Progress report on health, the environment and climate change

Regional Committee for the Eastern Mediterranean Sixty-sixth session Provisional agenda item 2(c) EM/RC66/INF.DOC.2 September 2019 Progress report on health, the environment and climate change Introduction 1. This progress report provides an update on the status of implementation of the regional strategy on health and the environment 2014–2019 and on progress made in implementing resolution EM/RC64/R.3 on climate change and health: a framework for action, adopted in 2017. Regional strategy on health and the environment 2014–2019 2. In October 2013, the 60th session of the Regional Committee for the Eastern Mediterranean issued resolution EM/RC60/R.5, in which it endorsed the regional strategy on health and the environment 2014– 2019 and its framework for action. 3. In the resolution, the Committee requested WHO to: provide technical support to Member States to adapt and implement the regional strategy on health and the environment; build partnerships with United Nations organizations and other relevant stakeholders to facilitate the implementation of the strategy; and monitor and report to the Regional Committee on a biennial basis on the progress achieved in implementing the strategy. 4. Two progress reports on implementation of the strategy were presented to the 62nd and 64th sessions of the Regional Committee in 2015 and 2017. The current report describes activities and progress undertaken by WHO and Member States to implement the regional strategy in 2018–2019. Progress achieved since 2017 5. During the period 2015–2017, a methodology and tools for implementing the regional strategy at national level were developed by WHO, shared with Member States, and used for the development of national strategies in Afghanistan, Egypt, Islamic Republic of Iran, Kuwait, Lebanon, Oman, Pakistan, Somalia and Sudan. In 2018–2019, Bahrain and Saudi Arabia were supported to develop their national frameworks for action. Similar support for Iraq and United Arab Emirates is underway in 2019. 6. In March 2017, the first joint meeting of Arab health and environment ministers was convened at the Arab League in collaboration with WHO and the United Nations Environment Programme. The meeting endorsed an updated regional strategy on health and the environment for Arab states and action guidelines with an expanded timeline (2017–2030) to coincide with the Sustainable Development Goals. The ministers also agreed to establish a joint ministerial forum on health and the environment; the first meeting was convened in March 2017 and the second is scheduled for 2020. 7. In April 2018, Arab leaders, during the Summit of the Arab League, convened in Dhahran, Saudi Arabia, adopted the Arab strategy on health and the environment and its strategic action guidelines (2017– 2030). Later in 2018, a methodology and tools for implementation of the Arab strategy at national level were developed by WHO and adopted by the League of Arab States. 8. Table 1 summarizes the status of achievement of the targets of the regional strategy on health and the environment 2014–2019 in the countries of the Region, based on WHO monitoring and a survey conducted recently by the Regional Centre for Environmental Health Action (CEHA) (answered by six countries), with additional input from some Member States. EM/RC66/INF.DOC.2 2 Table 1. Achievement of targets of the regional strategy on health and the environment 2014–2019 Priority area Indicator Baseline (2014) Current (2019) Target (May 2019) Water and sanitation No. of countries participating in GLAAS 8 11 15 No. of countries actively verifying WHO/UNICEF Joint Monitoring Programme (JMP) profiles 15 21 22 No. of countries with updated drinking water quality standards 15 17 20 No. of countries adopting water safety plans 7 11 12 No. of countries with updated wastewater reuse standards 7 12 12 Air quality No. of countries that are reporting particulate matter data to the WHO Global Database 8 17 15 No. of studies on burden of air pollution on health 0 5 6 No. of countries with ambient air quality early warning systems 1 4 3 Waste management and environmental health services No. of countries that have assessed environmental health services in their health care facilities 6 12 12 No. of countries with 50% of health care facilities meeting the WHO essential standards on environmental health services in health care facilities 6 10 12 No. of countries that have assessed the public health impact of waste management policies 0 1 6 Chemical safety No. of countries with public health strategies on the Strategic Approach to International Chemicals Management (SAICM) 4 5 5 Percentage of countries with capacity developed to deal with chemical events under the International Health Regulations (2005) 45% 85% 85% No. of countries covered by functional poison information centre services 11 14 15 Environmental health in emergencies No. of countries with environmental health in emergency profiles 0 5 6 Functional network for environmental health emergency experts and institutions 0 0 1 Percentage of emergencies adequately responded to with integrated environmental health services 50% 90% 90% Climate change and health No. of countries with vulnerability assessment and adaptation strategies on health adaptation to climate change 2 8 7 No. of countries incorporating climate data into national health information systems 1 3 4 Sustainable development No. of countries integrating public health into sustainable development policies as recommended by the United Nations Conference on Sustainable Development (Rio+20) in 2012 0 3 3 No. of countries with programmes on greening the health sector 0 2 3 EM/RC66/INF.DOC.2 3 Challenges 9. Some countries are not on track to achieve all environmental health targets due to a range of challenges. In some countries, environmental health is still not considered a priority in public health policies and allocation of resources, and even in more active countries there are policy “blind spots”, for example the widespread failure to engage with the public health impact of waste management and air quality policies. Emergencies in several countries of the Region not only negatively affect health and the environment, but also compromise planning and decision-making for environmental health. Information continues to be scarce and fragmented, reflecting the need for a multisectoral mechanism for the systematic collection of reliable data. Way forward 10. In 2018, the Regional Committee, in resolution EM/RC65/R.2 on a regional approach to implementing the Thirteenth General Programme of Work 2019–2023, endorsed the regional framework for action on health and the environment 2019–2023. 