2. WHO European Centre for Environment and Health From Environment to Environment & Health indicators: Status & challenges Michal Krzyzanowski Dafina Dalbokova Rokho Kim WHO ECEH Bonn Office http://www.euro.who.int/EHindicators

3. WHO European Centre for Environment and Health From ENVIRONMENT To Environment and HEALTH Indicators

4. WHO European Centre for Environment and Health Challenges for Envirnment and Health Information System: Simple message on a complex issue Scientific uncertainty Reporting overload Diversity of sectors involved

5. WHO European Centre for Environment and Health Sources of information support to decision making Evidence on causalityPoorGood Research Monitoring

6. WHO European Centre for Environment and Health Development of EG IS in Europe: WHO approach Declaration CEHAPE

7. WHO European Centre for Environment and Health Development of EG IS in Europe Ministerial Declaration, § 16d  Set up decision making process for selection and approval of system elements  Establish international steering mechanism  Develop and update methodological guidelines; capacity building  Establish a network based on local / national / international organizations, building on existing infrastructure Declaration, § 16e: tasks of MS, WHO, EEA, EC, UNECE, UNEP…

8. WHO European Centre for Environment and Health Development of EG IS in Europe  International mechanism for selection and approval of system elements supported by the Member States EHIS WG: 10 Nov 2004  A network active in the Region  Guidelines for a core set of indicators; - Development of EH indicators for EU countries (ECOEHIS) (2002-4) - Establishment of EH Info System in Europe: ENHIS (2004/5) & ENHIS2 (2005/7) (CEHAPE!!)  Progress report: IG Conference 2007

9. WHO European Centre for Environment and Health Evidence Reporting Indicators Elements of EHIS

10. WHO European Centre for Environment and Health EH indicators recommended by ECOEHIS DPSExEffA Air quality 31511 Noise111 Housing1 4 4 /1 1 1 /1 Traffic accidents 12 2 2 /1 Water & sanitation 1211 Chemical safety 13 Radiation11 Recommended for EC Health Indicators core set Recommended for WHO implementation

11. WHO European Centre for Environment and Health What is (magnitude of) environment-related health problems? When to act and how? Health benefits of interventions? Costs of interventions? Are policy measures effective? How to meet EU-obligations? Questions of policy-makers

12. Annoyance by certain sources of noise in Sweden 1999 NMHS31. Have you during the last 3 months been annoyed by any of the following inside or in the vicinity of your home? Noise from neighbors Road traffic noise Railway traffic noise Aircraft noise Industrial noise Ventilation noise Other noise sources Entertainment noise Yes (at least 1/week) Yes, but less often No, never 5%10%15%20% Men Women x x x x x x x x Any of the above

13. Arlanda airportEurope Stockholm County Arlanda 65 dBA 60 dBA 55 dBA 50 dBA Sweden Stockholm County Märsta Stockholm city

14. Prevalence of hypertension and aircraft noise level (FBN) <50 dBA 50-55 dBA55-60 dBA >60 dBA *Adjusted for age, sex, smoking, and educational level 1.1 (0.7-1.9) 1.5 (0.9-2.5) 2.0 (0.8-5.3) 1.0 OR*

15. How big is the problem? Estimates for The Netherlands (RIVM)

16. Whre to act?

17. Are policy measures effective: example noise

18. How are NL doing in comparison ? NL lowest % exp. to road traffic noise < 60 dB(A)? Different methods  differences in predicted noise levels up to 10-15 dB(A) Harmonisation at EU level under way Will be added to WHO- EHIS in future

19. WHO European Centre for Environment and Health Noise and health: Exposure indicators recommended for ECHI Noise_Ex1 Population exposed to various noise levels (Lden and Lnight) by different sources European directive 2002/49/EC for environmental noise: - maps of Lden (day-evening-night level) and Lnight (night level) - maps: the number of people located in areas exposed to nois - maps to be produced by June 30, 2007.

20. Premature mortality Hospital admissions Emergency room visits Visits to doctor Restricted activity/reduced performance Medication use Symptoms Impaired pulmonary function Sub clinical (subtle) effects Severity of health effect Proportion of population affected Air pollution health effects pyramid (ATS) Age

21. Birth10203040506070 80 Age (years) Not to scale Level below which symptoms occur I II IIIIV Development of lung function with age I: normal development II: development affected by an external factor (e.g. air pollution)

22. WHO European Centre for Environment and Health Air Pollution and Health: indicators Population exposure to PM10 Loss of LE preventible by 10% reduction in PM

23. 7000 8000 9000 10000 11000 12000 Car-kilometers/person 20000 25000 30000 35000 40000 Petrol consumption 0 10 20 30 40 Population weighted PM 10 /  g.m -3 199619971998199920002001 Year Car-km/person Petrol use PM 10 TRENDS IN CAR USE, PETROL CONSUMPTION & PM 10 LEVELS "Eco tax" “ECO TAXATION”, GERMANY ?

24. WHO European Centre for Environment and Health Source: Pope et al, JAMA 2002 Long term exposure to PM and risk of mortality in ACS cohort TFH 2003: “..apply the relative risk for all cause mortality… in the extended American Cancer Society (ACS) cohort study Pope et al. (2002).”

25. The health benefits of a ban of coal sales in Dublin

26. Anthropogenic contribution to PM2.5 2000 2020 Rural concentrations, Annual mean [µg/m3] from known anthropogenic sources excluding sec. org. aerosols Emissions for 2020, no further climate measures, Average meteorology for 1999 and 2003, Source: EMEP Eulerian model MSC-W

27. Loss in life expectancy due to PM2.5 No cut-off assumed Loss in average life expectancy (days) Mean meteorology 2000 2020 Source: IIASA

28. WHO European Centre for Environment and Health Exposure to air pollutants: indicators erecommended for ECHI AIR_EX1_PM 10 : population-weighted annual mean PM 10 concentration AIR_EX1_PM 2.5 : population-weighted annual mean PM 2.5 concentration AIR_EX1_O 3 : population-weighted annual mean ozone concentration AIR_EX1_NO 2 : population distribution of number of hours exceeding AQ limit values for NO 2 in urban areas (EEA AP13) AIR_EX1_SO 2 : population distribution of number of days exceeding AQ limit values for SO 2 in urban areas (EEA AP11)

29. Drinking water quality Access to safe drinking water Water borne disease Drinking water quality and health

31. WHO European Centre for Environment and Health Water and Sanitation: indicators erecommended for ECHI WatSan_Ex1 Safe drinking waters: Population connected to public water supply (EUROSTAT) WatSan_S2 Drinking water compliance Proportion of the drinking water samples analysed which fail to comply with the EU Directive on the quality of water intended for human consumptionrefers to regulated public water supplies

32. WHO European Centre for Environment and Health Conclusions Focus on Exposure – Effects -Actions Start with existing data Develop evidence-based messages EEA-USEPA Workshop 27-28 Sept 2004 From Environment to Environment & Health indicators: Status & challenges