Sixty-fifth Regional Committee for Europe: Vilnius, 14–17 September 2015: progress report on the European Environment and Health Process

© iStock REGIONAL COMMITTEE FOR EUROPE 65th SESSION Vilnius, Lithuania, 14–17 September 2015 Working document Progress report on the European Environment and Health Process Regional Committee for Europe EUR/RC65/18 65th session Vilnius, Lithuania, 14–17 September 2015 28 July 2015 150476 Provisional agenda item 5(j) ORIGINAL: ENGLISH Progress report on the European Environment and Health Process In accordance with resolution EUR/RC60/R7, the European Environment and Health Ministerial Board (EHMB) reports annually to the WHO Regional Committee for Europe and to the Committee on Environmental Policy of the United Nations Economic Commission for Europe on achievements and areas requiring greater effort, as well as on the activities, workplans and financial requirements of the EHMB and the European Environment and Health Task Force (EHTF). This progress report presents the activities undertaken by the EHMB and the EHTF and the implementation of their respective intersessional programmes of work. It also highlights the main outcomes of the High-level Mid-term Review Meeting of the EHTF, held in Haifa, Israel, on 28–30 April 2015, and presents the recommendations regarding the preparation of the Sixth Ministerial Conference on Environment and Health in 2017. Finally, the progress report brings to the attention of Member States the need to identify a host country for this Conference and other resource needs of the European Environment and Health Process. W ORL D H E A LT H O RG A N I Z AT IO N R EG I ON A L O F F I C E FO R EU R O P E UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Telephone: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: governance@euro.who.int Web: http://www.euro.who.int/en/who-we-are/governance Contents page Introduction ....................................................................................................................... 3 Governance and policy ...................................................................................................... 3 Feedback from the 20th session of the UNECE CEP .............................................. 3 Follow-up to the decisions of the UNECE CEP ...................................................... 4 Work of the EHMB .................................................................................................. 4 Intersessional work .............................................................................................. 4 Sixth meeting ....................................................................................................... 5 Work of the EHTF ................................................................................................... 6 Main outcomes of the High-level Mid-term Review Meeting .......................................... 8 Roadmap towards the Sixth Ministerial Conference on Environment and Health (2017) ................................................................................... 9 Results of the online consultation conducted on the roadmap ............................... 11 Results of the discussions on the roadmap held at the MTR ................................. 11 Annex. Overview of the structures of the European Environment and Health Process ...................................................................................................... 13 EUR/RC65/18 page 3 Introduction 1. In accordance with resolution EUR/RC60/R7 on the future of the European environment and health process, adopted in 2010, the European Environment and Health Ministerial Board (EHMB) reports to the WHO Regional Committee for Europe and to the Committee on Environmental Policy (CEP) of the United Nations Economic Commission for Europe (UNECE) on achievements and areas requiring greater effort, as well as on the activities, workplans and financial requirements of the EHMB and the European Environment and Health Task Force (EHTF). 2. This report to the 65th session of the Regional Committee and to the 21st session of the UNECE CEP represents an important milestone in the implementation of the European Environment and Health Process (EHP) between the Fifth Ministerial Conference on Environment and Health, held in March 2010, and the Sixth Ministerial Conference, to be held in 2017. It covers progress on implementation of the EHP since September 2014 and: • summarizes the work undertaken by the EHMB and the EHTF within the EHP and the challenges identified in fulfilling the commitments made in the Parma Declaration on Environment and Health; • presents the main outcomes of the High-level Mid-term Review Meeting (MTR) of the EHP, held in Haifa, Israel, on 28–30 April 2015; • outlines a roadmap for the preparation of the Sixth Ministerial Conference on Environment and Health. 