Development of a screening
tool for assessment of risks from combined exposure to multiple chemicals in indoor air: expert consultations and pilot testing
Budapest, Hungary, 24 May and 17 October 2019 Tallinn, Estonia, 24–25 October 2019
Minsk, Belarus, 11 November 2019
Bonn, Germany, 9 July 2020
Development of a screening
tool for assessment of risks from combined exposure to multiple chemicals in indoor air: expert consultations and pilot testing
Budapest, Hungary, 24 May and 17 October 2019 Tallinn, Estonia, 24–25 October 2019
Minsk, Belarus, 11 November 2019
Bonn, Germany, 9 July 2020
Abstract
In the past decades, assessment of risks from combined exposures and research on chemical mixtures in the environment and consumer products have taken on increased importance. Potentially higher risks of combined exposures are of high relevance in public settings for children. To facilitate assessment of such risks, the WHO European Centre for Environment and Health developed a screening tool. This publication describes how the screening tool has been developed and its pilot testing in Budapest, Hungary (24 May and 17 October 2019), Tallinn, Estonia (24–25 October 2019), Minsk, Belarus (11 November 2019), and in Bonn, Germany (9 July 2020).
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ACKNOWLEDGEMENTS ...iv
1. INTRODUCTION ...1
2. THE DEVELOPMENT PROCESS ...2
2.1 The first expert consultation ...2
2.2 The second expert consultation ...2
2.3 The third expert consultation (virtual) ...3
3. PILOT TRAINING AND TESTING WORKSHOPS ...4
3.1.Workshops in Budapest, Hungary ...4
3.2 Workshop in Tallinn, Estonia ...7
3.3 Workshop in Minsk, Belarus ...10
4. SUMMARY ...12
REFERENCES ...13
ANNEX 1. LIST OF PARTICIPANTS: BONN, GERMANY, 9 JULY 2020 ...15
ANNEX 2. LIST OF PARTICIPANTS: BUDAPEST, HUNGARY, 24 MAY 2019 ...17
ANNEX 3. LIST OF PARTICIPANTS: BUDAPEST, HUNGARY, 17 OCTOBER 2019 ...19
ANNEX 4. LIST OF PARTICIPANTS: TALLINN, ESTONIA, 24–25 OCTOBER 2019 ...20
ANNEX 5. LIST OF PARTICIPANTS: MINSK, BELARUS, 11 NOVEMBER 2019 ...22
CONTENTS
The WHO Regional Office for Europe gratefully acknowledges national experts and WHO temporary advisers for their valuable input during the pilot testing of the tool, and for their comments at different stages of the tool’s development.
This publication was prepared within the framework of a project on the development of a screening tool for calculating health risks from combined exposure to multiple chemicals in indoor air funded by the German Federal Ministry for Environment, Nature Conservation and Nuclear Safety.
ACKNOWLEDGEMENTS
1. INTRODUCTION
Throughout the life course, humans are exposed to a wide variety of substances from multiple sources every day. However, health risks from chemicals are usually evaluated on a substance-by-substance basis, and this is the main approach to chemical risk management.
In the past decades, cumulative risk assessment and research on chemical mixtures in the environment and consumer products have taken on increased importance. Assessment of risks from combined exposure to multiple chemicals is a WHO priority in the areas of chemical safety and the environmental health of children, given their increased vulnerability to chemicals (1–3).
Simultaneous exposure to multiple chemical substances is highly likely in public settings for children. Indoor air contains a wide range of pollutants originating from outdoor sources and sectors, such as traffic, industry and agriculture, and from indoor sources such as building materials, furnishing and consumer products. However, aside from some specific cases of exposure to at most two chemicals simultaneously, the evidence on the health effects of co- exposure is limited (4–6).
According to the literature reviewed in the context of this project, people in indoor environments are most frequently exposed to a combination of commonly identified indoor pollutants, particularly carbonyls, volatile organic compounds, particulate matter and polyaromatic hydrocarbons (4). Even if indoor concentrations of pollutants are lower than the suggested values in indoor air quality guidelines, acting collectively they can lead to higher health risks (5,7).
Given the growing evidence of the health effects of indoor air pollution, representatives of European Member States have identified the assessment of risks to children’s health from cumulative exposure to multiple chemicals in indoor air as one of the priorities for the practical application of the WHO–International Programme on Chemical Safety (IPCS) framework for assessment of risks from combined exposure to multiple chemicals (8,9). In response, the WHO European Centre for Environment and Health (WHO ECEH) undertook the task of developing a screening tool for assessment of risks to children’s health from combined exposure to multiple chemicals in indoor air in public settings such as schools, day-care centres and kindergartens.
The tool has been developed through a consultative process, involving leading experts in the areas of indoor air pollution and chemical risk assessment. National experts from 16 countries made significant contributions to the tool’s development thorough pilot testing, discussed during the workshops in Belarus, Estonia and Hungary.
