Report of the first session of the European Environment and Health Ministerial Board (EEHMB): Paris, France, 4–5 May 2011

European Environment and Health Ministerial Board (EEHMB) European Environment and Health Ministerial Board (EEHMB) Meeting report Paris, France 4-5 May 2011 The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan Original: English World Health Organization Regional Office for Europe Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: contact@euro.who.int Web site: www.euro.who.int Report of the first session of the European Environment and Health Ministerial Board (EEHMB) Paris, France 4–5 May 2011 ABSTRACT The European Environment and Health Ministerial Board (EHMB) was created by the Fifth Ministerial Conference on Environment and Health (Parma, Italy, March 2010) to provide leadership and guidance on refining the priorities for action identified in Parma and on monitoring work to ensure accountability with respect to the commitments made at the Conference. At its first session, the EHMB agreed on its rules of procedure, which ensure that the Board is fully transparent and accountable to WHO’s Member States. The Board discussed the next steps in the European environment and health process, emphasizing the need to clarify the priorities within that process, its links to existing multilateral environmental agreements and its contribution to the sustainable development agenda. The Board also considered the approaches and tools that could be used to monitor and follow up implementation of the Parma commitments, as well as the progress made towards establishing the European Environment and Health Task Force. Keywords ENVIRONMENTAL HEALTH ENVIRONMENTAL POLICY – trends CONGRESSES EUROPE Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2011 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. CONTENTS Page Introduction ....................................................................................................................... 1 Governance of the European environment and health process ................................................ 1 Follow-up to commitments made at the Parma Conference .................................................... 2 Priorities for follow-up ................................................................................................ 2 Multilateral environmental agreements ........................................................................ 3 The Environment for Europe process ........................................................................... 4 The global sustainable development agenda ................................................................ 4 Tools for monitoring follow-up .................................................................................... 5 Preparations for the first meeting of the European Environment and Health Task Force ... 6 Organization and sustainability of the European environment and health process ..................... 6 Annex 1. List of participants ................................................................................................ 7 Report of the first session of the EEHMB page 1 Introduction 1. The European Environment and Health Ministerial Board (EHMB) held its first session in Paris on 4–5 May 2011. Following a dinner hosted by Nora Berra, Secretary of State for Health, Ministry of Labour, Employment and Health, France on 4 May, the working meeting on 5 May was opened by Nora Berra. She recalled that her country had actively supported the European environment and health process over the years and had chaired the European Environment and Health Committee, the “predecessor” of the EHMB, between 2005 and 2007. Meeting participants are listed in Annex 1. 2. In her introductory statement, Zsuzsanna Jakab, WHO Regional Director for Europe, emphasized that by setting up the EHMB, representatives of Member States and stakeholders at the Fifth Ministerial Conference on Environment and Health (Parma, Italy, March 2010) had given that process a much higher political profile. They were looking to the EHMB to provide leadership and guidance on refining the priorities for action identified in Parma, on monitoring of actions assuring accountability in respect to the commitments taken in Parma and on reporting back to the WHO Regional Committee for Europe and the United Nations Economic Commission for Europe (UNECE) Committee on Environmental Policy. 3. Ján Kubiš, Executive Secretary, UNECE, in his opening statement, noted that the revitalized European environment and health process needed to be driven by Member States. That required a good understanding of the respective roles to be played by the EHMB and the European Environment and Health Task Force (EHTF), respectively, and a strong involvement and ownership of the Environment and Health Process (EHP) by the EHTF. The environment- related components of the process needed to be “rebalanced” with, and brought closer to, the health aspects. Governance of the European environment and health process 4. Through the Parma Declaration, participants in the Fifth Ministerial Conference had adopted an institutional framework for the European environment and health process for the period 2010–2016. In addition to national environment and health mechanisms, that framework included a task force and a ministerial board, both serviced by a secretariat located at the WHO Regional Office for Europe. Once the European Environment and Health Task Force (EHTF) had been constituted, its chairperson and co-chairperson would be ex officio members of the EHMB. 5. The Secretariat had prepared draft rules of procedure for the EHMB, based on those used by the Standing Committee of