REPORT O N WHO-HQICEHA REGIONAL WORKSHOP O N INTRO[)lICING EH T R A I N I N G M A N U A L ANI) T R A I N E R ' S CiII[)E
W O R L D HEALTH ORGANIZATION REGIONt-\L O F F I C E F O R T H E E A S T E R N VIEDITERRANEAN R E G I O N A L C E N T R E F O R ENVIRONI\lENT.AL H E A L T H ACTIVITIES ( C E H A ) AhlklAN, JORDAN Y1;1y 1908
CONTENTS
EXECUTIVE SUMMARY 1.
INTRODUCTION
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2.
TECHNICAL PRESENTATIONS.. Overview of environinental health training in the Eastern Mediterranean Region ( E r n ) of WHO Overview of training manual.. .. Overview of issues in environment and health .. Nature of environlnental health hazards Principles of risk assessment and risk management Water and sanitation Food safety anci nutrition.. .. Air quality and health assessment . . Indust~.ialpoll~~tion/cl~emical safetylwork environment Energy and global health problems . .. Global liealtl~ proble~ns.ethics arld action .. . . Human settlement and urbanization . EH curricula review and updating-case study in Egypt.. Introduction of Epi-lntb . ..
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PARTICIPANTS' PRESENTATIONS.. RECOMMENDATIONS ..
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STRATEGY FOR ENVIRONMENTAL.. . HEALTH TRAINMG AND EDUCATION IN EMR PLAN OF ACTION.. ANNEXES ..
6. 7.
7 1 72
Agenda Progra~n~ne
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L ~ s of t pa~tic~pants
EXECUTIVE SUMMARY The Eastern Mediterranean Regional Oftice (EMRO) of the World Health Organization (WHO) and its Center for Environmental Health Activities (CEHA) conducted a I ?-day regional worksliop on introducing an environmental healtli training manual and trainer's guides in Amman. Jordan fro11176 April to 7 Vlav 1998 for participants from Egypt. Jordan and Pakistan. Participants were professors or instn~ctorsof universities/trai~iersin environmental health fields witli regular teaching and research responsibilities and u ~ l i c l elated pi~ufcssionilis. The participants and obsc~vcrs inode presentations related to environmental health problerns faced in their countries. The overall objective of the \vorkslinp was to promote the teaching of environmental Iiealtli in u~iive~.sities and in co~~tinuirig edircatio~iprogrammes for professiorials ill the tield. I t wasplat~liedto'accorllplisl~ tliis by.
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providing a text, written cul-I-iculaand other resources as well as bl-ief lectul-es demonstrating a range of teaching approaches for erivironmental health themes allowing pa~ticipantsto experience and practice using teaching al~proaches they may not be familiar witli.
In this workshop, the pa~ticipating professors/teache~-s and other 111-ofessio~ials interactively took part in teachiny sessions hy liririzing .;lipporting documents e g studies, reports. relevant data fi-o~n country environmental liealth proble~ns.related case studies of local siti~ations and ongoing projects. The major topics on the agenda were: ldentitj/irig environmental Iiealtli hazards Principles of risk assessliient and risk management Air quality and liealth assessnie~it Water and health Fuud bitl'cry and n u t ~ - i t i r ? n
Human settlements and ~~r.bariization Indoor air qi~ality Industrial poll~itio~i, work environment. chemic;ll s:itkry Waste management. Iiealtli and energy use Global l~ealtli PI-oble~ns. Two tield visits were made. to Assanira Waste Water Treatment Plant and rU-Dulail Dairy Factory.
The H / r \ . i ~~ . ,rrl~ri.o~~n~r hr,1111/~ , ~ r l I r /t ~ v and t ~ ; V I I . / ~ J I, . y'r\t.i ~ l ideveloped ~ hy WHOIlieadqi~arters.which were introduced to workshop participants. are designed to facilitate and promote teaching of environmental health issues in both university settings and in-service training courses for government agency staff. industry professionals and managers. and interested people in nongovernmental organizations or co~nmunity 21-oups Specific target groups in universities include students in medicine, nursiny and other Iiealth professions. and in engineering. environmental science and management; and others needing a basic introduction to environ~nental health (including s t ~ ~ d e nin t sgeogr-aplly. urban planning, social work and environmental law)
A presentation was also made by Dr M. I . N-Khawashky, Acting WHO Representative for Egypt on review of environmental health curricula and updatingiriyEgypt which gave a broader insiglit to the participants of the meeting case s t ~ ~ d concerning environ~nentalhealth subjects The 1<')1-/11fi) saft\vare p a c h g e was introduced and found i~sefi~l. The last days of the workshop were used for tlie preparation of an intercountry strategy and plan of action f ~ >tlie r pronlotion of environmental health training and education -formal and infor-mal-in the Eastern Mediterranean Region. Recixn~nendationswere lnade by participants for the workshop Overall the workshop was evaluated as a successf~~l one
1.
INTRODUCTION
The objective of any environmental Ilealth education (EHE) clsive is to elicit the developlnent of health practices which will enable sustainable health creation and general well being. It. therefore. involves the provision of knowledge intended to afiect the attitude and behavior of the target audience. The teaching of e~~vironmental health (EH), however. is as complex as the labyrinth ofrelevant topics it should involve: The term "environment". is to man. the "co~iiplex assemblage of tlie physical, chemical, biological. social, cultural and economic conditions which differ according to local geography, infrastructure, season. time of day and activity t~ndertaken"Thus, 111uu~h the WUI-Id's first ltiter~ovcrnrncntnl Conference on Environmental Education sponsored by UNESCO and UNEP. over twenty years ago (in 1977 I-ecominendedthat environmental dimensions permeate all areas of scliool curriculum, the bane of envirori~iiental health ed~rcation has bee11the developnie~lt, not onlv. ot'c~rrriculawhich sutliciently elucidate these cc~mplesities appropriate to the dityerent levels of the within existing local educational svstem, but also the riglit E H E cn~npeteilcies. constraints and f:icilities. ~vliich\\,ill enable tlie etTecti\,e incol-11o1-ation of tlie environmental dimensioris ill education p ~ - o g ~ - a ~ ~ i ~ n e s Admittedly, there has been sig~iitica~it head~bayill EHE. especially from the late levels. Howevel-. tbr most 1980s to the present at the graduate/pc>stgsadi~i~te developing countries. the siti~atio~l is far from satisfactory, and t1ie1.eiremains a challenge to till the wide gap between national requirement and national Iiirman resource capacity The following. which include adaptations t'rom identified co~lstsaints to EHE in a 1987 UNESCO-UNEP publication " . s / ~ ~ t r / u ~ y i c . sI I,.fLi ~ I~ I I~ III;L ( ! # ' / L , ~ I L . / I C I .i.lS l still tl-i~e ~ s today: c ~ I I \ ~ I I . ~ I I I ~ ~ /c ~~ L~ , ( I / /(/ I C/ , L / I I C ~ L I / I ~ I I ' ". re~iiai~ a
The lack of clear definition of priorities and targets ill ~iatianal environmental health. which may serve as desired objects in the design of relevant eclircational programmes The ~clcc;lior~. clcvclcipmcnt, nndlur implelnentation of curricr11n1-materials and teaching strategies necessary to eftectiveiy achieve envirsn~ne~ital Iie;ilth (EH) goals with selected target groups that leal-ned The application oftlie theory of transfer of learning i n ensi~ring knowledge. attitudes, and cognitive skills will be t~.ansfes~-ed to life style decisio~imaking by the receivers The selectiori of effective ~nstl-uct~conal methodologies. nppropl-inte for the desired cognitive and etyective outcomes, receiver chal-actel-isticsand ava~lalde tacilities (e.g. t~me, money, pel-sonnel) The develop~nent and use of effective means of planning fcor instri~ctiu~l
Tlie efective evaliiation of EH curricula and niethods achievement with receivers in both cognitive and etfective domains. Tlie growirig t~riderstandirig of tlie cross sectoral nature of tlie principal issues relating to envil-onmental health viz., economic develop~nent, popillation growth. nonsustainable cons~~mption and resultant massive waste production, and their role in the environmental causes of i l l health, emphasizes tlie need to extend our understanding on localized Iiazards to Iliiman liealth. The emerging picture beyorid the Iiithelto ti~cus as to tlie direction of strategies hi. environ~neritalhealth education is tlie develop~nent of c111-ricula and co~iipetencieswllich will not only emphasize tlie intersectoral and holistic concept~~alization of Iiealth and environ~nentbut will also enable the t r a n z l n t i n n ~>t'L-nn~ledye to lit>style d e c i s i o n - m a k i n g by t h e target a u d i e n c e This will require a critical assessment of EHE programmes. within the context of relevant present uridersta~ldirig of issues and. as well. the developrnent of programmes wliicl~ will not only accurately retlect local and regional needs/goals. but also the socio-cultural and economic milie11 Tlie organization of this workshop, development tIlerefc71-e.is a \r,elco~ne Tlie overall objective oftllis worksliop was to strengthen environ~nental and occupational Ilealtl~education in tlie Member States of the Eastern Mediterranean Region. especially at the college. ~~niversity and professional levels. The imniediate objectives are to contribute to national/regional capacity building necessary for teaching environmental health education at the university, secondary and professional levels. - Familiarize participants with current theories and thinking in environmental health
