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Seventh Meeting of the EHC Advisory Committee, 18-21 July 1994, Kuala Lumpur, Malaysia : report

31 décembre 1994 Organisation mondiale de la santé

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RS/94/GE/10(MAA) 26 September 1994 ENGLISH ONLY

~PORT ,.-

•

.. 18 - 21 July 1994

SEVENTH MEETING OF THE EHC ADVISORY COMMITIEE

Convened by the WORLD HEALTII ORGANIZATION WESTERN PACIFIs:REGIONAL ENVIRONMENTAL HEALTII CENTRE (EHC) Kuala Lumpur, Malaysia

Not for sale Printed and distnbuted by the World Health Organization Western Pacific Regional Environmental Health Centre (EHC) P.O. Box 12550 50782 Kuala Lumpur Malaysia

September 1994

NOTE

• The views expressed in this report are those of the members of the WHO Western Pacific Regional Environmental Health Centre (EHC) Advisory Committee and do not ~ecessarily reflect the policies of the Organization..

CONTENTS

INTRODUCTION (HISTORICAL BACKGROUND AND 1ERMS OF REFERENCE) ......................... 1 CONCLUSIONS AND RECOMMENDATIONS ...:........................................................ 2 OPENING OF THE MEETING ........................................................................................... 5 PRESENTATIONS ON THE GLOBAL AND REGIONAL ENVIRONMENTAL HEALTH PROGRAMME ....................................5 4.1 The global health and environment programme .....................................:..................5.,i... 4.2 The regional health and environment programme .................................................... 6 . 4.3 Regional Directors observation.................................................................................... 6

2. 3. 4.

5. 6.

REPORT ON THE WORK OF EHC .................................................................................. 6 EHC ACTIVITIES IN THE CON1EXT OF THE REGIONAL HEALTH AND ENVIRONMENT STRATEGY{pROGRAMME...............................................................................................7 6.1 Community water supply and sanitation .....................................................................7 6.2 Environmental health in rural and urban development and housing ..................... 7 63 Health risk assessment of potentially toxic chemicals ............................................... 7 6.4 Control of environmental health hazards .................................................................... 8 6.5 Food safety ........................................................................................................................ 8

FUfURE ENVIRONMENTAL HEALTH ACTIVITIES IN THE CONTEXT OF THE NEW WHO STRATEGY................................................. 9 7.1 Glo~al pe~~ye ........................................................................................................... 9 7.2 Regtonal mtitiatiVes......................................................................................................... 9 73 Management survey report .......................................................................:.................... 9

8. 9.

FORMULATION OF RECOMMENDATIONS ............................................................ 10 PRESENTATION OF REPORT AND CLOSING .•...........•........................................... 10 ANNEXl : OPENING ADDRESS OFDRS.T. HAN, REGIONAL DIRECTOR. WHO REGIONAL OFFICE FOR WESTERN PACIFIC ..................................................... 11 ANNEX 2 ANNEX 3 ANNEX 4 LIST OF ADVISORY COMMITIEE MEMBERS AND SECRETARIAT STAFF ................................................................ 13 AGENDA ..................................................................................................... 1·5 REPORT ON THE WORK OF EHC (July 1991 - April 1994) .............................................................................. 19

ANNEX 5

REGIONAL STRATEGY ON HEALTH AND ENVIRONMENT ............................................................................ 73

SUMMARY

Objectives of the meeting: The objectives of the seventh meeting of the Advisory Committee to the WHO Western Pacific Regional Environmental Health Centre (EHC) were:

(1)

to review the current status of development of the Centre and its programmes, including implementation of the recommendations of the EHC Advisory Committee at its sixth meeting. and the activities planned for the future; and to discuss the direction of the Centre's activities, and to make recommendations on the·future courses of action.

(2)

.... Summary of proceedings, conclusions and recommendations:

The meeting was held in Kuala Lumpur, Malaysia, from 18 to 21 July 1994. Members of the Advisory Committee were from Australia, China, Fiji, Malaysia, New Zealand and the Republic of Korea. Presentations were made on WHO global and regional environmental health initiatives and programmes and on the activities of EHC in the various programme areas. The Advisory Committee itself then developed conclusions and recommendations based on the presentations, and on more general discussions regarding opportunities and constraints faced by the Centre. The Committee came to the view that there needs to be a more proactive approach towards activities, an enhanced team effort and a stronger role in advocating environmental health concerns. They felt that the recommendations of the sixth meeting directed at specific programme areas were carried out to a large extent, but noted that it had not been possible to implement some of the general recommendations in full largely due to lack of resources. This lack of resources was vi~ed with concern by the Committee. . The Committee noted that the UNCED meeting and all the follow-up activities associated with it, and the WHO Regional Strategy on Health and Environment would influence the work of EHe, and that this necessitated a review of the directions and activities of the Centre. They concluded that it was important for EHC to continue to reassert its role as a technical centre of the WHO Western Pacific Regional Office, working alongside donors and countries of the Region. The Committee made 28 recommendations on matters related to the work of EHe, to improve the efficiency and effectiveness of the Centre and to direct efforts to make the best use of its limited resources.

....

1. INTRODUcnON (HISTORICAL BACKGROUND AND TERMS OF REFERENCE)

The objectiv~ of EHC are to: promote and facilitate effective collaboration between institutions and scientific and technical personnel of Member States in the Region; and support the development by Member States of self-reliant institutions and capabilities in the field of environmental health. EHC collaborates with Member States in: developing policies for environmental health and resource enhancement; strengthening national environmental institutions; education and training of personnel for environmental planning, pollution control, water supply, waste management, chemical safety and food safety; providing information on various environmental health subjects; monitoring, collecting and processing information for environmental planning purposes; solving problems related to the improvement of environmental conditions and the protection of natural resources against pollution; and identifying and promoting low-cost, appropriate technology.

The Centre is engaged in activities at three levels: national, Regional and global. At national level, staff members and consultants are assigned to countries to provide advisory services in specialized areas of expertise and to collaborate in the conduct of national training activities. At the Regional level, collaborative activities include the organization of regional group educational activities and the promotion of applied studies. At the global level, ERC is responsible for the coordination of global programmes in the Region such as the Global Environmental Monitoring System (GEMS) projects on air, water and food contamination monitoring, the GEMS Human Exposure Assessment Location (HEAL) project, and the International Programme on Chemical Safety.

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. The sev~nth meeting of the Advisory Committee of the WHO Western Pacific RegIOnal EnvlTonmental ~eal~h Centre was held in Kuala Lumpur, Malaysia from 18 to 21 July 1994. The objectives of the meeting were: (1) !o revi.ew!he current s!atus of development of the Centre and its programmes, mcludmg unplementation of the recommendations of the Advisory Committee at its sixth.meeting, and the activities pl~ed for the future; and to discuss the direction of the Centre's activities, and to make recommendations on the future courses of action.

(2)

2. CONCLUSIONS AND RECOMMENDATIONS

The Committee felt that the recommendations of the sixth meeting of the Advisory Committee directed at specific programmes were carried out to a large extent but noted that it had not been possible to implement some of the general recommendations in full largely due to lack of resources. This lack of resources was viewed with concern by the Advisory Committee. The Committee noted that the UNCED meeting and all the following activities associated with it, and the WHO Regional Strategy for Health and Environment would influence the work of EHe. and recognized that this necessitated a review of the directions and activities of the Centre. In view of this, and the budgetary and personnel constraints facing ERC, it was particularly important for EHC to continue to re-assert its role as a technical centre of the WHO Western Pacific Regional Office working alongside donors and countries of the Region.

It was also seen as important for the success ofEHC that it should continue to improve its efficiency and effectiveness, and carefully direct its efforts to make the best use of its limited resources. 'The Committee was keen to see the Centre playa much stronger role in advocating that environmental health concerns be given high priority in the development of the Member States in the Region and in supporting efforts to raise awareness of the importance-of environmental health issues and how they can be addressed. The seventh meeting of the Advisory Committee makes the following recommendations: 2.1 TO MAKE BEST USE OF LIMITED RESOURCES, EHC SHOULD ADOPT THE FOLLOWING APPROACH TO PROJECT SELECTION:

the workplan of EHC should be based on the priorities of the ~O Regional Strategy on Health and Environment; .-

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to ensure that projects with posit~ve environmental.hea~th outcomes are implemented, EHC should work m close p~rtnershlp wIth: govern~ents, NG~s, community groups, external support agencies and bilateral donors m the plannmg, implementation and evaluation of projects; to facilitate the selection of the most urgent needs for traditional activities, EHC should develop a criteria matrix for countries in the Region taking into account: the country's environmental health needs, the support availa~le f~~m other external funding agencies, the level of local support, and the sustamability of the proposed project; for all EHC projects and activities, the proposal should clearly state the outcome or impact that the project/activity is aimed at achieving and its success criteria ( objectives and performance measures). The report should include an evaluation based on the performance criteria;

2.2

information on successful projects (and the lessons from. the others) should be used both to market the work of EHC and as models for other countries and agencies to base projects on. IN CARRYING OUT ITS ACTIVITIES, EHC SHOULD: actively advocate its skills and expertise, particularly to governments, NOOs, external support agencies, and bilateral donors involved in planning and implementing projects with a significant environmental health impact; give priority to working with these groups on planning and implementing such projects;

2.3 .-

intensify a cooperative team style of working. This will both ensure that the best use is made of the many skills of the staff and reflect the fact that environmental health problems are multi-faceted. AS ENVIRONMENTAL AND DEVELOPMENTAL ISSUES HAVE POTENTIALLY SIGNIFICANT IMPACTS ON HEALTII, EHC SHOULD: encourage and foster health agencies to become more involved with environmental and development agencies and thus provide for health issues to be taken into account in these agencies' activities; encourage collaboration between health and other agencies at all levels so that they become involved in activities concerned with intersectoral issues; participate in intersectoral issues. 2.4 EHC SHOULD SEEK TO DEVELOP AN APPROACH INVOLVING MORE ACTIVE COOPERATION WITHIN WHO AND BETWEEN COUNTRIES AND AGENCIES BY: making full use of the technical resources and skills within WHO at allleve1s and by all relevant programmes; working on joint projects with other WHO offices and programmes; working on joint projects with other agencies;

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promoting technical cooperation among countries; developing an improved procedure to formulate and implement country programmes, and to assess the expected benefits. 2.5 EHC SHOULD ASSESS THE MECHANISMS AVAILABLE TO UNDERTAKE RELEVANT HUMAN RESOURCES DEVELOPMENT BY: considering the most efficient form of providing this service, e.g. national and intercountry training courses and meetings, advisory services, on-the-job training or other methods of training; , en~g th~t ~e right participants attend the activity by setting appropriate

selectIon cntena; developing and implementing methods for determining the effectiveness of these activWes including follow-up with participants and their governments or sponsors and hence review their usefulness; in' recognition of the importance to the Region of an adequate workforce trained in environmental health, EHC should cooperate with education and training institutes in the Region. Where possible, it should contnbute training materials and provide the services of its staff to help the institutes deliver high quality environmental health components in their COUrses. 2.6 EHC SHOULD PROMOTE TIIE EXCHANGE OF INFORMATION AND EXPERTISE BY: providing for the proper dissemination of technical information to the relevant user; facilitating personnel exchanges and training attachments; facilitating the development and implementation of information management systems in Member States; providing information on the availability of documents related to aspects of environmental health and ensuring adequate accessibility; encouraging and facilitating cooperation between countries on information exchange; facilitating the development and implementation of environmental health management information systems; increasing awareness of the importance of global and Regional issues on health, development and environment to countries of the Region.

2.7

TIIAT: the Advisory Committee members, in recognition of their role as an advisory group providing direction to EHC and of their potential as advocates for the health and environment programmes of WHO, be kept informed of relevant matters on a regular basis and be invited, when fea81ble and appropriate, to participate in WHO activities.

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...

3. OPENING OF THE MEETING

Professor Dato' Dr Syed Jalaludin bin Syed Salim, Vice-Chancellor of the University of Agriculture, Malaysia (UPM) gave a welcoming address. Professor Dato' Dr Syed Salim expressed his appreciation for the presence of EHC at his university and the Centre's many contributions in environmental health within the host <!ountry. He supported the continued activities of EHC and stressed the increasing importance of environmental health issues. The meeting was opened by Dr S.T. Han, WHO Regional Director for the Western Pacific. Dr Han indicated that several events relevant to the work of EHC have occured over the last few years. The outcomes include the WHO Global and Regional Strategies for Health and the Environment which involve a new focus for traditional activities and the early identification of priority activities to ensure activeness and to maximize effectiveness. The Advisory Committee was invited to address these issues in an attempt to make the work of EH C more productive and relevant in the face of limited resources. The full text of Dr Han's speech is given in Annex 1. Thenfollowed a self-introduction of the Committee members and WHO staff, proceeding to nominations of officers, namely, Dato' Dr M. Jegathesan as Chairman, Dr Chen Jun-shi as Vice-Chairman and Dr G. Roberts as Rapporteur. A list of the Advisory Committee members and the WHO Secretariat is presented in Annex 2. The agenda of the meeting is given in Annex 3.

4. PRESENTATIONS ON THE GLOBAL AND REGIONAL ENVIRONMENTAL HEALTH PROGRAMME

The Chairman, Dato' Dr Jegathesan opened the first working session by extending a welcome from the Government of Malaysia to all visitors_ He spoke of the close working relationship between Malaysian agencies and EHC, to the benefit of all organizations. 4.1 The global health and environment programme

This first presentation was given by Mr G. Ozolins, Director, Office of Operational Support in Environmental Health (EOS), WHO Headquarters. Mr Ozolins reviewed activities at the global level and the WHO strategy on health and environment in relation to development. The Brundtland Commission Report, "Our Common Future" did not explicitly consider health concerns while concentrating on interrelationships between environment and sustainable development; the WHO Commission on Health and Environment addressed this concern. Based on the recommendations of the WHO Commission on Health and Environment and on the outcome of UNCED, WHO has formulated a new global strategy for health and environment which seeks to implement health and environment activities of Agenda 21 (arising out of UNCED). WHO must provide

- (, leadership in promoting health in the context of the environment and sustainable development. Mr Ozolins then proceeded to identify the five changes in WHO's new global strategy on health and environment and described the approaches and activities to be undertaken. 4.2 The regional health and environment programme

. The next presentation was given by Dr B. Kean, Director, Drug Policy. Envrronmental Health and Health Technology (DET), WHO Western Pacific Region. Dr Kean commenced with a brief outline of the history relating to the Regional Strategy on Health and Environment. The need for a Regional Strategy relates to the rapid changes occurring in the Region, many of which have an impact on health aspects which are generally underrepresented in development planning. The Regional Strategy involves a new focus for traditional activities and prioritization of work which, it is expected, will provide for sustainable development. 43 Reiional Director's observation

The Regional Director, Dr S.T. Han, in commenting on the regional programme, stated that he envisages health promotion and health protection as a new focus for the future work of WHO in the Region. He is also initiating a new partnership approach in seeking extrabudgetary resources for country programmes, whereby WHO works with donor agencies and national governments to develop, implement and evaluate programmes. The role of WHO is that of providing technical expertise and advice, and not necessarily seeking funds for execution. This approach has been well received by donor agencies and by national governments.

5. REPORT ON THE WORK OF EHC

Dr P. Guo, Director, EHC presented a brief overview of the highlights during the period 1 July 1991 to 30 April 1994. An important change has been the alteration in the name of the Centre from "WHO Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS)" to "WHO Western Pacific Regional Environmental Health Centre (EHC) " in October 1992, as recommended by the sixth meeting of the Centre's Advisory Committee and endorsed by the WHO Regional Committee for the Western Pacific.

During the period covered by the Report, there were 106 collaborative field activities, 50% in four countries. namely, China, Malaysia, Philippines and Viet Nam, which are rapidly industrializing nations. For the first time, collaborative activities were undertaken in Cambodia. Dr Guo indicated that the number of activities in each of the five programme areas has fluctuated greatly over the past 15 years. This is directly associated with the level of staffing and funding. In the past two years, budgets have been severely cut in real terms resulting in the inability to fill a number of staff positions. He informed the Committee of efforts to implement the 23 recommendations of the previous Advisory Committee and noted that all specific recommendations in programme areas have been largely

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implemented. He pointed out that lack of resourc~ prevented implementation of the recommendation on convening a senior level meetmg. The full report on the work of EHC is provided in Annex 4.

... 6.1

6. EHC ACTIVITIES IN THE CONTEXT'OF THE REGIONAL HEALTH AND ENVIRONMENT STRATEGY/PROGRAMME

Community water suwly and sanitation

Dr A. Basaran, Regional Adviser in Environmental Health, WHO Western Pacific Region made a presentation reviewing the objectives, targets and achievements in this programme area. The main focus in this area was in specialized technical support directed at specific problems and activities dealing with the provision of information, planning, implementation and management of systems to ensure safe water supply and adequate sanitation. There were five major training activities and seven missions to provide advisory services. Major constraints experienced included problems with operating and maintaining water supply and sanitation systems, a shortage of skilled human resources as well as funding limitations. As recommended at the sixth meeting of the Advisory Committee, EHC has had collaboration with national staff on protection of water supplies and has successfully promoted drinking·water quality and safety, as well as adequate sanitation particularly in countries where the greatest need has been identified.

6.2

Environmental health in rural and urban deve1opmel1t and housing

Dr H. Ogawa, Environmental Systems Engineer, EHC presented the report on environmental planning and impact assessment, solid waste management and improvement of urban environmental health. Activities were conducted in environmental and health impact assessment, integrated planning for development, environment and health and development of a healthy urban environment. The major problems identified included lack of qualified personnel to carry out impact assessments, increasing quantities of solid waste and rapid urbanization which overloads existing infrastructure. A total of 34 training activities and 11 advisory services were conducted. Based on recommendations of the sixth Advisory Committee, there was input into the Healthy Urban Environment project, assessments of health implications associated with low-cost housing development schemes and rural and urban development, and collaboration on the handling and disposal of hospital/clinical waste. 6.3 Health risk assessment of potentially toxic chemicals

Dr W. Harrington, Chemical Safety Specialist, EHC stated that the chemical safety programme has tended to be reactive in nature. The work in this area continued the involvement with national and international organizations dealing with chemical safety, hazardous waste management and occupational health.

