COMMISSION OF THE EUROPEAN COMMUNITIES 
Brussels, 04.06.1997 
COM(97) 266 final 
97/0153 (COD) 
COMMUNICATION FROM THE COMMISSION 
concerning a programme of Community action on 
pollution-related diseases in the context of the framework 
for action in the field of public health 
Proposal for a 
EUROPEAN PARLIAMENT AND COUNCIL DECISION 
adopting a programme of Community action 1999-2003 on pollution-related diseases in the 
context of the framework for action in the field of public health 
(presented by the Commission) 

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COMMUNICATION FROM THE COMMISSION 
concerning a programme of Community action on 
pollution-related diseases in the context of the framework 
for action in the field of public health 
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TABLE OF CONTENTS 
page 
I. INTRODUCTION 3 
II. POLLUTION-RELATED DISEASES IN THE EUROPEAN COMMUNITY 4 
III. THE PREVENTION OF POLLUTION-RELATED DISEASES 9 
IV. OVERVIEW OF PUBLIC HEALTH ACTIONS IN THE MEMBER STATES AND 
INTERNATIONALLY CONCERNING POLLUTION-RELATED DISEASES 10 
V. OVERVIEW OF COMMUNITY ACTIONS RELEVANT TO POLLUTION-RELATED 
DISEASES 11 
VI. APPROACH TO COMMUNITY PUBLIC HEALTH ACTION ON POLLUTION-
RELATED DISEASES. 13 
VII. COMMUNITY ACTION PROGRAMME ON POLLUTION-RELATED DISEASES... 15 
VIII. CONSULTATION ASSESSMENT AND REPORTS 18 
I. INTRODUCTION 
1. The protection of health has been made a priority under Articles 3(o) and 129 of the 
Treaty establishing the European Community. The Community's role is to contribute 
towards ensuring a high level of human health protection, directing actions towards the 
prevention of diseases, in particular by encouraging cooperation between Member 
States and, if necessary, lending support to their action, by promoting coordination of 
' their policies and programmes, and by fostering cooperation with third countries and 
the international organisations competent in the sphere of public health. 
2. In its communication of 24 November 1993 on the framework for action in the field of 
public health (COM (93) 559 final), the Commission defined a framework for future 
action at Community level in order to attain these objectives. In accordance with the 
criteria laid down in the Commission communication pollution-related diseases have 
been identified as a priority for Community action in the field of public health. 
3. Pollution-related diseases are those diseases which are caused, provoked or aggravated 
by environmental pollution. In the context of environmental programmes, pollution has 
been defined as an effect on the environment linked to human activities that disturbs the 
absorption and regeneration of the ecosystem. But in relation to public health a more 
limited definition is that pollution is an environmental imbalance or disturbance, man-
made or naturally occurring, which can have an adverse effect on human health. These 
pollutants may be biological, chemical or physical in nature and may be present in air, 
water, soil or food. 
H. POLLUTION-RELATED DISEASES IN THE EUROPEAN COMMUNITY 
4. Environmental pollution has created problems for health throughout the course of 
human history. But the increase of urbanisation and industrialisation and the rapid 
growth of population have led both to greater numbers and concentrations of pollutants 
and a greater number of people exposed to them. As knowledge has grown about the 
impact of pollution on health, so steps have been taken to control pollution and 
improve hygiene and living and working conditions, for example by supplying clean 
water and installing sewage systems in towns. Indeed the improvements in the state of 
health of Member States' populations over the last 200 years owe more to such 
measures than to advances in medical care and treatment. 
5. Today in the European Community many of the diseases linked to poor environment 
and hygiene that were previously rampant, notably infectious diseases arising from 
polluted water, such as cholera and typhoid fever, have been greatly reduced, and in 
many cases virtually eliminated. Although a number of infectious diseases do remain as 
significant threats to health, their place as the major 'health scourges' in the Member 
States has been to a large extent filled by diseases which are caused by an interaction 
between environment, genetics and life style, such as respiratory diseases and certain 
forms of cancer. Long-term exposure to relatively low levels of pollution and acute 
exposure to high concentrations may play a part in such interactions, and different 
pollutants may interact with each other. 
6. Although pollutants contribute to the causation, provocation or aggravation of these 
diseases, and are also associated with effects on health which might lead to subsequent 
disease, the extent of their impact in any particular case will depend on a range of 
factors, such as genotype, age, occupation and lifestyle of the people concerned. It is 
clear, however, that even where the contribution of a pollutant to the causatioa or 
aggravation of any specific disease is relatively small, the impact of the pollutant on 
public health may be considerable if that disease is responsible for significant morbidity 
and mortality. 
7. Pollution contributes to many of the major causes of morbidity and mortality in the 
European Community, including respiratory problems, allergies, cancers, cardio­
vascular diseases and infectious diseases, neurological disorders and immunological 
impairment. 
RESPIRATORY DISEASES 
8. Over the last decades there has been a rise in the prevalence of a number of serious 
respiratory diseases in the Community, such as asthma. 
Asthma 
9. Bronchial asthma is a disease of the respiratory tract characterised by unusually high 
sensitivity of the airways to a wide range of stimuli including inhaled irritants and 
allergens. Asthma, may be either episodic or chronic, and in some cases may be fatal. 
10. During the past few decades, there has apparently been a considerable increase in the 
prevalence of asthma in the European Community and in some other developed 
countries. This has created public concern about the disease and the possible causative 
factors involved. In the European Community the increase in death rate due to asthma 
was 27% between 1974-78 and 1980-84. In Finland the number of people with asthma 
more than doubled between 1964 and 1987. By 1994 3% of its population had been 
diagnosed as asthmatics. Similarly, in the Netherlands adult cases of asthma doubled 
between 1972 and 1991. In the UK a parallel increase has been seen. In 1994 asthma 
was estimated to affect 4% of adults sufficiently severely to require medical 
supervision. The trends among children are of especial concern. There has been a 
doubling of prevalence in young children during the 1970s and 1980s. Also in the UK, 
figures for 1994 indicate that 4-6% of children had asthma requiring medical 
supervision. It is estimated that twice as many have had a diagnosis of asthma. In 
Denmark between 1987 and 1994 the prevalence of asthma has increased from 3 to 
5%. 
11. It has been suggested that part of this reported increase in asthma may be the result of 
changes and improvements in diagnostic criteria and techniques. However, recent 
studies, which take into account these changes, point strongly to the conclusion that 
there has been a real and continuing rise in cases of asthma. Many factors have been 
put forward to explain this increase. 
12. There has been much interest in outdoor air pollution as a possible major cause. 
Although levels of some pollutants have decreased greatly, the relative importance of 
emissions from traffic has increased at the same time as increases in asthma prevalence 
in several Member States. However, the importance of the outdoor environment 
appears to be less significant than indoor air quality and lifestyle. There is a possibility, 
however, that there may be a link between some types of air pollution and the marked 
increase in the prevalence of early onset asthma which generally occurs in atopic 
individuals i.e. those who readily form IgE antibodies to commonly encountered 
allergens. Changes in the indoor environment, caused by changes in building 
construction, such as the increased use of central heating systems and insulation, 
(resulting in a warm, damp indoor climate which favours the growth of house-dust 
mites and fungus) and in people's lifestyles leading them to spend more time indoors, 
are deemed to be of particular importance in this respect. Smoking, particularly 
maternal smoking, and diet are among other factors which may play a part. 
13. Because of the large numbers of people within the European Community who are now 
affected by asthma, factors which exacerbate the disease are potentially important in 
public health terms. There is clear evidence of effects of outdoor air pollution on 
existing asthmatics. Several large-scale epidemiological studies analysing changes in 
daily concentrations of air pollutants have indicated that increases in concentration are 
associated with substantial increases in hospital admissions for asthma increased visits 
to paediatricians and emergency departments for asthma, and increased use of 
medication by asthmatics. 
Chronic Obstructive Pulmonary Disease 
14. Chronic Obstructive Pulmonary Disease (COPD), notably bronchitis and emphysema, is 
a significant cause of mortality and morbidity in the European Community. In France, 
for example, it has been estimated that 2.5 million people are suffering from chronic 
bronchitis, one third of them with chronic airway obstruction. Prevalence of COPD 
increases with age, and is currently higher for men than for women. Prevalence is also 
higher among smokers (and more women are now smoking), among those with low 
social status, and those who have worked in occupations where there are high 
concentrations of airborne particles. In Finland, the prevalence in the elderly in 1994 
was estimated at 12.5% for men but was less for women at 3%. With respect to 
mortality, COPD represents a major cause of death in developed countries. In some 
countries, the mortality rate has increased, for example in France the mortality rate rose 
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between 1980 and 1991 from 26.7 per 100,000 to 29 per 100,000 for men and from 
12.3 to 17.0 for women. 
