Public health policy and legislation instruments and tools: an updated review and proposal for further research

Public health policy and legislation instruments and tools: an updated review and proposal for further research Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). ABSTRACT This document reviews the current policy and legislation instruments and tools in place for delivering public health operations in the WHO European Region. It aims to underpin and complement the European Action Plan for Strengthening Public Health Capacities and Services (EAP). It provides initial findings on the wide spectrum of legal and policy frameworks at regional and global levels discovered by mapping the available public health instruments and tools across 10 essential public health operations (EPHOs). The main findings are that at the global level legally binding instruments and tools are mainly concentrated in EPHO 3 (health protection) with 306 tools, EPHO 4 (health promotion) with 31 and EPHO 6 (governance) with 41. This corresponds to more than 90% of the total number of public health tools. However, there were only 2 tools for EPHO 5 (disease prevention), 3 for EPHO 7 (workforce) and 1 for EPHO 8 (organizational structures and financing). No legally binding tools were found for EPHO 9 (communication) and EPHO 10 (research). For EPHO 1 (surveillance) and EPHO 2 (response to health hazards and emergencies), there is a more balanced use of both legally and non- legally binding tools. More evidence is needed on the cost–effectiveness of such instruments and tools. In addition, there is a need for greater advocacy, with a balance of regulation and persuasion, on what already exists – such as “best buy” interventions for noncommunicable diseases (NCDs) and the WHO Framework Convention on Tobacco Control (FCTC) – as well as a need to strengthen approaches to intersectoral governance. Keywords FINANCING, HEALTH HEALTH MANAGEMENT AND PLANNING HEALTH POLICY PUBLIC HEALTH – LEGISLATION AND JURISPRUDENCE – TRENDS PUBLIC HEALTH ADMINISTRATION © World Health Organization 2012 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. 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Document number: WHO/EURO:2012-2218-41973-57685 Public health policy and legislation instruments and tools: an updated review and proposal for further research page i Contents page Acknowledgements ...................................................................................................................... ii Abbreviations ............................................................................................................................... ii Executive summary ....................................................................................................................... 1 Introduction ................................................................................................................................... 7 Methods ......................................................................................................................................... 9 Findings ....................................................................................................................................... 14 Conclusions ................................................................................................................................. 27 References ................................................................................................................................... 33 Annex ............................................................................................................................................. 37 Public health policy and legislation instruments and tools: an updated review and proposal for further research page ii Acknowledgements This report was written by Carlos Dias and Rita Marques from the National Institute of Public Health, Portugal, and Maria Ruseva, Jo Nurse and Casimiro Dias from the WHO Regional Office for Europe. Other major contributions came from Snezhana Chichevalieva from the South-eastern Europe Health Network, Jose Pereira Miguel from the National Institute of Public Health, Portugal, and Jose Martin-Moreno and Hans Kluge from WHO Regional Office for Europe. Abbreviations CIS – Commonwealth of Independent States EAP – European Action Plan for Strengthening Public Health Capacities and Services EPHOs – Essential public health operations EU – European Union FCTC – Framework Convention on Tobacco Control GLC – Green Light Committee HiAP – Health in All Policies IHR – International Health Regulations LMICs – Low- and middle-income countries NCDs – Noncommunicable diseases SARS – Severe acute respiratory syndrome SEEHN – South-eastern Europe Health Network TB – Tuberculosis Public health policy and legislation instruments and tools: an updated review and proposal for further research page 1 Box 1. The 10 EPHOs 1.Surveillance of population health and well-being 2.Monitoring and response to health hazards and emergencies 3.Health protection, including environmental, occupational, food safety and others 4.Health promotion, including action to address social determinants and health inequity 5.Disease prevention, including early detection of illness 6. Assuring governance for health and well-being 7. Assuring a sufficient and competent public health workforce 8.Assuring sustainable organizational structures and financing 9.Advocacy, communication and social mobilization for health 10. Advancing public health research to inform policy and practice Executive summary 1. Through resolution EUR/RC61/R2 on strengthening public health capacities and services in Europe (1), the WHO Regional Committee for Europe endorsed the development of an action plan, to be led by the WHO Regional Office for Europe and submitted to the Regional Committee for consideration at its sixty-second session in September 2012. This plan would be centred on actions that are strategic and reflect modern public health practice (including a focus on both structural determinants and individual actions) and would form a key pillar of the new European health policy framework, Health 2020. The purpose of the plan is to ensure that public health services are strengthened to respond to the current and emerging public health challenges facing the WHO European Region. The overall vision is to support the delivery of the Health 2020 policy framework by promoting population health and well-being in a sustainable way. 2. The European Action Plan for Strengthening Public Health Capacities and Services (EAP) aims to support the 53 Member States of the WHO European Region in improving health and tackling inequalities by securing delivery of 10 essential public health operations (EPHOs) (see Box 1) and a core set of accessible, high-quality, efficient and effective individual, community and population-based public health services, and thus to strengthen public health capacities. This report aims to underpin and complement the EAP by reviewing the range of available public health instruments in order to develop evidence-based policies and tools for future programmes. Note: following resolution EUR/RC61/R2 on strengthening public health capacities and services in Europe (1), the 10 EPHOs which form the basis of the EAP were revised to the above in 2012. 3. The purpose of this review is to provide the Regional Office, Member States and other partners with direction in addressing, among others, the questions below. • What are the relative advantages of the different types of public health instruments and tools available? • How can the effectiveness of public health instruments and tools be enhanced at Member State level? • How can gaps in the toolkit of available instruments and strategies be addressed? Public health policy and legislation instruments and tools: an updated review and proposal for further research page 2 • How can evaluation and monitoring of these instruments and tools be made more effective? 4. It was not possible to answer these questions in full, but this study advances our understanding of the effective use of public health instruments and tools across the European Region. The following summarizes the responses to these questions. What are the relative advantages of the different types of public health instruments and tools available? 5. A recent report from the WHO Regional Office for Europe highlights four major roles for the law in advancing public health. These are: defining the objectives of public health and influencing its policy agenda; authorizing and limiting public health action with respect to protection of individual rights, as appropriate; serving as a tool for prevention; and facilitating the planning and coordination of governmental and nongovernmental health activities (2). 6. While for some areas (such as health protection) legally binding tools can reflect higher potential gains, for other areas (such as health promotion) the use of influence mechanisms can be more effective. Furthermore, both definition and enforcement of legally binding public health tools need to be considered when assessing the cost–effectiveness of these tools. It is particularly important to achieve a balanced approach with the different tools. While legislation is enforced through legal systems, national governments try to ensure implementation of national health strategies and policies through a range of monitoring, audit and performance management arrangements often associated with meeting standards. 7. This report concludes that an array of instruments and tools for policy and legislation is available to support the delivery of EPHOs in a wide variety of settings. The number and complexity of tools developed at the global and European levels has increased in recent years, as illustrated by the WHO Framework Convention on Tobacco Control (FCTC) and the International Health Regulations (IHR). While international regulations are non-negotiable, the degree and nature of governance arrangements, including regulation and legal enforcement, will vary across Member States. However, evaluation of these instruments and tools is not widely available; it is therefore difficult to compare the relative advantage of public health instruments and tools in different countries or at a regional level, or to recommend one tool over another. 8. The findings point out that the wide range of instruments available to WHO (including conventions, regulations, recommendations and standards) reflects the variations in deployment of specific instruments by different countries, and note changes in national regulatory frameworks arising from a growth in pluralism and democratization. There is a need to familiarize government and public health agencies with a range of current public health instruments and tools, and to provide guidance on how to deploy them in tackling the major challenges of population health. How can the effectiveness of public health instruments and tools be enhanced at Member State level? 9. Evidence on the effectiveness of different public health policy and legal instruments and tools is currently limited. This section summarizes examples of data in the main areas where evaluations were found. Overall, further evaluation is needed to inform the future effectiveness of different instruments and tools, including analysis of cost–effectiveness and feasibility of implementation. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 3 10. WHO has identified a set of evidence-based “best buy” interventions that are not only highly cost-effective but also feasible and appropriate to implement within the constraints of health systems. The report on “best buy” interventions for noncommunicable diseases (NCDs) concludes that there is a set of interventions that have significant public health impact and are highly cost-effective, inexpensive and feasible to implement (3). The primary benefit is a reduction in premature mortality from NCDs. Studies have found that implementing a specific set of “best buy” interventions for NCDs in 23 large low- and middle-income countries (LMICs) could prevent 30 million premature deaths between 2006 and 2015, or an average of 3 million per year. Population-based measures for reducing tobacco and harmful alcohol use, as well as unhealthy diet and physical inactivity, are estimated to cost US$ 2 billion per year for all LMICs; less than US$ 0 40 per person. 11. Approximately 3.8 billion people (55% of the world’s population) are covered by at least one tobacco control measure at the highest level of policy achievement, according to the latest WHO report on the global tobacco epidemic (4), including 1.1 billion covered by a new policy since 2008. In the WHO European Region, over 244 million people (27% of the population in the Region) became newly covered by at least one tobacco control measure at the highest level of achievement between 2008 and 2010. This has great potential to make remarkable improvements in health. For example: • just three months after the comprehensive smoke-free legislation was enacted in Scotland, bar workers reported a 26% decrease in respiratory symptoms and asthmatic bar workers showed reduced airway inflammation (5); • within the first year of the introduction of the tobacco control law in Turkey there was a substantial decrease of 24.2% in the number of patients with smoking-related diseases (6). How can gaps in the toolkit of available instruments and strategies be addressed? 12. The EAP sets out the 10 EPHOs which should be incorporated into public health practice and into current strategies to measure and improve public health performance (see Box 1). These EPHOs were used as a structure to map different instruments and tools and identify major strengths and weaknesses. 13. The extensive mapping exercise undertaken for this review indicates the EPHOs for which public health instruments and tools are available, as well as critical gaps, and highlights six major points. • There are 396 different tools for EPHO 3 (health protection) and 300 for EPHO 6 (governance). These two areas reflect more than 75% of the total number of public health tools available, and are particularly developed in European Union (EU) countries. • There are 58 instruments and tools for EPHO 1 (surveillance), 37 for EPHO 2 (response to health hazards and emergencies), 70 for EPHO 4 (health promotion), 17 for EPHO 5 (disease prevention), 14 for EPHO 7 (workforce) and 6 for EPHO 8 (organizational structures and financing). • EPHOs 9 (communication) and 10 (research) have only non-legally binding tools and instruments. • While countries of the Commonwealth of Independent States (CIS) and South-eastern Europe Health Network (SEEHN) have historically strong services in EPHOs 1–3, capacity and laboratory equipment have often become outdated, and legislation and policy also need updating. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 4 Advocate for effective tools – for example, good evidence exists to support “best buy” interventions for NCDs and the WHO FCTC. Legal approaches are best balanced with intersectoral policies that create environments for healthy living. Strengthening governance important to ensure effective implementation of laws is and accountability arrangements of cross-sectoral working. • At the global level, legally binding instruments and tools are mainly concentrated in EPHO 3 (health protection) with 306 tools, EPHO 4 (health promotion) with 31 and EPHO 6 (governance) with 41 tools. This corresponds to more than 90% of the total number of tools. • The WHO European Region has a particularly strong record of adopting legal public health measures compared to the global picture. Legally binding public health tools represent one-third of the total number of available tools in the Region: this proportion is more than double the global average. How can evaluation and monitoring of these instruments and tools be made more effective? 14. The review’s conclusion outlines further possible research for evaluation, including analysis of the processes, outcomes and cost–effectiveness of a wider range of instruments and tools. The main gaps identified in the survey of public health policy instruments and tools include a lack of explicit monitoring and impact assessment mechanisms. The population health outcomes and effectiveness of legal interventions might be compared directly with other options. Such an approach should be broad enough to include comparative effectiveness both for different laws and policies and for other types of intervention. 15. Adding a cost component to the assessment of the impact of public health laws and policies allows the identification of a set of strategies with the greatest value for money. A focus on improving both the processes and the health outcomes would allow a dynamic system of accountability. In line with this, standards for the delivery of public health services should be made explicit and their quality ensured through regular scrutiny, inspection or assessment arrangements and accreditation. Recommendations 16. Besides tackling the major gaps in public health tools by EPHO, there is also a need to reach a balance between regulation and persuasion. The effectiveness of traditional public health instruments and tools – including legislation, sanctions, regulations and taxes – may be limited without additional tools more focused on citizen engagement in behavioural changes. As the WHO report on governance states, “smart governance” is mainly evaluated in terms of the effective use of a specific tool within the context of a diversity of tools and modes of application Public health policy and legislation instruments and tools: an updated review and proposal for further research page 5 (7). With this in mind, the information collected in this review makes it possible to offer the following recommendations to Member States of the WHO European Region. Advocate for effective tools and apply evidence to different settings • Advocate for tools with good evidence of effectiveness, such as “best buy” interventions for NCDs, the WHO FCTC and IHR. • Advocate for tobacco control, including tax increases, smoke-free indoor workplaces and public places, health information and warnings, and bans on tobacco advertising, promotion and sponsorship. • Advocate for control of harmful alcohol use, including tax increases, restricted access to retailed alcohol, and bans on alcohol advertising. • Advocate for promotion of healthy diet and physical activity, including reduced salt intake in food, replacement of trans fats with polyunsaturated fats, and raising public awareness of diet and physical activity through mass media. Strike a balance between regulation and persuasion • Balance different instruments and tools, such as Health in All Policies (HiAP), governance, and both legally and non-legally binding tools; for example, toolkits, guidelines, approaches to citizen engagement, advocacy and communication. Strengthen intersectoral responses and governance • Develop and employ an HiAP approach to consider the health effects of major legislation, regulations, and other policies that could potentially have a meaningful impact on public health. • Make use of health impact assessment tools to strengthen health gains in an HiAP approach. • Strengthen the governance and accountability arrangements of cross-sectoral policy. Address gaps in instruments and tools • Consider appropriate instruments and tools, and respond to the relative gaps in the toolkit to support the delivery of the 10 EPHOs. • Specifically, consider the development of tools for EPHOs 5, 7, 8, 9 and 10 (disease prevention, workforce, organizational structures and financing, communication and research). • Focus on enhancing the integration of health promotion, health protection and disease prevention by strengthening primary health care. Strengthen tools for monitoring performance and accountability • Enhance effective use of time-bound targets and tools for monitoring and evaluating health trends and policy implementation at national, regional and global levels. • Develop standards for the delivery of public health services and ensure their quality through regular scrutiny, inspection or assessment arrangements and accreditation. Strengthen evidence • Create a resource map and gap analysis of a wider range of instruments and tools, including toolkits and guidelines at the national level. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 6 • Based on findings from the systematic review on legal and policy tools, summarize the main types of evaluation report and the key findings on the effectiveness of tools. • Evaluate the population health outcomes and costs of major legislation, regulations and policies: such evaluation should occur before and after enactment. • Evaluate the process and feasibility of developing and enforcing legislation and policy. • Develop research on the cost–effectiveness of public health tools to inform policy-makers of the interventions with higher value for money. • Enhance methodologies to evaluate the relative effectiveness on health of a range of different instruments and tools. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 7 Introduction Public health challenges 17. Health and well-being are vital components of social development; they have become critical macroeconomic and political factors throughout society (7), whose role has been reinforced as a result of the Millennium Development Goals initiative (8). The current financial crisis has tipped several countries into recession and forced governments to adopt restrictive policies, with consequences and impacts on investment, health spending, and the scope and quality of health care services (9). The new public health challenges in the WHO European Region, the re-emergence of “old challenges”, the need for a global response and concerns with the sustainability of health systems have an impact across all sectors. 18. Demographic changes continuing over the coming decades – including longer life expectancy and falling birth rates, which have led to an increase in the mean age of the population in Europe – will produce a major challenge for many areas of public policy. Alongside these demographic changes there has been an epidemiological shift; as a result, the large majority of the burden of disease across the Region is now accounted for by chronic NCDs (10) and mental health disorders, including Alzheimer’s and dementia among older people. NCDs have the greatest effect on public health across the European Region and account for most of the years of life lost, as well as the years of life lived with disability. 19. Communicable diseases also present new challenges for policy-makers and public health institutions and professionals. For example, the need to prepare for different strains of influenza, potential new pathogens such as severe acute respiratory syndrome (SARS), new drug-resistant strains of tuberculosis (TB) and rising HIV and AIDS infections in many countries of the Region are well documented. Communicable disease surveillance and response consequently remain a core occupation for public health services. 20. The large, avoidable and unfair differences in health outcomes between and within countries in the European Region persist and are growing in many countries, as structural determinants and conditions of daily life are affected. These have an impact on the distribution of power, income, goods and services, as well as on the circumstances of people’s lives, such as access to good quality health care and education, good working conditions and proper housing and environment (11). 21. Integration of the knowledge base – including tracing health disparities to their social determinants and to differences in access to services, financial coverage and deficits in patient empowerment in public policy instruments – is one of the critical benefits modern policy instruments and tools are expected to bring to public health efforts. Moreover, there is evidence that suggests that people at risk of social exclusion and those with special needs more generally – particularly migrants and people with mental health problems – continue to call for more attention in the further development of policy strategies and public health instruments. 22. Population health is also strongly dependent on the stability, productivity and resilience of the natural environment (12). The findings of several assessments, research projects and national health impact assessments have made it clear that climate change-related exposures will increase health effects from extreme weather events among other impacts of importance to human health in the next decades in the European Region (13; 14). 23. Globalization has given rise to particular challenges and opportunities for public health. Communicable diseases have never respected borders, but as the SARS outbreak and more recently pandemic (H1N1) 2009 have demonstrated, the global spread of disease occurs in a very short time scale and requires ever-improving surveillance, communication and action (15). Public health policy and legislation instruments and tools: an updated review and proposal for further research page 8 Public health instruments and tools 24. The number and complexity of health policy statements, strategies and other policy instruments developed by WHO has increased in recent years at the regional and global levels. There was a breakthrough with the advent of more legally binding types of instrument, such as the WHO FCTC and the IHR. At the same time the number of actors continues to increase, not least with the broader public health agenda of the EU (16). 25. Increasing pluralism and decentralization in Europe renders the task of seeking and building consensus and implementing various policy instruments more complex. This heterogeneity determines a multiplicity of specific instruments, varying by the nature of the actors involved (whether political, public or social), the sector of society upon which it intends to act (such as health, economy, education and so on) (17), and the aim that the government intends to pursue: “governments can act through different instruments to achieve particular goals” (18). Lascoumes and Le Galès, on the other hand, refer to the political and technical approach to the instruments within policies, which have a more pragmatic character (19). 26. For authors such as Perrels, the nature of the instruments also varies according to the level of government (global, central or local) (20) or, as referred in the EU White Paper on Governance: “the choice of the level at which action is taken (from EU to local) and the selection of the instruments used must be in proportion to the objectives pursued” (21). 27. The governance role of ministries of health increasingly entails activities outside the health system itself (22). It is a vital part of public health that the ministry of health and other actors responsible for health take or oversee selected intersectoral actions, where they take responsibility for advocating for improvements in areas outside their direct control. This may include actions in schools (education), road safety (transport), the workplace (labour and various regulatory bodies) or pollution (energy and environment). The intersectoral, multisetting dimension to public health services delivery is an essential component of health promotion and disease prevention. 28. These concerns should be reflected in whole-of-government policies at all levels – international, regional, national and local – which thus require action from the whole of society (7), involving an increasing number of stakeholders and actors. For this, governments have new and different ways to implement and achieve their objectives, and to bridge the gap between governance and society as a whole (15). The majority of recent authors call these forms of government action in the context of public policies “tools” and “instruments”. Impact and effectiveness of instruments and tools 29. Over the past 10 to 20 years, there has been a substantial increase in the number of public health policy statements, strategies and other policy instruments developed by WHO at both the global and the European Regional levels. The trend has been towards using more legally binding instruments; in particular at the global level. However, evaluation and monitoring of these instruments has been limited. 30. It seems timely to undertake a review of possible gaps in the instruments and tools available in response to the public health challenges for the WHO European Region in the 21st century. Three major questions on public health tools remain partially unanswered: to what extent are existing public health policy instruments able to address the full range of challenges that have been identified as priority areas of attention; how can the mix of instruments be improved; and what are some of the remaining challenges of monitoring and evaluation? While this review does not present a full and detailed answer to all these questions, it provides initial findings that might be the subject of further research in the near future. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 9 31. The review aims to address questions on the types of policy process and public health process that have worked well in terms of their impact on health and health systems; to what extent they were taken up by national governments and integrated in policy-making at national or subnational levels; and the results in terms of improved outcomes and processes (23). 32. The substantial growth of public health policy instruments – combined with the lack of evaluation and monitoring – justifies the effort to map the global and regional instruments of public policies. This first exercise and the classification of instruments by EPHO may assist with identification of the main areas of action for the EAP. 33. Simultaneously, the mapping exercise contributes to identification of those instruments that are already being evaluated, as well as those whose implementation has built-in monitoring mechanisms. This information is essential when considering the need to identify real and potential gains from public health instruments and tools and the best ways to enhance their effectiveness. In addition, evaluation of successful assessment and monitoring methods allows identification of the strengths and weaknesses of the models adopted, facilitating the search through benchmarking of the impact assessment models that best fit the specifics of governmental action on health (24). Methods 34. The many public health challenges identified above justify a renewed European health policy, as well as policy instruments and tools capable of strengthening the capacity of health systems to achieve better health for the Region. Adoption of the Health 2020 policy calls for the identification and analysis of “governance mechanisms and instruments that can improve health policy and deliver health outcomes in an equitable and sustainable manner and to consider how priorities are set and strategic goals are implemented” (25). 35. The increasing complexity of global and European governance in health, with a wide variety of actors and stakeholders (at international, regional and national levels), combined with an increasing differentiation and specialization of responses and implementation responsibilities and expectations (26), has been described and analysed in great depth by WHO. The current paper was grounded in this knowledge and the vast body of work already undertaken (2; 5; 27; 28; 29). 36. A new classification matrix based on a conceptual definition of public health policy instruments and tools was developed for this mapping exercise. The matrix aims to contribute to the new focus of Health 2020 on strengthening regulatory frameworks for protecting and improving health. It could be developed into an active “roadmap” of documents related to instruments and tools for public health, based on the identification of available data sources and the preliminary literature review and classification tables produced thus far. 37. The work for this review was undertaken in four phases: • definition of concepts • definition of the classification matrix • identification of available data sources • literature review. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 10 More legally binding Advisory Technical Advisory Group Expert Advisory Panel Expert Committee Study and Scientific Group Commission Normative Resolution Code Regulation Convention; agreement Collaborative Network or Independent governance, Independent alliance borrowed legal identity legal identity Operative WHO Secretariat strategy World Health Assembly, Regional Committee noted or endorsed strategy Negotiated strategy Definition of concepts 38. The definition of concepts consisted of an initial literature review on the basic concepts of “policy instrument” and “policy tool”. This was conducted using legal and public health databases to search for work including firstly descriptors of a legal nature (“legal”, “juridical”) and secondly descriptors of proximity to “public health policy”. During this phase search categories were also elicited and emerged when comparing the findings with previous reviews from WHO, including treaties, conventions, resolutions, codes, agreements, resolutions, strategies, recommendations and reports. 39. On the basis of the intended scope and purpose of the study, which is situated within subject of health governance and public health governance in particular, the instruments and tools specific to public health activities found during this search phase – such as epidemiological surveillance tools, monitoring tools for services, health surveys and user questionnaires, among others – were excluded. Only regulatory or normative instruments were considered for their importance for public health policy at global, national and subnational levels (30). 40. Thus, the search in this first phase focused on global and regional (European Region) governance. At this level, instruments with a normative nature – such as treaties, conventions and regulations – appeared to be the most important instruments and tools of governance. However, protocols, agreements and declarations emanating from international organizations are also important instruments. Policy instruments for public health differ in the degree to which they are legally binding and in the ways they are negotiated and implemented, where the role of WHO may focus on an advisory, normative, collaborative or operational role, including mixed strategies, as illustrated by Tables 1 and 2. Table 1. The broad range of policy instruments for public health Source: WHO Regional Office for Europe (31). Public health policy and legislation instruments and tools: an updated review and proposal for further research page 11 Table 2. Policy instruments according to the WHO Constitution Type of instrument Example at the global level Conventions and agreements (Article 2 (k)) FCTC Regulations (Article 2 (k)) IHR Recommendations (Article 2 (k)) Global strategy and plan of action on public health, innovation and intellectual property Nomenclatures (Article 2 (s)) International Nonproprietary Names for pharmaceutical substances Standards (Article 2 (u)) Codex Alimentarius Commission on food safety Source: WHO Regional Office for Europe (31). 41. At the European level there is also a variety of EU documents with different natures and purposes, such as conventions, directives, regulations and the “Green and White Papers, Communications, advisory committees, business test panels and ad hoc consultations” (19). 42. For the purpose of this review the concept of “instrument” will include the treaties, conventions, regulations, agreements, declarations, norms, nomenclatures and standards, strategies and frameworks – with different scopes and implementation levels – through which Member States, supranational organizations, national and local governments and other entities with competence govern and regulate areas of action and coordinate international, national and local initiatives to protect and promote public health, and ensure health in all policies and sectors of society. Definition of the classification matrix 43. Having identified the appropriate documents, it was necessary to build the mapping model. On the basis of the conceptual policy framework of Health 2020 and the EAP, a matrix was developed, showing seven key categories of the review findings: 1. EPHOs as thematic categories 2. EPHO subdivisions as thematic subcategories 3. title of instrument or tool and web link 4. lead organization 5. level of implementation 6. legal status 7. evaluation notes. 44. The success of the new strategy for public health in the European Region, Health 2020, and the EAP depends on their effective implementation and on a better understanding of the reality observed in each of the different Member States. In order to achieve these objectives, the 10 EPHOs (see Box 1) are set out as a detailed checklist for assessing public health capacities and services, alongside the actions required to strengthen them. The categories of the mapping document allow organization of the main documents chosen for the review in the light of the 10 EPHOs (category 1) and their operational aspects (category 2). Public health policy and legislation instruments and tools: an updated review and proposal for further research page 12 45. Category 3 displays the official title of the document and a link to the official latest updated version; the next category identifies its lead organization. Clear identification of the lead organization is a fundamental requirement, since the instruments of international law (conventions, treaties, protocols and agreements) are negotiated under the auspices of a transnational entity (or entities) with competence; this entity leads the negotiation process to its signature and entry into force, and – in the majority of the situations – becomes the entity with responsibility for monitoring the process of adoption and implementation of the instruments. 46. Category 5 identifies whether (at this first phase of the study) the document has global, regional or national and local implementation. At the end of the phase two, it should be possible to establish the relationship between the global and regional initiatives and local initiatives and strategies for action. The legal status of the instruments arises from the nature of the entity involved or from ratification by Member States, and for most of them it is the act of ratification that makes the text legally binding. 