Difference between revisions of "WHO:Eliminating environmental health hazards"

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:''This text is taken from the WHO report "Health and Environment in Europe: Progress Assessment", 2010, ISBN 978 92 890 4198 0. [http://www.euro.who.int/document/e93556.pdf]''
 
:''This text is taken from the WHO report "Health and Environment in Europe: Progress Assessment", 2010, ISBN 978 92 890 4198 0. [http://www.euro.who.int/document/e93556.pdf]''
  
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#occupational health, in particular work-related health problems.
 
#occupational health, in particular work-related health problems.
  
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Consideration is paid to the health burdens, public concerns, availability of data and evidence, and potential to take targeted action to benefit health. Despite their differences they are all of special concern for children’s health for similar reasons: the particular sensitivities of children in the pre- and postnatal periods due to their rapid development; their different metabolisms and behaviour compared to adults; and their longer life expectancy, which render them more vulnerable than adults to many environment hazards.
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Consideration is paid to the health burdens, public concerns, availability of data and evidence, and potential to take targeted action to benefit health. Despite their differences they are all of special concern for children’s health for similar reasons: the particular sensitivities of children in the pre- and postnatal periods due to their rapid development; their different metabolisms and behaviour compared to adults; and their longer life expectancy, which render them more vulnerable than adults to many environment hazards.<ref name="who"/>
  
 
==Chemical hazards==
 
==Chemical hazards==
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Food safety is one of the most important factors for good health. Several serious accidental poisonings have arisen due to food contaminated by POPs or heavy metals, and long-term low-level exposure can cause chronic health effects. Furthermore, the microbiological safety of food is crucially important for public health. The surveillance of foodborne diseases and the monitoring of contamination in the food chain are, however, inadequate. Reporting of foodborne disease only represents the tip of the iceberg. A risk-based approach is needed in the management of exposure to chemical hazards. Priority should be given to assessing those chemicals with the greatest risks for public health, those that accumulate in the body and those to which chronic exposure at low levels cause adverse health outcomes.
 
Food safety is one of the most important factors for good health. Several serious accidental poisonings have arisen due to food contaminated by POPs or heavy metals, and long-term low-level exposure can cause chronic health effects. Furthermore, the microbiological safety of food is crucially important for public health. The surveillance of foodborne diseases and the monitoring of contamination in the food chain are, however, inadequate. Reporting of foodborne disease only represents the tip of the iceberg. A risk-based approach is needed in the management of exposure to chemical hazards. Priority should be given to assessing those chemicals with the greatest risks for public health, those that accumulate in the body and those to which chronic exposure at low levels cause adverse health outcomes.
  
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Groups of chemicals that should be considered when assessing the safety of food are pesticide residues, veterinary drug residues, heavy metals, POPs and other organic contaminants, microbial toxins, food additives, compounds formed unintentionally during the processing of food, contaminants from packaging and storage and, last but not least, the major constituents of food itself, such as excess salt, sugar and fat. The inherent toxicity of a substance does not necessarily indicate high public health concern, as population exposure and vulnerability are also important determinants.
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Groups of chemicals that should be considered when assessing the safety of food are pesticide residues, veterinary drug residues, heavy metals, POPs and other organic contaminants, microbial toxins, food additives, compounds formed unintentionally during the processing of food, contaminants from packaging and storage and, last but not least, the major constituents of food itself, such as excess salt, sugar and fat. The inherent toxicity of a substance does not necessarily indicate high public health concern, as population exposure and vulnerability are also important determinants.<ref name="who"/>
  
 
====Persistent organic pollutants====
 
====Persistent organic pollutants====
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Among the POPs, polychlorinated dioxins (PCDDs) and dioxin-like chemicals (including polychlorinated dibenzofurans (PCDFs) and dioxin-like PCBs) appear to have the lowest safety margin and to be the most likely group to cause adverse effects in humans. During the 1970s, at concentrations 5–10 times higher than at present, they were possibly the cause of subtle effects such as effects on tooth development. The sources of these compounds were the incineration of municipal waste, chlorine gas bleaching of wood pulp and the metal industries, together with a number of minor sources. Until the 1980s, there were also important impurities in the production of certain chemicals (PCBs, chlorophenols and their derivatives). Advances in abatement have been greatest in areas such as waste incineration and the pulp and paper industry, resulting in the reduction of POP concentrations in environmental samples, including lake- and seabed sediment layers, fish, fish-eating birds and seals. The largest remaining sources are the metal and cement industries, landfill fires and small-scale wood and biomass burning. There may still be considerable variations among countries.
 
Among the POPs, polychlorinated dioxins (PCDDs) and dioxin-like chemicals (including polychlorinated dibenzofurans (PCDFs) and dioxin-like PCBs) appear to have the lowest safety margin and to be the most likely group to cause adverse effects in humans. During the 1970s, at concentrations 5–10 times higher than at present, they were possibly the cause of subtle effects such as effects on tooth development. The sources of these compounds were the incineration of municipal waste, chlorine gas bleaching of wood pulp and the metal industries, together with a number of minor sources. Until the 1980s, there were also important impurities in the production of certain chemicals (PCBs, chlorophenols and their derivatives). Advances in abatement have been greatest in areas such as waste incineration and the pulp and paper industry, resulting in the reduction of POP concentrations in environmental samples, including lake- and seabed sediment layers, fish, fish-eating birds and seals. The largest remaining sources are the metal and cement industries, landfill fires and small-scale wood and biomass burning. There may still be considerable variations among countries.
  
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There is evidence that developmental effects occur even at the lowest measured POP concentrations. Dioxin levels in human milk provide a long-term average of the body burden because these persistent compounds accumulate in breast tissue. They are relevant both as an indicator of risk during pregnancy and for measuring the chemical intake by the breastfed baby. Both of these steps are believed to be crucial for assessing the risk of developmental effects for the whole population. The most systematic information on POPs in humans is based on four rounds of human milk analysis studies of dioxins and PCBs coordinated by WHO. Dioxin levels in human milk have decreased in all countries monitored since 1988. Several European countries with higher initial levels have made particularly dramatic and important reductions. In spite of the decrease, the margin between currently prevalent and known toxic levels is still narrow enough to be of concern.
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There is evidence that developmental effects occur even at the lowest measured POP concentrations. Dioxin levels in human milk provide a long-term average of the body burden because these persistent compounds accumulate in breast tissue. They are relevant both as an indicator of risk during pregnancy and for measuring the chemical intake by the breastfed baby. Both of these steps are believed to be crucial for assessing the risk of developmental effects for the whole population. The most systematic information on POPs in humans is based on four rounds of human milk analysis studies of dioxins and PCBs coordinated by WHO. Dioxin levels in human milk have decreased in all countries monitored since 1988. Several European countries with higher initial levels have made particularly dramatic and important reductions. In spite of the decrease, the margin between currently prevalent and known toxic levels is still narrow enough to be of concern.<ref name="who"/>
  
 
WHO recognizes this concern. Nevertheless, the net beneficial effect of breastfeeding as the optimal food source for newborn babies should always be emphasized, especially when sharing information with the general public.
 
WHO recognizes this concern. Nevertheless, the net beneficial effect of breastfeeding as the optimal food source for newborn babies should always be emphasized, especially when sharing information with the general public.
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[[file:humanmilkdioxins.png|thumb|250px|Dioxin levels in human milk in selected countries, 1988-2007<ref name="who"/>]]
 
[[file:humanmilkdioxins.png|thumb|250px|Dioxin levels in human milk in selected countries, 1988-2007<ref name="who"/>]]
  
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Another new group of halogenated compounds is perfluorinated alkyl compounds (PFAs), such as perfluorooctane sulfonate, which were introduced as water repellents and for many other uses. They are also highly persistent and have been shown to accumulate in animals. Some of these compounds have, therefore, been voluntarily phased out by industry but are worth monitoring because of their persistence.
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Another new group of halogenated compounds is perfluorinated alkyl compounds (PFAs), such as perfluorooctane sulfonate, which were introduced as water repellents and for many other uses. They are also highly persistent and have been shown to accumulate in animals. Some of these compounds have, therefore, been voluntarily phased out by industry but are worth monitoring because of their persistence.<ref name="who"/>
  
 
====Heavy metals====
 
====Heavy metals====
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[[file:czechmetalsintotaldiet.png|thumb|250px|Mean level of selected hazardous metals in the total diet of the general population, Czech Republic, 1994−2007 <ref name="who"/>]]
 
[[file:czechmetalsintotaldiet.png|thumb|250px|Mean level of selected hazardous metals in the total diet of the general population, Czech Republic, 1994−2007 <ref name="who"/>]]
  
