An increasingly acute problem * WHO-Europe: the driving force * The European Union commitment in its action programmes * The stakes for Belgium * The involvement of civil society * Conclusions

An increasingly acute problem

· New aggravating factors

What determines whether people are in good or bad health? There are several determining factors, including the quality of our environment. We have always known that there is a link between the environment and health. But more recently, this question has taken a more worrisome turn. In our society, there are two main factors that are harmful to health: the proliferation of chemical (HTML) to which human beings are exposed, and the growing contribution of automotive transport (HTML) to overall pollution. For example, several scientific studies have demonstrated that, each year within the European Union, more people are killed by air pollution from cars than by traffic accidents.

· Why research and policy have lagged behind

According to European Commission figures (in French) (.PDF), around 20% of the diseases occurring in the industrialised countries can be attributed to environmental factors. Nobody questions that the environment has an impact on health. However, that being said, it is difficult to accurately measure and quantify that impact. Firstly, the environmental impact on health takes place over the long term. And secondly, the different pollutants interact with one another, in what is known as the “cocktail effect”. Scientific research has so far focused more on pinpointing the consequences of individual pollutants, which partly explains the slow government reaction (sse also fact sheet  NEHAP - citizens (HTML)).


WHO-Europe (WEB): the driving force

· The first alarm

On the political level, it was the World Health Organization (WHO) – Regional Office for Europe that first sounded the alarm and stressed the need to take environmental health seriously.

WHO-Europe brings together 52 countries of the wider Europe, from Portugal to Russia and from Caucasus and Central Asia to Finland, with Belgium naturally belonging to it as well.

Every five years, WHO-Europe organises an international conference bringing together the ministers of the environment and health of the organisation’s Member States. These conferences have played a key role in raising awareness of the links between environment and health, and have led to the adoption of the first measures on the subject.

· The four conferences

The first conference, held in Frankfurt in 1989, set the ball rolling; it highlighted the links between environment and health and recognised that “Every individual is entitled to an environment conducive to the highest attainable level of health and well-being” and endorsed the European Charter on Environment and Health (.PDF).

The second conference, held in Helsinki in 1994, initiated a process of mobilising all governments. The States were invited to draft National Environment and Health Action Plans. Thus on 3 April 2003, the Belgian NEHAP was signed by the environment and health ministers - at all levels of power. It called upon the administrations of the two departments to work more closely together.

The third conference, held in London in 1999, concentrated on two more specific themes: water and transport. This led to the establishment of a Protocol on Water and Health (WEB), ratified by Belgium in June 2004, and to a Charter on Transport – Environment and Health process(WEB).

The fourth conference, held in Budapest (WEB) in June 2004, focused on children. Belgium notably undertook to devise a “Children, Environment and Health” action plan. But other important aspects are also mentioned in the ministerial declaration (.PDF):
· follow-up of the preceding conferences;
· new concerns such as housing and the consequences of extreme weather events;
· the need to have reliable data and applying, if necessary, the precautionary principle in environmental and health policy-making;
· continuation of the process and the importance of closer cooperation between the WHO and other international organisations, notably including the European Union.


The European Union commitment in its action programmes


Since 1992, the protection of the environment and health have been enshrined by the Maastricht Treaty (article 175 EC Treaty). Numerous directives and regulations, notably those on waste management, outdoor air quality and water quality, are helping to improve public health. As the new EU Member States implement the body of Community law, this positive development will be consolidated further.

Nevertheless, as recent reports of the European Environment Agency (WEB) have demonstrated, a number of parameters continue to pose problems.

The environment, health and quality of life is thus one of the priority areas for action under the 2002-2012 APE programme. Water and air quality, but also chemicals, pesticides, noise and the urban environment are the most salient elements of the report. In this sense, the establishment of thematic strategies relating to air quality, pesticides (HTML), and the draft REACH Regulation(HTML), are all fundamental tools for a proactive environmental health policy.