15. It is, however, difficult to determine with precision the prevalence of COPD in the 
general population, because the diagnosis of the disease is usually made only on 
hospital patients using a variety of tests, including pulmonary function. It is also 
difficult to compare prevalences between countries as different definitions are used and 
data are not always available. 
16. With regard to causal factors for COPD, as with asthma, among known risk factors, 
some are genetic and others are related to behaviour. Smoking certainly plays a key 
role. Air pollution is known to play a part in worsening these conditions. The first 
results of the Community's European APHEA project (Air Pollution and Health: a 
European Approach) indicate that an increase in daily concentrations of some 
pollutants has a detectable effect on both hospital admissions for COPD in European 
cities and on COPD mortality. But further work is needed to determine the causative 
agents, and the relationships, temporal as well as spatial, between exposure levels to air 
pollutants and short and long term effects. 
ALLERGIES 
17. Over the last 20 years, there has been a substantial increase in illness perceived as 
allergies throughout Europe, particularly in urban areas. Since 1970 the prevalence of 
allergic rhinitis in both adults and children has doubled in a number of Community 
states, such as the UK and Sweden. Current prevalence rates in the Community vary 
from 2 to 10%. 
18. The response to foreign antigens is governed by the immune system and is influenced 
by a variety of factors including genetic predisposition, dietary habits, lifestyle and 
exposure to environmental allergens. It appears that although genetic factors play a 
very important role, environmental pollutants are key factors in influencing the specific 
allergens to which ? person will develop hypersensitivity. Among these, biological 
agents such as pollen, animal dander and house-dust mites are of significance. 
19. Pollen allergy is the most common form of allergic disease. 150 years ago when hay 
fever was first described, it was a rare condition, but in recent years it has been 
increasing rapidly, particularly in urban areas. Since the turn of the century, a 
correlation between the level of pollen and the extent of allergic symptoms, such as 
conjunctivitis and rhinitis, has been widely recognised. But since the level of pollen in 
the atmosphere has not increased, the observed rise in allergies cannot be due to this 
factor alone. 
20. The influence of air pollutants is a factor that has to be taken into account as they may 
worsen the problem in three ways. First they may increase the development of pollen 
allergy through a direct influence on the pollen grains to make them more allergenic. 
Second, there is evidence that people react more strongly to allergenic substances if 
they have already been exposed to certain outdoor air pollutants, such as particulates. 
Finally, exposure to pollutants in the urban atmosphere, such as suspended particulate 
matter and tobacco smoke, can cause a general increase in airway reactivity for 
example by assisting the pollen grains' penetration into the human body. 
21. Indoor air pollution is also a factor to be considered. The main allergens in the indoor 
environment are the droppings of house-dust mites, fungal spores and animal dander. 
House-dust mites, which live predominantly in and on mattresses and bedding and in 
floor dust, can provoke allergic reactions and aggravate existing respiratory allergic 
symptoms. The prevalence of sensitivity to these mites has been estimated to be almost 
30% in certain countries. As mentioned earlier insulation and poor ventilation may 
enhance the growth of house-dust mites and fungi. 
OTHER DISEASES 
22. A number of other diseases are associated with pollution, including both cardiovascular 
diseases and cancer, which are already covered by Community public health 
programmes. 
23. Cardiovascular diseases are the biggest cause of mortality in the Community. WHO 
has estimated that 1-2% of cardiovascular mortality (in people with pre-existing 
disease) in Europe may be attributable to small increases in fine particulate air 
pollution, and 3% or more in the most polluted areas. An association has been found 
between the level of fine particles (less than 10 mm or less than 2.5 mm) polluting the 
air on a given day and the level of mortality in people with pre-existing cardiovascular 
or respiratory diseases. The physiological mechanisms involved are not yet clear, but it 
is thought that the particulates may impair pulmonary function and produce acute 
inflammatory reactions. 
24. There is evidence that other pollutants, such as environmental tobacco smoke (ETS) 
and carbon monoxide may also aggravate cardiovascular disease. 
25. Cancer is second only to cardiovascular diseases as being the most important cause of 
overall death in the European Community. Chemical carcinogenesis, that is the 
causation of cancer by chemicals, has long been recognized in the occupational setting. 
The carcinogenic chemicals have for the most part, been the subject of legislation, both 
at national and at European Community level, in order to reduce levels of exposure. 
The presence of even low levels of carcinogens, both naturally occurring and man 
made, in the environment has raised concern about their possible effects on the general 
population. There are a number of factors that need to be given due consideration in 
the aetiology in this disease, including the long latency period. Studies of th^ 
geographical distribution of cancers give some leads as to the possible influence of 
environmental factors in their causation. However, it is considered that three quarters 
of cancer cases are linked to lifestyle, and tobacco alone is responsible for a third of 
cancer mortality. Although the major causal factor for lung cancer is smoking, non-
smokers also develop this disease. Estimates vary, but it has been suggested that some 
9 - 13% of cases in Europe have been associated with exposure to environmental 
tobacco smoke (ETS) i.e. passive smoking in the indoor environment. 
26. A lot of attention by the general public has been given to the increase in the use of 
electrical power in domestic and occupational environments, and in telecommunication 
and broadcasting devices which have resulted in increased levels of exposure to 
electromagnetic fields (EMF) and radiation. This has given rise to public concern 
about the possible consequences for health, notably whether living near electrical 
power lines can cause childhood leukaemia or brain cancer. However, there is no clear 
evidence of an increased risk of cancer from EMF. A recent Commission report (Non-
ionising radiation: sources, exposures and health effects - ÇEC/V/1/LUX/35/95) found 
that existing epidemiological data are inconclusive and that biological studies have not 
so far demonstrated a plausible biological mechanism for EMF carcinogenesis. 
27. Communicable diseases prevalence is in many cases related to environmental 
pollution. Contamination of drinking water and foods by microbiological agents can for 
instance lead to hepatitis A, typhoid fever, cholera and shigellosis, and tuberculosis is 
related to poor living conditions. Thus the improvements made in public hygiene and 
housing - proper waste disposal, sanitation, food processing and storage, and so on, 
combined with vaccination and other medical interventions, have greatly reduced the 
threat from many of these diseases in the European Community. However, the 
incidence of illness related to food contamination in particular with salmonella, 
Campylobacter and listeria has increased in certain countries and is a cause for concern. 
28. Auditory and non-auditory adverse health effects caused by noise is an issue of 
growing importance. Available European data indicate that noise levels in the urban 
environment are steadily increasing. Important sources of background noise in urban 
areas are road traffic, railways, aircraft, industry and construction work. On the other 
hand changes in lifestyle such as the increasing use of personal stereo systems and the 
exposure to high sound levels (e.g. in discotheques) have been associated with impaired 
hearing. Besides hearing impairment, auditory health effects include possible 
impairment of language acquisition and cognitive development in children. The 
non-auditory health effects include stress, anxiety and sleep disturbance. 
m. THE PREVENTION OF POLLUTION-RELATED DISEASES 
29. The prevention of pollution-related diseases has three elements.^First, reducing the 
amount of pollutants by taking action at their source; second, acting to limit the amount 
of people's exposure to them; and third, mitigating the effects on individuals who are 
exposed to them. Much work has already been done both in Member States and at 
Community-level on the first two elements in controlling levels of pollution in the fields 
of air, water, food, waste and radiation protection; in researching into health effects and 
in limiting exposure to pollutants in occupational and domestic settings. 
30. It is not feasible or cost effective to decrease the levels of all pollutants, or limit 
people's exposure to them, to the extent that they have no potential remaining to cause 
adverse effects on health. In the case of naturally occurring potentially harmful agents 
in the environment, such as UV light, pollen and some naturally occurring toxins, 
control of exposure is most likely to be achieved by changes in individual behaviour. 
However, the possibilities of synergism between air pollutants and pollen might make it 
possible to lessen the impact of pollen by controlling levels of ambient air pollution. 
Furthermore, controls on the levels of pollutants adequate for the protection of the 
general population may be insufficient to prevent adverse effects on the health of 
certain vulnerable individuals or groups in the population, such as children and the 
elderly. 
31. For these reasons it is necessary to complement the measures aimed at controlling 
emissions of and exposure to pollutants by public health actions relating directly to the 
general public. These actions have as their goal the prevention of the development of 
diseases by limiting the exposure of individuals and mitigating the related health effects. 
An example of such an action is the Directive on Ambient Air Quality: Council 
Directive 96/62/EC of 27 September 1996 on ambient air quality assessment and 
management (OJ No. L 296 21.11.96, p. 55-63). The Directive provides for limit 
values to protect human health, but also enables thresholds to be defined at which 
Member States would inform or warn the public of poor air quality. 
