Distr.: RESTRICTED NATIONAL INTEGRATED PROGRAMME ON ENVIRONMENT AND HEALTH IN THE SLOVAK REPUBLIC THE EFFECT ENVIRONMENTAF SO L FACTORS ON THE HEALTH STATUS OF THE POPULATION EASTERE TH N I N SLOVAKIA LOWLAND WORLD HEALTH ORGANIZATION REGIONAL OFFIC EUROPR EFO E EUROPEAN CENTRE FOR ENVIRONMENT AND HEALTH BILTHOVEN DIVISION Kfi2(- Copyrigh Worl) (c t d Health Organization 1993 The contents of this restricted document may not be divulged to persons other than those to whom It has been originally addressed. It may not be further distributed nor reproduced In any manner arid should not be referenced In bibliographical matter of cited. Environmental pollution in some regions of Central- and Eastern Europe has reached the point where the datsufficiene aar indicato t t e thahealte th t f theiho r inhabitant s deterioratedha s linn I .e wite hth recommendations stemming from the WHO European Charter for Environment and Health, the WHO Regional Offic Europer efo , throug Europeae hth n Centr Environmenr efo Healthd tan , foster Dialogue sth e betwee respective nth e national authorities responsbt environmentar efo l managemen publid an t c health administratio nationale th t na , regiona locad lan l level. Through a Trust Fund arrangement with the Government of The Netherlands, technical assistance activities are carried out by the European Centre for Environment and Health in the form of National Integrated Programme Environmenn so Healtd an t h with Poland Czece th , h Republic Slovae th , k Republid can Hungary. The National Integrated Programmes are addressed to: * establish more reliable linkages between environmenta lhealt factore th f d ho san affected population groups; * improv qualite eth monitorinf yo g dat foo soin ad o dlan contamination through interlaboratory test unified san d analytical methodsd ;an * train chronic disease epidemiologists to deal with the major environmental health problems arising from exposure to environmental contamination. For further informatio Nationae th n no l Integrated Programme Environmenn so Healthd tan , please contact: HeinrichW.Wyes Programme Manager Bifthoven WHO European Centre for Environment and Health, Bitthoven Division P.O. Box 1 3720 BA Bathoven The Netherlands (tel. +31-(0)30-29532 +3x 1fa 4 / -(0)30-294252 ) The attached report was supported by a Grant of the WHO-EURO European Centre for Environment and Health within the framework of the National Integrated Programmes on Environment and Health in countries of Central- and Eastern Europe. Specialized Institute of Hygiene and Epidemiology in Kosice The Effec f Environmentao t l Factore Healtth n o sh Statuf o s Population in the Eastern Slovakia Lowland Information about the current' knowledge Submitted: MUDr. Ol'ga IVANOVA head of the SIHE Kosice e SIPEe basith th f Hn o Reasos o WH : On programme : SeptembeDate r 1992 I LISRARY, !?JTERNAT!ONAL REFERENCE { CENTRE FOR COi.ittUXH 1 WA'I ER SUPPLY \ AMD G/M.-n'ATiC* . 1 i.ilvJ) |: P.O. Cox ^3iCO. 2^G2 AD Tlie Haguo .f- { Tel. (070) 8143)1 ext. H41/142 ,': i| The effect of environmental factors on the health status of population in the Eastern Slovakia Lowland Information about fulfilment according to the universal frame September 1992 I. General Data . Goals1 : - to identify the chosen risk factors in working conditions of the plants Chemko Strazske and Bukoza Vranov as well as thos n livini e g condition e Easterth f o ns Slovakia Lowland population. o estimatt - e thei e rpeopl th par n i et health status, o determin-t : e character, measur d rangan e f environmentao e l pollutio e Easterth n i n n Slovakia Lowland (ESL) o propost , e directed precautions for protection of people health and to determine their priority, to improve the methodology of epidemiologic examinations, ecological sanitary monitoring, analytical techniques and information system. 1.1. Characteristic e territorth f o s y e EasterTh n Slovakia Lowland represent n importana s t parf o t East Slovakia regarding the hygienic point. Administratively, ESL belongs inte districtth o s Michalovce(Mi), TrebiSov (Tv), Vranov nad Toplou (Vv d Humennan ) e e district(Hn) th e are f Th .o a s i s L represent ES f whico e t th hou 5,38, s m abouk 7 t? 1,60, i.e m .k 0 2 30 % predominantly in southern part. 416,000 inhabitants live in these districts e rangTh . e mountains Nizke Beskyd d Vihorlaan y t in the north and Slanske vrchy (hills) in the west demarcate the lowland. The lowland continues towards the east and south across e frontierth s CSF o Transcarpathiat R n Ukrain d Hungaryan e . Originally swamp d floodean y d territory with high numbef o r