of progress
18.
Similarly, access to safe drinking-water and sanitation remains a troubling problem, especially in rural areas; in particular, progress in the Caucasus and central Asia, for example, is stalled or even negative. Also, the prevalence of physical activity is disappointing, with children overweight and obesity possibly increasing throughout the region – trends that may in part reflect environments that are not conducive to walking and cycling, for example.
In contrast to the limited progress described above, sustained international and national efforts have resulted in significant progress in unintentional and road traffic injuries, halving them in a decade, until 2011; nonetheless, a gradient through income levels, both between and within countries, was observed. For exposure to hazardous chemicals – which are notoriously difficult to measure – mixed signals were reported for the period 1998–2012.
Decreasing levels of dioxins and furans in breast milk were observed in several EU and non-EU countries. On the other hand, 1.8 million children yearly are born in the EU with levels of methylmercury
that affect their cerebral development and cognitive performance in later years. In addition, significant efforts have been made to tackle asbestos-related diseases; on the international policy front, however, it is not yet possible to achieve a consensus for the inclusion of chrysotile asbestos among the chemicals subject to the provisions of the Rotterdam Convention.
On a more positive note, institutional arrangements and policy provisions have made important progress in the Region.
Far-reaching, legally binding international agreements are progressively extending their coverage. The 1999 Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and Lakes – a key instrument for reducing water-related diseases and pursuing sustainable and equitable access to water resources – has now reached 26 parties, covering 60% of the population in the Region. Similarly, agreements on ambient air quality are being ratified or will be adopted by Member States, both at the pan-European level (for example, the Convention on Long-range Transboundary
© World Health Organization/Andreas Alfredsson
Air Pollution, which since 2012 includes provisions for PM2.5) and at the EU level, with a new policy package on emissions on its way. The new package will commit EU countries and will possibly become a compelling target for non-EU Member States.
More than 60% of the 35 Regional Member States that responded to the WHO survey on children’s environments and injuries reported the introduction of new policies after the Parma Conference.
Together with other policies emanating from the education and road safety sectors, a robust policy framework seems to be in place on this issue, integrating multisectoral policies, particularly for urban areas, and promoting a more meaningful engagement of young people in implementing the Parma commitments.
As reported in a survey of 35 Regional Member States, various policy measures have been undertaken to deal with risks from hazardous chemicals, again including initiatives at the national level, as well as commitments to international agreements on chemical safety, though with limited explicit provision for the protection of children. Finally, the consolidation of policy instruments available to tackle emergencies, notably through the International Health Regulations, has provided a strong framework to support Member States in addressing several environmental cross-border threats, both related to chemical accidents and to the more frequent occurrence of extreme weather events. These consolidated policy instruments emphasize the importance of improving preparedness and resilience to these events and strengthening international collaboration.
Thus, all in all, it appears that the degree of political awareness and normative response has become rooted more deeply in many Member States and at the supranational level. However, as discussed earlier in this chapter, such progress on the policy front is not fully reflected by hard indicators. A reason for the difficulty in achieving substantial and measurable returns from policies is that large gains in environmental health quality
had previously been attained by many European countries. Though incrementally more difficult to achieve, further improvement is still necessary, especially where substantial burdens of disease are documented. It is also important that the best quality of environment and health found in Europe be regarded as a realistic and feasible target for all Member States and be regarded as an investment in the attainment of better health and quality of life for all and in the social and economic prosperity of the Region.
A limited connection between policy action and policy impact can also be seen in such broader thematic areas as climate change and sustainable development. Global, regional and national efforts on climate change mitigation and adaptation have been fruitful in producing influential and legally binding instruments, preparedness and response schemes, and adaptation plans, among other things. Through its organizations and agencies, the UN has put in place a global policy framework for sustainable development that has proven its worldwide influence.
These remarkable developments, however, have taken place against a background of rapid and apparently unstoppable deterioration of climate and ecosystems, continuing unsustainable patterns of production and consumption, and a lack of decoupling between economic development and the use of material resources. In addition, the economic crisis that has affected several Member States since 2008 has brought with it the danger that the protection of health and environment can be regarded as a dispensable luxury whose pursuit may be at odds with economic recovery and growth in a globalized and highly competitive market.
Therefore, more stringent implementation of existing policies and enforcement of existing norms and standards are needed or, more generally, a closer translation from evidence to concrete policy action seems warranted. The gap between evidence and policy action has received some attention, as shown (for example) by the growing interest in it raised by economic
considerations. Increasingly, evaluations of the economic benefits achievable through preventive action are being used to supplement data on the adverse effects on health and the effects of environmental factors. Such estimated economic benefits can be as high as percentage points of entire gross domestic products, as in the case of transport. At times of slow expansion or even contraction of most European economies, such additional economic evidence provides, or should provide, a strong incentive for investment in environmental health.
Similarly, the increased prominence of inequalities that result from the uneven distribution of environmental exposures and impacts adds to the urgency of increasing the rate of implementing policies and commitments. Health inequalities, in point of fact, have become most prominent in several strategic deliberations, such as those for the Health 2020 policy framework for public health in Europe.
