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Environment and Health Risks: the Influence and Effects of Social The WHO Regional Office for Europe ENVIRONMENT AND HEALTH RISKS: THE INFLUENCE AND EFFECTS OF SOCIAL INEQUALITIES ___________________________________________________________________________ The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. 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 conditions of the countries it serves. Significant social inequalities exist in the environmental burden of disease, both Member States between and within countries. A framework model developed by WHO describes the mechanisms through which social inequalities may affect exposure to and the Albania health outcomes from environmental risks. Andorra Armenia Austria To support policy-makers in Member States of the WHO European Region, and Azerbaijan as part of the preparatory process for the Fifth Ministerial Conference on Belarus Belgium Environment and Health in 2010, WHO has accumulated the available evidence Bosnia and Herzegovina on risk of injury, air pollution, inadequate living and working conditions and poor Bulgaria waste management, in order to assess the current knowledge. Further evidence Croatia Cyprus reviews were carried out for vulnerable groups (children and gender-related) and Czech Republic for the expected effects of climate change. A group of expert advisers convened Environment and Denmark by WHO was asked to review and discuss the compiled evidence and produce a Estonia Finland set of technical and policy recommendations on possible countermeasures. France health risks: the Georgia The expert group concluded that social determinants can significantly affect Germany Greece individuals’ exposure to environmental risk and that – although evidence is Hungary available only for certain countries– this can be considered a general issue for all influence and Iceland Member States. Addressing this challenge, the expert group developed summary Ireland Israel conclusions addressing the main issues and made recommendations for policy, Italy technical and research-related action. effects of social Kazakhstan Kyrgyzstan Latvia Lithuania inequalities Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Report of an expert group meeting Serbia Slovakia Slovenia Bonn, Germany Spain 9–10 September 2009 Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe ISBN Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark WHOLIS number Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: [email protected] Original: Web site: www.euro.who.int Environment and health risks: the influence and effects of social inequalities Report of an expert group meeting Bonn, Germany 9–10 September 2009 ABSTRACT Significant social inequalities exist in the environmental burden of disease, both between and within countries. A framework model developed by WHO describes the mechanisms through which social inequalities may affect exposure to and the health outcomes from environmental risks. To support policy-makers in Member States of the WHO European Region, and as part of the preparatory process for the Fifth Ministerial Conference on Environment and Health in 2010, WHO has accumulated the available evidence on risk of injury, air pollution, inadequate living and working conditions and poor waste management, in order to assess the current knowledge. Further evidence reviews were carried out for vulnerable groups (children and gender-related) and for the expected effects of climate change. A group of expert advisers convened by WHO was asked to review and discuss the compiled evidence and produce a set of technical and policy recommendations on possible countermeasures. The expert group concluded that social determinants can significantly affect individuals’ exposure to environmental risk and that – although evidence is available only for certain countries– this can be considered a general issue for all Member States. Addressing this challenge, the expert group developed summary conclusions addressing the main issues and made recommendations for policy, technical and research-related action. Keywords ENVIRONMENTAL HEALTH ENVIRONMENTAL EXPOSURE RISK FACTORS SOCIOECONOMIC FACTORS EUROPE Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2009 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. Meeting rapporteur: Teresa Lavin Language editor: Frank Theakston Environment and health risks: the influence and effects of social inequalities Page 1 CONTENTS Background and introduction................................................................................................. 2 Methods and approaches ...................................................................................................... 2 Contextual framework .................................................................................................. 2 Meeting preparation and objectives............................................................................... 4 Process ....................................................................................................................... 4 Plenary presentations ...........................................................................................................5 Presentations............................................................................................................... 5 Summary of the evidence and discussion ...................................................................... 7 Working groups..................................................................................................................12 Working group A: socioeconomic mechanisms ............................................................. 12 Working group B: gender- and age-related mechanisms............................................... 15 Working group C: mechanisms related to marginalized groups/minorities...................... 18 Conclusions........................................................................................................................ 21 Recommendations .............................................................................................................. 22 Policy issues .............................................................................................................. 22 Technical issues......................................................................................................... 22 Research issues ......................................................................................................... 23 References ........................................................................................................................ 25 Annex 1. Participants .......................................................................................................... 26 Annex 2. Summary reports from the evidence reviews provided to the meeting as background documentation ...................................................................................................................31 Social inequalities in health risks related to ambient air quality ..................................... 32 Social inequalities in environmental risks associated with housing and residential location34 Social inequalities in health risks related to unintentional injuries among children .......... 36 Inequalities, inequities and environmental justice in waste management and health ...... 38 Inequalities,
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