1st malaysian national environmental report...

Putrajaya International Convention Centre (PICC) Putrajaya, Malaysia

12-13 December 2007

RE

PO

RT

1st Malaysian National Environmental

Health Action Plan (NEHAP) Seminar 2007

Engineering Services Division Ministry of Health malaysia

Institute for Environment & Development (LESTARI)

Unversiti Kebangsaan Malaysia

Organised by

in collaboration with

REPORT

1ST MALAYSIAN NATIONAL ENVIRONMENTAL HEALTH ACTION PLAN (NEHAP) SEMINAR 2007

Putrajaya International Convention Centre (PICC) Putrajaya, Malaysia

12-13 December 2007

ORGANISED BY

ENGINEERING SERVICES DIVISION INSTITUTE FOR ENVIRONMENT AND DEVELOPMENT (LESTARI) MINISTRY OF HEALTH MALAYSIA UNIVERSITI KEBANGSAAN MALAYSIA

FEBRUARY 2008

i

EXECUTIVE SUMMARY This report is the major output from the initiative taken by the Ministry of Health, Malaysia, to conduct the first national seminar on National Environmental Health Action Plan (NEHAP) in Malaysia. The seminar was organized in collaboration with the Institute for Environment and Development (LESTARI) of Universiti Kebangsaan Malaysia. Aiming at providing awareness and acceptance of the importance of environmental health and the need for a Malaysian NEHAP, the seminar’s objectives were to discuss the scope and priority of environmental health in Malaysia; to discuss issues and challenges of environmental health in Malaysia; and to discuss the scope of Malaysian NEHAP to be prepared. Sixty-six representatives of various ministries, government departments, universities, the private sector and NGOs, who formed a representation of the stakeholders, attended the two-day seminar. Five papers were presented by renowned experts in the relevant fields, namely on ‘Environmental Health Concern in Malaysia’, ‘NEHAP Programmes: ;World Wide Experiences’, ‘Federalization of Sewerage Services in Malaysia’, ‘Issues and Challenges in Malaysian Environmental Health’ and ‘The Need for Malaysian NEHAP’. The group discussions which followed were lively and very fruitful, displaying the commitment of stakeholders to be involved in the preparation of the Malaysian NEHAP. The first discussion group, which discussed ‘The Scope and Priorities in Environmental Health in Malaysia and the Malaysian NEHAP’, undertook a ‘mini Delphi’ exercise to prioritise twenty-one EH issues which it first identified to be addressed in the Malaysian NEHAP. It was agreed that NEHAP would present the action plan which includes sources of information, as well as strategy/action programmes and indicator(s) for each issue. NEHAP should develop a method to gather baseline information, group the issues into groups, prioritise the issues, and define the action time frame according to priorities in line with National Development Plans. The second discussion group classified issues and challenges in Malaysian EH into issues and challenges on assessing, correcting, controlling and prevention of environment-related diseases. The group concluded that EH issues are very complex and requires greater inter-sectoral participation, change of mind-sets, public accountability, transparency of issues on the ground, full utilization of all resources and the issue of not having a clear policy to formulate NEHAP.

ii

The seminar discussions concluded that there is an urgent need for a Malaysian NEHAP. However preparation must be made, including a comprehensive identification of all relevant stakeholders, a decision on the policy framework, including a policy if necessary, for EH and NEHAP. The seminar achieved success in putting EH and NEHAP as a very important agenda among the relevant stakeholders. It was concluded that combined with the environmental baseline information on EH which was compiled by LESTARI in 2007, the MOH is now ready and should commence immediately on the preparation of a terms of reference for a Malaysian NEHAP, and that MOH should commence on the preparation of a Malaysian NEHAP before the Tenth Malaysian Plan.

iii

THE ORGANISING COMMITTEE ENGINEERING SERVICES DIVISION, MINISTRY OF HEALTH (MOH) MALAYSIA Y. M. Engku Azman Tuan Mat, Deputy Director, Engineering Services Division, Ministry of Health; En. Mohd Zaharon Mohd Talha, Principal Assistant Director, Engineering Services Division, Ministry of Health; En. Yazid Kuman, Assistant Director, Engineering Services Division, Ministry of Health. INSTITUTE FOR ENVIRONMENT AND DEVELOPMENT (LESTARI) UNIVERSITI KEBANGSAAN MALAYSIA Datin Paduka Dr. Halimaton Saadiah Hashim, Principal Fellow, Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia; Dr. Rahmah Elfithri, Research Fellow, Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia; Siti Norliyana Hassan, Research Assistant, Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia; Nurul Akmar Rasli, Research Assistant, Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia; Muslimah Mohd Nor, Research Assistant, Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia; Norazmi Abdul Kadir, Laboratory Assistant, Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia.

iv

ACKNOWLEDGMENTS This report is the result of a collaborative effort of many individuals and organisations with diversed backgrounds and experiences: government agencies, universities/research institutes, private sector and NGOs. We express our appreciation to all of them. We acknowledge our appreciation to the presenters who were willing to share their knowledge and valuable experience with participants during the seminar: Prof. Dr. Jamal Hisham Hashim, Faculty of Medicine, UKM; Dr. Mazrura Sahani, Faculty of Allied Health Sciences, UKM; Mr. Ahmad Rozian, Sewerage Services Department, MEWC; Datin Paduka Dr. Halimaton Saadiah Hashim, LESTARI, UKM; and Mr. Zaharon Talha, Engineering Services Division, MOH. We are highly indebted to the expert team members who were involved in the project entitled ‘Baseline Information on Environmental Health of Peninsular Malaysia’ for their invaluable suggestions and input while undertaking this project. Special thanks to Prof. Dr. Mazlin B. Mokhtar, Director of Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia for the encouragement and support in making this seminar successful. Profound gratitude to the members of the organising committee, both from MOH and LESTARI, UKM. This seminar would not have been successfully organised without the numerous people who availed themselves at various stages. We thank all of them for their help. Finally special acknowledgements for the Ministry of Health for providing generously funds for the seminar and all related works.

v

CONTENTS

Page EXECUTIVE SUMMARY i THE ORGANISING COMMITTEE iii ACKNOWLEDGEMENTS iv CONTENTS v LIST OF TABLES vi LIST OF FIGURES vi LIST OF ABBREVIATIONS vii

1. INTRODUCTION 1

2. SEMINAR PARTICIPANTS 2.1 Target Stakeholders 2.2 Seminar Approach and Structure

2 2 4

3. SEMINAR PRESENTATIONS 3.1 Opening Session: Welcoming address and Opening Ceremony 3.2 Paper Presentations Session: Issues and Challenges on EH and NEHAP in Malaysia

6 6

7

4. BREAK UP GROUP DISCUSSIONS 4.1 Break Up Group I: Scope and Priorities in Environmental Health in Malaysia and Malaysian NEHAP 4.2 Break Up Group II: Issues and challenges in Environmental Health in Malaysia

15 15

27

5. SEMINAR DISCUSSIONS

40

6. CONCLUSIONS

43

7. APPENDICES 44 Appendix 1 List of Participants 45 Appendix 2 Paper Presentations 52 Appendix 3 The Project Team Members 131

vi

LIST OF TABLES Table No Page

2.1 Stakeholders/Participating Organisations in the Seminar 2 4.1 Identified Issues in Environmental Health to be included in

Malaysian NEHAP 17

4.2 Issues and Challenges in Assessing 29 4.3 Issues and Challenges on Correcting 30 4.4 Issues and Challenges on Controlling 31 4.5 Issues and Challenges on Prevention 32

LIST OF FIGURES Figure No Page

2.1 During the 1st Malaysian NEHAP seminar 5 4.1 Presentation by Group I 16 4.2 Presentation by Group II 28

vii

LIST OF ABBREVIATIONS

AELB Atomic Energy License Board AFSB Alam Flora Sdn. Bhd CDC Communication Disease Control CEHAPE Children’s Environment and Health Action Plan for Europe CO Carbon Monoxide DBKL Dewan Bandaraya Kuala Lumpur (Kuala Lumpur City Hall) DID Department of Irrigation and Drainage DOA Department of Agriculture DOC Department of Chemistry DOE Department of Environment DSM Department of Survey and Mapping EH Environmental Health EHIA Environmental Health Impact Assessment EHRA Environmental Health Risk Assessment EIA Environmental Impact Assessment EPU Economic Planning Unit EU European Union FPSK Fakulti Pengurusan Sains Kesihatan (Faculty of Health

Science Management) FSKB Fakulti Sains Kesihatan Bersekutu (Faculty of Allied Health

Science) HIV Human Immunodeficiency Virus IMR Institute for Medical Research IRBM Integrated River Basin Management ISO International Standard Organization IWK Indah Water Konsortium Sdn. Bhd JAS Jabatan Alam Sekitar (Department of Environment) JPP Jabatan Perkhidmatan Pembentungan (Sewerage Services

Department) JPS Jabatan Pengairan dan Saliran (Drainage and Irrigation

Department) JPSM Jabatan Perhutanan Semenanjung Malaysia (Forestry

Services Department) JUPEM Jabatan Ukur dan Pemetaan Malaysia (Survey and

Mapping Department of Malaysia) KPI Key Performance Index KKM Kementerian Kesihatan Malaysia (Ministry of Health

Malaysia) KTAK Kementerian Tenaga, Air dan Komunikasi (Ministry of

Energy, Water and Communications) LUAS Lembaga Urus Air Selangor (Selangor Waters Management

Authority – SWMA) LESTARI Institute for Environment and Development, Universiti

viii

Kebangsaan Malaysia (UKM) MAEH Malaysian Association of Environmental Health MBPJ Majlis Bandaraya Petaling Jaya (Petaling Jaya City Council)MDG Millennium Development Goals MEWC Ministry of Energy, Water and Communication MHLG Ministry of Housing and Local Government MMA Malaysian Medical Association MMS Malaysian Meteorological Services MNA Malaysian Nuclear Agency MOH Ministry of Health MOHEHAP Ministry of Health Environmental Health Action Plan MP Malaysia Plan MQL Malaysian Quality of Life NAHRIM National Hydraulic Research Institute of Malaysia NEAP National Environmental Action Plan NEHAP National Environmental Health Action Plan NGOs Non-Governmental Organisations NIOSH National Institute for Occupational Safety and Health NWSC National Water Services Commission PERHILITAN Jabatan Perlindungan Hidupan Liar dan Taman Negara

(Wildlife Protection and National Parks Department) PICC Putrajaya International Convention Centre PNSB Puncak Niaga Sdn. Bhd SDP Sewerage Development Plan SOP Sewerage Operation Plan SPAN Suruhanjaya Perkhidmatan Air Negara (National Water

Services Commission - NWSC) SSD Sewerage Services Department STP Sewage Treatment Plant SWMA Selangor Water Resources Management Authority TOR Terms of Reference UKM Universiti Kebangsaan Malaysia UM Universiti Malaya UN United Nations UPM Universiti Putra Malaysia UK United Kingdom WHO World Health Organization WSIA Water Services Industry Act WSSD World Summit on Sustainable Development YM Yang Mulia

Seminar Report

1st Malaysian NEHAP Seminar: 12-13 December 2007 1

1st MALAYSIAN NATIONAL ENVIRONMENTAL HEALTH ACTION PLAN (NEHAP) 2007

12-13 December 2007

Putrajaya International Convention Centre (PICC) 1. INTRODUCTION The 1st Malaysian National Environmental Health Action Plan (NEHAP) Seminar was held from 12th to 13th December 2007 at the Putrajaya International Convention Centre (PICC), Putrajaya. The seminar was organised by the Ministry of Health (MOH) Malaysia (Engineering Services Division) in collaboration with the Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia. The seminar aimed to provide awareness and acceptance of the importance of environmental health (EH) and the need for National Environmental Health Action Plan (NEHAP) in Malaysia. NEHAP presents strategies on how to improve EH within a country and defines roles and responsibilities of various stakeholders. For the first time, key stakeholders on EH which comprise government departments/agencies and selected non-governmental organizations (NGOs) were grouped to discuss aspects of environmental health which are of concern to everybody. Objectives of the seminar were to discuss:

(1) the scope and priority of environmental health in Malaysia; (2) the issues and challenges of environmental health in Malaysia; and (3) the scope of Malaysian NEHAP.

Seminar Report


2. SEMINAR PARTICIPANTS 2.1 Target Stakeholders Initially, the organising committee identified three main stakeholder groups which comprise 85 organisations as identified in the Baseline Information on EH of Peninsular Malaysia Report (MOH 2007), namely (i) agencies/institutions under the Health Ministry; (ii) agencies/institutions under the Environment Ministry; and (iii) agencies/institutions under the Social and Economic Planning Ministries, Private sector and NGOs. The organising committee also included key internal stakeholders namely the Expert Group members from the project “Baseline Information on EH of Peninsular Malaysia” and a team of support staff to help with the facilitation process and compilation of feedbacks. The seminar was attended by multi stakeholders from various ministries and agencies, and representatives from the private sector and NGOs. Out of 85 invitees, a total of 39 organisations (46%) which were represented by 66 persons attended the seminar, representing different categories of stakeholders. The list of participants is in Appendix 1. The major government, non-government and private agencies/institutions that were represented at the seminar are listed in Table 2.1.

Table 2.1 Stakeholders/Participating Organisations in the Seminar

Stakeholders Groups Agencies/Institutions Federal Level 1. Engineering Services Division, MOH;

2. Health Education Division, MOH; 3. Food Safety and Quality Division, MOH; 4. Office of the Deputy Director General of Health,

MOH; 5. Institute for Medical Research (IMR); 6. National Hydraulic Research Institute of

Malaysia (NAHRIM); 7. Department of Agriculture (DOA) Malaysia; 8. Department of Environment (DOE) Malaysia; 9. Wildlife Protection Department and National

Park (PERHILITAN); 10. Department of Irrigation and Drainage (DID); 11. Department of Chemistry (DOC) Malaysia; 12. Department of Survey and Mapping (DSM)

Malaysia; 13. National Institute for Occupational Safety and

Health (NIOSH); 14. Department of Water Supply, Ministry of

Energy, Water and Communication (MEWC);

Seminar Report


15. Malaysian Meteorological Services (MMS); 16. Sewerage Services Department (SSD); 17. Forestry Department; 18. National Solid Waste Management Department,

Ministry of Housing And Local Government (MHLG)

19. Atomic Energy License Board (AELB); and 20. Malaysian Nuclear Agency (MNA).

State Level 1. Health Services Department, Selangor State; 2. Health Services Department, Perak State; 3. Health Services Office, Kinta, Perak; and 4. Selangor Water Resources Management

Authority (SWMA).

Local Authorities 1. Kuala Lumpur City Hall (DBKL); and 2. Petaling Jaya City Council (MBPJ).

Institutions of Higher Learning/Universities

1. Universiti Kebangsaan Malaysia (UKM); 2. Universiti Putra Malaysia (UPM); 3. Universiti Malaya (UM); 4. Institute for Environment and Development

(LESTARI), UKM; 5. Faculty of Allied Health Sciences, UKM; and 6. Department of Community Health, Faculty of

Health Science Management (FPSK), UPM.

Private sector 1. Indah Water Konsortium Sdn. Bhd (IWK); 2. Alam Flora Sdn. Bhd (AFSB); 3. Puncak Niaga Sdn. Bhd (PNSB); 4. Third World Network; and 5. Sime Darby Sdn. Bhd.

NGOs 1. Malaysian Association for Environmental Health

(MAEH); and 2. Malaysian Medical Association (MMA).

Seminar Report


2.2 Seminar Approach and Structure The seminar was sub-divided into three main parts. The first part consisted of an Official Opening Session, including a welcoming address by Mr. Zaman Huri (Engineering Services Division, MOH), followed by the official opening speech of the 1st Malaysian NEHAP Seminar by YM Engku Azman Tuan Mat (Deputy Director of Engineering Services Division, MOH), representing Datuk Ir. Dr. M. S. Pillay, the Deputy Director General of Health (Research and Technical Support), MOH. The second part of the Seminar consisted of the paper presentations session. There were five presenters from different organisations and expertise who cover issues on the following aspects (Full presentations are attached in Appendix 2):

1. Environmental Health Concern in Malaysia by Prof. Dr. Jamal Hisham Hashim (Faculty of Medicine, UKM);

2. NEHAP Programmes: World Wide Experiences by Dr. Mazrura Sahani (Faculty of Allied Health Sciences, UKM);

3. Federalization of Sewerage Services in Malaysia by Mr. Ahmad Rozian (Sewerage Services Department, MEWC)

4. Issues and Challenges in Malaysian Environmental Health, by Datin Paduka Dr. Halimaton Saadiah Hashim (LESTARI, UKM); and

5. The need for Malaysian NEHAP by Mr. Zaharon Talha (Engineering Services Division, MOH).

The third part is the Break-Up Group Discussions, in which seminar participants were divided into three break-up groups to discuss the following issues:

1. Scope and priority of Environmental Health in Malaysia; 2. Issues and Challenges in Environmental Health in Malaysia; and 3. Scope of Malaysian NEHAP.

