a handbook - kinder umwelt gesundheit · any translation should include the words: the translator...

1

A handbook

Planning to protect children against hazards

The website of the EuropeanEnvironment and Health Committeeacts as a notice board about implementation of the Children’sEnvironment and Health Action Planfor Europe and of other commitmentsmade at the Fourth MinisterialConference on Environment andHealth, held in Budapest in June2004.

The website:http://www.euro.who.int/eehc

© World Health Organization 2006All rights in this publication are reserved by the WHO Regional Office for Europe. The publication may nevertheless befreely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunctionwith commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem,permission must be sought from the WHO Regional Office. Any translation should include the words: The translator ofthis document is responsible for the accuracy of the translation.The Regional Office would appreciate receiving threecopies of any translation.

Contents

1. Purpose of this booklet . . . . . . . . . 5

2. How the CEHAPE came about . . . 6

3. Why children are at risk . . . . . . . . . 8

4. Principles underlying CEHAPE . . . 10

5. The Regional Priority Goals . . . . . 12

6. Making plans . . . . . . . . . . . . . . . . 27

7. Checklist of national activities . . . 28

8. Workshops . . . . . . . . . . . . . . . . . 30

9. Some reflections . . . . . . . . . . . . . 32

10. Some top tips . . . . . . . . . . . . . . . 36

11. Taking part . . . . . . . . . . . . . . . . . 38

12. Getting the message across . . . . 40

13. Information and monitoring . . . . . 43

14. Further resources . . . . . . . . . . . . 46

More detailsThis booklet draws on information tobe found within:

WHO Regional Office for Europe(2004). Children's Environment andHealth Action Plan for Europe: FourthMinisterial Conference onEnvironment and Health, Budapest,Hungary, 23-25 June 2004.Copenhagen, WHO Regional Officefor Europe;

WHO Regional Office for Europe,(2004). The children's health andenvironment case studies summarybook; work in progress. Copenhagen,WHO Regional Office for Europe

WHO Regional Office for Europe(2004). Table of child-specific actionson environment and health, part ofthe web-based CEHAPE Action Pack(http://www.euro.who.int/childhealt-henv/Policy/20050629_1)

Licari L, Nemer N, Tamburlini G(2005). Children's health and environment. Developing action plans. Copenhagen, WHO RegionalOffice for Europe

PHOTOS: STEVE TURNER (4, 6, 25, 30, 39, 48), HEINRIK FLEISCHER (1, 5, 12, 14, 29, 45), VOLKMAR SCHULZ/KEYSTONE (15)ILLUSTRATIONS: TOBIAS FLYGAR (32,33) DESIGN AND PRODUCTION: PARAMEDIA COPENHAGEN #1092, PRINTED ON RECYCLED PAPERTHANKS TO THE DESIGN STUDENTS OF THE COPENHAGEN TECHNICAL ACADEMY FOR THEIR IDEAS AND INPUT

The Children’s Environment and HealthAction Plan for Europe (CEHAPE) wasendorsed at Budapest in June 2004by ministers of health and environmentfrom across the European Region. Itsaim is to reduce and where possible,eliminate the exposure of children toenvironmental risk factors. The purposeof this booklet is to explain whatCEHAPE is and why it is needed, andto support its implementation.

Who is it for?This booklet is for people workingnationally or locally in health or environment or other relevant sectors,who may be involved in preparing and implementing a plan to reducechildren’s environmental exposures.This includes policymakers, healthand environment professionals, managers, technical experts, tradeunions, schools, nongovernmental

organizations (NGOs), and all thosewhose work and interests touch onchildren’s wellbeing. It will be of special interest to local authoritiesdeveloping policies to protect children’shealth from environmental hazards.

Use this booklet to find out:

• how children are at risk• what commitments were made

by governments in Budapest• what the Regional Priority Goals are• what measures may be needed• who to involve in your plans• how to use communication• case studies from countries• what works for some countries• further resources available

5PLANNING TO PROTECT CHILDREN AGAINST HAZARDS ·

Purpose of this booklet1

This poster is one of a series available from WHO Regional Office for Europe

What do we do about the damagethat our polluted environment is doingto children’s health? This was the bigquestion at the Fourth MinisterialConference on Environment andHealth, held in Budapest, Hungary, in June 2004 and attended by over athousand delegates, observers andjournalists from the 52 Member Statesin the WHO European Region. Thiswas not the first time this questionhad been asked: at least seven international agreements exist onprotecting children from environmentalrisks, and the European Commissionhad also contributed to environmentand health policy development. It wasfive years earlier, at WHO’s Third

Ministerial Conference onEnvironment and Health in London in 1999, that the idea had first beendiscussed of a strategic and evidence-based action plan on children’senvironmental health in the EuropeanRegion. The steering committee forthe Budapest Conference, theEuropean Environment and HealthCommittee (EEHC), was asked byMember States to adopt “The futurefor our children” as the main themein Budapest.

A concerted effort then began toaddress the environmental risk factorsthat affect children’s health, examinethe research, and come to ministerialagreement on the way forward.

The outcome documents were care-fully negotiated over four intergovern-mental meetings in the build-up toBudapest: the Budapest ConferenceDeclaration and the Children’sEnvironment and Health Action Planfor Europe, known as CEHAPE andpronounced “see happy”. These werefinally endorsed at the Conference.Full details of how to find these documents, and other resources andsources of information can be foundat the end of this booklet.

To support countries with theimplementation of the commitmentsthey made in the CEHAPE, the EEHCset up the CEHAPE Task Force, whichmeets twice a year, where the officialenvironment and health focal pointsfrom Member States in the EuropeanRegion monitor and discuss progress.The Task Force Chair in turn reportsto the EEHC, which also meets everysix months and oversees the environ-ment and health process. Some com-ments from the environment andhealth focal points are included in thisbooklet.

6 · PLANNING TO PROTECT CHILDREN AGAINST HAZARDS 7PLANNING TO PROTECT CHILDREN AGAINST HAZARDS ·

How the CEHAPE came about2

Member States gather in Budapest in June 2004 at the Fourth Ministerial Conference on

Environment and Health where they endorsed the Children’s Environment and Health

Action Plan for Europe (CEHAPE).

VulnerabilityThe burden of disease attributable toenvironmental factors is greater inchildren than in adults. Ensuring thatchildren can grow up and live healthylives requires special protectionbecause they are uniquely vulnerable.• At critical times, they are mostsusceptible to various chemical andphysical agents. From conception toadolescence, their organs, brain cells,nervous systems, immune and othersystems are growing and developingrapidly. • They have greater exposure: theytake in more air, water and food relativeto their body weight. • They put things in their mouths,and crawl on the ground. This andother typical toddler behaviour meansthey are more exposed to the physicalworld around them. • Their metabolism is immature:they absorb most toxicants more readily, yet safety standards for

chemicals are still based largely oncriteria used for adults. • Early exposures can cause healtheffects that damage health not only in childhood but also later in life oreven in future generations. • Children are subject to multipleexposures, such as smoke indoors, or chemical residues in food. • We often do not know or yet understand the risks to children presented by chemical and otherphysical agents. Monitoring andassessment, when it is available, isoften based on adults.

InequityThere are particular groups of childrenwho are most at risk. Those who arepoor are more likely to live in thoseneighbourhoods that are near factories,dumps, heavy traffic and other sourcesof pollution and contamination. Theywill have the least access to cleanwater, clean air, even education.

Many sectors have to be involved tohelp establish effective environmental,social and public health policies thatimprove children’s health. This issueis not one that can be solved by thehealth sector, or environment sectoralone, nor can it be solved by workingonly at the national level. Making anational plan is a consultative processthat draws its strength from its inclusiveness.

