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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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)

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

11. The changing environment
© Pan American Health Organization
Data Source: EM-DAT, OFDA/CRED (
Figure 3 – Natural disasters, Latin America and the Caribbean, (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

12. 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, (% pop)

13. 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.

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

15. 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.

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

17. 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.

18. 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

19. 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

20. 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!

21. 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