The seminar’s overall approach was designed to be simple and transparent enough for the participants/stakeholders to see where and how their feedback and contributions fit into the whole picture. Datin Paduka Dr. Halimaton Saadiah Hashim from LESTARI gave the seminar briefing to the participants before they started their discussions in their groups. Groups I and III were combined to become one group (Group I) due to the limited number of participants who selected these groups. Therefore the two groups covered the following aspects:

Seminar Report


1. GROUP 1: “Scope and priority of Environmental Health in Malaysia and

Malaysian NEHAP”; and 2. GROUP 2: “Issues and Challenges in Environmental Health in Malaysia”

Figure 2.1 During the 1st Malaysian NEHAP seminar One facilitator was assigned to each group. The facilitators began the session by assisting the two groups to appoint the following:

a. Chairman; b. Presenter; and c. Secretary/ Rapporteurs.

The elected Chairman of each group ensured that the discussion would follow the topics as assigned and the group members were given the opportunity to express their opinions/ideas. The discussions were also helped by facilitators and resource experts who were assigned to each group. The elected presenter was to prepare for the presentation by using power point presentation at the group presentation session on the second day of the seminar (13th December 2007). The secretary/rapporteur was to help the presenter to take notes of all discussion within the group and to prepare the power point presentation. Presentation of break-up group I and II are attached in Appendix 3.

Seminar Report


3. SEMINAR PRESENTATIONS 3.1 Opening Session: Welcoming address and Opening

Ceremony Welcoming Address: By Mr. Zaman Huri, Senior Assistant Director, Engineering Services Division, MOH. Below are some of the very pertinent essence of his speech:

1. Mr. Zaman Huri thanked Y.M Engku Azman Tuan Mat (Deputy Director, Engineering Services Division, MOH) who, on behalf of Datuk Ir. Dr. M. S. Pillay (Deputy Director General of Health, MOH) had agreed to officiate this seminar. He hoped that this first NEHAP seminar will contribute ideas for developing the Malaysian NEHAP and extend NEHAP preparation to the next level;

2. NEHAP is one of the programmes that have been approved in the 9th

Malaysia Plan (MP9) i.e. to prepare an action plan that will coordinate environment and health aspects and identify roles and responsibilities of strategic actions; and

3. This seminar was to discuss and identify issues and strategies to develop

NEHAP. He then presented some ideas and opinions on the preparation of NEHAP in Malaysia.

Official Opening Speech: By Y.M Engku Azman Tuan Mat, Deputy Director of Engineering Services Division, MOH. Below are some of the very pertinent essence of his speech.

1. Y.M Engku Azman Tuan Mat, on behalf of Datuk Ir. Dr. M. S. Pillay, the Deputy Director General of Health, MOH, expressed his thanks to the organizing committee (MOH and LESTARI) for organizing this seminar. He was very pleased because the stakeholders who attended the seminar were multi-sectoral and multi-disciplinary, representing those who would be involved in NEHAP;

2. This first Malaysian NEHAP Seminar was also in conjunction with 50

years of Malaysian Independence Celebrations. He stressed the importance of knowing the health status of the country, since a country that is able to report on its health status indicates the level of economic development of the country;

3. In Malaysia, it was found that environmental quality, especially air quality, declined from 2002. Water quality also declined, as presented in the

Seminar Report


media, where rivers are polluted due to toxic wastes that are dumped into the rivers;

4. Environmental quality very much influences environmental health,

especially air and water quality level. Therefore environmental health concepts have become important;

5. Malaysian Vision 2020 & the National Development Policy stressed that

the strategic development approach has to be based on sustainable development. The challenges for sustainable development are not only on physical development, but also on social and community development. Human capital development is a major condition to achieve the desired development;

6. The Malaysian government has taken initiatives and has utilised the

resources towards positive actions, for example, the combination of the sewerage services department under the Ministry of Energy, Water and Communication (MEWC). The government also took initiatives in the development of water supply services and established the Suruhanjaya Perkhidmatan Air Negara (SPAN) or National Water Services Commission (NWSC). Through these agencies, environmental management and disease prevention precautionary actions can be carried out more effectively. These will ensure Malaysian communities are in good health. These also need an integrated action plan;

7. The World Conference on Environment and Health in Bangkok in 2007

had launched a declaration on environment and health, where all countries agreed to develop NEHAPs in their respective countries. Currently, NEHAPs have been established in countries that are not yet developed such as Palau, Uzbekistan, Kazakhstan, etc. Malaysia is not late to develop NEHAP for this country. NEHAP is also as an indicator or a road map towards achieving a developed country status; and

8. This seminar is the first National Seminar on Action Plan for Environment and Health in Malaysia.

3.2 Paper Presentations Session: Issues and Challenges on

EH and NEHAP in Malaysia Paper 1: ‘Environmental Health Concern in Malaysia’ By Prof. Dr. Jamal Hisham Hashim (Professor in Faculty of Medicine, UKM) Below are some very pertinent aspects presented:

Seminar Report


1. Prof. Dr. Jamal Hisham Hashim explained the definition of health viz. a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. It is a very ambitious target, where the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, religion and political belief, economic or social condition;

2. He also presented the definition of EH by WHO (1993) viz. that

environmental health comprises those aspects of human health, including quality of life, that are determined by physical, biological, social and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling and preventing those factors in the environment that can potentially affect adversely the health of present and future generations;

3. Issues on squatter areas and river pollution are very detrimental to the

health of the population. Thermal fogging is also an issue to health but it is necessary to solve the Dengue problem;Illegal solid waste dumping and related issues are also related to health;Issues on climate change are not well covered in the media but we have to look at what is really happening with our air/weather and also issues on illegal solid waste and how do we control the issues of air pollution, noise pollution and radiation control;

7. Children may have to learn how to wear the face mask as a standard

apparel. These are challenges on issues that have to be captured in NEHAP & how do we deal with the issues, for example problems with Carbon Monoxide (CO), Toxic hazardous waste, etc;

8. We have to understand what NEHAP is and who would be a responsible

agency to this action plan. NEHAP is a government document that addresses environmental health problems and solutions in a comprehensive, holistic and inter-sectoral way. It is usually drawn up in cooperation with a wide range of partners, including professionals and technical experts, national, regional and local authorities and non-governmental organizations. It is usually integrated into national policies and development plans, encompassing both public and private initiatives. It should spell out action plans to address key environmental health issues and suggest key performance indicators to assess progress;

9. NEHAP must spell out what environmental improvements should be made

and who should be responsible for them. It should contain specific actions for improving environmental health in the nation, which should form a check list against which progress in improving environmental health can be measured; and

Seminar Report


10.Progress for and of NEHAP should be reviewed from time to time and the extent to which the actions set out in the plan have been completed should be reported.

Paper 2: ‘NEHAP Programmes: World Wide Experiences’ By Dr. Mazrura Sahani (Lecturer in Faculty of Allied Health Sciences, UKM) Dr. Mazrura Sahani presented the worldwide experiences of NEHAP programmes. She discussed about the background of NEHAP, which started with the Rio Declaration 1992, Millennium Development Goals (MDG) 2000, and the World Summit on Sustainable Development (WSSD) at Johannesburg 2002. Below are some very pertinent aspects presented:

1. WHO came up with a regional strategy to strengthen national capacity in environmental health risk assessment (EHRA) and management, enhance cooperation between health and environment sectors, and their cooperation with other socio-economic sectors in solving problems, and promote inter-country cooperation in solving common and trans-boundary environmental health problems;

2. The “UN Millenium Declaration” set the agenda for the new millenium to

fight against poverty (by 2015) and inequalities, and outlined some values which governments agree to be the basic principles for international relations in the twenty first century including freedom, equality, solidarity, tolerance, respect for nature and shared responsibility. To meet the aims of the declarations, governments signed up for the Millennium Development Goals (MDGs) in 2000;

3. High-level political commitment and co-ordination is expected to be more

effective when it is promoted at a high level and concerns all relevant levels of policy-making. Integrated activities, e.g. NEHAP actions are scored according to the importance for the health of the population, importance for the life of the environment, importance for social policy, extent of support for international activities and EU accession and feasibility (availability of personnel/specialists, technology, institutions);

4. NEHAP preparation processes usually cover a large scale, long term-

project, and includes all departments related to health and the environment. The NEHAP processes are at different stages in countries throughout the world. In most countries in Europe the plan has been prepared, either at the final stage of preparation or has already been adopted and entered into the implementation phase;

Seminar Report


5. NEHAP experiences in Europe are good examples in NEHAP preparation, since there was a formal preparation process undertaken by the EU. NEHAP UK which was published in 1996 contained an overview of the provision for environmental health and detailed analysis of many factors contributing to it. It set up a plan for improving environmental health in the UK. The UK Sustainable Development Strategy ‘A Better Quality of Life’ (1999) encompasses environmental goals alongside a social and economic agenda and replaces NEHAP UK (1996);

6. Belgium’s NEHAP had its first version which was accepted in 1997, where

Central Government authorities had three essential tasks to improve policy instruments for environment and health, to develop a strategy for implementing the NEHAP, and to manage, on a continuing basis, the framework for implementing the NEHAP;

7. NEHAP in Malta was first produced in 1997 to cover the period 1997-

2003. In 2002 Malta made the evaluation of this NEHAP and established the Draft National Environment & Health Action Plan, Malta for 2006-2010. This Draft was formulated to resume new targets and priority actions for the period 2006-2010. These actions were concerned primarily with the protection of public health through the protection of the environment. Finally Malta also produced the introduction of child-specific actions - Children’s Environment and Health Action Plan for Europe (CEHAPE);

8. In Eastern Europe there was the development and adoption of

comprehensive policies and programmes in the environment sector, including National Environmental Action Plans (NEAPs) and NEHAPs. There was also a process of setting sustainability objectives at the national level, moving towards the integration of environment & sustainable development objectives in the policies of economic sectors e.g. energy, tourism, agriculture and transport;

9. Palau’s NEHAP is a strategic approach by various partnerships in the

community. The key areas of focus are environmental health administration, community environmental health development, consumer safety, vector control & health quarantine, emerging issues, health education & promotion, environmental health information system, epidemiology, and human resource development;

10. Thailand started the preparation of NEHAP in 2007 with a vision of “Better

Environment for A Better Quality Of Life”, and goals to manage environmental health systematically and holistically, to integrate the implementation in all sectors of the environment and health, and to build the capacity and partnership of related sectors;

11. Laos has also started it’s process to develop NEHAP in August 2007; and

Seminar Report


12. This first Malaysian NEHAP Seminar will become a good start for

NEHAP’s development in Malaysia. Paper 3: ‘Federalization of sewerage services in Malaysia’: by Mr. Ahmad Rozian (Sewerage Services Department, MEWC) Below are some of the pertinent aspects presented:

1. Mr. Ahmad Rozian explained that sewage is identified as the major source of organic pollutants in Malaysian rivers. Therefore sewerage infrastructure is necessary and form an integral part of infrastructure development in order to protect its limited water resources, public health and the environment;

2. Sewage pollution comes from two sources viz. effluent from public sewage

treatment plant (STP) and from non-public STP sources, e.g. effluent from private STPs, effluent from individual septic tanks, sullage (from households), discharge of raw sewage (from squatters), sewage from primitive systems and wet markets/eateries;

3. He also explained about the historical background of sewerage system in

Malaysia, where most local authorities originated as sanitary boards. However sewerage remained low in government fund allocations, while 80% of existing plants are not performing;

4. On the current status of sewerage in Malaysia, the gazette date of

Sewerage Services Act was in 1993;The concession agreement for sewerage services in Malaysia was signed with IWK on 9th December 1993, and IWK began its first services on 1st April 1994. Wholly-owned by the Government since 23rd June 2000, IWK operates in 86 out of 98 local authorities in Peninsular Malaysia and Labuan Federal Territory;

5. There are four National sewerage guidelines for developers. They have

been formulated for reference in the provision of Sewerage Facilities in order to protect public health, preserve water resources and enhance environmental quality; and

6. Federalization of sewerage services since 1994 had brought sewerage

services in the country to a reasonable level today. Further enhancements could be achieved with the implementation of the SDP and SOP, to reach the set sustainable levels nationwide; and the way forward for the sewerage system in Malaysia is the Integration of water supply and sewerage initiated with the establishment of SPAN.

Seminar Report


Paper 4: ‘Issues and Challenges in Malaysian Environmental Health’: By Datin Paduka Dr. Halimaton Saadiah Hashim (Principal Fellow, Institute for Environment and Development (LESTARI), UKM). Below are some of the pertinent aspects presented:

1. Datin Paduka Dr. Halimaton Saadiah Hashim started her presentation with WHO’s definition of Health, i.e. “Health is a complete state of physical, mental, and social well-being, not just the absence of infirmity or disease.”;

2. She then presented WHO’s definition of environmental health (1993) i.e.

“Environmental health comprises of those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations;

3. She then presented a brief overview about the Malaysian Quality of Life

issues and status which was taken from the MQL Report (EPU 2006), followed by early findings of the project on Baseline Information Gathering on Malaysian Environmental Health by LESTARI for MOH (2007);

4. Getting stakeholders views on environmental health is very important. It is

followed by prioritisation of issues that also have to be made by stakeholders. There are four steps in getting stakeholders’ views that have been made in gathering information on Malaysian environmental health: (1) identification of stakeholders; (2) a questionnaire survey of identified stakeholders; (3) stakeholders consultation workshops; and (4) interviews of key stakeholders;

5. The stakeholder’s views (MOH 2007) on public health are mainly on the

following issues:- • Improvement and enforcement of laws, policies, control and effective

management of public health; • Impact of air, water and noise pollution, including polluted sources of

water, and other environmental problems on man; • Communication, awareness and public cooperation on improving

public health and control of diseases; • Traffic accidents, tsunami and other threats that affect public health; • Cultural values and consumers education on medicines and chemical-

free food; • Healthy environment that is guaranteed; • Human resource capital (capacity in information, experience and

ethics); • Use of chemicals in food and impact on man;

Seminar Report


• Use of chemicals in agriculture and impact of pesticides on farmers and consumers;

• Treatment of sludge before release to the environment; and • Strong economy has impact on public health;

6. She also highlighted about 10 major issues that were identified in the

baseline information gathering exercise, including aspects of concern on chemical, floods, drought, toxic waste, agricultural practices, land use and health, outdoor and indoor air, water, environmentally sensitive areas, and forest and diseases;

7. General observations from the baseline information gathering on

environmental health are as follows: • No central data depository on environmental health in Malaysia; • Few stakeholders knew of NEHAP but have relatively good grasp of

environmental health; • No policy or strategies on health or environmental health; and • Good cooperation between MOH and other environment-related

agencies but lack of consultation on environmental health and NEHAP/MOHEHAP; and

8. Her closing remarks focused on the following aspects:-

• There are wide-ranging issues but they are non-exhaustive because there is yet to have a vigorous approach to getting views from stakeholders;

• ‘Environmental health’ is not widely debated outside the Ministry of Health, although everyone is involved with environmental health (according to WHO’s definition);

• Need for more comprehensive information gathering for NEHAP; and • Present information is sufficient for the preparation of Terms of

Reference (TOR) for Malaysian NEHAP. Paper 5: ‘The need for Malaysian NEHAP’: By Mr. Zaharon Talha (Engineering Services Division, MOH) Some pertinent aspects include the following:

1. En Zaharon Talha (MOH) explained that environmental health is the science of protecting human health from the damaging effects of physical, chemical and biological agents in the environment. Environmental health combines disciplines in environmental sciences and health science together with management sciences to create a healthy environment;

2. Environmental health concerns are on many aspects: water pollution, air

pollution, solid waste pollution, toxic & hazardous waste and noise

Seminar Report


pollution. EH is influenced by globalisation, economics, demographics, health determinants, health reforms, social changes, information changes and technology;

3. The National Drinking Water Quality Surveillance Programme was initiated

based on high incidence of water borne diseases associated with poor water supply, where 2,600 cases of gastroenteritis were detected in Seremban in 1982. Pilot Projects started in the 80s to implement nation wide in the 6th MP, coordinated by the Technical Committees at Federal, State and District Levels. Programme Elements focused on monitoring, remedial action, data processing and evaluation, sanitary survey and, institutional examination.

