Tackling environmental health risks with policy

A European policy perspective

Leendert van Bree & Eva Kunseler

Overview

Introduction to Environmental Health Risks Environmental Legislation – Leendert

Hazard-oriented Standard-setting approach

Environmental Health Programmes – Eva Effect-oriented Health in All Policy approach

Break Policy Evaluation

Indicators - Eva

Impact assessment - Leendert

New developments - Both

Environmental Health Risks

What kind of environmental risks are negatively affecting health? What is health? What environmental risks?

What can EU policy do to tackle these risks What policy orientation? What policy instruments?

Health Perspective

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

(WHO 1948)

Conceptual model of public health

Source: RIVM (2006). Care for health. The 2006 Dutch Public Health Status and Forecasts Report

Environmental Risks: what perspective?

Hazard-oriented: air pollution, water pollution, soil pollution, waste and chemicals

Effect-oriented: ecological damage, social degradation, public health impact e.g. Gastrointestinal diseases: food safety, water and sanitation Cancers: air quality (indoor and outdoor), UV and ionizing radiation,

chemicals, radon Cardiovascular diseases: air quality (indoor and outdoor), noise Respiratory diseases: air quality (indoor and outdoor), dampness

and mould

Overview

Introduction to Environmental Health Risks Environmental Legislation – Leendert

Hazard-oriented Standard-setting approach

Environmental Health Programmes – Eva Effect-oriented Health in All Policy approach

Break Policy Evaluation

Indicators - Eva

Impact assessment - Leendert

New developments - Both

Environmental Legislation

Basically simple questions, simple answers?

1. Is there a problem?

2. What causes the problem?

3. Can we do something about it?

4. Will it help?

5. What does it cost?

6. Who is going to pay?

------------------------------------------------------

7. What is effective and efficient policy?

Environmental Legislation (2)

1. Focus on control and prevention

2. Hazard-oriented rationale behind environmental health policy targets for chemicals, external safety, food, air, and water

3. Checking quantified risks against standards

4. Equal (rights-based) protection of every citizen: no one above 10-6 norm for mortality!

-----------------------------------------------------------------------------------

>> Environmental problems with relatively large risks have been controlled or at least substantially reduced !

History of Environmental Policy

1. Environmental policy is a relatively recent EU policy area.

2. The Single European Act (1986) marked the beginning of a more prominent role for environmental protection in EU policy-making:- introducing the principal that environmental protection should be

considered in all new Community legislation.

3. EU environmental policy expanded by the Treaties of Maastricht (1992) and Amsterdam (1997): sustainable development one of EU's central objectives.

4. Sustainable development also forms a key part of the Lisbon Strategy (2000): EU policy regarding the single market.

Why EU Environmental Policy?

Arguments for The threat to the environment is global and should be tackled on an

international scale, but… the EU plays an important role in setting this agenda.

EU's commitment to environmental protection encourages other countries to adopt similar measures.

Environmental policy is an area with substantial public support for action at a Europe-wide level.

Arguments against The cost of EU environmental regulation can undermine the competitiveness

of EU businesses. If maximal environmental emission levels are set too high, firms have little

incentive to cut their emissions to meet the EU's wider targets.

Our Common (Sustainable) Future

Also known as the ‘Brundtland Report’, from the UN World Commission on Environment and Development, published in 1987.

An often-quoted definition of sustainable development is defined as:Development that meets the needs of the present without compromising the ability of future generations to meet their own needs.

Leading to the 1992 Earth Summit, the adoption of Agenda 21, the Rio Declaration, and the establishment of the Commission on Sustainable Development

Sustainable Development

Millennium Development Goals (2000)

Committing nations to a new global partnership to reduce extreme poverty and setting out a series of time-bound targets - with a deadline of 2015: Ranging from halving extreme poverty to

halting the spread of HIV/AIDS and providing universal primary education;

Goal 7: Integrate the principles of sustainable

development into country policies and programmes and reverse the loss of environmental resources

Goal 7…

Environmental Policieshttp://ec.europa.eu/environment/policy_en.htm

Example: Air Quality Legislation

Air Quality Framework Directive 96/62/EC: limit values for PM10, NOx, SO2, O3 Emission ceilings Source emission requirements for vehicles and constructions

