Environment and Health

Environment and health

– An international concordance on selected concepts

ABSTRACT

This publication presents the results of the first stage of a project to harmonize selected terms in environment and health. Based on the work of a group of experts supported by a much larger scientific community, it presents a common understanding of 73 selected terms which have been found to be open to misunderstanding within the international community.

KEYWORDS

ENVIRONMENTAL HEALTH - terminology INTERNATIONAL COOPERATION

ISBN 92-890-2286-8

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The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization.

Contents

Page

Acknowledgements …………………………………………………………….. i

Executive summary ……………………………………………………………. iii

1. Introduction ……………………………………………………………….. 1 1.1 Background ……………………………………………………………. 1 1.2 Purpose and objectives ………………………………………………… 2 1.3 Target users ……………………………………………………………. 2

2. Methodology ………………………………………………………………... 3 2.1 General …………………………………………………………………. 3 2.2 Process …………………………………………………………………. 4

3. International concordance on selected concepts ……………………….... 7 3.1 Conceptual framework for consensus definitions ……………………… 7 3.2 Concordance of selected terms ………………………………………… 7

References ……………………………………………………………………… 17

Bibliography ……………………………………………………………………. 19

Annex 1 Concordance Steering Committee …………………………………. 25 Annex 2 International Environmental Health Reference Group (IEHRG) .. 27 Annex 3 Terms not selected for concordance by the Steering Committee … 39

Acknowledgements

This concordance was made possible thanks to the dedicated work and unfailing support of the international panel of experts, who generously shared their experience and provided analytical insight into the current use of terms on environment and health.

Special thanks are due to Dr Dinko Kello, who initiated and oversaw the project while at the WHO Regional Office for Europe, and to Dr Elena Tschishowa, who coordinated the work while at the WHO collaborating centre for information and communication on environmental health at the Robert Koch Institute, Berlin, Germany.

Thanks are also due to the German Federal Institute for Health Protection of Consumers and Veterinary Medicine, Berlin, for providing professional software for preparing the initial questionnaire for the survey.

The project was financially supported by the Government of Germany and carried out by the WHO collaborating centre for information and communication on environmental health at the Robert Koch Institute.

i ii Executive summary

Environmental health is a relatively new and a multidisciplinary field. People active in the field come from widely varying backgrounds, each with its own opinions and traditions on the meaning and use of certain terms. Interaction and international cooperation, both across the boundaries of traditional scientific domains and in a multilingual, multicultural environment, have highlighted the need to clarify the scope and nuances of key terms in the field in order to avoid misunderstandings and confusion in communication. To address this need, a project on the harmonization of selected terms in environment and health was launched in 1998 by the Environment and Health Department at the WHO Regional Office for Europe.

This document is the outcome of the first stage of the project; it presents a common understanding of 73 selected terms which, though used internationally in the environment and health field, have at times been found to be open to misunderstanding within the international community. As a document it is special in design and intent. It is neither a concordance or vocabulary in the usual sense nor, strictly speaking, a terminology. The starting point was the identification, by a group of experts in the field, of situations of poor communication or misunderstanding that were attributable to differences in the use of terms. A consensus or concordance was then developed, within a much larger scientific community, on the common semantic features of the problem terms. Most importantly, it goes from the meaning (or concept) to the term rather than from the term to the meaning. Once a consensus can be reached on the actual meaning and boundaries of a concept, it can be embodied in a definition. A designated term may then be attached to each definition, for practical purposes.

The compilation of consensus definitions presented in this document (herein called a concordance) is essentially descriptive of what is consensually understood under each term in international English, as the meta-language of international communication. Consequently, concordance definitions can be rewritten in a variety of styles and adapted to suit speakers in a particular community or target audience. As descriptive statements, they can also be worded in different ways in different languages, to become the basis for selecting appropriate equivalents in other languages.

The concordance represents what the educated reader in the target community will understand when the corresponding term is used. Therefore, disagreement with the concordance definition should be an incentive for individual experts to clarify comparatively and explicitly to what extent their interpretations of the concepts differ from the common understanding in the community.

Practical constraints led the Concordance Steering Committee to organize the exercise in a stepwise manner. It was decided to limit the project development, in the first instance, to a consideration of some 50 selected terms that were perceived as creating problems during translation of documentation for the Third Ministerial Conference on Environment and Health, held in London in 1999. Work was initiated in early 1999 under the management of the WHO collaborating centre for information and communication on environmental health at the Robert Koch Institute, Berlin, Germany. The concordance itself is the outcome of analytical and editorial work conducted at the Medical Research Council Institute for Environment and Health, Leicester, United Kingdom, on the basis of:

(a) a compilation (undertaken at the German Federal Institute for Health Protection of Consumers and Veterinary Medicine (BgVV) in Berlin) of a list of selected terms with definitions collected from recognized reference sources; and iii (b) expert opinions collected from peer-selected specialists.

The international concordance, as presented here, is the beginning of a continuing process. It is intended to serve as a basis for the development of further terms in the future; the principles that have guided the work so far can be followed in the preparation of versions in other working languages. In proceeding from the meaning to the term, the concordance should be seen as something that can evolve over time to reflect shifts in the consensual meaning of terms. Comments and suggestions for improvement are welcome.

iv 1. Introduction

1.1 Background

In recent years, issues related to environment and health have increasingly attracted public attention because of emerging problems and intensified coverage in the media. As a relatively new field of investigation, boosted by unprecedented advances in science and technology and the sudden awareness of the global nature of the problems to be addressed, the discipline of environmental health has gradually absorbed contributions from a variety of other related disciplines. In doing so it has had to contend with many “language cultures”, whose legitimacy derives from their own individual frameworks and histories. However, as environmental health has developed as a discipline it has gradually produced an integrated corpus of knowledge that is more than the sum of the materials contributed by the individual disciplines.

A conceptual framework in constant evolution has thus given rise to new concepts, which, for the most part, have been described by “old” terms. Owing to a lack of consolidated references to the use of terms, changes in nuance or emphasis in the use of such terms have occasionally been misunderstood or simply gone unnoticed both by the expert community and by the general public. Attempts to remedy the situation have mostly been made on an ad hoc basis, resulting in glossaries and other terminology lists of limited scope. While some of these were intended for one-off use, others have reflected essentially the official views of the issuing institution. In areas where dynamics are so strong, stakes occasionally so high and political impact often so serious, attempts at compromise and consensus-building tend not to be well received.

Nonetheless, international cooperation is going ahead and, in order to resolve this clearly recognized problem and prevent further confusion, the Second European Conference on Environment and Health, held in Helsinki in 1994, made a strong recommendation that the World Health Organization Regional Office for Europe should develop a concordance of key environmental health terms in the four working languages of WHO in the European Region. This decision was supported by various WHO technical expert committees. The lack of an internationally agreed terminology was particularly noted during the process of developing national environmental health action plans (NEHAPs); problems arose in translating the relevant WHO guidelines, which had originally been produced in English. Since each NEHAP is an interdisciplinary exercise involving different government sectors and a variety of actors, difficulties in communication between different sectors and professionals were major problems.

The work undertaken was noted at the Third Ministerial Conference on Environment and Health, held in London in June 1999. Ministers of health and of the environment welcomed the work initiated by WHO on a concordance of key environmental health terms, as well as its use and further development into other languages. On the basis of this support, it was decided to prepare an international concordance of definitions of selected terms on environmental health (in English), which would subsequently serve as a basis for the preparation of versions of the concordance in other languages.

The international concordance presented here was developed in close collaboration with the WHO Global Programme on Evidence for Health Policy, and its development benefited from experience gained in the International Programme on Chemical Safety/Organisation for Economic Co-operation and Development (IPCS/OECD) Joint Project on the Harmonization 1 of Chemical Hazard/Risk Assessment Terminology, conducted under the aegis of the Inter- Organization Programme for the Sound Management of Chemicals (IOMC).

