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Lecture Eu Policy on EH Risks


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Lecture to bachelor students European Public Health

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Lecture Eu Policy on EH Risks

  1. 1. Tackling environmental health risks with policy A European policy perspective Leendert van Bree & Eva Kunseler
  2. 2. Overview <ul><li>Introduction to Environmental Health Risks </li></ul><ul><li>Environmental Legislation – Leendert </li></ul><ul><ul><li>Hazard-oriented </li></ul></ul><ul><ul><li>Standard-setting approach </li></ul></ul><ul><li>Environmental Health Programmes – Eva </li></ul><ul><ul><li>Effect-oriented </li></ul></ul><ul><ul><li>Health in All Policy approach </li></ul></ul><ul><li>Break </li></ul><ul><li>Policy Evaluation </li></ul><ul><ul><li>Indicators - Eva </li></ul></ul><ul><ul><li>Impact assessment - Leendert </li></ul></ul><ul><li>New developments - Both </li></ul>
  3. 3. Environmental Health Risks <ul><li>What kind of environmental risks are negatively affecting health? </li></ul><ul><ul><li>What is health? </li></ul></ul><ul><ul><li>What environmental risks? </li></ul></ul><ul><li>What can EU policy do to tackle these risks </li></ul><ul><ul><li>What policy orientation? </li></ul></ul><ul><ul><li>What policy instruments? </li></ul></ul>
  4. 4. Health Perspective <ul><li>Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity </li></ul><ul><li>( WHO 1948) </li></ul><ul><li>Conceptual model of public health </li></ul><ul><li>Source: RIVM (2006). Care for health. The 2006 Dutch Public Health Status and Forecasts Report </li></ul>
  5. 5. Environmental Risks: what perspective? <ul><li>Hazard-oriented: air pollution, water pollution, soil pollution, waste and chemicals </li></ul><ul><li>Effect-oriented: ecological damage, social degradation, public health impact e.g. </li></ul><ul><ul><li>Gastrointestinal diseases: food safety, water and sanitation </li></ul></ul><ul><ul><li>Cancers: air quality (indoor and outdoor), UV and ionizing radiation, chemicals, radon </li></ul></ul><ul><ul><li>Cardiovascular diseases: air quality (indoor and outdoor), noise </li></ul></ul><ul><ul><li>Respiratory diseases: air quality (indoor and outdoor), dampness and mould </li></ul></ul>
  6. 6. Overview <ul><li>Introduction to Environmental Health Risks </li></ul><ul><li>Environmental Legislation – Leendert </li></ul><ul><ul><li>Hazard-oriented </li></ul></ul><ul><ul><li>Standard-setting approach </li></ul></ul><ul><li>Environmental Health Programmes – Eva </li></ul><ul><ul><li>Effect-oriented </li></ul></ul><ul><ul><li>Health in All Policy approach </li></ul></ul><ul><li>Break </li></ul><ul><li>Policy Evaluation </li></ul><ul><ul><li>Indicators - Eva </li></ul></ul><ul><ul><li>Impact assessment - Leendert </li></ul></ul><ul><li>New developments - Both </li></ul>
  7. 7. Environmental Legislation <ul><li>Basically simple questions, simple answers? </li></ul><ul><ul><li>Is there a problem? </li></ul></ul><ul><ul><li>What causes the problem? </li></ul></ul><ul><ul><li>Can we do something about it? </li></ul></ul><ul><ul><li>Will it help? </li></ul></ul><ul><ul><li>What does it cost? </li></ul></ul><ul><ul><li>Who is going to pay? </li></ul></ul><ul><ul><li>------------------------------------------------------ </li></ul></ul><ul><ul><li>What is effective and efficient policy? </li></ul></ul>
  8. 8. Environmental Legislation (2) <ul><li>Focus on control and prevention </li></ul><ul><li>Hazard-oriented rationale behind environmental health policy targets for chemicals, external safety, food, air, and water </li></ul><ul><li>Checking quantified risks against standards </li></ul><ul><li>Equal (rights-based) protection of every citizen: no one above 10 -6 norm for mortality! </li></ul><ul><li>----------------------------------------------------------------------------------- </li></ul><ul><ul><li>>> Environmental problems with relatively large risks have been controlled or at least substantially reduced ! </li></ul></ul>