47. On the basis of the scope of the study, it was also considered important to include information on the process of assessing and monitoring implementation of the instruments and tools referenced. In this context, the last category contains information concerning the existence or lack of assessment and monitoring procedures, the competent authority and the existence and frequency of related reports. Identification of available data sources 48. The work to identify available data sources was then undertaken in the following stages: • an initial review and analysis of available WHO documents on the subject of public health policy, including available reviews of public health policy instruments and tools; • a search of available repositories of legal documents in the WHO Regional Office for Europe; • a web-based search of policy instruments and tools not included in previous sources; • a search in the libraries of the Portuguese National Republic Assembly, the National School of Public Health of the New University of Lisbon, the Higher Institute of Social Sciences and Policies and the Law Faculty of the University of Lisbon. 49. The results then determined the following steps: • identification of supranational organizations that produce documents with global and regional consequences for health and public health (conventions, treaties, protocols and agreements); • identification of the main texts produced (including the WHO FCTC, IHR, Convention on the Rights of the Child, Convention on the Rights of Persons with Disabilities, United Nations conventions, ILO conventions and others); • identification of the nature and juridical binding of the documents. 50. To comply with these procedures the authors researched the web pages of the international organizations involved, including the pages of the WHO international digest of health legislation; WHO tobacco control database; WHO IHR; United Nations Treaty Collection; United Nations Rule of Law; Office of the United Nations High Commissioner for Human Rights; UNECE conventions; ILOLEX; WTO documents and resources; EUR-Lex; ECOLEX; and others with institutional information. 51. At this stage other documents were considered, including declarations such as the Universal Declaration of Human Rights, the Berlin Declaration on Tuberculosis, World Health Public health policy and legislation instruments and tools: an updated review and proposal for further research page 13 Assembly resolutions, WHO Regional Committee for Europe resolutions and International Law Association rules, as well as charters such as the European Charter on Counteracting Obesity. Inclusion of these non-legally binding documents is justified by the importance they assume in health and public health promotion and protection, as in the case of the International Code of Marketing of Breast-milk Substitutes, which was adopted into national legislation by many of its signatory countries. Literature review 52. The literature review was conducted in English. Review of policy and legal documents was conducted in English and Portuguese, as all global instruments and tools have been adopted into national law. A detailed collection of global and regional documents and policy documents already compiled by WHO was used as the primary source for this review. The results of a consultation exercise by WHO also provided relevant material, particularly for some eastern European countries. A recent collection of European legislation by the National Portuguese Assembly was available and also used to update this information. 53. The literature search was undertaken using Boolean logic, was unrestricted concerning time frame and included indexed journals and books. It was performed in bibliographic databases searched through a national platform called B-on, provided by the Ministry of Science of Portugal. The following databases are covered by this platform and were included in the literature search: Academic Search Complete, American Chemical Society, American Institute of Physics, Annual Reviews, Elsevier, ACMDigital Library BioMed Central, BioOne, Bioline International, Blackwell, Cambridge University Press, Cinahl, DOAJ, Elite, Emerald, Future Science Group, Health Business, IEEE, IOP Publishing, MedLine, MedicLatina, Nature Publishing Group, Nursing Reference Center, Psychology and Behavioral Science, PubMed Central, Public Library of Science (PLoS), RCAAP, Royal Society of Chemistry, Sage Publication, Scielo Global, SIAM, SportDiscus. SpringerLink, Taylor & Francis, Web of Knowledge, Web of Science, Wiley. 54. The search terms used were “public health instruments”, “public health tools” and “public health instruments and tools” (as exact phrases).In a second stage the terms “policy”, and “legislation” were also included in the search algorithm. 55. The literature search included the following exact search phrases in the subject field: • “public health instruments”, which retrieved 9055 documents • “public health tools”, which retrieved 12533 documents • “public health instruments and tools”, which retrieved 3014 documents. 56. Including the word “policy” in the above search terms resulted in: • “public health policy instruments”, which retrieved 3055 documents • “public health policy tools”, which retrieved 5084 documents • “public health policy instruments and tools”, which retrieved 1305 documents. 57. Including the word “legislation” in the above search terms resulted in: • “public health legislation instruments”, which retrieved 1824 documents • “public health legislation tools”, which retrieved 958 documents • “public health legislation instruments and tools”, which retrieved 57 documents. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 14 58. A first step in the classification of documents into the EPHO subdivisions consisted of reading the texts of the documents in question. When a clear identification with the EPHOs was not possible, the authors sought the area of closest proximity; this approach may have led to a loss of information and bias on further analysis of the documents in light of the goals pursued by the study (32). Findings 59. This review provides a refined map of the main global and regional policy and legal instruments of the range and type set out in the WHO Constitution of 1948. The information is categorised in line with the revised version of the 10 EPHOs forming the basis of the EAP following resolution EUR/RC61/R2 on strengthening public health capacities and services in Europe (1; 32) (see Box 1). 60. Analysis of available public health policy instruments and tools reveals several major gaps. In particular, a great majority are related to EU initiatives and apply only to EU countries, whereas fewer instruments and tools are identifiable among CIS and SEEHN countries. 61. A clear concentration of public health policy instruments and tools is linked to the first EPHOs in the list. EPHO 1 (surveillance), for example, is associated with 58 policy instruments, while EPHO 3 (health protection) is associated with 396 instruments. On the other hand, instruments and tools are relatively scarce in relation to EPHOs 7 and 9 (workforce and communication). 62. Evidence of monitoring and evaluation of public health instruments and tools is relatively scarce, although some instruments – including some non-legally binding ones – have produced a series of evaluation mechanisms to facilitate this. Among the 58 policy instruments and tools classified within EPHO 1 (surveillance) only 29 provided evidence of any type of evaluation, such as monitoring and assessment reports, activity reports, expected outputs, country implementation or transparency. A total of 37 policy instruments were found for EPHO 2 (response to health hazards and emergencies), among which evidence of any type of evaluation was found for only 18. Of the 396 policy instruments and tools classified under EPHO 3 (health protection) evidence of evaluation was found for 214; of the 70 instruments for EPHO 4(health promotion) evidence of evaluation was found for 36; and of the 17 instruments for EPHO 5 (disease prevention) evidence of evaluation was found for only 6. The range of legally and non-legally binding public health instruments at global and regional levels 63. There has been significant progress over the past two decades in developing global and regional public health instruments that seek to address specific areas of public health. Overall, the range of policy instruments for public health has expanded considerably over time. They have also tended to become more complex, taking into account the growing complexity of health governance in Europe, but they now also apply more fully the range of legal instruments set out in the WHO Constitution (see Box 2). Public health policy and legislation instruments and tools: an updated review and proposal for further research page 15 Source: WHO (33). 64. One useful issue arising from the current exercise relates to the intersection of global and regional initiatives with national and local ones, as well as valuation models. The inclusion of information on all these aspects in a single study matrix may contribute to a better understanding of how implementation of global initiatives filters down to the local level, and the gains (or lack thereof) that these juridical initiatives bring to the lives of individuals and populations. 65. Policy instruments for public health differ in the degree to which they are legally binding and in the ways they are negotiated and implemented, where the role of WHO may focus on an advisory, normative, collaborative or operational role, including mixed strategies. Among the normative instruments, regulations, conventions and agreements are usually regarded as legally binding instruments in a strict sense. Since 2000, legally binding instruments have become increasingly common, in particular at the global level. 66. The WHO European Region has a particularly strong record of adopting legal public health measures compared to the global picture. Legally binding public health tools represent one-third of the total number of available tools in the Region: this proportion is more than double the global average. 67. Although an extensive literature search was completed, the current report faces some limitations. Full identification of the broad range of instruments cannot be regarded as complete. Additional protocols to conventions and treaties have not been included in this review, and other documents may also be missing. Although it is possible to find a greater number of documents than those identified and classified here (see Table 3), some of those documents may need monitoring because they are in the process of ratification, and thus additional protocols may also arise during the negotiation process. Box 2. Nosocomial infections – Norwegian regulations The nationwide occurrence of nosocomial infections in Norway was first estimated in three prevalence studies of 1979, 1985 and 1991. In 1996, the Norwegian Ministry of Health issued regulations on the prevention of nosocomial infections. These regulations were revised in 2005. As part of the infection control programme, hospitals and long-term care facilities are obliged to have a nosocomial infection surveillance system in place and to report the results to the Norwegian Institute of Public Health, which coordinates the surveillance activities and publishes annual statistics. This surveillance system is compatible with the recommendations of the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) cooperation project of the EU. Norway. Regulations No. 610 of 17 June 2005 on protection against infection in the health service. Made in pursuance of, inter alia, Law No. 55 of 5 August 1994 on protection against communicable diseases (see IDHL, 1995, 46, 27, Norw. 95.5), these Regulations repeal Regulations No. 699 of 5 July 1996 on protection against infection in health institutions – nosocomial infections (see ibid., 1997, 48, 164, Norw. 97.3). They impose the requirement of an infection control programme on a wider range of establishments than that covered by the repealed Regulations. They comprise the following Chapters: 1. Purpose, scope, and definitions (Sec. 1-1 to 1-3); 2. Infection control programme, organization and supervision (Secs. 2-1 to 2-5); 3. Responsibility and tasks (Sec. 3-1 to 3-6); and 4. Final provisions (Secs. 4-1 to 4-3). Public health policy and legislation instruments and tools: an updated review and proposal for further research page 16 Table 3. Public health instruments and tools at global and regional levels Total Legally binding Non-legally binding Global 253 39 214 Regional 664 378 299 68. The increasing use of legally binding instruments is illustrated by the fact that since 2000 three out of eight WHO commissions and seven of the sixteen strategies adopted by the World Health Assembly have been of a more legally binding nature. Most notably, this is the case for the two new instruments (of the five new global regulations and conventions since 2000) the WHO FCTC and the IHR (see Box 3). 69. Examples of other important policy framework developments relevant for public health in the European Region are: • the Millennium Development Goals • the Global Strategy on Diet, Physical Activity and Health • national environment and health actions plans • the Protocol on Water and Health • other strategies for NCDs, in areas such as diet and physical activity, tobacco and alcohol • the Mental Health Declaration and Action Plan for Europe (see Box 4) • the EU health strategy 2008–2013, which includes chapters on HiAP and on global health • the European Regional Framework for Action for protecting health from climate change. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 17 Box 3. Implementation of the IHR in the WHO European Region In 2005, WHO Member States adopted the current IHR, which entered into force in June 2007. Since then, the States Parties and WHO have reiterated their commitment and taken important steps towards meeting the legally binding IHR requirements. Between June 2007 and July 2009, the national focal points and the WHO IHR Contact Point were in contact in respect of over 200 public health events in more than 40 States Parties in the WHO European Region. The purpose and scope of the IHR are “to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade” (IHR, Article 2). Hence, the IHR adopt a multisectoral approach and encompass a broad range of public health hazards (biological, chemical, radionuclear and of unknown etiology). Implementation of the IHR represents a unique opportunity to mobilize resources and develop sustainable public health capacities, serving both domestic and global public health. Since their entry into force, States Parties to the IHR and WHO have reiterated their commitment and taken important steps towards meeting their legally binding IHR requirements, which is a challenge that requires time, commitment and a willingness to change. The WHO Regional Office for Europe has been providing assistance to States Parties to implement the IHR, and the wide range of activities carried out have generally corresponded to the areas of work outlined in the WHO document International Health Regulations (2005): Areas of work for implementation, published in 2007: namely, fostering global partnerships; strengthening national disease prevention, surveillance, control and response systems; strengthening public health security in travel and transport; strengthening WHO global/regional alert and response systems; the management of specific risks; sustaining rights, obligations and procedures; and conducting studies and monitoring progress. The IHR implementation process depends on the tireless engagement of professionals from different disciplines and sectors at subnational, national and international levels. The implementation process will also be supported by the extraction and documentation of lessons learned, so that these can lead to change and serve to optimize event management and capacity strengthening under the IHR framework. The key challenges are: • maintaining a balance between theoretical monitoring exercises and the spirit of the IHR, to improve domestic and international public health capacities; • facilitating mechanisms to extract and build on the lessons learned from practice in a continuous, consultative and systematic fashion, to harmonize interpretation of the IHR and related practices, and ultimately to further improve the application of the IHR and maximize their anticipated benefits; and • reviewing the tools, mechanisms and provisions outlined in the IHR, building on the lessons learned, and without jeopardizing the spirit of the IHR and those provisions that efficiently serve the interests of public health. Source: WHO (34). 70. Governance of health in the European Region has become increasingly complex. Over time, there has been a tendency to move from comprehensive, overarching policy frameworks such as the Health for All strategy (first published in 1981; last updated in 2005) – which acted as a prominent umbrella for setting public health goals and policy initiatives – to an increasing Public health policy and legislation instruments and tools: an updated review and proposal for further research page 18 Box 4. The Helsinki Mental Health Declaration and Action Plan for Europe: a milestone for public mental health Mental health was put prominently on the political agenda in January 2005 when ministers from Member States and key stakeholders, including service user representatives, met at the WHO European Ministerial Conference on Mental Health in Helsinki. The Conference was a response to concern about the increasing burden of mental disorders in Europe, and to the awareness of a need to develop community-based mental health services. The ministers endorsed the Mental Health Declaration and Action Plan for Europe. The Conference defined the scope of mental health policy, stating that it encompasses promotion of mental well-being; tackling of stigma, discrimination and social exclusion; prevention of mental health problems; care for people with mental health problems; and social inclusion of those who have experienced mental health problems. The ministers committed themselves to implementation of mental health policy actions and to report back to WHO on the progress of implementation of the Declaration at an intergovernmental meeting, yet to be organized. The Conference had a decisive impact on mental health policy in Europe. An evaluation performed by the WHO Regional Office for Europe in 2008 concluded that nearly all countries have made significant progress. More than half the responding Member States reported adopting new mental health policies or updating their existing policies since 2005. For the EU, the Helsinki Conference gave impetus to an extensive process, materialized through several conferences, projects and key documents. An outline of an EU mental health strategy, based on the Conference results, was launched in the EU Green Paper on mental health, supported by a European Parliament resolution, and in 2009 the EU launched the European Pact for Mental Health and Well-being. differentiation and specialization of public health strategies into an ever-larger number of individual instruments covering specific fields, as illustrated in the list above. 71. In this respect, mental health policy (see Box 4) provides one example of an area of public health where the Regional Office has successfully shown leadership by policy action that has focused on a specific field of public health concern. Mental health policy is a good example to illustrate the need for focused action: it remains one of the most important public health issues and is high in the burden of disease rankings, including when economic costs are taken into consideration. Moreover, mental health is an indispensable part of public health, but mental health policy was a neglected field for a long time, as a result of stigma and discrimination. Source: Di Fiandra (35). 72. Two further trends have added to the complexity of the current mix of public health policy instruments: the increasing number of instruments and partnerships at the global level and the growing role of the European Commission in the public health agenda in the Region. Moreover, the recognition of the importance of strengthening health systems and the links of health with other social and economic policies, which at a regional level culminated in the Tallinn Charter, have further widened the range of ways of working with Member States. 73. Inevitably, the process of negotiation, implementation and monitoring of legally binding instruments comes at a considerably higher cost than that of “softer” policy instruments that do not have a legally binding nature. In the EU context, “‘soft law’ is the term applied to EU measures, such as guidelines, declarations and opinions, which, in contrast to directives, regulations and decisions, are not binding” (36), but derive from primary “hard” law, such as treaties, conventions, directives, regulations and decisions, and have to respect the legal Public health policy and legislation instruments and tools: an updated review and proposal for further research page 19 frameworks and boundaries expressed in these documents. Examples of these in the European Region are: • Together for health: a strategic approach for the EU 2008–2013 • Community strategy 2007–2012 on health and safety at work • European Code against Cancer • European Road Safety Action Programme • European Road Safety Observatory. 74. Although soft law instruments do not have legally binding force, they can be classified as legal acts since they can contain principles and basic or fundamental rules, or represent an early stage of the legislative process, or may contain rules adopted into national law. It is also possible that national courts take these instruments into consideration when they are called to decide issues related with the interpretation of national measures. In recent years, soft law instruments are “sometimes presented as a more flexible instrument in achieving policy objectives” (36). 75. Other non-legally binding but ethically and politically binding instruments and tools put in place by the activity and powers of WHO include charters, declarations, statements, strategies, policies, guidelines, standards, frameworks, codes of conduct and reports (such as the world health report and the European health report). The research undertaken as part of WHO’s remit could also be considered a public health instrument, especially when it comes to governance and decision-making. 76. Both new and re-emerging public health threats call for global cooperation and increasingly complex policy instruments and partnerships. An important example is the Green Light Committee (GLC) to control multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB, especially in countries with a high burden of M/XDR-TB (see Box 5). 77. These examples illustrate that agreements on public health action are an important part of the governance of public health. But are they sufficient in themselves to achieve priority health goals that countries in the Region have identified? As well as exploring what other actions are needed at the international level, it is also important to develop strategies for their implementation at national level, including cross-government commitment that can ensure that policies in all sectors are consistent with health goals, and actively support them. How core health services can support a wider public health strategy is also an important consideration. 78. WHO has given technical support to the development of strategies at the national level in many areas of public health, and how best to link international policy instruments to implementation at national and subnational level is an important consideration for the design of any new mix of policy instruments, bearing in mind the important role played by the Regional Office in this respect for a number of public health challenges. One such example is food and nutrition action plans, which had been endorsed in 45 of the Region’s Member States by 2005. These aim through a variety of activities to address nutritional deficiencies and unbalanced diets and to ensure the availability of healthy food to the general population. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 20 Box 5. Controlling MDR-TB: the GLC The GLC was formed in 2000 by the Stop TB Partnership. It was established as a multi- institutional partnership to promote access to life-saving high-quality second-line drugs at reduced prices for the treatment of MDR-TB and under rigorous monitoring to prevent the creation of resistance to second-line drugs, the last line of defence against TB. Major reductions in the prices of second-line drugs were achieved through negotiations with pharmaceutical companies and pooled procurement of drugs. Before the creation of the GLC, most resource-limited countries did not diagnose and treat MDR-TB patients, whereas today 65 countries have been approved by the GLC for MDR-TB management, with approved treatments to almost 60 000 people in 2009. In 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria decided that all procurement of medications to treat MDR-TB must be conducted through the GLC. A few years later, UNITAID, which supports the supply of commodities for AIDS, TB and malaria from taxes on airline tickets, also committed significant funding for second-line anti-TB drugs to resource-limited countries. These decisions were major moves to ensure availability of adequate quantities of quality-assured drugs and technical assistance to resource-limited settings. The first years of the GLC were crucial for developing a replicable model for feasible and cost-effective MDR-TB control in resource-limited countries. The initial phase ended in 2005, when compelling evidence on feasibility, effectiveness and cost–effectiveness of MDR-TB management under programmatic conditions was obtained from the projects approved and monitored by the GLC. Drawing upon the experiences of the GLC projects, WHO developed international guidelines for the programmatic management of drug-resistant TB. Countries that meet the WHO guidelines, with a strong Directly Observed Treatment Short course (DOTS) foundation and a solid plan to manage MDR-TB, can benefit from the GLC services: quality-assured second-line drugs at reduced prices, horizontal collaboration and knowledge-sharing facilities. The GLC also offers technical assistance and help with monitoring performance. Furthermore, it helps to raise potential donors’ interest and operates in collaboration with the Global Fund, UNITAID, United States Agency for International Development and corporate sector stakeholders. Sources: Stop TB Partnership (37); Green Light Committee Initiative (38). Instruments and tools classified by EPHO 79. All the policy instruments and tools reviewed were classified in terms of the 10 EPHOs, whose relevance and importance is highlighted in the EAP. Such classification thus has the potential to enable the establishment of a complete toolkit for the delivery of EPHOs across the WHO European Region. Furthermore, it facilitates identification of major gaps in terms of tools. 80. A first step in the classification of documents into the EPHO subdivisions consisted of reading the texts of the documents in question. When a clear identification with the EPHOs was not possible, the authors sought the area of closest proximity; this may have led to a loss of information and bias on further analysis of the documents in light of the goals pursued by the study. 81. The change in the wording of the EPHOs following resolution EUR/RC61/R2 forced a revision of the review’s classification system. Nevertheless, to date the majority of instruments and tools – especially those with global scope – fall under EPHO 3 (health protection), EPHO 4 (health promotion) and EPHO 6 (governance) (see Table 4). Public health policy and legislation instruments and tools: an updated review and proposal for further research page 21 Table 4. Numbers of legally binding and non-legally binding public health policy instruments by EPHO EPHO 1 2 3 4 5 6 7 8 9 10 Legally binding 21 12 306 31 2 41 3 1 0 0 Non- legally binding 37 25 90 39 15 259 11 5 5 2 Total 58 37 396 70 17 300 14 6 5 2 82. The 396 different tools for EPHO 3 (health protection) and the 300 for EPHO 6 (governance) represent more than 75% of the total number of public health tools available, and are particularly developed for EU countries. While CIS and SEEHN countries have historically strong services in EPHOs 1–3, capacity and laboratory equipment have often become outdated, and legislation and policy also need updating. 83. At the global level, legally binding instruments and tools are mainly concentrated in EPHO 3 (health protection) with 306 tools, EPHO 4 (health promotion) with 31 and EPHO 6 (governance) with 41. This corresponds to more than 90% of the total number of tools. However, no legally binding tools are available for EPHO 9 (communication) and EPHO 10 (research). 84. EPHO 6 (governance) appears here as an individual category, and those documents involving the whole of society, which may be classified as instruments of governance, were listed in subdivision A (ensuring a whole-of-government and whole-of-society approach to health and well-being). This choice is justified by a sense of coherence with other European health strategies, such as the Health for All policy. 85. In addition to the documents directly related to governance, this category also contains a set of instruments that are not legally binding, but are ethically and politically binding; these constitute the basic texts in the sense that they contain the reference values and principles to which stakeholders, Member States and international organizations are bound, and which they must implement within their powers and mandates. 86. The current classification system cannot be seen as a closed process, since it stems from the need to analyse the full texts of some documents, followed by the need to change the category to which they belong in some cases. 87. A continuing survey of these instruments will allow monitoring of how the health impact assessment strategy is reflected in all sectors, including development of the international texts that often frame national legislative initiatives. The issue of monitoring and impact assessment, which should be considered both a concern and a necessity, would require a change in the proper juridical techniques of drafting these documents. In the medium and long term, inclusion of comparable monitoring and evaluation mechanisms could contribute to a better adaptation of the legislation to the real needs of different stakeholders. 88. The use of EPHOs as criteria for the classification of legal documents highlights a difficulty arising from the fact that the EPHOs were not set up to have this purpose or goal. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 22 Box 6. “Best buy” interventions for NCDs The set of “best buy” interventions includes: • o o o o • o o o tobacco use tax increases smoke-free indoor workplaces and public places health information and warnings bans on tobacco advertising, promotion and sponsorship harmful alcohol use tax increases restricted access to retailed alcohol bans on alcohol advertising • unhealthy diet and physical inactivity o reduced salt intake in food o replacement of trans fat with polyunsaturated fat o public awareness through mass media on diet and physical activity. Another difficulty arises from the operational nature of EPHOs and their subdivisions, which are a checklist for countries to assess their capacity in terms of public health and health services; this difficulty is even more clearly demonstrated with the latest version of the EPHOs (see Box 1), in which the definitions are much more operational than in previous versions. 89. In addition, the number of documents and their size seems to justify the creation of a platform to serve as a repository for all these documents, which would enable swift access to the necessary information. Effectiveness of instruments and tools 90. The use of these public health instruments and tools – including actions to reduce alcohol consumption through taxation and advertising bans, tobacco control measures and road safety – can be highly cost-effective. While many of these actions would already be justified for other reasons, the cost–effectiveness evidence is a further argument in favour of their implementation. 91. Specific evidence on the effectiveness of different public health policy and legal instruments is currently limited, which makes it difficult to recommend one tool over another. The following section summarizes examples of targets in the main areas where evaluations were found. Overall, further evaluation is needed to inform the future effectiveness of different instruments and tools, including cost–effectiveness and feasibility of implementation. 92. A recent WHO report on “best buy” interventions for NCDs concludes that there is a set of interventions that have significant public health impact and are highly cost-effective, inexpensive and feasible to implement within the constraints of health systems; these can be considered “best buys” for investors (see Box 6). A range of other interventions that constitute “good buys” is also identified (3). Source: WHO (3). Public health policy and legislation instruments and tools: an updated review and proposal for further research page 23 93. The primary benefit is a reduction in premature mortality from NCDs. Studies have found that implementing a specific set of “best buy” interventions for NCDs in 23 large LMICs could prevent 30 million premature deaths from 2006 to 2015, or an average of 3 million per year. Total deaths from the four NCDs that were the focus of the United Nations high-level meeting on NCDs in 2011 amounted to 23.7 million in 2004, which indicates that at least 10–15% of premature deaths could be successfully averted through the scaled-up implementation of a core intervention package. 94. Population-based measures for reducing tobacco and harmful alcohol use, as well as unhealthy diet and physical inactivity, are estimated to cost US$ 2 billion per year for all LMICs – less than US$ 0.40 per person. Individual-based “best buy” interventions for NCDs – which range from counselling and drug therapy for cardiovascular disease to measures to prevent cervical cancer – bring the total annual cost to US$ 11.4 billion. On a per-person basis, the annual investment ranges from under US$ 1 in low-income countries to US$ 3 in upper middle- income countries. In health terms, the return on this investment will be many millions of avoided premature deaths. In economic terms, the return will be many billions of dollars of additional output. For example, reducing the mortality rate for ischaemic heart disease and stroke by 10% would reduce economic losses in LMICs by an estimated US$ 25 billion per year, which is three times greater than the investment needed for the measures to achieve these benefits. The WHO report (3) supplements existing knowledge by demonstrating the costs and benefits related to addressing the challenges posed by NCDs. 95. Concern with evaluation and monitoring, which initially arose in the context of environmental protection, is now present in all sectors of activity and in various instruments and tools. It was possible to find examples of evaluation and monitoring at different levels of action and within different initiatives, treaties, conventions, strategies and actions plans, as demonstrated in the “evaluation notes” category of the classification matrix. The analysis shows that different bodies of United Nations and EU institutions, and more recently WHO – as in the cases of the WHO FCTC and IHR – are the entities that provide more tools for assessing and monitoring (such as convention sites, assessment reports and “guideline kits”). 96. In the case of legal instruments, such as conventions and treaties, the monitoring process usually focuses on the process of ratification and entry into force. So far, only a few well- defined documents refer to systems of health impact assessment; a move towards this can be seen in the WHO FCTC and IHR initiatives and EU legislative activity. 97. The WHO FCTC demonstrates continued global commitment to decisive action against the global tobacco epidemic, which kills millions of people and costs hundreds of billions of dollars each year. A total of 173 parties to the WHO FCTC, covering about 87% of the world’s population, have made a legally binding commitment to implement effective tobacco control policies. The WHO FCTC provides countries with the necessary tobacco control tools that, when implemented and enforced, will reduce tobacco use and save lives (see Box 7). 98. Evaluation of the impact of the WHO FCTC and its measures is essential. At the same time, it is crucial that measurements are not monitored prematurely. Otherwise, there is a risk of incorrectly portraying low levels of impact and endangering political support for the policy. Additionally, caution should be taken when interpreting the impact of policies. The nature of the measures and exemptions and possible loopholes that could impact the compliance and enforcement must be understood. Such shortfalls could, in turn, affect the appearance of the effectiveness of the WHO FCTC, and this needs to be recognized. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 24 Box 7. The WHO FCTC The WHO FCTC, which entered into force in February 2005, is the world’s first global public health treaty, designed to tackle the devastating health, social, environmental and economic consequences of tobacco consumption and exposure. As of July 2012, 49 of the 53 WHO European Member States, as well as the European Community, have become parties to the convention, committing themselves to developing and implementing a comprehensive mix of evidence-based tobacco control measures. Globalization of the tobacco epidemic diminishes the capacity of individual countries to regulate tobacco through domestic measures alone. A coordinated, international response is essential. The international community is committed to a shared goal and the idea that with collective action, obstacles can be overcome and creative solutions can be found. The WHO FCTC adopts a whole-of-government and intersectoral approach, expanding beyond health into the arena of education, customs and trade sectors and finance. It is a concrete example of the whole-of-government approach: increasing tax on tobacco is the most effective way of reducing tobacco use and has the added benefit of increasing government revenue. The WHO FCTC recommends increasing the excise tax on tobacco products to at least 70% of the price. It is clear that to implement this measure, collaboration between the health and the finance sectors is necessary. In addition, to control a possible increase in illicit trade as a result of the higher taxes, the customs and trade sectors should also be involved. Intersectoral collaboration is also essential for the successful implementation of other key measures, such as banning advertising, protecting people from second-hand smoke and warning the public about the dangers of tobacco use. Approximately 3.8 billion people (55% of the world’s population) are covered by at least one tobacco control measure at the highest level of policy achievement, according to the latest WHO report on the global tobacco epidemic, including 1.1 billion covered by a new policy since 2008. In the WHO European Region, over 244 million people (27% of the population in the Region) became newly covered by at least one tobacco control measure at the highest level of achievement between 2008 and 2010. This has great potential to make remarkable improvements in health. For example, comprehensive smoke-free policies can reduce mortality and morbidity from exposure to second-hand tobacco smoke, even within a few months after the implementation of the law. The scientific literature indicates that just a few months after the implementation of smoke-free laws, improvements in respiratory health are experienced very quickly, and hospitalizations for myocardial infarctions can decrease. For example: • just three months after the comprehensive smoke-free legislation was enacted in Scotland, bar workers reported a 26% decrease in respiratory symptoms and asthmatic bar workers showed reduced airway inflammation; • within the first year of the introduction of the tobacco control law in Turkey there was a substantial decrease of 24.2% in the number of patients with smoking-related diseases. Additionally, increasing the price of tobacco through higher taxes is the single most effective way to decrease consumption and encourage tobacco users to quit. Increasing tobacco taxes by 10% generally decreases tobacco consumption by 4% in high-income countries and by about 8% in LMICs, while tobacco revenues increase by nearly 7%. In Ukraine, the average excise per cigarette pack increased more than six-fold between September 2008 and January 2010. This was accompanied by a decline of 16% for adolescent and young adult (12–29 years old) smokers. Furthermore, contrary to tobacco industry claims, tax increases do not create increased smuggling. When Spain raised tobacco taxes and strengthened law enforcement in the late 1990s, smuggling declined dramatically, while tobacco revenues increased by 25%. Sources: WHO (4; 5; 6) Public health policy and legislation instruments and tools: an updated review and proposal for further research page 25 The use of time-bound targets and tools for monitoring and evaluation 99. Time-bound targets and tools for monitoring and evaluation of health trends and policy implementation at the global, regional and national level have played a prominent role in a broad range of policy instruments and health policy strategies governing the work of the Regional Office. Examples of important initiatives are: • the Health for All initiatives (the original version of 1981/1985 and the 1991, 1998 and 2005 updates); • the health-related Millennium Development Goals; • the objectives set in WHO’s Eleventh General Programme of Work (GPW11); • the Tallinn Charter, with its commitment to accountability and health systems performance assessment; • several specific public health instruments and strategies, such as those on environment and health or on mental health that all have subsections on evaluation and monitoring, and sometimes more specific strategies on indicator and measurement development, including recommendations on what action is needed at the international level (including setting of standards, norms and cross-country information gathering). 100. The challenges of target setting have been clearly formulated since the first version of the Health for All strategy, which stated that targets should be: • formulated on the basis of scientific knowledge • directed towards a significant health problem • reliable, realistic, and simply and clearly expressed • quantified as far as possible (making progress measurable) • relevant to the regional strategy, politically acceptable and meaningful • attractive to the public, politicians, administrators and professionals (39). 101. It has been noted that health targets are particularly relevant for supporting policies that go beyond health care services to other key sectors, addressing the broader socioeconomic determinants of health (40). Since the original Health for All strategy in the early 1980s there has been a gradual shift of emphasis, with more focus on encouraging countries to set national targets as key governance tools to help them implement their own, national (and subnational) health policies (26; 31) (see also Box 8), with a growing reluctance to include normative tools for the whole European Region. 102. In comparison, the original set of Health for All targets aimed at a high level of precision, defining targets on the basis of the magnitude of the (public health) problem, past trends in its development, the expected magnitude and nature of the problem at the target date if nothing were done (based on projections), the effectiveness of proposed actions in dealing with the problems and the desired situation for the target date, for which actions were proposed. However, as the 2005 Health for All review among Member States of the European Region showed, one of the main success stories from the Health for All legacy was the fact that national policies that include health targets had been extensively adopted or drafted, “although their nature and implementation varied widely” (40). Public health policy and legislation instruments and tools: an updated review and proposal for further research page 26 Box 8. The evolving role of targets in WHO Health for All policies Health for All by the year 2000 (1981) The initial Health for All policy contained 38 non-legally binding targets that covered a rather comprehensive range of public health and health system goals ranging from health status improvements to promotion of healthy lifestyles, healthy environment, quality-oriented and cost-effective health care and health development strategies (including health information support). The targets varied, some of them being rather ambitious, some defined in very precise terms, whereas other were defined more generally, for example in terms of desirable policy developments. Monitoring of progress on targets was initially based on a list of over 200 originally approved indicators (65 of which were considered essential). These were assessed and published (enhancing completion and accountability) at three-year intervals. Some measurements used in the monitoring and evaluation were related to changes in absolute values (averages, proportions or ratios, prevalence, incidence or mortality from different conditions or ratios characteristic) and differences (relative reductions of the indicators) between and within countries and their subpopulations. In 1996 it was agreed that basic health statistics would be reported annually and survey data every three years, and that national coordinators would be appointed in countries to ensure direct transfer of the data to the Regional Office, with a full-scale evaluation every six years. Health21 (1998 update) The Health for All process was renewed in the mid-1990s, also based on the recognition that many targets were not achievable in the foreseeable future, or only in a few countries. The experience gained from Health for All suggested the need for more realistic and achievable targets. Except for those related to disease elimination, targets were not expected to be equally applicable to all countries but based on their situation and their ability to achieve them. Selection and monitoring of indicators were aimed at ensuring continuity of the previous Health for All experience. Most health-related indicators were collected routinely or otherwise available at national or international levels, but WHO provided a health survey platform (EUROHIS) for some important indicators. Target levels were set using projections based on historical trends and current situation analysis, subject to availability and quality of data. Target levels were defined as regional averages and were assessed against a 1995 baseline with an end date of 2020. Finally, the 2005 update, which is currently the latest version, no longer includes any normative targets for the whole European Region. Sources: WHO (41; 42; 43). 103. A preliminary review of existing policy instruments illustrates that these differ greatly in their approach towards monitoring and targeting. • Numerical target setting coexists with more broadly formulated policy targets for which no specific indicators were proposed (sometimes in the same documents, such as the Health for All strategies). • Where targets are mentioned explicitly, strategies for their measurement are often missing, such as in collaborative arrangements to establish international statistical norms and in systematic support to Member States for their implementation. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 27 • It is often unclear whether the right balance has been struck between resources devoted to implementation and those devoted to systematic evaluation. • Evaluation may suffer from “myopia”, focusing on accountability of special action and programmes rather than establishing a sustainable infrastructure (at national, but also at international level) for long-term monitoring and analysis, including for international comparisons and cross-country learning from good practice examples of public health policies. • There is some evidence that the policy pendulum swings over time between enthusiasm for regional and global target setting in public health and periods that are more sceptical of the virtue of targets. 104. The analysis enabled verification of an increasing number of articles relating to impact assessment models, both in the environmental sector and in cross-sector research (44), as well as among communities (45). Impact assessment is also an important instrument for policy and programmes. Some research includes the concept of equity as a fundamental tool for health impact assessment although more research is needed in this area. 105. As a health impact assessment aims to assess the potential impacts of a proposal and make recommendations to improve the potential, it is possible to verify in the classification matrix that the legally binding documents are those where the health impact assessment methodology is evident, and where comparison between countries is easier. The main areas where health impact assessments are found are those of environmental and occupational safety, although they should be applied to all areas and levels of governance as an instrument to improve health outcomes and minimize inequalities (41). 106. The matrix analysis presents a wide variety of options for monitoring and evaluation. In some cases, as with conventions and treaties, the process sometimes combines aspects of a strictly juridical nature (such as ratification or entry into force) with others on impact assessment. Although the EU initiatives have broad provision of assessment tools, it would be useful to analyse the existing models and identify the best practices to benchmark both the findings and the health outcomes and gains – as well as the instruments to obtain them – in the different countries of the EU Region, particularly in terms of surveillance, access to health care, financing, involvement and empowerment of the communities and issues related with health professionals and research. 107. As already stated, progress with comparable health indicators, as well as with health information at the country level has been uneven in the Region, both in terms of availability and of data quality, and in particular in the coverage of topics relevant to monitoring public health trends and health determinants, such as inequality in health and health care, lifestyles, and trends in threats and morbidity from chronic diseases, NCDs and mental health disorders. Data fragmentation and data quality problems are present for some of the most fundamental public health information topics, such as tobacco and alcohol consumption and diabetes prevalence, as well as the most common diseases, such as cancer. Conclusions 108. The renewed focus on, and commitment to, strengthening public health capacities and services calls for a comprehensive action plan, centred on actions that are strategic, that reflect modern public health practice (including a focus on both structural determinants and individual actions) and that are fully integrated with the main conclusions and messages of Health 2020. The purpose of the EAP is to ensure that public health services are strengthened to respond to the current and emerging public health challenges facing the WHO European Region. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 28 109. This report underpins and complements the EAP by reviewing the range of available public health instruments in order to develop evidence-based policies and tools for future programmes. The review makes a classification and analysis of available policy instruments and tools. By putting together all the current tools, it provides an assessment of the toolkit and identifies major gaps to be tackled in the future. 110. The purpose of this review is to provide the Regional Office, Member States and other partners with direction in addressing, among others, the questions below. • What are the relative advantages of the different types of public health instruments and tools available? • How can the effectiveness of public health instruments and tools be enhanced at Member State level? • How can gaps in the toolkit of available instruments and strategies be addressed? • How can evaluation and monitoring of these instruments and tools be made more effective? 111. It was not possible to answer these questions in full, but this study advances our understanding of the effective use of public health instruments and tools across the European Region. The following summarizes the responses to these questions. What are the relative advantages of the different types of public health instruments and tools available? 112. A recent report from the WHO Regional Office for Europe highlights four major roles for the law in advancing public health. These are: defining the objectives of public health and influencing its policy agenda; authorizing and limiting public health action with respect to protection of individual rights, as appropriate; serving as a tool for prevention; and facilitating the planning and coordination of governmental and nongovernmental health activities (2). 113. While for some areas (such as health protection) legally binding tools can reflect higher potential gains, for other areas (such as health promotion) the use of influence mechanisms can be more effective. Furthermore, both definition and enforcement of legally binding public health tools need to be considered when assessing the cost–effectiveness of these tools. It is particularly important to achieve a balanced approach with the different tools. While legislation is enforced through legal systems, national governments try to ensure implementation of national health strategies and policies through a range of monitoring, audit and performance management arrangements often associated with meeting standards. 114. This report concludes that an array of instruments and tools for policy and legislation is available to support the delivery of EPHOs in a wide variety of settings. The number and complexity of tools developed at the global and European levels has increased in recent years, as illustrated by the WHO FCTC and the IHR. While international regulations are non- negotiable, the degree and nature of governance arrangements, including regulation and legal enforcement, will vary across Member States. However, evaluation of these instruments and tools is not widely available; it is therefore difficult to compare the relative advantage of public health instruments and tools in different countries or at a regional level, or to recommend one tool over another. 115. The findings point out that the wide range of instruments available to WHO (including conventions, regulations, recommendations and standards) reflects the variations in deployment of specific instruments by different countries, and note changes in national regulatory frameworks arising from a growth in pluralism and democratization. There is a need to Public health policy and legislation instruments and tools: an updated review and proposal for further research page 29 familiarize government and public health agencies with a range of current public health instruments and tools, and to provide guidance on how to deploy them in tackling the major challenges of population health. How can the effectiveness of public health instruments and tools be enhanced at Member State level? 116. The use of these public health instruments and tools – including actions to reduce alcohol consumption through taxation and advertising bans, tobacco control measures and road safety – can be highly cost-effective. While many of these actions would already be justified for other reasons, the cost–effectiveness evidence is a further argument in favour of their implementation. 117. Specific evidence on the effectiveness of different public health policy and legal instruments is currently limited, which makes it difficult to recommend one tool over another. Further evaluation is needed to inform the future effectiveness of different instruments and tools, including cost–effectiveness and feasibility of implementation. 118. A recent WHO report on “best buy” interventions for NCDs concludes that there is a set of interventions that have significant public health impact and are highly cost-effective, inexpensive and feasible to implement within the constraints of health systems (3). The primary benefit is a reduction in premature mortality from NCDs. Studies have found that implementing a specific set of “best buy” interventions for NCDs in 23 large LMICs could prevent 30 million premature deaths between 2006 and 2015, or an average of 3 million per year. Population-based measures for reducing tobacco and harmful alcohol use, as well as unhealthy diet and physical inactivity, are estimated to cost US$ 2 billion per year for all LMICs; less than US$ 0.40 per person. 119. Approximately 3.8 billion people (55% of the world’s population) are covered by at least one tobacco control measure at the highest level of policy achievement, according to the latest WHO report on the global tobacco epidemic (4),including 1.1 billion covered by a new policy since 2008. In the WHO European Region, over 244 million people (27% of the population in the Region) became newly covered by at least one tobacco control measure at the highest level of achievement between 2008 and 2010. This has great potential to make remarkable improvements in health. How can gaps in the toolkit of available instruments and strategies be addressed? 120. A common feature of many health policy strategies and other public health instruments of the WHO Regional Office for Europe (and at the global level) has been the explicit recognition that gaps in knowledge are themselves one of the major health challenges of the future. Several important gaps emerged from the classification and mapping exercise, including gaps in the evidence to support the creation of policy instruments and tools. 121. The extensive mapping exercise undertaken for this review, structured along the lines of the 10 EPHOs set out in the EAP, indicates the EPHOs for which public health instruments and tools are available, as well as critical gaps, and highlights six major points. • There are 396 different tools for EPHO 3 (health protection) and 300 for EPHO 6 (governance). These two areas reflect more than 75% of the total number of public health tools available, and are particularly developed in EU countries. • There are 58 instruments and tools for EPHO 1 (surveillance), 37 for EPHO 2 (response to health hazards and emergencies), 70 for EPHO 4 (health promotion), 17 for EPHO 5 Public health policy and legislation instruments and tools: an updated review and proposal for further research page 30 (disease prevention), 14 for EPHO 7 (workforce) and 6 for EPHO 8 (organizational structures and financing). • EPHOs 9 (communication) and 10 (research) have only non-legally binding tools and instruments. • While countries of the CIS and SEEHN have historically strong services in EPHOs 1–3, capacity and laboratory equipment have often become outdated, and legislation and policy also need updating. • At the global level, legally binding instruments and tools are mainly concentrated in EPHO 3 (health protection) with 306 tools, EPHO 4 (health promotion) with 31 and EPHO 6 (governance) with 41 tools. This corresponds to more than 90% of the total number of tools. • The WHO European Region has a particularly strong record of adopting legal public health measures compared to the global picture. Legally binding public health tools represent one-third of the total number of available tools in the Region: this proportion is more than double the global average. 122. This report explores and embraces an HiAP approach for its synergistic potential. Laws and public policies enacted in other sectors may have unintended consequences on public health areas. Therefore, laws and policies in other sectors should be designed and implemented through a broader approach to maximize their positive effects on population’s health. For example, alcohol policy is influenced by EU trade law, but case law has often supported alcohol policy measures supportive of public health. Two available tools – health impact assessment and intersectoral targets – are of particular relevance. These will strengthen policy-making across all sectors, involving a range of actors both in decision-making and in accountability practices. 123. Another key question is whether and how international agreements and instruments can provide a framework for multidimensional actions. The WHO FCTC is perhaps a good example of success, as it sets out many types of actions at many levels involving legislation, regulation, partnership and cooperation. In the long term, its eventual aims will require the building of consensus across organizations, groups, economic and social actors and populations as a whole. How can evaluation and monitoring of these instruments and tools be made more effective? 124. The major gaps identified in the public health policy instruments and tools surveyed include a lack of explicit monitoring and impact assessment mechanisms, which should be addressed in the medium and long term. This would contribute to a better adaptation of the legislation in response to expressed needs of stakeholders at different levels of implementation. 125. The findings of this review suggest the relevance of a broader approach, based on performance measurement and accountability mechanisms. Further possible research for evaluation could include analysis of the processes, population health outcomes and cost– effectiveness of a wider range of of legal and policy interventions, as well as comparison with other instruments and tools. For example, compliance with international agreements should be reflected in the assessment of the relevant EPHOs, in order to identify national progress towards meeting internationally agreed standards. 126. The effectiveness of policy interventions is especially noteworthy against a backdrop of current and future economic exigencies and the high premium placed on efficiency and accountability. Adding a cost component to the assessment of the impact of public health laws and policies allows the identification of a set of strategies with the greatest value for money. A focus on improving both the processes and the health outcomes would allow a dynamic system Public health policy and legislation instruments and tools: an updated review and proposal for further research page 31 of accountability. In line with this, standards for the delivery of public health services should be made explicit and their quality ensured through regular scrutiny, inspection or assessment arrangements and accreditation. 127. Evidence is also scarce to support improvement of the global and regional architecture of policy instruments that reduce inequalities by improving production and delivery of global and regional public goods, including financial and other resource commitments that need to be made sustainable. There is a clear need to expand the current review of instruments and tools to the national and subnational levels, while still updating evidence at the regional level. Theoretical models of policy change should be included in further phases of analysis to help describe policy at different levels, to explain unanticipated rapid policy changes – such as have been seen following the WHO FCTC – and to identify idiosyncratic elements of policy change. 128. Further analysis at national level should also include more explicit concern about contextual factors and the quality of the sources of evidence used to avoid biased and incomplete explanations that do not take dynamic factors into account when analysing policy change. Approaches based on different models of analysis and on narratives of change are also possibilities for further research. Recommendations 129. Besides tackling the major gaps in public health tools by EPHO, there is also a need to reach a balance between regulation and persuasion. In fact, the effectiveness of traditional public health instruments and tools – including legislation, sanctions, regulations and taxes – may be limited without additional tools more focused on citizen engagement in behavioural changes. As the WHO report on governance states, “smart governance” is mainly evaluative, with regard not only to the tool being used but also to the choice and use of the tool in the context of a plurality of tools and modes of application (7). With this in mind, the information collected in this review makes it possible to offer the following recommendations to Member States of the WHO European Region. Advocate for effective tools and apply evidence to different settings • Advocate for tools with good evidence of effectiveness, such as “best buy” interventions for NCDs, the WHO FCTC and IHR. • Advocate for tobacco control, including tax increases, smoke-free indoor workplaces and public places, health information and warnings, and bans on tobacco advertising, promotion and sponsorship. • Advocate for control of harmful alcohol use, including tax increases, restricted access to retailed alcohol, and bans on alcohol advertising. • Advocate for promotion of healthy diet and physical activity, including reduced salt intake in food, replacement of trans fats with polyunsaturated fats, and raising public awareness of diet and physical activity through mass media. Strike a balance between regulation and persuasion • Balance different instruments and tools, such as HiAP, governance, and both legally and non-legally binding tools; for example, toolkits, guidelines, approaches to citizen engagement, advocacy and communication. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 32 Strengthen intersectoral responses and governance • Develop and employ an HiAP approach to consider the health effects of major legislation, regulations, and other policies that could potentially have a meaningful impact on public health. • Make use of health impact assessment tools to strengthen health gains in an HiAP approach. • Strengthen the governance and accountability arrangements of cross-sectoral policy. Address gaps in instruments and tools • Consider appropriate instruments and tools, and respond to the relative gaps in the toolkit to support the delivery of the 10 EPHOs. • Specifically, consider the development of tools for EPHOs 5, 7, 8, 9 and 10 (disease prevention, workforce, organizational structures and financing, communication and research). • Focus on enhancing the integration of health promotion, health protection and disease prevention by strengthening primary health care. Strengthen tools for monitoring performance and accountability • Enhance effective use of time-bound targets and tools for monitoring and evaluating health trends and policy implementation at national, regional and global levels. • Develop standards for the delivery of public health services and ensure their quality through regular scrutiny, inspection or assessment arrangements and accreditation. Strengthen evidence • Create a resource map and gap analysis of a wider range of instruments and tools, including toolkits and guidelines at the national level. • Based on findings from the systematic review on legal and policy tools, summarize the main types of evaluation report and the key findings on the effectiveness of tools. • Evaluate the population health outcomes and costs of major legislation, regulations and policies: such evaluation should occur before and after enactment. • Evaluate the process and feasibility of developing and enforcing legislation and policy. • Develop research on the cost–effectiveness of public health tools to inform policy-makers of the interventions with higher value for money. • Enhance methodologies to evaluate the relative effectiveness on health of a range of different instruments and tools. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 33 References 1. WHO Regional Committee for Europe resolution EUR/RC61/R2 on strengthening public health capacities and services in Europe: a framework for action. Copenhagen, WHO Regional Office for Europe, 2011 (http://www.euro.who.int/ data/assets/pdf_file/0017/150623/RC61_Res_02.pdf, accessed 12 July 2012). 2. Chichevalieva S. Developing a framework for public health law in Europe. Copenhagen, WHO Regional Office for Europe, 2011 (http://www.euro.who.int/ data/assets/pdf_file/0004/151375/e95783.pdf, accessed 12 July 2012). 3. From burden to “best buys”: reducing the economic impact of NCDs in low- and middle- income countries. Geneva, World Health Organization, 2011 (http://www.who.int/nmh/publications/best_buys_summary.pdf, accessed 12 July 2012). 4. WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. Geneva, World Health Organization, 2011 (http://whqlibdoc.who.int/publications/2011/9789240687813_eng.pdf, accessed 12 July 2012). 5. WHO report on the global tobacco epidemic, 2009: implementing smoke-free environments. Geneva, World Health Organization, 2009 (http://whqlibdoc.who.int/publications/2009/9789241563918_eng_full.pdf, accessed 12 July 2012). 6. Bilir N, Özcebe H, Ergüder T, Mauer-Stender K. Tobacco control in Turkey: story of commitment and leadership. Copenhagen, WHO Regional Office for Europe, 2012 (http://www.euro.who.int/ data/assets/pdf_file/0009/163854/e96532.pdf, accessed 12 July 2012). 7. Governance for health in the 21st century. Copenhagen, WHO Regional Office for Europe, 2011 (http://www.euro.who.int/ data/assets/pdf_file/0019/154252/Health-2020- Conf.-Governance-for-health .... pdf, accessed 12 July 2012). 8. Millennium Development Goals Report 2012. New York, United Nations, 2012 (http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2012/English2012.pdf, accessed 12 July 2012). 9. The financial crisis and global health: report of a high-level consultation. Geneva, World Health Organization, 2009 (http://www.who.int/mediacentre/events/meetings/2009_financial_crisis_report_en_.pdf, accessed 12 July 2012). 10. Nolte E, McKee M, eds. Caring for people with chronic conditions: a health system perspective. Maidenhead, Open University Press, 2008 (European Observatory on Health Systems and Policies series; http://www.euro.who.int/ data/assets/pdf_file/0006/96468/E91878.pdf, accessed 12 July 2012). 11. CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva, World Health Organization, 2008 (http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf, accessed 12 July 2012). 12. Protecting health in an environment challenged by climate change: European Regional Framework for Action Contribution of the Climate Change and Health Task Force. Copenhagen, WHO Regional Office for Europe, Public health policy and legislation instruments and tools: an updated review and proposal for further research page 34 2010(http://www.euro.who.int/ data/assets/pdf_file/0005/95882/Parma_EH_Conf_edoc 06rev1.pdf, accessed 12 July 2012). 13. McMichael AJ, Neira M, Bertollini R, Campbell-Lendrum D, Hales S. Climate change: a time of need and opportunity for the health sector. Lancet, 2009, 374(9707):2123–2125. 14. Menne B, Apfel F, Kovats S, Racioppi F. Protecting health in Europe from climate change. Copenhagen, WHO Regional Office for Europe, 2007 (http://www.euro.who.int/ data/assets/pdf_file/0016/74401/E91865.pdf, accessed 12 July 2012). 15. The European health report 2009: health and health systems. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/ data/assets/pdf_file/0009/82386/E93103.pdf, accessed 12 July 2012). 16. Public health services: policy [web site]. Copenhagen, WHO Regional Office for Europe, 2012 (http://www.euro.who.int/en/what-we-do/health-topics/Health-systems/public- health-services/policy, accessed 13 July 2012). 17. Vabo SI, Røiseland A. Tools of government in governance: the case of Norwegian urban government EURA Conference: City Futures in a Globalising World, Madrid, 2009 (http://www.cityfutures2009.com/PDF/24_Roiseland_Asbjorn.pdf, accessed 13 July 2012). 18. Harman G. Political instruments employed by governments to enhance university research and knowledge transfer capacity. IMHE General Conference 2004: Choices and Responsibilities: Higher Education in the Knowledge Society. Paris, OECD: Programme on Institutional Management in Higher Education, 2004 (http://www.oecd.org/dataoecd/12/44/33652724.PDF, accessed 13 July 2012). 19. Lascoumes P, Le Galès P. Understanding public policy through its instruments—from the nature of instruments to the sociology of public policy instrumentation. Governance: An International Journal of Policy, Administration, and Institutions, 2007, 20(1):1–21. 20. Perrels A. Selecting instruments for a greenhouse gas reduction policy in Finland, VATT Report 69. Helsinki, VATT, 2000. 21. White Paper on European Governance. Brussels, European Commission, 2001 (http://eur-lex.europa.eu/LexUriServ/site/en/com/2001/com2001_0428en01.pdf, accessed 13 July 2012). 22. Adelaide Statement on Health in All Policies: moving towards a shared governance for health and well-being. Adelaide, WHO, Government of South Australia, 2012 (http://www.who.int/social_determinants/hiap_statement_who_sa_final.pdf, accessed 13 July 2012). 23. Salamon L. The new governance and the tools of public action: an introduction. Fordham Urban Law Journal, 2000 28(5):1611–1674. 24. Siddiqi S, Masud TI, Nishtar S, Peters DH, Sabri B, Bile KM, Jama MA. Framework for assessing governance of the health system in developing countries: gateway to good governance. Health Policy, 2009, 90:13–25. 25. Developing the new European policy for health – Health 2020. Copenhagen, WHO Regional Office for Europe, 2011 (http://www.euro.who.int/ data/assets/pdf_file/0010/134299/07E_Health2020_110419_ eng.pdf, accessed 13 July 2012). 26. Lee K, Buse K, Fustukian S, eds. Health policy in a globalising world. Cambridge, Cambridge University Press, 2002. Public health policy and legislation instruments and tools: an updated review and proposal for further research page 35 27. Marks L, Hunter DJ, Alderslade R. Strengthening public health capacity and services in Europe: a concept paper. Copenhagen, WHO Regional Office for Europe, 2011 (http://www.euro.who.int/ data/assets/pdf_file/0007/152683/e95877.pdf, accessed 13 July 2012). 28. The new European policy for health – Health 2020. Copenhagen, WHO Regional Office for Europe, 2011 (http://www.euro.who.int/ data/assets/pdf_file/0005/148946/RC61_InfDoc4.pdf, accessed 13 July 2012). 29. Interim second report on social determinants of health and the health divide in the WHO European Region. Copenhagen, WHO Regional Office for Europe, 2011 (http://www.euro.who.int/ data/assets/pdf_file/0010/148375/id5E_2ndRepSocialDet- jh.pdf, accessed 13 July 2012). 30. International expert consultation on public health law. Rome, IDLO, WHO, O’Neill Institute for National and Global Health Law at Georgetown University, 2009 (http://www.who.int/hhr/health_law/idloconsultationreport1.pdf, accessed 13 July 2012). 31. The use of public policy instruments for public health in the European Region: experiences and potential. Copenhagen, WHO Regional Office for Europe, 2010 (document EUR/RC59/SC(4)/11). 32. European Action Plan for Strengthening Public Health Capacities and Services. Copenhagen, WHO Regional Office for Europe, 2012. 33. WHO international digest of health legislation [online database]. Geneva, World Health Organization, 2012 (http://apps.who.int/idhl- rils/results.cfm?language=english&type=ByTopic&strTopicCode=IVA1&strRefCode=N orw, accessed 16 July 2012). 34. Implementation of the International Health Regulations (2005) in the WHO European Region. Copenhagen, WHO Regional Office for Europe, 2009 (http://www.euro.who.int/ data/assets/pdf_file/0005/66992/RC59_edoc10.pdf, accessed 16 July 2012). 35. Di Fiandra T. European strategies for mental health. Annali dell’Istituto Superiore di Sanità, 2009 45(1):54–58. 36. European industrial relations dictionary [web site]. Dublin, Eurofound, 2011 (http://www.eurofound.europa.eu/areas/industrialrelations/dictionary/definitions/softlaw. htm, accessed 16 July 2012). 37. Stop TB Partnership: Stop TB Working Group on MDR-TB [web site]. Geneva, World Health Organization, 2011 (http://www.stoptb.org/wg/mdrtb/about.asp, accessed 17 July 2012). 38. Green Light Committee Initiative. Annual report 2009. Geneva, World Health Organization, 2009 (http://whqlibdoc.who.int/hq/2010/WHO_HTM_TB_2010.14_eng.pdf, accessed 17 July 2012). 39. Ritsatakis A, Barnes R, Dekker E, Harrington P, Kokko S, Makara P, eds. Exploring health policy development in Europe. Copenhagen, WHO Regional Office for Europe, 2000 (http://www.euro.who.int/ data/assets/pdf_file/0003/98301/E68395.pdf, accessed 17 July 2012). 40. Wismar M, McKee M, Ernst K, Srivastava D, Busse R, eds. Health targets in Europe: learning from experience. Copenhagen, WHO Regional Office for Europe, 2008 (Observatory Studies Series, No. 13; Public health policy and legislation instruments and tools: an updated review and proposal for further research page 36 http://www.euro.who.int/ data/assets/pdf_file/0008/98396/E91867.pdf, accessed 17 July 2012). 