1.2 Purpose and objectives

The purpose of the concordance is to present broadly accepted (i.e. concordant) definitions for selected environmental health concepts, and to identify the best terms in various languages to convey the meaning spelled out in the definitions in order to improve accuracy and ease of communication among the various parties involved.

Agreeing on the content of the definitions does not mean that there should be one single correct wording for each of them. Specific wordings accepted by the specific domains (or disciplines) that use them will sound familiar and facilitate intra-domain communication; nevertheless, there should be no doubt as to which semantic features are essential parts of the concordant definition for use at international level, and which of them cannot be assumed to be understood by a large community of users in an international audience. Reaching explicit agreement on the largest possible set of semantic features will make it possible to establish unambiguous working definitions for use in WHO projects and communication.

The main objective of this project has been to develop an international concordance on definitions of selected terms on environment and health (in English), which will serve as a basis for subsequent preparation of other language versions of the concordance, starting with the three other official languages of the WHO European Region (French, German and Russian). From this perspective, ministers have recommended that, in the framework of implementation of NEHAPs, each country should develop its own national glossary of terms in environmental health, based on the concordance definitions. Although the concordance was initially developed to help give effect to the London Conference decisions, it will also facilitate better communication on environment and health in general. The concordance could also serve as a starting point for the preparation of a more ambitious global glossary on environment and health terms.

1.3 Target users

Target groups of users of the concordance are health and environment professionals and political actors at all levels. The concordance may be also used as a basis for preparing other material primarily aimed at public information and health education.

2 2. Methodology

2.1 General

This project was carried out following a standard terminological method (1) and drawing on recent experience gained in the joint OECD/WHO Joint Project on the Harmonization of Chemical Hazard/Risk Assessment Terminology (2). Similar exercises had been conducted previously (3,4). In designing the project, a number of criteria were established as outlined below.

2.1.1 Focus on problem-solving

While it is generally recognized that an internationally applicable terminology of environment and health is highly desirable, the initial scope of the current project focused on those terms that were perceived as creating communication problems in the context of the 1999 London Conference. It would be useful to expand the concordance in the future.

2.1.2 State-of-the-art awareness

Despite the initial focus on conference-related documentation, deliberate steps were taken to ensure, wherever possible, the widest possible consistency of recommended terminology currently used in the environment and health community. For some terms existing definitions published in recommended sources differed substantially, and the project therefore sought the opinion of leading peer-nominated experts around the world.

2.1.3 Cross-cultural sensitivity and multidisciplinary approach

The direct involvement of representatives from various language communities was considered crucial in ensuring cross-language understanding. Additionally, an attempt was made to ensure a broad representation of subject subfields. The numerous interactions between the various subject fields have resulted in a growing recognition of the importance of both multidisciplinary approaches and the need for a clear understanding of conceptual frameworks.

2.1.4 Conceptual framework

At any point in time, the collection of terms used in a particular area of knowledge may be mapped to indicate the conceptual coverage of the subject field. However, terms thus collected are not used with the same frequency by all members of the group or with quite the same meaning, a trend that is only emphasized as subgroups become identifiable as separate entities. Observed groups of terms and their corresponding meanings turn into indicators of specialized subject subfields in their own right, and occasionally they may develop into well- structured terminologies.

2.1.5 Time limitation

Terminology may be seen as an indicator of both the scope and dynamics of the subject field it serves. Looking at such terminology over time, not only the choice of terms but also their evolution in meaning and importance to the specialist community that uses them may change substantially. It may therefore be necessary to re-evaluate the conceptual framework and the adopted definitions from time to time. 3

2.2 Process

In line with the principles of the adopted methodology, the work was structured in three phases.

1. For the first phase (orientation), the Concordance Steering Committee (see Annex 1) adopted a methodology based on current best practices (1).

2. During the second phase (harmonization), a modified Delphi method was used (5). Building on expert opinions, consensus on the meaning of the terms – and hence on their respective definitions – was sought wherever feasible.

3. The third and final phase (consolidation) produced a concordance of the definitions, somewhat similar to an annotated glossary of terms, which focused on the 1999 London Conference documentation and followed, in format and presentation, international standards as defined by the International Organization for Standardization (ISO) technical committee concerned with terminology (TC 37).

2.2.1 Orientation

Selecting the terms There are several ways to approach the selection of terms, ranging from an exhaustive coverage of the subject to an ad hoc selection for the purpose of a particular paper or publication. While the first method is geared to a long-term effort well beyond the time frame allocated to the present project, the second provides only a narrow insight into the terminology and thus is not suited for harmonization purposes. The aim of the present project is to clarify the meaning of selected terms that are considered to be relevant for multidisciplinary work and often a source of confusion and misunderstanding in international communication. A Terminology Planning Working Group, established under the Joint OECD/IPCS Project on the Harmonization of Chemical Hazard/Risk Assessment Terminology, pointed out the current difficulties and nominated several of its members to work with WHO on the concordance.

Concordance Steering Committee A Concordance Steering Committee (Annex 1) was established, composed of experts from various disciplines and professional backgrounds, including several terminologists, and representing the four working languages of the WHO Regional Office for Europe (English, French, German and Russian). The Committee’s mandate covered the definition and adoption of the project’s rules of procedure, and definition of the criteria and principles that would guide various choices and decisions. Members of the Steering Committee were asked to list the terms they felt required attention. Several rounds of consultation were necessary to reduce a cumulative list of 231 terms down to the about 90 terms and related synonyms that constituted the initial list considered in the project.

Reference database Based on recommendations by the Steering Committee, material on the subject was assembled to build a reference corpus. The reference material (see References and Bibliography) included documents such as glossaries, textbooks, guidelines and orientation papers. All definitions for the terms on the initial list found in any of these reference materials were entered into a reference database. The database, which constituted the starting point for 4 actual project implementation, was prepared at the German Federal Institute for Health Protection of Consumers and Veterinary Medicine (BgVV) in Berlin.

2.2.2 Harmonization

International Environmental Health Reference Group (IEHRG) An international group of experts was established (Annex 2) to advise the Steering Committee on substantive scientific issues. The adopted procedure, inspired by the Delphi method, called for opinions to be sought from the group members by correspondence in order to give more flexibility to respondents and to avoid undue interference by group dynamics. In two rounds of consultations, organized and carried out by the WHO collaborating centre at the Robert Koch Institute, members of the IEHRG were invited to express their preferences for particular definitions or their reservations with respect to other definitions and, if appropriate, to suggest other terms to be included in the process. Provision was made to allow comments as needed. It was felt that the mapping of preferences, adjusted in accordance with comments received, would be useful for guiding subsequent analysis. The resulting terminological product was expected to be both technically valid and widely acceptable as a “snapshot” picture of the terminology on environment and health.

Survey and statistical analysis The analysis of the IEHRG responses from both rounds of consultation was conducted by the Medical Research Council Institute for Environment and Health, Leicester, United Kingdom. In the first round of consultation, IEHRG members were asked to comment on the initial list of about 90 terms and related synonyms. Analysis of these responses led to the provisional adoption by the Steering Committee of definitions for 46 terms, and the generation of a second list of 34 terms for which further advice was sought from the IEHRG. The remaining terms were not considered to be essential for the concordance at that stage and were dropped from further consideration (see Annex 3). In the second round of consultation, the IEHRG was also asked to comment on a structured concordance (comprising the 46 provisionally accepted terms and definitions) developed by the Steering Committee following consideration of the results of the first consultation.

In the first round of consultation, the WHO collaborating centre sent out about 400 questionnaires to experts working in environment and health and related fields; 108 responses were received, of which 71 were in a form that could be numerically analysed. Questionnaires in the second round of consultation were sent to those responding to the first consultation; 90 responses were received, of which 83 could be analysed.

In analysing the responses, two main criteria were adopted:

1. If, for a given key term, one of the offered definitions was accepted in 66% or more of the responses, with or without some proposed modification, that definition was retained for further consideration by the Steering Committee.

