Communication from the Commission to the Council, the European Parliament and the European Economic and Social Committee - A European Environment and Health Strategy
Date: 2003-06-11
Institutions: European Commission
Subjects: EU programme, air quality, child, cooperation policy, environmental law, environmental policy, health policy, public awareness campaign, sustainable development

COMMISSION OF THE EUROPEAN COMMUNITIES

Brussels, 11.6.2003
COM (2003) 338 final

COMMUNICATION FROM THE COMMISSION
TO THE COUNCIL, THE EUROPEAN PARLIAMENT
AND THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE

A European Environment and Health Strategy

TABLE OF CONTENTS

1.

2.

3.

4.

4.1.

4.2.

4.3.

4.4.

4.5.

4.6.

5.

5.1.

5.2.

5.3.

5.4.

6.

6.1.

Introduction................................................................................................................ 3

Rationale ..................................................................................................................... 4

Objectives of the Strategy.......................................................................................... 5

What is already being done ? .................................................................................... 5

EU chemicals and environment policies ...................................................................... 5

EU action programmes and legislation on health ........................................................ 6

EU research on environment and health ...................................................................... 6

Occupational health...................................................................................................... 7

International action ...................................................................................................... 7

Environment and health in the present and acceding Member States and world-wide 7

The Key Elements of an EU Environment and Health Strategy ........................... 8

An integrated approach ................................................................................................ 8

An incremental strategy ............................................................................................... 9

A focus on children .................................................................................................... 10

Acceding Countries.................................................................................................... 10

A European Environment and Health Strategy.................................................... 11

Finding Common Ground : a European Integrated Environment and Health
Monitoring and Response System.............................................................................. 11

6.2.

Scope of the first cycle (2004-2010).......................................................................... 13

6.2.1.

European Integrated Environment & Health Monitoring and Response System ...... 14

6.2.2. Research ..................................................................................................................... 16

6.2.3. Reducing exposure..................................................................................................... 17

7.

7.1.

7.2.

8.

9.

10.

11.

12.

Implementation ........................................................................................................ 19

Full Stakeholder Involvement .................................................................................... 19

Preparing the “Action Plan 2004-2010” .................................................................... 20

Conclusions ............................................................................................................... 20

Annex A : – The problem ........................................................................................ 22

Annex B : – EU policies related to environment and health ................................ 26

Annex C : – EU Research on environment and health ......................................... 31

Annex D : – International actions on environment and health............................ 34

2

1. 

INTRODUCTION

The  World  Health  Organisation  (WHO)  defines  “environment  and  health”  as
including  “both  the  direct  pathological  effects  of  chemicals,  radiation  and  some
biological  agents,  and  the  effects  (often  indirect)  on  health  and  well-being  of  the
broad  physical,  psychological,  social  and  aesthetic  environment,  which  includes
housing,  urban  development,  land  use  and  transport.”1  This  is  a  wide  definition
which  requires  a  comprehensive  approach  if  we  are  to  understand  the  issue  and
develop relevant policies.

From  its  very  beginning  EU  environmental  policy  has  been  driven  primarily  by
health  considerations.  Many  environment  and  health  related  problems  have  been
solved,  but  much  remains  to  be  done,  in  particular  with  respect  to  the  health
implications  of  chronic  exposures,  such  as  those  reported  by  the  European
Environmental Agency, WHO, and a number of national organisations. They indicate
that  the  interaction  between  environment  and  health  is  far  more  intimate  and
complex than is commonly understood. In particular, little attention has been paid to
the  interaction  of  different  pollutants  in  the  human  body  as  well  as  in  the
environment.  Even  low  level  exposure  over  decades  to  a  complex  cocktail  of
pollutants in air, water, food, consumer products and buildings can have a significant
effect on the health status of European citizens.

In  its  Article  152  and  174  the  Amsterdam  Treaty  provides  legal  provisions  for
Community action in the field  of  Environment  and Health, and  the  EU  has  already
begun to respond to these concerns. In the Sixth Environmental Action Programme it
has  set  itself  the  goal  of  contributing  “to  a  high  level  of  quality  of  life  and  social
well-being for citizens by providing an environment where the level of pollution does
not  give  rise  to  harmful  effects  on  human  health  and  the  environment."  The
Community Action Programme on public health (2003-2008) takes the environment
as a major health determinant, while the EU Research Framework Programmes have
included specific actions on this issue.

Given the size and complexity of environment and health issues, it is time for a new
approach.  This  Communication  therefore  presents  a  European  Environment  and
Health  Strategy,  to  be  launched  as  the  « SCALE  initiative ».  We  need  to  scale  up
our efforts so that, in line with the objectives of sustainable development, we protect
both the most vulnerable groups in our society and those that will form tomorrow’s
society:  children.  The  initiative  will  develop  a  policy  framework  to  ensure  the
protection of society as a whole. But SCALE also stands for a comprehensive, long-
term approach :

–  based on Science, drawing together knowledge from a wide range of networks of
stakeholders, including environment and health experts from present and acceding
countries, international, non-governmental and consumer organisations.

1

Environment and health. The European Charter and commentary. Copenhagen, WHO Regional Office
for Europe, 1990 (WHO Regional Publications, European Series, No 35).

3

                                                
–  focusing on Children, because investing in children’s health is essential to ensure
human  and  economic  development.  Children  are  particularly  vulnerable  to
environmental  hazards  and  they  cannot  be  considered  as  « little  adults »  since
their physiology, metabolism, diet and behaviour are different compared to adults.
Furthermore,  it  is  important  to  focus  on  children  because  children’s  health  is  a
basic  human  right : the  UN Convention on Children’s Rights  requires  children’s
« best achievable health ».

–  that raises Awareness on the interconnection between environment and health and
removes  the  scales  from  the  eyes  of  society  so  that  everyone  can  see  how
environmental  degradation  harms  everyone's  health,  in  particular  children’s
health.

–  that uses the Legal instruments provided by the Treaty to add value to the actions
undertaken  at  international  and  national  level,  by  requiring  actions  at  EU  level
that target environment-related health problems in an integrated way.

–  including  constant  and  continuous  Evaluation  to  verify  the  efficacy  and  cost-
effectiveness  of  the  actions  in  terms  of  the  reduction  of  the  environment-related
health  problems.  This  evaluation  will  provide  further  scientific  knowledge,  the
basis for new or corrective actions and further awareness raising.

2. 

RATIONALE

Until  now  environmental  assessments  and  policy  actions  have  focused  on  single
pollutants  in  single  environmental  compartments  (air,  water,  soil,  …)  and  many
related environmental health problems have indeed been solved. However, by doing
so some health impacts are underestimated, because in reality the situation is much
more  complicated:  pollutants  are  transferred  between  different  environmental
compartments  (air  to  soil,  to  water,  …);  people  are  exposed  to  a  combination  of
pollutants that interact in the environment and in the human body ; These facts are
not  sufficiently  taken  into  account  in  the  actual  policy  responses.  Furthermore,  the
present  policy  responses  are  not  sufficiently  integrated  (e.g  air  monitoring  data  are
not  linked  to  water  monitoring  data,  to  soil  monitoring  data,  ….  and  to  health
monitoring  data)  and  therefore  do  not  always  effectively  address  the  specific
“environment and  health” interface.  Such  integration  is  essential  to  further  develop
environmental legislation and measures to protect human health.

The  added  value  of  the  proposed  “European  Environment  and  Health  Strategy”  is
therefore  the  development  of  a  Community  System  integrating  information  on  the
state  of  the  environment,  the  ecosystem  and  human  health.  This  will  render  the
assessment of the  overall environmental impact on  human  health  more  efficient  by
taking into account effects such as: cocktail effects, combined exposure, cumulative
effects,  etc…  as  described  in  Annex  A  under  “Complexity  of  the  problem”.  The
ultimate  goal  of  the  proposed  strategy  is  to  develop  an  environment  and  health
“cause-effect  framework”  that  will  provide  the  necessary  information  for  the
development of Community policy dealing with sources and the impact pathway of
health  stressors.  To  achieve  this  goal  an  integrated  approach  is  needed  within  the
framework of the Community’s sustainable development policy.

4

3. 

OBJECTIVES OF THE STRATEGY

A range of health effects are suspected to be related to environmental factors, notably
respiratory diseases, asthma and allergies are associated with indoor and outdoor air
pollution; neurodevelopmental disorders can be caused by heavy metals, POPs2, such
as  dioxins  &  PCBs,  pesticides;  childhood  cancer  could  be  related  to  a  number  of
physical,  chemical  and  biological  agents  (e.g.  parental  tobacco  smoke,  parental
occupational  exposure  to  solvents).  Furthermore,  environmental  exposures  are
associated with multiple health effects: exposure to tobacco smoke during pregnancy
increases the  risk of  sudden  infant  death syndrome, low birth weight, reduced  lung
function,  asthma,  lower  respiratory  illness  and  middle  ear  infection.  Pesticides  are
possibly  related  to  immunological  effects,  endocrine-disrupting  effects,  neurotoxic
disorders  and  cancer.  Ultraviolet  radiation  may  suppress  immunological  responses
and is a  major  risk  factor  for  the  development  of  skin  cancer.  Research  has  shown
that  exposure  to  elevated  and/or  persistent  noise  levels  near  and  around  schools  is
statistically likely to impair the learning abilities of school children.

While  it  has  been  possible  to  establish  links  between  the  health  effects  and  some
individual environmental factors, no clear overall picture of health impacts resulting
from complex, real life exposure is available. The proposed strategy aims to achieve
a  better  understanding  of  the  environmental  threats  to  human  health  to  identify  the
disease  burden  caused  by  environmental  factors  in  the  EU  and  to  plan  policy
responses to the challenges that emerge.

The ultimate objectives of the proposed strategy are :

(cid:1)  to reduce the disease burden caused by environmental factors in the EU

(cid:1)  to identify and to prevent new health threats caused by environmental factors

(cid:1)  to strengthen EU capacity for policymaking in this area

The  main  thrust  of  the  strategy  is  to  fill  the  knowledge  gap  on  the  link  between
environment  and  health,  in  a  first  phase  focusing  on  a  number  of  priority  adverse
health effects.

The  Commission  will  act  as  a  catalyst  and  clearing  house  for  a  stronger  European
focus on environment and health, particularly for children.

4. 

WHAT IS ALREADY BEING DONE ?

4.1. 

EU chemicals and environment policies

Health  has  always  been  a  major  driver  for  environmental  policy  development.  The
Community’s  environment  legislation  is  based  on  safety  standards,  monitoring
systems and controls covering many of the known health hazardous agents. The main
areas are chemicals, including dioxins & PCBs, endocrine disrupters and pesticides,
air  pollution,  water  protection  and  management,  noise,  waste,  major  industrial
accidents, ionising radiation (for details see Annex B).