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. Ther~ were .1 ~ ~rai~ing courses and 21 advisory services undertaken during the peno~. Major act~v~tIes ~cluded two regional workshops held at ERC and a workshop on cleanmg-up a pestIcIde spill. Much?f the work in this area was carried out as part of the UNDP-funded, WHO-executed project on the safety and control of toxic chemicals and hazardous wastes. . RecommendationS of the sixth meeting of the Advisory Committee on developing a legISlative framework for safe handling and disposal of hazardous wastes, controlling transboundary movement of hazardous wastes, and management of toxic chemicals have been implemented. 6.4 Control of environmental health hazards

Mr K. Rolfe, Air Quality Management Specialist, EHC gave a presentation of the main problems faced in the Region, stressing that in view of rapidly expanding economi~ air quality is deteriorating in many cities and becoming detrimental to human health. 'I'Mfocus of this programme area is directed at the most serious urban and industrial air pollutants.and at indoor air pollution. Staff were involved in five training courses, seven advisory services and five applied studies. EHC plays a coordinating role in the collection of data from regional participants in the GEMS/air quality monitoring project and is involved in the GEMS/HEAL project. The recommendations of the sixth meeting of the Advisory Committee to encourage the use of alternative fuels and cleaner fuels, reduce motor vehicle related air pollution, and promote an awareness of health impacts of ozone depletion. climate change and natural disasters were addressed. Dr Guo stated that there is considerable variation in the ability of countries in the Region to effectively manage water pollution. Water quality continues to have an impact on the health and well-being of inhabitants. There were three training courses, eight advisory services as well as participation in the GEMS/water quality monitoring project. As recommended by the sixth meeting of the Advisory Committee, better water quality management and the capability to assess water quality were fostered. Training activities on groundwater management were, however, limited owing to budgetary constraints. 6.5 Food safety

Dr Basaran indicated that food safety remained a high priority in the Region. EHC was involved in strengthening the continued development and evolution of food safety programmes with a view to support and promote food safety. Unfortunately, there was a reduction in the number of activities in this area since the Food Safety Specialist post at EHC became vacant in February 1991. Five training activities and five missions to provide advisory services were implemented. In particular, training courses on Hazard Analysis Critical Control Point (HACCP) procedures were carried out in China, Philippines and Viet Nam. Countries continued their participation in the GEMS/food contamination monitoring project. An international se1ninar on harmonization of regulations on food irradiation was

held.

.... - !) -

....

Countries are encouraged to join the Codex Alimentarius Commission and adopt Codex Standards for food to ensure food safety domestically and to enable the free movement offoo'd commodities internationally. The lack of a legislative framework in many Member States has proved to be a hindrance in this regard. Based on the recommendations of the sixth meeting of the Advisory Committee, EHC has provided advisory services to develop infrastructure in food safety programmes and to enhance the capability of detection of food contaminants. Activities have been instituted in an attempt to improve the safety of street-vended foods in the Region.

7. FUTURE ENVIRONMENTAL HEALTH AcrIVITIES IN THE CONTEXT OF THE NEW WHO STRATEGY

....

7.1

Global perspective

Mr Ozolins indicated that the challenge for WHO is to become more supportive of national efforts in the development and implementation of action plans for health and environment. Health agencies should be encouraged to work together with other ministries to undertake programmes in line with Agenda 21. At the intemationallevel, WHO is cooperating with sister agencies such as United Nations Development Programme (UNDP) in developing and planning initiatives for sustainable development. Interaction between WHO and Member States is expected to become more of a partnership with other agencies in supporting national efforts on health and environment. The work of WHO at all its levels must be brought to bear in providing support to countries. 7.2 Regional intitiatives

....

...

Mr Rolfe spoke on matters of health and sustainable development based on visits by the Subcommittee of the Regional Committee on Programmes and Technical Cooperation to three countries in the Region. It was concluded that there needs to be a strong political commitJ)1ent on the part of national governments to deal with issues of health and sustainable devleopment. The role of WHO should be included in the provision of technical support, in facilitating the use of expertise in the Region and in encouraging intersectoral coordination. Dr Ogawa presented a study protocol aimed at identifying health and environmental problems in the face of rapid urban development. The capabilities of the infrastructure to cope with the development would be assessed and measures to resolve problems would be delineated. Additionally, the feasibility of formulating plans for health and environmental management in the face of future development would be considered. 73 Management survey re.port

....

Dr Kean presented a summary of the Management Survey Report which was designed to assess the overall management and operations of ERe. The report focused on the opportunities for improvement and the future actions needed to be taken by ERe. The strength ofthe Centre, namely its ability to respond promptly to requests from

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Member States and the availability of highly qualified technical staiI were recognized. In contrast, there are a number of constraints facing the Centre induding the inability of many developing countries to deal with environmental health problems. In view of budgetary constraints, certain posts are to remain vacant. Additionally it was suggested that to improve efficiency, there need to be greater cooperation and ' interaction between staff with a view to providing multidisciplinary responses where appropriate. Delegation of authority within EHC and greater coordination with the Regional Office were seen as mechanisms to enhance the management process, and steps are being taken to address these issues.

8. FORMULATION OF RECOMMENDATIONS

The Advisory Committee was provided with information on environmental health policies arid programmes at global and Regional level as well as a detailed report on the work of EHC. The Committee felt at this time, with a series of changes at policy level in place, that a review of the directions and method of operation of the Centre was called for. The Committee's discussions and meetings with EHC staff focused on this approach with a view to articulating changes in direction and style of operation of EHC within the context of the WHO Regional Strategy on Health and Environment. The Committee did not, as in previous years, make specific recommendations on individual programme areas, except to reaffrrm the importance of food safety in addition to priorities contained in the Regional Strategy. The recommendations made by the Advisory Committee are presented in Section 2.

9. PRESENTATION OF REPORT AND CLOSING

The report of the Committee was endorsed by the meeting after some minor revisions. The Chairman of the meeting, Dato' Dr Jegathesan, thanked the Secretariat for its assistance and support to the meeting. Dr Kean, in closing the meeting, thanked the Committee members for their dehberation and valuable contribution to the success of the meeting.

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AJ~NEX

OPENING ADDRESS OF DR S.T. HAN, REGIONAL DIRECTOR WHO REGIONAL OFFICE FOR WESTERN PACIFIC

Professor Dato' Dr Syed Jalaludin bin Syed Salim, Vice-Chancellor, University of Agriculture, Malaysia; Distinguished Members of the Advisory Committee; Ladies and Gentlemen:

First, I would like to give a very warm welcome to all of you to the Seventh meeting of the ERC Advisory Committee. There are four new members of the Committee here today (Dr Roberts from Australia, Dr Boladuadua from Fiji, Dr Kim from the Republic of Korea and Dato' Dr J egathesan from Malaysia) and I wish to extend a special welcome to them and hope their fresh input and ideas will be particularly valuable to us. OUr last meeting was held in December 1991 and several events that are very relevant to the work of EHC have occurred since that meeting. These include the preparation of the Global and the Regional Strategy on Health and Environment, the 1991 Consultative Group meeting on Health and Environment in Manila and the 1992 United Nations Conference on Environment and Development held in Brazil. The Regional Strategy document was endorsed at the 44th Session of the Regional Committee held in September 1993. It is intended to guide WHO activities in environmental health over the next six years and comprises two separate but interrelated parts:

1) a new focus for traditional activities; and

2)" the identification of priority activities based on significance, timeliness and

practicability. The strategy does not represent a radical change, but does envision a major shift in thinking about how we do our work, recognizing that we have limited resources and therefore must focus on priority activities to maximize effectiveness and impact. In convening this Advisory Committee meeting, I am asking you to reflect on this strategy and to offer your guidance on how it can be translated into more effective interventions in the field. Much has been achieved by the Centre in the field of environmental health over the past decade. This is due in part to the able guidance of its Advisory Committee members, whose continued contribution is sought to make the Centre vibrant, effective, and relevant in the face of a changing environment.

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Your main task as a Committee member is to look to the future with the aim of making the Centre more productive and its work more worthwhile. I would especially ask that you consider what you as Committee Members might do to help bring this about. At present, the staff strength at the Centre is at a low level This is partly because of budgetary constraints and partly because of the recent decentralization of WHO water supply and sanitation activities to Cambodia, Lao People's Democratic Republic and Viet Nam and the Pacific island countries. Nevertheless, this.provides an opportune time to assess staffing and programme priorities bearing in mimi, country needs and the possible use of consultants in some specialised areas. In a recent management review of the Centre, it was concluded that the Centre has achieved much in the field of enviro~ental health over the past decade. The review recommended that the practical implications of the strategy document that relate to EHC's future work programme should be studied with a view to producing concrete, implementable plans for action. I would like to take this opportunity to thank the University of Agriculture in Malaysia, for its generosity in continuing to provide facilities for the EHC on its campus. I would ~o like to thank the Government of Malaysia for its generous contribution to the costs of running the Centre. Finally, I declare this meeting open and wish you all success in your task.

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ANNEX 2

LIST OF ADVISORY COMMIT'IltE MEMBERS AND SECRETARIAT STAFF

Members 1.

Desiwation and address Director Toxicology Evaluation Section Commonwealth Department of Human Services and Health GPO Box 9848 Canberra ACT 2601 Australia Tel: 61.6.289-7188 Fax: 61.6.289-7222 Deputy Director Institute of Nutrition and Food Hygiene Chinese Academy of Preventive Medicine 29 Nan Wei Road Beijing 100050 People's Republic of China Tel: 86.1.301-1875 Fax: 86.1.301-1875 Director for Preventive and Primary Health Services Ministry of Health and Social Welfare Kaunikuila House, Flagstaff P.O. Box 2223, Government Buildings Suva Fiji Tel: 679.306177 Fax: 679.306163 Deputy Director-General of Health (Research and Technical Support) Ministry of Health Institute for Medical Research lalan Pahang 50588 Kuala Lumpur Malaysia Tel: 61.3.298-9820 Fax: 61.3.292-0675

Dr Gladwin Roberts

Dr Chen lun-shi

Dr (Ms) Asinate U. Boladuadua

...

Dato' Dr Manikavasagam legathesan

...

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Mr Jonathan Christopher Fletcher

Group Manager Development Christchurch City Council 63-173 Tuam Street P.O. Box 237 Christchurch 1 New Zealand Tel: 64.3.379-1660 Fax: 64.3.371-1786 Director-General

....

Dr Kim Jong-suk

Air Quality Management Bureau Ministry of Environment Kwacheon 427-760 Republic of Korea Tel: 82.2.504-9247 Fax: 82.2.504-9208

Secretariat 7. Dr Bernard Peter Kean Director Drug Policy, Environmental Health and Health Technology, WHO Western Pacific Region Regional Adviser in Environmental Health, WHO Western Pacific Region Director Office of Operational Support in Environmental Health, WHO Headquarters Director, EHC

Dr Ali Basaran Mr Guntis Ozolins •

10.

Dr Paul Guo Mr Kevin Rolfe Dr Wayne Harrington Dr Hisashi Ogawa Ms Chan Lai Yee Ms Tan Yit May Ms Normah Mahmod

It 12. 13. 14. 15. 16.

Air Quality Management Adviser, EHC Chemical Safety Adviser, EHC Environmental Systems Engineer, EHC Administrative Officer, ERC Special Assistant, ERC Secretary, ERC

- 15 ANNEX 3

Monday. 18 July 1994

AGENDA

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0900-0930:

Opening session Introductory remarks by Dr P. Guo, Director, EHC

...

Welcome address by Professor Dato' Dr Syed lalaludin bin Syed Salim, Vice-Chancellor, University of Agriculture, Malaysia Opening address by Dr S.T. Han, Regional Director, WHO Western Pacific Region Self-introduction of the Committee members and WHO staff Nomination of officers

...

0930-1000: 1000-1005: 1005-1010: 1010-1050:

Group photograph Refreshments Administrative briefing by Ms L.Y. Chan, Administrative Officer, EHC Remarks by the Chairman of the Advisory Committee The Global health and environment programme by Mr G. Ozolins, Director, Office of Operational Support in Environmental Health (EOS), WHO Headquarters The Regional health and environment programme by Dr B. Kean, Director, Drug Policy, Environmental Health and Health Technology (DET), WHO Western Pacific Region Presentation of the EHC report by Dr P. Guo, Director, EHC Lunch Discussion of EHC Report

1050-1130:

1130-1200: 1200-1400: 1400-1430:

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Annex 3

1430-1520:

EHC activities in the context of the Regional health and environment strategy/programme - Introduction by Dr B. Kean and Dr P. Guo - Community water supplY and sanitation - Food safety - Discussion

1520-1540: 1540-1630:

Refreshments EHC activities in the context of the Regional health and environment strategy/programme (contd.) - Chemical safety and occupational health and safety

- Air and water pollution control - Solid and hazardous waste management - Development of healthy urban environment - Discussion Tuesday. 19 July 1994 0900-1020: Future environmental health activities in the context of the new WHO Strategy - Introduction by Dr B. Kean and Dr P. Guo - Global perspective by Mr G. Ozolins - Resource sharing - Extrabudgetary funding - Regional initiatives: - The Sub-Committee of the Regional Committee by Mr K. Rolfe, Air Quality Management Adviser, EHC 1020-1040: 1040-1200: Refreshments - The Viet Nam and China urban health development initiatives by Dr H. Ogawa, Environmental Systems Engineer, EHC - Discussion

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1200-1400: 1400-1630: -.

Annex 3

Lunch Future environmental health activities in the context of the new WHO strategy (contd.) - Discussion of Global perspective and Regional initiatives - The future role of the Environmental Health Centre by Dr B. Kean - Review of objectives and functions of EHC - Management assessment study - Discussion

...

(R~freshments

at 1500-1520)

...

Wednesday. 20 July 1994

0900-1630:

Development of Advisory Committee recommendations to the Regional Director, including a proposed plan of work for Committee members for the period 1995-1997. Preparation of Committee report

(Refreshments and lunch at same time as on previous days)

Thursday. 21 July 1994

...

0900-1430:

Review and finalization of recommendations, plan of work, and Committee report

(Refreshments and lunch at same time as on previous days)

1430-1500:

Closing session

- 19 ANNEX 4

WPRjRUDjEHC(1)j94.2 . 10 June 1994 ENGLISH ONLY

REPORT ON TIlE WORK OF EHC (July 1991-April1994)

PREPARED FOR THE SEVENTH MEETING OF THEEHCAD~SORYCOMMnnEE

KUAlA LUMPUR, MAIAYSIA . 18-21 July 1994

Printed and distributed by the WORLD HEALTH ORGANIZATION Western Pacific Regional Environmental Health Centre (EHC) P.O. Box 12550 50782 Kuala Lumpur Malaysia

·20·

Annex 4

CONTENTS

HIGHLIGHTS_._ ..._._ _ _ __

1.1 Chan~e of the Centre'~ name: .. :..: ................................................................................22 1.2 OvervIew of collaboratIve actIvitIes ............................................................................22 1.3 UNCED and Agenda 21 ...............................................................................................25 1.4 Global and regional strategies on health and environment.... _ .............................26 2.

WHO POLICY ON THE PROMOTION OF ENVIRONMENTAL HEALTII

2.1 . Global programme .........................................................................................................26 2.2 WHO Western Pacific regional programme .............................................................27

3. 4.

OBJE~ANDFUNCTIONSOFEHC~

_____________________

~28

SITUATION ANALYSIS _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4.1 4.2 4.3 4.4 45 4.6

~29

Introduction ................................................................................................................... .29 Community water supply and sanitation ....................................................................29 Environmental health in rural and urban development and housing .................. .30 Health risk assessment of potentially toxic chemicals ............................................ 32 Control of environmental health hazards ................................................................. 32 Food safety ..................................................................................................................... 35

REVIEW OF ACTIVITIES AND ACHIEVEMENTS _ _ _ _ _ _ _ _ _ _. ..36

5.1 Community water supply and sanitation ...................................................................36 5.2 Environmental health in rural and urban development and housing ..................37 5.3 Health risk assessment of potentially toxic chemicals ............................................ 39 5.4 Control of environmental health hazards ................................................................. .40 55 Food safety ......................................................................................................................44 5.6 Information service programme ..................................................................................45 6. FUTURE PROSPECfS ............. _ _ ..._ ..._ _ _ _ _ _ _ _ _ _ _ _ _...._46 6.1 6.2 6.3 6.4 6.5 7. Community water supply and sanitation....................................................................46 Environmental health in rural and urban development and housing ...................47 Health risk assessment of potentially toxic chemicals ............................................. 47 Control of environmental health hazards ..................................................................48 Food safety ......................................................................................................................49

ACTION ON RECOMMENDATIONS OF THE SIXTH MEETING OF THE ADVISORY COMMITfEE _ _ _ _ _ _ _ _ _ _ _ _ _ _--J50 7.1 7.2 7.3 7.4 75 7.6 General recommendations ...........................................................................................50 Community water supply and sanitation ................................................................... 52 Environmental health in rural and urban development and housing ..................52 Health risk assessment of potentially toxic chemica1s ............................................53 Control of environmental health hazards ..................................................................54 Food safety ............................................................................................. ··· ..................... .55

- 21 -

Annex 4

8.: PROGMMME SUPPORT DEVELOPMENT _ ..__. _ "......_ .........." .._._..." .._ ..56 8.1 8.2 8.3 8.4 8.5 Staffing ................... :....................................................... _................................................. .56 Regular budget .............................................................................................................. .56 Extra-budgetary support .............................................................................................. .56 Short-term consultants ................................................................................................. .57 Other administrative matters .......................................................................................57

APPENDICES:

APPENDIX 1 APPENDIX 2

UST OF EHC ACTIVITIES July 1991 - April 1994 .......................................................................58 EHCSTAFF (As at 30 April 1994) ........................................................................72

- 22-

Annex 4

l. HIGHLIGHTS

1.1-

Change of the Centre's name

Since its establishment in 1979, the Centre has been lqlown as the WHO Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS). At the Sixth Meeting of the Centre's Advisory Committee held in December 1991, the name of the Centre was discussed. The Committee members favoured a change of name because the PEPAS acronym was found difficult to understand and recall. The Committee's suggestion to rename the Centre as "WHO Western Pacific Regional Environmental Health Centre (EHC)" was agreed by the WHO Regional Director and approved by the WHO Regional Committee for the Western Pacific at its 43rd session held in September 1992. The new name of the Centre took effect on 1 October 1992. 1.2 Overvierif collaborative activities

During. the period under review, i.e. from July 1991 to April 1994, EHC collaborated with 24 countries and areas of the Region to implement 106 field activities. It also convened seven regional group educational activities in various environmental health programme areas. The list of the activities is presented in Appendix 1. A breakdown of the number of activities according to country/area is given in Table I, while Figure 1 shows a percentage breakdown of all the collaborative activities according to programme area. It can be seen from Table 1 that more than half ofEHC's collaborative activities were implemented in four countries - China (13.2%), Malaysia (19.0%), Philippines (8.5%) and Viet Nam (9.4%). These are rapidly industrializing countries where environmental pollution problems are increasing and the Governments are taking action to ensure that environmental control measures are incorporated into their development programmes.