2. THE DEVELOPMENT PROCESS
WHO ECEH organized three expert consultations in Bonn, Germany, to develop a methodological approach for the tool for assessment of risks from combined exposure to multiple chemicals, and to collect the information needed to move this work forward. The first consultation took place on 3–4 December 2018, the second on 23–24 September 2019, and the third on 9 July 2020.
2.1 The first expert consultation
At the first expert consultation, 18 experts from 14 countries discussed the overall methodological approach to the tool’s development and a search strategy for collecting toxicological information for assessment of combined exposure risks (10). The identification of priority adverse-effect endpoints to be addressed was another critical topic of discussion.
Plenary consultation and discussions in working groups yielded conclusions that created a foundation for further development of the tool. The experts concurred that the WHO–
IPCS framework for assessment of risks from combined exposure to multiple chemicals (8) provides an appropriate construct for the tool’s development. They agreed to apply health- based guideline values and other points of departure, such as no-observed-adverse-effect levels (NOAELs) and lowest-observed-adverse-effect levels (LOAELs), for Tier 0 and Tier 1 of the WHO–IPCS framework (8).
The group identified a limited number of adverse-effect endpoints for grouping chemicals for inclusion in the first version of the tool, including respiratory, nervous and cardiovascular disorders, carcinogenicity, and irritation.
The experts also agreed on two lists of hazardous chemicals commonly detected in public settings for children for further consideration: a priority list of 19 chemicals and an optional list for future consideration for inclusion in the tool (36 substances divided into 5 groups stratified according to their priority in terms of human health). They recommended that WHO prepare a document describing the scientific basis for the proposed approach to assessment of risks from combined exposure, with assumptions and limitations of the tool as well as a user manual.
2.2 The second expert consultation
The second consultation was called to finalize the methodological approach and to agree on the compilation of toxicological information for calculating risk using the tool (11). Other topics included the approach to selecting sampling sites, methods for sampling and analysis of chemicals of concern in indoor air in public settings for children, and an educational course for health-care and public-health professionals on indoor air pollution and children’s health.
Through the group discussion on exposure assessment alongside the sampling strategy, participants agreed to accept, in the first version of the tool, the concept of calculating exposure over 24 hours for 5 days (a school week) given a potentially equal exposure level in other settings, including households. Participants also agreed on a screening questionnaire
for the selection of sampling sites, where concentrations of hazardous chemicals and exposure are likely to be higher, and accepted a document describing a sampling strategy and methods for sampling and analysis of chemicals of concern for health. They suggested that the publication of the educational course on indoor air pollution and children’s health be prioritized after its final revision and piloting in the trainings in Tallinn, Estonia, and Budapest, Hungary, in October 2019. Finally, the group proposed that a software prototype be tested at a third expert consultation in mid-2020.
2.3 The third expert consultation (virtual)
Building on the outcomes of the two expert consultations held at WHO ECEH (3–4 December 2018 and 23–24 September 2019), a third, online expert meeting was organized on 9 July 2020 (see Annex 1 for the list of participants). The specific objectives of this meeting were to:
♦ present the prototype of the software for calculating risks from combined exposure to multiple chemicals in indoor air and demonstrate how it works;
♦ discuss the operational characteristics of the prototype; and
♦ conclude on the compliance of the calculation used in the prototype with the methodological approach for risk assessment proposed by WHO.
Leading experts in the areas of indoor air pollution and risk assessment agreed that the prototype is an advanced model that responds to the need to assess risks from chronic exposure to indoor pollutants. They proposed a number of additions and changes for developing the prototype into the software, and requested that WHO:
♦ undertake a final revision of the tables with toxicological information to avoid misleading software users;
♦ incorporate explanatory information on the welcome page of the software; and
♦ provide more options for the combination of sources of information with other data from the toxicological database.
The participants authorized a group of toxicologists with experience in combined-exposure risk assessment to check the calculation of the point of departure index, and to explain it clearly in the document describing the methodological approach underlying the software.
They concluded that testing of the prototype could continue for two weeks following the meeting to ensure that all opinions are taken into account. Finally, they decided to meet face to face or virtually in mid-November 2020 for a final meeting within the framework of the project.
3. PILOT TRAINING AND TESTING WORKSHOPS
To ensure the applicability of the screening tool for assessment of risks from combined exposure to multiple chemicals and to evaluate the contribution of documents related to exposure assessment, the WHO Regional Office for Europe organized several pilot training and testing workshops in collaboration with health sector authorities and institutions in three European Member States.
3.1. Workshops in Budapest, Hungary
The first workshop in Budapest, held on 24 May 2019, focused on selecting sampling sites using the draft questionnaire and calculating health risks from exposure to multiple chemicals in indoor air in public settings for children. The second event, held on 17 October 2019, focused on risk communication. Both workshops are described in the following sections.
