENTS Page Introduction...1 The Fifth Ministerial Conference on Environment and Health...2 Current health and environment priorities and needs...3 Country presentations...3 Identifying common problems and needs: discussion...6 Protecting health and the environment from climate change...7 Formulation of the statement for the Declaration...8 Follow-up actions...8 Annex 1. List of participants...9 Annex 2. Draft Statement developed at the Consultation meeting on environment and health priorities and needs in SEE Member States and presented in the Ministerial Preparatory Meeting, October 2009, Palma, Italy...12

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5 page 1 Introduction The Consultation meeting on environment and health priorities and needs in the south-eastern European Member States was held in Belgrade, Serbia from 24 to 25 September This meeting was part of a preparation process for the Fifth Ministerial Conference on Environment and Health to be held in Parma, Italy from 10 to 12 March The meeting was opened by Dr Perisa Simonovic, State Secretary of the Ministry of Health, Serbia. The participants were welcomed by Ms Mirjana Djuranovic, (International Cooperation Adviser and National Health Coordinator for the South-eastern Europe Health Network (SEEHN) for the Montenegro Ministry of Health for which Montenegro holds the Chair of the Environmental Health Secretariat) and Dr Elizabet Paunovic, (Assistant Minister of Health, Sector for the European Union (EU) Integrations, International Cooperation and Projects and National counterpart for environmental health, Serbia). Dr Srdan Matic, (Unit Head, Noncommunicable Diseases and Environment, WHO Regional Office for Europe and Conference Coordinator) thanked the ministries of health in Serbia and Montenegro for hosting and organizing the meeting. Participants welcomed the overall shape of the meeting programme together with the scope and purpose. Dr Paunovic was elected as the Chairperson of the meeting and Ms Mirjana Djuranovic was elected as the Co-chairperson. Ms Mirha Osijan acted as Rapporteur. Dr Dafina Dalbokova, Manager, Environment and Health Information System, European Centre for Environment and Health, Bonn, gave a brief introduction of goals and objectives of the meeting and highlighted specific environmental health issues in the south-eastern European (SEE) region. She drew attention to the need for assistance from those countries that are more progressive as well as the need to follow the available best practices. The meeting had the following four objectives: to identify key priorities for action in SEE countries and needs to address them; to provide input on the SEE-specific needs for international support at the Parma Conference; to identify specific priorities for action among the common health and environment problems: country feedback; to qualify specific health and environment priorities for action clearly define the problem and clarify the request for assistance from the international community and WHO s role; and to decide on the input for taking forward the request for assistance to the Parma Conference: a brief statement for the Declaration and a paper on SEE-specific needs.

6 page 2 The Fifth Ministerial Conference on Environment and Health Dr Matic, Conference Coordinator, highlighted that the preparation process for the Fifth Ministerial Conference on Environment and Health to be held in Parma in 2010, was progressing well and that this process had commenced in Budapest in 2004 and was also a culmination of the 20 year health and environment process marked by a ministerial conference every four years. Dr Matic pointed out that a decision on the future of this process should be made in Parma. Dr Matic also raised the recommendation for a discussion to be held on whether the SEEHN should be expanded to include other countries from this region such as Cyprus, Greece and Slovenia. Dr Matic stated that the key document outputs for the Ministerial Conference will be the Ministerial Declaration together with three policy briefs addressing: socioeconomic and gender inequities in the WHO European Region specific needs of newly independent states (NIS) and SEE countries and WHO and climate change in the European Region. Additional documents to be released for the conference include: an indicator-assessment of progress in the health and environment sector and policies in this area; a draft regulatory framework for health-relevant action on climate change; country profiles on climate change and health (web); an overview of the 20 year process of environment and health in Europe; a protocol on water and health; a web-based information on inequities in health and environment in Europe; and the updated European Environment and Health Information System (ENHIS); Furthermore, Dr Matic highlighted that the main expected outcomes of the Ministerial Conference is the Ministerial Declaration together with: commitment of Member States to increase efforts to address key environmental health challenges socio-economic and gender inequalities in health and environment risks climate change emerging issues strengthening the implementation of the Children's Environment and Health Action Plan for Europe (CEHAPE) commitment of working across the sectors strengthening collaboration with NIS and SEE countries. Dr Paunovic highlighted that this meeting should agree that the countries in the region should join their efforts in the health and environment process in Europe as the SEEHN has now become independent. Dr Paunovic pointed out that the health and environment priorities and needs in the SEE countries should be looked at in the broad context of the pan-european health