2 

Persistent Organic Pollutants

5

                                                
Despite the positive impact on human health of all this existing legislation, measures
have  generally  tended  to  be  developed  either  with  limited  knowledge  of  overall
exposure  to  one  particular  substance,  or  with  inadequate  knowledge  of  the
synergistic  effects  of  several  substances,  either  on  humans  or  on  the  environment.
Furthermore,  the  need  for  on-going  education  of  the  public  on  the  links  between
environmental  risks  and  health  is  even  more  pronounced  as  it  would  contribute
significantly 
increasing  public  awareness  and  facilitating  prevention  of
to 
environment related diseases.

4.2. 

EU action programmes and legislation on health

Several  actions  took  place  under  the  Community  Action  Programme  on  pollution-
related  diseases3  and  on  health  promotion  and  health  monitoring4.  The  new
programme of Community action in the field of public health (2003-2008)5 replacing
them  and  adopted  by  the  European  Parliament  and  the  Council  on  23  September
2002, is the new key instrument underpinning the development of the Community’s
health strategy6.

These are coupled with other EU health activities in the area of tobacco control, food
impact
legislation,  recommendation  on  electromagnetic  fields,  health 
safety 
assessment guidelines, radiation protection legislation (see Annex B).

4.3. 

EU research on environment and health

The  primary  EU  research  objective  is  to  establish  the  European  Research  Area
(ERA) which  will contribute  to the creation of better overall  framework  conditions
for  research  in  Europe,  utilising  the  RTD  Framework  Programme  as  an  instrument
through which this will be achieved. Research on ‘environment and health’ has been
included within this framework :

–  The  European  Framework  Programmes  for  Research  and  Technological
Development started to tackle the issue of “Environment & Health” in earnest by
financing  a  number  of  research  projects  during  the  4th  Framework  Programme
(1995-1998) both  from the aspect  of  health  impacts  (under  Programmes  such  as
BIOMED)  and  tackling  the  issue  of  safer,  more  environmentally  friendly
production methods (e.g. under the Brite/Euram Programmes).

–  The 5th Framework Programme (1999-2002) gave greater visibility and financial
means to address this issue by introducing a focused “key action” on environment
and health with a budget of 160 million Euro to finance research actions. Further
research  support  was  made  available  through  the  Energy,  Environment  and
Sustainable  Development  Programme,  particularly  through  the  Water  key  action
and  under  the  Competitive  and  Sustainable  growth  Programme,  which  placed
emphasis on clean production and on the avoidance of health hazards arising from
industrial  processes.  Research  on  environment  undertaken  at  the  EU’s  own
research  facility,  the  Joint  Research  Center  (JRC)  also  started  under  the  5th
Framework Programme.

3

4

5

6

Decision 1296/1999 of the European Parliament and the Council
Decisions 645/96/EC and 1400/97/EC of the European Parliament and of the Council
Decision 1786/2002/CE (OJ L 271/1 of 9.10.2002).
as set out in the Commission’s May 2000 Communication (COM (2000) 285 final of 16.5.2000).

6

                                                
–  In  the  6th  Framework  Programme,  research  on  environment  and  health  can  be
financed  by  several  thematic  priorities  (Food  Quality  &  Safety;  Sustainable
Development,  Global  Change  and  Ecosystems;  Policy-orientated  Research;
Genomics & Biotechnology for Health, nanotechnologies and nanosciences). For
the  first  time,  the  JRC  work  programme  includes  one  Integrated  Scientific  Area
on  environment  and  health;  in  addition,  several  direct  JRC  actions  contribute  to
this issue.

As a result of these efforts at European level a “critical mass” of European research
on  environment  and  health  is  being  established,  which  will  help  to  ensure
dissemination and exchange of research results.

4.4. 

Occupational health

As  there  is  an  impact  of  work  environment  policies  on  health,  the  European
Environment  and  Health  Strategy  will  develop  synergies  with  the  Community
Strategy on Health and Safety at Work.

4.5. 

International action

The main activities in this area linked to the EU’s work include :

–  Adoption  of  the  European  Charter  on  Environment  and  Health  (Frankfurt  1989)
by  the  Environment  and  Health  Ministers  of  the  European  Region  of  WHO,
followed  by  the  Helsinki  (1994)  and  London  (1999)  declarations.  Within  this
context,  most  Member  States  and  Acceding  countries  have  developed  National
Environmental Health Action Plans (NEHAPs).

–  Commission’s  contributing 

the  next  pan-European
Ministerial Conference on Environment and Health to be held in Budapest in June
2004, with the theme "The future for our children".

the  preparation  of 

to 

–  Effective  follow-up  to  the  Plan  of  Implementation  agreed  in  Johannesburg,
September 2002 at the World Summit on Sustainable Development (WSSD).

–  Launch of a world partnership project "Healthy Environment for Children – Call
for  a  Global  Alliance"  at  the  World  Summit  for  Sustainable  Development  in
Johannesburg in 2002 by WHO with the support of the EU.

–  The  implementation  of  the  UN/ECE  Protocol  on  Persistent  Organic  Pollutants
(POPs), which reflect an international commitment to deal with chemicals which
are persistent, highly toxic and accumulative.

4.6. 

Environment and health in the present and acceding Member States and world-
wide

The  interaction  between  environment  and  health  is  receiving  more  and  more
attention  in  the  Member  States  and  in  the  Acceding  Countries.  Several  Member
States  and  Acceding  Countries  have  prepared  or  are  preparing  “National
Environmental  Health  Action  Plans”  (NEHAPs)  and  have  presented  environmental
health reports and/or strategies.

7

Environmental  health  problems  differ  in  Europe,  e.g.  the  prevalence  of  waterborne
diseases  is  higher  in  Acceding  Countries.  Given  the  geographical  discrepancies  in
Europe,  this  strategy  will  be  developed  for  the  enlarged  Union,  fully  involving  the
Acceding Countries from the outset.

Environment and health is also high on the global agenda. A number of the goals set
by the Johannesburg World Summit on Sustainable Development (WSSD) and/or by
e.g. the United Nations Millennium Development Goals deal with human health and
sanitation  and  are  related  to  environmental  degradation.  These  goals  acknowledge
that  the  majority  of  the  burden  of  environment  related  disease  falls  on  developing
countries.

5. 

THE KEY ELEMENTS OF AN EU ENVIRONMENT AND HEALTH STRATEGY

5.1. 

An integrated approach

In order to establish a better understanding of the cause-effect relationships between
environmental threats and adverse health effects and to enable policy makers to take
due account of the effects of combined exposure, interactions between environmental
pollutants, etc… an integrated approach is required.

This integrated approach implies :

(cid:1)  the “integration of information”, i.e. to pool and to link available knowledge and
experience  across 
the  Community,  providing  a  strategic  overview  of
environmental threats to health, irrespective of the type of burden involved or the
transmitted.
through  which 
environmental  compartment 

that  burden 

is 

Such  a  Community  approach  entails  the  collection  and  linking  of  data  on
environmental  pollutants  in  all  the  different  environmental  compartments
(including the cycle of pollutants) and in the whole ecosystem (bio-indicators) to
health data (epidemiological, toxicological, morbidity)7.

(cid:1)  Integrating  research:  successive  EU  Research  Framework  Programmes  have
brought together research teams across Europe to collaborate on environment and
health  topics  and  importantly  to  develop  common  understanding  and  trust.  The
European  Research  Area  (ERA)  will  deepen  this  integration  by  fostering
collaboration  and  the  development  of  a  common  vision  and  objectives  for
research  at  the  level  of  research  institutes  and  research  programmes.  This
approach  will  equally  apply  to  policy  development,  with  research  providing  the
necessary scientific underpinning.

(cid:1)  Further  integration  of  environment  and  health  concerns  into  other  Community
policies  and  activities:  a  number  of  policies  have  a  direct  or  indirect  effect  on
health and the environment. Albeit efforts have been made to address environment
and health concerns, further consideration should be given to these concerns when
developing  sectoral  policies 
through  clean
production systems) rather than curative aspects.

to  maximise  prevention  (e.g. 

7

without prejudice of the Council and Parliament Decision requiring the establishment of a Public Health
Monitoring  System  under 
the  new  Public  Health  Programme  (Decision
1786/2002/CE)

the  framework  of 

8

                                                
(cid:1)  An  integrated  understanding  of  the  cycle  of  pollutants:  once  released  into  the
environment,  pollutants  can  be  transferred  between  different  environmental
compartments  e.g. dioxins  are  released  and  transported  through  the  atmosphere,
deposited in soil, vegetation and water and continue to move between them (e.g.
air  to  soil,  water  to  sediment).  A  better  knowledge  of  the  cycle  of  the  pollutant
will  make  it  possible  to  identify  the  most  efficient  way  of  preventing  human
contamination, in  particular, in cases where  specific  environmental  legislation  is
insufficient.

The  thematic  strategies  foreseen  under  the  6th  Environment  Action  Programme
will  provide  environmental  data  and  knowledge  on  pollutants  in  the  different
media whatever their sources and nature.  Linking this information will show the
cycle of  a pollutant  thereby permitting  better  assessment of  global  exposure  and
identification  of  the  main  sources  of  production.  The  new  public  health
programme  will  provide  inter  alia  health  data  and  health  impact  assessment  for
environmental threats while the 6thEU RTD Framework Programme and the Joint
Research  Centre’s  Multi-Annual  Work  Programme  for  2003-2006  will  explore
contamination  and  exposure  pathways  and  causality  links  for  the  pollutants  and
the application of research to the development of novel and improved production
systems  to  reduce  potential  health  hazards.  Linking  all  this  environment,  health
and research information will enable an integrated approach showing the cycle of
a  pollutant,  assessing  global  exposure  and  associated  health  effects  and
identifying the most productive action routes.

(cid:1)  Integrated  intervention:  to  eliminate,  reduce  or  avoid  negative  health  effects  of
environmental factors, questions of feasibility (technical, economic and practical),
cost-effectiveness and ethics must be considered. Responses can then focus either
on  exposure  by  reduction  or  elimination  of  the  pollutant  or  on  health  effects  by
prevention,  early  identification  or  stopping  the  progression  of  disease.  The
responses may also be concentrated on the individual encouraging  a behavioural
change or medical intervention.

(cid:1)  Integration of stakeholders: to ensure efficient implementation of this strategy, it
is important to develop a close co-operation with all stakeholders and to promote
co-ordination between the health and the environment sectors. This should include
national, local and regional authorities, the public, industry, academia, as well as
international and non-governmental organisations.

5.2. 

An incremental strategy

Given  the  complexity  and  breadth  of  the  scope  of  this  exercise,  the  integrated
approach will be implemented in successive cycles and will be incremental in scope.
The first cycle (2004-2010) will focus on well identified priorities and will create the
basis for the next cycle. It will make it possible to set up a Community system that
will  provide  the  necessary  information  for  assessing  the  overall  environmental
impact  on  human  health  and  the  cause-effect  link,  for  identifying  and  monitoring
health  threats  caused  by  environmental  factors  and  for  preparing  and  reviewing
policy related to environment and health.