3. This report is supported by the publication Improving environment and health in Europe: how far have we gotten?,1 which is a comprehensive account of progress achieved in the implementation of the Parma Declaration and the EHP since 2010. The document also reflects input from Member States and stakeholders represented on the EHTF. Governance and policy Feedback from the 20th session of the UNECE CEP 4. The UNECE CEP welcomed the information provided during a panel discussion on the EHP, which took place on 30 October 2014, expressed appreciation to the panellists for their contributions, and: (a) acknowledged the importance of effective cooperation between the environment and health sectors, including within the framework of the EHP; (b) underscored the role of multilateral environmental agreements in achieving environment and health goals; 1 Improving environment and health in Europe: how far have we gotten? Copenhagen: WHO Regional Office for Europe; 2015 (http://www.euro.who.int/en/media-centre/events/events/2015/04/ehp-mid-term- review/publications/improving-environment-and-health-in-europe-how-far-have-we-gotten, accessed 20 July 2015). EUR/RC65/18 page 4 (c) acknowledged the role, and welcomed the participation, of civil society organizations and other nongovernmental stakeholders in the EHP; (d) encouraged both the CEP and the EHP to continue to organize joint meetings, possibly including a tripartite meeting of the CEP Bureau, EHMB alternates and chairs of UNECE multilateral environmental agreements, and to extend invitations to participate in each other’s meetings; (e) agreed to allocate time within the CEP agenda to discuss environment and health issues; (f) agreed to contribute to the MTR (Haifa, Israel, April 2015), as well as to the Sixth Ministerial Conference on Environment and Health (2017); (g) took note of the progress report on the EHP (EUR/RC64/24 Rev.1); (h) thanked outgoing members of the EHMB for their contribution to the process; and (i) appointed as new members to the EHMB the Ministers of Environment of Armenia, Portugal and the Russian Federation (2015–2016); Montenegro (2015); and the former Yugoslav Republic of Macedonia (2016). Follow-up to the decisions of the UNECE CEP 5. In line with the above decisions, the following steps were undertaken. (a) The EHMB, at its sixth meeting in Madrid, Spain, on 24 February 2014, decided to consider the modalities for inviting nongovernmental organizations that are represented on the EHTF as observers at EHMB meetings. (b) A dedicated session on the EHP will be included on the agenda of the 21st session of the CEP in October 2015. (c) The Chair of the CEP and chairs of multilateral environmental agreements administered by the UNECE and the United Nations Environment Programme (UNEP) were invited to the MTR in 2015; the Chair of the CEP and the Chair of the Protocol on Water and Health actively contributed to the meeting discussions. Work of the EHMB Intersessional work 6. Preparatory meetings of the EHMB alternates took place in November 2014 in Bonn, Germany, and in February 2015 in Copenhagen, Denmark. The purpose was to prepare the sixth meeting of the EHMB on 24 February 2015; to review preparations for the MTR; to discuss elements of a programme of activities for EHMB members in the intersessional period; to advise the Secretariat on an initial proposal for a roadmap to guide the preparation of the Sixth Ministerial Conference on Environment and Health; and to welcome the newly appointed EHMB members from the environment sector, who took up their places on the EHMB on 1 January 2015. The alternates prepared a proposal on high-level events that EHMB members could attend (for example, conferences of the parties to conventions and the World Health Assembly, among others) and at which they could make statements on behalf of the EHMB; and developed drafts of these statements for approval by the EHMB at its sixth meeting. EUR/RC65/18 page 5 They also discussed a proposal by the Chair of the EHTF and Germany for the possible participation of nongovernmental organizations as observers at EHMB meetings. In addition, one session of both the November 2014 and the February 2015 meetings, which discussed governance aspects of the EHP and the preparations for the MTR, were held jointly with the Ad-Hoc Working Group (AWG) of the EHTF. Sixth meeting 7. The Government of Spain hosted the sixth meeting of the EHMB in Madrid, Spain, on 24 February 2015. The EHMB elected the Minister of Health of Spain and the Minister of Environment of Armenia as its Co-Chairpersons. In addition, the new Board members from Armenia, Montenegro, Portugal and the Russian Federation, representing the environment sector, assumed their seats, following their nominations by the CEP at its 20th session in October 2014. 8. The EHMB strongly agreed on the importance of strengthening the links and synergy between the health and the environment sectors, expressing concern that there was still insufficient awareness at the political level about the value and necessity of engaging in intersectoral work, as also advocated by Health 2020. The value of multilateral environmental agreements was also highlighted, as well as the importance of being informed by the global context of relevant forthcoming developments (such as the Third United Nations World Conference on Disaster Risk Reduction, the conferences of the parties to the Basel, Rotterdam and Stockholm conventions, the United Nations Summit to Adopt the Post-2015 Development Agenda and the 21st session of the Conference of the Parties (COP 21) to the United Nations Framework Convention on Climate Change (UNFCCC). In particular, the EHP could provide a means to implement the relevant sustainable development goals in the WHO European Region. 9. Among the strategic partnerships for the EHP, EHMB members placed particular emphasis on the need to continue efforts to re-engage the European Commission in the EHP, and agreed on several steps towards this objective, including high-level meetings with senior European Union (EU) officials, whose preparation is under discussion with EU counterparts, and advocacy actions by EHMB members that are also EU member states. 