4. Clinical Waste Management Programme was initiated because Malaysia

had no proper system for the management of medical waste. The emergence of HIV has initiated the revision of policies and guidelines for the prevention and control of infectious diseases and medical waste handling. The Ministry of Health in collaboration with the Department of Environment took initiatives to include medical waste in the category of scheduled wastes, as defined in the Environmental Quality (Scheduled Wastes) Regulations, 1989. In 1993, clinical waste definition was adopted by MOH and the following documents were prepared:-Policy on Hospital

Waste Management; • Guidelines for the Management of Clinical and Related Wastes in

Hospital and Health Care Establishments; and • Action Plan for Waste Management in Hospitals and Health Care

Establishments.

5. The Clinical Waste Management Programme of MOH’s hospitals was privatised in 1997;

6. Reasons why Malaysia needs NEHAP include the following:

• NEHAP is widely accepted worldwide as a planning tool for sustainable development;

• First Ministerial Regional Forum on Environment and Health in South East and East Asian Countries held in Bangkok in August 2007 agreed that member countries should prepare and regularly update NEHAP;

• Agreed by EPU as one of the KPIs in the 9th MP; and • To come up with strategies on how to improve environmental health in

Malaysia and define the roles and responsibilities of various stakeholders; and NEHAP for Malaysia is an important initiative that will determine the future health status of the population. It is crucial that all stakeholders play their parts in the development of NEHAP for the country. NEHAP should not be a static document but must be dynamic in nature and continuously evolve to take care of unexpected changes in the future.

Seminar Report


4. BREAK UP GROUP DISCUSSIONS The paper presentations provided a good input to spark discussions on the various issues concerning environment and health aspects. The approach to discussing environmental health issues and challenges was based on group discussions and free flow dialogue among all participants. The results of the break up group’s session are described below and these were presented on the second day of the seminar. 4.1 Break Up Group 1: Scope and Priorities in Environmental

Health in Malaysia and Malaysian NEHAP Members of Group 1 are as follows:- Advisor: Datin Paduka Dr. Halimaton Saadiah Hashim, Institute for Environment and Development (LESTARI) UKM Facilitators:

1. Assoc. Prof. Dr. Joy J. Pereira, Institute for Environment and Development (LESTARI) UKM

2. Dr. Mazrura Sahani, Faculty of Allied Health Science (FSKB), UKM Chairperson & Presenter: Tuan Haji Rosnani Bin Ab. Hamid, Ministry of Health Secretaries/Rapporteurs:

1. Nurul Akmar Rasli, Institute for Environment and Development (LESTARI) UKM

2. Siti Norliyana Hassan, Institute for Environment and Development (LESTARI) UKM

Group Members:

1. Dr. Lokman Hakim Sulaiman, Institute for Medical Research (IMR), Ministry of Health (MOH)

2. Prof. Dr.Jamal Hisham Hashim, Faculty of Allied Health Science (FSKB), UKM

3. Prof.Dr. Zalina Hashim, Universiti Putra Malaysia (UPM) 4. Danny Wee, Malaysian Association for Environmental Health (MAEH) 5. Esther Ong (Third World Network) 6. Nor Aziah Jaafar, department of Environment (DOE) 7. Mohd Azhar Mohd Noor, Universiti Kebangsaan Malaysia (UKM) 8. Mohd Rafee Baharudin, Universiti Kebangsaan Malaysia (UKM) 9. Haji Ismail Ahmad, Department of Irrigation and Drainage (DID) 10. Abdul Kadir Ishak, Malaysian Nuclear Agency (MNA)

Seminar Report


11. Zainal Abidin Husain, Atomic Energy License Board (AELB) 12. Haw Ai Beng, Ministry of Health (MOH)

The following were the outputs from the group discussion: A. EH Issues to be addressed in Malaysian NEHAP Members deliberated at length and depth to identify and prioritise issues that should be addressed in Malaysian NEHAP. The concern was that it should be comprehensive and holistic but at the same time should not be too overwhelmingly wide that the preparation and implementation will be unmanageable. The identification of issues were based on WHO’s framework which was informed to the members during the discussion and the list of issues identified in the project on EH baseline information by LESTARI-MOH (2007). The prioritisation was done through a very simple Delphi exercise among the group members. Each member was asked to prioritise the issues on a piece of paper and the summary of all priorities was synthesized by the secretaries and the group prioritization was derived and produced.

Figure 4.1 Presentation by Group I The group suggested that the Malaysian NEHAP preparation will identify the sources of information for each issue and recommend strategic actions to address each issue as well as indicators to monitor implementation success, as indicated in Table 4.1.

Seminar Report


Table 4.1 Identified Issues in Environmental Health to be included in Malaysian

NEHAP No. Issues (prioritised) Information

Source* Strategic Action*

Indicators*

1 Public water supply 2 Waste water management 3 Solid waste management 4 Toxic and Hazardous waste

management

5 Vector control 6 Food hygiene and safety 7 Disaster and emerging

preparedness

8 Urban development (planning, migration etc.)

9 Soil pollution (landuse activities )

10 Indoor air quality 11 Outdoor air quality 12 Noise control 13 Transboundry issues (land,

air, sea)

14 Radiation 15 Accident prevention (home,

workplace, recreational, roads etc)

16 Housing (design, ventilation, building)

17 Public recreational ( water quality, beach, swimming pool)

18 Occupational health 19 Social ills (violent crimes,

mental health, drugs, stress, lifestyle, etc)

20 Ecosystem & emerging diseases

21 Poverty & inequity Note: * to be filled in the Malaysian NEHAP

Seminar Report


B. Approach to Malaysian NEHAP The group deliberated on several approaches but finally agreed to the following steps in the preparation of Malaysian NEHAP:

i. Develop a systematic method and use it to prioritise EH issues; ii. Need baseline information/statistics; iii. Cross-check and update the list of issues with the Centre for

Communication Disease Control (CDC, MOH); iv. Prioritise the issues into groups for strategic actions; and v. Define the time frame for actions according to priority in line with

National Development Plans C. Proposed Framework for Health Hazard Minimisation The group agreed to the following framework. For each potential health hazard, identify the following:

i. Source of health hazard; ii. Mode of transmission; iii. Exposure of human to the hazard; and iv. Approaches in Risk minimization.

The presentation slides of group 1 on “Scope and Priorities of Environmental Health in Malaysia and Malaysian NEHAP” are given below:-

Seminar Report


GROUP 1

SCOPE AND PRIORITY OF ENVIRONMENTAL HEALTH IN MALAYSIA & THE SCOPE OF

MALAYSIAN NEHAP

GROUP 1 PRESENTATION SLIDES ON SCOPE AND PRIORITY OF ENVIRONMENTAL HEALTH

IN MALAYSIA AND MALAYSIAN NEHAP

CHAIRPERSON :TUAN HAJI ROSNANI BIN AB. HAMID (MOH)

ADVISOR:DATIN PADUKA DR. HALIMATON SAADIAH HASHIM (LESTARI, UKM)

FACILITATORS:DR. JOY J. PEREIRA ( LESTARI UKM)DR. MAZRURA SAHANI (FSKB, UKM)

MEMBERS:DANNY WEE (MALAYSIAN ASSOCIATE OF ENVIRONMENTAL HEALTH)

ESTHER ONG (THIRD WORLD NETWORK)NOR AZIAH JAAFAR (JABATAN ALAM SEKITAR)

MOHD AZHAR MOHD NOOR (UKM (Environmental Studies))MOHD RAFEE BAHARUDIN (UKM (Environmental Studies))

HAJI ISMAIL AHMAD (JPS)ABDUL KADIR ISHAK (Nuklear Malaysia)

ZAINAL ABIDIN HUSAIN (AELB)PROF. DR.JAMAL HISHAM HASHIM (FSKB, UKM)

DR. LOKMAN HAKIM SULAIMAN (IMR)PROF. ZALINA HASHIM (UPM)

HAW AI BENG (MOH)

Seminar Report


Indoor air quality10

Soil pollution ( landuse activities )9

Urban development ( planning, migration etc.)

8

Disaster and emerging preparedness7

Food hygiene and safety6

Vector control5

Toxic and Hazardous waste management

4

Solid waste management3

Waste water management2

Public water supply 1

IndicatorStrategy/ActionSourceIssues/ScopeNo.

IDENTIFIED ISSUES IN ENVIRONMENTAL HEALTH AND NEHAP

Poverty & inequity21

Ecosystem & emerging diseases20

Social ills (violent crimes, mental health, drugs, stress, lifestyle, etc)

19

Occupational health18

Public recreational ( water quality, beach, swimming pool)

17

Housing (design, ventilation, building)16

Accident prevention ( home, workplace, recreational, roads etc)

15

Radiation14

Transboundry issues ( land, air, sea)13

Noise control12

Outdoor air quality11

Seminar Report


APPROACH TO ISSUES PRIORITISATION

1. Develop method to prioritise issues2. Need baseline information/statistics3. Check with Centre for Communication

Disease Control (CDC, MOH)4. Prioritise the issues into groups- critical,

moderately critical, less-critical5. Define time frame according to priority in

line with National Development Plans

Proposed framework for analysis

Source of hazardMode of the transmissionExposure of humans to hazardApproaches for risk minimization

Seminar Report


GROUP PERCEPTION OF IMPORTANCE OF ISSUES ON ENVIRONMENTAL HEALTH IN MALAYSIA

194Indoor air quality10

185Soil pollution ( landuse activities )9

194Urban development ( planning, migration etc.)

8

185Disaster and emerging preparedness

7

212Food hygiene and safety6

311Vector control5

212Toxic and Hazardous waste management

4

14Solid waste management3

113Waste water management2

212Public water supply 1

LESS CRITICAL

MODERATELY CRITICAL

CRITICALISSUESNO

382Poverty & inequity21

365Ecosystem & emerging diseases

20

545Social ills (violent crimes, mental health, drugs, stress, lifestyle, etc)

19

95Occupational health18

383Public recreational ( water quality, beach, swimming pool)

17

194Housing (design, ventilation, building)

16

59Accident prevention ( home, workplace, recreational, roads etc)

15

671Radiation14

2102Transboundry issues ( land, air, sea)

13

2102Noise control12

167Outdoor air quality11

Seminar Report


CRITICAL ISSUES

1. Solid waste management (100%)2. Waste water management (93%)3. Public water supply(86%)4. Toxic and Hazardous waste

management(86%)5. Food hygiene and safety (86%)6. Vector control (79%)7. Accident prevention ( home, workplace,

recreational, roads etc) (64%)8. Outdoor air quality (50%)

MODERATELY CRITICAL ISSUES1. Noise control (71%)2. Transboundry issues ( land, air, sea) (71%)3. Urban development ( planning, migration etc.) (64%)4. Indoor air quality (64%)5. Housing (design, ventilation, building) (64%)6. Occupational health (64%)7. Disaster and emerging preparedness (57%)8. Soil pollution ( landuse activities ) (57%)9. Public recreational ( water quality, beach, swimming

pool) (57%)10. Poverty & inequity (57%)11. Radiation (50%)

Seminar Report


NON-CRITICAL ISSUES

1. Radiation (43%)2. Social ills (violent crimes, mental health,

drugs, stress, lifestyle, etc) (36%)3. Ecosystem & emerging diseases (21%)4. Poverty & inequity (21%)

NOTE:PRIORITISATION OF ISSUES NEED TO BE FINALISED WITH THE COUNTRY’S BURDEN OF DISEASE (CDC, MOH)

Seminar Report


SCOPE AND FRAMEWORK OF MALAYSIAN NEHAP

1. ISSUES2. OBJECTIVES3. POLICY FRAMEWORK :

Environmental policyHealth policyOther related policies

4. STRATEGIES AND ACTIONS5. PERFORMANCE INDICATORS

STRATEGIES AND ACTIONS

1. Volume of solid waste generated per capita2. Amount/ percentage of solid waste recycled per capita

1. Solid Waste Mngt (MHLG)2. Ministry of Education3. Local Authority4. Public sector5. NGOs6. Media

SHORTTERM1. Awareness

programe2. Recycling

centres and infrastructures

MEDIUMTERM1. Improveme

nt of the integrated SWM

LONG TERM1. Ongoing

Public Awareness

Public education and awereanessprogrames- diseases associated with improper SWM- 3Rs - to promote schools as recycling centre- to establish community recycling centre

1. To promote the 3Rs 2. To improve the integrated SWM programe

Solid waste mgt

PERFORMANCE INDICATORS

RESPONSIBLE BODIES(Agencies/Deparment/etc)

TIMEFRAMEACTIONSSTRATEGIESISSUES

Seminar Report


THANK YOU..

Seminar Report


4.2 Break Up Group 2: Issues and challenges in Environmental Health in Malaysia

Group 2 comprises the following members: Facilitator: Dr. Rahmah Elfithri, Institute for Environment and Development (LESTARI) UKM Chairman: Encik Zaman Huri, Ministry of Health (MOH) Presenter: Dr. Hajah Sadiah Abdullah, Petaling Jaya City Council (MBPJ) Secretary: Muslimah Mohd Nor, Institute for Environment and Development (LESTARI) UKM Group Members:

1. Dr. Fauziah Nordin (Health Department, Perak State) 2. Mat Rusni Bin Hasan (Health Department, Selangor State) 3. Salina Hashim (Health Department, Perak State) 4. Noorhayati Kassim, Ministry of Health (MOH) 5. Sasitheran K, Ministry of Health (MOH) 6. Hanifar Sulaiman, Ministry of Health (MOH) 7. Norhafizan Daud, Ministry of Health (MOH) 8. Dr. Sumitra Sahamparam, Institute for Medical Research (IMR), Ministry

of Health (MOH) 9. Jailan Simon, Malaysian Meteorological Services (MMS) 10. Wan Mohd. Zamri B. Wan Nawang, Selangor Waters Management

Authority (LUAS) 11. Abd. Rashid Abd Rahman, Indah Water Konsortium (IWK Sdn Bhd) 12. Faridah Ahmad, Department of Agriculture (DOA) 13. Sawal Yamon, Puncak Niaga Sdn Bhd (PNSB) 14. Nor Atiza Mohamed Akil, Puncak Niaga Sdn Bhd (PNSB) 15. Yuzaini Yusof, National Institute for Occupational Safety and Health

(NIOSH) 16. Dr. Silverraji Samiveloo, Department of Chemistry (DOC) 17. T. Ponna, Kuala Lumpur City Hall (DBKL) 18. Nurlailah Abdillah, National Hydraulic Research Institute Malaysia

(NAHRIM) 19. Tan Teow Soon, National Hydraulic Research Institute Malaysia

(NAHRIM) 20. Shahsiah Abd Cedrik, Forestry Services Department (JPSM)

Seminar Report


Figure 4.2 Presentation by Group II Members of Group 2 classified issues and challenges in environmental health as issues and challenges in: (i) assessing; (ii) correcting; (iii) controlling; and (iv) prevention, as shown in Table 4.2 – 4.5:-

Seminar Report


Table 4.2 Issues and Challenges in Assessing

ISSUES CHALLENGES

There is no clear policy on environmental health issues

How to make environmental issues as the No. 1 priority of Malaysians?

There is no specific agency/organisation that is responsible for environmental health issues

Do we need council/committee/org to coordinate?

Lack of political will – must have a strong political will; Public accountability is poor among decision makers;

Transparency; Change of attitudes – need for paradigm shifts

Segmented organization leads to segmented thinking, goals, etc; Too many agencies – overlapping of functions.

Clear channel of communication & coordination of activities

Lack of understanding among the decision makers/ politicians about issues on the ground.

How to tackle the politicians / leaders / decision makers? How to make them more accountable?

Slow in action. Attitude of ’wait & see’, and ‘tak apa’ (let it happen)

Be more proactive. Must identify issues early/precautionary issues; Need to establish early warning systems.

Information of source of population not shared. Red tape, bureaucracy.

One information hub for the gathering & disseminating information with regards to environment health issues.

Issues in education and awareness: Lack of understanding on

Environmental Health; Lack of education; Problems of the public attitude or

apathy; Accountability; Prevention through education –

start from pre-school; There is no background

environment especially from departments dealing with development;

Action plan must address the environment concerns.

How to improve long-life learning in environmental health?

Seminar Report


Table 4.3 Issues and Challenges on Correcting

ISSUES CHALLENGES

Standard are not properly interpreted to local needs.

To develop Malaysia’s standards for all aspects of environment.

Correction & rehabilitation of environmental problems is very costly (financial & technical expertise).