The European Action Programme in the field of public health (2003 - 2008) (WEB)
In the wake of the Community Action Programme (WEB) relating to pollution-related diseases (1999-2001), the 2003-2008 programme highlights the importance of the environment as a decisive factor for health. It calls for:

· improved information and knowledge with a view to promoting public health and health systems;
· a better capability to make a rapid and coordinated response in light of cross-border threats such as HIV, the new variant of Creutzfeldt-Jakob disease and pollution-related ailments;
· action on the determinants of health while placing the priority on factors related to lifestyle, socio-economic situation and the environment (consumption of tobacco, alcohol, drug addiction, nutrition, stress).

· The (see link The Sixth Framework Programme for Research and Technological Development (2002 - 2006) (WEB)).

One of the key actions of the 5th Framework Programme (WEB) (1998-2002) had the objective of reducing the impact on health of factors such as air pollution, heavy metals, toxic substances, electromagnetic radiation and noise pollution, notably in the workplace.

The 6th Framework Programme (2002-2006) aims to set up a “European Research Area”, notably by establishing networks of excellence and integrated projects on a wide range of themes.

· The Environment and Health Strategy (WEB)

In line with these programmes and to tie in with the work of the WHO, in June 2003 the European Commission adopted a “European Environment and Health Strategy (.PDF). The overall objective of this strategy is to prevent diseases caused by environmental factors. It is based on the following fundamental principles, adding up to the acronym SCALE:
o It is based on Science, in order to expand our knowledge about the often very complex links between the environment and health.
o It is focused on Children, because they are particularly vulnerable to environmental hazards.
o It calls for providing information and raising Awareness of health problems relating to the environment and the ways to solve them.
o It argues for a revision of Community Legislation so as to take account of the particular situation and needs of children.
o It operates within a logic of continuous Evaluation.

The guiding thread of the strategy is integration, because it entails:
- integrating all information on the relationship between the environment and health;
- integrating the environmental health issue into all Community policies (e.g., transport);
- integrating all of the parties involved, by advocating cooperation among all the players concerned.

To respond to this, the members of the Commission responsible for the environment, public health and research are developing action plans in cycles.
The first plan covers the period 2004-2010 and concerns diseases that target children:
· respiratory diseases of children, asthma, allergies;
· neurological development disorders;
· childhood cancers;
· disorders of the endocrine system.

Various environmental factors can cause or contribute to aggravating these diseases. Within this framework, particular attention has been paid to heavy metals, dioxins, PCBs and endocrine disruptors.

Belgian experts in various fields took part in the working groups which answered a whole series of questions, and proposed measures to the Commission.

On the basis of this work, at the Budapest Conference the Commission presented the Environment & Health Action Plan 2004-2010 (vol 1) (WEB) and vol 2 (WEB), whose actions are concentrated in three areas        

· Better understanding how exposure to the environment impinges on health. The measures include monitoring parameters relating to health and the environment as well as the various routes of exposure.
· Strengthening research activities, notably on the four priority diseases but also on emerging issues such as the impacts of climate change on health.
· Re-examining and adapting the risk reduction policy; improving communication.

The stakes for Belgium

· The repartition of powers in Belgium (see also: NEHAP - documents (doc I) (WEB))

In Belgium, according to the special law of institutional reform of 8 August 1980 the three regions are responsible for most areas of the environment. But the Federal Government retains still some important prerogatives.

The mission of the Federal Agency for Nuclear Control (WEB) is to protect the population against ionising radiation.

The FPS for Employment and Labour manages the internal police measures concerning the protection of workers (WEB).

The activities of the Directorate-General for Environment focus on:
- integrated product policy;
- reducing greenhouse gas emissions, in line with the commitments made under the Kyoto Protocol;
- policy on the marketing of chemicals and the prevention of hazards due to non-ionising radiation (mobile telephones) and noise;
- inspection related to the marketing, approval and use of these products;
- the registration and inspection of waste in transit;
- co-ordinating and implementing international environmental policy like biodiversity;
- protection of the North Sea.

