1. Development of Policy Instruments: Environmental Health Indicators Veerle Arren Human Ecology Department Vrije Universiteit Brussel International Symposium December 15th, 2006

2. Environmental Health Indicators 15/12/2006 2 Contents 1.What are Environmental Health Indicators ? 2.The DPSEEA-framework 3.Inventory of international and national EHI 4.Filling-in of selected EHI for Flanders: a)Outdoor air pollution b)Water quality c)Food safety 5.Conclusions

3. Environmental Health Indicators 15/12/2006 3 1.What are Environmental Health Indicators (EHI) ? (1/2) EHI: “Measurable units suggesting a relevant and simple relationship between health and environment. Health effects arise from human exposure to environmental pollution.” Cause-consequence relation Changes environment  changes health & well- being of people Need to develop EHI to support policy

4. Environmental Health Indicators 15/12/2006 4 1.What are Environmental Health Indicators (EHI) ? (2/2) Selection criteria for a good EHI: 1.Policy relevance 2.Availability and follow-up of data 3.Simplicity & clarity 4.Sensitivity 5.Validity 6.Reliability & objectivity 7.Specificity

5. Environmental Health Indicators 15/12/2006 5 2.The DPSEEA-framework Developed by WHO Driving forces Pressure State Exposure Effects Actions

6. Environmental Health Indicators 15/12/2006 6 3.Inventory of international and national EHI (1/3) State of the art: worldwide overview based on: –International studies on indicators for SD WHO UN OECD EU –National studies: MIRA (‘Environmental report for Flanders’) VRIND (‘Regional indicators for Flanders’) Highlighting themes within E & H, relevant for Flanders

7. Environmental Health Indicators 15/12/2006 7 3.Inventory of international and national EHI (2/3) Testing proposed indicators to criteria for good indicators: Policy relevance, data availability, simplicity, sensitivity, validity, reliability, specificity  To obtain a set indicators to integrate in Flemish EHIS Resulted in core set with 42 relevant indicators for Flanders Classified within the DPSEEA-framework

8. Environmental Health Indicators 15/12/2006 8 3.Inventory of international and national EHI (3/3) Considered themes: –Outdoor air pollution (17 selected indicators) –Indoor air quality & housing (5) –Noise (4) –Soil pollution (1) –Waste pollution (2) –Water quality (9) –Food safety (1) –Environmental radiation (2) –Smell nuisance (1)

9. Environmental Health Indicators 15/12/2006 9 4.Filling-in of selected EHI for Flanders (1/2) Filling-in EHI for 3 priority themes with important health impacts: –Outdoor air pollution –Water quality –Food safety

10. Environmental Health Indicators 15/12/2006 10 4.Filling-in of selected EHI for Flanders (2/2) Implementation: Fact-sheets 1.Results & analysis: Environment & health context: state of the art Policy relevance & context Analysis of the current state 2.Methodology for implementation 3.Data 4.Metadata: Geographical range, time range, frequency datacollection 5.Quality, bottlenecks & weaknesses 6.Alternative indicator(s) 7.Comparison with indicator in other countries

11. Environmental Health Indicators 15/12/2006 11 4.Filling-in of selected EHI for Flanders a) Outdoor air pollution (1/6) Driving forcesPressureStateExposureEffectAction Energy use by road traffic Yearly emissions of SO 2, NO x and NMVOC Mean year-conc. of SO 2 Population-weighed exceedances of reference concentrations for NO 2 Yearly child mortality due to respiratory diseases Yearly emissions of 8 heavy metals Mean year-conc. of NO 2 Population-weighed exceedances of reference concentrations for PM 10 Yearly mortality due to respiratory diseases Emissions of 17 dioxins Mean year-conc. of PM 10 Population-weighed exceedances of reference concentrations for O 3 Lung cancer incidence Days with exceedance of threshold value for highest mean 8-hours O 3 -conc. Population-weighed exposure to NO 2 DALYs because of PM 10 Mean year-conc. of benzene & 1,3- dichloroethane Population-weighed exposure to PM 10 Mean year-conc. of BaP & PAK’s Population-weighed exposure to ozone Deposition of dioxins Heavy metal concentrations

