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
Date: 1997-06-04
Institutions: European Commission
Subjects: EU programme, disease prevention, health policy, pollution, public health

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) 

-1 

-

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 

-2-

TABLE OF CONTENTS 

I. INTRODUCTION 

II. POLLUTION-RELATED DISEASES IN THE EUROPEAN COMMUNITY 

III. THE PREVENTION OF POLLUTION-RELATED DISEASES 

page 

3 

4 

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. 

2. 

3. 

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. 

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. 

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. 

5. 

6. 

7. 

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. 

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. 

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. 

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 

11. 

12. 

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%. 

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. 

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 

-6-

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. 

18. 

19. 

20. 

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%. 

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. 

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. 

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. 

30. 

31. 

32. 

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. 

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. 

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. 

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. 

-10-

IV.  OVERVIEW OF PUBLIC HEALTH ACTIONS IN THE MEMBER STATES 
AND INTERNATIONALLY CONCERNING POLLUTION-RELATED 
DISEASES 

Member States 

33. 

34. 

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. 

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. 

-11-

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. 

41. 

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. 

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). 

Actions In Other Policy Areas 

-12-

42. 

43. 

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. 

Finally,  within 

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. 
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 
including  environmental  aspects,  and  treatment  and  management  of 
aetiology, 
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 
the 
international  organizations  regarding 
environment. 

the  relationship  between  health  and 

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. 

-13-

VI.  APPROACH  TO COMMUNITY PUBLIC HEALTH ACTION  ON 

POLLUTION-RELATED  DISEASES 

47. 

48. 

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. 

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. 

52. 

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. 

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. 

-14-

53. 

54. 

55. 

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. 

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) 

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. 

-15-

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. 

62. 

63. 

64. 

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. 

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. 

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. 

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. 

Vm. CONSULTATION, ASSESSMENT AND REPORTS 

-18-

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. 

2. 

3. 

4. 

5. 

6. 

7. 

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. 

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. 

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. 

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. 

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. 

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. 

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. 

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. 

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. 

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. 

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; 
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; 
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. 

b) 

c) 

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. 

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; 

8. 

9. 

10. 

11. 

12. 

13. 

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) 
(b) 

the criteria, and procedures for selecting and financing projects under this programme; 
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 
The President 

For the Council 
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. 

2. 

H. 

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. 

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. 

4. 

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. 

ffl. 

RESPIRATORY  DISEASES AND  ALLERGIES 

Objective: 

to  support  activities  aimed  at  preventing  and  reducing  the  numbers  of  these 
diseases. 

5. 

6. 

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. 

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 
to.  their  action,  promoting 
Member  States,  and 
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. 

lending  support 

if  necessary 

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 

ACTION AREA 

YEARS 

1999 

2000 

2001 

2002 

2003 

TOTAL 

Indicative programming 

0.3 

0.3 

Improvement  of 
information  on pollution-
related  diseases 

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. 

0.1 

Oo 

0.1 

OBJECTIVE 

ACTION AREA 

YEARS 

1999 

2000 

2001 

2002 

2003 

TOTAL 

Risk perception and risk 
management 

Respiratory diseases 
and allergies 

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. 
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 
cos^enefit  analyses. 

0.2 

0.1 

0.3 

0.3 

0.2 

0.1 

0.3 

0.3 

t/J 
00 

T O T AL 

1.3 

pm 

pm 

pm 

pm 

1.3 

3M 

7.3 

Indicative schedule of appropriations (in ECU million) 

2000 

2001 

2002 

2003 

TOTAL 

0.78 

0.52 

1999 

1.3 

0.78 

0.52 

Commitment 
appropriations 
Payment 
appropriations 

1999 

2000 

2001 

2002 

2003 

Subsequent years 

TOTAL 

1.3 

pm 

pm 

pm 

pm 

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. 

2. 

3. 

Competent health authorities of the Member States, at national, regional and 
local level and competent international  organisations in the sphere of public 
health; 
Health  professionals,  health  epidemiological  services,  health  and  medical 
associations, academic institutions etc; 
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 

Staff carrying out action 

Source of employees 

Duration 

permanent 
employees 

temporary 
employees 

from within DG 
or service 

supplementary staff 

Officials or 
temporary agents 

A 
B 
C 

Other resources 

Total 

1 
1 
1 

3 

0 
0 
0 

0 

1 
1 
1 

3 

10.2  Financial  impact of supplementary  staff 

No supplementary staff are envisaged 

0 
0 
0 

0 

10.3 

Increase in other running costs arising from  the action 

Budget line 

Meetings A2510 
° 

Amounts 

104,250 ecus 

Method  of calculation 

? 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