2. If, for a given key term, no single definition was accepted in 66% of the responses but a combination of definitions reached such a degree of acceptance, the combination was carried forward for further consideration by the Steering Committee, with the proviso that any single definition thus carried forward must have been accepted in at least 5% of the responses.

5 In addition to the numerical analysis, all textual comments made in all the responses received (whether or not they could be included in the numerical analysis) were collated, including any proposals for new or modified definitions. The results of the analyses and all comments were considered by the Steering Committee in the development of revised definitions for the selected terms.

In considering the selected terms and preferred definitions, the Steering Committee developed a conceptual framework through which related terms could be grouped in “clusters”. Terms function in clusters in a meaningful manner. If the constitutive semantic features of a definition of a term and their relationships are clearly and explicitly spelled out, then using the conceptual framework enables communication about the concepts to become much clearer and unambiguous. This clarity, combined with proper communication about the conceptual framework, should facilitate subsequent preparation of the concordance in other languages and help avoid the frequent difficulty arising from translating terms first then trying to make the definitions fit.

2.2.3 Consolidation

Once the Steering Committee was satisfied that harmonization had been reached on an appropriate number and choice of terms, a third round of consultation with the IEHRG was conducted by the WHO collaborating centre at the Robert Koch Institute, through which members were asked to adopt a compilation of selected concepts (or terms) and consensus definitions. The compilation is presented in section 3. An alphabetical list of other terms considered by the Steering Committee for which no consensus could be reached on definitions is given in Annex 3.

Following the support given at the 1999 London Conference, the English language version of the international concordance presented herein should serve as the basis for the development of concordances on selected environment and health concepts in other languages. Individual language task forces have the responsibility (a) to develop appropriate translations of the definitions of selected concepts given in this English language version and then (b) to determine the best term to describe, in the target language, the definition of the concept.

6 3. International concordance on selected concepts

Within the context of this concordance on selected environment and health concepts, “health” is taken, as described in the WHO Constitution, to mean “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”; “environment” is taken, in accordance with the WHO European health for all targets, to refer to the total environment, both outdoor and indoor (home, occupational and any other), including water, air, food and soil. The consensus definitions developed under the conceptual framework presented herein follow the understanding of “environment” and “health” as underlying the ministerial environment and health conferences held in Helsinki (1994), London (1999) and Budapest (2004).

3.1 Conceptual framework for consensus definitions

The conceptual framework for consensus definitions is shown in Fig. 1. Each of the selected terms or concepts was assigned to one (or more) of the main headings (or clusters); within each main heading, smaller clusters of terms may also occur (Fig. 2).

3.2 Concordance of selected terms

For ease of use, the concordance is arranged alphabetically. Nonetheless, it should be borne in mind that the underlying conceptual framework as described above is essential both for understanding how the various terms relate to each other and for producing subsequent versions of the concordance in languages other than English.

Definitions that are unattributed were developed by the Steering Committee as described in section 2. Where a source is attributed, the definition is normally given as found in that source. Where slight modifications to an attributed definition were made by the Steering Committee, the attribution is given as being “after” the source. acceptable daily intake The maximum amount of a substance to which persons may be exposed daily over their lifetime without appreciable health risk (after Lewalle (2)). acceptable risk Level of risk such that the benefits derived by an organism, a population or an ecological system are perceived to outweigh the adverse effects that might affect them as a result of being administered or exposed to a particular agent. See also acceptable daily intake. adverse effect Change in morphology, physiology, growth, development or life span of an organism, a population or an ecological system that results in an impairment of functional capacity, an impairment of the capacity to compensate for additional stress, or an increase in susceptibility to other environmental influences (after Lewalle (2)). compliance Conformance with a desire, demand, proposal or coercion, for example as set out in voluntary agreements, medical treatment regimens, codes of practice or official, legislative or regulatory requirements.

7 Fig. 3.1 ConceptualFig.1. Conceptual framework for framework consensus definitions. for consensus definitions

PRINCIPLES

EQUITY ENVIRONMENTAL INTERSECTOR-ALITY POLLUTER PRECAUTIONARY SUBSIDIARITY EQUITY PAYS PRINCIPLE PRINCIPLE DEVOLUTION SUSTAINABILITY EQUITY IN HEALTH

POLICY INSTRUMENT 8

LEGAL AND ASSESSMENT ADMINISTRATIVE ECONOMIC AND MANAGEMENT

IMPLEMENTATION

GOOD SCIENTIFIC PRACTICE AND TECHNICAL

Fig. 2 Structure of concordance, with clusters of terms within main headings indicated in bold italics

Environment and health ecology environmental medicine environmental health public health environmental hygiene

PRINCIPLES

Equity Environmental equity Intersectorality Polluter pays principle Precautionary principles Subsidarity Devolution Sustainability Equity in health

Policy instrument

Legal and Administrative Economic Assessment and Management dose-response relationship hazard standard economic instrument environmental risk externality assessment/environmental impact acceptable risk internalization assessment risk analysis evidence risk assessment evidence-based medicine exposure assessment sufficient evidence risk management weight evidence risk communication uncertainty

Implementation enforcement sector public participatory technique 9 environmental auditing stakeholder vulnerable group inequity in health environmental health professional surveillance intervention environmental health service health surveillance monitoring public information sustainable development compliance public participation

Good practice Scientific and technical good agricultural practice acceptable daily intake good laboratory practice and adverse effect good laboratory principles epidemiology good manufacturing practice principles environmental epidemiology good practice in the use of veterinary drugs occupational epidemiology environmental monitoring guidelines evidence-based medicine life-cycle of a product exposure environmental exposure quality assurance exposure level quality control exposure assessment quality management health surveillance

devolution The principle of transfer of rights, powers or responsibility from one authority to another. dose–response relationship Link between the amount of an agent absorbed by a population and the change developed in that population in reaction to it (Lewalle (2)). Note: It may be expressed as the magnitude of an effect in one organism (or part of an organism), in which case it is more specifically called “dose–effect relationship”. It may also be expressed as the proportion of a population exposed to the agent that shows a specific reaction. ecology The interrelationships between organisms and between organisms and their environment; the study of such interrelationships. economic instrument A measure taken by governments, agencies or managers to alter the operation of the market, involving the stimulation or suppression of demand or supply of goods and services, often by the manipulation of prices (after Roberts (6)). Note: Taxes, subsidies, prices for licences and incentive payments are common examples. enforcement Legal action taken by competent government, national or local authorities or their executive or legal branches to obtain compliance with, or to ensure operation or observance of, laws, rules, regulations, orders, contracts or agreements and/or to obtain penalties or criminal sanctions for violations. Note: Enforcement procedures may vary depending on the requirements of different laws and regulations having an impact on environment and health. environment and health A conceptual domain covering the interrelationship between human health and the environment, linking improvement of human health, now and in future generations, to the protection, restoration and improvement of environmental quality. environmental assessment/environmental impact assessment The process of evaluating the possible environmental consequences of a past, current or proposed action, development project or piece of legislation, as an aid to decision-making, that may result in the production of an environmental impact statement. It also attempts to evaluate the measures to be taken to minimize an adverse effect. Note: Environmental impact assessment is generally used to describe a formal process dealing with specific proposed actions. In some cases an environmental assessment will also include evaluation of the consequences for human health. environmental auditing A management tool, comprising a systematic, independent, documented, periodic and objective evaluation of the current status and performance of an organization, its management system and process requirements, in relation to protection of the environment. Note: Environmental auditing aims to: facilitate management control of practices that may have an impact on the environment, to assess compliance with the organization’s environmental policies, practices and controls and to determine the effectiveness and suitability of such activities. environmental epidemiology The study and interpretation of the relationship between environment and health in a population by applying epidemiological methods. environmental equity The principle of being fair to all with reference to protection from an environmental hazard.

