WHO Regional Office for Europe, Division of Technical Support
Sustainable Management of Transboundary Waters in Europe
Dr. R. Bertollini
Director
Division for Technical Services
WHO Regional Office for Europe
WHO Regional Office for Europe, Division of Technical Support
Programme
• Review of policy • WHO EURO Region• Future work• Discussion
WHO Regional Office for Europe, Division of Technical Support
Policy Formulation Timeline2000 2001 2002
Jan Report by the Sec Gen to CSD
FebMar Ministerial
Declatarion of the Hage 22 March
AprMayJunJulAug WSSD
Sep UN Millennium Summit
UNECE Regional Committee for the WSSD and WHO RC 51
Oct WHO RC 50
NovDec International
Freshwater Conference
WHO Regional Office for Europe, Division of Technical Support
Protocol on Water and Health - Article 1 Objective
The objective of this Protocol is to promote at all appropriate levels, as well as in transboundary and international contexts, the protection of human health and well-being, both individual and collective, within a framework of sustainable development, through improving water management, including the protection of water ecosystems, and through preventing, controlling and reducing water-related diseases.
WHO Regional Office for Europe, Division of Technical Support
Protocol 3 - Scope
• Surface freshwater• Groundwater• Estuaries• Coastal waters (recreation, aqua)• Enclosing waters (bathing)• Water during abstraction, transport, treatment,
supply• Waste water
WHO Regional Office for Europe, Division of Technical Support
Protocol 4 - Provisions
a) Adequate supplies of wholesome drinking water
b) Adequate sanitation protecting health and environment
c) Effective protection of resources
d) Protection of disease from recreational waters
e) Monitoring systems
WHO Regional Office for Europe, Division of Technical Support
Protocol 5 - approaches
f) Management action at lowest administrative level
g) Social, economic and environmental values
h) Economic instruments & awareness
i) Access to information and public participation in decision making needed
WHO Regional Office for Europe, Division of Technical Support
Protocol 5 - Approaches
j) Integrated management on catchment basis
k) Special consideration to vulnerable populations
l) Equitable access to water for all, especially socially disadvantaged and (economically excluded)
WHO Regional Office for Europe, Division of Technical Support
UN Millennium Declaration
Art 19: We resolve further to halve, by 2015, the proportion of the world’s people whose income is less than US$1/d and the proportion of people who suffer from hunger and, by the same date, to halve the proportion of people who are unable to reach or to afford safe drinking water
Poor people are powerless to prevent degradation of resources on which their health depends.
WHO Regional Office for Europe, Division of Technical Support
UN Millennium Declaration
Art 23 We resolve … to stop the unsustainable exploitation of water resources by developing management strategies at the regional, national, and local levels, which promote both equitable access and adequate supplies
WHO Regional Office for Europe, Division of Technical Support
WHO Regional Committee 51EUR/RC51/R7 WSSD
• Recognizing that many health problems will be exacerbated by inadequate water and sanitation … urges MS to
a) Actively involve the Health Sector in national preparations of the WSSD
b) Address the links between health, environment, and development in particular health and poverty alleviation
WHO Regional Office for Europe, Division of Technical Support
Bonn Freshwater Conference 8. Protect Water Quality and Ecosystems
• Drinking water quality should be safeguarded because it is essential for human health
• Water supplies should be protected from pollution from the source to the user
• Treatment of wastewater to be intensified and made more affordable
WHO Regional Office for Europe, Division of Technical Support
Bonn Freshwater Conference15. Improve economic efficiency
• Cost recovery objectives should be no barrier to poor people’s access to water supply and sanitation. Where the poor can not afford to pay the full cost of water supply and sanitation, tariff systems that allow social targeting should be established.
