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CHILDREN’S HEALTH AND THE ENVIRONMENT IN EUROPE: A BASELINE ASSESSMENT VORSPANN_final_final 15.11.2007 14:22 Uhr Seite 1 CHILDREN’S HEALTH AND THE ENVIRONMENT IN EUROPE: A BASELINE ASSESSMENT VORSPANN_final_final 15.11.2007 14:22 Uhr Seite 2 ABSTRACT This report summarizes the information gathered by the European environment and health information system (EHIS). EHIS was developed by the WHO Regional Office for Europe in collaboration with a wide group of Member States, following the recommendations of the Fourth Ministerial Conference on Environment and Health held in Budapest in 2004. The work is conducted in a series of projects supported by grants from the Directorate-General for Health and Consumer Protection of the European Commission, and contributes to the implementation of the public health action programme of the European Community. The report gives an overview of the establishment of the system and the outcomes of the methodological work. It provides information on the scientific basis, framework and scope of the system, and presents plans for future action. The use of the system is highlighted by presenting its main product: an indicator-based assessment of children’s health and the environ- ment in the WHO European Region in the context of the Children’s Environment and Health Action Plan for Europe. The assessment provides a baseline against which the progress and effects of action taken can be evaluated at the Fifth Ministerial Conference in 2009. KEYWORDS ENVIRONMENTAL HEALTH CHILD WELFARE INFORMATION SYSTEMS POLICY MAKING HEALTH STATUS INDICATORS EUROPE EU/06/5067821 ISBN: 978 92 890 7297 7 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 WHO/Europe web site at http://www.euro.who.int/pubrequest. © World Health Organization 2007 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 opin- ion 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 recom- mended 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 European Commission or the World Health Organization. Text editor: Rosemary Bohr Cover design and layout: Dagmar Bengs Printed in Denmark by Phoenix Design Aid VORSPANN_final_final 15.11.2007 14:22 Uhr Seite 3 CHILDREN’S HEALTH AND THE ENVIRONMENT IN EUROPE: A BASELINE ASSESSMENT Edited by D. Dalbokova, M. Krzyzanowski, S. Lloyd VORSPANN_final_final 13.03.2008 18:42 Uhr Seite 4 ACKNOWLEDGEMENTS Supported by Grant Agreement SPC 2004124 from the European Commission Directorate-General for Health and Consumer Protection Partner Institutions • Austrian Health Institute, Vienna, Austria • Ministry of Health, Sofia, Bulgaria • State Health Institute, Prague, Czech Republic • Health Protection Inspectorate, Tallinn, Estonia • National Public Health Institute, Kuopio, Finland • French Institute for Public Health Surveillance, St Maurice, France • Institute of Public Health North Rhine-Westphalia, Bielefeld, Germany • National School of Public Health, Athens, Greece • National Institute for Environmental Health, Budapest, Hungary • Agency for Environmental Protection and Technical Services, Rome, Italy • State Environmental Health Centre, Vilnius, Lithuania • National Institute for Public Health and the Environment, Bilthoven, Netherlands • Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland • General Directorate of Health, Lisbon, Portugal • Institute of Public Health, Bucharest, Romania • National Public Health Authority, Bratislava, Slovakia • National Institute of Public Health, Ljubljana, Slovenia • Public Health Agency of Barcelona, Barcelona, Spain • Andalusian School of Public Health, Granada, Spain • Institute of Health Carlos III Foundation for International Cooperation and Health, Madrid, Spain • European Environment Agency, Copenhagen, Denmark • European Child Safety Alliance, Amsterdam, Netherlands • National Board of Health and Welfare, Stockholm, Sweden Collaborating Institutions • French Agency for Environmental and Occupational Health and Safety, Maisons-Alfort, France • European Commission