3.1.1 Piloting a questionnaire for the selection of sampling sites and the calculation of risk
The WHO Regional Office for Europe organized the workshop on 24 May 2019 as a side event to the International Conference on Integrated Problem-solving Approaches to Ensure Schoolchildren’s Health, which took place on 23–24 May 2019 in Budapest. Its purpose was to introduce a methodology for the tool’s development, test the selection of sampling sites and risk assessment from combined exposure, and collect feedback from national experts on the tool and its applicability in practice. In total, 28 experts from 13 countries took part in the workshop (see Annex 2 for the list of participants). Dr Irina Zastenskaya of WHO ECEH facilitated the event.
Dr Tamas Szigeti, Head of the Air Hygiene Laboratory at the National Public Health Centre in Hungary, and Dr Dorota Jarosinska, Programme Manager of Living and Working Environments at WHO ECEH, opened the meeting. They noted that the tool being developed by WHO ECEH represents a practical approach in the area of combined-exposure risk assessment, and that the workshop would be the first attempt to calculate risk by applying the proposed methodological scheme. They stressed that WHO is particularly interested in gathering critical feedback from participants to guide the completion of this work.
Presentations outlined the context and the scientific aspects of the tool, as well as the approach to collecting toxicological information, including:
♦ the evidence of the negative impacts of hazardous chemicals in indoor air on children’s health;
♦ the WHO–IPCS framework for assessment of risks of combined exposure to multiple chemicals (8) and its application for the tool; and
♦ the status of the collection of toxicological data and the information for exposure assessment needed for the tool.
In a practical exercise, workshop participants worked with the training materials provided, including a questionnaire for the selection of sampling sites, case studies, and tables and data
for risk calculation. They had an opportunity to select sampling sites where concentrations of hazardous chemicals were likely to be higher, and to calculate risk to the respiratory system from combined exposure to multiple hazardous chemicals in indoor air.
Participants welcomed the tool for risk calculation and the draft questionnaire for the selection of sampling sites, and encouraged WHO ECEH to finalize the development of the tool and the accompanying documents as soon as possible. They noted the importance of shifting from a chemical-to-chemical risk assessment approach to the assessment of combined- exposure risks to better protect children’s health.
Regarding a draft questionnaire for selecting sampling sites, participants offered several suggestions for consideration, such as that WHO:
♦ include a definition of “green zone” (lawn, park, etc.);
♦ evaluate water-based paints as safer in comparison to other types of paints in terms of chemical emissions;
♦ explain the terminology related to “low emission” cleaning products (for example, while using of cleaning products makes cleaning easier and better, products with no hazardous chemicals and lower emission rates should be a priority choice for schools and other settings for children); and
♦ consider adding questions about:
• the presence of mould as a sign of high moisture, since microclimate parameters can influence chemical releases;
• the presence of pests in a room as a sign that insecticides were or may be used; and
• the mode of cleaning blackboards (wet or dry).
The proposals were discussed at the second expert consultation and taken into account for finalizing the document.
3.1.2 Communicating risk from combined exposure to multiple chemicals in indoor air
The WHO Regional Office for Europe organized a training on risk communication on 17 October 2019 for specialists from the National Public Health Center of Hungary within the framework of its biennial collaborative agreement with the Ministry of Human Capacities of Hungary. The purpose of the workshop was to:
♦ review WHO ECEH’s educational module for health-care and public-health professionals on the communication of risks to children’s health from chemicals in indoor air;
♦ practise risk communication in a simulation exercise;
♦ experience the development of a risk communication strategy; and
♦ learn about the communication of health risks from chemicals in indoor air to mass media.
The event gathered 16 professionals from the National Public Health Center (see Annex 3 for the list of participants). Ms Irina Zastenskaya and Mr James Creswick of WHO ECEH facilitated the training.
Dr Cecília Müller, Chief Medical Officer at the National Public Health Center, opened the workshop by welcoming participants. She stressed that while risk communication is critically important, it remains a challenge for public health specialists who frequently lack professional skills in this area. She emphasized the significance of this workshop in developing national capacities to communicate the risks of indoor air pollution.
Dr Ledia Lazeri, WHO Representative to Hungary, pointed out the successful cooperation of the WHO Regional Office for Europe and the Ministry of Human Capacities of Hungary. She noted that the workshop was organized to address risk communication, considered a priority area of the Ministry, and wished participants a day of fruitful discussion.
The workshop included a simulation of a municipal meeting to address an emergency at a school in a regional city: high indoor air pollution due to recent renovations. Participants played the roles of public-health and health-care professionals, city and school authorities, and parents of children affected by the polluted air. Together they explored the process of reaching an agreement on short- and long-term actions to improve indoor air quality. After the simulation exercise, participants formulated proposals for improving future exercises, such as including additional roles and considering a national context.