9

5.3. 

A focus on children

Of all vulnerable populations, children are a unique section of the population with a
particular susceptibility to environmental agents. Starting at the foetal stage, the close
physiological  relationship  between  a  pregnant  woman  and  the  foetus  she  carries
makes  the  foetus  vulnerable  to  dangerous  agents  the  mother  has  been  exposed,
especially  those  affecting  development.  Many  toxic  or  allergenic  agents  present  in
maternal  blood  may  also  be  present  in  mother’s  milk  and  a  number  are  capable  of
crossing  the  placental  barrier.  This  potential  for  transfer  of  environmental
contaminants  from  the  mother  to  the  foetus  and  the  neonate,  further  reinforces  the
need 
from  environmental
contamination as a way to ensure a healthy start in children’s life.

to  protect  pregnant  and  breastfeeding  women 

Children  have  a  unique  vulnerability.  They  go  through  a  succession  of  distinct
developmental and learning phases e.g. the foetal, neonatal, school-age and pubertal
phases. At each of these stages, a child is vulnerable and exposed to different agents:
an adolescent may be more vulnerable to attacks on the reproductive system, while a
baby  is  more  vulnerable  to  dust  at  ground  level.  Children  also  face  a  potentially
longer exposure to toxicants. In view of their life expectancy, children are the section
of the population likeliest to endure exposure for the longest time.

Their  higher  vulnerability  is  an  important  reason  to  take  specific  action  for  this
population  group  when  both  assessing  and  managing  risks.  Furthermore,  the
economic  impacts  of  environment-related  childhood  illnesses  highlight  the  need  to
pay particular attention to  children. This vulnerability and related  economic  impact
has  guided  the  focus  on  children  throughout  the  Strategy  and  the  choice  of  the
specific pollutants to be addressed.

5.4. 

Acceding Countries

Environmental  health  problems  differ  in  Europe,  e.g.  the  prevalence  of  waterborne
diseases  and  exposure  to  outdoor  pollution  are  higher  in  the  Acceding  Countries
while the prevalence of asthma is higher in some of the current EU Member States.
Given  the  geographical  discrepancies  in  Europe,  this  strategy  will  be  developed,
from the outset, for the enlarged Union. This will not only allow better understanding
of the environmental health discrepancies in Europe, but it will also provide a better
basis  to  correlate  long-term  health  effects  and  environmental  factors  by  especially
target socio-economic aspects of environmental health.

Full  implementation  of  the  environmental  “acquis”  will  bring  significant  health
improvements in the Acceding Countries as a result of efforts to ensure cleaner air,
water  and  better  waste  management.  Fully  implementing  the  EU  Directives  on  air
quality can lead to at least 15 000 fewer cases of premature deaths from exposure to
air pollution and between 43 000 and 180 000 fewer cases of chronic bronchitis. 8

An  EU-funded  Project  being  carried  out  by  the  WHO  is  currently  assessing  the
environmental health situation in the countries of the European Union, the Acceding
Countries and the countries in the Western Balkans. The results will contribute to the
overall pan-European assessment for the Budapest 2004 Conference.

8

“The benefits of compliance with the environmental acquis for the Acceding countries” (ECOTEC et al
2001)

10

                                                
The results of the EU funded projects “Dioxin emissions in Acceding Countries” (end
of 2004) and “Dioxins & PCBs : environmental levels and human exposure” (end of
2003)  will  provide  a  first  insight  into  the  dioxin-health  situation  in  the  Acceding
countries, which may be different from the prevailing EU situation.

Special  attention  will  be  given  to  the  Acceding  Countries  in  all  the  actions
announced  in  the  Strategy.  The  Consultative  Group  and  the  Technical  Working
Groups  will  include  experts  from  the  Acceding  Countries.  The  three  Regional
Conferences  (Baltic,  Central  Europe,  Mediterranean)  will  ensure  a  broad
involvement of the different Acceding Countries. The Baseline Report 2004 and the
Action  Plan  2004-2010  will  include  the  situation  in  Acceding  Countries  for  the
different items.

6. 

A EUROPEAN ENVIRONMENT AND HEALTH STRATEGY

This  Strategy will be incremental in  scope  and  will  be  implemented  in  cycles.  The
first  cycle  will  focus  on  a  set  of  well-identified  priorities  and  will  set  the  basis  for
further  work. The  Strategy  is based on  the  participation  of  all  stakeholders  and  on
the  best  available  scientific  knowledge,  as  stated  in  the  6th  Environmental  Action
Programme and will complement existing legislation.

6.1. 

Finding  Common  Ground  :  a  European  Integrated  Environment  and  Health
Monitoring and Response System

In order to achieve the long-term objectives of this strategy, it is necessary to set up
an  integrated  environment  and  health  monitoring  system  for  the  systematic  and
comprehensive collection of data over time. Member States are already involved in
data collection on a national basis. The value added at European level is to generate
synergies and facilitate the sharing of data and methodologies in order to increase the
understanding of the environment and health relationship. Health data will be linked
to  the  full  range  of  environmental  data,  including  all  the  different  environmental
compartments and the whole ecosystem, in order to obtain a picture of the exposure
of  populations  to  environmental  contaminants  and  their  adverse  health  effects.
Taking  advantage  of  the  future  Health  Monitoring  and  Information  System,  such
systematic  and  integrated  monitoring,  helped  by  the  Global  Monitoring  for
Environment  and  Security  (GMES)9  initiative,  will  facilitate  the  creation  of  a  solid
EU knowledge base from which to formulate health and environment policy. It will
also allow the identification of new and/or emerging issues.

In  order  to  set  up  such  a  system,  a  mechanism  for  data  sharing,  improved  data
availability, accessibility, comparability and enhanced exchange of information must
be established.

Data sharing: agreement on the type of data which will be shared at European level
is needed. This should include :

–  toxicological  data  demonstrating  that  specific  factors  can  induce  biological  and

physical changes

9

GMES is a  key  initiative  for  the  provision  of  integrated  services  on  monitoring  environmental  health
stressors from space, which paved the way to the INSPIRE initiative.

11

                                                
–  epidemiological  data  demonstrating  a  connection  between  certain  diseases  and

exposure to a given environmental factor

–  environmental  data  relevant  for  demonstration  of  the  impact  of  environmental

factors on the pathways leading to adverse health effects.

Effort will also need to be devoted to the development of standardised protocols for
data collection to facilitate future data sharing.

Improving data availability, accessibility and comparability: data for which there
is  a  Community  obligation  to  notify  (e.g.  atmospheric  pollution,  water  quality
monitoring  data)  is  available  but  often  not  in  a  format  that  allows  for  evaluating
potential health impacts. Other monitoring data is less standardised and is dependent
on  national  or  local  priorities,  such  as  indoor  pollution  and  drinking  water
distribution networks.

The  Global  Monitoring  for  Environment  and  Security  (GMES)  initiative  of  the
Commission,  will  bring  to  bear  a  comprehensive  understanding  of  environmental
stressors  on  the  global  scale  exploiting  the  potential  of  Earth  observation.  Gaining
access to health data is a particular problem. The necessary information on morbidity
and  mortality  is  not  always  accessible,  for  instance  for  reasons  of  confidentiality.
Another  problem  is  that  in  some  important  areas  there  is  no  standardised  medical
nomenclature.

Apart  from  data  availability  and  accessibility  problems,  there  are  often  problems
with  the  comparability  of  information  because  of  data  being  scattered  in  time,
inappropriate  geographic  or  temporal  resolution,  application  of  different  standards,
etc…

Improving  accessibility  and  comparability  of  data  on  diseases  that  may  be
attributable to environmental factors will be a major undertaking in the strategy. First
steps  have  already  been  taken  to  establish  a  common  long-term  database.  The
European  Environment  Agency,  which  has  extensive  experience  in  gathering  and
assessing  environmental  data,  and  WHO-Europe  are,  with  the  support  of  the
Commission, involved in developing a health and environment information exchange
platform. This database will be fed by and be accessible to Member States and will
provide  appropriate  tools  for  policy  makers.  Information  to  be  shared  covers
indicators,  monitoring  results,  assessment  of  the  environmental  health  burden  of
disease,  elements  for  analysis  of  cost-effectiveness  of  environmental  health
intervention  and  information  on  environment  and  health  initiatives  launched  at
international, national, regional and local level.

The  INSPIRE  initiative,  currently  being  prepared  by  the  Commission,  is  a  multi-
thematic  and  multi-sectoral  system  which  will  co-ordinate  the  collection  and
dissemination  of  spatial  data  for  the  support  of  environment  policies.  This  spatial
dimension  will  support  our  understanding  of  the  interaction  between  environment
and  health.  Co-ordination  is  needed  with  the  newly  created  information  platform
within the new Community public health programme, called European Public Health
Informatic  Network  (EUPHIN)  which  will  be  storing  the  Environmental  Health
Indicators.

12

Assessing available knowledge and experience: with a view to making best use of
existing  information  and  expertise,  the  exchange  of  scientific  and  technical
information,  the  validation  of  results,  and  the  identification  of  knowledge  and  data
gaps  will  be  promoted.  Such  exchanges  will  be  facilitated  through  the  progressive
adoption and putting into practice of the collaboration provided under the European
Research Area.

Reviewing  current  policies  and  existing  early  warning  systems:  current  policies
often tend to regulate potentially hazardous substances separately. Some substances
may  be  covered  by  more  than  one  policy  which  may  in  turn  be  based  on  different
risk  assessments,  which  may  not  take  account  of  human  and/or  environmental
exposure  to  other  uses  of  the  same  substance.  The  integrated  approach  will,  in
combination with the new Chemicals policy, improve knowledge of environment and
health impacts. This information will allow better cost and benefit calculations. The
resulting  information  is  therefore  likely  to  lead  to  policy  recommendations  in  the
form of reviews of existing standards and limit values (e.g. thresholds for substances
in  the  environment).  Similarly,  the  development  of  new  Community  policies  will
benefit  from  improved  information  related  to  a  health  and  environment  impact
assessment.

Several Community early warning systems are established. An appropriate response
to environment and  health threats would  require  a coordinated  reaction of  all  those
existing systems.  The  interrelations between  them  should  be  reviewed  to  maximise
an efficient Community response.

Furthermore,  with  the  significant  amount,  and  quality  of,  scientific  knowledge
generated with the Union, the EU is well placed to contribute to the development of
safer  products  with  a  diminished  impact  on  human  health  and  the  environment  in
developing  countries.  Non  confidential 
information  and  data  can  also  be
disseminated  to  and  shared  with  public  authorities  and  stakeholders  in  third
countries.  Technology  and  research  capacities  can  play  a  role  assisting  public
authorities  in  health  and  environment  monitoring  systems,  including  early  warning
mechanisms.

6.2. 

