Health and Environment


he environment influences human health in many ways — through exposures to physical, chemical and biological risk factors, and through related changes in behaviour in response to those factors. According to the WHO, 13 million deaths annually are due to preventable environmental causes. Mitigating environmental risk could save as many as four million lives a year in children alone, mostly in developing countries.

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The impact of the environment on health is a growing concern for the WMA and its members. Since 2007, the Association has been engaged in policy development and other activities, promoting the role of medical associations and individual physicians in preventing the damaging effects of the environment on health.

HEALTH AND CLIMATE CHANGE
HEALTH AND CHEMICALS
HEALTH AND MERCURY
BUILT ENVIRONMENT
GREEN HEALTH

HEALTH AND CLIMATE CHANGE

“Climate change will affect, in profoundly adverse ways, some of the most fundamental determinants of health: food, air and water. The warming of the planet will be gradual, but the increasing frequency and severity of extreme weather events, such as intense storms, heat waves, droughts and floods, will be abrupt and the consequences will be acutely felt. The earliest and most severe threats are to developing countries, with negative implications for the achievement of the health-related Millennium Development Goals and for health equity. It is therefore essential to formulate a clear response in order to protect human health and ensure that it is placed at the centre of the climate debate.” WHO, report by the secretariat, January 2009

In May 2009, the World Health Assembly adopted a resolution on health protection from climate change, signaling a much higher level of engagement from the health sector. The resolution draws attention to the further strengthening of the evidence for human-induced climate change, and consequent risks to global health, the achievement of the Millennium Development Goals, and health equity.

At the global level, representatives of the world's government have been meeting several times over the last years to discuss climate change, in particular around the United Nations Climage Convention on climate change as well as the kyoto protocol.

WMA Policy & Action

The WMA is committed to ensuring that the health sector is fully integrated in the current global debates and actions on climate change and to engaging physicians further for the protection of health from climate change.

On 1 of September 2009, the WMA held a seminar “Climate Change and Health Care” in Copenhagen to bring together physician leaders, other health actors and high-level experts from around the world in order to exchange experiences on the impact of climate change on health and to develop a global strategy, in particular in the context of the coming 15th Conference of the Parties to the UN Framework Convention on Climate Change.

At its annual General Assembly in New Delhi, India (17 October), the WMA approved a Declaration setting out an action plan to bring health to the forefront of the climate change debate and to mitigate the serious health risks facing the world. WMA leaders insisted that physicians must be more involved in the development of policies to protect the health of all their patients.

The WMA follows the governmental talks in the context of the United Nations climate change negotiations. Physicians are concerned that the negotiations do not take fully into consideration the well-evidenced impact of climate change on health as well as  the public health benefits of climate change mitigation activities. Based on the skills, experience and knowledge of their members, medical associations act to make health an inherent component of governmental talks in the context of the UN climate change process.

Together with environment & health NGOs, WMA endorsed the Cancun statement "The time to act is now" at the occasion of the UN Cancun Summit (December 2010).

The  Durban Summit (COP17 on climate change, December 2011) brought together a strong global health coalition, in which WMA was represented, bringing forward physicians' concerns in this area. A Durban Climate and Health Declaration and Plan of Action were adopted in the parallel NGO Climate and Health Summit.

Building upon this successful climate and health summit, an informal alliance of health organizations around the world (that includes WMA) has adopted the Doha Declaration on Climate, Health and Wellbeing to accompany the Doha Climate Change Conference (COP18). The statement details why health experts are extremely worried about the slow progress at the international climate negotiations, and highlights why health co-benefits can be important argument for ambitious climate mitigation. 

With two years now gone since the adoption of the Durban Declaration and the Health Sector Call to Action in Durban, the same health organisations organised a second Climate and Health Summit in parallel with the 19th COP negotiations in Warsaw, Poland next November (11-22/11/2013), with the support of WHO. It provided an opportunity for groups to collaborate and share progress in the development and implementation of strategies and projects to build resilience to the impacts of climate change on health.

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HEALTH AND CHEMICALS

Some chemicals have been recognised or are suspected to cause serious health hazards. Advances in environmental health research including environmental and human sampling and measuring techniques, and better information about the potential of low dose human health effects have helped to underscore emerging concerns.

Several notable international agreements on chemicals exist. These were prompted by the first United Nations Conference on the Human Environment declaration in 1972 (Stockholm) on the discharge of toxic substances into the environment; These agreements include the 1989 Basel Convention to control/prevent trans-boundary movements of hazardous wastes, the 1992 Rio Declaration on Environment and Development, the 1998 Rotterdam Convention on informed consent and shipment of hazardous substances, and the 2001 Stockholm Convention on Persistent Organic Pollutants.