41. Global strategy for Health for All by the year 2000. Geneva, World Health Organization, 1981 (Health for All Series, No. 3; http://whqlibdoc.who.int/publications/9241800038.pdf, accessed 17 July 2012). 42. HEALTH21: an introduction to the Health for All policy framework for the WHO European Region. Copenhagen, WHO Regional Office for Europe, 1998 (Health for All Series, No. 5; http://www.euro.who.int/ data/assets/pdf_file/0004/109759/EHFA5- E.pdf, accessed 17 July 2012). 43. The Health for All policy framework for the WHO European Region: 2005 update. Copenhagen, WHO Regional Office for Europe, 2005 (http://www.euro.who.int/ data/assets/pdf_file/0008/98387/E87861.pdf, accessed 17 July 2012). 44. Mindell J, Bowen C, Herriot N, Findlay G, Atkinson S. Institutionalizing health impact assessment in London as a public health tool for increasing synergy between policies in other areas. Public Health, 2010, 124(2):107–114. 45. Cameron C, Ghosh S, Eaton SL. Facilitating communities in designing and using their own community health impact assessment tool. Environmental Impact Assessment Review, 2011, 31(4):433–437. 37 Annex to the document “Public health policy and legislation instruments and tools: an updated review and proposal for further research” EPHO 1: Surveillance of population health and well-being Title of instrument or tool with hyperlink Lead organiza- tion Level: global, regional, national or local Legal status Evaluation notes (monitoring and assessment reports; activity reports; expected outputs; countries implementation; transparency) International Health Regulations (2005) WHO Global Legally binding http://www.who.int/ihr/IHR_Monitoring_Framework_Checklis t_and_Indicators.pdf Commission Delegated Regulation (EU) No 363/2012 of 23 February 2012 on the procedural rules for the recognition and withdrawal of recognition of monitoring organisations as provided for in Regulation (EU) No 995/2010 of the European Parliament and of the Council laying down the obligations of operators who place timber and timber products on the market European Union (EU) Regional Legally binding not available (n/a) Commission Implementing Decision 2012/112/EU of 17 February 2012 amending Annex E to Council Directive 92/65/EEC as regards the model health certificates for animals from holdings and animals, semen, ova and embryos from approved bodies, institutes or centres EU Regional Legally binding n/a Commission Decision 2008/896/EC of 20 November 2008 on guidelines for the purpose of the risk-based animal health surveillance schemes provided for in Council Directive 2006/88/EC EU Regional Legally binding n/a Decision No 2119/98/EC of the European Parliament and of the Council of 24 September 1988 setting up a network for the epidemiological surveillance and control of communicable diseases in the Community EU Regional Legally binding http://ecdc.europa.eu/en/publications/Publications/Forms/EC DC_DispForm.aspx?ID=916; http://ecdc.europa.eu/en/publications/surveillance_reports/C ommunicable-Disease-Threats-Report/Pages/Communicable- Disease-Threats-Report.aspx; http://ecdc.europa.eu/en/publications/Publications/Forms/EC DC_DispForm.aspx?ID=767 Commission Decision 2003/534/EC of 17 July 2003 amending Decision No 2119/98/EC of the European Parliament and of the Council and Decision 2000/96/EC as regards communicable diseases listed in those decisions and amending Decision 2002/253/EC as regards the case definitions for communicable diseases EU Regional Legally binding n/a 38 Commission Decision 2007/875/EC of 18 December 2007 amending Decision No 2119/98/EC of the European Parliament and of the Council and Decision 2000/96/EC as regards communicable diseases listed in those decisions EU Regional Legally binding n/a Commission Decision 2000/57/EC of 22 December 1999 on the early warning and response system for the prevention and control of communicable diseases under Decision No 2119/98/EC of the European Parliament and of the Council EU Regional Legally binding n/a Commission Decision 2008/351/EC of 28 April 2008 amending Decision 2000/57/EC as regards events to be reported within the early warning and response system for the prevention and control of communicable diseases EU Regional Legally binding n/a Commission Decision 2009/547/EC of 10 July 2009 amending Decision 2000/57/EC on early warning and response system for the prevention and control of communicable diseases under Decision No 2119/98/EC of the European Parliament and of the Council EU Regional Legally binding n/a COM(2009) 228 final – Report from the Commission to the Council and the European Parliament: operation of the Early Warning and Response System (EWRS) of the Community Network for the epidemiological surveillance and control of communicable diseases during 2006 and 2007 (Decision 2000/57/EC) EU Regional Non- legally binding n/a COM(2007) 121 final – Report from the Commission to the Council and the European Parliament: on the operation of the Early Warning and Response Systems (EWRS) of the Community Network for the epidemiological surveillance and control of communicable diseases during years 2004 and 2005 (Decision 2000/57/EC) EU Regional Non- legally binding n/a COM(2005) 104 final – Report from the Commission to the Council and the European Parliament: report on the operation of the Early Warning and Response System of the community network for the epidemiological surveillance and control of communicable diseases (Decision 2000/57/EC) during 2002 and 2003 EU Regional Non- legally binding n/a The Tashkent Declaration “The Move from Malaria Control to Elimination” in the WHO European Region (2005) WHO Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_file/0004/147712 /RC61_edoc05.pdf; http://www.euro.who.int/__data/assets/pdf_file/0008/98774/ E92012.pdf 39 Decision No 2119/98/EC of the European Parliament and of the Council of 24 September 1998 setting up a network for the epidemiological surveillance and control of communicable diseases in the Community (on the network of epidemiological surveillance) EU Regional Legally binding http://ec.europa.eu/health/communicable_diseases/early_war ning/comm_legislation_en.htm; http://ec.europa.eu/health/communicable_diseases/labs/proj ects/index_en.htm; http://ec.europa.eu/health/preparedness_response/generic_p reparedness/index_en.htm; Decision No 2119/98/EC of the European Parliament and of the Council of 24 September 1998 setting up a network for the epidemiological surveillance and control of communicable diseases in the Community (on the communicable diseases to be covered) EU Regional Legally binding http://www.ecdc.europa.eu/en/publications/publications/101 1_sur_annual_epidemiological_report_on_communicable_dise ases_in_europe.pdf; http://ecdc.europa.eu/en/aboutus/Key%20Documents/08- 13_KD_Surveillance_of_CD.pdf Framework Action Plan to Fight Tuberculosis in the European Union EU/Europe an Centre for Disease Prevention and Control (ECDC) Regional Legally binding http://ecdc.europa.eu/en/publications/Publications/101111_S PR_Progressing_towards_TB_elimination.pdf; http://ecdc.europa.eu/en/publications/Publications/0803_SPR _TB_Action_plan.pdf Tuberculosis surveillance and monitoring in Europe WHO/ECD C Regional Non- legally binding http://ecdc.europa.eu/en/publications/publications/1203- annual-tb-report.pdf; Tuberculosis Programme ECDC Regional Non- legally binding http://ecdc.europa.eu/en/publications/Publications/101111_S PR_Progressing_towards_TB_elimination.pdf European Tuberculosis Surveillance Network ECDC Regional Non- legally binding n/a Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region 2011–2015 WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_file/0007/147832 /wd15E_TB_ActionPlan_111388.pdf&sa=U&ei=TDLPUIWNG6ia 0QXqvYGABg&ved=0CBUQFjAA&usg=AFQjCNG_M3BNwq0sUD 2gB-YHDDbE5YIwzQ Heat–health action plans WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we-do/health- topics/environment-and-health/Climate- change/activities/public-health-responses-to-weather- extremes2 Regional Committee resolution EUR/RC61/R3: Action Plan for implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012–2016 WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_file/0017/150614 /RC61_Res_03.pdf 40 Action plan for implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012–2016 WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_file/0009/164457 /e96502.pdf Regional Committee working document EUR/RC61/14: European strategic action plan on antibiotic resistance WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/who-we-are/whd/past-themes- of-world-health-day/world-health-day-2011-antibiotic- resistance-no-action-today,-no-cure-tomorrow/world-health- day-2011/developing-a-national-surveillance-system-for- antimicrobial-resistance; http://www.euro.who.int/en/where- we-work/member- states/belarus/news/news/2012/06/assessing-antibiotic- resistance-in-belarus Eliminating measles and rubella and preventing congenital rubella infection: WHO European Region strategic plan 2005–2010 WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we-do/health- topics/communicable-diseases/measles-and-rubella; http://www.euro.who.int/en/what-we-do/health- topics/disease-prevention/vaccines-and- immunization/publications/2012/who-epidemiological-brief- 24-measles-and-rubella-update,-afp-surveillance-review-in- kyrgyzstan; http://data.euro.who.int/cisid/ Health planning for large public events WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we-publish/information- for-the-media/sections/features/2012/health-planning-for- large-public- events&sa=U&ei=yTLPUMXtHIeO0AXmoIHQCA&ved=0CBUQFj AA&usg=AFQjCNFP7NKQqEC-bT4TOdWAiz9L2_uXPQ The European Surveillance System (TESSy) ECDC Regional Non- legally binding http://ecdc.europa.eu/en/activities/surveillance/tessy/pages/t essy.aspx&sa=U&ei=3zLPUMuQLYKd0QWKwIHIBQ&ved=0CBY QFjAA&usg=AFQjCNED96rDCNunWM9UMZiwmcXaDuJuCA Surveillance of Communicable Diseases in the European Union: a long-term strategy: 2008–2013 ECDC Regional Non- legally binding http://www.ecdc.europa.eu/en/activities/surveillance/strategi es_principles/Pages/surveillance_strategy.aspx&sa=U&ei=8jLP UP_ZNqqn0QXdqYAI&ved=0CBYQFjAA&usg=AFQjCNFkUFdNLfR utyqZRzUEcSLxyhgpjQ European Influenza Surveillance Network (EISN) ECDC Regional Non- legally binding http://ecdc.europa.eu/en/activities/surveillance/EISN/&sa=U& ei=CTPPUPmsKdSY1AWXgYE4&ved=0CBcQFjAA&usg=AFQjCNH a5wD9nvMJTXN8coLA4dI7fDLBEQ 41 WHO Regional Office for Europe influenza surveillance (EuroFlu.org) WHO Regional Office for Europe Regional Non- legally binding http://ecdc.europa.eu/en/publications/surveillance_reports/in fluenza/Pages/weekly_influenza_surveillance_overview.aspx European Network for HIV/AIDS Surveillance ECDC/WH O Regional Office for Europe Regional Non- legally binding http://ecdc.europa.eu/en/publications/Publications/Forms/EC DC_DispForm.aspx?ID=898; http://www.ecdc.europa.eu/en/publications/Publications/111 129_SUR_Annual_HIV_Report.pdf; http://ecdc.europa.eu/en/publications/Publications/101129_S UR_HIV_2009.pdf European Network for STI Surveillance ECDC Regional Non- legally binding http://ecdc.europa.eu/en/publications/Publications/Forms/EC DC_DispForm.aspx?ID=903; http://ecdc.europa.eu/en/publications/Publications/Forms/EC DC_DispForm.aspx?ID=902 European surveillance networks ECDC Regional Non- legally binding http://ecdpc.europa.eu/Activities/surveillance/EU_evaluation. html EU network for the epidemiological surveillance and control of communicable diseases EU Regional Non- legally binding n/a Antimicrobial Resistance and Healthcare-associated Infections Programme ECDC Regional Non- legally binding http://ecdc.europa.eu/en/activities/diseaseprogrammes/ARHA I/Pages/about_programme.aspx Emerging and Vector-borne Diseases Programme ECDC Regional Non- legally binding http://ecdc.europa.eu/en/activities/diseaseprogrammes/emer ging_and_vector_borne_diseases/Pages/strategy.aspx Food- and Waterborne Diseases and Zoonoses Programme ECDC Regional Non- legally binding http://ecdc.europa.eu/en/publications/Publications/Forms/EC DC_DispForm.aspx?ID=832; Influenza Programme ECDC Regional Non- legally binding http://www.ecdc.europa.eu/en/publications/Publications/110 9_TER_risk_assessment_H5N1_bird_flu_resurgence.pdf; http://www.ecdc.europa.eu/en/publications/Publications/110 906_TER_Rapid_Risk_Assessment_Oseltamivir- resistant%20influenza%20A.pdf 42 Sexually Transmitted Infections, including HIV and Blood-borne Viruses Programme ECDC Regional Non- legally binding http://ecdc.europa.eu/en/activities/diseaseprogrammes/hash/ Pages/about_programme.aspx; http://ec.europa.eu/health/sti_prevention/docs/ecdc_hiv_aids _surveillance_in_europe_2010_en.pdf; http://www.europarl.europa.eu/sides/getDoc.do?type=MOTIO N&reference=B7-2011-0615&language=EN Vaccine-preventable Diseases Programme ECDC Regional Non- legally binding http://ecdc.europa.eu/en/activities/diseaseprogrammes/vpd/P ages/index.aspx&sa=U&ei=ajXPULOFKaaO0AXZuICwDg&ved=0 CCsQFjAE&usg=AFQjCNGBohZUof4s2HM86VEPbmcQRgqUWg Tuberculosis, Influenza and Legionnaires’ disease Programme ECDC Regional Non- legally binding http://ecdc.europa.eu/en/activities/diseaseprogrammes/progr amme_tuberculosis/Pages/index.aspx; http://ecdc.europa.eu/en/activities/diseaseprogrammes/progr amme_on_influenza/Pages/index.aspx; http://ecdc.europa.eu/en/activities/surveillance/ELDSNet/Pag es/Index.aspx Epidemic intelligence Programme ECDC Regional Non- legally binding http://ecdc.europa.eu/en/activities/epidemicintelligence/Page s/Activities_EpidemicIntelligence.aspx&sa=U&ei=pTXPUIm3B-- S0QX4v4CADA&ved=0CBgQFjAA&usg=AFQjCNHExD- 2ABNJSvcgjMPCmzeJMjpr3w European Global Oral Health Indicators Development Project EU Regional Non- legally binding http://ec.europa.eu/health/ph_projects/2002/monitoring/fp_ monitoring_2002_frep_03b_en.pdf Commission Decision 2008/426/EC of 28 April 2008 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council EU Regional Legally binding http://ecdc.europa.eu/en/aboutus/Key%20Documents/08- 13_KD_Surveillance_of_CD.pdf Commission Decision 2009/363/EC of 30 April 2009 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2009:110:00 58:01:EN:HTML Commission Decision 2009/540/EC of 10 July 2009 amending Decision 2002/253/EC as regards case definitions for reporting Influenza A(H1N1) to the Community network EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2009:180:00 24:0024:EN:PDF Health Security in the European Union and Internationally EU Regional Non- legally binding http://ec.europa.eu/health/preparedness_response/docs/heal thsecurity_report_en.pdf 43 Commission staff working document on lessons learnt from the H1N1 pandemic and on health security in the European Union EU Regional Non- legally binding n/a Commission Decision 2009/547/EC of 10 July 2009 amending Decision 2000/57/EC on early warning and response system for the prevention and control of communicable diseases under Decision No 2119/98/EC of the European Parliament and of the Council EU Regional Legally binding n/a Commission Decision 2009/539/EC of 10 July 2009 amending Decision 2000/96/EC on communicable diseases to be progressively covered by the Community network under Decision No 2119/98/EC of the European Parliament and of the Council EU Regional Legally binding n/a Commission Decision 2009/540/EC of 10 July 2009 amending Decision 2002/253/EC as regards case definitions for reporting Influenza A(H1N1) to the Community network EU Regional Legally binding n/a Bremen Declaration on Responsibility and Partnership – Together Against HIV/AIDS EU Regional Non- legally binding http://ec.europa.eu/eahc/projects/linkedocument/800054.pdf Technical guidance document on procedure for communication about SARS events Technical guidance document on procedure for communication to Member States, the European Centre for Disease prevention and Control and the Commission and about SARS events EU Regional Non- legally binding n/a Commission Decision 2009/312/EC of 2 April 2009 amending Decision 2000/96/EC as regards dedicated surveillance networks for communicable diseases EU Regional Legally binding n/a Council Recommendation 2009/C 151/01 of 9 June 2009 on patient safety, including the prevention and control of healthcare associated infections EU Regional Non- legally binding n/a COM(2008) 679 final – Communication from the Commission to the European parliament, the Council, the European Economic and Social Committee and the Committee of the Regions: on rare diseases: Europe's challenges EU Regional Non- legally binding http://ec.europa.eu/health/ph_threats/non_com/docs/rare_c om_en.pdf Council Recommendation 2009/C 151/02 of 8 June 2009 on an action in the field of rare diseases EU Regional Non- legally binding n/a Communicable disease control in emergencies WHO Global Non- legally binding http://www.who.int/diseasecontrol_emergencies/en/ WHO recommended surveillance standards WHO Global Non- legally n/a 44 binding Protocol for the Assessment of National Surveillance Systems WHO Global Non- legally binding n/a Communicable disease surveillance and response systems: guide to monitoring and evaluating WHO Global Non- legally binding n/a European Guidelines for Control and Prevention of Travel Associated Legionnaires’ Disease EU Regional Non- legally binding n/a 45 EPHO 2: Monitoring and response to health hazards and emergencies EPHO subdivision Title of instrument or tool with hyperlink Lead organization Level: global, regional, national or local Legal status Evaluation notes (monitoring and assessment reports; activity reports; expected outputs; countries implementation; transparency) A .C on tr ol o f c om m un ic ab le d is ea se Action plan for implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012–2016 WHO Regional Office for Europe Regional Non- legally binding n/a Regulation (EC) No 1907/2006 of the European Parliament and of the Council of 18 December 2006 concerning the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) EU Regional Legally binding http://epp.eurostat.ec.europa.eu/statistics_ex plained/index.php?title=File:REACH_Baseline_C over.PNG&filetimestamp=20100831100357 Environmental health in emergencies and disasters: a practical guide (2002) WHO Global Non- legally binding http://www.who.int/water_sanitation_health/ hygiene/emergencies/em2002intro.pdf Emergency waste management guidelines WHO Global Non- legally binding http://www.who.int/hac/techguidance/pht/75 61EmergencyWasteManagementGuidelines.pdf &sa=U&ei=ijbPULHaBcSX0QWJp4GwBA&ved=0 CBoQFjAC&usg=AFQjCNEGGhd92JTrAvcKgZQgZ UUw5QV_Kg B. Co nt ro l o f e nv ir on m en ta l h ea lth ha za rd s WHO Human Health Risk Assessment Toolkit: Chemical Hazards WHO Global Non- legally binding http://www.who.int/ipcs/methods/harmonizati on/areas/ra_toolkit/en/index.html&sa=U&ei=n TbPUNL_FLDK0AXPmYDQDQ&ved=0CBYQFjAA &usg=AFQjCNHxJfHKeCPl4SbZZJqjD4_B69goag Assessing microbial safety of drinking-water: Improving approaches and methods WHO/ Organisation for Economic Co-operation and Development ( OECD) Global Non- legally binding http://www.who.int/water_sanitation_health/ dwq/9241546301/en/&sa=U&ei=rTbPUMjvF4m I0AXZjoCwDA&ved=0CBYQFjAA&usg=AFQjCNF7 XgSS6_Y5aWLl-JzJqG76XMGpvg Council Directive 98/83/EC of 3 November 1998 on the quality of water intended for human consumption EU Regional Legally binding http://ec.europa.eu/environment/water/water -drink/reporting_en.html 46 Commission Decision 2005/618/EC of 18 August 2005 amending Directive 2002/95/EC of the European Parliament and of the Council for the purpose of establishing the maximum concentration values for certain hazardous substances in electrical and electronic equipment EU Regional Legally binding http://ec.europa.eu/environment/waste/weee /legis_en.htm; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:52008SC2933:EN:NoT; http://www.consilium.europa.eu/uedocs/cms_ data/docs/pressdata/en/jha/130724.pdf Directive 2008/35/EC of the European Parliament and of the Council of 11 March 2008 amending Directive 2002/95/EC on the restriction of the use of certain hazardous substances in electrical and electronic equipment as regards the implementing powers conferred on the Commission EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2008:081:0067:0068:EN:PDF Directive 2011/65/EU of the European Parliament and of the Council of 8 June 2011 on the restriction of the use of certain hazardous substances in electrical and electronic equipment (recast) EU Regional Legally binding http://ec.europa.eu/environment/waste/weee /studies_weee_en.htm; http://www.who.int/ipcs/methods/harmonizati on/areas/final_report.pdf Rotterdam Convention on the Prior Informed Consent Procedure for certain hazardous Chemicals and Pesticides in international trade United Nations Global Legally binding http://www.pic.int/Implementation/ProgressR eport/tabid/1127/language/en- US/Default.aspx; http://www2.unitar.org/cwm/publications/cw/ rotterdam/Rotterdam_Guidance_23_Feb_09.p df Council Decision 2006/730/EC of 25 September 2006 on the conclusion, on behalf of the European Community, of the Rotterdam Convention on the Prior Informed Consent Procedure for certain hazardous chemicals and pesticides in international trade EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2006:299:0023:0025:EN:PDF Council Decision 2011/162/EU of 14 March 2011 establishing the position to be taken by the European Union within the fifth meeting of the Conference of the Parties of the Rotterdam Convention as regards the amendments to Annex III to the Rotterdam Convention on the Prior Informed Consent Procedure for certain hazardous chemicals and pesticides in international trade EU Regional Legally binding http://eur- lex.europa.eu/Result.do?direct=yes&lang=en& xsl=celex-som,celex- txt&PgSize=128&where=CC:15102050* Flooding in Europe: health risks EU Regional Non- legally binding http://www.eib.org/attachments/strategies/flo od_risk_management_guide_en.pdf 47 Directive 2007/60/EC of the European Parliament and of the Council of 23 October 2007 on the assessment and management of flood risks EU Regional Legally binding http://ec.europa.eu/environment/water/flood _risk/implem.htm European Flood Alert System (EFAS) EU Regional Non- legally binding http://www.efas.eu/&sa=U&ei=- jbPUJ6nOa2Y0QWu4IDICw&ved=0CBUQFjAA& usg=AFQjCNGxNTA2GCtZUajW1_Wd0tHcb5O9 UA Technical Guidelines – Emergency Management Essentials WHO Global Non- legally binding http://www.who.int/hac/techguidance/ems/en /&sa=U&ei=CzfPULKOFKbF0QWZrIC4Aw&ved= 0CBUQFjAA&usg=AFQjCNELtBtSPApMCLzcDPslx NkqPgTWZg Directive 96/82/EC of 9 December 1996 on the control of major-accident hazards involving dangerous substance EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71996L0082:EN:NoT; http://ec.europa.eu/environment/seveso/revie w.htm Security Technology Assessment Unit EU Regional Non- legally binding http://sta.jrc.ec.europa.eu/&sa=U&ei=HTfPULu 4NtCp0AWM7IDIDQ&ved=0CBYQFjAA&usg=AF QjCNGcAL1WzTdwvpdksZsQlPrKUPtRyw Regulation (EC) No 1272/2008 of the European Parliament and of the Council of 16 December 2008 on classification, labelling and packaging of substances and mixtures EU Regional Legally binding http://ec.europa.eu/enterprise/sectors/chemic als/documents/classification/archives/index_en .htm Guidelines for drinking-water quality, fourth edition 2011 WHO Global Non- legally binding http://www.who.int/water_sanitation_health/r esources/hia/en/index.html Guidelines for safe recreational waters WHO Global Non- legally binding http://whqlibdoc.who.int/publications/2003/9 241545801.pdf&sa=U&ei=MTfPUNCMFeWr0AX nrICQBw&ved=0CBwQFjAC&usg=AFQjCNEg5ZH F8C2u38uE7NtXti8otAMUyA WHO Air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide – global update 2005 WHO Global Non- legally binding http://www.who.int/hia/tools/toolkit/en/index .html Guidelines for the safe use of wastewater, excreta and greywater WHO Global Non- legally binding http://www.who.int/water_sanitation_health/ wastewater/en/ 48 Outbreak surveillance and response in humanitarian emergencies: WHO Guidelines for EWARN implementation (2012) WHO Global Non- legally binding http://whqlibdoc.who.int/hq/2012/WHO_HSE_ GAR_DCE_2012_1_eng.pdf&sa=U&ei=RzfPUJy9 NsWS0QWBzYGIAg&ved=0CBUQFjAA&usg=AF QjCNE_QS6-8lWu3X8kOobpPx0v7TS8WQ C. La bo ra to ry s up po rt fo r in ve st ig at io n of h ea lth th re at s Natural disaster mitigation in drinking-water and sewerage systems: guidelines for vulnerability analysis Pan American Health Organization (PAHO) /WHO Global Non- legally binding http://www.paho.org/english/Ped/nd- water_mit.pdf&sa=U&ei=WDfPUN6uOsSs0QW L0IH4Cw&ved=0CBYQFjAA&usg=AFQjCNHX7JP 7Glk2ktHkkogfnmoYNbSXBA WHO European Region influenza laboratory network WHO Regional Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/communicable- diseases/influenza/news/news/2012/5/better- labs-for-better-health-strengthening- laboratory-services-in-tajikistan; http://www.euro.who.int/__data/assets/pdf_fi le/0009/146979/NIC_evaluation_report_v2.pdf Decision No 2119/98/EC of the European Parliament and of the Council of 24 September 1998 setting up a network for the epidemiological surveillance and control of communicable diseases in the Community EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do%3Furi %3DCELEX:31998D2119:EN:NOT&sa=U&ei=gTf PUOCNA6m00QXH- ICgDQ&ved=0CBUQFjAA&usg=AFQjCNE9VeR0X 62THUI1mDhGL2_qQ922xA D .P re pa re dn es s an d re sp on se to p ub lic h ea lth em er ge nc ie s Communicable diseases: laboratory networking EU Regional Non- legally binding http://ec.europa.eu/food/food/biosafety/labor atories/bio_risks_en.htm Proposal 2011/0421 (COD) for a Decision of the European Parliament and of the Council on serious cross-border threats to health EU Regional Legally binding http://ec.europa.eu/health/preparedness_resp onse/docs/hsi_ia_en.pdf Communication COM(2005) 607 final from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions on Pandemic Influenza Preparedness and Response Planning in the European Community EU Regional Non- legally binding http://ec.europa.eu/health/preparedness_resp onse/docs/0712_ter_pandemic_influenza_prep aredness_in_eu_eea.pdf Council Conclusions on strengthening chemical, biological, radiological and nuclear (CBRN) security in the European Union - an EU CBRN Action Plan EU Re Non- legally binding http://register.consilium.europa.eu/pdf/en/09/ st15/st15505-re01.en09.pdf Biological Risks EU Regional Non- legally n/a 49 binding Technical guidance on generic preparedness planning for public health emergencies EU Regional Non- legally binding n/a Biological Incident Response and Environmental Sampling – a European Guideline on Principles of Field Investigation EU Regional Non- legally binding n/a Generic Public Health Preparedness in Europe EU Regional Non- legally binding n/a Communication COM (2003) 338 from the Commission to the Council, the European Parliament and the European Economic and Social Committee: A European Environment and Health Strategy EU Regional Non- legally binding http://ec.europa.eu/eahc/health/highlights11. html 50 EPHO 3: Health protection, including environmental, occupational, food safety and others EPHO subdivision Title of instrument or tool with hyperlink Lead organization Level: global, regional, national or local Legal status Evaluation notes (monitoring and assessment reports; activity reports; expected outputs; countries implementation; transparency) A .E nv ir on m en ta l s af et y Doha Declaration on TRIPS Agreement and Public Health World Trade Organization (WTO) Global Non- legally binding http://www.wto.org/english/tratop_e/trips_e/ public_health_e.htm 1979 Convention on Long-Range Transboundary Air Pollution United Nations Economic Commission for Europe (UNECE) Regional Legally binding http://www.unece.org/env/lrtap/ic/reports.ht ml Convention on the Protection and Use of Transboundary Watercourses and International Lakes UNECE Regional Legally binding http://www.unece.org/index.php?id=11644&L =0 Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes UNECE Regional Legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0007/88603/E89602.pdf Stockholm Convention on Persistent Organic Pollutants United Nations Global Legally binding http://chm.pops.int/Implementation/GlobalMo nitoringPlan/MonitoringReports/tabid/525/Def ault.aspx; http://chm.pops.int/Implementation/Effectiven essEvaluation/Implementation/tabid/139/Defa ult.aspx; http://ec.europa.eu/environment/pops/pdf/se c_2007_341.pdf Preliminary dose estimation from the nuclear accident after the 2011 Great East Japan Earthquake and Tsunami WHO Global (and Japan) Non- legally binding http://whqlibdoc.who.int/publications/2012/9 789241503662_eng.pdf Regional Sea Conventions United Nations Regional Legally binding http://www.marinebiodiversityseries.org/repor ts/UNEP%20Global%20Synthesis%20Marine%2 0Biodiversity%20Series.pdf 51 Directive 2002/49/EC of the European Parliament and of the Council of 25 June 2002 relating to the assessment and management of environmental noise EU Regional Legally binding http://www.mepa.org.mt/file.aspx?f=6847; http://bib.irb.hr/datoteka/202624.718-0.pdf; http://www.epa.ie/downloads/advice/Noisema pping/EPA%20Guidance%20Note%20for%20No ise%20Action%20Planning.pdf Directive 2000/60/EC of the European Parliament and of the Council of 23 October 2000 establishing a framework for Community action in the field of water policy EU Regional Legally binding http://ec.europa.eu/environment/pubs/pdf/fac tsheets/water-framework-directive.pdf Directive 2006/118/EC of the European Parliament of the Council of 12 December 2006 on the protection of groundwater against pollution and deterioration EU Regional Legally binding http://circa.europa.eu/Public/irc/env/wfd/libra ry?l=/framework_directive/guidance_documen ts/guidance_n18pdf/_EN_1.0_&a=d Commission Directive 2009/90/EC of 31 July 2009 laying down, pursuant to Directive 2000/60/EC of the European Parliament and of the Council, technical specifications for chemical analysis and monitoring of water status EU Regional Legally binding http://ec.europa.eu/environment/water/water -dangersub/index.htm#technical Directive 2006/7/EC or the European Parliament and of the Council of 15 February 2006 concerning the management of bathing water quality and repealing Directive 76/160/EEC EU Regional Legally binding http://ec.europa.eu/environment/water/water -bathing/report_2012.html Directive 2008/1/EC of the European Parliament and of the Council of 15 January 2008 concerning integrated pollution prevention and control EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2008:024:0008:0029:en:PDF Council Directive 91/676/EEC of 12 December 1991 concerning the protection of water against pollution caused by nitrates from agricultural sources EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:52002DC0407:EN:NoT Climate law – Acquis of the European Union EU Regional Legally binding http://ec.europa.eu/clima/policies/lowcarbon/ ccs/implementation/index_en.htm Kiev Protocol on Pollutant Release and Transfer Registers UNECE Regional Legally binding http://www.unece.org/fileadmin/DAM/env/pp /prtr/guidance/PRTR_May_2008_for_CD.pdf Convention on access to information, public participation and access to justice in environmental matters (Aahrus Convention) UNECE Regional Legally binding http://www.unece.org/env/pp/related.html; http://www.unece.org/fileadmin/DAM/env/pp /Implementation%20reports%202008/Estonia_ as_submitted_2007_12_3.pdf; http://www.unece.org/fileadmin/DAM/env/pp /acig.pdf 52 Directive 2001/18/EC of the European Parliament and of the Council of 12 March 2001 on the deliberate release into the environment of genetically modified organisms and repealing Council Directive 90/220/EEC – Commission Declaration EU Regional Legally binding http://gmo- crl.jrc.ec.europa.eu/statusofdoss.htm The Vienna Convention for the Protection of the Ozone Layer United Nations Global Legally binding http://ozone.unep.org/Data_Reporting/ The Helsinki Rules on Uses of the Waters of International Rivers (1966), updated in 2004 by the Berlin Rules on Water Resources International Law Association Global Non- legally binding http://www.nri.org/projects/waterlaw/Docum ents/Inception_Report.pdf Agenda 21 United Nations Global Non- legally binding http://www.un.org/esa/dsd/dsd_sd21st/21_pd f/SD21_Study1_Synthesis.pdf; http://www.johannesburgsummit.org/html/pre p_process/national_reports/kazakstan_natl_as sess3008.pdf United Nations Framework Convention on Climate Change United Nations Global Legally binding http://unfccc.int/national_reports/items/1408. php Rio Declaration on Environment and Development United Nations Global Non- legally binding n/a EU Mercury Strategy EU Regional Legally binding http://ec.europa.eu/environment/chemicals/m ercury/pdf/extended_impact_assessment.pdf Regulation (EC) No 1102/2008 of the European Parliament and of the Council of 22 October 2008 on the banning of exports of metallic mercury and certain mercury compounds and mixtures and the safe storage of metallic mercury EU Regional Legally binding http://ec.europa.eu/environment/chemicals/m ercury/pdf/extended_impact_assessment.pdf Exposure to mercury: a major public health concern WHO Global Non- legally binding n/a Rio+20 United Nations Conference on Sustainable Development United Nations Global Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/environment-and- health/sections/news/2012/06/rio20-puts- health-at-the-heart-of-development-goals United Nations Environmental Law United Nations Global Legally binding http://www.unep.org/geo/GEO_news.asp; http://www.unep.org/geo/GEO_assessment.as p Bahia Declaration on Chemical Safety WHO Global Non- legally http://www.chem.unep.ch/pops/POPs_Inc/INC _5/inf5-8/inf8.pdf 53 binding Environment: Chemicals EU Regional Legally binding http://library.certh.gr/libfiles/PDF/SPIN-321- EU-ASSESSMNT-TOOLS-NEW-EU-CHEMICALS- POLICY-REACH040122-PP15-Y-2003.pdf; http://ec.europa.eu/enterprise/sectors/chemic als/documents/reach/review2012/baseline_en. htm; http://ec.europa.eu/enterprise/sectors/chemic als/documents/reach/review2012/restrictions_ en.htm; http://ec.europa.eu/enterprise/sectors/chemic als/documents/reach/review2012/health_env_ benefits_en.htm Directive 2004/35/CE of the European Parliament and of the Council of 21 April 2004 on environmental liability with regard to the prevention and remedying of environmental damage EU Regional Legally binding http://europa.eu/legislation_summaries/enter prise/interaction_with_other_policies/l28120_ en.htm Directive 2008/99/EC of the European Parliament and of the Council of 19 November 2008 on the protection of the environment through criminal law EU Regional Legally binding http://europa.eu/legislation_summaries/justice _freedom_security/fight_against_organized_cri me/ev0012_en.htm Council Directive 91/271/EEC of 21 May 1991 concerning urban waste water treatment EU Regional Legally binding http://ec.europa.eu/environment/legal/imple mentation_en.htm Commission Directive 98/15/EC of 27 February 1998 amending Council Directive 91/271/EEC with respect to certain requirements established in Annex I thereof EU Regional Legally binding http://eur- lex.europa.eu/Result.do?direct=yes&lang=en& where=LB%3A31991L0271&whereihm=Base+ju ridique%3A31991L0271 Regulation (EC) No 1907/2006 of 18 December 2006 concerning the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) and establishing a European Chemicals Agency EU Regional Legally binding http://ec.europa.eu/environment/chemicals/re ach/background/i_a_en.htm The European Environment and Health Process (2010–2016): Institutional framework WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/environment-and- health/evidence-and-data 54 Regulation (EC) No 1272/2008 of the European Parliament and of the Council of 16 December 2008 on classification, labelling and packaging of substances and mixtures amending and repealing Directives 67/548/EEC and 1999/45/EC, and amending Regulation (EC) No 1907/2006 EU Regional Legally binding http://echa.europa.eu/web/guest/regulations/ clp/legislation Communication COM(2005) 446 final from the Commission to the Council and the European Parliament: Thematic Strategy on Air Pollution EU Regional Legally binding http://ec.europa.eu/environment/air/review_a ir_policy.htm Clean Air For Europe (CAFE) Programme EU Regional Legally binding Directive 2008/50/EC of the European Parliament and of the Council of 21 May 2008 on ambient air quality and cleaner air for Europe EU Regional Legally binding http://europa.eu/legislation_summaries/enviro nment/air_pollution/ev0002_en.htm; http://ec.europa.eu/environment/air/pdf/Surv ey%20AQD%20review%20- %20Part%20I%20Main%20results.pdf Council Directive 96/62/EC of 27 September 1996 on ambient air quality assessment and management EU Regional Legally binding http://ec.europa.eu/environment/air/quality/l egislation/index.htm Council Directive 1999/30/EC of 22 April 1999 relating to limit values for sulphur dioxide, nitrogen dioxide and oxides of nitrogen, particulate matter and lead in ambient air EU Regional Legally binding http://ec.europa.eu/environment/air/pdf/1999 _30_ec_review_report.pdf Directive 2000/69/EC of the European Parliament and of the Council of 16 November 2000 relating to limit values for benzene and carbon monoxide in ambient air EU Regional Legally binding http://ec.europa.eu/environment/air/quality/l egislation/reporting.htm Directive 2002/3/EC of the European Parliament and of the Council of 12 February 2002 relating to ozone in ambient air EU Regional Legally binding Directive 2004/107/EC of the European Parliament and of the Council of 15 December 2004 relating to arsenic, cadmium, mercury, nickel and polycyclic aromatic hydrocarbons in ambient air EU Regional Legally binding Council Decision 97/101/EC of 27 January 1997 establishing a reciprocal exchange of information and data from networks and individual stations measuring ambient air pollution within the Member States EU Regional Legally binding http://ec.europa.eu/environment/air/pdf/guid ancetoannexes97101ec.pdf 55 Commission Decision 2004/461/EC of 29 April 2004 laying down a questionnaire for annual reporting on ambient air quality assessment under Council Directives 96/62/EC and 1999/30/EC and under Directives 2000/69/EC and 2002/3/EC of the European Parliament and of the Council EU Regional Legally binding http://ec.europa.eu/environment/air/quality/l egislation/reporting.htm Commission Decision 2004/224/EC of 20 February 2004 laying down arrangements for the submission of information on plans or programmes required under Council Directive 96/62/EC in relation to limit values for certain pollutants in ambient air EU Regional Legally binding http://ec.europa.eu/environment/air/quality/l egislation/reporting.htmCouncil Directive 80/779/EEC of 15 July 1980 on air quality limit values and guide values for sulphur dioxide and suspended particulates EU Regional Legally binding Council Directive 85/203/EEC of 7 March 1985 on air quality