the WHO Regional Committee for Europe. In line with discussions at the dinner the previous evening and taking into consideration of comments and suggestions by a few Member States, a revised version was tabled, incorporating two amendments designed to make the EHMB more transparent and accountable to all Member States of WHO in the European Region: they would be informed about the convening of sessions of the EHMB, would have the opportunity to propose items for inclusion in the agenda of a session and would have the working papers for the session made available to them. The EHMB would report annually to the WHO Regional Committee for Europe and the UNECE Committee on Environmental Policy and submit its decisions to them for endorsement. Report of the first session of the EEHMB page 2 6. Further amendments to the draft rules of procedure were agreed by the EHMB: working papers would be sent out no later than three weeks before the session (the word “normally” in Rule 4.3 should be deleted); co-chairpersons or their alternates would be empowered to preside at a session (the corresponding wording should be inserted in Rule 11); and co-chairpersons or their alternates would also be responsible for handling points of order (Rule 10 should be amended accordingly). In addition, Rule 2.2 should read: “Representatives of Member States may be accompanied by one alternate and by advisers” and a new sub-paragraph should be added in Rule 5 to allow for the possibility of attending the EHMB meeting by videoconference or teleconference. References to “summary records” of sessions of the EHMB (e.g. in Rules 15.1 and 18) should be amended to “reports”, in the interests of consistency. In Rule 7.1 (c), it was not necessary to mention the WHO Regional Office for Europe, UNECE or the United Nations Environment Programme (UNEP) by name, since their representatives were already members of the EHMB. The working languages of WHO in the European Region were English, French, German and Russian; Rule 18 (concerning the EHMB’s recommendations and decisions, as well as reports of its sessions) should be amended to reflect that fact. On the other hand, Rule 17.1 should be deleted, and the languages used at sessions of the EHMB should be decided on a pragmatic, ad hoc basis. 7. The Rules of Procedure would be made available for comments by all Member States for a period of 30 days. The EHMB could subsequently amend its Rules of Procedure at any time. 8. The EHMB elected Lázló Borbély, Minister of Environment and Forests, Romania and Dorijan Marusic, Minister of Health, Slovenia, as co-chairpersons of the Ministerial Board. 9. Members of the EHMB endorsed the roles proposed for them, of representing the Ministerial Board in high-level meetings, reporting on implementation of the European environment and health process, acting as “champions” of the process, bringing emerging issues to the attention of other Board members and the Secretariat, and exchanging experiences. However, they agreed that the EHMB’s top priority would be to give guidance to Member States, notably on the “political” question of multisectoral national mechanisms; to that end, the topic could be taken up again at a subsequent session. One of the co-chairpersons reported that his country had established an intersectoral working group after the Parma Conference and accordingly proposed that the third priority listed above should be expanded to include national policy debates in areas such as transport, agriculture and industry. Follow-up to commitments made at the Parma Conference Priorities for follow-up 10. In the Parma Declaration, Member States had committed themselves to tackling a number of persisting or emerging environment and health problems. In order to match the need to support national action, on the one hand, with the need to concentrate resources where they could provide the greatest added value, on the other, the Secretariat had identified a number of possible priorities for follow-up by the EHMB: • further develop the institutional framework and monitoring infrastructure (establishment of the EHTF and of mechanisms for the involvement of young people and other stakeholders, and further development of the Environment and Health Information System – ENHIS); • elaborate tools and approaches to assess the positive links between attainment of environment and health objectives and development of the “green economy”; Report of the first session of the EEHMB page 3 • strengthen national capacities and develop tools for health and environment ministries to engage in national policy debates on energy, with full consideration of the implications of different policy options; and • leverage the links between the European environment and health process and other multilateral mechanisms of environment and health governance. 11. In the context of heightened accountability and follow-up by the EHMB, “monitoring” should be understood as efforts aimed at assessing the extent to which countries were meeting the commitments they had made in the Parma Declaration, rather than as more technical monitoring of environmental risks (concentrations of air pollutants, for instance). At a WHO meeting in Bonn in November 2010, experts from 35 countries in the WHO European Region and three international institutions had accordingly selected 18 environmental health indicators addressing the five time-limited Parma Conference commitments. 