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The organic form of mercury, methylmercury, appears to be of greatest concern for children notwithstanding the significant limitations of information on children’s exposure to heavy metals in food. Methylmercury is highly toxic, particularly to the nervous system; the developing brain is known to be particularly sensitive. Owing to the transport of mercury through the environment and its bioaccumulation, the main source of exposure to methylmercury in the general population is diet, in particular through the consumption of fish, particularly via certain species. It is assumed that all of the mercury in fish is present as methylmercury. Toxicity has been demonstrated at low exposure levels, but fish can also be an important component of a healthy diet. It is, therefore, essential that clear guidelines for optimal fish consumption levels are widely publicized. Food sources other than fish and seafood products may contain inorganic mercury, which is considerably less toxic than methylmercury.
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The organic form of mercury, methylmercury, appears to be of greatest concern for children notwithstanding the significant limitations of information on children’s exposure to heavy metals in food. Methylmercury is highly toxic, particularly to the nervous system; the developing brain is known to be particularly sensitive. Owing to the transport of mercury through the environment and its bioaccumulation, the main source of exposure to methylmercury in the general population is diet, in particular through the consumption of fish, particularly via certain species. It is assumed that all of the mercury in fish is present as methylmercury. Toxicity has been demonstrated at low exposure levels, but fish can also be an important component of a healthy diet. It is, therefore, essential that clear guidelines for optimal fish consumption levels are widely publicized. Food sources other than fish and seafood products may contain inorganic mercury, which is considerably less toxic than methylmercury.<ref name="who"/>
  
 
The estimated intakes of methylmercury in Europe vary by country and region, depending on the contamination level and the amount and type of fish consumed. Some population groups may frequently consume large predatory fish (such as swordfish, tuna and pike), which are at the top of the food chain and often have a higher concentration of methylmercury. A recent EU assessment suggested that as many as 1 in 20 people may be affected. The study estimated that 1–5% of the general population in Europe (3 to 15 million people) are over the limit that the EU uses. Even more worrying is the fact that a proportion of this population, notably Mediterranean fishing communities, have levels ten times as high as the recommended norm.
 
The estimated intakes of methylmercury in Europe vary by country and region, depending on the contamination level and the amount and type of fish consumed. Some population groups may frequently consume large predatory fish (such as swordfish, tuna and pike), which are at the top of the food chain and often have a higher concentration of methylmercury. A recent EU assessment suggested that as many as 1 in 20 people may be affected. The study estimated that 1–5% of the general population in Europe (3 to 15 million people) are over the limit that the EU uses. Even more worrying is the fact that a proportion of this population, notably Mediterranean fishing communities, have levels ten times as high as the recommended norm.
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The benefits of switching completely to unleaded petrol are further illustrated by a series of blood lead measurements in 3700 children living in urban Sweden. A dramatic decline was observed between 1978 and 2005, with the first decrease in the early 1980s when unleaded fuel was introduced. Residual exposure to re-suspended lead disappeared only after the complete elimination of leaded petrol from the market in 1994.
 
The benefits of switching completely to unleaded petrol are further illustrated by a series of blood lead measurements in 3700 children living in urban Sweden. A dramatic decline was observed between 1978 and 2005, with the first decrease in the early 1980s when unleaded fuel was introduced. Residual exposure to re-suspended lead disappeared only after the complete elimination of leaded petrol from the market in 1994.
  
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Although many countries have applied systematic interventions to phase out industrial sources of lead emissions, leaded petrol still exists in some countries in the east of the Region. For example, it will not be completely phased out in Montenegro and Serbia until 2015. Furthermore, measurements of blood lead levels in children living near hot-spots show that plumbing and local industries continue to be important sources of concern in some countries (e.g. Bulgaria, Poland, Russian Federation, The former Yugoslav Republic of Macedonia, Ukraine). Although lead levels in people show a decrease in all these countries, it is difficult to assess progress owing to a lack of systematic human bio-monitoring. Regular population-based surveys of lead in blood, and monitoring of other chemicals of concern, using uniform protocols specific to various age groups, would greatly enhance the ability to assess exposure and trends as well as the potential health impacts and effectiveness of policy measures.
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Although many countries have applied systematic interventions to phase out industrial sources of lead emissions, leaded petrol still exists in some countries in the east of the Region. For example, it will not be completely phased out in Montenegro and Serbia until 2015. Furthermore, measurements of blood lead levels in children living near hot-spots show that plumbing and local industries continue to be important sources of concern in some countries (e.g. Bulgaria, Poland, Russian Federation, The former Yugoslav Republic of Macedonia, Ukraine). Although lead levels in people show a decrease in all these countries, it is difficult to assess progress owing to a lack of systematic human bio-monitoring. Regular population-based surveys of lead in blood, and monitoring of other chemicals of concern, using uniform protocols specific to various age groups, would greatly enhance the ability to assess exposure and trends as well as the potential health impacts and effectiveness of policy measures.<ref name="who"/>
  
 
[[file:bloodleadswedishkids.png|thumb|250px|Blood lead levels in Swedish children, 1978−2005 (Leaded petrol was phased out from the beginning of the 1980s.)<ref name="who"/>]]
 
[[file:bloodleadswedishkids.png|thumb|250px|Blood lead levels in Swedish children, 1978−2005 (Leaded petrol was phased out from the beginning of the 1980s.)<ref name="who"/>]]
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Although a strong theme in this chapter is chemical contamination of food, it is essential that exposure to hazardous microbiological agents in food should not be overlooked. Foodborne disease caused by microbes, both sporadic cases and outbreaks, is very common throughout the Region, even in countries with high hygiene standards. The most common clinical presentation of microbiological foodborne diseases takes the form of gastrointestinal symptoms, but such diseases can also lead to chronic symptoms including arthritis, neurological or immunological disorders and cancer as well as septicaemia, multi-organ failure and death. Foodborne outbreaks are about an order of magnitude commoner than waterborne episodes, although fewer people are typically involved in each foodborne outbreak.
 
Although a strong theme in this chapter is chemical contamination of food, it is essential that exposure to hazardous microbiological agents in food should not be overlooked. Foodborne disease caused by microbes, both sporadic cases and outbreaks, is very common throughout the Region, even in countries with high hygiene standards. The most common clinical presentation of microbiological foodborne diseases takes the form of gastrointestinal symptoms, but such diseases can also lead to chronic symptoms including arthritis, neurological or immunological disorders and cancer as well as septicaemia, multi-organ failure and death. Foodborne outbreaks are about an order of magnitude commoner than waterborne episodes, although fewer people are typically involved in each foodborne outbreak.
  
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The global burden of foodborne diseases and its impact on development and trade are currently unknown. Data are sparse and only cover people who have sought medical care and who have received an accurate diagnosis, provided the reporting system is operational and efficient. Reliable epidemiological data are, however, urgently needed to enable policy-makers as well as other stakeholders to develop, monitor and evaluate food safety measures intended to prevent and control foodborne disease. In response to this need, the WHO Department of Food Safety and Zoonoses has, in collaboration with multiple partners, launched a new Initiative to Estimate the Global Burden of Foodborne Disease.
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The global burden of foodborne diseases and its impact on development and trade are currently unknown. Data are sparse and only cover people who have sought medical care and who have received an accurate diagnosis, provided the reporting system is operational and efficient. Reliable epidemiological data are, however, urgently needed to enable policy-makers as well as other stakeholders to develop, monitor and evaluate food safety measures intended to prevent and control foodborne disease. In response to this need, the WHO Department of Food Safety and Zoonoses has, in collaboration with multiple partners, launched a new Initiative to Estimate the Global Burden of Foodborne Disease.<ref name="who"/>
  
 
'''Microbiological contamination and foodborne illness'''
 
'''Microbiological contamination and foodborne illness'''
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Thirty-seven Member States responded to the four core policy topics, although not necessarily to all of them (for more information see Annex 1). The focus here is on food safety, the chemical safety of heavy metals and environmental noise and countries’ policy profiles are analysed along the six key aspects (for the methods, see Annex 2).
 
Thirty-seven Member States responded to the four core policy topics, although not necessarily to all of them (for more information see Annex 1). The focus here is on food safety, the chemical safety of heavy metals and environmental noise and countries’ policy profiles are analysed along the six key aspects (for the methods, see Annex 2).
  
