Approaches to Environmental Health Policy Development

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Approaches to Environmental Health Policy
Development
Dr Carlos Dora and Dr Zhanat Carr Public Health
and Environment
IAEA Environet Meeting Vienna, 23 November 2009
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Content

• The WHO agenda, core functions and structure
• Environmental health in WHO areas strategy,
  stakeholders engagement
• Radiation health scenarios/case studies
• Central Asia
• Chernobyl
• Good-practice models
• Risk assessment, management
• Risk communication

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World Health Assembly, supreme decision-making
body for WHO. It meets each year in May in Geneva.
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The WHO agenda

• 1. Promoting development
• 2. Fostering health security
• 3. Strengthening health systems
• 4. Harnessing research, information and evidence
• 5. Enhancing partnerships
• 6. Improving performance

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Radiation and environmental health

• The WHO medium-term strategic plan 2008-2013
  includes thirteen strategic objectives, one of
  which specifically addresses environmental health

" SO8 To promote a healthier environment,
intensify primary prevention and influence public
policies in all sectors so as to address the root
causes of environmental threats to health"
Biological, chemical, physical and psychosocial
hazards
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Programs dealing with Radiation Health Issues
Director General Office (DGO)
General Management (GM)
Health Security and Environment (HSE)
Partnerships and United Nations Reform (PUN)
IARC/Lyon
Health Action in Crises (HAC)
WHO HQ
Family and Community Health (FCH)
Health Systems and Services (HSS)
Non-communicable Diseases Mental Health (NMH)
Links to 6 Regional and 147 Country Offices
Cancer Control Programme
Information, evidence and research (IER)
HIV, TB, Malaria, Neglected Tropical Diseases,
(HTM)
IARC/Lyon
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Place of Radiation program at WHO HQ

• Health Security and Environment (HSE)

CLUSTER
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WHO Partners in Radiation
WHO Expert Panels/ Advisory Committees
International Organizations
National Authorities of 193 MS
WHO Collaborating Centres
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WHO's Areas of Work in Radiation Health
Existing sources natural radiation, radon,
cosmic
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Environmental Health strategic approach
Translating scientific evidence into policies and
programmes
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Semipalatinsk Polygon

• More than 100 atmospheric tests and 300 hundred
  underground tests conducted at the Semipalatinsk
  nuclear weapons testing site
• Residents of the down-wind settlements have been
  exposed to radioactive fallout from the
  explosions in 1949, 1951, and 1953
• National studies show increase in all
  cancers mortality, and selected
  solid cancers
• Dosimetry is inconsistent
• Study methodology questionable
• Risk perception issue and lack of
  information for affected communities

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Semipalatinsk test site assessment and on-going
mitigation

• UN General Assembly resolutions adopted
  concerning the detrimental effect of the STS on
  the environment and health
• International technical working group led by the
  IAEA
• Recognition of concerns and importance which
  allowed the Government of Kazakhstan to establish
  a national programme and provide national funds.
• Current inter-interagency UN initiative led by
  UNDP has to be targeted and focus on the most
  pressing needs relevant to the STS impact
  Framework document is being currently development

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(No Transcript)
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Uranium Mining and Milling Waste in CA

• Solid wastes
• Waste rock and low grade ore from open pits
  and underground mines (including sub-economic
  material)
• Industrial waste
• Liquid wastes
• Contaminated mine dewatering water
• Contaminated surface water (process residues,
  oily wastes etc)
• Airborne emissions
• Radon emissions from waste rock and ore
  piles, open-pits and underground mines
• Dust emissions from mining and hauling activities
• Dust from screening and crushing operations
• Toxic fumes from the mill, acid plant, calciner
  etc
• Yellow cake particles

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Koshkar-Ata Example of Typical Radiological
Issues

• Former Caspian Hydrometallurgical Plant
• 52 Mt of mining waste spread over an area of 66
  km2
• Uranium tailings pond extending over an area of
  77 km2
• Half of the tailings pond area is covered by
  water, the extent of the water cover varies
  within seasons of the year
• The dry half of the tailings pond is a source of
  radon exhalation and dust emissions
• The gamma-dose rates over the tailings vary from
  several Sv/h to approximately 10µSv/h
• Approximately 140 Kt of radioactive waste
  unrelated to uranium processing were disposed
  here.

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Potential agenda for a potential CA project

• Identify priority environmental radiation health
  issues in the region
• Identify key national and international
  stakeholders and provide a forum for an open
  dialog and advocacy for international scientific
  and donor community
• Assess demographic and health situation in target
  areas
• Review available data from past/ongoing research,
  gaps and needs
• Foster collaborative research projects
• Collect the evidence and develop
  recommendations/policy for national public health
  authorities

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Health Risk Assessment
Problem Formulation
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What could be done in an ideal world.
1. Health statistics review, needs identification
2. Hazard identification and exposure assessment
information
3. Set up infrastructure, registries, build
national capacity, train specialists
4. Identification of target population,
bio-samples collection
Cost millions?
8. Evidence-based policy development
5. Feasibility Study / Questionnaire/survey
6. Population/Ecological study
7. Analytical Study Cohort/Case-Control
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US studies on populations residing near U mining
facilities
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US studies on populations residing near U mining
facilities
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Findings of Colorado Studies

• No cause of death of a priori interest was
  significantly increased in any group, i.e.
  cancers of the kidney, liver, breast, lymphoma or
  leukemia or non-malignant respiratory disease,
  renal disease or liver disease.
• A significant excess of lung cancer among males
  who had been employed as underground miners. This
  excess was attributed to the historically high
  levels of radon in uranium mines of the Colorado
  Plateau, coupled with the heavy use of tobacco
  products.

