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Concern for Europe’s Tomorrow Health and the Environment in the WHO European Region The use of general descriptive names, trade names, trademarks, etc. in a publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The views expressed in this publication are those of the contributors and do not necessarily represent the decisions or the stated policy of the World Health Organization. The Federal Minister for the Environment, Nature Conversation and Nuclear Safety (Federal Republic of Germany) provided financial support for, and undertook the printing of, this publication. Die Deutsche Bibliothek – CIP-Einheitsaufnahme Concern for Europe’s tomorrow : health and the environment in the WHO European region / WHO European Centre for Environment and Health. [Publ. on behalf of the World Health Organization Regional Office for Europe]. – Stuttgart : Wiss. Verl.-Ges., 1995 ISBN 3–8047–1406–4 NE: European Centre for Environment and Health © World Health Organization 1995 Published on behalf of the World Health Organization Regional Office for Europe by Wissenschaftliche Verlagsgesellschaft mbH All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the copyright holder. Wissenschaftliche Verlagsgesellschaft mbH, Birkenwaldstraße 44, D-70191 Stuttgart, Germany. Printed in Germany 5 Foreword The remarkable political changes that have taken place within the European Region in the last five years have greatly enlarged the potential for international collaboration. The First European Conference on Environment and Health was held in Frankfurt in December 1989, when these dramatic changes were at their height. Ministers from 29 countries, and the European Commission, approved a Charter that set out the principles, strategy and priorities for achieving an effective approach to the many areas in which environmental conditions may significantly affect human health. The Charter reflected the ministers’ concern that the nature and extent of environmental health problems throughout the Region had not been adequately assessed. The WHO European Centre for Environment and Health, which was established as a direct result of the Conference’s recommendations, was therefore given as its first major task the development of a comprehensive review of available data in such fields as water supply and sanitation, air and water pollution, radiation protection, food safety, occupational health, and housing and settlements. The project was entitled Concern for Europe’s Tomorrow, and the Scientific Advisory Board of the European Centre decided that the final report should be available as the scientific basis for deliberations at the Second European Conference on Environment and Health in Helsinki in June 1994. The time available for preparation was extremely limited. The fact that a summary of the final report was available in time for the Second European Conference reflects great credit on the many scientists (more than 270) and officially established national focal points in the Member States who have taken part in this major undertaking. The report highlights a number of issues that demand urgent attention and has confirmed the existence of major differences in environmental conditions and the health status of populations between the western countries of the Region and the countries of central and eastern Europe and the newly independent states of the former USSR. None of the countries of our Region, however, has room for complacency. As one example, substantial areas of many European cities provide a deteriorating environment for their citizens, owing to traffic noise, pollution and congestion, and social deprivation. Clearly, not all issues are of equal importance and it is hoped that the objective scientific nature of this report will help to allay unjustified public fears and to provide a more realistic perception of risk. Above all, the report is intended to be of assistance in rational decision-making, so that real priorities may be identified and limited resources efficiently utilized. The process of developing this report has demonstrated the shortcomings of the available data, in both coverage and consistency. Nevertheless, the report is a major step forward. I am confident that the network of national focal points, which has now been firmly established, and the close collaboration between the WHO Regional Office for Europe and other international organizations, in particular the European Environment Agency, provide excellent prospects for considerable improvements in the quantity 6 Foreword and quality of available information between now and the Third