- Review erivironnlerital liealth education in the Eastern Mediterranean Region (EMR) and to define areas of intervention towards the strengthening of educational programmes
- Demonstrate Iiealth risk and impact assessment of projects to hands on tield visits
- bac~l~tate I~nkages arid colnmilnrcatlon between countrres In the reglon on EHE through netwclrkirig of workshop participants The workshop covered: Teaching approaciies for enviroriniental health and evaluation of educational programmes (for-~nal and non-formal) The introduction ot'the principles and methodologies applied to environmental health The macro-level intluences on Iiealth, touching on social science disciplines Nature of environ~iietitalhazards: toxicology. microbiology. health physics. injury analysis arid psvcliosc~cial concepts. as well as the identification of different investigative rnethods
WHO-EMICEHAIS7-E Page 3
* Approaches to risk assessment
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Principles of risk management: Includirig ~ l basil; ~ e I C L I L I ~ I ~ I I IKJI C ~c I l~ Y ~e ~ t i v e surveillance, the selection and evaluation of control strategies, econo~nic evaluation of environmental health inte~ventions. factors atfecting risk perception The concept of exposure
Special considerations: This included human settlements and urbanization, food and agriculture. water and sanitation. work place envil.onment and industrial pollution and chemical safety The agenda and programnle of the workshop are attached as .Annexes 1 and 2 respectively. The workshop was attended by participants and obser\,ers tiom Egypt. Jordan and Pakistan. List of participants is given in Annex 3 . The workshop was carried out under technical responsibility of Dr Sernra Cli~atam.TI-aininc!and Research Adviser ofCEH.4. The elections ti>]cllairprrsn~~ and rapporteur were not held. but instead the two external resource pe~vc~ns ria~nely Dr A. Yassi and WIr Jamal Harb conducted the worksllop The introduction of tlie Training Manual and Teacher's G~ride was inade by Dr .Annalee Yassi, hIr Ja~iialHal-b, Dr Fathi Saleh. Dr Madi AI-Jaghbeer. Dr Atallah Rabi' and Mr Hussitin .A/- Khandak During the last two days of tlie workshop. inter count^? strategy and plan of action for. promotion of environmental health training and education in EMR \\.as developed by participants. conveyed the greetings of His Royal Highness. I'rince Tala1 Bin Dr 2 . M i h y ~ Abdulaziz, President of Arab r J ~ ~ l t ~ P r ~ ~ ~thr r:~ 1-Inited ~ i l ~ iNatirlnq ie D~.velollrnent Organizations (AGFUND) and His Highness' best \vishes tbr the silccess of this workshop and briefed the participants about AGFUND collaboratior~ with WHO that has always proved beneficial. AGFUND have sn tar contributed in the financing of 49 projects for WHO, since the inception of the organization i n April Ic)SI . for the benefit of children and noth hers, AGFUND main target gl-oirp. AGFUND has been a partner in 370 develop~nentprojects with 16 United Nations organizations and agencies Its collaboration with WHO has covered many areas. among these disease prevention and control. nledical services I'l-ima~y Health Care (PHC) arid Fvli~therChild Health (blTH). Inirni~nii.ation enviro~lnlentalhealth. a good nun~ber of teaching and training. In the East Mediterranean Region. q~lite improvements during the last decade and a half has been scored. Cliild and infant mortality rates have decreased and life expectancy at birth has increased. Yet, AGFUND believes that the training component for medical statfand para-medical personnel should be considel-ecl in 01-delto set olJjectives of acceptable levels of distribution of health services in both 111-banand rill-al areas. TRAINING constitutes the corner stone ot' AGFUND co-operation with the United Nations system of organizations. in Another topic which AGFI IND is currently focussing on is 111-evention and the first one whicli environmental health. WHO - EMRO have at hand 14 prc~jects needs to be mentioned here is the creation oftlie Regional Centre fol Environmental Health Activities (CEHA) in Aninian, in 1986. The Centre is co~itributing a lot for the Region. All the remaining projects deal with the pl.eventinn aspect
He conclirded that collaboration oustit to concentrate on T R m T N G and this workshop is a perfect example thereof Training on tlie local level if continued svsternaticallv, will ensure an even better performance of Healtli Institutions in the Region and tlierebv I-elevant acllievements will be felt even better, He wished the workshop all conlplete success. of the Regional Center for Environmental Dl- M Z .Ali Khan. Coordi~lator Health Activities welcomed participants on behalf of Dr H . A. Gezairy, WHO Regional Director for tile Eastern Mediterranean. In his message. Dr Gezai1.1~ ~nentionedthe increasing importance of environ~neutalhealth issues for ameliclration of health of Ii~~~n beings an
He noted that teacl~i~iy e~iviro~iniental health which is a regional and global WHO is promoting to strengthen lii~mancapacity for need. is one of tlie Inanv etY1)r-t~ the i~nproverneritnt'envirn~inientalliealtli and to enciwrage actions that eliminate, pr-event or- minl~nizeIiazards: Tlie qi~alitvof ~ L I I -envil-onnient and the lieiiltl~ elYects resulting from negative environ~iientaltictors are of increasing concern in both developed and tleveloping coi~ntl-ies. Tlie extent of these health efects is often t~nknownand the tecllnology to prevent and control environmental hazards needs fi~rtlier development A variety of well-trained professicmal groups is needed to ~dentifv and etfect~velv address current and t i ~ t i ~ problenls re related to environment and liealtli t ~ i ~ r text ~ ~ and ~ ~ / ( I l Dl- Gezairy ti~l-ther lloped that tlie Hcr.\~c~ ' t ~ i ~ t ~ ~ o/IL'(I/I/) developed bv WHOIHeadquarters which is introduced to workshop part~cipantswill facilitate and promote environmental liealtli teaching in both ilniversity settirigs and in-service training courses for govern~nental agency statf. indi~stry protessionals and Inanagers. and interested people in nongovernmental organizations or co~nmunity groups. Specific tal-get groups in universities include students in medicine, nursing, other health professions. engineering. environmental science and management, and others needing a basic introduction to environmental health (including students in geography, i~rbariplanning. social pork and environmental law). In fact, environ~nental Ilealth edircatiori is desirable tbr most prot'essions. /i,c1c/7~'1. '.s ,VIIIL/L'
Dr Sul~enlan Jafar~.Dlrector General of Med~calS e ~ v ~ c eM s ,~ n ~ s t r of y Health and Health Care inaugurated the workshop on behalf of Dr Ashraf Ai-Kurdi, Minister of Health and Health Care, Jordan. He noted that environment is the core of social and cconomicul fnctol-Ythat lcud to thc huppincss ot'humon bcings nnd Jordan had established Inany institutions actively working in the domain of environment and health. In addition. he emphasized the necessity of teaching environmental health in academical instit~~tions.
2.
TECHNICAL PRESENTATIONS
2.1
Overview of EH t~.;lirli~lg in the E:lster~lPlediterrnnen~~ Region (EMR) of WHO
Dr
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I ~ / I I ( I / L I I I ~~ . ~ . ( I I I I I c111d I I ~ I ( L ' . \ ~ I I I . c / I A L / v I . \ ~ I . . ( 'EHA
The need for the strengthening of national and regional capacitv to develop Iiutnan resources necessary to adequately address these risks. cannot be overemphasized. This is si~ccinctly captured in the WHO Eastern Mediterranean II.LIIIIC~LIII~ Regional Strategy for Environmental ~ealtlil. thus: '' AL/~L'YIILII~/J: c . ~ / ~ e ~ ~ i e t ~ c e crre ~ / /~ ~.~ ~~ :Y oC ~ I)~/ /o II c( ~ cope ~/ 111i//?/ / 7 ~ COIII/I/~.Y I . ~ / ~ I I ~ ~ I I . V /? /~ e // /~Jv c eI/?L) /~ I ~ I ~ II I 1 I1 / / / .
