1. International Conference of the Central and Eastern European Chapter of the International Society for Environmental Epidemiology, Celadna, Czech Republic, 26-29 November 2007 Development of Environmental Health Information System in Central and Eastern Europe Dafina Dalbokova World Health Organization Regional Office for Europe On behalf of ENHIS project group

2. International Conference of the Central and Eastern European Chapter of the International Society for Environmental Epidemiology, Celadna, Czech Republic, 26-29 November 2007 This presentation: Development of European EH Information System (ENHIS): highlights Assessment of children’s EH by CEHAPE RPG: situation in Central and Eastern Europe and need for a system Next steps and actions needed to advance the EH information system in Central and Eastern Europe Development of Environmental Health Information System in Central and Eastern Europe

3. ENHIS – European EH information system: partners The product of EC-DG Sanco co-sponsored projects: ENHIS (2004 - 5) (SPC2003112) ENHIS 2 (2005 - 7) (SPC2004124)

4. International process to develop EH Information System in Europe, 2004-2007  Defining the scope of the system  Covering four CEHAPE RPGs  Focus on health related exposures, health effects and actions  Screening for:  policy relevance  scientific evidence  feasibility  Development of methodological guidelines  Testing of methodology  Evaluation of the process by the MS  Implementation EC-DG Sanco co-sponsored projects coordinated by WHO:  ENHIS (2004 - 5) (SPC2003112) – 12 partner MS  ENHIS 2 (2005 - 7) (SPC2004124) – 20 partners from 19 MS Eight key meetings (18-29 MS represented) Progress reports to EC H&E Working Party and EEHC

5. ENHIS was launched at the Intergovernmental Mid-term Review meeting between the Fourth and the Fifth Ministerial Conferences on Environment and Health (Vienna, 13-15 June 2007) Endorsement and support from the MS

6. Children exposure and health effects: main linkages Air pollution Unsafe water and sanitation Chemicals and heavy metals Physical agents Unsafe housing Mobility and transport Child labour Respiratory diseases Gastrointestinal diseases Neurodevelopmental disorders Cardiovascular disorders Cancer Injuries Effects on reproductive health ? ? Scope of the ENHIS information: evidence on the linkages & the interventions CEHAPE Regional Priority Goals I,II,III,IV

7. Core set of indicators: Country coverage and data sources RPG1 Case studies Eurostat WHO/ UNICEF JMP DG Env; EEA RPG2 WHO MDB WHO HBSC ENHIS Survey RPG3 ISAAC WHO MDB EEA AirBase GYTS Survey Eurostat (SILC) World Health Statistics WHO Tobacco DB RPG4 ACCIS IARC GLOBOCAN WHO POP Survey EU SCOOP project Case studies EC DG JRC Eurostat ENHIS Survey

8. European EH information system products Methodology for 26 core indicators International and national data bases Data from surveys Analysis and assessment (including HIA) 26 FACT SHEETS http://www.enhis.org http://euro.who.int/document/E90767.pdf

9. Building EH information base: indicator fact sheet Standardized format (4 pages) Sections: Indicator name, definition Key message & rationale 1-2 charts (with description) Health and environment context Policy relevance and context Assessment (including HIA) Meta-data (data-about-data) References Sections available on the WWW PDF printout available Updated with new/ more info Effective use and re-use of information

10. ENHIS web: options for access to data/ information Health Impact Assessment Environmental Burden of Disease estimates by country www.who.int  Environment and health issues  Health effects of the environment  Country profiles  Environment and health policy  Methods and tools  Links

11. ENHIS web: country profiles

12. WHO Environmental Burden of Diesease (ENHIS):

13. International Conference of the Central and Eastern European Chapter of the International Society for Environmental Epidemiology, Celadna, Czech Republic, 26-29 November 2007 This presentation: Development of European EH Information System (ENHIS): highlights Assessment of children’s EH by CEHAPE RPG: situation in Central and Eastern Europe and need for a system Next steps and actions needed to advance the EH information system in Central and Eastern Europe Development of Environmental Health Information System in Central and Eastern Europe

14. EH situation assessment 2000-5: CEHAPE RPG I  Access to public water supply: for <40% of population of rural areas of some MS  House connected to sanitation facilities: <50% of population in rural areas of some MS CEHAPE RPG I: Gastro-intestinal diseases and safe water and sanitation

15. EH Situation 2000-5: CEHAPE RPG I Waterborne outbreaks recorded in Finland, 1980-2004 compulsory monitoring Role of improved surveillance and monitoring: Reveals under-reported morbidity Reduces risks Bathing water quality in Portugal: 1995-2005 No harmonized surveillance of water-borne diseases -> case examples; Only Croatia child-specific

16. EH situation assessment 2000-5: CEHAPE RPG II EH situation assessment 2000-5: CEHAPE RPG II Non-traffic related injuries in early childhood:  Over 75,000 deaths per year  >10x disparities in death rates between MS  Large differences between MS in causes – use info to focus risk reduction Policies can reduce the risk CEHAPE RPG II: Injuries and physical activity by supportive and safe environments

17. EH Situation 2000-5: CEHAPE RPG II Road traffic related injuries, age <25:  Over 32,000 deaths per year  >5x inequality in death rates between MS

18. EH situation assessment 2000-5: CEHAPE RPG II Physical activity:  Excess body weight & obesity: in 5% to 35% of children  Over 50% of children not sufficiently active  Policy implementation varies among countries Degree of implementation of 12 policies to reduce excess body weight and obesity in children, 2005 - 2006