More recently, the UNEP developped a Strategic Approach to International Chemicals Management (SAICM). The SAICM, adopted in Dubai 2006 by the International Conference for Chemicals Management at its first session, is a multi-sectoral and multi-stakeholder policy framework aimed at promoting the sound management of chemicals and hazardous waste in the context of sustainable development. At its second session, in 2009, the International Conference on Chemicals Management requested the development of a strategy for strengthening the engagement of the health sector in the implementation of the Strategic Approach, in consultation with WHO. Special attention is required to protect those in society that are particularly vulnerable to risks from hazardous chemicals, children, and workers. 

Read more: Strategic Approach to International Chemical Management (SAICM)

WMA current policy and action

Since 2009, the WMA has been engaged in the development of the strategy for strengthening the engagement of the health sector in SAICM.

At its General Assembly in Vancouver in October 2010, the WMA adopted a Statement on Environmental Degradation and Sound Management of Chemicals.

On the 19th of September 2012, WMA together with the World Federation of Public Health Associations (WFPHA), the government of Slovenia and the WHO organised a side-event "SAICM health - A prescription for multi-sectoral engagement" to look at the adoption of a specific strategy related to the strengthening of the health sector role in sound management of chemicals. This event took place in the context of the third session of the International Conference on Chemicals Manegement (ICCM3) taking place in Nairobi on 17-21 Sept. 2012. Some recent innovations in multi-stakeholder engagement promising a healthy outcome for all were presented. More details in the programme.

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HEALTH AND MERCURY

Mercury, even in relatively low doses, can have serious adverse impacts on health, in particular in relation to neurodevelopment. Mercury has been an integral part of many medical devices, most prominently thermometers and sphygmomanometers. These devices break or leak with regularity, adding to the global burden of mercury in the environment and exposing health care personnel to the acute effects of the metal itself.

Read more on Mercury and Health Care (Health Care Without Harm)

An increasing number of health and environment organisations engage in advocacy and sponsor projects worldwide to reduce the over-exposure in mercury in children and adults and to explore the replacement of mercury-based medical devices by affordable, accurate and safer alternatives.

WMA Current Policy & Action

In October 2008, the WMA adopted a statement on Reducing the Global Burden of Mercury. Recognising the urgent need to reduce both the supply and demand of mercury in the health care sector, the WMA makes a range of recommendations, including that the National medical associations lobby their governments for the reduction of risks related to mercury in the environment and that physicians at the local level explore ways to eliminate mercury-containing products in their offices and clinical practices.

Further to this statement, the WMA joined the UNEP Global Mercury Partnership and in particular the “Mercury in products” area, sharing the partnership’s goal of protecting human health and the global environment from the release of mercury and its compounds.

At its  General Assembly in New Delhi (India) in October 2009, Mr A.K. Sengupta from WHO-India presented WHO Activities in the area of Mercury in Health Care with focus on Regional Perspective, including the Mercury Free Healthcare Initiative, co-lead by Health Care Without Harm (HCWH) and the WHO. This initiative is based on the 2005 WHO Policy Paper that calls for short, medium and long-term steps to achieve the gradual substitution of mercury-based medical devices. This initiative is a component of the UN Environment Programme’s Mercury Products Partnership.

The WMA is also involved in the negotiation of the UNEP (UN Environment Programme) for a legally binding instrument on mercury. The UNEP  convened an intergovernmental negotiating committee (INC) with the mandate to prepare the legally binding instrument. The first session of the committee was held in Stockholm, Sweden, from 7 to 11 June 2010. WMA was represented at the meeting, bringing forward its 2008 mercury resolution.

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BUILT ENVIRONMENT

The term ‘built environment' refers to human-made resources and infrastructure designed to support human activity, such as buildings, roads, parks, and other facilities. The characteristics of the built environment can affect the health of residents in multiple ways. Studies have shown that people, particularly those in low income areas, can be negatively influenced by their built environment (for example, transportation, traffic noise, eating facilities...).

According to WHO, over the next thirty years, most of the world's population growth will occur in cities and towns of poor countries. Rapid, unplanned and unsustainable patterns of urban development are making developing cities focal points for many emerging environment and health hazards. As urban populations grow, the quality of the urban environment, will play an increasingly important role in public health with respect to issues ranging from solid waste disposal, provision of safe water and sanitation, and injury prevention, to the interface between urban poverty, environment and health.

The WMA working group on Health and the Environment together with the Canadian Medical Association commissioned a review on Health and the Built Environment to Urban Design 4 Health. The report provides a brief foundation on the connections between the built environment, health and wellbeing through a summary of key research and evidence. Read the report

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GREEN HEALTH

The health care sector generates millions of tons of waste each year - solid, liquid and gaseous wastes, including such potent pollutants as dioxins (from the incineration of PVC) and mercury. It uses plastics, paper, lumber and other resources. As a result of these and similar activities, the health sector contributes to the loss of global habitat and biodiversity and the impairment of the health of the world's ecosystem.