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The policy profiles for food safety and chemical safety of heavy metals (lead and mercury) revealed rather distinct patterns. Food safety, with its symmetrical profile and high scores on all aspects except equity considerations, shows that this topic has been the focus of public policy throughout the Region. Overall, this was the topic with the highest scores of all EH policy topics screened using the WHO survey. For heavy metals, the scores are lower and the patterns differ substantially among the country groupings, reflecting the lack of a comprehensive approach to this topic as an environmental public health issue.
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The policy profiles for food safety and chemical safety of heavy metals (lead and mercury) revealed rather distinct patterns. Food safety, with its symmetrical profile and high scores on all aspects except equity considerations, shows that this topic has been the focus of public policy throughout the Region. Overall, this was the topic with the highest scores of all EH policy topics screened using the WHO survey. For heavy metals, the scores are lower and the patterns differ substantially among the country groupings, reflecting the lack of a comprehensive approach to this topic as an environmental public health issue.<ref name="who"/>
  
 
====Public governance====
 
====Public governance====
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The high scores on policy development in all country groupings indicate the importance of food safety for many decades in the Member States. A closer look at national policy measures shows that compliance with food safety standards, regulations and international commitments both at EU and Region-wide level (the Codex Alimentarius) is the most frequently reported objective (85–100%). The same holds true for policy on modern approaches to risk management through the implementation of Hazard Analysis and Critical Control Point system in food industries, although the rates in the newly independent states are lower.
 
The high scores on policy development in all country groupings indicate the importance of food safety for many decades in the Member States. A closer look at national policy measures shows that compliance with food safety standards, regulations and international commitments both at EU and Region-wide level (the Codex Alimentarius) is the most frequently reported objective (85–100%). The same holds true for policy on modern approaches to risk management through the implementation of Hazard Analysis and Critical Control Point system in food industries, although the rates in the newly independent states are lower.
  
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[[file:policyprofilefoodchemicals.png|thumb|250px|Profiles for food safety and chemical safety of heavy metals policy along the six aspects, by country grouping<ref name="who"/>]]
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[[file:policy
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Policy objectives related to the control, reduction and abatement of contaminants in primary production were reported to a less extent (75–90%) and so were those on food safety education for industry. Food safety education for primary producers was also of limited policy focus (45–70%). These lower rates are troubling as both the WHO/Food and Agriculture Organization’s (FAO) food safety guidelines and European Community legislation emphasize the benefits of integrated risk prevention throughout the entire food chain up to the consumer. Preparedness and response to emergencies, to ensure the protection of health, was subject to greater policy focus in EurG-A and EurG-B countries than in the other Member States.
 
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Where the scope of food safety policies is concerned, the key health issues covered reflect historical trends. Most countries have policies for traditional infectious diseases such as salmonellosis and clostridium botulism as well as for chemical contaminants such as heavy metals and pesticides. Specific policies for listeriosis and brucellosis have also generally been adopted, with the exception of the EurG-D grouping where they were less often reported. EU countries reported policies for campylobacteriosis and POPs to a greater extent than the other two groupings. Policies covering emerging issues, such as antimicrobial resistance, are only evident in the EurG-A grouping.
 
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With respect to policy objectives regarding heavy metals, as with most other topics compliance with international commitments such as the Convention on Long-Range Transboundary Air Pollution and EU legislation is at the top of the policy agenda across the Region, with rates of 80–85%. There was less prevention and reduction of health risks (60–80%), with the highest rates in the newly independent states. There were many fewer reports of policy measures relating to education in personal protection and in healthy behaviour, notably in the EurG-B and EurG-C groupings (20% and 15%, respectively). National laws and regulations regarding chemicals in the newly independent states have generally been inherited from the Soviet era and are in need of further modernization and harmonization to meet present international requirements.
 
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Only EurG-A countries focus on regulations to control products containing heavy metals throughout their entire life-cycles (classification, labelling, packaging, marketing, storage, use, distribution, trade and disposal) (85%). EurG-C countries lack important objectives for their policy measures, especially the control and disposal of stocks of outdated products and preparedness and response to emergencies.
 
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The scope of chemical safety measures (i.e. key health-environment issues covered in the policies) differ for lead and mercury and between country groupings. All countries have reported lead in petrol as a key policy issue, yet it is still used in many countries. Only the EurG-A countries have effectively phased out leaded petrol, and the consequences are apparent from the trends in population exposure to lead. The use of lead in industry and in consumer products has a very long tradition, and the difficulties in phasing it out are most probably the reason for differences in country rates.
 
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[[file:scopeofpolicyleadsafety.png|thumb|250px|Scope of policy measures on chemical safety aspects of lead, by country grouping<ref name="who"/>]]
 
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So far as mercury is concerned, EurG-A and EurG-B countries have harmonized their legislation, notably as regards the intentional use of mercury in industrial processes and in consumer products. In response to continuing concern over mercury exposure, the European Commission has proposed a regulation to ban the export of mercury in the EU and to ensure the safe storage of surplus mercury. This has been confirmed by the European Parliament and will take effect in March 2011. Significant gaps remain regarding key health issues in national policies, in particular in EurG-C countries, including the intentional use of mercury in industry and consumer products, as well as pollution hotspots.
 
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[[file:scopeofpolicymercurysafety.png|thumb|250px|Scope of policy measures on chemical safety aspects of mercury, by country grouping<ref name="who"/>]]
 
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On average, 70% of the countries reported that they had legislation in place concerning food safety and the chemical safety aspects of lead and mercury. Few other policies were reported for heavy metals. The number of action plans or guidelines is somewhat higher for food safety. Legislation on heavy metals is generally somewhat older than food safety legislation, reflecting rapid recent developments within food safety policy. As the environmental health situation varies widely in Europe, a further analysis of the reported types of legislation shows that regulations covering mercury are more widespread in EurG-A and EurG-B countries than in the EurG-C or EurG-D groupings, while the differences are less marked for lead.
 
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[[file:policyinstrumentfoodleadmercury.png|thumb|250px|Types of policy instrument for food safety, mercury and lead<ref name="who"/>]]
 
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Food safety was among the first environmental health issues to be globalized. Since the food trade is extensive and requires common ground for quality and safety issues, FAO established the following three global standards on food safety:
 
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*the Codex Alimentarius for food;
 
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*the International Plant Protection Convention for plants; and
 
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*the World Organisation for Animal Health for animals.
 
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The Codex Alimentarius Commission sets hundreds of food standards, guidelines and codes of practice covering all parts of the global food chain from the producer to the consumer. It has also set more than 1000 maximum limits for food additives and more than 3000 maximum residue limits for pesticides and veterinary drugs.
 
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The three bodies together help countries to comply with the World Trade Organization’s Agreement on the Application of Sanitary and Phyto-sanitary Measures. This recognizes a country’s right to restrict trade in order to protect human, plant and animal health, but any regulations must be based on sound science and international agreements and not used simply to restrict trade. As stated above, global standards drive the compliance policies of the Member States. They are also the basis for the EU integrated approach to food safety, which aims to assure a high level of food safety, animal health, animal welfare and plant health through coherent farm-to-table measures and adequate monitoring, while also ensuring the effective functioning of the internal market.
 
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The WHO Regional Office for Europe has developed the European Action Plan for Food and Nutrition Policy, establishing nutrition, food safety and food security goals. It provides a coherent set of integrated action spanning different government sectors and involving public and private actors. Member States take these into account when setting their own national policies for health system governance, as do international organizations at the regional and global levels.
 
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The 1998 Aarhus Protocol on Heavy Metals, adopted within the framework of the Convention on Long-Range Transboundary Air Pollution, aimed at limiting emissions of mercury, lead and cadmium in Europe and North America. The Protocol lays down stringent limit values for emissions from stationary sources and indicates the best available techniques for these sources, such as special filters or scrubbers for combustion sources or mercury-free processes. The Protocol also requires Parties to phase out leaded petrol. This Protocol is yet to be signed and ratified by many EurG-C and EurG-D countries.
 
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The Strategic Approach to International Chemicals Management is an international mechanism of growing importance for improvements to health. It focuses on safe and environmentally sound waste management, the sound management of obsolete pesticides and other obsolete chemicals, and the development of the global legal instrument on mercury.
 
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European Community Directives 2002/95/EC and 2002/96/EC are also important tools in helping to limit exposure to heavy metals, especially mercury and lead, through restricting the use of hazardous substances in electrical and electronic equipment and promoting the collection and recycling of such equipment.
 
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Measures in cases of non-compliance with existing policies are quite similar across the Region, both as regards food safety and the chemical safety aspects of lead and mercury. The food safety measures score much higher than those on lead and mercury.
 
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Penalties for infringement of the legal provisions regarding food safety are highest in the EurG-D countries. EurG-A countries tend to rely more on this approach than EurG-B and EurG-C countries. The EurG-A and EurG-D groupings reported a lower rate than the other two groupings for remedial measures to reduce or eliminate the risk of non-compliance, instead placing greater policy priority on the rectification of problems at source.
 
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There are considerable shortcomings with the enforcement of and compliance with safety policies covering lead and mercury; the EurG-C countries in particular reported these as being under-provided. As with other policy topics, the penalties for infringement were highest in the EurG-D countries. The prohibition or restricted use of food, water and products contaminated with heavy metals which endanger health are the most common measures in EurG-A countries. EurG-B and EurG-D countries reported an 80% rate of remedial measures to reduce or eliminate the risk of non-compliance.
 