Table 1 also shows that 31 % of EHC's collaborative activities were implemented in 14 Pacific island countries and 20% in three countries - Cambodia, Lao People's Democratic Republic and Viet Nam. This indicates a significant increase in collaborative activities in these countries compared to previous review periods. In the Pacific island countries, there has been a drift of people towards urban lifestyles in recent years. Because the island ecosystems are fragile, freshwater resources are scarce and adequate facilities for disposal of wastes are lacking, the environmental health problems caused by urbanization are raising concern. Cambodia, ~o People's Democratic Republic and Viet Nam have begun to industrialize in recent years and environmental health problems are becoming serious. These factors have led to the increase in collaborative activities with these two groups of countries. EHC continued to promote the integration of health and environment into national plans for sustainable development. In Malaysia, an inter-ministerial (Ministry of Health/Ministry of Science, Technology and Environment) Environmental Health Research Centre is being established. In this connection, a national conference on environmental health research was held in April 1994 to discuss, among other things, the operational aspects of the Centre. EHC actively participated in the conference which identified research gaps and prioritized environmental health issues for inclusion in Malaysia's Seventh Five-Year Development Plan (1996 to 2000). With the establishment of the Environmental Health Research Centre, EHC collaboration with the Malaysian Government is expected to increase significantly in the future.

- 23 -

Annex 4 Table 1: Breakdown of the number of activities according to country/area

Country/area American Samoa Brunei Darussalam Cambodia China Cook Islands Fiji Republic of Korea Lao !'...vy!./s Democratic Republic Macao Malaysia Marshall Islands Federated States of Micronesia

Nwnber of activities I

% of total

0.9 2.8 4.7 13.2 5.7 0.9 2.0 5.7 0.9 19.0 0.9 3.8 0.9 0.9 0.9 3.8 8.5 3.8 2.8 0.9 4.7 0.9 2.0 9.4

5 14 6 I

2 6 I

20 1 4 1

Niue Commonwealth of tht: Northern Mariana Islands Palau

1 I

Papua New Guinea Phi'" .:. Samoa Singapore Solomon Islands Tonga Tuvalu

4 9 4 3 1 5 1

Vanuatu Viet Nam

2 10 :.,}'{{<

:.<)100gg;

- 24Annex 4

Figure 1: Percentage breakdown of collaborative activities based on programme areas

RUD 26%

cws 10%

pes 28%

FOS-

CEH 27%

CWS :

Community water supply and sanitation

RUD: PCS: CEH : FOS:

Environmental health in rural and urban development and housing Health risk assessment of potentially toxic chemicals Control of environmental health hazards Food safety

.. - 25 -

Annex 4

With the growing concern over the health risk of infectious wastes from health care facilities, clinical wastes are coming under increasing scrutiny by national authorities. To deal with such wastes, ERC prepared, in 1993, a set of guidelines on health care waste management which will be published in the near future. During the review period, ERC initiated the development of environmental health indicators to assess and monitor environmental health qualitY in Member States. This exercise helped identify needs and priorities for ERC collaborative activities in the future. Indicators were developed for the various programme areas. ERC also contributed to a WHO global consultation on the development and use of environmental health indicators held in Duesseldorf, Germany in December 1992, where different approaches to the development of environmental health indicators were discussed.

As part of its information service, four documents were prepared by EHC. These were the "Food Import Inspection Manual", "Compendium of Rapid Tests for Food Safety", "Information Management for Municipal Solid Waste Management Services" and "Biofiltration - An Appropriate Control Technology for Gaseous Pollutants". The documents have been found very useful and are in great demand. ERC also worked closely with other international and intergovernmental agencies in carrying out a number of collaborative activities in waste management, chemical safety, water supply, sanitation and environmental health impact assessment. These activities are included in Appendix l. 1.3 UNCED and Agenda 21

In June 1992, the United Nations Conference on Environment and Development (UNCED) was held in Rio de Janeiro, Brazil. The conference brought together the heads or senior officials of 179 governments to dehberate and discuss the critical environmental issues faced by the global community. At the conference, Agenda 21, a global plan of action which provides comprehensive work programmes for the 21st century, was adopted. The environmental health programmes are highlighted in Chapter 6: "Protection and promotion of human health" of Agenda 21. Other chapters dealing with environmental health are Chapter 7: "Promoting sustainable human settlement development", Chapter 9: "Protection of the atmosphere", Chapter 18: "Protection of the quality and supply of freshwater resources", Chapter 19: "Environmentally sound management of toxic chemicals", Chapter 20: "Environmentally sound management of hazardous waste", and Chapter 21: "Environmentally sound maila~ement of solid wastes and sewage-related issues". Since the UNCED, EHC has been working with Member States to promote the development of national action plans to implement Agenda 21 and the integration of health into national plans for sustainable development. These activities were carried out in coordination with the Environmental Health Unit of the Regional Office. During the review period, EHC also participated in three UNCED-related meetings to dehberate on ways and means to implement Agenda 21 at country level.

- 26Annex 4

1.4

Global and regional strategies on health and environment

A new global WHO strategy for environmental health was developed by WHO Headquarters, and endorsed by the World Health Assembly in May 1993. The strategy was b~d on the findings and recommendations of the WHO Commission on Health and Environment* and on the outcome of UNCED. The goals for health and environment as given in the strategy are to achieve a sustainable basis for health f{Sf all; provide an environment that promotes health; and make all individuals and organizations aware of their responsibility for health and its environmental basis.

In connection with the global strategy, the WHO Western Pacific Regional Office, with technical input from EHC, prepared a Regional Strategy on Health and Environment. This strategy was adopted at the 44th session of the WHO Regional Committee for the Western Pacific in September 1993. The Regional Strategy is intended to guide regional activities over . the next six years. The priority activities identified in .the Regional Strategy are the assessmeatof the impact of development on health, development of environmental health action plans, . information management, drinking water quality guidelines, safety and control of toxic chemicals and hazardous wastes, motor vehicle emissions control, coal use, and urban health development..

2. WHO POLICY ON TIIE PROMOTION OF ENVIRONMENTAL HEALTH

2.1

Global programme

Since its inception in 1947, WHO has been concerned with environmental factors and their effects on human health. The main objective of the WHO programme for the promotion of environmental health is to promote human health through the prevention and control of environmental conditions that adversely affect health. WHO operates under a general programme of work which defines objectives and targets and the overall direction of work for a specific period, usually six years. The programme of work is drawn up based on an assessment of the need at global and regional levels and an evaluation of previous programmes of work. In the Eighth General Programme of Work for the period 1990-1995, environmental health activities are classified into five basic programme areas, namely, community water supply and sanitation, environmental health in rural and urban development and housing. health risk assessment of potentially toxic chemicals, control of environmental health hazards, and food safety. During this period, the major thrusts are to continue advocating the provision of water supply and sanitation systems as essential components of primary health care; the incorporation of environmental health principles into development projects; the development and strengthening of infrastructures to monitor, assess and control chemical, physical and biological hazards; and the promotion of international collaboration to control global environmental health problems such as acid rain, depletion of the ozone layer, global warming and transboundary pollution.

* The WHO Commission on Health and Environment was established in early 1990 to prepare WHO's contribution to UNCED. The Commission is composed of 22 members supported by four expert panels on food and agriculture, ~ industry and urbanization.

-. - 27 -

Annex 4 -.

The WHO global programme will be guided by the new WHO global strategy for health and environment. The global strategy provides the basis for WHO environmental health programmes at Headquarters, in the Regions and in countries to devise workplans in order to implement the health and environment activities of Agenda 21 . . 2.2 WHO Western Pacific regional programme At the regional level, efforts are made to complement the activities of the global programme by building up national capabilities to identify and assess existing and potential environmental health hazards and to take the necessary precautionary or abatement measures. Technical cooperation is provided to Member States in the Region in the development of institutions, policies, strategies and legislation, training of human resources, provision of information, and promotion of appropriate technology in solving environmental health problems. The Regional Strategy on Health and Environment, mentioned in Section 1.4, will guide the activities in the Region, which fall under the following broad subjects of each programme area: -.

Community water supply and sanitation (CWS) Ptomotion of safe drinking water and adequate sanitation Improvement in coverage and the quality of water supply and sanitation services in countries and areas of the Region Development of appropriate technology for water and wastewater treatment Coordination with other agencies and mobilization of extrabudgetary resources Environmental health in rural and urban development and housing (RUD) Improvement of environmental health in human settlements and urban areas Solid waste management Environmental impact assessment/environmental health impact assessment Environmental planning Health risk assessment of potentially toxic chemicals (PCS) Assessment of environmental conditions regarding toxic and hazardous materials Development/upgrading of legislation on the production, transport, use and disposal of hazardous materials Development and strengthening of chemical safety management programmes Exchange of information and promotion of public awareness Conttoi of environmental health hazards (CEH) Air quality management Water quality management Noise abatement and control. Environmental epidemiology Food safety (FOS) Development of national food safety programmes Development of food legislation and standards Strengthening food contamination monitoring programmes Exchange of information and promotion of public awareness

d) e)

In the WHO Western Pacific Regional Office (WPRO), overall administration of the regional environmental health programme is the responsibility of the Director of Drug Policy, Environmental Health and Health Technology Division (DET). Under DET, two Regional Advisers in environmental health are responsible for projects in various countries funded by the WHO country budget. EHe is a technical centre of WPRO and has an intercountry

- 28Annex 4

programme budget for implementation of environmental health activities which are not funded by the WHO country budget. When requests are received from Member States for technical cooperation, a priority for eaeh request is determined in relation to available financial and human resources and its reiative importance. At the country level, WHO field staff play an important role in promoting national environmental health activities. .

3. OBJECTIVES AND FUNCI10NS OF EHC

-. EHC was formally established in January 1979 at the campus of the University of Agriculture, Malaysia (Universiti Pertanian Malaysia - UPM). It was known as the WHO Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS) until October 1992 when it was renamed. As a technical and scientific centre' of WPRO, ERe provides technical cooperation and information services and promotes applied studies in the area of environmental health. The Centre has staff positions in various disciplines of the environmental health programme; namely, community water supply and sanitation (until January 1994), environmental systems engineering, air quality management, water quality management, chemical safety and food safety. The objectiVes of the Centre as agreed upon by the Member States of the WHO Western Pacific Region and contained in the Regional Committee resolution WPR/RC 28.R13 are as follows: (a) (b) to promote and facilitate collaboration with environmental institutions and personnel of Member States within the Region; and to support the development of, and strengthen national capability of Member States in environmental health.

The functions of EHC include:

(a)

provision of technical cooperation services to Member States in the Region to t;levelop competent national policies in environmental health; technical cooperation with Member States in the Region to strengthen the capability of national environmental institutions; collaboration with Member States in the Region in the development and implementation of education and training programmes for personnel engaged in environmental health activities; service as a regional technical information and reference centre in environmental health; cooperation with Member States in the Region in the monitoring, collection and processing of data/information for environmental planning purposes; provision, in cooperation with Member States in the Region, of technical solutions to problems related to environmental health and the protection of natural resources against pollution; and

(b) (c)

(d)

(e) (f)

(g)

- 29-

Annex 4

identification, promotion and demonstration of low-cost and appropriate technology.

The Centre is engaged in activities at three levels: national, regional and global. At national level, staff members and consultants are assigned to countries to provide technical advisory services in specialized areas of expertise and to collaborate in the conduct of national training activities. At the regional level, collaborative activities include the organization of regional group educational activities and the promotion of applied studies. At the global level, EHC is responsible for the coordination of global programmes in the Region such as the Global Environmental Monitoring System (GEMS) projects on air, water and food contamination monitoring, GEMS Human Exposure Assessment Location (HEAL) project, and the International Programme on Chemical Safety.

4.1 Introduction

4. SITUATION ANALYSIS

The Western Pacific Region is probably the most economically and geographically diverse of the six regions of WHO and covers nearly a third of the world's population. Populations in Member States of the Region range from as high as 1 200 million to as low as 2 000. Some of the countries consist of vast land masses while others are low-lying coral atolls surrounded by thousands of square kilometres of ocean. Within.the Region lie some of the world's least developed countries as well as its most rapidly growing economies. In many countries of the Region, the effects of economic growth have led to serious environmental problems. Industrialization in some countries has led to environmental pollution of air, water and land, and this is adversely affecting human health. Diarrhoeal disease that results from drinking contaminated water continues to be a childhood killer. In many cities, levels of hazardous particulate matter and sulphur dioxide in the air exceed WHO guidelines. The level of heavy metals and organic compounds in many rivers is well above accepted standards, and many groundwater resources are overused and seriously contaminated. Many Member States in the Region have become aware that without adequate environmental protection, development will be undermined. They have begun to take action to respond to the environmental challenges and EHC has been able to collaborate with them to deal with the environmental health problems in the Region. 4.2 Community water supply and sanitation

•

In 1980, Member States set national targets for drinking water supply and sanitation to be achieved in 1990 in the context of the International Drinking Water Supply and Sanitation Decade. The majority of these Member States have achieved or exceeded their targets. Those which have not yet reached their targets have achieved substantial increases in coverage and improvement in service levels. It is expected that most will reach their national goals by the year 2000. The low coverage areas continue to be in Cambodia, Lao People's Democratic Republic, Viet Nam and the Pac;ific island countries.

....

The main constraints to progress in the water and sanitation sector are operation and maintenance problems, shortage of skilled human resources, lack of funds and inadequate cost recovery systems. However, the training efforts and fmancial resources provided to promote

- 3D Annex 4

....

appropriate technology have generally raised country capabilities to design and construct basic water and sanitation facilities in rural areas. The need for WHO technical support has shifted to more specialized services such as legislation, financial and economic planning of projects and improved water treatment and quality surveillance. Some Pacific island countries have virtually no-legislation covering the water and sanitation sector and many urban areas in the Pacific island countries have inadequate water treatment.methods. There is still a high risk of waterborne diseases in cowitries such as Cook Islands, Federated States of Micronesia, Tuvalu and Western Samoa. While lack of funds is a major obstacle to improving water and sanitation facilities, there is generally donor support available for well prepared projects having major health benefits. A number of countries in the Region has recently reported an outbreak of the new cholera strain classified as Vibrio cholerae 0139. In view of the occurence of the new strain and potential threat of major outbreaks, WHO will continue to emphasize the importance of safe drinking water and adequate sanitation and collaborate with Member States to prevent and control cholera in the Region. At the end of the International Drinking Water Supply and Sanitation Decade in 1990, WHO and UNICEF developed a joint monitoring programme for water supply and sanitation which was designed according to individual country requirements. By supporting countries in upgrading their ability to monitor water supply and sanitation development, it is hoped that they will develop a capability in using the monitoring results to improve planning and management. 4.3 4.3.1 Environmental health in rural and urban development and housing Environmental and health impact assessment

Integrating health and environmental concerns into socioeconomic development activities has been a focus of worldwide efforts to promote sustainable development. Among the national programmes to achieve balanced devdopment, environmental impact assessment (EIA) has received considerable attention. Although most Mt:mber States in the Region have statutory or administrative requirements for EIA (see Table 2), the EIA programmes have not been implemented effectively. Common problems associated with the implementation of EIA include the lack of qualified human reSources to carry out EIA; inadequate provision of information on EIA requirements to assessors; failure to address the main concerns of the affected communities or to involve appropriate groups; and insufficient intersectoral consultation.. Most EIAs pay little attention to the health impact components. As a result, health impact assessment has rarely been fully addressed in EIA. The involvement of health agencies in EIA has also been very limited. However, the re-orientation of health services to promote healthy lifestyles and supportive physical and social environments has been taking place in some countries in the Region, and the strengthening of health impact assessment in EIA has been considered as a priority. The regional workshop on environmental health impact assessment (EHIA) held at EHC in November 1993 revealed that Australia had developed a national framework for EHIA, the Philippine Department of Health had created a new Division of EHIA in the Environmental Health Services, New Zealand had been developing a national plan for EHIA, Malaysia had established the Environmental Health Research Centre with EHIA as one of its priority activities, and China and Papua New Guinea had initiated dialogues between their health and environmental agencies. Further developments in this field are expected in many Member States.

- 31 -

Annex 4 Table 2:

EIA Requirements in the Western Pacific Region

....

·Countries and areas with legislation related to EIA

Australia (most States) China Malaysia Marshall Islands Federated States of Micronesia New Zealand Papua New Guinea Philippines Republic of Korea United States and French territories in the Pacific

Countries arid areas with administrative requirements for EIA

Cook Islands Fiji Hong Kong Japan Singapore Tonga Vanuatu Western Samoa

4.3.2

Urban health and environmental development

As in other WHO Regions, the developing countries in the Region are experiencing rapid urbanization and the associated overloading of urban infrastructure and services. This has led to increasingly high levels of air, water and noise pollution, reduction of open spaces and greenery, improper control of liquid and solid waste, increasing numbers of the urban poor and homeless, and elevated crime rates and stress of living in urban areas. Although a number of urban management activities have been implemented by national agencies and local authorities, these activities have rarely been coordinated, resulting in piecemeal and ineffective implementation of potentially useful programmes.

The Healthy Cities initiatives were developed and implemented in 1990 to 1992 in several Australian towns and cities and Tokyo, Japan. The Ministry of Health and Welfare of Japan now supports selected cities to promote the Healthy and Cultural Cities activities. In contrast to these initiatives in the more industrialized countries in the Region, most developing countries do not have programmes to improve urban health and environmental qUality. In China, there has been a considerable national effort to evaluate the cleanliness of cities, but action plans to focus activities to protect and upgrade the health and environmental quality of these cities have not been developed. 4.3.3 Solid waste management

The management of municipal solid waste is a priority in both more developed and developing countries of the Region. In more developed countries, the emphasis of solid waste management is on the minimization and reduction of waste and recycling of reusable materials.

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Annex 4

Various new regulatory programmes and public awareness activities have been introduced to encourage waste minimization and recycling. Although considerable improvement has been made in solid waste management in some citjes and towns in developing countries of the Region, the overall performance of solid waste management in most municipalities of these countries is still poor. The growing economies of these municipalities produce larger volumes of solid waste fQr which more effective and efficient collection and disposal services must be provided. As indicated in Table 3, there is a need in these countries to improve national government support for municipal solid waste management, provide adequate legislation, upgrade financial and information management and planning, and encourage public participation. 4.4 Health risk assessment of potentially toxic chemicals

Chemical safety and hazardous waste issues have become increasingly prominent in the: Western Pacific Region over the last decade in the face of rapid industrialization and economic growth. While the importance of industrial and agricultural chemicals in the developing national econQmies of Member States should not be underestimated, the extent of detriment to human health; ecological damage, and the resultant economic losses have not been adequately assessed. Nevertheless, it is clear that toxic chemical exposures have created a situation serious enough to compromise national and regional development. Most Member States in the Region have not been successful in their efforts to coordinate the multitude of chemical-safety-related activities undertaken among the different responsible agencies and sectors. Poor communications, particularly with regard to planning and development activities, seriously impede the implementation of effective control programmes. In general, the number of staff available to deal with chemical safety problems is inadequate, and many, particularly decision-makers and enforcement personnel, lack the necessary training and information to implement comprehensive control strategies effectively. The general population is frequently uninformed about the dangers of the substances to which they are exposed, the various routes of exposure and the.associated risks. Most countries in the Region do not have specific pt;ogrammes for the control of toxic chemicals and hazardous wastes; or, where legislation exists, institutional development is not sufficient to control the manufacture, registration, labelling. packaging. marketing. transportation, storage, treatment and disposal of toxic chemicals and hazardous wastes. The lack of definitive policy related to the coordination of intersectoral chemical safety issues is a serious hand~cap to the implementation of preventive programmes. Health agencies do not appear to be-taking the necessary leading role in chemical safety or hazardous waste control, and this frequently results in serious neglect in the area of environmental health. Generally, poison control centres have not been developed, and few provisions exist for chemical emergencies or the evaluation of risk from chemicals. 4.5 4.5.1 Control of environmental health hazards

Air quality management

The air quality is deteriorating in many urban and industrial areas of the Region, and in a few cities it is becoming a significant threat to human health. Some of the Member States have rapidly expanding economies, and this is reflected in the deteriorating air quality. This is particularly evident in urban areas, with increasing numbers of motor vehicles and traffic congestion_

- 33 -

Annex 4

Table 3: Municipal Solid Waste Management of Selected Countries in the Western Pacific Region

Components

Fiji

Hong Kong

. Japan

Malaysia

Papua New Guinea

Viet Nam

Collection service (30 points)

Recycling/processing (10 points)

Final disposal (25 points)

Public awareness/participation (5 points)

Administration/management (10 points)

Legislation (10 points)

Note:

This table is an example of ERC's environmental health indicators, and employs a rating method to evaluate municipal solid waste management programmes of selected countries/areas in the Region.

