Document: Health and Environment Ministerial Conference – Budapest 2004
Background Document – draft Ministerial CEHAPE – Ministerial Document – Children’s Environment and Health Action Plan for Europe
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DRAFT presented at
the Third Intergovernmental Preparatory Meeting
Evora, 27-28 November 2003
Fourth Ministerial Conference EUR/03/5045637/5
on Environment and Health 2004 4 November 2003
“The future for our children” 32371
Children’s Environment and Health Action Plan for Europe
Introduction: background and rationale for the Children’s Environment and Health Action Plan for Europe (CEHAPE)
1. We, the Ministers of Member States in the European Region of WHO responsible for health and environment, and the Commissioners for Health and Environment within the European Commission, recognize that many European children today benefit from better nutrition, cleaner water, more effective preventive health measures and a higher standard of living than ever before and that, on the whole, the health of children in the 52 countries of the European Region shows continuous improvement. However, we understand that improvement is not homogeneous across the Region and within countries, and that the health of a substantial proportion of children is threatened by the consequences of poverty, disruption of social protection and health systems, armed conflict and violence.
2. We recognize that children have the right to grow and live in healthy environments, as stated by the United Nations Convention on the Rights of the Child in November 1989, then emphasized at the United Nations General Assembly Special Session on Children in May 2002 and at the World Summit on Sustainable Development in September 2002. We are well aware that protecting children’s health and environment is crucial to the sustainable development of countries.
3. We are increasingly concerned about the effects on children’s health of unsafe and unhealthy environments. We understand that developing organisms, especially during embryonic and fetal periods and early years of life, are particularly susceptible, and may be more exposed than adults, to many environmental factors, such as polluted air, contaminated water, food and soil, unhealthy housing, unsafe transport and the consequences of armed conflict and environmental disasters. We realize that all children suffer from the consequences of polluted and unsafe environments but also that children living in the poorest countries and belonging to the most disadvantaged population groups are at the highest risk. Underdevelopment and poverty are strongly related to the burden of environmentally attributable disease and this is even more true for children.
4. We note that, in the European Region, about one third of the total burden of disease from birth to 18 years can be attributed to unsafe and unhealthy environments:
a) Injuries alone represent the first cause of death in this age group and account, on average, for about 1/6 of the total burden of death and disease, but this proportion can be as high as 1/3 in some countries.
b) Exposure to contaminated water, air, food and soil causes gastrointestinal and respiratory diseases, birth defects and neuro-developmental disorders, all of these accounting for another 1/6 of the total burden of disease.
c) Malnutrition is still a problem for too many children and at the same time the prevalence of obesity and the risk of later development of diabetes and cardiovascular disease is increasing as a consequence of both unhealthy diet and inadequate physical activity.
d) Finally, there is increasing concern regarding the potential for long-term toxicity, including the carcinogenic, neurotoxic, immunotoxic, genotoxic and endocrine-disrupting effects of many chemicals, especially of persistent organic pollutants (POPs) and physical agents (such as ultraviolet (UV) radiation, radiation and noise) that contaminate the environment and to which pregnant women and children may be exposed.
5. We recognize that our understanding of the nature and the amount of health effects produced on developing organisms, from the prenatal period to adolescence, by exposure to environmental agents is still incomplete. However, the evidence we already have of the role played by several environmental factors in determining disease and injury in children, and in inducing effects that may become manifest only in adult life, makes it mandatory to commit ourselves to coordinated and sustained action now to protect children’s health, today and for the future. We realize that when there are knowledge gaps and evidence is not yet sufficient, more effort has to be put into research, to improve our knowledge of causal links, the magnitude of effects and effective interventions. However, so as not to delay the implementation of policies that may protect children’s health and minimize the risk of severe and irreversible health effects, the precautionary principle should be applied.
6. We recommend that effective action be based on systematic reviews of interventions designed to reduce risk, whenever this information is available, and built on existing experience and best practices. Effective action also requires multisectoral approaches, such as those needed to ensure clean air, safe water and safe and supportive human settlements, and full information and involvement of communities, parents and young people themselves.