10. Following up on its fifth meeting, held in Vilnius, Lithuania, on 1 July 2014, which had identified air pollution, as well as chemical safety and climate change, among the main environmental risks to people’s health requiring political action in the European Region in the coming years, the EHMB reaffirmed the importance of these issues. In particular, it expressed its full support for the negotiation of World Health Assembly resolution WHA68.8 on addressing the health impact of air pollution, and decided to address a letter to the WHO Director-General and to finalize a statement in support of the resolution to be delivered by an EHMB representative at the Sixty-eighth World Health Assembly in May 2015. The letter was delivered to the WHO Director- General by Spain, in its capacity as Co-Chair of the EHMB representing the health sector. In addition, the EHMB appreciated the link to other policy instruments, such as the Convention on Long-range Transboundary Air Pollution and resolution 1/7 on strengthening the role of the United Nations Environment Programme in promoting air quality, adopted by the United Nations Environment Assembly (UNEA) of the UNEP at EUR/RC65/18 page 6 its first session in June 2014. They also appreciated that UNECE, UNEP and WHO held a tripartite interagency meeting, during which they agreed to work together on the interlinkages of environment and health, and to use forthcoming opportunities to deliver strong outcomes. These include the Sixty-eighth World Health Assembly; the development of partnerships with the Climate and Clean Air Coalition to Reduce Short- Lived Climate Pollutants and with the Basel, Rotterdam and Stockholm conventions; the plan to hold a side event at UNFCCC COP 21 in December 2015; to ensure a strong presence at the UNEA 2 in May 2016; and to collaborate in view of the Eighth Environment for Europe Ministerial Conference, to be held in Batumi, Georgia, in June 2016, where air pollution would be one of the two themes of the Conference. 11. The EHMB noted the proposed roadmap for the preparation of the Sixth Ministerial Conference on Environment and Health and the proposed broad consultation process around it. It appreciated the links between the technical topics suggested as the thematic background to the preparations of the political outcome of the Conference and the sustainable development goals of the post-2015 development agenda, as well as the proposal to develop specific, measurable, achievable, relevant and time-bound (SMART) objectives as an outcome of the Conference. 12. The EHMB discussed and adopted its intersessional programme of work, and considered the draft statements and letters that had been prepared to support its advocacy activities in relation to the conferences of the parties to the Basel, Rotterdam and Stockholm conventions; the fourth session of the International Conference on Chemicals Management; the Sixty-eighth World Health Assembly; and the meetings of the UNFCCC. Regarding the proposal to invite one of the nongovernmental organizations that are EHTF members as an observer at EHMB meetings, it agreed to develop a short paper further analysing the situation and proposing the principles according to which the observer(s) would be invited to participate in such meetings. The EHMB would take a decision through electronic consultation ahead of its seventh meeting. The EHMB also took note of the ongoing discussions among WHO Member States on a framework of engagement with non-State actors, which is pending an intergovernmental negotiation and a decision by the Sixty-ninth World Health Assembly. 13. The EHMB noted the update of the Chair and the Co-Chair of the EHTF on the preparations for the MTR, supported by the EHTF AWG. In particular, it noted the report, Governing the European Environment and Health Process: lessons learned and way forward, on EHP governance. 14. The EHMB noted with gratitude the offer of Georgia to consider hosting a meeting of the EHTF and/or to organize a side event on environment and health back to back with the Eighth Environment for Europe Ministerial Conference in 2016. It also agreed to send to all Member States a call to host the Sixth Ministerial Conference on Environment and Health in 2017. The seventh meeting of the EHMB will take place in Zagreb, Croatia, in the autumn of 2015 at the invitation of the Croatian Government. Work of the EHTF 15. Following up on the decisions taken at the third meeting of the EHTF, held in Brussels, Belgium, in December 2013, an editorial board consisting of EHTF members EUR/RC65/18 page 7 representing Estonia, Germany, Italy, Slovenia, the European Environment Agency, the Health and Environment Alliance, the Regional Environmental Center for Central and Eastern Europe (REC), the United Nations Development Programme (UNDP), UNECE, UNEP and the WHO Secretariat was set up to support the preparation of the MTR report Improving environment and health in Europe: how far have we gotten?2 16. In addition, an AWG to support the Chairperson, the Co-Chairperson and the WHO Secretariat in the preparations of the MTR was established. 