  9. 9. History of Environmental Policy <ul><li>Environmental policy is a relatively recent EU policy area. </li></ul><ul><li>The Single European Act (1986) marked the beginning of a more prominent role for environmental protection in EU policy-making: </li></ul><ul><ul><li>- introducing the principal that environmental protection should be considered in all new Community legislation. </li></ul></ul><ul><li>EU environmental policy expanded by the Treaties of Maastricht (1992) and Amsterdam (1997): sustainable development one of EU's central objectives. </li></ul><ul><li>Sustainable development also forms a key part of the Lisbon Strategy (2000): EU policy regarding the single market. </li></ul>
  10. 10. Why EU Environmental Policy? <ul><li>Arguments for </li></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>EU's commitment to environmental protection encourages other countries to adopt similar measures. </li></ul></ul><ul><ul><li>Environmental policy is an area with substantial public support for action at a Europe-wide level. </li></ul></ul><ul><li>Arguments against </li></ul><ul><ul><li>The cost of EU environmental regulation can undermine the competitiveness of EU businesses. </li></ul></ul><ul><ul><li>If maximal environmental emission levels are set too high, firms have little incentive to cut their emissions to meet the EU's wider targets. </li></ul></ul>
  11. 11. Our Common (Sustainable) Future <ul><li>Also known as the ‘Brundtland Report’, from the UN World Commission on Environment and Development, published in 1987. </li></ul><ul><li>An often-quoted definition of sustainable development is defined as: </li></ul><ul><ul><li>Development that meets the needs of the present without compromising the ability of future generations to meet their own needs. </li></ul></ul><ul><li>Leading to the 1992 Earth Summit, the adoption of Agenda 21, the Rio Declaration, and the establishment of the Commission on Sustainable Development </li></ul>
  12. 12. Sustainable Development
  13. 13. Millennium Development Goals (2000) <ul><li>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: </li></ul><ul><ul><li>Ranging from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education; </li></ul></ul><ul><li>Goal 7: </li></ul><ul><ul><li>Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources </li></ul></ul>
  14. 14. Goal 7…
  15. 15. Environmental Policies
  16. 16. Example: Air Quality Legislation <ul><li>Air Quality Framework Directive 96/62/EC: limit values for PM 10 , NO x , SO 2 , O 3 </li></ul><ul><ul><li>Emission ceilings </li></ul></ul><ul><ul><li>Source emission requirements for vehicles and constructions </li></ul></ul><ul><li>New EU Air quality Directive 11 June 2008: </li></ul><ul><ul><li>New PM2,5 legislation: Mean exposure index Concentrations measured at urban background levels </li></ul></ul><ul><ul><li>Enforcement not needed at locations that are restricted to the general public and do not hold permanent occupation </li></ul></ul>
  17. 17. Environmental Health Programmes <ul><li>WHO Europe environment and health process (since 1989 Helsinki) </li></ul><ul><ul><li>Aim: eliminating the most significant environmental threats to health, based on the premise that prevention is better than cure </li></ul></ul><ul><ul><li>Framework: Health for All (since 1977) </li></ul></ul><ul><li>European environment and health strategy (since 2003) </li></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>Framework: Health in All Policy (since 2007) </li></ul></ul>