New EU Air quality Directive 11 June 2008: New PM2,5 legislation: Mean exposure index

Concentrations measured at urban background levels Enforcement not needed at locations that are restricted to the

general public and do not hold permanent occupation

Environmental Health Programmes

WHO Europe environment and health process (since 1989 Helsinki) Aim: eliminating the most significant environmental threats to

health, based on the premise that prevention is better than cure Framework: Health for All (since 1977)

European environment and health strategy (since 2003) Environment and Health Action Plan 2004-2010: reduce the

adverse health impacts of specific environmental factors and to enhance cooperation between actors in the environment, health and research fields

Framework: Health in All Policy (since 2007)

Health Frameworks

WHO Health for All: a process of bringing countries to progressive improvement in the health of all their citizens. Equity: everyone has a fair opportunity to attain his or her full health

potential; Solidarity: everyone contributes to the health system according to

his or her ability

EU Health in All Policy: Important health determinants cannot be influenced by health policy

on its own; There is a need for co-ordinated actions involving other policy areas

such as environmental, social or economic policies.

Focus in Environmental Health Programmes

Children’s health Children’s Environmental Health Action Plan for Europe Priorities: air quality, healthy transport, water&sanitation,

chemical safety, healthy housing

Climate change and health Fifth Ministerial Conference

on Environment and Health

(Parma 2010)

Sustainable Development

BREAK

Steering Paradigm for Policy Development & Evaluation

Decisions, regulatory actions, and legislation Risk management analysis

Regulatory options Evaluation of public health, social, and economic consequences Target achievement, cost-benefit, health effectiveness, equity,

cost-efficiency, scenario’s

Risk communication Data and information exchange Stakeholders needs and participation

Impact and exposure assessment Quantifying health impacts, exposures, and link to sources Indicators for ‘mortality, morbidity and(‘quality of life’)

The cause-effect pathway

WHO 2005

CO2 emitting activities

Climate change

Higher mortality / Heat stress/ Adaptation?

Exposed to higher temperatures

Temp. rise

Mitigation: towards energy neutral act.

Accomodating buildings; spatial planning: more green, water, wind

Information & education

Environmental Health Indicators

Environmental Health Indicators are usually numbers that represent and communicate a certain state of the environment, exposure, health state and/ or policy actions.

Use and purpose of indicators:1. Policy development and priority-setting

2. Health impact assessment and monitoring

3. Policy implementation or economic consequence assessment

4. Public information and awareness raising or risk perception

Indicators to evaluate EU and WHO programmes

WHO ENHIS: Environment and Health Information System (www.enhis.org)

EEA (European Environment Agency): Core set of indicators (http://themes.eea.europa.eu/IMS/CSI)

Prevalence of asthma symptoms in children aged 6–7 years and 13–14 years, ISAAC Phase Three, 1999–2004

Degree of implementation of action to reduce exposure of the population to UVR in 26 countries in the WHO European Region, 2006

Risk Management Indicators

Decision-making based on appraisal of: How is the risk quantified? (impact) How is the risk perceived? (acceptability) Weighing costs and benefits? Is it a governmental responsibility? Is action feasible with policy?

PBL/RIVM ‘Weighing and Appraisal’ indicators: 1. Policy deficit index

2. Burden of disease index

3. Economic consequence index

4. Risk perception and acceptability index

Examples of policy deficit indicators

Distance to emission standards Distance to environmental quality standards Distance to exposure / intake / body burden standards Distance to health risk / disease burden reduction targets

Burden of disease indicator

DALY = YLL + YLD

Years of Lost Life

(due to mortality)

Years Lived with Disability

(due to injury & illness)

1 0

0

1

2 0 3 0 4 0 5 0 6 0 7 0 8 0

popu la tion

le u k a e m iap n e u m o n ia p ro g re s siv e c a rd io -p u lm o n a ry d is e a se

se r io u s a n n o y a n c e

age

d isab ilityw eigh t

p oten tia l h ea lth y life yea rs

'hea lth ' lo ss

Risks ranked according to DALYs

1,E

+00

1,E

+01

1,E

+02

1,E

+03

1,E

+04

1,E

+05

1,E

+06

1,E

+07

Blik

sem

insl

ag

Ext

erne

Vei

lighe

id

Hoo

gspa

nnin

gslij

nen

Gro

otsc

halig

e ov

erst

rom

ing

Cam

pylo

bact

er (

alle

gev

alle

n)

