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Water and Health in Europe. a Joint Report from the European 7!4%2 !.$ (%!,4( ). %52/0% !JOINTREPORTFROM THE%UROPEAN %NVIRONMENT!GENCY ANDTHE7(/2EGIONAL 7!4%2 /FlCEFOR%UROPE !.$ (%!,4( ). 7(/2EGIONAL0UBLICATIONS %UROPEAN3ERIES .O %52/0% The World Health Organization was established in 1948 as a specialized agency of the United Nations serving as the directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health, a responsibility that it fulfils in part through its publications programmes. Through its publications, the Organi- zation seeks to support national health strategies and address the most pressing public health concerns. 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 problems of the countries it serves. The European Region embraces some 870 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of the Russian Federation. The European programme of WHO therefore concentrates both on the problems associated with industrial and post-industrial society and on those faced by the emerging democracies of central and eastern Europe and the former USSR. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad international distribution of its publications and encourages their translation and adaptation. By helping to promote and protect health and prevent and control disease, WHO’s books contribute to achieving the Organization’s principal objective – the attainment by all people of the highest possible level of health. The European Environment Agency is one of 12 specialized EU agencies located in the various member states. EEA and the related European Environmental Information and Observation Network (EIONET) were conceived to deliver improved data on the environment and to contribute to the availability of better information for environmental policy-making. EEA and EIONET were set up on the basis of EC Regulation 1210/ 90, adopted in May 1990 and revised in 1999. EIONET includes five European Topic Centres covering water, air and climate change, waste and material flows, terrestrial environment, and nature protection and biodiversity. Where necessary, EEA buys in expertise for projects from all over Europe. According to its mission statement, “the Agency aims to support sustainable development and to help achieve significant and measurable improvement in Europe’s environment through the provision of timely, targeted, relevant and reliable information to policy- making agents and the public”. This must be done using existing data and information, building on and improving existing capacities in member states and European institutions. No matter how thoroughly data are logged and amassed, they cannot be useful until selected, pooled and organized with known end-users in mind. The EEA acts as an interface between data producers and information users by producing information that can then be put to work. The geographical scope of the EEA’s work is not confined to the EU member states. Most of the EFTA countries were members from the outset, and as of May 2002 most of the accession countries have joined the EEA as full members, making the agency the first EU body to include these countries. Enlargement will increase the number of EEA member countries from 18 to 31. The Agency also maintains close cooperation with international organizations such as UNEP and WHO. Water and health in Europe A joint report from the European Environment Agency and the WHO Regional Office for Europe WHO Library Cataloguing in Publication Data Water and health in Europe : a joint report from the European Environment Agency and the WHO Regional Office for Europe / edited by Jamie Bartram...[et al.] (WHO regional publications. European series ; No. 93) 1.Water supply 2.Potable water 3.Water quality 4.Water purification 5.Water microbiology 6.Water pollution, Chemical 7.Legislation 8.Europe I.Series II.Bartram, Jamie III.Thyssen, Niels IV.Gowers, Alison V.Pond, Kathy VI.Lack, Tim ISBN 92 890 1360 5 (NLM Classification: WA 675) ISSN 0378-2255 Text editing: David Breuer/Frank Theakston Cover design: Sven Lund Cover illustration: Patricija Kavaliauskaite, 5 years old, Kindergarten “Zilvitis”, Jonava, Lithuania. This school participates in the European Network of Health Promoting Schools, a joint project of the European Commission, the Council of Europe and the WHO Regional Office for Europe. Water and health in Europe A joint report from the European Environment Agency and the WHO Regional Office for Europe Edited by Jamie Bartram, Niels Thyssen, Alison Gowers, Kathy Pond and Tim Lack WHO Regional Publications European Series, No. 93 ISBN 92 890 1360 5 ISSN 0378-2255 The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its pub- lications, in part or in full. Applications and enquiries should be addressed to the Publications unit, WHO Regional Office for Eu- rope, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations al- ready available. © World Health Organization 2002 Publications of the World Health Organization enjoy copyright pro- tection in accordance with the provisions of Protocol 2 of the Uni- versal Copyright Convention. All rights reserved. The designations employed and the presentation of the material, in- cluding any maps, in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization or of the European Environment Agency con- cerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or bounda- ries. Dotted lines in maps represent approximate border lines for which there may not be full agreement. The names of countries or areas used in this publication are those that obtained at the time the original language edition of the book was prepared. The mention of specific companies or of certain manufacturers’ prod- ucts does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar na- ture that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The views expressed in this publication are those of the authors/ contributors and do not necessarily represent the decisions or the stated policy of the World Health Organization or the European En- vironment Agency. PRINTED IN FINLAND Contents Page Foreword ........................................................................................... vii Executive summary .......................................................................... xi Data collection ...............................................................................xvii Acknowledgements ........................................................................xix 1. Introduction ................................................................................... 1 2. European water resources ............................................................ 7 3. Driving forces and pressures on water resources .................... 47 4. Access to safe water ................................................................... 75 5. Health effects ............................................................................103 6. Present policies .........................................................................161 7. International, administrative and legal initiatives ..................187 References ......................................................................................205 Foreword Profound pressures on Europe’s water resources affect health, the economy and sustainable development. Industrialization, intensifi- cation of agriculture, growing populations and increases in recrea- tional demands accentuate the necessity for sufficient high-quality water resources. Conflicts between uses and users, coupled with the occurrence of natural disasters such as droughts and floods, high- light the need for sustainable management of water. Universal access to safe drinking-water and sanitation that protect human health and the environment is of primary concern in the pursuit of health and develop- ment. Nevertheless, water-related diseases occur throughout Europe, to which rural populations, socially excluded people and populations in areas affected by armed hostilities are especially vulnerable. Although some aspects of water quality and supply have improved in some countries over the last decade, progress has been variable. Renewed emphasis is being placed on microbial quality and the ac- knowledgement of previously unrecognized and re-emerging microbial and other hazards. Many of the suggested solutions are as applicable today as they were a decade ago. However, major changes in adminis- trative arrangements affected many countries in Europe in the 1990s, including the supply of water and sanitation services, land-use activi- ties, pollution control and activities related to public health surveillance. WHO’S current health for all policy framework for the European Region is based on solidarity and a multisectoral
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