- 34-

Annex 4

Motor vehicles are the predominant sources of air pollution in most countries of the Region. Gasoline vehicles are responsible for the elevated concentrations of carbon monoxide, hydrocarbons and nitrogen oxides that occur in congested inner city streets. Corrective measures, namely catalytic converters on the exhaust systems of vehicles, are not yet widely used in the Region. The addition of alkyl lead compounds to gasoline as oetane enhancers has contributed to lead pollution in the environment. Many countries are now introducing unleaded gasoline, and a few (such as Hong Kong, Malaysia and Singapore) are encouraging its purchase through a lower price than for leaded gasoline. Diesel vehicles are a major source of urban air pollution in certain countries of the Region, including the Republic of Korea, Malaysia and the Philippines. Fine particulate matter from diesel vehicles is a serious air pollution problem. which needs to be addressed through improvements to diesel quality and installation of particulate collection devices on exhaust .rsystems. Industri!ilidevelopment and increasing fossil fuel combustion also adversely affect air qUality. The air pollution levels in urban and industrial areas of China are among the highest in the Region, because of the increasing use of coal for electricity production, heating and as a process fuel. The presence of high levels of fluorides in some coals produces severe indoor air pollution in some parts of China. Endemic fluorosis, partly caused through coal smoke inhalation from traditional methods of cooking and heating, affects approximately 70 million people. In all countries of the Region, most people spend a major part of the day indoors, and a significant amount of air pollutants are generated by the indoor environment, including cigarette smoke. For many air pollutants, concentrations indoors exceed those outdoors. Greater efforts are required in the Region to effectively control both outdoor and indoor air pollution, so as to protect human health, and to encourage Member States to implement control programmes to ensure that air quality meets WHO guidelines or established national standards. 4.5.2 Water quality management During the review period, the Region has seen improvement of water quality in some countries and deterioration in others. The country which has made the most significant progress in water quality management is the Republic ofKorea. During the past five years, classification of ambient water resources and development of ambient water criteria have been upgraded and the water quality monitoring network has been strengthened. The percentage of sewage discharges that are treated is planned to double by 1996. The investment in environmental pollution control has increased to more than 1% of the GNP. Associated with these improvements are a strong Government commitment to the implementation and enforcement of water quality standards and water pollution control legislation. The situation in China is one ofvery rapid growth. Signs are that pollution control efforts are keeping up with development. Efforts are being made to improve unsatisfactory conditions where they exist. Strong support and encouragement are being given by the Government to clean up polluted water bodies and improve water quality. In Malaysia, the development of water quality criteria for various beneficial uses of water resources was completed in 1990. Increased public awareness of the impacts of pollution and

...

- 35 Annex 4

governmental pressures on industrial establishments to control wastewater discharges, together with the privatization of sewerage services indicate the commitment of the Government to combat pollution_ These new developments will lead to widespread improvements in water quality in Malaysia in the future_ In the Philippines, although some progress has been made in the past in the development of water pollution source inventory and pollution control standards, there is no sign of improvement in water quality. Funding for pollution control facilities and enforcement personnel is severly lacking. Neglect of operation and maintenance requirements over the past years has led to existing wastewater treatment facilities being degraded to a state where replacement is often the best practicable solution. This when added to the cost for providing new facilities under the severe economic conditions does not bode well for short-term improvements in water quality in this country. A country which has accelerated its development process is Viet Nam. During the revi~ period, the request for EHC technical collaboration in various fields of environmental health, increased very substantially. In October 1992, a Department of Environment was created under the Ministry of Science, Technology and Environment to deal with environmental pollution problems. Ai:1UNDP-funded WHO-executed project to strengthen the technical capability of the Institute for Tropical Technology and Environmental Protection was completed in 1991. As a result, the Institute has been very active in the monitoring of water quality, development of water pollution control technology and training of human resources for water quality management. A country likely to develop rapidly very soon is the Lao People's Democratic RepUblic. Following the new economic policy introduced by the Government in 1988, foreign investment in Lao People's Democratic Republic has increased significantly. The water pollution problem caused by the discharge of untreated municipal sewage is compounded by the wastewater generated from the fast developing industrial sector in the country. In April 1993, a Department of Environment was established under the Organization of Science, Technology and Environment to deal with the worsening environmental pollution problems. For the affluent countries in the Region such as Australia, Guam, Hong Kong, Japan, New Zealand and Singapore, the water pollution problems are generally under good control, because they have sufficient human and fmancial resources to deal with the problems. For the Pacific island countries, the prospects for industrialization are low at this time_ Water pollutipn problems are generally localized. The sensitivity of the limited water resources to pollution-iil these countries makes the control of polluting sources an urgent issue. These countries generally lack the water quality management tools to control water pollution effectively. Lack of clear and consistent government policy hampers the effectiveness of control programmes. 4.6 Food safety

...

Active cooperation with Member States on food safety has enabled some progress to be made in assuring the safety of food in the Region. Most countries have established an institutional and legislative framework for food safety administration. Nevertheless, foodborne diseases continue to be a major problem in most developing countries, usually ranking high in morbidity statistics. This is primarily because of the failure to commit sufficient resources to the implementation of national food safety programmes. Also, it has been difficult to foster the necessary changes in public food handling habits which contribute to contamination. In this regard, training and education programmes need to be sustained and expanded to make people continually aware of safe food handling practices. The Hazard Analysis Critical Control Point (HACCP) system remains an important means of identifying and managing food safety risks.

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Annex 4

In addition, because of the importance of food safety in the home, efforts need to be stepped up to integrate food safety in primary health care activities. ' National food safety authorities are becoming more concerned with food additives, pesticide residues, and other food contaminants because of their potential carcinogenic hazard. Chemical contamination, especially by pesticide residues, could also become a serious impediment to trade, resulting in serious financial losses in terms of rejected shipments and lost markets. The ability to analyse foods for chemical contamination varies throughout the Region. Many laboratories are unable to undertake the most simple analyses because they lack resources, appropriate equipment and trained staff.

During the review period, 106 field collaborative activities (including 38 training activities) and seven regional group educational activities were implemented. In addition, three applied studies on various environmental health subject areas were carried out. These activities are highlighted in the following sections. 5.1 5.1.1 Community water supply and sanitation Training activities

"""

In Lao People's Democratic Republic, a rural water supply and sanitation project, funded by the Swedish International Development Authority (SIDA) was implemented. The project involved the construction of latrines, roof catchment water supplies and a gravity-fed piped water supply. Following completion of the project, a workshop was held to summarize experience learned from the project, particularly with respect to cost recovery, community organization and design criteria. In the Philippines, EHC cooperated in a workshop on operation and maintenance of water supply and sanitation systems which has contributed to the development of action plans for implementation by the relevant agencies to improve the performance of water supply and sanitation systems. Following a typhoid fever outbreak in Western Samoa in 1993, EHC collaborated in the conduct of two workshops focusing on water, sanitation and food. EHC convened a sub-regional workshop on drinking water quality monitoring and surveillance for Pacific island countries in Suva in December 1993. Drinking water contamination in many Pacific island countries is still a common problem. The workshop reviewed the new WHO Guidelines Drinking Water Quality and formulated action plans to establish practical surveillance programmes. 5.1.2 Technical advisory services

Seven missions to provide technical advisory services were implemented on various aspects of water supply and sanitation. In Cambodia, an assessment was made of the water supply and sanitation conditions in selected hospitals and remedial measures for their improvement were recommended. In China, EHC participated in a World Food Programme mission in Ningxia Hui Autonomous Region to appraise the water supply component of a poverty alleviation and environment rehabilitation project in three rural upland countries. Recommendations were made to improve the implementation of the project activities. EHC cooperated with the Ministry of Health in Viet Nam to formulate projects to improve water supply and sanitation in schools, with particular emphasis on health education. Funding is

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Annex 4

being sought from external support agencies which have expressed interest in implementing such projects in Viet Nam.

Technical advisory services to Cook Islands were provided to design measures to ensure adequate water supply and sanitation during the large influx of visitors for the Festival of Pacific Arts in October 1992~ In the Federated States of Micronesia, a mission was implemented to improve the operation of the sewage treatment plant in Weno, Chuuk State. Proposals were also made to alleviate the poor water supply conditions in outer islands due to prolonged drought. As a result of the proposals, WHO supplied diaphragm pumps and drinking water disinfection equipment to enable groundwater sources in the centre of the atolls to be utilized for drinking water. In Niue, ERC advised on remedial measures to control bacteriological contamination of groundwater which is used as a drinking water source. A WHO mission was invited by Tuvalu to assess the overall health situation, identify priority areas for collaboration and participate in the preparation of a national health development plan. ERC participated in the mission to develop collaborative activities in water supply, sanitation and vector control. ERC participated in a four-week UNDP-funded mission to four Pacific island countries (Fiji, Papua New Guinea, Solomon Islands and Vanuatu) to prepare a programme outline and a project formulation framework to address the major subregional needs in the water supply and sanitation sector. An evaluation of the UNDPfUN Department of Economic and Social Development (UNDESD) regional water and sanitation project for the Pacific island countries, and recommendations for the future direction of this project, were also made. 5.2 Environmental health in rural and urban development and housing

This programme area covered activities in environmental planning and impact assessment, solid waste·management, and improvement of urban environmental health. A total of 45 activities in the form of technical advisory services, training courses, information exchange and attendance at meetings were carried out. Included in these activities were three regional workshops: a workshop on recycling and resource recovery from municipal solid wastes; a workshop on solid waste management in the Pacific countries; and a workshop on environmental health impact assessment. -.

5.2.1

Environmental planning and impact assessment

ERC collaboration in environmental planning and impact assessment emphasized the development of human resources. ERC conducted a regional workshop, and collaborated in 15 national training activities. 5.2.1.1 Training activities

EHC conducted a regional workshop on environmental health impact assessment (ERIA) from 15 to 19 November 1993. The workshop, involving participants from both health and environmental agencies, discussed ways to strengthen the health impact assessment component of environmental impact assessment (EIA) and identified activities which need to be carried out in each participating country. In connection with this workshop, a guideline document on EHIA was prepared. In Malaysia and the Philippines, national workshops on environmental risk assessment and management were conducted. These workshops focused on the health risks and safety issues associated with industrial development activities, and included problem-solving exercises which were based on real cases. In Malaysia and Viet Nam, training courses on EIA were conducted, during which the procedures and techniques of environmental impact assessment

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Annex 4

were discussed, and case-study exercises carried out. EHC also collaborated with Lao People's Democratic Republic and Malaysia in training courses on environmental planning and management. The workshop in the Lao People's Democratic Republic focused on the assessment and management of environmental health hazards and the development of national programmes for environmental health. The Malaysian courses addressed the issues of integrating environmental planning into socioeconomic development processes, covering: EIA, geographical information system and spatial planning, industrial hazardous waste management, risk assessment, and watershed management. 5.2.1.2 Technical advisory services

In the Lao People's Democratic Republic, a training programme was prepared, based on the assessment of environmental health hazards, and a national workshop was conducted as . mentioned above.

5.2.2 5.2.2.1

Solid waste management Trainirig activities

EHC organized two regional workshops on solid waste management: a regional workshop on recycling and resource recovery from municipal solid wastes, held at EHC in November 1991, which addressed technological options, public participation, and institutional issues of promoting recycling and resource recovery activities in Member States; and a regional workshop on solid waste management in the Pacific countries held in Suva, Fiji in May 1992, which focused on technical and managerial options available for providing adequate solid waste management systems in small island countries. EHC participated in two regional workshops on solid waste management organized by . other international agencies; one organized by the UNDP{World Bank in Singapore in July 1991; and the other by the United Nations Centre for Regional Development (UNCRD) in Penang, Malaysia in January 1993. Eight national training activities were implemented. Two national workshops were conducted in China, one focusing on composting and sanitary landfill; and the other dealing with the management of both municipal and industrial wastes in small and medium-sized cities. In the Philip'pines, a seminar-workshop for local government solid waste managers was held to ·discuss technical issues of solid waste management and prepare project proposals for specific local governments. In Malaysia, EHC participated in a national seminar on management and technology of municipal and industrial wastes, a national training workshop on hazardous waste management, and two intensive courses on environmental health for public health engineers, in which municipal solid waste, industrial hazardous waste and hospital waste were among the subjects discussed. A training package and technical guidelines for clinical waste management . were prepared following the second intensive course. In Lao People's Democratic Republic, a workshop on waste disposal management was held to provide training on the proper management of both solid waste and wastewater applicable to the local conditions in the country.

5.2.2.2

Technical advisory services

EHC collaborated in assessing the solid waste management situation in selected cities. Solid waste management practices in Apia, Samoa and Rarotonga, Cook Islands were assessed and recommendations for improvement made in June 1992, with follow-up missions provided in

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Annex 4

March 1994. In Tonga, EHC advised on the development and management of a new landfill site and collection operation for Nuku'alofa. In Yap, Federated States of Micronesia, a new landfill site was evaluated for its technical and environmental feasibility. EHC also provided an assessment of special waste in some countries, namely piggery and chicken wastes in Cook Islands, and a project to develop a hazardous waste inventory and action plan in 11 Pacific island countries. EHC cooperated with the UNDPjWorld Bank Water and Sanitation Programme to assess solid waste management problems and develop activities in Hanoi, Haiphong and Ho Chi Minh City in Viet Nam. In Cambodia, EHC advised on measures to improve cleanliness and solid waste management in Phnom Penh. 5.2.3 Urban environmental health

5.2.3.1· Training activities EHC served in the secretariat of two WHO regional meetings on urban health development, the regional working group on urban health development in Osaka, Japan in September 1991, and the biregional meeting on urban health development in Manila, Philippines in August 1993. The working group in Osaka built on the foundation set up by the WHO working group on the integration of environmental health into planning for urban development, held at EHC in February 1991, to develop a framework for promoting healthy urban environments in the Region. These working groups led to the technical discussions on the subject during the 43rd session of the Regional Committee in September 1992. The Regional Committee advocated an intersectoral approach to promoting healthy urban development. Subsequently, the biregional meeting in Manila produced 18 city-specific project proposals to develop and improve urban health programmes. In Viet Nam, EHC cooperated in conducting a national workshop on environmental health in urban development. The workshop focused on interagency cooperation between health and urban construction sectors at both national and provincialleve!s to improve environmental health services in urban areas.

5.2.3.2

Technical advisory services

In China, EHC assessed urban environmental management programmes in four cities (Zbenjiang and Wuxi in Jiangsu Province, Shanghai and Beijing) and suggested an integrated environmental management approach to control industrial and domestic pollution problems. In Cook Islands; ERC collaborated with the Ministries of Health and Works in assessing the health and environmental implications of housing programmes and urban development plans and suggested the environmental health criteria for such development.

5.3

Health risk aSsessment of potentially toxic chemicals

EHC implemented 32 collaborative activities in this programme area during the review period. Eleven were training activities while the rest involved technical advisory services. Thirteen activities were undertaken as part of a UNDP-funded, WHO-executed project on the safety and control of toxic chemicals and hazardous wastes. 5.3.1 Training activities

Training workshops were held in China, Malaysia, Philippines, Singapore and Viet Nam to improve national capabilities in the management of toxic chemicals and hazardous wastes, and occupational safety and health. In addition, material was gathered from various countries for the development of educational/training material for industrial chemical safety.

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Annex 4

A regional workshop on chemical safety legislation held at EHC in October 1991 resulted in the development of a model chemical safety law which could be used by countries in the Region to develop their own national legislation, with modification to suit the country's situation. Another regional workshop held at EHC in late 1992 on effective management of chemical safety information assessed existing information management systems and defmed actions and resources required by Member States to develop' effective systems. In Federated States of Micronesia and Vanuatu, EHC presented a workshop on cleaning up chemical spills in which participants prepared a work plan and health and safety plan for cleaning up an actual pesticide spill. In an unusual workshop exercise, participants then donned safety equipment and cleaned up the spilled pesticides in accordance with the two plans. The Governments endorsed the concept of teaching local professionals how to safely solve a typical chemical safety problem. The activity not only ameliorated a potentially dangerous situation, but also instilled workshop participants with a sense of confidence in their ability to handle chemical spills. 5.3.2 Technical advisory services

In Brunei Darussalam, EHC collaborated with the Ministry of Health in assessing hazardous waste management practices and outlined an approach to strengthen the country's capabilities in this field. In China, the technical problems associated with the incineration of chemical wastes were reviewed in cooperation with the Ministry of Chemical Industry, and conceptual designs and cost estimates for incineration plants were prepared. EHC assessed Cook Island's programme of occupational safety and health, and advised on measures to improve the programme. In Malaysia, a plan of action for the long-term development of regulatory programmes on chemical safety was delineated by EHC following a review of existing legislation and regulations on chemical safety. Other advisory services implemented were related to the preparation of proposals for improving the capabilities for environmental assessments and environmental testing services in the Philippines; the establishment of a chemical safety information centre in Singapore; and, safety in the use of agricultural chemicals in Tonga. A project was implemented to develop a hazardous waste inventory and action plan for 11 Pacific island countries where hazardous waste management problems are acute because land-based disposal and resource recovery alternatives are not readily available. 5.4 5.4.1 5.4.1.1 Control of environmental health hazards Air· quality management and environmental epidemiology Training activities

EHC provided consultants for environmental epidemiology courses held in the Philippines (July 1992), Viet Nam (October 1992), and China (October 1993). The Philippine course included lectures on measuring health and disease, types of epidemiological study designs, how to approach the analysis of data, measuring exposure and dose, and an introduction to the delivery of environmental and health services in the Philippines. The course in Viet Nam was more advanced, and focused on epidemiological research methods. The course in China was on air pollution epidemiology. It reviewed previous epidemiological field studies in China, introduced the participants to some recent techniques in environmental epidemiology and considered the design of future air pollution epidemiology studies. Lectures on air quality management and environmental epidemiology were given at an Intensive Course on Environmental Health for Public Health Engineers, held in Kuala Lumpur in October 1992. In another Malaysian training activity, air quality management

5.4.1.2 Technical advisory services

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Annex 4

was included in an Integrated Environmental Planning and Manage~ent Course, organized by the National Institute of Public Administration and held in October 1993.

