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Health and Environment
PAHO-UNEP Cooperation and the
Regional Agenda
11 March 2014
Side event at the Forum of Ministers of Environment
of Latin America and the Caribbean
Public Health and the Environment
- Framing PAHO-UNEP Cooperation with MS •
“Health is a precondition for and an outcome and indicator of all three dimensions
of sustainable development” (UNCSD “Rio+20”, The Future We Want)
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Environmental determinants of health can be natural or anthropogenic, physical,
chemical, biological, and ecological
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24% of the years lived with disability, and 23% of premature mortality are
attributable to the environment. (Pruss-Ustun et al, 2006, Lim SS et al., 2012)
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Risks are socioeconomically determined: half of infant deaths and 46% of total
maternal deaths in the Region are concentrated among the third of countries with
the lowest access to piped water. (PAHO, 2012)
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Our changing environment: 63 LAC cities have one million or more inhabitants; 38
of them are in areas at greatest risk for at least one type of natural disaster; six are
in areas at greatest risk for two types; and two are in areas at greatest risk for three
or more types (PAHO, 2012)
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Mining activities doubled or tripled in various countries between 2001 and 2011,
contributing as much as 11% to 27% of national GDP (ECLAC, 2012), increasing health
risks.
Objectives and areas of PAHO-UNEP cooperation
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Objective: Develop stronger links between environment and health in
policy and planning, including in the work of PAHO and UNEP and
ministries of health and environment
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PAHO, UNEP, the Organization of American States (OAS) and other
partners supported the Health and Environment Ministers of the
Americas (HEMA) process, initiated in 2002
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Participated in Task Force of senior health and environment officials, which
agreed on a set of concrete actions in line with 8 priorities and 12 goals
identified by the HEMA meeting in Ottawa in 2002
Follow up to Declaration of Mar de la Plata 2005 (three priority issues: integrated
management of water resources and solid waste; sound management of
chemicals; and children´s environmental health)
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GEO Health methodology developed and tested in Brazil and Argentina
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Areas of cooperation—recent or under development:
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Chemicals
Air pollution
Climate change
Chemicals: UNEP-PAHO GEF DDT project
2003-2008 – ext 2011
Objectives
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To prevent the reintroduction of DDT for malaria control through the
demonstration and evaluation of alternative and integrated methods of
vector control that are cost effective, replicable, and sustainable.
Participants
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Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua,
and Panama
Results:
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Participation of 202 communities in 52 municipalities, mostly indigenous;
Sustainable strengthening of disease surveillance, with 63% reduction in
malaria cases – some malaria free communities;
184.404 tons of DDT and other POPs repacked or incinerated.
High impact project, as the methodologies tested in the project were
instrumental to design similar UNEP projects in Asia and Africa.
Chemicals: Total Diet Studies in Panama
Government of Panama, PAHO, UNEP, UNDP, FAO, WFP
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Intensive agrochemicals use in Central America: food is one of
the main sources of chemical exposure
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Total Diet Studies take into account average diet, and chemical
concentrations in different components of it
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They can support science-based and appropriate regulations
and/or recommendations for the food industry
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Project aims to develop national capacity, and serve as a case
study for possible replication by other countries
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Results due to be published in mid 2014
Chemicals: Mercury
Implementing the Minamata Convention
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The Convention recognizes the role of WHO in the preamble.
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Diplomatic Conference resolution on the Convention invites
WHO to support implementation of the Convention.
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WHO Executive Board recommended the 67th World Health
Assembly in May 2014 to pass a resolution on the role of
WHO and Ministries of Health in implementation of the
Convention.
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Greening the health sector – phasing out the use of mercury
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Artisanal and Small-Scale Gold Mining (ASGM)
Air Pollution and Health
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Indoor air pollution from the use of solid fuels is the leading
environmental risk factor worldwide, and the fourth overall risk factor
for burden of diseases. (Pruss-Ustun et al, 2006, Lim SS et al., 2012)
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Solid Fuel Use social gradient: 58.2% of the population exposed to solid fuels is
concentrated in the lowest quartile of HDI, while 5% was concentrated in the
highest quintile of HDI. Rural/urban rate is 2.3 in the lowest HDI quartile and 11.7
in the highest quartile of HDI, respectively;
Air pollution is the second leading environmental risk factor, being the
ninth overall risk factor for burden of diseases (cancer was not
included in the estimates). (Pruss-Ustun et al, 2006, Lim SS et al., 2012)
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Most of the large and medium-sized cities of the Region, and some capital cities,
do not have air quality monitoring networks ( PAHO, 2012).