This was followed by a presentation on Hungary’s experience communicating environmental health risks with a focus on risk perception. Two examples – a chemical emergency in Hungary (2010) and the Chernobyl catastrophe (1986) – were used to demonstrate the theory of risk perception and communication. The results of a national project on communicating emergencies and environmental health risks demonstrated both the complexity and the effectiveness of proper risk communication.
A presentation on the educational module developed by WHO ECEH covered:
♦ information on the objectives of risk communication and its formulation using the principle of the single, overarching communication message (SOCO);
♦ approaches to identifying target populations and appropriate communication modes and channels;
♦ the challenges of risk communication;
♦ principles of communicating with mass media; and
♦ examples of key messages to different target groups.
Using this knowledge, participants practised formulating an objective for a communication strategy given the needs and roles of different population groups (parents, children, governmental authorities, teachers and managers of public buildings for children, journalists) using the SOCO principle. They also identified the most effective way to deliver risk-related messages.
The afternoon session included a presentation on indoor air pollution and the risks it poses to children’s health. This information, which can be used to educate allied professionals and for communicating risks from indoor air pollution, is summarized in the educational course prepared by WHO ECEH.
Overall, participants concluded that:
♦ the training was useful for strengthening risk communication skills of public-health professionals;
♦ follow-up trainings should be planned at the local level in the near future; and
♦ the WHO educational course and relevant training materials are valuable resources that can support trainings at the national level.
They encouraged WHO to publish the educational material as soon as possible.
3.2 Workshop in Tallinn, Estonia
Assessing real-life exposure to chemicals, including in indoor air, and the associated health risks is a priority for the health sector in the area of environmental health in Estonia and Lithuania. To advance work in this area, the WHO Regional Office for Europe organized several subregional workshops and trainings. The first workshop on implementation of cumulative risk assessment took place on 14–15 October 2015 in Vilnius, Lithuania. This was followed by a meeting on assessment and mitigation of risks to children’s health from chemicals in indoor air on 25–26 May 2017 in Tallinn, Estonia (9,12).
Discussing further support from WHO, participants requested advice on exposure assessment and technical resources such as a tool for calculating combined-exposure risks. They also stressed the need for educational and training materials on chemical risk assessment and risk communication.
As a follow-up, the WHO Regional Office for Europe organized a training workshop on 24–25 October 2019 in Tallinn within the framework of its biennial collaborative agreement with the Health Board of Estonia. It was an opportunity to report on progress in the past two years, discuss the tool with public health professionals, including its methodological approach and accompanying documents, and contribute to building national capacities for the implementation of cumulative risk assessment from selected chemicals in indoor air.
The objectives of the two-day workshop were to:
♦ discuss capacities needed at the national level to implement standardized methods for sampling and analysis of the most common hazardous pollutants in indoor air;
♦ check the applicability of the screening questionnaire for the selection of sampling sites;
♦ share national experiences in collecting information on children’s exposure to chemical pollutants in indoor air in schools;
♦ present the methodological approach to combined-exposure risk assessment and test the calculation of risks; and
♦ practise risk communication with different stakeholders.
The event gathered 21 professionals from the Health Board of Estonia and its regional offices, the University of Tartu, and the Estonian Ministry of Social Affairs (see Annex 4 for the list of participants). Ms Irina Zastenskaya and Mr James Creswick facilitated the workshop.
Dr Jelena Tomasova, Deputy Director General for Health of the Health Board, opened the workshop by warmly welcoming participants and emphasizing the importance of risk assessment in the reduction of children’s exposure to chemicals. Dr Tomasova expressed her wish that the workshop be an arena for open discussion and the exchange of knowledge and experience among national and international experts.
Ms Marge Reinap, WHO Representative to Estonia, recalled the valuable experience gained through the subregional workshops in 2015 and 2017, and expressed gratitude to the Health Board of Estonia for the opportunity to move this work forward. Ms Reinap noted that the workshop outcomes would be important at a national level for strengthening capacities and gathering new knowledge and experience, and to WHO ECEH’s finalization of the tool and accompanying documents.
3.2.1 Introduction to assessment of risks from combined exposure to multiple chemicals
The presentation by WHO ECEH introduced the importance of risk assessment from combined exposure to multiple chemicals in indoor air. It emphasized that creating nontoxic environments for children, including good indoor air quality in places where they learn and live, is a goal in the WHO European Region. Health professionals play a leading role in achieving this goal through, for example, research and knowledge dissemination, assessment of exposures and health impacts, advocacy for relevant policies and decisions, and education and awareness-raising about indoor pollution by chemicals and its health effects.
Children are particularly vulnerable to the impact of chemicals due to developmental immaturity and behavioural, physiological and biochemical characteristics. Depending on the type of chemicals, their concentrations in indoor air and the characteristics of individuals, chemicals can increase the risk of developing acute and chronic health adverse effects, including respiratory, immune and neurodevelopmental disorders. Unfortunately, hazardous chemicals in indoor air in schools and other public settings for children were detected in air quality studies. Actions are needed to improve combined-exposure risk assessment to enable the planning and implementing of effective measures for minimizing and preventing harm.