12. More generally, the EHMB wished to place emphasis on the positive health impact of sound environmental management, and on the positive synergies between the environment and health. The European environment and health process should therefore be given due prominence in UNECE’s Environment for Europe process (and notably at the Seventh “Environment for Europe” Ministerial Conference to be held in Astana, Kazakhstan on 21–23 September 2011), as well as in preparations for the 2012 United Nations Conference on Sustainable Development (“Rio +20”), including a regional meeting to be organized by UNECE in Geneva in early December 2011. 13. The EHMB endorsed the proposal to ask the Secretariat to work on further defining the priorities in the area of environment and health, given that there was general understanding of its importance but some confusion as to what it encompassed and what was the relative priority of specific issues, either to health and well-being or to the environment. The Board shared the impression that there was a need to conceptualize those issues in a clear and understandable way, which would help in advocating for cross-sectoral action on environment and health. Clarity was needed about the relationship between the environment and health, on the one hand, and noncommunicable diseases, sustainable development, health security, energy, natural resources, human well-being and other areas of global importance, on the other. Multilateral environmental agreements 14. The new governance mechanism established at the Parma Conference (consisting of the EHMB, the EHTF and national coordination bodies) offered the potential to mainstream the environment and health agenda through a broad range of multilateral environmental agreements (MEAs) to which Member States were parties. It would be important to ensure consistency and synergy of national inputs to MEAs while, for their part, the various United Nations agencies acting as secretariats to those agreements could secure their contribution to the European environment and health process. 15. Christophe Bouvier, Director, UNEP Regional Office for Europe noted that his organization provided a common secretariat and executive head for the three conventions on chemicals and waste (Basel, Rotterdam and Stockholm), and such a governance mechanism was an effective means to promote coordination, synergy and coherence among related MEAs. The Nagoya Protocol (on access to genetic resources and the fair and equitable sharing of benefits arising from their utilization) to the Convention on Biological Diversity underlined the importance of ecosystems management, while the UNECE Convention on Access to Report of the first session of the EEHMB page 4 Information, Public Participation in Decision-making and Access to Justice in Environmental Matters (the “Aarhus Convention”) focused on interactions between the public and public authorities in a democratic context. The overall aims of current work on MEAs were to simplify reporting requirements and to promote implementation at country level. 16. EHMB members suggested that the draft overview of MEAs relevant to work on the Parma Conference commitments should be supplemented with references to conventions on nuclear accidents, industrial accidents, etc. In addition, it would be useful to analyse those commitments in terms of their links with the International Health Regulations (2005). 17. Members of the Ministerial Board from the three participating organizations (UNECE, UNEP and WHO), together with the two co-chairs, would correct and complete the list of MEAs and draw up a matrix of the Parma Conference commitments, mapping multilateral and national responsibilities, in preparation for a more detailed discussion at the first meeting of the EHTF. In addition, the Secretariat would draw up a report on “Governance in environment and health in Europe”, containing a critical review and discussion of the different past and current governance models in environment and health. The Environment for Europe process 18. Following an agreement reached at the UNECE Committee on Environment Policy’s sixteenth session in 2009, the two themes for the seventh “Environment for Europe” Ministerial Conference (Astana, Kazakhstan, 21–23 September 2011) would be sustainable management of water and water-related ecosystems, and greening the economy: mainstreaming the environment into economic development. For environment and health issues, the main entry point into the first theme would be the Protocol on Water and Health to the Convention on the Protection and Use of Transboundary Watercourses and International Lakes (the “Water Convention”), while for the second theme it would be the Transport, Health and Environment Pan-European Programme (THE PEP). 19. One of the EHMB co-chairs informed participants that his country would be organizing a side event at the Astana Conference on implementation of the Water Convention in eastern European, Caucasus and central Asian countries. EHMB members looked forward to receiving working papers and the list of side events for the Astana Conference, so they could ensure the visibility of the European environment and health process at the Conference. The global sustainable development agenda 20. It was hoped that the next United Nations Conference on Sustainable Development, to be held in Rio de Janeiro, Brazil in June 2012 to mark the twentieth anniversary of the first United Nations Conference on Environment and Development, would lead to a new paradigm of sustainable development. There was no trade-off between economic growth, on the one hand, and social or environmental costs, on the other. Instead, it was worth investing in all forms of human, natural, economic and financial capital, as well as in protection of the ecosystem. The approach of using gross domestic product (GDP) as the only measure of progress was judged as outdated. 