It is estimated that more than 100 million inhabitants are exposed to
concentrations of environmental contaminants exceeding the recommended
level in WHO air quality guidelines.
The GBD2010 attributes a quarter of a million premature deaths per year in the
Region to ambient air pollution.
Regional Action Plan on Air Pollution
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Proposal presented to this session of the Forum, prepared by Clean
Air Institute (CAI) and Mexico´s National Institute of Ecology and
Climate Change (INECC) with contributions from experts in Regional
Intergovernmental Network on Atmospheric Pollution
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Includes objectives, strategy, priority pollutants, and strategic actions
in different sectors (transport, bricks, biomass for cooking, power
plants, oil and gas, solid waste and wastewater, agriculture, forestry
and livestock, and others)
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Medium term goals including:
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Goal 1 (4 years): “100% of countries in the region have adopted national
standards for air quality in direction to WHO guidelines, and/or harmonization
processes”
Goal 4 (8 years) “Reduce the growth rate of the population exposed to levels of
particulate matter above the limits set by WHO”
WHO Air Quality Guidelines
• For each 10 µg/m3 increase of PM10 there is an estimated excess or risk of
death of 0.7% in Mexico City, Santiago and São Paulo (HEI, 2012. ESCALA)
• National Air Quality legislation present in 19/23 countries; no
information from 12/35 countries
• Most countries in LAC do not follow WHO AQG
Climate change
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Cooperation on this theme within the framework of the Strategy and
Plan of Action on Climate Change and Health in the Americas
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International Seminar on Climate Change and Health, Mexico, 4-6 Sept
2013
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Representatives from Ministries of Health and Environment from more than 15
countries in Latin America and the Caribbean
Development of a virtual community of practice for knowledge
exchange on climate change and health (REGATTA programme)
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Moderated by the Mexican Institute of Public Health
To be launched late March 2014
Project on raising public awareness of air pollution and climate
change in Mexico City
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Builds on the Mexico City Programme of Action on Climate Change 2008-2012
Components include:
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Strengthening the science base
Creation of capacities
Communications campaign
Public policy recommendations
Health and environment in the ILAC framework
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A number of health and environment issues reflected in current ILAC framework: air and water
pollution, sanitation, urban green space, renewable energy
THEMATIC AREA
OBJECTIVE
SPECIFIC OBJECTIVE
2. WATER RESOURCES 2.4 Improve the quality of terrestrial 2.4.1 Improve the quality of effluents and reduce the discharge of pollutants to surface and underground
MANAGEMENT
waters
water bodies and to coastal areas
3.3 Reduce air pollution
3.3.1 Reduce the concentration of polluting emissions in the air
3.4 Reduce water pollution
3.4.1 Widen the coverage of water supply and waste water treatment
3. VULNERABILITY,
3.5.1 Reduce the generation of solid waste (from domestic and industrial sources) and promote recycling and
HUMAN SETTLEMENTS
AND SUSTAINABLE
3.5 Integrated management of solid reuse
CITIES
waste
3.5.2 Implement integrated management of solid waste, including treatment and adequate final disposal.
4. SOCIAL ISSUES,
INCLUDING HEALTH,
INEQUITY AND
POVERTY
4.1 Reduce the prevalence of HIV /
AIDS and morbility due to illness
related to the environment
4.1.1 Implement integrated measures to control and reverse the spread of HIV/AIDS, including the
development of coordinated approaches for research, education, treatment and access to retroviral
pharmaceuticals
4.1.2 Implement policies and plans to reduce environmental risks that cause health problems, especially
waterborne diseases, vectors, airborne diseases and those borne through exposure to chemical substances
4.1.3 Increase the proportion of green and healthy areas per capita
5. ECONOMIC ISSUES, 5.1 Increase the use of renewable
INCLUDING TRADE AND energy
PATTERNS OF
PRODUCTION AND
5.2 Increase clean production
CONSUMPTION
5.1.1 Include at least 10% of renewable energy in the energy matrix of the region by 2010
5.2.1 Install Cleaner Production Centres in all countries of the region
The way forward
Pos 2015 and the SDGs
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Inter-agency and multisectoral collaboration is key to implement the Regional public
health and the environment agenda
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Public health and environment indicators are essential to measure the SDGs
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Identify the health co-benefits & risks in environmental policies
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Focus on policies/investments that are beneficial to health and equity; Example:
policies to mitigate climate change and air pollution
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Knowledge needed: improve data on air quality; relative contribution of different
sources of pollution; evidence on the effectiveness of interventions; strengthen
systems to collect and analyze local environmental and health data to inform trends
and impact of policy measures; improve methods to estimate emissions where
exposure is not measured