7 page 3 and environment process and that this meeting should formulate a brief text for submission in the next Ministerial preparatory meeting in October Current health and environment priorities and needs To set the discussion focus on common health and environment priorities and needs, Dr Dalbokova reviewed the current environmental health situation and policy in SEE countries based on the assessment tools developed by WHO/Europe together with several Member States. These include health and environment policy surveys, Environment and Health Performance Reviews (EHPR) and the ENHIS indicators. The assessment of health and environment policy in the SEE identified advances in policy development and the establishment of coherent legal and policy frameworks. Periodic monitoring and evaluation of health effects of different administrative regulations, action programmes, health promotion and educational activities emerged as a common priority in the SEE countries that was considered in need of considerable improvement. Strengthening the capacity for health and environment information preparation and for policy-oriented reporting as part of the core mandate of the country health systems is considered of equal importance. The overview of the health and environment situation based on the ENHIS system pointed out a few common health and environment priorities for actions in the SEE region such as access to safe water and sanitation in particular in the rural areas and the persisting urban-rural health inequalities, road traffic injuries, air pollution and environmental tobacco smoke. SEE countries have made significant progress since the Budapest Ministerial Conference in the use of ENHIS indicators and related reporting. Indeed country information is available in international databases mostly due to the ongoing harmonization with the EU legislation and the ratification of international conventions. Nevertheless, urgent action should be taken to improve data availability and its use both in the countries as well as in the Region. For example, chemical safety of heavy metals is a priority health and environment issue of concern but the information on blood lead level in children is available in very few countries. The WHO environmental health performance reviews of Montenegro, Serbia and the The former Yugoslav Republic of Macedonia pinpointed similar health and environment priorities for action related to access to safe drinking-water and sanitation, road traffic injuries, air pollution and tobacco smoke exposure and leaded gasoline. The reviews also highlighted that strategic policy developments (ensuring consistent and coherent action on health and environment) are under way and that upgrading the health and environment institutional infrastructure and creating a legal framework to support intersectoral collaboration are now key focuses. At the same time the reports flagged the importance of strengthening countries health information capacity for reporting to ENHIS and the need to strengthen policy-oriented monitoring and evaluation for the support of the evidence based approach in policy debate using risk assessment and other methods. Country presentations Several participants (e.g. from Croatia, Serbia and The former Yugoslav Republic of Macedonia) acknowledged the usefulness of the policy assessment survey and its practical implementation in the context of the stewardship function of the country health systems in SEE and Region-wide. It

8 page 4 was emphasized that the tool was of particular use for health and environment due to its crosssectoral nature and application to diverse institutions and stakeholders. Participants also commended the ENHIS system as providing reliable and comparable health and environment information as well as the EHPR reviews. Participants from each country presented the country-view of the situation and policy actions in the context of the CEHAPE programme. Albania reported on the progress in the development of a national strategy and implementation of a plan on climate change and health within the framework of the WHO Biennial Collaborative Agreement (BCA) activities. Bosnia and Herzegovina shared their experiences from the ongoing youth health project which shows that road traffic injuries is a serious problem in the country and which is contributing to the high mortality rate in year-old men. They highlighted that tobacco consumption had decreased but alcohol use continues to be an important risk factor in youngsters of school age. The need for capacity building in the information preparation sector and improved educational measures was identified as a priority. The Croatian presentation highlighted that numerous laws, sub-legal acts and action plans have been put in place, mostly as part of the transposition of the Acquis environmental health provision into the national legislation. Croatia is involved in several EU projects focusing on food safety, nutrition and obesity. A heat-health action plan has been developed within the framework of WHO BCA. Croatia conducted a self-policy review using the WHO environment and health (EH) policy survey and the tool was instrumental in clearly identifying the weak points and measures to be tackled. The policy review showed that legislation in alignment with the EU is now in place for drinking-water quality, road transport injuries, indoor air quality and food safety. An increase in the overall public-water supply coverage, local water quality problems together with waste management remain one of the highest priorities at national level. Several priorities for action related to unintentional injuries and physical activity, indoor air quality and housing conditions, and chemical safety have also been pinpointed. The major challenges for EH policy in Croatia are: the lack of a legislative framework and policy documents; a lack of authority mandated in EH policy implementation and evaluation; an insufficiently developed information system and exchange among different data providers; and insufficient human and financial resources. Croatia saw the SEE country collaboration as very beneficial to all countries involved given the regional similarities in many EH areas. Activities suggested can be diverse and include areas such as: implementing a common project which involves several SEE countries; continued exchange of professionals; and sharing of experience and lessons learned during the accession process. Romania has advanced in terms of using EH indicators, particularly those related to CEHAPE regional priority goals (RPGs) RPGI and RPG II, thanks to the European Commission's Directorate General for Health and Consumer Affairs (DG SANCO) multinational ENHIS projects coordinated by WHO. With respect to RPG III, the implementation of the legal framework has started together with a surveillance system for monitoring health effects of environmental hazards. A National Health Programme has been launched and the Public Health