Seven assignments on technical advisory services on air quality management were carried out during the review period. . Serious air pollution from coal combustion and industrial processes exists in many cities of China. EHC has renewed contact with relevant agencies in China. Two assignments were carried out in November 1992 and April 1993. In cooperation with WHO headquarters, EHC was also in~olved in a pilot study on the health effects of air pollution in Shenyan&. The pilot study found direct relationships between air pollution levels and total mortality and lung-heart disease mortality. EHC collaborated with the Environmental Management Bureau in the Philippines on the preparation of an air quality management master plan for the country. A draft plan has been prepared. The. goal of the plan is to achieve a healthy air environment throughout the Philippines by the year 2000 and beyond. Practicable measures to correct the degraded air pollution situation include improvements in fuel quality, a change in ItUtomotive fuel pricing policy, a strengthened air pollution conttollicensing system for industrial development projects, and a series of national initiatives on motor vehicle emission control. There have recently been positive developments in some of those areas, with the introduction of low lead gasoline, the preparation of a draft Clean Air Bill and the issuing of revised air quality standards. The Republic of Korea has a proactive air quality management programme, and significant progress has been made on reducing a previous problem of high levels of sulphur dioxide and suspended particulates in winter months from space heating facilities. However, summer time peak concentrations of photochemical oxidants are high,· and are likely to get worse. With a large proportion of diesel vehicles in the Republic of Korea, the focus of air quality management activities is on emissions of nitrogen oxides and particulate matter from that source. EHC collaborated with the Institute of Environmental Research in Seoul on measures to reduce atmospheric emissions from diesel vehicles. A mission was undertaken to Brunei Darussalam on air quality management in February 1993. The air quality of Brunei is generally pristine, and the strategy of air quality activities should be to preserve that condition. A large part of the country is forested, and it is evident that v~getation fires and open burning occur frequently. There is a need to restrict these. With little industrial development, motor vehicles are the predominant potential sources of air pollution.. Recommendations on measures to control emissions from motor vehicles and on requirements for an air quality monitoring programme were made. A major air quality management study of the Kelang Valley region of Malaysia, funded by the Japan International Cooperation Agency, was carried out in the review period The study included meteorological observations, ambient air monitoring. source emission testing. traffic surveys, and an air dispersion simulation model EHC was represented on the Technical Committee for the study. A seminar to present the results of the study was held in Kuala Lumpur on 16-17 October 1993, at which an EHe staff member presented the keynote lecture. 5.4.1.3 Applied studies

A quality assurance audit of air quality monitoring in China, Malaysia and the Philippines, funded by the Government of Japan was carried out by two researchers from the Institute of Public Health, Tokyo. Their recommendations were forwarded to the relevant

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Annex 4

Government agencies by E~C. A partially successful applied study was the development of low ~ost perso~al exposll!~ momtors, by the New South Wales State Pollution Control Commission ~ A~tralia. The ongmal proposal was to develop monitors for nitrogen dioxide, sulphur dIO:lOde and hydrogen fluoride. Only the first of these progressed to completion. • ~demic fluorosis is a severe and ctn:0nic problc:m in some parts of China. affecting tens of millions of people. EHC collaborated WIth the InStitute of Environmental Health and Engine~ring ~ Beijing on measures to reduce the occurrence of endemic fluorosis from coal smoke inhalatIOn. A study was made of six coal burning regions with different severities of fluorosis, and one control area. The fluoride concentrations in the coal, the indoor air and the outdoor air were analysed, as were the amounts of fluoride intake by digestion and inhalation. The study found that the fluorosis is largely caused by jnhalation of smoke from the traditional methods ofcooking and heating. using high fluoride content cOal as the fuel. An evaluation was made of the effect of various types of improved stoves. They were found to be a most effective and feasible measure to reduce the incidence of fluorosis. 5.4.1.4 GEM§,lair quality monitoring project

There'are currently six countries and areas in the Region participating in the GEMS/Air project - China, Hong Kong. Japan, Malaysia, New Zealand and Philippines. EHC maintains contact with national participating agencies and coordinates the collection of data. Responsibility for the GEMS/air programme in China transferred on 1 January 1993 from the Institute of Environmental Health Monitoring to the National Environmental Protection Agency. Participating agencies in the Region have been contributing data to the project since 1m7. A GEMS/Air meeting in Geneva in November 1991 urged WHO and UNEP to improve and strengthen the programme. There seems to have been little progress on that, although recently there has been some interest from the Republic of Korea and Viet Nam to join GEMS/Air. 5.4.1.5 GEMS/HEAL project

The UNEP/WHO Human Exposure Assessment Location (HEAL) project provides comparable assessments of human exposures to environmental pollutants in various countries. In this Region, five Member States are participating in the project - China, Japan, Philippines, Singapore and Viet Nam. Hong Kong and the Republic of Korea have indicated an interest in joining GEMS/HEAL A GEMS/HEAL coordinators meeting was held in Bangkok in November 1992. EHC was represented at the meeting. 'There was considerable interest in expanding GEMS/HEAL to other environmental pollutants, in addition to the three groupS of chemicals currently monitored - heavy metals (lead and cadmium). organic chemicals (hexachlorobenzene and dichlorodiphenyltrichloroethane) and nitrogen dioxide. Technical Coordinating Centres were established for each of the original groups of chemicals in the pilot phase of HEAL, and they are now either available or have been identified for another nine chemicals or gr~ups of chemicals - mercury, polycyclic aromatic hydrocarbons, volatile organic compounds, fluorides, arsenic, pesticides, polychlorinated biphenyls, polychlorinated dibenzo-p-dioxins and carbon monoxide. 5.4.2 Water quality management During the review period, three training activities and eight technical assignments were implemented.

5.4.2.1 Training activities

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Annex 4

In the Philippines, a training course on the operation and maintenance of water and wastewater treatment plants was undertaken in collaboration with the Ministry of Health. A national workshop was carried out in China in July 1993 in collaboration with the Chinese Research Academy for Environmental Sciences (CRABS) on the management and control of groundwater resources. The principal purpose was to introduce participants to management techniques and control technologies for groundwater resources applicable to China. EHe also collaborated with CRAES in a training course on protection of drinking water sources. The course was timely in view of the increasing pollution problems associated with drinking water sources in China.

5.4.22

Technical advisory services

In Macao, EHe advised on estuarine water quality monitoring activities. The mission was undertaken to assess and improve the existing programme. In the Philippines, a proposal for the development of a Master Plan for the use of the water and land resources under the Laguna Lake Development Authority jurisdiction was prepared. The intent was to use the proposal to obtain funding from a lending agency. Recommendations and a preliminary design concept for the provision of sewage collection and treatment services along a severely polluted river flowing into Laguna de Bay were provided. In Brunei Darussalam, technical advisory services were provided on water pollution control strategies. Brunei is a country that is expanding its industrial base and increasing housing development for its population. Good measures have put in place for domestic wastewater control; however, better controls are required for wastewater from manufacturing and commercial establishments. As a result of a diesel fuel spill to a well in the aquifer supplying the capital of Tonga, Nuku'alofa, EHe was requested to provide advice on the potability of the water supply and on measures to prevent such incidents in the future. This assignment recommended changes to the operation and maintenance of the well field to prevent oil and other contaminants from entering the groundwater in the future. In the Republic of Korea, EHC cooperated with the Ministry of Environment on the development of an environmental data base, computer needs in support of data collection and the data blll!c; and geographic information system (GIS) needs. As a result of a phenol spill that contaminated a water supply system, advice was also given on the development of a telemetering system for water quality. In Malaysia, a water quality disaster management plan was developed with the Ministry of Health on an intermittent basis during 19~ and 1993. The plan was to address the provision of safe water during times of disaster such as flooding, monsoons, earthquakes, chemical spills and drought. The plan is designed to be complementary to existing contingency plans in Malaysia. In another activity in Malaysia, EHC worked with the Ministry of Health to develop course outlines and certification systems for operators of water and wastewater treatment plants. The certification system is required following the privatization of sewerage and water supply services to ensure that operators meet the desired standards of performance. With the expansion of industrial activities, and the fact that most industrial establishments are not equipped with pollution control facilities, industrial water pollution has become a growing concern in the Lao People's Democratic Republic and the Government is faced with increasing pressure to control and regulate pollution from industrial sources. At present, no water pollution control standards exist to control and regulate the wastewater

....

- 44Annex 4

di~haf!~ed from the industrial sector. In January 1994, EHC cooperated with the Government to Id~ntify water pOll.ution p.roblems caused by industries, advise on measures to control, momtor and reduce mdustnal wastes and develop national standards for industrial water pollution control. 5.4.23 GEMS/Water quality monitoring project

~g the r~vi~ peri~, 11 countries and areas continued to participate in the GEMS Water quality momtonng proJect. In 1992, Phase II of the project came into effect The implementation of the new thrust will expand the number of stations and media monitored. In support of the e:q>anded activities and in support of the project in the Mekong riparian countries, an EHC staff member participated as a resource person in a training programme for these countries held in Bangkok in 1993. Training in sediment sampling and RAISON, a GlSbased data analysis software package was offered through Mekong Secretariat funding in collaboration with the National Water Research Institute at Burlington, Canada, a WHO Collaborating Centre. EHC has acquired the RAISON software in order to support Member States with water.quality data analysis and interpretation.

5.5

Food sarety

There was a reduction in the number of collaborative activities in food safety during the review period because the post has been vacant since February 1991. During the review period, 12 activities were implemented. 5.5.1 Training activities

To improve public awareness and understanding of food irradiation, EHC collaborated with the International Atomic Energy Agency and the Food and Agriculture Organization of the United Nations to convene an international seminar on harmonization of regulations on food irradiation in Asia and the Pacific in January 1992. The seminar was attended by 54 participants and observers from 22 countries.' It provided a forum to exchange information on food irradiation and its potential to facilitate food trade. The seminar was helpful in disseminating information on how irradiation could control two of the most serious problems connected with food supplies - the extensive loss of food through deterioration, and the illness and death that result from food contaminated with pathogens and parasites. In Viet Nam, EHC collaborated in the conduct of two food inspection workshops which were held in late 1991. The workshops addressed the public health risks associated with contaminated food and introduced Hazard Analysis Critical Control Point (HACCP) principles in food inspection. These workshops were particularly relevant since, in recent years, the statecontrolled system of production, supply and distribution of food has been supplemented by a free enterprise -system that is more difficult to regulate with respect to food hygiene and safety. In 1993, EHC provided further training througa two courses on food safety in Viet Nam. The courses contnbuted to the development of food inspection expertise in the country. In Papua New Guinea, EHC collaborated with the Department of Health to conduct a food safety legislation workshop in October 1991. The workshop introduced the new Food Sanitation Act to the country's food surveillance personnel In collaboration with WHO Headquarters food safety unit and the Industry Council for Development, a national training course on HACCP principles was held in China and the Philippines in 1993. These courses helped strengthen the national food safety programmes in these countries.

- 45 Annex 4

Diarrhoeal diseases and gastroenteritis are a leading cause of morbidity in Cambodiil, particularly among children up to the age of five. In March 1994, EHC cooperated with the Ministry of Health to conduct the first national training course in food safety. The course enhanced the skills and knowledge of health officials performing food safety surveillance a<;tivities in Cambodia. 5.5.2 Technical advisory services

Technical advisory services were provided to China, Cook Islands, Papua New Guinea and Tonga. In China. EHC provided a consultant to assess the current use of inununoassays in the detection of mycotoxins in food. This activity has enabled the relevant institutions to increase the sensitivity and accuracy of their mycotoxin detection methods and initiated research programmes on the detection of various mycotoxins. A number of countries in the Region do not have food safety legislation or have legislation that is outdated. EHC cooperated with Cook Islands, Fiji, Papua New Guinea and Tonga to review their food safety legislation. The need for new legislation and implementing regulations was discussed. The missions resulted in the drafting of a Food Act for the Cook Islands; a Food Act, Regulations and Standards for Fiji; a Food Sanitation Act for Papua New Guinea; and, a new Public Helath Act for Tonga. with a section addressing food safety and quality issues. In Tonga, EHC also advised on the use of HACCP procedures for the control of typhoid fever. 5.5.3 Applied study

In Viet Nam, there is concern over food contamination by aflatoxins as a result of poor harvesting and storage conditions, and high temperature and humidity. In view of the health implications that may arise from the consumption of aflatoxin-contaminated food, EHC is funding a two-year (1994-1995) study on control and reduction of aflatoxin in food. The study also includes an educational training programme to consumers, producers, importers and exporters of food prone to aflatoxin contamination. Through this study, a monitoring programme for aflatoxin contamination in foods will be initiated nationwide. 5.5.4 Food safety documents

A project to develop a compendium of rapid food tests was completed. The bulk of the information ·covers commercially available test kits which could be utilized in the field. The compendium will be of particular value to those working in food analysis. EHC also completed the publication of a food inspection manual for imported foods. This manual describes the responsibilities of food inspectors, sampling programmes and equipment, wharf examination, and microbiological and chemical analyses, and proposes measures to be taken for foods identified as unsatisfactory.

5.6

Information service programme

EHC has continued to fulfill its role as a regional information centre in environmental health. It responds to about 200 requests yearly for information on environmental health issues and distributes environmental health publications issued by WHO. Information exchange networks have been established for environmental and health impact assessment, solid waste management, food safety, water supply and sanitation, air quality management, water quality management and chemical safety. These networks have been useful in facilitating the exchange of information among network members in the Region.

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Annex 4

EHC has been continually improving its collection of publications and audio-visual materials in its library. The information available in the library, as well as EHC's on-line access to international computerized data bases have helped to provide an effective and timely information service to Member States.

6. FUTURE PROSPECfS

The future activities of EHC will be planned in such a way that most of them will have a linkage with those proposed in the WHO global and regional strategies on health and environment, as well as those in UNCED's Agenda 21. EHC will work closely with WHO Headquarters and Regional Office to meet the goals of the WHO global and regional stratetgies, and with UNDP and other relevant international agencies to meet the goals of Agenda 21. 6.1 Community water supply and sanitation

There has been a change in the nature of the constraints experienced in the past decade. The principal constraint experienced in the past was the insufficiency of trained professional and sub-professional personnel but this has now changed to problems with operating and maintaining water supply and saniation systems, as well as funding limitations. A major challenge for the programme in the future is the provision of adequate services in remote areas, especially the outer islands of Pacific countries. Furthermore, as more people have access to adequate and safe drinking water, collection and disposal of wastewater from communities and thus sanitation will require more attention and resources. Collaborative activities will need to be strengthened further to:

(1) (2) (3) (4) (5) (6)

improve drinking water quality through the promotion of new methods to solve both new and existing pollution problems; identify projects suitable for support by donor agencies; provide information services aimed at transfer of technology and know-how for capability development in the sector; provide a stronger advocacy role by WHO; provide more active collaboration with other national and international organizations; prioritize issues; better assess effectiveness; promote a closer working relationship with those who influence decision-making, including nongovernmental organizations and the private sector as well as Governments; and develop and promote appropriate innovative management tools such as the Water Supply and Sanitation Monitoring System (WASAMS) developed by WHO and

(7) (8)

(9)

- 47 Annex 4

UNICEF to expedite capacity building at country level especially for the improvement of planning and management of sector activities/investments.

In early 1994, there was a decentralization of WHO environmental health staff. A staff to Hanoi, Viet Nam to serve Cambodia, Lao People's Democratic Republic and Viet Nam while another was posted to Suva, Fiji to serve the Pacific island countries. Therefore, the water supply and sanitation component of EHC activities is expected to be reduced in the future. However, EHC will continue to provide technical advisory services in the sector. m~mber was posted

6.2

Environmental health in rural and urban deyeJopment and housing

Guided by the Regional Strategy on Health and Environment, this programme area will develop and implement future activities in environmental and health impact assessment, integrated planning for development, environment and health, development of healthy urban environment, and environmental health support for disaster management, Follo~ the regional workshop and the Philippine training course on environmental health impact assessment (EHIA), EHC plans to collaborate with the Governments of China, Malaysia and Papua New Guinea in conducting similar courses in these countries. In order to enhance the quality of such training activities, case-studies on EHIA of development activities relevant to these countries will be prepared in the form of training exercise materials. EHC will work closely with WHO Headquarters, Asian Development Bank and other international agencies interested in cooperation in this field. .

EHC will participate in the formulation of a national plan for integration of health and environmental issues into the national Agenda 21 in Viet Nam. Where opportunities arise, EHC will collaborate with Member States at both national and local levels, to develop and implement similar activities. EHC Vlill continue to support urban health development activities in Member States. Following the initial discussions with China and Malaysia, support will be provided to local studies in selected cities to compile urban health profiles and healthy urban environment plans, and to implement priority activities identified in the planning processes.. As part of the urban health development activities, EHe will collaborate with Member States to assess and improve municipal solid waste management in major towns and cities. In th~ J?hilippines, Viet Nam, China and some Pacific island countries, national workshops on health support for emergency management are planned. These workshops will be conducted in coordination with other activities in emergency management supported by WHO and other UN agencies. This effort by EHe will be a contribution to the United Nations International Decade for Natural Disaster Reduction. 6.3 Health risk assessment of potentially toxic c;hemicals

The planned activities of EHe in this programme area will include training activities. technical advisory services, and involvement with national and international organizations dealing with chemical safety, hazardous waste management, and occupational health. Training activities will continue to include workshops, seminars, training courses, and . lectures. A regional workshop on hazardous waste management for the Pacific island countries is planned for 1995. Participants will share hazardoWi waste management experience, be exposed to currently available waste management technology, and discuss how best to adapt that technology to common problems. EHe plans to focus at least part of the workshop on problems with collection and disposal of waste motor. oil.

- 48Annex 4

Other planned training activities include national workshops in Viet Nam and Malaysia. In Viet Nam, EHC will collaborate with the Ministry of Health in conducting workshops on occupational health and safety and environmental epidemiology. In Malaysia. EHC will collaborate with the Ministry of Health in conducting a workshop on toxicological investigations. Member States which participated in the UNDP-fundCd Project on Safety and Control of Toxic Chemicals and Hazardous Wastes noted the importance of chemical safety awareness training for all levels of chemical users in our Region. Building on that recommendation, EHC plans to seek ways for providing chemical safety awareness training. As an initial step, a modular training programme will be formulated to focus on health and safety as regards the most commonly-encountered chemicals, The training would be suitable for government officials (environmental, occupational safety and health. customs, agriculture, defence supplies), hospital and laboratory workers, general industry workers, university students, disaster preparedness planners, emergency response personnel, firemen, and police. EHC plans to: (1) (2) (3) present lectures in conjunction with duty travel occasioned by other activities; train trainers in Member States; and make the modules available to trainers in Member States.