10 Note: This applies to individuals, groups and communities regardless of age, sex, ethnicity or economic status. It includes also the development, implementation and enforcement of environmental laws, regulations and policies, and implies that no population should be forced to shoulder a disproportionate share of the negative environmental impacts of pollution or environmental hazard because of a lack of political or economic strength. environmental exposure Exposure through environmental pathways. environmental health Those aspects of human health and disease that are determined by factors in the environment. It also refers to the theory and practice of assessing and controlling factors in the environment that can potentially affect health. Environmental health includes both the direct pathological effects of chemicals, radiation and some biological agents, and the effects (often indirect) on health and well-being of the broad physical, psychological, social and aesthetic environment, which includes housing, urban development, land use and transport (WHO (7)). environmental health impact assessment The process of estimating or the estimate of the adverse health effects or risk likely to follow from a proposed or expected environmental change or development. environmental health professional A person who has undergone formal training and engaged in evaluating or managing environmental hazard and risk to health, including legislative, administrative and technical measures. environmental health service An organization that implements environmental health policies through monitoring and control activities and engages in health promotion by encouraging the use of environmentally friendly and healthy technologies and behaviour. environmental hygiene Practical prevention and control measures used to improve the basic environmental conditions affecting human health, for example clean water supply, human and animal waste disposal, protection of food from contamination and provision of healthy housing, all of which are concerned with the quality of the human environment (after Duffus (8)). environmental medicine A medical discipline that deals with environmentally related disease. Also used in some contexts as a synonym for environmental health. environmental monitoring Periodic, continuous or repeated observation and measurement of agents in the environment to evaluate environmental exposure and possible damage by comparison with appropriate reference values (after Duffus (8)). epidemiology The study of the distribution and determinants of health-related states or events in populations and the application of this study to the control of health problems (after Last (9)). equity The principle of being fair to all, with reference to a defined and recognized set of values. equity in health The principle of giving to all individuals, groups or communities a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential (after WHO (1)). See also inequity in health. evidence The collection of facts and scientific references for the purpose of identifying and evaluating a phenomenon. evidence-based medicine The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.

11 See also evidence. exposure The process by which an agent becomes available for absorption by a target system, by any given route. exposure assessment Quantitative and qualitative analysis of the presence of an agent (including its derivatives) that may be present in a given environment and the inference of the possible consequences it may have for a target system of particular concern (after Lewalle (2); see Fig. 3). exposure level Concentration, amount or intensity of a particular agent that reaches a target system. It is usually expressed in numerical terms such as substance concentration, duration, frequency and intensity. Note: Often synonymous with exposure; see Lewalle (2). externality A factor, such as social benefit and cost, caused by some parties, that affects the well-being or economic activity of other parties and that is not normally included in primary economic transactions (e.g. in the market price of an economic good) or in the decisions of market players. Note: Mostly used in the plural. good agricultural practice The process of appropriately managing land and using chemicals or other agents in agriculture and ensuring standards of defined quality at all stages. See also good practice. Note: There may be specific applications for the use of specific agents, such as pesticides, herbicides and fertilizers. good laboratory practice/good laboratory principles The process of appropriate organization of laboratory work and ensuring standards of defined quality at all stages. See also good practice. good manufacturing practice principles The process of effective organization of production and ensuring standards of defined quality at all stages of production, distribution and marketing and of the management of waste. See also good practice. good practice In quality assurance, processes that are defined in terms of quality and safety criteria, on the basis of best authoritative expert opinion, as being methods, procedures or measurements that are widely accepted as the best available. Note: Good practice may evolve over time and may serve as a basis for a code of conduct or for the enforcement of regulations by regulatory authorities. good practice in the use of veterinary drugs The process of appropriately using drugs in veterinary practice and ensuring standards of defined quality at all stages. See also good practice. guidelines Descriptions of the steps that should be taken in performing a task or implementing a policy and the manner of doing so, including application of recommended values. Note: Guidelines are frequently built up from reviews of practice. They are more specific and more detailed than guiding principles, on which they are based. They are not prescriptive or enforceable (in the way a standard may be) but are issued to assist managers in devising local means of implementing policy. Guidelines may incorporate recommendations for numerical values for pollutants of concern, such as WHO’s guidelines on air and drinking- water quality.

12 hazard The inherent property of an agent or situation capable of having adverse effects on an organism, population or ecological system, and hence the substance, agent, source of energy or situation having that property (after Lewalle (2)).

13 Fig. 3 Hazard/risk assessment concept system

risk analysis

risk assessment

risk communication

risk management 1 4 risk evaluation risk assessment hazard assessment hazard risk monitoring identification

hazard identification risk characterization emission and exposure control hazard evaluation

dose-response assessment hazard characterization exposure assessment

health surveillance Periodic, continuous or repeated scrutiny of a phenomenon, situation or condition related to health. Note: Health surveillance may include collation and interpretation of data on specific diseases or biological markers of disease collected from periodic medico- physiological monitoring programmes and data from any other available source. One purpose is to detect changes in trends or distribution in order to initiate investigative or control measures. inequity in health The effect of differences in health status that are not only unnecessary and avoidable but, in addition, are considered unfair and unjust (after Abelin (10)). instrument A means by which something is done. internalization Incorporation of an externality into the decision-making process through action such as economic or regulatory intervention. intersectorality The principle of involving, where appropriate or necessary, two or more sectors in addressing specific issues or actions in order to achieve common goals. See also sector. intervention Action taken to prevent, halt, remedy or reduce a process having an adverse effect on the environment or human health. life-cycle of a product All stages of a product’s existence, from extraction or creation/synthesis to production, transport, marketing, use and disposal. Note: Life-cycle analysis (sometimes called cradle-to-grave product analysis) describes the tracking of a product and evaluation of its environmental impact and use of energy and resources through all the above-mentioned stages. monitoring Periodic, continuous or repeated observation and measurement of data for defined purposes, according to prearranged schedules in space and time, using comparable methods for sensing and data collection. occupational epidemiology The study and interpretation of the relationship between the workplace and health by the application of epidemiological methods. polluter pays principle The principle of having the costs of measures to prevent, control and remedy pollution borne by the polluter. Note: First adopted by OECD in 1972 and later by other organizations. precautionary principle The principle whereby the lack of full scientific certainty shall not be used as a reason for postponing cost-effective, proportionate and economically acceptable measures to ensure that all that reasonably can be expected is done to prevent unnecessary risks and prevent environmental degradation or deleterious health effects in present or future generations. Note: The principle is particularly important where there are threats of serious or irreversible damage. Decisions about the best ways to manage or reduce a risk should reflect a preference for avoiding unnecessary health risks instead of unnecessary economic expenditure.

15 public health One of the efforts organized by society to protect, promote and restore the people’s health. It is the combination of sciences, skills and beliefs that is directed to the maintenance and improvement of the health of all the people through collective or social actions (after Last (9)). Note: The programmes, services and institutions involved emphasize the prevention of disease and the health needs of the population as a whole. Public health activities change with changing technology and social values, but the goals remain the same: to reduce the amount of disease, premature death and disease-produced discomfort and disability in the population. Public health is thus a social institution, a discipline and a practice. public information Information made available to the public and the process whereby this takes place. public participation The process whereby individual citizens and interested groups are involved in planning and managing environmental and health matters that affect them (including having access to legislation and information and participation in decision-making processes). public participatory technique A method of involving individual citizens and interested groups in the deliberation process leading to a policy choice and its implementation. quality assurance Part of quality management focused on providing confidence that the relevant quality requirement will be fulfilled (pending final ISO definition). quality control Control of the nature of an object [process] related to needs and expectations (pending final ISO decision). quality management A complete set of processes used in a system to establish quality policy and quality objectives and to achieve those objectives (pending final ISO definition). risk The probability of adverse effects caused under specified circumstances by an agent in an organism, a population or an ecological system (after Lewalle (2); see Fig. 3). risk analysis Process for controlling situations where populations or ecological systems could be exposed to a hazard. It usually comprises three steps, namely risk assessment, risk management and risk communication (after Lewalle (2); see Fig. 3). risk assessment A process intended to calculate or estimate the risk for a given target system following exposure to a particular agent, taking into account the inherent characteristics of an agent of concern as well as the characteristics of the specific target system. The process includes four steps: hazard identification; dose–response assessment; exposure assessment; risk characterization. It is also the first step in risk analysis (after Lewalle (2); see Fig. 3). risk communication Interactive exchange of information about risks among risk assessors, managers, news media, interested groups and the general public (Lewalle (2); see Fig. 3). risk evaluation The establishment of a qualitative or quantitative relationship between risks and benefits, involving the complex process of determining the significance of the identified hazards and estimated risks to those organisms or people