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For heavy metals, it is notable that, to a greater extent than the other groupings, the newly independent states tended to report that
 
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#immediate investigations were carried out to identify the cause of the environmental contamination,
 
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#mandatory reporting was required, and
 
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#a competent authority existed.
 
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However, as concluded by the WHO meeting on chemical safety in newly independent states, although most countries have laws regarding the safe production, transport and trade of chemicals, their enforcement falls under the authority of different ministries (e.g. of the interior, transport, trade, health, environment, labour, customs and agriculture) and communication among them is often inadequate for the effective management of chemical risks.
 
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Furthermore, with the primary reliance of law enforcement authorities on existing skills for inspection (e.g. sanitary, veterinarian, environmental and ecological), there is wide variability in the levels of inspection, law enforcement and compliance. Some sub-laws and other legal acts contain varying standards for pollutants in various media. Evidently, however, there are often no standards for monitoring and evaluating newly emerging pollutants.
 
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====Healthy public policy====
 
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All country groupings scored much higher on policy accountability for health and the involvement of the health sector in food safety, thus indicating a great degree of health policy integration in the countries. In contrast, the heavy metal policy scores are rather low, reflecting very fragmented consideration of health issues in national policies on this topic, particularly in EurG-C countries. All country groupings except the newly independent states gave low scores with respect to involvement of the health sector.
 
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The most common evaluation methods in all country groupings are those based on foodborne disease surveillance and monitoring systems for microbiological and chemical food contamination, with all their deficiencies. However, actually using this information to identify and assess food-related health risks and the effectiveness of policy action is the most infrequent measure reported. As already noted, more effort is needed to use food monitoring data effectively to assess exposure to food contaminants in different population groups. Furthermore, national foodborne disease surveillance and food contamination systems need to be strengthened, notably regarding better integration of laboratory-based surveillance and better collaboration among health, veterinary and food-related disciplines.
 
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The monitoring of progress under the policy, using specific food safety indicators and periodic reviews of policy obligations and targets, was reported as a common practice in EurG-A and EurG-B countries, whoalso reported greater use of systems for monitoring antimicrobial resistance in food bacteria.
 
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The health accountability of policies on chemical safety of lead and mercury is weak throughout the Region. This is the result of poor monitoring systems, both of heavy metals in the physical environment and even more so regarding exposure and bio-monitoring (Fig. 54). EurG-A and EurG-B groupings have put more emphasis on heavy metals monitoring, the use of health-relevant indicators, and periodic reports to review policy targets. EurG-C countries reported the most infrequent use of several health accountability measures. The only exception was for the surveillance of heavy metals poisonings. A similar pattern appears within the EurG-D grouping.
 
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The health sector’s involvement throughout the food safety policy cycle is very high across the Region. This likely reflects the focus on independent governmental food safety control in society, both with the aim of maintaining health, and also to fulfil safety and quality standards of food- and feed-stuffs as traded goods. The lower extent of health sector involvement reported by new EU member states might be explained by some challenges in communication between the health sector and the relatively new national food safety authorities. Newly independent states reported a very high health
 
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sector involvement.
 
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The involvement of the health sector in policies related to heavy metals is low for all groupings except the newly independent states (Fig. 55B), suggesting that other sectors are generally responsible for monitoring and enforcing these policies in the Region.
 
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For food safety policies, equity issues are higher on the agenda in the EurG-C grouping than elsewhere: several EurG-C countries reported policies targeted directly at children, including education about food safety in schools. As regards heavy metal policies, EurG-B and EurG-D countries reported a focus on pollution hotspots and on children, most probably because of country-specific environmental health issues and priorities.
 
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[[file:policymeasuresheavymetals.png|thumb|250px|Measures for health accountability for policies covering heavy metals, by country grouping<ref name="who"/>]]
 
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[[file:healthsectorinvolvementpolicies.png|thumb|250px|Reported involvement of the health sector in policies covering A) food safety and B) the chemical safety aspects of lead and mercury, by country grouping<ref name="who"/>]]
 
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====Transparency and communication====
 
−
 
 
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Information to the public has a high priority in food safety policies. The slightly lower overall scores for EurG-C and EurG-D countries are mainly due to a lower focus on consumer information and food safety campaigns.
 
−
 
 
−
The EurG-A and EurG-B countries reached significantly higher scores than the other countries on information to the public about heavy metals. Most of these countries have reported information on action programmes and plans to reduce heavy metals, publish regular public reports on heavy metals in food, water and the air and promote action on the protection of public health and prevention of contamination from heavy metals. Only a few countries in the EurG-C and EurG-D groupings take action in this field. Another important issue could be that EurG-C and EurG-D countries have no monitoring results to communicate.
 
−
 
 
−
The European Pollutant Emission Register is becoming increasingly important. This Europe-wide register provides easily accessible key environmental data from industrial facilities in EU member states and in Iceland, Liechtenstein and Norway, and contributes to transparency and public participation in environmental decision-making. For the European Community it implements the Pollutant Release and Transfer Registries Protocol to the Aarhus Convention on Access to Information, Public Participation in Decision-making and Access to Justice in Environmental Matters. The Protocol became international law, binding its Parties on 8 October 2009.
 
−
 
 
−
An assessment of exposure to mercury and the environmental and health effects has never been carried out at European level. Moreover, the status of the implementation of the Aarhus Protocol on Heavy Metals is quite weak in parts of Europe, so it cannot be expected that such an assessment will be completed within the next few years.
 
−
 
 
−
===Overall progress===
 
−
 
 
−
Several environmental hazards, including POPs, some chemicals found in food and lead, have been monitored fairly systematically in the Region for some time. The data indicate that exposures have generally declined since the implementation of remedial programmes and policies. This provides evidence for the feasibility and effectiveness of risk prevention policies and for the importance of expanding monitoring – both for exposure to environmental hazards and for health outcomes.
 
−
 
 
−
While food safety issues are high on the environmental health agenda throughout the Region, health-related aspects of heavy metals are less intensively addressed. The lack of political priority given to these issues is not consistent with the available data on existing exposures or their potential health effects.
 
−
 
 
−
==Environmental noise==
 
−
 
 
−
Noise has emerged as the leading environmental nuisance in Europe, and excessive noise is an increasingly
 
−
common public complaint.
 
−
 
 
−
===Exposure to environmental noise and its health effects===
 
−
 
 
−
Environmental noise is one of the most frequently complained about environmental hazards in Europe. In the EU member states, Iceland, Norway, Switzerland and Turkey, one in four households reports being annoyed by noise from neighbours or from the street, with the percentage of the population complaining about noise ranging from 12% (in Hungary, Iceland, Ireland and Norway) to 31% (in Cyprus and Romania). People so exposed are at risk of adverse health impacts such as annoyance, sleep disturbance, learning impairment, cardiovascular disorders, hearing impairment and tinnitus. No notable decrease in the percentage of the population at risk was apparent in the countries surveyed during the period 2004-2008.
 
−
 
 
−
A good night’s sleep is essential for health and well-being. Night-time noise disturbs normal sleep patterns and diminishes the quality of sleep. According to the strategic noise mapping database, one in five persons living in relatively large cities (>250 000 inhabitants) is exposed to a night noise level higher than 55dB Lnight – the noise indicator for night time as defined by the EU directive on environmental noise of 2002 and the interim target of WHO’s Night noise guidelines for Europe. Exposure to noise levels higher than the interim target level is dangerous for public health: adverse health effects occur frequently, and a sizeable proportion of the population is highly annoyed and suffers sleep disturbance. There is epidemiological evidence that the risk of cardiovascular disease increases at this high level of exposure.
 
−
 
 
−
According to the preliminary results of the multinational Environmental Burden of Disease in Europe pilot project, environmental noise is the third largest environmental burden of disease (after ambient air pollution and exposure to SHS in six European countries), as expressed in DALYs.
 
−
 
 
−
Strategic noise mapping data show remarkable variations in the percentages of populations exposed to high levels of noise, both between cities and between countries. Specific data concerning population exposure to noise from airports also show large differences resulting from location and type of aircraft. These variations indicate that substantial improvements can come from appropriate remediation action by local and central governments.
 
−
 
 
−
Member States are encouraged to develop and implement action plans to reduce the proportion of their populations exposed to levels over the interim target (Lnight=55dB) in the context of meeting wider sustainable development objectives. It is highly recommended that risk assessment and management activities should be carried out at local and national levels. These should target the exposed population, and aim to reduce night noise to the levels recommended by WHO in its night noise guidelines.
 