Scope of the first cycle (2004-2010)

The  first  cycle  aims  to  establish  a  good  understanding  of  the  link  between
environmental factors and :

(1) 

childhood respiratory diseases, asthma, allergies,

(2) 

neurodevelopmental disorders

(3) 

childhood cancer

(4) 

endocrine disrupting effects

and  it  aims  to  identify  and  to  prevent  new  health  threats  caused  by  environmental
factors.  It  also  aims  at  reinforcing  the  institutional  structure  needed  to  strengthen
policy-making and to integrate environment and health into other policy areas.

The  first  cycle  will  therefore  focus  on  a  set  of  environmental  pollutants  that  are
suspected  to  be  associated  with  these  health  effects.  It  will  generate  the  necessary

13

information  for  establishing  the  cause-effect  link,  for  identifying  and  monitoring
environmental  health  threats  and  for  preparing  and  reviewing  policy  related  to
environment  and  health,  taking  into  account  cost  benefit  analysis.  This  first  cycle
will also identify new environmental health threats to be addressed in the next cycle.

The items selected for the first cycle relate to the following three main pillars :

–  European Integrated Environment & Health Monitoring and Response System, in

order to assess the overall environmental impact on human health

–  Research, in order to achieve a better fundamental understanding on environment

and health issues

–  Reducing exposure

6.2.1.  European Integrated Environment & Health Monitoring and Response System

a)

Children - Establishing an EU Bio-monitoring Framework

In  order  to  assess  environment  and  health  linkages  relative  to  children  and  to
generate  appropriate  policy  responses,  the  gap  in  knowledge  has  to  be  closed.
Several Member States and some Acceding Countries have set up « environment and
health »  bio-monitoring  campaigns  and  related  initiatives  to  explore  environmental
factors  that  influence  human  health.  Some  joint  initiatives  including  several
European  countries  are  ongoing,  but  the  work  should  be  better  co-ordinated.
Different  Member  States  are  using  different  parameters.  The  intention  is  to  work
with  the  Member  States  to  see  how  far  it  will  be  possible  to  establish  common
indicators and a common monitoring framework.

The Commission will facilitate and actively encourage the exchange of information
and experience in this area. In the long-term the Commission will consider together
with  Member  States  the  development  of  a  permanent  harmonised  European  bio-
monitoring  system.  Such  a  system  will  allow  better  understanding  of  environment
and  health  linkages  and  long-term  health  effects  and  will  be  used  as  a  tool  for  the
development of further environmental policy.

This  approach,  which  will  be  built  around  ongoing  monitoring  -  with  special
attention  to  priority  pollutants  and  urban  areas  -  in  the  Member  States  and  the
Acceding  Countries  would,  in  addition  to  gathering  additional  data  for  national
purposes, have the advantage of providing harmonised data on a much larger sample
population.  This  would  improve  the  validity  of  results  and  also  allow  for  a  wider
variety of factors and influences to be studied.

b)

Pilot projects on Dioxins, Heavy Metals and Endocrine Disrupters,

The  Commission  considers  to  launch  three  pilot  projects  to  monitor  priority
pollutants with the aim of developing a methodology for integrated environment and
health monitoring and to review related legislation. This will be undertaken in close
co-operation  with  the  Member  States.  The  results  will  be  used  to  develop  a
“European  Integrated  Environment  and  Health  Monitoring  and  Response  System”
that will be extended to other substances. Particular attention will be paid to the link
between  the  data  collected  and  their  geographical  distribution  at  local,  regional,

14

national  and  Community  level.  This  will  lead  to  a  Community-wide  geographical
representation of environmental factors having an impact on health.

The selected pilot projects focus on particularly hazardous substances for which data
collection and monitoring is already well underway. The vulnerability of children has
also  guided  the  choice  of  the  specific  pollutants,  because  these  pollutants  affect
children in  a  significant way so  special  attention  will  be  given  to  these  substances.
The three pilot project that have been selected are :

(cid:1)  dioxins and PCBs: in the framework of the implementation of the  “Community
Strategy  for  Dioxins,  Furans  and  Polychlorinated  Biphenyls”10  and  of  the
“Community  Marine  Strategy”11  a  pilot  project  on  « Integrated  dioxin  and  PCB
Monitoring in the Baltic Region  » is been developed. In close co-operation  with
HELCOM12  the  Commission  will  examine  the  possibility  of  linking  current
environment, fish and human health monitoring data and programmes for dioxins
and  PCBs  in  the  Baltic  Area  and  identify  ways  of  developing  integrated
environment and health monitoring for dioxins and PCBs in the Baltic Area. This
will  provide  the  necessary  information  to  assess  the  link  between  dioxins  and
through  different
PCBs 
the
environmental  compartments,  their  accumulation 
ecosystem  and  food,  and their effects  on  health.  The  integrated  information  will
be used as a basis for further policy development.

transport 
in 

the  environment, 

the  environment, 

released 

their 

into 

(cid:1)  heavy metals: in order to assess the overall exposure and the different  routes of
exposure to heavy metals different monitoring programmes will be proposed and
will be linked together. The Commission will propose that Member States monitor
ambient  air  quality  for  Arsenic,  Nickel  and  Cadmium  in  areas  where  the
population  is  exposed  to  concentrations  above  certain  thresholds,  e.g.  in  the
vicinity  of  industrial  sites.  The  Commission  will  also  propose  harmonised  soil
monitoring of heavy metals in the vicinity of industrial sites and traffic as part of
the  EU  Thematic  Strategy  on  Soil.  This  monitoring  on  heavy  metals  could  be
extended to other environmental media to understand the full cycle and to ensure
an integrated monitoring.

(cid:1)  endocrine  disrupters:  as  part  of  the  “Community  Strategy  for  Endocrine
Disrupters”13  a  priority  list  of  substances  for  further  evaluation  has  been
established.  Substances  with  evidence  and/or  potential  evidence  of  endocrine
disruption were identified, including pesticides, industrial chemicals, by-products
and  metals.  In  a  second  step,  definitive  testing  for  their  endocrine  disrupting
potential  will  be  performed  once  OECD  agreed  test  methods  are  available.  The
final objective is to manage the induced risk  by  adapting  the  relevant  legislative
instruments, supported by on-going and future research efforts. The Commission
will,  in  close  co-operation  with  the  Member  States,  establish  monitoring
programmes in water to estimate exposure to and effects of the substances on the
priority list of endocrine disrupters in order to gather evidence that could be used

10

11

12

13

COM(2001)593
COM(2002)539
Helsinki Commission for the Protection of the Baltic Marine Environment
COM(1999)706

15

                                                
in future revisions of different legislative instruments, such as the drinking water
directive and the water framework directive.

c)

Developing harmonised Environment and Health Indicators

The development of environment and health indicators within the new public health
programme  will  be  conducted  in  the  context  of  the  European  Community  Health
Indicators Project (ECHI project) of which environmental indicators form a part. A
project  to  develop  these  environmental  indicators  has  been  financed  by  the
Community Health Monitoring Programme (“Development of Environmental Health
Indicators  for  EU  Countries”).  When  this  project  is  concluded,  it  will  provide  an
input to the Health Monitoring and  Information System  to be established under the
Community Public Health Programme (2003-2008).

6.2.2.  Research

a)

Application of research results

Research  results  arising  from  activities  funded  under  the  EU  RTD  Framework
Programmes have played a part in the development and implementation of European
environment and health related policies. By way of an example, as an integral part of
the ‘Community Strategy on Endocrine Disrupters’, a call for research proposals was
launched in 2001 with a dedicated  budget of 20 million euros, this in addition to a
budget of 40 million euro already dedicated to endocrine disrupter research projects.
The results of the research commissioned will be available as planned as an input to
the  further  development  of  the  Community  Strategy  over  the  next  2–5  years.  This
direct research support to policy will be further encouraged though the establishment
of  mechanisms  to  focus  and  direct  research  outputs  at  policy  objectives.  Already
specific focussed initiatives have been initiated in areas such as the health impacts of
air pollution, electro-magnetic fields, water, etc.

Recent  progress  in  genomics  research  is  promising  new  and  more  comprehensive
insights on the interaction between environment and the human genome. While very
promising, this  area  of  research is very  large  and  calls  for  a  structured  approach  at
European level.  The  Joint  Research Centre  will  analyse  opportunities  and  ways  for
developing  a  pan-European  research  approach  in  priority  areas  such  as  children’s
health. A preliminary example of a co-ordinated approach can be found in the EU-
funded research network on children’s susceptibility and exposure to environmental
genotoxicants. The European Science Foundation networks on genetic susceptibility
to  environmental  toxicants  and  their  impacts  on  human  health  with  particular
attention to the interaction between nutritional, environmental and genetic factors in
early human development will also provide scientific input to this investigation.

Annual  research  meetings  and  reports  on  Children’s  Health  and  the

b)
Environment

Within the context of the European Health Forum (see Section 7.1 below), a “Policy
Interpretation  Network  on  Children’s  Health  and  the  Environment”  has  been
established.  This  will  provide  a  focus  for  the  co-ordination  and  interpretation  of
research  results  from  a  number  of  EU  funded  projects  on  children’s  environmental
health  and  genetic  susceptibility  to  environmental  toxicants  in  relation  to  the
development of policy.

16

The  Commission  will  organise  annual  research  meetings  and  reports  on  children’s
health and environment, the first one in Summer 2003 with subsequent conferences
planned  for  2004  and  2005.  The  Commission  will  also  establish  a  database  of
research projects on children’s environmental health by the end of 2003.

c)

Combined exposure

As part of its research activities the Commission will develop methodologies to help
to identify  exposures  and to  perform  combined  exposure  analysis  of  environmental
factors  connected  to  particular  diseases  (e.g.  development  of  specific  cancers)  and
risk  assessment 
individual  susceptibilities  and  genetic
predisposition.  Under  Thematic  Priority  1  of  the  6th  Framework  Programme  for
research "Genomics & Biotechnology for Health", funding possibilities exist within
the  sub-area  "Combating  cancer"  which  is  part  of  the  section  addressing  major
diseases.

into  account 

taking 

In  this  context,  the  Commission  will  strenghten  the  research  base  for  the
development of integrated exposure models to estimate the human intake of mixtures
of  chemicals  through  all  environmental  compartments,  including  air  and  water
intake,  food  and  consumer  products.  Such  models  could  be  used  to  articulate
scenarios for total exposure assessment and suggestions for policy action leading to
exposure reduction.

d)

Economic valuation of health

The  Commission  will  strengthen  the  research  base  for  the  economic  valuation  of
health  impact  of  policies,  measures  and  technologies,  with  particular  focus  on
environment and children’s health.