  18. 18. Health Frameworks <ul><li>WHO Health for All: a process of bringing countries to progressive improvement in the health of all their citizens. </li></ul><ul><ul><li>Equity: everyone has a fair opportunity to attain his or her full health potential ; </li></ul></ul><ul><ul><li>Solidarity: everyone contributes to the health system according to his or her ability </li></ul></ul><ul><li>EU Health in All Policy: </li></ul><ul><ul><li>Important health determinants cannot be influenced by health policy on its own; </li></ul></ul><ul><ul><li>There is a need for co-ordinated actions involving other policy areas such as environmental, social or economic policies. </li></ul></ul>
  19. 19. Focus in Environmental Health Programmes <ul><li>Children’s health </li></ul><ul><ul><li>Children’s Environmental Health Action Plan for Europe </li></ul></ul><ul><ul><li>Priorities: air quality, healthy transport, water&sanitation, chemical safety, healthy housing </li></ul></ul><ul><li>Climate change and health </li></ul><ul><ul><li>Fifth Ministerial Conference </li></ul></ul><ul><ul><li>on Environment and Health </li></ul></ul><ul><ul><li>(Parma 2010) </li></ul></ul>
  20. 20. Sustainable Development
  21. 21. BREAK
  22. 22. Steering Paradigm for Policy Development & Evaluation <ul><li>Decisions, regulatory actions, and legislation </li></ul><ul><li>Risk management analysis </li></ul><ul><ul><ul><li>Regulatory options </li></ul></ul></ul><ul><ul><ul><li>Evaluation of public health, social, and economic consequences </li></ul></ul></ul><ul><ul><ul><li>Target achievement, cost-benefit, health effectiveness, equity, cost-efficiency, scenario’s </li></ul></ul></ul><ul><li>Risk communication </li></ul><ul><ul><ul><li>Data and information exchange </li></ul></ul></ul><ul><ul><ul><li>Stakeholders needs and participation </li></ul></ul></ul><ul><li>Impact and exposure assessment </li></ul><ul><ul><ul><li>Quantifying health impacts, exposures, and link to sources </li></ul></ul></ul><ul><ul><ul><li>Indicators for ‘mortality, morbidity and ( ‘quality of life’) </li></ul></ul></ul>
  23. 23. The cause-effect pathway WHO 2005 CO 2 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
  24. 24. Environmental Health Indicators <ul><li>Environmental Health Indicators are usually numbers that represent and communicate a certain state of the environment, exposure, health state and/ or policy actions. </li></ul><ul><li>Use and purpose of indicators: </li></ul><ul><ul><li>Policy development and priority-setting </li></ul></ul><ul><ul><li>Health impact assessment and monitoring </li></ul></ul><ul><ul><li>Policy implementation or economic consequence assessment </li></ul></ul><ul><ul><li>Public information and awareness raising or risk perception </li></ul></ul>
  25. 25. Indicators to evaluate EU and WHO programmes <ul><li>WHO ENHIS: Environment and Health Information System ( www. enhis .org ) </li></ul><ul><li>EEA (European Environment Agency): Core set of indicators ( http://themes. eea . europa . eu /IMS/CSI ) </li></ul>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
  26. 26. Risk Management Indicators <ul><li>Decision-making based on appraisal of: </li></ul><ul><ul><li>How is the risk quantified? (impact) </li></ul></ul><ul><ul><li>How is the risk perceived? (acceptability) </li></ul></ul><ul><ul><li>Weighing costs and benefits? </li></ul></ul><ul><ul><li>Is it a governmental responsibility? </li></ul></ul><ul><ul><li>Is action feasible with policy? </li></ul></ul><ul><li>PBL/RIVM ‘Weighing and Appraisal’ indicators: </li></ul><ul><ul><li>Policy deficit index </li></ul></ul><ul><ul><li>Burden of disease index </li></ul></ul><ul><ul><li>Economic consequence index </li></ul></ul><ul><ul><li>Risk perception and acceptability index </li></ul></ul>