−
 
 
−
[[file:peopleexposednightnoise.png|thumb|250px|Percentage of people exposed to a night noise level of L<sub>night</sub> >55dB from roads in European agglomerations with populations of ≥250 000<ref name="who"/>]]
 
−
 
 
−
===Policies on environmental noise===
 
−
 
 
−
Noise policies differ widely among different European country groups. While the number of policies covering noise might be substantial, their implementation and enforcement, involvement of the health sector and health accountability are weak in EurG-C countries, and not particularly good in other country groups.
 
−
 
 
−
====Public governance====
 
−
 
 
−
It is not unexpected that EurG-A and EurG-B countries generally have noise pollution policies covering a wider range of key issues than EurG-C and EurG-D countries. However, fewer than half of the European countries have policies dealing directly with the reduction of health risks or the prevention of noise.
 
−
 
 
−
[[file:policyprofileenvironmentalnoise.png|thumb|250px|Policy profile for environmental noise, by country grouping<ref name="who"/>]]
 
−
[[file:policyscopenoise.png|thumb|250px|Scope of policy measures on noise, by country grouping<ref name="who"/>]]
 
−
 
 
−
Most EurG-A and EurG-B countries reported that their environmental noise regulations were enforced, mainly because of recent EU legislation in the field. It is striking that enforcement was rarely reported from any EurG-C country, perhaps reflecting a lack of policy attention given to noise in these countries. Remarkably, no EurG-C country has yet published a report describing the health risks of environmental noise.
 
−
 
 
−
Legislation is the most common policy instrument for dealing with noise throughout Europe. Other instruments, such as action plans, only exist in a limited number of countries. Non-compliance measures differ among country groups. In the EU, more emphasis is put on control activities. The questionnaire did not list the development of action plans as an option in the case of non-compliance. EU legislation does, however, give member states an opportunity to address local noise issues by drawing up action plans to reduce noise where necessary and maintain environmental noise quality where it is good.
 
−
 
 
−
[[file:policyinstrumentcombatnoise.png|thumb|250px|Policy instruments deployed to combat noise<ref name="who"/>]]
 
−
[[file:measureensurescompliancenoise.png|thumb|250px|Measures to ensure policy compliance for noise, by country group<ref name="who"/>]]
 
−
 
 
−
The first EU directive on environmental noise was a relatively modern policy instrument, requiring the competent authorities in member states to produce strategic noise maps on the basis of harmonized indicators, to inform the public about exposure to noise and its effects, and to draw up action plans to address issues related to noise. This directive, together with the establishment of European expert networks and a renewed focus on engine and tyre technology in relation to noise, have put noise higher on the European environmental health agenda.
 
−
 
 
−
After several years of effort, the Regional Office has also developed guidelines for night noise to help countries recognize and address issues related to noise and health. The guidelines present ground-breaking evidence of the damage that exposure to night noise can have on people’s health. They also provide recommendations to countries for introducing night noise limits, thus supporting the implementation of the EU Directive which requires countries to map hotspots of noise and reduce exposure but does not set any limit values.
 
−
 
 
−
====Healthy public policy====
 
−
 
 
−
Noise has not traditionally been high on the healthy public policy agenda. This is evident in the answers from different country groups, even if some of the results from EU member states could be considered the results of the integration of noise policies into other sectors. The score in EurG-C countries is particularly low.
 
−
 
 
−
There are differences in various national approaches to health accountability. Some EurG-A and EurG-B countries have chosen a variety of measures to monitor progress towards policy targets. EurG-D countries, on the other hand, place greater emphasis on disseminating information about the health risks and publishing periodic reports on noise as an environmental health problem. Notably, the survey results from EurG-D countries do not correspond with European noise data published so far, nor with other data reported in the same survey. Periodic reports on noise issues, published in EurG-D countries, are quite rare.
 
−
 
 
−
[[file:healthmeasuresnoisepolicies.png|thumb|250px|Health accountability measures for noise policies, by country grouping<ref name="who"/>]]
 
−
 
 
−
The involvement of the health sector in noise-related policies is seen particularly in EurG-B and EurG-D countries, where the health sector has wide responsibilities from policy formulation and implementation to control, evaluation and dissemination of information. For EurG-A countries, this responsibility lies, to a larger extent, with other sectors. For EurG-C countries, it is unclear whether any responsibility for noise exists in any country.
 
−
 
 
−
EurG-B countries have put more emphasis on equity in their noise policies than the other country groups. In these countries, policies focus more on groups at serious risk from high noise levels and children. Noise may to a certain extent be considered a universal issue, involving the promotion of noise-free environments for all. On the other hand, in order to start work on reducing the risks of noise to health, it will be necessary to give priority to certain areas or groups at risk.
 
−
 
 
−
[[file:healthsectorinvolvementnoise.png|thumb|250px|Reported health sector involvement in noise policy, by country grouping<ref name="who"/>]]
 
−
 
 
−
====Transparency and communication====
 
−
 
 
−
The lack of publicly available noise maps and of other information on noise explains the low score of the EurG-C and EurG-D countries. For EurG-A and EurG-B countries, the Noise Observation and Information Service for Europe (NOISE) database provides, through the European Environment Agency, a picture of the number of people exposed to noise generated by air, rail and road traffic across Europe and in 102 large urban agglomerations. Compiling information from 19 of the 32 European Environment Agency member countries, the NOISE database represents a major step towards a comprehensive pan-European service.
 
−
 
 
−
Information on noise and health in the eastern part of the Region is generally unacceptably poor. There is a lack of relevant published information regarding current exposure and effects, the distribution of effects and mitigation measures. Noise policies are under development. The most promising tool so far is the EU directive on environmental noise with its noise maps. The international regulations on noise sources have succeeded in limiting transport-related emissions such as noise from lorries, outdoor machinery, aeroplanes and trains. Some progress on tyre noise has been made as well as on motorcycles.
 
−
 
 
−
 
 
−
 
 
−
==See also==
 
−
 
 
−
*[[Health and Environment in Europe: Progress Assessment]]
 
−
*[[WHO:Clean water - a basic human right]]
 
−
*[[WHO:Clean air for health]]
 
−
*[[WHO:Be mobile, active - and safe!]]
 
−
*[[WHO:Implementing the CEHAP for Europe:the role of intersectoral collaboration]]
 
−
 
 
−
==References==
 
−
 
 
−
<references/>
 
−
 
 
−
*REACH. What is REACH? [web site]. Brussels, European Commission, 2010 ([http://ec.europa.eu/environment/chemicals/reach/reach_intro.htm], accessed 13 February 2010).
 
−
*Dalbokova D, Krzyzanowski M, Lloyd S, eds. Children’s health and the environment in Europe: a baseline assessment. Copenhagen, WHO Office for Europe, 2007.
 
−
*Technical Working Group on Integrated Monitoring. Final report on actions and recommendations for “Integrated monitoring of dioxins and PCBs in the Baltic Region” in the framework of the European Environment and Health Strategy (COM(2003)338 Final). Brussels, European Commission, 2004 ([http://ec.europa.eu/environment/health/pdf/dioxin_final.pdf], accessed 13 February 2010).
 
−
*Miettinen, H. The effects of TCDD on the development of teeth and cortical bones in rats: implications for risk assessment [dissertation]. Kuopio, National Public Health Institute, 2006 ([http://www.ktl.fi/attachments/suomi/julkaisut/julkaisusarja_a/2006/2006a10.pdf], accessed 13 February 2010).
 
−
*Vos JG ''et al.'' Health effects of endocrine-disrupting chemicals on wildlife, with special reference to the European situation. Critical Reviews in Toxicology, 2000, 30:71–133.
 
−
*Alaluusua S ''et al.'' Polychlorinated dibenzo-p-dioxins and dibenzofurans via mother’s milk may cause developmental defects in the child’s teeth. Environmental Toxicology and Pharmacology, 1996, 1:193–197.
 
−
*Persistent organic pollutants in human milk. Copenhagen, WHO Regional Office for Europe, 2009 (ENHIS Fact Sheet 4.3).
 
−
*Dioxin exposure and health. Brussels, European Commission, 2008 ([http://ec.europa.eu/environment/dioxin/index.htm], accessed on 13 February 2010).
 
−
*Mead MN. Contaminants in human milk. Weighing the risks against the benefits of breastfeeding. Environmental Health Perspectives, 2008, 116(10):A427–434.
 
−
*Kiviranta H. Exposure and human PCDD/F and PCB body burden in Finland [dissertation]. Kuopio, National Public Health Institute, 2005 ([http://www.ktl.fi/attachments/suomi/julkaisut/julkaisusarja_a/2005/2005a14.pdf], accessed 13 February 2010).
 
−
*Tuomisto JT ''et al.'' Soft tissue sarcoma and dioxins – a case control study. International Journal of Cancer, 2004, 108:893–900.
 
−
*Turunen AW ''et al.'' Mortality in a cohort with high fish consumption. International Journal of Epidemiology, 2008, 37:1008–1017.
 