32. A prerequisite for undertaking such preventive actions effectively is having appropriate 
information about the problems to be tackled. At the European Community level, 
current data do not provide a clear picture of the relationship between environmental 
pollution and disease, particularly as regards quantitative exposure-effect relationships. 
Although data on environmental pollution have been collected for a long period at 
Community level and in the Member States, these data are primarily about levels and 
kinds of pollution. Data on the effects of pollutants on health in the Member States, 
particularly the acute effects do exist. But in many instances the precise causal 
relationships involved have not yet been established. The difficulties involved in doing 
so include problems in making accurate assessments of exposure, particularly long-term 
exposure, in establishing links between levels of exposure to pollutants of individuals 
or populations and longer term effects on health and the long latency periods between 
exposure to a pollutant and the development of clinical symptoms, together with the 
presence of confounding factors. Moreover, relatively little data exist for the 
Community as a whole, and this is an issue that needs to be addressed. 
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IV. OVERVIEW OF PUBLIC HEALTH ACTIONS IN THE MEMBER STATES 
AND INTERNATIONALLY CONCERNING POLLUTION-RELATED 
DISEASES 
Member States 
33. The growing importance of pollution-related diseases across the European Community, 
and the increase in public concern, has led a number of Member States to initiate 
preventive activities, particularly in relation to asthma and other respiratory diseases 
and to allergies. For example, in Denmark, the Ministry of Health produced an "Action 
Plan for a Strengthened Prevention of Asthma and Allergy" in 1993, and the following 
year the French Ministry of Health and .the Comité Français d'Education pour la Santé 
launched a four-year programme aimed at raising the awareness of the public and 
health professionals about these diseases. 
34. Specifically on asthma, Finland has established a ten-year programme which includes a 
range of measures aiming to increase information, improve early diagnosis, strengthen 
guided self-care and decrease atmospheric irritants which provoke asthma, such as 
tobacco smoke. With regard to allergies, in 1995 Sweden carried out a nationwide 
campaign 'Allergy year 95' which featured among other things a travelling exhibition, 
the "allergy train' designed to spread information about the practical effects of allergies 
on people's lives, promoted training of key groups, such as teachers and parents and 
provided support for local projects. 
International Action 
35. At the international level, the WHO organised a Second European Conference on 
Environment and Health with financial support from the Commission. A report on 
environmental health in the European Region entitled "Concern for Europe's 
Tomorrow" was prepared for the Conference .which was held in Helsinki in June 1994 
and included representatives of 47 of the WHO/EURO Member States. The 
representatives endorsed the Environmental Health Action Plan for Europe, a strategy 
to prevent and control environmental health hazards, and adopted a Declaration on 
Action for Environment and Health in Europe. Under this the participating countries 
committed their respective health and environment departments to developing jointly 
national environmental health action plans by the end of 1997. Italy and the United 
Kingdom are two of the six countries participating in a Pilot Project to develop their 
action plans by 1996 and to share their experiences with other countries. 
36. The Conference also established a European Environment and Health Committee to 
support the development of National Environmental Health Action Plans and to assist 
in the coordination and evaluation of the implementation of Environmental Health 
Action Plan for Europe. The Commission is represented on this committee so helping 
to ensure that these activities complement rather than overlap Community action. 
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V. OVERVIEW OF COMMUNITY ACTIONS RELEVANT TO POLLUTION-
RELATED DISEASES 
Environment Policy 
37. Many measures to control pollution and exposure levels are being taken in the 
framework of the Fifth Community Action Programme for the Environment "Towards 
Sustainability" (OJ No. C 138, 17.5.93). Among its priorities are "the improvement of 
public health and safety" and the integration of environmental concerns into all aspects 
of Community policy and decision making. This programme builds upon the large 
volume of existing Community legislation on air, water and soil pollution, chemicals, 
waste disposal and protection from radioactivity. 
38. A Framework Air Quality Directive has recently been adopted (Council Directive 
96/62/EC on ambient air quality assessment and management (OJ L 296 21.11.96, 
p.55-63). Within the context of this Framework Directive, the Commission is 
developing or revising legislation on ambient air quality standards for the major 
atmospheric pollutants taking into account the impact on human health and the 
environment. Pertinent proposals will also include provisions for the dissemination of 
information to the public. 
39. New initiatives are being taken in several areas, such as controlling emissions from 
motor vehicles, revising existing directives on bathing and drinking water quality, 
providing public information about the effects of radiation on health and drawing up a 
strategy to reduce the risks from chemical products. On the other hand, work under 
the directive on the classification and labelling of both new and existing dangerous 
chemical substances (OJ L 133, 30.5.88), and under the directive on the classification 
and labelling of dangerous chemical preparations (OJ L 187, 16.7.88, p. 14) is on­
going. These directives contain the criteria that need to be fulfilled for chemicals to be 
classified on the basis of their e.g. dermal toxicity and by the inhalation route, skin 
sensitization, skin and eye irritation. Such criteria can be updated on the basis of the 
latest scientific evidence. 
40. The European Environment Agency was established to provide policy makers at 
European and national level with environmental information that is objective, reliable 
and comparable. The Agency, working closely with national authorities and the 
Commission, is compiling information on air and water pollution, with details of the 
pollution sources that will be a useful input to the field of pollution-related diseases. It 
is collaborating with the WHO and has produced a first report on Environment and 
Health. The Agency plans to undertake further studies in this area. 
41. Commission services and the European Environment Agency have recently compiled 
extensive information concerning both current and future air quality. In addition, 
initiatives to reduce anthropogenic emissions of atmospheric pollutants are already in 
place or being developed via a number of Community initiatives e.g. the Auto Oil 
Programme and the resulting legislation on vehicle emissions (OJ No. L 100, 19.4.94, 
p. 42), the Directive on Integrated Pollution Prevention and Control (OJ No. C 87, 
25.3.96, p. 8), and the Directive on the control of Emission from Non-road Mobile 
Machinery (OJ No. C 328, 7.12.95, p.l). 
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Actions In Other Policy Areas 
42. Relevant Community activities are also being undertaken within other policy areas. 
Within the foods policy framework, three directives were adopted by the Council in 
1995 on maximum residue levels for a number of active substances in pesticides. In 
health and safety at work there is an extensive body of up-to-date legislation to protect 
the worker, including directives on the physical, chemical and biological agents at 
work. Activities are on-going, including work on occupational exposure limits for 
chemical substances (including broadening the existing directive on occupational 
exposure to carcinogens), and in developing the Safety Action for Europe (SAFE) 
programme which aims at improving safety, hygiene and health at work, particularly in 
small and medium-sized enterprises. 
43. In 1995 the Commission also presented a Green Paper for a European Union Energy 
Policy ( COM (94) 659 final 11.1.1995) which inter alia covers public health issues and 
makes proposals for the support of new clean technologies to reduce emission of 
pollutants. Finally, within the framework of the Community Research and 
Technological Development Programme, relevant research projects are being carried 
out in the programmes on Environment and Climate, Agriculture and Fisheries, and 
Biomedicine and Health. In the Community's Fourth Framework Programme for 
research and technological development (Decision 94/1110/EC of 26.04.1994, OJ 
L126, 18.05.94, p.l, as amended by Decision 96/616/EC of 25.03.1996, OJ L86, 
04.04.96, p. 69), namely the Biomedicine and Health Programme, the research under 
the area of "Chronic diseases, Ageing and Age-related diseases" is conducted on 
aetiology, including environmental aspects, and treatment and management of 
respiratory problems including asthma. Research objectives under the research area of 
"Occupational and Environmental Health" cover identification of important risk factors 
and their control also related to respiratory problems and allergies of public and 
occupational health importance. 
Council 
44. In its Resolution of 11 November 1991 (OJ C304 23.11.91, p. 6) the Council and the 
Ministers for Health, meeting within the Council, invited the Commission, in close 
cooperation with the competent authorities of the Member States to take stock of the 
knowledge and experience available in the Member States, the Community and 
international organizations regarding the relationship between health and the 
environment. 
European Parliament 
45. In its Resolution A4-0311/95 (OJ C 032 05.02.96, p. 15-24) on the Medium-Term 
Social Action Programme 1995-1997 the Parliament asked the Commission to present, 
under the proper procedures, the action programme foreseen in the Commission's 
framework communication on public health for pollution-related diseases as well as the 
other two programmes foreseen, on rare diseases and on accidents and injuries. 
Economic and Social Committee 
46. In recent years the Committee has delivered a number of Opinions relating to 
environmental pollution and to health. In its wide-ranging Opinion of 6 July 1994 on 
the Commission's framework communication on public health it urged the Commission 
to adopt a broad approach to the subject and emphasised the importance of the 
environment for health promotion. 