21. There would be two main themes of Rio +20: a green economy in the context of sustainable development and poverty eradication, and the institutional framework for sustainable development. At a meeting of regional directors of the United Nations agencies in Europe and Report of the first session of the EEHMB page 5 central Asia, held at the WHO Regional Office for Europe on 16 March 2011, participants had agreed to prepare a regional inter-agency report on the green economy for Rio +20. That report would emphasize the importance of a green economy for achieving the Millennium Development Goals, lessening the burden of communicable and noncommunicable diseases, promoting social inclusion, and reducing poverty and the impact of climate change and other global environmental changes. Further work needed to be done to clarify the health sector’s contribution to greening of the economy, possibly leading to development of a separate report on “Creating a sustainable and green health sector: opportunities for action”. The institutional framework would be considered in detail as part of the analysis of MEAs. 22. EHMB members believed that it would necessary to identify priorities from among the Parma Conference commitments. They acknowledged that specific actions could be taken by the health sector in pursuit of sustainable development, such as the creation of “green hospitals”, but they recognized that the green economy was a multisectoral, whole-of-government task that exceeded the fields of responsibility of ministries of health or the environment. Tools for monitoring follow-up 23. As noted earlier, monitoring the implementation of the commitments made at the Parma Conference was to be seen as a broad process involving case studies and other “soft” instruments, with the overall objectives of minimizing the reporting burden and building on existing systems while ensuring greater accountability on the part of Member States. Nonetheless, the adoption of five time-limited commitments implied that countries were ready and willing to report to the sixth ministerial conference in 2016, with a baseline assessment report at a mid-term review meeting in 2014. To that end,WHO had been working with Member States and other relevant international partners to develop an appropriate set of indicators and data collection procedures related to the time-limited commitments as well as to the health effects of climate change and to socioeconomic and gender inequalities in the effects of the environment on health. The information collected would be stored and made available by the updated Environment and Health Information System (ENHIS), accessible through a new, interactive information technology platform. 24. The EHMB acknowledged that many health- and environment-related data were already collected by national institutions made available through environmental performance reviews or the European Commission’s programme of environmental monitoring and assessment. It recognized, however, that it would need to give countries further advice on the organization of data collection activities and suggested that, against a background of voluntary submission of information, thought should be given to introducing an “incentive-based” system, whereby the lack of data would be clearly apparent. 25. The Secretariat confirmed that there was indeed a need to collect additional data and was proposing, for instance, to undertake a limited, school-based survey using existing research and asking a small number of specific questions. It advocated the use of a common, integrated system that would enable the same data to be made available to a range of different audiences. Report of the first session of the EEHMB page 6 Preparations for the first meeting of the European Environment and Health Task Force 26. Countries had been asked to nominate national focal points as members of the EHTF; to date, 40 had done so, with most countries designating one person from the environment sector and one from the health sector. By the end of May 2011, the appointment of EHTF members should be completed and the host country for the first meeting of the EHTF (planned for early October 2011) should be identified. 27. It was suggested that an informal joint preparatory group of staff from UNECE, UNEP and WHO should work further on elaborating agenda items. The preparatory group would also draw up a list of the nongovernmental organizations and other bodies that could be invited to join the EHTF; the list would be reviewed in electronic consultation with EHMB members. 28. The EHMB recognized the need to ensure consistency and coordination with similar initiatives being taken by WHO in other regions. Organization and sustainability of the European environment and health process 29. The Regional Director reported that the WHO European Centre for Environment and Health had hitherto operated from offices in two locations, Bonn and Rome. It had become clear through recent negotiations, however, that the Italian government’s priorities had changed and it no longer intends to continue supporting the work of the Rome Office. She had therefore sent an official communication to the Italian Government two days earlier, informing them that as a consequence of their decision to withdraw from their agreement with WHO, the Organization would start taking steps towards the closure of the Rome Office. She was taking the opportunity to consolidate the Regional Office’s environment and health activities: all technical work would in future be carried out from the Bonn and Copenhagen Offices, but driven from the latter. Overall policy guidance, including the management of the European environment and health process would be done from the regional head office in Copenhagen. She would keep in constant contact with the EHMB co-chairs as developments unfolded and would distribute a briefing paper to EHMB members once the situation became clearer. 