16 concerned with or affected by them. It is the first step in risk management (Lewalle (2); see Fig. 3). risk management A decision-making process involving considerations of political, social, economic and technical factors with relevant risk assessment information relating to a hazard so as to develop, analyse and compare regulatory and nonregulatory options and to select and implement the optimal decisions and actions for safety from that hazard. Essentially risk management is the combination of three steps: risk evaluation; emission and exposure control; and risk monitoring (Lewalle (2); see Fig. 3). sector Part or branch of an economy or of a particular industry or activity. stakeholder Any organization, group or individual that has an interest in or may be affected by a given policy decision or activity. standard A document established by consensus and approved by a recognized body that provides, for common and repeated use, rules, guidelines or characteristics for activities or their results, aimed at the achievement of the optimum degree of order in a given context (ISO (11)). Note: In certain fields the term may apply to other concepts, e. g. to guidelines or numerical limits, and the possibility of enforcing standards may vary. subsidiarity The principle of vesting authority for action in the lowest managerial level appropriate to the action and its consequences; in government terms, this means that decisions are taken as closely as possible to the citizen. sufficient evidence The collection of facts and scientific references that is definite enough to establish that a cause is associated with an effect. surveillance Periodic, continuous or repeated scrutiny of a phenomenon, situation or condition, generally using methods distinguished by their practicability, uniformity and frequently their rapidity rather than their complete accuracy. Note: Its main purpose is to detect changes in trends or distribution in order to initiate investigative or control measures. sustainability The principle of meeting the needs of the present without compromising the ability of future generations to meet their own needs.

See also sustainable development. sustainable development Development that meets the needs of the present without compromising the ability of future generations to meet their own needs. uncertainty A situation of imperfect knowledge concerning the present or future state of a system under consideration (after Lewalle (2)). vulnerable group Any subpopulation that may be at greater risk of harm than the majority of the population weight of evidence The extent to which the available data support a given hypothesis.

17 References

1. Suonuuti H. Guide to terminology. Helsinki, Nordterm, 1999 (Nordterm Series, No. 8). 2. Lewalle P. Risk assessment terminology: methodological considerations and provisional results. Terminology Standardization and Harmonization, 1999, 11:1– 28. 3. Gatterman MI, Hansen DT. Development of chiropractic nomenclature through consensus. Journal of Manipulative and Physiological Therapeutics, 1994, 17:302–309. 4. Rinaldi RC. Clarification and standardization of substance abuse terminology. Journal of the American Medical Association, 1988, 259:555–557. 5. Adler M, Ziglio E. Gazing into the Oracle. London, Jessica Kingsley Publishers, 1996. 6. Roberts JL. Terminology – a glossary of technical terms on the economics and finance of health services. Copenhagen, WHO Regional Office for Europe, 1998 (document EUR/ICP/CARE 94 01/CN01). 7. Health21: the health for all policy framework for the WHO European Region. Copenhagen, WHO Regional Office for Europe, 1999 (European Health for All Series, No. 6). 8. Duffus JH. Glossary of terms relevant to toxicology. In: Environmental toxicology and ecotoxicology. Proceedings of the International Course, Edinburgh, United Kingdom, 3–6 September, 1985. Copenhagen, WHO Regional Office for Europe, 1986. 9. Last JM. A dictionary of epidemiology, 3rd ed. Oxford, Oxford University Press, 1995. 10. Abelin T. Measurement in health promotion and protection. Copenhagen, WHO Regional Office for Europe, 1987 (WHO Regional Publications, European Series, No. 22). 11. ISO Guide 2. Geneva, International Organization for Standardization, 1986.

19 Bibliography

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Agreed terms on health effects evaluation and risk and hazard assessment of environmental agents. Geneva, World Health Organization, 1979. Aldrich T, Griffith J. Environmental epidemiology and risk assessment. New York, Van Nostrand Reinhold, 1993. American Heritage dictionary of the English language, 3rd ed. (CD version). Cambridge, MA, Learning Company Properties, 1998. Application of risk analysis to food standard issues. Geneva, World Health Organization, 1995 (document WHO/FNU/FOS/95.3). Beaglehole R, Bonita R, Kjellström T. Basic epidemiology. Geneva, World Health Organization, 1993. Briggs B, Corvolan C, Nurminen M, eds. Linkage methods in environmental health analysis: general guidelines. Geneva, World Health Organization, 1996 (document WHO/EHG/95.25). British Government Panel on Sustainable Development. Sustainable development: the UK strategy. London, H.M. Stationery Office, 1994. Callaghan PW, ed. Integrated environmental management handbook, London, Wiley, 1996. Clarification and working definition of health services functions and terminology. In: Organizational study on methods of promoting the development of basic health services. Geneva, World Health Organization, 1973. Codex Alimentarius Commission, procedural manual, 11th ed. Geneva, World Health Organization, 2000. Cohrssen JJ, Covello VT. Risk analysis: a guide to principles and methods for analyzing health and environmental risks. Washington, DC, Council on Environmental Quality, 1989. Commission Directive 1999/11/EC of 8 March 1999 adapting to technical progress the principles of good laboratory practice as specified in Council Directive 87/18/EC on the harmonization laws, regulations and administration provisions relating to the application of the principles of good laboratory practice and the verification of their application for tests on chemical substances. Official journal of the European Communities, 1999, L77:23.03.99. Commission Directive 93/67/EEC of 20 July 1993 laying down the principles for assessment of risks to man and the environment of substances notified in accordance with Council Directive 67/548/EEC. Official Journal of the European Communities, 1993, L227:08.09.93. Commission Directive 97/18/EC of 17 April 1997 postponing the data after which animal tests are prohibited for ingredients or combinations of ingredients of cosmetic products (text with EEA relevance). Official journal of the European Communities, 1997, L114:01.05.97.

20 Control of environmental hazards – assessment and management of environmental health hazards. Geneva, World Health Organization, 1989 (document WHO/PEP/89.6). Cooke MA et al. Guidelines for the compilation of occupational health-related records for future epidemiological studies of chemical exposure. Occupational Medicine, 1999, 49:439–442. Corvalán C, Nurminen M, Pastides H. Linkage methods for environment and health analysis: technical guidelines. Geneva, World Health Organization, 1997 (document WHO/EHG/97.11). Cothern CJ, ed. Handbook for environmental risk decision making: values, perceptions, and ethics. Boca Raton, FL, CRC Lewis, 1996. Council Directive 97/11/EC of 3 March 1997, amending Directive 85/337/EC on the assessment of the effects of certain public and private projects on the environment. Official Journal of the European Communities, 1997, L73:14.03.97. Council Regulation (EEC) No 1836/93 of 29 June 1993 allowing voluntary participation by companies in the industrial sector in a community eco-management and audit scheme. Official Journal of the European Communities, 1993, L168:10.07.93. Crosby BL. Stakeholder analysis: a vital tool for strategic managers. Washington, DC, US Agency for International Development, 1992 (Implementing Policy Change Series). Declaration by the Ministers of Environment of the Region of the United Nations Economic Commission for Europe. In: Fourth Ministerial Conference – Environment for Europe, Aarhus, Denmark, 23–25 June, 1998 (ECE/CEP/57). Geneva, United Nations Economic Commission for Europe, 2000. Department of the Environment. A guide to risk assessment and risk management for environmental protection. London, H.M. Stationery Office, 1995. Development of environmental health criteria for urban planning: report of a WHO Scientific Group. Geneva, World Health Organization, 1972 (WHO Technical Report Series, No. 511). Duffus JH. Glossary for chemists of terms used in toxicology (IUPAC Recommendations). Pure and Applied Chemistry, 1993, 65:2003–2112. Earth Summit CD-ROM, A guide to Agenda 21: a global partnership. New York, United Nations, 2000. Economics and environment. An English–Russian glossary. Harvard, OECD Center for Co-operation with the Economies in Transition and Harvard Institute for International Development, 1996. Efficient transport for Europe – policies for internalisation of external costs. Paris, European Conference of Ministers of Transport, 1998. Environment and “health as a sustainable state”. Rome, WHO Collaborating Centre for Training and Research in District Health Systems, 1992. Environment and health. The European Charter and commentary. Copenhagen, WHO Regional Office for Europe, 1990 (WHO Regional Publications, European Series, No. 35).