To apply Integrated management systems e.g. IWRM/IRBM/ICZM. However, the Integrated management systems are very expensive to implement, highly technical & need support from all stakeholders. Need subsidy e.g Malaysia Organic Scheme – to identify as organics farmer.

Monitoring & surveillances systems are weak

Need for additional manpower with proper training. How to make the polluters responsible – self regulated? Enforcement of Polluters Pay Principle.

Seminar Report


Table 4.4 Issues and Challenges on Controlling

ISSUES CHALLENGES

Environmental programme is not economic.

Industries must be self regulated. There must be a self-monitoring system.

No policy on environmental Health. Environmental Health policy needs to be developed; which defines strategies & action plans.

Issues in term of Law and Enforcement:

Must have the EIA and EHIA before starting a development project;

Must have subsidy to reduce cost;

Must have an incentive and recognition on environmental contribution;

Having a guideline but doesn't use it or using it only when there is an enforcement agency;

Front liners take the water sample then DOE do the action;

The right channel to open he issues – HOTLINE or through Karam Singh Walia / TV3;

Amendment of the law.

Politician must cooperate to take actions; Everything must be transparent.

Monitoring & surveillance systems are weak e.g. misleading labeling of food & drug products.

To have optimum manpower with proper training; How to make the polluters to be responsible – self regulated? Polluters Pay Principle.

Product is not presented to consumer in a transparent, honest, truthful manner.

Accountability problem; Standard of labeling, ISO 14001.

Seminar Report


Table 4.5 Issues and Challenges on Prevention

ISSUES CHALLENGES

Lack of a formal or dedicated hannel to voice out concerns

Hotline for the public. Who is responsible?

Planning of development not taking into account environmental issues sufficiently, e.g. Development along the river is not in balance with the capacity of the river; Must have an eco balance and changes of evidence.

Informed managers/ decision makers e.g. Determine the assimilative capacity of the river

Knowledge & attitude of public / decision makers towards environmental health issues is low.

Early exposure on healthy environment e.g. early education from primary level will lead to good practices; Continues campaign & awareness road shows; How to change third class mind towards first class mind?

Lack of indicators for environmental health

Need to develop relevant environmental health indicators to complement sustainable development indicators.

Group 2 concluded that environmental health issues are very complex and it requires the following actions:

Greater intersectoral participation; Changing of mind set; Public accountability; Transparency of issues on the gourd; Full utilization of all resources; and Clear policy to formulate NEHAP.

The presentation slides of group 2 on “Issues and Challenges of Environmental Health in Malaysia” are as follow:-

Seminar Report


GROUP 2ISSUES AND CHALLENGES IN ENVIRONMENTAL HEALTH IN

MALAYSIA1ST MALAYSIAN NEHAP SEMINAR 2007

12-13 DECEMBER 2007PUTRAJAYA INTERNATIONAL CONVENTION CENTRE (PICC)

LIST OF MEMBERS

1. FACILITATOR : DR. RAHMAH ELFITHRI (LESTARI, UKM)

2. CHAIRMAN : ENCIK ZAMAN HURI (KKM)

3. PRESENTER : DR. HAJAH SADIAH ABDULLAH (MBPJ)

4. SECRETARY : MUSLIMAH MOHD NOR (LESTARI, UKM)

5. NOORHAYATI KASSIM (BHG. PENDIDIKAN KESIHATAN)

6. DR. FAUZIAH NORDIN (JBT. KESIHATAN NEGERI PERAK)

7. SALINA HASHIM (JBT. KESIHATAN NEGERI PERAK)

8. WAN MOHD. ZAMRI B. WAN NAWANG (LUAS)

9. ABD. RASHID ABD RAHMAN (IWK SDN BHD)

10. FARIDAH AHMAD (JABATAN PERTANIAN)

11. SAWAL YAMON (PUNCAK NIAGA SDN BHD)

12. NOR ATIZA MOHAMED AKIL (PUNCAK NIAGA SDN BHD)

13. SASITHERAN K. (KKM)14. MAT RUZMI 15. YUZAINI YUSOF (NIOSH)16. DR. SILVERRAJI SAMIVELOO (JBT.

KIMIA )17. T. PONNA (DBKL)18. HANIFAR SULAIMAN (KKM)19. NURLAILAH ABDILLAH (NAHRIM)20. TAN TEOW SOON (NAHRIM)21. SHAHSIAH ABD CEDRIK (JPSM)22. DR. SUMITRA SAHAMPARAM (IMR)23. NORHAFIZAN DAUD (KKM)24. JAILAN SIMON (JMM)

GROUP 2 PRESENTATION SLIDES ON ISSUES AND CHALLENGES OF ENVIRONMENTAL HEALTH IN MALAYSIA

Seminar Report


INTRODUCTION

ENVIRONMENTAL HEALTH IS THE SCIENCE OF PROTECTING HUMAN HEALTH FROM THE DAMAGING EFFECTS OF PHYSICAL, CHEMICAL AND BIOLOGICAL AGENTS IN THE ENVIRONMENT.ENVIRONMENTAL HEALTH COMBINES DISCIPLINES IN ENVIRONMENTAL SCIENCES AND HEALTH SCIENCE TOGETHER WITH MANAGEMENT SCIENCES TO CREATE A HEALTHY ENVIROMENT.

DEFINITION

“WORLD HEALTH ORGANIZATION (WHO) (DRAFT DEFINITION DEVELOPED AT A WHO CONSULTATION IN SOFIA, BULGARIA, 1993)Environment health comprises of those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social and psychosocial factors in the environment. It also refers to the theory and practice of accessing, correcting, controlling and preventing those factors in the environment that potentially affect adversely the health of present and future generations.

Seminar Report


ISSUES AND CHALLENGES

TransparencyChange of attitudes – paradigm shift

Lack of political will – must have a strong political will;Public accountability is poor among decision makers;

How to tackle the politicians / leaders / decision makers?How to make them more accountable?

Lack of understanding among the decision maker/ politicians about issues on the ground

Clear channel of communication & coordination of activities

Segmented organization lead to segmented thinking, goals, etc. Too many agencies –overlapping of functions.

Do we need council/committee/org to coordinate?

There is no specific agency/organisation to be responsible

How to make environmental issues as a NO. 1 priority of Malaysians?

There is no clear policy on environmental health issues

CHALLENGESISSUESASSESSING

ENVIRONMENTAL HEALTH

HEALTHY HUMAN HOST (AGE, SEX, ETHNICITY, GENETIC, IMUNITY)

UNHEALTHY HUMAN HOST

ACUTE HEALTH EFFECTS

(EG. COMMUNICABLE DISEASES)

CHRONIC HEALTH EFFECTS(EG. NONCOMMUNICABLE

DISEASES)

ENVIRONMENTAL STRESSORS•PHYSICAL (AIR, WATER, FOOD, SOIL AND FOMITES)•CHEMICAL (HEAVY METAL, CARCINOGENS)•BIOLOGICAL (INSECT, VIRUSES, BACTERIAS, )•SOCIAL (HABIT, LIFE SYTLE)•PHYSOSOCIAL (URBANIZATION, MIGRATION)

Seminar Report



Be more proactive. Must identify issues early/precautionary issues;Need to establish early warning system.

Slow in action. Sikap wait & see, sikap ‘ tak apa’

One information hub for the gathering & disseminating information with regards to environment health issues.

Information of source of population not shared. Red tape, bureaucracy.

EDUCATION AND AWARENESSLack of understanding on Environmental Health;Lack of education;Problems of the public attitude or apathy;Accountability;Prevention to lack of education – start from pre-

school;There’s no background of environment especially

from Development Department;Action plan must take the environment concern.

CHALLENGESISSUESASSESSING

To apply Integrated management systems e.g. IWRM/IRBM/ICZM.However, the Integrated management systems are very expensive to implement, highly technical & need support from all stakeholders.Need subsidy e.g Malaysia Organic Scheme –to identify as organics farmer.

Correction & rehabilitation of environmental problems is very costly (financial & technical expertise).

To develop Malaysian’s standard for all aspects of environment.

The standard is not properly interpreted to local needs.

CHALLENGESISSUES

Manpower, proper trainingHow to make the polluters to be responsible –self regulated?Polluters Pay Principle.

Monitoring & surveillances systems weak

ISSUES AND CHALLENGESCORRECTING

Seminar Report


Environmental Health policy need to be developed which define strategy & action plans.

No policy on environmental Health.

Industry must self regulated/self-monitoring system.

Environmental program is not economic.

The politician must cooperate together to take the actions;Everything must be transparency.

LAW AND ENFORCEMENTMust have the EIA and EHIA before start the

project;Must have subsidy to reduce cost;Must have an incentive and recognition;Have a guideline but doesn't use it only when

have an enforcement agency;First line take the water sample then DOE do

the action;The right channel to open he issues –

HOTLINE or through Karam Singh Walia / TV3;Amend of law.

CHALLENGESISSUES

ISSUES AND CHALLENGESCONTROLLING

Accountability problem;Standard of labeling, ISO 14001.

Product is not presented to consumer in a transparent, honest, truthful manner.

CHALLENGESISSUESManpower, proper training;How to make the polluters to be responsible –self regulated?Polluters Pay Principle.

Monitoring & surveillances systems weak e.g misleading labeling of food & drug products.

CONTROLLING


Seminar Report


CONCLUSION

ENVIRONMENTAL ISSUES ARE VERY COMPLEX ISSUES, REQUIRE GREATER

INTER-SECTORAL PARTICIPATION, CHANGING MINDSET, PUBLIC

ACCOUNTABILITY, TRANSPARANCY OF ISSUES ON THE GROUND & FULL

UTILIZATION OF ALL RESOURCES.

Hotline for publicWho’s responsible?

Channel to voice out

Need to develop relevant environmental health indicators to complement sustainable development indicator.

Lack of indicator for environmental health

Early exposure on healthy environment e.g. early education from primary level will lead to good practices.Continues campaign & awareness road showChange minda kelas ketiga towards minda kelas pertama

Knowledge & attitude of public / decision makers towards environmental health issues

Informed managers/ decision makers e.g. Determine the assimilative capacity of the river

Planning of development not taking into account environmental issues, E.g. Development along the river is not in balance with the capacity of the river;Must have an eco balance and changes of evidence.

CHALLENGESISSUES

ISSUES AND CHALLENGESPREVENTION

Seminar Report


THANK YOU

Seminar Report


5. SEMINAR DISCUSSION The knowledge gaps and issues discussed during the various sessions were highlighted below by participants of the seminar who raised questions which were answered by the respective presenters or contributed by other participants. Prof. Dr. Zalina Hashim (UPM) asked about the environmental health survey that was conducted among stakeholders that are related to environmental health, i.e. whether it had included university representatives. According to her it is important to include the universities, because the university is an important institution, since universities such as UPM conduct many programmes on EH. For example UKM has a programme on environmental science and environmental management; UPM’s programme on EH/environmental science, and others. Mind sets of the people can be changed through environmental courses in the university. Academicians too (including teachers) can contribute to NEHAP. Datin Paduka Dr. Halimaton Saadiah Hashim (LESTARI, UKM) explained that at the beginning of the survey preparation process, the project team wanted to include universities in the workshops, but because of logistic reasons the project team only included UKM for the survey but invited the other public universities to this seminar. She agreed that universities should play active roles in the preparation of NEHAP. Prof. Madya Dr. Joy J. Pereira (LESTARI, UKM) noted that there were different views between Groups 1 & 2. Group 1 wanted to relate NEHAP to the present environment policy, but Group 2 requested that there should be a new policy for NEHAP. Dr. Sadiah Abdullah (MBPJ) highlighted that some diseases are caused by environmental influence while some are chronic diseases. Therefore there can be one policy that is more specific i.e. there is a need for a new policy for EH and NEHAP. Dr. Lokman Hakim Sulaiman (IMR, MOH) was of the view that NEHAP should be in line with the environment policy. The existing environment policy does not express explicitly EH and the need for NEHAP, and therefore should be amended to be in line with the need for NEHAP. The scope that was discussed is more to the scope of EH, but to define it with more details. Both addressed the same things, but are lacking on the specific action plan and effects on EH and human. NEHAP is an extension of the Environment policy. However in environment policy there is no explicit explanation on EH. Y.M. Engku Azman Tuan Mat (MOH) added that NEHAP is an Action Plan. In the formulation of NEHAP one has to be clear that NEHAP is prepared based on which policy. There is a need for a policy to be followed by NEHAP. We can use

Seminar Report


the present policy, but it will take a longer time to prepare NEHAP. DOE’s policy is to achieve safe, healthy and productive environment for future generations. The possibility of adding EH and NEHAP to the draft policy on health must be explored, or even a new policy on EH and NEHAP. Dr. Lokman Hakim Sulaiman (IMR) stressed about the indicators to be clearer and we have to look at other aspects. We need to look at action plans. Issues on EH should be highlighted in the process to be managed. Y.M. Engku Azman Tuan Mat (MOH) added that the development of indicators are very costly, and it is not so clear. There are other indicators that need to be selected carefully. Work on this has been done, but what have we achieved? What have we done - is it effective or not? What is the impact on EH? Prof. Dr. Zalina Hashim (UPM) mentioned that everybody think that they are ‘EH people’. For a long-term action plan, we have to change the mindset of everybody, where everybody plays important roles in EH at the primary level, secondary level and university level. The first world people look at the developing countries negatively, but why should the first world people blame the developing countries? The healthy environment should start from education at the early level. There is a need to prepare a list of courses that should be taken, list of faculties, etc to make people aware of the environment and to be more sensitive to the environment. So we have to change the mindset in decision-making. Education plays a vital role so we have to educate the public. Danny Wee (MAEH) commented on the big world of EH, where every body are very concerned about the environment even though they do not know what is EH but they do know what are the effects on health and environment. Every field is the environment and we are researchers. NEHAP must have a platform and the government has to support it. NEHAP needs the political will. There are a lot of efforts that have been made and need to be included in NEHAP. This seminar is a good platform for NEHAP since it has the concern on EH and is of concern to MOH. NEHAP is very important to the Malaysian environment. Y.M. Engku Azman Tuan Mat (MOH) added that education is important. Political will of leaders are also important and normally they can accept it. We do not have to create something new. We have made a move towards EH. What we have done is in the correct way. Let us have a platform for common goals. We are doing a good move towards NEHAP. We can discuss in a good manner to create a good platform where everybody/stakeholders are involved. Prof. Dr. Zalina Hashim (UPM) added we want to get a good platform through Islam Hadhari where one of the aspects of concern is the environment.

Seminar Report


Y.M. Engku Azman Tuan Mat (MOH) further added that Islam Hadhari was there, besides Malaysian vision 2020 that already mentioned environmental health concerns.

Seminar Report


6. CONCLUSION The 1st Malaysian NEHAP seminar has successfully brought together various stakeholders from various sectors and levels. Issues in Environmental Health have been prioritized and addressed, and need to be included in the Malaysian NEHAP. Issues and challenges have also been identified and classified. For NEHAP to be implemented, it requires greater intersectoral participation, changing of mind sets, public accountability, and transparency of issues on the ground and optimum utilization of all resources. It is recognized that there is still no clear policy to formulate NEHAP in Malaysia. There is a need for future NEHAP seminar to provide more information and knowledge on EH and NEHAP in order to attract more stakeholders to be involved in the seminar and NEHAP process. This will improve the level of awareness and country wide adoption of NEHAP in Malaysia. As a conclusion, all participants of the seminar agreed to the following: 1. Malaysian NEHAP should be prepared immediately; 2. A programme on NEHAP has to be developed and approved by the MOH to

to bring it to the next level; 3. Support from the government and all related stakeholders are very important; 4. NEHAP can be used as an indicator for efficiency and effectiveness of the

government in dealing with health issues; and 5. NEHAP can also be used as one of the reasons or pressures to strengthen

institutional capacities, e.g. number of DOE officers is not enough, so NEHAP can be used as a platform to inform the government that it needs more people.