T/~LJ I Y I I I ~ L ~!f'.~k.ki//.s ' c111d / I . L I I I I I I I ~ ~leeds crl.c1 ~ ' . v / r e n w / I /> ~I . ~ L I L / . ~ ~ / ~L~ II/C , / /LI.s.YL,.Y.Y/I/L'//I. . ~ ~ / ; < ,f ; ; / t c ~ / / c . i c /L / I / I ~/ /~ / . o : , I . ~ / / / ~ I ~ ~ L '
Tl71.si1tc111cie. I I I I C ~ Ic11ic1, . I L / L , I I / I ~ I < : L I / ~ O/I)I ~ , CJI~CVI/IO LIIIL/ I I c:011/1~0/( ! ~ ' ~ I I I - I I . ~ I I I ~ /w ~L~ I /I/ /I ~ /~I/ / / ~ / - c / d.\, / i/!fo/ I I I L / I / ~ ~ SI I~ l~1cI~l~l~ycll7etl/.
To realize this goal. WHO Regional Office for the Eastern Mediterranea~t (EWCRO), togethel- with its Regional Centre for Environmental Health Activities broad training related endeavours at the national (CEHA), have been involved i n fo~lr and regional levels.
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Direct training of EH professio~ialslworke~~s of educational Traininglassistance towal-ds the developmentlsrre~igtltet~i~i~ programmes such as the development of school c~irricula kuld 11a i ~ ~ i lllillel ~ i y ialh for various levels of education. as well as. public edr~cation Strengthening of EH traininS/teacltiltg facilities and pel-sonliel training Training related to EH information management and exchanye
The present workshop is seen as a follow-up to two regional ~neetingson EH education. Namely: " T / l r Fil:sl X ~ " q i o t ~ W ~ rol~ . k . s l ~ o / ) , f iE , ~I .I I ~ ~ I . ~ IH Ie I eI rI/ /~ /r I 13d11cc11or.s" I ~ ~ ~ ~ in 1990, held at I, such as the design of educational CEHA. The workshop considered, III/L,I. ( I ~ ~ Lissues and trarnlng packages; revtew and evalilatiori of teaching Inerhods; inclusion of community participation in pi~blichealth engineering (PHE) course curricula; use of "self-paced" methods in PHE education; computer-aided learning in ['HE education; EH data bases, int'ortnatiotl exchanye and net\vorkiny; teaci~iny s~~stninahle technologies in water si~pply. I I I I I k l ~ i c , ~LIIIJ t' The second l.egiorial meeting was the " NL,SIOIILI/ ( ' ~ I I . Y I I / / L I / I O O in 1994. also held at CEHA. The meeting looked at Agenda I2 (UNCED) and global strategies on Health and Environment and the implicatiolts for education and training in EH and other sectors plug'tllurrcb in thc and dlsc~pltnes.I t evaluated the existing EH training and educatio~~ EMR, highli~hting deficiencies and constraints on curriculum develop~nentand llpr-ltifi~~ O~~ r ' / ~ I I ~ I I ~ ~ I I IH I Ic~ cI i lI //l ~ ~ ( I' I/I I . I . I ~ I I / L" I
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WHO
E;~slcrt~ Mcditcrr;~l~c;ln Rcgion;ll Slc~lcg!Tor Hc;~llll : I I I ~E I I \ . ~ ~ O I I I I I ~ I I I
recommended strategies for close institi~tiotial and sector cooperation. The meeting also considered regional SLIPPOI-t for coordinated traininy, research a n d information
exchange by CEHX. and as well, identified priority areas for action arid tollow-up. CEHA's EH training activities are carried out ~ ~ r l d tlie e r following Programme .Areas in EH: LVater Supply arid Sanitatioli [-'I-omotionof Healthy Cities, Villapes and Co~nnii~nities E~ivir-onmerital Health Risk Assessment and blanage~netit Cllemical Safety Cnvironmcntnl Henlth in R e f i ~ ~ Cn~npb ce n ~ r dE I I I C I S C ~ I L ~ C > Food Safety Inf~3rmationExchange
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Tliis I.wogr.alniile area concentrates on str-e~igtlietiing national EH inforniation s!,stenis tliroi~yl~ tl-ailling and Iii~nianresources development. as well as providing advisorv services Siyr~iticantly. tlie Regional Environmental Health Inf~3rmation Network (CEHANET) which was established in I9SS in collaboration with tlie International Developlnent Research Centre of Canada. has t h e e broad objectives: - improvenient ot'systems. services and tools for managing and using information relevant to EH - building 11atic)nalcapacity within tlie Region for. tlie etfective management and applic;ition ot'i~iti>r~nntirln tijr d e v e l o p ~ n r n t
- fosterins cooper-ation and coordination in development I-esear-cli through
infcjr~natiotisharing
WHO, in collaboration wit11 UNICEF, UNESCO and ISESCO, have designed o ~ ~ t l i n on e s the ~iletliodsand tecliniq~~es for the evaluation of the Prototype ActionOriented School Health Cu~-r-icul~~ni (PAOSHC) in late 1980's. being implemented by several countries in tlie Region. The package consist of a teacliel.'~guide. teacher's resource book (seven volumes) and a national giridelines for implementation. The teacher's gilide incorporates tlle principles and ~nethndologies reconiliiended for teaching Iiealth in p r i m n ~ y schools. including salnplc Icsson plruis d c ~ n o n s t r a t i n g thc
integration of health materials in the various school subjects and activities. The teacher's resource book presents various health subjects as teaching topics or units, each relating to act~vities to be learned or performed by pupils. It is wolrlly to note that CEHA's keen desire to contribute to tlie implementation of tlie PAOSHC is being demonstrated by tlie initiation of a pilot project: " E t t v t ~ . o t r r t r c ~ t / ~ HCLI///IJ!II r/~v School I t l i / i ( ~ / i i ~ c in ' ' collaboration with some Jordanian schools. The initiative seeks to promote the involvement of school administration. pilpils and parents in the creation of healthy school environment. With n loris term uL?jecrive of t h e inteyration o f E H ed~~carion in prirnary and secondary school cilrricula. i t is initially fostering its integration into extra-curricula activities.
In recognition ofCEHA pioneering role in EH education in the Region, it rcccivcd a spccinl letter of iiwnrd on its distinguished "Environ~nentalEducation and r!f'/heArt117 L ~ (ietier~r/ c ~ Information" Activities from the (;errertrl .Se~.re/c1r1tr/ A d n i ~ t i ~ . ~ t r t i t I o Ecot~oiii~c i ~ , j i ) ~ ~ Ajir/r.s. T c c / ~ i i ~ c .Scc:rc/~rrIcr/ t~/ (!f'/he ( ' o ~ ~ t i c I / , fArt117 i)r
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Milristc~s Ne.vpoii.sih/c,fi)r /he /<i~:,,v~ruirmn~~. Tlie awards cites CEHA's activities in
awareness raising and the production of education and training Inatel ids, particularly. the training videos o n Lolc*-c.o\/Wirtrr Si~ppIJj curd S ~ I I I I / ~ I I ill I~ Ar~rhlc. II It is the plan ot'CEHA to train, by the year 1000, up to a cu~ilulative figi~re of 9000 professionals througli its training programmes. There is pl-esentlv. on-~oing evaluation within EMRO and CEHA on training proyr.alnlnes wit11 the view to ti~rtller maximizing their etfectiveness. Thus. increasing arrenrion will be give11i n l i r i i l r t : programmes. to follow-up evaluation of country implemeritations.