6.2.3.  Reducing exposure

a)

Air quality (indoors and outdoors)

The  Commission  will  further  contribute  to  the  improvement  of  air  quality  by
developing  a  thematic  strategy  based  on  the  results  of  the  ongoing  Clean  Air  for
Europe  programme  (CAFE),  addressing  in  particular  particulate  matter,  nitrogen
dioxide and ozone.  As part  of this programme it will review directive 1999/30/EC,
which sets limit values for the concentration of SO2, NO2, NOx, lead and particulate
matter in ambient air quality for airborne particles, by  the  end of 2003. A proposal
for a new directive relating to heavy metals and polyaromatic hydrocarbons (PAH) in
ambient air is due to be adopted. Specific research actions are also under way as part
of  the  5th  EU  RTD  Framework  Programme  and  planned  in  the  6th  Framework
Programme,  to  draw  together  in  a  policy  context,  the  latest  EU  funded  research
results  related  to  the  impact  of  air  quality  on  health  with  the  objective  to  further
improve the scientific underpinning of policy actions. These results will be integrated
into the thematic strategy.

Giving the existing evidence showing that exposure to environmental smoke causes
increased risks of several illnesses in children and that this exposure of non-smoking
women  during  pregnancy  also  causes  reductions  in  foetal  growth,  the  Commission
fully  supports  tobacco  control  policies  including  measures  to  protect  people  from
passive  smoking  like  the  banning  of  smoking  in  public  places.  However  the

17

Commission cannot propose binding legislation in this area. Therefore, the Tobacco
Recommendation  adopted  by  the  Council  at  the  end  of  2002,  following  a
Commission  proposal  calls  upon  Member  States  to  implement  legislation  and/or
other  effective  measures  that  provide  protection  from  exposure  to  environmental
tobacco  smoke  in  indoor  workplaces,  enclosed  public  places,  and  public  transport.
Priority  considerations  should  be  given  to,  inter  alia,  educational  establishments,
health care facilities and places providing services to children.

In addition, specifically to protect pregnant workers and workers who have recently
given  birth  or  are  breast  feeding,  Directive  92/85/EEC  of  19/10/92  on  measures  to
improve  safety  and  health  of  pregnant  workers  states  that  employers  must  inform
these  workers  of  the  potential  risks  and  take  appropriate  measures  when  the
employee is exposed to carbon monoxide.

b)

Heavy metals

In the field of heavy metals, the Commission :

–  will  develop  a  Strategy  on  Mercury  in  2004  to  protect  human  health  and  the
environment  from  the  release  of  mercury  based  on  a  life-cycle  approach,  taking
into account production, use, waste treatment and emissions from the burning of
fossil fuels.

–  intends to develop legislative proposals in 2003 on setting environmental quality
standards and emission controls measures for priority substances under the Water
Framework  Directive  (Directive  2000/60/EC).  Mercury  and  cadmium  and  their
respective compounds are among those defined as priority hazardous substances.

c)

Electro-magnetic fields

The Commission will support the WHO Health Risk Assessment of electro-magnetic
fields  to  be  completed  by  2005  and  will  take  all  necessary  actions  to  study  any
possible health effects of exposure to electro-magnetic fields and will pay particular
attention to the protection of children and teenagers as specially exposed vulnerable
group. The Commission will review the 12 July 1999 Council Recommendation on
limiting the exposure of the general public to electro-magnetic fields by 2004.

d)

A healthy urban environment

By  mid-2005  the  Commission  will  propose  a  thematic  strategy  on  the  urban
environment  that  will  aim  to  contribute  to  improvement  of  the  environmental
efficiency  of  urban  areas  and  to  secure  a  healthy  living  environment  for  urban
citizens. The package of measures proposed in this strategy will, among other things,
focus on sustainable urban transport, thereby contributing to reducing morbidity and
mortality  related  to  air  pollution,  noise  and  traffic  accidents.  Results  of  related  EU
sponsored  research  projects  (on  noise,  air  pollution,  water  quality,  etc..)  will
similarly provide an input to policy actions in this area. To accompany this strategy,
the  Commission  will,  within  the  framework  of  the  new  Public  Health  Programme,
launch  by  2005  a  series  of  projects  to  promote  a  healthy  urban  environment,
including  reducing  traffic  accidents.  The  bio-monitoring  of  children  will  focus  on
children in an urban environment, where, a series of stress factors combine to have a
negative  combined impact on health. This will, in  the  long-term,  allow  us  to  see  if

18

progress  in  improving  the  urban  environment  is  reflected  in  the  improvement  of
children’s health, and in which towns and cities extra effort is required.

7. 

IMPLEMENTATION

7.1. 

Full Stakeholder Involvement

information 

Broad stakeholder involvement is essential for strengthening dialogue and exchange
sectors
stakeholders 
of 
(health/environment, public/private, air/water…). The Commission therefore intends
in 2003 to set up :

different 

between 

from 

the 

all 

(cid:1)  A Consultative Group on « Environment & Health » consisting of environment
and  health  experts  from  Member  States  and  Acceding  Countries,  Community
entities  such  as  the  Commission’s  Joint  Research  Centre,  the  European
Environment  Agency  and  the  European  Food  Safety  Authority,  representatives
from  international  organisations,  such  as  WHO,  and  the  medical  community
(including  paediatric  medicine),  academic, 
research,  NGO’s,  consumer
organisations  and  certain  industrial  sectors.  The  Group  will  analyse  scientific
environment  and  health  data,  identify  environment  and  health  risk  management
measures,  analyse  their  cost  efficiency,  and  regularly  review  relevant  policies
related  to  environment  and  health  and  advise  on  appropriate  adjustments.  This
Group  will  rely  in  large  part  on  the  work  of  the  SCTEE14  and  will  be  part  of  a
broad  Community  system  on  Environment  and  Health.  The  group  will  in
particular coordinate and explore synergies with the SCTEE and identify missing
links in existing monitoring systems in order to develop the European Integrated
Environment and Health Monitoring and Response System.

(cid:1)  Technical  Working  Groups  on  inter  alia  biomonitoring  of  children,  dioxins,
endocrine  disrupters,  heavy  metals,  indicators,  consisting  of  relevant  experts.
Existing  working  groups  on  air  quality,  urban  environment,  electro-magnetic
fields  will  be  linked  to  the  Consultative  Group.  In  a  later  stage,  new  working
groups  will  be  created  when  the  need  has  been  identified.  The  working  groups
will  provide  the  best  available  scientific  knowledge  and  assist  the  Commission
with the implementation of the Strategy.

To ensure added value and policy coherence, the Commission will ensure that these
new  groups  will  not  impinge  on  the  work  of  established  scientific  committees  and
other advisory fora set up to advise the Commission.

(cid:1)  The  development  of  this  strategy  will  be  regularly  presented  during  the  annual
"Green  Week"  and  in  the  “European  Health  Forum”,  established  by  the
Commission  in  2001  and  consisting  of  representatives  of  NGO’s,  health
providers, patients, industry and health professionals and will also be presented on
“European Health Day” to be organised from 2004 onwards.

14

Scientific  Committee  on  Toxicity,  Ecotoxicity  and  the  Environment  established  by  Commission
Decision N° 97/579/EC of 23 July 1997

19

                                                
7.2. 

Preparing the “Action Plan 2004-2010”

Three Regional Conferences to prepare a “Baseline Report 2004”

In autumn 2003 the Commission will organise three conferences to discuss with the
Consultative Group and the Working Groups the efficient implementation of the first
cycle of the strategy, to define a baseline and to identify elements for the next cycle.
In order to fully involve all parts of the enlarged EU the conferences will be held in
different regions: the Baltic region, Central Europe, Mediterranean.

All three Conferences will address the general items, such as integrated environment
and  health  monitoring,  biomonitoring  of  children,  knowledge  of  regional  partners,
baseline  identification.  Furthermore,  each  conference  will  be  devoted  to  specific
items in order to cover the full scope of the first cycle. For example, the pilot projects
on dioxins and endocrine disrupters will be addressed in the Baltic Conference.

The  final  outcome  of  the  three  conferences  will  be  a  “Baseline  Report  2004”
providing a picture of the situation in  2004 and a  draft implementation  plan  for  all
the  items  of  the  first  cycle:  biomonitoring  of  children,  pilot  projects  on  integrated
monitoring  of  dioxins,  heavy  metals,  endocrine  disrupters,  indicators,  research  on
children’s environment and health and on combined exposure, air quality, EMF, and
urban environment.

A Major Stakeholder Conference to prepare an “Action Plan 2004-2010 »

In  spring  2004  the  Commission  will  organise  a  Major  Stakeholder  Conference
involving  the  Consultative  Group  and  all  the  Working  Groups,  with  the  aim  of
finalising a detailed action plan with defined goals and actions for the period 2004-
2010.

Fourth Ministerial Conference on Environment and Health, Budapest 2004 “The
future for our children”

The  “Action  Plan  2004-2010”  will  be  the  Commission’s  contribution  to  the
Ministerial Conference in Budapest 2004. As the Strategy is incremental, addressing
priority  issues  in  the  first  cycle  and  setting  the  basis  for  further  work,  the  second
cycle will focus on new items (e.g. noise, pesticides15, socio-economic determinants
of environmental health, other risk groups such as elderly, poor and women of child-
bearing age, etc.) and will also identify the elements for the next cycle.

This  incremental  approach,  based  on  participation  and  best  available  scientific
knowledge will  gradually  improve  knowledge  of the link between  environment and
health and will make it possible to further develop relevant policy on the sources.

8. 

CONCLUSIONS

This  Communication  underlines  the  Commission's  commitment  to  provide  "an
environment  where  the  level  of  pollution  does  not  give  rise  to  harmful  effects  on

15 

Pesticides will also be specifically covered in the upcoming Thematic Strategy on the Sustainable Use
of Pesticides.

20

                                                
human  health  and  the  environment",  as  stated  in  the  Sixth  Environment  Action
Programme. It proposes an integrated Strategy for Environment and Health,  with a
special  focus  on  children  and  other  vulnerable  population  groups.  It  helps  policy
makers  at  EU  and  national  level  to  deal  with  the  complex  interactions  between
environment and health.

It  aims  to  achieve  a  better  understanding,  to  fill  gaps  and  promote  a  better
understanding  of  environmental  threats  to  human  health  and  take  action  to  prevent
and  reduce  these  threats.  The  ultimate  objectives  will  reduce  the  disease  burden
caused by environmental factors and strengthen the policymaking in this area.

The strategy will be implemented in cycles, will be incremental in scope and is to be
known as the “SCALE initiative”, since it is based on Science, focuses on Children,
aimes  at  Raising  Awareness,  uses  Legal  instruments  and  includes  constant
Evaluation.

21

9. 

ANNEX A : – THE PROBLEM

Some facts

Although  many  environmental  health  problems  have  been  solved  serious  problems
remain. The report on “Children’s health and environment: a review of evidence”16
highlights that :

(cid:1)  A  significant  increase  in  childhood  asthma  in  “western  affluent”  countries  over
the  last  few  decades,  with  a  trend  ranging  from  only  a  slight  increase  up  to  a
three-fold increase.

