1. WHO European Centre for Environment and Health Environmental health indicators system: a pilot project Dafina Dalbokova, Michal Krzyzanowski, WHO Working Group WHO – ECEH, Bonn Office

2. WHO European Centre for Environment and Health Why indicators? 1. To facilitate national and international assessments 2. To provide coherent structure to EH information system

3. WHO European Centre for Environment and Health The scope of environmental health indicators (C. Corválan, D. Briggs, G. Zielhuis, WHO, 2000) A C B A: environmental health indicators: indicator + an EH linkage B: environmental indicators indicating potential human impact, e.g. deforestation C: health indicators with unknown but possible environmental cause, e.g. cancers Environmental domain Health domain Source WHO, 2000, page 32

4. Source Activities Emissions Environmental Concentration AirWaterFoodSoil Exposure External Exposure Dose Early/ Subclinical Moderate/ Clinical Advanced/ Permanent Health Effects Traditional hazards Modern hazards Human activities Natural phenomena Development activities Driving force Pressure State Exposure Effect ActIonsActIons Source: WHO, 2000, page 43

5. WHO European Centre for Environment and Health What indicators? Cover the EH issues of a clear public health significance both at sub- and multi- national level DPSEEA framework : … => [ State of Environment] => E XPOSURE => HEALTH E FFECTS A CTIONS: Health protection & Intersectorial policies Clear definition and known EH linkage : WHO profiles’ key forms ( WHO/SDE/OEH/99.10 ) Assuring continuity of earlier (inter)-national work

6. WHO European Centre for Environment and Health EH ISSUEDriving Force PressureStateExposureEffectAction Air Quality #### #### ####### #### Housing and Settlements ####### Traffic Accidents #### Noise #### # Waste and Contaminated Lands ####### Radiation ### # + ? Water and Sanitation ####### ######## # ? #### Food Safety ##### ? Chemical Emergencies ########## Workplace ###### Core set of EH indicators (WHO Consultation, May 2000)

7. WHO European Centre for Environment and Health Feasibility Study on agreed protocol to test: Data availability, quality and reliability Data accessibility and exchange mechanisms Capacity for multi-agency (net)-working Use and usefulness of the indicators Participating countries: Armenia, Bulgaria*, Czech Republic*, Estonia, Finland, Hungary, Latvia*, Lithuania, The Netherlands, Poland, Romania*, Russia, Slovakia, Spain, Switzerland* * Study completed Pilot implementation in selected countries (WHO planning meeting, October 2000)

8. WHO European Centre for Environment and Health 1. Data availability and quality Data-holder (data collection) organisation..……………...…………... Use of standardized methodology for data collection..……………… Quality Control/ Quality Assurance system ………………………….… Data compapability over time ……………………………………….…. Data coverage re. population ……………………………………….….. Spatial coverage & resolution re. sources/ pollutants and population Regular population-based survey or surveillance programme …...… Sensitivity of the system to detect ‘hotspots’ / ‘events’ ……...………. Stratification/ aggregation (age, gender, area, time) ……...…………. Statutory requirement for the data collection …………………………../. Evaluating feasibility: WHO questionnaire (1 of 2)

9. WHO European Centre for Environment and Health 2. Data accessibility and exchange mechanisms Inter-institutional framework for data access/ exchange ….….……. Access through electronic networks and common format ………… Access to the data at central level …………………………………… Data-flow & possibilities for streamlining..…………………………. Legal restrictions ……………………………………….……………… Costs for data access …………………………………………………. Timeliness of the data vs. accessibility …………………………….. 3. Relevance/ usefulness of the indicator Relation to a policy objective or to existing standards ……….…….. Understandable/ interpretable ………………………………………… Action-orientation ………………………………………………………. Evaluating feasibility: WHO questionnaire (2 of 2)

10. WHO European Centre for Environment and Health 1. Very useful outcomes: Standardised inventories of data availability and quality, data-flows and data-holders on a wide range of EH issues, which: facilitates multi-agency networking & streamlining the information provides a basis for a meta-information system promote working relationships with the data-providers Identifying which data collection needs further harmonisation or methodological developments Creating synergies with relevant ongoing indicator projects based on the knowledge gained throughout the study./. Feasibility study: General feedback (1 of 3) WHO review meeting, July 2001