Dr Yassi in her I-eview11oted that the rleed ti) transcerid discipliriary boundaries in the teaching ofenvironnientaI sti~dies had become iiicl-easinglyobvious. with particular recognization that the relationship between e~iviron~ne~ital factor-sant1 Iit~man health needs to be taught mi~cli inore broadly at ~~niversities. She described liow a n international collaborative effort. led by WHO. was begun in 1994 to develop a course to teach core knowledge in envirclnmental liealtli to liealtli professionals as well as others from a wide variety ofdisciplina~y backgroi~~ids. She explained ho\v tlie course utilizes interactive learning methods and takes a holistic approach to t h r .;rrl?jrc~ 1n;ltter-,linking the macro socio-economic issues with the physical. chemical. biological, ~nechanical,and psychological Iiazards. as well as with tlie liu~nan health etfects. She stressed that it also aims to build skills in risk assessment. managelnent, and commi~ilication. 2.3
Overview of issues in e ~ ~ v i r o ~ l ;111d ~ ~ 11e:lltll ~e~lt Llr A I I ~ I ~ I ~ I'tr.\.\1 L~L'
In this presentation. particular tbci~s was on the definitions ot'health and tlie environment, and the link between them. Dr Yassi brietly reviewed some of the obstacles for resolviny environlnental health prt>hletnc.tlie importance of considering needs of vulnerable groups arid the cn~cial role played by political and socioeconomic factors
Dr Yassi utilized the "question cad" neth hod to discuss tlie cllapter 2 content. Participants were asked to draw a piece of paper froin a cardboard box and say a tew things about the issue or subject written in the paper. Other pa~ticip;intswere tlien asked to join in and add to tlie discussion for another few minutes before going on to the next issue drawn from tlw I ~ O Y This method allowed a qt~ick overview of the riatilre ot'environinental health hazards includi~ig tlie definitions of hazards and risks. and a wide variety of biological. chemical. physical, mechanical and psychological Iiazards. A good I-ailgeot'top~cs were
drawn and most participants actively contribirted to the discussion. Despite the initial reluctance of one o r two participants who originally f e l t a little intimidated by this method. it appeared to have worked very well at engaging pa~ticipants to pay close attention to the discussion of the subiect matter 2.5
Principles of risk sssesstllellt and risk nlan;rgemetlt 111. A t / t t ~ t / c cYL/.\.\I ~
Dr Yassl began tlie coverage of these complex topics bv presenting overheads from the Basic enviro~inlentalhealth test. These covered the e~~vironniental health I-isk assessment and risk management fra~nework, epide~niological methods. hazard identiticatinn in the tieid, tlie relationship between dose and health outcome, human exposure assessment. health risk characterization, and health in environ~nentalimpact assessment (EIAs) There was good interaction around the overheads shown, although cleal-ly the material was being covered too qlricklv for sollie participants. particularly, those without much background in epidemiology. This was acknowledged as necessary dire to the time co~~stl-airlts, but the proup was ~eassurert that some of the problem solving exercises which tbliowed w o ~ ~ assist l d in clari@ingsome of the complex material raised. Atier the presentation. the group was divided into four small groups together to solve a probleln about lead poisoning. i~tilizirig some of tlie principles reviewed in the presentation . -The problem presented required the groups to synthesize their knowledge on the effects of lead on health and i~tilize dose-response and dose-etfect information provided in tlie scenario, to calculate the level ot'risk to which the workers were exposed. Then. i~tilizing infor~nationpresented in the overview regarding control measures, they retill-ned to this scenario to discuss issues such as workers' rights. threshold limit values and biological exposure indices (see chapter I0 discussion). The participants, then, discussed, in sniall groups in plenary. how a risk management strategy could be oper-ationalized ~rtilizingprinciples of occupational health surveillance.
This chapter was dealt with utilizing three methods of teaching. The first was a presentatlon del~vel-ed by Mr Khandak by ilslng overhead transparencies showing the baslc concepts and approaches. During the presentation tile audience were allowed to comment on different issi~es and they were also given a chance to ask questions and answer those lnndc by thc spcnkcr Thc sccond was through a ticld visit to n major wastc watcr treatment plant (Assamra Ponds) whicli is a stabilization pond system. One day before the visit. the group was briefed about the plant with regard to basic background information as well as the health and environmental impacts of the plant. A sheet containing the major points to be looked at during the visit was also prepared before hand and distributed to the participants. In the visit, the group was subdivided into four groups where each was assigned certain points to take care of. 111the site. tlie plant manager welcomed tlie group and gave details about the plant including treatment processes, operational problems, impact on health and environment Finally. the group toured the plant seeing ditferent stages of treatment. and t i ~ t i ~platis. re
After leaving the plant, the group was taken in a trip alongside the valley where the treated efilueni ru~ls to see t i l t : lypas ul'c;~ops which al~e alluwed tu bc il-rigntcd by thc etilue~it which are trees and animal feed. The objectives of the visit were satistiictorily achieved. The third method was through a problem solving exercise wliicli was conducted by Mr Harb. Here, the large group was divided into smaller groups and were asked to work collectively and solve an environmental health problem related to water .As a result, the groups utilized the concepts learned from chapters I to 6 More specitically, the groups addressed the importance of water sources. described the multiple causes of water borne illness outbreaks and debated the importance of well defined legislatio~ls pertainmy to protecting the health of the public.
Tlie major topics in this chapter were covered by Dr Fathi. ;I Keyional WHO Advisor. Delive~y of the main concepts included using a lecture style presentation, a problem solving exercise and a tield trip to a dairy plant. In the 1ectu1-e portion of this session. Dr Fathi addressed the main topics o f chapter 7 by usi~ig overheads. Topics included Health and Nutrition. Foodborne Diseases, Food Quality Criteria and Assul-ance. Global Food Production and Focld Security Audience participation was encouraged tl~rouplioutthe presentation by inviting questions and posing questions which required the audience to apply information presented. .4 brief summary which addressed key concepts concluded the presecitation.
Following the lecture, a problem solving exercise was i~tilizedto apply the concepts learned from this chapter. Here. the large g ~ - o t ~ was p divided into s~nall subgroups. Each subgroirp was given a scenario to solve a foodborne illness outbreak by determining the soul-ce of the causative agent. In order to solve the outbreak. the subgroups needed to apply the oi~tbrenk investigative procedures outlined in chapter 7 After solving tlie outbreak. tlie subgroups made reconlmendations to 111-event fi~~tlier incidences of this nature. The skills and concepts learned from the lecture atid problem solving exercise were applied in the field througl~a visit to a dairy plant. Prior to the visit. an introduction to tlie plant was presented to tlie participallts which outlined the different processes and products to the participants which recluired produced in the plant. In addition, a task was ass~gned the g r o ~ ~ topidenti% Critical Control Points from the raw product aciluisition stage to tlie final product. Upon co~npletion of the visit. the group reconvened to evaluate the effectiveness of the field visit and share findings of critical control points.
The content oftllis cliapter was covered l~tilizing two ~netliods.First, participants were divided into four small groups where each asked to list the air pollutants in their communities or countries. state tlie health effects o t tllese pollutants (potential and
actually documented), describe the soilrces of these pollutants. arid discuss control q t r n t ~ g i tn ~ s reduce euposure The yroups then reported h a c k to the plenary on their deliberations. Very ~rseti~l information was exchanged . and. with the collective knowledge in the groups, Iligli quality discussiorl ensued. This was f~)llowed by a problem-solving exercise. a g i n conducted in small groups. An investigation of an outbreak of asthma was utilized. This was a case-control study that allowed the participants to learn tlie steps in outbreak investigation and Iiow to calculate odds ratios to determine tlie likely causative factor. As an untblding case study of an actual occurrence (asthtna due to soy beans in Barcelona) the participants were able to acquire methodological skills as well as discuss the nature of asthma and potential controls for community expnstlre<t1-1 air pollt~tant< expressed displeasure at havi~ig to "teach" others in Wliile niie of the participa~its this small group wlio were less familiar with epidi~niology. tlie exercise was very well received by most pa~rticipa~its. I t was a good illustration of ~ni~ltidisciplinary problemsolving in which tosicological. epide~niologicaland environmental engineering was brought together
Another p l - o b l e ~ i i - s l vexercise i~ was used for this session. Tliis time the case groups then in plena~y. was one of pesticide poisoning in discussed. again tirst in s~nall Pakistan It. too. was an unfoldirlg case st~rdy, but this time it was a cross-sectional study rathel- than a case-control which was i~setiilin demonstrating anotlier epidelniological method The palticipants had an opporttinity to discuss tlie advantages and disadvantages of ditferent sti~dy designs, tlie importance of choosing an appropriate case definition and sampling strategy. while at the same time appreciating tlie importance of chemical safety and workplace issires. The groups successti~lly identified the many factors that must be considered when assessing and controlling workplace health problems. Tliis was tt>llowedby returning to the lead poiso~iirig case to resume the discussion ot'workers' riglits: the right to know, tlie right to palticipate. the right to refi~se unsafe work. as well as the right to safe working conditions. tlie right ti3 compensation for workplace injury or ~llness.and the right to contident~al~ty when their health concerns and health problems are being investigated and managed. 2.10
Energy I I I I ~global he:lltl~problems I ) r h/crtii ,-I l-.l(r~qhheer, L(ICLI/ Tct11f)or~n.y Achli.se1.. 111 ~i~rer:si!y r!f' Af)f)licd Scie?/ce.s, #
/ord~lt 1
Dr Madi Al-Jaghbeer conducted this double session addressing the energy and global health problems. He began by dividing the participants into small groups to list the sources of energy in their countries, cornlnent in the potential environmental and health etfecrs of use of rliese energy sources. explore rhe advantages and disadvantages of the alternative energy sources. Each slnall group answered the questions collectively then reported to tlie large g1-OLI~ i ~ participants f were fi~l-ther discussed.