17. Since its establishment, the AWG has held four face-to-face meetings (15 July 2014, Copenhagen, Denmark; 10 September 2014, Frankfurt, Germany; 13– 14 November 2014, Bonn, Germany; 5 February 2015, Copenhagen, Denmark) and four virtual meetings (12 June 2014; and 23 March, 13 April and 22 April 2015). Parts of the fourth meeting of the AWG, held in Bonn on 13–14 November 2014, and of its fifth meeting, held in Copenhagen on 5 February 2015, were held jointly with the EHMB alternates. In addition, part of the fourth meeting was open to all interested EHTF members. The next meeting of the EHTF, hosted by the former Yugoslav Republic of Macedonia, will take place in Skopje on 24–25 November 2015. 18. The work of the AWG focused on different aspects of the preparations for the MTR, including the development of its programme, the list of invitees, preparation of the working documents and advocacy and communications activities for the meeting, and ensuring the broadest possible participation of all EHTF members in the event, including through the opportunity to showcase experiences at the national level concerning implementation of the commitments made under the Parma Declaration. 19. The AWG was consulted on the development of the proposed roadmap for the preparations of the Sixth Ministerial Conference and agreed on the proposed set of events for the intersessional programme of work of the EHTF. 20. At its third meeting, held on 10 September 2014 in Frankfurt, Germany, the AWG decided to develop an additional working document for the MTR, Governing the European Environment and Health Process: lessons learned and way forward. The document serves to provide background for discussion at the MTR on possible improvements to the governance of the EHP during the period between the MTR in 2015 and the Sixth Ministerial Conference, to be held in 2017. It takes stock of the challenges faced in the application of the institutional governance mechanisms for the EHP adopted at the Fifth Ministerial Conference, held in Parma, Italy, in 2010; the practical steps that have been taken to address such challenges since then; and the positive experience developed with the establishment of the AWG by the third meeting of the EHTF. 21. The Working Group on Health in Climate Change (HIC) supports and facilitates dialogue and communication among Member States and other stakeholders on matters related to climate change and health. It also supports and monitors implementation of the relevant commitments contained in the Parma Declaration, guided by the European Regional Framework for Action on Climate Change and Health. It comprises 38 2 See footnote 1. EUR/RC65/18 page 8 Member States and five international organizations. At the fourth meeting of HIC, held on 1–2 June 2015, consensus on messages for UNFCCC COP 21, to be held in Paris, France, in December 2015, was reached. Main outcomes of the High-level Mid-term Review Meeting 22. The High-level Mid-term Review Meeting of the EHTF was generously hosted by the Government of Israel in Haifa on 28–30 April 2015. The MTR was prepared by the AWG, which had been set up for this purpose by the EHTF at its third meeting, held in Brussels, Belgium, in December 2013. The meeting was cosponsored by UNECE. 23. The meeting was attended by nearly 200 representatives of 37 Member States, as well as stakeholders of the EHP (the European Centre for Disease Prevention and Control, the European ECO Forum, the European Environment and Health Youth Coalition, the Health and Environment Alliance, the Organisation for Economic Co- operation and Development, the Regional Environmental Center for Central and Eastern Europe, UNDP, UNECE and UNEP). In addition, representatives of the WHO Standing Committee of the Regional Committee for Europe, the UNECE CEP, WHO headquarters and the WHO Regional Office for South-East Asia participated in the meeting. Observers included WHO collaborating centres, the World Bank, the Global Alliance on Health and Pollution, No Excuse Slovenia, and the South-eastern Europe Health Network. 24. The MTR reviewed the implementation of commitments made by Member States and international, intergovernmental and nongovernmental organizations with regard to the EHP. It examined progress, assessed the challenges still faced by Member States, and provided an opportunity for Member States and stakeholders to exchange experiences and demonstrate important achievements and actions undertaken towards fulfilling those commitments. 25. Member States and stakeholders also reviewed EHP governance and a roadmap towards the Sixth Ministerial Conference on Environment and Health. They made recommendations to the WHO Regional Committee for Europe and the UNECE CEP on the priority decisions required towards achieving the Parma commitments. These included a focus on achieving the time-bound targets adopted under the Parma Declaration and on addressing air pollution, chemical safety and climate change as a matter of priority. Member States and stakeholders also provided input into the work of the EHMB leading up to the Ministerial Conference. 26. The MTR provided an opportunity for showcasing achievements, through a poster exhibition of success stories at the national level, as well as a dedicated website. The meeting was underpinned by a robust and comprehensive communications strategy, developed and implemented in collaboration with the Communications Working Group of the EHP and all members of the EHTF. EUR/RC65/18 page 9 27. In addition to its main working documents, which consisted of the MTR report Improving environment and health in Europe: how far have we gotten?3 and the paper Governing the European Environment and Health Process: lessons learned and way forward, the meeting was underpinned by a series of information documents4 that provided additional evidence and background to the substantive discussions held during the meeting: (a) Towards the elimination of asbestos-related diseases in the WHO European Region: assessment of current policies in Member States, 2014 (b) Water and sanitation in the WHO European Region: 2014 highlights (c) Implementing the European Regional Framework for Action to protect health from climate change: a status report; (d) Human biomonitoring: facts and figures; (e) School environment: policies and current status; and (f) Economic cost of the health impact of air pollution in Europe: clean air, health and wealth. 