Won

ingb

rand

en

Bod

emve

ront

rein

igin

g

Aid

s

Arb

eid:

ong

eval

slet

sel

Rad

on in

won

inge

n

Spo

rtbl

essu

res

Gel

uid

Sch

ipho

l

Arb

eid:

blo

otst

ellin

g aa

n st

offe

n

Ver

keer

song

eval

len

Afh

anke

lijkh

eid

van

alco

hol

Lich

amel

ijke

inac

tivite

it

Gel

uid

weg

verk

eer

Fijn

sto

f

Ove

rgew

icht

Ong

ezon

de v

oedi

ng

Rok

en

DA

LY's

(/jr

)

Risks ranked according to YLL

1,E+00 1,E+01 1,E+02 1,E+03 1,E+04 1,E+05 1,E+06 1,E+07

Sportblessures

Blikseminslag

Externe Veiligheid

Hoogspanningslijnen

Grootschalige overstroming

Geluid Schiphol

Campylobacter (alle gevallen)

Geluid wegverkeer

Woningbranden

Bodemverontreiniging

Aids

Arbeid: ongevalsletsel

Lichamelijke inactiviteit

Ongezonde voeding

Overgewicht

Radon in woningen

Afhankelijkheid van alcohol

Arbeid: blootstelling aan stoffen

Verkeersongevallen

Fijn stof

YLLs (/jr)

Risks ranked according to costs (€)

1,E+00 1,E+02 1,E+04 1,E+06 1,E+08 1,E+10

Lichamelijkeinactiviteit

Ongezonde voeding

Overgewicht

Roken

Hoogspanningslijnen

Externe Veiligheid

Campylobacter (allegevallen)

Geluid Schiphol

Woningbranden

Grootschaligeoverstroming

Verwachtingswaarde economische schade (euro per jaar)

Family of impact assessments

EC Impact Assessment Guidance Methodologies:

Health Impact Assessment Equity Impact Assessment Environmental Impact Assessment Ensures that environmental consequences of projects are identified and assessed

before authorisation is given.

Strategic Environmental Assessment Key tool for sustainable development.

Integrated Assessment Cross-sectoral policy assessment (multi-hazard, multi-effect) Example: climate-proof & sustainable cities

Assessment framework (INTARESE)

Issue framing Design Execution Reporting

Initial-isationScoping

ComplexificationPrioritisation &

screening(simplification)Alternatives

Indicatorselection

Definition ofscenarios

Quality criteriaMethods & models

Data sourcesAssessment protocols

Data collectionExpert elicitation

Modelling & estimationUncertainty analysisTesting & validation

Evaluation

InterpretationCommunication withusers & stakeholders

Documentation &presentation

StakeholdersPolicy-makers

Industry

Scientists

Media

Public

Generators

Purveyors

Assessors

Regulators

Victims

Example: Integrated Assessment in Practice

Source: http://en.opasnet.org/w/Assessment_on_impacts_of_emission_trading_on_city-level_(ET-CL)

New Developments in EH Risk Policy

1. Putting integrated assessment in practice

2. Appraisal of risks from wider perspective

3. Stakeholder involvement?

4. Dealing with uncertainty and controversy on risks?

5. The precautionary principle?

Environmental health risk as technical construct

Dictionary: (bad) chance for injury, damage, or loss

Dutch Health Council 1995: possibility, with a certain probability, of damage to human health, in combination with nature and extent of damage

Risks are objective and can be univocally measured or assessed from cause-effect pathways

Environmental health risk as societal construct

Risks are societal perceptions of danger, damage, injury Risks are value-loaded: the acceptability of a risk depends

on the context and individual perspective Voluntary vs. Involuntary Controllable vs. Uncontrollable Direct & short-term effect vs. Indirect &long-term effect Observable vs. Not observable