−
*Alaluusua S ''et al.'' Developmental dental aberrations after the dioxin accident in Seveso. Environmental Health Perspectives, 2004, 112:1313–1318.
 
−
*Mocarelli P ''et al.'' Paternal concentrations of dioxin and sex ratio of offspring. Lancet, 2000, 355:1858–1863.
 
−
*Steenland K ''et al.'' Dioxin revisited: developments since the 1997 IARC classification of dioxin as a human carcinogen. Environmental Health Perspectives, 2004, 112:1265–1268.
 
−
*Thuresson K ''et al.'' Apparent half-lives of hepta- to decabrominated diphenyl ethers in human serum as determined in occupationally exposed workers. Environmental Health Perspectives, 2006, 114:176–181.
 
−
*Exposure of children to chemical hazards in food. Copenhagen, WHO Regional Office for Europe, 2009 (ENHIS Fact Sheet 4.4).
 
−
*Assessment of the dietary exposure to arsenic, cadmium, lead and mercury of the population of the EU member states. Brussels, Commission of the European Communities, Directorate-General Health and Consumer Protection, 2004 ([http://ec.europa.eu/food/food/chemicalsafety/contaminants/scoop_3-2-11_heavy_metals_report_en.pdf], accessed 13 February 2010).
 
−
*Castoldi A ''et al.'' Human developmental neurotoxicity of methylmercury: impact of variables and risk modifiers. Regulatory Toxicology and Pharmacology, 2008, 51:201–214.
 
−
*Communication from the Commission to the Council and the European Parliament on Community strategy concerning mercury. Extended impact assessment. Brussels, Commission of the European Communities, 2005 (Commission Staff Working Paper SEC(2005)101, [http://ec.europa.eu/environment/chemicals/mercury/pdf/extended_impact_assessment.pdf#search=%22EU%20Extended%20Impact%20Assessment%20%20Mercury%22], accessed 13 February 2010).
 
−
*Levels of lead in children’s blood. Copenhagen, WHO Regional Office for Europe, 2009 (ENHIS fact sheet 4.5).
 
−
*Health risks of heavy metals from long-range transboundary air pollution. Copenhagen, WHO Regional Office for Europe, 2007.
 
−
*Initiative to estimate the Global Burden of Foodborne Diseases. Geneva, World Health Organization, 2010 ([http://www.who.int/foodsafety/foodborne_disease/ferg/en/index.html], accessed 12 February 2010).
 
−
*Harmonization of methods for assessment of EH policies in the Member States: report on a WHO working group, Bonn, 22–23 May 2008. Copenhagen, WHO Regional Office for Europe, 2008 ([http://www.euro.who.int/Document/E92205.pdf], accessed 12 February 2010).
 
−
*FAO/WHO Food Standards. Codex Alimentarius [web site]. Geneva, World Health Organization and Rome, Food and Agriculture Organization, 2010 ([http://www.codexalimentarius.net/web/index_en.jsp], accessed 13 February 2010).
 
−
*Assuring food safety and quality: Guidelines for strengthening national food control systems. Geneva, World Health
 
−
Organization and Rome, Food and Agriculture Organization, 2003 ([http://www.who.int/foodsafety/publications/capacity/en/Englsih_Guidelines_Food_control.pdf], accessed 13 February 2010).
 
−
*Food safety. Geneva, World Health Organization, 2010 ([http://www.who.int/foodsafety], accessed 12 February 2010).
 
−
*Food safety – from the farm to the fork. Brussels, European Commission, 2010 ([http://ec.europa.eu/food/food/index_en.htm], accessed 13 February 2010).
 
−
*Europa. Summaries of European legislation. Food hygiene [web site]. Brussels, European Union, 2007 ([http://europa.eu/legislation_summaries/food_safety/veterinary_checks_and_food_hygiene/f84001_en.htm], accessed 13 February 2010).
 
−
*Convention on Long-Range Transboundary Air Pollution. Geneva, United Nations Economic Commission for Europe, 2010 (http://www.unece.org/env/lrtap/, accessed 14 February 2010).
 
−
*The role of health systems in chemical safety for eastern European, Caucasus and central Asian (EECCA) countries. Copenhagen, WHO Regional Office for Europe, 2009 ([http://www.euro.who.int/chemsafety/News/20080401_1], accessed 13 February 2010).
 
−
*EU leading the way towards world mercury export ban, press release. EEB/Zeromercury/Health & Environment alliance/ Health care without harm, 2006 ([http://www.env-health.org/IMG/pdf/061025ExportBanRegAdoptionPR.pdf], accessed 13 February 2010).
 
−
*WHO European Action Plan for Food and Nutrition Policy [web site]. Copenhagen, WHO Regional Office for Europe, 2009 ([http://www.euro.who.int/eprise/main/WHO/Progs/fos/Assistance/20070115_1?language=] , accessed 13 February 2010).
 
−
*Convention on Long-Range Transboundary Air Pollution. The 1998 Aarhus Protocol on Heavy Metals. Geneva, United Nations Economic Commission for Europe, 2010 ([http://www.unece.org/env/lrtap/hm_h1.htm], accessed 13 February 2010).
 
−
*UNEP Strategic Approach to International Chemicals Management [web site]. Geneva, SAICM Secretariat, 2010
 
−
(http://www.saicm.org/index.php?ql=h&content=home, accessed 13 February 2010).
 
−
*Strategic approach to international chemicals management: report by the Secretariat. Geneva, World Health Organization, 2010 (WHO Executive Board 126th Session, Geneva, 18–23 January 2010) ([http://apps.who.int/gb/ebwha/pdf_files/EB126/B126_20-en.pdf], accessed 12 February 2010).
 
−
*Directive [http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2003:037:0019:0023:en:PDF 2002/95/EC] of the European Parliament and of the Council of 27 January 2003 on the restriction of the use of certain hazardous substances in electrical and electronic equipment. Official Journal, 13/02/2003, L 037: 0019–0023 ([http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32002L0095:EN:HTML], accessed 13 February 2010).
 
−
38. Directive [http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2003:037:0024:0038:en:PDF 2002/96/EC] of the European Parliament and of the Council of 27 January 2003 on waste electrical and electronic equipment (WEEE). Official Journal, 13/02/2003, L 37: 24–38 (http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2003:037:0024:0038:EN:PDF, accessed 13 February 2010).
 
−
* EPER. The European Pollutant Emission Register. Copenhagen, European Environment Agency, 2010 ([http://www.eper.ec.europa.eu/eper/], accessed 13 February 2010).
 
−
* Kiev Protocol on Pollutant Release and Transfer Registers. Geneva, United Nations Economic Commission for Europe, 2010 ([http://www.unece.org/env/pp/prtr.htm], accessed 13 February 2010).
 
−
*Aarhus Convention on Access to Information, Public Participation in Decision-making and Access to Justice in Environmental Matters. Geneva, United Nations Economic Commission for Europe, 2010 ([http://www.unece.org/env/pp/documents/cep43e.pdf], accessed 13 February 2010).
 
−
*Noise from neighbours or from the street [online database]. Brussels, Eurostat, 2010 ([http://nui.epp.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_mddw01&lang=en], accessed 13 February 2010).
 
−
*Noise Observation and Information Service for Europe – NOISE. Copenhagen, European Environment Agency, 2010 ([http://noise.eionet.europa.eu], accessed 13 February 2010).
 
−
*The directive on environmental noise. European Brussels, European Commission, 2008 (2002/49/EC, [http://ec.europa.eu/environment/noise/directive.htm], accessed 13 February 2010).
 
−
*Night noise guidelines for Europe. Copenhagen, WHO Regional Office for Europe, 2009 (]http://www.euro.who.int/InformationSources/Publications/Catalogue/20090904_12], accessed 13 February 2010).
 
−
*Ranking of environmental stressors by health impact in Europe (EBoDE pilot). Opasnet, 2010 ([http://en.opasnet.org/w/EBoDE], accessed 13 February 2010).
 

Latest revision as of 09:41, 15 June 2012

This text is taken from the WHO report "Health and Environment in Europe: Progress Assessment", 2010, ISBN 978 92 890 4198 0. [1]

Regional priority goal IV: We commit ourselves to reducing the risk of disease and disability arising from exposure to hazardous chemicals (such as heavy metals), physical agents (e.g. excessive noise), and biological agents and to hazardous working environments during pregnancy, childhood and adolescence.[1]

Key messages

  • Policies and action to limit exposure to persistent organic pollutants (POPs) and heavy metals in food, and to eliminate exposure to lead from leaded petrol have all achieved considerable success within the Region. Constant awareness is, however, needed. Moreover, there are still challenges in many countries, with a need for improved monitoring and enforcement.
  • Iternational cooperation on food safety has proved efficient, as countries develop coherent standards and regulations aiming to ensure the same level of health protection for as many citizens as possible.
  • There is a lack of appropriate publicly available environmental health data, especially regarding exposure to heavy metals but also regarding contamination of the food chain and the burden of foodborne disease.
  • Consideration of health aspects in environmental policies for heavy metals is low in most countries and is not proportional to the risks to health which heavy metals may create.
  • Environmental noise is perceived as the most common stressor: a quarter of the population in EU countries is exposed to noise levels leading to a wide range of health effects. Noise abatement policies in many Member States need to be strengthened to address health problems effectively.
  • Safety in the occupational environment improved significantly in the 1990s, but in the last decade the improvement has levelled of in the eastern part of the Region.