"""

EHC will continue to provide Member States with technical advisory services in the areas of chemical safety, hazardous waste management, and occupational health. Services presently requested include: (1) (2) (3) reviewing approaches for the disposal ofus~ motor oil; advising on the design of a laboratory for toxicological investigations; and repackaging spilled pesticides.

EHC will continue to be involved with the WHO/UNEP IILO International Programme on Chemical Safety (IPCS). By preparing information on chemical safety, IPCS links chemical users with vital technical knowledge.. However, a lack of technically trained personnel in many Member States of this Region means that EHC is frequently needed to translate the technical knowledge into guidelines which are both safe and practical. By the same token, EHC provides important feedback regarding IPCS products to the IPCS secretariaL

6.4

Control of environmental health hazards

6.4.1 Air quality management Rapid industrialization and urbanization in many countries of the Region will continue to be reflected in deteriorating air quality_ The focus of the air quality management activities of EHC will be on the most ~rious urban and industrial air pollution problems, and on indoor air pollution. Future activities will include the formulation of air quality management policies and plans, carrying out reviews of existing legislation, development of air quality and emission standards, implementation of specific projects (especially those related to the health effects of air pollution), and training of human resources on selected topics. At the country level, efforts to control motor vehicle air pollution, such as in Kuala Lumpur. Manila and Seoul, will continue to be supported. In China. the adverse health impacts of coal combustion will also continue to receive attention, in an effort to identify and implement effective control measures. At the

- 49-

Annex 4

intercountry level, a workshop on motor vehicle emission control, involving participants from ten countries in the Region, will be held in September 1994. In recognition of the changing nature of environmental management, the future activities o(EHC will need to include such matters as integrated pollution control and pollution prevention, as well as an extension to include global (in addition to local) impacts. 6.4.2 Water quality management

The quality of the water resources will continue to have an impact on the health and economic well-being of the Region. EHC will continue to provide technical support to Member States to develop policies and strategies for the improvement of water quality and the conservation and wise use of water resources. Riverine systems are most readily impacted by land use, urbanization, industrialization and domestic waste disposal. The results of a water quality enhancement programme are also most rapidly realized in rivers. EHC will continue to promote basin-wide water quality management f~r the major rivers in the Region. . The increasing population and water use of Pacific island peoples will continue to challenge the management of the scarce and sensitive water resources in those Member States. Islands served by floating groundwater lenses in porous coral formations will require special attention as these aquifers are highly vulnerable to both overuse and contamination. EHC will continue to support Member States in their development of water resources with the aim of ensuring sustainability of those resources and their suitability as a low cost source of good quality drinking water. With the publication of the new WHO Drinking Water Guidelines, EHC will step up its collaboration with Member States to introduce and promote the guidelines in the future. For those countries which have not yet developed national drinking water standards, EHC will collaborate with them to do so. For those already having such standards, EHC will cooperate in revising them. EHC technical collaboration with Member States will be strengthened to control water pollution problems from increasing urban and industrial developments. To ensure that the rapid development taking place in the developing countries of the Region does not result in more widespread water pollution problems, EHC will continue its effort to support the Governments. in developing viable water pollution control legislation and mechanisms. 6.5 Food safety

Food safety will remain a high priority for Member States, Ongoing concerns about foodborne disease and worldwide trends toward the production of clean food highlight the need for the continued development and evolution of food safety programmes. Accordingly, EHC will help in the strengthening of these programmes as a strategic initiative designed to promote food safety. EHC will collaborate with Member States in the development of training and education programmes on food safety and food surveillance, and in the provision of technical advice on matters relating to food safety. Specifically, this will include promoting the implementation of food legislation, training in food surveillance for health officials, enhancing food analysis capabilities, street food safety control. promoting Codex standards on food safety, and developing and promoting appropriate and innovative technologies in food processing and preservation to reduce food losses due to spoilage and pests.

- 50-

Annex 4

Member States will be encouraged to strengthen purposeful investment in data collection, analysis and dissemination, especially to improve foodborne disease surveillance, reporting and epidemiological investigations. . Future activities include a study to improve the safety of street-vended foods funded by Japanese Government Voluntary Contnbution (JVC). The food safety problems associated with street foods are a persistent problem throughout the Rc;gion, and this pilot study will seek to apply the HACCP technique to the development of training material and handling protocols which ensure food safety is not compromised. The study is to take place in one of the cities in the Region. EHC will continue to strengthen the new initiative of promoting the use of HACCP in all stages of food production, processing and consumption. The monitoring and surveillance of food contamination will continue via the GEMS food contamination monitoring programme.

7. ACTION ON RECOMMENDATIONS OF THE SIXTH MEETING OF THE ADVISORY COMMl1TEE

The Advisory Committee which had its sixth meeting in December 1991 formulated seven general recommendations and 16 recommendations in vario~ programme areas. The summarized recommendations and actions taken so far are given in the following sections:

7.1 7.1.1

General recommendations EHC should give increased emphasis to the implementation of applied studies and demonstration projects in environmental health

EHC continued to support applied studies and demonstration projects. In China. a study on the effectiveness of chlorination procedures for the cistern water supplied to villagers from irrigation canals was implemented. In Viet Nam, EHC is funding a two-year (1994-1995) study on control and reduction of aflatoxin in food. In Federated States of Micronesia and Vanuatu, EHC carried out a demonstration project to provide training in the repackaging of spilled pesticides. A study on the effect of water sealed toilets on groundwater quality in atolls was implemented. in Federated States of Micronesia. While it is the intention of EHC to increase the emphlU!~ on the implementation of applied studies and demonstration projects, EHC's efforts are hampered by the limited availability of funds.

7.1.2

EHCshould enhance its ability to advise on the development of health indicators to quantify environmental health elJects, and encourage the application of epidemiology

EHC initiated the development of environmental health indicators in various programme areas to monitor environmental health quality and its trend in Member States. EHC presented the approach used in its development of indicators at a WHO global consultation on development and use of environmental health indicators held in Dusseldorf, Germany in December 1992, and contnbuted to the consultation. To encourage the application of epidemiology, EHC collaborated in the implementation of three environmental epidemiology training courses, one each in China. the Philippines and Viet Nam. A post of Environmental Epidemiologist was established at EHC in January 1994. However, because of budgetary constraints, the post has not been filled.

....

,.. 7.1.3

- 51 -

Annex 4

EHC should give priority to implementing the recommendations of the WHO Consultative Group on Health and Environment* held in November 1991, particularly to cooperate with Member States to establish environmental health standards, and provide better linkages with external support agences in developing protocols to address environmental health problems

Many of EHC's activities were relat~ to the reco1ll1D.Cndations of the WHO Consultative Group. With regard to the establishment of environmental health standards, EHC cooperated with Brunei Darussalam to advise on air quality guidelines and emission criteria for motor vehicles; with Papua New Guinea to prepare guidelines on hospital waste management; and, with Lao People's Democratic Republic to draft industrial wastewater standards. There has been increased collaboration with external support agencies, including the UNDP Regional Water and Sanitation Project in the South Pacific, the UNDP/World Bank and UNCRD in solid waste management activities, the UNDP in the management of toxic chemicals and hazardous wastes, the World Food Programme in the review of the water supply and sanitation aspects of their poverty alleviation projects, and UNEP in the expansion of the GEMS water quality monitoring programme in the Mekong riparian countries (in cooperation with the Mekong Secretariat). In addition, EHC staff have prepared 21 project proposals for funding consideration by donor agencies.

7.1.4

EHC should use the evaluation framework drawn up by the Consultative Group for selecting priority work programmes

EHC has followed the Consultative Group framework in selecting its activities to ensure that priority is given to those with impacts on health improvements, and that countries with the greatest need get priority attention. 7.1.5 EHC should continue upgrading its services to facilitate the development, . collection, dissemination and exchange of environmental health information

In its efforts to provide an effective information service, EHC constantly acquires recent publications on environmental health and has continued to maintain an on-line link with database vendors. Information networks on the various environmental health subjects have been established to promote information exchange. 7.1.6 EHC should expand its role in practical training of environmental health officials in the Region

EHC continued to collaborate with Member States in conducting group educational activities. During the review period, 38 national and seven regional group ,educational activities were carried out. As much as posstble, laboratory equipment and field test kits were used during those courses where practical training was required.

,..

* The WHO Consultative Group on Health and Environment had reco~ the development of a regional action plan for environmental health with emphasis on seven areas -lead exposure reduction; integration of environmental health goab in public policy-making of a demonstration city such as Manila; coal-burning; use of economic· instruments to control environmental health impact of development; indoor air pollution; monitoring offood safety standards; and hazardous waste management

- 52 -

Annex 4

7.1.7

To enhance health promotion, marketing and advocacy activities, WHO should convene a senior level meeting to address the environmental health implications arising from UNCED, strategic interventions on major environmental health issues, and a Regional Declaration on the promotion of environmental health

No action has been taken on this recommendation to convene a senior level meeting because of budgetary constraints. However, WHO has convened national and regional workshops to address various environmental health issues, as mentioned earlier in this report. WHO has also been working with Member States to promote the development of national action plans to implement UNCED's Agenda 21 and the integration of health and environment issues in national plans for sustainable development.

7.2 7.2.1

Community water supply and sanitation EHC should collaborate in the promotion of water allocation plans so as to protectdrinking water supply sources

EHC has been promoting the use of water allocation plans to protect drinking water sources. ActiVities implemented so far were limited to discussions with national staff and to bring to their attention the importance of the matter. Based on the information collected from Member States in this Region, it is noted that top priority is given by most countries to protecting drinking water supply sources.

7.2.2

Practical water quality control and quality assurance programmes should be promoted

EHC has implemented missions in China, Cook Islands, Lao People's Democratic Republic, Malaysia, Federated States of Micronesia, Samoa and Viet Nam to promote water quality control and quality assurance programmes. A sub-regional workshop on drinking water quality monitoring and surveillance for Pacific island countries was held in Suva. Fiji in December 1993.

7.2.3

Priority should be given to implement water supply and sanitation activities in cambodia, Lao People's Democratic Republic, Viet Nam and the uoderserved Pacific island countries

About 75% of EHC activities in water supply and sanitation were implemented in these countries during the reporting period. To strengthen the collaborative activities in water supply and sanitatiOn, one WHO Sanitary Engineer each was posted to Suva. Fiji and Hanoi. Viet Nam in early 1994 to serve the Pacific island countries, and Cambodia, Lao People's Democratic Republic and Viet Nam, respectively.

7.3 7.3.1

Environmental health in rural and urban development and housine EHC should provide technical input to the Healthy Urban Environment project.

EHC participated in the WHO regional working group on urban health development in Osaka, and the biregional meeting on urban health development in Manila. In Viet Nam, EHC cooperated in conducting a national workshop on environmental health in urban development, and has initiated country-level healthy urban development activities in China and Malaysia. Coordination between EHC and other UN agencies in this field has been enhanced through frequent communication and participation in meetingll.

- 53 Annex 4

73.2

EHC should collaborate in assessing the health implications and in establishing environmental health criteria and standards for low-cost housing development schemes

. EHC collaborated with the Government of Cook Islands to assess the health and environmental implications of current housing and urban development programmes and review the regulations and guidelines for housing and urban development.

733

RHC should also collaborate in assessing the health risks associated with rural and urban development activities

A regional workshop on environmental health impact assessment was conducted at EHC in November 1993, which focused on the assessment of health impacts/risks of industrial and water resources development projects. EHC collaborated with Malaysia and the Philippines to conduct courses on environmental risk assessment and management, associated with industriaf' development. In the Philippines, a preliminary assessment of the potential risks to health and the environment of a contaminated site was made.

73.4

EHC should collaborate with Member States in assessing the handling and disposal alternatives for hospital/clinical waste with urgent attention to AIDS-related waste.

EHC collaborated with Papua New Guinea to assess the current problems of hospital waste management in major towns and prepare guidelines for the management of hospital waste. The adequacy of water supply, sanitation and solid waste management of several hospitals in Cambodia was evaluated by EHC. In Malaysia. EHC collaborated with the Ministry of Health in preparing training materials and conducting a course on clinical waste management for key hospital personnel involved in waste management. EHC also prepared draft guidelines for health care waste management suitable for use by developing countries. EHC plans to conduct a regional workshop on clinical waste management in November 1994, HSing the draft guidelines and other materials produced during the missions in Malaysia and Papua New Guinea.

7.4 7.4.1

Health risk assessment ofpotentiallv toxic chemicals EHC should collaborate with Member States in developing a legislative framework and technical and managerial capabilities for safe handling and disposal of hazardous waste within the countries as well as for controlling transboundary movement of hazardous substances.

EHC collaborated with the Governments of Malaysia and Philippines to produce legislative frameworks for chemical safety. Additionally, the need for chemical safety legislation was acknowledged in China. EHC convened two regional workshops, one on chemical safety legislation and the other on effective management of chemical safety infozmation. These workshops covered the legislative and management aspects of the handling and disposal of hazardous substances.

7.4.2

EHC should encourage the provision of information and training activities on health impacts/risks and management of toxic chemicals to the community and end-user levels.

EHC collaborated with Member States in conducting 13 workshops, seminars, lectures, and training courses on hazardous waste management, control of toxic chemicals, industrial

- 54 -

Annex 4

chemical safety and management, environmental risk assessment and control technology, and environmental health. In one very effective training activity involving spilled pesticides, EHe familiarized participants with practical aspects of chemical safety by supervising the preparation of a workplan and a health and safety plan for repackaging the ptlSticides, and subsequently supervising the actual clean-up.

7.5 7.5.1

Control of environmental health hazards

Air quality management Ene should collaborate with Member States on.measures to encourage the use of alternative fuels and the production of cleaner fuels; and on measures to rednce motor vehicle air pollution.

7.5.1.1

EHe pCOY.ided advisory services to the Republic of Korea on soot reduction technologies for diesel vehicles in May!June 1992, and to the Philippines on the preparation of an air quality management"Inaster plan in August/September 1992 and June/July 1993. ·The air quality management study of the Kelang Valley of Malaysia, with which ERe had an involvement, also addressed measures to prevent a serious deterioration in air quality, including the use of cleaner fuels. Two EHe assignments to China, in November 1992 and April/May 1993, focused on indoor and outdoor air pollution from coal combustion and the health effects of air pollution. The assignment to China on the health effects of air pollution was followed by a national workshop on air pollution epidemiology, held in Beijing in October 1993. ERe provided a consultant for the workshop. The lectures of an ERe staff member to Mala}'llian Government courses (Ministry of Health and the National Institute of Public AdmjnWtration) included motor vehicle emission control options.

7.5.1.2

EnC should also collaborate with Member States to promote awareness of the potentIal beaItb impacts ofJ'egional issues such as stratospheriC ozone depletion, climatic: c:bange and natural disasters.

EHe was represented by a staff member on a Mala}'llian Government committee on haze. Haze blanketed much of the country in October 1991, during which concentrations of fine particulate matter exceeded WHO guidelines by more than three and a ha1f times. Anecdotal evidence suggested increases in respiratory tract illness when the haze was present. The haze ~partially caused by forest fires from a source external to the country. External sources of a:ir pollution, including from volcanic eruptions, were also found to be an issue in Brunei Darussalam, during an EHe air quality management assignment in early 1993. On more general activities, through the participation of a staff member at a ESCAP/UNDP high-level meeting on environmentally sound and sustainable development in Asia and the Pacific, ERe was able to provide a health focus to a framework of regional action for sustainable development An environmental health input was also made to the Bangkok Statement on Supportive Environments for Promoting Health in the Asia-Pacific Region, prepared at a WHOfUNEP interregional meeting held in late 1993.

7.5.2 7.5.2.1

Water quality management

EHC should implement regional and national group training ac:tirities on groundwater management

In July 1993, EHe collaborated with the Chinese Research Academy of Environmental Sciences (CRABS) to conduct a national workshop on management of groundwater resources.

.. - 55 -

Annex 4

Twenty people from the central and provincial environmental health agencies participated. Topics covered during the workshop related to quality and quantity of groundwater, types of pollution problems and their impacts, and control options.

...

An earlier plan to conduct a sub-regional workshop on groundwater management for the Pacific island countries was not implemented because of budgetary constraints. If the budget situation improves in the future, the activity may be implemented. 7.5.2.2 To foster better water quality management, EHe should also collaborate with· Member States to improve the capability to assess water quality; and strengthen quality assurance systems from sampling to data processing

In Macao, ERC provided technical advisory services on the monitoring of estuarine water quality, while in Lao People's Democratic Republic, ERC collaborated in the development of water quality monitoring programmes and effluent standards for industrial sectors.

ERC continued to collaborate with 11 countries in the Region to implement the GEMSjWater·Project. In 1993, ERC acquired RAlSON,a GIS-based data analysis software, to support Member States in the management of water quality data/information. 7.6 Food safety EHe should continue to collaborate with Member States to develop the basic infrastructure to plan, implement, monitor and evaluate food safety programmes

7.6.1

ERC provided advisory services to Cook Islands, Papua New Guinea, Tonga and Viet Nam to improve the food safety infrastructure in these countries. The missions in Cook Islands, Papua New Guinea and Tonga covered the legislative aspects; while the missions to Viet Nam and Tonga covered the food inspection aspects. The international seminar on food irradiation convened by ERC in January 1992 provided a forum to promote awareness and understanding of food irradiation technology. It is expected that this seminar would lead to further development of the food safety infrastructure after the technology is accepted by national authorities.

... ...

7.6.2

EHe should also enhance analytical capability in the detection offood contaminants

Advisory services were provided to China on analysis of mycotoxins in food. In Viet Nam, funds were provided to implement a national study on control and reduction of aflatoxin in food which includes a sampling and analytical programme for aflatoxincontaminated food. . 7.6.3 To assure the safety of street foods, EHe should facilitate a programme of cooperation among Member States and international organizations

A study on the safety of street foods in Viet Nam was completed in early 1992. In October 1993, WHO cooperated with the International Life Sciences Institute to convene an international conference on street foods in Beijing. Funds have been secured from the Government of Japan for a project on improving the safety of street-vended foods in this Region. The project will involve the evaluation of common street-vended foods to identify potential health hazards and formulate training programmes to inform industry and the public of the health risks associated with street foods and of measures to prevent foodborne hazards.

- 56-

Annex 4

8. PROGRAMME SUPPORT DEVELOPMENT

8.1"

Staffing

Since the last advisory meeting in December 1991, Dr.W. Harrington joined EHC as Chemical Safety Specialist on 22 June 1992; Ms Mimi Lai, Secretary, and Mr T. Dafoe, Water Quality Management Specialist, left the Centre on 1 July 1992 and 24 September 1993 respectively. Mr B. Fisher, Sanitary Engineer was reassigned to Fiji in January 1994. Ms Lai's position is replaced by a temporary secretary. At present, the posts of food safety specialist and water quality management specialist remain vacant. A list of current staff members is attached as Appendix 2.