standards for nitrogen dioxide EU Regional Legally binding Directive 2001/81/EC of the European Parliament and the Council of 23 October 2001 on National Emission Ceilings for certain pollutants EU Regional Legally binding http://ec.europa.eu/environment/air/pollutant s/implem_nec_directive.htm Directive 94/63/EC of the European Parliament and of the Council of 20 December 1994 on the control of volatile organic compound (VOC) emissions resulting from the storage of petrol and its distribution from terminals to service stations EU Regional Legally binding http://ec.europa.eu/environment/air/pollutant s/stationary/solvents/implementation_en.htm Council Directive 1999/13/EC of 11 March 1999 on the limitation of emissions of volatile organic compounds due to the use of organic solvents in certain activities and installations EU Regional Legally binding Council Directive 1999/32/EC of 26 April 1999 relating to a reduction in sulphur content of certain liquid fuels and amending Directive 93/12/EEC EU Regional Legally binding n/a Commission Implementing Decision of 12 December 2011 laying down rules for Directives 2004/107/EC and 2008/50/EC of the European Parliament and of the Council as regards the reciprocal exchange of information and reporting on ambient air quality EU Regional Legally binding http://ec.europa.eu/environment/air/quality/l egislation/reporting.htm European Pollutant Release and Transfer Register (E-PRTR) EU Regional Legally binding http://ec.europa.eu/environment/air/pollutant s/stationary/eper/implementation.htm 56 Directive 2010/75/EU of the European Parliament and of the Council of 24 November 2010 on industrial emissions (integrated pollution prevention and control) EU Regional Legally binding http://ec.europa.eu/environment/air/pollutant s/stationary/ied/implementation.htm Directive 2001/80/EC of the European Parliament and of the Council of 23 October 2001 on the limitation of emissions of certain pollutants into the air from large combustion plants EU Regional Legally binding http://ec.europa.eu/environment/air/pollutant s/stationary/lcp/implementation.htm Directive 2000/76/EC of the European Parliament and of the Council of 4 December 2000 on the incineration of waste EU Regional Legally binding http://ec.europa.eu/environment/air/pollutant s/stationary/wid/implementation.htm Council Directive 82/883/EEC of 3 December 1982 on procedures for the surveillance and monitoring of environments concerned by waste from the titanium dioxide industry EU Regional Legally binding n/a Council Directive 92/112/EEC of 15 December 1992 on procedures for harmonizing the programmes for the reduction and eventual elimination of pollution caused by waste from the titanium dioxide industry EU Regional Legally binding n/a Chemical safety and biosafety: Organization of the Environment, Health and Safety Programme OECD Global Legally binding n/a Convention on the Transboundary Effects of Industrial Accidents UNECE Regional Legally binding http://www.unece.org/env/teia/wgimplement ation.html Framework Directive on the Sustainable Use of Pesticides EU Regional Legally binding http://www.efsa.europa.eu/cs/Satellite Regulation on Authorisation of Plant Protection Products EU Regional Non- legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2009:309:0001:0050:EN:PDF Regulation (EU) No 528/2012 of the European Parliament and of the Council of 22 May 2012 concerning the making available on the market and use of biocidal products EU Regional Legally binding http://ec.europa.eu/environment/biocides/imp lementation.htm Directive 2002/49/EC of the European Parliament and of the Council of 25 June 2002 relating to the assessment and management of environmental noise EU Regional Legally binding http://ec.europa.eu/environment/Noise/impl_ directive.htm; 57 Night noise guidelines for Europe WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0017/43316/E92845.pdf EU Framework waste legislation EU Regional Legally binding http://ec.europa.eu/environment/waste/repor ting/index.htm A Blueprint to safeguard Europe’s Waters EU Regional Legally binding http://ec.europa.eu/environment/water/bluep rint/pdf/COM-2012-673final_EN_ACT-cov.pdf Human, Animal and Plant Health Impacts of Climate Change EU Regional Non- legally binding n/a White Paper: Adapting to climate change: Towards a European framework for action EU Regional Non- legally binding n/a Communication COM/2003/0338 final from the Commission to the Council, the European Parliament and the European Economic and Social Committee - A European Environment and Health Strategy EU Regional Non- legally binding n/a EU action on electromagnetic fields EU Regional Non- legally binding http://ec.europa.eu/health/electromagnetic_fi elds/research/index_en.htm B. O cc up at io na l s af et y Protocol on Strategic Environmental Assessment to the Convention on Environmental Impact Assessment in a Transboundary Context (Kyiv, 2003) UNECE Regional Legally binding http://www.unece.org/env/eia/implementatio n/review_implementation.html Communication COM/2007/0062 final from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions - Improving quality and productivity at work: Community strategy 2007-2012 on health and safety at work EU Regional Non- legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:52004DC0062:EN:NoT; http://www.europarl.europa.eu/meetdocs/200 9_2014/documents/sec/com_sec(2011)0547_/ com_sec(2011)0547_en.pdf EU Chemical Policy and Occupational Health EU Regional Legally binding http://ec.europa.eu/environment/chemicals/re ach/background/docs/finrep_occ_health.pdf 58 Directive 2007/30/EC of the European Parliament and the Council of 20 June 2007 amending Council Directive 89/391/EEC, its individual Directives and Council Directives 83/477/EEC, 91/383/EEC, 92/29/EEC and 94/33/EC with a view to simplifying and rationalising the reports on practical implementation EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:52004DC0062:EN:NoT Directive 2009/104/EC – use of work equipment concerning the minimum safety and health requirements for the use of work equipment by workers at work (second individual Directive within the meaning of Article 16(1) of Directive 89/391/EEC) EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72009L0104:EN:NoT Directive 1999/92/EC of 16 December 1999 on minimum requirements for improving the safety and health protection of workers potentially at risk from explosive atmospheres EU Regional Legally binding http://www.ohsa.org.mt/showpage.asp?pageid =202 Directive 92/58/EEC of 24 June 1992 on the minimum requirements for the provision of safety and/or health signs at work EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71992L0058:EN:NoT Directive 89/656/EEC of 30 November 1989 on the minimum health and safety requirements for the use by workers of personal protective equipment at the workplace EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71989L0656:EN:NoT; http://europa.eu/legislation_summaries/emplo yment_and_social_policy/health_hygiene_safe ty_at_work/c11149_en.htm Directive 89/654/EEC of 30 November 1989 concerning the minimum safety and health requirements for the workplace EU Regional Legally binding http://europa.eu/legislation_summaries/emplo yment_and_social_policy/health_hygiene_safe ty_at_work/c11149_en.htm; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71989L0654:EN:NoT Directive 2009/161/EU of 17 December 2009 establishing a third list of indicative occupational exposure limit values in implementation of Council Directive 98/24/EC and amending Commission Directive 2000/39/EC EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72009L0161:EN:NoT Directive 2009/148/EC of 30 November 2009 on the protection of workers from the risks related to exposure to asbestos at work EU Regional Legally binding http://www.legislation.gov.uk/uksi/2012/632/p dfs/uksi_20120632_en.pdf; http://www.Noforasbestos.net/attachments/ar ticle/73/Action%20plan%20BiH.pdf; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE 59 LEX:72009L0148:EN:NoT Directive 2006/15/EC of 7 February 2006 establishing a second list of indicative occupational exposure limit values in implementation of Council Directive 98/24/EC and amending Directives 91/322/EEC and 2000/39/EC EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2006:038:0036:0039:EN:PDF Directive 2004/37/EC of 29 April 2004 on the protection of workers from the risks related to exposure to carcinogens or mutagens at work EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2004:229:0023:0034:EN:PDF Directive 2000/39/EC of 8 June 2000 establishing a first list of indicative occupational exposure limit values in implementation of Council Directive 98/24/EC on the protection of the health and safety of workers from the risks related to chemical agents at work EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72000L0039:EN:NoT Directive 98/24/EC of 7 April 1998 on the protection of the health and safety of workers from the risks related to chemical agents at work EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71998L0024:EN:NoT; http://www.hse.gov.uk/ria/chemical/coshh.pdf Directive 91/322/EEC – indicative limit values of 29 May 1991 on establishing indicative limit values by implementing Council Directive 80/1107/EEC on the protection of workers from the risks related to exposure to chemical, physical and biological agents at work EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71991L0322:EN:NoT Regulation (EC) No 1272/2008 of the European Parliament and of the Council of 16 December 2008 on classification, labelling and packaging of substances and mixtures, amending and repealing Directives 67/548/EEC and 1999/45/EC, and amending Regulation (EC) No 1907/2006 EU Regional Legally binding n/a Directive 2008/68/EC of the European Parliament and of the Council of 24 September 2008 on the inland transport of dangerous goods EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72008L0068:EN:NoT 60 Directive 1999/45/EC of the European Parliament and of the Council of 31 May 1999 concerning the approximation of the laws, regulations and administrative provisions of the Member States relating to the classification, packaging and labelling of dangerous preparations EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71999L0045:EN:NoT Directive 95/50/EC of 6 October 1995 on uniform procedures for checks on the transport of dangerous goods by road EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71995L0050:EN:NoT; http://europa.eu/legislation_summaries/transp ort/road_transport/l24052_en.htm Directive 91/414/EEC of 15 July 1991 concerning the placing of plant protection products on the market EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71991L0414:EN:NoT; http://eupra.com/report.pdf Directive 67/548/EEC of 27 June 1967 on the approximation of laws, regulations and administrative provisions relating to the classification, packaging and labelling of dangerous substances EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71967L0548:EN:NoT; http://aei.pitt.edu/4960/ Directive 2006/25/EC on the minimum health and safety requirements regarding the exposure of the workers to risks arising from physical agents EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72006L0025:EN:NoT; http://ec.europa.eu/social/BlobServlet?docId= 6790&langId=en Directive 2004/40/EC of 29 April 2004 on the minimum health and safety requirements regarding the exposure of the workers to risks arising from electromagnetic fields and waves (18th individual Directive within the meaning of Art. 16(1) of Directive 89/391/EEC) as amended by Directive 2012/11/EU of 19 April 2012 extending the deadline for transposition to 31 October 2013 EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72004L0040:EN:NoT Directive 2003/10/EC of 6 February 2003 on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (noise) EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72003L0010:EN:NoT Directive 2002/44/EC of the of 25 June 2002 on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (vibration) EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72002L0044:EN:NoT 61 Directive 96/29/Euratom of 13 May 1996 laying down basic safety standards for the protection of the health of workers and the general public against the dangers arising from ionizing radiation EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71996L0029:EN:NoT; http://www.ncbi.nlm.nih.gov/sites/entrez?Db= pubmed&Cmd=Retrieve&list_uids=16832973& dopt=abstractplus Directive 2009/71/Euratom of 25 June 2009 establishing a Community framework for the nuclear safety of nuclear installations EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72009L0071:EN:NoT; http://ec.europa.eu/energy/nuclear/safety/saf ety_en.htm Directive 2004/108/EC of the European Parliament and of the Council of 15 December 2004 on the approximation of the laws of the Member States relating to electromagnetic compatibility and repealing Directive 89/336/EEC EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72004L0108:EN:NoT; http://ec.europa.eu/enterprise/policies/single- market-goods/regulatory-policies-common- rules-for-products/new-legislative-framework/; http://ec.europa.eu/enterprise/sectors/electric al/files/emcguide_may2007_en.pdf Directive 2003/122/Euratom of 22 December 2003 on the control of high-activity sealed radioactive sources and orphan sources EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72003L0122:EN:NoT Directive 2000/14/EC of the European Parliament and of the Council of 8 May 2000 on the approximation of the laws of the Member States relating to the Noise emission in the environment by equipment for use outdoors EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72000L0014:EN:NoT; http://ec.europa.eu/enterprise/sectors/mecha nical/documents/guidance/noise- emissions/index_en.htm; http://www.bis.gov.uk/files/file11981.pdf Directive 2000/54/EC of the European Parliament and of the Council of 18 September 2000 on the protection of workers from risks related to exposure to biological agents at work EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72000L0054:EN:NoT Directive 90/270/EEC of 29 May 1990 on the minimum safety and health requirements for work with display screen equipment EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71990L0270:EN:NoT; http://www.szu.cz/uploads/documents/cpl/Ver ze_AJ/VDU_CZ_National_Report.pdf; http://europa.eu/legislation_summaries/emplo yment_and_social_policy/health_hygiene_safe ty_at_work/c11149_en.htm 62 Directive 90/269/EEC of 29 May 1990 on the minimum health and safety requirements for the manual handling of loads where there is a risk particularly of back injury to workers EU Regional Legally binding http://europa.eu/legislation_summaries/emplo yment_and_social_policy/health_hygiene_safe ty_at_work/c11149_en.htm; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71989L0654:EN:NoT; Directive 2003/88/EC of 4 November 2003 concerning certain aspects of the organization of working time EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72003L0088:EN:NoT; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=C OM:2010:0802:FIN:EN:PDF Directive 2002/15/EC of 11 March 2002 on the organization of the working time of persons performing mobile road transport activities EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72002L0015:EN:NoT; http://www.europa- nu.nl/id/vi7eat2sjuzs/commission_staff_workin g_document Directive 2000/79/EC of 27 November 2000 concerning the European Agreement on the Organization of Working Time of Mobile Workers in Civil Aviation. Concluded by the Association of European Airlines (AEA), the European Transport Workers’ Federation (ETF), the European Cockpit Association (ECA), the European Regions Airline Association (ERA) and the International Air Carrier Association (IACA) EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2000:302:0057:0060:EN:PDF Directive 2010/32/EU of 10 May 2010 implementing the Framework Agreement on prevention from sharp injuries in the hospital and health care sector concluded by HOSPEEM and EPSU EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72010L0032:EN:NoT; http://www.europeanbiosafetynetwork.eu/res ources Directive 94/33/EC of 22 June 1994 on the protection of young people at work EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71994L0033:EN:NoT; http://ec.europa.eu/social/main.jsp?catId=706 &langId=en&intPageId=209 Directive 93/103/EC of 23 November 1993 concerning the minimum safety and health requirements for work on board fishing vessels EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71993L0103:EN:NoT; https://osha.europa.eu/en/legislation/directive s/sector-specific-and-worker-related- provisions/osh-directives/17 63 Directive 92/104/EEC of 3 December 1992 on the minimum requirements for improving the safety and health protection of workers in surface and underground mineral-extracting industries EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71992L0104:EN:NoT; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:52009DC0449:EN:NoT Directive 92/91/EEC of 3 November 1992 concerning the minimum requirements for improving the safety and health protection of workers in the mineral-extracting industries through drilling EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71992L0091:EN:NoT; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:52009DC0449:EN:NoT Directive 92/85/EEC of 19 October 1992 on the introduction of measures to encourage improvements in the safety and health at work of pregnant workers and workers who have recently given birth or are breastfeeding EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71992L0085:EN:NoT; https://osha.europa.eu/en/legislation/directive s/sector-specific-and-worker-related- provisions/osh-directives/10 Directive 92/57/EEC –of 24 June 1992 on the implementation of minimum safety and health requirements at temporary or mobile construction sites EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71992L0057:EN:NoT Directive 92/29/EEC of 31 March 1992 on the minimum safety and health requirements for improved medical treatment on board vessels EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71992L0029:EN:NoT; https://osha.europa.eu/en/legislation/directive s/sector-specific-and-worker-related- provisions/osh-directives/17 Directive 91/383/EEC of 25 June 1991 supplementing the measures to encourage improvements in the safety and health at work of workers with a fixed-duration employment relationship or a temporary employment relationship EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71991L0383:EN:NoT; http://ec.europa.eu/social/main.jsp?catId=706 &langId=en&intPageId=200 Directive 2008/104/EC of 19 November 2008 on temporary agency work EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72008L0104:EN:NoT; 64 Directive 2002/73/EC of 23 September 2002 amending Council Directive 76/207/EEC on the implementation of the principle of equal treatment for men and women as regards access to employment, vocational training and promotion, and working conditions EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72002L0073:EN:NoT Directive 2000/78/EC of 27 November 2000, establishing a general framework for equal treatment in employment and occupation EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72000L0078:EN:NoT Directives and regulations – road traffic EU Regional Legally binding http://europa.eu/legislation_summaries/transp ort/road_transport/index_en.htm Directive 2009/38/EC of 6 May 2009, on the establishment of a European Works Council or a procedure in undertakings for the purposes of informing and consulting employees EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72009L0038:EN:NoT; http://ec.europa.eu/social/main.jsp?catId=707 &langId=en&intPageId=211 European Community Strategy for Health and Safety at Work (2007–2012) EU Regional Non- legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=C OM:2007:0062:FIN:en:PDF Council Resolution of 25 June 2007 on a new Community strategy on health and safety at work (2007–2012) EU Regional Non- legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :C:2007:145:0001:0004:EN:PDF Council Directive 89/391 of 12 June 1989 on the introduction of measures to encourage improvements in the safety and health of workers at work – "Framework Directive" EU Regional Legally binding https://osha.europa.eu/data/links/guidance- on-risk-assessment-at- work?utm_source=oshmail&utm_medium=em ail&utm_campaign=index_html Improving quality and productivity at work – Community strategy 2007–2012 on health and safety at work EU Regional Non- legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=C OM:2007:0062:FIN:en:PDF The increasing use of portable computing and communication devices and its impact on the health of EU workers EU Regional Non- legally binding n/a Non-binding guide to good practice for implementing Directive 2001/45/EC (Work at a height) EU Regional Non- legally binding n/a 65 Non-binding guide to good practice for implementing Directive 1999/92/EC “ATEX” (explosive atmospheres) EU Regional Non- legally binding n/a Framework agreement on telework EU Regional Non- legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=SE C:2008:2178:FIN:EN:PDF&utm_source=oshmail &utm_medium=e- mail&utm_campaign=index_html A practical guide on best practice to prevent or minimise asbestos risks EU Regional Non- legally binding n/a Practical guidelines of a non-binding nature on the protection of the health and safety of workers from the risks related to chemical agents at work EU Regional Non- legally binding n/a Agreement on Workers Health Protection through the Good Handling and Use of Crystalline Silica and Products containing it EU Regional Non- legally binding n/a Communication COM/2008/0366 final from the Commission to the European Parliament, the Council and the European Economic and Social Committee – Regulatory aspects of nanomaterials [SEC(2008) 2036] EU Regional Non- legally binding n/a Communication COM/2005/0243 final from the Commission to the Council, the European Parliament and the Economic and Social Committee - Nanosciences and nanotechnologies: an action plan for Europe 2005–2009 EU Regional Non- legally binding http://www.framingnano.eu/index.php?option =com_content&task=view&id=152&Itemid=40 Communication COM/2004/0338 final from the Commission – Towards a European Strategy for Nanotechnology EU Regional Non- legally binding ECHA Guidance EU Regional Non- legally binding http://echa.europa.eu/web/guest/guidance- documents/guidance-on-information- requirements-and-chemical-safety-assessment Labelling and Safety Data Sheets (CLP) EU Regional Non- legally binding n/a Evaluation of the implementation of radiation protection measures for aircrew EU Regional Non- legally binding n/a Non-binding guide to good practice for implementing Directive 2006/25/EC ‘artificial EU Regional Non- legally n/a 66 optical radiation’ binding Technical recommendations for monitoring individuals occupationally exposed to external radiation EU Regional Non- legally binding n/a Council Directive 96/29/Euratom of 13 May 1996 laying down basic safety standards for the protection of the health of workers and the general public against the dangers arising from ionizing radiation EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:71996L0029:EN:NoT; http://ec.europa.eu/governance/impact/ia_car ried_out/docs/ia_2011/sec_2011_1097_en.pdf Non-binding guide to good practice for the application of Directive 2003/10/EC of the European Parliament and of the Council on the minimum safety and health requirements regarding the exposure of workers to the risks arising from physical agents (Noise) EU Regional Non- legally binding n/a Non-binding guide to good practice with a view to implementation of Directive 2002/44/EC on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (vibrations) EU Regional Non- legally binding n/a Council Recommendation 1999/519/EC on the limitation of exposure of the general public to electromagnetic fields (0 Hz to 300 GHz) EU Regional Non- legally binding http://ec.europa.eu/health/ph_determinants/e nvironment/EMF/implement_rep_en.pdf?utm_ source=oshmail&utm_medium=email&utm_ca mpaign=index_html European agreement on the reduction of workers’ exposure to the risk of work-related musculo- skeletal disorders in agriculture EU Regional Non- legally binding n/a Framework agreement on harassment and violence at work EU Regional Non- legally binding http://www.etuc.org/IMG/pdf/BROCHURE_har assment7_2_.pdf Framework agreement on work-related stress EU Regional Non- legally binding Report on the implementation of the European social partners’ Framework Agreement on Work-related Stress Guidance on work-related stress: Spice of life or kiss of death EU Regional Non- legally binding n/a Occupational health and safety risks in the healthcare sector – Guide to prevention and good practice EU Regional Non- legally binding n/a 67 Non-binding guide to good practice for understanding and implementing Directive 92/57/EEC on the implementation of minimum safety and health requirements at temporary or mobile construction sites EU Regional Non- legally binding n/a Framework agreement on prevention from sharp injuries in the hospital and healthcare EU Regional Non- legally binding n/a Council recommendation of 18 February 2003 concerning the improvement of the protection of the health and safety at work of self-employed workers EU Regional Legally binding n/a Guidelines on the assessment of the chemical, physical and biological agents and industrial processes considered hazardous for the safety or health of pregnant workers and workers who have recently given birth or are breastfeeding (92/85/EEC) EU Regional Non- legally binding n/a Commission Recommendation of 19 September 2003 concerning the European schedule of occupational diseases EU Regional Non- legally binding n/a European Schedule of Occupational Diseases EU Regional Non- legally binding n/a Practical guidelines of a non-binding nature on the protection of the health and safety of workers from the risks related to chemical agents at work EU Regional Non- legally binding n/a Declaration on occupational health for all WHO Global Non- legally binding n/a Workers’ Health: global plan of action WHO Global Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/environment-and- health/occupational- health/publications/2010/global-plan-of- action-of-workers-health GOHNET (Global Occupational Health Network) newsletter WHO Global Non- legally binding n/a 68 Convention concerning Occupational Safety and Health and the Working Environment United Nations/ International Labour Organization (ILO) Global Legally binding n/a Convention concerning the promotional framework for occupational safety and health ILO Global Legally binding n/a The Seoul Declaration on Safety and Health at Work ILO Global Non- legally binding http://www.seouldeclaration.org/en/Resources European programme for action to tackle the critical shortage of health workers in developing countries (2007–2013) EU Regional Non- legally binding http://ec.europa.eu/development/icenter/repo sitory/health_progress_report_implementation _2008_en.pdf C. Fo od s af et y WHO global strategy for food safety: safer food for better health WHO Global Non- legally binding http://www.who.int/foodsafety/capacity/links/ en/index.html Codex Alimentarius WHO/United Nations Global Non- legally binding http://www.codexalimentarius.org/meetings- reports/en/ Codex Alimentarius Standards WHO/United Nations Global Non- legally binding n/a White Paper on Food Safety EU Regional Non- legally binding http://ec.europa.eu/dgs/health_consumer/libr ary/pub/pub06_en.pdf Regulation (EC) No 178/2002 of the European Parliament and of the Council of 28 January 2002 laying down the general principles and requirements of food law, establishing the European Food Safety Authority and laying down procedures in matters of food safety EU Regional Legally binding http://europa.eu/legislation_summaries/consu mers/consumer_information/f80501_en.htm Commission Regulation (EC) No 2230/2004 of 23 December 2004 laying down detailed rules for the implementation of European Parliament and Council Regulation (EC) No 178/2002 with regard to the network of organizations operating in the fields within the European Food Safety Authority’s mission EU Regional Legally binding n/a 69 Regulation (EC) No 178/2002 of the European Parliament and of the Council of 28 January 2002 laying down the general principles and requirements of food law, establishing the European Food Safety Authority and laying down procedures in matters of food safety EU Regional Legally binding http://ec.europa.eu/food/food/chemicalsafety /residues/residues_paper_2003_en.pdf Rapid Alert System for Food and Feed EU Regional Legally binding http://ec.europa.eu/food/food/rapidalert/rasff _portal_database_en.htm Modus Operandi for the management of new food safety incidents with a potential for extension involving a chemical substance EU Regional Non- legally binding n/a Regulation (EC) No 767/2009 of the European Parliament and of the Council of 13 July 2009 on the placing on the market and use of feed, amending European Parliament and Council Regulation (EC) No 1831/2003 and repealing Council Directive 79/373/EEC, Commission Directive 80/511/EEC, Council Directives 82/471/EEC, 83/228/EEC, 93/74/EEC, 93/113/EC and 96/25/EC and Commission Decision 2004/217/EC EU Regional Legally binding http://ec.europa.eu/food/fvo/act_getPDF.cfm? PDF_ID=9001 Commission Regulation (EU) No 575/2011 of 16 June 2011 on the Catalogue of feed materials EU Regional Legally binding n/a Commission Regulation (EU) No 454/2010 of 26 May 2010 on on transitional measures under Regulation (EC) No 767/2009 of the European Parliament and of the Council as regards the labelling provisions for feed EU Regional Legally binding http://ec.europa.eu/food/fvo/act_getPDF.cfm? PDF_ID=9001 Commission Regulation (EU) No 939/2010 of 20 October 2010 amending Annex IV to Regulation (EC) No 767/2009 on permitted tolerances for the compositional labelling of feed materials or compound feed as referred to in Article 11(5) EU Regional Legally binding n/a 70 Regulation (EU) No 1169/2011 of the European Parliament and of the Council of 25 October 2011 on the provision of food information to consumers, amending Regulations (EC) No 1924/2006 and (EC) No 1925/2006 of the European Parliament and of the Council, and repealing Commission Directive 87/250/EEC, Council Directive 90/496/EEC, Commission Directive 1999/10/EC, Directive 2000/13/EC of the European Parliament and of the Council, Commission Directives 2002/67/EC and 2008/5/EC and Commission Regulation (EC) No 608/2004 EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/foodlabelling/publications/ia_general_food _labelling.pdf; http://ec.europa.eu/food/food/labellingnutriti on/foodlabelling/publications/ia_nutrition_lab elling.pdf Directive 2000/13/EC of the European Parliament and of the Council of 20 March 2000 on the approximation of the laws of the Member States relating to the labelling, presentation and advertising of foodstuffs EU Regional Legally binding http://www.rand.org/pubs/technical_reports/2 008/RAND_TR532.pdf Council Directive 90/496/EEC of 24 September 1990 on nutrition labelling for foodstuffs EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/foodlabelling/publications/ia_nutrition_lab elling.pdf Commission Directive 2008/100/EC of 28 October 2008 amending Council Directive 90/496/EEC on nutrition labelling for foodstuffs as regards recommended daily allowances, energy conversion factors and definitions EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/nutritionlabel/impact_assessment.pdf Regulation (EU) No 1169/2011 of the European Parliament and of the Council of 25 October 2011 on the provision of food information to consumers, amending Regulations (EC) No 1924/2006 and (EC) No 1925/2006 of the European Parliament and of the Council, and repealing Commission Directive 87/250/EEC, Council Directive 90/496/EEC, Commission Directive 1999/10/EC, Directive 2000/13/EC of the European Parliament and of the Council, Commission Directives 2002/67/EC and 2008/5/EC and Commission Regulation (EC) No 608/2004 EU Regional Legally binding n/a Regulation (EC) No 1760/2000 of the European Parliament and of the Council of 17 July 2000 establishing a system for the identification and registration of bovine animals and regarding the EU Regional Legally binding http://ec.europa.eu/agriculture/publi/reports/ beeflabel/fullrep_en.pdf 71 labelling of beef and beef products and repealing Council Regulation (EC) No 820/97 Commission Directive 2001/101/EC of 26 November 2001 amending Directive 2000/13/EC of the European Parliament and of the Council on the approximation of the laws of the Member States relating to the labelling, presentation and advertising of foodstuffs EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/foodlabelling/comm_legisl_en.htm Directive 2003/89/EC of the European Parliament and of the Council amending Directive 2000/13/EC as regards indication of the ingredients present in foodstuffs EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/foodlabelling/comm_legisl_en.htm Guidelines relating to article 6 paragraph 10 of Directive 2000/13/EC as amended by Directive 2003/89/EC EU Regional Legally binding n/a Guidelines from the Commission services for the contents of the notifications requested by new paragraph 11 of Directive 2000/13/EC, as amended by Directive 2003/89/EC EU Regional Non- legally binding n/a Commission Directive 2005/26/EC of 21 March 2005 establishing a list of food ingredients or substances provisionally excluded from Annex IIIa of Directive 2000/13/EC of the European Parliament and of the Council EU Regional Legally binding Evaluation of the food labelling legislation FINAL REPORT Main Text Second administrative guidance from the Commission services for the application of article 6 paragraph 11 of Directive 2000/13/EC EU Regional Non- legally binding http://ec.europa.eu/food/food/labellingnutriti on/foodlabelling/publications/ia_general_food _labelling.pdf Directive 98/6/EC of the European Parliament and of the Council of 16 February 1998 on on consumer protection in the indication of the prices of products offered to consumers EU Regional Legally binding http://ec.europa.eu/consumers/cons_int/safe_ shop/price_ind/disclaimer_en.pdf Commission Directive No 2002/67/EC of 18 July 2002 on the labelling of foodstuffs containing quinine, and of foodstuffs containing caffeine EU Regional Legally binding n/a 72 Regulation (EC) No 1829/2003 of the European Parliament and of the Council of 22 September 2003 on genetically modified food and feed EU Regional Legally binding http://ec.europa.eu/food/food/biotechnology/ evaluation/evaluation_documents_en.htm; http://ec.europa.eu/food/food/biotechnology/i ndex_en.htm; http://www.efsa.europa.eu/en/gmo/gmoapplic ations.htm Regulation (EC) No 1830/2003 of the European Parliament and of the Council of 22 September 2003 concerning the traceability and labelling of genetically modified organisms and the traceability of food and feed products produced from genetically modified organisms and amending Directive 2001/18/EC EU Regional Legally binding http://ec.europa.eu/food/plant/gmo/evaluatio n/index_en.htm; http://ec.europa.eu/food/food/biotechnology/ evaluation/docs/gmo_cultivation_report_en.pd f Regulation (EC) No 1924/2006 of the European Parliament and of the Council of 20 December 2006 on nutrition and health claims made on foods EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/claims/further_assessment_health_claims_ en.htm Guidance on the implementation of Regulation No 1924/2006 on nutrition and health claims made on foods: Conclusions of the Standing Committee on the food chain and animal health EU Regional Non- legally binding http://ec.europa.eu/food/committees/regulato ry/docs/genet_sum_17012012_en.pdf Commission Regulation (EC) No 353/2008 of 18 April 2008 establishing implementing rules for applications for authorisation of health claims as provided for in Article 15 of Regulation (EC) No 1924/2006 of the European Parliament and of the Council EU Regional Legally binding http://www.efsa.europa.eu/en/nda/ndaguideli nes.htm Commission Regulation (EU) No 116/2010 of 9 February 2010 amending Regulation (EC) No 1924/2006 of the European Parliament and of the Council with regard to the list of nutrition claims EU Regional Legally binding n/a Directive 2009/54/EC of the European Parliament and of the Council of 18 June 2009 on the exploitation and marketing of natural mineral waters (recast) EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/water/index_en.htm Commission Directive 2003/40/EC of 16 May 2003 establishing the list, concentration limits and labelling requirements for the constituents of natural mineral waters and the conditions for using ozone-enriched air for the treatment of natural mineral water EU Regional Legally binding 73 Commission Regulation (EU) No 115/2010 of 9 February 2010 laying down the conditions for use of activated alumina for the removal of fluoride from natural mineral waters and spring waters EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/water/report_adhod_wg_water_en.pdf Directive 2002/46/EC of the European Parliament and of the Council of 10 June 2002 on the approximation of the laws of the Member States relating to food supplements EU Regional Legally binding http://europa.eu/legislation_summaries/consu mers/product_labelling_and_packaging/l21102 _en.htm Commission Directive 2006/37/EC of 30 March 2006 amending Annex II to Directive 2002/46/EC of the European Parliament and of the Council as regards the inclusion of certain substances EU Regional Legally binding n/a Commission Regulation (EC) No 1170/2009 of 30 November 2009 amending Directive 2002/46/EC of the European Parliament and of Council and Regulation (EC) No 1925/2006 of the European Parliament and of the Council as regards the lists of vitamin and minerals and their forms that can be added to foods, including food supplements EU Regional Legally binding n/a Commission Regulation (EU) No 1161/2011 of 14 November 2011 amending Directive 2002/46/EC of the European Parliament and of the Council, Regulation (EC) No 1925/2006 of the European Parliament and of the Council and Commission Regulation (EC) No 953/2009 as regards the lists of mineral substances that can be added to foods EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/supplements/index_en.htm Regulation (EC) No 1137/2008 of the European Parliament and of the Council of 22 October 2008 adapting a number of instruments subject to the procedure laid down in Article 251 of the Treaty to Council Decision 1999/468/EC, with regard to the regulatory procedure with scrutiny EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/supplements/documents/2007_A540169_st