9 page 5 Centres in Bucharest, Timisoara, Cluj-Napoca and Iasi are in charge of this. Technical equipment and training in medical waste management has also been provided through a Phare project. Significant progress has been achieved in the legal framework development in Serbia favourable both for EH actions and for implementing the EU stabilization requirements. The Public Health Law and Strategy have been adopted in 2009 together with a budget line which can be applied for by institutions in the country. The CEHAPE development served as a vehicle to develop greater intersectoral collaboration and a national CEHAP programme has been prepared with a grant from the government of Norway. The Public Health Institute in Belgrade has been appointed as a focal point for the International Health Regulations. Progress has been made in the management of infectious medical waste through activities and funds in the framework of CARDS (Community Assistance for Reconstruction, Development and Stability in the Balkans) and Instrument for Pre-Accession Assistance (IPA). The development of a heathealth action plan has been incorporated into the BCA activities for The country has made an important step in combating climate change through improving the energy efficiency in 17 clinical centres in Belgrade through a World Bank-loan which allowed for the refurbishment and renovation of their heating systems. Challenges faced by the country health system stem from the lack of institutional framework for intersectoral collaboration which currently relies mainly on good-will. Also an important chemical hazard for children comes from the continued use of leaded gasoline which is now planned to be completely phased out in compliance with the sustainable development strategy by A lack of information on the EH situation and trends as well as a lack of conduction and information gathered from risk and health impact assessments. In The former Yugoslav Republic of Macedonia positive developments relate to the development of the legal framework and the accreditation of EH laboratories. Waste management (both solid and landfills) is in need of considerable development and so is chemical safety. Housing is to some extent being tackled in the current legislation but given the very fast urbanization much more is needed for health-relevant policy. Shortcomings in information, research and human resource problems are exacerbated under the present socio-economic situation and hinder the integration of health into environmental and other sectors policy. The question remains for all SEE countries on how to find a magic formula to mobilize all relevant stakeholders for EH action. The overview of findings from the short Questionnaire sent to SEE countries on general environmental health was presented by Ms Geraldine McWeeney. The results presented information from the seven completed questionnaires. Q1. The countries identified improved legislation with movement towards EU legislation together with a focus on children s EH and CEHAP development as the main achievements and progress in EH since the Budapest Conference Q2. The countries presented a full and varied range of EH projects and funding implemented since Budapest 2004 and no particular common theme or field was highlighted. Multiple donors were indicated with EU funding being the most commonly cited. Q3. The major hurdles and gaps seen that need to be over come since the Budapest 2004 were identified as lack of financial resources which was identified by all seven respondents, and lack

