EHJ August 2003, pages 250-251 Tina Garrity looks at proposals to forge a more integrated and co-ordinated approach to environment and health within EU policy making

A more co-ordinated approach to environmental health issues within EU policy making is on the cards with the publication by the Commission of a new European environment and health strategy. Traditionally, environment and health have been treated as somewhat separate entities, each having its own action programme. These programmes will continue, but will increasingly interact with each other to inform the new strategy.

Rationale and objectives

The strategy begins by setting out its rationale, namely that while many environmental health problems have undoubtedly been solved under the current approach of focusing on single pollutants in separate environmental media, some health impacts have also been underestimated because the underlying situation can be more complicated than appears.

According to the Commission, the transfer of pollutants between different environmental media and the fact that people are exposed to a combination of pollutants which then interact in the environment and the human body, gives rise to a complexity not taken account of in existing policy responses. The new strategy envisages a community system which integrates information on the state of the environment, the eco-system and human health, and thus creates an environmental health "cause-effect" framework to inform future EU policy making.

Three key objectives for the strategy are laid out:

• to reduce the disease burden caused by environmental factors in the EU;
• to identify and prevent new health threats caused by environmental factors; and
• to strengthen EU capacity for policymaking in this area.

A longer-term objective will be to strengthen the research base for the economic valuation of health impact of policies, measures and technologies, with particular focus on environment and children's health. Like all good strategies it will have an acronym - SCALE - reflecting its key elements: S means it will be based on science; C means it will focus on children; A means it will raise awareness; L means it will use legal instruments; and E means it will include constant and continuous evaluation.

Need for integration

The word "integration" is used repeatedly throughout the text. The strategy envisages the integration of information, the integration of research, and the further integration of environmental health concerns into EU policies and activities. Additionally, it will promote an integrated understanding of the cycle of pollutants, once released into the environment. Also envisaged is a policy of integrated intervention in environmental health matters. Last, the Commission wants to see more integration of stakeholders so that there is close co-ordination between the environment and health sectors. The strategy states that this should include national, local and regional authorities, the public, industry, academia, as well as international and non-governmental organisations.

Data collection

There are several environment and health information initiatives being developed at present and a number of existing programmes collecting information. Much of the data to support the strategy will come from the 6th environment action programme (EHJ, November 2002, page 344.) Data on the health impact assessment of environmental threats will come from the new public health action programme (2003-2008) adopted in September last year, eg, through its European public health informatic network (EUPHIN) which will be storing the EU's environmental health indicators. Added to this, the EU's research programmes will explore contamination and exposure pathways and causality links for pollutants and the application of research to the development of novel and improved production systems to reduce potential health hazards.

The new chemicals strategy, REACH, (EHJ, July 2003, page 220) will also furnish useful information for the strategy, while it will also need to develop synergies with the Community Strategy on Health and Safety at Work, it recognises. One key objective is to agree on the type of data that should be shared at European level and to develop standardised protocols for data collection. A major problem at present is the lack of comparable data with which to make meaningful judgements.

Two particular initiatives will inform the strategy. The global monitoring for environment and security (GMES) initiative seeks to bring understanding of environmental stressors on a global scale exploiting the potential of earth observation. Meanwhile the INSPIRE initiative will seek to collect and disseminate spatial data to support environmental policies.

Integrated monitoring system

Three key elements are envisaged to kick start the new system. First, existing national campaigns and related initiatives on bio-monitoring with respect to children will be better co-ordinated with a view to developing a permanent harmonised European bio-monitoring system. Special attention will be paid to priority pollutants and urban areas.

Second, there will be three pilot projects on dioxins, heavy metals (including a strategy on mercury next year) and endocrine disruptors, designed to develop methodology for integrated environmental and health monitoring and to review related legislation. The results will be used to develop a European integrated environment and health monitoring and response system.

Third, the development of environment and health indicators within the new public health programme will be conducted in the context of the European Community health indicators project (ECHI) of which environmental indicators form a part.

Parts of the strategy are already in place. For example, within the context of the European Health Forum, established in 2001, there is a policy interpretation network on children's health and the environment. This will provide a focus for the co-ordination and interpretation of research results from a number of EU-funded projects on children's environmental health and genetic susceptibility to environmental toxicants in relation to the development of policy. There will be annual research meetings and reports on children's health and environment, along with a database of research projects in the area.

The Commission is also developing methodologies to help to identify exposures and to perform combined exposure analysis of environmental factors connected to particular diseases (eg development of specific cancers) and risk assessment, taking into account individual susceptibilities and genetic predisposition.

Particular areas of focus under the strategy will be indoor air quality, electro-magnetic fields and the urban environment with a thematic strategy due to be published on the latter in 2005.

Implementation programme

The new approach will be implemented in successive cycles and will be incremental in approach. The first one (2004 to 2010) will focus on well identified priorities and will concentrate on creating the new, integrated information system. In the first instance, work will begin on establishing a good understanding of the link between environmental factors and childhood respiratory diseases, asthma, and allergies; neurodevelopmental disorders; childhood cancer; and endocrine disrupting effects, with a view to identifying and preventing new health threats caused by environmental factors.

The strategy will aim to reinforce the institutional structures needed to strengthen policy-making and to integrate environment and health into other policy areas. To assist it in its work the Commission will call upon a consultative group on environment and health, consisting of environment and health experts from member states and from the key stakeholder groups.

COM (2003) 338 final. Communication from the Commission to the Council, the European Parliament and the European Economic and Social Committee - A European environment and health strategy. Brussels, 11.6.2003. http://europa.eu.int/eur-lex/en/com/cnc/2003/com2003_0338en01.pdf