(cid:1)  The  occurrence  of  developmental  disabilities,  such  as  learning  disabilities,
intellectual  retardation  and  attention  deficit  hyperactivity  disorder  (ADHD)  is
certainly large enough to constitute a significant public health problem.

It  is  estimated  that  around  20%  of  the  total  burden  of  disease  in  industrialised
countries can be attributed to environmental factors17, with the bulk of this affecting
children  and  vulnerable  groups,  such  as  poor  and  women  in  reproductive  age.  The
magnitude  of  the  problem  is  clearly  perceived  by  the  European  public:  in  a  recent
Eurobarometer  survey,  some  89%  of  the  respondents  expressed  concern  about  the
potential  impact  of  the  environment  on  their  health18.  New  technologies,  changing
lifestyles, work and life patterns, present new and sometimes unexpected impacts on
the environment and its influence on health. A few examples are presented below.

An  estimate  of  mortality  due  to  long-term  exposure  in  124  European  cities  (for  a
total of 80 million inhabitants), showed that around 60 000 deaths per  year may be
associated  with  the  long-term  exposure  to  particulate  air  pollution  exceeding  the
level19 in the 124 cities with particulate matter data.

Over the last few decades, asthma and allergies have increased throughout Europe.
On  average,  10%  of  children  suffer  from  asthmatic  symptoms.  For  1995-1996,  the
International Study of Asthma and Allergies in Childhood (ISAAC) found an 11.5%
annual average prevalence of self-reported asthma symptoms in children aged 13–14
years.  In  Western  Europe,  the  symptom  rate  is  up  to  ten  times  than  in  eastern
countries. This suggests that a western lifestyle is associated with allergic diseases in
childhood.  Environmental  tobacco  smoke  and  air  pollution  are  among  the  major
threats to respiratory health, especially early in life, and are likely to worsen asthma.
Environmental  tobacco  smoke  increases  the  risk  of  lung  cancer  in  non-smokers  by
20-30 %.20 Also women are particularly exposed to passive smoking. It is estimated

16

17

18

19

20

A  joint  report  from  the  European  Environment  Agency,  Copenhagen  and  the  World  Health
Organisation, Regional Office for Europe (2002)
How  Much  Global  Ill  Health  Is  Attributable  to  Environmental  Factors?,  K.R.  Smith  et  al.,
Epidemiology 1999
Flash  Eurobarometer  EB123 
et  préoccupations
environnementales  des  européens"  (Europeans'  perception  of  sustainable  development  and
environmental concerns) April 2002
equivalent to particulate matter 10 = 5mg/m3. “Europe’s environment: the third assessment” European
Environment Agency, Copenhagen (2003)
“Europe’s environment: the third assessment” European Environment Agency, Copenhagen (2003)

"Perception  du  développement  durable 

22

                                                
that the majority of the 1000 deaths/year from lung cancer in non-smokers in the 15
EU countries are females.

In  European  countries,  1  out  of  5000  children  is  estimated  to  be  diagnosed  with
cancer  before  the  age  of  15.  Although  the  role  of  environmental  exposure  in
childhood cancer is limited, children are more prone to biological events potentially
related  to  the  development  of  cancer  because  exposure  to  carcinogens  during
childhood  can  be  reflected  in  cancer  occurrence  later  in  life  (as  in  the  case  of
excessive  ultraviolet  radiation  exposure  causing  melanoma).  A  10%  decrease  in
stratospheric ozone is projected to cause an additional 300 000 non-melanoma skin
cancers and 4  500  melanoma  cases  per  year,  world-wide.  For  each  1%  decrease  in
stratospheric  ozone,  average  annual  percentage  increase  in  the  incidence  of  non-
melanoma skin cancer ranges from 1 % to 6 %, and for squamous cell carcinoma and
basal cell carcinoma ranges from 1,5-2.5%.21

The  developing  nervous  system  is  particularly  vulnerable  very  early  in  life  to
damaging effects of exposure to specific contaminants such as lead, methylmercury
and  polychlorinated  biphenyls  (PCBs).  A  child  can  absorb  as  much  as  50%  of  the
lead  present  in  food,  while  an  adult  takes  up  only  10%22.  Exposure  to  such
substances  has  been  associated  with  developmental  disabilities  in  the  form  of
physical, cognitive, sensory and speech impairments, including in particular learning
disabilities  and  intellectual  retardation.  Prevalence  rates  are  up  to  about  10%  in
certain populations. When incurred early in life such developmental effects are likely
to be permanent.

Increased incidences of testicular cancer and breast cancer, as well as a decline in the
quality of sperm, have been observed in several countries. The causes of these trends
are  largely  unknown;  exposure  to  chemicals  may  be  responsible  (the  endocrine-
disrupter hypothesis), but so may changes in lifestyle. In general, scientific evidence
and  information  concerning  actual  exposures  to  chemical  substances  and  their
possible health effect is lacking in most European countries.23

Socio-economic conditions  throughout  life  clearly shape  health  and  risk  of  disease.
There is a strong scientific link between poverty and environment. In the example of
the  U.K.,  a  recent  study  found  that  of  the  11  400  tones  of  carcinogenic  chemicals
emitted to the air in 1992, 82% were from factories located in the most deprived 20%
of local authority wards24. Moreover, it has been found that respiratory problems are
especially concentrated in poorer areas and they tend to correlate with high levels of
traffic.  However,  the  environmental  responsibility  is  not  equally  worn,  which  is
clearly demonstrated by the low degree of car ownership in the areas with the worse
level of traffic.

The  seriousness  and  complexity  across  Europe  of  the  issues  highlighted  here,  calls
for  the  rapid  establishment  of  a  pan-European  approach  to  mobilise  expertise  and
resources on a sufficient scale to match this challenge. This strategy aims to build a

21

22
23 
24

“Europe’s environment: the third assessment” European Environment Agency, Copenhagen (2003)
United States Environmental Protection Agency (US EPA) estimates in 1986
“Europe’s environment: the third assessment” European Environment Agency (2003)
Stephens,  C.,  Bullock,  S.,  Scott,  A.,  2001  Environmental  Justice,  Rights  and  Means  to  a  Healthy
Environment for All, ESRC Global Environmental Change Programme, Special Briefing No 7

23

                                                
European  framework  for  policy  development,  the  sharing  of  expertise  and  the
pooling of resources.

The complexity of the problem

to  date,  been 

Establishing a causal link between environmental factors and adverse health effects
poses many challenges. As a consequence, the relationship between environment and
health  has, 
insufficiently  addressed.  Previous  environmental
assessments and policy actions have concentrated on the effects of single pollutants.
This  has  made  them  easier  to  address  but  may  well  have  under-estimated  the  true
health impacts. An integrated approach is therefore required since the links between
environment and health are very complex, as illustrated by the following elements :

–  There  are  many  different  environmental  burdens25  (e.g.  from  pesticides,  noise,

radiation) arising from human activities.

–  There  are  four  routes  for  human  exposure  (inhalation,  ingestion,  contact,
irradiation)  but  the  pathways  leading  to  human  and  environmental  exposure  can
be  long  and  difficult  to  determine  because  of  the  mobility  of  pollutants  in  and
across environmental compartments.

–  The  types  of  health  impacts  incurred  are  diverse  and  each  pollutant  may  have
more  than  one  effect  (e.g.  some  chemicals  can  have  carcinogenic  effects  and
endocrine disrupting effects).

–  Adverse  health 

from  varying
combinations of genetic predisposition, lifestyle, culture, socio-economic factors,
geographical location, climate and exposure to environmental stresses.

impacts  of  environmental 

factors 

result 

–  Once released in the environment, pollutants can be transferred between different
environmental  compartments  (e.g. dioxins  are  released  and  transported  through
the  atmosphere,  deposited  to  soil,  vegetation  and  water)  and  continue  to  move
between them (e.g. air to soil, water to sediment) and the ecosystem.

in 

–  Beyond  physical and chemical  effects, biological  mechanisms play  an  important
part 
the  environmental  distribution  of  contaminants.  Some  pollutants
accumulate  in  the  body  of  plants  and  animals  at  a  higher  concentration  than
encountered  in  the  environment.  Concentrations  of  some  contaminants  in  living
organisms  increase  along  the  natural  food  chains.  Both  phenomena  can  lead  to
concentrations  in  living  organisms  many  thousands  of  times  higher  than  in  the
surrounding environment.

–  Everyone is individually exposed to a combination of environmental factors. This
can  be  the  simultaneous  exposure  to  several  factors  (e.g.  pesticide  residues  and
noise) or the successive exposure to a range of factors in different periods of life
(e.g.  brominated  flame  retardants  from  breast  milk,  UV  from  beachgoing  in
childhood,  tobacco  smoke,  occupational  exposure  to  chemicals,  exposure  to
extremely low frequency electromagnetic fields …).

25

Burden = any threat to health and the environment. It includes chemical, physical and microbiological
pollution, the risk of physical accidents, …

24

                                                
–  Many diseases, such as cancers, are multifactorial, in other words might be caused
by  multiple  environmental  and  genetic  factors.  Exposure  to  several  of  those
factors will favour their development (cocktail effects).

–  There  is  significant  spatial  and  temporal  variation  in  the  importance  of
environmental  burdens  through  geographical,  economic  and  cultural  factors  as
well as through the state of environmental regulation.

–  Long  time  scales  are  needed  to  account  properly  for  the  effects  of  persistent
organic  and  non-organic  pollutants  and  heavy  metals.  Some  are  present  in  the
environment  in  very  low  doses,  but  they  accumulate  in  the  environment,  in  the
food  chain and in human  bodies  and  their  effects  will  only  become  visible  after
many years (low dose-long term effects) (e.g. dioxins, PCBs).

–  Indirect effects: nutrient releases to water bodies or increase of water temperature
may  have  a  profound  effect  on  human  health  as  a  result  of  the  increase  of
waterborne diseases.

All  these  factors  contribute  to  make  the  job  of  epidemiologists  and  public  health
specialists  difficult.  However,  our  understanding  of  the  complex  links  between
environment and health, while still vastly insufficient, is growing.

25

10. 