udy_other_substances.pdf Regulation (EC) No 1925/2006 of the European Parliament and of the Council of 20 December 2006 on the addition of vitamins and minerals and of certain other substances to foods EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/vitamins/index_en.htm Regulation (EC) No 108/2008 of the European Parliament and of the Council of 15 January 2008 amending Regulation (EC) No 1925/2006 on the addition of vitamins and minerals and of certain other substances to foods EU Regional Legally binding n/a 74 Commission Implementing Regulation (EU) No 307/2012 of 11 April 2012 establishing implementing rules for the application of Article 8 of Regulation (EC) No 1925/2006 of the European Parliament and of the Council on the addition of vitamins and minerals and of certain other substances to foods EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/vitamins/sa_yohimbe_en.pdf; http://ec.europa.eu/food/food/labellingnutriti on/vitamins/sa_ephedra_supp_en.pdf Commission Implementing Regulation (EU) No 489/2012 of 8 June 2012 establishing implementing rules for the application of Article 16 of Regulation (EC) No 1925/2006 of the European Parliament and of the Council on the addition of vitamins and minerals and certain other substances to foods EU Regional Legally binding n/a Proposal 2011/0156 (COD) for a Regulation of the European Parliament and of the Council on food intended for infants and young children and on food for special medical purposes EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/nutritional/docs/impact_assessment_en.pd f Directive 2009/39/EC of the European Parliament and of the Council of 6 May 2009 on foodstuffs intended for particular nutritional uses (recast) EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/nutritional/docs/sanco_11224_2011_rev5_ en.pdf Commission Directive 2006/141/EC of 22 December 2006 on infant formulae and follow-on formulae and amending Directive 1999/21/EC EU Regional Legally binding http://ec.europa.eu/food/fvo/specialreports/2 010_8768_en.pdf Development of a Global Strategy on Infant and Young Child Feeding WHO Regional Office for Europe Global Non- legally binding http://www.who.int/nutrition/publications/im plementing_gs_iycf_report_content.pdf Commission Directive 2006/125/EC of 5 December 2006 on processed cereal-based foods and baby foods for infants and young children EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/children/baby_food_en.htm Commission Regulation (EC) No 953/2009 of 13 October 2009 on substances that may be added for specific nutritional purposes in foods for particular nutritional uses EU Regional Legally binding http://ec.europa.eu/food/food/labellingnutriti on/nutritional/docs/impact_assessment_en.pd f Commission Regulation (EC) No 1609/2006 of 27 October 2006 authorising the placing on the market of infant formulae based on hydrolysates of whey protein derived from cows’ milk protein for a two-year period EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2006:299:0009:0010:EN:PDF 75 Commission Regulation (EC) No 1243/2008 of 12 December 2008 amending Annexes III and VI to Directive 2006/141/EC as regards compositional requirements for certain infant formulae EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2008:335:0025:0027:EN:PDF Council Resolution 92/C 172/01 of 18 June 1992 on the marketing of breast-milk substitutes in third countries by Community-based manufacturers EU Regional Non- legally binding n/a Council Directive 92/52/EEC of 18 June 1992 on infant formulae and follow-on formulae intended for export to third countries EU Regional Legally binding n/a Commission Directive 1999/50/EC of 25 May 1999 amending Directive 91/321/EEC on infant formulae and follow-on formulae EU Regional Legally binding n/a Commission Directive 2006/125/EC of 5 December 2006 on processed cereal-based foods and baby foods for infants and young children EU Regional Legally binding n/a Commission Directive 1999/39/EC of 6 May 1999 amending Directive 96/5/EC on processed cereal- based foods and baby foods for infants and young children EU Regional Legally binding n/a Commission Directive 96/8/EC of 26 February 1996 on foods intended for use in energy-restricted diets for weight reduction EU Regional Legally binding n/a Commission Regulation (EC) No 953/2009 of 13 October 2009 on substances that may be added for specific nutritional purposes in foods for particular nutritional uses EU Regional Legally binding n/a Commission Directive 2007/29/EC of 30 May 2007 amending Directive 96/8/EC as regards labelling, advertising or presenting foods intended for use in energy-restricted diets for weight reduction EU Regional Legally binding n/a Commission Directive 1999/21/EC of 25 March 1999 on dietary foods for special medical purposes EU Regional Legally binding n/a Commission Directive 2006/141/EC of 22 December 2006 on infant formulae and follow-on formulae and amending Directive 1999/21/EC EU Regional Legally binding n/a 76 Commission Regulation (EC) No 41/2009 of 20 January 2009 concerning the composition and labelling of foodstuffs suitable for people intolerant to gluten EU Regional Legally binding n/a Report COM/2008/0392 final from the Commission to the European Parliament and the Council on foods for persons suffering from carbohydrate metabolism disorders EU Regional Non- legally binding n/a Council Directive 89/398/EEC of 3 May 1989 on the approximation of the laws of Member States relating to foodstuffs intended for particular nutritional uses EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:52008DC0393:EN:NOT Council Directives concerning Legislation on Food Hygiene EU Regional Legally binding http://ec.europa.eu/food/food/biosafety/hygie nelegislation/docs/report_act_part1_en.pdf Regulation (EC) 852/2004 of the European Parliament and of the Council of 29 April 2004 on the hygiene of foodstuffs EU Regional Legally binding http://ec.europa.eu/food/food/biosafety/hygie nelegislation/guidance_doc_852-2004_en.pdf; http://ec.europa.eu/food/food/biosafety/hygie nelegislation/guidance_doc_haccp_en.pdf Regulation (EC) 853/2004 of the European Parliament and of the Council of 29 April 2004 laying down specific hygiene rules for food of animal origin EU Regional Legally binding http://ec.europa.eu/food/food/biosafety/hygie nelegislation/guidance_doc_853-2004_en.pdf Regulation (EC) No 854/2004 of the European Parliament and of the Council of 29 April 2004 laying down specific rules for the organisation of official controls on products of animal origin intended for human consumption EU Regional Legally binding http://europa.eu/legislation_summaries/food_ safety/veterinary_checks_and_food_hygiene/f 84003_en.htm Directive 2004/41/EC of the European Parliament and of the Council of 21 April 2004 repealing certain Directives concerning food hygiene and health conditions for the production and placing on the market of certain products of animal origin intended for human consumption and amending Council Directives 89/662/EEC and 92/118/EEC and Council Decision 95/408/EC, 21 April 2004 EU Regional Legally binding n/a Regulation (EC) No 882/2004 of the European Parliament and of the Council of 29 April 2004 on official controls performed to ensure the verification of compliance with feed and food law, animal health and animal welfare rules EU Regional Legally binding http://ec.europa.eu/food/international/trade/i nterpretation_imports.pdf; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :C:2011:271:0009:0017:EN:PDF 77 Council Directive 2002/99/EC of 16 December 2002 laying down the animal health rules governing the production, processing, distribution and introduction of products of animal origin for human consumption EU Regional Legally binding n/a Council Directive 89/107/EEC of 21 December 1988 on the approximation of the laws of the Member States concerning food additives authorised for use in foodstuffs intended for human consumption EU Regional Legally binding n/a European Parliament and Council Directive 94/34/EC of 30 June 1994 amending Directive 89/107/EEC on the approximation of the laws of Member States concerning food additives authorised for use in foodstuffs intended for human consumption EU Regional Legally binding n/a Directive 2006/52/EC of the European Parliament and of the Council of 5 July 2006 amending Directive 95/2/EC on food additives other than colours and sweeteners and Directive 94/35/EC on sweeteners for use in foodstuffs EU Regional Legally binding n/a Legislation on authorised colourants EU Regional Legally binding n/a Legislation on authorised colouring matters EU Regional Legally binding n/a Legislation on authorised sweeteners EU Regional Legally binding http://eur- lex.europa.eu/smartapi/cgi/sga_doc?smartapi! celexapi!prod!DocNumber&type_doc=COMfina l&an_doc=2007&nu_doc=0418&model=guichet i&lg=en Legislation on additives other than authorised colours and sweeteners EU Regional Legally binding n/a Legislation on verification of purity criteria for certain authorised additives EU Regional Legally binding n/a Regulation (EC) No 1331/2008 of the European Parliament and of the Council of 16 December 2008 establishing a common authorisation procedure for food additives, food enzymes and food flavourings EU Regional Legally binding n/a 78 Regulation (EC) No 1332/2008 of the European Parliament and of the Council of 16 December 2008 on food enzymes and amending Council Directive 83/417/EEC, Council Regulation (EC) No 1493/1999, Directive 2000/13/EC, Council Directive 2001/112/EC and Regulation (EC) No 258/97 EU Regional Legally binding n/a Regulation (EC) No 1333/2008 of the European Parliament and of the Council of 16 December 2008 on food additives EU Regional Legally binding n/a Regulation (EC) No 1334/2008 of the European Parliament and of the Council of 16 December 2008 on flavouring and certain food ingredients with flavouring properties amending Council Regulation (EEC) No 1601/91, Regulations (EC) No 2232/96 and (EC) No 110/2008 and Directive 2000/13/EC EU Regional Legally binding n/a Commission Directive 2008/5/EC of 30 January 2008 concerning the compulsory indication on the labelling of certain foodstuffs of particulars other than those provided for in Directive 2000/13/EC of the European Parliament and of the Council EU Regional Legally binding n/a European Parliament and Council Directive 94/35/EC of 30 June 1994 on sweeteners for use in foodstuffs, amended by Directives 96/83/EC and 2003/115/EC and Directive 2006/52/EC EU Regional Legally binding n/a Report COM/2001/0542 final from the Commission on Dietary Food Additive Intake in the European Union EU Regional Non- legally binding n/a Council Regulation (EEC) No 315/93 of 8 February 1993 laying down Community procedures for contaminants in food EU Regional Legally binding n/a Commission Regulation (EC) No 1881/2006 of 19 December 2006 setting maximum levels for certain contaminants in foodstuffs EU Regional Legally binding n/a Commission Recommendation of 28 March 2007 on the monitoring of the presence of furan in foodstuffs EU Regional Non- legally binding http://www.efsa.europa.eu/en/scdocs/doc/17 02.pdf Commission Recommendation of 2 June 2010 on the monitoring of acrylamide levels in food EU Regional Non- legally http://ec.europa.eu/food/food/chemicalsafety /contaminants/acryl_database_en.htm 79 binding Commission Recommendation 2010/133/EU of 2 March 2010 on the prevention and reduction of ethyl carbamate contamination in stone fruit spirits and stone fruit marc spirits and on the monitoring of ethyl carbamate levels in these beverages EU Regional Non- legally binding n/a Commission Recommendation of 17 March 2010 on the monitoring of perfluoroalkylated substances in food EU Regional Non- legally binding n/a Salmonella and Food-borne Diseases Legislation EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:1999:210:0012:0012:EN:PDF; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:1993:062:0038:0048:EN:PDF Commission Directive 98/15/EC of 27 February 1998 amending Council Directive 91/271/EEC with respect to certain requirements established in Annex I thereof EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:52001DC0452:EN:HTML Food contaminants EU Regional Legally binding http://ec.europa.eu/food/food/chemicalsafety /contaminants/fs_contaminants_final_web_en. pdf Regulation (EC) No 470/2009 of the European Parliament and of the Council of 6 May 2009 laying down Community procedures for the establishment of residue limits of pharmacologically active substances in foodstuffs of animal origin, repealing Council Regulation (EEC) No 2377/90 and amending Directive 2001/82/EC of the European Parliament and of the Council and Regulation (EC) No 726/2004 of the European Parliament and of the Council EU Regional Legally binding n/a Commission Decision 97/747/EC of 27 October 1997 fixing the levels and frequencies of sampling provided for by Council Directive 96/23/EC for the monitoring of certain substances and residues thereof in certain animal products EU Regional Legally binding http://ec.europa.eu/food/food/chemicalsafety /residues/workdoc_2010_en.pdf 80 Council Directive 96/23/EC of 29 April 1996 on measures to monitor certain substances and residues thereof in live animals and animal products and repealing Directives 85/358/EEC and 846/469/EEC and Decisions 89/187/EEC and 91/664/EEC EU Regional Legally binding http://ec.europa.eu/food/food/chemicalsafety /residues/workdoc_2010_en.pdf; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2011:070:0040:0046:EN:PDF Regulation (EC) No 396/2005 of the European Parliament and of the Council of 23 February 2005 on maximum residue levels of pesticides in or on food and feed of plant and animal origin and amending Council Directive 91/414/EEC EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2005:070:0001:0016:en:PDF Regulation (EC) No 299/2008 of the European Parliament and of the Council of 11 March 2008 amending Regulation (EC) No 396/2005 on maximum residue levels of pesticides in or on food and feed of plant and animal origin, as regards the implementing powers conferred on the Commission EU Regional Legally binding n/a Commission Regulation (EU) No 600/2010 of 8 July 2010 amending Annex I to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards additions and modification of the examples of related varieties or other products to which the same MRL applies EU Regional Legally binding n/a Commission Regulation (EC) No 178/2006 of 1 February 2006 amending Regulation (EC) No 396/2005 of the European Parliament and of the Council to establish Annex I listing the food and feed products to which maximum levels for pesticide residues apply EU Regional Legally binding n/a Commission Regulation (EU) No 473/2012 of 04 June 2012 amending Annex III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for spinetoram (XDE-175) in or on certain products EU Regional Legally binding n/a 81 Commission Regulation (EU) No 441/2012 of 24 May 2012 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for bifenazate, bifenthrin, boscalid, cadusafos, chlorantraniliprole, chlorothalonil, clothianidin, cyproconazole, deltamethrin, dicamba, difenoconazole, dinocap, etoxazole, fenpyroximate, flubendiamide, fludioxonil, glyphosate, metalaxyl-M, meptyldinocap, novaluron, thiamethoxam, and triazophos in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 322/2012 of 16 April 2012 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for clopyralid, dimethomorph, fenpyrazamine, folpet and pendimethalin in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 270/2012 of 26 March 2012 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for amidosulfuron, azoxystrobin, bentazone, bixafen, cyproconazole, fluopyram, imazapic, malathion, propiconazole and spinosad in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 978/2011 of 3 October 2011 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for acetamiprid, biphenyl, captan, chlorantraniliprole, cyflufenamid, cymoxanil, dichlorprop-P, difenoconazole, dimethomorph, dithiocarbamates, epoxiconazole, ethephon, flutriafol, fluxapyroxad, isopyrazam, propamocarb, pyraclostrobin, pyrimethanil and spirotetramat in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 813/2011 of 11 August 2011 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for acequinocyl, emamectin benzoate, ethametsulfuron- methyl, EU Regional Legally binding n/a 82 flubendiamide, fludioxonil, kresoxim-methyl, methoxyf(e)nozide, Novaluron, thiacloprid and trifloxystrobin in or on certain products Commission Regulation (EU) No 812/2011 of 10 August 2011 amending Annex III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for dimethomorph, fluopicolide, mandipropamid, metrafenone, nicotine and spirotetramat in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 559/2011 of 7 June 2011 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for captan, carbendazim, cyromazine, ethephon, fenamiphos, thiophanate- methyl, triasulfuron and triticonazole in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 524/2011 of 26 May 2011 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for biphenyl, deltamethrin, ethofumesate, isopyrazam, propiconazole, pymetrozine, pyrimethanil and tebuconazole in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 520/2011 of 25 May 2011 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for benalaxyl, boscalid, buprofezin, carbofuran, carbosulfan, cypermethrin, fluopicolide, hexythiazox, indoxacarb, metaflumizone, methoxy- fenozide, paraquat, prochloraz, spirodiclofen, prothioconazole and zoxamide in or on certain products EU Regional Legally binding n/a 83 Commission Regulation (EU) No 508/2011 of 24 May 2011 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for abamectin, acetamiprid, cyprodinil, difenoconazole, dimethomorph, fenhexamid, proquinazid, prothioconazole, pyraclostrobin, spirotetramat, thiacloprid, thiamethoxam and trifloxystrobin in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 460/2011 of 12 May 2011 amending Annex III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards the maximum residue level for chlorantraniliprole (DPX E-2Y45) in or on carrots EU Regional Legally binding n/a Commission Regulation (EU) No 310/2011 of 28 March 2011 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for aldicarb, bromopropylate, chlorfenvinphos, endosulfan, EPTC, ethion, fenthion, fomesafen, methabenzthiazuron, methidathion, simazine, tetradifon and triforine in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 893/2010 of 8 October 2010 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for acequinocyl, bentazone, carbendazim, cyfluthrin, fenamidone, fenazaquin, flonicamid, flutriafol, imidacloprid, ioxynil, metconazole, prothioconazole, tebufenozide and thiophanate-methyl in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 765/2010 of 25 August 2010 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for chlorothalonil, clothianidin, difenoconazole, fenhexamid, flubendiamide, nicotine, spirotetramat, thiacloprid and thiamethoxam in or on certain products EU Regional Legally binding n/a 84 Commission Regulation (EU) No 750/2010 of 7 July 2010 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for certain pesticides in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 459/2010 of 27 May 2010 amending Annexes II, III and IV to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for certain pesticides in or on certain products EU Regional Legally binding n/a Commission Regulation (EU) No 304/2010 of 9 April 2010 amending Annex II to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for 2- phenylphenol in or on certain products EU Regional Legally binding n/a Commission Regulation (EC) No 1097/2009 of 16 November 2009 amending Annex II to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for dimethoate, ethephon, fenamiphos, fenarimol, methamidophos, methomyl, omethoate, oxydemeton-methyl, procymidone, thiodicarb and vinclozolin in or on certain products EU Regional Legally binding n/a Commission Regulation (EC) No 1050/2009 of 28 October 2009 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for azoxystrobin, acetamiprid, clomazone, cyflufenamid, emamectin benzoate, famoxadone, fenbutatin oxide, flufenoxuron, fluopicolide, indoxacarb, ioxynil, mepanipyrim, prothioconazole, pyridalyl, thiacloprid and trifloxystrobin in or on certain products EU Regional Legally binding n/a 85 Commission Regulation (EC) No 822/2009 of 27 August 2009 amending Annexes II, III and IV to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for azoxystrobin, atrazine, chlormequat, cyprodinil, dithiocarbamates, fludioxonil, fluroxypyr, indoxacarb, mandipropamid, potassium tri-iodide, spirotetramat, tetraconazole, and thiram in or on certain products EU Regional Legally binding n/a Commission Regulation (EC) No 256/2009 of 23 March 2009 amending Annexes II and III to Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards maximum residue levels for azoxystrobin and fludioxonil in or on certain products EU Regional Legally binding n/a Commission Regulation (EC) No 839/2008 of 30 August 2008 amending Regulation (EC) No 396/2005 of the European Parliament and of the Council as regards Annexes II, III and IV on maximum residue levels of pesticides in or on certain products EU Regional Legally binding n/a Commission Regulation (EC) No 149/2008 of 29 January 2008 amending Regulation (EC) No 396/2005 of the European Parliament and of the Council by establishing Annexes II, III and IV setting maximum residue levels for products covered by Annex I thereto EU Regional Legally binding n/a Commission Regulation (EC) No 260/2008 of 18 March 2008 amending Regulation (EC) No 396/2005 of the European Parliament and of the Council by establishing Annex VII listing active substance/product combinations covered by a derogation as regards post harvest treatments with a fumigant EU Regional Legally binding n/a Directive 98/8/EC of the European Parliament and of the Council of 16 February 1998 concerning the placing of biocidal products on the market EU Regional Legally binding http://europa.eu/legislation_summaries/food_ safety/contamination_environmental_factors/l 21178_en.htm 86 EU Plant Health Law EU Regional Legally binding http://ec.europa.eu/governance/impact/plann ed_ia/docs/2013_sanco_002_eu_plant_health_ law_en.pdf Seeds and propagating material EU Regional Legally binding http://ec.europa.eu/food/plant/propagation/e valuation/index_en.htm Plant Property Rights EU Regional http://ec.europa.eu/food/plant/propertyrights /docs/cpvr_evaluation_final_report.pdf International Treaty on Plant Genetic Resources for Food and Agriculture United Nations Global Legally binding http://www.pgrfa.org/gpa/selectcountry.jspx Directive 2011/91/EU of the European Parliament and of the Council of 13 December 2011 on indications or marks identifying the lot to which a foodstuff belongs EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2011:334:0001:0005:EN:PDF Commission Directive 2010/59/EU of 26 August 2010 amending Directive 2009/32/EC of the European Parliament and of the Council on the approximation of the laws of the Member States on extraction solvents used in the production of foodstuffs and food ingredients EU Regional Legally binding n/a Commission Regulation (EU) No 257/2010 of 25 March 2010 setting up a programme for the re- evaluation of approved food additives in accordance with Regulation (EC) No 1333/2008 of the European Parliament and of the Council on food additives EU Regional Legally binding n/a Commission Regulation (EU) No 375/2010 of 3 May 2010 refusing to authorise a health claim made on foods, other than those referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a Commission Regulation (EU) No 382/2010 of 5 May 2010 refusing to authorise certain health claims made on foods, other than those referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a 87 Commission Regulation (EU) No 383/2010 of 5 May 2010 refusing to authorise a health claim made on foods, other than those referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a Commission Regulation (EU) No 384/2010 of 5 May 2010 on the authorisation and refusal of authorisation of certain health claims made on foods and referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a Commission Regulation (EU) No 605/2010 of 2 July 2010 laying down animal and public health and veterinary certification conditions for the introduction into the European Union of raw milk and dairy products intended for human consumption EU Regional Legally binding n/a Commission Regulation (EU) No 957/2010 of 22 October 2010 on the authorisation and refusal of authorisation of certain health claims made on foods and referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a Commission Regulation (EU) No 958/2010 of 22 October 2010 refusing to authorise a health claim made on foods, other than those referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a Commission Regulation (EU) No 1161/2010 of 9 December 2010 refusing to authorise a health claim made on foods, other than those referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a Commission Regulation (EU) No 1162/2010 of 9 December 2010 refusing to authorise certain health claims made on foods and referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a 88 Commission Decision 2011/73/EU of 2 February 2011 authorising the placing on the market of a mycelial extract from Lentinula edodes (Shiitake mushroom) as a novel food ingredient under Regulation (EC) No 258/97 of the European Parliament and of the Council EU Regional Legally binding n/a Commission Decision 2011/76/EU of 2 February 2011 authorising the placing on the market of a chitin-glucan from Aspergillus niger as a novel food ingredient under Regulation (EC) No 258/97 of the European Parliament and of the Council EU Regional Legally binding n/a Commission Decision 2011/80/EU of 4 February 2011 authorising the placing on the market of a fish (Sardinops sagax) peptide product as a novel food ingredient under Regulation (EC) No 258/97 of the European Parliament and of the Council EU Regional Legally binding n/a Commission Decision 2011/242/EU of 14 April 2011 on the members of the advisory group on the food chain and animal and plant health established by Decision 2004/613/EC EU Regional Legally binding n/a Commission Decision 2011/320/EU of 27 May 2011 authorising the placing on the market of Chromium Picolinate as a novel food ingredient under Regulation (EC) No 258/97 of the European Parliament and of the Council EU Regional Legally binding n/a Commission Implementing Decision 2011/494/EU of 5 August 2011 authorising the placing on the market of phosphated maize starch as a novel food ingredient under Regulation (EC) No 258/97 of the European Parliament and of the Council EU Regional Legally binding n/a Commission Implementing Decision 2011/497/EU of 9 August 2011 authorising the placing on the market of fermented black bean extract as a novel food ingredient under Regulation (EC) No 258/97 of the European Parliament and of the Council EU Regional Legally binding n/a Commission Implementing Decision 2011/761/EU of 24 November 2011 authorising the placing on the market of flavonoids from Glycyrrhiza glabra L. as a novel food ingredient under Regulation (EC) No 258/97 of the European Parliament and of the Council EU Regional Legally binding n/a 89 Commission Implementing Decision 2011/762/EU of 24 November 2011 authorising the placing on the market of yeast beta-glucans as a novel food ingredient under Regulation (EC) No 258/97 of the European Parliament and of the Council EU Regional Legally binding n/a Commission Implementing Decision 2011/882/EU of 21 December 2011 authorising the placing on the market of a novel chewing gum base as a novel food ingredient under Regulation (EC) No 258/97 of the European Parliament and of the Council EU Regional Legally binding n/a Commission Decision 2011/C 271/05 of 12 September 2011 on the financing for the year 2011 of several measures necessary to ensure the application of Regulation (EC) No 882/2004 EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :C:2011:271:0009:0017:EN:PDF Commission Regulation (EU) No 10/2011 of 14 January 2011 on plastic materials and articles intended to come into contact with food EU Regional Legally binding n/a Commission Regulation (EU) No 234/2011 of 10 March 2011 implementing Regulation (EC) No 1331/2008 of the European Parliament and of the Council establishing a common authorisation procedure for food additives, food enzymes and food flavourings EU Regional Legally binding n/a Commission Implementing Regulation (EU) No 844/2011 of 23 August 2011 approving the pre- export checks carried out by Canada on wheat and wheat flour as regards the presence of ochratoxin A EU Regional Legally binding n/a Commission Regulation (EU) No 1129/2011 of 11 November 2011 amending Annex II to Regulation (EC) No 1333/2008 of the European Parliament and of the Council by establishing a Union list of food additives EU Regional Legally binding n/a Commission Regulation (EU) No 1160/2011 of 14 November 2011 on the authorisation and refusal of authorisation of certain health claims made on foods and referring to the reduction of disease risk EU Regional Legally binding n/a 90 Commission Regulation (EU) No 1170/2011 of 16 November 2011 refusing to authorise certain health claims made on foods and referring to the reduction of disease risk EU Regional Legally binding n/a Commission Regulation (EU) No 1171/2011 of 16 November 2011 refusing to authorise certain health claims made on foods, other than those referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a Commission Implementing Regulation (EU) No 1274/2011 of 7 December 2011 concerning a coordinated multiannual control programme of the Union for 2012, 2013 and 2014 to ensure compliance with maximum residue levels of pesticides and to assess the consumer exposure to pesticide residues in and on food of plant and animal origin EU Regional Legally binding n/a Commission Regulation (EU) No 231/2012 of 9 March 2012 laying down specifications for food additives listed in Annexes II and III to Regulation (EC) No 1333/2008 of the European Parliament and of the Council EU Regional Legally binding n/a Commission Implementing Regulation (EU) No 307/2012 of 11 April 2012 establishing implementing rules for the application of Article 8 of Regulation (EC) No 1925/2006 of the European Parliament and of the Council on the addition of vitamins and minerals and of certain other substances to foods EU Regional Legally binding n/a Commission Regulation (EU) No 378/2012 of 3 May 2012 refusing to authorise certain health claims made on foods and referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a Commission Regulation (EU) No 379/2012 of 3 May 2012 refusing to authorise certain health claims made on foods, other than those referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a 91 Commission Regulation (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods, other than those referring to the reduction of disease risk and to children’s development and health EU Regional Legally binding n/a The WTO Agreement on the Application of Sanitary and Phytosanitary Measures (SPS Agreement) WTO Global Legally binding http://www.wto.org/english/tratop_e/monitor _e/monitor_e.htm The new Animal Health Strategy (2007-2013): “prevention is better than cure” EU Regional Non- legally binding http://ec.europa.eu/food/animal/diseases/stra tegy/archives/final_report_en.htm D .O th er s Council Recommendation 2009/C 151/01 of 9 June 2009 on patient safety, including the prevention and control of healthcare associated infections EU Regional Non- legally binding http://www.ecdc.europa.eu/en/healthtopics/H ealth care- associated_infections/Pages/index.aspx Proposal COM(2008) 837 final/2 for a Council Recommendation on patient safety, including the prevention and control of health care associated infections EU Regional Non- legally binding n/a Directive 2002/98/EC of the European Parliament and of the Council of 27 January 2003 setting standards of quality and safety for the collection, testing, processing, storage and distribution of human blood and blood components and amending Directive 2001/83/EC EU Regional Legally binding http://ec.europa.eu/health/blood_tissues_orga ns/docs/blood_reportdonation_en.pdf; http://eur- lex.europa.eu/Notice.do?mode=dbl&lang=en&i hmlang=en&lng1=en,en&lng2=cs,da,de,el,en,es ,et,fi,fr,hu,it,lt,lv,mt,nl,pl,pt,sk,sl,sv,&val=42854 0:cs&page=; http://ec.europa.eu/health/ph_threats/human _substance/documents/blood_com_0217_en.p df; http://ec.europa.eu/health/ph_risk/committee s/scmp/documents/out49_en.pdf; http://www.coe.int/t/dg3/health/publications_ en.asp Commission Implementing Directive 2011/38/EU of 11 April 2011 amending Annex V to Directive 2004/33/EC with regards to maximum pH values for platelets concentrates at the end of the shelf life EU Regional Legally binding Commission Directive 2009/135/EC of 3 November 2009 allowing temporary derogations to certain eligibility criteria for whole blood and blood components donors laid down in Annex III to Directive 2004/33/EC in the context of a risk of shortage caused by the Influenza A(H1N1) pandemic EU Regional Legally binding Commission Directive 2005/62/EC of 30 September 2005 implementing Directive 2002/98/EC of the European Parliament and of the Council as regards Community standards and specifications relating to a quality system for blood establishments EU Regional Legally binding 92 Commission Directive 2005/61/EC of 30 September 2005 implementing Directive 2002/98/EC of the European Parliament and of the Council as regards traceability requirements and notification of serious adverse reactions and events EU Regional Legally binding Commission Directive 2004/33/EC of 22 March 2004 implementing Directive 2002/98/EC of the European Parliament and of the Council as regards certain technical requirements for blood and blood components EU Regional Legally binding Directive 2002/98/EC of the European Parliament and of the Council of 27 January 2003 setting standards of quality and safety for the collection, testing, processing, storage and distribution of human blood and blood components and amending Directive 2001/83/EC EU Regional Legally binding Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use EU Regional Legally binding European Parliament legislative resolution COM(2000) 816 on the proposal for a European Parliament and Council directive setting standards of quality and safety for the collection, testing, processing, storage, and distribution of human blood and blood components and amending Council Directive 89/381/EEC EU Regional Non- legally binding Directive 2000/70/EC of the European Parliament and of the Council of 16 November 2000 amending Council Directive 93/42/EEC as regards medical devices incorporating stable derivates of human blood or human plasma EU Regional Legally binding Global database on blood safety WHO Global Non- legally binding http://www.who.int/bloodsafety/global_datab ase/GDBS_Summary_Report_2011.pdf; http://www.who.int/bloodsafety/global_datab ase/tools/en/index.html Corrigendum to Directive 2010/45/EU of the European Parliament and of the Council of 7 July 2010 on standards of quality and safety of human organs intended for transplantation EU Regional Legally binding n/a 93 Directive 2010/45/EU of the European Parliament and of the Council of 7 July 2010 on standards of quality and safety of human organs intended for transplantation EU Regional Legally binding n/a Proposal COM(2008) 819 final for a Directive of the European Parliament and of the Council on standards of quality and safety of human organs intended for transplantation EU Regional Legally binding http://ec.europa.eu/health/ph_threats/human _substance/oc_organs/docs/impact_en.pdf Action plan on Organ Donation and Transplantation (2009–2015): Strengthened Cooperation between Member States EU Regional Non- legally binding European Parliament Resolution 2007/2210 of 22 April 2008 on organ donation and transplantation: Policy actions at EU level EU Regional Non- legally binding n/a Organ donation and transplantation: Policy options at EU level – Consultation document of 27 June 2006 EU Regional Non- legally binding n/a Commission Decision 2010/453/EU of 3 August 2010 establishing guidelines concerning the conditions of inspections and control measures, and on the training and qualification of officials, in the field of human tissues and cells provided for in Directive 2004/23/EC of the European Parliament and of the Council EU Regional Legally binding http://ec.europa.eu/health/blood_tissues_orga ns/docs/tissues_voluntary_report_en.pdf; http://eur- lex.europa.eu/smartapi/cgi/sga_doc?smartapi! celexplus!prod!DocNumber&lg=EN&type_doc= COMfinal&an_doc=2011&nu_doc=352; http://ec.europa.eu/health/ph_threats/human _substance/survey_tissues.pdf; http://ec.europa.eu/health/archive/ph_threats /human_substance/documents/tissues_frep_e n.pdf; http://ec.europa.eu/health/blood_tissues_orga ns/docs/study_eshre_en.pdf; http://ec.europa.eu/health/blood_tissues_orga ns/key_documents/index_en.htm; http://ec.europa.eu/bepa/european-group- ethics/docs/publ_op19_en.pdf; http://www.coe.int/t/dg3/health/Source/Guid eSecurity2_en.pdf; Commission Directive 2006/86/EC of 24 October 2006 implementing Directive 2004/23/EC of the European Parliament and of the Council as regards traceability requirements, notification of serious adverse reactions and events and certain technical requirements for the coding, processing, preservation, storage and distribution of human tissues and cells EU Regional Legally binding Commission Directive 2006/17/EC of 8 February 2006 implementing Directive 2004/23/EC of the European Parliament and of the Council as regards certain technical requirements for the donation, procurement and testing of human tissues and cells EU Regional Legally binding 94 Directive 2004/23/EC of the European Parliament and of the Council of 31 March 2004 on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells EU Regional Legally binding https://wcd.coe.int/com.instranet.InstraServlet ?command=com.instranet.CmdBlobGet&Instra netImage=533950&SecMode=1&DocId=508796 &Usage=2 European Parliament legislative resolution 10133/3/2003 – C5-0416/2003 – 2002/0128(COD) on the Council common position adopting a European Parliament and Council directive on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells EU Regional Non- legally binding Opinion of the European Economic and Social Committee on the “Proposal for a Directive of the European Parliament and of the Council setting standards of quality and safety for the donation, procurement, testing, processing, storage, and distribution of human tissues and