12. Environmental Health Indicators 15/12/2006 12 4.a) Outdoor air pollution (2/6) Air_D1: Energy use by road traffic

13. Environmental Health Indicators 15/12/2006 13 4.a) Outdoor air pollution (3/6) Air_P1: Yearly emissions of SO 2, NO x & NM VOC

14. Environmental Health Indicators 15/12/2006 14 4.a) Outdoor air pollution (4/6) Air_S2: Mean yearly concentrations of PM 10

15. Environmental Health Indicators 15/12/2006 15 4.a) Outdoor air pollution (5/6) Air_E xp 5: Population-weighed exposure to ozone

16. Environmental Health Indicators 15/12/2006 16 4.a) Outdoor air pollution (6/6) Air_E ff 2: Yearly mortality due to respiratory diseases

17. Environmental Health Indicators 15/12/2006 17 4.Filling-in of selected EHI for Flanders b) Water quality (1/5) Driving forcesPressureStateExposureEffectAction Waste water treatment coverage Exceedance of limit values for microbiological values in surface water (recreational) Outbreaks of waterborne diseases (Waste water treatment coverage) % of surface water measure points with a basic quality for BOD Concentration of pesticides in surface water above the basic guideline value Concentration of pesticides in ground water above the basic guideline value Concentration of pesticides in eel Exceedance of WHO guideline values for drinking water for microbiological parameters Exceedance of WHO guideline values for drinking water for chemical parameters

18. Environmental Health Indicators 15/12/2006 18 4.b) Water quality (2/5) Water_P1: Waste water treatment coverage

19. Environmental Health Indicators 15/12/2006 19 4.b) Water quality (3/5) Water_S5: Concentration of pesticides in eel

20. Environmental Health Indicators 15/12/2006 20 4.b) Water quality (4/5) Water_S6: Exceedance of WHO guideline values for drinking water for microbiological parameters Tap water (100 – 98 %) Well water (100 – 80 %)

21. Environmental Health Indicators 15/12/2006 21 4.b) Water quality (5/5) Water_E ff 1: Outbreaks of water borne diseases

22. Environmental Health Indicators 15/12/2006 22 4.Filling-in of selected EHI for Flanders c) Food safety (1/4) Driving forces PressureStateExposureEffectAction Dioxins & PCB’s in cow’s milk Residues of pesticides in food stuffs (fruit & vegetables) Food borne infections Estimated daily intake (pesticides) Monitoring of chemicals in food stuffs Dioxins & PCB’s in breast milk Lead (Pb) in children’s blood Cadmium (Cd) in children’s blood (urine) POP’s in blood Only one indicator was retained after selection, therefore also the alternative indicators are included in this overview (in italic print)

23. Environmental Health Indicators 15/12/2006 23 4.c) Food safety (2/4) Food_E xp 1: Residues of pesticides in food stuffs (fruit & vegetables)

24. Environmental Health Indicators 15/12/2006 24 4.c) Food safety (3/4) Food_S1: Dioxins and PCB’s in cow’s milk

25. Environmental Health Indicators 15/12/2006 25 4.c) Food safety (4/4) Food_E ff 1: Food borne infections Distribution potential food borne infections Distribution sources collective food borne infections

26. Environmental Health Indicators 15/12/2006 26 5.Conclusions Follow-up specific environment & health situations –Identify potential health risks / vulnerable populations –Visualise past & current state –Forecast distance-to-target –Facilitate decision-making –Evaluate policy and measures –International comparison & benchmarking  policy supporting & evaluating instruments

27. Environmental Health Indicators 15/12/2006 27 Thank you for your attention! Contact Information: Veerle.Arren@vub.ac.be Human Ecology Department Vrije Universiteit Brussel Laarbeeklaan 103 B – 1090 Brussels Belgium Phone: +32/2/477.42.81 Fax: +32/2/477.49.64 E-mail: human.ecology@vub.ac.behuman.ecology@vub.ac.be Homepage: http://www.vub.ac.be/MEKO