Dr Al-Jaghbeer then systematically reviewed the information in chapter 9. using overheads and stirnulatint; intcl-action around tlie material presented. This discussion covered the need, for energy to use of biomass fi~els, f~~ssil fi~els. 1iyd1-npower, nuclear power. wind and solar power and other possibilities To cover tlie material in chapter I I , the "question can" ~netliodwas utilized. A very well size of topics were hereby covered ranging t'rom environniental and health direct and indirect consequences of depletion. climate change, desertitication. biodiversity, acid precipitin, natural disasters and global chemical contamination. Dr Al-Jaglibeer then reviewed using overheads and group interaction around the material prcscntcd. 2.1 1
G1ob:ll I~e:iltl~ problerlls, etliics :ind ;ictioll [)I. , ~ / / / I ~ I / ~ L1'11.~.51 ?
A case study was utilized to introduce issues ti-o~n this cliapte1-. The scenario was that of an environmental liealth professicl~lal e~nployedby an American-owned oil company operating in Thailand. I t raised the issue of different environnlental standards in mo~-e regulated versus less regulated countries. and tlie role of environmental health professionals in this setting. I t also addr-essed tlie need to appreciate the perspectives of all stakeholders. recognizing the need to respect both tlie duty to maintain confidentiality and the duty for disclosure. Discussion followed regarding tlie procedul-es that could be implemented that provide for accountability and tninimize unethical bellaviour with I-egal-d to confidentiality and disclosure. Other issues regarding ethics and action were discussed briefly.
In this section, learning objectives were defined as: Description of basic sequirenleuts of lu~man settlenlents Discussion of principles governing healthy housing Discussion of health problems related to urbanization Understanding tlie principles of"healthy city" planning and be able to develop a strategy for implementing this approach in a given setting. corn~ni~nities living i l l substandal-d It was higiiliyll~edthat based on social ~.esearch. housing have higher I-ate of the many diseases and social problems as compared to cotnmunities living in houses meeting the standards. (s~~b-standard) house were Ho~iselioldenvironment indicators of an i~nsanita~y ititrod~~ced in drt:lil :)nd principles related to liealth needs and housirig \r el-e listed as. Protection against communicable diseases Protection against inj~rries.poiso~ling.and chronic diseases
Reduc~ng psychological and social stresses to a ~ninimil~n l~nproving the hoitsinS envirolitnent Making informed use of housing Protecting popillations at special risks Following characterization of l-ural areas. tlie fundame~italchanges whicli were brouglit by urbanizatiorl were discussed. Factol-s intluencing air pollution proble~nsin nlegacities were addressed including: c~ty size and rate ofg~.owth. topography. demography. meteorology. level and rate of industrialization. socioeconolnic develop~nentand over-all environlnental conditions. A guidance for the plaruiers of urban areas was given for ~naking ~~rba settlements n as healthv settings
2.13
E H crlrricr~l;lreview ;111d rrl)d;~tirig-c:~se str~dv iri Egypt 111. /Li.1. A /-h~/~<~tt~ii.s/~kj:, ,4 C : / / I / , ~WHO /~L,/)I~L~.SC,II/<I/I I~L,,/OI, /:,;y~7)/
Dr Al-Klla\vashkv made a compl-ellensive review of environmental health curricula at tlie ~~niversity level in Egypt. He inentioned that certain ci~rriculaare partici~larto some tvpe of institi~ticl~ls such as epide~niology, environmental physiology and n ~ r a l sanitation in the Faculties of Medicine and High Institilte of Public Health. He noted that other curricrrla such as environmental sanitation. natitral resources. regional and town planning are shared by the Institi~te of Envirorumental Studies and tlie Fac~llties of Engineering alilny wit11 tlie Faculties of Medicine and tlie High lnstitilte ot'Public Health. Dr Al-Kliawasliky stated that Faculties of Law deal wit11 legal and institutional aspects of envirunrnental protection and share two activities with the Institute of Environmental Stitdies natnely, social problems of environment and e~ivironlnental education He stated that it is ili~ite evident that Innst of the topics of the EH curricula are mi~ltidisciplinaty,yet there is vely little or no coordination between the different institutions dealing with tile salne topic. Even in the same group of faculties, the curricula dealing with envirol~rnentalaspects are not always unifor~nand may depend on the preferences of the staff and not on a standard accepted policy. Dr Al-Klia\vashky fi~rtlier said that s~~itabiiity of EH curricula to the Egyptian Environmental Situation and rhe Global. Regional and National Environmental Health Strategies need to be reassessed.
WHO-EMlCEHAB7-E Pugc 1.3
2.14
Introduction of Epi-Info Dr Ali Khalil Shukri Al-Arbaji, Director of Malaria, Schistosoiniasis and Zoonotic Diseases Division. Disease Control Directorate, Ministry of Health and Health Care, Jordnn
The mail1 purpose of introduction of pi-lnfo' was to give practical examples of the use of the Epi Info software package I t also provided reinforcement of and statistical principles It \\as also expected that p:-trticipantswill have some basic knowleaye of epidemiological concepts and methods. The datasets into the four IBM compatible microcomputers Iiard disks we!-e located and, for sinlplicity of operation. into the same directory as the one in which Epi Int'o resides. Data for exercises is provided on one diskette. with one data set per exercise. as foilo~vs Exercise I Photosensitivity among petrochemicai refinery workers (dataset PHOTOS.REC) blela~~nm in a Relation to Fluorescent Light E~posul-e (dataset \IELANOhlA.REC). Hearing loss among coal miners (daraser H E A R R E C ) .Alzlieinler's Disease and Aluminum in Drinking Ll'ater (dataset .ALZHEIM.REC) L u n g cancer alnoiig asbestos ~iliners(dataset 4SBES REC)
Esercise 11
Exercise I11 Esercise IV
Exercise \ '
Tile doci:illrnt \\it11 a diskette ~.\.iiicli co!itaills all rele\,ant tiles EI'I-IYFO proy~11i1111e tiist~-~i:~~:cd Set;)~t. tile .;essir,ll I he prayranlnle. LUCTISTIC' . ~bllicllis an Epi 111ti) c~lillpi~~ihle ~ I O ~ I ~ I I I I l IuI ~ C
performing logistic regression. was also included. This co~isists ot'tile ~ ~ r - o g r a ~ nitself nle (LOGISTIC.EXE). and its documentation (LOGIST[C DOC).
3.
PARTICIPANTS' PRESENTATIONS
Participants and obsel-\/el-swere recluested to prepare presentations that t'clcused on describing environmental issues with healtll i~~iplications. The main objective of such presentations was to allow the presenters to practice the \/arioos teaclling niethods or
EPIINFO \.crstou 0 0 2 (CDC/\VHO. 1004 LOGISTIC.. \ C I S I O I I ;0 ; E
(D;III;II GE. Is')?
'
techniques learned in the workshop. In addition, methods of self evaluation and group evaluations were utilized for irnproviny the techniques. Overall, there were titieen presentations made by eleven participants and four obsemers. The presenters and the presentation topics are as follows: Name of Preseater I Dr Javed .Aziz. Pakistari 7 Dr Mohammed Raslizd. E s y t
Topic Status of wastewater treatment in Pakistan The role of SHORUK in EH enhancing in nlrai areas in Egypt Industrial pollution and health Wnbtewater stabelization ponds
3 Dr .Altaf Khari. Pakistan
1 Dr Z ~ a d Gliazc?\\r Jordan
6 Prof Dr XI A h ; Es; pt
Water pollut~on of llalimodea cannel Envirori~neritalhazar-ds in your country Food additives-chemical food preservatives Acc~dents -Pollutants from buildi~igco~istn~ction -Erlviro~i~nental pollution from pliospliates Issues of sustainability in developing countries
7 Dr .Alnir Joiii-i. Pahi>taii
S Dr Basseni Dababneli. Jni-dan 9
blr H a n ~ Nacvatleh. Jordan
10 Eng. Muhammad Xkour. Jordan
II
Dr Saclrb Slialiab. Pakistan
I. ; L): lbr-aliiln Hr3,:zr. Egypt
Pestic~tles Air qi~ality and health assessment
I4 Dr Muhamed 41-Khafif. Egypt
The presentation srvles varied from one presenter to the next. The majority of which were lecture styles incorporating small groups exercises, question can, role plays and large groups discussions Remainder of presentations employed debate style discussions, slide pr.esentations and problem solving exercises.