cells” (COM(2002) 319 final – 2002/0128 (COD)) EU Regional Legally binding Consensus Statement of the Amsterdam Forum on the Care of the Live Kidney Donor WHO Global Non- legally binding n/a WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation WHO Global Non- legally binding n/a WHO Transplantation Documentation WHO Global Non- legally binding http://www.who.int/transplantation/tra_song/ en/index.html; http://www.who.int/transplantation/tra_notify /en/index.html; http://www.who.int/entity/transplantation/act ivities/ReportGlossaryMeeting.pdf; http://www.who.int/transplantation/ReportOtt awaCTTx.pdf Global Glossary of Terms and Definitions on Donation and Transplantation WHO Global Non- legally binding http://www.who.int/entity/transplantation/act ivities/ReportGlossaryMeeting.pdf Xenotransplantation – Guidance on Infectious Disease Prevention and Management WHO Global Non- legally binding https://extranet.who.int/iris/restricted/bitstrea m/10665/65511/1/WHO_EMC_ZOO_98.1.pdf 95 WHO Guidance on Xenogeneic Infection/Disease Surveillance and Response: A Strategy for International Cooperation and Coordination WHO Global Non- legally binding n/a Quality Risk Management EU Regional Non- legally binding n/a Pharmaceuticals in Drinking-water WHO Global Non- legally binding http://ecologic.eu/download/projekte/1850- 1899/1878/knappe_d31_state_of_art_policy.p df Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use EU Regional Legally binding n/a Guideline on the Environmental Risk Assessment of Medicinal Products for Human Use EU Regional Non- legally binding n/a Directive 2004/27/EC of the European Parliament and of the Council of 31 March 2004 amending Directive 2001/83/EC on the Community code relating to medicinal products for human use EU Regional Legally binding n/a Council Directive 87/357/EEC of 25 June 1987 on the approximation of the laws of the Member States concerning products which, appearing to be other than they are, endanger the health or safety of consumers EU Regional Legally binding n/a Directive 2001/95/EC of the European Parliament and of the Council of 3 December 2001 on general product safety EU Regional Legally binding http://ec.europa.eu/consumers/safety/prod_le gis/docs/report_impl_gpsd_en.pdf Commission Decision 2008/329/EC of 21 April 2008 requiring Member States to ensure that magnetic toys placed or made available on the market display a warning about the health and safety risks they pose EU Regional Legally binding http://ec.europa.eu/consumers/safety/prod_le gis/index_en.htm#other Directive 2009/48/EC of the European Parliament and of the Council of 18 June 2009 on the safety of toys EU Regional Legally binding n/a Council Directive 88/378/EEC of 3 May 1988 on the approximation of the laws of the Member States concerning the safety of toys EU Regional Legally binding n/a 96 Council Directive 89/686/EEC of 21 December 1989 on the approximation of the laws of the Member States relating to personal protective equipment EU Regional Legally binding n/a Directive 2006/42/EC of the European Parliament and of the Council of 17 May 2006 on machinery, and amending Directive 95/16/EC EU Regional Legally binding n/a Directive 2000/14/EC of the European Parliament and of the Council of 8 May 2000 on the approximation of the laws of the Member States relating to the noise emission in the environment by equipment for use outdoors EU Regional Legally binding n/a Directive 97/68/EC of the European Parliament and of the Council of 16 December 1997 on the approximation of the laws of the Member States relating to measures against the emission of gaseous and particulate pollutants from internal combustion engines to be installed in non-road mobile machinery EU Regional Legally binding n/a Council Directive 76/768/EEC of 27 July 1976 on the approximation of the laws of the Member States relating to cosmetic products EU Regional Legally binding http://ec.europa.eu/consumers/sectors/cosme tics/documents/guidelines/index_en.htm Measuring Errors and Adverse Events in Health Care EU Regional Non- legally binding n/a WHO Guidelines on HIV/AIDS (2011–2012) WHO Global Non- legally binding n/a Diarrhoea treatment guidelines including new recommendations for the use of ORS and zinc supplementation for clinic-based healthcare workers WHO Global Non- legally binding n/a 97 EPHO 4: Health promotion, including action to address social determinants and health inequity EPHO subdivision Title of instrument or tool with hyperlink Lead organization Level: global, regional, national or local Legal status Evaluation notes (monitoring and assessment reports; activity reports; expected outputs; countries implementation; transparency) A .B ui ld in g an d st re ng th en in g th e re si lie nc e of c om m un iti es Proposal COD/2008/0256 for a Directive of the European Parliament and of the Council amending, as regards information to the general public on medicinal products subject to medical prescription, Directive 2001/83/EC on the Community code relating to medicinal products for human use EU Regional Legally binding n/a Public health developments ECDC Regional Non- legally binding n/a Building Healthy Communities 2011 EU Regional Non- legally binding http://urbact.eu/fileadmin/Projects/Building_H ealthy_Communities__BHC_/documents_medi a/Final_Report_bhc_saved.pdf Risk communication ECDC n/a Non- legally binding n/a B. H ea lth p ro m ot io n ac tiv iti es ta rg et in g th e po pu la tio n at la rg e th ro ug h a gr ad ie nt a pp ro ac h, a s w el l a s ta rg et in g vu ln er ab le s ub gr ou ps a t i nc re as ed ri sk o f n eg at iv e he al th o ut co m es Framework Convention on Tobacco Control WHO Global Legally binding http://www.who.int/fctc/implementation/reso urces/en/; http://www.who.int/fctc/implementation/nee ds/en/ Council Recommendation 2003/54/EC of 2 December 2002 on the prevention of smoking and on initiatives to improve tobacco control EU Regional Legally binding n/a EU Directives on tobacco control EU Regional Legally binding http://ec.europa.eu/health/tobacco/indicators /index_en.htm Directive 2001/37/EC of the European Parliament and of the Council of 5 June 2001 on the approximation of the laws, regulations and administrative provisions of the Member States concerning the manufacture, presentation and sale of tobacco products EU Regional Legally binding http://ec.europa.eu/health/tobacco/events/ind ex_en.htm#anchor; http://ec.europa.eu/health/tobacco/indicators /index_en.htm 98 Directive 2003/33/EC of the European Parliament and of the Council of 26 May 2003 on the approximation of the laws, regulations and administrative provisions of the Member States relating to the advertising and sponsorship of tobacco products WHO Global Legally binding Council Directive 2010/12/EU of 16 February 2010 amending Directives 92/79/EEC, 92/80/EEC and 95/59/EC on the structure and rates of excise duty applied on manufactured tobacco and Directive 2008/118/EC EU Regional Legally binding Convention against illicit traffic in narcotic drugs and psychotropic substances United Nations Global Legally binding http://mdgs.un.org/unsd/mdg/Resources/Stati c/Products/GAResolutions/65/a_65_L_1_En.pd f; http://www.mdgmonitor.org/index.cfm; http://www.un.org/millenniumgoals/pdf/(2011 E)_MDReport2011_ProgressChart.pdf; http://www.un.org/millenniumgoals/11_MDG %20Report_EN.pdf; http://www.unodc.org/unodc/en/data-and- analysis/WDR-2011.html 2011 Political Declaration on HIV/AIDS United Nations Global Non- legally binding http://www.unaids.org/en/targetsandcommit ments/ Moscow Declaration: commitment to action, way forward WHO Global Non- legally binding n/a Regional Committee resolution EUR/RC61/R4: European action plan to reduce the harmful use of alcohol 2012–2020 WHO Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0003/149160/RC61_Pres_Galea_alcohol.pdf Global Strategy to reduce the harmful use of alcohol WHO Global Non- legally binding http://www.who.int/substance_abuse/publicat ions/global_alcohol_report/en/index.html White Paper A Strategy on Nutrition, Overweight, and Obesity-related health issues EU Regional Non- legally binding n/a Nutrition Policy databases WHO Regional Non- legally binding n/a EU platform for action on diet, physical activity and health EU Regional Non- legally binding http://ec.europa.eu/health/archive/ph_determ inants/life_style/nutrition/platform/docs/eu_pl atform_mon-framework_en.pdf 99 EU strategy to support Member States in reducing alcohol related harm EU Regional Non- legally binding http://ec.europa.eu/health/archive/ph_determ inants/life_style/alcohol/documents/alcohol_p rogress.pdf Meetings of the EU Regulatory Committee for Tobacco Control EU Regional Non- legally binding n/a EU drugs strategy 2005-2012 EU Regional Non- legally binding http://eur- lex.europa.eu/LexUriServ/site/en/com/2007/co m2007_0199en01.pdf; http://ec.europa.eu/health/drugs/projects/ind ex_en.htm Directive 2003/33/EC of the European Parliament and of the Council of 26 May 2003 on the approximation of the laws, regulations and administrative provisions of the Member States relating to the advertising and sponsorship of tobacco products EU Regional Legally binding http://ec.europa.eu/health/archive/ph_determ inants/life_style/tobacco/documents/com_200 80520_en.pdf Directive 2007/65/EC of the European Parliament and of the Council of 11 December 2007 amending Council Directive 89/552/EEC on the coordination of certain provisions laid down by law, regulation or administrative action in Member States concerning the pursuit of television broadcasting activities EU Regional Legally binding http://ec.europa.eu/avpolicy/info_centre/librar y/studies/index_en.htm#promot Directive 2001/37/EC of the European Parliament and of the Council of 5 June 2001 on the approximation of the laws, regulations and administrative provisions of the Member States concerning the manufacture, presentation and sale of tobacco products EU Regional Legally binding http://ec.europa.eu/health/tobacco/docs/toba cco_ia_rand_en.pdf Green Paper - Improving the mental health of the population: Towards a strategy on mental health for the European Union EU Regional Non- legally binding n/a EU High Level Conference “Together For Mental Health And Well-Being” Brussels, 13 June 2008 EU Regional Non- legally binding http://ec.europa.eu/health/archive/ph_determ inants/life_style/mental/docs/mh_conference_ mi_en.pdf European Pact for Mental Health and Well-Being EU Regional Non- legally binding http://ec.europa.eu/health/mental_health/doc s/mhpact_en.pdf Annual epidemiological report on communicable diseases in Europe EU Regional Non- legally n/a 100 binding Directive 2010/13/EU of the European Parliament and of the Council of 10 March 2010 on the coordination of certain provisions laid down by law, regulation or administrative action in Member States concerning the provision of audiovisual media services EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=S WD:2012:0125:FIN:EN:PDF C. A ct io n to a dd re ss s oc ia l d et er m in an ts o f h ea lth Closing the Gap: Strategies for Action to tackle Health Inequalities in Europe WHO Global Non- legally binding http://ec.europa.eu/health/social_determinant s/events/ev_20120619_en.htm Communication COM/2009/0567 final from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions - Solidarity in health: reducing health inequalities in the EU EU Regional Non- legally binding n/a International Code of Marketing of Breast-milk Substitutes WHO Global Non- legally binding http://www.who.int/nutrition/publications/inf antfeeding/WHO_NUT_98.11/en/index.html; http://www.who.int/nutrition/publications/inf antfeeding/WHO_NUT_96.2/en/index.html European strategy for child and adolescent health and development WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we- publish/abstracts/social-determinants-of- health-and-well-being-among-young-people.- health-behaviour-in-school-aged-children-hbsc- study Youth Health Initiative EU Regional Non- legally binding n/a Communication COM(2012) 83 final from the Commission to the European Parliament and the Council – Taking forward the Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing EU Regional Non- legally binding http://ec.europa.eu/health/ageing/docs/com_ 2012_83_en.pdf Healthy Ageing: Health Systems – Innovations – Consumers EU Regional Non- legally binding n/a 101 Principles for the protection of persons with mental illness and the improvement of mental health care United Nations Global Non- legally binding n/a Rio Political Declaration on Social Determinants of Health WHO Global Non- legally binding http://www.who.int/social_determinants/en/ World Health Assembly resolution WHA62.14: Reducing health inequities through action on the social determinants of health WHO Global Non- legally binding n/a Directive 2006/54/EC of the European Parliament and of the Council of 5 July 2006 on the implementation of the principle of equal opportunities and equal treatment of men and women in matters of employment and occupation EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:72006L0054:EN:NoT; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:52009DC0409:EN:HTML; http://ec.europa.eu/justice/gender- equality/files/2009reportrecastdirectivefinal_e n.pdf A Women’s Charter: A strengthened commitment towards equality between women and men EU Regional Non- legally binding http://europa.eu/legislation_summaries/emplo yment_and_social_policy/equality_between_m en_and_women/em0037_en.htm; http://ec.europa.eu/social/BlobServlet?docId= 6562&langId=en Declaration on equality of women and men EU Regional Non- legally binding http://www.coe.int/t/dghl/standardsetting/eq uality/02factsheets/index_en.asp; http://www.eige.europa.eu/content/women- and-men-in-the-eu-facts-and-figures Roadmap for equality between women and men (2006–2010) EU Regional Non- legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=C OM:2006:0092:FIN:EN:PDF Addressing the social determinants of health: the urban dimension and the role of local government WHO Regional Office for Europe Regional Non- legally binding n/a Directive 2003/20/EC of the European Parliament and of the Council of 8 April 2003 amending Council Directive 91/671/EEC on the approximation of the laws of the Member States relating to compulsory use of safety belts in EU Regional Legally binding n/a 102 vehicles of less than 3,5 tonnes Directive 2005/39/EC of the European Parliament and of the Council of 7 September 2005 amending Council Directive 74/408/EEC relating to motor vehicles with regard to the seats, their anchorages and head restraints EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2005:255:0143:0145:EN:PDF D .I nt er se ct or al a ct io n Directive 2005/40/EC of the European Parliament and of the Council of 7 September 2005 amending Council Directive 77/541/EEC on the approximation of the laws of the Member States relating to safety belts and restraint systems of motor vehicles EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2005:255:0146:0148:EN:PDF Directive 2005/41/EC of the European Parliament and of the Council of 7 September 2005 amending Council Directive 76/115/EEC on the approximation of the laws of the Member States relating to anchorages for motor-vehicle safety belts EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2005:255:0149:0151:EN:PDF Regulation 44 – Uniform provisions concerning the approval of restraining devices for child occupants of power driven vehicles (‘child restraint systems’) UNECE Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ :L:2005:330:0056:0157:EN:PDF Road safety: Road Safety Action Programme (2003–2010) EU Regional Non- legally binding http://ec.europa.eu/transport/road_safety/spe cialist/knowledge/index.htm Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment United Nations Global Legally binding ]http://www2.ohchr.org/english/law/pdf/cat.p df Abolition of Forced Labour Convention ILO Global Legally binding http://www2.ohchr.org/english/law/abolition.h tm Convention concerning Discrimination in Respect of Employment and Occupation ILO Global Legally binding http://www2.ohchr.org/english/law/employme nt.htm Convention concerning Minimum Age for Admission to Employment ILO Global Legally binding http://www2.ohchr.org/english/law/ageconven tion.htm Convention concerning the Prohibition and Immediate Action for the Elimination of the Worst Forms of Child Labour ILO Global Legally binding http://treaties.un.org/Pages/Treaties.aspx?id=4 &subid=A&lang=en International Convention for the Protection of All Persons from Enforced Disappearance United Nations Global Legally binding http://treaties.un.org/Pages/Treaties.aspx?id=4 &subid=A&lang=en 103 Convention concerning Forced or Compulsory Labour ILO Global Legally binding http://www.ilo.org/dyn/normlex/en/f?p=NOR MLEXPUB:12100:0::NO:12100:P12100_ILO_CO DE:C029 Convention concerning Equal Remuneration for Men and Women Workers for Work of Equal Value ILO Global Legally binding http://treaties.un.org/Pages/Treaties.aspx?id=4 &subid=A&lang=en [only for ratification process] International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families United Nations Global Legally binding http://treaties.un.org/Pages/Treaties.aspx?id=4 &subid=A&lang=en Maritime Labour Convention ILO Global Legally binding http://www.ilo.org/global/standards/maritime- labour-convention/lang--en/index.htm The Convention on the Elimination of all forms of Discrimination against Women ILO Global Legally binding http://www.un.org/womenwatch/daw/cedaw/ reports.htm Council Directive 89/391/EEC of 12 June 1989 on the introduction of measures to encourage improvements in the safety and health of workers at work EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=C ONSLEG:1989L0391:20081211:EN:PDF The Charter of Fundamental Rights and the Agency for Fundamental Rights EU Regional Legally binding n/a Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions - Non-discrimination and equal opportunities: A renewed commitment EU Regional Non- legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=C OM:2008:0420:FIN:EN:PDF EU strategy for sustainable development EU Regional Non- legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=C OM:2001:0264:FIN:EN:PDF Communication from the Commission to the European Parliament, the Council - European Innovation Partnership on Active and Healthy Ageing EU Regional Non- legally binding http://ec.europa.eu/health/ageing/docs/com_ 2012_83_en.pdf Strategic Implementation Plan for the European Innovation Partnership on Active and Healthy Ageing EU Regional Non- legally binding http://ec.europa.eu/research/innovation- union/pdf/active-healthy-ageing/steering- group/implementation_plan.pdf Confronting “Death on Wheels”: Making Roads Safe in Europe and Central Asia World Bank Regional Non- legally binding http://siteresources.worldbank.org/INTECA/Re sources/DeathonWheelsWeb.pdf EU Salt Reduction Framework EU Regional Non- legally binding http://ec.europa.eu/health/nutrition_physical_ activity/docs/salt_report_en.pdf 104 European Interim Agreement on Social Security Schemes Relating to Old Age, Invalidity and Survivors EU Regional Non- legally binding n/a 105 EPHO 5: Disease prevention, including early detection of illness EPHO subdivision Title of instrument or tool with hyperlink Lead organization Level: global, regional, national or local Legal status Evaluation notes (monitoring and assessment reports; activity reports; expected outputs; countries implementation; transparency) A .P ri m ar y pr ev en tio n WHO global forum for chief nursing and midwifery officers: strengthening their role in NCD prevention WHO Global Non- legally binding n/a Vaccine-preventable Diseases Programme ECDC Regional Non- legally binding http://ecdc.europa.eu/en/activities/diseasepro grammes/vpd/Pages/phd.aspx Vaccines against cervical cancer EU Regional Non- legally binding http://ec.europa.eu/health/vaccination/hpv/in dex_en.htm Vaccination strategies against pandemic (H1N1) 2009 EU Regional Non- legally binding n/a Council Recommendation 2009/1019/EU of 22 December 2009 on seasonal influenza vaccination EU Regional Non- legally binding n/a Vaccination schedules ECDC Regional Non- legally binding http://www.ema.europa.eu/ema/index.jsp?cur l=pages/medicines/landing/epar_search.jsp&m id=WC0b01ac058001d124 Communication COM(2006) 328 final from the Commission to the European Parliament and the Council on Actions for a Safer Europe EU Regional Non- legally binding n/a B. Se co nd ar y pr ev en tio n Council Recommendation 2003/878/EC of 2 December 2003 on cancer screening EU Regional Non- legally binding n/a Major and chronic diseases: Cancer EU Regional Non- legally binding http://ec.europa.eu/health/major_chronic_dis eases/diseases/cancer/index_en.htm Screening and genetics: Prenatal screening EU Regional Non- legally binding http://www.europeristat.com/our- publications/european-perinatal-health- report.html Reproductive health EU Regional Non- legally binding n/a 106 Communication COM/2009/0291 final of 24 June 2009 from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions on Action against Cancer: European Partnership EU Regional Non- legally binding n/a European guidelines for quality assurance in cervical cancer screening and diagnosis EU Regional Non- legally binding n/a Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) WTO Global Legally binding http://www.wto.org/english/tratop_e/trips_e/ par6laws_e.htm; http://www.wto.org/english/tratop_e/trips_e/t a_docs_e/3_ipc61_e.pdf C. Te rt ia ry p re ve nt io n European guidelines for the management of chronic non-specific low back pain EU Regional Non- legally binding n/a WHO Treatment Guidelines on chronic non- malignant pain in adults: scoping document WHO Global Non- legally binding n/a European Convention relating to the Formalities required for Patent Applications EU Regional Legally binding n/a 107 EPHO 6: Assuring governance for health and well-being EPHO subdivision Title of instrument or tool with hyperlink Lead organization Level: global, regional, national or local Legal status Evaluation notes (monitoring and assessment reports; activity reports; expected outputs; countries implementation; transparency) A .E ns ur in g a w ho le o f g ov er nm en t a nd w ho le o f s oc ie ty a pp ro ac h to h ea lth a nd w el l-b ei ng Constitution of the World Health Organization WHO Global Legally binding http://www.who.int/governance/eb/who_cons titution_en.pdf Charter of United Nations United Nations Global Legally binding http://unu.edu/ Acquis communautaire EU Regional Legally binding n/a Universal Declaration of Human Rights United Nations Global Legally binding http://www.ohchr.org/EN/HRBodies/Pages/Uni versalHumanRightsIndexDatabase.aspx Universal Declaration on the Human Genome and Human Rights United Nations Global Legally binding http://www.unesco.org/new/en/social-and- human-sciences/themes/global-ethics- observatory/ International Declaration on Human Genetic Data United Nations Global Legally binding Universal Declaration on Bioethics and Human Rights United Nations Global Legally binding Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine EU Regional Legally binding http://conventions.coe.int/Treaty/en/Treaties/ html/164.htm Convention for the Protection of Human Rights and Fundamental Freedoms EU Regional Legally binding http://conventions.coe.int/Treaty/Commun/Qu eVoulezVous.asp?NT=005&CL=ENG Protocol to the Convention for the Protection of Human Rights and Fundamental Freedoms EU Regional Legally binding http://assembly.coe.int/Main.asp?link=/Commi ttee/JUR/role_E.htm Charter of Fundamental Rights of the European Union EU Global Legally binding http://www.europarl.europa.eu/charter/defaul t_en.htm; http://ec.europa.eu/justice/policies/rights/doc s/com_2011_160_en.pdf Convention on the Rights of the Child United Nations Global Legally binding http://www.unicef.org/crc/index_30210.html Convention on the Rights of Persons with Disabilities United Nations Global Legally binding http://www.ohchr.org/Documents/Publications /Disabilities_training_17EN.pdf 108 Food Assistance Convention United Nations Global Legally binding http://treaties.un.org/doc/source/signature/20 12/CTC_XIX-48.pdf ILO Constitution ILO Global Legally binding http://www.ilo.org/public/english/bureau/leg/ download/constitution.pdf International Covenant on Civil and Political Rights United Nations Global Legally binding http://www2.ohchr.org/english/bodies/hrc/ind ex.htm International Covenant on Economic, Social and Cultural Rights United Nations Global Legally binding http://www2.ohchr.org/english/bodies/cescr/i ndex.htm United Nations Convention on the Law of the Sea United Nations Global Legally binding http://untreaty.un.org/cod/avl/ls/Freestone_LS .html The Convention on Biological Diversity United Nations Global Legally binding http://www.cbd.int/convention/mechanisms/i ntro.shtml Millennium Development Goals United Nations Global Legally binding http://www.un.org/millenniumgoals/reports.sh tml The Paris Declaration on Aid Effectiveness (2005) and Accra Agenda for Action (2008) OECD Global Non- legally binding http://www.oecd.org/document/60/0,3746,en _21571361_34047972_38242748_1_1_1_1,00. html General Comment No. 15 (2002) The right to water (arts. 11 and 12 of the International Covenant on Economic, Social and Cultural Rights) United Nations Global Non- legally binding n/a European Social Charter EU Regional Legally binding http://www.coe.int/t/dghl/monitoring/socialch arter/presentation/aboutcharter_EN.asp#The_i mpact_of_the_Charter_in_member_States Treaty of Lisbon amending the Treaty on European Union and the Treaty on the Functioning of the European Union (2009) EU Regional Legally binding http://www.just.ro/Portals/0/Analiza%20aprof undat%C4%83%20a%20impactului%20Tratatul ui%20de%20la%20Lisabona.pdf; http://europa.eu/lisbon_treaty/index_en.htm Council Framework Decision 2008/913/JHA of 28 November 2008 on combating certain forms and expressions of racism and xenophobia by means of criminal law EU Regional Legally binding n/a Directive 2011/36/EU of the European Parliament and of the Council of 5 April 2011 on preventing and combating trafficking in human beings and protecting its victims, and replacing Council Framework Decision 2002/629/JHA EU Regional Legally binding http://ec.europa.eu/anti- trafficking/entity.action?id=77172b8d-5d04- 4cf0-b276-49f733ab93c8 109 Madrid Statement: Mainstreaming gender equity in health: The need to move forward WHO Regional Office for Europe Regional Non- legally binding http://www.who.int/gender/documents/gende r/en/; http://www.who.int/gender/topics/en/; http://www.euro.who.int/en/what-we- do/health-topics/health- determinants/gender/publications/young- peoples-health-as-a-whole-of-society-response- series; http://www.who.int/gender/documents/gende r/9789241597708/en/index.html The Madrid International Plan of Action on Ageing United Nations Global Non- legally binding http://www.un.org/ageing/documents/building _natl_capacity/guiding.pdf; http://www.monitoringris.org/documents/imp _nat/risimp/AUT.pdf; http://www.huksam.hacettepe.edu.tr/English/ Files/WHO_RapportDEF.pdf; http://aprodev.eu/files/Gender/Pub_Everywhe reNowhere02.pdf The Toronto Declaration on the Global Prevention of Elder Abuse WHO Global Non- legally binding http://www.who.int/ageing/projects/elder_ab use/en/ B. H ea lth p ol ic y pl an ni ng a nd im pl em en ta tio n Health 2020: the European policy for health and well-being WHO Regional Office for Europe Regional Non- legally binding http://issuu.com/whoeurope/docs/health2020 _policyframework_strategy?mode=window&ba ckgroundColor=%23222222 Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare EU Regional Legally binding n/a White Paper: Together for Health: A Strategic Approach for the EU 2008–2013 EU Regional Non- legally binding http://ec.europa.eu/health/strategy/implemen tation/index_en.htm Proposal for a Regulation of the European Parliament and of the Council on establishing a Health for Growth Programme, the third multi- annual programme of EU action in the field of health for the period 2014–2020 EU Regional Non- legally binding http://ec.europa.eu/health/programme/docs/i a_progr2014_en.pdf Health in all policies EU Regional Non- legally binding http://ec.europa.eu/health/health_policies/im pact/index_en.htm 110 Communication COM(2005) 243 final from the Commission to the Council, the European Parliament and the Economic and Social Committee Nanosciences and nanotechnologies: An action plan for Europe 2005-2009 EU Regional Non- legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=C OM:2007:0505:FIN:EN:PDF; http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=C OM:2009:0607:FIN:EN:PDF Gaining Health: The European Strategy for the Prevention and Control of Noncommunicable Diseases WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0008/76526/E89306.pdf European Convention on Social and Medical Assistance EU Regional Legally binding n/a Protocol to the European Convention on Social and Medical Assistance EU Regional Legally binding n/a The Tallinn Charter: Health Systems for Health and Wealth WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0019/134470/08E_InterimTallinn_110515- V2.pdf The Berlin Declaration on Tuberculosis WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/communicable- diseases/tuberculosis/news/news/2012/6/euro pean-health-authorities-discuss-essential-steps- to-curb-the-tb-and-mxdr-tb-epidemic; http://www.euro.who.int/__data/assets/pdf_fi le/0007/68794/E92047.pdf HEALTH21: The health for all policy framework for the WHO European Region WHO Regional Office for Europe Regional Non- legally binding http://www.who.int/sdhconference/resources/ implementinghiapadel-sahealth-100622.pdf European Charter on Counteracting Obesity WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0020/128027/RD_speech_Obesity_Brussels_ Dec_2010.pdf; http://www.euro.who.int/en/what-we- do/health-topics/noncommunicable- diseases/obesity/activities Mental Health Declaration for Europe: Facing the Challenges, Building Solutions WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0006/96450/E91732.pdf; http://www.euro.who.int/__data/assets/pdf_fi le/0017/158102/316637_WHO_brochure_226x 226_1-mental-health.pdf 111 Children’s Environment and Health Action Plan for Europe WHO Regional Office for Europe Regional Non- legally binding http://www.hpa.org.uk/webc/HPAwebFile/HPA web_C/1194947328059 Declaration of Fourth Ministerial Conference on Environment and Health, Budapest, Hungary, 23– 25 June 2004 WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/environment-and- health/health-impact-assessment; http://www.euro.who.int/en/what-we- do/event/fifth-ministerial-conference-on- environment-and-health/documentation Regional Committee resolution EUR/RC54/R3 on Environment and health WHO Regional Office for Europe Regional Non- legally binding Warsaw Declaration for a Tobacco-free Europe WHO Regional Office for Europe Regional Non- legally binding http://www.iuhpe.org/upload/File/adv_fleitma n.pdf; http://www.euro.who.int/en/what-we- do/health-topics/disease-prevention/tobacco European Strategy for Tobacco Control WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/disease- prevention/tobacco/policy The Charter Against Tobacco, 1988 WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0003/115338/E93946.pdf Declaration on Young People and Alcohol WHO Regional Office for Europe Regional Non- legally binding http://ec.europa.eu/health/ph_projects/2000/ promotion/fp_promotion_2000_exs_07_en.pdf Munich Declaration: Nurses and Midwives: a Force for Health, 2000 WHO Regional Office for Europe Regional Non- legally binding http://apps.who.int/gb/archive/pdf_files/WHA 56/ea5619.pdf; http://www.euro.who.int/__data/assets/pdf_fi le/0019/114157/E93980.pdf London Declaration on Action in Partnership WHO Regional Office for Europe Regional Non- legally binding http://www.unece.org/env/eia/about/health.h tml 112 Charter on Transport, Environment and Health WHO Regional Office for Europe Regional Non- legally binding http://www.thepep.org/ClearingHouse/docfiles /Towards_healthy_and_sustainable_Finland_Ri sto.pdf; http://www.unece.org/fileadmin/DAM/thepep /en/hlm/documents/2002/eur.02.5050828.3.e. pdf; http://www.who.int/bulletin/volumes/81/6/do ra.pdf HEALTH21 – health for all in the 21st century: an introduction WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we- do/data-and-evidence/databases/european- health-for-all-database-hfa-db2 Athens Declaration for Healthy Cities WHO Regional Office for Europe Regional Non- legally binding n/a The Milan Declaration on Healthy Cities WHO Regional Office for Europe Regional Non- legally binding n/a Zagreb Declaration for Healthy Cities WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0009/100989/E92260.pdf WHO European Healthy Cities Network WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/environment-and- health/urban-health/activities/healthy- cities/who-european-healthy-cities- network/the-2012-healthy-cities-conference; http://www.euro.who.int/en/what-we- do/health-topics/environment-and- health/urban-health/activities/health-impact- assessment National Healthy Cities Networks WHO Regional Office for Europe Regional Non- legally binding n/a Healthy cities tackle the social determinants of inequities in health: a framework for action WHO Regional Office for Europe Regional Non- legally binding n/a 113 European Charter on Environment and Health, 1989 WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0019/114085/ICP_RUD_113.pdf Parma Declaration on Environment and Health, 2010 WHO Regional Office for Europe Regional Non- legally binding http://www.who.int/gho/phe/en/index.html; http://www.euro.who.int/__data/assets/pdf_fi le/0016/104515/E93535.pdf Declaration of Alma-Ata WHO Regional Office for Europe Regional Non- legally binding n/a Ljubljana charter on reforming health care in Europe WHO Regional Office for Europe Regional Non- legally binding n/a European Charter on Alcohol WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0008/79406/EUR_ICP_ALDT_94_03_CN01.p df Framework for alcohol policy in the WHO European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0011/87995/RC55_ebd01.pdf; http://www.euro.who.int/__data/assets/pdf_fi le/0003/160680/e96457.pdf; http://www.euro.who.int/__data/assets/pdf_fi le/0014/114323/E93937.pdf The Copenhagen Declaration on Health Policy, 1994 WHO Regional Office for Europe Regional Non- legally binding n/a Declaration on Action for Environment and Health in Europe WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0005/109877/EUR_ICP_CEH_212A.pdf; http://www.who.int/heli/impacts/en/ Vienna Statement on Investing in Women’s Health in the Countries of Central and Eastern Europe, 1994 WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0007/69532/E73519.pdf; http://www.euro.who.int/en/where-we- work/member- states/slovenia/news/news/2012/06/assessing- the-impact-of-policies-on-health-equity-in- slovenia 114 Vienna Declaration on Nursing in Support of the European Targets for Health for All, 1988 WHO Regional Office for Europe Regional Non- legally binding n/a Ottawa Charter for Health Promotion, 1986 WHO Regional Office for Europe Regional Non- legally binding http://www.who.int/healthpromotion/en/ Knowledge Translation on Ageing and Health: a framework for policy development, 2012 WHO Global Non- legally binding n/a Global health and ageing WHO Global Non- legally binding n/a Second WHO European action plan for food and nutrition policy: tackling noncommunicable and acute diseases WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0010/57655/fs0507e.pdf WHO European Action Plan for Food and Nutrition Policy 2007–2012 WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/disease- prevention/nutrition/activities; http://www.euro.who.int/en/what-we- do/health-topics/disease- prevention/nutrition/activities/monitoring-and- surveillance European Action Plan for Strengthening Public Health Capacities and Services WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0005/171770/RC62wd12rev1-Eng.pdf Better health, better lives: children and young people with intellectual disabilities and their families WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/noncommunicable- diseases/mental-health/activities/intellectual- disabilities Regional Committee resolution EUR/RC61/R5: WHO European Declaration and Action Plan on the Health of Children and Young People with Intellectual Disabilities and their Families WHO Regional Office for Europe Regional Non- legally binding Regional Committee resolution EUR/RC61/R1: The new European policy for health – Health 2020: Vision, values, main directions and approaches WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0004/150619/RC61_Res_01.pdf 115 Regional Committee resolution EUR/RC61/R2: Strengthening public health capacities and services in Europe: a framework for action WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0017/150623/RC61_Res_02.pdf Regional Committee resolution EUR/RC61/R7: Multidrug- and extensively drug-resistant tuberculosis in the WHO European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0017/150632/RC61_Res_07.pdf Regional Committee resolution EUR/RC61/R8: European action plan for HIV/AIDS 2012–2015 WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0011/153875/e95953.pdf Regional Committee resolution EUR/RC60/R2: Better health for Europe: Adapting the Regional Office for Europe to the changing European environment: the Regional Director’s perspective WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0015/122226/RC60_eRes2.pdf Regional Committee resolution EUR/RC60/R5: Addressing key public health and health policy challenges in Europe: moving forwards in the quest for better health in the WHO European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0010/119539/RC60_edoc13.pdf Regional Committee resolution EUR/RC60/R6: Health in foreign policy and development cooperation: public health is global health WHO Regional Office for Europe Regional Non- legally binding http://www.who.int/trade/glossary/story042/e n/index.html Regional Committee resolution EUR/RC60/R7: The future of the European environment and health process WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0011/78608/E93618.pdf; http://www.euro.who.int/__data/assets/pdf_fi le/0007/119554/RC60_edoc17.pdf; Regional Committee resolution EUR/RC60/R12: Renewed commitment to elimination of measles and rubella and prevention of congenital rubella syndrome by 2015 and Sustained support for polio- free status in the WHO European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0005/167450/EpiBrief-Issue-25.pdf Regional Committee resolution EUR/RC59/R3: Health in times of global economic crisis: implications for the WHO European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0005/68945/RC59_eres03.pdf