South Eastern Mediterranean Environmental Health Action Plan Draft Proposal Interagency Meeting on Environmental Health Marseille, France March 2012 _____________________________________________________________________________________ I- Background and Introduction 1. Water scarcity, poor water quality, and air pollution are the major contributing environmental factors to the burden of disease in the Southern and Eastern Mediterranean Countries (SEMC). Nearly one quarter of the overall burden of disease in the Southern and Eastern Mediterranean Countries (SEMC)1 is linked to environmental determinants2. Based on the WHO Country profiles for Environmental Burden of Disease, exposure to two risk factors have been identified as being responsible for most of this burden in SEMC. Limited or inadequate accesses to water, as well as outdoor and indoor air pollution, are responsible each for approximately 30,000 deaths per year. Although not yet estimated, but preliminary findings point to waste management as being a third critical risk factor. 2. Globally, the MENA Region is by far the least endowed when it comes to access to water (1.4 percent of world available resources). Each year water resources shrink to such an extent that the lack of water available for human consumption is recurrent and henceforth threatens almost all the countries in the region. Further, many countries in the region still suffer from poor water quality mainly linked to the poor management of sewage, the lack of sanitation, and industrial and agricultural pollution. Combined with poor hygiene practices, water scarcity and quality negatively impact on water-borne diseases and child malnutrition. 3. The SEMC are faced with a worrying increase in air pollution, especially in the large conurbations, due to the combined effect of demographic growth, urban concentration, economic development and use of low quality solid fuel and oil products. Beyond the effect of classic pollutants (CO, CO2, SOx, NOx), particulate matter (PM2.5 and PM10) – one of the most poisonous compounds of atmospheric pollution for human health – is responsible for causing lung cancer, chronic respiratory diseases, as well as, cardiovascular diseases. Although less well-publicized, indoor air pollution also represents a risk to health in the region. Limited access to energy sources of higher fuel efficiency such as natural gas, liquefied petroleum products (LPG) and electricity favors the use of solid fuels such as dung, plant residues, firewood or charcoal. Exposure to hazardous by-products emitted by use of such solid fuels is at the origin of numerous respiratory diseases. 4. Climate change may further aggravate the environmental health burden in the region. This calls for strengthening adaptive capacities in SEMC. The SEMC are known to be one of the main hot 1
SEMC is a group of 9 countries, including: Morocco; Algeria; Tunisia; Libya; Egypt; Palestinian Territories; Jordan; Lebanon; and Syria. 2
“Managing the linkages for sustainable development – A toolkit for decision-makers”, p.16, WHO 2008 (http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf); “Preventing disease through healthy environment”, p.9, WHO 2006 (http://www.who.int/quantifying_ehimpacts/publications/preventingdisease.pdf).
spots for the rise of temperature due to climate change: from +2 to +3° by 2050, and up to +5° by 2100 (Blue Plan, following IPCC). Climate change is on one hand an aggravating factor for actual issues – less precipitation and more heat waves – while, on the other hand, it generates new vulnerabilities – marine submersion due to sea level rise, resurgence and growing magnitude of extreme episodes such as floods, droughts and sand storms. Of particular importance, and due to the inherent water scarcity situation coupled with high demographic pressure, SEMC are considered one of the most vulnerable regions to climate change, particularly because of its arid nature and its dependency on rain-fed agricultural production. To cope with a more variable and warmer environment, this calls for more efforts to strengthen adaptive capacities in the region. 5. To address the existing environmental health challenge, SEMC need stronger information systems, cross-sectoral policies and integrated strategies. Evidence or the lack of it thereof, points to the need to better evaluate the health consequences of environmental degradation. Epidemiologic data are highly incomplete, often based on estimates, and mostly available at a macro level when they should be as geo-localized as possible. In addition, many countries have not so far developed monitoring and/or modeling systems for air quality, and have little information on qualitative measures for drinkable water. To address the existing environmental health challenge in SEMC it is critical to strengthen information systems, and to link health and environment data, for more informed decision making and action. 6. Promotion of cross-sectoral policies to address environmental health issues is vital, given that action against determinants of environmental health mostly lie outside the jurisdiction of the health sector. In the Region, dialogue with other Ministries (Agriculture, Infrastructures, Transports, Water, Energy, etc.) is in many instances insufficient, resulting in sectoral policies being at odds or misaligned with each other, or simply oblivious to health concerns. In many cases, the environment sector lacks both human and financial resources, and the health sector is predominantly dedicated to curative rather than preventive actions. It is therefore imperative that health authorities work in close conjunction with other respective sectors in environment, agriculture, water, energy as well as others, to develop “healthy” policies and joint action plans and strategies. 7. A number of international and regional organizations have been investing in environmental health in SEMC, but to maintain and augment the momentum a joint action plan is required. The WHO Centre for Environmental Health Activities (CEHA) has over the past several years been promoting environmental health through strengthening national capabilities and programs in countries of the Eastern Mediterranean Region. Inspired from the Libreville Declaration, Morocco has decided to launch an ambitious National Environmental Health Plan. Further, the WHO has developed many useful tools such as the Environment Burden of Disease Country Profiles (released in 2008), and the Sanitation Analysis and Needs Assessment (SANA), both of which have greatly assisted in quantifying the burden in the region. From another perspective, and complimentary to this work, the World Bank has been leading numerous studies over the past ten years within the METAP program, and has recently published a report3 quantifying the cost of environmental degradation and its repercussions on human health in the entire Middle East and North Africa (MENA) region. Furthermore, the World Bank together with the French Development Agency have been working through the Marseille Centre for Mediterranean Integration 3
The costs of environmental degradation in the MENA region. World Bank 2010.