3.2.2 Selection of sampling sites and methods for sampling and analysis of chemicals
The second session focused on indoor air sampling and analysis. The characterization of sampling sites is useful for identifying spaces where exposure is likely to be higher due to different factors, such as the presence and characteristics of indoor or outdoor sources of chemicals, ventilation rates, cleaning practices or time since renovations. To facilitate selection of sampling sites, two questionnaires were presented: one developed within the national surveys with descriptions of all relevant conditions; and another prepared by WHO ECEH with binary answers to a number of questions related to indoor air quality to simplify assessment.
Both questionnaires address factors influencing indoor air pollution but for different purposes: the first one focuses on revealing links between indoor air pollutions and sources of hazardous chemicals, and the second one focuses on the selection of sampling sites for
risk assessment from combined exposure to multiple chemicals. They are complementary and can be used jointly for national surveys.
National experts then presented experience from the investigation of outdoor air quality within the national monitoring programme; methods used for the analysis of chemicals; the results of various studies; and the links between outdoor air quality and the presence of industrial enterprises.
A WHO expert presented passive and active sampling methods and methods for the analysis of chemicals identified for inclusion in the tool and other common pollutants of health concern. It is important to note that at both national and international levels, International Organization for Standardization (ISO) and European Normative (EN) methods are the first choice, followed by nationally authorized methods.
In the plenary discussion, participants stressed the need for additional human and technical resources to enable the use of ISO methods for all chemicals of concern. Experts noted that incomplete availability of ISO methods remains a barrier.
Following the plenary, participants practised sampling site selection using the questionnaire proposed by WHO ECEH. In a follow-up discussion, they concluded that the questionnaire is a useful instrument that can be easily and widely used at national, regional and local levels, particularly as questions can be answered based on visual investigation, and no specific knowledge or skills are required. The simple analysis of the majority of factors influencing indoor air pollution enabled better evaluation of potential sampling sites.
3.2.3 Assessment of risks to children’s health from combined exposure to multiple chemicals in indoor air
In this session, experts from WHO ECEH introduced the tool for risk assessment from combined exposure to multiple chemicals, the tiered approach to exposure and hazard assessment of the WHO–IPCS framework (8) and its application in the tool, the tool’s methodological approach, case studies, and risk calculation examples. The presentation was followed by practical exercises in which participants used data from national surveys to calculate the health risks of indoor air pollution in schools by applying Tier 0 and Tier 1 of the WHO–IPCS framework.
The national experts agreed that the tool, once finalized, could be implemented at national and local levels. However, they noted that more trainings are needed to establish a pool of national experts skilled in assessing combined exposure and its risks to health.
3.2.4 Communicating risk from combined exposure to multiple chemicals in indoor air
The second day of the workshop was devoted to risk communication. It began with an exercise simulating an emergency in which high levels of chemicals in indoor air following renovations in a school building caused acute health effects among students. The exercise included a simulated meeting where participants played the roles of school and city authorities, public-health professionals, parents of children affected by the chemicals and representatives of mass media. They used the results of the risk assessment from the first
day of the training to communicate risk to different target groups and to develop a realistic plan for short- and long-term risk reduction.
After the simulation exercise, the educational module on communicating health risks from combined exposure to multiple chemicals in indoor air was presented. The session included information on developing communication objectives and achieving them with the support of a communication strategy, and basic principles of health risk communication such as providing the target audience with facts confirming that a situation can be improved and actions that can be taken to reduce risks.
Through a number of examples, participants explored common challenges and how to address them effectively with different audiences in mind. They also practised developing a risk communication strategy with clear objectives using the SOCO principle.
3.2.5 Workshop conclusions and next steps
Overall, participants welcomed the tool and its accompanying documents as useful and effective. They expressed particular appreciation for the overview of methods for sampling and analysis of chemicals in indoor air and the screening questionnaire facilitating the selection of sampling sites. They added that additional trainings are needed to ensure successful implementation, and invited WHO to collaborate further in the area of chemical safety.
3.3 Workshop in Minsk, Belarus
The pilot training on assessment of risks from combined exposure to multiple chemicals in indoor air took place in Minsk on 11 November 2019. The WHO Regional Office for Europe organized this training within the framework of the workshop “Health and environment risk and impact assessment within a national system of sound chemical management” on 11–
13 November 2019. It featured the participation of 41 national experts from the three countries (Belarus, Georgia and Kazakhstan) involved in implementation of the project “Establishment of key elements of national systems for sound chemical management in selected countries in eastern Europe, the Caucasus and central Asia” funded by the German Environment Agency through its Advisory Assistance Programme (see Annex 5 for the list of participants).
The objective of the training was to introduce the WHO–IPCS framework (8) and demonstrate its practical applicability using assessment of risks from multiple chemicals in indoor air as an example.