19. EH situation assessment 2000-5: CEHAPE RPG III Respiratory diseases in children:  Asthma: prevalence >15% in many MS  ARI mortality – 100x differences between the MS Post-neonatal ARI mortality (log scale) CEHAPE RPG III: Respiratory diseases and outdoor and indoor air quality

20. EH situation assessment 2000-5: CEHAPE RPG III Exposure to outdoor air pollution (particles)  PM10 level > AQG for 90% children in WHO/Euro  No improvement in urban air quality in the current decade  No data on air quality for 43% of population in the Region

21. EH situation assessment 2000-5: CEHAPE RPG III Indoor air exposures Environmental Tobacco Smoke  Over 50% children exposed to ETS at home  No data on children exposure to ETS in West  Policies to reduce children’s exposure to ETS in public places exist in most MS but smoking ban still insufficient Proportion of WHO/Euro MS implementing policies to reduce exposure of children to ETS

22. EH situation assessment 2000-5: CEHAPE RPG III Indoor air exposures (cont’d) Current exposure to ETS contribute to an additional 10,380 asthma attacks in a city with 20,000 children aged 0-14 yrs and 3% of asthma prevalence and 300 asthma attacks per child x year Mould and Dampness No data on exposures in the school environment!!

23. EH situation assessment 2000-5: CEHAPE RPG IV Melanoma incidence rates (age <55) high in N and W Europe Implementation of actions to reduce children excessive exposure to UV in 26 MS CEHAPE RPG IV: An environment free of hazardous chemicals and other hazards Excessive exposure to UV

24. EH situation assessment 2000-5: CEHAPE RPG IV Exposure to hazardous chemicals  Decrease of lead exposure due to un- leaded fuels (but plumbing and local industries continue to be of concern)  POPs exposure – the lowest safety margins – monitoring is warranted Dioxins in human milk Pb in blood Implications for human bio-monitoring

25. Children’s health and the environment in Europe: Main messages Health-related environmental conditions around 2004-5: Big inequalities in health and exposure: – between various parts of the European Region of WHO – between various population groups within the Member States Substantial differences in policy addressing the risk Data availability:  International reporting (WHO, EEA, EUROSTAT) facilitates access of MS to the standardized data for national and international analyses  Improved surveillance reveals „unnoticed“ problems  Internationally coordinated population-based surveys are important source of the most relevant data The need for a system in CEE

26. International Conference of the Central and Eastern European Chapter of the International Society for Environmental Epidemiology, Celadna, Czech Republic, 26-29 November 2007 This presentation: Development of European EH Information System (ENHIS): highlights Assessment of children’s EH by CEHAPE RPG: situation in Central and Eastern Europe and need for a system Next steps and actions needed to advance the EH information system in Central and Eastern Europe Development of Environmental Health Information System in Central and Eastern Europe

27. On the horizon - 2009 Fifth Ministerial Conference on EH (Rome, fall 2009) Maintenance of the system -> its ability for policy monitoring & evaluation Improvement of geographical coverage (53 WHO/EURO MS) National extensions of the system (sub-national data; country-specific indicators) & of the EH information network (incl. extension within countries) Extension of thematic scope to address emerging issues (e.g. climate change)

28. European Environmental Health Information System: integrating regional and local level Population groups Adapted from CIHR-IPPH conceptual framework of population health, Annu. Rev. Public Health, 2006, 27 Scale International & National Local Generic Specific EH risks Web-based, secure information system that exists at the local, regional, and national/ international levels  System consisting of distributed information systems & a network  Enhance the use & re-use of existing data

29. ENHIS Network – Important system resource Responsive partner institutions –mechanism for transfer of knowledge to the MS  Several national workshops on ENHIS: e.g. Slovakia, Spain, Hungary, Czech Republic …  Increased capacity in preparation & use of EH information in policy debate in a national context -> 10+ national indicator fact sheets under way  Maintaining communication links getting “everybody on the same page”; ENHIS SharePoint: e-networking & common info space  Member States consider advancing national systems building on ENHIS with network as important resource (possible proposal in early 2008 under EC health action programme 2008-2013) Join the ENHIS network!!

30. Activities & needs to advance national EH information systems: together we can make it!! Evaluating of the prospects for development of national EH information systems using the WHO/ ENHIS methodology Mapping your own country needs in strengthening public health capacities -> tailor WHO activities both on technical & policy site Looking for mechanisms and resources for joint technical projects Initiated effort on farther transfer of the system in South East Europe (WHO meeting, Bucharest, 12-13 November 2007) Necessary actions: Take an active part in creating a national EH information network (incl. your country ENHIS partner) to link people, projects, institutions to the ENHIS one WHO:

31. Activities & needs to advance national EH information systems: together we can make it!! Necessary actions: Stimulating the academia work on system improvement, a.o. conducting studies using routine indicators and data Capacity building: introducing EH surveillance in the academic curricula Intervention studies and accountability research Human bio-monitoring to improve our knowledge of H-E links Remote sensing for environmental monitoring and GIS Research:

32. International Conference of the Central and Eastern European Chapter of the International Society for Environmental Epidemiology, Celadna, Czech Republic, 26-29 November 2007 Thank you

33. Background information about the System Overview of children’s environmental health indicators

34. Children vulnerability to environmental hazards Unique exposure pathways Transplacental Breastfeeding Exploratory behaviours leading to exposures Hand-to-mouth, object-to-mouth Non-nutritive ingestion Stature and living zones, microenvironments Location – lower to the ground High surface area to volume ratio Children do not understand danger Pre-ambulatory Adolescence – “high risk” behaviours