30. The European environment and health process operated on a voluntary basis and required the mobilization of substantial human and financial resources. Now that the respective roles of the EHTF and the EHMB had been clarified, the Ministerial Board’s guidance would be sought on an appropriate resource mobilization strategy, firmly located within a framework of sustainability, transparency and accountability. Once the institutional framework for the process was perceived as necessary and was given moral support by countries, it would be easier to raise the necessary financial and human resources. 31. The EHMB agreed that the report of its first meeting would serve to demonstrate the seriousness of the initiative. A working group would be established to provide guidance to the secretariat on the development of a proposal for the attainment of a predictable and sustainable basis of resources for the implementation of the EEHP and to develop a resource mobilization strategy for the sustainable implementation of the EEHP; Report of the first session of the EEHMB page 7 Annex 1. List of participants Azerbaijan Mr Hussein Bagirov, EEHMB member Minister of Ecology and Natural Resources Mr Elmar Mammadov First Secretary, Economic Affairs, Embassy of Azerbaijan in France Belarus Mr Vladimir Malevich Counsellor, Embassy of Belarus in France Ms Ina Rusaya Deputy Head, Department for Regulation of Impact on Atmospheric Air and Water Resources, Ministry of Natural Resources and Environment Protection France Ms Nora Berra, EEHMB member Secrétaire d'État chargée de la santé, ministère du Travail, de l'Emploi et de la Santé Professor Didier Houssin Directeur général de la santé, ministère du Travail, de l’Emploi et de la Santé Ms Brigitte Arthur Chef du bureau international Santé et protection sociale, délégation aux Affaires européennes et internationales, ministère du Travail, de l’Emploi et de la Santé Ms Géraldine Bonnin Chargée de mission, Organisation mondiale de la santé, délégation aux Affaires européennes et internationales, ministère du Travail, de l'Emploi et de la Santé Mr Emmanuel Briand Chef du bureau Environnement intérieur, milieux du travail et accidents, direction générale de la Santé, Secrétariat d’État à la santé, ministère du Travail, de l’Emploi et de la Santé Mr Loïc Josseran Ministère du Travail, de l’Emploi et de la Santé Ms Caroline Paul Chef du bureau Environnement extérieur et produits chimiques, direction générale de la Santé, Secrétariat d’État à la santé, ministère du Travail, de l’Emploi et de la Santé Mr Charles Saout Adjoint à la sous–directrice, Prévention des risques liés à l’environnement et à l’alimentation, direction générale de la Santé, Secrétariat d’État à la santé, ministère du Travail, de l’Emploi et de la Santé Report of the first session of the EEHMB page 8 Mr Alexandre de la Volpilière Chef de mission, Affaires européennes et internationales, direction générale de la Santé, Secrétariat d’État à la santé, ministère du Travail, de l’Emploi et de la Santé Malta Dr Joseph Cassar, EEHMB member Minister for Health, the Elderly and Community Care Mr Malcolm Vella Haber Private Secretary to the Minister for Health, the Elderly and Community Care Mr John Attard Kingswell Director, Department for Environmental Health, Ministry for Health, the Elderly and Community Care Romania Mr Lázló Borbély, EEHMB member Minister of Environment and Forests Dr Franciska Zsigmond Head, External Relations and Protocol, Ministry of Environment and Forests Mr Eugen Rosca First Secretary, Embassy of Romania in France Serbia Prim. Dr Elizabet Paunovic State Secretary, Ministry of Health, Government of the Republic of Serbia Slovenia Mr Dorijan Marušič, EEHMB member Minister of Health Dr Marta Ciraj Secretary, EU Affairs and International Relations Office, Ministry of Health Dr Pia Vracko Physician, National Institute of Public Health Turkey Professor Lutfi Akca Under-Secretary, Ministry of Environment and Forestry Mr Ziya Pala Researcher, Department of Foreign Relations and the EU, Ministry of Environment and Forestry Report of the first session of the EEHMB page 9 UNECE Mr Ján Kubiš, EEHMB member Executive Secretary Ms Brinda Wachs Environmental Affairs Officer, Transport, Health and Environment Pan-European Programme (THE PEP) UNEP Dr Christophe Bouvier, EEHMB member Director and Regional Representative, UNEP Regional Office for Europe Mr Wondwosen K. Asnake Regional Coordinator, UNEP Regional Office for Europe European Commission Ms Natacha Grenier Directorate of Public Health and Risk Assessment (observer) WHO Regional Office for Europe Ms Zsuzsanna Jakab, EEHMB member Regional Director Dr Guénaël Rodier Director Communicable Diseases, Health Security and Environment Dr Srdan Matic Coordinator, Environment and Health WHO Secretariat Ms Francesca Racioppi, Director a.i., ECEH Rome Office Dr Michal Krzyzanowski, Director, ECEH Bonn Office Mr Charles Robson, Head, Languages (Rapporteur) Ms Marina Hansen, Programme Assistant, Environment and Health Ms Suzanne Gravesen, Secretary, WHO Regional Office for Europe Ms Helena Shkarubo, Secretary, ECEH Rome Office European Environment and Health Ministerial Board (EEHMB) European Environment and Health Ministerial Board (EEHMB) Meeting report Paris, France 4-5 May 2011 The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan Original: English World Health Organization Regional Office for Europe Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: contact@euro.who.int Web site: www.euro.who.int