8.2

Regnlar.budget

For the. 1990-1991 biennium, EHC received a total of US$2 348 100. Funds for 1992-1993 amounted to US$2 474 700 which were subsequently reduced by 24% to US$1 862200 due to budgetary constraints. The revised budget represents a decrease of 20% over the previous biennium. For 1994-1995, the original budget of US$2 844 600 was reduced by 20% to US$2 267 000. This represents a 21 % increase over 1992-1993. Table 4: Regular budgetary funds available to EHC (in US dollars)

1990-1991

1992-1993

1994-1995

ICPIRUD/OOI

2348100

1 862200

2267000

Increase (decrease) over previ~ biennium'

(20%)

21%

8.3

Extra-budgetary sypport

The regular budget is supported by extra-budgetary funds from other agencies. The total extra-budgetary support received for the reporting period amounted to US$842 000. This includes the Malaysian Government's annual contnbution of MYR100 000 (approximately US$36 000). The Japanese Government, under the Special Programme of Technology Transfer, provided US$38 ()()O for a regional workshop on recycling and resource recovery for municipal solid wastes, 1991 and US$40 000 for a regional workshop on effective management of chemical safety information, 1992. Both meetings were held at EHC. In 1993 it funded US$35 000 for a workshop on drinking water quality monitoring and surveillance for Pacific island countries in Suva. The workshop was co-sponsored by the British Overseas Development Administration

- 57 -

Annex 4

which contributed U$20 000. The hazardous waste inventory and action plan development and pesticides repacking programmes in the Pacific were completed by EHC staff members. The project was supported by US$40 000 from the Special Programme on Technology Transfer. The Japan Shipbuilding Industry Foundation (JSIF) provided US$40 000 for the workshop on environmental health impact assessment held ~ EHC in 1993. This amount was supplemented by an additional contribution of US$5 000 from WHO Headquarters. EHC carried out the UNDP-funded WHO-executed project on safety and control of toxic chemicals and hazardous wastes to which UNDP contributed US$498 000. Other activities for which support was received from international agencies include participation of EHC staff members in meetings orgarrized or sponsored by UNCRD, UNDP, World Bank.and UNEP.

...

EHC also collaborated with WHO Headquarters by sharing resources for the following activities: (1) National training programme on hazardous waste management, Viet Nam, 18-28 November 1991 (HQ provided the services of a consultant and local costs of US$3000); National workshop on environmental epidemiology, Philippines, 21 July - 4 August 1992 (EHC provided a consultant while HQ provided local costs of US$6 000); and National workshop on environmental epidemiology, Viet Nam, 7-14 October 1992 (HQ provided the services of a HQ staff member and a consultant, and local costs of US$8 000) .

... ...

(2)

(3)

Additionally, WHO Headquarters funded the travel costs of EHC staff mc;mbers to participate in the WHO consultation on environmental health indicators, Dusseldorf in 1992 and the school hygiene project formulation workshop, Viet Nam in 1993.

...

8.4

Short-tenn consultants

For the biennium of 1990-1991, 39 man-months were available, of which six for group educational activities. In comparison, only 15 man-months were available for 1992-1993, of which three man-months were for group educational activities. The situation has improved for 1994-1995 with 23 man-months, inclusive of three man-months for group educational activities. m~-months.were

Details of the consultant assignments for the review period are presented in Appendix 1.

8.5

Other administrative matters

...

There was no significant change in the physical facilities of our Centr.e. A Toyota Hiace van was purchased in June 1993 to replace the old van. . Communication f~cilities were upgraded with the installatio~ of higher capacity computer eqUIpment and accessones, a local area network (lAN), photocopler and overhead projector.

- 58-

APPENDIX 1

LIST OF EHC ACflVITlES July 1991 - April 1994

FIELD TECHNICAL COOPERATION ACTIVITIES Carried out Qy Date

AMERICAN SAMOA 1. Field visit to assess EHC collaborative activities in environmental health BRUNEI DARUSSALM1 P.Guo 10-14 Aug 1992

1. 2. 3.

Water pollution control Collaboration on air quality management Hazardous waste disposal CAMBODIA

T.Dafoe K Rolfe W. Harrington

6-18 Dec 1992 31 Jan-l0 Feb 1992 11-21 Apr 1993

1. 2. 3. 4.

Water supply and sanitation in hospitals Environmental health programme development TeChnical collaboration on solid waste management Assessment of solid waste management in Phnom Penh Training course in food safety CIllNA

B. Fisher P.Guo P.Guo H. Ogawa D.Mahoney

21 Jun-5 Jul1992 19-24 Feb 1993 8-15 Aug 1993 16-28 Jan 1994 28 Mar-l Apr 1994

National workshop on safety and control of toxic chemicals and hazardous wastes, and preparation of proposals for the implementation of workshop recommendations

T.Shen

21 Aug-8 Sep 1991

- 59Appendix 1

I I I

- 60Appendix 1

Carried out by CHINA (contd.) 14. WHOjUNEP national workshop on air pollution epidemiology COOK ISLANDS 1. Field visit to assess EHC collaborative activities in environmental health Water supply and sanitation facilities for the Festival of Pacific Arts and water quality monitoring programme AssesSment of solid and hazardous waste management in Rarotonga Review offood safety legislation Occupational safety and health programme review Advisory services on piggery and chicken waste treatment; health, housing and urban planning; and solid waste management P.Guo B.H.Chen D.W. Dockery

Date

12 Oct-4 Nov 1993

8-10 Aug 1991

B. Fisher

17 Mar-3 Apr 1992

3. 4. 5.

H.Ogawa D.B. Mahoney W. Harrington H.Ogawa

31 May-10 Jun 1992 20-31 Jul1992 18-23 Sep 1993 6-19 Mar 1994

FIJI 1. Hazardous waste inventory and disposal K~REA,

H.Ogawa

13-15 May 1992

REPUBUC OF

Reduction of particulate matter emissions from diesel vehicles, and participation in the World Environment Day International Seminar on Urban Air Pollution and Strategies Environmental information database management

.K. Rolfe

23 May-21 Jun 1992

T.Dafoe L Murdoch

15-28 Aug 1993

- 61 Appendix 1

Carried out by

Date

LAO PEOPLE'S DEMOCRATIC REPUBLIC 1. Promotion of environmental health programme, Phase 1 - Assessment of environmental hazards and preparation of a plan for training National workshop on management of environmental health hazards Environmental health programme development Water supply and sanitation workshop Workshop on waste disposal management Industrial water pollution control MACAO 1. Estuarine water quality monitoring MALAYSIA 1. Advisory services on development of environmental quality surveillance and monitoring programme for toxic pollutants (Phase 2) National seminar on management C. Barber 14 JuI-10 Aug 1991 T.Dafoe 3-16 May 1992 H.Ogaw~.

24 Apr-1 May 1992

2. 3.

H.Ogawa P.Guo P.Guo

2-18 Feb 1993 10-19 Feb 1993 10-16 Oct 1993 31 Oct-6 Nov 1993 9-29 Jan 1994

B. Fisher H.Ogawa P.Guo

5. 6.

H.Ogawa

18-19 Feb 1992

and technology of municipal and industrial wastes organized by Universiti Pertanian Malaysia and sponsored by UNESCO 3. Review of chemical safety legislation Technical study and national workshop on environmental risk assessment and control technologies National workshop on environmental impact assessment organized by the Public Works Department LMortimer 26 JuI-lS Aug 1992 20 Sep-13 Oct 1992

...

.1. Spickett H. Ogawa H.Ogawa

19 Oct 1992

...

- 62Appendix 1

Carried out by

Date

MALAYSIA (contd.)

Intensive course on environmental health for public health engineers

T. Dafoe H.Ogawa K. Rolfe A. Woodward H.Ogawa

12-16 Oct 1992

'""

Training programme on environmental planning and management for the National Institute of Public Administration Seminar-workshop on partnerships towards responsive solid waste management in South East Asia Attendance at the seminar on safety management of chemical substances for prevention of industrial pollution Water quality disaster management plan Attendance at the course on environmental impact assessment, Sarawak 'Attendance at the course on planning and control of the environment for local authorities Attendance at the course on environmental risk assessment and management Development of a registration and training system for operators of water and wastewater treatment plants Attendance at the course on integrated environmental planning and management Intensive course on environmental health for public health engineers. and seminar/workshop on management of hospital waste for key hospital personnel

1 Apr-31 Dec 1992 (intermittently)

H.Ogawa

17-22 Jan 1993

H. Ogawa

22 Feb 1993

10. 11.

T.Dafoe H.Ogawa

8 Apr-l0 Sep 1993 (intermittently) 18-26 May 1993

12.

H.Ogawa

15 Jun 1993

13.

H.Ogawa

5-8Jul1993

14.

B. Fisher

22 Jul-23 Nov 1993 (intermittently)

15.

H. Ogawa K. Rolfe C.B.Saw H. Ogawa W. Harrington

4-8 Oct 1993

16.

11-20 Oct 1993

- 63-

Carried out by' Date

Appendix 1

MALAYSIA (contd.) 17. 18. 19. Seminar on air quality management study for the Klang Valley Region National workshop on occupational health Presentation on health effects of industrial chemicals at University of Malaya National conference on environmental health research K Rolfe T.Ng W. Harrington W. Harrington 26-27 Oct 1993 1-5 Nov 1993 30 Dec 1993

20.

P.Guo W. Harrington H.Ogawa K Rolfe

18-21 Apr 1994

MARSHALL ISLANDS

....

Hazardous waste inventory and action plan development

W. Harrington

11-17 Sep 1992

MICRONESIA, FEDERATED STATES OF

....

1. 2. 3. 4.

Urban water supply and sanitation programmes Hazardous waste inventory and action plan development Hazardous waste survey-pesticide repackaging Assessment of solid waste landfill site in Yap NIUE

B. Fisher W. Harrington W. Harrington H.Ogawa

13-23 Apr 1992 4-11 Sep 1992 25-29 Sep 1993 30 Mar-6 apr 1994

....

.... 1.

Field visit to investigate the problems of bacteriologically contaminated drinking water

P.Guo

14-16 Aug 1991

.... 1.

NORTHERN MARIANA ISLANDS, COMMONWEALTH OF THE Hazardous waste inventory and action plan development W. Harrington 29 Aug-4 Sep 1992

...

PAlAU 1. Hazardous waste inventory and action plan development W. Harrington 25-29 Aug 1992

-64Appendix 1

Carried out by

Date

PAPUA NEW GUINEA

Advisory services on the national food safety programme and collaboration in the conduct of a food safety legislation workshop Hazardous waste inventory and action plan development Food safety legislation Hospital waste management PHILIPPINES

A. Hazzard

28 Sep-12 Oct 1991

2. 3.

1. Wallis A. Hazzard

3-12 Sep 1992 1-13 Nov 1992 7 Feb-21 Mar 1993

W. Harrington

National workshop on operation and maintenance of water supply and sanitation systems National workshop on environmental epidemiology Preparation of air quality management master plan Seminar-workshop for local government solid waste managers Water quality management for Laguna Lake Region, Phase 2 Preparation of national priority proposals on site assessment and chemical testing services Symposium and seminar-workshop on safety and management of chemicals and hazardous wastes Preparation of an air quality management master plan (Phase 2) and participation in the World Bank Urban Air Quality Management Workshop National workshop on environmental risk assessment and control technology

T.Dafoe B. Fisher R. Etzel T. Kjellstrom

15-25 Jul1992

2. 3.

21 Jul-4 Aug 1992 23 Aug-19 Sep 1992 20-24 Oct 1992 7-15 Jul and 27 Jul-14 Aug 1992 10 Jan-l Feb 1993

K Rolfe H.Ogawa T.Dafoe W. Harrington

4. 5.

H_ Ogawa

27 Mar-3 Apr 1993

K Rolfe

20 Jun-28 Jull993

H.Ogawa J. Spickett

15-27 Aug 1993

- 65 -

Appendix 1

Carried out by

Date

SAMOA 1. 2. 3. 4. Field visit to assess collaborative activities in environmental health Assessment of solid and hazardous waste management Water supply and sanitation Follow-up advisory services on solid waste management SINGAPORE 1. National workshop on control of toxic chemicals, and preparation of proposals for the implementation of workshop recommendations Establishment of a chemical safety information centre Visit to discuss possible collaborative activities in environmental epidemiology SOLOMON ISLANDS 1.

P.Guo H.Ogawa B. Fisher H.Ogawa

2-8 Aug 1991 25-31 May 1992 20 Sep-7 Oct 1993 21-25 Mar 1994

H. Ogawa J. Spickett

20-30Jan 1992

2. 3.

T. Kaminuma . P.Guo B.Kean

14-22 Feb 1993 10Jun 1993

Hazardous waste inventory and action plan development TONGA

I. Wallis

12-16 Sep 1992

Review oUood safety legislation Development and management of solid waste landfill sites and operation of collection systems, assessment of magnitude of environmental pollution, and hazardous waste inventory and disposal Hazard analaysis critical control point concept in typhoid fever control Chemical safety for agricultural chemicals

D.Mahoney H.Ogawa

11 Jun-3 JuI 1992 12-27 Jun 1992

D.Mahoney

6-17 JuI1992

W. Harrington

19-23 Sep 1992

- 66-

Appendix 1

Carried out by

Date

TONGA (contd.)

Investigation of the potability of the Nuku'alofa water supply contaminated by diesel fuel TUVALU

T. Dafoe.

26 Apr-6 May 1993

Preparation of a health development plan (environmental health aspects) VANUATU

B. Fisher

4-14 Nov 1992

1. 2.

Hazardous waste inventory and action plan development Hazardous waste survey pesticide repackaging VIETNAM

I. Wallis

16-23 Sep 1992 11-18Sep 1993

W. Harrington

Joint WHO/UNDPfWorld Bank reconnaisance mission to identify salient issues on solid waste management National training programme on hazardous waste management Workshops in Hanoi and Ho Chi Minh City on food safety and inspection with particular emphasis on the Hazard Analysis Critical Control Point procedure National workshop on environmental health in urban development National workshop on environmental epidemiology research methods Environmental health programme development Courses on food safety and inspection Water supply and sanitation

H. Ogawa

6-13 JuI 1991

2 3.

J. Spickett K. Leighton J. Lytwyn

18-28 Nov 1991 . 14 Oct-2 Nov 1991

H.Ogawa

20-24 Apr 1992

T. Kjellstrom A Woodward P.Guo D.Mahoney B. Fisher

30 Sep-16 Oct 1992

4-10 Feb 1993 31 Mar-20Apr 1993 31 May-14 Jun 1993

- 67-

Appendix 1

Carried out by

Date

VIETNAM 9. 10. Training course on environmental impact assessment Advisory services in connection with the establishment of an information centre on environmental epidemiology REGIONAL ACTIVITIES Regional workshop on chemical safety legislation, Kuala Lumpur, Malaysia WHO/UNDP/World Bank regional workshop on recycling and resource recovery from municipal solid wastes, Kuala Lumpur, Malaysia WHO/IAEA/FAO seminar on harmonization of regulations on food irradiation in Asia and the Pacific, Kuala Lumpur, Malaysia Assessment of UNDP regional water and sanitation project in Fiji in Vanuatu, Solomon Islands and Papua New Guinea Regional workshop on solid waste management in the Pacific countries, Suva, Fiji Preparation of educational/training materials on chemical safety - China. Malaysia, Philippines, Republic of Korea and Singapore Regional workshop on effective management of chemical safety information Preparation of draft regional guidelines for hospital waste management in developing countries L. Mortimer H. Ogawa M.Prabhu H.Ogawa E. Ouano J.H.Tay A. Hazzard G.Moy N. Tape P. Pothisiri P. Loaharanu

H.Ogawa .. J. Stober

10-15 Jan 1994 4·17 Apr 1994

B. l.

7·11 Oct 1991

11-15 Nov 1991

3. 4.

20-24 Jan 1992

B. Fisher

17 Feb-18 Mar 1992

... 5.

H.Ogawa A. Thorstensen D.Ferry

18-22 May 1992

31 May-4 Jul1992

W. Harrington T.Kaminuma H.Ogawa C.B.Saw

30 Nov-4 Dec 1992

13-24 Sep 1993

- 68-

Appendix 1

Carried out by

Date

REGIONALACfMTIES (contd.) 9. Workshop on environmental health impact assessment, Kuala Lumpur, Malaysia Workshop on drinking water quality monitoring and surveillance for Pacific island countries, Suva, Fiji Coordination of the UNEP/WHO Global Environmental Monitoring System (GEMS) air quality monitoring project Coordination of the GEMS water quality monitoring project Coordination of the GEMS food contamination monitoring project Coordination of the GEMS human exposure assessment locations (HEAL) project Environmental information service programme M. Birley D. Calvert H.Ogawa B. Fisher B.lloyd 15-19 Nov 1993

10.

6-10 Dec 1993

11.

EHC staff

continually

12.

EHCstaff EHCstaff EHCstaff

continually .continually continually

13. 14.

15.

EHCstaff

continually

C. 1.

A~ANCEATMEETINGSQRGAmZEDBYOTHERAGEN~

Attendance at the first Pacific Islands environmental health conference: Mobilizing resources fm: effective environmental health programmes, Noumea, New Caledonia Attendance at the WHO regional working group on urban health development, Osaka, Japan Attendance at the UNCRD Expert group seminar on environmentally sound management of industrial development in Asian countries. ~takyushu,Japan

P.Guo

19-23 Aug 1991

H.Ogawa

17-22 Sep 1991

H.Ogawa

25-28 Sep 1991

- 69-

Appendix 1

Carried out by

Date

. ATI'ENDANCE AT MEETINGS ORGANIZED BY OTIIER AGENCIES (contd.)

Attendance at the Eleventh Meeting of the Joint WHO/FAO/UNEP/UNCHS Panel of Experts on Environmental Management for Vector Control (PEEM), Kuala Lumpur, Malaysia Attendance at the Second Congress of the regional network of local authorities for the management of human settlements for Asia and the Pacific, K~ Lumpur & Penang, Malaysia Attendance at the UNDP/ World Bank meeting on coordination of solid waste management activities, Jakarta, Indonesia

B. Fisher

21-25 Oct 1991

B.Fisher

4-8 Nov 1991

H. Ogawa

11-12 May 1992

H.Ogawa Attendance at the international symposium on UNCED and prospect on the environmental regime in the 21st century, Seoul, Rep. of Korea . H.Ogawa Attendance at the Intercountry consultative meeting on the urban management programme for Asia and the Pacific, Kuala Lumpur Attendance at the meeting on ~EMS/Water Mekong project, Bangkok, Thailand Attendance at the international exlubition and conference on environmental protection and control technology (ENVIROPRO'92), Kuala Lumpur, Malaysia Attendance at the WHOjUNEP GEMS HEAL coordinators meeting, Bangkok, Thailand P.Guo

2-5Sep 1992

16-18 Sep 1992

10 Oct 1992

10.