APPENDIX 1

LIST OF PARTICIPANTS

Seminar Report

1st Malaysian NEHAP Seminar: 12-13 Dec 2007 45

Appendix 1 - List of Participants

MINISTRY OF HEALTH MALAYSIA (ENGINEERING SERVICES DIVISION)

AND INSTITUTE FOR ENVIRONMENT AND DEVELOPMENT (LESTARI)

UNIVERSITI KEBANGSAAN MALAYSIA

1ST MALAYSIAN NEHAP SEMINAR 12-13 December 2007

PICC, Putrajaya

LIST OF PARTICIPANTS

Bil Nama Jabatan No. Telefon E-mail 1. Noraziah Jaafar Department of Environment

(DOE) 03-88712319 [email protected]

2. Lili Suhana Adnan Department of Environment (DOE)

03-88712290 [email protected]

3. Grace P. Emang Department of Environment (DOE)


4. Mohd Rosiskada Mohamed Department of Environment (DOE)


5. Hj. Ismail Ahmad Department of Irrigation and Drainage (DID)


6. Dr. B. Jagden Singh Malaysia Medical Assocation (MMA)


7. Danny Wee Malaysian Association of Environmental Health (MAEH)


Seminar Report


8. Dr. Sumitra Sitamparam Institute for Medical Research (IMR)


9. Dr. Lokman Hakim Sulaiman

Institute for Medical Research (IMR)

10. T. Ponna Dewan Bandaraya Kuala Lumpur (DBKL)


11. Mohd Nor Khairo Eruan Nor Department of Water Supply, Ministry of Energy, Water and Communication (MEWC)


12. Abd Kadir Hashim Wildlife Protection and National Parks Department (PERHILITAN)


13. Haw Ai Beng Office of the Deputy Director General of Health, MOH


14. Hj Rosnani Abd Hamid Office of the Deputy Director General of Health, MOH


15. Noorhayati Kassim Health Education Division, MOH


16. Hanif Sulaiman Food Safety and Quality Division, MOH


17. Norhafizan Daud Engineering Services Division, MOH


18. Zulkefli Hussain

Engineering Services Division, MOH

03-88832265

19. Zaman Huri Engineering Services Division, MOH

20. Mariah Hassan Engineering Services Division, MOH

21. Sasitheran K. Noor Ministry of Health (MOH) Malaysia


Seminar Report


22. Mat Rusni Bin Hasan Health Department, Selangor State

03-51237333

23. Hj. Mohd Rozdi B. Hj. Mohammad

Health Department, Selangor State

03-51237333

24. Salina Hashim Health Department, Perak State


25. Dr. Fauziah Nordin Health Department, Perak State


26. Shahrul Afzan Daud Health Office, Kinta, Perak 012-5277917 27. Ibrahim Mohd Desa Health Office, Kinta, Perak 017-5915334 28. Dr. Silverraji. S Department of Chemistry

(DOC) Malaysia 03-79853154 [email protected]

29. Noor Helmi B. Noordin

Department of Survey and Mapping (DSM) Malaysia


30. Abd Kadir Ishak Malaysian Nuclear Agency (MNA)

019-2249733 abdkadir@nuclearmalaysia

31. Nurlailah Abdillah National Hydraulic Research Institute Malaysia (NAHRIM)


32. Tan Teow Soon National Hydraulic Research Institute Malaysia (NAHRIM)

33. Yuzainie Yusof National Institute for Occupational Safety and Health (NIOSH)


34. Hafizah Hasan National Solid Waste Management Department, Ministry of Housing And Local Government (MHLG)


35. Abd Rashid Abd Rahman Indah Water Konsortium (IWK) Sdn Bhd


Seminar Report


36. Sawal Yamon Puncak Niaga Sdn. Bhd. (PNSB)

03-32792008

37. Nor Atiza Mohamed Akil Puncak Niaga Sdn. Bhd. (PNSB)


38. Azila Azhar Puncak Niaga Sdn. Bhd. (PNSB)


39. Dr. Ramizu Abd Rahim Alam Flora Sdn. Bhd. (AFSB) 019-3162000 [email protected] 40. Jailan Simon Malaysian Meteorological

Services (MMS) 03-79678162 [email protected]

41. Zainal Abidin B. Hashim Atomic Energy Licensing Board (AELB)


42. Faridah Hj Ahmad Department of Agriculture (DOA)


43. Wan Mohd Zamri Wan Nawang

Lembaga Urus Air Selangor (LUAS) / Selangor Waters Management Authority (SWMA)


44. Ahmad Rozian Sewerage Services Department (SSD)

45. Shashiah Abd. Karim Forestry Department of Peninsular Malaysia (JPSM)

013-3263926

46. Esther Ong Third World Network 03-23002585 [email protected] 47. Dr. Sadiah Abdullah Majlis Bandaraya Petaling Jaya

(MBPJ) 019-2121560 [email protected]

48. Joseph Leong Sime Darby Sdn. Bhd. 019-3503009 [email protected] 49. Prof. Dr. Zalina Hashim Department of Community

Health, Faculty of Health Science Management (FPSK), Universiti Putra Malaysia (UPM)

03-89472406 zalina @medic.upm.edu.my

Seminar Report


50. Prof. Agamuthu Department of Chemistry, Universiti Malaya (UM)


51. Dr. Jamal Hisham Hashim Faculty of Allied Health Sciences, UKM


52. Mohd Rafee B. Baharudin Universiti Kebangsaan Malaysia (UKM)


53. Mohamad Azhar B. Mohd Noor

Universiti Kebangsaan Malaysia (UKM)


Committee Members (MOH) 55. Y.M. Engku Azman Tuan

Mat Engineering Services Division, Ministry of Health (MOH)

03-88832222

56. Mohd Zaharon Mohd Talha Engineering Services Division, Ministry of Health (MOH)


57. Yazid Kuman Engineering Services Division, Ministry of Health (MOH)

03-88832254

Committee Members (LESTARI) 58. Datin Paduka Dr. Halimaton

Saadiah Hashim Institute for Environment and Development (LESTARI), UKM

03-8921 4513 [email protected] [email protected]

59. Dr. Rahmah Elfithri Institute for Environment and Development (LESTARI), UKM

03-8921 4152 [email protected]

60. Siti Norliyana Hassan Institute for Environment and Development (LESTARI), UKM


61. Nurul Akmar Rasli Institute for Environment and Development (LESTARI), UKM


62. Muslimah Mohd Nor Institute for Environment and Development (LESTARI), UKM


63. Norazmi Abdul Kadir Institute for Environment and Development (LESTARI), UKM

03-8921 4149

Seminar Report


Expert Groups (UKM)

64. Assoc. Prof. Dr. Joy J. Pereira

Institute for Environment and Development (LESTARI), UKM


65. Dr. Mazrura Sahani Faculty of Allied Health Sciences, UKM


66. Assoc. Prof. Dr. Abdul Hamid Jaafar

Institute for Environment and Development (LESTARI), UKM


APPENDIX 2

PAPER PRESENTATIONS

Seminar Report


Appendix 2 – Paper Presentations

Presentation 1 - ENVIRONMENTAL HEALTH CONCERN IN MALAYSIA by Prof. Dr. Jamal Hisham Hashim (Faculty of Medicine, UKM)

Environment and Health : Environment and Health : In the Context of a National In the Context of a National

Environmental Health Action Plan Environmental Health Action Plan

Jamal Hisham Hashim, PhDProfessor of Environmental HealthDepartment of Community Health

Faculty of MedicineUniversiti Kebangsaan Malaysia

Outline of TalkOutline of Talk• Definition of health and environmental health.• WHO scope of environmental health.• Environmental health hazards and their transmission.• WHO report on environmental risk factors and diseases.

• What is NEHAP.• Features of NEHAP.

Seminar Report


Definition of HealthDefinition of Health• Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

• The enjoyment of the highest attainable standard

of health is one of the fundamental rights of every

human being, without distinction of race, religion,

political belief, economic or social condition.Based on the Constitution of WHO, 1948.

Definition of Environmental HealthDefinition of Environmental HealthEnvironmental health comprises those aspects of human health, including quality of life, that are determined by physical, biological, social and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling and preventing those factors in the environment that can potentially affect adversely the health of present and future generations. (WHO, 1993).

Seminar Report


1. Water supply, with special reference to the provision of adequate quantities of safe drinking water that are readily accessible to the user, giving dueconsideration to other essential uses of water resources.

2. Wastewater treatment and water pollution control including domestic sewage, and the control of the quality of surface and ground water.

3. Solid waste management, including sanitary handling and disposal.4. Vector control, including the control of arthropods, molluscs, rodents, and

other alternative hosts of disease.5. Food hygiene, including milk hygiene.6. Sanitation measures associated with epidemics, emergencies, disasters,

and migrations of populations.7. Prevention or control of soil pollution by human excreta and by

substances detrimental to human, animal or plant life.

The World Health Organization (1970) proposed that the scope of Environmental Health should include or relate to the following :

Seminar Report


Squatter area and river pollution

Thermal fogging of a Dengue case’s home by a MOH personnel.

Seminar Report


Illegal solid waste dumping near Chemor, Perak

8. Control of air pollution.9. Control of noise control.10. Environmental health aspects of air, sea, or land transport.11. Radiation control.12. Accident prevention.13. Housing and its immediate environment, in particular the public health

aspects of residential, public, and institutional buildings14. Urban and regional planning.15. Public recreation and tourism, in particular the environmental health aspects

of public beaches, swimming pools, camping sites, etc.16. Occupational health, in particular the control of physical, chemical,

and biological hazards.17. Preventive measures required to ensure that the general environment

is free from risk to health.

The World Health Organization (1970) proposed that the scope of Environmental Health should include or relate to the following :

Seminar Report


Air pollution from a coal-fired power plant.

Seminar Report


PLANE CRASH IN MEDAN, INDONESIA

Seminar Report


Environmental Health HazardsEnvironmental Health Hazards• Microbiological, chemical and physical contaminants in drinking waterand foods.

• Microbiological agents, particulates, gaseous pollutants and allergens in indoor air of residential and work environments and in ambient air.

• Vectorborne and zoonotic disease agents.• Solid and liquid wastes, hazardous wastes and soil pollutants.• Accidents due to natural disasters, transportation, recreational, home and work environments.

• Noise, heat, ionizing and non-ionizing radiation from residential and work environments.

Seminar Report


AGENT RESERVOIR *(EG. ANIMALS, HUMANS& POLLUTANT SOURCES)

MODE OF RELEASE * (EG. INSECT BITES, FECES, INDUSTRIAL EFFLUENTS & EMISSIONS)

AGENT *(BIOLOGICAL, CHEMICAL &

PHYSICAL)

VECTORBORNE *(EG. MOSQUITOES,

FLIES & FLEAS)

VEHICLE-TRANSMITTED *(EG. AIR, WATER, FOOD,

SOIL & FOMITES)

DIRECT CONTACT(EG. VENEREAL & SKIN DISEASES)

MODES OF AGENT TRANSMISSION

HEALTHY HUMAN HOST *

INTRINSIC FACTORS(EG. AGE, SEX,

ETHNICITY, GENETIC & IMMUNITY)

EXTRINSIC FACTORS *(EG. PERSONAL HYGIENE, HABIT,

NUTRITION & OCCUPATION)

MODE OF ENTRY(EG. INHALATION, INGESTION, SKIN

ABSORPTION & INSECT BITES)

UNHEALTHY HUMAN HOST

ACUTE HEALTH EFFECTS

(EG. COMMUNICABLE DISEASES)

CHRONIC HEALTH EFFECTS(EG. NONCOMMUNICABLE DISEASES)

HAZARD TRANSMISSION IN ENVIRONMENTAL HEALTH

* CRITICAL POINTS OF ENVIRONMENTAL HEALTH STRATEGIES Source : Jamal H.H. & Zailina H. (2004)

Environment and HealthEnvironment and Health• The World Health Organisation (WHO) conducted a systematic literature review and consulted 100 experts worldwide for their estimates of how much environmental risk factors contribute tothe disease burden of 85 diseases.

• Environmental risk factors play a role in more than 85 (80%) of the 102 major diseases reported in the World Health Report, 2004 by WHO.

• Globally, 24% of the global disease burden (healthy life years lost) and 23% of all deaths (premature mortality) were attributable to environmental factors.

• In children (below 15 years old), environmental risk factors can account for 36% of all deaths.

Seminar Report


Source : WHO. 2006. Preventing diseases through healthy environments. Geneva : WHO Press.

Seminar Report


1.4 x 10-8Lifetime acceptable risk level of 10-6

8.9 x 10-7Struck by falling objects

1.0 x 10-6DOE’s tolerable risk limit for fatal accident among public

1.7 x 10-6Natural disasters

2.1 x 10-6Railway accidents

2.1 x 10-6Dengue Fever

4.0 x 10-6Accidents due to firearms and explosive

4.2 x 10-6Accidental poisoning

7.1 x 10-6Fires and flames

9.0 x 10-6Homicide

1.0 x 10-5DOE’s tolerable risk limit for fatal accident among workers

1.3 x 10-5Suicide

1.9 x 10-5Asthma

2.0 x 10-5Falls

2.5 x 10-5Drowning

3.6 x 10-5Liver disease

4.6 x 10-5Chronic obstructive pulmonary disease

4.8 x 10-5Kidney disease

8.7 x 10-5Pneumonia

1.7 x 10-4Motor vehicle accidents

2.2 x 10-4Cancers

5.7 x 10-4Cardiovascular disease

Individual riskCause of mortality

Relationship Between Particulate Matter and Asthmatic Attack

Relationship between asthmatic attack and PM10 among children in Klang Valley

( Sep. 1-Dec 31, 1994)

y = 0.2x - 3.34R2 = 0.54

0

10

20

30

40

50

60

70

80

0 50 10 0 150 200 250 300PM10 concentration (ug/m3)

Inci

denc

e of

atta

ck (

%)

Source : Zailina H. et. al, 1997

% asthmatic attacks = -10.67 + 0.21 (PM10inμg/m3) + 0.06 (NO2 in ppm) + 0.71 (SO2 in ppm)

Seminar Report




Seminar Report


Lead fumes from a soldering process in an electronic factory.

Infant blood lead (ug/dL)

1086420

Psyc

omot

or D

evel

opm

ent I

ndex

(PD

I)

160

140

120

100

80

60 Rsq = 0.6779

Source : Shamsul B.S. (2003)

Seminar Report




Seminar Report


Important Findings Important Findings • Heading the list of diseases impacted by environmental risks are diarrhoea (90%) lower respiratory infection (20-42%), unintentional injuries (44%), malaria (42%), road traffic injuries (40%) andchronic obstructive pulmonary disease (COPD) (42%).

• Diarrhoeal diseases associated with a lack of access to safe drinking water and inadequate sanitation result in nearly 1.7 million deaths annually.

• Household use of biomass fuels and coal by over half of the world’s population, results in 1.5 million deaths a year from pollution-related respiratory diseases.

Seminar Report


Important Findings Important Findings • Deaths from environmentally-mediated diseases is much higher in the developing (25%) than in the developed world (17%).

• However, for certain non-communicable diseases such as cardiovascular diseases (7 times) and cancers (4 times), the disease burden is higher in the developed countries.

• 4 million children worldwide die from environmentally-caused deaths yearly, mostly in developing countries.

• Infant death rate from environmental causes is 12 times higher in developing than in developed countries.

• In developing countries, diarrhoea, respiratory infections and malaria alone account for 26% of all deaths among children under 5 years old.

What is a NEHAPWhat is a NEHAP• NEHAP is a government documents that addresses environmental

health problems and solutions in a comprehensive, holistic and

intersectoral way.

• It is usually drawn up in cooperation with a wide range of partners,

including professional and technical experts, national, regional and

local authorities and non-governmental organizations.

• It is usually integrated into the national policies and development

plans, encompassing both public and private initiatives.

• It should spell out action plans to address key environmental health

issues and suggest key performance indicators to assess progress.

Seminar Report


Features of a NEHAPFeatures of a NEHAP• The plan must spell out what environmental improvements

should be made and who should be responsible for them.

• It should contains specific actions for improving

environmental health in the nation, which should form a

check list against which progress in improving environmental

health can be measured.

• Progress of the Plan should be reviewed from time to time.

• Extent to which the actions set out in the plan have been

completed should be reported.

References• Jamal H.H., Pillay M.S., Zailina H., Shamsul B.S., Sinha K., Zaman Huri Z., Khew S.L.,

Mazrura S., Ambu S., Rahimah A. and Ruzita M.S. 2004. A Study of Health Impact & Risk Assessment of Urban Air Pollution in Klang Valley, Malaysia. Kuala Lumpur : UKM Pakarunding Sdn Bhd.

• Jamal H.H. and Zailina H. 2004. Assessing cancer risks from chemical carcinogens. Environmental Health Focus, 2(2): 11-20.

• Niza S. and Jamal H.H. 2007. Carbon monoxide assessment among toll operators in KlangValley, Kuala Lumpur, Malaysia. International Journal of Environmental Health Research, 17(2): 95-103.

• Shamsul B.S. 2003. Blood lead among pregnant women and its implications on maternal and child health. PhD thesis, UKM.

• World Health Organisation. 2006. Preventing diseases through healthy environments. Geneva: WHO Press.

• Weili L., Zhang J., Jamal H.H., Juliana J., Zailina H. and Goldstein B.D. 2003. Mosquito coil emissions and health implications. Environmental Health Perspectives, 111(12): 1454-1460.