Children are entitled to grow and

live in healthy environments…. CEHAPE, paragraph 2


Why children are at risk3We are increasingly concerned about the effects on children’s

health of unsafe and unhealthy environments. We understand

that developing organisms, especially during embryonic and

fetal periods and early years of life, are often particularly

susceptible, and may be more exposed than adults to many

environmental factors. Children’s Environment and Health Action Plan for Europe, (CEHAPE), paragraph 4

Children living in institutions or on the street, are particularly likely to be exposed to injuries, abuse and hazardous work. Economic crisis,armed conflict and migration areadded risk factors. For all children theexposure to environmental threats,either direct or indirect, is influencedby not only different biological andsocial factors but also factors such as market forces, the mass media,decisions taken by industry, and thegrowth of urban areas.

Burden of diseaseAccording to the environmentalburden of disease study publishedby the Lancet in June 2004, outdoor and indoor air pollution,unsafe water, lead and injuriescause 34% of deaths and 25% ofhealthy life lost (DALYs: disabilityadjusted life years) among childrenand young people under 19 yearsold, in the European Region.Most of these health effects arethe result of injuries. The studydid not include those areas thatare more difficult to assess, suchas the health effects of chemicals.

In the CEHAPE, countries committedthemselves to “coordinated andsustained action to protect children’shealth”. They recognized that effectiveaction should emphasize:

• primary prevention – improving theenvironment itself, including air,water, housing and transport;• equity – helping children in specialneed, such as abandoned children orrefugees; • poverty reduction – because peoplein poor neighbourhoods are usuallyexposed to the worst amount of environmental contamination;

• health promotion – because it alsomatters how people live, what theydo and what they buy; • measures should be applied basedon the precautionary principle so asnot to delay policies that protect chil-dren’s health, and also to minimizethe risk of severe and irreversiblehealth effects.

A working group of Member Statesare producing guidelines on how toapply the precautionary principle, andthese will be completed by the midterm review to be conducted byMember States in 2007.

“We reaffirm the importance of

the precautionary principle as a

risk management tool and we

recommend it should be applied

where the possibility of serious or

irreversible damage to health or

the environment has been identified

and where scientific evaluation,

based on available data, proves

inconclusive for assessing the

existence of risk and its level but is

deemed to be sufficient to warrant

passing from inactivity to policy

alternatives.” (Budapest Declaration, paragraph 17a)

The precautionary principleDecisions under the precautionaryprinciple are those taken on issues ofscientific uncertainty. They:

• are based on the best evidenceavailable, using informed judgementand common sense;• demand rigorous science that isexplicit in its limitations and gaps inknowledge;• advocate the need to improve thescientific basis for decisions;• may be reached using tools such asprudent avoidance, ie taking simpleavoidance measures to reduce exposures, or the approach known asALARA (as low as reasonably achie-vable); • use a lower level of proof thanhitherto, to justify public policy actions.

Some environmental risks that affectthe population at large and children inparticular are uncertain and highlycomplex, including exposure to dangerous chemicals, hazardouswastes, non-ionizing radiation andindustrial pollutants through food,water, air and everyday products.Such exposure may in some casesresult in irreversible effects that appearmany years later. Such risks raiseanxiety because the need for morescientific evidence on such risks hassometimes been used as a reason todo nothing about them. The tool thatis increasingly invoked and applied in such cases is the precautionaryprinciple.

Using this principle to make preventive interventions in a flexibleand timely manner involves identifyingrisks early, using a wide range of scientific tools and perspectives,increasing the transparency of decision-making and the range of stakeholdersinvolved in making decisions, identify-ing early warnings of risks and settingup surveillance programmes, andinvesting in research and developmentto find safer and cleaner alternativesto the products, processes andconsumption patterns that are causing concern.

A proactive approach that aims tocreate the conditions for sustainabilityand health, rather than simplyresponding to problems after theyoccur, is invaluable in the struggle fora world that protects children and future generations.


Principles underlying CEHAPE4

We aim to prevent and significantly reduce the morbidity and

mortality arising from gastrointestinal disorders and other

health effects, by ensuring that adequate measures are taken

to improve access to safe and affordable water and adequate

sanitation for all children. (RPGI)

In the CEHAPE, countries agreed to

reduce the burden of disease by

focusing on four priority areas where

children’s health is at risk: the four

Regional Priority Goals. (RPGs)

Access to a reliable, safe supply is ahuman right. Unsafe, contaminatedwater transmits numerous diseases.Improving access to water enables andencourages hygiene practices such aswashing, food hygiene, laundry andgeneral household hygiene that preventdiarrhoeal and other diseases. In theEuropean Region, diarrhoea causedby poor water, sanitation and hygieneaccounts for 5.3% of all deaths of

children under 15. Most of these areamong children in eastern Europe and central Asia.

What can be done?

• include child-specific targets in national measures to implement theProtocol on Water and Health;• conduct assessment of safety ofwater and sanitation in schools andnurseries; • promote safe storage of water andhousehold water treatment in familyhomes where necessary; • improve children’s access to cleanwater and sanitation by 2015, in linewith Millennium Development Goals; • find out where sewage is beingdischarged, or leaking, to ensure it isnot posing a threat to children; • introduce public campaigns to educate teachers, parents and childrenon the importance of basic hygiene,water quality and of washing hands;• introduce these topics onto primaryschool curricula.


waterRegional Priority Goal I

The Regional Priority Goals5

Unsafe water and sanitation, HungarySome people in Hungary usewater from private wells withoutknowing if it contains high nitrateand nitrite levels, or arsenic. In afour-month project as part of thenational environment and healthaction plan, teachers were giveninformation on the importance offinding out what was in thewater, children took water sam-ples and villagers were given thedata that had been collected.

We aim to prevent and substantially reduce health

consequences from accidents and injuries and pursue

a decrease in morbidity from lack of adequate physical

activity, by promoting safe, secure and supportive

human settlements for all children. (RPGII)

Country experience: Uzbekistan”After the Budapest Conference,

Uzbekistan established a forum to

coordinate efforts and to raise awa-

reness of the public and govern-

ment ministries. This inter-sectoral

collaboration also involves the edu-

cation ministry and ministry of the

interior, and nongovernmental orga-

nizations. A new programme on

environment and health has just

been passed, running up to 2010.

It includes raising awareness

on environmental health among

children and families and improving

water quality, and the conditions

in schools and kindergartens.”

Country experience: Tajikistan“Clean water in schools and pre-

school institutions is a priority in

Tajikistan, to reduce morbidity

among children. In 2004 a campaign

was carried out with NGOs using

mobile brigades in schools. 93% of

Tajikistan is mountainous and much

of the population live in valleys pol-

luted by dangerous chemicals.The

department of geology is creating a

map of clean water springs in the

country as part of a small project to

increase use of clean spring water.

Close work is being undertaken

with about 40 NGOs.”

Unintentional injuriesIn the European Region, injuries arethe leading cause of death in childrenbetween the age of 0–14 years, accounting for a total of 36% of allchildhood deaths. Every year 28 000children lose their lives from thiscause, or three every hour. Manymore may be disabled or emotionallytraumatized, often permanently. It isestimated that 4 million children areadmitted to hospital and 52 millionattend emergency departments everyyear due to injuries. The majority (89%)are due to unintentional causes, suchas road traffic injuries, poisoning,drowning, fires and falls. Out of theover 127 000 road deaths estimatedto have occurred in the WHO EuropeanRegion in 2002, some 6 500 wereamong children younger than 15. Car crashes are the leading cause ofdeath for young people aged 5 to 29years.

In the past, injuries were consideredto be an inevitable part of everydaylife but there is now scientific evidencethat injuries can be predicted and prevented by cost effective measures.

Safety for children and adults is asocietal responsibility. In the promotionof safety measures, research hasshown that a combination of legislation,mass-media campaigns and financialincentives are more effective thanindividual approaches. Central to thisis ensuring children a safer physicaland social environment.


accidents and injuriesRegional Priority Goal II

“Clean hands – yes please!” was the motto for kindergartensin a project run by public healthnurses in Odense, Denmark.Children attending nurseries oftenhave many sick days with variousillnesses. Using written material,information about hygiene andfairy stories about a princess whowould not wash her hands andsongs and riddles, this six-monthproject involved staff, parents andchildren.The result was reducedsick days, particularly those caused by eye infections and diarrhoea.

What can be done?For road safety, effective measuresexist to tackle all the factors whichrequire urgent remedy such as excessive speed; drink driving; notwearing protective gear such as carseat restraints and helmets; not beingeasily visible; and defective roaddesign which allows vulnerable roadusers to be exposed to vehicles.Measures involve laws and policyacross sectors. For example, childrenwho walk or cycle can be protectedby reducing speed limits to 30km/hour near schools and residentialareas, having pedestrian walkwaysand bicycle lanes and encouraging the use of helmets.

The health impact of overall trans-port policy needs to be considered,not only by promoting public transport,but also by involving urban planners.Increasing children’s physical exercisewill reduce the current epidemic ofchildhood obesity, and will decreaserespiratory illness from pollution.

Land useIn order to create safer environments,child safety considerations need to begiven importance in land-use, leisureand transport policy and in the designof roads, products, cars, housing,public spaces and buildings.PoisoningStoring household cleaning products,pesticides, fuels and medicines awayfrom children's reach and using child-proof containers reduce the risk ofpoisoning. Poison centres save lives.DrowningImproving swimming skills, betterparental supervision, the provision oflifeguards and flotation devices, andfencing and gates around swimmingpools decrease deaths fromdrowning. FiresThe provision of working smoke alarms,child proof lighters, self-extinguishingcigarettes, and banning the use offlammable materials for children’sclothing reduces mortality and disfiguration.

Country experience: Netherlands“In the Netherlands, a programme

was set up to reduce the problem

of accidental poisoning with

legislation to make child-resistant

packaging compulsory for house-

hold chemicals and pharmaceuticals,

because children under five years

were suffering a relatively high

number of unintentional poisonings

by household chemicals and phar-

maceuticals, resulting in a large

number of hospital admissions.

The programme required partner-

ship between the Ministry of Health,

Welfare and Sport, the Consumer

Safety Institute, the National

Poison Information Centre and

manufacturers, and included

consultations with manufacturers

and other stakeholders.

Surveillance data on poisoning

were used to advocate legislation.

In response, the Ministry called for

child-resistant packaging of certain

hazardous substances as part

of the Commodities Act. The pro-

gramme also includes educational

campaigns and has resulted in a

more than 50% decrease in

hospitalization from poisoning.”


Examples of financial savings from selected injury prevention interventions:

Expenditure of one euro each on: Is associated witha saving of (euro):

Child safety seats 32

Bicycle helmets 29

Simple road safety improvements of line markings 3

Prevention counselling by paediatricians 10

Poison control services 7

Smoke alarms 69

(from "Injuries and Violence in Europe - why they matter and what can be done" - Summary (2005)WHO Regional Office for Europe)

School travel strategyThe City of York, in the UnitedKingdom, included a school travelstrategy in its five year LocalTransport Plan, in cooperationwith Sustrans, a nongovernmentalorganization. Working withschools to reduce car use andtraffic accidents on school journeys and to increase levels ofcycling to school, safety zoneswere set up round schools, 14schools adopted school travelplans, and special measures were put in place, such as cyclestorage, a four-stage road safetystudent training programme and a newsletter. The project hasresulted in fewer accidents, morecycling and less car use in schoolswhere cycle parking has beeninstalled and plans adopted.

Less school trafficConcerned about the number ofroad accidents to children andtheir lack of exercise, the FederalMinistries in Austria launchedSchool Mobility ManagementPlans to promote cycling, walking,public transport use and trafficsafety and to reduce car-trafficand its attendant risks on the wayto school. Pilot schemes wereset up in Graz, involved many different sectors including police,teachers, parents and traffic planners and the children them-selves. The result was a decreasein Graz in school traffic of 12%.

18 19PLANNING TO PROTECT CHILDREN AGAINST HAZARDS ·

We aim to bring about a

reduction in the prevalence

of overweight and obesity.(part of RPGII)

What can be done? • provide safe conditions for childrento be physically active in their dailylife, including on the way to and fromschools and to different amenities,promoting road safety, enforcementof speed limits, and provision of safeinfrastructures for vulnerable roadusers;• improve physical activity in schoolcurricula, both as physical educationand during recess and extra-curricularactivities;• increase provision of play space,green areas and playgrounds for playand sports and ensure safe access toit by cycling and walking;• promote increased physical activityfor children and young people in thecommunity; • implement health promotion activities as agreed in WHO's GlobalStrategy on Physical Activity;• liaise with other sectors, such aseducation, urban planning, housing,transport and environment, to makephysical activity an easy choice through improved infrastructure, information, education and promotingthe benefits of physical activity.

Walking Bus (in at least 17 countries inthe European Region) A walking bus is a group of childrenand adults who walk to schooltogether along a set route. Thereare 'stops' or pick-up pointswhere children can join the groupand walk with them. Parentsvolunteer to 'drive' the bus on aroster basis - each walking bushas an adult 'driver' at the frontand an adult 'conductor' bringingup the rear. It's a method of reducing car travel, increasingphysical activity and having lots of fun. It is now widely used byschools. In one school in theUnited Kingdom the number of 8-10 year olds walking to schoolrose from 48% to 75%. See anew handbook athttp://www.thewalkingbus.co.uk

Children and physical activity

Children and young people shouldachieve a total of at least 60 minutesof at least moderate-intensity physicalactivity each day, including activitiesthat produce high physical stresseson the bones, and improve musclestrength and flexibility. Excess bodyweight is now the commonest child-hood disorder in Europe, affectingon average one child out of five,and in some countries as many asone child in three. Recent reportsestimate that the number of over-weight children is increasing at therate of 400 000 per year.

Overweight children are morelikely to become overweight adults,with a greater risk of cardiovasculardisease, diabetes and other disorders.Type 2 diabetes, until recentlyregarded as a weight-related diseaseof old age, is now being reported in children in several Europeancountries, including Poland,Sweden and the United Kingdom.

Other complications of excessweight in childhood are hypertension,orthopaedic problems, sleep apnoea(i.e. interruptions of breathingduring sleep), adverse blood lipidsprofiles (i.e. increase in “bad” anddecrease in “good” blood cholesterollevels) and psychological ill health,which may be expressed in eatingdisorders, poor social relations andeducational disadvantages.

These concerns were reflected in the decision to hold a WHOEuropean ministerial conference oncounteracting obesity in November2006 in Istanbul, Turkey.

Walking and cycling to school andfor leisure can help. However, thenumber of children cycling and walking to school is declining inseveral European countries, whilethe number of those being drivento school is increasing. Safety con-cerns are an important barrier towalking and cycling: several studiesindicate that parents are worriedabout traffic hazards. Addressingthe safety of vulnerable road users,and especially of children, thereforeappears to be a key enabling factorfor promoting sustainable and healthier mobility, along with interventions that provide greateropportunity to be active in daily life,including in the neighbourhood.

· PLANNING TO PROTECT CHILDREN AGAINST HAZARDS

WHO evidence reportWhat is the evidence on the success of school health promotion in improving health orpreventing disease? See theEvidence Report, Feb 2006. Seehttp://www.euro.who.int/HEN

Outdoor air pollutionStudies conducted in Europe report thatthe incidence of acute respiratory in-fections is up to 50% higher in childrenliving in the most polluted areas thanthose in the least polluted areas.

Air pollution, particularly from traffic,is causing permanent damage to children’s lungs: with lungs that do notgrow or work properly, they have moredifficulty breathing. Particulate air pollution, mainly from vehicle exhaust,may increase the severity of a commonrespiratory infection in babies whichleads in some cases to the child’sdeath. Along with ozone, air pollutionfrom particulates is aggravating asthmaand increasing coughs and bronchitis.Lead – mostly from petrol – is affectingchildren’s brains.

It is thought likely that pollutionaffects birth weight, premature birthand intrauterine growth retardation. It has been suggested that air pollution is related to other diseases such ascancer.

We aim to prevent and reduce respiratory disease due to

outdoor and indoor air pollution, thereby contributing to a

reduction in the frequency of asthmatic attacks in order to

ensure that children can live in an environment with clean air.

We aim to achieve a substantial reduction in the morbidity

and mortality from acute and chronic and respiratory

disorders in children and adolescents. (RPGIII)

What can be done?

• reduce emissions of particles byequipping new diesel motor vehicleswith particle filters; • set up a pollution-free school zone,particularly for diesel vehicles; • set up monitoring and smog alertsystems in cities, to alert schools andthe public;• educate parents on what to dowhen the smog level is high;• reduce emissions of air pollutantsfrom transport-related industrial andother sources, through air qualitystandards based on the WHO Air quality guidelines;• establish pollution-free schoolzones;• provide training and awareness ontobacco control (WHO FrameworkConvention on Tobacco Control, article 12).

Country experience: Netherlands“On several occasions already,

local authorities in the Netherlands

have refused to grant planning

permission for new roads, offices,

even a new football stadium,

because of the pollution implications

of very heavy traffic. Outdoor air

pollution is one of the driving

forces, along with traffic jams and

noise, for new mobility and trans-

port plans that will make the

urban environment more liveable,

especially in the inner cities and

larger urban areas. Stimulating the

use of cleaner energy, vehicles and

transport modes is one of the prio-

rities. The National Air Quality

Action Plan provides several

measures at national level, such

as stimulating cleaner vehicles

through taxes, and revision and

further limitation of emission levels

for companies through the use

of European BREFs (reference

documents on best available

technology”.

Indoor air pollution High levels of smoke from cookingwith coal or biomass are causingincreased illness and deaths in children from respiratory disorders.The chemicals in tobacco, furnishingsand mould also damage health.

Exposure to tobacco smoke is linked to abortion, premature birth,low birth weight and congenital malformations and also health effectsin adult life, e.g. chronic respiratorydisease and lung cancer.


airRegional Priority Goal III

EvidenceWhat are the effects of air pollution on children's health and develop-ment, and how large a risk tohealth is air pollution, and whatare effective measures to reduceit? See the summary reports ofWHO Health Evidence Networkhttp://www.euro.who.int/HEN

We commit ourselves to reducing the risk of disease and

disability arising from exposure to hazardous chemicals,

physical agents and biological agents and to hazardous

working environments during pregnancy, childhood and

adolescence. We will aim to reduce the proportion of children

with birth defects, mental retardation and developmental

disorders and to decrease the incidence of melanoma and

non-melanoma skin cancer in later life and other childhood

cancers. (RPGIV)

them, often at night when they are

cheaper to use. The young people

are exposed to air pollution of

different kinds: a survey found that

the formaldehyde levels were

20 times over the limit, there was

pollution from heavy metals, and

strong electro-magnetic fields.”

Country experience: Estonia”This year the recommendations to

kindergartens will be revised and

next year there will be a monitoring

database on environmental

conditions in children's day-care

facilities. One important change

has been made in adopting a policy

on school and kindergarten buildings

so that improving their living envi-

ronment is guaranteed.”

What can be done?

• enforce article 12 of the FrameworkConvention on Tobacco Control onpublic awareness;• ban smoking in public places, parti-cularly schools and health facilitiesand also transportation;• promote smoke-free homes;• make healthier fuel available;• avoid children’s exposure to smokefrom heating and cooking;• define and implement minimumindoor air quality requirements inschools, housing and public buildings;• limit construction and finishingmaterials that may damage health.

Country experience: Ukraine“A special problem which will be

addressed in the plans for children’s

health is air quality in internet

cafes. The 3 800 internet cafes are

often open 24 hours a day, and

children and young people spend

up to nine hours at a stretch in

Around 1 500 new chemicals are produced each year, adding to the 80 000 the world currently produces,and those figures are only going torise. It is estimated that over the next15 years there will be an 85% increasein the manufacture of chemicals globally.


chemicals and other physical agentsRegional Priority Goal IV

Clearing the air of tobaccosmoke – PolandPilot studies showed that in twocities, Bydgoszcz and Ciechanow,77% and 60% of small children,respectively, were exposed totobacco smoke at home.A campaign was conducted, wor-king through the local authorities,kindergartens, schools, hospitals,cultural centres, churches and TVchannels, to increase the numberof smoke-free homes, smoke-freekindergartens and schools andnon-smoking pregnant women.They used meetings, workshops,press conferences, leaflets, coun-selling and many other methods,and the campaign showed results.In Bydogoscz half the schoolsbanned smoking and 72% of children asked their parents notto smoke in their presence. The number of children exposedat home decreased from 77% to58% and from 60% to 44%.

Children’s brains at risk?Some studies indicate that in theUnited States of America onechild in six now has developmen-tal disabilities. The causes are notfully understood. However, fivesubstances have been documen-ted as toxic to the developingbrain of a fetus – lead, polychlori-nated biphenyls, methylmercury,arsenic and toluene – and hugegaps in evidence remain to be filled in. Over a thousand chemi-cals have been shown to be neurotoxic in animal tests. 206 ofthese are known to be neurotoxicto humans and there is notadequate evidence that the othersare safe. There are also thousandsof mixed exposures from differentcombinations. In the absence ofevidence of their safety to thedeveloping brain, more has to bedone to protect children: theyonly grow their brains once.

What can be done?

• Ban leaded petrol and develop legislation on the content of lead inbuilding materials;• Develop legislation on:

- composition, labelling and information to the public on “do-it-yourself” products;

- exposure to hazardous chemicals in toys and other products;

- the use of childproof caps for medications and household cleaning agents;

- protecting workers from chemi-cals that harm the reproductive system;

• Develop regulations to minimizerisk from hazardous building materialssuch as asbestos, wood preservativessuch as creosote and arsenic, flameretardants, volatile organic compounds;• Apply the international Conventionsalready in force on persistent organicpollutants, waste production andidentification of hazardous chemicals(Stockholm, Basel and RotterdamConventions);• Apply the Strategic Approach toInternational Chemicals Management(SAICM).• Apply the precautionary principlethroughout policy processes.

MonitoringMonitor the chemical contaminants ofwater and soil that are most hazardousto children, such as heavy metals,organochlorine pesticides and PCBs.

Monitor reproductive health indicators including birth weight, congenital malformations and time to pregnancy, to detect potentialhazards to reproductive health.

Noise In children the most important andcommon effects of noise are inter-ference with speech, communicationand learning. Background noise mayalso interfere with concentration andsleep and cause changes in behaviour.Acute noise from headphones or indiscotheques can cause hearing loss.

What can be done?

• Monitor noise exposure in publicbuildings used by children and youngpeople.• Include noise reduction measuresin urban and infrastructure planning,including insulation of buildings.• Educate young people, parents andschool staff about noise health hazards.

“We note that large quantities of

chemicals are currently produced

and marketed with largely

unknown effects on human health

and the environment.”

(Budapest Declaration

paragraph. 11a)

Hazardous workSeven million adolescents are legallyemployed in Europe. Many others,including children as young as seven,are illegally employed in farm, shopsand factories, exposed to hazardousconditions, and subject to injuries,acute and chronic poisoning, respiratory disorders, cancer andmusculo-skeletal problems.

What can be done?• Ratify ILO Convention 182 prohibi-ting and eliminating the worst formsof child labour, including work whichharms the health, safety or morals ofchildren; • Create programmes or pass laws to remove children from hazardousworking conditions;• Protect adults from reproductiverisks arising from exposure to hazardsat work;• Promote awareness amongemployers of hazards to young people;• Promote awareness among youngpeople of their safety rights and therisks they face at work.


In the European Union, the newRegistration, Evaluation andAuthorization of Chemicals policy(REACH) programme aims toensure that industry provides theinformation necessary for takingrisk management action to prevent future threats to human health andthe environment. The EuropeanUnion has directives that relate tomany of the areas below, such aslead, noise and PCBs.

Toxicological risk assessmentRisk assessments should be basedon children’s exposure patterns,and bio-monitoring should beused more extensively. The inter-national community has recognizedthe need to improve methods toassess the risk of chronic andacute hazards posed by chemicalsand physical agents to infants andchildren. Assessing such risksand hazards is particularly difficult,not only because of the verylarge number of new chemicalsand technologies on the marketbut also because of other factorsto take into account: complexinteractions, different suscepti-bilities in children, separation ofcause and effect and cumulativeeffects. Laboratory assays shouldbe expanded to incorporate exposure during the perinatalperiod and development stages,and epidemiological studies areneeded on utero, perinatal andchildhood exposure.

What other risk factors shouldbe addressed by national plansto protect children againsthazards?

Food contaminationIn northern and western Europe, foodborne disease increased threefoldbetween 1980 and the late 1990s.

Poor nutritionPoverty is the main cause of poor nutrition but children and infants oftenreceive inappropriate nutrition, rangingfrom babies of two weeks being givensugared tea and cereal, to children ofall ages consuming high-sugar drinks

“Clean information”booklet from DenmarkA guide to products for

children and pregnant

women, recommending

products which do not

contain chemicals that are

environmentally degrading,

have hormonal effects or

contain perfume.

and junk food. Iodine deficiency isalso widespread in parts of westernand eastern Europe. An inadequatediet can lead to a lower immuneresponse and more infectious diseases,growth retardation, impaired learning,iron deficiency anaemia, congenitalanomalies, and obesity.

Hostile social environmentsAbandoned children, street childrenand trafficking of children in the sextrade have increased in the last decade, as migration, falling salaries,war, alcoholism and deregulation have taken their toll, particularly incountries in transition.


Making plans and putting them into practice6

Making national plansSome countries are preparing specificplans on children’s environment andhealth, whether national plans, localplans or plans addressing particularissues, such as a plan to reduce childinjury, or a plan for child-friendly urbanenvironments. Other countries areupdating existing plans.

These plans usually include anassessment of environmental andhealth impacts on children, an evalua-tion of the economic impacts and thesetting of quantitative targets as wellas the suitably phased implementationof actions.

Countries will be involved in:• Setting priorities, through weighingup the data on environmental andhealth impacts, community opinionand political support combined withthe severity of the problem and thehealth benefits gained by tackling it.• Working with many partners to planand implement measures. These willinclude local authorities, interest

To ensure the development and implementation of national

children’s environment and health action plans, we commit

ourselves to using and adapting existing national bodies on

environment and health or to establishing new mechanisms

that will involve all relevant stakeholders, including the

corporate sector, trade unions, child-focused NGOs and

parents, children’s and youth organizations. (CEHAPE paragraph 23)

groups, professionals, nongovern-mental organizations, local industry,schools and parent groups, youngpeople themselves.

Policymakers in health or environ-ment, or related areas, such as finance,transport, education, culture, energy,urban and rural planning, labour andsocial services – or anyone with a personal or professional interest inthe health of children now and in thefuture – will find that their contributi-on will make a difference.

Country experience: Serbia and Montenegro”The National CEHAP Committee

was set up on 7 October, 2005.

It covers several important

sectors: health, environment,

education, architecture, toxicology,

epidemiology, occupational

health, toxicology, international

cooperation and traffic, and it

plans to meet every two months”.

These are some steps that othercountries have found helpful in prepa-ring their children’s environment andhealth action plans

CommitteeAppoint a cross-sectoral committee tomeet regularly, representing ministriesof health, environment, education,transport, any other relevant ministries,NGOs and young people. Each meetingcould be organized around a particularRegional Priority Goal.

The committee could also organizesmall working groups on specific topicswith other interested stakeholders, eg local authorities or the public, eachonly convened only once or twice, to ensure their input and gain theirinterest, and report back to the maincommittee.

EvidenceExamine the evidence available: whatdata exists already on the exposure ofchildren to environmental hazards inyour country, and how is it affectingthem?

Identify what further data is needed,where it might be found and who can help obtain it. Obtaining furtherinformation can be part of the plan.

PrioritiesLooking at the evidence and with the Regional Priority Goals in mind,discuss and consider the priorities for

the children of your country: forexample, traffic-related air pollutionmight be more of a problem for yourcountry’s children than poor waterquality.

MappingNational legislation or governmentstrategies will already exist on someof the areas of CEHAPE. Look atwhere the overlaps are and wherethe gaps are. For example there mayalready be obligations under aEuropean Union Directive, or aConvention, or a relevant governmentstrategy. These may already havebudgets allocated to which you couldhave access and will give the NEHAPmore political clout.

Make sure that if there are otherrelevant government initiatives underway currently, on for exampleobesity or child safety, the CEHAPforms part of the thinking.

MeasuresMake decisions on the measures youwant to propose, using the CEHAPETable of Actions, the results of yourconsultations, evidence search, priority-setting and mapping.

Each proposal in the CEHAP shouldbe accompanied by the reason it isneeded, and what is already going onin that area. Be specific when itcomes to responsibilities and budget .

It might be helpful to make a tablethat shows which ministry and natio-nal authority is responsible for each ofthe actions, and at which level it sho-uld be carried out.

CommunicationConsider how to reach the differentgroups you need to support theCEHAP – for example politicians, pro-fessionals, NGOs, the media and thepublic. A workshop? A newspaper article? A booklet or TV spot? Thesegroups will make the difference inputting the plans into practice effectively.

ImplementationAllocate responsibility to specificmembers of the committee to promo-te, ensure and monitor implementationof the priorities identified above.Establish a mechanism whereby thisis regularly reported back to the

Steering Committee and to the environment and health focal point.

EvaluationEstablish a mechanism, for exampleindicators, or regular questionnaires,so that feedback is received from allstakeholders including civic society,nongovernmental organizations, localauthorities, national authorities andprivate industry. This will allow you to adapt and adjust the process ofimplementation as you go, as situations, resources and require-ments change, thereby achieving themaximum implementation possible.

Country experience: Hungary “We have made a review of the

national Hungarian legislation rela-

ting to children and containing

environment and health aspects.

19 pieces of legislation are under

analysis by environmental health

specialists.”


Checklist of national activities7

Making strategic plans involves manymeetings, whether internal meetingswith colleagues, or meetings withspecific groups such as paediatriciansor urban planners. The multi-sectoralmeetings are particularly valuable.Bringing various sectors together fora day workshop can focus minds andestablish the way forward. Plenarysessions will bring the participantstogether in a common purpose, and working groups will engage theindividual participants so that they canhave their say, see their contributionmore clearly and increase commit-ment. Initially, the participants mayknow little about the plan. Thesequestions may help in the workinggroups when they first meet:

1. Countries throughout Europe aredrawing up national action plans toreduce the environmental hazardsthreatening their children’s health.What do you see as the benefits foryour country of having such a plan?

2. What activities, strategies or pro-grammes are you already engaged in which are relevant to children’senvironmental health on for example,water, air quality, injuries, chemicalsand noise?

3. What problems do you anticipatedeveloping, promoting and implemen-ting the plan and how can they beovercome?

4. How best can you contribute to theplanning and implementation?

5. Your national plan will have to bedeveloped in many different sectors.How will you ensure that it is nonet-heless high on the political agenda?

6. What institutional frameworkwould you recommend to ensureimplementation and monitoring of thisplan for example a national commit-tee, an interdepartmental task force, agroup of scientific experts?

These questions may help in a latersession, once specifics start to bediscussed:

1. What do you think are the prioritiesfor the children of your country?

2. There are four regional prioritygoals within the Children’sEnvironment and Health Action Planfor Europe - on water and sanitation;air quality indoors and outdoors; injuries,accidents and physical activity, andchemicals, other physical agents, andoccupational health. Which are themost important areas for your country’schildren?

3. What evidence/information/data doyou think are still needed to identifythe priorities and the measures needed? What is already known andcan it be collected together?

4. What are the main sectors/depart-ments/stakeholders that should beinvolved in these Regional PriorityGoals, to ensure full consultation andappropriate implementation?

5. What existing strategies or programmes should be involved inthe CEHAP process?

6. National environment health action plans sometimes achieve cross-sectoral collaboration and endorsement at the high levels, butfail to reach a wider audience so failto be implemented. How will youensure that this action plan reachesall levels of society from the beginning, from the general public, to civil society, local authorities andthe different ministries?


Workshops: some questions8

Our CEHAPE work is to a large extentbased on meetings between people,and the longer we work, the more werealize how important it is to createfora for discussion between stake-holders that perhaps would not meetotherwise. We also realize how muchinformation and how many initiativesthere are already. Our experiencewith small working groups may behelpful to others.

Identifying subjectsWe have kept closely to the RegionalPriority Goals, which we find is anexcellent basis. To identify the mostimportant subjects to work on inSweden we have used our

Environmental Health Report, but thiscould be done in many ways, forexample in a small interview studywith a number of relevant stakehol-ders. As your work proceeds you willprobably change some of your prioriti-es anyway. It is often more importantto start, than to start in a “correct”way. If you do not have a good know-ledge basis for priority setting, a proposal on collecting environmentalhealth data may be an important partof the action plan.

Working groupsIn Sweden people have been veryeager to take part in the working groups. We try to keep the meetings

focused on one subject, for example“accidents”. We limit the number ofpeople to about five, so this is veryinformal. We present the idea of theCEHAPE and ask them to describewhat they do in their organizations inconnection to environment and children.We then ask them to provide us withreports and other documents thatmay be relevant, and we also askthem to make a proposal with actionsthey think should be included in theSwedish CEHAPE. At the same timewe try to make clear that in the end,the National Board of Health andWelfare will decide which proposalsto include. We do not plan to havemany meetings with each of the

working groups: probably two is enough. The rest of the communi-cation will be by e-mail.

Other groupsIn addition to this, we have a referencegroup and a steering group, and wewill organize a couple of workshops,but to prepare the plan itself, theworking groups are probably the mostimportant way to make progress. Thereference group and workshops areimportant for making the CEHAPEwork known in the country. We alsoinform our general director and theMinistry to keep them updated.


CEHAPE work in Sweden – some reflections from the focal point9

The Swedish CEHAPThe actual Swedish CEHAP will contain proposals for actions. It istempting to focus only on implemen-tation immediately, but to make progress it is essential to spend quite a bit of energy on planning andpreparation first. If this is done pro-perly, implementation will be a loteasier. We will structure our actionplan according to the RPGs. Eachsection will include subsections onwhat we want to do (proposals), why(evidence), and what’s already goingon. We will also be very specificwhen it comes to responsibilities andbudget (who should do it, and whoshould pay). We will probably make atable that shows which ministry andnational authority is responsible foreach of the actions, and at whichlevel (national/regional/ local) level itshould be performed.

Country experience: Austria“A national task force has been set

up known as the CEHAP Ö Task

Force, to develop a children's envi-

ronment and health action plan for

Austria. This task force is an inter-

ministerial coordination group

which meets at least twice a year,

and involves the ministries of envi-

ronment, transport, health, internal

affairs, education, labour, and inter-

ested regions and municipalities,

the Austrian Chamber of Doctors

and NGOs such as Doctors for the

Environment. Austria has carried

out a public awareness campaign

on CEHAPE and related initiatives,

with a brochure, "A healthy envi-

ronment for our children", drawn

up with the four ministries, the

chamber of doctors and doctors'

NGO. 16 000 copies are being

placed in doctors' waiting rooms

and sent to the municipalities”.

Country experience: Finland“We held an open seminar on

children, environment and health.

Its aim was to discuss threats to

children's health caused by envi-

ronmental factors in Finland and

potential actions to improve the

situation. There were altogether

almost 250 participants, including

representatives from environmen-

tal, school and other health care,

day care, education, science, admi-

nistration, local political decision-

making and NGOs. Using a written

questionnaire, the participants

were invited to submit their ideas

on how to proceed with the prepa-

ration of the action plan and their

opinions about the most important

problems and actions needed in

terms of children's environmental

health in Finland”


A representative national forum, suchas an interdepartmental steering group(ISG), can channel experiences andinformation to establish a national line.

• Focus can be maintained in theforum by having subcommittees anda secretariat to develop coherentplans and proposals for considerationby the wider group.

• Consider linking work on CEHAPEto very specific national goals or priorities in the area.

• Consider a “systems-based” approach to pursue both national andCEHAPE goals.

• Engage the health and environmen-tal constituencies and stakeholdersearly in the process and work toensure their continued involvement.

• Recognize the social, economic,cultural and behavioural context tomany environmental health problemsand their effect on health outcomes.

• Establish what is going on througha Scoping Study.

The United Kingdom’s response toCEHAPE is co-ordinated through anISG which brings together the relevantgovernment departments, representa-tives of government in NorthernIreland, Scotland and Wales and other agencies that will be involved in delivering CEHAPE Goals. TheDepartment of Health, which chairsthe ISG, has given the HealthProtection Agency (HPA) a lead role intaking forward aspects of the work inrelation to CEHAPE. The ISG alsodeals with the United Kingdom’sresponse to the European Union’sEnvironment & Health Action Planrelated to SCALE, the EU strategy onenvironment and health.

The ISG has capacity to combinerelevant scientific and policy expertiseon environment and health in a forumthat represents the breadth of secto-ral and institutional interests. Thus, itcan oversee and guide the delivery ofCEHAPE within the United Kingdom,but draw on examples of good practicefrom throughout the United Kingdomand beyond.

Important achievements driven by the ISG and/or its members to dateinclude:

• The commissioning of the CEHAPEScoping Study to offer a clear pictureof work that is relevant to the pursuitof CEHAPE (and SCALE) goals.

• Work to scope configuration andcontent of a United Kingdom Environ-ment and Health Information system,and a strategic approach to Environ-ment and Health.

The Scottish ExperienceScotland is now developing a systems-based Strategic Framework forEnvironment and Health to pursue anenvironment that is consistent withand promoting of human health.Initial priorities (cardiovascular diseaseand asthma) were chosen becausethey are important causes of morbidityand mortality in Scotland. Each is ahealth inequalities issue, in whichenvironment plays an important role.

A new conceptual model has beendeveloped to link environmental factors to health and also the range offactors which bear on the transitionfrom environmental state to exposureto health outcome. A document willbe published in Scotland to fullyexplain the overarching goal, the initialpriorities, the general approach, andthe core systems of strategy. It willalso address the practicalities of delivery.

The United Kingdom plans to useCEHAPE as a driver for a more strategic and effective approach to environment and health for childrenand for adults.

36 · PLANNING TO PROTECT CHILDREN AGAINST HAZARDS 37

Some top tips from the United Kingdom 10

PLANNING TO PROTECT CHILDREN AGAINST HAZARDS ·

• The commissioning of a HumanBiomonitoring Scoping Study to determine what national work is inprogress, relevant to a EuropeanHuman Biomonitoring Programme.

• The publication of the HPA’s “HealthProtection in the 21st Century” (theBurden of Disease Study). This exploresthe contribution of environment tohuman health in England and Wales.

• The publication of the EnvironmentAgency for England and Wales document, “Better Environment – Healthier People”. This seeks toidentify the big issues in environmentand health for England and Wales.

• An evaluation of the 44 environ-ment and health indicators proposedfor a European Environment andHealth Information System (EHIS).

It will take active involvement by all groups in society, including govern-ments, local authorities, parents,schools, professionals, trade unions,industry, NGOs and young people, toprotect children. Very often the NGOsand other civil society groups hold the

We affirm the importance of and need for communication

with the public at large on environment and health,

particularly where the interests of children and other

vulnerable groups are involved. We equally emphasize

the importance of the participation of children (Budapest Conference Declaration paragraph 18a)

key to implementation on the ground.They have members, publications,meetings and many fora at whichinformation about CEHAPE, its aimsand policies, can be disseminated,thus increasing ownership and professional, public and community

involvement. Every Member Statehas its own such groups, and manyare members of the European Environ-ment Network of the European PublicHealth Alliance, an international non-governmental organization advocatinggreater protection of the environmentas a means to improving the healthand well being of European citizens,and of the European EcoForum, anetwork of over 200 citizens’ environmental organizations.

Young peopleChildren and young people should be actively involved in reducing children’s exposure to health hazards.Child-friendly documents should bedeveloped and disseminated, to stimulate debate. Schools should beinvited to be involved and youngpeople engaged in dialogue with professionals.

Real youth participation Ensuring that young people have theirsay in national plans will make a diffe-rence to implementation and MemberStates are encouraged to involveyoung people on their planning committees and groups. At Budapest itself, there were youth delegates, a youth parliament and a YouthDeclaration. Meaningful, democraticyouth participation in decision-makingis being developed in the environmentand health process itself, as part of aproject supported by the Irish NationalChildren’s Office, Norway, the Baltic

Youth Forum, the European YouthParliament and Tunza, the youth wingof the United Nations EnvironmentProgramme. All Member States areinvited to get involved with this project, whose aim is to ensure thatyouth delegates have a meaningfulmandate to participate as members ofthe EEHC and the CEHAPE TaskForce.


Taking part 11

Young people at the Budapest Conference

An international workshop on environment and health youth participation, held in

Somarka in Norway, March 2006.

Country experience: Slovakia“Slovakia has a network of

environmental health advisory

centres for the public who are

interested about information and

advice in the environmental health

field, for example about drinking

water, quality of outdoor and

indoor air, envronmental noise, etc.“

Communication is essential when youare working across sectors, and willform an part of the plan. It should notbe an afterthought when all the meetings have been held. If themedia and the public are involvedearly in the planning, it will enhance

the ownership of the plan, becausepeople will understand the need for it,and implementation will become easier.It will also help to raise awareness,which you need if you are trying to get real changes in what people think andwhat they do. The target audience ofcommunication may be policymakers,industry, doctors, teachers, parents oryoung people, and close contact andcollaboration with them will help tofind the best way to reach the audienceyou need. At Budapest it was agreedto incorporate children’s environmentalhealth issues into professional curricula, so health professionals should be an early participating group.

Because environment and healthissues cut across the sectors, theycan be edged out by other depart-mental priorities and be politicallyweak unless the profile is kept high,thus ensuring that the budgets youneed access to are made available.Maintaining a high profile among decision-makers will mean involvingthe media, the research communityand NGOs.

Advocacy, communication, informationand education strategies may includeholding media briefings on the latestdata and issues relating to children’shealth and environment, or allowingmedia access to workshops held on the issues by parents, schools,teachers and doctors.

Public information campaignsAt Budapest, countries agreed to disseminate information on children’senvironment and health. Build thecost of your programme of communi-cation/ education into your projectplanning and consider the economicbenefits gained by the changes ofbehaviour, opinion or understandingthat you seek to bring about.

Tips for strategies • clarify your audience and how bestto reach them including websites,blogs, radio spots etc. How many ofus read leaflets?• define the change you want or riskfactor you want to highlight;

• define the messages and makesure they are consistent. No jargon!Make scientific material easy tounderstand;• include educators and managersfrom the beginning, make partnerships;• involve children and young peopleas communicators;• integrate environmental health intoprofessional curricula of health professionals;• evaluate outcomes and the channelsused;• adopt a professional approach throughout, as you would for otherpublic health topics;


Getting the message across12

The Arhus Convention whichcame into force in 2001, givesthe public the right to accessenvironmental information heldby public authorities. This caninclude information on the stateof the environment, but also onpolicies or measures taken, or onthe state of human health andsafety where this can be affectedby the state of the environment.Citizens are entitled to obtain thisinformation within one month ofthe request and without having tosay why they require it. In additi-on, public authorities are obliged,under the Convention, to activelydisseminate environmental infor-mation in their possession.

Thanks to TB advocacy: a practical guide,1999 (WHO)

Differences between scientific and advocacy communication

Science Advocacy

• Detailed explanations useful • Simplification vital

• Qualifications necessary • Qualifications can blur message

• Technical language needed • Jargon confuses people

• Can make several points • One or two strong messages best

• Must be objective and unbiased • Passion based on fact

• Builds case gradually • State conclusions first then support them

• Needs supporting evidence • Too many facts and figures overwhelm

• Haste can destroy credibility • Speed, with accuracy, needed

• Celebrity support irrelevant • Celebrity support may benefit

• Science truth “objective” • Political truth “subjective”

We recommend that effective action should be based on

systematic reviews of interventions designed to prevent and

reduce risk, whenever this information is available, and built

on existing experience and best practices. (CEHAPE paragraph 9)

At Budapest, countries agreed to col-lect data by using valid and comparab-le child-specific health and environ-ment indicators.

What is the infant mortality rate andwhat proportion is associated withenvironmental risk factors? Howmany children under 5 years of ageare dying from diarrhoeal diseases, or from cancer? What is the prevalen-ce of childhood asthma and is itdecreasing? What proportion of chil-dren have hazardous blood levels?How effective is a smoking ban inpublic places in terms of reducingchildren’s exposure to environmentaltobacco smoke? Without data andagreed indicators, it is impossible toanswer questions like these, and tomonitor how much progress is beingmade to protect children’s health against environmental hazards.

Work has been going on for sometime to establish a set of indicatorson children’s health and environmentto measure the environmental healthrisks and effects of interventions aswell as to enable international andinterregional comparisons to be linkedto national assessments.

Country experience: Finland“The Finnish Register for Conge-

nital Malformations monitors

congenital anomalies of live and

still-born children under one year

of age in order to identify potential

new teratogens. The register is

national and population-based,

run and funded by the National

Research and Development Centre

for Welfare and Health. This and

other registers (birth registry,

hospital discharge registry) have

been extensively used in epidemio-

logical studies investigating e.g.

trends in sex ratio and occurrence

of hypospadias in Finland. Finland

is involved in international studies

on congenital malformations of

male reproductive organs. For

example, studies are underway to

examine associations between

selected chemicals (persistent

organic pollutants, pesticides,

phthalates) and cryptochordism.”


Information and monitoring 13

Campaigns on environmental tobacco smoke and children from Cyprus and Latvia.

Translation: "Daddy, put that cigarette out." " Don't take that puff. Protect your children

from tobacco smoke."

Running with the herd? from the “Don’t drive like an animal” road safety campaign, Finland

The Budapest Conference reconfir-med the need for the environmentand health information system as anessential tool to support policy-makingin this field, enhancing access toinformation and facilitating communi-cation with the public. Through signingthe Declaration, the Member Statescommitted themselves to joining national and international actions withWHO, the European Commission andother international agencies on methodological and technical develop-ments.

A network of collaborating centresfor sharing information, expertise andgood practice examples benefitinghealth and environment – an impor-tant mechanism to ensure system

operation and its relevance for theMember States - has been established.Technical activities involving severalMember States are currently beingimplemented to develop and applyindicators, methods and tools forinformation generation, analysis andreporting to enable effective transferof the scientific knowledge aboutenvironmental health risks and theirprevention and mitigation in the policydebate. Any other Member Stateswho are interested in joining thisnetwork of partners and its methodo-logical development are welcome, asthis will ensure that the system willmaintain relevance to countriesacross the European Region.

Country experience: Serbia and Montenegro“The Environmental Atlas of

Belgrade has been produced which

represents a basis for the balanced

determination between quality of

the environment and the city

spatial-function. The Atlas analyzes

and estimates the environment,

based on existing data, studies

and measurements, validates space

from the environmental standpoint,

makes environmental zoning of

the Belgrade area and estimates

optimal intended use of the area

in the function of sustainable

development. The results of these

studies add to the evaluation of

the most important environmental

hazards and related health

consequences in children.”

The indicators on children’s healthand environment focus on exposuresand related health effects taking into account children’s needs and vulnerability. They also include actionindicators, which count policy initativesthat have been taken, such as puttinginto place policies on child labour,reducing child obesity or the enforce-ment of legislation to prohibit smokingin public places. More information canbe found on the environment andhealth information system athttp//:www.euro.who.int/ehindicators.

The aim of the EuropeanCommission´s contribution to theBudapest Conference, theEnvironment and Health Action Plan

2004-2010, is to generate the infor-mation needed to analyze potentialimpacts, to assess whether currentaction is sufficient and to identifyareas where new action is needed.

Country experience: France“In France, a national birth cohort

study of 20 000 children and their

families, is being prepared (action

26 of the NEHAP). The children will

be followed from birth to adulthood.

This long-term project aims at

understanding the links between

environmental risk factors and

health effects. The enrolment of

the cohort will start in 2008 and

children will be monitored until

they reach adulthood.”


WHO Regional Office for Europe(2004) Children's Environment andHealth Action Plan for Europe: Fourth Ministerial Conference onEnvironment and Health, Budapest,Hungary, 23-25 June 2004.Copenhagen, WHO Regional Officefor Europe(http://www.euro.who.int/document/e83338.pdf).

WHO Regional Office for Europe(2004) Declaration: Fourth MinisterialConference on Environment andHealth, Budapest, Hungary, 23-25June 2004. Copenhagen, WHORegional Office for Europe.(http://www.euro.who.int/document/e83335.pdf).

WHO Regional Office for Europe(2004. Youth Declaration: FourthMinisterial Conference onEnvironment and Health, Budapest,Hungary, 23-25 June 2004,Copenhagen, WHO Regional Officefor Europe.(http://www.euro.who.int/document/e83350.pdf).

Licari L, Nemer N, Tamburlini G(2005). Children’s health and environ-ment. Developing action plans.Copenhagen, WHO Regional Officefor Europe(http://www.euro.who.int/eprise/main/WHO/

InformationSources/Publications/Catalogue/20050812_1).

Valent F et al (2004) Burden of disea-se attributable to selected environ-mental factors and injury among chil-dren and adolescents in Europe.Lancet, 363 (9426): 2032 – 2039.

WHO Regional Office for Europe,(2004), The children’s health and envi-ronment case studies summary book;work in progress. Copenhagen, WHORegional Office for Europe(http://www.euro.who.int/Document/CHE/

CHECSSBook.pdf)

Also web-based CEHAPE ActionPack, including the Table of child specific actions on environment and health(http://www.euro.who.int/childhealthenv/Policy/

20050629_1)

Valent F et al, (2004) Burden of disea-se attributable to selected environ-mental factors and injury amongEurope’s children and adolescents.Geneva, World Health Organization,(Environmental Burden of diseaseseries, No 8. http://whqlibdoc.who.int/publications/2004/

9241591900.pdf)

Robertson A et al. Food and health inEurope: a new basis for action, (2005)WHO Regional Office for EuropeWHO Regional Publications, EuropeanSeries, No. 96(http://www.euro.who.int/document/e82161.pdf).

WHO Regional Office for Europe(2006) Environment and health - aninternational concordance of selectedconcepts, Copenhagen, WHORegional Office for Europe. (in publi-cation)

World Health CommunicationAssociation (2005) Working with themedia: Health and environment com-munication. Action Guide. I 2005.ISBN 0-9547620-2-9- Available fromthe European Public Health Alliance.(http://www.env-health.org/IMG/pdf/English_final-2.pdf).

Websites WHO’s Children’s Health andEnvironment Programme website,with special pages on CEHAPE imple-mentation, and Action Pack.http://www.euro.who.int/childhealthenv

A country-by-country implementationmap, plus activities and plans beingdeveloped in Member States on theRPGs, can be found on the websiteof the European Environment andHealth Committee (EEHC) http://www.euro.who.int/eehc/ctryinfo/ctryinfo

Activities of the CEHAPE Task Force,which brings together the Region’sofficially designated environment andhealth focal points can be found athttp://www.euro.who.int/eehc

European Environment and Healthhomepage of the EuropeanCommission:http://www.europa.eu.int/comm/environment/health/

index_en.htm

European Environment Network ofthe European Public Health Alliance, anetwork of nongovernmental organi-zations. EPHA has a CEHAPE imple-mentation website. http://www.cehape.env-health.org

Audio visual materialVideo messages on environment andhealth: highlights from theWHO/Europe Media Award 2004.(VHS format) Useful for classroomsand meetings; examples of powerfulpublic service announcements madefor television. With accompanyingscript in English and Russian. Write [email protected]

Posters on implementation of CEHAPE can be obtained from thesame email address or from theSpecial Programme on Health andEnvironment, WHO Regional Officefor Europe, Scherfigsvej 8, DK2100,Copenhagen, Denmark.

All websites accessed 3 March 2006


Further resources14

Support from WHOWHO Regional Office for Europeprovides not only technical assistance but also tools that can be useful in capacity buildingin for example, workshops ondeveloping policy on CEHAPE,training in methodology for assessment of burden of disease,training the trainers and mediainvolvement. Contact details overleaf.

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Environment and Health Coordination and PartnershipSpecial Programme on Health and EnvironmentWHO Regional Office for Europe

Scherfigsvej 82100 Copenhagen ØDenmark

Tel: + 45 39 171717Fax: + 45 39 171818

Email: [email protected]: http://www.euro.who.int

This booklet was produced with the kind support of the Department of Health and Children, Ireland.

a handbook - kinder umwelt gesundheit · any translation should include the words: the translator...

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