28. The EHTF decided to extend the mandate of the AWG until the Sixth Ministerial Conference, tasking the AWG with supporting the preparations for the Conference, as well as with the development of concrete proposals on how the governance structure of the EHP could be further enhanced (see the Annex for an overview of the current governance structure). These proposals would provide an input to the preparatory discussions and negotiations leading to the Conference. The AWG would also continue to facilitate collaboration with the EHMB. The Task Force also adopted the new terms of reference of the AWG, including its proposed membership, and decided that the meetings of the Working Group would be open to all interested EHTF members. 29. The EHTF also adopted the proposed revision to its Rules of Procedure. Roadmap towards the Sixth Ministerial Conference on Environment and Health (2017) 30. The roadmap towards the Sixth Ministerial Conference on Environment and Health, to take place in 2017, was reviewed by the EHMB at its sixth meeting, held in Madrid, Spain, on 24 February 2015, and discussed by the EHTF at the MTR. In addition, with the aim of ensuring the broadest possible consultation, an online consultation was undertaken from 18 March to 25 April 2015, which was open to all Member States and EHMB and EHTF members; its results were highlighted at the MTR. 3 See footnote 1. 4 For the series of information documents, please see the following website. In: WHO Regional Office for Europe/Media centre/Events/EHP – Mid-term Review/Publications [website]. Copenhagen: WHO Regional Office for Europe; 2015 (http://www.euro.who.int/en/media-centre/events/events/2015/04/ehp- mid-term-review/publications, accessed 20 July 2015). EUR/RC65/18 page 10 31. The purpose of the roadmap is to guide the EHP until the Sixth Ministerial Conference through a two-pronged approach. It proposes that: (a) the first component be a political negotiation process that would result in a ministerial declaration and political commitments to be adopted by the Sixth Ministerial Conference; and (b) the second component would consist of a series of thematic technical consultations, whose outcomes would, in turn, inform the political negotiations. These consultations could follow the same thematic areas discussed at the Rio+20 Conference (such as air, chemicals, cities, disasters, energy, food, waste and water) and/or be related to the sustainable development goals to facilitate anchoring the EHP in the global post-2015 agenda. 32. The political process leading to the Sixth Ministerial Conference should provide adequate opportunity for Member States and EHP stakeholders to discuss and develop a consensus on the political outcomes of the Conference. This political component of the process will be informed by a series of thematic technical events. 33. In the political negotiation process, Member States and stakeholders will identify and agree on the outcome document(s) of the Ministerial Conference and the specific commitments to be agreed upon and adopted by all Member States in 2017. Without prejudice to the course of action that Member States will decide to take, a limited number of negotiated and widely adopted SMART objectives and targets would enhance the significance and relevance of the EHP. 34. Since the negotiations of the political outcome document should be transparent and inclusive, the EHTF may provide the appropriate framework in which those negotiations should take place. 35. The themes for the preparatory process proposed in the roadmap are fully consistent with the 17 proposed sustainable development goals that will be finally reviewed and adopted at the special session of the United Nations General Assembly in September 2015. They represent a logical framework within which the various aspects of environment and health of relevance to the European Region can be understood, conceptualized and put into practice, and provide a useful means to facilitate anchoring and aligning the EHP with the post-2015 development agenda and Health 2020. In turn, this will highlight the role of the EHP as a policy framework to be used by Member States to implement their commitments under the post-2015 development agenda and Health 2020. 36. With the impact on health and well-being as the key focus, each theme would also be explored in the context of sustainability, production and consumption patterns and trends, global change (primarily climate change), equity, human rights and opportunity for action. The themes are not exclusive; there are significant correlations and interlinkages among them that should be recognized in this process. 