Tile \\or.ksliop acklio\vledges and comnierlds tlie effilrt of\\'tlO and its collaborators in introducing tile textbook - Ho.\ic L , I I I ~ I I . O I I ~l~ccilli~. II~.~II and ~I~ recolnlnends the following:
1.
Develop a strategic plan for- promoting the text on Basic E~ivirori~nrntal Health at the nntional a n d resional ie\.els
2.
Strengtheniny. prorlioting and updating tlie esisting CEHANET s\stem of networks c::\ ;.-,:-:-e::::.! :!:-I ~ ! - o f c . ~ s i o\\1tlii11 r ~ ; ~ l the C L ~ L I I I ! ~ I;11it: !~~ter-r~:tti~~ri:~Ily co;;~?ec: \\ HO sili~illd';s>i>t cnullt~.ic.s t d orsnllizt. trairlillg coii~-srs for- tlie o:i?ntatiorl of r;illc;iti)l'~O!l e::i ~i'dll!li~ll;.l! lit:l!tll ilrl(i t ~ ~ ~ l l l ~ OfitS j ~ g ii~tl l' l ~ lllllll,i.ltiil~~
3
5
Strengthen the education iind disselllinntion of infc)r-lnatronof E H ihi~ies relating to pesi-i~l.barlS I L I I T ~ and deprived areas as well as rural cr~i~il::ilnities. \lainr:till tleribilit> ill rlie rc.\tbook to allo\\ zo~ilitr.ies to ~llcluiie I cases 01-ell\ i~-o~ill~elltal lleiiltil C O I I C ~ ~ I I S V C ~
o
.ili-spec~tic
7
Encourage the use and dissen~innriunof information ofrlle ( ' I H - l I I ~ J I I ~ . \ / ~ ~ I / c ~ I fo r ~~cl?ar~ ofgir~ : i f ~liatioll c~ :iiiiong in\titiltiorl.i .illocate lll<lse I . ~ : S ~ ~ L I Ifor . C ~ erl\i~.~)~lllle~lt;il S I~et~ltll issues arid lia;i;11-6. Corrll~lirnit\.. and rlongoverlilnellt orgsliization'i trainilly on en\.il.niilnental health issues in olde!- to tulfill tlie~rresl)orislbillties
S
9
10
.At the national level. trailiiilg alid educatillg the pliblic environnie~ltalley~slatior~
ill
~enel.~ oii ~I existilly
I I
Gove~-n~nellt sllo~ild be r~:coul.ayedto iiistit~~tio~ializr: e~lvisollnierlt.i;iciellces a r ~ d education tecllnulogies.
inci~rde existing national I-egulatiorls arld codes 12. Educational curricula sl~ould
5.
S T R A T E G Y F O R E N \ ' l R O N h l E N T A L IIEALTII T M I S I X G AND E D I I C i T I O h IS THE E.iSTERN XIEDITERR.ASE.AS REGIOS
I~itrotiuctio~i ;111d
of tlie str;lteuv
Tile 1:ia111target of eiivironr:leutal iiealth contrnl strategy is to er?l:ance si~stainable rnipro\.ement of t l i t q~ialit!. of life for all tlie inliabitants i~:'~?~ral niid ~irharicon~~nunities tllr-O11~!1 I
Iricreas~~ig k~io\\ledge ::rid irlfc>smatio~l 011 erlvironme~ltal hazards arid their impact on !ienlth
3
Raising eri\-iro~i~nenral iiealth aivareness among the public
4
Irirersecto~-al np111-oaciiesicollaboratio~~ 111 addr-essin~ Y::\ jrl~:ir::~::~~.~ !-siiltli issires in trailling and educational actiiities
I
Integration ofen\:ironinental Iiealth concepts in ditkrent s~rbjects at \ arious ed~rcationallevels in national educatiorial systems. I rilization c>finriovative educational al)proaclies and metiiodoloy~rs
3 3 4
O!>rimi~m ~it~lizatic~ri and cooi.diriatio11~i'fornlaland irlfornlai ed~~s:~ricrial systems. Prioritizatiori of teachirig environmental Iiealtli si~l?iects accosdirig ro rile most ye\.alenr prol~lerns.of local ccrrntm~~n~ties 0i1r11nal~ ~ t i l ~ z a tand ~ o ii~i\e>tnlerit l of Iiirina~~ rcsoiIscea Lle\elilped 5 7 : . : n ~ o l v e ~ n ein nt t.n\.ir-onnlei~tai Iiealtli educatiorl pro,~rrarnii~es Innovat~\e community based-problem solving methodologies to Inanage and imple~nenrr~i\rronn~enral llealrli pro,~.~ramrnes
5
6.
6.
P L A S OF ACTION
General I .All curr~ci~la at prlmary. secondary and tert~ary levels to be updated t o Include
most important concepts of environmental health. Topics on personal hygiene and healthy lifestyles be included at the first level of education
17. 3
Institi~tio~ls irivolved
ill
ellvirollrnental I~ealth education to be str-i.llgr1~enedt h r o ~ ~ g h
statftraining arid p r o v i ~ i o n ofcuscntinl cquipmcnt a n d litcrnt~~l-e
Interactio~inlid ~ieti\orkillgamong institi~tiollsdeaiing with dityel-elit environnlental health edtication aspects to be PI-nmoted. This ci111 be achieved tlirougi~exchange ,>f espelrs ti? deliver lectl~res on specific top~c.;and througil joint 1-eseascli prc*ects Institi~tin::~ to be e~icour-aged ,il oti'er shalt colll.ses tbr in-sf[-\ 1i.e ! ~ r - ~ > f e ~ s ~ 1 1 o 1 1 ~lols e~i\.iro~i~iielltaI liealtli so '1s to keep tliem info~-ll~eti about the Intett tirt\,elopl~~erits in :he field LVorkshops and conferences 011aspects of envi~.on~nental healtll to be held pretkrabl\ i l l collnboraticln \ ~ i t h natiolial and internntin~ialagriicic..; Keepilig 111 ~ i e [hell~ t capabilities. i'arioirs institutions to be deslg~iaicdas tileal poi~its ti^ 1110111t01~111g of e11\1101111lt'1itirl Ileirltll i\\iies alii! rheii. i~i~iic,::,~~..; Tllese i;~stit~~ti~>r:,\ 5i:ot1ic! e.;:L~i~lisli ciilii~L>i~ses for d ~ s s e ~ i i ~ ~ i ofi11fo1 i~tior~ 111;rti,11i
4
5
6
1
\\'here l>i>ssible. ile\\ yr.ailirnte l i r o g ~ ~ i ~ ~ to~be i ~ in~tiateci. i~es irrtr.y~.atii:gall coiiip~~ile~lts of e~i\ir o~rnleutirlIiealrli educatioil The intake to sucll :>I-clgrani~lies sllc>i~ld be ~ i i ~ ~ l t i d i s c i \ > l i ~ i : ~ ~ ~ \ Relei n i l [ ciianges iri hen Ice c:u.rcl. S I I - ~ I C ~ L 10 I I be . ~ ~iliicle for i~dc~li~;::c. r ~ i ~l b i to i i~ )~~ oi'doctor.~.enyneels, xientists. la\\yers. econc~iillsts and siic:iol,)g~~:< \LIIL) specialize irl e~l\,ir-ori~lirrital Ileait11 ed~~cntion
II
3.
Introduce rile cnrlcept of liar-ticipato~y ~>lanriillg at corninu~l~t!. Ic\el .:nd h n i ~ to incorporiire e~l\;ii.onmelitai~~rotection illto colil~nurlity:rctivil~e\ Stress tile inlpoi-tance ot'selt-reliance arrd n:c>biliz;~ticl~i ofa\.ailaiilt: ; ;.hniirces tile cjuality of life to ensure s i ~ s t a ~ n a b ~111 l ~~liip~-oving ty
;
I
i , j ;tddl-ess e ~ i \ ~ i i - i ~ : i ~ i i e lie;11tli iitnI l ~ i - ~ g ~ - ; ~ ~ ati iditferent i ~ i e s educaticliini levels aiid ~ i p d a t i i i yrile existing pl-oyrsmines. includiny theoretical, practical and simulating denic>rlstratinn aspects.