H.Ogawa

27-31 Oct 1992

11.

K. Rolfe

15-20 Nov 1992

-70 -

Appendix 1

Carried out by

Date

ATTENDANCE AT MEETINGS ORGANIZED BY OTHER AGENCIES (contd.) 12. Attendance at the WHO interregional consultation on environmental health, Geneva, Switzerland Attendance at the WHO consultation on development and use of environmental health indicators, Duesseldorf, Germany Attendance at the ESCAP interagency working group meeting on environment and development, Bangkok, Thailand Attendance at the ESCAPfUNDP high-level meeting on environmentally sound and sustainable development in Asia and the Pacific, Kuala Lumpur, Malaysia Attendance at the UNEP/Japan Society for the Water Environment workshop on human resources development in river water quality management, Kuala Lumpur, Malaysia Attendance at the training course on water quality for Mekong riparian countries, Bangkok, Thailand Attendance at the Second Programme Steering Committee Meeting on the Urban Management Programme for Asia and the Pacific, Kuala Lumpur, Malaysia S. Tamplin P.Guo 10-18 Oct 1992

13.

H.Ogawa

13-19 Dec 1992

.....

14.

P.Guo

1-3 Feb 1993

15.

K. Rolfe

15-19 Feb 1993

16.

T.Dafoe

12-16 Apr 1993

17.

T.Dafoe

9-22 May 1993

18.

H.Ogawa

24-25 Jun 1993

19.

H.Ogawa Attendance at the bi-regional meeting on urban health development, Manila, Philippines

8-16 Aug 1993

-71 -

Carried out by Date

Appendix 1

. ATI'ENDANCE AT MEETINGS ORGANIZED BY OTHER AGENCIES (contd.) 20. Attendance at the Seventh Meeting of the International Programme on Chemical Safety (IPCS) Programme Advisory Committee, Brussels, Belgium Attendance at the WHO Interregional consultation on environmental health, Toluca, Mexico Attendance at the WHOjUNEP Interregional meeting on education and promotion for supportive environments for health, Bangkok, Thailand Attendance at the Senior Expert Meeting on the Mekong water quality monitoring and assessment; and at the Thirty-second session of the interagency task force on water for Asia and the Pacific, Bangkok, Thailand Attendance at the Regional study and workshop on the environmental assessment and management of aquaculture development, Bangkok, Thailand Attendance at the Seminar on urbanization, sustainable development and the media, Singapore Attendance at the International conference on chemical safety, Stockholm, Sweden W. HarriJ?gton 4-10 Oct 1993

21.

P.Guo

11-16 Oct 1993

22.

K. Rolfe

31 Oct-6 Nov 1993

23.

P.Guo

28 Nov-2 Dec 1993

24.

P.Guo

20-'1:1 Feb 1994

25.

W. Harrington

7-9 Apr 1994

26.

W. Harrington

23-30 Apr 1994

-72 -

APPENDIX 2

EHCSTAFF (As at 30 April 1994)

DrP.Guo Technical staff:

Director

MrK. Rolfe Dr~.

Air Quality Management Specialist Chemical Safety Specialist Environmental Systems Engineer Food Safety Specialist (expected to be filled in 1994) Water Quality Management Specialist Environmental Epidemiologist

Harrington

DrH. Ogawa Vacant Vacant Vacant Administrative staff:

MsL.Y.Chan Prougmme support staff:

Administrative Officer

MsY.M. Tan Secretaries:

Special Assistant

Ms Normah Mahmod

MsM.RTan MsM.Pieris

Drivers: Mr Shahruddin Asmuni Mr Masim Satarum

- 73 -

ANNEX 5

Regional Strategy on

-HEALTH AND

ENVIRONMENT

WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THEWESTERN PACIAC 1994

-74 -

Annex 5

Regional Strategy on

Health and Environment evaluated its past approaches to environmental health problem-solving and developed a more effective strategy, outlined in this d.ocwnen.t. Initiated by a Regional Consultative Group on Health and EnvironnientinNovember 1991, this process ofreview has resulted in a Regional Strategy on Health and Envirorunent intended to guide regional activities over the next six years.

MiO has

· P artictl.l.qr emphasis is placed on priority acttvities that are significa.rrt, timely and practicable. In addition,

a new focus for traditional activities is suggested.

Specific plans of action will be prepared. These will be dynamic documents rejlectiJ1g priority concerns, responsive to changing circumstances, but always moving to improve health in measurable ways. The corrunitment of Member States is vital. as these plans must be advocated and conducted at national and local levels.

~==============================l

- 75 -

1. INTRODUCTION

Annex 5

In the past, WHO has organized environmental health· activities into five programme areas: community water supply and sanitation, rural and urban development and housing, control of environmental health hazards, food safety, and chemical safety. In implementing these programmes, WHO has provided technical advisory services, fostered human resources development through fellowships and group training activities, and purchased small amounts of supplies and equipment to support the development of institutions and infrastructures. This has been done with varying degrees of effectiveness, but on balance it has made a significant contribution to coping with increasingly severe environmental health problems. ¢-

However, in light of the growing challenges of resolving complex health-environmentdevelopment issues and the increasing demand for limited organizational resources, it has been necessary to r~ew these past approaches to environmental health problem solving in order to develop a more effective and efficient programme strategy. For WHO, at the global level, this process focused on the work of the WHO Commission on Health and Environment (19901992); at the regional level, it was initiated by a Consultative Group on Health and Environment, convened in Manila, Philippines, in November 1991. In addition, the 1992 United Nations Conference on Environment and Development, held in Brazil. further confirmed the critical need to depart from business as usual approaches.

2. THE STRATEGY

The Regional Strategy on Health and Environment is intended to guide WHO activities over the next six years. It recognizes that many of the activities under the five traditional programme areas will continue, though many will need to be supplemented with more effective and practicable mechanisms for implementation and coordination with others. WHO has limited resources; and they must be focused on priority activities which situations which maximize effectiveness and impact. The striltegy is made up of two separate but interrelated components:

(1) (2)

a new focus for traditional activities, and the identification of priority activities based on signifirJt.DCe, timeliness, and practicability..

This is not a dramatically different approach. It recognizes the need for building on the lessons of the past and focusing on those activities which, when put together with the work of others, solve environmental health problems in sustainable ways rather than on simply responding to immediate needs.

-76 -

Annex 5

2.1

The goals

. The environmental health programme goals formulated by the WHO S0mmission on Health and Environment, and reflected in the 1993 global strategy document ,also cover the broad range of interactive health and environment needs in tp.e Western Pacific Region: o o o 2.2 to achieve a sustainable basis for health for all; to provide an environment that promotes health; and to make all individuals and orgailizations aware of their responsibility for health and its environmental basis.

The objectives

Similarly, the broad organization-wide objectives set out in the global strategy document are equally applicable at the Regional level: To sUpport countries in providing the environmental elements required to meet basic health needs; to promote increased awareness and understanding of interaction between health, the environment, and development among leaders and the public, so as to strengthen community action for health and sustainable development; to collaborate with national and local authorities in the creation of supportive environments for health; to promote the central role of health in decision-making and programmes on matters of environment and development, and to foster cooperation between the health sector and related sectors in these processes; to strengthen capabilities for emergency preparedness and response to cover the public health aspects of disasters and violent conflicts; to strengthen national capacities for human resources development in work related .to health, the environment, and development;

to improve technical capabilities for the monitoring and assessment of environmental risks to health; to improve technical capabilities for the management of environmental risks to health, i.e., their prevention, abatement, and control; to strengthen local, national and international environmental health information systems, for the exchange and proper use of information;

1Draft WHO Global Strategy for Health and Environment, docwnentA46/11 (23 March 1993) for the Forty-sixth World Health Assembly, Geneva, May 1993.

- 77-

Annex 5

to pr~mote resear~h on a p~ogressively stronger scientific and technical basis for the wIde range of mterventlOns needed to achieve the health goals of sustainable development; to foster enviro~mentally safe and so~d meth<?ds :md technology for the effective control, preventIon and treatment of dISease and dISability· , and, to prom<?te and s~~port other ~tj~tjonal and .sectoral capacities for improving progressively POliCies, plans, legISlation and actIOns on health, the environment and development.

To a gi-eat extent, WHO's General Programme of Work and the associated budgetary process will continue to shape activities along traditional lines. In order to be more effective, however, these activities will need a new focus. This new focus will be on: (1) (2) (3) (4) identifying the most urgent needs and declining less urgent requests; identifying simple measures that positively affect complex: environmental health problem solving; networking more effectively among organizations involved in environmental health problem solving; advocating timely involvement of government officials in critical decision-making in other sectors; and, promoting and educating in regard to health to bring about behavioural change.

(5)

Successfully dealing with the most urgent needs will, in most cases, require collaboration among several external support agencies; extended coordination with national and local officials; ~d close cooperation with community leaders. Networking more effectively among organizations includes the idea of working with logical geographical subgroups of countries such as north-east Asia (China, Japan. the Republic of Korea, Mongolia, the Democratic People's Republic of Korea). This implies interregional sharing of resources such as the use of Western Pacific Environmental Health Centre (EHC) staff in WHO's South-East Asia Region.

4. PRIORI1Y ACI'MTIES

Based on current knowledge of national interests and needs, the likely availability and allocation of resources, and significant external factors such as the impact of the United Nations Conference on Environment and Development, the following are identified as priority activity areas:

-78 -

Annex 5

4.1

Assessment of the impact of development on health

. Although it is deskabie to evaluate, in practical !el1DS;> the impact of development. on health, this has rarely been achieved because the relat~ons~p betwe~n ca~se.and effect IS complex and long-term in nature. However, progr~ 18 ?emg made m ~ ~ifficult ~ea of quantifying health-environment-development relationships to support decJ.slOn-making for the future. In this regard, the following are priority activities:

(1) (2)

the development and implementation of environmental health impact assessment guidelines in collaboration with the Asian Development Bank and others; and, the promotion of environmental epidemiology training and applied studies to influence decision-making [the creation of the new post of Environmental Epidemiologist at EHC in 1994; ongoing work with the University of the . Philippines related to the health impacts of transportation-related air pollutants; ana interaction with the Centre for Environmental Epidemiology in Singapore are important in this regard.

4.2

Motor vehicle emissions control

In the congested urban areas of Asia, motor vehicle-related pollution is perceived as one of the most serious environmental health problems. Aiming at the source of the problem, a great deal of attention is being given to fuel quality, emissions control hardware, and mass transportation alternatives by government regulators and private sector producers. In this regard, the following are priority actiVities:

(1)

promotion and support of the development and implementation of diesel particulate control technology, particularly in the Republic of Korea (recognizing the potential for its use throughout Asia); collaboration with the Government of the Philippines, the Asian Development Bank, the World Bank and others in the development of an air pollution control master PIan. with particular emphasis on motor vehicle emissions control in Metro Manila; and regionwide support fOJ" initiatives to reduce the lead content of gasoline, including, .in the Philippines, a study of the impact of motor vehicle emissions on the health . of vulnerable populations.

(2)

(3)

4.3

Drinking-water Wlality guidelines

The revised WHO Guidelines for drinking-water quality, issued in early 1993, have returned attention to related environmental health problems as countries assess their status with respect to these guidelines. The priority activities identified in this situation are: (1) (2) promotion of the new WHO drinking-water quality guideWies and the importance of safe drinking water to health; the protection of fragile drinking-water supplies (ie., supplies that are vulnerable to contamination and overuse) in South Pacific island countries, with emphasis on developing appropriate national standards and promoting good sanitation practices;

- 79-

(3) (4)

Annex 5

technology transfer to solve chemical contamination p~oblems related t~ drinking-water supplies in highly industr~ed countnes.where conventIona~ treatment is no longer adequate (e.g., Chma, the Republic of Korea, MalaYSIa, and the Philippines); and promotion of a comprehensive ~pproach to v:'ai~r re.s0urces plann~g and management in broad geographIcal terms, wIth partIcul~r emphaSIS on urban drinking-water supplies and related development planmng.

4.4

Development of environmental action plans

External support agencies play an important role in ensuring that significant socioeconomic growth is linked to responsible environmental management. For example, in ;; 1992, the "Viet Nam National Plan for Environment and Sustainable Development: 1991-200l} Framework for Action" was developed with UNDP funding. Earlier, the Government of Viet Nam, in collaboration with WHO and UNDP, was successful in building· up the environmental health problem solving capabilities of the Vietnamese Institute of Tropical Technology and Environmental Protection located in Ho Chi Minh City. These complementary activities offer the opportunity to deal effectively with environmental problems as part of the development process. With the support of external funding agencies, this could be most effectively realized through development of an environmental action plan(s). A similar approach would be appropriate for other countries of the Region as well. WHO priority activities in this regard are identified as follows: (1) liaising with multi- and bi-Iateral support agencies (e.g., the Asian Development Bank and the World Bank) and others regarding support for the development of environmental action plans in those areas with high development potential (e.g., the Subic Bay Metropolitan Authority site in the Philippines); using the expertise of WHO/EHC staff, collaborate with the Vietnamese Institute of Tropical Technology and Environmental Protection and appropriate government officials in the development of an environmental management plan for Ho Chi Minh. City and other areas in the southern part of Viet Nam; using the expertise of WHO/EHC and the intercountry programme staff based in Hanoi (1994), develop enhanced institutional capabilities in the northern part of . ·Viet Nam; and, using the expertise ofWHO/EHC staff, the intercountry programme staff based in Hanoi (1994) and national institutional capabilities in the concerned countries as a basis for increased involvement in the Global Environmental Monitoring Systems (GEMS) water project in the Mekong River and other initiatives affecting the Indo-China peninsula.

(2)

(3)

(4)

Safety and control of toxic chemicals and hazardous wastes

Environmental health problems associated with toxic chemicals and hazardous wastes are of significant concern throughout the Region. The WHO/UNDP project on the safety and control of toxic chemicals and hazardous wastes (completed in early 1993) was successful in increasing awareness, identifying priority issues and problems, and raising expectations of possible solutions. In addition, each participating country developed follow-up project proposals for funding consideration by external support agencies. WHO must continue its involvement in this process through the following priority activities:

-I - 80-

Annex 5

( 1)

c,:,llaborati?n with China, Malaysia, the Philippines, the Republic of Korea and Smgapore m the further development, promotion and implementation of follow.up proposals to the WHOjUNDPproject; d.evelol?ment and ~romotion of practical guideJ..ines for hazardous waste disposal (mcludmg appropnate technology transfer) in South Pacific island countries; development and promotion of practical guidelines for the handling and disposal of hazardous hospital wastes; and collaboration with selected governments and industries regarding specific priority environmental health problems in the workplace.

(2) (3) (4) 4.6

Information management to improve environmental health decision-makiu

Data coJ,lectionand information analysis should playa more direct role in decisionmaking in developing countries. Among other things, this necessitates the building of national capacities for information management. In this regard, priority activities are as follows:

(1)

collaboration with UNICEF and national governments in the improvement of management practices through the promotion and implementation of newly developed environmental health database programmes which can be adjusted to fit the needs of decision·makers; development of environmental health indicators in relation to the Environmental Health Impact Assessment Guidelines formulated in cooperation with the Asian Development Bank and a new emphasis on environmental epidemiology; development and promotion of practical street food safety guidelines, and the provision of required basic water and sanitation services to street food vendors; and, training of people in the monitoring of chemical or pesticide residues in food, including the development of laboratory capabilities.

(2)

(3)

(4) 4.7

Coal use

Coal will continue to be a major source of energy supporting industrial development, as well as commercial and domestic heating, in parts of Asia. Air and water pollution resulting from the extraction, processing and combustion of coal has a widespread adverse impact on health. For example. in certain areas of China, the high fluoride content of coal results in serious indoor air pollution problems that contnbute significantly to clinical fluorosis. The priority activities identified with respect to this situation are:

(1)

the promotion of technology transfer to remove pollutants (e.g., fluoride. sulphur, sulphur dioxide. nitrogen oxides, etc.) from coal, wastewater associated with coal preparation, and coal combustion emissions; in China, the promotion of technology transfer to resolve that aspect of the fluorosis problem associated with contaminated groundwater from coal preparation activities (e.g., by promotion and application of appropriate fluoride removal methods for use by individual households or communities); and

(2)

- 81 -

(3) 4.8 Urban health development

Annex 5

collaboration with UNDP/World Bank water sector projects, and with other organizations supporting coal-use projects in the energy and industrial development sectors.

Each of the priority activities listed above has an important urban environmental health component. Many of WHO's other programmes have significant environmental health-related dimensions (e.g., communicable disease control, occupational health, nutrition, etc.). Because of the complex: factors affecting health in an urban environment, individual programme efforts often fall short of their goals for improving health and well-being. Although it is no easy task, it is essential that more effective cross-programme projects be developed in health and environment, making a synergistic response to a complex: set of problems. However, such projects cannot be developed in isolation or imposed on communities from the outside; they must be developed in cooperation with community leaders and decision-makers. A1so, from WHO's perspective, it is essential that these cross-programme projects be manageable; be fully supported by the leadership of the programmes and organizations involved; and receive the solid commitment of participating staff.

In the area of urban health development, the following priority activities have been identified, recognizing that much work remains to be done to define others:

(1)

a meeting of officials from selected cities in the Region was convened by WHO in Manila in August 1993 to delineate specific cross-programme projects which will have loca1leadership support; and collaboration with national and local officials and nongovernmental organizations in the Philippines in developing and implementing a chronic emergency response programme for communities affected by mud flow and ash fallout from the Mt. Pinatubo and Mt. Mayon volcanoes.

(2)

5. FUTUREACTION

The principal work for the future will be the formulation of specific plans of action for the new focus and each of the priority activities. These will be dynamic documents, responsive to changing circumstances, but always improving health in measurable ways. The successful implementation of this strategy requires improved collaboration among national and external support agencies involved in health-environment-development activities. More importantly, it involves a renewed sense of partnership between WHO and its Member States. Effective solutions to complex environmental health problems cannot be developed or implemented in isolation; neither can they be imposed from the outside. The key to clear decision-making in the complex of health-environment-<ievelopment, and a vital role for WHO in the future, is to focus on specific needs at the source of the problems and push for fundamental change in the way that planning and development activities that affect health are carried out.

- 82-

Annex 5

... "HEALTH PROFESSIONALS SHOULD NOT WAIT TO BE INVITED INfO DISCUSSIONS ON SUSTAINABLE DEVELOPMENT. THEY MUST INVITE THEMSELVES."

Ronald Labonte, "Econology: integrating health and sustainable development", Health Promotion International, vol. 6, no. 2, 1991, Oxford University Press.

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Technical Documents

Date d'adoption 31 décembre 1994

Source Organisation mondiale de la santé