37. The transdisciplinary and cross-cutting nature of public and environmental health implies a particular need to be sensitive and responsive to change in many areas and sectors. Economic, environmental, social and other factors are continually shaping and reshaping the foundations on which population health must be built. Transitions of EUR/RC65/18 page 11 different types also affect critical areas, such as the science/policy interface and the translation of policy into practice. An appreciation of these influential elements is essential in charting the future course of the EHP. 38. The eight themes proposed for review in the preparatory process are organized around complex risk factors (such as air, chemicals, contaminated sites, waste or water), complex systems of direct relevance to environment and health (such as cities, energy or food) and matters of international environment and health security (such as climate change and disasters). Results of the online consultation conducted on the roadmap 39. The online consultation on the roadmap took place from 18 March to 25 April 2015 to solicit suggestions and views from all members of the EHTF on the proposed themes and the procedure for negotiation and development of the outcome document(s) of the Sixth Ministerial Conference on Environment and Health. 40. A total of 36 separate replies were received from 21 Member States and five stakeholders (the European Commission, the European ECO Forum, the Health and Environment Alliance, UNECE and WHO), resulting in 26 aggregated replies that were analysed. Approximately 20% of the replies from Member States came from the environment sector and 80% from the health sector. 41. Overall, there was strong agreement among all respondents on the specific criteria proposed regarding the process outlined in the roadmap, the guiding principles for the outcome document(s) of the Sixth Ministerial Conference and the themes proposed. In particular, respondents felt that a roadmap guiding the preparation for the Conference was very important and useful and that such preparations should include a review of the state of environment and health and its main challenges, regardless of which specific political commitments would be negotiated at the Conference. The negotiations of the ministerial declaration should be supported by technical discussions on major issues concerning environment and health in the WHO European Region. 42. For each of the proposed themes, at least one Member State or stakeholder expressed an interest in leading the technical consultations, with many more interested in participating, even though there was less interest in the themes of energy and food compared to the other topics. Results of the discussions on the roadmap held at the MTR 43. The discussions during the MTR were consistent with the findings of the online consultation. In particular, they confirmed the importance for the EHP to remain rooted in Health 2020 and the post-2015 development agenda in order to provide added value to Member States and to achieve effective implementation through collaboration between the environment and health sectors around a clearly defined common agenda. This can be achieved by capitalizing on the distinctive features of the EHP, namely, its capacity to provide evidence-based assessments and tools, as well as normative guidance and synergy for the implementation of many multilateral environmental agreements; its strong institutional legitimacy, clear mandate, broad convening capacity and links to the political governing bodies of both the health and the environment EUR/RC65/18 page 12 sectors, through the partnership between WHO and UNECE, as well as with UNEP; and its capacity to establish and develop partnerships with other intergovernmental and, hopefully, regional economic integration organizations and civil society, including young people. 44. Participants agreed that despite the significant progress achieved on many aspects of environment and health, there was still work to be done, particularly with regard to the health risks posed by hazardous chemicals, air pollution and lack of access to safe water and sanitation. This remaining work needs to be tackled, in particular, by focusing on the achievement of the time-limited targets agreed in 2010 at the Fifth Ministerial Conference on Environment and Health (with the elimination of asbestos-related diseases as the most imminent among the Parma targets). At the same time, it is necessary to stand up to new challenges and to link effectively with ongoing processes that provide synergy. This will require reconciling the complexity of the underlying global issues with the need to deliver a strong, clear and focused political outcome for the Sixth Ministerial Conference. 45. Participants also agreed that the preparatory process for the Ministerial Conference should be inclusive, transparent, streamlined and visible to all parties involved. In line with these principles, the EHTF would be the main body to lead the preparations for the Ministerial Conference and to serve as the forum to negotiate the outcome document on the basis of the involvement of all Member States and stakeholder organizations, in consultation with the EHMB, as well as the governing bodies of WHO and UNECE, and with the public. 46. The WHO Regional Committee for Europe and the UNECE CEP are invited to note this progress report, including the decisions of the MTR regarding the extension of the mandate of the AWG, its terms of reference and its membership, and the proposed way forward for the preparation of the Sixth Ministerial Conference on Environment and Health. EUR/RC65/18 page 13 Annex. Overview of the structures of the European Environment and Health Process = = =