2. WHO European Centre for Environment and Health Environment and Health Information System: achievements, challenges and future prospects ISEE Central and Eastern European Chapter Meeting 4-6 September, Balatonföldvár, Hungary, 2003 Dafina Dalbokova, Michal Krzyzanowski http://www.euro.who.int/EHindicators

3. WHO European Centre for Environment and Health The WHO EH indicators system  Combines both ‘top-down’ and ‘bottom-up’ approach: useful for the individual countries as well as enables international comparisons  ‘Scalable’ - used at different geographical scales (local, state …)  Takes into account existing international indicator sets  Based on a valid exposure-effect relationship

4. WHO European Centre for Environment and Health D P S E E A Framework and overview of the core set ISSUE/ TOPIC D riving Forces P ressures S tate E xposure E ffect A ctions Air Quality #### ######### ###### # Housing ####### Traffic Accidents #### Noise #### # Waste and Con- taminated lands ### Radiation ## Water and Sanitation ####### #### #### # # Food Safety ##### #### Chemical Emergencies ########## Workplace ###### # http://www.euro.who.int/EHindicators # EH INDICATOR

5. WHO European Centre for Environment and Health EH reporting tools: The EH Indicator fact-sheet Key message EH context Policy context Assessment Effective use and re-use of data and information Standard and clear format of presentation Experiences from pilot MS

6. WHO European Centre for Environment and Health Key message: synthetic and clear description Smiley to help communication Visualization: An information layer!! ‘easy-to –catch’

7. WHO European Centre for Environment and Health  Evidence for health-environment link on the topic/ indicator  Key upstream determinants  Evidence of possibility to risk reduction by active intervention Environmental Health Context:

8. WHO European Centre for Environment and Health  The legal/ policy context associated with the issue/ indicator  The existence of a specific policy target associated with the issue/ indicator  The level/ process (DPSEEA chain) on which the policy/ legislation acts Policy Context: Assessment (i) :  Interlinks within the DPSEEA  Link to ongoing policies (policy context)

9. WHO European Centre for Environment and Health Assessment (ii) causes attributable to Health outcome Exposure  Environmental Health Linkage analyses DPS Ex E A; Indication on policy effectiveness  Health Impacts (‘ideal’) Applying HIA,BoD (caution!!)  Environmental – quantitative targets Monitoring performance – ‘distance to target’

10. WHO European Centre for Environment and Health Policy not implemented Countries, regions Ex1 Exposure Health Impact Estimate Assessment (iii) : an example Needs systematic review and analysis of the policies!!

11. WHO European Centre for Environment and Health Assessment (iv) : Population ‘at risk’ (Pilot EHI project, J. Thelen, UBA, GERMANY) Urban population exposure to PM10

12. WHO European Centre for Environment and Health  Data quality, comparability  Data completeness Data issues Meta-data: data-about-the data To document in a transparent way:  Entire procedure and criteria in choosing the approach Example: air pollution exposure indicator  Data differences To serve monitoring and comparative assessments

13. WHO European Centre for Environment and Health Main meta-data items: Synthetic description of the data set Data source and access: data-provider and access constrains Data collection description incl. statutory requirement Methods of data collection Data coverage: geographical, population Data completeness over time Data quality: QA/QC, representativeness Preprocessing, data manipulation Consistency with WHO definitions, units of measurement A scoring system over ‘quality’ and ‘completeness’ - under development

14. WHO European Centre for Environment and Health Using predefined variables and territorial units Standard” database structure (MS Access 2000) Added functionality to easily import and export data Allows uniform data collection and “easy” access/ exchange by: Allows EH indicators calculation and visualisation ‘EuroIndy’: the EH Indicators Software Meta-data

15. WHO European Centre for Environment and Health Territorial units based on 1 st 3 Eurostat NUTS levels + towns > 100000 inhabitants Indicators are grouped by “theme”and “topic” Data collection 1 ‘field by field’ “metadata”

16. WHO European Centre for Environment and Health (Tabular entry) Data collection 2

17. WHO European Centre for Environment and Health Products for the Budapest Conference: Pilot indicator report: On-going work  four thematic chapters: Tools: web-based EHIS, ‘EuroIndy’ Air pollution and health Water and sanitation Traffic accidents Noise  collection of (inter)- and national EH indicator fact-sheets

18. WHO European Centre for Environment and Health What’s next Mechanisms for data reporting:  Mechanisms for inter-agency co-operation: EEA EIONET Methodological developments: Flexibility: ‘User windows’ on children’s health (CEHAPE)  Policy review and analysis – towards a ‘responsive’ system!  Indicators and assessment mechanisms (e.g. CRA)  From predefined EuroIndy concept towards priority data-flows and shared information infrastructure concept

19. WHO European Centre for Environment and Health Methodological limitations in quantifying EH impacts  health-relevant environmental monitoring;  surveys on living environment, annoyance;  geographical scale: both local and central level;  data access/ exchange with many data-holders. Integrating EH in Public Health reporting – difficult: No comprehensive framework to account for risk prevention; a focus on ‘first-order’ determinants Linking with policies – difficult: multisectorial policies outside health sector Data and information needs: Challenges in EH Indicator Reporting

20. WHO European Centre for Environment and Health

22. Assessment (v) : Composite indicator on ETS policies (Pilot EHI project, WHO – ECEH, Bonn)

23. WHO European Centre for Environment and Health

24. EH indicators are more than depiction of data They are only meaningful as a framework story They must be considered in policy context and their relevance to a concrete measure - specified They summarize the evidence and knowledge on health-environmental linkages in a meaningful and measurable way that is amenable to action

25. WHO European Centre for Environment and Health D P S E E A The DPSEEA cause-effect framework What is the problem? - in health terms What/who is causing it? - economic activities, sectors Is the problem being solved? - what has been done? - is it effective?

26. WHO European Centre for Environment and Health Population X Exposure Population X health status Exposure - Response IMPACT ESTIMATE FOR POPULATION X