Regional priority goal IV addresses a wider range of environmental health issues than goals I–III and is associated with diverse environmental health risks such as toxic chemicals, physical agents (e.g. harmful noise, and ionizing and ultraviolet radiation) and hazardous working environments. It focuses on policy action to reduce and prevent hazardous exposure with an emphasis on children and other age-specific sensitivity windows. Furthermore, this goal pays particular attention to child labour and advocates the elimination of its worst forms.

This chapter focuses on three areas, giving an assessment of the situation, progress and policy action regarding:

  1. issues related to
    1. food safety, including exposure to hazardous chemicals in food;
    2. general exposure to lead; and
    3. chemical safety aspects of other heavy metals;
  2. environmental noise;
  3. occupational health, in particular work-related health problems.

Consideration is paid to the health burdens, public concerns, availability of data and evidence, and potential to take targeted action to benefit health. Despite their differences they are all of special concern for children’s health for similar reasons: the particular sensitivities of children in the pre- and postnatal periods due to their rapid development; their different metabolisms and behaviour compared to adults; and their longer life expectancy, which render them more vulnerable than adults to many environment hazards.[1]

Chemical hazards

Exposure to chemical hazards

People are exposed to huge numbers of industrial and household chemicals, pesticides and metals in air, water, food and consumer products. Many of these chemicals can be hazardous to health, especially if they are used inappropriately. Children are particularly vulnerable to chemical hazards for various reasons including naïve behaviour and because their organ systems are rapidly developing. Symptoms arising from prolonged low-level chemical exposure may only appear later in life and may be chronic and irreversible. Global industrialization, urbanization and intensive agriculture, together with growing patterns of unsustainable consumption and environmental degradation, contribute to exposure to hazardous chemicals.

New chemicals are constantly synthesized for various purposes and the capacity rigorously to test the safety of all of them prior to use is very limited. The EU Registration, Evaluation, Authorization and Restriction of Chemicals (REACH) regulation, introduced in June 2007, makes industry responsible for assessing and managing the risks posed by chemicals and providing appropriate safety information to their users. Adverse health outcomes are a result of many factors including the compound’s toxicity, and the exposure levels and characteristics of the exposed population. It is, however, assumed that many new chemicals will not take on public health importance.

Food safety is one of the most important factors for good health. Several serious accidental poisonings have arisen due to food contaminated by POPs or heavy metals, and long-term low-level exposure can cause chronic health effects. Furthermore, the microbiological safety of food is crucially important for public health. The surveillance of foodborne diseases and the monitoring of contamination in the food chain are, however, inadequate. Reporting of foodborne disease only represents the tip of the iceberg. A risk-based approach is needed in the management of exposure to chemical hazards. Priority should be given to assessing those chemicals with the greatest risks for public health, those that accumulate in the body and those to which chronic exposure at low levels cause adverse health outcomes.

Groups of chemicals that should be considered when assessing the safety of food are pesticide residues, veterinary drug residues, heavy metals, POPs and other organic contaminants, microbial toxins, food additives, compounds formed unintentionally during the processing of food, contaminants from packaging and storage and, last but not least, the major constituents of food itself, such as excess salt, sugar and fat. The inherent toxicity of a substance does not necessarily indicate high public health concern, as population exposure and vulnerability are also important determinants.[1]

Persistent organic pollutants

POPs have been recognized as a serious concern since the 1960s and 1970s, when dichlorodiphenyltrichloroethane (DDT) and polychlorinated biphenyls (PCBs) were banned or phased out in many industrialized countries. Over time, it became clear that this was not sufficient. Besides staying in the environment for long periods, POPs are prone to accumulate in higher organisms and to magnify in the food chain: levels increase by several orders of magnitude from sea plankton up the food chain to people. Owing to their semi-volatility and persistence, some are transported through air and water to locations where they have never been used, such as the Arctic. At high concentrations, POPs cause reproductive and developmental effects in wild and laboratory animals. There is more uncertainty about health effects in humans at typical levels of exposure, which can be lower than in some other species.

Among the POPs, polychlorinated dioxins (PCDDs) and dioxin-like chemicals (including polychlorinated dibenzofurans (PCDFs) and dioxin-like PCBs) appear to have the lowest safety margin and to be the most likely group to cause adverse effects in humans. During the 1970s, at concentrations 5–10 times higher than at present, they were possibly the cause of subtle effects such as effects on tooth development. The sources of these compounds were the incineration of municipal waste, chlorine gas bleaching of wood pulp and the metal industries, together with a number of minor sources. Until the 1980s, there were also important impurities in the production of certain chemicals (PCBs, chlorophenols and their derivatives). Advances in abatement have been greatest in areas such as waste incineration and the pulp and paper industry, resulting in the reduction of POP concentrations in environmental samples, including lake- and seabed sediment layers, fish, fish-eating birds and seals. The largest remaining sources are the metal and cement industries, landfill fires and small-scale wood and biomass burning. There may still be considerable variations among countries.

There is evidence that developmental effects occur even at the lowest measured POP concentrations. Dioxin levels in human milk provide a long-term average of the body burden because these persistent compounds accumulate in breast tissue. They are relevant both as an indicator of risk during pregnancy and for measuring the chemical intake by the breastfed baby. Both of these steps are believed to be crucial for assessing the risk of developmental effects for the whole population. The most systematic information on POPs in humans is based on four rounds of human milk analysis studies of dioxins and PCBs coordinated by WHO. Dioxin levels in human milk have decreased in all countries monitored since 1988. Several European countries with higher initial levels have made particularly dramatic and important reductions. In spite of the decrease, the margin between currently prevalent and known toxic levels is still narrow enough to be of concern.[1]

WHO recognizes this concern. Nevertheless, the net beneficial effect of breastfeeding as the optimal food source for newborn babies should always be emphasized, especially when sharing information with the general public.

The body burden is clearly age-dependent and is lowest in younger age groups. For older populations with higher body burdens, the relative risk of cancer, while real, is not very high even at the highest industrial exposures. Recent results of studies on families of fishermen indicated that, despite much higher dioxin and PCB body burdens, mortality (including cancer mortality) was lower than in the general population, possibly due to the other, beneficial effects of consuming fish. In Seveso, Italy, after a very high level of accidental exposure, there were reports of developmental effects on teeth, altered sex ratios and a possible increase in some rare types of cancer.

It is more difficult to assess the health risks of compounds other than dioxins, as the data on both exposures and effects are less systematic. Organochlorine pesticides or their metabolites can still be found in human samples in Europe, but the concentrations are low and their health relevance has clearly decreased. Some compounds have more recently come into focus. Polybrominated diphenyl ethers (PBDEs – flame retardants used in plastics and textiles) were found in human milk at the end of 1990s. Certain brominated diphenylethers, such as tetra- to octa-congeners, are absorbed by different animal species and bioaccumulate to some extent. They were therefore banned by the European Commission in 2004 and their concentrations in Europe are now decreasing. Even so, continued monitoring is warranted because there is uncertainty about the metabolic fate of decabromodiphenyl ether (BDE-209), which is still in production. It is itself very poorly absorbed by biota and fairly rapidly eliminated in humans, but it may be broken down into more toxic forms.

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Dioxin levels in human milk in selected countries, 1988-2007[1]

Another new group of halogenated compounds is perfluorinated alkyl compounds (PFAs), such as perfluorooctane sulfonate, which were introduced as water repellents and for many other uses. They are also highly persistent and have been shown to accumulate in animals. Some of these compounds have, therefore, been voluntarily phased out by industry but are worth monitoring because of their persistence.[1]

Heavy metals

Heavy metals remain of particular concern, despite being a priority for regulatory measures for decades. This section focuses on lead, mercury, cadmium and arsenic, for which the evidence on hazardous properties and population exposures is the most reliable. These four metals differ in their sources and the potential outcomes of exposure.

