Health and Environment PAHO-UNEP Cooperation and the Regional Agenda 11 March 2014 Side event at the Forum of Ministers of Environment of Latin America and the Caribbean

Public Health and the Environment - Framing PAHO-UNEP Cooperation with MS - “Health is a precondition for and an outcome and indicator of all three dimensions of sustainable development” (UNCSD “Rio+20”, The Future We Want) Environmental determinants of health can be natural or anthropogenic, physical, chemical, biological, and ecological 24% of the years lived with disability, and 23% of premature mortality are attributable to the environment. (Pruss-Ustun et al, 2006, Lim SS et al., 2012) Risks are socioeconomically determined: half of infant deaths and 46% of total maternal deaths in the Region are concentrated among the third of countries with the lowest access to piped water. (PAHO, 2012) Our changing environment: 63 LAC cities have one million or more inhabitants; 38 of them are in areas at greatest risk for at least one type of natural disaster; six are in areas at greatest risk for two types; and two are in areas at greatest risk for three or more types (PAHO, 2012) Mining activities doubled or tripled in various countries between 2001 and 2011, contributing as much as 11% to 27% of national GDP (ECLAC, 2012), increasing health risks.

Objectives and areas of PAHO-UNEP cooperation Objective: Develop stronger links between environment and health in policy and planning, including in the work of PAHO and UNEP and ministries of health and environment PAHO, UNEP, the Organization of American States (OAS) and other partners supported the Health and Environment Ministers of the Americas (HEMA) process, initiated in 2002 –Participated in Task Force of senior health and environment officials, which agreed on a set of concrete actions in line with 8 priorities and 12 goals identified by the HEMA meeting in Ottawa in 2002 –Follow up to Declaration of Mar de la Plata 2005 (three priority issues: integrated management of water resources and solid waste; sound management of chemicals; and children´s environmental health) GEO Health methodology developed and tested in Brazil and Argentina Areas of cooperation—recent or under development: –Chemicals –Air pollution –Climate change

Chemicals: UNEP-PAHO GEF DDT project – ext 2011 Objectives To prevent the reintroduction of DDT for malaria control through the demonstration and evaluation of alternative and integrated methods of vector control that are cost effective, replicable, and sustainable. Participants Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama Results: Participation of 202 communities in 52 municipalities, mostly indigenous; Sustainable strengthening of disease surveillance, with 63% reduction in malaria cases – some malaria free communities; tons of DDT and other POPs repacked or incinerated. High impact project, as the methodologies tested in the project were instrumental to design similar UNEP projects in Asia and Africa.

Chemicals: Total Diet Studies in Panama Government of Panama, PAHO, UNEP, UNDP, FAO, WFP Intensive agrochemicals use in Central America: food is one of the main sources of chemical exposure Total Diet Studies take into account average diet, and chemical concentrations in different components of it They can support science-based and appropriate regulations and/or recommendations for the food industry Project aims to develop national capacity, and serve as a case study for possible replication by other countries Results due to be published in mid 2014

Chemicals: Mercury Implementing the Minamata Convention The Convention recognizes the role of WHO in the preamble. Diplomatic Conference resolution on the Convention invites WHO to support implementation of the Convention. WHO Executive Board recommended the 67th World Health Assembly in May 2014 to pass a resolution on the role of WHO and Ministries of Health in implementation of the Convention. Greening the health sector – phasing out the use of mercury Artisanal and Small-Scale Gold Mining (ASGM)

Air Pollution and Health Indoor air pollution from the use of solid fuels is the leading environmental risk factor worldwide, and the fourth overall risk factor for burden of diseases. (Pruss-Ustun et al, 2006, Lim SS et al., 2012) –Solid Fuel Use social gradient: 58.2% of the population exposed to solid fuels is concentrated in the lowest quartile of HDI, while 5% was concentrated in the highest quintile of HDI. Rural/urban rate is 2.3 in the lowest HDI quartile and 11.7 in the highest quartile of HDI, respectively; Air pollution is the second leading environmental risk factor, being the ninth overall risk factor for burden of diseases (cancer was not included in the estimates). (Pruss-Ustun et al, 2006, Lim SS et al., 2012) –Most of the large and medium-sized cities of the Region, and some capital cities, do not have air quality monitoring networks ( PAHO, 2012). –It is estimated that more than 100 million inhabitants are exposed to concentrations of environmental contaminants exceeding the recommended level in WHO air quality guidelines. –The GBD2010 attributes a quarter of a million premature deaths per year in the Region to ambient air pollution.