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VI. APPROACH TO COMMUNITY PUBLIC HEALTH ACTION ON 
POLLUTION-RELATED DISEASES 
47. Future Community public health action on pollution-related diseases must take account 
of the existing large body of work in particular that undertaken under Articles 129 and 
130r of the E.C. treaty. In accordance with Article 129 of the Treaty the Community 
shall contribute towards ensuring a high level of human health protection by 
encouraging cooperation between Member States, lending support to their actions and 
promoting, in close contact with them, coordination of their policies and programmes, 
and fostering cooperation with third countries and international organisations 
competent in the sphere of public health. 
48. According to the principle of subsidiarity, the Community shall take action in this field 
only if and in so far as, by reason of its scale or effects the proposed action can be 
better achieved by the Community, compared to action at national level. In addition 
action by the Community must be proportional to the objectives to be achieved, 
selected on the basis of prior appraisal and expected to yield added value. 
49. With the limited resources available it would be impractical for a Community public 
health programme to address all the numerous pollution-related diseases. Moreover, to 
try to do so would both reduce the effectiveness of such a programme by making the 
actions too diffuse and also increase the risk of straying into areas covered by other 
Community programmes. 
50. In order to select which pollution-related diseases should be priorities for this 
programme a number of selection criteria have to be considered, based on the 
methodology for setting priorities described in Commission communication COM (93) 
559 on the framework for action in the field of public health. These are that 
public health actions relating to the disease are not being undertaken as part 
of other Community programmes; 
there is evidence that current levels of exposure to pollutants represent a health 
risk and furthermore there is considerable population exposure; 
the disease produces a substantial burden of morbidity and/or mortality in the 
Community and/or there is evidence of its prevalence increasing significantly; 
and 
actions by the Community add value compared to the activities of the Member 
States. 
51. In the light of these criteria this programme will place the central focus on diseases 
related to air pollution, primarily respiratory diseases and allergies. Currently in the 
European Community, the highest exposure levels of the population to pollutants are 
to atmospheric pollutants. Moreover, despite a reduction in the concentration of some 
air pollutants, recent evidence shows that there are still important effects associated 
with pollution at concentrations now present in the European Community. These 
effects may be associated with short term changes in concentrations of pollution and 
there is emerging evidence of effects from long-term exposure. The resulting morbidity 
and mortality are giving rise to public concern. 
52. Second, preventive actions on several of the other categories of pollution-related 
disease are already being taken within the framework of the Community's public health 
strategy. Actions in relation to cancer fall within the scope of the Europe against cancer 
programme; prevention of cardio-vascular diseases is covered in the programme on 
health promotion; and actions on communicable diseases are being undertaken under 
the programme on AIDS and certain other communicable diseases. 
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53. As regards diseases related to noise, effective prevention has to be focused on actions 
to reduce emissions and exposure levels. Community-wide requirements regarding 
occupational exposure to noise have been laid down in directive 86/188/EEC (OJ L 
137 24.05.86, p.28) and proposals for amending provisions have been put forward by 
the Commission. 
54. There are several Community initiatives addressing the various issues and aspects of 
air pollution e.g. THERMIE II (COM (94 ) 654 final), CO^ from cars strategy paper 
(COM(95) 689 final), and the Green paper on Fair and Efficient Pricing in Transport 
policy - options for internalizing the external cost of transport in the EU (COM(95) 
691 final) 
55. Respiratory diseases and allergies, on the other hand, are not within the ambit of other 
public health programmes. They also offer significant opportunities for action to be 
taken by the Community which can complement both the existing Community work on 
control of pollution in the environment and the activities of the Member States. Action 
on these diseases will therefore constitute the core of a programme on pollution-related 
diseases which is the object of a proposal by the Commission pursuant to Article 129, 
for a decision by the European Parliament and the Council. 
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VH. COMMUNITY ACTION PROGRAMME ON POLLUTION-RELATED 
DISEASES 
56. In order to make the best possible contribution to efforts directed at pollution-related 
diseases, the proposed Community action programme contains a mix of horizontal, and 
disease-specific actions focusing on respiratory diseases and allergies. Several 
horizontal actions aiming at the improvement and sharing of information and 
experience on risk perception and risk management of pollution-related diseases are 
proposed which will help underpin the actions directed at specific pollution-related 
diseases. There is a need to ensure complementarity between the information collected 
by this programme and other Community programmes or activities which are relevant 
to this area of public health. 
1. Improvement of Information on pollution-related diseases at Community Level 
57. Data on pollution-related diseases exist but at present are insufficient and inadequate at 
Community level for use, in particular, in decision-making or for the provision of 
information to the public about risks to health. In large part this is because the data are 
not detailed enough or suitable for the purpose of understanding causation, thresholds 
for effects and exposure-response relationships or synergisms; also data are often not 
comparable. In connection with respiratory diseases, in particular, there are 
considerable variations in diagnostic criteria and classification of the different diseases. 
58. What is needed is to work towards critically reviewing the data and then to improve 
their comparability. This will involve for instance seeking agreement on diagnostic 
criteria and surveillance methods and establishing comparable indicators. This latter 
task must be undertaken in tandem with the proposed Community programme on 
health monitoring (COM(95)449 of 16.10.1995). It will require strengthening 
cooperation between those involved in the collection and analysis of the data 
concerning pollution-related diseases and improving the existing mechanisms for 
exchanging data between the Member States. It will be necessary to check that 
pollution data are available to support health effect analysis. Long-term data abou. 
pollution should be sought in addition to data about short-term peaks. 
59. The objective of Community action is 
to contribute towards a better understanding of the role of pollutants in the 
causation and aggravation of diseases in the European Community and of the 
basis and effectiveness of preventive actions. 
60. The actions to be taken to achieve this objective could include: 
Establishing priorities for the identification of those diseases in which specific 
pollutants are thought to play a role; comparing their prevalence and/or 
incidence and their relation to data on environmental factors in the different 
parts of the European Community; examining the data quality and identifying 
where data are lacking; analysing and reviewing data currently available on the 
toxicology of these pollutants, and identifying gaps in knowledge; comparing 
these data, including methods of collections, definitions and criteria used, as 
well as the way in which the information is used in analyses, in determining the 
actions taken and in informing the public. 
Contributing to improve the comparability of data used in preventive actions by 
the support of exchanges of information on pollution-related diseases and their 
prevention, including cost-benefit analysis of the effectiveness of actions. 
-16-
2. Risk Perception and Risk Management with respect to pollution-related diseases 
61. The public perception of the risks to health from pollution, especially their magnitude 
and their ranking in terms of importance from the health point of view, often differ 
considerably from an expert assessment, and this can lead to unnecessary public 
concern and pressure for disproportionate actions to be taken. 
62. Experience shows that there are several reasons for this. First, people are better 
informed and made much more aware of risks by information provided through the 
media. Second, the expectation that there should be zero risk to health is an ideal that 
is rarely achieved, if ever, in practice. Third, there is frequently a lack of understanding 
of how pollution-related risks are assessed and the principles adopted for their 
management and of the scope of some of the terminology, such as "negligible", 
"tolerable" or "acceptable" levels of risk, as used in national and Community prevention 
and control measures. 
63. Fourth, misunderstandings can arise because of a lack of information about the 
proportion of the risk to health attributable to pollutants compared with other factors, 
such as lifestyle, and because of the ways in which the media sometimes present the 
information. The tendency of the public to underrate the contribution of smoking, 
including environmental tobacco smoke, compared with that of ambient air pollutants 
to the causation of respiratory and cardiovascular diseases illustrates this point. The 
public concern about possible risks from Electromagnetic Fields (EMF) provides 
another example of the disparity between experts and public opinion. 
64. Fifth, in general the public perceives risk differently than what is suggested by scientific 
evidence. This might mean that factors that lead to certain lesser risks are given much 
greater importance compared to others. This is in part due to the acceptance of risk as 
a result of the degree of personal control that can be exercised over the sources of 
risks. 
65. In this light the objective of Community actions is: 
to increase the level of knowledge and understanding about pollution-related 
health risks, their perception, assessment and management. 
66. The actions to be taken to achieve this objective could include: 
Supporting actions aimed at achieving better public understanding of risks, their 
assessment and management; promoting work on the public perceptions of 
pollution-related risks to health throughout the Community. 
Promoting actions and exchanges of information on the methods of increasing 
the level of knowledge of the general public and opinion-formers about the 
assessment of pollution-related risks to health. 