Dr Nataliya Zhukova, Deputy Minister of Health of Belarus, opened the meeting. She stressed the importance of trainings on priority topics in chemical safety, including assessment of risks from combined exposure to multiple chemicals, for creating a network of trainers for further dissemination of knowledge and experience within and between countries. She expressed her sincere gratitude to the WHO Regional Office for Europe and the German Government for their technical and financial support in this area.
Dr Batyr Berdyklychev, WHO Representative to Belarus, noted that combined-exposure risk assessment is a priority for WHO due to the significant health impacts of chemicals. He emphasized that additional actions are needed to address the problem and minimize harm to human health. They both wished participants a successful training.
The workshop followed an agenda similar to those of the workshops on the calculation of risks from combined exposure in Budapest and Tallinn. It began with a presentation of the WHO–IPCS framework (8). In working groups, participants then practised calculating risk from chemical pollutants in indoor air using the methodological approach proposed by WHO ECEH. During the discussion that followed, participants noted that the tool and accompanying instructions made it easy to calculate risks in spite of the fact that it was a new experience for the majority of them. However, they added that complications related to the collection of information on exposure may arise due to the need for additional technical and financial resources.
4. SUMMARY
The four pilot workshops described above provided valuable opportunities to test the tool for assessment of risks from combined exposure to multiple chemicals in public settings for children, to discuss its accompanying documents, and to build national capacities related to risk assessment and risk communication. The proposals and feedback from participants were taken into consideration to ensure the practicability of the developed instruments and resources, and contributed to the finalization of the first version of the screening tool.
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12. Assessment of chemical risks for human health: training and capacity building sub- regional workshop for Estonia, Latvia and Lithuania. Meeting report. Vilnius, Lithuania, 14–15 October 2015. Copenhagen: WHO Regional Office for Europe; 2015 (http://
www.euro.who.int/__data/assets/pdf_file/0003/298470/Assessment-chemical-risks-for- human-health-training-capacity-Estonia-Latvia-Lithuania-Report.pdf?ua=1, accessed 24 September 2020).
ANNEX 1. LIST OF PARTICIPANTS: BONN, GERMANY, 9 JULY 2020
Dovile Adamonyte
Public Health Specialist, Environmental Health
Centre for Health Education and Disease Prevention
Lithuania Kristina Aidla Chief Specialist Health Board Estonia
Katleen De Brouwere Senior Health Researcher VITOBelgium
Małgorzata Dębiak
Office of the Committee for Indoor Standards
Department II 1.2 – Toxicology Federal Environment Agency Germany
Sani Dimitroulopoulou
Principal Environmental Public Health Scientist
Centre for Radiation, Chemical and Environmental Hazards
Public Health England United Kingdom Marta Gabriel Researcher, Energy
Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI)
Portugal
Alexandr Gankine Researcher
Scientific and Practical Centre of Hygiene Laboratory of Environmental Factors and Health Risk Analysis
Ministry of Health Belarus
Michael Ilyukov
Consultant, Information Technology Belarus
Marike Kolossa-Gehring Head of Toxicology Section
Health-related Environmental Monitoring Federal Environment Agency
Germany
Olita Kriukoviene
Public Health Specialist
Centre for Health Education and Disease Prevention
Lithuania Corinne Mandin
Head of Health and Comfort Unit Scientific and Technical Centre for Building (CSTB)
France
M.E. (Bette) Meek Associate
McLaughlin Centre University of Ottawa Canada
Tamas Szigeti
Head of Laboratory, Air Hygiene National Public Health Center Hungary
Maria Uhl Senior Expert
Team Studies and Consulting Umweltbundesamt Laboratories Environment Agency Austria Austria
Theo Vermeire
Senior Risk Assessor for Chemicals
National Institute for Public Health and the Environment
Centre for Safety of Substances and Products
The Netherlands
WHO Regional Office for Europe Dorota Jarosinska
Programme Manager
Living and Working Environments
WHO European Centre for Environment and Health (ECEH)
Roman Perez Velasco Technical Officer Air Quality and Health
Living and Working Environments WHO ECEH
Irina Zastenskaya Technical Officer Chemical Safety
Living and Working Environments WHO ECEH
ANNEX 2. LIST OF PARTICIPANTS: BUDAPEST, HUNGARY, 24 MAY 2019
Kristina Aidla Chief Specialist Health Board Estonia Éva Csobod