7. We recall the commitments made by the international community to ensure the right of children to healthy environments, in particular, the Declaration adopted at the Third Ministerial Conference on Environment and Health held in London in 1999. We commend the efforts of the European Commission (EC) towards ensuring a healthier environment for children through the development of an Action Plan 2004-2010 as a means of ensuring implementation of the EC Communication on the European Environment and Health Strategy. We also commend the Declaration of Ministers of the CIS which was adopted/signed in ….
8. We recognize the need to focus our actions on health and environment priorities that are associated with a substantial disease burden in children and for which feasible and effective action is possible within a reasonable time frame. We therefore agree to aim at reducing the burden of disease caused by major environmental risk factors by committing ourselves to four regional priority goals through the implementation of a series of actions for each goal.
9. We recognize that effective actions fall within the responsibility of different government ministries and local authorities and we commit ourselves to advocating the implementation of the actions listed below within our decision-making bodies.
Regional Priority Goals, actions and expected health outcomes
10. Regional Priority Goal I. We aim to reduce the morbidity and mortality arising from gastrointestinal disorders and other health effects by ensuring that adequate measures are taken to improve access to safe water and adequate sanitation for all children.
We aim at achieving this goal in accordance with the commitments made in the Millennium Development Goals by:
a) ensuring that all day-care centres and schools are provided with adequate safe water and basic sanitation;
b) implementing national plans to increase the proportion of households with access to safe water and adequate sanitation, thereby ensuring that the proportion of children without access to clean water and sanitation is halved by 2015;
c) raising awareness amongst the population, particularly caregivers, and ensuring the provision of education on basic hygiene.
11. Regional Priority Goal II. We aim at bringing about a substantial decrease in health consequences from accidents and injuries and pursue a decrease in morbidity from lack of adequate physical activity by promoting safe, secure and supportive human settlements for all children.
We will address the overall mortality and morbidity due to external causes in children and adolescents by:
a) developing, implementing and enforcing strict child-specific regulations that will better protect children and adolescents from injuries at and around their homes and schools;
b) supporting child-friendly urban planning;
c) implementing road safety education for children and adolescents coupled with skill acquisition, practice, feedback and the enforcement of corresponding legislation and laws (in particular, the recommendations of the WHO World and European Reports on Road Traffic Injury Prevention);
d) advocating safe access to green areas and safer mobility within the community.
We aim at bringing about a reduction in the prevalence of overweight and obesity by:
a) implementing health promotion activities in accordance with the WHO Global Strategy on Diet and Physical Activity;
b) pursuing opportunities for partnerships and synergies with other sectors to promote the benefits of physical activity.
12. Regional Priority Goal III. We aim at reducing respiratory disease due to outdoor and indoor air pollution by ensuring the right of all European children to live in an environment with clean air.
We aim at achieving a substantial reduction in the morbidity and mortality from acute and chronic respiratory disorders in children and adolescents by:
a) implementing the Framework Convention on Tobacco Control, through the drafting and enforcement of the necessary regulations and by setting up health promotion programmes that will reduce the exposure of pregnant women and children to environmental tobacco smoke;
b) improving access of households to healthier and safer heating and cooking systems as well as cleaner fuel;
c) applying and enforcing building regulations that ensure adequate indoor air quality, especially in housing, day-care centres and schools;
d) reducing emissions of outdoor air pollutants from transport-related, industrial and other sources through appropriate legislation and regulatory measures which ensure that air quality is kept within the limits set by the WHO Air Quality Guidelines for Europe.
13. Regional Priority Goal IV. We commit ourselves to reducing the risk of disease and disability arising from exposure to hazardous chemical, physical and biological agents and to hazardous working environments during pregnancy, childhood and adolescence.
We aim at reducing the proportion of children with birth defects, mild mental retardation and developmental disorders and bring about a reduction in the incidence of melanoma and skin cancer in later life by:
a) passing and enforcing legislation and regulations, and implementing national and international conventions and programmes to:
i. monitor in a harmonized way and reduce exposure of children and pregnant women to hazardous chemical, physical and biological agents;
ii. ensure appropriate testing for effects on the health of developing organisms of chemicals before their marketing and release into the environment;
iii. ensure the safe collection, storage, transportation, recycling and destruction of solid organic, inorganic and toxic waste;
b) implementing policies to raise awareness and ensure reduction of exposure to ultra-violet radiation, particularly in children and adolescents;
c) promoting programmes that minimize the consequences of major industrial and nuclear accidents such as Chernobyl and that take into consideration the needs of children and people of reproductive age.