(CMI) on a number of environmental issues. Jointly, they launched in 2011 a program focussing on health and environment, with the objective to identify priorities for the SEMC, as well as, to address the gaps in national policies, legislation, technical and institutional capacities, and look into existing and potential inter-sectoral strategies. In light of the aforementioned, the time could not be better to push forward for a joint interagency action plan for environmental health in SEMC to sustain the existing momentum. II- Development Objective 8. The main objective is to assist SEMCs to develop and implement well-aligned and environmentally healthy policies, strategies and instruments taking into account the existing challenges, needs and opportunities. Such assistance would require that regional and international agencies align their strategic positioning and respective resources, and serve their constituencies in harmony to improve the overall combined effectiveness and efficiency of their: a. Advisory services/technical assistance on environmental health issues and existing policy, political and technical challenges using a multi-sectoral approach. b. Advocacy for a regional strategic framework through the elaboration of a common Charter on environmental health for the region. c. Analysis of the environmental health hazards to better inform policy/decision makers on key priorities and programs, including assessment of policies, regulatory and other interventions to prevent, alleviate and/or manage the health burden attributable to these hazards. III- Proposed Activities 9. To realize the envisaged objective, a number of activities falling under five broad categories are proposed below. i. Strengthening Environmental Health Capacity in SEMC Establishing a regional community of practice for environmental health, and strengthening its capacity through technical meetings, expert consultations and other platforms for knowledge sharing. Providing access to regional experts to the currently available E-community – hosted by the CMI (www.cmimarseille.org) – as an online platform for knowledge sharing and exchange of experiences. ii. Developing Regional Resources for Environmental Health Developing and launching an online thesaurus for environmental health terms and concepts in Arabic, English and French. [EH1] Developing a guidebook on environmental health challenges and opportunities for SEMC. This would include best practices from the region and will highlight successful experiences. Additionally, it will present the results of a second-phase Costs Benefits Analysis for identified policies to be implemented in each country and offer a set of recommendations. [EH2]
iii. Supporting Regional Operational Research Funding and implementing at least two pilot projects – one for water management and another for air pollution management – with rigorous health impact assessments. [EH3] iv. Analyzing the Environmental Burden of Disease & Assessing Risk Factors Updating/developing country profiles for the environment burden of disease with assistance from CEHA, and carrying out (on a voluntary basis) the Sanitation Analysis and Needs Assessment (SANA) in SEMC. [EH4] v. Building Political Commitment for Environmental Health Organizing a regional conference at ministerial level by 2013/2014, during which a draft Regional Charter of Framework Convention on Environmental Health in the SEMC will be presented. [EH5] IV- Schedule and Milestones March 14, 2012
First Consultation meeting during Marseilles World Water Forum; Adoption of the content of the projects, time line, defining responsibilities, budget and human resources.
April 2012
Developing the design of the proposed pilot projects.
May 2012
Launching of the on-line environmental health thesaurus
Launching of the regional guidebook on environmental health challenges and opportunities.
1st technical meeting in Marseilles; Approval of SANA by one or more countries.
First draft for all chapters of the guidebook on environmental health challenges and opportunities.
2nd technical meeting in the selected city; Presentation of the preliminary results of the two pilot projects
Guidebook on environmental health challenges and opportunities sent to printing
Regional Conference in the selected city; Release and presentation of the Guidebook, Health Impact Assessment progress, and the National SANA guides Launching of a Regional Initiative
June 2012
November 2012
March 2013
May 2013
September 2013
December 2013