11. Member States are urged to continue supporting environmental health programmes and to undertake the following actions. • Establish/strengthen specialized environmental health units/entities in all ministries of health to address the root causes of disease. • Conduct/update a thorough situation analysis of each priority area in the strategy, focusing on those showing least progress, and map all challenges and resources needed, taking into consideration the cross-cutting nature of environmental health. • Collaborate with WHO to continue developing policy, plans, networks and capacity to implement the strategy at national level. • Utilize the joint ministerial forum on health and the environment to share experiences and lessons learnt. Climate change and health: a framework for action 12. In 2017, the 64th session of the Regional Committee for the Eastern Mediterranean adopted resolution EM/RC64/R.3 on climate change and health: a framework for action, in which it endorsed the framework for action on climate change and health in the Eastern Mediterranean Region (2017–2021). 13. In the resolution, the Committee called on Member States to: 1) designate and empower a national health and climate change focal point to facilitate and coordinate the development of the public health response to climate change; 2) increase the climate resilience of health systems, including through the integration of surveillance, early warning systems and management of the impact of climate change on health outcomes; and 3) ensure support for health and climate action by engaging the health community, relevant sectors and other stakeholders in mitigation of and adaptation to climate change. 14. Also in the resolution, the Committee requested the Regional Director to report on progress to its 66th and 68th sessions. This report describes progress achieved in the past two years. Progress achieved since 2017 15. National profiles on health and climate change for eight countries are being updated by WHO and national focal points, and an additional five country profiles are being developed in 2019. The country profiles provide a reference for national dialogue within the health community and with other national climate change stakeholders on developing the health protection agenda in the face of climate change. EM/RC66/INF.DOC.2 4 16. Table 2 summarizes responses by eight Member States, namely Afghanistan, Iran (Islamic Republic of), Iraq, Jordan, Saudi Arabia, Oman, Lebanon and Morocco, to a survey questionnaire conducted in early 2019 by CEHA to track progress on implementing the main elements of the framework for action. A majority of responding countries have yet to assess health vulnerability to climate change in order to establish evidence for developing their national strategy and action plan for the public health response to climate change. It is worth noting that an overwhelming majority of reporting countries have yet to assess their health infrastructure and operations in the face of climate change to be able to undertake adaptation and mitigation measures to enhance the resilience of the health sector to extreme weather events. 17. Vector-, water-, air- and food-borne diseases are identified by most reporting countries as the top climate-sensitive diseases of concern for national health sector action against climate change. Climate change impacts on nutrition, mental health, injuries due to extreme weather events and respiratory diseases are also being reported. Reported health sector action includes enhanced surveillance with expanded geographical coverage. 18. Meanwhile, from 30 June to 1 July 2019, the UAE hosted the Preparatory Meeting for the UN Climate Action Summit, a high-profile climate event organized by the UN Secretary General which will convene on 23 September in New York. The meeting was attended by the Regional Director and numerous health and environment ministers from the Region and beyond, and WHO provided technical support to the UAE Ministry of Health and Prevention in its organization of the event. Challenges 19. A majority of countries in the Region have not yet designated a national health and climate change focal point with clearly assigned responsibility, accountability and budgetary allocation to facilitate and coordinate, within the health ministry/sector, the development of the public health response to climate change. 20. Most reporting countries cited the need for financing support, in addition to technical references to guide the development of the public health response to climate change. Additionally, all reporting countries requested technical support and training to develop the capacity of health sector personnel to assess vulnerability to and the impact of climate change on health, and on developing health programme response plans of action. Way forward 21. Member States are encouraged to undertake the necessary action towards implementation of the provisions of resolution RC64/R.3 and the endorsed framework for action on climate change and health in the Eastern Mediterranean Region. WHO can offer guidance and technical support, but political commitment, resources and ownership need to come from Member States. 22. It is of the utmost importance to mobilize financial resources to support Member State progress on health and climate change. WHO will support countries to access the Green Climate Fund (GCF) for Table 2. Progress in implementing the main elements of the framework for action Priority action areas Status of action taken by Member States (8 reporting) Completed In process Not started Designate and empower national focal point on health and climate change 1 5 2 Undertake national assessment of health vulnerability to climate change 2 3 3 Develop national policy, strategy and action plan on health and climate change 2 2 4 Develop climate-based early warning system for climate-sensitive diseases 2 4 2 Update strategic plans of national health programmes on climate-sensitive diseases to take into account the outcome of health vulnerability assessment 0 3 5 Assess climate resilience of health infrastructures and update national standards and building codes for health care facilities. 0 2 6 EM/RC66/INF.DOC.2 5 support for advancing the health and climate change agenda. Health ministries are encouraged to ensure that health protection from climate change is placed on the funding priorities of the GCF national designated authority. 23. It is also important that WHO provides technical guidance, support and training to build the capacity of designated national health and climate change focal points and other health personnel for developing the various components of the public health response and resilience to climate change system.