10 page 6 of political support, human resources, training and capacity, intersectoral cooperation and lack of completion and execution of EH legal frameworks. Q4. The questionnaire provided a list of 15 EH themes and each country was asked to identify the five EH issues of greatest concern in order of priority. The fifteen themes were: air, chemicals and heavy metals, children s health and environment, food safety, climate change, physical activity, radiation, housing, noise, occupational health, EH and inequalities, transport, violence/ and injuries, water and sanitation, and waste. The five priorities identified were (in order of priority): 1. chemicals and heavy metals and water and sanitation in joint first position 2. food safety 3. housing and waste management in joint third position For the five priorities it was decided it was necessary to identify where the need for legislation, monitoring, promotion and training or finance is. It was agreed that all of these five priorities are compounded by social, economic and environmental inequalities. Q5. Chemical safety and heavy metals, waste management, housing, climate change, water and sanitation were identified as the main EH concerns which would be best dealt with through collaborative efforts and support from the SEE subregion. Q6. The main technical support identified that would be of benefit to the countries is: expert and technical support Particularly in the areas of ENHIS and surveillance development and legislation development; financial support; experience sharing and meeting with other experts; and capacity building of EH staff in countries. Identifying common problems and needs: discussion The five priorities were accepted as the priorities to be added to the draft statement for consideration in the Ministerial declaration statement but discussions on the housing theme broadened this fifth priority to social, economic and environmental inequalities in the remaining four priorities and abandoning the housing theme. Common challenges were identified such as: the lack of adequate place for EH and weak coordination in the health and other sectors; insufficient country data and information system activities; and insufficient political and financial support to address EH determinants. The need to address environmental health inequalities and population subgroups was emphasized. An example was provided in Serbia which has an estimated population of Roma and a significant number involved in collecting waste as a means of generating income. Through this activity they are exposed to occupational and public health risks and the SWIFT project (Sustainable Waste management Initiative For a healthier Tomorrow a comprehensive project focusing on the social determinants of health in vulnerable populations involved in the

11 page 7 informal waste sector in Belgrade) is starting to address many of these issues in Belgrade. Albania also stated that they had the same problem. Professor Dragan Gjorgjev highlighted issues that all SEE countries are facing, such as the lack of: coordination with other sectors financing human resources data and information systems health inequalities and vulnerable population subgroups regional sharing of experiences training of staff in the Region harmonized surveys EH issues related to living environment Ms McWeeney suggested the possibility of the development of a SEE proposal focusing on the priority themes of concern identified in the general questionnaire and incorporating the above issues highlighted by Professor Gjorgjev and the general questionnaire. Ms McWeeney offered assistance in the development of such a proposal if all countries or a number of countries were in agreement as funding opportunities, particularly for transboundary issues, had potential for funding possibilities. The initiative was considered as an opportunity to be followed up. Protecting health and the environment from climate change Dr Bettina Menne, WHO Medical Officer, Global Change and Health and Associate Professor Dr Vladimir Kendrovski, WHO National Counterpart on Climate Change and Health together with Dr Krunoslav Capak, Head, Environmental Health Ecology Service, National Institute of Public Health, Croatia provided presentations on Protecting health in Europe from climate change, Macedonian Experiences in Developing a National adaptation strategy in Health Sector due to Climate Change, and the Heat-wave Plan for Croatia. It was presented that in south-eastern Europe the important exposures relevant to human health are: heat-waves reduced water availability increased drought increased forest fires increased energy demand in summer increased salinity and eutrophication of coastal waters air pollution episodes infectious disease outbreaks and risks of tropical strains

12 page 8 A plenary discussion on the specific needs of SEE countries on protecting health from climate change raised the following needs and concerns: work limitations during a heat-wave are not addressed such as in construction work and working in the field; the need to create specific policies; the lack of systematic data, indicators, evidence and surveillance; the need for support in risk management, including assessment and communication (assisting and training people in performing risk management); the need for increased awareness and education; the possibility of the introduction of a special information system; the need for establishment of multidisciplinary working groups; the need for sharing lessons learned between countries; and the need to assess cost effectiveness of action (how many lives were saved during heatwaves). It was stated that there is sufficient evidence about the health impacts of climate change in the SEE countries but a focused approach is needed to address these. The process should start with a few major interventions that have important health benefits and work. The health systems should monitor and evaluate the situation in the context of policies and keep other sectors on their toes For the purpose clear guidance the development of a toolkits were suggested, such as climate change health impact assessment, policy impact assessment and evaluation of the costs. Formulation of the statement for the Declaration A round table meeting was held to discuss and agree on a draft of the statement to be presented at the next preparatory meeting to be held in October 2009 in Palma, Italy and the draft statement was finalized. This statement incorporated the main objectives and outcomes presented and discussed in this meeting (Annex 2). Follow-up actions The deadline for sending comments on draft statement is 5 October The conclusion of this meeting as well as draft statement will be presented at the meeting of Drafting Group, which will be held in Parma in the period from 12 to 14 October 2009.