European Conference planned for 1999. The present volume, which has been developed in very close cooperation with the Europe’s Environment Task Force of the European Commission, represents a major step forward in collaboration among all 50 countries of the WHO European Region. It is hoped that it will be widely used, not only by government agencies but also by the very many nongovernmental organizations dealing with different aspects of the issues addressed by Concern for Europe’s Tomorrow. J.E. Asvall WHO Regional Director for Europe 7 Table of Contents Foreword Acknowledgements Contributors 5 17 17 Introduction The Setting The Genesis of Concern for Europe’s Tomorrow The Development of Concern for Europe’s Tomorrow The Scope and Purpose of Concern for Europe’s Tomorrow 23 24 Limitations and Constraints Beyond Concern for Europe’s Tomorrow References 28 1.5 1.5.1 1.6 1.6.1 1.7 1.7.1 1.8 1.8.1 1.9 1.9.1 1.10 48 48 51 53 54 54 56 56 58 59 60 61 28 29 26 27 Part I Background 1 1.1 1.2 1.2.1 1.2.2 1.2.3 1.3 1.3.1 1.3.2 1.4 1.4.1 Economic Sectors Introduction The WHO European Region Basic features and indicators Development of economic activities The CCEE and NIS An Outlook for the Future Some trends Some scenarios Energy Indicators and trends 33 33 33 36 36 39 39 40 40 41 Industry Indicators and trends Agriculture Indicators and trends Transport Indicators and trends Tourism Indicators and trends Urban Development Indicators and trends Conclusions References 8 Table of Contents 2 2.1 2.2 2.3 2.4 3 3.1 3.1.1 3.1.2 3.2 3.2.1 3.3 3.4 4 4.1 4.2 4.2.1 4.2.2 4.2.3 4.2.4 4.3 4.4 4.5 4.5.1 Environmental Health Management Introduction Environmental Health Services Intersectorality Involvement at the Local and Regional Levels 63 64 65 2.5 2.6 2.7 2.8 66 Intervention and Control Public Participation Environmental Health Professionals Conclusions References 69 70 72 73 73 Economics, the Environment and Health Introduction Links Environmental epidemiology and environmental health economics The Productive Economy and the Environment Response of industry to environmental concerns Investment in Environment and Health Failure of Economic Systems 75 75 3.5 3.6 76 76 77 3.7 3.8 3.9 3.9.1 3.9.2 78 Issues for the CCEE and NIS Funding and Management of Environmental Improvement Economic Instruments Information Conclusions Economic strategy Information References 81 83 84 85 87 87 88 88 81 State of Human Health Introduction Demographic, Socioeconomic and Lifestyle Data Population size and age structure Population distribution Socioeconomic factors Lifestyle indicators Availability and Interpretation of Health Data Infant Mortality Life Expectancy and Total Mortality Life expectancy 90 4.5.2 4.5.3 91 4.6 91 92 92 93 93 96 4.6.1 4.6.2 4.7 4.8 98 98 All causes of mortality Spatial patterns at the subnational level Occurrence of Selected Diseases Structure of total mortality by cause Selected groups of diseases Inequalities in Health Status Conclusions References 101 102 103 103 103 122 124 125 Table of Contents 9 Part II Environmental Exposure 5 5.1 5.2 5.2.1 5.2.2 5.2.3 5.2.4 5.3 5.3.1 5.3.2 5.3.3 5.3.4 5.3.5 5.3.6 5.4 5.4.1 Air Pollution Introduction Potential Health Effects Sulfur dioxide and suspended particulate matter Lead Nitrogen dioxide Ozone Ambient Air Pollution and Exposure Assessment Methodology Sulfur dioxide Suspended particulate matter Lead Nitrogen dioxide Ozone Indoor Air Pollution Pollutants and their sources 6 Water Supply and Quality 6.1 6.1.1 Health Effects Guidelines and standards for drinking-water Microbial contaminants Chemical contaminants Exposure Exposure to microbial contamination Exposure to chemical contamination Water supply coverage and shortages Causes of Exposure to Waterborne Hazards 6.1.2 6.1.3 6.2 6.2.1 6.2.2 6.2.3 6.3 139 140 141 144 144 145 146 146 147 151 153 155 157 160 5.4.2 5.4.3 5.5 5.5.1 5.5.2 5.5.3 5.6 5.6.1 5.6.2 5.6.3 5.6.4 5.7 160 176 6.3.1 177 178 179 184 6.3.2 184 6.4.2 6.4.3 6.4.4 187 191 194 6.4 6.4.1 6.4.5 6.5 Effects on health Exposure in Europe Global and Transboundary Air Pollution Climate change in the European Region Ozone depletion in the European Region Acid deposition in the European Region Trends Ambient air Indoor air Problems in exposure and health risk assessment Global and transboundary air pollution Conclusions References Inadequate raw water quality and quantity Inadequate treatment and distribution Trends Demands for surface water and groundwater Quality Sources of pollution Technical and infrastructure needs Management and control Conclusions References 161 164 165 166 167 167 168 168 170 170 171 171 172 195 196 196 196 197 198 198 199 199 201