WHO Regional Office for Europe, Division of Technical Support
Report of UN Secretary General II Major Trends
33. Contaminated water, inadequate sanitation, and poor hygiene cause a large proportion of ill health and disease… Malaria… cholera, typhoid, viral hepatitis A, dysentery, intestinal worms, trachoma, river blindness, schistosomiasis, arsenic poisoning, and dengue fever, and other water-related diseases affect millions of people in developing countries
WHO Regional Office for Europe, Division of Technical Support
Report of UN Secretary General II Major Trends (cont)
38. Areas of water scarcity are increasing … One third of the countries in the water-stressed regions of the world are expected to face severe water shortages in the twenty-first century. By 2025, as much as two-thirds of the world’s population could live in countries with moderate or severe water stress
WHO Regional Office for Europe, Division of Technical Support
Report of UN Secretary General III.B. Urban poverty
59. Number of urban dwellers lacking access to safe drinking water increased by 62 million. Providing safe water and adequate sanitation to urban and peri-urban population will be a major challenge.
61. Sustainability of urban development threatened by wastewater treatment capacity.
WHO Regional Office for Europe, Division of Technical Support
Member States of the WHO EURO Region
WHO Regional Office for Europe, Division of Technical Support
The Six Sub-regions
1. High Human Development and High Income2. High Human Development and Upper Middle Income3. High Human Development and Lower Middle Income 4. Medium Human Development and Upper Middle Income5. Medium Human Development and Lower Middle Income 6. Medium Human Development and Low Income
High Human Development (HHD): Human Development Index (HDI) value 0.800 and upMedium Human Development (MHD): HDI value 0.500-0.800High Income (HIC): GNP per capita US$9,266 and upUpper Middle Income (UMI): GNP per capita US$2,996-9,265Lower Middle Income (LMD): GNP per capita US$756-2,995Low Income (LIC): GNP per capita US$755 or less
WHO Regional Office for Europe, Division of Technical Support
Distribution of Population by Levels of Human Development and Income (1998)
12.40%105.8 million
25.02%213.5 million
7.56%64.5 million
0.43%3.7 million
8.25%70.4 million
46.34%395.5 million
High Human Development & High Income
High Human Development & Upper Middle Income
High Human Development & Lower Middle Income
Medium Human Development & Upper Middle Income
Medium Human Development & Lower Middle Income
Medium Human Development & Low Income
74.6078.71
64.60
71.0773.60
80.10
73.10
84.50
57.52
63.49
53.11
60.84
0
10
20
30
40
50
60
70
80
90
High HumanDevelopment & High
Income
High HumanDevelopment & Upper
Middle Income
High HumanDevelopment & Lower
Middle Income
Medium HumanDevelopment & Upper
Middle Income
Medium HumanDevelopment & Lower
Middle Income
Medium HumanDevelopment & Low
Income
Percentage of Urban Population by Levels of Human Development and Income
1998
2015
75.0
80.9
68.4
77.1
66.9
77.2
66.8
72.5
63.5
72.3
62.5
69.7
0
10
20
30
40
50
60
70
80
90
High HumanDevelopment & High
Income
High HumanDevelopment & Upper
Middle Income
High HumanDevelopment & Lower
Middle Income
Medium HumanDevelopment & Upper
Middle Income
Medium HumanDevelopment & Lower
Middle Income
Medium HumanDevelopment & Low
Income
Life Expectancy at Birth by Levels of Human Development and Income (2000)
Male
Female
3.1
7.8
18.0
22.7
26.0
0
5
10
15
20
25
30
Su
b-r
egio
nal
Ave
rag
e P
ove
rty
Lev
el M
easu
red
at
Po
pu
lati
on
B
elo
w $
2 p
er D
ay (
%)
High HumanDevelopment & High
Income
High HumanDevelopment &
Upper Middle Income
High HumanDevelopment &Low er Middle
Income
Medium HumanDevelopment &
Upper Middle Income
Medium HumanDevelopment &Low er Middle
Income
Medium HumanDevelopment & Low
Income
Sub-regional Comparison of Average Poverty Levels (Collected data varying from those of 1992 through 1999)
N/A
11
2
13
5
2
4
1 1 11
7
1
7
0
5
10
15
20
25
High HumanDevelopment &
High Income
High HumanDevelopment &Upper Middle
Income
High HumanDevelopment &Lower Middle
Income
Medium HumanDevelopment &Upper Middle
Income
Medium HumanDevelopment &Lower Middle
Income
Medium HumanDevelopment &
Low Income
Water availability of countries in sub-regions
no data
2500-
1700-2500
1000-1700 (w ater stress)
-1000 (w ater scarce)
WHO Regional Office for Europe, Division of Technical Support
22.68
236.3
26.00
163.2
81.00
150.9
14.00
162.0
11.63
290.1
0
50
100
150
200
250
300
Lit
ers
per
cap
ita p
er
day
High HumanDevelopment & High
Income
High HumanDevelopment &
Upper Middle Income
High HumanDevelopment &
Low er Middle Income
Medium HumanDevelopment &
Upper Middle Income
Medium HumanDevelopment &
Low er Middle Income
Medium HumanDevelopment & Low
Income
Domestic Use of Water and Its Percentage of Total
Domestic Use as Percentage of Total
Domestic Use per Capita per Day
N/A
WHO Regional Office for Europe, Division of Technical Support
WHO Information Systems
• Health for All• Computerized Information Systems for
Infectious Diseases - CISID
WHO Regional Office for Europe, Division of Technical Support
European Health for All Database
• Provides easy and rapid access to a wide range of basic health statistics for the 51 member states of the WHO European region.