~ i healtli concepts i n underT l i e ail11 of this pilase IS t o proniote tlie i ~ i t e y x t i oof grnduzte and y.ad:i;rte ciirl-icula at all pclssible le\,els
I
8 . . L ~ . , ) ~ i i ~ iit ~ I... ii) f~ e i~ i ~ i i i ~ i i ~ ~ l i )e i( ~~i t e ;~ c tl iCo LI ~ I~ i I . ~ C ~ I /\$it11 ~I eiiipl~asisC ~ I I i i i ~ i i i a i i :.,,ilil~ pr-otecri,~ii ill ilit'frieiit thculties. e s ~ e c i a l l \ i i i eiiyi~ieering scieiice. ~ i i e d i c a l ,i:::i e i l i ~ c : lc>i:,il ~t ;iiculties I.
_
.
\ c t \ \ o r k i ~ ~\g ) t t ' x ~ s t i ~~ ig ~ i s t i t i i ta~ n id~en s~ clla~iye o t ~iito~.niatiu t ioi r::sur'e c,~inplime~itar-ity Tile npplic<lt~i)n ot'r-ecent ,iietiiod:; clnd n e w t e c i i n ~ l o ~ i e :in ; envir-on11:entaI iienlth
1
c.!iicntion
To srrenythen c o l i i n i ~ ~ n iawareness tv raisiii? as regarditig tlie identificatiu:i vfcommunit)i Iiealtl: problenis. id coiiiiiii~ni:y ~ i i o b i l i z a t i n n for e~iviroriiiiental hazard c ~ ~ r i t rand o l EH education
1.
Using ditfererlt mass 11iedia.TV. radio, illter.net. etc Elnpiiasizi~lgpersorlal co~n~ni~nication ~iietllods.to special ~ I - o L inclucliris I ~ ~ . ; \iorl\ers. \+omen. e!i
3.
ivornen's developlilent progralnnles \VOI LCI t ~ i t i i i i i iPI ~ LISI CIIIIIIIC>
ag~.icuitu~.al eser-cise proyraniliies
O v e n ie\\ <I:' en\ ~ ~ - o ~ i ~ i ~litaltli e ~ ; ! a training l in the €,)stel-n Yledite!-r:.nean Region ( E L l R ) c>f\\'HO O \ e ~ - \ . i e \ot'i.\si~es \ iri etl\irorilllent anti Iiealtli - ~ ~ i t ~ . c ~ i u canti t i o rysoiip i !-ole pla! exercise
I-'riricii~ie> ,>t'i
ibX
; i ~ ~ t . s z i i i and ~ [ l [ rick iilanayement
F o r d >at;.t! ~ i l d ri~ltritio~i
Ener-9~ atid slollal health 111-oblerns
Participant 111-esentaticlns EH C L I I . I . I C L I I.C\.IC\V ~~I
and
1 1 p d t l t i 1 1 ~C
~ S C s
t~~d i nyE ~ v p t
I t i t r o d i ~ c t l oo l~ f EPI-INFO
.Aduption ot'strategy and plat1 of action fc>r environmental Iiealth training and recolnmendations editcation iri EVIR and wo~-ksIi~>p
Su~lday 26 April, 1998 0S:OO - 08-30 0S:;O
Rezistration. Video on CEH.A standal-d presr~l!;~ri,>~i Opening ccrclnong,
- 09:;O
-Welcome addresses (EblROIC'EHPJHQ) - AGFLJND niessage by Dr Z \,lihyu -RD's message -H E Tile h.li~iiste~ot'Healtli slid Healti1 (';ilc. J[>:-ciall. i11augul.alacidl.ess Objectives aiid scope ot'the \\orkslinl~. E.ister11 Overvie\v of e11vir.onnientalllealtli training 111 i i ~ c kledites~.anea~~ Regioll ( E L I R ) ot'Li'HO Dl. S ~ I I I IIlluatalii. -a T1-aini113 ;111d Reseal-cli . A d , i,c: C'EH.A
Overvie\v of the course and aduption ot'age11tI:i Dr hnnalee Ytissi. WHO Te~iipol-;u-y advise^.
Groul> role piah' eyerclse Dl- .A \'asxi
-
Nature o f e ~ l v ~ l . o n ~ i i eliei~ltll ~ ~ t a I Iiazards ( c n ~ i t ~ : l ~ ~ c i ) "iluestior~ call" Ds .A Yassi 'Homework' assigllnlents lead po~so~iing cast.
['r-illc11.7lrs oi'!.iil\ asses.;liiellt and risk ~llnliazenle!it I sont) -Prohle111sol\ illy esel-cise ( lend case ) Dr 4 Y'LISSI
Risk , .. - . arlri 11ln1layemelltesercise ( co!~tirliled ) . ,l>se>s~llent r)r .A Y~ISSI Ct'atel- a11d sarlitation - o\,r~-\,ie\\ -1xobIe111-\ol~i!1 ese~.cise preparatioll tbr lvaste water treatlilellt plant v i s ~ t hlr H~isseili .\I-Klla~idak.Local Ternpolx~?Adviser
12 1 :.
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-
1.3
I 15
Evaluatio~i of tield visit
15
-
1;
Footi safety ant1 nutl-ition D r Fathi Salell. Local T e ! i ~ l , n ~ - aAdviser l~.
0s clr, -
I
00
Field v i s i t
to
Ai-Dulail dairy fnctoly
1 2 3 0 - 13 IS I 3 15 - 14-15
Evaluation o f field visit llealtli assessment Air quality '~nd D r ,A. Ynssi and M r Ja~nalHarb. W H O Telnporan .Advisers. IJiliversity of h l a ~ i i t o b a Industrial pollution/cIlemical safetylwork environment Dl- 4 Yassi
15 00 - I h 30
16:30 - 17:OO
Humewnl.k assignments Pesticide casc
08:30 - 10:30
I~idustrial pollutiodche~nicalsafetylwork envil.onment (cont.) and problelii solving eser-cise Dr '4. Ynssi and J . Harb I~ldust~.ial pollutioi~cliemicalsat'ety/\vork eu\.i~c)n~:ient (cont) and problem solving exercise DI. .A Y n s s i and h l r J Hnr-b Energ1 arid ylclbal health prnblen~s Dl- Vlacii .Al-J::y!!!:~e:.. Lc?c:!! Ten~;>o~-;try .Ad\.ise~Global Iiealtll psobleliis. etliics a!ld action Dl- .A 1';issi )
10.45 - 12.30
13.00 - 15:OO
15.15 - I6 30
08:30 - 10:45
Hu~nan setrle~ne~its a~ld i~rba~lization DI. Atallah Rabi', Local Te111l)ol-21-y .Advisel.
12.30 - 13.30
p.: nlt!c~l,alltpresentations '
1O:OO - 17:00 12:.;0 - 11.30 - I6 30 14~15
Participant p~~esetltatinr~s (cot~tii~ued) I~itr.oduct~on of CEHA libixiy Discussions of tile EH Mnnili~l
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AIIII~ 3X LIST OF PARTICIP.4NTS
EGYPT Dr Ibrahim Soli~nan Hegazi Professor of Public Health Kasr .A1 Ainy Faculty of Medicine Cairo University
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,111 0
.