Regional Action Plan on Air Pollution Proposal presented to this session of the Forum, prepared by Clean Air Institute (CAI) and Mexico´s National Institute of Ecology and Climate Change (INECC) with contributions from experts in Regional Intergovernmental Network on Atmospheric Pollution Includes objectives, strategy, priority pollutants, and strategic actions in different sectors (transport, bricks, biomass for cooking, power plants, oil and gas, solid waste and wastewater, agriculture, forestry and livestock, and others) Medium term goals including: –Goal 1 (4 years): “100% of countries in the region have adopted national standards for air quality in direction to WHO guidelines, and/or harmonization processes” –Goal 4 (8 years) “Reduce the growth rate of the population exposed to levels of particulate matter above the limits set by WHO”

WHO Air Quality Guidelines For each 10 µg/m 3 increase of PM 10 there is an estimated excess or risk of death of 0.7% in Mexico City, Santiago and São Paulo (HEI, ESCALA) National Air Quality legislation present in 19/23 countries; no information from 12/35 countries Most countries in LAC do not follow WHO AQG

Climate change Cooperation on this theme within the framework of the Strategy and Plan of Action on Climate Change and Health in the Americas International Seminar on Climate Change and Health, Mexico, 4-6 Sept 2013 –Representatives from Ministries of Health and Environment from more than 15 countries in Latin America and the Caribbean Development of a virtual community of practice for knowledge exchange on climate change and health (REGATTA programme) –Moderated by the Mexican Institute of Public Health –To be launched late March 2014 Project on raising public awareness of air pollution and climate change in Mexico City –Builds on the Mexico City Programme of Action on Climate Change –Components include: Strengthening the science base Creation of capacities Communications campaign Public policy recommendations

Health and environment in the ILAC framework A number of health and environment issues reflected in current ILAC framework: air and water pollution, sanitation, urban green space, renewable energy THEMATIC AREAOBJECTIVESPECIFIC OBJECTIVE 2. WATER RESOURCES MANAGEMENT 2.4 Improve the quality of terrestrial waters Improve the quality of effluents and reduce the discharge of pollutants to surface and underground water bodies and to coastal areas 3. VULNERABILITY, HUMAN SETTLEMENTS AND SUSTAINABLE CITIES 3.3 Reduce air pollution3.3.1 Reduce the concentration of polluting emissions in the air 3.4 Reduce water pollution Widen the coverage of water supply and waste water treatment 3.5 Integrated management of solid waste Reduce the generation of solid waste (from domestic and industrial sources) and promote recycling and reuse Implement integrated management of solid waste, including treatment and adequate final disposal. 4. SOCIAL ISSUES, INCLUDING HEALTH, INEQUITY AND POVERTY 4.1 Reduce the prevalence of HIV / AIDS and morbility due to illness related to the environment Implement integrated measures to control and reverse the spread of HIV/AIDS, including the development of coordinated approaches for research, education, treatment and access to retroviral pharmaceuticals Implement policies and plans to reduce environmental risks that cause health problems, especially waterborne diseases, vectors, airborne diseases and those borne through exposure to chemical substances Increase the proportion of green and healthy areas per capita 5. ECONOMIC ISSUES, INCLUDING TRADE AND PATTERNS OF PRODUCTION AND CONSUMPTION 5.1 Increase the use of renewable energy Include at least 10% of renewable energy in the energy matrix of the region by Increase clean production5.2.1 Install Cleaner Production Centres in all countries of the region

The way forward Pos 2015 and the SDGs Inter-agency and multisectoral collaboration is key to implement the Regional public health and the environment agenda Public health and environment indicators are essential to measure the SDGs Identify the health co-benefits & risks in environmental policies Focus on policies/investments that are beneficial to health and equity; Example: policies to mitigate climate change and air pollution Knowledge needed: improve data on air quality; relative contribution of different sources of pollution; evidence on the effectiveness of interventions; strengthen systems to collect and analyze local environmental and health data to inform trends and impact of policy measures; improve methods to estimate emissions where exposure is not measured