21 Environmental epidemiology, Vol. 1. Washington, DC, National Research Council, 1991. Environmental epidemiology, Vol. 2. Washington, DC, National Research Council, 1994. Environmental management – life cycle assessment: principles and framework. Geneva, International Organization for Standardization, 1997. Environmental management – vocabulary. Geneva, International Organization for Standardization, 1998 (ISO 14050:1998). Evaluation of certain veterinary drug residues in food. Geneva, World Health Organization, 1991. Federal Register – guidelines for exposure assessment (EPA600Z92001). Washington, DC, US Environmental Protection Agency, 1992. Fitzpatrick M, Bonnefoy X. Environmental health services in Europe 3 – professional profiles. Copenhagen, WHO Regional Office for Europe, 1998 (WHO Regional Publications, European Series, No. 82). Framework Convention on Climate Change, Article 3(3). New York, United Nations, 1992. Framework for ecological risk assessment. Washington, DC, US Environmental Protection Agency, 1992 (EPA/630/R–92/001). Framework for environmental health risk management (final report). Washington, DC, Presidential/Congressional Commission on Risk Assessment and Risk Management, 1997. Gate PB, ed. Webster’s third new international dictionary of the English language. London, Encyclopaedia Britannica, 1993. General terms and their definitions concerning standardization and certification. In: ISO guide 2. Geneva, International Organization for Standardization, 1976. Gifis SH. Law dictionary, 2nd ed. Hauppauge, NY, Barron’s Educational Series, 2000. Glossary of terms on chemical safety for use in IPCS publications. Geneva, International Programme on Chemical Safety, 1989. Glossary of terms used in the “Health For All” Series No. 1–8. Geneva, World Health Organization, 1984 (“Health For All” Series, No. 9). Gray PCR, Stern RM, Biocca M, eds. Communicating about risks to environment and health in Europe. London, Kluwer Academic Publishers, 1998. Guidelines for drinking-water quality, 2nd ed. Geneva, World Health Organization, 1993. Guidelines for the inclusion of safety aspects in standards, 51st ed. Geneva, International Organization for Standardization, 1990. Guiding principles for chemical accident prevention, preparedness and response. Guidance for public authorities, industry, labour and others. Paris, Organisation for Economic Co-operation and Development, 1992.

22 Guralink DB. Webster’s new world dictionary, 2nd ed. New York, Simon and Schuster, 1980. Health and environment in sustainable development – five years after the Earth Summit. Geneva, World Health Organization, 1997 (unpublished document). Health and Safety Executive. The tolerability of risk from nuclear power stations. London, H.M. Stationery Office, 1992. Healthy and productive lives in harmony with nature. A WHO global strategy for health and environment. Geneva, World Health Organization, 1994 (document WHO/EHE/94.1). Helsinki Conference glossary of terms. Copenhagen, WHO Regional Office for Europe, 1993 (unpublished document 0970h, Annex 7). Holdgate M, Kassas M, White G, eds. World environment 1972–1982. Dublin, United Nations Environment Programme and Tycooly International, 1982. Holland P. Glossary of terms relating to pesticides (IUPAC Reports on Pesticides 36). Pure and Applied Chemistry, 1996, 68:1167–1193. Implementing NEHAPs in partnership. Third Ministerial Conference on Environment and Health, London, 16–18 June 1999. Copenhagen, WHO Regional Office for Europe, 1999 (Conference document EUR/ICP/EHCO 020205/10 03749). International Code of Conduct on the Distribution and Use of Pesticides. Rome, Food and Agriculture Organization of the United Nations, 1990. International terminology standards – preparation and layout. Geneva, International Organization for Standardization, 1992 (ISO 10241:1992(E)). Jager D, Visser C. Uniform system for the evaluation of substances (USES). The Hague, Ministry of Housing, Spatial Planning and the Environment, 1994. Jones DA, ed. Nomenclature for hazard and risk assessment in the process industries. Rugby, Institution of Chemical Engineers, 1992. Key elements of a national programme for chemicals management and safety. Geneva, Inter-Organization Programme for the Sound Management of Chemicals, 1998. Komarov YM et al. Health care quality glossary. Russia–USA Joint Commission on Economic and Technological Cooperation, 1999 (HRN-C-00-69-90013-03). Last JM. A dictionary of epidemiology, 2nd ed. Oxford, Oxford University Press, 1988. Lawrence E, Jackson ARW, Jackson JM. Longman dictionary of environmental science. Harlow, Longman Publishers, 1998. Le Guen J, ed. Generic terms and concepts in the assessment and regulation of industrial risks. London, Health and Safety Executive, 1995. Lewis RT, Sax NI. Sax’s dangerous properties of industrial materials, 10th ed. New York, Wiley and Sons, 1999. Making markets work for the environment. London, H.M. Stationery Office, 1993. McDonald M, Dunbar I. Market segmentation: a step by step approach to creating profitable market segments. Basingstoke, MacMillan Business, 1995.

23 National Research Council. Science and judgement in risk assessment. Washington, DC, National Academy Press, 1994. Perelet R. Eco-efficiency. Paris, Organisation for Economic Co-operation and Development, 1994. Risk: analysis perception and management. London, Royal Society, 1992. Schaefer M. Concepts and issues of programme evaluation in environmental health. Geneva, World Health Organization, 1973 (WHO Technical Report Series, No. 528). Standardization and related activities – general vocabulary. Geneva, International Organization for Standardization, 1996 (IOS/TEC Guide 2). Suter GW II. Ecological risk assessment. London, Lewis Publishers, 1993. TACIS English–Russian glossary. Brussels, European Commission, TACIS Information Office, 1994. Terminology for the European Health Policy Conference – a glossary with equivalents in French, German and Russian. Copenhagen, WHO Regional Office for Europe, 1994. Terminology work – harmonization of concepts and terms. Geneva, International Organization for Standardization, 1996 (ISO 860:1996). Terms of environment: glossary, abbreviations and acronyms. Washington, DC, US Environmental Protection Agency, 1997. The Aarhus Convention: an implementation guide. Geneva, United Nations Economic Commission for Europe, 2000 (ECE/CEP/72). Twenty steps for developing a Healthy Cities project, 3rd ed. Copenhagen, WHO Regional Office for Europe, 1997. WHO Regional Office for Europe (1980) Glossary on Air Pollution, Copenhagen, WHO Regional Office for Europe. (WHO Regional Publications European Series No.9) Woolston H. Environmental auditing: an introduction and practical guide. London, British Library, 1993.