The cycle of producing evidence, formulating policy and concrete implementation is very complex.
Strengthening this cycle’s overall effectiveness, arguably an overarching goal of the environment and health process, requires consideration of several factors. Where observed, lack of progress should not be ascribed simplistically to ineffective implementation or poor compliance. Among the factors that need to be considered is the time lag, where the effects of policy developments may show up a few years later as measurable benefits. More importantly, available indicators are only able to provide a partial picture of the adverse effects on health of environmental factors – for example, because of their failure to detect important dimensions of well-being and quality of life. If this is the case, as indeed it appears to be, then it is also true that such indicators can only provide a partial picture of the overall benefits of existing policies. For example, although policies that tackle ambient air emissions from transport by curbing urban motor vehicle traffic may result in modest improvements
in air quality (because of the contribution of distant sources), they can bring about considerable co-benefits, such as less noise and improved quality and liveability in the urban environment. In other words, a more telling assessment of policies might result from broader evaluations that extend beyond their immediate area of pertinence.
Complexity, in point of fact, remains a challenge when studying the adverse effects on health of the environment and assessing policy responses. The production and evaluation of evidence and the use of indicators for monitoring partly reflect a compartmentalized view of environment and health (subdivided into air, water and other categories) that goes back several decades. In light of evolving evidence, this view has been maturing; but still needs to progress if it is to embrace the inherent complexity of contemporary challenges in environment and health. This is especially true if broad, distal determinants – those having indirect effects, such as national, institutional, political, legal, and cultural determinants – are going to be considered holistically. A number of lessons are being learnt from the science of climate change, and we may need more resources and greater capacity to deal with other complex systems, such as energy and agriculture – work that involves substantial uncertainty and calls for precautionary policies.
Moreover, institutional and societal complexity plays an important role. The ultimate effect of policies is modulated by political, strategic and socioeconomic considerations, opportunities, and constraints, which together embody a very challenging situation for the European Region.
The environment and health process is an ideal platform for pursuing this challenging agenda. It remains the only multilateral platform where both health and environment constituencies participate on an equal footing and can pursue common objectives. Its distinctive governance platform provides
the environment and health process with the necessary breadth of vision and understanding of the interactions between different sectoral policies and their effect on multiple exposures, which is necessary to embrace the irreducible complexity of addressing environment and health issues. Furthermore, the environment and health process can enhance the implementation of several multilateral environmental agreements, which are explicitly identified in the Parma Declaration as being key to the attainment of its goals and commitments.
The changing understanding of the relationship between environment and health and well-being implies, however, that the European environment and health process needs to update its objectives and priorities in light of the new knowledge and understanding of the interrelationships between environment and health. A renewed vision and focus – aligned with current and emerging knowledge, policy frameworks and processes – will ensure the continuing relevance of the environment and health process to Member States and their continued interest in this unique intersectoral policy platform in the WHO European Region.
To maintain its relevance and usefulness to Member States, the future shaping of the European environment and health process needs to be fully informed by these changes, as well as by an understanding of the political and socioeconomic context. Accordingly, it needs to adjust its capacity to:
• establish links and strategic partnerships with different actors, stakeholders and processes;
• utilize fully the already established policy instruments and tools;
• provide guidance and strengthen capacities to address environment and health challenges, while embracing their underlying complexity and uncertainty;
• enhance the understanding and use of economic arguments to support action on environment and health issues; and
• harmonize with the forthcoming post-2015 sustainable development agenda and contribute to its implementation in the European Region.
Table A1 covers the national adaptation plans or strategies and health in the WHO European Region.
Table A1. Inclusion of health in national climate change adaptation plans, by Member State (Dec. 2013)
Member
State Year(s) NAP/
NAS
H in
NAP HNAP Source
Albania 2012 N N Y Republic of Albania Ministry of Health (2011) Austria 2012 Y Y -- Federal Ministry of Agriculture, Forestry,
Environment and Water Management (2012)
Belgium 2010 Y Y -- NCC (2010)
Czech
Republic 2004 Y Y -- Ministry of the Environment (2004)
Denmark 2012 Y Y -- Task Force for Climate Change Adaptation (2012)
Estonia 2012 N N Y Sotsiaalministeerium [Ministry of Social Affairs] (2012)
Finland 2005 Y Y -- Ministry of Agriculture and Forestry (2005) France 2011 Y Y -- Ministère de l’Écologie, du Développement
durable, des Transports et du Logement (2011)
Germany 2011 Y Y -- Bundesregierung (2011)
Hungary 2008 Y Y -- NAK (2008)
Ireland 2012 Y Y -- Department of the Environment, Community and Local Government (2012)
Israel 2012 Y Y -- Ministry of Environmental Protection (2012) Italy 2013 Y Y -- Ministero dell’Ambiente e della Tutela del
Territorio e del Mare [Italian Ministry of Environment, Land and Sea] (2013)
Kazakhstan 2014 N N Y Under approval
Kyrgyzstan 2011, 2013
Y Y Y Ministry of Health of the Kyrgyz Republic (2011)
Government of the Kyrgyz Republic (2013) Malta 2010 Y Y -- Ministry for Resources and Rural Affairs
(2012)