• Zailina H., Juliana J., Norzila M.Z., Azizi, H.O. and Jamal H.H. 1997. The relationship between Kuala Lumpur haze and asthmatic attacks in children. Malaysian J. Child Health, 9 (2): 151-159.

Seminar Report


Presentation 2 - NEHAP PROGRAMMES WORLD WIDE EXPERIENCES by Dr. Mazrura Sahani (Faculty of Allied Health Sciences, UKM)

NEHAP NEHAP --WORLDWIDE WORLDWIDE EXPERIENCESEXPERIENCES

DR MAZRURA SAHANIDR MAZRURA SAHANI11STST MM’’SIAN NEHAP SEMINARSIAN NEHAP SEMINAR

1212--1313THTH DECEMBER 2007DECEMBER 2007PTCCPTCC

Global Challenges and Framework for Action

•• Environmental risks cause 4.5 million deaths annually Environmental risks cause 4.5 million deaths annually worldwideworldwide

•• Global framework for action to reduce environmental Global framework for action to reduce environmental risks to health provided by:risks to health provided by:

–– Rio DeclarationRio Declaration-- Agenda 21, 1992Agenda 21, 1992• a comprehensive programme of action for national governments

based on the principles of sustainable development (economic development, social development and environmental protection)

–– Millennium Development Goals, 2000Millennium Development Goals, 2000

–– Johannesburg Plan of Implementation, 2002Johannesburg Plan of Implementation, 2002•• World Summit for Sustainable DevelopmentWorld Summit for Sustainable Development

–– Various International ConventionsVarious International Conventions•• related to toxic chemicals, hazardous chemicals, climate related to toxic chemicals, hazardous chemicals, climate

change and biodiversitychange and biodiversity

Seminar Report


Mortality attributable to various environmental risks in the Western Pacific Region

503

373

7731 3

0

100200

300

400500

600

Indoorsmoke fromsolid fuels

Urban airpollution

Unsafewater,

sanitation, &hygiene

Leadexposure

Climatechange

Deat

hs in

100

0

Burden of disease attributable to various environmental risks in the Western Pacific Region

01000200030004000500060007000

Indoorsmoke fromsolid fuels

Unsafewater,

sanitation,& hygiene

Urban airpollution

Leadexposure

ClimatechangeD

isab

ility

-adj

uste

d lif

e ye

ars

in

1000

Seminar Report


Different environmental health Different environmental health risks in different settingsrisks in different settings

• Urban air pollution in rapidly developing and

urbanizing countries

• Unsafe water and poor sanitation in poor rural

and undeserved urban settings

• Indoor smoke from solid fuels in poor rural and

underserved urban settings

WHO Regional StrategyWHO Regional Strategy

•• Strengthen national capacity in environmental health risk Strengthen national capacity in environmental health risk

assessment and managementassessment and management

•• Enhance cooperation between health and environment Enhance cooperation between health and environment

sectors, and their cooperation with other sociosectors, and their cooperation with other socio--economic economic

sectors in solving problemssectors in solving problems

•• Promote interPromote inter--country cooperation in solving common country cooperation in solving common

and and transboundarytransboundary environmental health problemsenvironmental health problems

Seminar Report


WHO Regional InitiativesWHO Regional Initiatives

•• First HighFirst High--Level Meeting on Health and Environment in ASEAN and East Level Meeting on Health and Environment in ASEAN and East Asian Countries, Nov. 2004Asian Countries, Nov. 2004–– National levelNational level

•• Coordination Mechanism (Technical Working Group)Coordination Mechanism (Technical Working Group)

•• Environmental Health Country Profile (EHCP) and Data SheetEnvironmental Health Country Profile (EHCP) and Data Sheet

•• National Environmental Action Plan (NEHAP)National Environmental Action Plan (NEHAP)

•• Regular National Forum on Environmental Health Regular National Forum on Environmental Health

–– Regional LevelRegional Level

•• Convening of the Regional Forum at ministerial level in 2006Convening of the Regional Forum at ministerial level in 2006

•• Establishment of a task force to prepare for the Regional ForumEstablishment of a task force to prepare for the Regional Forum

–– National actionNational action•• Coordination mechanismCoordination mechanism

–– Existing mechanism (e.g. Philippine Interagency Committee on EnvExisting mechanism (e.g. Philippine Interagency Committee on Environmental ironmental Health)Health)

–– New mechanismNew mechanism

–– National Forum, 2005 and revision of EHCP and development of NEHNational Forum, 2005 and revision of EHCP and development of NEHAPAP

•• Lao PDR (Jul.), Mongolia (Aug.), China (Nov.), Viet Nam (Nov.), Lao PDR (Jul.), Mongolia (Aug.), China (Nov.), Viet Nam (Nov.), Philippines (Nov.), Cambodia (Dec.)Philippines (Nov.), Cambodia (Dec.)

UN Millennium Declaration, 2000UN Millennium Declaration, 2000

“We will spare no effort to free our fellow men, women and children from the abject and dehumanizing conditions of extreme poverty, to which more than a billion of them are currently subjected. We are committed to making the right to development a reality for everyone and to freeing the entire human race from want.”

• This declaration set agenda for the new millennium - to fight against poverty by 2015 and inequalities- outline some values which governments agree the basic principles for international

relations in the twenty first century including freedom, equality, solidarity, tolerance, respect for nature and shared responsibility

• To meet the aims of the declarations, governments signed up the Millennium Development Goals (MDGs)

Seminar Report


MDGs represents a major steps forward in global level frameworks for action

Epidemiological situationEpidemiological situation in Europein Europe

Good news Bad news• improving trend of • premature death highest in

life expectancy at birth since 1996 accession countries • infant mortality decline (10 yrs) • high middle age mortality• external causes of death, • CVD 3 times higher than EU average

suicide (4th place in Europe) • cancer (51. place)• stomach cancer - lung (highest in Europe)• HIV/AIDS low - breast• syphilis, mumps, whooping • diseases of digestive system highest

cough low in accession countries• communicable diseases 0.09 • smoking – highest in accession

countries• alcohol – 9,5l capita• environmental factors

• air, water

Seminar Report


Facilitation of EH policy coordination

• High-level political commitment: co-ordination is expected to be more effective when it is promoted at a high level and concerns all relevant levels of policy-making

• Integrated activities, e.g NEHAP actions are scored according to• 1. importance for the health of the population health• 2. importance for the life environment• 3. importance for social policy• 4. extent of support for international activities and EU accession• 5. feasibility (availability of personnel / specialists, technology,institutions)

NEHAP ProcessNEHAP Process•• Usually a large scale, long termUsually a large scale, long term--projectproject

•• Covers all Covers all deptsdepts related to health and environmentsrelated to health and environments

•• NEHAP process is at different stages in countries NEHAP process is at different stages in countries

thoughtoutthoughtout the worldthe world

•• Most countries in Europe the plan has been prepared, Most countries in Europe the plan has been prepared,

either at the final stage of adoption or has already either at the final stage of adoption or has already

adopted and entered into the implementation phaseadopted and entered into the implementation phase

Seminar Report


NEHAP Experiences in EuropeNEHAP Experiences in Europe

•• Good examples in NEHAP preparationGood examples in NEHAP preparation•• 22ndnd Ministerial Conference in Ministerial Conference in EnvEnv & & HlthHlth , Helsinki 1994 , Helsinki 1994

gave higher priority to the development of NEHAPS gave higher priority to the development of NEHAPS under EHAPEunder EHAPE

•• A National Health Strategy was adopted by the National A National Health Strategy was adopted by the National Assembly in Bulgaria adopted Assembly in Bulgaria adopted

•• NEHAP in UK was published since 1996NEHAP in UK was published since 1996–– Contained overview of the provision of environmental health and Contained overview of the provision of environmental health and

detailed analysis of many factors contributing to it and set updetailed analysis of many factors contributing to it and set up a a plan for improving environmental health in UKplan for improving environmental health in UK

–– UK Sustainable Development Strategy ‘ A Better Quality of Life’ UK Sustainable Development Strategy ‘ A Better Quality of Life’ --1999 encompasses environmental goals alongside a social and 1999 encompasses environmental goals alongside a social and economic agendaeconomic agenda

Belgian NEHAPBelgian NEHAP

Central Government authorities have 3 essential tasks:

1. To improve policy instruments for environment and health

2. To develop strategy for implementing the NEHAP

3. To manage, on a continuing basis, the framework for implementing the NEHAP

Seminar Report


NEHAP in MaltaNEHAP in Malta•• First NEHAP was produced in 1997 to cover the period 1997First NEHAP was produced in 1997 to cover the period 1997--20032003

•• 20022002-- Evaluation of this NEHAPEvaluation of this NEHAP

–– Draft National Environment & Health Action Plan, Malta (2006Draft National Environment & Health Action Plan, Malta (2006--

2010) 2010)

•• to resume new targets and priority actions for the period to resume new targets and priority actions for the period

20062006--20102010

•• These actions are concerned primarily with the protection of These actions are concerned primarily with the protection of

public health through protection of the environment public health through protection of the environment

•• The introduction of childThe introduction of child--specific actionsspecific actions-- ChildrenChildren’’s s

Environment and Health Action Plan for Europe (CEHAPE) Environment and Health Action Plan for Europe (CEHAPE)

••

Seminar Report


Eastern EuropeEastern EuropeAlbania, Bosnia and Herzegovina, Croatia, Former Yugoslav Republic of

Macedonia, Montenegro, Serbia and Kosovo

• Have developed and adopted comprehensive policies and programmes in the environment sector – including National Environmental Action Plans (NEAPs), NEHAPs,

waste, water and wastewater master plans setting road maps for implementation of the EU acquis) and are in the process of setting sustainability objectives at the national level;

• move towards integration of env & SD objectives in the policies of economic sectors eg. energy, tourism, agriculture and transport

Source: UNDP- Env Policy in South Eastern Europe, 2007

Estonian Estonian Health PolicyHealth Policy::• Estonian Health Policy

• Estonian Hospital Master Plan 2015

• National HIV/AIDS Prevention Programme for 2002-2006

• National environmental health action plan of Estonia (NEHAP)

• National Programme of Research and Development in Public Health for the Years 1999–2009

Seminar Report


Palau NEHAPPalau NEHAP• Strategic approaches by various

partnerships in the community• Key areas

– EEnvironmental Health Administration

– CCommunity Environmental Health Development

– CConsumer Safety– VVector Control & Health

Quarantine– EEmerging Issues– HHealth Education &

Promotion– EEnvironmental Health

Information System– EEpidemiology– HHuman Resource

Development

Draft of Thailand’s National Strategic Draft of Thailand’s National Strategic Environmental Health Plan, 2007Environmental Health Plan, 2007

Vision:Vision: “Better environment for a better quality of life” “Better environment for a better quality of life”

Goals:• To manage environmental health systematically

and holistically.• To integrate the implementation from all sectors

of the environment and health.• To build the capacity and partnership of related

sectors.

Seminar Report


Establish National Coordinating CommitteeMay. 2006

1st Meeting of National EH. Coordinating

Committee Jul. 2006

Taskforce NEHAP 1st Draft May. 2007

Stakeholders Review NEHAP 1st

Draft Sep. 2007

Revision of NEHAP 1st Draft Oct. 2007

Stakeholders Review NEHAP 2nd

Draft Nov. 2007

Revision of NEHAP 2nd Draft Nov.

2007

Nat’l EH Policy Implementation

Comm. Dec 2007

Nat’l EH Coordinating

Comm. Jan 2008

Cabinet Approval Feb.2008

Implementation Monitoring Evaluation

THAILAND

LAOSLAOS-- NEHAP ProcessNEHAP Process(August 07)

NEHAP

Ministry of Health

Water Resources Environment Agency:• Department of Environment

• Environment Research Institute

Ministry of Industry and Commerce

Ministry of Construction Transport Post

and Communication

Ministry of Agriculture and forestry

Ministry of EducationMinistry of Information

and Culture

International organizations:WHO, JICA, Aus-Aids,

UNICEF, WSP-EAP

National University

Vientiane Capital

Ministry of Labor and Welfare

Active participation

Conducted 4 meetings

Seminar Report


Presentation 3 - FEDERALIZATION OF SEWERAGE SERVICES IN MALAYSIA by Mr. Ahmad Rozian (Sewerage Services Department, MEWC)

SEWERAGE MANAGEMENT IN

MALAYSIA

1 st MALAYSIAN NEHAP SEMINAR

12 th DECEMEBER 2007

• Sewage – identified as the major source of organic

pollutants in Malaysian rivers.

• Sewerage infrastructure – necessary and form an integral part of

infrastructure development in order to protect its limited water resources, public health and the environment.

Seminar Report


SOURCES OF SEWAGE POLLUTION

• Effluent from public Sewage Treatment

Plants(STP)

Non-Public STP Sources

• Effluent from private STPs

• Effluent from Individual Septic Tanks

• Sullage (from households)

• Discharge of raw sewage(squatters)

• Sewage from primitive systems

• Wet markets/Eateries

Overflow from individual Overflow from individual septic tank to drainsseptic tank to drains

Sources of River PollutionSources of River Pollution

Seminar Report


SullageSullage from houses flows via drains to from houses flows via drains to riversrivers

Sullage Piping

Sources of pollutionSources of pollution

Organic effluent/waste Organic effluent/waste from a market flows from a market flows directly into a monsoon directly into a monsoon drain which leads to the drain which leads to the nearby rivernearby river

Sources of PollutionSources of Pollution

Seminar Report



Industrial Industrial Wastewater Wastewater DischargeDischarge


Effluent from Effluent from

Sewage Treatment Sewage Treatment PlantPlant

Seminar Report


HISTORICAL BACKGROUND

MOST LOCAL AUTHORITIES ORIGINATED AS SANITARY BOARDS (PRESENT 144).

IN 1970, ONLY 3.4% OF POPULATION WITH CENTRAL SYSTEM.

IN 1980’S GOVERNMENT LAUNCHED N.S.D.P. (20 MASTER PLANS COMPLETED).

INABILITY OF EXISTING FINANCING STRUCTURES - MAIN OBSTACLE.

SEWERAGE REMAINED LOW IN GOVERNMENT FUND ALLOCATIONS.

3RD TO 6TH MALAYSIAN PLANS (RM328 MILLION VS. RM 7.8 BILLION).

ONLY 1% OF THE OVER 1 MILLION SEPTIC TANKS DESLUDGED.

80% OF EXISTING PLANTS WERE NOT PERFORMING.

SUB-STANDARD SEWERAGE SYSTEMS IN PLACE.

ENACTMENT OF SSA IN SEPTEMBER 1993 (ACT 508), CREATION OF SSD, DGSS AND IWK.

CONCESSION AGREEMENT SIGNED ON 9 DECEMBER 1993, TAKE OVER IN STAGES.

SCOPE - PLAN, DESIGN, REFURBISH, UPGRADE, CONSTRUCT, OPERATE, MAINTAIN AND COLLECT BILLS.

2 MAIN TYPE OF SERVICES: CONNECTED & SEPTIC TANK.

TARGET : 49 LARGE LAs (85 : 15) 95 SMALLER LAs (30 : 70).

Standard A Standard BParameterAbsolute Design

BOD5 mg/L 20 10 50 20

SS mg/L 50 20 100 40

Absolute Design

Effluent standards

To control the level of pollution in the waterways, 2 effluent standards:

Standard A – for upstream of water catchmentsStandard B – for downstream of water catchments

Effluent standards set as Absolute Standards.

Seminar Report


Current Status of Sewerage Management

The Privatisation

• Gazette date of Sewerage Services Act was in 1993.

• Concession agreement signed with IWK on 9 Dec 1993.

• IWK began it first service on 1st April 1994.

• Wholly-owned by Government since 23 June 2000.

• Operates in 86 Local Authorities out of 98 in Peninsular Malaysia and W.P. Labuan.

Seminar Report


Status of Assets and Coverage as of Nov 2007

11,478Number of Samples / year

3 unitsCentral Laboratory Facilities602 unitsVehicles (tankers,lorries,vans)

2,637 StaffStaffing

Current Status

Resource/Coverage

17,018 kmLength of Sewers639 unitsNo of Pump Stations

No of Sewage Treatment Plants

Sewerage Assets

8,666 units

17 unitsNumber of Unit Offices2.8 millionNumber of Customers

Number of Local Authorities 86

Distribution of sewerage systems

IST23.4%

Public Plants (IWK)67.70%

Private plants/ primitive

8.90%

Seminar Report


Profile of Sewerage AssetsTotal Population Equivalent Served by IWK is 15 million

Total Sewerage Asset Value is Approximately RM 10 billion

Communal Septic Tanks & Imhoff Tanks

4,400 no.