24 25 Annex 1

Concordance Steering Committee Affiliations shown are as of 2000

Professor Simon Avaliani Department of Community Hygiene Russian Academy of Advanced Medical Studies Russian Federation

Mrs Andrea Bartel Translator/Terminologist on behalf of the Federal Institute for Health Protection of Consumers and Veterinary Medicine Germany

Mr Emmanuel Briand Direction départementale à l’action sanitaire et sociale des Vosges France

Dr John H. Duffus The Edinburgh Centre for Toxicology (Edintox) Heriot-Watt University United Kingdom

Mr Christian Galinski International Information Centre for Terminology (Infoterm) and Technical Committee ISO/TC 37 of the International Organization for Standardization Austria

Dr Kersten Gutschmidt Department of Health Protection of the Human Environment Occupational and Environmental Health World Health Organization Switzerland

Dr Dinko Kello Environment and Health Policy WHO Regional Office for Europe Denmark

Dr Norman J. King Consultant and former Chairman of WHO NEHAP Task Force United Kingdom

Dr Alexander Kutscherenko Department of the State Sanitary/Epidemiological Surveillance Russian Academy of Advanced Medical Studies Russian Federation

26 Mr Pierre Lewalle Global Programme on Evidence for Health Policy World Health Organization Switzerland

Mrs Brigitte Moissonnier Direction départementale à l’action sanitaire et sociale du Rhône France

Mr Georgy Peegnasty Translator on behalf of the Department of the State/Epidemiological Surveillance Ministry of Health Russian Federation

Mr Charles Robson Health Documentation Services WHO Regional Office for Europe Denmark

Dr Linda K. Shuker Institute for Environment and Health University of Leicester United Kingdom

Dr Elena Schiller (Tschishowa) WHO Collaborating Centre for Information and Communication on Environmental Health Robert Koch Institute Germany

Dr Roland Suchenwirth Environmental Health Department Public Health Administration Niedersächsischen Landesgesundheitsamt

27 Annex 2

International Environmental Health Reference Group (IEHRG)

Affiliations shown are as of 2000

Dr Sousa Piedade Abreu Ministry of Health Portugal

Mme Agnès Alexandre-Bird Direction départementale à l’action sanitaire et sociale de l’Isère France

Dr Maria Christina Leite de Castro Fraga Amaral Ministry of Health Portugal

Dr Diana Anderson Educational Services TNO BIBRA International Ltd United Kingdom

Dr Filomena de Oliveira Araújo Division of Environmental Health Directorate General of Health Portugal

Dr Herman Autrup Department of Environmental Medicine Aarhus University Denmark

Dr Simon L. Avaliani Department of Community Hygiene Russian Academy of Advanced Medical Studies Russian Federation

Dr Boguslaw Baranski Occupational Health WHO European Centre for Environment and Health (WHO Regional Office for Europe) Netherlands

Ms Andrea Bartel Translator/Terminologist on behalf of the Federal Institute for Health Protection of Consumers and Veterinary Medicine Germany

28 Mme Zoé Bauchet Direction départementale à l’action sanitaire et sociale du Doubs France

Dr Richard A. Becker Chemical Manufacturers’ Association USA

Dr Françoise Belmont Regional Office for Europe United Nations Environment Programme Switzerland

Mr Robert P. Benson US Environmental Protection Agency USA

Dr Antonio de Blasio Healthy City Foundation of Pécs Hungary

Mr Xavier Bonnefoy Environmental Health Planning/Ecology WHO Regional Office for Europe Denmark

Mme Jocelyne Boudot Fédération française des centres de lutte contre le cancer France

Dr Ezzeddine Boutrif Food Quality and Standards Service Food and Nutrition Division Food and Agriculture Organization of the United Nations Italy

Professor Dr Gerhard Budin International Society for Environmental Protection University of Vienna Austria

Ms Alexandra Burke Europe and the New Independent States Environment, Energy, and Urban Development US Agency for International Development USA

Dr Krunoslav Capak Croatian National Institute of Public Health Croatia

29 Mme Maria-Jose Palos Caravina Translation Centre for the Bodies of the European Union Luxembourg

Mr Pierre Chantrel DRASS du Centre France

Dr F. Saverio Civili Mediterranean Action Plan United Nations Environment Programme Greece

Dr Ivan Ciznár Institute of Preventive and Clinical Medicine Slovakia

Dr Michael Csicsaky Ministerium für Frauen, Arbeit und Soziales Germany

Dr William Dab Directeur de Cabinet du DGS Ministère de l’Emploi/Solidarité France

Dr Terri Damstra International Programme on Chemical Safety USA

Dr Günter Danner Deutsche Sozialversicherung Europavertretung Belgium

Dr Marc Danzon Prévention et Promotion de la Santé Mutualité Française France

Mr Eduard I. Denisov Research Institute of Occupational Health WHO Collaborating Centre Russian Federation

Dr Dergacheva Institute of Human Ecology RAMN Russian Federation

Dr Jacques Descotes Lyon Picon Centre France

Professor Illis Dési Department of Public Health University Medical School Hungary

Dr John H. Duffus The Edinburgh Centre for Toxicology (Edintox) Heriot-Watt University United Kingdom

Dr Anca Dumitrescu Institute of Public Health Bucharest Ministry of Health Romania

Dr Gyula Dura National Institute of Environmental Health Hungary

Dr Erik Dybing National Institute of Public Health Norway

Dr Marina Fesenko Research Institute of Occupational Health WHO Collaborating Centre Russian Federation

Dr Elsa Figueiredo Ministry of Health Portugal

Dr Martin Fitzpatrick Dublin City Council Ireland

Dr Jeffery A. Foran WATER Institute USA

Dr Robert J. Frederick National Center for Environmental Assessment Office of Research and Development US Environmental Protection Agency USA

Dr Herman Gibb National Center for Environmental Assessment Office of Research and Development US Environmental Protection Agency USA

Dr Laurent Gilotte Environmental Health Planning/Ecology WHO Regional Office for Europe Denmark

Dr Marina Glazkova Department of State Sanitary/Epidemiological Surveillance Ministry of Health Russian Federation

Dr Philippe Glorennec Ministère de l’Emploi et de la Solidarité France

Dr Olivier Godard Laboratoire d’économétrie de l’école polytechnique France

Dr Josep M. Goicoechea Ministry of Health Andorra

Dr Shalom Goldberger Ministry of Health Israel

Dr H.N.B. Gopalan Policy Analysis, Review and Development Unit Division of Environmental Policy Development United Nation Environmental Programme Kenya

Professor Dr Ursula Gundert-Remy Bundesinstitut für Gesundheitlichen Verbraucherschutz und Veterinärmedizin Germany

Dr Kersten Gutschmidt Department of Protection of the Human Environment World Health Organization Switzerland

Dr Katarina Halzlova Ministry of Health Slovakia

Professor Kaido P. Hanson Petrov Research Institute of Oncology Russian Federation

32 Dr Borivoj Havlík Ministry of Health Czech Republic

Dr Birger Heinzow Landesamt für Natur und Umwelt des Landes Schleswig-Holstein Germany

Dr Tharald Hetland Ministry of Health and Social Affairs Norway

Dr Roy Hickman Health Protection Branch Health Canada Canada

Dr Charalingayya Hiremath US Environmental Protection Agency USA

Mr Allan H. Howard Project Development Office Union of International Associations Belgium

Professor Nikolai Izmerov Research Institute of Occupational Health WHO Collaborating Centre Russian Federation

Dr Farhat Nigar Jaffery Industrial Toxicology Research Centre India

Mr Vincent Josselin Direction départementale à l’action sanitaire et sociale de l’Aube France

Dr Uwe Kaiser WHO Collaborating Centre for Information and Communication on Environmental Health Robert Koch Institute Germany

Professor Dr W.J. Kakebeeke International Environmental Cooperation Ministry of Environment Netherlands

33 Professor Serguey V. Kanayev Petrov Research Institute of Oncology Russian Federation

Dr Alla I. Khalepo Research Institute of Occupational Health WHO Collaborating Centre Russian Federation

Dr George Kamizoulis Mediterranean Action Plan Greece

Dr Andreas Kappos Behörde für Arbeit, Gesundheit und Soziales Germany

Dr Dinko Kello Environment and Health Policy WHO Regional Office for Europe Denmark

