Sustainable development:
Social issues & the environment

Maria Neira

Dr Maria Neira, WHO

Dr Maria Neira is Director of the Department of Public Health & Environment at WHO

Health and the environment

Why Geneva needs a Green Forum for Public Health

WHO's Environment and Public Health Department has launched an initiative to draw attention to the links between health and environment issues - covering priority risks such as vector-borne disease, the urban environment, indoor air pollution, water, climate change and toxic substances. But is the international community doing enough? Dr Maria Neira of WHO thinks international efforts could go further.

Our efforts for a healthier environment in the workplace offer a prime example of the importance of partnerships. Some 50% of the world's population are workers - so many people in all that we depend on partners to be able to have an effect on their health and the environment. Around the globe we can call on 70 collaborating centers dealing with occupational health. Both scientific and economic institutions contribute to our work. We enjoy very good relations with the trade union groups through the ILO and union organizations, and businesses through the Geneva-based International Organization of Employers. Our networking partners obviously include WHO's members through country offices - reaching ministers of health, labor and environment - and the chemical safety networks. Among the formal partnerships, we participate in SAICM, contribute to the International Programme on Chemical Safety, housed in WHO, and the Water Supply and Sanitation Collaborative Council. We also organize regular roundtables with the private sector, and a partnership with the Vienna-based International Agency for Atomic Energy on radiation and nuclear issues, particularly the radiation emergencies response group.

This is one reason I have been pressing for creation of a forum where we can discuss issues of environment, public health and sustainable development. Geneva offers an amazing platform for dialogue that in my opinion is not properly exploited. Apart from the organizations clustered in Environment House I and II, Geneva is home to a great many leaders of UN specialized agencies, the world business community, international NGOs and emergency groups.

Partnership must extend from international bodies to local authorities.

The WHO Health and Environment Linkages Initiative (HELI) encourages countries to address health and environment linkages as integral to economic development. HELI supports valuation of ecosystem 'services' to human health and well-being - services ranging from climate regulation to provision/replenishment of air, water, food and energy sources, and generally healthy living and working environments. HELI activities include country-level pilot projects and refinement of assessment tools to support decisionmaking. A Geneva Forum dedicated to such issues could offer an effective umbrella to partnership activities of this kind.

We estimate that 25% of the world's disease burden - the number of years lost in people's lives through sickness - is due to environmental factors. In the global public health sector we are particularly concerne about indoor air pollution from smoke, which kills a million and a half people each year, from respiratory diseases because of the use of solid fuels in inefficient and poorly ventilated stoves. Every hour, 100 children die as a result of exposure to indoor smoke from solid fuels. In addition, solid fuel dependency exacerbates deforestation, a process that contributes to the build-up of greenhouse gasses. Locally, deforestation can generate soil erosion, pollution of streams with sediment and debris, loss of biodiversity, and changed patterns of vector-borne disease transmission - all of which have an impact on health.

WHO has developed a comprehensive program to support developing countries. WHO's Programme on Indoor Air Pollution, in collaboration with the inter-agency UN-Energy, focuses on research and evaluation, capacity-building and evidence for policy-makers. WHO recently developed guidelines for conducting a cost-benefit analysis of interventions to reduce indoor air pollution, and has been supporting a controlled trial in the highlands of Guatemala. It directly measures, for the first time, the change in acute lower respiratory infections in young children after the introduction of improved stoves.

This is a problem which affects developing countries in particular, and the root causes of environmental health problems lie outside those covered by the health sector's core activities - and the solutions, too: another reason for building alliances with other institutions.

We can see this in tackling problems nearer to us in Geneva. Urban air pollution generated by vehicles, industries and energy production kills approximately 800,000 people annually. HELI is working with the Geneva authorities to encourage better provision and use of public transport as a way of reducing pollution from motor traffic. We surveyed WHO staff. We heard two major complaints: that crossborder connections to and from France are not good, and that there is a shortage of parking spaces outside the city. It showed that we need to bring the local authorities in France and the Swiss canton of Vaud into discussions as partners.

In short, a green movement for public health is needed. People in charge of health, environment, industry and issues such as transport should have a platform for dialogue, and Geneva would be the ideal place for such a Forum.