The special law of 8 August 1980 (.PDF) devolved the powers concerning health between the Communities and the Federal Government.
Generally speaking, the Communities are responsible for health promotion, the departments of inspection and screening of infectious diseases and cancers, collection of health data and prevention policies, notably vaccination.
The Federal Government covers the other aspects of health policy, which notably include health and disability insurance, the basic rules for financing hospitals and national disease-prevention measures.

In practice, however, things are more complex, as a few examples will illustrate.
· Flanders opted for a Community-Region merger.
· The French-speaking Community transferred some of its powers to institutions of the Walloon Region and the Brussels-Capital Region.
· The German-speaking Community exercises all the powers devolved by the special law regarding health but the Walloon Region is competent regarding environment.
· The Brussels-Capital Region works on its territory with its Community Commissions and, for some aspects, together with the Flemish and French-speaking Communities.
· Some of the tasks mentioned above have been delegated to other organisations, such as the Provinces, the Institute of Public Health, etc.

· The challenges

Given this institutional reality, Belgium must rise to four major challenges in order to act effectively:

1. Structuring measures into a coherent overall plan

Whatever levels are competent, measures can be effective only if they are coordinated and form part of a coherent overall plan.
A first step was taken with the establishment of the Joint Inter-ministerial Conference on Environment and Health (JICEH). This conference brings together the competent ministers from the three levels of government: Federal, Regional and Community (see fact sheet CCIEP - administration (HTML)). On 10 December 2003, the JICEH also approved a cooperation agreement aimed at coordinating the management of environmental health policies.

2. Speaking with one voice at international level (see fact sheet  CCIEP - administration (HTML))

Belgium must be able to speak with one voice in international and European fora; The co-operation agreement of 10 December 2003 set up a national Cell on environment and health in which the competent administrations are represented; its mission is to prepare Belgian positions and drafts to be submitted to the JICEH.

3. Bringing the environmental and health players closer together

Even today, environment and health specialists still tend to work separately from each other. Despite being complementary, these two sectors speak different languages and use approaches that are sometimes quite different from one another. The goal is therefore to foster cooperation and create a real synergy between them.

4. Establishing links with other sectors (transport, energy, economy, etc.) and taking account of sustainable development

The example of air pollution is illuminating. Effective environment and health measures can be taken only if the transport and energy policies are both involved and an assessment of the costs and benefits of action or inaction is made on the economic, social and environmental levels.

· The National Environmental Health Action Plan (NEHAP)

Faced with these challenges, the NEHAP contributes more than just Belgium’s response to the commitment made in 1994. It takes stock of the scientific data currently available on environmental health issues. It inventories the measures taken at community, regional and federal levels. (see link NEHAP - documents (doc I) (WEB))

It reports on the general situation of the links between the environment and health in this country (see link NEHAP - documents (doc II) (WEB). And finally, it proposes priorities for action and a general framework applicable to all the players.

· The basis: seven specific recommendations

The NEHAP makes seven recommendations, which serve as a basis for government action as a whole (see also link NEHAP - documents (doc III) (WEB):

1. Establish functional cooperation between the existing structures of the environment and health.
The adoption of the NEHAP, the signature of the cooperation agreement and the setting-up of cooperative structures at different levels of government are the first steps in that direction.
2. Develop and manage databases covering all aspects of environment and health.
The data are the basis of all government policy and depend, in these subject matters, on the three levels of government involved in the agreement.
3. Define priorities for research into the relationships between the environment and health.
It is essential that this research be coordinated at international and European level, so creating the necessary synergies.
4. Develop a prevention policy for the relationships between the environment and health.
Prevention is one of the basic tools in the field of the relationships between the environment and health.
5. Communicate on the relationships between the environment and health.
In particular, it is necessary to find an effective way to bring the public’s concerns to the attention of the appropriate decision-making level.
6. Support the development of specific courses and training on the relationships between the environment and health.
Among other things, the challenge is to integrate the environmental dimension into the training of health professionals.
7. Raise awareness and educate people about the relationships between the environment and health.
The goal is ultimately to get citizens – especially young people - to change their everyday habits (for example, with regard to transport or domestic lifestyles).

The NEHAP partners thus act on two levels:

· By jointly deciding on and financing common projects, proposed by the national Cell and implemented within the framework of the cooperation agreement (e.g. a study on environmental health indicators). On this level, DG Environment plays a central role, notably by handling international representation and the federal secretariat of this unit. More information: link NEHAP (WEB)

· By informing one another of their own projects that they are implementing under their exclusive competence.

Thus Flanders adopted an environmental health policy based on the debates within the Flemish Parliament early in 2001. More information: milieu en gezondheid (WEB) and milieugezondheidszorg (NL) (WEB)

Wallonia, on the other hand, has created an environmental health platform responsible for proposing a regional environmental health action plan. More information:
Institut scientifique de service public (FR/NL) (WEB)

Since 1999, the Brussels-Capital Region has had a health-environment interface which is also planning to draft such a regional plan. More information: Bruxelles Environnement - IBGE (FR/NL) (WEB)

In its five-year programme (2004-2008), the French-speaking Community made the promotion of environments favourable to health one of its priorities. More information: Direction générale de la santé (FR) (WEB)

Not wishing to be outdone, the federal authority has introduced environmental aspects into the “health” measures of the Federal Plan for Sustainable Development (2004-2008). More information: Commission Interdépartementale du Développement Durable (WEB)

In short, things are starting to happen, and this is only a first glimpse of the potential action in Belgium. In this connection, it is worth taking a look at the NEHAPs devised by our neighbours. (see also NEHAP (WEB))

The involvement of civil society

Environmental health is a relatively recent issue, including for civil society. In Belgium, however, it is in the process of taking shape. Increasingly, groups of patients, neighbourhood committees and other associations are setting themselves up as information relays or interfaces between government, scientific experts and the public. Unions are gathering information and passing it on to workers. Business federations are also making their voices heard.

Depending on the issues involved, NGOs are also joining international networks, so allowing them to make an active contribution to the discussions going on within the WHO and the European Union as well as in Belgium.
Thus, for example, many Belgian NGOs (WEB) took part in the preparation of the European Commission’s Environment & Health Action Plan 2004-2010.

Various representatives of civil society, including from the union and corporate worlds, took part in the Belgian ministerial delegation attending the Budapest Conference. (see link NEHAP (WEB))
Furthermore, the Paris Appeal (WEB), launched in May 2004 at the initiative of scientists and doctors, has gone well beyond its initial framework. Nowadays, the whole of civil society is backing this Appeal in order to expose the chemical hazards threatening human health. The trade-unions (WEB), business federations and NGOs have taken an active part in the consultation on the NEHAP by submitting their own opinions or by sitting on the various advisory councils, including the Federal Sustainable Development Council (.PDF).

In December 2003, the NEHAP (WEB) partners organised the first “Belgian Environmental Health Day” bringing together the main Belgian players involved in this issue. The federal administration is continuing to develop this dialogue and these exchanges with civil society.


The links between the environment and health have clearly become a topic of discussion in most decision-making circles, despite the scientific uncertainty that remains about some aspects.
Nevertheless, it is important that a common line be followed from international to local level, and that these links give rise to preventive or corrective measures, even where there is no legal obligation to do so.

Belgium has not remained inactive. Despite its complex institutional context and the high stakes, it has succeeded in developing a mechanism for coordinating all the levels of government around these environment and health links. The first concrete measures are now taking shape. These are only the first steps that will be taken in order to offer the Belgian public a high level of well-being.