Dr René Kersauze WHO Nancy Project Office European Centre for Environmental Health (WHO Regional Office for Europe) France

Dr Norman J. King Consultant and former Chairman of WHO NEHAP Task Force United Kingdom

Dr Jury Krasovsky Institute of Human Ecology RAMN Russian Federation

Dr Eugeny Kutepov Institute of Human Ecology Russian Federation

Mr Gérard Larbaigt CEP Consultant France

Ms Martine Ledrans Institut de veille sanitaire France

Dr Lucianne Licari Ministry of Health Malta

Dr Maureen Lichtveld Division of Health Education and Promotion Agency for Toxic Substances and Disease Registry USA

Dr Nikolai Litvinov Russian Toxicology Information and Advisory Centre Russian Federation

Dr Inge Mangelsdorf Frauenhofer Institut für Toxikologie und Aerosolforschung Germany

Dr Francisco Vargas Marcos Subdirectorate of Environmental Health Directorate General of Public Health Ministry of Health and Consumer Affairs Spain

Dr Karel Markvart National Institute of Public Health Czech Republic

Dr Olga Mayan National Institute of Health Ministry of Health Portugal

Dr Volker Mersch-Sundermann Department of Medical Microbiology and Hygiene University Hospital Mannheim Germany

Ms Brigitte Moissonnier Direction départementale à l’action sanitaire et sociale du Rhône France

Dr Kubanychbek Monolbaev CAR NEHAP Implementation Office for Central Asian Republics Uzbekistan

Dr Jan-Peter Mout Ministry of Foreign Affairs Netherlands

Dr Gerald Moy Food Safety Programme World Health Organization Switzerland

Professor Dr Diether Neubert Benjamin Franklin Medical Centre Free University Berlin Germany

Dr Sergey Novikov Institute of Human Ecology and Environmental Health Russian Academy of Medical Science Russian Federation

Dr Bernhard Nowotny International Society for Environmental Protection Austria

Dr Matthias Otto Dokumentations- und Informationsstelle für Umweltfragen der Kinderärzte Germany

Dr Georgy Peegnasty Ministry of Health Russian Federation

Dr Renat Perelet Institute for Systems Analysis Russian Academy of Sciences Russian Federation

Dr David Leonard Perridge Independent consultant United Kingdom

Dr Werner Pillmann International Society for Environmental Protection Austria

Mr Jean-Luc Potelon Department EGERIES-ENSP Ecole nationale de la santé publique France

Dr Bernhard Prinz Landesumweltamt Nordrhein-Westfalen Germany

Dr Marlene Proctor Dublin Institute of Technology Ireland

Dr Francesca Racioppi

36 Epidemiology European Centre for Environment and Health (WHO Regional Office for Europe) Italy

Ms Helene Reemann Bundeszentrale für Gesundheitliche Aufklärung Germany

Dr Ana Isabel dos Reis Ministry of Health Portugal

Mr Charles Robson Health Documentation Services WHO Regional Office for Europe Denmark

Dr Nina B. Rubtsova Research Institute of Occupational Health WHO Collaborating Centre Russian Federation

Dr Philip Rushbrook Waste Management European Centre for Environment and Health (WHO Regional Office for Europe) Italy

Dr Romualdas Sabaliauskas Department Public Health Ministry of Health Lithuania

Dr I. V. Sanotskij Research Institute of Occupational Health WHO Collaborating Centre Russian Federation

Dr John Schaum National Center for Environmental Assessment Office of Research and Development US Environment Protection Agency USA

Dr Christopher Schonwalder International Programs National Institute of Environmental Health Sciences USA

Dr Prahlad Kishore Seth Industrial Toxicology Research Centre India

Dr Vytautas Silickas State Public Health Centre Lithuania

Professor Raiot Silla Health Protection Department Ministry of Social Affairs Estonia

Dr Olga V. Sivochvalova Research Institute of Occupational Health WHO Collaborating Centre Russian Federation

Dr Colin L. Soskolne Department of Public Health Sciences Faculty of Medicine and Dentistry University of Alberta Canada

Dr Roland Suchenwirth Niedersächsisches Landesgesundheitsamt Germany

Dr G. Suvorov Research Institute of Occupational Health WHO Collaborating Centre Russian Federation

M. Claude Tillier Direction départementale à l’action sanitaire et sociale de Saône et Loire France

Dr Timothy Tinker Communication & Research Branch Division of Health Education and Promotion Agency for Toxic Substances and Disease Registry USA

Dr Ursula Ulrich-Vögtlin Bundesamt für Gesundheit Switzerland

Dr Harri Vainio Institute of Environmental Medicine Karolinska Institute Sweden

38 Dr Vera Vashkova Institute of Human Ecology Russian Federation

Dr Glyn N. Volans Medical Toxicology Unit Guy’s and St. Thomas’ Hospital Trust United Kingdom

Dr Fritz Wagner Bundesministerium für Arbeit, Gesundheit und Soziales Austria

Dr W.M.D. Wagner American Conference of Governmental Industrial Hygienists USA

Dr Bernd Warnat Federal Ministry for the Environment, Nature Conservation and Nuclear Safety Germany

Dr John David Williamson Faculty of Health Brighton University United Kingdom

Dr Ute Wolf Department of Epidemiology and Health Robert Koch Institute Germany

Dr V.S. Zhurkov Sysin Research Institute of Human Ecology and Environmental Health RAMS Russian Federation

Dr Nándor Zoltai Ministry for Environment Hungary

Dr Ingrida Zurlyte Public Health Monitoring Division National Public Health Centre Lithuania

39 Annex 3

Terms not selected for concordance by the Steering Committee

A number of terms that were either proposed in the initial list of terms considered in the first IEHRG survey or proposed by IEHRG respondents in either survey have not, ultimately, been included in this concordance. This is because either no consensus definition of a concept could be found (in some cases because of cultural and/or linguistic differences) or the concept was not thought to be required in a concordance on terms specific to environment and health.

audit/study audit1 intersectoral action carrying capacity2 multisectoral action checking/lifestyle1 norm cleaner production2 particulates2 collective systems1 particulate matter, suspended2 control1 public1 drinking-water1 public authority1 eco/ecological efficiency2 public perception ecohealth2 public perception of risk1 environmental health indicator sanitation1 environmental indicator stakeholder analysis 1 goal/objective/target3 supervision 2 green productivity2 suspended particulates health belief2 tolerable risk hygiene3 urban ecology 1 injunctive relief2 water-related disease inspection1

______

1 General consensus from the second IEHRG survey that the term is not needed in concordance. 2 Following the first IEHRG survey, the Steering Committee decided not to consider the term further as it was not thought to be required in a concordance on terms specific to environment and health. 3 No appropriate concept associated with the term in English owing to cultural and/or linguistic differences in the use of the term.

40 The WHO Regional ENVIRONMENT AND HEALTH – AN INTERNATIONAL CONCORDANCE Office for Europe ON SELECTED CONCEPTS The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for Environmental health is a relatively new and a international health matters and public health. multidisciplinary field. People active in the field The WHO Regional Office for Europe is one of six regional offices throughout the world, each with come from widely varying backgrounds, each with its own programme geared to the particular its own opinions and traditions on the meaning health conditions of the countries it serves. and use of certain terms. Interaction and Member States international cooperation, both across the

Albania boundaries of traditional scientific domains and in Andorra a multilingual, multicultural environment, have Armenia Austria highlighted the need to clarify the scope and Azerbaijan nuances of key terms in the field in order to avoid Belarus Belgium misunderstandings and confusion in Bosnia and Herzegovina communication. To address this need WHO Bulgaria Croatia brought together a group of experts, supported Cyprus by consultation with a much larger scientific Czech Republic Denmark community, to harmonize selected terms in Estonia environment and health. This publication presents Finland a common understanding of 73 selected terms France Georgia which have been found to be open to Germany misunderstanding within the international Greece

Hungary community. Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan

EUR/05/5059725 ISBN 92-890-2286-8 E88308 Original: English