Tel: -202-35619 l51356405213.562319 Dr Xhmed Sayed Mours\, Head. Environnlental Resear-clies Unit Satio~ial Reseascll Centre Tahrir St. Dokki Cairo Off Tel. +202-337 10 10 Res Tel +202-3375934 Fax: -202--3.3709.; 11-3601 S77 Al-Kliatit' Dr Xlollanled .Abd El Kl~ades Head. Medical Sciences Depart~nent Institute of Eiivi~.onnientalStildies and Resear-clies Ein Sharns U~iiversity Cairo Res. Tel: +202-3606 I00 Ott' Tel: ~202-2470-337 Fax. +202-2470326 Dr hloliamed Carnal ElDi~iRashed Vice-Dean Social Services and Envir-o~lriiental Develi~l~ment Faculty of Agricult~rr-e Assii~tUniversity Assiut Tel: OSS- 14-333721lOSS 10-34729s Fis. 9YS-34729S E-hiail g.Raslied(ii)aun.e~~n eg Dr hlekkawi Akel Health Depar~~nent Head of the En\/~rnnmental High Institute of Public Health Alexandria University Alexnndri:~ Tel: 12 15575
Eng \luliamln;id 50~11 .Al-.Ako~il. .Al-Balrla' .Applied University .Al-Husn College for Englrieeriny S;1lt 1 . 1 s r i 02-2 10400 Tel 02-277399. .A1 H F a s 03-2 IO3OS t111d01-17;I OD
Dr- Z ~ a d .AI-(illazn\~ I Civil Ensinerring Depal-trnent Jordan L'nver-sit? of Science and Technology lrl~i(i l el -0G3-2-'lOi 1 1 1 . ezt 2 I.?-! Res -002-2-274472 Fax -9(>2-2-2Oi 12.;
Dr Ja\-ed Ari~vnr,-4ziz Dil-ectorInstitute o f Envir-rlr~mental Engineel-in: arid Resear-ch and Technoloyy I.'ni~ersitv oi'Engi1ieer111y L;ht~orc Pel -02--42-.>.>024S Fay -02-42-(>S22i(30 Ur S a q ~ b Sliallal~ Assistant Professor. Environmental and Occupational Acndcny Henlth, Hcnltli SCI-viccs Isl:lrrlal);~(i Tel -92-5 1-7s 1207/97_-5I-9222034 Fax -91-5 1-829.547 E-hiail ssIialinbl(~shaip srlrlpk uridp org
Dr Aamir Elalli Julu i
Assistant Professor and Head Institute of Public Healtli nepartrnent of F-nvirnntnetltal Health Lahore Res. Tel: +92-42-57 12S95/92-42-S72S9.5 Off Tel: +92-42-7.583915 Res. Fax: +92-42-57 12990 Of' Fax: +92-42-75S6;9C E-Mail: jnlpl{{)aster- corn pak Dr A. K Ansari Director in stir:::^ nt'Friviron~nentalEngine:-i;:g iiltd \la~ingenteut X;lehran Univel-sity of Engiliet.~.i~i~ and Tecilrioloyy .J:~~iislioro. Si11dli Tel: -97-22 1-77 1 I S7 Fax. -92-22 1-77 13S2 e-Mail. ansari%ieeniiZ;~~i~et ~ t siiper s net.pk Dl. JI Altaf Klian Director In<ritttte of F.nviran~ile~ital Studies L'nil-ersity of Karachi K:ir:~chi Tel. -92-2 1-4969054 Fax. -92-2 1-1969054 E-hlail ieku@:lpaknet.? ptc-pk Dr \ I . Soilail Kariln Hashnii Natio~ialProgramlne kla~iager Erlvironn:c~italHealth Lrnit 1 1D West Fel-oz Ce1ttl.e Blue Area Ministry of Health 1sl;ini;ibiitl Tel: +92-5 1-92042 16 Fax 702-5 I -92G43 10
W H O Secret:~ri:it
I . Al-Khawashky Dr \I. Acting WHO Representative Cairo Tel: +202-3557706/355370S Fax: +202-3553756
EQYP~
Dr lV1 7 Ali K h a n CoordinatorW H O Repiorial ('e~itl-eftv Envir-or~nlental Health Activities. C'EHA Tel. -')67_-6 557_7_4055/5.53 1657 Fax -902-0-55 1059 I E - l l a i l CEH.-\fir)\~lin-celia ory.jo
Dr- S e ~ ~ i r1;luatnin -a slid TI-ai~i~n g Reseal-cli .Ad\;iser L i ' H O Rezintiai I ' r t i t r r ti>[.Fnvil-nntnent:II Health Activities. C E H A Tel -962-0 S i 7 _ 7 4 ( ~ 5 5 / 51657 3 Fax -962-6-55 l h 5 9 1 E-Vlail CEHr\/fii\blio-celia ory jo Dr. .Annalee )'ashi E~ter-nal Te~nl~or-ary .Adv~ser IJlii\,ersitv of h,,I:~l~itob:~ Canada Tel - 1 -204-7SOilS'J Fa\; - 1 -304-7S0-.~005 E-Ylail yassi/%cc u~iinnitoba.ca
blr-Jarnal Hal-b External Teriipo~.a~.\ .Adviser Ilrli\.ersity o f Vlariitol~a C'arinda Pel - 1-204-284-1740 Fax - 1-204-739-3095 E - M a i l LrV1HAKBJi;ljcc i~rnanitob ca Ill-Jacoli E Willialiis Associate I-'rukssic~~lal OtEcerW H O Keyrolial C entl'e tor t n v ~ r a ~ l ~ i i e n t a l Health Activities. C E H A Tel -962-6 552740551553 I657 Fax. -062-6-55 1 (>501 E-Mall: CEHAic?)\vlicr-cehaclryjo
Dr Atallah Rabi'
Local Ternporaiy Adviser Public Health Department Faculty of Medicine Jordan University of Science and Technology Irbid Jordan Res Tel. 02-7 100016 Fax: 02-295 123 L-Mail: rabi@ji~stc d ~jo l
klr Hussein Al-Kliandak Locx! Te~ilpoi-aiy .Adviser Chief of Water i\ilouiri>i-1n3 Di\:ision Environ~nent;~l Healtli Directar:~re A 111111:111
Jordan Of Tel- +901-6-56S5300 Res. Tel +90?!-0j0538 17 Fax. 7962-6-5066 147 Dr Fatlii Sale11 Local Temporary Adviser. Deputy Dil-ector Food Safety Depar-tliie~lt Ministry of Health and Health Care A1111n:111 Jordan Tel: +962-6-5607 114 Fax: +962-6-5638286 Dr Madi Al-Jaglibeer Local Te~nporaiyAdviseiUniversity of Applied Sciences A 111mil n Jordan l'el: +962-6- 5 I56 l S>.2 . ; 7 I S I Fax: +962-6- S.>2S99 E-Mail: Madi-phm(@go coln jo
O T H E R ORCXNIZ.-\TIONS Dr Zuhair klillvu Director Internatic~rialProgra~limeSection Arab Gulf Proy~.alrinie for United Nations Development 01-ga~iizatinns (AGFUND) Riy;~tlh Saudi .Arabia TeI - -13 102-10 Fay 441 ?9h; E-Mail .ACiF[.'S[)(ri;KHALEEJ Y E T B H OBSERVERS h11-Harii Na\vntlcti College of Niirsiti~ XI-Zayroonah U~livcrsit> I-' 0 Box 1-70 , A t ~ i ~ n1i1733 ~~i Jot-dan Tel -%37_6 5 0 I570 01.50 1004. (I.<-? 1 .560.30 Fax -')(17_6 5 0 1570
\Is Fatin Xlaiali Colleye of Nur-sill2 .Jordan I~lniversity oi'Scierice and Teclinoloyy P 0 Box 3030 Irbid Tel (17-7-95 l 1 1 :?02.; Fax 0 2 295 12.: E-Ylail Fatin253lci:'niailevcite c o ~ n tht~n hl;liali$)usa.riet Di- ?;lalier L Sal~tii Facultv o f Pliai-nincy and i\/leriical Scierices Arnman L'nivessity P 0 Box 337 A ru 111;i 11 Tel. 962-6-535 I (I(, Fax: -962-6-i.7 5 I 0') Dr Basem Dababneli Faculty o f Phat-macv and Medical Sciences ,Amman University P. 0. Box 337 Ar~iri~n~~ Ott' Tel +962-h-5.:.3.5 166 Res. Tel +963-6-8 15(19 1 Fax. -062-6-533' I00
WHO-EM/CEHA/X7-E Pngc -3 l
Dr Mazen K Qatr-,
Acting Dean College of Pharmacy Al-Isra University P. 0. Box 67 1356 Ammall - Al-Shiliyyi~li1 1 162 Tel: 08-59 1710. 591S3O/I Fax: 05-59 1505 Dr Naela Bolotova COIIPQP of P h n r m a r y
Al-lsra University P. 0 . Box 62 1786 ,41n111i11i - '41-Sliiliyyi~liI I I62 Tel: OX-59 17 I U. 5 0 18301i Fax: 08-50 1505
Eng. Muhammad Al .Abadi C/O Ministry of Health and Healtli C a ~ e Arnrnal~ Off. l'el: 56S5.<9617 Res. Tel: 5666 147 Mr Samer Malkawi Technician htinist~y of Health and Health Care Anlln:111 Tel: +962-6- 5666 137 Fax: +962-6-j666 147