Senior Expert in Environment and Health Regional Environmental Centre for Central and Eastern Europe
Hungary
Claire Dassonville Project Manager
Scientific and Technical Building Centre France
Marta Gabriel Researcher
Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI)
Portugal Ádám Hofer
Head of Department
National Public Health Center Hungary
Zsolt Homoki Researcher
National Public Health Center Hungary
Anja Jutraz Architect
National Institute of Public Health Slovenia
Réka Kakucs
Medical Doctor, Medical Expert National Public Health Center
Bohumil Kotlík Senior Researcher
National Institute of Public Health Czechia
Anna Kozajda Senior Scientist
Nofer Institute of Occupational Medicine Poland
Szilvia Közepesy Public Health Expert
National Public Health Center Hungary
Helena Kozmarová Director
National Institute of Public Health Czechia
Lennart Larsson Professor
Lund University Sweden
Donat Magyar Aerobiologist
National Public Health Center Hungary
Tibor Málnási Biologist
National Public Health Center Hungary
Peter Otorepec Head of Department
National Institute of Public Health Slovenia
Anna Páldy
Medical Doctor, Senior Consultant National Public Health Center Hungary
Tamás Pándics
Medical Doctor, Head of Section National Public Health Center Hungary
Joaquim Rovira Solano Postdoctoral Researcher Rovira i Virgili University Spain
Péter Rudnai
Medical Doctor, Senior Consultant National Public Health Center Hungary
Ana Maria Scutaru Research Assistant
German Environment Agency Germany
Magdalena Suchan Project Manager
Marshal’s Office of the Lodzkie Region Poland
Máté Szabados
Environmental Scientist National Public Health Center Hungary
Ágnes Szigeti Researcher
National Public Health Center Hungary
Tamás Szigeti Head of Laboratory
National Public Health Center Hungary
Maria Uhl Toxicologist
Environment Agency Austria
Andrej Ursic Senior Researcher
National Institute of Public Health Slovenia
Simona Ursic Senior Researcher
National Institute of Public Health Slovenia
WHO Regional Office for Europe Dorota Jarosinska
Programme Manager
Living and Working Environments
WHO European Centre for Environment and Health (WHO ECEH)
Irina Zastenskaya Technical Officer Chemical Safety WHO ECEH
ANNEX 3. LIST OF PARTICIPANTS: BUDAPEST, HUNGARY, 17 OCTOBER 2019
National Public Health Center of Hungary
Izsák Bálint
Public Health Expert Zsófia Csákó
Analytical Chemist Veronika Gál
Head of Communication Eszter Horváth
Medical Expert Ádám Hofer
Head of Department Dorottya Jáki-Vékony Communication Expert Réka Kakucs
Medical Doctor, Medical Expert Donát Magyar
Aerobiologist Cecília Müller
Chief Medical Officer Anna Páldy
Medical Doctor, Senior Consultant Tamás Pándics
Medical Doctor, Head of Section Kinga Róna
Communication Expert Máté Szabados
Environmental Scientist
Tamás Szigeti Head of Laboratory Középesy Szilvia Public Health Expert Eszter Tüske-Szabó Epidemiologist
WHO Regional Office for Europe James Creswick
Technical Officer Communications WHO ECEH Ledia Lazeri
WHO Representative to Hungary Irina Zastenskaya
Technical Officer Chemical Safety WHO ECEH
ANNEX 4. LIST OF PARTICIPANTS: TALLINN, ESTONIA, 24–25 OCTOBER 2019
Health Board of Estonia Kaia Adelman
Inspector Western Region Kristina Aidla Leading Specialist
Environmental Health Department Alli Alas
Senior Inspector Eastern Region Leena Albreht
HeadEnvironmental Health Department
Marleen Alttoa Senior Specialist
Central Chemical Laboratory Sofia Annikova
Senior Specialist
Laboratory of Chemical Analysis Urve Eek
Inspector South Region Konstantin Kislitson Leading Specialist
Laboratory of Chemical Analysis Triin Kuusik
Inspector Western Region Jalena Laarin Inspector South Region Märten Lukk Adviser
Janne Nurme Inspector North Region Mari Reinik
Laboratory Specialist Kaili Sillamaa Specialist
Environmental Health Department Natalja Šubina
Specialist
Environmental Health Department Jelena Tomasova
Deputy Director-General Kaili Tuulik
Specialist
Environmental Health Department University of Tartu
Ene Indermitte Lecturer
Institute of Family Medicine and Public Health
Hans Orru Lecturer
Institute of Family Medicine and Public Health
Ministry of Social Affairs of Estonia Marilin Lutsoja
Chief Specialist Ramon Nahkur Adviser
WHO Regional Office for Europe James Creswick
Technical Officer Communications WHO ECEH Marge Peinap
WHO Representative to Estonia Gerli Sirk
Administration Assistant
WHO Country Office in Estonia Irina Zastenskaya
Technical Officer Chemical Safety WHO ECEH
ANNEX 5. LIST OF PARTICIPANTS: MINSK, BELARUS, 11 NOVEMBER 2019
Belarus
Ruslan Bogdanov
Head of Laboratory of Industrial Toxicology
Scientific and Practical Centre of Hygiene Maksim Bogdanovich
Head of Occupational Health Unit Centre of Hygiene and Epidemiology of Brest Region