3. Respiratory diseases and allergies 
67. The increase in the prevalence of respiratory diseases and allergies in recent decades 
has created increasing burdens on society in general, added pressure on health services, 
and led to considerable public concern. 
•17-
68. The objective of Community actions in this area is 
to support activities aimed at reducing the prevalence and/or incidence of these 
diseases. 
69. The actions to be taken to achieve this objective could include 
Contributing to the provision of information to the general public and to 
specific groups, on these diseases and the agents that play a role in them; 
supporting the development of ways to reinforce and link information 
campaigns; contributing to the efforts of self-help or support groups active in 
the field of respiratory diseases and allergies. 
Contributing to the comparison of various education and training initiatives 
used to combat these diseases, with a view to promoting best practice; 
reviewing the effectiveness of the preventive measures undertaken, including 
cost/benefit analyses. 
-18-
Vm. CONSULTATION, ASSESSMENT AND REPORTS 
Consultation 
70. The actions of this programme will be implemented in close collaboration with the 
Member States, particularly in so far as regards coordination of their policies and 
programmes. To facilitate this, the Commission proposes the creation of an Advisory 
Committee of representatives of the Member States. Appropriate links will also be 
maintained with the European Environment Agency, the WHO, other relevant 
international organisations and third countries in accordance with the requirements of 
the programme's actions. 
Evaluation reports 
71. Assessment of the programme will be provided in two reports: 
an evaluation report during the third year of this programme to the Council, the 
European Parliament, the Economic and Social Committee, and the Committee 
of the Regions. The purpose of this report is to ensure that the Community 
institutions and, through them, all the parties concerned, are kept fully informed 
on the progress of actions undertaken in the context of this programme. 
a final report on the implementation of the programme, which will include an 
evaluation of the actions undertaken, will be submitted to the above mentioned 
institutions by the Commission after the completion of the programme. 
General information activities 
72. The Commission will ensure that reports on the activities undertaken are made 
available to concerned parties and the general public. 
A <3 
Proposal for a 
EUROPEAN PARLIAMENT AND COUNCIL DECISION 
adopting a programme of Community action 1999-2003 on pollution-related diseases in the 
context of the framework for action in the field of public health 
la 
EXPLANATORY MEMORANDUM 
1. In its Communication (COM(93) 559 final) of 24 November 1993 on the framework 
for action in the field of public health, the Commission outlined the principles and 
strategy to be followed in undertaking Community activities directed towards the 
attainment of the objectives on health protection laid down in Articles 3(o) and 129 of 
the Treaty establishing the European Community. The role of the Community is 
identified as underpinning the efforts of the Member States in the public health field, 
assisting in the formulation and implementation of objectives and strategies, and 
contributing to the provision of health protection across the Community, setting as the 
target the best results already obtained in a given area anywhere in the Community. 
2. In accordance with Article 129, the Commission presents proposals for the adoption by 
the European Parliament and the Council of incentive measures intended to contribute 
towards ensuring a high-level of human health protection. The aforementioned 
Commission's communication sets out criteria on which to determine priority areas for 
Community action programmes. In accordance with these criteria, pollution-related 
diseases were identified as such a priority area. 
3. The present Commission proposal, based on Article 129 and already announced in the 
Commission programme of work for 1996, comes under the principle of shared 
competence between the Community and the Member States, and seeks to improve 
information on and prevention of pollution-related diseases especially respiratory 
diseases and allergies, and increase the level of knowledge and understanding about risk 
• perception, and risk assessment and management with respect to these, in order to 
contribute towards ensuring a high-level of protection against pollution-related 
diseases. Community action in this field does not come under the exclusive competence 
of the Community and is geared towards the prevention of pollution-related diseases. 
According to the principle of subsidiarity, Community action shall be undertaken only if 
and in so far as, by reason of its scale or effects, it may be better achieved at 
Community level. 
4. Pollution-related diseases are those diseases which are caused, provoked or aggravated 
by environmental pollution. These diseases, particularly those linked to air pollution, 
both indoor and outdoor, constitute an important and growing part of morbidity and 
mortality in the European Community, and they are the object of considerable public 
concern. 
5. The prevention of pollution-related disease pre-supposes knowledge of relationships 
between pollutants and diseases, and has three subsequent elements. First, reducing the 
emission of pollutants by taking action at their source; second, acting to limit 
concentrations of pollutants and exposure to them; and third, mitigating the effects on 
individuals who are exposed to them. Much work has already been done both in 
Member States and at Community-level in controlling levels of pollution in air, water, 
soil, food and waste, in researching into its effects and in limiting exposure to 
pollutants. 
6. The proposed 5-year action programme seeks to complement this work by actions 
addressed to the public, health professionals, and the authorities, which aim to enhance 
people's ability to reduce exposure and mitigate the effects of pollution on their health. 
7. With the limited resources available it would be impractical for a Community public 
health programme to address all the numerous pollution-related diseases. This 
programme will therefore place its central focus on diseases related to indoor and 
outdoor air pollution, primarily respiratory diseases, and on allergies. In the context of 
this programme indoor air relates to non-occupational environments, where less is 
known at Community level about the nature and extent of exposures. Currently the 
highest exposure levels of the Community population to pollutants are to atmospheric 
pollutants, and this exposure is creating a significant risk to health; The prevalence of 
pollution-related diseases is continuing to rise with accompanying public concern. 
Finally, these diseases offer significant opportunities for action to be taken by the 
Community which can complement both its existing work on control of pollution in the 
environment and the activities of the Member States. 
8. To underpin these actions, it is also proposed to undertake, in close cooperation with 
the Member States, actions in two general fields. The first is aimed at improving 
information on pollution-related diseases at Community level. This is currently 
inadequate, particularly because Member States' data are often not comparable. Action 
to improve this situation is proposed to be undertaken, complementary to that 
proposed under the future health monitoring programme (amended proposal COM(96) 
222 final). The second set of actions is aimed at addressing the problems that arise from 
people's perception of the risks to health from pollutants and how these risks are 
assessed and managed, as well as from the lack of adequate information on such 
perceptions. 
9. In selecting objectives and defining actions to be included in the programme, account 
has been taken of the situation currently existing in the Member States and at 
Community level in the field covered by the programme. The programme aims at 
bringing about an accelerated and effective sharing of information and experience, 
Community wide understanding of key issues and questions on tackling pollution-
related diseases, and increased cooperation of Member States so as to avoid 
unnecessary duplication of work and speed up the adoption of best solution to 
problems common to all the Member States concerning such diseases. 
10. These problems have been the object of resolutions by the Council and the Ministers 
for Health of the Member States meeting within the Council on 11.11 1991 (OJ No C 
304, 23.11.91, p. 6) as well as by the European Parliament A4-0311/95 (OJ No C 032 
05.02.96, p. 15-24) calling for Commission proposals in the area. 
11. The implementation of the programme will yield added value in a number of ways: 
a) It will bring together the Member States in a common effort to critically review 
and improve methods for collecting and using information on pollution-related 
diseases and its content, extent and quality; 
b) It will improve the collective capacity of the Member States to analyze public 
perceptions of pollution-related risks and better explain how they are assessed 
and managed, especially when contributors to pollution in a given Member 
State have their origin or source in other Member States; 
c) It will accelerate and deepen the process of addressing the increased prevalence 
and concern over respiratory diseases and allergies by promoting focused 
cooperation between the Member States in this area. 
12. This programme is undertaken on the basis of a European Parliament and Council 
decision pursuant to Article 129. It does not require the harmonisation of national 
provisions in the field covered. 
13. An evaluation of the actions implemented under this programme will be provided in 
two reports that will be transmitted to the Council, the European Parliament, the 
Economic and Social Committee, and the Committee of the Regions: 
during the third year of the programme, an evaluation report; 
2. z 
- a final report on the implementation of the programme. 
These reports will incorporate information on Community financing in the various 
fields of action as well as the results of evaluations. 
