Environmental Health Strategy for the Region of the Americas Strengthening the regional approach for more effective local action

Carlos Santos-Burgoa, MD, MPH, PhD Agnes Soares da Silva, MD, MPH Kirsten Brownstein, MPH Julietta Rodriguez-Guzman, MD Ana Boischio, MSc, PhD Carlos Corvalan, MPH, PhD Ana Treasure, Ing. MA Oscar Mujica, MD, MPH Pan American Health Organization, PAHO/ WHO 525 23rd Street NW, Washington, DC 20037

Overview Introduction Background Environmental Health Situation Analysis Institutional Capacities Principles Purpose and Vision Strategy formulation

Introduction Environmental health is a field of knowledge and public health practice that addresses the way in which the environmental determinants (natural and anthropogenic, physical, chemical, biological, and ecological) affect the health of human beings and populations. (UN A/RES/66/288) The situation of the environment in the Americas has improved, but challenges to health remain at large Need to strengthen the health sector leadership and interaction with other sectors

Background 1972 – Stockholm Convention – UN Conference on Human Environment 1978 – Alma Ata – Primary Health Care 1986 – Ottawa – Health Promotion (+ 5 others followed) 1989 – Bruntland Report “ Our Common Future” (Sustainable Development) 1992 – Rio Earth Summit: Agenda 21 2000 – UN General Assembly: UN Milleniun Declaration (MDGs) 2001 – WHO Commission on Macroeconomics and Health 2002 – Johannesburg – World Summit on Sustainable Development 2003 – WHA53 – The Framework on Tobacco Convention 2005 – WHO-EU - Health in All Policies adopted by the EU WHA58.3 Revision of the International Health Regulations 2008 – WHA61 – Global Plan on NCD - Commission Report on Social Determinants of Health 2009 – WHA62.14 – Resolution: Reducing Inequities through action on the social determinants of health 2012 – Rio+20 Conference 186 milhões de expostos a queima de biomassa 60% concentrado no quartil de menor IDH 16 milhões no México 13 milhões no Brasil Haiti, Guatemala, Honduras, Paraguay, e Nicaragua – mais de 50% da população usa biomassa (lenha e outros

Figure 1 – The UN Sustainable Development Framework Source: UNTT. Realizing the Future we Want for all. June 2012 Figure 1 – The UN Sustainable Development Framework

Situation analysis The Environment and the Burden of Diseases Emerging Global Issues (the changing environment) Unresolved Regional Issues (the unfinished agenda) Emerging Regional Issues Economic growth & Economic inequities Consumption expansion Extractive industry Agricultural expansion Natural resources at risk: water scarcity, food insecurity Region with large and increasing Emerging Global Issues Institutional Capacities

The Environment and the Burden of Diseases 24% of the years lived with disability, and 23% of premature mortality are attributable to environmental and occupational exposures; 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. 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)

Figure 2 - Epidemiological transition, Costa Rica and Guatemala, 1965-2006 (Percentages) (ECLAC. Inter-agency document. Sustainable Development, 20 years from the Earth Summit. 2012)

The changing environment © Pan American Health Organization Data Source: EM-DAT, OFDA/CRED (http://www.emdat.be) Figure 3 – Natural disasters, Latin America and the Caribbean, 1970-2009 (PAHO, 2012) Pan American Health Organization (PAHO). Environmental Health and Human Security, Chapter III, Health in the Americas 2012. Emerging Global Issues: The changing environment, Urbanization, Vulnerability to Disaster, © Pan American Health Organization © Pan American Health Organization

Solid Fuel Use (SFU) See Poster #287890: © Pan American Health Organization Source: elaborated from data provided by Bonjour S et al., 2013 See Poster #287890: Exploratory analysis of social gradients and inequalities in the use of solid fuels in Latin America and the Caribbean Figure 4 – SFU in selected countries, Latin America and the Caribbean, 1990-2010 (% pop)

Water and Sanitation Source: PAHO. Environment and Human Security. In Chapter III, Health in the Americas 2012 Figure 5 - Inequalities in under-5 and maternal mortality as determined by the social gradient defined by access to sanitation and water respectively. The Americas, 2008.

Air pollution WHO guidelines annual mean PM10 = 20µ Table 1 - PM10 concentration, selected cities of the Americas, 2006-2010 Emerging issues Source: PAHO/WHO. The Environment and Human Security. In Chapter III, Health in the Americas, 2012 WHO guidelines annual mean PM10 = 20µ

Institutional Capacities All countries (except Brazil, Canada, Chile, Colombia, Costa Rica and the United States) – postponed the implementation of the IHR, mostly because of lack of capacity on chemical and radiological risks. No reliable poisoning surveillance systems in the Region. Few countries with national environmental health strategies, plans or programs.

Principles Public Health Protection Sustainable Development Environmental Health in All Policies Universal Health Coverage Human Security Health Equity Global Vision with Local Approach

Purpose Strengthen the capacity of Member States to protect, promote, and effectively address environmental health, with focus on children, pregnant women, the elderly and vulnerable populations. Strengthen the leadership role of health authorities. Contributes to achieving universal health coverage.

Vision A health system that is capable of exercising its sectoral and inter-sectoral stewardship over environmental determinants of health, based on the state of the art knowledge, towards health equity

Strategy Formulation Strengthening stewardship and governance Environmental health promotion and care Universal approach, addressing the social and environmental determinants of health during the life-course Action in specific areas Evidence and competencies for knowledge management

Looking forward to hearing your comments and suggestions! Way forward Consultation process Submission to governing bodies LET ME KNOW NOW! Looking forward to hearing your comments and suggestions!

Thank you! Contact: soaresag@paho.org Sustainable Development and Health Equity, Pan American Health Organization, PAHO/ WHO 525 23rd Street NW, Washington, DC 20037 © Pan American Health Organization