Regional Committee resolution EUR/RC59/R4: Health workforce policies in the WHO European Region WHO Regional Office for Europe Regional Non- legally binding http://www.who.int/hrh/governance/en/ 116 Regional Committee resolution EUR/RC59/R5: Implementation of the International Health Regulations (2005) in the WHO European Region WHO Regional Office for Europe Regional Non- legally binding http://www.who.int/ihr/legal_issues/en/ Regional Committee resolution EUR/RC58/R4: Stewardship/governance of health systems in the WHO European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0019/160813/HSPA_A-tool-for-health- governance-in-the-21st-century.pdf Regional Committee resolution EUR/RC58/R8: Behaviour change strategies and health: the role of health systems WHO Regional Office for Europe Regional Non- legally binding http://www.epha.org/a/3259 Regional Committee resolution EUR/RC57/R1: Health workforce policies in the European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0010/68950/RC59_eres04.pdf Regional Committee resolution EUR/RC57/R2: The Millennium Development Goals in the WHO European Region: Health systems and health of mothers and children – lessons learned WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/Life-stages/maternal-and- newborn-health; http://www.euro.who.int/__data/assets/pdf_fi le/0016/154141/e95980.pdf; http://www.euro.who.int/__data/assets/pdf_fi le/0008/146978/313914_Entre_Nous_74_low. pdf Regional Committee resolution EUR/RC57/R4: Follow-up to the WHO European Ministerial Conference on Counteracting Obesity and Second European Action Plan for Food and Nutrition Policy WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0009/87462/E89567.pdf; http://whqlibdoc.who.int/publications/924154 5747.pdf Regional Committee resolution EUR/RC56/R2: Prevention and control of noncommunicable diseases in the WHO European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0009/122976/E94316.pdf Regional Committee resolution EUR/RC55/R1: Framework for alcohol policy in the WHO European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0007/79396/E88335.pdf Regional Committee resolution EUR/RC55/R2: WHO European Ministerial Conference on Mental Health WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0008/88595/E85445.pdf 117 Regional Committee resolution EUR/RC55/R4: The Health for All policy framework for the WHO European Region: 2005 update WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0008/98387/E87861.pdf Regional Committee resolution EUR/RC55/R6: European strategy for child and adolescent health and development WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0020/79400/E87710.pdf Regional Committee resolution EUR/RC55/R7: Strengthening national immunization systems through measles and rubella elimination and prevention of congenital rubella infection in WHO’s European Region WHO Regional Office for Europe Regional Non- legally binding http://www.who.int/bulletin/volumes/87/2/07 -050187/en/index.html Regional Committee resolution EUR/RC55/R8: Strengthening European health systems as a continuation of the WHO Regional Office for Europe’s Country Strategy “Matching services to new needs” WHO Regional Office for Europe Regional Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) Regional Committee resolution EUR/RC55/R9: Prevention of injuries in the WHO European Region WHO Regional Office for Europe Regional Non- legally binding Regional Committee resolution EUR/RC54/R4: Prevention and control of noncommunicable diseases in WHO’s European Region WHO Regional Office for Europe Regional Non- legally binding see EPHO 1 Regional Committee resolution EUR/RC53/R2: Progress in implementing the WHO Regional Office for Europe’s Country Strategy “Matching services to new needs” WHO Regional Office for Europe Regional Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) Regional Committee resolution EUR/RC53/R3: Update of the regional Health for All (HFA) policy framework WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0009/87813/RC53_eres03.pdf Regional Committee resolution EUR/RC53/R4: Mental health in WHO’s European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0008/88595/E85445.pdf Regional Committee resolution EUR/RC53/R7: The health of children and adolescents in WHO’s WHO Regional Regional Non- legally http://www.euro.who.int/__data/assets/pdf_fi le/0020/79400/E87710.pdf 118 European Region Office for Europe binding Regional Committee resolution EUR/RC52/R2: Certification of the European Region of WHO as a territory free from indigenous wild poliovirus WHO Regional Office for Europe Regional Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) Regional Committee resolution EUR/RC52/R3: Recommendations of the FAO/WHO Pan-European Conference on Food Safety and Quality, 25–28 February 2002 WHO Regional Office for Europe Regional Non- legally binding see EPHO 3 (C. Food Safety) Regional Committee resolution EUR/RC52/R6: Fourth Ministerial Conference on Environment and Health WHO Regional Office for Europe Regional Non- legally binding see EPHOs 2, 3 and 6 Regional Committee resolution EUR/RC52/R7: Poverty and health – Evidence and action in WHO’s European Region WHO Regional Office for Europe Regional Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) Regional Committee resolution EUR/RC52/R8: Scaling up the response to tuberculosis in the European Region of WHO WHO Regional Office for Europe Regional Non- legally binding see EPHOs 1 and 4 Regional Committee resolution EUR/RC52/R9: Scaling up the response to HIV/AIDS in the European Region of WHO WHO Regional Office for Europe Regional Non- legally binding see EPHOs 1 and 4 Regional Committee resolution EUR/RC52/R10: Scaling up the response to malaria in the European Region of WHO WHO Regional Office for Europe Regional Non- legally binding see EPHOs 1 and 4 Regional Committee resolution EUR/RC51/R3: The European Health Report – information and knowledge management WHO Regional Office for Europe Regional Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) Regional Committee resolution EUR/RC51/R4: Progress report on the European Alcohol Action Plan, including follow-up to the WHO European Ministerial Conference on Young People and Alcohol WHO Regional Office for Europe Regional Non- legally binding see EPHO 4; http://www.who.int/substance_abuse/activitie s/gsrhua/en/index.html; http://www.euro.who.int/__data/assets/pdf_fi le/0007/79396/E88335.pdf 119 Regional Committee resolution EUR/RC51/R5: the Athens Declaration on Mental Health and Man- Made Disasters, Stigma and Community Care WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0008/88595/E85445.pdf Regional Committee resolution EUR/RC51/R6: Poverty and health – Evidence and action by WHO’s European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/who-we- are/governance/regional-committee-for- europe Regional Committee resolution EUR/RC51/R7: Health and sustainable development: World Summit on Sustainable Development WHO Regional Office for Europe Regional Non- legally binding Regional Committee resolution EUR/RC50/R3: Poliomyelitis Eradication WHO Regional Office for Europe Regional Non- legally binding Regional Committee resolution EUR/RC49/R6: Necessary public health action on natural disasters and emergencies and international cooperation for emergency preparedness WHO Regional Office for Europe Regional Non- legally binding Regional Committee resolution EUR/RC49/R8: European Alcohol Action Plan – third phase WHO Regional Office for Europe Regional Non- legally binding Regional Committee resolution EUR/RC49/R9: Upgrading the Role of Public Health in the European Region WHO Regional Office for Europe Regional Non- legally binding Regional Committee resolution EUR/RC49/R10, Health for All Indicators for monitoring and evaluation of HEALTH21 WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/who-we- are/governance/regional-committee-for- europe Regional Committee resolution EUR/RC48/R3: Strengthening action for health for all at local and city levels in the European Region of WHO WHO Regional Office for Europe Regional Non- legally binding Regional Committee resolution EUR/RC48/R5: Health for All Policy Framework for the European Region for the 21st Century WHO Regional Office for Europe Regional Non- legally binding 120 World Health Assembly resolution WHA65.3: Strengthening noncommunicable disease policies to promote active ageing WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA65.4: The global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level WHO Global Non- legally binding World Health Assembly resolution WHA65.5: Poliomyelitis: intensification of the global eradication initiative WHO Global Non- legally binding World Health Assembly resolution WHA65.6: Maternal, infant and young child nutrition WHO Global Non- legally binding World Health Assembly resolution WHA65.7: Implementation of the recommendations of the Commission on Information and Accountability for Women’s and Children’s Health WHO Global Non- legally binding World Health Assembly resolution WHA65.8: Outcome of the World Conference on Social Determinants of Health WHO Global Non- legally binding World Health Assembly resolution WHA65.9: Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan WHO Global Non- legally binding World Health Assembly resolution WHA65.17: Global vaccine action plan WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA65.18: World Immunization Week WHO Global Non- legally binding World Health Assembly resolution WHA65.19: Substandard/spurious/falsely- labelled/falsified/counterfeit medical products WHO Global Non- legally binding World Health Assembly resolution WHA65.20: WHO’s response, and role as the health cluster lead, in meeting the growing demands of health in humanitarian emergencies WHO Global Non- legally binding 121 World Health Assembly resolution WHA65.21: Elimination of schistosomiasis WHO Global Non- legally binding World Health Assembly resolution WHA65.23: Implementation of the International Health Regulations (2005) WHO Global Non- legally binding World Health Assembly resolution WHA64.1: Implementation of the International Health Regulations (2005) WHO Global Non- legally binding World Health Assembly resolution WHA64.4: Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan WHO Global Non- legally binding World Health Assembly resolution WHA64.5: Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits WHO Global Non- legally binding World Health Assembly resolution WHA64.6: Health workforce strengthening WHO Global Non- legally binding World Health Assembly resolution WHA64.7: Strengthening nursing and midwifery WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA64.8: Strengthening national policy dialogue to build more robust health policies, strategies and plans WHO Global Non- legally binding World Health Assembly resolution WHA64.9: Sustainable health financing structures and universal coverage WHO Global Non- legally binding World Health Assembly resolution WHA64.10: Strengthening national health emergency and disaster management capacities and resilience of health systems WHO Global Non- legally binding World Health Assembly resolution WHA64.11: Preparations for the High-level Meeting of the United Nations General Assembly on the prevention and control of noncommunicable diseases, following on the Moscow Conference WHO Global Non- legally binding 122 World Health Assembly resolution WHA64.12: WHO’s role in the follow-up to the United Nations High-level Plenary Meeting of the General Assembly on the Millennium Development Goals WHO Global Non- legally binding World Health Assembly resolution WHA64.13: Working towards the reduction of perinatal and neonatal mortality WHO Global Non- legally binding World Health Assembly resolution WHA64.14: Global health sector strategy on HIV/AIDS, 2011– 2015 WHO Global Non- legally binding World Health Assembly resolution WHA64.15: Cholera: mechanism for control and prevention WHO Global Non- legally binding World Health Assembly resolution WHA64.16: Eradication of dracunculiasis WHO Global Non- legally binding World Health Assembly resolution WHA64.17: Malaria WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA64.24: on Drinking-Water, Sanitation and Health WHO Global Non- legally binding World Health Assembly resolution WHA64.26: International Agency for Research on Cancer: amendments to Statute WHO Global Non- legally binding World Health Assembly resolution WHA64.27: Child injury prevention WHO Global Non- legally binding World Health Assembly resolution WHA64.28: Youth and health risks WHO Global Non- legally binding World Health Assembly resolution WHA63.1: Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits WHO Global Non- legally binding World Health Assembly resolution WHA63.2: Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan WHO Global Non- legally binding 123 World Health Assembly resolution WHA63.3: Advancing food safety initiatives WHO Global Non- legally binding World Health Assembly resolution WHA63.12: Availability, safety and quality of blood products WHO Global Non- legally binding World Health Assembly resolution WHA63.13: Global strategy to reduce the harmful use of alcohol WHO Global Non- legally binding World Health Assembly resolution WHA63.14: Marketing of food and non-alcoholic beverages to children WHO Global Non- legally binding World Health Assembly resolution WHA63.15: Monitoring of the achievement of the health- related Millennium Development Goals WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA63.16: WHO Global Code of Practice on the International Recruitment of Health Personnel WHO Global Non- legally binding World Health Assembly resolution WHA63.17: Birth defects WHO Global Non- legally binding World Health Assembly resolution WHA63.18: Viral hepatitis WHO Global Non- legally binding World Health Assembly resolution WHA63.19: WHO HIV/AIDS strategy for 2011–2015 WHO Global Non- legally binding World Health Assembly resolution WHA63.20: Chagas disease: control and elimination WHO Global Non- legally binding World Health Assembly resolution WHA63.21: WHO’s role and responsibilities in health research WHO Global Non- legally binding World Health Assembly resolution WHA63.22: Human organ and tissue transplantation WHO Global Non- legally binding 124 World Health Assembly resolution WHA63.23: on infant and young child nutrition WHO Global Non- legally binding World Health Assembly resolution WHA63.24: Accelerated progress towards achievement of Millennium Development Goal 4 to reduce child mortality: prevention and treatment of pneumonia WHO Global Non- legally binding World Health Assembly resolution WHA 63.25: Improvement of health through on safe and environmentally sound waste management WHO Global Non- legally binding World Health Assembly resolution WHA63.26: Improvement of health through sound management of obsolete pesticides and other obsolete chemicals WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA63.27: Strengthening the capacity of governments to constructively engage the private sector in providing essential health-care services WHO Global Non- legally binding World Health Assembly resolution WHA63.28: Establishment of a consultative expert working group on research and development: financing and coordination WHO Global Non- legally binding World Health Assembly resolution WHA62.10: Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits WHO Global Non- legally binding World Health Assembly resolution WHA62.12: Primary health care, including health system strengthening WHO Global Non- legally binding World Health Assembly resolution WHA62.14: Reducing health inequities through action on the social determinants of health WHO Global Non- legally binding World Health Assembly resolution WHA62.15: Prevention and control of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis WHO Global Non- legally binding World Health Assembly resolution WHA62.16: Global strategy and plan of action on public health, innovation and intellectual property WHO Global Non- legally binding 125 World Health Assembly resolution WHA61.1: Poliomyelitis: mechanism for management of potential risks to eradication WHO Global Non- legally binding World Health Assembly resolution WHA61.2: Implementation of the International Health Regulations (2005) WHO Global Non- legally binding World Health Assembly resolution WHA61.4: Strategies to reduce the harmful use of alcohol WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA61.14: Prevention and control of noncommunicable diseases: implementation of the global strategy WHO Global Non- legally binding World Health Assembly resolution WHA61.15: Global immunization strategy WHO Global Non- legally binding World Health Assembly resolution WHA61.17: Health of migrants WHO Global Non- legally binding World Health Assembly resolution WHA61.18: Monitoring of the achievement of the health- related Millennium Development Goals WHO Global Non- legally binding World Health Assembly resolution WHA61.19: Climate change and health WHO Global Non- legally binding World Health Assembly resolution WHA61.20: Infant and young child nutrition: biennial progress report WHO Global Non- legally binding World Health Assembly resolution WHA61.21: Global strategy and plan of action on public health, innovation and intellectual property WHO Global Non- legally binding World Health Assembly resolution WHA60.1: Smallpox eradication: destruction of variola virus stocks WHO Global Non- legally binding World Health Assembly resolution WHA60.14: Poliomyelitis: mechanism for management of potential risks to eradication WHO Global Non- legally binding World Health Assembly resolution WHA60.15: WHO’s role and responsibilities in health research WHO Global Non- legally 126 binding World Health Assembly resolution WHA60.16: Progress in the rational use of medicines WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA60.17: Oral health: action plan for promotion and integrated disease prevention WHO Global Non- legally binding World Health Assembly resolution WHA60.18: Malaria, including proposal for establishment of World Malaria Day WHO Global Non- legally binding World Health Assembly resolution WHA60.19: Tuberculosis control: progress and long-term planning WHO Global Non- legally binding World Health Assembly resolution WHA60.20: Better medicines for children WHO Global Non- legally binding World Health Assembly resolution WHA60.21: Sustaining the elimination of iodine deficiency disorders WHO Global Non- legally binding World Health Assembly resolution WHA60.22: Health systems: emergency-care systems WHO Global Non- legally binding World Health Assembly resolution WHA60.23: Prevention and control of noncommunicable diseases: implementation of the global strategy WHO Global Non- legally binding World Health Assembly resolution WHA60.24: Health promotion in a globalized world WHO Global Non- legally binding World Health Assembly resolution WHA60.25: Integrating gender analysis and actions into the work of WHO: draft strategy WHO Global Non- legally binding World Health Assembly resolution WHA60.26: Workers’ health: global plan of action WHO Global Non- legally binding World Health Assembly resolution WHA59.1: Eradication of poliomyelitis WHO Global Non- legally binding 127 World Health Assembly resolution WHA59.2: Application of the International Health Regulations (2005) WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA59.11: Nutrition and HIV/AIDS WHO Global Non- legally binding World Health Assembly resolution WHA59.12: Implementation by WHO of the recommendations of the Global Task Team on Improving AIDS Coordination among Multilateral Institutions and International Donors WHO Global Non- legally binding World Health Assembly resolution WHA59.15: Strategic Approach to International Chemicals Management WHO Global Non- legally binding World Health Assembly resolution WHA59.16: Codex Alimentarius Commission: amendments to Statutes WHO Global Non- legally binding World Health Assembly resolution WHA59.17: Outcome of the first session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control WHO Global Non- legally binding World Health Assembly resolution WHA59.19: Prevention and control of sexually transmitted infections: global strategy WHO Global Non- legally binding World Health Assembly resolution WHA59.20: Sickle-cell anaemia WHO Global Non- legally binding World Health Assembly resolution WHA59.21: Infant and young child nutrition 2006 WHO Global Non- legally binding World Health Assembly resolution WHA59.22: Emergency preparedness and response WHO Global Non- legally binding World Health Assembly resolution WHA59.23: Rapid scaling up of health workforce production WHO Global Non- legally binding World Health Assembly resolution WHA59.25: Prevention of avoidable blindness and visual impairment WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) 128 World Health Assembly resolution WHA59.26: International trade and health WHO Global Non- legally binding World Health Assembly resolution WHA59.27: Strengthening nursing and midwifery WHO Global Non- legally binding World Health Assembly resolution WHA58.1: Health action in relation to crises and disasters, with particular emphasis on the earthquakes and tsunamis of 26 December 2004 WHO Global Non- legally binding World Health Assembly resolution WHA58.2: Malaria control WHO Global Non- legally binding World Health Assembly resolution WHA58.3: Revision of the International Health Regulations WHO Global Non- legally binding World Health Assembly resolution WHA58.5: Strengthening pandemic-influenza preparedness and response WHO Global Non- legally binding World Health Assembly resolution WHA58.13: Blood safety: proposal to establish World Blood Donor Day WHO Global Non- legally binding World Health Assembly resolution WHA58.14: Sustainable financing for tuberculosis prevention and control WHO Global Non- legally binding World Health Assembly resolution WHA58.15: Global immunization strategy WHO Global Non- legally binding World Health Assembly resolution WHA58.16: Strengthening active and healthy ageing WHO Global Non- legally binding World Health Assembly resolution WHA58.17: International migration of health personnel: a challenge for health systems in developing countries WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA58.22: Cancer prevention and control WHO Global Non- legally binding 129 World Health Assembly resolution WHA58.23: Disability, including prevention, management and rehabilitation WHO Global Non- legally binding World Health Assembly resolution WHA58.24: Sustaining the elimination of iodine deficiency disorders WHO Global Non- legally binding World Health Assembly resolution WHA58.26: Public-health problems caused by harmful use of alcohol WHO Global Non- legally binding World Health Assembly resolution WHA58.27: Improving the containment of antimicrobial resistance WHO Global Non- legally binding World Health Assembly resolution WHA58.28: eHealth WHO Global Non- legally binding World Health Assembly resolution WHA58.29: Enhancement of laboratory biosafety WHO Global Non- legally binding World Health Assembly resolution WHA58.30: Accelerating achievement of the internationally agreed health-related development goals, including those contained in the Millennium Declaration WHO Global Non- legally binding World Health Assembly resolution WHA58.31: Working towards universal coverage of maternal, newborn and child health interventions WHO Global Non- legally binding World Health Assembly resolution WHA58.32: Infant and young child nutrition WHO Global Non- legally binding World Health Assembly resolution WHA58.33: Sustainable health financing, universal coverage and social health insurance WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA58.34: Ministerial Summit on Health Research WHO Global Non- legally binding World Health Assembly resolution WHA57.1: Surveillance and control of Mycobacterium ulcerans disease (Buruli ulcer) WHO Global Non- legally binding 130 World Health Assembly resolution WHA57.2: Control of human African trypanosomiasis WHO Global Non- legally binding World Health Assembly resolution WHA57.10: Road safety and health WHO Global Non- legally binding World Health Assembly resolution WHA57.11 Family and health in the context of the tenth anniversary of the International Year of the Family WHO Global Non- legally binding World Health Assembly resolution WHA57.12: Reproductive health: draft strategy to accelerate progress towards the attainment of international development goals and targets WHO Global Non- legally binding World Health Assembly resolution WHA57.14: Scaling up treatment and care within a coordinated and comprehensive response to HIV/AIDS WHO Global Non- legally binding World Health Assembly resolution WHA57.16: Health promotion and healthy lifestyles WHO Global Non- legally binding World Health Assembly resolution WHA57.17: Global strategy on diet, physical activity and health WHO Global Non- legally binding World Health Assembly resolution WHA57.18: Human organ and tissue transplantation WHO Global Non- legally binding World Health Assembly resolution WHA57.19: International migration of health personnel: a challenge for health systems in developing countries WHO Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) World Health Assembly resolution WHA53.15: Food safety WHO Global Non- legally binding United Nations General Assembly resolution 66/260: Improving global road safety United Nations Global Non- legally binding United Nations General Assembly resolution 66/231: Oceans and the law of the sea United Nations Global Non- legally binding 131 United Nations General Assembly resolution 66/229: Convention on the Rights of Persons with Disabilities and the Optional Protocol thereto United Nations Global Non- legally binding United Nations General Assembly resolution 66/227: International cooperation on humanitarian assistance in the field of natural disasters, from relief to development United Nations Global Non- legally binding United Nations General Assembly resolution 66/224: People’s empowerment and development United Nations Global Non- legally binding United Nations General Assembly resolution 66/220: Agriculture development and food security United Nations Global Non- legally binding United Nations General Assembly resolution 66/215: Second United Nations Decade for the Eradication of Poverty (2008–2017) United Nations Global Non- legally binding United Nations General Assembly resolution 66/183: International cooperation against the world drug problem United Nations Global Non- legally binding United Nations General Assembly resolution 66/172: Protection of migrants United Nations Global Non- legally binding United Nations General Assembly resolution 66/158: The right to food United Nations Global Non- legally binding details of the implementation of most of these resolutions are included as separate documents (policies, frameworks, strategies, action plans) United Nations General Assembly resolution 66/148: International Covenants on Human Rights United Nations Global Non- legally binding United Nations General Assembly resolution 66/141: Rights of the child United Nations Global Non- legally binding United Nations General Assembly resolution 66/115: Global health and foreign policy United Nations Global Non- legally binding United Nations General Assembly resolution 65/95: Global health and foreign policy United Nations Global Non- legally binding 132 United Nations General Assembly resolution 65/238: Scope, modalities, format and organization of the high-level meeting of the General Assembly on the prevention and control of non- communicable diseases United Nations Global Non- legally binding United Nations General Assembly resolution 64/255: Improving global road safety United Nations Global Non- legally binding United Nations General Assembly resolution 65/1: Keeping the promise: united to achieve the Millennium Development Goals United Nations Global Non- legally binding United Nations Economic and Social Council resolution 2010/8: Tobacco use and maternal and child health United Nations Global Non- legally binding United Nations General Assembly resolution 64/265: Prevention and control of non- communicable diseases United Nations Global Non- legally binding C. Re gu la tio n an d co nt ro l The EU pharmacovigilance system EU Regional Legally binding http://ec.europa.eu/health/human- use/pharmacovigilance/developments/index_e n.htm Commission Regulation (EC) No 540/95 of 10 March 1995 laying down the arrangements for reporting suspected unexpected adverse reactions which are not serious, whether arising in the Community or in a third country, to medicinal products for human or veterinary use authorized in accordance with the provisions of Council Regulation (EEC) No 2309/93 EU Regional Legally binding Regulation (EC) No 726/2004 of the European Parliament and of the Council of 31 March 2004 laying down Community procedures for the authorisation and supervision of medicinal products for human and veterinary use and establishing a European Medicines Agency EU Regional Legally binding Directive 2010/84/EU of the European Parliament and of the Council of 15 December 2010 amending, as regards pharmacovigilance, Directive 2001/83/EC on the Community code relating to medicinal products for human use EU Regional Legally binding 133 Regulation (EU) No 1235/2010 of the European Parliament and of the Council of 15 December 2010 amending, as regards pharmacovigilance of medicinal products for human use, Regulation (EC) No 726/2004 laying down Community procedures for the authorisation and supervision of medicinal products for human and veterinary use and establishing a European Medicines Agency, and Regulation (EC) No 1394/2007 on advanced therapy medicinal products EU Regional Legally binding Strategy to Better Protect Public Health by Strengthening and Rationalising EU Pharmacovigilance EU Regional Non- legally binding n/a Implementing act on the requirements for the assessment of the regulatory framework applicable to the manufacturing of active substances of medicinal products for human use – Concept paper submitted for public consultation EU Regional Non- legally binding http://www.ema.europa.eu/ema/index.jsp?cur l=pages/medicines/landing/epar_search.jsp&m id=WC0b01ac058001d125 EudraLex – Volume 4 Good manufacturing practice (GMP) Guidelines EU Regional Legally binding n/a Commission Directive 91/412/EEC of 23 July 1991 laying down the principles and guidelines of good manufacturing practice for veterinary medicinal products EU Regional Legally binding n/a Commission Directive 2003/94/EC of 8 October 2003 laying down the principles and guidelines of good manufacturing practice in respect of medicinal products for human use and investigational medicinal products for human use EU Regional Legally binding n/a Note for guidance 2011/C 73/01 on minimising the risk of transmitting animal spongiform encephalopathy agents via human and veterinary medicinal products EU Regional Non- legally binding n/a EudraLex – Volume 3 Scientific guidelines for medicinal products for human use EU Regional Legally binding n/a Directive 2001/82/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to veterinary medicinal products EU Regional Legally binding n/a 134 Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use EU Regional Legally binding n/a Council Directive 90/385/EEC of 20 June 1990 on the approximation of the laws of the Member States relating to active implantable medical devices EU Regional Legally binding http://ec.europa.eu/health/medical- devices/files/revision_docs/entr_pe_dts_ia_md _en.pdf Council Directive 93/42/EEC of 14 June 1993 concerning medical devices EU Regional Legally binding n/a Directive 98/79/EC of the European Parliament and of the Council of 27 October 1998 on in vitro diagnostic medical devices EU Regional Legally binding n/a Medicines Policy WHO Global Non- legally binding http://www.who.int/medicines/publications/m onitor/en/index.html Medical Devices: Managing the Mismatch WHO Global Non- legally binding http://www.who.int/gho/health_technologies/ medical_devices/en/ The International Pharmacopoeia (Ph.Int.) WHO Global Non- legally binding n/a IMS Health Report to WHO Examines Effect of the Global Economic Crisis on Pharmaceutical Consumption, Expenditure and Unit Prices WHO Global Non- legally binding http://www.pharmaceuticalpolicy.nl/Publicatio ns/Reports/Buysse_report%20impact%20reces sion_2010.pdf D .A cc re di ta tio n an d lic en si ng o f se rv ic e pr ov id er s n/a n/a n/a n/a n/a E. Ev al ua tio n of qu al ity o f t he in di vi du al a nd co m m un ity p ub lic he al th s er vi ce s de liv er ed a cr os s th e so ci al g ra di en t n/a n/a n/a n/a n/a 135 EPHO 7: Assuring a sufficient and competent public health workforce EPHO subdivision Title of instrument or tool with hyperlink Lead organization Level: global, regional, national or local Legal status Evaluation notes (monitoring and assessment reports; activity reports; expected outputs; countries implementation; transparency) A .H um an r es ou rc es p la nn in g European mobility of medical and nursing workforce EU Regional Legally binding n/a The OECD Human Resources for Health Care Study OECD Global Non- legally binding n/a Total number of qualified nurses and midwives per 100 000 inhabitants EU Regional Non- legally binding n/a Practising physicians per 100 000 inhabitants EU Regional Non- legally binding n/a Physicians licensed to practise per 100 000 inhabitants EU Regional Non- legally binding n/a Registered medical specialists - Absolute numbers and rates per 100 000 of population, 2003 EU Regional Non- legally binding n/a Practising dentists per 100 000 inhabitants EU Regional Non- legally binding n/a Eurostat: Health statistics EU Regional Non- legally binding n/a B. Pu bl ic h ea lth w or kf or ce s ta nd ar ds Handbook on monitoring and evaluation of human resources for health, with special applications for low- and middle-income countries WHO Global Non- legally binding http://whqlibdoc.who.int/publications/2009/9 789241547703_eng.pdf European Union Standards for Nursing and Midwifery: Information for Accession Countries WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0005/102200/E92852.pdf 136 WHO Global Code of Practice on the International Recruitment of Health Personnel WHO Global Non- legally binding http://www.who.int/hrh/migration/code/code _nri/en/index.html World Health Report 2006: Working together for health WHO Global Non- legally binding http://www.euro.who.int/en/what-we- do/health-topics/Health-systems/health- workforce/policy Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications EU Regional Legally binding http://ec.europa.eu/internal_market/qualificati ons/policy_developments/legislation_en.htm#i mplementation Council Directive 93/16/EEC of 5 April 1993 to facilitate the free movement of doctors and the mutual recognition of their diplomas, certificates and other evidence of formal qualifications EU Regional Legally binding http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CE LEX:31993L0016:EN:HTML C. ed uc at io n an d ac cr ed ita tio n n/a n/a n/a n/a n/a D .T ra in in g of ot he r ac to rs w ith im pa ct n/a n/a n/a n/a n/a 137 EPHO 8: Assuring sustainable organizational structures and financing EPHO subdivision Title of instrument or tool with hyperlink Lead organization Level: global, regional, national or local Legal status Evaluation notes (monitoring and assessment reports; activity reports; expected outputs; countries implementation; transparency) A .E ns ur e ap pr op ri at e or ga ni za tio na l st ru ct ur es to de liv er E PH O s Preliminary review of institutional models for delivering essential public health operations in Europe WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0003/172731/Preliminary-review-of- institutional-models-for-delivering-essential- public-health-operations-in-Europe.pdf B. Co or di na tio n of or ga ni za tio na l st ru ct ur es European Observatory on Health Systems and Policies WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/en/who-we- are/partners/observatory/health-systems-in- transition-hit-series/about-the-hits-series C. Pe rf or m an ce as se ss m en t Essential Public Health Operations (EPHO) and Services in Europe (Annex 1) WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0005/171770/RC62wd12rev1-Eng.pdf Review of public health capacities and services in the European Region WHO Regional Office for Europe Regional Non- legally binding http://www.euro.who.int/__data/assets/pdf_fi le/0010/172729/Review-of-public-health- capacities-and-services-in-the-European- Region.pdf D .I nv es tm en t in p ub lic h ea lth The EU cohesion policy and health EU Regional Legally binding http://ec.europa.eu/health/health_structural_f unds/policy/index_en.htm E. Fi na nc in g pu bl ic h ea lth se rv ic es Evaluating the costs and benefits of national surveillance and response systems WHO Global Non- legally binding n/a Health systems expenditure EU Regional Non- legally binding http://epp.eurostat.ec.europa.eu/portal/page/ portal/health/public_health/data_public_healt h/database 138 EPHO 9: Advocacy, communication and social mobilization for health Title of instrument or tool with hyperlink Lead organization Level: global, regional, national or local Legal status Evaluation notes (monitoring and assessment reports; activity reports; expected outputs; countries implementation; transparency) Health communication for prevention and control of communicable diseases ECDC Regional Non-legally binding n/a Health Communication ECDC Regional Non-legally binding n/a Communicable disease prevention among Roma ECDC Regional Non-legally binding n/a WHO Outbreak communication guidelines WHO Global Non-legally binding n/a Communication toolkit on tick-borne diseases EU Regional Non-legally binding n/a 139 EPHO 10: Advancing public health research to inform policy and practice Title of instrument or tool with hyperlink Lead organization Level: global, regional, national or local Legal status Evaluation notes (monitoring and assessment reports; activity reports; expected outputs; countries implementation; transparency) World Health Assembly resolution WHA62/16: Public health, innovation and intellectual property: global strategy and plan of action WHO Global Non- legally binding http://apps.who.int/gb/CEWG/pdf/A62_R16-en.pdf Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects World Medical Association Global Non- legally binding http://www.who.int/bulletin/archives/79(4)373.pdf The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands North Macedonia Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eurocontact@who.int Website: www.euro.who.int WHO/EURO:2012-2218-41973-57685