  27. 27. Examples of policy deficit indicators <ul><li>Distance to emission standards </li></ul><ul><li>Distance to environmental quality standards </li></ul><ul><li>Distance to exposure / intake / body burden standards </li></ul><ul><li>Distance to health risk / disease burden reduction targets </li></ul>
  28. 28. Burden of disease indicator <ul><li>DALY = YLL + YLD </li></ul><ul><ul><li>Y ears of L ost L ife </li></ul></ul><ul><ul><li>(due to mortality) </li></ul></ul><ul><ul><li>Y ears L ived with D isability </li></ul></ul><ul><ul><li>(due to injury & illness) </li></ul></ul>
  29. 29. 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 Blikseminslag Externe Veiligheid Hoogspanningslijnen Grootschalige overstroming Campylobacter (alle gevallen) Woningbranden Bodemverontreiniging Aids Arbeid: ongevalsletsel Radon in woningen Sportblessures Geluid Schiphol Arbeid: blootstelling aan stoffen Verkeersongevallen Afhankelijkheid van alcohol Lichamelijke inactiviteit Geluid wegverkeer Fijn stof Overgewicht Ongezonde voeding Roken DALY's (/jr)
  30. 30. Risks ranked according to YLL
  31. 31. Risks ranked according to costs (€)
  32. 32. Family of impact assessments <ul><li>EC Impact Assessment Guidance </li></ul><ul><li>Methodologies: </li></ul><ul><ul><li>Health Impact Assessment </li></ul></ul><ul><ul><li>Equity Impact Assessment </li></ul></ul><ul><ul><li>Environmental Impact Assessment </li></ul></ul><ul><ul><li>Ensures that environmental consequences of projects are identified and assessed before authorisation is given. </li></ul></ul><ul><ul><li>Strategic Environmental Assessment </li></ul></ul><ul><ul><li>Key tool for sustainable development. </li></ul></ul><ul><ul><li>Integrated Assessment </li></ul></ul><ul><ul><li>Cross-sectoral policy assessment (multi-hazard, multi-effect) </li></ul></ul><ul><ul><li>Example : climate-proof & sustainable cities </li></ul></ul>
  33. 33. Assessment framework (INTARESE) Issue framing Design Execution Reporting Initial- isation Scoping Complexification Prioritisation & screening (simplification) Alternatives Indicator selection Definition of scenarios Quality criteria Methods & models Data sources Assessment protocols Data collection Expert elicitation Modelling & estimation Uncertainty analysis Testing & validation Evaluation Interpretation Communication with users & stakeholders Documentation & presentation Stakeholders Policy-makers Industry Scientists Media Public Generators Purveyors Assessors Regulators Victims
  34. 34. Example: Integrated Assessment in Practice Source :
  35. 35. New Developments in EH Risk Policy <ul><li>Putting integrated assessment in practice </li></ul><ul><li>Appraisal of risks from wider perspective </li></ul><ul><li>Stakeholder involvement? </li></ul><ul><li>Dealing with uncertainty and controversy on risks? </li></ul><ul><li>The precautionary principle? </li></ul>
  36. 36. Environmental health risk as technical construct <ul><li>Dictionary: (bad) chance for injury, damage, or loss </li></ul><ul><li>Dutch Health Council 1995: possibility, with a certain probability, of damage to human health, in combination with nature and extent of damage </li></ul><ul><li>Risks are objective and can be univocally measured or assessed from cause-effect pathways </li></ul>
  37. 37. Environmental health risk as societal construct <ul><li>Risks are societal perceptions of danger, damage, injury </li></ul><ul><li>Risks are value-loaded: the acceptability of a risk depends on the context and individual perspective </li></ul><ul><ul><li>Voluntary vs. Involuntary </li></ul></ul><ul><ul><li>Controllable vs. Uncontrollable </li></ul></ul><ul><ul><li>Direct & short-term effect vs. Indirect &long-term effect </li></ul></ul><ul><ul><li>Observable vs. Not observable </li></ul></ul>