• The data are submitted by the European member states to the Regional Office or collected from other international organizations or other sources and are updated twice a year in January and June.
0
20
40
60
80
100
120
140
160
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Under 5 Mortality Rate from Diarrhoreal Diseases per 100000
High Human Development & High Income
High Human Development & Upper Middle Income
High Human Development & Lower Middle Income
Medium Human Development & Upper Middle Income
Medium Human Development & Lower Middle Income
Medium Human Development & Low Income
0
50
100
150
200
250
300
350
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Viral Hepatitis A Incident per 100000
High Human Development & High Income
High Human Development & Upper Middle Income
High Human Development & Lower Middle Income
Medium Human Development & Upper Middle Income
Medium Human Development & Lower Middle Income
Medium Human Development & Low Income
0
20
40
60
80
100
120
140
160
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Malaria Incidence per 100000
High Human Development & High Income
High Human Development & Upper Middle Income
High Human Development & Lower Middle Income
Medium Human Development & Upper Middle Income
Medium Human Development & Lower Middle Income
Medium Human Development & Low Income
WHO Regional Office for Europe, Division of Technical Support
CISID Database
• Computerized Information System for Infectious Diseases (CISID) is a work of the Communicable Disease Surveillance and Response (CSR) Programme and the Informatics Support unit (ISS) of the WHO Regional Office for Europe.
• The first objective is to improve the standardization, timeliness and completeness of data reported by Member States.
• The second objective is to allow sharing of data at the sub-national level to identify specific geographic areas of risk, as well as the identification of risk groups by age and gender.
• CISID eventually aims to monitor some infectious diseases by first (and in some cases, second) administrative level within the region, and provide a detailed description of clusters of cases by time, place and person.
0
5000
10000
15000
20000
25000
30000
35000
Typ
ho
id F
ever
Cases
1998 1999 2000
0
10
20
30
40
50
60
70
80
90
Ch
ole
ra C
ase
s
1998 1999 2000
Cholera and Typhoid Fever from CISID Database
WHO Regional Office for Europe, Division of Technical Support
WHO 2000 - 2001
• Protocol– Expert meeting on evidence base
– Expert meeting on surveillance of natural and man-made outbreaks
– Expert meeting on aquifer recharge
– Expert meeting on terrorism
• Bilateral assistance– Tajikistan, Azerbaijan
• Global: DWQG
WHO Regional Office for Europe, Division of Technical Support
WHO 2002 – 2003 - BCA
• MALTA Health systems in tourist areas
• ROMANIA Surveillance of wbd
• RUSSIAN FEDERATION Implementation of the Protocol
• TAJIKISTAN dwq
• TURKEMISTAN urban dwq
• CAS Surveillance
WHO Regional Office for Europe, Division of Technical Support
IVth Ministerial Conference on Environment and Health
• Children and future generations• Transport, environment and health• Water and health• Local activities• NEHAPNew issue: Sustainable resource management Harmonizing reporting systems
WHO Regional Office for Europe, Division of Technical Support
THANK YOU