Joint Research Centre, Ispra, Italy • Health Protection Agency, United Kingdom Coordination and Management • World Health Organization European Centre for Environment and Health, Bonn, Germany VORSPANN_final_final 15.11.2007 14:22 Uhr Seite 5 CONTENTS CONTRIBUTORS i GLOSSARY iv FOREWORD v EXECUTIVE SUMMARY vi INTRODUCTION 1 Development of EHIS 1 Technical activities Involvement of Member States EHIS outcomes 3 Objectives of the CEHAPE indicator-based assessment and the questions it answers 4 PART I. ASSESSMENT OF THE SITUATION AND PROGRESS TOWARDS THE RPGS 7 CHAPTER 1. CLEAN WATER – CONDITION OF LIFE 9 RPG I 9 Key messages 9 Importance for public health 9 Water-related health determinants: geographical and time patterns 12 Safe recreational water environments 15 Policy response 20 United Nations Economic Commission for Europe (UNECE)/WHO Protocol on Water and Health 20 Surveillance 21 Small water supplies 22 EU Bathing Water Directive 23 Bathing water management 23 WHO Guidelines for drinking-water quality 24 EC Water Framework Directive 25 Overall progress 25 References 27 CHAPTER 2. BE MOBILE AND ACTIVE – BUT SAFELY! 31 RPG II 31 Key messages 31 Why are injuries and physical inactivity public health problems? 31 Early childhood: key risks, causes and prevention of non-traffic-related unintentional injuries 33 Drowning 34 Poisoning 36 Falls 36 Burns 36 Policy action 37 From childhood into adolescence and adulthood: addressing risks posed by RTIs 39 Physical activity and obesity 41 Policy action on transport safety and the promotion of physical activity 43 Safe mobility 43 Healthy mobility 45 Overall progress 45 References 46 CHAPTER 3. CLEAN AIR FOR HEALTH 49 RPG III 49 Key messages 49 Importance for public health 49 Environmental factors that may explain the geographical and time patterns 53 in respiratory health VORSPANN_final_final 15.11.2007 14:22 Uhr Seite 6 Respiratory health and outdoor air pollution 53 Indoor air exposure 56 Policy response 63 Environmental tobacco smoke 64 Outdoor air pollution 65 Indoor air pollution 66 Overall progress 67 References 68 CHAPTER 4. ELIMINATING HAZARDS FROM CHILDREN’S ENVIRONMENT 73 RPG IV 73 Key messages 73 Childhood leukaemia 74 Introduction and overview 74 Key messages 74 Incidence and burden of disease 74 Aetiology and risk factors 76 Prospects for reducing the disease burden 77 Policies and action 77 References 78 Enjoying the sun safely 79 Introduction and overview 79 Key messages 79 Public health and UVR 79 Malignant melanoma in Europe 80 UVR as a determinant of environmental health 81 UVR protection policies and action 83 Stopping depletion of the ozone layer 85 Conclusions 86 References 87 Safe food: crucial for child development 88 Introduction and overview 88 Key messages 88 Groups of chemicals of potential concern in Europe 89 Policy response 93 Conclusions 94 References 96 Health and safety at work for children and young people 98 Introduction and overview 98 Key messages 98 Children and young people at work: health issues 98 Work injuries in children and young people in Europe 100 Policy response 102 Conclusions 104 References 105 PART II. ENHIS 107 CHAPTER 5. ABOUT ENHIS 109 Scientific basis 109 Elements of the system 110 Framework and scope 111 Geographical coverage 111 Future developments 112 European level 112 National level 113 ANNEX 1. EPIDEMIOLOGICAL SUB-REGIONS OF THE WHO EUROPEAN REGION 115 ANNEX 2. CEHAPE INDICATORS 116 VORSPANN_final_final 15.11.2007 14:22 Uhr Seite i adata/information contributor b(co-)author of fact sheet/assessment report CONTRIBUTORS creviewer dwork package leader Marita Afezollia Vladimíra Puklováa,b Alain le Tertrea Ministry of Health, State Health Institute, French Institute for Public Health Tirana, Albania Prague, Czech Republic Surveillance, St Maurice, France Lysien Alia Jüri Ruuta,b Ministry of Health, Health Protection Inspectorate, Mariam Bakhtadzea Tirana, Albania Tallinn, Estonia Ministry of Environment, Tbilisi, Georgia Nune
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