ANNEX B : –  EU POLICIES RELATED TO ENVIRONMENT AND HEALTH

Chemicals and environment policies

Industrial  chemicals:  In  2001  the  Commission  adopted  a  White  Paper  on  the
Strategy for a new Chemicals Policy26. The need for a new strategy arose from wide
acceptance that the existing legislation was not capable of responding adequately to
public  and  political  concern  in  Europe  about  the  potential  impact  of  chemicals  on
health and the environment. The proposed REACH system (Registration, Evaluation,
Authorisation  of  Chemicals)  provides  for  the  stepwise  collection  of  information  on
the  estimated  30,000  chemical  substances  above  1 tonne/year/manufacturer  (or
importer) in the EU, including their toxicological properties and their uses, in order
to  provide  for  appropriate  risk  management  measures.  Registration  will  place  the
information  submitted  by  industry  in  a  central  database.  The  information  in  the
database  will  also  be  useful  and  validated  for  the  establishment  of  a  causal  link
between  environmental  factors  and  adverse  health  effects  resulting  from  chemical
production  and  use.  For  about  20  %  of  the  substances  an  in-depth  and  tailor-made
Evaluation will be required, including testing for long-term and chronic effects such
as cancer. Authorisation will be required for substances of very high concern, namely
those with CMR27 (category 1 and 2) or POPs28 characteristics, whenever identified
and whatever their tonnage. Also PBT29 and VPVB30 substances as well as endocrine
disrupters are considered. It is expected that not more than 5 % of all substances will
be proposed for authorisation, and industry will have to provide the evidence for safe
use.  To  ensure  a  sound  technical-scientific  implementation  across  the  EU  a
chemicals Agency will be proposed. It is expected that the Commission will present
its legal proposal to the European Parliament and the Council in autumn 2003.

in 

Dioxins  and  PCBs: 
its  Community  Strategy  for  Dioxins,  Furans  and
Polychlorinated  Biphenyls31,  adopted  in  October  2001,  the  Commission  set  out  a
strategy for controlling contamination in the environment which, linked to a tighter
control  of  the  food  chain,  will  contribute  to  a  reduction  in  human  exposure.  As
dioxins  and  PCBs  are  “multi-media  pollutants” the  strategy  encompasses  an
integrated approach.

Endocrine  disrupters:  as  part  of 
the  Community  Strategy  for  Endocrine
Disrupters32  adopted  by  the  Commission  in  December  1999,  a  priority  list  of
substances for further  evaluation has been established. This list includes substances
with evidence and/or potential evidence of endocrine disruption, including pesticides,
industrial chemicals, by-products and metals. The strategy also encourages increased
research efforts and international co-operation.

Air  pollution:  One  of  the  main  thrusts  of  policy  on  air  pollution  is  to  reduce  the
amount  of  material  deleterious  to  health  that  reaches  the  human  body,  whether

26

27

28

29

30

31

32

COM(2001) 88 Final
Carcinogenic, mutagenic, toxic to reproduction
Persistent Organic Pollutants
Persistent, Bio-accumulative and Toxic
Very Persistent, Very Bio-accumulative
COM(2001)593
COM(1999)706

26

                                                
directly  or  indirectly.  EU  air  quality  standards  have  been  set  since  1996,  requiring
Member States to set up and maintain a system for assessing air quality, identifying
areas  where  limit  values  are  likely  to  be  exceeded,  and  drawing  up  action  plans  to
reduce the risk of exceedance as well as meeting the objectives of the EC directives.
Limit  values  have  been  adopted  for  air  concentrations  of  sulphur  dioxide,  nitrogen
dioxide,  particulate  matter,  lead,  carbon  monoxide  and  benzene.  In  2001,  the
Commission launched a new air quality  programme  -  “Clean  Air  for  Europe”-  that
will lead to a long term, integrated thematic strategy on air pollution.

Water  protection  and  management:  the  aim  of  EU  water  policy  is  to  guarantee
high safety standards for drinking water and to reduce adverse environmental effects
of certain agricultural and industrial practices. The new Water Framework Directive
highlights the need for protective measures for all water uses and aquatic ecosystems
at the point where pollution occurs. It introduces a priority list of substances that are
dangerous for the environment, to be phased out in the future. It also has provisions
for  monitoring  and  assessment  measures  to  be  applied  in  case  of  accidental  water
pollution.

Noise: Public concern about exposure to noise pollution remains high in spite of EU
policies at EU and Member State level. EU legislation sets noise emission limits for
products  (cars,  trucks,  aircraft  and  industrial  equipment)  and  harmonises  the
assessment  and  management  of  environmental  noise.  However,  the  situation  is  not
satisfactory:  25%  of  the  European  population  report  noise-induced  annoyance  and
between 5 and 15% of the population suffer serious noise-induced sleep disturbance.

Major  industrial  accidents:  the  Seveso  Directives  were  adopted  following  major
industrial accidents with serious consequences for both man and the environment to
reduce the risks arising from the production, transportation and storage of dangerous
chemicals.  A  revision  of  the  Seveso  Directives  is  currently  being  planned.  In
particular  it  will  aim  at  studying  the  complementary  measures  likely  to  be  adopted
for sectors which are currently excluded from the scope of the Seveso Directive such
as ports, marshalling yards or pipelines.

Ionising  radiation:  The  protection  of  the  health  of  workers  and  members  of  the
public  against  ionising  radiation  is  assured  by  an  important  body  of  Community
legislation  set  up  under  Chapter  III  of  the  Euratom  Treaty  (1957).  The  European
Union radiation protection Basic Safety Standards Council Directive 96/29 Euratom,
include  specific  provisions  for  the  protection  of  the  general  public  from  enhanced
levels  of  radioactivity  in  the  environment.  Other  important  complementary
Community radiation  protection  legislation  includes  provisions  on  natural  radiation
sources (including radon gas), radioactive substances in the environment as a result
of  discharges  of  nuclear  installations  in  normal  operation,  and  as  a  result  of
accidents.  In  addition  Articles  35  to  38  of  the  Euratom  Treaty  confer  direct
responsibilities  to  the  European  Commission  with  regard 
to  environmental
radioactivity.

Health policies

The past Community Action Programme on pollution-related diseases has identified
two  main  objectives:  to  improve  information  on  pollution-related  diseases  and  to
enhance  knowledge  and  understanding  of  the  assessment  and  management  of
pollution-related  diseases.  The  programme  launched  interesting  initiatives  such  as

27

the  development  of  geographic  information  systems  allowing  for  a  better  health
impact  assessment  of  environmental  living  conditions  such  as  the  proximity  to
radioactive  landfill  sites,  or  a  better  prevention  of  asthma  and  respiratory  allergies
depending on regional climatic and housing conditions.

The  ended  Community  Action  Programmes  on  health  promotion  and  health
monitoring  aimed  at  improving  awareness  of  the  benefits  of  healthy  lifestyles  and
behaviour and have led to a broader approach to environmental health determinants.
The  health-monitoring  programme  has  led  to  the  development  of  harmonised
environmental  health  indicators.  In  particular  the  European  Community  Health
Indicators  Project  (ECHI)  has  provided  a  framework  for  the  development  of  these
Community public health indicators. It covers outdoor air quality, housing, drinking
water  supply,  sewage  system,  ionising  radiation,  noise,  physical  and  mental
workplace exposures, accidents related to work and occupational diseases. The ECHI
project also includes indicators on the social and cultural environment, such as social
support, social isolation, life events and violence.

The new programme of Community action in the field of public health (2003-2008)
adopted  by  the  European  Parliament  and  the  Council  on  23  September  2002  sets
three main objectives :

(cid:1)  to  improve  information  and  knowledge  for  the  development  of  public  health

policy;

(cid:1)  to  enhance  the  capability  of  responding  rapidly  and  in  a  co-ordinated  fashion  to

health threats;

(cid:1)  to  promote  health  and  prevent  disease  through  addressing  health  determinants

across all policies and activities.

In the field of health and the environment the programme will thereby contribute to :

(cid:1)  ensuring  a  high  level  of  human  health  protection  in  the  definition  and
implementation  of  all  Community  policies  and  activities,  through  the  promotion
of an integrated and intersectoral health strategy;

(cid:1)  tackling inequalities in health even those linked with environmental  factors  such

as housing conditions;

(cid:1)  encouraging co-operation between Member States.

As  such  this  programme  is  a  key  instrument  underpinning  the  development  of  the
Community’s health strategy33. Actions under the programme will inform, support
and advance policy development in priority areas of the strategy.

Tobacco:  The  Community  tobacco  legislation  has  an  overall  positive  impact  on
health and the environment. While aiming at reducing the prevalence of smoking, it
also  reduces  the  exposure  to  environmental  tobacco  smoke.  Two  instruments  in
particular address directly the issue of the protection from exposure to environmental
tobacco smoke: the Resolution of the Council of 18 July 1989 on banning smoking in

33

as set out in the Commission’s May 2000 Communication (COM (2000) 285 final of 16.5.2000)

28

                                                
places open to the public34, and the Council Recommendation of 2 December 2002
on the prevention of smoking and on initiatives to improve tobacco control35, which
recommends  that  Member  States  implement  legislation  and/or  other  effective
measures  to  provide  protection  from  exposure  to  environmental  tobacco  smoke  in
transport.  Further,
indoor  workplaces,  enclosed  public  places,  and  public 
environmental tobacco smoke and the protection of children and foetus from tobacco
smoke  are  also  briefly  addressed  in  Directive  2001/37/EC  on  the  manufacture,
presentation  and  sale  of  tobacco  products36.  Moreover,  the  Community  played  an
important part in the negotiations for the WHO Framework Convention on Tobacco
Control, which was adopted by the World Health  Assembly on 21 May  2003. This
first ever international treaty for public health aims at protecting present  and future
generations from the consequences of tobacco consumption and exposure to tobacco
smoke. For this purpose, it provides a framework for tobacco control measures to be
implemented  by  the  Parties  at  national,  regional  and  international  levels.  All  the
major provisions of the Community’s tobacco control legislation are reflected in the
Convention, which will be signed by the Community on 16 June 2003.

Food  safety:  In  the  White  Paper  on  Food  Safety,  the  Commission  identified
environmental  sources  as  the  origin  of  the  presence  of  contaminants  in  the  food
chain. The paper called for mechanisms to control and enforce limits of contaminants
and residues in  foodstuffs.  It also identifies surveillance, information gathering  and
analysis as essential elements of food safety policy. There is  ample opportunity  for
synergies.

Pesticides: Plant Protection Directive (91/414/EEC), Biocides Directive (98/8/EEC),
Pesticide residue directives (76/895/EEC, 86/362/EEC, 86/363/EEC, 90/642/EEC).

Health impact assessment: In January 2003 the Commission launched an Integrated
Impact  Assessment  tool37  which  will  identify  health  impacts,  amongst  others,  of
projects, policy proposals and strategies not primarily meant to affect health and how
these can be assessed. This will aid policy makers to assess trade-offs and  compare
different scenarios when deciding on a specific course of action. Impact assessment
will  be  applied  to  the  major  initiatives  presented  by  the  Commission  in  its  annual
Policy  Strategy  or  its  Work  Programme.  More  over,  there  is  considerable
international  experience  in  integrating  health  aspects  into  environmental  impact
assessments. This experience as well as the experience of health impact assessments
should be drawn from when looking at potential health impacts of policy proposals in
other areas than health - particularly when conducting extended impact assessments
in  the  fields  of  health  and  environment.  The  new  procedure,  i.e.  implementing  the
new  integrated  impact  assessment  tool,  provides  an  excellent  opportunity  for
reviewing policy proposals in other areas and their potential impacts on health.