23 
Proposal for a 
EUROPEAN PARLIAMENT AND COUNCIL DECISION 
adopting a programme of Community action 1999 - 2003 on pollution-related diseases 
in the context of the framework for action in the field of public health 
THE EUROPEAN PARLIAMENT AND THE COUNCIL OF THE EUROPEAN UNION 
Having regard to the Treaty establishing the European Community, and in particular Article 
129 thereof, 
Having regard to the proposal from the Commission, 
Having regard to the opinion of the Economic and Social Committee, 
Having regard to the opinion of the Committee of the Regions, 
Acting in accordance with the procedure referred to in Article 189b of the Treaty, 
1. Whereas pollution-related diseases are growing in importance throughout the European 
Community and raising public concern; 
2. Whereas, in accordance with point (o) of Article 3 of the Treaty, Community action shall 
include a contribution to the attainment of a high level of health protection; 
3. Whereas Article 129 expressly provides for Community competence in this field, by 
encouraging cooperation between the Member States and, if necessary, lending support t„ 
their action; promoting coordination of their policies and programmes, and fostering 
cooperation with third countries and international organisations competent in the sphere of 
public health; whereas Community action should be directed towards the prevention of 
diseases, and the promotion of health education and information; 
4. Whereas Article 13Or of the Treaty states that Community policy on the environment shall 
contribute to protecting public health; 
5. Whereas the prevention of pollution-related diseases has to include not only measures aimed 
at the sources and concentrations of pollutants and on limiting exposure, but also public health 
actions directed at the public to enable individuals to reduce exposure and mitigate adverse 
effects on health and whereas data on health effects and on exposure should be collected in 
parallel with data on concentrations of air pollutants; 
6. Whereas in its Resolution of 11 November 19911 the Council and the Ministers for Health 
of the Member States, meeting within the Council, invited the Commission, in close 
cooperation with the competent authorities of the Member States, to take stock of the 
knowledge and experience available in the Member States, the Commumty and international 
organizations regarding the relationship between health and the environment; 
1 OJN°C304 23.11.91, p. 5 
2V 
7. Whereas pollution-related diseases have been identified as a priority area for Community 
action within the framework for action in the field of public health2; 
8. Whereas in its Resolution (A4-0311/95) on the Medium-Term Social Action Programme 
1995-19973 the Parliament asked the Commission to present, under the proper procedures, the 
action programme on pollution-related diseases foreseen in the Commission's framework 
communication on public health; 
9. Whereas, in accordance with the principle of subsidiarity, action on matters not under the 
exclusive competence of the Community, such as action on pollution-related diseases, must be 
undertaken by the Community only if and in so far as, by reason of its scale or effects, it may 
be better achieved at Community level; 
10. Whereas the proposed measures in the present programme will yield a Community-added 
value by bringing together activities already undertaken in relative isolation at national level 
and by complementing one another with significant results for the Community as a whole, by 
contributing to the strenghtening of solidarity and cohesion in the Community and by leading, 
where the need is recognised, to the establishment of best practice norms and standards. 
11. Whereas cooperation with the international organisations competent in the field of public 
health and with third countries should be fostered; 
12. Whereas, by providing support for acquiring better knowledge and understanding of, and 
wider dissemination of information about, pollution-related diseases, their association with 
pollutants and their prevention, ensuring improved comparability of information on these 
subjects and by developing actions complementary to existing Community programmes and 
actions, while avoiding unnecessary duplication, the programme will contribute to the 
achievement of the Community objectives set out in Article 129; 
13. Whereas a "modus vivendi" between the European Parliament, the Council and the 
Commission concerning the implementing measures for acts adopted in accordance with the 
procedure laid down in Article 189b of the Treaty was concluded on 20 December 1994; 
14. Whereas this decision lays down, a financial framework constituting the principal point of 
reference, within the meaning of point 1 of the Declaration of the European Parliament, the 
Council and the Commission of 6 March 1995, for the budgetary authority during the annual 
budgetary procedure; 
15. Whereas the Community's financial perspective is valid up until 1999 and will have to be 
revised for the period beyond that date; 
16. Whereas the financial framework for the last four years of the programme (2000-2003) 
shall be determined after the establishment of the future financial perspectives; 
17. Whereas, in order to increase the value and impact of the programme, a continuous 
assessment of the actions undertaken should be carried out, with particular regard to their 
effectiveness and the achievement of the objectives set and, with a view where appropriate, to 
making the necessary adjustments; 
2 COM (93) 559 final 
3 OJ N° C 032 05.02.96, p. 15-24 
2-S 
18. Whereas this programme should be of five-year duration in order to allow sufficient time 
for actions to be implemented to achieve the objectives set; 
HAVE DECIDED AS FOLLOWS 
Article 1 
Establishment of the programme 
1. A programme of Community action against diseases which are caused, provoked or 
aggravated by environmental pollution, hereinafter referred to as "this programme", is hereby 
adopted for the period 1 January 1999 to 31 December 2003 in the context of the framework 
for action in the field of public health. 
2. The aim of this programme is to contribute towards ensuring a high level of health 
protection against pollution-related diseases by improving knowledge and understanding about 
health risks associated with them and how to address them, in particular with regard to asthma 
and other respiratory diseases, and to allergies. 
3. The actions to be implemented under this programme and their specific objectives are set 
out in the Annex under the headings: 
1. Actions on improvement of information on pollution-related diseases 
2. Risk perception and risk management with respect to pollution-related diseases 
3. Respiratory diseases and allergies 
Article 2 
Implementation 
1. The Commission shall ensure implementation, in close cooperation with the Member States, 
of the actions set out in the Annex. 
2. The Commission shall cooperate with institutions and organisations active in the field of 
pollution-related diseases. 
Article 3 
Budget 
1. The financial framework for the implementation of the programme for the year 1999 shall be 
ECU 1.3 Million, in keeping with current financial perspectives. The financial framework for 
the final four years of the programme (2000-2003) shall be determined in detail after the 
establishment of the future financial perspectives. 
2. The annual appropriations shall be established by the Budgetary Authority in accordance 
with the financial perspectives. 
Article 4 
Consistency and complementarity 
The Commission shall ensure that there is consistency and complementarity between the 
Community actions to be implemented under this programme and those implemented under 
other relevant Community programmes and actions. 
Article 5 
Committee 
1. In implementing this action plan, the Commission shall be assisted by an advisory 
committee, hereinafter referred to as "the Committee", consisting of representatives of the 
Member States and chaired by the Commission representative. 
2. The representative of the Commission shall submit to the Committee a draft of the measures 
to be taken concerning, in particular: 
(a) the criteria, and procedures for selecting and financing projects under this programme; 
(b) the evaluation procedure. 
The Committee shall deliver its opinion on the draft, within a time limit which the chairperson 
may lay down according to the urgency of the matter, if necessary by taking a vote. 
The opinion shall be recorded in the minutes; in addition, each Member State shall have the 
right to ask to have its position recorded in the minutes. 
The Commission shall take the utmost account of the opinion delivered by the Committee. It 
shall inform the Committee on the manner in which its opinion has been taken into account. 
3. The representative of the Commission shall keep the Committee regularly informed about 
Commission proposals or Community initiatives and the implementation of programmes in 
other policy areas which are relevant to the achievement of the objectives of this programme. 
Article 6 
International cooperation 
1. In the course of implementing this programme, cooperation with third countries and with 
international organisations competent in the field of public health shall be fostered. 
2. This programme shall be open to participation by the associated countries of Central 
Europe (CEC), in accordance with the conditions laid down in the Association Agreements or 
Additional Protocols related thereto concerning participation in Community programmes. This 
programme shall be open to participation by Cyprus and Malta on the basis of additional 
appropriations in accordance with the same rules as those applied to the EFTA countries, in 
accordance with procedures to be agreed with those countries. 
Article 7 
Monitoring and evaluation 
1. In the implementation of this Decision the Commission shall take the necessary measures to 
ensure the monitoring and continuous evaluation of the programme, taking account of the 
general and specific objectives referred to in Article 1 and in the Annex. 
2. In the third year of operation of this programme, the Commission shall present to the 
European Parliament and the Council an evaluation report. 
3. The Commission shall submit to the European Parliament and the Council a final report on 
completion of this programme. 
4. The Commission shall incorporate into these two reports information on Community 
financing in the various fields of action and on complementarity with the other actions referred 
to in Article 4, as well as the results of the evaluations. The reports shall also be submitted to 
the Economic and Social Committee and the Committee of the Regions. 
Done at Brussels, 
For the European Parliament For the Council 
The President The President 
ANNEX 
SPECIFIC OBJECTIVES AND ACTIONS 
L ACTIONS ON IMPROVEMENT OF INFORMATION ON POLLUTION-
RELATED DISEASES 
Objective: to contribute towards a better understanding of the role of pollutants in the 
causation and aggravation of diseases in the European Community and of the 
basis and effectiveness of preventive actions. 
1. Establishing priorities for the identification of those diseases in which specific 
pollutants are thought to play a role; comparing their prevalence and/or incidence and 
their relation to data on environmental factors in the different parts of the European 
Community; examining the data quality and identifying where data are lacking; 
analysing and reviewing data currently available on the toxicology of these pollutants, 
and identifying gaps in knowledge; comparing these data, including methods of 
collections, definitions and criteria used, as well as the way in which the information is 
used in analyses, in determining the actions taken and in informing the public. 
2. Contributing to improve the comparability of data used in preventive actions by the 
support of exchanges of information on pollution-related diseases and their prevention, 
including cost-benefit analysis of the effectiveness of actions. 