Oxidation Pond / Marine Outfall

443 no.

Mechanical plants

3,669 no.

Aerated Lagoon

154 no.

Pipe Network

17,018 km

Pump Stations

639 no.

Individual Septic Tanks

Approx. 1 million IST35% Scheduled Desludging

COMMUNAL SEPTIC TANK (CST)

Seminar Report


IMHOFF TANK (IT)

OXIDATION POND (OP)

Seminar Report


AERATED LAGOON (AL)

EXTENDED AERATION (EA)

Seminar Report


CONVENTIONAL ACTIVATED SLUDGE (CAS)

Sewerage Management is Required for Protection of :

Public Health Protect Water Resources

Environment

Immediate Focus for Next Three Decades is on River Pollution and Water Resources

Prio

rity

Leve

ls

Evolution

Publ

ic H

ealth

Prot

ect W

ater

Res

ourc

es

Envi

ronm

ent

Gradual Shift of Priority to Protecting Water Resources and

Environment

Publ

ic H

ealth

Prot

ect W

ater

Res

ourc

es

Envi

ronm

ent

Eventual focus of priority on all 3

aspects

Initial Priority for Public Health

Publ

ic H

ealth

Prot

ect W

ater

R

esou

rces

Envi

ronm

ent

Seminar Report


Sewerage Management Components

Structural Measures Non-structural measures

1. Sewerage Development Plan

• refurbishment• upgrading• sludge facilities• regionalisation• property connection• sullage (grey water) connection• conversion of pour flush

2. Developer investment

1. Operation & Maintenance

2. Desludging Services

3. Training & accreditation

4. Standardisation

5. Education & communications

6. Development Control

The National Sewerage Guidelines

Reference in the provision of Sewerage Facilities in order to

protect Public Health, Preserve the Water Resources and

Enhance Environmental Quality .

Seminar Report


Category 2Plants Constructed From 1 Jan 1999 to Gazette Date

Category 3Plants Constructed Before 1 Jan 1999

Gradual Improvements to Match DOE Discharge Standards

All plants must meet Category 1 Standard by 10 years in Catchment A and 15 Years in Catchment B (except CST and IT)

Category 1 Plants Constructed From New Gazette Date

A gradual implementation of the effluent discharge standards has been agreed with DOE as follows:-

National Sewerage Development Objective

Priority Needs

(2005-2020)

Long TermNeeds

(2021-2035)

Enhance Environmental

Efficiencies through

Regionalisation

To improve asset condition

and meet regulatory Standard

Seminar Report


Immediate Priorities

• Refurbishment to meet DOE requirement.

• Sludge Management Facilities for immediate

needs.

• Land Acquisition for priority projects.

• Development Seed Fund to encourage

regionalisation of priority areas.

SEWERAGE CAPITAL WORKS

GOVERNMENT FUNDED CONCESSIONAIRE FUNDED DEVELOPER FUNDED

Scenario of Current Investment

Major Portion of Sewerage Investment is funded via Private Developers

- Hence there is a need for very close integration of sewerage investment via planning controls

Seminar Report


• Federalisation of Sewerage since 1994 had brought sewerage services in the country to a reasonable level today.

• Further enhancements could be achieved with the implementation of the SDP and SOP, to reach the set sustainable levels nationwide.

• Integration of water and sewerage – the way forward.

Holistic Approach towards Sewerage Management

Water Supply and Sewerage Integration

The water cycle illustrate 2 key common areas i.e.

1. Extraction and Discharge

2. Billing and Customer

THE WATER CYCLE

START

Water Collection

Reservoirs/dam

Water treatment

Service reservoirsDistribution to customers

and wastewater collection

Waste water

treatment

Sludge treatment

Clean water returned to

river

Evaporation from sea

Operations are distinct but integration can create cost rationalization plus economies of scale in financing

Seminar Report


Thank You

Seminar Report


Presentation 4 - ISSUES AND CHALLENGES IN MALAYSIA ENVIRONMENTAL HEALTH

by Datin Paduka Dr. Halimaton Saadiah Hashim (LESTARI, UKM)

Issues and Challenges in Environmental Health in Malaysia

Datin Paduka Dr. Halimaton Saadiah Hashim

Institute for Environment and Development (LESTARI) Universiti Kebangsaan Malaysia (UKM)

2

Presentation outline

1. Some definitions2. Malaysian Quality of Life Report 20043. Issues and Challenges in

Environmental Health in Malaysia –Stakeholders’ Views

4. Observations and concluding remarks

Seminar Report


3

WHO’s definition of ‘health’:“Health is a complete state of physical, mental, and social well-being, not just the absence of infirmity or disease.”

4

World Health Organization (WHO) (draft definition developed at a WHO consultation in Sofia, Bulgaria, 1993)

—Environmental health comprises of those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations.

Seminar Report


5

• From the content of the 28 definitions listed by the United States Department of Health and Human Services in 1998 it is possible to observe some features that are prevalent across the definitions:

• All definitions mention human health, public health, or humans, or similar words.

• In addition to mention of human health, some definitions mention ecologic health or ecological balances.

• A few definitions mention specific environmental stressors, such as physical, chemical, and biologic agents.

6

QUALITY OF LIFE IN PENINSULAR MALAYSIA

For Peninsular Malaysia, the MQLI 2002 was computed using 42 indicators, representing eleven components of life:

1. Income and distribution;2. Working life;3. Transport and communications;4. Health;5. Education;6. Housing;7. Environment;8. Family life;9. Social participation;10. Public safety; and11. Culture and leisure.

Seminar Report


7

Due to data constraints, for the States, the MQLI was computed using only five components:

1. Income and distribution;2. Transport and communications;3. Health;4. Education; and5. Public amenities.

8

Table 1: Components of the Malaysian Quality of Life Index (MQLI) 2002COMPONENTS INDICATORS

Income and distribution

Real per capita incomeGini coefficientIncidence of poverty

Working life Unemployment rateTrade disputesMan days lost due to industrial actionsIndustrial accident rate

Transport and communications

Private motorcars and motocyclesCommercial vehiclesRoad development indexTelephonesInternet subscribersAverage daily newspaper circulation

Seminar Report


9

Health Male life expectancy at birthFemale life expectancy at birthInfant mortality rateDoctor-population ratio

Education Literacy ratePre-school participation rateSecondary school participation rateUniversity participation ratePrimary school teacher-student ratioSecondary school teacher-student ratio

Housing Average price of low-medium-cost houseLow-cost housing unitsHousing units with piped waterHousing units with electricity

10

Environment Air qualityWater qualityForested land

Family life DivorcesCrude birth rateHousehold sizeJuvenile crimes

Social participation Registered votersMembership in registered non-profit organizationsRegistered residents’ associations

Public safety CrimesRoad accidents

Culture leisure Membership in public librariesTelevision viewersDomestic hotel guests

Seminar Report


11

Table 3: Changes in component indices and the MQLI 1990-2002COMPONENTS IMPROVEMENTS/

DETERIORATIONSMQLI

Transport & communications

Increase in registered private and commercial vehicles and better telecommunications.

120.88

Working life Significant reduction in the number of man-days lost due to industrial actions.

107.51

Education Increase in literacy rate, teacher-student ratio and participation rates at pre-school and university levels.

117.35

Housing Significant rise in the % of low-cost housing units to total low-income households, and the % of housing units with access to piped water and electricity.

116.48

Health Improvements in life expectancy at birth, doctor-population ratio and infant mortality rate.

115.84

12

Table 3: Changes in component indices and the MQLI 1990-2002

COMPONENTS IMPROVEMENTS/DETERIORATIONS

MQLI

Transport & communications

Increase in registered private and commercial vehicles and better telecommunications.

120.88

Working life Significant reduction in the number of man-days lost due to industrial actions.

107.51

Education Increase in literacy rate, teacher-student ratio and participation rates at pre-school and university levels.

117.35

Housing Significant rise in the % of low-cost housing units to total low-income households, and the % of housing units with access to piped water and electricity.

116.48

Health Improvements in life expectancy at birth, doctor-population ratio and infant mortality rate.

115.84

Seminar Report


13

Culture and leisure Increase in the number of public library membership and hotel occupancy by domestic travelers.

114.13

Social participation Higher voter registration and larger membership in selected organizations.

107.15

Income and distribution Reduction in incidence of poverty. 107.51

Family life Decline in crude birth rate, household size and divorce rate.

107.15

14

Environment Decline in air quality due to increase in transboundary atmospheric pollution caused by forest fires; decline in water quality as indicated by the increase in % of clean rivers (53% in 1990 to 40% in 2002).

98.22

Public safety Crime rate increased from 3.8% in 1990 to 6.2% in 2002; road accidents per thousand vehicles increased from 19.4% in 1990 to 23.2% in 2002.

80.08

MQLI 109.82

Seminar Report


15

PROCESS OF GETTING STAKEHOLDERS’ VIEWS ON EH

The identification of issues and challenges in environmental health in Malaysia was carried out by getting stakeholders’views on subjects and fields which are either directly or indirectly related to their scope of work. The process of getting stakeholders’ views were through three steps:

Step 1 : Identification of stakeholders;Step 2 : A questionnaire survey of the identified stakeholders;Step 3 : 3 Stakeholders Consultation Workshops; andStep 4 : Interviews of key stakeholders.

16

•Agencies under the Ministry of Health Malaysia;•Agencies under the Ministry of Natural Resources and Environment; and•Government agencies under the social, economic and other fields, private agencies and Non-governmental organizations (NGOs).

Identification of Stakeholders

Seminar Report


17

Key stakeholders in Malaysian environmental health :

1. Bahagian Keselamatan dan Kualiti Makanan, Kementerian Kesihatan Malaysia 2. Bahagian Kawalan Penyakit, Cawangan Penyakit Bawaan Vektor, Kementerian

Kesihatan Malaysia3. Bahagian Kawalan Penyakit, Cawangan Kesihatan Pekerjaan dan Alam Sekitar

(KPAS) , Kementerian Kesihatan Malaysia4. Bahagian Kawalan Penyakit, Cawangan Penyakit Berjangkit, Kementerian Kesihatan

Malaysia5. Pusat Penyelidikan Kesihatan Alam Sekitar, Institut Penyelidikan Perubatan6. Bahagian Perkhidmatan Kejuruteraan, Kementerian Kesihatan Malaysia7. Jabatan Alam Sekitar (JAS), Kementerian Sumber Asli dan Alam Sekitar8. Jabatan Pertanian, Kementerian Sumber Asli dan Alam Sekitar9. Jabatan Keselamatan Pekerjaan dan Kesihatan (DOSH)10. Persatuan Pencinta Alam Malaysia (MNS) 11. SIRIM Berhad 12. Jabatan Kimia Malaysia13. Lembaga Perlesenan Tenaga Atom, Kementerian Sains, Teknologi dan Inovasi14. Jabatan Perkhidmatan Pembetungan15. Jabatan Bekalan Air, Kementerian Tenaga, Air dan Komunikasi Malaysia16. Perbadanan Pengurusan Sisa Pepejal Negara

18

The Stakeholders’ views…

Seminar Report


19

ON PUBLIC HEALTH ISSUES…

Improvement and enforcement of laws, policies, control and effective management of public health;Impact of air, water and noise pollution, including polluted sources of water, and other environmental problems on man;Communication, awareness and public cooperation on improving public health and control of diseases;Traffic accidents, tsunami and other threats that affect public health;Cultural values and consumers education on medicines and chemical-free food;Healthy environment that is guaranteed;Human resource capital (capacity in information, experience and ethics);Use of chemicals in food and impact on man;Use of chemicals in agriculture and impact of pesticides on farmers and consumers;Treatment of sludge before release to the environment; andStrong economy has impact on public health;

20

ISSUES IN ORDER OF PRIORITY

1. Chemicals2. Floods3. Drought4. Toxic wastes5. Agricultural practices6. Land use activities7. Outdoor air8. Water 9. Ecosystem10. Indoor air11. Sound12. Radioactive rays13. Radiation

Seminar Report


21

ASPECTS OF CONCERN ON CHEMICALS

Enforcement of legislation, control and monitoring by public agencies;Impact on man;Impact of on the environment;Management of scheduled wastes;Education, information, awareness, exposure of individuals and community to chemical hazards;Identification of all legal and illegal dumping sites;Impact on foods.

22

ASPECTS OF CONCERN ON FLOODS

Law enforcement, control and monitoring by the government;Communication problems between Ministry of Health and communities;Flood occurrence warnings;Environmental impacts on human health, irrigation, drainage and topography and damage to assets;Need for planning for hazards;

Seminar Report


23

ASPECTS OF CONCERN ON DROUGHT

Impacts of water shortage on the community, environment and the economic activities;Enforcement of legislation and regulation;Impact of haze on man and economy;Education, information and public awareness of the impact of drought;Climate change and impacts on the environment and man;

24

ASPECTS OF CONCERN ON TOXIC WASTES

Indiscriminate dumping of toxic wastes result in negative environmental and health impacts;Enforcement of legislation, control and monitoring by the government;Education, information, awareness, exposure of individuals and community on the danger of toxic wastes;No identification and registration of places of dumping of toxic wastes;

Seminar Report


25

ASPECTS OF CONCERN ON AGRICULTURAL PRACTICES

Impacts of man’s activities on the environment;Enforcement of legislation, control and monitoring by the government;Safety and health issues of farmers;Impact of commercialization of agricultural practices;Effects of pesticides on humans and environment;Effective sustainable agricultural practices Impact of pesticides on humans and the environment;Impacts of uncontrolled use of fertilizers

26

ASPECTS OF CONCERN ON LAND USE ACTIVITIES

Impacts of man’s activities on the environment;Enforcement of legislation, control and monitoring by the government;Impact of land use activities on man and the environment;Pollution and land slides;Importance of land for stability;Land is an increasingly limited resource;Pollution by chemicals and agriculture;Adverse impacts of agriculture without habitat.

Seminar Report


27

ASPECTS OF CONCERN ON OUTDOOR AIR

Open burning activities and air pollution;Law enforcement, control and monitoring by the government;Dust in construction sites;Uncontrolled deforestation;Forest canopy’s role in filtering polluted air;Smoke from factories and vehicles.

28

ASPECTS OF CONCERN ON WATER

Polluted water and rivers cause diseases and affect the safety of consumers and users;Need for better enforcement of laws and monitoring by the government;Planning is not transparent;Inefficient water supply;Water catchments must be protected from encroachment;Protected forests are important water catchments;

Seminar Report


29

ASPECTS OF CONCERN ON ECOSYSTEMS

Pollution and ecosystem disturbance due to development;Enforcement of legislation, control and monitoring by the government;Ecosystem change affects man;Misuse of power;Need for a balanced ecosystem towards a dynamic environment;Need for ecosystem studies and planning;Impact on man’s health;Impact of dumping of toxic wastes.

30

ASPECTS OF CONCERN ON INDOOR AIR

Problems with indoor air systems;Building designs with poor ventilation;Bad air conditioning systems;Public awareness and education for smokers; andEducation; information, awareness of the public to environmental issues;

Seminar Report


31

ASPECTS OF CONCERN ON SOUND

Sound pollution around factories;Impact of sound pollution on man;Enforcement of legislation, control and monitoring by the government;Not serious.

32

ASPECTS OF CONCERN ON IONISED RADIATION

Education, information, awareness, exposure to individuals and communities;Enforcement of legislation, control and monitoring by the government;Important uses in offices;Use of x-ray in treatment of diseases;Impact on man;Disposal of radioactive products; Not serious.

Seminar Report


33

ASPECTS OF CONCERN ON NON-IONISED RADIATION

Education, information, awareness, exposure to individuals and communities;Impact on man and environment;Enforcement of legislation, control and monitoring by the government;Use of radioactive rays in the preservation of food and pesticides;Disposal of radioactive wastes.

34

General observations…1. No central data depository on

environmental health in Malaysia2. Few stakeholders knew of NEHAP but have

good grasp of Environmental Health3. No policy or strategies on HEALTH or

ENVIRONMENTAL HEALTH4. Good cooperation between MOH and other

environment-related agencies but lack of consultation on Environmental Health and NEHAP

Seminar Report


35

Closing remarks…

1. The issues are non-exhaustive because yet to have a vigorous approach to getting views from stakeholders;

2. ‘Environmental health’ is not widely debated outside the Ministry of Health, although everyone is involved with environmental health.