13 page 9 Annex 1 LIST OF PARTICIPANTS Albania Dr Leonard Boduri Adviser of the Minister, Ministry of Environment, Forestry and Water Administration Bosnia and Herzegovina Ms Mirha Osijan (Rapporteur) Senior Specialist for Monitoring of Health Sector and Planning, Department for Health Ministry of Civil Affairs Croatia Dr Krunoslav Capak Head, Environmental Health Ecology Service, National Institute of Public Health Montenegro Ms Marina Miskovic Senior Adviser, Department for Nature Protection and Environmental Assessment Ministry of Tourism and Environment Ms Mirjana Djuranovic (Co-Chair) International Cooperation Adviser, National Health Coordinator for SEEHN, Ministry of Health Republic of Moldova Dr Oleg Lozan Deputy Minister, Ministry of Health Romania Mr Mihail Ovidiu Parvu European Affairs Adviser, Ministry of Health Serbia Dr Elizabet Paunovic (Chair) Assistant Minister of Health, Sector for the European Union (EU) Integrations, International Cooperation and Projects and National counterpart for environmental health, Serbia The former Yugoslav Republic of Macedonia Professor Dragan Gjorgjev Director, Republic Institute for Health Protection, Ministry of Health

14 page 10 Regional Environmental Center for Central and Eastern Europe Dr Eva Csobod Director, Environment and Health Topic Leader, Hungary Country Office Ms Zorica Korać Project Manager, Serbia Country Office Temporary Advisers Associate Professor Dr Vladimir Kendrovski WHO National Counterpart on Climate Change and Health, Institute of Pubic Health The former Yugoslav Republic of Macedonia Dr Perisa Simonovic State Secretary, Ministry of Health, Serbia Observers Professor Dr Petar Bulat University of Belgrade School of Medicine, Serbian Institute of Occupational Health Dr Slobodan Tosovic Director, Institute for Public Health of Belgrade, Ministry of Health, Serbia Dr Marija Jevtić, General Manager, Institute for Public Health of Vojvodina Ms Biljana Filipovic Adviser, Ministry of Environment and Spatial Planning, Sector for International Cooperation, Serbia Ms Tijana Spasic Junior Adviser, Ministry of Environment and Spatial Planning Sector for International Cooperation Ms Biljana Jovic Serbian Environment Protection Agency Ms Milena Jovasevic, PhD VINCA Institute of Nuclear Sciences WHO Regional Office for Europe Dr Srdan Matic (Conference Coordinator) Unit Head, Noncommunicable Diseases and Environment Dr Dafina Dalbokova Manager, Environment and Health Information System Dr Bettina Menne Medical Officer, Global Change and Health Dr Dorit Nitzan Kaluski Manager

15 Ms Geraldine McWeeney Technical officer, Environment and Health in SEE Region Report of the Consultation meeting page 11

16 page 12 Annex 2 DRAFT STATEMENT DEVELOPED AT THE CONSULTATION MEETING ON ENVIRONMENT AND HEALTH PRIORITIES AND NEEDS IN SEE MEMBER STATES AND PRESENTED IN THE MINISTERIAL PREPARATORY MEETING, OCTOBER 2009, PALMA, ITALY Since the Budapest conference, significant progress was achieved in the nine south eastern European (SEE) countries 1 in developing legislation, related strategies and showing political commitment to address environmental health challenges. We recognize that more challenges are still ahead. SEE countries recognize that chemicals and heavy metals, water and sanitation, food safety and waste management are ongoing serious threats for health which are aggravated by social, economic and environmental inequalities. The environment and health sectors are calling upon other sectors and stakeholders, in particular youth and civil society, to join forces in taking action. A variety of policy tools focused on health need to be strengthened, implemented and enforced particularly regulatory measures, data, information and intelligence, and adequate recognition and financing of health and environment activities. We recognize that climate change is a serious threat, not only for today s generation but increasingly for future generations. Therefore supportive actions should be taken to anticipate threats and protect health in particular through strengthening early warning systems, greening health services, developing adaptation plans, promotion of healthy and energy efficient settings and behaviours, and also raising awareness on protective measures. We reconfirm our commitment and invite other countries to strengthen actions on environmental health in south-eastern Europe and particularly looking forward to stronger collaboration and transfer of experience with other countries in Europe. 1 SEE countries Albania, Bosnia and Herzegovina Bulgaria Croatia Montenegro Republic of Moldova Romania Serbia The former Yugoslav Republic of Macedonia