H. RISK PERCEPTION AND RISK MANAGEMENT WITH RESPECT TO 
POLLUTION-RELATED DISEASES 
Objective: to increase the level of knowledge and understanding about pollution-related 
health risks and their perception, assessment and management. 
3. Supporting actions aimed at achieving better public understanding of risks, their 
assessment and management; promoting work on the public perceptions of pollution-
related risks to health throughout the Community. 
4. Promoting actions and exchanges of information on the methods of increasing the level 
of knowledge of the general public and opinion-formers about the assessment of 
pollution-related risks to health. 
ffl. RESPIRATORY DISEASES AND ALLERGIES 
Objective: to support activities aimed at preventing and reducing the numbers of these 
diseases. 
5. Contributing to the provision of information to the general public and to specific 
groups, on these diseases and the agents that play a role in them; supporting the 
development of ways to reinforce and link information campaigns; contributing to the 
efforts of self-help or support groups active in the field of respiratory diseases and 
allergies. 
6. Contributing to the comparison of various education and training initiatives used to 
combat these diseases, with a view to promoting best practice; reviewing the 
effectiveness of the preventive measures undertaken, including cost/benefit analyses. 
2-3 
FINANCIAL STATEMENT 
1. TITLE OF OPERATION 
Proposal for a European Parliament and Council Decision adopting a programme of 
Community action 1999-2003 on pollution-related diseases in the context of the 
framework for action in the field of public health 
2. BUDGET HEADING INVOLVED 
B3-
3. LEGAL BASIS 
Article 3(o) and Article 129 of the Treaty establishing the European Community. 
4. DESCRIPTION OF OPERATION 
4.1 General objective 
To contribute to achieving the objectives laid down by the Treaty: 
- under Article 3 (o), the Community is required to make a contribution to the 
attainment of a high level of health protection; 
- Article 129 requires the Community to contribute towards ensuring a high-level of 
human health protection, in particular by encouraging cooperation between the 
Member States, and if necessary lending support to. their action, promoting 
coordination of their policies and programmes, and fostering cooperation with third 
countries and the competent international organisations in the sphere of public health. 
Community action is directed towards the prevention of diseases, in particular major 
health scourges, by promoting research into their causes and their transmission, as well 
as health information and education. 
The general objective of the action programme is to contribute towards ensuring a high 
level of health protection against pollution-related diseases by improving knowledge 
and understanding about pollution-related health risks and how to address them, in 
particular with regard to asthma and other respiratory diseases, and allergies. 
The method for achieving this objective consists of undertaking actions which: 
contribute towards a better understanding of the role of pollutants in the 
causation and aggravation of diseases in the European Community and of the 
basis and effectiveness of preventive actions; 
increase the level of knowledge and understanding about pollution-related 
health risks, their perception, assessment and management; 
support activities aimed at preventing and reducing the numbers of these 
diseases. 
3>^ 
4.2 Period covered and arrangements for renewal or extension 
5 years: 01.01.1999 to 31.12.2003 
Report on implementation to be transmitted to the Council and European 
Parliament during the third year of operation of the programme. 
Report to the Council and European Parliament after completion of the 
programme together with the results of evaluations. 
5. CLASSIFICATION OF EXPENDITURE OR REVENUE 
Non-compulsory expenditure 
Differentiated appropriations 
6. TYPE OF EXPENDITURE OR REVENUE 
Subsidy for joint financing with other sources in the public and/or private sector (not 
exceeding a certain percentage of the total cost of the proposed projects). 
The level of funding granted depends on the scope of the measure to be financed and 
on the extent to which the action programme is reflected in the various activities 
planned. Such funding will not exceed 70% of the total budget earmarked for the 
proposed projects except in the case of networks and work ordered and of direct use to 
the Commission, where the subsidy may amount to 100%. 
7. FINANCIAL IMPACT 
7.1 Method of calculating the total cost of operation (definition of unit cost) 
The method of calculation is the result of experience acquired in previous activities 
related to public health. This encompasses the various types of Community action listed 
in Table 4 of the Commission Communication (93) 559 final of 24 November 1994, 
and represents extensive experience in financing cooperative efforts with Member 
States as well as Non Governmental Organisations as regards collection, analysis and 
dissemination of information, setting up networks, the establishment of mechanisms and 
procedures of consultation and cooperation for setting common objectives and for 
policy coordination and for the formulation and development of strategies at 
Community level. 
The specific cost estimates are based on the assumption that half of the activities to be 
undertaken under this programme will require 100 percent funding while the other half 
will require 50 percent funding and that the activities to be undertaken will involve 
most or all of the Member States. 
An amount of ECU 1.3 Million is deemed necessary for the implementation of these 
activities for the first year of the programme, 1999. The budget framework for the 
subsequent four years of operation shall be established by taking into account the 
Community's future financial perspectives. The annual allocations will be decided in 
accordance with the normal budgetary procedures. 
7.1.1 Improvement of information on pollution-related diseases 
Reviews on the data currently available on pollution-related diseases shall be 
undertaken. The cost estimate for this is 100.000 ECU for the first year. In addition, 
networks have to be set up in order to work on the information gained by these 
reviews. For the setting up of networks in this context the minimum amount of 200.000 
ECU is deemed necessary. 
7.1.2 Improvement of risk perception and risk management 
Dissemination of information targeted at the public and specific groups such as 
journalists has been scheduled at an average cost of 200.000 ECU. In parallel actions to 
better understand public perception of pollution-related health risks shall be launched. 
For this a budget of 100.000 ECU is forseen. 
7.1.3 Prevention of respiratory diseases and allergies 
Support for networks to promote information on the prevention of respiratory diseases 
and allergies in order to link information campaigns will require an estimated cost of 
300.000 ECU in the first year of operation of the programme. This activity shall take 
into account the information gained from a comparision of various education and 
training initiatives undertaken in order to promote best practice. 300.000 ECU are 
planned to be spent on this. 
7.2 Itemized breakdown of cost (in ECU million) 
OBJECTIVE 
Improvement of 
information on pollution-
related diseases ACTION AREA 
Establishing priorities for the identification of 
those diseases in which specific pollutants are 
thought to play a role; comparing *heir prevalence 
and/or incidence and their relation to data on 
environmental factors in the different parts of the 
European Community; examining the data quality 
and identifying where data are lacking; analysing 
and reviewing data currently available on the 
toxicology of these pollutants, and identifying gaps 
in knowledge; comparing these data, including 
methods of collection, definitions and criteria used, 
as well as the way in which the information is used 
in analyses, in determining the actions taken and in 
informing the public. 
Contributing to improving the comparability of 
data used in preventive actions by the support of 
exchanges of information on pollution-related 
diseases and their prevention, including cost-
benefit analyses of the effectiveness of actions. YEARS 
1999 2000 2001 2002 2003 TOTAL 
Indicative programming 
0.3 
0.1 0.3 
0.1 Oo 
OBJECTIVE ACTION AREA YEARS 
1999 2000 2001 2002 2003 TOTAL 
Risk perception and risk 
management Supporting actions aimed at achieving better 
public understanding of risks, their assessment and 
management; promoting work on the public 
perceptions of pollution-related risks to health 
throughout the Community. 0.2 0.2 
Promoting actions and exchanges of information 
on the methods of increasing the level of 
knowledge of the general public and opinion-
formers about the assessment of pollution-related 
risks to health. 0.1 0.1 
Respiratory diseases 
and allergies Contributing to the provision of information to the 
general public and to specific groups, on these 
diseases and the agents that play a role in them; 
supporting the development of ways to reinforce 
and link information campaigns; contributing to 
the efforts of self-help or support groups active in 
the field of respiratory diseases and allergies. 0.3 0.3 t/J 
00 
Contributing to the comparison of various 
education and training initiatives used to combat 
these diseases, with a view to promoting best 
practice; reviewing the effectiveness of the 
preventive measures undertaken, including 
cos^enefit analyses. 0.3 0.3 
TOTAL 1.3 pm pm pm pm 1.3 
3M 
7.3 Indicative schedule of appropriations (in ECU million) 
Commitment 
appropriations 
Payment 
appropriations 
1999 
2000 
2001 
2002 
2003 
Subsequent years 
TOTAL 1999 
1.3 
0.78 
0.52 
1.3 2000 
pm 2001 
pm 2002 
pm 2003 
pm TOTAL 
0.78 
0.52 
1.3 
FRAUD PREVENTION MEASURES; RESULTS OF MEASURES TAKEN 
The grant application forms will require information on the identity and nature of 
potential beneficiaries so that their reliability can be assessed in advance. 