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Study on Pennsylvania population residing near
nuclear material processing facilities
results are consistent with previous studies
indicating that living in municipalities near the
former Apollo-Parks nuclear facilities was not
associated with an increase in cancer occurrence.
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Study on Texas population residing near former U
mining/milling facilities
There was no difference between the total cancer
mortality rates in Karnes County and those in the
control counties. There were no significant
increases in Karnes County for any cancer when
comparisons were made with either the US
population, the State of Texas or the control
counties.
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US studies on populations residing near U mining
facilities
Currently available evidence for a positive
association between internal exposure to uranium
and the risk of cancer is limited. The common
weaknesses in reviewed studies include low
statistical power and inaccurate assessment of
internal exposure to uranium.
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UN Chernobyl Forum

• Lead by UN with participation of several UN
  organizations and the governments of Belarus,
  Russian Federation and Ukraine in 2003-2006
• Reviewed the findings of 20 years of research of
  environmental (IAEA), health (WHO), and
  socio-economic (UNDP, WB) impact of the accident
• Produced authoritative statements and
  recommendations for future research and national
  policies on Chernobyl recovery and sustainable
  development

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Psycho-social impact of Chernobyl

• Chernobyl Forum The mental health impact of
  Chernobyl is the largest public health problem
  unleashed by the accident to date.
• Anxiety levels 2 fold higher than in controls -
  Chernobyl victim" syndrome, and 4 times more
  likely to report multiple unexplained physical
  symptoms and subjective poor health
• Findings of psycho-social studies show that fear
  of radiation is a more potent health threat than
  radiation itself
• Fear, uncertainty, lack of information create
  chronic stress
• Knowledge and information are crucial to reassure
  population and address psychological impact and
  mental health of the local residents
• Poverty, not radiation, is the biggest challenge
  and creating livelihoods is the solution allowing
  victims to become survivors
• People can live and work safely in most of the
  affected regions

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Information needs in BY, UA, and RF are similar

• The top three answers to the question
• "What worries you the most?" are
• Health Effects
• Low living standards, poverty
• Radioactivity in the environment

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UN priorities for work on Chernobyl

• UN Action Plan on Chernobyl to 2016
• General public and decision makers to be
  adequately informed and regain trust in
  scientific info delivered through trustworthy
  sources
• Provision of accurate information to affected
  populations, including promotion of healthy
  lifestyles
• Support of community-based social and economic
  development
• Keep awareness and high-profile of the Chernobyl
  agenda at UN family organizations headquarters
• Provision of evidence-based policy advice to
  national authorities

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Way forward ICRIN project

• ICRIN International Chernobyl Research and
  Information Network
• Multi-agency initiative IAEA, UNDP, UNICEF and
  WHO
• Countries covered Belarus, the Russian
  Federation and Ukraine
• Sustainable response mechanism
• UN Trust Fund for Human Security provided 2.5
  mln USD grant for a 3 year project with the main
  purpose of building a bridge between science and
  people
• Started in Jan 2009

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ICRIN Project - Main activities

• To match current scientific knowledge to local
  information needs and to introduce most efficient
  methods of dissemination
• ICRIN Advisory Committee and ICRIN Scientific
  Board, analysis of information needs development
  of information materials
• To set up a monitoring system with focus on
  changes in human security levels, behavioral
  patterns and perceptions of the affected
  population
• Community information and education initiatives
• trainings for media representatives and
  journalists for health authorities and health
  workers teachers and scientists decision makers
  and local authorities

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ICRIN Project - Expected Outcomes

• Reassuring messages coming from trusted sources
  will help people regain confidence and
  self-reliance
• Local stakeholders and general public will have
  access to and rely on up-to-date scientifically
  accurate information
• Will overcome stigma of the affected territory
• Revival of small enterprise in the local
  communities will fight poverty
• Forward-looking solutions adopted by the affected
  communities
• Healthy lifestyles promoted among all age groups
• Good Will Ambassador Maria Sharapova
• A generation of defeated victims turns into a
  generation of proud survivors

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ICRIN as a good-practice model

• ICRIN project is a good model of inter-agency
  cooperation for assisting countries and people
  affected by an large environmental problem
• ICRIN demonstrates the power of joint efforts of
  several international agencies and sets example
  of efficient fund-raising approach
• ICRIN develops a model and addresses
  environmental issue in a multisectoral approach
  (health, environment, socio-economic) for
  sustainable development of the region

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Public perception of risk

• A common issue
• Overestimation of remote risks
• Underestimation of common risks

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Fright factors for risk perception

• Risks are less acceptable if perceived as
• involuntary, inescapable
• inequitably distributed
• unfamiliar or novel source
• cause dreaded illness or hidden and irreversible
  damage particularly dangerous to children or
  future generations
• poorly understood
• contradictory statements from authoritative
  sources

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Summary

• WHO has extensive experience in dealing with
  environmental health issues and providing
  technical assistance and advice to MS
• In most of "legacy" sites radiological risk is a
  matter of public perception
• Transparent process based on multi-sector
  involvement and open dialog it the way forward
  risk communication is a top priority need
• Existing good-practice models can be analysed and
  used in affected states as appropriated

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Contact for further feedback and
consultationCarrz_at_who.int