Alena Drozdova
Deputy Director for Science
Scientific and Practical Centre of Hygiene Sergey Dubinin
HeadOrganization Department Unit
Centre of Hygiene and Epidemiology of Gomel Region
Ekaterina Fedorenko Deputy Director
Scientific and Practical Centre of Hygiene Tatjana Gribok
HeadOccupational Health Unit
Centre of Hygiene and Epidemiology of Vitebsk Region
Natalija Grigorovich Registration Specialist Enterprise “NAFTAN”
Irina Iliukova
HeadLaboratory for Preventive and Environmental Toxicology
Scientific and Practical Centre of Hygiene
Tatjana Kapustinskaya
Head of Occupational Health Unit Republican Сentre of Hygiene, Epidemiology and Public Health Denis Kovalenko
Climate Consultant
Nongovernmental organization (NGO)
“Ecological Initiative”
Daria Krupskaya
Head of Occupational Health Unit Centre of Hygiene and Epidemiology of Minsk City
Elena Ljubchik
Standardization and Certification Engineer Enterprise “NAFTAN”
Eduard Moroz
Head of Department of Hygiene, Epidemiology and Prevention Ministry of Health
Lilija Nadzharjan Registration Specialist Enterprise “ADAMA RUS”
Liudmila Navitskaya
Head of Marketing and Agronomy Service Enterprise “AgroIndustry”
Galina Nekrasova Registration Specialist Enterprise “MAV”
Liudmila Pavlova
Environmental Management Team Leader Enterprise “Avgust-BEL”
Gennady Pavlovich
Head of Occupational Health Unit Centre of Hygiene and Epidemiology of Grodno Region
Elena Pevetz
Registration Specialist Enterprise “BASF”
Alina Shturich Scientist
Laboratory for Preventive and Environmental Toxicology
Scientific and Practical Centre of Hygiene Elena Smirnova
Head of Occupational Health Unit Centre of Hygiene and Epidemiology of Minsk Region
Nelly Stameniuk Chief Specialist
Department of Conformity Assessment and Licensing
State Committee for Standardization Sergey Strunevsky
Head of Department of Technical Regulation and Standardization in the Chemical, Light and Woodworking Industries
State Committee for Standardization Sergey Sychek
Director
Scientific and Practical Centre of Hygiene Natalija Tabeleva
Head of Scientific Testing Department Scientific and Practical Centre of Hygiene
Demko Vadim
Head of Department of Waste Management
Ministry of Natural Resources and Environment Protection
Natalia Vajmacheva
Head of Department of Social and
Hygienic Monitoring and Risk Assessment Centre of Hygiene and Epidemiology of Mogilev Region
Marina Vasilieva Scientist
Laboratory for Preventive and Environmental Toxicology
Scientific and Practical Centre of Hygiene Olga Volkova
Deputy Chairman
NGO “Ecological Initiative”
Nataliya Zhukova
Deputy Minister of Health Chief State Sanitarian Ministry of Health Georgia
Lali Ebanoidze
Head of Legal Department
National Centre for Disease Control and Public Health
Nana Gabriadze
Head of Environmental Health Division National Centre for Disease Control and Public Health
Nino Jibgashvili Specialist
National Centre for Disease Control and Public Health
Kazakhstan Elmira Aimbetova
Head of Chemical Safety Department National Centre for the Integrated Processing of Mineral Resources Ministry of Industry and Infrastructure Development
Dinara Astaeva Laboratory Assistant
Reference Laboratory of the Toxicology of Polymers and Other Chemicals
National Centre for Public Health Ministry of Health
Dinara Kenesary Executive Director Enterprise “Kenesary”
Zhanneta Nurdauletova
Head of Department of State Metrological and Analytical Control
Ministry of Ecology, Geology and Natural Resources
Ardak Sapieva Associate Professor
Department of General and Biological Chemistry
Medical University of Astana Korlan Semenova
Acting Chief Specialist
National Centre for Public Health Ministry of Health
Nasima Zhunusova
Head of Department for Monitoring Non-infectious Diseases
National Centre for Public Health Ministry of Health
Sanam Zikiriyarova
Acting Head of Department of Epidemiology of Public Health Kazakh National Medical University WHO temporary advisers
Otto Hanninen Senior Researcher University of Kuopio Finland
Milena Horvat
Head of Department of Environmental Sciences
Jožef Stefan Institute Slovenia
Katerina Sebkova Director
National Centre of Toxic Compounds Stockholm Convention Regional Centre for Capacity Building and Transfer of Technologies
Masaryk University Czechia
WHO Regional Office for Europe Batyr Berdyklychev
WHO Representative to Belarus Julia Nowacki (remotely)
Technical Officer
Health Impact Assessment WHO ECEH
Irina Zastenskaya Technical Officer Chemical Safety WHO ECEH
WHO/EURO:2020-1747-41498-56597 The WHO Regional Office for Europe
The World Health Organization (WHO) is a specialized agency of the United Nations creted in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves.
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