Main sources, potential health problems from exposure and provisional tolerable weekly intake for arsenic, lead, methylmercury and cadmium

Main sources Primarly health concerns Provisional tolerable weekly intake (mg/kg body weight)
Arsebic Contaminated food/water, some paints Neurological and developmental disorders 0.015
Lead Air, water, fuels, marine life Neurodevelopmental and neurological disorders; organ damage 0.025
Mehtyl mercury Fish/seafood Neurological and developmental disorders 0.0016
Cadmium Contaminated food Kidney damage, low birth weight, spontaneous abortion 0.007

Average intake levels of lead, mercury, cadmium and arsenic in the adult diet in 13 European countries in the early 2000s are available from the EU scientific cooperation assessment of dietary exposure. In most countries, adult intake levels were typically 10–30% of provisional tolerable weekly intake (PTWI), but sometimes higher. Data on intake by children are patchy: total intake seems to be lower than in adults, but intake per unit of body weight is higher.

Monitoring of chemical contaminants in food through total diet studies is an established practice in the Czech Republic. The observed amount of all metals in the total diet of the general population between 1994 and 2007 was far below the PTWI values. However, young children tend to eat different types of food, and different amounts per unit of body weight, so these results are not directly applicable to children under three years of age who are particularly vulnerable to the neurotoxic effects of chemicals.

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Mean level of selected hazardous metals in the total diet of the general population, Czech Republic, 1994−2007 [1]

The organic form of mercury, methylmercury, appears to be of greatest concern for children notwithstanding the significant limitations of information on children’s exposure to heavy metals in food. Methylmercury is highly toxic, particularly to the nervous system; the developing brain is known to be particularly sensitive. Owing to the transport of mercury through the environment and its bioaccumulation, the main source of exposure to methylmercury in the general population is diet, in particular through the consumption of fish, particularly via certain species. It is assumed that all of the mercury in fish is present as methylmercury. Toxicity has been demonstrated at low exposure levels, but fish can also be an important component of a healthy diet. It is, therefore, essential that clear guidelines for optimal fish consumption levels are widely publicized. Food sources other than fish and seafood products may contain inorganic mercury, which is considerably less toxic than methylmercury.[1]

The estimated intakes of methylmercury in Europe vary by country and region, depending on the contamination level and the amount and type of fish consumed. Some population groups may frequently consume large predatory fish (such as swordfish, tuna and pike), which are at the top of the food chain and often have a higher concentration of methylmercury. A recent EU assessment suggested that as many as 1 in 20 people may be affected. The study estimated that 1–5% of the general population in Europe (3 to 15 million people) are over the limit that the EU uses. Even more worrying is the fact that a proportion of this population, notably Mediterranean fishing communities, have levels ten times as high as the recommended norm.

The potential negative effects on health from consuming contaminated food can be greatly reduced by improving the production, processing and handling of food, educating people to limit the intake of high-risk foods and, as a priority for a longer time span, reducing environmental pollution. Lead is one of the most dangerous chemicals to children. The most important effect of long-term exposure is neurotoxicity, particularly during the first two to three years of life when early development of the central nervous system occurs. Exposure to lead during this time increases the risk of mild mental retardation, attention deficit hyperactivity disorder and other developmental disabilities. An elevated blood lead level (10 μg/dl or above) has been associated with toxicity in the developing brain and nervous system of young children, leading to a lower intelligence quotient. More recent evidence indicates that similar effects may occur below 10 μg/dl and that preventive activities should therefore aim to bring down the amount of lead in the blood to the lowest possible levels. Lead in the environment has multiple sources, including the combustion of leaded petrol, industrial processes, paint, solder in canned foods and water pipes. Exposure to lead occurs through a number of pathways (such as air, household dust, road dirt, soil, water and food). Evaluation of the relative contribution of the different sources is complex and is likely to differ between areas and population groups.

Exposure to lead in Europe has clearly decreased in the last 20 years following the elimination of tetraethyl lead as an anti-knock additive in petrol in many countries. Generally, lead in blood levels began to decline earlier in western European and Scandinavian countries than in eastern Europe, largely due to the earlier introduction of unleaded petrol. Emission trends from 24 European countries have shown that total emissions of lead dropped by 90% from 1990 to 2003 (22). In the mid-1980s, a collaborative study between WHO and the European Commission found levels of lead in children’s blood of 18.2–18.9 μg/dl in Bulgaria, Hungary and Romania compared to 11.0 μg/dl in Italy and 7.4 μg/dl in Germany. This difference was still evident in the 1990s, with considerably lower levels in France, Germany, Israel and Sweden compared to Hungary and the Russian Federation.

The benefits of switching completely to unleaded petrol are further illustrated by a series of blood lead measurements in 3700 children living in urban Sweden. A dramatic decline was observed between 1978 and 2005, with the first decrease in the early 1980s when unleaded fuel was introduced. Residual exposure to re-suspended lead disappeared only after the complete elimination of leaded petrol from the market in 1994.

Although many countries have applied systematic interventions to phase out industrial sources of lead emissions, leaded petrol still exists in some countries in the east of the Region. For example, it will not be completely phased out in Montenegro and Serbia until 2015. Furthermore, measurements of blood lead levels in children living near hot-spots show that plumbing and local industries continue to be important sources of concern in some countries (e.g. Bulgaria, Poland, Russian Federation, The former Yugoslav Republic of Macedonia, Ukraine). Although lead levels in people show a decrease in all these countries, it is difficult to assess progress owing to a lack of systematic human bio-monitoring. Regular population-based surveys of lead in blood, and monitoring of other chemicals of concern, using uniform protocols specific to various age groups, would greatly enhance the ability to assess exposure and trends as well as the potential health impacts and effectiveness of policy measures.[1]

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Blood lead levels in Swedish children, 1978−2005 (Leaded petrol was phased out from the beginning of the 1980s.)[1]

Microbial contamination of food

Although a strong theme in this chapter is chemical contamination of food, it is essential that exposure to hazardous microbiological agents in food should not be overlooked. Foodborne disease caused by microbes, both sporadic cases and outbreaks, is very common throughout the Region, even in countries with high hygiene standards. The most common clinical presentation of microbiological foodborne diseases takes the form of gastrointestinal symptoms, but such diseases can also lead to chronic symptoms including arthritis, neurological or immunological disorders and cancer as well as septicaemia, multi-organ failure and death. Foodborne outbreaks are about an order of magnitude commoner than waterborne episodes, although fewer people are typically involved in each foodborne outbreak.

The global burden of foodborne diseases and its impact on development and trade are currently unknown. Data are sparse and only cover people who have sought medical care and who have received an accurate diagnosis, provided the reporting system is operational and efficient. Reliable epidemiological data are, however, urgently needed to enable policy-makers as well as other stakeholders to develop, monitor and evaluate food safety measures intended to prevent and control foodborne disease. In response to this need, the WHO Department of Food Safety and Zoonoses has, in collaboration with multiple partners, launched a new Initiative to Estimate the Global Burden of Foodborne Disease.[1]

Microbiological contamination and foodborne illness

The aims of the Initiative to Estimate the Global Burden of Foodborne Diseases are to:
  1. obtain reliable epidemiological estimates on current, projected and averted morbidity, disability and mortality of foodborne diseases;
  2. provide countries with simple, user-friendly tools to conduct their own foodborne disease burden studies and examine the effectiveness of their prevention and intervention efforts.

Food safety and chemical safety aspects of heavy metals: policy analysis

The policy survey covers the following four topics from regional priority goal IV: food safety, chemical safety of pesticides, chemical safety of heavy metals (especially lead and mercury) and environmental noise. Two additional policy topics were also covered: ultraviolet radiation and radon in dwellings. The WHO working group agreed to consider them optional and hence beyond of the scope of this assessment.

Thirty-seven Member States responded to the four core policy topics, although not necessarily to all of them (for more information see Annex 1). The focus here is on food safety, the chemical safety of heavy metals and environmental noise and countries’ policy profiles are analysed along the six key aspects (for the methods, see Annex 2).

The policy profiles for food safety and chemical safety of heavy metals (lead and mercury) revealed rather distinct patterns. Food safety, with its symmetrical profile and high scores on all aspects except equity considerations, shows that this topic has been the focus of public policy throughout the Region. Overall, this was the topic with the highest scores of all EH policy topics screened using the WHO survey. For heavy metals, the scores are lower and the patterns differ substantially among the country groupings, reflecting the lack of a comprehensive approach to this topic as an environmental public health issue.[1]

Public governance

The high scores on policy development in all country groupings indicate the importance of food safety for many decades in the Member States. A closer look at national policy measures shows that compliance with food safety standards, regulations and international commitments both at EU and Region-wide level (the Codex Alimentarius) is the most frequently reported objective (85–100%). The same holds true for policy on modern approaches to risk management through the implementation of Hazard Analysis and Critical Control Point system in food industries, although the rates in the newly independent states are lower.

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  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 WHO Health and Environment in Europe: Progress Assessment, 2010, ISBN 978 92 890 4198 0[2]
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