Data collection to monitor progress towards goals set at the 5th Ministerial

Conference on Environment and Health

Andrey Egorov

European Centre for Environment and Health

World Health Organization, Regional Office for Europe

13th session of the Working Group on Environmental Monitoring and Assessment, UNECE

2 November 2012

Geneva, Switzerland

5th Ministerial Conference on Environment and Health (Parma, Italy, March 2010)

• Decided to establish European Environment and Health Ministerial Board (EHMB) and Task Force (EHTF)

• Adopted Commitment to Act:– A. Protect children from EH risks

• RPG 1 Water and sanitation• RPG 2 Obesity, injuries, physical activity• RPG 3 Outdoor and indoor air quality• RPG 4 Chemical, biological and physical environ.

– B. Protect health from climate change– D. Develop knowledge and tools for policy making:

9. …develop indicators

11. Develop consistent approach to human biomonitoring to assist evidence-based public health measures

European Environment and Health Information System (ENHIS)

• Country level indicators• Exposure• Health effect• Policy action

• Existing data sources• Further development

• Sub-national data• New surveys – data warehouse• Russian language

www.euro.who.int/enhis - publications, meeting reports, archive of indicator fact sheets http://data.euro.who.int/eceh-enhis - new indicators, interactive IT platform

RPG 3. Preventing disease through improved outdoor and indoor air quality

i. Decrease the incidence of respiratory diseases through reduction of exposure to ultrafine particles and ground level ozone

iii. Provide each child by 2020 with healthy indoor environment in child care facilities, kindergartens, schools…, implementing WHO’s indoor air quality guidelines and… ensuring these are smoke-free by 2015.

New indicators and data collection tools• Nov 2010 (Bonn) – preliminary list of recommended indicators

• Apr 2011 (Bonn, co-funded by Joint Research Centre, EC) – indoor air quality indicators and school survey design

• Sep 2011 (Bonn) – detailed methodologies of data collection

– Climate change indicators from the EC-funded Climate, Environment and Health Action Plan and Information System (CEHAPIS) project

• Apr 2012 (Catania, Italy – funded by the Sicilian Regional Government) – design and methods of an HBM survey in maternities

• Extraordinary 2nd meeting of the European Environment and Health Task Force (May-June 2012, The Hague, Netherlands)

• Oct 2012 (Bonn) – organization of data collection for Parma follow-up

Technical meetings in Bonn were supported by the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety of Germany

New indicators using existing data sources

– Existing international or national databases:• urban population exposure to ground level ozone (EEA, EUROSTAT)• urban exposure to noise and its health effects (EEA, EUROSTAT)• urban population exposure to PM10 and PM2.5• incidence of hepatitis A in children • Lyme borelliosis incidence

– Policy surveys (national EH focal points)– National or local data requiring processing and analysis:

• access to public green spaces in cities (GIS analysis)• population vulnerability to floods and population exposure to actual floods

(GIS analysis)• exposure to allergenic pollen (pollen monitoring + population data) • exposure to and mortality from heat waves (analysis of daily mortality data)

Exposure assessment survey in schoolsSurvey with stratified randomized clustered design– Ventilation rate in classrooms (3 per school)– Exposure to NO2, formaldehyde and benzene in

classrooms (3 per school and outdoor sites)– Exposure to mould/dampness (all school premises)– Smoking in school and on school ground (questionnaire, 3

classes per school) – Access to proper sanitary facilities– Hygiene practices in pupils– Mode of transportation to school

WHO role: – Standardized methodology– Facilitate training and technical assistance to national surveys– International data compilation, data analysis and reporting

Role of Member States:– Implementation of national surveys– Use of results to support the implementation of Parma commitments

Pilot surveys in schools in Albania and Croatia• ALB: 12 schools in 3 clusters• CRO: 2 schools in one cluster• >850 questionnaires from pupils• CO2 and air pollution monitoring in 42

classrooms and at 14 outdoor sites• Major problems identified:

– Low indoor temperature and very poor ventilation in winter (ALB)

– Mould and dampness (ALB and CRO)– Poorly maintained toilets (ALB)– Smoking in schools (CRO)– High benzene levels in few classrooms

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Further survey development

• Coordinated pilot surveys in three Baltic states (Lithuania, Latvia, Estonia) – Jan-Mar 2013

• National survey in Croatia

– Dec 2012-Jan 2013: questionnaires and inspections in ~ 200 schools in 17 areas

– 2013: ventilation and air pollution monitoring in a subset of schools

• Pilot surveys in other countries (2013)

• 1st round of reporting (winter 2013-2014)

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Proposed HBM survey design and list of biomarkers• Randomized clustered cross-sectional survey in maternities

• Contaminated areas/exposure hot spots vs. general population

• Non-invasive sampling (maternal hair and urine, cord blood):

– Hg in maternal hair (and in urine if elemental Hg is an issue)

– Cadmium in maternal urine

– Cotinine in maternal urine (exposure to tobacco smoke)

– Lead in cord blood

– Additional biomarkers for industrially contaminated areas: to be identified using data on emissions and environ. levels

• Plans for further development and application

– Collaboration with the Regional Administration of Sicily, Italy

– UNEP/WHO collaboration on mercury monitoring (proposed)