streams (Topl'a, Ondava, Laborec, Uh, Latorica, Bodrog, Tisa) was the region with endemic incidencf 50'so d .en f malario e e th y b a The large hydromelioration treatments (realized till now) and transformatio o intensivt n e utilizatio f agriculturao n l soil create^here the second most important agricultural region in Slo- vakia .Important centre f recreatioo s n near water also arose'(Zemp- - 2 - linska Sirava, Vinianske e nealak th s wela res a lbasi n Vel'k- Do a masa). Within the 50's and 60's the plants of chemical and wood in- dustry (Chemko Strafske, Bukoza Vranov, Chemlon Humenne) began to b ee centrabuilth n i t l part alon e riverth g s without appropriate hygieni d ecologicaan c l precaution r environmentafo s l protection. Besides air pollution (dust, S09, NO , mercaptanes, formaldehyde, PAU, benzene) also a wide contaminatiotm A n of water, soil as well as food-chain with pollutants especiall f organio y c origi - polychlon - rinated biphenyls (PCB), formaldehyde, nitrogenous compounds and others occurred. Early in the 70's a large energetic source for solid fuel and e mazuPoweTh - rt plan - Vojant y m higwit 0 hh30 chimneyd an 0 20 s was built here, too. Contamination of water and soil with agrochemicals and from animal production appears to be of great importance. For the pollutant spreading it is important that predominant direction of wind is from the north, above sea level rapidly drops from the north towards the south (Streda nad Bodrogom - the lowest region in CSFR), and rivers flow from the north and east towards the south. e presene basith Oth nf o st data about risk factor n livini s g and working condition f ESLo se chosw ,e regioth e n wher e healtth e h of inhabitants may be unfavourably influenced by the specific risk from industrial and agricultural production, i.e. exposed region, and that where these risk t expectedfactorno e ar s , i.e. compara- tive region. See the map. Exposed region represents a larger part of the districts Trebisov and Michalovce and the southern parts of the districts Vranov nad Topl'o d Humenne e an regiou th n I n. 9 townsther e 8 villagear e12 , s with about 252,400 inhabitants. Comparative regio s situate i ne north-easth n i d e district th par f o t t Michalovce - the area surrounding the town Sobrance. In this region 1 townther e 4 village5 ar ,e s with about 29,200 inhabitants. 1.2. Above 416,000 inhabitants 4 districtliv n i e s reaching into the ESL territory. In exposed region there are about 250,000 in- habitants, what represente totath f lo numbet sou f abouo % r 1 6 t inhabitants of the given districts. - 3 - 1.3e compleTh . x clinal-epidemiologica le peopl studth f o ey health statu n thii s st beeregiono ns donha n e yet. Partial monitoring performed by the former district and regional authorities, IPS (medical second opinio s welna s compariso a boardlS H e d th an ) f o n data published by the medical statistics show especially: - higher incidence of congenital developmental diseases (e.g. Potter's syndrome), - nitrate methemoglobinemia in infants, - increas e incidencth n i e f tumorouo e s diseases, - higher incidence of respiratory disease (a chosen set of children from the town Strazske situated close to the Chemical works - Chemko Strazske. B findingPC e n Th humai s n mild biologicaan k l material- in s dicate the relationship of people expcsurecto PCB in their envi- ronment . e seconth 1.4 n I d.e projecstagth f o t eshouli t e focuseb d : on d a) introducing a monitoring system of air pollution (non- specifi d specifian c c contaminants), - directed monitorin f contaminatioo g f watero n , soid an l foodstuffs with foreign substances (PCB, metals, metalloids, nit- rogenous compounds) as well as the presence of substances with bio- positive e healtactioth n n thesi o hn e environmental factors (e.g. selenium, etc.) b) - directed monitoring of the life way of inhabitants (nutri- tion, alcohol, smoking) - Continuatio ) c d heav n monitorinan i n B y PC - metal hu e n th gi s man milk, biological and necroptic materials, - continuation in monitoring the health status of inhabitants with more detailed view to the diseases given in item 1.3. 2. 0. Methods e firsth 2.1 n tI r .study phasou e socio-demographif o th e, c data, dat n environmentao a l pollutio e healtth d han n statu f inhabitanto s s have been used. The socio-demographic data were obtained from individua- de l partments of the Sloval Statistic Office and Institute of Medical Informatio d Statisticsan n . e numbe th e dat Th n f e inhabitantpreseno o arth r fo t e proar s - - 4 - claimed preliminary result r 1991fo s .