We commit ourselves to applying International Labour Organization (ILO) Convention 182 which calls for the elimination of the worst forms of child labour.
14. To effectively pursue the four priority goals, we, the Ministers, recognize the need for, and commit our governments to, increased intercountry collaboration and solidarity, in order to support the efforts of countries whose children bear the greatest part of the environmental burden and that may need additional, technical and financial support to act effectively.
15. We recognize the need for assistance from international organizations and call upon WHO, other international organizations such as the European Commission, the United Nations Environment Program, the United Nations Economic Commission for Europe, the United Nations Children’s Fund, the Organisation for Economic Co-operation and Development, the World Bank, the European Environment Agency (EEA) and the ILO, and international nongovernmental organizations to promote and strengthen international collaboration among themselves on common priority issues and to identify new partners for the future of the Environment and Health Process.
16. We ask that such collaboration should ensure implementation of the CEHAPE by:
a) ensuring coordination between, and technical support for, countries;
b) developing and providing training opportunities and materials and promoting the incorporation of child health and environment issues in the training curricula of child and adolescent health professionals;
c) supporting the evaluation of the economic costs and benefits of action and inaction, promoting the internalization of such evaluation in cost-benefit analyses, and promoting policy development;
d) ensuring the exchange of information on relevant existing environmental health legislation;
e) identifying partners and funding sources for collaborative research and development;
f) developing child participation models.
17. We call upon WHO to develop, collect and disseminate information on evidence-based interventions and methodologies for use in child-focused health impact assessments. We also request that WHO should develop guidelines and tools on advocacy, information, education and communication to ensure the appropriate dissemination of information by the countries. We request that WHO and EEA collaborate with the European Commission on the further development of a coherent environment and health indicator system which includes child-specific effects, exposures and actions.
National Children’s environment and health action plans
18. We, the Ministers, will commit our governments to developing and starting to implement national children’s environment and health action plans by 2007. To ensure this, we will make best use of existing plans such as National Environment and Health Action Plans (NEHAPs) or develop new child-specific plans.
19. We will include child-specific actions in the national plans, which will ensure the achievement of the four Regional Priority Goals. We will also make use of the Table of actions attached in Annex I and indicators being developed by EEA and WHO to set child-specific and quantitative targets according to our own priorities and needs.
20. To ensure the development and implementation of national children’s environment and health action plans, we commit ourselves to using and adapting existing national bodies on environment and health or to establishing new mechanisms that will involve all relevant stakeholders, including child-focused NGOs, parents’ and children’s and youth organizations.
21. We acknowledge the lessons learnt from successful policies and interventions and recognize that effective action to protect children’s health from environmental threats requires close collaboration between health and environment authorities, as well as cooperation with other sectors such as transport, education, energy, urban planning, labour, social services and the corporate sector.
22. We will strengthen the professional capacity of the health and environment sectors by ensuring that children’s environmental health issues are incorporated into curricula and continuing education programmes of professionals in all cross-cutting sectors, particularly environmental specialists, land-use planners, public health officers, family doctors, paediatricians and other paramedics. We will make use of a strategy on advocacy, information, education and communication that will ensure adequate dissemination of information with the support of, and in collaboration with, WHO.
23. We recognize that we need harmonized and comparable monitoring data in order to investigate further the cause-effect relationship between environmental factors and adverse health effects that is crucial to developing environment and health policy. We will ensure that our existing monitoring systems facilitate the collection of data by using the child-specific health and environment indicators for national monitoring of the implementation of the children’s plan to allow for intercountry comparison at an international level.
24. We commit ourselves to reporting back to WHO on the development of national children’s environment and health action plans and the implementation of actions addressing national priorities and regional priority goals at a midterm review intergovernmental meeting to be held at the end of 2007.
We, the undersigned, on behalf of all the Ministers of Health and Environment and on behalf of the WHO Regional Office for Europe and the European Commission gathered here in Budapest on 25 June 2004, pledge to continue to support the initiatives outlined above. We hereby fully adopt the commitments made in this document.
Minister of Health, Hungary Regional Director, WHO/EURO
Minister of Environment, Hungary