3. NEED for more comprehensive information gathering for NEHAP

4. Present information is sufficient for the Terms of Reference for Malaysian NEHAP

36

Terima Kasih

Seminar Report


Presentation 5 - THE NEED FOR MALAYSIAN NEHAP by Mr. Zaharon Talha (Engineering Services Division, MOH)

THE NEEDS FOR THE NEEDS FOR MALAYSIAN NEHAPMALAYSIAN NEHAP

PRESENTED BYPRESENTED BYMohd Zaharon Mohd Talha Mohd Zaharon Mohd Talha

ENGINEERING SERVICES DIVISIONENGINEERING SERVICES DIVISIONMINISTRY OF HEALTH MALAYSIAMINISTRY OF HEALTH MALAYSIA

CONTENTSCONTENTS

IntroductionIntroduction

Environmental Health Concerns and Environmental Health Concerns and

InitiativesInitiatives

Why Malaysia Needs NEHAPWhy Malaysia Needs NEHAP

ConclusionConclusion

Seminar Report


INTRODUCTIONINTRODUCTION

Environmental health is the science of Environmental health is the science of protecting human health from the damaging protecting human health from the damaging effects of physical, chemical and biological effects of physical, chemical and biological agents in the environmentagents in the environment

Environmental health combines disciplines in Environmental health combines disciplines in environmental sciences and health science environmental sciences and health science together with management sciences to create together with management sciences to create a healthy environmenta healthy environment

INTRODUCTIONINTRODUCTION

““Environmental health comprises those aspects of Environmental health comprises those aspects of human health, including quality of life, that are human health, including quality of life, that are determined by physical, biological, social and determined by physical, biological, social and psychosocial factors in the environment. It also psychosocial factors in the environment. It also refers to the theory and practice of assessing , refers to the theory and practice of assessing , correcting, controlling and preventing those factors correcting, controlling and preventing those factors in the environment that can potentially affect in the environment that can potentially affect adversely the health of present and future adversely the health of present and future generationsgenerations”” (WHO, 1993)(WHO, 1993)

Seminar Report


ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH CONCERNS AND INITIATIVESCONCERNS AND INITIATIVES

Physical alteration ofnatural environment

Accidental discharges & spillage of toxic products Improper management

of human waste

Industrial and agricultural waste

Engineering Services Division, Ministry of Health, Malaysia

Environmental Health ThreatsEnvironmental Health Threats

Seminar Report


Environmental Health

Population Dynamics

Urbanization

Poverty

Inequity

Technical & Scientific Development

Consumption Patterns

Production Patterns

Economic Development

Engineering Services Division, Ministry of Health, Malaysia

Driving ForcesDriving Forces

Influences in Environmental HealthInfluences in Environmental Health

Globalisation Globalisation Economics Economics Demographics Demographics Health determinants Health determinants Health reforms Health reforms Social changes Social changes Information changes Information changes Technology Technology

Seminar Report


Environmental Health ConcernsEnvironmental Health Concerns

Water PollutionWater Pollution-- approximately 98% of drinking water obtained approximately 98% of drinking water obtained

from streams and rivers. from streams and rivers. -- out of 120 rivers (DOE 2004):out of 120 rivers (DOE 2004):

•• 44.1% heavily polluted (53 Nos)44.1% heavily polluted (53 Nos)•• 30% was polluted by ammonical nitrogen (due to 30% was polluted by ammonical nitrogen (due to

sewage and animal waste) sewage and animal waste)

-- 13.3% of raw water 13.3% of raw water –– total coliform > total coliform > 5000/100ml (MOH 5000/100ml (MOH –– 2006 )2006 )

Seminar Report


E nvironmental Health C oncerns

AIR POLLUTION

- Particulate Matter (PM1 0) which can cause eye and throat irritation and cardiopulmonary diseases in 2004 was 48 ug/m3 almost reaching The Malaysian Ambient Air Quality Guideline ( 50 ug/m3 )

- Highest number of unhealthy days recorded at one location in 2004 was 88 days compared to 56 days in 2003 in Klang Valley ( DOE)

- In 2004 ,the number of registration passenger cars increased by 8.1 7%, motorcycle by 6.20%, buses by 3.91 %, good vehicles by 4.1 1 % and taxis by 6.59% compared to 2003

Seminar Report


Seminar Report



SOLID WASTE POLLUTION‐ Rural‐urban migration increased- 50.8% of disposal grounds were open dumps which

is inadequate:‐• potential threat of toxic substances from leachate• 420 cases of accidental burning reported is from

landfills (DOE 1 998) ‐ contribute to air pollution

Seminar Report


Leachate from solid waste disposal

TOXIC AND HAZARDOUS WASTE

- 469,584.07 tonnes(2004 ) of schedule waste generated compared to460,865.74 tonnes(2003)‐DOE 2004

NOISE POLLUTION

- Greater risk to industrial worker, residential areas, hospitals andschools


Seminar Report


ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH INITIATIVESINITIATIVES

Rural Environmental Sanitation ProgrammeRural Environmental Sanitation ProgrammeBackground / Existing ProgrammeBackground / Existing Programme

– Pilot projects in the late 60s– Outbreak of communicable diseases

• Massive cholera outbreak affected the whole of Peninsular Malaysia in 1978 with 1536 cases and 62 deaths

– Implemented nation wide in 2nd MP– Construction of low cost / low technology: water supply, latrine, sullage, and solid

waste systems

Future FocusFuture Focus–– General Environmental Health Monitoring in Rural AreasGeneral Environmental Health Monitoring in Rural Areas–– Cottage Industries, Home stayCottage Industries, Home stay

PROGRAMMES INITIATED BY MINISTRY OF PROGRAMMES INITIATED BY MINISTRY OF HEALTHHEALTH

Seminar Report


National Drinking Water Quality Surveillance ProgrammeNational Drinking Water Quality Surveillance Programme

Background / Existing ProgrammeBackground / Existing Programme– High incidence of water borne diseases associated with poor water supply

•• 2,600 cases of gastroenteritis in Seremban in 1982 2,600 cases of gastroenteritis in Seremban in 1982 –– Pilot Projects in the 80sPilot Projects in the 80s–– Implemented nation wide in 6Implemented nation wide in 6thth MPMP–– Coordinated by Technical Committee at Federal, State and DistricCoordinated by Technical Committee at Federal, State and District Levelst Levels–– Programme Elements: Monitoring, Remedial Action, Data ProcessingProgramme Elements: Monitoring, Remedial Action, Data Processing and Evaluation, Sanitary and Evaluation, Sanitary

Survey, Institutional ExaminationSurvey, Institutional Examination

Health Risk Associated with contaminated Water SupplyHealth Risk Associated with contaminated Water Supply–– Contamination of sewageContamination of sewage

•• 81 cases of infectious hepatitis in Raub in 198781 cases of infectious hepatitis in Raub in 1987•• 940 cases of infectious hepatitis in Kota Belud in 1988940 cases of infectious hepatitis in Kota Belud in 1988•• 300 cases of typhoid fever in Johor Bahru in 1990300 cases of typhoid fever in Johor Bahru in 1990•• 1278 cases of cholera mostly in Pulau Pinang in May 19961278 cases of cholera mostly in Pulau Pinang in May 1996

–– Contamination of heavy metals such as mercury and cadmium(detectContamination of heavy metals such as mercury and cadmium(detected in raw water):ed in raw water):•• minimata disease (mercury contamination)minimata disease (mercury contamination)•• itaiitai--itai disease (cadmium contamination)itai disease (cadmium contamination)

Future FocusFuture Focus–– Water Safety PlanWater Safety Plan–– Safe Drinking Water ActSafe Drinking Water Act–– ResearchResearch

Clinical Waste ManagementClinical Waste Management

Background / Existing ProgrammeBackground / Existing Programme–– Up until 1980s, Malaysia has no proper system for the managementUp until 1980s, Malaysia has no proper system for the management of medical wasteof medical waste

–– The emergence of HIV has initiated the revision of policies and The emergence of HIV has initiated the revision of policies and guidelines for the guidelines for the prevention and control of infectious diseases and medical waste prevention and control of infectious diseases and medical waste handling.handling.

–– The Ministry of Health in collaboration of Department of EnvironThe Ministry of Health in collaboration of Department of Environment took initiatives to ment took initiatives to include medical waste in the category of scheduled waste, as is include medical waste in the category of scheduled waste, as is defined in the defined in the Environmental Quality (Scheduled Wastes) Regulations, 1989.Environmental Quality (Scheduled Wastes) Regulations, 1989.

–– In 1993, clinical waste definition was adopted by MOH and the foIn 1993, clinical waste definition was adopted by MOH and the following documents llowing documents were formulated:were formulated:

Policy on Hospital Waste ManagementPolicy on Hospital Waste ManagementGuidelines for the Management of Clinical and Related Wastes in Guidelines for the Management of Clinical and Related Wastes in Hospital and Hospital and Health Care EstablishmentsHealth Care EstablishmentsAction Plan for Waste Management in Hospitals and Health Care EsAction Plan for Waste Management in Hospitals and Health Care Establishmentstablishments

–– Clinical waste management of MOHClinical waste management of MOH’’s hospital was privatised in 1997s hospital was privatised in 1997

Future FocusFuture Focus–– Private Healthcare FacilitiesPrivate Healthcare Facilities

Seminar Report


Environmental Health Impact Assessment GuidelinesEnvironmental Health Impact Assessment Guidelines

Background / Existing Background / Existing ProgrammeProgramme

-- Health impacts from development of projects not given proper attHealth impacts from development of projects not given proper attention ention in most EIA reportsin most EIA reports

-- EHIA Guidelines developed in 1997EHIA Guidelines developed in 1997

-- MOH can set up EHIA panel for Dam and Incinerator projectsMOH can set up EHIA panel for Dam and Incinerator projects

Healthy CitiesHealthy CitiesIRBM, IWRM initiativesIRBM, IWRM initiativesNational Water Services Industry Bill ( water supply and seweragNational Water Services Industry Bill ( water supply and sewerage ) e ) --20062006Air QualityAir Quality-- Haze Committee set up in 1992Haze Committee set up in 1992-- The National Action Plan for Air QualityThe National Action Plan for Air Quality-- Study on Impact of Human along RoadsStudy on Impact of Human along Roads-- Epidemiological Study under the Haze Committee Working GroupEpidemiological Study under the Haze Committee Working Group-- Immediate and long term effects on morbidity and mortality in MaImmediate and long term effects on morbidity and mortality in Malaysialaysia

Solid, Toxic and Hazardous WastesSolid, Toxic and Hazardous Wastes-- Basel ConventionBasel Convention-- Integrated scheduled waste disposal and treatment facilitiesIntegrated scheduled waste disposal and treatment facilities-- Solid Waste Management & Public Cleansing Act 2007Solid Waste Management & Public Cleansing Act 2007

Other Environmental Health InitiativesOther Environmental Health Initiatives

Seminar Report


Other Areas of EH To Be ConsideredOther Areas of EH To Be Considered

Food ProductsFood Products-- Fishery Fishery -- Agricultural Agricultural

Food SanitationFood SanitationVector control Vector control Indoor environmentIndoor environmentOccupational healthOccupational healthAir pollution impact on Air pollution impact on healthhealth

HousingHousingWater pollution Water pollution DeforestationDeforestation

•• Soil contaminationSoil contamination•• Climate changeClimate change•• Recreational waterRecreational water•• Ionizing / NonIonizing / Non--ionizing ionizing

RadiationRadiation

Why Malaysia Needs NEHAPWhy Malaysia Needs NEHAP

Widely accepted worldwide as a planning tool for sustainable Widely accepted worldwide as a planning tool for sustainable developmentdevelopment

First Ministerial Regional Forum on Environment and Health in First Ministerial Regional Forum on Environment and Health in South East and East Asian Countries held in Bangkok in August South East and East Asian Countries held in Bangkok in August 2007 agreed that member countries should prepare and regularly 2007 agreed that member countries should prepare and regularly update NEHAPupdate NEHAP

Agreed by EPU as one of the KPI in 9Agreed by EPU as one of the KPI in 9thth MPMP

To come up with strategies on how to improve environmental To come up with strategies on how to improve environmental health in Malaysia and define the roles and responsibilities of health in Malaysia and define the roles and responsibilities of various stakeholdersvarious stakeholders

Seminar Report


ConclusionConclusion

NEHAP for Malaysia is an important initiative that will NEHAP for Malaysia is an important initiative that will determine the future health status of the populationdetermine the future health status of the population

Crucial that all stakeholders play their part in the Crucial that all stakeholders play their part in the development of the NEHAP for the countrydevelopment of the NEHAP for the country

NEHAP should not be a static document but must be NEHAP should not be a static document but must be dynamic in nature and continuously evolve to take dynamic in nature and continuously evolve to take care of unexpected changes in the futurecare of unexpected changes in the future

Thank you

APPENDIX 3

THE PROJECT TEAM MEMBERS

Seminar Report


Appendix 3 – The Project Team Members

THE PROJECT TEAM MEMBERS OF “BASELINE INFORMATION ON ENVIRONMENTAL HEALTH OF

PENINSULAR MALAYSIA” Project Management: 1. Datin Paduka Dr. Halimaton Saadiah Hashim Project Director

Principal Fellow (Land Use Planning) Institute for environment and development (LESTARI) Universiti Kebangsaan Malaysia Tel: 03-8921 4513 Fax: 03-8925 5104 Email: [email protected]/[email protected]

2. Dr. Rahmah Elfithri Project Manager Fellow (Water Resources Management) Institute for environment and development (LESTARI) Universiti Kebangsaan Malaysia Tel: 03-8921 4152 Fax: 03-8925 5104 Email: [email protected]

Experts/Researchers: 1. Professor Dato’ Dr. Ibrahim Komoo (Engineering Geology)

Deputy Vice Chancellor Research and Innovation Affairs Universiti Kebangsaan Malaysia Tel: 03-8921 5080 Fax: 03-8921 4243 Email: [email protected]

2. Prof. Dr. Mazlin B. Mokhtar (Environmental & Analytical Chemistry) Director Institute for environment and development (LESTARI) Universiti Kebangsaan Malaysia Tel: 03-8921 4144 Fax: 03-8925 5104 Email: [email protected]

Seminar Report


3. Dato’ Shaharuddin Mohamad Ismail (Forestry) Principal Fellow Institute for environment and development (LESTARI) Universiti Kebangsaan Malaysia Tel: 03-8921 4514 Fax: 03-8925 5104 Email: [email protected]

4. Assoc. Prof. Dr. Joy J. Pereira (Environmental Geology) Senior Fellow Institute for environment and development (LESTARI) Universiti Kebangsaan Malaysia Tel: 03-8921 4153 Fax: 03-8925 5104 Email: [email protected]

5. Assoc. Prof. Dr. Abdul Hamid Jaafar (Economy) Senior Fellow Institute for environment and development (LESTARI) Universiti Kebangsaan Malaysia Tel: 03-8921 3757/5789/013-2453662 Fax: 03-8925 5104 Email: [email protected]

6. Prof. Dr. Ismail Bahari (Occupational Safety and Health) Faculty Science and Technology Universiti Kebangsaan Malaysia Tel: 03-8921 4179/5478 Fax: 03-8921 4179 Email: [email protected]

7. Prof. Dr. Ismail Sahid (Agriculture) Deputy Dean Centre for Graduate Studies Universiti Kebangsaan Malaysia Tel: 03-8921 4183 Fax: 03-8925 2699 Email: [email protected]

8. Dr. Mazrura Sahani (Environmental Health) Health and Environmental Science Faculty of Allied Health Sciences Universiti Kebangsaan Malaysia Tel: 03-26983197/012-3883957 Fax: 03-26913132 Email: [email protected]

Seminar Report


9. Dr. Er Ah Choy (Environmental economy)

Faculty of Science Social and Humanities Universiti Kebangsaan Malaysia Tel: 03-8921 3945/012-6071868 Fax: 03-8921 3334 Email: [email protected]

10. Assoc. Prof. Dr. Salmaan Hussain Bin Inayat Hussain (Toxicology) Faculty of Allied Health Sciences Universiti Kebangsaan Malaysia Tel: 03-4040 5627/012-2981689 Fax: 03-2692 9032/03-2691 4304 Email: [email protected]

11. Dr. Mohd Talib Latip (Air Quality) Faculty of Science and Technology Universiti Kebangsaan Malaysia Tel: 03-8921 3822/019-9462645 Fax: 03-89253357 Email: [email protected]

Research Assistants: 1. Siti Norliyana Hassan (Environmental Management)

Institute for environment and development (LESTARI) Universiti Kebangsaan Malaysia Tel: 03-8921 4159/012-2828723 Fax: 03-8925 5104 Email: [email protected]

1st malaysian national environmental report...

Documents