Health and the environment in the WHO European Region:

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Situation and policy at the beginning of the 21st century

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World Health Organization

2004

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Table of contents

Foreword 1

PART 1: THE ENVIRONMENTAL HEALTH SITUATION IN THE EUROPEAN REGION 3

1.1. Health and the environment3

1.1.1. Human vulnerability to environmental factors .4

1.1.2. Uncertainties 5

1.1.3. Environmental determinants of health 6

1.2. Health Status in the European Region 7

1.2.1. Environmental burden of disease9

1.2.2. Causes of mortality .17

1.3. Environmental Risks and Their Health Effects 22

1.3.1. Ambient air 22

Particulate matter24

Sulphur Dioxide.29

Ozone.30

Carbon monoxide 33

Nitrogen oxides34

Heavy metals .35

Other pollutants.37

Air pollution – general situation38

Health effects of air pollution40

1.3.2. Indoor air41

1.3.3. Housing and health43

1.3.4. Water and health .45

Drinking water 45

Recreational water 50

Water – general situation 51

Health effects of water contamination51

1.3.5. Food .54

Microbiological contamination and incidence of foodborne diseases .55

Chemical contamination58

Inadequate nutrition 59

1.3.6. Working environment .60

Occupational risks.61

Health effects of working conditions 63

Hazardous child labour.67

Workplace health protection 68

1.3.7. Hazardous waste and landfills.69

1.3.8. Traffic and transport73

1.3.9. Injuries .75

1.3.10. Physical factors .77

Noise77

Ionizing radiation 79

Electromagnetic fields .80

Ultraviolet light .81

1.3.11. Climate change.82

Heat waves 84

Vector and rodent borne diseases.85

Water and food borne diseases87

Floods and rises in sea levels .87

1.3.12. Chemicals.88

Endocrine disruptors .88

Persistent organic pollutants.89

1.4. Children’s health and the environment 90

1.4.1. Environmental risks for children.92

1.4.2. Effects of environmental risks on children’s health95

Asthma, allergies and respiratory health .95

Neurodevelopment disorders.97

Cancer .97

Birth defects.99

Waterborne diseases99

Food borne diseases 100

Injuries.100

UV radiation101

Electromagnetic fields .101

Ionising radiation 102

Child labour 102

1.5. Risk Perception and Behaviour 102

1.5.1. Risk perception .102

1.5.2. Perception of environmental risks in the European Union .103

1.5.3. Risk perceptions in the Balkans and the CIS 108

1.6. Conclusions 109

PART 2: ENVIRONMENTAL HEALTH IN THE COMMONWEALTH OF INDEPENDENT STATES

112

2.1. Environmental health policy 113

2.1.1. Environmental health planning .114

2.1.2. Other national programmes and plans.114

2.1.3. Legislation and standards115

2.2. Environmental risks and their health effects 115

2.2.1. Ambient air 116

2.2.2. Indoor air120

2.2.3. Drinking water 121

2.2.4. Soil, hazardous wastes and pesticides.126

2.2.5. Physical factors .128

Noise128

Ionizing radiation 128

2.2.6. Food safety and nutrition 129

2.2.7. Occupational health.132

2.2.8. Chemicals.135

2.2.9. Specific health effects .135

Cancer .135

Allergies.136

Congenital anomalies136

Low birth weight136

Reproductive health.137

2.3. Children’s health and the environment 137

2.3.1. Environmental risks 138

2.3.2. Deficiency states .139

2.3.3. Living and school conditions of children139

2.3.4. Hazardous child labour .140

2.4. Social inequalities in health and the environment 141

2.4.1. Gender141

2.4.2. Poverty .142

2.4.3. Indigenous people .144

2.5. Environmental health problems during the socio-economic transition 145

2.6. Conclusions 147

PART 3: THE ENVIRONMENT AND HEALTH PROCESS IN EUROPE: EVALUATION 150

3.1. National Processes 152

3.1.1. Methodology152

3.1.2. Results154

NEHAP planning process154

NEHAP implementation phase .155

Impact of the NEHAP in the country 157

Effects of international efforts 162

3.1.3. Conclusions166

Analytical approaches .166

Findings.167

3.2. Full-Scale Evaluation of the Environment and Health Process in Europe 168

3.2.1. Methodology168

3.2.2. Results171

Overall Environmental Health Problems and Quality of Environment171

European Charter on Environment and Health, Frankfurt, 1989 171

Environment and Health Action Plan for Europe, Helsinki 1994 175

Charter on Transport Environment and Health, London 1999 176

Protocol on Water and Health, London 1999.177

Children’s Environment and Health Action Plan for Europe, Budapest 2004.178

Environment and Health Information, Budapest 2004.181

Overall Evaluation of the Impact of International Processes.183

3.2.3. Conclusions..184

STATISTICAL ANNEX 187

References 194