11. WHO European Centre for Environment and Health 2. Main problems:  Necessity to communicate with numerous institutions, i.e. : Bringing together more than ten different agencies/ bodies Coping with reluctance and insufficient interest  Large variety of parallel initiatives on indicators at (inter)-national scale: Several indicators already reported to the EEA, OECD, etc. Insufficient inter-agency co-ordination  Organisational changes, transitional period in changing legislation, on-going health sector reforms  Human resources under conditions of lilmited funding./. Feasibility study: General feedback (2 of 3)

12. WHO European Centre for Environment and Health 3. Specific difficulties:  Time-consuming translation  Finding out the primary data source  More than one data source (registry, survey)  Data gathering & electronic networks (future) Feasibility study: General feedback (3 of 3)

13. WHO European Centre for Environment and Health Participating countries rated the core set of EH indicators over the following criteria: Data availability: (score 1 – 3) 1 NO 2 OBTAINABLE WITH EFFORT 3 YES Data quality:(score 1 – 3) 1 POOR 2 FAIR 3 GOOD Usefulness/ Interpretability: (score 1 – 3) 1 NOT USEFUL 2 SOME UTILITY 3 VERY USEFUL First-round evaluation of the indicators WHO review meeting, July 2001

14. Average Ratings of the EH Indicators (1 of 2) Indicator code Indicator Code

15. Average Ratings of the EH Indicators (2 of 2)

16. WHO European Centre for Environment and Health Focus on « A » to meet policy needs A C B Environmental domain Health domain Source WHO, 2000, page 32 Focus efforts on ‘ filling the gaps ’ Link to overlapping initiatives

17. WHO European Centre for Environment and Health Improving system “sensitivity” by focused data collection through household surveys e.g. on noise, indoor air Development of cost-effective methodology for data collection Increasing system “specificity” by integrating health - environment linkage analysis Development of documented guidance and case examples Focus on health protection measures for action indicators Increasing utility for decision-making (incl. presentations) Increasing relevance for highly developed countries

18. WHO European Centre for Environment and Health IMPORTANT ACTIVITIES ALSO INCLUDE:  Review of the existing environment and health information systems; evaluating the existing capacity  Creation of network for exchanging experience and information  Information sharing with similar initiatives e.g. US EPHI  Close co-operation and better inter-agency co-ordination

19. WHO European Centre for Environment and Health WHO Working Group ALBANIA: M. Afezolli ARMENIA: N. Bakunts AUSTRIA: J. Behofsics BELGIUM: F. van Hoof BULGARIA: H. Mileva CZECH REPUBLIC: F. Kožíšek, R. Kubínová DENMARK: B. Jensen ESTONIA: J. Ruut FINLAND: E. Alanen A. Nevalainen, P-J. Penttilä, T. Wiikinkoski, FRANCE: S. Medina GERMANY: R. Fehr, W. Hellmeier HUNGARY: A. Pintér, A. Páldy, M. Kádár, T. Málnási LATVIA: S. Velina, I. Feldmane LITHUANIA: I. Zurlyte, A. Ciuladaite NETHERLANDS: M. van den Berg, A. Dusseldorp, H. Eerens, P. Frintrop, P. Kramers, J. Lembrechts, M. Ruijten, B. Staatsen POLAND: B. Wojtyniak, J. Zejda ROMANIA: D. Chiriac, A. Cucu, I. Draguescu, I. Iacob RUSSIAN FEDERATION: V. Fourman, N. Burtseva, V. Pavlov SLOVAKIA: K. Halzlova, M. Kapasny SWEDEN: P. Körsén SWITZERLAND: R. Lawrence, C. Braun, S. Kahlmeier UNITED KINGDOM: D. Briggs, E. MacDonald, K. Pond, Ch. Pugh, J. Queenborough, P. Wilkinson, EBRD: N. Ichikawa EEA: P. Bosch