Electromagnetic  fields:  the  Council  adopted  in  July  1999  a  Recommendation
limiting  the  exposure  of  the  general  public  to  non-ionising  radiation  in  a  view  of
protecting  human  health  against  well-known  acute  health  effects  by  introducing
safety  margins  in  the  exposure  limits.  These  limits  also  protect  against  long-term
health effects, even though no such effects have as yet been demonstrated.

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35

36

37

OJ C 189, 26/07/1989, p. 1.
OJ L 022 , 25/01/2003 p. 31.
OJ L 194, 18/07/2001, p.26
Communication from the Commission on Impact Assessment COM (2002) 276 final of 5.06.2002

29

                                                
Ionising  radiation:  Health  protection  of  the  general  public  and  of  workers  against
dangers arising from ionising radiation is assured by Community radiation protection
legislation under Chapter  III  of the  Euratom Treaty. The European  Union  radiation
protection  Basic  Safety  Standards  have  been  regularly  updated  in  the  light  of
emerging  scientific  evidence  on  low  level  radiation  exposure  health  effects.  Other
Community  radiation  protection  legislation  includes  medical  applications,  outside
workers, as well as foodstuffs. Radiation protection requirements are also included in
EU legislation on cosmetics, toys and on specific consumer products.

Development and health: The issue is covered in the Communication on Health and
Poverty reduction in developing countries (COM(2002) 129) and the Communication
'Update on  the  EC  programme  of  action;  accelerated  action  on  HIV/AIDS,  malaria
and tuberculosis in the context of poverty reduction' (COM(2003) 93).

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11. 

ANNEX C : – EU RESEARCH ON ENVIRONMENT AND HEALTH

Since  the  4th  EU  RTD  Framework  Programme  for  Research  and  Technological
Development,  environment  and  health  have  been  part  of  the  EU  research  funding
mechanisms.  Under  the  5th  EU  RTD  Framework  Programme,  160  M€  were
dedicated  “Environment  and  Health”  of  the  Quality  of  Life  and  Management  of
Living  Resources  programme.  More  than  90  projects  were  launched  considering
potential health impacts of environmental factors in fields as varied as air pollution,
asthma  and  allergies,  fibres  and  dust,  chemicals,  endocrine  disrupters,  water,
electromagnetic fields, noise and combined exposures. Some particular emphasis has
been  placed  on  the  health  threats  to  vulnerable  groups,  including  children.  In  this
respect  the  Commission  has  funded  a  specific  network  -  ‘Policy  Interpretation
Network on Children’s Health and Environment’ (PINCHE) - which aims to improve
understanding of research results and their implications on children’s environmental
health.  It  will  provide  a  common  structure  to  pull  together  and  to  interpret  results
from EU and nationally funded research on exposure assessment, epidemiology and
toxicity to risk and health impact assessment and socio-economic impact in a policy
relevant context.

Still  under  the  5th  EU  RTD  Framework  Programme,  the  Environment  and
Sustainable Development Programme (EESD) of FP5 the areas relative to the issue
of  environment  and  health  were  mainly  implemented  in  the  key  action  “Water
management and quality”. Projects were supported dealing with quality and safety of
drinking water, environmental and health effects of endocrine disrupters and residues
of pharmaceuticals including development of related environmental technologies. In
addition,  in  the  key  action  “City  of  Tomorrow”  research  projects  are  supported
addressing the improvement of the quality of urban life in the field of air pollution,
noise reduction, population health and waste management.

Similarly,  under  the  Competitive  and  Sustainable  Growth  Programme,  research  on
industrial  technologies  has  integrated  the  dimensions  of  environmental  and  social
impacts [e.g. cleaner and safer production systems and solutions, waste management,
life-cycle  product  approach,  adapted  materials  to  minimize  environment  impact,
avoidance  of  hazardous materials, use of  materials  protecting  from  electromagnetic
(EM)  radiation  (mobile  phones,  personal  computers,  etc.),  new  organizational
approaches at the industry improving health and the environment, etc.

For  its  part,  during  the  5th  Framework  Programme,  the  JRC  carried  out  a  research
project on “environmental integrity and human health”, working on the development
of methodologies to evaluate the impact of hazardous chemicals on the environment
and human health.

In  the  6th  EU  RTD  Framework  Programme,  research  relevant  for  environment
and  health  will  be  funded  and  integrated  across  various  priorities,  primarily  in  the
Food  Quality  and  Safety  thematic  priority;  the  Sustainable  development,  global
change and ecosystems thematic priority; the section dealing with Policy-orientated
Research  and  the  Genomics  and  Biotechnology  for  Health  thematic  priority.  More
specifically  in  the  Food  Quality  and  Safety  thematic  priority  a  specific  actions  on
‘Environmental  health  risks’  is  included.  The  objectives  of  this  part  of  the
Programme  are  to  identify  the  environmental  factors  that  are  detrimental  to  health,
understand  the  mechanisms  involved  and  determine  how  to  prevent  or  minimise

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these  effects  and  risks.  This  will  focus  on:  (a)  Risks  linked  to  the  food-chain
(chemical,  biological  and  physical);  (b)  Combined  exposures  of  authorised
substances,  including  impact  of  local  environmental  disasters  and  pollution  on  the
safety  of  foodstuffs,  with  emphasis  being  placed  on  cumulative  risks  and  health
impacts of environmental pollutants, transmission routes to human beings, long-term
effects and exposure to small doses, prevention  strategies,  as  well  as  the impact on
particularly sensitive groups, and especially children.

In  the  Thematic  Priority  Global  Change  and  Ecosystems  a  specific  action  on
Complementary  Research  is  included.  The  research  will  specifically  focus  on  risk
assessment,  appraisal  of  environmental  quality  including  reliable  indicators  of
population  health  and  environmental  conditions  and  risk  evaluation  in  relation  to
outdoor and indoor exposure. In addition, under the area of Cross-cutting issues the
aim is to assess monetary valuation of environmental and health externalities relative
to  activities  and  technologies  linked  to  the  EU  Sustainable  Development  strategy
covering topics like energy, transport, land use, agriculture, forest and water.

Under  Thematic  Priority  Genomics  and  Biotechnology  for  Health,  there  may  be
possibilities under the various sub-areas such as "Studying human development and
the  ageing  process",  where  the  understanding  of  human  development  from
conception  to  adolescence  is  expected  to  have  application  as  regards  child  health.
Two other possibilities include the sub-area "Combating cancer" which is part of the
section  addressing  major  diseases  and  "Confronting  the  major  communicable
diseases linked to poverty" which is likely to include clinical trials for children who
are victims of these diseases.

In  the  Nanotechnologies  and  nano-sciences,  knowledge-based  multifunctional
materials and new production processes and devices Thematic Priority, research on
industrial technologies will continue to focus upstream and by contributing research
solutions, preventing pollution and negative health impact within the most common
sources  of potential  pollution and  work  and  life places: the industry and  the  use  of
products  in  everyday  life.  In  the  section  on  Policy-orientated  Research  thematic
priority,  several  sub-areas  address  research  required  to  support  policy  related  to
environment and health :

i) Sub-area Environmental assessment (soil, water, air, noise including the effects of
chemical substances).

ii)  Sub-area  Assessment  of  environmental  technologies  for  support  of  policy
decisions in particular concerning effective but low-cost technologies in the context
of fulfilling environmental legislation.

iii)  Sub-area  Public  health  issues  including  disease  prevention  and  responses  to
emerging,  rare  and  communicable  diseases,  allergies,  procedures  for  secure  blood
and organ donations.

iv) Sub-area ‘The impact of environmental issues on health (including safety at work
and  methods  for  risk  assessment  and  the  mitigation  of  risks  of  natural  disasters  to
people). Since these are also areas in which research is ongoing in the national and
other  contexts,  one  of  the  principal  objectives  of  research  activities  under  this
heading will therefore be to bring together existing and future research results in the

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most important domains, interpret them and assemble coherent inputs to the relevant
community policies.

In  its  new  Multi-Annual  Work  Programme  (2003-2006),  the  Joint  Research  Centre
addresses human health and its interrelation with environmental risk factors. One of
the  main  objectives  is  to  develop  the  concept  of  human  envirogenomics  in  the
context of total human exposure and to introduce this concept in risk assessment and
risk reduction practices in relation to environmental risk factors. Another objective is
to build knowledge and expertise as well as to share know-how in the validation and
harmonisation  of  methodologies  and  models  for  assessing  human  exposure  to,  and
health  impact  of,  chemicals  released  from  consumer  products  and  articles.  The
efforts  of  the  JRC  in  this  area  will  focus  on  filling  the  exposure  data  gaps  in  a
systematic  and  coherent  manner,  integrating  current  knowledge  with  novel
methodologies  in  order  to  develop  a  total  human  exposure  approach  (products,
articles,  environment,  food)  and  will  be  performed  in  close  collaboration  with
Environment and Health specialists internationally.

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12. 

ANNEX D : – INTERNATIONAL ACTIONS ON ENVIRONMENT AND HEALTH

The European Charter on Environment and Health (Frankfurt 1989) adopted by the
Environment  and  Health  Ministers  of  the  European  Region  of  WHO  marked  the
beginning  of  a  process  that  led  to  the  Helsinki  (1994)  and  London  (1999)
declarations which identified further avenues for action.

As  a  result,  some  Member  States  and  most  Acceding  countries  have  developed
National Environmental Health Action Plans (NEHAPs). A recent pilot evaluation of
NEHAPs  has  underlined  their  importance  in  bringing  together  the  environment,
health and other sectors on a common project and giving environmental factors more
prominence  in  the  health  sector.  This  process  has  stimulated  the  development  of
environmental legislation in Central and Eastern Europe. The implementation of the
“acquis”  in  the  environmental  field  and  the  improvement  of  the  health  of  the
population  in  the  Acceding  countries  underlines  the  role  of  efficient  legislation  in
dealing with the health impact of environmental threats.

Aside  from  NEHAP,  specific  national  initiatives  have  also  been  developed
independently  in  areas  such  as  indoor  air  quality,  living  conditions,  prevention  of
legionnaires' disease, using  tools  like  information and public  awareness  campaigns,
staff training, environmental health monitoring and surveys.

Regional co-operation initiatives have been set up around the Baltic Sea  and in  the
Balkan countries.

In 1997, the G8 countries signed the Miami Declaration on children's environmental
health, which seeks to reduce the impact on children's health of a number of priority
contaminants,  such  as  lead  and  endocrine  disrupters.  The  G8  countries  have  been
particularly active in developing appropriate policy and have paid special attention to
children’s health issues.

At the World Summit for Sustainable Development in Johannesburg in 2002 a world
partnership project "Healthy Environment for Children – Call for a Global Alliance",
was launched by WHO with the support of the EU.

The Commission is helping to prepare the pan-European Ministerial Conference on
Environment and Health to be held in Budapest in 2004, which has as its theme "The
future for our children". This conference will be attended by environment and health
ministers from the 52 member countries of WHO Europe.

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