The WMA is calling on all its members and on the global health community to adopt an environmentally responsible approach to their activities. Achieving change requires raising awareness and sustained advocacy. This includes: 

=> Making health practice environmentally responsible
=> Greening Medical Associations

Making Health Practice Environmentally Responsible

Key facts (Source: WHO, November 2011):
http://www.who.int/mediacentre/factsheets/fs253/en/index.html

- Of the total amount of waste generated by health-care activities, about 80% is general waste.
- The remaining 20% is considered hazardous material that may be infectious, toxic or radioactive.
- Every year an estimated 16 000 million injections are administered worldwide, but not all of the needles and syringes are properly disposed of afterwards.
- Health-care waste contains potentially harmful microorganisms, which can infect hospital patients, health-care workers and the general public.

There are various ways to make hospitals and clinics environmentally responsible through a wiser management of waste, such as limiting incineration of waste, recycling non-hazardous wastes responsibly and the reduction of paper usage with the use of Electronic Medical Records (EMRs). Hospitals and clinics can also be designed and built to make the most efficient use of clean energy and to optimise recycling.

At the micro level, in daily medical practice, the same principles apply, for example:

  • Ensure the most efficient and economic use of hot water heaters
  • Use tap water instead of bottled when available
  • Ensure recycling bins are available and use recycled paper
  • Switch to electric hand dryers in restrooms
  • Use only environmentally friendly office cleaning and pest control chemicals
  • Reduce the use of mercury-containing equipment such as sphygmomanometers, thermometers, and thermostats
  • Maintain a consistent pharmaceutical disposal strategy
  • Be community leaders and set a good example: carpool or ride bike to work, telecommunicate as much as possible
  • Educate patients and staff about the health and environmental benefits of acting green. 
    Case Study:
    Green Nephrology' (Centre for Sustainable Healthcare) is a programme to improve the sustainability of kidney care. Set up by the Campaign for Greener Healthcare in response to the call for the NHS to reduce its carbon foot- print, the programme funds a Green Nephrology Fellowship, in which a nephrology trainee is seconded to work on climate change mitigation issues within kidney care. The Green Nephrology Programme aims to align the provision of more sustainable health care with higher quality care at lower financial costs. http://greenerhealthcare.org/
    Source: "Fair Society, healthy Lives" The Marmot review, Strategies of Health Inequalities in England post 2010 http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review
    Green Policies and Campaigns of Major Hospitals in Korea: The Korean Medical Association conducted a survey on green policies among major hospitals in Korea and complied the results of the survey#mce_temp_url#.
    Launching of the Korea Society for Green Hospitals, an organisation devoted to low-carbon growth in medical practice (June 2013): the Korea Society for Green Hospital will focus on encouraging Korean hospitals to join international green hospital networks and on preparing efficient response plans for the implementation of international green certifications- More

    More information:

    Greening Medical Associations

    This includes working to reduce the carbon footprint of associations' supply chain and day-to-day operations. In an effort to move towards green practices, the WMA and its members are committed to developing green working methods and meetings.

    For that purpose, the WMA Green Working Group laid down general Green Guidelines:

    Travel / Transport

    • Explore the use of shared travel / taxi options for WMA members whenever possible.
    • Adopt an environmentally sound transport policy, setting targets to reduce staff travel, especially by car and air. Encourage the use of public transport and walking for local travel where time constraints allow. Encourage the use of cycling where practicable.
    • Encourage the use of electronic communications, including video conferencing as alternatives to meetings.

    Reducing waste

    • Switching all standard paper from virgin to recycle.
    • Switching to electronic communications wherever possible
    • Maximise ecological use of computers and other office electronic equipment
    • Ensure widespread and systematic use of recycling bins.
    • Where offices are renovated, prioritise, green options (movement-sensitive lights, low-flush toilets, heating etc) where possible. Maximise energy efficiency, using the best and most cost-effective techniques,. Explore renewable energy sources.
    • Avoid the use of building materials from unsustainable sources, giving preference to timber and wood products from responsibly managed forests.

    General issues

    • ‘Staff engagement' is critical to the success of the policy. Although ultimate responsibility for implementation rests with management, all staff and members have a role in minimising adverse effects on the environment.
    • Ensure compliance with all relevant environmental legislation.
    • Demand the best environmental standards from suppliers.

    Monitoring mechanism

    • Review the office's carbon footprint by evaluating on a regular basis the cost of paper-usage, electricity, water etc in the office.
    • Appoint one staff member to coordinate the implementation of the proposals.

    For general information on the greening process, check the below organisations designed to help the meetings and events industry move towards sustainability: