This document discusses the implications of the Minamata Convention for oral health in resource-constrained settings from WHO's perspective. It provides context on mercury as a toxic heavy metal used widely in industry and healthcare. In healthcare, mercury is used in dental amalgam, thermometers, and other devices. The convention aims to phase down dental amalgam use through promoting prevention, alternatives, training, and sound waste management. It highlights interventions like the UNEP Global Mercury Partnership and East Africa Dental Amalgam Phase-Down Project to support implementation. The convention is seen as an opportunity for oral health to promote prevention, alternatives, multisectoral partnerships, capacity building, and responsible environmental practices.

1. EXECUTIVE BOARD
130th session
Geneva, 16-23 January 2012
TECHNICAL BRIEFING
Implementing the Political Declaration on NCDs:
Commitments of Member States and WHO
What does Minamata mean for the oral health
community in a resource-constrained setting?
WHO’s views and perspectives from the African region
Dr Benoit Varenne, DDS, MPH, PhD
Regional Adviser, Oral Health
Non Communicable Diseases Cluster
WHO Regional Office for Africa

2. 2 |
1. Context of the Minamata Convention
development and coming into force
2. Current and future interventions
3. The Minamata Convention - an opportunity for
oral health
Presentation outline

3. 3 |
=> Mercury can only
be eliminated by
reducing its use
through introduction
of alternatives
Global context - Mercury
 Mercury is a highly toxic heavy metal
 Mercury is one of the ten chemicals
of major public health concern
 Mercury is a natural element that
cannot be created or destroyed
 Most mercury comes from human
activities & heavy industry
 Excess mercury supply should be
stored
(Source: UNEP & WHO)

4. 4 |
Global context - Mercury in Healthcare Facilities
 Thermometer
 blood pressure devices
 Fluorescent Lamps
 Dental amalgam
 Batteries
 pharmaceuticals and
vaccines

5. 5 |
 A significant
amount of mercury
is released from
the use of dental
amalgam into the
environment
 Low awareness of
both oral health
community, policy
makers and
population at large
African Context - Dental Amalgam
 A majority of restorations are made in
Amalgam
 The use of capsulated amalgam is increasing
but mercury liquid & alloy mixing devices are
still used
 Designated containers for waste dental
amalgam & amalgam separators are rare
 Unsound waste management practices mixing
its hazardous wastes with general wastes
 Lack of data, legislations and policy
 Suppliers of amalgam to Africa: China, US,
Australia, Turkey, Iran, Europe & India
(Source: East Africa Dental Amalgam Phase down project)

6. 6 |
Global Context - Global Mercury Consumption by Sector
__________________________________________________________
Global mercury demand (metric tonnes) 2015
___________________
Small-scale/artisanal gold mining 650-1,000
Vinyl chloride monomer (VCM) production 1,250
Chlor-alkali production 315-385
Batteries 130-178
Dental use 270-360
Measuring and control devices 165-193
Lighting 108-135
Electrical and electronic devices 102-126
Other (paints, laboratory, pharmaceutical, etc.) 170-357 ___
Total 2,160-3,984
(Source: UNEP. Mercury-containing products partnership area business plan, 2013)
1/3

7. 7 |
Highlights of the Minamata Convention
 The MC provides controls and reductions across a
range of products, processes and industries
 The treaty also addresses the direct mining of
mercury, export and import of the metal and safe
storage of waste
 A range of mercury products will be banned by 2020
 Certain types of non-electronic medical devices are
also included for phase-out by 2020
 Exceptions for some large measuring devices where
currently there are no mercury-free- alternatives
 Vaccines have been excluded from the treaty
 The MC calls for a phase down of dental fillings using
mercury amalgam

8. 8 |
128 signatures - 30 ratifications
China is the 30th country to have ratified. Twelve African countries.
The Convention comes into force 90 days after ratification by 50 countries
Who have signed & ratified the Convention?
http://www.mercuryconvention.org/Home/tabid/3360/Default.aspx

9. 9 |
…to phase down the use of dental amalgam shall include two or more
of the measures from the following list:
Highlights of the Convention
Measures to be taken by a Party…
i. Setting national objectives aiming at dental caries prevention & health
promotion
ii. Setting national objectives aiming at minimizing its use
iii. Promoting the use of cost-effective and clinically effective mercury-free
alternatives
iv. Promoting research & development of quality mercury-free materials
v. Encouraging professional organizations and dental schools to educate &
train dental professionals and students on the use of mercury-free dental
restoration alternatives & on promoting best management practices
vi. Discouraging insurance policies, & programmes that favor dental amalgam
use
vii. Encouraging insurance policies & programmes that favor the use of quality
alternatives to dental amalgam
viii. Restricting the use of dental amalgam to its encapsulated form
ix. Promoting the use of best environmental practices in dental facilities

10. 10 |
Interventions - The UNEP Global Mercury Partnership
 The UNEP Global Mercury
Partnership works closely with
stakeholders to assist in ratification
and effective implementation of the
Minamata Convention on Mercury
 Goal: to protect human health and
the environment from the release of
mercury and its compounds to the
environment
 It is a voluntary multi-stakeholder
partnership

11. 11 |
Interventions - The UNEP Global Mercury Partnership
• The 8 work areas of
the Partnership have
business plans setting
out objectives, targets
and priorities for
action
• Initial funding has
been pledged by
Japan, Norway and
Switzerland
• Support for countries
is also provided by the
Global Environment
Facility (GEF)

12. 12 |
Interventions - EADP, East Africa Dental Amalgam
Phase-Down Project, Phase I (2012-15)
 WHO and UNEP initiated demonstration projects to phase
down dental amalgam in partnership with FDI and IDM
 Focused on 3 countries: Kenya, Tanzania and Uganda
 Aims: to demonstrate the phase-down approach of dental
amalgam use in low-income countries
 Priority areas and outcomes :
 Strengthen oral health promotion and disease prevention
 Environmentally sound management of waste in dental clinics
 Promotion of measures to reduce releases during trade and supply as
well as from dental clinics
 Strengthen the awareness of the general public to dental amalgam
alternatives
 Training dental professionals

13. 13 |
Interventions - EADP Phase II
 The project has shown that dental
amalgam phase down is applicable in
LMICs
 The successes and gains of Phase I
resulted in an extension to a 2nd phase
 “Phase down of Dental Amalgam
through an Environmentally Sound
Lifecycle Approach and multi-sectoral
action in Ethiopia, Kenya, Tanzania,
Uganda and Zambia”

14. 14 |
1. Context of the Minamata Convention
development and coming into force
2. Current and future interventions
3. The Minamata Convention - an
opportunity for oral health
Presentation outline

15. Supporting the
inclusion of oral
health-care
interventions in
third-party payment
schemes as a means
of achieving UHC &
contributing to SDGs
Encouraging oral
health community
working through
multisectoral
approach &
partnership beyond
the health sector
Building capacities of
oral health
professionals on oral
health promotion
and disease
prevention
Promoting research
of quality,
affordable, safe, and
environmentally
friendly alternatives
to dental amalgam
Why the Minamata Convention should be considered as an
opportunity for the oral health community ?
1
Creating
awareness of the
environmental risks
in health care
facilities & promoting
responsible
environmental
stewardship
Promoting
preventive
interventions at PHC
level, in school
settings and toward
communities to
increase control over
their health
2 3
456

16. 16 |
varenneb@who.int
Dziękuję! Thank You!