Fraud prevention measures (checks, intermediate reports, final report) are included 
in the agreements or contracts between the Commission and beneficiaries. The 
Commission will check reports and ensure that work has been properly carried out 
before intermediate and final payments are made. 
In addition, spot checks are carried out by the Commission to verify how funds have 
been used. Checks have already been carried out in other public health budget lines 
in relation to the financial years 1991 to 1995 and have shown their effectiveness. 
ELEMENTS OF COST-EFFECTIVENESS ANALYSIS 
9.1 Specific and quantifiable objectives 
The Community measures aim at contributing towards ensuring a high level of 
health protection against pollution-related diseases by improving knowledge and 
understanding about pollution-related health risks and how to address them, in 
particular with regard to asthma and other respiratory diseases, and allergies. 
The indicators showing whether or not objectives are achieved will include measures 
of the following kinds. These will be redefined further in collaboration with the new 
Community programme on health monitoring whose tasks include the development 
3T 
of indicators for Community public health policies. The method for achieving this 
objective consists of undertaking actions which : 
encourage and assist the creation of networks that contribute towards a 
better understanding of the role of pollutants in the causation and 
aggravation of diseases in the European Commumty; and of the basis and 
effectiveness of preventive actions (membership, production of e.g. 
information bulletins, conferences, www-discussion groups etc.); 
disseminate information about pollution-related health risks, their perception, 
assessment and management; 
improve information and data on pollution-related diseases at Community 
level and the prevalence and/or incidence rates of these diseases 
foster consultation and cooperation between Member States (description of 
cases of such consultation etc.) and 
help public health bodies assisted in making better use of other Community 
policies in their efforts aiming at the prevention of pollution-related diseases. 
Target Population 
1. Competent health authorities of the Member States, at national, regional and 
local level and competent international organisations in the sphere of public 
health; 
2. Health professionals, health epidemiological services, health and medical 
associations, academic institutions etc; 
3. NGO's and other bodies interested in health matters, and the public in 
general. 
9.2 Grounds for the operation 
In initiating action under Article 129, the Community has to address itself to 
preventing diseases and protecting health. The Commission's communication on the 
framework for action in the field for public health (COM(93) 559 final of 23.11.93) 
sets out criteria on which to determine priority areas for Community programmes. In 
accordance with these criteria, the 1993 "framework" communication evaluated the 
different options for addressing diseases, in particular major scourges and their 
underlying causes, by various types of Commumty actions and retained on the basis 
of criteria listed in that communication, eight priority areas of which the prevention 
of pollution-related diseases was one. 
In its Resolution of 11 November 1991 the Council and the Ministers for Health of 
the Member States, meeting within the Council, invited the Commission, in close 
cooperation with the competent authorities of the Member States, to take stock of 
the knowledge and experience available in the Member States, the Community and 
international organizations regarding the relationship between health and the 
environment. 
In its Resolution A4-0311/95 on the Medium-Term Social Action Programme 1995-
1997 the Parliament asked the Commission to present, under the proper procedures, 
the action programme on pollution-related diseases foreseen in the Commission's 
framework communication. 
The programme aims at bringing about an accelerated and effective sharing of 
information and experience, Community wide understanding of key issues and 
questions on tackling pollution-related diseases, and increased cooperation of 
Member States so as to avoid unnecessary duplication of work and speed up the 
adoption of best solution to problems common to Member States concerning such 
diseases. This input envisaged for the Community and the Commission by Article 
129 provides a clear common framework of rules. This would be substantially more 
effective than leaving such questions to inter-governmental co-operation without a 
Community contribution. 
As regards the intervention methods and the allocation of funds, the following will 
apply: 
specific application of the principle of subsidiarity when identifying measures 
to be undertaken and co-financed; 
identification and selection of projects for co-financing in the fields of 
pollution-related diseases 
the concept of added Community value, which will continue to be realised in 
particular through the coordination of national measures, the dissemination 
of information and experiences, the establishment of priorities, the 
development of networking as appropriate, selection of European projects 
and the motivation and mobilisation of all involved. 
Two methods will be employed to implement the programme. One is to support 
projects carried out in Member States and at the Community level. The selection of 
priority projects is based largely on general and intermediate objectives, and 
implementation of the measures themselves depends on the quality and effectiveness 
of projects submitted to the competent department during the course of the year. 
The other is to undertake specific activities necessary to achieve the objectives of 
the programme, which will be fully financed by the programme. 
The selection criteria for projects are as follows: 
Compatibility with the objectives and conformity with at least one of the 
established objectives; 
Examination of the "added Community value" of the projects (transnational 
participation, development of a model applicable in other Member States, 
information usable in other Member States, etc.); 
Presumed effectiveness and profitability; 
Clarity and justification of requirements; 
Relevance of selected methodology; 
Organizational competence and experience; 
Suitability of budget for objectives; 
Support for projects from national partners; 
Objective assessment; 
Opinion of the advisory committee involved. 
The budget proposed for this programme, of 1.3 MECU for the first year of this 
programme, matches that proposed at the same time for the Community action 
programmes on rare diseases and injury prevention. This reflects the equal priority 
attached to these fields for action determined by the Commission Communication on 
the framework for action in the field of public health (1993), an evaluation which 
remains valid today. The amount proposed represents the bare minimum required to 
start the programme. 
9.3 Monitoring and evaluation of the operation 
9.3.1 Monitoring of the operation 
Monitoring at the Community level is to be carried out by the Commission, 
which will submit a report half-way through the implementation of the 
programme, and a final report after its completion to the Council, the 
European Parliament, the Economic and Social Committee, and 
the Committee -of the Regions, drawing from national reports as well as 
evaluations of the actions under the programme and of individual projects. 
9.3.2 Evaluation 
Evaluation will be by means of: 
An evaluation of the main measures and of subsidised projects 
involving, where necessary, the participation of independent experts; 
An evaluation report during the third year, 
An overall report on the quality and effectiveness of projects 
implemented under the action plan, to be submitted by the 
Commission to the other Community institutions after completion of 
the programme. 
Performance indicators selected for this evaluation: 
Evaluation of projects by Commission officials and/or those 
cooperating with them; 
Analysis of intermediate reports on measures scheduled and financed, 
allowing a shifting of emphasis where possible; 
Impact studies by external bodies 
Relevance of the methodology used by organizers; 
Suitability of the budget for the objectives; 
Skills and experience of bodies; 
Dissemination of results; 
Evaluation procedures and intervals: 
Drawing up of intermediate and final reports on the various measures 
undertaken in the field; 
Development of a "standard" evaluation form for the measure, to be 
forwarded by the beneficiaries with their final reports, and checking 
of these documents by officials either at the Commission or in the 
field. 
3* 
10. ADMINISTRATIVE EXPENDITURE (PART A OF THE BUDGET) 
Actual mobilisation of the necessary administrative resources will be conditioned by 
the Commission's annual decision on the allocation of resources, having regard in 
particular to additional staff and funds provided by the budgetary authority. 
10.1 Impact on the number of employees 
Types of employees 
Officials or 
temporary agents A 
B 
C 
Other resources 
Total Staff carrying out action 
permanent 
employees 
1 
1 
1 
3 temporary 
employees 
0 
0 
0 
0 Source of employees 
from within DG 
or service 
1 
1 
1 
3 supplementary staff 
0 
0 
0 
0 Duration 
10.2 Financial impact of supplementary staff 
No supplementary staff are envisaged 
10.3 Increase in other running costs arising from the action 
Budget line Amounts Method of calculation 
Meetings A2510 104,250 ecus ? meetingsi of ad^sory cornmittee/year, 
° 1 representative/Member State = 
2 meetings/year x 15 reprs x 695 
ecus/reprs x 5 years = 104,250 ecus 
The resources necessary to cover the expenditure below for the 5-year period will be 
obtained by re-deployment of existing financial resources and the use of supplementary 
resources will not be required. 
a) Personnel Expenses (Title Al, A2 and A5) 
3 x 100,000 ecus x 5 years = 1,500,000 ecus 
b) Operational Expenses 
Expenses for meetings (A-250) 
2 meetings/year x ID experts x 825 ecus/expert x 5 years = 123,750 ecus 
Expenses for travel (A-130) 
24 missions/year Brussels-Luxembourg x 200 ecus/mission x 5 years = 24 000 
30 missions/year to Member States x l000 ecus/mission x 5 years = 150,000 < ecus 
ecus 
c) Total: 1,797,750 ecus 



23 
ISSN 0254-1475 
COM(97) 266 final 
DOCUMENTS 
EN 04 05 14 13 
Catalogue number : CB-CO-97-253-EN-C 
ISBN 92-78-20670-9 
Office for Official Publications of the European Communities 
L-2985 Luxembourg